By Dr: Saunders  On Diseases of Women The diseases which are peculiar to Women being in general connected with Menstruation we shall first speak of the Menses. By the Menses we mean that periodical Discharge of a red fluid from the Vessels of the Uterus. That this fluid is not Blood, is proved from its not coagulating. The period at which the Menses first appear is sooner in warm Countries than cold; In this Country the usual time is between the age of 15 or 16. sometimes sooner at others later. The Menses we know come from the Uterine Vessels and not the Vagina. the following Symptoms indicate their approach. the Breasts become tense, tumid & painful with pain in the back & loins, an oppressed Pulse; the Discharge is at first a serous kind of fluid scarcely coloured; after the Menses have once appeared they do not immediately become regular; often a period of two or three months elapses before they again appear, & it is not till after many months after their first appearance that they become regular: they then generally occur  at the end of every four weeks. It is not very easy to say what may be the efficient Cause of the Menses. Its final cause we know is the nutriment of the Fœtus. Some have supposed Women to be more Plethoric than Men and the Menses were a salutary outlet; but even supposing the Menstrual discharge was blood, yet still Plethora will not account for it because it occurs previous to the plethoric period & we have many Instances of very weak persons Menstruating a great deal. The quantity menstruated each time is not on an average more than 4 or 5 ounces in 4 or 5 Days. This is too small a quantity and in too gradual a manner to relieve Plethora from the whole system. The Drs. Theory is that the Uterus from its situation and vascularity & also from the slowness of its circulation favors partial accumulation in it, which is relieved by the secretion of the Menstrual fluid. As soon as a woman conceives this excess is wanted for the nutriment of the Fœtus. When the Menses are regularly established  by the Constitution & habit, they are only interrupted by Pregnancy or Disease, The discharge ceases earlier in warm countries than in cold according as they appear earlier or later in life. In this Country Females cease to menstruate about the age of 50. before wh. period, the Menses become irregular, sometimes profuse at other times interrupted. We must consider the Uterus as an organ of secretion. Women are subject to affections under which the Menses don't appear. When the Symptoms of approaching Menstruation don't terminate in the Menses, the Female becomes Chlorotic. If the Menses have appeared she ceases to Menstruate, if there is any Discharge it is not tinged red. In the Chlorosis or Febris Alba of Sydenham the patient becomes pallid, is subject to Headach, difficult breathing and palpitation of the Heart on the least motion, has a capricious appetite or a desire eat chalk and other. unwholesome things attended with Eructation, & acidity and other dyspeptic symptoms, the pulse full & quick, the Body Costive, hot  dry skin and the lower Extremities become ædematous; When this disease occurs before the Menses appear it postpones them. It is a very common and vulgar error to consider this disease as arising from obstructed or suppressed Menses. When you are consulted on these occasions, you will find that the Women have an idea that if you can by any means bring about the Menses the disease will cease; but this is a very vulgar error, for if you could bring any direct Stimulus on the Uterus and procure the discharge of the Menses, it wod. not cure the disease. The way by which the disease is to be cured is by increasing the [Va] Vitality and energy of the Constitution in general, the Menses will then be regular. Steel and exercise are as certain in the Cure of Chlorosis as Bark in [Ague] an Ague on Mercury in the Lues. Altho' Chlorosis is attended with quick Pulse and dry skin, the Dr. never found Chalybeates heat the patient; the Body should be kept soluble, Myrrh may be joined with the Chalybeates but the cure depends chiefly on the latter. It don't signify much what preparations  of Steel are made use of; they should be given in such doses as to set easy on the Stomach. This disease if taken early may be thus easily cured. After it has continued for two or three years it may be thus successfully treated Our prognosis may therefore be favorable. Females are subject to a discharge of a serous fluid from the Uterus & Vagina, sometimes neither Acrid or offensive to the smell at other times very offensive to the smell & excoriating the Labia & neighbouring parts. It is either connected with the Habit or local. This discharge is called Fluor albus & may or may not be connected with Chlorosis, when it is Myrrh & Steel will prove an effectual cure. When local it may be relieved by topical Applications, as a solution of white Vitriol. Cold bathing will frequently be of service. Giving the warmer gums & Balsams are sometimes useful. When unconnected with general disease Tonics are unnecessary. The Uterus in common with other organs is liable to Inflammation Ulceration & Hæmorrhagy but most so to the latter, You are then not to consider it an increased Secretion of Menses but as Hæmorrhagy from a diseased Action  of the blood vessels of the Uterus. Hæmorrhagy is