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ARMY MEDICAL LIBRARY  !

       WASHINGTON

          Founded 1886
}
i
Section.




N umber
3.j~%.  %f.$.L.
       Form 113c. W. I).. .S. C. O.
»—10643    (Revised June I.i. m.'Jdj
It
 ~i 
 
 
AN
IMPROVED
SYSTEM   OF   MIDWIFERY,
ADAPTED TO
THE REFORMED PRACTICE OF  MEDICINE;
ILLUSTRATED BY NUMEROUS PLATES.
                         TO WHICH IS ANNEXED,

A COMPENDIUM OF THE TREATMENT OF  FEMALE AND INFANTILE DISEASES,
REMARKS ON PHYSIOLOGICAL AND MORAL ELEVATION.
BY W.  BEACH,  M. D.,
AUTHOR OF " THE AMERICAN PRACTICE OF MEDICINE," CORRESPONDING MEMBER OF THE ROYAL COLLEGE Or
                PHYSICIANS AND SURGEONS OF BERLIN, ETC.
     »I have heard a voice as of a woman in travail, and the anguish as of her that bringeth forth her first child."-J£R. i». 31.
■ Dame Nature is the best midwife in the world. ... Meddlesome midwifery is fraught with evil  . . The less done generally the tetter.
                Non interference is the corner-stone of midwifery. '—Prof. Oilman.
          NEW YORK:
JAS. McAUSTER, 141 FULTON STREET.
             1847. 
wa
 B365a
  12H-1-
             Entered, according to act of Congress, in the year 1840,
                      By WOOSTER  BEACH,
in the Clerk's Office of the District  Court of the United Slates, in and for the Southern
                           District of New York.
      D. FANSHAW,
BOOK  AND JOB  PRINTER,
  Corner of Ann and NasaaaatreeU.
STEREOTYPED DY REDFIELD & SAVAG3,
        !3 Chambers Street, N Y 
                                       TO






THE  MEMBERS OF THE REFORMED* SCHOOL OF MEDICINE OF THE UNITED  STATES,





                               A8 A TRIBUTE OF ESTEEM





              TOT. THEIK HtDIANE AND ZEALOUS EFFORTS TO PROMOTE THE CAUSE Of






                      MMIKDM  ISBIP(D)ISIflA-iP3I<DH9











                   tg RK'JI £> !r;.LLY INSCRIBED BY THEIR FRIEXT: AND COADJUTOR,






                                                       W. BEACH, M. D.
s 
AUTHORS  REFERRED   TO  IN   THIS  WORK.
MoreauV Practical Midwifery ; eighty plates.
Denman's Introduction to the Practice of Midwifery.
Rigby's System of Midwifery.
Ramsbotham's Principles and Practice of Obstetric Medicine and
Surgery ; illustrated with one hundred and forty-five figures.
Campbell s System of Midwifery.
Lee's Lectures on the Theory and Practice of Midwifery.
Maygrier's Midwifery.
Blundel's Lectures on the Practice of Midwifery.
M. Chnilly's Practical Treatise on Midwifery.
Dcwees' Compendious System of Midwifery.
Meigs's Philadelphia Practice of Midwifery.
Hamilton's Outlines on the Theory and Practice of Midwifery.
Spence's System of Theoretical and Practical Midwifery.
Maubray's Complete Female Physician.
Bard's Compendium of the Theory and Practice of Midwifery.
Murphy's Lectures on Natural and Difficult Parturition.
Collins's Practical Treatise on Midwifery.
Gooch's Lectures on Practical Midwifery.
Severn's First Lines on the Practice of Midwifery.
Maunsell's Dublin Practice of Midwifery.
Maunsell's London Practice of Midwifery.
Daventer's Art of Midwifery Improved.
Mervis's Midwife's Pocket Companion.
Madame Boivin's (late chief midwife to the  Maternity Lying-in
  Hospital, Paris) Art of Midwifery ; with plates. Untranslated.
Moreceau's Mother's Book.
Ewell's Letters to Ladies.
Smcllie's Treatise on  the  Theory and Practice  of Midwifery;
  three volumes.
Waller's Elements of Practical Midwifery.
Reid's Manual of Practical Midwifery.
.laten's Manual of Practical Obstetrics.
Warrington's Obstetrical Catechism.
Ludlow's Manual of Examinations.
MendenhaU's Student's Vade Mecum.
Chavasse's Advice to Wives on the Management of themselves
  cfuring the Periods of Pregnancy, Labor, and  Sickling.
Denman's Aphorisms on Practical Obstctricy.
Brcvit's Female Medical Repository.
 Howard's Midwifery.
 Hersey's Woman's Friend.
 Comfort's Midwifery.
 Churchill's Diseases of Females.
 Gooch on the Most Important Diseases of Women.
 Blundell's Observations  on some  of  the more Important Dis-
   eases of Women.
 Lever's Prize Essay on the Organic Diseases of the Uterus.
 Manning's Treatise on Female Diseases.
 Evanson and Maunsell's Practical Treatise on the Management
   of the Diseases of Children.
 Billard on the Diseases of Infants.
 Combe on the Physiological and Moral Management of Infancy.
 Mrs. Barwell's Infant Treatment, with Directions to Mothers.
 Ackerly on the Management of Children in Sickness  and Health.
 Underwood on the Diseases of Children ; three volumes.
 Heberden's Epitome of the Diseases Incident to Children.
 Parr's Medical Dictionary.
 Cyclopaedia of the Arts and Sciences.
 Dungleson's Physiology.
 Roget's Outlines of Physiology anl Phrenology.
 Richerand's Physiology.
 Blumenbach's Physiology.
 Carpenter's  Manual of Physiology.
 Cruveilheir's Anatomy.
 Wilson's Human Anatomy.
 Masse's Anatomical  Atlas; one hundred and twelv: cnciavings.
 Cyclopaedia of Popular Medicine.
 Chitty's Medical Jurisprudence.
 Williams's Catechism on Medical Jurisprudence.
 Beach's American Practice.
 Dungleson's Practice ol Medicine.
 Heberden's Commentaries.
 London Medical Pocket Companion.
 Dixon on the Diseases of the Sexual Organs.
 Smith's Botanic Physician.
 Spratt's Illustrated Atlas.
 Lizar's Anatomical Plates.
 Kennedy on Auscultation during Pregnancy.
J Manuscript Note? of Prof<"=«or Gilmar.'« L^ctnre?. 
PREFACE
   Some years ago, I announced to  the public my intention  to issue a treatise on Midwifery, adapted
 to the reformed practice of medicine.  I am at length gratified in being able to redeem my promise, and
 to lay before the reader the contemplated work.  How far it will answer the  expectations of my friends,
 I know  not.  I do not flatter myself that the work  is altogether perfect;  but if some inaccuracies are
 discovered, I feel confident that the  general principles inculcated will be found correct and reliable, as I
 have labored more to accomplish this object than to embellish the volume in other respects.  I have, in a
 word, endeavored to make it a practical work — a safe guide to the physician,  midwife, and student.
   The importance of a more correct knowledge of this branch of medical science, and of a practice  more
 in accordance with the process  of  Nature, will  not now be called in  question  by any who are  either
 acquainted with the magnitude of the subject,  are concerned for the well-being of society, or are familiar
 with the many abuses which have been practised  by the  prevailing  system under the garb  of science.
 Many volumes have been  written  upon this subject by the  mineral or depletive practitioners of medicine
 and others ; but there are  none adapted to the peculiar principles of the reformed system.   A reformation
 therefore, in this  branch,  is imperiously required.   There are  many very valid  objections to the  pre-
 vailing system  of midwifery, as  taught in our colleges,  and practised by the generality of physician--.
 Their treatment before, at the time, and after delivery,  is injudicious, injurious, and not unfrequently
 fatal, as  may be proved  by their own reports of cases published in their medical periodicals, and by  daily
 observation.   It consists  principally of bleeding, mercury, untimely and improper interference, and the
 frequent and needless use  of instruments, &c,  &c.
   How  many cases of mal-practice are from  time  to time  communicated to us from different sources of
 obstetrical history !   Some attempt  has  been  made to reform  these  abuses by Thomsonian writers ;
 but no one of their works on midwifery that I  have seen is either in accordance with science or  the result
 of experience : they inveigh  against interference with the  efforts of  Nature, yet are always interfering by
 "courses of medicine,"  "composition," Cayenne-pepper,  or some other stimulating agents, which are all
 usually unnecessary, and frequently as injurious as the treatment against which  they so  loudly protect,
 as all  judicious practitioners are aware.  With  this state of things before  us,  there seems a fair field
 open for improvement in this branch  of medical science.
   It will be perceived, by  reference  to the  list of writers  on another page, that I have examined a  great
 number of authors on this subject, both ancient and modern ; and every rule and  sentiment of any value
 I  have  imbodied  in this work.   Some of these authorities  have recently appeared, and are scarcely
 known in this country ; they display great research and much clinical experience ; and our practice being
essentially " eclectic," I have adopted everything really useful from every source within my reach.   I think* 
6
PREFACE
then, that I  may state, without any  desire of  ostentation, that these advantages, together with my own
experience of a long series of years in the active  duties of my profession, enable me to offer a work
which may be relied upon as authority in the lying-in chamber, and which I am confident will not disap-
point the expectation of the friends of reform.  The student will perceive, as he  peruses this volume,
that I have endeavored to carry out the principles inculcated in the motto on our title-page, namely, that
'• Dame Nature is the best midwife in  the world .... meddlesome midwifery is fraught with evil .... the
less done, generally the better .... non-interference is the corner-stone of midwifery;" and all who will
adopt it will, I am confident, find their practice crowned with eminent success.
   I have taken great pains to procure good illustrations,  and  have obtained them from various sources :
some have been copied or reduced from other large engravings, and others have  been  copied by Mr.
Me veh, a distinguished artist,  from  preparations  in my anatomical museum, most of  which  I have
imported from Europe (and  I believe  a better  or more  diversified collection  is not to be found in this
country).  These I consider very important: the student is  enabled by their aid to acquire a knowledge
of the science with much greater facility, as all impressions made through the eye are more deep, lasting,
and  interesting, than those produced in any other  manner.  I have  therefore endeavored to  convey the
knowledge  of  obstetrics to the mind  through  the  eye, as well as through the perceptive faculties, so that
the student may understand the subject either by the plates or by the text; but the study of both together,
with ordinary attention, will  render a knowledge of it pleasing and easy to all who may desire it.
   We rejoice that a new era in the science of obstetrics, or the art of midwifery, is about  to dawn on  the
world, after  being so long enveloped in mystery by the votaries  of science, falsely so called, and which
has proved so fatal to thousands, either by wrong medical practice, improper interference  in labor, or  the
use of instruments; and that it is  about to emerge from this chaotic state, and to be elevated to a  more
exalted standard of usefulness, which will, we  trust, ere long, emancipate the female sex (the  most inter-
esting portion of the human  family)  from the evils and abuses under which they have so long suffered.
   I must not forget to add that I am indebted  to Dr. J. Hassell, who has acted as my amanuensis, and
who is associated with me in practice, for many very valuable hints and suggestions, which I consider of
great benefit to the  work ; and I take  this opportunity of  observing that Dr. Hassell is a  very competent
teacher and  practitioner of midwifery, and also of the reformed practice of medicine generally.
   I have prepared this work, as  I have all  my others, under such great disadvantages, occasioned by so
many engagements  and interruptions, that I have not been  able to devote more than one fourth of  the
lime to it that I should,had I been differently situated.
   I have had numerous applications for  the different medical works which I have promised,  namely, an
Improved System of Midwifery; the  Treatise on Anatomy  ; the  Medical Dictionary; and the Medical
Reformer.   The first is now published.  For the second, on Anatomy, I have some thirty plates ready;
and, for the  Reformer, I have most of the matter prepared.  1 hope, therefore, to have them all pub-
lished at no distant  period.  I intend  that  these works, when completed (with those already issued, with
revision), shall form a complete library on medical  reform, as follows :  1. American Practice,  in  two
volumes.  2. The  Family Physician.  3. An Improved System of Midwifery.  4.  A Treatise on Anat-
omy and Physiology.  5. Medical Dictionary.  6. Medical Reformer.  7. History of the  Reformed
Practice  of  Medicine.
   I have received the  following   communication  from  a  distinguished physician  of the " old  school"
(Dr. Joseph Warrington,  of Philadelphia), propounding  the  following questions, with  a view, no
doubt, to correct and improve the present practice of midwifery.   The information the gentleman requires
lie will find  in the present volume, to  which I respectfully refer him :— 
PREFACE.
7
  u Dear Doctor : Believing that a free interchange of useful knowledge among the intelligent  members of
the  medical profession, is  earnestly desired by those who  are engaged in collecting and arranging  facts for the
promotion of science, I have taken the liberty to address you, as among the number of physicians who are
experienced in all the departments of obstetric medicine, the following questions, viz. :—
" A.  At what  age do  the  female children of American, English, German, French, Irish, Indian, and Negro
         residents in your vicinity commence and cease to menstruate ?
" B.  Do your observations confirm or refute the doctrine of Negrier,  Paterson, Jones, Pouchet, Raciborski>
         Bischoff, and others, on the vesicular or ovular origin of the catamenia ?
" C.  1. Are the women under your care  subject to many disturbances  of the catamenial function?  2.  Defi-
         cient?   3.  Excessive?   4. Painful and difficult menstruation?  5.  How, and  with what success, do
         you treat these several varieties of disorder ?
" D.  1. Are organic diseases of the uterus of frequent occurrence ?  2. What are the varieties ?  3. At what
         age, and under what circumstances, do they occur ?  4. What is  your treatment  of engorgements,
         congestions, inflammations, acute  and chronic, ulcerations, simple and cancerous, of the womb ?  5. Of
         inflammation, acute find  chronic, of the ovaries, and Fallopian tubes ?   6.  Dropsy of the ovaries, or
         uterus  ?  7. Do you meet with any cases of physometra ?  8.  What is  your mode of diagnosticating
         either of the several affections above named ?
" E.  1. Are mammary diseases of non-pregnant women common ?  2.  What is their character ?  3.  How, and
         with what success, are they treated ?
" F.  1. At what  age do women usually marry ?  2. At what period of life  do they begin to reproduce ?
         3. Are diseases of the ovum common ?  4. What are they ?  Hydatids, amorphous moles,  monsters by
         excess or defect of development  ?  5. Have you met with any case  in which either limb of the foetus
         has been constricted or amputated in utero by the coils of the umbilical cord ?
" G.  What effect does pregnancy usually have upon women ?
" H.  Do you know any mode of treatment  by which the development of the fcetus in utero can be diminished
         or increased 1
" I.   Are you familiar with any plan by which  the pains  of  parturition can  be  diminished, and the delivery
         expedited safely ?
" K.  1. What arrangements  do  pregnant women usually make  for their lying-in ?  2. Do physicians take the
         entire  charge of the case, or is it left to females altogether ?
" L.  1. What are the usual practices of  patients during  the several stages of  labor, as regards  positions of the
         body?   2. What posture would  they naturally assume in the second and third stages ?
"M.  1. What rules of conduct do you impose  upon patients, in regard to position and dress, during the first
         stage ?  2. What in reference to their persons and beds during the second and  third stages ?
" N.  What is the usual duration of each  of the three stages ?
" O.  1. In what proportion of cases is manual or instrumental interference found necessary? 2.  Have you
         any rule as to time in which you have recourse  to manual or instrumental assistance ?  3. Do you use
         ergot ?  4. Under what circumstances X  5.  With what effect ?
"P.  1. Have you any rule  for the choice of the hand with which to operate in rectifying a deviated position
         of the head ?  2. To make version by  the feet,  in arm  or shoulder presentations ?   3.  Is  the value of
         such a rule tested by actual experience ?
" Q.  1. In what proportion of cases which have come under your care did  you find it necessary to use the
         forceps ?  2. The blunt-hook ?   3.  The crotchet ?
"R.  1. What kind of forceps, perforator, or  crotchet, do  you use?  2. What position  for the patient do you
         deem the best for manual or instrumental delivery ?
" S.  1. What number of your obstetric patients become subjects of accidents arising from the pregnant, parturi-
         ent, puerperal states ?  2. Are haemorrhages, convulsions, metritis, metro-peritonitis, pure peritonitis, of
         a common occurrence ?  3. How  do you treat the several diseases above named ?  4. With what success? 
H
PREFACE.
'  T    1. What id your observation in reference to the completion of the  third stage of labor?  2. How much
         time do  you think it  usually requires for the spontaneous delivery of the  placenta ?   3.  What  is
         your practice in reference to delay or assistance in  this matter'  4. Do you stimulate  the womb  to
         action by frictions upon the hypogastrium ?   5.  Do you draw upon the cord ?   6.  Under what circum-
         stances do you insert a portion or the  whole of a hand into the uterus for the withdrawal of the secun-
         dines ?  7. Can you give me  any statistics as to the relative number of cases in which the placenta  is
         retained ?   8. In which it is adherent ?  9. Your mode of completing delivery  in the former case ?
         10. Your treatment of the latter, and its success ?  11.  Are you assured that it is  necessary to withdraw
         the placenta, when it is found to be adherent ?  12.  What is your experience of the results of cases
         in which the mass  is  stripped or peeled off'  13.  Those in which it  has  been allowed to remain
         attached?   It.  Has experience  taught  you that  in  hour-glass  contractions  of the  womb upon the
         placenta,  you ought or ought not to use prompt measures to overcome such contractions and secure the
         speedy delivery of it?  15. What  means  do you  use,  and with what success7    16.  Have you
         permitted the womb to remain undisturbed, and with what results ?
"I'.   1. Have you any careful observations respecting the lochial discharge ?   2.  Its amount every twenty-four
         hours ?  3. Its  change in color, &c,  in the same periods *   4.  The time of its cessation ?
" V.   1. What is the practice respecting the time of placing the child at the breast'  2. What do you know  in
         favor of this practice ?  3. Are mammary engorgements common ?  4. Are they sanguineous or lactif-
         erous ?  5. How, and with what success, do you treat them ?  6. Do you know of  any ill consequences
         resulting from nursing very much and very long ?  7. What are  they ?
" W.   1. How many women within your knowledge suffer from the soreness of the mouth only during pregnancy
         or nursing ?  2.  Do you know of any treatment adapted to the speedy cure of this affliction ?
" X.   1. What have you observed tending to prove that original vaccination is prophylactic of small-pox, when
         well performed ?  2.  What  do you know to establish the fact  that  revaccination is  mostly, or  even
         occasionally, necessary ?  3.  How often should it be repeated ?
'• Y.   1. How long do you usually continue obstetric cases under your care ?  2. How much service  do you
         render on  the occasion ?  3.  What fee do you require ?
u Z.    1. Are good monthly nurses readily to be obtained?  2. What is the amount of their weekly compensa-
         tion ?   3.  Do you believe any benefit would be derived to patients and their families by the employment
         of intelligent, well-educated, companionable  women, as  monthly nurses, and to take  care  of the  sick
         generally, under the direction of judicious physicians ?
                                                   "I am, respectfully, <kc,
                                                                      "JOSEPH WARRINGTON, M. D.
   " 229 Vine Street (Franklin Square), Philadelphia, May 1, 1846."

  I have introduced the  above  letter  in  this connexion,  for  the  purpose of showing the  distrust and
desire for improvement in midwifery among the more enlightened  and progressive physicians  of the " old
school," and which proves, more  conclusively than  any  language which  I  can employ, their extreme
want  of confidence in the science of obstetrics as taught by their own standard authorities.
  That the system of midwifery, as exhibited  in the present  work, will tend  in some  measure to supply
existing deficiencies, and meet the wants of the friends  of  medical reform  generally,  is the sincere  and
ardent desire of
                                                                                 THE  AUTHOR
      New York, November  1, 184G. 
CONTENTS.
                                                                                                   PAOS.
  PRELIMINARY REMARKS...................................................................................  11
  PART I. —REPRODUCTION.................................................................................. 22
            Origin of Vegetable Life........................................................................ 22
            Origin of Animal Life...."........................................................................ 28
            Origin of Human Life...................................................................•........ 32
            Pregnancy........................................................................................ 62
            Infanticide.......,............................................................................... 80
 PART II. — EXPULSION  OF THE FGETUS..................................................................... 89
            The Pelvis........................................................................................ 90
            The Fcetus........................................................................................ 92
            Parturition,  or Labor............................................................................ 95
            Natural Labor....................................................................................103
            Duties of the  Accoucheur........................................................................ 117
            Difficult Labor..................................................................................136
            Preternatural Labor............................................................................. 144
            Complex Labor....................................................................................149
            Instrumental Labor.....................................................«.........................166
PART III. —DISEASES OF WOMEN AND CHILDREN........................................................179
            Sexual Diseases...................................................................................179
            Diseases  of Pregnancy............................................................................189
            Diseases  following Delivery......................................................................191
            Diseases  of Children.............................................................................199
PART IV. —PHYSIOLOGICAL AND MORAL ELEVATION OF MANKIND.....................................225
            Physical Training of Children....................................................................225
            Intellectual Education of Children.............................................................245
            Moral Training of Children.....................................................................247
            Religious Education  of Children................................................................257
            Summary of Rules for  Mothers...................................................................259
            Facility of Labor.................................................................................264
            Miscellaneous  Subjects.............................................,......,......................267
                                                   2 
EXPLANATION    OF   PL  A
Pl.ATr.  1.....................PORTRAIT
P: \te  2.................frontispiece
  Fi'tix in vtero. painted from the magnificent
  female wax figure placed in the av.'rc of the
  obstetric room of my Anatomical Museum.
Pi ate  I..........."............page 22
  Dissection of the American Aloe, or Century-
  plant: fig. 1. A. the seed ; 1, 15, scrim-n mi-
  nified to show the seeds, v. hich are removed
  one side ; 2, transverse view  of the gormen ;
  3,  pistil; 4, anther and filaments  enlarged :
  one side  discloses the farina; .">, first stage
  petals closed;  6, second >tagc: anthers shoot-
  iiig ; filaments curled downward ; 7, third
  stage: filaments taking their position; 8, fourth
  stage: filaments erect; 9, fifth stage :  pistil
  peeping ;  10, sixth stage :  pistils nearly the
  height of the stamens ; flower in perfection ;
  11, seventh stage : impregnated pistil  elon-
  gated ; stamens drooping ; 12. eighth stage :
  ail except the germ decayed ; 13, front view,
  to show  the stamens, ixc.; 14, back view;
  l.~>, the < Yuiury tree or plant complete
II.
24
  Fiji.  I. Il 'v.cof the Hyosaimusor Henbane ;
  2. hack view of one of the stamens, as seen
  through the microscope ;  3, a stamen or male
  part  of the flower, natural  size;  -1, anther
  magnified : front view closed ; 5, its two com-
  partments  opened, and unfolding  the farina
  or seed ; 6, pistillum, or  female  part of the
  flower, naturul size ; 7, the pistillum, as seen
  with the microscope.—Fig. f, flower of the
  Mesereon, natural size ; 9, the same, magni-
  fied ; the eight stamens attached to the corolla
  l>y short filaments: the pistil in the centre like
  a bottle : the/ swollen part, A, being the vege-
  table womb—Fig. 10, drawing of the com-
  mon  wild  Lily (flower in perfection),  which
  I brought  from the country, and had figured,
  :.} show the stamens with the anthers attach-
  ed, filled with the  farina,  a yellow fructifying
  dust, and also the pistil in the centre ;  11, the
  pistil, which I laid  open, and discovered the
  pollen or seed in the centre passing down to
  the germ  or womb (these specimens were
  si en  clearly and to groat advantage; : 12, a
  portion of  the same flower.
Plate 111........................p. 2S
  Inc.iliation of the Egg. This plufb  illustrates
  the cluster of eggs found in the common fowl,
  A, in which are a  great number of all sizes :
  i»ne entering the oviduct, and one is seen at
  the moment of the passage ; B, the  egg in its
  natural scaie ; fig. 1, its appearance  after hav-
  ing been under the fowl one day, and thus on
  up to the twenty first day, or until the time of
  bursting the shell.
Plate IV.......................p. 29
  The  same  : successive development.
Plate V........................p. 30
  The  same.
Plate XII.......................p. 32
  Male Organs : 1 2. body of the testicle ; 3,
  prostate gland ; 4, vesiculie .-eminales or semi-
  nal bag;  5,  bulb  of tlie  urethra;  6,  clans-
  penis;  7.  corpus  or  body ot the  penis;  3,
  prepuce ; 9, tunica vaginalis testis ;  10 corpus
  cavernosa.
Plate XIII......................p. 3o
  This plate represent*  the womb and  its ap-
  pendages  .natural  size),  a front  view of the
  uriioiprcgualcd  uterus and  its appendages.
  with a section of the upper part of the vagi-
  na :  1, vagina open ; 2, mouth of the uterus ;
  3 3. round ligaments;  4  4. broad ligaments ;
  5. bodv of  the uterus, lili 6, Fallopian  lubes ;
  7 7. fnnibi:p ;  6  8,  ovaria.
Plate XIV......................p. 3fi
  The  same, with the uterus open.
Plate XV.......................p. 37
  Fkmai.k  Organs:  1, mons veneris  2. labi-
  um cV.-r:ium ,  3, ::y.n;diTe : 4 perineum; 5,
  rectum ; 6, clitoris , 7. opening of the urethra ]
  or urinary canal; ■<  mouth or opening of 'he ^
  vagina.                                   i
Plate  XVI......................p. 38 j
  Represents an ii ;ect-d uterus at the full pe- |
  riod of pregnanes, half its natural size : in- !
  tended to illustrate the enlarged s'ze of  the I
  vessels,  their  distrioiiion, and union with J
  each other.                               I
?i.o-E  xvii.....................p. *;i |
  Fig.  1, profile view of a female iu the  fifth
  month of pregnancy ; the other, A A, the full I
  period (nine months), with a full grown foetus j
  in utero presenting iu the natural position.
Plate  XVIII....................p. 54
  Virgin state ;  womb vacant; the form, sym  |
  nietrv, and integuments, demonstrated.      I
Plate  XIX......................p. 52 j
  The  viscera or internal organs, drawn from
  my anatomical female figure: 1,  heart;  2,
  lungs -. 3, stomach : 4, liver ; ~>. ovaria ; 6, ute-
  rus ;  7, bladder.
Plate  XXI......................p. 91
  Male and female pelvis, half size of nature.
Plate  XXII.....................p. 92
  Foetal skeleton articulated.
Plate  XXIII....................p. 93
  Bones of the fecial skeleton disarticulated.
Plate  XXIV....................p. 120
  Uterus at the full period of pregnancy, with
  a finger in the os, which is a  little dilated, to
  show the first stage of labor and examination.
  (In the beginning of labor, it is best to exam-
  ine with the middle finger of the right hand.)
Plate  II and XXXIV
  Shows the woman in the  be.-.t position (on
  the back) for delivery.
Plate  XXVI...................p.  125
  Section of the left side of the female pelvis
  with its contents, the  upper portion of the
  left thigh, nates, <5cc.;  the uterus at  the full
  period of gestation, before labor has begun ;
  the orifice of the womb, now h ing high up,
  not dilated ;  the finger in the vagina, in the
  act of examination.
Plate  XXVII...................p. 122
  Section of the polvi-., showing the child in the
  act of parturition : the head has advanced in-
  to the brim of the pelvis diagonally, with one
  ear inclined  toward the right groin,  and the
  other toward the junction of the sacrum and
  ilium: the most favorable position for passing
  through the upper chamber of the-pelvis.
Plate  XXVIII..................p. 123
  The  same, further progression ; head turning
  and advancing.
Plate  XXIX...................p.  126
  The  womb at the full period of gestation and
  commencement of labor : the bag of  waters,
  which envelops the infant, is forced through
  the orifice of the uterus by its  contractions,
  aud appears in the form of a tumor or cyst.
Plate  XXX....................p. 123,
  Further progress of the child toward deliv-*
  ery : the head in the cavity of the pelvis, the
  forehead iu the hollow of the sacrum, and the
  occiput passing under the arch of the pubes ;
  the right hand of the accoucheur  may sup-
  port  the child in its pa-sage.
Plate XXXI......... ."..........p. 127
  Head delivered
Plate XXXII...................p.  ,>j
  Front view ; progressive development of the
  lotus  1, the embryo at two or three months
  ot age ; 2, erubryo at five months, with pla-
  centa attached to the uterus ; 3, fu;tus in ute-
  ro at eight months, with the  surrounding or-
  gans—breast, stomach, liver, intestines, Ac
Plate XXXIII..................p. 12<J
  Body delivered.                           I
Plate XXXIV..................p. 130 !
  .•5»'paratioTj-jf the child h'jiii the moll..,.-  pla j
 TES.

  ccnta retained, connee'ed by the cord, mo.lo
  of severing the cord, one inch from the body.
Plate XXXV...................P-  131
  Fu'turt and viscera ,  foetal side ot '.he placenta
  and cord.
Plate XXXVI..................P-. '3-'
  Face turned upward :  3 tedious and  painful
  labor, but not requiting instruments
Platf  XXXVII.................P-  1-15
  Breech presentation: delivery accomplished
  without change of position, or the use >f in
  struments. but very painful.
Plate  XXXVIII................p.  H"
  Ann presentation : hand seizing the  feet, in
  the act of turning, but not alwayb necessary.
Plate  XXXIX..................p.  !H
  The  feet brought down: in  this case the fa. •■
  nret he kept turned to the  sacrum or spine.
Plate  XI.......................P-  MS'
  The  bod>  of the child  partly delivered,  and
  grasped ov the accoucheur's hand.
Plate  XLI.....................P-  I ''
  The  b./dy  delivered, and the operator's bund
  bringing down the arm of the infant.
Plate  XLII....................p-  I5'i
  Mode of extracting the retained placenta
Plate  XLI1I...................p.  157
  R-eteiriou  of the placenta by irregular uteri no
  contraction, called the hour-glass contraction.
Plate  X LI V....................p.  1 'i 1
  Cord and  placenta presenting.
Plate  XLV.....................p.  17 1
  Twins, in  separate cavities or  membrane-'
Plate  XLVI....................p.  IT:>
  The  mode of applying  the left-hand  blade
  of the forceps to the head.
Plate  XLVII...................p.  17■>
  Applying  the second blade  of  the forceps.
Plate  XLVIII..................p.  177
  Both blades of the short forcep3 introduce!,
  locked, and placed against  the perineum.
Plate  XLIX....................p.  17S
  The head more advanced :  the occiput emer-
  ging from  under the arch of the pubes ; also
  the first action of  the forceps after locking—
  made by bringing  the handles, firmly grasped
  in one or both hands,slowly toward the pub-is.
Plate  L........................p.  17'J
  Embryotomy : the female on the back, with
  the left hand of the accoucheur iu the vagiui,
  guiding the point  of the perforator.
Plate  LI.......................p.  171
  Second stage of  embryotomy :  the  in.,rru
  ment penetrating  the brain.
Plate  LI I......................p.  17)
  Third stage of embryotomy :  the instrument
  having made a small opening in the head.
Plate  LIII.....................p.  17)
  Fourth stage of embryotomy :  section of the
  parts ; the  crotchet in the opening of the era
  nium, with the left hand of the operator in the
  vagina, to  guard against laceration.   A very
  rare case to require  this horrid operation.
Plate  A.........................p. o'2
  Illustrations of the  origin  and development
  of vegetable, animal, aud human iife.
Plate  B.........................p. 4'i
  1, situation of the neck of  the womb in dit
  ferent periods of  pregnancy ;  2, muscles of
  the uterus ;  3, mammary gland ;  4, tumor of
  the womb ; 5, fulling of the womb ; 6, turning
  the child ;  7. fimbriiu grasping an ovum.
Plate C.........................p. 95
  1, deformed  pelvis;  2, section  of the sacrum ,
  3, section  and angle  of the sacrum ; 4, sacrum
  and  fetus in utero ; ">, placenta, fcetal  sur-
  face ; H. the  same, m.-Keinal surface.
 Plate D.........................p. 71
   Figures of various  kinds of monsters.
 f~%r' The other figures and plates of the woik
   are explained iu  then appropriyv- p.acga. 
                                  IMPROVED




       SYSTEM     OF      MIDWIFERY.






                               PRELIMINARY  REMARKS.

 •  Definition of  Midwifery. — By the  term midwifery,  we understand the act  of superintending
and  assisting nature, during parturition or child-birth ; and in a more extended  sense, it implies the
treatment of female and infantile diseases.
   History of  Midwifery. — This branch of medicine must have  been coeval with the formation of
society.   The knowledge of it  was, no doubt, first  acquired by experience, and that probably induced
by observing the phenomena of labor in the brute creation.
   In the early ages of the world, women alone officiated in child-birth.  From the Scriptures, it appears
that, among the Jews, the practice of midwifery was exclusively confined  to females.  Common history
also  informs us that this same  practice prevailed  among the ancient nations of Greece and Rome.   In
fact,  we have no account, in the history of any nation, of men  ever officiating in child-birth, except in
some desperate cases, until the sixteenth century.
   Previous to the above  century, very few treatises had  ever  been  published, either by physicians or
midwives, on this subject;  from which fact we infer that the practice must have been  principally, if not
altogether,  empirical.
   Hippocrates was the first who wrote on  this subject, of which we have any knowledge ;  he flourished
about four hundred years before the  Christian era.   This work  was the chief guide of midwives until the
sixteenth century — after the revival  of learning, and the invention of  the  art  of  printing — which com-
prises a period of two thousand years.
   The first work on midwifery ever printed in the English language was  published in London, by Dr.
Uaynald, in the  year 1-340.  It was originally published  by him  in Latin ;  and it had been  translated
into Dutch, French, Spanish, and other European languages.   "It was called 'The Woman's Book;
or, the Carden of Lying-in Women  and Midwives.1   He enjoins  that ladies and  gentlemen do have this
look on their hands, and  that they cause such parts  of it as are applicable to be read before the midwife
and the rest of the women  present  at  the  labor, whereby, he says the laboring woman  may be g;er lv
comforted and alleviated, in her travail." 
12
IMPROVED SYSTEM OF MIDWIFERY.
  In  1665  another work was published, by Ambrose Pare, a  French  surgeon, who was  the  first that
recommended tlie  operation of turning the  child, and delivering by the feet, in all  cross presentations.
This may be considered the first recorded improvement in midwifery since the time of Hippocrates, two
thousand years before.
  About the beginning of the seventeenth century, we have the  first undisputed  work written by a female
on midwifery — Loueiza Brewster, a pupil of Ambrose Pare.   She wrote on sterility, abortions, fertility,
child-birth, and diseases of women and newborn infants.
  During the sixteenth century, the forceps were invented  by  Dr. Chamberlain, in  England, which for
many years  he kept a secret, and obtained great  reputation by their use  in difficult labors.   Dr. John
Maubray was the first public lecturer on midwifery in England ; he lectured in his own house, in Bond
street, London.   I have before  me  this work.   In 1723  he published  a work on midwifery, in which
he exclaims with great vehemence against the use of the instruments invented by Dr.  Chamberlain, which
had now become pretty generally known.
  All  those who  may be desirous to  learn  with  what  temerity the art of midwifery was practised, both
manual and instrumental, in  that  day, may read the work of Dr. Burton, of York, England, whose
practice has been  consecrated to the ridicule of after-ages, by the pen of Sterne.
  Shortly after this lime, in the year 1760, there  appeared a treatise on the "Art of  Midwifery," setting
forth  its various  abuses, especially in  the  use of instruments, written by a Mrs. Elizabeth Nihell, pro-
fessed midwife.   It was addressed to all fathers and mothers, and those likely soon  to be  either.  The
avowed object of  the book was, to inculcate a preference  of women  to men in  the practice of obstetrics.
Nothing can exceed  the vehemence of her invective  against male attendants.  There is, «he  observes,
" a curse that attends their operations ; for difficult and fatal labors have never been so rife or so frequent
as since their intermeddling.  The cruelty of Herod," she adds, " extended to no more than to  infants —
not to the mothers ;  but that the cruelty of these  pretenders extended to both."  There can be no doubt
but that her  abuse was mainly directed against Smellie,  Burton, Mackenzie, and Hunter, as among the
most  extensive practitioners of midwifery in  that day.
   Dr. Shippen, of Philadelphia, was  the first  public  lecturer  on midwifery in the United States.  His
first course  was delivered in 1762, and it was attended  by only ten pupils; but he lived  to lecture to a
class  of two hundred and fifty.
   A  Dr. Atwood was the first in the city of New York who had  the confidence to advertise himself as a
man-midwife, which he did  in 1762.
   Dr.  Bard, born and educated in Europe, came to this  country and established himself in practice in
New  York, and was chosen the first president of the first  medical college founded in this state.   He was
a judicious practitioner, and he wrote  a practical treatise  on  midwifery, for the use of  midwives and stu-
dents.  I believe it was the first published  in this country, and it was the best that  has been published.
 But it has fallen  into disrepute, in consequence  of his placing too  much reliance  on  the resources  of
nature, to suit the officious meddlers of the  day.   I  remember this venerable old physician, bending with
 age and infirmity (when I attended lectures in the old university of the state of New Y'ork, in Barclay
street), coming in and taking his seat  by the side of Professor Hossack, and calling our particular atten-
tion,  in a very feeble tone of voice, to some facts connected with the subject on which the professor was
 lecturing.   His hoary locks and profound attainments excited among us a universal veneration.
   According to  Astruc, the dutchess of Villiers, mistress to Louis XIV. of France, was  the first female
 who  was induced to place herself under the exclusive obstetric  care of a professor of surgery, without
 any anticipated necessity of a surgical operation.  This  took  place  in 1663 ; and  the  surgeon, Julian
 Clement, was conducted in disguise to the  dwelling of his patient.  The case  terminated favorably, and
 he was soon after appointed accoucheur to  the princess of France.  The example thus .set spread rapidly
 among the  aristocracy of France, and was imitated by other nations,  until at length it has spread through
 every rank of civilized  society.
   So indecent did it appear, before this time, for a  man  to be present at an ordinary labor, that one Dr. 
PRELIMINARY  REMARKS.
13
Vites, of  Hamburg, whose  curiosity was  greater than his judgment, was publicly branded for  being
present at one in female attire.  Another writer states that he was condemned to the flames.
  About this period, when man-midwifery was first  practised in France and England, many books were
written on this subject, purporting to contain improvements; and although  some judicious treatises have
been written, and some improvements made, among  which that  by Dr. Denman is the best in the English
language — although there are many more recent authors, such as Campbell, Ramsbotham, Lee, Blundel,
Gooch,  Murphy, Collins,  &c, who display great learning and  research on particular subjects  in mid-
wifery—yet, according to the testimony of judges, in consequence of the rash and untimely interference
on the part of the accoucheur, together with the improper medical treatment, and the very frequent use of
instruments, there has been and now is more injury to the children and to  the organs of the mother, and
more fatal cases, than  there ever were before the light of science and literature began to dawn, when the
practice was exclusively confined to the female sex.   And  even at  the present day, there is no part of
medicine which in this respect needs a reformation  more than  does the practice  of midwifery, although
some of the most celebrated  practitioners of modern  times are females : among whom have been Madame
Boivin  and Madame La Chapelle, whose  treatises on this subject are quoted as authority by our best
English and American male  practitioners.   These ladies have delivered over twenty thousand each, and
have very seldom resorted to the use of instruments  in delivery.  Their success has been unparalleled in
ancient  or modern history.  And in this country there are numerous others, also, among whom may be
mentioned Mrs. Alexander,  of Boston ; the late Mrs.  Stebbins, of Massachusetts ; Mrs. Halsey, Mrs.
Haynes, and Mrs. Russell, of this city, and numerous others — all of whom have been remarkably suc-
cessful,  and an honor to their profession.
   Who shall officiate  in parturition? — In consequence of the practice which prevails in the
present  day, this has become a grave question.   The physician contends with much zeal that it is  his
province to officiate.  Females, he alleges, are incompetent. And these  assertions  of physicians have
influenced the minds of females to such an  extent, that they are forcibly impressed with  the belief that
there are no others competent;  and when it is proposed to many women to employ a  midwife, they ap-
pear to shrink with horror: and many  even suppose  that in trusting themselves to  the most accomplished
female accoucheur, they jeopard their  lives.   The confidence of the females in the physician is so  great,
that it is almost impossible to effect a reformation in  the prevailing practice  in this respect.
   The physician takes it  for granted, and  even boasts, that if he  can  attend  one single  case  of mid-
wifery in  a  family, he has ever  after secured their patronage ;  so that both  interest and prejudice
operate  as  obstacles  and barriers to  any improvement or  change in   the practice.  And  although
the most  fearful consequences  have and are still daily occurring, modern females cling to this unnatural
practice.
   Notwithstanding, however, the existence  of the above  obstacles, we  are well assured  that females, if
rightly qualified, are not  only as fully  capable  as  men, but are even more so ;  and therefore the most
valid and  conclusive reasons may be assigned why a reformation should  take  place in  this  department
of the practice.   What more conclusive than the fact of the actual attendance of women in child-birth in
all nations previous to the sixteenth century, and  the attestation  of competent persons, during  the first
century of man-midwifery, to the fact that not half so many fatal ^ases occurred before as after the inno-
vation ?   And in the first settlement  of this country, when females attended exclusively on such  oc-
casions, it was as rare a fact to hear of a woman perishing in  child-birth as  it is now to  hear  of  an
Indian or an animal perishing in labor,  who are delivered  by the unaided powers of nature.
   But in  this  age it is quite  common to hear of persons who die in child-birth, or from some of its con-
sequences : either bleeding  before, mal-practice at  the time, or the  subsequent  use of some poisonous
minerals.   The  advantage? therefore vastly preponderate in the employment of females.
   The  objections to employing  men  are  various  and  weighty, among which I would enumerate the
following:—
   1.  The practice has an immoral tendency.   The great intimacy cmd confidence which exist  between 
It
IMPROVED  SYSTEM  OF  MIDWIFERY.
the physician and the patient, give? the most unbounded  liberties and temptations to the unprincipled
and licentious to alienate their affections from their husbands.
   L\ It is indelicate for  men to attend on such occasions.
   3. The hands of men are larger, and are therefore less calculated to manipulate when such practice is
necessary.
   4. The presence of a man gives such a shock  to the nervous system  of some women in labor, as to
arrest the pains,  and sometimes completely to suspend them ;  and exerts a baneful and serious influence
on the result.  It was this,  it is said, which proved fatal to  the princess Charlotte of England.
   5. Men have less sympathy on these occasions  than women.   A woman  who has borne children  has
certainly more sympathy for the sex than the male can have ; besides, women have more  patience and
perseverance than men.   A female, when properly instructed, possesses a tact and adroitness in rendering
assistance in the  hour of nature's peril, which is unequalled by the male.
   6. Their whole time  being devoted to this one branch of medicine, would  render them  greater profi-
cients in the art than the general practitioner can attain.
   7.  This part of the practice rightly belongs to females, and it would give employment to many virtuous
and  highly-deserving widows and others, who  would be  very  useful to  their sex, and obtain  a good
living, who are now deprived of these advantages  by the prevailing practice.   As evidences of the capa-
bility and great success  of women  in this department, we  need only refer to  Madame Boivin, Madame
La Chapelle, and others, in all parts of the world, named before.   Dr. Ewell, in his " Letters to Ladies,"
has the following remarks on this  subject:—
   " The serious object  of my present solicitude is, to wrest the  practice of midwifery  from  the hands of
men, and to transfer it to women, as  it was  in  the beginning, and ever should be.   I have seldom felt
a more ardent desire to  succeed  in any undertaking, because I  view the present increasing practice of
calling on men in ordinary births as a source of serious evils to child-bearing ;  as an imposition upon the
credulity of women, and upon the fears of their husbands ; as a means of sacrificing  delicacy, and con-
sequently virtue; as a robbery of many of the  good common women of  their proper employment and
support.  Truly it shows as extraordinary a  revolution  in  practice as any afforded from a survey of all
the arts.  That  all females do bring forth their  young without assistance, excepting the human in  a
state of civilization, and that women should call for the assistance of men — the only animals tormented
by jealousy — is a fact that will scarcely be  credited in a  Turkish harem, or  by the Christians of some
future and purer age.   Should the strangers to the practice inquire if our  men have large, unwieldy
hands — great curiosity  about women ;  should they  ask  if our women had the requisites for useful ser-
vices— small hands, good sense  of touch, and patience in attendance — they will absolutely deny this
monstrous perversion of the course of nature.
   '• From the peaceful  and retired occupations  of women, they are generally more numerous  in the
community than men.   Nevertheless, the men  have  assumed several offices  properly belonging to  the
weaker sex.  The natural consequence is, that many women — as men in similar circumstances — wanting
profitable occupation, seek the employments of the vicious.   Inasmuch, therefore, as these men-midwives
have meddled with this  proper business of women, they have been instrumental in the  depravity of many.
Indeed, it is owing to their acting whqje they are  not required, that the female practitioners are so often
ignorant — not having the opportunity or means to qualify  themselves for attendance on ladies.
   " Several observing moralists  have  remarked that the  practice  of employing men-midwives  has in-
creased the  corruption  among married women.  Even  among  the French, so prone to  set aside the
ceremonies between  the sexes, the immorality of  such  exposures has been  noticed.   In an a-necdote of
Voltaire, it  is related that when  a  gentleman  boasted  to him of the  birth  of his son, he asked who
resisted at the  delivery.   To the answer, 'A  man-midwife,' he replied,  'Then you are  travelling the
road to cuckoldom !'   The acutely-observing historian of  nature, Count Buffon (on puberty), observes  :
'  Virginity is a moral being, existing solely  in  purity of heart.   In the submission  of women to the un-
necessary examinations  of physicians, exposing the secrets of nature, it is forgotten that every indecency 
PRELIMINARY REMARKS.
15
of this kind ia a violent attack against chastity ; that every situation which produces an internal blush, is
a real prostitution.'   It is  very certain, where these exposures have been most common, as in large cities,
there adultery has been most frequent.  Be it folly, or prejudice, or not, there is a value in the belief that
the husband's hands alone are to have access to his  sacred wife.  Break through  the  prejudice, if you
please  to call it so, but for once — unless powerful reasons command it, the Rubicon is passed ; and rely
upon it, the barriers, on future emergencies, will not be so insuperable.   Time and opportunity to press
on a grateful heart for  a favor in regions where  magnified favors have been conferred, have been  used,
and more frequently desired.  To convince  you of  this, you will not require me to enter into the secret
history of  adultery.   Many of these  modest-looking doctors, inflamed with thoughts of the well-shaped
bodies of the women they have  delivered, handled, hung over for hours, secretly glorying in  the privilege,
have to their patients, as priests  to  their penitents, pressed for  accommodation, and driven to adultery
and madness, where they were thought most innocently occupied.  In one case, I was well assured that
a physician in Charleston, infuriated with the sight of the woman he had just delivered, leaped into her
bed before she was restored to a state of nature.   The melancholy tale of the seduction of  the wife of a
member of Congress from Carolina, by her accoucheur, is a warning that ought  not  to be disregarded.
The beautiful organization of the lady preyed on his mind for years : he sought her from one to the other
extremity of the country, regardless of all dangers ;  and, on  acquiring his game, received  a premature
and violent death — leaving horror and  ruin in the family he had been hired to serve.
   " Whatever you may think on this subject, there are many  husbands to whom the idea of their wives'
exposure of person is horribly distressing.   I have heard  of cases  affording singular mixtures  of the
ludicrous and distressing.  In one case in my neighborhood, the husband  sent for his physician to his
wife in labor, yet was so strongly excited at the idea of her exposure, that very solemnly he declared to
the doctor he would demolish him if he touched or looked at his wife !   No man, possessed of a correct  ,
and delicate regard for his wife,  would  subject her  to any exposure to  a doctor,  that could be avoided
without danger.
   " But the opposition, the  detestation of this practice, can not be so great in  any husband as among
some women.   The idea of it has driven some to convulsions and derangement; and every one, of the
least delicacy, feels  deeply humiliated  at  the exposure.   Many of them while  in  labor have been so
shocked at the entrance of a man in their apartment, as to have all their pains banished.  Others, to the
very last of their senses, suffering the severest torments, have rejected the assistance of men.....They
did err on the side of delicate feeling: but their  errors will be blotted out for ever !   To be instrumental
in relieving one of this truly interesting  cast,  will be a heavenly consolation to all who can be alive to the
pleasure of serving the virtuous.
   " It requires but  a little understanding of this subject to enable you frequently to prove of great service
in removing the  fears  and forebodings  of many ignorant sufferers,  who  imagine  that only professional
skill can afford relief.   Many such objects of commiseration  have languished day after day, solely from
the want of a little information   in one of the attendants — all unnecessarily  lamenting that physicans can
not be procured.  By a little information, you can at all times prevent the miserable mutilation of mother
and child, which  has frequently been committed in a shocking  manner, solely from the grossest ignorance.
Indeed, to be able to say  to  ignorant midwives, fancying  they must be  doing something continually —
' Thou shalt not  interfere—thou shalt not meddle with nature' — will alone  be  sufficient to  effect essen-
tial service.  On other occasions, and in all parts of the country, sudden labors coming on before proper
attendance can be had, you will be able to do important good to mother and child.   One case of suffering
of this  kind, from want of assistance, in  my opinion, is a great reflection on the ladies who are convenient
for attendance.   Indeed, I think it disgraceful that any female should be allowed to grow up in ignorance
— in pursuit  of  pleasure — too  fancifully nice — so falsely delicate  as  not deliberately to  get so much
knowledge in  one hour as will enable her to do,  or  to direct the unlearned servant how to  perform the
little offices required on the emergency, to which all  of them are subject.
   " It  is not to be disguised  that all classes in the community have  to deplore the loss of some friend in 
lfi
IMPROVED  SYSTEM OF MIDWIFERY.
child-bed.  Many are mourning at the loss of amiable wives, victims to what ought to have been  the
subject of their joy.  Parents are still lamenting the premature death of their daughters — buoyed up
with the hopes of feeling as mothers, when the pains of labor were forgotten.   Innumerable babes have
been sacrificed in the most afflicting manner, many of whom might have become ornaments to their coun-
try.   All such calamities might have been prevented, if but one lady in  the neighborhood of each case had
devoted but  a part of the time  spent  in  guessing  about  the operation, to an accurate knowledge of
the subject, so that she might have directed the ignorant and meddling attendants.  It is said the Lord
declared he would save the city of Sodom if but ten good men were found in it; and surely it is equally
certain that the whole of you should attend to  this subject, with the prospect even that only ten might be
called on to render the needful assistance.
   " Every day shows that the practice of  midwifery  requires no particular skill, no superior knowledge,
no sleight-of-hand, nothing beyond the most common sense  and  observation, to do  all  that  is required
with perfect success.  Nature has  so wisely provided for the birth of  the young, that even the extensive
practice so highly rated  among  ladies is not necessary for the discharge of all the duties required from
attendants.  The male practitioners, who  in general from accidents have got into great repute, received
their first impressions from books, from directions which any one in the country can comprehend.  The
increasing applications to these women-doctors, remaining satisfied with such business, are really made in
vain ; for  most commonly in qualifications  they are not far removed from the sisters of the  profession.
Physicians of the best abilities, discovering that it  is by the fingers instead of the talents that many get the
most profitable business, attend to  this subject only in the beginning.   An introduction into  better occu-
pation, excepting in the  cases  of their favorites, is almost  invariably followed by an abandonment of
midwifery ;  so that the ladies have often to look out for different attendants.

   " During the simplicity of the early ages, women  alone  officiated at births.   In Egypt, the  cradle of
so much science, they were the  sole actors.   At Athens, a  law was passed forbidding  them to practise ;
but from perseverance among the  delicate, preferring death  to exposure, the law was  speedily repealed.
Since then, no government, it is believed, has been  so ridiculous as to compel  such  unnatural interfe-
rence.  In consequence, the practice has been  confined to women, until within  a few  years, in some
European countries and their colonies.  The  excessive spirit for  meddling with women is  nowhere  so
great as in France.   They are so fond of indulging their curiosity at births, that they even attend on the
domestic animals in labor.   Mr. S----told me  that he witnessed the operation by a professional char-
acter for cows.   The cow, displeased with his intrusion, made all  possible resistance ;  and,  when it was
over, for hours endeavored to attack the meddler.  There is a  stronger sense of propriety among  the
northern neighbors of the  French.   The Danish government, viewing the employment of men-midwives
in natural labor as highly  improper, established schools for the instruction of women in the principles of
midwifery.   Several  of  the German states have imitated  the  example.   The  American  government
should establish such institutions.   The legislators  in Congress would  thereby render the nation more
essential service than they have done for years.
   " If the difficulty of obtaining doctors at the proper time ; if the indelicacy and tendency to immorality
of having them in any but the critical and unnatural cases;  if the  propriety of giving to helpless women
proper encouragement and support; if the salvation of many women,  who, shocked at male  interference,
have their pains banished and minds deranged, and who sometimes prefer death to exposure ;  if the  sal-
vation of many children born almost without warning; if the prevention of the destructive interference of
;gnorant attendants can not, united, induce you to attend to this subject—the  mechanical advantage be-
tween a man's and a delicate woman's hand ought to command  your decision  in favor of employing  and
encouraging  female assistants.   Such is the confined organization of the parts for our birth, and such the
large size of men's hands, that I verily believe as much mischief as good has been done by them, as has
been stated by more extensive  observers  than  myself.  I conclude with the remarks,  that when profes-
sional assistance  becomes necessary, from unnatural occurrences, the case is altogether altered.   The 
PRELIMINARY REMARKS.                                 17
exposure is not of parts in a natural state, but deranged ; the woman becomes a patient for his operation ;
is a subject of commiseration ;  and the solicitude to remove her danger and agonies is the only thought a
man can have.  In such cases, there ought  not to  be the least hesitation in the female to submit to ex-
amination ; there  is no indelicacy in it.   Religion, future usefulness, command that life should be pre-
served at the expense of a hundred such sacrifices.  The rule that I would prescribe to the females  for
whom I felt  most  affection and solicitude would be, that which I now urge :  on no account submit to the
interference  of men in common labor ; do it most readily in the uncommon cases, when a midwife under
the direction  of a physician can not afford relief.   I will venture to add that there is not  a  disinterested
physician, of sound sense,  who would not approve of the rule.   The best authors on midwifery decidedly
recommend it."
   James Boyle, a physician of the reform school,  also takes the same view of the subject.   He remarks
as follows :—
   "Women  the Divinely-appointed  accoucheurs. — The attention of the public is called to the
present false, improper, demoralizing, and destructive opinions which  are  entertained by the majority of
the community, and which  are sustained  by a  powerful class  of interested men, respecting the true
persons who  should officiate as accoucheurs in obstetrical cases.  The prevailing doctrine is, that women
can not be sufficiently informed, self-possessed, and efficient, to qualify them to act in such cases as prin-
cipals, and that in all instances male-midwives  are necessary.  This  I know, and so do thousands  of
others, to be false, utterly so.   Man never can be  equal to  woman  in any case, except where  the use of
instruments  is indispensable,  and such instances  are exceedingly rare ; and in all  such  cases, a male
accoucheur  can as well  be called in  when  the  time arrives which indicates the necessity  for their em-
ployment.   Women can be as well informed as  it is possible for men to be ; as self-possessed, vigorous,
efficient, as men ; and they are far more  tender and careful — know better  how to  adapt themselves to
the case — have freer communication  with the patient — do not arrest the process of  nature by shocking
the  modesty and  delicacy of woman, which is always sure to  do  injury.   Where is the  man who can
exceed Madame La  Chapelle and Madame  Boivin, of  France; Mrs. Alexander, of Boston, Mass. ; the
late  Mrs. Halsey, or the present Mrs. Haynes, of this city ?  Thousands of mothers will testify that these,
and many, very many other women, are to be preferred to  any male accoucheur  which  the world knows.
I hesitate not to say that hundreds  of women perish in child-birth from the employment of males, all  of
whom would have been saved if females had officiated.
   " I would say to women, everywhere, that they owe it to the  modesty of their sex—to the principles
of good morals—to their own lives — to the lives of their children — and the good of  mankind — to set
their faces against the present destructive, disgraceful, and  unrighteous  practice of employing in ordinary
cases, males  instead of females, as midwives.
   " The manner in which women are obliged to submit themselves — sometimes months before the time
of accouchment — to the shocking liberties which-male-midwives may  and  often do take with them, un-
der the pretence of performing professional duties, but really to test their willingness to sacrifice their virtue
to lust, should arouse every virtuous husband and  wife in the land ; should awaken the  moral indignation
of the entire  community, and induce them to combine to abolish a practice  which is full of abominations,
and which should be tolerated in no civilized or Christian country, for in  heathen  countries it is not!
No virtuous man, jealous of the honor and dignity of his wife, as an affectionate, virtuous husband — no
man or woman of chaste moral principle — will think our language  too strong, who are aware that women
are more susceptible to temptation  during pregnancy than  at any other time, and who  will  examine the
plates and the remarks made under the head of '  touching,' in the large  works on  obstetrics—as,  for
example, Doane's translation of ' Magrier on Midwifery' — and who will observe the shameless positions
in which men are presented in contact with women!  Oh, loathsome abomination ! — If such  plates  or
illustrations are necessary (?) why not introduce  women instead of men ?   Ah !  there 's the rub : ' Our
craft would be  endangered, by teaching women  a lesson  that they might learn to our  disadvantage !'
   " That Book, which is the standard of all genuine morality, recognises none other than  female midwives :
                                             3 
H                          IMPROVED SYSTEM OF MIDWIFERY.
ami all the time that  sacred  canon was filling up, till its last revelation was completed, none other were
known or dreamed of than  female accoucheurs.  The Jews knew no other ; the early Christians also.
So with all nations during those times: and  yet mothers delivered their children as easily, as safely, and
as speedily, as they have during any period since.  The employment of males is a comparatively modern
practice, and has  come in with other corruptions which distinguish these  modem days from those mor*
simple, unartifijeial, primitive times.
   " In the preceding remarks, it is not intended that men should be  discouraged  in  acquiring a thor
©ugh knowledge  of  midwifery.   This they should most certainly possess in order that they may be pre-
pared to  act in emergencies where  their services are really needed, in order that they may be qualified to
teach others, especially the women of our country, who are  truly in great  darkness  on this subject, and
I must think criminally so — in  order that they may act till women are in all places sufficiently enlight-
ened, and so far reformed, as to be disposed to take  the matter into their own hands ;  and, finally, in
order that they may always be qualified to act  in all cases where  no  other assistance  is at hand.   But
while males are  to a great extent compelled to officiate  as accoucheurs at the present day, let them labor
as honest, disinterested, and virtuous men — as men who have wives, sisters, daughters,  and an interest in the
modesty, purity, rights, and  interests, and, what is paramount to all, the virtue of the female sex — to
bring about that period when they can properly abdicate their usurped office, and restore it to its rightful
and original proprietors.   Let them not, for the  sake of a fee, for the sake of sordid  self-interest, place
themselves in the way of temptation, or the women who confided  in them  ; let them not shock the deli-
cacy, impair the modesty, and thus prepare the way for the fall of her who is the connecting link between
angels and  men, and who,  under  God, is  the means  of  civilizing, refining, and  preserving man from
unbounded licentiousness : for men  as a mass are born libertines — women as a mass  are born chaste ;
hence male-midwifery originated with men, and came from beneath ; it never could  have originated with
chaste, pure, virtuous woman !   Let them not  labor to  perpetuate so  odious a practice, by keeping
women in  ignorance—by endeavoring to discourage them from informing themselves — by depreciating
their ability — by decrying female  midwives—by working upon the fears of prospective mothers, and
inducing, them to  distrust the capacities of their own sex.  And let  those  medical gentlemen who have
thus far acted from a pure and honest purpose, but in ignorance of  the infinite mischiefs which have re-
sulted from an intrusion into a department which never belonged to them — I say, let them not, by their
kxample, sustain a  practice which has licensed, which now licenses, hundreds of  libidinous fiends in
human shape, wolves in sheep's clothing, under the cloak of the  medical profession,  to  plunder  thou-
sands of women of the dearest pearl of their human, domestic, social life ; and thus,  by rnal-practice and
immoral conduct, from generation to generation, plunge husbands, wives, parents, children, and  friends,
into irretrievable wretchedness and disgrace.   For humanity's sake, if for no other, seek to rid yourselves
of this pernicious practice !
   " It may be objected, that there are as delicate cases connected with the diseases of women as any part
of midwifery can be — as diseases of the uterus, the vulva, the  vagina, the urethra, &c.   I acknowledge it,
and claim that women ought to be the physicians and surgeons  in all such cases.   They have officiated
in England, France,  and in this country, as scientifically, efficiently,  and  successfully, as men ever have,
even in the  worst cases, and to their hands all  such cases should be committed.   Many women  prefer
deal'i in such cases, especially young women, to  the interference of  males.  And  let me add here, that
every man who- insists upon  officiating in  such  cases, and v/ho  thrusts women aside as practitioners, by
usurping their places, is thereby compelling multitudes of magnanimous, modest, and pure-minded females
— the very noblesse  of the sex—to lay their lives as sacrifices  upon the bloody altar  of their accursed
love of pelf and plunder!
  " Some such there are,  and I can  not but believe that  many noble-minded  physicians and surgeons
are to be found — men who highly respect and appreciate  woman—men who  are husbands, fathers,
so:>..-. — who fear God and  hate covetousness, and have  assumed the province of  woman in these case?
1, .:n necessity — who will appreciate  these remarks,  and who would  rejoice to see a  new era introduced, 
PRELIMINARY  REMARKS.
19
which would place all  these  matters in their true relations.   With such — with  enlightened women —
with Him who rules the affairs  of  men — I leave  my testimony; and  to Him and  them I make my
appeal.'
   To show  how grossly  and wickedly  women are sometimes deceived and imposed upon by medical
men, I give  the following paragraph from the " London Practice of Midwifery :"—
   "A patient, after the waters  are  discharged," says the author, "requires a little management.   It is
not just to stay with her at the time ; and yet it is necessary,  if we leave  her, to leave her in confidence.
Therefore we may give her the idea of making provision for  whatever  may happen in our absence :  we
may pass our finger up the vagina or opening to the womb, and make a moderate  degree of pressure, for
a few seconds, on any part of it, so that she may just feel it;  after which we  may say to her,  ' There,
ma'am, I  have done something  that will be of great use to your labor.'   This she trusts to ; and if,
when she  sends for us, we get there in  time, it is well: if later than we should be, we easily satisfy her.
(For 'the doctor  knows !') —' Yes ! you know I told you I did something which  would be of great ser-
vice to you  in your labor !'   If the  placenta is  not  yet  come away —' Oh, I am quite in time for the
after-birth, and that, you  know, is of the greatest consequence  in labor !'   And if the whole has come
away —' We are glad the after-birth is  all come away in consequence of what we  did before we last left,
and the labor terminated  just as we intended it should !' "
   This farce and deception probably costs the husband five or ten guineas.
   Do you  think, reader, that one  of  our North American Indian women  could  be thus cheated  and
humbugged ?
   Notwithstanding the above severe strictures on *he  employment of men-midwives, I do not wish for a
moment to be understood to state that they are not to be taught, or that they are never to officiate, in par-
turition.   On the contrary, their services will be often needed.
   In the first place, such is the custom of society, that a portion of females will employ no others.   For
this reason,  it is indispensable that they should be taught the  true method of assisting nature, instead of
forcing her with instruments.  Not  only so,  but even where females attend,  cases will be frequently oc-
curring in which  their counsel will be required and even demanded ; so that they ought to be thoroughly
masters of the art in all its departments — ready and able to act in any emergency that may occur.   Besides,
in the present state of society, it  is  to well-instructed and capable male practitioners to which females
must look for instruction.   Again, there are  but very few females in the present day that are even toler-
ably well qualified to attend to  this department; hence,  also, the  great  necessity for the  physician
well to understand this  branch.   Schools should  be immediately established for  the  instruction of
females ; and any well-qualified,  reformed practitioner could privately instruct them  in  the absence of
such schools.
   I hope  none of my medical brethren  will draw wrong inferences, or take offence at any of my remarks
on this subject, or suppose that I  desire to injure them in their practice.  I am confident  that if they will
seriously reflect on this subject, they will not feel aggrieved, or be at all unwilling  to give  up the practice
to well-educated females, to whom it rightly belongs, at least in all ordinary cases.
   On the score of interest, I am  sure they will be gainers by the change ;  for a man could make more
money in  attending ordinary cases of sickness in the same time, than  his fee would  amount to for at-
tending a case of labor,   especially  where  it  is  much protracted.   Besides, another disadvantage  to
the physician engaged in this practice is, that most of these cases occur in the night, and  the practitioner
is  roused from his sweet slumbers, which to most men is a source of great vexation and annoyance, and
which very much injures his health, and renders him  unfit  for the other duties of his profession for sev-
eral successive days.   Sometimes he is compelled to ride a great distance, and during a protracted labor
kept under intense anxiety of mind for  several days, for which  no money can compensate him ; for I
assert, without any fear of contradiction, that  this branch  is  the most laborious  and trying part of the
medical profession.  May we not, then, hail an exemption  from this  duty with acclamations of joy, in-
stead of regret ? 
20
IMPROVED SYSTEM OF MIDWIFERY.
  Qualifications of  Midwives. — Respecting the qualifications of midwives, I feel it incumbent &a
me  to state explicitly that  all those, either male  or  female, who engage  in  this noble and responsible
branch of medicine, should be well qualified, both  in theory and practice.  I would not allow any to
commence the profession of midwifery without first having expended  a suitable  length of time in study
under competent persons.   No ignorant or inexperienced  man  or woman should ever officiate in this
department.   They should first acquire a knowledge of midwifery, either by lectures, recitations, exam-
inations, or,  above all, by  clinical practice, or actual attendance in the  lying-in room, under the superin-
tendence of qualified teachers.
  And I would also recommend to every student of  midwifery, either male or female, who may wish to
become properly qualified  in the  art, to take this work, as a text-book, into the lying-in room with them ;
and there to study it during the progress of labor—during the intervals in which no assistance is necessary.
By this means, the  student will acquire competent knowledge, both theoretical and practical, which is the
only way to attain perfection in the science ; and that all should be required by the public to give evidence
of having so studied, by a diploma from the school, or certificate from  the physician, with whom  they
have studied.  It is only in this manner  that we can  expect that the confidence of the public will be given
to females, or their  services can be made available in the lying-in chamber.
  I will conclude my observations on this subject by quoting a few quaint remarks of Dr. Maubray, on
the  character of those who should  be employed in midwifery.  He wrote over  a  hundred  years  ago,
when female accoucheurs were more in fashion than they now  are :—
  " A midwife ought not to be an ignorant, stupid,  indolent, or a dull person ; and especially not inca-
pable of conceiving matters distinctly, or judging of things aright.  Neither ought she to be a self-indulger,
slothful, or lazy j nor a light, dissolute, or daring person.  She ought  not to be inconsiderate,  negligent,
or forgetful; nor proud, passionate, or obstinate : neither peevish, morose, nor surly ; nor fearful, doubtful,
or wavering-minded.  Neither ought she to be  a  tippler  or drunkard, nor a tattler or vagabond, nor a
covetous or mercenary person.
  " But, on the other hand, in the affirmative, she ought—1.  To be a woman of a good  middle age, of
solid parts, of full experience, of a healthy, strong, and vigorous body, with clever, small hands :  since
nothing can be more agreeable and conducive to the art of  midwifery than  slender hands, long  fingers,
and a ready feeling.
  " 2. She ought to be grave  and considerate, endued with  resolution and presence  of mind, in  order
to foresee and prevent accidents ; sagacious and prudent in difficult cases, so as not to take all upon her
own shoulders or judgment, but to have  immediate  recourse  to the ablest practiser in the art, and freely
submit her thoughts to the discerning faculty of the more learned and skilful.
  " 3. She  ought to be watchful, diligent, and expert, in all cases and  conditions that can or may occur;
so that no opportunity in the beginning of the labor be lost:  since I have more than once observed that
the mistake  or neglect of  improving a critical minute  hath cost the mother many violent or heavy pains
afterward, and the child also its life.   For which reason  it is of the greatest importance to nick  the
opportunity, conformable to  Cato's saying :—

                              "'Fronte capillata, post est  occasio calva.'

  " 4. She ought to be a true fearer of God, a conscientious person,  of good life  and  conversation:
since matters of the greatest moment  are committed to her  care, and depend entirely upon the faithful
discharge of her duty :  for she has the first and  best opportunity of showing her compassion and tender-
ness to mankind,  in this infant and helpless state.   In short,  charity ought  always  to engage  her, to be
as ready to help the poor as the rich ; the life of the one being as dear as the other's, and the image of
God being equally  stamped upon both : for the ineffable  recompense  of charity far exceeds all other
considerations of  trifling gain.
  " 5. She  ought to be patient and pleasant — soft, meek, and mild, in  her  temper, in order to  encour-
age and comfort the laboring woman.  She should  pass by and forgive her small failings and  peevish 
PRELIMINARY REMARKS.
21
faults, instructing her gently when she does or says amiss ;  but if she will not follow advice, and neces-
sity require, the midwife ought to reprimand and put her smartly in  mind of her duty :  yet always in
such a manner, however, as to encourage her with the hopes of a happy and  speedy delivery.
  " 6. In like manner as  she ought to be modest, temperate, and sober, so she ought to  be faithful  and
silent; always upon her guard to conceal those things which ought not to  be  spoken of."
  Another very ancient  author on the same subject remarks :—
  " If the fear of God does  not engage  her to act conscientiously, and to discharge her  duty faithfully,
serious accidents  may happen, both to mother  and  infant.   But being forearmed with  the fear of the
Lord, and not confiding altogether in  her own knowledge, knowing that she stands in need of Divine
assistance, will be earnest in  prayer.   She will therefore act wisely,  in  thus relying  upon Divine Provi-
dence, who graciously supplies with wisdom all those who need and  ask for it.
  " A midwife should be mild, kind, and meek,  for women  are the weaker vessels ;  and  those in labor
are full of pain and peevishness, and  often  desponding, whom the midwife is to support  and encourage
with hopes, as far as the condition of the  mother  and  infant will permit.  The woman should never be
intimidated by her, nor should  she suffer  others  to intimidate  her, by relating stories  of accidents which
have befell others.  And when there is  any real difficulty in  a case,  she should be willing and desirous
to send for an experienced physician,  with whom to counsel  before it is too late to remedy the evil."
  In conclusion, a few words from Dr. Maubray on instruments :—
  " What can be more  inconsistent with the tender  nature of  women, or more  terrible to them, than to
see  men come armed against themselves  and  their tender infants, with knives, hooks, iron forceps,  &c,
thereby, as it wrere, to help them in time of their extremest agony ?   For my  part, I am positive that, let
who will use instruments, they kill many more infants than they save, and ruin  many more women than
they deliver fairly.   And this I think will be easily agreed to by all  those who  have any knowledge of
the parts of generation in that sex, as (I believe) it is also sufficiently  evident even to those who have no
judgment that way, by the notorious fatalities and tragical events they daily hear of in fact.
  " However, I know some chirurgeon-practitioners are too much  acquainted with  the  use of  instru-
ments to lay them aside  ; no, they do  not (it may be) think  themselves in their duty,  or proper office, if
they have  not  their cruel accoutrements in hand; and what  is  most  unaccountable  and  unbecoming a
Christian is, that when they have perhaps wounded the mother, killed the  infant, and, with violent torture
and inexpressible pain drawn it out by piecemeal, they think no reward sufficient for such an extraordinary
piece  of mangled work !
  " But, in short, I would advise such to practise butchery iather than midwifery ; for in that case  they
could sell  what they slay;  but in this, by handling man so, they only bring infamy upon their  own profes-
sion, and expose it to  the contempt and hatred of others." 
PART   FIRST.
REPRODUCTION.
                                        CHAPTER  I.

                            ORIGIN  OF  VEGETABLE  LIFE.

   The limits which have been set by the Creator to the duration  of the life of each being that exists at
any one time on the surface  of the globe, would cause the earth to be speedily unpeopled, were  not  a
compensation provided in the faculty of reproduction — or of the formation of a new being similar to it-
self— possessed by every kind of plant and animal.   This power of creating (as it were) a living struc-
ture, with all its wondrous  mechanism — possessed, too, in  animals of the faculties  of sensation and
thought, and in man the residence of an immortal spirit — seems at first sight more extraordinary and mys-
terious than any which we elsewhere  witness.   Yet it is not perhaps so in reality.  The processes  which
are constantly taking  place  during the life of  each  being, and which  are  necessary to the maintenance
of its own  existence, are no  less wonderful, and no less removed from anything which we witness  in the
world of dead matter.   When the tree unfolds  its leaves with the returning warmth of spring, there is as
much to  interest and astonish, in the  beautiful structure and  important uses of these parts, as  there is in
the expansion of its more gay and variegated blossoms ; and when  it puts forth  new buds, which by their
extension prolong its branches over a part of the ground previously unshaded by its foliage, the process
is in itself as wonderful as the formation of the seed that  is to propagate its race in some distant spot.
Thus it is  that  scientific knowledge  heightens our  interest in nature, by  showing that, in those  things
which seem most common, there are  as many sources of interest and  instruction as in that which, from
its apparently mysterious character, is usually regarded with more curiosity.
   The parts of a flower essentially  concerned in the  reproductive process are the stamens and  pistil.
The stamens are a number of little bodies, having yellow heads mounted on long  stalks, which are seen
around but not  in the  centre  of the flower.   These stalks are  called filaments, while the heads  are  called
the anthers.  Each head is usually seen to be  more or less completely divided into two parts, which are
termed anther-lobes.   These are commonly united together,  as in  fig.  1, a, b, c, d ;  but sometimes they
are separated, as at c;  and occasionally only a  single lobe is  present,  as at /.  Within the stamens are
produced a  number of minute yellow bodies,  usually  of a globular form,  which  together  constitute the
fine dust known as the pollen or farina of the flower.*  Each grain of pollen, when examined with the
microscope, is seen to consist of a cell exactly analogous to  that which constitutes a spore.  It has  two
or more coats, which enclose a fluid ; and in this a  large number  of extremely minute granules may be 
ORIGIN OF VEGETABLE LIFE.
23
 seen  with a good microscope.   These granules are probably the germs of new cells ; being analogous to
 those which are sent  forth from the Red Snow.  They may be  seen to move within the parent cell, or
 pollen-grain, previously to the  time when its walls  become too thick to  allow of their being observed
 through them ; and, when the  contents  of  the pollen-grain are  mixed with water, they are seen  to be
 constantly performing a sort of vibratory motion.
   The  anthers, or  receptacles of pollen, burst when  their contents  are  mature,  and  scatter the grains
 forth.   They have various ways of opening :  sometimes  they split along their length, as  at a, fig. 1
 sometimes they split transversely, sometimes  by little openings at  their extremity,  termed pores, as at c;
 and sometimes by valves, as aid.  These different methods are characteristic  of different tribes of flower-
 ing-plants.
   Now the portion of the reproductive system  is that which  is denominated  the ovarium or seed-vessel,
 which occupies the centre of the flower, being  sometimes situated  above and sometimes below the point
 at which the  leafy parts of the flower arise from the  axis which bears them.   This  ovarium is the part in
 which are formed the ovules or young seeds  ; and these, after being fertilized in the  manner presently to
 be described, ripen into the perfect seeds.   Sometimes it consists  of  several evident divisions ;  in other
 instances, these are united together, more or less closely ;  and all mark of  a division may even disappear.
 Fig. 2 represents the  centre of a flower in which the several parts of the ovarium remain separated ; three
 only are seen, the others being concealed by them.   These separate  parts are termed carpels.  Each
 carpel is surmounted  by a sort of pillar,  termed the style ; which  usually expands at its  summit  into a
 fleshy surface, called  the stigma.   When the carpels adhere  closely together, their styles also frequently
 unite, so as to form a single pillar, which sometimes, however, divides again  into several branches at the
 top.  The ovarium, with  its  style and stigma,  is then called the  pistil;  and  sometimes each  separate
 carpel with its own style and stigma, receives the same appellation.   An excellent  illustration of an ova-
 rium  consisting of many carpels, appearing externally single, but each really separate from the rest, is the
 orange : the  rind of this fruit is formed by the external part of the flower  which wraps over the ovarium,
 while the juicy part is the ovarium itself, composed of a number of carpels adhering together, but not so
 closely united as to prevent their being torn  apart.  The position of the pips or seeds of the orange will
 give a good idea of the manner in which  they are  usually situated within the  carpels, especially when
 they are few  in number.   Sometimes, however, they are attached to the whole  length of the carpel, from
 one end to the other,  as is seen in the common  pea,  of which each pod is a separate carpel.   The portion
 of the carpel from which ovules arise  is usually thick and fleshy, and  is termed the placenta.   The
 section of the pistil of the whortleberry  will give an idea of the arrangement of the parts in an  ovarium
 whose carpels and  styles  have united.   The ovarium  of this flower is wrapped  over, like that of the
 orange,  by the leafy portion of the flower itself, which is  seen to  rise  beyond it.  The centre  of the
 ovarium is occupied by a  thick fleshy placenta, formed by  the union of that of the several carpels ;  and
 on this the ovules are clustered.  Above is seen the single style with its stigma.  Another variety of  the
 same  kind of structure is shown in this plant: here the ovarium is in like manner enveloped by the outer
 part of the flower ; and the  partitions between the carpels have  entirely disappeared, so that only one
 central pillar  is left, around which the ovules are clustered.   There is another common form  of  the ova-
 rium, of which that of the common heartsease  may be taken as an  example.   In this the partitions have
 disappeared ; but the placenta of the several  carpels, instead of remaining clustered together, are  attached
separately to  the walls of the ovarium.
   These two  sets  of organs  are  by no means constantly united,  however,  in  the  same flower.  The
staminifcrous or stamen-bearing flowers are frequently distinct from  those which are pistilliferous or bear
pistils.  When they occur on  some other  part of the same plant, it is  said to be monoecious (sino-le-
housed); if on a different plant, it is dioecious (or  double-housed).  Sometimes the same collection  of
flowers contains some perfect ones, with others staminiferous, and  others pistilliferous  only,   There  is
reason to believe that, when either set of organs  is  not developed, the rudiments of it really exist;  for
these parts are frequently made to appear by cultivation. 
SM
IMPROVED SYSTEM OF MIDWIFERY.
  If the ovarium be cut into, previously to the opening of the flower, it will usually be found to contain
a great number of the ovules or young seeds.   These are at that period quite soft;  and their interior is
filled up with a kind of pulp, which is enclosed  in two  or  more envelopes.   These seed-coats do not
entirely cover the  central  envelope,  but leave  a small opening, which  is called the foramen.   This
opening may be easily  detected in the perfect seed, although it has there nearly closed up, by soaking it
in water, and then pressing out the fluid that has been absorbed, which will  be seen to issue from  this
little orifice.  The foramen, as will  presently appear,  has a very important purpose in the  fertilization of
the  seed ; which, at the period now described, contains no trace of the germ of the new plant.
  This germ appears to be conveyed into it from  the  pollen in the following curious manner: The little
grains or cells, when set free from the anthers, fall upon the  stigma of the pistil.  In general, the anthers
are  situated above the  stigma — the stamens being longer   than the pistil in  flowers that  are  erect or
upright, and shorter in  those which  hang  down ;  but  sometimes a special provision is necessary for the
conveyance of the pollen to the stigma, especially in  monoecious or dioecious plants.  This function is
often accomplished by  insects, which, in going from flower to flower in search of honey, cover over their
bodies with pollen-dust, and rub them accidentally against the pistils of other flowers.   When the pollen
falls on the stigma, it is caused to adhere  to it by a  honey-like  secretion  from its  surface ;  and after a
short time, it undergoes a remarkable change.
  The outer coat of the pollen-cell appears to burst at one  or two points, and to allow the inner coat to
pass out through  it in  the  form of a tube.  This tube insinuates itself between the cells  of the stigma,
and passes down  between the long and loosely-arranged cells of the style.   It  gradually extends, until it
reaches the ovarium itself, even when the style is  several inches long.  The pollen-grains  are not always
globular, but are sometimes triangular, and emit  a pollen-tube at each corner, as the figure.  The tubes,
when they arrive at the ovarium, direct themselves toward its different  chambers, and have been seen to
enter the apertures in the several ovules, which are at that time directed toward the part of  the  base of
the style, from which  the  pollen-tubes project themselves.   Sometimes a considerable  change in the
position of the ovule is necessary, in order that the foramen  should be applied  to the right portion of the
wall of the ovary: but this  change always takes place  just as the pollen-tubes are passing down the style.
The granules which the pollen-grain originally contained, are seen to pass down the tube ; and some of
them are conveyed by it into each ovule.   While yet within the tube, they are seen  to  develop  them-
selves  into new cells ;  and  these cells are  the rudiment of the  future plant.
   The germs are thus  conveyed  into a sort of receptable  or vegetable womb, where  they are supplied
with nourishment that has been previously prepared and stored up for their use by the parent structure  ;
and they are  thus greatly assisted in their  early development.  The pulpy matter contained in the ovules
consists of starch and  sugar; and these  nutricious  substances are absorbed by the cells of the  embryo,
which  increase at their expense.  The first increase of these  cells does not  so much tend, however, to
form those parts which are  afterward to be developed  into the stem, root, and leaves, as to produce  those
temporary structures, termed cotyledons, or seed-leaves, which are destined, like the primary frond of the
ferns,  to assist for a time in the development of the permanent structure,  and then to wither and decay.
Hence, at the time of  the ripening  of  the seed, the cotyledon forms the greatest part  of  the  embryo or
young plant.  Besides this, the seed contains a considerable quantity of starch, destined for the  nourish-
ment of the  young plant, when it is beginning to sprout, and while yet unable to take in  food for  itself.
This starch is sometimes absorbed into the tissue of the cotyledons, rendering them thick and fleshy, as
in the  pea or bean ; and then these, with the small germ to which they belong, form the  entire contents
of  the seed.  In other instances, however, the cotyledons  are  thin leafy organs, and occupy,  with the
germ,  but  a small part of the seed; the remainder then consists of a separate store, which closely resem-
bles the yolk-bag of the egg, and is  termed the albumen.   This is the case in the seeds of the ash and
horse-chestnut.
   The structure of the seed of the two principal divisions of the phanerogamia plant  is  easily  shown.
 In  the fig., is seen that  of  the bean, a dicotyledon, after the seed-coats  have  been stripped off, and the 
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ORIGIN OF VEGETABLE LIFE.
25
cotyledons separated.   The  two large fleshy lobes, a a, are the cotyledons, into which the whole of the
starch originally contained in the ovule has been absorbed.  Between these  is the real germ ;  the upper
extremity of which, termed  the plumula, subsequently develops itself into  the stem,  and puts forth
leaves ; while the lower  part, which is  always directed  toward the foramen, becomes  the root.  The
plumula sometimes presents the appearance of the plant  in miniature ; its  leaves and buds being quite
discernible, though on a very small scale.   The  subsequent development of the germ contained in  the
seed into the perfect plant, is that which in  its early stage is known as germination.   Of the causes which
excite it, we shall  presently speak.  When a seed  like that of the bean begins to germinate, it first swells
and bursts its  seed-coats ; the  plumula then extends  upward, bringing  the cotyledons  just above  the
surface of the ground, while  the radicle penetrates it in the opposite direction.  In some plants, however,
the cotyledons remain under ground, as in the oak ; and  there are a few in which they are entirely absent.
The cotyledons, when exposed to the light, become green, and perform  for a  time (though imperfectly)
the functions of leaves,  at the same time  yielding to  the young plant the  nourishment they contain.   By
the time  this is exhausted, the  true leaves  and  roots are sufficiently developed for the  support of  the
structure ; and the cotyledons, being then no longer required, decay away.
   The representation of the seed of the marvel of Peru,  will  afford  an  example of a dicotyledonous
seed possessing leafy cotyledons and a separate albumen ; in these, the process of germination is  the
same, except that  the cotyledons only perform the functions  of temporary leaves, the nutritious  part of
the seed being retained wfthin its coats, -until it is exhausted by  the young plant.
   In the seeds of the monocotyledons, the structure of which is illustrated by the representation of that
of the onion  or wild lily, the albumen is  always separate ; and the embryo, which  occupies but a small
proportion of the whole  mass, can not always be readily distinguished in the  midst of it until germination
commences.   The cotyledon  at first completely sheathes the plumula, which afterward  pierces it, and
unrolls its first true leaf.
   The conditions  requisite for the  germination of  the seed, are warmth, moisture, and  the presence of
oxygen.   The process is also favored by darkness.  The influence of each of these agents will be readily
understood.  No vital action can go on without a certain amount olheat; and where  this is not produced
within  the being, it must be derived from without.  The germination of the  seed is  as much dependent
upon warmth, therefore, as the  hatching of the egg of a bird;  though the  amount it requires is not nearly
so great.  Moisture is also evidently required, for the  conversion into a fluid state of the dry nutriment
which has been previously stored up in the seed :  and no change can commence until this be supplied.
The presence of oxygen is necessary, because the conversion of starch into sugar requires that some of
the carbon of the  former  should be set free;  and this can only be accomplished by the union of it with
oxygen,  so as to form carbonic acid.  This process is favored by darkness, because  light  has a tendency
to produce the contrary change — the fixation of the carbon within the structure.
   It is interesting  to observe how all these  conditions are  supplied, in  the ordinary  course of nature, by
the soil in which the seed is dropped.  If it be sown during the spring or summer,  it  speedily begins to
germinate ; but if it is deposited in the autumn,  it remains  almost unchanged, until the  winter has passed,
and the returning warmth of the air and  earth  arouses  it into  activity.  It is seldom that the soil is so
completely destitute of moisture, for any long time together, as  not to be able to excite seeds to germinate ;
but their sprouting is well known to be favored  by damp  weather:  and if seeds, through being put into
the ground  during a drought, remain  undeveloped, they  are brought  forward very rapidly by a genial
shower.  A porous soil is to be preferred, on account of  the free admission of  air  which  it gives to a
germinating seed,  as well as for the other processes of vegetation.   A stiff clay soil prevents this neces-
sary contact, and thus impedes germination.  So complete a check, indeed,  may be thus  produced, that
it has been proposed to bury seeds in  clay rammed  hard, when it  is desired  to convey  them from  one
part  of the  world  to another through very hot climates;  the  high temperature of which might destroy
their vitality, if its  influence were not partly prevented by the bad-conducting power  of the mass in which
they are  thus enclosed.   If seeds be buried very deep, even in a light soil, the  contact of oxygen will be
                                                4 
IMPROVED SYSTEM OF MIDWIFERY.
sufficiently impeded to prevent their germination ;  and the  bringing such seeds nearer to the surface will
then have as much influence in causing them to sprout as the supply of either of the agents just mentioned,
which might have been previously deficient.
   The seeds of most plants are endowed with a remarkable  power  of preserving  their vitality for an
almost unlimited time, if they  are placed in circumstances which neither call their properties into active
exercise, nor occasion the decay of their structure.   The conditions most favorable for this preservation
will evidently be a low or moderate temperature, dryness of the surrounding medium, and the absence of
oxygen.   If all these  be supplied in the most favorable manner, there seems  no limit to the period during
which  seeds may  retain  their vitality — that is, their power,of performing  their  vital  operations, when
placed in the proper circumstances.  And  even if moisture or oxygen be not entirely excluded, the same
effect may result, provided that the  temperature  be low and uniform.   Thus  the  seeds of  most  plants
may be  kept  for  several years, freely exposed  to  the  air, provided  they are not exposed to dampness,
which will either cause them to germinate or to decay.   Some of those which had been kept  in seed-
vessels of plants preserved in  the herbarium of Tournefort, a French botanist, were found to retain their
fertility after the lapse of nearly a century.
   The following circumstance, which occurred about thirty years ago in the state of Maine, is remarkable :
Some well-diggers, when sinking a  well at the  distance of about  forty miles from the sea, struck, at the
depth of  about twenty feet, a  layer  of sand.  This strongly  excited curiosity and interest, from the cir-
cumstance that no similar sand was to be found anywhere in the neighborhood, or  anywhere nearer than
the seabeach.   As it  was  drawn  up from  the well, it was  placed in a pile  by itself, an unwillingness
having been felt to mix it with the  stones  and gravel which were also drawn up.  But when the work
was about to be finished, and the pile of stones  and gravel to be removed,  it was found  necessary  to
remove also the sand-heap.   This,  therefore, was  scattered about the spot on  which it had been formed,
and was for some  time scarcely remembered.  In  a year or  two, however,  it was  perceived that a great
number of small trees had sprung from the ground over which the sand had been strewn.   These trees
became, in  their turn, objects  of strong interest; and care was taken  that no injury should come to them.
At length it was ascertained  that they were beach-plum trees : and  they actually bore  the  beach-plum,
which had never before been seen,  except  immediately upon  the seashore.  These trees must, therefore,
have sprung up from seeds which had existed in the stratum  of sea-sand  pierced by the well-diggers ;
and until this was  dispersed, in such a manner  as to expose them  to the  air, they remained  inactive.
" By what convulsion of  the  elements," adds the  narrator, " they had been  thrown there,  or how long
they had quietly slept beneath the  surface of  the  earth, must  be determined by those who know very
much more than I do."
   Perhaps the most  remarkable  instance on record, as  presenting satisfactory proof of the lapse of  at
least sixteen hundred or seventeen hundred years, is one related by Dr. Lindley : "I have now before
me." he says, " three plants of raspberries, which have  been raised  in  the  gardens of the  Horticultural
Society, from seeds taken  from the stomach of a  man, whose skeleton was  found thirty feet below the
surface of the earth,  at the bottom of a barrow,* which was opened  near Dorchester.   He had been
buried with some  coins of the emperor Hadrian'."    Corn-grains enclosed in the bandages which envelop
the mummies,  are said to have occasionally germinated, though  most of them  seem to have lost their
vitality.   There is nothing improbable in the fact;  but as the Arabs, from whom  the mummies are com-
 monly obtained, are in the habit of previously unrolling them  nrsearclf of coins, &c, it is not  always
certain that the seeds which have sprouted were really at first enclosed with the mummies.
   The plant developed from  a  seed  produced  by the  agency of two races, is termed  a hybrid.  It is
necessary, in order that the seeds thus formed should be fertile, that the parent species should  be nearly

   * These barrows, as they arc termed, are large mounds 6f earth, which are very common on the downs along the soath coast of England
 They are evidently artificial, not natural; and when dug into, are usually found to contain human remains, with pottery weapons &c  Hence
they are evidently burial places : and as a large number of them are generally found together, they seem to have been erected on fields'of battle
 to contain tlie bodies of  the slaia. 
ORIGIN OF VEGETABLE  LIFE.
27
allied to each other ; and it is very seldom that a hybrid can be produced when they do not belong to the
same genus.   Now, if the hybrid bear flowers, and its  stigma be fertilized with its own  pollen, it may
produce seeds that can be raised into plants like itself; and these may flower and produce a third gener-
ation in like manner.   But there  is no instance in which  a hybrid race, which  has thus originated in the
intermixture of two species really  distinct, has ever been continued without intermixture beyond the fourth
or fifth generation.   The plant, when  not fertile  by  itself, may bear seed, if its stigma  be  sprinkled with
the pollen of one of its parent species;  and its pollen may be fertile when placed on the stigma of either
of these.  In diis manner, a race intermediate between  the hybrid and one of the parent  species is pro-
duced ;  and this is continued  longer,  just  in proportion as it is caused to approach the pure breed by a
successive intermixture of this kind.  The end of all hybrid races, produced between species really dis-
tinct, appears to be, therefore, that either the race becomes soon extinct, which it will do if kept separate,
or it merges into one of the parent races, if  continued by intermixture with either of them.   This principle
affords a valuable test for determining what really are, and what are not, distinct species :  for if a hybrid
race can be  produced between them, which continues to be fertile of itself, the probability is strong that
they are only varieties.  Cultivators of  flowers are constantly in the habit of  producing such new races
between the different varieties of  many plants.
   The  embryo consists of two portions, one named  the rostel, and becoming the root; while  the other,
termed  plumelet, ascends above the surface, to form the stem and the herbage.
   If we observe the order of these changes, it will be found that the seed first swells from  the absorption
of moisture :  its coats burst and decay, the rostel being enlarged by the  sustenance which it receives from
the lobes, descends and becomes  attached to the ground ; after which the cotyledons are elevated above
the surface, and at last the plumelet appears emanating from the base of the seminal leaves.
   But  a better idea  of  these successive  changes  may  be  derived  from the  following examples, the
former  being  seeds with  two  cotyledons, and the latter  with  one, which remained beneath  the  earth's
surface  :—
   At a  season favorable to vegetation, Malpighi planted some  seeds of the gourd, and the following were
his observations respecting the development of the  young plants : At the end of the first  day, the seeds
were considerably enlarged ; their coats were moist;  a  small  orifice was  discernible  at  their summit,
through which the fluids seemed to have been  absorbed, and the cotyledons had already begun  to assume
the appearance of seminal leaves.   At the  end of the second day, the  embryo was somewhat enlarged,
the traces of its organization were more  evident,  and its radicle was distinctly visible.  At the end of the
third day, the exterior  membranes had  become brown, the rostel had burst through it, and the plumelet
had begun to expand.  At the end of  the fourth day, the young plant  had considerably enlarged, and
the nerves of the seminal  leaves,  which were still enclosed by the coats of the seed, had become very
perceptible.   At  the end of the  ninth day, the plant  had wholly escaped  from the  seed, though the
plumelet was still enveloped in the seminal leaves, yellowish in its appearance, but generally assuming a
tinge of green.   At length its extrication was effected, and the rostel converted into a root; the rudiments
of a stem developed ; and on the twentieth day the plant  was  complete.
   The other example will serve to illustrate the  growth of seeds with one cotyledon :  Some  rye was
planted  in good soil, and  at the end of the second hour its radicle was discernible.   At the end of twenty-
four hours, the embryo had escaped from its integuments.   On the second day, the fibres of the root had
augmented, but the leaves had not appeared.   On the fourth  day, the first leaf began  to  appear  above-
ground, at which time its color was red.  On the fifth day, it had grown to the length of an inch,  and its
color was now green.   On the sixth day, the second leaf had appeared.
  These effects are produced by the united influence of air, water, and heat.
  Homberg,  a distinguished philosopher of Europe, planted  a variety of seeds under  the  exhausted
receiver of an air-pump.   They rarely germinated, and in this  situation never continued to grow.   The
experiments  of Homberg have been repeated with great fidelity by others, who infer that in the cases of
germination  mentioned by  him  the  vacuum  must  have been  very  incomplete.   Seeds which  have 
28                          IMPROVED SYSTEM OF MIDWIFERY.
remained  fo» years unchanged buried deep in the earth, are often  seen to germinate when raised within
the influence of the atmosphere ;  and the  chestnut and acorn are found to grow better on the surface of
the earth than when buried beneath it.   Achard proved that seeds  grow more luxuriantly in compressed
than in rarefied air; and the successors of the illustrious Scheele have, by a series of ingenious  experi-
ments, ascertained that it is the oxygen of the atmosphere which excites their germination.
   Water and heat are also agents of primary importance.   The arid sands of Africa are  scarcely  embel-
lished  by a single plant, and  the  cold of our winter most  effectually prevents the germination  of the
seeds which are scattered over the earth: but let the rain descend, and it will cause the  desert to blossom
as the rose ; and when spring returns, diffusing cheerfulness and warmth, it will revive the energies which
slumber within  the coats of the seed.
   The moisture which causes the first  enlargement of the seed is chiefly absorbed through the  scar (a
small point by which it was  originally connected  with  the  fruit, and easily  discernible on the surface of
most seeds), but it is also  imbibed by the integuments :  for the  entire exclusion of water from the scar
retards but does not arrest the process of germination.   In either case, the water which is absorbed passes
through the vessels of the cotyledons to the rostel of  the infant plant, which exhibits the  first indications
of vitality.  Hence we  learn  how these vessels  are tinged  when  the  germinating seed is  placed  In a
colored fluid, and why the young  plant inevitably dies if the cotyledons are prematurely removed.
   But the fluids thus imbibed  by the seed do not reach its embryo unchanged.   They dissolve the farina
of the albumen or lobes, a quantity  of carbonic acid gas is disengaged,  and a fermentation is thus  begun,
which terminates only in the evolution of the new plant, or in the destruction of its vitality.  If no oxygen
gas be present, the latter consequence ensues :  for whether it stimulates the vital  principle, supplies  the
embryo with food, or converts the farina of the cotyledons into a  mild and nutritive substance resembling
sugar — whatever be its  mode of operation — the importance of this agent, nay, its necessity  to germination,
has been most fully established.
   By removing even a minute portion of Its carbon, the farina of seeds  Is converted  into sugar; and,
from the very luminous experiments of the younger Saussure, it has been reasonably inferred  that oxygen
promotes the germination of seeds only as it combines with their carbon, and enables it to escape.   Thus,
by a process nearly allied to that of malting, the infant plant is supplied with food ; and it is probable that
in the former, as well as in the latter case, a small  portion of heat is disengaged.  " I conceive," says
Dr. Smith, " the evolution of this heat may powerfully further the progress of vegetation, by stimulating
the vital principle of the embryo, till its leaves unfold and  assume their functions."   Whether this conceit
be true or not, it is certain that germination may be  much advanced by the application  of artificial heat:
and seeds have in this way  been  made to vegetate in  three  hours, which  under ordinary circumstances
require twelve.
        CHAPTER  II.

ORIGIN OF ANIMAL LIFE.
  We have  given  the  process and  gradual  development of vegetable life, from  the  seed, through its
different stages, to the period of maturity.   The next subject in order is the origin and  development of
animal life, which is analogous to it.
  All the researches made upon the subject tend to establish one great law of Nature,  viz., that there is
a similarity or analogy between the reproduction of vegetable, animal, and human life ; and very strikingly 
                                   ORIGIN  OF  ANIMAL LIFE.                                 29

between the ova or eggs of the mammalia, or higher, and those of the lower classes, more especially of
birds, which afford the best opportunity of investigating the subject.   Hence we have chosen the egg of
the hen in illustration.   A writer on this subject remarks, that " at the earliest periods, the human ovum
bears a perfect analogy to the eggs  of fishes, amphibia, and birds ; and that it is only by a careful exam-
ining of the changes produced by the impregnation of the eggs of these lower classes of animals, that we
have been enabled to discover them in animals and the human subject.  It is  interesting, then, to trace
this analogy."
   On  opening a  fowl, we discover a  large yellow cluster  of  ova,  or  eggs, varying in  size  from  the
smallest seed to the full-grown egg, the largest of which is seen entering the ovisac, which  corresponds
with the fallopian-tubes of the female ;'and as the egg passes down the tube, it acquires a white covering,
which  becomes hard and dense,  called the shell.   In this state it is expelled.
   If it has been impregnated by the male, incubation may follow ; otherwise, not.
   From the evidence we have, it is precisely so with  the human female, as we have  elsewhere stated.
The first or primitive  trace of the embryo is in  the germinal membrane which contained the  germinal
vesicle before its disappearance.   In the centre  of this, upon its upper surface, may be  discovered a
small,  dark line.   This line or primitive trace is swollen at one  extremity,  and  is placed in the  direction
of the transverse  axis  of  the egg.  The impregnated  yolk is retained in its capsule or covering, in  the
ovary, precisely as in the human female subject — the whole of which has a clustered appearance, like a
bunch of  grapes.   The rupture of  the germinal vesicle, containing  the female germ, has been supposed
by Mr. T. W. Jones to take place  before impregnation, which appears the  most reasonable.   According
to this, then, the elementary principles of the embryo furnished by the  female must pass out of the ovary,
and  into the  fallopian-tubes or ovisac, and come in contact with the seminal fluid of the male, before it is
impregnated.
   We shall next describe the changes that  take place in the progress of—
   Incubation.— The following  progressive series  of  phenomena are  daily  observable during  the
progress of  incubation, in the egg  of the common fowl:  In an  impregnated egg, previous  to the com-
mencement of incubation, a small spot is discernible upon the yolk, composed  apparently of a  membra-
neous  sac or bag, containing a fluid matter,  in which swims the embryo of the future chick, and seemino-ly
connected with other vesicles around it.
   First day.   In a kw hours after exposure to the proper  temperature, the  microscope discovers that a
humid matter has formed within  the limits of the embryo.  At the expiration of twelve or fourteen hours,
this matter bears some  resemblance to the shape of a little head ; a number of new vesicles also succes-
sively appear, foreshadowing  the different parts of the future body of  the chick  :  those first formed, and
most easily distinguished, may afterward be recognised  as  assuming the shape of the vertebral bones  of
the back.
   Second day.  The  eyes begin to make  their appearance  about  the  thirtieth hour;  and additional
vessels, closely joined  together, indicate the situation of the  navel.  The brain  and spinal  marrow, rudi-
ments  of  the wings, and  principal  muscles, become  observable.  The  formation  of  the  head is also
evidently  proceeding.
   Third day.  The beating of the heart is  perceptible, although  no blood  is visible ;  after a few hours,
however, two vesicles containing blood make their appearance—one forming the left ventricle, the othei
the great artery.  The  auricle of the heart is next seen, and in the whole  pulsation is evident.
  . Fourth  day.  The wings  now assume a more defined  shape, and the  increased  size of the head
renders the globules containing the brain, the  beak, and the front and  hind  parts of the head, distinctly
visible.
   Fifth day.   The liver makes its  appearance,  and both auricles, now plainly seen, approach nearer the
heart than  before.   That splendid phenomenon, the circulation of the  blood, is  now evident.
   Sixth day.   The lungs and stomach are now distinguishable, and the full gush of blood from the heart
is  distinctly apparent. 
30
IMPROVED SYSTEM OF MIDWIFERY.
   Seventh day.   The intestine?, veins  and upper  mandible, become visible, and the brain begins to
assume a distinct form.
   Eighth  day.  The beak for  the  first time opens,  and the formation of flesh  upon the breast com-
mences.
   Ninth day.  The deposition of matter forming the  ribs takes place, and the gall-bladder is perceptible.
   Tenth day.   The bile is distinguishable by its green color,  and the first voluntary motion of the body
of the chick is seen, if separated from its integuments.
   Eleventh day.  The matter forming the skull now becomes cartilaginous, and the protrusion of feathers
may be noticed.
   Twelfth day.   The orbits of sight are apparent, and the ribs are'perfected.
   Thirteenth day.  The spleen gradually approaches to  its proper position in the stomach.
   Fourteenth clay.  The lungs become enclosed within the breast.
   Fifteenth, sixteenth, and seventeenth days.   During these days, the infinity of phenomena in this won-
derful piece of vital mechanism elaborate it into more perfect  form, and it presents an appearance closely
approaching the  mature state.  The yolk of the egg, however, from which  it derives its nourishment, is
still outside the body.
   Eighteenth day.  The outward and audible sign of developed life is apparent, by the faint piping of the
chick being for the first time heard.
   Nineteenth, twentieth, and twenty-first days.   Continually increasing in size and strength ;  the  remain-
der of the yolk gradually becomes enclosed within its body ;  then, with uncommon power, for so small
and  frail a being, it liberates itself from its  prison in  a peculiar and curious manner, by repeated efforts
made with its bill, seconded by muscular exertion with its limbs, and emerges into a new  existence.
   The position of the chicken in the  shell is such as to occupy the least  possible space.  The head,
which is large and heavy in proportion to the rest  of the  body, is placed in front of the abdomen, with its
beak under the right wing ; the feet are  gathered  up like a bird trussed for the spit:  yet in this singular
manner, and apparently uncomfortable position, it is  by  no  means cramped or confined, but performs all
the necessary motions and efforts required for  its liberation with the  most perfect ease, and that consume
mate skill  which instinct renders almost infallible.
   The chicken,  at the time it breaks the shell,  is heavier than the  whole egg was at first.
   An egg will not hatch in vacuo.
   The infinite wisdom of  the  Great Architect  of the animal frame is remarkably manifested in its provi-
ding the chick with  a sharp and hard substance on the tip of the bill, by means of which it is enabled to
fracture the shell, to liberate itself from  its imprisonment.  Its own bill is too soft to enable it to break
the shell therewith, and in  two  days or less this  hard and  pointed substance  disappears, the  young bird no
longer requiring  to use  it.
   Equally extraordinary and wonderful is the fact that the germ of the  chick is provided  with  the ability
to keep itself always on the top of the yolk of the egg, to  the end that it may take the heat from the parent
bird when setting, to produce incubation.
   Such is the process of incubation !—such the interesting nature of the phenomena displayed  by  it—
phenomena so  magnificent and  so pregnant with wonders, as to fill with  admiration and awe alike  the
mind of the profoundest philosopher and the least contemplative  of the human race.  Nor is it possible
that the most unintelligent Christian  can survey them with indifference, and his reflections thereon not
lead him —
                               " Through Nature up to  Nature's God !"

   The following additional facts are taken from the British "  Provincial Journal :"__
   " The progress of the  incubation of the chicken is a  subject curious and interesting.   The hen  has
scarcely sat on the egg twelve  hours before some lineaments of the head and body of the chicken appear.
The heart may be seen to beat at the end of the second  day: it has at that  time somewhat the form of a 
ORIGIN OF ANIMAL  LIFE.
31
horse-shoe, but no blood yet appears.   At the end of two  days, two vesicles of blood are to be distin-
guished, the pulsation of which is very visible ; one of these is the left ventricle, and the other the root of
the great artery.  At the fiftieth hour  (two days and two hours), one  auricle of  the heart appears, resem-
bling a noose folded down upon itself.  The beating  of the heart is first observed in  the auricle, and
afterward in the ventricle.  At the end of seventy hours  (two  days and twenty-two hours),  the wings are
distinguishable ; and on the head two bubbles are seen for the brain, one for the bill, and two others for
the fore and hind part of the head.   Toward the end of  the fourth day, the two auricles, already visible,
draw nearer to the heart than before.   The liver appears toward the fifth day.   At the end  of a hundred
and thirty-one hours (five days and  eleven hours), the first voluntary motion is observed.  At the end of
seven hours more (that is, five  days and eighteen hours), the lungs and  stomach  become visible ;  and
four hours after this (five days and twenty-two hours), the intestines,  the  loins,  and the  upper jaw.   At
the hundred and forty-fourth hour (or at the end of  the sixth day), two ventricles  are visible, and two
drops of blood  instead of the single one as seen before.   The seventh day, the brain begins  to have some
consistency.  At the hundred and  ninetieth  hour of incubation (seven days and twenty-two hours), the
bill opens,  and the flesh appears in  the breast; in four hours more (eight days and two hours), the breast-
bone is seen; and in six hours  after  this (eight days and eight hours), the ribs  appear forming from the
back, and the bill is very visible, as well as the gall-bladder.   The bill becomes green at the end of two
hundred and thirty-six hours (nine  days and twenty hours);  and if the chicken  be taken out of its cover-
ings, it  evidently moves  itself.  The feathers begin to shoot out toward the two hundred and fortieth hour
(ten days), and the  skull becomes  gristly.   At the two hundred and sixty-fourth hour (eleven days), the
eyes appear.  At the two hundred and  eighty-eighth (twelve days), the  ribs are perfect.   At the  three
hundred and thirty-first  (thirteen days and nineteen  hours), the spleen draws near the stomach, and the
lungs to the chest.  At the end of three hundred and fifty-five hours  (fourteen days and  nineteen hours),
the bill  frequently opens and shuts ; and at the end  of the  eighteenth day, the  first cry of the  chicken
is heard.   It  afterward gets more  strength, and grows continually,  till  at length it is  enabled to  set
itself  free.
   " In  the whole of this process we must remark that every part appears exactly at its  proper time.   If,
for example, the liver is formed on  the  fifth day, it is founded on the  preceding situation of the chicken,
and on the changes  that were to  follow.  No part  of the body could  possibly appear  either  sooner
or  later, without the  whole  embryo  suffering ;  and each  of the  limbs   becomes visible  at the  proper
moment.
   " This ordination,  so wise and  so invariable, is  manifestly the work  of a Supreme Being :  but we
must still  more sensibly acknowledge his creative  powers,  when we consider  the  manner in which the
chicken is  formed  out  of the  parts which compose  the egg. How astonishing  must  it  appear to an
observing mind, that in  this  substance there should be at  all the vital  principle of an animated bein°-! —
that all  the parts of an animal's  body should  be  concealed  in it, and require nothing but heat  to unfold
and quicken them ! — that the whole formation of the chicken should be so constant and regular !—that
exactly at the same time, the same  changes will  take place in the generality of eggs !—that the chicken
the moment it is hatched, is heavier than the  egg was before !
   " But even these are not  all the  wonders in the formation  of the  bird  from  the egg (for this instance
will serve to illustrate the whole  of the  feathered tribes) ;  there are others, altogether hidden from our
observation : and of which, from our very limited faculties, we must ever  remain ignorant." 
32
IMPROVED  SYSTEM OF  MIDWIFERY.
                                      CHAPTER  III.

                               ORIGIN OF HUMAN LIFE.

  There is no subject, either in natural history or  physiology, more interesting to the philosopher than
that of the reproduction of our species.  No  man, with even a superficial  knowledge of its wonderful
phenomena, can meditate upon it without being forcibly impressed with the most profound sentiments of
veneration and awe, and being irresistibly led to  adore  the wisdom and  power  of  the Great Author of
this mysterious and wonderful process.
  In all ages of the world, the manner  in which  conception  takes place has been investigated by the
most learned and powerful minds ;  and at this  very time the subject is  engaging the  profound attention
of the learned anatomists and physiologists of Europe and of  the world.
  From the abstruse nature of the subject itself, and the  almost insurmountable difficulties by which a full
investigation of it is surrounded, we need not  be surprised  that various  and contradictory theories have
been advanced respecting it.
  But from the uniformity of Nature's laws, as we have seen, in the reproduction of plants and animals,
and from the vast many dissections which of late years  have  been made, we are at  length  enabled to
arrive at conclusions which, if not in every respect perfectly accurate, are nevertheless satisfactory, and
generally demonstrable.
  There are some facts  connected with this  subject  that are shown  as  clearly as  are  any principles of
physiology.  And from the results of the  laborious investigations of many learned physiologists, both
ancient and modern, together with our own researches, we  believe wre shall be enabled  to present the
subject before  the world in  a  tolerably clear and  satisfactory manner.  This we propose to do  by
fair,  analogical reasoning, founded upon innumerable  experiments, and on  universally-admitted  ana-
tomical facts.
  It is obvious to every one that there  exists  a strong  and  general tendency in the  opposite sexes to
unite, under the powerfully-impelling influence of the  principle termed love.   Without this universal
stimulus  implanted  in the human organization, which, like that of hunger,  does not depend upon the
will, there would be little or no procreation of the human species.   This fact admitted, we shall  proceed
briefly to show in  what manner this takes place; and shall treat first of the parts or organs concerned in
reproduction.
     SECTION  I.

THE  MALE  ORGANS
   Before speaking of the function, we shall briefly describe the anatomical structure of the male organs
of reproduction, which furnish the seed or living principle.
   The preparation of the seminal fluid is the office of the two glandular bodies called the testicles or
testes.  They are suspended in a  portion  of common integument  having the form of sac, termed the
scrotum, by a round band,  called the spermatic cord, which pursues a very serpentine course; a plexus
of veins, the assemblage of which  has received the name of corpus pampinoformc, consisting of the sper- 
 
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Pun'*
 

 
 
 

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ORIGIN OF HUMAN  LIFE.
33
made artery, a plexus of  absorbents, a plexus of nerves, and  lastly the vas deferens, or excretory duct;
and  they are further  supported by a  sub-cutaneous layer  of muscular  fibres, termed  the darlos.   The
scrotum is divided into two chambers, one testis  being lodged  in each, by a  membranous  partition, or
septum.  Each testicle is loosely contained in a sac, formed  by an external serous membrane,  the tunica
vaginalis, derived from the  peritoneum, which forms a cavity for  its reception similar to that of other
serous membranes.  This tunic is reflected, like those of other cavities, over the body of the organ ;  and
the reflected portion, which is called, from its  white color, the tunica albuginea, forms the proper capsule
of the  testis.  When  this  latter tunic is divided, the testis is found to consist of a flattened oval  substance,
to the  upper, outer, and back part of which a narrow and  flat  slip of substance, called the epididymis,
is found adherent.
   The substance of the testicle is extremely vascular, and the  ultimate branches of its spermatic arteries
are collected into  small bundles  of fine  convoluted vessels, separated from one  another  by septula, or
membranous partitions.   From these the vasa seminifera, or beginnings of the excretory ducts, take their
rise, and gradually unite to form a smaller number of canals of larger diameter, but exceedingly tortuous
in their course.   On  arriving at the  surface and back part of the testicle, 4hey suddenly become straight,
assuming  the name  of the  vasa recta; they, however, again subdivide,  and their  branches  have very
numerous communications with one another, composing the net-work  of tubes called the corpus highmo-
rianum, or  the rete testis.   From the  rete testis arise  the  ducts denominated  the vasa efferentia, which,
after being again contorted into numerous convolutions, form  the  conical bodies called coni  vasculosi ;
these, again, alternately join  to form  the  epididymis, already mentioned, which consists of  one slender
tube, of enormous length, coiled upon itself into a small compass.*   The epididymis at length emerges,
in the form  of a tube  of larger diameter, which is the vas deferens, and  which ascends along the spermatic
cord toward the abdomen.   On tracing these ducts into  the pelvis, we find them passing up  by a circu-
itous route through the spermatic passage, and on reaching the pelvis, again descending by the  lower  side
of the bladder, to the under part of its cervix.  Each duct is here connected with an oblong membranous
bag, called  the vesicula seminalis, which is  a long blind sac,  folded  many times upon itself; its open
extremity entering the vas deferens at an acute angle.   These sacs are supposed to be receptacles for the
retention and accumulation of semen, until the time when it  is required to be expelled.  But Hunter
remarked that the fluid contained in them is somewhat different from that obtained from the seminal ducts
of the testicle itself;  and he  therefore supposed  that  these vesicles  secrete a  peculiar fluid which  may
perhaps dilute and add to the bulk of the semen.  He  even contended that the proper office of these
cavities is not that of reservoirs of semen : supporting his opinion by arguments  derived from comparative
anatomy, which furnishes many examples where  no direct  communication exists between them and the
vas  deferens, and others where these vesicles  are  entirely absent.  Notwithstanding these analogies, the
prevailing opinion is  in favor of the vesicula?  seminales in man being reservoirs of the seminal secretion.
   From the vesicula? seminales  and  the vas deferens, the  semen  is  occasionally discharged  through  a
duct common to both,  and  about  half an inch  in length, which perforates  a body called  the  prostate
gland, and  then  opens on each side into a canal, termed the urethra, which is continued from the urinary
bladder, close to a small eminence in that canal,  termed the verumontanum, or caput gallinaa-inis.    The
prostate gland is of the size of a small chestnut;  in  shape it  resembles a heart, with the apex  directed
forward.  Its texture is firm  and tough;  it is divided  into two lateral lobes and  one  anterior lobe, and
contains a great number of follicles, into  which a white opaque viscid fluid is secreted.  This secretion
is discharged by ten or twelve excretory ducts opening  obliquely into the  urethra, in a furrow  at the  side
of the verumontanum.
   The urethra is a canal, lined by a mucous membrane, serving the  double  purpose of discharging the
urine and the semen.  As it proceeds forward from the neck  of the bladder, it passes through the pros-

  * The whole  length of the excretory vessels of the testes is very extraordinary.  Their diameter  has been stated to be no greater than*the
two hundredth part of an inch; and it  has been estimated that the total length of the vessels which compose one of the testes amounts to more
than five hundred feet.
                                                 5 
3|                           IMPROYED SYSTEM  OF  MIDWIFERY.             4

tatc -IcinJ, on emer-ing from which it becomes  more contracted  in  its diameter, and  passes under the
svmphvsis pubis.  At this part, for the length of about an inch, it is supported only by firm cellular and
ligamentous membranes ;  this part of the canal  is termed the membranous portion of the UFethra.   It is
then dilated into what is called the bulb, or sinus  of the urethra ; and  it afterward receives  the  ducts of
several mucous glands, which  have been denominated the glands of Cowpcr, and which are generally
very minute, but sometimes have the size of peas.  One of these is placed on each side of 'he  membra-
nous portion of  the  urethra, below which they are united by an  isthmus  ; and the duct of each, about
three inches in length, opens by perforating the  mucous membrane lining  the  spongy body of the penis.
Mucus is  also furnished to various parts of the canal by lacuna provided for that purpose. At Its bulbous
part, the urethra takes a considerable curve forward, and  is surrounded in the  rest  of its  course  by a
peculiar  erectile  texture,  denominated the  corpus spongiosum urethra.  This substance is  expanded, at
the extremity of the penis, into what is termed the glans, which is covered  by a fold of the skin called the
prepuce.  The corpora cavernosa are the cylindrical bodies which compose the chief bulk of the penis.
They arise by two crura,  one from  each  ascending  ramus of the os ischii, and are chiefly composed of
the peculiar structure termed  the erectile  tissue.   At  its extremity, the urethra is considerably  narrower
than where it passes along the  corpus spongiosum.
   These  parts,  namely, the  glans  and corpora  cavernosa penis, and the corpus spongiosum  urethra?,
consist principally of large  convoluted veins,  which  in the last-named part are  particularly dilated  and
branched, and are bound  together  and crossed  in various directions  by  ligamentous bands and fibres.
This arrangement, by obscuring  the connexions  which the veins have with one another, as  well as then-
tortuous course, has led to the mistake that  has so long prevailed  among anatomists, of ascribing to these
bodies a cellular structure.   These bands appear to have been  provided for the purpose  of limiting the
distention of the vessels, and adding to the rigidity occasioned by the accumulation of blood in the venous
convolutions during erection.  The means  by which  the blood is made to  pass from  the small arteries
into these convoluted veins, is not clearly understood.  Professor Muller*  has lately discovered a remark-
able set  of  minute  dilated  and  ramified branches, which  he  terms arteria hellicina,  and which are
appended to the terminal  twigs of the arteries  distributed  on the sides  and  interspaces  of the venous cavi-
ties in the penis of man and several animals, and which he represents as projecting into the interior of the
veins,  and pouring their blood  into  them ; -a mechanism which  must  doubtless have some direct relation
with the process of  erection.t  Dr. Houston^ has described some muscles, under the name of  compres-
sors vena dorsalis penis, to the contraction  of which, and the consequent impediment to the return of the
blood from the penis, he attributes  the erection  of that organ.  It is  more  probable, however,  that  this
effect is produced principally by an altered action of the blood-vessels themselves, and is analogous to
the turgid state of the vessels which occurs in blushing, than  is owing to any mechanical cause.   The
purpose served by the dilatation, elongation, and  rigidity, of  the male organ, effected by this vascular
action, is obviously that of enabling it to penetrate to a sufficient distance into the female organ during
coition,  for  the  conveyance of  the semen to  the  uterus.   With this view, the secretions   from the
testes, vesiculae seminales,  prostate gland, and  the glands of  Cowper,  are poured  together into the
bulb of the  urethra,  and  thence  expelled with force  by the action of the  muscles called the ejaculatorcs
seminis.
   The seminal fluid, which acts  so important  a part in the process of generation, has at all times  attracted
much attention.   It  is found to be  considerably heavier  than water, and  to have a peculiar odor, which
increases on keeping ; to  exhibit alkaline properties, and to give  off  ammonia when  heated.  From the
analysis of  Vauquelin, it  appears that human semen contains  six per  cent,  of animal mucus,  three of
                                                                                      • »*_
  * Archiv. far Physiol., &c, 1833; pp. 27 and 220.                                                   <
  t The researches of Valentin (Miiller's Archiv., and  Lond. Med. Gaz. June 23, 133?, p. 543) are  not in accordance with  those of Muller.
The result of numerous examinations has convinced him that the helicine arteries are not peculiar vessels, but merely minute arteries that
have been divided or torn, and that the real distribution of the vessels of the corpora cavernosa follows, in every reaped!, the  most simple
li<-iS.
  t Dublin Hospital Reports, vol. v. 
                                   ORIGIN OF HUMAN LIFE.                                 35

phosphate  of  lime, and  one of uncombined  soda ; the rest  being water.   The  phosphate of iime is
deposited in crystals when the fluid is at rest.
   The spermatozoa are minute filamentous bodies, set free by the rupture of the spermatic cells, and are
distinguished by their power of spontaneous movements ; which occasioned them to be long regarded as
proper animalcules.  It is  now clear, however, from the history of  their  development, as well as from
other considerations, that they can  not be justly regarded in this light; and that they are analogous to the
reproductive particles in plants, which, in many cases, exhibit a spontaneous  motion of extraordinary
activity after they have been set free from the parent structure.
   The human spermatozoa consist of a little oval flattened body, from the one  six hundredth to the one
eight hundredth  of a line in length, from which proceeds a  filiform tail, gradually tapering to a  very fine
point of one fiftieth, or, at most, one fortieth of a line in length.   The whole is perfectly transparent; and
nothing that can  be called structure can be  satisfactorily distinguished within it.   The movements  are
principally  by  the undulations of the tail, which give a propulsive action to the body.   They may con-
tinue active for many hours, if they are not checked by cold, or by admixture with urine or  other secre-
tions.  When the seminal fluid  remains  in  contact with  a living surface,  such  as the generative organs
of the female, the spermatozoa may retain their vitality for some days.
      SECTION II.

