THE ■ " - FEMALE MEDICAL REPOSITORY. TO WHICH IS ADDED, A TREATISE ON THE PRIMARY DISEASES OF INFANTS: ADAPTED TO THE USE OF TnB Female Practitioners and Intelligent Mothers; THE TECHNICAL TEEMS ARE EXPLAINED, f.SD AN ATTEMPT HATH BEEN THESE TRANCHES Of *** “ HEALING ART» ** IK" A J T'v TO CONdfrajEMts* AtfD Fl^RSrrCUlTY BY JOSEPH BBCrffT?fM. D ji.*cr 'and PREFACE. THE real necessity of a publication, similar to the present, I may presume, would need no ad- litional recommendation by way of preface, had not the general maxim evinced a singularity, if not an impropriety in offering our labors to the public without : Suffice it to say ; a long and successful practice, in this branch of “ the healing art,” and tlie many lamentable proofs of the ig- norance and abuse of it, alone hath induced my attempt. If! have reduced the labors of the learned, to an approached familiarity, with the minds of those tins work is principally designed to instruct, and amongst whom a very great majority of this practice is intrusted and established, if I can be assured of the inexpressible satisfaction, of having contributed in rescuing a mother or her infant from the rapacious jaw's of ignorance and death, my hope will enjoy an exquisite gratifica- tion, and my labor an ample return. Or further, if it may emulate an abler pen to forward my at- tempt to a nearer approach of excellence, rny assistance, wishes and works are cheerfully offered FREFACJE. him ; far be it from my wish to depreciate so lau- dable a design ; the service of my fellow brethren, and the preservation of the present and rising ge- nerations, in whom we may continue to live and flourish, dictates my every wish. As a purity of expression and sentiment has been my guarded care through this treatise, I am led to hope, the most virtuous mind will find no reason to fear an offence, though the most delicate sub- jects have been considered. INTRODUCTION. Midwifery is the knowledge of pregnancy, ou the gravid state of the female, together with the changes natural and diseased, of which, this state is an evident cause. These variations, from the general order of na- ture, at other periods, require little or no medi- cinal assistance, generally ; while the latter too frequently confound the endeavours of the most skilful physicians, and judicious attendants. It is also, most essentially requisite for the practi- tioner *n midwifery, to possess an accurate anato- mical and mechanical knowledge of the parts con- cerned in this practice, both in the mother and child, and also, to be expert in the rules of pro- portion, established by the best authors and pro- fessors on these subjects, before he can obtain any true information in the science, or practice with any share of approved confidence or general ap- probation. The anatomical part, then necessarily forms my fust section. They who presume to offer themselves as prac- titioners for the assistance of child-bed woman, without the possession of this necessary acquire- INTRODUCTION. ment, are not only imprudent and unfit persons, but ought to be more feared and guarded against, than the dark assassin, or the furiated armed savage. The innumerable lives of infants that are, not only lost that may be restored, but the murders wan- tonly committed, are deplorably too obvious to every discerning mind to be controverted, as will be exemplified in the succeeding pages. I am very apprehensive, this want of informa- tion must too generally prevail ; at least with the female practitioners I may speak with more confi- dence; though injustice I must with pleasure ac- knowledge there are some, even in this circle, of merited exceptions : public demonstrations are not sufficiently general and supported to afford the opportunities of practitioners universally ac- quiring this necessary knowledge, therefore the exertions of too many have been but too much established on the mechanical principles of prac- tice only. This publication is more particularly offered for the assistance of women likely to become mothers, in regulating aright their conduct, during their pregnancy, labor and after-management ; and also to afford them a knowledge, in these eventful pe- riods, of the propriety, or otherwise in the atten- dants and their measures pursued. It is further offered for the assistance of female practitioners, or others who may have been pre- maturely, and improperly introduced, into the practiceof midwifery, without the opportunity of receiving a scientific knowledge : I shall therefore, as much as the nature of the work will admit, avoid technical terms ; but a3 some may be indispem* INTRODUCTION. sible, I shall attempt an explanation as [ treat the different subjects ; and a glossary will be ad- ded for their more complete elucidation. The mother or nurse merely, may dispense with the first, or anatomical section, in which these terms must necessarily, more frequently occur : but the practitioner must ever be reproachfully igno- rant, and consequently dreadfully to be feared and avoided, to whom it may be said,“ he possesseth not anatomical knowledge, asthe basis or “ foun- dation of his presumption to practice.” I shall occasionally quote from the truly valu- able publications of the humane Dr. Buchan, which 1 highly approve, and recommend to be kept to read in all families; and also from such authors as have w rote for, and are familiarly read, by per- sons of the class for whom this w’oik is more par- ticularly prepared. I presume to hope, my little tract may be found useful, for occasional reference, to such as may be recently, and, perhaps too immaturely engaged io> the practice of midwifery. SECTION I. ANATOMY. OF THE rELVIS. ANATOMISTS, for distinction and demon- stration, have divided the human body into the Head, Trunk, and Extremities : and the Trunk is ajjain subdivided into the Thorax, Abdomen and Pelvis. The last of these divisions, viz : the Pelvis, with its appendages and contents, aie the only parts of the mother immediately concerned in the practice of midwifery : necessarily none others (except what relates to the foetus or child, which will be illustrated in proper place) may he esteemed as essentially necessary to be explained in ibis work. The female pelvis, with its appendages and con- tents, are composed of many jrarts ; and are di- vided into hard and soft : The hard parts, or bones, form the basis or fa- bric of the whole, and serve to give it shape and firmness ; and will, therefore, it is presumed, bo the lirst, most proper for demonstration. Every student or practitioner is recommended to procure the possession of a real female pelvis, well formed, if possibly practicable; and accu- rately examine it generally, and particularly as the descriptions are pursued ; for all representa- 10 or THE PELVIS. tions, either by plates, drawings, casts, or descrip- tions, alone are insufficient and imperfect. The pelvis has received its name from its sup- posed approaching similitude to a bason, and it composed of eight bones, viz. The os sacrum, or sacred bone posteriorly. The os cocc> x, vel coxygis, a mere continuation from the os sat rum. And in some quadrupeds so elongated as to form the tail. The ossa innominatum vel ilium, or hips, which are situated on each side, forming the anterior la- teral and inferior portions. The os innominata in infancy is divided into tin ee distinct portions or bones, which anatomists have called The os ilia, which forms the hip, or superior broad portion ; The os ischism, the inferior part, or seat ; The os pubis, the anterior or share bones. As soon as the body arrives at maturity, these several bones, become completely ossified or grown together, by a strong union, and are called os inno- minata, which however, still retain their infantine appellations for the purpose of ease and accuracy in demonstration : and will be here separately considered, previous to giving a description of the pelvis entire. Each of these bones or portions, has its fellow, which, when taken complete form at least four fifths of the whole pelvis. On the external surface of these hones, is found a deep depression or cup, called the acetabulum, which receives the head of tho thigh bone ; to which it is tied or united by a strong round liga- or THE PELVIS. tn?n :jou.9 rope called ligamenta rotunda, or round 'U.i wint, inserted into the middle of the bottom ot ri cup in which the thigh bone rotates. " V acetabulum is situated in a posterior, 1 and somewhat inferior situation, and has a portion ot each bone of the innominata in its formation : which will he considered separate when treating of the hones distinctly. The os ilium, or hip bone, is of the class of flat bones, i. e. it is not exactly a flat bone, but of an irregular form ; but its approaching, when viewed altogether, nearer the flat figure than any other, anatomists, have consequently arranged it in that class : this same rule must be kept in mind, as we go along in all other bones of different formations, for the purpose of order and demonstration. Tb wit, there are many hones of the skeleton, that are not immediately of the form of a cylinder or rounded, but as they approach nearer to that figure than any other, are therefore considered of the class of cylindrical bones : and so of the rest. The hip bone forms the superior and by much the largest portion of the os innominata : the su- perior semicircular edge, is called its spine ; and is covered by a strong cartilaginous substance on the outer surface, which is culled its dorsum or back ; it is found to be irregularly convex, for the attachment of muscles and other soft parts ; and gives out four processes, called the spinal processes of the hip bone. Two are situated superior, and anteriorly. Two are situated inferior and anteriorly : and continued as far back as the transverse section of the acetabulum, of which it forms one third. 12 OP TIIE PELVIS. The internal surface of this bone is cohce r, > t hollowed to enlarge the dimensions of the iny of the pelvis : some way down its inner si ace, is observed, a shaip ridge which arises posti orly and is continued forward till it unites wi 1 if*: fellow, when it nearly surrounds the whole cavity of the pelvis, and is called the brim of the pelvis : above which is situated an aperture or opening for the passage of the medullary vessels. The os ischium, or seat bone, is the second of the innominata, and is of an irregular form ; it is continued interiorly where it gives out a tube- rosity on which we rest when sitting, and by some, this portion has been therefrom called os scdentarium : this bone also gives off’ a second process, continued forward and upward, and on its superior part forms the segment or part of a circle, and unites with the os pubis. On the superior thick portion of this bone pos- teriorly, is formed a sharp process called the spinous process of the ischium, from whence seve- ral muscles arise, and has attached to it the sacrosciatic ligament, which is a strong ligamen- tous substance extended from one process to the other, leaving an opening which is closed by soft ubstance. The os pubis or share hone, is the last of the in- nominata ; it originates at the acetabulum, where it is largest, diminishes as it advances forward and inward, when it again increases and gives off a pro- cess inferiorly, which unites with the ramus or leg of the ischium, forming a large oval aperture called the foramen ovulas vel thyroidea; it is afterwards united with its fellow by a strong cartilaginous OF THE PELVIS. union called symphysis pubis, which together form an arch extending from one side to the oilier of the pelvis anteriorly. The os sacrum, the sacred or haunch bone, is si- tuated immediately under the last vertebrae, or bone of the loins, to which it is attached by a strong intervening cartilage,; it is generally call- ed the first of the false vertebrae, ana is of an irre- gular triangular figure, internally concave, exter- nally unequally convex or rounded : it. is the lightest bone of it’s magnitude in the skeleton, on account of the manv perforations through it, and the abundance of its cancelli : it derives it’s name from the religious customs oi the antients in ma- king it an offering in sacrifices. This hone is divided, in infancy, into five dis- tinct portions which become ossified into one as the body advances to maturity : these maiks of separation, are however, still seen to exist m the adult, or even extreme age, by tour transverse lines on it’s anterior or iunei surface. This bone is found to be widest, superiorly and diminishes as it decends ; it has a continuation of the vertebral perforation for a portion ot the spinal marrow which passes through it, giving < iff several branches of nerves; the elongation ot the spinal marrow through this hone is found like the bone itseif, to diminish greatly in diameter as it descends. On the superior and lateral ; art of this bone on each side* is tnundaii indentation or notch which opposes a s niuiar one, on the mlerior la- teral surface of the Iasi hone or the verteb ae of the loins on each side, and when brought into con- tact form two openings, through which pass the 14 07 THE PELT1S. twenty fourth pair of nerves ; below these are also I four other apertures on each side, through which | pass some very large nerves to be distributed to the parts of generation and lower extremeties. On the posterior or external surface are also an equal number of perforations, through which pass nervous branches, to be continued and distributed to the muscles and adjacent soft parts. It is strongly united on each side to the ossa ilium or hip bones, by a broad extended surface where are found innumerable processes perforating corresponding depressions in the ilium ; and an equal number from the ilium perforate indenta- tions in this bone, so that their union is the most compact and immovable. The os coccygis vel coccyx or rump bone, is by some anatomists considered, only as a continu- ation or elongation of the sacrum : it derives it’s name from it’s supposed approached resemblance of a cue koo’s bill, and is made up of five distinct bony portions : at the time of birth it is in part catlilagmous ; but at puberty, the ossifications or formation of hone is complete, but they still re- main united by cartilage. It is of a triangular figure, decreasing from above downward nearly to a point. It has an extensive motion forward and backward, at the junc tion of each bony portion, but most so at the union with the inlet lor surface of the os sacrum. It is internally very concave for the support of the intestines and muscles that are attached'to it. It is externally very convex. y I tn last or fortieth pair of nerves pass through af aperture formed by a depression on each side OF THE rELVIS. of the superior surface, antagonized by two in the opposite situations, brought in contact, on the lower side of the os sacrum. The mobility, or motion of this bone diminishes as the person advances in age, and more especially ■when the cartilaginous divisions have not been kept flexible, which soon become ossified ; this is probably one reason women who remain long unmarried have in general difficult and laborious labors rand in advanced age it becomes one com- plete bone with the os sacrum. Having now considered, the bones forming the pelvis separately, I come next to speak of them generally or when united, and which forms or completes the pelvis. The pelvis, forms a large cylindrical cavity, to envelope and defend from external injuries it’s contents, viz. the intestinum rectum, or last inti- tule, urinal bladder, muscles, ligaments, nerves and blood-vessels; to which, in the female are added the womb and it’s appendages for the purpose cf child bearing. The female pelvis, is necessarily materially larger than the male and differs essentially in it’s figure : by which principally the skeleton is distinguished from the other. It is above widely expanded by the hip bones for the support of the abdominal viscera, &c. And is contracted (or someway downward when tlrere is observed a ridge or elevated line, conti- nued nearly round the internal surface : all above this line or brim of the pelvis is called the superior or large pelvis ; all that portion below it OF THE PELVIS. is denominated, the inferior, lesser, or true pelvis. The professors and authors on midwifery have established the following mensurations,- for tiie rule of proportion of a standard, or common size pelvis, viz. From the lower edge of the symphysis or angle of the pub s to the protuberance of the sacrum anteriorly.—4 TO inches; from side to side, at the brim of the pelvis,—j i-2 inches; from this measure meat the diameter of the pelvis approaches an oval form internally ; it’s greatest ex'ent being from side tos.de, which in the male pelvis is reversed, it’s greatest diameter being from the pubes to lire sacrum. From one tuberosity to the other of the ischium, 4 inches ; this is the outlet of the pelvis or those parts on which we rest while sitting or the os se- sedcntarium : the passage at these parts is reversed to its opening superiorly ; which in delivery is a circumstance must be kept in mind, for essential reasons which will be examplified when treating that subject more immediatt ly. The pelvis mea- sures in depth posteriorly, from the top of the os sacrum to the extremity of the os coccygis, When extended—six inches ; Cm the side—four inches, and Anteriorly, or in front—two only. These are the measurements on proportions ge- nerally laid down and established as the dimensions of a standard pelvis: yet a pelvis may vary ma- terially from these, and in no way distorted or disarranged. Per example; a woman above or below the middle or common stature, for which or THE PELVIS. these dimensions are applied : differing very ma- terialy in the proportions of the other parts of the body, it must necessarily be expected to differ in the pelvis also, and no malconformation exist. The oblique situation of the pelvis is a circum- stance also of thefirst consequence to the acoucheur to be kept in view : it has, in many publications been described as horizontally situated in the erect position of the body, and thereby rendered the discriptions inaccurate and false throughout, and consequently the young practitioner, among others, into irretrievable error, in deciding the projection ofthesacrutn for the presentation ofthe headofthe child, which has been wantonly perforated and the patient murdered. When the person stands erect or upright, the position of the pelvis is obliquely forward and downward. When lying in the horizontal position, the pelvis is reversed, obliquly upward and forward. When half sitting, half lying, as when bolstered up in the bed, the pelvis is horizontal. When leaning or inclining forward from the erect posture, as when resting the arms upon the hack of a chair, &c. the pelvis is erect or perpen- dicular. It is of the most essential consequences to be conversant and expert in these rules in the practice of midwifery; where the practitioner omits to ap- ply them he is necessarily, some times led into fatal errors, and by an absurd malpractice may lose both the mother and her offspring. The pelvis is best measured by the hand, which 18 OF THE PELVIS. is the only true mode, and after a little practice may be ascertained with great expertness and ac- curacy. Having now gone through the descriptions of the hard parts or pelvis, I proceed next to explain, the dimensions and form of the foetal head ; and to shew it’s necessary changes or elongations in it’s passage in parturition or birth. OF THE FCETAL HEAD. Of the head of the Foetus or Child. It is coin* posed of eight bones in the formation of the skull, and thirteen in the face, and critical accuracy may also add the four small bones in the organiza- tion of the ear. But as I propose to enter into an explication of such parts only as are essential to the plan of the work, the first or those bones which compose the skull, need only to be demon- strated, for the rest the student is referred to works more particularly written on anatomical subjects. The eight bones of the cranium or skull, are divided into six proper, or concerned in the for- mation of the skull alone, and two common to the skull and face, viz. The os frontis, or forehead, which forms the fore, and part of the superior portion of the skull, and is supposed to approach, in similitude of fi- gure, to the cockle-shell form. The ossaparietaliae, vel bregmatis, are two bones situated one on each side, forming the sides and middle portion of the superior part of the skull : they unite with each other in a straight line, on the top of the head; this junction is called, the sigittal suture;and an- teriorly, with the posterior portion of the os frontis, forming-what is called the sutura coronalis or co- OF THE FCETAL HEAD. ronal suture. The osocciptis, the occiput or hind- head, forms the whole of the prominent portion posteriorly : and unites it’s superior edge, with the posterior edges or terminations of the ossaparie- talia; whose junction constitutes what is called the lambdoidal suture, from it’ssupposed resemblance to the greek letter (a) lambda. The ossa temporum or temple bones, form the lateral portions of the skull iuferiorly. The two bones, common to skull and face, are the os ethmoides and sphenoides, and are found situated on the inferior part of the skull internally, these bones being no way concerned in the practice of midwifery, need no description here. This general and superficial view’ of these bones appear to me all that may be absolutely necessary to know of them in this practice, as tending to assist in a general description or knowledge of the foetal head and it’s formation : for a more minute account I would reter my reader to some esteemed anatomical work* Oi sutures which unite these several bones, or are formed by their union, it is requisite to be more descriptive, as an accurate knowledge of their situations and courses is of the first consequence, as will be shown hereafter. * See the “ History of Anatomy.” THE SUTURES. The suturae coronalis or coronal suture, unites the os front is with the ossa parietalia : it originates some way behind and above the orbit and rises obliquely upward and backward to the middle of the superior part of the skull, where it forms an obtuse angle, when it is continued obliquely down- ward and forward in the same direction on the other side. The suturae lambdoidalis or lambdoidal suture, originates some way behind and above the ear, and is continued obliquely upward and backward to the middle point on the back part of the head, where it forms an obtuse angle, when it is continued obliquely downward and outward in the same direction on the opposite sid^. The suturae sagitalis, or sagital suture, unites the ossa parilia, on the top of the skull, and is found to progress from the obtuse angular point formed by the lambdoidal, in a straight line to the angular