ADVICE TO WC 
ON THE 
CARE OF THE HEALTH 
BEFORE, DURING, AND AFTER 
CONFINEMENT, 
BY 
FLORENCE STACPOOLE, 
DIPLOMEE OF THE LONDON OBSTETRICAL SOCIETY, AND LECTURER TO THE NATIONAL 
HEALTH SOCIETY. < 
THE PEERLESS SERIES, No. 66. Issued Monthly. January, 1893. $3.00 per year. Entered at 
New York Post-Office as second-class matter. Copyright, 1892, by J. S. Ogilvie. 
New York : 
J. S. OGILVIE, PUBLISHER, 
57 Rose Street. CONTENTS 
Page 
CHAPTER I. 
INTRODUCTION. 5 
CHAPTER IL 
SIGNS AND SYMPTOMS OF PREGNANCY. 
Normal Duration of Pregnancy-Signs and Symptoms of Preg- 
nancy-Mistakes That may be made about It-Quickening; 
What It Means-How to fix the Probable Date of a Con- 
finement-Ready Reckoner for Calculating the Date of 
Confinement-Circumstances which may make a Difficulty 
in Fixing the Date-Why Careful Calculation of the Date 
is Important-Advice to Nurses. 6 
CHAPTER III. 
CARE OF THE HEALTH DURING PREGNANCY. 
Importance of and Necessity for Care of the Health during 
Pregnancy-Diet-Dress-Exercise-Baths and Sea-Bathing 
-Necessity for Care of the Breasts before Confinement. 18 
CHAPTER IV. 
SOME OF THE TROUBLES OF PREGNANCY, AND HOW TO 
TREAT THEM. 
Nausea and Vomiting-Heart-burn-Acidity-Flatulence and 
Indigestion-Salivation-Constipation - Diarrhoea-Piles- 
Varicose Veins - Nerve Pains - Toothache - Headache- 
Cramp-Pains in the Breasts, Abdomen, etc.-Spasmodic 
Cdugh-Fainting-Palpitation-Breathlessness-Irritability 
of Temper-Depression of Spirits-Sleeplessness-Bladder 
Troubles-Difficulty of Passing Water, etc.'-Leucorrhcea- 
Pruritis-Swelling of the Legs, etc.-Apprehensions-A 
Word of Consolation. 34 CONTENTS. 
Page 
CHAPTER V. 
M I S C A R R I A GES. 
Difference between Miscarriage and Premature Confinement- 
Cause of Miscarriages-Treatment for the Prevention of 
Miscarriage-Threatening Symptoms of Miscarriage, and 
Treatment if it Should Occur-Danger of Neglected Mis- 
carriages. ~ 61 
CHAPTER VI. 
WHAT MODERN MEDICAL SCIENCE HAS DONE TO LESSEN 
DANGER IN CHILDBIRTH. 
Puerperal Fever: What it is and How it may be Prevented- 
The Story of Semmelweis, and What it leaches-Statistics 
of the Lying-in Hospitals-The Best Antiseptic for Use in 
Midwifery-What Bad Drainage may do-Advice to Those 
who go to Apartments for their Confinements. 69 
CHAPTER VII. 
WHAT MODERN MEDICAL SCIENCE HAS DONE TO LESSEN 
SUFFERING IN CHILDBIRTH. 
Difference in the Treatment of Confinements Now and Formerly 
-Story of the Death of the Princess Charlotte of Wales, 
and What It Teaches-The use of Forceps and Anaesthetics 
in Confinements-Foolish Prejudices against Them-Im- 
portance of good Medical Attendance in Confinements. 96 
CHAPTER VIII. 
LIST OF THINGS REQUIRED FOR A CONFINEMENT. Ill 
CHAPTER IX. 
GENERAL MANAGEMENT OF A CONFINEMENT-WHAT TO 
DO IN CASE OF HEMORRHAGE. 
The Nurse-The Room-Premonitory Symptoms of Labor- 
False Pains-The First. Thing to do when Labor Com- 
mences-The Bed-Dress during Labor-Things to Remem- 
ber while Labor is in Progress-Effect of Age on Labor- 
Its Average Duration-Importance of Good Binding after 
the Birth of the Child-What to do if the Doctor has not 
Come-Care Required Immediately after Confinement- 
"What to do in case of Hemorrhage-After-pains-What to 
do if there is Difficulty in Passing Water. 116 
CHAPTER X. 
HOW TO TAKE CARE OF THE HEALTH AFTER CONFINE- 
MENT. 
Five Necessary Things-Care of the Breasts after Confinement. 123 ADVICE TO WOMEN. 
CHAPTER I. 
INTRODUCTION. 
Confinements are often looked forward to with appre- 
hension, as well on account of the physical suffering, 
the danger with which they are attended. 
Childbirth is naturally accompanied by pain, more or 
less severe, and often by considerable danger. In former 
years so little was known of any way by which the suffer- 
ing could be lessened, or the danger be prevented, that 
serious apprehension on the subject was no doubt justifi- 
able. Nowadays, however, owing to the scientific discov- 
eries of recent years, confinements need not be looked for- 
ward to with alarm, because the pain of childbirth can be 
almost totally conquered, while the danger can be almost 
entirely prevented. 
Medical Science has made great strides during the last 
quarter of a century. Its two greatest have been made in 
the prevention of suffering and in the prevention of dis- 
ease, and in no department of medicine is this more ap- 
parent than in that of midwifery. 
I am sure that all women who are not already familiar 
with what, modern medical science has done for the pre- 6 
ADVICE TO WOMEN. 
vention of suffering in childbirth, and for the prevention 
of the chief dangers attending it, will, when they have 
read the medical evidence on the subject which I have 
gathered together in these pages, feel very thankfid that 
they are living at this end of the nineteenth century, and 
not in " the good old times " of their grandmothers. 
SIGNS AND SYMPTOMS OF PREGNANCY. 
CHAPTER II. 
Normal Duration of Pregnancy-Signs and Symptoms of Preg- 
nancy-Mistakes That may be made about It-Quickening; What 
It Means-How to fix the Probable Date of a Confinement- 
Ready Reckoner for Calculating the Date of Confinement- 
Circumstances which may make a Difficulty in Fixing the Date 
-Why Careful Calculation of the Date is Important-Advice 
to Nurses. 
The time required for the full developemnt of a child 
in the womb is a period varying between 273 and 280 
days, that is, between thirty-nine weeks or nine calendar 
months, and forty weeks or ten lunar months. This is the 
usual duration of pregnancy, but, as Dr. Playfair remarks, 
" in individual instances very considerable variations both 
above and below these limits may be found to exist. " 
Thus, though nine months is the nominal duration of 
pregnancy, a child may be born strong enough to live at 
the beginning of the seventh month, and cases have oc- 
curred in which the pregnancy has been prolonged for 
some weeks beyond the nine months. Cases (rare ones) 
are on record in which pregnancy is said to have lasted 
for more than a year, but as such a supposed abnormal length of the pregnancy may really be due to some n.._ 
take in fixing the date of its commencement, actual cer- 
tainty can hardly be entertained that such a thing is pos- 
sible. 
The first symptom of pregnancy is stoppage of the 
monthly periods, but this alone can never be taken as an 
absolutely certain proof of its existence, because cold, 
delicacy of the health from various causes (particularly from 
the existence of phthisis, or consumption), a growing 
tumor, and with some people even mental emotions, may 
arrest the usual monthly appearance. 
When, however, a person who expects pregnancy, and 
who has before been in good health, and quite " regular,'> 
finds that the monthly period does not make its appear- 
ance, and then begins to suffer from nausea, and perhaps 
even vomiting, particularly in the morning, and more or 
less from indigestion and loss of appetite, and if these 
symptoms are followed in the next month (still without 
the periods returning) by swelling and tenderness in the 
breasts, there can be hardly any doubt about the matter. 
Although these are the general signs which indicate that 
pregnancy has commenced, it must not be forgotten that 
some people have no feelings of nausea whatever, and for 
some weeks, until the breast symptoms begin,.may have 
nothing to lead them to suppose they are enceinte but the 
disappearance of the monthly flow. 
Increased size, and a sensation of fullness, throbbing, 
and tenderness in the breasts, usually begin about the sec- 
ond month of pregnancy; the abdomen does not begin to 
enlarge until the end of the third or even the beginning of xvurth month. As a rule, during the first month or 
two of pregnancy the abdomen is flatter than it was before, 
because the womb, in these first weeks of this condition, 
falls rather downward in the cavity of the pelvis.* This 
has given rise to an old French saying, " En ventre plat, 
enfant il y a." 
The appearance of the breasts is also a sign that, to an 
experienced eye, is often almost proof positive of the exist- 
ence of pregnancy. They not only, when pregnancy ex- 
ists, become larger and firmer, and the nipples more 
prominent, turgid, and tender, but the areola (the colored 
ring around the nipple) becomes enlarged and of a deeper 
color; in fair-complexioned women this is not so observ- 
able, but in dark-complexioned people it is very notice- 
able, sometimes being of a very deep brown indeed. There 
is also a moist appearance about the region of the nipples 
never seen unless pregnancy exists. As the breasts in- 
crease in size blue veins can be seen running over them; 
these, of course, are most visible in women of clear, fair 
skin; in women who have before had children, silvery 
white streaks can, if the breasts are much enlarged, be seen 
radiating from the areola outward. " In first pregnan- 
cies/' says Dr. Playfair, " the presence of milk in the 
breasts may be considered an almost certain sign.'' By 
pressing the nipple, sometimes as early as the third month, 
a drop or two of milky fluid can be seen. This, in women 
* The word pelvis in Latin signifies a " basin." The bony 
cavity in the lower part of the abdomen, formed by the end of the 
spine and the hip-bones, is called the pelvis because in shape it 
somewhat resembles a basin. ADVICE TO WOMEN. 
9 
who have had families, is not nearly so certain a sign as in 
those who have never borne a child, because after suck- 
ling milk may be retained in the breasts " even for several 
years. " Enlarged veins in the legs are another sign often 
observed early in pregnancy. 
Although these signs are all very strong evidence of the 
existence of pregnancy, still if it is necessary that the true 
state of things should be absolutely proved beyond question 
(as in the case of an unmarried person being suspected of 
pregnancy), it can only be done by an examination made by 
a doctor. 
Cases have occurred (of course they are very rare), in 
which all or most of the symptoms of pregnancy men- 
tioned above have been present, even with secretion of milk 
in the breasts, without the patient being really pregnant. 
This curious condition of things is called " spurious preg- 
nancy/' The subject of it has sometimes been undeceived 
by the symptoms passing off after a few weeks or months, 
in other cases they have existed during the whole nine 
months-air in the bowels has been mistaken for the 
movements of the child, and labor pains (false ones, of 
course) have in due time actually set in. 
1 knew a lady who was the victim of this unfortunate 
delusion, and who had her nurse engaged, and the baby's 
clothes made! The poor thing suffered great chagrin when 
the illusion was dispelled, because numerous friends who 
were looking forward to the interesting event called at 
the expected time to ask after Mrs. So-and-So and the 
baby. 
An amusing story of the same kind is related from the 10 
ADVICE Tn WOl'FEX. 
•WpCTittuce or th? late Sir James Simpson. When he was 
house physician at one of the Maternity Hospitals in Edin- 
burgh, a student in charge of a " labor ward " came to 
him one day to request that he would give an opinion on a 
case that had been under his (the student's) care for some 
hours, but in which no progress toward delivery seemed to 
be taking place. When Dr. Simpson examined the pa- 
tient, he found she was not in the supposed condition at 
all! It was a case of spurious pregnancy and false labor, 
but the difficulty of convincing the patient and her friends 
of this extraordinary state of things, and of inducing her 
to leave the hospital, was so great that it required a con- 
siderable time to accomplish. 
It is supposed that a form "of hysteria gives rise to this 
peculiar state, and it is a curious fact that when an an- 
aesthetic is administered, the swelling of the abdomen, 
which was supposed to be due to the presence of the child, 
decreases, and increases again as consciousness returns. 
The existence of such a state of things can always be de- 
termined by an examination made by a doctor, but it must 
be remembered that such cases are extremely rare. It is a 
curious fact that this remarkable phenomenon has also 
been observed in animals. 
Quickening. 
When pregnancy exists, the movements of the child are 
first felt about the end of the fourth month, but they may 
not be felt for some weeks later. The first movements 
usually resemble a feeble fluttering, as of the stirring of a 
little bird, though ip some cases they may, of course, be ADVICE 
stronger than this. Some women faint, either actually oi 
partially, when this first stirring of the child is felt. 
There is a foolish old idea, which is even still sometimes 
believed by the ignorant, that life has suddenly Hashed, as 
it were, into the child, when its movements are thus felt. 
From this idea comes the popular term " quickening " 
bestowed upon this sensation. 
It is, of course, absurd to think that life has only just 
corne into the child's body when the mother can feel its 
movements. The seed is nZwe from the moment of con- 
ception; if it were not, it could not grow. But its move- 
ments are first felt generally about the sixteenth or seven- 
teenth week of pregnancy, because at that time the womb 
has grown large enough to come into contact with the 
inner lining of the abdomen. 
The muscular envelope called the womb, which incloses 
the child, is not sensitive; but when it rises so as to touch 
the inner lining of the abdominal wall, which is sensitive, 
the movements become apparent to the mother. Besides 
this, it is only in the fourth month that the muscles of the 
foetus (as in medical language the child is called while still 
in the womb) are sufficiently formed to produce distinct 
movements of the limbs. 1 
After this so-called quickening many people get rid of 
the disagreeable feelings of nausea and sickness from which 
they suffered previously. 
How to Fix the Probable Date of a Confinement. 
There are certain physiological reasons that make it 
quite impossible to determine the exact date when concep- _ nOMEN. 
..jii actually commenced; therefore it is always impossible, 
even for the most experienced physician, to calculate what 
the exact date will be when the confinement will take 
place; but the probable date can be easily calculated (if all 
goes well), by remembering the date on which the last 
monthly period ceased, from the very ingenious Rfeady 
Reckoner constructed by Dr. Prothero Smith, which is 
here appended. 
READY RECKONER. 
Nine Calendar Months. 
Ten Lunar Months. 
From 
To 
Days 
To 
Days 
Jan. 1 
Sept. 30 
273 
Oct. 7 
280 
Feb. 1 
Oct. 31 
273 
Nov. 7 
280 
Mar. 1 
Nov. 30 
275 
Dec. 5 
280 
April 1 
Dec. 31 
275 
Jan. 5 
280 
May 1 
Jan. 31 
276 
Feb. 4 
280 
June 1 
Feb. 28 
273 
Mar. 7 
280 
July 1 
Mar. 31 
274 
April 6 
280 
Aug. 1 
April 30 
273 
May 7 
280 
£» Sept. 1 
May 31 
273 
June 7 
280 
' Oct. 1 
JOne 30 
273 
July 7 
280 
Nov. 1 
July 31 
273 
Aug. 7 
280 
' Dec. 1 
Aug. 31 
274 
Sept. 6 
280 
r- . 
This Ready Reckoner consists of two columns, one of 
calendar, the other of lunar months. It is read as fol- 
lows: A patient has ceased to menstruate on the 1st of Jan- 
(i. e., the usual monthly period having taken place, 
f was quite over on the 1st of January, and was not followed 
/by another period), her confinement may be expected at 
soonest about the 30th of September-the end of nine 
calendar months-or at the latest on the 7ih of October, 
the end of ten lunar months. Nine calendar, or ten ADVICE TO WOMEN. 
13 
lunar, months forward from any day on which the periods 
ceased can be calculated in a moment by a glance at this 
most easily read Reckoner in the following way: Suppos- 
ing the day when the last sign of being " unwell " was 
observed was January 4th, it is only necessary to add four 
days to the date opposite January 1st in the Reckoner- 
i. e., to September 30th, you will then get October 4th, 
which is nine calendar months from January 4th; add 
seven more days, which will bring you to October 11th, 
and you have ten lunar months from January 4th. The 
confinement may then be expected at soonest on October 
4th, at latest on October 11th. Or, say the monthly ap- 
pearance was not seen after February Sth, you then add 
eight days to October 31st (the date opposite February 1st 
in the Reckoner), which will give November Sth, and this 
will be the earliest date at which the confinement may be 
expected. Add seven days to November 8th to find the 
end of the ten lunar months, and you arrive at November 
15th, which will be the latest day on which the confine- 
ment may be looked for. Or, again, menstruation ceased 
on, say, March 11th-add eleven days to November 30th 
(which in the Reckoner is the date opposite March) and 
you have December 11th; seven more days will bring you 
to December 18th. The confinement may be expected be- 
tween those dates. In this way, by merely adding the date 
on which menstruation ceased in any month, to the date 
opposite to that month as given in the Reckoner, you will 
get the exact date of nine calendar months forward from 
the day on which the periods ceased. By adding another 
seven days, the exact date of ten lunar months forward 14 
ADVICE TO WOMEN. 
will be found, and between these dates expect the confine- 
ment. 
There are some circumstances that may cause great 
difficulty in fixing the date of the expected confinement. 
People with whom the monthly periods are always irregu- 
lar and uncertain, may, from want of a certain date to 
count from, find a great difficulty in this. It also happens 
occasionally that though pregnancy really exists, one, or 
even several of the monthly periods continue as usual, 
though they are mostly of much shorter duration and 
amount than before. Cases-very rare ones, of course- 
have been met where menstruation occurred as usual every 
month all through pregnancy, and a few well-authenti- 
cated cases are mentioned by writers on obstetrics, where 
the patient only menstruated during pregnancy, and 
others where pregnancy took place before menstruation 
had commenced. It happens occasionally that pregnancy 
occurs while the mother is nursing a former child. The 
monthly periods cease, or should do so, during suckling; 
therefore it is possible for a woman to receive her first in- 
timation of being again enceinte by feeling the movements 
of the child within her. This, however, does not often 
happen, because if conception occurs during suckling, a 
miscarriage is likely to take place, owing to the strain on 
the system occasioned by lactation and gestation going on 
at the same time. 
In all such cases as these, there must naturally be much 
difficulty in fixing a probable date with any precision. 
The only thing to fall back upon then will be the date of 
what ;s called quickening, or the feeling of the first move- ADVICE TO WOMEN-. 
15 
meats of the child-these are generally perceived some- 
where about the sixteenth week of pregnancy, but may 
not be felt until two or more weeks later. In default of 
any better date to go upon, a calculation of four and a 
half months forward from the time when quickening was 
distinctly felt will probably enable the date to be arrived 
at with some approach to correctness. 
In these circumstances it is well, if possible, to have the 
advice of the doctor to assist in determining the date when 
the coming " little stranger " may be expected, which is 
always very important to ascertain as nearly as may be. 
All sorts of inconveniences and even dangers may arise 
from not being tolerably sure of the date. First of all, it 
is important on account of the nurse. Some people are so 
foolish as to put off arranging for the attendance of doctor 
and nurse almost until the last month. As a consequence, 
at least as far as the nurse is concerned, they have then 
often to put up with any one they can get. A good and 
experienced nurse is generally engaged very quickly by 
former patients, or others to whom they have recom- 
mended her, and seldom has many of the months in the 
immediate future at her disposal; therefore, for fear of 
having to take the services of an inferior person, it is 
necessary to engage the nurse as soon as it can conveni- 
ently be done. 
From not carefully calculating the time when the con- 
finement is to be expected, the danger may arise of being 
absent from home, perhaps even on a journey at the time. 
If people were more accurate about this, we should prob- 
ably not hear of so many, cases of confinement taking 16 
ADVICE TO WOMEX. 
place in railway carriages and other inconvenient places. 
Besides this, by knowing the time when the baby may 
be expected, the mother can have everything necessary for 
the confinement provided m time. 
Now, by in time 1 do not mean that the required things 
should be all ready by the end of the ninth month. By 
no means. Everything that is absolutely necessary to 
have in the room at the time the confinement takes place 
ought to be ready at the end of the fourth or fifth month. 
In Chapter VIII. a list will be found of everything re- 
quired in a confinement, and it will be seen that it is not a 
long or costly one; but everything mentioned in it is neces- 
sary. The reason these things should be ready so soon is on 
account of the possibility, which always exists during 
pregnancy, that some unforeseen accident may bring on a 
miscarriage or premature confinement. Supposing such 
a thing to take place, what a comfort to have everything 
at hand that will be required! »What fussing, confusion, 
and trouble it will save, and these three things are just 
what should be avoided in every sick-room. 
Of course, it is not necessary to have the baby's clothes 
ready at this early date. If they are prepared by the 
seventh or eighth month, it will be time enough.* I am 
speaking of the things necessary for the mother. 
* Many a young woman does herself and her baby much harm 
by daily spending hours with bent back, contracted chest, and 
strained eyes, preparing the "layette." Often a stock of clothes 
are got ready for the first baby that would do for a dozen babies. 
If its mother were laying in a good stock of health instead, by tak- 
ing fresh air and exercise, it would be very much better. ADVICE TO WOMEN. 
17 
It would be well for nurses, particularly those who have 
cases in distant parts of the country, always to remember 
this difficulty of fixing the exact date of delivery, and to 
remember also that a slight thing, such as a sudden agita- 
tion or disturbance, often merely of a trivial domestic nat- 
ure, such as some worry with the servants, may, with some 
people, bring on the confinement several days before it 
has been calculated to be due. Nurses should therefore 
immediately inform their expectant patients of any change 
in their whereabouts, so that a patient who is taken ill be- 
fore she expects it may know where to send for her nurse 
without delay. Of course, the nurse may be attending a 
patient with whom her month has not expired, but in such 
case she will probably know of some one who can take her 
place pro tern. This may save much trouble in hunting 
for a nurse. I have known great annoyance caused by a 
nurse omitting to inform a lady who had engaged her, that 
she was returning home from a case a day or two sooner 
than she had originally intended to do. The confinement 
came on a week before it was expected, and the lady, 
thinking her nurse was in a distant part of the country, 
telegraphed to her. Being Sunday, great delay occurred 
in informing the patient that the nurse was already in 
London, she having arrived overnight, and being actually 
within ten minutes' walk of the house, while friends and 
relations were distractedly hunting everywhere for a sub- 
stitute. The consequence was that the baby was born 
several hours before the nurse's arrival., 18 
ADVICE TO WOMEN. 
CHAPTER III. 
CARE OF THE HEALTH DURING PREGNANCY. 
Importance of and Necessity for Care of the Health during Preg- 
nancy-Diet-Dress-Exercise-Baths and Sea-Bathing-Neces- 
sity for Care of the Breasts before Confinement. 
It is very important to know how to take care of the 
health before confinement, and it is very important to un- 
derstand why care of the health is so necessary at this 
time. 
It is necessary for two reasons-first, for the sake of the 
mother; secondly, for the sake of the child. If a woman 
knows how to take care of her health before confinement, 
and acts on her knowledge, she will have a much safer 
and better confinement; she will recover more quickly; 
she will have a healthier baby; she will, in all probability, 
be able to nurse it herself; and she will, if she lives to be 
an old woman, have every likelihood of enjoying a strong, 
healthy old age. 