THE  FEMALE  ORGANS.
   The  female  organs  which subserve the purposes of reproduction are commonly divided into  two
 classes — the  external  and internal.   By the external  organs, are  meant such  as  can be  seen  and
 inspected without dissection ;  the internal are  such  as are contained within the pelvis, and can not be all
 brought into view without  the assistance of the knife.   The external  organs are — the mons veneris ; the
 labia pudendi; the perineum ; the clitoris ; the nympha ; the vestibule ; the meatus urinarius ; the hymen ;
 the caruncula myrtiformes.
   Mons Veneris. — This is situated at the  lower part of the  abdomen, from which it is separated  by
 a groove, more or less marked in proportion to the corpulency of the woman, and bounded on the sides
 by the folds of the groins.  It lies  immediately over the os pubis, and consists  of cellular and adipose
 tissue, forming a soft, cushion-like eminence, of a triangular form, about three inches in  breadth and  two
 in depth, and  at puberty it is ornamented with a  number of short hairs.  Its degree of prominence is
 regulated by a variety of circumstances.   It is more prominent in young and vigorous females who have
 not borne children, than in  such of the sex as are advanced in age, or  are the  mothers of a  family.
 During coition, and on  the approach of the menstrual period,  it is  more elevated than when the individ-
 ual is not under the influence of any excitement.   It is more prominent in young females  in tropical
 climates than in  those of equal age  in this country.
  Labia Pudendi. — At the inferior or  lower portion  of  the mons veneris,  it bifurcates or divides, and
 passes down on  each side,  and thus form  the labia pudendi, or lips ; which become thinner as they pass
 downward and backward toward the anus, and at about  one inch from which they again unite, and  the
 union is called the fourchette.   The labia are  composed of the same tissue as the mons veneris, and are
 influenced by coition and by other irritation in  the same  manner;  and, like it, are  covered with hairs at
 puberty.   Internally they  are lined with  a smooth, shining   mucous  membrane,  of a vermilion color
 (resembling  the  lining of  the  lips  or mouth), and  of great sensibility in young women ;  but, as they
 advance in age, its color becomes dark, and the sensibility gradually fails.   This membrane is very vas-
cular, and is abundantly supplied  with glands and follicles, which  furnish a considerable  quantity of
mucus to protect the inner surface of the organs from the effects  of friction, and from  the acridity of  the
urine.  They serve, in  the  ordinary condition, to protect the parts within from the  effects of air and 
3G
IMPROVED  SYSTEM OF MIDWIFERY".
external agents ;  and also, during the passage of the child, their folds dilate, and increase the capacity of
the vulva, till it equals that of the bony outlet of the pelvis.
   In the natural state of the parts,  its  opening, formed by the separation of the lips, is called the fossa
mao-na, in which are contained several other of the external genital organs.   Toward the posterior union
of the labia the opening becomes larger and deeper; and, from its resemblance to a small boat, is called
the fossa navicidaris.
   The Perineum. — This term is applied to that part between the posterior commissure of the vagina
and the rectum.  Its breadth, in the quiescent state, is  generally from one to one and one fourth inches ;
but during  parturition it is extended from four to five inches;  and  in consequence  of its  being chiefly
composed  of muscular fibre, its contractions are very rapid.   From the vagina to  the anus, something
resembling a seam runs along the perineum, which is termed the raphe.
   The Clitoris. — When we separate the labia pudendi, other of what are called the external organs
are brought to view : among which are, first, the clitoris, which  is a small body of a vermilion hue,  that
projects from the symphysis  pubis at the commencement, and just at the superior bifurcation of the labia
pudendi.   In construction and  formation it bears a great analogy to the  male penis.  It resembles it,
indeed, in every respect except two :  its small size, and its not being perforated by the urethra.  Like
the male penis, it is composed of two crura, which arise from the ramus of the oschia and pubis; one on
each side runs up to the junction of the symphysis pubis, and there form the corpora cavernosa.  These
are also furnished with two muscles resembling the erectoris*penis in the male.   At the extremity of the
corpora cavernosa is placed the  gland ; this is the only part of the  organ which we  can observe by the
eye, the others being imbedded between  the mucous membrane and the bone.   It  is liberally supplied
with blood from the pubic artery, and with nerves from  the  pubic vaciculi.  It is  the seat  of  pleasure
during coition, or when, from any cause,  the  passions are excited; on which occasions its cells become
distended,  and the organ  itself enlarged.  Titillation and friction cause  a distention of this body, which
is followed by a discharge from the vagina.   And this practice has been  known  to be persisted in to such
an extent by some young girls,  as to produce marasmus, for the removal of which, and the prevention of
other injurious effects, the excision of  the clitoris, it is stated, has alone proved effectual.
   The size of this organ  varies  exceedingly in females in different parts of the world.  Its size in females
in this country varies from a quarter to a full inch.  It is  larger in  proportion  in infants than in adults.
It is longer in warm than in  temperate latitudes.   In some hot countries  it has been met with of almost
incredible length — even equal to that of the male penis !   This*unusual size of the clitoris has led to the
supposition that they were hermaphrodite.
   The Nymphs. — These are sometimes  also called the labia minora.    They are situated within  the
labia  pudendh  In shape  they resemble a cock's comb; they surround  and  form a prepuce for the
clitoris, and become narrower as they pass  downward ; and they are lost about the middle of the orifice
of the vagina.
   They are covered with  mucous membrane ; internally they are composed  of erectile tissue styled corpus
cavernosum, and  a congeries of blood-vessels.   When  the passions of the individual  are excited, the
nymphae become enlarged and tense, and are endowed with a considerable  degree of sensibility.  They
 dso serve to direct the course of the urine.   In  healthy young  girls, the nymphae are smooth, firm,  and
roseate ; flaccid and pale in  women of  lymphatic temperament and those affected with leucorrhcea;  they
are granulated and dark in brunettes.
   Generally speaking, the nymphae are enclosed within the  labia pudendi, but  sometimes they are very
much  elongated.   This  elongation of the  nymphae, which occasionally occurs  in  this country, occurs
especially among  some tribes in Africa, such as the Moors and the Copts, who consequently cause the
organs to be circumcised; but,  in the Hottentots, the nymphae are so prodigiously elongated, as to form
a kind of apron extending four  or five inches below the margin of the labia.
   The Vestibule.—Just at  the top of  the pubic arch is a small bulbous projection, which encloses
the surface of the urethra.  The triangular space included between the  bulb  and  the nymphae is called 
ORIGIN OF HUMAN LIFE.
37
 the vestibule.   It is of importance to understand its position, because it is one of the guides in  introducing
 the catheter through the urethra.
   The  Meatus  Urinarius. — This is situated in the vestibule, about three fourths of an  inch below
 the clitoris, immediately above the vagina.   The urethra is a canal, about one and a half to two inches in
 length ;  in its course toward  the  bladder it is very slightly curved, but  during gestation its direction is
 affected  by the particular position of the uterus.  During the early months, the urethra will  rise almost
 perpendicularly behind the pubes; but in advanced gestation, the bladder  is often thrown forward  over
 these bones,  which occasions a considerable curve in the urinary canal, a circumstance which ought ever
 to be remembered in passing the catheter.
   The  Hymen. — This is a duplicate fold of the fine villous membrane which lines the canal or vagina.
 It is spread across the mouth of the vagina, just within its entrance.  It differs very much in  appearance
 in different females :  in some  it appears in the shape of a crescent, or half moon ; in  others it completely
 covers the entrance of the vagina, having a small aperture in the centre; in a third class, the hymen forms
 a cruciform septum ;  in a fourth, it may be found in the shape of a strong  membranous band, extending
 from the pubic to  the  perineal surface of the  canal; and,  in  the  fifth, it  may completely intercept the
 vagina, a condition which may remain unknown — and when the catamenia are secreted, it will prevent
 their discharge, and produce  incalculable mischief to the constitution  by their retention.   The state of
 the hymen should always be a point which we should examine in all cases of  retention of the  menses in
 young girls when they have  never flown.   Sometimes, it  is  stated, this  membrane  is so firm, that the
 husband can not rupture it, and it  has to be divided  by the surgeon before  the  nuptial rites can be  con-
 summated.   The presence of the hymen was the Mosaic test of virginity, and the Jews and many others
 to this day attach strong suspicions of incontinence to those  in whom this  test  is wanting.  Perhaps its
 texture is more uniformly strong among the  Jewesses than it is among the  females of this  country ; for
 while no females are born without  it, that  many in this country do  not retain  it till  marriage, is no less
 certain, who  yet never had intercourse with a man ;  in some it  is so slender, that it has been said to be
 broken by the nurse, in wiping the parts, after washing the infant.   But there can be no doubt that the
 too common  practice  of onanism among our unmarried females is a very frequent cause of rupture of the
 hymen, where their chastity has never been violated by any of the male sex.
   The  internal Organs  of  Reproduction. —These  are  contained within the pelvis,  and  can
 only be examined by plates and models.   They  consist of the vagina ; the  uterus ; the Fallopian tubes ;
 and  ligaments by which the uterus is retained in situ.
   The  Vagina. — This is a muco-membranous canal, running from the external organs of  generation
 up the centre of the pelvis, to  about one inch above the os uteri.   It describes a curve, like the sacrum ;
 its length varies from three  to six  inches or more.   At its  mouth, we find  muscular fibres, forming a
 species of sphincter, called the sphincter vagina.   At about an inch  from  its mouth we find its narrowest
 part: it is there formed of  erectile  tissue, and it is called  the plexus rectiformis.   Its internal surface is
 lined with a  soft villous  mucous membrane, which, especially in young subjects after puberty, is laid in
 longitudinal and transverse folds or ruga;  which, with the  erectile tissue,  is designed  to  increase the
 mutual pleasure during coition : and, in labor, to unfold and'expand its ruga?, and thus allow  the child's
 head to pass.
  It has  also, between the folds, many orifices of mucous glands, which serve to lubricate the  parts ; but
 by the frequent use of venery, and still more in consequence of frequent child-bearing, the folds become
 more and more obliterated, until, in old women, who have borne many children, they are scarcely percep-
tible.   The upper  or  superior wall of  the vagina is in immediate contact with the  peritoneum, which
separates it from the cavity of  the  abdomen.  This is the weak spot, and that  in which so much injury
is sometimes done  by instruments ; and which requires our utmost care when an  operation  is really
necessary : as any injury inflicted here will generally  be followed by inflammation and death.
  The  Uterus. — This is  a flattened pyriform  body, from two  inches  and a half to three inches in
length, one inch in thickness from  before, backward, and one inch  and  a  half  in  breadth  at  its upper 
38
IMPROVED  SYSTEM OF MIDWIFERY.
(broad) extremity.   It is divided, for the purpose of description, into the fundus, which is the upper and
broadest part; the cervix,  or  lower extremity;  the body, which is that portion between the fundus and
cervix ; and, lastly, the os uteri  or os tinea, an opening situated at the  termination of  the cervix, and
leading from the vagina to the cavity.
   The substance of the uterus is from  one third to three quarters of an  inch in thickness, and is com-
posed of  a peculiar dense, grayish, fibrous tissue, containing abundance of nerves, blood-vessels, and
lymphatics.   Upon cutting.into it, we  observe  that  it  contains numerous sinuses.   The  fibres  of  the
unimpregnated uterus can not be observed to follow any regular course : they possess all the powers, and
most of the appearances, of muscle ; although it is a favorite whim with certain anatomists to  deny them
the name.
   Within the solid walls  of the  uterus a  cavity is formed, triangular in  that  portion  contained  in  the
fundus, and with its lower angle prolonged into  a narrow  canal, which  passes through  the  body and
cervix to the os tinea?.  At the upper  angles on each  side  are situated the openings  of the Fallopian
tubes.  The whole cavity is  lined  by  mucous  membrane, continuous with that of  the vagina.   In  the
young subject, this is arranged into folds ;  it has numerous mucous lacunae, particularly in the cervix.
   The os uteri is a transverse slit in the lower  extremity of the  cervix, varying in  length from three to
eight lines.  It has two lips, which in  the virgin  are smooth,  but, in persons  who  have  had children,
frequently present a tuberculated and irregular feel.   In the  neighborhood of the os are  situated some
follicles, termed the glandula Nabothi, which secrete a tough sebaceous matter, and are supposed to  be
the seat of the cancer that occasionally attacks this part.
   The situation  of the uterus is  near the middle of the pelvis, between the bladder  and  rectum, its axis
coinciding with'that of the brim.  . It is covered on both sides  by peritoneum, and is held in situ  by the
following ligaments ; the  broad ligaments, which  are merely folds of peritoneum, passing off from  the
sides of the womb  to the sides of the pelvic cavity ; each is formed by twro  layers of peritoneum, between
which are situated, at the upper margin, the Fallopian  tubes and ovaries, and, lower down, the vessels
and nerves of the  organ.   The anterior and posterior ligaments are also folds of peritoneum passing off
respectively upon the bladder and rectum.  The round ligaments  differ  from   any  of the former : they
pass off on each side from  the  fundus  uteri, close to the insertion of the tubes, and, passing out  of  the
abdomen through the  inguinal ring, are lost upon the mons veneris and labia ;  they are  composed of a
number of blood-vessels, lymphatics, nerves, and cellular substance, and form a thick round cord.  The
use of these ligaments has been  much  disputed.  By Sir C. Bell they have been ingeniously supposed
to answer  the purpose of tendons, and to  furnish a fixed point for the two circular muscles, which  he has
described  as existing at the fundus of the  womb.  Professor  Jorg, of Leipsic, believes that they commu-
nicate sensation from the  clitoris to the Fallopian tubes  and  ovaries at the moment of  coition, so as to
establish a consent of  all the parts concerned in generation.
   The Fallopian tubes are two  firm cords, about four inches in length, formed of  a spongy cavernous
tissue, with  blood-vessels, lymphatics,  nerves,  and probably muscular fibres.    They  contain  a canal,
which opens into the fundus of the uterus  upon  each side, by an opening merely large enough to contain
a bristle.   The canal enlarges as it  runs toward the opposite free extremity, and opens into the cavity of
the peritoneum, its termination being  surrounded by fimbriae, and denominated the morsus diaboli (or
fimbriated extremity of the Fallopian tube).  The  tubes lie in the upper fold  of the  broad ligaments in a
very tortuous manner.
   The ovaries also lie in the  upper fold of the  broad ligament (or rather  in a fold of the posterior layer
of the ligament), behind the tubes ; they  are flattened whitish bodies, from an inch to an inch and a half
long, resembling in appearance and feel  the  male testes.   In the early  foetus  this resemblance is so
remarkable, that we can  sometimes with difficulty distinguish whether the  bodies lying in the lower part
of the abdomen be actually ovaria or testes.  The ovaries are composed of a peculiar cellular tissue, and
each  contains fifteen  or  twenty globular  cells  or vesicles,  including a drop  of albuminous  fluid, and
denominated  the vesicula  Graafiana or eggs.   Each of these  vesicles is  supposed  to contain an ovum, 
ORIGIN OF HUMAN LIFE.
39
which escapes by the bursting of the  peritoneal coat, of the ovary at the moment of conception, leaving
behind a small cicatrix.   At  the same  period an oval glandular body is observed to be formed in the
ovary,  about one third of an inch in diameter, and resembling much the secretory portion of the kidney :
this is named the corpus luteum.  It  continues to exist from the time of conception until three or four
months after parturition, but of its uses we are nearly quite ignorant.*
  In connexion  with the foregoing description of the hard and soft parts immediately concerned in the
generative function, it may be interesting to reflect upon the effects  likely to be produced upon  the other
organs contained in the  pelvis by the  changes resulting from  the exercise of this function.  The uterus,
we have seen, is situated between the  bladder and rectum : and accordingly, as might have been expected,
its enlargement frequently interferes with the  action of both  these organs.   If the pressure particularly
affect the former viscus, it will  be found to occasion frequent micturition and  other symptoms of irrita-
tion ; and when the part pressed upon is the urethra or neck of the bladder, retention of urine may be the
consequence.   In  like manner, pressure upon the rectum may cause  either tenesmus, pressing, or con-
stipation, and by interfering with the  free return of the  blood, produce or  aggravate . piles.   The great
blood-vessels which traverse  the pelvis in  their course to  or  from  the  lower extremities, as well as the
numerous lymphatics, are also frequently subjected to interruption of their functions from pressure of
the enlarged uterus, to which  maybe traced the varices and edema of the limbs  so common in pregnancy.
The pressure, also, upon the great nerves, may satisfactorily explain  the numbness and cramps of the
legs frequently complained of during labor, and at the latter periods of gestation.
  SECTION  III.

MENSTRUATION.
   Definition. —Before proceeding immediately to the physiology of generation, there is one function
 of the female organs which will require some consideration : that is, the menstrual or periodical discharge
 from the womb, similar to blood, commencing at puberty, and continuing during the whole time  a female
 is capable of conceiving;  occurring usually about every twenty-eight days, and continuing from three to
 six days : but in some it occurs every twenty-one days, and with others  it runs every thirty-five days.
 This discharge is called by the sex by various names — as the catamenia, menses, flowers, being unwell, &c.
 It appears to be peculiar  to the human species alone, although the  celebrated F. Cuvier asserts that he
 has discovered indications of it in some females of certain animals, during their sexual season ; but by
 others this is considered nothing more than an exudation of bloody mucus.
   Symptoms with which  it  commences. —We have stated, in our definition of menstruation, that
 it first takes place at puberty, or that period at which the  female is capable of  propagating her species.
 This period must vary considerably, according  as  it may  be influenced by climate, constitution, modes
 of life, &c.  : always being some earlier in warm than in  cold countries ;  and sooner in cities than in the
 country.  Before the catamenia makes its appearance, there is almost always an alteration in the condition
 of the female :  the mamma or breasts increase in size ;  the voice undergoes a slight change ; the pubes
 are covered  with hair; and all the best proportions which the individual is capable of are  now suddenly,
 as it were, developed.   The  mind also undergoes a complete change: childish amusements now yield to
 mature enjoyments and rational inquiry ; the attachments of caprice give place to sincere,  unaffected, and
permanent friendship ;  in  a word, a new creature, almost, seems to be suddenly formed.   The yet nearer
approach of the catamenia is still further announced  by headache,  dulness of the eyes, pains in the pelvic
region, lassitude, capricious appetite,  slight fluor albus, and frequent itching and slight irritation of the
• Sir E. Home supposed that corpora lutca might exist in the virgin. 
40                          IMPROVED SYSTEM OF MIDWIFERY.

parts   After these have continued for  a longer or. a shorter  period, they suddenly cease,  and a small
quantity of fluid is discharged from  the vagina, and that not  much colored at first.  Sometimes it comes
on without any of these painful warnings.  The last-named circumstance serves to explain those cases of
impregnation which are said to have taken place previously to the  eruption of the  menses.
  Thfs discharge ceases in a short time, and is  frequently succeeded  by a sense of languor and faintness.
After a few months, the same  symptoms again commence ;  and  after  their thus  occurring a kw times,
menstruation is fully established;  subsequently to which they generally appear monthly, with great regu-
larity, unless interrupted by pregnancy, lactation, or some  diseases.
  Age  of  its Appearance.—It is  said that, in Lapland, females  do not begin to menstruate until
after they are twenty years old ; while in India they commence  as early as nine or ten years.  A cele-
brated traveller states that, " in Japan, he saw  a number of little girls, with children either at the breast,
or in their arms, their youthful appearance strikingly contrasting with  their maternal occupation."   In
Java, females are married  when only about nine or  ten years  old.  In this climate, the  menses generally
occur between  the ages of twelve and sixteen.
  Period of  their Duration. — The period of their duration and  consequent cessation  is as various
as that of their commencement.   As a  general rule, menstruation continues about thirty years; and, in
this climate, usually ceases at about forty-five.   The sex instinctively apprehend great danger at this period.
When it is about  to disappear, it becomes very irregular, both as to  period and quantity.   In medical
history, we have an example  of one female who menstruated till she was ninety years old !   We have an
example  of another who  ceased to  menstruate for twenty years,  and then commenced again, at the age
of seventy, and continued the secretion for many years !
   We extract the  following remarks from  "Lectures on Midwifery," by Dr. Lee, of London :—
   Character of the  Discharge. — The first appearance of the catamenia at the age of puberty, its
suspension during pregnancy and lactation, and its cessation in advanced years, are circumstances which
prove that it is intimately connected with the process of reproduction.
   Some physiologists think that menstruation puts or preserves the uterus in a state fit for impregnation ;
but the function is never performed  unless the  uterus is previously in a healthy condition.   It might  be
affirmed with equal truth, that the secretion of  the bile puts or  preserves the liver in a healthy state ;  the
urine, the kidneys ; and the gastric fluid the coats of the stomach.   That the uterus can be in a fit state
for conception without  menstruation is  proved by this  fact — that some women have become pregnant
who have never menstruated, and many have conceived during suckling who have not menstruated since
their previous conception, or even during successive pregnancies and the  intervals of suckling.
   Some have attributed menstruation to the  influence  of the moon, to the upright position of women, fo
the presence of an undue  proportion of azote in the blood  of the uterus, fermentation of the blood, sexual
desire, and many other hypothetical causes.  It has been referred with greater reason, since the days ol
Aristotle, to a periodical plethora of the vessels  of the uterus — a molimen, irritation, or effort of the uterine
system every month — but no  adequate  cause  has been  assigned  for this.   The sensations usually expe-
rienced at  the time the catamenia are present, and the  examination of the bodies of  those who have died
from disease during menstruation, prove that the uterine arteries and veins are then distended with blood.
Blood is not unfrequently extravasated with the catamenial fluid ; and  if the uterus be examined during
the monthly period, it is usually found to be larger and heavier than during the intervals of menstruation.
That something more than a mere determination of blood  to the uterine system  is required for menstrua-
tion will  appear from the fact that suppression of the catamenia is  not unfrequently produced by unusual
congestion of the  uterine vessels, and that the  obstruction  is  removed by the local abstraction of blood.
   That the determination of blood which takes place  to the  uterine system every month, and that all tne
phenomena of menstruation, depend upon the ovaria, and that  at each period a Graafian vesicle bursts
and its contents escape, is rendered extremely  probable by the following facts :—
   If the ovaria are wanting, or removed artificially, or have their healthy structure destroyed by disease,
menstruation either never  commences,  or it entirely ceases.   The case of a young woman  who died at 
P  3L  A  f
       Orifice of the Womb, in the first month of pregnancy.
       Orifice of the Womb, in the seventh month of pregnancy.
       Orifice of the Womb, in the last month of pregnancy.
Fig. 4.  Transverse, oblique, and longitudinal Muscular Fibres of the Womb
Fig. 5.  Mammary  Gland, showing the lacteal or milk tubes.
       Turning the Child in the Womb.
       Polypus or Tumor of the Uterus falling into the Vagina.
       Prolapsus,  or falling of the Womb.
       (6) The Fimbria seizing an Ovum from the Ovarium (c) and carry-
  ing it to the mouth of Fallopian Tube, (a) through which it is conveyed
  to the Uterus (d) for impregnation.
Fig. 6.
Fig. 7.
Fig. 8.
Fig. 9 
 
Plate 16.
*w#tf' 
 
ORIGIN OF HUMAN LIFE.
41
 the age  of twenty-nine, in whom  the  ovaria were wanting, was published  by Mr. Charles Pears, in the
 " London Philosophical Transactions" for 1805, and  the  following appearances  have been  recorded :
 " Having ceased to grow at ten  years  of age, she was  in stature not more than four feet six inches high.
 The breadth across  the  shoulders was as  much as fourteen inches, but her pelvis  measured only nine
 inches from the ossa illia to the sacrum ;  her breasts and  nipples never enlarged more than in the male
 subject.   She  never menstruated, there  was  no appearance  of hair  on the pubes, nor were  there any
 indications of puberty,  in mind  or body, at twenty-nine years of age."
   In the young woman whose ovaria were extirpated  by Mr. Pott, in an operation  for inguinal hernia,
 the voice became hoarse, the mammae  shrunk, and hair appeared on the chin and upper lip.  Before the
 operation, this  female was stout, large-breasted, and menstruated regularly.
   Menstruation disappears if the structure  of both ovaria  be destroyed by any disease.  In  ovarian
 dropsy, if  one ovary only be affected, menstruation  continues until the  powers of the constitution are
 greatly impaired, but if  the disease exists in  both ovaria from the beginning, the function is soon inter-
 rupted.  The same effect is produced if the structure of the ovaria be  disorganized by any other disease.
 A woman, aged twenty-one, died in  1836, in St. George's hospital, from tubercular  phthisis, and both
 ovaria and Fallopian tubes were  completely changed by scrofulous disease.   She never menstruated, and
 the uterus was like the uterus of a child, with a long neck and small body.  In many young women who
 die of chronic disease, the ovaria are flaccid, and  extremely small.   Something not very dissimilar to
 these effects in the human subject  when the ovaria have been removed,  has been  observed by Mr. Yarrell
 in birds.  He has shown that where  there is a shrinking and  shrivelling of the ovaria from disease in
 young birds, the hen-bird, in many instances, assumes the plumage of the male.  Thus, in several mules
 (hen-birds with male plumage) the ovarium has been found variously diseased :  sometimes the oviducts
 appear to have been  inflamed, and adhesion to have taken place between  their opposite  sides, so that
 they become obliterated ; at other times the ovaria are  shrivelled, and of  a black color, and appear as if
 they had never been  in progress  to maturity.  This black color also pervades the oviduct, which is smaller
 than natural, and often impervious in some part.  In old birds it might fairly have been alleged that the
 destruction  of  the ovarium and the  change of  plumage followed only the general obliteration induced
 by age, and that the  one was not dependent on the other:  but the fact that destruction by disease of the
 ovarium, in the young  bird, induces  a similar  change, and the destruction of the oviduct by art being
 followed by an alteration, incomplete  indeed,  but, in many respects, resembling the one mentioned, sets
 the question at rest.
   In cases where the uterus has  been wanting, and  the  ovaria  have been present and fully formed, women
 have usually experienced violent pains within the pelvis every month, and all the symptoms of menstrua-
 tion have been  present except the discharge.
   In 1831, I saw a  case, with Dr. Girdwood, in which there appeared to be a deficiency of the uterus,
 and an effort at menstruation every monthly period.   The woman was   twenty-five years of  age, and had
 been  married two years,  though  she had  never menstruated.   Every month there was great pain in the
 region of the pelvis, which lasted several days, and then went off, without any menstrual discharge takino-
 place.  The mammae and external sexual organs were fully developed.   On examination at the posterior
 part of the vagina, the finger readily passed into a short cul-de-sac,  about an inch and a half in len°-th,
 but there was no uterus  above.
  Dr. Stein related  a case several years  ago to a  medical  society in Berlin, of  a  married lady, a^ed
twenty-four, well formed, and  the mamma? fully developed, whose vagina was found  imperforated ;  and
in performing the necessary operation, no uterus could be discovered, but  its place was  supplied'by a
soft mass of cellular tissue.   She had never menstruated, though there  was a regular  effort at each cata-
menial period.  Other cases similar to  these have been  recorded by authors.   One very distinct case of
this kind came  under the observation of Dr. Elliotson and Mr. Cline;  there was no uterus, but there
was excruciating pain about the pelvis every month;  the ovaria had certainly been developed.
  On the 11th of March,  1831,  I examined the body of a young woman who died, during menstruation, 
42
IMPROVED  SYSTEM  OF  MIDWIFERY.
from intlv.nmvjon of the median  basilic vein.   The left ovarium was larger than the right, and at  one
point a small circular opening, with a thin irregular edge, was observed in the peritoneal coat, which led
to a cavity of no great depth in the ovarium.  Around the opening, to  an extent of three or four lines,
t!;e surface  of the  ovarium was of  a bright red color, and considerably elevated above the surrounding
part of the peritoneal coat.  On cutting into the ovarium, its substance around the opening and depres-
sion was vascular, and  several Graafian vesicles  of  different sizes were  observed.  The right  ovarium
was in  the ordinary  state.   Both Fallopian  tubes were intensely red and swollen, and their cavities were
filled with what appeared to be menstrual fluid.   The lining membrane of the uterus was coated with the
same fluid, and the parietes were soft and vascular.   The size of the uterus was not increased.  I pointed
out this opening in the peritoneum of the ovary, which I accidentally discovered, to Dr. Girdwood  and
Dr. Prout, and  suspected that there was some relation between this and the state  of the uterus.  At  this
time, I had  not seen the human  ovum in the  Graafian vesicle  before impregnation, and was not then
aware that cicatrices are never present on the surface of the ovaria before menstruation  has commenced.
   In the autumn of 1831, Dr. John Prout saw a woman, under twenty years of age, who died suddenly
from acute  inflammation of the lungs while menstruating.   He examined the  body, and brought  the
uterine organs to  me, having taken the greatest care that they should  not suffer any force during their
removal from the pelvis.  A red, soft, elevated portion of the right ovarium was also here observed,  and
at one  part the peritoneal coat, to  a  small  extent, had been  removed.   The edge  of the opening  was
extremely thin and irregular ; and in the substance of the ovarium, under  the opening, was an enlarged
Graafian vesicle, filled with transparent fluid.  Numerous small  blood-vessels were  seen running  along
the peritoneal coat of the ovary to the opening.   When the substance  of the ovarium was laid open,
several vesicles, of various  sizes, and at different depths, were found  imbedded in it.  The left ovarium
presented a  natural  appearance.   The  free extremities of the Fallopian tubes were gorged with blood.
Their cavities were  filled with a red-colored fluid.   The uterus was not enlarged, but the  parietes were
unusually full of blood, and  the  lining membrane  of the fundus was coated with  menstrual fluid.   A
small coagulum of blood likewise adhered  to the upper part of the uterus.  I now felt convinced  that
there must be some  connexion between this state  of the ovaria and menstruation, and mentioned the facts
to Sir Astley Cooper.
   On the 2d of  July, 1832, Sir Astley sent me the ovarium of  a woman who died from cholera while
menstruating.  The ovarium was  much larger than  natural, and at one point there was a small irregular
aperture  in its peritoneal coat, through  which a portion of a slender coagulum of blood was suspended.
On cutting into  the  substance of the ovarium, it was found to be occupied with three  small cysts or
cavities, one of which was  filled with a clear, ropy fluid, another with semi-fluid blood, and  the third,
which communicated with the opening in the peritoneal coat of the ovarium, with  a firm coagulum.
   On the 18th of November, 1832, Dr. Girdwood  and Mr. Webster removed the uterine organs from
the body of a young woman who had died  suddenly  the preceding day when the catamenia were flowing.
Both ovaria were remarkably large, and both Fallopian tubes were red and turgid.   The peritoneal coat
of the left ovarium was perforated, at that extremity which was nearest to the uterus, by a circular opening,
around which aperture, for  several lines, the surface  of the ovarium was slightly elevated, and of a bright
scarlet  color; the margin of the opening was thin  and smooth, and did not appear  to have been produced
by any external force.   Its centre was slightly depressed below the  level of the  edges, but there  was
scarcely the appearance of a cavity beneath.  The right ovarium was much larger  than the left, and when
cut into,  a cyst or cavity was seen filled with half-coagulated blood; the  peritoneal coat of the ovarium
was entire.  The uterus was large, and when cut into, appeared to contain an unusual  quantity of blood.
The inner membrane was of a bright-red color, and  coated with a thin layer of catamenial fluid.  Both
Fallopian tubes were red and turgid, and  the anterior of the  left was filled with  menstrual fluid.
  On the 14th of January, 1S37, a woman, thirty-seven years of age, who had  long suffered from hys-
teria, died suddenly  in St. George's  hospital, during  menstruation.  No morbid appearance was found to
account for her death.  A small circular aperture was observed in the peritoneum of the  left ovarium. 
                                  ORIGIN  OF  HUMAN  LIFE.                                 43

This opening communicated with a cavity in the substance of the ovarium, which was surrounded with a
soft yellow substance of an oval shape.   In the preparation, you see  the aperture in the peritoneal coat
of the ovary, and the cavity with which it communicates.  This aperture would probably not have been
detected if the parts  had not been covered with pure water when examined.
   On the  31st of May, 1841, Mr. A. Shaw was present at the inspection  of the  body of a woman who
died during menstruation in the Middlesex hospital.  In  the  right ovarium, he says, the appearance was
presented  of one of  the Graafian vesicles having been recently ruptured.  A part  of the  surface, of the
size of a fourpenny piece, was  distinguished by a  dark  stain upon it; and here the peritoneal coat was
slightly  elevated, and the ragged  edges  toward the centre  of  the  stained spot were  of a  particularly
black color.
   In Dr.  Gendrin's  " Traite  Philosophique de Medecine Pratique"  (1839), there  is a description of the
same state of the ovaria in  five women who died during menstruation.   In the first, the left ovarium was
vascular, and in  the  middle was an aperture about a line  in diameter, with an  irregular margin.   Its
cavity would have  contained  a hemp-seed ;  its walls were red, and it was obviously a ruptured Graafian
vesicle.    In the second case, a small circular  ragged opening led to a cavity two lines in diameter, the
walls of which were of a bright-red color.   In the fourth, the right ovary had  an aperture a line and a
half in diameter, leading to a small  cavity, with vascular walls.   M. Negrier has  given an  account of
similar appearances in the ovaria during menstruation.  A warm controversy has been carried  on between
M. Negrier and  Dr.  Gendrin on the priority of the discovery, and they appear to have been wholly una-
ware— which adds much to the importance  of their observations — that an account of precisely the same
appearances had  not  only  been published by me, seven  years before, in the second volume of the
" Cyclopaedia  of Practical Medicine," but,  fifty-eight years before, in the " Philosophical Transactions,"
by Mr. Cruikshank.   " 1  also have in my possession  the  uterus and  ovaria of a young woman," he
observed,  " who died with the menses upon her :  the external membranes of the ovaria are burst at one
place, whence I suspect an ovum  escaped, descended through  the  tube to the uterus, and was  washed
off by the menstrual blood."   There is no further observation made in this paper from which it can be
inferred that Mr. Cruikshank  supposed all the  phenomena of menstruation to  depend on this state of the
ovaria.  Even  as  early as  1672, it appears Kirkringius believed that ova were  sometimes  discharged
from the ovaria during the monthly periods ; for he says, " Aliquando fcemina?  dejiciunt ha?c ova, imprimis
tempore menstruorum."   I have not had time to examine the work of Kirkringius, to ascertain whether
he states this from  Em actual examination of the ovaria of women who died during menstruation, or if he
adopted the opinion  on  purely hopothetical  grounds, as  Dr.  Power did, and stated in his " Essay on the
Periodical Discharge of the Human Female."
   " It is thought by some," says Dewees, " to differ materially from common  blood, from its not possess-
ing fibrin.  Of this I can not  speak with certainty; but I am disposed to believe that this  part  of the
blood has  only undergone  a  change during  elaboration — more  especially, as  the  coagulating lymph is
always  found  to accompany the red globules, whenever blood has  been  accidentally extravasated, or
designedly drawn.    My reasons for thinking that the fibrin of the blood has only suffered an alteration of
property,  and  that it is constantly present  in  the menstruous blood, but is  altered, are, that, in  many
instances, nothing  more is necessary to this  effect than the establishment of some peculiar arterial action :
thus, we find,  in certain kinds of small-pox, fevers  termed putrid, scurvy, &c, the blood loses the power
of coagulation  ; in  the blood of those who die from  lightning, blows upon the stomach, &c, it is said that
the coagulating lymph loses the capacity to coagulate : therefore,  the mere absence of coagulability is not
sufficient to prove  the absence of fibrin.
   " In this, Nature has shown her beneficence ; for to what wretchedness would  the woman be doomed
at each menstrual period, did  it retain its property of coagulation !   Mr. Hunter thought that the property
of coagulation  was lost from the blood losing its living principle during the secretion ; but to this we can
not subscribe — as this fluid, as has already been noticed, is thought to resist putrefaction  longer than
common blood." 
44
IMPROVED  SYSTEM OF  MIDWIFERY.
                                         SECTION  IV.

                          DIFFERENCE  BETWEEN  THE  SEXES.

  The accompanying representations exhibit the difference in the external forms of the male and female
sexes:—
   There is a striking difference between  the sexes, whether we regard them physically, intellectually, or
morally :—
   1.  Physically.—It is very obvious to all that there is a great difference in the physical organization
of the male and female, independently of the sexual organs.   There is a striking difference in the osseous
system.  The male skeleton is larger, and is  more coarse and rough, than that of the female ;  and it is
as easy for an  anatomist to  distinguish  a  male from  a female skeleton among a number, as it is to distin-
guish male from female during life.   There are also peculiarities of structure, by which the male may be
easily distinguished from the  female — such as the deficiency in  the  female of the thyroid cartilage or
"Adam's apple," as  it is  called; that is, the prominence in  the neck of the male, by which  a person
may,  by passing their hand over the throat, distinguish the sexes blindfolded or in the  dark.
   They may be easily distinguished also  by the beard.   There is a great difference  also  in the voice:
the female voice is more shrill and sonorous.   The organ of language in the female is also more promi-
nent than in the male — often making good the proverb, that " a woman's tongue is never still!"  There
is a great contrast also between the mammary glands or breast  of the sexes; imparting to this portion of
the female both beauty and utility.   The  pelvis of the female  is  much larger than that of  the male, and
somewhat different in shape, for the obvious purpose  of allowing the result of reproduction, or the infant,
to  pass into the world.
   The size and weight of the female is much less than that of  the male ; her muscular powers  are much
less developed than are those of the  male : all which clearly constitute her the weaker vesselt and jit her
for less laborious employment-, and the duties of domestic life. 
ORIGIN OF HUMAN LIFE.
45
  2. Intellectually. — The intellectual powers of the female are, as a general rule, less than those
of the male.   She is not as capable  as  the  male  of performing  the  solution of a  deep mathematical
problem, or of accomplishing those great and important operations of mind which require extraordinary
mental energy; but  she is infinitely his  superior in devising and carrying out an intrigue of any kind.
On all subjects, her perceptive faculties, and sensibilities, are greater than those of men.
  Her nervous organization is much  more acute and more finely balanced than  the male ; all of which
develop in  the female a train of  deeper emotions or passions : hence, when these emotions are carried to
excess, she is easily thrown into violent excitement, hysteria, and a long train  of  nervous affections.
  3. Morally.—As a general rule, women possess a much greater proportion of good moral traits of
character than the male sex.  Their  sympathies being greater, they exercise more benevolence ;  their
patience  and perseverance are more remarkable.  This we may daily see exemplified, in their fidelity at
the bedside of a sick husband, child,  or friend.  As a modern writer observes —" Woman is inferior to
man in her reasoning powers and corporeal strength :  but  she possesses more  sensibility of body and
mind ; more tenderness, affection, and compassion ;  more of all that is endearing, and capable of soothing
human woes.  But she possesses less firmness of character, except, indeed, where strong affection exists :
then nothing is too  long, too irksome, too painful, or too  perilous, for a mother, wife, or  mistress, to
endure or attempt, for the object of her love."
   These interesting traits in the character of woman are happily illustrated in the  beautiful  lines of the
celebrated  traveller, Ledyard, as follows :—

                             " Through  many a land and clime a ranger,
                                 With toilsome  steps I have held my way;
                               A lonely, unprotected stranger,
                                 To  all  the stranger's ills a prey!
                             " While steering thus my  course precarious,
                                 It has  been my fortune to ever find
                               Men's ways and dispositions various,
                       . ,.        But gentle woman's ever kind:
                             " Alive to every tender feeling,
                                 To  deeds of mercy always  prone —
                               The selfsame, endearing creature,
                                 From sultry India  to the pole."
                                           SECTION V.

                                         COPULATION.

   Copulation is the conjunction of both the sexes.  It is supposed  to be the pinnacle of their natural
felicity.  Tt is the superlative degree of their earthly happiness, beyond which  they  can  not aspire  in
human society.   It is  also the utmost height of their desires, and the greatest extent of their languishing
wishes.  It is at once the abatement, as well as the completion, of their previously-unbounded passions.
   Part performed  by the  Male. — In the union  of the sexes in the process of reproduction, the
part performed by the male  is the introduction  of the  penis, by which the sperm or seminal  fluid  is
conveyed to the uterus.   In  the flaccid state  of the organ, this penetration is impracticable.  It is first
necessary that, under the excitement of the venereal desire, the  organ should attain  a suitable state of
rigidity, which is called  erection.   In this state, the organ becomes very much enlarged, and raised toward
the abdomen ; its arteries beat forcibly, the veins become tumid, the skin of the  glands more colored,
and the heat augmented ; it  becomes  also  of a  triangular shape : and these changes are accompanied 
46
IMPROVED SYSTEM OF MIDWIFERY.
with a feeling of  pleasure,  but far  less than is generally anticipated.   This erection is  caused by an
increased  flow and congestion of blood, which may be stimulated by contact  with the female, or  any
other friction, or by the influence of the imagination alone.
   The arteries first respond to the appeal;  the  organ  is  at the  same time raised by the  appropriate
muscles, and its tissue becomes distended ; the plexus  of  veins become turgid, and the return of blood
impeded.   In this way, the organ acquires the  rigidity  necessary for penetrating the parts of the female.
The friction which then occurs keeps  up  the voluptuous excitement and  the  state of erection.   This
excitement is extended to the whole generative system.   The secretion of the testicles is augmented ; the
sperm arrives in greater quantity in the vesiculae seminales.  The testicles are drawn up toward  the
abdominal rings by the contraction of the dartos and cremastor muscle, so that the vas deferens  is rendered
shorter; and (in the opinion of some) the sperm, filling the excretory ducts of the testicles, is in this manner
forced mechanically forward toward the vesicles.  When these have attained a certain degree of disten-
tion, they contract suddenly and powerfully, and the sperm is projected through  the ejaculatory ducts and
the urethra in jets.  At this period the sexual pleasure is at its height.
   The quantity of sperm discharged varies considerably ; its average is estimated at about two drachms.
The true sperm is diluted with the secretions of the prostate glands and the glands of Cowper.  When
the emission  is accomplished,  the penis gradually returns to  its ordinary state of flaccidity; and it is
generally unable to repeat tne  effort without some interval  of repose.   In some  persons,  however,  the
excitability is so great, and the secretion of sperm so ready, that little or no interval is required between
the first and second attempts.
   Part performed by the  Female. — During copulation, when both sexes  burn with  that animal
instinct which is superior to all  others in universality and violence, the clitoris of the female is in a state
of erection, like the penis of the male ; and so also is the spongy and erectile tissue of the  nymphae and
of the vagina.  It is in these parts particularly that the female experiences pleasure during sexual inter-
course ; and  this  feeling continues during the time of coition, as in the male, and  is attended by a
similar convulsive  excitement, and a sudden  discharge from the vulva  and mucous follicles.   After  the
excitement, both are thrown  into a state of languor and debility; and when tqo  often repeated, brings on
various diseases.
                                         SECTION  VI.

                                        CONCEPTION.

   Different  Theories  of Impregnation. — Having thus stated  the provisions which have been
made by nature for the concurrent offices  of the two sexes, we  may here examine various  speculations
and opinions which, from time to time, have been entertained relative to  the nature of this marvellous  and
mysterious process — speculations which, although  for the most part exceedingly hypothetical, and often
completely visionary, have been dignified with  the appellation of theories of generation.  Thrs it is our
intention to do very briefly, and to notice only the more important of these theories: for the total number
of hypotheses which have been advanced on this subject is so great, that their mere  enumeration  might
occupy many pages.   Drelincourt, who lived in the latter part of the  seventeenth century, collected from
the writings of his predecessors as many as two hundred  and sixty-two '• groundless  hypotheses" con-
cerning generation ; and " nothing is more certain," observes Blumenbach, " than that Drelincourt's own
theory formed the  two hundred and sixty-third."
   These theories may be arranged according as they relate to the action of the  parent organs, or to the
changes in the egg occurring during the formation of the  new animal;  and Haller divided the  first of these
classes into three divisions, according as the offspring is  supposed to proceed : first, exclusively from the 
ORIGIN OF HUMAN LIFE.
47
 organs of the male parent, which is the theory of the Spermatist; or, secondly, entirely from those of the
 female, which is that of the Ovists ; or, thirdly, from the union of the male and female products, which is
 the theory of Syngenesis.  The second class, again, may be  arranged under two heads, according as the
 new animal is supposed,  first, to have its parts  rendered visible, by their  being  expanded, unfolded, or
 evolved from a  previously-existing though imperceptible condition of  the  germ, which  is  the  theory of
 evolution ; or, secondly, to be newly-formed from  amorphous materials at the  time when it  makes its
 appearance in the ovum,  which constitutes the theory of Epige?iesis.
   The  theory of the Spermatists regarded the  male semen  as furnishing  all the vital parts of the  new
 animal, the female organs merely affording  the offspring  a  fit receptacle  and suitable  materials for its
 nourishment, until it could exist by the  independent exercise of its  own functions.  One  of the earliest
 supporters of this hypothesis was Galen ;  but its  modern revival dates from the period of the  discovery
 of the seminal animalcules, which were  regarded  by Leewenhoek as the proper rudiments of  the foetus.
 They were even considered by some to  be miniature representations of men, and were styled homunculi;
 one author going so far as to delineate in each the body, limbs, features, and all the parts, of the grown
 human body.   Even Leewenhoek describes minutely the manner in which  they gain the  interior  of the
 ovum, and are retained after their entrance by a valvular apparatus.
   The Ovists, comprising some of the older philosophers, such  as Pythagoras and Aristotle, maintained
 that the female  parent affords all the  materials necessary for  the  formation of the offspring, the office of
 the male being  merely to awaken the dormant formative powers residing  in the female products.  Mal-
 pighi  and Harvey asserted that the rudiments of the foetus are derived principally from the female ovum ;
 an opinion which is also  elaborately defended by Vallisneri.
   The theory of Syngenesis, or  of the  simultaneous combination  of products derived from both sexes,
 which, after sexual intercourse, are supposed to  unite together to form  the  germ, is also of very ancient
 date.   In connexion with this theory may be mentioned that modification of it which may be termed the
 theory of metamorphosis, according  to which a formative  substance is held to  exist, but is allowed to
 change its form, in order to be converted  into the new being ;  as  also the hypothesis of Buffon, which
 was eagerly adopted by Needham, who  conceived  that certain  molecules, which  they termed organic,
 and which they believed  universally to  pervade plants  and  animals, were all endowed with productive
 powers, which enabled them, when  placed in suitable situations, to attract one another, and to  compose
 by their union living organized bodies.   They imagined that, in the process of generation, the supera-
 bundant  portion of  these organic molecules were  accumulated in the  generative organs,  and  there
 constituted the rudiments of the offspring.
   The hypothesis of evolution, or of pre-existing germs,  coincides with that of the Ovists, in  considering
_the foetus as solely the  production of the female ; but it  further assumes that it already exists, with all its
 organs, in some part of  the female system  previous to  the sexual intercourse ;  and that  it receives no
 proper addition from  the male semen, the action of which is merely that  of exciting the powers  of the
 foetus, and of endowing it with vitality.   The observations of Haller with respect to the gradual enlarge-
 ment or evolution of the chick during the process  of incubation, were conceived to lend great support to
 the advocates of this theory, of whom the most strenuous and enthusiastic was Bonnet.   This  naturalist
 so celebrated for the boldness of  his speculations,  contended, not only that the whole of the parts of the
 foetus  pre-exist in the ovum, before they actually make   their appearance,  but that the  germs of all  the
 animals which are in future to be  born, also  pre-exist in the female  parent; so  that the  ovaries of the
 first parents of  any species of animal contained  the germs  of all  their posterity, included the one within
 the other, like a nest of  boxes :  from which comparison  he termed his theory that of " emboUement.'"
 This extravagant notion was adopted by many physiologists, principally-from its affording some kind of
 explanation of  what no other theory seemed in the least adequate  to solve.  Spallanzani, in  particular,
 was a  zealous defender  of  the hypothesis  of pre-existing  germs.   It appears, however, to be  totally
 irreconcilable with  the phenomena of hybrid productions, and of the resemblance which, in  so many
 instances, the offspring bears to its male  parent. 
48
IM-PROVED SYSTEM OF MIDWIFERY.
   We have already mentioned that Harvey and Malpighi.  ascribed the formation of the foetus principally
to the powers of the female.   This opinion  gave origin to the modern theory of Epigenesis, first clearly
promulgated by Caspar Frederick  Wolff,* who not only described a successive production of organs, of
the previous formation of which there existed no trace ;  but  showed also, that after parts are first formed,
they undergo many important changes in their shape and  structure, before arriving at their finished state.
The more recent researches, aided by delicate  microscopical observation,  of Meckel,  Pander, Baer,
Rathke, Oken, Purkinje, and Valentin ; Serres,  Rolando, Dutrochet, Prevost and  Dumas, Coste,  and
others, have demonstrated thnt the theory of Epigenesis, or superformation  of  parts, is much more con-
sistent with the observed phenomena than  that of evolution.   The facts which have thus been brought to
light are of peculiar interest with reference  to  the  plans of nature, into  which  they give us a more
extended  insight, by exhibiting  new  and unexpected affinities between remote families  and  classes of
animals ; by showing that at one period the type of their formation is nearly the same, and by explaining
the seeming caprice of nature in instances of monstrous and defective formation.   But  to attempt adducing
the proofs and illustrations  of these positions, would engage us into details requiring  an extensive survey
of  the whole animal creation, to enter into which would occupy more space than  is  compatible with the
limits of the' present treatise.
   The next class have advocated the theory of absorption.  These maintain that the seminal fluid, after
having been thrown into the vagina, is taken up by the absorbents, and thus carried into the circulation  ;
and is  subsequently deposited in  the ovaria, and  there impregnates it.  It  is in this  manner  that they
suppose the various hereditary diseases are communicated to the foetus.
   Having adverted  to the various theories which  have prevailed at different  periods, I will now mention
one which is advocated by  the generality of physiologists of the present day.   They now generally believe
that the semen is injected into the vagina, passes through the uterus and the Fallopian  tubes, and is then
thrown on the ovaria by their fimbriated extremity :  and thus  the ovum is  impregnated.   They believe
that in about one week  after impregnation the fimbria seize the ovaria, and, as it were, force out  the
ovum or product of conception, and convey it  along the tubes  into the  uterus, where  it is nourished
and perfected.
   Most authors  in the present  day advocate this theory;  and, although it is somewhat  plausible, the
arguments in its  favor are by no means conclusive.   There  is no certain evidence that the semen takes
such a circuitous route ; and from the small  size of the uterine aperture of  the Fallopian tubes (so small
as not to admit without  dilatation a substance larger  than  a  bristle), it is highly improbable, to say the
least, that the semen passes through them.
   Again, we would ask, what evidence is there that the Fallopian tube, which naturally hangs pendulous,
performs the office of erection,  in order to throw the semen on the ovaria?   Not only so, but, accord-*
ing to this theory, the female remains passive in the act of conception, and contributes nothing during the
venereal orgasm to the formation of the embryo.
   It is asserted,  in favor of this  theory, that there is every  appearance after impregnation that an  ovum
has escaped from the ovaria,  leaving a red excavated spot, called the  corpus lutium, which is  supposed
to be the bed of the  fecundated ovum.  But this  is refuted by the recently well-established fact that the
same phenomenon is observed in virgins after menstruation,  as well as others.
   The most valid argument in favor of this  doctrine is,  that conception, either true or  false, occasionally
occurs in the ovaria, the Fallopian  tubes, or the cavity of the abdomen ; arising, as is  alleged, from nature
having, from some cause, failed to  carry the impregnated  ovum to the cavity of the uterus.  But, from
all the  investigations and observations we  have been able to  make, it appears to  me  that, generally at
least, it is the female portion of the foetus called the ovum only that has thus escaped,  without ever having
been impregnated ;  and that, by  a  constant accumulation of new materials to the part, it has continued to
grow, and thus formed a mola or a superfcetation.

                 " Iu his inaugural dissertation, entitled " Tlieoria Geuerationis/' published at Berlin in 1759. 
ORIGIN OF HUMAN LIFE.
49
  Since writing the above, I have found  the following additional testimony in favor of this opinion from
an experiment made and recorded in the "Medical and Physical Journal," vol. ix., p. 56.   It appears
evident, from this experiment, that an imperfectly-developed foetus may be formed without any intercourse
with the male.  The following is the account:—
  " If a female rabbit be shut  up with  the male, but so as that, although she can  see, she can have  no
access to him, and kept in this situation until the heat is over, the frimbia have not only been found tinged
with blood, of a  dark-mulberry color, writhing in an  extraordinary manner, having a strong  peristaltic
motion, and embracing with  their  fimbriated  extremities the ovaria,  but seven  ova  have been seen
enlarged, and actually burst from their cells; and in the ovaria of a young woman, who, from the circum-
stance of an imperforate hymen and  restraint, there was the strongest reason to believe had had no sexual
commerce with men, but was probably of a warm constitution, and had indulged in lascivious practices,
hair,  teeth, bones, and other signs of imperfect conception, were discovered!
  " Experiments of Drs. Heighton  and Cruikshank, on rabbits, also confirm the opinion of Blumenbach,
that under particular circumstances of lascivious feeling, something similar to impregnation, and escape of
ovum, may take place without coition, or in a  state of virginity.  It therefore appears evident, from numer-
ous experiments, that there is  a periodical discharge of ova, eggs, or seminal secretion, from the female,
as from the male  testicles, by which  name the ovaria were formerly  known.   This elementary principle,
by  whatever name it may be called, is discharged from the exterior  or surface of the ovaria, prepared or
in a fit state for impregnation,  during the whole time that she is in  a condition to  conceive.   The same
phenomenon takes place in animals in a state of heat."
  A case,  however, is related  by a  Dr. Heine,  in Germany, in which  he says  he extracted a living child
from the abdomen.
  But supposing this to be true, is  it not, I  ask, as rational to believe that the embryo might have passed
from the uterus, through the Fallopian tubes, to the  cavity of the abdomen, immediately after conception,
as it is to believe that the embryo is always carried after conception by the Fallopian tubes into the uterus?
Indeed, have we  any well-authenticated case of a well-formed  living foetus ever having been found any-
where but in the cavity of the  uterus ?
  Have not all cases of tubal,  abdominal, and  ovarian conception,  been imperfect?  Have they not all
been a diseased or a partially-developed ovum ?
   This theory, therefore, to say the least of it, savors of great improbability.   According to  it, the  Fallo-
pian tubes must perform,  not  only  a double action, but two directly opposite actions: first, of propelling
the semen  to the ovaria ; and, second,  of propelling in a contrary direction the ovum to the uterus.
   Our own Theory. — We have now given the  principal theories  of the doctrine of conception that
have been, or now are, advocated by the most  distinguished physiologists.   It now only remains for us
to give our own ; and this  we  have  deduced from well-known  and acknowledged anatomical  and physio-
logical facts, demonstrated by experiments,  both upon tfie  human  subject and upon the lower animals.
Here  we  may remind our readers  that we  have before shown that  Nature has made abundant provision,
throughout all her varieties of animated beings,  both for the male and female, to contribute to the formation
and removal of their offspring.   And I maintain, as an incontrovertible fact, that each sex furnishes about
an  equal share of the materials which produce the physical, intellectual, and moral  qualities,  entering into
the formation of the foetus  :—
  1.  Physical  Materials. — No fact is more  clearly  demonstrated than that, in  the union of  the
sexes, during the sexual congress, the female ejects a fluid substance from her system as really as the male.
The same  heightened  feelings and the same convulsive motions attend  the ejaculation, and the sensations
experienced are precisely  similar in one sex as  in the other.
   That each  parent contributes an  equal amount of material toward  the physical  organization tff  the
infant, we have the most positive and unequivocal  evidence, in  the  product of conception itself.  This is
more clearly seen  (though  not more real) when the parents are a Caucasian or white and an African: the
offspring is  unlike either parent, but possesses a portion of  the physical traits of each.
                                                 7




                              \~.y    AUC1S Vtf .. ■■ 
50
IMPROVED SYSTEM OF MIDWIFERY.
   The color i.>  midway between the two, constituting what we term  a mulatto ;  thus showing » mos*
 perfect and  most extraordinary combination of original elementary principles, perfectly and harmoniously
 blended : whereas, did  the father alone contribute to the  production of the offspring, the color and other
 physical traits would resemble him.
   2.  Intellectually. — It must  be  perfectly obvious to all  that children resemble their parents  hi
 their intellectual peculiarities ; sometimes resembling one more than the other, but the mother as often  as
 the father;  and  that sometimes these intellectual traits are very happily blended.
   3.  Morally. — That the child usually resembles either the  mother or the father in disposition, is so
 strikingly manifest, as to become proverbial.   And  not  unfrequently do we see the peculiar disposition
 of each intimately blended ; all  which shows  conclusively that  each sex generally contributes equally  in
 every respect to the formation of the offspring ;  and that in the act of sexual intercourse,  the elementary
 principles, physical, mental, and moral, must  be secreted  on  the part of the female as well as the male.
 And  probably the  reason why certain traits of one  parent predominate more than another is, that the
 parent which the child most favors has contributed most of that part of the materials for its formation.
   Similarity  of the  generative Organs of both  Sexes. — The great similarity between the
 male  and female organs of generation  is remarkable, although  to superficial  observation they appear so
 different.   So much is this the case, that it has  been said by some writers on  this subject, that  a man
 turned outside in, is a female ;  and  that a woman turned inside out,  is  a male.  On the  subject  of the
 similarity of the  male and female organs  of generation, Dr. Ramsbotham has the following remarks :—
   " Although the  organs of generation  appear to  be so widely different in  the two  sexes, and indeed
 give them their distinctive character ; yet there is seen, on closely comparing them, a great similarity, not
 only in function, but even in formation : so that  we  can not withhold our belief that they have both been
 fashioned on a common model.   The  resemblance between the ovaria and testes in office, form, organic
 elements, and original  situation, is most striking.   The  testes  lie in  the abdomen until about  seven
 months of foetal life is past.  And both  the testes and ovaria are supplied with blood-vessels arising from
 tlie same  source (namely, the spermatic), and following the same track.   The uterus  has been  likened
 to the prostate gland of the male, and it  certainly bears  a great similitude in its position,  at least during
 foetal  life.   The vasa deferentia  and  Fallopian tubes resemble each other in function and construction.
   " The  clitoris may be likened to the penis, and the labia to«the scrotum.  In many instances, the con-
 fusion  arising from this similitude is so  remarkable, that it is  difficult to decide, during  fcetal life, to
 which sex the individual  belongs.  It  must  be  observed, indeed, that  the  earlier  the time chosen for
 making the  comparison, the stronger will the resemblance be.   The clitoris of a foetus of three months  is
 as large as the penis of a male of the same age; and at  a more  recent period of intra-uterine existence,
 the distinction of the sex is by no means perceptible."
   To  the presence of these little glands, the ovaria (which are removed in some animals by castration, to
 prevent conception), the female is as  much indebted for the distinctive physical marks and moral attributes
 of her sex as the male is to the possession of the testicles.
   When  we reflect how wonderful the  function of  reproduction appears to  our finite Intelligence, and
 how attractive it is to the  inquiring mind, we  can scarcely be surprised at the  numerous  theories  which
 have sprung up  respecting it:  each to  be displaced  by another, more plausible than the preceding ; for
 every philosopher, anatomist, and physiologist, of any celebrity, has  directed his attention more or less to
 the study  of generation  or reproduction.   Many of these theories, however, are without a  fact to support
 them, and have no better foundation  than the  imagination  or reasoning of their author ; and they  would
 scarcely claim our attention, were it  not that we  find them attached to some name  of note, or from their
being curious  matter of history.  Thus Hippocrates, Pythagoras, and  many  of the older philosophers,
together with Descartes, Buffon, and others, in later years, imagined that,  during copulation, the female
emitted a fecundating fluid ; but .this idea was opposed by Zeno and the stoic school, and, in more  modern
time.?, by  Fallopius.  Hippocrates, Aristotle, and others,  believed that  the  seed of the male and female
 were mingled, and that according to whichever of these was most powerfvl, a foetus of that sex was pro- 
                                   ORIGIN  OF  HUMAN LIFE.                                 31

 riuced.  Descartes and his followers imagined  that when the seminal fluids were mingled, a fcnnentutian
 took place, and a foetus was formed.  Again, it was asserted that the seed of the male was acid, and that
 of the female alkaline, and an  effervescence ensued;  or that, like two chymical agents, they reacted —
 a double decomposition took place,  and  a foetus was precipitated !  Another set of philosophers, again,
 thought that the parts of the fatus were distributed (already existing perfectly formed) in the seed of  the
 male and female, part of  them  in each, and that by the act of copulation they united themselves.  The
 stoics thought that  the foetus was the produce of the male seed alone, and that the  female  merely served
 as the soil, supplying the  nutriment necessary to bring it to  perfection. >
   Buffon considered the  foetus to be a combination of atoms, from each individual  part of the male and
 of the female.   If  this were so, it might have led to some very curious malformations  resulting from
 maimed  parents.   Nor must I omit the  doctrine of Dr. Leewenhoek,  derived from his knowledge of  the
 spermatic animalcules — that man was at first a worm; that he passed  through several transmigrations in
 the womb, and that his formation was gradually unfolded, as the butterfly is developed from the caterpillar.
   It  does not appear to me that any of the above theories require any further remarks than have been
 given.
   The whole, then, which we  desire to say on the subject of conception, may be resolved into  the two
 following principal points or doctrines, which indeed very nearly resemble each other in the most essen-
 tial particulars :—
   How Conception takes  place. — 1. That conception takes  place  in the  human female in  the
 same manner as it does in all the females of the mammalia order of animals, which is the very same or
 similar to the manner in which it takes place in the fowl.
   A  large number of small globular bodies, called ovum or eggs, are formed, and are successively devel-
 oped, from their  smallest and almost imperceptible size to  the full-grown egg (which we have more fully
 illustrated in  the chapter on animal life).   These eggs pass at maturity into a tube, called  the  ova duct,
 and are afterward expelled.   Now these eggs may be both  formed and expelled without the influence of
 the male, and frequently are so.  But every one in the habit of raising  poultry knows  that such  eggs will
 never produce chickens ;  but  that if the eggs be so fecundated — that is, if they contain the " tread," or
 as it is technically called,  \he pimcta vita — and are exposed to a certain heat for a suitable period, either
 under the hen, or artificially, a new being is the result.
   One view  of our doctrine of  conception  then is, that human  conception is analogous to this process;
 that all the human species  are born from an egg ;  and that this takes place in the following  manner :—
   We have already stated that the  ovaria  of the human female  are rounded  glandular bodies, situated
 near the  fundus of the womb,  and containing a great number of  vesicles or eggs, similar to those of the
 fowl.   It was formerly supposed that there were only fifteen or twenty of these vesicles in  the  ovaria
 called by physiologists "  Graafian vesicles ;" and  that every  time the woman was  impregnated,  one  of
 these was used up :  so that  she could  by no  possibility have more children than there were Graafian
 vesicles.   But now it is ascertained that these vesicles are innumerable ; indeed, that the substance of  the
 ovaria is composed of them.  Although  they are very  minute in  size at first, yet they are continually and
 gradually enlarging, until  they attain that of the ripe external vesicle.
   These vesicles, or rather drops of albuminous yellow serum, coagulate, like the  white of eo-o-s, if the
 recent ones be plunged into boiling water.
   At every time the woman menstruates, or the animal is in heat, or perhaps, if a vesicle be ripe, every
 time sexual intercourse takes  place, one  of these vesicles bursts, and  the ovum which it contains is taken
 up by the Fallopian tubes  or oviduct, and carried toward the  uterus and the external  world.  If  it meet
 with any of the seminal fluid of the male in its progress through the uterus, it becomes impregnated ;  if
 not, it passes off  through  the vagina.   The time  occupied in  its passage  is supposed to be from five to
 ten days.   That the ovaria do part with  an ovum at the menstrual period,  we may refer the reader to the
 very conclusive anatomical investigations which took  place on a number of females who died suddenly
during menstruation, which we  mentioned  under the  article " Menstruation;"  And all the above  facts 
52
IMPROVED  SYSTEM  OF  MIDWIFERY.
also have been observed, by direct experiment, to take place in the lower animals of the mammalia order :
thus making the similitude between the manner of impregnation in the human female and in the mammalia
order  of the animal kingdom strikingly resemble that which takes place in the fowl.
  2.  The next view which we take of this subject, and which is nearly allied to the last, is, the doctrine
of the union of the  male and female seminal fluid, in the following manner :  That the semen on the part
of the female, secreted by the ovaria (which corresponds to the male testicles), and which is contained in
the  ripened vesicle,  is, in  the act of  copulation, seized by the  fimbriated end of the  Fallopian  tubes
(which correspond to the vas deferens of the  male), and then passes  through these tubes to the womb ;
and is thus brought in contact with the semen of the male, and impregnated, and constitutes the embryo
or germ of the new being.
  In  favor of this latter view, Dr. Blumenbach, a celebrated European physiologist, has  some very per-
tinent remarks.  He says :  " When a woman  admits the  embraces of a man, and both burn with that
animal instinct which is so superior  to  all others  in  universality and violence, the uterus, I conceive,
swelling with a kind of inflammatory orgasm, and animated by its vita propria, draws in, as it were, the
semen ejaculated by the male, and pours forth a fluid of its own against it, which  is supplied as follows:
During the act of coition,  the tubes become  rigid,* and  their fimbria embrace the ovaria,  in one (or both,
in case of  twins)  of which a  ripe Graafian vesicle is contained;  and,  by  their pressure, it bursts like an
abscess, and is jetted through the uterus and vagina ; and the ovum or albuminous  drop, as it is called, is
retained in the womb, and impregnated by the male semen."
  After impregnation has taken place, the lips of the seam become closed by an external  cicatrix, leaving
in the ovary a corpus lutium.
   "Such an albuminous  drop," says Blumenbach, "appears to be what the. female contributes in  the
process of conception.   And it is probable that during  the  adult state these drops become mature in suc-
cession, so that, one by one, they burst the covering of the ovarium, and are received by the abdominal
end of the Fallopian tube,  and  conveyed into  the uterus, where  they come in contact  with the seminal
fluid,  and thus become impregnated."
  In  conclusion, we believe the evidence decisively preponderates in favor of our theory, viz., that the
seminal fluid, during coition, is thrown from  the seminal  vesicle and  urethra  of the male, through  the
vagina into the uterus of  the female; while the seminal fluid of the female is thrown from the ovaria,
through the Fallopian tubes, the ovum of which, coming in contact with the  male  semen, becomes impreg-
nated, and forms the embryo or the foetus.
  At any rate, this, or  the  preceding doctrine,  which is so nearly allied to it, is at once the most rational
and philosophical,  and accords with all the physiological facts resulting from the  experiments of  the
greatest anatomists and physiologists of all ages.
                                        SECTION VII.

                  THE  progressive  development  of  the  OVUM.

  Embryo. —There is, perhaps, no department of  physiology which  has been so remarkably enriched
by recent discoveries, as that which  relates to the primitive development of  the ovum  and its embryo.
The researches of Baer, Rathke, Purkinje, Valentin, &c, in Germany; of Dutrochet, Prevost, Dumas]
and  Coste, &c,  in France ; and  of Owen, Sharpey, Allen  Thomson, Jones, and Martin  Barry, in
England, but more  especially those  of the celebrated Baer, have greatly advanced  our knowledge'of
these subjects, and  led us  deeply into those mysterious processes  of Nature which  relate to our first
origin and formation. 
ORIGIN OF HUMAN LIFE.
53
    These researches have all tended to establish one great law, connected with the early development of
 the human embryo and that of other mammiferous animals, viz., that it at first possesses a structure and
 arrangement analogous to  that of animals  in a much lower scale of formation ;  this observation also
 applies, of course, to the ovum itself, since a  variety of changes take place in  it after  impregnation, before
 a trace of the embryo can be detected.
    At the earliest periods, the  human ovum bears a perfect analogy to  the eggs  of fishes, amphibia, and
 birds ; and it is only by carefully examining  the  changes produced by impregnation in the ova  of these
 lower classes of animals, that we have been enabled to discover them in the mammalia and human subject.
    As the bird's egg, from  its size,  best affords us the means of investigating  these changes, and as in all
 essential respects  they  are the same in the human ovum, it has been  necessary for  us to lay before our
 readers a short account of its  structure and  contents, and  also of the changes which  it undergoes after
 impregnation.
    The ovum at first exists in the state  of a small  membranous egg, filled with a transparent fluid, which,
 if put in hot water, will coagulate ;  in the centre of which is the embryo, like  the tread or puncta vita of
 the egg of  the fowl.
    At this period, its parietes or sides are composed solely  of two delicate membranes : the outer  one is
 called the chorion, the inner one is  called the  amnion.
    Deciduary. — As soon as conception has taken place, a new action also takes  place  in the uterus.
 It secretes a semi-fluid  opaque membrane, which  lines the whole  cavity of the uterus, except where the
 ovum is situated :  there it  passes  over it.   It is called the deciduary membrane.   It consists of  two
 layers : that which is next  to the uterus  is  flocculent,  and that which is next the ovum is smooth  and
 plain.   It is highly vascular, and is supplied  with  blood  from the  uterine vessels.  In the  early periods
 of pregnancy,  the two layers are  separated from each other, especially toward the  fundus  uteri, by
. a  quantity   of red-colored fluid, partly serous  and partly half-coagulated;  it is a kind  of serous-albu-
 minous fluid.
    As gestation advances, this  fluid  is  gradually absorbed, and  the two laminae come in close contact at
 every point, except where the placenta  intervenes between  them.   For this membrane  splits at the edge
 of the placenta, and one layer passes between it and the uterus, and the other covers the foetal face of it.
 The use of this membrane appears to be the  nutrition and  preservation of  the vitality of the embryo,
 before the elaboration of the placenta.
    When the ovum is first seen, it is completely surrounded by minute, filamentous, mossy vessels, as with
 an  efflorescence, which  proceed from  the chorion, and imbed themselves  in the semi-fluid deciduary
 membrane, secreted by  the uterus.  These filamentous vessels  are called the shaggy chorion.  As the
 ovum continues to grow, the chorion and the amnion  increase in extent; but the flocculent vessels do
 not increase in the same  proportion.   They now no  longer  surround it at all points, and at length
 occupy only, as it were, one corner, where they become clustered together, and then  form what is  called
 the placenta or after-birth;  while the increased growth of the  chorion  and amnion envelops the o-reater
 part of the  ovum.
    The Chorion  is a  thin, glistening,  transparent  membrane, very much resembling the serous tissues,
 very tough  enveloping, and  affording an external covering to the whole  of the ovum, with the  exception
 of the placenta, which is interposed between it  and the uterus.   It passes  over the  foetal face of the
 placenta, and gives a coat to that surface, and also gives a  coat to the  umbilical cord.   It possesses no
 blood-vessels to the naked eye; but we  can not deny its vascularity, because it is subject to disease : and
 in many of the mammalia it can be readily injected.   It is desig'ned,  in conjunction with the amnion,
 both for the protection of the embryo, and of  assisting to form a bag of waters called  the liquor amnii__
 which, forming  a soft wedge, dilate the structures during labor, with the least possible  chance of injury.
   The  Amnion. —This is another thin, transparent, tough membrane,  resembling the chorion in  appear-
 ance, to which it adheres, taking generally a very nice dissection to separate them ; though sometimes the
 gelatirfous substance by which they  are united is found in a tolerably thick stratum.   Its use is the same 
34
IMPROVED SYSTEM OF MIDWIFERY.
as that of the chorion, so far as affording a covering  to the ovum is concerned ;  but it also performs  an
additional, distinct function,  viz.:  it secretes the liquor amnii.
   Liquor Amnii. — This is a fluid  enclosed by the above  membranes, in which  the  foetus floats.  It
varies very much, both in quantity and in quality, in different pregnancies.   Its quantity may vary from a
few ounces to a gallon or more.   The quality may vary, from a perfectly pellucid and inodorous fluid, to
one which is thick, viscid, and dirty, resembling  a strong infusion of coffee, and of a putrid odor.  Its
usual appearance is that of  a rather dingy water,  of a greenish or yellowish cast.  Its relative proportion
with the size of the foetus is greatest in the early stages of pregnancy.  Its use has  been much disputed
by physiologists, some supposing  that  it was intended to nourish the foetus ; but we have  no need of it
for that purpose, because we. have a regular system  of  vessels communicating-with the  mother :  and,
Desides, it contains little or  no nutritious properties.
   Its real  use  appears  to  be, to defend the young embryo from  pressure, blows, and  injuries, and
to protect the funis and  placenta during  the later months of pregnancy from a degree of compression
which would impede the regular  flow of blood through them to and from the foetus, and  to allow free
motion to its limbs;  and also, water being a bad conductor  of heat, it serves  to  keep up an  equable
temperature in the foetus, to  whatever vicissitudes  of temperature the  mother may be subject.
                                        SECTION  VIII.

                 the  progressive  development  of  the  embryo.

   According to Prevost, Baer, and  Dumas, the blood  is formed independently of the heart.   The .
 arteries, veins, and heart, are formed successively.   The development of the nervous system commences
 from the circumference  of  the  embryo, proceeding toward  the centre ;  hence the lateral nerves of the
 head, trunk, and  pelvis, are developed, while the cerebro-spinal system is yet in a  liquid state.
   Of the digestive organs, the  intestinal canal is the first to  appear : it consists, during the first days of
 its formation,  of a curved open tube, extending the whole  length of the embryo, placed before the  verte-
 bral column.   It  communicates with the vesicula umbilicalis.  It  extends and expands, and its superior
 extremity, the mouth, opens about the fourth or fifth week  ; the inferior extremity,  the anus, opens about
 the seventh :   the  outlines of the stomach are visible  about the ninth week.  Before the seventh day we
 can not perceive anything in the uterus which indicates the presence of a new being.   On  the tenth day
 a semi-transparent, grayish flake may be perceived, of an indeterminate form.   From  the  twelfth  to the
 thirteenth day, the presence of a vesicle, the size of a pea, containing a thick fluid, in the middle of which
 swims an  opaque  spot, presents the  first lineaments of the new being that bears  the  name of embryo:  it is
 enveloped by  the  membranes chorion and amnion; the weight is equal to one grain.
   The  embryo may be perceived with the naked eye at  the fourteenth day after  conception.   On the
 twenty-first day, it resembles, in form, a large ant or lettuce-seed  ;  its  length is from  four to five lines,
 and weight from three to four grains :  at this  period the different parts of the foetus present a little more
 consistence, and those which are to  form bones  pass into a cartilaginous state.   On the thirtieth day it is
 about the  size of a  horse-fly, and  resembles a  worm  bent  together.   At this period we may perceive,
 although faintly, some traits of  the  principal organs: the head appears as large as the rest  of the body  ;
 there are also, in the former, black  dots marking the spots for the eyes;  its weight is from  nine  to ten
grains, and its length from ten to  twelve lines.   At the period  of  forty-five days, the development  of the
 oetus  in various parts becomes well  determined : the  superior  and inferior extremities appear under the
 brm of globular tubercles, the former preceding the latter by a  short period of time ;  the body lengthens,
but keeps  the  ovoid figure ;  blackish spots indicate the presence of the eyes, the  mouth, and the  nose  ;
 weight  one drachm, length  one inch.  At from sixty to  seventy days, the  various  parts  of the  foetus 
ORIGIN OF HUMAN  LIFE.
55
become progressively  developed :  the  black  spots  which  represent the  eyes  enlarge, the eyelids are
visible, the nose becomes a little prominent, the mouth enlarges, the external concha of the ear becomes
distinctly delineated, the brain is soft  and pulpy, the  neck  is defined, and the  heart is fully developed.
At ninety days (three months), the  development of all the essential  parts of the foetus becomes perfectly
defined : the  eyelids are distinctly delineated, but  closely shut; the lips are  very distinct and drawn
together;  the organs of generation  are exceedingly prominent  in the male as well as in the female — the
penis in the former and the clitoris  in the latter are remarkably elongated.  The heart beats with force,
and the larger vessels carry red blood ;  the  fingers  and toes are defined ;  the muscular system begins to
characterize itself:  weight, about two ounces and a half;  length, from four to five inches.
  At one hundred  and twenty days, or four  months, the  development  of the  foetus in all its  parts is
remarkably increased :  the brain and spinal marrow acquire more consistence ; the  muscular system is
distinct; and here and there  we meet with some cellular tissue.  The abdomen is fully covered in, and
the intestines are no longer visible ; in the latter a little meconium collects : weight, seven to eight ounces.
  At one hundred  and fifty  days,  or five  months, the development of every part  of the foetus  is very
considerably increased :  the lungs enlarge, and are susceptible  of experiencing a certain  dilatation.   The
cutaneous envelope acquires  at this period  much consistence,  the epidermis is  stronger and thicker, the
situation of the nails is  determined, and the  meconium  is more  abundant, and lower in  the intestines  :
length,  eight or ten  inches ;  weight, fourteen or sixteen ounces ;  intellectual faculties void.
   At one hundred and eighty days (six months), the foetus  is increased  in  its shape and formation : the
nails are marked ; a little down appears on the head, the first indication  of hair ;  the cellular tissue is
abundant, and a little adipose substance is deposited in its cells :  length, from nine  to ten or twelve
inches ; weight, from one and a half to two pounds ; intellectual functions void.
   At two hundred and ten days (seven months), every part of the foetus  has progressively increased in
volume, size, and weight: the  nails are formed, the  hair appears, the  testicles descend,  the meconium
increases in the large intestines, and the bony system is nearly  complete  : length, from twelve to  fourteen
inches ; weight, two and  a half to three pounds ; intellectual functions void.
   From the seventh to the ninth  month, the  successive development  of the foetus is  limited  to  mere
weight and size.  At the period of nine months, the  cutaneous, arterial,  and  capillary systems  become
very active, the skin appears colored,  and the perspiration is established.  The  intellectual  functions
void ; but the  animal functions are  well  developed, especially that of taste.   The child is sensible of
pain, of hunger, and of heat and  cold :  weight, from five to eight pounds ;  length,  from eighteen to
twenty-two inches.
   The  following additional  remarks on the  progressive development  of the foetus are  extracted from
Dr. Severn,  of London :—
   " Impregnation having taken  place, and the ovum conveyed to the interior of the uterus, its presence
may be demonstrated as early  as  the  eighth  day, when a mucilaginous  semi-transparent drop will be
found adherent to the interior of the uterus, generally toward its fundus.
   " At the twelfth or thirteenth day, it is increased in size,  and forms a vesicle  filled with a turbid, floc-
culent fluid,  in the  centre of  which  will  be seen a dark spot, the puncturn saliens, or  heart of the foetus.
   " At the twenty-first day, the embryo is increased to the size of a large  ant.
   " At the thirtieth  day, it resembles in size and figure a maggot, curled up.  At this time, the  buddin°-
projections of the limbs are visible, but their shape is not defined.
  " At  six weeks, the size of the foetus  is about that of a bee ; the clavicles, scapula?, and other  bones, are
traceable ;  the limbs are not yet formed,  but are still rounded  prominences, not having  acquired  their
relative length,  or  definite shape.   The nose, the  eyes, and  the  mouth, are  distinctly visible, and the
head is  larger than the rest of the body.
  " At  two  months, the various parts are so much developed,  that  we can sometimes decide on  the sex •
the features are  enlarged ; the heart and the course of the larger vessels can be traced.
  "At three months, the foetus is  still  further developed: its length  is  three inches, and the genital 
56                          IMPROVED SYSTEM OF MIDWIFERY.

organs are sufficiently formed to enable us to distinguish its sex.   The liver is large in proportion to the
other abdominal viscera, the lungs small, the bones of the extremities are forming, as well as  those  of
the head and spine.
   " At four months, the parts are all progressively increased, and the length of the foetus is rather more
than five inches ;  a small quantity of meconium is found within the intestines, and the movements of the
foetus are felt by the mother, although very feebly and indistinctly.
   " At five  months, its  length is from  six to seven inches, the  nails  are beginning to be formed, the
muscles are traceable, and the mother perceives that its movements are growing gradually stronger.
   " At six months, it is from eight to nine inches in length, meconium is found throughout the whole of
the intestinal canal; and if an abortion take place, the  child is sometimes born alive, but seldom breathes
more than a few minutes.
   " At seven months, it is  between eleven and twelve inches  long ;  and if  now expelled,  it is called a
premature birth, and the child is  capable of being reared.
   " At eight months, it measures from fourteen to fifteen inches.
   " At nine months, it is from eighteen to twenty-two or twenty-three inches in  length."  See n. p. 88.
                                         SECTION  IX.

                      the  umbilical  cord, or  navel-string.

  The umbilical cord is an essential part of the ovum, connecting the foetus to its placenta.  It is found
in oviparous and viviparous animals, and also in  plants;  but in these  different classes it appears with
many modifications.  In the human subject, it consists of  three vessels ; of which two are arteries, and
one is a vein.   On the eighth day, we find this to  be a flattened vascular bag, containing fluid, spreading
over the amnion and yolk,  all  the way to the junction of  the yolk and  albumen.  The vascular mem-
brane of the  yolk extends  no further over it than to that junction.   On separating the yolk-bag from
its adhesion  to  the  albumen, we see, on that part of the  bag, a broad circle, as if there had  been a
deficiency, closed by the albumen.   By the  tenth day,  the vascular  production is no longer a bag, but
the  fluid is gone, and the sides coming in contact,  we find two layers of membrane.  There is, however,
a difference in this respect,  in point«of date, for sometimes the fluid  is gone much earlier.   The double
membrane gradually extends more and more over the albumen, and completely encloses it and the yolk
about the fourteenth day.   Just before this, a small  deficiency exists, through which the albumen could
escape.   In  proportion as the albumen is absorbed, its connexion with the yolk becomes narrower, and,
in the same  degree, the vascular areolar membrane extends.   About  the fifteenth day, the connexion is
by  a very narrow neck,  and the whole vitelline  membrane is vascular to that  neck, which is still more
contracted.   These are imbedded  in gluten, and covered with  a double membranous coat.   The two
arteries are continuations of the arteria hypogastrica of the child, which, passing out at the navel, run in
distinct and unconnected trunks until they reach the placenta, where  they ramify and  dip down into its
substance.  When they reach the placenta, the  one artery, in some cases, sends across a branch, to com-
municate  with the other.  The vein  commences in  the substance of the placenta, forms  numerous rays
on  its surface, corresponding to the branches  of the arteries ;  and, near the spot where the arteries be<rin
to give off branches, these rays unite into a single  trunk, the area of which is rather more than that of the
two arteries.   None of  these vessels are furnished with valves.
   The umbilical vessels run in a spiral  direction,  within the covering of the cord, and  the  twist is gener-
ally from  right  to  left.   Besides this twisting, we  also find that the vessels, especially tlie arteries, form
very frequent coils, loosely lodged in the gluten. 
 
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ORIGIN OF HUMAN  LIFE.
57
   The cord does not consist entirely of vessels, but partly of  a tenacious  transparent gluten, which is
 contained in a cellular structure ; and these numerous cells, together with the vessels, are covered with a
 sheath, formed by the reflection of both chorion and amnion from  the  placenta ;  and, of necessity, the
 amnion forms the outer coat of  the cord.  The chorion adheres  firmly to the cord  everywhere, but the
 amnion does not adhere to the chorion ; it is not even  in  contact with  it at the placental extremity, but
 forms there a slight expansion, which, from its  shape, has been called  by Albinus the processus infundi-
 buliformis.
   The  proportion of gluten is larger in the early than in the advanced stage of  gestation, and the vessels
 at first run through it in straight lines.   In some instances  the cells  distend or augment in number, so as
 to form tumors on the cord, which hang from it like a dog's ear.
   There is a small sac, or bladder,  found  on the  placenta, at or  near the  extremity of the cord, in  the
 early part of gestation.   It is most  distinct between the third and  fourth months of pregnancy, and is
 placed  exterior to the  amnion.   It  is filled, though  not quite  distended, with  a whitish fluid, on which
 account it is called the  vesicula  alba.   From  this  a very fine vessel proceeds  along  the  cord, adhering
 firmly to the amnion ;  but, without  a glass, it can not be traced all the way to the  navel.   It has been
 supposed to be  subservient to the nourishment  of the foetus in its early  stage.   A  small artery and  vein
 pass along the cord from the navel  to the vesicle which is between the chorion  and amnion.   These are
 the omphalomesenteric vessels.
   Besides  the  blood-vessels, there  is  in  brutes  another  vessel,  which  is  a continuation of the fundus
 vesicae.   It  passes out  at  the navel, and, running along the  cord,  terminates in a bag, which is placed
 between the chorion and amnion.   This bag is called  the allantois, and the duct the urachus.   In  the
 human  subject, in place of the urachus, we find only a small, white, impervious  cord.   There is, of
 course, no allantois.
   When  the ovum is first visible in  the  uterus, there is no cord — the  embryo adhering  directly to  the
 involucra, but it soon recedes ;  and, within the  sixth week, a cord of communication is perceptible.
   The  cord at the full  time varies in length from six inches to four feet, but its usual length is two feet.
 When it is too long, it is often  twisted  round the neck  or body  of the child, or occasionally has knots
 formed on it, most frequently, perhaps,  by the child passing through a coil of it during labor.*
   The vessels of the cord sometimes become varicose and form very considerable tumors.   These occa-
 sionally so far impede the circulation, as to interfere with the  growth of the child, or even  to destroy it
 altogether.   Sometimes the vessels burst, and blood  is poured  into the  uterus,  which produces a feeling
 of distension, and excites pain.   There can, however, be no certainty of this accident havino- taken place
 until the membranes burst, when clots of blood are discharged.   If the foetal and maternal vessels should
 communicate, the mother is weakened,  and may even faint ; and in  every instance the child suffers but
 does not always die.  Delivery  must be resorted to, either on  account  of the  effects  produced  on  the
 mother, or to prevent the destruction of the child.
   The  cord may, by a  fall, or violent concussion of the body, be  torn at a very  early period of gestation.
 In this  case, the child  dies, but is  not always immediately expelled.   It may be retained for  several
 weeks ; afterward the ovum is thrown off, like a confused  mass, enclosing a foetus, corresponding in size
 to the period when the  accident happened.  The cord may be filled with hydatids.
   The  cord has been found unusually small  and delicate, or,  on  the contrary, very thick.   In the latter
case, it  is  always proper to apply two ligatures, instead of one, on the portion which remains attached to
the child.t  It has  happened that, by the shrinking of  the cord under the  ligature, the child has died
from haemorrhage.
   Two  cords have been met with, connected with one  placenta, or  with two  placenta? belonging  to  one
child.   In other instances, the vessels  are supernumerary or  deficient.   Stories have been°told of the
cord being altogether wanting, but these are incompatible with the fcetal economy.
   "  Dr. Hunter thinks he has twice seen these formed previous to birth.
   t This was proposed by Mauriceau, in consequence of meeting with an instance where the child suffered much from loss of blood
                                                 8 
53
IMPROVED SYSTEM OF MIDWIFERY.
                                           SECTION  X.

                            the  placenta,  or  after-birth.

   A  placexta, or something equivalent to it, is to be found  connected with the young of every living
 creature.
   We find it requisite that a pabulum should be supplied to every animal, and  that  certain  changes
 should be  performed on the  blood, qualifying it for  supporting life.   In oviparous animals, two  different
 parts of  the  ovum  perform these  separate functions.   The umbilical vessels  of the chick ramify on the
 membrane of the albumen, and thus come in contact with the air, which is  absorbed through the pores
 of the shell;  and, by this  contrivance, changes, analogous to those effected by respiration, are produced
 on the blood.  From the inner surface ,of the membrane of the vitellus, a  nourishing fluid is absorbed,
 and  before the chick  is hatched, the  remainder of this fluid, enclosed in the membrane of the vitellus,  is
 taken within  the abdomen,  and covered with the abdominal integuments.
   In many quadrupeds, we find that after impregnation, certain portions of the  inner surface of the uterus
 enlarge, and  form protuberances,  having  many hollows or foramina, from which  a milky fluid can be
 squeezed.   From the chorion, corresponding vascular efflorescences arise, which shoot into these aper-
 tures ; and thus a union is effected between the mother  and foetus.
   In the sow and the mare there is no  projection from  the uterus, but its surface is  everywhere smooth
 and  vascular.  There is no efflorescence from the chorion, but  it has numerous vessels disposed over it,
 which are  the extremities of the  umbilical arteries and veins.  In these animals, then, wre  have  no distinct
 placenta — the chorion alone serving that purpose.
   1. The placenta is a cellular, vascular, spongy mass, which differs somewhat in size and shape, but  is
 always nearly circular.   It is connected by its outer  surface to the interior of the uterus,  and to the funis
 by the branches of the umbilical arteries and  vein ; the  membranes pass off at its edge,  and encircle the
 foetus, forming the bag in which the  child and liquor amnii are contained.  The most usual place of its
 attachment is to the posterior and upper part of the uterus ; but it may be adherent to the sides, to the
 edges of  the os uteri, or immediately over it.  The  external  convex surface  of the placenta is divided
 into  lobules,  by  fissures, which penetrate a little way  into its substance.   The  internal surface is covered
 by the amnion and chorion, and on it are  arranged in a  radiated direction the branches of the umbilical
 vessels, which pass to form the funis.  There is usually a separate placenta to each child, but this is not
 invariable : in some cases of twins, the funes umbilicales are found to be attached to a single placenta.
  2.  The  funis umbilicalis is composed of the convolutions of the umbilical arteries and vein, contained
 in an investment which is derived from  the membranes : its length  and size   are various, and there  are
 sometimes knots formed in it, especially if it  is  of  more  than the ordinary length.  It  is smaller  and
 weaker at the point of union with the placenta than at the umbilicus of the foetus : great caution  is there-
 fore  requisite in  extracting the placenta: if this be attempted violently, hastily,  or suddenly, the funis  will
 be torn off, and  the  placenta  left  remaining  in utero.  The umbilical  cord  is mostly  attached to the
 centre of  the placenta, but this  is subject  to  some variety — it being occasionally joined to its  side, or
 near its edge.
  ii.  The  membranes consist  of two layers of the decidua, the chorion, and the amnion.
  The decidua externa is in immediate contact with the uterus.
  The decidua reflcxa adheres to the decidua.
  The chorion is a strong membrane, in which the foetus is enveloped ; it gives a covering to the funis,
ami is naarly transparent.
  The amnion is the  thinner of the two; it is transparent, and very strong in texture.
  4.  The liquor amnii varies  in quantity ;  it  is, as its name denotes, contained within the amnion.  In
the early months it is  limpid, but gradually becomes thicker, and, toward the end of pregnancy, is various 
ir
ORIGIN OF HUMAN  LIFE.
59
in its color and appearance.  It preserves the foetus  from pressure, while  remaining in utero, and at the
time of parturition it renders the dilatation of the  os uteri more gradual and easy, by forming a soft and
compressible wedge, by which  the  passages are gradually expanded, and prepared for the expulsion of
the child.
                                          SECTION XI

                                 the  fcetal  circulation.

   The  most remarkable peculiarity of the foetus is its circulation.   Its system  of blood-vessels differs
from that found in the breathing animal, and the blood circulates by a different route.   From the  internal
iliac, or  hypogastric artery of the foetus, on each  side, proceeds a branch (or  rather the continued trunk
itself of each artery), which passes upward on each side of the bladder, emerges at the umbilicus, runs
along the cord or funis umbilicalis, and ramifies in the placenta with infinite minuteness.   The umbilical
vein  is formed by the convergence of  innumerable branches in  the  placenta, which finally unite into one
vessel;  and through this vein  the  blood passes from the mother to the foetus,  for the purposes of its
nutrition and growth.  This vein is enclosed  in the funis ;  it passes  into the abdomen at the  umbilicus,
and enters the liver at the cleft which  separates this viscus into  the right and left lobes, to each of which
it gives off branches  ; the most numerous  go to the  left  side  of the liver, one  to  the vena  portae, and
another considerable  branch, or rather the continued trunk of the umbilical vein, called the ductus veno-
sus, passes direct to the  vena cava inferior.   Those branches of the umbilical vein which are  distributed
in the liver, and  also  those of the vena portae, discharge their contents into the inferior  cava  by the venae
cava? hepaticae.   The superior and inferior cavae enter  the right auricle of the heart.   In  breathing ani-
mals there is a complete septum or partition between the two auricles, which prevents the passage of the
blood from one into the other ; but in the foetus in utero there  is a communication between the auricles.
This opening or communication is called the foramen  ovale, through which the  blood passes from the right
into the left auricle.   Thus the two auricles are filled  with blood at the same time, and, contracting at the
same time, propel their contents into the  two ventricles.   From the  left ventricle  the blood escapes into
the aorta, and from the right ventricle  into the pulmonary artery ;  which latter, instead of conveying all
its blood to the lungs, disposes of three fourths of it through a  vessel called  the ductus arteriosus,  which,
proceeding from  the pulmonary artery, enters  the  descending aorta.   By this apparatus nearly the whole
of the blood brought to  the heart  by the  cavae is  sent from both ventricles into  the  aorta :  part  of this
blood is returned to the  placenta through the funis by the hypogastric arteries, and the remainder is dis-
tributed through  the vessels of the foetus.   Thus the blood in the aorta is impelled synchronously by the
force of  both ventricles;  which is  probably  no more than is absolutely necessary for the accomplishment
also of the more  distant circulation of the  placenta.
   Immediately on the child being born, and respiration taking  place, the circulation is admitted through
the lungs, the foramen ovale  becomes  closed by means of a valve, and its permanent obliteration  is soon
effected.    Those vessels, also, which were alone subservient to  the circulation  of the foetus in utero, soon
become obliterated, and exist only as ligaments of trivial or no use ; while that portion of the  circulation
of the liver connected with the  ductus venosus now becomes a part of the circulation of the vena ports. 
50
IMPROVED SYSTEM OF MIDWIFERY.
                                        SECTION  XII.

                        nutrition  of  the  ovum  and  foetus.

   As the chorion  and its villi are  composed of nucleated cells, we can easily understand their growth,
previous to the development of vessels, and we may  consider the villi of the chorion, to be to the foetus,
what the spongiolets are to  plants ; this resemblance  holds good, not  only in the earlier stages,  but even
when the ovum is  mature ;  the spongiolets are  merely a  loose layer of lax cellular tissue, frequently con-
taining ducts : the  nutriment of the  plant is attracted by them from the surrounding medium, and is passed
from one cell to another until it  reaches the  ducts.  In  the human  ovum the process is the same :  the
nutritious matter is taken up by  the villi, and passed through their cells to the vessels which they contain.
After the circulation in the  placenta, both foetal and maternal, is fully developed, it is evident that the ovum
is  supplied with nutriment, by its villi being there bathed in  the maternal  blood ;  but previous  to  the
placental connexion, we must  suppose the nourishment of the  ovum  to be maintained by some  matter
afforded by the decidua, in short, some material elaborated by the uterine glands.  We believe this to be
the only use of the decidua, although Velpeau has ingeniously imagined that its office was to prevent the
ovum sinking in the uterus, and the placental  attachment being formed over the cervix.   A milky chy-
lous fluid has been discovered in the cells  of the decidua, and it has been observed  that the liquor amnii
contains globules nearly identical in  appearance  and  properties with those  of the thymus gland, which
again are known  to bear a strong analogy to those of chyle.   These two facts  contribute  much  to
strengthen the belief which we have expressed above ;  as the amnion may, by  the  action of its organic
cells, absorb from  the chorion  the  matters  which its villi have taken  up from the decidua, and  deposite
them in the  liquor amnii, as nourishment for the foetus;  and it is also well ascertained that the  solids of
the liquor amnii are much more  abundant during the early months of gestation, but when the placental
connexion between the mother and foetus is  fully established, the nutritive powers of the liquor amnii can
exert but little influence.
                                        SECTION  XIII.

              the  gravid  uterus,  or  full  period  of  pregnancy.

   When we compare the  unimpregnated with the gravid uterus at the full time, we must be astonished
at the change which has taken place during gestation, in its magnitude alone.
   In the ninth month, the size of the womb is so much increased, that it extends almost to the ensiform
cartilage of the sternum ; and this augmentation it receives gradually,  but not equally, in  given times ; for
it is found to enlarge much faster in the latter than in. the earlier months  of pregnancy.  This is true,
however, only with regard to the absolute increase ; for, in the first month, the uterus perhaps doubles its
original size, but  it does not go on in the same ratio.   It is  not twice  as  large in the  ninth  as in  the
eighth  month.
   In the second month, the uterus is  enlarged  in  every part without much  change of shape.  Toward
the end of the third month, it generally measures from the mouth to the fundus about five inches, one of
which belongs to the cervix.   In the fourth, it reaches  a  little higher, and measures five inches from  the
fundus to the beginning of the neck.   In the fifth, it has become so  much larger, as to  render the belly
tense, and  may be felt like a  ball, extending to a middle point between the pubis and the navel,  and
measures about six inches from the cervix to  the fundus.   In other two months, it reaches  to the navel,
and measures about eight inches.   In the eighth month, it ascends still  higher, reaching to about half 
ORIGIN OF HUMAN  LIFE.
61
way between the navel and the sternum.  In the ninth month, it reaches almost to the extremity of that
bone, at least in a first pregnancy, when the  tightness of  the parietes  prevents it from hanging so much
forward as it afterward does.   At this time, it  measures,  from  top "to bottom, about twelve, or, from the
fundus to the brim of the pelvis, eleven inches, and is more globular  than elliptical in its shape.  The
broadest part is a little above the middle, and is ten inches.   For the first month, the shape of the uterus
is scarcely altered ; it  is enlarged  in every  direction.  But after this, it swells  before and behind, and
soon becomes somewhat globular, having the cylindrical undistended cervix depending from  it; after the
fifth month, it becomes  more  oblong,  and, by the seventh, it  resembles a balloon.   These calculations
are not invariably exact,  suiting every case, but admit of modifications.
  In pregnancy, the mouth of the uterus is  extended  backward, while the fundus lies forward.   This
obliquity, however, does not take  place  until  the uterus begins to  rise out of the pelvis, and it  always
exists in a greater degree in those who  have borne many children.
  From this position it appears that the intestines can  never be before the uterus,  but must lie behind it
and round its sides.
  The uterus is  usually  directed to the right side ; but in the last months, if the parietes of the abdomen
be  not relaxed, it mounts more perpendicular.
   Previous to the descent  of the ovum, the uterus  begins to  enlarge, especially at  its upper  part, or
fundus ; and it is worthy of notice, that  the posterior face  of the uterus always distends more than the
anterior one, as we ascertain by examining the  situation of the orifices  of the Fallopian tubes.
   When the fundus begins to increase, it not only grows heavier, but  also presents a greater surface for
pressure to the intestines above; it, therefore, will naturally descend lower in the pelvis, and thus  project
further into the vagina.   In this situation the uterus will remain, until it  becomes  so  large as  to rise out
of the pelvis.   This ascent takes place  generally about the sixteenth week of pregnancy, if the pelvis be
well formed, and the uterus increase in  the usual ratio.
  In the fifth month of pregnancy, the cervix begins to be developed ;  so that, by the end of the  month,
one quarter of its length  has become distended, and contributed to augment the uterine cavity ; the other
three fourths, which remain  projecting,  become considerably softer, rather thicker, and  more spon°y.   In
another month, one half of the cervix is distended, and the rest is still more thickened, or the circumfer-
ence of the projecting part greater ; the uterus has also  risen further up, and the vagina is more elongated.
In  the seventh, we may,  with  the  finger, distinguish the head of the child pressing on the lower  part of
the uterus, which we  can seldom do before this.  In the eighth month, the  neck is  nearly effaced, and
its  orifice is as high as the brim of the  pelvis.   In the ninth month, the cervix is completely developed,
and the whole uterus  more  enlarged.   The  alterations of the  cervix are discovered  by introducing the
finger into the vagina, and  estimating  the distance  between the os uteri and  the body of the  uterus
which we feel expanding like a balloon.
  Soon  after conception, the  os  uteri  is  said  to close, but this is only correct in so far as it is at the
end of the cervix, shut up by  albuminous substance.   Its lips  become a little softer, rather thicker, and
the orifice sometimes, but not always, seems more circular.  The changes, however, in the early period
are not so marked as to afford of themselves  positive indications of  pregnancv.  In proportion as gesta-
tion advances, and the cervix stretches, the lips become rather  thicker, and, although in a few instances
they may shorten, yet they always continue to project  until  labor commences.   All the inner surface of
the  cervix uteri, in the whole course of  gestation, is full of glandular follicles, whtch  secrete a thick,
viscid mucus.  This  extends from the  one side  to the  other, and fills  up the top of the mouth of the
uterus very perfectly,  being thus interposed as a  guard  between  the membranes and  any foreign body.
By  maceration, it may be extracted entire, when a mould of the lacunas will be obtained by floating it in
spirits, saturated with  fine sugar.
  Vesalius describes three strata of muscular fibres — transverse, perpendicular, and oblique.  Malphigi
describes them as forming a kind of network ; while Ruysch maintains that they appear at the fundus, in
concentric planes, forming an orbicular  muscle.   Dr. Hunter paints them as transverse in the body of the 
fi
IMPROVED  SYSTEM OF MIDWIFERY.
uterus, but at the fundus describing concentric circles  around each of the Fallopian tubes.   These con-
tradictions of anatomists serve to show, what may readily be seen by examining the uterus, that the fibres
are not very regular and distinct in their course, but the circular seem to predominate.   The lips of  the
os uteri have few, if any, muscular fibres.
   The increased size  of  the uterus  is  by no means entirely owing to the addition  of muscular fibres.
These become indeed larger and better developed, but do not contribute so much to the increase as  the
enlargement of the blood-vessels, and  perhaps  the deposition of  the cellular substance.  This gives  the
uterus a very spongy texture, and makes it  so ductile, that a small aperture may be greatly  dilated
without tearing.   From examination, it appears that, although the whole uterus do not grow thinner, in
proportion to its increase, yet it does, at the full time,  become a little thinner near the mouth ;  while  the
fundus continues the same, or perhaps grows  rather thicker, at least where  the placenta  is attached.
   No one, who understands the anatomy of the ligaments of the unimpregnated uterus, will be surprised
to find a great change  produced in  their  situation and direction, by pregnancy.    The  broad ligament,
which is only an extension  of the peritoneum from the sides of the uterus, is, in the ninth month, by  the
increase  of that viscus, spread completely over its  surface ; and, consequently, were we  to search  for this
ligament, we should  be disappointed.   Its duplicatures are  all separated  and laid smoothly over  the
uterus.   It will therefore be evident  that we  can  no longer find  the ovaria and Fallopian tubes  floating
loose in the pelvis, nor the round ligaments running out at  an  angle from the fundus uteri to the groin.
All these are contained within duplicatures of the peritoneum, or ligamentum latum ; and therefore, when
this is spread over the uterus, it follows that the ovaria, tubes, and round ligaments, particularly the lasi,
can  not now run out so loosely from the uterus, but  must be laid flatter on its surface, by the extended
peritoneum.   This description  applies  only to the state of the uterus at the full time.   Earlier, we may
readily observe the broad ligament floating out, so that the ovaria are more  distant.  The loose extremity
of the tube becomes more expanded, and  very vascular, and forms a kind of cavity called the antrum.
   The state of the ovarium has already been  described.
   CHAPTER IV.

PREGNANCY.
                                          SECTION  I.

                                the  signs  of  pregnancy.

   When impregnation has taken place, certain changes are usually produced in the female system and
generative organs.  It is very important that the accoucheur should be able to distinguish these changes
from others which resemble them, and to determine  whether  the female be pregnant or not; because her
reputation, as well as  the moral reputation of the female, will frequently depend on a correct or incorrect
diagnosis of a supposed case of pregnancy.  Young women who are  illegitimately pregnant, when sus-
pected, will  generally deny the fact, and that with great warmth, declaring that they are slandered, if he
concur in this opinion ; so  that wTe must depend upon the accuracy of our own knowledge, and expect no
assistance from  the female under such circumstances.
   We shall  find others who are not pregnant, who  suppose  themselves to be so, or are supposed to be
bo by others, in  consequence of  suppressed  menses, enlarged  abdomen, &c.  And we  shall doubtless 
PREGNANCY.
63
find that it will take all the tact and judgment we can possess, to enable us sometimes to form a correct
opinion on a case of supposed pregnancy.   The following amusing anecdote, which occurred in this city
some years ago,  may serve to illustrate the importance of knowing whether a woman is pregnant or not,
perhaps better than any argument which  we could advance :—
  A lady, aged forty-seven, who had been married since  her thirtieth year, had entertained a most anx-
ious desire to become a mother, but had not  succeeded  in  her wishes, and was  about abandoning all
hope, when, of  a sudden, she  noticed  that her  abdomen began  gradually to enlarge, and she  really
imagined herself pregnant.  In  addition  to the  ordinary symptoms of gestation,  she thought she distinctly
felt the motion of her child.   She received the congratulations of her friends, was complimented on her
prowess and the final accomplishment of her hopes after years of fruitless effort, and commenced making the
necessary  preparations for her approaching accouchement.  Her physician was sent for, and was informed
that his services  would be required,  &c.   In the course of a few months, the labor commenced; a mes-
senger hastened to admonish the doctor that the lady's time had come, with a request that he would lose
no time in reaching the bedside of his delighted patient.   The doctor arrived — all  in the house was con-
fusion— the nurse was enchanted — the  husband could scarcely realize the advent of this long-expected
era in his  life — the patient was  in actual labor — the pains frequent and distressing.  The physician was
entreated to lose no time in assisting madam:  he  instituted  an  examination—the silence of death now
pervaded the  lying-in chamber to hear from the lips of the oracle the exact facts of the case.   They were
soon made joyful by hearing  from the doctor that all was  right — that the labor was quite advanced, and
in a very short time would be completed.   The sufferings of the patient increased — she was requested
to make the most of her pains — to bear  down and assist nature — when, lo  ! in the midst of one of those
powerful efforts to "assist nature," there was heard an explosion, which struck terror into the hearts of
all present, the  doctor included.  The  patient immediately exclaimed, " Oh ! dear doctor, it's all over :
do tell me  if it is a boy !"  The explosion was nothing more than an escape of air from the bowels, the
patient having mistaken flatulence for pregnancy, and the  rumbling of the  gas  in  the  intestines for the
motions of the foetus.   Comment is here unnecessary ;  let this  case, however, admonish all of the neces-
sity of caution.
  It is a well-known fact that Dr. Clarke, physician to the queen  of England, pronounced  one of her
maids-of-honor pregnant, and occasioned great' affliction,  both to herself and all her  friends :  and  it was
afterward  proved that she labored under disease, and  not pregnancy.  Physicians, without great  care,
may on this subject make many very unpardonable mistakes.   One which came to  light a short  time ago,
in the neighborhood of this city, we may relate, as a warning to  all to take care how they give an opinion
on this subject without indubitable evidence.   The  anecdote is now annually repeated in one of our
colleges in this  city by the professor of midwifery, as a warning to all students and others who may be
present:—
  A minister  and  his daughter, a  young lady  aged  eighteen, emigrated  to  this country ;  and, before
leaving England, an attachment was formed between her and a  respectable attorney, which resulted  in a
matrimonial  engagement.  Soon after this, her  health began to decline.  There was loss of appetite,
irregularity in her menses, and  swelling of  her abdomen ;  she was, in  short, suspected of pregnancy.
The lawyer, hearing of  these reports, immediately  wrote  to  her father, and begged to be released from
the contract, which was acceded to.   Her physician likewise pronounced her pregnant.  But her father,
feeling indignant at this imputation against her  virtue, requested an additional consultation, which resulted
in the same opinion.  The father and daughter now set sail for  America ; and on the passage  she became
very ill, vomiting from sea-sickness.  A physician  on  board, concurring in the previous opinions  given,
apprehended a  premature delivery.  On her  arrival  in  this country, and becoming located near New
Y'ork, a physician was sent to visit her, and, upon examination,  pronounced her not pregnant;  and gave
his opinion that  the lady was afflicted with a  tumor  in the uterus, and that she was laboring under the
last stage  of consumption : which proved to  be  the case, and  she survived  but  a  short period.   The
same  physician held a post-mortem examination, and found that the lady had been laboring under a cal- 
6t
IMPROVED  SYSTEM  OF  MIDWIFERY.
careous tumor of the womb, which  had given rise to all  the  symptoms resembling  pregnancy.   This
instance shows still further the necessity of exercising great caution in giving our opinion in a supposed
case of pregnancy.
   Numerous cases are on record, where a  false diagnosis in women convicted of capital offences, has led
to most lamentable results, and where dissection of the body after death has shown that she was pregnant.
Dr. Evory Kennedy has recorded an interesting  case of this sort which occurred at Norwich, England,
in 1833, when a pregnant woman was on the point of being executed through the ignorance of a female
jury.  We may also mention  a  dreadful  case of this nature which occurred  to the celebrated Baude-
locque, at Paris, during the  horrors of the French revolution.   A young French countess was imprisoned
during the revolution, being suspected of carrying on a treasonable correspondence with her husband, an
emigrant.  She was condemned, but declared herself pregnant; two of the best midwives in Paris were
ordered to examine her, and they declared that she was not pregnant.  She was accordingly guillotined,
and her body taken to the school of anatomy, where it was opened by Baudelocque, who found twins in
the fifth month of pregnancy!
   In many instances the character and  happiness of  the  individual must depend  upon the  judgment
which the practitioner pronounces ;  and, painful  as will be the task of communicating an opinion which
implies guilt and  loss of honor, how infinitely revolting and  inexcusable  must  that step be considered
which turns out to have  been founded upon an incorrect diagnosis !   Hence the importance of separating
those symptoms of pregnancy which  may be considered certain, and therefore trustworthy, from the crowd
of others, which, although collectively they may warrant a suspicion, yet never can justify a decision that
pregnancy exists, more especially in cases  where  so much is at stake.   No two symptoms have led more
frequently to this cruel error, and therefore to  the most unjust suspicions, than the cessation of the menses
with swelling of the abdomen, and yet from how many different causes may they arise besides that of preg-
nancy !  Putting even the impulse of common feeling aside, we would ask how a practitioner can dare
recklessly to incur  the  responsibility of injuring a woman's character by hazarding  an  opinion  which
involves so  much, and  is  based upon  symptoms which, by themselves, prove so little ?   Whether he
exercise his profession in town or country, cases of doubtful pregnancy will constantly come under his
notice.  We can not, therefore, too  strongly urge the  importance of ascertaining how many of the certain
symptoms are present, before  we allow ourselves  to be influenced by those which are uncertain.
   In speaking of the enlargement of the abdomen as a sign of pregnancy which is extremely equivocal,
Dr. Dewees well observes : " But little reliance can  be  placed upon  this circumstance alone, or even
when combined with several others ; for I have  had the  pleasure in several instances of doing away an
injurious and cruel suspicion,  to which this enlargement had given rise.   Within a short time, I relieved
an anxious and tender mother from an almost heart-breaking apprehension for the condition of an only
and beautiful daughter on whom  suspicion  had fallen,  though  not quite fifteen years  of age : this case, it
must be confessed, combined several circumstances which rendered it one of great doubt,  and, without
having had recourse to the most careful and minute examination, might readily have embarrassed a young
practitioner.   This lady's case was submitted  to a medical gentleman, who, from  its history and the feel
of the  abdomen, pronounced it to be a case of pregnancy, and advised the sorrow-stricken mother to send
her daughter immediately to the country as the best mode of concealing her shame.  Not willing to yield
to the  opinion of her physician (a young man), and  moved  by the positive denials of her agonized child,
the mother consulted me in this case.  The menses had ceased, the abdomen had gradually swelled, the
stomach was much affected, especially in the morning, and  the breasts were a little enlarged.  On  exam-
ination, it proved to be a case of  enlarged spleen."
   We occasionally observe certain conditions of  the female system which put on a  most striking resem-
blance to pregnancy, both  functionally as well  as  organically, without at all depending  on the actual
presence of pregnancy.   The abdomen begins to swell from the pubic region exactly in the  same gradual
manner as  in  pregnancy; the  breasts become painful, swell, and  secrete a  lymphatic  fluid, frequently
resembling milk;  the digestive organs become disordered ;  there is  irregular appetite, nausea,  and inch- 
s$?*.  -•--•'■  '>■■   -
  ■:.:         "■ - ->■- - 
IP  3L  A T
IQllmflto&ftiteia  ®$  Vs&oltaiM© ILaif©<
 Fig. 1.  Reproductive parts of the flower,
-tamens and pistils.
   a Lily.    c Potato.   e Ginger.
   >> Senna,   dBarberry. /Sage.
  Fi
eoty
               , .   „     •  . •      Fig 2.  Section of the  top of the style   Fig. 3.  Pollen gram of JEnothtra bien-
g. 4.  The seed of the Bean, with its  0f ^ragon, showing the passage of the nis, sending its tubes (a) between the cells
ledons (aa) separated.  (6) Germ.       „     b f between its cells             (6) of the
the Stigma.
HEllmBtoaifciifl&m off  Anafimall  Off©.
Fig. 1.
Fig. 2.
Fig. 3.
Fig. 4.
Fig. 5.
Fig. 6.
Ovum of a Rabbit, third day after impregnation, magnified 40 diameters
Ovum of the Frog, recently laid, magnified 2 diameters.
The Ovum of the Water Newt, magnified rather more than twice.
Ovum of the Water Newt, more fully developed.
Embryo of the Frog, more fully developed.
Ovum of a Rabbit, seven days after impregnation, magnified 40 diameters.


     EIlEmstoattaom off Etasisiim Mifoo
*  2
Fig. 1.  Diagram of a human foetus of the third week, enclosed in the decidua.  Size of life, in its natural situation in the womo.
Fig. 2.  Ovum more advanced, with the membrane laid open.
Fig. 3  Firms not fully developed.
Fig 4  More advanced—two months after conception.
Fig. 5  Foetus within the membrane in the early months of pregnancy—head very large,and extremities small and imperfectly formed.
Fig. 6.  Corpus Luteum, or appearance of the Ovarium after conception. 
PREGNANCY.
G5
nation to vomit;  constipation, muscular debility, change in the color of the skin, and frequently of the
whole condition of the body; the nervous  system suffers, and even the mind itself frequently sympathizes;
the patient is sensible of movements in the abdomen like those of a living foetus, then bearing-down pains
running from the  loins to the pubes ; at last actual labor-pains come on as with a woman in labor, and if
by chance her former labors have been  attended by any peculiar symptoms, these, as it were, to complete
the illusion, appear likewise.
  In  the early part of my practice, females have frequently applied to me, professing to labor under some
diseased irregularity  of the menses ;  when, on investigation, I discovered and pronounced some of them
pregnant:  and although  it was strenuously denied at the time, I  have afterward  been called to attend
them  in labor.  While, on the other hand, I have frequently known various diseases of the womb, com-
plicated with disease in other  parts of the system, so closely to resemble pregnancy, as to deceive many.
Hence the necessity  of great caution and accuracy.  I believe I have never yet given a wrong opinion
on this subject.  In making  up our minds, we should not be  too positive, unless indubitable evidence be
present.  If  we are doubtful, let us say so.  Our opinion must not  be formed on one, but on the  concur-
rence or the assemblage of reliable symptoms.  The following are the principal symptoms of pregnancy :
   1.  The  Menses. — If the menses  are arrested,  and the female had previously been both regular and
in good health, and there is no other evidence that "she has  taken cold — and, more than all, if, added to
this, there  is no dizziness of the  head — there  is  a very strong probability that she  is pregnant.   If the
female, after sexual intercourse since her last  menstruation, has experienced  any sudden  excitement, or
change of  the  system, as chills, lassitude, &c, without any known adequate cause, it affords additional
evidence that she has conceived.
   2.  Morning Sickness. — In most  cases,  not in  all, a  very distressing nausea or sickness, resembling
sea-sickness, is experienced, especially in the  morning.
   3.  Salivation. — There is sometimes in  pregnancy a preternatural disposition to secrete saliva, and
especially to spit  what some term an "English shilling."
   4.  A short time after conception, there is often a  preternatural fulness of the abdomen in the evening;
but in the morning there is a perfecfsubsidence, and the abdomen then appears even less than natural.
   5.  The breasts or mammary glands become larger  than  usual, the  small  papillae become elongated,
and the areola or circle  around it  becomes of a darker  hue.   The milk is sometimes secreted  early iu
pregnancy,  and toward the end it often  escapes from the nipple.
   6.  The  urine is generally more abundant, and more pale and limpid.
   7.  Neck of the Uterus. — In the early part  of  pregnancy, the neck of the womb becomes lower
in the vagina, and the os is closed by coagulable  lymph.  As pregnancy advances, the neck shortens.
   8.  A gradual and prominent enlargement of the abdomen, of a  peculiar rotundity,  and a globular-like
form, imparting a peculiar appearance and gait, easily recognised.
   9.  The appetite is very capricious—^sometimes  the patient eating enormously;  at others,  scarcely
able  to eat at all.
   10. Nervous  System. — In most cases of pregnancy there is great  irritability of the nervous  system.
Cramps and numbness of the lower extremities are sometimes accompaniments of pregnancy.
   If  these symptoms generally are present, in  the great majority of cases the female is pregnant, but not
in all  cases when  present.   The only infallible signs of pregnancy are —
   1.  The  Movement  of the  Child — not  the woman's fancies — for many women have  been
deceived on this point.   To ascertain the movement of the child, place the woman on her back, with
the legs a little  flexed ; bare the abdomen, and dip the  hand in some very cold water, and apply it sud-
denly over the tumor: and the motions of the  child will infallibly,  if alive, declare its  existence.
  2.  Beating of the fcetal Heart. — By the stethoscope, or even by the naked ear, applied  to
the abdomen of the mother, the fcetal heart can be heard to beat, at the rate of one hundred and thirty to
one hundred and  forty per minute.   When  this is heard,  of course it is infallible ;  but we should never
forget that a female may be pregnant, and neither  of  these signs be present, because neither of them arc
                                               9 
06                          IMPROVED SYSTEM  OF  MIDWIFERY.

available until after quickening:  and even then the child may die.   So that, although these last are infal-
lible signs when they are present, yet  their absence  does not as certainly prove the negative :  since the
rh'dd may be dead, or it may not have arrived at the age at  which the test is available.
                                          SECTION  II.

                             THE  DURATION  OF  PREGNANCT.

   Experience has shown that the ordinary term of human pregnancy, wherever it has been capable of
 being determined with any degree of  accuracy, is two hundred and eighty days, or forty weeks ; and this
 period seems to have been generally allowed even from the remotest ages.   As, however, it is so difficult
 to fix the precise moment of conception, it  has  been customary in different  countries to allow a certain
 number  of days beyond the usual time : thus the "Code Napoleon" ordains three  hundred days as the
 extreme  duration of pregnancy, allowing twenty days over to make up for inaccuracy  of reckoning.   In
 Prussia it is three hundred and  one days, or three weeks beyond the usual time.   In England  the limit
 of gestation is not so accurately  determined by law, and therefore gives rise occasionally to  much discrep-
 ancy of  opinion.
   On this subject Dr. Huston, of Philadelphia,  has  the following observations :—
   " There  can be no doubt but that, as  a  general  rule, gestation  in  the human female is completed in
 about two hundred and eighty days ;  but we have well-attested cases on record in which it certainly con-
 tinued much longer—sufficiently numerous, indeed, to establish the fact that much variety occurs in  that
 respect.   I have known at least two instances in which I had the strongest  reasons for believing that it
 extended, in one case two weeks, and in the other  three weeks, beyond the usual period, or nine calen-
 dar  months.   It is  undeniable that children  are  often born short of that period, healthy  and well grown ;
 and there is certainly no reason  why  nature  should not deviate fro|n her accustomed cause in delaying as
 well as anticipating the time : especially is it unreasonable to deny that such deviations may occur in the
 human female, when it is known that  it happens every day with inferior animals that are far less  exposed
 to the causes most  likely to produce such irregularities."
   By the law of Scotland, a child born six months after the marriage of  the  mother, or ten calendar
 months after the  death of the father,  is considered legitimate.   The last case of labor which I  attended,
 the woman had evidendy run her full  period, yet she did  not calculate to be confined for thirty days after-
 ward : all which shows the difficulty of ascertaining  precisely the time of  conception, or the duration of
 pregnancy.
   It would therefore appear that, in making  up our minds on the subject of the duration  of pregnancy,
 we must allow  considerable latitude, in consequence, first, of the difficulty  of  at all times ascertaining the
 precise moment when conception takes place ; and, secondly, from our knowledge of the peculiar organi-
 zation of some women, and the protracting influence  which depressing passions may have on the  duration
 of pregnancy in such cases.   We have on record an account  of the decision  of a court of law in  Europe.
 in favor of a lady  who wa3 delivered  of a child  ten months after the death  of her husband; and from the
 reputation of the woman, and other circumstances, no doubt was  entertained of the  correctness of her
 statement.   From all which facts, the  physician and others must learn to be very guarded in their opinion
 in all cases where the character  and reputation of the person  is involved, and that we should all exercise
 great charity toward all those charged with guilt of this nature : especially when we remember that con-
 siderable variation^ frequently take  place in,the  duration  of the pregnancy of our domesticated animals,
4>( who-e period of gestation we  can k^ep an exact account — as the cow, the mare, the  sheen, &c. 
PREGNANCY.
G7
                                          SECTION III.

           THE  SIGNS  OF  IMMATURITY  AND  MATURITY  OF  THE  FCETUS.

   It is unnecessary for  me to enter  here into a long  detail of the signs  of immaturity which the foetus
presents, because they are  merely the changes which take place in its different organs, as its development
progresses, and these have already been detailed at full length.
   To determine the age of a child, then, the  first points to  be examined are — its length and weight; the
position of the central point of the body; the  size of the head ; the length  of the hair ; the dimensions of
the fontanelles ;  the organization  and development  of the  nails ; the texture, density,  and color, of the
skin ; the presence of fat; and the sebaceous coating of the  skin.  We ought then to observe the state of
the various functions — respiration, digestion,  and circulation.
   The length of the foetus at various times, has  been  already carefully given.   At the  full time it varies
much, but  the average Is between eighteen and twenty-two inches.  The weight has also  been  noticed ;
at the full period (two hundred and eighty days) that of the  male has been  found on an average of neatly
seven thousand cases to be six and three  quarters pounds, and that of the  female five and a half pounds.
 The central point of the  body is situated, at the sixth month, on the ensiform cartilage of the sternum ; at
the seventh, between the ensiform cartilage and the umbilicus, but  nearer the  former, yet  this varies much ;
in one case by Devergie, it was found only two lines  above the  umbilicus  ; in  another, an inch  and a
half above it.  At the eighth month, it is still nearer the umbilicus ; and at  the ninth month, it is said to
be situated at the umbilicus; by Moreau it is placed ten lines above it, and by Devergie seven ; it appears
to me that  the position of the central  point of  the body is  far from being so infallible a  sign  as is generally
alleged.   The hair of the head appears like down at the fifth month, and becomes longer  until the ninth
month, when it has been seen two or three inches in length, and that especially if of a dark color.   The
head in the fifth month is disproportionably large when compared with  the rest of the  body ; but as the
body becomes larger, this  disproportion diminishes ; the fontanelles are also very large, and wide in the
early months, and the bones  move with very  great freedom on each other;  but as the child grows older,
the fontanelles become smaller, and the bones  move  with less ease, although  they still overlap to  a certain
degree with facility.   In a foetus  at the full time, the  average  dimensions of the head are as  follows:
from the vertex to  the root of the nose, four inches;  from the vertex to the chin, five inches;  from the
one spheno-parietal  articulation  to the other,  three inches six lines ; the  circumference round the super-
ciliary ridges and occipital  protuberance, fourteen  inches.
   The nails begin to appear in the  fourth month ;  are very distinct in  the fifth, but  are  still  red and
fleshy.  They do not yet reach the extremities of the fingers  in the seventh ; in  the  ninth, they cover
the fingers  to their points.
   The skin, in the fourth month, is reddish and  dense ;  in  the sixth, it presents fibres in its substance,
and  is covered with  a white silvery down ;  in the seventh, it is still reddish, but more fibrous, thicker,
and  generally much  wrinkled ; this gives to the features the expression  of  old age; at the ninth, the skin
is firm, smooth, at first bluish, but afterward reddish, and then of the usual skin-color.
   The fat is first observed in the fourth month, and gradually increases, and  generally abounds in con-
siderable quantities at birth.   The sebaceous coating  first appears in the  seventh month,  is well marked in
the eighth,  and generally abundant in the ninth.
   As to the function of respiration,  a  mature child  breathes  freely, and cries loudly; but an immature
child breathes with difficulty, as if it were about to  be choked, or as if it  required  to rest and recover
itself before making a second inspiration, and instead of  crying, it utters frequent low moans.
   With regard to the function of the digestive organs, the mature  infant sucks vigorously, and  passes
meconium  and urine soon  after birth ;  but the immature infant can not suck, perhaps not even  swallow,
and  its bowels are moved with difficulty.            , 
G8
IMPROVED SYSTEM OF MIDWIFERY.
  As to the circulation in the mature child, the heart beats strong and  quick ; in the immature  infanf,
feeble and slow ;  it is unable to maintain its own warmth, and requires to be  carefully wrapped up and
its heat maintained by various artificial  means;  it also sleeps  almost  constantly.   Such  are the differ-
ences which characterize the mature and immature foetus; and  by means of these, together with an
examination of the degree of development of individual organs  as  above given, a  tolerably  accurate
opinion  may be formed as to its age.
                                         SECTION IV.

                        ABNORMAL  OR   UNHEALTHY  PREGNANCY.