point of the coronal suture, where it commonly terminates ; though frequently it is found to sepa- rate the frontal bone down to the nose. The suluisc temporalis, the tefnporal or squa- mose suture, originates some way above the ear, and is continued upward and backward in a semicir- cular line till it unites posteriorly with the lamb- doidal suture; when they are continued together 22 THE SUTURES. downward, backward and inward, on the inferior po tion of the skull, and this part of the suture has been named additimentum suturae lamb- doidalis, or the addition to the Jambdoidal suture. There are in addition to these sutures the trans- verse, ethmoid, sphenoid and zygomatic, but they are so inconsiderably concerned in this practice, that I conceive them not necessary to be described in a work of this nature. At each end or point of the sagital suture is commonly found, in infancy, an insufficiency of os- sific or bony matter, so that a considerable vaccuum in the skull is detected at these parts, and are called the greater and lesser fontineU, or openings of the head, but as the infant advances to the adult state or mature age, these openings are found com- pletely filled up, and the sutures are all firmly united except prevented by diseaesas hydroce- phalus, rickets, &c. but the vestages remain to the most advanced age; however some times the ossific deposit is not sufficient at the fontinels, and a distinct ossification, or formation of bone is com- menced from the centre, which is continued in a radiated manner, till the dtficiences are entirely filled by distinct triangular bones which are called tiiquetra. The form of the head approaches theoval figure, and is nicely adapted t® the dimensions of the pelvis, the sutures being perfectly loose, admit the head to moftld, elongate and accommodate it- self to it’s passage; it admits a considerable com- pression and diminution on it’s sides, which much lessens it’s.circumference, and in proportion increa- sing it’s length, till it approaches some what the TIIE STTTTinES. conical or sugar loaf figure, by the loose attach- ment of the sutures, which allow the uones to'lap over, or ride upon each other, like the scales of a fish, while neither the skull nor it’s contents suffer any injury, but soon recover their natural posi- tions. The advantages of this admirable piece of me- chanism of the skull of an infant atvthe time of birth, admits the head to pass with ease and safety, when, had it been one complete,and consequently irresistable bone, it’s passage could not, except the head was preternaturally small, possibly be effected safely. The shouldersand pelvis of the foetus also mould to compression ; the first by tneir loose attachment (by muscles or flesh only) to the body ; the latter by the ossa inuominatum being composed of thiee distinct bones at this period, as already ex- plained * (which see) ; by thiswise formation of the child ye may be apprized of the impropriety in hurrying, (by instruments or otherwise) nature in her work ; who is so kindly disposed to accom- * Well may we declare with David : How fearfully and wonderfully we are made ' let the atheistical infidel read this, and acknowledge the hand of divine wisdom through all it’s works, and on his faullering tongue tremble out, for- give me my blasphemous temerity ! O my father and my god. That the study of the medical profession, so liberal in it- self and extensively usetul to the world, should be the cause of any of it’s votaries becoming orremaining infidels, which is much to be feared is the case, is to me a specimen of the most extraordinary perversion of the human mind, I can possibly conceive : a person accurately illumined with a knowledge ol (he mechanism ot li's own frame, to deny a “ first grt at cause,” must be worse than mad he must be des|>erately wicked “ Let no such man be trusted.” 24 the sutures. modate herself to the most desperate cases, and complete with safety, what is but too often des- troyed by officious impatience and murdering ig- norance. OF THE DISTORTED PELVIS. Of the distortion or malconformation of the pelvis. Any material alteration in the formation ot these bones either natural or diseased, must, in an equal proportion, retard and make difficult the progress of parturition ; and if in any very great degree, and the child full grown, it is then totally impracticable, without injury to the mother or off- spring. In the course of this work I shall endea- vour to make these discriminations with as much minuteness and accuracy as I am capable of and which is a subject that will require the practi- tioners invariable attention. The pelvis may measure it’s full distance from the symphysis pubis, to the projection of the sa- crum, and the diameter be very considerably di- minished, by their branches being depressed, or convexity lessened on the external surfaces, form- ing an angle instead of an arch at their junction; and if the distance, in the last instance be found diminished, the angle of the pubes becomes still more acute, which in an equal degree, is iound to increase the obstruction of the passing of the faetus. The os coccygis, is sometimes found curved up like a hook, hut this distortion never obstru t.- tie progress of labor, (as has been asserted) for 26 OF TIIE DISTORTED PELVIS. when it exists, it is found to be always in an equal degree turned to one side. The os. sacrum, is also sometimes forced inward bv the gravitating weight of the trunk, &c, and the bones softened by diseases, i. e. the ossific or bony matter is absorded, leaving little more than the membranous portion: the bones in this case become soft and flexible, as in the ricketts, a dis- ease very common among European children, but happily for us, it exists but very rarely upon this continent : it is generally brought on by dibility, the consequence of bad nursing. This distortion sometimes, causes the internal concave surface of the sacrum to become convex or prominent, consequently very materially to di- minish the cavity of the pelvis. This disease generally, in an equal degree affects the inferior extremities ; and if violent the head shares of it and becomes much enlarged, the su- perior extremities, ribs, and the whole spine par- take of the disease ; in the anatomical theatre in St. Thomas’s hospital, Southwark, London, the pro- fessor of anatomy, Henry Cline, exhibits the skele- ton of a child, about four years old, so universally affected by this disease, that not the smallest l*one in the body but what partook of it and suffered distortion. The tuberosities of the ossa ischium, may also be too near each other and consequently in an equal degree diminish the aperture or outlet of the pelvis. The vertebrae of the loins are sometimes so protrud ed forward as to diminish the cavity of the pel ris ; sometimes the destortion is confined to the OF THE DISTORTED PELVIS. brim and larger pelvis which is difficult to be dis- covered till the labor is someway advanced when, the conical point of the head descends sufficiently to be discovered by the touch : and the bones at the sutures are found to lap considerably more than common over each other, and leads you to suspect the distortion. These are the principal, or most common distor- tions to which the pelvis is subjected ; and when in a very great degree the expulsion of the fas* us is reduced to an impossible event for nature to ac- complish : in this case manual operation must be the dernier resort : either upon the faetus by les- soning the head, or upon the mother by incision, as the circumstances of the case may point out, and justify, per example: The caesarian section, &c. which in it’s proper place will be considered. A woman naturally well formed, and borne many children with ease and safety ; may after- wards have the pelvis become distorted, by acci- dent or disease, as fracture a softening of the bones.. &c. The pelvis may generally be judged' of by external appearances, which however is only a probable decision, viz. Too great a curvature of the spine, or vete- brae of the loins inward. The legs and thighs crooked and shortened, the navel appearing at a greater distance from the head than the feet; and the woman has a shuffling walk bring for- ward first one hip, and then the other: under these circumstances, there is very great reason to suspect, the pelvis equally shares the distortion : these are subjects I should always wish to avoid 28 OF THE DESTORTED PELVIS. the attendance of if practicable—however, though it is geneially it is not universally, the case: for women with all the external marks just now described, have been found with tolerably well formed pelvis; and have, though perhaps with extraordinary difficulty, borne many healthy full grown children. The spine may be curved to the right or the left; (a circumstance frequently caused by young girls quilting,) and the pelvis no way deformed— as a maxim, when a woman is well proportioned in the lower extremities, and walks well, the pel- vis is generally well formed, whatever contortions the spine may have suffered. OF THE FEMALE ORGANS OF GENERATION. Like the male are formed of many parts situ- ated externally and internally, and which are principally concerned in forming the soft parts necessary to be known in the practice of midwife- ry : and are all subordinate to one principal organ situated internally, called Matrix or Uterus or womb, which is a strong fibrous body of an oblong triangular figure, supposed to have an approached resemblance to a winsor pear. It has three aper- tures or openings, one situated inferiorly and somewhat anteriorly called the mouth of the womb or osutcii, and from its supposed simili- tude to the mouth of the tench fish, has been called os tincce, a name by which it is most fre- quently designated : and one opening at each su- perior posterior angle, at the fundus or bottom of the womb, which leads to two passages, particu- larly described, first by Fallopius an ancient physi- cian and anatomist, and have, consequently, been called after his name tuba fullopiance or fallo- pean tubes. The womb is flattened on its anterior and pos- terior surfaces in virgins, but after impregnation, 30 ON THE FEMALE ORGANS it remains more globular. It is situated between the bladder and the last or straight intestine. The womb is divided into its fundus, body and neck: The fundus forms its least angle, and is commonly of the breadth of two fingers in length, and its sides about one finger’s breadrh more; their junctions with the extremities of the fundus form the two posterior angular points; they are then continued downward and forward approaching each other, and form the anterior and inferior angle called the cervix or neck of the womb. It is externally of a whitish color, and of a solid substance made up of muscular fibres dis- persed in many different directions, which ren- der them difficult to be traced and unravelled. The late professor of anatomy, Else, in St. Tho- mas’s Hospital, London, denied the existence of muscular fibres in the substance of the uterus, for the above reason, and was so bigotted in his error as to support it, in opposition to his own judg- ment on occular demonstration. Dr. Lowder, late professor of midwifery in itie sump Hospital, ex- hibited to him a portion of the uterus marked un* commonly distinct with muscular fibres, and ask- ed, “ What is exhibited ?” the professor in sur- prise, laconicly answered, “ muscular fibres to be sure!!!" on being assured it was a portion of the uterus, he put on his spectacles, made a more minute examination, and declared “They were not muscular fibres.” The uterus internally forms a very flat triangu- lar cavity, which in the virgin state, or before menstruation, with difficulty will admit a hog’s OF GENERATION. 31 bristle: but after impregnation always remains wider. rl he inferior aperture, or mouth of the womb will admit the introduction of a small si>1 let. At the edge of this orifice, are found its labiae or lips, which are composed of a uunrhei of small glandular bodies, which separate a viscid lyniphae discharged through an equa ■ umbn of excietory dm is observeable on the surface near the edge of the orifice. OF THE APPENDAGES OF THE WOMB INTERNALLY. Tuboe fallopianae, or the tubes of Fallopius, are two small canals originating at each pos- terior angle of the uterus from whence the aperture is continued in a tortuous direction; at its origin, it with difficulty will admit a hog’s bristle, but increases its diameter as it advances, 1'ke a trumpet and terminates in a jagged floating extremity railed morsus diaboli where is found the ovaria?. The ovar ge, or female testes, situated one on each side, about the size of a common nutmeg but are subject to much variation in this respect, in different subjects: Their texture is in part compact and spongy, made up of blood vessels and vesiculse or bladders, in which is observed a transparent glairy fluid. Some physiologists have consider the vesiculae, as ova or eggs, and others are induced to consider them as containing the female semen, as a celebrated professor,# lias observed— “ When a woman dies with child one peculiar ca- vity is observed which was thought to be the calyx from which the ova drops, and is called coipus * Hajniltott, THE WOMB AND ITS APPENDAGES. 33 luteum; but later physiologists think that these corpora; lutea are glands containing the female semen, which in the time of coition bursts and throws out their contents into the fallopean tube in the form of a liquid. A fluid evidently comes from the ovarium which mixed with the male ser men is supposed to be conveyed through the tube into the uterus, to become rudiments of the future fetus.” The number of these vesicles are different; in different women, and it is said each ma> produce a fetus. Sabatier says they are commonly about ten or twelve, but Haller has found fifteen and up- wards in each ovaria. Ligamenta rotunda uteri, or the round liga- ment of the womb, originates from each side of the womb a little below and before the origin of the fallopean tubes, and pass through the perforation in the lower edge of the abdominal muscles, and are inserted in the groins where they are lost, in the adipose or fatty membrance immediately un- der the integuments or skins: they are made up of muscular fibres, nerves and blood vessels and serve to retain the womb in its natural situation. These several appendages recieve one common covering from a continuation of the peritonaeum, the membrane which envelopes the intestines and abdominal vicera, called the ligamenta lata, or the broad ligament of the womb. The vagina, or the passage to the womb may be considered as partly internal and partly exter- nal, and unites the organs of generation which come under these distinctions or separate arrange- 34 THE WOMB AND ITS APPENDAGE merits: it is also an appendage to the uterus, therefore requires adistinct description in thisplace. The passage is about four inches in length and its diameter nearly equal with the intestine, but in both respects subject to much variation: it is found made up of muscular fibres dispersed in different directions, and which frequently inter- sect each other through the whole extent, by which mechanism they are found capable of lengthening, shortening, contracting and dilating the canal, in the time of parturition &c. It has also innumerable glands and blond vessels, and is internally lined bv a fine villous membrane, inter- sected with excretory ducts and contracted inpli- cae, or small transverse folds which are found nearly obliterated after childbirth. The inner or posterior extremity of the vagina is found united with the mouth of the womb, which it receives protruded some way within its cavity near the anterior extremity are found two small glandu- lar bodies discovered and described by Cow per, culled after his name. OF THE EXTERNAL ORGANS OF GENEUATION. Moris Veneris, or mount of Venus, is situated at the inferior termination of the abdomen, im- mediately above the pubes, and is made up of adipose and cellular substances collected under it, and forms a kind of cushion which at puberty be- comes covered with hair, at its inferior part is found to commence the labia pudendae or alae, which may be considered as a continuation of the mons veneris, and are found to bifercate or di- vide immediately below the pubes, forming a sinus which is continued to within about an inch of the anus or intestinal outlet, when they are again bounded by the perinoeum* a fleshy portion between the vulva and anus, and these termina- tions of the fissure are called the superior or ante- rior, and inferior posterior commissures. The labia are found to be more ligamentous than the mons veneris, diminishing as they de” scend and terminate in mere integuments: they are internally lined b\ a fine glandular membrane, separating a sebacious fluid to lubricate it’s sur- face, and is abundantly supplied with nerves and blood vessels. 36 THE EXTERNAL ORGANS OF GENERATION. Lacunae, is a small hole observable on each side on the inner surface of thelahi®, when sepa- rated, which are the termination of the excretory ducts from two small follicular glands of the same name, separating a viscid fluid. Nymph®, are two fleshy productions formed by a duplicature, or fold of the internal mem- brane of the labia and are sometimes called labia minoris vel interna or the lesser or internal lips: they commence by an acute angle, and are con- tinued downward and outward, separating wider from each other as they are continued on the outside of the mouth of the vagina, where they are insensibly lost: they have also small glandu- lar corpuscles which separate a sebacious mucus to lubricate the parts adjacent. Clitoris, is a small prominent red body found situated in the angle of the nymph® which serves it as a prepuse or covering, and appears like an imperforate gians: it is internally made up of a spongy substance and very elastic coats: some- way towards the pubes it is found divided into two crura or legs, and is inserted into the rami of these bones; it is abundantly furnished with nerves and blood vessels, and of exquisite sensibili- ty ; it is capable of extension, and subject to much variety in size. Urethr®. or the excretory duct from the blad- der, is found m a straight line, about one inch below the clitoris, surrounded by small labi® or prominence of muscular fibres forming a sort of sphincter muscle. Os Externum or aperture of the vagina, im- mediately below the urethrae, is surrounded by THE EXTERNAL ORGANS ©E ©ENERATION. 37 a sphincter muscle originating from the peri- nacum continued upward and forward on each side of the os externum, and insensibly lost in the crime of the clitoris. Hymen, is a fine membranous covering extend- ing nearly over the os externum, and is peculiar to infancy, leaving only a small aperture for the escape oi the menstrual evacuation, and is of a crescent-like form. It is ruptured on the con- summation of matrimony, and totally destroyed by parturition, leaving only a few irregu lar eminences on the inferior portion of the orifice: and from their supposed approached resemblance to myrtle leaves have been called carunuclae myrtifonnes. This membrane by some is considered as the test of virginity, but it is a very fallacious depen- dence, as it may be destroyed by too great a flux of the menses, imprudence, and other particular accidents, as inflammation, ulceration, cancer, &c. The perinaeum, is that fleshy portion situated between the posterior commissure of the vulva and the anus, about one inch in length, and di- vided into two equal portions by an external cu- taneous line, called the raphae. A knowledge and attention to this part is in the practice of mid- wifery of the first importance, as will be explain- ed in its proper place, MENSTRUATION, Is a periodical evacuation peculiar to the fe* male, and returns generally every month, but in many cases subject to much variety. It receives it’s name from the latin word men- sis, a month: in some this evacuation is found to return every three week’s or less, while in others once only in five or even six weeks or more; and in a third class the intervals are uniformly irregu- lar. It has been asserted by some to be influen- ced by the periodical changes of the Moon * asm lunatics, but that this idea is erroneous, is self evi- dent from the evacuation itself, for there is not a day in the year but in which some women men- struate, consequently had the lunar revolutions regulated this effect, all women would have menstruated at the same time, and had the same vacations; but as this is found net to be the case, others have endeavored to account for it in a different manner, but it is still mere hypothesis and appears ever will remain so—some assert plethora or too great a fulness of the blood ves- sels is the cause by which evacuation they are emp- tied and relieved ; but this opinion is controverted by the most relaxed habiU affording frequently * A' istotle, MENSTRUATION. 39 the most profuse evacuations; and the quantity of blood being diminished, or it’s texture reduced does not appear to lessen this discharge. A late celebrated and ingenious professor* attributes it to topical congestion, which opinion is supported by this fluid’s incapability of coagulation, and consequently has been asserted by some, not to be blood, but a red fluid separated by the womb itself as the secreting organ, from the general mass of blood. This hypothesis is further support- ed by the glandular corpuscles found between the tunics of the womb, for the purpose of regulating and making fit this organ for conception, and af- terwards for the nourishment and support of the foetus. This evacuation is found to commence in this climate about the age of fourteen, in more south- ern latitudes much earlier, while in a more noth- ern clime it frequently remains till maturity. The first appearance of menstruation is said to determine the age of pube rty or ripened years, and at which period a considerable change evi- dently occurs in the female, the breasts enlarge, the countenance becomes more clear and anima- ted, and the pubes covered. In infancy is observed to transude, only a whitish colored fluid, and in the young girl a sort of serum which is now evidently tinged with red blood or fluid: it is however observed the sooner the discharge commences, the sooner it finishes, which is gene- rally about the forty-fifth, to the fiftieth year, when the womb is rendered no longer capable of * Dr. Cullen. 