distinguished from the Menstrual discharge by the blood in the former coming away in Clots & grumous Masses, the Hæmorrhagic period seldom comes on till Women have ceased to menstruate. The Hæmorrhagy may be either Active or Passive. If connected with Heat, Fever & local pain it must be treated like other active Hæmorrhagies; If passive Tonics must be had recourse to. After Hæmorrhagy has once occured from this Organ, it is very apt to inflame & ulcerate, also to become Scirrhus & at last Cancerous; this is one of the most dreadfull complaints that females are subject to. The Dr. thinks if Women when they arrive at the period when the Menses are about to have them, would adhere to a cooling diet, now & then loosing a little blood & keep to the Antiphlogistic plan for a little while, many would be saved from Cancers of the Uterus, instead of this heating Medicines, Tonics & Cold Bathing are advised by which the disposition to Hæmorrhagy from the Uterus is increased. Treatment, When the Uterus is inflamed or in a Cancerous state  tepid bathing, Opiates to allay the excessive pain, & keeping the Body soluble by solutions of the neutral salts is all that can be done. Mercury the Dr. has not found so useful in the Scirrhus state of this Organ as of others. Cicuta is given with advantage to ease Pain Women when they have the Menses are more irritable [crossed out] and more susceptible of disease than at other times, this they well know & endeavour to guard against by wearing more cloths &c. When the Menses are suddenly stopped, the Constitution suffers, Inflammn. is the consequence, therefore keeping the body warm, Bleeding and gentle Laxatives must be used. They are seldom or ever, after being thus stopped, made to return till the succeeding period at which time they should be very careful not to take Cold, they will be promoted by an opiate & tepid bathing. Chlorosis precedes & is not caused by obstructed Menses but by a want of energy in the Constitution. Some Women are subject to violent pain at every Menstruation period, They ought to take a full dose of Opium which will generally have a good effect.  On the Diseases of Children In the Infant state there is a greater degree of Sensibility & Irritability than in any other time of Life; Perhaps it may be from the sudden transition from one Fluid to another, which they undergo in passing from the Womb into the common Atmosphere, or from their Nerves being larger, their skin thinner & their blood vessels being larger in proportion to the solid parts; Dr. Saunders condemns the giving Children Syrup of Violets, Oil of Almonds &c to clear off the Meconium which he thinks would be much better done by giving the Child the Breast directly, instead of waiting three or four days as is usually done. The first disease to which Children are subject to in general, is the Jaundice or what is commonly called the red Gum. This proceeds from some obstruction in the Biliary Ducts to the entrance of the Bile into the Duodenum; this is attended with no danger & may be safely left to Nature. The next disease & which they most commonly have in the Mouth is the Aptha or Thrush. This disease is often very troublesome, the Tongue & Mouth covered  with a Caseous Matter; the disease most probably extends through the whole intestinal Canal, for the same kind of Specks may be often seen at the extremity of the Rectum as in the Mouth & Fauces. The Child is listless, feverish & often unable to embrace the Nipple, From the frequency of this Apheous Inflaming [crossed out] occurring in Children Dr. S. is induced to believe it more a process of Nature to get rid of a Cuticle and form another than a disease. It is very seldom a Child dies of it altho' many crops of Aptha are sometimes succeeding each other. Dr. S. believes the less that is done to it the better. He is convinced that much mischief ensues from checking them by Astringents &c A little Borax dissolved in Mucilage Honey or Jelly is the best Application. Children brought up by Hand are much more subject to it than others. It sometimes falls on the Bowels causing Diarrhea, a drop or two of Laudanum may be safely given and an Enema of Linseed Oil thrown up Children are extremely Subject to fits, which seem to be of the mixed kind of Epilepsy & Tetanus. When Children have fits their fingers & Toes are often rigid sometimes they are drawn back as in the Opisthatonos  Opisthatonos, Nurses talk of external & internal fits, by the former they mean when the Extremities are convulsed, by the latter which are the most dangerous, they mean when the Eyes & Muscles of the face are chiefly affected by Convulsions. It is difficult to say what the fits proceed from Dr. S is convinced nurses bring them on by stuffing Children with too much food at a time, in these Cases gentle Emetics as a grain or two of Ipecacuanha but no Tart. Emet. for Dr. S has so often seen Infants die under the Nauseating effects of Tart. Emetic that he never allows its use. In Cases of Tetanus the Child shd. be put into a bath about 95. degrees of Farenheits Thermometer, and irritation allayed by a drop or two of Laudanum. The prima Via must be emptied by a little Rhubarb & Magnesia. The Dr. has never [seen] observed any advantages from blistering in this disease which is a common practice. Those Infants that are fed with farinaceous & acescent