   By abnormal pregnancy we mean  all those pregnancies which deviate from the usual natural order—
whether as to time, place, form, or appearance of the foetus.
   Superfcetation. — By this term we understand the impregnation  and development of an additional
ovum or foetus in  a woman not only already pregnant, but after that function has made some progress.
   The circumstances  which have  given rise  to, and tended, from time  to time, to  support  the idea of
superfcetation, are, females in plural deliveries producing infants of different sizes and various colors, and
within a few weeks or months of each other.
   And although  some doubt the fact, yet, from  some well-authenticated records, it seems quite probable.
One strong reason  in favor  of its probability is, that  the menses  sometimes  continue to flow for several
months after impregnation has  taken place, which  appears  in  such cases to continue the female in a
condition capable of again conceiving.
   The production of  a foetus of different colors at a birth is a strong  evidence  of this occurring.  The
oldest on record  is by M. Buffon, in which  a woman at Charleston, South Carolina, produced in 1714
a dark and a white child at one birth !   This remarkable  occurrence  led to an investigation, which the
woman herself at length satisfactorily explained, by acknowledging that, one morning, after the departure
of her  husband, the black valet entered  her bedroom, and menaced  her with instant destruction, unless
she submitted to his embraces.  Such was her story, which, whether true or false, is of but little conse-
quence to the  fact itself, viz., that she had  conceived by both of them, and that, of course, at different
times, either of a longer or a shorter interval.
   Dr. Mosely, also, relates an example somewhat similar to the above, which occurred on  the Shortwood
estate, on  the island  of Jamaica, while he  resided there : A negro woman on the  estate produced  two
infants at a birth, the one the  same color as herself, the other a mulatto.   On inquiry as to their want of
resemblance, the woman replied that she was perfectly aware of the cause ; for that, one morning, after her
sable husband had quitted her, she received the embraces, of a white man who came to her hut.  These
cases, however, should  not be regarded as examples of superfcetation,  but rather as instances of contem-
poraneous conception, arising from sexual intercourse with two different men.
   But there are  many cases on  record in which the foe.tus has been expelled at intervals of weeks and
even months of  each  other.   These  cases are not always so easy to understand or  explain.   The  most
extraordinary cases of this kind on record  are  of rather recent date.   The first case is one  reported by
Dr. Desgranges, of Lyons, in France.  He reports that the wife of Raymond Villiers, of that city, mar-
ried at  twenty-two years of  age, became  pregnant five years afterward, and on the  20th of May, 1799,
was delivered at the seventh month.   In a month from this time she conceived again; and seven months
after, she  brought forth  a  living child.  This delivery, however, was not followed by the usual changes,
such as  the milk, lochia, diminution of the abdomen, &c.  Two  surgeons visited her, but being unable
to account for these  circumstances, they called Dr. Desgranges in consultation :  and he gave as his
opinion that there was another foetus in the uterus. 
PREGNANCY.
69
  Three weeks after this opinion was given, the movements of the child confirmed it:  and five months
and sixteen days after the birth of the first  infant, Madame Villiers produced another living  daughter!
The milk was now secreted, and the mother enabled to nurse it.
  The  next  case we shall  mention  is that  recorded by Dr.  Maton.  Mrs. T-------,  an Italian lady,
married to an English gentleman  attached to the commissariat of the British army, then in  Sicily, was
delivered of a male child on the 12th of November, 1807, which  had every appearance of health.   The
lady was delivered under very painful circumstances, the child  having been expelled among a quantity
of straw, at midnight, in an uninhabited apartment, and it only lived nine days.   (Such privations are not
uncommon to ladies  who accompany invading armies.)   On the 2d of February, 1808, rather more than
two and a half months afterward, Mrs. T-------was delivered  of another male infant,  completely formed,
and apparently in good health.  When about three months old, this child fell a victim  to measles.
  Sachias relates a  case, where a widow, eight  months after the death of her husband, was delivered of a
deformed foetus, \vhich died during labor.   The woman's abdomen  continuing large, it was suspected to
contain a second child ; but all efforts to procure its expulsion  proved unavailing, until one month and a
day afterward, when labor supervened, and a healthy living infant  was produced.
  M. Velpeau, in his "Elements of Midwifery," relates the case of a Madame Bigaud, who, on the 30th
of April, 1748, produced  a living male child,  and, on the 17th of  September following, another infant,
which was also living and lively.   He also gives another case,  of a woman named Artes, who, in 1796,
gave birth to a child at  the full term, and, five  months afterward, to  another, which also was thought to
be at the full term.
  Lobstein,  in the " London Medical and Physical Journal," states  that he delivered a woman  of two
infants, one a month  after the other ;  and was able to convince himself that she had two uteri, and to each
a distinct branch of  the vagina.
  Dr. Purcel, in examining the body of a woman, discovered  that  she  had  a double uterus, in  one of
which he found a foetus.   There was but one tube and ovary to each uterus.
  Dr. Norton delivered a woman of a black foetus of the eighth month, and of a white one of the fourth
month.   Having attempted to extract the placenta of the first before the second was born, he  discovered
» passage so  narrow that it would not admit his hand ;  so that this woman must have possessed a double
uterus, and to each a vagina.
  There is a preparation of a double uterus in the museum of Professor Rockitanski, at Vienna, and each
uterus presents the appearance of having been,  at one time  at least, pregnant.
  While, therefore,  we admit that superfcetation is possible, yet the majority of supposed cases, we doubt
not,  will be found to be either the result of a double  uterus, the expulsion of a twin at seven months (while
the  other is  carried  to full time, or even beyond), or a blighted  ovum, in  a  double  or  treble conception,
which has ceased to grow, and presents, when born, the  appearance of  a  foetus several months,  it may
be,  younger than the others.
                                          SECTION  V.

                                     MOLE  PREGNANCY.

   When, from any cause, the life of the embryo is destroyed during the early weeks of pregnancy, one
of these two results follows : either expulsion takes place, or the membranes of the ovum become remarkably
changed, and continue to grow for some time longer, until at length they form a fleshy fibrous mass, called
mole or false conception.
   Moles generally increase faster in size than natural pregnancy ;  so that generally the  uterus is as large
in the third month, as it is in the fifth month in true pregnancy. 
70
IMPROVED  SYSTEM OF  MIDWIFERY.
   In one form of mole, the uterus is filled with a large mass of vesicles of irregular size, and appear like
hydatids.   Many other varieties of molar growth have been enumerated by authors, too tedious to specify.
In fact, the term mole has been rather vaguely applied  to  almost  every shapeless mass  which has issued
from the womb, whether  as coagulated blood, tumors, or  blighted ovum after conception.   For the first
eight or ten weeks, we know  of no  symptom by which  we can distinguish molar from natural pregnancy.
In all cases of moles, flooding  sooner or  later takes place.   The patient's  health declines :  a discharge
from the vagina  usually succeeds  to swelled feet; the  discharge  from the  wotmb is usually excessively
putrid  and  offensive, and at length the mole is discharged.
   The process of expulsion resembles that of abortion  : pain in the back, groins, and lower part of the
abdomen,  with more or less discharge of blood; but at  length bearing-down pains succeed, and the  mass
is  expelled.  Sometimes, on examination, we shall  find the os uteri relaxed and  dilated, and probably a
portion of  the mass protruding  into  the vagina : it may  then be seized by the fingers and extracted.   The
after-treatment must be the same  as in  abortion.   Those  who suffer  from  frequent molar  pregnancies,
generally have their health  much reduced by leticorrhoea,  floodings, or obstructions of  the menses, with
many other troublesome and  dangerous symptoms, the  recovery from  which will be slow and  difficult —
requiring generally a course of  tonic medicines, change of air, &c.
                                         SECTION  VI.

                               E X T R A-U T E R I N E  PREGNANCY.

   Tubal, ovarian, and ventral pregnancy, occasionally  occur.  The embryo, or  something very much
resembling it, is sometimes found in  the ovaria, sometimes in some parts of the Fallopian tubes, or even
in the cavity of the abdomen.
   According to the opinion entertained by modern physiologists on conception, as before  stated, the
ovum or egg is  impregnated in the  ovaria, and is  afterward conveyed  into the uterus  by the Fallopian
tubes.   In these cases, they consider that these tubes do not perform their office from some cause ; some-
times they do not take it up at all: then we have ovarian pregnancy.   Sometimes  the ovum is left in the
tubes, constituting tubal pregnancy.   Sometimes they imagine that the fimbriated extremity of the tubes,
after seizing the ovum, drops it into the cavity of the abdomen, constituting ventral pregnancy.  I have
always, however, entertained very serious doubts whether a perfect foetus was ever developed in these parts,
particularly in the ovaria, as I have intimated on another  occasion in a previous chapter.   It does appear
to me, from both reason and analogy, founded on the facts brought to light by recent physiological inves-
tigations, that the  elementary rudiments of the foetus furnished by the female  alone, are found deposited
in other parts besides the uterus, and that there  is afterward a constant  accumulation of new materials,
which have at length produced  a formation resembling somewhat a human foetus.
   I have, however, in my  anatomical museum, models  of a perfectly-formed foetus, both in the ovary
and in the  Fallopian tube.  These models I imported from Paris, and I have no reason to doubt their
accuracy.   But, even allowing that such  have been found  perfectly  formed, thus proving that the ovum
has been impregnated by the male semen, is it not as easy to believe that the impregnated ovum,  in its early
stage  after impregnation, escaped from the uterus  into  the Fallopian tubes, as it  is to believe that  the
impregnated ovum always passes through this small aperture  into the uterus ?
   Besides, from the great  length of time which these pregnancies  frequently exist,  which is sometimes
for many  years, the  phenomena appear  to  be utterly different  from ordinary  pregnancy.  Professor
Neagle, of Helderberg, has a preparation of a foetus which was retained for fifty-four years.  This singu-
lar deviation from the usual course of pregnancy is happily of rare occurrence ; but, when it does occur,
it seldom terminates favorably.   If it  occur in the Fallopian tube or in the ovary, these become  immensely 
PREGNANCY.
71
distended into a sac, or cyst, to the sides  of which the placenta adheres.  As the ovum  increases, the
sides of the tube at  length give way from  the  immense distension, and the  patient usually dies from
internal hemorrhage.  In ventral pregnancy, the sac is  attached to the  abdominal viscera, and is usually
imbedded among the convolutions of the intestines.
   In ventral pregnancy, there is plenty  of room,  and the child  may not only be carried to the full term,
but for many years.  Hence you  perceive that the length  of extra-uterine pregnancy will depend very
much upon  its situation.   Thus, if it be  in the Fallopian lube, it rarely lasts beyond two months ; whereas,
ovarian pregnancy will continue for five or six months ; while ventral pregnancy may be continued for an
indefinite length of time.   Although the  uterus does not receive or retain the ovum  in  its  cavity, as in
natural  pregnancy, yet the uterus undergoes many of those changes which take  place in  it in regular
pregnancy.
   Treatment. — This must be regulated  by the various symptoms.   If the  abdomen is  tender  to the
touch,  warm fomentations must  be applied.  If the bowels  are costive, regulate them.  If there is an
effort of nature to discharge the foetus by means  of an abscess, the powers  of the system  must be sus-
tained by tonic medicine and nutritious diet through the  long-protracted struggle.  Sometimes the abscess
opens into the intestines, and portions of the foetus come  away from time to  time, and  then  the passage
of the  bones produces very great suffering.  Sometimes the mass adheres to the parietes or sides  of the
abdomen, and an operation is  then performed to extract the foetus or foreign mass.  The danger of an
operation, however, is frequently very great.   A  lady in this city, a short time since, was operated upon,
and the substance extracted ; and the patient, it is stated, is recovering.   When the mass contracts adhe-
sions to the  abdominal walls, and form  an abscess for the purpose of  expelling it, the patient is most
likely to recover.  But the presence of  such a mass of semi-decomposed animal matter in  the abdomen,
whatever the nature of it may be, is of itself sufficient to materially injure the general health.
                                        SECTION VII.

                                          MONSTERS.

   By the term monster, we understand a foetus which differs from the  natural  order  of organization,
whether the organization be compatible with life or not.  They may consist of deficiency, excess,  or mis-
placement of parts.   Productions of this nature  are formed, not only in the human, but also in the animal
and vegetable kingdoms.  I saw a lamb exhibited some years ago in this city, which was in every respect
fully developed, but had two heads  on one body, and  also supernumerary extremities.
   I have a  sister who was born with  an  additional thumb, which  she  continued to wear till she was a
young woman,  when it was extirpated.  I also have a nephew who has  six toes and six fingers, which in
many families is hereditary.   Sometimes  there is a deficiency of parts.   A case is related where the child
was  born with  the  nose deficient.   Jisew, in 1718, exhibited  to  the Royal Academy of Sciences, in
England, a Portuguese female, nineteen years of age, who was born without a tongue.   (A very remark-
able  phenomenon, especially for a woman !)   Almost every part of the  body has been  found misplaced.
Some have had both extremities united in one  stump.  I have  a  drawing in my museum which repre-
sents  a case, attended by a physician in this city, where the   head is remarkably large, and all the organs
of the body arc placed on  the reverse side.
   When I attended lectures in the  old Barclay-street university, a human  monster was produced, which
had two perfect heads on  one body.   There  is  an account, in the American museum of this city, with
the figure attached,  in which two females  are united, and the  account states that they lived man}' years.
   Since writing the above,  I  have  visited the  museum,  and copied the following  singular fact, and at 
IMPROVED SYSTEM OF MIDWIFERY.
  the same time took a drawing.   The following paper was found, and is now pasted in the inside of an old
  trunk brought from Ireland, and presented to the American museum of this city, by Edward  Windhurst,
  December, 1836 :—
     " Short but concise account of Eliza and Mary Skulkhurst, who were born joined together by the hips
  and shoulders, A. D. 1100, at Biddendin, in the county of Kent; commonly palled the Biddendin maid."
     The  reader will observe by the plate given of them, that they lived together in the above-joined state
  thirty-four years ; at the expiration of which time one of them was taken ill, and in a short time  died.   The
  surviving one was advised to be separated from the body of her deceased sister by dissection  ; but she
  absolutely refused,  saying these words : "As we came together, we will also go  together."  And in the
  space of about six hours after her sister's decease, she was taken ill and died also.
     By their will is conveyed  to the  church-wardens of the parish of Biddendin,  and their  successors for
  ever, a certain piece or parcel  containing twenty acres, more or less, which now lets for thirty-one  pounds
  ten shillings per annum.
     There are usually made for  these wonderful phenomena of nature about one thousand rolls  of bread,
  with their impressions printed  on them, and given  away  to all strangers on Easter Sunday, after Divine
  service in the afternoon ;  also  about three hundred  quartern loaves, and cheese in proportion, to all the
  poor inhabitants of said parish.
     One of the most interesting of this  class  of births occurred on  the 26th of  October,  1701,  at  Szony,
  in Hungary.   They were two  sisters joined, and were baptized Helen  and Judith.   The body of Helen
  was first excluded  as far as  the  umbilicus ;  three hours  after, the  feet were  expelled, together with the
  body of Judith, connected to that of Helen.   Although they were united at the back below the  loins, yet
  they were turned with their faces and bodies half sidewise to each other.  One  anus, situated between
  the right femur of  Helen and  the left  of Judith, was  common to both.   Unam quoque habebant  vulvaml
  intra 4 pedes rcconditam, ut  dum  erectis starent corporibus, ne  vestigium ejus conspicuum esset.  The
 . desires to attend to the calls of nature affected them separately.   In  her sixth year, Judith was seized
  with palsy of the right side,  and continued  to suffer from  its effects for the remainder of life ;  but  Helen,
  on the contrary, became more active, lively, and  beautiful.  A difference was  also observable in  their
  vital, animal, and natural functions,  in health as  well as in disease ;  and although  they had  the small-pox
  and measles  at the same time, yet they had  other  disorders separately.   Judith was often  convulsed,
  while Helen  remained free  from indisposition.   Helen had a pleuritic affection.  Judith had a fever.
  One of them had a catarrh and a colic, while the other continued well.  At the age of  sixteen the cata-
  menia appeared and continued, but  not at  the same time, or in the same  manner, or in equal quantity.
  Sometimes the one, sometimes the other, would be more  disordered on such occasions; but  Judith was
  more frequently convulsed, and was subject to various hysterical and pectoral affections.   In their intel-
_ lectual powers there was  a striking difference: Helen was very engaging in  her manners; they both,
  besides  their vernacular tongue, could speak German, French, and  English ; they could  read, write, and
  sing, very prettily.   While the one  was asleep, the other was often awake.
     On the 8th of February, 1723, in the twenty-second year of their age, Judith  was seized with violent
  convulsions,  succeeded by coma, which terminated fatally on  the 23d of February.  During  this  time
  Helen was affected with fever, accompanied by frequent faintings, whereby she was so much debilitated,
  that, although she was still sensible,  and could speak, she  fell into extreme suffering, three minutes before
  Judith ; and after a short struggle, they both expired almost at the same instant.
     On dissection, each was found to be provided with  distinct viscera, though  they had  but one anus in
  common ; and  their sacra,  aorta?, and venae cava,  were connected.   The viscera of Helen  were all
  healthy ; but the heart of Judith was much enlarged, and enclosed  in a very strong pericardium ; the
  right lobe of the lungs was  in a putrid state.  The spines of each were distinct to the second portion of
  the sacrum, where they became united.  The aorta from each formed a common trunk upon the sacrum,
  and afterward divided into common iiiacs.   In  like  manner  the common iliac veins formed  upon the
  sacrum a common  trunk, which  afterward  divided  into  a vena cava  for  each body. 
F  3L A  T
  Fig. 1.  Biddendin Maid.
  Fig 2.  Monster, resembling a Mermaid, re-
corded to have been bora in Uavenna, Italy.
  Fig. 3.  Siamese Twins.
  Fig. 4.  Monster,  part  man  and part bjeast,
stated in history to h*ve been born in 1603,  of a
woman  who had intercourse with  a dog.
  Fig 5  Monster stated in Aristotle  to have
been born in Aries, Provence, France, 1597, co-
vered with hair, like an animal.
  Fig 6.  Monster stated bv a writer  to have
been born at Navarre, in  1530,  with four arms
and legs.
  Fig. 7.  Monster stated to  have  been  born in
the reign of  Henry HI  with two heads and  four
arms, and the bodies joined at the  back.
  Fig. 8.  Mother's Mark—-Varus Materna.
40 
 
PREGNANCY.
73
  A case is related, where a separation was successfully accomplished in two female foetuses united by the
ensiform cartilages, the union extending to the umbilicus.  In the " Journal de Verdun" for 1709, there
is a case resembling the Hungarian sisters ;  the  age to which the ladies lived is not mentioned, but it  is
stated that they had  acquired a knowledge of several languages.  In the "London Philosophical Trans-
actions" is related a  case with one body, two heads, four  hands and arms, three legs, one navel, one anus
and two sets of female genital organs.   WThile one head  was awake, the other slept; or the one was quiet
while the other would cry.   They both  died at the same instant.  Dr. Berry relates the particulars  of
two female  children united by their sterna.  Medicine  given to either affected both ;  one would wake
while the other slept, but both generally slept  at the same time ;  and, what is more remarkable,  one was
entirely nourished, for some months after birth,  by what  was received into the stomach of the other.
  The case of the Siamese twins presents a most extraordinary instance  of lusus natura,  being a living
double child.   The name  of one is Chang, and the  other Eng.  They were born  in  the kingdom of
Siam, between the Siamese and Burmese empires.
  Many of  the houses in this country are built of bamboo upon rafts,  and anchored  in the rivers.   The
palace  of the king is enclosed within walls about two miles in circumference.  His household consists of
about three thousand individuals, of whom seven hundred are his wives.
  Chang and  Eng  are  natives  of a small village  on  the seacoast of Siam, about sixty miles  from the
capital.  They were born  in May,  1811, of Chinese parents.   A native midwife assisted  at the birth,
which  is said to have been  easy, notwithstanding their  union.   They are united together by a fleshy band
about three and a half inches in length, and eight in circumference, formed at the extremity of the breast-
bone of each, and extending downward to the abdomen.  The upper  part of the  band is a strong carti-
laginous substance ; the lower part is soft and fleshy.   There is but one navel between them.  Although
there is a  great union  of sympathy between them, it  is very evident  that they are  two distinct human
beings.  Their mother  observed that  she suffered no greater  inconvenience at their birth than at those
of her former  children,  as they were very small, and  the head  of one was presented between the legs of
the other.
  Their resemblance  to each other was not remarkable.  With the exception of the  spine of Chang,
which  had  a lateral curvature, all  their parts were well formed.  Chang's left eye was weaker  than the
right;  but this was reversed in the case of Eng:  so that each would see best with the  eye nearest \m
brother.  Asparagus given in the food of either, separately, did not communicate any odor to  the urine
of the  brother who  did  not partake of" it: which shows that the vascular communication between them is
not extensive.  On the  9th of  December, 1829, both had bronchitis,  and the pulse  of each beat ninety.
They both had measles; and, at eight years  of age, the  confluent small-pox.  They take their meals
together, but  neither will eat or drink what the other  dislikes, though they occasionally  take  different
kinds of food.  When  the appetite of  the one is satiated, that of the other  is also.  They always fall
asleep  at the same moment,  and  it is impossible  to wake one without also arousing the other.  When
asleep, if the  one be touched, the other invariably answers; when  restless,  and they desire to vary their
position, the one must roll  entirely over the other;  and they have frequently been  observed to do  this
without waking or being disturbed by  the change.
  They appear to suffer no inconvenience from their  union.   They are contented, and will not consent
to any  separation.   They are quite intelligent and witty.   Their parents were  of the poorer class, and
were engaged  in fishing, making cocoa-nut oil,  keeping  poultry, &c, to support their family.  A  visiter
once asked them "what was  their occupation  in their  own country?"   One of them wittily replied that
" they  were merchants,  having been engaged in  the duck and egg trade !"
  The twins left Siam the  1st of April,  1829, under the protection of Captain Coffin, and arrived in this
country, where they were exhibited, and visited  by thousands.   They  then left for Europe, where it was
supposed they were visited by about three hundred thousand individuals.
  Within a few years, they have returned and  located in  one  of the  southern states (North Carolina),
and, what is very extraordinary, been  married to two sisters.
                                              10 
7t
IMPROVED  SYSTEM  OF  MIDWIFERY.
   Aristotle, a very old writer, ha& the following curious accounts of monsters :—
   " By the ancients, monsters are ascribed to depraved conceptions, and are designated to be excursions
of nature, which are vicious one of these fouT ways : either in figure, magnitude, situation, or number.
   " In figure, when a man bears the character of a beast, as did the  beast in Saxony; in magnitude,
when one part doth not equalize with another — as when one part is too big or too little.
   " I proceed to explain the cause of their generation, which is either Divine or natural.   The Divine
cause proceeds from God's  permissive will  suffering  parents to bring forth abomination for their filthy
and corrupt affections, which are let loose unto wickedness, like  brute beasts that have no understanding.
Wherefore it was enacted among the ancient Romans, that those who  were in any way deformed should
not be admitted into religious houses.   And St. Jerome was grieved, in  his time, to see the deformed and
lame offering up spiritual sacrifices to God in religious houses.  And Keckerman, by way of inference,
excludeth all that are ill-shaped from this presbyterian function in the church.  And  that which is of
more force than  all, God himself commanded Moses  not  to receive such to  offer  sacrifice among his
people, and he  renders the reason, Lev. xxii. 28 : ' Lest he pollute my sanctuaries.'  Because the out-
ward  deformity of the body is often a sign of the pollutions of the heart, as  a curse laid upon the child for
the incontinency of the parents.   Yet it is  not always so.   Let us, therefore, duly examine, and search
out the natural cause of their generation, which (according to the  ancients, who have dived into the secrets
of  nature) is either in the matter  or in the agent—in the seed or in the womb.
   "The matter may be in default  two ways — by defect  or  by  excess: by defect, when the  child hath
but one arm ; by excess, when it hath three hands or two heads.   Some monsters are begot by a woman's
unnatural lying with beasts : as in the year 1603, there was a monster begotten  by a woman's generating
with a dog ; which  monster, from the navel  upward, had the perfect resemblance of its mother, but from
its  navel downward it resembled a dog.
   " The agent, or womb, may  be in fault three ways :  first, the formative  faculty, which  may be too
strong or too weak, by which is procured  a depraved figure ;  secondly,  in the instrument, or place of
conception, the  evil conformation  or disposition whereof will cause a  monstrous birth ; thirdly, in the
imaginative power at the time of conception, which is of such force, that it stamps the character  of the
thing  imagined on the child.   So that the children of an adulteress may be like her own husband,  though
begot by another man, which is caused through the force of imagination that the woman hath of her own
husband in the act  of coition.  And I have heard of a  woman, who, at the time of conception, beholding
the picture of a blackamoor, conceived and brought  forth an Ethiopian.  I will not trouble you with
more  human testimonies, but conclude with a stronger warrant.    We read  (Gen. xxx.  31) how  Jacob,
having agreed with Laban to have all the spotted  sheep for keeping his flock, to augment  his wages, took
hazel-rods and peeled white  streaks on them, and laid them before the sheep when they came to drink,
which, coupling  together there while they beheld  the rods, conceived and brought forth young.
   " Another monster, representing a hairy child :  It was all covered with  hair like a beast.   That which
rendered it more frightful was, that its navel  was  in the place where the nose should  stand, and its eyes
placed where the mouth should have been ; and its mouth was in the chin.   It was of the male kind, and
was born in France, in the year 1597, at a  town  called Aries, in Provence, and lived a  few days, fright-
ening all that beheld  it.   It was  looked upon as a  forerunner of those desolations which soon after
happened in that kingdom, where men toward each other were more like beasts than human creatures:

                            "Where children thus are  born with hairy coats,
                            Heaven's wrath unto the  kingdom it denotes!

  " Likewise,  in the reign of Henry III. of  France, there was a woman delivered of a child having two
heads and four arms, and the bodies were joined  at the back side.   The heads were  so placed that thev
looked contrary ways; each had two distinct arms  and hands;  they would both  laugh, both speak, and
both cry, and be hungry, together; sometimes the one would speak, and  the other would  keep silence,
and sometimes both speak together.   It lived several years, but one outlived the other three years, car- 
PREGNANCY.
75
rying the dead one (for there was no parting them) till it fainted with the burden, and more with the stench
of the  dead carcass.
   " The  imagination also works  on the child after conception, for which we have a pregnant instance :
A worthy gentlewoman  in  Suffolk, England, who being with child, and passing by a butcher killing his
meat, a drop of blood sprung on her face ; whereupon she said her child would have a blemish on its
face ; and, at the birth, it was found marked with a red spot.
   " It is certain that monstrous births often happen by means of undue copulation :  for some there are,
who, having been long absent from one another, and having an eager desire for enjoyment, consider not,
as they ought, to do as their circumstances require.  And if it happen that they come together when the
woman's  menses are flowing, and notwithstanding proceed to the act of copulation, which is both  unclean
and unnatural,  the issue of such  copulation does often prove monstrous,  as a just punishment for doing
what nature forbids ; and, therefore, though men should  be ever so eager for  it, yet women, knowing
their own conditions, should  at such times refuse their company.   And  though such copulations do not
always produce monstrous births, yet the children then begotten are generally heavy, dull, and sluggish,
and defective in their understandings, wanting the vivacity and liveliness with which children got in propeT
seasons are endowed.
   " It remains now that 1 make some inquiry whether those that are born  monsters have reasonable souls,
and are capable of resurrection.   And here  both divines  and  physicians are generally of opinion that
those who, according to the order of generation deduced from our first parents, proceed by natural means
from either sex, though their outward shape may be deformed and monstrous, have notwithstanding a
 reasonable soul, and  consequently their bodies are capable of a resurrection, as other men's and women's
are :. but  those monsters that are not begotten by men, but  are the product of women's unnatural lusts in
copulating with other creatures, shall perish as the brute beasts by whom they were begotten, not having
a reasonable soul, or  any breath of the Almighty infused into them ; and  such can never be capable of a
 resurrection.   And the same is also true of imperfect and abortive births.
   " Some are  of opinion  that  monsters may be  engendered by gome infernal spirit.  Of this mind was
 Agidus Facius, speaking of a deformed monster born at Cracovis ; and Hironamus Gardanus wrote of a
 maid who was got with child of a devil, she  thinking it had  been a fair  young man.  The like also is
 recorded by Vicentius, of the prophet Merlin, that he was begotten by an evil spirit.   But what a repug-
 nance would it be, both to religion and  nature, if the devils could beget men!  when we are taught to
 believe that not any was ever begotten without human seed, except the Son  of  God.  The devil, then,,
 being a spirit,  and having no corporeal substance, has therefore no seed of generation.   To  say  that  he'
 can use the act of generation effectually, is to affirm that he can make something of  nothing,  and conse-
 quently to affirm the  devil to be God, for creation belongs to God only.  Again, if the devil could assume
 to himself a human body, and  enliven the faculties of it, and cause it to generate, as some affirm he can,
 yet this body must bear the image of the devil.  Again, it borders upon blasphemy to think that God
 should so far give leave to the  devil, as out of God's image to raise his own diabolical offspring.   In the
 school of Nature we are taught the contrary, viz., that like begets like : therefore of  a devil can not man
 be born.   Yet it is not denied but that devils, transforming  themselves  into  human shapes, may abuse
 both men  and women, and with wicked  people use  carnal copulation ; but, that  any such unnatural
 conjunction can bring forth a hum,an  creature, is contrary to nature and religion."
    As it regards the origin of monsters, there  has been, and now is, an  almost endless variety  of opin-
 ions :  some regarding them as the produce of the imagination of the mother ; others that they arise from
 unnatural intercourse between  the human female and some of the lower  order of animals — as  the dog,
 the monkey, &c.
    But the  evidence is very slight on which either of  these hypotheses  rests.  That the powers of the
 imagination are very great, is freely admitted, and that some females have submitted to intercourse with
 brutes, is readily granted ;  but neither of these facts proves that monsters are the result.  Indeed  we have
 no  sufficiently accurate  experiments to demonstrate tjjat pregnancy would result from such intercourse 
70
IMPROVED SYSTEM OF MIDWIFERY.
and yet, on the other hand, it is stated, from good authority, that a woman in the northern  part of Ver-
mont, many years ago, who had  intercourse with a dog, was delivered of a litter of puppies!
  M. G. II. Hilau, in  his investigations  on this  subject, relates many instances  in which malformations
could be clearly traced to a variety of injuries, as blows in the abdomen, corsets too  firmly laced round
the body, and  to severe mental agitation,  produced by unpleasant sights and other similar causes.
  Almost every variety of monster may be referred to some morbid change-; yea, almost every one of
them retains traces of the affection from which it has  derived its origin.   All twin monsters are the pro-
duction, in  one germinal membrane, of two embryocs, which have afterward grown  together.  This affords
the best explanation of the greater part of double monsters.  M. Brano, an artist in this city, has a very
extraordinary preparation, which represents a perfect  foetus growing out of the  abdomen, taken from a
man  in  the East Indies, which appears to be well authenticated.   I intend to add this  to my collection,
for the benefit of the curious.
  That monsters are produced from  comparatively slight natural causes, is  evident from the fact that we
can produce them at pleasure in chickens,  only by a slight increase of the  heat of the eggs applied during
incubation.   It is very remarkable that we never  meet with two  subjects joined  by different parts :  for
example, we never see the union of the abdomen  of one foetus to the extremities of another; of the belly
to the back ; or of the  head to the sides of the trunk — showing clearly that there  is uniformity and order
even in  unnatural productions, as well as disease.
                                        SECTION VIII.

                                     HERMAPHRODITES.

   By this term we understand a: union of the sexes in one person.  But it is a question among anatomists
whether such a production ever really occurs.   There are, however, a great many cases of malformation
of the  generative organs, which veiy much resemble a union of the two sexes.   Sometimes the clitoris
of the female is so enormously enlarged, as to resemble very much the male penis ; but, after all, it is an
overgrown female clitoris still.   These are very common among the natives at the Cape of Good Hope.
If hermaphrodites do not literally occur, there are some  cases that so closely resemble them, as  to be
hard to distinguih.
   In the early part of my practice in this city, I was called to  examine a case where  I found the male
and the female organs apparently both tolerably well developed ; and I do not know which sex appeared
the most perfectly developed,  nor  can I say that the parts were  anything more than  a  malformation.  I
have a  model of an hermaphrodite in my  collection, taken  by  Brano, which very much resembles the
organs of generation  of  both sexes.  The  penis is short, the prepuce natural;  but the female organs are
not so well developed as the male, yet they bear a very close resemblance to nature.
   Since writing the  above, I  have seen a  wax model of a person  in Brussels, Belgium, very much
resembling in the genital organs both male and female.   The penis is quite natural; the urethra the  same
as that of a  female ;  but other female parts are deficient.   In this  case, there was apparently no vagina,
and the urine was discharged about one inch below  the penis.   A gentleman, who saw  this model at the
same time, thought the organ which so much resembled  the penis was  only  an  elongation of  the clitoris.
The child from whom it was taken was a native of Brussels. 
PREGNANCY.
77
                                          SECTION  IX.

                          NEVUS  MATERNA,  OR MOTHERS'  MARK.

   By this term we  understand  a discoloration of the skin at birth.   It  occurs  in various forms, and  in
 different parts of the body, but it is most usually  located on the face or neck.   The integument is a little
 raised,  and its  surface assumes various colors, as red,  purple, black, &c.;  these marks also frequently  in
 shape resemble  various objects, and are  not very uncommon, rendering those who have  them quite con-
 spicuous.   The cause of these marks  affords a very curious and  interesting subject  of inquiry to the
 philosopher and the physiologist.
   I recollect, when I attended lectures in the university of the state  of New York, this question afforded
 a great  subject of controversy between two of the most distinguished professors of the college, Hossack
 and Post: the  one contending very zealously that the ncevus  materna were impressed upon the child  in
 consequence of the  mother's seeing certain  disgusting  objects,  or  by her " longing" for certain things
 which she could not obtain ;  while the other maintained  with equalwarmth  that no  amount of mental
 excitement, nor any power of the imagination of  the mother, could ever communicate these marks to the
 child in the womb.   And certainly it does appear very improbable and very inexplicable  that such marks
 should  be transmitted to the  child through such means.  All rational theory is certainly against it.   But,
 on the  other hand, if  we  may judge from the most positive  and unequivocal testimony of all mothers
 wherever it occurs, we are bound to believe that such  is the case.   That these marks  strikingly resemble
 certain  objects, all can perceive ; and when we add to  this, that, in every  instance where a child has been
 impressed with a mark of this kind, the mother invariably traces it to  some spontaneous and irresisitible
 desire which she felt to indulge her appetite in some kind of food or fruit, the evidence  appears conclu-
 sive.   This fact is so common, as to have become  proverbial.  Evidence  much less than  this  is  quite
 sufficient in a court  of justice to sentence a culprit to capital punishment.   Shall it go for nothing in
 philosophy ?  As Pope says —

                           " From God above, from  men below,
                            What can we reason, but from what we know ?"

   Volumes might be cited in evidence on this subject, but I will only insert three or four cases, which
 have occurred within my  own knowledge :—
   In my own case, I was born  with a mark of this kind, on the integument over the shoulder, resembling
 a raisin.  The explanation of the case is this :  During the pregnancy of my mother, a  pedlar exposed
 some fine raisins for sale ;  at the time, no disposition  on  the part of my mother was felt to purchase or
 eat them.   Subsequently, however,  she experienced  very great  anxiety for them.   My father went in
 pursuit  of the pedlar, but  could  not  overtake him.   At birth, the above mark, resembling a raisin, was
 discovered,  and has  remained  ever since;  and, as is said always  to be  the case, I am very fond of
 that fruit.
   Another case I may relate, of a lady who  resides within a short distance of my office.   This is a very
 striking case.   The greater part of one  side of the face is a little  raised, and is of a purple color.  This
 case was so very conspicuous, as to induce me to inquire respecting it: when  I found  that she accounted
 for it by a peculiar longing which her mother experienced.  I obtained permission to take a model of it,
 which I have in wax in my museum.
   In  another case,  of an  extraordinary character, which came to my knowledge very recently, the marks
 extended over the face and forehead of  a woman, and even under the  hair.   She accidentally came into
 my office, and I took this  occasion to inquire if she could explain the cause of the mark : but she gave
 me an evasive answer.  I subsequently found, however, that  she was  embarrassed, in consequence of
several others being in the office  at the time.   She afterward, in  a  private interview, stated to me  that.
* 
78
IMPROVED  SYSTEM  OF  MIDWIFERY.
during  the  period  of gestation, while  some  of  the  family were  cutting  up the  meat  of an animal  jus*
slaughtered, her mother felt  a very strong desire to  eat some of it.   Accordingly, it was  placed  on  the
fire a few minutes,  when a  stranger entered the room : she grasped up the meat, and  held it in her apron,
and leaned  her head  on  her  hand  upon the table, with the  fingers in  her hair,  precisely as it is marked ;
and the mark over  the  whole face  of the daughter  exactly  resembles  a  piece of  raw meat.   Dr. King
was in  my office at the  time, and  witnessed the mark.   He  has since written to me on the subject.*
    Since  writing  the  above,  I  have  seen  a  case more singular  than  any  others which I have  ever  wit-
nessed.   Passing down one of  our streets within a few days, I noticed a peculiar  mark on the  face of a
child  in company with its  mother.   I was at  the time in a stage, which I immediately  left,  in pursuit  of
the woman, to obtain a history of the  case.   The  lady (Mrs. Murphy) verv  readily  complied with  my

                                                                                                             May 13, 181C.
  "W. Beach, M. D. —  Honored  Sir; In  reply to your Inquiry concerning what are usually known as " mothers'mark,-'I would say that
notwithstanding the prejudices or sneers of ' would-be oracles of  wisdom' in  medical matters, I  am firmly convinced  that  there is truth in it,
and that  not from theoretical guessing, but from practical investigation.  I have witnessed many instances  of the  'marking of children' —
enough to prove satisfactorily its existence —  and some of the most remarkable I will relate :—
  " 1. My own brother has a mark on his shoulder, which can only be seen during the season  of watermelons, and which closely resembles
the red meat and black seed of that fruit — occasioned, as my mother is well aware, by a longing for watermelons, and during which time
she recollects perfectly well  having scratched  or rubbed  her own shoulder.  The same brother had a pendulous tumor cut from his right nostril
when only three days old, by Dr. Minor, of New York city, and which it was almost impossible to detect from a piece of pork : this was occa-
uioned by a disappointment  in not getting, at  the dinner table, a  favorite slice of pork, which so affected my mother, that she retired to her
bedroom, to give vent to her tears, and ' to snuff!'
  " 2. Mr. Asa Wood, of  New Bedford, Massachusetts, can  probably eat more clams than any other man living, and is extremely fond of
them.  When only three  or  four days old, he  ate two dozen cooked clams, without the least detriment to his health — but which was followed
by a cessation of crying, which  had  been almost continuous from  the time of his birth.  His  mother  during her pregnancy had a very great
longing for clams.
  " 3. A  Mrs. Harris, of New York, was chased by a large baboon during her pregnancy.  When  her  son James was born, he verv much
resembled that animal in features, and, as he approached manhood, evinced much of its sagacity and cunning.  He was very deaf, and articu-
lated with difficulty.
  " 4. You may probably recollect  the lady whom I  saw at your office, Mrs. Mary Cosgrove, then residing at 39 Forsyth street, who had a
dark reddish mark extending from the right eye upward to the centre of the head.   Upon questioning her, she at first was very reluctant to say
anything  about it, but finding that it was from other motives than mere idle curiosity that these inquiries were made, she cheerfully gave its
history.   Her mother, during pregnancy, wished to obtain a particular piece of beef which was  in the house, and wished to be secret about it,
and have no one as witness to it — or, as  Mrs. C. expressed it, ' My mother longed for a particular piece of beef,  and wanted  no one else to
see it taken ; and then she passed her hand from her eye to the top of  her head, rubbing the head with her fingers — studying how to get it'
(the'beef).
  " I could relate a number of other instances as remarkable as the  above, and which  strongly  prove the influence of the brain and nervous
system of the mother upon the formation, character, &c, of the foetus in utero, but presume the above  will  be sufficient.
  " I have cured several cases of prolapsus uteri, and one of retroversion, by giving the ' restorative cordial' internally, astringent vaginal injec-
tions, and by having the female raised two or three times a day as follows: have the patient lie on  her back, wrap the drees around the
extremities, and have the  feet apart from one foot to one foot  and  a half; then raise her slowly upward by the  feet  until  the whole body is
raised from  the floor or bed, so that she rests entirely  upon the upper portion of the shoulders and neck ;  then, still holding by the feet, give a
slight tremulous motion from right to left, and upward and downward ; continue this for a few minutes, and then gradually replace her on her
back, with the hips and extremities raised a little.  This is a most easy and satisfactory method of replacing the uterus, and one which requires
no pessary or other instrument as an auxiliary aid.  I became acquainted with it from an old lady, a midwife, who has had  an extensive and
successful practice of nearly fifty years.  She informed  me that, in cases of impacted head, she had performed the above operation  during the
intervals between labor-pain, and invariably produced the desired result.  She also informed me  that for the last twenty-five years she has not
had a case of prolapsus to succeed delivery, which she attributes to the fact that, invariably after deliver}', she introduces one or two fingers,
and returns the uterus to its  natural position as  nearly as possible. I mention these facts, as they may prove serviceable at some future time,
and open a way to a more perfect and natural method of treatment in the diseases of females.
  " This  lady has delivered three thousand two hundred different women, and with remarkable success.  In any  haemorrhage after deliverv
she severely censures the  use of cold water, &c. Her method is, to push the uterus up as high as possible, then bring the mouth of the womb
to the left side, pressing the lips together against the bone, while the left hand is applied over the bowels, and pushes the fundus to the right
side.  After holding the mouth thus for a minute, a clot forms; in a short time, remove this clot if necessary, or as soon as pain comes on.
  " She was formerly much in the habit of giving ergot in those cases where the pains died away, or were lingering, and of no account; but she
says that  for a number of  years  past she has not used  a particle of it, as she succeeds as well, and even better, by applying, from time to time,
on the mons veneris, vulva, perineum, &c , cloths wet with water and spirits as warm as can be borne; this, she tells me, soon brings on heat,
perepiration, and active pains.   She has had only four or five placental presentations, and she succeeded in each case by loosening the placenta
and pushing it to one side  of the uterus; and in each case the child and all came away together.  In difficult  oases, where turning is required, or
in replacing the uterus in  prolapsus,  &c, she says that the operations can be performed much more easily by having the patient lie as much as
she  can on her face, instead of the side or back.
  "  One thing, entirely novel to  me, I must mention, and that is,  whenever a mothers' mark becomes inflamed, or  produces inflammation, by
rubbing it several times with the article longed for, it will certainly, says this old lady, remove the inflammation.
  " I mention these particulars, so that if you can derive any information of  importance for the  readers of your work on midwifery, you may
use  it
                                                                                         " Your friend, respectfully, 
PREGNANCY.
7'J
request.  She stated to me that, a short time before her accouchement, she was in a store, and there saw
a gentleman  who had upon  his cheek precisely the  same mark as the child.  On  her  return home, she
stated that such was the impression made upon her mind, that she knew that her child would be marked in a
similar manner, which proved to be the case.   This mark consisted of a slight elevation of the cuticle  or
skin, over the left molar bone of the face, extending nearly to the  ear ; the color  was a  deep  brown, with
two or three scaly herpetic eruptions in different parts of the mark.  But the most striking peculiarity of
the case consists in the growth of large black  hair from every part of it, resembling in size and  color
ordinary whiskers, and were perfectly similar to those of the mark upon  the person ; which the mother is
convinced were by this means communicated to her offspring before birth.
   The following incredible, though well-authenticated case,  was  handed me by  my friend Samuel Peet,
of Bridgeport, Connecticut.- The acount is extracted from a London paper :—
   "The  'Napoleon'  Child. — On  Friday, August  8, we paid a visit to   the ' Bazar,' in Oxford
street, to witness this  extraordinary sport of nature.   The child  is an  engaging little girl, about three
years old.  The color of her eye  is  pale blue, and  on  the  iris or  circle round  their pupils the inscrip-
tion on —
                        Left eye,                                       Bight eye,
                     NAPOLEON                                 EMPEREUPt
                     EMPEREUR                                  NAPOLEON

may be traced in the above-sized letters, although  all the letters are not equally visible, the commence-
ment ' NAP' and c EMP' being the most distinct.  The color of the  letters is  almost  white, and at first
sight of the child appear like rays, which make the eye  appear vivacious and sparkling.   The accuracy
of the inspections is  much assisted by the stillness  of  the eye, on its  being directed upward, as to  an
object  on the ceiling  of  the room, &c.; and, with this  aid, the  several letters  may be traced with  the
naked  eye.
   " This effect is accounted for by the child's mother earnestly looking at a franc-piece of Napoleon's
which  was given to her by her brother, previous to a long absence ; and this operating during her preg-
nancy, has produced the appearance  in question.   It was visible at the child's'birth,  and has increased
with her growth."
   A most remarkable case of mothers' mark has  recently been related  to me,'as having occurred many
years since in Cheshire county, New  Hampshire.  A lady during gestation  experienced a strong desire
for eating sausages, which could not be readily procured.   Thus  disappointed in satisfying  the cravings
of  her appetite, she  gave  birth to a  female child, marked  in a  wonderful manner: one  arm, from  the
elbow  to the wrist, bore the perfect resemblance of a sausage  in shape and color  ; it was formed of a soft,
pulpy mass,  apparently  devoid  of bones or sinews ;  and on receiving  the slightest wound, it was difficult
to check the flow of blood.   In place of the hand, there were  two unsightly stumps representing  the
thumb and fore-finger, the others being entirely wanting.   The subject was of a  weakly constitution, and
died in her sixteenth  year. 
80
IMPROVED SYSTEM OF MIDWIFERY.
     CHAPTER  V.

INFANTICIDE.
                                          SECTION  I.

                                HISTORY  OF  INFANTICIDE.

   By this term is to be understood, simply, the murder of the newborn infant; but so nearly allied to tne
subject is foeticide, or the destruction of the foetus in  utero, that they have usually been  discussed under
one head.  Whether we consider the helplessness or the innocence of those who are its victims, there is
certainly no crime which can appear more unfeeling  to a humane mind, or more calculated to  call forth
all the finer sympathies of our nature, than infanticide.  Nothing, therefore, short of the desire to preserve
in society the reputation of  chastity, which constitutes the highest ornament of the sex, and which  has
often proved dearer to them  than life itself, could be imagined  to impel  them  to an act so unprovoked
and so unnatural as the  murder of that  inoffensive being, whose existence, under other circumstances,
they would willingly sacrifice their own to protect.   The  accused,  however, until  her guilt is clearly
proved, should rather excite  our compassion than aversion ; for she stands in a situation in which no other
criminal does.   The very circumstance of her being  known as  the mother of an illegitimate child, gives
rise to suspicions which excite the tide of public opinion against her,  whereby the case is prejudged.
   Though  there is much reason  to  believe that this crime is  still  too familiar to the  public, yet, from
some of the causes which may lead to the death of an  infant, either during parturition or after it,  not
being studied with that attention which their  importance  deserves, it is to be apprehended  that  cases of
groundless  accusation are not unfrequent.   The married, as well as  the  single, may be the  authors of
this crime, to conceal their  guilt  and infidelity from an  absent husband.  An example lately  occurred
in England where the object was to obtain thirty shillings  of burial-money for the dead child.
   If the history of foeticide be  glanced  at, we  find that few nations  of antiquity were  exempt from it.
The Mosaic code is silent on the subject, from which we  may infer that the Jews were strangers to it, at
least during the existence of their  great legislator.   They may have been deterred from it, on the one
hand, by the severe punishments which were  denounced  against those who should be guilty of  murder;
while, on the other, they had been afforded the  most cheering  inducements to  avoid the commission of
it, by having been forewarned that  the Messiah  should one  day be numbered among their  descendants.
They did not long continue, however, to be an  exception to other nations ; for, as their intimacy with the
Canaanites  increased, they imbibed their habits, and polluted themselves with their worst  crimes.   These
crimes were carried to a dreadful extent by the Canaanites, who immolated  their sons and  daughters to
their gods.
   The Egyptians,  desirous to prevent the  increase of the Jewish male population, lest they should  ulti-
mately  become  their  rulers, enacted  the most  cruel laws  to  effect this  object, but toward their own
offspring they conducted themselves with greater humanity.  Strabo, in particular, eulogizes them as an
honorable exception to those nations who assumed  the power of disposing of the lives of their infants.
   If we except Thebes, the unfeeling conduct  of the Canaanites was  more  or less prevalent  over  the
whole of the ancient world.   The Carthaginians, who had a law by  which  four  infants of noble family 
INFANTICIDE.
81
were regularly immolated upon the altars of Saturn, attributed their defeat by Agathocles, king of  Sicily,
to an omission of  these sacrifices ; and, in order to atone for  their past neglect, they offered up at one
time two hundred  of the sons of their nobility !
   The Spartan was enjoined by the law to toss his weak or deformed  children into the caverns of  Mount
Taygetus ; with him physical vigor was virtue — all that was worth living for.  The Athenian writers
make frequent allusion to the practice of infanticide : it  was enjoined  by Aristotle, and justified by  Plato
and Solon, probably to palliate a  practice they were unable to check.   It was reserved for Thebes, how-
ever, to set an example of humanity to the people  that surrounded her ; for, by her laws, it was strictly
forbidden to imitate those countries who were accustomed to expose infants  at their birth.
   The Roman,  too, was  absolute master of  his  children's life and death, and from the time of Romulus.
to that of Constantine they exercised their right  with inexorable severity.
   But this crime  was  not limited to, nor has  it ceased  with, the  ancients.  It has, unfortunately, been
transmitted  to  modern nations, some of which, in  the  present age  even, it  still  continues  to disgrace.
Among the Chinese, the  prevalence of this horrid  practice is incredible.   It was stated  by Mr. Barrow,
of England, that in Pekin alone  the  number of children  exposed was about nine thousand annually.
The Hindoos were equally addicted to it; but, of late years, by the efforts of some of the British officers,
it has been completely abolished  in  many of the provinces.  In Otaheite, previous to its conversion  to
Christianity, the frequency of the crime was such, that it threatened the depopulation of the island.   The
natives of New  South Wales, and a tribe of  those of the  Cape of Good Hope, termed,  by Mr. Barrow,
Bosjesmans, are addicted, the former to the  procuring of abortion, and the latter to the destruction of
dieir infants, in various  ways.   To the latter, however, a  good example was set by their former masters
the Dutch, who are said to have been  in the habit  of shooting them  with  as little ceremony as the wild
game of the country.
   In the  present day,  the palace  of the sultan  is not  unfrequently stained with the blood  of innocent
victims.   Thornton, in his account of the Turkish empire, informs us  that the offspring of  the younger
princes of the royal family, who are kept in confinement in the palace,  for the throne or the bowstring as
it may chance, are destroyed as soon as they are born.
   By the history of America, it would seem that infanticide was more or less  prevalent over the whole
of it.   The crime does not appear to have been  resorted  to, in any of  those countries, from  any ferocity
natural to the people, but to appease the supposed wants of their deities, under circumstances of indispo-
sition or misfortune in war; to save their parents the trouble of providing for their support;  and to cele-
brate their success in  arms, or the  coronation of their sovereign:.   The Mexicans, and other nations,
restricted their sacrifices to prisoners taken in battle.
                                          SECTION  II.

                          CRIMINAL  ABORTION,  OR  FOETICIDE.

   Although this crime is generally limited to  individuals who  have been  impregnated illegitimately,
yet we are not without a strong apprehension that it is induced by married females for the sake of accom-
modation.   What inferences are we  to draw when we meet with  sensible  individuals in society, whom
the strongest representations are  insufficient  to deter from  causes  likely to produce it?  It is  doubtful
whether the extraordinary notions which  have  been entertained  by legal as well as medical professors,
both in ancient and modern times, have not tended rather to the encouragement than the suppression of
this criminal practice.
   Hippocrates supposed that a  male foetus was  not animated until the thirtieth, while in the female this
was protracted until  the forty-second day after  conception.   It was  the belief of the stoics that the soul
                                                 11 
S3
IMPROVED SYSTEM OF MIDWIFERY
was not united to the body until the act of respiration, and that the foetus was inanimate during its residence
in utero.
   The opinions of the  modern.,, again,  must have  been as injurious  as  they were absurd, by denying
the vitality of the embryo  until the period of quickening ; and this absurd idea is still perpetuated :  by the
present British  law (9 George IV., chapter 31) it is enacted that  the use of means to procure abortion
before quickening is only a misdemeanor, but after  this  period it is punishable  with  death as a felony.
Tlicsc ideas can not  be  doubted to have  had  a dangerous tendency, by impressing  the  ignorant  and
unprincipled  of both sexes with a  belief  that, as the foetus was  not endowed with life before a certain
time,  the  procuring of abortion, previously to that  particular  period, could not be viewed as  a  crime.
The fcetus, however, possesses vitality from the moment of conception, although evidences of its anima-
tion are not for some time cognizable to  our senses :  in  proof  of which, it is no sooner distinctly  visible
in utero, than the pulsations of the heart can be distinguished ; on the seventeenth day from  its transfer-
ence to that cavity, it contains blood ;  and an embryo has  been seen  to  move its  limbs a considerable
time  before quickening :  and it  requires no proof or  argument to show that it  would be  morally as
felonious  to destroy an ovum at the moment of conception, as  a foetus at the full time.
   The detection of feticide, unless the  investigation be speedily undertaken after the  crime has  been com
mitted, is  attended with  unsurmountable  difficulties ; for, in twelve  hours  afterward even,  there is little
haemorrhage ; and in a shorter period still, no relaxation  of the external genitals can be traced.  So late
as the third dayr an unusual dilatation  of the os uteri may be  distinguished : all this, however,  depends
on the age of the ovum ;  but when other proofs can not be obtained, we are unable to determine, during
life, whether this condition of  the  aperture  may  not have  arisen from the transit of a  mole, or a small
collection of hydatids ;  the sex  may say that the body thrown off  was a false conception, a term with
which many of  them are acquainted and know the import;  but if  it can not be produced, or good testi-
mony in support of this statement,  the  inference must  be unfavorable to the accused.   The proofs of
expulsion of  the uterine contents after  the  fifth, or in the later months, present little ambiguity.   These
symptoms, however, will merely prove  that abortion has taken place, but not whether it has been  induced
criminally or accidentally.   We  must therefore attempt to discover whether there  are signs of violence
having been done to the person, or of such  drugs having been  administered, as are by the vulgar believed
to possess the power of producing abortion.
   To induce foeticide, the expedients resorted to may be divided into local and general.  Both of these
may affect the uterine system  either directly or  indirectly.  A local cause,  such, for  example, as some
mechanical contrivance, may, by a person  acquainted with the structure of  the parts, be conveyed  into
the uterus, and the ovum  destroyed, without such  a mode  being  succeeded by constitutional derange-
ment ; but, more  frequently attempts  are made  to  attain  the  same end in a less scientific manner,  and
severe general  disturbance sc{ ner  or  later ensues.*    The causes which may be  included  under  the
second head, as the exhibition of some of the more  active  agents of the materia medica, invariably exert
their primary influence on the  system of  the parent in general,  and the  uterus is sympathetically affected.
The ultimate modus operandi of both sets of causes  is to destroy, either from the first,  or eventually, the
union between  the  ovum  and  the organ which  contains it, whereby the  development of the former  is
arrested, and the latter is prematurely excited to dislodge its contents.
   The local causes will  be first considered, and of these two only can be particularized, viz., blows either
on the loins or  on the  anterior part of the  abdomen  ; and the introduction of some contrivance  into the
uterus, to rupture the membranes, or in some other way irritate that organ.  Except where  some predis-
position to abortion exists, much  severe  pressure may  sometimes  be exerted on the  abdomen without
either exciting the action of the uterus  or injuring its contents,  in consequence of the plastic structure of
the organ, and the uniform support afforded  by the contained fluid  to  its  inner surface, as  also the addi-
tional protection which it  receives from the abdominal parietes.

  * That which was alluded to iu  the trhil of Angus  (in Lancaster, Englaud) for the murder of Miss Coras, was de-vrihed as a silver tube
v» '.:'a a sli'f, at the end of which was a dart with three points. 
INFANTICIDE.
83
   " In the summer of 1823," says Dr. Campbell, of Edinburgh, "1 was called on by a pei.~on whom I
afterward ascertained  to be a procurer of abortion, and who  requested I should take charge of a young
female in a state of pregnancy, and that I might have the child myself.   I inquired if the infant was dead,
and was  answered in the  negative, but  that the necessary steps had  been adopted to destroy it.  On
visiting the woman I found the foetus alive ; she stated that it was illegitimate, and her first.  After warn-
ing her against what I had heard, she confessed that  she had repeatedly suffered herself to be violently
struck over the abdomen ;  to have  some strong liquids, as ale and porter, injected into the vagina ; and
the os uteri scratched with a stocking-wire.   She  was delivered in due time  of a healthy living child.
Such freedom can not always be used with impunity, for the  foetus is very generally destroyed ; and the
like violence frequently also involves the life of the mother.
   " Dr.  Smith relates the case of  a man who was executed  at Stafford,  England,  for the  murder of his
wife.  She was in a state of pregnancy  at the time, and  he succeeded in causing abortion by elbowing
her in bed, rolling over her, &c, which proved fatal to her.
   " In April, 1822, I was called  to a woman  in  the last month of pregnancy, who had been struck on
the abdomen by her husband.   An extensive detachment  of  the placenta led to the immediate death of
the foetus, and to that of the mother in fifty-one hours afterward."
   Sometimes it may  be disputed whether the cause  assigned may  have had any share in producing the
abortion  ; in which case it becomes necessery to determine, in the first place, if the  injury has  been suffi-
cient of itself to cause it;  and, in  the second, if the complainer has neglected tc»adopt those precautions
which had been recommended to her to prevent premature expulsion.   The following cases  from Belloc,
of  France, may assist a practitioner in his decision  :—
   A young woman,  between the third and fourth month of pregnancy,  had received, from a robust man,
several kicks, and blows with the fist, the marks of which were  evident.  Immediately after the accident
she was  put to bed, was bled, and  had various  remedies  given her  by a surgeon.  The haemorrhage,
however, continued, with  pains in  the loins and abdomen, and the following day  the ovum  was expelled.
In his examination, Belloc declared that the accident was the  result of the violence  inflicted.
   In a second instance, a woman gave birth  to a dead foetus  of the fourth month, two  days after having
been struck, in a dispute with her husband.  Instead of betaking herself to bed, or at least keeping quiet,
she walked a league that day, and  on the next a quarter of a league, when she was at last compelled to
go to bed.   In this case, Belloc  decided that  it was very possible, had she remained quiet, and called for
proper assistance,  the abortion might not have taken place.
   On the iniquitous practice of -introducing instruments into the uterus, little need be said, since it must
already be too well known.  We shall therefore merely add the history of two cases in which  it proved
fatal to the foetus and to the parent:—
   At the Durham (England) assizes, in  1781, Margaret Tincler was indicted for the murder of Janet
Parkinson, by inserting pieces of  wood  into  her womb.   The deceased took  to her bed  on  the 2d of
July, and from that  period  thought she must die, using various expressions to that effect.   She expired
on the 23d.   During her  illness she declared that she was with  child to a married man, who advised her
to place  herself under the  care of the prisoner, as she was a midwife, and would assist in relieving her of
the child, which was then  between  the fifth and sixth month.  Three days previous to the birth  of the
foetus, which  happened  on the 10th of July, the prisoner took the patient around  the waist,  and  shook
her in a violent manner  five or  six different times, and tossed her up and down.    The child died instantly
after birth, and was proved by surgeons to have been perfect.  On examining  the uterus, it appeared
perforated at two  points by wooden skewers : one of the openings was inflamed, the other gangrenous.
Additional evidences  of injury were also discovered.
  In the  London " Medico-Chirurgical Review" for April, 1825, is copied the  following case from the
" Gazette de Sante"  for November. 1824 : Messrs. Fodere  and Ristelhueher  having  repaired to the
house of the deceased, on  the 7th of March, 1822, they found the body of Catherine S-------extended
on a table, and already exhibiting marks of incipient putrefaction, although death had taken place only 
84
IMPROVED SYSTEM OF MIDWIFERY.
the preceding day, after a short illness.   On examination, there was nothing particular observable on the
chest.   In  the abdomen, the peritoneum  was inflamed, and  some  spots  of  inflammation on the mucous
membrane of the stomach and  bowels.   In the neighborhood of the uterus, there was a sanguineous effu-
sion, with some clots of blood, in the midst of which was found a foetus of about sixty days' growth, with
its umbilical cord.  The womb was  flattened, red, and  inflamed.  On more minute examination, it was
found to be ruptured, the opening being  about the size of a three-franc piece.   The internal  surface of
the uterus was also inflamed.  The membranes of the foetus were found perforated in two places, near
the cervix uteri, and opposite the rupture in  the  parietes of the uterus, through which the  foetus  had
escaped into the abdomen.  Nothing remarkable about the external  genitals.   The medical commission
called before them and examined some witnesses, by which it appeared that a midwife had been closeted
with the deceased, a day or two previous to her death, and made use of a syringe with  a long ivory pipe,
which  instrument was  produced.  Shortly after  this interview, the  deceased  discharged  a  quantity of
black blood from  the vagina,  and was  seized with excruciating pains, which  continued till  death took
place.   From these data, the reporters  came to the following conclusion, viz.:  first, that "the deceased
died of a violent inflammation, with rupture of the  uterus, followed  by  expulsion  of the  foetus into the
abdomen ; second, that this inflammation and rupture""being rare accidents, and not likely to take  place,
except as the effect or consequences of a grave malady, in the last stage of utero-gestation, it was probable
that they were, in this  instance, the result of violence, from  the  forcible introduction of  the pipe of a
syringe into the os uteri, *md the injection of some acrid and stimulating  liquid into the  cavity of  that
organ."   The jury found the  midwife guilty, and condemned her to ten years' imprisonment.
   " The causes lohich are thought to act on the general system," continues Dr. Campbell,  " will now be
considered.  These are  venesection,  cathartics,  emetics, diuretics, and  emmenagogues.  The opinion
that venesection,  when  copiously  directed, induces  abortion, especially if the  blood be drawn from the
foot, is  as ancient as the time of Hippocrates ;  but the  best  refutation of such a notion  is, that  it is a
remedy in  daily use, and found most efficient in  preventing the accident.  Profuse evacuations of blood
certainly occasion great irritability of system in the gravid state, and  may in this way  lay the  foundation
for a predisposition to premature evacuation of the  uterine contents.  It must also, I presume, be well
known  to every practical man, that if the uterine derangement amount to a partial dilatation of its aperture,
so large a detraction of blood as shall have the effect of producing deliquium, will assuredly be speedily
followed by the expulsion of the ovum.   Where  no tendency to expulsion exists, venesection will not
excite  it.   No doubt, if a woman were brought extremely  low by the practice, the system would be inca-
pable of furnishing sufficient materials for the development of the uterus,  and the premature expulsion of
its contents would be the result.   Cases are related,  if we are to believe them, where the experiment was
very fairly tried, without exerting any influence on  the uterus.   Mauriceau says that he bled one pregnant
woman forty-eight, and  another ninety times, for an  inflammation  of  the chest, and that both went on to
the full time.*   Where, in any instance, the evacuation  has been  profuse  and  repeated, without  any
obvious reason, the conduct of the operator should be investigated.
   " Cathartics of a drastic nature, especially those which act chiefly on the rectum, and cause much tenes-
mus, if frequently repeated  in females of  moderate vigor even, with or without predisposition, may no
doubt excite abortion ; and occasionally a similar result may succeed the reiterated use of those of a milder
description.  I have seen two women, who formerly had  children, laboring under icterus  in  the  seventh
month, unattended by a single acute symptom, for which each of them used a  few doses Submur. Hyd.
 and Pulv.  Jalap C. combined,  and in both, the  result was the premature expulsion of the foetus ; and I
am disposed to believe that this would not have happened  had the vegetable cathartic alone  been used.
It is well known  that active aperients are frequently  exhibited during gestation, without, generally speak-
ing, being  productive  of any unpleasant effect;  thus  Dr. Rush  states  that, during  the yellow fever of
1793,  he administered calomel and jalap,  in  large and  frequently-repeated doses, to females  in every
  * Capuron M^decine Legale, p. 307.  I have great difficulty in believing this; for although the French have bled sufficiently in the field,
they are chary of phlebotomy. 
INFANTICIDE.
So
stage of pregnancy, and yet in no case were the medicines followed by abortion.  When there is any
suspicion that they have been administered with an improper view, the object for which they have been
ordered, their nature, quantity, and how often  they have been repeated, must  be ascertained.   By  the
frequent use of aperients, the uterus must  imbibe a sympathetic influence from  the intestines, whereby
its fibres are excited.
   " Calomel, if given to such extent as  to  cause pytalism in a woman at all predisposed to  abortion, is
sure to be followed by this accident: if the foetus be strongly contaminated with syphilis, the same thing
will  happen whether mercury has been  exhibited in  sufficient quantity to affect  the gums or not.   But
unless there be a predisposition to premature uterine action,  this drug may be exhibited to the extent of
inducing violent  salivation without  occasioning  any disturbance  in the  genital system.  These remarks
will  explain the discrepancy which may be observed in the sentiments of professional men, regarding  the
effects of calomel on females in the gravid  state : some contending that it will, and others that it will not,
cause the premature evacuation of the uterus.   I remember being asked, a few years ago, to visit a young
girl, whom  I found so violently salivated, with  a view  to excite abortion, that her tongue could be com-
pared to nothing else than a honeycomb; but, notwithstanding her  extreme suffering,  she went on to the
full time.   Through the kindness of Mr. Gibson, of  this city (Edinburgh), I had an opportunity of wit-
nessing the following case, in which the violent  action of calomel  produced abortion :  The patient took
two pills, each containing about five grains of calomel; the purging and tenesmus which they  caused was
so severe, as to induce  detachment of the placenta, and she lost about four pounds of  blood before any
one saw her; in four hours after this turning was effected, a dead foetus extracted, and  the patient herself
died in less than two hours afterward.
   "Emetics are dreaded by sensible females in a state  of pregnancy, and justly;  for although spontaneous
vomiting  has rarely been known by practitioners to be succeeded by premature  evacuation  of the uterine
contents, yet the same action artificially  excited is, by the general concurrence  of accoucheurs, very apt
to induce uterine  action.  Velpeau, however,  mentions one woman who took fourteen  grains of tartar of
antimony : severe vomiting ensued, but no abortion.
   " When  an idea  exists that the  emetic  was exhibited with  a  corrupt intention, we  should ascertain
whether it was given in  a concealed  form or not.  The action of vomiting may destroy the ovum, either
by the  uterine fibres being excited and causing detachment of  the placenta, or  by the contraction of  the
abdominal muscles, causing a rupture of the membranes  of the ovum.
   "Diuretics have been said  to  possess the power of exciting abortion, but daily experience seems  to
prove the contrary, by this  aceident  not  supervening in  cases of pregnancy complicated with dropsy, in
many of  which the foetus has been retained to the full time,  notwithstanding the vigorous use of several
active agents of this class.  Such medicines have no  specific  power, but what might be equally  derived
from the repeated use of strong cathartics.   The continued exhibition of digitalis  will, I think, poison the
foetus and lead to abortion ; but, what is  equally to be  dreaded, it will also destroy the parent, as may be
said to  have happened in the following instance :—
   " A married female aged twenty-six, fair complexion, relaxed,  delicate habit,  but not spare, the mother
of several children, had ascites in  her  former  confinement,  and  applied for the same  complaint when in
the eighth month of this her fourth pregnancy.   In  the  course of twelve days  she took six  drachms of
tincture of  digitalis.*  On the twelfth day,  at two o'clock, a. m., the foetus, still-born, was  thrown  off
before assistance could be afforded to her; and in twelve and a half hours afterward, the woman herself
expired, although  she was in the most favorable  state when left after her delivery.   The child seemed to
have  been but a very short time dead, for  it  exhibited  no  evidences  of putrefaction.   This medicine

  * The particulars of a case which happened some years ago, in Edinburgh, were communicated to me, in which  an eminent practitioner
ordered in a common mixture, some tincture of digitalis for a middle aged female.  She continued its use for some days, but suddenly experi-
enced some unusual symptoms, and in a very few hours  thereafter died. A gentleman who had been called in, in the hurry  of the moment
declared that the patient had been poisoned with fox-glove.  The husband charged the ordinary medical attendant with this grave error ; but
to convince him that the medicine was not in fault, the prcscriber offered to take the same quantity liimself, an experiment which, fortunately,
was not insisted on by the com plainer. 
86
IMPROVED  SYSTEM  OF  MIDWIFERY.
sometimes accumulates in the system, and declares  its effects suddenly, as  in the foregoing case.   The
body was examined twenty-five hours after death :  it was running rapidly into putrefaction.   About three
pounds of water were contained in the chest; in the  pericardium were found  a few ounces ot sero-
sanguineous fluid ;  in  the abdomen the effusion was very trifling.
  " Cantharidcs has been taken in rather large doses, with a view to excite the uterus, but without effect.
Mr. Lucas mentions a case, where a woman swallowed about a drachm of this drug ; and though it occa-
sioned frequent vomiting, violent spurious  pains, tenesmus, and immoderate diuresis, with fever, which
reduced her to  extreme weakness, yet  she went  on to  the full time.   Fodere mentions a  woman who
swallowed half  an ounce of  powdered cantharides ;  in a short time she was seized with labor-pains, and
brought forth a  living, healthy child, amid  excruciating torture, but died herself  the  next  evening.   A
woman in Edinburgh swallowed a handful of saltpetre, and in half an hour abortion was induced, without
injury to herself.
  " Of the class emmenagogue, some articles may be mentioned as particularly calculated  to induce abor-
tion.  The powder or an infusion  of the  leaves juniperus sabina, are drugs which have long been used
as a secret remedy to  produce  abortion, and there is little doubt, when exhibited in large doses, it excites
violent disturbance in the general system, and consequent abortion.   There is reason to believe that both
its oil and substance have been given for this iniquitous purpose.   In the case of  Miss Burns, for whose
murder Mr.  Angus was tried at Lancaster, in 1808,  it was supposed the oil of this  medicine  had been
used.   Some years ago, I was called by Mr. Blyth, now a medical  officer attached to one of the divisions
of royal  marines, to assist him in the case of an unmarried woman, who was reputed to possess some
secret by which she could excite abortion at pleasure.  The foetus was in the commencement of the sixth
month, still-born ; and I was assured that she had  produced  several in  the same way.   It was currently
reported that she used Savine powder; and I might probably have known more of her arts, had I not, in
the  feeling of the moment, forcibly pointed out to her the criminality of what had come to my knowledge
— after which I heard no more of her.   Of  the strong  poisonous quality of this  drug, it is  sufficient to
state that, in the experiments which M. Orfila performed with it on two dogs, six grains  of it killed  the
one in sixteen,  and four grains  the other in thirteen hours.
  " It does  not always, however, produce  abortion ; for M. Fodere relates the case of  a poor girl, half
idiotic, cachectic, and  seven months pregnant, who took from the hands of the person who was supposed
to be the father of  the child, a glass  of wine containing  some Savine powder.   She became so  much
indisposed after it,  that it was deemed expedient to send a report of the transaction to a magistrate, who
ordered Fodere to  visit her.  She informed him that, after having swallowed the drug, she felt a sensa-
tion of pungent heat in her bowels, accompanied with hiccough and vomiting, followed by a violent fever,
which continued upward of fifteen days.  These symptoms were nevertheless relieved by  refrigerants, the
woman was  kept under surveillance, and at the end of two months she was safely delivered of a healthy
child.
  "Of late years much  has  been  said regarding the  power which the secale cornutom, ergot, or spurred
rye, possesses of acting upon the uterus.  Some writers  assert that it has no influence whatever on  this
organ ; others, again, say it  has, but only when  labor is present or impending.  I can not, however, agree
with either: for, from cases which have  happened  in my own  practice, I maintain that the ergot  will
excite contractions of the uterus, though labor is not impending, and even though the organ  be not preg-
nant, as I have in more  than one instance,  in the case of deformed pelves, induced labor by the adminis-
tration of this drug; and in  a case where a woman applied to me, to be relieved of a  uterine  polypus, the
tumor being found, on examination, to be  situated  so high that it  was  impossible to reach  it, ergot  was
administered, and after she had taken it four times a day for two days,  bearing-down efforts supervened,
and the tumor was forced so low that it could be reached with facility.   On  these grounds, then, there is
no reason to doubt that the  ergot  of rye will induce uterine contractions, without injury to the mother ;
in some instances, however,  it appears to be inert.   Its administration is not, without danger to the life of
the foetus, but it is not yet agreed in what way the ergot  exerts its  deleterious  influence upon it — 
INFANTICIDE.
87
whether it acts as a poison, or whether it destroys the  infant merely by the  violence of the uterine con-
tractions which it causes.   I am inclined to adopt the latter view, because the life of the foetus is destroyed
almost solely in those cases where ergot has been administered after rupture  of the membranes, and  under
the same circumstances I have  observed fractures of the cranium ; and also, that the children born where
ergot was  given,  frequently  died  shortly after birth,  of meningeal  inflammation  and  hydrocephalus,
probably caused by pressure.
   "Natural causes, or those in which  no criminal intention can be ascribed  to the party concerned, are
numerous.   All acute  diseases, syphilis, the intemperate use of  cordials, violent exercise of any kind, the
elevating passions, particularly anger, accidental blows on the abdomen, the death of the foetus, detach-
ment of  the placenta,  excess  in  venery,  irritation  of  neighboring organs from  constipation, dysentery,
haemorrhoids, diarrhoea, and catarrhus vesicae, may  all, in a  habit predisposed, lead to abortion, without
any participation on the part of the  parent.  Dr. Arrowsmith, of Edinburgh, states that when the foetus is
lost from detachment of the placenta, it is  owing to haemorrhage.   Many opportunities have enabled me
to remark that a detachment of from'a third to a fourth of the mass, will shortly afterward be followed by
the death of the child ; but when the placenta is adherent at any  point above the cervix uteri, the bleeding
is so trifling, that the death of the foetus can not be ascribed to  it;  and, moreover, none  of the effusion
comes from the foetal vessels : the loss  is altogether maternal.  The destruction of the infant, therefore,
must arise  from the destruction of a function requiring integrity  of the placental attachment.
   " In conducting these investigations, it  is necessary to examine the extruded  mass, to ascertain whether
it consist of hydatids, a  mole, or a foetus ; and, if the latter, its age.   It is desirable to learn by what means
the expulsion has been accomplished : whether with the consent  of the female, or by exhibiting drugs in  a
concealed form ; or whether she has herself been using medicines, and of what nature.   When the child
is expelled, any wounds, though  mere cuticular  abrasions, should be carefully  noticed.   The head must
be minutely examined, to determine the presence of pin or needle punctures.
   " From  the foregoing observations, it is  obvious, in  the  first  place, that all our pharmaceutical agents,
reputed for exciting abortion, are uncertain in accomplishing this  unwarrantable act;  and, secondly, that
the attempt is very liable to involve the life of the  mother — who, indeed, may be the only victim, while
the real object of  persecution  escapes uninjured.   M.  Fodere mentions the case of a cook, who, finding
herself pregnant, and being anxious to conceal her situation, swallowed half an ounce of powdered can-
tharides, with an ounce of the sulphate of magnesia.   Some hours  afterward she was seized with severe
pains resembling colic, and she  produced a living  child in  the sixth month ;  but, in  the course of the
same nififht, she expired in great agony.   These  latter points  I wish  to be  urgently  impressed on the;
mind of the medical  attendant, lest  he  may at any  time,  by  powerful  incentive, suffer  himself  to be
betrayed into an act so  contrary to  every  moral  obligation, and  so liable to be  succeeded by fatal conse-
quences : for I conceive the  accessaries and  accomplices in this unprincipled  experiment to  be as ame-
nable for whatever may befall  the  parent, as for  the  destruction of the foetus.  And it has been very
properly observed by Dr. Percival, with  equal  truth and  beauty of  expression, that ' to extinguish the
first spark  of life  is a crime of the same nature, both against our Maker and society, as to destroy an
infant, a child, or  a man :  these regular and successive stages of existence being the ordinances of God,
and subject alone  to the Divine will.' " 
83
IMPROVED  SYSTEM OF MIDWIFERY.
                                               SECTION III.


                      PENAL  STATUTES  AND   FOUNDLING-HOSPITALS.


   In  England, in 1803, it was enacted by Lord Ellenborough, that  persons  administering  medicines

wilfully, or using any instrument to procure abortion, previous to  quickening, as well  as  their counsellors,

aiders, and abettors, shall be declared guilty  of felony,  and shall be liable to be fined, imprisoned, put on

the pillory, privately or publicly whipped, or transported beyond  seas for fourteen years.   The same act

ordains,  that administering medicines, &c,  with intent  to  procure  abortion  after  quickening, shall be

punishable with  death.

   Of the whole, the law of  Scotland on this head  is the most ridiculous :  for the  learned commentator

observes that all procuring of abortion or  destruction  of future birth,  whether quick or not,  is excluded

from the idea of murder;  because, though it  be  quick, still it  is only pars viscerum matris, and not  a

separate  being ;  or, in plain  language, if an  individual cuts  his own  throat, we are not  to interfere, since

he has a "right to dispose  of himself as he pleases!   Child-murder, in  almost all civilized countries,  is

considered a capital crime.

   Foundling-hospitals have been established  in different countries to receive illegitimate children, with a

view to the diminution  or prevention of the crime of child-murder, but it may be doubted how far they

have answered these highly-commendable intentions.   It is very  certain that they tend to the demoraliza-

tion of the community, while facts  would seem to prove that they have not remedied the evil,  but merely

rendered it less conspicuous  in the eyes of  the public.  The existence of these  establishments, by con-

cealing the frailties of the sex, and sheltering them  from that ignominy  and censure inseparable from their

situation, has in a great degree removed the most powerful check on illicit intercourse.    That foundling-

 hospitals have not  conferred  that benefit on  humanity which it was expected would flow from them, their

 own  records  sufficiently  prove :   In Paris, in 1790, more than  23,000, and  in  1800, about  62,000

children were received ;  and it is  estimated that eleven thirteenths of  all the foundlings perish annually,

 through hunger and neglect.   It is mentioned, also,  that great numbers of them die from a disease which

 is styled endurcissement du tissue cellulaire, called  in English  " skin-bound disease," and of  rare occur-

 rence in private practice.   Sir John Blaquiere, of Ireland, stated to the house  of commons that of 19,420

 infants admitted into the foundling-hospital of  Dublin, during  the ten  years  preceding  1843, 17,440

 were dead or  unaccounted for.   In  Moscow,  with  every possible advantage,  of 37,607 admitted in the

 course of twenty years, only 1,028 were sent out.   In London, the results  have been more favorable :

 the number of deaths under twelve months have been fewer than one in six.


   Note to page 56.—Discharge of matured ova, &c.   Besides proving that at each period of heat in animals ova are regularly discharged,
 whether sexual intercourse  coincidently  takes place or  not, Bischoff has added some curious observations, showing that the bursting of the
 Graafian follicles, and consequent discharge of ova, is entirely independent of sexual orgasm, or of the influence of spermatozoa; thus: coitus
 may take place, and examination of the ovaries, six, eighteen, or twenty hours afterward, prove that no ovum has escaped, although spermatozoa
 may have reached the ovaries.  Examination immediately after coitus, may detect ova which  have advanced two or more inches along  the
 F;tl!opian  tube, to have done which they must have started some considerable  time before the act of coition.   Bischoff considers it to be imma-
 terial at what part of the Fallopian tube the spermatozoa and ovum come in contact;  so that they meet before the ovum has reached the uterus,
 impregnation is sure to take place.  He states that he has clearly traced live spermatozoa up to the ovaries; this statement, and the inference
 he deduces from it, that fecundation of the ovum may take place at any part of the Fallopian tube, is called in question by M. Pouchet, who has
 recently offered a table showing hourly the progress and condition of the spermatic fluid in the generative apparatus of the mammiferous
 female. His experiments were chiefly made on rabbits.  From the sixteenth to the twenty-fifth hour after copulation, live spermatozoa were
 constantly found in the vagina and uterine horus.  Even to the twenty-first or twenty-third hour, these animalcules [?] continued very active,
 but shortly after that, they lost their vivacity, and died toward the twenty-fifth hour; so that nothing but broken-up, tailless spermatozoa could
 be seen.  He was never able to see live spermatozoa reach more than a very short distance up the uterine extremity of the Fallopian tube;  and
 lie considers tlie observations of Bischoff and Wagner, who had found live spermatozoa on the ovaries, to  he erroneous.  According to his
 own view, it is iu the uterus alone, or probably also at the mouth of the Fallopian tube, that impregnation of the ovum can be effected.
   With regard to animals, numerous observations and experiments, especially those by Bischoff and Raciborski, have rendered it quite certain
 that at every period of heat one or more  ova are matured and discharged from the ovary, and this moreover  quite independent of sexual inter-
 coarse. The statement of these eminent physiologists are founded on the surest of all evidence, the actual detection of ova in the Fallopian
 lubes of auimals in whom sexual intercourse had not taken place ; thus Bischoff found in a  lamb, killed a few hours  after becoming in rut for
 ti.e first time (and in whom coition had not  been effected), a ruptured Graafian vesicle in the right ovary, and an ovum in the corespondiug
 Fallopian tube.  Again, in a bitch two days after becoming in heat, and apparently inclined to admit the male (which it was prevented from
 doing), Bischoff extirpated the left ovary and Fallopiau tube, aud closed the wound by suture; no Graafian vesicle iu this ovary had burst, but four
 were extremely turgid.  Five days afterward the bitch  was killed; four large corpora lutea were found in the right ovary, and four ova in
 the corresponding Fallopian tube.  From this it appear-i quite certain, as Bischoff' concludes, that, during the rut of animals, ova become
 detached trom the ovary and enter the Fallopian tube or uterus, where they perish, unless sexual intercourse coiiirideatly occurs, in which  case
 the ova in all probability become impregnated.  The same may be con.-idered U> hold good hi the human female. 
 
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FLif
   Fig 1.  Deformed Pelvis.
   Fig 2.  Section or side view of
 the lower part of the Pelvis.
   Fig. 3.  Section and angle of the
 Pelvis.
   Fig 4. Section of the Pelvis, with
 a view of the Foetus (A) Sacrum (B)
 Rectum (C) Uterus (U) Bladder (E)
 Finger in the Vagina.
  Fig- 5.  Placenta, fcetal side.
  Fig 6.  Placenta, maternal surface
and cord.
^<QZ?'   /
 
 
PART   SECOND.
THE   EXPULSION    OF    THE   FOETUS,
                                           OR
                    PRODUCT  OF   CONCEPTION,
                               PRELIMINARY  REMARKS.

   After having remained for a longer or a shorter period in  the cavity of the uterus, and there having
 passed through the  whole, or  perhaps only a part of the changes ^cessary to its  complete development,
 the product of conception is  expelled  from that organ.   This  expulsion  constitutes a  function of the
 female system which  is designated  by the  general  name  of parturition, or  labor;  and is  usually per-
 formed  when the foetus  arrives at maturity.  Sometimes, however, it occurs before ; and in  some few,
 very rare cases, it is protracted beyond the full period of gestation.  When the product of conception is
 expelled before the  sixth month, it  is called abortion, or miscarriage;  after the  sixth month, and before
 the ninth, it is called premature delivery ; if it occur at the full  period of gestation, it is called delivery at
 term,  or maturity ;  when extended beyond the  full period,  it is  called tardy delivery.
   Labor at  full term being the usual final result of pregnancy — the object which nature always  endeavors
 to accomplish — we shall at  once  commence its  study, and  consider its phenomena.   Abortion and
 premature delivery, which are only deviations in the progress and duration  of  labor, we shall consider
 hereafter.  But, before  entering on  the immediate consideration  of labor, it will be necessary to make
 ourselves acquainted with the  pelvis, or long canal, through which  the foetus  has  to pass  ; and  also with
 the relative diameters  of the substance to be propelled through  this crooked channel.
   Many  writers insist very strenuously  upon a minute knowledge of the pelvis, both in its healthy and its
 diseased state ; but I think that a good general knowledge of its character, in  connexion with every other
 organ of the system, is quite sufficient to practise this branch of medicine successfully.   I have generally
 found in midwifery, as in anatomy, that those practitioners who  have attached  an undue value, not only to
 the anatomical structure of the pelvis, but any other part of the system, have been the most unsuccessful
 in practice:  hence we seldom  see a good anatomist  a  skilful  physician.   When the student, therefore,
 acquires a knowledge of the pelvis — and I care not how minute — he must  study well the relative function
 of every other organ connected with obstetrics or general practice : an excellent knowledge of the pelvis and
 the mechanism of labor can be  acquired  by the model called the  " Manikin," one of which  I have imported
from France.   This model I exhibited  to my class during my course of  lectures of last session in the
Cincinnati Medical  College.    It illustrates well the different presentations and exit of the foetus.
                                               12 
CO
IMPROVED  SYSTEM  OF  MIDWIFERY.
    CHAPTER  I.

THE  PELVIS.
  Definition-. — The  term pelvis literally signifies a basin, and was so  called by  the  ancients, on
account of a fancied resemblance to those then in common use.
  Situation. — The pelvis is situated immediately below the spine, the termination of which forms the
posterior and back part of it.  It rests on the upper part  of the lower extremities, or thigh-bones, three
of the bones of which unite to form the socket which receives  the  head of the femur, viz., the ilium, the
ischium, and the pubes.
  General Description'. — Its shape at the brim is an irregular oval opening, having a short and a
long diameter.  The pelvis may be compared to the heart with its apex pointing downward.
  Bones of  the  Pelvis. — The pelvis is composed of the two ossa innominata,  the sacrum, and the
coccygis.  The two ossa innominata form the anterior, lateral, and by far the largest portion of the pelvis ;
they are broad and expanded ;  and during childhood, each of them are separated by  cartilages into three
portions, the names of which are  retained in after-life.  They are —
  1. The ilium (or haunch-bone), which forms the superior and largest portion of the ossa innominata;
it gives  attachment  to the large and powerful muscles  connected  with the lower extremities, and forms
the  upper portion  of the acetabulum, which receives the head of the os femoris, or thigh-bone.
  2. The ischium (the sitting-bone).  It is situated below the  ilium, forming, with the os pubes, the for-
amen thyroideum, and, with the ilium, forming the inferior and larger portion of the  acetabulum.
  3. The pubes (the share-bone), which forms the superior and anterior division of the ossa innomina-
tum, and is united with its fellow anteriorly.   The space  between  the articulation in front, and  the rami,
is called the arch  of the pubes. 
THE PELVIS.                                        SI
   The Sacrum (the rump-bone). — This bone forms the superior and posterior boundary of the pelvis;
it is concave internally, and convex externally.   Its figure  is triangular:  on the base of the  triangle the
last lumbar vertebras rests, and the os coccygis is articulated to its apex.   The projection at the superior
and anterior part of the bone is called the promontory of the sacrum.
   The os  Coccygis (the knuckle-bone). — This bone  is divided into two, three, four, and sometimes
five portions.   It forms  the  extremity of the spine, and  is  curved forward ;  it is  articulated with  the
sacrum by an  intermediate fibro-cartilaginous structure, admitting some  degree of motion, by which  the
long diameter  of the outlet is  considerably increased.
   Articulations of  the Pelvis. — The  bones of the pelvis are united by cartilage  and  strong
ligaments, and always  continue so united in a healthy state.   There are three articulations : one ante-
rior, called the symphysis pubis, by which the two pubic bones are united ;  two posterior,  by which the
ossa innominata are united to the sacrum, one on each side, and -are called  the right and left sacro-iliac
synchondrosis.
   Contents of the  Pelvis. — The pelvis contains the bladder, the rectum,  the vagina,  the uterus,
and its appendages.
   Division of  the  Pelvis. — The pelvis is divided into the superior and inferior aperture or cavity.
The upper brim is the inferior boundary  of the superior cavity ;  it is of an oval form, to correspond with
the shape of the foetal head.   The hip-bones form the sides, and  the abdomen the front of this  cavity.   It
is also called the false pelvis.
   The inferior aperture or cavity is of an irregular quadrangular form, and  constitutes that bony, crooked
canal,  through which the foetus has to pass, and with which we can not make ourselves too familiar.  Its
anterior wall is formed by the os pubes ;  its  lateral walls by the ischium ; and its posterior wall is formed
by the sacrum and coccygis.
   Diameters  of the Outlets  of  the Female Pelvis.— The longest diameter of measure-
ment of the superior strait is the  transverse, or that  from side to side, which measures about five and a
half inches on an average, and is called  the standard measurement.   The next diameter is the oblique ;
this is  measured from the sacro-iliac symphysis (or where the  os innominata is united to the  sacrum) to
the back of the acetabulum, and in the standard pelvis is five and a quarter inches.   The shortest diameter
is the antro-posterior, which is measured  from the symphyses pubis to the promontory of the sacrum, an<J
in the  standard or average pelvis is four and  a quarter inches.
   The diameters of the inferior strait are the reverse of the superior ; for  the antro-posterior, instead of
being the shortest, as in  the  superior strait, is, in the inferior, the longest, and  is equal  to the oblique
diameter of the superior, which is five and quarter inches in length : and  is measured from the  arch of the
pubes  to the tip of the  coccygis ;  while the transverse diameter of the inferior strait is measured from the
tips of the ischium, and  is four  and a quarter inches — the same as the antro-posterior diameter of the
superior strait.
   Deformed Pelvis. — It occasionally though rarely happens that the pelvis is deformed,  which may
arise from rickets, mollities ossium, bony and other tumors; this deformity may be so great, that a foetus
at full  term can not pass.  Various instruments have been invented to  measure  the pelvis  during life,
such as the pelvimeter  of Catoule, and the callipers of Baudelocque ; but the accoucheur^'sfingers, intelli-
gently  used, make the best pelvimeters and callipers known — vastly  superior to all instruments ever invented
for the purpose.
   To  measure the diameter of the living pelvis,  pass the middle finger up the vagina, curving it upward
and backward, till it reach the promontory of the sacrum ; then observe what part of the finger or hand is
in contact with the symphysis, which may be applied to a rule when withdrawn : this will  give you the
antro-posterior diameter.   Again, by depressing  the tip of the finger, so as to rest upon the tip  of  the
coccygis, you  may ascertain the antro-posterior diameter of the inferior strait in a similar manner.   But
sometimes there are contractions on one or both sides of the promontory, or an acute angle may exist at
the symphyses pubis :  to detect  these,  we may introduce two or three fingers  into the vagina; we can 
92                          IMPROVED  SYSTEM OF MIDWIFERY.

then span round, by stretching our fingers, and thus easily detect any deformity that may be present; lay
your fingers flat against the back of the symphisis, to detect any angle which may exist in the symphysis
pubes.   In this way, every necessary information may be obtained respecting the diameters and deformi-
ties of the female pelvis.
   Difference in  the Male  and  Female Pelves. — The  male  pelvis is  narrow,  deep,  and
strong, enabling him to walk with a firm step, and fitting him for great exertions of strength.   The female
pelvis is  light, shallow, and capacious, which is the cause of that swelling of the hips by which the female
form is distinguished from  the  male, and  which, while  it adds to the beauty  of  woman, lessens her
strength, but at the same  time  most wonderfully fits  her for the important function of parturition.  If we
place the male and female pelves by the side  of each other, and compare  them,  we  shall easily perceive
that in the male pelvis there  is a certain roughness, bulkiness, and weight, which strikingly contrast with
the lighter, smoother, and more  elegant  pelvis of  the female.   In the male pelvis, too, the wings of the
ossa innominata are more erect; in the female, they are more  expanded.   In the  male pelvis, the brim is
more rounded, and although tending somewhat to  an ellipsis, the long  diameter stretches from before,
backward ; in the female, the brim is generally oval, and  the long  diameter from side to side.  In the
male, the pelvis is deep ;  in the female, it is shallow.
   In the male, we have a very small outlet; in the female, we have a very capacious one.   In the male,
the arch  of the pubes is  contracted ; in the female, it is expanded, to make room for  the more  ready
passage of the head of the child.  So that, in general, nothing  is more  easy than  for an accoucheur to
distinguish at a glance a  male  from a female pelvis, although  it may have been  buried  for  many years,
and no other part of the  skeleton found.
   CHAPTER  II.

THE   FGETUS
   We may now advantageously turn our attention to the properties of the foetus, so far as they relate to
its passage through the pelvic canal.
   While in  the womb, the various parts of the child are packed together in such a manner as to occupy
the least possible space, forming a mass  somewhat of an oval shape.  The head is flexed, so as to bring
the chin upon the thorax, the  arms are applied  to the sides, and the forearms  and hands  flexed  and
applied, often crossing each other, to the breast; the thighs are flexed on the abdomen, and the legs upon
the thighs, the feet often,  like the hands, crossing each other.  In this way the head forms one extremity
of the oval we have mentioned, while the other is composed of the feet and nates.
   The foetus, we are to observe, is somewhat flexible in a lateral direction, very much so anteriorly,  and
but little posteriorly.  The parts of it requiring to be  particularly measured and examined are,  the head,
the shoulders, and  the breech.  The first  more  especially demands our  attention,  both as  being, upon
the whole, the most bulky and least compressible, and also as being the part which is usually first engaged
in the pelvic passages.
   The head of the foetus, detached and without the face, is described as oval, with the large  extremity
posteriorly.   The desire  of  pointing out resemblances seems  to be a besetting passion with anatomists ;
but, in truth, in this, as in many other  instances, the likening of the head to any known figure conveys
but little information.   The student, then, who desires correct notions upon the subject, must  set before
him a foetal skull of the standard (or average) dimensions and  shape, and carefully examine upon it the
properties which I  shall now endeavor to indicate. 
THE F03TUS.
9?
   The first circumstance that strikes us in our examination is  the great mobility of the bones upon each
other,  owing to their incomplete ossification, and the cartilaginous connexion between them.
   To  these separations between the bones  the term suture is applied.   That which  passes from before
backward, between the parietal bones, is called the sagittal suture; that which separates the parietal bones
from the frontal, is called the coronal suture; while that between the parietal  bones and the occipital bone
behind, is the lambdoidal suture.
   The mobility of the bones is also increased by the prolongation  of the sagittal suture through the centre
of the os frontis, so as  actually to divide it into two bones, and it can be produced to such an extent as
to admit of the bulk of the head being considerably diminished in  one of its diameters, and proportionally
increased in another.  The situation  and  yielding nature of  the sutures requires to be attended to;  their
general direction  is the same as in the adult, but the sagittal  is always prolonged, as we have mentioned,
to the  root of the nose :  sometimes, but rarely, it passes backward into the occipital bone.  At the junc-
tion of the  lambdoid and  sagittal sutures, owing to the non-ossification of the occipital  and parietal bones,
a triangular space is left,  closed only by cartilage,  and called the lesser or posterior fontanelle. A similar
but larger space  occurs  between the parietal and  frontal bones, at  the  intersection  of the  coronal and
sagittal sutures;  this is termed the greater or anterior fontanelle, and is distinguishable by being lozenge-
shaped,  and having  four concurrent sutures, while the former is triangular, and has only three concurrent
sutures.   A knowledge  of the differences  between these fontanelles will  assist us in  a diagnosis of the
situation of the head during labor.
   " The head of a child  at birth," observes Dr. Waller, of London,  "is  composed of a number of bones,
having loose cartilaginous attachments  with each other, called  sutures.   This will  allow  of its being
squeezed or fashioned into the shape of the cavity through  which it is passing ; and hence, when the
action of the uterus is powerful, a very considerable degree of difficulty may be overcome in consequence
of this accommodative power.   Where the sutures are ossified, of course this moulding process can not
take place."
   We shall now inquire  into the dimensions of the standard foetal head, which are usually measured by
lines, somewhat loosely denominated diameters.
   The shortest of these is the bi-parietal, or that stretched between the tuberosities of the parietal bones
on  either side, and is about three and a half inches, or three  and  a quarter inches in length ; this, it is
plain,  can  meet with no  obstruction in  passing  through any  part  of the  standard  pelvis, the  shortest
diameter of the latter being nowhere less than four inches.
   There are, however, three  other  measurements  to  be considered, which, from being all in the long
''xis of the head, are usually called  the long diameters.  One or  other of these, together with  the bi-
parietal diameter,  may be considered as the measure of the bulk of the  passing  body, in every head-
presentation.
   The shortest (called occipito-frontal), and that which is most usually opposed to the long diameters of
the pelvis,  is described by an  imaginary  right line, extending from the upper part of  the forehead to the
lower part  of the  occiput.  This can only become the opposing  diameter when the  chin  is very much
depressed toward the chest, as it usually is, the vertex being  the presenting part.   The length  of this
line is about four inches,  which, it will be remembered, is  not  greater than  the shortest diameter of the
pelvis, but  as it is naturally opposed to the  longest diameters of that passage, there can, of  course, be no
want of  room in  such a  case.  Such, then, are  the  relations, as to dimensions, between  the head  and
pelvis  under the most favorable circumstances.
   The next in length, of the great diameters, is that between the lower part of the forehead and the upper
part of the  occiput (called antero-posterior).  It usually measures four  and  a  half inches, being about
half an inch longer than the last.   This comes to  be the opposing diameter in  that variety of head-pre-
sentation in which the head is extended  upon the  neck and the forehead  applied  toward  the pubis,
called  also  the fontanelle-presentation, in  consequence  of the  anterior fontanelle being in such cases the
presenting  part. 
94
IMPROVED SYSTEM OF MIDWIFERY.
  The longest diameter of the head is that  between the  point of the  chin and the vertex,   ft measures
five inches, and is the opposing diameter in  another variety of natural presentation, viz., when the face is
the  presenting part: it must be obvious that this position of the head will materially increase the difficulties
of its transit.
  The depth of  the  head, from the sagittal  suture to the  occipital foramen, may be estimated at about
three and a quarter inches.
  The dimensions, of course, vary in  different individuals, but those we have given are about the aver-
age.  The heads of female children are  usually somewhat less than those of males : Dr. Joseph Clark,
in the " London Philosophical Transactions," estimates  the  difference at one  twenty-eighth  or one
thirtieth of the circumference.
  The movements of the head now claim a little  attention.  These are, flexion  forward  and extension
backward ; both, especially the former, capable of being carried to a considerable extent.   Direct lateral
inclination is only admitted to a slight degree, and rotation can  be carried  just so far as to allow of the
chin resting on the shoulder, but not further, without endangering the child's safety.
  We have spoken of variations from  the natural form and average  size of the pelvic passage,  and we
shall also be liable to detect similar  deviations from  the standard in the head of the foetus.   It may, for
instance, be very small, which of course will have  no effect, except to facilitate  its  expulsion.   It may,
on the other hand, be very large, and if it be so, disproportionately with the size of the pelvis,  difficult
labor will be the consequence, and it is even possible that the use of instruments may be necessary.  On
this point, however, it is proper to  think with caution, as  the extraordinary change of shape which may
be effected on the head by compression, will often suffice to counterbalance even a  considerable  dispro-
portion of size.
  The head is occasionally enlarged, while in the womb, by  hydrocephalus, and may require diminution
by means of instruments : the  head of a dead foetus  is also sometimes swollen  by the  air disengaged
during putrefaction.   A peculiar form of head is not very rarely met with, in which the upper portion of
the cranium  is  malformed, and partly  deficient,  and the situation  of the brain occupied by a sort of
fungous mass.   These are denominated acephalous, or (by the Germans) cat-headed foetuses : they may
create confusion in our first examinations, by wanting the  peculiar firm feel of the natural  head, but they
are not often themselves productive of difficulty in the act of parturition.
  The shoulders of the foetus are generally  about five inches in breadth, but the effect of their size  is
counteracted by  their possessing capability of motion to such  an extent, that one can  precede the other  in
their entry into the pelvis.
  From  what has been said,  it is obvious that the  long axes  of the  head and shoulders decussate, or are
at right angles with each other ; and we can now perceive the  value  of a similar arrangement which we
adverted to before, of the  long diameters of  the brim and outlet of the pelvis.  At the moment when the
head  is escaping in the  most  favorable manner through the latter, the  shoulders are accommodated in the
long diameter of the former.
  We have next to say a  word upon the pelvic extremity of  the foetus, as it is packed in the uterus, and
sometimes presents in the pelvic passage.   Occasionally, the nates form the whole bulk of the presenting
part; at  other times  the  feet are assembled with them ; and, again, the feet or knees pass first  into the
world.  These  differences make a  good deal of variation in the antero-posterior diameter of the pelvic
extremity, but it is almost always less than the transverse, which pretty constantly measures four inches.
  Presentation and Position. — Before proceeding to the consideration of the mode in which the
child is propelled through the pelvis, we shall briefly explain the meaning which we attach to two words
frequently employed,  and  already made use  of in  the preceding observations, viz., presentation and posi-
tion.  By the first, we wish to designate that part  of the child  which, during labor,  may be opposite the
centre of the pelvic passage ; and by the second, the relative position of the child with respect to the bones
of the mother's pelvis.  Thus, if we say the vertex presents, we announce the presentation ; and if we add
with the occiput toward the pubis, or toward  the sacrum, as the case may be, we describe the position. 
PARTURITION, OR LABOR.
95
                CHAPTER  III.

PARTURITION,  OR   LABOR.
                                          SECTION I.

                                      CAUSE  OF  LABOR.

   Definition  of Labor. — By the term labor, we  understand the progress and final expulsion of the
foetus and sccundines from the uterus, at*the full period of gestation, or pregnancy.
   When  gestation or pregnancy is  completed, a  new action  is  set up in the uterus, which is denomi-
nated labor, or parturition.
   Various have  been the theories which have  prevailed in different ages of the world, respecting the
immediate  or exciting cause of labor.  Some have ascribed it to  the reaction of the  over-distended ute-
rus ; others to the instinctive efforts of the foetus, &c.
   Hippocrates, and  indeed all the  ancients, believed that a  child was  born by its  own efforts — efforts
which, as some supposed, it was incited to make by the  necessity it felt  for  breathing cool air, in order
to moderate the  heat which had been generated by its  long  confinement in the uterus.
   By others it was supposed that the foetus was incited  to these  instinctive efforts  by a want of nourish-
ment, the sources of which they supposed had either failed or become depraved.
   By one school it was taught that the foetus was excited to these efforts by the acridity of the meconium
and other secretions  of  its body; while  by another, with equal confidence, it was affirmed that the foetus
was only stimulated to these efforts by the want of room for  its future growth, and that  therefore it escaped
out of the  uterus as out of a prison.
   These, and a thousand other variously-conflicting and contradictory opinions, respecting  the cause of
labor, have  been tenaciously held by different schools  and in  different  ages, not one of which at all
contributes to  elucidate  the true cause or origin of  its  phenomena.
   Why the foetus, which for  nine months had been a  stimulus to the growth of the  uterus, should now
suddenly turn  round, as it were, and  stimulate it to contract, throw off the foetus, and return  to its  original
size, none of the above, nor  any other speculations, give us any  more satisfaction respecting it than  does
the declaration of old Dr. Avercenna (an Arabian physician of the eleventh century), who, with great
humility and devotion, contents himself by saying, "At the proper time,  labor comes on, at the command
of  God;"  or  as  another author of more  modern  date,  the late Dr.  Bard,  of  this  city, remarks, " We
know no more  of the immediate, exciting cause of labor, than we  do why strawberries ripen  in June and
peaches in  August.  It is a law of nature, established  by the Creator: that is all we know about it."
   But while we know nothing of the immediate or exciting cause of labor, we  do  know  something of
the efficient cause ; or,  in other words, we  do know that  the contractions  of the uterus  are the chief
agents in its accomplishment.   That these  are the  chief agents in the  act of parturition, is evident  from
the fact that women  have been delivered of both  living and dead children, who have been  paralyzed in
all the voluntary muscles of the lower half of the body.   Others have been delivered by the contractions
of the uterus alone, in whom that organ had suffered perfect prolapsus  in the early part of pregnancy, in
which case, of course, its contractile  action could  be seen ;  and, in the former case, no other muscles 
96                           IMPROVED  SYSTEM OF MIDWIFERY.
could be brought to assist, on account of their loss of action.  Yet, in ordinary cases, both the abdominal
muscles and the diaphragm, especially in the  latter part of  labor,  do assist in the expulsion of the foetus,
although they are not absolutely necessary to its ejection.
  If we examine the construction of the  uterus, we shall find that  it  contains both transverse and longitu-
dinal fibres ; the contractions of which, in each  direction, when  in  action, must necessarily lessen the
volume of the uterus, and expel the child.  It is  by this beautiful mechanism  that the Creator has pro-
vided  for the  expulsion of the product  of conception, and the  subsequent restoration of  this  vastly-
augmented organ to its normal size.
                                          SECTION II.

                                   PHENOMENA  OF  LABOR.

   We shall now briefly explain the phenomena or mechanism of labor, when the head presents,  which
consists  of a  beautiful application of mechanical contrivance Employed by the Creator to accomplish
delivery, and demonstrates, in language which  can not  be misunderstood, the wisdom and perfection of
the Divine Architect.
   The  impression of  a  person unacquainted  with  the anatomy and physiology of the  parts through
which the foetus has to  pass, would be, that it descended in a straight  line from the uterus, in the  abdo-
men, into the external world ; but this is far from  being the fact.  The opening through which the child
has to pass is a crooked canal; and it describes in its passage a perfect half circle: besides, the diameters
of its brim or entrance and  outlet are reversed.   Therefore, in order for  delivery to take place, there
must be  a spiral motion of the  foetus, to enable  the head and trunk  exactly to adapt themselves  to the
mechanism of the pelvis  in their transit  through this crooked, bony  canal.   The head, on entering the
brim, or  superior strait, enters diagonally, with  the occiput behind one acetabulum, generally the left, and
the forehead toward the  sacro-iliac synchondrosis (generally the  right).   In this  position it descends
obliquely through the superior strait;  it then takes a quarter turn, so  that the  face lodges in the cavity of
the sacrum, which motion brings the long diameter of the foetal head to correspond with the long diameter
of the outlet, which is the reverse of that of the superior strait.   While the head passes the inferior strait,
the shoulders are passing  the superior or reverse diameter of the other.
  Immediately after the head has passed the inferior strait, it makes a quarter turn, so as to bring the
long diameters  of the shoulders to correspond with that of the inferior strait.   Thus this spiral motion is
continued, from the moment the  head enters  the superior strait, till the trunk of  the child is expelled
from the mother ;  this  motion resembles somewhat the  spiral turn of a screw-auger.  From these facts,
then, we may deduce the following beautiful yet simple law respecting the mechanism  of  labor,  where
the head presents, viz., that the head enters, passes through, and emerges from  the pelvis, not directly
forward or downward, but obliquely or spirally.
  By this arrangement the side of the head is  always lowest or deepest in the pelvis ;  all which  exem-
plifies the beautiful  mechanism and nice  adaptation of the motions of the foetus  to the hard, crooked,
bony canal, through which it has to pass :  for,  on account of this oblique position, there is no moment
during the  whole of labor in which either  the  greatest breadth or length of the foetal head is occupying
any of the short diameters of the pelvis.  And  this obliquity  of the presentation, and spiral  motion  of the
child, is continued till the whole foetus is expelled: thus admirably exhibiting the great wisdom displayed
in the exact adaptation of the means to the end contrived in  the act or phenomena of parturition. 
PARTURITION, OR LABOR.
97
                                         SECTION  III.

                                    FACILITY  OF  LABOR.

  Why the human female suffers more during child-birth in  civilized society than she  does in rude or
savage life, or more than is suffered by the female of the brute creation, is a subject worthy of the deep
investigation and profound research of the philanthropist and  the philosopher.   It has been supposed to
arise from the fact that the  pelvis, through which the child has to  pass, forms a  crooked canal in the
human female, while it is straight in the lower animals.  This, doubtless, is one cause of the increase of
pain ; but this is comparatively little, for the God of Nature is  always uniform  in his operation, adapting
the  means to the end with wonderful  precision.  And if we cast our eyes abroad in the world, we shall
see  a  vast difference in the facility of labor among the different tribes and nations of the earth, although
human females possess a pelvis fashioned after one general model; so  that this is not the only  nor yet even
the  principal cause of difficult and painful  labor.
  We are told that, among some of the fndian tribes of our own country, when a woman finds her labor
approach, she retires alone to some secluded  spot near a stream, and there, without assistance, remains
till she is delivered ; when, after having washed her infant and bathed herself in the water, she returns to
her cabin and her occupations: thus showing that labor  among them is accomplished  with  nearly the
same  facility, to say the least, that it is even among the inferior animals.
  Washington Irving corroborates this account  of the Indian females, in his travels among them.  He
relates that " a squaw belonging  to the company, who was pregnant, one day left the company, and the
next day overtook us on her horse, with her infant in her arms, and  rejoined our party."
  What a striking contrast is this to  the  management during a labor of  one of our fashionable women  !
Great preparations must be made : a  nurse and  perhaps other women engaged ; and, of course,  the ser-
vices of a  doctor must be secured a long time previously to the expected event—the whole affair assuming
a most serious aspect.   Perhaps  the woman will  be put under a course of physic, or bleeding, or both,
during gestation, in order to prepare her for the important occurrence ; and not unfrequently, at the time
of her accouchement, by the  untimely and often unnecessary interference of the doctor and his instru-
ments, endanger,  yea, may even  destroy the lives of both  mother and child.   Examples of  this kind we
know have often occurred, and that, too, under the management of  some of our most celebrated physi-
cians.  This contrast between one  of our " fashionables" in labor, and the females of our forest,  may
teach us a very important practical lesson.
  The same facility in child-birth is said to take  place in the females of many other nations besides our
Indians — as the natives of Abyssinia, and most other African nations.   In some parts of the West India
islands the slaves are seldom confined from employment more than a day or two, and very difficult cases
of labor seldom occur among them.    The females among the lower  class of Irish, and indeed all females
who have much exercise in  the  open air, bring forth their young with  less pain and suffering than do
American women.
  Parturition is not followed by  the same  degree of  exhaustion in those women who  are employed in
manual labor in the open air, even in this country, as it is in those females who move in  what are termed
the  " higher  circles," whose life  is almost wholly artificial.  We see the wives  of laborers in the country,
as a general rule, soon able to resume their duties after their confinement;  while  the wives of the same
class  of society in our large  cities  are confined from their duties  much longer, and they  require more
care and attention  ; and serious and fatal consequences often result.
  Now I believe this difference arises from the more sedentary habits of those in the city,  and the artifi-
cial state of  society to which  they are subject.   To what else, but the perversion of our nature, is the
origin of these difficulties to  be ascribed?—by deviating from her established laws in our habits, customs,
and  fashionable way of living — our  erroneous  diet, want of exercise, tight  lacing, and various other
                                                13 
OS
IMPROVED  SYSTEM  OF  MIDWIFERY.
fashionable vice, common to civilized society :  to  these, rather than  to the peculiar form of the pelvis, is
woman indebted for the chief portion of the pains of labor, as is proved by those who live more agreeably
tv Nature's laws.
  " In proportion," says Crantz, in his " History of Greenland," " as we remove women from a state of
simplicity to luxury and  refinement, we  find that  the powers  of the system become  impaired, and the
process of parturition is rendered more painful.
  " In a state of natural simplicity, women in all climates bear their  children easily, and recover speedily.
The Greenlanders,  mostly, do all of their  common business  just before and after delivery ;  and a still-
born or deformed child is seldom heard of."
  Long  tells us that the American Indian  women, as soon  as  they  bear  a child, go into  the water and
immerse it.   " One evening, I asked an Indian where his  wife was.  ' He supposed  she  had gone into
the woods to set  a collar  for a partridge.'   In about  an hour she returned with a  newborn infant in
her arms, and coming  up to me, said, in  Chippeway,  « Oway, Saggonash, payshik shomagonish /'—or,
 Here, Englishman, is a young warrior!' "
  M. Chardin, in his " Voyages," remarks as follows : " Comme les accOuchemens  sons tres-aises  en
Perse, de meme  que dans les autres pais chauds  de I'Orient, il n'y a point de  sages femmes.  Les
parentes  agees et les plus graves, font cet office, mais comme il ri*y a queres de vieilles matrones dans le
harum, on en fait venir dehors dans  le besoin."
  Lampriere also observes :  " Women  in  this  country (Morocco) suffer but little inconvenience  from
child-bearing.  They are frequently up  next day, and  go  through all the  duties of the house with the
infant on the back."
   Winterbottom says that, " with the Africans, the labor is very easy, and trusted solely to nature, nobody
knowing of it till the woman appears at the door of the hut with the child."
   " The Shangalla women," says the traveller Bruce, "bring forth  children with the  utmost ease, and
never rest or confine themselves after delivery; but, washing themselves and  the child with cold water,
they wrap it up in a soft cloth, made of the bark of trees, and hang it up on  a branch, that the ants with
which they are infested, and the serpents, may not devour it."
  In Otaheite,  New South Wales, Surinam, &c, parturition is easy  ; and many more instances might, if
necessary, be adduced.  We are not, however, to suppose  that  in warm climates women  do not some-
times suffer materially ; for Bartholomew states that,  in the  East Indies,  " many of the women lose their
lives the  first time they bring forth."  This may be ascribed to youthful marriages, at the age  of nine or ten,
  Undomesticated animals generally bring  forth their young with  considerable ease ; but sometimes they
suffer much pain, and, when domesticated, occasionally lose their lives.
  " With respect to the  facility of  labor," says Dr. Dewees, " it would be wrong to  suppose  that the
labor of the female  brute is performed upon different principles from that of the  human female,  because
she is for the most part exempt from pain; for truly the  same general process occurs in  both, and in each
the uterus exerts the same kind of action.   The only difference is, the  one is performed with pain, and
the other without.   Whatever  difference, therefore, there may be in the pain of each, must  arise from
artificial causes.  This would seem to be proved  by the consequences which seem everywhere to  follow
civilization and refinement.
  " The consequences of domestication may be traced in  those animals which  participate with man in
his departure from his original simplicity:  for we  are informed that the  artificial condition in which the
cow is placed, in our large cities, subjects  her to more  difficult and  dangerous labors  than those in the
natural or less artificial state."
  A lady in  this  city has  written an  excellent  treatise on  this  subject, entitled " Child-Birth without
Pain," the object of which  is to  prove  that if  females were to live  up to the laws  of  their being,  estab-
lished by the Creator, they would be measurably exempt from  the sufferings which they now  experience
in labor,  and would produce their offspring with equal facility with the brute creation ;  that if these laws
were obeyed, instead of seeing one  half  the human race cut off  in  infancy, their children would  be as 
PARTURITION, OR LABOR.
99
exempt from disease as the young of the lower animals.   This subject affords a very interesting topic of
inquiry to the physiologist, the philosopher, and  the philanthropist;  and, if duly investigated by them,
would no doubt lead  to discoveries  and improvements in the mode of living, which would tend to* bring
back  the human family to that state of simplicity and happiness which was intended by their Creator, and
would also cut short at least  half the diseases which affect our race, and thus  extensively ameliorate the
condition of  our species.*
                                          SECTION  IV.

                             PREMONITORY  SIGNS  OF  LABOR.

  Among the symptoms  of approaching labor, is, subsidence of the abdomen.   Some days before  labor
commences, we  may observe a remarkable subsidence of the abdomen, and diminution in the size of the
woman  is apparent.   She feels lighter, breathes freer, and is more cheerful.   This is occasioned partly by
the  sinking of the cervix uteri or neck of the womb and its contents into the brim of the pelvis, and partly
by the gradual closure of  the  uterine walls previous to their  taking on active contractile  efforts.  When
this symptom is  present, it  is always a favorable one, because it  indicates room in the pelvis ;  for if the
head will sink into the pelvis covered with the uterus, there can be no want of room for it there when it
is forced out of the uterus.   This symptom of approaching labor is not present where there is any dispro-
portion  between  the head  and the pelvis, from any cause.
  Relaxation and  Moisture of  the  Parts. — In approaching  labor,  considerable  relaxation,
and increased moisture of  the vagina  and external parts, are  observed, frequently causing some  slight
tumefaction  of the vulva.    This  is  a  good  symptom when  it occurs, because  it shows that  there is a
disposition in the passages to become relaxed and dilated.
  Some physiologists would teach us that dilatation in  labor is  entirely a mechanical act; that, as the
uterus contracts, it propels the  head, first through the os uteri,  by dilating  it  mechanically, then through
the  vagina, and  lastly through  the external parts, solely by the same forcible  distention.   It is evident,
from the structure  of the organs, that a mechanical dilatation to so great an extent never could take place,
unless a corresponding  disposition to relax were given  them at the same  time ; and therefore we  must
consider the dilatation  of the  passages  not  entirely dependent on mechanical distention, but that it  is
principally to be attributed  to one of  Nature's unerring laws, by which the  parts  become relaxed and
softened when the  uterus is  about to  commence its contractions.
  Anxiety and  Restlessness. — We often observe, several days before labor commences, an unu-
sual anxiety, restlessness,  and concern, respecting  the issue of the case ;  sometimes fearful forebodings
seize the mind, but an increased anxiety  is always present, as a precursor of  labor.
  Irritability of  the  Bladder  and  Rectum. — This  is manifested  by an increased  desire to
urinate,  and evacuate the  bowels.  Sometimes this is very  troublesome.  It is caused by the head of the
child pressing on the nerves of the bladder and rectum ;  sometimes there is a tingling or even numbness
in one of the limbs — seldom in both — arising from the pressure of the child's head on the great sciatic
nerve.   This generally  disappears when  the  labor  has  made some  progress.   Should irritability of the
rectum become very annoying, and the labor not making much  progress, we may give a demulcent injec-
tion ;  if this does not arrest it,  we may repeat, and add  a few drops of laudanum.
  Nausea  and Vomiting. — These very often  accompany the early  part of labor, and  sometimes
even in  its  more advanced stage ;  it is a good symptom, and is usually the precursor of full relaxations
of the parts.
 * Those who  may wish to investigate this subject farther, are referred to the treatise above mentioned — " Child Birth without Pain.v by
Mrs. Pendleton,  of this city — and also another work, by the same author, entitled " Moral and Physical Traits transmitted by the Parents to
tlieir Offspring;."  See also " Walker on Intermarriage.' 
100
IMPROVED  SYSTEM  OF  MIDWIFERY.
   Glary  Mucus  tinged with Blood. — Sometimes, with the above  premonitory symptoms, we
have combined a discharge, which issues from the vagina, consisting of mucus tinged with a little blood.
This rs what the nurses call a show.  The mucus issues from the large and numerous follicles which lie
in the  mouth and neck of the womb, and the blood consists of a small drain from a few capillary vessels
passing from the cervix uteri to the membranes which have been ruptured by the slight dilatation of the
os uteri.  Hence it is, because the show of blood is indicative of the dilatation of the os uteri and descent
of the membranes,  that this sanguineous appearance  may be  looked  on as  the token of labor actually
commencing.
   Intermittent  Pains. — When labor actually commences, it usually does so with more or less pain
at intervals.  These pains may be frequent or remote — occurring every few minutes, or with an interval
of half an hour or more between them.  Labor usually commences  with pain, but it may make consider-
able progress without any pain whatever ; sometimes the  os uteri is dilated before any pains have been
experienced, but these cases are very rare : the patient is much more likely to be tormented with —
   False  Pains. — There  are two  kinds of pains which are liable to manifest themselves at the latter
part of pregnancy, and  about the commencement of  labor : the one  is  called  true, and  the other is
called false pains ; and it is of the utmost importance, both to the  patient and to our own reputation, to
be  able  to distinguish them.  This  we  may  readily do  by keeping  before our minds  the following
distinctions:—
   1.  False pains do not  recur uniformly, as do true pains.   We have  stated that true pains are regular
in their intervals : they may recur once in half an hour, or once in  five minutes — or in any intervening
time ; but whatever form  they assume, they are regular: for example, there will not be an interval of one
quarter of  an hour  between  one paroxysm, and five minutes  between  the next.   Whatever form  they
assume, they are regular, except  in this particular, that they gradually become more frequent.  If, there-
fore, the pains are very irregular  in their recurrence, they are generally false pains.
   2. False pains are very apt to come  on at night, trouble  the patient very much, and pass  off  during
the day.  Sometimes the patient will be annoyed for four or five weeks, or even longer, by these pains,
before labor commences; they are more frequent in first pregnancies than in  subsequent ones.
   3. But the only means of distinguishing false from true pains with absolute certainty in all cases, is, to
ascertain their effect on  the uterus.  False pains, however severe, do not  concentrate themselves upon the
uterus, nor at all accelerate the labor.
   If we place our hand on the abdomen during the pains (the patient lying on her back, with her limbs
flexed), if they are true pains, we shall feel the uterus contract and become harder under our hand as the
pain increases, and  grow softer again as the pain goes off; but if they are false  pains, they will not have
any effect on the uterus.   Again, if we examine  the vagina during  a true  pain,  we shall feel the os  uteri
dilate a little, and the membranes protrude through the os ; but if the pains, however severe they may be,
have no effect on the os uteri, they are false and spurious.
   Sometimes the midwife or the accoucheur has  been kept  for several days in attendance, and the pains
have at length gone off,  and  perhaps the woman has  not  been in labor for  a  month or  more.  Dr.
Hassell (who has made midwifery and the diseases of women and children his peculiar study) has just
related to me a case in point, of a  young doctor who had been three days attending  upon a woman sup-
posed  to be in hard  labor, but  no progress was made.   The doctor  said  he could not make out the
presentation, and thought it must be  a cross birth.  At length  he begged of Dr. Hassell to accompany
him and  examine the case, which  he did, and found  the pains very much to resemble labor-pains, and
well calculated to deceive any one who judged from appearance only ; but the pains had no effect on the
os uteri, or, in other words, the woman was not in labor.  He took  the young doctor aside, and told him
that the woman was not in labor, and that if he would evacuate the bowels freely, and then <rive her an
anodyne, he might perhaps leave her comfortable for a month.  He did so, and  she had no  return of the
pains ;  and in one month and two days afterward, she was  delivered  of a fine child, after about six hours'
labor. 
PARTURITION, OR LABOR.
101
  Now those who do not know enough to distinguish false from true labor-pains, ought to acquire more
knowledge on this subject.  Strict attention to the above rule will prevent the possibility of such mistakes.
  Remember that false pains, however severe, produce no effect  on the os uteri; while all true labor-
pains produce contractions of the uterus, which can be felt by the hands through the abdomen, and also
produce dilatation of the os  uteri, and  some  protrusion of the membranes, which may  be readily felt by
examination per vagina.   To prevent the possibility of mistake,  we may examine both ways, if necessary,
or if we have any doubt.
  Treatment  of spurious or false Pains'. — This will depend  materially upon the cause, and
the state of the system.   Frequently it arises from a costive state of the bowels ;  the length of  time that
the rectum may  remain during pregnancy without an evacuation, and  the woman  appear to feel no
inconvenience from it, is far beyond what we  might suppose: a fortnight, and even three weeks, is not
uncommon.  And we often  find it very difficult to ascertain the true  condition  of the bowels ; for the
patient herself is frequently  deceived, and imagines that her bovyels are quite regular, because  she has  a
daily inclination to go to stool :  when there  is perhaps  on  such  occasions a  slight, scanty  discharge
of loose, feculent matter, leaving the mass undisturbed. We can not, therefore, pay too  much attention
to this state of the bowels, because, when the  rectum is in  this condition, the whole of the large intestines
become distended with wind, which causes spasmodic pains, that are often mistaken for labor-pains; the
distended rectum may be felt through the walls of  the vagina  in such cases.  The indication is, here, to
evacuate the bowels by a mild  purgative, as  castor-oil, &c, and  at the same time give a large but mild
and emollient enema, perhaps of warm water and molasses — not an irritating one.  All irritating purga-
tives and enemas at such times  should  be  avoided, because they may be, and are, indeed,  liable to com-
municate  the  irritation  by sympathy to the  uterus, and perhaps bring on premature  labor.   After the
bowels are thus  thoroughly evacuated, give  an anodyne  if any pain,  irritation, or  restlessness remain.
Instruct such a patient  to keep  her bowels regular  during  the remainder of her pregnancy, and she will
pass it in tolerable comfort; at least she will not be annoyed by false pains.
   Sometimes these false pains will follow the opposite state of the bowels, or a protracted diarrhoea : then
an anodyne only  will be  needed ; generally in severe  cases, however, it may require  to be treated  as in
diarrhoea or dysentery, as laid down in my " Reformed Practice of Medicine."   Where neither obstinate
constipation nor diarrhoea prevail, an anodyne may be  given immediately (as the tincture of hop), followed
by  some gentle aperient, and all false pain will be removed.
                                          SECTION  V.

                               CLASSIFICATION  of  labor.

   Almost every systematic writer on midwifery, since the days of Hippocrates, has adopted some clas
sification of labors, in accordance with his  own  views.   The great father of medicine, as he  is called,
adopted but two classes, natural and  unnatural.  He called all those labors natural in which the head
presents, and all those unnatural where any other part besides the head  presents.  Smellie, who wrote
in 1752, added to this  simple arrangement another class, which  he calls  laborious labors, in which class
he includ.es all those labors in which either  manual or instrumental  assistance  becomes necessary.   Bau-
delocque also divided labor into three classes, as did Smellie, but his arrangement was different: he called
all labors natural which  are  terminated by  the natural powers, whether the head, breech, or the  inferior
extremities present; he calls all those preternatural which present by the side or  upper extremities, which,
although they may require the aid of art, that assistance is afforded  by the hand  alone ;  he calls all those
laborious labors where instruments become necessary.
   Dewees follows the arrangement  of Baudelocque, except that he  divides instrumental deliveries into
two orders : the one accomplished by instruments which are supposed to do no injury, either to mother 
102
IMPROVED SYSTEM OF MIDWIFERY.
 or child ; the other accomplished  by cutting instruments applied either  to the  foetal  or  the  maternal
 body.
   Davis makes four classes :  natural, when the  head presents ;  preternatural, when some other part pre-
 sents ; complex,  when  some  accidental circumstance of an embarrassing nature occurs ;  instrumental,
 when assistance by instruments is necessary.
   Blundell adopts five divisions :  he calls those natural, when the head presents, and the whole labor is
 terminated in twenty-four hours ; preternatural, when some other part  of  the child  presents ;  flooding,
 when attended with haemorrhage ; laborious, when instruments are required ; and anomalous, when some
 extraordinary symptoms are superadded.
   Ashwell  makes three  divisions : natural, difficult, and flooding.   Merriman arranges all labors under
 two classes only, which  he  calls entocia and dystocia, from Greek words signifying easy and  difficult;
 but under dystocia, or  difficult  labors, he  introduces fifteen orders, embracing every circumstance that
 can in any way render the case tedious, difficult, or dangerous.
   Conquest includes all labors in two classes — natural and preternatural — and divides  the second class
 into six orders.   Power arranges labor under  two heads, entocia and dystocia (easy and difficult), and
 he divides the latter class into three orders, nervosa, mechanica, and accidcntales, into which he introduces
 twenty-four genera.   Ryan makes four  classes — natural, preternatural, manual, and instrumental — which
 he subdivides into forty-three  orders.   Burns  multiplies the classes to seven — natural, premature, pre-
 ternatural, tedious, laborious, impracticable, and  complicated.
   Denman divides  labor into four classes — natural, difficult,  preternatural, and complex.  Hamilton,
 Lee, Ramsbotham, and  a host  of others — in  fact, almost all  late  English  authors — adopt Denman's
 division,  with some slight modifications.   He defines  natural  labor to be one in which the process is
 complete within twenty-four hours, the  head of the child presenting, and no adventitious assistance being
 required.  But many authors  have regarded natural labor as much more contracted in its features.  Thus,
 Mauriceau considered it essential to a natural  labor that the foetus should be living ; Burns, that  it should
 have arrived at intra-uterine maturity ;  Baudelocque, that the vertex should  present; Merriman, Burns,
 and Campbell, define it to be a  vertex  presentation, in which the face turns into the hollow of the sacrum
 before expulsion.   There is also a difference with regard  to time proposed by different professors: thus,
 Professor Cooper restricts the period to twelve,  and Professor Power to six hours.
    The following is the classification which we shall adopt, and under which we propose to embrace every
 kind of  labor which it is necessary to distinguish :—
    We shall  divide all labors into five classes — natural, difficult, unnatural, complex, and instrumental.
    By natural labor, we mean those  labors in which the  head  presents, and which  are completed with
 ordinary facility,  without any  artificial assistance  from medicine,  the hand, or from instruments.
   By difficult labor, we  mean those labors in  which the  head  of the child presents, but which is  not
 born with ordinary facility, being  protracted, and  usually  requiring assistance, either from medicine, the
 hand, or possibly from instruments.
    By unnatural  labor, we mean all those labors in which any other part except the head presents.
    By complex labors, we mean all those  labors, whatever  be the presentation, in which some  untoward
; circumstance occurs, or is complicated  with it.
   By instrumental labor, we mean all those labors which  can not be terminated without the use of some
 artificial instrument, which I believe to  be extremely rare. 
NATURAL  LABOR.
103
                                       CHAPTER  IV.