40 MENSTRUATION. con'- f tion, but in this respect is subject t© much vanety. The uterine evacuation does not flow in a stream but gently drills for three or lour days, though most commonly for three only; and the quantity discharged is generally between five and ten ounces. Some authors ha.e asserted the menstrual fluid is discharged from the vagina, but the evident superiority ol vascular distribution in the uterus, supports a contrary opinion, and Dr. Ruysch, in Holland, confirms this, where he says, “ He saw an inverted uterus and the menstrual fluid issu- ing from the parietics of it’s internal surface.” Having now attempted the anatomical des- criptions of the pelvis, and parts of generation, to- gether with the menstrual evacuation ; I shall conclude this section, but it may be well to pre- mise, the descriptions now given, I am very sensi- ble, are insufficient alone, or even otheTs much more elaborate and perfect (to which I consider my attempt as a mere introduction by way of clearing the path of some difficulties and fa- miliarizing the language of science) to convey that anatomical knowledge required in this prac- tice: public demonstrations should be attended, where preparations are exhibited, and cases affor- ded, by which only an accurate knowledge either general or particular can possibly be acquired; where these are not enjoyed a real pelvis should be procured, and accurately examined; as the descriptions are pursued together with the assist- ance ol esteemed anatomical plates and drawings, tf w hich those of Albinus, Drs. Hunter, Smeliie, MENSTRUATION. 41 Hamilton, and others bear the pre-eminence for accuracy and elegance in execution. * The most proficient pen is alone incapable to convey that clear, true and permanent knowledge which may be acquired by the plan just now described. The second section will be descriptive of the diseases of these parts, their causes, and methods of cure. 41 See th* History of Anatomy* SECTION II. FEMALE DISEASES. MENSTRUATION OBSTRUCTED. Is divided into two kinds, viz. Retention and iU| pression. Retention, when the usual time for their ap- pearance has elapsed, and they do not flow. Suppression when they have appeared periodi- cal !y from time to time, and from some cause, (conception excepted) they cease to return, or are cheeked during the time of the flow. It is didicult, precisely to assign any time for the commencement of this evacuation, as differ- ent women, have very different periods; some sooner, and others much later, and no inconve- nience, or mark of disease n ay exist; as before observed, w hen treating on menstruation, in the close of last section: climate, habit, mode of liv- ing &c. ai! tend to change, very materially, the actions and states of both solids and fluids, which compose the human frame. Causes. The retention or non-appearance, is frequently symptomatic, as well as idiopatic, i. e. the consequence or effect; as well as the cause of diseases : per example : In consumption, debilita- ted constitutions, &c. the blood is improverished, the quantity reduced, and the vessels flag in their MENSTRUATION OBSTRUCTED. actions, consequently the disposition to menstru- ate is not excited. In this case our attention is colled to the prr mary disease, or cause; in restoring the consti- tution, and tone or actions of the blood vessels; when the discharge will necessarily flow. Spore diet, a sedentary, inactive life, warm rooms, or clothing, &c. are all remote causes producing debility, of suppressed and irregular menstruation. In suppression, any of the above causes, to which may be added the various pas. sions, fear, grief, anger, &c. cold applied to the low- er extremeties, and more especially when moisture be enjoined ; sometimes the Hymen may be imper- forate, and the separated fluid retained till the additional accumulations, at every period of menstruation, become self-evident, by the pro- trusion of the membrane externally, and the inconvenience of the collected fluid, together with the evident change which the constitution suffers. I had a case of this kind in a young woman of about eighteen years of age, a few years past, who came from the other side of the Alleghany Mountains on purpose to be cured ; her surgeon there mistaking it for polypus, or some fungus excrescence, which blocked up the os ex- ternum, endeavoured to tear it away, and gave her much pain: I experienced no difficulty to detect the true state of the case, and assured her I could relieve her with as much ease as letting blood; accordingly a day was appointed, I made a longitudinal incision of about one inch, through the membrane which protruded like the head of a child, and I compute the discharge altogether to MENSTRUATION OBSTRUCTED. be about a gallon of stagnated menstrua, of the consitence and appearance of balsam of sulphur, or tar, which continued to discharge itself for a day or two, gradually diminishing. I recom- mended a cerated sponge tent to be kept in the incision till the next period of menstruation, to prevent a reunion. I heard no more of her com- plaint: she is still, I believe, in this city, in bloom* ing health. Reflection. It is evident in this case, that the cavities of the vagina and uterus itself were gorged with the accumulation. The complexion sallow, appetite destroyed, the stomach loathing the ap- pearance of food, the body emaciated, and fre- quently a spitting of blood or red matter from a regurgitation, in consequence of the total obstuc- tion: It doubtless, if not relieved, would soon have ended in consumption and death. Symptoms. Relaxation of the whole system, debility, pains in the back, loins and hips, increas- ed and difficult breathing, laborious action of the body, sluggishness, indigestion, but at times pre- ternatural appetite, the face becomes pale and sometimes of a yellowish hue, with a dark circle or disk round the eyes, legs and feet swelled, and sometimes dropsical, violent palpitations of the heart, faintings,a dull heavy gravitating sensation, pains in the head, sometimes blood issues from the lungs, eyes, ears, &c. apoplexy, spasms, convulsi- ons, asthma, &c. Cure. In an imperforate Hymen, the membrane should be punctured with a lancet or trocar, and the accumulated contents will immediately tscape, and the cause be removed when effects MCNSTRUATION OBSTIlUCTEB. 45 *r symptoms only remain to contend will), as* vacuity, debility,&c. But the greatest care is required in this ope’ ration, lest the adjacent parts be wounded ; and Jso to distinguish accurately this disease from a protrusion of the mouth of the womb, glandular enlargements, Ike. when irretrievable injuries may accrue, from imprudt nt incisions. In retention from other causes, we must direct our endeavours to restore the generally impaired habit, and to excite the discharge: The mind should be kept easy and cheerful, exercise en- couraged, nith the advantage of a free open dry air, a w holesome nutritious diet, of easy digestion, which (with the other powers of the body) is ge- nerally much impaired; at times sitting over the steams of hot water or the use of the warm bath, will be found to relax the extreme branches of the uterine vessels, increase the momentum ofthe blood, and dispose the vessels to throw out their contents; genetous liquors may also at times be given with advantage in this case, and medicines of the tonic and astringent kinds, may be added, as batk, steel, &c. Bandages applied round, and over the hips and loins, may also teud further to assist and dispose the blood into the extreme branches in addition to which, opium by the mouth and injection may he administered with advantage, as it tends to al- leviate the pain and remove'spasmodic affections, which are sometimes required also of a more sti- inulent kind, as caster, assafcetida Ike. The in- testines should he kept moderately soluble during the cure ; for this purpose the purgatives of the MENSTRUATION OBSTRUCTED. more etimulent, or drastic kind are found most efficacious, as jalap, black hellebore, scamniony, aloes, mercury, bitter apple, &c. these are found to influence the circulation, and promote the discharge: in addition to which horehound has been much extolled by the French : Hellebore, has also frequently been used in the form of tinc- ture, but its action is violent, and if given in a full dose, is found to purge too roughly, aud pro- fuse, and even to vomit. Savin, has been used externally with success, and from the essential oil it contains, there is no doubt, but it acts as a very powerful stimulent. The madder root, has been looked upon by Some as a specific, in stimulating the uterine ves- sels. by its penetrating properties, as when mixed with food, is found to tinge the most compact bone, i. e. the enamel of the teeth, which experi- ment I have seen proved in feeding young pigs, Cantharides, or Spanish flies, in tincture, from, its stimulating effects on the neck of the bladder has been recommended, but for its general effects on the system, 1 believe, but little is to be expec- ted from it • and is objectionable from its tenden- cy to produce strangury, or suppression of urine; 1 should therefore be extremely cautious in usein<* it. Electricity, generally and sometimes locally ap„ plied, has frequently been known to restore the discharge. Ligatures on the thighs,$ have been used and ma) be serviceable ; when an accumulation, or * Sec Medical Essays. 47 indisposition of the vessels to action exists they have succeeded; but should be used with much caution and art. Cold Bathing may be used where exercise cannot be freely given, but in any local affection in the viscera of the body, or dropsy, it is found to be prejudicial. Antimonials, and mercurials, have been suc- cessfully given when other medicines have failed; but are improper in weak and debilitated habits. Mecurials should never be used where a saliva- tion may be induced, but as alteiatives, where it never produces a quick cure, but acts in a gra- dual manner in promoting a free circulation and removing obstructions. The prevention. The female youth ought to use free exercise in the air, and indulge a cheerful- ness, and volatility of disposition, as indolence of either bodyor mind, engenders a viscid and languid state ot the circulation and secretions, and conse- quently produces a train of baleful diseases, as scrophulae or evil, scurvy, glandular obstructions! nervous diseases, &c. cold, tight garments, astrin- gents or binders, either in food or otherwise, un- wholesome food, or any thing injurious to digestion should becarfully avoided. * Menstruation, immoderate flux of—Irregulari- ties in this periodical evacuation are common- ly attendant on bad health, weak and debi- litated habits; consequently the most healthy, are generally the most regular, both as to period, and quantity: to preserve this then, in due time MENSTRUATION OBSTRUCTED, * See Rieketioa ou Health wi the Nounaturaly, MENSTRUATION INCREASED. and proportion, is to observe and employ every practice, which conduces to invigorate and strengthen the system, sweeten the blood and juices, and promote a free and active circulation ; for this purpose, exercise, wholesome nutritious diet of easy digestion, with the advantage of a free, dry, pure air, ail tend to establish and preserve that health of body and mind in which all things go well: consequently, the studious, sedentary and inactive life, together with the stimulating and weakening effects of luxurious banqueting, in high life, have diametrically an opposite tenden- cy, in producing a weakened and relaxed fibre, a thin and acrid state of the blood and other juices, and dispose these women to menstruate more fre- quent and profuse than the more laborious poor : in these the exercise of labor gives a sweetness to the well earned morsel, wnicli all the contrivances of confeclionary, and extravagance strive in vain to afford; digestion is well performed, the chyle, or nutritious fluid, plentifully seperated and con- veyed with speed and vigor to the general mass of blood, which it continually restores and sup- plies, and the circulation is forwarded with free- dom and vigor to the most extreme arteries, by their own contrastile powers, while ihe various secretions purge and throw off the numerous im- purities and superfluities, as they are seperated, and health, rosy health is the blest consequence. It is considered, an immoderate flow of men- struation, when it occurs more frequently, con- tinues longer, or is more abundant than ordinary: yet any of these variations may exist in a small excess seperateiy or jointly, and yet constitute no MENSTRUATION INCREASED. disease : as most women are subject to some irre- gularities, consequently where the health, action or strength of the body is not impaired, little more is required than rest, and a solubility of the intestines. Causes. Every thing tending to produce pletho- ra, or a fulness of the blood vessels ; more especi- ally those branches distributed to the womb, and its appendages; and increase the texture or red particles of the blood, and thereby stimulating an increased action in the uterine vessels, to throw their contained fluids in such profusion, as to con- stitute the irregularity on which I am now treat- ing: of these, full, gross, nourishing diet, strong malt, or vinous liquors, &c. and frequent intoxi- cation, violent exercises, as jumping, dancing, raising heavy burthens, vomitings, and straining of the frame generally; falls, blows, &c. in which contusions may be caused : obstinate costiveness, straining violently at stools, &c. The menstrual flux, in increased profusion, is also attendant on weakened and debilitated ha- bits, in which the contractions of the extreme, vessels, which deposit this fluid in the womb, are relaxed in their contratile powers, and there- by rendered incapable of containing their fluids against the least efforts, or actions, which may force them into their terminations. This state of the body, is induced by abortions, frequent and difficult labours, drinking much weak, warm, enervating liquors, as tea, coffee, &c. and every thing tending to relax or weaken the action of the organs, and the system generally. Plethoric symptoms.—Head-ache, violent palpi- tations of heart and arteries, vertigo, or faintings, 50 MENSTRUATION INCREASED. &c. sometimes nature relieves herself, by expel- ling the superabundant accumulation, from the eyes, nose, mouth, &c. sometimes the haemor- rhoids, or bleeding piles, or some other outlet, is opened for its discharge. In relaxed habits,—The contractions of the < xtrenre vessels, are rendered feeble, and incapa- citated of restraining a profuse discharge, which tends further to weaken and relax the system, and increase the discharge; if not timely pre- vented. The consequent symptoms, or effects, are general debility, and feebleness of the body, a want of appetite, indigestion, palpitations of the heart, frequent faintings, a great irritability and susceptibility of the mind, subjected to the most violent emotions on the slightest occasions; these symptoms are commonly followed by the fluor a lb us, or whites, ( which I shall treat of distinctly) 'swellings of the feet and legs, dropsies, consump- tion, and death closes the scene. Cure. In plethoric, or too great a fulness of I the habit, the antiphlogistic, or spare diet treat- ment will be found generally to succeed : but as’ soon as the pulse becomes softened and more regular, the lancet must be discontinued, other- wise the discharge becomes a consequence of relaxation and weakness, or what is called astinic which 1 conceive to be a much more dangerous 'state of the disease, and difficult of cure; as a well known maxim, “ It is much more easy to pul! down, than build up,” exemplifies. The remote causes (it possible) should be obviated, the person should retire early to rest, in the horizon- tal posture, with the head placed rather lower MENSTRUATIUN INCREASED. than the feet, that the course of the fluids may be diverted,external heat and light should be avoided, as warm chambers, soft beds, light rooms, &c. as these tend to promote the discharge ; a mattrass ne- cessarily would be preferable, in a darkened room. The body should be kept soluble by the mildest aperients, as an infus'on of senna and prunes, cas- tor oil, rhubarb, cream of tartar, manna, or such like, and such other means, as tend to reduce fever, plethora, irritability, &c. In debility.—An opposite mode of treatment to the former,‘ will be found necessary in this case; astringents externally, and interua'ly ap- plied, cloths wet with venegar and brandy, or ve- negar alone, and applied to the loins, belly and pubes. Internally,—May be given the infusion of rose-leaves with vitriolic acid, or the tincture of steel in the spirit of salt, or tincture of saturn, with occasional opiates, and such other medicines tend to weaken the nervous influence and iiri- Kibility; if these means prove insufficient, more active and immediate applications will become requisite, and recourse must be had to the mode of cure prescribed for violent floodings, which see. After the evacuation is stopt, it will he requi- site to restore the constitution, and strengthen the relaxed solids, by tonic medicines, as bark, steel, «Scc. cordial aromatics, together with the assistance of gentle exercise, mild astringents, and gene- rous nutritious diet. At every periodical return of the menses, it will be necessary to remove every disposition to cos- MENSTRUATION INCREASE®. tiveness by some of the mild aperients mentioned above; a composed and tranquil mind, the exer- cise moderate, ar.d at times the indulgence of the aopha may be permitted, during the period of menstruation ; every existing cause should be carefully-avoided, for irregularity to a woman na- turally regular, is often productive of the most violent symptoms, and consequent diseases. '{'hat period of life at which we generally find a cessation, or discontinuance of menstruation, vis. from forty to fifty years of age or upwards, is/also a circumstance which requires the utmost care and good management ; otherwise the foun- dation of innumerable chronic or hectic diseases will be laid, and the patient become a miserable sufferer for life, which, however in this case is generally short ; and on the other hand, such wo- men that pass this period without contracting any of the above diseases, it is observed, become more healthy than at any former period of life, which may be continued to a very advanced age: it therefore is surely requisite for every woman to ob- serve that conduct and regularity which tends to establish this very desirable event. It will be well, then, at this period, if the woman is of a good habit of body, to reduce somewhat of the quantity and quality of her mode of living, more especially ol ihe nutritious kind; to take a few uloetic purgatives and preparations of steel, and yield to a few repeated bleedings from the arms, in small quantities. In more weak and relaxed habits these precautions are, perhaps, less neces- sary. MENSTRUATION DISCONTINUED. It very frequently happens, women, at this pe- riod, have tumefactions, or swellings, more parti- cularly on the lower extremities, which ulcerate and are disposed to suppurate for some time ; and in women of a full habit, they ought to be consi- dered salutary, and accordingly promoted, by soft warm suppurating poultices, fomentations of mu- cilaginous herbs, as mallows, mullen, and such like, mild digestive ointment, &c. If they are hastily and imprudently checked, they are gene- rally followed by an acute or chronic disease : if of the former, the person is commonly soon carri- ed off: If of the latter, the miserable sufferer may linger out a few years, a life of pain and sor- row, and at last die, a worn out exhausted consti- tution, when, perhaps much more than the meri- dian of life has not elapsed. It would he prudent to soiicit or assist the dis- position to evacuate or throw off the superfluous matter from the blood, by the applications of mild digestives and occasionally soft poultices, till the usual disposition to evacuate the superabun- dant accumulation gradually disappears, when an issue or seton, and aperient medicines ought to be employed, before they are permitted to he drisd up. r01u FLUOR ALBUS OR WHITES. This disease may be considered by som , as a more advanced state of the last, or an effect re- maining of which repeated immoderate m listiu- ation is commonly a cause however, as it some- 54 FLUOR ALBUS OR WHITES. times exists entirely independent of the former, or rather when no appearance of its excess hath happened, I conceive it merits a distinct des- cription • It is commonly a whitish coloured discharge, though sometimes yellowish, pale green, or even dark coloured, separated from the posterior ex- tremity of the vagina, and the mouth of the womb. It is often observed, like menstruation, to be periodical; and in proportion, as this dischage is increased, the former is diminished. Women abounding with serum, and of a lax- fibre, are generally most subjected to this disease, more especially on the first approach of men- struation, and at the flower of age. But has been known iu young children, and advanced age, con- sequently, no period of life can be considered entirely exempt from it. It is found to be extremely injurious to weak habits, and therefore requires our strict atten- tion. Causes. Frequent, and immoderate menstru- ations, abortions, violent extractions of the after birth, a sedentary inactive life, a poor spare diet, close confinement to study or otherwise, extreme indolence, warm death’d, and heated apart- ments, whatever has a tendency to wreaken and relax the system, exposure to cold, and moist air, and sometimes the cause might he local, as whatever might be productive of irritation on the mucous glands of the vagina, from whence this discharge principally originates; drinking too- much warm, weakening, enervating liquors. FLUOR ALBUS OR WHITES. Symptoms,—In this disease, are also very simiN lar to the last, a general debilitated relaxed ha- bit is induced, indigestion, a sallow complexion, and a weakness of the general system. The discharge, on its first appearance, is gene- rally mild, but after a long duration, it becomes acrid, and erodes, ulcerates and inflames the ad- jacent parts; pain, and weakness in the back and loins, and much fatigued on a slight exertions. Cure. A gentle vomit, is frequently given in the early stages of this disease with advantage; and occasionally an opiate to allay the irritation, which frequently prevents rest, and consequently tends further to induce debility, and increase the disease: The warm aromatic gums and balsams, which have a stimulating, and bracing effect on the urinary passages: of this class are the gums olibanum, galbanum, amber; balsams of capivj, and turpentine, cantharides, &c. to these must be joined, moderate exercise, in a dry open atmos- phere; a nutritious and easy digested regimen, with medicines of the tonic, astringent proper- ties, as bark, steel, port wine, pyrtnont water, to which may be enjoined occasional astringent washes, or injections of Japon’s earth, alium, in- fusion of red rose leaves, or strong green tea, &c. with the use of the cold bath, and every method which braces the fibres, stimulates the actions of the blood and its vessels, and tends to restore the general health, tone and vigor of the system. However, sometimes this disease is the effect of a full, gross, plethoric habit, when the mode of treatment must be the reverse of the foregoing: as repeated bleeding, opening medicines, a dinjjmi- DISEASES OE THE GENITAL SYSTEM. tion of the mode of living, more especially of the things affording too much nourishment, as eggs, milk, animal food ; also of indulgence too long in bed, &c. to these restrictions must be enjoined exercise, and every thing which reduces the habit to that temperament in which health only can be said truly to be established. ON THE DISEASES OF THE GENITAL SYSTEM. Before I commence a description of these dis- eases, it may be well to premise, that the existence of the obstacle of false delicacy too generally pre- vents a timely discovery, and necessarily, frequent- ly the wished-for relief: Natural modesty, more especially in the fair sex, so highly commenda- ble, and much to be admired and approved, is, when carried to too great a length, or exceeds a certain limitation, justly accounted false delica*- cy, and ought to be overruled, i. e. when health and life may be the risk of such extreme pru- dence, it then, certainly becomes blamable. In all cases of this nature, if in a young woman, I would recommend a more aged and experienced matron should be consulted, and be permitted to make a strict examination, in an early stage of the complaint, and if there appears any thing ex- traordinary for which she is not able competently to account, an experienced physician ought im- mediately to be consulted, when by a timely discovery, and a thorough knowledge of the case, with proper applications the disease may be re* DISEASES OF THE GENITAL SYSTEM. 