ISurely these are a sufficient number of good things to 
have in prospect to make it worth while to take proper 
care of the health during this important period. 
As to the child, I think that often the mother does not 
sufficiently recognize what a great responsibility rests 
upon her with regard to the health and constitution of the 
being she is going to bring into the world. 
No inheritance is so valuable as that of a " good con- 
stitution." A sound constitution is as necessary to the 
well-being of the individual body as a sound constitution ADVICE TO WOMEX. 
19 
of another sort is necessary to the well-being of the col- 
lective body of the State. 
Now the foundations of the bodily constitution (ay, anl 
more than we think, of the mental, too) are laid in the, 
mother's icomb. 
Mothers, you should remember this, and seriously con- 
sider that when you neglect, risk, or injure your own 
health during pregnancy, you do a direct injustice to, and 
commit a real crime against, your unborn baby. And not 
only will neglect and injury of the mother's physical 
health during pregnancy be likely to seriously affect the 
child in after-life, but neglect and injury of her brain-health 
at this time-as, for instance, by prolonged mental over- 
work, with its consequent overstrain and nervous exhaus- 
tion-will very probably have a serious influence for evil 
on that too little considered part of the child's being, the 
mysterious and wonderful " nervous system." 
Can we logically expect, when we know how intimate is 
the sympathy between the mother and the child growing 
within her, that things which injuriously affect her will 
not injuriously affect the foetus also? 
This topic requires the earnest attention of the young 
mothers of the present day, because in these times of 
severe mental competition, women may be tempted to lose 
sight of its significance and danger, and of the injury that 
they, by too great a pressure of brain-work during preg- 
nancy, may inflict on many of the coming generation. 
For the general care of the health during the period be- 
fore the birth of a child, certain broad principles may be 
laid down which every woman of sense and intelligence 20 
ADVICE TO WOMEN. 
can apply for herself. These principles teach us what are 
the best things to do, and what are the best to avoid in 
order to keep the health at this time up to the best possi- 
ble standard. 
The very first requisite in order to have good health at 
any time, and during pregnancy in particular, is to 
Breathe Pzire A ir. 
The reason for this is that the blood during pregnancy is 
nearly always in a poor state. This was not always 
known; in fact, formerly quite the reverse was supposed 
to be the case. 
I shall give Dr. Playfair's words on the subject, though 
they are quoted from his book written for members of the 
medical profession; they are so clear that any one can un- 
derstand them. He is writing on the various changes that 
go on in the body during pregnancy. 
" Among those which are most constant and impor- 
tant," he says, " are the alterations in the composition of 
the blood. The opinion of the profession on this subject 
has, of late years, undergone a remarkable change. 
Formerly it was universally believed that pregnancy was, 
as a rule, associated with a condition analogous to pleth- 
ora,* and that this explained many characteristic phe- 
nomena of common occurrence, such as headache, palpita- 
tion, singing in the ears, shortness of breath, and the like. 
As a consequence, it was the habitual custom, not yet by 
any means entirely abandoned, to treat pregnant women 
on an antiphlogistic! system; to place them on low diet, 
* Excessive fullness of blood. 
! I. e., lowering. ADVICE TO 
21 
to administer lowering remedies, and often to practice 
venesection* to a surprising extent. Thus it was by no 
means rare for women to be bled six or eight times during 
the latter months, even when no definite symptoms of dis- 
ease existed, and many of the older authors record cases 
where depletion was practiced every fortnight as a matter 
of routine, and when the symptoms were well marked, 
even from fifty to ninety times in the course of a single 
pregnancy. Numerous careful analyses have conclusively 
proved that the composition of the blood during preg- 
nancy is very generally-perhaps it would not be too 
much to say always-profoundly altered." 
After describing the various alterations to be found in 
the composition of the blood at this time, he goes on to 
say: " The truth is that the blood of the pregnant woman 
is generally in a state much more nearly approaching the 
condition of anaemiaf than of plethora, and it is certain 
that most of the phenomena attributed to plethora may be 
explained equally well and better on this view. These 
changes are much more strangely marked at the latter 
end of pregnancy than at its commencement, and it is in- 
teresting to observe that it is then that the concomitant 
phenomena alluded to are most frequently met with." 
This is valuable and important knowledge. We can 
only truly treat any bodily derangement when we know 
what causes it. Therefore, by knowing that the tendency 
of the blood during pregnancy is toward a poor state, we 
can use means to make it richer. 
There is nothing in the world so necessary for making 
* Bleeding. 
•f Deficiency or poverty of blood. 22 
ADVICE TO WOMEN. 
pure blood as breathing pure air. 1 expect that, as in 
these days the elements of hygiene are known to most peo- 
ple, my readers will understand why this should be so, be- 
cause they will know that the blood undergoes purification 
in the lungs by coming in contact with the oxygen in- 
spired into them. To inspire plenty of oxygen should 
then be a cardinal principle with every woman who is 
about to become a mother. The greatest amount of oxy- 
gen can only be had in the open air. The more she is in 
the open air the better will the health of the expectant 
mother be. When she is in the house she should take 
care to live in well-ventilated rooms, both by night as well 
as by day. If she sits up late in rooms overheated with 
gas, she is breathing in air laden with carbonic acid gas, 
which slowly poisons the blood, and, as a natural conse- 
quence, it poisons the blood of the unborn baby too. We 
must remember that there are degrees in poisoning-our 
blood may be sufficiently poisoned to result in lowered 
health, though not in death. 
Diet During Pregnancy. 
What we eat and drink has of course an effect on the 
blood-therefore good food that will enrich the blood is 
important during pregnancy. Rich food is not as nu- 
tritious, and therefore will not enrich the blood as much, 
as that wnich is plain and easily digested. Any kind of 
rich food is also likely to cause acidity, heart-burn, and in- 
digestion. It should, therefore, be carefully avoided. 
It is very useful to remember that some foods are of a 
distinctly fattening kind. It has been truly remarked ADVICE TO WOMEN. 
23 
that during pregnancy a woman should be as careful to 
avoid growing fat as an athlete is who is training for a 
race. The aim of the athlete is to cultivate the muscu- 
lar, not the adipose tissues of the body. The muscular 
tissues constitute what we call the lean, the adipose the 
fat part of the flesh. Much adipose tissue makes the body 
unwieldy, whereas good muscular flesh makes it strong; 
besides which much fattening food eaten by the mother 
tends to fatten the child, which will cause it to be more 
difficult to bring forth, without giving it any increase of 
strength, for, as Sir Andrew Clarke says, " bulk is not 
the measure of power." Food, then, which will improve 
the muscular growth without producing an overabundance 
of fat should be eaten. 
Meat, fish, game, poultry, eggs, oatmeal porridge, and 
milk,* all contribute to muscular growth. The three last 
contain an abundance of the lime and earthly salts so 
necessary for giving strength to the growing bones of the 
child. Fruit of all kinds, and vegetables, unless there is 
much tendency to diarrhoea, may be freely eaten; they are 
good for the blood. Potatoes should form an exception in 
the list of vegetables; they are fattening, and therefore 
should be eaten only in moderation. Rice, potatoes, malt 
liquors, and fat all come under the head of " carbona- 
ceous " food, which has no effect on the nutrition of muscle, 
but rather the reverse, but promotes the production of 
fat. Such foods may of course be eaten, but the point to 
* "Milk," says Dr. Bunge, Professor of Physiological Chem- 
istry in Basle, " contains more lime even than lime water, and next 
to niilk the yelk of eggs." 24 
ADVICE TO WOMEN. 
remember is that they should not form the staple articles 
of diet in pregnancy.* 
Alcoholic drinks of all kinds are particularly to be 
avoided (unless, of course, under medical advice) during 
this period. Such drinks inflame the blood, but do not 
enrich it. Very weakly and delicate women may be the 
better of a small amount of some stimulant at dinner 
time, but as a rule the stomach and the blood, and most 
assuredly the coming baby, will be very much healthier 
for total abstinence from such things during pregnancy. 
With regard to the amount of food eaten, the appetite 
forms the best guide, and women at this time should be 
allowed to be guided by their appetites, not by the ideas 
of their friends in the matter, f 
I draw attention to this particularly because young women 
(especially when expecting a first baby), if their appetites 
fall off at the beginning of pregnancy, are often absolutely 
worried to eat by anxious and well-meaning, though igno- 
rant husbands and relatives. This forcing of food upon 
an unwilling stomach constantly results in illness. If 
the appetite is bad, it must not be forced; it usually re- 
* Plethoric people who suffer from flushing of the face, etc., may 
be forbidden animal food. Such cases occasionally occur in preg- 
nancy; this advice, of course, does not apply to them. 
f At the beginning of the fourth month of pregnancy the foetus 
only weighs about a quarter of a pound, thus showing that in these 
early months a woman does not need " food for two." Later, the 
child's growth is very rapid, and she then requires, as there is a 
great drain on her constitution, a liberal afld nourishing diet, if her 
digestion is good enough to assimilate it. ADVICE TO WOMEN". 
25 
turns gradually; but until it does, it is both cruel and 
very mischievous to try to compel the patient to eat. Lit- 
tle dishes that she' may fancy should be prepared for her, 
and if she can be spared ordering the dinner and going to 
the butcher's, she is very much more likely to have an ap- 
petite at dinner-time. Sometimes the sight of the con- 
tents of the butcher's shop, and even of the uncooked 
meat in the kitchen, will, during the early part of preg- 
nancy, quite prevent some women from eating meat at all. 
A husband whose wife's appetite is very bad at this time, 
if he will himself order the dinner, and occasionally see 
that the cook prepares for her some unexpected little dish 
in the way of a surprise, will do a great deal more good 
than by tormenting her to eat, and threatening to call in 
the doctor, as is sometimes done on these occasions. 
Every one has heard of the cravings or longings which 
the expectant mother often has. If these longings are for 
any kind of food, she may indulge them as much as she 
likes; but sometimes they take a morbid turn for such 
things as soap, cinders, and so on, which naturally would 
be injurious, and in these cases she must be prevented 
from having them. 
Dress. 
Common sense ought surely to teach every one that 
tight-lacing during any part of the period before the birth 
of a child must be extremely injurious. Some people per- 
haps do this from the absurd idea that they will, by tight- 
lacing, preserve their figures after confinement. The 
preservation of the figure after confinement is a matter by 
no means to be despised. There is no need whatever for 26 
ADVICE TO WOMEN. 
any woman to lose a pretty figure because she is a moth- 
er, but the preservation of the figure depends on good 
binding after confinement, not on tight-lacing before it. 
Miscarriage, premature confinement, bearing down of 
the womb, cross-birth, injury to the nipples,* injury to 
and deformity of the child, and sometimes great suffering 
during labor, may all possibly result from such a mis- 
chievous practice as tight-lacing during pregnancy. Sure- 
ly, this list ought to be enough to warn any one. 
Even a dress that compresses the chest or any part of 
the figure ought not to be worn during this period. If 
the dress body is so tight that a deep breath can not be 
taken when it is on, the digestion is very likely to be in- 
terfered with, and the purification of the blood also, be- 
cause the compression prevents the proper expansion of 
the lungs, and consequently prevents them from taking in 
the necessary amount of oxygen. 
Heavy skirts should also be carefully avoided. It is 
very bad for women and girls at any time to wear heavy 
clothing depending from the hips, and it is curious how 
much more sensible men are in the matter. Though they 
have much stronger backs and internal organs than wom- 
en, yet they suspend much of the weight of their lower gar- 
ments by means of braces over their shoulders, while 
women continually forget the fact that by fastening a 
heavy burden round the waist, which weighs down the 
hips, they are subjecting to a heavy strain some of the 
* The nipples are sometimes so compressed, from the wearing of 
tight high stays during pregnancy, that the child can not draw 
them out by any effort, ADVICE TO WOMEN. 
27 
most important and most delicate organs of the body. If 
this is injurious in ordinary health-what must it be at a 
time such as that of pregnancy? Displacing of the womb 
and other serious injuries may result from wearing, and 
taking exercise in, heavy skirts. 
The question of wearing any stays at all during preg- 
nancy is sometimes a vexed one. Dr. Playfair's advice on 
the matter is, therefore, worth quoting; he recommends, 
after the fourth month, when the figure begins to enlarge, 
" a specially constructed pair of stays with elastic let into 
the sides and front, so that they accommodate themselves 
to the gradual increase of the figure. Such are made by 
all stay-makers, and should be worn whenever the circum- 
stances of the patient permit. Failing this, it is better to 
avoid the use of the corset altogether, and to have as little 
pressure on the uterus as possible." 
Exercise. 
During pregnancy, exercise is very necessary for several 
reasons-first, on account of the health. No one can be 
healthy who does not take exercise. It is also necessary 
inorder to keep the muscles strong. The importance of 
a good development of the muscles in the woman who is 
expecting to become a mother needs a few words of ex- 
planation. * 
The womb is a muscular organ. Dr. Playfair describes 
it and its growth so clearly that I will simply quote his 
words: 
" As soon as conception has taken place, a series of re- 
markable changes commences in the uterus (i.e., the 28 
ADVICE TO WOMEN. 
womb), which progress until the termination of preg- 
nancy, and are well worthy of careful study. They pro- 
duce those marvelous modifications which effect the trans- 
formation of the small, undeveloped uterus of the non- 
pregnant state into the large and fully developed uterus 
of pregnancy, and have no parallel in the whole animal 
economy. The unimpregnated uterus measures two and a 
half inches in length, and weighs about one ounce; while 
at the full term of pregnancy it has so immensely grown as 
to weigh twenty-four ounces, and measures twelve inches. 
" The growth commences as soon as the ovum reaches 
the uterus, and continues uninterruptedly until delivery." 
It must be remembered that what is here spoken of is 
the actual womb itself, quite independently of the child, 
and that this womb is a kind of bag, so to speak, which is 
composed of muscular tissue. 
We know that the strength of the limbs depends chiefly 
on the quality of the muscles of those limbs. If the mus- 
cles of the legs are weak, we can not walk well; if the 
muscles of the arms are weak, we can not work well. 
Now, if the muscular tissue of the womb is weak, it will 
not contract (or close up) well after the child is born; and 
it is this want of proper contraction of the womb which 
leads to hemorrhage or flooding after delivery. 
Without exercise of the body it is impossible to have 
well-developed muscles, because exercise strengthens the 
muscles and makes them grow. This is one of the reasons 
why it is so important to exercise the body during preg- 
nancy. Most of the cases of hemorrhage after confine- 
ment occur in people who have been in weak health or ADVICE TO WOMEN*. 
29 
confined to bed from illness before the confinement took 
place. 
In India, English women, who are prevented by the hot 
climate from taking much exercise before their confine- 
ments, and who are enervated by the heat, suffer much 
more often from hemorrhage after delivery than they do 
in temperate climates; and it is also remarked by ob- 
stetrical physicians that lady patients who lie up a good 
deal and who drive in carriages are much more subject to 
flooding after their confinements than working-women who 
are obliged to work, often up to the day they are taken 
with labor. 
It is said that in Germany it is the custom for women to 
lie up a great deal before confinement, and that the mor- 
tality during the childbirth is greater there than it is in 
Great Britain. Therefore it is very important not to give 
way to laziness at this time. 
Nevertheless, though exercise is most necessary, too 
much exercise, or exercise of the wrong kind, must be 
most carefully guarded against. Anything that would 
strain the body should be avoided. Lifting heavy weights, 
overstretching to reach things off a high pice, pushing or 
pulling heavy pieces of furniture, etc., may all cause inter- 
nal injury. Working women should know that throwing 
clothes over a line (as is done after a washing) may, dur- 
ing pregnancy, produce serious internal injury. I re- 
member a poor woman saying to me, after I had warned 
my audience against this at a " Maternity Talk " at Nine 
Elms, in the south of London, " Oh, ma'am, 1 wish there 
had been more of this kind of teaching sooner. Eight 30 
ADVICE TO WOMEK. 
years ago I injured myself internally by throwing clothes 
over the line in my yard before one of my children was 
born, and 1 have never been right since." Too long walks 
and riding on horseback are very bad, in fact, anything 
that would overfatigue the body is injurious; but apart 
from this a walk every day is most beneficial, and so, too, 
is exercise about household duties. 
It is said that singing is a very good exercise at this 
time. It is probably on account of the exercise it gives to 
the muscles of the chest and diaphragm,* which come 
greatly into play during labor, and also from its tendency 
to expand the chest. 
But though exercise is so important in pregnancy, it 
must be remembered that occasions may occur, such as a 
liability to miscarriage or to varicose veins, in which the 
doctor may forbid walking; in such cases absolute .rest 
may be imperatively required. 
Baths and Sea-Bathing .in Pregnancy. 
People have sometimes thought that baths of any kind 
during pregnancy were likely to be injurious. This is a 
great mistake. There is nothing more beneficial to the 
health than a bath every day, provided it is not taken too 
soon after a meal, and that it is not dawdled over so as to 
give a chill. If the skin is well washed and rubbed every 
day, the pores are kept open, which enables the skin to 
act in a healthy manner. A bath in the house, before 
breakfast, as a rule, is the best time, unless for a very 
* The large muscle which divides the chest from the abdomen. ADVICE TO WOMEN-. 
31 
delicate person. Hot or very warm baths are weakening; 
very cold baths are dangerous for people with sluggish 
livers. During pregnancy the bath should be just tepid. 
The healthy action of the skin promoted by brisk rubbing 
with a rough towel after the bath is one of the hygienic 
measures that are very good for the health at this time. 
In getting in and out of the bath, particularly the large 
fitted baths now in general use, care should be taken to 
avoid slipping or straining the body. A hassock placed 
beside the bath will prevent this, and a piece of felt on 
the floor will prevent the slipperiness often felt on oil- 
cloth. With regard to sea-bathing in pregnancy, Dr. 
Sydney Ringer says that this may do harm to a woman 
who has previously had miscarriages, or who is of an ex- 
citable temperament, and that in far advanced pregnancy 
it may bring on a premature confinement. " But under 
other circumstances," he adds, " and with due regard to 
the conditions previously laid down, bathing will benefit 
both mother and child." The conditions previously laid 
down are those to be observed by a person not in the most 
robust health, and comprise the following rules: If the 
water is cold, or the person very weak, to begin with a 
tepid bath, reducing the temperature gradually till that 
of the sea is reached; then, if the day is fine and the sea 
calm, to bathe in the open air; not to stay long in the 
water when used to it; in warm weather five, or at most 
ten, minutes should be the longest stay. To bathe about 
three hours after breakfast. Bathing before breakfast 
may depress the bodily functions, and bathing immediate- 
ly before a meal interferes with the secretion of the gastric 32 
ADVICE TO WOMEN. 
juice; this is particularly injurious before dinner, as the 
gastric juice is specially required for the digestion of meat. 
A person who has never been in the habit of sea-bath- 
ing, and can not therefore tell whether it will agree with 
her or not (as it disagrees very much with some), should 
on no account commence sea-bathing during pregnancy, 
nor should swimming or violent exercises in the water be 
indulged in at this time, lest they may induce a mishap. 
Necessity for Care of the Breasts before Confinement. 
Many people either do not know that the nipples of the 
breasts require special care before confinement, or, if they 
have been told of it, they are too lazy or too careless to take 
the advice given to them, and so they run the risk of suf- 
fering severely from cracked nipples when the child begins 
to suck. It is sometimes advised that the nipples should 
be hardened beforehand by washing them with some as- 
tringent lotion. This, however, is not nearly such a good 
plan as that advocated by some physicians who advise the 
application of an ointment which, while keeping the skin 
of the nipple moist,* will prepare and strengthen it. We 
know that a dry skin is the most likely to crack; a drying 
wind will cause the lips to crack, therefore a drying lotion 
* Dr. Parvin, an eminent American obstetrical authority, says, 
on this point: " It certainly does not appear rational that when 
Nature has provided a part with such a vast number of fat glands 
as she has the nipple, we should by astringents endeavor to lessen 
that secretion, and by alcohol dissolve that which is furnished. 
Further, Nature meant the skin of the nipple to be soft and pliable,' 
not hard and stiff, as astringent applications tend to make it." ADVICE TO WOMEN. 
33 
will have much the same effect on the delicate skin of the 
nipple. The ointment recommended for the purpose is 
made of one part of subnitrate of bismuth, one part of 
borax, and eight parts of simple ointment. This can be 
had from any chemist for about sixpence. For some 
weeks before the confinement is expected, a little of this 
ointment should be rubbed into the nipples, and they also 
should be well washed night and morning; then a bit of 
clean rag can be kept over them to keep the ointment 
from soiling the clothing. Surely, this will not give much 
trouble; but if it gave ten times as much, it would be 
worth it, considering what trouble it might save. Only 
those who have suffered from it, know what is the torment 
of a cracked nipple. In women whose constitutions are 
run down or weakly, it has often led, when neglected, to 
abscess in the breast, which is one of the most terrible 
things from which a woman can suffer. 
To be in good health at the time of confinement, and to 
attend to the nipples beforehand, as advised above, are the 
things which prevent the danger of abscess in the breast. 34 
ADVICE TO WOMEK. 
SOME OF THE TROUBLES OF PREGNANCY, AND HOW TO 
TREAT THEM. 
CHAPTER IV. 
Nausea and Vomiting-Heart-burn-Acftlity-Flatulence and Indi- 
gestion-Salivation-Constipation - Diarrhoea-Piles-Varicose 
Veins-Nerve Pains-Toothache-Headache-Cramp-Pains in 
the Breasts, Abdomen, etc.-Spasmodic Cough-Fainting- 
Palpitation-Breathlessness-Irritability of Temper-Depression 
of Spirits-Sleeplessness-Bladder Troubles-Difficulty of Pass- 
ing Water, etc.-Leucorrhoea-Pruritis-Swelling of the Legs, 
etc.-Apprehensions-A Word of Consolation. 
"We have now seen that fresh air, good food, sensible 
clothing, proper exercise, and attention to the general 
principles of hygiene, are specially required for the main- 
tenance of good health during pregnancy. 
Nevertheless, in spite of every care, and in spite of the 
fact which must never be lost sight of-that pregnancy is 
not a disease, but a natural function-there are some 
bodily troubles often met with in this state that are more 
or less unavoidable. 
Now, though these, in many cases, require to be attended 
to by a doctor, still there are some simple methods of 
treatment that will often be found extremely useful in 
alleviating them. 
Some of the unpleasant sensations to which women at 
this time are unfortunately liable, cause great anxiety and 
alarm to the inexperienced. It will be useful to those 
who know little or nothing about these things, to under- Advice to women-. 
35 
stand that many of what 1 call the troubles of pregnancy 
are not causes for alarm, but are merely, as Dr. Barnes 
truly says, " an exaggeration of some of the signs and 
symptoms of pregnancy," and are therefore to be expected 
in a greater or less degree. 