food will be subject to fits, for Nature intended that the Child should suck, no other food will be necessary if there is no deficiency of Milk for six, eight or ten Months when they may be weaned. Cold Bathing may be & is useful in  preventing Fits, which is done by rendering them hardy & less irritable, but the temperature should be regulated according to the strength &c of the Infant & the Cold may be gradually increased. Infants are subject to acidity, flatulency Abdominal pain &c. These likewise arise from too much farinaceous & ascescent food, There is a defect in the Bile, for the stools are as green as grass, a few grains of Pulse Chel. C. ppt. and a few grains of Rhubarb are very serviceable, the Rhubarb adds to the bitterness of the Bile & the Acidity is corrected by the Pulse Chel. a grain of Sal Sodæ may be added to the Rhubarb. Those Children that are not well exercised & are kept quiet by Godfreys Cordial are most subject to the disease. The delicacy of Childrens skin disposes them to have Eruptions. They are subject to Inflammation of the skin from their being a surplus of Acrimony not being carried off by the other excretions. Sometimes small red Eruptions a little elevated above the Skin, at other times they have Excoriations which may often times be from a want of cleanliness. These excoriations are frequently covered with a Scab; sometimes they Ulcerate & penetrate  deep & prove fatal by bringing on a symptomatic fever, keeping the body open & correcting the Acidity are the best means of treating these eruptions; Othiops Mineral certainly has a tendency to divert it from the skin & also serves to keep the Body Laxative. Most of these Eruptions seem to originate in the Primæ Via. When the Eruption is very bad & spreads fast a very diluted solution of corrosive Sublimate applied to the surrounding sound parts prevents the disease from spreading & may very safely be used. Teething may be considered as an act of violence, for the Gums are lacerated by the protrusion the Teeth, this Process takes place earlier in strong than in weak Children; they usually begin cut their Teeth at 5-6. or 7 Months old, sooner or later & continue every now & then cutting some till they arrive at the age of three years [old]. The process of Teething in many Children is attended with fever, a white Tongue, quick pulse, hot skin, is sometimes deririous & Convulsed, the Child is continually putting its Fingers & every thing else to its Mouth, the Gums are found elevated and inflamed, a Diarrhœa coming on at this time is favorable, the Child is  subject frequently to fits when it is not accompanied with Diarrhœa. We are called on to promote this Process of Nature which needs by lancing the Gums. Dr. S. thinks it is not so much the cutting down to the Tooth as the relaxation of the Membrane produced by the bleeding. If there is no tendency to diarhœa we must bring on one by a little Magnesia & Rhubarb &c. There is certainly some advantage arising from the Childs rubbing its Gums with a Coral; a piece of Stick Liquorice would answer the purpose better. They at this time secrete a great deal of Saliva. If there is much irritation a drop or two of Laudanum may be safely given; A great deal of food ought not to be given the Child, as the fever is of the Inflammatory kind. - Worms. - There is scarcely a disease to which Children are subject that is not attributed to Worms. If a Child eats too much, or two little, it is caused by Worms &c. &c. Dr. S. believes that Worms are never the Cause, but the effect of disease They will always be found in those whose Bowels are weak & have not peristaltic motion enough to get rid of them. The Eggs of these are equally taken in by all persons &  hatched in weak Bowels, whilst strong & healthy Bowels digest them. They therefore are best cured by giving strength & Vigor to the Constitution. When a Child has a fever the situation is too hot for the worms, they then come away and People immediately concluded they were the cause of the fever or illness. Worms are of three kinds, the round, which is exactly like an earth worm, and are never very numerous. The flat worms, or Tænia, may prove injurious from the quantity. Dr. S. has seen one 16 or 18 yards long. The Ascarides or thread Worm are principally in the Rectum, at the extremity of which they keep up a continual irritation and are very apt to come from the Anus. Every Symptom will be by Nurses &c. attributed to Worms & it is best not to oppose their prejudicies. Some brisk Cathartic, as the Peels Basilic. should be given and afterwards Tonics The Dr supposes Mr. Evans of Knightsbridge goes on the same plan. Formerly powdered glass was to be swallowed, which was to cut the Worms & not to wound the Intestines, Dr. S. thinks there is no specific for Worm amongst the Anthelmintics. -  Diseases of Children contd. A frequent disease of Infancy is the Rickets which may be defined a preture natural softness of the Bones by which they are rendered incapable of supporting the weight of the Body. the bones therefore become crooked. It may proceed either from an imperfect condition of the Osseous matter, or from a want of a due secretion of it most likely both concur in forming the Disease. The disease occurs from the 6th. month to the third year, seldom after the 5 year, there are instances tho' rare of