57 moved; which is certainly much more likely to be ascertained in the beginning of the disease, than when further advanced, or complicated with many others, of which this, the primary disease may be the cause and means to establish : per example—an imperforate hymen obstructs the evacuation of men- struation, till the increased accumulation causes distention, inflammation, irritation, consump- tion and death: when had it been early ascertain ed and punctured, the cause would have been re- moved, the accumulation discharged, and the dis- ease of itself cease, without further applications: as in the case of the young woman before recited. OF THE FUROR UTERINUS, Or an itching of the genitals. This disease is said hy some, to be a species of, or a more advanced state of the fluor albus, in which an increasing acrimony of the discharge, is the cause of irrita- tion, excoriation,heat, itching, and pain; and the brain also partaking of the affection, from the sympathy which exists between the brain and uterus, is an effect only, while other-s as pointed- ly deny the doctrine, and avow the primary cause to exist in the brain, and nervous system: the celebrated Dr. Cullen was of this last opinion, and called the disease nymphomaniac : however as the cause seems to be undetermined, I would refer the inquisitive reader to such authors as have wrote more particularly, and elaborately, upon these subjects, as Cullen, Astruc, Hamilton, White and others, and proceed to the symptoms. BISEASES OF THE GENITAL SYSTEM. Symptoms. An acrimony of the muscous se- cretions of the genital system, an itching, irrita- tion, heat, and inflammation, an increased hard pulse, melancholy, taciturnity, redness of the eyes and face, irregular hysteric affections, as cry- ing, laughing, &c. alternately;libidinous speeches and gestures, and an uncommon latitude in the whole deportment, and if not timely relieved, the symptoms relax and increase till the patient looses her senses, and she degenerates into mad- ness, when there remains but little hope of a cure. Method of treatment. Bleeding repeatedly af- ter moderate intervals, as the strength of the pa- tient will admit, or till the pulse is somewhat softened and reduced. The antiphlogistic or spare diet plan of regimen generally; injections or lotions of sugar of lead, or rose or elder flower water, the white camphorated ointment of the old Edinburg pharmacopea, cooling brisk purges with nitre, cooling diuretic drinks, as ptisan, barley, or tamarind water, broths, gruels, or mal- lows tea, frequent emollient glysters, the tepid bath, occasional opiates to allay the irritation, both externally and internally, and these are some- times advantageously combined witii other nar- cotics, as henbane, hemlock, tobacco, &c. which should he occasionally injected into the vagina.— Camphor internally combined with small doses of nitre, have been found beneficial: sometimes the irritation has been discovered to be seated in the urethra, or water passage, when bougies have pro- cured relief. DISEASES OF THE GENITAL SYSTEM. 59 Mons Veneris, is subject to inflammation, heat, burning, lancinating pain, of excessive tenderness to the touch, which point out cancer deep seat- ed. Labi® pudend®, are also subject to inflamma- tion, ulceration, cancer, dropsical enlargements, excoriations, and of being grown together: this last affection frequently assumes a venereal ap- pearance, and consequently requires our most care- ful attention to discriminate with precision ; our determinations should be influenced by the pati- ent’s situation and character, and our decision pronounced with the utmost diffidence and cau- tion, otherwise an innocent character may suffer undeservingly, and the feelings of a sympathetic mind regret the imprudence of a hasty, and per- haps erroneous judgment. It would be well in this case to permit the nurse, or other attendants, to use for a while their own endeavours; if the symptoms disappear all will be well; if not, it may be suspected to be of a venereal taint, and treated as such. See venereal disease. The cicatrized membrane to be carefully divi- ded with a knife or lancet, and frequent use made of some healing detergent lotion, or ointment. The nymphae, or internal labiae, are subject to the diseases of the external, just now described, and come under the same mode of treatment. The Clitoris. T his part is subject to inflamma- tion, excoriation, ossification, and a preternatural enlargement, and when in a very great degree, it constitutes what is generally esteemed the her- mophrodite, that monstrous production, said to partake of both s*xes, but from my own observa- 60 DISK ASKS OF THE GENITAL SYSTEM. tions, and information from others, have alway# found it to consist of the disease just now describ- ed : However, much may be said upon this dis- eased enlargement, and anecdotes quoted, but as they would tend only fo feed the minds of sala- cious appetites, and in no way illustrate the dis- ease or its cure, delicacy, which I am determi- ned to pursue as far as clearness and elucidation will permit me, forbids recital of them. I shall therefore, proceed to the method pf cure. Cure. Which consists of its removal either by the knife or ligature, and the parts afterwards healed with digestices, vulnerary balsams, &c. The Urethra, or excretory duct of the bladder. This canal is subject to spasm, inflammation, excoriation, sometimes also calculous or stony concretions are found to obstruct or block up the passage, and cause many painful and dangerous diseases: it is subject to violent relaxation or loss of tone, and also a diminution of its muscular sub- stance or coats of which it is composed, when the patient is rendered incapable of retaining the urine, which involuntarily escapes. Cure. In this last case, rest only is frequently found to be sufficient; while others require bark, steel, and other tonics, or bracing medicines, with the use of the cold batn, and astringent lotions; a blister applied to the region of the os sacrum, is found frequently successful in producing slran- guary, or a suppression of urine, which is the ef- fect desired. In fungous excrescences, the bougie is the best remedy. In contusions, emollient applications DISEASES GY THE GENITAL SYSTEM. 61 and fomentations. In excoriations, detergent, and healing balsams 1 In inflammation, bluod let- ting generally and locally if the case requires it— opening and sudorific, or sweating medicines, a low cooling regimen, &c. ' In gangrene, or mortification, bark, steel, port- wine, &c. in as large, and repeated doses as the stomach will bear. In stones lodged in the pas- sage, the warm-bath, with such other means, as tend to dilate the passage should be first used, which if ineffectual, an incision made immediate- y upon the stone, when it is to be extracted, with a small pair of forceps, or any other convenient instrument, and afterwards the parts to be treated as in the existence of a common wound, and pal- liate the most urgent symptoms. In spasmodic affections. The medicines of that class called antispasmodics, as camphor, as- safcet da opium, castar, vilerian, musk, laven- der, &c. with the use of the warm hath. The Vagina,—Is subject to most of the diseases just now described in the urethrae, and come un- der the same mode of cure. In addition to which, the imperforate hymen is sometimes found to shut the passage entirely, but the inconvenience is not discovered till puberty, or the time of menstrua- tion commencing; when the accumulation in- creasing at every menstruation by its retention, the protruding membrane, with its attendant symptoms, render this externally obvious (see menstruation obstructed); great care is required not to mistake this disease, for the protrusion of the membranes as in labor, which, to the su- perficial touch, is extremely singular. The diame- 62 DISEASES 01’ THE GENITAL SYSTEM. ter or width of this passage, is generally equal to the intestmum rectum, or last gut, but is sometimes subjected to a diseased diminution or narrowness; * this may be natural, or the effect of accident or disease, as erosions, ulcerations, or laceration from severe and difficult labors; and sometimes it is spasmodic, and is to be treated as such. The cure must be attempted by emollient poul- tices and fomentations : the introduction of a compressed spongetent smeared over with soft pomatum, or some unctious substance : the sponge imbibes, or drinks up the secreted fluid, and con- sequently becomes swelled, and expanded, and the passage gradually enlarged : the tent should be removed every morning, cleaned, dried, and applied as befoie. If this and every other application proves inef* fectual, recourse must be bad to incision, as the last expedient, which is an operation requiring the greatest caution, judgment and expertness. If the patient has no* had a child the process of parturi- tion will be found generally sufficient to effect-a cure; it is therefore advisable to wait this, as the expulsion of the foetus, will sufficiently dilate the contractions of the muscular fibres, of which this passage is evidently composed. Sometimes there is such a mal-conformation of the genital system, as the vagina forming a small opening or canal only for the evacuation of the menstrual fluid: and in o',her cases, has been known entirely wanting, and sometimes preter- naturaliv siluated. The late professor, Lowder, n St. Thomas’s Hospital, London, relates a case ■' SN PREGNANCY AND ITS EFFECTS. By the womb being in a grave state, we mean pregnancy, when the male semen has been de- posited within its cavity, and incoporates with, or fecundates the ripe ova in theovaria, or produ- ces conception. The particular phenomenon of the animal race producing each, their own species, or conception in the female, has been the subject of a variety of physiological disputations and inquiries, for lime immemorial, and has been productive of many ingenious theories, and speculative ideas; as well as absurd and far sought hypotheses : nor have we at this day any thing better than mere ■conjectures, and doubtful reasoning concerning ithowever as it is a subject not necessary for my plan, I shall begin where this cuds, in preg- nancy. As soon as conception has taken place and the ■embryo in any degree formed, *ve find a very con- siderable change to have taken place in the body of the woman : The menstrual evacuation is to- tally or parAially checked': if but partially, we find it to decrease at every repealed period, till it totally disappears, The cavity of the womb which was before flat, becomes now more globular or rounded; and we GESTATION. 77 find, if we examine, the womb itself becomes more weighty upon the finger, and consequently gravitates into and shortens the vagina: at about the third month, we find the mouth of the womb, somewhat softer and more dilated, and smeared over with a slimy mucus. / Till after this period, the womb occupies tjie cavity of the pelvis; after which, becoming too large to be contained, it rises into the cavity of the abdomen or belly ; draws the os uteri along with it, and the vagina upon ie-examination is found to he considerably lengthened, and the mouth uf the womb receded from the touch. The bulk of the womb continuing to increase at every menstrual period, the enlargement now becomes self evident externally; which in the latter months advances so high up-, as to be in contact with the breast bone, occupying all the anterior portion of the abdominal cavity. The substance of the womb during impregna- tion, is generally not much altered (except ren- dered so by disease) in which case it may suffer a morbid change of increase or diminution; the first state is often productive of disagreeable ef- fects, in the latter the most fatal consequences. In an increased thickness of the substance of the womb, the woman has a sense of bearing dowm, which is apt very much to alarm her, how- ever, it generally goes off in a month, and re»- quires only encouragement, as bespeaking a good labor—and a medicine foi the mind, as saline draughts, &c. • • • „ ■ In the latter case, or when the substance of the womb i? reduced to a preternatural loss of thicks 78 GE3TATIOX. ness or substance, it will not admit of a Tegular distention in every part : and in the latter months may be subject to laceration or giving way, and the foetus and contents escape in the ca- vity of the belly. Sometimes the womb in this case will admit of its full expansion, and at the time of labor, in its strong efforts to contract, it may give way, in the diseased part, ana the foetus, &c. escape into the abdominal cavity as be- fore. The woman in this case feels the most ex-* cruciating pain, the womb loses the further pow- er of contraction, which is followed, by faintings, convulsions, and death soon relieves the miserable sufferer. The uterine vessels are branches from the sper- inatics and hy pogasti ics, which 1 need not ex- plain ; and are commonly distributed upon the sur- face of the womb, in zigzag, or serpentine di- rections ; by which wise mechanism, they admit the expansion of the womb, during its gravid en- largement, without being ruptured, or too vio- lently extended, so as to impede the circulation of the blood through them. The blood vessels of the womb are found to he without valves; and on one particular part exter- nally, is always found a group of them, running in all directions; opposite this part is attach- ed, internally, the placenta or after-birth. The common signs of pregnancy, or the womb having become in a gravid state; are* X. Absent menstruation, at the regular time of appearing : 2. Naus a, vomitting particularly in the morn- mg, but often relieved upon lying down. gestation. 79 3. Prejudiced against common food, or what is at other times desired : 4. A desire for unnatural food : 5. A changed appearance in the face : (). A peevishness of temper : 7* Slight febrile actions, not improperly called pregnant, fevers: 8. Uncommon pains—as toothe ache, &c. 9 Enlarged breasts, with increased tenderness; and the aureola, or disk round the nipple, darkened in its color : 10. Quickening, or the first sensation of the child’s motion : Authors have divided, or exten- ded thesymptoms of pregnancy, into an almost unlimited number, where the curious have ac- cess. Any of these various signs may exist, (ex- cept the last) and pregnancy not have taken place: therefore it is requisite to have a combina- tion of them, before any decision can with cer- tainty be made. If the absence of the menstrual evacuation he admitted as a sign, it is requisite to be informed, if the woman before marriage has beeu subject to omissions or irregularity ; if not, and the woman young and lately married, we may receive it : and also a woman may menstruate during her preg- nancy. Women who arc pregnant generally lose their appetite and flesh, and belly also, in the first months: hut about the fourth month, they begin to enlarge. If they enlarge in the first months, it is a dis- ease and not pregnancy. GESTATION. Women may omit menstruation, the breasts enlarge and become tuider, and discharge a glairy milk like fluid, and not be pregnant. A dropsical ovaria frequently gives rise to a suspicion of pregnancy; which is generally at- tended, with high coloured urine, deposited in small quantities: but in pregnancy generally of a light yellow colour. The womb thus enlarged in its size, while it is yet contained within the cavity of the pelvis, and from its increased weight at its fundus or bottom, (where the embryo is situated,) gives it a diposition to gravitate, and elevate the mouth of the womb, and causes it to make pressure upon the neck of the bladder, the fundus of the womb is increased, both in bulk and gravity, which gives it a disposition to retroversion or overturning, especially if the pelvis be large; when the fun- dus of the womb presses against the intestine, and causes violent costiveness, followed by tenesmus or a disposition (with forcing) to stool, without elfect, as in dysentary or bloody flux. This dis. eased alteration of the situation of the womb is discovered by examining for the mouth, which is, in this case, too high up to be felt; and the fun- dus of the womb is found to bag posteriorly : this is a never erring proof of the presence of the disease. It is found generally in very large or smaH pelvises, rather than the standard size ; but may be produced by many mher causes. The Cure,—Consists in, first empyting the bladder and intestine: if this can be effected without fever, there is no danger, vice versa. JietroyertEd womb. 81 \?hen you have accomplished the above, the womb may be attempted to be returned to its natural situation; which is done by introducing the hand into the vagina, and carry it along the concavity or hollow of the sacrum, till you force the fundus uteri, above the projection of the sa- crum : sometimes there exists a difficulty in in- troducing the hand entire into the vagina of a woman who has had no birth ; in this case you are not to use very violent efforts, but to intro- duce one finger at a time, (first greasing well the hand, with soft pomatum, fresh lard, or some unc- tioussubstance) till the whole hand passes. The distention of the urinal bladder, brought on in this case, will sometimes be so great, as to cause it to occupy nearly the whole cavity ol the abdomen anteriorly ; being flattened on both sides, posteriorly by the enlarged and expanded womb, and anteriorly by the abdominal muscles; which the patient will frequently suppose to be dropsy : and it will require our strictest attention to obviate the mistake, as a very sensible fluctuation of wa- ter exists. In this case, it is requisite to attempt the in- troduction of the catheter, to draw off the 'water immediately the disease is detected. In this ope- ration, in common cases, it is immeteiial what kind of catheter may be employed ; sometimes from the increased length of the urethra, or w’ater- passage, the male catheter is found to be the most convenient: In parturition, when the head of the child is found to press against the symphysis pubis, it is recommended to use the flat catheter, ON THE USE OJ1 THE CATHETER. of which the least degree of curvature is suffi- cient. Contraction, spasm, inflammation, and an al- teration in the direction or situation of the urethra, will cause a difficulty in passing the catheter; in this case, the elastic catheter will be highly ser- viceable. The catheter should be introduced gradually, and with but slight exertions or force: the mind of the operator, should be kept as serene and com- posed, at this period, as possible. In passing the finger to dicover the meatus uri— narius, or opening to the badder, it should be con- tinued about one inch in a straight line from the clitoris; where may be felt a small soft, spongy rising, or eminence, composed of a few strata, of muscular fibres, forming a sort of spincter muscle to the aparture, which is found contained within: except this examination be done very delicately, the pulpy rising is destroyed or depressed, and it escapes the observation ; and also if it is not continued in a straight line from the clitoris, the aperture to the urinal duct will escape the point of the catheter, and it will find an introduction into one of the excretory ducts of the lacuna glands, which are situated on each side, and are some- times equal in size, w'ith the meatus urinafius. If an obstruction to the introduction of the catheter, should be present, the instrument should be gently moved in every direction with much time and caution, till it passes, which sometimes will be a very considerable time first. Dr. Lew- der has used a quill when a catheter was not at hand: sometimes it is requisite to introduce Che THE URETHRA, finger into the vagina to keep up the womb, dur- ing the introduction of the catheter, and even longer, till the waters are off. The catheter is known to be in the uthera by its passing imme- diately under the branches or symphysis of the pubes, and being discovered by the fingerin the vagina to be surrounded in a smooth membranous sheath, formed by the tunics, or coats of the uthera. It the head of the foetus should be found to be the impediment to the introduction, it may be moved somewhat backward and upward, and it will pass in a more erect direction than usual. Delivery in some instances, may bring on an inversion of the uterius; when the urethra will be found directly downward. It is highly requisite to examine occasionlly,the extremity of the catheter, as the perforations in this part sometimes become blocked up, and there® by prevent the passage of the water. Some authors have asserted, “ that the bladder in this disease, is frequently divided into distinct chambers, by the transverse sections or compres- sions of the womb the catheter, must therefore, necessarily, be in different situations, to draw off the whole of the waters. lu inflammation, use emollient injection* with opium—fomentations—camphorated oil rubbed upon the groin and lower region of the belly.