The first and commonest of the troubles of pregnancy is 
nausea, generally accompanied by vomiting. Most people 
suffer from this, though some escape it; those who do es- 
cape it are often troubled with heart-burn, and some with 
attacks of faintness. 
There is an old saying among nurses that " a sick preg- 
nancy is a safe one," which perhaps may be some comfort 
to the sufferer. 
In most cases the nausea does not begin until pregnancy 
has gone on for a few weeks. It then is principally felt 
in the morning; this is familiarly known as " morning 
sickness." There may be only a feeling of nausea, or 
there may be much vomiting. After " quickening," it 
usually ceases. 
" Nausea and vomiting may, however," says Dr. Graily 
Hewitt, " set in as early as the first day of pregnancy, and 
may be prolonged, in exceptional cases, during the whole 
of the pregnancy. There are some few cases also in which 
it has been observed for the first time during the middle 
or latter months." Now and then people with whom the 
nausea and sickness began early in pregnancy, and then 
after a few weeks ceased, have had it return again toward 
the end of the time. 
The cause of the sickness of pregnancy has-been much 
debated. " A sympathy of a very intimate kind exists be- 36 
ADVICE TO WOMEN. 
tween the uterus and the nervous and digestive systems," 
remarks Dr. Leishman, Professor of Midwifery in Glas- 
gow, " and we can not wonder, then, that during preg- 
nancy, when the function of the uterus is so exalted, this 
sympathetic action should also be exaggerated. The symp- 
toms manifested are infinite in their variety, according to 
the constitution of the individual." " The stretching of 
the uterine fibers, and consequent irritation of the uterine 
nerves "-caused by the growth of the child-" is the gen- 
erally received, and probably correct explanation," writes 
Dr. Playfair. When the vomiting is severe, Dr. Graily 
Hewitt, who has made it a subject of special study, con- 
siders it is caused by some displacement of the womb, and 
he gives a number of instances in which, after the doctor 
had rectified this displacement, the vomiting ceased. It is 
well to remember this, and not to allow severe vomiting to 
continue for any length of time without seeking medical aid. 
There are some drugs that relieve and sometimes cure 
this sickness. They must, however, always be prescribed 
for each special case only by the doctor. No book written 
fcr popular use should ever give prescriptions-first, be- 
cajse symptoms, no matter how similar, do not always pro- 
ceed from the same cause; secondly, because a prescription 
that may suit one person may, from some constitutional 
reason, perhaps only understood by the doctor, be utterly 
unsuited to another. If people remembered this, we 
should not have so much mischief done by the indis- 
criminate handing about of prescriptions and medicines 
which, because they have done good in one case, are sup- 
posed to be equally serviceable in all. ADVICE TO WOMEN. 
37 
There are, however, some simple methods of treatment 
and simple medicines that give very great relief; they 
should be tried before resorting to more active treatment; 
if they fail, medical aid should be obtained, as long-con- 
tinued sickness may result in serious injury to the health, 
or in miscarriage, though it is a matter of remark that 
much sickness and inability to take nourishment on the 
part of the mother have often no effect on the child, 
"whose development steadily goes on." One of the 
simplest remedies recommended for " morning sickness" 
and vomiting, is that of taking a cup of strong tea, or 
some other nourishment, before rising. 
Dr. Playfair says " great benefit is often derived from 
recommending the patient not to rise from the recumbent 
position in the morning until she has taken something. 
Half a cup of milk and lime-water, or a cup of strong 
coffee, or a little rum and milk, or cocoa and milk, a glass 
of sparkling koumiss, or even a morsel of biscuit, taken on 
waking, often has a remarkable effect in diminishing the 
nausea." 
" In many instances," says Dr. Leishman, " we have 
known the nausea to be greatly relieved, and the vomiting 
to be entirely checked, by breakfasting in bed, and not 
rising for some little time afterward." Dr. Graily Hewitt 
also advises the same thing. He recommends those who 
suffer much in this way, while not neglecting to take 
moderate exercise, to lie down often. Lying, he says, is 
better than sitting. A shock or strong mental emotion 
has been known to bring on uncontrollable vomiting in 
pregnancy; that is one reason why tranquillity of mind at 38 
ADVICE TO WOMEN. 
this period is so important. The state of the bowels must 
be carefully attended to, and the diet regulated when this 
nausea is present. It is most important that the bowels 
should be opened once a day. This end must never be 
gained by the use of strong purgatives, which should never 
be used during pregnancy. Either an enema should be 
used, or a mild saline laxative taken. 
" There is, perhaps," observes Dr. Lcishman, writing on 
this trouble of pregnancy, " no class of remedies which is 
attended with such beneficial results as effervescing 
draughts, among the best of which may be mentioned the 
granular effervescing citrate of magnesia." This, besides 
acting on the bowels, has a salutary effect on the digestion, 
and is often of great service in relieving the nausea. Any 
of the mineral waters, as the Hunyadi Janos, Carlsbad, 
or Friedrichshall waters, taken according to the directions 
un the bottle, will be found to act as gentle aperients. Or 
an ordinary seidlitz powder may be taken. The patient 
must be very careful not to eat rich and indigestible food, 
nor to take late and heavy suppers, and as much time as 
possible should be spent in the open air. In some cases 
the vomiting is very severe, the sufferer being able actually 
to retain no solid food whatever. 
Dr. Playfair's advice is very valuable for such cases. 
" When any attempt at swallowing solid food brings on 
vomiting, it is better to give up all pretense at keeping to 
regular meals, and to order such light and easily assimi- 
lated food, at short intervals, as can be retained. Iced 
milk, with lime or soda-water, given frequently, and not 
more than a mouthful at a time, will frequently be re- ADVICE TO WOMEN. 
39 
tained when nothing-else will. Cold beef jelly, a spoonful 
at a time, will also be often kept down. Sparkling 
koumiss* has been strongly recommended as very useful 
in such cases, and is worthy of trial. It is well, however, 
to bear in mind in regulating the diet, that the stomach 
is fanciful and capricious, and that the patient may be 
able to retain strange and apparently unlikely articles of 
food; and that, if she express a desire for such, the experi- 
ment of letting her have them should certainly be tried/' 
Dr. Leishman advises that stimulants should be tried if 
there is much exhaustion of the patient's strength. 
" These," he says, " when taken in moderate quantities, 
and in an effervescing fobm, such as champagne, or brandy 
and soda-water, seem almost to exercise a specific influ- 
ence. Sometimes," he continues, after mentioning vari- 
ous drugs which-may be tried, " when such of the above 
measures as may have been selected are totally devoid of 
effect, we stumble fortunately upon some agent which may 
chance to have the desired effect, even though it be of the 
simplest possible character. Of such a nature is milk and 
lime-water and barley-water; indeed, in reference td tffe 
latter, we have seen such striking instances of its efficacy, 
in which it has been retained by the stomach when all elsQ 
has been rejected, that we have come to look upon it as 
among the most valuable agents which we have at com- 
mand." 
When all drugs have failed in checking the vomiting, 
* Koumiss is supplied of different ages. Old- koumiss is gener- 
ally best for cases where little or nothing can be retained on the 
stomach. I have seen valuable results from it in liver complaint. 40 
ADVICE TO WOMEN. 
Dr. Playfair says he has in many cases found that the ap- 
plication of a special ice-bag to the cervical vertebrae (that 
is, to the spine at the back of the neck and just below it), 
as recommended by Dr. Chapman, has succeeded in check- 
ing it. 
" The ice/' he says, " may be placed in one of Chap- 
man's spinal ice-bags,* and applied for half an hour or an 
hour twice or three times a day. It invariably produces a 
comforting sensation of warmth, which is always agreeable 
to the patient. Ice may be given to suck ad libitum, and 
is very useful; while, if there be much exhaustion, small 
quantities of iced champagne may also be given from time 
to time." 
When the nausea and vomiting are so severe that no 
food can be retained in the stomach, it is often very useful 
to give nourishment by the bowels. There are two ways 
of doing this, one is by a nutrient enema, the other by 
nutrient suppositories. In many cases of illness, when 
nourishment taken into the stomach is immediately thrown 
up again, these have been the means of preserving life, by 
causing nourishment to be injected into the intestines; if 
it is retained in them, the greater quantity of it will be ab- 
sorbed, and so will contribute to the nourishment of the 
body. The great object to be aimed at is, to have the 
* These ice-bags cost from seven shillings to fourteen shillings. 
Where this expense is thought too great, a little ingenuity may con- 
struct a bag for applying ice out of an ordinary oil-skin bathing- 
cap, which in default of better may serve as a makeshift. Gutta- 
percha tissue cut into strips and the edges fastened together with 
chloroform, is very useful for making ice-bags. 41 
ADVICE TO WOMEN-. 
nourishment given retained, and for this reason a nutritive 
enema should always consist of only a small quantity of 
nourishment. If a large quantity is given, it stimulates 
or excites the bowels to act, and the nourishment is ex- 
pelled too quickly to do any good'; but if given in small 
quantities, it will, 'in all probability, be retained and 
absorbed. The best appliance with which to give this 
kind of enema is a glass syringe (it can be obtained for the 
purpose at any chemist's), or a small ball-enema may be 
used. The douche tin, mentioned later, would, of course, 
be quite unsuitable for this special purpose, though much 
the best apparatus for giving an ordinary enema for open- 
ing the bowels. The nourishment given may consist of 
strong beef-tea, thickened with arrowroot to the consist- 
ence of good cream (this helps the beef-tea to be retained), 
well-beaten yelk of egg, cream, and occasionally a little 
wine or brandy may be ordered to be added. These things 
may be given separately, or a t'able-spoonfu] of each may 
be mixed, together to make about six or eight, table-spoon- 
fuls and administered. More than eight table-spoonfuls 
should never be given at one time, or the food will prob- 
ably not be retained. It is always well if the can 
be peptonized before being administered, as it will then be 
more easily absorbed. A nutritive enema may be given 
in exactly the same way as described under the head of 
"How to Give an Enema" at page 4G, except that a 
glass syringeshould contain the nourishment, which ought 
to be just tepid, and that it should be administered very 
slowly; the more gently it is injected, the less chance 
there will be of the intestines being excited to contract, 42 
ADVICE TO WOMEN. 
which would at once eject the nourishment. Thcsyringe 
should be held firmly in the left hand, and the piston 
slowly pushed down with the right; in this way hurtful 
pressure on the patient is prevented. Before giving an 
enema of this kind it must be ascertained if the bowels 
have recently acted; if not, an ordinary enema of warm 
water should be given half an hour before the nutrient one, 
to clear them out, or we could not expect the nourishment 
to be absorbed. Nutritive enemata should be repeated at 
intervals of about three hours. 
Nutrient suppositories, which are sometimes given 
instead of nutrient enemata, are little conical-shaped 
masses about as long as the first joint of the little finger. 
One should be oiled and gently pressed into and a little 
way up the bowel, which should retain and absorb it. If 
the patient can not do it for herself, the nurse must oil 
her finger and do it for her. They are generally supplied 
already peptonised or predigested. Peptonising powders, 
-by which milk, beef-tea, etc., can be digested before being 
swallowed, can be had from any chemist, with clear direc- 
tions for use along with them. This process is very valu- 
able in illness when the stomach is in too weak a state to 
properly perform its own work of digesting. 
Heart-burn, acidity, flatulence, and indigestion are com- 
mon troubles of pregnancy. They are principally caused 
by that sympathy between the womb and the digestive 
system before mentioned. In the latter months the press- 
ure of the child against the digestive organs often causes 
the heart-burn to be very troublesome. Delivery is the 
only cure for these distressing sensations, which, though ADVICE TO WOMEN. 
43 
very distressing, need not cause alarm, but they may be 
considerably relieved by avoiding rich and fatty food, and 
by never allowing the bowels to become constipated. 
Dinneford's fluid magnesia, the effervescing citrate, or 
bicarbonate of potash (as much as can be taken on a three- 
penny-piece in a little water) are recommended by Dr. 
Leishman. The stooping posture aggravates heart-burn, 
and should be avoided as much as possible. Half a tea- 
spoonful of bicarbonate of soda (ordinary cooking soda) in 
a wine-glass, or less, of water, taken directly after meals, 
is a simple and most useful remedy for any of these 
troubles. The soda, being an alkali, neutralizes the acid 
secretions of the stomach and prevents " sour risings, " 
disperses the flatulence, and relieves the heart-burn and 
indigestion. Potash or soda-water, with or without milk, 
is also good. I have head of heart-burn being greatly 
relieved by eating- almonds (skinned first), and in some 
cases by merely taking a spoonful of cream-occasionally. 
Salivation is a profuse flow of saliva, with which some 
women are troubled in pregnancy. The acidity of the 
saliva in some cases causes excoriation of the skin round 
the mouth. It is believed to be of an entirely nervous 
character, and is sometimes quite impossible to relieve 
while pregnancy lasts. Astringent gargles of tannin and 
chlorate of potash, frequent sucking of ice and tannin 
lozenges, or an occasional charcoal biscuit, are the reme- 
dies of a simple nature that may be tried. 
The coiislijjation that often accompanies pregnancy 
must never be neglected On any account. It increases the 
tendency to piles usual at this time, makes sickness anti 44 
ADVICE TO WOMEN. 
symptoms of indigestion much worse, and, if not carefully 
prevented immediately before confinement, may retard the 
labor and cause much suffering. Many people suffer from 
constipation during pregnancy, though not at other times, 
because in the latter montbs it is chiefly caused by the 
pressure of the child on the intestines. Simple means, 
which should always be tried first, sometimes remove the 
constipation. A tumbler of hot or of cold water taken 
while dressing for breakfast is sometimes efficacious; no 
fresh bread should be .eaten, but coarse brown bread; 
cocoa, coffee, or chocolate must be used instead of tea at 
breakfast; oatmeal porridge, treacle, honey (if this can be 
had in the comb it will have a much better aperient effect 
than that sold in jars, which often is not honey at all, but 
an artificial syrup, not improving to the digestion), plenty 
of all sorts of fruit (except nuts) and vegetables, stewed 
fruit instead of pastry or heavy puddings, fresh salad with 
good salad oil in abundance, light, easily digested food- 
as- fish, fowl, tender mutton, or game-are one and all 
excellent. 
Such a regimen should always be adopted when consti- 
pation is a trouble. 
Plenty of cold water as a beverage (unless it distinctly 
disagrees) is most valuable at all times to people who suffer 
from constipation, because, as Dr. Sydney Ringer tells us, 
" free water-drinking increases the water, but not the 
solids of the faeces" (z. e., the motions). The value of 
this in constipation does not need explanation. 
Regular habits are very essential for the prevention of 
this trouble;, if people would keep to a certain hour every ADVICE TO "WOMEN-. 
45 
day for this function of nature, say directly after break- 
fast, or just before going to bed at night, much trouble 
with the bowels would often be saved. 
When the constipation is caused by the mechanical 
pressure of the child, there are only two ways of combat- 
ing it. Either aperient medicine must be taken, or an 
enema must be given. The aperient should be of a 
kind. One of the best is compound liquorice powder, to 
be had of any chemist. This is, par excellence, the aperient 
for pregnancy. It is pleasant to take, inexpensive, and 
safe. A tea-spoonful in a wine-glass or more of water or 
milk at bed-time should be tried. If this much does not 
act, the dose may be increased. Any of the natural min- 
eral waters, or any of the effervescing powders already 
mentioned, may be used. They should always be taken 
before breakfast, and if mixed with warm instead of colei 
water, will have a more purgative effect. Castor oil is 
not a good purgative in obstinate constipation, because, 
though it acts very well on the bowels, it constipates after- 
ward, and so its use must be continually kept up. This is 
just what we should try to avoid, as there is nothing worse 
than to get into the habit of continual pltysicing, which 
injures the digestion, weakens the bowels and the health, 
and has helped to turn many a woman into a chronic 
-invalid. 
An enema is far better than medicine for frequent use. 
Every woman who is expecting her confinement should 
have one of the douche tins described at page 113, with 
which, if need be, she can administer the enema to her- 
self. 46 
ADVICE TO WOMEN* 
How to Give an Enema. 
There are a few necessary things to know about the 
giving of enemas, not alone in pregnancy, but at any 
time. First, the giving of an enema is a very easy thing. 
I heard an amusing story the other day of a doctor who 
told the village nurse in a country-place in Devonshire to 
give an enema to a patient, and she replied with aston- 
ishment, " Oh, sir, I have never been asked before to do 
that; 1 always leave operations to the doctor!" It is an 
actual fact that there are many women, and some even 
who call themselves nurses, who do not know how to 
administer this simple remedy. I shall, therefore, describe 
as clearly as possible how it should be done. The patient 
must lie quite on the side (the left) at the edge of the bed, 
the knees should be drawn well up toward the abdomen. 
There is no need for being undressed if the clothes are 
raised, and a towel tucked well underneath. The douche 
tin, which has been nearly filled, either with plain tepid 
prater or soap and water, should be held in one hand of the 
attendant. Then the nozzle of the apparatus must be 
gently introduced into the opening of the back passage. 
If this can be done by the patient herself, it will be much 
better. The nozzle must first have been well oiled-this 
is a most important point to remember. It should on no 
account be roughly pushed in, as this may do great harm, 
but should be insinuated, as it were, without any force, 
and it will generally easily slip into the bowel. When it 
is in place, the tin may be either hung on a nail in the 
wall or held up, and then the tap should be turned. The 
patient can manage to hang it on the nail or to hold it up ADVICE TO WOMElt. 
47 
herself, but it will be very much better if she has some 
one to do it for her.* The higher the tin is held, the 
greater will be the force with which the water ascends, so 
if it is held low at first, and gradually raised, it will act 
better. If possible, the whole contents of the tin should 
be injected; then the pipe must be withdrawn. A folded 
towel should be pressed against the back passage directly 
the pipe is removed, as it is necessary to retain the enema 
for some minutes if possible; it will then have a much 
better effect than if the water is allowed to come away 
immediately. It is often thought that an enema meiely 
clears out the contents of the lower bowel, and that it is, 
therefore, of little use. compared to purgative medicines 
for emptying the bowels. Dr. Sydney Ringer explains 
the error of this idea. He says that the injection " stimu- 
lates the whole intestinal tract to more vigorous peristaltic 
action, by which means the contents are propelled along 
the canal and finally expelled." The peristaltic action of 
the bowels resembles the progress of a worm or leech 
along the ground. These creatures in moving along first 
contract into a small compass, and then lengthen them- 
selves out; the intestines act in the same way. Constipa- 
tion occurs when the intestines, from weakness or other 
reasons, lose this power of contracting and expanding, and 
can not therefore expel (heir contents. Purgatives excite 
this action, but when their use is long continued, the 
intestine responds less to their influence, so the dose has to 
* There are enema apparatus especially made by which people 
can administer an enema to themselves. They are generally ex- 
pensive. 48 
ADVICE TO WOMEN. 
be increased and more frequently repeated, till injury to 
the coating of the stomach and intestines is finally caused. 
" An enema constantly fails/' says Dr. Ringer, " because 
not enough fluid is introduced to excite contraction. It 
is necessary to introduce a considerable quantity of fluid, 
as much as two, three, or even four pints." 
The difficulty in following this advice is to get the 
patient to retain the fluid, because as soon as a very small 
quantity is introduced griping is often felt, and a great 
desire to evacuate. If the patient, however, will endeavor 
to bear as long as possible with these sensations, and will 
lie with the head and shoulders low down on the bed, and 
if the administrator (whose services are required, because 
to give a very copious injection to one's self would be very 
difficult) will lower the tin when the griping is complained 
of, and press a towel or a couple of fingers firmly against 
the passage, the griping will pass off. Then the tin can 
be raised again, and so on until it is emptied. By care of 
this kind a considerable quantity of fluid can be injected. 
The heat of the water injected is a very important matter. 
For occasional use, only water of 100° F. may be used. 
An enema as hot as this is very soothing in many com- 
plaints, and besides helping to relieve the bowels, the 
warmth relaxes and relieves the surrounding parts; but if 
through carelessness or ignorance water much hotter than 
this should be injected, serious mischief may be done. 
When an enema has to be used every day, the water should 
be only tepid. Frequent injections of hot water would 
weaken the intestines; cold water is often used with 
advantage. 49 
ADVICE TO WOMEN. 
Glycerine syringes have been introduced for the relief of 
constipation. They are small, cheap glass syringes, with 
which a tea-spoonful or two of glycerine can be injected to 
one's self without trouble in the w. c. This stimulates 
(when the constipation is not too obstinate) the bowel to 
act. Glycerine suppositories are useful for the same pur- 
pose. The syringes and suppositories can be got through 
any chemist. 
If soap and water is used (this is useful if plain water 
does not cause sufficient action), it is prepared by simply 
rubbing a little ordinary yellow soap into the water as in 
washing the hands, and using the soapy water. Thin 
gruel is sometimes ordeyed instbad of soap and water. 
Occasionally the doctor may order a certain amount of tur- 
pentine, castor oil, or olive oil, to be given in the enema. 
Now, if either of these were put into the entire quantity of 
water to be used, they would probably not be injected at 
all, because oil and turpentine, being lighter than water, 
float on the top of it; and while the water underneath 
would be injected, the turpentine or oil would not. When 
either has to be used, therefore, the quantity ordered 
should be mixed up in about a breakfast-cupful of soap and 
water. This must be put into the tin and injected first, 
slowly. The enema nozzle must not be withdrawn, but 
when it is seen that the soap and water and oil or turpen- 
tine has all passed up, then the rest of the enema (the 
water, soap and water, or gruel) can be poured into the 
tin and injected after it. In this way the bowels will 
receive the medicament, which otherwise would be lost. 
Jff constipation has been allowed to go on for some time 50 
ADVICE TO WOMEN. 
without being relieved, it sometimes happens that the con- 
tents of the bowel become packed in such a hard mass 
that the nozzle-pipe of the enema can not be made to pass 
through it. In such cases, it has occasionally to be broken 
up and removed with a little implement made for the pur- 
pose. Such a disagreeable contingency may be avoided by 
seeing to the proper relief of the bowels in time. 
Diarrhoea in pregnancy should, if it is at all excessive, 
be treated at once. " I have frequently observed," says 
Dr. Playfair, " premature labor to follow a sharp attack 
of diarrhoea." If this has been caused by eating things 
that have produced irritation in the bowels, a moderate 
dose of castor oil, which will clear them, and, as castor oil 
does, afterward constipate, may suffice to cure it. liest 
in bed is important in diarrhoea, and often of itself would 
effect a cure if the diet be also attended to. Fruit, 
vegetables, meat, even beef-tea should not be taken; boiled 
milk, bread and milk, rice, arrowroot, and such things 
should be the only diet till the attack is over. Chalk 
mixture, with aromatic confection, which can be had from 
any chemist, is a very useful medicine and quite safe. 
A starch enema is often of value in restraining diarrhoea. 