                                NATURAL  LABOR.

  Definition. — By the term natural labor, we mean all those labors which occur at the full period of
gestation, in which the head presents, and which are completed with ordinary facility, without  requiring
any artificial assistance from medicine, the hand, or from instruments.
  Natural labors form a  standard, by which  we judge of and measure every other class of labors.   It is,
therefore, indispensable that we should first obtain a precise and accurate  knowledge  of natural labor,
before we can begin to understand difficult, complex, or instrumental labors.
  If, in any given case of labor, any of the  characteristics in our definition of natural labor be wanting, it
is not a case of natural labor.   For  example, if any other part besides the head presents, it belongs to the
class of unnatural labors.  If  the labor be such  as to require assistance from medicine or the hand of the
accoucheur, it is  a difficult labor, whatever may be the presentation.   If  convulsions,  haemorrhage, or
any other  unusual circumstance,  occur  during  its progress, it  is a complex labor.   If the labor can not
be concluded without the use of instruments,  it belongs to the class of instrumental labors.
                                          SECTION I.

                                     STAGES  OF  LABOR.

   Although labor is, in reality, but one continued process, from beginning to end, without any inter-
mediate state or suspension  between any one  period  and another, yet, for the  sake of perspicuity and
precision in treating of it, we shall find it very convenient to divide its progress into four stages :—
   The first stage of labor commences with the attack of true labor-pains, in contradistinction to
those which are spurious, and occupies the whole  period (whether long or short) from this attack till the
full dilatation of the mouth of  the womb.  About  this  time  the  membranes generally rupture, and the
waters are discharged.
   The second  stage  of  labor commences  with the full dilatation of the os uteri, and occupies the
whole period during which the  head  of the child passes  through the superior strait into the concavity of
the sacrum, and presses on the  perineum, dilating  it and the external soft parts :  thus  forming what  is
termed the perineal tumor.
   The third  stage  of  labor  commences with the perineal tumor, and occupies the  whole period
during which the head and body of  the child are being expelled, and the cord divided.
   The fourth stage of labor consists in the expulsion of the placenta and secundines.
   The accoucheur  who keeps in mind this  division of labor, and well  understands the process  which
takes place in each — who has learned that, in a perfectly-natural labor, each of these processes is con-
ducted by the unaided powers of nature — and who has  been accustomed to sit by  the bedside of  a  par-
turient woman, and there watch the  efforts of nature in their steady, onward course, through  all these
successive stages — will at once see the impropriety, folly, and danger, of attempting, by  any interference
of his own. to shorten any one  of these periods ;  and should he thus interfere, he  knows  that he  would 
104
IMPROVED SYSTEM OF MIDWIFERY.
only interrupt the salutary efforts of nature, and thus render the labor more painful, difficult, and danger
ous :  for he is well aware that every regular symptom and  stage of labor performs a double office — not
only accomplishing the present object, but  preparing the parts, which  are  next to be concerned, for the
more  easy performance of what is to follow.
                                         SECTION II.

                              the  first  stage  of  labor.
                                                                                 <
   The first stage of labor, we have said, commences with the attack of true labor-pains, in contradistinc-
tion to those which are spurious, and occupies the whole period (whether long or short) from this attack
till the full dilatation of the mouth of the womb.  About this period, also, the membranes generally rupture,
and the waters are discharged.
   We must bear in  mind that,  during  the first stage  of labor, no sensible  change is  perceived in the
position of the foetus ; the uterine aperture is the only part which experiences any marked alteration.   The
first stage of natural labor, then, is occupied in opening and  dilating the orifice of the womb.   This stage
frequently commences with £ slight shivering, and sometimes with a very considerable chill: when these
symptoms are connected with regular labor-pains, they are esteemed favorable ; but when succeeded  by
fever, they are unfavorable symptoms.
   Most commonly, however, labor  begins with pain in the back and loins ;  stretching thence across the
abdomen to  the pubes, and ending on the  upper part of the  thighs : this pain soon passes off, and leaves
the woman free ,* but returns  again, at  longer or shorter intervals.   These pains at first are  generally
slight, with long intervals between, but the intervals soon grow  shorter, and the pains become exceedingly
sharp and cutting.   When they  assume  this character, the mucous discharge from the vagina is  generally
discolored by a little blood, called by nurses a show, arising from the rupture  of some of the small vessels
passing across the internal mouth of the  womb during its dilatation, after which the very sharp and cutting
sensation commonly  abates ; and although, on the whole, the  pains grow stronger,  and return at shorter
intervals, yet they are usually less distressing, and are borne with less impatience.   The cause  of labor-
pains is, unquestionably, the  contractions  of the muscular fibres of the uterus, by which it is lessened in
every direction, but principally in its longest diameter, from the fundus to the  os tincee.  When, therefore,
all the longitudinal fibres contract, we can easily perceive that  the os uteri must be drawn back upon the
presenting part of the child, and thus cause it to be forcibly dilated ; but  the pains soon relax,  from the
nature of all muscular action,  which, when natural, never can be permanent.
   Variations  in  the Position of  the  Os Uteri. — In the  early part of this stage, the os uteri
is commonly found much nearer the sacrum than the pubes or other points of the pelvis ; but as parturition
advances, it comes more into the centre of the brim.   At other times, it feels as if it were drawn toward
either ilium ;  and sometimes, though rarely, it is felt much nearer the pubes than the sacrum.  These
occasional positions of the os uteri should be remembered, because  it will tend  to remove one  of the
greatest  difficulties  which the novice  in  midwifery has to encounter, viz., tracing the os uteri in the
early stage of labor.
   Variations  in the  State of  the Os  Uteri. — If  an examination be  made at this  period
(which should not be often repeated, and always performed with the greatest caution, for fear of breaking
the membranes), the variety in the sharpness and severity of the pains in different labors, will be found
connected with the situation,  and to depend on the state, of the os tinea?.  In some, it will be found soft,
lax, and yielding — and, though not dilated,  still dilatable ; while in  others it is  hard, firm, rigid, and
unyielding — not allowing itself to be at all  distended  by the  finger, any  more than  a  piece of hard
leather would. 
NATURAL LABOR.
105
   There are four chief varieties in the character of the os uteri, which we may meet with during the first
stage of labor:  The first is when  it is thick, soft, moist, cool, sensible to the touch, but not painfully so
— having very much the feel  of a piece of thick, wet, chamois leather.   The  second variety is, when it
is  thick, hard, and rigid — perhaps also  hot, dry, and tender — and  gives  a  sensation to the finger ver
much like the touch of a piece of cartilage.  In the third variety, the os  uteri is thin, soft, moist,  cool,
and  not painful when  touched, its  edge  feeling like a piece  of  moist brown paper, and so  thin that the
head of the child can be  distinctly felt  through  its substance.   The fourth  variety is when  it is also not
only found thin, but hard and rigid, sometimes very tender to the touch, and  having a glazed feel, with
its edge surrounding the presenting part  of the child, and tightly embracing it, like a piece of whipcord.
   Under one or other of these varieties we shall always  find the  os uteri soon after the commencement
of labor.   In perfectly-natural labor, it will be  found in one or other of the soft»states ;  when  found in
either of the hard, hot, tender states, it  generally  indicates a difficult labor, which will at least need some
assistance from relaxing agents, of which we shall speak more particularly when we treat of difficult labor.
At present, except incidentally, we have only to  do with  natural labor.   In  natural labor, the os tineas is
at first generally found far back and high  up, but sometimes so low that it is met with  just within the
vagina, with the edges thick and  soft, and  the opening small, and perhaps scarcely perceptible ; as the
pains continue, the internal orifice descends and  comes forward in the vagina;  the edges grow thin  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  distended, but, as  the pain remits,  becomes loose  and
flaccid.  As the  internal orifice of the womb enlarges, this bag  protrudes through, and assists in dilating
it.   At length  the  thick  edges of the orifice are entirely obliterated, and the womb and the vagina form
one  continuous canal, like a porter-bottle ;  and  the membranous bag, no longer supported  by the  edges
of the os uteri, give way, and the waters are discharged.   Sickness and vomiting are frequent and salu-
tary accompaniments of this stage of labor : the nausea contributes to the relaxation of the whole system,
and  the retching  adds  somewhat to the  dilating effects of  the pains.
   Duration  of the  first Stage. — The  duration  of the  first stage  of labor is  very different  in
different women, and  often varies in the same woman in different labors;  but in  general it requires more
time with the first child than with subsequent ones, and in all well-formed women it commonly occupies
much more time than  any other stage of labor.  If the membranes burst early,  before the labor begins, or
very soon after, the os uteri will require to  be dilated by the head of the  child  :  in this case, the pains in
the  back are generally more grinding, and  the dilatation in all  respects more tedious  and painful;  but if,
on examination, the os uteri continue soft, cool, and without pain, it will'only require more time,  patience,
and caution, in our examinations.
   In ordinary cases, the first part of the  dilating process  usually advances slower than the later part ;
hence we find that that degree of  dilatation under which the organ acquires the  diameter of a half dollar —
or sufficiently large to admit  the tips of the two  fingers — will perhaps occupy a longer  period  of time,
than will its dilatation  from that small  size to  the full and entire dimension which will  easily allow the
head of the child to  pass through it.   This partly  arises, perhaps,  from  the natural  disposition in the os
uteri to open more readily after it has acquired a certain diameter ; but it is doubtless owing also in some
degree to mechanical  action : for, when it has become expanded  to such an extent as to admit  the mem-
branous bag or any portion of the  child's head to occupy its aperture, the protruded part acts  like  a wedge,
and forcibly distends it.    The cause, however, is not entirely and purely mechanical, for it depends also
in a great measure on the principle of vitality.
   It is quite impossible  that we can give even a probable estimate  as to the time which any particular os
uteri will require for the perfection of its dilatation ;  for sometimes one that has been from the commence-
ment highly rigid, scarcely showing the least  disposition to open, will  suddenly become  relaxed, and
rapidly distend its circle  to its full dimensions ;  while at another  time, though the os uteri be soft and
flaccid, the pains will altogether  subside without  any apparent cause, the process of dilatation become
suspended, and the labor  remain  stationary for hours.   In short, there  is, particularly in this respect, sq
                                                 14 
 1>3                         IMPROVED  SYSTEM OF  MIDWIFERY.

 great a variety, that it is in vain to attempt to assign any time to the duration of natural labor or any of
 its  stages.  Some women  have been  delivered  in  their sleep — in  the room  in which  they were first
 seized, without being able to get to their, beds — or while  on  a visit — perhaps in a  ball-room — or in
 passing up or  down stairs — at the close stool, or the privy — without having time allowed them to return
 home, or reach the house, or make the least preparation ; while others occupy many hours : some require
 many days for the safe and happy accomplishment of a labor perfectly natural  ; and in some women there
 is, now and then, almost as great a variety in the  duration of different labors.
   No  Akt can shorten this  Stage. — In the first stage of a natural  labor, according to the defini-
 tion we have given of it, and consequently what we mean by the term, no skill or art of the midwife, nor
 exertion of the woman  (in this stage) can  in the least  contribute to  lessen the  severity of the pains, or
 shorten their duration.^  They are  intended  by nature to accomplish a necessary and important object—
 the complete dilatation of the internal orifice of the womb ; which, from a rigid ring, of some considerable
 thickness, and generally close shut, is to be softened, relaxed, and worn away, until it  is entirely obliter-
 ated,, and so prodigiously enlarged, as to permit the child to pass through.   Hence we learn the reason
 why more time and pains are required to open the orifice of the womb to the size of a half dollar, than to
 obtain all the  remainder of the dilatation  necessary for the  delivery;  a fact which young practitioners
 should constantly recollect when forming an opinion on the probable duration of labor: that, on the one
 hand,  they may not fatigue their  patient, by urging her to unnecessary exertions  at  the  beginning or
 during this stage of labor ; nor, on the other, expose her to the hazard of being delivered alone toward
 the conclusion.  Hence, too, we see the cause why the pains are more severe, cutting, and grinding, at
 the commencement, than they are toward the end  of the first stage :  at the  beginning, the  lips of the
 internal orifice are thick and rigid—consequently they make  great resistance, and are in some measure
 torn asunder by the force of the pains ; but as this stage advances, they continually grow thinner, and are
 more and more  relaxed  and softened, and  consequently they make less resistance, and are more easily
 distended.
   But, although the accoucheur during this stage can neither  lessen  his patient's pain, nor  shorten its
 duration — and although he is absolutely forbidden  to interfere in  any manner  with the  progress  of  a
 purely-natural labor—yet his presence, so  far from  being useless, is very necessary;  for that man is but
 little used to the exercise of the social  virtues, who is ignorant of the influence which a kind  and feeling
 conduct has upon his suffering patient:  and to deprive her of it, is withholding a right  for which nothing
 can compensate ; and which, in her estimation, when freely bestowed,  almost compensates for any  want
 of skill and experience  which she  may discover.   Our patient is entitled to all the consolations which  a
 well-grounded assurance of a happy termination of her sufferings  can afford;  and this must be offered to
 her, from time to time, that she  may profit by its encouraging  influence.   Yet we must beware that we
 do not betray her into false hopes, by any ill-judged  promise of a speedy issue, when the termination^
 from the very  nature of the case, must be remote.   Nothing will so completely destroy  the confidence of
 the patient, and all present, in our professed knowledge, as a labor to continue  long after we have foretold
 its termination : truly, here, " hope  deferred maketh the heart sick."
  From the knowledge  which the  foregoing pages will  afford of the  beneficence displayed by the God
 of Nature throughout the whole process of utero-gestation and labor, and of  the admirable contrivances
 adopted  by  him  to  overcome difficulties and avert dangers, it will be evident  that in all cases of strictly-
 natural labor, the duties of the attendant  must be few and simple.  Generally, indeed, no active assistance
is necessary, until after the  birth of the child ; all that is required of the attendant being, that he should
remain an observant though unofficious spectator of the process — ready to exert himself with promptitude
and energy on the first appearance  of any deviation from a  perfectly-natural  labor, or  on the first acces-
sion  of any alarming symptom ;  but at the same time he should be equally — nay, even more__ready to
allow the changes necessary for the completion of  Nature's object to  proceed without interruption from
 any meddlesome interference of his.  For no  maxim  in obstetric  science is of more universal application
than this,  that  all unnecessary assistance, rendered with the view of expediting the termination of a case, 
NATURAL LABOR.
If. 7
or shortening the sufferings of the patient, is not only useless, but is in the highest degree injurious, and
well calculated to defeat its own end.
   Let it not for a moment be supposed that this declaration includes the admission that a partial acquaint-
ance with the subject of midwifery is sufficient  for the  safe practice of the profession ; for, although in
nine cases out of ten, little  or  nothing is  required to be done before  the birth  of the child, yet, in  the
tenth, such danger  may occur, as  can only be arrested by the most prompt, decisive, and judiciously-
directed  assistance ; and no person knows, when called to attend  a labor, what character that labor may
assume.
   Much accurate knowledge is  necessary, to discriminate between the kind of cases in which ac-sistance
is  proper, and  to determine the time  at  which  that assistance ought to be  employed,  as  well  as  the
proper mode of its  application.  It is this which distinguishes the  scientific accoucheur from  the ignorant
charlatan ;  it is upon  the possession and  exercise of this  important knowledge, that the future com-
fort, health, and even life, of many a parturient  patient  of  every practitioner must depend.   But on this
subject we shall speak  more particularly and in detail when treating of the other  divisions  of  labor, in
the practice of which, all the skill and knowledge which we can possibly attain,  will not unfrequently be
called in requisition.
   In the manner, then, which we have described, the labor is to  be suffered to go  on without any inter-
ference ; the pains  continuing, gradually open the internal orifice  of the womb, and force  the membranes
through  it in the form of a purse, which, acting as a  soft wedge, contributes  in  the easiest way to its
further dilatation.   Of the progress, the accoucheur may occasionally assure himself by examination, but
as seldom as possible, at the same  time taking especial care not to fret or irritate  the  parts  by  too-frequent
repetition,  or by any want of gentleness  and caution.  Although we  must always  introduce the  finger
during the accession of a pain, because the woman will then most readily submit, yet we must not usually
attempt  any accurate examinations  until it remits, lest the membranes  should burst, and the  water be let
out before the  internal orifice be fully dilated — an accident which always protracts labor, and  may convert
a natural labor into a difficult  one.   Another argument against frequent examinations is, that  it has a ten-
dency to remove the natural mucus already secreted, and to inflame the tender lining of the vagina, so as
to check the further 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 labor.
   The only reason which can be urged in favor of frequent examinations is, that it enables us to encour-
age the  woman, by more frequent  announcements of the progress of the labor, which, in some  particular
cases, if managed with great discretion, may  perhaps be practised with  advantage.
   But, if it be necessary to be thus cautious in a careful and occasional examination, what terms shall we
use, sufficiently strong to condemn  as it deserves, the  abominable  practice of boring, scooping, and
stretching the soft parts of the mother, under the preposterous idea of making  room for the child to pass I
" It is impossible," says Bard, " to censure  this idle, indecent, and  dangerous practice, too  severely ;  it
is always wrong, nor can there  be any one  period  in any labor — the most  easy and  natural,  the  most
tedious  and difficult, the most regular and preternatural — in which it can be of  the  least  use — in which,
indeed,  it  will not unavoidably do great mischief, and ever betrays the grossest ignorance and mal-practice :
for it will render an easy labor painful;  that which would  be short,  tedious ;  and one  which, if left to
nature,  would terminate happily,  highly dangerous ;  and particularly  it  will  endanger the  laceration
of the  perineum,  by  rendering  it  dry,  rigid, and inflamed, instead  of leaving it  soft, moist,  and
dilatable.
   " I am the  more solicitous," continues  the  same  experienced writer, " to express  myself  fully and
clearly upon this  subject, because I know the  practice which I am condemning, even now, to be very
general  in our country, particularly out of the  large cities ; and  that we have to combat the prejudices,
not only of the common midwives and less enlightened practitioners, but also of by far the greater number
of their patients, upon  this subject; and that, although we may convince the judgment of the more candid
and unprejudiced  practitioners, whether male or female, they will not be  always  suffered  to execute it 
108
IMPROVED SYSTEM OF MIDWIFERY.
unless they have considerable firmness and self-possession to resist the solicitations  and importunities
of the patient and her mistaken friends.
   " The  practitioner will not only be importuned on  some  occasions of a little delay, but he will be
reproached with permitting  his patient to  suffer without  assistance, and  will often  be  threatened with
application to others,  and the  loss of his reputation.  I speak from  experience.  For  these reasons, We
must be firm, and resolved to  withstand the entreaties which the distress of the patien,t may urge her to
make; as we must also the  dictates of vehemence and ignorance of the bystanders.
   " Others may be impatient, but we  must possess ourselves, and  act  upon principle.  The event will
justify our conduct;  and, though there  maybe temporary dislike and  blame, yet we shall have the
approbation of our own minds, and ultimately secure permanent favor and reputation."
   Leaving nature, therefore, to her own  unassisted and 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, and by  encouraging her to do so with her friends.  We should  direct  her to walk
about the  chamber, or from  room  to room ;  to  sit  or  lie down, as  she finds most agreeable to herself;
and, if she can, to sleep between her pains, which some  women are  very apt to do.   But she should not
be allowed to remain  continually in a horizontal posture until the neck of the womb is completely dilated.
It is not uncommon to find  the parts dilating slowly while  the woman is in a horizontal posture, an'd for
labor to  advance with rapidity upon  the woman's walking about or being seated on  a chair, in which
posture the weight  of the ovum makes a greater  resistance to the  contractions of the womb, and thus
assists in dilating the internal orifice.   We should converse freely with the family, and not only leave
our patient with her friends to pass her urine, but to manifest our own ease and confidence in the natural
progress and happy termination of the labor ; and thus excite the hopes and confidence of our patient,
which, more  than anything else, will tend to give strength and regularity to her pains.
   Do not allow too many persons to remain  in  the room with a woman  in labor.   A great number of
witnesses  is always injurious,  because  they are  in the way; they vitiate the air, and increase the heat;
and they are generally women wanting in courage  or discretion :  some  faint, and require that assistance
which should be exclusively reserved  for the patient;  others amuse themselves by the recital  of unfortu-
nate deliveries, which they always misrepresent and exaggerate, so that the female becomes uneasy, lc*ses
her patience, or receives  an impression which may exert  an  injurious  influence.   All useless persons,
therefore,  should be desired to leave the room, and  only one or two intelligent assistants remain, such as
a mother, sister, relation, or intimate friend,  and the nurse.
   And  here  I must  pause to allude  to a common practice, which I  consider very reprehensible and
demoralizing, and  which consists in the unrestrained indulgence of light, frivolous, and obscene conversa-
tion, unbecoming the  dignity of all genteel society.   Such conversation also has a depressing and injuri-
ous effect on the patient, as  well as polluting the minds of  all present.
   At a proper season during labor, some refreshments, which  should always be light  and sparine, may
serve to divert the attention ; and every occasion of this nature should be embraced, to  lessen impatience
and  protract expectation.  Indeed, to  gain time during this painful and  irritable period, is an  acquisition
of  no inconsiderable  moment: for the time which uninterrupted  nature  requires  to bring about the great
changes which are now being  accomplished, is  always necessary ; and when no  morbid cause interferes,
it is  unquestionably true that women in general  recover better after a rather slow labor than after one that
is quick and  sudden.
  In this manner the  first stage of labor is to be passed, the attendant now and then cautiously examining
its progress ;  in doing which, when the internal orifice is sufficiently open to  easily admit the finder, the
head of the child may frequently be  felt, and  distinguished by its regular shape, smoothness, and hard-
ness, through the lax  membranes ; and may be made another  source of consolation  and encouragement
to the patient, by assuring her  of it.  But we must be very cautious how we predict a speedy  termination
of the labor; for many untoward circumstances, which we can not now discover, may arise during the 
NATURAL  LABOR.
109
labor, to retard or even  to complicate it, and we shall thereby lose  the confidence of, as well as depress
our patient.
   The following figure shows the position of the foetus when about to enter the superior strait of the pelvis :
{a, acetabulum ; c, walls of the uterus ; C, foramen ovale ; d, crest of the illium ; g, the ear ; h, arch of the pubes; i, ischia; K K, brim of pelvis.)
   Variations in  the Period of the Rupture of the Membranes.— We have thus described
the progress of natural labor prior to the rupture of the membranes, taking it for granted that the waters
will not be evacuated until the os uteri is dilated to nearly its full extent;  but these two occurrences —
the full dilatation of the os uteri, and the rupture of the membranous cyst — are not always found in prac-
tice to correspond with regard to  time:  for sometimes the membranes break before the os uteri is  dilated
to the size of a quarter of a dollar, white  at others they protrude considerably through the vulva before
they rupture — the head of the child having descended so low, as to occupy the cavity of the pelvis,  and
the os uteri having been widely open for  a considerable  time.   Generally, however,  the  membranes
burst when the mouth of  the womb  has become fully dilated,  and  the next  two or three pains at most
will usually expel the head through  its orifice.
  As the membranes are  more or less rigid, and  the mouth of the womb more or less yielding, so  will be
die length of time consumed previous to the discharge of the  waters.  When the os uteri is soft, and the
membranous bag tough, it will probably be long before it ruptures ; but when  the  os uteri is rigid,  and
the membranes  are thin  and  tender, they generally break early.   The  period, therefore, at which  the
membranes  rupture, will not  only depend upon  their own toughness or tenuity,  but it will also be regu-
lated by the pressure which the edge of the os uteri exerts on them while they are protruding through it.
The more lax the os uteri is, the  less it  compresses the extended  portion of the cyst, because it easily
distends before the  power operating from within.   But if the os be rigid, the pressure is great, and  the
inner  margin closely and  strongly  embraces  the  tense membranes all  around, producing  by its very
resistance a deep circular  groove, and thus exposing the bag to premature laceration. 
no
IMPROVED SYSTEM OF MIDWIFERY.
  It is always desirable in practice to preserve the membranous bag entire as long as possible, or at least
until it has performed the whole office destined for it by nature, namely, the dilatation  of the os uteri, the
vagina, and somewhat  of the external  parts.   When the membranes appear externally to the vulva, or
indeed before, we may suppose that they have then effected all the good that can be expected from them;
that their remaining longer entire may possibly be retarding the labor ; and we may, in that case,  venture
to rupture them :  which we  may do by pressing the finger  against them during a pain, when the waters
gush out copiously.   But we  must ever remember that  it is  one of the first  axioms to be learned in
obstetric  practice, not  officiously or  unnecessarily to destroy the cyst, or bag of waters, so long as  any
advantage can be obtained  by its dilating powers.   When, therefore, the os uteri is fully dilated, and we
feel within the vagina a large bag of waters, which appears to be retarding the labor, it should be ruptured,
and we shall find  that the labor will be greatly expedited by it; the patient will feel great relief,  and the
character of the pains be very much improved.
  As soon, then, as the os tinea?  is fully dilated, particularly if the membranes break, is  the time, by a
very careful examination, to ascertain  more fully the presentation.  If the posterior fontanelle or crown
can be discovered toward (or rather before) the centre of the pelvis, and, tracing the longitudinal suture,
we  can discover the anterior fontanelle backward and  a little to one side, and the ear can be felt under
and a little to one side of the pubes, we may  be certain that the presentation is perfectly natural.  And I
would advise every young practitioner, on every occasion, carefully and deliberately to make this exami-
nation ; as much with  the view of acquiring the art of ascertaining  the presentation with accuracy, as for
present information, which will be of great service to us in preternatural  and many difficult labors :  for,
although we may not at first perfectly satisfy ourselves, which will  frequently be the case,  we are not to
make ourselves uneasy, so long as we are sure it is the head ; as there  are few  or no positions of the
head, which nature,  left to her own efforts, in a well-formed pelvis,  will not rectify  or overcome.
                                         SECTION  III.

                             the  second  stage  of  labor.

  This stage of labor commences with a full and complete dilatation of the orifice or neck of the womb,
and ends when the child's head has sunk so low through  the pelvis, as to rest upon  and distend the
external soft parts  of the  mother, forming  the  perineal tumor.   The discharge of the liquor amnii or
waters, as we have before observed, usually  takes place at the termination of the  first stage of labor ;
sometimes, however, it is protracted more or less into the second stage ; but-whenever it  occurs, it  is
usually followed by a respite from pain, of rather longer duration  than  had been experienced for some
time before ; yet, when   the uterine contractions return, they are  generally increased, both in length and
severity: they are more  forcing,  and are attended with bearing-down efforts of greater or less violence.
  So long as the grinding pains  continue, there  is not much  prospect of a speedy termination of labor ;
but as soon  as more forcing pains commence, caused by renewed and more powerful contractions of the
uterus, the patient will make a  peculiar and very different outcry from the preceding, or perhaps she
expresses  the acuteness of  her pangs by loud and shrill cries, which are sufficient sometimes, as a writer
remarks, "to  make the  ears ring," or  by deep, stifled, or  suppressed  groans,  calculated  to make the
hearer tremble ; in other  cases, the pain is less, of short duration, and soon forgotten.   The patient forces
down with every pain, which are now very severe, and  follow each other in quick succession, with "reat
straining and commotion  of the  whole system.   When  these symptoms begin, and  the character of the
pains becomes thus changed, hope is infused, and fresh spirits instilled, which sustain her powers ; the
sufferings of the woman  are rendered more  tolerable, and she  experiences  an  increase of resignation
and patience. 
NATURAL  LABOR
111
  At the time the  head is  passing  through the  os uteri, severe  rigors frequently occur — not from cold,
as one unaccustomed to observe them might suppose, for the surface is usually quite warm — but from
some agitation of the nervous system.   It occurs more frequently, and with most violence,  in persons of
a very nervous temperament.
  If  an internal examination be made at the beginning of the second stage of  a natural labor, we shall
find the vagina feeling as though it had been dilated ; its walls  will be found ungous and flabby, and thus
prepared to yield to the pressure of the head.   The head  itself will  perhaps  be perceived at the upper
part  of the pelvis, filling it more  or less  completely — descending with  each  pain, and receding at its
conclusion ;  but the advance exceeds  the recession, and the excess marks the rate of the progress of the
labor.   As the labor advances, the head may be felt on the floor of the pelvis ;  here it sometimes meets
with considerable resistance, which  is  overcome  by the spiral movement in the mechanism or phenomena
of labor before described, to which  we refer the  reader.
  It is during this stage of labor that  the child's head — which enters the pelvis  diagonally, with one ear
toward the pubes,  and the other  toward the sacrum — in its descent  gradually turns, so as to throw the
forehead into the hollow of the sacrum, the vertex  to the pubes, and the ears to the right  and left sides
of the pelvis.  And it is the various obstacles which may occur to prevent this  favorable turn in the posi-
tion  of  the child's head, which protract this stage of labor, and sometimes occasion  it to be the mosl
tedious of any.
  But, so long as  the parts are relaxed, moist, and cool, w}th a well-formed pelvis, and not a hydroceph-
alus or dropsical  head, it is a natural labor, and must be left  to nature.   The  cases which may  require
assistance we  shall speak  of under difficult labor.   The difficulties or  little delays which may arise from
slight deviations and  disproportions in the relative size of the  head and openings of the  pelvis, or some
irregularity in the  shape, or  a little deviation  in the presentation, are all  circumstances which  nature,
when left to herself, will generally vary  so wonderfully, as to adapt the one to the other in every stage or
progress of  the  labor.  The imperfect ossification of  the bones in the head of  the human foetus, and the
loose manner in which  they are  connected  by membranes, is  the wise provision which nature has made
for overcoming these difficulties and facilitating delivery:  where  the head is large, or  the pelvis narrow,
the bones, being subject to great pressure,  ride over or overlap one another, diminishing the size of the
head as it is forced through  the brim, and  sometimes rendering its shape very long and pointed, with a
considerable corrugation, tumor, or swelling, at the presenting  part.
   The  Character of the Contractions of the  second Stage. — This differs widely from
that  which is observed  in  the first stage — so much  so, that  an experienced  attendant  will form  no
inaccurate judgment  of the  stage  and progress of the labor, by  observing the patient's manner,  and
hearing her  cries.   The pains in this stage are  much stronger,  and their duration is  more  protracted ;
while the interval of ease between  each is longer and more perfect;  they are accompanied by very for-
cible bearing-down efforts, and the patient expresses her sense of pain  in a much graver tone of voice, or
perhaps bears them in silence.  While  her sufferings  are greatly increased, she is much more patient and
resigned under them  ; when a pain threatens, the sufferer prepares for a severe struggle :  she clings for
support to the nearest object, and,  with  the view of exerting the propelling powers of  her  system to the
utmost, she  takes a deep inspiration, inclines the chest upon  the abdomen, and pushes the feet against
some fixed point.   The condition  of the  diaphragm is changed from an arch  to a plane, and  presses
with great power upon  the fundus  uteri; and the powerful muscular walls of the abdomen are called into
action, and press upon  it anteriorly, while the uterus itself makes a strong contractile effort in conjunction
with the other powers mentioned, to force the contents through the pelvis.  During the agonizing efforts
of the patient, the respiration ceases,  which causes  an arrest of  the circulation,  by which the vessels of
the head and neck become congested, the  surface florid, and the face sometimes  purple — the eyes bright
and  prominent, the heat of the skin greatly increased,  and a profuse perspiration  ensues.
  If this or  the  next  stage (in which the character of  the pains is similar)  be much prolonged, the  patient
will  commonly feel heavy and sleepy, and  dose between  her  pains, to be awakened  by their approach, 
112
IMPROVED SYSTEM OF MIDWIFERY.
only to realize renewed sufferings.   This dozing  between the  pains  is partly the result  of  fatigue, and
partly (perhaps principally) from the congestion about the  face and  head, the consequence of suppressed
respiration during the pains.
   Under ordinary circumstances this should excite  no uneasiness : it is a merciful provision of the Creator
to obliterate,  part of the  time, the  patient's consciousness of sufferings, and thereby refresh her for the
ensuing pain.   But if this coma should  be excessive,  and accompanied by severe pain in the  head, we
must be on our guard against an attack of convulsions.
   Duration of the  second Stage. — The duration of this stage of labor is regulated by a variety
of circumstances — as both the energy of the  mind, and the power of  the propelling agents ;  the relative
size of the head and pelvis ; the condition of the membranes of the ovum, and soft parts  of the mother.
In first labors, this stage may continue even ten or twelve hours ; while  in  other cases,  and  especially
where the passages have  been previously dilated by child-bearing, and where the uterine  action is ener-
getic, it may be concluded in less than an hour.  Sometimes, indeed, as soon as the waters are discharged
(where the pelvis is large, or the head small, ar*d the parts well  dilated), the  head falls by  its own  gravity
through the pelvis,  and  delivery  succeeds immediately,  even  before the  patient can be  removed to
the bed !
   When such a state of the parts exists, the patient should be  placed in the horizontal position  toward
the conclusion of the first stage.   In such cases the child is usually  covered  with  the membranes : this is
termed a caul, and very superstitious notions,are held by some people respecting it.  Captains of vessels
have taken them to sea, in the full confidence that  their ship could not sink, nor  themselves be  drowned,
while they possessed  them !   As  much as  forty pounds sterling  (or two  hundred  dollars) have  been
given for them in London.  But at length, a  sea-captain being  found drowned with a caul in his pocket
shook the faith of some.
   It is a commonly-received opinion, especially in the  country, that the  child  should  be  born speedily
after the rupture of the membranes and discharge of  the waters.  This opinion is founded on sound
observation, and was probably first promulged by those who were engaged in the care of breeding cattle,
in which this is the  usual course and order of parturition ; and I believe it would much more frequently
happen in the human species, if the progress of the labor were as little disturbed or interrupted as in the
lower order of animals.   But practitioners are  urged  by the distress and suffering of those  whom they
are attending, by the concern of friends,  by a persuasion  of  its  propriety and advantage,  and sometimes
perhaps by their own impatience, to break the  membranes before the os uteri is dilated.   Now nothing
can be more clear than that, if  these are ruptured, either  spontaneously or artificially, before  the os uteri
is dilated, the child can not follow speedily.   Moreover, by this premature rupture of the membranes, we
often defeat our very purpose, and, by disturbing,  protract instead of hasten the labor.
   During this stage  of labor, women are less inclined  to move  than during the first stage  ; still, they are
not to be confined to one posture, but indulged, and even encouraged occasionally to rise from the bed,
to walk about, and to endure some pains leaning over the back of a chair, supported by their friends, or
kneeling at the side  of the bed.  I have  often  been agreeably surprised at  the sudden and happy effect
of this change of posture ;  after the woman has perhaps been confined for hours to a horizontal position,
and wherever the progress of labor appears to be arrested, this change should be tried, and we shall often
witness its salutary  effects.
   During this stage, also, the impatience and apprehensions  of the patient  are frequently much excited ;
the pains, which are  desired, yet dreaded, return at short intervals, and are strong and bearing ;  she longs,
and hopes, and strives, for a speedy termination of her sufferings ; and it requires much prudence and no
little management to check  her impatience, while at the same time  we support her hopes.   Our principal
aim should be, especially when this stage is somewhat  tedious, to soothe her sufferings, to calm her fears,
and to excite her hopes, by encouragement; above all, must we carefully avoid alarming  her by whisper-
ing, or by  any appearance of mystery and concealment; we must not appear anxious, or too busy, in any
apparent or real efforts to shorten the labor. 
NATURAL  LABOR.
113
   When the head presses on  the perineum, and, by dilating the soft parts, forms a tumor, this stage is
over, and we should place the patient in a suitable posture for delivery.  The subjoined representation
indicates the position of the foetus at this period of labor: —
SECTION  IV.
                              the   third  stage  of  labor.

   We have said that the third stage of labor begins at the time when the head of the foetus, having sunk
so low through the pelvis, begins to rest upon and distend the soft parts of the mother, and continues until
the birth of the child.  When the head  thus  presses on the perineum and  soft  parts of the vulva, the
vertex presents at the external orifice, and the  forehead and face occupy the hollow of the sacrum.
   There is, about this  period, great pain in the lower part of the spine  or back, owing to the pressure of
the head against the sacrum, which is always a favorable symptom to announce to the patient, and which
may  encourage  her  in the great excitement  and  tremendous efforts which she now makes with much
power and effect.  During this great struggle,  the face often changes its  expression remarkably—so much
so, that her friends scarcely recognise her.
   In this position the foetus continues  to advance, until  the perineum is stretched and distended into the
form of a large protuberant tumor, and the external orifice so far dilated,  as to suffer the head and body
of the child to pass through without injury.
   At this period of the labor, when the head is  distending the perineum and  dilating the external orifice,
both the sufferings and the exertion of the patient, which we described in the second stage, reach  their
greatest height.   The vertex or crown first appears externally, and, as it descends lower and lower, the
labia or external parts become opened, the anus dilated, the perineum  distended, heated, and very much
thinned ;  and yet it is  beautiful  to observe how cautiously (so to speak) and  how securely the process of
                                                '5 
Ill
IMPROVED SYSTEM OF MIDWIFERY.
expulsion U effected.   Adequate expulsive force is called into action, and if that force were continuous,
nothing could save the patient from injury ; but each pain is just long enough to gain upon the  advance
made by its predecessor :  and the head, detained for  a few moments at its farthest point of advance, then
recedes ; and this is repeated until the perineum is completely softened, and the os externum fully dilated.
Nor is this all : the resistance offered by the perineum carries the head forward, so that its lowest point
shall press against the outlet; and by the  time the perineum yields, the  orifice becomes sufficiently wide
to secure  the proper direction of the head in its passage through the vulva.
   At this crisis, the head  will be nearly expelled  at  every pain, then  recede and be  again buried by the
labia closing around it.  " Here, again," says an author, speaking of this part of labor, " we can not help
remarking the beauty of Nature's ordinances ; it is impossible, indeed, to contemplate a single provision
even  of the minutest  character adapted to the exigencies of  labor, without being fervidly and awfully
impressed with the extent of that wisdom, power,  and beneficence, which establishes  the laws of Nature,
and controls her operations."
   This retrocession  of the head, then, is wisely designed to protect  the  perineum  and soft parts from
rupture and laceration, and which it does protect, in a manner which the hand of man can never accom-
plish.   Were the child to be suddenly forced through  the  passage, it might prove fatal to it, as well  as
to the mother.
   At the  latter part of the third stage, the pains are  often what are  called double ; that is, they succeed
each other so quickly, that a new one commences before the former has quite terminated.  At length, the
head of the  child, greatly compressed, or perhaps swollen, is forced  partly through  the external  parts,
and docs  not recede when the pains cease.  Finally,  the force of the pains conquers all resistance, and,
with a throe of agony, or a wild, piercing  shriek, the head  is expelled,, after which there is a short rest,
equal to the length of two  or three pains.   When the  head is on the point of passing, the contents of the
rectum  are commonly forced  out.   After  the  head  is  born, the woman  feels, as  it were, completely
relieved from the distending force, and consequently from the violent  agony which  she  endured : and
usually  expresses herself  in  some strong sentiment of  gratitude and joy, or perhaps gives vent to her
feeling's of delight in a flood  of tears.
   Under  all states of the system, the sudden removal  of intense pain  brings with it a sensation  of positive
pleasure ; and in no case is the instantaneous transition from extreme misery to actual  joy more conspicu-
ous than immediately on the delivery  of the head, particularly in a first labor.  After a short respite, the
uterus resumes its action,  for the purpose of completing the delivery.   When the head is born, the shoul-
ders are within the pelvis, with their long, diameter parallel to the shortest diameter of  the pelvis; but they
can not be born in this position : hence they make a turn within the pelvis, as did the  head, which throws
one shoulder into the hollow of  the sacrum, and the  other to the  arch of the pubes.   As the shoulders
make this turn, the  head  also may be seen to turn,  so  that the face, which looked  toward the sacrum
when born, now looks toward the right thigh of  the mother, or nearly in this position.  The body of the
child, then, is expelled sidewise  through the outlet, with  one shoulder  and arm distending the perineum,
rind the other insinuating itself under  the arch of  the pubes.   One pain is  sometimes sufficient to  make
this turn,  and to expel the shoulders ; at  other  times, several are  necessary.  In a very short time after.
the breech is expelled ; then the legs  and  foet either immediately pass  out, or remain a minute or two in
the vagina, and are expelled  by  its contractions.
   As soon as the head i,  expelled, introduce the end  of your finger into the  mouth, to clear away the
mucus,  if any obstruct its  breathing, and  examine the neck  of  the  child, to feel if the umbilical cord
is coiled around it: if so, draw  a little more of it down, so as to form  a loop, which can be slipped over
the head,  or through which  the  shoulders can  pass.   The child will  frequently cry  very soon after the
head is  born.   As the body  is propelled through  the outlet, we must  support it with our hand, that the
bed-clothes may form no  obstruction  to its egress.   After birth, as soon  as respiration  is  established,
which is known by its cries, the  umbilical cord should  be divided.  Take a piece of tape-strin°- or sever.il
folds of strong thread, and tie securely around the cord about an  inch  from the navel, and then separate 
NATURAL LABOR.
115
it with a pair of scissors.   Never tie  the cord under the bed-clothes ;  we may draw the child  into view
without exposing the mother, and we must always see what we are doing.   Some, in trying to be  over-
delicate, by tying the cord under the  bed-clothes, have cut off the child's finger or penis with the cord,
as recently happened in this city !   The delicacy of  the  accoucheur,  however, is a poor apology to the
child, as he  grows up, for the loss of one  of his members.   There is such a  disposition in the cord  to
bleed after having been divided, that  in  general  I think  it  best to tie it twice, at or near the same place,
and which I did in the last case I attended.
   The  time occupied by the passage of the child through the external aperture of the pelvis, is as various
and uncertain as the duration of either of the preceding stages.   Sometimes the same  pain, under which
the membranes burst, expels the  head,  and  perhaps  the  body also ; at  others, one, two, or even  many
hours of wearisome suffering, are endured before the head emerges.  The length of time after the birth of
the head before that of the shoulders and body,  is  also  somewhat various :  sometimes scarcely a minute
intervenes ; at others, a considerable time  elapses ; usually, however, the child is entirely expelled within
about five minutes after the head has  passed.
   " It must be forcibly impressed on the mind of the  attendant, that, notwithstanding her great anxiety at
this critical moment, when the body of the child is  half  expelled — whatever  solicitations there may be
from  the patient or  her friends, or whatever  her  temptations  may be to  interfere — nothing more should
be done than  to support the child, and remove  obstructions to its  free  passage.   There  is  one remark,
however, I would here make, on leaving the child  in  every case to be  entirely expelled by uterine action
alone :  although, generally  speaking, no assistance whatever should  be given,  yet I have known several
instances where the child was probably lost by adhering strictly to this rule, where uterine action was tardy
in returning after expelling the head.   When, therefore, in three  or four minutes after the head has been
protruded, the pains do not return — particularly if  the face of the child be observed to be very livid, or,
still more, when  the child  makes efforts to breathe — we  should  give  gentle assistance, so as merely to
excite uterine action; but the moment that we  notice the body making  the least progress, we must desist,
and leave the expulsion to  be  effected  by nature, as  before  stated.  These means, it is  carefully  to be
recollected, must only be employed in such cases as described : they are chiefly met with when the child
is unusually large, or the labor protracted."
   But, whatever difference there may be in the duration of any of the stages of labor, I wish especially
to impress upon all  students of midwifery that labor must always be regarded as natural, and consequently
left wholly to the efforts of nature, where  from the beginning we find  the os uteri lax, soft, moist,  thick,
cool, and not tender on pressure; where we find, also,  the vagina soft, moist, relaxed, and  cool, and the
perineum distensible ; the pelvis well formed ; the head presenting in  the usual manner, and not dropsical ;
and the contractions of a moderate strength :  in  all such cases, whatever be  the duration, I repeat, while
these  symptoms continue, it is positively bad practice  to  interfere in any way.   The labor should be left
ivholly  to natural efforts — ever remembering that, in  all such cases, Dame Nature is the best  accoucheur
in the world.
                                          SECTION  V.

                              the  fourth  stage  of  labor.

   This stage of labor includes the detachment and expulsion of the placenta.   This is as necessary and
as natural a parf of the process of labor as that of the delivery of the child ; and the efforts  of nature,
without the intervention of art, are in most cases as  fully able to accomplish it.  All unnecessary inter-
ference is equally pernicious here  as in  the delivery of the child.  In some cases, the contractions which
expel the  child, also expel the after-birth ; and, in the generality of instances, it is either partially or wholly 
116
IMPROVED SYSTEM OF MIDWIFERY.
detached by them, and remains in the uterus or vagina, whence it is soon expelled by the natural powers
alone, or aided by very gentle.extension with the cord.   The interval which elapses, after the expulsion
of the child, before the uterus  again actively contracts to expel the placenta, varies considerably—usually
from  five minutes  to  an hour—according to the fatigue which  the organ has  previously undergone.
When this interval (whatever it be) has elapsed, the  uterus again contracts, but much less forcibly, and,
by one or  two pains,  the  connexion between  the  placenta  and uterus is severed.   The now-useless
appendage is extruded into the vagina, and by its contractions it is expelled with a gush of blood or clots.
If the placenta be not thus expelled by the powers of nature within an hour, it is a retained placenta, of
the treatment of which we shall speak hereafter, as I wish here to present natural labor and nothing else.
   I may here add that  it is remarkable the fortitude and resignation with which women bear the agonizing
throes of child-birth, and the  rapidity with which the system recovers from its lengthened  suffering,  and
health and  strength return.  This must likewise be  regarded as one of Nature's mercies ; but there is
this great difference between the pain of labor and all other pains : the latter are unnatural, and dependent
on morbid  actions ;  the  former  is natural, and  inseparably connected with  the performance of  a healthy
function.
   I wish to impress on  the mind  of the student the very great importance of carefully  and  minutely
studying the subject of natural labor,  if he desires ever to understand the practice of midwifery ; it must
be studied not in  books only (however well they may be written), but  also  at the bedside of the patient.
He should make  himself perfectly familiar with natural labor for two  especial reasons, among others:—
   1.  Because natural  labors are more frequent than any other.   Madame Boivin, of France, reports that
of 20,517 children born in the institution over which she  presides, 19,810 were head presentations; and
Professor Moreau that in 82,164 labors which he noted,  the  head presented 81,806 times.  It is gener-
ally admitted that at least two  thirds (and  some say four fifths) of all head presentations are natural labors,
if they are not rendered  difficult by officious interference.
   2.  Because natural  labor forms the standard by which all other labors arc measured;  and  unless  we
understand the rule well, we can never understand the exceptions, as all other labors must be regarded.
   Such is the progress of natural labor, which should be most carefully and thoroughly understood  by
all persons who take charge of a parturient woman, and to which, if it were possible, they ought for a
considerable time to confine their  practice ;  for  they only who are  conversant with  natural labor, and
understand in  all  their  minute circumstances the  progress  and resources of Nature, can be qualified to
assist her in such labors as  are  difficult and  preternatural.   Nor can it be too frequently  repeated,  nor
too Strongly impressed upon young practitioners,  that in  a natural labor they have nothing to do but to
calm  their patient's  fears ; to fortify her with patience; to regulate her conduct, her diet, and her evacua-
tions ; to check all improper efforts ; to prevent the accidents of premature and hasty delivery; to remove
obstructions, to receive the child, to  tie  the cord, and to  deliver the  after-birth, in the  most cautious
manner.  There  are frequently, however, many circumstances which may occur to convert a natural into
a difficult labor.   These are sometimes the result of causes  over which we have no control ;  but more
frequently they are the consequence of our own or others' erroneous conduct in  the beginning or during
the progress of labor.   Upon  this subject that eminent professor of midwifery, Denman, remarks :  " It
would be unpardonable to make an assertion  which  is  not  supported by  experience ;  but I  am fully
convinced that in the far greater part of really difficult labors to which I have  been called —and I must
not conceal the truth  on this occasion —many of  those  which have been under  my  care originally,
were  not of  that description  from  unavoidable necessity, but were  rendered  such by  improper man-
agement in the commencement or the course of labor."
  Such a confession, from a man of Professor Denman's experience and  unquestionable  knowledge, is
of inestimable value ; and  if duly reflected on and  constantly remembered by the  young and inexpe
rienced, will preserve the lives of very many women and children, save themselves many painful recol-
lections, and do more to improve their knowledge and asefulness, than years of careless and inattentive
practice. 
DUTIES OF THE  ATTENDANT  AT A  LABOR.
117
                                  CHAPTER  V.

DUTIES  OF  THE  ATTENDANT   AT   A   LABOR.
                                          SECTION  I.

                  general  requirements  of  the  accoucheur.

  Let us now turn  from the description of the phenomena of natural labor to the duties of the attendant
during a labor, and the mode of managing it.
  And first, let all, especially young practitioners, remember that when they are called to take charge of
a woman in labor, they are not generally  called to a sick person, and  they  are not necessarily either to
prescribe medicine or  offer artificial assistance of any kind ;  but that  they  are summoned to witness a
natural function of the female system, for  which, in all ordinary  cases,  nature has made as  ample provis-
ion  as for the passage of the fceces or urine  : but as, in these functions, nature sometimes fails, and it becomes
necessary to administer a cathartic or an  injection, and introduce the catheter, so  likewise  nature some-
times fails to perform the function  of parturition regularly, and  requires to be assisted by art.   To know
when and how to assist nature in such circumstances, is what distinguishes the well-instructed accoucheur
from the  ignorant charlatan.   Most  of the modern improvements in  the treatment  of difficult, preter-
natural, and  complex  labors, which we shall  lay before  the student, have  been  discovered  by a more
correct appreciation of the natural  powers to effect expulsion ;  and the great improvement in the manage-
ment of natural labor which we shall inculcate, will be non-interference.
  There is, in truth, but very little for the practitioner to do, if the  case  be  one of purely natural labor,
where all its  attendant  circumstances transpire  favorably ; and, under such  circumstances, there is  very
little which  he need  take with him, except patience, gentleness,  and  good-humor: and therefore  the old
practice of carrying  with him certain medicines and instruments is strongly to be deprecated, because,
to say the least, it is a  needless exposure of himself to the temptation of  administering the one, or of
using the other.
  In the management of the most natural labors,  much  judgment and caution are required in our inter-
ference, or we shall  convert the  simplest case into a laborious  or even a dangerous one.   Ill-directed
measures always  produce  mischief.  There is no  one circumstance  that  so  largely and so certainly
contributes to divert  Nature from her proper course as the  persuasion that she can always be  assisted by
art.  It is this impression which prompts the constant employment of all those ill-directed manoeuvres of
the  ignorant attendant; and, unfortunately for the best interest  of the pregnant woman, it requires more
knowledge not to be  officious than  falls to the share  of many of  those who pretend to practise midwifery.
Nor is this unfortunate  prejudice confined to the more ignorant but would-be-thought-scientific meddlers
in midwifery, but it has also a powerful hold on the popular mind.   It is a common belief that great and
constant benefit can be derived from the  attendant, especially during the active  state of pain ; and this
feeling is but too  often  encouraged by the ignorant  and  designing, to the injury  of the patient, and the
disgrace of the profession.
  In a perfectly natural labor, the  active  duties of the attendant are  very limited indeed ; it is only when
there is some deviation  from  a natural labor, that the active  duties are  called in requisition  :  but to be 
118
IMPROVED SYSTEM  OF  MIDWIFERY.
able  to discriminate  between the two  conditions,  requires a thorough knowledge  of  all the phenomena
in  which a healthy natural labor consists, and this can only be known  with  certainty by those who are
wtll  experienced in the principles and practice of their profession.
   To conduct labor with  safety, the practitioner should be intimately acquainted with the order and suc-
cession of its phenomena ; to be able to decide when certain of them are wanting, or when others are in
excess ;  to estimate  the relative or positive importance of  each ;  the force and effect of each pain ; the
necessity of preserving or wasting the waters ; the degree of resistance which the  os uteri or external
parts may offer;  the situation  of the former  as regards  the  presenting parts ;  to  ascertain precisely the
presentation ;  the mode  of  rectifying  any error in the presentation, and the proper time to do it; the
capability of regulating it  with the greatest advantage to the patient and to the infant;  and, " though last,
not least" in importance, he should be able to pursue a firm, candid, and feeling conduct,  throughout the
whole  scene — that,  on the one hand, he may  not  be betrayed into the indiscretion of premature interfe-
rence ;  nor, on the other,  suffer the golden  moment of interference to pass, by vacillation and indecision.
   When  we are called to a person  supposed  to  be in labor, we  should  obey the summons as soon as
possible, and that for two  reasons : in the first place, our  promptness will give the  patient a favorable
impression of our assiduity and attention to her welfare ; and, secondly,  it will give us the earliest oppor-
tunity of rectifying any error  in the presentation, or of administering any relaxing medicine which the case
may happen to need.
   First, after our arrival,  inquire of the nurse  how long since the pains  commenced ; what is their char-
acter ;  whether  she  has had what nurses call  a  show — that is, a  discharge from the vagina of mucus
streaked with blood  ; whether the waters have broken ; whether it is a first child,  &c.  The answers to
these questions, from an intelligent nurse, will afford us some good general idea of the state of the labor.
When we are introduced into the lying-in chamber, after a little general conversation, we should make a
vaginal examination  ; or,  which is better, proceed directly to the bed, and merely say, as you  begin to
examine the patient, "Allow me to see if all is right;"  tell her that we wish to  know at  the berinnin<>-
whether the child presents right,  or whether it is a cross birth ; and that it is for this purpose, we wish to
examine in the lying-in room.
            SECTION II.

examination  of  the   female
   Having  thus obtained the  patient's consent, she should be placed in a proper  position for examina-*
tion.   Some recommend us to examine in the standing attitude ; others, that she  be laid on her left side
near the edge of the bed, with her limbs flexed ;  but the position which I esteem  most convenient and
which affords the greatest facility to the hand, is the following :  r Let the female  sit on the very ed«e  of
the bed, with her  feet  on stools, her body bent forward, and the limbs somewhat  extended ;  or she may
be placed on a chair in the same  position.   Now call for a napkin, and  some sweet-oil, lard  or other
unctuous matter, with  which to lubricate the  finger, previously warmed, which should never be neglected,
for two important reasons: first, the  finger,  when  lubricated, is  not so liable to  fret or irritate the soft
parts  during examination as when introduced dry ; secondly, the finger should be  lubricated, to prevent
the chance of innoculation with any morbid secretion, should the patient be  laboring  under any venereal
affection,* whtch is not uncommon, especially  in large cities, with perfect  innocence on the  part  of  the
woman.   Being  now  prepared for an  examination, we must  have  distinctly before  our mind  all  the

 * A physician from a  distance lately applied to me for advice : he had  been thus  innoculated with venereal disease, in  consequence ol
examining a female during pregnancy, while he had some excoriation of the skin on  the earae finger.  Henc< the importance, not only of
lubricating the finger, but cf washing well with soap and-water i-ubeequently. 
DUTIES OF THE ATTENDANT AT A  LABOR.                      119
objects  for which we examine, and each  should, as far as possible, be ascertained before the finger i.s
withdrawn.
   The objects  for which  a  first examination is  made  are  the following :  1. To ascertain whether the
woman is pregnant.   2.  If pregnant,  whether she is in labor.  3.  If in labor, what is  the presentation.
4. How far the  labor has advanced.   5. The formation of the pelvis.  6. The state of the  soft parts.
7. To direct our future conduct.   8.  To encourage the patient and her friends.
   1.  To  ascertain whether she is pregnant.—It  may  be  thought  superfluous to  examine
whether a woman  be pregnant, who  has sent for you because she  considers herself in labor; we may
suppose that she must at least be in the latter months of pregnancy.  But instances are of daily occur-
rence in large cities which prove  the  fallacy of this mode of reasoning ; and  professional persons have
been in attendance for days (and in some cases even for weeks)  on a woman supposed to be  in labor,
who proved not even to be pregnant:  and  have thus exposed themselves  to the censure, the  quizzical
inuendoes, and sarcastic ridicule, of all who hear of their exploits.  And we are all liable to be placed in
the same predicament, if we rely upon the  woman's assurance that  she  is  pregnant,  or  do  not know
enough to satisfy ourselves by examination — or, knowing, neglect to make it.   Dr. Hassell, of this city
(a physician  of  the reform school, who has devoted  much  attention to  midwifery), has  just told me that
he was recently  called to a labor in great haste.   When  he arrived, he found that the nurse had placed
the woman in a  properly prepared bed for  delivery, and was  in the greatest alarm and excitement, lest
the doctor should not arrive before the child was born,  as  he  was not at home when the messenger first
arrived.   The nurse  and the  lady both stated that the waters had  broken several hours,  and that it could
not now be long before the child would be born, for that she was never very  long in labor, and that this
was her fourth child.  The nurse had  arranged everything in neat order :  a bandage  for the lady, the
scissors, the  tape, and all necessary, was in its  place.  The  doctor  made  an examination, in  order to
ascertain the state and stage of the labor — when, lo and behold !  he discovered that the woman was not
pregnant.  It had been a serous  or watery tumor  of the womb, which had  enlarged the abdomen, and
finally burst, which she regarded as the waters.   The surprise of the lady, the nurse, and the friends, at
such a termination of the labor, may be better imagined than  described — the woman constantly reitera-
ting, " Why, I have  felt the movements  of  the child  these  four  months or more !   I have had children
before ! — is it possible that I can be deceived like this ?"
   Many unhealthy actions will cause the abdomen and even  the womb itself to  swell,  and simulate the
distended appearance of gestation ;  and the consequent spasms of different muscles (when  their action  is
'interfered with by the enlargement) will pretty closely imitate, as  to sensation, situation,  and severity, the
early pains of labor.    While this gradual  enlargement  is going on, the woman will find no difficulty in
persuading herself, or in being persuaded by others, that she is pregnant;  and when the spasmodic pains
set in, she will as readily conclude that labor  has begun.   Perhaps the lady is a  perfect stranger  to the
attendant, and he  has no means  of knowing the true state of the case but by examination.   And if  he
does not know enough to distinguish  the  occasional swellings of  the abdomen from pregnancy, he will
probably waste his time  for many days, till some  one better  informed is called in, and he finds himself
subject to ridicule and sarcasm.
   Swelling of the abdomen, arising from  pregnancy or from  other causes, may be distinguished in the
two following ways :  first, by placing the hands on the bare abdomen.   If it be disease, simulating preg-
nancy, we shall probably find the abdomen  tympanitic, or inflated with flatus or wind, pent up in the intes-
tines—perhaps enlarged  from fluid effused  in  the peritoneal cavity,  or from the presence of a solid tumor.
   Now if we have made ourselves familiar with the  feel of the abdomen during the latter part of pregnancy
or the commencement of  labor, we shall readily  distinguish that  it  is softer or harder, larger or smaller,
more diffused or more circumscribed,  than  in  true pregnancy ; that  it is not of the same  shape — perhaps
it is irregular on its surface — does not occupy the same position — and, above all, that it does  not possess
that peculiar springy  elasticity  which so strongly characterizes the impregnated womb at  or about the end
of the term of gestation. 
.20
IMPROVED SYSTEM OF MIDWIFERY.
  Secondly, if we are not perfectly satisfied (or  perhaps with  a view still further to confirm  the  above
means  of diagnosis), we should introduce the finger within  the vagina up to the os uteri.:  if it be  a ease
of similated pregnancy, the orifice of  the womb will be  found not only closed,  but  undeveloped ; the
neck of the womb will not be expanded ; and the womb itself, on pressing it with the end of  the finger,
while the other hand is placed on the abdomen where the fundus should be, will be found small, light,
and moveable, if it be not diseased ; and if it is  diseased, and  enlarged, it will be found to be  much less
than the gravid uterus at full term.  But, on the  other hand, if the patient be pregnant, and near the end
of her time, we shall find the os fully developed, the neck  expanded, and perhaps the mouth  somewhat
open, so that we can detect the foetus within or through the thinned walls of the neck.  If we attend  to
these things, we can  always be  certain whether a female is  pregnant, who fancies herself in labor, or  to
have arrived at her full term.
  2. We examine,  to  learn whether, if  pregnant,  she is in labor, or  whether her  pains  are what are
termed false or spurious pains.  For  the mode  of doing  this, and  the treatment, when  the  pains are
spurious, I refer the  reader  to the section on "  false pains," in the chapter on the " signs of  approach-
ing labor."
  o. If the patient is pregnant, we examine, to ascertain the presentation.
  Great caution is necessary in making  these examinations, lest we  break  the membranes, let  out the
waters, and cause a  protracted or difficult labor.  We should  introduce the finger  during  a pain, but
should not examine very minutely until a remission takes place ; when  the  membranes become  lax, the
presenting  part descends, and if the os be open,  the presentation may usually be recognised, if examina-
tion be skilfully made.
  Carefully pass  up the  index or middle finger  (some use  both, previously oiled, and warmed  if it  be
cold weather)  into the vagina, until it  penetrates  the os tincae, which  may usually be  known by its hard-
ness and ring-like circle of more  or less  diameter.   Let  the finger be  passed through the ring  into the
uterus : if a pain comes on while the finger is  within, let it remain perfectly still until it  is over; then
press the finger back, and pass it  around the  presentation, in  order  to ascertain what it is.   The  head
may be known from every other part that can present, by its greater hardness to the touch, by  its greater
rotundity, by its sutures, and  by  its anterior and posterior fontanelles.   The face may be distinguished
from the breech by  the forehead, and by  its general features : especially the mouth may be distinguished
from the anus, by its larger size, and by the tongue.   (Remember, that in pointing out these distinctions,
I take it for granted  that the attendant  is present from the first, and not that he is called in to repair the
blunders of those who have preceded  him, and  who, by rude and improper  handling, have so irritated,
inflamed, and  bruised the parts, that they are swollen out of all shape, so that it  has  become impossible
to distinguish  one from the other.    In  such a case, it  may be  impracticable  to ascertain the presentation
without introducing  the whole  hand into the vagina or the womb.)   The breech may be easily recog-
nised by the two  globules  of the nates, with a cleft between them, and the anus within the cleft, and  by
their shape, softness, and elastic feel, compared with  the head.  The parts of generation above the cleft,
in the male especially, are easily distinguished, the scrotum of  which becomes very much swollen as the
labor advances : and generally the finger will  be soiled with  meconeum, which  usually passes  freely in
breech presentations.  The shoulder may be distinguished  from the hip, by its  smaller size, and by tho
axilla or arm-pits ; and the ribs, by the clavicle, scapulae, and the arm, which is so very much smaller and
more moveable than the thigh.   The  foot  may  be  known   from  the  hand  by its greater thickness and
length, by the projection of the heel, by the shortness and  evenness of the toes, and by the great toe
being on a line with and close to  the rest, while the thumb is shorter  than  the fingers, and  at a  distance
from them.  The elbow may be  known  from the knee by  its much greater sharpness, and by the  small
size of the arm and  the forearm leading from it.
   All these distinctions appear very plain and easy as we read them, or see them engraved  on paper, or
have a young child  on the lap to feel them ; but we  shall find  it  quite another thing to distinguish them
while the  child is impacted in the uterus, or pressed  into the pelvis, especially in  our first  attemots. 
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DUTIES OF THE ATTENDANT AT A LABOR.
.21
  The best way to improve our tact is, to give ourselves the habit of feeling the different parts of very
young living or dead children, as opportunity may offer ; and when we make examinations per vagina, to
proceed coolly and deliberately,  and not to withdraw our finger if possible until we are satisfied.   If we
can not satisfy ourselves with the first  examination, wait a little while, and try again :  and by a  perse-
verance in these means, we  shall soon obtain sufficient  dexterity  to  discover any  presentation  which
may offer.
  4.  How far the Labor has advanced. — Having ascertained the presentation, we wish to know
what progress  has been made before we arrivedJ   If it has but recently commenced, we shall find the oa
uteri slightly dilated, with  the  membranes pressing against the opening during a pain.  If more progress
has been made, we may find  the os uteri dilated to the size of a  half-dollar, and the membranous bag
protruding during a pain ; in  such a case, we consider the first stage of labor half  over : for  usually it
requires as much time to produce this dilatation, as afterward to distend it to the extent necessary to pass
the fcetal head.  We may find  the waters broken, and  the  presenting  part  above the  brim, within the
pelvis, or pressing on and dilating the  perineum — all which at once determine the  condition  and stage
of the labor.
   5.  If we arrive in  the early  stage of parturition, particularly if it be a first labor, it is necessary (should
there be any suspicions) to ascertain the general formation of the pelvis.    We may do this by carrying the
finger backward and upward toward the promontory of  the  sacrum  ; if we  can not  easily touch it with
the tip of the  finger, there is room  enough there.  Then  introduce two fingers, and  stretch them out  in
various directions within the pelvis ; if  there be any especial deformity, we shall easily perceive it:  par-
ticularly, we qpay lay our  two fingers flat against the symphysis pubis, to  ascertain if there be  any angle
there.  If the pelvis be unusually small, deformed, or  have any tumors — either bony, sarcometous,  or
serous — we can not fail by these means, intelligently used, to discover it.
   6.  The State of  the soft Parts. — Here I would refer the  reader  to the four states (in one
of which the os uteri may always be found) on page 105 ; as also the  further description of the state of
the external soft parts ;  the precise condition  of which it is very desirable to ascertain as soon as possible
after  we arrive at a labor.
   7.  How to  direct  our  own future  Conduct. — If it is a natural labor, we shall have little  or
nothing to do  till the child is  born, but observe the process, which  young  practitioners especially ought
to do attentively, in order to become familiar  with it.  If there be a head presentation, but rigidity of the
parts, we must  treat it as described under protracted or difficult labor.   If the breech, the arm, or any
other unusual part present, or if it be complicated with convulsions, haemorrhage, or  any other difficulty,
we must treat it as laid down under its respective head ; and we should  lose no time in endeavoring  to
remove the difficulty, according to the  rules there laid down.
   8. To encourage  the Patient and her Friends. — All will be very anxious to know whether
everything is right,  and if it be, we should encourage the woman with the assurance all we can ;  if not,
we should give  her such encouragement as the circumstances of her, case will admit: and this we should
do from time  to time, which will operate as an anodyne to her  fears, and a stimulus to her exertions and
her patience.   But we should never allow ourselves to  be betrayed into the expression of an opinion  of
the time the  labor will occupy; because many unforeseen circumstances  may occur  to disappoint us.
which will very probably  destroy her  confidence  in our ability to conduct as well as our knowledge  of
 the duration of a labor,  and perhaps produce so much excitement, fear, and alarm, as to cause consider-
able  disaster in  the latter part  of the labor.
   There are few subjects  upon  which  the attendant is so frequently importuned, or  about which  it  is  so
 difficult to give a decided opinion, as  the probable duration of  labor.   It is natural enough that both the
 patient and her friends should  be anxious to  know how long this process of  suffering is likely to last;
 nothing, however, is more hazardous than a prognosis or opinion in  these cases: and we would  especially
 warn young practitioners  to be very cautious how they venture an opinion, the  result  of which may prove
 it to  have been  founded upon guess-work or in ignorance.   A labor which bas commenced briskly and
                                                 16 
12-2                         IMPROVED SYSTEM OF  MIDWIFERY

regularly, with every promise of a rapid progress and termination, frequently becomes exceedingly linger-
ing during the second stage, so that the expelling powers may perhaps even fail altogether in making the
head pass through the  os externum ;  whereas, on the  other hand, a labor, the first stage  of which has
been slow and protracted,  frequently experiences  a complete alteration of character, and advances with a
degree of quickness and energy which could  scarcely have been anticipated from  the manner in which it
commenced.   In prima para, or first labors, especially, it is particularly difficult to foretell, with  any-
thing like certainty, the duration of labor ; hence it is that all unguarded assertions in this respect are not
only liable to disappoint the patient, but also to destroy her confidence in the practitioner.
   We have already stated that the course of labor varies in every possible way.  In some cases, the
same  peculiar character of labor shows itself through two or three successive generations.   Hence it has
been observed that very tedious or very violent and rapid  labors  sometimes seem to be hereditary :  the
mother, daughter, and grand-daughter, being all remarkable for their lingering or rapid labors.
   Having now made our examination, and satisfied ourselves on the various points specified, and made
our announcement to the friends, and in our own  mind assigned the labor to the class to which it belongs,
a.- before observed, it must be treated  according to  the rules laid down under the various denominations
of either natural, difficult, preternatural, complex, or instrumental labors.   I shall presume that it is a
case of natural labor, and  shall therefore proceed  still further to point out the  duties of  the  attendant
during its progress ; and the peculiar treatment of any other kind  of  labor must be sought  under  its
respective head.
   How  the  Midwife  should  conduct herself. — Since every one can judge of the appearance
and deportment of the practitioner, though not of her abilities, she should practise the art^f pleasing, so
far at  least as it is conformable to the principles of honor and good-breeding.  And everything connected
with the state of the patient must be at all times  regarded  with peculiar interest and delicacy.   But we
are not to attempt to please by cant and hypocrisy, nor by the performance of menial offices in the cham-
bers of the  sick ;  nor by entering  into  league with nurses and other menials ; nor by imposing on the
uninformed  by pompous and pedantic jargon,  or by astonishing the weak-minded with  pretended and
miraculou's cases — a species of knavery better  suited to mountebanks  than  to persons who have conse-
crated  themselves to the cause of science and humanity:  but we must seek  to please by  the exercise of
principles the very reverse of all these, whether physician or midwife.
                                         SECTION III.

             MANAGEMENT  OF  THE  FIRST  STAGE  OF  NATURAL  LABOR

   Pregnant women are very liable to constipation, and ought, especially in the later period of gestation,
to keep their bowels lax ;  and if our services are engaged beforehand, we ought  to  see that a  salutary
state of the bowels exist, particularly during the last few days of pregnancy.  Attention  to the state of the
bowels is of the first importance, and must never be neglected.   It is a subject, however, in which preg-
nant1 females are remarkably careless ; and they will frequently, when not attended to by the practitioner,
allow their  labor to  come on with their  bowels in a very loaded and  highly improper condition.
   There is perhaps no one circumstance which  is  found to exert such a prejudicial influence on natural
labor, in so many different ways, as deranged and constipated bowels.  Where  the  contents  are  of an
unhealthy character, the irritation which  they produce in the bowels is quickly transmitted to the uterus
and tends not a little to  pervert and derange  the due and healthy  action  of this organ ; hence arises one
of the most fertile sources of spurious  or false pains, of which we have before treated, under the "signs
of approaching labor."   Where  the bowels are loaded, in consequence of the pressure upon  the ascend-
ing c-iva or great  vein, considerable obstruction to the  free return of the  blood from  the  pelvic organs is 
DUTIES OF THE ATTENDANT  AT  A LABOR.                      1C3
produced, the vessels of which become considerably congested.  No organ feels these effects more than
the uterus:  from the immensely dilated condition of its veins, a,state of local plethora or fulness is pro-
duced, which greatly interferes with the free  and regular  action of  its foetus, and thus not unfrequently
predisposes  to haemorrhage and piles.  Again, the rectum  being distended with foeces,  diminishes  pro-
portionably the capacity of the pelvis, and  thus forms  a mechanical obstruction, and prevents the ready
descent of the  head into it.   Occasionally it forms, at the beginning of labor, a solid  mass of indurated
foeces,  so hard, as at the first  touch  during examination almost to induce  the suspicion  of a projecting
sacrum or tumor.
   As a measure of common cleanliness, the  bowels ought to  be attended  to before labor ;  for, besides
the more serious effects now enumerated, the labor may be rendered exceedingly filthy for  the  patient,
and not less disgusting to the practitioner :  since, as the sphincter ani loses all power of contraction  when
the head advances deep into the pelvis, it follows that whatever foecal matter is  contained  in the rectum
is  now forced out, to the  no  little mortification  of the patient  and  her friends, and the disgust of the
attendant.    Hence, therefore, for the last few days of pregnancy, the bowels should  be regularly opened
(unless they are so spontaneously,  which is seldom  the case) by castor-oil, or by a dose of Alexandria
senna and manna, with a little fennel-seed,  to which a teaspoonful of Epsom  salts have been added : this
will be found  an  excellent medicine.   The above may be prepared by infusion in warm or hot water,
or  any other mild laxative will  answer.  But if  this  has  been neglected,  and labor already begun — if
there be sufficient time, it  must be given immediately ; if  the first stage of labor is somewhat advanced,
and there is not likely to be sufficient time, before the  head enters and descends into the pelvis, for the
medicine to operate, an injection should be  given without delay.   The enema or injection  may be made
us follows :—

             Mix together of strong catnep-tea, or warm water       .      .      .     one pint;
             Sweet-oil, or butter    ......      one wine-glass  full ;
             Milk     .      .     .      .     .     .       .      .      .    half a pint:
             Molasses     ........        one gill;
              Table-salt        .......     one tablespoonful.

Then let the nurse take  a large French or other syringe, and  inject it in the following manner:  Place
the patient on her back, with  a sheet folded and  laid  under the hips ; let  the legs be flexed somewhat
on the abdomen ;  then let the syringe be slowly but completely filled, to exclude all the atmospheric air ;
grasp the lower part of it with  the left hand and carry it to the rectum, raising it a little toward the abdo-
men, and then  slowly and cautiously introduce the point into the rectum up  to the shoulder;  then apply
the right hand to the piston, and make moderate but continued  pressure thereon, while you press against
it  with the left hand to prevent injury to the anus or rectum.   When all the contents  are thus injected
into the rectum, it may be repeated several times, according to  the  size of the  syringe.   The common
method of giving injections is very inefficient: the liquor injected is not proper, nor is the quantity usually
given sufficient to  produce the desired effect.  If there be also false pains, a teaspoonful of  laudanum
may be added to the injection  with great advantage.
   The preparatory pains of labor, which form  the first stage, do not require that the patient should take
to her  bed  at  this early period; and  this is especially the case in first  labors, where the first stao-e is
somewhat tedious.  Until near the end of the first stage, she ought rather  to be induced to suppose that
actual labor  has scarcely yet  commenced,  and  that she may still sit up, or walk about the room, as best
suits her feelings ; taking care at the same  time  that everything is  in readiness against the  moment  when
it shall become necessary for her to lie  down.
   Directions for  the  Nurse. — The following are duties-which should be  performed by the nurse,
but should also be well understood by the  practitioner  or midwife, for two reasons : first, that they may
know when  they are properly  performed ; secondly, because in some cases of sudden  labor they raav, in
the absence  of  a regular nurse, be required to perform some of them :— 
1:24
IMPROVED SYSTEM OF MIDWIFERY.
  Preparation of the Bed. —This  may be on  a  cot, or, what  is better, an ordinary bedstead, on
which should be laid a straw-mattress, and over this  a hair-mattress, if possessed (but by no means on a
feather-bed) ; and over  the mattress a skin of leather, a square of  oiled silk, or a piece of India-rubber
cloth, is to be laid on that part  of  the  bed which will be occupied by the  patient's  hips, to  protect it.
Or, where these are not in readiness, or not possessed, take an old blanket and fold it a number of times;
then over this  the sheets, folded in the same  manner, and placed  under the hips of the patient, which
serve a twofold purpose :  first,  to protect the discharges ; and, secondly, to elevate the hips during labor,
which is  very essential.   These folded  sheets will absorb the discharges, and can afterward be removed
without disturbing the patient, leaving dry bed-muslin underneath.   The skin, blanket, or oiled silk, is
allowed to remain some days longer.
  During my attendance at  a labor very recently, the nurse, who had lived many years in  the neighbor-
hood of  the Indians in  this country, stated that when the female  Indian is attacked with labor-pains^ she
retires a  short distance from the cabin to a lodge always  in readiness for their women during confinement
and menstruation (from which, and from their  language and  other customs, it has been inferred that the
aborigines of this country are descendants of the lost tribes of Israel).
  The pregnant woman, when  her pains commence, retires to this lodge  or cabin alone, and, as labor
advances, places herself in a  recumbent posture on  the  back, and grasps a pole, previously placed hori-
zontally over her, which  extends from the head to the feet, and is securely fastened to two stakes in the
ground.   When she is attacked with  a  pain, she seizes the  pole  and  raises herself  up, and continues in
this  position till  it ceases.  The advantage of this  contrivance  is evident, independent  of  the relief
afforded : the weight of the fcetus increases the uterine contractions, and thus affords additional aid in the
expulsion of the foetus.
  Mrs. Davis  (the nurse who communicated this information) states that no  one is allowed to be present
;—not even a female — and should  an Indian venture near the lodge, it is  deemed sacrilegious, and the
tribe would expect no good luck to follow them in  hunting, &c.  There is one  exception, however, to
this : when the woman  in labor  becomes  alarmed, she utters a whoop as a signal, when  some elderly
female goes to her assistance.
  A short time after the labor is completed, the woman  washes herself and child  in a contiguous  stream,
and  returns to her  cabin.   Their practice is  to wash  their children  in  cold  water—as they say, to
strengthen them.  This, no  doubt, prevents rickets, scrofula, &c, which are seldom  or never found
among the Indians.    This lady, who lived some time among  them, also states that she scarcely ever  saw
a weak or sickly child at  any time.   She asked the wife of a chief  of  the Oneida tribe why they have
so few sickly children ;  the reply was, " Because we wash them in cold water."   The squaws, she says,
never suffer so  much in labor as the whites, and the  reason assigned was, in consequence of their eatin^
freely of slippery-elm bark, bathing the parts in bear's-grease, and taking plenty of exercise.  The infant
is usually fastened to a board  on  the back, secured by a band over  the forehead, suspended over the
shoulder of the squaw, and thus carried.  This board is also suspended between two stakes,  and consti-
tutes the child's cradle.
  Having prepared the  bed,  the nurse will next procure a kettle of warm water (soap, water, and towel,
for  the use of the attendant),  a  pair of scissors, and a piece of tape,  or strong cord ; a  little  sweet-oil; the
clothes of the infant to be placed near the fire ; a blanket to  receive  the child, and  a suitable vessel to
contain the after-birth; a dry  tub to deposite all the soiled linen in: this will have a tendency to prevent a
check of perspiration from wet clothes after labor, which otherwise might occur; a piece of muslin, half
the  size of the hand, folded several times, with a hole in the  centre for the  cord to pass through ; also a
muslin bandage to cover this  and pass round the body of the child, when  washed and ready for dressing;
a broad bandage, suitable to be placed around the body of the woman after delivery ; muslin (not linen)
chemise, well aired  and dried, to be put on  after the wet cloths are  all removed ;  an old soft linen towel,
for the purpose of placing over the external parts to receive  the discharge, after they have been  washed
with a little warm spirits-and-water j a basin or tub,  with water and soap, towel, &c,  to wash  the child. 
                        DUTIES OF THE ATTENDANT AT  A LABOR.                      125

   Some of the preceding directions  might  appear  superfluous to many people ;  but whoever has been
long in  the practice of midwifery will very often  have been annoyed from  either the want or untimely
preparation of many of them — and that, too, in society where we  might expect better  arrangements.
   Having seen that the foregoing  articles are provided  and in readiness, or having  given  orders, and
leaving  the nurse to  prepare  them,  it is  not necessary that the practitioner (especially if a physician)
should remain all the time in the room ; for, since the first stage  of labor, particularly in a first child, is
usually  protracted,  the  constant presence of the attendant, especially if  a  male,  in  the lying-in room,
would not only be unnecessary, but  highly  improper:  unnecessary, because, after seeing to the above
preparations, he  has  frequently little or  nothing to do; and improper, since the woman  requires, from
time to  time, to attend to the calls of nature, from increased irritability of the bladder  and rectum, which
is  very  common during the first  stage of  labor.  Besides, if the practitioner remain in continual attend-
ance, it may lead the  patient to think that she is in a situation to  require assistance, or else that there  is
a prospect of her obtaining speedy relief;  but  neither of these  being realized, fear, despondency, and
suspended uterine action, may ensue.  If she  is unwilling that he should  leave  the house, he may be
provided with another room, or retire to rest.
   Frequent examinations should not be made, particularly during the first stage.   We  can do no  good by
such a practice ;  after we have  once gained the information  we require, we can not facilitate  the first
stage of a natural labor, but we may do  a great deal of  injury by too-frequent examination : we denude
the vagina of  that soft,  relaxing  mucus, which is  designed  by  nature to protect it; we incur the risk of
destroying the membranes ;  we  may predispose the parts to inflammation, and retard the  dilatation of the
os uteri itself.  As, however, it is a common idea among women  that, under such examination, material
assistance is rendered, we shall frequently be urged, even during the first stage, especially if  the labor be
rather slower than usual, to  remain in close  attendance upon the patient's person ;  and those solicitations
are-often advanced  with a degree of fervency that  it appears  the extreme  of cruelty not to accede to-
Should  this  be the  case, the finger may be introduced from time to time with  the greatest  caution and
gentleness — more to  pacify the patient's  mind, by an announcement to her  of the progress of the labor,
and to assure her that she is not neglected, than with any other  view than  that of merely watching the
progress of dilatation.   Still it is unnecessary.   The more rigid the parts are, the more do they need the
softening influence  of the natural secretion, and.the  more careful must we be to preserve  it.
   Should there be  any  obliquity in the os uteri, it must  be corrected by the position  of  the  patient.  If
the os is far back against the sacrum, let  the patient lie on her back, and take a few pains ; this will cause
the fundus to fall toward the spine, and the os will be  thereby removed nearer the centre of the pelvis.
If the os is on  the  right side, let  the  patient lie  on that side, and the fundus falling, will force  the os
nearer the centre of the pelvis ;  if on  the left side, vice  versa.   These changes of position will usually
remove this  obliquity better than any other method,  and  will often greatly expedite the labor.   We are
advised by some authors, in order to remove this difficulty, to hook our finger  in the os uteri and-draw
it  forward to the centre  of the  pelvis, and retain it there during  two or three pains; but there is a rudeness
and violence in, this plan which will be easily understood by such as make  the  attempt,  and who, more-
over, will often find that they  can  not retain it in its place without using so much  force as to expose the
os uteri to contusion or rupture, which not unfrequently follows  this method of  removing the  obliquity
of the uterus.
   Temperature of  the Room. — Where  the  apartment  can be  selected, it should be, as far as
practicable, spacious,  quiet,  and  well ventilated ; and the temperature  should be kept moderate, for too
great heat predisposes to flooding and debility of the  womb, while too much cold predisposes to peritoneal
inflammation : so that every practical means should be resorted to, to  keep the room  of  a moderate and
equable temperature.
   Rupturing the  Membranes. — In most  cases, as soon as the os uteri  is fully dilated, the mem-
branes burst and the water escapes, its influence as a dilating agent being no longer needed.  But when
the membranes are  unusually tough, they will often remain entire until the head  has cleared  the  os uteri 
m                         IMPROVED SYSTEM OF MIDWIFERY.

or even (but more rarely) until it has  passed the os externum.   When we are satisfied from examination
  a th  os meliis fully dilated, especially if the head has passed through ,«. we may rupture the mem-
tan s by prLing .h/finger against them during a pain, as their rematn.ng enfre after th,s per,oJ,sa„
impediment to the advance of the child ; but it should no. be done hastdy, nor unttl we have firs, surfed
ourselves  that their usefulness is at an end.
                                         SECTION IV.

            MANAGEMENT OF  THE  SECOND  STAGE  OF  NATURAL  LABOR.

  The second stage of labor commences with  the  full dilatation of the womb, and continues until the
head, having passed  through the pelvis, rests upon and distends  the perineum  and external  soft parts,
forming the perineal tumor.   (See plate on page 113.)
  Best Periods for ascertaining  the  Presentation. —There are three periods in  labor at
which it is more easy to ascertain the presentation than at any other times :  first, when the os uteri is
dilated to about the size of a half-dollar, and will readily admit two fingers  within : the presenting part
may then be easily felt, if examination be  made ; second, when the  os uteri is fully dilated, the mem-
branes recently ruptured, and the head on the point of entering the  brim of  the pelvis; third, when the
head is at the inferior strait, and has formed the perineal tumor.
  The first  opportunity has  passed;  the second now offers itself:  and we  may avail ourselves of  an
examination at this time, either to confirm our former opinion,  or to correct it.
  In a natural labor, we can now not only easily distinguish  the  head from any other part which may
present, but the head having entered the  brim, we can  as  readily learn the exact position in which it has
entered. Many practitioners fail  egregiously in their diagnoses of the presentation :  yet the  fault is not
in the rules, but in the  person.   The precise position of the  head at the brim of the pelvis is easily made
out — to discover which, we should first endeavor to distinguish the ear, by introducing  the finger between
the symphysis pubis  and the head of the child, and then we shall probably find the ear a little to one side.
   We can readily determine what is the position of the head by examining  the sutures and fontanelles.
When we  have found  the  sagittal  suture, we  can  trace our  finger along it till we come to one of the
fontanelles  or  larger openings  where  the sutures  meet; these  are  called the anterior  and posterior
fontanelles, and  may easily  be  distinguished by  remembering the following particulars :   the posterior
fontanelle is formed by  the junction of  the  two  limbs of the lambdoidal and the sagittal  sutures,
and  consequently forms a triangle, which  is at  once  distinguished by  the finger :  where  this fonta-
nelle is found, there  is  the occiput.  Having found this, trace the finger along the sagittal suture to the
other extremity, and we shall discover the anterior fontanelle, which  may be  known by the union of four
sutures, the two legs of the coronal, the sagittal, and the frontal;  this fontanelle  is near the  face, and the
position in  which these are found shows with certainty  the situation of the head in the  pelvis ; so that, by
carefully examining  the ear, sutures, and fontanelles,  of  the  head, in ordinary  labors, the  position may
be discriminated with great exactitude.   When the waters have been  long broken, and the head subject
to great compression, it becomes so much swollen at the presenting part, as not to be easily  recognised —
which swelling will sometimes remain for some days after  birth.
   When the second stage of labor  is  much protracted, the  sufferer  is sure to become despondent; ana
this is one  of  the  most  annoying  circumstances to be  encountered  during  parturition.  The patient
exclaims that she is not making any progress ;  that she shall  never  get better;  that  she  is dying ; and
many other discouraging  expressions  of a like  nature  are used, which are  much calculated to frighten
the attendants, and unhinge a young practitioner.   This is often very distressing to the young accoucheur;
and, without exercising great patience and  fortitude, he will  often be  alarmed, and tempted to abandon 
DUTIES OF THE ATTENDANT AT  A LABOR.
127
the case, or send for counsel.   But let the attendant put on courage and resolution, bearing in mind the
great  resources of nature, and he will be carried triumphantly through all these painful and distressing
scenes — when the happy termination will requite him as well as the female for all the sufferings endured.
   But the skilful practitioner will not judge of the amount of danger by these evidences, declared either
by the patient or her friends.   In all  such cases, the  physician  or  midwife will  estimate the amount of
danger by the condition of the pulse&nd  of the passages, and not by the clamor of the inmates of a lying-in
room.   Whenever the structures of the parent begin to suffer from  pressure, the parts become hot, dry,
and tender to the touch ; and such a condition  never fails to accelerate the circulation :  but the process
of parturition may go on for many hours, or even for several days, under good management, without
materially affecting the pulse.   So long, therefore, as this function shall continue undisturbed, the attend-
ant may keep the mind at ease ; and it is  a duty to appear steady, confident, cheerful, and  obliging, and
strictly to enjoin  the  same  line  of conduct  upon others, with  a view to inspire the patient with hope.
Every effort must be  made  to  support  the woman's spirit; for if this despondency be allowed to gain
ground, suspended uterine action may be the consequence, which may result in a different class of labor.
When there is the least tendency in the  contractions  to  become lingering, the  attendant must redouble
his efforts to support the confidence  and revive  the drooping spirits of the patient.   We should not run
into the very common error of judging of the danger of a labor by the time which it has occupied, or the
severity of-the pains, but by the  symptoms which it presents.
   Sometimes there is very severe and unusual pain in  the back : this may be relieved by passing a napkin
folded lengthwise under her loins, the extremities of which should be raised by a person on each side of
the bed during a pain.  At the  latter part of this stage, there is commonly great pain experienced in the
sacrum, caused doubtless by  the head pressing upon the nerves which pass out thence: counter-pressure
is  the only means of relief; let the nurse take her station at the bedside, and press hard against the sacrum
or lower part of  the spine, on the recurrence of a pain.   Spasms of the lower limbs are also occasionally
the attendants of the second stage of labor.   Sometimes they pursue the course of the crural; at other
times that of the great sacro-sciatic nerves,  more especially when  the head  is  long retained.  During
their continuance, they are productive of the most excruciating sensations.   The most efficient remedies
are dry  friction with the hand, ligatures around the affected part, and a hot smoothing-iron applied to the
sole of the foot.                                     •
   Position of  the Patient. — Toward the conclusion of this stage, if it is  a first labor (and it will
soon arrive if she has borne children before), the female should be placed in an obstetrical position, as it
is  termed, or the position in which she is to be delivered.   The posture for delivery has varied at different
times, and still varies  in different countries. .  In the  earliest periods, the  sitting posture was preferred :
and in Ambrose Pare, Daventon, and other old  writers, we have a description and plates of labor-chairs.
In China, and in Cornwall  (England), the patient is delivered on her knees, or leaning over a chair ; but
generally throughout Great Britain, and in many parts of this country, she is delivered  on the left side,
the hips being close to the edge of  the bed, and  the knees drawn up toward the abdomen, with a  pillow
between them to keep  them separate.
   The position which I prefer is on the back, with the  knees drawn up, the feet against the foot-board,
and a rope, sheet, or towel, tied to the  bed-post (or the Indian method, as described, on page 124), on
which she can pull during a  pain.  This  last position, I think, is decidedly the best, for  the  following
reasons  :  YY hen the patient is on the side, the pains do not concentrate themselves on the  foetus as they
do while lying on the back ;  the woman, to use a common  phrase in the  lying-in room, " can not help
herself" so well  as when on  the back.   All women, indeed, when  left  to  their  own choice, invariably
and instinctively choose this  position, evidently showing that  it is the posture dictated by  nature.
   Besides, lying on the side frequently produces obliquity of the uterus, which interferes with and retards
its power, and consequently impedes labor.   This has been demonstrated again and again by placing the
same  woman in both positions.   If the  patient  lies on her back, the  fundus of the womb  will fall back
toward the spine, thus  bringing its axis into  a  proper direction, and of course  the os uteri will  present in 
128
IMPROVED SYSTEM OF MIDWIFERY.
a more favorable manner ,*  consequently the child will be  delivered with greater ease, and much sooner,
if the back-position be  taken  in  preference to that of the side.   So very uneasy and agitated  do some
women become on the side, that  they can not be delivered ;  but  just as soon as they are placed on the
back, labor proceeds and speedily terminates.
  Again, the limbs are too close together when the patient is on the side,  and  the labor is thereby retarded.
So sensible have the advocates of this position been that the closeness of the limbs retards the passage of
the child,  that they recommend a pillow placed between the knees  to  keep them apart.  But  there are
four  reasons why  the pillow is objectionable : it increases the heat of  the person,  perhaps  already pro-
fusely perspiring ;  it does not afford sufficient support to prevent the legs from being pressed  together ; in
the height of the pain it will often slip away from between the knees, and we lose its advantage just when
we most require it; lastly,  if there were  none of the above objections, it is impossible to keep the limbs
apart, as they naturally are, when the patient is  on her back :  all which shows the vast superiority of  this
over every other position.
  I can not imagine a more awkward situation for the accoucheur  than the act of  sitting at the bedside
of the female, with  her posteriors turned toward his face — one half of a folded sheet under  her hips,
and  the other half in  his lap — his coat-sleeves  rolled up like those of a butcher — one hand pressing on
the perineum, the  other manipulating in the vagina!   The picture is ridiculous.
  At length, the head advances  and presses on the perineum, and very fully  distdnds the  soft parts of
the mother.   Then commences the expulsion through the outlet of the pelvis, which  leads  us to the
 iuties of the third stage.
                                          SECTION  V.

                   MANAGEMENT  OF  THE  THIRD  STAGE  OF  LABOR.

   Supporting the Perineum. — Most works on midwifery abound with strict injunctions and minute
directions respecting the  great  importance and the particular  manner in which the perineum should be
supported during this stage ;  for all which I never could  see the least reason :  but  one author appears to
have copied from another, while none  have paused to inquire into  its  necessity.   To suppose that the
perineum can not endure the necessary amount of tension required to perform its office, is unreasonable :
it is equivalent to asserting that the Creator has made less adequate and more imperfect provision in this
than in all other parts connected with the expulsion of the foetus, and that' he has made more inadequate
provision for the integrity of  the parts  in the  human female than in those of the lower animals, or for the
due performance of any other function of the  system.
   Who supports the  perineum of the lower animals during  parturition ?—yet who ever saw this organ
lacerated in  any of them, except indeed in those cases where the necessity of their situation was supposed
to require assistance ?  And  this being given  in  ignorance  and violence (always two very familiar com-
panions),  may properly be  considered the cause of the accident.   Who ever saw or heard of laceration
of  the perineum in the human female when  they were delivered alone, or among the various tribes and
nations of the earth where no such custom  of supporting it  prevails ?   It is also very  remarkable that
none of the ancient writers on midwifery ever refer to this accident:  they neither advise  any method by
which it may be prevented, nor any means to  be  used for its relief when occurring — proof positive that
they were unacquainted with  the  accident.  We may therefore  rely on the belief that it never occurred
in  their practice.
   In  fact, we do not hear anything about this  dreadful  accident (and it  is, indeed, dreadful  when  it
occurs) until after the invention and common use of forceps to  hasten delivery,  before the parts were
prepared by nature for such extensive dilatation ;  and  the other  abominable  and utterly  useless practice 
r'lar.  31-
 
 
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DUTIES OF THE ATTENDANT AT A LABOR.
129
of boring, scooping, and stretching, the soft parts of the mother, under the absurd pretext of making room
for the child to pass !
   I believe no observation is more generally true than that which recognises the existence  of a power in
the structure and constitution of every animal, by which evils are prevented and remedied, and by which
the greater part of the difficulties occurring at the time of their parturition are overcome ;  which power,
combined with sympathetic  or corresponding actions of other parts, is commonly exerted with  a degree
of energy and effect proportionate  to  the  difficulty.   Every change which is made in the parts, both
external and internal, at the  time of labor, is successive,  and  every pain seem3 to produce two effects : it
dilates one part, and gives  to some other  part a disposition to be dilated.   If, therefore, by  hurry or
imprudent management, the  head of the child, in its  passage through the pelvis, be brought into contact
with parts which have not yet acquired their disposition  to dilate, or if,  by artificial dilatation, we attempt
to supply the want of the natural, the parts will be more  easily lacerated than distended; besides, all such
conduct tends to irritate and inflame the parts,  making them rigid, and  thus utterly preventing their dila-
tation.  Under such circumstances it is no wonder that the perineum should be lacerated ; but then these
are all circumstances of our own creating.
   Even  the celebrated  Dr. Churchill, after  recommending the practice  of  supporting the  perineum,
admits that  it  is frequently  productive of much evil.  He says (page 218):  " I really believe that it
would be better not to  touch the perineum, than to make injudicious pressure.  It has been my lot to
ivitness more than one case where rupture was owing to excessive and injudicious support."
   Receiving  the  Child.— As  the head passes through the  vaginal  orifice, the  attendant, having
removed all obstructions, should receive it in  the right hand, allowing it to make the usual rotation, and
carrying  it forward as the pains  expel the  shoulders and body of the  child.   With  a napkin in the left
hand, wipe the face of the child, and clear the mouth of any mucus which may be there, preventing the
infant from breathing.  Before the shoulders are expelled, feel whether there be any coil of cord around
the neck.  It frequently happens that  there is one, sometimes there are two, and occasionally three  or
four, folds of the navel-string coiled  around the neck ; and if it were not liberated, it is very possible that
the pain  which expels the shoulders might cause the  placenta to  be drawn away from its  attachment,  to
the great peril of the mother, from haemorrhage ;  it might even cause an  inversion of the uterus.   But the
chief danger is to  the infant.  If, on its expulsion, the cord  be drawn tightly  around its neck, the circu-
lation of the funis will  be arrested by the compression of the vessels ;  and the same compression may
also  close the trachea to such an extent as to prevent the ingress  of air into the lungs :  thus  the two
sources by which life is maintained  being  cut off at the same time, strangulation  must  be a necessary
consequence.   In such a case, a deep livid ring  will be  found encircling the neck.  Should such a birth
take  place in  an unmarried woman, who  had any interest in  concealing  it, very possibly she  might  be
accused  of murder, founded on the appearance of  the mark  around the child's neck,  which could  not be
distinguished from the effects of a cord applied  with the intention of destroying its life.
   Sometimes the membranes cover nearly the whole body, and prevent respiration ;  when this happens,
the features can not be distinguished.   In this case, the  hand must  be  passed downward,  and the mem-
branes drawn over the head.  I attended a case where  this occurred.   The whole  body was  nearly
covered with a thin, blue, transparent  membrane, which gave a very strange and novel appearance  to
the child.
   As soon as the child is born, it should  be laid on one side, with its back to  the mother; by this  means
the danger of  the  copious discharge, which follows  delivery, getting into  the mouth and suffocating  it,
will be completely avoided.
   Separating the Child. — As soon  as signs of  life  in the infant are manifest, which sometimes
take  place before it is wholly born, aud  at others  not until some time after, and which are generally known
by the child's crying (when breathing, life is established), the cord  may be separated.  Let the  child be
withdrawn from beneath the bed-clothes, the mother's person being left perfectly covered and concealed.
Sometimes the funis is very  short; this should be examined  before we withdraw the child, or the sudden
                                                17 
110
IMPROVED SYSTEM OF MIDWIFERY.
jork may separate the placenta, and cause an alarming haemorrhage.   Sometimes inversion of the uterus
may be the consequence.   If  we find the cord sufficiently long, which is usually the case, we may place
the child more completely in view, and, by lifting the bed-clothes from  above it, proceed to tie the cord,
and separate it from the mother.
   The ligature may consist of a piece of fine tape, bobbin, or eight or ten pieces of thread, which may be
placed together, and tied at both ends : and this preparation should be made before the child is born.   Even
in forming the ligature,  some attention is necessary; for if it  be too thick, it will not compress the arteries
sufficiently to  prevent bleeding after the funis is cut, and it is also liable to lose its hold and slip altogether
off the cord, thus leaving  the vessels entirely unprotected ;  and if, on the  contrary, it is too thin, it will
probably cut through  the membranes covering  the cord, as  well as the  coats of the vessels themselves,
and thus fail to prevent haemorrhage.   If the ligature be made of threads, it is necessary that they should
be all  of equal length : for if  one or two be shorter than the rest, they alone  will make compression, and
consequently they will act as though the ligature were composed of them only.
   The ligature is to be tied a full inch from the umbilicus.   Some tie it two  and even three  inches  from
the umbilicus, but when tied long, the disagreeable odor during its separation is increased, without being
of any benefit.  The place where the ligature is fixed does not at all affect the place where the cord sepa-
rates :  this is a certain fixed line near the umbilicus, evidently marked at the time of birth.   Most authors
improperly recommend two  inches.  They also recommend  a second  ligature, about two  inches  from
the first, and to divide the cord between them ; but this additional ligature is  entirely unnecessary, unless
there should be twins attached to one  placenta, which very  rarely occurs ;  a single knot, however, may ,
be tied in the  cord itself; but should there be  twins, it will  be safest to tie  the cord twice.   " But," say
some authors, " the mother may bleed  to  death if the placenta remains attached to the uterus, and the
cord be not ligatured/'   Such persons  are ignorant of the placental  circulation, or they would know
better  than this.
   YYrhen we take up  the child to lay it in the blanket held by  the nurse, we (especially young practitioners)
must remember that  it is as " slippery as an eel," and we  shall be very liable to  drop it if  we are not
careful, and do not  take  hold of it properly.   It should  be taken with the left hand by one or  both
ankles ; the back of the neck ought to rest in the arch  formed by the thumb and forefinger of the attena-
ant's right hand, while the  back lies in its palm, and the points of the remaining three fingers are under
'ts right axilla, or armpit.   If held  in this manner, it can by  no means fall to  the floor.
   To   ascertain whether there  be  another  Child  in  the  Womb. — As soon  as we  have
delivered the  infant to the  nurse,  we  may examine to see whether there be another foetus in  the womb :
for it  has repeatedly happened, with  young practitioners especially, that they have wished  the parents
joy, and retired from the room ;  and before they have  reached home, a messenger has followed them, to
announce the  birth of another child !
   In order to avoid  so gross an error, we ought in all cases, as soon as the  child has emerged from the
womb, to ascertain whether there be a second.  If the uterus contain  another foetus, its fundus will be
felt high up above the umbilicus, and its general bulk will be  almost as great as it was before the expul-
sion of the  first.   YYre  shall  be able to define it distinctly, and  it will present that peculiar elasticity and
degree of subdued fluctuation which is  so characteristic of the gravid uterus toward the close of preg-
nancy.  But  if there be no other child in the cavity, we shall find the womb in one or other of the five
following conditions : first, it  may be almost as small  and hard as a fcetal head, so that we can grasp its
body completely,  and it will feel nearly as solid as a ball; secondly, it  may  be  almost equally small, but
softer, so that when we press it, it relaxes under our hands,  and has somewhat of a doughy feel; thirdly,
it may  be about the same size, but one minute hard, and the next soft; fourthly, it may be nearly as  large
as an adult head, and so hard, that we can  perfectly define  it with the hand  : it bears the character of a
large solid tumor :  and, fifthly, it  may be  a3 large as an adult head, and soft, its general volume not so
 cHsily  defined, also   communicating a  doughy sensation to the touch, and, when  grasped, it becomes
harder in substance and less in bulk. 
DUTIES  OF  THE ATTENDANT  AT A LABOR.
131
   The first three states announce that the placenta has  almost wholly passed into the vaginal cavity,  and
the last two  indicate that it is still in utero ; the fourth proves that the uterus  is contracted  around the
mass, and the fifth shows that it  has not  yet  taken on  itself the office of contraction for the  purpose of
expelling it.
   To  ascertain whether the perineum has suffered any  injury (which should occasionally be done for our
own satisfaction, and to confirm our  views respecting  the uselessness of supporting it), if it has been at all
injured, the anterior edge will feel rough  and  exceedingly sensible to the touch; but if otherwise, it  will
be smooth and not  unusually painful.  Generally, however, this practice may be  dispensed with.
  Having thus separated and disposed of the  child, we must attend to the duties pertaining to the fourth
stage of labor.
                                          SECTION VI.

            MANAGEMENT  OF  THE  FOURTH  STAGE  OF  NATURAL  LABOR.

   This stage, as already observed, consists in the delivery of the placenta.   From all that has been said
in the foregoing pages of the previous stages of a natural labor, we can not fail to have perceived that all
the passive changes which the parts  undergo,  and all  the  active powers exerted for producing  these
changes, are not only entirely independent of the will of the patient,  but are fully equal to the end which
they were designed  to accomplish, without any especial assistance ; which  is usually no more required
for the purpose of forwarding a natural labor, than for any of the ordinary functions of the body.
   When, therefore,  we have seen a  child  safely expelled by a  process beautiful in itself, and regulated
by the greatest wisdom, there seems to be no reason why we should  be apprehensive of error or inability
in those same powers for the separation or exclusion of the placenta,  which is  but an inferior or secondary
part of the same process.   Having accomplished the greater, why should we doubt their ability to perform
the lesser ?  And why should we not in this, as well as in all other cases of medicine, be first convinced
of the necessity of using  art, before we  attempt to give assistance ?  On our errors of conduct here  the
life of the patient may depend : it  is  therefore  necessary that  our conduct should be guided, not by
prejudice, nor by blind submission to medical or other authority, but by the dictates of reason and sound
experience.
   Having observed the  condition  of the uterus immediately after the birth  of the child (when we were
ascertaining whether there was another  in the womb), we may, if there have been no subsequent contrac-
tions, know whether the  placenta be in the womb or in the vagina.   Where  the  placenta is  not ejected
from the womb with the  last pains which expelled the  child, which is very  rarely the case,  in about ten
minutes  the  contractions are generally renewed,  although very slight compared  with what they were
before.   Having disposed of the child,  we may again place our hand on the abdomen and mark the state
of the uterus, which may have changed much since our first examination.  If the uterus  be  found hard,
small,  and low in the hypogastric region, we may be sure that  the  placenta is expelled from the womb
and is lying in  the vagina, from which  it will soon be ejected by the  natural powers.   But  occasionally
the vagina is somewhat paralyzed by over-distension, and does not readily take on renewed contractions
in such a case, very gentle traction on the  cord  in the axis  of the vulva will deliver it.   When  there is
a larger circumference of  the uterus felt, and a soft, doughy feel on  pressure, wind the cord  around  the
fingers of the left hand, and introduce the index or middle finger, or both (of the right), into the vagina,
as in an examination, and follow the cord : if we can  not reach the placenta,  it is still in the uterus,  or, if
we can only reach a little of it,  it is  but partially expelled ;  but if the placenta is in the vagina, that state
of the womb denotes internal haemorrhage, and must be treated as directed in another part of  the work,
in labor complicated with internal hamorrhage.   If the  placenta be not expelled, 2nd there is no  haemor- 
132
IMPROVED SYSTEM OF MIDWIFERY.
rhage, we must wait a little, and make slight friction on the abdomen, which will generally excite uterine
contractions.   If the placenta be within the uterus, we must never pull on or jerk the cord, because by
so doing we may tear away the adherent placenta from the uterus while there are no contractions  going
on to close the mouths of the vessels laid open  by the separation, and fatal haemorrhage may follow ;  or
we'may tear the cord from  the placenta, or revert the  flaccid uterus,  or even produce a perfect prolapsus
of that organ — all which are fearful accidents, frequently resulting from improper extension  on  the cord.
   Generally, in a natural labor, the placenta will be expelled, at least into the vagina, in twenty or thirty
minutes, and sometimes sooner, whence it may be  easily drawn by slight pulling on the cord ; but it may
be retarded somewhat, especially after a very protracted labor:  we should therefore wait, and if it be not
in the vagina,  but remains in  the womb  more than an  hour, we then  deem it not a natural but a complex
labor, complicated with a retained  placenta — for the proper management of which, see  directions under
that head.
   After the  placenta is delivered, put on  the bandage, which ought  to extend from the hips to  the ensi-
form  cartilage  or stomach.  Let the wet cloths  be  removed, which  may be  done without disturbing the
woman much, if they have  been arranged  as  before recommended.   Before  leaving jthe house, see that
the uterus is well contracted : it should  feel through the integuments  about as large as the fist;  some are
not as small, however ; but the smaller it is, the better for the patient, who, if left with a well-contracted
uterine globe,  may safely be pronounced beyond the reach of danger  from any effusions of blood that can
with propriety be denominated uterine haemorrhage.   The parts should be washed  by the  nurse with a
little  warm spirits-and-water,  and a warm cloth laid to  them.
                                         SECTION  VII.

     RECAPITULATION  AND  FAMILIAR  ILLUSTRATION  OF NATURAL  LABOR

   I have thus given the duties of the accoucheur during a natural labor ; and  the  student  or  midwiie,
by bearing in mind the directions  therein  contained, will be  able successfully to  conduct the  female
through its various stages.
   It has occurred to me that it would  illustrate the subject still further, to detail or give the minutes of
the latest case of labor which I have  attended.  And to show the estimation in which the reformed
practice is held by some of the higher class of our citizens, I would observe that the pregnant lady was
in possession of my medical work, and, notwithstanding  she believed none but midwives should officiate
in parturition, she was unwilling that any but the author should attend :—
   Mr.-------, of this city (residing in one of those splendid  mansions near the Battery), about one
o'clock in the morning sent a carriage, with an earnest request for me immediately to  attend on his wife,
supposed to be in  labor.  I was  aroused from  sleep, with the most urgent  importunity to visit  the
lady as soon as possible.  On arriving at the house, and being introduced to the patient, I found that it
was a case of first labor.
   As usual, I endeavored to  exercise  composure myself and to produce  the same in the minds  of  the
friends, by a few timely words, all  which has  a tendency to  allay the  excitement  and  agitation which
usually accompany the first stage  of labor.
   After a short respite, I proceeded to make inquiry respecting the  general health of  the lady : found it
good, and that she had been for the last three months taking freely the mucilage  of  slippery-elm bark, to
the use of  which might be attributed the healthy state of her system, and  which apparently prepared the
way for a safe and  speedy delivery.  I now took  my seat by the side of the  bed, to ascertain more par-
ticularly  whether labor had  commenced.   Having obtained  a history of her  case,  my  attention was
directed to the pains : first, their severity; second,  their frequency ; third,  their duration ; fourth, whether 
DUTIES OF THE ATTENDANT AT A  LABOR.
133
true or false — on the assemblage of which I formed  my diagnosis  respecting her state and condition,
and made up my mind as to my future conduct in relation to  the case.   This occupied about one hour.
The pains were  moderate, renewed at long intervals, and  of that character termed " grinding," which
convinced me that  it was the incipient stage of labor.
  I now made an  examination ; but not, however, as is  customary with  most physicians, by intimating
anything of the kind to the woman, for the anticipation  is  always worse than the reality.   After having
immersed the  middle finger in a little sweet-oil, and on the accession of a  pain, in a low  tone of voice,
I observed to her as follows: " If you please, allow me  to see whether you are in  labor, and if  all is
right"—to which she readily assented, without the least emotion or apparently unpleasant sensation, and
which would not have been the  case had I previously proposed to her an examination.   Passing my  hand
under the bed-clothes and over  the limb, I requested her to  flex her knees and distend them a little apart.
I then carried the finger slowly  and cautiously to the orifice of the womb, and found that it had become
dilated to about the size of a half-dollar.   After washing the hand with soap-and-water, I again seated
myself by the  side  of the patient's bed, and  announced to her  friends that labor had actually commenced.
The pains being moderate and  uniform, and there being no immediate necessity for my attendance,  1 left
the room and  retired  to bed.   I did not fully ascertain  the presenting part, but was very  confident that
it was the head.
  About five o'clock in the morning, I was again summoned to attend.  The grinding pains had ceased,
and those more  bearing or pressing, more  frequent  and severe, had  succeeded, which convinced me
that there was a  full dilatation of the orifice  of the womb, and  that the patient was in the second  stage of
labor.   I now examined in  the same  manner as  before, and found .the vertex or crown  of the  head
evidently the presenting  portion of the foetus.   At this time  the uterine  contractions were very acute,
and  the  patient  laboring under  great  despondency.   She  cried out for several hours in succession, " I
shall die ! — I shall die ! — I am dying !"  And  as  many cases of labor  as I have attended, had I not
been satisfied that the presentation  was natural, and the pains  regular and efficient — had I  not been well
acquainted with  the great resources of nature — possessing a nervous temperament, and feeling much  sym-
pathy— I might  have been discouraged, and sent for counsel;  but  like an experienced mariner at the
helm of  his ship in the midst of a  storm, I felt  calm and confident, being well  assured that the woman
would have a safe  delivery.  I permitted her to change her  position  as she pleased : to stand upright
in the bed, supported under the arm  by two  persons ; at other times she  was allowed to walk about
the apartment.
  When labor had progressed  a little further, and the third stage was about to commence, the head  of
the child being  in  the hollow of the  sacrum, and  pressure Beginning to  be  made on the perineum, I
deemed it advisable to direct the bed to be made.  I ordered  an old blanket or coverlid* to be folded a
number of times and laid on the mattress ; then a muslin sheet folded in the same manner  and laid over
it;  and the patient (then in her night-dress) placed in bed, with her hips  on the same.   During a  pain,
she pressed her  feet against her husband, who sat  at  the foot of the bed, and the hand of an attendant
was seized.   In  this condition she continued for some time, the pains becoming more severe, producing
great outcries and  continued depression of spirits.   I encouraged her by every means  in my power.
Occasionally I made an examination, to satisfy myself and  the friends that  there was no impediment to
delivery.  Still the scene was gloomy : and I was  involuntarily led to  inquire  how it is that the female
sex — the most interesting portion of the human race — is doomed to pass through such a fiery ordeal of
suffering.  I felt assured, however, at the same time, that all was well for the mother  and child,  and that
the  labor would terminate favorably: I judged so from the size of  the vagina,  the capacity and proper
standard of the pelvis, the regularity of the pains, freedom from fever, and coolness  of the soft parts, as
well as from her general health.
  Presently, the membranes broke,  and the waters  gushed forth.  Respite and relief now followed ; but
in a few  minutes the uterus, as if to compensate for lost time,  redoubled its energy, and forced die vertex
against the perineum, forming the  perineal tumor or enlargement   Notwithstanding  the exquisite pains 
134
IMPROVED  SYSTEM OF MIDWIFERY.
of the patient, new courage was now experienced, not  only by myself  but  by the  attendants, and which
was also imparted to the woman.   At thi3 moment the contractions of the uterus were tremendous, and
the patient in a state  of  phrensy while  the  head was  passing through the  soft  parts.   I continued  to
encourage her as  she constantly cried out that she was dying :  " Woman," said I, " it is impossible for
you to die in this state ; every pain you have  is necessary; the worse you are now, the better for you —
the sooner your  difficulty will be over,"  &c.   I stood  by her side, and  kept my  hand  under the bod-
clothes, to see that every  obstruction was removed, and also to be in readiness to support and receive
the child.
   In a few minutes, the perineum had become  enormously  tense and distended, and as  thin as paper,
allowing the foetal  head to pass out.   The pangs of the patient were now changed for relief, mutual con-
gratulation, and  joy.  In about a  minute after the exit of the head, the womb renewed its contractions,
and expelled the body and limbs of the  child, with  the cord twisted  twice  around its  neck,  which, of
course, I immediately disengaged.
   It is under these circumstances that the ignorance and alarm  of bystanders, both male and female, arc
manifest and self-evident.   Possessing no knowledge of physiology and midwifery, their education in this
respect having been shamefully neglected, instead of rendering  proper assistance to the mother or child
in the moment of peril (which a few  hours' instruction would  enable any one to afford), they utter shrieks
of alarm and precipitately fly from the woman, and perhaps leave  her and her infant to perish  !  Young
ladies are not allowed  to acquire  any knowledge of these subjects, it being considered too indelicate or
too unpopular.   They are taught foreign languages, embroidery, to  dance, to sing, to read novels, and
in their dress to  lace themselves almost to death, or induce  some serious or fatal disease !   Hence  they
know nothing of the laws of  health,  and thus their ignorance  and  the  ignorance  of their mothers when
they become sick.   Instead of availing themselves of a rational  and judicious reformed practice of medi-
cine, they resort for aid to our fashionable mineral and depletive  doctors, and very often fall  a prey to
their malpractice,  by bleeding, mercury,  &c.
   But to resume the subject, after this short digression  :  I-now  removed  the  child a short distance, and
placed it either on the  back or side, taking  care to secure the  clothing of the mother, and keeping  the
parts well covered, but at the same time exposing the infant to full view.  In a few  moments I proceeded
 .o tie the umbilical cord : I passed a strong and soft piece of twine around the cord, and tied it securely
 about an inch   from  the  umbilicus ; I then  carefully passed the scissors near where it was tied, exam-
 ined well to see that there was no member in contact, and, dividing it, placed the infant in the blanket,
 and passed  it to the nurse.
   I left the patient about twenty minutes in  the  same  condition, and  watched her  attentively, to see  if
 there was flooding, or  any pain to expel  the placenta, which was still retained : there being none, I pro-
 ceeded to remove it.  With  the left hand I took hold  of the cord, passed the fore and middle fingers of
 the right hand up  the vagina, and requested  an  attendant to lay her hand on the abdomen and gently
 press downward, while at the  same time I directed the patient to retain her breath and to press down.
 1 now made gentle extension on the cord, and  at the same moment  seized the  edge of the  after-birth
 with the  fingers.   These four  propelling powers united disengaged it with the  greatest facility.   It  is
 customary to place the  placenta in a " chamber," and   have  it buried, or thrown into the privy ; but in
 this case, as I wished to preserve a  specimen for my  museum,  I washed it in several waters, brought it
 to my office, and  put it in alcohol.
   I then ordered  all the wet cloths,  blanket,  and sheets, to be removed, placed in a tub, and taken  from
 the room ;  the parts to be washed in a little warm spirits-and-water, to  diminish the irritation ; and after-
ward a warm dry  towel to be applied, to absorb  the lochial  discharges ; subsequently, a  bandage to the
 abdomen.   The wet cloths were removed as follows :  two persons, one on each side of the female, with
her arms over each, raised her up, while a third removed the cloths.   If the  muslin or any other part of
the cloths  be wet, the  whole  must  be removed,  and  dry ones   substituted, otherwise the cold  moisture
occasioned  by the discharges may produce a  check of  perspiration, followed by fever.  Many physicians 
                         DUTIES OF THE ATTENDANT AT A LABOR.                     135

endanger the lives of their  patients by suffering them  to lie for a  length of time in  the same wet and
uncomfortable position in which the child has been born.
   This, then, completed my duties for the present toward the patient;  and I  now directed  my attention
to the infant, giving directions  to the nurse what the treatment should be, as some nurses are at a loss, or
ignorant of their  duty in this respect.  I advised her first  to bathe the  whole  surface with a little sweet-
oil before washing it with  soap-and-water.   Next, a compress, with a hole in  the centre, was  placed on
the umbilicus, the cord put through the opening, and over this a muslin bandage ;  the  dress  was  then
fitted on the  child, which I directed should be much lighter and  looser than ordinary,  the clothing being
generally too thick and  cumbersome, as well as fitting too tight, which  exerts  an unhealthy influence on
the infant.
   In every case of child-birth, the nurse or  some one else proposes with great zeal  the administering of
some medicine  to the  infant—usually  molasses-and-water —"  to expel," as one said,  " the economy,"
meaning the meconium.   In this instance, the nurse proposed the same, to which I objected, stating  at the
same time that the mother's  milk was the best and only proper medicine for the child, and that it should
be put to the breast in a few hours.
   The patient, now free from  pain, fell asleep ; and the  labor having been thus favorably and happily
terminated, I took my leave, with the thanks and congratulations of the  friends.
   Next day I paid a visit to the woman, and found  her in a  very excellent state :  no flooding, pain, or
fever ; appearance and feelings almost as natural as ever.   I directed a mild purgative to be administered
on the following morning, it being the second day after delivery,  and  the bowels subsequently to be kept
regular ;  the diet  to be light and  nutritious, the room of  a proper temperature, with very little company
or conversation.
   In two  or three days I called  again, and  found all the symptoms  so favorable, that I considered  it
unnecessary to repeat my visits.
   1  take this opportunity to  remark that physicians generally are in  the practice of and  recommend fre-
quent and attentive examination of the abdomen  for various reasons ;  but I have  never deemed this
necessary :  an examination  to see if there be twins is  usually quite  sufficient.  This practice, which
indeed is recommended by most authors, appears to me to be an interference uncalled for, and constitutes
what one writer terms " meddlesome midwifery."
   In concluding  my minutes of  the  preceding case, I will state that, in all the labors  I  ever attended, I
never found one which, from beginning to end, terminated so favorably;  and  it has been a question in
my mind whether I  ought not to  impute it to the free use of the  mucilage of slippery-elm bark for  three
months before confinement.
   I  have thus given the  details of the management of the above  case more particularly, that the young
student or midwife may learn  every step in  the  progress  of  a  natural  labor,  as well as to illustrate the
preceding rules  on this subject: all which, together with the plates,  are quite sufficient, with a little
practice, to render every one of ordinary capacity proficient in the art of midwifery. 
136
IMPROVED SYSTEM OF MIDWIFERY
         CHAPTER  VI.

DIFFICULT  LABOR.
                                         SECTION I.

                   DEFINITION  AND  CAUSES  OF  DIFFICULT  LABOR.

   Bv difficult labors, I mean  all  those  labors which, although the head  presents, are not accomplished
with  ordinary  facility, and  are protracted  beyond  the  average  duration, or  are  attended with  unusual
suffering.
   The causes of difficult labors are very numerous,  but  it is unnecessary to treat of each of them sepa-
rately ; for this purpose they may all very conveniently be divided into two classes :—
   1.  All those causes which lessen the force of the expelling powers.
   2.  All those causes which increase the resistance to the passage of the foetus.
   First,  then, we shall treat briefly of those causes  which lessen  the force  of the expelling powers, and
thus produce inertia or debility of the uterus.
   By this, of course, we do not mean absolute inaction of that organ, since that would preclude the idea
of  all power;  but we  mean  an imperfect, irregular, and  inefficient contraction, inadequate to expel  the
child.  This state may be produced —
   1.  By general weakness  of the constitution,  arising from disease not necessarily  connected  with
pregnancy,  as  consumption, and  convalescence from fevers or other debilitating diseases.  But at  the
same time it should be remembered that, while difficult labors sometimes depend on general feebleness
of  the constitution, yet they do not necessarily follow : for we occasionally see women in the last stage
of  consumption or  typhoid fevers expel their children with ordinary facility, even but a few hours before
their  own decease.   Yet, sometimes these debilitating  diseases become the cause of action after premature
excitement.
   2.  It is occasioned at times by  over-distension of  the uterus, combined  with  extreme  thickness of the
membranes, which  produces paralysis of the  womb, as over-distension of the bladder produces paralysis
of  that organ.  This may be caused by superabundance of the liquor amnii, or by dropsy of the desidua
or of the chorion, called, when  it occurs, the false  waters.  When inertia arises from this cause, which
may be presumed in the absence of all others, the  abdomen will be unusually large, and the os uteri pretty
well dilated  or  dilatable.
  3.  Sometimes it  may be  produced  by too early evacuation of the  liquor amnii, which is occasionally
known to take  place some days or  even weeks previous to the  commencement of  labor-pains ; and in
other  cases it occurs at the beginning of the first stage of labor : this is caused by bringing the hard head
of the child to  dilate  the os uteri, instead of the soft, wedge-like, dilating power of the  liquor amnii in
the  membranes.
  4.  Again, it  may be caused in  some instances by very sudden and powerful affections of the mind,
such as fear, anger,  joy, &c.  These  at times so strongly affect some  individuals, as to  produce a com-
plete suspension of  their pains. 
   jm.
■ - 
 
DIFFICULT  LABOR.
137
                                           SECTION II.

                       TREATMENT  OF  DEBILITY OF  THE  UTERUS.