®— The warm hath, &c. The state, or more particularly the diseases of pregnancy, are, discovered to be universally ac- companied with an infl.immato y or febrile achon, from the siiy properties of the blood ; conse® i'HB VRfiTHRA; quently, small bleedings, as the causes become urgent, may be employed with advantage, in every period of the state. The cavity of the womb, which before im- pregnation was flat, becomes now more globular, from the distention of its additional contents : this distinction in the eaily months, is confined to the fundus or bottom of the womb, while its neck and mouth remain unchanged : it is found, if examined in the vagina, the womb is become more weigthy upon the finger, and consequently gravitates into, and shortens the passage : and at about the third month, we find the mouth of the womb smeared over with a slimy adhesive mucus, which it completely stops; this is also of- fered as a farther impediment to menstruation during pregnancy :* after this period the enlarge- ment of the womb exceeds the dimensions of the cavity of the pelvis, consequently, rises above into the cavity of the abdomen, and draws the mouth of the womb along with it. The diseased alterations, the consequence of pregnancy, arise commonly from irritation and sympathy; which may be further distinguished, into primary or direct, and secondary or interme- diate causes; per example, the womb after con- ception, acquires an increased irritability, and from the direct sympathy which exists, between it and the stomach, the latter becomes equally af- fected ; when vomiting, indigestion and other dis- eases, which will be presently separately consi- dered, are the general effects : these then may be * Sec Hamilton’s Female Physician, GESTATION. 85 admitted as consistent with my distinction. The primary, first or immediate consequence; and every part of the system, is more or less affected, from the sympathy, which universally prevails with the womb.* The secondary or intermediate effect may be diseases of the brain, as head-ache, giddiness, fainting, See. from the immediate consent between them ; this then is the effect, or an effect; or a cause, in the etfect of a primary cause and so oi the rest. These diseases or effects of pregnancy, may be divided into those of the early and latter months ; and quickening, which commonly oc- curs near a middle period, draws the line of dis- tinction, and which l propose to treat of in the regular order of succession. As we cannot immediately discover the causes of all pregnant diseases, we must bv conjecture and reason, regulate our conduct in the mode of treatment: as the womb when gravid retains blood, and consequently produces plethora and irritability; and requires the use of the lancet with opening medicines : but these as well as every active medicine should be administered with ex- treme caution at this time. Many authors have endeavoured to establish rules; to ascertain the progress of pregnancy ; which in general, I believe are tolerably applica- ble, viz. * Est enim uterus prjncipalcs quae totum co; piu facile in conseusum tralut. Harv. exercitai tie partu, VOMITTING About the fourth month, the womb becomes so enlarged, as not to be contained within the cavity of the pelvis ; and ascends to the abdomen, when the increase externally, may be said to com- mence. The fifth month it is found above the nubes : “ Sixth month, midway, between ttie pubes and navel : “ Seventh month, as high up as the navel, which is found to protude: “ Eighth month, midway, between the navel and breast bone. “ Ninth month, or full time, to press against the under part of the stomach, occupy the whole of the abdominal cavity anteriorly: “ The intestines are found forced behind, against the hack bone, and violently com- pressed, which causes, at this advanced pe- riod, the incapability of retaining any thing upon the stomach; with the general dispo- sition to costivenese, or obstructions in the bowels, which should be carefully guarded against ; and in order, comes next to be con- sidered. OF THE DISEASES OF THE STOMACH AND INTESTINES. Vomiting is a very general attendant on early pregnancy, though sometimes it is found to con- tinue in the latter months ; and except it is very violent, it is best left to nature’s management; as l conceive it so far from being prejudicial or dan- VOMriTINC. 87 gerous, that I believe it to be serviceable in dis- charging acrid and other injurious matter; it also tends to give energy to the womb, and is generally found to be relieved by retiring to the horizon- tal position; but if it continues in excess, recourse must be bad to more active remedies: we should inquire into the state of the habit, and if plotbera should be the cause, the lancet may be cautious- ly used ; but tins frequently is the effect of irri- tability when bleeding would be found to be hr jurious : the vomitting ought never to be totally checked without first opening the bowels, by gen- tle cooling cathartics, or by glysters : if the sto- mach will not retain the former sufficiently long to alfect the bowels, the saline draughts, in a state of effervescence or ferment, may be given com- bined with bitters, of which the Colombo root has been found best to succeed, when every thing else has failed ; to these, absorbent earths may be added ; and occasionally an opiate is requisite, when they have been found most successful, in the form of pills. Magnesia and mint, pepper- mint, or cinnamon waters : elixir of vitriol in cold water, or cold chamomile tea, to which may be added, some aromatic, and occasionally light cordials are required, of which the confec- tion of kerms in cinnamon water is found to he the most grateful Sometimes, vomitting proceeds from a tender- ness of the belly, and stomach ; in this case (which proceeds from inflammation) we must bleed, foment externally, give opiates, both by the mouth and glysters : some have recommend-, ed the theriaca andromica ; or London treacle of INBTfiESTION the shops, to be applied externally; but the best application is the expressed oil of mace with opi. uni, or cloths wet with laudanum and applied to the region of the stomach, a change of air is ne- cessary where the case is not dangerous. In frequent inclinations to vomit without evac- uation, gentle emetics have been by some esteem- ed the best remedy ; but for my own part, I should be extremely cautious in using them : sometimes however, vomitling will continue in spite of every endeavour to the contrary, until the time of quickening, when it will generally, of itself, cease. Indigestion—-Or a depraved appetite is another attendant of pregnancy,from the same cause as the former, and is commonly productive of longings or desires for strange and unnatural food, which, if not materially objectionable, may be indulged. The Navel String, or the connection between the mother and child being entirely dispossessed of nerves, and of course sensibility, the mother’s influence over it, to cause any particularity in marks has been denied by the most able teachers and writers upon these subjects; while others have as arduously contended for its existence. As the stomach is at times loaded with hu- mors of an alkalescent or acid quality, the desires are varied, as the one prefers the most savory and high seasoned food, and the other acid fruits, ve- getables, and drinks of the most cooling proper- ties, and might in both cases be indulged with ad- vantages. In this case the acid elixir of vitriol with aromatic bitters have been serviceable. H2ART BURN. 89 Heart Burn—Improperly so called, for it is not any disease of that organ, but sour painful eruc- tations from the stomach, with a painful sense of heat in the throat and fauces, and lound frequent- ly to attend women throughout the whole period of gestation or pregnancy : it often is a conse- quence of indigestion, when sharp acrid humors are secreted and accumulated in the stomach which frequently cause anxiety, sickness, and a disposition to vomit. In weakness and indigestion, the stomach may be cleansed with a dose of calomel and rhubarb, or rhubarb alone ; and afterwards, strengthened with bark and vitriol, to which may be added any of the stomachic bitters with occasionally a little generous wine or spirits. If acidity abounds, as the cause of these com- plaints, any of the absoibents, as chalk, prepared oyster shells, magnesia and peppermint, or cinna- mon water, aniseed or common water; this com- ing in contact with the abounding acidity, neu- tralizes or decomposes it, in which a fermentation is produced, which is still of further advantage in expelling flatulency. If bile superabounds, and-occasions heart burn, the sweet spirit of nitre in a glass of water, will generally be found to afford relief ; or a dose of calomel and rhubarb, which frequently causes it to take the intestinal course and produce a free evacuation downward ; when the complaint is violent and irresistible by these means, a gentle vomit of i'pecaucanha or stiong chamomile tea, or an infusion of daflodil root, or the blessed thistle is found to be tiie most effectual remedy* COSTIVENESS. If grease abounds in the stomach, and is the cause; a glass of brandy, spirituous cinnamon, aniseed, or pepperment water, generally procures relief. Some authors * have asserted the chewing of green tea dry, has cured this disease in preg- nant women. Costiveness. Is a complaint which pregnant women are frequently attended with, through the whole period of gestation : if not prudently guard- ed against by regimen, medicine and exercise. The form of medicine for this troublesome com- plaint, should be of the most mild, soluble, aperient and cooling properties, as senna and its electuary manna, castor oil, soluble tartar, rhubarb and magnesia, and such like : if the intention is an- swered by any of the above remedies, the effects are always better than when drastic or more heat- ing and violent purgatives are used, as jalap, aloes, scammony, bitter apple, &c. The aloes are in more common use among the lower class of people, on account of their cheapness, and convenience in forming into pills; but I should object to them or account of their heitingand drying qualities, which after their operaii m, leaves a greater disposition to costiveness or intestiual ob- structions than before. The common cathartic salts dissolved in’simple mint or cinnamon water, is said, will oiten rest upon the stomach better than aperients of a less nauseous taste : and the cooling dissolvent proper- ties which they possess, would lead me to prefer them : Thus far then may be considered, as the * Buchan. PILES. prevention and cure of the first stage of this diease : I come next to speak of it in its more advanced state : a long and continued obstinate costiveness may be brought on by indolence and inaction, remaining too long in the horizontal posture, too warm clothing, soft beds, and other things which divert the secretions to the surface of the body; all heating and astringent or binding regimen ; the foeces by remaining too long in the intestines become indurated or dried, to such a degree that nature in all her efforts, and every medicine, both by the mouth and glyster, fails to effect their dis- charge ; and yet a small quantity ofdissolved foeces may have escaped between the column of hard- ened excrements and the intestine, and often prevents the disease being thoroughly detected and relieved, till an examination be made; the pain in the efforts to expel them, which returns perio- dically, attended with a dry feverish heat, tension of the abdomen, inflammation of the parts and soreness on examining the belly externally, should lead us to suspect the presence of ihe disease : which if not timely relieved, generally terminates in mortification of the intestine, and death soon closes the scene. The Cure—Consists in dividing the dry liard- dened foeces with a convenient instrument; as the handle of a tablespoon, and afterwards to be scooped or picked out and washed away by repeated emollient glysters of broth, gruel, starch, or such like. Dr. I ,owder has said, he lias known a bougie passed into the hardened excrements to soften and break down their texture, and they are after- PILES. wards totally expelled : This operation is very familiar among farriers, and is called raking. Hermorrhoids, or piles,—This is a disease to which the female, from constitution, and seden- tary life, is more subjected than the other sex ; and more particularly during pregnancy, from the compressions which the intestines suffer; by the enlarged and gravid womb. This disease is distinguished, into bleeding and blind piles; the first when blood is discharged from the Hemorrhoidal veins, or blood vessels distributed about the termination of the intestine. T he latter'when the vessels are distended and protrude, but discharge no blood. They are also distinguished or divided into ex-, lernal and internal: The first when they are louiul to protrude and assume various appearances, when they are readily distinguished. The latter when they are situated internally, and are discovered by great pain and tension on going to stool, or slight motion : these last descri- bed, are always productive of most pain, and dif- ficulty of cure; while the outward piles gene- rally relieve themselves; for when their distensi- ons are complete, the side of the vessels give way, burst and throw out their contained b'ood, and the disease is relieved at least temporally or for the present, till the accumulation again exists: sometimes, however, this discharge is immoderate, and tends greatly to weaken the patient; in tHis case, it must he provided against, by treating as in immoderate menstruation, (which see.) The common causes of piles, are plethora, ob- stinate costiveness, and venal obstructions, or PILES. 93 more immediately in the hemorrhoids, or veins si. tuatedin the parts where piles when present, are found always to exist: The cure. Open the body with mild cooling purgatives, as manna, senna with cream of tar- tar or sulphur, or both, which is perhaps prefera- ble; bleeding generally and topically ; this latter operation is more conveniently done by applying leeches to the piles most tumefied and enlarged, soft poultices, or frequent washings with a weak solution of sugar of lead, fomentations of an ano- dyne quality, as poppy heads, &c, sitting over the steams of hot water, or emollient herbs, as mal- lows, mullen, slippery elm bark, &c, and the warm bath, which may he advantageously en- joined- This disease is frequently productive of the he- morrhoidal cholic, which is also relieved when the disease is removed ; but in this case lauda- num in tincture of rhubarb, and peppermint or cinnamon water, may be given to alleviate the pain. Piles bleeding to excess, has induced dropsy i in this case the cold drawm linseed oil, with tinc- ture of rhubarb given internally, has rarely failed to relieve : ointment of elder mixed with brown sugar, or sulphur and laudanum has been esteem- ed an excellent application: The balsam of capivi given internally is found to cool and open the bowels, and alleviate the pain; some recommend each pile to be pressed with a steady firm compression to procure relief; but this, l conceive would tend to bruise the tu- mor more than remove or relieve the diseases 94 PILES* Crude sal armoniac, and salt petre finely powdered and mixed toge!her, has been recommended by Henry Cline professor of anatomy and surgery in St. Thomas' hospital in the borough of Southwaik, London, to be applied to an inflamed and tumi- fied tonsil, and the discharge of blood which it produced, procured immediate relief, the hint caused me to make the same application to a pile which vras attended with equal advantages. As these various complaints of women receive a disposition during the growth, from the gene- rally improper mode of bringing up girls, to a too much confined and sedentary a life, under the false impression of making them delicateand gen- teel, and acquiring what are esteemed the ac- complishments of education, as music, drawing ; tambours and other fine needle work, which are in fact superfluities, the acquiring of w hich, sap the foundation of health in the bud, and lay an establishment for all the train of future mala- dies, irregularities, costiveness, indigestion, weak and depraved appetites, head aches, vertigos,. hysterics, and the train of maladies attendant on elevated and polite life; while the rustic maid with a roseate bloom on her cheeks, animation in her eyes, and health and life in all her actions, rarely know*s any thing of these things, she breathes the pure air, and draw’s in health at every inspiration. Her body is healthy and vigor* ous and her mind free and unimpaired by the ma- ladies brought on by polite education and restrain, ed action, and when she enters the married life, her offspring are most likely to partake of the health of the stock they spring from : it was 9J- GESTATION ADVANCED. ways an observation of mine from very early life, that girls called tomboys, if the prudential care of the parents, especially the mother restrain from running into licentiousness, are the most healthy mothers and generally the most domestic and best wives, and if I should be blest to raise my daughter, I propose to encourage this disposition tvith no other restraint, but prudence. Women during pregnancy, from bil ary and uterine obstructions, are sometimes subject to spots or blotches, appearing in different parts of their bodies, but more especially about the face, neck and breast ; some are anxious for their remo- val, hut otherwise are of no importance; use laxatives, exercise, ripe fiuits and a vegetable diet, and wash with rose or elder flower water; if these do not answer, tell the patient they are not bud signs of her future ivtll doing and she will endure them with patience and satisfaction. OF ADVANCED PREGNANCY, AND ITS DISEASES. The advanced state or latter months of preg- nancy are very properly considered to commence after quickening, or first sensation of the motion of the fcetus, in the womb, which at this time becomes much enlarged and occupying a greater portion of the cavity of the belly than the other viscera, which sutler necessarily, more compres- sion, consequently obstructions are more frequent and lasting, the circulation of tire blood is more languid, the diseases are more accute and danger- 96 stranguary. ous ; therefore require greater attention and man- agement than in the early months: Costiveness and its consequences, which have been before treated of, are found more obstinately to prevail, therefore require continually to be obviated, by occasional mild and cooling cathartics, and injec- tions of broths, gruels, starch, and such-like ; otherwise it is productive of a disturbed stomach which require gentle emetics of ipecacuanha or cardus benedictus, i. e. the blessed thistle. If fever should succeed, an occasional use of the lancet may be employed advantageously; however, if not timely removed, is sometimes productive of a diarrhoea dysentary or tenesmus, i. e. violent painful and weakening evacuations by stools, or as the last term implies a frequent inclination to stool, with bearing down and nothing is discharg- ed, but an acrid irritating mucus, with much pain and burning, which is esteemed much more weakening than the former state, and is relieved by emollient and strengthening injections of oil with laudanum, or castor oil or rhubarb given in- ternally, with light nutritious healing regimen, as sag**, vermicelli, calf s foot jelly, salop, tapioca and such like. Stranguary—Or frequent inclinations to pass urine, which is voided with much pain in small quantities, this obstruction frequently occurs in early pregnancy, from the sympathy which ex- ists Between the bladder and the womb ; and is generally relieved by a mild regimen, nitre and barley water, ptisan, or such like : but in the lat- ter months, it is caused solely by the pressure of the enlarged womb upon the neck of the bladder; 8TRANGUARY. 97 tvomen frequently from restraint,* or false deli- cacy in company, cause a voluntary suppression of urine winch 1 would recommend to be over- come by retiring either with a friendly female, or alone. If the cause should be suspected by the male part of the company, the more thinking and well bred will never seem to notice it, in such a a manner as to give to the most suseeptable mo- desty, the hast apprehension or cause for pain, the lady need not hazard the blush ; tor the liber- tine, I should be ltd to hope, will invariably meet that reproach and condemnation, even from his own sex, his ungenerous, unfeeling, and I hesitate not to declare, his unmanly and reproachful con- duct merits. These causes frequently bring on a total sup- pression. In all cases of stranguary, the bowels should be emptied and kept soluble by mild cooling purga- tives and glysters, and if inflammation arises, bleeding will become indispensably necessary: opiates to allay occasional spasms and irritation, and the water should be drawn off. [See the use of the catheter.] Involuntary emissions of urine frequently oc- cur in the latter months of pregnancy, especially in the erect posture or standing, or on the slight- est motions or exertions, as coughing, sneezing, &c. however these complaints admit only of pal- * It is said, the truely humane and justly celebrated Dr. Fothergill died a martyr to his indiscretion, in suffering the calls ol nature in this way, and thereby brought on such diseases in the urinal passages, as terminated only with his life. DROPSY. liation in the pregnant state, and the cure follows when the cause be removed, which is the com- pression suffered by the gravid enlarged womb, on the side of the bladder ; however, these arc symptoms indicating a good labor, for the presen- tations in these cases are generally natural and well disposed. Anasarca or Dropsy.—Women when gravid are generally subjected to anasarcous or dropsical swellings of the lower extremities, from the com- pression of the womb on the sides of the blood vessels : which has, in some, given great uneasi- ness in suspecting it may continue after delivery, or through life, but of this there is no danger : sometimes in violent swellings of the feet and legs the patient becomes alaimed lest they should hurst : which would he dangerous and difficult of cure : in this case the feet may be steeped in warm water, or rubbed with the warm hand, or cam- phorated oil, to remove the tension of the skin, and relieve the pain : ii these, or other such sim- ple applications fail of relief, the skin on the top of the foot may he slightly scarified with the shoulder of a lancet, or scalpel or scarificator, and the water will gravitate from the upper parts of the body and gradually escape, till the tension is removed, or sometimes 1 have applied a small blistering plaster, about the size of a dollar, with good effect, where there lias existed a strong ob- jection to the operation ; however, for fear of stranguary brought on by the sympathetic effect of the- neck of the bladder with the action of the blistering flies, the operation, which is very slight and of inconsiderable pain, should be preferred.