It should be given from a glass syringe, in precisely the 
same way as a nutrient enema; a small quantity (for the 
same reasons) of cool-boiled starch, just thick enough to 
be injected, should be gently given, and the great thing is 
to have it retained. To make boiled starch, blend about a 
dessert-spoonful of starch with a little cold water till it is 
dissolved; then pour slowly over it as much hoiliny water 
as will make it sufficiently thick to use as above. When ADVICE TO WOMEN-. 
51 
it has cooled down so as to be nearly cold, it may be 
givQn. 
Piles are a frequent trouble of pregnancy, generally 
caused by the pressure of the heavy womb upon the intes- 
tines. They may also be brought on any one at any time 
by getting the feet wet, sitting on cold stones or damp 
grass, or by any such indiscretion. Piles may be internal 
or external; in the latter case they protrude beyond the 
opening of the back passage, and often give great pain on 
sitting down and rising; and if the bowels are allowed to 
become in the least constipated, they will cause much 
suffering. It is very important, then, that the bowels 
should operate evdry day. Ilunyrdi Janos water is very 
useful indeed as an aperient. Dr. Playfair specially 
recommends the confection. of sulphur, or sulphur 
electuary. 
Some doctors recommend a cold enema every night, and 
there is no doubt of an enema, every day being most 
valuable. Occasionally the. piles bleed-sometimes con- 
siderably. For this Dr. Leishman recommends cold in- 
jections, " which," he says, " may be quite freely used 
without risk." WJien the piles are internal, the action of 
the bowels often cause them to protrude; they should then 
bo gently pressed back with the finger, which should be 
oiled. Fomenting the part with a sponge wrung out of 
hot water, and applied successively as hot as can be borne, 
"is often," says' Dr. Leishman, " attended with the 
greatest possible relief and comfort." A bread-and-milk 
poultice is also very soothing.- Nutgall ointment is a well- 
known and highly recommended remedy, and so is pow- 52 
ADVICE TO WOMEN. 
dering with Fuller's earth after bathing the piles in water 
in which poppy heads have been boiled; but there is no 
cure until after the confinement, as any of the operations 
that often have to be resorted to for the removal of pro- 
truding piles can not be employed during pregnancy. 
Alcohol, pepper, mustard, and coffee always make piles 
worse. 
Varicose Veins are often a trouble of pregnancy; they 
result from the pressure upon the veins of the lower part 
of the abdomen. The veins of the legs, and those around 
the front passage, are often greatly swollen. The principal 
means of relief is an abdominal belt, which, by supporting 
the womb, takes some of the pressure off the veins. 
People suffering from varicose veins, should lie down as 
much as possible, and if the veins are much swollen, 
should have an elastic stocking, or the leg carefully band- 
aged. If by any accident one of the veins should be cut, 
immediate pressure should be made upon it by the 
finger. , < 
Toothache torments many women during pregnancy. 
Sometimes it is due to neuralgia, to which there is nat- 
urally a predisposition from the lowered state of the system 
at the time; but often it is caused by actual decay of the 
teeth, there being a predisposition to this also, supposed to 
be on account of the dyspeptic symptoms so prevalent at 
the time, which cause acid secretions of the mouth injuri- 
ous to the teeth. There is an old saying, " for every child 
a tooth." When neuralgia is the cause, quinine is often 
valuable, but the dose had better be prescribed by a doctor. 
A bad tooth causing much suffering ought to come out, if ADVICE TO WOMEN. 
53 
it can not be filled in a way to cure the aching. We have 
the high authority of Dr. Playfair for this. lie says 
" there is much unreasonable dread among practitioners 
as to interfering with the teeth during pregnancy, and 
some recommend that all operations, even stopping, should 
be postponed until after delivery. It seems to me certain 
that the suffering of severe toothache is likely to give rise 
to far more severe irritation than the operation required' 
for its relief, and I have frequently seen badly decayed 
teeth extracted during pregnancy, and with only a bene- 
ficial result." 
I hope this adviqe, taken to heart, will spare some of the 
suffering 1 have known people,to bear on account of 
what Dr. Playfair truly calls tjje " unreasonable dread " 
of taking the tooth out. In those days, when, apart Irom 
gas- or anaesthetics, there are so many applications which, 
merely rubbed on the gum, deaden the pain of extraction, 
it is surely the height of folly to allow the strength to be 
lowered by that most wearing of pains, toothache. Two 
or three drops of chloroform on cotton-wool put into a 
hollow tooth and into the car of the same side, often 
relieve or cure toothache, and should always be tried. 
Headache is often" a trouble. If .it proceed from neu- 
ralgia, quinine is valuable, when properly prescribed. For 
neuralgia in the forehead-r-and also for various kinds of 
headache-great relief, is often felt from having a sponge 
or flannel wrung out of hot water, and laid all over the 
brow, then covered with a thick towel or dry flannel to 
retain the heat; this may be continued for some time. 
Fresh air and attention to the diet, bowels, and general 54 
ADVICE TO WOMEN. 
laws of health, are all important when people suffer from 
headache. 
Nerve Pains, Cramp, and Pain in the Breasts.-Dur- 
ing the latter part of pregnancy, many women suffer 
much from the pressure of the child upon the nerves of 
the lower part of the abdomen, which causes pain in the 
groins and thighs, pain and cramp in the legs, which 
sometimes is very severe. An abdominal belt, either an 
elastic one, which can be procured from a surgical- 
instrument-maker's, or a stout bandage, as already men- 
tioned, will, by relieving the pressure on the nerves, often 
give great relief. If the pains come, as they sometimes 
do, from rheumatic or neuralgic tendency, rubbing with 
chloroform liniment (to be had from any chemist) often 
gives ease. When cramp in the legs occurs at night, it is 
always better to get up and walk about for a few minutes; 
even standing on the feet gives relief. The pain so often 
felt in the breasts is chiefly on account of the sympathy 
existing between the breasts ;aad the womb, and on 
account of the change going on in preparation for the 
function of suckling. When the pain is severe, gentle 
rubbing with warm oil, or if the pain is very severe, with 
chloroform liniment, or fomenting with hot water, and 
keeping a piece of flannel or a silk handkerchief folded 
over them, is the best remedy. 
Spasmodic Cough.-This, which is occasionally a 
trouble, is, as a rule, a nervous affection, not connected 
with having caught cold. It often resembles whooping- 
cough in its nature, and, if very violent, some sedative and 
anti-spasmodic medicine should be obtained from the doc- ADVICE TO WOMEN. 
55 
tor, as the paroxysms of the cough have been known to 
induce miscarriage. 
Fainting is not a common trouble, of. pregnancy, but 
still it is one from which some delicate women suffer; If 
fainting fits occur several times during pregnancy, it need 
hardly be said that good medical advice should always be 
obtained. The immediate treatment of fainting or faint- 
- ness should be understood by every one; it is curious how 
often people do just the wrong thing with a fainting per- 
son. The treatment is to lay the patient on the back, 
with the head as low as possible. The reason why this 
shouldybe done is in order t.o keep the blood circulating 
through the brain. Fainting is caused by a lack of blood 
to the brain, from some condition, such as exhaustion, 
I 
shock, poverty of blood, etc., which causes the blood to 
recede from the brain. Now, if we stand a fainting person 
up, we cause the blood to leave the brain even further; 
whereas, by laying her flat, with the head slanting back, 
we keep the blood circulating through the brain, and this 
treatment alone is often sufficient to revive the patient. 
Sprinkling cold water on the face, allowing plenty of fresh 
air into tire room, fanning, andL giving a little sal-volatile, 
and, above all, keeping anxious friends from crowding 
round and taking up the " air space," will generally be 
quite sufficient treatment. Wlierb fainting fits are fre- 
quent, Dr. Playfair says that the daily application of the 
spinal ice-bag has proved of much service. 
Palpitation and Breathlessness are sometimes experi- 
enced in pregnancy, occasionally during-the early months, 
but more usually in the later, when they are caused by 56 
ADVICE TO WOMEN-. 
the mechanical pressure of the enlarged womb upon the 
surrounding organs. Palpitation often occurs in delicate 
women whose blood is in a poor state. They require 
plenty of fresh air, nourishing food, and some tonic medi- 
cine, which, of course, should be prescribed by a doctor. 
They need be under no apprehension of heart disease, as 
people often are who suffer from palpitation, as the dis- 
tressing symptom will disappear after the birth of the 
child. When breathlessness is a trouble during the later 
months, the patient will often find relief at night in sleep- 
ing propped up; if a bed-rest is at hand it can be used, 
but a very convenient inpromptu one can be made by 
placing a chair (a light cane one is the best) upside down 
at the head of the bed; the back of the chair slants on to 
the mattress toward the patient's'back, while its legs stick 
up into the air. Against the back of the chair pillows are 
laid, and this makes a most comfortable and costless bed- 
rest. Then clothing, when breathlessness is a trouble, 
must, of course, be as loose as possible, and the diet very 
digestible; anything of a " stuffing " nature-potatoes, 
suet-puddings, and the like-will naturally aggravate it. 
There is no cure for it but delivery. 
Effects on the Nervous System. 
Pregnancy often exerts a serious influence on the nerv- 
ous system. It is only natural to expect this, and not to 
be alarmed at the irritability of temper, and sometimes 
profound depression of spirits and despondency, occasion- 
ally met with in this condition. Cheerful society, if it 
can be had-, is very important in the last case; it is very ADVICE TO WOMEN. 
57 
bad for young married women suffering in this way to be 
left alone all day, as they so often are, while their hus- 
bands are away. Coming, as they sometimes have, from 
a large and , lively family, the physical depression conse- 
quent on the state of the health makes lonely surroundings 
often absolutely injurious. In such a case the presence of 
the much-abused mother-in-law or sister-in-law may prove 
an excellent medicine. insteac of having an 
injurious effect on the nerves and temper, pregnancy has 
been known actually to improve them. " Amusing cases 
are narrated/' says Dr. Leishman, " in which whole house- 
holds learned to hail with pleasure the pregnancy of the 
lady of . the which was divulged to them by un- 
wonted gentleness of maimer and genial cheerfulness." 
Sleeplessness, if carried to any great extent, may, says 
Dr. Playfair, "cause serious trouble.from the irritability 
and exhaustion it produces. In such cases,"? he writes, 
" we should endeavor to lessen the excitable state of the 
nerves by insisting on tire of late hours, over- 
much society, exciting amusements, and the like." 
Plenty of fresh air, a well-ventilated bedroom, and light, 
nourishing diet, are a great necessity. A warm drink 
when in bed often will induce sleep. The vfarm liquid in 
the stomach draws the blood from the brain and so acts as 
a sedative. A hop pillow is an excellent soporific. Hops 
can be obtained at a chemist's for about one shilling six- 
pence per pound. A-pound of hops will make a pillow. 
If these means fail, the doctor must be consulted. He 
will probably prescribe chloral. This is a most valuable 
remedy for sleeplessness when taken according to the doc- 58 
ADVICE TO WOMEN. 
tor's orders, but I can not give too strong a warning 
against its use without the doctor's orders. People some- 
times even go on taking it in spite of their medical ad- 
viser's express injunctions to the contrary. 1 have seen 
such lamentable results from the overuse of this drug, 
that I can find no words forcible enough for pointing out 
its danger. The patient who persists in taking it, when 
the absolute need for it has passed, becomes as mdch a 
slave to it as the drunkard to his dram. The moral nat- 
ure often becomes perverted by its overuse, and temper, 
truthfulness, and disposition are injured to a sad and 
strange degree. Its too long continuance also injures the 
appetite and digestion, interferes with the secretion of bile, 
and brings on depression and nervousness, and often a 
return of the very symptom it was used to cure-sleepless- 
ness. Sometimes it induces a certain amount of paraly- 
sis. 
Bladder Troubles are frequent during pregnancy, more 
particularly during the later weeks, when the pressure of 
the womb upon the neck of the bladder in some cases 
causes great difficulty in passing water. Sometimes by 
placing herself on her knees and elbows the patient is en- 
abled to pass water easily, because in that position the 
bladder is considerably relieved from the weight of the 
womb. An abdominal bandage or belt, which relieves 
this pressure, is also often of great service; but if neither 
of these means succeed, it is important at once to consult 
a doctor, as prolonged retention of the water may lead to 
very serious and it may be caused by a displa ;e- 
ment of the womjb, which the doctor must rectify, liri- ADVICE TO WOMEN. 
59 
tability of the bladder, which is shown by continually de- 
siring to pass water, may give much trouble, and greatly 
disturb the rest at night. It also is generally caused by 
pressure or displacement of the womb, and if not relieved 
by a supporting bandage, will require the attention of the 
doctor. Inability to retain the urine is a trouble to which 
those who have already had large families are sometimes 
liable in pregnancy. A supporting-belt often considerably 
relieves this. A large soft pad of absorbent wood-wool, 
mentioned in Chapter VIII., may be worn to receive the 
dribbling of the water, which may cause the surrounding 
skin be irritated. If the parts are frequently bathed, 
and vaseline is applied to The skin, this ir.itation may be 
prevented. When, as sometimes happens, the passing of 
the water is attended.with smarting pain, the front pas- 
sage should be anointed frequently with vaseline or cold 
cream, and barley-water or flax-seed tea* drunk occasion- 
ally. 
LeUQorrhoea is popularly known as "the whites -a 
thick, white discharge, which often is troublesome in 
pregnancy. If it is excessive, a doctor should be consult- 
ed, as it may proceed from some cause that requires treat- 
ment; but, otherwise, occasional bathing with tepid water 
will be sufficient. 1 
Pruritis is the name given to a troublesome itching of 
the front passage, which in some cases is a great trouble 
* Flax seed tea is made by'boiling about a.tea-cupful of flax- 
seed in a quart of water, till it is like very thin gum. It maybe 
sweetened and flavored to taste, and is very useful in irritation of 
the bladder, ... 60 
ADVICE TO WOMEN. 
during pregnancy, and often hard to cure. Frequent 
washing with soap and warm water, and then bathing 
with weak lead lotion, or Condy's fluid and water is use- 
ful. Dr. Playfair recommends smearing the parts with 
an ointment consisting of boracic acid and vaseline, which, 
he says, " often answers admirably." 
Swelling of the legs often occurs at the latter end of 
pregnancy, as a result of the pressure upon the veins that 
carry the blood from the lower extremities back to the 
heart. Sometimes it is from some condition of the blood. 
It should always be mentioned to a doctor. If there is a 
puffiness of the skin about the ankles, under the eyes, or 
on any other part a doctor should always he consulted 
immediately. It shows a state of the blood that may 
cause trouble if not attended to at once. 
Apprehensions.-Many women during pregnancy are 
full of fancies and fears that are often without the least 
foundation. The most common of these are apprehen- 
sions about the child. Some womun, if they see anything 
unpleasant, as a deformed object in the street, and so on, 
are filled with nervous dread that this will affect the child. 
There is positively no need for any such fear. Again, if 
the movements of the child are not felt for some time, 
some women imagine it is dead. This is not at all neces-' 
sarily so. The movements are often not felt for some 
time merely because the child is quiet. 
A UorrZ of Consolation.-Pregnancy is a trying time to 
some; it is a time of little or no trouble to others. When 
it is over many women have better health than they ever 
had in their lives before. I have known more than one ADVICE TO AVOA :N. 
61 
case where, during unmarried life, great pain was suffered 
during the monthly periods, an I where there was great 
delicacy of health; but after the birth of the first child the 
pain was never felt again, and'th health was better than 
ever before. 
CHAPTER V., 
Difference between Miscarriage and Premature Confinement- 
Cause of Miscarriages-Treatment for* the Prevention of Mis- 
carriage-Threatening Symptoms of Miscarriage, and Treatment 
if it Should Occur-Danger of Neglected Miscarriages: 
A miscarriage is; not the same thing as a premature 
confinement. A miscarriage, mishap, or abortion, as it is 
variously called, is the discharge from the womb of the 
embryo or foetus before it is capable of surviving apart 
from the mother. The embryo is the name given to the 
first rudimentary formation of the child in the'womb, be- 
fore the limbs are distinctly formed; that is to say, during 
the first three months of pregnancy; after this, until 
birth, in medical language, it is called the foetus. As 
already mentioned, the embryo is alive from the time it is 
conceived, but the child is not capable of existing apart 
from the mother until the beginning of the seventh 
month. If. it is born during the seventh or eighth month 
it is capable of a separate existence, but being born before 
the full time, it is called premature. Ignorant people 
have often asserted that children born in the seventh 
month have a better chance of becoming healthy and 
strong children than those born in the eighth month. 
MISCARRIAGES. 62 
ADVICE TO WOMEET. 
The idea is of course absurd and illogical, as the nearer 
the child approaches to the full time the more mature it 
will be and the greater the chance will be of its growing 
up in health and strength. The notion entirely originated 
in the popular superstition that seven is a more lucky 
number than eight. 
A miscarriage or a premature confinement may be 
brought on by any mental shock, fright, or great excite- 
ment, or by a fall, blow, or accident of any kind which 
jars the body. It maj' be brought on by slipping acci- 
dentally down one or two steps, by tight lacing, by pro- 
longed dancing, or by too much of any kind of even pleas- 
urable excitement, by lifting heavy weights, straining to 
reach things from a high place, or by a very long walk, 
long and jolting railway journey, or exercise on horse- 
back, sometimes, though rarely, even by a strong dose of 
a drastic medicine.* 
There are women who, from delicacy of constitution or 
from some blood taint, are peculiarly liable to miscarry. 
Upon such women very slight c'auses, which would have 
no effect upon a strong, healthy person, will bring a mis- 
hap. They get into the habit of miscarrying, and it seems 
almost impossible that they should ever become the moth- 
ers of living children. These cases should always be 
treated by an experienced physician. Directly the patient 
considers herself to be pregnant, she should have good 
medical advice, as it is often possible, by the administra- 
* If a woman should, during pregnancy, be taken ill with any 
of the infectious diseases, as scarlet fever, measles, etc., she will 
be wy likely to miscarry. ADVICE TO WOMEN. 
63 
tion of proper drugs, so to act on the blood as to enable a 
woman who has previously miscarried continually at 
length to bear a living child. Dr. Cullingworth, the ob- 
stetric physician to St. Thomas's Hospital, gives this val- 
uable piece of advice on such cases: " When previous 
pregnancies have been cut short by miscarriage, it is very 
necessary that the greatest precautions should be observed 
to avoid the repetition of such an accident. We know 
from experience that miscarriages are most apt to take 
place at those, times which, in the absence cf pregnancy, 
would have been tjie ordinary menstrual, periods. It is 
on these occasions,.therefore, that preventive measures are 
most needed, and most likely to be useful. Every month, 
then, during the time that the patient would, under other 
circumstances, have been unwell, she should maintain the 
recumbent posture, if not in bed, at any rate on a couch. 
If this simple rule were attended to, many a miscarriage 
would be averted." 
Long railway journeys-indeed, traveling of any sort 
that involves fatigue-late hours, excitement, in fact, un- 
healthy living of every kind,, should be carefully avoided 
by any one who has a predisposition to miscarry. And of 
all things, alcoholic stimulants of every kind must only be 
taken by the doctor's'orders; and it'is. very unlikely he 
will' cyder them in such circumstances, as alcohol has a 
direct tendency to inflame the blood, and, when indulged 
in to any excess, has been known to be the sole cause of a 
miscarriage. 
The first symptom of a threatening miscarriage is a dis- 
charge of iblood from the vagina (/. e., the front passage 64 
ADVICE TO WOMEN. 
that leads to the womb). This may be very slight, merely 
a " show." It may have been preceded for a day or two 
by weariness and uneasiness, pains and aches in the back, 
abdomen, thighs, and legs. Such symptoms in pregnancy 
should always been looked upon as " danger signals." 
The sufferer should never make the foolish mistake of 
attempting to " fight them off." If she sensibly suc- 
cumbs at once, goes to bed (she should always have a bed 
to herself on such occasions*), and keeps lying quiet, the 
threatening symptoms may disappear, and she may be all 
right in a few days. 
The discharge may, however, be more than a mere show. 
Whenever this is so, the doctor should at once be sent for> 
and the patient should lie on her back in bed on a rather 
hard hair mattress. A wool mattress or feather-bed 
should, if possible, not be used; they are much warmer 
and more enervating than a mattress made of horse-hair. 
The room and patient must both be kept very cool and 
as quiet as possible; the diet must be light and unstimu- 
lating-milk, milk puddings, a little beef-tea, or light fish, 
such as whiting, with, of course, no stimulants whatever. 
The less the bowels act for a day or two, the better, and 
no medicine to cause them to do so should be given unless 
j by the doctor's orders. A bed-pan must always be used, 
as the patient should not get up for any purpose. The 
doctor will probably prescribe a few drops of laudanum or 
other sedative, and by being treated thus and taken in time 
the patient may be saved from miscarrying, and in the 
course of a week or so may be able to be up and about 
* This is very important for women who are prone to miscarry. ADVICE TO WOMEN. 
65 
again. Having once had such symptoms, however, she 
must take great care of herself during the rest of hex* preg- 
nancy; any indiscretion or slight accident may cause the 
symptoms to recur. 
Sometimes, instead of a slight discharge, there may be 
a violent attack of hemorrhage or flooding, which may 
come on suddenly. It is most important to know how 
this should be treated, as it is a very serious matter. 
A doctor should immediately be sent for-the nearest 
doctor, so that no time may be lost-and he should be sent 
for, if possible, by a message in writing. This is always 
important to remember in sending for a doctor in a case 
where every moment is precious; if he knows the nature 
of the-case, he will knoyy what to bring with him, and so 
loss of time in sending for remedies or instruments is 
avoided. 
The patient should, in the meantime, be Iti&flat on her 
hack, with her head Iqw, and a pad or pillow under the 
small of the back, so as to incline the body backward. 
The object of this is the same as in fainting-to keep the 
blood circulating through the brain, so that the patient 
may be kept as long as possible from losing consciousness. 
The room must, of course, be kepi; very cool, all the 
patient's clothing loosened, and'as much of it taken off as 
can be removed, and cloths wrung lightly out of vinegar 
and water should be applied fronj time to time all round 
the region of_ the womb, and to the part from which the 
blood is rushing. They should be frequently renewed, so 
t[iat they may be cold. A sponge or diaper soaked in weak 
vinegar and water, or weak Condy's fluid and water, may 66 
ADVICE TO WOMEX. 
be gently pushed up the front passage from which the 
blood is flowing. This can easily be done without force or 
violence, with a little presence of mind, common sense, 
and freedom from panic. The object is to restrain the 
hemorrhage as much as possible until the doctor's arrival, 
as he alone can properly treat such a case. These last 
measures, it must be remembered, are only to be taken in 
the event of actual flooding, not when there is merely a 
little gush of blood, which quietness, resting flat on the 
back, and keeping the room and person cool, will probably 
arrest until the doctor has suggested further treatment. 