   The best general treatment,  and that which ought always to be first administered, and which likewise
should accompany all other remedies, is, patience and sympathy, with cheerful and encouraging conversa-
tion.   Especially should the intelligent  practitioner  aim to inspire  the patient  with  confidence in the
goodness of  Divine Providence, and the ample resources of nature which he has established.
   Where inertia arises from  debility of the constitution, the patient's strength must be supported.   This
will  be best effected  by mild  nourishment, as gruel, arrow-root, panada,  chocolate or cocoa, chicken-
broth,  &c.   If the pulse be very feeble, add a little wine.
   If there be found great irritability of the  nervous system, with inefficient  uterine contractions, whether
it arise from  original inertia, from reaction  following  premature excitement to hasten labor, or from too
free  use of stimulants, give from ten'to twenty drops of laudanum, which may be repeated if necessary.
   In a great many cases of inaction arising from the weak expulsive power of  the  uterus, the resistive
power will  be found  to be  yet weaker.   In such cases, Nature will  generally  perform  her work, and
delivery will be effected with but little assistance from art.
   To  know how to wait, and when  to wait, in cases of inertia, is a strong mark of a judicious practitioner.
We should cheer up such a  patient;  and  if there be  any one in the room who acts differently, do not
allow her to remain, or the inertia will most  likely  increase.   Sometimes labors of this character will last
for several days.  Generally such a patient has no appetite, and is exhausted from want of nourishment.
When this is the case, tempt her appetite with any kind of  nourishing food she may fancy ; but  do not
give her stimulants, unless she  is accustomed to them, or her great debility indicates their necessity : then
a little will be  of service, taken  in  connexion with  some nourishing  food.   Warm diluent drinks will
frequently arouse the  dormant  powers of the uterus.   Gentle friction on the abdomen, frequent change
of position — any or all of these may be tried in succession, and they will often be attended with success.
If she  is inclined to sleep, let her be indulged.  If it is at night, sometimes it is good to give an anodyne
to promote sleep where there are few or no pains ; but  do not give  her too much, or it may produce  a
comatose state :  nor yet too  little, for a very small dose of opium or laudanum will keep a person more
awake than if we had not given anything.   It should, however, be a universal rule never to give  an ano-
dyne in any form during labor, unless the  bowels  are ftee, either naturally or artificially, and it is clearly
indicated.   Average dose of  laudanum, twenty to  thirty  drops, which may be repeated if  necessary.
The tincture of  hop is still better.   If, after she awake, the inertnes^of the uterus continues,  and there
be no  diarrhoea,  give her  a gentle  aperient, followed by an enema  of one  or  one and a half  pints  of
common injection, or of warm water with  a tablespoonful of  salt dissolved in it.   This, besides  evacua-
ting the  bowels, will generally  by sympathy arouse  the dormant  powers  of the uterus  to action.   " A
strong tea of bethroot and cohosh," says a botanic physician, " may now be  given,  which will frequently
be attended with great success  in exciting uterine contractions."
   Should the above means, however, all fail, then  it may be  necessary to excite the contractions of the
uterus by ergot.*  But there are two things to which we  must pay  especial attention, if we ever expect
to use ergot with any advantage to our patients or  with credit  to ourselves :—
   1.  We must see that the patient be in a  proper state for its use.
   2.  That the quality of the ergot be good.
   With respect to the state of the  patient, we must remember —

   * I give the rules for its administration, but of late years I have very seldom used it; and a question has arisen in my mind whether it
 would not be the better practice to dispense with it altogether, or at least in most of the cases where it is recommended.  Sometimes it forces
 the child through the pelvis with such power as to destroy it, or lacerate the soft parts of the mother; at other times it has no effect at all; and
 in yet other instances it appears to exert a prostrating effect upon  the nervous system.  Occasionally, I have witnessed a very happy result
 from the use of it.  Let it be still further tested. Notes should be taken of every Gase where it is administered.
                                                  18 
139
IMPROVED SYSTEM  OF  MIDWIFERY.
   1.  That ergot should never be  given until we know that the os uteri is fully dilated, and  that there is
no rigidity of the other soft parts ; or  it will be very liable to produce inflammation of  the  uterus, or
laceration of the soft parts of the  mother.
   2.  Never give ergot till you  are  certain that there  is no deformity  of  the  pelvis ;  or it may produce
rupture of the uterus.
   3.  Never administer ergot in  a  case  where the head  of the foetus is dropsical ; or similar consequences
will result.
   4.  Ergot should never be given in any preternatural presentation : always  be sure that  the head  pre-
sents  right before administering it.
   5.  Never give ergot if  there are any convulsions or any strongly-marked head-symptoms.
   G.  Never give ergot while the woman's strength is greatly exhausted.  If it is  not  given  before then,
it  must be suspended until the strength is in some measure recruited, lest the  exhaustion which it brings
on be more than she can  bear.   The pains which ergot generally excites are very violent, long-continued,
and without intermission,  until  the child is expelled.
   But if the passages are well dilated,  the os uteri fully open,  and the head  low down  in the pelvis, with
plenty of room — in fact, if nothing but the want of pains prevent its expulsion — we may use ergot with
safety, and  generally  with  great  success.  YY'ith these precautions, ergot  may  not do harm, but will
always be found to be adapted  to  such cases of inaction of the uterus.   Perhaps all the frightful stories
which have been told, and the  fearful consequences which have actually resulted from the use of ergot,
have  been derived  from  ignorance or  neglect of some one or more of the above rules.   Therefore, as
before intimated, let it be  further tested.
   I have heard of some practitioners who are either so ignorant or so reckless, as to  give ergot in almost
every case, to expedite the labor,  and thus save their time!  Such triflers  with human  life  and the future
health of their patients ought to be discarded from society by every honest practitioner.  Ergot certainly
should never be  given at all, where there is anything like an  average amount  of uterine contractions  or
pains;  "in  inertia of the  uterus, given  in subjection  to  the above rules, it  may prove valuable."   If
ergot, then, is capable of doing incalculable good or incalculable  evil, whichever may be its result in our
practice,  will  depend on the judgment  and discretion with which we may use it.
   Perhaps the best way to administer it is to take one  drachm of  the powder,  pour over it  half a pint  of
boiling water, let it stand awhile,  and then give one  third of it  every twenty minutes till the pains are
excited.  Some prefer to give about  twenty grains of the powder in molasses or  honey every twenty
minutes.   Or the  tincture maybe  given in teaspoonful  doses, repeated every twenty minutes.  It seldom
requires more than two or three djfces to excite uterine contractions ; sometimes only one,  if the ergot h
of good quality.   YY'here three doses do not succeed,  it is generally useless to repeat,  unless we can get
a  fresh sample.
   Again, we  should see that the ergot  is good.   It should  be  obtained as fresh as possible, as it deterio-
rates  very much by keeping.  It  should be  kept  in  the  grains, and  pulverized when wanted.   If it is
good, its odor when pulverized  will resemble  that of new-mown hay ;  that which is  inert,  or of  inferior
quality, has commonly a  musty  smell.   Perhaps the best way to  preserve it is, when we  procure some
of good quality, to tincture it  for future use.  In tincture it  will preserve its virtues for an  indefinite
period.   To make the tincture, put two ounces of  the pulverized ergot into a pint of dilute alcohol : let
it  stand fourteen days, and strain it.   It should be kept in a well-stopped vial. 
DIFFICULT LABOR.
39
                                        SECTION III.

                        SECOND  CLASS  OF  DIFFICULT  LAEORS.

   This class embraces all those causes which  increase the resistance to the passage of the foetus.  Here,
there is no want of pains, but  the  resistive powers of the  parts are too great to be overcome by the
ordinary efforts of the uterus, and consequently cause great and long-protracted suffering.
   1. Difficult or lingering labors may arise from rigidity of the os uteri, vagina, or perineum : either or
all of  them may cause a  lingering labor.   This condition may be produced by any cause which excites
a febrile state of the  woman's system, or local  irritation of the parts :  a hot state of the room ; too many
bed-clothes ;  stimulating  drinks ; costive state  of the  bowels ; retention of urine from  the child's  head
pressing  upon  the  neck of the bladder,  &c, are all causes which  very frequently produce a general
febrile excitement in  the  system, and rigidity of the soft  parts concerned in  parturition.   Local irritation
sufficient to produce great rigidity  of the  parts may be caused by too early rupture of  the  membranes,
where the rupture is  followed by active contractions or  pains.  This, by bringing the hard head of tbe
child into contact with the mouth of the womb, instead  of  the soft dilating wedge formed by the bag of
waters, will frequently excite irritation of the parts, and produce a state of local fever which will prevent
dilatation, and occasion a tedious and difficult labor.   Frequent and rude examination will often  produce
the same effect.
   2.  From Mal-Position of the Os Uteri. — Mal-position  of the os uteri is  not an unfrequent
cause of difficult and protracted labor.  The mouth of the womb, instead of being near the centre of the
pelvis, may be  found against either its right or left side, which during a pain forms an  effectual resistance
to the  advance of the child.  Sometimes its  mouth  projects backward  against the  promontory of the
sacrum ; and  at others, though very rarely, the  mouth of the womb  projects  forward above the symphysis
pubis — when the head of the child is driven against the abdominal walls in the hypogastric region, instead
of the axis of the  pelvis.  When  the  mouth  of the womb is found in  any of these positions, we mav
expect a difficult and protracted labor, unless the  position be rectified  either  by  nature  or  art.
   3.  From  a Face Presentation. — In  this  presentation, labor is generally lingering, in conse-
quence of the bones of  the cranium  not  being  capable of compression in this direction, and therefore
yielding with  great difficulty to the  form of the  pelvis.  The child is usually born alive, but the lineaments
of the face are wonderfully distorted, and sometimes  they  do not  resume  their natural appearance  for
many days.
   4.  From Mechanical  Obstructions  of  the  Soft Parts. — Labor  is  sometimes much pro-
tracted and rendered difficult from  strong  adhesive bands which are found in the upper or lower part of
the vagina.   These may  be congenital, if it be a first child ; or the obstruction may arise from adhesions
or bands formed by previous inflammations of tbe  vagina or neck  of the womb, occurring either durin^
a former labor, or being caused by other and subsequent inflammations.   Sometimes   polypi  or  other
tumors (sarcometous, steatomatus,  bony, or watery) are found growing from the pelvis, the  neck of  the
womb, or other organs  of  generation, presenting  very serious obstruction to the passage of the child.
Occasionally  a diseased  ovary will  descend  and obstruct the passage through  the pelvis.  Not unfre-
quently, too,  the bladder, distended with urine, will be forced into the pelvis before the head of the child,
which prevents its evacuation, retards the progress of the foetus, and protracts  the  labor.   Sometimes
there  is a vaginal hernia obstructing the passage, in which is contained  a portion  of the intestines or of
the omentum.
   5.  Disproportion between  the Pelvis  and Head. — The pelvis may be  smaller than usual,
which is very liable to be found  in tall women with wide shoulders  and  narrow hips ;  or the head may
De unusually  large from hydrocephalus, or perhaps be unyielding from the more perfect union by ossifi-
cation of the  bones of the eraninm, and difficult and lingering labor  be the necessary result.
t
• 
. to
IMPROVED SYSTEM OF MIDWIFERY
   G.  Anchilosis  of the  Coccygis. — This bone in  early life is susceptible of considerable motion,
and it increases the diameter of the outlet a full inch or more ;  but  in women who are not married till
late  in  life  it is  apt  to  become anchilosed  and unyielding, and  thus retarding very much the progress
of labor.
   7.  Deformity  of the  Bones  of the  Pelvis. — At times there is found more or less  deformity
of the bones of tlie pelvis, altering  its shape,  and  thus retarding or altogether preventing the passage of
the child through its cavity.   These may  be caused by rickets in early life, moletus ossium, by fracture'
occasioned by falls  or other accidents, either '-* p^iMhond nr nfter puberty.
                                          SECTION IV.

                        DISCRIMINATION  OF  DIFFICULT  LABOR.

   Now, since difficult labor may arise from so many different causes, it must be obvious  to all that the
first thing for the practitioner to do when  called to  a  difficult or lingering labor is, to ascertain, by very
close  and critical examination, to which of these several causes the difficulty in question is  to be ascribed.
YYrithout this, if he attempts to relieve it, he will be  like  a blind man groping in the dark—quite as liable
to injure the patient as to remove the evil.  But if he be familiar with the anatomy  and condition of the
parts, he will find no  difficulty, on a careful examination, in determining to what the obstruction in ques-
tion (if extraordinary) is owing.
   YVIien the  difficulty arises from  rigidity of any of jhe soft  parts  of the mother, it may be  readily
detected by the finger on examination per vagina.   If the evil  be occasioned by rigidity of the os uteri,
we shall discover on examination that, although the pains are strong, and  perhaps have continued for a
long time, yet that the os uteri  is but  little dilated ; and instead of feeling soft, thick, and spongy, like
wet chamois-leather, or soft and thin, like wet brown paper, as it does in the early part of a natural labor,
it is either firm,  thick, and hard, like cartilage or  sole-leather, or thin, firm, and rigid.  Sometimes the
os uteri will be found well dilated, but there will be  great rigidity of  the  vagina or  the perineum.   In
natural  labor, both these  are  soft, cushion-like,  exceedingly flexible,  cool,  and  well lubricated with
mucus.   In rigidity of  these organs, instead of this, the vagina will feel hot and dry, together with con-
siderable  firmness,  narrowness, and  want of distensibility — so  much so, as sometimes to make  an
examination painful.
   Mai-positions  of  the  os uteri are likely  to be overlooked,  especially by young practitioners and  others,
who are not very critical in their examinations.  The pelvis in these cases appears to be almost filled  up
by the head, and  making rapid  advance toward delivery ; yet it is not the naked head of the child which
they feel in contact with the finger, but the anterior surface of the uterus, which may be  known  by the
want of hair on  the scalp ; and on a more  minute examination we shall  find the os uteri scarcely at all
dilated, the opening almost beyond the reach of the  finger, against the lateral  or posterior walls of the
pelvis, and the uterus spending its energies in fruitless attempts to expel the child.
   In  face presentations, the inequality of  the  presenting surface (the eyes, nose, mouth, and chin, which
may be easily  detected) serves  to distinguish it from the breech, with which alone it can be confounded.
Morbid adhesions of  the vagina, bands passing across, or tumors, polypi, &c, are  easily known.   To
distinguish these tumors from prolapsus of the bladder,  introduce the catheter: if it be the bladder, it will
disappear on evacuation.   To distinguish them from hernia of  the  intestines, evacuate the bowels  by
enema,  and it  will disappear.    By these means we  shall not confound them, and the sense of  touch will
generally determine whether the tumors are sarcometous, serous, or osseou'S.
   Should there be  disproportion between the head and the pelvis, it  may be* ascertained  as follows : if
the pelvis be smaller than usual, it  may be known  by introducing two  fingers into the vagina,  separating
                     f 
DIFFICULT LABOR.
141
them as much as possible after they are within, and thus gauging from the promontory of the sacrum  to
the lateral walls on either side, and from the symphysis pubis to the promontory of the sacrum.  Notice
the span of the two fingers, and we may thus measure with tolerable accuracy.  If the head be unusually
large from dropsy, the fontanelles and sutures will be very much wider than usual.  To  ascertain whether
the coccygis is anchelosed, introduce the finger  into the vagina, point downward, let the upper part rest
against the arch of the  pubes, feel with the tip  of the  finger for the point of the  coccygis, and  press
downward and backward : if it is anchelosed, it  will not  give way under the finger; if otherwise, it will
spring back perhaps an inch or more.
   Deformity in the bones of the pelvis may be  ascertained by introducing two or more fingers into the
vagina, and passing them carefully round the entire circumference of the  pelvis.  To learn if  there be
any angle at the symphysis pubis, which  is frequently the case, introduce two  fingers  and  lay them flat
behind the symphysis.
                                          SECTION  V.

                            TREATMENT  OF  DIFFICULT LABOR.

   When the difficulty arises from  rigidity of the os uteri  or other soft parts of the mother, or if the
room be too warm, or the patient be clothed too much, regulate the temperature of the apartment and the
quantity of the dress.
   If the rigidity be caused by retention of the foeces, evacuate the bowels by a dose of castor-oil or other
mild, aperient medicine, or administer a large injection of warm water  or molasses-and-water, with salt.
   When the rigidity is occasioned by retention of urine, the bladder must be evacuated  by the catheter,
if the patient be unable to void it, or it may burst and destroy her.  To do this well, without exposing
the woman's person, requires some  tact (and the person should not be uncovered without the most urgent
necessity); but, of course, it would  be better to expose her  person, if we do not know enough  to perform
the duty otherwise, than to leave her to perish, as would almost inevitably be the case.
   There are  several ways of performing  this operation, some adopting  one  and others another mode —
and it is of little or  no consequence which is preferred, if  it be skilfully performed.  I have found the
following to be the most  convenient method :  Place the woman in a sitting  posture on the very edge of
the bed, with her limbs  apart (or across the bed on the back, with  the  thighs flexed on the abdomen,  if
she prefers it, or is unable to sit up from  any cause), and her feet elevated  on two stools; let some one
be placed behind  her to assist her if she be unable to  support herself;  the operator, standing before her,
will now introduce the index finger  of one hand under the clothes and within the vagina, carrying it behind
the pubes : he will there feel the urethra, like a small hard cord; if he now draw the finger outward along
the cord until the bulb arrives at the margin  of the vagina,  he will there observe a slight depression  as
the cord passes from under the finger; keep the bulb of the finger there, and  take the catheter (previously
oiled) in the other  hand with the concave side uppermost, and slide its point along the finger into the
depression ; when it is entered, remember the  position  of the bladder in pregnant women, which usually
projects over the pubis, and  bear down the hand  in which  is the catheter toward the floor,  more  or less
according to the pendulous state of the abdomen ; when it has thus passed in about two inches, the water
will begin to flow.
   But if the  bladder is forced  down  before the head of the child into  the vagina, the catheter  must  be
entered  with the concave side downward, and the hand below the vagina ; after  it is  entered, the hand
must be elevated  as it passes  in ; when the bladder is  thus evacuated, the head can pass on.  Then
let the woman take her pains in the  horizontal position ; introduce the fingers within the vagina and carry
the bladder above the head of the child, and keep it there during several pains, until  the head has made
some advance. 
142
IMPROVED SYSTEM OF MIDWIFERY.
  If the above means fail to remove the rigidity of the parts, as they sometimes will, it will be necessary
to have recourse to more energetic  treatment.  Bleeding  is the principal  remedy relied  on by practi-
tioners of the " old school," to remove the rigidity of  the parts :  Dewees says, " Bleeding is a certain
and  never-failing remedy for rigidity of the  soft  parts ;" Blundell, Burns, and many others of high
authority among them, place  implicit confidence in  it.   Professor Hamilton was  accustomed to assure
his class that he could always relax  the  os uteri by bleeding, and  that he  never allowed the first stage
of labor to continue more than  from twelve to fourteen hours, so  completely had he  the process under
his control.
  Now, although bleeding is  certainly a  very powerful  means  in  procuring relaxation, yet it  is by no
means a safe one, and is frequently productive  of serious evil.   There is one great objection to bleeding
at the  commencement of labor, which, if there were no other  (but " their  name  is legion"), ought for
ever to prohibit its use — namely, the fact that the  patient must necessarily  lose a certain quantity of
blood after the child is born, and we  are in perfect  ignorance how much that may amount to : fearful
haemorrhages after delivery, producing death, are by  no means uncommon.   It is therefore a wanton risk
of human life to take blood from the arm at all during the stages of labor,  because, if the  quantity thus
abstracted had been  preserved in  the woman's  system, it might have turned the vacillating beam of life in
her favor, and thus snatched her from impending death.
  Injections of  simple warm water,  with  no  kind of stimulating ingredients  in  it, will be found very
relaxing in these cases ;  or a warm, or perhaps a vapor  bath ; and nauseating doses of emetics, frequent
fomentations to the parts, and anodynes, will be much more  safe and  equally certain means of relaxing tlie
rigidity of these organs.
  In retroversion or displacement of the  mouth of the  uterus, some  of the "old school" in medicine
recommend hooking the  finger  in the mouth  of the womb and  drawing it more into the centre of the
pelvis.   But this can seldom do any good, and  may cSuse  very great injury :  the neck of the womb has
frequently been lacerated by this means ; besides, it  is always difficult, and  often impossible, to retain  it
in the centre of the  pelvis, even if we succeed  in drawing it there.   The method which I prefer, which
is vastly more successful, and free from all danger, is the following :  When the displacement is lateral,
let the patient stand  erect, and suffer some pains in that position ; if necessary, she may be supported by
an assistant on each  side.  If  this fail, let  her lie on  the  opposite side, and use gentle friction  on the
fundus of the womb, slightly bearing it toward  the  centre  of the pelvis, and the  mal-position will soon
be rectified.
  If the  os  uteri project backward—which is  a  very common form  of this difficulty, especially where the
woman has borne  many children, has a  large  pelvis, and a pendulous abdomen — in such cases, let the
patient retire to bed, and take her pains while  lying on the  back, together with gentle friction and bearing
over backward of the fundus of the womb.
   [n cases of face presentation, we must be very careful in our  examinations, lest  we injure the eye with
our  finger.   Keep  the  parts cool  and well relaxed ;  and, with time and  patience, nature will  usually
effect the delivery, and without any instruments.
   The treatment of mechanical obstruction  of the soft  parts will, of  course, depend  upon the character
of the impediment.   When  the labor  is obstructed by bands  across  the vagina, the child's  head will
usually rupture them, and, with patience and perseverance, a safe delivery will be  effected.
   A case occurred very  recently in this city of  perfect adhesion of the  neck of the uterus  throughout its
whole length (caused by inflammation resulting from criminal  attempts to procure  abortion by instru-
ments), which was*  opened  by  a guarded  stiletto, and  the woman safely  delivered.   When there  are
tumors in the vagina, growing from some of the organs of generation, sometimes they are small and do not
prevent the  passage  of the child,  but only render tlie labor more protracted.  But occasionally they are
found so large as to  render delivery impossible without the intervention  of some kind of instruments.   It
.hen belongs to the class of instrumental labors.
   In cases of disproportion between the  head and  the pelvis — in  anchilosis of the  coccygis__and in 
DIFFICULT LABOR.
143
deformity of the pelvis — hopeless as these cases would at first sight appear to  those who are not practi-
cally acquainted with the mighty resources of nature, especially where the  woman is strong and#healthy,
we sometimes find these efforts of nature will  be sufficient to  force the child (with the head very much
compressed) through the contracted or the deformed pelvis.  Much, of course, will depend in such cases
on  the smallness and the compressibility of the head, and the strength of the pains.
   It becomes us to be exceedingly cautious not to  presume, upon light and insufficient grounds, that the
distortion is too great to  allow the child  to pass through without the  intervention  of instruments;  and
more particularly  when the question relates to the  employment of the perforator, an  instrument  always
incompatible with the life of the child.  We ought in such cases  to weigh  every circumstance very care-
fully, and if possible procure the opinion of some other and more experienced practitioner than ourselves,
before  we place it among the class  of instrumental labors.  The existence of a human being depends
upon our decision : we ought not therefore to decide but with the greatest and most prayerful deliberation
and caution.  It is  always one  of the  most difficult points in  such cases to decide  upon the exact  time
when we can no longer trust to nature, but must have recourse to instrumental  assistance.  In consid-
ering how much suffering the  patient can bear without constitutional or local mischief being the result,
every practitioner will, in the  individual  case  before  him, be very much guided  by his own judgment:
no  rule of time can be laid down, for one patient maybe left unassisted for sixty hours better than another
can for ten.   We can therefore only state collectively those symptoms during the presence of which the
patient may be left to nature, and also those symptoms and conditions which indicate danger: after which
the general medical knowledge of every practitioner must inform him as to the weight which ought to be
attached to the occurrence of one or more of these in any given case.
   The patient may be safely left to  nature while the vagina and  os uteri  can be kept cool, moist,  and
dilatable, by the relaxents before recommended  in rigidity of the parts — together with the following con-
ditions : while there is a regular recurrence of uterine action ; the patient's strength unimpaired; her mind
tranquil, with a disposition to sleep between the pains ; able to void her urine ; some perceptible progress
in the labor,  however slow ; and the absence of all general fever or local inflammation.
   But, on the  other hand, where there is  great heat and  soreness in  the vagina,  notwithstanding  the free
use of the cooling and relaxing treatment recommended in rigidity; great disturbance and intense anxiety
of mind ; severe shivering,fits during the second stage of  labor; frequent and constant vomitings after the
os uteri is dilated ;  a cessation of true uterine action, after many hours' true labor, and  the substitution
of irregular  and unproductive pains ;  the accession  of general fever;  violent pain of and continued sore-
ness of the abdomen, rendered exceedingly tender to the touch ; offensive discharges from the vagina ; low,
muttering delirium ;  a very quick and weak, or else a very low and sinking pulse, accompanied by clammy
sweats—these symptoms indicate the presence of great danger.
   In persons having difficult labor, whose  constitutions have been weakened by former ill health, or  by
having suffered much and frequently in former labors, even without the accession of fever as enumerated
above, we occasionally meet with great and alarming debility, prostration of strength, weak, failing pulse,
and a countenance which must be known to every  practitioner who is accustomed to see bad cases, but
which  I can not describe otherwise than by saying  that it bespeaks a want of power  to resist disease:  this
appearance is one of those points which can be learned  only  at  the  bedside  of the  sick ; it would  be
absurd to attempt to describe it in words.   In proportion, then, to the number and severity of the above
symptoms,  will be the danger of the patient; and unless  artificial aid be timely afforded, the soft parts of
the mother will suffer irreparable injury, or both mother and child will perish.
   The irremedial injury of the soft parts  (which is of but too frequent occurrence) is recto, or else viscco
vaginal fistula, or both, than which  no greater calamity can befall a  living  woman.   Only  for a moment
conceive of the loathsome condition  of a female with the urine  continually  dribbling away every moment,
or her j'ceces passing through the vagina !
   Yet  this  is a difficulty which  not  unfrequently results from the use of instruments.  Dr. Hassell
related to me the  following most flagrant case of mal-practice which came to his knowledge, by one of the 
144
IMPROVED SYSTEM OF MIDWIFERY.
would-be-thought only scientific physicians, which occurred recently in  this city.   The  doctor  says  he
was called to see a woman at the point of death, who had just been given up  by her physician.   When
he arrived, he perceived that it was indeed a hopeless case:  the  patient was reduced to a mere skeleton ;
she complained that  she could not hold  her water, but  that it continually dribbled  away from her, and
that in this way (she imagined, because her physician had told  her so) it was that her  strength wasted
away.   On inquiry as to the length of time she had had  this incontinence of urine, she replied, ever since
her last labor, two years  ago.   She said  she was in  labor five days, but that no instruments  were used.
Dr. Hassell asked her if her physician had examined the parts.   She replied  that he never expressed a
desire to ; but that he had been giving her medicine continually for two years to stop the incontinence  of
urine,  which  he said was wasting her away, and which, if he  could  prevent, would  cure her.  Dr.
Hassell, suspecting that a  vesico-vaginal fistula existed, made the necessary examination, and found one
an inch long, produced doubtless by inflammation and consequent sloughing of the soft parts, from the want
of timely relief  in labor, or perhaps merely from the absence  of  some relaxing medicines — for the child
was at length born by the  natural powers of the system  :  and this ignorant man-midwife, under the garb
of science, had drugged the woman to death, under the  pretence of curing a difficulty that all the medi-
cine in creation  could never  even alleviate, much less  cure — all  her  emaciation  and death being the
result  of the  long-continued and debilitating effects of medicine.   Dr. Hassell say3 that this woman died
in three or four days after he  first  saw her, an immolated victim on the  altar of licensed quackery and
diplomatized ignorance!   Had such an instance of flagrant mal-practice occurred to a reformed physician
(which God forbid !) he would have been tried for  tbe outrage, and sent  to the  stateprison ; and the
grand " regulars" would,  through the newspapers, have  trumpeted his exploits through every state, from
Maine to California!
   When, therefore,  from  the  symptoms  above enumerated, the  woman  begins to sink, and  nature has
done all it can  to effect delivery, art should step in and perform what  nature has failed to accomplish
The case should be  classed at once among instrumental labors; for tbe  further  management of  which,
see directions under that head.
                                      CHAPTER  VII.

                       PRETERNATURAL   LABOR.


                                         SECTION  I.

         DEFINITION  AND  CLASSIFICATION  OF  PRETERNATURAL  LABOR.

   By the term preternatural labor, is meant all those labors in which any other part of the child presents
except the head.
   This class of  labors is  by many practitioners  divided  into a  great many subdivisions, one  for  every
actual  or fancied position  in which the child may present; but,  for all  practical  purposes, they may be
embraced under  two subdivisions, viz.:—
   1. All those cases in which some part of the inferior extremities present.
   2. Those in which any part of  the sides, back, abdomen, shoulder, or  the superior extremities, present.
   Either of these classes, in the common phraseology of the lying-in chamber, is termed a cross-birth,
but, in strictness of  language, it should be  applied  to the second alone, because it is the only class in
which the child actually lies transversely in the womb. 
 
 
 
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PRETERNATURAL LABOR.
145
               SECTION  II.

SIGNS  OF  PRETERNATURAL  LABOR.
   It is of the greatest possible importance to ascertain these cases in  the early part of labor, especially
those of the second class, as the golden opportunity for rendering efficient assistance, compatible with the
safety of both mother and child, may be lost.   Various signs of preternatural labor have been relied on
by different practitioners — as peculiar motions of the child, singular shapes of the mother, slow progress
of the first stage of labor, early rupture of the membranes, and many others — but the only certain infor-
mation is to be gained by examination per vaginam.
  Whenever, in  the early stage  of labor, we  make  an examination, and  find  the  os uteri somewhat
dilated, and yet are unable to detect any part of the child presenting, we have strong reason  to  presume
that the head is not the presenting part.   It is imperative that such a case be closely watched until more
progress has been  made, and we are able to feel the  presentation ; and  as  soon  as that can be felt, we
must ascertain with precision what that part is.
   The best way to improve our tact in detecting the presentation early is, to give ourselves the habit of
feeling the different parts of very young living or dead children, as opportunity may offer ; and whenever
we make examinations per vaginam, to proceed coolly and deliberately, and  not to Withdraw our finger if
possible till we are satisfied.  If, however, we  can  not  satisfy ourselves during the first examination, we
must wait a little while, and try again ;  and we  shall by such  means  soon  obtain sufficient  dexterity to
learn any presentation which may offer.   (For the various  sensations communicated  by the  touch from
the different presentations of the foetus in utero, see page 120.)   Having diagnosed the presentation,  and
found it to belong to the  class of preternatural labor, the next question is, " What is to be done?" This
will depend on the subdivision to which they belong.
  First, the treatment of those cases in which the breech or the lower extremities  present:  it  may be the
feet,  the knees, the breech, or perhaps one foot or one knee.
                                         SECTION III.

    MECHANISM OF  LABOR  IN  PRESENTATION  OF  THE  LOWER  EXTREMITIES.

   In presentations of the nates and lower extremities, most frequently the back of the child is toward the
abdomen of the mother; at other times, the back of the foetus is toward the sacrum of  the mother: not
that the back of the child in either case looks directly forward or backward, but obliquely, the breadth of
the child passing in one  of the oblique diameters of the pelvis.
   In  a breech presentation, one of the  ischia (usually  that which is most anterior, or nearest the pubes)
descends the lowest, and therefore first meets the finger in examination.
   The breech  is  generally transmitted  through the outlet with one  hip  directed obliquely toward the
pubes and the other toward the sacrum.  The  shoulders pass the  brim with their breadth in the line of
the oblique diameter of the  pelvis ;  but in passing the outlet they have their position changed, being then
inclined, the one  toward  the pubes and  the  other  toward the sacrum.   By this inclination, the head  is
brought through the brim with the forehead toward the sacro-iliac synchondrosis  and the  occiput toward
the opposite acetabulum.   The shoulders having  been expelled, the  face  turns  into the hollow of the
sacrum: the chin is depressed toward the chest, and so escapes posteriorly; and, lastly, the vertex passes
out from under the pubes.
   Generally, I  would observe, concerning all presentations of the inferior extremities,  that if tbe pelvis
                                                19                                           * 
llti
IMPROVED SYSTEM OF MIDWIFERY.
be of a natural size, and the parts cool and relaxed, Nature is fully competent lo effect the delivery, and
it should be left to her unaided powers  as in natural labor.
   But it will be always  proper to  inform the friends, especially the  husband, that  the  child  does not
present naturally, although it will require no operation, and will not be attended  by any unusual risk to
the mother; but yet that  the child may be still-born.  Do not inform the patient of this, however:  it will
perhaps only dispirit her, without doing any good.
   The reasons why breech and footling cases are more liable to be fatal to the child than vertex presen-
tations, are chiefly because they do not dilate  the soft parts so much.   The head is the  largest part of
the foetus, and when it passes first, it so effectually dilates  the passage, that the other parts quickly follow.
But in footling cases, each successive part that passes is larger  than the preceding : the  legs and thighs
are smaller than the pelvis ; these, in turn, are smaller than the shoulders ; and these, again, are smaller
than the head — which produces such  great determination of blood to the latter organ,  as frequently to
cause apoplexy.  Besides all  this, the larger parts of the child passing last, and having still further to
dilate the passage, exert  such undue  pressure on the umbilical  cord as to  stop the circulation, and thus
cause death ; the convulsive agonies of which are not unfrequently observed after more than half the body
is in the world,  and while the head  is passing the brim of the pelvis.
   When, therefore, the breech  presents, the parts  are  more dilated, and  the  shoulders  and head pasa
quicker than in footling cases, and consequently the  child  is more likely to be born alive.
   Some practitioners  recommend  hooking  the  fingers  in the groins, passing  a fillet over them, or the
blunt-hook, for the purpose of making traction and  extension, in order to expedite  the  passage of the
breech ; but we shall do far better to leave it to nature: because the passages will thereby become  more
dilated, so that the other parts will pass with greater ease  ; besides,  there is no danger from pressure on
the cord until after the umbilicus is born,  and  the shoulders and  head respectively enter the brim of the
pelvis.  Another reason  why traction should not be  made on the limbs and body of the child in the early
part of these labors is, that the  arms  are thereby forced over  the head, and increase the difficulty of the
passage — an obstruction which seldom occurs when traction is not made.  It is always better to leave
these cases to nature until the umbilicus is born ; then to  draw down  the  cord a little, so as to keep it
slack during the remainder of the labor :  because the umbilical  arteries being tortuous in the cord, their
calibre is lessened when  it is  unduly stretched, and this  may as  effectually stop  the circulation as the
pressure of the head in the pelvis.   But after the arms have entered  the pelvis, there is no danger of their
passing above the head,  and  we may then expedite  the labor by gentle traction or extension during the
pains ;  for so long  as the cord pulsates, the life of  the child  is not endangered.  Should  the arms, how-
ever, from  any cause, be unduly elevated, we  must  bring them cautiously down.   To do  this, we should
pass the forefinger into the bend of  each arm successively, gently sweep the forearm over the breast, and
bring it down  and out carefully, and not with a jerk, lest  we  injure the already-distended perineum.
Take care that we make the  arms sweep over the breast : if we make them  sweep the  back, we  shall
dislocate the shoulder, which it takes but very little force to accomplish.
   Generally, the expulsion of the head will soon follow that of the body, the face turning into the hollow
of the sacrum as in natural labor.   If the head  should not pass quickly, and the cord cease to pulsate, or
its pulsations begin to intermit,  or  if  we feel any convulsive motions in the body of the  child, we  must
then hasten the passage of the  head, or in a very few minutes the child will  cease to exist.  The best
way to do this is, to pass the first two fingers of the right  hand around the bac'k of the child's neck so as
to support it, and press it gently upward ;  at the same time pass the left arm under the body of the child,
so as to bear it upward a little, and introduce  the finger into  the mouth and depress the chin during the
pains, which are now almost constant; and, as the head advances, gently raise  the  back of the  child
toward  the  abdomen of  the  mother.  By this manoeuvre, we sometimes make a channel for the  air to
reach the  mouth of the  child,  by which means it can breathe,  and  it has in many cases  done so  for a
considerable time before  the  head  is  born, which will  generally save its life.   Besides, this manner will
greatly expedite the birth of the head.  Remember that the face  first passes out in these presentations. 
                   v                PRETERNATURAL LABOR.                                147

   If we manage  ordinary cases of breech, knee,  or  footling  presentations, as above  directed, we  shall
seldom  have any very serious difficulty in these labors.   But still, at the same time, it must  be remem-
bered that, as in presentations of the head, the labor may be rendered difficult by inertia of the uterus, or
rigidity  of the os uteri or other soft parts of the  mother, we may have resico or intestinal hernia; we may
have tumors of various kinds in  the pelvis; or we may even have deformity of the pelvis ; in fact, we may
have difficulty from any or all the causes which at  times produce obstacles in presentations of the head.
In all cases of this character, we must treat the difficulty as directed in our remarks  under the  head  of
difficult  labor.
                                          SECTION  IV.

                     SECOND  CLASS  OF  PRETERNATURAL  LABORS.

   This class comprises all those cases in which any part of the side, back, abdomen, shoulder, or superior
extremities, present.   We  have included all  these  under one  head, because, whichever of them pre-
sent,  the  indication  of  treatment is  the same.   There is but one  universal  rule in all these presen-
tations, and that is,  to turn  the child and deliver  by the feet.   The rule of treatment in  this  class
is  the very reverse  of that  enjoined in the  first class of preternatural  labors :  for  whereas, in  that,
interference in  the early part of labor is peremptorily forbidden, in this  second class it is as universally
demanded.
   It is true that in  some very  rare instances,  nature  has performed what is  termed a spontaneous evolu-
tion, yet, when this has occurred, it has been  in  cases  of  premature births,  at six or seven months, and
where the  pelvis has  been unusually large.  It is now generally agreed  among practitioners that when
the child is mature, we can not safely trust to this natural operation; and that it is incumbent on  us in
every such case to follow  Nature, and  perform  that evolution  which she always strives to effect, but
is  unable to accomplish  after the  foetus  has arrived  at maturity.   If this  be performed skilfully, it may
be  done with but little suffering or danger to  the woman,  and, if undertaken in due time, vVith certainty
of success.
   If  we are called  early, and  on the first examination we  suspect any of  the above  presentations, we
should make them out perfectly as soon  as possible,  even if we  have  to introduce the whole hand to do
it; but we must be very careful  that we  do  not  rupture  the membranes.  If the os  uteri  be not fully
dilated, but dilatable, the pelvis natural, and the soft parts cool and dilatable, it will be better to  place the
woman in  a horizontal  position, that the os uteri may complete  its dilatation with  less risk of  rupturing
the membranes.
   We should inform  the friends concerning the presentation, and  of the absolute necessity of turning the
child  ; and, if possible, obtain the assistance and advice of a friendly and more experienced practitioner—
not to do the work, but to  recommend the proper course to be pursued in  the premises, and to  share the
responsibility incident to that  course.   The  advantage  of such counsel  is especially  necessary in our
first cases.
   In  the meantime, give a mild, unirritating, and emollient injection, to evacuate the bowels: warm water
is  as good  as anything in these cases.   Evacuate the bladder by the  catheter, if you are not sure that it
be empty; for on no account must this operation be attempted unless  both these evacuations  are effected,
either by natural or artificial means.
   Our assistants being  in readiness,  as soon as the ofc uteri is  fully dilated, we  must  proceed to the
operation  of turning, as detailed in the following section. 
148
IMPROVED  SYSTEM OF MIDWIFERY.
                                          SECTION V.

                     TURNING  THE  CHILD  WITHIN  THE  PELVIS.

   To perform  this operation,  the woman may be placed either on  the edge of the bed, with a person
behind to sustain  her, and her feet placed  on two stools, with an assistant on each  side to keep her limbs
apart ; or she may be placed on the back, across the bed,  with her hips on its edge, and her feet on two
high stools, so as to flex her limbs well, and thus relax the abdominal muscles.  The patient being thus placed,
we may proceed coolly to take off our coat, make bare our  arm, and anoint it well with sweet-oil or lard ;
sit down between her limbs, with  a covering to  protect our garments, and cloths  on  the floor to receive
the secretions.  Be cool and deliberate.  Let our medical friend (if we are so fortunate as to obtain one)
place his hands on  the  fundus of  the womb, to steady it, and to keep up  a gentle pressure downward.
Introduce the fingers within  the vulva in a  conical form  during a pain :  this will cause considerable suffer-
ing to the woman while  passing the sphincter of the  vagina ; but when  that  is passed, we shall find ample
room,  and the presence of the hand will  then  produce  very little pain.    Let  the  hand  now  remain
stationary a little while,  to dilate the parts, and to produce  toleration of its  presence.  Now prepare to
introduce the hand within the uterus ; but this must  not be done during a pain, lest we rupture the mem-
branes before the arm sufficiently plugs  up the vagina to prevent the escape of the waters.   The fingers
must be entered into the mouth of the womb in a  conical shape, as they were previously introduced within
the vagina, and then proceed very  gently until our hand is  fairly within the  womb.   The introduction of
the hand into the womb will in all probability rupture  the  membranes, but the arm will  now be so  far
advanced as  to prevent  the waters from escaping: however, if the membranes are not by this time broken,
we should now rupture  them.  The hand  must be kept perfectly still  during a pain ; but in the interval
we should feel  for  the abdomen  of the  child :  and,  flexed upon it, we  shall usually find  the  lower
extremities.  Seize hold of one or both  of them,  and bring them down ; we  must take care, however, that
we do not bring down a hand and a foot, or the  presentation will not be improved.  Keep cool, and do
not hurry.   Some practitioners recommend us to bring down but one foot,  and others one knee, because
it then more  nearly resembles a breech presentation, and gives the child  a  better chance for life; but, at
all events,  we must be sure that it is one of the lower extremities, if we conclude to bring down but one,
or if we find that we can not easily obtain  a hold of both.
   Having obtained a firm hold  of the limb or limbs, we must commence the withdrawal of our arm very
gently during a pain.   As we withdraw the arm, the waters will gush out, and, if our clothes  are not
protected, they will be soiled.  The limb or limbs should be well brought down into  the vagina.   Some
recommend to tie a fillet or  narrow bandage round the limb, on which extension can be made to prevent
its return ; but this is generally unnecessary.
   Now gently lay the woman in bed, and leave the case to nature till the umbilicus is born ; then treat it
in all respects as  a breech or a footling case, for which  see page 146.
   It is not often, however, that we  are so  fortunate as to be called  to a case of preternatural labor thus
eaily ; and should  we be  so called, it is not always that the parts are  in so favorable a condition for the
manipulation as we have supposed.  Often  the  membranes rupture early, especially where the hand or
elbow presents.   Sometimes there is great rigidity and irritation of the parts; at  others, the difficulty is
not discovered until the  hand protrudes  through the  vulva — the shoulder impacted in the  pelvis — and
the uterus  excited to very powerful contractions.   This is especially apt to be the case where persons,
either male or female, have been in attendance who  know but little of the mechanism of labor, or how to
diagnose the  various presentations : in all such cases we must proceed with great caution.
   In cases of simple rigidity or irritation  of the os uteri and soft parts of the  mother, relaxation should first
be produced  by the means described in difficult labor (seep. 141) ; for on no account  must we attempt to
turn the child while these impediments exist: when they are removed, we can proceed as before directed. 
PRETERNATURAL LABOR.                               149
  When the membranes are ruptured before we are called, but the pains not yet very strong, the pelvis
of the natural size and with no deformity, the os uteri fully dilated, and the parts  cool, no time should
be lost, but we must proceed to the manipulation immediately, as before directed.   But when the waters
are  discharged, the uterus grasps the foetus so closely, that it is difficult to perform a perfect evolution of
the  child : its body is apt to remain in a manner twisted in  the womb.   When this  is the case, it will be
of great service, after we have brought down the foot or feet, to  keep hold of them, making gentle trac-
tion, while during a pain we introduce the other hand (with  the fingers extended) along the lower side of
the  child till they arrive in the  axilla, and then press them upward, so as to place the axis of the child's
body, as nearly as  may be,  perpendicular with the axis of the womb.
  But in those cases to which  we are sometimes called, in which the labor has continued a great while —
the  membranes long been ruptured, and we find the child's arm protruding from the  vulva, perhaps black
and swollen, and the body of the child closely impacted in the pelvis, with the uterine contractions strong
and sometimes violent — the first thing to be  done is, if possible, to arrest the action  of the uterus.  This
may generally be accomplished by full doses of opium.   We need not be afraid of any deleterious effects
from this drug so long as the  pains continue ; a large dose, however,  given  after they have ceased, or
nearly so, may produce coma,  with all  its fearful consequences :  but the quantity which may be given in
regular and  oft-repeated doses  while the pains continue, without  any injurious effects, is truly surprising.
Besides arresting  the  contractions  of the womb, the  opium will usually  produce very  considerable
relaxation of the uterus and soft  parts ;  after which we  can introduce the hand, and often succeed in
turning the child, as  before described.
  Let the woman  now be kept quiet.  The operation will often again arouse the powers of the uterus,
but  sometimes not; when it does not, let the patient remain quiet until the effects of the drug have passed
off: the labor will  then be resumed, which must be treated as before directed.
  But not unfrequently we meet with cases  in which we are unable  by any treatment to arrest the con-
tractions of  the uterus ; or if  we  succeed in  arresting them, the slightest attempts  at manipulations will
sometimes excite its powers to reaction, and  it will  grasp  the child so firmly, that it  is impossible to turn
it.  In  such a case, we have  no alternative, but  either  to leave the woman to the slender chance of
spontaneous evolution, or proceed to embryotomy.
  Whether  we shall give her the  chance of evolution, of  course must depend upon  the size of the pelvis
and the period of pregnancy ;  and especially it must depend on the state of her system  at the time.   If
she  shows any of the signs of  sinking or exhaustion, of which we spoke under the head  of difficult labor
(page 143),  no time is to be lost if we would save  her life.   It becomes, of necessity, a case of  instru-
mental labor.  The child will  be  dead, any  how ;  yet we must  save  the life of the mother if possible.
But if her strength be good, and  the above favorable circumstances exist, we should give her the chance
of spontaneous evolution, slender as it may be ; but watch  her closely, and  always  remember that this
and every other operation, should only be resorted  to as the  last alternative. 
.51)
IMPROVED  SYSTEM  OF  MIDWIFERY
                                     CHAPTER  VIII.

                               COMPLEX   LABOR.

  By the term complex labor, we mean all those labors in Which some other malady occurs immediately
preceding, during, or directly after  labor, but which is not at all necessarily connected with parturition :
the principal of which  are — convulsions, flooding, syncope, retained  placenta, rupture of  the uterus,
rupture of the bladder, prolapsus of the umbilical cord, premature desceht of the hand, and plurality of
children, &c.
                                          SECTION  I.

                      LABOR  COMPLICATED  WITH  CONVULSIONS.

  These may take place either  durihg labor or a few hours before it  commehces :  after the labor  has
terminated, or some months  previous to  its occurrence.  This disease  is characterized by insensibility,
accompahied by convulsions, in connexion with pregnancy.   The attack is preceded  by a determination
of blood to  the brain, manifested  by giddiness, headache, and singing in the ears ;  sometimes sparks of
fire seem to  flash  before the  eyes, the mind wanders, and the vessels of the face and  neck are turgid 5
the  face is swollen, there is an irritation  about the  pericardia, and  sickness and pain in the  stomach —
making altogether a combination of  symptoms from which much danger is to  be apprehended.  The fit
is preceded  and accompanied by a slow  pulse, which sometimes sinks as low as fifty in a minute, and is
also generally preceded by some  or all of  these symptoms ; but  it sometimes comes on without  any
warning.  During the attack, the eyes are turned upward ; the  eyelids  quiver;  the  mouth  is drawn to
one side, and exhibits spasmodic twitches ;  frequently the  tongue  is thrust out;  there is foaming at the
mouth ; and the whole countenance is frightfully distorted;  the  respiration is performed with  a hissing
noise, and the whole body is violently convulsed.  This  state continues perhaps for a few minutes, and
then subsides.   During the interval  of the convulsions,  the patient is generally insensible, and lies quiet
and motionless, in a state  of stupor.   Sometimes she awakes from her lethargy, and complains of pain in
her head or  spine, gets up in the  bed, and looks wildly about.   If  she  is questioned, she shows no con-
sciousness of what has occurred.   After a time, varying from a few minutes to two hours, the symptoms
just described are renewed.
  If convulsions  occur in any stage of pregnancy, contractions of the uterus also generally begin, and
labor is the consequence.   These alarming symptoms  may also  occur   a few hours after the labor has
commenced, which advances in consequence  more rapidly; the child is very soon expelled, and  appa-
rently without pains.  Sometimes, as soon as the child is  born, and the  uterus empty, the symptoms  just
detailed cease, and the patient goes on favorably.  But this is not always the case :  experience shows
that both the convulsions  and the stupor may continue to  succeed each  other after the uterus  is emptied,
with little or no abatement.   The convulsions may even commence after the  labor is over.  Some authors
have classed this disease with  epilepsy, but it differs essentially from that disease : epilepsy is dependent
on morbid irritation  in the brain ;  this  on morbid irritation in the  uterus.  Nothing has been found on
examination  after  death in some instances to account for  the fatal termination  of this disease ; while in 
COMPLEX LABOR.
151
others there  have been  found considerable  turgescence of the vessels  of  the  brain, with  effusion or
extravasation.
  Convulsions odcur under two extreme states  of  the  system  diametrically opposed to each other :  tha
one in persons of a full and plethoric state of the system, in which the  cerebral vessels are inordinately
distended with blood ; and the other when they have been drained almost  empty, as in  cases of excessive
haemorrhage, and great  irritability of the system ;  and  it is a  very curious  fact  that these two perfectly
opposite  states will produce in this  respect exactly the  same phenomena.   Depressing passions of the
mind  also frequently  cause this complaint.
  Treatment. — Inasmuch as the disease may be produced  by directly opposite states of the system,
it must be obvious to all that  the indications of treatment should  be of an equally opposite character.
When it arises from  depressing passions of the mind, great  nervous  irritability, or a feeble and delicate
constitution, nervines, anti-spasmodics, and soothing measures,  are  indicated.   But  our first duty  on the
accession of a fit should be, to protect the patient from injuring  herself  by the violence of her struggles,
and afterward to endeavor to prevent a recurrence of the paroxysm.   Place her if possible on a bed,  and
let one or more persons hold her there, so  as to preclude the possibility of her throwing herself from it,
or striking her head  or arms against any hard body.
  Advantage must be taken of the depression of the lower jaw, which  occurs at  the commencement of
each  convulsive  paroxysm, to insert some hard substance between  the  molar  teeth, with  the view to
protect the tongue.  A  piece of firewood, which can generally  be procured in an  instant, will answer the
purpose  perfectly well;  it should be wrapped around with a handkerchief or a small piece of linen,  and
kept steadily in its place by an assistant till  the end  of the fit:  if allowed  to slip out  for a moment, the
jaws  may be violently closed, and extensive injury  sustained.   I have many  times known the tongue so
swollen  by inflammation consequent  on laceration, as  to prevent  the  patient  from closing her mouth.
When the convulsions occur in a  patient of plethoric habit, or where  there is great turgescence of tho
blood-vessels about  the  head, face, and neck,  the indication  is, to  lessen  the  quantity of blood in the
system, and equalize the circulation : not, however, by abstracting large quantities of blood from  the
veins, by bleeding to the amount of forty to sixty ounces, several times repeated, as recommended and
practised by the " old school" — thereby producing the opposite state of the systen*, which  is frequently
the cause of convulsions, and can only tend to  perpetuate them.   This they call their sheet-anchor.   It
is indeed an  anchor, whose  flukes hang firmly on  to  the  grave, and  often envelopes the patient  in a
winding-sheet!
   The  treatment  on which I rely, and which  I know  is vastly more successful  than  copious  and  oft-
repeated bleedings, is the following :  Apply ice to the head, and mustard-draughts  to the feet, between the
shoulders, and over  the  stomach ; or the feet may be immersed  in hot water in which is infused plenty of
mustard, and the heat of the water kept up  by  frequent additions ; one, two, or three drops of Croton-oil,
according to its strength, mixed with a little butter,  may be inserted in the back part of the mouth when
the patient can not swallow ;  also large  enemas,  in which anti-spasmodics  may be  infused, when they can
not be taken by  the  mouth :  these to be repeated  until  full  and free evacuations  are produced, which
must  be  continued until  all  the  symptoms of convulsions have ceased ;  and  hot bricks, covered with
muslin or flannel dipped in vinegar, may likewise be applied to the  feet  and lower extremities to produce
perspiration.
  It must be a hopeless  case that this treatment will  not cure.   When  there is considerable extravasation
of blood  in the  brain, no treatment will cure :  but  we can never be certain of  this extravasation during
life :  and therefore we ought to use the best means  of remedy  in our power, and  calmly await the  result.
  Some authors recommend expediting the delivery by the forceps, perforator, &c.; but I consider this
in every case to be bad  practice, because there is no certainty that the convulsions will  cease on delivery,
and the  manipulations  necessary to expedite delivery  frequently aggravate  the  convulsions.  Besides,
owing to the violent contortions  and  struggles of  the woman, irreparable  injury is often  done  to tlie
stiuctures of  the mother. 
152
IMPROVED SYSTEM OF MIDWIFERY
  The treatment, then, on which I should  rely, is powerful evacuants where the vessels of the head are
turgid, or the  patient plethoric, with  counter irritations and  sudorifics ;  anti-spasmodics  in all weak,
nervous,  and irritable patients ;  equalize the circulation in all.
                                          SECTION  II.

                         LABOR  COMPLICATED   WITH  FLOODING.

   Hemorrhage is by far  the most frequent complication of labor.   It is a complication which is at
once common in  its occurrence, alarming in its nature, and fatal in its effects ;  and consequently calls  for
our most anxious and serious attention.   Although copious haemorrhage is always greatly to be dreaded,
yet in practice we ought not to regard so much the quantity of blood that  flows, as  the  effect which the
loss produces on  the constitution of the patient;  for it is found that  different women vary remarkably in
their ability to bear up against the results of haemorrhage.  It is  truly surprising to notice  how slight a
degree of depression  will follow an excessive flooding in  some women, and how small a discharge will
destroy others : so that the quantity which  would constitute a dangerous haemorrhage in  one constitution
would produce but little alarm in another.
   Besides  the quantity of blood  lost, the danger to the patient depends very much on the rapidity with
which it flows.  If a pint escape at one gush, it  is usually followed  by  a state of faintness,  and perhaps
complete syncope ; but a slow draining may  go on for a considerable time, until  in  the  whole many
pounds may have oozed away, with but little constitutional disturbance.  And this difference may depend
on two  circumstances : in the first place, the arteries through the entire body, by  the power of contraction
inherent in their structure, accommodate  themselves in diameter  to  the decreased quantity of their con-
tents : this  diminution of calibre they have an opportunity of effecting when the blood drains  away slowly,
but not when it passes out with  great rapidity ;  and, secondly, at the  same time that  the  discharge is
going on, fresh blood  is also formed by the assimilation of nourishment,  and thus the deficiency is in part
supplied, and a more  equal balance of the circulation  kept up.
   When a woman floods in labor, it is  very  seldom  that the  discharge will  continue with  the  same
impetuosity until  death supervenes ; but  the patient faints, and rallies, and faints again, until at length a
perfect syncope will paralyze  the  senses,  deaden the nervous  energy, and put a stop for ever to the
action  of the heart.   Occasionally,  indeed, one tremendous  burst  takes  place, which so completely
depresses the system,  that a mortal faintness at once  occurs :  the heart and  sanguiniferous  vessels
become so  rapidly emptied, that  they possess no longer  the power of contracting upon their diminished
contents so as to  propel them onward ; and thus, after making some vain and futile efforts to keep  up
the circulation, their action  entirely ceases, never to be restored, although this  is comparatively rare.
Sometimes, again, a slow draining will go  on for a length of  time, the  faintness increasing  with the loss
of blood, the heart's action never being perfectly suspended during the continuance of the discharge, and
the first attack of syncope will be fatal.
   Haemorrhage may occur previous to, during/or after labor :—
   First, of haemorrhages occurring during pregnancy, previous to labor.   These may  be  again divided
into three classes, viz. :—
  (1.)  Haemorrhage occurring during the early months of pregnancy, usually called abortion.
  (2.)  Haemorrhage occurring from the sixth to the ninth month of pregnancy, usually called miscarriage.
  (3.)  Hemorrhage occurring at  the full  period  of gestation, just previous to or at the commencemem
of labor :
   1. Abortion. — This is always accompanied by a loss of blood,  to  a  greater or less extent.  Some-
times the quantity lost amounts to a fearful  haemorrhage ;  at others, it is  very small. 
 
n.-itc n.
 
 
Plate  43
/,ik./??. Fulnm .ft.-V- i' 
COMPLEX LABOR.
153
   The cause of the haemorrhage  is always a partial or total separation of the placenta from the uterus.
But the causes of the separation of the placenta are exceedingly various — such as constitutional debility ;
menstruation during the early months of pregnancy ; fluor albus ; hereditary diseases ; secondary syphilis
in either or both parents ; falls; frights ; depressing intelligence ; excessive fatigue ; heavy lifting ; drastic
purges ;  excessive venery,  &c, &c.
   The symptoms of abortions are, a frequent  desire to pass urine ;  tenesmus ;  pains  in the back, abdo-
men, and groins ; with a considerable sense of weight in the region  of the uterus.  But the most certain
sign of  all is, a discharge of  blood from the uterus  through the vagina, because  it proves that some part
at least of the placenta is separated from the uterus.
   It is said by many practitioners that when  this last symptom appears, there  is  scarcely a  possibility of
the patient proceeding in her  pregnancy.   But I have met with a  number of cases in  practice, in which,
notwithstanding this  symptom, the progress  of abortion  has been arrested, and the woman carried  the
foetus to the full term of pregnancy.  Sometimes  these symptoms will continue for several days, and at
length  there will  be discharged  a quantity of water and  coagulated blood, mingled with which will be
found the ovum or embryo.
   Treatment. — The object of treatment  at the first should be, to arrest if  possible the  abortion, and
thus enable the woman to carry the embryo to the full period.   In order to do  this, first give an anodyne
(as tincture of hop, or opium in some  of its forms) to allay the uterine and other pains ;  and  rub  the
abdomen and spine with  some  stimulating  liniment, as the tincture of capsicum.   The  woman must
remain perfectly quiet, and in a horizontal  position.   The bowels should be kept regular by a mild injec-
tion, cold fomentations over the hypogastric region,  cold injections, ice, &c.   When,  however, the pains
continue, notwithstanding this treatment, and  on examination  per vagina the membranes protrude with
every pain, abortion will certainly take place.   When the flooding is very considerable or long continued.
and  the  ovum not delivered, the haemorrhage  will  usually continue  under any treatment, unless  the
embryo is extracted.  To do this, pass up the fore or longest finger as far as possible within the neck of
the womb, until it comes in contact with the ovum ;  then  bend the finger in the form of  a  hook, and
seize it; and  instruct the patient to hold  her breath and to  press down,  as during the expulsion of  the
placenta : by these means the ovum may commonly  be extracted, and, the cause of the haemorrhage being
removed, the effect will cease.  But if it can not readily be extracted  by the above  means, these meas-
ures must not be long continued,  since repeated attempts to extract  by force may excite inflammation oft
the parts.  It is much better  to leave it  to nature, at the same time using all suitable  means to suppress
the haemorrhage until the embryo be expelled, either by nature or  art.   If the  embryo be  not expelled
within a reasonable time, and the  haemorrhage becomes alarming, ergot given  in  twenty grains at a dose,
and  repeated if necessary, may soon effect the expulsion of the ovum, and insure the contractions of  the
uterus : and thus  effectually arrest the haemorrhage.
   2. Premature Labor,  attended with hemorrhage, and hemorrhage preceding and accompanying
labor at term. — These are  produced by one or other of the  following causes : first, by a partial or total
separation of the placenta from the  uterus ;  or, second, by the  placenta being situated over the os uteri.
Examination per vagina will determine to  which of these  causes  the  haemorrhage in  question is to be
ascribed.  If it be from placental  presentation, of course this part will be in contact with the finger at the
os uteri instead of the membranes.
   Treatment. — When the haemorrhage arises from a partial or  total  separation of the  placenta,  the
refrigerant means  spoken of before may be used ; if these  do not arrest it, and the os is dilated or dila-
table, the-membranes must  be ruptured, which will  evacuate the water, and allow the uterus to contract
more, and thus diminish the size  of the orifice of the bleeding vessels.  If the contractions are feeble, and
there be  nothing to contraindicate, ergot may be given to  expedite the  delivery, and, subsequently, to
contract the uterus.  If it fail, give two  grains of opium and four of capsicum  combined every hour.
   When the placenta is situated over the mouth of the womb, as soon  a3  the os uteri is  dilatable, the
child must be turned and delivered  by the feet (the  manner of doing which has already been described
                                               20 
101                          IMPROVE;)  SYSTEM  OK  MIDWIFERY.

under pivL-rn.sural labor).   When the hand arrives at  the os uteri, by insinuating the fingers between tho
placenta  and uterus around the os, we shall find if there be any part that is not fully attached.   Sometimes
one edge barely covers the os : in such cases, the hand must be introduced through  this part ;  if no such
partial separation is to be found, the  placenta should be perforated by the fingers.  If the hand be passed
through the placenta, it will come directly in contact with that part of the child which presents.   But if
\rc separate the placenta to the edge, the hand will be on the outside of the membranes, which must be
ruptured before we can lay hold of the feet of the child.  No regard is to be paid to the part of the child
which presents, as it must always be delivered by the feet.   The feet being brought slowly into the pelvis,
we must wait till the uterus  is  contracted to  the body of  the child, which will soon take place, and is
known by the application of our hand to  the abdomen.
   The contractions of the uterus may be excited by the use of ergot.  It should  be  given in a full dose a
few minutes before the hand is introduced,  and repeated when the hand is entered, unless the pains aro
e>:eited.   Thus given, it may expedite the delivery and suppress the haemorrhage,  by which the patient
might otherwise be destroyed.   The  delivery must then be  terminated very slowly, to give the  uterus
time to contract as the child is withdrawn  from  its cavity.   An assistant  may make moderate pressure on
the abdomen, to aid the contractions  of the uterus, jind thus prevent all ill consequences from the sudden
emptying of the abdomen.
   As soon as the child is born, the hemorrhage will generally cease, if the  operation has been  performed
slowly ;  but if  the delivery has been effected very rapidly,  and the womb be not well contracted, fearful
haemorrhage may result.  It must then be treated as hereafter to be described in hemorrhage with retained
placenta.  Should no other uncommon difficulty attend the delivery, the  child will be  often born alive,
even in cases of  hemorrhage which  are  accompanied  by the utmost danger to the  mother — sometimes,
in fact, after her death.
   3.  Hemorrhage  after Delivery. — This may occur  before or subsequently to the delivery of
the after-birth : it may be internal or external.  But whichever form it assumes,  a want of contractions is
the cause.   Where the womb is well and  permanently contracted, no dangerous haemorrhage can happen.
Flooding after delivery,  then, is kept up by a torpid state of the uterus,  thus preventing it from contract-
ing with  sufficient force to close the mouths  of the bleeding vessels.   The  effects of the loss of blood arc
the same, whether the haemorrhage be internal or external ; and any one acquainted with the consequences
of the loss  of biood will easily detect the symptoms, even where there is  no external haemorrhage: it may
occur not only  from a want of contractions of  the vessels, but  also from  some  portion of  the placenta
remaining  attached to the uterus.   In either case, very alarming symptoms ensue, which call for prompt
interference.   If the  placenta has not been removed, it must be cautiously extracted, and gentle friction
made on the abdomen, to excite the  contractions  of the uterus ; likewise  cold applications  to the abdo-
men, or  a stream of cold water let fall upon it ,• an injection of cold water; cold water may be drank ;
an infusion of gezanun maculatum  is  very good ; ergot, to excite the contractions of the uterus ;  and the
following pill is also excellent: pulv. opium; capsicum gr.  4.
   A melancholy  case of death from haemorrhage after the birth of the child took  place in this city,  in tho
person of Mrs. Andrews (the wife of one of our most  respectable citizens, confined with her first child).
The following is the history of the case,  as communicated to me by the  husband and the  nurse :  The
labor was tedious, but there was nothing  special  to  excite alarm.  After delivery, the nurse  observed
symptoms of flooding, and  mentioned it to  the attending physician, who sat on  the opposite side of the
room ; but he iki'u! no attention to  it: this was  repeated several times, with the  same result.  At length
the friends  became very much alarmed, and  went to the doctor, stating  that they were afraid the hsemor-
lhagc was so great, that it would prove fatal if nothing were  done.  The  physician was appealed to, to
know whether this was not  the condition of the  patient:  he replied in the negative, without even  an
examination to see whether it was  the case or  not.  He continued  in the  room for three or four hours,
at a f.rcat distance from the patient, " waiting," as he  said, " for the expulsion of the  placenta."   And
though there were marked symptoms  of sinking and prostration, the doctor did not appear to be conscious 
COMPLEX LABOR.
155
that it arose from hamorrhage.  The patient continued to sink, and the friends becoming more alarmed,
requested another doctor.   The  moment he arrived and  saw the case, he removed the placenta — what
ought to have  been done at the first; but the patient  had not strength to rally :  she  rapidly sunk ;  in
short, she had  bled to death !  The certificate  given to the coroner was, that  she died  of haemorrhage ;
but afterward,  when the friends expressed  their dissatisfaction at his practice, he said her death was not
caused by haemorrhage,  but by exhaustion !
  If the history  of this case as related to  me be correct, it is one of the most flagrant  instances of mal-
practice I have heard of for several  years;  and had a  reformed  physician  been guilty of such  gross
neglect, he  would have been prosecuted for the outrage against professional science, and his name blasted
for ever.  But the patient was killed sccundon artem, and her destroyer roams  at  large.   In all human
probability, if the placenta had been removed at the commencement of the haemorrhage,  the victim  would
have been a happy wife  and mother, instead of a  tenant of the silent tomb, leaving a bereaved husband
and an orphan child through life to  mourn her loss.
  There can be  but one opinion  among all good accoucheurs of the old or new school in cases of this
kind : all will unite in enjoining (whenever the placenta is retained and haemorrhage occurs) the necessity
of immediately removing it with prudence and caution ;  and to condemn in the most unqualified manner
the  conduct of any man who would sit three long hours during haemorrhage frflm the uterus, without
even an attempt  to extract the placenta, or in  any other way  to arrest the bleeding !  It  seems incredible
that any physician, pretending to even the slightest information and skill, should thus wantonly trifle with
human life.
                                        SECTION III.

                         LABOR  COMPLICATED  WITH  SYNCOPE.

   This may arise either from haemorrhage or rupture of the genitals.   Syncope is not unfrequently met
with in the two extremes of  society.   It occurs among women in the  higher ranks of life, who are of a
delicate, nervous, and hysterical constitution.  It is also not unfrequently met with in the various abodes
of poverty in our large cities, where a want of proper ventilation and sufficient nourishment, combined
perhaps with an  habitual use  of ardent spirits, have conspired to  destroy the vigor  of the system, and
incapacitate it to bear up against the exertions attendant upon  labor, especially  when  it is accompanied
by any unusual sufferings.
   Such attacks of syncope most generally follow rapid labors; and those patients who are of  a relaxed
fibre, and  whose minds possess a gloomy turn — but more  especially those who have  entertained deeply-
rooted apprehensions with regard to their recovery — are most  usually the .subjects of this  dangerous
affection.
   Treatment. — In  all such cases, arising from either of the causes  above mentioned, the vital powers
must be sustained at a  healthy point  by the  stimulus, either  of  warmth, fresh  air, and easily-digestible
nutriment, or by the judicious use of wine, spirits, or some stimulus which serve to offer the  most
effectual means of restoring  the tone of the circulating system. 
156
IMPROVED SYSTEM OF MIDWIFERY.
                                          SECTION iv.

                  LABOR  COMPLICATED  WITH  RETAINED  PLACENTA.

   When the placenta is not expelled within an hour after the birth of the child, it is termed a retained,
 placenta.  This  may take  place without haemorrhage.   It  is  usually expelled  in less  than an hour —
 frequently in  from fifteen to thirty minutes.  But no patient ought to be left before the placenta is brought
 away, because, although there may be no existing haemorrhage, a  most  dangerous one is liable at any
 time to  ensue while  the placenta is  retained.   The  placenta may be retained in  the uterus from three
 causes,  viz. :—
   1.  From a want of uterine contractions.  2.  From irregular  uterine contractions.  3. From scirrhous
 adhesions.
   I. Retention  of the Placenta from Want of  Uterine  Contractions. — This is very
 liable to follow a protracted  labor which  has been attended with unusual  sufferings.  Gentle frictions on
 the abdomen, and slight traction on the  umbilical  cord in the direction of the axis of the pelvis, are cal-
 culated  to excite the action  of the uterus.  But if  much  force  be used  in traction on the cord, serious
 consequences may result: first, there will be danger of tearing the cord from the  placenta ; second,  there
 will be  danger of inverting the uterus ; third, there will be danger of producing prolapsus of the uterus ;
 fourth, there  will be danger of tearing the placenta from the uterus, and thus causing copious and perhaps
 fatal haemorrhage.   The danger of producing the above consequences is much greater  when undue  force
 is used  to extract the placenta by the cord than  when the hand is prudently introduced into the uterus for
 that  purpose.  Ergot given in such cases will usually expel the  placenta, and  insure the subsequent
 perfect  contractions of the uterus.  Gentle traction, however, may be made on the funis, first on the axis
 of the brim,  which  is done by drawing with the cord against  the perineum, and afterward on the axis of
 the outlet.   In cases where  the uterus acts insufficiently, by using just so much force on the cord as will
 prevent the placenta from retracting  during inspiration, and  holding on to what is  gained during expira-
 tion, will be  sufficient to extract it in a little time, without  danger of any injurious effects ; and this is as
 much force as ought ever to be used in such cases on the cord.
   2. Retention  of the  Placenta from irregular Action of the  Uterus. — Bearin°- in
                                                                                             O
 mind what has been said in a former part of the  work on the construction  of the uterus, we shall perceive
 that there are both  longitudinal  and transverse  muscular fibres in this  organ,  either of which may be
 excited  to action while the others are  quiescent, and which may contract the uterus into the  form of
 a cylinder, or into the shape of an hour-glass,  thus  firmly closing upon  the  placenta and preventing its
 expulsion.
   Sometimes steady but not strong extension upon the cord,  long continued without relaxation, will  over-
 come the spasmodic contraction of the uterus.   If it does not, the hand must  be introduced,  and the
 placenta carefully extracted,  in the  manner hereafter to be described.
   3. Retention of the  Placenta from morbid Adhesion. — Morbid adhesions of the placenta
 may arise from inflammation  and  the effusion of coagulable lymph  connecting the two ;  it may also be
 caused by induration ; or it may arise from calcareous or scirrhous deposition.  But from whatever cause
 it may arise,  the adhesion is  generally limited.  This accident  being the result  of disease during  preg-
 nancy, it has no relation, of  course, to the kind of labor.   It is much  more dangerous than irregular
 contraction, because the uterine action detaches more or less  of  the placenta ; but the adhesion, retaining
 the mass in the uterus, prevents  its contraction  and  the closure  of the  bleeding  orifices  of the  uterine
 vessels.   The diagnosis is, in almost all cases of morbid adhesion, or of retention from irregular contraction,
 utterly impossible to arrive at with  certainty until  the hand is introduced  into the uterus ; we may,  how-
 ever, always strongly suspect that retention arises  from one or other of the above causes  when the  after-
pains are long continued and strong,  and the placenta is not extruded. 
COMPLEX LABOR.
157
   Treatment. — Since we  can not be  sure  that retention  arises from the above  causes, the means
before recommended must be duly tried ;  if they fail  to  expel it, the  hand  must be introduced in the
following manner: make bare the arm,  and well warm and oil  the  hand and arm; let  the accoucheur
place himself on the bed, on his knees, between  the limbs of the patient; then take hold of the cord  with
the left hand, and put it on the stretch as a guide for.the other hand to the placenta ;  now introduce the
thumb, fore and middle fingers, along the cord into the vagina, and let them remain in that position  for a
few minutes, which will often excite the contractions of the uterus after other means have been tried in
vain ; at the same time the woman may  be directed to place her hand upon her mouth, retain her breath,
and bear down, which compresses the abdominal muscles, and exerts a great  force upon the uterus ; the
nurse may  also place  her hand on the abdomen  over the region  of the uterus,  and press gently down
toward the  pelvis.  These manipulations will very commonly  cause the uterus to contract, detach the
placenta, and force it into the vagina.
   Should the  means above recommended fail to be successful, or if there have been strong contractions
of the uterus previously without extruding the placenta, or should there be copious haemorrhage, the hand
in a conical shape should be  gently insinuated into the vagina  along the cord, and, following it, must be
carefully entered through  the os uteri until  it arrives at the insertion of the  cord ; then search  for the
margin of the  placenta.  If  there be hour-glass contraction, we must  gently dilate the contraction  by  a
conical position of the  fingers, until we arrive at the  placenta.   Having found  its margin, insinuate the
hand between it and the uterus to ascertain if it be free  : should  it not be free, and yet there be no morbid
adhesion, very slight insinuation of the fingers between it and the uterus will separate it.   Then continu-
ing to keep the cord on the stretch, take firm hold of the  placenta and retain it fast; the previous working
of the fingers will have excited the contractions of the uterus where they had been dormant, or increase
them where they had been active ; then, keeping hold of  the placenta with one hand, and the cord  on the
stretch with the other, the nurse at the same time making gentle downward pressure over  the uterus, and
the woman assisting as before by retaining her  breath  and bearing down-—let the  uterus expel both the
hand and the placenta grasped by it.  This course v%<11 insure the contractions of the uterus and prevent
fatal haemorrhage,  which will  be very  liable to follow if the placenta be  extracted by force,  without  thus
insuring its contraction.
   When the  retention  of the  placenta is caused by morbid adhesion, it  is recommended by physicians
generally to separate it  by manual force.   But I deem the practice  of using great force very injudicious
and  highly dangerous, and it  has often  destroyed the patient.   For an obvious reason, the uterus  is also
very commonly diseased : this prevents  its contractions, and consequently the mouths of the blood-vessels
are left open after this forcible  separation, which  pour  out blood very copiously, and constitutes haemor-
rhage of the most dangerous character.  If we can separate it  by moderate force, the uterus is  not so
much implicated, and the contractions may perfectly close the vessels ; but if,  after a moderate attempt to
detach the  placenta,  we  fail,  it is  a much better practice  to let it remain in the womb for a  day or  two,
until sloughing take place : it will then  be  disengaged very slowly, and, either with or without resort to
any  means, give the uterus an  opportunity gradually to contract on the mouths of the vessels as it becomes
separated, and thus prevent a fatal haemorrhage.
   I know that some practitioners urge, as  an objection  to this practice, that leaving  such a  mass of foreign
matter within  the  uterus  may also act very injuriously ;  but I have never had any evidence of this.   I
have extracted the placenta after it had been retained a long time — left, too, after the fruitless and violent
mal-practice of another physician, who had failed even in  his forcible attempts to extract it.  The placenta
had softened and become detached in  consequence ;  even putrescence had far advanced ;  and its effluvia
was so great after its extraction, that it caused vomiting in a person who was in an adjoining room . yet
no injury was  sustained  by the  patient.
   When, therefore, the  placenta can not  be removed without great violence, it  may be  permitted to
remain until it is detached by nature ;  at the same time the attendant must occasionally examine, and, as
soon as it is separated, remove it in the  manner described above. 
i;.e
IMPROVED  SYSTEM OF MIDWIFERY.
   In a recent conversation with one  of the  most respectable and aged physicians of this  city (Dr. Boyd),

he told me that he also had frequently left the placenta remaining for about two weeks without  any injury ;
he stated likewise that he  had been in the practice of midwifery especially about fifty-five  years, and  that

the result of all  his  experience  could  be couched  in a few words, viz.:  " We must  depend  more  on

nature, and less  on art."
   The late Dr.  Young, professor of midwifery in the university of Edinburgh, states, in his  lectures  on

the management of  the  placenta, that  a woman would suffer  less  from a  portion of adherent  placenta
being  left in the  uterus than from its  forcible detachment,  and that he would rather  leave it to nature than

employ harsh measures for  its removal.   He  likewise  relates  a case  in  which  the  mass  could not  be
brought  away, and  yet  no foetid matter nor  anything like  a placenta had  ever  made its appearance.
There are also  several other well-authenticated cases of this kind on medical record.    In all these cases,
there  must have  been  either absorption of  the placenta, or  it  must  have been dissolved  and  passed  oft'

unconsciously with the lochia through the vagina.
   It should, however,  be forcibly impressed on the mind of the accoucheur that there  is at least one grand
exception to  this rule, viz.: when a copious  and dangerous  flooding takes place,  the placenta  must  be
extracted at all hazards, because immediate death will ensue if the haemorrhage be not arrested ;  but there
is a chance that the uterus may contract, and  the patient  recover.    A  memorable  case of mal-practice
occurred  recently in  this city, where, through the want  of  this  precaution, the woman  perished from
flooding.   (See  page  154.)   It is necessary again to caution  the  practitioner against all violent measures
in  extracting the placenta :  it must always be done  with great care, prudence, and  mildness.
    A physician  in this city a  few years ago was  tried,  convicted, and  sent to the  penitentiary,  for gross
and criminal mal-practice in an attempt  to remove  the placenta.   From   a combination of inexcusable
ignorance  of the anatomy of the parts,  and  the exercise of  great  violence, he drew  out  the womb instead
of the placenta, which  almost   immediately proved fatal.    The following  is  the report of  the  caa§, as it

appeared in the  public papers at the  time :—*

   •"Trial of Dr. Septimus Hunter  for Manslaughter, in  causing  the Death  of  Mrs. Justine  Cozzens,  of  New York.—
The district-attorney opened the case to the jury, stating that this was a novel case, and that only two sach were on record  as ever having
occurred ; that it was evidently a case arising from the gross and entire ignorance of the person charged with the professional duties he? under-
took to perform, and which unhappily caused tlie death of the female  he was called to attend.
   " Elizabeth Farrington sworn. —' I live at 328 Madison street, and  am married, having no living children.  I only knew Justine Cozzens as
living in the house ; saw her four or five months before her death — was never in her apartment until the evening  before her death.  She was
a married woman nnd was healthy.  She  had one child  besides the  last; she occupied the basement and part  of the second floor.  She was
confined with the second child at ten o'clock at night, about the Gth  of April.  She complained in  the  morning, and at ten at night the baby
was born.  I did not attend upon her during the birth ; she was confined in the basement;  I was not present,  and did not see the child until
about one o'clock in the morning, when I was called down hy my sister, Eliza Dennis, who resides in the 6ame house.  She was not with her
during her confinement.  I went down at one o'clock, and found the sister of the deceased, Mrs.  Newman, my sister, and another lady.  I
found the woman apparently doing well, and not in much pain, lying  on a mattress or a cot; I saw the babe then — it was a healthy little boy.
I stayed there about half an hour, when I went with her sister for the doctor, as nothing had followed the birth ; and I went merely as a com-
panion for the sister, who became fearful.   The child was in one of  the female's lap when I went down.  I persuaded the sister to have Dr.
Nichols, and went with the intention of bringing him.  We went down Grand street, and met two watchmen,  whom we asked where there
was a doctor near : one watchman pointed out the house where Dr. Hunter lived — I think, at the corner of Scammel, East Broadway, and
Grand street; I met a watchman  at the door, and he knocked until  he waked Dr. Hunter up.  It appeared to  be a large drug-store and he
appeared to be in the back room adjoining the drug-store. He came to the door, and we told him what we wanted, and  the situation of the
woman.  He asked if the baby was born, and we told him it was born at ten o'clock.  He asked who had taken the baby.   The sister said
she had taken it.  Ho asked then if  she had meddled with anything else. She  said not.  He  asked if we had given her anything to drink.
She answered that she had given her some tea.  He said we ought to have given her some brandy.  She said they had  got some brandy, in
t ase it should be needed.   At the door we told him the child was born, but nothing had followed, and we came for a doctor.  We got back
to the house of Mr. Cozzens a few minutes after two  o'clock.  When we got in, the woman appeared  pretty lively, and he gave her 6ome
raw brandy.  He then commenced, after asking if we had meddled with anything else, aud said it was a good job that they had not meddled
with anything else.  I showed him ttie child before he commenced his operations. The child was alive  and well, and was dressed. I did
not hear him ask any questions as to the cord before he began to operate.'
  " The witness was then  ordered to go on and detail what further occurred, and what the prisoner did, when she was interrupted by the
counsel for the accused, who objected to the introduction of further testimony on this point, for the reason that the defendant was indicted  as a
laborer and not as a pkvsician, and was not charged wiih having been guilty of culpable negligence in his professional capacity.a.»a physi-
c ian, but merely as a laborer, in which latter capacity he could not ho guilty of the offence as charged !  The court decided that the indictment
was sufficient, and denied the motion of defendant's counsel.  The witness then proceeded :—
   ■ • The accused, after giving the brandy, commenced and was engaged two or three minutes, when he broke  the cord.  He put his hand
under the cover, and I could not see what he did.  I eaw him band the cord to one of the females, and told her she could throw it away.  It
was about tlirce quarters of a yard of the cord ; he did not say what it was.  The deceased during this did not say anything; she did not appear 
COMPLEX  LABOR.
15'J
    Another case is recorded in  a  recent  medical  work, of a  physician  near  this city, who  drew  out  the
 intestines instead of the placenta, which was, of course,  fatal also.    Hence  we  see how important it is  that
 those  who take upon themselves the practice of this noble and very responsible branch of medical  science
 should be well  instructed and thoroughly understand how.to   manage  the various  difficulties and dangers
 which may occur  in connexion with  parturition, and particularly that  they should  learn  the very impor-
 tant art,  of non-interference  in the great majority of obstetric cases.    When to do nothing  is a great lesson

 to be iu much pain, and laid pretty quiet.  After some time, he  took  something else, and said  there was a little left back.  This was about
 twenty minutes after taking the cord.  She appeared then to have more pain, but did not complain.  I did not  see the second substance he
 took. He then commenced again, and she screamed out very much, and said he was dragging her heart out. He appeared  to be pulling then
 very hard.  She screamed out several times, and jerked herself back very  much ; she was lying on her left side.  She told him he was hurting
 her so much, she could not stand it.  The cot was standing against the wall, and she got  against the wall.  When she told  him he hurt her so
 much, he got up, and said if anything happened, she must charge it to her  own misconduct, for she had displaced all he had done, and it would
 take him twenty minutes to replace it.   He then came into the front basement, took  his coat, and said he could do nothing unless two or three
 came in and assisted him.  I then went  iu, and the sister of deceased and  another witness went into the back basement.  He then placed me
 at her head to bathe her face with  vinegar, and the sister at her side.  He then went on  his knees, and, taking a cloth in both hands, and
 placing  both his  bauds under the cover, commenced pulling very hard.   Mrs. Cozzens screamed very much ; she  said it was killing her.
 Prisoner told her to cough several  times; she tried to cough as well as she was able, but grew so weak that she could not cough.   The sister
 of deceased told the defendant that her sifter was dying; he said no — she was only faint — and told us he guessed wc would all be faint if we
 had gone through what she had done.  He  continued pulling until I observed her mouth drawn toward her ear.  Three times during that
 time  she ceased to make any  complaint. When we found her so quiet we thought she was dead, and we  would  have another doctor.   He
 continued still pulling, and told her sister to leave the room, a3 she would  make her feel worse, for she was only faint.   He told me also to
 bathe her temples, and was still pulling.
   " ' He said to her, " You are wonderful, patient, now ! — all will be over in a few minutes, and then you can take a nice  sleep."  He said,
 '• I have got it now s here it is !" — and  brought something forward in both hands,  and said, " Here it is !"   He then desired me to bathe  her
 again.  He asked us if we ever saw such  a curious tiling to form in the human body, and showed it to us. We told him no, we did not.   He
 said he thought it looked like  a false conception.  He then washed it in three waters, and turned it, for it appeared to be very bloody.  There
 was an old check-apron lying on the cot, and he asked if it was of any use to us.  We said it was  not, and he folded it up in the apron ; he
 then placed it on the table in  the front room.   They then all left the back room except  me and the doctor.  I told  him she  had no pulse ; he
 said it was  because she was faint,  and told me to bathe her  temples.  He then asked her if her gown was too tight for her: no answer.   Ha
 asked her if she would have a little brandy :  but there was no reply.  He asked  me to give him  a little, and I gave him  some mixed with
 sugar aud water, and a spoon, to give to deceased.  He took some in the  spoon and put it to her mouth, but  it ran upon  the pillow, as her
 teeth were clinched.  He then turned to me and said, " She is gone, and has been gone some minutes!" — but wished me not to name it in the
 room. I went out immediately and named it.
   " ' He then asked for his coat and the  other that he had taken. I told him that I  had got that safe, and should not let it go.  He said it was
 no matter:  for what had happened would have happened  to  any other medical gentleman;  and we  told him we could not let him go until
 another  medical gentleman was sent for.  He said he would bring one — went out, and was gone .about an hour.  Nearly an hour elapsed
 after he came there, and the time  the last substance was taken from her.  When he went out he returned with Dr. Nichols.  What passed
 between them, or what  conversation passed between them, I can not say.   Dr.  Nichols saw the  body; • I took  charge  of the  substance
 in the check-apron ; it was shown to Dr. Nichols, but by whom I can not say ;  it was then placed again  in the basement-window.  Dr. Nichols
 did not remain many minutes  : the doctors both went away.  About five o'clock in  the morning we sent for the cproner, who came about four
 o'clock.   The body was  left lying in the same place  until he came.   The*  substance taken from her  by the doctor was  in the same condition
 aud place that Hunter left it;  the body was also in the same condition as when he left it.  There was an inquest then held on the body ; other
 physicians,  strangers to me, were there ; they went into the room where the body was, and we were all ordered out.  The  substance in  the
 apron was also handed  over to them, and they had the body and substance both in the same  condition as when Hunter left.   The  cord was
 handed to another witness, who put it into the slop-pail, at my instance, and I saw her take it toward the pail.  I do not know what became of
 the second substance that was taken.  I showed the doctors the cord  in the pail.  I think this woman-was about twenty-nine years of age__
 very stout and fleshy.  When the  sister of deceased and witness went for Hunter, she asked him if he was the doctor, and he said " Yes."
 This was directly after we came to the door.   I omitted to say that  prisoner asked  for a pair of scissors after the second substance came, and
 he said there was a little more to come, and they were handed to him.'
  " Cross-examined. —' Mrs. Cozzens had been often in my room before her last illness.   I had never before been in hers.  She wa3 in my
 room the very morning of her confinement, and  remained about twenty minutes.  She had pains, but got better, and went down again.  She
 was very strong, only when she had pains.  I did not see her again until one o'clock next morning,  when I found her on a cot in a little dark
 room in the basement, large enough for a cot, table, cradle, &c.  She was dozing when I first went in : her sister spoke to her and she awoke,
 seemed lively, talked about the baby and the cap  it had on.  After Dr. Hunter was gone, I found a great deal of blood under the cot on the
 floor, and much under the bed-clothes on the cot:  it appeared to be running down fresh.   The former and oldest child of Mrs. Cozzens is still
 living, and is about seventeen  months old.'
  "Direct examination resumed. — • When she jerked herself, his hands were under the cover, and the  doctor appeared rather in a rage; I did
 not see her limbs move : he then took his coat off.  She had exclaimed once before  that he was tearing her  heart out.  When he was on his
 knees, pulling with both his hands, she exclaimed again, and he was pulling very hard, and in a profuse perspiration.  I did not see any bWI
 on the floor before he took the last substance away, nor until after the coroner arrived.   The other two witnesses held  her by the feet, and I
 by tbe wrist, to keep her steady,  according to the doctor's order.  By holding her wrist, I found when her pulse was gone.  She X:\-l t>
 disengage her arms and throw them about.  She laid quiet some minutes before he brought the last substance from her.'
  " Mrs..CMpline Newman sworn. —' I  am sister to the deceased.  She was born in Switzerland, and was going on twenty-nine years of age
 She was married in this city about  three  years ago.  Her health was good up to the time  of her marriage. The child  was born at ten o'clock
by the watch.  I delivered her.  There was no difficulty about it.  Her labor was short;  she did not expect it would be so  soon, and had an
easy time of it.  I separated the cord with scissors, and put the ligature  around it.  The child was healthy, aud the mother in good spirits
after the delivery.  The placenta did not come in due time.  There wa3 no unsual flooding.  She had a family doctor. Dr.  Wright, but had
iu time to send  for him, it came so quick.  After the- delivery I waited until about two o'clock,  whe-a I  sve-.*. for the doctor.  Before that, I 
160
IMPROVED  SYSTEM -OF  MIDWIFERY.
for us  to learn,  not only in  the practice of midwifery, but also in that  of medicine  generally ;  and he who

has learned  this ivcll, has  made great progress in his profession.
   In  concluding this  section, I  may  state  that  in my practice I  have  never  yet failed  to  remove  the

placenta by  following the  rules laid  down  above.   I  have  not only succeeded  in  my own  cases,  but  I
have frequently been called  in consultation  with  other  and  excellent  physicians where  there  has  been
retention of  the  placenta, and  have  likewise  succeeded :   and I am  confident that   similar  success will

attend all others who carefully pursue  the  same  course.

examined her from lime to time to  see if the placenta had come, and  then Mrs. Farrington and myself went for Dr. Nichols, but he was not in ;
aud we.went to a watchman, and  he directed us to Dr. Hunter.  The umbilical  cord was all right before the doctor came ;  the part he pulled
out was half or three quarters of  a yard long.  The afterbirth,  or placenta, was about the usual size.  I whispered to him that I feared she
would die, and he  said he would insure her life.  When my sister would not have him any longer, he called us to  hold her, and placed me at
the knees  with the other woman, and Mrs. Farrington, I think, at the head, and we held her to keep her from moving.  As the doctor worked,
she tried to get clear of us all, and  said she would rather die than to be so treated.  He was in a great sweat, and on his knees, pulling, and she
fcroaming. When the last substance  came away, he asked us if we knew what it was.  I said, " No."  He said it was a false conception.
When she lay still, he said she fainted, but she was dead.  She ceased struggling or complaining about five minutes before the last substance
was taken from her.   The body and  the  substance taken from her were in the same condition whenJhe doctors came as  they were when the
prisoner left her.'
  " Dr. John H. Griscom  sworn.— ' I am a physician.  I examined  this woman on Sunday the 7th of April: I was called about eight o'clock,
and arrived between eight and nine.   Dr. Ellis assisted me, and Drs. Nichols, Lobstien, and Walters, were also present.  Before examining
the body, we were shown substances in a bowl taken from the body.  The first  was the human uterus with adjacent  parts attached — such as
one of the  tubes, portions of the broad ligaments by which the uterus is suspended, and an inch of the vagina.  The outside was stripped of its
lining membrane so as to  expose its muscular fibres.   There was no  violence exhibited on the uterus, except that its adjacent parts were taken
from it.  The ligaments were verjynuch torn and ragged.  We were shown the placenta, which had no umbilical cord attached to it: one end
of this cord is fastened to the placenta, and the other end to the child. The length of this cord ranges from eighteen  inches to three feet; it is
the only connecting link between the mother and the child, and all the sustenance is  taken  through  this cord to the  child:  it is composed of
blood-vessels, &c.  After the birth of a child, we usually wish the placenta should be  thrown off within the hour.  It is absolutely necessary for
 he patient that it should be discharged.  When it  is not thrown off, we  usually excite  contractions of the  uterus :  first, by pulling the cord
gently from side to side, but not to pull so hard as to break it; then by gently pressing upon the uterus. We found  the cord in the slop pail;
it was about eighteen or twenty inches long ;  had a portion of the covering of the placenta attached to it,  and appeared to have been torn off.
We found the body in the little room, brought  it into the larger one, and stripped it.  Our attention was first  attracted by the enormous quantities
of blood :  a large quantity of coagulated blood was between the thighs, the bed was soaked with it, and a large pufldle of  it on the floor.  The
abdomen was sunken.  We made incisions, and the first thing that presented itself was a vacaut abdomen as far as the uterus was concerned.
The intestines were high up, and not in their usual position ; two spots of extravasated blood, one on  each side of the abdomen ; one Fallopian
tube remaining, one absent; both  ovaries remained in  the abdomen. The upper end of the vagina was open, so that  the fingers could be
passed through it externally.  Both broad ligaments that support the uterus were torn, ragged on the edges, and part of them gone.  The appear-
ance of the body indicated that the uterus had been taken from it.  The treatment was not proper : no one  that bad ever seen a case before
would mistake the uterus for the placenta ; none but an exceedingly ignorant man would do it.  If anything is supposed to remain, the hand
must he inserted, and the part can  be easily ascertained.  The placenta that I saw was perfect.  I think no person of any skill could mistake the
uterus for  the placenta: the former is a solid substance ;  the latter a soft, spongy one.  It is possible  there  would be a case in which a man of
skill might mistake the uterus for the placenta, when the latter was in a compressed state. It would require a great deal of force to draw out  a
uterus, situated as they are : a strong man might do it.'
  " Cross-examined. —' If the placenta were left in, it would decay, produce disease of the uterus, <fcc.  Its removal, as to its effects upon the
mother, is almost as important as the removal of the child itself.  I have practised eight years,  and have delivered at least one hundred females,
but never  had a case where the umbilical cord was pulled out or entirely removed from the placenta.'
  " Richard Merrell sworn. — ' First knew Mr. Hunter in Manchester, Kent county, England ; have known him thirty years.  His father waa
a surgeon  in extensive practice; he was in his father's office studying.  I understood he went to London, to practise in the hospital.  When he
returned from London, he practised  as a surgeon, and had his sign up for  four or five years.  He  has attended my wife in her  confinement,
and given satisfaction, as he has in all his treatment of my family.'
   " The jury retired, and, after an absence of two hours, returned into court with a verdict of ' Guilty of manslaughter in the fourth degree.
   •' The recorder then addressed the prisoner as follows: ' In this case you have  been indicted for manslaughter in the first degree.  The juryt
 however,  convicted you only in the  fourth degree.  For this degree of manslaughter, the punishment varies from two years in the stateprison
to one year in the penitentiary and one thousand dollars' fine.  It is  not now necessary to detail the circumstances on which the jury found  you
guilty.  It is sufficient to say that  there was  a chain of circumstances, or rather  facts, proved in evidence, which, from the testimony given of
your character and disposition, must have been as painful to your own feelings as  they have been to the community at large.  When the jury
first came into court, they brought in a verdict of " Guilty of gross ignorance ;"  and when informed that  such a verdict would not be a legal
one, they  returned  a verdict of  manslaughter in the fourth degree, accompanied  by an earnest recommendation to mercy.  It is, however,  due
to the court to say that, after reading the testimony, which the jury also  heard, there can not be conceived a case  of grosser ignorance, more
 fully established, or more fatal in its results ; and if the jury had not so strongly recommended you to mercy, the court would have felt themselves
bound, by their duty to the community, and in order to protect the  poor and ignorant from similar impositions, to  sentence  you to the highest
 penalty that the law allows.  But the court could not do so without disregarding the recommendation of twelve respectable men, who paid the
f.:r;rtest attention to this  trial, and who, notwithstanding that they exhibited strong feelings of pity for you, have also shown that they possessed
 a >trong and honest determination to do their duty.   The court has paid all the attention which it deserved to the testimony of those wjtoessc-s who
spoke in such high terms of your professional character, and the services they received from you.  But it appeared that the services you gave them
 required little or no knowledge, and that nature alone had performed the  office of physician.  The court has referred  to these circumstances,  in
 order that they may not be considered as regardless of the public welfare, in inflicting no higher punishment on you than they are about to do.
 And. were it not for the  recommendation of the jury, the court  would certainly be obnoxious to the charge of having disregarded Uie welfiuo
 of :heir fellow citizens —The court will not inflict any fine upon you, but seatence you to one year's imprisonment in the penitentiary.' ' 
 
"=^.^/-:.:>'.; 
COMPLEX LABOR.
161
                                          SECTION  V.

              LABOR  COMPLICATED  WITH  RUPTURE  OF  THE  UTERUS.

  The rupture of the uterus is fortunately of rare occurrence ;  but when  it does occur, it is generally-
fatal, although there are some few cases of recovery.
  Causes. — Rupture of the uterus may arise from the forcible introduction of  the hand into the womb
in the undilated state of the os tincse, or by improper violence used in turning the child after the waters
have been long discharged  and the uterus much  contracted, or  by the  unskilful management of instru-
ments.  It is a prevalent opinion  among some physicians that  a  healthy uterus may be lacerated  by a
forcible or irregular and violent contraction against any hard, unyielding substance, such as the  promon-
tory of the sacrum, the linear ilio-pectinea in the pelvis of the mother, &c, when there is an unusual and
sharp projection.
  That the uterus  may  be lacerated by its own  action,  is readily admitted ; but  I  very much doubt
whether this would occur  unless  the parietes of the uterus were  unusually thin, or  there was in some
part an alteration  of its texture.  And the supposition of some change of this kind has usually been  con-
firmed in examinations after death.   In  some instances,  the  change of texture predisposing to laceration
has been so great, that it has occurred  in the early part  of labor, and where the pains have  been of the
weakest kind.
  Symptoms. — When the labor, to all appearance, is going on  well, perhaps in the height of one of the
pains, the patient suddenly shrieks, or  cries out that something  has given way within  her, and  manifests
the most violent agony.  From that time, all  uterine action is very much diminished or entirely ceases.
If an extensive rent be  formed at once, tbe labor-pains will be  instantly suspended ;  but if it  be  only
slight in the first instance,  they will be  continued  for some little time : yet  their character will  be more
feeble, and each successive contraction will increase the  extent of the laceration.   As  the pains  of partu-
rition cease, their place will be supplied by a  new one,  which is referred to  one  fixed  spot, and which is
constant, extremely  agonizing, and much more difficult to bear than the throes of labor.   On  examination
per vagina, we shall usually find that the head of the foetus, which was  easily detected by the  finger in
previous examinations, can now only just  be  reached, or it may have  receded completely out of the
range of the finger, so as to elude our  search.  This is  owing to the admission of the child's body  more
or less into the cavity of the abdomen through  the  rent;  however, this  does not always  take place, for
sometimes the head has previously become locked in the pelvis andean not recede.  The pulse  becomes
quick, irregular, and so feeble, as  to  be scarcely perceptible ;  the  respiration  is hurried, labored, and
painful;  the countenance  anxious and  dejected ;  the eyes sunken, dull, and inexpressive ; the  abdomen
swells  rapidly, and  almost  immediately becomes  very tender to  the touch ;  vomiting of a dark-colored
matter supervenes, sometimes almost instantaneously, at others occurring at  a later period ;  there is also
generally hiccough ; the extremities become cold  and insensible; a cold sweat appears on the face,  fore-
head, neck, and chest;  and if delivery  be not effected, the patient will sink  in a very  few hours.
  Laceration of the uterus is the most  formidable accident which can occur during labor, with the excep-
tion of rupture of the  bladder, which  is  generally  fatal.   But there  are cases on record in which the
woman has recovered from  rupture  of  the uterus, and  even borne children afterward.  So that we are
not to give up the case as hopeless : we are both authorized and encouraged  to make some efforts to save
the life of the patient.
  Treatment.— There  is but one mode of treatment which offers the least chance  of life,  and that is,
speedy delivery.  The instant we  know that the accident has occurred, we  should proceed to extract the
child ; but sometimes the  uterus  contracts after  expelling the child and placenta into the  cavity of the
abdomen, and closes up the rent,  so that it i3 impossible to effect delivery except by the cesarian section.
But if the head be locked  in the  pelvis, so that either the long or short forceps can  be  used, the  child
                                                21 
K.J                         IMPROVED SYSTEM  OF  MIDWIFERY.

i.i;:.,t be extracted by them.   Generally, however, the foetus has receded beyond the reach of the forceps :  we
mu-jt then introduce the hand  into the  uterus, follow the child's body, through the rent made, into  the
abdomen, search for the feet, draw it by their  means back through  the same opening into the cavity of
the uterus, and extract it per vaginam.   Nothing can be more appalling than the sensation communicated
by the intestines encircling and  coiling around the fingers while the hand  is within the centre of  the
abdomen of a living person  ; but however horrifying the  idea or the reality may be, all feelings of repug-
nance must give way before a stern sense of duty.
 "As soon as delivery has been  accomplished, a large  dose of opium or morphine should be given ;  the
utmost quietude must  be  observed ;  everything stimulating  (unless the depressed state  of the system
requires  the administration of a cordial) is to be avoided  ; and the restorative powers  of nature must  be
trusted to for the recovery.  I know no medicines but  those of the soothing  kind that are at  all likely to
be of service ; and no other specific means can be adopted until inflammatory symptoms  appear, when
the case  must be treated as inflammation of the abdomen."
                                         SECTION  VI.

             LABOR  COMPLICATED  WITH  RUPTURE  OF  THE  BLADDER

  This is a more certainly-fatal  accident than  even rupture of the uterus — no case  of recovery ever
having been recorded under any treatment that has come to our knowledge.
  High authorities have suggested and  tried opening the abdominal cavity ; sponging  out the extrava-
sated  urine ; cleansing the peritoneum  by ablutions of  warm water ; drawing up the bladder, placing a
ligature around  the lacerated opening, and keeping a catheter in the  bladder to draw off the urine as it is
collected, to prevent its distension ;  and hopes have been entertained that adhesive inflammation would
close  the aperture :  but the treatment has uniformly failed.
  This accident is generally, if not  always, the effect either of neglect or improper interference.   It can
seldom or never occur in the hands  of careful practitioners.   It may be caused by undue distension of
the  bladder during labor, which will never be allowed by a judicious attendant;  by vesical hernia, which
will be rectified by a skilful accoucheur ;  from the careless and rash employment of instruments  under a
distended state of the bladder; and from turning the child without first evacuating the bladder: these are
the  most common causes of this fatal accident.
  Since rupture of the bladder is  so universally fatal, and since it can easily be prevented by  keeping- its
contents evacuated, it becomes at all  times one  of our especial duties to have a watchful eye  over its
condition during the  whole period of labor ;  and where the silver catheter can not be introduced  into the
bladder in consequence of the  pressure of the child's h*ad on its  neck, or the pendulous state of the
abdomen, a flexible male catheter  must be used.
  Symptoms.— When laceration of  the bladder takes  place, the  symptoms are very much   like  thoso
described under rupture of the uterus:  the same sudden manifestation of violent pain, accompanied with
a shriek, and a declaration by the  patient that something has burst within  her; rapid  sinking of  the powers
of life ; and general tumefaction and  great tenderness of the abdomen.  The particular symptoms present
in this case and absent in rupture  of the uterus are, a  continuance  of the  uterine  contractions,  and no
recession of the child.
  Tkeatmext. — Since this accident  is  unavoidably fatal, our  principal  care should be directed to the
preservation of the child, and to endeavor to extract it before its death, either by the forceps or  by  turning
which must be determined  by the stage of the labor in which the  accident occurs.   In  all cases where
the  powers  of life are not sinking  rapidly, but the woman's  strength  remains unimpaired,  and  the uterine
contractions active, there is so long  a chance of the child's life being preserved in utero, and of the labor 
COMPLEX LABOR.
163
being completed  by its  natural action :  for when the death  of the  child  does occur,  it arises from tbe
exhausted state of the  mother's system.   The child's life having thus been secured,  although our solici-
tude for the life of the mother is wrought up to the highest pitch, all our efforts to save her will be fruitless
and disappointed.   Prevention is the remedy.
                                         SECTION  VII.

               LABOR  COMPLICATED  WITH  PROLAPSUS  OF  THE  CORD.

  The cord may descend in a loop by the side of or  before the head, or the breech.   The longer the
cord is, the  more likely is this complication to  occur.   It gravitates to  the os uteri, and collects there in
a fold ; and when  the membranes break, it is carried down  into the vagina by the gush of the escaping
waters.
  Such a complication does not bring with it any danger to the mother, but parturition goes on just as if
it had  not happened : for the space occupied by the cord is too inconsiderable to  impede the progress of
the  labor.  But the life of the child is generally in extreme peril, in  consequence  of the  pressure  to
which  the cord is subject  between  the presenting part and the bony walls of the pelvis.   The life  of  the
foetus in utero is sustained by the circulation  through the cord :  any interruption, therefore, to the free
passage of the blood is attended with great hazard ;  and  if it be suspended for any length of time continu-
ously,  death will ensue as surely as if breathing were prevented after birth.   It is consequently a matter
of great moment that we take every means in our power for its preservation.
  Treatment. — If, when we are called to  a labor, we find the cord external, cold, and flaccid, and
the  pulsations having entirely ceased, there can be  no doubt of the  child's death.   Any interference in
such a case  is useless : the labor must be allowed to go on without interruption by any attempts to obviate
the  difficulty.   But if the arteries are still beating, however feebly, means must be immediately taken to
prevent the pressure to which they are or will unavoidably be subject in such a situation,  before the birth
can be perfected.
  The following are the  methods proposed by different  celebrated practitioners, some relying on one and
some on another :   1.  Pushing the prolapsed cord  to that  part of one  side of the pelvis where there is
most room, and where it will be  less in the way  of injury from  pressure.   2. Returning the  cord and
keeping it above the presenting part until the foetus is  partly in the world.   3. Hastening the delivery
by the forceps.  4.  Turning the child, and delivering by the feet.
  I can not recommend  the practitioner to rely on any one of these methods in all cases.   Much will
depend upon the stage of labor in  which the prolapsus is discovered, or the practitioner arrives ; whether
it is a mature or premature labor;  the size of the pelvis  and head of the child ;  the state of the soft parts,
&c.   Sometimes one and sometimes another of the above methods will  be the best: the choice must be
left  to  the judgment  of the practitioner.   We  may remark, however,  that in mature births, unless  the
pelvis be large, but little reliance can be had  in  placing the cord to one side of the pelvis ; because  the
head usually  occupies the space so nearly, as to fail in  preventing compression of the cord.   But when
the  pelvis is large, and the head of a normal size,  or in premature labors at six, seven, or eight months,
this method  will frequently be successful: yet this can only be accomplished where the head has not sunk
very low in the pelvis.
  With respect to  carrying the cord above the presenting part  and  retaining it there until the labor  has
advanced, this will occasionally be successful if attempted before the head  has  passed the brim  of  the
pelvis ; but  sometimes as soon as  the fingers are removed, prolapsus again takes place.   In such cases,
the  cord may perhaps be retained  by the  insertion  beneath it of a piece of sponge or cloth, and thus
carry it above the presentation.   But where the head has fairly  entered  the brim of the  pelvis, there is
little chance of success by this means. 
01
IMPROVED  SYSTEM  OF  MIDWIFERY.
  Hastening the delivery, says Severn, may be successful where  the foregoing means fail.  Great care,
however, must be taken in this case.
  Turning the child should never be attempted  unless the  prolapsus  is discovered in the sac before the
membranes break.  The operation of  turning is always attended  with some risk to the mother:  and the
life  of the parent, or the integrity  of her parts, is not to be  put in  competition with  the life of  an unborn
child ;  but where the prolapsus is discovered before the membranes break, turning may be practised with
success — taking great care to place the cord so completely out of the way while the hand is in  the womb,
as that it will  not prolapse  after  the  child is turned.   Some practitioners  introduce the hand into the
womb and  hook the cord on  the legs of the child ; and where the head has  not entered the brim of the
pelvis, and the parts are well dilated, this may be practised  at times with success.
                                       SECTION VIII.

               LABOR COMPLICATED  WITH  DESCENT  OF  THE  HAND.

   Sometimes one or both hands will  descend by the side of the head  or the breech, and  materially
obstruct the progress of the labor.   This is to be ascribed to  the original position  of the foetus in utero.
Usually the arms are placed across the chest;  but sometimes  one, and occasionally both, are placed on
the side of the head against each ear.   And where this is the case, on  the rupture of the membranes,
and evacuation of the liquor amnii, they descend more or less by the side of the head.
   Although this complication does not  imply danger to the life, either  of the mother or child, yet it is
frequently productive of considerable suffering to both.  It increases  the sufferings of the mother in
consequence  of the space which the hand or hands occupy, proportionably retarding the labor, requiring
more  violent  and  more  numerous pains  to propel it through the pelvis, and the hand and arm of the child
are generally  much swollen and sometimes inflamed in consequence of  their position.
   Treatment. — In such cases, as soon as the membranes rupture (if it has  been  discovered before),
the hand must be seized by the two  fingers, carried  above the presenting part, and  kept  there during
several pains, or until the presentation has made some advance, and thus prevent the liability to  a second
prolapse.   If we withdraw our fingers immediately after we have passed the hand up, the next  pain will
probably protrude it; but if, after keeping it there some time, it should be again protruded, a  piece of
sponge  may be used in the same manner as recommended in  prolapsus of the cord.   Should, however,
all our judicious  attempts  to keep it up be baffled, it will arise from largeness of the pelvis, and it may
then be  suffered to remain ; for it wilj probably be only slightly swollen, and that is better than to irritate
the vagina by frequent and useless efforts to retain it above.   But when we are not called till the labor
has made considerable advance, and the head has sunk low in  the pelvis, and the pelvis is not  unusually
wide (or it  may be narrower than usual) — if the foetus foes not advance, and symptoms of sinking or
exhaustion  appear, the foetus may be delivered by rendering such aid as  may  be required in the judgment
of the practitioner.
                                        SECTION IX.

              LABOR  COMPLICATED  WITH  PLURALITY  OF  CHILDREN.

  Although the human female is  usually  uniform,  yet, like  other uniparient animals, she sometimes
produces more than one offspring at a birth ;  and, when more than  one, twins  are by  far the most fre-
quent ; but occasionally she will have three  or four.   In  some very rare  cases, five children have been 
COMPLEX LABOR.
165
delivered at a birth ; and it is stated in the " London Practice of Midwifery" that Dr. Osborn met with
six distinct ova thrown off at one abortion !
   Each foetus is enveloped in  its own distinct membrane, so that one body is not in contact with another;
each possesses its own quantity of liquor amnii, has a separate funis, and a separate  placenta.  The pla
centae are generally attached to different parts of the uterus ; sometimes their  edges unite without any
anastamosis of the circulation ; but at other times there is a perfect anastamosis between them.   In some
very rare cases there has been but one placenta and but one cord, which afterward divides off and passes
to each ; and, in yet more rare instances, both children have been enclosed in one bag of membranes.
   Symptoms. — Various indications have been relied on to diagnose the presence of twins in the womb
during the later periods of gestation, almost all of which are liable  to great fallacy — such as the uterus
being of a larger size than usual (but this may depend on  an increased quantity of liquor amnii as well
as on twin pregnancy);  the woman  feeling two distinct  movements  at different parts of the uterus (but
the sensations of a pregnant  patient on this  point  are  scarcely ever to be relied  upon,  as experience
abundantly proves); and an irregularity in the shape of  the womb,  its  being broader than common, and
measuring more laterally than  in its longitudinal direction (but this may be the consequence of a transverse
position of the foetus, or some irregular development of the uterine fibres).
   The detection of the sound of two  distinct foetal hearts by auscultation is the only reliable means of
diagnosis before labor :  yet this requires great practice and considerable tact to determine ; but happily it
is of little consequence whether it be  detected before labor or  not, as  the knowledge would not at all
change our practice, for  it would  not be in the least influenced by our discovery.
   Treatment. — As soon as a  child is born, we  should always lay our hand on  the abdomen  of the
mother to ascertain whether there be a second child ;  if so, the womb will be found still large, its fundus
rising to  or above the umbilicus, and occupying a space apparently almost as great as before the first was
born.  We shall also detect similar  elasticity and subdued  fluctuation, which  is so characteristic  of the
later term of pregnancy.   As soon as we have detected the presence of a second child, we must ascertain
its presentation ; and if the head  or  breech present,  rupture the membranes, and the depending part will
fall immediately into the  pelvis.   If it lies transversely, turn it.   There is no necessity for preserving the
membranes of the second child entire,  because the parts are all well  dilated, and the  rupture of the mem-
branes excites the  uterus to increased action,  thus facilitating the  termination of the  case.   It will  occa-
sionally happen that both children are expelled so rapidly, as scarcely to give time to separate one before
the second is born.
   If the  uterine contractions are of an average power, the birth of the second  child is seldom protracted,
unless it is either misplaced in utero, monstrous in formation, or much  larger in size than the one first
expelled.   Women seldom suffer much during the birth  of the second twin ;  because the principal pains
of labor are those caused by dilatation,  and the sufferings  are in proportion to the resistance experienced :
the os uteri and the soft  parts  being well dilated by the passage of the first, the  second passes without any
great effort or much painful sensation.
   Generally it is best not to tell the  woman that there is a second child, it depresses her spirits so much ;
because she naturally expects that she will have  to pass  through  the same sufferings  again.  No attempt
should ever be made to remove the placenta of the first  child until  after  the second  is  born, or floodin°-
will almost certainly supervene.  After the birth of the second child, we must examine again, to ascertain
as before whether there be a third; so likewise with  regard to a fourth, fifth, sixth, &c, as any practitioner
may possibly meet with such a case.  Cases  are on  record where one foetus  and placenta have  been
expelled  prematurely, and the  other retained and carried to the full period of gestation, without dangerous
loss  of blood.  In some rare instances, the membranes of both children rupture before the first is born;
and sometimes they will  both present together — perhaps  the head of one and  the feet of the other, or one
foot  of each.  In such cases, one must be returned as much as possible, or retained in its position,  while
the other is suffered to advance.  I need scarcely to say  that if flooding, convulsions, deformity of pelvis
&c, occur, the case must be treated as laid down under these respective heads. 
166
IMPROVED  SYSTEM OF MIDWIFERY.
              CHAPTER  IX.

INSTRUMENTAL   LABOR
                                         SECTION I.

                    V    THE  GENERAL   USE  OF  INSTRUMENTS.

  No instrument will be found so powerful as the unassisted efforts of nature.
  Never use instruments, or even art of any description, except in aid of nature, when she is decidedly and
absolutely incompetent to the completion of labor.
  I think it incumbent on me, while treating of this part of midwifery, to bear a most pointed and faithful
testimony again,=t the very general use of instruments in labor.  For instruments have  been used in mid-
wifery by men-midwives, both in this country and in Europe, to a  most fearful and a most fatal extent;
and the injury from their use  has been so glaring, that even  some of the " old-school" physicians have
been  appalled by it, and have condemned the practice in the severest terms.  One of the most learned and
experienced accoucheurs  in England has the  following  remarks on  the abuse of instruments :  " The
people," says he, "cage  up wild  beasts; but a being worse  than these — the accoucheur, meddlesome
and violent, yet responsible to no one — has been injuriously  let loose upon society, with all his instru-
ments of destruction about him."
  Can we  wonder that so much mischief is done by physicians in this department  of medicine, when we
reflect upon the  very scanty opportunities afforded to our students  to obtain a practical knowledge of
midwifery in our schools and  colleges?  Here the student is required to  attend two  sessions,  durino-
which he is obliged to listen to five or six  lectures a day on the various branches  of study (as anatomy,
chymistry,  &c.); which  is vastly more than any  one  can digest:  and  if  they could  even digest it all,
their minds would  only be filled with theory, which, however correct, would never make them competent
practitioners in midwifery or any other  branch of medicine.  Instruments  are exhibited to them,  the
manner of  using them explained, and their wonderful powers descanted upon, until they thirst  for an
opportunity to display their dexterity.
  A  student  thus educated, without ever having been  present at a single case of midwifery, receives his
diploma, goes out into the world, obtains a location, and  commences practice.  Perhaps amono- his first
cases he is called to a woman  in labor.   What, I  ask, are  his  qualifications to conduct it with safety and
discretion ?  He is a mere tyro, and has now for  the first time entered the only school where the science
of obstetrics  can be correctly learned.   If it happen to be a regular natural labor, he will, in all proba-
bility, by his  officiousness, soon convert it into a difficult and perhaps  dangerous one (for none  are so
officious as those who are ignorant).  Should  it chance to be a difficult or  preternatural labor originally,
if tlie mother, or child, or both, do not fall a prey to his ignorance or mal-practice, she will have°a most
fortunate and unusual escape : for the  fatal  cases  in such  hands which might be recorded would fill
many volumes.  Such a one will have  to practise many years before he begins to understand the duties
of his profession.   Now I ask would not that woman be far better off in the hands of a female  who had
been  taught at the  bedside by a midwife, who had herself  been well instructed  in the  art by some one 
INSTRUMENTAL LABOR.                                167
 male or female competent to teach her, than under the management of such  an ignoran  practitioner '?
 Yet such is the custom of society, and such the  cupidity of females  upon this  subject, that  they prefer
 such men to such women ;  and when  an experienced  midwife is  recommended  to them, they spurn and
 are indignant at the thought of employing them !
   Is there  no  remedy for these evils and crying abuses ?  Will not the female sex (if not the male), whose
 welfare and happiness  are so vitally concerned in this  matter, be aroused, and led to the only proper
 means to rescue their sex from this  degrading and heart-sickening state, viz.,  the practical education of
 suitable females, to qualify them for the discharge of these duties ?   But whether male or female,  none
 should be permitted to  take eharge  of the life of the  mother and child  on such occasions but such as
 have been well instructed, both in theory and  practice, in the lying-in chamber.   This is the only way
 to make good  and competent practitioners, and to elevate the standard of this important  branch  of medical
 practice ; for nowhere  is reform more imperiously required than in the practice  of midwifery.   That many
 most valuable  lives would thus be saved there  can  be no question.  It is  enough to  make the blood run
 cold to hear of the many cases of flagrant mal-practice continually occurring.
   In illustration of the gross ignorance and incapacity of young men when they enter on the active duties
 of  their  profession, I  will  here give  an anecdote which one of  our most noted professors of midwifery
 (Dr. Bedford) is in the habit of relating to  his class, of his  own  first attempt in the  lying-in chamber.
 He states that, having received his  diploma, and obtained a  location, he was one night  called up by a
 gentleman to attend his wife in labor.   He proceeded to the place,  and after remaining some time, and
 the pains and suffering of the woman greatly increasing, her cries and distress threw him into such violent
 agitation and alarm, that he determined if possible to find some way of escape.    At length he  went down
 stairs under some trivial pretence, and, as soon as he got into the street, he ran  home with all his might,
 and jumped into  bed !   He had  not  been there  more than an hour before the husband came in search,
 and rang the bell repeateuly with great violence ; but the doctor, agitated and alarmed, covered himself up
 with the bed-clothes, and preserved  a trembling  silence.  At length  the man  retired,  perhaps  to  seek
 another equally ignorant practitioner,  but  possessing more nerve  and feeling.  The doctor says he  soon
 after left the city and went to Paris: he also states that he never heard whether the woman  lived or died !
 Perhaps he has there since learned to support  the perineum and use instruments !
   I have introduced this chapter on  instrumental midwifery,  as much to protest against their indiscrimi-
 nate use, and to show the qualification or rather the want of qualification of  great numbers of  those who
 use them, as to point out the manner in which they should be used in those very few cases in  which they
 may be needed.
   Professor Gilman, of this city, is in the habit of stating to  his class when on this subject, that he  takes
 no pleasure whatever in lecturing 'upon the use  of instruments, because of the  gcat injury and fatal conse-
 quences which so frequently result from them.   Instruments, he says, may sometimes be used "with advan-
 tage by men who  well  understand what they are doing ; but with respect to  all others he  declares that they
 have many  chances to do harm, but only one to  do good : and  lays  it down  as a  rule never to be lost  sight
 of, that unless  the life of the mother  or child can  not be saved without the use of  instruments, they should
 not be put  in requisition.
   A very respectable elderly physician, formerly of this city, informed me that while attending Professor
Hamilton's lectures on midwifery in Edinburgh, when on the subject of instruments he  would exhibit the
forceps, and remark that he introduced them to his class that they might see  them, but added that he had
never once  used them in all his practice.
  It is related of  the great Dr. Hunter, of London, that'when lecturing  on instruments, he  invariably
sent for his man John (who  attended  him as a ,kind  of confidant as well  as a servant)  to seek for his
forceps and bring  them in to him.   The  servant's long absence in looking  for them generally gave the
doctor a good  opportunity to enlarge and animadvert upon  their use, which  he never failed to do, to the
edification and satisfaction of his pupils.  After a long and unsuccessful attempt, the servant would return
to the lecture-room to announce his fruitless search : the doctor would urge him  to make  a second attempt, 
168
IMPROVED SYSTEM OF MIDWIFERY.
and which perhaps would not occupy less time  than  the first, when, in some obscure  place, he would
find them (for the  doctor never used them excepting on these occasions).   On the  servant's return, they
would be exhibited, nearly destroyed by rust;  when the doctor would exclaim —"  There, gentlemen, you
are my witnesses, by the  state of my forceps,  how seldom I have used them."   Then follows this precious
confession : " I assure you, gentlemen, that in the course of  my long and extensive practice, I never
used them but  once in my life; and, if you  will forgive  me  that once,  I will  promise you never to use
them again."
  On instrumental interference, Dr. Blundell, a  celebrated  European  accoucheur, holds the following
language  in his published lectures: "Floodings, tremendous lacerations,  and inversions  of the uterus,
arc the common effects of obstetrical violence—furious and atrocious obstetrical violence—that insatiable
and gory Moloch, before whose bloody shrine so many have been sacrificed, to be succeeded in future years
by still more nv?nerous victims !"
  And  again  he  remarks :  " Do not  needlessly thrust the hand into the uterus :  he that hath cars  to
hear,  kt him  hear it I   Do not  needlessly  thrust  the hand  into  the  vagina :  he that hath ears  to
hear,  let him  hear it !   Do not needlessly pass the hand into the  genital fissure :  he that hath cars  to
hear,  let him  hear it!"  And after exhibiting to his class a number of morbid specimens of the genital
organs of women  who  had died in consequence of injuries  received from  instruments during labor, he
concludes by exclaiming —" After examining  the morbid preparations before you, tell me,  is it too much
to assert that a, thrust with the hand is  more  dreadful  than a  thrust of the bayonet ?  Could the field of
 Waterloo itself exhibit injuries more dreadful than these ?— Observe for yourselves !  think for yourselves !
act for yourselves!"
  I am confident  that in  most of the  cases  in which instruments have been used, had  the attendant
recognised the salutary resources  of nature, and known how to wait for  or how to stimulate her power.-,
the labor would have terminated better without than by their use.
  I have never had  occasion to use them during all  rny practice, from its  earliest  period  to the present
time;  and I have never lost but two cases in  my life : one was caused  by puerperal convulsions ; the
other  was a case of a young woman who was  pregnant of an illegitimate child, and  who had made many
attempts during gestation to procure abortion.   The  labor progressed slowly,  but she was  delivered by
the natural powers,  after  a  somewhat protracted labor ; shortly after, however, she died  suddenly, the
cause of which I could  never divine.
  I have been present in three  cases  where the  forceps were used, and an  attempt was  made to use
them on a fourth person in a labor in which I  was  concerned ;  and in every case I am well assured that
the labor would have terminated  favorably without any interference whatever,  had  each been left to the
unaided  powers of nature.   In one of these instances, the use of the forceps brought on one of the worst
cases  of prolapsus uteri I ever saw.  In another of the  above cases the woman was healthy, had head
presentation, a normal pelvis, and  the pains were uniform ; yet, during  my absence, the attending physi-
cian made  an ineffectual  attempt to  apply  the  forceps :  afterward  he opened the cranium with the
trephine, and  then took an  ordinary boot-hook and  introduced  it within  the skull, and thus extracted
the child.
  A physician, who attended my own  sister in labor, urged  the absolute  necessity of using instruments
in her delivery, to which she resolutely refused to submit;  and, after  some  length of time, the child was
safely born, without  any accident or injury to either mother or child.
  That the first principles of operative midwife/y are  not settled, even  among the greatest advocates for
instrumental interference, every one may satisfy himself by reference to the following table of the practice
of the various lying-in  hospitals in Europe,  as officially published  by the principal  physician  attached  to
each.    By reference to  it, the student will perceive that while one practitioner uses instruments once  in
every  seven cases  of  labor, another more prudent, has used them only once  in seven hundred and twenty-
tight  cases :  all which  demonstrates  that they have no  fixed rules for their application, but that each in
governed by his otfn whim and caprice, or his desir? for operations :— 
INSTRUMENTAL LABOR.
169
_________________Hospitals and Accoucheurs
Dublin, Clarke.....................
   "    Collins.....................
Paris, Baudelocque..................
   "  La Chapelle...................
   "  Boivin........................
Vienna, Boer.......................
Heidelberg, Naegele................
Berlin, Kluge......................
Dresden, Cams.....................
Berlin, Sicbold......................
Number of Labors
10,199
16,654
17,388
22,243
20,517
 9,589
 1,711
 1.111
 2,549
 2,093
Forceps Cases.	Proportion.
14	1 in 728
27	1 in 617
31	1 in 561
76	1 in 293
96	1 in 214
35	1 in 274
55	1 in 31
68	1 in 16
184	1 in 14
300	1 in 7
Craniotomy Cases
 49
118
  6
 12
 16
 13
  1
  6
  9
  1
Proportion.
1 in  248
1 in  141
1 in 2,898
1 in 1,854
1 in 1,282
1 in  737-
1 in 1,711
1 in  185
1 in  283
1 in 2,093
   The question then arises, " Should instruments ever be used?"   To which I reply — I would not say
that there was no case in which they  were admissible ; but this I would state, that the cases in which it is
ever justifiable to use them are exceedingly rare ; and that instrumental delivery should never be attempted
until all the means  recommended to alleviate  the sufferings and expedite the birth under difficult, preter-
natural, and  complex labors, have been tried  in vain.   And if so,  I believe that, with most practitioners,
instruments will become as rusty as did those of Dr. Hunter, of London.
   And it is with no small  pleasure that I  perceive these principles (which I have so long and  so ardently
advocated) beginning to be acknowledged by  some of the most illustrious teachers of midwifery, both in
Europe and  America, although they cautiously avoid admitting the source whence they have  derived the
very doctrines which they inculcate :  yet it is well known by all  reformed practitioners throughout the
length and breadth  of the  land, that I had denounced  the common use of instruments, and insisted upon
the sufficiency of the powers of nature to effect delivery in most if not in all the cases where  instruments
were employed by  the " old-school"  physicians — long before these men became teachers of medicine, and
before some of them became even medical students.   But I rejoice exceedingly in the progress of truth and
the onward march  of correct principles of  medical practice, whether  men  acknowledge the source from
which  they have derived them  or not.
   That more correct views respecting the  use and  abuse of instruments  are  finding their way into the
colleges of  Europe, you will see  by the  following extract  from the  recently-published lectures of Dr.
Murphy,  professor  of midwifery in the university college, London.   When speaking of the contradictory
rules laid down by  different accoucheurs  on the use of instruments, he says —
   " I shall not, gentlemen, so far trespass on your patience as to ask you to unravel with me  this tangled
web of contradictory experience.  It is sufficient if I convince you of the difficulty of this subject, and if
it induce you to give patient attention  to the only mode that I can adopt to draw a legitimate  conclusion:
that is,  to derive it  as  nearly as possible from facts, without reference  to opinions.  I think this may be
done.   Bearing in  mind that the great and leading principle to be  observed in these  difficult cases is, to
preserve both mother and child, if possible, from injury, I think it is in our power to compare the results
of cases where the  forceps has been applied with  those where it has  been withheld, and thus determine
the practice which  presents the  greatest success.   We shall first direct  your attention to the following
tables of operative midwifery, given by British, French, and German practitioners; you will find in them
the total number of cases given by each, the number of forceps operations,  and the results to  mother and
child, when they are given.
   " You  will perceive that in  these tables the number of forceps  operations  in British practice is 138;
in  thirty-five  of which the child was still-born, being in the proportion of one  in every fourth case.  In
order to prevent error in this proportion,  we have  separated Dr. Lee's forceps cases ; the total number
of which given by him is fifty-five ; the mortality of .children, thirty-eight;  which would be  quite out of
proportion (being more than one half) if  these cases were  not carefully examined.  I have  endeavored
to  do so, and to make the  necessary corrections.   In nineteen  of these fifty-five cases, the forceps failed:
they therefore became  cases for perforation ; of the  remaining thirty-six cases, one half the children,
eighteen, were lost, but twelve of these eighteen were destroyed by other causes than the  forceps.
Deducting, therefore, all such  cases from the whole number, the  remainder will be twenty-four forceps
                                                22 
170
IMPROVED SYSTEM  OF  MIDWIFERY.
cases, in which eighteen children were saved and six lost, being in the  same  proportion—that  is, one
iu four.
   " In  the French reports, forty-one  children were  lost in 173 forceps  operations :  being  one in  four,
nearly.
   '• In  the German reports of Riecke and Kluge, which state the mortality of the children, the number
of  their forceps  operations  united  is 2,808;  the deaths  of children,  650:  being also  one in  four.
nearly:—
         COMPARATIVE VIEW  OF  FORCEPS  OPERATIONS AND  PERFORATIONS.
                                         BRITISH REPORTS.
Date.			Total cases.	Forceps.	Deaths.		Perfora-tions.	Deaths : Mothers.	Total operations.
					Children. 1 Mothers.				
1781 ....		Dr. R. Bland......	1,897 2,947 35,745 10,387 16,414 1,182 1,640 5,699	4 21 49 14 24 9 3 14	6 11 8 4 1 5	3 2 4 1	8 9 38 49 79 3 12 29	6 16 15 1 6	12 30
	cc	Dr. F. Ramsbotham Dr. J. Clarke......							
1828 to 1843___	cc								87
1787 to 1793....' 1826 to 1833....	cc								63 103 |
1835 to 1837....	cc								12
1835 to 1840___'	c<	Dr. Churchill......							15
1832 to 1835___	cc								43
									
			75,911	138 55	35 38	10 9	227 127	44 23	365 182
FRENCH REPORTS.									
1797 to 1811....			20,357 22,243	96 77	23 18	-	16 j — 1.2 —		J12 89
1812 to 1820___	«								
									
1			42,600 | 173		41	—	28 | —		201
	GERMAN REPORTS.								
1821 to 1825.... 1801 to 1821.... 1197 to 1827.... 1811 to 1827.... 1825 to 1827.... 1814 to 1827.... 1817 to 1828.... 1823 to 1827....	Wurtemburg....		221,923 26,965 13,365 12,329 9,392 2,549 2,093 1,111 1,711	2,740 100 341 120 120 184 300 i. 68 55	636 127		98 43 5 4 4 9 1 8 5	35 1 3	2,838 143 346 124 124 193 301 76 60
		Boer..............							
									