— DROPSY. But neither of these modes of relief should be at- tempted, until the distention becomes so great, as to oppress the breathing, which it will do when violently charged, by the water returning from the lower extremities to the body, after reclining in the horizontal posture, from the communications this cellular membrane possesses, throughout the whole body ; it is found situated immediately un - der the skins, between them and the muscles oe flesh, and the receptacle of the fat, which situa- tion this fluid occupies, the former being general- ly, in these cases, nearly removed. It is requesite in these cases to use as much rest as possible, with flannel bandages upon those whose situations will admit them to rest. These bandages are found not to agree with every one, but sometimes produce oppression upon the chest, by forcing the water towards the upper parts of the body, and cause a laborious difficulty of breathing : when such are their ef- fects, they should be discontinued, and gentle opening medicines be given and often repeated. The veins on the lower extremities, and on the surface of the belly, in the latter months of preg- nancy, from compression become varicose or so violently distended and enlarged, as to assume a strange torturous and alarming appearance ; some- times they are relieved by gentle compression cr bandage ; if from too great a fulness of blood, bleeding has been advantageously applied, which is further assisted by gentle purgatives and a spare cooling regimen. These several diseases are invariably removed alter delivery, when the cause, e, the coropres- 100 DROPSY. sion of the enlarged womb is taken off, these ef- fects insensibly die away. There is sometimes a black appearance on the surface of the belly, which the patient frequently mistakes for morbific or mortified, but it is mere- ly extravasated blood, from the small venal branches being ruptured by the distention of the belly : apply warm camptiorated oil rubbed in with the warm hand, ora soft of poultice of bread and milk or bruised flaxseed. Ascites, or Dropsy in the cavity of the abdo- men or belly. 1 his diseased accumulation of water in the cavity of the belly, let it be remem- bered, is perfectly distinct from and has no con- nexion with anasarca, or the accumulation in the eellelar texture between the skin apd the flesh, but is confined to a circumscribed cavity, and has no communication with any other beyond its own extent; therefore while parturition or delivery cures the one by removing the cause of the dis- ease, viz. compression, it avails nothing in this, though they may and often do exist, at the same time, the one is removed while the other remains. This disease is sometimes present in pregnancy and furnishes the patient with many pertinent and embarrassing inquiries; but it is found gene- rally to assist delivery, as it relaxes the fibres and assists their delitations : it is said, a person labor- ing under this disease,may become pregnant, but these are two things frequently mistook for each other. When pregnancy has been mistook for dropsy, and the operation of tapping been performed, and the trocar or instrument employed perforates the KUPTURES. 101 substance of the womb, afterwards the child’s head or elsewhere, and the death of the mother and her child been the inevitable consequence. Pregnant women in the last stage of the drop- sy will certainly be carried off by the disease. Some have asserted this has been cured by pregnancy or delivery : women frequently de- ceive themselves, in entertaining and nurturing this opinion, that their delivery will effect their cure, but affords very little hope of success, as the cavities containing the liquor amnii, or child’s waters as they are commonly called, and the dis- eased accumulation in dropsy, are perfectly dis- tinct : the womb itself being surrounded by the dropsical collection. As the treatment of this disease would be in- jurious to pregnancy in promoting abortion, &c> it is to be delayed until after delivery, and lap- ping or otherwise not to be attempted, except death indirates the necessity, and it requires to be performed in the most cautious and skilful man- lier. For the cure of dropsy, see Ovaria diseased, section 2. Ilerniae or Rupture.*—This is a very danger- ous disease in the time of pregnancy, and every prudent practitioner who can obtain any fore- knowledge of the existence of it will endeavor to avoid attending such patients ; for if it be ir- returnable, it is productive of the wrorst and most alarming consequences : while a returnable rup- ture is often happily cured by pregnancy, by the womb being so much distended forces back the in. testines to the back bone, and closes the apetture 102 RUPTURES. through which the intestine protruded, which may be found firmly to adhere or grown up by the time pregnancy is completed. The cure (surgically) for ruptures, is to return the protruded intestine to its natural situation, and confine it by a truss, or some other proper bandage: use the horizontal position, and every' thing tending 1o prevent and remove costiveness, flatulency and every cause of distention in the in- testines : an irreturnable hernia in advanced preg- nancy, or at child birth, is very likely to become strangulated. The cure, or prevention from speedy and ine- vitable death, consists in the operation of dilating the orifice, or ring through which the intestine protrudes, with a scalpel or crooked history. As this operation is not to be attempted, but by the most expert surgeon, of accurate anatomi- ul knowledge, to attempt to explain it in a work not principally intended to investigate surgical o- p: r ttions or for such as have not been professionally and scientifically learned, but for family assistance, would be vague and absurd ; but the se who wish a description of this operation, may find it much more accurate and elaborate than 1 could give it fexcept I was to their words) from the works of Gooch, Bell, and others who have wrote particularly on these subjects : however, when aiuplure appears to resist the common efforts to return it, it may be assisted by applications of cold astringents, as vinegar and water, Goulard’s lead- water,•See. if these fail, recourse must be had to emollient applications, as soft warm poultices, fo- venereal disease. 103 mentations and the warm hath, emollient injections with cooling soluble medicines by the mouth, as manna and cream of tartar, soluble tartar, cas- tor oil and such hke, to empty the intestines and reduce the bulk of the protruded portion of intes- tine; small doses of ipecacuanha to produce a slight nausea or sickness, will very frequently re- lax the rigid contractions of the aperture, when every other method has failed : If these and such- like methods are ineffectual, recourse must im- mediately be had to the operation* as the only prevention of death, when strangulated or morti- fied. When a rupture exists during the process of child birth, it should be carefully supported while the labor pain continues ; and after delivery again supported by proper bandages, carefully guarding against inflammation, distension, and the r usual consequences by bleeding, purging &c. as the con- stitution may support. 'i'he Venereal Disease—or the disease of Venus, or the foul disease, as it is commonly termed ; is sometimes found to exist during pregnancy. Some contend the infection received after conception, cannot be communicated to tiie foetus in utero ; as tiie mouth of the womb is so firmly closed, which prevents the virus passing into its cavity: * SeeClieseldon’s anatomy. In St. Thomas’ hospital in Southwork, London, was a man who supported the operation of a considerable portion o the intestine being removed, being mortified, it cicatri- zed, or healed to the opening in the groin made in the opera- tion, through which the excrements ever after involunlary passed. 104 VENEREAL DISEASE. but I must confess, I am of a different opinion, the womb may not always be perfectly closed, or how is it superfcetation takes place after concep- tion, if the mouth of the womb was closed, the male semen could not possibly pass to the womb, for future fecundation, and the womb already gra- vid, which is a circumstance celebrated authors may be brought forward w-ho advocate, as well as others who oppose this theory ; * if so the virus cf the venereal disease may pass the mouth of the womb and infect the foetus in utero : however, it much more frequently occurs at conception, or the mother being previously diseased. Sometimes the child may be excoriated or hurt in the passage, and coming in contact with the vi- rus or the ulcerated parts in the mother, may as- sume a venereal appearance, in a few days after the birth : but I should be led to presume, the ad- hesive matter found generally dispersed over the whole surface of the child’s body, &.c. after birth, would tend to ward off the venereal poison and prevent its attacking the'tender surface of the in- fant : or otherwise, the washing and cleansing so necessary and generally used to free the child from this matter, which is frequently a work of much labor, would inevitably remove the venere- al virus, before its irritation could produce inflam- mation and absorption, by which mode only the infection could be communicated in this case, f * Sec Haller’s pathological observations, page 107. f 1 have seen instances of children being born of diseased parents, at the birth apparently free of every mark of infec- ;ion ; and in a few days or week.-, break out in eve) v viru- lence of the disease in its most confirmed state. 105 VENEREAL DISEASE. ■however this is merely hypothesis. So that I am ■led to conclude whenever a child is infected with Ithe venereal disease from diseased parents, the ■infection must be generally premature to the Ibiri h. The venereal disease is divided into two stages, and virulent, or local and confirmed, i. e. confined to the parts of generation, or dispersed through the system and habit universally atfected. 1 shall say nothing of the cause, but proceed to the symptoms, which are an increased secretion of mucus, heat and irritation in the vagina and parts adjacent, which become inflamed and tumi- fied, and an evident dischaige appears ; at first simple and limpid, afterwards acrid and opake, which inflames and ulcerates whatever part it comes in contact with, if not immediately remo- ved by washing or otherwise: this disease is mild-* sr in women, but often of more ditficult cure, than in men ; and the more virulent the disease is, the sooner it appears after infection, and admits of more difficulty of cure. In the confirmed state, the symptoms are more violent, and generally distributed throughout the system; the ulcerations are found to become foul it the bottom, with a buff colored covering, and hardened base, very much indisposed to heal; and from the absorption of the virus in these ulcers railed chancres, being conveyed to the glands in the groins they partake of the disease : one or both becomes enlarged and tumified : and at length the whole system becomes atfected, like in- noculation : blotches of a scorbutic nature are found on the skin, which peel off, and at length VENEREAL DISEASE. assume a copper colored appearance ; pains, swel- lings and at length rottenness of the bones of the skull, * arms, legs, &c. Ulcerations in the throat, fauces and nose, which is at last destroyed and falls in, and extracted with the palate of the mouth, with a pair of forceps, f attended with excruciating nocturnal pains, when warm in bed. Treatment.—-If this, or any other peculiar dis- ease should occur during pregnancy, you may trtat it in every respect as at other times ; but on- ly to bear in mind, all active medicines, as emet- ics, cathartics, &c. should be administered with a •paring hand. A pregnant woman with a confirmed lues vene- rea should not be salivated, except there be time sufficient, to complete the cure before delivery ; otherwise we should only paliate the most urgent symptoms and salivate after the month In this| case mercury, (of which corrosive sublimate is by, some esteemed the besi) should always be combi-j ned with opium, to prevent cholic, or passing offj too hastily by the bowels. In the simple state of this disease, when it is local, and confined to the parts of generation and * Professor Cline exhibits the skull of a man with the frontal bone perforated l>ke a cullender by this disease. f A man also exhibited himself in the anatom-cal theatre of St. Thomas’ hospital, London, in whom the palate bone of the mouth had come away, after being seven years mar- ried and had had several children. lie declared his wife to be a virtuous woman, and that he had never defiled the mar- riage bed himself, his general character substantiated his report. So latent, yet potent, are the effects and progress of this noxious disease. VENEREAL DISEASE, adjacents, mercury is unnecessary, but when it may be used, it should be as an alterative, i. e. in small and frequently repeated doses, in which no sensible operation is discovered : however, in ge- neral, with cooling purgatives and diuretics, the washing the diseased parts frequently with milk and water, or a weak solution ol sugar of lead with mucilage of gum arabic, (i. e. the gum dis- solved in water) will be found to be sullicient to effect the cure. Internally, give cooling laxative medicines, as cream of tartar, soluble tartar, sulphur, neutral salts, and such-like ; accompanied with rest, a spare thin diluting diet, avoiding wines, spices, and every thing of a heating irritating quality. In the confirmed state, mercury is the only re- medy we can depend upon ; which should be in- troduced into the system, both by the mouth and skin, the form of strong mercurial ointment, rub- bed alternately on the inside of each thigh, till a soreness with a copper taste in the mouth is detect- ed, which is a proof of the constitution being sa- turated or sufficiently charged with it: we should then desist for a few days, till the symptoms somewhat abate, then resuming our applications as before, and continuing for ten days or a foit- night after every symptom of the disease disap- pears; great care should be taken to clean the mouth three or four times everyday to prevent the most disagreeable consequences. I had some few years since, a patient among the Cyprian dames, whom 1 was necessitated to salivate, and gave particular injunctions when the soreness and copper taste were produced, to 108 VENEREAL DISEASE. desist from the means, and apply to me for in- structions; but she imprudently doubled her dose,: under the old error, if a little was good, morel was better and her tongue was swelled out of lier mouth, which with the inside of her cheeks! were one entire raw' surlace; her attendants scarce deserved the name, her mouth was taken no care ofj she got well, but her tongue wras grown fast to the cheeks, she could not bring her teeth in contact, necessarily she could not masti- cate, but had to live upon suction and spoon meats. I attempted to separate the tongue and restore its liberty, but she would not submit to the operation, and left this city in that condition, and for aught I know, may remain tongue-tied for life, as a punishment for her indiscretions. The mercurial course ought not to be attempt- ed, after the sixth month of pregnancy, as the debility and relaxation produced, may endanger abortion : bur anytime previous to this, if pru- dently managed, both mother and child may re- ceive a radical cure. Bubos or venereal tumors, in the groins or else- where, are best to be repelled, or caused to he re- absorbed, or again taken up into tin1 system ; which will be generally effected by rubbing with mercu- rial ointment and camphor, or washed with a so- lution of sugar of lead : if however, suppuration, or the formation of matter in them should have taken place, and it is considered as impracticable to persist in repelling in this case, they must be forwarded by continual and frequently repeated applications, of warm suppurative poultices, as bread and milk, bruised flax-seed, or such-likei venereal diseese. during this process every thing of an opening quality should be desisted from, as prejudicial to suppuration : on the contrary, the body should be supported, by a nourishing diet and generous regimen, that nature may be assisted in her ef- forts, to throw off the offending matter, in the way she may have pointed out, which always should direct our endeavors, except contrary to reason and the common laws of the animal (Econo- my, as nature will sometimes, though rarely err; t then becomes the duty and office of the practi- tioner, to regulate and set aright by such means is the powers of medicine may afford. After this tumor is broke or burst, or been o- pened with a scalpel or lancet, I always found it to be most advantageous to continue the poultices, with dry lint to till up the cavity of the tumor, for three or four days or a week, till the most profuse of the matter may be discharged : when the mer- curials may be resumed, with the abstemious diet: if the edges of the wound become hard and cal- lous, apply caustic, red precipitate, or blue vitri- ol ; and scarifications, with the shoulder of the lancet are found to be highly conducive to the :ure. Chancres—or venereal ulcers, are sometimes formed indifferent situations, and are best destroy- ed by caustic, red precipitate, or such like, and ifterwards cleansed and healed by detergent and cicatrizing balsams, or washes. After a continued mercurial course, it is esteem- ed necessary to cleanse the blood and juices, by Irinking largely of the decoction of the woods, is sarsaparilla, sassafras, guaiacum, china root, 110 er-ratk; pains* mezereon, &c. and the constitution to be afteiw wards restored by bark, steel, a milk diet, change of air, exercise, &c. Restlessness, and Inquietude—are common and troublesome attendants, to women in advanced pregnancy, and more particularly in the night sea- son, although having a strong disposition to sleep ; however, the woman is much refreshed by indul- ging and reposing upon the sofa, in the eve of the day, which I think should be indulged: It is presumed the absorbing powers of the child,, are more than equal to what the mother can spare, consequently a woman naturally loses her flesh, during her pregnancy, and more particu- larly in the latter months: however, it is general- ly observed, such women have good labors and healthy children, which more than compensates for their sufferings. If the mother grows fat, in the latter months of her pregnancy, with little inquietude, the child is generally small, puny, and poor, from its Hot having received its due proportion of nourish- ment : and if the c hild dies before delivery, the inquietude totally ceases; and therefore this ces- sation may be esteemed, a symptom of a dead child. Women are generally relieved, by small and repeated bleedings and gentle cooling opening medicine. Hoffman’s anodyne liquor, laudanum, Ixc. are sometimes occasionally used with advan- tage- Erratic Pains—or pains wandering about, no where settled, are discovered in different parts of the body, but more particularly in the hips and loins; the first from the pressure of the enlarged and gravid womb, made on the large ischiatic or nervous brunches, as tiny pass through the per- forations in the os sacrum, anteriorly. (See os sa- crum.) The last from the weight of the gravid womb and its contents, and the increased debility of the woman; these complaints, admit of but a tempo- rary relief, or being palliated ; by spirituous em- brocations, or rubbings with camphor, opium, or such-like: t il delivery removes the cause, and the pains consequently cease. A pain in the groin is not unusual in the latter months of pregnancy, caused by the round liga- ment of the womb, which is inserted into and lost in the cellular substance of the groin, which being put upon the stretch from the womb’s dis- tention and elongation, or rising into the cavity of the abdomen. This is relieved by being rub- bed wnlr camphorated oil and the warm hand, e- moilient fomentations, or sitting in an incumbent posture, or leaning forward. The pressure of the womb will cause numb- ness, or a sort of temporary palsy of the lower extremities, confined generally for the most parr to one s de. The Cramp—is another attendant, from the same cause at this particular period ; this is a very troublesome complaint, more especially in the night, but not dangerous; if violent, is sometimes relieved by small bleedings, and such medicines as abate the uterine irritatation and spasms: The warm bath, opiates, camphor, antispasmodics, ge-. CRAMP. 112 CRAMP. nerallv, with friction, and embrocations to the parts affected. In pendulous bellies. Pains are frequently cau- sed in the lower part, by the pressure it makes on the share bones, and is best relieved by a sup- porting bandage or long napkin carried over the shoulders, and secured on the back of the neck. It is not unusual, or without reason, that wo- men as they advance towards the conclusion of gestation, though at other periods patient and re- solute, will intimate their apprehensions for their safety, and well doing: it is our business in these cases, to endeavor to instil a confidence in their minds, of their situation, that nature, and the goodness of the “ great first cause,” is over all his works, to support and strengthen them, togowell safely through their sufferings: If it appears to be only an hysteric affection, little else is neces- sary, than friendly sympathy and support and a medicine for the mind, as a little syrup and mint, or pc ppermint water, or suck-like. But if febrile symptoms attend, an increased pulse, heat, a foul tongue, costiveness, pain in a- ny part, more particularly the belly, our greatest care and attention are required. Procure an intestinal evacuation, by some mild opening medicine, or by a common house glyster: bleeding in a small quantity, is requisite, retire to rest, promote a gentle determination to the akin, more particularly of the lower extremities, by warm bathing, and afterwards wrapped in warm flannels, and support the constitution by wines, cordials &c. during the intervals of fever. SICKNESS. Sickness,—Will also very frequently, accom- pany the latter periods of pregnancy, as well as the early months; which is caused by the com- pression of the womb, upon the bottom of the stomach, and admits only of palliation, by saline draughts in a state of effervescence or ferment, with laudanum, lavender or such like combined. The compression of the enlarged gravid womb, on the extremity of ihe intestine, very generally produces costiveness, which should, at this time more par- ticularly, be carefully guarded against; as it dis- poses to a good labor and safe delivery, by emp- tying the intestines, and affording more room for the child, who requires all there may be to spare, which is generally little enough, The same cause, or pressure upon the neck and fundus of the bladder, will occasionally cause an involuntary emission of urine, more especially when standing up right, which indicate a good labor, and happy uprising, from this state of sor- row and suffering, as before observed, Epileptic Fits,—Assume a dreadful and alarm- ing appearance, and may occur in every period of pregnancy, from accidents or otherwise: and are commonly attendant of the greatest danger, which is increased as the woman advances in her pregnancy. Causes,—Irritation of the womb, from too great distention: a large foetus, twins, triplets, ike. or any irritating cause; sometimes they are here- d.tary, or have descended from the parent to the child; or they may arise from frights, blows, or falls, and more particularly, when the braiw or beliy may have been injured ; violent passions EPJLEPTIC FITS. of the mind, hysteric affections, repeated de- bauches, contagious diseases, &c. Symptoms.