If, without being an actual downright flooding, the dis- 
charge of blood should be severe, and pain should come 
on, particularly if the pain is of a forcing character, it 
generally means that the embryo has been separated from 
the mother's womb. When this has taken place, of course 
no treatment can prevent a miscarriage, because the 
embryo can not exist apart from the mother, and, sooner 
or later, it will be discharged from the womb-the sooner, 
in these circumstances, the better. When a miscarriage 
takes place during the early months, it will be often diffi- 
cult, if not quite impossible, for an inexperienced eye to 
detect the embryo among the clots of blood, which are 
usually passed from the womb at the same time. Every- 
thing, therefore, that comes away should be carefully kept 
for the doctor's inspection. Serious mischief may be 
caused to the patient by the retention of those matters that 
should be expelled from the womb as soon as possible; for 
this reason, the attendant should always be most particular 
to see that the doctor inspects the diapers, or anything ADVICE TO WOMEN. 
67 
else, in which the discharges have been received. The 
after-treatment of a miscarriage or premature confine- 
ment should be managed on the same plans (particularly 
with regard to the use of antiseptics aud res/) as are 
detailed in Chapters IX. and X., where the management 
of a confinement and the care of the health after it are 
considered. Many women imagine that a miscarriage that 
comes on during the early months of pregnancy is of very 
little consequence. This is a profound mistake. Any 
miscarriage, no matter when it comes on, is serious, and 
requires to be treated seriously. It is only people who 
have no knowledge whatever of the nature of a woman's 
internal organs who speak of " a slight mishap." Women 
should know that there is no such thing as a slight mishap. 
I have given, in the previous chapter, some description 
of .the womb. 11 we understand the nature of this'organ, 
we can see that from the time of conception it becomes 
altered, it undergoes changes from that time, and, there- 
fore, if a miscarriage takes place, after even a few weeks of 
pregnancy, a period of rest is required to allow the altered 
womb to return to its normal state. 
I would- most earnestly impress upon my readers the 
fact that every physician who has made the diseases of 
women a special study, lays it down most imperatively 
that neglected miscarriages are the cause of a large per- 
centage of these diseases. It is said that there is more 
danger in proportion to their number from miscarriages 
than from confinements, simply because they are treated 
so lightly. 
It would be impossible to give the opinions of every emi- 68 
ADVICE TO WOMEN. 
nent physician who has written on this subject; they would 
fill a volume. The following very clear advice on the 
matter, given by Dr. Cullingworth, represents the teaching 
of the entire profession on the matter: 
" The after-treatment of patients who have miscarried is 
a most important matter, and one which receives far too 
little attention. It is no uncommon thing among patients 
of the laboring and middle classes for women to go about 
their ordinary duties as early as the second or third day, 
and some do not even rest for more than a few hours. 
" Now, although this neglect of proper precaution may 
not result in any immediate ill effects, it frequently lays 
the foundation of chronic disease, with much attendant 
misery and suffering. Whenever nurses have an opportu- 
nity they should tell their patients what there is in store 
for them if they resume their ordinary duties too soon after 
such an occurrence. No absolute rule can belaid down as 
to the length of time during which rest is necessary; it de- 
pends so entirely on circumstances that vary in different 
cases. Thus, in a case of abortion during the early 
months, for instance, where the loss has been small and 
the health has not suffered, four to six days' absolute rest 
in bed, followed during the next ten to fourteen days by 
the greatest care and prudence, will, in the absence of 
special directions from the medical attendant, be generally 
found sufficient. When the health is unaffected, it be- 
comes very irksome to lie in bed for the time here indi- 
cated; nevertheless, this rule can not be neglected without 
running grave risk. Should the pregnancy be further ad- 
vanced, or the circumstances less favorable, a longer period ADVICE TO WOMEN. 
69 
of rest will be required. Where there has been severe or 
long-continued flooding, a patient is frequently reduced to 
a condition of weakness quite equal to that following an 
ordinary confinement. In such cases it is only reasonable 
to expect the same care to be exercised as after a labor at 
full term. On no account should a patient leave her bed 
after a miscarriage, so long as any discharge of blood con- 
tinues. While that persists, it is uncertain whether there 
may not be some portion of t,he after-birth or membranes 
still remaining in.the womb, in which case the patient will 
be liable to further attacks of flooding." 
This is valuable advice. Surely- it is better to endure 
the irksomeness of two or three weeks' rest than to suffer 
perhaps for many a year from chronic womb disease, with 
what Dr. Culling worth so truly calls its " attendant mis- 
ery." 
CHAPTER'VI. 
WHAT MODERN MEDICAL SCIENCE HAS DONE TO LESSEN 
DANGER IN CHILDBIRTH. 
Puerperal Fever: What it is and How it may be Prevented-The 
Story of Semmelweis, and What it teaches-Statistics of the 
Lying-in Hospitals-The Best Antiseptic for Use in Midwifery 
-What Bad Drainage may do-Advice to Those who go to 
Apartments for their Confinements. 
The word puerperal is taken from two Latin words, 
puer, " a boy," and papio, " to bring forth," and means 
simply, " pertaining to childbirth." When women are 
spoken of as being " in the puerperal state," it merely 
means that they are in the lying-in condition. - 70 
ADVICE TO WOMEN-. 
Puerperal fever means, therefore, fever associated with 
the period of childbirth. It used to be supposed formerly 
that this fever was one peculiar to the time of childbirth, 
only, that, in fact, it was in itself a specific fever, just as 
scarlet fever, typhus, or any of the other infectious fevers 
are in themselves specific fevers. 
Modern research happily shows this view to be cpmplelely 
and absolutely false. " The whole tendency of recent in- 
vestigation," says Dr. Playfair in the latest edition of his 
standard work on midwifery, " is daily rendering it more 
and more certain that obstetricians have been led into 
error by the special virulence and intensity of the disease, 
and that they have erroneously considered it to be some- 
thing special to the puerperal state, instead of recognizing 
in it a form of septic* disease, practically identical with 
that which is familiar to surgeons under the name of 
pyaemia or septicaemia." 
The word septicaemia comes from two Greek words, 
sepo, to " putrefy," and haima," blood," and it means, 
in plain English, blood-poisoning. 
The disease, therefore, commonly known as puerperal 
fever is really a fever caused, not by anything specially 
connected with childbirth, but by the introduction into the 
biood from without of some germs of putrefaction which 
set up blood-poisoning. 
How this remarkable fact was discovered, how "puer- 
peral septicaemia " (which is a more strictly accurate name 
for the disease than " puerperal fever ") is caused, and 
how it may be prevented, are subjects of the greatest 
* Septic-f, " having power to promote putrefaction," ADVICE TO WOMEN. 
71 
interest, particularly to women who are expecting to be- 
come mothers, and also to those who are going to nurse 
them. 
It is absurd to argue that the knowledge of these things 
will frighten women, and make them nervous; on the con- 
trary, this knowledge ought to do away with fear. If we 
know where our foe lurks, we can avoid him, and so we 
need not fear him. It is the enemy who may spring upon 
us unseen and unsuspected that is to be dreaded. Puer- 
peral fever jn the past was such an enemy, and so it is still 
to the ignorant. It need be so no longer, because not only 
do we now know what causes Xhis disease, but we also know 
what can be done to prevent it. 
" More," says Dr. Cullingworth, " is said to have been 
written on this than on any other disease. Doctor For- 
dyce Barker found that within the comparatively short 
period of twenty years (1854 to 1874) upward of 20,000 
pages had been published on the subject. The fact that 
scarcely anything was known about it did not in any way 
preclude vast numbers of men from propounding their 
views and theories with a dogmatism of which a sister pro- 
fession has been erroneously supposed to have a mo- 
nopoly."* 
It is only within the last twenty years, since the discov- 
eries of Professor Sir Joseph Lister, Professor Koch, M. 
* I can remember hearing educated people assert that puerperal, 
fever appeared every seven years, when the tiger had its young! 
Theie was such a dread mystery about the disease twenty-five years 
ago, and it was so fatal, that many women could not endure to 
have the subject named before them. One Dublin doctor, eminent 72 
ADVICE TO WOMEN-. 
Pasteur, and the other eminent men who have made the 
study of bacteria their specialty, that true knowledge has 
existed on the subject of the introduction of micro-organ- 
isms into the blood and the diseases caused thereby. 
In no department of medicine is this knowledge of 
greater practical value than in that which belongs to the 
treatment of women during and after confinement, and 
when this knowledge has penetrated to all classes of women 
-when all women are treated in their confinements as this 
knowledge teaches us they should be treated, then " puer- 
peral fever " will be a thing of the past, just as much as 
the plague, which in the Middle Ages ravaged England, is 
now a thing of the past, a disease of antiquity, looked back 
upon with curiosity and without fear. 
That that day has not yet arrived is unfortunately true. 
Dr. Cullingworth, in his introductory address on " Puer- 
peral Fever as a Preventive Disease/' delivered at St. 
Thomas's Hospital, at the opening of the session 1888-9, 
said, " The most reliable statistics go to show that puer- 
peral fever in one or other of its manifestations is account- 
able for at least sixty-five to seventy-five per cent, of all 
the deaths from childbirth; but happily," he goes on, after 
mentioning other causes that may lead to a fatal issue'in 
childbirth, " I hope before I conclude to succeed in con- 
in those days, committed suicide from the horror and shock caused 
by the number of patients he lost from the disease, and doctors 
used to recommend poor women to enduie any discomforts in their 
confinements in their poor cabins at home rather than risk going 
to the Lying-in Hospital, ADVICE TO WOMEN-. 
73 
vincing you that almost the whole of this mortality may in 
future be avoided, and that puerperal fever may be prac- 
tically stamped out." What woman of intelligence and 
common-sense will say that she is made nervous by hearing 
of this? Surely, better news could hardly be told to 
women. 
The story of how the real nature of this fever first came 
to be known is deeply interesting, but very sad. It was 
given at full length by Dr. Duka in " The Lancet " of 
July 31st and August 7 th, 1886, and upon it the lecture 
on its prevention by Dr. Cullingworth, referred to above, 
was based. This lecture, and. Dr. Duka's papers in " The 
Lancet," put the whole matter so forcibly that an epitome 
of them will throw as much light on the subject as volumes 
of reading: 
" In the early part of 1846 a young Hungarian, Ignatius 
P. Semmelweis, who was born in the city of Buda on July 
17th, 1818, and who had been urged by his parents to 
make the law his study, but who, accidentally hearing a 
lecture on anatomy, determined to devote himself to medi- 
cine, became assistant to Professor Klein, the head of the 
Maternity Department in the General Hospital at Vienna. 
For some years previously the mortality from puerperal 
fever in that hospital had been excessive. The death- 
rate, which during the first thirty-nine years of its exist- 
ence was only 12| per 1,000, rose to 50, and sometimes to 
more than 70 per 1,000. A peculiar feature of this in- 
crease in the mortality was that it.was most marked in 
that portion of the department where the students received 
their instruction; While in Doctor Bartsch's clinic, in which 74 
ADVICE TO WOMEN. 
instruction was given exclusively to midwives, the increase 
was comparatively slight. 
" During the six years, 1841-6, the mortality per 1,000 
in the students' clinic was 92; in that of the midwives, 
33.8. The Government issued one commission of inquiry 
after another, but no satisfactory explanation of this differ- 
ence was forthcoming. Atmospheric influences were 
clearly not the cause, and, as to overcrowding, Professor 
Klein's clinic was the less crowded of the two. It was said 
that things would be changed if the number of foreign 
students was diminished; accordingly, half of them were 
sent away, and yet the death-rate remained unaffected, and 
the bad name of Professor Klein's clinic spread to such an 
extent that patients, on finding themselves among the in- 
mates of the dreaded clinic, fell on their knees, and with 
clasped hands begged to be allowed to return to their 
homes. Occurrences like these made a profound im- 
pression, and the sound of bells which used to be rung in 
the wards when the priest was administering the last sac- 
rament to the dying-a circumstance, unfortunately, of 
almost daily occurrence-told with increasing effect on the 
sensitive mind of Semmelweis. ' I myself was terror- 
stricken,' he said, ' when I heard the sound of the bells at 
my door, a deep sigh rose in my breast for the unfortunate 
mother who was the victim to a cause hitherto unknown. 
This worked on me as a fresh incentive that 1 should, to 
the best of my ability, endeavor to discover the mysterious 
agent.' Thus he was roused to a strong determination to 
find out the cause of this fearful mortality. 
• ' He noticed.' that women who were delivered before ADVICE TO WOMEN. 
75 
arriving at the hospital-and such cases occurred to the 
number of a hundred-almost all escaped. He further 
noticed that nearly every case of protracted labor in Pro- 
fessor Klein's clinic terminated fatally, while in the Ko. 2 
clinic the duration of labor made no difference. At last 
the light dawned upon him-a friend died from the effects 
of a dissection wound. 
" The symptoms his friend's illness were identical 
with those continually observed in the puerperal fever cases 
under his care. Hero, then, was the clew. In clinic No. 
2 the patients were attended entirely by midwives, who 
had nothing to do with dissections and post-mortem exami- 
nations. In clinic No. 1 the women were delivered by 
students. A great impetus had of late been given to the 
study of anatomy and pathology in Vienna, and the stud- 
ents were diligent in their attendance in the dissecting and 
yost-nlortem rooms. All they did in the way of purifying 
themselves was to wash' their hands with soap and water. 
It became clear to Semmelweis that the poor women in 
No. 1 clinic lost their lives from the same cause as his 
fiiend, Professor Kolletschka. In May, 1847, he gave 
orders that, in clinic No. 1 every person should, before 
proceeding to examine any' patient, wash his hands in 
liquid chlorine, or chlorinated lime-water. The mortality 
at'once fell. By the following November and .December it 
had fallen to 30 per 1,000, and in the second year of the 
experiment the mortality was reduced to 12} per 1,000, a 
lower rate than prevailed even in No. 2 clinic." 
This is a wonderful story, wonderfid that in those days, 
when little o? nothing of the true nature of infection wa« 76 
ADVICE TO WOMEN. 
known, one young man should by sheer force of a feeling 
heart and his own powers of persistent observation, have 
put his finger on the secret, which was afterward to be 
made so perfectly clear. Now for the sad part of the tale, 
and it is very sad: " In the enunciation of his views/' says 
Dr. Cullingworth, " Semmelweis evoked the most bitter 
opposition. His life henceforth was a ceaseless struggle, 
an object of dislike and ridicule; he became despondent 
and irritable, until at last his mind gave way under the 
strain. But, in the meantime, he had accomplished a 
great work, not only, as Hirsch says, for the Vienna Hos- 
pital, but for mankind at large; and he has left behind 
him a name that obstetricians, and surgeons, too, should 
ever delight to honor.* The discovery, some years later," 
continues Dr. Cullingworth, " of the active part played by 
micro-organisms in the production of septicaemia furnished 
the key to the whole situation. Everything was accounted 
for. The propagation by personal contact; the manner in 
which the disease dogged the footsteps of individual prac- 
* Should not women still more delight to honor the name of him 
who was the pioneer in this greaUwork of stamping out " puerperal 
fever," which, before its cause was known, annually claimed its 
thousands of victims? Will no one take his story to heart an 1 
start a memorial to him? If it took the form of a " convalescent 
home " for poor women who, after their confinements in the ma- 
ternity hospitals, are obliged to turn out at the end of the allotted 
fortnight, and whom I have seen so often leaving hospital when 
their poor weak legs could hardly carry them back to the home 
where the hard drudgery of life was immediately to begin again, it 
would, I am sure, if he could know of it, be approved of by one 
who felt so much for the sufferings of women. ADVICE TO WOMEN. 
77 
tioners and became the scourge of lying-in hospitals; the 
fatal results of cadaveric contamination; the deleterious 
influence of protracted labor, involving as it did repeated 
examinations; the almost entire immunity from the disease 
of women confined in the streets and elsewhere, in whom 
no examination at all was made; the success that attended 
the purification of the hands by chlorine; all these facts 
were now easily explained. Already, in a well-known and 
thoughtful essay, the lijte Sir James Simpson had called 
attention to the analogies between puerperal' and surgical 
fever, and had shown not only how similar were the two 
diseases in their symptoms and the morbid lesions* they 
left behind them, but also how the anatomical condition 
of the patient is practically the same in both. Corre- 
sponding to the wound of the surgical patient, we have in 
the obstetrical always a wounded surface within the 
uterus, where the plaeentaf was attached, and very often, 
in addition to this, wounds of the cervix uteri,| of the 
vagina,|| and of the The facilities for infec- 
tion by morbid matters are thus as great after delivery as 
after a surgical operation. 
" In each case micro-organisms, if once brought into 
eon tact with the exposed surface, find a. ready entrance. 
How much the knowledge of the dependency of septicaemia 
on micro-organisms, and the methods of treatment founded 
upon it, have accomplished for surgery, 1 need not in this 
* I. e., wound, injury.' f After-birth. J Neck of the womb. 
|| Front passage leading to the womb. 
*[[ Part between the vagina and the opening to the bowels. 78 
ADVICE TO V'OMDN'. 
hospital remind you. What 1 desire to impress upon you 
to-day is that they are capable of effecting an equally 
stupendous revolution in midwifery. The old idea of 
puerperal fever was that it was sometimes the result of 
infection from without (heterogenesis), and sometimes of 
infection from within (autogenesis). 
There is now abundant evidence to show that the disease 
is always due to the introduction of pathogenetic* micro- 
organisms from without. These micro-organisms may 
either be varieties of septic bacteria or the common bac- 
teria of putrefaction. The modus operand* differs in the 
two cases. Fortunately, the same means that prevents 
the one form of puerperal fever prevents the other, what 
is required in both cases being that no micro-organisms 
shall be allowed entrance to the genital tract, either dur- 
ing or immediately after the process of parturition. 
" And now let me bring before you some of the results 
of the employment of antiseptics in midwifery. The ob- 
stetricians have been slower than the surgeons to profit by 
the teachings of Lister, and even now I am ashamed to say 
that British obstetricians-are far behind their continental 
brethren in this matter. Let me take, first of all, the 
experience of the great lying-in hospital at Vienna, the 
largest institution of the kind in the world. I have already 
recounted to you one interesting episode in its history. In 
a paper recently published, Professor Braun has given us 
a statistical statement commencing with the year 1857, 
• * Pathogenetic-i. e., producing disease; pathogenetic micro- 
organisms or germs capable of producing disease. ADVICE TO WOMEN. 
79 
when he took charge of the clinic. The account covers a 
period of twenty-nine years. During this time there were 
108,889 births in the hospital. In the first six years 
(1857-62) the mortality was 28 per 1,000. A number of 
hygienic improvements were then carried out, and the 
heating and ventilating apparatus were reconstructed. The 
consequence of these measures was a reduction of the mor- 
tality during the next eighteen years (1863-80) to 16 per 
1,000, the deaths from puerperal fever being at the rate of 
13 per 1,000.. ' 
STATISTICS OF BIRTHS AT THE IMPERIAL LYING IN HOSPITAL, 
' VIENNA. 
Mortality 
Date. 
Deliveries. 
Deaths. 
per 1,000. 
1857-62 
25,123 
722 
28 
1863-80 
68,770 
1,117 
16 
1881-85 
15,070 
107 
7 
Mortality from Puerperal Fever. 
Date. 
Rate per 1,000. 
1863-80 
. - . <. . . 11 
1881-85 
4 
Then came the introduction of antiseptics, and during 
the next five years (1881-5) the total mortality fell to 7 
per 1,000, and from puerperal fever to 4 per 1,000. It is 
worthy oFnote that during the twenty-nine years in ques- 
tion no fewer than 7,961 students attended the clinic. It 
should also be remembered that in a hospital of this kind 
there is a large percentage of dangerous and difficult 
cases. In proof of this, 1 may point out that during the 
five years (1881-85), among 15,070 deliveries, the number 80 
ADVICE TO WOMEN. 
of operations was 2,518, including nine Csesarean sections. 
These facts serve only to increase our admiration at the 
marvelous results obtained." 
Dr. Cullingworth then mentions that he has spoken first 
of the Vienna Hospital, " because its statistics deal with 
such large numbers as to have, on that account, a special 
value." He then passes on to consider the hospitals of 
Dresden, New York, Boston, and Paris, where the results 
obtained in lowering the death-rate from puerperal fever, 
since the strict use of antiseptics in every case, are equally 
" marvelous. " 
These are some of the figures: In the Boston Lying-in 
Hospital the deaths from puerperal fever in 1882 were 16; 
1883, 11; 1884, 5; 1885, 2; 1886, 0. Each year the 
knowledge of the necessity for, and the use of, antiseptics 
was increasing. 
In the New York Maternity Hospital the figures are 
equally striking. The deaths from the disease were, in 
1883, 26; in 1884, 3; in 1885, 1; in 1886, 1. 
In the Paris Maternite the mortality from all causes is 
given as follows: * 
Mortality. 
Per 1,000. 
1858-69 . . . . 
93 
1870-81 . . . . 
.' . . . 23 
1882-87 
11 
The later figures from 1882 to 1887 show hardly more 
than 1 per cent., and considering the number of cases of 
all kinds that come into a hospital in a city like Paris, we 
must wonder at such an extraordinarily low death-rate. It ADVICE TO WOMEN. 
81 
was reached, as our authority points out, when " anti- 
septic precautions were rigidly observed. "* 
" Such instances," Dr. Cullingworth proceeds to re- 
mark, "could be multiplied almost indefinitely. I. will, 
however," be says, " only inflict one more upon you, that 
of our near neighbor, the General Lying-in Hospital in 
York Road, Lambeth. Until the year 1877 this hospital 
was scarcely ever free from puerperal fever, and the mor- 
* In his -Introductory Address at the opening of the Section Ob- 
stetric Medicine, at 'the Annual Meeting of the British Medical As- 
sociation, at Nottingham, in July, 1892, Dr. Galabin, 6f Guy's 
Hospital, said: " Of more importance probably than any operative 
improvement is the saving of life likely to be obtained by the 
gradual extension and perfection of- antiseptic midwifery in private 
practice. . '. The advance attained in the course of years may 
be illustrated by the records of the Guy's Hospital Lying-in Chari- 
te which corresponds more nearly to private practice than to the 
conditions existing in a lying-in hospital. For the first 21 years of 
its existence the! total death-jate was 7.1 per l,00C, for the next 
twelve years 4.4 per 1,000, for the following ten years 3.4 per 
1,000, but for "the last three years, since -the use of mercuric chlo- 
ride as an antiseptic for hands and non-metallic instruments has 
been introduced, , it has been only 1.3 1,000, and the proportion 
of deaths fropi- Septicaemia hhs been reduced to less than one third 
of what it previously had been. Thus the mortality has been re- 
-duced to less than, one fifth of what it was. 30 or 40 years ago, 
although even the forpicr rate was not greater than that which has 
been estimated as the general puerperal mortality for the country 
at large. I think,these statistics give ground for the belief that the 
general puerperal mortality of the country is capable of still further 
reduction if stringent antiseptic precautions are universally 
adopted. Let women see that they are adopted. " 82 
ADVICE TO WOMEN-. 
tality, always high, occasionally became fearful. In 1838, 
of 71 women delivered, 19 died; in 1861, 14 died out of 
195; and in 1877, 9 out of 63. On several occasions the 
hospital had to be closed for long preiods, and thousands 
of pounds were spent on the sanitary improvement of the 
building. Since October, 1879, when it was reopened 
after having been closed for two years, the hospital has 
been conducted on antiseptic principles, the details vary- 
ing from time to time, as increased knowledge and experi- 
ence dictated. Mark the result. The total mortality, 
which from 1833 to 1860 averaged* 30.8 per 1,000, apd 
from 1861 to 1877, 17 per 1,000, has fallen during the 
last eight years to an average of 6 per 1,000. Puerperal 
fever has been almost entirely banished. Only one death 
has taken place from this cause during the last three 
years,* and it has come to be regarded as quite an unusual 
event for a patient's temperature during convalescence to 
exceed 100° F. 