									
									
	Berlin..........				14	—			
									
	cc	Kluge.............							
									
									
L____			291,438 ! 4,028		650	127	177	39	4,205
  " Thus, then, we may conclude that one fourth of the children delivered by the  forceps  are lost.
What is the result when these protracted cases  are left to themselves ?   Is the mortality increased ?   I
do not think such will be found to be the case.   In order to determine this  question, I must refer you
to Dr. Collins's valuable  report — the  only report  which, from  its extreme  accuracy  and minuteness,
affords the elementsmpon which to form a calculation.   Dr. Collins has given  tables to show the duration
of labor in all the cases he reports;  he has also given separate  tables to  show the  duration of labor in
forceps cases, and in those which were preternatural.   We may also assume  that, perforation being only
had recourse to '• when,' as Dr.  Collins observes,  ' after the most patient trial,  the impracticability of labor
being terminated in safety by any other means was clearly proved,'  all  these cases exceeded twenty-four
hours.  From  these data, then,  we shall endeavor to draw a fair conclusion :—
CASES OF LABOR PROTRACTED TO TWENTY-FOUR HOURS AND UPWARD, FROM DR. COLLINS'S REPORT.
TOTAL CASKS, 430.
Delivered by forceps ............... 12
   '•    by perforating............. 79
   '•'    preternaturally............ 15
   '•'    naturally.................324

                              430|
STILL-BORN CHILDREN, 150.
Still-born...........................  4jMothersdead.
   "   ........................... 79    "
MOTHERS DEAD, 40.
150 
INSTRUMENTAL LABOR.
171
  " From this table you perceive that of 430 cases in which labor lasted twenty-four hours or exceeded
it, 324  of them were natural cases, delivered withouf assistance ; and that of  these 324, the children
were lost in sixty-one instances, which would be  about one in five cases.  The result of my  own inqui-
ries on this subject is nearly  similar, and has  been  obtained from  the same source, the Dublin  lying-in
hospital :—

         REPORT OF TWO HUNDRED AND EIGHTEEN  CASES OF LABOR PROTRACTED TO OR BEYOND TWENTY-FOUR HOUR?.
Delivered.	Cases. 14 29 175		Boys.		Girls.			Mothers .dead.	Causes of Mother's Death.
		Living.	Dead.	Putrid.	Living.	Dead.	Putrid.		
		4 76	1 20 19	1 5	5 52	4 7 22	1 1 1	4 6 8	C 1 puerperal fever. { 1 rupture of uterus. ( 1 puerperal fever. ( 1 rupture of uterus. 3 puerperal fever.
									
									
									
	218	80	40	6	57	33	1 2	18	
   " In 5,699 cases, 218 were protracted to this degree ; and of these, 175 were delivered naturally, and
forty-one children not putrid were still-born, being one in four, nearly.  Thus, then, you perceive that,
taking the widest, and, we would say, the fairest view of this question, the proportion  of still-born chil-
dren in these difficult and protracted  cases is  nearly the  same, whether  the forceps  be employed  or
otherwise; that the difference, if any exist,  is in favor of Dr. Collins's practice of leaving these cases to
nature.   But this is only one view of the question.
   " It may be said,  and has been said, in the energetic language of Dr. Burns, that the mother must be
considered : ' From the strength of the recommendations of the partisans of nature, we  should suppose
that whenever the child could actually be born without aid, no  hazard occurred ;  and, on  the other hand,
that instruments must of necessity prove not only very painful in their application, but dangerous in their
effects.   Now, the first supposition  is notoriously wrong, for innumerable  instances are met with, where
die mother does bear her child without artificial aid, and much, doubtless,  to the  temporary exultation of
the practitioner ; but,  nevertheless, death takes  place, or, at  the best, a  tedious recovery is the  con-
sequence.'*
   " Is such the case ?   It is totally opposed to my personal experience : on the contrary, I have been
surprised at the rapid recovery of patients who have  suffered this protraction, when I had erroneously
anticipated, from that very circumstance, all the unpleasant  consequences here  detailed.  But I would
again  ask you to put aside, for the  present, individual  experience, and examine  the facts.  In doing so,
our data are more limited  than those  which  assisted us in  the  former question :  because, in the French
reports, there is a most ominous silence regarding the  mortality of the mothers — they say nothing about
it   In the  German reports, we are limited to that of Dr. Riecke, who gives 127 deaths in 2,740 cases :
being one in twenty-one, nearly.
   " But take Dr. Churchill's more extensive researches on this question,  from whose valuable work  on
operative  midwifery these  tables of French and  German practice  are partly formed.   He states that,
' among the French and Germans, in 479 cases, thirty-five mothers were lost, or about one in  thirteen.'*
Dr. Churchill gives the proportionate mortality in British practice as one in twenty-one ; but you perceive
that, in the comparative view we  have placed before you, there were ten  deaths in 138  cases, which is
about one in thirteen.  Compare this with the result where the cases have  been left to the natural efforts.
In Dr. Collins's report, there were twenty-five deaths  in 324 cases, or one  in  thirteen — precisely the
same as where the forceps  had been used.   Among  those cases which I have observed, there were eight
deaths in 175 cases, or  one in twenty-two — a  proportion in which  I can place the  more confidence;
because it is derived from  personal observation.
• Burns, p. 434.
t Churchill's " Operative Midwifery," p. IZi. 
172
IMPROVED SYSTEM OF  MIDWIFERY.
   " With regard, then, to the second question—the mortality of the mother — take the  estimate in any
 way you  please, and  you must arrive  at  the same conclusion, viz., that  the mortality is  certainly not
 increased when these cases  are  not interfered with, and all  the  dreaded consequences which Dr. Burns
 anticipates from  such practice have no foundation in fact.   But we might even go further :  we might
 say that, so far from such evils following our Fabian practice, the evidence seems to point the other way,
 and to prove that  the actual  mortality  is diminished.  The twenty-five deaths reported by Dr. Collins
 include cases of puerperal fever, and other causes of death which might be  called accidental, because he
 gives, under a distinct head, the number of deaths, the ' effects of tedious and difficult labors.'*  These
 are just eleven cases, or one in thirty cases, nearly.   The eight deaths which took place under my own
 observation, include  three  deaths  from  puerperal fever, leaving only five  deaths from  the  severity and
 protraction of labor, which would be in the proportion of one to thirty-seven  cases.  Caution,  however,
 is necessary,  when we would derive  a just conclusion from statistics.  It is  therefore possible that if the"
 reports of these  forceps operations were more fully given, so  as to separate  the deaths from accidental
 causes from those resulting from the operation, the proportion of mortality would be diminished in the
 same ratio.f
   " We  do not  wish  you to assume more than what we  think has  been  proved, viz.,  that the  mortality
 of the  mothers is not  increased by leaving these cases to nature.  The safety  of  the mother  or  child can
 not, therefore, be advanced  as a reason for instrumental delivery, when  the head is making a  very slow
 but a certain  progress.
   " One  argument, however, has been much used by the advocates for interference, which is  very clearly
 expressed by Dr. Burns :  ' Granting,' he observes, «the recovery to be excellent, is it no consideration
 that the patient has been subject to twelve,  perhaps twenty-four, hours of  suffering of body and anxiety
 of mind,  which might have been spared  V$   You must perceive that if this argument be worth anything,
 it will  admit  of  a  much  more  extended application than  Dr. Burns would give to  it.   It might be
 employed to justify the use of the forceps in every case where the head was within reach, and the  labor
 at all severe.   Because, why should  your patient be  exposed to any bodily suffering or anxiety  of mind,
 if it were in your power to relieve her from  her miseries?   On this  principle, the forceps might be used
 (as indeed they have been  used) in every tenth case, and the  practitioner relieved from the most anxious
 portion of his duties.
   " But the design of nature will not thus  be  thwarted ; and we might reply to such an argument in the
 language  of Naegele : * If we  admit  that proportionate difficulties, according to the constitution of each
 individual, and an  effort  of  strength (requisite in child-birth), are  inseparable from  the nature of this
 process, we must conclude that an abbreviation of this process, though performed  by an able hand, before
 the salutary change, on which the preservation  of health depends, has taken  place in the organization of
 the mother, that a premature  and sudden removal of these difficulties can not be a matter of indifference;
 that such  a violent interference with  the  functions  of  nature must  incur the risk of destroying the health,
 though this should not  ensue for some time  after.'||  A  more  immediate  injury, however, sometimes
 follows the application of  the  forceps in the  case we are supposing, as well as in cases of  impaction.
 The pressure of  the  instrument  may cause slough of the  neck  of the  bladder  or the urethra,  and  thus
 establish a fistulous  opening into the vagina ;  and the  incontinence of urine that follows renders  the
 patient's life miserable afterward.  It  is difficult, in all instances, to  trace this accident to the use of the
 forceps.  When  a forceps  operation is described to us, we are seldom told that any mischief  is  the con-
 sequence.   The  splendor  of success is very  dazzling, and while we admire  the operation,  we are  too
 often left in the dark as to  the effects.
   " Nevertheless, I  have been able to trace  this  accident clearly to the use  of  the forceps  in several
instances.  The  usual account given  by  the  patient is, that «  she had been delivered by  instruments, and
   * Collins, p. 365.
   t It ia probable that the reports include deaths from puerperal fever, and those following delivery of the impacted head by tbe forceps.
   J Bums, p. 434.                                          y Naegele's " Mechanism of Parturition," by Rigby, p. 88. 
INSTRUMENTAL LABOR.                                 173
the child's life saved.'   Dr. R. Lee, in  his * Clinical Reports,' gives  a candid and clear  statement of
the results in the forceps cases he details : ' Four died  from  the  rash  and  inconsiderate use  of the
forceps ; seven had the  perineum  more or less  injured ;  one had  the recto-vaginal septum torn ;  five
were left with cicatrices  of the vagina, after sloughing; and  one with incurable vesico-vaginal fistula.'*
Dr. Collins records only one case of vesico-vaginal fistula  in the whole of his  report of 16,654 cases —
that was  a  case of  perforation : consequently this accident never  was found  among those cases which
were delivered naturally.   The  only case  of  fistula which occurred in the 5,699 cases to  which I have
so often referred, was  one in which I employed  the  forceps  to  deliver a child that presented the fore-
head.  The  principal  cause of difficulty in Dr. Collins's cases was, the large head  of the  male child
forcing its way through a very osseous pelvis ;  the pressure on  the soft parts must be very great, and if
fistula  could be  produced by great protraction of labor in cases that ultimately were delivered without
assistance,  it must have  been an accident of frequent occurrence in these cases, when  the soft parts
were so much compressed ; but such did not happen, and therefore they  afford a very favorable contrast
to the  cases delivered by the  forceps in nearly similar circumstances.   The intelligent practitioner would
therefore hesitate to expose his patient to the risk  of vesico-vaginal fistula, for the  mere gratification of
shortening  the severities of labor.
   " We have been reluctantly compelled to dwell  longer  upon  the management of this degree  of dis-
proportion  than  we desired.  The  difficulty of the question  it  involves, and  the  contradictions  among
the most experienced writers, must be our apology.   In the case that we are considering — that in which
the second stage of labor is protracted, and the head of the child  advancing very slowly — we have shown
you that  there is no increased danger to the  mother or  child  by  leaving the  case to nature in place of
delivering by the forceps ; that if there  be any difference  in the ratios of  mortality, it is  in favor of non-
interference, and rather against the  forceps.
   " We have pointed out,  as  far  as imperfectly-detailed facts would enable  us, that  the post-partum
accidents of labor follow operations with the  forceps  more frequently than  cases which are left to them-
selves  : and, consequently, the conclusion  at which we  must arrive is hostile to the use of that instrument,
under  the circumstances  stated.
   " But recollect that  there is no general rule without an  exception, and  you will sometimes meet with
cases so feeble in their habits that they will not endure a protracted  labor without  great  risk of exhaus-
tion ;  you  may be called  to patients where you dare not temporize — whom you must deliver, although
the head is making a tardy progress.  We only ask you  to consider  these as the  exceptions, not often
met with, but still necessary^o be  studied and understood.  It is for this reason we have brought before
your notice the symptoms of exhaustion, and those which precede it.  The same desire to direct your
attention  to the study of  individual cases which may be exceptions to the general principle, we would
wish to govern you, leads me to  bring  before you the varieties, not only in  the formation, but  in  the
resistance of the pelvis, so that you may know where an  operation  might be undertaken, and where it
can not be  attempted."
   Since, then, there is a possibility that we may be compelled to use  instruments in order to save life, after
every other means have  failed, I shall subjoin plain and concise instructions for their application, when
absolutely necessary.
* " Clinical Midwifery." p. 33. 
                             IMPROVED SYSTEM  OF  MIDWIFERY.

                                                                                             p
                                         SECTION II.

                    THE  MANNER  OF  USING  THE  SHORT  FORCEPS.

  When, from an attentive consideration of all the circumstances of the case, we have decided on the
necessity of having recourse to instrumental assistance, and that the ghort forceps is best adapted to afford
it, the bladder should be evacuated, and the rectum emptied  of its contents  by an enema.   The lower
blade of the forceps, having previously been warmed by holding it in water at a proper degree of tempera-
ture, should be slowly and cautiously  insinuated, in a curved line, between the fingers of the accoucheur,
previous^ introduced, and  the head of the child, over its ear ;  when the  first blade has been  applied, so
as to receive in its fenestra  the protuberance of that parietal bone which is situated toward the  left side, it
must be retained in its position :  and the two fingers of the accoucheur are to be placed on the opposite
side of  the head, or to  the right, and over the ear of the child ; then  the second blade is to be passed
slowly between the fingers and the opposite parietal bone ;  taking care that the direction of the blades it.
such, as to make  them properly and  exactly antagonize, and lock into  each other :  if  this  be  not readily
accomplished, the second blade  may  be withdrawn a little, and slowly introduced again in a more favor-
able direction.  In  accomplishing this, extreme caution is  required, to avoid  the  entanglement of any of
the  maternal parjs, which would produce severe, cutting pain.   Having  locked the blades together, it '
usually  recommended to tie them ;  if this be  done, the ligature  should be slack, to  avoid unnecessary
pressure on the foetal head.
  After having secured the forceps, we should recollect that  they are required to assist in the expulsion
of the foetus, and to aid, rather than  supersede, the expulsive contractions of the uterus.   It is therefore
proper,  in ordinary cases, to wait till  these  efforts come on ;  and, during a pain, exerting only a  very
moderate degree of  extractile  force, to move the  handles of  the instrument slowly and cautiously from
side to side with one hand, while the other is employed at the same time in  supporting  the perineum,
and preventing the danger  of its laceration, especially when the head is passing through the outlet.   The
caution  suggested in tying the blades is equally necessary to be observed while extracting with the handles
of  the forceps :  pressure on the foetal head is unnecessary, attended with danger, and must be avoided.
Sudden  extraction is always  highly  improper;  and  perseverance  in  co-operating with  the expulsive
powers  will generally accomplish the  object, without injury to either mother  or child, while both may be
sacrificed by operating in a violent and hasty manner.
  As the head descends and approaches the outlet, a change in the directionP>of the handles of the forceps
is necessary, which should be raised gradually toward  the  abdomen of the mother, to bring the occiput
forward and upward, in  ord^er  that its  passage may take place in the curved line of the pelvis.
  Another difficulty which  may require  the  employment of  the forceps is,  when the face is  turned for-
ward, under the pubes,  and tbe  occiput is  consequently situated in  the hollow of the sacrum.   This is
always productive of a tedious labor, when the pelvis and foetal head are  of the standard size  ; but when
the latter is unusually small, if the labor occur before the full term of gestation is complete, or the pelvis
be  larger than ordinary, the child may sometimes be expelled without much difficulty.   When  discovered
early, before the head  has  descended  into the pelvis, the position  may sometimes be rectified with the
lever; but when it has descended into the cavity of the pelvis, and the case is lingering and attended with
danger, by applying the blades of the forceps over the sides of the head  as in a natural situation and pre-
sentation, and extracting in the same lateral  direction, co-operating with  the  pains, we may facilitate
delivery : if this be  done while the  head is in the cavity of the pelvis, and prior to its  arrival  at the arch
of  the  pubis, the face, when obliquely  situated,  may  sometimes be turned toward  the  hollow of the
sacrum, and the situation thus rendered natural.
  If, however, the symptoms do not lead us to use the forceps until the head has arrived at the outlet,
this change can not be accomplished, and  should not  be attempted.  The utmost caution is required to
prevent laceration, as the pressure on the perineum is considerable.   Extraction  should be very gradually 
INSTRUMENTAL LABOR.
175
and slowly made, guarding the perineum from danger by a steady and firm support with the hand ;  and
directing the head upward, forward, and outward, when it begins to bear on the external parts, by elevating
the handles of the forceps gradually more and more toward the abdomen of the mother.
                                        SECTION III.

                    THE  MANNER  OF  USING  THE  LONG  FORCEPS.

  The long forceps are more difficult to use than those of ordinary dimensions, and  are  applicable in
cases where there is such a degree of contraction at the brim, as  prevents the descent of the head after
the os  uteri has been long dilated.   They are curved  in a direction corresponding with the  curve of the
sacrum, and may sometimes supersede the necessity of  performing the  operation of  embryotomy.   In
the cases referred to, although the  upper opening of  the pelvis may be deficient in room, the cavity and
outlet may equal or  exceed the standard dimensions — a difficulty which may, by the long forceps, be
often readily overcome without injury to either mother or infant.
  It is necessary, before employing  them, to  acquire a  distinct  and  accurate  idea  of the presentation
and situation of  the child, and the cause  of the  existing difficulty.   It has  happened that, after having
submitted to the operation of embryotomy, under the care of one practitioner, the woman has been, in a
future parturition, delivered by another of a living child with the long forceps.   To use them successfully,
the same general rules must be observed which were given in the  last section, the same cautions attended
to,  and the rectum and bladder evacuated.
   In passing the blades, the curve of each  should  correspond with the curve of the sacrum, and they
are to  be passed over the forehead and occiput of the child, instead of over the parietal bones ; the lower
blade being introduced first.   Having accomplished the locking, a slow  and  gentle movement of extrac-
tion should be made, co-operating  with the pains, directing the handles from side to side without violence
or any sudden exertion of  force, or bearing  the instrument against the parts  of the mother.  When the
head has passed the  brim, and advanced within the cavity of the pelvis, if there exist no want of room in
it or at the outlet, and if the uterine contractions be strong and effective, the  birth will be quickly accom-
plished without further instrumental  assistance : the  long forceps  may therefore be withdrawn.  But if,
from exhaustion, there is a deficiency of pain — should there be haemorrhage or other alarming symptoms,
an  unusually large head, or a narrowing and  distortion of the pelvis, below as well as above — the forceps
may be reapplied over the  parietal bones, and  the delivery accomplished as before described.  These
instruments,'however, are but  seldom used.
                                          SECTION IV.

                         THE  MANNER  OF  USING  THE  VECTIS.

  Having detailed the method of applying the forceps, we  now have to consider the mode of employing
the vectis, which may be, in  judicious hands,  a highly-useful  instrument.   It ought, however, rather to
be called " the tractor," in compliance with  the suggestion  of  one of the most enlightened and scientific
accoucheurs of England.   It possesses some advantages over the  forceps, as  it does not occupy more
room in the pelvis than  a single blade ; and  practitioners who find a difficulty in  using forceps, may with
the lever succeed in rectifying mal-position at  the brim ; but it is an instrument safe or not according to
the manner in which it is used, and  the ideas, whether clear  or  otherwise, of the individual who em-
ploys it.   The change  of  certain  mal-position  of  the  head, previous to its  descent, and the conversion 
176
IMPROVED SYSTEM OF MIDWIFERY.
of an unfavorable into  a vertex presentation, are advantages which can  sometimes  be obtained with
the vectis.
   Before using it, the external parts as well as the os uteri should be dilated, and the bladder and rectum
evacuated.   Two fingers of one hand should be placed on that part of the head to which it is intended
to apply the vectis, and  the blade is to be gradually, slowly, and  cautiously glided  under them and over
the head : and if this be  the occiput, it will afford sufficient hold to exert a moderate degree of extraction.
   Neither the handle nor any other part of  the  instrument should bear at  all  on the  soft parts ; and in
bringing down the head, it should be borne from side to side, and turned slowly and progressively, so as
to keep its long  axis  in  apposition with the long axis, whether  of the brim  or outlet—observing the
curved line of the pelvis, by drawing in a direction downward, forward,  upward,  and  outward.   Thus
states Severn, but we consider this instrument of little or no use.
                                          SECTION  V.

EMBRYOTOMY, AND  THE  SYMPTOMS  WHICH  INDICATE  THE  DEATH  OF THE FffiTUS,

   The death of the child may occur either at the period of  labor,  or  may have  taken place some time
before ; in the latter case, it will be in a state of decomposition, more  or less  advanced, according to the
cause of its death,  and the time which  has elapsed since.  If life  have  been long  extinct, its  size is
altered, and the bones of the head are loose ;  but  if death  has taken place during labor, or a short time
before, there will be  no change in the size of the head, which requires  as much room for its transmission as
if it were living.   The causes which may destroy the child are various : those occurring during labor are,
its long-continued exposure to the violent expulsive efforts  of the uterus,  pressing its head against  the
bony pelvis, and pressure on the funis, interrupting its circulation.
   Accidents of any  kind, falls or blows on the abdomen,  may destroy the life  of the child, without occa-
sioning its immediate expulsion ; or  diseases in the parents,  of  which the venereal  is one  of the most
frequent.   We  may ascertain, from several circumstances, that the child is dead : the most usual previous
indications are,  when  the mother, who  before could readily feel  its  movements, has, found them growing
gradually weaker and weaker, and  after a short  time they cease  altogether;  the abdomen sinks, and
although smaller, it  becomes more cumbersome — there  is a feeling of coldness and weight, falling to
which side soever the patient turns herself; the breasts shrink, and are flattened ; the eyes are surrounded
by a dark or bluish  circle;  the nose becomes slender, the  lips pale,  the tongue is  white or brownish, the
appetite is either impaired or lost, and the sleep is unrefreshing, and  disturbed by dreams.   These symp-
toms may continue  some days, without the patient being aware of the cause whence  they originate, until
the membranes  giving way, from incipient decomposition, there  is,  with or without  pain, a gush  of the
liquor amnii, and the cord in a softened  state, or  one of the limbs of the child, is  pushed through the os
uteri;  and the skin  may be emphysematous,  or the  epidermis separating.  If the  head be the presenting
part, the bones on  examination  will  be  felt  moveable, or projecting over each other.  The discharges
have a peculiarly foetid, putrid  smell: and from these circumstances  we  can decide with certainty that the
child is dead.
   In a doubtful case as to the propriety  of embryotomy, it is always advisable to have a second opinion;
for it has happened  that, by the gradually increasing force  of the expelling powers,  a living child lias been
born, which a hasty and negligent accoucheur has considered as  a dead one.   It has  also happened that,
soon after the perforator has been employed, and  when little if any of the  contents of the head has been
evacuated,  violent and forcing pains have come on, and pushed away a living  child, which has continued
to breathe for several hours.  Of this horrible occurrence we could detail examples.   But when the signs
of death are decisive, and there is either a contracted pelvis or threatening  symptoms, there can be no
reason  for keeping the patient in a state  of suffering and danger,  and embryotomy  should not be delayed. 
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INSTRUMENTAL LABOR.
177
   When the head presents, and  the short forceps have been tried in vain, with  certain signs of a dead
child, it3 detention may arise from narrowness of the pelvis, or in consequence of the head having become
enlarged from disease, it is then necessary to open it, and, by removing the greater part of the brain,  to
reduce its size so as to allow it to be extracted.
   The patient lying near the edge of the bed, the fore and middle fingers of the left hand are to be intro-
duced until they reach one  of the fontanelles ;  then  taking  the perforator in the right hand, it is to be
passed along the hollow between  the fingers, already introduced, and applied to either of the  fontanelles
or to the sagittal suture, keeping the instrument fixed in that position by the fingers of the left: a semi-rotary
motion is given with the right to  the handle of  the perforator, and the  summit of the instrument, once
within the skull, is  to  be passed  downward  immediately  toward the base ; the handles are then to be
separated from each other,  in the  long diameter of the pelvis, and turned within the skull in every direc-
tion, to  break down  and discharge the cerebral mass, and  thus diminish the size  of the head.   The left
hand  should  be kept in contact with the perforator, both while this is done and at  the time the  instrument
is withdrawn ; and  a scoop may be used, or a common  spoon,  to remove the brain, which will be much
facilitated if the opening in the direction of the long diameter be made sufficiently  large to allow the brain
freely to escape.
   If the short forceps have been tried before  employing the perforator,  they may be of some service after
the size of the head is reduced,  which may be held by  them  steadily fixed, and  thus the instruments
employed in  embryotomy can be  most advantageously applied.   If the handles are kept close togethen
as the head collapses, it  can be  extracted with  much greater facility and  safety by the forceps  than the
crotchet, which often breaks off  a  portion of bone, and thus the  vagina or uterus may be  excoriated or
lacerated, without great caution.
   It is therefore best always to use forceps for the  purpose of extraction.  Dr.  Blundell recommends
those of Mr. Holmes, which have several tooth-like processes in one blade, with corresponding concavi-
ties in the other;  and they are well  adapted to remove the head when in a state of  collapse, after the
brain has been evacuated.  They should be passed, remembering  the curve of the pelvis, and the foetus
extracted downward, forward, upward, and outward, covering  the rough and projecting pieces of bone,
rf there be any, with the fingers,  to prevent excoriation, and thus the patient will be saved from unneces-
sary suffering.    The  operation  of embryotomy  may  occasionally be required  in  cases  of  congenital
hydrocephalus; but, although not an unfrequent  disease at birth, it seldom obliges us to have  recourse to
this operation.   Dr. Meigs, of Philadelphia, has invented the best instrument of this kind.
   Another case requiring instrumental assistance is, the separation of the  child's  head, and its being left
within the vagina, or uterine cavity  : in  consequence  of the accoucheur having dragged at the feet, and
not having observed the  curved line of the pelvis, it is separated from the trunk, and left in utero.   This
will be very likely to take place, if  in a state of advanced decomposition.   Sometimes the action  of the
uterus throws it into a favorable situation to be  discharged, so that it escapes without assistance, but this
is a circumstance extremely rare.
   In consequence of the separation having taken place  at  the cervical vertebrae, it  lies in utero  in the
most favorable situation for the use of instruments.   The crotchet  may  sometimes, directed  by the finger,
be made to fix upon the base of  the cranium, through the foramen magnum, by which the head may be
brought through the cavity of the pelvis ;  and, if this  fail,  the forceps before described will often without
much difficulty accomplish the purpose.
   The French accoucheurs are in the habit of employing in  these cases an instrument called a tire tete,
which consists of a shank of sufficient length to be passed  into the uterus ;  it is formed of iron, and to its
summit a small piece of iron  is fixed, with a hinge, to the  extremities of which a ligature is attached.   It
is  to be  passed into the interior of  the skull, through the foramen magnum, with the cross-bar parallel
with the shank of the instrument;  and  when within the cranium, by drawing the ligature, the cross-bar
becomes transversely situated, and, lying  across  the  interior  of the  occipital bone  over the  foramen
magnum, the head can be removed with facility.
                                                23 
•^8
IMPROVED SYSTEM OF MIDWIFERY.
                                         SECTION VI.

               PREMATURE  LABOR  A  SUBSTITUTE  FOR  EMBItY O-T O M Y

  When there exists such a degree of deformity or contraction as to render it impossible for parturition
to take place at the full time, without having recourse to the perforator,  by adopting  the measures  here-
after described, there may be a probability in  any future pregnancy of rescuing the infant from inevitable
destruction, and ourselves from the necessity of performing an  operation which, supposing  the  child is
living, nothing  but the  inevitable  injury or  death  of the mother, if  it  were  omitted, we conceive can
possibly justify.
  The smaller size of the foetal head at seven or eight months — the less complete ossification then, than
at the full period of gestation—the greater  separation  of the sutures  and fontanelles, and  therefore its
easier compressibility — will in some instances  allow it to  pass : and  the parent may thus have  a living
child, which must be sacrificed  if it continue the full  time in utero.   Children born  at seven months are
usually weaker at first than if  retained  to the termination of the ninth ; but there are not wanting  many
instances of seven months' children being reared : and, from this to  the eighth month,  the chances  of their
living are gradually increased.   We are in such instances to bring on premature labor, and the evacuation
of the liquor amnii is  the most safe and certain means of doing this.  At the  conclusion of the seventh,
or between that and the  eighth  month,  the patient who has such a  degree of distortion as would  prevent
delivery when the time of gestation is  complete, should inform  her accoucheur (and it is recommended
that operations in midwifery should seldom or  never be attempted without a second  opinion);  and labor
may be safely brought on in the following manner:—
  The patient lying on  her left side, the first two fingers of the left hand being passed so as to touch the
os uteri,  one of them should  be  slowly and cautiously insinuated, without violence   or hurry, until the
membranes distended with  liquor amnii can  be felt: keeping the finger in  contact with the membranes,
the  stilelte of a catheter should be held in the right hand,  and passed  upon the fingers of the left; and
when its  point (which should rather be  obtuse than sharp) reaches the ovum, a puncture should be made,
giving the stilette a rotatory motion, by rubbing it between the finger and thumb of the right hand :  while
tins is done, its point must  be kept steadily in the same  place, and must only touch the membranes.
When the opening is made, the discharge of water will show that the object  is attained,  and the stiletto
should be carefully withdrawn.   Uterine contraction may come  on shortly, or a day or two may elapse
before its occurrence ; and, during the interval, the patient should  avoid exertion,  and continue as much
as possible in the recumbent position.
END  OF  PART  SECOND. 
                            PART   THIRD.

DISEASES  OE   WOMEN  AND  CHILDREN.
          CHAPTER  I.

SEXUAL  DISEASES.
                                         SECTION I.

                    CHLOROSIS, OR  RETENTION  OF  THE  MENSES.
                                                      1
   Description. — It is well known that females from the age of twelve to sixteen (or according to the
 climate) begin to menstruate, and which constitutes a critical period in their lives, as health depends very
 much upon this discharge.  It is liable from various  causes to become obstructed at the period when it
 ought to appear ;  and when this takes place, it is attended with very painful or  serious effects : and  if
 nature is not  assisted,  the health is impaired, or  the  constitution undermined, inducing consumption or
 some other complaint.
   Causes. — The remote cause of this complaint is, most frequently, suppressed perspiration;  and it
 may arise in part from an inactive  and sedentary life, and such habits as are peculiar to the higher classes
 of society, particularly in cities and towns.
   The proximate  cause of it seems to be, a want of power in the system, arising from inability to propel
 the blood into the uterine vessels with sufficient force to open their extremities, and to allow a discharge
 of blood from them.
   Symptoms. — Heaviness, listlessness to motion, fatigue  on the least  exercise, palpitations at the heart,
 pains in the back,  loins, and hips, flatulency, and acidity in the stomach and bowels, costiveness, a pre-
 ternatural appetite for chalk, lime, and various other absorbents, together with many dyspeptic symptoms,
 usually attend chlorosis.
  As it advances  in its progress, the face  becomes pale, and afterward assumes a yellowish hue, even
 verging upon  green, whence  it has been called green-sickness;  tlie  lips lose their rosy color; the eyes
 are encircled  with a livid areola;  the whole body has an unhealthy appearance,  with every indication of
 a want of  power and energy in  the  constitution ;  the feet are  affected with oedematous swellings ; the
 breathing is much hurried by any vigorous  exertion of the body ; the pulse is quick, but feeble ; and the
 person is apt to be affected with a cough and with  many of the symptoms of hysteria.  Sometimes a
great quantity of pale urine is discharged in the morning, and not unfrequently hectic fever attends. 
180
DISEASES OF WOMEN  AND  CHILDREN.
  In  cases of a more chronic character, "there is a continued though  variable state of  sallowness, of
yellowness, or icterode hue; of darkness, or of  a wan, squalid, or sordid paleness of complexion ; or a
ring of darkness  surrounding  the eyes,  and extending a  little perhaps toward  the temples  and cheeks,
and sometimes encircling the mouth — without tumidity, as well  as without  the pallidness of the lips,
already mentioned."
  Common Practice. — Bleeding, mercury, iron, salts, &c.
  Reformed Practice. — As this disease proceeds from  debility, it is evident that the  great object to
be fulfilled will be, to give tone and energy to the system  ; and if this debility  has arisen from a sedentary
life, the patient must begin immediately to exercise in the  open  air, and,  if practicable,  to change her
residence.   I once had a case so very violent and  protracted, that the patient often had  fits resembling
apoplexy.   I gave her medicine, and during the  time she was taking it she  went to the seashore, bathed,
took herb-tea,  and after a few weeks or  months, was  entirely restored to  health.  The  change of air,
bathing, &c, appeared to  contribute as  much to the cure as the other means  made use of.   The  tepid
or warm bath should be used in preference to  the cold.
  The first medicine given may be the pulverized mandrake-root, combined with a little cream of tartar,
and where the stomach  is very irritable, our  common purgative will be  found very good.   This,  as
well as other medicines, should  be  taken upon an  empty stomach,  and, after  it  has  been  given,
peppermint-tea should be freely drunk.   After the exhibition of this purgative,  which  may occasionally
be repeated, gum-aloes may be  taken,  combined in such  a manner as will  prevent  the piles.   This
medicine, from its action upon the  uterus through the medium of the rectum, is very useful in retention
of the menses ;  and its  benefit is much  increased  by combining it with other articles :  hence we have
used it in the form of the anti-dyspeptic  pill, which  answers the  purpose very well.  It is mild, gently
laxative, and tonic ;  two or three of these may be taken  at bedtime, or as many as are sufficient to keep
the bowels in a soluble state.  During the use of these  pills, let the patient take the  restorative cordial.
Emenagogues, or#" forcing medicines,"  should not be used to  bring on the menses, except  there be a
struggle or effort of nature to effect it, and this will  be known by the periodical pains and  pressing down
about the hips and loins.   When  this  happens, let  the  feet be bathed, and perspiration  promoted  by-
drinking freely of diluent teas, such as  pennyroyal, motherwort, and garden-thyme.  Should consider-
able pains attend  the complaint,  eight  or ten  grains of the diaphoretic  powders may  be given, and
fomentations of bitter herbs applied over the region of the womb.
  The patient should be very  careful not to expose herself to the vicissitudes of the weather ; the feet or
clothes should not be suffered to become wet; warm clothing should  be worn, and  particularly flannel.
Chalybeate waters, such as Ballston and  Saratoga, have been  taken with success in this complaint.   The
diet should be light,  nutritious, and easy of digestion.   The  following is excellent: tincture of aloes, four
ounces ; mercurial tincture of  iron, half an ounce; dose, a teaspoonful in water night and  morning.
                                         SECTION II.

                  AMENORRHEA,  OR  SUPPRESSION  OF THE  MENSES.

  Description. — By this disease we understand a partial or total obstruction of the menses in women
from other causes than pregnancy and old age.   The menses should be regular as to quantity and quality ;
and that this discharge should observe the monthly period, is essential  to health.   When it is  obstructed,
nature makes her efforts to obtain for it some other outlet; when  these efforts of nature fail, the conse-
quence may  be  fever,  pulmonic  diseases, spasmodic affections, hysteria, epilepsy,  mania, apoplexy,
chlorosis,  &c, according to the general habit and disposition of the patient.
  Any interruption occurring after the menstrual flux  has once been established in its regular course,
except when occasioned  by conception, is always to  be  considered as  a case of suppression.  A con-
striction of the  extremities of the vessels  of the uterus, arising from accidental  circumstances, such as 
SEXUAL DISEASES.
181
 cold, anxiety of mind, fear, inactivity of body, the frequent use of acids and other  sedatives, &c.,. is the
 cause which evidently produces a  suppression of the menses.  In some few cases it appears as a symp-
 tom of other diseases, and particularly of  general debility in  the system.  Herein there is a want of  the
 necessary propelling force or due action of the vessels.
   When the menstrual flux has been suppressed for any considerable length of  time, it not unfrequently
 happens that the blood, which should  have passed off by the uterus, being  determined  more copiously
 and forcibly  to other parts, gives rise  to  haemorrhages :  hence  it is  frequently poured out  from  the
 nose, stomach, lungs, and other parts, in  such cases.  At first, however, febrile  or  inflammatory symp-
 toms appear, the pulse is  hard and frequent, the skin hot, and there is a severe pain in the head, back,
 and loins.   Besides being subject to these occurrences, the patient is likewise much troubled with costive-
 ness, colic-pains, and dyspeptic and hysteric symptoms.
   Our prognostic in this  disease is  to be directed by the cause which  has given rise to it, the length of
 time it has  continued, and the state of the person's  health in other respects.   When  menstruation  is
 suddenly suppressed in consequence of cold, it  may easily be  restored by pursuing proper means ; but
 where the suppression has been of long standing, and leucorrhcea attends, we ought  always to consider
 such circumstances as less favorable, though not  incurable.
   Common Practice, — Bleeding repeatedly,  antimony, mercury,  &c.
   Reformed Practice. — It will be  necessary in the treatment of  this disease, to  remove urgent
 symptoms if they are present.   If  the patient be in severe pain, give ten  grains of the diaphoretic pow-
 ders, and at the same time let  a  strong  infusion  of garden-thyme  and pennyroyal  be freely given ; the
 feet should  likewise be  immersed in warm ley-water, and  rubbed well  with  flannel.   If  relief  be  not
 obtained in  the course of an hour,  or in a very short time, a strong decoction of bitter herbs should  be
 thrown into a proper vessel, and the patient steamed  fifteen or twenty minutes — as long as  she is able to
 bear—or until  perspiration is produced; and, immediately afterward, let  her  be put in bed,  covered
 warm, and the herbs be enclosed in flannel or muslin, and applied to the lower  part of the abdomen or
 belly.   This process will almost immediately relieve the urgent symptoms.   After this,  our next object
 will be, to regulate  the  menstrual  discharge, by a  proper course of strengthening medicine;  and that
 recommended under the head of chlorosis, or retention of the menses, maybe taken with advantage.  Inas-
 much  as this complaint, like the preceding,  proceeds  from  debility, it is evident  that this debility must be
 removed in  order  to effect a  cure ;  and  therefore  that medicine and  treatment which  strengthen and
 invigorates the system will invariably benefit  the patient.   The skin,  stomach,  and  intestines,  all seem
 concerned in the production  of this disease, and hence our attention  should be  directed to a restoration
 of their proper offices : the stomach and bowels should be cleansed, and stimulated to a healthy action ;
 perspiration  must be promoted ; and, in short, every secretion and excretion of the system.
   If the  stomach is in a  morbid condition, let an  emetic occasionally be given, after which a dose  of
 mandrake ;  both of which  may be repeated  as occasion requires.  The patient may then take the follow-
 ing tonic bitters :—
              Take prickly-ash bark.....................................................two ounces ;
                  Wild cherry-tree bark................................................two ounces;
                  Seneca snake-root....................................................one ounce;
                  Tansy...............................................................one ounce;
                  Gum soctorine-aloes....................,.........................half an ounce;
                  Devii'i-bet.......................................................... t,wo ounces ;
 Pulverize, and to every tvyo ounces of the powder add half a  pint of boiling water and one quart of
 Holland gin.  Half a wine-glass may be taken three  or four times a day; this may be continued  while it
 agrees with the patient, or as long as benefit is derived.
  About once a  month there will generally  be felt more or less symptoms  preceding  a  catamenial dis-
charge.  Considerable pain will be  felt through the lower part of the abdomen, hips, and loins,  showing
that there is  a strong effort or  struggle  of nature  to return  the  menses.   Our principal object when this
occurs should be, to aid her salutary efforts, as directed  in the  preceding complaint:  the patient should 
182                        DISEASES OF WOMEN AND CHILDREN.

sit over the steam of bitter herbs for ten or fifteen minutes, retaining the steam by means of a blanket, to
concentrate it upon the lower part of the body ; at the same time the feet should be bathed, and tansy-tea
freely drunk.   The abdomen  should also  be fomented, as before directed.   It will  not be  necessary,
however, to  use these means except there is an obvious indication to return the menses.
  It must be recollected that, when the  patient labors under some  other  disease, there is such, debility,
that there is  not superfluous blood sufficient to  keep up the menstrual discharge ; and  in this case, our
attention must be directed to the primary affection, without any regard to such symptoms ; aud it is also
very necessary  to bear in  mind the fact that the menses   are often  suppressed from  pregnancy, and the
physician will be applied to, to return them, with a view to procure abortion.   No man possessed  of any
principle will ever  be guilty of prescribing  medicine in such a case with a view to return them.   Such
conduct would  be very criminal, and an indictable offence.  Great rewards or  remuneration are in  such
cases held out  to the practitioner :  but as he values his  reputation, character, and  conscience, let him
never yield to the temptation.
   By a proper attention he can always discriminate between a suppression of the menses and pregnancy ;
and the principal diagnostic symptom is, that in  the former complaint there is a pain or an affection of the
head, attended  with dizziness.
   Lieutaud  makes the following  remarks  upon this  subject:  " Those who are desirous  to cure this
disease, ought strictly to inquire whether there be  any suspicion  of pregnancy : since numberless pseudo-
virgins, or wanton  little prostitutes, are met with, who are impregnated, and by every art endeavor to
conceal their very scandalous situation ;  under the semblance  of curing this pretended  disease, they
desire to be  bled in the saphcena, in hope of future  abortion ; so that even the  most guarded are  daily
deceived."
   If the preceding treatment does not cure the disease, which will  seldom if  ever be found the case, if
persevered in,  the  patient may take  fifteen or twenty grains of the euphor ipecacuanha about twice a
week in a little molasses ;  and a tea made of the green ozier may likewise  be  drunk through the  day.
This will be found an excellent medicine.
   I once attended a case  of amenorrhoea which had existed for two years, and the abdomen, had  gradu-
ally acquired an enormous magnitude — much larger than  a female in the last month of pregnancy ;  and
after having  tried all my ordinary remedies  to  return the  menses, I succeeded with  the  following treat-
ment :  I first gave a tea or infusion of digitalis or foxglove ;  in the next place, a purgative was ordered
once or twice a week.   During the same time the patient was ordered to  drink freely of parsley-tea; and
the whole abdomen was rubbed twice a day with sweet-oil, and as often  with white precipitate ointment.
   From the very time that the patient commenced this treatment, the  belly began to  subside ;  in a short
time the courses returned ;  she soon entirely recovered her  health, and has  been well for many years-
Having exhausted  my skill in trying all ordinary remedies, I resorted to this  treatment as an  experiment,
or as the last alternative, and never was a medicine more   strikingly successful.  The cure was a  matter
of astonishment to  all who witnessed it: the abdomen was  perfectly tense and hard, and  appeared  almost
in a state of scirrhus.  Of the modus operandi of the medicine, I must leave the reader to jud^e.
   Some physicians have been  very  much in the habit of using the " golden tincture" — made  by  addin"
spirits to black  hellebore and  logwood, till  a saturated  tincture was formed, and then giving one  or two
teaspoonfuls three or four  times a day.
  A person  informed me  some years ago  that a physician on Long island cured his wife of  obstructed
menses, which  had placed her life in the greatest jeopardy, and which other physicians could  not remove.
The following formula was used :—
                       Take tincture of gum-myrrh,
                              "      castor, equal parts.
       Give a spoonful  three or four times a day.
  Since writing the preceding remarks upon this complaint, I  administered a dose  of  mandrake foi a
bilious  complaint to  a young  woman who  had  been afflicted with partial or deficient menses for  many 
SEXUAL DISEASES.
183
years, and which not only removed  the  symptoms for which  it was given, but likewise 'returned  the
menses.
  Since writing the foregoing, also, a gentleman has come a distance of forty mile3 to obtain relief for his
daughter, who has been laboring  under a spasmodic affection  from suppressed or  obstructed menses.
Two physicians have attended her, and pursued the usual  course of bleeding, &c, the effect of which
has been, as I predicted, an aggravation of the complaint t the  bleeding soon induced greater spasms, and
finally convulsions.   I explained to the father the nature of the  disease, and gave him my opinion that it
proceeded, not from repletion or excess of blood, as his physician stated, but from an unequal circulation,
or an undue quantity thrown  upon the brain.   He then stated that her  feet  and legs were as cold as a
dead person's, showing evidently a recession of blood from these  parts to the head.  After stating  my
views and treatment of the disease, he appeared forcibly struck with the difference between my views and
those of other physicians, exclaiming, " How you doctors do differ 1"
  Dr. Tidd, with whom I studied, was in  the habit of giving a preparation which has been attended  with
great  success, and which I have formerly been in  the practice of giving.   He procured it from some
person in the section  of the country  where  he resided, who  obtained great celebrity for removing this
disease.  It is made as follows :—
             Take gum-myrrh.........................................................four ounces;
                  flowers of sulphur..................................................four ounces ;
                  steel-filings.........................................................four ounces;
                  loaf-sugar..........................................................four ounces;
Pulverize, and simmer all in a quart of wine, until the mass becomes nearly dry ; after which remove from
the fire, and when dry, pulverize.  Of this  let the patient  take half  a teaspoonful two or three times a
day.  Some prefer taking the same quantity in the form of pills.   Under the treatment here laid down,
I know not that I recollect a single instance of failure.
   The following case occurred within  my knowledge :  A  young  lady had  labored under almost a total
suppression of the menses for many years.  She had tried almost every kind of medicine, without receiving
the least benefit, and her case appeared  utterly hopeless.   She was advised to  apply to a woman  who
was very noted for curing this disease only.   She called upon her, stated her symptoms, received a box
of pills, and took  them according to her directions: the  effect of which was, the natural return of  the
catamenial discharge,  and perfect restoration  to health.  The  father presented me with a few of the pills,
which I found to be composed of about four parts of white turpentine gum, and one part of sulphate of
iron (green vitriol), formerly called sal-mortis — two or three pills of the same to be taken at a dose three
or four times a day.
                                         SECTION  III.

         DYSMENORRHEA,  OR  PAINFUL  AND  IMPERFECT  MENSTRUATION.

   Description. — Besides the two  deviations from  the usual course of nature already mentioned,
there sometimes occurs a third, viz.: where menstruation, although not wholly suppressed, is nevertheless
somewhat difficult, and accompanied with severe pains in the back, loins, and bottom of the belly.
   This disease is owing to a weak action of the vessels of the uterus,  or spasm of its extreme vessels ;
and is to be obviated by tonics, warm bathing, both topical and general, together with the use of anodynes,
which should be employed as soon as the symptoms that denote its approach are apparent.
   This complaint is a common and generally an extremely harassing affection.   It may occur at every
period  during the menstrual stage of life, but it  appears to be  most common between  the twentieth and
thirtieth years of age, and in subjects of an irritable and sanguineous temperament.  In many instances
severe  pains are  experienced in the back, loins, and lower part of the abdomen, for five or six hours 
184
DISEASES OF WOMEN  AND CHILDREN.
previous to the appearance of the  menstruous evacuation.   This, however, soon  ceases, and  an imme-
diate aggravation of the torturing pain follows.  Sometimes the catamenia begin to flow moderately, with
little or no previous pains ; but in  an hour  or two they suddenly become arrested, at the same time that
violent  pains come on in  the hips, hypogastrium, loins, back, and thighs, with a distressing sensation of
forcing or bearing down in the pelvis.  Occasionally a very slight menstrual discharge continues uninter-
ruptedly for three or four days, accompanied  throughout with extremely severe pains in the pelvis and
lower portion of the abdomen ; and  in some  rare instances the catamenial evacuation, although attended
with great suffering, is sufficiently copious  and prolongs  in its course, and may even exceed the regular
duration and quantity of  an ordinary healthy menstruation.
   Common Treatment. — Mercury, &c.
   Reformed  Practice. — Since it is well  known that a derangement in the  uterine functions must
generally proceed from  a check of perspiration, astringing the minute  ends of the uterine vessels, or in
some manner deranging their functions, causing debility, &c, it  will  appear clear that our first attention
must be directed to the skin.  Cold appears to be the cause of the disease, and heat seems to  remove it.
Therefore, when these periods of distress occur, let the patient sit over a strong decoction of bitter herbs,
such as tansy, horehound, wormwood, catnep, and hops, while a blanket is thrown around the waist of
the patient,  to confine the steam to  the lower parts.  After the patient  has  been thus steamed, and the
feet bathed,  let the person be put into a bed warmly covered, and diluent  drinks  given, such as tansy,
thyme, pennyroyal, &c.;  at the same time  let fomentations  of the same herbs enclosed in a flannel bag
be applied to the abdomen as before  directed.
 ■  This will produce perspiration, and afford immediate relief; and when these distressing symptoms are
removed, and the patient becomes comfortable, a course of treatment mu3t be adopted to prevent a recur-
rence of these symptoms, or to produce a  natural flow of the  catamenial discharge,  and  similar to that
recomended under the  two  preceding complaints.  A tea made  of the  bark of green  ozier  may be
drunk freely.
   A writer  on  this subject  thus  remarks : " This case of painful menstruation deserves particular atten-
tion, because it impairs the health of patients by its present effects, and seems  to render them less prolific
in future.  Dr. Fothargill has afforded relief to several by the following process :  Let the patient have
by her a few pills, consisting of opium, one grain in each, made soft with a little of any kind of conserve.
She is to take one of these pills the moment she finds the pain attending this discharge coming  on ; a pill
may be taken every hour till the pain goes off; and more  than two of these pills will seldom be required,
but it must be taken in such a quantity as to  mitigate the pain.   Let the patient keep either in or upon
the bed, at least in  a recumbent  posture, drinking  moderately of  any diluting liquor, as the  herb-teas,
weak whey, or thin broth.  When the time is past, a course of chalybeate bitters, in small doses,  may
be continued till within a few days  of the return ;  and the bowels should be kept open with some proper
laxative.  This excruciating pain seems to  be spasmodic, and to proceed from the extreme irritability of
the uterine system."
   The  diaphoretic powders will be found very useful.  Diet and exercise are important.
                                         SECTION IV.

                                HVSTERIA,  or  hysterics.

  Description. — Hysteria or hysterics is characterized by a grumbling noise in the bowels, followed
by a ball ascending to the throat, attended with a sense  of suffocation, stupor, insensibility, convulsions
laughing and  crying without visible cause,  sleep  interrupted  by  sighing and groaning,  attended  with
flatulence. 
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SEXUAL DISEASES.
185
  Hoffman calls the hysteric affection  "a cohort of  diseases."   Sydenham compares  it, for the  infinite
variety of its forms, to Proteus, and, for the mutability of its appearances, to a chameleon.  It is attended
with more or less delirium.
  Causes. —This disorder maybe produced by various causes.  It usually arises from certain passions
operating upon a feeble constitution.
  The persons most liable to this disease are females, from the time of puberty to the age of thirty-five,
unmarried women,  and young widows, chiefly those  of the sanguine temperament, of a  relaxed habit, of
great sensibility, and of an  irritable fibre — more especially after profuse  evacuations, whether sanguine
or serous ; the indolent, and those who are exhausted, either by long-protracted fevers or habits of intem-
perance ; and  such  also in whom the uterine haemorrhage is unseasonably stopped or habitually obstructed.
Can we  therefore hesitate to assign, as  the predisponent cause, debility with morbid irritability ?
  Symptoms. — The disease attacks in paroxysms or fits.  These are  sometimes preceded by dejection
of spirits, anxiety of mind, effusion of tears,  difficulty of breathing, sickness at the stomach, and palpita-
tions at the heart; but it more usually  happens that a pain is felt on the left side, about the flexure of the
colon, with a  sense of distention, advancing upward till  it  gets into  the stomach ;  and,  removing thence
into the  throat, it occasions  by its pressure  a sensation  as if  a ball  were  lodged  there, which by some
authors has been called globus hystericus.  The disease  having arrived at this height, the patient appears
to be threatened with suffocation, becomes faint, and is affected with stupor and insensibility; while at the
same time the trunk of the body is turned to and fro, the limbs are variously agitated, wild and irregular
actions take place  in the  alternate fits  of laughter, crying, and screaming ;  incoherent expressions are
uttered,  a temporary delirium prevails, and a frothy saliva is discharged from the mouth.  The spasms at
length abating,  a  quantity of wind is evacuated upward,  with frequent  sighing and  sobbing, and the
woman recovers the exercise of sense and motion without any recollection of what has taken place during
the fit; feeling, however, a severe pain in the head, and a soreness over  the whole body.   In  some cases
there is  little or no  convulsive movement, and  the  person lies for  some time seemingly in  a state  of
profound sleep, without either sense or motion.
   Hiccup is a symptom which likewise  attends in some  instances on  the hysteric disease ; and now and
then it happens  that a fit of hysteria consists of this alone.  In some cases of this nature it has been known
to continue for two or  three days, during which it frequently seems as if  it would suffocate  the patient,
and proceeds, gradually weakening her,  till  it either  goes off, or else occasions death by suffocation : but
this last  is extremely rare.   Besides hiccup, other slight spasmodic affections sometimes wholly form a fit
of  hysteria, which perhaps continue for a day or two, and then either go off themselves, or are removed
by  the aid of  medicine.
  In some cases the patient is attacked with violent  pains in  the back,  which  extend from the spine to
the sternum,  and at length  become fixed  upon the region of the stomach, being evidently of a spasmodic
nature, and often prevailing in so high  a degree as to cause clammy sweats, a pale, cadaverous look,
coldness of the  extremities, and a pulse scarcely perceptible. — Thomas.
  Discrimination. — Hysteria differs  from the hypochondriac affection in the following  particulars :  it
attacks more  generally the sanguine and plethoric ;  comes on soon  after the  age  of puberty, makes its
attacks suddenly and violently, and deprives the patient of sensation and voluntary  motion.   It is  accom-
panied with a sensation of a ball rising in the throat with a sense of  suffocation, and is attended  usually
with a spasmodic affection.
  The reverse happens in  hypochondriasis : it attacks the melancholy ; seldom occurs till after the age
of thirty-five ; is a  tedious disease, and more  difficult to remove.   Another  difference may be pointed
out between the two diseases, which  is, that hysteria  is much relieved by advancing  in  age ; whereas,
hypochondriasis usually becomes  aggravated.
  The two diseases have  often  been confounded  together \  but, from duly considering the foregoing
circumstance, it appears that a proper line of distinction  should  be drawn between them.   The hysteric
passion likewise differs from syncope :  as in this there  is an entire cessation of the pulse,  a contracted
                                                24 
1m»                        DISEASES'OF WOMEN AND CHILDREN.

face, and a ghastly countenance ; whereas, in the uterine disorder, there is often somewhat of a color, and
the face is more expanded ; there is likewise a pulse, though  languid ; and this state may continue two or
three days, which never happens in syncope.
   It also differs from  apoplexy, in which the abolition  of sense and voluntary motion is attended with a
sort of snoring, great difficulty of breathing, and a  quick pulse — which do not take place in  hysteric
ca>es.
   It differs from epilepsy, in that this is  supposed to  arise in consequence of a distention  of  the vessels
of the  brain ;  whereas, in  hysteria, the spasmodic  and convulsive motions  arise from a turgescence  of
blood in the uterus, or in other parts of the  genital system.   Hysteria may be distinguished from epilepsy
by the  globus hystericus, by the great  flow  of limpid urine, by the  sudden transitions from laughing  to
crying, and by the fear of death preceding and succeeding to the paroxysm.
   However dreadful and alarming an hysteric fit may appear, still it is seldom accompanied with danger;
and the disease never terminates  fatally,  unless it changes into epilepsy or mania, or the  patient is in a
very weak, reduced state.
   Common Treatment. — Bleeding copiously and repeatedly, sulphate  of zinc, mercury, antimony,
&r.   Is it not passing strange that the very practice should be  recommended and pursued by physicians
which  more often proves an exciting  cause of  the  disease than anything else?   Every one knows that
the nervous and the feeble  are  the  subjects  to this complaint.  With what  propriety, then, can  blood-
letting be  practised, when  it so invariably aggravates  the characteristic  symptoms of it ?  I have seen
delicate persons nearly bled to death, when every successive paroxysm was induced by the  very practice !
   Reformed Practice. — In the cure of hysteria, two indications are to be attended to : the first  is,
to allay the spasmodic symptoms  which constitute the fit;  and  the  second, to  lessen the excitability of
the nervous system, and  strengthen the whole frame during the intermissions  of the paroxysms.
   During a fit, the patient's dress should be  loosened, so that the circulation and respiration may be  as
little as possible embarrassed ; cold water should  be  sprinkled (or rather dashed) over the face, the body
laid in a recumbent position, with the  head elevated, and  a  current of  air admitted into the  apartment.
The attendants may  be employed in rubbing the temples, abdomen, and extremities.  Five or six per-
sons are often in the habit of clinching the  patient during  a hysteric fit, and  confining her to the bed,  or
in a certain position ; but this  practice should be  avoided.
   It is best to use only force sufficient to keep the patient  from  injuring herself or her attendants.   When
she suddenly rises and springs from the bed,  allow as much  latitude, liberty, and motion, to the body
and limbs, as  possible.
   If the patient discovers a disposition to roll upon the floor — to use the language of the late Professor
Smith, of New Haven,  " let her  roll."
   When  called to treat the disease during  the paroxysm, the first object will be, to suspend or shorten  it.
To this end, such measures must be adopted as have a tendency to divert the blood from the centre of
the circulating system to  the extremities ; in  other words, to  equalize the circulation and nervous excite-
ment.   That there is such  unequal  circulation, is very evident  from  the coldness of the extremities —
the feet, the hands, and the surface — while there is  a morbid or altered  condition of the  head or brain.
It will  therefore be of the first and greatest consequence to immerse the feet and legs in very warm water.
It is altogether  useless  to  prescribe  medicine, until such means  have  been taken as  are calculated  to
restore the balance of the circulation and the nervous influence.
   Having attended to the first step  in the treatment of hysteria, it will be necessary in the next place to
administer an  anti-spasmodic, or such medicine as will aid in cutting short the paroxysm.  I have found
the following medicine preferable  to any other, where there were no symptoms to contra-indicate the use
of an emetic : I allude to the tincture of  lobelia.  A tablespoonful may be taken, diluted with a little tea
or water, between  the fits,  provided  there  be  an intermission,  as  there  is in most cases.  It acts as  a
nervine, having a powerful tendency to allay the irritability of the nervous system ;  it removes the rising
in the  throat,  sense of suffocation, and the phlegm or mucus  collected upon  the stomach, while at the 
SEXUAL DISEASES.
It7
same time it throws the blood to the  surface and  extremities, and  makes  such an impression upon  the
brain and nervous system, that the paroxysm is often cut short by a single dose, even under the influ-
ence of spasms.   Where the teeth are tightly clinched, a small quantity of this tincture introduced into
the mouth, and between the  teeth, will relax the  muscles,  cause the patient  to  open  her mouth, and
enable her to  swallow.   Should it be, however, from any cause, impracticable to administer medicine
internally, administer the following injection or clyster:—
              Take a strong infusion of eatnep.............................................one pint;
                  milk...............................................................half a pint;
                  sweet or olive oil......................................................one gill;
                  molasses..............................................................one gill;
                  laudanum..................................................a small teaspoonful;
                  fine salt....................................................   "      "
   Mix, and let the whole be, if possible, introduced at a time, blood-warm, with a French syringe.
   This alone  rarely fails to moderate  the symptoms very speedily, and to  induce a complete intermission
of the  spasmodic action.
   It will be necessary also to apply fomentations to the  abdomen.   The following may be used :—
                             Take hops, wormwood, and tansy, equal parts.
Boil an hour or two in vinegar-and-water, and apply to the abdomen ; to be renewed as often as it grows
cold.   This course will soon bring about  an intermission of the  hysteric fit.  I  have seldom known  a
failure where it has been properly attended to.
   Should it fail, however, from any cause whatever, give  to the patient a  pill of opium containing about
three grains, or about the size of  a pea.   This is kjfallible under all circumstances and in all cases.   I
have prescribed it where a  number have  attended the person (under the influence of hysteric fits for a
whole  day), and, in  an hour or two, the  patient was free  from pain,  and convalescent.   I have  now
spoken of the  treatment of hysteria during a paroxysm ;  and  having suspended it, our next object will be,
to prevent a recurrence, which the patient is very liable to :  and this must be effected  by restoring the
tone of the system.
   We may commence  by giving  a  moderate cathartic ;  this will cleanse the stomach and bowels, and
prepare the way for medicine.   After  the  operation of  it, an  aperient pill must be taken to regulate  the
bowels, which in  this complaint  are habitually constipated ;  for this  purpose, I give a mild preparation,
denominated the anti-dyspeptic pill: it acts mildly upon the bowels, without leaving them costive ; neither
does it induce any nausea or griping.   Two  or three should be taken at bedtime, in a little currant-jelly
or roasted apple,  to be continued until the bowels become regular.   This  is very  necessary, as the corn-
plaint is often  induced  by an inactive or torpid  state of them, causing foetid gases and feculent matter to
accumulate in  the intestines.
   During the  day, the  patient should  take from half a wine-glass to a wine-glass of the  restorative cordial
or bitters.  This  preparation invariably improves the condition of the patient: it creates an appetite, gives
tone and energy to the nervous  system,  and  prevents a recurrence of  the  hysteric paroxysm.   The
following infusion may be  taken  with this preparation :—
                                  Take wild  valerian, or lady's-slipper ;
                                 •    skunk-cabbage : equal parts.
Add sufficient boiling water to make an infusion, to be taken cold through the  day, and particularly with
a view to allay that extreme irritability of the nervous system which causes wakefulness or want of sleep,
and which, indeed, is one of the characteristic symptoms of the complaint.  This  infusion is nervine and
anti-spasmodic.
   Where we  wish  to effect  a radical cure, a mild emetic may be  given  once a week.   Our common
emetic powders answer the  best  purpose  of any preparation with which  I am acquainted.  It  is  only
necessary to  excite gentle vomiting, which  contributes  much toward  the cure  by imparting tone and
energy to the  stomach and nerves. 
188
DISEASES OF WOMEN AND  CHILDREN.
   Where the hysteria assumes a lingering  or  chronic  character,  mild  emetics are very valuable.  Dr.
Dean, of Harrisburg, speaks of their efficacy in the following language.   He says : " In some cases
where the patients had labored under the disease for ten years, and during that time had, by the advice
and direction  of  respectable physicians, exhausted (with at most but temporary benefit) the whole class
of remedies which are usually prescribed, I have, by the  continued exhibition of vomits, either entirely
removed the complaint, or so far interrupted the habits of the diseased action in the stomach, that anti-
spasmodic and tonic medicines would, in general,  complete the cure."
   Dr. Tidd was  very much in the habit of administering the following preparation, which he called "the
hysteric pill:"—
              Take gum-assafcetida.......................................................four parts;
                  salts of hartshorn.....................................................two parts;
                  gum-opium............................................................one part.
Dissolve the gum-assafoetida over a slow fire, then combine it with the opium, which should be soft; and
afterward add the salts of hartshorn, made fine.   Let the whole be well incorporated together, and roiled
into pills of about two grains each :  one or two of these to  be given at a dose, particularly when there
are any cramps or hysteric symptoms.
   The above treatment with  me has been  uniformly and  invariably successful.  I have  been called to
the patient when  she  has been  nearly destroyed by the lancet, with a succession of paroxysms occasioned
by it — irritable, delirious, extremely feeble, countenance almost as white as marble ; and, by discontinuing
such  practice, and substituting the course here  recommended, a remission of all the hysteric and nervous
symptoms has foljowed, with convalescence and recovery.
   The following is the preparation so highly extolled_and  recommended by Sir Astley Cooper:—
              Take salts of hartshorn {carbonate of ammonia)...........................half a drachm;
                   mint-water {aqua menlha virode).............................one and a half ounces;
                   compound tincture of cardaman................(comp. tine, cardaman") half an ounce.
   Mix, and give two tablespoonfuls three times per  day.
   Regimen. — There is no disorder that requires  more care  and attention as regards diet, soothing or
kind  treatment, &c.  Nothing harsh  or censorious must be  said to the patient, or anything calculated to
arouse the passions or emotions of the mind ; she should  be kept as quiet and composed as  possible : no
sad intelligence is to  be suddenly imparted, if  at all; the mind to be kept as free as possible from every
kind of anxiety.  She must avoid  great fatigue or  labor—nursing of  infants who are too old — and, in
short, every cause of debility.  She must  exercise often  in the country, or  in the open air ; she must
never overload the stomach, but use a nutritious diet, and  such as easily digests.
   Some  years ago, I was called to a young lady of this city, recently from England, or Canada, laboring
 under this complaint, which had been brought  on  by adversity.  She had become reduced from  a degree
 of affluence to great poverty;  and, being ashamed  to make known her situation, she  submitted to great
 privation.  She was  finally assisted by a religious society; but a sense of her former and present situation
produced great nervous debility, hysterics, together with more  or less delirium.  A physician  of this city
had greatly aggravated  her  symptoms by his treatment:  he bled her until her countenance became like
 marble, her strength  gone, confined to the bed  with  great irritability of the nervous system, &c.   Besides,
 the family with whom she resided did not treat her  kindly.  All theee circumstances   rendered her truly
 miserable.   I  now reversed the treatment, and received her  into my family, endeavored to treat her with
 tenderness, in addition to proper  medical treatment.  The  change was surprising:  all  her unfavorable
 symptoms vanished; her appetite  returned, her  flesh, and her reason — strength and spirits; in short,
 she entirely recovered, and has remained well, at least ten years. 
DISEASES OF PREGNANCY.
189
                   CHAPTER  II.

DISEAS.ES   OF   PREGNANCY.
                                          SECTION  I.

                                        PREGNANCY.

  As soon as the female becomes pregnant, many new symptoms follow, such  as sickness at the stom-
ach, heartburn, peculiar longings, indigestion, headache, giddiness, Sec.
  The breasts become enlarged, shooting pains extend through them, and the  circle around the nipple
alters to a dark-brown color ; there often occurs likewise  a feverish disposition, with debility, emaciation,
irritability, and  peevishness of temper, and a total alteration of the  countenance, every feature of which
becomes sharpened.   Some women breed so easily as to experience hardly any kind of inconvenience
whatever; while  others, again, are perfectly incapable of retaining the least thing on their stomach, and
are thereby reduced to a state of extreme weakness.
   With some women the vomiting will continue during the whole or greater part of the second stage of
pregnancy, as well as the first; but this does not  usually  happen.  Partial suppressions of  urine, with a
frequent inclination to void  it, itching  about  the external  parts of generation, costiveness, tenesmus, and
the piles, are what they are chiefly incommoded by during this period.  Most women quicken  about the
sixteenth week after conception, at which time the mother becomes sensible of the slightest efforts of the
child ; and besides the  complaints just enumerated, she will then be liable to sudden faintings and slight
hysteric affections.
  According to the commonly-received opinion,  quickening, so  termed, has been  generally understood
to commence at the time when  particular sensations are perceived by the  mother, supposed to be occa-
sioned by the first motion of the child.   The most usual time of feeling any such symptoms is about the
latter end of the fourth or beginning of the fifth month of pregnancy  : at this period,  the uterus, filling up
the pelvis, slips out and rises above the rim ;  and, from that sudden transition, women of a  delicate consti-
tution and irritable fibre are apt to faint, more particularly so if in an erect position.
  During the last three months,  or third stage of pregnancy, general uneasiness, restlessness (particular y
by night), costiveness, oedematous swellings of the feet, ankles, and  private parts, cramps  in the legs and
thighs, difficulty of retaining the urine for any length  of time, varicose swellings of  the veins of the belly
and lower extremities, and  the piles, are the  affections which usually prove  most troublesome.  In weak,
delicate women, of an irritable habit, convulsive fits sometimes arise, which are ever to be regarded in a
dangerous light.
                                         SECTION II.

                       PARTICULAR  SYMPTOMS OF  PREGNANCY.

   Sickness of  the Stomach. — Some women are incessantly harassed by nausea, or sickness of
the stomach, and  that during the whole period of gestation or pregnancy.  For this" symptom  the patient
should take the following preparation :— 
190
DISEASES  OF WOMEN  AND CHILDREN.
             Take sala-ratus (bi-carbonate of potash)................................one drachm ;
                  distilled peppermint-water......................................eight ounces.—Mix.
   Of  this let a tablespoonful be taken occasionally, to  be accompanied with the use of  spearmint-tea.
Soda-powders  have also been found very serviceable to allay the irritability of the stomach in such cases;
but the best preparation that  I have ever found to relieve the sickness of the stomach  attendant on preg-
nancy is, an infusion or tea made of the rose-willow bark (cornus  sericca): this has proved in  my hands
exceedingly  valuable.  The bowels must be regulated by gentle laxatives.
   Heartburn. — For  the  heartburn, which  sometimes takes place in pregnancy, let  the mixture be
given mentioned under the head of sickness of the stomach.  If this  fail, let large teaspoonfuls of car-
bonate of magnesia be taken morning  and evening in a little milk  or syrup.
   Lethargy, Headache, &c. — When there is a  sense of fulness  in the head, with  giddiness and
plethora, a dose of our common 2>hysic should be given ; the feet must be immersed in warm ley-water,
and mustard-plasters applied to  them.  A vegetable and spare diet should  be  strictly adhered to : this
will prevent  the  necessity of bleeding.
   Costiveness. — If costiveness supervene, laxative medicine Ynust be taken ; but it  is  always better to
regulate the  bowels by stewed fruits, such as apples, peaches, prunes,  &c.
   Piles. — For the piles, apply the stremonum ointment, and obviate costiveness by the use of cream of
tartar and flower of sulphur, &c.
   Suppression of Urine. — For the suppression of urine, let half a wine-glass of best Holland gin
be taken in a tumbler of spearmint-tea.   If this fail to afford relief, apply fomentations  over the region of
the bladder,  and drink freely of parsley-tea.
   Toothache. — To relieve the toothache, a few drops of the  oil of cloves, red pepper, or  any other
essential oil, applied to the affected tooth, will often remove it for the time.
   Longings. — It is always  desirable  to gratify the peculiar  longings  of pregnant women :  otherwise
they are apt to miscarry, from the anxiety these occasion, when  not indulged in them.   That the child in
the womb can  be marked  by any depraved appetite of  the  mother, or  be mutilated by any disagreeable
sight that may  be present  to her, although perhaps not readily admitted by the majority of  medical men,
yet numerous instances are afforded of the marking of children  in  so singular a manner, that we can
scarcely refer them to any other than the above  causes, operating powerfully on  the  imao-ination  of  the
mother during  a  critical  period of gestation.   (For more extended  observations on this subject, see
accounts of  remarkable cases under the head of ncevus materna, or "mothers'1 mark," pao-es 77,  78.)
   Swelling  and Pain in the Breast. — Sometimes the breasts become swollen and very painful.
To obviate this symptom,  great care should be taken that no part  of  the  dress be tight over the breasts,
and they should be rubbed with a little sassafras-oil morning and night.
   Palpitation  of  the Heart. — When this affection occurs during pregnancy, it is usually from a
disordered state of the stomach, and it  must therefore  be cleansed by  moderate doses  of physic :  fifteen
or twenty drops of the tincture of digitalis to be taken three or four times per day in a little tea.
   Swellings. — There are often puffy  swellings in advanced stages of pregnancy, particularly toward
evening.  For this symptom, bathe the feet often,  and apply fomentations of  bitter herbs.
   Cramps. — For cramps of the legs  and thighs, which  often occur, let the  parts be rubbed with tinc-
ture of  capsicum ; the feet  must be often bathed in warm water, and the legs  should be  well covered
with flannel.
   Wakefulness,  &c. — Ftfr  wakefulness, want of sleep, &c,  give the tincture or  extract of hoos at
bedtime, and let exercise be  taken through the day.
   False  Pains. — False pains, resembling those attendant on actual labor, are  apt to  come on at a late
period of pregnancy, often occasioning unnecessary alarm.   Confinement in a horizontal position, laxa-
tive medicines  if costive,, and giving small and frequent doses of some opiate  until  the patient finds relief
may in such cases  be" necessary. 
DISEASES FOLLOWING  DELIVERY.                          191
                         CHAPTER  III.

DISEASES  FOLLOWING  DELIVERY.
                                          SECTION  I.

                                        AFTER-PAINS.

  Soon after delivery, these usually come on, and with  some women prove  remarkably severe.  The
quicker the  labor  has  been, the slighter will they prove in  general.   Women with their first child are
seldom much troubled  with after-pains ;  but as the uterus  is thought to contract less readily after each
future labor, so they are more liable to suffer from them in any succeeding delivery than in the first.
  When after-pains prove so troublesome as to deprive the  patient  of her rest, it will be necessary to
have recourse to fomentations or anodynes : red pepper and spirits simmered together a few minutes, and
flannels dipped in  it and applied to  the belly, will generally relieve them.  If it fail, apply a  fomentation
of bitter herbs, and give two teaspoonfuls of the tincture of hops in  milk  or tea.   If this fail, which I
never knew,  give fifty drops of laudanum.   These means are to be assisted by keeping  up a sufficient
pressure on  the belly at the same time, by means of a broad bandage.
  Costiveness. — This  is apt to  prevail after delivery,  and should  always be removed by a laxative
clyster, or some gentle purgative, such as senna  and manna, or  about an ounce of the oleum ricini, or
castor-oil.
                                         SECTION II.

                              UNDUE  FLOW  OF  THE  LOCHIA.

   In all women  a certain degree  of  haemorrhage usually takes place after delivery, produced  by the
removal of the placenta, which thereby lays  bare the mouths of the blood-vessels in the inside of the
uterus ; and this  commonly continues until the womb contracts to such a size as to close them up again.
The discharge for the first four or five days consists usually of florid blood, after which time it assumes a
mucous appearance, and so ceases gradually.
   In weak and relaxed  habits, it sometimes happens that, instead of saturating a cloth now and then, as
is  natural to all women,  the  blood  gushes out with  such  rapidity and violence as to run quickly  through
all the bed-clothes, and even to soak through the  bed itself, in which case the patient will be reduced
to  a  state of great debility if the haemorrhage  is not soon  restrained.  To effect this, the feet must be
immediately immersed in warm water ;  and if tljere is great pain in the abdomen,  a fomentation of hops
and wormwood must be applied, and the following powder given internally:—
             Take diaphoretic powders..............................................ten grains ;
                  capsicum, or Cayenne pepper...........•...........................ten grains.—Mix.
II  the pain and haemorrhage  be  considerable, give the whole; otherwise give one  half, and, in an hour,
give  the other.   At the  same time  administer  a strong decoction of the black cohosh and bethroot; apply 
192
DISEASES OF WOMEN  AND  CHILDREN.
cloths wet with vinegar, spirits, and rain-water, to the abdomen  and over the vagina.   If this does not
check the discharge in a short time, let the  patient  take alum-whey.  Pouring cold water on  the abdo-
men, over the region  of the uterus, from  a  height  of four or five feet, will generally arrest the flooding
immediately.
   Where a  suppression of the lochia ensues before  the accustomed period,  the discharge ought again to
be promoted, if possible, by plentiful  dilution, and  the application of warm fomentations to the parts.
Should these means prove ineffectual, gentle evacuations from the bowels must be made, the feet  bathed.
and perspiration promoted.
                                         SECTION  III.

                                     PUERPERAL   FEVER.

   Description. — This is a disease peculiar to women after delivery, particularly in lying-in hospitals,
and is supposed to occasion the death of nearly  one half who die in child-bed.  Three fourths of those
who have been attacked have fallen victims to it.   It commences, in general, three or four days  (some-
times a week) after delivery ; and it appears to occur oftentimes  as an epidemic.
   Causes. — Various reasons have been assigned  as the cause  of puerperal fever, but none very satis-
factory seems  as yet  to have been  given.   A check of  perspiration, from cold, combined  with a moist
and unhealthy state  of the atmosphere, probably gives  rise to it.   Morbific matter is retained, enters the
circulation, and is thrown upon some of the viscera of the abdomen, exciting inflammation and other
symptoms of the complaint;  or it may cause the complaint, by mixing with the circulating  mass.
   The  late Dr. Young, professor of midwifery at Edinburgh, was of opinion  that the puerperal fever,
strictly so called, is in every instance the consequence of contagion ; but  he contends that the contagious
matter of this disease is capable only of producing its effects,  in consequence of a peculiar predisposition
given by delivery and its results.  In support of this doctrine  he  remarks, in a paper read in the " Philo-
sophical  Society" of Edinburgh, that for many years the  disease was  altogether unknown in the lying-iu
ward of  the Royal infirmary in that city ;  but that after it was once  introduced into the hospital,  almost
every woman  was, in a short time after delivery, attacked with it: although prior to  delivery she may have
lain even for weeks  together, not only in the same ward  with the  infected, but even in the very next bed.
He further remarks  that it was  only eradicated  from the hospital in consequence of the wards being
entirely  emptied, thoroughly ventilated, and  newly painted :  after these processes, puerperal females in
the hospital remained as free from the disease as  formerly.
   With respect to the  infectious nature of this fever, a great contrariety of sentiment has indeed existed :
the probability is in favor  of its being so ;  but it is nearly impossible to form a decided opinion on  the
subject.  Doubtless  it will be the safest practice to consider it as infectious, and to  cut off all intercourse
of pregnant and parturient women with those who labor under it.
   It is certain that puerperal fever  has a  strong tendency to  the  typhoid type in an advanced   sta«-e,
although at its commencement, or  during the first twenty-four or thirty-six  hours,  it is  usually attended
with inflammatory symptoms,  and  even  with topical  inflammation in the  abdominal viscera, but more
particularly in the peritoneum, or membrane which envelopes  them.
   Symptoms. — Puerperal fever commences with rigor or chills, which are succeeded by great heat, and
frequently ends in perspiration ; but its characteristic symptom, by which it is always accompanied, is
pain in the region of the uterus, which, although generally attended with remarkable aggravations,  resem-
bling after-pains, has no complete intermission as they always have.  It is increased by motion, attended
by extreme soreness  and tenderness to the touch, and accompanied by a pulse so rapid as to rise  to one
hundred  and forty or one hundred  and sixty in a few hours after  the attack.
   The pulse,  especially during epidemic complaints, although full and strong, and  but moderately quick, 
DISEASES FOLLOWING  DELIVERY.
193
at the very commencement of the disease, in a few hours becomes very rapid, running up to one hundred
and sixty strokes in a minute, and is  then  proportionably small; at the same time the patient's strength
rapidly fails, her countenance expresses great pain and anxiety, and her head is frequently affected with
pain,  giddiness, and with  a ringing in her ears.  The secretion of milk is generally suppressed, and the
breast becomes suddenly flaccid.  The bowels in the  commencement are generally costive, but a diar-
rhoea  is soon apt to come on.   The belly swells to  a  great extent, and the tenderness is spread over the
whole abdomen, compelling the patient to lie immoveable in one posture, with her extremities drawn up,
and generally on her back ; although such is the extreme tenderness, that she can not bear the weight of
the bed-clothes.   The tongue soon becomes  foul;  the stomach  is oppressed with  nausea; and the teeth
collect a brown sordes.  The breath is offensive ; purple or red spots appear ; and extreme debility comes
on sooner in this than in any fever which begins with such decided symptoms of inflammation, and makes
a sudden and total change of its nature into that of  a putrid and malignant fever.
   This complaint frequently attacks within forty-eight hours ; usually within five days after delivery; and
in general, the earlier the  attack, the  more violent are  its symptoms.   It  runs through its  course  in a
very short period of time, ending in death in a few  days : indeed, a great and sudden mortality, particu-
larly in some epidemic  constitutions,  has  proved the  most distinguishing  as well as  the  most  terrible
characteristic of the  disease.    In some epidemics, very few indeed, in others it is  said none have recov-
ered : some patients  have  died  within  eighteen hours, and most of the fatal cases have ended within three
or four days ; but when it has  ended  in recovery,  the symptoms  have often been protracted  to six  or
eight days, with occasional but irregular intermissions and exacerbations; and it has been remarked  that,
after very  considerable  remissions — indeed, after  such  complete intermissions as to afford the most
sanguine hopes of recovery — the attack has been renewed with increased danger.
   Such, in general, is the course of the puerperal fever;  the symptoms of which, however, may be often
varied, according to  the constitution  of the patient, the  degree  of the  disease, and its earlier or  later
invasion after delivery.
   Prognosis. — The reappearance of the lochia, and a gradual subsidence of the abdominal tension and
soreness after copious stools, the  pulse at  the  same time  becoming  slower, with  a  moist skin, may  be
regarded in a very favorable light.  On the contrary, an  agitated  countenance, with  a hurried,  uncon-
nected manner of speaking, constant sighing, attended with a tossing about of the arms, pain and oppres-
sion at the chest,  visual  deceptions, imaginary strange sounds and voices, muttering and stupor, are to  be
considered as unfavorable  symptoms.   An extensive swelling  of the  belly, so as  to sound on striking it
with the  fingers,  sudden cessation of pain, irregularity  of  the pulse, coldness in the extremities, clammy-
moisture diffused over  the whole body, frequent dark-colored and foetid evacuations  by stool, and an
indifference to all external objects, denote  certain and  speedy death.
  Dissection. — The  morbid appearances observed on  dissection are usually confined to the abdomen.
The first thing that often presents  itself is a collection  of  whey-like fluid in  the  cavity of the abdomen,
which is  sometimes so considerable in quantity as to amount to several quarts ; and  it  has a peculiarity of
smell  different from that of any  other fluid to be met with in the human body, either in health or disease.
Where it is large in quantity, the surfaces of the different viscera and of  the peritoneum will usually be
found covered with a  crust formed of a solid part of this matter, resembling coagulated lymph.  If there
be any interstices between the intestines or the other viscera, they are frequently filled with large  masses
of the same, adapted exactly to the shape and size of such  interstices.  In a few cases, a deposite  of a
caseous and serous nature has  been discovered likewise in the head, breast, and external  cellular mem-
brane.  In most instances, there is found a slight degree of inflammation in some part of the  cavity ;  but
it is not confined invariably to  any particular place : as the uterus, ovaria, peritoneum, omentum, intes-
tines,  and bladder, have all in their turn been  observed in a state of inflammation.  In  many cases of
dissection, a considerable quantity of  purulent matter has likewise been  found  in  the  cavity  of the
abdomen.
  Common Treatment. — Bleeding, profusely and  repeatedly, mercury, blisters, opium,  &c.
                                               25 
191
DISEASES OF WOMEN  AND CHILDREN.
   Keiokmijd Practice. — It requires no discernment to see  the  pernicious effect  of  the  preceding
practice.  Some  bleed  five or six times  in  succession, which soon sinks the  patient into the arms of
death.   Mercury  is also given  at the same time, which hastens dissolution.
   Indications  of Cure. — The  principal  indication in the cure of this disease is, to subdue the
inflammatory symptoms : to effect which, sweating  and purging  are the  two herculean remedies  to be
relied on.
   Some prescribe emetics in  puerperal  fever, but  I have  very little confidence  in  their  utility.   The
sweating-drops must be given in doses of a teaspoonful in a tumbler of  catnep-tea every two hours until
free perspiration  is produced.  Physicians in  general  place their greatest reliance on  copious bleeding.
We place our greatest reliance on copious perspiration.   It must  be  continued  until  the  inflammatory
symptoms subside.   Bathing the surface and feet greatly promotes it.
   Purgatives are exceedingly important in reducing this fever.  For this purpose give saffron and snake-
root tea, which should be  repeated at  least once a day.   If  vomiting  supervenes, administer  the saline
purgative :—
             Take Epsom salts............................................".%>.........eight ounces;
                  hot or boiling water................................................eight ounces ;
                  muriatic acid........................................................one drachm.
   Give a tablespoonful in a tumbler of mint-tea every hour till it acts upon the  bowels.  This stops the
vomiting, allays the heat, and in every respect acts favorably.
   " To alleviate  the soreness  and  distention of  the  abdomen, we may recommend the  application of
fomentations both inwardly and externally : inwardly, by injecting every four  or six hours,  and adminis-
tering emollient clysters from time  to time ;  and externally,  by applying flannel cloths wrung out in  a
warm decoction  of equal  parts of camomile-flowers and-bruised poppy-heads, with an  addition of  about
one third of rectified  spirits, over the whole region of  the  abdomen ; and  these ought  to be renewed as
often  as they become cold, taking  due care that  they are not so wet as to run about the bed and incom-
mode the patient."
   After suitable evacuations, diaphoretic powders may be given, particularly at bedtime.   The  dose must
depend on the severity of the pain,  and the age and constitution of the patient;  it may be repeated  every
two hours until there is a mitigation of the symptoms and a moisture of the skin.
   Should putrid  or malignant  symptoms commence, yeast must be given — as much as the stomach will
bear.    Wine and porter may likewise occasionally be given ;  an infusion of camomile-flowers,  cold, may
also be taken to  keep up the strength of the patient, with nourishing diet, &c.   Dr. Guinot recommends
ten or twelve grains of the carbonate of potash to  be  given in any proper vehicle three times  a day, not
only in puerperal fever, but in all  diseases connected with the secretion of milk.  This treatment he
recommends under the idea that the disease is occasioned by a predominance of acid.  Other practitioners
likewise speak of its good effects.
   Regimen. — A very light,  cooling diet should be used in  the  commencement  of the disease ;  and in
the latter stages of  it a more nutritious diet is  recommended, such as Indian-meal  gruel,  panado, toast,
and bread-water,  barley-water, rice-water,  &c.
   Precaution. —" It would appear," says an  experienced physician, " that the effluvia of a patient
under puerperal fever is an animal poison sui generis, capable  of acting on pregnant females,  their situ
ation  giving the predisposition necessary for the operation of its influence.  The usual  mode of commu
nicating the infection  in private  practice is by being delivered by some accoucheur who has lately been
attending a  woman laboring under  puerperal fever, or her being visited by female friends who  have been
where it prevailed.  It therefore behooves every practitioner, when he meets with the disease,  to observe
every possible precaution  in changing his clothes, and  by careful ablution of his  hands to  guard against
conveying infection to other parturient women :  moreover, all pregnant  women  should  be  excluded from
the house ;  nor  should  the nurse  or other  persons  about the sick be permitted to go abroad and visit
women in a stage of pregnancy. 
DISEASES FOLLOWING  DELIVERY.
195
  " To prevent the disease from  occurring, it will be  proper to  keep the  patient's  mind, both before,
during the time  of labor, and afterward, as  free from  every kind  of uneasiness as possible, as anxiety
might greatly predispose to an attack  of it.   She  should likewise carefully avoid any exposure  to  the
infection of  fever before delivery, as well as to the occasional causes of it afterward.   Every woman
lately delivered ought cautiously to guard against cold ; but,  in doing this, her room should at the same
time be kept of  a proper temperature by allowing a sufficient ventilation.
  " It being a well-known  fact that puerperal fever  has been  chiefly confined to close apartments and
small hospitals — and that since the lying-chambers have been made more  airy and commodious, and the
hospitals larger,  the disease seldom  prevails  epidemically, or becomes  general — due attention should be
paid to a free ventilation ;  for it is by no means improbable that  a cool air in a lying-in chamber will
frequently prevent, and its opposite be likely to induce,  the phenomena of puerperal fever.
  " The patient should observe the strictest cleanliness, both as to  herself and  the  bedding.   On  the
coming of the milk, her breasts ought to be  drawn repeatedly throughout the course of the day, by some
person accustomed to the business, or by applying the child ;  her body  should be kept  perfectly open
after she is  delivered, as well  as  before her confinement, by some mild purgative medicine, and she
should abstain from all food of a heating or  irritating nature.
  "An upright  posture will be most  proper, in  order  to  discharge  more readily any putrescent matter
that  may be in the uterus."
  When the disease prevails as an epidemic among puerperal women,  or  occurs  in a lying-in hospital,
all communication ought immediately to be cut off between those  who  are affected and such as have
lately lain in, or expect shortly to do so ;  and in order to root out the disease and stifle contagion, we
should have recourse  to fumigations, and afterward to  painting,  whitewashing, and  a  free  ventilation.
Vinegar should  be frequently burnt in the patient's room, particularly after the bowels  have been evacu-
ated.   The hands, body, and face of the patient may occasionally be  bathed with vinegar.  Bitter and
aromatic herbs may be kept  continually in the room ;  if  it is in the winter  season, let these  herbs be
boiled with  vinegar and water, and the vapor from  them be diffused through the room.   This is not only
very refreshing to the patient, but it  likewise  prevents  the spread of the contagion.  As little  noise as
possible should  be permitted, and the patient must be kept cool and  quiet.
                                          SECTION IV.

                                         MILK-FEVER.

  About the third or fourth day after  delivery, the  breasts generally become turgid and  painful, from
the secretion  of milk which theai takes place in them.   When this is moderate and free, no inconvenience
will be experienced ; but when copious, and accompanied  by any obstruction in the lactiferous tubes, in
consequence  of the use of some repellant application, or  of an exposure to cold, the  breasts will then
become hard, swelled, and painful,  and  a small fever will arise, accompanied  by nausea, restlessness,
pains in the head and back, and a considerable degree of thirst.
  To prevent any consequences of this kind, it will  always be advisable to apply the child to the breast
at a very early period after delivery.   By delaying to do so immediately on the secretion  of milk com-
mencing, the breasts are not only apt to become much enlarged and distended, but the nipples are often
so much retracted, that the child can not lay hold of them  without the greatest difficulty.
  Where the mother's milk will not admit of her suckling  the child, or any other thing happens to pre-
vent it, she should be careful to  have her breast  drawn three or  four times a day by some other person ;
and with the  view of preventing a copious secretion  of milk, she should use a very spare diet, keep her
body perfectly open with laxative medicines, and abstain  as much  as  possible from all liquids.  This 
196
DISEASES OF WOMEN  AND  CHILDREN.
mode of proceeding will be far preferable to the use of repellant applications to dry up or put a stop to
tiie secretion.
   If any degree of fever arises, besides confining the patient to a spare diet, keeping her very quiet, and
obviating costiveness by means of cooling laxatives, bathe the feet and promote perspiration.
                                          SECTION V.

                    INFLAMMATION  AND  TUMORS  OF  THE  BREAST.

   From exposure to cold, and neglecting to put the child  at an  early period to the breast, or  to  get
them drawn by some other person, accidents of this nature happen very frequently to lying-in women.
   The same practice should be adopted in this case of inflammation as in every other, and the discus-
sion of the tumor ought to be attempted on its first appearance; the distress and pain which always attend
on a suppuration of the breasts  being very great.   When the inflammation and  swelling have been of
such long standing as to show an evident  tendency  to suppurate, any attempt to discuss  the  tumor will
not be advisable.
   Where discussion is proper, recourse should be had at a very early period to a  strict pursuance of the
antiphlogistic and discutient plan.  The strength is to be supported by a cool, spare diet;  the body is to
be kept perfectly open  with mild laxatives ; febrile heat is to be abated by refrigerants ; pain and irritation
are to be allayed by sufficient doses of the diaphoretic powders ; and the inflammation, when consider-
able, is  to be abated by means of fomentations applied to the part, as likewise by the application of linen
cloths dipped in some sedative lotion.  To assist the effect of these means, the breasts are to be evacu-
ated frequently throughout the course of the day, but more  particularly the  one  diseased, either  by the
infant or some other person accustomed to  the  business.   When they are so much  swelled as not to
allow of laying hold of the nipple, the proper glasses made for that purpose should be employed.
   If the tumor proceeds to suppuration, notwithstanding we may have  used every  endeavor to prevent
it, we should then assist the operations  of  nature by the application of emollient  poultices and fomenta-
tions.   As soon as the suppuration  is completed, the  tumor should  be opened, after which it may be
dressed with dry lint, and  a plaster of black salve be laid over all.  Should any fresh suppuration  ensue,
which not unfrequently happens, the same mode of treatment must be adopted ; and  that proper pus may
be formed, the restorative  cordial, with a moderate quantity of wine, will be necessary.
                                         SECTION  VI.

                          PHLEGMASIA  DOLENS, OR  MILK-LEG.

   This'disease is not of very frequent occurrence;  but it is occasionally met with in women a few days
after delivery, and is evidently of an inflammatory nature, not only affecting the limb, but also the whole
system in some degree.   Some  cases do occur in which the complaint is not confined to only one of the
lower extremities, but occupies both of them ; and it sometimes happens that, after it has subsided in one
limb, the other  1ms been attacked in a  similar way.
   Symptoms. — The disease is marked by a firm, glossy, elastic,  and  painful swelling, of a white or
pile color,  which pretty suddenly seizes the  leg,  foot, and thigh of a  woman some days  after her delivery
of the  child, and thence extends upward to  the external parts of generation,  groin  of  the side affected
and loins.    The attack is generally preceded by a sense of coldness over  the whole body, with shiver-
ing?, which are succeeded by febrile heat, thirst, and an  acceleration of the  pulse.   At first the patient 
DISEASES FOLLOWING DELIVERY.                          197
experiences a  stiffness, weight, and pain in the limb, which  are  much increased upon her making any
attempt to move it or the lower portion of the body.  After  a time the extremity becomes very tender to
the touch, hut shows no discoloration ; it is, however, hotter than what is natural, and feels much fuller
than usual.  When pressed upon with the finger, very little  indentation takes place, and what  does occur
is soon effaced.   If a puncture is made into the  limb, no fluid in general  is discharged ;  but  should any
escape, it does not coagulate.
   In the course of some days (say from six to twelve), the  febrile symptoms diminish, and the swelling,
heat, tension, and tenderness of the affected limb, begin to abate, first in the upper part of the thigh, and
afterward in the leg and foot.  The febrile symptoms having  gone off, the patient experiences considerable
debility,  and the extremity feels stiff, benumbed,  heavy, and  weak.  It seldom returns to its original size,
but on the  contrary remains enlarged throughout life.
     Causes. —This disease is occasioned by tedious and  difficult labors, exposures to cold, by getting
out of bed too soon, the suppression of natural secretions,  particularly the lochial discharge and flowing
of the milk, or by improper treatment of the woman after delivery.   Some physicians have assigned  an
obstruction  or  rupture of  the lymphatic vessels of the part, as  a cause  of the complaint.  It seldom
terminates  fatally, and but very rarely is  followed by any suppuration in the parts affected.
   Treatment  and Regimen. — Due regard must be paid to the stage  in which  the disease exists.
During its  first or inflammatory stage, if the  febrile symptoms run high, perspiration  must be promoted,
the bowels  must be well opened by some gentle cathartic, and then  the circulation be determined to the
surface of  the body, and a gentle moisture of the skin promoted.
   The limb may at the  same time  be well fomented with flannel cloths wrung out in a  warm decoction
of hops  boiled in vinegar.
   During  the first or inflammatory stage of the disease, the patient must be restricted to a  cooling and low
diet; but,  in the last, more effective nourishment should be allowed her, together with a use of wine —
proportioning both to the existing degree of  debility.
                                        SECTION  VII.

                   PROLAPSUS  UTERI,  OR  FALLING  OF  THE  WOMB.

   This complaint is frequently met with among women who have  had many children or frequent  mis-
carriages, particularly those of a delicate constitution and with lax fibres.  Sometimes it is occasioned by
risin"- too soon out of bed after delivery, and before the parts have regained their usual tone or strength.
In single women it now and then  takes place, from lifting some heavy weight, jumping, dancing, or some
violent exertion during or soon after menstruation ;  and occasionally it has arisen as a consequence of the
whites long continued.
   The disease is usually accompanied by a sense of bearing down, as also pains in the back, groins, and
private parts, which  unpleasant  symptoms are relieved by a  horizontal position.   In some cases  the
womb only falls lower than it ought to do ; but in others, it protrudes beyond the external parts.  Before
the tumor appears outwardly, there is sometimes a considerable discharge of  a mucous fluid,  but this is
generally lessened when the protrusion takes place.
   A falling of the womb, although a local  disease, is often  productive  of distressing symptoms which
injure the woman's general health  : and these arise from the functions of the  stomach  and bowels being
impaired, and the nervous  system  somewhat affected.
   Treatment. — In slight cases of this complaint, confining  the woman  a. good  deal to a recumbent
posture upon a sofa or hair-mattress, instructing her to make use of cold water, and, by means of a large
sponge, well wetting  the back, bottom of  the  belly, and  parts  more  immediately concerned, and  the 
198                        DISEASES OF WOMEN  AND CHILDREN.

injecting a little of the fluid up the vagina by means of a syringe, will sometimes be sufficient, particularly
if assisted by a nutritive diet, and medicines of a  strengthening nature, such  as  the  restorative cordial.
Costiveness  must at the same time  be guarded  against, by taking,  if necessary, some gentle laxative —
observing, however, not to excite the bowels to over-action, as this would be injurious.
  In cases of long standing, and which resist the simple ablution and injecting with cold water, or where
there is a considerable discharge of mucus  or  other matter, it will then be necessary to substitute some
more powerful injection, such as a decoction of oak-bark, in which is dissolved a little alum.
  Where the womb  protrudes,  it ought to be  replaced  by laying the woman on  her  back, applying the
fingers and thumb to the  lower  part of the tumor, and then by a  gradual and gentle pressure carried
upward into its centre,, and continued, the  parts  are  to  be returned to their natural place.  This, being
effected, a proper-sized sponge is  to  be introduced,  and  the woman kept in a  recumbent posture for
several hours ; the sponge ought to be introduced as high up the vagina  as can be borne easily, and it
must occasionally be removed and well cleansed.   As the parts recover  their proper strength and tone,
one somewhat of a smaller size should be substituted.  It will  be necessary to use a bandage, made by
passing a piece of linen, of a suitable width, just above the hips, and fastened on the right or left side of
the abdomen with tapes  or buttons ;  a piece fastened to this  behind, brought between the  legs,  and
secured to the'bandage around the body ; likewise in front, or before, in the same  manner.
  A woman afflicted with this complaint, and who  becomes  pregnant, will not require  the use  of the
sponge after the  third  month, and, by being very cautious  after her  delivery, may perhaps be  able to
prevent any  return of the  disorder.   Let her not therefore be in too great a hurry to  quit  her bed ;  and
when sufficiently recovered  so to do, she  should avoid as much as possible for some  time an erect
position, and all active exercise,  or  much exertion.
                                        SECTION  VIII.

                              INFLAMMATION  OF  THE  WOMB.

  An inflammation of the womb is a dangerous and not unfrequent disease after delivery.  It is known
by pains in the lower part of the belly, which  are  greatly increased upon  touching ;  by the  tension or
tightness of the parts; great weakness; change of countenance ;  a constant fever, with a weak and hard
pulse; a  slight delirium, or raving;  sometimes incessant vomiting ;  a hiccup ;  a discharge  of reddish,
stinking, sharp water, from  the womb ; an  inclination to go frequently to stool;  a  heat, and  sometimes
total suppression of urine.
  This  must be treated  like  other inflammatory disorders, by fomentations, purgatives, and  sudorifics.
The drink may be thin gruel or  barley-water ; in a cup of which, half a drachm of nitre may be dissolved,
and taken three or four times  a  day.   Clysters must be frequently administered,  and the belly should be
fomented by hops simmered in vinegar.
                                         SECTION  IX.

                                  EXCORIATED  NIPPLES.

   From the constant state of moisture in which these parts are kept with  those who give suck, sucn
occurrences are very apt to happen.   When excoriations  do arise, these parts should be washed  often
with borax-water, and then be  sprinkled with  a little  powder of elm-bark ;  afterward  a plaster of the
healing or black salve applied.  This  will soon  cure them.  The infant may be nursed, notwithstanding
these applications. 
DISEASES OF CHILDREN.                                199
                                          SECTION  X.

                                ATROPHY  FROM  SUCKLING,

  Some women of a delicate constitution can not suckle long without an evident appearance of declining
  ilth ;  and if persisted in, it might terminate in a general wasting of the body and loss  of strength, or
some morbid affection of the lungs.   When, therefore, a woman finds her health declining, and that  she
gets  weaker every day, with languor and loss of appetite, she ought  immediately to leave off suckling :
she should use a  very generous diet, with a moderate quantity of wine daily;  and, if convenient, change
the air,  particularly if an  inhabitant of a large  and populous city or town.   If  the change is not found
sufficiently efficacious of itself, when conjoined with a restorative diet, a course of tonics should be given.
Gentle exercise on horseback or in a carriage will greatly assist the effect of these remedies.
                CHAPTER  IV.

DISEASES  OF   CHILDREN.
                                          SECTION I.
                                    STILL-BORN  INFANTS.

  Infants are sometimes born without showing  any appearance of life ,* but  where this, at the same
time, is only suspended (not totally annihilated), the apparent cessation of the action of the heart and lungs
may be owing to a variety of causes — such as universal weakness of the vital powers ; collections  of
glairy matter in the windpipe ; or a congestion of blood in the lungs, arising either from a long-protracted
labor, and consequent detention of the head in the passage, or the neck of the infant being  lightly encircled
by the navel-string or the mouth of  the womb, so as to stop the circulation of the blood.
  When the infant shows little or no  signs of  life after a tedious labor, it ought  to be cleansed, and then
be wrapped up in flannel, having first well rubbed its chest with volatile spirits  mixed with brandy, and
stimulated its nostrils with volatile salts.  Should these means fail in reanimating it, we may introduce a pipe
or flexible catheter into its mouth, and thereby endeavor to fill the lungs with  air, and make them perform
the  office of respiration : which plan  ought to  be persevered in for a considerable time.   Besides these
means, the infant may be immersed in a warm  bath, in order that a proper degree of heat may be restored
to its body.   In all such cases it will  be of the utmost consequence also not  to  detach the after-birth  too
soon from its connexion with the womb, and not to  be in a hurry to apply a  ligature on  the navel-string.
These are the first steps to be attended  to.
  If  a portion of the  glairy fluid in which the child floats  in the womb gets into the windpipe or  the
mouth, and renders the breathing difficult or rattling, its throat ought not only to be well rinsed and washed
out, but it should be placed in an attitude that will facilitate  the discharge of  the fluid ;  that is, by laying
its head lower than its  body.  This being done, endeavors should be made to reanimate  the infant: first,
by inflating the lungs in the manner before mentioned, and  then  pressing  on the chest to extricate  the
air — imitating thereby natural respiration.
  Where there is either stupor present, or congestion  in  the lungs, it will  be  advisable  to  lessen  the
determination of the blood to tbe head or chest,  by suffering a small quantity  of blood to be lost  from  the
divided navel-string prior to putting a ligature round it. — Thomas. 
200
DISEASES OF WOMEN  AND  CHILDREN.
                                         SECTION II.

                             RETENTION  OF  THE  MECONIUM.

  The bowels of all infants at the time of their birth are filled with a blackish-colored and viscid matter
of the consistence of syrup, known by the name  of meconium.   The efforts of nature are in general suffi-
 ;ent to dislodge and carry it off, if assisted by the  mother's milk, which  is always  at first of a laxative
quality, and therefore infants should be applied to the breast as soon as they show an inclination  to suck.
But should it be  retained, or not sufficiently carried off, a  small teaspoonful  of castor-oil, or a  little
senna-tea may be given, particularly if the secretion of milk in the mother's breast is rather tardy.
                                         SECTION  III,

                        ACIDITIES,  FLATULENCY,  AND  GRIPES.

   The species of food most commonly employed for the nourishment of children being of  an acescent
nature, is apt to turn sour on the stomach, particularly if the body be any way disordered.   Hence most
of the complaints of children are accompanied with evident  signs of acidity, such as flatulency^, griping
pains, and stools of a green color.   The  child so affected becomes restless, cries much, and draws up
its legs forcibly to its body ; is  troubled with sour belchings,  vomiting, or purging, and not  unfrequently
becomes convulsed.
   Newborn infants, until they are about three months old, are apt to be affected with much distress from
flatulence (or wind), or some of the causes mentioned.   An infusion  or tea made of the  flowers or leaves
of catnep will always  afford relief.  Sometimes a few fennel-seeds may be  added, with  a little gin.   If
the pain  be very great, and prevents the infant from sleeping, one or  two hops may be added, and the
tea sweetened with loaf-sugar :  a  few spoonfuls of it may be  given.
   It answers a much better purpose than paregoric, or any other preparation of  opium : affording relief
without producing costiveness, nausea, or  any other unpleasant symptom.   Sometimes, however, it may
become necessary to give some preparation of opium, such as paregoric, or  syrup  of poppy.
   To remove offending  matter, it will be  sometimes necessary to give  the  infant about two grains of
salaeratus and rhubarb, mixed in a little peppermint-water, or  tea-and-water, with loaf-sugar.   The medi-
cine, at the same  time that it occasions a gentle  operation of the bowels, will  tend  to correct the  acidity :
by which  means it not only removes  the  disease, but  obviates its  cause.   If necessary,  it  should be
repeated the succeeding day, being far preferable to prepared  chalk and such other medicines, which,
although they correct  the acidity,  are apt to lodge in the bowels, and occasion costiveness.
   A costive habit  is, indeed, of itself, a frequent cause  of flatulency and griping pains in infants ;  and
when it occurs, ought to be obviated by administering the above medicine.   If not found sufficiently active
fifteen or twenty drops of the compound tincture  of senna may be added.   When the  griping pains are
very acute, warmth may also be applied externally to the  stomach and bowels, by fomenting them with
bitter herbs.
   In  infants who  are brought up by the hand, it will  be necessary to  pay the  strictest attention to their
food,  and carefully to observe what seems to agree best with  them.  Such infants are very apt  to be
troubled with acidity and flatulency in their stomach and bowels, and therefore it ought to be prepared
fresh once or twice a day, and to  have a few fennel-seeds (enclosed in a small bag) boiled up in whatever
farinaceous substances are given to them  as food.   Where  pap, arrow-root, or the like productions, do
not seem to agree, the crumbs of bread, mashed very fine in  a little chicken-broth  or weak beef-tea, may
be substituted occasionally. 
DISEASES OF CHILDREN.
201
                                         SECTION IV.

                               GALLING  AND  EXCORIATION.

  Young children are very apt  to become excoriated in  particular  parts of the body, especially about
the  groins, wrinkles of the neck, behind the  ears, and under the arms — such places being kept much
moistened by urine or sweat.
  These complaints prove very troublesome to children, and  are in some measure owing to a want of
due cleanliness in the mother or nurse.   To prevent them, and  likewise to  remove  them when they do
occur, it will be necessary to wash the parts  well with cold water  once or twice a  day, to change the
linen often, and keep the child perfectly clean  and sweet.  After the  child is washed and dried, tbe parts
affected may be sprinkled with a little fine elm-bark.   Where the galling or excoriation is considerable,
the  parts, after having been washed with cold  water, may be  wetted with a linen rag moistened in equal
parts of Jamaica spirits and common water, and then be dressed with  fine lint spread with elder-ointment.
                                          SECTION  V.

                                 LOOSENESS,  OR   PURGING.

   This complaint, as well as  flatulency and gripes, often arises in children from  the  introduction of
unwholesome food into the stomach, as well as the sudden disappearance of some cutaneous eruption of
a critical nature ;  and infants who have been recently deprived of the breast are sometimes greatly disor-
dered in their  bowels by frequent, watery stools, attended with gripes, and occasionally by convulsions.
When this happens, restoring  the child to the breast of its former  nurse, or that of another, should not
be neglected, as the first necessary step to be taken.  A little of the neutralizing physic or mixture will
soon remove this  complaint.
                                         SECTION VI.

                                 TEETHING,  OR  DENTITION.

   Arbuthnot states that above a tenth part of infants die in teething, by symptoms proceeding from the
irritation of the tender nervous parts of the jaws, occasioning inflammation, fever, convulsions, gangrenes,
&c.  These symptoms  are in a  considerable measure owing to the great delicacy and exquisite sensibility
of the nervous system at this  time of life, which is too often increased by an effeminate education : hence
it comes to pass that children who are delicately brought up always suffer most in teething, and often fall
by convulsive disorders.
   About  the sixth  or  seventh  month, the teeth generally begin  to make  their appearance : first, the
incisors, or fore-teeth ;  next,  the canini, or dog-teeth ; and, lastly, the molares, or grinders.  About the
seventh year, there comes a new set;  and,  about the twentieth, the  two inner grinders, called denies
sapientie — the teeth of wisdom.
  Children, about the time of cutting their teeth,  slaver much, and have generally a looseness.  When
the teething is difficult, especially when  the  dog-teeth  begin  to make  their way through the gums, the
child has  startings in its sleep,  tumors  of  the  gums, watchings, gripes,  green stools, the thrush, fever,
difficult breathing,  and convulsions.
  Difficult teething  requires nearly  the  same  treatment  as  an inflammatory disease.  If the body be
bound, it must be opened  either  by emollient clysters or gentle purgatives, as senna,  manna, rhubarb, &c.
                                                26 
?02
DISEASES OF WOMEN  AND CHILDREN.
The food should be  light, and in small quantity;  the drink plentiful, but weak and diluting, as infusions
of balm,  catnep-flowcrs, &c, to  which about a third or fourth part of milk may be added.
   Sydenham says that, in fevers occasioned by teething, he never  found any remedy so effectual as two,
three, or four drops  of spirits of hartshorn  in a spoonful of simple water  or other convenient vehicle,
given every four hours.
   When children are cutting their teeth, a small strengthening-plaster may be placed between their shoul-
ders : this  generally eases the tickling cough which attends  teething, and  is by no  means  a useless
application.   When  the  teeth are cut with difficulty, it ought to be kept on during the whole time of
teething.   It may be enlarged as occasion  requires, and  ought  to be renewed at least once a fortnight.
   Several things have been recommended  for rubbing the gums, as oils, mucilages, &c.; but from these
not much is to be expected.   If anything  of this kind is  to be used, we would recommend  a little  fine
honey, which may be rubbed on with  the  finger  three  or four times a day.   Children at this  time arc
generally disposed to chew whatever  they get into their hands :  for this reason  they ought never to  be
without somewhat that will yield a little to  the pressure of  their gums.
   With regard to cutting the gums, we have seldom known it of any great benefit.  In obstinate cases,
however, it ought to  be tried.  It may be performed by  a  penknife or lancet.
   In order to render the  teething less difficult, parents  ought to  take  care  that their children's food be
light and wholesome, and that their nerves be braced by sufficient exercise.
   Infants during dentition are subject to sudden attacks  of spasm about the windpipe, producing a tem-
porary feeling of suffocation, with a crowing sound : but there is no hoarse cough.   It  is apt to  take
place suddenly at night, or when  crying.  It is cured by giving  a combination of tincture of bloodroot
and  lobelia, and  by using laxatives; the tepid bath is also useful.   The gum may be cut; and if there be
any  tendency to  a return — particularly if the child be hot, the pulse quick, the eye heavy, and the face
unusually pale, or flushed — purgatives should be given, the  feet bathed, and garlic applied  to them.
                                         SECTION VII.

                            BOWEL  COMPLAINTS   GENERALLY.

   A great proportion of infants are cut off before they are a year old, from bowel complaints, particu-
larly in populous cities ; and  most of them arise from  an unnatural (and I was  about to  say wicked)
practice of such vast numbers of persons crowding together in  small, filthy, and confined  apartments  or
houses.  In this city there  are instances where a dozen families occupy one tenement; and in Europe it
is no doubt much worse.   This alone is  sufficient to account for most of the bowel and other complaints
of infant children ;  but when we add to this the  great quantities of trash  or green fruit they eat, can we
wonder that so many are sent to an untimely grave ?
   Children are  always sickly in the fruit season, which  may be thus accounted for :  Two thirds of the
fruit which comes to market in  this country is really unripe ;  and  children, not  being in a condition to
judge  for themselves, eat whatever they can lay their hands upon,  which  often  proves  little better than a
poison to their tender bowels.   Servants and others, who have the care of children,  should  be strictly
forbidden  to give them any fruit without the knowledge of their parents.
   In all these complaints it must be recollected that prevention is better than cure.   Their diet  must be
attended to : it should consist principally of milk, and at  a suitable  age it must  be boiled with a little
flour.   No fruit should be  given, extept it  be fresh and ripe.   Their apartments, persons, and clothing
must be kept perfectly  clean ;  and  it is of the highest importance that they be placed in pure air, and, if
possible, in the country.
   As soon as the bowels become disordered, the  neutralizing cordial or mixture must be given.   This 
                                  DISEASES OF CHILDREN.                               203

medicine will almost immediately remove the acidity of the stomach and pain in the bowels, change the
appearance of the passages, and, in  a word,  cure the complaint.
  Sometimes it may be necessary to give an infusion or tea of raspberry-leaves, bene plant, &c.; foment
the  bowels also with bitter herbs.
                                       SECTION VIII.

              A P T H H iE ,'  THRUSH,  OR  CANKER,  AND  CONVULSIONS.

  Infants and children  are often  affected with little sore spots or  eruptions about the mouth, and it
usually extends from the stomach to the end of the bowels, giving  rise to  many painful  and unpleasant
symptoms.   This complaint arises from a morbid state of the stomach, and it must be treated by giving
a gentle neutralizing  physic.   The  mouth  may be often washed  with  a decoction  of sage and hyssop,
sweetened with honey, with a little fine borax added.
  Convulsions.—When fits or convulsions arise from teething or any other cause, the feet must be
immediately bathed  in  warm  ley-water, and  an anodyne must be  administered, such as the  syrup of
poppy or paregoric.
  Garlic should be bruised and applied to the stomach ;  and if there be heat  of the head, spirits, rain-
water, and  vinegar, may be applied.   These means must be Repeated as often as fits occur ; in  obstinate
cases it  may be necessary  to use  a warm bath.
                                         SECTION  IX.

       SORENESS  OF  THE  NAVEL-STRING,  RUPTURE,  TONGUE-TIED,  ETC.

   About the time the umbilical cord  separates, there  is sometimes  soreness and* inflammation.  For
such symptoms, spriiokle with a powder of slippery-elm bark, and apply the black salve.
   Rupture (Hernia). — Sometimes, from crying,  or other  causes, infants are afflicted with ruptures.
When this happens, the earliest attention is required.
   The infant or child should be placed in  a recumbent position, or on its back.   Then press the tumor
or protruded part  back, make a compress of linen, which has been previously wet in a decoction of oak-
bark,  apply it over the rupture, and secure  it by a bandage.  If this fails to keep it in its proper situation,
apply a truss.
   Tongue-tied,  or Division  of the  Frenum Lingua.— Sometimes the frenum of the tongue is
so contracted, that the child can not nurse or suck.   When this occurs (and only then), there must be a
very slight incision made with a pair of scissors or lancet.
   The cut must be very small and superficial,  lest  a blood-vessel  be wounded.  If the child can nurse,
this practice must never be resorted to.   In almost  every case  this is an imaginary complaint; and when
parents or a  parent insists upon its being done, from a mistaken notion, the back of the  lancet may be
used,  and this will satisfy them.
                                         SECTION  X.

                IMPERFORATED  VAGINA,  CLUB-FEET,  AND  CHOKING.

  Sometimes a thin membrane forms  across the  mouth of the vagina, which partially or wholly closes
it.  This is very easily divided by a lancet or pair of scissors. 
204
DISEASES OF WOMEN AND CHILDREN.
  Club,  crooked, or deformed Feet. — When children  are born with this  deformity, an intelli-
gent person informs me  that a  certain  practitioner is always in the habit of immediately turning them at
birth into a right position, and securing them with  proper splints  and bandages.  This, he says, always
obviates the deformity.
  Choking. — Infants often become  choked  by getting various substances into their mouth and throat.
When this accident occurs,  let the child  be placed upon the lap of the  mother or nurse, and  its  head
turned downward, while it is gently struck a few  times on the back between the  shoulders.  If this does
not immediately remove it,  let the  fore-finger  be  introduced and extract it.  Should  this fail, give a
mild emetic.
                                        SECTION XI.

                            VENEREAL  DISEASE  OF  INFANTS.

  It is now common in this  corrupt age for infants  to be born with  the venereal  disease, received in
consequence of the licentious conduct of the parent or nurse, giving rise to  ulcers in some parts of the
body.  I have known some children almost a mass of corruption from  the venereal disease communi-
cated in this manner.  The poison, instead  of affecting the mother during pregnancy, is communicated
to the infant.   When such a complaint occurs, the  medicine  must principally be given to the  mother,
instead of the child.  The alterative syrup must be administered, which is made in the following manner:
Take bloodroot (sanguinaria Canadensis) ;  bark of the root  of sumach  (rhus glabrum) ; root  of blue
flag (iris versicol) : bruise the roots, and  make a strong decoction.  Let  the patient drink  freely.   This
makes a very purifying or alterative decoction ;  and some botanical  physicians  rely almost  exclusively
upon the blue  flag for the cure of the venereal disease, while  others  depend almost entirely upon the
mandrake.
  Who can calculate the magnitude of the vices of  men who  entail such  a loathsome and horrid disease
upon their offspring?   Why  are crimes, which dwindle into insignificance compared with this, punished,
while this is pissed over without any penalty ?
  I have sometimes thought,  from  the  prevalence of this vice, that half of the diseases of women and
children were  produced by it.   Besides  the miseries  inflicted upon  innocent  children, what domestic
broils and difficulties are the consequences !
  The reader would be astonished  if  he knew how many young  men are ruined by visiting houses of
ill-fame.   It either brings thousands to an untimely  grave, or  cripples  or  diseases them  for life;  and the
only method to put down  this disgraceful and destructive vice is, for the  municipal authorities of every
county wholly to  exterminate every house  of the  kind,  by employing officers who, instead  of counte-
nancing or  visiting them, as is now the case,  will faithfully and  rigidly  perform their duty.   Not only so,
but every female who has the least regard for virtue  or morals should resolve never to associate with or
show the least favor to any young man who is known or suspected of keeping the company of prostitutes.
Nor should any person guilty of this vice be treated with  respect  until he reforms.  Let him be viewed
in the same light as a thief or a robber, and then we  may1 expect to see  a reformation.   The vice must
be stamped with public disgrace  and infamy.
  The Jews, by their laws, were in certain  cases forbidden  to have  any manner of commerce with the
diseased ; and to this all wise legislators ought to have a special regard.   In  some countries diseased
persons have  actually been  forbidden to  marry.  This  is an  evil  of a complicated  kind — a natural
deformity, and a social mischief:  and therefore requires a public consideration.
  (For a full history and description of the venereal  disease  (lues venerea) or syphilis, with an account
of the various remedies proposed  under different  modes of treatment,  see  my " American Practice,"
volume ii., pages 237-264.) 
DISEASES OF CHILDREN.                                205
                                         SECTION  XII.

                                       INOCULATION.