—Pain in the head, unusual lassi- tude and weakness, stupor, dowsiness, dimness of the sight, palpitations of the heart, flatulency, languid pulse, and pale countenance: sometimes however, the fit comes on without any of these preceding symptoms, when the patient suddenly falls down, and is violently convulsed ; the body,' extremities and eyes are contracted and distorted, foams at the mouth, produces various frightful gesticulations, and an involuntary discharge of stool and urine follow. Treatment.—If the vessels appear much distem- ded, bleed, give opening medicines, a cool spare diet, i xercise and free open air; if the stomach appears loaded with bile, or any other acrid offen. sive matter, a gentle puke of ipecacuanha or such like may be administered with advantage; but should be very cautiously employed on these oc- casions. If the patient be nervous and debilitated, a very serious distinction, and a very opposite mode of treatment is required; the spasmodic affections must be allayed by medicines of the atispasmodic class, as musk, opium, castor, valerian, assafaetida animal oil, camphor, cinnabar, &c. frequently re- peated emollient glysters with some of the above ingredients combined : the legs and feet soaked in warm water, or the warm bath: if a stupor or insensibility exist, blisters, mustard poultices, &c. may be applied to the feet, legs or hands, With setons and issues kept open: the flowers of zinc have been much recommended and approved in A FALSE CONCEPTION. 115 these cases, from one grain to three, three or four times a day. The constitution is to be restored, with hark, steel and warm nervous cordials, cold bathing, exercise, open air and a light but nourishing diet. OF A FALSE CONCEPTION, OR A MOLE, Which generally consists of some diseased col- lection of solid or fluid matter, as dropsy, polypus, wind, See. (which see) to these may be added, the dissolution or destruction of the foetus, after being once formed, by obstructions to the circulation thro’the funis or navel string, or some such accident by which the embryo is deprived of future nou- rishment, lffe and growth : this, however, is im- properly termed a false conception, as the c in- ception and formation were perfect, but after- wards destroyed. The secundines or after birth, is also sometimes retained in the womb, and becomes augmented by the occasional additional accumulations of coa- gulated blood,and is at last expelled in an indura- ted and enlarged state of a pulpy, fleshly, fibrous like mass. The coagulated blood retained in the womb af- ter delivery, or immoderate menstruation may liecome compressed by the contractions of the womb, into a fibrous like mass, which may also be further increased by additional menstrua, or other matter; and from the enlargement of the belly* suppressed menstruation, pains in the head, and occasional sickness and vomitting, tumefaction, MISCARRIAGE. hardness, and enlarged breasts, sometimes sep ara ting a glairy fluid, the abdominal tumor rolling from side to side, with the motions of the woman, all contribute to confirm her in Iter opinion of real pregnancy, until time discovers the mistake, The destruction of the foetus with its mem- branes or merely coagula, are generally expelled, and no dangerous consequences may succeed; but the former diseases are of a more serious na- ture, and require our nicest discrimination and care. ABORTION & MISCARRIAGE. By abortion may be understood, the untimely*! or premature expulsion of the foetus: by some v this is divided into a miscarriage, of the early and ' latter months; the first is called untimely or a- bortive ; the last a premature birth: which if at,or after the seventh month, the child may bear the ,, pressure of the atmosphere and lire. Causes.—A detachment partially or totally of’ the after-birth, or secondines, from the side of the womb internally : which is succeeded by violent floodings, and if they cannot be timely checked,, soon terminate in abortion, and death of both the mother and her offspring : but as these are but secondary causes,or proceed as effects from others it will he necessary to inquire into the first, or original cause which may bring on a detachment of the after birth, and floodings; and then pro- ceed to examine these as effects of a primary or first cause : and afterwards become the causes of miscarriage. secondary, or ultimate effects, in their regular or- der : and these may be again divided into exter- nal aud internal. And first, of The external causes,—Are blows, falls, hurts, frights, violent passions, as fear, grief, surprize, joy, anger, &c. to these may be added violent mo- tions, as jumping, dancing, rough riding, raising heavy burdens, medicines of strong operative pro- perties, as strong vomits,purges, and all that sum- late to uterine contractions, &e.* Internal Causes.—A dead foetus in utero,which is detected by the following symptoms : The foetus loses its motions, and is no more felt, except as a loose dead mass falling from side to side, as the motions of the mother may be va- ried : the breasts become flaccid, pendulous, and cold ; the belly also partakes of the coldness and a subsiding of ils tumor or enlargement: sickness, fainting, rigor and cold sweats ; a discharge from the womb, highly putrid and offensive : however none of these signs either single or entire atfoid ample positive proof, of the death of the child; but should always lead us to suspect it, and regu- late our actions accordingly. Method of Treatment by way of prevention.— Women subject to miscarriage, should continue within doors, until alter the fourth month of their * I feel constrained to note here the horrid depravity of hliman weakness, in wretches lost to every sense ot reli- g on, morality, and that mutual attachment from a mo- ther to her offspring, and every tender tie in nature, seek the means to procure abortion : nor are there wanting, in the other sex, infernals wicked enough to aid their endea- vours. 118 MISCARRIAGE. pregnancy; and be permitted the free indulgence of the sopha or bed : avoid going upon the water, or any other situation that may subject them to frights : tight lacing is also very hurtful, also the passions of the mind should be particularly guard- ed against, by preserving a serenity and evenness of temper. Pregnant women longing for any unnatural substance, except t x’remely inconsistent, may be indulged, as a peculiarity of humors separated in the stomach may indicate the propriety of the thing desired- Miscarriages are generally found to occur be- tween the third and seventh months of pregnani cy ; p-nods jeq bring particular guard* d care, by prudentiaily avoiding every thing likely to disturb the system : the body to be kept open by mild soluble medicines : endeavour frequently to pass the water to prevent the compression of the distended bladder and intestines upon the womb, and assist to excite it to contractions. Vomiting, during pregnancy, should not be practised, unless symptoms indicate their real ne- cessity : when they should be given with the greatest mildness and caution. Bleeding may be used sparingly when symp- toms require it, but with extreme caution for fear of producing debility. If the patient, be prejudiced against bleeding, we should endeavour to overcome it, by conviu- ing her of its real necessity. Treatment —When symptoms of abortion or premature birth are apprehended, the patient should immediately retire to the sopha or bed : MISCARRIAGE. ill tightness in the dress relieved, and blood may >e drawn from the arm, according to the strength )f the patient, and urgency of the case : give litre combined with mild opening medicines, and iccasionally an opiate to allay irritation and spasms : the bowels to be kept open, by soft emol- ient injections, in small quantities for fear of in- creasing distention ; a free open air, if dry, should >e permitted through the patient’s apartment, but he current not immediately over the bed, and the ■oom darkened, as much light acts as a stimulus, n this case, should be carefully avoided in every form. If on the contrary, the patient is very debilita- ted and irritable, a contrary mode of treatment will be necessary to he pursued : bleeding must aot beattempted, the diet nourishing and increas- sd, to whkh may be sparingly added occasionally light wines of the astringent class, as claret, dilu- ted port, and other cordials; the irritation obvi- ated by opiates, and styptics of colothar or burnt vitrol may beapplied tt» the mouth of the womb, and cloths wet with vim gar, may be applied to the genitals, pubes, belly and loins: sugar of lead in solution, given internally in large doses, of from one grain to three or lour has been recom- mended, and used to much advantage. If the Hooding continues, in spite of every en* devour to the contrary, recouise must be had to immediate delivery; by attempting |an introduc- tion of the hand, in the cautious manner before directed, and seek for the feet of the child, which must he brought down, and managed as in a foot” ling case, (which see sect. 4) wheu the woman ip 120 tnsCARRlAGC. to be treated with opiates, spermaceti and other restoratives, in every respect as after a birth at full time. The foetus at any time previous to the fifth month, will rarely require manual assistance to extract it, the contractions of the womb itself, and the slight opposing force, met w'lth from the smallness of its bulk, distends not the fibres suffi« ciently to impede its expulsion : however, this is found not to be the case at more advanced pe- riods. SECTION IV. PRACTICAL MIDWIFERY. Labour lias generally been divided into three stages, viz. First, The coming away of the liquor amnii, or waters : Second, The expulsion of the foetus, or child : Third, The extraction of the placenta, or after- jirth: But these three are sometimes not distinct, but ;on(ounded with each other. Dr. Lowder records a case of a woman who iad the foetus, placenta and membranes, with heir waters,come away c omplete, and the woman lid well, but this is a very rare case. Laboursare also divided into three distinct clas~ .ifications, natural,laborious, or lingering, and pre- .ernaturul. Natural labor, when the head presents at the ull time, and the delivery completed in a reason- ible time, by the efforts of nature. Laborious or lingering, when the birth is pro- racted beyond the usual time, or cannot be ac- romplished without extraordinary assistance. Preternatural, when any part of the foetus pre- ,ents except the vertex, or crown of lh«-r head. The good women, lurther distinguish labours nto sick, sleeping, wet and dry. NAlURAL LABOR. The two first of these, I need not describe. r~ 13y a wet labour, is generally understood, when the membranes burst eaiiyin the labor, and the liquor amnii continues coming away in continued small repeated quantities, during the whole pe- riod of parturition : and they esteem it a never erring mark of a protracted labor : which is gene- rally found to be the case. By a dry labour is understood, when the mem* branes do not give way until their proper time, and the laceration is from side to side, and the wa- ters are immediately and entirely evacuated ; and delivery generally soon follows. In different periods and countries women are .delivered in different situations and positions,trom which they are not favorable to any deviation, in short, they appear distressed and make a formi- dable opposition, if any such tiling be suggested : the practitioner must therefore accustom himself, that he may acquire an expertness and tamilianty to all their different modes, for he will find it al- ways much easier to give way himself in particu- lars of this kind, than attempt to stem the tide of opposition and prejudice; which after a little ex- perience he will find to be no difficult ta^k The nurse will sometimes request of the prac- titioner, even if a male, his instructions how the bed should be guarded ! which is a thing, in itself, trifling and indifferent, and ever) old woman has a competent knowledge of. It is best to resign it to her superior judgment in this particular as a part ot her province, and compliment her in per- mitting her to order as she thinks best, which- NATURAL LABOR. 123 by the way, she will do, however you may labor to instruct her to the contrary : it is a trap offered to detect your depth and experience, which, if you happen to be of a new fledged bearded ap- pearance, they will use many such snares to dis- cover. I have frequently, when young in years and practice, been very unenviably situated by these little artifices, however, experience and grey hairs have now placed me tolerably above their reach, and they will you, if you are pene- trating and prudent: they expect you should be conversant in this and many such other trifling contingences, or they strongly suspect your igno- rance in matters of more importance ; and fre- quently will not hesitate to say so, this you must put by in the best manner your ingenuity can de- vise, resistance or high toned language is vain, es- pecially in a young man. Age is sometimes staggered by it, to youth it would be perdition! I would very willingly lead you through a know- ledge of all the etiquette, & modes of contending with it, but I freely acknowledge it is not in my power, il is in the book of long.experier.ee I have learnt that portion of ft I possess, but cannot communicate it, by pen or speech ; it is there you must learn it. It is this certain something, experience possesses and cannot convey, that gives age such advantage over youth ; and causes fhe councils of the one to he heard with serious attention and implicit confidence, whilst the other is regarded with suspicion and doubt. The sutures of the head are sometimes ossified or grown together at the time of birth, which is found to be a great embarrassment and retarding 124 PRESENTATION. of its extraction: this is discovered by making pr< ssure upon the part presenting, i. e. the part first discoveied by the touch ; when the bones of the c ranium are found to produce a peculiar kind of noise or sensation, by riding upon and rubbing against each other, similar to the cutting of a cork : but if ossification has taken place, they are rendered incapable of producing these motions or sensations. OF PRESENTATION: Or the part which presents, being the part first discovered by the touch of the accouchier : which may be the same, and yet the position oi the foetal head be essentially d fferent : per example, the face of the child may be towards the pubes or sacrum, or to either side or diagonally, ai.d the vertex or crown of the head be the part present- ing; and so of most other presentations. A natural presentation, or what is commonly called when the child is right and straight, is when the verttx presents, and the face progressing from a lateral to a posterior position ; which po- sition and progression is discovered by examining occasionally the sigittalsuture. In a face presentation, which is so strongly marked by the features, as not to be mistaken, consequently needs no description : the chinot the child, is generally towards the pubes or belly of the mother ; and the farther the chin is from the breast of the child the better: in a natuial presen- THE NAVEL STRING. tation the closer they are in contact the more ad- vantageous, for reasons which will be hereafter explained. It is a bad case, when the chin of the child, in a face presentation, is towards the sacrum or back of the mother; but probably never occured. Dr. Smellie, in his plates on midwifery, gives a draw- ing, representing the depression of the skull, in its passage under the pubes, but he never met with it. It also is a very unfavorable position when the forehead presents, where the greatest diameter of the head, viz. from the chin to the vertex, be- comes wedged in the narrowest part of the pel- vis, and will generally be found to behest restored to a face case, by bringing the chin forward, if it be towards the pubes. The breech and shoulders are the part9 most commonly mistook for the head ; but if accurate- ly examined their characteristics are found so dis- tinctly marked as to need not explanation. The armpits detect the first, the fissure between the buttocks and privities sufficiently decides the last OF THE FUNIS UMBELICALIS, OR NA- VEL STRING, N Which is a vascular cord, continued from the navel of the child, to the placenta or aftercake ; and is the only communication between the mo- ther and laetus during pregnancy. This cord is made up of two arteries and one vein ; these ves- sels are sometimes continued ip parallel lipes, THE PLACENTA. while in other instances, they assume a contorted appearance: the interstices of the vessels are fill- ed up with a gelatinous substance, or mucus, de- posited in membranous cells, which serve to pre- vent obstructions in the circulation of the blood through its vessels from compression, or some- times the changed positions of the child, while in utero will form a knot, when, were it not for the elasticity of the intervening mucus, the cir- culation would be stopped, and ihe destruction of the child’s life, be the inevitable consequence. This cord may be in length from one foot to a yard or more, though commonly about two feet, its thickness also, which is dependant on its inter- mediate mucus, is subjected to much variety. The funis being continued from the navel of the child, is commonly inserted into, about the middle of the after birth; but sometimes, it is attached to near its edge, which is, by some, esteemed a more favorable attachment for the se- paration and extraction of the placenta. Dr. Low- der exhibits a preparation of the funis originat- ing from the side of the belly of the child.— 1’here is found also in the navel cord, a membra- nous canal, through which the urine passes from the bladder of the child, before its birth, called the urachus: after the birth, the urine takes its natural course, consequently, this tube is no lon- ger necessary, when it becomes a solid ligamen- tuous cord, and through life acts as a suspensory ligament to the bladder. OF THE PLACENTA, OR AFTERBIRTH; Or Secundines; is so called from its supposed approached resemblance to a cake, and is a large vascular, rounded substance, flatted on its sides; of a membranous or fleshy appearance. Its sub- stance is thick in the middle, or where the string is commonly inserted,and gradually grows thinner as you approach its edge; from which its mem- branes are given off, and are found to line the whole of the internal surface of the womb, form- ing a complete membranous bag containing the child and its waters: these membranes, more par- ticularly in advanced pregnancy, are found not closely to adhere, when consequently a fluid will sometimes be found collected between them: the outer will sometimes burst, and this fluid escape, which has been called the false or bye wa- ters; and no ill consequence ensue. These membranes', where originally divided into two only, viz. the chorion and amnios, the first immediately lining, and in contact with the internal surface of the womb: the latter on the inside of the chorion completely enveloping the foetus and its waters : but later physiologists have discovered the chorion to be composed of tw’o layers of fibres, the outer spongy chorion, Dr. II untcr has called decidua from the Latin, de from, cado to fall,or caduca, which lias the same signification, from the membrane after the ex- THE MEMBRANES. traction of the placenta being found to fall off, and left to be expelled with the cleansings. The internal lamimaof this membrane, he has been induced to call decidua reflexa or true cho- iioii from itsseperaiing from the outer tunic at the edge of the after-birth, and reflecting an outer co- vering, which is continued with the amnios along the turns or navel string: these membranes are found to be vascular,spongy and rough. The Amnios—or inner membrane, is of a trans-. parent fine texture, but tough ; internally smooth, externally rough, where it unites with the former' membrane, which it is found to line throughout, and is continued over thesuifaeeof the after-cake and along the outer surface of the funis, to which it is firmly united, and affords an outward cover to th.s membrane, and surrounds and contains ihe child and its waters. * To the above membrane has been added by some, the allantois, or urinary membrane. Dr. Hunter, with others of equal ce- lebrity, have denied the existence of th.s mem- brane in the human species, and avow it is to be found in the brute only. While Dr. Hale says, “if you first find the hole, whence the urine came forth, if the allantois is too much torn, you may blow up this membrane with a pipe to its di- mensions, and you can separate much of it from the chorion.” And thisopimon is strengthened by Dr. James, and de Graaf, and is said to retain the urine which is conveyed from the bladder by the * See Dr. Win. Hunter’s beautiful plates, on the gravid uterus. LIQUOR AMNII. 129 urachus, and is situated between the amnios and chorion. Liquor Amnii—or the liquor of the amnion, or waters, is a serous kind of fluid, and has many uses; it is found in the early months, thin, trans- parent and limpid ; and in more advanced preg- nancy, it becomes of a thickened, ropy consis- tence, and more opake and darkened in its color: is also diminished in quantity as the pregnancy advances: The embryo floats in it and is entirely surrounded, which preserves it from the ill effects of compression, from external injuries : which is beautifully illustrated, by placing a wax feather in the centre of a bladder of water, and making compressions in different directions externally, when the feather will remain entire and unhurt, by the compression, the support aft'oided by the fluid being equal on all sides; but immediately it is withdrawn ihe pressure of the atmospheric air, w hich is unequal, destroys it. Compressions and injuries of this nature are continually made on the womb or its contents by uterine and muscular contractions, falls, blows, &c. and while the mem- branes remain entire,and the watt rs retained com- plele, the foetus is preserved and nourished: but immediately these escape, the compression, act- ing directly upon the surface of the foetus, the consequence is, it is either expelkdor destroyed. The waters at the time of labor, have a further use, in dilating the mouth of the womb, (and af- terwards bursting its membranes) escape, and in the evacuation wet and lubricate the passages for the expulsion of ihe foetus, which is thereby con* «iderably facilitated. 