"In the face of such results as these, it is surely time to 
give up talking about an autogenetic variety of puerperal 
fever. The precise character of the antiseptic measures to 
* Evep this one death here mentioned can not be regarded as a 
case of puerperal fever contracted in this hospital. I came to the 
knowledge of this curiously enough. Some time ago I was giving 
a " Maternity Lecture " in the drawing-room of a lady's house in 
a village in Kent. In the course of it I read this part of Dr. Cull- 
ingworth's address, as proving how the use of antiseptics had ban- 
ished puerperal fever from the London hospitals. After the lect- 
ure, a young lady who was present told me that she had been train- 
ing in the hospital mentioned when that death occurred in it, that 
Jt was the case of a woman who had been in labor for three or four 83 
ADVICE TO WOMEN. 
which these wonderful results are due varied in different 
hospitals, and varied, too, in the same hospital from year 
to year. It would, therefore, serve no good purpose to 
attempt to describe them in detail. The object at which 
they all aimed was the same; namely, the exclusion of 
pathogenetic micro-organisms from the genital passages. 
As to the best methods of effecting this object, there is, no 
doubt, still some difference of opinion. The best authori- 
ties, however, are, I believe, quite agreed: 
"1. That the fundamental rule in antiseptic midwifery, 
the neglect of which renders all other measures futile, is 
to insure perfect antiseptic cleanliness of the hands of the 
attendants, of any instruments or appliances that may be 
required, and of everything that is liable to be brought 
into contact with.the genital passages. 
" 2. That the most efficient antiseptic for this purpose 
at present known is corrosive sublimate.* 
days before she was brought to the hospital, who had been attended 
by several 'people outside, and therefore, of course, had been ex- 
amined repeatedly-probably without antiseptics. Does not this 
exactly bear out all that has been quoted on the subject? No 
stronger testimony to the importance-nay, the absolute necessity- 
of antiseptic treatment in midwifery can be given than this instance 
of the General Lying-in Hospital, and its three years of perfect im- 
munity from puerperal fever when under antiseptic management. 
* " It may be useful to relate here the grounds ou which corro- 
sive sublimate is now accepted as the most reliable of all known 
disinfectants. In 1874 Billroth showed that septic bacteria were 
killed by a solution of corrosive sublimate 1 in 9,600, and in 1881 
the researches of Koch as to the relative power possessed by vari- 
c 84 
•ADVICE TO WOMEN. 
" 3. That the best method of insuring antiseptic clean- 
liness of the hands is to wash them thoroughly with soap 
and warm water, using a nail-brush vigorously, and then 
to rinse them carefully, again with the help of a nail- 
brush, in a solution of corrosive sublimate, 1 in 1,000. 
. . . As a disinfectant for the hands, instruments, and 
other appliances, corrosive sublimate is perfectly free from 
danger, and at present stands unrivaled. I plead to-day," 
says Dr. Culling worth, in concluding this address, " for the 
more general adoption of antiseptics in midwifery. The 
lying-in hospitals have very properly led the way; but, 
although many private practitioners have taken the matter 
up with enthusiasm, the practice of antiseptic midwifery is 
as yet far from being universal. There is still a notion 
abroad that this question of puerperal fever is one that 
chiefly concerns the lying-in hospitals. It is obvious, 
however, that the 2,708 deaths from puerperal fever reg- 
istered in England and Wales in 188G could not all be 
hospital cases. As a matter of fact, nearly two thirds of 
them occurred in counties where not a single lying-in hos- 
pital exists; and even as to the remaining third, the lying- 
in-hospitals of this country are so few in number, and so 
ous reputed antiseptics in the case of the spores and bacilli of an- 
thrax, established the superiority of sublimate in a most remarkable 
manner. The spores of anthrax are exceedingly tenacious of life, 
probably surpassing in this respect any germs of micro-organisms 
hitherto known. A solution of carbolic acid 1 in 20 required two 
days to kill them, yet a momentary contact with a solution of cor- 
rosive sublimate, 1 in 5,000, sufficed to destroy them immediately." 
-British Medical Journal, October 6th, 1888. ADVICE TO WOMEN. 
85 
comparatively small in size, that they can not possibly be 
accountable for more than an inconsiderable proportion of 
the cases. A certain number, no doubt, occurred in the 
< i 
work-houses, but the immense majority took place in the 
patients' own homes. The only way to avoid this terrible 
mortality, and to avoid also the enormous amount of puer- 
peral disease which, because it is not fatal, remains unre- 
corded, is for every practitioner in midwifery to recognize 
his personal responsibility in the matter." 
Now, I maintain that loomen themselves have a 
responsibility in this matter also. They should not be 
content passively to allow their lives to lie in the hands of 
others who may-or may not-choose to use antiseptics. 
Women who are expecting their confinements should 
satisfy themselves beforehand that the doctor and the 
nurse engaged to attend will conscientiously use these 
safeguards. z 
" The essential antiseptic measures," continues Dr. 
Cullingworth, " are very simple, and their habitual em- 
ployment is by no means burdensome. A pint of corrosive 
sublimate solution of the proper strength (1 in 1,000) can 
be prepared in a minute or .two from a ten-grain powder, 
a dozen of which can be put in a little box and carried in 
the pocket. In the powders supplied by my direction to 
the obstetric clerks in connection with our own maternity 
department at St. Thomas's, the ten grains of corrosive 
sublimate are mixed' with fifty grains of tartaric acid and 
a grain of cochineal.* 
* This is the prescription given for No. 7 in the list in Chapter 
VIII. 86 
ADVICE TO WOMEN. 
" The tartaric acid increases the bulk of the powder, 
and, what is more,important, lessens the risk of a portion 
of the mercury being lost by precipitation, either from 
being formed into an insoluble, albuminate, or from the 
alkalinity of the water, as in the case of London. The 
cochineal is, of course, merely a coloring agent to prevent 
the solution being mistaken for anything else. 
"A solation of corrosive sublimate does not, like sola- 
tions 'of potassium permanganate, lose its antiseptic 
property after being once used. It is, therefore, usually 
sufficient to prepare a supply on entering the lying-in 
room, to renew it when the labor is over, and afterward to 
prepare a fresh solution once a day. The solution should 
be placed in a small bowl on the wash-stand by the side of 
the wash-hand basin, and kept there ready for immediate 
use, from the time the first internal examination is made 
to the end of the puerperal'week. 
" The best antiseptic lubricant with which we are at 
present acquainted is a solation of corrosive sublimate in 
glycerine, 1 part to 1,000, and this also can be easily car- 
ried about in a suitable and well-secured bottle. In Ger- 
many the use of antiseptics in private midwifery practice 
is a matter of State regulation. You are, no doubt, aware 
that it is the custom in that country for all classes to be 
attended in their confinements by midwives, the doctors 
being summoned only in cases of difficulty or danger. 
Every midwife is compelled by law to carry with her a bag 
containing ... all the apparatus necessary for disin- 
fection, including the indispensable nail-brush; and to 
give completeness to the arrangements, thdre is in every ADVICE TO WOMEN-. 
87 
bag a book of instructions. If any midwife fails to use 
these things, she is liable to punishment. The tendency 
of public opinion in this country is not in the direction of 
compulsory legislation in such matters. use of anti- 
septics in Great Britain is, and is likely to remain, a ques- 
tion of individual responsibility, not of penal enactment. 
Surely, it ought not on that account to be considered the 
less binding." 
My chief object irM writing these pages is to impress upon 
women that they should' recognize an individual responsi- 
bility ;in this matter,-and .should not leave it altogether in 
the hands of those who are going to attend them. 
Dr. Cullingworth, writing ip 1888, said, as quoted above, 
" the practice of antiseptic midwifery is, assyet, far from 
being universal," though, no doubt, every year sees the 
practice becoming more' universal, still even now it is not 
entirely so. I lately heard a doctor pooh-pooh the neces- 
sity itffthe use of disinfectants in confinements. 
I ca'n only say that every-woman who reads this chapter 
see what an overwhelming amount of evidence is 
brought forward to prove that the use of antiseptics in 
midwifery is absolutely essential for safety. If in spite of 
it there is to be found a woman who will not trouble her- 
self to make sure that in her confinement she is treated on 
antiseptic principles, she has but herself to thank if she is 
the victim of blood-poisoning. If women, as 1 think they 
should, understand clearly the necessity for such treat- 
ment, we shall,- before long, find that the practice has be- 
come universal. It is with the hope of furthering this 
end that I have endeavored to make this teaching-taken 88 
ADVICE TO WOMEN. 
from the best authorities-as clear as possible. It may be 
well to mention that some medical attendants occasionally 
prefer another antiseptic than that mentioned above. In 
such a case the patient and nurse are of course bound to fol- 
low the wishes of the doctor who has charge of the case, be- 
cause he may have special reasons of his own for preferring 
to employ some other antiseptic. The reason I consider it to 
be a duty for women to have a disinfectant, as mentioned 
in the list in Chapter VIII., ready prepared beforehand 
when a confinement is expected, is that in these cases there 
is no telling when an emergency may arise in which, per- 
haps, a strange doctor or nurse may have to be called in 
at a moment's notice. A doctor suddenly summoned to a 
case for which he had not previously been engaged can not 
be expected, as a matter of course, to carry disinfectants 
in his pocket. Therefore, if the patient has done her duty 
to herself, and has the required preparation ready for use 
without the delay of having to send for it, the basin con- 
taining the disinfectant may be presented to the doctor, 
who will, no doubt, come to the conclusion that he has a 
sensible woman to deal with, and will be very glad to 
make use of it. 
There is one other preventible cause of puerperal fever 
besides that which has been considered. It is very impor- 
tant that women should be warned about its danger, as it 
lies in their power to have it removed, or to remove them- 
selves from it. This cause is bad drainage. 
Dr. Playfair, in an address to a branch of the British 
Medical Association, in 1887, spoke as follows: 
" I therefore resolved to direct your attention to a ADVICE TO WOMEN. 
89 
hardly appreciated source of septic disease to which 1 have 
myself traced many otherwise inexplicable cases of septicae- 
mia in childbirth, and to which my attention has been 
more particularly di;awn within-the last few ihonths, from 
the fact that I have had the misfortune to meet' with what 
I believe to be a well-marked instance of it in the person 
of the wife of an esteemed professional friend, whose ter- 
rible illness was traced to this source. 1 refer to the pois- 
oning of lying-in women from sewer-gas, conveyed to the 
house in consequence of defective sanitary arrangements. 
Ilere, at least, is a topic which must interest you all, for 
if there is one thing more than another which the prac- 
titioner has to dread, it is the development of this insidious 
and terrible illness after delivery, defying, as it so often 
does, the most strenuous and best-directed treatment, deso- 
lating happy homes, and too often leading to most unde- 
served blame and injury to the medical man who has the 
misfortune to meet with a case in his practice." 
Surely, if this is " a topic which must interest " doctors, 
it is also one which must interest patients-particularly as 
the causes that may lean to this dreadful kind qf poisoning 
are often quite within the power of intelligent women to 
discover and have removed. 1 r 
In-Dr. Playfair's work on "The Science''and 
of Midwifery " are given several very remarkable in- 
stances, proving conclusively that an escape of sewer-gas 
into the lying-in room is of itself quite sufficient to set up . 
puerperal septicaemia. It is his expressed opinion that 
posure to sewer-gas may produce the disease. " In twb 
cases of the kind I had the opportunity of watching," he 90 
ADVICE TO WOMEN. 
says, " an untrapped drain opened directly into the bed- 
room- in one instance into a bath, in the other into a w. 
c. Both cases were indistinguishable from the ordinary 
form of the disease, and in both improvement commenced 
as soon as the patient vyas removed into another room. In 
a case 1 saw some, years ago in Notting Hill, the patient, 
who had been confined within a week, had all the symp- 
toms of a most intense attack of septicaemia, but none of 
a diphtheritic character, while her husband lay in an ad- 
joining room suffering from a diphtheritic sore throat. 
Here the waste-pipe of the bath was found to communicate 
directly with the sewer. In spite of her intense illness, I 
had the patient removed to another house, and from that 
moment she began to improve. " 
" In another case," says Dr. Playfair, " a lady was con- 
fined in the country of her first -child, in a large and ex- 
pensive house, newly built, and supposed to be supplied 
with all the most perfect sanitary arrangements. There 
was nothing particular about the labor, and for the first 
ten days the convalescence left nothing to be desired. On 
the eleventh day she got up and lay on the sofa opposite 
the fire in the bedroom, which, as it was January, was 
burning night and day. The day after, although she had 
a headache and felt poorly, she again got up and lay on 
the sofa. The subsequent day, although feeling very ill, 
she again insisted on getting up, and lay on a sofa opposite 
the fire in her husband's dressing-rocm. On the following 
day she was very ill indeed, with a temperature of 104° 
and pulse 130. 1 was summoned, and was satisfied it was 
paused by defective sanitation. I advised her removal to ADVICE TO WOMEN. 
91 
a.house in the neighborhood, in spite of the very grave 
symptoms that existed, with the m >st satisfactory results, 
for within twenty-four hours her temperature had fallen, 
and she rapidly became convalescent. Of course, at this 
time nothing was known of what actually existed, but I 
was.led to form the conclusion, from the fact that a num- 
ber of the servants and residents Were suffering from sore 
throats, and from being told tftat almost every one- who 
came to stay felt ill and out of sorts. Subsequently the 
sanitary state of the house was thcrortgbly investigated by 
one of the most distinguished sanitary engineers in Lon- 
don. It is useless to enter into a description of all the 
abominations that were found to exist, which, in a house 
of the kind, in the building of which no expense was 
spared, were almost past belief. For the purpose of my 
story it will suffice to say that the smoke test showed that 
there as a very abundant escape of sewer-gas into both 
the bedroom and 3ressing-room, which, from the fact that 
there were large fires burning constantly in.both rooms, 
passed in a ' continuous current ' from the door to the 
chimney, the bed standing at one side of the large room, 
quite out of the way of this current, whereas the sofa stood 
before the fire, directly in it. . / - • 
"In additionbthe plumbing work in the closet in the 
dressing-room had been so imperfectly done, that its con- 
tents found their way out under the floor. Now, mark 
how thoroughly and curiously these facts prove the cause? 
of the disease. The patient lay in the bed, which, from 
the accident of its being winter, and the current of sewer- 
gas being drawn therefore to the chimney, was quite out 92 
ADVICE TO WOMEN. 
of its reach, and for the first ten days after her confine- 
ment, while she remained in bed, she was perfectly well. 
On the eleventh day, when she got up, she was placed 
directly in the current of sewer-gas (on the sofa in front of 
the fire) and instantly got poisoned. On the twelfth and 
thirteenth days she was again exposed to the absorption of 
further and more intense poisoning, while immediately on 
her removal to fresh and uncontaminated air all her 
threatening symptoms disappeared. Remark, also, that 
there was nothing peculiar in the symptomatology, nothing 
different from an ordinary and rapidly progressing case of 
puerperal septicaemia. It seems to me that this instructive 
history is about as complete a demonstration of the origin 
of puerperal disease from defective sanitation as any one 
could possibly desire, andJ can see no flaw in the chain of 
evidence." 
Who will say that this is a subject which is of no inter- 
est to women? Is it not of the very last moment to every 
woman who is likely to become a mother, and not only to 
her, but to her husband and relations, to know this simple 
but very, important fact, that seicer-gas escaping into the 
house is very likely, if not absolutely certain, to set up 
blood-poisoning in a woman after her confinement? 
The history of these illnesses is not given to frighten, 
but to warn and teach, and a very important lesson they 
teach, i. e., that prevention is better than cure. It is in- 
finitely better {and how much easier!) to have the drains 
put right in time, than to have to carry the patient in 
high fever out of the house to another at a distance. 
If there is any doubt at all about the sanitary condition ADVICE TO WOMEN. , 
93 
of the house in which a confinement is expected, it should 
be seen to, and put to rights at once. It is after confine- 
ment that the danger is most likely to develop, because 
the body then is in a more susceptible state than it was 
before, but living before confinement in an atmosphere 
poisoned with sewer-gas is dangerous, as the poison may 
accumulate in the system to develop afterward. 
If there have been several cases of sore throat, diarrhoea, 
or general malaise in the family, something ,wrong with 
the drains may be'suspected,, and, if possible, it would be 
better for the confinement to take 'place in some other 
house than ohe in which such are manifested. 
In any case, the drainage of such a house requires immedi- 
ate overhauling by a competent person. 
As defective drainage is sq serious a danger at the time 
of confinement, it may be useful to give here a few general 
hints on the subject of house drainage in general, so that 
the inexperienced in this important matter may know at 
least'where the chief dangers lie. x 
In the first place, it ought to be distinctly understood 
that water-closets should mver be built in the center of the 
house, the drain-pipes should never run under the house, 
and the pipes from the waiter-closet should always run 
down the outside of the house. Having the?water closet 
ahd its pipes in the center of the house is, as Dr. Playfair 
has remarked, " quite incompatible with perfect sanita- 
tion.'* ' .. , ' . r _ 
Now these defects, at least, as regards the w. c. and.' 
pipes in the middle of the house, are apparent to every 
eye. The most inexperienced in house sanitation, if they 94 
ADVICE TO WOMEN". 
are made aware of the danger of a house built in this way, 
can avoid it. In choosing a house for the newly married, 
the utter unsanitariness of such an arrangement should 
always be borne in mind. It is always well, in taking a 
new house, that " a plan of the drains " should be asked 
for. How many tragedies of disease and death might be 
avoided if gay young couples,-who are looking out for a 
cozy nest in which to settle, would make the drainage, not 
the drawing-room, the first consideration. Young house- 
wives should also remember that the " traps" (z. e., the 
little iron gratings which are to be found in the basements 
and yard, and through which waste water, etc., runs into 
the drains) aie always in good order, covered with water, 
and are not choked with sand, grease, etc. by servants. 
Too often sewer-gas is allowed to enter the house by the 
carelessness and inattention of the mistress and servants 
with regard to the traps in the basement. The master's 
or mistress's eye should also observe if the w. c.'s are well 
supplied with water and constantly flushed. If the traps 
are always covered with water, and the drains kept well 
flushed, along step is taken toward preserving the house 
in sanitary order. Besides this, it is quite easy for any one 
with "intelligence, no matter how inexperienced, to see for 
themselves where the pipe that carries the waste water 
from baths and sinks, etc. ends. Such pipes should never 
run into the sewer or drain; they should be raised a few 
inches over the trap, and should open over it. 
If the house is so constructed that no drains run under 
it, there can never occur the danger of leakage under the 
basement from defective joints in the drain-pipes. If such ADVICE TO WOMEN-. 
95 
leakage occurs under the floor of the basement, it may 
cause serious mischief. Defects like this, of course, re- 
quire an experienced person to discover. 
If rats are found in a house,'it may nearly always be 
taken as a sign that there is something wrong with the 
drains. These creatures often work their way through the 
■'drains, causing openings from the drain into the basement. 
Their presence should always be regarded as a danger sig- 
nal. ; 
In concluding this chapter, I will give a word of warn- 
ing to any one who is contemplating going "to lodgings for 
her bonfinement. \ ; 
•<- Frequently pedple come from the country to London, or 
other large townsr to be confined, in order to have good 
medical advice, etc. In choosing lodgings,-what has bepif 
already said about drainage should bo borne in mind. 
Rooms for a confinement should not be taken in a house 
that has thp w. c. built in the middle of it. The w. c. 
shout/ be go placed that its principal wall -is an outside 
one, and down this wall the soil-pipe should run. Some 
guarantee of the sanitary state of the house and the 
i 
healthiness of its inmates should also be obtained; also of 
the general salubrity of the neighborhood, and if the water 
i s good* 
These are points that it may take a little trouble to dis- 
. cover, but surely the trouble is nothing compared to the 
risk of illness and even death. 
If the medical officer of health in the neighborhood be 
applied to, trustworthy information can be gained. 
There is one other thing that should always be carefully 96 
ADVICE TO WOMEN. 
inspected in taking furnished apartments for a confine- 
ment. 
That is the bed. 
I will mention here a story on this subject, as it was told 
tome; it requires little comment, and in its mere state- 
ment it ought to be warning enough. 
A lady came to town to be confined; a friend engaged 
apartments for her. After the confinement she fell ill, 
and died of puerperal fever. 
After she was dead her friends bethought themselves to 
examine the bed which she occupied, and they found the 
mattress stained with blood, and evident traces that the 
bed had beeh used before in a confinement, and had not 
been even cleaned. 
If the ordinary precaution had been taken of examining 
the bed before the confinement, not after the death, the 
poor young woman's life would probably have been saved. 
CHAPTER VII. 
WHAT MODERN MEDICAL SCIENCE HAS DONE TO LESSEN 
SUFFERING IN CHILDBIRTH. 
Difference in the Treatment of Confinements Now and Formerly- 
| Story of the Death of the Princess Charlotte of Wales, and 
What It Teaches-The use of Forceps and Anaesthetics in Con- 
finements-Foolish Prejudices against Them-Importance of 
good Medical Attendance in Confinements. 
" Those who have studied the progress of midwifery," 
says Dr. Playfair. " know that there is no department of 
medicine in which more has been done of late years, and ADVICE TO WOMEK. 
97 
none in which modern views of practice differ more widely 
from those prevalent only a short time ago." 
For this the women of the present day have cause to be 
profoundly thankful. When we contrast a confinement 
managed on the humane and common-sense principles 
which the science of to-day dictates, with one managed ac- 
cording to the teaching that obtained some years ago, we 
can hardly repress a shudder at what the unfortunate 
women of those days had to endure. 
The teaching then was that " interference with nature " 
was bad and dangerous., Women were oftpn allowed to 
linger actually for days in labor without a hand being 
stretched out to relieve them. Anaesthetics in midwifery 
. were unknown, and when delivery by forceps was at length 
in some cases decided to be unavoidable, lhe unfortunate 
patient had to submit to the operation without any of the 
blessed unconsciousness to suffering'that can now be ob-. 
tamed the poorest hospital patient. 