  The small-pox, says Townsend, so destructive to  preceding generations, is now, under proper man-
agement, no more to be dreaded than fire on the hearth.
  For this change we are indebted to inoculation, introduced at the commencement of the present cen-
tury by Pylarini,  an eminent practitioner of Italy, who being then resident at Constantinople, sent to the
Royal Society the first account both of the operation and its effects on  the inhabitants of that metropolis.
By  his relation, it appears  that to  them  originally the  practice had been derived from Greece, where it
was found, not in the hands of physicians, but of the peasants.
  And by a  subsequent account, transmitted to the same society by Timoni, in the year 1713, it is
evident that the Circassians  and Georgians had been long in the habit of performing this kind office for
their  female  children, in order to preserve their  beauty.  Their principal  intention was, however, to
increase their value, when, at  the age of maturity, they  were sold to the Turkish officers.
  In  the  year 1717, the son of Wortley Montague, then at Constantinople, was inoculated ;  and Lady
Mary, on her return to England, introduced the practice, where it was first tried on the malefactors then
in Newgate,  under sentence of death.  In consequence of the propitious issue of that essay, it was adopted
by  the royal  family.
   Dr. Jurin, physician to  the  court, having observed,  so  early as the year  1722, that, instead of one
in five—the usual proportion lost  by the natural small-pox — not  more than  one in ninety failed under
inoculation, he communicated the information to the public, gave a description of his practice, and firmly
established it.
   When the matter of small-pox is inserted under the skin,.a  pimple  appears on the third day, followed
by  swelling in  the  axilla.   The  pimple then becomes  surrounded by a jagged  areola,  in which small
vesications are observable.  On the seventh, or, at farthest, the  eighth day from the  insertion of the virus,
rigors occur, and in forty-eight hours afterward the eruption appears.   In a large majority of  cases, the
eruption proves to be of the mild and distinct sort; and in very many instances the number  of pustules
over  the whole body does not exceed one hundred.  The further  progress of the disorder differs  in  no
respect from that of the distinct casual small-pox.
   Nothing has ever been suggested  calculated to  throw the smallest light on  the curious fact  that the
mode of reception into the system should thus influence the quantity of eruption.   To so great a decree
does  this take place, that the mortality by inoculated small-pox, without any restriction as to age or strength
of constitution, does not exceed one in  five hundred.   We select for the period of inoculation that season
of the year, and that time of life, when inflammatory tendencies  are least to be expected.  It is sufficiently
ascertained that beyond a few doses of a cooling aperient, no preparatory course of medicine is requisite.
A spare vegetable diet, cool air, and subacid drinks,  will contribute to render the  disease mild and  safe.
Improper management may, of course, increase the amount  of eruption, and with it the danger of the
patient.   Some attention, therefore, ought always  to  be p,aid  to the  treatment,of  inoculated small-pox ;
but the principles to be observed in regard to the distinct and confluent species are equally applicable in
the present case, and will be sufficient, without further detail, for the guidance of the practitioner.
   It  has  been estimated that, before the  introduction  of  inoculation, four hundred and fifty  thousand
individuals died annually of small-pox in Europe ! 
20C
DISEASES OF WOMEN  AND  CHILDREN.
                                         SECTION  XIII.

                                   VACCINA,  OR  COW-POX.

   It is about thirty-five or forty years since  a treatise on this disease, from the pen of Dr. Jenner, was
 laid before the public, making it known  therein that it  had been  discovered  that those who  had been
 infected by it were, in general, secured ever afterward from the infection of the small-pox ; that it was a
•very mild disease in comparison with the latter, never having been found to prove fatal; and, moreover,
 that from  its not  being infectious  but  by inoculation alone, it might be introduced into a family without
 extending to others.
   In many of  the dairy countries, it  had long  ago, indeed, been observed, that cows  were subject to an
 eruption on their teats and udders, which occasionally was  communicated  to the fingers and other parts
 of the hands  of those who milked them, giving rise to a few ulcerations, accompanied by some  degree of
 fever; and it had been noticed that those who had  thus gone through the vaccine disease were  never after-
 ward attacked by the small-pox, either naturally or by inoculation.   This knowledge had, however, never
 been improved, or acted upon, until Dr. Jenner's publication ; and it is to him that mankind are indebted
 for the promulgation of this valuable discovery.
   The pustules,  on their first appearance, when the infection is received from the cow, somewhat resem-
 ble small  vesications occasioned by a  burn ;  these superficial suppurations assume a circular form, their
 edges being more elevated than the centre, and are of a bluish color ;  tumors, in consequence of the
 absorption of the morbid poison, appear in the arm-pits, with some affection of the system, such as slight
 shiverings, lassitude, a  quick  pulse, sickness at the stomach, vomiting, and occasionally delirium :  these
 symptoms, however, generally go  off in  a few days, leaving the ulcers in a state unfriendly to healing.
   It is now well  ascertained, however, that tbe vaccine virus is rendered much milder by passing through
 different persons, than when received directly from the cow ; and  so  gentle is  the disease when it arises
 from inoculation, that the aid of medicine is seldom if  ever necessary, either prior to the appearance of
 the pustules or during their continuance  or  suppurative stage ; but as  soon  as the eschar  on the arm
 where the vaccine matter was introduced  begins to become dry, and  the few pustules which had shown
 themselves to disappear, it may be advisable to give one or two doses of some  gentle purgative, suffering
 three or four days to intervene between each  dose.
   The following circumstances are deserving of attention in inoculating for the  cow-pox, and  substituting
 this mild and safe disease for that dangerous and pestilential one, the small-pox  :—
   1. That the matter with which we inoculate be  not taken later in the disease  than the ninth day.
   2. That the fluid be perfectly transparent, as it is not to be depended upon  when  it is in any degree
 become opaque.
   3. That the matter taken should be allowed to  dry gradually and thoroughly before it is  laid  by for
 use, when not  employed immediately,  or in its fluid state.
   1. That the punctures with the  besmeared lancet be done as superficially as possible, and only one be
 made in the same arm.
   Here it may not be improper to remark that the inoculation for this disease will not be likely to succeed
 well if there be any herpetic eruption on the skin.  On  the  third or fourth  day after inoculation, the
 wound will appear a little prominent and red  around its edges, which will  keep increasing to about the
 ninth or tenth day, when the constitution will  show some  symptoms of being affected, such as a slight
 degree of febrile  heat, and probably a  little enlargement of  the glands in  the  pit of the inoculated arm.
 Should any excess of inflammation happen to arise in the inoculated part, immediate attention  should
 ue  paid to it.
   It will be of the highest importance, after vaccine inoculation, to -ascertain  that the vesicle in the arm
 nas  not acted locally, but that it has  effected the  desired  change in the  constitution.   With  this  view. 
DISEASES OF CHILDREN.
207
it may be advisable to revaccinate  at  some  after period, to test the security from any exposure hereafter
to variolous infection.   If parents  will not be satisfied with this test, matter taken from a  small-pox pus-
tule may then be substituted instead of the vaccine.  In one instance out often thousand, perhaps, small-
pox may take place after the constitution has been  satisfactorily acted  upon  by vaccine inoculation, and
even when this has happened, the  disease has usually been very mild indeed.
   Some persons have been known to have  the  small-pox  a second time, and this irregularity may per-
haps account for a few of the cases of  small-pox which have  occurred after vaccine inoculation.  The
majority of such cases may, however, justly be attributed to imperfect or improper vaccine matter having
been employed for the inoculation, and which had not the power of securing the person so inoculated
from the contagion of the small-pox.   This spurious sort of vaccine matter is wholly inefficacious.
   We  have  only to take a  comparative view of the effects of  the  inoculated cow-pox, the natural
small-pox, and  the inoculated small-pox, to  be fully satisfied of  the  decided  preference to which the
former is entitled.
   The inoculated  cow-pox  is uniformly a  mild  and  inoffensive  disease :  it  is neither loathsome nor
attended with any danger; in general, it  forms  no  eruption,  except a  pustule or two  on the inoculated
part; requires neither confinement, loss of  time, nor expense, as few or no medicines  are necessary ;  it
occasions no subsequent disfiguration ; induces no supervenient disease ; and, lastly, is  not contagious, and
may therefore be introduced into any  family without its extending to others.
   It is  well known that  the natural small-pox  is frequently a painful,  loathsome, and  fatal disease, and
that, from a computation, one person in six falls a martyr to it.   It is of a highly contagious nature, and
spreads rapidly ; the eruptions are painful, numerous, and disgusting  in  their appearance, and leave
behind deep scars,  or pits, especially  in the face ;  it requires some weeks' confinement, loss of time, and
more or less expense, as  medical  treatment and attendance are requisite, both during the continuance of
the disease and afterward ; and when it ceases, it is apt to induce inflammation oT the eyes, deafness,Dis-
eases of the skin, glands, and joints, and to bring into action scrofula, which is dormant in the constitution.
   " It is not known," says Eberle, " at what period the srnall-pox made  its first appearance.   In the wri-
tings of the Greek and Roman physicians we find nothing which could lead us to believe  that they had any
particular knowledge of this devastating malady, although we can scarcely doubt that  its origin was of a
much earlier date.  The Arabian  physicians were the first who gave a distinct description of this disease ;
and it is to the small work of Rhazes, who lived about  the beginning of the tenth century, that we must
look for an account of its early history.   It may be collected, from the writings of  Rhazes and others,
that small-pox was probably at first brought from Ethiopia into Arabia,  and that  it was thence conveyed
into the Levant,  Spain, and Sicily, by the Saracens, during  their  hostile irruptions into these  countries.
In the eleventh  and twelfth  centuries, it gained vast ground during  the wars  waged by the Christian
potentates against the infidel Saracens for the  recovery of the Holy Land.   From that time forward, its
desolating visitations were frequently renewed in every part of Europe: and there  is  perhaps no single
disease, with which the  Almighty has  thought it  good to afflict  mankind, which  has  carried off  so many
victims to the grave as the present one."
   The  inoculated small-pox is generally mild, but  in  some instances  is attended with all the  violence,
disgusting appearances, and danger* of  the natural.  Of those who are  inoculated, it  has been computed
that one out of three hundred is destroyed, and that one in forty has  the disease in  a dangerous form.
Eruptions more or less numerous are  scattered over the body, and the  disease  requires  preparation  by
diet and medicine  before the appearance  of the  eruptions, as well as confinement,  loss  of  time, and
expense, during its  different stages.  It is, moreover, as contagious as the  natural small-pox, and, where
it proves severe, is apt to leave deep pits  or scars behind it, as well as to call into action other diseases,
particularly scrofula.  Besides  these  disadvantages, it can not be practised  with safety in early infancy,
or old age, or during a state of pregnancy ; whereas, vaccine inoculation is  subject to  no such restrictiono
and inconveniences. — Thomas.
   In many instances, as has been  already stated, vaccination protects the system completely against infec- 
'JOS
DISEASES OF WOMEN  AND CHILDREN.
tion from small-pox contagion.   In other cases, the system is either only partially freed from its aptitude
to variolous infection, or this susceptibility, though for  a time entirely subdued  by  the  vaccine influence,
gradually returns and regains a greater or  less degree of intensity.   The disease which results  from the
action of small-pox contagion on a system thus partially deprived of its variolous susceptibility, and which
has of late years been so common, deviates  more or less conspicuously from  regular  small-pox, and is,
in a great measure, divested of  the dangerous character of the latter affection.
   A variety of opinions  have been entertained respecting tbe effect of true small-pox on the foetus in utero :
a sufficient number of instances, however, have been recorded, to ascertain that the disease  may  be com-
municated from the mother to the child.   In some cases the body of the child at  its birth has been covered
with pustules ;  and the  nature of the disease  has been  most  satisfactorily ascertained by inoculating with
matter taken from  these pustules.  In other cases there has been no appearance of the disease at the time
of the birth ; but  an  eruption and  other symptoms of the malady have appeared so early,  as to indicate
that the infection must have been received previously to the removal of the child from the uterus.
                                          SECTION  XIV.

                                  CHICKEN  OR  SWINE  POX,

   Svmptoms. — The eruptions make their appearance, in many instances, without any previous illness ;
 in others, they are preceded by a slight degree of chilliness, lassitude, cough, interrupted  sleep, wander-
 ing pains, loss of appetite, and a febrile disposition  for three or four days.  Most of  the eruptions are of
 the common size of those of the small-pox, but they are not numerous  or confluent.   On the first  day
 they are red, and much resemble in their appearance, the small-pox.   On the second day, the red pim-
 ples have become small vesicles, containing a colorless fluid, but sometimes a yellowish liquor.  On the
 third, the pustules arrive at full maturity, and in some instances  so  much  resemble the small-pox as to be
 distinguished with difficulty.   When  the little  bladder  is broken  by accident or rubbing, as  sometimes
 happens on  the first  or second day, there forms a thin  scab, and  the swelling  of the other  part abates
 without its ever being converted into proper matter,  as it is in the small-pox ; the few which escape being
 burst, have the little drop of fluid contained in the vesicle at the top of them, turn yellow  and thick, and
 it dries  into  a scab.   On the fifth day of the eruption, the pustules are  almost dried,  and covered with a
 slight crust,  but no cicatrix or mark is left behind when this falls off.
  Diagnosis. — The  only disease for which the one under consideration can be mistaken is, the small-
 pox of  the mildest and most distinct kind ; but the former may readily be  distinguished from the latter,
 by the small degree of fever, by the eruption being  generally first visible in the  back, each vesicle beino-
 filled with a limpid fluid on the second or  third day, and crusts covering the pocks on the fifth day,  at
 which time those  of  the small-pox are not at the height of their suppuration.
  It is proper to  remark here that the  pocks are occasionally so large, and come to  such  maturity, as to
 be mistaken for the small-pox; and inoculators have been so unwary as to take matter  from  them, whereby
 some have been  supposed to have taken the true small-pox a second»time, and  others have fallen a sac-
 rifice to the  disease,  under the  fatal idea of  their being secure.
  The chicken-pox  is  perfectly free from danger,  unless  the eruption be of  the confluent kind — a rare
 occurrence indeed—when it is to be appreciated  from the degree of violence in the accompanying fever.
  Treatment  and  Regimen. — The complaint is usually of so trivial a nature, as seldom to require
the aid of medicine ; but should the febrile symptoms run high previous to the  appearance of the eruption,
or after  it has shown itself, it may be advisable to give the patient some  cooling medicine from time  to
time — drinking plentifully of cool,-diluting liquors, and keeping the bowels open, if necessary,  by some
gentle aperient medicine.   After the disappearance of the eruption, one or two doses of any mild purgative
had better be administered, with an interval of three or four days between each. 
                                   DISEASES OF CHILDREN.                               209


                                         SECTION  XV.

                                  RUBEOLA,  OR  MEASLES.

  Description.^—The measles are  known by the appearance of small eruptions, somewhat resembling
flea-bites, over the face and body, but particularly about the neck  and breast,  not tending to suppuration.
Many of these spots soon run into each other, and form red streaks or suffusions, larger or smaller," which
give the skin an inflammatory appearance, and produce a  perceptible swelling of the face ; each spot is
raised a little above the surface, especially in the face, where they  are  manifest to the touch :  in the  limb3
and trunk they  form only a roughness.
  The disease is highly infectious ;  it  often prevails epidemically,  however ; and the constitution that has
been once under its influence is seldom liable to a second attack :  it only happens  when the person has at
first had a very mild or spurious species of measles
  Causes. — The measles  are  produced by a specific infection,  or  contagious matter received into the
constitution, if this is predisposed to favor the progress of such matter, and produces febrile effects in the
habit: for if such a predisposition be wanting at the time that this  disease or any other of a similar nature
is epidemical, the effects peculiar to infectious or contagious matter can not be produced.  Children are
more liable to the measles than grown people, and the winter is the season of the year when the disease
is most apt to be prevalent.
  Symptoms. — The symptoms which characterize measles and distinguish it from  other eruptive disor-
ders are, the dry cough and hoarseness, the heaviness of the head and drowsiness, the appearance of the
eyes, which are red, swelled, itchy, very sensible to light, and  frequently beset with tears, together with
frequent sneezing, and an  acrid thin discharge from the nostrils.
  The measles  may prevail at all seasons of the  year as an epidemic, but the  middle of winter is the time
they are usually the most prevalent; and they attack persons of all ages, but  children are most liable to
them.   They prove most  unfavorable  to such as are of a  plethoric or scrofulous habit.   Like the small-
pox, they never affect  persons but once in their life : their contagion appears to be of a specific nature.
The eruption is usually preceded by a general  uneasiness, chilliness, shivering, and pain in  the head, in
grown persons  ; but in children, by a heaviness and soreness of the throat, sickness, and vomiting, with
other affections, such  as happen in  most fevers.  But the chief characteristic symptoms are, a heaviness
about the  eyes, with  swelling, inflammation, a defluxion of sharp  tears,  and great acuteness of sensation,
so that they can  not bear the light without pain,  together with a discharge of much serous humor from the
nostrils, which produces sneezing.   The heat and other febrile symptoms increase very rapidly, to which
succeeds a frequent and dry cough, a stuffing, great oppression, and  oftentimes retching to vomit, with
violent pains in  the loins, and sometimes a looseness ;  at  other times there is great sweating, the tongue
foul and white, the thirst very great, and, in general, the  fever runs much higher than  in the milder sort
of  the regular small-pox.   The eruptions appear about the fourth or fifth day, and sometimes about the
end of the third.   On the  third or fourth day from their first appearance  the redness  diminishes, the spots
(or  very small papulae) dry up, the^cuticle peels off, and is replaced  by a new one.   The symptoms  do
not  go off  on the eruption, as in the small-pox, except  the vomiting: the cough  and headache continue,
with the weakness and defluxion of the  eyes, and  a considerable  degree of fever.  On the ninth or elev-
enth day,  no trace of  redness is to be found, but the skin assumes its wonted appearance :  yet, without
there having been some considerable evacuations, either by the skin or by vomiting, the patient will hardly
recover strength, but  the  cough will  continue, the fever  return with new violence, and bring on great
distress and danger.
  In the more  alarming cases, spasms of the limbs, lethargy, delirium^ or, what more frequently happens,
twitching  of the tendons, supervene.  This last symptom so frequently attends the  eruptive fever  of
measles, that by some practitioners it is regarded as one of its diagnostics.   In measles, as in other febrile
                                                27 
»
210                       DISEASES  OF  WOMEN AND CHILDREN.

disease.-., the symptoms generally suffer some remission toward  the morning: returning, however, toward
the evening, with increased  severity.
   The  measles, when  violent, are not usually attended with a putrid tendency ; but it sometimes happens
that such a  disposition prevails, both in the course of the disease and  at its termination.  In such cases.
livid or black spots are to be observed interspersed among the  eruptions, and these  last become livid, or
assume almost  a black color.  Haemorrhages break out from different parts of the body, jhe pulse becomes
frequent, feeble, and perhaps irregular,  universal debility ensues, and the patient is destroyed.
   Prognosis.— We are to regard  in  a  favorable light  the febrile and  other  symptoms being mild, a
gentle moisture diffused equally over the whole body on  the  coming out of the eruptions, early and free
expectoration, and open bowels.  On the contrary, the fever  increasing after the appearance of the erup-
tions, great  pain in the head and eyes, anxious respiration, no expectoration  before  the fourth day, an
inflammatory affection  of  the lungs,  a small but rapid  pulse, delirium, the sudden disappearance of the
eruptions, or these becoming of a livid hue, violent purging, great loss of strength, purple spots on different
parts of the  body,  with other marks of  putrescency, are  very unfavorable symptoms : indeed, the  latter
clearly point out that a fatal  termination is near at hand.
   A disposition to consumption, attended by hectic  fever,  and an  obstinate inflammation of the  eyes,
are not  unfrequently observed  after  measles have  gone off, and ought therefore to be carefully guarded
against.
   Dissection. — The morbid  appearances to be  observed  on dissection of those who die of measles
are pretty much confined to the lungs  and intestines,  the  former of which  always show strong marks of
inflammation, and  sometimes a tendency to mortification.   Where the patient dies under the eruption,
the trachea  and larger  branches of the bronchia, as in the small-pox, are often covered with it, which may
account for  the increase of the cough after the disappearance  of the eruption.
   Discrimination. — Scarlatina sometimes resembles the measles so exactly as  not to be easily distin-
guishable.   The redness of the scarlet fever  is more  equally diffused than in the measles, and  is not
in distinct spots with the natural color of the skin interposed : yet  in a few it has been observed so.   In
the measles, the eruption rises  more above the skin, and occasions  a manifest  roughness to the touch,
which is hardly observable in the scarlet fever, except a very little roughness sometimes in the arms.   In
the scarlet fever, there is seldom a severe cough,  the  eyes do  not water much, and the eyelids are not
red and swollen ;  all which rarely fail  to  attend  the  measles.  The  time  of  the eruptions is likewise
different:  for it appears in  the  scarlet fever both  in  the face and arms  on the  second day; but in the
measles it begins only  about the third day  to be visible on the chin and breast, and does not come to the
arms and.hands till the fourth or fifth day.
   Common  Practice. — Bleeding, blistering, antimony, calomel, laudanum, nitre, muriate  of ammonia
or squills, ice-water, and other cold applications.
   Reformed  Practice. — Indications of cure:   1.  It is our duty in this disease, as well as  in small-
pox, to  assist nature in expelling the  eruption, if her efforts be too feeble ; and when they are  too violent,
they must be moderated by suitable evacuations.
   2. The attention must be directed to urgent and  particular  symptoms, such as cough, restlessness,
difficulty of  breathing, Sec.                                        •
   The  greatest danger in the treatment  of measles, as well as  in most other diseases, consists in  doing
too much by improper  and untimely interference, and thus taking the business out of the hands of nature,
and trusting  it  to  the  danger  and uncertainty of  art.  The  measles  being  usually attended with great
inflammation, it is  often the  first business of the physician to moderate it.   The first step to be taken will
be, to immerse  the feet in warm  ley-water, and  bathe the surface with  the same once  or twice a day,
according to the  urgency of the symptoms, until  the  eruptions appear ; this will relieve the head, and
facilitate the appearance of the eruptions.  The following infusion should be given as early as  possible :__
             Take saffron......................................  .........................two parts;
                  Virginia saakerout..................................................one part. 
DISEASES OF CHILDREN.
211
             Make a tea, sweeten with loaf-sugar, and give warm : to be repeated, and as much drunk as the stomach
          will bear.   This infusion,  with the means before  recommended, will lessen the distressing and  urgent
          symptoms attendant  on the forming stage,  by  diminishing  excessive inflammation, as well as aid the
          expulsion of the eruptions.
             If,  from debility,  cold, or  any other cause,  the eruptions should only partially appear — or,  after
          their appearance, should there be a recession  of them — in addition to these means, give sudorific drops,
          warm milk-punch, &c. , and should this not be sufficient, use the warm bath.  When they have  made
          their appearance on the surface,  and assume a healthy appearance, very little medicine is  necessary.   In
          this complaint the eyes  are  generally very  much affected ; when this  is the  case, they may be washed
          with the mucilage of  slippery-elm bark  and borax-water.
             There are also pneumonic or  pulmonary symptoms  in  measles, which prove very distressing to the
          patient.   When there is difficulty of respiration, from  the accumulation  of mucus, give a  dose  of the
          tincture  of  lobelia sufficient to dislodge it, to be  repeated on the return of the  symptoms ;  in addition to
          which give the following :—
                                  Take pleurisy-root (asclepias tuberosa) ;
                                      horehound (rnarrub. vulgar) .- equal parts.
          Add sufficient boiling water  to make a strong infusion;  sweeten with honey.   Let this be  freely given.
          Should the pain of the  head be very great, with delirium or convulsions, continue to bathe the  feet often,
          and apply to them the mustard-paste.
             There is usually considerable  febrile excitement, restlessness, and pain.  For these symptoms, as well
          as  to keep up a continual  moisture of the skin,  give a dose (according to the  age of the person) of the
           diaphoretic powders every night at  bedtime.   Should  nausea or vomiting prevail, let mint-tea and bi-
          carbonate of potash be given.
             It is of the greatest consequence  in measles to attend to the bowels.  In the first stages of this disease
          a purgative should be given, and repeated according to the violence of the disease  and inflammation.   If
          the excitement is very great, a moderate  dose of physic may be  given every day ;  but in general every
          two or three days will be sufficient, till  the eruptions have fully appeared, when it may be  necessary to
          repeat them oftener, in  order to prevent any morbific matter which may have been retained in the system
           from being thrown upon some organ, and thus causing  subsequent diseases, such  as chronic ophthalmy,
           dropsy,  consumption, &c.  The following purgative,  under these circumstances, may be given :—
                                  Take senna,
                                       manna,
                                       cream of tartar.
           Of the first two articles, take two drachms of each ;  add half a pint of boiling water; simmer until the
           strength is extracted  ; then add a teaspoonful  of cream of tartar: sweeten.  For a child of two years old,
           give a tablespoonful every two hours until it acts  upon the bowels.   This purgative may be occasionally
           repeated.
              Should any disease remain after the measles  have  disappeared, let it be  treated the same  as  arising
           from other causes.  If great debility of the system should take place, denoting a tendency to putrescency,
           give yeast mixed with a little sweet-oil  and molasses three or four times  a day.  Give also wine-sling or
           sangaree, warm, with plenty of nutmeg grated into it.
             Regimen. — Panado, gruel, ripe fruits, currant-jelly, &c, may be taken.   The patient may also  drink
          barley-water,  toast-water, buttermilk-whey, &c.   The room should be well ventilated, clean, and of a mod-
>          erate temperature, and the clothes should  be often changed.   Patients recovering from the measles should
          be careful about their diet.  Their food for  some time  ought to be light, and in small  quantities, their
           drink cooling, and rather of an opening nature.
              This  treatment will carry the  patient safe through the disease ; while  the opposite course (bleeding,
          mercury, &c), will cause  such debility or putrescency in the fluids, as to protract the complaint, harass
          and distress the patient, if not prove  fatal.
9 
                            DISEASES OF WOMEN AND CHILDREN.


                                         SECTION XVI.

                            SCARLATINA,  OR  SCARLET  FEVRR.

   Description.—The scarlet fever is so denominated from the scarlet color and eruptions which appear
on the body.  It occurs at all seasons  of the year, but generally in the fall, or beginning of winter ; it
often  seizes whole families, but children and  young persons are  more subject to it.  It is divided into
three  principal kinds : simple scarlatina, when  the throat  is not affected ;  scarlatina anginosa, when the
throat is affected ; and, when  accompanied with  symptoms of  putrescency and malignancy, it is  called
scarlatina maligna.   The two latter kinds are  generally blended  together.  There  has  been  a dispute
whether the scarlet fever and  malignant  sore throat are the same diseases,  or  only a  variety of the same.
" It is  now pretty generally admitted,"  says  a  writer, " that the scarlet fever in all its forms, as well  as
putrid sore throat (cynanche maligna) is produced by the same  specific contagion."
   Causes. — Scarlet fever arises from a specific contagious effluvia.   This disease is seldom, if ever,
 ..ken the second time.   There are some instances on record of the fact that, in this type of fever, as in
many others, individuals are rendered unsusceptible of its contagion.
   Gregory states that there is abundant evidence that fever attended with scarlet eruption, and  possessing
all the  other characters of this disease, does occasionally arise from exposure to cold.   The cause  or
contagion of scarlet fever will remain  in one  place  for several  years, a  few individuals becoming from
time to time affected  with  it.
   " This disease," says Thatcher, " has long been considered  as highly contagious, spreading epidemi-
cally  through villages and  districts, with an alarming degree of  mortality.   In the  years  1735 and '36 it
prevailed extensively throughout our country in  its  most  malignant form, and  it was estimated that  in
Massachusetts about one thousand persons became its victims.*  It is recorded that in 1741, '46, and'60,
the disease termed  anginosa maligna, or  the putrid and  ulcerated  sore throat, prevailed and extended
through the colonies with mortal rage, in opposition to the  united  endeavors of the faculty.  It swept  all
before it, and some villages were almost depopulated.   It appeared  again in 1784, and spread through
the New-England states ;  at subsequent periods it has  been recognised either as an epidemic,  or as spo-
radic  cases, without assuming  in a high  degree characteristic contagious  powers.   Scarlatina, in  all  its
forms, is produced by the  same specific  contagion ; and  frequently the symptoms are  so blended in the
first onset, that the particular species can scarcely be designated.  It may  be  communicated by the con-
taminated atmosphere, and by simple contact of the  patient, either in the heat  of summer  or cold  of
winter ; but it most frequently occurs in  autumn, and becomes a  very prevalent epidemic, often continuing
through the summer months.   It  frequently attacks young people in the most sequestered situation, where
communication  with the sick had been  impossible, appearing in   some families and  passing others  con-
tiguously situated.  It produces its operation on the system about the fourth or  fifth day after exposure
to the contagion, and it  not  unfrequently happens that persons  exposed escape the  disease ;  as in other
contagions, although  in general persons  are not susceptible of a  second attack, some instances to the con-
trary  have  undoubtedly occurred.   Children and persons  of weak  lax habit are most commonly the
subjects of this  disease.  In its mildest form it is  known as the simple scarlet fever,  receiving its name
from  the singular color which pervades the skin, resembling the shell of a boiled lobster,  or appearing as if
diffused with  red wine."
   Symptoms. — The scarlet fever commences  with a chill and  shivering,  like other kinds of fever, with
nansea and often vomiting, great sickness, succeeded  by  heat, thirst, and headache : sometimes in  a very

  * Dr. William Douglas, a  respectable physician of Boston at that day, published a valuable practical essay on the anginosa ulcusculosa'
which prevailed in New England in 1735 and '36, in which he detailed  the characteristics of the disease, and the method of treatment.  He
nys : " Most of those who died of the physician, died by immoderate evacuations."  It has been related, by tradition, that the physicians of
that day, or of some other period, adopted the plan of bleeding from the vein nnder the tongue; -and although in almost all instances it proved
fatal, tbe practice waa persisted in longer than could have been deemed warrantable. 
DISEASES OF CHILDREN.
213
mild degree, at others more violent.   The pulse is  accelerated, the breathing  is frequent or interrupted,
the eyes red, and eyelids swollen.   In two or three days the flesh begins to swell, a pricking sensation is
experienced, and an eruption appears on the body in  the  form of a  red  stain or  blotch, or rather of a
fiery^redness.   It usually appears first upon the face, breast, and  arms, then over the whole  body, of a
unif%n red color.   In about three days a gentle perspiration takes place, the efflorescence or eruptions
disappear, the cuticle peels off, and there remains a kind of branny scales dispersed over the whole body,
which sometimes reappear two  or three  times.
   The scarlet fever  may be distinguished from  the  measles, by the eruptions of the former (scarlatina)
being more of a fiery redness, and diffused over the whole body, and not, as in measles, in distinct spots ;
nor is it accompanied with  any  cough, or a weeping or watering of the eyes ; and the efflorescence of the
measles does not appear till about two days later  than  the scarlet fever.   Where the disease appears in
the simplest form, there is little required from art: a simple course of treatment soon removes it.
   Scarlatina Anginosa (affecting the throat). — Scarlatina anginosa, in some  instances,  approaches
very near to the malignant  form.   The  patient is seized not only with a coldness and shivering, but like-
wise with great languor, debility, and sickness, succeeded by heat,  nausea, vomiting of bilious  matter,
soreness of the throat, inflammation and ulceration in the tonsils, &c, a frequent and laborious breathing,
and a quick and small, depressed  pulse.   When the efflorescence  appears, which is  usually  on the
third day, it brings  no relief:  on the contrary, the existing symptoms are much aggravated, and  fresh
ones arise.
   In the progress of the disease, one universal redness, unattended, however, by any pustular eruption,
pervades the face, body, and limbs, which parts appear somewhat swollen ; the eyes and nostrils partake
likewise more or less of the redness,  and, in proportion as the former have an inflamed appearance, so
does the tendency to delirium prevail.
   On  the first attack, the fauces are often much inflamed ; but this is  usually soon succeeded by  grayish
sloughs, which give  the parts  a speckled appearance, and  render the  breath more or less fetid.   The
patient is often cut off in a few days ;  and even if he recover, it  will be by slow degrees : dropsical
swellings or tumors  of the  parotid and other glands, slowly suppurating, being  very  apt to follow.
   ;' The patient," says an  author, " complains  of a stiffness in the neck, with  acute  pain in the back of
the head.   The throat is sore  and inflamed, exhibiting a shining redness of a  deeper color than in  com-
mon  inflammatory  sore-throat, and  interspersed  with pale or ash-colored spots.   In  many cases, the
affection of the throat is among the first symptoms, a dark-red line extending along  the velum pendulum
 palati, and lower part of the uvula.   The breath  is highly offensive, the tongue is covered with a yellow
mucus or thick brown fur,  and  the inside of the lips  is beset with vesicles containing  an acrid  matter,
which excoriates the corners of the mouth and  other parts.  In the progress of the disease, the inside of
the nose becomes red and  inflamed, and a thin acrid  matter issues from the  nostrils which corrodes the
skin wherever applied."
   Scarlatina Maligna (Malignant Species). —" This," says Dr. Thatcher, "is the cynanche ma-
ligna of  Cullen, the ulcerated  or  putrid sore-throat of Huxham and other authors."  This form of the
disease has several symptoms in common  with scarlatina anginosa : it comes on with rigors, dejection  of
spirits, pain iu  the  head and back, giddiness, vomiting, and  much general oppression.  The eruption
comes out in blotches, or small  points scattered over the body and  extremities, of  a dark, purplish, or
livid hue ;  the  fever is intense,  and progresses with rapidity, but manifesting an exacerbation in the even-
ino- and slight remission in  the morning; the pulse  is small, indistinct, and irregular; there is very  great
determination of blood to the brain, producing  redness of the eyes,  intolerance  of light, throbbing, pain
of tbe  head, and delirium or coma; the whole  neck sometimes swells and assumes  a dark-red color.  It
sometimes happens  thai cynanche maligna appears  without any affection or efflorescence of the skin, as
scarlatina in some cases presents itself without any  ulceration  of the throat.  As the sloughs about the
fauces spread, they  generally become of a darker color; the whole internal fauces are  at length covered
with thick sloughs, which, when they fall  off, discover ulcers very deeply seated : the parts appear  quite 
.11
DISEASES OF WOMEN  AND CHILDREN.
black, and the sloughs often extend throughout the whole of the alimentary canal.   The eruption some-
times suddenly recedes, and an alarming train of symptoms ensues, as also when the eruption suddenly
assumes a very pale and livid appearance.
   The symptoms called putrid and malignant are now conspicuous :  a disordered state of  the blood is
indicated by inky petechia, oozings of black gore from the nostrils, gangrenous appearances of ihe^proat,
spots upon the skin, and hemorrhages from various  parts of the  body.   Cynanche  maligna  generally
arrives at its height about the fifth or sixth day, but in some fatal cases  the scene closes as early as on the
third day.  The inflammation, as in  cynanche tonsillaris,  on some occasions affects the eustachian tube,
producing ulceration in the internal ear, and  often extending to  the  parotid,  maxillary, and other glands
of the fauces, which become swelled and  painful.
   The malignant or putrid sore-throat may be distinguished from the inflammatory,  by the looseness and
vomiting, the puffy and  dark-colored redness  attending the swelling, and by the fetid ulcers of the throat,
covered with white or ash-colored sloughs.  It may also be distinguished by the slight delirium  appearing
early in the disease, and by the sudden weakness with which the patient is seized.
   Common Treatment. — Mercury, bleeding, antimony, &c.
   Reformed  Practice. — Indications of  Cure. — From the appearance of the eruptions  on the skin,
soon after the commencement of the  disease,  it is very evident that this fever is produced by some mor-
bific matter taken into the  circulation  through the medium of the lungs, and that the increased action in
the system is a healthy effort of nature to throw off such humors or morbific  matter.  It is therefore  our
duty to  aid nature in her salutary efforts : if unable to expel the irritating cause from the system, she must
be assisted by sudorifics, or sweating medicine ;  if her struggles  are too great, by which  much  inflamma-
tion is  produced, she must then be restrained  or moderated.
   Emetics. — Emetics will be found very useful in the commencement of  the fever.  None  will  have a
better effect than pulverized ipecacuanha  and lobelia given  in suitable  doses, according to the age of the
patient.  It is not always  necessary, however, to  give them ; but if there is soreness of the throat, and an
accumulation of mucus impeding respiration, a mild emetic will have a beneficial effect.   When given in
the forming stage of  the disease, or at a very early period, they abate the  febrile symptoms, render  the
subsequent effects of the fever less violent, and  in some cases  cure the disease  or render it  extremely
light.   Withering recommends them throughout  the whole course of the fever.   But the  best effects arise
from their use  in the early stages of it.   One great effect derived from emetics in  febrile diseases is, the
sympathetic action  they exert upon  the capillary system.  The connexion  which  exists between  the
stomach and skin is so great, that  if  a healthy action is exerted upon the one, the  other experiences a
correspondent good effect.   They appear to overcome that tension and stricture which exist  in the pores
of the skin, by their stimulating effects upon the  cutaneous exhalents.
   Purgatives. — Purgatives in this fever, as well as in others, are highly useful.  Hamilton on purgative
medicines speaks of their  utility in  scarlet fever in the highest terms : they moderate arterial action, relieve
the pain in the head, prevent delirium, and  remove  the morbid state of  the liver, stomach, and whole
alimentary canal.   It must be borne in  mind, however, that there  is  a great difference in  purgatives :
some pass through the stomach and  bowels without carrying away or  removing  any feculent  matter, or
altering  the  condition of  the mucous membrane.  In general, castor-oil  and  salts  may be mentioned
among this class of purgatives.
   No kind will be found so useful as  the common purgative :  a teaspoonful of this  powder to be  put  in a
teacup or tumbler, with  a lump of sugar sufficient to sweeten, then add  a gill of boiling water or mint-tea.
An adult will take the whole of it  when cool; but it  should be  recollected  that children, among whom
scarlatina generally prevails, must take a dose proportioned  to their age.   This thoroughly  cleanses the
stomach and bowels, and invariably benefits the patient.  It may be repeated every  other morning, or, at
farthest,  every  third morning.
   " I think," says an old and  experienced  physician, " the  opinion gains ground that purgatives are
useful in scarlatina.   Many years ago, when the  prejudices against them were more prevalent than  they 
DISEASES OF CHILDREN.  ,
215
are at this time, I ventured to employ them.  My doing so was, indeed, a necessary consequence of the
benefit I had  experienced from  purgative medicines in typhus.  I had learned that the  symptoms of
debility which take place in typhus fever, so far  from being  increased, were obviously relieved by the
evacuation of the bowels.   1 was therefore under little apprehension from them in scarlatina;  and I have
never,  in a long course of experience, witnessed sinking and fainting, as mentioned by some authors, and
so much dreaded by them ; neither have I observed  revulsion from the surface of the body, and conse-
quent premature fading, or, in common language, ' striking in' of the  efflorescence, from the exhibition
of purgatives.  Accordingly, in treating scarlatina,  I  have confided much in the use  of  purgative medi-
cines;  and no variety of  the disease, as appearing  in different epidemics, or in the course of the same
epidemic, has  hitherto prevented  me  from following out this practice to the extent which I have found
necessary.
   " I have observed the pungent heat of  surface, violent headache, turgescence of  features, flushing of
countenance, and full and quick pulse, the earliest symptoms in  some epidemics of scarlatina, and which
may have suggested  and warranted the  practice  of blood-letting, to be quickly subdued by  one or two
brisk purgatives.   Full purging  is not required in the subsequent periods of the disease, in which the
sole object is to remedy the impaired action of the  intestines,  to secure the  complete and regular expul-
sion of their contents, and thus  to prevent the accumulation of foeces,  which never fails to  aggravate the
symptoms, and to  prove the source of further suffering to the  patient.
   " It is generally admitted, I believe, that  purgative medicines are useful  in removing dropsical swel-
lings, the consequence of scarlatina, and are given with this view toward the decline  of the  disease, when
the weakness of the patient is often very great.  I conceive  that  purgatives  also afford  a means of pre-
venting this swelling, and other derangements of  health ; and for this reason I give purgatives during the
fever, when the strength is not  altogether broke down, and  for some time after  convalescence has com-
menced.
   " In scarlatina, as in typhus, we should  keep  in view the procuring the effect of purgatives during the
day, and the avoiding, in  this manner, the disturbance of the sick in the night-time.   It is  of moment to
examine the fceces, to ascertain their state and quantity, circumstances  necessary to determine the subse
quent dose of the  purgative, and the frequency of its exhibition.
   " The use of purgative medicines in  scarlatina does not supersede the other sources of relief and com-
fort which have been found proper in the treatment  of the disease, and which our patients, or their friends
and attendants, may  expect, and which the  habits of  practitioners may suggest.   Upon a  dispassionate
review, however, of the whole of the present inquiry,  I feel myself at liberty to say, that,  under the regu-
lated exhibition of purgative medicines, conjoined with personal cleanliness, and  access to  pure air, I
have not found the necessity of employing other remedies to be  great, and certainly not so  urgent as I at
one time thought it to be."
   Sudorifics. — Since the mischief exists  in the capillary vessels, or the skin, the exhalents not perform-
ing their offices, such medicines must be given as will open the  pores and  cause  perspiration.   In this
state of the system there  are two difficulties :  first, obstructed perspiration, by which the poison is retained
in the system; and,  second, the want of perspirable matter, by  which the process of evaporation is carried
on, keeping the skin moist and cool.  Hence it is necessary to give sudorifics to promote the excretions
of the  skin.
   In the first stages  of scarlet fever, the  feet must be bathed, and an infusion or tea of saffron freely given  ;
also a teaspoonful  of the sudorific or sweating drops, added  to  a tumbler of catnep-tea, to  be repeated
every two hours, until moderate  perspiration  follows.  The  same  dose  may afterward  be given  in the
same manner, three  or four times through the day, to keep up a determination to the surface, except the
temperature of the body is  too  great to  admit  of this  stimulating diaphoretic medicine, which  is very
seldom the case, especially if  every other excretion of the body has  been  duly attended to.   Should this
be the  case, however, we  must rely on those medicines which  produce perspiration without  increasing the
heat of the body, such as an infusion of catnep, aramanthus,  &c, which may be taken warm, and druak 
210
DISEASES OF WOMEN  AND  CHILDREN.
freely through the day.   An  infusion or tea made of lemon-balm,  or sage, may likewise be given as a
change.
   Bathing the Surface. — Cold  affusions  have been  highly extolled by some authors, as well  as  cold
drinks.   I grant that cold water  may often be applied  to the surface with impunity, and often  with benefit
even in the different forms of scarlet fever  ; but injury may arise from its indiscriminate use.   The subse-
quent effects arising from the  repeated and sudden applications of  cold  to the body, under a great  state of
excitement, especially in an eruptive  disease like scarlatina, may prevent the appearance of the eraption,
and cause a recession of them after they have appeared, and thus prove fatal.  Bathing the surface  with
warm rain-water, to which has been added a little ley, is far  preferable.  No  dangerous reaction takes
place from  the use of tepid, as from  cold water;  nor  will any danger  result  from it whatever, as it  is  a
most valuable auxiliary, and the use  of it  can not  be too strongly  recommended.   We  may say,  with
Bateman, when speaking of the  application of cold water—" We  are  possessed of no physical agent,
so far as my experience has taught me, by which the functions of  the animal economy are-controlled  with
so much certainty,  safety, and promptitude, as by the application of cold  water  to  the skin, under the
augmented heat of scarlatina and of some other fevers.   This expedient combines in  itself all  the  medici-
nal properties which are indicated in  this state of disease, and  which we should scarcely expect  it  to
possess,  for it  is not only the most  effectual  febrifuge, the lfcbrifugum magnum,'' as a reverend author
(Dr. Hancoke) long ago called it, but it is in fact the only sudorific or anodyne  which will not disappoint
the expectation of the  practitioner under these circumstances.   I  have had the satisfaction, in numerous
instances, of witnessing the immediate improvement of the symptoms,-and the rapid change in the coun-
tenance of  the  patient, produced by washing  the skin.   Invariably  in the course of a few  minutes the
pulse has been diminished in  frequency, the thirst abated, the tongue has become moist, a general free
perspiration has broken forth, the skin has  become-soft and cool, and  the  eyes have brightened ; and these
indications  of relief have been speedily followed by a calm and refreshing sleep."
   It may be applied as often  as  the fever'increases ; but should be omitted if there is any chill, or if the
skin is not above the natural temperature :  it may then, however,  be  applied very warm.
   When the throat is sore  and the swallowing difficult,  which often  occurs in  the scarlet fever, it must
be bathed with the following liniment or oil*:—
                       Take spirits of turpentine,
                            oil  of sassafras,
                            olive or sweet oil,
                            spirits of hartshorn,
                            gum-camphor.  Equal parts.  Mix.

   Apply warm, after which bind a flannel around the neck.  The throat may be gargled, if it  can be
conveniently done,  with the following:—
                       Take sage,
                            hyssop.  Equal parts.

   Make a strong tea or decoction, sweeten with honey,  add a small piece of borax, and gargle often.
   Mustard-plasters, made weak, may be applied to the feet.  I have  always seen the happiest effects also
from anodynes, combined with diaphoretics.
   Our diaphoretic powders are attended with very excellent effects.   They tranquillize the system, miti-
gate pain, procure sleep, lessen  the  fever  by causing perspiration, and will have the desired effect  in
every and any stage of the complaint, particularly after the evacuants recommended have been made.
   When there is  some inflammation  of  the brain present, Eberle, among  other means, recommends
bleeding; but there is  much more danger to be apprehended from bleeding than there is from  the inflam-
mation, even without any means made use of to lessen it.  There is great debility present in this as well
as in  other kinds of fever, and  therefore  common sense shows that, whatever tends to augment this
debility or  prostration,  must tend also  to  hasten its  fatal termination.  Bleeding in this, as well  as in
other fevers, almost inevitably precipitates the patient into fatal  prostration.    I  know of  nothing  mora 
DISEASES OF CHILDREN.
217
unnatural or absurd than to plunge a lancet into the arm of the little sufferer, under pretence of reducing
the inflammation or fever.
   When, there are symptoms of inflammation of the brain  present, bathing the feet, and  applying tepid
water or cooling lotions to the head, such as a  mixture  of water,  vinegar, and brandy, with frequently
bathing the feet and applying sinapisms, will do  more to allay it, than drawing any quantity of blood from
the system.   If no other means  would subdue  it, leeches or cupping might  be resorted to : but I have
never found either necessary in all my practice.
   Some apply blisters under such circumstances, but I object to them.   Blisters sometimes are as mis-
chievous as bleeding :  they cause a general  or preternatural excitement  of the  system, and the parts to
which  they are applied often mortify.
                                        SECTION XVII.

         ACUTE  HYDROCEPHALUS, OR  DROPSY  IN  THE  HEAD  OR  BRAIN.

  Description. — By dropsy of the  head,  we understand  a  collection of water, either between the
membranes of the brain or in the ventricles.  It is divided into two species, internal and external: inter-
nal, when the  fluid is collected within the ventricles  of the brain ;  external, when it is collected between
the  membranes of the brain.  In this  latter case it is usually of a chronic nature, and water has  been
known to increase to  an enormous quantity, swelling the  head to a prodigious size,  widely separating the
bones of the head, and sometimes causing an absorption  of  the brain.
  Pain in the  head, particularly across the brow, stupor, dilatation of the  pupils  of the eyes, nausea, vom-
iting, preternatural slowness of the  pulse, and convulsions, are the pathognomonic symptoms  of this
disease, which have been laid down by the generality of  writers.
  Hydrocephalus is almost  peculiar to children, being rarely known to extend  beyond the age of twelve
or fourteen ;  and it  seems  more  frequently to arise in  those of a scrofolous  and rickety habit than in
others.   It is  a disease which has been observed  to  pervade families, affecting all  or the greater  part of
the children at a certain period of *heir life ; which seems to  show that in  many  cases it depends more on
the general habit than on any local affection or accidental cause.
  Causes. — The disease has generally  been  supposed to  arise in  consequence either of injuries  done
to the  brain  itself, by blows, falls, &c, from scirrhous tumors  or  excrescences  within  the  skull,  from
original laxity or weakness in the brain, or from general  debility and an  impoverished state of the blood.
  With respect to  its proximate cause, very opposite opinions are still  entertained by medical writers,
which, in conjunction with the equivocal nature of its symptoms, prove  a source of considerable embar-
rassment to the young practitioner.   Some believe it to be inflammatory, and bleed largely.
  Dr. Withering observes that in a great  many cases, if  not in all, congestion or slight inflammation are
the precursors to the  aqueous accumulation.
  Dr. Rush thinks that, instead of its being considered an idiophatic dropsy, it should be considered only
as an effect of a primary inflammation or congestion  of blood in  the brain.  " It appears," says he, " that
the disease, in its first stage, is the effect of causes which produce a less degree of that inflammation which
constitutes phrenitis or inflammation, and that its second stage  is  a less degree of that  effusion which
produces  serous apoplexy in adults.   The former partakes of the nature of the chronic inflammation of
Dr. Cullen, and the asthenic inflammation of Dr.  Brown."   There are others, again, who view the sub-
ject in a very different light.  Dr. Darwin supposes  inactivity, or torpor of  the absorbent vessels of the
brain, to be the cause of hydrocephalus internus ;  but he confesses, in  another  part of his work,  that the
torpor of  the absorbent vessels may often  exist  as a secondary effect.
  Dr. Whytt, who has published an  ingenious  treatise on the disease, observes that the immediate cause
of every kind of dropsy is  the same, viz., such a state of the parts as makes the exhalent arteries throw
                                                 23 
2L6
DISEASES OF WOMEN  AND  CHILDREN.
out a greater quantity of fluids than the absorbents can take up.   From what  he afterward mentions, he
evidently con-iders this state as consisting in debility.
   As manv cases are accompanied with an increased or inflammatory action of  the vessels of the brain,
and others, again, are observed to  prevail along with  general  anasarca, it seems  rational  to allow that
hydrocephalus is in some instances the consequence of congestion or slight inflammation of the brain, or
of general  debility.
   A morbid  state of  the stomach and bowels has been supposed by some to be a predisposing cause ;
but,  of all  the causes which contribute to  the production of this disease,  cold  plays the most conspicu-
ous part.
   Symptoms. — Hydrocephalus may, for the purpose of  instruction,  be  considered as exhibiting four
stages or sets of symptoms : but the distinction must be viewed  as a very arbitrary one ;  and  it should
be thoroughly understood that, in  many  cases, the  symptoms  of  different stages will be found  blended
together, or one or more of them altogether wanting:—
   1.  The  symptoms which characterize the first or premonitory stage of hydrocephalus are those of com-
mon infantile fever, such as often accompany the state  of dentition or teething, or a foul stomach, or a
disordered state of the bowels,  more  especially when  complicated with the presence  of worms.  The
pulse is quick and irregular, the  skin hot, and the tongue white ; there is also some degree of nausea and
vomiting, with thirst, restlessness, and  loss  of appetite.   The child droops ; the fauces being very dry, he
picks the nose so as often to make it bleed ; the body wastes, and the skin is  flabby.   The symptoms
have irregular exacerbations and remissions : so that this state  of disease is generally known by the name
of infantile remittent fever.   An exacerbation or remission of the symptoms usually takes place toward
evening.
   2. The  second set of symptoms are those which more unequivocally direct attention to the head as the
seat of  the disease :  they are — headache,  sometimes  diffused, sometimes  referred to a particular spot ;
impatience of light and  noise ;  a flushed countenance ;  preternatural  redness of the eyes ;  contracted
pupil;  tossing the arms to the head, and occasional screaming or shrieking without any obvious cause.
With these are joined the common symptoms of infantile fever, and they denote acute inflammatory action
of the vessels of the  brain.
   3. The  train of symptoms which characterize a third stage of the disease  are of a different kind : the
pulse, before quick, becomes  slow, intermitting, or irregular; the  pupils are permanently dilated, and
cease to contract on  the approach of light:  there is also squinting.   Instead of being restless,  and tossing
about his arms, the child falls into a state of stupor, and is insensible to things and persons around him ;
the screaming fits occur more  frequently, and there  is  an almost constant  moaning ; the child will often
vomit on being brought into the erect posture ; any sudden exertion brings  on a fit or convulsion,  in which
the child dies.   These symptoms are supposed  to mark that water is  now poured out  by the vessels of
the brain.
   4. If the child survives this stage, it is occasionally found that after  a time the pulse again  rises, so as
to beat one hundred and fifty or more in  a  minute,  and is withal  small and feeble.   The child  lies per-
fectly insensible, and takes nourishment from actual  inability to swallow ; the stools and  urine pass invol-
untarily ; the face is pale ; the tongue dry and brown ; convulsions or partial paralysis occurs : occasionally
one side becomes perfectly paralytic ; severe pustular ophthalmy or inflammation  of the«eyes is sometimes
witnessed.   The immediate approach of death is often preceded by gangrenous spots, appearing particu-
larly about the neck, hips, or tips of the ears.
   The first stage is sometimes wanting, the attack  being  sudden, and  perhaps the first evidence of the
disease a strong convulsive fit.   In  many instances the  pulse never  becomes  slow.   In a still larger
proportion  of cases the disease  never exhibits  that remarkable change from the slow to the rapid pulse
which characterizes the fourth stage.   Occasionally there  is neither permanent contraction nor dilatation
of the pupil, but throughout the whole course of the disease an irregularity in the contractions of the iris
may be noticed.  The pupil of the eye dilates on the approach of the candle, and contracts as it recede 
DISEASES OF CHILDREN.
219
In a few cases I have seen children continue sensible to the last moment.   Other and even more singular
varieties in the symptoms will  be found recorded  in the writings of authors.  It is  certainlv worthy of
remark, considering the universality of delirium as a symptom of inflammation of the brain in the adult,
that aberration of  intellect can scarcely be said  to  occur in this, or indeed  in  any of  tt.e  diseases of
early life.
   The  duration  of hydrocephalus is  liable to almost as much  variation as the symptoms which charac-
terize it.  It has been known to proye fatal in a  week.  Some  cases run on even as far as two months,
but these are  comparatively rare.   The average  duration  of the  complaint  may be stated to be three
weeks. — Gregory.
   The  extremities are cold, showing a determination of blood to the head, or an unequal circulation, and
in some cases there is costiveness in the commencement of  the disease ; there  is in others, particularly
when the attack  is very violent, free purging ;  there  is also, generally, great heat or inflammation of the
head, and this may be the principal cause of the  disease.
   (For a description of the chronic form of hydrocephalus, or that which is accompanied  by enlargement
of the skull, and which  is a disease of rare occurrence, the reader  may refer to my " American Practice,"
volume i., pages 4S0, 481.)
   Discrimination. — It is to be distinguished from apoplexy  by its being attended  with fever, and from
simple typhus by the paroxysm being very irregular, with perfect intermissions many times a day.   What-
ever difficulties there may be in the early stage,  particularly in  infants, there  is  no disease more easily
distinguished in  the advanced  stages than hydrocephalus.   " Indeed,"  says a writer, " how can we mis-
take when we see a child rolling its head on the pillow, or  perhaps sawing the air with one hand, while
the opposite side is palsied ; with a hectic on the cheek, his eyelids half concealing the pupil, and the
eyes deprived of their vivacity by the filmy covering of the cornea ; the complete  dilatation of one or both
pupils,  and the suffusion of the adnata;  drawing a long sigh ;  frequently grinding his  teeth ; quite incohe-
rent, or in a state of complete  insensibility ; with a burning fever on the skin, or  sweat forced from every
pore :  and all these symptoms alternating  with, and at last finished by, a palpitating breathing and violent
convulsions?"
   Dissection. — An accumulation of  water in  the ventricles  of  the brain is one of the most common
appearances to be  observed on  digsection.  In different cases this is accumulated in greater or less quan-
tities :  it sometimes amounts only to a few ounces, and occasionally to  some pints.  When the quantity
of water is considerable, the fornix is raised at its anterior extremity, in  consequence of its accumulation,
and an  immediate opening or  communication is thereby formed  between the  lateral ventricles.   The
water is of a purer color and more limpid  than what is found in the dropsy of the thorax, or abdomen  ;
it appears, however,  to be generally of the same nature with the water that is  accumulated in these cavi-
ties.  In  some instances, the  water  in  hydrocephalus contains a very small proportion of coagulable
matter,  and in others it is entirely free from it.  When the water is accumulated to a very large quantity
in the ventricles, the substance  of the brain  appears to be a sort of pulpy bag, containing a fluid.  The
skull upon such  occasions is very much enlarged in  its size, and  altered  in  its shape ;  and it appears
exceedingly large in  proportion to the face.
   Common Practice. — Bleeding repeatedly from  the arm or jugular veins, mercury, blisters, &c.
   Reformed Practice. — Indications of Cure :  1. The indication of cure in this disease is, to lessen
the inflammatorv action, by equalizing the circulation, and thus  preventing  a  serous effusion.  2. When
water has been collected, to evacuate it  through the medium  of the absorbents, by stimulating them to a
healthy  action.
   From the nature of this complaint, it is evident  that  it becomes more  difficult to remove than most
others.   But by prompt and suitable measures, it may often be  successfully treated.
   When the disease is marked by inflammation, the first steps to be taken are, to use such means as are
calculated to subdue it.   Bleeding is resorted  to by physicians generally;  but with what  propriety, I am
unable to determine.  It may produce or  exasperate, but  can never cure the disease.  The  usual effect 
220
DISEASES OF WOMEN AND CHILDREN.
of blood-letting, viz., that of debility or prostration, is sensibly experienced in  hydrocephalus, and that,
loo, without at all lessening  arterial action.
  To reduce  the inflammation, our reliance must be placed upon more appropriate means, and such, iu
general, must be resorted to as have been laid down under the head of other inflammatory complaints, in
order to divert the blood from the head, and recall it to the extremities and the surface.   Let the feet and
legs be immersed in  warm ley-water, and well rubbed with flannel or muslin.  Let the  surface be bathed
with the same ; both of which processes  must  be often repeated, or  according  to  tbe  urgency of the
symptoms.
  Great reliance in the treatment of this  disease must be placed upon purgatives, and such as  act equally
through the whole alimentary canal.  Our common purgative, combined with cream of tartar, answers
well for this purpose.  About equal parts of the two articles may be combined, and given in any suitable
vehicle.
  It is difficult to  lay down any precise rule for the repetition of purgatives, as this depends upon the
violence of the disease,  constitution, &c. ; but  as a general rule, in severe attacks they may be given
daily, and in protracted cases every two or three days.  In most cases immediate amendment follows their
administration, either when there is inflammation  or serous effusion.
  It is indispensably necessary in  this, as in  most other  diseases, to pay strict  attention to the capillary
system.   Such medicines must be given, and such means taken, as are calculated to promote perspira-
tion.  In  addition to bathing the feet and surface mentioned above, sudorific medicines must  be given.
For this purpose, give the sudorific or sweating  drops, in doses according  to the  age of the child, to be
accompanied with the free use of the infusion of spearmint (mentha sativa), and the same tea or infusion
to be given when the child  is thirsty.   This plant has a threefold effect upon the system :  first, it allays
the irritability of the stomach ;  second, it promotes gentle perspiration ; third, it promotes a preternatural
discharge of urine.
  Should the sweating-drops prove too  stimulating, and thus increase  the  febrile excitement, substitute
the diaphoretic powders : two or three grains may be given to a child  two  years  old three or four times
through the course  of the  day, and particularly  given at night, to allay irritation, procure rest, promote
perspiration, &c.
  Should all these means fail of producing perspiration,  which,  from  ike dry and  constricted state of the
skin, may occasionally be the case, let the child be held in the arms of its mother or nurse, and a blanket
thrown around  it, and let both be  placed over a tub containing  a strong decoction of bitter herbs.   The
steam must be permitted gradually to come in contact with  the  body of the child ; after which let  it be
wrapped in a blanket, and placed in a bed or cradle.   If benefit is  experienced from this process, let it
be repeated.
  In almost every case of hydrocephalus, there  is great heat or inflammation of the head, and therefore
it is necessary to  apply refrigerant or  cooling lotions or applications to it.   Equal parts of spirits, rain-
water, and vinegar, to which a little  salt  has  been added, may be  often  applied to the head, tepid.  I
have applied it cold, and sometimes warm  : and  when I have ascertained which affords the most relief, I
have continued it of the same temperature.
  Should  this  only partially relieve, or  should it lose its efficacy after  frequent  applications, let  it be
omitted, and let hops simmered  in vinegar be applied  to the whole head.  Great benefit is invariably
experienced from these applications : the child,  after great restlessness and pain, will  generally fall asleep
after they  have been applied.
  In some cases, where  the disease has been of  an  unusually obstinate character, resisting the ordinary
remedies of this nature, I have applied with decided benefit a poultice of slippery-elm bark over the whole
head, to be removed before  it becomes dry.  Care must be taken in making these applications that  there
be not too speedy an evaporation.  The head should be covered with a cap or handkerchief.
  I have administered (and, as far as I have been able to ascertain, with great advantage) the tincture of
foxglove  or digitalis.   Five or  six drops  (according  to  age) of the  tinqture  may be  given  in  a little 
DISEASES OF  CHILDREN.
221
parsley-tea, at morning, noon, evening, and bedtime : other internal remedies to be suspended during the
day, while these drops are administered.   Purgatives, however, may be given in the morning, if necessary,
and the diaphoretic powders at night.
  Mustard-plasters must be kept to  the  feet, sufficiently strong to excite a little redness, after which  let
them be applied between  the shoulders, and thus changed alternately.
  Cupping in this disease has been  highly spoken  of by some.   A physician of this  city became very
celebrated some years ago for the cure of dropsy of  the head, and his principal reliance was upon  this
operation.  I have occasionally tried it in the worst or most  desperate  cases, but I am  not  clear in my
own mind how far it is beneficial.  In one case, which was given  up as incurable, and one of the worst
I ever saw, as a last alternative, I ordered the child to be cupped :  it  appeared  to  mitigate  all the pain,
tlie  child fell asleep, and soon recovered.   It might be resorted to, should all other means fail; the cups
should be placed  upon the temples and nape of the  neck.
  Regimen. — It is very necessary that the room  should be kept quiet and  somewhat darkened.  For
nourishment, give arrowroot-tea, milk, panado, &c.
  When nourishment can not  be taken by the mouth, it may be given by the way of injection.  By this
treatment  we have cured  many cases of this disease which appeared beyond the control of medicine.
                                       SECTION XVIII.

                                    VERMES, OR  WORMS,

   Description. — These are chiefly of three kinds, viz. : the tenia, or tape-worm ; the teres, or round
and long worm ; and the ascarides, or round and short worm.   There  are many other kinds of worms
found in the human body ;  but as they proceed in a great measure from similar causes, have nearly the
same symptoms, and require almost the  same method of treatment as these already mentioned,  we shall
not spend time in enumerating them.
   The tape-worm is white, very  long, and full of joints.  It is generally bred  either in the stomach or
small intestines.  The round and long worm is likewise bred in the small entrails, and sometimes in the
stomach.  The round  and  short worms commonly lodge in the rectum, and  occasion  a disagreeable
itchino' about the seat.   The long round worms occasion squeamishness, vomiting, a disagreeable breath,
gripes, looseness, swelling of the abdomen, swoonings, loathing  of food ;  and at other times a voracious
appetite, a dry cough, convulsions, epileptic fits, and sometimes a  privation of speech.   These worms
have been known to perforate the intestines, and get into the  cavity  of the  belly.  The effects of the
tape-worm are nearly the same with those of the long and round, but  rather more violent.
   Andry says that the following  symptoms particularly attend the solium, which is a species of tape-worm,
viz., swoonings, privation  of speech, and  a voracious appetite.  The  round  worms, called ascarides,
besides an itching of the anus, cause  swoonings, and tenesmus, or an inclination to go to stool.
   Causes. — Worms may proceed from various causes ; but they are seldom found except in weak and
relaxed stomachs, where the digestion is  bad.   Sedentary persons are  more liable to them than the active
and laborious.   Those who eat great quantities of unripe fruit, or who live much on raw herbs and roots,
are generally subject to  worms.   There seems  to be  an  hereditary disposition  in some  persons to this
complaint.
   Symptoms. — The common symptoms of worms are, paleness of the countenance, and at other times
a universal flushing  of the  face;  itching of the nose (this, however, is doubtful, as children pick their
noses in all diseases); starting and grinding of the teeth in sleep ; swelling of the upper lip ; the appetite
sometimes bad, at other times quite  voracious ;  looseness ;  a sour  or  slinking breath ; a hard, swelled
abdomen ; great thirst;  the urine frothy, and sometimes of a whitish color ; griping or c>  'ic'pains ; an 
222
DISEASES  OF  WOMEN AND CHILDREN.
involuntary discliarge of saliva, especially when asleep ; frequent pains of the side, with a dry cough, and
unequal pulse; palpitations  of the heart; swoonings, drowsiness, cold  sweats, palsy, epileptic fits, with
many other unaccountable nervous symptoms, which  were formerly  attributed to witchcraft, or the influ-
ence of evil spirits.   Small bodies in  the excrements,  resembling melon or cucumber seeds, are symptoms
of the tape-worm.   Says Buchan —" I  lately saw some very surprising  effects  of worms in  a little girl
about five years of age, who used to  lie  for whole  hours  as  if dead.   She at last expired, and, upon
opening her body, a number of the teres, or long round worms, were found  in her intestines,  which  were
considerably inflamed ; and what anatomists call an  intus-susceptio, or the involving of one part of the gut
within another, had taken place in no less than four different parts of the intestinal canal."
   Treatment. — Calomel is now principally used for the removal  of worms :  but this medicine is very
dangerous to administer.   Calomel or mercury is the basis or principal ingredient of most of the  highly-
reputed nostrums for worms, such  as  worm  lozenges, vermifuges, &c.  The following preparation will
be found very effectual in expelling different kinds of worms from the system :—
                       Take Carolina  pinkroot (spigelia maylandka),
                           Alexandria senna {cassia senna),
                           manna {fraxinus ornus) ; of each half an ounce.
   Bruise all, and add to the powder  one quart of  boiling water ; let  it  stand  a short time, in order to
extract the strength of the articles ; sweeten with molasses, and  add  a  small  quantity of milk.  For a
child five years old, give a gill three or four times a day on an empty stomach, and if this does not purge,
increase the dose until  the effect  is produced.
   Worms sometimes ascend into the throats of children  and choke  them.   This symptom  may  readily
be removed  by giving a little salts-and-water : repeating it occasionally will often expel them,  and  always
is a  preventive.  This will  be found a  very valuable  remedy for different kinds of worms ; and even
should none  exist, it will  cleanse  the stomach  and  bowels,  and prove very  beneficial.   I have  tried
various articles for worms, but find that the compound described above exceeds every other  preparation.
   When small worms infect the rectum,  a weak infusion  of tobacco, used  as an injection, will dislodge
them, and the above medicine should likewise be given.
   This treatment may also be used for the tenia, or tape-worm, but I can not recommend it  as a certain
remedy, nor do I know any treatment that is always capable of removing this species of worms ;  I  have
given thirty or forty different agents, but none of which have proved entirely effectual.  A person informs
me that a small quantity of indigo cured   one case in Kentucky.   The male fern has also been  highly
extolled for it, but I can not speak with  any certainty of its effects.   One case was cured in one of the
New-England  states by a very curious process, and which  perhaps is an infallible remedy, but which  to
many might be a very  unpleasant one :  The patient was  suffered to get extremely hungry,  after which
he was suspended over a boiling  vessel of food, with his mouth open, in order that the worm might inhale
the steam arising from it.   This had the  desired effect: the reptile rushed from  the stomach to the mouth
to satisfy the cravings of hunger,  when his head was-clipped with a pair of scissors, and thus removed.
   A young woman  at  Peekskill, New York,  was attended for  dyspepsia.   After  her decease,  worms
were discharged from her mouth.
                                        SECTION XIX.

                            PERTUSSIS,  OR  HOOPING-COUGH.

  Description. — This is a disease known by a convulsive, strangulating cough, with hooping return-
ing  by fits that are usually terminated by vomiting.   Children  are  most commonly  the subjects of this
disease, and it seems to depend  on a specific contagion, which  affects them but once in their life.  The
di-ease being once produced,  the  fits of coughing are often repeated without any evident causes  ; but, in 
DISEASES OF CHILDREN.
223
 many cases, the contagion  may be considered as only giving the predisposition, and the frequency of the
 fits may depend  upon various exciting  causes, such  as violent  exercise, a full  meal, the having  taken
 food of  difficult digestion,  and irritation of the lungs by dust, smoke, or disagreeable odors.   Emotions
 of the mind may likewise prove an exciting cause.
   Causes. — It is evidently produced by contagion.   Its proximate or immediate cause seems to be a
 viscid matter or phlegm lodged  about  the  bronchia, trachea, and  fauces, which sticks so close as  to be
 expectorated with the greatest difficulty.  Some  have supposed it to be  a morbid irritability of the  stom-
 ach, with increased action of its mucous glands; but the affection ofxhe stomach which takes place in the
 disease  is clearly only of a secondary nature, so that this opinion must be erroneous.
   Symptoms. — The hooping-cough usually comes  on with  a  difficulty of  breathing, some  degree of
 thirst, a  quick pulse, and other slight febrile symptoms, which are succeeded by a hoarseness, cough, and
 difficulty of expectoration.   These symptoms continue  perhaps for a fortnight or more, at the end of
 which time the disease puts  on  its peculiar  and characteristic form, and is now evident, as  the cough
 becomes convulsive, and is attended with a sound which has been called a hoop.
   When the sonorous inspiration  has happened, the  coughing is again renewed,  and  continues in  the
 same manner  as before, till either a quantity of mucus is thrown up  from the lungs, or the contents of the
 stomach are evacuated by vomiting.   The fit is then terminated, and  the patient remains free from any
 other for some time ; and shortly afterward returns to the amusements he was employed  in before the fit,
 expresses a desire for food, and when it is given to  him, takes it  greedily.   In those  cases, however,
 where the attack has been  severe, he often seems much fatigued, makes quick inspirations, and falls into
 a faint.   On the first coming on of the disease,  there is little or no expectoration, or if any,  it consists
 only of thin mucus : and as long as this is the case, the fits of  coughing are frequent and of considerable
 duration ; but on the expectoration becoming free and copious, the fits of coughing are less frequent, as
 well as  of shorter duration.   By the violence of coughing,  the free transmission of blood through  the
 lungs is  somewhat interrupted, as  likewise the free return of the blood  from the head, which  produces
 that turgescence  and suffusion  of the  face which  commonly attend the attack, and in  some instances
 brings on a haemorrhage either from the nose  or ears.   The disease, having arrived at its height, usually
 continues for some weeks longer, and at length goes  off gradually.  In some  cases, however, it is
 protracted for several months, or even a year, and sometimes terminates in other complaints.
  Prognosis. — Although the hooping-cough often  proves  tedious, and is liable to return with violence
 on any fresh exposure to cold, when not entirely removed, it  nevertheless is seldom fatal, except to very
 young children, who are always  likely to suffer more from it than those of a more advanced age.  The
 danger seems  indeed  always to be in proportion to the youth of the person, and the degree of fever and
 difficulty of breathing which  accompany the disease, as  likewise the state of debility which prevails." It
 has been known in some instances to terminate in  apoplexy  and suffocation.   If the  fits are  terminated
 by vomiting, it may be regarded as a favorable symptom, as may likewise the taking place of a moderate
 and free expectoration, or the ensuing of a slight haemorrhage from the  nose or ears.
  Dissection. — Dissections of those who die  of the hooping-cough usually  show the consequence of
 the  organs of respiration being affected, and particularly those parts  which are the seat of catarrh.  When
 the  disease has been long protracted, it is apt to degenerate into pulmonary consumption, asthma, or vis-
 ceral obstructions, in which last case the glands of the mesentery are found in a hard and enlarged stale.
  Common Treatment. — Squills, antimony, bleeding, &c.
  Reformed  Practice. — It  is generally reckoned a  favorable symptom when a  fit of coughing makes
 the  patient vomit: this cleanses  the stomach, and greatly relieves the cough ;  it will therefore be proper
 to promote this discharge, by giving a lobelia-emetic.   Emetics not only cleanse the stomach, which in
this disease is generally loaded with viscid phlegm, but they likewise promote  perspiration and the other
secretions, and ought therefore to be repeated according to the obstinacy of the disease.  They should
not, however, be strong: gentle  vomits, frequently  repeated,  are both less dangerous and more beneficial
than stron^ ones.  For this purpose, a teaspoonful of the tincture  of lobelia  may be given to a child a 
22 t
DISEASES OF WOMEN  AND CHILDREN.
year old, in aay kind of tea sweetened, every half hour, till it operates as a gentle emetic. ;  it maybe repeated
whenever  a fit of coughing occurs, and there is  a sense of suffocation ;  or if there is great debility, or the
attack is not very severe, a sufficient quantity may be given to loosen the mucus or phlegm, and to cause
the child to breathe freely.   The  following syrup may also be given : four ounces of elecampane-root and
half a pint of honey ;  bake  it in  a well-glazed  earthen pot in a heated oven.  If the root be green, it
needs no water; if dry, add half a pint of water.  A teaspoonful of the  syrup to be given occasionally, or
three times a day.   The pulmonary syrup is likewise  an excellent  remedy in this complaint.
   Opiates are sometimes necessary to allay the violence of the cough.   For this purpose, a little of the
syrup of poppies, according  to the age of the patient, maybe taken  in a cup of hyssop or pennyroyal tea,
and repeated occasionally.   The  bowels must be kept freely open by gentle laxatives.   A good medicine
for this  purpose is the cold-pressed castor-oil, mixed with a little sweetened milk :  a teaspoonful or two
may be  given to a child one year  old two or three times a day, as  there is occasion ; for those that are
older, the  dose must be increased, and repeated till it has the  desired effect.   Those who can not be in
this manner induced to take  the castor-oil, may have it mixed with a little syrup or currant-jelly to disguise
the taste ;  most children  are fond  of  syrups and jellies, and seldom refuse a disagreeable medicine when
mixed with them.  Bathe the feet in warm ley-water every  night, and apply draughts or sinapisms.
   Regimen.—Whatever injures the digestion, obstructs the  perspiration, or relaxes the solids, disposes
to this disease ; consequently its cure must depend upon cleansing and strengthening  the stomach, bracing
the solids, and  at the  same time promoting perspiration and the different secretions.   The diet must be
light and of easy digestion : for children, good bread made into pap  or pudding, chicken-broth, with other
light spoon-meats, are proper; but those who are further advanced may be allowed gruel,  and, if the fever
be not high, a little boiled chicken.   The drink may be hyssop or pennyroyal tea, sweetened with honey
or sugar-candy, small-wine  whey, or,  if the patient be  weak, he may sometimes be allowed a little wine.
   One  of the most effectual remedies in the hooping-cough is change  of air.   This often removes tho
malady, even when the change  seems to be from a purer to  a less  wholesome air;  this  may in some
measure depend on the patient's being removed from the place where the infection prevails.   Most of the
diseases of children are infectious ; nor is it at all uncommon to find the complaint prevailing in one town
or village, when another at   a very small  distance is quite free from it.   The feet should  be  frequently
bathed  in  lukewarm water, and a sweating or strengthening plaster kept constantly between the shoulders.
END  OF  PART THIRD. 
                              PART  FOURTH.

PHYSIOLOGICAL  AND  MORAL  ELEVATION  OF  MANKIND.
         "TRAIN UP A CHILD IN THE WAY HE SHOULD GO, AND WHEN HE IS OLD HE WILL NOT DEPART PROM IT."

  Having treated of all the subjects immediately connected with the reproduction of  our race, I deem
it expedient to conclude the work  by considering  briefly a few more subjects which I  regard as very
important to the well-being of our species, although somewhat disconnected with this branch of medicine.
                                      CHAPTER I.

           PHYSICAL  TRAINING  OF   CHILDREN.

  There is no subject so intimately connected with the happiness of our race, and which is at the same
time so much  neglected, as the proper education of infants and children.
  I shall, therefore, in as brief and concise a manner as possible, lay down such rules and regulations as
I deem necessary for the due discharge of the important duties devolving upon parents toward the rising
generation.
  I shall commence with the  proper physical  training of infants, because this is very justly considered
the  foundation on  which all  other correct training must be  based.  If the  physical organization be
deranged,  it will materially interfere  with  the  due formation of the  intellectual, moral, and religious
character of the child.
  In laying down the proper rules for the formation of a healthy physicial  constitution, I shall compre-
hend those which are necessary in dress, food,  bathing, air, exercise, exposure, &c.
                                        SECTION  I.
                                          DRESS.

  The clothing of infants will always be more or less under the dominion of the fashion of the day, and
therefore we need  not specify any particular form or  construction as that which ought constantly to be
preferred.   The leading qualities required in the material are lightness, softness, and warmth; and it must
consequently vary  somewhat according to the climate and season of the year.  In construction, the dress
ought to admit of being easily put on and taken off;  and while it affords ample protection to the body, it
                                             29 
•::6               PHYSIOLOGICAL AND MORAL  ELEVATION OF MANKIND.

ought to admit of the fullest expansion of the chest  and abdomen,  and  perfect freedom of motion in the
limbs and joints.   Provided it fulfil these ends, there will be no occasion for interfering with the mother's
taste, although plainness  is always the most becoming.   But whatever tends  either to compress the body
or to restrain the  arms or legs, ought to be unrelentingly forbidden :  and  particularly every approach to the
former practice of swaddling the infant in rollers like a mummy — a practice  still prevalent in many parts
or section-, and the only advantage of which is, that the mother, when  called out of the room  or house
for a time, can  hang up her infant on a nail, like an inanimate bundle, with the positive certainty of finding
it in  the same position on her return, neither burnt to death by the  fire, nor with its face scratched  or its
eves put out by  the  cat. as sometimes happens when it is carelessly left sprawling on the floor, or even
in its cradle.
   If the child has been prematurely born, or is of a weak constitution, or if it  be the winter season, flannel
ought generally to be preferred  for the whole of the  dress, but not  in contact with the skin.   From the
protection which  it affords, and also the  slight  stimulus which it  gives  to  the cutaneous vessels, it is
extremely useful  in warding off  the  internal congestions, and  inflammatory and bowel complaints, to
which weakly children are liable.   I know an instance where  a very delicate  and  premature  infant was
saved, contrary to all expectation, by lying imbedded in cotton in a basket, and was thus safely brought
to town from a considerable distance.  But whatever material  is used,  the greatest attention should  be
paid to frequent changes and to avoiding  irritation.   When,  as  sometimes  happens, from any unusual
sensibility of the  skin, or  other  causes,  flannel  induces perspiration,  cotton or  fine  linen should  bo
preferred — care being taken never to put them on till  thoroughly aired  and   made  comfortably warm at
the fire.
   As to the other parts of  dress, it is impossible to lay down any specific rules,  because they  ought to
vary in quantity and quality according to individual  circumstances.    The great thing is, never to forget
that  the supply of animal heat is smaller in  infancy than at any later period ;  and that,  consequently, the
dress ought to be such as  to insure due warmth, more especially during the winter and  spring.   The
necessity of warmth in infancy  is strikingly illustrated by the tender care with which many of  the lower
animals  protect their young from external cold.  Moved by iustinct, the  hen  gathers her chickens under
her wings, and  fosters them with her own warmth ; and when left to its own impulse, the infant  nestles in
its mother's bosom, and  shuns  the  contact  of  cold.   Its dress, therefore, must  be such as to  insure  its
comfortable and equal warmth,  without any chance of overheating or relaxing.  For, however prejudicial
exposure to cold  may be in infancy, excessive wrapping up, or  living in too hot rooms, is not less hurtful,
and  ought to be as scrupulously avoided as the opposite extreme.    Perfect  freedom  of motion in  the
limbs and joints,  and the absence  of all pressure on the chest  or  bowels from undue tightness of  the
dress, are equally indispensable to health,  and if it is faulty in  any of these respects, not an hour should
be lost in making the requisite alterations.   As  far as possible, too, strings should be used  instead of pins
for fastening the clothes.   Where pins are not  very carefully inserted, they are apt to penetrate the flesh
on any accidental twisting of the body, and  to produce serious suffering and danger.  By good manage-
ment, indeed, they may be  entirely dispensed with.
   The common practice  of dressing infants in long flowing clothes during the first few months, is attended
with  the advantage of protecting the body and lower  extremities against cold air and draughts ;  and when
it is  not carried so fir as to  overheat the child, no .harm can  arise from following it.   In  cold weather,
the feet should  be further protected by soft woollen socks or knitted worsted  shoes, which retain warmth
without  in any  degree compressing the feet.
  Dr. Eberle has very properly called attention to a  glaring inconsistency in infant clothing, which ou^ht
to be immediately remedied, and which consists  in  leaving  the neck, shoulders, and arms, quite  bare,
while the rest of the body is kept abundantly warm : a practice which is generally continued durinf the first
five or six years of life, and the impropriety of which,  especially in winter, shows  itself in  the  dry rouMi
state of  the skin on the arms and hands, as contrasted with  its softness and smoothness where  it is cov-
ered.  Dr. Eberle remarks, that, while adults are  so careful to keep  these parts well covered, it is strand
                                                              Li.                i          n' 
PHYSICAL TRAINING OF CHILDREN.
227
that children should be universally left without equal protection, not only in winter, but  even frequently
out of doors in cold and damp weather.   " It has been supposed," he says, " that this custom is one  of
the principal reasons why inflammatory affections of the  respiratory organs are so  much  more common
during the period of childhood than at a more advanced age ;  and there can be no doubt that its influence
in this respect  is very  considerable." — " Croup, inflammation  of  the  lungs, catarrh,  and general fever,
are doubtless frequently the consequences  of this  irrational  custom ;  and it is not  improbable that the
foundation of  pulmonary consumption is  often thus  laid during  the  first  few years of  life."*   These
remarks  are strongly borne out by the results of late investigations made in Europe, which prove that the
proportion of deaths in childhood from inflammatory  affections  of the organs  of  respiration is greatby
beyond what was formerly supposed.   Thus, in the appendix  to  the  first annual  report of the registrar
general  of births, marriages, and  deaths, in England, we  find  it stated  by  Mr. Farr, that, among "the
diseases of the respiratory organs, pneumonia,  which,  it must be recollected, includes ' inflammation  of
the chest,' was next in fatality to consumption ;  but young children J'urnished the majority of the  cases :
of 379 fatal cases of pneumonia in the metropolis, and in  some  county  districts, 228 were children under
three years of  age."  (Report, p. 74.)   When  we  take further  into  consideration that consumption most
frequently attacks the  upper  part  of  the  lungs, we  have  an   additional presumption  that the  unguarded
exposure of the corresponding parts of the chest is not without its influence in determining the subsequent
disease.    That this exposure really  operates as a predisposing cause, is  rendered still more probable  by
the greater liability to  consumption of females than of males.   Female children continue to have the shoul-
ders and upper part of the chest uncovered, while  in  males  the practice ceases with the assumption  of
their distinctive dress.t  In conformity with this, we find from Mr. Farr's analysis of the registrar's report
(p. 74), that while " bronchitis, pleurisy, pneumonia, hydrothorax, and asthma, (diseases from active expo-
sure), destroyed  more  males than  females out of the same number living,  consumption  and  decline
destroyed more females  than males, in the  ratio of 4,155 to 3,771."   I do not mean to affirm that this
defect of  dress is the  sole cause of the excess  of  consumption in females ;  but when their comparative
exemption from many of the other causes is considered, such as reckless exposure  to the weather and to
fatigue,  as well as the  debilitating effects of irregular living and active dissipation, it will  be difficult to
deny that it  has a share in the  result, and ought, therefore, to  be  guarded  against.   This  opinion is, I
find, confirmed by the testimony of a late popular writer,! who  declares herself " convinced by repeated
observation in  various countries, that children who  have their bosoms and arms covered for the first two
years, are not  subject to those severe coughs and inflammations  of the  lungs, which,  during the  time  of
teething, are fatal to so many."
   Knowing, however, the strong tendency of excited feeling  to  run  into extremes,  I would here once
more caution parents  against falling into the opposite error of  loading the child with  too many clothes, and
coverino- the shoulders and  neck with warm tippets or shawls, even within  doors.   More mischief may
be done by the excessive relaxation  thus induced, than by leaving   them exposed ; all that is wanted  is,
that the  ordinary  upper dress shall extend sufficiently high to protect the neck and upper part of the chest
from variations of temperature, and that the sleeves  be  made long enough to  reach nearly to the wrist.
   The head is very commonly kept  too warm  in  infancy ; which, considering the natural tendency  to
nervous  excitement and  rapid  circulation  in early  life, is  an  improper practice.   In warm weather, the
thinnest  possible covering will be sufficient  for its  protection  ;  and even  in cold weather, a warmer cap
  * Eberle on the " Diseases of Children," p. Q4.
  t Dr. Bell, also, in supposing that the parents who advocate this defective dress for infants might think they were following the example of
Spartan mothers, well remarks : " Many are, we fear, influenced by more unworthy motives — motives which an affectionate mother ought to
be ashamed to avow — such as a desire to imitate other people who  dress their children in this way, and a love of exposing their beautiful
breasts and round arms ! Do these parents love that their children should have  catarrhs, cWups, violent colics, &c. ?  One would suppose
they did.  Or are they prepared to answer this question :  ' Is it a greater pity for a  child to be unfashionably dressed, than to be tossing about
in all the agonies of disease, and threatened every hour with suffocation, and not unfrequently finding repose only in the sleep of Heath?'
What, we would ask, has fashion to do with children, or  they with fashion ?  It is  enough for mothers and  grown daughters to be the victims .
to fashion,  as when they parade with bare shoulders and tightly-corseted waists, and paper-soled shoes, without inflicting punishment on
young beings, who, insensible to the admiration of the idle and the silly, find no compensation for their sufferings in gratified vanity."'
  X " Advice to Young Mothers on the Physical Education of Children, by a Grandmother," chap. i. 
228                PHYSIOLOGICAL  AND MORAL ELEVATION  OF MANKIND.

will  be required  only when going into the open air.*   When in the house,  the temperature  is generally
kept high enough  by fires  to  render  much  wrapping  up  neither  necessary nor safe.   When  cold  is
induced by wearing thin caps, it  is  generally  in  consequence of the  infant  being laid  to sleep with the
head immersed in a very soft warm pillow, which causes an unusual flow of blood  toward it, accompa-
nied by con-iderable perspiration on its surface.   This plan  has the  double  disadvantage  of leaving the
upper part of the head which  is not sunk in  the pillow comparatively cold, while the rest is overheated
and  in  a state of  perspiration.   In  such  circumstances  the  rational remedy is,  not to put on a thicker
covering by day, but, by the use of a proper  pillow, to guard against  overheating by night.   When "the
head is kept very warm,  the  nervous excitability is greatly increased, so that every change makes  an
impression upon  the infant, and any accidental  irritation  is  more likely to be followed  by  spasmodic  or
convulsive fits.
   When,  in  the lapse of a  few months,  strength and activity, and their natural concomitant a desire for
motion, become developed, the dress  requires to be so arranged as  to leave the   feet free and unencum-
bered.   Soft warm stockings and easy comfortable shoes are then advisable, but no  compression in any
form ought to be  permitted.   In making the  change to  short clothes, however, regard  must be Iiad to
the  weather,  and due care be taken to  keep the legs and feet warm when the child is carried out into the
open air.
   Nearly  akin to dress by day is the provision  of proper bedclothing  during the night, and during the
many hours of sleep.   If an infant is buried under a mass of bedclothes when asleep, and dressed in the
ordinary way when  awake, the very transition  is  apt to be hurtful.   Consistency in  this  respect is  as
material as in every other.   I have  seen  mothers guard carefully against too much wrapping up by day,
who nevertheless acted at night as if the health  and comfort  of the infant depended entirely on  the  quan-
tity  of blankets which it  could  sustain without  being smothered.  And yet, considering  that three parts
out  of four of infant life are spent in sleep, nothing can be more preposterous than thus to counteract with
one hand  the good done by the other.
   In arranging night-coverings, the soft feather-bed is very often estimated  as  nothing ; or, in other words,
the  same provision of blankets is considered  equally indispensable, whether we lie upon a hard mattress,
or immersed in down.   It is from this confusion that the common mistake above  alluded to takes its rise.
The mother, looking only to the coverings laid over the child,  forgets those on which it lies, although in
reality the latter  may be the warmer of the two.   An infant deposited in a downy  bed has at least two
thirds of its  body in contact with the  feathers, and may thus  be perspiring at every  pore, when, from  its
having only a single  covering  thrown  over  it, the mother may imagine it to be enjoying the  restorative
influence of  agreeable slumbers.   In  hot summer weather, much mischief may be done by an oversight
of this kind.
   As already mentioned, the infant constitution  possesses a  low power of generating heat, and therefore
it requires to be warmly rather than imperfectly clothed  during sleep as well as during its  waking hours.
  * A better practice still is now getting into fashion.  It is, for the infant not to wear caps at all.  The flannel slip  or half shawl, which is put
round the neck and shoulders of the newly arrived being, when it is in its mother's or nnse's arms, can easily bo made to give the requisite
protection to tbe upper and back part of the head.  Very goon the natural covering of the hair will be found to be sufficient. Of the inconve-
niences and absurdity,  too, of a child's wearing a cap in the house, and especially in the nursery, I have elsewhere spoken;  and as experience
since the time in which I expressed my opinions has still further confirmed me in their accuracy, I will repeat what I then said on the subject:
" The bad effects of this covering to the head are manifold.  It invites, by its warmth, a still  greater quantity of blood to a part (the brain)
which is soft and vascular, and liable to inflammation from the large amount of this fluid in it.  Surely this is no reason why a mother should
put on, and a physician allow, a warm cap.  The scalp or tegument covered by the skin is tender and irritable, and prone to eruptions in
early life: no cause certainly why it must therefore be chafed and irritated by a worked cap full of rough projections.  The ears are apt to inflame
and discharge, or the skin behind them to be excoriated. Now, assuredly, we shall not prevent these effects by excluding air from the ear,
and keeping this part closely pressed  against the side of the head.  In vain does the poor child scratch its head with all possible force ; in vain
does it cry and toss about on account of the q^ing, or heat and pain caused by the cap !  The thing is pretty, and therefore must be worn,
even  though the mother should pass sleepless nights in consequence of the child's fretfulness, or the doctor have to be sent for in order to devise
roeans^fbr composing the little dear!
  •• We have not yet adverted to the string which passes under the chin, and which is at times tied, or becomes so tight by the child throwic
iu head back, as to act the part of a ligature, and give the poor little sufferer the sensation of the first stage of hanging.
 " In our professional experience, we have often found it impossible to cure cases of diseased scalp, and sore ears, so long as caps
'hese left off, tbe sores and breakings out soon disappeared." — Bell ("Journal of Health." vol ii., p. 85.) 
PHYSICAL TRAINING  OF  CHILDREN.
229
But here, as in everything, the extremes ought to be carefully guarded against; and while due warmth is
provided for when in bed, reason and consistency  ought to be  adhered to, and  excessive  heat  be as
scrupulously avoided as debilitating cold.  [Combe on Infants.]
  A fear of inducing relaxation by excessive wrapping up, has  led many parents to the opposite extreme
of clothing their children in a most imperfect and injurious  manner.  In alluding to  this fact, and to the
feeble power  of resisting cold in  infancy, Dr. Maunsell, of Edinburgh, very forcibly expresses the wish
that he could " adequately  depict one of those miserable victims of parental vanity, whose appearance in
our streets will sometimes,  upon  a March or November day, strike cold into our  hearts.  The cap and
feathers set upon, not covering, the child's head, and probably of a color and richness contrasting mourn-
fully with blue ears, sharpened  nose, and shrunken cheeks, in which cold has assumed the features of
starvation — the short  kilt and Highland hose, exposing between  them cracked and shivering knees —
altogether require for their description more graphic power than we presume  to lay claim to."  I have
known families to which this description applied with almost literal  accuracy; and  although acute disease
was  not the immediate result, several of the children soon manifested symptoms of glandular  obstruction,
and  a  strong  tendency to  scrofula.   The  dress, therefore, ought to be amply sufficient to  protect  the
child from every sensation  of cold or chill ; but, at the same time, light in  quality and  easy  in construc-
tion, so as to admit of the  utmost freedom and activity of motion  without any chance of overheating.
                                          SECTION  II.

                                        TIGHT-LACING.

  There are few customs, if any, which exert such a baneful influence  on the system as that of tigbt-
lacing, and therefore can not  be too generally censured.   It produces no benefit,  real or imaginary, but
positive injury ;  and is the offspring of great weakness, folly, and sin.
  The structure of the chest is such  that, it forms a  spacious arched chamber or  cavity, in which the
heart, lungs, and innumerable arteries, veins, valves, and muscles, perform their important offices :  con-
tracting,  dilating ; inhaling fresh air with one set of cells, using part of it to purify  the venous blood, and
then exhaling it through another set;  receiving from the veins blood which has gone its round, cleansing
it with wonderful art in a few  moments, and sending it on  again  by the arteries to meander through and
renovate  continually every part of the frame.  At every  breath, the lungs dilate  and contract;  at every
breath, the heart receives a  tide of blood into one of its divisions, and pours out an equal tide at another—
propelling it with a force equal to  forty or  fifty pounds'  weight.   For all these delicate and  momentous
operations, the chamber which  nature has  provided is exactly of the proper size — not a  hair's breadth
too small, nor a  hair's breadth too large :  nay, it is large enough, and  the vital movements  can  be  per-
formed only by certain motions  of the bones which compose it.   The ribs hinge  into the spine, and the
gristles and collar-bones  hinge into the sternum ;  there are joints also where the  ribs and gristles unite.
By means of these hinges and joints, the bones and gristles incessantly play in and out, or up  and down,
at each movement of the lungs ; and to their healthful movement  the freedom of that play is indispensable.
  Now a corset, or tight-lacing  of any kind, fetters the  freedom of those bones,  destroys all the advan-
tages of  the joints and hinges which nature has provided,  and thus lessens the room in which the lungs
and heart move, besides depriving them  of the aid, the impulse, they derive from the  motion of the
bones and muscles.   But all this is not half the mischief.   The ribs, especially at  the joints or hinges,
beinw soft in youn°- people, and the gristles much softer,  are compressed  by the lacing so as to approach
nearer and nearer to the  breast-bone in front; sometimes they lap over it and meet  each other: nay, there
are instances of  tight-lacing where  the  ribs have  not only passed  the sternum and  met, but have over-
lapped each other! 
230              PHYSIOLOGICAL AND MORAL ELEVATION OF MANKIND.

  Far short of that extreme, however, fatal  effects may be expected.   Quite a moderate degree of lacing
suffices to bring the points of the ribs several inches  forward, and to press the sternum  inward — narrow-
ing  just so much  that chamber which was at first not a hair's breadth too large for the lungs and heart to
work in,  besides stopping the auxiliary motion of the bones themselves.   The consequences need not be
detailed.   That the lungs, thus cribbed and forced to beat  in vain against  the contracted walls  of  their
prison, should be  inflamed and diseased ; that the  breathing should become short and difficult;  that the
heart should be subject to unnatural palpitations, and no longer drive the blood with regular and healthful
vigor along the arteries ; that youth's joyous and active sports must be prematurely abandoned ; and that
life  itself, perhaps, after years of  suffering, should retire from its besieged and oppressed citadel, can excite
no wonder.
  One fact will show most strikingly the horrible violence done  to nature  by tight-lacing.  The fabric I
have described—composed of  the  spine,  the  sternum,  the ribs, and their gristles — is  naturally cone-
shaped, smallest at the  top, and broadest at the bottom, where  the  diaphragm  separates it from the
stomach, &c.   Now, by  lacing, the lower ribs are so compressed — their greater portions  being gristle —
that the lowest part of the cone is made the smallest: and this it is which makes those foolishly-admired
waists, tapering downward.   Let every man who does not wish to marry  consumption,  carditis, angina
pectoris, or dyspepsia, beware of that taper waist!
  When (as it always is) the lacing is carried below  the diaphragm, injury little less fatal  ensues.  Then
softer and more compressible parts are  affected—various muscles, the stomach, and  other viscera.   I
leave you to infertile inevitable mischief to  these from reducing them, by force, to half the volume which
the  all-wise Creator has given.   Thus cramped  and fettered, it is impossible that their nice and compli-
cated functions can be well performed ;  and, accordingly, in all my practice I have met \jith no cases of
inflamed stomach, disordered digestion, and dyspepsia  in all its forms, half so malignant as those which
sprung from tight-lacing.
  A sense of oppression and weight is always experienced about the breast when  the corset is drawn
very tight around the body ; the breathing  is short, quick, and panting ; and not only is  the blood pre-
vented in a great  measure from  undergoing that change in the lungs by which it is adapted to the healthy
nourishment of the  various  organs, but the actions of the heart are also impeded : violent palpitation of
the latter is  not  unfrequently produced, accompanied by a sense of vertigo, and  occasionally  fainting.
When the corset  is worn constantly from early youth, the growth of the  ribs is prevented, and  the whole
capacity of the chest is  permanently contracted : and hence spitting of  blood, difficulty of breathing, or
even more dangerous and fatal diseases of the lungs and heart, are induced.
  Consumption is a very common complaint, the production  or  aggravation  of which may be  traced to
tight lacing.   But it is not merely to  tbe chest that the injurious  effects of the  corset are confined :  it
likewise compresses the whole of the upper portion of the  abdomen, and, by the yielding nature of this
portion of the body, the pressure upon the organs within is even more considerable than that experienced
by  the heart and lungs.   The liver, the  stomach, and the intestines,  in particular, experience  this pres-
sure to  a very great extent:  in consequence, the free and healthy secretions  of  the liver  are  prevented
from taking place, the stomach and the bowels can no longer  perform  their functions with proper vigor
and regularity, the  digestion of  the food  is  impeded, and the bowels  become costive and distended with
wind.   In this  manner, in  connexion with the injury inflicted upon  the  lungs, the vigor of  the whole
system becomes prostrated from  the use  of corsets ; the skin  assumes a sallow hue, the countenance a
haggard  and wrinkled appearance, and all  the  functions of life  are performed imperfectly.  It is a fact,
that nothing is better adapted to  produce the premature decay  of beauty, and the early  appearance of old
age, than the use of the corset.
  There are two other effects produced by this article of dress,  which would be sufficient of themselves
to induce every prudent and sensible female  to  abandon it.  The first  is, the injury inflicted upon the
breasts, by which their proper development is prevented, and the nipple is  almost entirely obliterated, so
ilia;, when called  upon to fulfil  the sacred  office of nurse toward her offspring, the mother finds, to her 
PHYSICAL TRAINING  OF  CHILDREN.
231
(FIG. 3. — COMPRESSED WAIST.)
(FIG. 2.—NATURAL FORM.)
(FIG. 4.—NATCEAL WAIST.)
sorrow, that, from her folly, she has totally incapacitated herself from performiug-its duties or experiencing
its pleasures.  The second  effect is that produced  by the  pressure of the corset upon the pelvis and the
womb, more  especially when worn  in early youth  or  during the  first stages of  pregnancy.   From this
cause, barrenness, miscarriages, or a stunted and deformed offspring, may result, or the  pains, the diffi-
culties, and the dangers of child-birth may be increased to a frightful degree.
   The injuries inflicted by compression of  the vital parts  are too numerous to be here recounted.   Im-
paired digestion, obstructed  circulation, pulmonary disease, and nervous wretchedness, are in their train. 
%
23>              PHYSIOLOGICAL AND  MORAL  ELEVATION OF MANKIND.

A physician, distinguished by practical knowledge  of the  Protean forms  of insanity, asserted  that  he
gained many patients from that cause.   Another medical gentleman of eminence, led by  philanthropy to
investigate the subject of tight-lacing, has assured the  public that multitudes annually die by the severe
discipline of busk and corset.   His theory is  sustained by collateral proof, and illustrated  by dissections.
   Remedy. — The only remedy, as for ardent  spirits, is total abstinence.   As soon as the corsets are
removed, the spine becomes weak from want of its customary support — the  muscles having lost their
action from  want of proper exercise.  This debility must be fought against.   The corset must be left off
for several hours every day, and for a longer and longer time daily.   While it is  off, the body must  be
rubbed briskly, and as hard as can well be  endured,  for ten or fifteen  minutes at a time, with a coarse
towel or flesh-brush ; and the patient must ride on  horseback, or walk till somewhat fatigued, keeping as
erect as possible.   The rubbing should be  done by the patient as far as practicable, and then  by a friend.
When the corset is again put on, it should  be made  no tighter than is absolutely necessary to support the
frame;  and the  degree  of tightness should  be lessened every day—as it  readily may  be — while  the
muscles  regain  their  strength.   After dry rubbing  for  some days, it  may be well  to apply cold  water
with a sponge or the hand, and then rub dry  with the coarse towel.
   This plan, pursued for a few months — perhaps even for six weeks — will cause  the wasted muscles to
swell and strengthen so,  that the corset  may  be laid  aside altogether — as it should  be the moment it can
be spared.
   Mrs.  Mary S. Gove, who has written an  interesting and useful treatise  on anatomy and  physiology, has
the following observations on tight-lacing :  "  I speak of that worse than heathen abomination, tight-lacing.
Truly it is far more to be  deprecated than the hook with which the wretched inhabitants of Hindostan
pierce their flesh, and thus suspend themselves in the  air, the victims of a cruel superstition.  The suf-
fering and  death produced in this way are not to be compared with  the misery and death arising from
compression.   Injuries to those bones which guard the heart and  lungs  are almost as fatal as injuries  to
those which guard the brain.  The breast-bone may be made to  press inward upon the heart in such  a
manner as to burst  it: but more  commonly the  poor sufferer dies a slow and miserable death, worn out
by anxiety and  oppression, fainting, palpitations, anxious breathings, quick  and  interrupted pulse, still
more frequent faintings, terminating fatally !"
   Some idea may  be formed of the injurious  habit of tight-lacing, from the great contrast of the precedin
figures:  fig. 1 shows the absurd  appearance  of a female with corsets,  in which the vital  parts are much
compressed ; fig. 2 represents the natural and healthy form, as designed by Nature ; fig. 3 is  the waist in
a compressed state  ;  fig. 4, the natural appearance of the waist.
                                         SECTION  III.

                                       FOOD  AND  DRINK.

   The circumstances which,  among the middle and  higher classes,  are most influential in impairing the
fitness of the parent for the duties of a nurse,  are precisely those which deteriorate the general health,
viz., neglect  of exercise ; confinement in  overheated, close rooms ; the exclusion of wholesome air during
the night by closely-drawn bed-curtains or small bedrooms; the relaxing effect of soft feather-beds; dissipation
of mind, or the absence of any serious or healthful interests or occupation ; indulgence in  late hours  night
and morning, and in passion and caprice of temper; eating more than the  system requires, or the stomach
can digest; drinking unseasonably or too largely of strong tea, malt-liquors, or other liquids ;  livin°- in a
bad situation  ; inattention to  the state of the skin, and to proper and  sufficient clothing; excessive novel-
reading, &c.   And, while such causes as these are left  in unheeded  operation,  the mother has herself to
blame, and not Nature, if she finds her bodily functions thereby disordered  to such an extent  as to deprive
her of the power of nursing her offspring. 
PHYSICAL TRAINING  OF  CHILDREN.
233
  It is from overlooking the necessity, on the part of the mother, of a rigid observance  of the laws  of
health, that the flow of milk is often greatly lessened or even arrested in a country nurse suddenly trans-
planted into town.  Accustomed to open doors, a constant free circulation of air, much bodily activity,
and the healthy digestion of a moderate meal, the  nurse is suddenly transferred  to  a warm room, whose
well-fitted windows and doors  exclude  the  fresh air, and where, although  she has  no longer any direct
call to active exertion  to excite a natural appetite for food, she is nevertheless  encouraged to eat largely
and frequently, and often to indulge in the  use  of  stimulants to  which she has never been accustomed.
Is it wonderful, that, under such  circumstances, the  digestive powers  should give way, and  the bowels
become disordered, the general system deranged, and the secretion of  milk either deteriorated in quality,
or altogether stopped?  Or, rather, could human ingenuity devise a  more likely  means to impair it, were
such the aim we had in view ?
   A favorable state of the general  health being the chief condition  required to  constitute  a good  nurse,
every mother who wishes to suckle her own child, ought, then, to adhere  scrupulously  to that mode of
life which experience  has  proved to be conducive to her welfare.   Consequently, when a healthy country
woman, who has always been  accustomed to plain fare and active exertion in the open  air,  is removed to
town to take charge of a child in  a  higher rank of life, the more steadily she adheres to  her  former habits,
the more certainly will her health and value as a  nurse  be preserved.   It is true that,  while  nursing, an
increased expenditure, requiring a proportionate supply, takes place.  But nature contributes to the neces-
sary adjustment, by generally  suppressing the customary monthly discharge during that period, and occa-
sionally also by a  certain  increase of appetite, which  may be  safely indulged by a moderate increase of
simple and nourishing food.   But this excitement of appetite ought never to be converted into an excuse
for indulging, as is often done, in a richness and variety of diet, which seldom fail to derange the health
of the nurse,  and  impair the quantity and quality of  the milk.
   If any mother  who may happen  to read  these pages should still remain  unconvinced of the propriety
of adhering to a simple and unstimulating diet while  acting as a nurse,  I would earnestly direct her atten-
tion to the unquestionable fact that  the best and healthiest nurses are to be found  among women belonging
to the agricultural population,  who, although actively employed, and much in the open air, scarcely ever
taste of fermented liquors of  any kind, but live principally on soups,  tea.  and vegetable and farinaceous
food.   Among mothers so circumstanced, it is rare to  meet with  one who experiences  any difficulty in
nursin"- her child, and many of them have milk enough  for a second infant.  This result is of itself suffi-
cient to prove that the best supply of healthy milk is to be derived, not from a  concentrated  and  highly
nutritious diet, but rather from one consisting of a  due  proportion of mild vegetable, farinaceous, and
liquid food, with a moderate allowance of meat and stimuli.
   " Evidence to this  effect," says Dr. Bell,  " is readily furnished  by any physician who is  a professional
adviser to mothers.  Among the latest and most positive, on this head, is a communication in the ' Lon-
don Lancet,' of February 8, 1840, from Mr. A. Courtenay, surgeon.   This gentleman  informs  us that
he has  resided in  Ramsgate during nearly eight years,  and has in that time attended 1,127  mothers in
child-bed.   He invariably found  that,  ' other circumstances being equal, those mothers who never tasted
malt-liqnors, wine, or spirits, during and subsequent to  the period of  labor, have had  the  easiest labors,
the earliest recoveries, and the  best health afterward.   Nay, more,' continues  Mr. C,  ' I know several
mothers who never could nurse their children  under the  ale and porter system, without suffering greatly
in health  but  who, after  relinquishing the use  of  those  baneful  stimulants, have experienced a perfect
freedom from  disorder during  lactation.  Nor was this all: the offspring of such mothers have enjoyed an
unprecedented immunity  from  disease also.'   After some  remarks tending to  show that  no mother is
ultimately-exempt from the  effects of this stimulating regimen, Mr. Courtenay gives  additional testimony
ao-ainst it in the following language  : ' I have under my  own eye many mothers who are experiencing the
ill effects of the moderate (not the  immoderate) use of these falsely-denominated " strengthening"  bever-
ages, in the form of liver and stomach complaints, skin-diseases, asthma, dropsy, &c, and every impar-
tial and observant member of  the profession must have noticed similar results.   Thousands  of children
                                                 30 
231              PHYSIOLOGICAL AND  MORAL  ELEVATION OF MANKIND

are annually cut off  by convulsions,  &c, from  the effects of  these  beverages acting through  the
mother.'
   " Mr. Courtenay very properly observes : ' Strong drinks excite a feverish state of the body, and create
an artificial thirst — a thirst which  is not expressive of any real want of  the  constitution, but  a certain
proof that the want does not exist.  The greater the  craving for  them, under these circumstances, the
more  certain we may be that  they are not needed, and  that  they  will  cause positive  mischief  to  both
mother and  child.   The constitutions of both are stimulated beyond what nature ever intended that they
should be.   The laws which  govern the animal economy are positively infringed, and it is impossible
that either mother or child can escape the penalty of that infringement.   Both  will suffer to a certainty in
some  shape or other ;  if not immediately, at a future period.' "
   As regards the quality of the  milk, there can be no doubt that a mild diet is of great  advantage.   The
milk derived from the  use of concentrated food  is too  thick, rich, and stimulating, for  most infants.   In
the case of the cow, we have direct evidence of the quality of the milk being immediately influenced by a
change of diet.   The  same thing  occurs in the  nurse  ; and  hence  the necessity of regulating  her diet
according to the state of the child.
   Supposing the health  of both  mother and child to continue good,  and the supply of milk abundant,  no
pretence whatever can  exist for  giving any other food,  till  the  teeth begin  to  appear; because, till then,
Nature has denied the  organization required for  the proper digestion of other substances.   This truth is
now much more generally acted upon than formerly.   Wanting faith in the  sufficiency of Cod's arrange-
ments to effect his own purposes, both medical men and  mothers used  to  advise the addition of gruel,
arrowroot, or some other farinaceous food, almost from the first month ;  and the common results  were,
impaired digestion,  and a greater liability to convulsions and other diseases, of irritation, especially during
the time of teething.
   But now, a better acquaintance with  the  laws  of the  animal  economy,  joined with a more  implicit
reliance upon the wisdom and benevolence of the Creator, has at last convinced us that the more closely
we adhere  to the path  which God  has marked out for us,  the more successful shall we  be in rearing the
young.   If, indeed, we bear constantly in mind that the  great  mortality in  infancy is not a part of the
scheme of  Providence, but arises chiefly from  removable causes, and has  already diminished as  our
knowledge has advanced, we shall become more and more anxious  to discover and fulfil  the laws of the
infant organization, as  the surest way of benefiting  and preserving the child.
   Unfortunately, however, mothers and  nurses are sometimes  unable to supply a sufficiency of milk for
their infants ; and it then becomes a question how the  deficiency is to  be supplied.  Where the mother
is healthy,  and the  milk  is of  good quality, but merely insufficient in quantity  to constitute the sole suste-
nance of the child, the balance  is decidedly  in favor of her continuing to suckle, and  giving some mild
supplementary food.   The  infant will  generally thrive  better by following  this  plan than  by an entire
change of nurse.   But if the  deficiency proceeds from impaired health  in the  mother, or any other  cause
likely to injure  the  nursling, the substitution  of another breast is  clearly indicated ; and the sooner the
change is made, the better for both parties.
   Where additional nourishment  is required, the  principle for its  right selection is, to procure the  kind
most  nearly allied in its nature to  the mother's milk.   Some  experienced men  recommend  goat's and
others ass's  milk  as an  excellent substitute, and  either will generally answer remarkably well.   When
neither can be obtained, fresh or  boiled cow's  milk,  diluted with  one third  or one  half of tepid  water
according to the age, and slightly sweetened, may be given with great advantage.  If it  is  found to agree,
nothing else need be tried till the appearance of the front teeth indicates the  propriety of a change.   But
when, as occasionally happens, it  proves too heavy, and  gives rise to frequent vomiting, acidity,  flatu-
lence, and  gripe.-, it must  not be persevered in, but  recourse must be had  to thin barley-water, arrow-
root,  or panado, slightly thickened according to the  age, constitution, and  circumstances, at  the  time.
Sometimes, when diluted milk disagrees, the addition  of  a small quantity of  any farinaceous substance,
such  as rusk, arrowroot, or  well-baked bread, cut into  slices and toasted almost to drynes-, and boiled in 
                             PHYSICAL  TRAINING OF CHILDREN.                         235

a small quantity of water to which milk is afterward added, obviates every inconvenience, and restores the
evacuations to their healthy state.
   It sometimes happens that, notwithstanding every attention, the  inability of the mother  to  nurse her
child becomes  so decided, as to render it imperative on her to desist from the attempt, and  to  procure a
substitute.   I shall now, therefore, consider  the  qualities  by which the  choice  of a nurse ought to be
determined.
                                          SECTION IV.

                         CHOICE  AND  PROPERTIES  OF  A  NURSE.

  The selection of a nurse being generally confided to, or at least sanctioned by, ihe medical attendant,
it is unnecessary to discuss all the qualities which ought to be deemed  indispensable.  Sound health, a
robust constitution, freedom from  any hereditary taint,  cheerfulness and presence of  mind, orderly, neat,
and temperate habits, patient kindliness and good-humor, and, above  all, a strong and  innate liking for
children, are of the first importance.   If the child be unusually predisposed to any disease, a nurse char-
acterized by  a similar predisposition ought on no  account to be chosen ;  and  a strict  investigation of this
point is a duty  incumbent on the professional man.  For the same  reason, violence of temper,  extreme
nervousness of disposition, intemperance, want of truthfulness, inattention to order  and cleanliness, and
other moral defects, ought to be held  as  insuperable obstacles to the  selection  of any woman  in whom
they are conspicuous.
  "An irritable, passionate, and sour-tempered female," as  is justly remarked  by  Eberle, "is  but ill-
suited for this important duty.   Not only is the child liable to be  maltreated by a nurse  of this character,
during the  fits of ill-nature and passion, but the most serious and alarming effects may be produced on its
tender organization by the milk of such a nurse.   It is well known that violent anger and habitual sourness
of temper  are peculiarly apt to give a pernicious quality to the milk.  Children have been thrown  into
convulsions by suckling soon  after the nurse has  been  agitated by violent anger or rage ;  and alarming
vomiting and purging are  particularly apt  to occur from this cause.   Indeed, every inordinate excite-
ment or depression of the mind is  unfavorable to the secretion of healthy  milk.   Protracted grief, sorrow,
or mental distress  and anxiety, in the nurse, seldom fail to produce a  prejudicial effect  on the health of
the  nursling.  Women, consequently, whose domestic  relations expose  them to moral  affections of this
kind, can not be regarded as well  adapted for this office.   Tranquillity of mind  and evenness of temper
are  particularly desirable in  a nurse, and no female  ought  to  be  admitted to this duty who is, either by
temperament or extraneous circumstances, placed  in an opposite condition."*
  The destructive influence of passion in the mother or nurse on the system of the child, is strikingly
illustrated in a case  mentioned in  the  excellent little work of Dr. Von Ammon,  physician to the  king of
Saxony :t  "A carpenter fell into a quarrel with a  soldier billetted in his house,  and  was set upon by the
latter with  his drawn sword.   The wife of the carpenter first trembled from fear and terror, and then  sud-
denly threw herself furiously between the combatants, wrested the sword from the soldier's hand, broke
it in pieces, and threw it away.   During the tumult,  some  neighbors  came in  and separated the men.
While in this state of strong excitement, the mother took  up her child from the cradle, where it lay play-
ino- and in  the most perfect  health, never having  had a moment's illness ; she gave  it the breast, and  in
so doing sealed its fate.   In a  few minutes the  infant left off sucking, became restless, panted, and  sank
dead on its ?nothcr,s bosom !   The physician who was instantly  called  in found  the child lying in the
cradle  as  if asleep,  and with its features undisturbed ;  but  all  his  resources   were fruitless.   It was
irrecoverably gone."
* Eberle on " Diseases of Children," p. 35.
t " Die ereten Motterpflichten und die erete Kbdespflege," p. 102 ; third edition.  Leipsig, 1839 
 236              PHYSIOLOGICAL AND MORAL ELEVATION OF MANKIND.

   It is seldom that so remarkable a case occurs in private life ; but there are unfortunately many in which
 perpetually recurring fits  of ordinary bad temper, especially near or during the time of suckling, produce
 similar effects in a  more slow and gradual manner, but with  almost equal certainty ; and if anything can
 exert a salutary influence  on  mothers who are prone to the indulgence of passion, it must be the contem-
 plation of such a case as that of  the carpenter's wife.
   Another  strong reason for rejecting a nurse  characterized  by a bad temper  or other moral deficiencies
 is, the general  system of  mismanagement and  concealment in other respects which is sure to ensue,  and
 which it is sometimes so difficult for the mother to detect, that the health  of the child may be ruined with-
 out  any one being able to discover why it is  suffering at all.  We  can not, therefore, attach too great
 importance  to moral character in the first selection of  a nurse;.  for every change is attended  with serious
 inconvenience, and, when deceit is once practised, confidence can never be restored.
   But of all the defects which a nurse can have, none is more directly destructive of infant life than that
 in which  many mothers, as well  as nurses, indulge, of administering, of their own accord,  strong and
 dangerous medicines to children.  Not to mention the thousands of cases in which health is injured by
 the  injudicious use of medicines  in infancy, it appears, from  a late return, printed by order of the house
 of commons, of all inquests held  in England and Wales in 1837 and 1838, in cases of death from poison,
 that 72, or  nearly one seventh of the whole number, resulted from carelessness of  mothers  and nurses in
 administering medicines with the properties of which they were not acquainted, in doses far beyond those
 in which they are ever prescribed by medical men.   The  return shows, for example, that the deaths of
 very young children (most of them at the breast) from  opium  or  its preparations, were 52 ; and from
 opium or laudanum,  given by mistake for other medicine, 20 more.  Mr. Browne, the  coroner for Not-
 tingham, adds  that a  celebrated  quack " cordial"* for children  destroys great numbers yearly in  that
 borough, but, as they die  off gradually, the cases do  not come under his  official notice.t
   In addition to cases of absolute poisoning  of the  above description, it is well known to practitioners
 that much havoc is made  among  infants by calomel and other medicines, which  procure momentary relief,
 but  end by  producing incurable disease : and it has often excited my astonishment to see how recklessly
 remedies of this kind  are had recourse to, on  the  most trifling occasions, by physicians, mothers, and
 nurses, who would be horrified if they knew the nature of the power they are wielding, and the extent'of
 injury they  are inflicting.
   Whenever a child shows  any symptom of  uneasiness, instead of inquiring whether  it  may not have
 been caused by some error of regimen, which only requires to be avoided in future to remove the suffer-
 ing,  many mother; act as if it were indispensably necessary to interfere immediately and forcibly with  the
 operations of Nature, by giving some powerful  medicine to counteract its effects ; and if relief does not
 ensue  within an hour or two, the dose must be  repeated !   In this way, it is not uncommon for a medi-
 cal man to be sent for in alarm, and told that the child began to  complain at  such  a time ;  that notwith-
 standing that a large dose of calomel, or laudanum, or  tincture of rhubarb, was immediately given, and
 repeated every  hour or two, it  is still very ill,  or  becoming  hourly worse ; and that, if he  can not do
 something instantly, it will soon be beyond recovery.   Whereas, it may appear on examination, that there
 was  at first  only a slight indisposition, which required  no  active treatment at all, and that the urgent
 symptoms are those caused solely by the intended remedies.
   That there are cases of diseases in which very active  means must be promptly used to save the child,
 is  perfectly true.   But it is not less certain that these  are cases of which no  mother or nurse ought to
attempt the treatment.   As a general rule, indeed, where the child is well  managed, medicine of any kind
is  very rarely required : and if disease were more generally regarded in its true light, not as a something
thrust into the system, which requires to be expelled by force, but as an  aberration from a  natural mode
of action  produced  by some  external cause, we should be  in  less  haste to attack  it by medicine, and

 • Godfrey'*.  Twelve deaths of children from this cordial are recorded in the  returns ordered by the bouse of commons, referred to in
the text
 t Chambers's Journal, Nc WO, p. 3a. 
PHYSICAL TRAINING  OF  CHILDREN.
237
more watchful, and therefore more successful, in our  management and in its prevention.   Accordingly,
where a constant demand for medicine exists in a nursery,  the  mother  may rest  assured  that there is
something essentially wrong in the treatment of her children.
                                          SECTION  V.

                                            WEANING.

   As a general rule, a child should  be weaned  at the  age of  twelve months ;  and the summer, or hot
season,  is not so favorable as at other periods, there being such a  tendency to bowel-complaints, which
may be induced by a change of diet.   There  may be exceptions to this rule in cases where the infant is
weakly  or sickly.   Where the mother, however, is laboring under any disease — particularly if it be con-
stitutional— the child should either be weaned immediately, or never allowed to nurse :  as it is in this
manner, by living on  diseased blood under the name of milk, that  so  many affections are transmitted,
such  as consumption,  scrofula, venereal disease, &c.   This  is a very important subject, and should
engage  the deep interest of parents.
   A good method is, to wean the  child by degrees: that is, let it nurse a portion of the time, and occa-
sionally give it food.  In cases where the infant is taken from the breast immediately, or soon after birth,
the best food for  it consists  in  substituting fresh country-cow's milk, given tepid, diluted with  one half
or one third  water, and slightly sweetened.  When the teeth appear, bread (at least one day old) may be
mixed with the milk.
   There are many causes which  render mothers  unfit  for  nursing their  children, most of which  are
pointed out by Combe  in  his treatise  on the  " Physiological and Moral Management of  Infancy."   He
remarks as follows :—
   " The time of weaning ought to be determined chiefly by two circumstances, viz., the health and state
of  the mother, and the  development and health of the child.   When the health of the mother continues
perfect, and the supply  of milk abundant,  weaning ought not to take place  till  the development of  the
teeth shows that a change of food  is required.   This usually happens  about the ninth or tenth  month ;
but in delicate children  teething  may be  delayed for even  several months  longer, and, in  such  a  case,
weaning ought not to be effected so soon.
   " If,  however, the supply of milk proves  insufficient for  the  nourishment  of the  child, and the health
of the mother begins to  suffer before the expiration of the usual time  of nursing, it may become necessary,
for both its sake and her own, to wean it gradually before any indications of teething present themselves.
But, in  this  case, weaning is  recommended, not as proper in itself, but merely as  the smaller of two evils.
To continue nursing under  such circumstances, would lead to more mischief than  if it were given  up.
In some countries,  nursing is continued for  eighteen months or two years ;  but  unless in very feeble or
ill-constituted children,  this is an unnecessary prolongation  of the process.   In weak, scrofulous children,
however, the teeth are often very late in appearing, and this may be taken as a sure sign  that the breast
ought still to constitute the chief source of their nourishment, whatever their age may be.
   " The grand rule in weaning is, to  accustom the child gradually  to the use of other nourishment, and
to withdraw the breast from it by equally slow  degrees.  Formerly,  the  transition used to be made sud-
denly, to the direct injury of both mother and child.  Now, however, it is accomplished in  such a  gradual
manner, that  many sustain no inconvenience from it.  If, when  the front teeth begin to appear (about the
sixth or seventh month,  for example), some light  food be given once or  twice a day, and  the quantity be
afterward gradually increased and repeated so as to lessen the appetite for the breast m an  equally gradual
manner, weaning will become comparatively easy and safe for both mother and child.  But if the suckling
be suddenly put a stop  to, the  mother will suffer ftom the suppression of  the  usual secretion, and  the
infam from the rapid change to an  unaccustomed  diet.   On this latter  account,  weaning  ought never to 
238               PHYSIOLOGICAL AND MURAL ELEVATION  OF MANKIND.

be effected while the infant  suffers  under the  irritation  of teething or  any active disease, as the risk of
convulsions or serious intestinal disorder will be thereby greatly increased.
   "After the  child has been weaned, its principal nourishment ought still to consist of liquid or semifluid
substances.   Milk ; milk boiled with bread, or slightly thickened with rice or wheat flour ; rice ; prepara-
tions of arrowroot, tapioca, or sago ; oatmeal-gruel, and pulverized crackers dissolved in warm water with
a little milk and sweetened — should  constitute  the principal nourishment until  the eye-teeth or fangs
have made  their appearance.  Along with these fluid  alimentary substances, small portions of bread,
bread and butter, and weak and simple liquids, may be allowed occasionally with perfect propriety.   It is
particularly important to guard against too full  and  nourishing a  diet immediately after the weaning has
been accomplished.   Though gradually brought, in the way just stated, to bear the simpler kinds of solid
nourishment when taken at distant intervals, the stomach is readily oppressed and disordered at this period,
if the transition  to a substantial diet be abrupt."
                                         SECTION  VI.

                                            BATHING.