its occurring in persons grown up. We are told this is a Modern disease, perhaps it may be from our becoming less active & more luxurious than our Ancestors. The Children who are most frequently attacked with this disease are full of activity and vivacity, which they loose when the disease affects them, their Muscles become flabby, the joints enlarged, the bones of the Legs give way & become crooked, the Spine is generally curved, & it is very seldom but that the Chest and Pelvis suffer some alteration in this Disease, Rickets are much  allied to strumous affections of the Glands, Struma & Rickets generally exist together in the same Person. Mesenteric enlargements may be often felt; there is a tendency to Diarrhœa. It appears hereditary, for the Children of those who have had Rickets are generally debile & weakly, which is an hereditary propensity. In Children of the poorer Class it may arise for want of proper nourishment; they are stuffed with Oatmeal & other farinaceous diet which does not afford sufficient nourishment. The Child becomes pallid, the Cellular membrane loaded with Water, or Hectic. The diet of rich Persons Children is often equally improper as it often consists of made dishes, which the digestive powers of the Child are not able to extract sufficient nourishment. Treatment. - The diet must be changed the Child should eat little at a time & often there is a great defect in the Bile, therefore small doses of Rhubarb are useful; the propulsive power of the Intestines is weakened & altho' there is a diarrhœa, yet it is rather a fretting discharge than a copious evacuation. Calomel must be given as a purgative  purgative which will bring away any hard lumps of Fœces which are the Cause of the Diarrhœa Small doses of Chalybeates may be of service. Sea bathing is better than the Cold bath. The temperature of the latter being too [cold] low, i.e. about 40. whilst that of the Sea is about 65. degrees of Farenheits. If it is not convenient to bath in the Sea, the temperature may be regulated at Home, but if there is any thing in the Sea Air, we cannot make that. All Ricketty Children should be rubbed two or three times a day with a coarse Cloth, which will energy to the absorbing System. Hydrocephalus Internus. This is a disease scarcely known fifty years ago, tho perhaps as frequent then tho' less understood than at present. Like the Rickets it is a Constitutional Disease The Children most subject to this are very lively & active sensible & acute beyond their years, with a fine skin and handsome. It generally occurs from three to nine years of age; this don't exclude the earlier or later period, but it most frequently happens during that period  period. This disease comes on in so insidious a manner as of often to deceive us; there are may anomalous symptoms. The first attack is like that of a common Fever, as little chills succeeded by heat, Languor, loss of spirits; it goes on in this way for several days, and we are apt to refer it to some irritating cause in the Primæ Viæ & to give a purgative expecting to carry the fever by it. but the Child is not relieved by the purg[crossed out]ing, complains of pain in his Head, keeps his hand to his forehead & Eyes, cannot bear the least noise or light becomes timid. one very striking symptom is flushing of the Face with great dislike to noise and light This should always make us suspect Water in the Ventricles of the brain. Sometimes the Child has a lucid interval, is rational and active as usual. The Pulse is constantly quicker than natural, sometimes the disease will last only five or eight days, sometimes two or three Weeks. The Pupil is either very much dilated, or preturnaturally contracted, generally dilated. The sight becomes lost and the Child frequently screams suddenly and violently fetches deep sighs. The Head gets  longer without the Sutures opening but by the Skull expanding & becoming thinner. We always find a difficulty [of] in procuring Stools, there is frequently a retention of Urine. Often there are partial palsies, as of one Eyelid; these are sometimes successive, as a Patient will have a palsy of the Eyelid one day, of the Tongue and of the act of deglution the next. the dilated Pupil is a Palsy. When the Pressure is considerable, the Pulse will now and then be much reduced in quietness, you must not suppose your Patient better for that reason alone. In the latter stages convulsive motions all over the body particularly of the Eye & Face. The disease when ascertained in its beginning often proves fatal generally so when not discovered early. Dr S. believes that in all cases it arises from Inflammation. Dissection has always shewn the Dura & Pia Mater adhering with the Vessels enlarged & other marks of Inflammn. The treatment shd. therefore be in the first Instance to shave the head & apply Leeches & also to take blood from  from the Arm. purging & keeping the Child from light or noise. The Dr. would persist in this plan for about 36 hours and afterwards have recourse to Mercurial friction which if it can be made to act on the Mouth will be likely to effect a Cure. This the Dr. has seen in some null [crossed out] marked cases where even bad symptoms had occurred as Palsies &c. &c. The Mercury should be made to act on the Mouth, that indeed is the surest Criterion we have of its acting on the System.