There is on record a most melancholy case, whiqh clearly 
proves how fatal was the ignorant old notion that in child- 
birth nature should not be assisted by art, i£ unassisted 
nature could possibly effect delivery. 
It is the case of the Princess .Charlotte of Wales; whose 
death created such profound national sorrow in the year 
1817. 
Dr. Playfair has published, in a recent edition of his 
work, a letter from one of the doctors who was, with the 
princess at the time of her death, and which is not only 
interesting from a historical point of view, but also as 
illustrating the value of the great changes that have taken 98 
Advice to women. 
place in the theory and practice of midwifery during the 
last half century. 
As I am sure that the story will interest all women, be- 
sides showing them how much they should rejoice that 
they are not living in those " good old days/' I will copy 
the letter here, with Dr. Playfair's remarks on it, and also 
one or two extracts from the memoirs of Baron Stockmar, 
who was the princess's husband's German physician. 
Writing on the danger of allowing lingering labors to 
continue without assistance, Dr. Playfair says: " It may, 
perhaps, be of interest in connection with this important 
topic if 1 reprint a letter I published ih the ' Medical 
Times and Gazette.' A historical case, such as that of 
which it treats, will better illustrate the evil effects that 
may follow unnecessary delay, than any amount of argu- 
ment. It seems to me impossible to read the details of 
the delivery it describes without being forcibly struck with 
the disastrous results which followed the practice adopted, 
which, however, was strictly in accordance with that con- 
sidered correct, up to a quite recent date, by the highest 
obstetrical authorities. { 
ON THE DEATH OF THE PRINCESS CHAR- 
LOTTE OF WALES. 
" ' To the Editor of The Medical Times and Gazette. 
" ' Sir,-The letter of your correspondent, " An Old 
Accoucheur," regarding thejdeath of the Princess Char- 
lotte, raises a question of great interest-viz., whether the 
fatal result might have been averted under other treat- 
ment? The history of the case is most instructive, and I ADVICE TO WOMEN. 
99 
think a careful consideration of it leaves little room to 
doubt that, though rhe management of the labor was quite 
in accordance with the teaching of the day, it was entirely 
opposed to that of modern obstetrical science. The fol- 
lowing account of the labor may interest your readers, and 
will probably be new to most of them. It is contained in 
a letter from Doctor John Sims to the late Doctor Joseph 
Clarks, of Dublin. 
" ' London, November 15, 1817. 
• '■ * 
" ' My dear Sir,-I do not wonder at your wishing to 
haye a direct statement of the labor of Iler Royal High- 
ness the Princess Charlotte, the fatal issue of which has 
involved the whole nation in distress. You must excuse 
my being very concise, as 1 have been, and am very much 
hurried. I take the opportunity of writing this in a lying- 
in chamber. Her royal highness's labor commenced by 
the discharg>-ot the liquor amnii,* about seven o'clock on 
Monday evening, andjthe pains followed soon after. They 
continued through the night, and a greater part of the 
next day, sharp, soft, but very ineffectual. Toward«even- 
ing Sir Richard Croft began to suspect that labor might 
not terminate without artificial assistance, and a message 
was dispatched for me. I arrived at two o'clock op Wed- 
nesday morning. The labor was now advancing more fav- 
orably, and both Doctor Baillie and myself concurred in 
(be opinion that it would not be advisable to inform her 
royal highness of my arrival. From this time to the end 
of her labor the progress was uniform, though very slow, 
the patient in good spirits, the pulse calm, and there never 
* Popularly called " the waters," 
L 100 
ADVICE TO WOMEN. 
was room to entertain a question about the use of instru- 
ments. About six in the afternoon the discharge became 
of a green, color, which led to the suspicion that the child 
might be dead; stil], the giving assistance was quite out of 
the question, as the pains now became more effectual, and 
the labor proceeded regularly, though slowly. The child 
was born without artificial assistance at nine o'clock in the 
evening. Attempts were made for a good while to reani- 
mate it by inflating the lungs, friction, hot baths, etc., but 
without effect-the heart could not be made to beat even 
once. Soon after delivery Sir It Croft discovered that the 
uterus was contracted in the middle in the hour-glass 
form, and as some hemorrhage commenced, it was agreed 
that the placenta should be brought away by introducing 
the hand. This was done about half an hour after the de- 
livery of the child, with more ease and less blood than 
usual. < 
" ' Iler royal highness continued well for about two 
hours; she then complained of being sick at stomach, and 
of noise in the ears, began to be talkative, and her pulse 
became frequent; but I understand she was very quiet after 
this, and her pulse calm. About half past twelve she 
complained of severe pain in the chest, became extremely 
restless, with rapid, weak, and irregular pulse. At this 
time I saw her for the first time. It has been said that we 
had all gone to bed, buMhat is not a fact; Croft did not 
leave her room. Baillie retired about eleven, and 1 went 
to my bed-chamber and lay down in my clothes at twelve. 
By dissection, some bloody fluid, two ounces, was found in 
the pericardium, supposed to be thrown out in articulQ ADVICE TO WOMEN. 
101 
mortis. The brain and other organs all sound, except the 
right ovarium, which was distended into a cyst, the size of 
a hen's egg. The,hour-glass contraction of the uterus still 
visible, and a considerable quantity of blood in the cavity 
of the uterus, but those present dispute about the quantity 
so much as from twelve ounces to a pound and a half, her 
uterus extending as high as her navel. The cause of her 
royal highness's death is certainly somewhat obscure; the 
symptoms were such as attend death from hemorrhage, 
but the loss of blood did not seem to be sufficient to ac- 
count for fatal issue. It is possible that the into 
the pericardium took place earlier than was supposed, and 
it does not seem to be quite certain, that this might not be 
the cause. That I did not see her royal highness more 
early was awkward, and it would have been better that I 
had been introduced before the labor was expected, and it 
should have [been understood that when labor came on I 
should bt/sent for without waiting to know whether a con-, 
sulfation was Accessary or lYOh . I thought-so at the time, 
but'X. could not propose such an arrangement to Croft.1 
But'this is entirely entre nous. I am glad to hear that 
your son is well, and-, with all my family, wish to be re- 
membered to him. We were luyopy to hear that, he was 
agreeably married. I remain,, my dear doctor, eve)* yours 
most truly, / ' , 
. ' - , " ' John1 Sims, M. D. 
'' ' This letter is confidential, as perhaps I might be 
blamed for writing any particulars without the permission 
of Prince JlieopOld.' 
" What are the facts here shown? Here was a delicate 102 
ADVICE TO WOMEN. 
young woman prepared for the trial before her, as Baron 
Stockmar tells us, by ' lowering the organic strength of 
the mother by bleeding aperients and low diet,' who was 
allowed to go on in lingering, feeble labor for no less than 
fifty-two hours after the escape of the liquor amnn. Such 
was the groundless dread of instrumental interference then 
prevalent, that although the case dragged on its weary 
length with feeble, ineffectual pains, every now and then 
increasing a little in intensity, and then falling off again, 
it is stated ' there never was room to entertain a question 
about the use of instruments/ And even ' when the dis- 
charge became of a green color . . . still the giving 
of assistance was quite out of the question!' Can any 
reasonable man doubt that if the forceps had been em- 
ployed hours ancl hours before, say on Tuesday, when the 
pains fell off, the result would probably have been very 
different, aud that the life of the child destroyed by the 
enormously prolonged second stage would have been saved? 
It must be remembered that early on Tuesday morning 
delivery was expected, so that the head must then have 
been low in the pelvis. (Vide ' Stockmar's Memoirs,' 
vol. i. p. 63.) It would be difficult to find a case which 
more forcibly illustrates the danger of delay in the second 
stage of labor. Then what follows? The uterus, ex- 
hausted by the lengthy efforts it should have been spared, 
fails to contract effectually; nor do we hear of any at- 
tempts to produce contraction by pressure. The relaxed 
organ becomes full of clots, extending up to the umbilicus, 
and all the most characteristic symptoms of concealed post- 
por turn hemorrhage develop themselves. She complained ADVICE TO WOMEN. 
103 
of being sick at stomach, and of noise in her ears; began 
to be talkative, and her pulse became frequent. Before 
long other symptoms came on, graphically described by 
Baron Stockmar, and which seem to point to the forma- 
tion of a clot in the heart and pulmonary arteries-a most 
likely occurrence after such a history. ' Baillie sent me 
word that he wished me to see the princess. I hesitated, 
but at last went with him. She was suffering from spasms 
of the chest and difficulty of breathing, in great pain, and 
very'restless, and threw herself continually from one side 
of the bed to the other,-speaking now to Baillie, now to 
Croft. Baillie'said to her, " Here comes an old friend of 
yours." She held out her left hand to me hastily, and 
pressed mine warmly twice. I felt her pulse; it wasugoing 
very fast, the beats now strong, now feeble, now intermit- 
tent.' Here was evidently something different from the 
exhaustion of hemorrhage, and no one who has witnessed a 
case of,-f)ulmonary obstruction can fail to recognize in this • 
account an accurate delineation of its dreadful symptoms. 
Surely, this lamentable story can only lead to the conclu- 
sion that the unhappy and gifted princess fell a victim to 
the dread of that bugbear, 'meddlesome midwifery,' 
which has so long retarded the progress of obstetrics. I 
am, etc., > y 
r ' ' " W. S. Playfair. 
" November 29th, 1872."- 
ffn Baron Stockmar's diary the sad story is graphically 
told 
. " Although the first pains were unusually slight, and 
the labor therefore progressed but slowly, yet, during the 104 
ADVICE TO WOMEN. 
night of the 3d to 4th, all had gone on so far well that a 
happy termination was expected within the next six hours, 
and the great dignitaries of State necessary to attest the 
birth, the' Archbishop of Canterbury, etc., were sum- 
moned. This had hardly been done when, about two in 
the morning, the pains, ceased almost entirely. Although 
the strength of the princess kept up, the labor progressed 
but very solwly; the night of the 4th to the 5th passed by 
in exactly the same manner. On the 5th, toward noon, 
the pains increased, and at last, at nine in the evening, the 
princess was delivered of a fine, large, Imme- 
diately after the birth, the princess appeared quite well. 
The news of the death of her child had not particularly 
affected her. This state only lasted till midnight. Then 
Croft came to my bedside, took my hand, and said the 
princess was dangerously ill; and that the prince alone I 
must go and inform of the state of things. 
" I found him resigned to the death of the child, and 
he did not appear to understand that the state of the 
princess was very serious. In about a quarter of an hour 
Baillie sent to say that he wished I would see the prin- 
cess;" then follows the description of the state in which 
the unfortunate young woman was found by him, as 
already quoted in Dr. Playfair's letter. " Baillie kept 
giving her wine constantly," goes on Stockmar's diary. 
" She said to me, ' they have made me tipsy.' For about 
a quarter of an hour I went in and out of the room; then 
the rattle in the throat began. I had just left the room, 
when she called out loudly, ' Stocky! Stocky'' I went 
frack; she was quieter, but the rattle continued, She ADVICE TO WOMEN. 
105 
turned more than once over on her face, drew her legs up, 
and her hands grew cold. At two o'clock in the morning 
of November 6th, 1817-therefore about five hours after 
the birth of the child-she was no more." 
One would have thought that this terrible story*-the 
fifty-two hours of suffering-with its calamitous ending, 
changing the order of succession of a great dynasty, deso- 
lating the life of Prince Leopold, and bringing universal 
regret, would have caused a revolution in the midwifery 
practice of the day, but it was many years before the old- 
fashioned doctrine of the English physicians-, " never to 
use artificial means when nature could effect delivery," 
* Forceps were used for effecting delivery centuries ago by the 
early Arabian physicians, but in the ignorance and darkless of the 
Middle Ages their use was lost sight of, and they were unknown 
till, in the 17th century, Dr. Peter Chamberlin, a Huguenot refu- 
gee practicing in England, invented a pair, and imparted the 
knowledge to his three sons. This they kept as a family secret for 
many.years. _ In those days-there was-not the honorable feeling 
now existing in the medical profession, that it is degrading to keep 
foe private profit knowledge which will benefit suffering humanity. 
So for years the Chamberlins were made'rich by their special skill, . 
as it was supposed, in attending difficult labors, and one of them 
was appointed to attend the queen ip her confinements. Ultimate- 
ly one of the sons Sold the secret to several foreign physicians, and. 
from them iy gradually leaked out. In 1813, in an old country 
house near Waldon, in Essex, which nearly'two hundred years be- 
fore belonged to Dr. Peter Chamberlin, several pairs of the actual 
fpreeps used by him were discovered in a space concealed behind, a 
trap-door, and are' now in the possession of The Royal Chirurgicgl 
Society. For the principal part of this information the public aro 
indebted to Df, Aveling's researches. ■ 106 
ADVICE TO WOMEN. 
which they had faithfully adhered to in their treatment of 
the unfortunate princess, came to be recognized as mis- 
chievous, dangerous, and absurd, and it is only within the 
last half of this century that the use of the forceps* for 
lessening the duration of labor has been employed with 
frequency. 
But the crowning triumph of modern medical science in 
doing away with the sufferings of childbirth has, of course, 
been in the discovery of the use of anaesthetics, and their 
employment during labor and delivery. 
In the year 1847, Dr. (afterward Sir James) Simpson, 
of Edinburgh, impelled by his intense sympathy for the 
suffering of the women whom he attended in their confine- 
ments, essayed the use of ether to conquer the anguish of 
childbirth-and with complete success. It is a curious 
and interesting coincidence that the man who first discov- 
ered the true cause of puerperal fever, and whose discov- 
ery is gradually leading to the stamping out of that terri- 
ble disease, was also impelled to the discovery by his 
intense sympathy with the poor women who fell victims 
to it. 
These are points that women should remember, because 
we sometimes hear people speak of " men doctors," as if' 
they were quite incapable of feeling for the sufferings of 
their patients; but here are two of the most triumphant 
* Sir Richard Croft, whose mind was greatly unhinged by the 
disaster, wTas attending a lingering labor in the following Febru- 
ary, and, being in a state of dreadful nervous excitement, shot him- 
self in the night. The lady he was attending fortunately recov- 
ered. ADVICE TO WOMEN. 
107 
achievements of modern medical science, which are doing 
marvels for women in conquering disease and suffering, 
the beginnings of which we can distinctly trace to the 
sympathy of the doctor for his patient. 
It is also a coincidence worth notice that the first steps 
toward both these discoveries were taken within a year or 
so of each other. Both met at first with bitter opposi- 
tion. We have seen what the Consequences of this were to 
poor Semmelweis. Dr. Simpson had not that kind of op- 
position to encounter, but he had to meet, and even from 
some of his professional brethren, too, a certain amount of 
absurd and fanatical opposition from, those who tried to 
maintain that women were ordained by God to suffer dur- 
ing all time in childbirth, as a punishment for five's sin. 
His reply, to which" his enlightened and humane oppon- 
ents could" find no answer, is well known: " The first 
operation ever performed on man was," he said, " that 
performed on Adam, when there was removed 
from him h rib, out of which to make woman/ and before 
to operate, God himsejf cast the man into a 
deep sleep. \ ♦ 
But although Sir James Simpson* proved the value and 
blessedness of producing unconsciousness during- the birth 
of a child forty-five years ago, it is only of recent years 
ik4e of ansesthetics in confinement's has become 
really popular, and even now their use is much more 
' * Sir James Simpson was not the inventor of chloroform; it Was 
the outcome of the researches of several men during many years, 
dating from tlid beginning of this century, but he was the first tq 
make a practical use of anesthetics in midwifery practice, 108 
ADVICE TO WOMEN. 
general in the practice of doctors of the Scottish schools of 
obstetrics than in that of English practitioners. 
Many women suffer all the anguish of childbirth rather 
than have an anaesthetic, simply because they know so 
little of how this is used in childbirth, and that with- 
out their even being made absolutely unconscious, very 
great relief can be afforded by its application in proper 
hands. Chloroform administered at intervals gives this 
relief. " This intermittent administration constitutes 
the peculiar safety of chloroform administered in labor," 
says Dr. Playfair, " and it is a fortunate circumstance 
that, as yet, there is, I believe, no ease on record of 
death during the inhalation of chloroform for obstetrical 
purposes." There are, however, some women who think 
more of the advice given to them by friends than of any 
doctor's opinion. They will be guided by the talk of the 
ignorant, much more than by those who have made the 
study of medicine the chief aim of their lives. People who 
know nothing about the matter often rail against the use 
of anaesthetics in labor, and try to induce their friends to 
believe that the use of such is, if not sinful and wicked, at 
least dangerous in a terrible degree. 
With such people it is seldom of any use to reason, be-' 
cause their minds are incapable of considering both sides 
of a question, and their reasoning powers aie too limited 
to admit of their judgitfg-a question purely by the evidence 
given of its merits, but it is a pity that people who are 
capable of better things should be the victims of such ad- 
visers; therefore, to those who will listen to the voice of 
experience rather than to that of prejudiced ignorance, I 109 
ADVICE TO WOMEN. 
would say that the highest medical authorities of the day 
consider that chloroform (or other anaesthetic) if adminis- 
tered by a doctor, is of the utmost value in confinements. 
I do not say in all confinements. It is a fact that some 
women-particularly those who have had several children 
-suffer very little in their, confinements, which are so easy 
and rapid that it would be hardly worth while to employ an 
anaesthetic. But where the forceps have to be used, it is 
the undoubted opinion of all the best midwifery teachers 
that an anaesthetic is of immense service, and often absolu- 
tely necessary. ' - ' 
We know nowadays' that paz'H is not good for people. 
Long ago many really seemed to think that it was. The 
more any patient is saved from the exhausting effects of 
pain, the better recovery, naturally, will that patient 
make. This applies as much to the midwifery patient as 
to the one who has to undergo a surgical operation, and 
this, in fact, is the whole gist outlie matter. 
The woman who has "by a clever doctor been spared 
hours of agony, who has (with the help of the forceps if 
jrecdssary) been delivered under an anaesthetic before she is 
worn out > by suffering, has had her, vitality conserved, 
therefore her vital powers are ready to assist her,to rally 
from the shock to the system, which even the most pain- 
less confinement causes, and the consequence is that she 
has'what is familiarly called "a good getting about." 
What a different recovery she makes as compared with the 
Woman who 'i entirely " left to nature," those who have 
witnessed both treatments can testify, and it is for this 
reason-that- strength may be saved as well as suffering- 110 
ADVICE TO WOMEK. 
that I would strongly urge on women the importance of 
being attended in their confinements by a good doctor. 
Neither forceps nbr anaesthetics can be used by any but 
a qualified doctor. Without the help of the forceps, some- 
times the child could not-be brought into the world, but 
there is no reason; to dread the use ,of this instrument. 
It is only second to an anaesthetic in lessening suffering in 
childbirth. The doctor may sometimes direct the nurse or 
other assistant to use the anaesthetic; it is then done under 
his personal supervision. But if an unqualified person 
should be so ignorant and foolish as to attempt the use of 
such things in the absence of a doctor, the consequences 
will probably be fatal. Therefore, unless the services of 
a doctor are secured, no woman can with safety have 
chloroform in her confinement. 
There are two reasons why women often do not have a 
doctor to attend them in their confinements-one is on ac- 
count of the expense, the other is from motives of mod- 
esty. As to the first reason, I can only say that, if it can 
possibly be afforded, it is very false economy to save in 
such an important matter. The difference between good 
and inferior attendance at the time of confinement, par- 
ticularly at a first confinement, may make all the differ- 
ence between health and comfort, or the reverse, during 
the future life. It may make all the difference between a 
good confinement with a speedy recovery, and the reverse; 
there are occasions when it may make the difference be- 
tween life and death. With regard to the second reason, 
it is one with which every woman can sympathize, but still 
it must be remembered that in matters of life or death, Advice to womeX. 
111 
common sense must be used, and there is no need for the 
dreadful apprehensions of the exposure of the person which 
some people have,,and which a lady once told me " took 
all pleasure in the prospect of the baby from her, and 
caused her to feel for those who do suffer acutely, and 
unfortunately these are in the majority, and for cases 
where they spend a whole night in weeping." 
The patient may rely upon it that exposure is, as much 
as possible, guarded against by both doctor and nurse. 
CHAPTER VIII. 
LIST OF THINGS REQUIRED FOR A CONFINEMENT. 
It may be of no moment to rich people hoyv much 
money they lay out in preparing for a confinement, but in 
families where the yearly income does not amount to many 
hundreds, it_is a matter of importance that no more money 
.than je necessary shall be spent in such preparations. - 
It'is a fact that sometimes young women, who have no 
experienced friend to advise them, are induced, by people 
who ar%-interested in supplying them,"to purchase many 
articles they "do not really need. 
In this chapter will ba found a complete list of every- 
thing that is necessary foNa confinement. It includes all 
that is needed for the comfort and 'safety of the-patient, so 
that her confinement may be on those antiseptic 
principles, the importance of which will ba (if 
they were not 'understood before) by every one who has 
read the preceding chapters. 112 
ADVICE TO WOMEN". 
1. Waterproof material for protecting the bed. Macin- 
tosh sheeting for this purpose can be bought at any india- 
rubber shop. One piece, about a yard and a half square, 
and a strip about a yard wide and a yard and a half or two 
yards long, will be required. Ordinary American cloth is 
cheaper, and as efficacious. New stout carpet felt will 
protect the bed very well if neither of the others is at 
hand. 
In the maternity hospitals in Taris, squares of brown 
paper covered with pitch are used instead of macintosh 
sheeting; these are burned after use-an excellent plan in 
a hospital. I commend the idea to those xwho have to 
practice rigid economy, also to district nurses, and those 
who nurse among the poor. 
2. Three or four binders. The figure will be all the 
better for the binder being worn for three weeks after con- 
finement; it will therefore require to be washed from time 
to time. About a yard and a quarter will be sufficiently 
long for one, and it should be about eighteen inches wide. 
Stout linen toweling or jean is the best material; and un- 
less very stout, it had better be sufficiently wide to be 
folded in two lengthways. 
3. A bed-pan. This is an absolute necessity. A large, 
slipper-shaped one is the best. - A small bed-pan is very 
uncomfortable. Where economy is necessary, this kind of 
bed-pan can be used instead of a bed-bath, and placed 
under the patients thighs for washing, the water for the 
ablution being placed in a small basin, and the patient can 
be sponged or douched into the bed-pan. Where expense 
is not a great consideration, a bed-bath will be found most 113 
ADVICE TO WOMEN. 
convenient. Jt can be had from any surgical-instrument- 
maker. • ' ' -z 
The tinman should be instructed to make a tin (to hold 
three pints) in the shape of an ordinary milk-can, but 
with a flat back, no lid, a loop at the top of the back for 
hanging it up with,, and a little pipe, about an inch long 
with a tap to it, fixed into the bottom of the tin in front. 
Five feet of tubing, nozzle, and vaginal tube can be got at 
any india-rubber shop, and then the apparatus will be 
complete. 