  In infancy, cleanliness  is of the first importance to health.   Not only is the skin  extremely delicate,
sensitive, and easily injured, but it is the seat of a continual excretion or exhalation of waste matter, in the
form of perspiration, often exceeding  in  quantity that  from the bowels and  kidneys  united.   This per-
spired  matter consists of solid and of fluid parts; and, according to Thenard,is composed of much water,
a small quantity of acetic acid,  common  salt, muriate  of potassa, some earthy phosphates, and a very
small quantity of animal matter.
  But, in addition to this, a secretion  of  an  oily matter takes place on the cutaneous surface, having for
its object to keep the skin soft and pliable, and  also, in  some  degree, to protect it from injury.   This
secretion is most abundant on the scalp, in the  arm-pits and folds of the joints, and also on the forehead
and nose, and it has  a  peculiar smell,  by  which it is easily distinguished.   It is this oily secretion which
prevents  the hair from  becoming dry, and which causes water applied to the skin  to gather into globules,
exactly as when applied to any oiled surface.   In the folds of the skin,  it serves  to prevent the two con-
tiguous surfaces from irritating or adhering to each other, as, from their mutual friction, they  would other
wise be apt to do.
  In adult age, the oily secretion above described has,  in some constitutions, a strong disagreeable smell,
particularly in situations where it is abundant, as in the  arm-pits,  and also in some savage  tribes and  in
the  negro.   But in infancy it rarely exceeds in quantity what is absolutely required to preserve the softness
and pliability of the skin, and, during  health,  never gives rise to any unpleasant odor.
  At the usual temperature of the  body, the  fluid part of the perspiration escapes,  and mingles with the
air in the form  of vapor, while a considerable portion of the solid or saline ingredients is left adhering  to
the  skin  and clothes, both of which it  speedily dirties.   The vapor, not being visible, is little thought  of
in estimating the effects of perspiration ; but its reality and  active properties become very apparent when
it is allowed to accumulate from a number of persons congregated for hours in close rooms, especially  on
a warm day, or is condensed in the tissue of a dress not duly changed.   We may easily  recognise  its
presence, also, on entering an unventilated bedroom in  the  morning  from  the open  air ; and we  are  not
equally sensible of it during the day, merely  because it is diffused through the  atmosphere almost as fast
as it is formed.
  When  the  impurities  thrown out  by  perspiration  are  allowed to remain long in  contact  with  the
skin, they become a source  of  irritation, and, by obstructing its  pores, necessarily impede any  further
exhalation.  The consequence is, that the waste matter, deprived of its usual  free  outlet, is either partially 
PHYSICAL TRAINING  OF  CHILDREN.
239
and hurtfully retained in the system, or  makes  its egress by some other channel, such  as  the  bowels,
kidneys, or lungs, at the risk of  producing disease  in them by the over-excitement of their  functions.
At other times, the skin itself suffers, and becomes the seat of  troublesome and obstinate eruptions.
   Such being the source and extent of the impurities to which the surface of the body is exposed, and
such their effects when  not duly removed, it will not appear surprising that cleanliness is one of the chief
conditions  of health at all periods of life, and especially in infancy.   We have now, therefore, to consider
by what means this condition may be most safely and effectually fulfilled.
   Keeping in view the  composition of the  perspired matter, we must provide, first, for the ready escape
of the invisible vapor which forms so large a portion of it; and, secondly, for the frequent removal of the
solid saline residue left  in contact with the skin.   The first  purpose will be completely effected by usitig
a dress  of  light and porous materials not too tightly fitted  to  the body, and  by frequently  changing  it.
The second will  be best fulfilled  by frequent and regular ablution with tepid soap-suds, and subsequently
applying clear water.   On all ordinary occasions, ablution or bathing the surface with pure  soft  water is
to be preferred.
   The  whole surface  of the body, and especially the folds of the skin  and joints,  should  be carefully
washed with a soft sponge, so that  every vestige of impurity may be removed.  The infant should then
be quickly but gently rubbed dry with soft  napkins, and afterward  with the hand, and carefully dressed.
The best times  for washing the infant are, in the morning as soon as  it is taken  out  of  bed, and in  the
evening before being put to sleep.
   On account of the great susceptibility of cold which exists in infancy, and the difficulty with  which  the
system  resists the influence  of any sudden  change, the  temperature  of  the water ought, at first, to  be
nearly the  same as that of the body, namely, about ninety-six or  ninety-eight degrees Fahrenheit.  Says
Bell, " When there is not a  thermometer at hand, I always direct the mother or attendant to immerse  her
arm in the bath, by which she can judge pretty  accurately of its temperature."  The younger  the infant,
the more rigidly should this standard be adhered to ;  and  it is not till after growth and  strength have made
sonfe progress, that it becomes safe to reduce the temperature by a few degrees.
   In addition to  the regular  morning ablution, the tepid bath may if necessary be repeated every  evening
for a few minutes.  Properly managed, and  not too warm, it has the double  advantage of  soothing the
nervous system, which  is always  irritable in  infancy, and of sustaining  an equable circulation  of the blood
toward the surface, and thus warding off internal disease.   It  ought  not, however, to be either too long
continued  or  used in  a  cold  room.   With  these  precautions, the  most unequivocal  advantage often
results from its use, especially in scrofulous and delicate children.  For  restless and irritable children,
also, the evening bath is often of immense advantage, from  the quiet and  refreshing sleep which it rarely
fails  to induce.   As a sedative, too, it is of great value  in subduing nervous excitement.  Bathing  also
renders the child less liable to a check of perspiration, which causes so many diseases.  But when used
too warm, or continued too long, the bath is apt to excite undue perspiration, and  to  increase the liability
to cold.
   Some physicians and parents prefer the cold to the tepid  bath even for  infants ; but reason and experi-
ence concur in condemning it; and it is only when the infant is strongly constituted,  that it escapes from
the use of the cold bath unhurt.   After the lapse of a few months, the temperature of the water used for
the morning ablution may with propriety be gradually reduced, provided the child continues healthy and
the season of the year is warm.  But  to  make any sudden  change in  winter, or  where considerable
delicacy exists, would  be attended with risk.
  Another important element of cleanliness  in infancy is, the immediate removal of every soiled or damp
portion  of the dress, and the  careful washing from the skin of every vestige of impurity arising from either
of the natural  evacuations.  In early infancy, the  discharges  from the bowels and bladder  are frequent
and involuntary ;  but after a short time, an attentive nurse  can generally discover some indications of
what is about to happen, and take measures accordingly.   It  is surprising  how early regularity in this
respect may be introduced  by a little care and attention. 
2 10              PHYSIOLOGICAL AND MORAL ELEVATION OF MANKIND.


                                         SECTION VII.

                                  AIR  AND  VENTILATION.

   We have only to contrast the blanched  and  feeble appearance  of  children  inhabiting the dark and
narrow streets  of  a  crowded city, with  the  rosy  freshness of those of the same classes residing in the
suburbs or in the  country, to  obtain  a  pretty correct notion of the importance of a well-selected locality.
   Considering the susceptibility of  the influence  of cold  in early infancy,  I need hardly add that a high
aid bleak situation, or one exposed  to the full force of the north and east winds, is equally  unfavorable,
and ought to be carefully avoided.
   Cellars are  damp and  unhealthy.  In  selecting rooms for  a nursery,  those  which have  a  southern
exposure ought to be  preferred, for  the reasons already mentioned when treating of the locality.   That  a
nursery ought also to be large, airy,  easily  warmed, and easily ventilated, will, I think, be readily admit-
ted ;  for.  without such conditions,  it  is  evidently impossible to  surround  the infant with that pure and
renovating atmosphere which is indispensable to health.
   In  one respect, pure air is even more essential  to the formation of good  blood than  supplies of proper
food.   The influence of the air we breathe never ceases for a single moment of our lives, while  that of food
recurs only at intervals.  By night  and  by day, respiration goes on  without  a  pause, and, every  time we
breathe, we  take in  an influence necessarily good  or bad,  according to  the  quality of the air which sur-
rounds us.  No wonder, then, that a  cause, thus permanently in operation, should, after a lapse of time,
produce great changes on the health ; and no wonder that  attention  to  the purity of  the air we breathe
should amply  and surely reward the trouble we may bestow in procuring it.  Accordingly, of all the inju-
rious  influences by  which childhood is surrounded, few indeed operate more certainly or extensively than
the constant breathing of a corrupt and vitiated  air : and, on the contrary, few things have such an imme-
diate  and extensive  effect in  renovating the health of a feeble child, as change from a  vitiated to  a  purer
atmosphere.
   Vitiated air and bad food are the  two grand sources  of that hydra-headed scourge of many  countries —
scrofulous disease;  and either of them, in a  concentrated state, is sufficient to produce  it,  without the co-
operation  of the other : but when  both are combined, as they often are  among the  poor in our larger
towns, then  scrofula,  in its worst form, is the result.   Accordingly,  we can produce scrofula in the lower
animals at will, simply by confining them in a vitiated  atmosphere, and restricting them  to  an impover-
ished  diet.
   Scrofula, in one or other of its numerous forms, is acknowledged to be in Great Britain (and possibly
in the United  States)  perhaps the most prevalent  and  fatal disease which afflicts the earlier years of life.
It is the most  usual cause of glandular obstruction, defective  nutrition, affections  of the joints, and other
morbid conditions,  which either give  rise to, or greatly aggravate the danger  of many other diseases —
such as consumption, measles, hooping-cough, fever, teething, and convulsions ; and in this way it proves
fearfully destructive of life.   But so powerful  is  the  continued  breathing of  a cold,  damp,  and vitiated
atmosphere in producing it, that where such a cause is allowed to operate, the most promising combina-
tion of other conditions will often prove insufficient to  ward off the  evil.   Sir James Clark expresses the
conviction that living  in an impure atmosphere is  even  more influential in deteriorating health  than defec-
tive food,  and  that the immense  mortality among  children reared in workhouses, is ascribable even more
to the former than to  the latter cause.
   So long ago as 1810, Mr. Richard Carmichael, of Dublin, in an  excellent little treatise  on scrofula,
drew  the attention of  the medical profession to  this cause, and,  on the strongest evidence, denounced the
great  impurity of the  air in the Dublin house of industry as the grand cause of the excessive prevalence
of scrofula among the children at the time  he wrote.  In one ward,  measuring  sixty feet by eighteen, and
of very moderate height, there were thirty-eight beds,  each  containing three children,  or  114 children in 
PHYSICAL TRAINING  OF  CHILDREN.
241
all.  When the door was opened in the morning, the matron  found the air insupportable, and, during
the day, the children were either in the same ward, or crowded to the number of several hundreds in a
schoolroom.   Keeping in mind the  necessity of  pure air to the formation  of  healthy and nutritive blood, ,
we can scarcely feel surprise that scrofula was eitremely prevalent under circumstances so calculated for
its production.
   In the Dublin lying-in hospital, formerly, the influence of vitiated air caused fatal convulsions in thousands
of the infants for year after year, till the cause was at last discovered and obviated, and the mortality con-,
sequently  reduced from  every sixth child, within  the  first nine  days, to only one in every twenty, on an
average of five years !    To these striking facts I here  refer, because it is  by such extreme cases that the
reality of the cause is demonstrated beyond the possibility of doubt, and  that the attention of  reflecting but
ignorant minds is most powerfully arrested.
   Keeping these facts in view, it will be obvious that, especially where  there are several  children, the
rooms appropriated for their use should be considerably elevated above  the ground, large, cheerful, lofty
in the ceiling, not over-crowded with furniture, and provided with the means  of ample ventilation, without
exposing their inmates to currents of cold  or damp air.  Instead of these conditions being generally ful-
filled, however, it is common even  among  the middle classes to find some wretched apartment at the top
or bottom of the house  selected as  a nursery, although possessed of no convenience for  the purpose ;
while one or two large  and  excellent rooms are set  apart to be used  perhaps twice or thrice a year for
the reception of strangers, for whom, in their hearts, the  parents care nothing, and  to whom the size or
position of the apartment in which they spent the few nights of their stay,  would, at the worst, be of very
little moment.
   From pure ignorance  on the part of the parents, it is also  a common practice, not only to crowd sev-
eral children and one or two nursery-maids into a small room, but to allow cooking, washing, and  other
household operations connected with the nursery, to be carried on in it.   Nothing, however, can be  more
injudicious, or more directly at variance with the duty of parents to promote  to the  utmost the welfare of
their offspring.  No mother ought to be satisfied with herself until, in obedience to the wants of the infant
organization, she has provided for her children the most suitable and best-aired nursery within her power,
and strictly prohibited every kind of operation by which its atmosphere  can  be vitiated or its cleanliness
impaired.
   When  persons faint in the vitiated  atmosphere  of a crowded theatre,  nothing  further is required to
restore  animation than to carry them out into  a purer air.   Here everybody at once  recognises the
difference between the sustaining power of a pure and that of a contaminated atmosphere.   In infancy,
the difference is  often exhibited  in an equally striking  degree.   The wailings and convulsions which
infants, brought up in a  heated and  confined air, often experience from any  slight  irritation, yield  more
readily to the free admission of a pure and refreshing air, than to  any  other single appliance, while they
often resist the most vigorous treatment when, from  fear, pure air  continues to  be excluded.  I knew a
remarkable instance of this  kind, where a well-constituted child passed  within a few minutes from a state
of spasmodic irritation and twitching, bordering on convulsions, to perfect health and good-humor, simply
by the admission of fresh air into  a very  close, ill-ventilated  nursery, in which  even the  fire was half
extinguished for want of air to keep it alive.
   Those  whose attention has never  been specially directed to the subject, can have no idea of the extent
to which this cause of bad health in the young is left in operation  among even  the  middle classes of
society, and  much more from  ignorance than any unavoidable  necessity.  I have seen many examples
of this, but the most  striking which  I have met with was in a very large  family, in which scrofula raged
with an intensity almost  exactly proportioned to the degree of  vitiation  of the  air in  which its  several
members lived.   The  first-bsrn children escaped  altogether, because, in their day, the nursery and  bed-
rooms were of course least crowded, and it was easier to have the occupants  much in the open air ; but
afterward, when five or six young people, and the nursery-maids, lived  and  slept  in one room of very
moderate  dimensions, in which cooking and washing were carried on, and two more in a small, ill-aired
                                               31 
:\Z              PHYSIOLOGICAL  AND  MORAL  ELEVATION  OF MANKIND.

h  l-closct adjoining, every one of them  suffered severely from the disease.   The bad air not being sus-
pected to have any share in the result,  no attempt was made  to  improve  it by adequate ventilation even
during the day :  and, in  consequence, all the  medical treatment and  means  resorted to served only to
retard the progress of the scrofula, but without  being able to cure it.  In this way, the younger members
of the family suffered under it for several years, and, in a large proportion of them,  it was either directly
or indirectly the cause of death.   If one half  of the expense  incurred for medical attendance and sea-
bathing had been devoted from the first to removing the original cause, and procuring a permanent supply
of fresh air, a vast amount of anxiety  and suffering might have been saved to all, and  to none more than
to the fond parents, who could  only  mourn over a  fatality which they never imagined it  possible to
prevent.
   When the weather is cold and  damp, tlie windows ought never to be thrown open till the children are
removed, and  the sun has been  for some time above  the  horizon.  The  bedclothes  ought to be turned
down as soon  as the child is taken up, and  to be exposed to the air  for several hours, that they may be
entirely freed from the effluvia collected  during the  night.   This point is, in general, too little attended
to ;  the appearance  of order and  neatness  being  generally preferred  to  the  real welfare  of the  child.
While due care  is  taken to  insure an  adequate temperature, every approach to  overheating  must  be
scrupulously avoided.
                                        SECTION VIII.
                                           EXERCISE.

   Ix infancy, motion of the body is a3 essential to health, and the appetite for it is as unequivocally mani-
fested, as at any period of  life.  To regulate it  properly, we have only to keep in view the state of  tin?
infant organization, and the laws under which the principal functions operate.
   Such is the state of the  constitution in the earliest months of existence, that it naturally follows that,
for some weeks after birth, exercise should be  of a purely passive  kind, and that we should be in  no
haste to excite the child to  premature exertion, or to place it in a sitting or erect  position.   If  this pre-
caution be neglected, and the child be carried in a  sitting  posture  from the first, the soft  and  yielding
spine will bend under the weight of the upper part of the body, and  probably induce not only permanent
deformity, but, as its necessary consequence, undue pressure  upon the lungs, heart, and digestive organs,
and disorder  of their respective  functions.  Hence, in  the beginning of life, exercise ought to con-
sist simply in being carried about the nursery, or into the open air, in  a  horizontal or slightly-reclining
position on the nurse's arms, or in a carriage ; and in gentle  friction with the hand  over the whole surface
of the body and limbs, an  operation which is not less agreeable to the infant than beneficial  in promoting
a free and equal circulation.
   In lifting young children, the nurse should  be very careful never  to  lay hold of them by the  arms, as
is  sometimes thoughtlessly  done ;  but always to  place the hands,  one on each side of the chest,  immedi-
ately below the arm-pits.   Iu infancy, the sockets of the joints are  so  shallow, and the bones so feebly
bound down  and connected with each other, that dislocation may easily be produced by  neglecting  this
rule.   For the same reason, it is a bad practice to support a child by one, or even  by both arms,  when it
makes its first attempts to walk.   The grand aim which  the child has in view is, to preserve  its  equilib-
rium, and it should be equally supported by the  waist.
   Great discretion requires to be exercised  in the common custom  of dandling,  swinging, and  jolting
verv voung infants.  In a very moderate degree, such exercises seem to be agreeable to them, and need
not be prohibited ; but, in the  rough way in which  they are sometimes  indulged in, they can not but be
prejudicial.
   Li fine weather, passive exercise in a child's carriage in the open air,  and over a tolerable road, is very 
PHYSICAL TRAINING  OF  CHILDREN.
213
salubrious ;  and, as the infant can be laid at full length, and perfectly protected, it is an exercise attended
with little fatigue,  and quite  unobjectionable after  the  first five or six weeks.  But  in cold weather it is
not so suitable.  In general,  children are fond  of it, but very rapid or rough motion ought to be avoided.
   It is the swaddling,  bandaging, stays, and  forced exercise of modern civilization, and not the natural
action  of the body, which give rise to ©urvature of the  spine and deformity of the limbs ; and hence such
deviations are never met with among the Indians.  " They do not swaddle their infants," says an  old
author in a tone of regret, when speaking of the Caribs, " but leave them to  tumble about at liberty in
their little hammocks,  or on beds of leaves spread on the earth in a corner of their huts ; and, neverthe-
less, their  limbs do not become crooked, and their whole body is perfectly well  made." — "Although  the
little creatures are  left  to roll about on the ground in a state of nudity, they nevertheless  grow marvel-
lously well, and most of them become so robust as to be able to walk without support at six months old."*
This quotation shows, in a very striking manner, the superiority of the Creator's ways over those of man,
and how implicitly we  may rely on  a successful result when  we adapt our conduct to the  law of  God,
instead of capriciously chalking out a course of our own not sanctioned by him.
   The next stage  of infant exercise is walking ; and here, again, provided we  do not stimulate the child
to premature efforts, we may safely trust to itself.  After a child  has acquired  a certain degree of  vigor
and command over its muscles by crawling  about, it will begin of its own accord to try to stand and walk
by  laying  hold of chairs, or seeking a little support  from the nurse.  But we should be careful not to
accustom  an infant to  rely too much upon  others.  In infancy, as in later life, the  grand principle of
education ought to be to promote self-regulated action, whether of body or of mind,  and to guide
inexperience to the mode in  which Nature intended the action to be performed.   So long as we continue
to be machines moved by the will and defended by the prudence of another, we can not, by possibility,
possess the  strength of bodily or mental endowment to which our constitution is naturally adequate ; and
it is an entire mistake  to suppose that this principle does not hold even from early infancy.
   Imprudent exposure in the nursery or out of doors is a very common source of disease in the second
year of infancy, against which  provision may generally  be made.   Within doors, exposure to draughts
of air, and to the damp of a  recently-washed floor, are the most frequent exciting causes of this descrip-
tion, and, in delicate children, often give rise to  inflammatory affections of the windpipe, chest, or bowels.
Out of doors, injury  is sometimes inflicted, especially  in cold or damp weather, by allowing the child to \
remain inactive or lie down  on the  ground while the  nurse is talking, or sitting down  to read or work,
instead of occupying herself with her proper charge.   Playful activity is the  proper remedy for this evil.
   Sufficient exercise and pure air are indispensable conditions of health during the second year, and both
conduce greatly to the safety of the child during the irritation of teething.   In fine weather, the child can
not be too much in the open air, exercising his muscles in  his own way and at his  own  pleasure.  If
very young,  and unable to walk, he  may be laid  down on  the  grass with a few toys  around him, and
allowed free  scope with them.  If the grass is not perfectly dry, a shawl or a piece #f water-proof  cloth
should be spread over it.   In the nursery, the child may be placed  on a  carpet  for the same purpose.
By self-exercise of this description, he will  not only amuse  himself better, but  develop  his muscular
strength, and acquire  the power of standing and walking, sooner and more securely than if  attempted  to
be taught  exclusively  by another.  Premature attempts  at walking by the aid  of an attendant ought  to be
strictly forbidden.   When the child feels himself able for it, he will lose no time  in exercising his powers ;
and it  is better that he  should  gain strength  by crawling for a week  or  two longer on all-fours, than that
his  limbs or spine  should  become bent  by premature  exertion.   Injudicious parents often consult  their
own vanity and pleasure much more than the child's happiness, by  exciting him to the utmost to attempt
to walk before the  organization is sufficiently matured for the purpose ; and I  can not help repeating, that
it would be well  for  them to ascertain  clearly whether their impelling  motive is  not  simply their own
amusement, before  they seek to act  upon it.   If this were done, the child would frequently escape, where
at present it is sure to  suffer.
                         * •• Histoire Natnr-.tc et Morale des Isles Antilles."  Rotterdam. IOCS, 
244              PHYSIOLOGICAL  AND MORAL ELEVATION  OF MANKIND.
                                          SECTION IX.

                                              SLEEP.

   When the stomach is distended, and digestion just beginning, sleep is generally uneasy and disturbed.
 The infant, therefore, ought not to be put  to rest immediately after a full meal.  During the first month,
 it is true, he goes to sleep  directly after having the  breast; but  he sucks little at a time, and the milk is
 then so diluted as scarcely to require digestion : it  is at a later period that the precaution becomes  really
 important.
   So much must always depend on individual constitution, health, and management, that no fixed  hours
 can be  named at which  the infant  should  be  put  to rest.  If he  sleeps tranquilly, and when awake is
 active and cheerful, and his various bodily functions  are  executed with regularity,  we may rest assured
 that no great error is committed, and that it is a matter of  perfect indifference whether he sleeps an hour
 more or an hour less than  another child  of his own  age.  Where, on the contrary, he sleeps heavily or
 uneasily, and when awake is either stupid or fretful, and his other functions  are perverted, we  may be
 certain that some  error  is committed, and that he is either rocked to sleep immediately after a full  meal,
 or otherwise mismanaged.
   There are few things  which  distress an  anxious  mother or annoy an impatient nurse more than sleep-
 lessness in her infant change, and there is  nothing  which both are  so desirous  to  remove by the readiest
 means which present themselves.   A healthy child properly treated, and not unduly excited, will always
 be ready for sleep at the usual  time ; and when it appears excited or restless, we  may infer with certainty
 that some active cause has made it so, and  should try to find out and remove it.  If no adequate external
 cause can be discovered, we may infer with equal  certainty that its health has in  some way  suffered, and
 that it is sleepless from  being ill.  In this  case, the  proper course is to seek professional advice, and to
 employ the means best adapted for the  restoration of health, after which sleep will return as before.
 From not attending to the true  origin of  the restlessness, however, and regarding  it merely as a state
 troublesome to all  parties, many mothers  and nurses are in the habit of resorting immediately to lauda-
 num, sedative drops, poppy-syrup, spirits, and other means of forcing sleep, without regard to their effects
 on the disease and on the system ;  and are quite satisfied if they succeed in inducing the appearance of
 slumber, no matter whether the reality be sleep, stupor, or  apoplectic oppression.   The mischief done in
 this way is inconceivably great; and astonishment would be excited if it were generally known what quan-
 tities of quack " cordials," " anodynes," and even spirits, are recklessly given with the view  of producing
 quiet and sleep.   In Germany, milk mixed with a  decoction  of  poppy-heads  is  in common use for this
 purpose ; and Von Ammon  mentions a case  of a  child of six months  old, whose  parents were at first
 delighted with the pjacid slumber induced  by it, but in the morning were horrified on  finding the  body
 stiff, the extremities cold, the eyes turned up, the pulse nearly gone, and the surface covered with a cold
 sweat!   Many an infant, the true  cause  of whose  death was not  always  suspected, even by the  guilty
 person, has thus passed prematurely to its grave.
   Plants, flowers, and strong-smelling perfumes, ought to be wholly banished from  the  sleeping-apart-
 ments  of children, as  they act injuriously on  their delicate nervous  system.   The German  physician
 Kopp mentions a  melancholy example, in  which  a  child of  fourteen days old was killed, apparently by
 the strong scent of sabine-oil diffused through the   room,  the father having  rubbed  his thigh very freely
 with it for rheumatism, in the close vicinity of the child's cradle.  No other cause of death could be dis-
 covered, and, till then, the infant was perfectly healthy.
   In infancy, as  in adult age, it  is  highly conducive to health and sound sleep, that  the night and bed
clothes should be thoroughly purified by several hours' exposure  to the air every day before the child is
put to bed.   The effect of perfectly fresh coverings  is soothing and  healthful in a high degree.  The
quantity of bedclothes ought to be quite sufficient  to sustain the natural  heat of the  body, without  beino- 
INTELLECTUAL EDUCATION OF CHILDREN.
245
so great as to relax or excite perspiration ;  and  for this reason a soft, yielding feather-bed is very objec-
tionable, particularly in summer, or in a warm room.     In infancy, there is a natural tendency of blood
to the head : and where this is encouraged by warm caps, the consequences are often hurtful.   The heads
therefore, ought to be  only lightly covered.   When the infant  is habitually restless, give catnep-tea, and
bathe the whole surface with tepid water. — Combe.
                               CHAPTER  II.

INTELLECTUAL   EDUCATION  OF   CHILDREN.
                SECTION I.

FIRST  IMPRESSIONS  OF  CHILDHOOD.
  " The intellectual education of children, until two years of age," says Mrs. Barwell, " consists in pre-
paring the senses for the reception of correct ideas of things.   The rudiments of all learning are acquired
by means of the  sight, hearing, smell, touch, and taste ;  as  these increase in strength and activity, new
ideas  are gained,  and new impressions made."
  The mind of an infant is at first much like a  blank sheet  of  paper, and almost any impression can be
made upon  it, either good or evil — as intelligence or  ignorance, prejudice  or superstition — and these
impressions are almost indelible.  Hence the poet  well says —

                              " 'Tis education forms  the common  mind,
                               As the twig is bent,  the tree is inclined."

From  this fact we deduce  the importance of teaching the infant mind  correct principles  and  useful
knowledge.   It should be the constant solicitude on  the  part  of the  mother very early to instruct her
offspring in  everything which  relates to  its present and future welfare, according to its capacity.   It  is
surprising how soon the intellect begins to unfold itself and comprehend things; and this is  the golden
opportunity  to present pleasing objects of diversion,  and give sensible and moral illustrations.   All nature
is filled with them, adapted to every gradation  and progressive development of the mind.
  The only care to be expected from a young child is, abstaining from direct violence, and the endeavor
to gather his playthings together, and put them by in the box, drawer, or cupboard, allotted to them ;  and
even  in this he must be assisted, for when amusement is  over,  the interest in  them is over also, and the
child  can not be  expected to understand the utility  of order, till he has had experience of its advantages.
  We do not mean that children should be taught  to play, or that their faculties should be systematically
put to work ;  the object is to  furnish the means  of  employing the activity with which they are so largely
o-ifted  so that it may not be used injuriously to themselves or others, but  be turned  to  the development
of many of the mental qualities.  Neglected children exhibit melancholy examples of the misapplication
of their  early powers.   The  well-worn  adage — "Idleness is the root of all evil" — applies to infants  as
well as to adults  : with this difference, that their  idleness is not a matter of choice, and that, intellectually
as well as physically, they are dependent beings.
  The playthings of children may be made serviceable in giving them  notions of property.   Furniture,
utensils, bookstand the ornaments of a house, offer constant temptations to the curiosity  and activity of
children, and are often materially injured  by them ;  they are  continually infringing  positive  commands 
246               PHYSIOLOGICAL AND MORAL  ELEVATION OF MANKIND.

when they meddle with them ;  but if provided  with proper objects of amusement  and observation — if
they be repeatedly sliown that these objects are  their own, but  not  the furniture — the temptation  to err
will be less.   Besides which, there ought to be as scrupulous  a regard to the  property of  a child, as is
required from  him with regard to the possessions of others,  while the understanding  may be strengthened
by reserving some few articles, which can be lent when asked for.   These should be kept apart, and over
his own toys there should be perfect power, while  they are  not applied  to  injure other people.   When
there is a determination  to destroy, no new toys should  be  bestowed,  but  it is scarcely fair to  take away
those already in possession :  an article once given becomes  property, which the owner can  not be  justly
made to resign.   No moral law should be infringed, because a  child is in  the power of its parents :  if sos
the rule is admitted that authority — superior strength — in short, whatever constitutes  power,  may do
wrong at its pleasure.   Children should feel  that their  parents are their protectors, who will  not only
rescue them from  the danger of the  moment, but also foresee and prevent evil.  Having felt  this  in  all
that regards comfort, health, the  allaying of hunger  and thirst, alleviation  of pain, &c, they will soon
make an instinctive moral application of the protective power and inclination.
   By endeavoring in this manner  to amuse  or delight the tender perceptions of infants,  mothers will have
performed an  important part of their duty.
                                          SECTION  II.

                            GRADUAL   DEVELOPMENT  OF  MIND.

   Under two years of age — or even under three or  four, according to circumstances — children should
not be incited to acquire  any species of knowledge which requires a considerable exertion of the intellect-
Attempts to  teach very young children to read, to repeat answers to catechisms,  &c, are  highly blame.
able.   All that is brought under the notice of the infant  should excite  joyous conceptions in his tender
mind, and gently encourage the growth  of those habits which are an  ornament in youth as well as later
years.   Children being the creatures of imitation, should, by all means, be reared only by female attend-
ants who possess an equable temper, and will study to cultivate correct sentiments  and  habits in their
young charge.   For the  same reason, children should not be allowed to associate with persons who talk
coarsely or indelicately.  Let mothers be assured  that they can not commit a greater error in the rearin"-
of their children, than assigning them to the charge of incompetent nurses and attendants ; for thus habits
are ingrafted which no discipline or education  in after years can.altogether eradicate.
   It may be asked, whether there should be any difference between the mode of rearing male and female
infants.  We answer, none  at first.   The mental faculties of both sexes  are radically alike.   It  may,
however, be useful to mention, that boys are usually more difficult  to rear than girls.   It is allowed, for
instance, that they are  more liable to convulsion-fits.
   As infants approach two  or three  years  of  age, they will have a tendency to amuse themselves  in  a
manner befitting their sex.  A taste for nursing seems a  strongly-implanted passion in females, and will
readily demonstrate itself in  the fondling and  dressing of dolls.  This is  a sentiment which should be
encouraged  by the mother or nurse, not only because it is natural  and  innocent, but because  it leads to
careful and tasteful habits.
   Many women  will acknowledge that their taste for neatness in attire was first cultivated by the attentions
which  they  lavished on their dolls.  Boys will, in  the same manner, exhibit peculiar tastes and tenden-
cies, which  will  admit of similar regulation.
   At two, or it may be three years of age, infants pass imperceptibly into a condition of mind and body
which calls for a more enlarged course  of  treatment than  that to  which they  have been previously sub-
jected.  Now should commence that species of training  which is always best carried out socially, or with
respect to a  number of children together, either at home or in the infant-school, or both. — Mr.«. Barwei.t.. 
MORAL TRAINING OF CHILDREN.
2(7
  The child should not only be taught the arbitrary names of objects, but a knowledge and use of them.
The first rudiments of education can soon  be taught, followed by natural  history, botany, astronomy,
physiology,  &c.  It requires but a short time for a very young child, by means of a» wooden  skeleton and
models, to learn the names and uses of all parts of the human system.  All education should  be practi
cal.   As the child  progresses,  it should be  taught  only the more solid  and useful branches, such as are
required  in the ordinary concerns of life.
  There is no excuse in this day for permitting children to grow up in ignorance,  and consequently in
vice, when there is such provision for  their learning.   In general, where practicable, it  is better to teach
them at home than  at a public school, where so many are  collected  and trained up in bad habits : for we
read that " evil communications corrupt good manners."   A very moral child will  soon  become  con-
taminated by associating with children  where  correct training has been neglected.
  The mind, then,  of the infant and the child should be constantly trained and enlightened,  as it is grad-
ually prepared to receive instruction, in every branch of useful  knowledge and  education, as well as of
good morals.
                                        CHAPTER  III.

                MORAL   TRAINING  OF   CHILDREN.


                                           SECTION  I.

                         IMPORTANCE  OF  EARLY  IMPRESSIONS.

   During the first few weeks of life, happiness is solely derived from the healthy operation of the bodily
functions.  Until the senses begin to act so as to convey impressions to the brain, there can be no pleas-
ure drawn from  external  circumstances.   The  activity of  the senses, and  the  enjoyment produced, will
be in proportion to the state of the health.
   An infant who is continually in pain, who is either  crying, moaning, or in a state of repletion  or of
exhaustion from the consequences of suffering, will be but little attracted by the light, sound, or motion,
which first engage the senses of infancy.   In no  other instance, perhaps, are the influences of the physi-
cal condition  so immediate and so evident.   An  infant, even of three weeks old, will exhibit a haggard,
grief-worn  countenance,  sunken  eyes,  and  shrunken face, painful to those whose  experience tells them
what these signs indicate.  But the fair,  plump, contented look of the healthy babe, speaks a language of
comfort,  prophetic of the approaching dawn of intellect.   How early does such an infant smile upon its
nurse, fix its eyes upon  her with a look  of  awakening intelligence when  she  speaks in accents  never
addressed but to infancy, and reply with  the little  dove-like sounds only uttered by the healthy babe •
The happiness or misery of this period of  life is  wholly derived from  the physical condition, and the
dawnings of the  sentiments and the intelligence are  in proportion to the health.
   The general irritability caused by disordered functions, renders the impression  upon  the senses even
more painful than pleasurable ; the disposition for enjoyment bestowed by the feeling of health is denied ;
the mother's voice, her smile, are associated  with pain as much as with  pleasure, and the affections are
imperfectly and tardily aroused.  As weeks pass  on, habits form, and instead of a habit of contentment,
there is one of fretfulness.   An infant  so constituted  is either reared with an indifference to its continual
crying and fretfulness, or with the apprehension which causes its nurse to be continually seeking how she
may quiet  or  prevent its cries.  At the age when food alone appeases it,  the babe is always eating or 
218               PHYSIOLOGICAL AND MORAL ELEVATION OF MANKIND.

sucking:  as it grows older, sugar, cake, &c, are  superadded, with the addition of noises or rough exer-
cise, and  but too  frequently some  sedative  or  composing draught,  which the mother believes  herself
obliged to adopt in order to procure the child needful repose, or the servant surreptitiously administers to
relieve herself from incessant fatigue.   When  the time arrives  that restraints and guidance  should  be
adopted, the  fear of further  irritation by contradiction  leads to a system of bribes, deceit, and coaxing ;
all the low est sentiments of human  nature are appealed  to ; and at two years old we have a selfish, wilful,
ill-tempered child, with violence apportioned to its strength, and intelligence prompted by ill feelings.   It
is not to be supposed that these moral disorders belong exclusively to bad health.   A  healthy child may
be selfish, wilful, and ill-tempered,  at two years of age, if injudicious treatment have cultivated the lower
sentiments ; but tbe healthy infant is predisposed to receive happy impressions, and enjoys the condition
called  good temper — a term which in  infancy is  synonymous with good health.    The  nurse has fewer
temptations to mismanagement; and, the affections and  intelligence being more healthful and active, moral
mismanagement actually produces less permanent injury.
  There can not, then, be  too much value attached to the physical condition of an  infant, to the condition
of the parent while pregnant and while nursing, and to  the  regulation of every particular connected with
the health of her offspring.  This being the first object, both in point of time and importance,  the  next
consideration is, the means of developing the moral and intellectual faculties.
                                          SECTION II.

                          NECESSITY  OF  CAREFUL  TREATMENT.

   The brain, on which the mental functions depend, is in infancy the least perfect organ.   Only a few of
the simpler instincts, as the appetite for food,  are  at first in  any degree active.  After the child is a few
weeks old, he begins to exercise his senses, and the first  traces of intellect and feeling are exhibited.   But
still, and for long after, the brain is in  a tender and delicate state, calling for the gentlest treatment.   No
loud or harsh  sound should therefore ever reach the ears of young children ; no violent light should be
allowed to come before their eyes ; they should always  be  addressed in the softest tones ;  and nothing
should ever be done in the least degree calculated to frighten them.   These are the chief particulars of
treatment which we are called upon to attend to, with regard to the mental system of children, during the
first few months.   Opposite conduct is apt to produce serious damage, and that of a very durable  nature.
   There are particular cases and circumstances, in which the value of kind and gentle treatment is greater
than usual.  Perhaps the infant may have  derived from  nature a constitutional irritability ;  or he may be
accidentally pained by some derangement  of  his  system.   In these cases, caresses, gentle changes of
position, and lulling sounds and movements, are of  great consequence ;  while all loud singing, talking,
rough and sudden jerks, and particularly scolding, should be avoided.
   For further progress in the moral management of infants,  it is in the  first place  necessary to bear in
mind  that the  mental faculties, in their  various  degrees of natural strength, rest at first undeveloped, but
ready to be brought into activity in accordance with the respective circumstances which  are  naturally
calculated to stimulate  them.   All  of these faculties are designed for useful purposes, under the guidance
of reason and  moral  principle ; but it may so happen  that some  of them are naturally in very strong
activity, or are called into great force by the  circumstances with which  the individual is surrounded, so
that the character may  ultimately be of a very  irregular  and uncontrollable kind.  In moral education, it
ought to be the first object of a mother to put  the more lively faculties of  her infant under proper  regula-
tion, or restraint if necessary, and so to evoke  and  train  the rest, that, in the result, she may have the  best
character which nature admits of in that case.
   Practically,  the circumstances by which  the infant is surrounded are sufficient to serve the whole  end 
MORAL TRAINING OF CHILDREN.
249
In view, as far as very young infants are concerned; for it is clear that if a child, for example, be brought
up  in a scene where angry words are  never heard, and where nothing of an unduly irritating nature is
allowed to visit him, his own angry feelings, though strong naturally, must be in a great measure kept out
of exercise, and consequently weakened ; just as the same circumstances, by their  soothing and pleasing
nature, are likely to have an active and positive effect in bringing out his own kindest and softest feelings.
In like  manner, supposing that a child may have a strong natural tendency to secretiveness, and that he
never witnesses or hears from those near him anything but  the  most  perfect candor  and directness, his
tendency is  just as  liable to be kept below the point at which lying and deception take place, as his
opposite feeling in behalf of truth is likely to be positively encouraged.
  The first duty, then, is  for the mother to be and to do on her own part as she would wish her child to
be and to do ; and to accommodate all other circumstances, as far as possible, to the same  end, particu-
larly as regards the selection  of attendants.   She must be on her guard against the delusive notion that an
infant of a few months old is  not capable of being affected by the conduct of those in whose arms he lives.
Though unacquainted with words, he is perfectly alive to what may be called the natural language of the
feelings, as harsh looks, loud and sharp tones, or the reverse.   At three months, the smile of his  mother
elicits from him an answering and sympathizing smile ; and at the same age an angry gesture will frighten
him.  And not only is he sensible of  language  of  either  kind addressed to "himself, but also of what is
addressed to others.   An instance is on record of a child  falling  into fits  in consequence of a violent
altercation between his nurse and another person, which took place in his presence.
  An infant may possess such gentle dispositions, that he will contract no disposition to quarrelling from
seeing his elders always doing so ;  but this  is a  mere chance.  The dispositions may naturally  have a
strong bent that way, and  he will then be, as it  were, in the very school calculated to make him  a thor-
ough quarreller.   The more  perfectly that the home of infancy is a home of peace and love,  the chances
are  unquestionably the greater that the  children will grow up creatures  of gentleness and affection.
                                          SECTION III.

                                   LANGUAGE  OF  INFANCY.

   The earliest intercourse between a mother and her child, is carried on by means of the expression of
the countenance and  the tones of  the voice.  The first language of  an infant is the  language of signs;
these are at first involuntary, and indicate his wants  and  sufferings.   After some time he  begins  to be
sensible of the existence of external objects, and to distinguish his mother's face from that of all others.
In this face he  reads  his first  lesson.   The child ascertains that there is one who takes constant care of
him, to whom he can make  known his wants and wishes; he looks, and she understands ; he cries, and
she hastens to his relief; he improves daily-in the use of a language  which he finds is intelligible to her,
and becomes at length a little  master of pantomime.  He  sees, too, that she looks differently at him  at
different times, and that the  tones  of  her voice vary, indicating pleasure, pain, approbation, and reproof.
Thus, long before oral language is used, the mother and child have established a symbolical language of
the countenance and tones of the  voice, to which, if the  child is sprightly, and  the mother has a tact for
it, gesticulation is added.  The mother has perhaps used this natural language unconsciously, but she
may do much to improve and  refine it, and to extend its use  in the development of the moral and  intel-*
lectual powers of her child.   Expression of countenance adds greatly to the force of speech ; and as it is
subject to the will, it can be cultivated and improved.
   A mother should take care  that every feature, look, and movement, corresponds with her feelings, and
this without affectation.  Let her feel as she ought, and then endeavor  to look as she feels.   Let her, when
the occasion calls forth the corresponding feeling, cast upon her child a  look of pity, of  sympathy, of
                                                 32 
  250              PHYSIOLOGICAL AND MORAL ELEVATION  OF  MANKIND.

  consolation, of composure, of interest, or of playfdncss, giving  to each  a  distinct character, while Iu?r
  habitual expression should bear the stamp of gentleness, patience, cheerfulness, and hope.   When gov-
  ernment and discipline are necessary, let the countenance exhibit authority, decision, firmness, disappro-
  bation, and a determination to be obeyed — mingled,  however, with entire composure and self-possession.
    In infancy and childhood, the muscles of the face which give  it  expression arc exceedingly  pliable, and
  yield an almost involuntary obedience to the emotions and operations of the mind.   In  addition to the
  care which mothers should take to  preserve a command  over  their own features and  tones of voice, it is
  important that the same care should be exercised over the children  themselves.  By these means much
  may be done to mould the features into forms indicative of virtuous emotions.  Habits of expression have
  a powerful influence  upon  the  internal feelings.   A smile,  even  if produced with  effort, will assist in
  <ralming angry emotions.   There need be no hypocrisy in  this.   We  adopt various methods  of self-
  control, and effect that by indirect means, which we find by experience direct efforts  of the will  can not
  accomplish.
    The effort to control our features aids  us  in subduing  internal emotion.   This principle may be per-
  verted, and applied to the worst purposes, for all that is  good is  subject  to abuse.   The child who is
  early habituated to avoid disagreeable, sullen, fretful,  and unkind  looks, and whose  affections are  at the
  same time cultivated on sound principles, will have  additional  security given to the  exercise  of these
  affections, and a power of subduing contrary  feelings, wanting to the  child over whose features  and modes
  of  expression no such discipline has been exercised.
    Great pains are often taken to cultivate the manners, and to give them an  air of courtesy, respect, and
  kindness.  The tones of the voice, articulation, pronunciation, and modes of speech,  are made matter of
  early instruction.  There is no doubt that all this has an  influence  in moulding the intellectual and  moral
  character.   The various expressions of countenance are as  susceptible of  control  and discipline, and
  react on the mind  with as great a  force.  They should  therefore  be formed into habits, as well  as the
  manners, or the voice, for there can be no greater danger of offending against nature and simplicity in the
  one case than in the other.
    The effect of these principles is fully seen in the change which takes place in the countenance  of an
  uneducated deaf mute, after he has enjoyed a few weeks' intercourse with his companions in misfortune
  in an asylum.  His features, expressions of  countenance, and general deportment, undergo a wonderful
  transformation, and seem to acquire a new power.   Catching by imitation the spirit of those around, they
  become instruments for the expanding mind to employ,  and have no small  degree of influence in forming
  habits of thinking  and feeling.
   It is neither necessary nor desirable to  school children into studying the  expression of their features.
  As  their violent emotions  should be repressed, so  every expression of that  violence, whether shown in
  voice, feature, or gesture,  should be gradually checked :  not thrown  back to be indulged silently, and in
  concealment, but in infancy, by the  mother's calm' expression of  pity, regret, or  condemnation, and in
  childhood by the same means, strengthened  by rational  appeals to the good  feelings.   A glance  of the
  mother's eye is often sufficient to deter a child from error, a  gesture to  recall former advice, a word  to
  overcome resistance, or soften rebellion.   This power must have been established from the first.
   However much the gift of  personal  beauty may have  been misused, and  although  it be confessedly
  secondary to moral and mental beauty, yet the charm of an agreeable  and  expressive face can neither be
  denied nor unfelt.   Young children generally possess this charm ; and if it do not remain in  after years,
  it may be because the indulgence  of bad passions or bad habits have marred it.   It  is obviously the
•mother's duty to preserve the  best gifts of nature, and to  endeavor that the pure affections, lively intelli-
  gence, and gentle sympathies, they seek to cultivate in their children, should speak in their countenances
  as well as in their  actions. 
                               MORAL TRAINING OF  CHILDREN.                           '<51


                                          SECTION  IV.

                            INFANT  DESIRES   AND  INSTINCTS.

  For some time a child is content to enjoy the sight  of objects, but  growth and increasing strength
apparently inspire  the desire to touch and to grasp.   The  efforts to do this are for months uncertain and
imperfect;  there is no knowledge of distance or size  ; the  infant reaches too far, or not far enough ; too
much on side or the other ;  and when the  hand accomplishes its intention, it has no power to hold or
grasp the object of  its  desire.  Next  comes the wish for possession.  All who have observed the  early
manifestations of infancy, know that a child  is not satisfied to  touch and take hold : it wants to have.  No
matter how unwiekty the object, possession  alone will satisfy.   The gestures  accompanying these desires
are animated in  proportion  to physical strength and energy ;  the infant leans forward, stretches out its
nrms, kicks  its legs about, sometimes  with a little straining  scream, not, however, of anger, but of anxious
expectation.   The  cry of  anger comes when the object can  not be obtained, or when  it is  s tdden'y
removed.
  Disappointment and vexation  being expressed by the  same means  as  bodily pain or hunger, it is not
improbable that the attention which such manifestations have procured, leads the child to expect jthat cry-
ing will obtain all its desires.  This impression should  be removed, and  a contrary lesson impressed.
First, the infant should not be allowed to have what  it cries for ;  and as the countenance and manner of
the mother may have been the means of awakening happy emotion, so they should express concern a: the
evidences of impatience.   If the child desires an object  which it may touch, the wish should be granted
before it grows into irritability, yet not in such  haste as to  preclude a small exercise of  patience and for-
bearance.
   Instant and constant attention to the wants and wishes-of children, renders them  exacting, violent, or
fretful, and will even engender a love  of command, and impatience of control, quite inimical to obedience-
Playful notice, while  the  child waits,  will at first serve  to restrain  irritable feelings.  It is too much to
expect an infant to  await its gratification with no  other occupation than expectation.  This comes when
time and habit have confirmed the certainty that the  mother  will attend to  the wishes of the child  ; reliance
upon her, and confidence in her love and truth, tending  to confirm  serenity  of temper.   The  influence
of love fosters our  best feelings.  Love is our moral  sunshine.  An infant who is always surrounded by
kind looks and gentle voices, not only imitates what he sees  and hears, but  all  his emotions are of that
happy character which inspires kindness.   As months  and days increase, his sources of happiness increase »
he is prepared by his own  physical comfort, and the affection  he experiences, to look upon every new
object with confidence and cheerfulness ; anticipating nothing  but benevolence, he welcomes everybody
and  everything with gladness.  Constitutional timidity is  checked, and a  habit of contentment formed.
   An infant, when  once excited, often continues to cry  after the exciting scene has ceased.   To change
the nature of the emotion should be the object; and  where everything is new and unknown,  this is suffi-
ciently easy.  A pleasing sound, a  bright object, will often suddenly put an end  to a fit of  anger.  To
prevent irritating circumstances is still more important.   Uneasiness,  however trifling the cause, disturbs
peacefulness, and it is from  peacefulness that cheerfulness  and good  temper  spring.  When the feelings
are thus prepared, trifling annoyances are, after a while,  more  patiently endured ; and  as  intelligence
appears, there is a greater readiness to observe and  to derive  happiness from  external objects.  Differ-
ences of temperament are  early manifested ;  excitable natures must be  moderated by calmness and gentle-
ness ; slun-o-ish natures excited, yet never with violence.   A fat, quiet, white-looking child, may  give little
trouble, and this condition is therefore called sweet temper; but it is quite as nearly allied to insensibility.
which must  be shaken  off by the activity of the parent; otherwise,  selfishness, and a love of  whatever
contributes to selfish pleasures, may spring up.
   A young  infant requires constant attention ; but as time goes  on, enotigli of this  may be given, although 
252              PHYSIOLOGICAL  AND MORAL  ELEVATION OF MANKIND.

the child be left (or apparently left) to  itself.   Thus, at a tender age, he acquires a  species of indepen-
dence, namely, that of finding happiness in himself and for himself.   A babe of six  weeks old, awake in
his bed, is preparing for this independence ; at ten weeks, he will  have fixed his eyes  upon some  attrac-
tive object, perhaps upon  his own moving fingers, and he is happily occupied.   At a  later period, when
he can sit in a chair, or on the floor amid his playthings, he will require the watchful glance of the mother,
and occasionally a word, or a little help, to assure him of her  presence and sympathy.  If the child be
inactive and dull, then he  will need to have his  powers of observation  frequently addressed and kept  alive ;
but an excitable child is best left to wear out the liveliness of his impressions upon a few objects, without
interruption, or any other  stimulus than that which is innate, or aroused  by the objects themselves.  An
infant with lively feelings and quick perceptions is  more  likely to be impatient and violent than one of
slow perceptions and deficient sensibility, and will need a counteracting rather than an exciting power; he
should not be hurried from feeling to feeling, and from object to object, but encouraged to dwell upon one.
   Every office  performed  for a  child should be done with gentleness and care.   When carelessness per-
vades the general management, the child must be continually uneasy  ; he consequently gets the reputation
of bad temper, and is deprived of those kind influences which can alone foster goodness.   The close
connexion between  physical comfort and  moral development ought never to be overlooked.  Perhaps the.
most  difficult period of infancy is that in which the want of speech is felt, but without the power of utter-
ance.   The intelligence is often  great; the sentiments active ; wishes and wants are intensely felt: but the
means of expression are imperfect, and often unintelligible.  The more intelligent the child, the greater is
the probability of violent  emotion following the unsuccessful  attempt to understand and be understood.
This  is the time when the mother's influence, and the experience  she has gained of her child's character,
will come  into  use.  A child who can not make himself understood usually screams ;  it is in vain to
attempt to silence him by  giving him something that he does not cry for ; neither will  any good  purpose
be served by talking to him while crying :  while violence is at its height, calmness and silence are the
best reproofs.
   Besides, when a  child is screaming, the voice of the mother must be elevated to loud or shrill  tones in
order to  be heard ;  such  sounds can only be  associated with scolding, or with a noisy mirth, ill befitting
the feeling with which she should witness violence.   The object is to show that screaming is of no avail,
and that  some better means must be adopted to express and  obtain its wishes ; there  will be many  bursts
of anger before  this is effected, but no evil need be  apprehended.    While the mother  is firm and calm,
the child will not cease to love  her, but, on the contrary, her  aid will be felt upon this point quite as much
as in  matters of bodily suffering.
   It is not unusual  for a child so treated to  soften into tears of real  grief,  on finding  that his mother's
countenance looks sorrowful, and  so to forget the cause of  his excitement.  It is always better for the
parent and  child to  be alone together during such scenes.  A child of a year old, when  crying with  an"-er,
will often look  round on his observers  with an air of defiance or determined resistance,  or, conscious that
they have no sympathy, relapse  into stubbornness.   However erring, he should at no age feel that he has
lost his mother's  sympathy ; and on the slightest evidence that  grief has succeeded to anger, she must be
ready to  encourage  and to aid.   A shake of the head, a firm but  gentle no, silence, or  placing the child
in solitude, will sometimes calm the passions ;  but this  must be  cautiously tried, lest  it cause terror or
greater violence.
   It is an error to induce children to  cease crying  by promising them what they want as sobn as they
leave  off; for if they can understand the words, " When  you  have ceased crying, I will give it to you,"
they can  quite as well comprehend, "  You can not have it, because you have  cried;" but when ano-er has
subsided, amusement must be provided, so  that the child shall not   relapse  into fretfulness ;  the  object
being, not punishment, but to show the child  that violence will not  obtain its wishes.    It is  difficult  to
discover  how children acquire  the power of interpreting language,  but they do so  long before they can
use it : tone of voice, and  expression of face, assist considerably; strangers, particularly when not  accus-
tomed to children, being rarely understood by  them. 
MORAL TRAINING OF CHILDREN.
253
                                          SECTION V.
                         MORAL  GOVERNMENT,  MANNERS,  ETC.

   It seems desirable to  accustom a child to listen to a few words from the mother relating to familiar
objects or persons, or to  some of his own actions, that he  may be habituated to comprehend, or at least
to endeavor to do so ; and he might be questioned by words and signs, so that he shall reply by gestures,
and by such sounds  as he is able to utter.   As the violence of this  period of  childhood arises so much
from want of language, pains should be taken by the  mother  to establish between herself and her child
some means of communication that will smooth the difficulty.
   Constant warnings, threats, or entreaties, have a most pernicious effect, when  the obedience they would
obtain is not insisted upon : the child, becoming accustomed to them, ceases to regard them, and imper-
ceptibly discovers that words do not really mean what they pretend to convey, and thus a disregard for
truth  is  first taught.   When a prohibition is given, it should be adhered to  ; it will  bo necessary to repeat
it many times, because the tender  mind can not be expected to retain ideas which may immediately influ-
ence  conduct;  but the repetition must be made seriously and  patiently, not by an angry ejaculation or
reproof, uttered  in haste and  irritation.   The  oft-repeated — " Let that alone"—" Be quiet" — "Doix't
do so" — "How naughty you are!" — only conveys  that something  is wrong: no impression  is  mades
except one, characterized by some annoyance  felt equally by  both  parties ; and  no fixed  and definite
experience is obtained.
   A  mother should  always endeavor to ascertain  what qualities or tendencies are most injuriously active,
and,  as far as possible, suppress them by a gentle course of  treatment; at the  same time, she should
observe what are the weakest points of character, and  if these belong to the  good  qualities of the mind,
let them be cultivated and exercised with all the diligence which she can command.
   For example, if the child incline to be destructive, by breaking toys, killing flies or other small animals,
abusing his companions, &c, it is of importance to check and  suppress this dangerous propensity, and to
rouse into activity benevolence and gentleness of  manner in its stead.   If  the child show a deficiency in
any  useful quality, as  memory, language, power of observation, and  so on, these should  be frequently
exercised, because exercise strengthens ; and the longer that the exercise is continued, the power of  per-
formance becomes the more easy and agreeable.   In  a word, check bad propensities, encourage good ones,
and  in either case with gentleness and moderation, according to circumstances.
   It  is important to  recollect that the vicious or disagreeable tendencies of  children are at first weak, and
in most instances may with little trouble be remedied.  But as the  disease is  superficial, the corrective
should be light.  It should be the  object of the mother to prevent rather than to cure.   If she keep her
child from evil communications — that is, associating with persons, old or  young,  who are likely to sully
the infant mind, and nothing is more easily done — she will be  spared days, weeks, perhaps years, of toil,
iu eradicating the mischievous tendency which has been excited.  But in  the worst circumstances  that
may arise, do not on all occasions oppose and correct.   The child should not be aware of your  intentions
to correct it systematically, for he soon discovers that  he is to be thwarted, and is  as ready for combat as
his opponent.   In this manner, injudicious correction  has spoiled many children, who  might otherwise
have been the pride  and  solace of their parents in after-years.
   Cleanliness, order, and general  propriety of demeanor, are to be ranked  among moral virtues, and  their
foundation is to  be laid in childhood.  Parental example will  do much, whether manifested in the obser-
vance of regular hours, of neatness, delicacy, genuine courtesy, and the ease which always accompanies
true refinement.  Children can not be taught what is termed manners without rendering them affected and
insincere, for these are usually artificial and conventional ; but they may be practised in the true elements
of politeness, namely, self-respect and a delicate regard to the rights and feelings of others, in contradis-
tinction to the mere  desire of admiration, or the  selfishness which has no  regard  for opinion, and which
only  prompts to individual gratification. 
  *&i               PHYSIOLOGICAL  AND MORAL ELE\AT1GN  OF MANKIND.

     L is desirable that children should observe a cleanly and delicate method of eating and drinking : while
  they are  too young to feed themselves,  their food  should be given to them  with attention to neatness and
  comfort ; as  soon  as they can assist themselves, continued care will be necessary to  accustom them to
  the spoon, fork, and knife, and also to arrange the food on the plate, so that it may be eaten with attention
  lo the method usually observed.   Drinking  or speaking with the month full, putting the fingers into die
  plate and mingling the food, should be  checked at first.   Picking the  teeth, spitting, or blowing the nose
  at the table or before others, should also be discountenanced.
     Conduct at table is worthy of attention.  Children are often inclined to play  with the different utensils,
  and so to break or overturn them : this  habit, with that  of reaching for what  they  require, putting their
  elbows on the table, sitting awkwardly,  and other uncouth  demeanor, often  interrupt the comfort  of  the
  family meal.   A love of order is so natural to  some children, that any change  from  their customary rou-
  tine, or in the usual place of the different objects around them, has  been known  to  excite them to anger
  or tears.   There are other minds, however, in  which a love of order must be created.
    Mutual confidence should be a governing principle in the communion between parent and child.   This
  can not exist  where the former acts only as a judge and  lawgiver, who acknowledges no compassion, no
  sorrow, who  can not weep and  hope with the  offender.  The few words, "lam sorry that you arc
  angry" —'; Try to be good, and I will help  you" — " Wipe away your tears, and  let me hear what vexes
  you?'— are more  likely  to overcome error,  or turn away wrath, than stern commands or cold  disappro-
  bation : for this treatment does not conceal that there  is error, or disguise its evils, while it differs  totally
  from the  compassion which fondles or  coaxes, and  bribes  a child to soften its violence or withdraw its
  opposition.  Are there not moments in the  lives of all, when  a confession of error to a friend  whose
  sympathy, consolation, and encouragement, are certain, lessens the bitterness of self-accusation and con-
  firms good resolutions ?   Are there not also moments, when the want of such a friend, or the reproaches
^ and cold  contempt of  those who  possess a right to condemn, hardens the heart, and  converts a waverino-
" repentance into dogged perversity ?  If, then, at  an  age when  experience  and self-dependence are  so
  influenced by the denial of sympathy and the administering of stern  reproach, how much more must the
  tender buds of infantine feelings  be nipped and withered by the  chilling frosts of severity !  Nothing  can
  be more beautiful than the conduct of a child reared under the influence of love.  It enters amoiF stran-
  gers unabashed and undismayed, ready  to welcome, to be welcomed, seeking happiness, and prepared to
  find it  in everything, and with  everybody ;  so willing to be pleased, that  every gratification, however
  trifling, is prized and enjoyed ;  habituated to cheerfulness, yet  so full of the sympathy it has so largely
  enjoyed, that,  however gay, it does  not lose sight of the comfort  or sorrows of others ; however amused
  there is no  selfishness in  its enjoyments ;  the  mind  is  active  and  energetic, and  the  whole character
  beaming with intelligence and happiness.
    Reverse this picture, and see the child who has been governed by fear :  a suspicious timid glance,  an
  endeavor  to escape observation, no spontaneous prattle, no words or actions pouring out the unrestrained
  thoughts and feelings;  nothing truly enjoyed,  because there is an  undefined fear of doing or saying some-
  thing which may provoke rebuke ;  or if there  be enjoyments, they  are  received in silence, and in that
  solitude of heart which leads to selfishness.  Candor is a quality to be encouraged in children ;  indeed,
  it is natural to them :  their helpless dependent  nature  leads them to seek and bestow confidence ; thev
  have no reason for concealment, but such  as fear induces,  if it  be  needful, as assuredly it is, to learn
 the character of a  child's disposition  and  feelings, to  trace out the beginnings of error, to observe how
 impressions are made, and  what are their effects, how  can this be done when fear influences the child  to
 conceal, to misrepresent, to affect, and to deceive ?
    To a young  mother whose career of maternal duties has but just commenced, it may seem unnecessary
 to  dwell upon the importance of an  affection which she believes is already too full for increase ;  but she
 must look  forward to the  time when she  will be surrounded with little ones,  of different  dispositions, the
 novelty of her situation worn off,  and  youthful spirits less joyous and  elastic.  When pecuniary means
 are not <o  equal to the support and comfort of main ?.= of or.*,  when  cares  r.nd  anxieties of all kinds 
MORAL TRAINING OF CHILDREN.
255
 increase, then comes the time for the exercise of perfect love, when it is most powerfully taxL-d, and when
 it is most likely to give way.  The  active mind is more liable to irritability  than the indolent;  therefore
 the best informed, the most ardent, anxious,  and well-meaning parents, are the most likely to forget their
 previous convictions, and in  a moment of impatience to inspire their children with fear, and thus to shake
 the confidence which the child ought to repose  in its  parent.   So true  is it, that before we can  govern
 children, we must be able to govern ourselves.
   Obedience from child to parent is justly insisted upon ; but  it is not sufficiently considered that the
 means of establishing it depends  more upon the conduct of the parent than upon that of the child.   Obe-
 dience, to be of any use  in forming  goodness, must be based  upon love,  respect, and confidence.
   Ins  by no means unusual for  children to be told that whatever their parents  do  or say is  right, that
 they must be loved and looked up to as patterns, and obeyed without hesitation.   Now, instead of telling
 them this, it would be wiser to make them feel it;  and  by the exercise of kindness and gentleness to all,
 industrious  attention to duties, strict  and universal  observance of truth, to earn  the  love and respect we
 would command, and, by example and practice, accustom the young to witness and experience the effects
 of the virtues we  recommend.   The feelings  of ojiildren may be subjected to habit as  readily as  their
 appetites, and they can only be  habituated to  goodness by continually feeling its effects.   The serenity
 and happiness produced by kind treatment nourishes  love to others ; example  shows how that love may
 be made active.  The child  who sees that its mother's occupations  have a reference to the advantage or
 welfare of  others, that they contribute to the comfort of all, and  that she finds  pleasure in these occupa-
 tions, has learned a practical lesson in benevolence ;  and if it seek  to  act  upon what it has learned,  its
 effort should be gratefully received :  no matter whether they are serviceable or  not, the intention is the
 thing to be valued.   It exercises  the benevolence to employ a child in  little  services, snch as fetching  an
 article that is wanted, putting  things in  their places, picking up  litter,  &c. ; when  cheerfully executed,
 they should be acknowledged, and if unwillingly performed, thanks are still due ; but the child might  be
 made to perceive that a willing service is most prized.
   A mother gains nothing, and loses everything, by making a child fear her.  Fear may compel  obedi-
 ence, bnt it will establish  no real  goodness, no spontaneous wish to do right;  on the contrary, commands
 will be  evaded, whenever it may be done with impunity.   There will be  concealment of thoughts, feelings,
 and actions  ;  and  cunning and deceit will take the  place of truth  and honesty, and the mother will never
 have any influence, nothing but temporary power.  The  only fear a  child  should feel,  is the fear to do
 wrong ;  not, however, because it dreads punishment, for  this  is a low debasing  motive, but because it
 would not pain those it loves.  The  fear  of a  mother's  sorrowful countenance will be a more efficient
 check, a more healthful influence to a young child,  than the fear  of her  angry looks or her angry  voice.
 Confidence  in a mother is very necessary to obedience,  and can  only be  obtained by such a practice of
 truth and steadfastness on her part, that  there is  a  perfect reliance  upon her.  A child  has little or no
 experience of the consequences of his actions, nor  will he with the best guidance always consent to take
warnings and prohibitions upon trust;  but  when he is never deceived, when  promises are never broken,
threats never made in vain, there grows up a faith in the mother that leads a child to respect and to obey.
 To gain this faith, this  perfect reliance, the  mother must be consistent, equal in temper, the same to-day
as yesterday — otherwise the  child becomes confused, does  not  understand why the  permission of  yes-
terday is changed into  a denial to-day, or why the smile of affection is now altered to the tone of irritable
complaint.
   Falsehoods of a very fearful kind are sometimes uttered to deter children from  errors.   Threats  of old
men and black men, and  other like terrors, false and  true, are  resorted to, to frighten them  into obedi-
ence.  It is ascertained that  deaths,  fits, idiocy, or  insanity, have been  the  consequences of such inhu-
manity.  But setting aside the probable chance of such calamities, there  are other certain results : if the child
discovers the falsehoods practised upon  him, he becomes boldly indifferent to the  threats, is more disobe-
dient and wilful than ever; disbelieves all that is said to him, and, finding no respect for truth in others,
has no regard for it himself.   What becomes of the timid child ?   He lives in a state of fear of he knows 
256               PHYSIOLOGICAL  AND  MORAL  ELEVATION OF MANKIND.

not what; the sight of a strange face or a new object fills him with terror, for it may be one of the horrors
with which he has been threatened ; his faculties are all deceived, and diverted from their proper objects ;
he lives a life of fear and doubt, unable to distinguish  between what is true or false, real or unreal, good
or bad.  He loves  nothing:  it is well if he does not hate.   But he is not the more obedient.
   The exercise of any sort of cruelty toward  children renders them insensible to the sufferings of others.
And this  is the reason why they should not be  subjected to personal chastisement.   Imitation being one
of the  strongest faculties, the child  who is beaten also uses blows to effect his purpose.  There are many
parents who, upon  calm reflection, would  shrink  from inflicting  a  personal correction, or  encouraging
violence^ yet are continually  fostering a passion for fighting.   For instance,  a child  falls down and hurts
itself  against the floor or the furniture, and is immediately urged  to beat them.   This is the first lesson,
practically showing that revenge is to be indulged.   Above all things, let the mother beware how irritability
betray her into a slight pat, a twitch, or  a gentle  shake : if indulged, they inevitably  lead to  something
more,  and personal correction becomes a regular habit.   When once recourse  is had to blows, nothing
else is left; the child  is hardened  to the sense of pain,  indifferent to disgrace,  and, before committing a
fault,  does not consider whether  he is about to do right or wrong, but weighs the chance of escape, and
the proposed gratification against the pain of  a beating.  There is a quality in most minds which resents
injustice and feels disgrace.   It is a valuable sentiment, and  gives that  self-respect which assists in eleva-
ting the character, and preserving the individual  from everything base and  degrading.    When this senti-
ment is powerful, a resentful  feeling is aroused by violent correction — not the humility which is necessary
to a sense of  error and consequent amendment.   Where it is not active, chastisement extinguishes all
feeling of self-respect, of honest and worthy ambition,  of generous desire, and establishes in  their stead a
taste for all that is base, low, and sensual.
   Every  correction that is inflicted in  anger  bears the appearance of revenge, and  seems  intended to
gratify the offended feelings  of the parent, not to amend  the child.  If a parent is angry, she must wait
before she speaks ; this will  give her time for reflection, and then she will  seldom err.  It is a habit that
should be perseveringly practised by every irritable nature ;  many persons  act wrong  upon impulse,  who
are right upon reflection ;  with such, reflection should  always  precede action.
   No man submits to a blow ; he  considers it  the heaviest  indignity he can receive ; while  to  strike a
woman is deemed so  great an act of cowardice, that few  persons, however debased, are found guilty of
the practice.  Her weakness is  her protection.   How comes  it, then, that  children  are subjected  to a
degradation which  a  man  revolts from  enduring or inflicting ?  The nature of a blow is not altered by
the person on whom  it is inflicted, except that the physical weakness of the one party reflects  upon the
individual who  deals  the blow : the influence  is, that the parent who inflicts personal chastisement is more
degraded than the child who receives it; and though the child can not reason thus, he feels thus, together
with a sense of injury that must break up all filial respect and confidence.   These remarks apply to a later
period than childhood ; but  the beginning is then,  and  the parent  must beware  of first steps.  She must
guard her own habits  as well as those of her children.*
   Some children early evince a love of cruelty : they torture insects ;  they destroy wantonly, and pull in
pieces, break, crush,  and tear, everything that comes in  their  way.  To cultivate the  opposite feelinc,  as
has been  already mentioned, is the  mother's part; she must prevent every circumstance that can encourage
the propensity, manifesting  dislike at its  exhibition.   No  better  check can be found  than occupation,
giving a child  something to  do that will  employ its energies harmlessly.   She ought to  show it how ani-
mals should be  treated, first  making use of a toy,  teaching the child  to  feed, and caress, and protect, the
representation of the dog or horse, and taking it away on the first exhibition of  unkindness.   When the
child can comprehend her,  she  should relate tales of  mercy, never of  cruelly, even when the imaginary
delinquent is punished ; for where  there is  a propensity to cruelty, the mind  receives pleasure in listening
to its details ; indeed, it is  seldom prudent to tell children any stories which illustrate misconduct; all  their
  * What monsters those parents and  school teachers are who always, under excitement, repeatedly scold, strike, box, ferule, bruise, and whip
iLildren! They a;e ignorant, base, and iuliir.nia. and instil the satus spirit iuto those under their charge. 
                            RELIGIOUS EDUCATION  OF  CHILDREN.                       257

early ideas should be of goodness ; their curiosity is often so much excited, that they are frequently impelled
to do the things they hear of, in order to ascertain the facts.
   Neither is it wise to excite the feelings by tales of deep  sorrow or suffering: indifference or unhealthy
sensibility too often  succeeds  such excitements, and  compassion  and  tenderness  are  exhausted  upon
fiction, instead of being exercised upon  realities.   No child should  be allowed to witness the death of
trapped mice, rats, and drowning of puppies  and kittens, &c. ; they can not be  made sensible of the
reasons for their destruction ; they do not know the nature  of suffering and death, but only derive amuse-
ment from the spectacle, and learn to look upon pain as matter for sport  and  pastime.
   Love, then, should  be the impelling reason, the directing power of education.  Where love influences
the parent, the children of a family will be actuated by the  same spirit—a spirit subversive of selfishness.
Dissimilar as all characters are, different as all  intellects  are,  and different  as all  situations are, the great
duty of life is the same — the promotion of the welfare and happiness of our fellow-men.   There are few
errors, perhaps none, which do not affect the happiness of  others as well  as of ourselves :  each  individual
who improves himself, improves society ;  and every  mother who rears her child aright, aids the universal
progress  toward excellence. — Mas. Barwell.      9
   As soon, therefore,  as the understanding begins to dawn, every pains should be  taken to cultivate the
principles of virtue, and this will be perhaps most effectually done by holding up to the  child the odious
nature of vice.   The principles  of justice, kindness, mercy, and benevolence, should all be taught and
illustrated in the conduct and character of the parents.
   All  harshness and cruelty, both to men and animals, should be avoided in the presence of a child.  He
should never be suffered to deride any deformity in a fellow-being.  He should  be taught  to despise every
species of vice — as dishonesty, intemperance, cheating, lying, swearing, and licentiousness of every kind.
   Never let a child learn the trade of a butcher,  a soldier (or the infernal profession of killing our neigh-
bors, instead of loving them as ourselves,  as the Savior commanded).  Nor should he  learn any business
which  is  not lawful or  useful to society, or which has a tendency to  render the heart callous, or to injure
the constitution.
                                        CHAPTER  IV.

              RELIGIOUS   EDUCATION   OF  CHILDREN.

   All the preceding rules have a tendency to  lay the foundation and  prepare the way for a sound reli-
gious education.   But no rules, relating either to the intellectual or moral culture, can ever become a
substitute for true religion.   Genuine religion is spiritual in its nature,  and all its  requirements are only
known by the Book of Divine revelation.
   The few remarks which I shall make on this subject will be, first, negatively, or that which the child
should not be taught:—
   1.  The mind should not be  influenced by sectarianism or prejudice.   Almost any form of religion
may be impressed on the young and tender mind of a child who has been subject to correct intellectual
and moral training, if  great pains be taken at an early age.  Hence  we  see most  children adopt the
relio-ious faith of their parents; a striking example of which is seen in the perpetuation of  the religion of
the Hindoos, Chinese, and Mohammedans, as well as the numerous  sects into which the Christian world
is divided, to the disgrace of the professors of Christianity.
  2.  Children should not be taught  to lay  undue  stress on any outward observances  or ceremonies, nor
to  attach too  much importance to creeds, liturgies, or formulas of religion  of any kind.
                                                 33 
 'ioi              PHVSIOI.jr.iCAL AND MORAL ELEVATION  OF  MANKIND.

   Having thus very briefly hinted  at the kind  of religious  instruction which should be avoided, I shall
 proceed to give that which I consider proper to form an intelligent and sound religious character :—
   1. The mind of the child, as soon  as intelligence  begins  to  manifest itself, should  be  taught  what  is
 termed natural religion.   The  numerous subjects which  natural history furnishes, and which  abound on
 the earth, in the air, and in the sea, should be laid  before  it;  their  structure,  beauty, and  harmonious
 organization, should be illustrated and  presented to  it in a manner adapted to its capacities, and thus
 lead it  " from Nature up to Nature's God," the Almighty Maker of all.
   2. The child should be instructed in  the law of God as contained  in the Scriptures, and on all occa-
 sions to yield implicit obedience to the voice of conscience  (God's vicegerent in the human breast) ;  he
 should  be taught that this is a monitor placed within us, continually to  direct us  in the path of rectitude,
 and that our greatest safety is in all respects to follow its light and dictates  under the guidance  of that
 universal principle, the climax  of all  morality, taught by the Savior :  " Whatsoever ye would that men
 should do to you, do ye even so to them, for this is the law and the prophets."
   Lastly, as the child advances in years, it  should  be directed  to  the Scriptures, without note or com-
 ment, especially to all  its  plain and  practical duties«-to  the provision which is therein  made  for  the
 salvation of man as a transgressor of  the  Divine  law by repentance,  faith, and  obedience.   In a word,
 the rising generation should be taught that " to fear  God  and to  keep his commandments is  the whole
 duty of man."
   The following excellent plan  of religious  education, adopted by the exemplary parents of the Wesley
 family,  is worthy of all  imitation :—
   " As self-will is the root of all sin and misery, so whatever  cherishes this in  children insures their after-
 wretchedness and irreligion : whatever checks and mortifies it, promotes their future happiness  and piety.
 This is still more evident if we further consider that  religion is  nothing else than  the doing the  will of
 God, and not our own ;  that the one grand impediment  to our temporal and eternal happiness being this
 self-will, no indulgences of it can be trivial, no denial unprofitable.....So that the parent who  studies
 to subdue it in his child, works  together with God in  the  renewing and  saving  a soul;  the parent who
 indulges it does the devil's work......
   " Our children were  taught, as soon as they could speak, the Lord's prayer, which  they were made to
 say at rising and bedtime constantly ;  to which, as they grew bigger, were added a short prayer for their
 parents, and some collects, a short catechism, and some portion  of scripture, as their  memories could
 bear."
   (It is an  excellent  custom to collect  the  family together  daily,  not only to read the Bible and other
 useful books, but also for meditation or conversation on religious subjects, prayer, &c.)
   " There  were several  by-laws  observed  among us.   I  mention them here, because  I  think them
 useful:—
   "1.  It had been observed that cowardice  and fear  of  punishment often lead  children  into lying, till
 they get a custom of it  which they can not  leave.   To prevent  this, a law was  made that whoever was
 charged with a fault, of which  they were guilty, if they would ingenuously confess  it, and promise  to
 amend, should not be beaten.   This rule prevented a great deal of lying; and would  have done more, if
 one in the  family would have observed it.   But he could  not be  prevailed  on,  and therefore was often
 imposed upon by false colors  and   equivocations, which  none would have used  but  one  had they been
 kindly dealt with ; and  some, in spite of all, would always speak truth  plainly.
   " 2.  That no sinful action, as lying, pilfering, disobedience, quarrelling, &c, should ever pass unpun-
ished.
   "  3.  That no child should be chid, or punished  twice for  the  same  fault; and that if they amended,
they should never be  again upbraided with it afterward.
   "  4.  That every signal act of obedience, especially when it crossed upon their own inclinations,  should
be always commended, and frequently rewarded, according to the merits of the case.
   " 5.  That if ever any child performed  an  act of obedience, or  did anything with an  intention to  please, 
SUMMARY OF RULES  FOR MOTHERS.
259
though the performance was not well, yet the obedience and intention should be kindly accepted, and the
child with sweetness directed how to do better for the future.
   " 6. That propriety be inviolably preserved ; and none suffered to invade the property of another in
the smallest matter, though it were but of the value of a farthing or a pin ; which they might not take from
the owner without (much less against) his consent.  This  rule can never be too much inculcated on the
minds of children ;  and from  the want of  parents or  governors  doing  it as they ought, proceeds  that
shameful neglect of justice which we may observe in the world.
   " 7. That promises be strictly observed ;  and a gift once bestowed, and so the right passed away from
the donor, be not resumed, but left to the disposal of him  to whom it was given ;  unless  it were condi-
tional, and the condition of  the obligation not performed."--Adam Clarke's Lives of  the Wesley Family.
                                        CHAPTER  V.

            SUMMARY   OF   RULES  FOR   MOTHERS.

                            RULES FOR SELF-GUIDANCE DURING PREGNANCY.
   Let the future mother remember that the constitution of her child depends on natural circumstances,
many of which are under her own control.
   Study and obey the laws which regulate health.
   Maintain a serene mind and an even unruffled temper.
   Regard child-bearing as a natural and not a diseased condition, and dismiss an unnecessary and hurtful
dread of it.
   Suspend all the severer cares of life, and  avoid  the causes  of extraordinary excitement,  danger, and
alarm.
   Live on nourishing, but simple and moderate diet, with few  or  no stimulants.
   Take regular and gentle exercise every day in the open air.
   Continue, as far as possible, the ordinary occupations of life.
   Endeavor to repress any tendency to nervous exeitement.

              RULES FOR TREATMENT OF  THE CHILD AFTER EIRTH AND BEFORE WEANING.
   Give the breast within twelve hours after birth, at latest.
   Foment the breasts with warm  water if  the  milk does  not flow  ; avoid rubbing the breasts with spirits.
   If there be much milk, drink little, and take opening medicine.
   As a nurse, wear easy dresses about the bosom and chest.
   Keep down the  tendency of the abdomen to enlarge, by exercise.
   If the nipple is small or turned in, have  it drawn by an older or stronger infant,  not by artificial means ;
but let the newborn child have the first milk.
   Choose a hired wet-nurse (when required)  nearly of the  same  age with the mother, like her in consti-
tutional peculiarities, and who has been confined about the  same time.
   When nursing, live on nutritious, but not  heavy diet.   A  full habit  requires  less  nutriment than a
delicate constitution.  Stimulating liquors  are  to be avoided.   Simple diluents, such as water, cocoa, or
chocolate, are quite enough as drinks for many mothers.
   The mother's milk is the best food for the newborn child for three  months.
   An infant from two to four months old,  requires to be suckled once about every three  hours. 
2G0
PHYSIOLOGICAL AND MORAL ELEVATION OF MANKIND.
   The best substitute for the breast, but as temporary as possible, is ass's or  diluted cow's milk; but on
no account should farinaceous food be given at this early period.
   Apply a flannel bandage  to  the  lower part of the body in  bowel-complaints.   A warm bath soothes
irritation.
   After six  months, an approach may be made to a more solid diet.
   In general, give no stimulants, carraway-seeds, carminatives, &c. ;  they are most pernicious.
   Give as little medicine to a child as possible.
   Never overfeed," and never stop crying by feeding.
   Avoid rough jolting and patting on the back.
   Train an  infant to regularity in all its wants.

                                        RULES FOR WEANING.
   Wean gradually, discontinuing suckling in  the night: the gradual  change is beneficial to both mother
and child.   Avoid weaning in severe weather.   Take for yourself  a cooling purgative, and refrain from
fluids and stimulating diet.
   In weaning, apply to the  breasts three  ounces compound soap-liniment, three drachms laudanum, one
drachm camphor-liniment.   If this is too irritating, foment with warm water, or poppy-heads and camomile-
flowers  boiled in  water.  Avoid tightness or pressure from the dress, and all roughness, for fear of abscess.
Avoid drawing the breasts :  avoid exposure to cold.

                           RULES FOR TREATMENT AFTER WEANING--FOOD.
   Study the child's constitution, digestive  powers, teeth, strength, and proportion the  kind and quantity
of food.  Bread  and milk is the best diet for tbe child.
   Avoid too nourishing a diet with  a violent-tempered child.
   Give a nourishing diet to a white-looking lymphatic child.
   Both overfeeding and underfeeding produce scrofula and consumption.
   The spoiled and petted child is injured both in health and temper.
   Avoid seasoned dishes, fried  and salted meats, pastry, uncooked vegetables, unripe fruits, wine, and
    cake.
   Insist on  thorough chewing or mastication.
   Never tempt the appetite when disinclined.
   Vary the  food from day to day, but avoid variety at one meal.
   Take care that the child's food is well  cooked.   Give no new bread.
   Sweetmeats and confections are only to be given to children in a very sparing  manner, if given at all
Never pamper or reward with eatables.
                                         RULES FOR SLEEP.
   Allow the child plenty of sleep without disturbance.
   Avoid accustoming the child to sleep on the lap ; it will not sleep in bed if so accustomed.
   Establish  times for regular sleeping.
   Keep the hands, feet, and face, comfortably warm — blankets are  better than sheets.
   Support every part of the body, raising by a slope the head and shoulders.
  Avoid laying the child in the same bed  with an adult, unless for a short  time to  restore warmth if it fail.
  Never rouse the child by play when taken up during the night.

                                       RULES FOR  CLOTHING.
  In the first stage of infancy, warmth depends on  clothing alone, for there is no muscular movement.
  Avoid a degree of warmth which produces sensible perspiration.
  Flannel and calico are the best materials in all seasons.
  Dress the child loosely, and fasten with strings and not pins. 
                             SUMMARY OF RULES  FOR MOTHERS.                         261

  The umbilical cord, navel,  and belly-band, require much attention.
  Avoid keeping the child's head too warm or its feet cold.
  Avoid chilling the child,  or taking it abroad in cold weather.
  Attend to the form and size of the child's shoes, so that the feet shall l.ot be cramped.
  The practice of plunging infants in cold water, to render them hardy, is exceedingly dangerous.
  Let a  child's washing be very completely and carefully performed.  Keep  the child always perfectly
clean and neat.
  Be very attentive to ventilate  the apartment where a child lives, but never expose it to draughts of air.
  Begin  early to form habits of personal cleanliness and delicacy.
  Regard should be had to the  effect of light upon the infant.

                                             MEDICINE.
  It is improper to administer purgative medicines to the newborn infant.
  If the  child is well managed,  medicine will rarely be required.
  Physiological knowledge is very important to mothers.

                                            VACCINATION.
  Let the child be vaccinated from  six weeks to two  months  after birth, and  that by a proper medical
attendant.  Vaccination should  take place before teething.

                                   DEFORMITIES  AND DISTORTIONS.
  Be very vigilant with rickets  or soft bones.   Never allow the rickety child to support  its own weight.
It ought  to be kept on its back for many months, and carried about on a little mattress on a board or tray,
and have nourishing diet, and the proper medicine to give solidity to the bones.
  Never jerk or swing children  by the arms; much mischief  has been done by this practice.
  When a child falls or meets  with any accident, it  is  highly culpable in a nurse to conceal it.  If she
do not immediately mention it, she may be the cause of the child's deformity and lameness for life.
  With proper attention, a  tendency to be left-handed may be easily cured in a child.
  Prevent all tricks and ill  habits which injure the features and  organs, such as stuffing the nostrils, ears,
&c, or distending the mouth with too large a spoon.
  Curvature of the spine is of very frequent  occurrence from  mismanaging children, by tight-lacing, long
sitting without support to the back — (all school seats and forms should have backs).   Take all deformi-
ties of the spine in time, before  they get fixed.

                                            PRECOCITY.
  When a child appears to be over-intelligent, or too clever, or wise, for its age, this is a symptom of an
unnatural development of the brain  : it is a kind of disease.   Avoid, therefore, exercising the  child's
ability ; treat  it, as  an animal, with nutritious food, muscular outdoor exercise, and plenty of sleep ; and do
this, and this only, for some years.
  No child should be kept engaged  for more than a few minutes at a time in mental study.

                             STAMMERING AND DEFECTIVE ARTICULATION.
  This defect, with care, may be cured ; or rather, when it is first threatened, it may be prevented.
  Practise the child in letters or articulations where a peculiar defect appears.

                                             SQUINTING.
  Watch this very common weakness, check it in the infant  by holding the hand over the eyes till they
are  shut; and when opened again, if they have not assumed a proper position, repeat the operation.  It
may have often  to be  repeated.   Careless nurses are very apt to produce  squinting in children.   The
habit of  looking obliquely, either with one eye or both, is that which  has to be chiefly guarded against. 
202              PHYSIOLOGICAL AND  MORAL  ELEVATION' OF MANKIND.

                                             TEETHING.
  The first sign of  teething is heat in the mouth of the child — felt by the mother during sucking—flow
of saliva — biting and grinding the gums.  A piece of India-rubber is better than coral, ivory, or any hard
substance, for rubbing the gums.
  When the bowels are confined, give without delay a gentle purgative,  such  as  castor-oil,  manna, mag-
nesia, or senna.  The warm bath  at  ninety-six degrees soothes  the child.
  A child's mouth  should be often examined, even  after three years  of age.
  Wayward  temper, cough, and even croup, have been traced  to cutting a double tooth.

                                     EXERCISE--WALKING ALONE.
  Very little motion, and that of  the gentlest and most careful kind, is  all the infant should have for a
considerable  time after birth.
  Avoid the upright posture as much as possible.
  Avoid all  sudden and violent jerking, and long-continued positions.
  Allow the child to move its limbs  freely on the floor or in bed.
  Watch the first efforts of the child to walk alone,  and interfere rather with eye and hand than by excla-
mations of caution  and  alarm : these last do much harm.
  Avoid sympathizing too strongly with the child when hurt:  assist quietly, and show how the accident
happened.   Children who are angry when hurt, should see that you do not sympathize with their rage
although you do with their sufferings.
  Abjure all leading-strings and go-carts, or other artificial means of teaching the child to walk.   Never
drag the child by one hand, or lift it by either one or both arms.
   When the child  walks alone, it should not be permitted to over-fatigue itself.
   The mother should have her eye both on her  child and its  attendant  out-of-doors, and be as much as
she can in her child's company.
                                        MORAL  GOVERNMENT.
  Anticipate and prevent fretfulness and ill-temper by keeping the child in good health, ease, and com-
fort.  Never quiet with giving to eat, or by bribing in  any way,  still less by opiates.
  For the first few  months, avoid loud and harsh sounds in the hearing of children, or violent  lights in their
sight: address them in  soft tones; do nothing to  frighten thern  ; and never jerk or roughly handle them.
  Avoid angry words, violence, striking, pushing, or whipping  a child (if at  all  whip, never  do it  in a
rage) ; by which means a naturally violent child will be trained  to gentleness.
  Moderate  any propensity of a child, such as anger, violence, greediness for  food, cunning, &c, which
appears too active.   Show him no example  of these.
  Let the mother be, and let her  select servants such  as she wishes the child to be.  The youngest child
is affected by the conduct of those in whose arms he ^ives.
  Cultivate and express benevolence  and  cheerfulness : in such  an atmosphere, a child must become
benevolent and cheerful.
  Let the mother feel as she  ought, and she will look as she feels.   Much of a child's earliest moral
training is by looks and  gestures.  (Like begets  like  :  love or hatred is infused  by the mother or nurse
into children.)
  When  necessary, exhibit firmness  and authority,  always  with  perfect temper, composure, and self-
possession.
  Never give the child that which it  cries for; and avoid  being too ready in  answering children's de-
mands, else they become impatient of refusal, and selfish.
  When the child is most violent, the mother should be most calm and silent.   Out-screaming a scream-
ing child  is as useless as it is mischievous.   Steady denial of the  object screamed for, is  the best cure
for screaming. 
                             SUMMARY OF RULES  FOR MOTHERS.                         263

  Iu such contests, witnesses  should withdraw, and leave mother and child alone.  A child is very ready
to look round and attract the aid of foreign sympathy in its little rebellions.
  Never promise to  give when the child leaves off crying.  Let the crying be the reason for not giving.
  Constant  warnings, reproofs,  threats,  and entreaties — as. "Let that alone" — "Be quiet"—"How
naughty you are.'" &c,  all uttered in  haste  and irritation, are most  pernicious.   No fixed  or definite
moral improvement,  but  the reverse, results from this too common practice.
  Watch destructiveness, manifested in  fly and  insect  killing, and smashing and  breaking, quarrelling,
striking, &c.   Never encourage revenge.   Never allow a child  to witness killing animals.
  Counterwork secretiveness  by exposing  its  manoeuvres.  Regulate  notions  of  property — one's  own
and another's.
  Never strike a child, and never teach it to strike again.  Never tell a child to beat or threaten any
animal or object.  Corporeal  correction may be avoided  by judicious substitutes.
  Set an example  of cleanliness, order, punctuality,  delicacy, politeness, and  proper ease  of manner.
This  is better than teaching manners, as it is called.
  Inculcate early, and  manifest in yourself, a delicate regard for the  rights of  others and their feelings,
in contrast with  selfish vanity,  arrogance, and exclusive  attention to one's own ease, comfort, and  grati-
fication.
   Prevent all indelicacies and  slovenly habits at table — touching  the utensils, stretching for  what  is
wanted, sitting awkwardly, &c.
   (Never use a particle  of tobacco in presence of a child or otherwise.  The practice  is too filthy even
to be named.)
   Study early to gain  a child's confidence by judicious sympathy in its joys and  sorrows.   Have  no
concealment with it.
   Govern by love, and not by fear :  the contrast between children  governed by the one and the other is
truly  instructive.  Never forget that kindness is power with  man and beast.   The  Arab never strikes his
horse.
   Cultivate truth, justice,  and candor,  in the child, and manifest them in yourself.
   With a child whose firmness is  apt to run  into obstinacy, never contend :  in doing so, you aggravate
the feeling by manifesting  the same feeling  in yourself; and by  further  showing your combativeness, exci-
ting the child's opposition.  Divert the child from the  object, and  put in activity its benevolence, justice,
and reason.
   Never frighten to obtain a  child's obedience :  threats of hobgoblins, and all false terrors, are  now uni-
versally exploded, as atrocities toward the young ; death, fits, idiocy, insanity, have been the consequences.
They are besides soon discovered to be falsehoods, and operate most immorally.

                                  EARLIEST INTELLECTUAL EDUCATION.
   Cultivate by exercise  the five senses of seeing, hearing, touching, smelling, tasting.
   Teach the child to observe forms, sizes, weights, colors, arrangements, and numbers.
   Practise all  a child's  knowing faculties on objects — feathers, shells, ribands, buttons, pictures of ani-
mals,  &c.
   Practise distinct articulation.   If at  four years of age a child has  any defect, it ought to be systemati-
cally taught to pronounce  correctly.
   Let a child  put  its toy  to  another than  the intended  use, if it does not destroy it.  This  exercises
invention.
   Encourage construction, and furnish the materials, leaving ingenuity to work.
   Accustom the child to find its own  amusement.   It  is the  most  unprofitable slavery to be constantly
finding amusement  for it.
   Remember that children love stories — the simpler the better; and  delight to have  them told again and
again.  Always give them a moral turn and character. 
264
PHYSIOLOGICAL  AND MORAL ELEVATION  OF MANKIND.
   Be  sparing of the marvellous ; exclude  the terrible and horrible ;  and  utterly proscribe all ghost and
witch stories.
   Accustom children to  reptiles, insects, &c. ;  and prevent  the foolish fear of these creatures which is
often found  in adults, and leads  to the constant and most unnecessary  destruction of them.
   Induce a  child to give attention, by presenting  objects, and giving narratives which interest it.   Do not
tell it that it must give attention.
   Avoid employing  female servants as nurses who  possess  coarse  habits and sentiments, or whose mode
of speaking is coarse and indelicate.
   No difference need at first be  made between the rearing and training of male and female infants.  Allow
female children as they grow up to amuse themselves with dolls ; and  in a similar manner encourage and
regulate the amusements of boys.
   (Accustom them to sleep separately at a very early age.)

                     INFANTILE DISEASES AND TREATMENT IN  THE  UNITED STATES.
   The mortality among infants is much greater in the  United  States than in Europe.
   The cause is to be found in the extreme vicissitudes of our climate, and certain errors of treatment.
   A stimulating diet of animal food is often  pernicious to  infant constitutions.
   Gluttony  is too  much encouraged among  infants.
   Improper food is the chief cause of fatality in  teething.
   During the first twelve  or fourteen  months, the mother's milk  should  constitute  the sole nutriment of
the child.
   Autumn in this  country is the most proper season for weaning a  child.
   More attention should be paid to the clothing of  infants.
   Fine Welsh  flannel is  the most suitable  material for infant  clothing during the  spring, winter, and
autumnal months.
   Pure air is of  the utmost importance.   Pernicious consequences often  result from inhaling the  gas
from anthracite  coal. — Mrs. Barjvell.
             CHAPTER  VI.

FACILITY   OF   LABOR*
   The lamentable state of ignorance at present existing, among even the more educated and  intehVent
in regard to the complicated machinery by which the functions  of animal life are performed, necessarily
produces constant deviation  from the laws of Nature, the penalty of which is sufferino\  Woman  in  a
peculiar manner, has been hitherto excluded  from that self-knowledge which is equally necessary to health
and happiness in the physical as in the  mental world.   But the darkness induced for a time by barbarism,
and followed by an over-fastidious delicacy, is fast being dispelled — a few struggling  ray3 of intelligence
have penetrated the  clouds — and soon,  we trust, they will brighten  into the perfect day.
   In particular is to be regretted  her ignorance in regard to the nature of that delicate and peculiar  rela-
tionship which exists between a mother and the  being whose existence  is as  yet a part of her own  and
whose future  constitution, health, and  character, are to be  moulded  in a great  measure by  the mother
during the period of gestation.   Nor  is  it the child alone who receives the benefit or endures the penalty,
  * The substance of this article is compiled chiefly from the valuable little treatise of Mrs. Pendleton, of this city, entitled " Child Bca. ine
without Pain." 
FACILITY OF  LABOR.
265
 as Nature's laws are violated or obeyed.  To the mother it is a question  of infinite moment, and will
 decide whether child-bearing shall continue to be, as it now is, but another name for suffering and torture,
 preceded by months of exhaustion and distress, or be rendered a natural and comparatively an easy pro-
 cess.  Yes, startling as it may appear, this may become comparatively an easy process.
   Dr. Dewees, professor of obstetrics  in the Medical School  of Pennsylvania, takes the ground that
 " pain in child-birth is a morbid symptom, the consequence of artificial modes of  life and treatment; and
 could be avoided by appropriate  habits and  treatment."  The words  of Holy  Writ, " In sorrow shalt
 thou bring forth," is believed by many sufficient  to account  for the prevalence of this suffering, but the
 more recent investigations into causes and effects have resulted happily in showing that, inasmuch as the
 laws of health are obeyed, there is a proportionate exemption.
   Dr. Eberle remarks :  " Child-bearing is a natural and not a morbid process ;  and in the facility with
 which healthy and regular-living women pass through   it, we have abundant evidence that  the Creator
 did not design it to be necessarily a  time of suffering and danger."   Nature has made abundant provision
 for the discharge of the function of  parturition without  danger, as is evident from the different  structure
 of  the male and female  pelvis ; nor have we any reason  to suppose parturition, in a healthy system, a
 more hazardous process than digestion or  respiration.   If  this be  indeed true — if mothers may escape
 these months  of wretchedness — if the pain of labor may be not  only lessened in intensity, but  abridged
 from forty-eight hours  to two or even one,  as has been  known to be the case — the earnest question will
 be  asked from the thousands who groan under existing  evils,  " What, then, can be done ?  Point us the
 remedy."  Gladly will we mark the road—gladly show the way  of escape.
   In introducing the few simple means  by which this desirable end is to be  attained, we take the liberty
 of extracting from an excellent work on the subject, some remarks from the account of an  experiment for
 securing child-birth with safety and little pain, related by S. Rowbotham, author of an  essay on " Human
 Parturition,"  &c.  " While reading the article 'Age,' " says Mr.  Rowbotham, " in the ' Penny Cyclo-
 paedia,' published by the ' Society for the Diffusion of Useful Knowledge,'  I  was  forcibly impressed with
 this paragraph :—
   " ' When first the human embryo  becomes distinctly  visible, it is almost wholly fluid, consisting only of
 a soft gelatinous pulp.  In  this gelatinous pulp, solid  substances are formed, which  gradually  increase
 and are  fashioned  into  organs.  These  organs,  in  their rudimental state, are soft  and  tender, but, in
 progress of their development, constantly acquiring a greater number of solid particles, the adhesion of
 which progressively increases, the organs at length become dense and firm.   As  the soft solids  augment
 in bulk and density, bony particles are deposited, sparingly at first, and in detached masses, but  accumu-
 lating by degrees ;  these, too, are at length fashioned into distinct osseous structures, which, extending in
 every direction, until they unite at  every point, ultimately form  the connecting bony framework of the
 system.   This bony fabric, like the  soft solids, tender and  yielding at first, becomes by degrees  firm and
 resisting.' "
  Mr. Rowbotham reasoned  from this that the firmness and density of the foetus depends upon the amount
 of the bony matter deposited, or entering into its constitution ; and, as the foetus is built up,  nourished,
 and  supported  by the  mother's  blood, the mother's blood  must  be  the  source  of  bony matter which
 hardens and consolidates the foetus.  But blood is derived from food and drink ; consequently, if different
kinds of food and drink contain different proportions of this bony matter, it follows, that, according to the
kind of food which the mother subsists upon  during pregnancy, (hat is to say, according to the amount
of earthy or bony matter existing in it, will be the amount  existing in  or entering into combination with
her blood ; and consequently will the foetus be more or  less firm and resisting.
  Chymical investigations have taught us that " the phosphate  of lime and magnesia contained in food, and
 thus conveyed into the blood, can not be converted into cellular tissue, neither can they be  consumed by
the  respiratory organs, but a portion of them is deposited in the form of bone."   We see hence  the pro-
priety of Mr. Rowbotham's conclusion that the diet of pregnant women should consist of food containing
less of the ossifying ingredients, as thereby the   ossification of  the foetus would  be  retarded — greatly
                                                34 
                  PHYSIOLOGICAL  AND MORAL  ELEVATION OF MANKIND-

fiLilitiMij; the process of  parturition.   Care  should  be  taken, however, to  avoid  the extreme of this
course, lest, from  want of stamina in the mother, she inflict upon her child all the evils arising from  a
defective or weakly-organized constitution.
   Attention to diet, then, is a fundamental principle  in  securing  to the mother a  mitigation of the pains
of labor, and  giving the child a strong  and healthy constitution.   "A notion is very prevalent," says the
celebrated  Dr. Combe, "that an  unusual supply of nourishing food is required during pregnancy, on
account of the rapid development of the new being in  the maternal womb.  In some, in which  the gen-
eral  health, digestive  powers, and appetite, improve during gestation, an  increased allowance of food
becomes necessary, and is productive of much advantage.   But in the majority of cases, when no such
improvement takes place, and the appetite is already more vigorous.than the powers of digestion, nothing
but mischief can follow from increased  eating." — " It is true that substance is expended on the develop-
ment of  the infant being in the mother's womb, but Nature herself  has  provided for that demand, by  a
suppression of the periodical discharge, to which they are  at other times subject,  and which ceases alto-
gether when the age of child-bearing is past; and therefore  during pregnancy, when the health is  good,
and the appetite natural, there is no need whatever of increasing the quantity or quality of the food which
is found  by experiment to agree with the constitution, and nothing but harm can result from attempting to
support the system by too nutritious diet."
   "  The foetus is  duly nourished only," continues the  same  author, " when the proper food in itself is
also  properly digested : if the digestion be imperfect, no food, however nutritious, will  afford a healthy
sustenance.  Many  mothers in the higher classes give birth  to feeble and badly-developed children, from
inattention to this  fact.  Fond of indulging in  every luxury, they eat unseasonably and largely, until the
powers of the stomach  are exhausted, and digestion becomes so much impaired, that food ceases  to be
nutritious.   Morally considered,  it is as culpable on her part to starve the infant before birth, by volunta-
rily impairing her  own powers of nourishing  it, as by directly refusing it food after  it  is born.*'
   Dr.  Eberle remarks : " There is no  period of life at which it is of so much consequence to observe
moderation and simplicity of diet, and avoid  the  use of heating food and stimulants, as during pregnancy.
Not  only is the general system then unusually susceptible of impressions, and disordered by slight causes,
hut in  nervous constitutions the stomach is the seat of peculiar irritability, accompanied  by a craving and
capricious appetite, to which it requires much  good sense and self-denial  on the part of the parent to
refrain from giving way."
   On  the subject  of diet,  Dr. Oilman, professor of obstetrics in the New Y'ork  College of Physicians and
Surgeons,  says : " This should be light, not very nutritious,  and rather laxative.   Nature, in most cases,
points  out this course :  the  appetite is for fruits, vegetables, and the lighter  meats,  while gross food, such
as goose, pork, fat, &c, are loathsome.   Follow here the dictates of nature : let  the patient  take  vege-
tables, and especially fruits, freely, and  abstain from gross articles, from highly-seasoned  meats, and from
stimulating drinks."
   Next to diet, or rather of equal importance with it, is the  necessity of exercise  taken freely and  judi-
ciously.   " During pregnancy, the great aim for the  sake of both parent and  child should be, to sustain the
general health in its  highest state  of efficiency; and, in  order to attain this, the  mother should  pursue her
usual avocations and mode of life, provided these be compatible with the laws of health.   Regular daily
exercise, cheerful  occupation and society, moderate diet, pure air, early hours, clothing suitable to the sea-
son,  and healthy activity of the skin,  are all more essential than ever, because now the permanent welfare
of another being is at stake, in addition to that of the mother.   But  any of  these, carried to excess, may
become a source of danger to both mother and child.   Dancing, riding, and travelling over rough roads,
have brought on   abortion."  The same writer remarks : " In regard to regular exercise in the open air,
the greatest attention is necessary on the part of the mother.   Nothing contributes more essentially than
this to  a sound state of health during gestation, and a  safe and easy recovery after delivery.   With ordinary
care, walking  may be continued almost  to the last hour, and  with excellent effect upon all the functions."
  Dr.  Oilman, speaking of exercise, says : " This should  be strongly insisted  upon ; none of the  means 
MISCELLANEOUS SUBJECTS.
2C7
of preserving the health  of pregnant women are more valuable than this.   It  should  always be taken in
the open air, and carried so far as to produce fatigue, but not exhaustion.  As to the  kind of exercise,
walking is best; riding in an open carriage will do well."
   Cleanliness and fresh air are important aids to health  at all times, and  doubly  necessary during gesta-
tion.   Hence the propriety of having recourse to the tepid bath  every few days, especially in the case of
females in  the middling  and higher classes, in whom the nervous system is unusually excitable.





                                       CHAPTER  VII.

                    MISCELLANEOUS   SUBJECTS.


                                           SECTION I.

                                     EARLY  MARRIAGES.

   Nature has intended  that all  the parts  of the system, both  in  the human and in  the lower order of
animals, shall be fully formed and developed before  they begin  to  propagate their species ; and  if the
organs of reproduction are thus prematurely  used before  that period, there will be a violation of Nature's
laws, resulting in injury  to  the parents as well as to their offspring.  This is a  well-known fact among
farmers, and they are careful to keep the female from the male until  a suitable age ; otherwise the animal
may perish in delivery, or  its growth be  much  retarded.  The same law holds  good in relation to the
human species.  Labor becomes more painful or dangerous  in  early marriages,  and  a full development
and  growth of the system  is arrested.   Not  only so, but a  much  more  numerous  offspring is entailed,
which, in the present state of society, often becomes  a fruitful source of suffering.   AH this usually arises
in consequence of the  sexes indulging in  those morbid, premature, and excited feelings, peculiar to a very
early age, and which should be guarded  against, as a means of avoiding many physical and mental evils,
and  promoting their  happiness.   It was  an   excellent law of  the ancient  Germans, forbidding  marriages
under the age of twenty-five  in the male  and twenty  in the female :  their offspring were vigorous.
                                          SECTION II.

                            PROCREATING  SEXES  AT  CHOICE.

   ......" Here presents itself the great question which has for a long time agitated the schools — I
mean that of generating or procreating males  and females.  Hippocrates, in his forty-eighth aphorism,
section fifth, tells us —' The male foetuses are on the right side, and  the female  on the left side.'   The
commentators have added —' If the first step the woman makes, standing up, is  of the right foot; if, being
seated, she leans rather the right hand  on the right knee ;  if the right eye is  more vivid, the right nipple
more enlarged,  all her  motions  more lively and ready  on  the right side, with all  tbe other symptoms of
pregnancy accompanying, it is a sign she bears a male.'  Hence there is a means to fecundate the uterus
accordingly, which the accoucheur Millot, of Paris, relates in his ' Androgenesy,'  after thirty years' expe-
rience.   The means he proposes is easy, and every husband can use it at choice :  To procreate a boy,
the husband must lie on the right side of the wife ; the bed making an inclined plane, the right ovarium
will be fecundated in that position.  By sleeping on the left side, tbe prolific spirit will instil itself into the 
268              PHYSIOLOGICAL  AND  MORAL  ELEVATION OF MANKIND.
left ovarium, and she will procreate a girl, by means of the paternal degree of heat and stimulus commu-
nicated to the ovarium or human ess.   Rubbing the side also will add to the stimulus of the contact of
the two spouses."  The above statement has proved to be correct by the translator in a certain number of
cases examined. — Dr. Zknder's " Megalanthropogcnesie" (translated by Dr. Roberts, of Paris).
                                         SECTION III.

        PHYSICAL,  MORAL,  AND  INTELLECTUAL  TRAITS  TRANSMISSIBLE.

   It is very evident to the observing mind that physical, moral, and intellectual traits of character and
constitution,  may be transmitted from the  parent to the offspring.   This  may be seen not only in indi-
vidual but even in national character.  Hence we  know the  inhabitants  of  different  nations at the first
view of them, from the peculiarities of  physiogonomy and muscular  development, as well as by their
intellectual and moral peculiarities.   The aborigines of this country are noted for their extraordinary mus-
cular development; the Germans for their general integrity of character : the Spaniards and the Portuguese
are noted for the  opposite  traits.   So, likewise, the  great enterprise, energy, and versatility of  character,
displayed by the Americans, is attributable to the constant  influx and fusion of different races of people.
   The same law  extends to the animal creation.  It is a well-known  fact that  the  cattle-breeder recog-
nises this principle, and improves his stock by  increasing  valuable  traits  of size, beauty, symmetry, and
even disposition.   In  this  way, some small, defective native  animals, by judicious crosses, have become
so much improved, that the original  stock  is no longer known.  Nor does  the  same  law stop here ; it
extends to the vegetable creation : and all our fruits and garden-productions have been completely changed
for the better by improvement in cultivation.  This perfection in the three kingdoms of nature is the result
of  fixed and well-known laws.  In the  animal, if it be small, the defect is removed  by crossing it with a
larger one ; if one part be deficient in symmetry, it is removed in a similar manner.   If the disposition  be
vicious, the  offspring becomes more docile by the same means.  In applying this principle to our race,
no  person should marry who labors  under any serious disease:  if the  individual be afflicted with vene-
real complaints, scrofula, or is  predisposed to  consumption (or if it has  proved fatal  to several  in  the
family), there is the same objection.   If either party be deficient in intellect, or an  idiot, it should be a
barrier to matrimonial alliance ; if either possess any very bad constitutional trait of character, particularly
if it has existed  in  the  parents, the  same objection prevails.   If, then, in  a word, there be one  radical
defect, in body, mind,  or  morals, it will be transmitted to  the offspring in a greater or less degree :  and
are not those criminal who thus, by marriage, inflict pain and misery upon their children ?   The influence
of impression upon the foetus in utero from the mother is very great.   A fit of anger before nursing  causes
great distress to the child  ; exposure  to  cold  or  other deviations are communicated immediately to the
infant;  and  it is in this manner that  either good or injurious  impressions are conveyed  during pregnancy
as well  as before.   A rule  of  great practical  importance is, that during this period, if we wish the foetus
to be born in a good condition in all respects, the mother  must obey the laws of health and morality.
That the mother gives to her child its physical constitution,  regulated by her own regard to  its health
during gestation, the following letter from the  interesting work on child-birth, before quoted, will prove :—
   " I was,"  says the writer, " married at  the age of twenty-five, inheriting from both my parents  a most
vigorous constitution.  My husband was four years my senior,  and alike blessed with most perfect  health.
But we started wrong,  after all, for we  were both determined  to be rich, let  what would come.  We
occupied # large farm ; and I, in my eagerness to amass wealth,  which has been a canker to my happiness,
would never employ help for a day, frequently doing all the labor for a family of twenty during the period
of gestation.   My first  children were twins.   My living at the time was what is  commonly called the
plain living of farmers, but which I now consider as  much  too luxurious  for health.  Previous  to my
accouchement, a  cutaneous eruption appeared  on  my face, hands, and neck, together with swelling  of 
MISCELLANEOUS SUBJECTS.
269
joints.   This I looked upon as the  effect of heat, which would soon pass off;  but what was my disap-
pointment at the birth of my babes, to have presented to  me two emaciated little  beings, covered with the
same eruption, which proved  to be  a scrofula  induced by heating my blood, with wrong living!   I had
most ardently desired children, and my love of riches gave way before my maternal feelings: but in less
than four months bolh the little sufferers were carried to their resting-place.   I regarded myself as stricken
of God ; I sought to submit myself to my trying fate  as a Christian, for I did not regard myself as having
anything to  do with  my  affliction.   A third, fourth, and  fifth child followed, diseased  in the  same way,
and only lingered a  short period.   At length my desires were gratified in everything  except living chil-
dren :  I wept and prayed much for a child that might bless our old age.
   "At length the illness of a beloved parent called me to a different scene, and during almost the entire
period of my pregnancy with my sixth child  I was  occupied with her care.   Being no longer actively
engaged, having  scarcely sufficient exercise for my health, my mind turned naturally to  the investigation
of causes that had co-operated to produce  such painful results, if causes there were.   ' Does God,' I
asked, ' arbitrarily punish us in this  world for infringements of the moral law ?   If so,  of what use is the
atonement,  or death of Christ ?'   Then first dawned upon my mind the belief that there were natural as
well as moral laws, given to  govern  us, and that an  infringement of them would  be followed  by a just
punishment.   The period of parturition arrived.  Conceive, if you can, the joy and gratitude of my heart,
to find myself the mother of a fair and beautiful boy, who still lives to bless and comfort me : but although
he lives, and the three daughters that followed  him,  yet they too  partake of the  feeble  constitution which
I entailed upon them ; for my health had become greatly impaired during my struggle after riches."
   Many similar cases might be adduced,  where mothers have had their moral sense awakened to the impor-
tance  of the subject, and following the path of duty, have reaped blessings to themselves and their offspring.
                                         SECTION IV.

                   SEXUAL  INTERCOURSE,  ONANISM,  VENERY,  ETC.

   Thi§ subject, from the nature of it, is not generally  treated of by writers on health.  But none is more
important, as it involves consequences of the most serious kind.   The semen is the most subtile, vital,
and ethereal part of the body :  it contributes to the support of the nerves, as well as tbe reproduction of
the species ;  its evacuation  is  by  no means  necessary, and, when retained, adds greater strength to the
system.  The emission of the semen enfeebles the body more  than the loss of twenty times the same quan-
tity of blood, and more than violent  cathartics, emetics, &c.   Hence excess of  this nature produces  a
debilitating effect on  the whole nervous system — on both body and mind.   It is founded on the observa-
tions of the ablest physiologists that the greater part of this refined fluid is reabsorbed and mixed with the
blood, of  which it constitutes the most rarefied and volatile part ; and it  imparts  to the body peculiar
spriwhtliness, vivacity, and vigor.   These beneficial effects can not be produced if the semen be wantonly
and imprudently wasted.  Besides, the emission  of it is accompanied  with lassitude and relaxation, and
often with great nervous depression.   It should therefore  never be evacuated except in  a state of super-
fluity, and even  then  never unnaturally.  Perhaps the best criterion  for married persons is this :  never
indulge in the propensity while it can well be avoided, for the same reason that we should never eat till we
are hungry ;  any deviation from this rule will be attended directly or  indirectly with debilitating effects,
especially with the weak and nervous.   Persons  should never practise masturbation or onanism under
any pretence, except they wish to  expose or ruin their health  and morals.  By these terms is  meant the
emission of  semen artificially, and  which prevails among both  sexes  to a most fearful extent.  Obey the
injunction of the apostle : " Flee  youthful  lusts."  This doctrine  is agreeable to the laws of physiology
or nature, as well as the law of God.   Emitting the semen artificially by the too common  practice of onan-
ism,  lays the foundation for  many  incurable complaints, and causes more bad health than even physicians 
?70              PHYSIOLOGICAL AND MORAL ELE\ATION OF MANKIND.

are aware of.  It has been shown, by reports of lunatic asylums, that it often causes insanity in both sexe*.
" The fact  that  the ceremony of marriage has been performed, will  not  save people from the conse-
quence, of venereal excesses.   The laws of our nature remain the same ;  and, if violated, we must suffer
the consequences.   Hundreds and thousands are hurried into a premature grave, or made wretched while
they live, by diseases induced  by  venereal excesses, with no knowledge of  their causes."   The practice
of self-pollution  pervades all ranks, male and  female.   Professed Christians are often among its victims.
" Some time since," says Mrs. Mary S. Gove, " I became acquainted with a lovely and intellectual young
man, wdio was a  student in one of our  theological seminaries.   His  health  became so  poor, that he was
obliged to leave  the seminary and  return to his friends.  I saw him lose his reason and become a maniac.
I was satisfied, from all  the symptoms in the case, that this sin was the cause of his wretched condition.
He died without recovering his reason :  and a friend of his, who was in the seminary with him, told me,
after his decease, that he was indeed a victim of solitary vice ;  that it caused his death."
   A short time since I was conversing with a physician who  seemed to feel deeply on the subject: " But,"
said he, " what can be done ?  I dare not offend parents by telling them the habits of their children.   Only
the other day,  I  was called to a youth who was  destroying himself by this practice, but I dared not men-
tion it.  The parents would have  been very angry if I had."  Dr. S. B. Woodward, late superintendent
of the asylum for the insane at  Worcester, has the following remarks on this  practice : " For the last four
years, it has fallen to my lot to witness, examine, and mark, the progress of from ten to  twenty-five  cases
daily, who have  been the victims of  this debasing  habit, and I aver that no  cause whatever, which oper-
ates on the  human  system, prostrates all its energies, mental, moral, and physical, to an equal extent.   I
have seen more cases of idiocy from this cause  alone, than from all the other causes of insanity."   Con-
sumptions, spinal distortions, weak and  painful  eyes, weak  stomachs, nervous  headaches, and a host of
other diseases, mark its influence  upon the one — loss of memory and the power of application,  insanity,
and idiotism, show  its devastating effects  upon the  other.   It is equally opposed  to moral  purity and
mental vigor.  The evil is common ;  its danger little known.   Let the young beware of it; and those
who are in the way of danger, abandon it for ever !   See Tissot, Graham's " Advice to Young Men," &c-
   The best  preventive is abstinence, diet, and regimen—to avoid all animal food and stimulants, and to
use vegetables and fruits only.   High-living excites venery,  and leads directly  to sensuality.
                                          SECTION  V.

         FALSE  DELICACY  AND  NOTIONS  ON  ANATOMY  AND  PHYSIOLOGY.

   Some persons think it wrong to exhibit plates and  models illustrating different parts of the female, pa/
ticularly to youth.   But this  is an improper view of the  subject:  it is the result of false delicacy, and
arises from ignorance.   The  more we attempt to conceal from children or others, the greater is  their curi-
osity, and the stronger their desire to  gratify it unobserved.  Such is the law  of perverted nature.   The
best way is to inculcate no secrecy, by restricting a knowledge of any part of the system, but allow  every
part to be studied, and let children be taught very little reserve.  It is not the  most fastidious who are the
most virtuous, and we  should suspect such much sooner  than  others.   It is only by  an early study of
physiology that the mind can  be disenthralled from the false notions which  are now so common on these
subjects.  An excellent method to curb the venereal appetite, and to elevate  and refine the character, is to
study well every part  of the human system, and recognise the Divine Architect in its wonderful mechanism.
" To the pure," says the apostle, " all things are pure."   During my popular lectures on  midwifery in
Philadelphia, a  sensible lady, after hearing them, made the following pertinent observation :  "  I am "lad
ihat the time has come when  people are not ashamed of God's work." 
INDEX.
Abortion, or Foeticide..........page 81
Acidities...............^^.......  200
Adhesion of the Placenta.Wp.......156
After-Birth, or Placenta.............  58
After-Pains......................... 191
Air and Ventilation.................240
Amnium Membrane................  53
Animal Life,  Origin of..............  28
AphthEe...........................203
Atrophy from Suckling..............199
B.
Bathing...........................238
Bladder, Rupture of the, in Labor---162
Bowel-Complaints..................202
Breast, Inflammation of.............196
C.
Canker............................203
Chicken-Pox.......................208
Children, Diseases of...............199
    "    Early Impressions of.......247
    "    Intellectual Education of---245
    "    Moral Training of.........247
    "      "   Government of......253
    "    Physical Training of.......225
Choking of Infants.................203
Chorion Membrane.................  53
Circulation of  the Foetus............  59
Classification of Labors.............101
    "         " Unnatural Labors.. .144
Club-Foot........................203
Conception........................  46
    "     Theory of................  49
    "     how it  takes  place........  51
Convulsions in Children.............203
    "      Labor complicated with. .150
Copulation........................  45
Cow-Pox..........................206
D.
Decid uary Membran e................ 53
Dentition.........................201
Discharge,  lochial..................191
Dress.............................225
Drink.............................232
Dropsy in the Head.................217
Du'.ieJ of the Accoucheur, or Midwife. 117 ,
E.
Education of Children..........page 245
Egg, Incubation of..................  29
Embryo, Development of............  54
Embryotomy....................... 176
Ergot (ought it ever to be used ? — see
   note)..........................137
Examination of the Female..........118
Excoriations and Galling............201
Exercise..........................242
Expulsion of the Foetus.............  89

                  F.

Facility of Labor...................  97
Fainting, Labor complicated with.....155
Fallopian  Tubes....................  38
Female, Examination of the..........118
Female Organs.....................  35
Foetal  Circulation.. .\..............  59
Foetus, Expulsion of the.............  89
   "   Maturity of the..............  67
   "   or Infant....................  92
   "   or Ovum, Development of the.  52
Fever, Milk........................195
   "   Puerperal...................192
   "   Scarlet......................212
Flatulency.........................200
Flooding after  Delivery.............154
   "    Labor complicated with......152
Food and Drink....................232
Forceps, Tables showing the use of, 170,171
   "    Manner of using the Short... 174
   "    Manner of using the Long... 175
Foundling-Hospitals.................  88

                  G.

Galling and Excoriations............201
Gripes.............................200

                  H.

Hermaphrodite....................  76
Hooping-Cough.....................222
Human Life, Origin of...............  32
Hymen.............................  37
Hysterics..........................134
I.
Illustration of different Stages of Labor.132
     "       of Natural Labdr......132
Impositions in Midwifery by a Lon-
  don Physician................page 19
Impregnation, different  Theories of...  46
Incubation of the Egg..............  29
Infancy, Language of..............249
Infanticide.........................  80
Infants, Desires and Instincts of......251
   "   Still-Born...................199
Inflammation of the Breast...........196
     "      "     Womb...........198
Inoculation........................205
Instrumental Labor.................166
Instruments, Use  of.................166

                  L.

Labia Pudenda...............  .....  35
Labor, Phenomena of................  96
  "    Facility of...................  97
  "    Signs of.....................  99
  "    Classification of..............101
  "    Natural.....................103
  "    Stages of....................103
  "    First  Stage of................104
  "    Second Stage of...............110
  "    Third Stage of...............113
  "    Fourth Stage of..............115
  "    Natural,  Management of  the
                     First Stage---122
  "      "      "    Second Stage.. 126
  "      "      "    Third Stage... 128
  "      "      "    Fourth Stage.. 131
  "    Difficult, First Class of........136
              Second  Class of......139
         "    Discrimination of..... 140
         "    Treatment of........111
  "   Preternatural................144
  "      "        Classification of.. 144
  "      "        Mechanism of___145
  "      "        Signs bf.........145
  "      "         Second Class of.. 147
  <•'    Complex.....................150
  "    Complicated with Convulsions.. 150
  "      "         "  Flooding.....152
  "      "         "  Fainting.....155
  "      "         "  Retained Pla-
                        centa......156
  '■'      "         "  Rupture of the
                        Uterus---161
  "      "         "  Rupture of the
                        Bladder....162
  "      "         "  Descent of the
                        Hand......164
  "      "         "  Plurality   of
                        Children... 161
t 
INDEX
Labor, In-truir.cni.al...........PAGE 166
  "    Premature, a Substitute for Em-
         bryotomy..................178
Lochia! Discharges..................191
Looseness..........................201
Male Organs....................... 32
Management of the first Stage of Labor. 122
Mankind, Moral Elevation of........225
Maturity of the Foetus.............. 67
Measles............................209
Meatus Urinarius.................. 37 |
Mechanism  of unnatural Labor......115
Meconium, Retention of.............200
Menses       "     "  ............179
   "   Suppression of...............180
Menstruation, painful...............183
     "       Symptoms, Duration,and
               Discharge........... 39
Midwives, Qualifications of.......... 20
Milk-Fever........................195
Milk-Leg..........................196
Mind, Development of..............246
Mole Pregnancy.................... 69 j
Monsters.......................... 71
Mons Veneris...................... 35
Mother's  Murk..................... 77
N.
Natural Labor....................  103
Navel-String.......................  56
  ':    "   Soreness of..............203
Nccvus Materna....................  77
Nipples, excoriated..................198
Nurse, Choice of...................235
Nutrition of the Foetus..............  60
Nymphae..........................  36
O.
Organs of Reproduction, internal.....  37
Origin of Animal Life...............  28
   "  " Human Life...............  32
   "  " Vegetable Life............  22
Os Uteri...........................  38
Ovaries...........................  38
Ovum, or Foetus, Development of....  52
Parturition, or Labor.............
     "     who shall officiate in ?.
 Pelvis.........................page  90
   "  Deformed.....................  91
 Perineum..........................  36
 Physical and Moral Elevation of Man-
   kind............................225
 Placenta, or After-Birth.............  58
    "     Adhesion of...............156
    "     Labor complicated with re-
           tained..................156
 Plate showing the first Stage of Labor.. 109
   "    <•'   " third  "     "   ..113
   '•' of Tight-Lacing................231
 Pregnancy, Abnormal............... 68
    "     Diseases of..............189
    "     Duration  of.............. 66
    "     Extra-Uterine............70
    '•'     Full Period of............ 60 |
    "     Mole................... 69 |
    "     Signs of................. 62 |
    "     Symptoms of.............189
Preliminary Remarks............... 11
Prolapsus  of the Cord...............163
    "    Uteri....................197
Puerperal  Fever....................192
Q.
Qualifications of Midwives..........  20
R.
Recapitulation of the  different Stages
  of Labor........................132
Remarks, preliminary...............  11
Reproduction.......................  32
Requirements of the Accoucheur at  a
  Labor...........................117
Retention of the Meconium.........200
    "    "   "  Placenta...........156
Rupture of the Infant...............203
    "   "  "  Uterus, Labor compli-
                cated with.........161
    "   '•  "  Bladder  "  .........162
S.
Scarlet-Fever.......................212
Schools  established  to instruct Mid-
  wives ...........................  16
Sexes, Difference between the........  44
Signs of Labor.....................  99
Similarity between the Male and Female
  Organs..........................  60
Sleep...............................244
  Stages of Labor...............tack  103
    "   "   "    First, Management of
                  the, with Plate.. 109,  V3:>
    "   «   "    Second...............1H
    "   "   "   Third, with Plate.....11.!
    "   "   "    Fourth..............113
    "   "   "   Second,  Management
                   of the............126
    "   "   «   Third     "    ......127
    "  "    "   Fourth    "    ......131

                   T.

 Teething...........................201
1 Theory of Conception...............  4!)
 Thrush..........................203
| Tight-Lacing.........*............229
 Tongue-tied........................203
 Training of Children................225
 Treatment of Debility of the Uterus.. 137
 Trial of Dr. Septimus Hunter for Man-
   slaughter.........................158
 Turning of the Child in the Womb... 148



            P   ""
 Umbilical CoflTT,...................  56
 Unnatural Labor, Mechanism of.....145
     "      "    Signs of...........145
 Uterus.............................  37
    "  Gravid......................  60
    " Rupture of the, in Labor......161


                  V.

 Vagina............................ 37
   "  Imperforated................203
 Vectis, Manner of using it..........175
 Vegetable Life, Origin of............ 22
 Ventilation.........................240
 Vestibule.......................... 36
 Vites,Dr., of Hamburgh, publicly brand-
  ed for attending a Female.........  13

                  W.

Weaning..........................237
Womb............................ 37
  "   Falling of the................197
  "   Inflammation of the...........198
Women and Children, Diseases of___179
        the Divinely-appointed  Mid-
          wives.................... 17
Worms............................ 237
THE   END. 
 
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