4. A iew sheets .of cotton-wool.' This is much better 
for washing the parts with than either Sponge or flannel, 
as the pieces of wool used can be burned after washing, 
and therefore can never be the carriers of infection, which 
sponges or flannels, though clean to the naked eye, may 
sometimes be. We must never forget that the germs of 
infection are generally microscopical. 
5. A douche tin. This can be used for internal douch- 
ing or for an enema, as already, explained. One can be 
madexfor about two shillings at any tm shop, or can be 
bought complete for from five to ten shillings. The ordi- 
nary enema syringe should never be used for 
giving an internal douche, before or aft.er delivery, because 
it is impossible' to make sure that the ball of the syringe is 
clean. The way sijch a syringe is worked, by alternately 
compressing and relaxing the ball, makes' it capable of 
drafting back into it offensive matter; some of this may 
adhere to, the sides of the ball. One of the physicians of 
Queen Charlotte's Hospital said that he had known of two 
deaths from germs of infection conveyed by these india- 114 
rubber syringes. When cut open they were found to he 
filthy. 
6. One or two pounds of hygienic absorbent wood-wool, 
and a few yards of antiseptic gauze, or else a couple of 
dozen wood-wool hygienic diapers. ' 
The nurse can make the wool and gauze into large, soft 
pads, to use instead ofjinen diapers after the confinement. 
These are generally more comfortable at this-time than 
the sanitary towels bought in packets, which, however, can 
be used if preferred. Diapers that have to be sent to the 
laundry should never be used after confinement. 
7. Twelve powders, made up as follows: Each powder 
to contain ten grains of corrosive sublimate, fifty grains of 
tartaric acid, and a grain of cochineal. One of these 
powders to be dissolved in a pint of hot wateis for rinsing 
the hands of the attendants only. This recipe is Dr. Cull- 
ingworth's, 41s already given. It is a deadly poison if 
swallowed, but so would any real antiseptic be. It is the 
great safeguard against septicaemia in childbirth. It must 
of course be kept out of reach of children, and only used 
for the attendant's hands. Kings should be removed be- 
fore the hands are dipped in it, as mercury is very injuri- 
ous to gold. These powders cost about fourpence each, 
and can be had from any chemist, who, however, must be 
told for what purpose they are required, or he will not 
supply them. 
8. A bottle of sublimated vaseline. This will be re- 
quired by the doctor. 
9. A box of steel safety-pins. "These do not bend as the 
common ones do, and therefore keep the binder in its 
place much better than the ordinary ones. They can be 
had silvered, and then do not rust. 
10. Two or thtbe pennyworths of permanganate of pot- 
ash. A tea-spoonful of this put into a wine-bottle of 
water makes Condy's fluid, at a hundredth part of the ex- 
pense of buying it ready made. It is useful for putting 
ADVICE TO WOMEK. ADVICE TO WOMUfT. 
115 
into the bed-pan before and after use, for putting down 
sinks, into slop-pails, etc., and for external washing of the 
parts after confinement. It is an excellent deodorizer, but 
not a strong disinfectant. If dropped on linen, it stains it 
an ugly brown, so it must be very carefully used about the 
"bed* It must be thrown away after once using, and if 
kept for any time should be in a glass-stoppered bottle. 
11. A feeding-cup. This can be bought for a few 
pence, and should be used for drinking out of for a few 
days after confinement. It is easy to eat while lying 
down, but impossible to drink in that position, so impor- 
tant to maintain for three days after childbirth, without 
the help of a cup with a spout. 
12. Some brandy. This is only .required in case of 
emergency. - k • * .'> 
13. A small bottle of carbolic acid. This is sometimes 
needed for purposes for which the corrosive sublimate is 
not suitable, and should always be at hand. 
This is an entire Ijst of all that is needed for conduHing 
a confinement on antiseptic principles. Surely it is neither 
long nor costly. 
A good supply of bed-linen, towels, and night-dresse.s, 
will also/be required, plenty of hot and cold water, and 
two or three' basins, and a long roller-towel-its use will 
be mentioned in the next chapter. , ' \ 
Everything brought near the person of a woman in her 
confinement, I need hardly say, should be thoroughly 
clean. If everything can be washed at home it will be 
safer. Ilow can we be quite sure that infected-tilings are 
never sent laundress, and so spread infection? 
Thorough balling kills all germs of disease;- if all linen 
could bb boiled before .use, it would be safe. 1 would par- 
ticularly direct the attention of charitablb societies and 
ladies who give those "Maternity Bags" which are 
such a boon to poor women, to this point: The contents of 
these bag's should always be boiled for at least half an hour 116 
before being sent from one case to another. The women 
are always required to return the things clean, but that is 
not enough unless they have been also boiled.* 
I would also like to say a word of warning about friends 
lending one another things for use at the time of confine- 
ment. Macintosh sheetings and such things should not be 
lent from one to another unless quite clean, and then 
thoroughly scrubbed over with strong carbolic acid or cor- 
rosive sublimate and water. Enemas should not be lent 
about, but bought new. It is much safer to have every- 
thing new; but if it be impossible to avoid borrowing, 
never neglect disinfection, though you may know of no 
cause for it. 
ADVICE TO WOMEN. 
CHAPTER IX. 
GENERAL MANAGEMENT OF A CONFINEMENT-WHAT TO 
DO -IN CASE OF HEMORRHAGE. 
The Nurse-The Room-Premonitory Symptoms of Labor-False 
Pains-The First. Thing to do when Labor Commences-The 
Bed-Dress during Labor-Things to Remember while Labor is 
in Progress-Effect of Age on Labor-Its Average Duration- 
Importance of Good Binding after the Birth of the Child-What 
to do if the Doctor has not Come-Care Required Immediately 
after Confinement-What to do in case of Hemorrhage-After- 
pains-What to do if there is Difficulty in Passing Water. 
No trouble is too great to take to secure a good monthly 
nurse. In these days, when the maternity hospitals train 
such numbers every year, there ought not to be much'difii- 
culty in securing one. If possible, she ought to be in the 
house a day or two beforehand, particularly if she is a 
stranger, so that she may know where everything is, and 
* I would particularly direct the attention of ladies interested in 
district nursing to the great care that should be taken by the dis- 
trict nurse if she goes to give a helping hand to poor women after 
their confinements. If she has cases of erysipelas on her list, or 
has to dress purulent sores of any kind, she should not go near a 
lying-in woman. ADVICE TO WOMEN. 
117 
that she and her patient may get used to each other, and 
that she may be at hand directly she is wanted. 
The lying-in room, it possible, should be large; it always 
should have an open chimney, and windows that open top 
and bottom. Free ventilation and plenty of fresh air are 
of vast importance during and after confinement. Fresh 
air and good ventilation need not mean draughts. In the 
lying-in hospitals the windows are kept open night aud 
day. The room should be a quiet one, as far removed as 
possible from the noises of the house and from the w. c. 
A screen is a very useful article in the room, and there 
should always be a thermometer on the wall near the head 
of the bed, and'the temperature kept at about 60° F. A 
few days, but sometimes only a day or two before delivery) 
the wonjb §inks into the pelvis; this, which is commonly 
called " the lightening before labor/' gives a feeling of 
greater lightness and ease to the expectant mother. She 
can breathe more freely, and generally can walk vfith 
more comfort. Experienced people know that labor is 
not far off when they feel like this. Labor, of course, 
always begins with pain. Sometimes what are called 
" false pains " occur-sonie days, or perhaps even weekk, 
labor sets in; generally they are caused by 
having eaten something indigestible. They may be known 
by threes signs-first, they are nob accompanied, by any 
" show," that is, by any sign of a discharge of blood; this 
always is seen, more or less, when true labor sets in. The 
false pains are short, and come at irregular intervals; the 
true increase in length as they proceed, and return regu- 
larly. pdre fdlse are felt chiefly in front of tfie abdomen.; 
the true, more in the back. A dose of castor oil, taken in 
a dessert-spoonful of brandy, is the best cure for .these 
"false pains." When, however, it is known by "the 
show ''that real labor has begun, the nurse should, if not 
in the house, be sent for at once, and also the doctor. 
rJ?he first necessity, when labor lias is to see that 118 
the bowels are well cleared out. If this is not attended to, 
the labor may be greatly retarded by the loaded state of 
the intestines. Besides, very unpleasant consequences may 
occur while the child is being born, as the contents of the 
bowels may be expelled during the last part of the labor, 
without the patient being able to help it; and how dis- 
agreeable this would be need not be expatiated upon. A 
good nurse always prevents this by giving a full enema of 
warm soap and water directly labor begins; this is much 
better than castor oil, which may cause sickness. An 
enema, besides clearing the bowels, helps to relax the 
parts, and so to give ease. A second one may be given 
later if necessary. A warm enema is invaluable in labor. 
If the pains fall off, this simple remedy has often the effect 
of bringing them on again, and so expedites delivery. 
Care must be taken if an ehema has been given when labor 
has been going on some time, especially to a patient who 
has had several children, to use the bed-pan on the bed ; 
for if she went to the w. c., the child might be born there, 
as labor sometimes is finished very rapidly. 
The preparation of the bed is the next thing to see to. 
The mattress should be covered with a piece of waterproof 
material; over this the bed-clothes may be arranged in the 
usual way; then a second strip of waterproof, about a yard 
and a quarter wide, and long enough to reach across the 
bed, and tucked in under the mattress at each side, should 
be laid. A draw-sheet should be put over th)®: it is a 
sheet folded lengthways, one end is rolled up and tucked 
under the mattress at one side of the bed, the rest of the 
sheet is laid across the bed; both ends should be secured to 
the mattress with safety-pins. This.draw-sheet saves fre- 
quent changing of the under-sheet; if it becomes a little 
soiled, the nurse has only to unpin it, and draw a fresh 
piece under the patient, rolling up and pinning each end. 
The bed is now complete for use after confinement. 
There should now be laid upon it a blanket folded square. 
ADVICE TO WOMEN. 119 
covered with a sheet folded in the same way; on these the 
patient will lie durjng the end of the labor. When this 
sheet becomes wet with the discharges, it should be re- 
placed with another; thus the bed-clothes under the 
blanket will be kept dry and clean. * And when the child 
is born, this folded sheet and blanket need only be re- 
moved, and the patient will have the clean, comfortable 
bed to lie on without being disturbed by changing sheets. 
A stout roller towel should be fastened at the end of the 
bed on the same side that the patient lies, this giving great 
help to her if she hcHds it, and pulls from it when the pro- 
pulsive pains,come on. 
In America and. most parts of the Continent women are 
generally delivered lying on the back-in England lying 
on the left side, which is much pleasanter for them, and 
does not cause nearly so much exposure of the person; 
therefore the right side of the bed should be prepared with 
the folded blanket and sheet. The valance also should be 
removed from that side of the bed. 
(. As soon fairly begun, the patient should un- 
dress add put on-ajchemise-, which should not go over the 
shoulders, but should loo /fastened under the arms with a 
safety-pin; a clean night-dress should then be put oh and 
rolled peatly above the waist, and pinned with safety-pins; 
over these p. petticoat, and a dressing or tea-gown. By 
this arrangement no disturbance is caused after the baby 
. is borif, as the soiled chemise is merely down and 
taken away, the night-dress unpinned and drawn into its 
place, and al/raising of the armsjmd back, which is bad, 
and may even be dangerous directly after childbirth, is 
avoided. • • . . 
While labor is progressing, it is important to keep up the 
patient's strength with a little strong beef-tea (this ought 
• always to be made when the first symptoms of labor 
begin), an egg beaten up in milkr or anything of a like 
nature. It is always very important to see that the water 
ADVICE TO WOMEN. 120 
ADVICE TO WOMEN. 
is passed frequently-if the bladder is full, it may consid- 
erably retard labor ; this will show the necessity for atten- 
tion to this point. It is a great mistake to go to bed too 
soon. It is much better to be up, and to walk about until 
the pains become forcing, unless it is possible to get a 
snatch of sleep in the interval of the pains. When the 
pains become very forcing, bed should be'taken to at once. 
It may be a comfort to any one whose first confinement 
occurs late in life-say, after forty-to know that, con- 
trary to the general impression, people of that age fre- 
quently have short labors and easy deliveries. Young girls 
under eighteen often suffer more in childbirth than rather 
elderly women. t 
There are three stages of labor. The first is from the 
commencement of the pains till the mouth.of the womb is 
fully opened; the second, from the opening of this till the 
birth of the child; the third stage is from the birth of the 
child till the after-birth has come away. When the second 
stage begins, the pains become of a propulsive forcing 
nature; and until they do, the patient should never bear 
dozen ; if she does this, she may do herself harm. 
The second stage is generally known to have been 
reached by the appearance of a gush of water. The child 
is surrounded in the womb with water; this, during labor, 
helps to dilate the mouth of the womb, and when dilated, 
the membrane in which the water is inclosed breaks, 
though on some occasions "the waters break at the very be- 
ginning of labor. First labors average from 8 to 24 hours 
-but may be much shorter. After-labors may vary from 
3 to 12; but of course there is no fixed rule. A fit of 
shuddering, during which the teeth may chatter violently, 
sometimes occurs in labor. It is merely a nervous sign, 
and need not cause uneasiness. 
There is no need for the doctor to be in the room all the 
time during labor, but he must from time to time be 
allowed to make an examination. This is merely done with the finger, while the patient is covered with the bed- 
clothes; but if she foolishly objects to it, serious results 
may follow, as the sooner the doctor is satisfied that the 
child is in the right position the better. When the child 
is born, the doctor generally fastens the binder for the 
first time himself. It is very important for the preserva- 
tion of a good, figure that the nurse should know how to 
bind well; she should bind over and lelow the hips; the 
ligaments which unite the bones of the pelvis expand dur- 
ing labor and pregnancy, and good binding helps to bring 
these bones back Jnto place, and the figure is prevented 
from the spreading which causes women, who are neglected 
in this particular, to look so unwieldy in after-life. 
It sometimes happens that the baby is born before the 
doctor arrives. If so, there should be no fuss. There are 
two things to do-to keep the mother lying as quietly as 
possible; and if the child is lively and well, not to separate 
it until the navel cord has ceased pulsating, -'J'hen it may 
be tied and cut.* The binder must never be put on 
until the. after-birth has come away and the womb is 
properly contracted. If the after-birth comes away before 
the'docter's ;t must be removed, and the nurse 
must keep her hand occasionally on the patient's abdomen, 
to see if the womb contracts ((. becomes hard). If it 
does, there is no danger of hemorrhage. Perfect quiet> 
and rest flat on the back, must be maintained. But it is 
after the birth of the child that good treatment is so im- 
portant. " By proper care at this time," says Dr. Play- 
fair, " the risk of pgst-partunu hemorrhage is reduced to 
a minimum, the efficient contraction of theuterus secured, 
and intensity of after-pains lessened " 
ADVICE TO WOMEN. 
121 
* The researches of Budin, Ribemont, and others show that there 
is'a distinct advantage in not tying thez cord .until the child has 
cried lustily, as the act of respiration tends to withdraw the., 
placental blood, and thus increases the entire amojint of blood in 
the foetus. It is said that'after late ligature of the cord the child is 
more vigorous and active than when it is tied too early,' 122 
ADVICE TO WOMEN-. 
Thus it will be seen how important it is that the doctor 
should be present. 
What to do in Case of Hemorrhage. 
If hemorrhage should occur after confinement, the near- 
est doctor must be sent for instantly. The patient must 
be kept lying quite flat, with her head' slanting back, and 
the nurse should immediately give her a glass of vinegar 
to drink. This has been found to have the most marvel- 
ous effect in stopping hemorrhage after confinement. Its 
use was earnestly recommended in Queen Charlotte's Hos- 
pital in the midwifery lectures given there. I have since 
advised its use in my " Maternity Talks," and I have lately 
heard of two women, whose friends had attended those 
Talks, whose lives have been saved by this simple means. 
It is believed to be no specific action of the vinegar which 
arrests the hemorrhage, but a kind of shock which it 
causes,, that produces a reaction which arrests the bleed- 
ing. . 
When the child has sucked, the risk of hemorrhage is 
greatly lessened. It should be put to the breast therefore 
as soon as possible. There arO two other treatments of a 
flooding-douching; that is, injecting hot water (110° F.) 
into the vagina-or pushing into it pieces of ice. The hot- 
water method may advantageously follow the vinegar 
dose.'* 
After-pains seldom or never occur after a first confino 
ment; the quicker confinements follow one another, the 
worse the after-pains are. If the discharge of blood is not 
heavy, a linseed poultice sprinkled with laudanum often 
gives relief. The doctor should always be consulted, as 
there are some medicines that give much relief. 
There is often great difficulty in passing water for some 
* After an attack of hemorrhage a patient should not be allowed 
to exert her arms by raising them over the head-as'in doing the 
hair, for instance-for three or four weeks. Jt has been known to 
be fatal, ADVICE TO WOMEN. 
123 
time after confinement, but it is very important that it 
should be passed four or five hours after the birth. Now, 
it is well to know that there is not the least danger in the 
patient's turning over on to her face, and, supported on 
her knees and elbows, and with the bed-pan under her, 
passing water into it. Sitting up would be extremely 
dangerous, but assuming this position is not, and in it 
there is often not the least difficulty in making water. 
CHAPTER X 
HOW-TO -TAKE CARE OF THE HEALTH AFTER CONFINE- 
s. • ' WENT. 
Five Necessary Tilings-Care of the Breasts after Confinement. 
Convalescence is always an important time, though too 
often this fact is not recognized. 
After an illness, when the patient is pronounced " out 
of danger," people often act as if they thought the ex- 
pression meant that the patient never could be in danger 
again.* Therefore relapses and complications, lyhich other- 
wise might never have occurred, often do occur, simply 
the relaxation of the care exercised while the atten- 
dants were frightened. 
Though confinements, if managed on antiseptic princi- 
ples, need not be looked upon as necessarily dangerous, 
nor as periods of illness, still we must not forget that at 
such ignorance or carelessness may cause serious 
misehier. * - 
Neglect after a confinement, no matter how easy and 
natural it has been, may be productive of lasting ill- 
health, if not of worse. z 
There are five things absolutely necessary after confine- 
ment: f ,r • , 
1. Best. 
2. Quiet, 124 
ADVICE TO WOMEN. 
3. Cleanliness. 
4. Good and proper food. 
5. Avoidance of draughts and chills. 
Rest. 
For quite three days after a confinement, absolute rest, 
without sitting up, is what may truly be called a vital 
necessity. Violent hemorrhage, even sudden death, has 
been known to occur when women have been allowed to 
sit up too soon after confinement. After this time, if she 
is progressing well, the patient may be propped up with 
pillows when she is taking her meals, and while the muse 
is washing her face, etc.; but the more she keeps to the 
recumbent position for a fortnight, the better, tihe ought 
not to get up for a fortnight. I know quite well that there 
are many people who will ridicule this statement. There 
are nurses who boast of always getting their patients up 
on the proverbial ninth day. I have heard women boast 
of the long walks they took " only a fortnight " after their 
confinement. But such boasting is only an unconscious 
admission of their utter ignorance of the anatomy and 
physiology of their frame. 
1 have already explained what Dr. Playfair truly calls 
" the marvelous modifications " which that curious organ, 
the womb, undergoes during pregnancy. It takes from 
six weeks to two months before the womb after childbirth 
becomes in the samq state as it was in before conception in 
it commenced. This is a fact in physiology. No amount 
of good nursing can hurry on the process; therefore, the 
nurse who urges her patient to get up soon after her con- 
finement, or the patient who disregards advice in the mat- 
ter, merely shows her ignorance of this process of nature- 
After fourteen days the- womb has greatly regained ils 
normal position, but not entirely so for from.six to eight 
weeks. During this time there is always the possibility of 
Seniorrhage. liemember this, There is, of course, no need for lying down all this time. 
A woman who has had a normal confinement may get up 
at the end of a fortnight, but she will be wise not to walk 
up and down-stairs for a month. She ought to be car- 
ried if such ascent and descent are desired. If the weather 
is warm and fine, and she is well, she will be all the better 
for a drive of an hour or so at the end of three weeks. 
The feet should be propped up on the opposite seat. 
Change of air to the sea-side, if too long a railway journey 
can be avoided* is always beneficial at the end of six or 
seven weeks; but active exertion should not be undertaken 
for fight weeks after confinement. The reward will be 
freed6m from the falling ci the womb, enlargement of the 
woinb, heavy periodical discharge, and many other of 
those wearisome internal complications that make the lives 
of so many married women a burden, and cause them to 
be prematurely aged.* ? r 
AbVTCE TO WOMEN-. 
125 
Quiet 
/'Quiet of mind surroundings is most important after 
confinement, J igitors (in the accepted sense) should 
never be let in for a fortnight. Those who insist on coin- 
ing in before show but little consideration for their friend. 
Where there are other children, much mischief is often 
done by allowing them to be in and out of the room at 
pleasure. The following story, mentioned by Dr. Gala- 
bin, is as good .as pages of warning on this point: " I have 
known a case in which, so late as the fourteenth day, a 
lady was greatly agitated by one of her children, alone i11 
the room with her, being nearly choked by a grape. 
Pyrexia (Lver) commenced from that time, and ended 
fatally." / 
* In using the chamber utensil for eight weeks after confinement, 
it should be placed on a chair; it should hot be sat upon on the floor. 
Attention to this trifling point may save the bringing on of much 
bladder trouble. 126 
ADVICE TO WOMEK. 
Much talking is very bad, and often occasions headache 
during the first week or so; and late hours, it need hardly 
be said, are injurious. The good nurse will always have 
her patient, room, and herself settled for the night by half 
past nine at latest. 
Cleanliness. 
This is most important, as can be understood when we 
know the danger that may arise from septic (putrefactive) 
poisoning. The linen should be frequently changed, and 
once or twice a day the parts around the vagina should be 
well bathed in tepid Condy's fluid and water-this should 
be pale rose-colored. Douching or syringing out the 
vagina once or twice a day is generally ordered by the 
doctor, and is valuable for both comfort and safety. The 
disinfectant for this should be used as directed by the doc-* 
tor. Olikfashioned people often object to this washing and 
douOh'ng, which, they imagine, will give cold. They do 
noc .•■ci-lleei ! it aids in the healing of those parts, and 
prevents the danger • •i sC-p1. ' ' «i;.a. A. good nurse will 
carefully protect the bed from damp, and her patDnt from 
such exposure as may give cold, and will be able to change 
sheets and night-gown, as every hospital nurse can, with- 
out requiring the patient to sit up. 
Good and Proper Food. 
The patient's appetite for the first week is the best 
guide. If she has an absolute dislike to solid food, she 
must not be forced to take it; the dislike shows she prob- 
ably will be unable to digest it, and then it would be likely 
to cause much mischief. She may, however, be 
to eat, which is very different from being tormented. She 
should not be asked what she would like; something suit- 
able should be brought to her; generally she will take it. 
In the " good old days " starvation or water-gruel was the