130 SYMPTOMS OF LABOR. Some have asserted, the child takes in a quan- tity of this fluid for nourishment, during its resi- dence in the womb; on account of its becoming diminished in advanced pregnancy : that the foe- tus may absorb or take a small portion by its sur- face, I will not take upon me to deny, but its sa- line or salt pruperties render it very unfit for nou- rishment. OF THE SYMPTOMS OF APPROACHING LABOR. Anxiety and fears for their well doing are com- monly present with women at these periods: and indeed, this dejection of spirits is not confined to the human, but brutes evidently partake of it, seeking for solitude and retirement, and refuse every proffered aid. A humane sympathy would lead us to soothe their sufferings, alleviate their fears, and encou- rage a patient confidence of her well doing, by a tenderness and attention to her complaints. A woman’s fears and anxiety, may frequently prevail upon you, to attempt her relief, before na- ture has so far forwarded her work, as to afford you the power of assistance ; when your interpo- sitions are injurious and unavailing. The falling of the abdominal tumor, or bur- then, as it is commonly called, is esteemed also, a symtom of approaching labor; with pains in the loins and back, attended with great restlessness: Rigors, or chills, in which the heat or powers of the body, are disposed to contribute their assis- SYMPTOMS OP LABOR. 131 I nee towards forwarding and completing this eat eflort of nature. Stranguary, or suppression urine, and constipation, or obstructions of the >wels are symbmis of labor, caused by the head the child descending a d compressing the neck the bladder and s de of the intestines, which >wever will he by every prudent woman, who i lies to have an easy safe labor, and speedy covery, timely obviated; by warm applications id fomentations, sitting over the steams of warm attr, and frequent attempts to pass unne; oc» sional mild opening medicines, and laxative ysters, to remove intestinal obsiructions, which rther lubricate and solten the adjacent parts, by hich the rigidity of the fibres will be relaxed, id deli ery facilitated. Sometimes, also the pressure of the progressing 2 us will cause involuntary emissions of urine tritig the pain. T he mucus, or glairy discharge from the vagi- i is found generally tinged or streaked wilh ood, or a small quantity of blood is alone dis— larged, which the women generally, and very roperly term, a shew of labor: and is caused by lation of the month of the womb, in which se» iral small branches of vessels are torn and give Jt tlleir contents: It is requisite also to distinguish between spu- ous or false pains, and genuine or true pains of bor. The former are found prrticularly troublesome i the night season, and abate through the day? icy are irregular in their returns, and of trifling id short duration: They are produced by cos- SYMPTOMS or LABOK. tiveness and uterine compression and enlarge- ment ; the mouth of the womb remains firmly closed and no mocus or shew is discharged from, the vag na. The symptoms of true, or real labor having been alrtady described, it is useless to repeat them; further than, the mouth of the womb is found dilated, the membranes protrude forward and are found during the pain, tense aud firraj upon the finger, the pains return atiei regular intervals, and affect very sensibly, lie back and loins, aid are continued round the btlly and pubes; the inferior ext rein ties also partake of the affection, ana instances almost general afford u- bundant proof that no part of the system is ex- cepted. if in the stomach more particularly, it produces vomitling ; in the brain convulsions, and so of the other parts : and as the labor advances, the pains become more fiequent and strong : till at last the intervals scarcely admits of being dis- tinguished, and ihese are tailed by the good wo- men the linking c>r bearing pains, when delivery generally soon follows. In the earlier periods of labor, the woman ge- nerally cries, moans, becomes petulent and impa- tient, perhaps acc uses you for want of assistance and relief, and leaving her to si ffer, when she conceives it may he in your power to remove it, and intimates her sufferings are greater than wo- men, have borne before her, and appears at times tinctured with vehement accusations against you; winch you must bear patiently and in good part, this i* a critical moment with ,he young practi- tioner, and your actions and deportment will be as symptoms op labor. 133 as critically observed, by the attendant women, and their opinions formed accordingly of you : be es- pecially careful that no irritation rufles your mind, and nothing like reproachful returns escape your lips, but let tenderness, delicacy, and sympathy govern all your actions; endeavor to impress the mind of the poor sufferer, and her attendants, with your anxious care and good wishes foi her service and safe delivery; that you sympathetically share in her pain, and would equally rejoice (if it were possible) in her recovery: Remember! I beseech you, remember! her actions and words are not, at this time, the effusions of cool reflec- tions, but of a mind much disordered by suffer- ing, and look upon her, and act by her as she de- serves, as an object of tender pity and compassion, site will abundantly repay you by her gratitude and blessings after her delivery has been safely ef- fected, and what is still more, the consolations and enjoyments in your own mind for having thus conducted yourself, with the complaisant looks of your patient, with sweet infant on her arm, de- claring, and perhaps verbally pronouncing (next to her God and father of mercies) you, the saviour of the life of herself, and her beloved offspring; eee her eyes glisten with a new, and perhaps till yet, inexperienced delight of maternal love and af- fection, a new and inexpressible glow of pureand seraphic fondness, till yet unknown, uniting her to the offspring and image of herself, or perhaps of her beloved husband, which she has j.ust ush- ered into life and existence; if you have a soub these emotions escape you? they certainly cajyiot! if you are insensible of them, drop your 134 SYMPTOMS OF LABOR. pursuit in this practice I beseech you—you are not equal to it, you are not worthy to be admit* ted to such superlative gratifications, and ought not to stand in the way of those who are capable of such sympathetic delights. This my young friend is not mere theory, it ii not the mere sallies of a wild and luxurient ima- gination ; but theeffusions of long experience an< deep reflections, and the delineations of pract ical truths; I would have you prize them as such and profit accordingly. This flight l could pur- sue through volumes, it is inexhaustible, but le this suffice: now to my subject. As the labor advan* ces and the pains become more forcible, she has a sense of lancinating pain, which is detected by an acute shrill piercing tone of voice, and thesl are called the cutting or rending pains; there ifl thea, generally, a slight cessation, and the voice becomes more grave and deep, as the child pr<*4 greases, when the parts dilate and she again raise! her voice to its former, or perhaps increased pier«j cing sharpness; that it sometimes appears to rei verberate on the panes of glass in the window's, of upon such glasses as may be in the apartment; or otherwise she remains peifeci ly silent, except deep inward moaning, sweating at eve;y pore and trembling at every joint ; when violent and in- voluntary efforts of the system are exerted to ex- pel the feetus, and be delivered. There is then a solemn pause 1 or as the women sometimes ex- press themselves, the divine presence seems to be especially present, to guard the poor suffeier in his great shock of nature, and soothe her suffer- ngs in a momentary respite from pam, and per SYMPTOMS OF LABOR. 135 haps into a slumbering forgetfulness, to recruit the tone of the system : when the pains perhaps return in a slighter degree for the expulsion of the after-birth, &c. a circumstance with me always to be wished. 1 know not how the reader may feel affected, in studying the descriptions of the scenes just developed, hut to me, while 1 am wri- ting, they agitate the inmost recesses of my soul, from having repeatedly witnessed, and felt lor, their actual existence. These circumstances may appear insignificant and triflingly minute in a work of this kind, of professed conciseness; to me they are highly inte- resting, and may be turned to a good account by the experienced practitioner, by accurately ob- serving them you may learn to judge of the pro- gress of the labor, with nearly the minuteness and certainty of incessant examinations, and offi- cious forwardness, which tend rather to retard, than forward the work, and leave behind excoria- tions, swellings, and soreness, which may hare been prevented, but now remain for your own in ternal reproach and cure. Besides, these inces- sant examinations bespeak a greenness in practice, and an offensive indelicacy, in conduct. I know this knowledge is not to be obtained but by long experience, and profound observations, words cannot convey it, reflections cannot fathom it: I have given you a general outline, I wish 1 could give you more, but sympathy and experi- ence must complete, what theory can only point out; I have done my best for you and shall rejoica to see another do more. 136 NATURAL LABORS. After the membranes have been advanced ag far as the outer aperture, if they do not give way before, I have always found it expedient to se- parate them, during the pain, with the nail of my tore finger, previously scraped sharp for that pur- pose; when the waters have been evacuated, and delivery generally soon follows; however, I would not recommend a forwardness to do this except nature seems tardy, and the progress of labor thereby unnecessarily suppressed. This completes the first stage of labor, and the second commences by the head of the fee'us being found to progress forward, and occupy the place of the membranes before they gave way, or were lacerated, as described above. 'I'be fontinel, or crown of the head, is-found making its way from under the pubes, which may be facilitated by carrying the finger gently round the mouth of the womb, which is now found spread over the child’s head like a tight cap or bandage, by which means its dilitations are facili- tated and the head forwarded : the contractions or throw's of thew'omb are assisted by a slight and regular compression on the belly externally, which is perhaps better done by the woman herself, and is as good a position for her hands and arms as they may be employed in, and serve to keep her from improper attitudes: the contractions of the womb are further assisted by the actions of the diaphregm or midrib and also the abdominal mus- cles : The pains may now be permitted to have their natural and full effect, till the parts become externally swelled by the protrusion of the child’s head on the parinoeum, (or that fleshy portion be- NATURAL LABOR. 137 ween the parts of generation and the intestine) vhich now becomes put upon the stretch, and if lot timely supported and assisted, may be lacera- ed or caused to give way by the rapidity and vio- ence of its distention, which is productive of the nost disagreeable consequences, and may conti- melong unhealed, and in some cases through life. The lamentable effect of this accident, is a divi- ;ion of the sphincter muscle of the anus, or termi- lationof the intestine and inserted into the peri- lGDum, and thereby rendered incapable to retain .he excrements, which involuntary escape. If the external parts are now sufficiently dila- ed, the head should be supported and kept back .vith the palm of the hand, and some unctious lubstance, as sweet oil, hog’s lard, goose grease, )r fresh butter, applied and well rubbed into the perinoeum and parts in extention, which will tend to soften their rigidity and assist the dilita- tions : the parts clearly suffer a9 much distention as they can possibly bear, at every returning pain ; therefore all attempts artificially to dilate them or to slide the perinoeum over the head, is a perni- cious mal practice,and tends much to induce lace- ration, which would have been prevented had it been omitted. It is a practice with some, to se- parate the perinoeum with a knife or lancet to fa- cilitate delivery, but such a barbarous attempt bught not to escape with impunity,for the reasons above recited. It has been offered as an expedient with some to assist the progress of the child’s head ; but in general in a quick labor the head is disposed to ad- vance before the dilitations of the parts are suffirU 138 NATURAL LABOR. ently prepared to admit its passage, without injury or laceration: l should in these cases, invariably, be induced to keep back the emerging of the head, by an opposed force with the palm of my hand, as before described, against it, and permitting it to come forward in a very slow, easy and gradual manner; at the same time affording support to the perinceum. The woman after the expulsion of the head finds an instantaneous cessation from pain and misery. It is recommended by some to bring the- body immediately and directly forward, least it should suffer by its confined situation ; however, later experience has proved this suspicion to be* fallacious and prejudicial, and that it is better to wait fnr the returning action of the womb, when ns the shoulders fall into the upper pelvis towards each side, being the longest axis at this part, it will be observed as they advance, they will make the same mechanical turn of a quarter section, and pass the external outlet forward and backward as the head had donebefore them : as this is an essen- tial circumstance to attend to, to secure their safe passage without injury to the mother; the im- propriety to use force in attempting their expul- sion in a straight line, must appear obvious to com- mon sense. 'flic hips, if large, observe the same mechanical progressional change, and require a portion of the same care: as the shoulders ad- vance it is still requisite to afford support to the perinceum, when weareto place the child in such a situation, that it may respire or breathe freely; keeping its head covered, and as soon as it has ciied freely and forcibly, and the pulsation c* ases NATURAL LABOR. 139 in the navel string, and not until then, it may be tied and divided; it must be obvious when we consider the change in the circulation of blood in the child, which takes place, at this juncture, in forcing its passage through a new set of vessels in the lungs now dilated and made free of access by respiration, and the aperture in the septum of the heart closed, by which it can no fnore take its usual course; the impropriety of immediately destroying the connection of circulation between the child and placenta, without allowing sufficient time for this important change to take place, which is when the pulsation ceases in the funis or string when it may be divided in the following manner, and the child given to the nurse or by- stander. THE METHOD OF DIVIDING THE FUNIS OR NAVEL STRING. Several folds of thread or cotton, waxed fiat like a piece of narrow tape, (which I sometimes use) or if round (which I think inferior to the first method) about the thickness of a crow quill, the rial thread or tape, not being so likely to cut, of which there is danger when the string is very rot- ten, which is sometimes the case. ' The ligature should be made four inches from the belly of the child, a greater or less distance than this is found to be attended with many in- conveniences; and a second ligature about two inches from the first on the side towards the mo- ther, the intermediate space being previously emp- 140 CUTTINS THE TUNIS, tied of its contained blood by pressing it with the thumb and finger towards the placenta, when it may be secured with the ligature, by the opera- tor or an assistant; these ligatures ate to be tied sufficiently tight to prevent an escape of the con- tents, more than this is unnecessary and perhaps, inconvenient, in endangering the cutting through of the string, which would be an awkward trou- blesome, if not a dangerous accident. Some practitioners have thought one ligature on the child’s side to be sufficient, as leaving the- other untied will be attendtd with no dangerous discharge of blood on the mother's part, and that the placenta will discharge itself, become reduc- ed in its bulk, less firm in its resistance,and there- by of easier separation : in this instance, I will not contend, but leave every one to act as practice and their own experience suggests: for my own part, I prefer the opposite mode, of using a se- cond, or if it may be so called, a maternal liga- ture : as I prefer the placenta being gorged, to give it bulk and firmness, that the contractions of the uterus may act better upon it, and separate it more easily by its own efforts : besides, if so left without ligature,! have frequently found the re- maining blood to escape upon the floor, bed clothe* or operator : which has an indelicate and an of- fensive slovenly appearance, and may have been •avoided by the above method and precautions. Some have asserte d that the string should al- ways be tied and divided under the bed clothes : but as accidents of tying and cutting off a part of the penis or fingers of the child has happened by this custom, 1 would always in this case, wish to see what l was about EXTRACTION OF THE AFTERBIRTH. 141 Of the extraction of the placenta or after caket - <* fecundities . —-however, previous to any attempt s ’ing made to extract tii*- plecenta, it should be » certamed if there may not be a second child, to .ctect this (see twins) which is fust to be deli— „ red. It always is best to wait from fifteen minutes half an hour after the delivery of the child, be- ' re any at empt be made to i xtract the afterbirth, »t. which time, the womb will generally contract, pioduce a slight pain sufficient for its separation, ‘#hen very little force is necessary; which would vc* further assis'ed by placing the woman’s hands ,u‘On the belly with slight regular compression, pon the spot where the alter birth seems to be .ttached, which is not always in the same situ- ation. The brute creation, are generally found after delivery, to separate the navel string with the t_eth, and to assist the extraction of the secun- ,*mes by drawing with moderate and regular force by the funis ; this may serve as nature’s Ies« . >n to us, that this process may be assisted but <>ot forcibly : therefore little more than to draw jt away, if it were loose is all that is generally re- quired : while much force, particularly in a weak and debilitated habit, may bring on a partial or a o'tal inversion of the w omb, or rather drawing it kv-ut of the vagina; when very little hope of the pa- tient’s recovery remains : yet women have lived in this state, and the menses continued to flow, as petitioned by Ruysch, of Holland. A partial in- - of the womb is but rarerly detected and ereforc our iguorauce of the case prevents the 142 EXTRACTION OF THE AFTERBIRTH. necessary relief being afforded. This is in a de- gree discovered by an inability to feel the womb globular externally, and is attended with pain, syncope, convulsions and death, if not timely re- stored ; which is done by carefully and gradual!* introducing the hand and return it to its natural situation, when the hand is to be continued in utero, as a stimulus to its contractions, which wc are to wait for, before it is attempted to be with- drawn : when this is discovered, the hand is to be regularly and slowly withdrawn as the womb closes upon or follows it. This accident is commonly the consequence of too firm an attachment of the after birth, or as it commonly said, the afterbirth sticks, when it i« imprudently and incautiously separated. I be- lieve force is never necessary, but in cases of vio- lent floodings and the woman’s life is thereby in evident danger. The hand of the midwife should be well lubri- cated with sweet oil, lard, or some such soft unc- tious substance, and introduced gradually by the direction of the cord, w7ith the utmost care and tenderness, when he will detect a soft spongy emi* nence or rising : he is then carefully to separate its edges all around, picking it with the nails of the thumb and fore finger, until the w hole is de- tached : when it should be as cautiously aud gradually brought away, in the direction of the vagina, together with its membranes, and coagu- lated blood, which are the principal causes of af- terpains. Sometimes the mouth of the womb, immedi- ately contracts on the expulsions ot the child, or EXTRACTION OF THE AFTTERBIRTII. 143 may be contracted in its middle, with the after- butli in the fundus or bottom of the womb, this is called the hour-glass or figure of 8 contraction : in either case the hand is to be introduced as be- fore directed; first inserting one finger, then a se- cond, and a third and so on, until the whole hand has passed the stricture, when the after birth is to be firmly taken hold of in the points of the thumb and fingers, the hand preserving its coni- cal figure, when it is to be brought away as be- fore directed. Perhaps once in a hundred times the string will be found so tender or rotten, as not to admit the necessary force to bring away the afterbirth : when the hand must be introduced as before directed and it must be extracted. Some have recommended the afterbirth and its membranes to be left to nature to expel, which T believe she would generuly do ; but if it should happen to ihe contrary, puiridity, spasms con- vulsions and death would terminate the case as the effects of the fatal omission. Women are also generally solicituous and un- easy until the afteibirth is away, conceiving, very justly, all may not be well : it is therefore, a point f should surely not omit to before i left my patient. OF DIFFICULT, LABORIOUS OR LINGER- ING LABORS. Labor ix generally admitted to come under the above terms, when protracted beyond its usual 144 LINGERING LABOR. duration, in natural cases: per example, twenty four or thirty hours. From whatever cause it may arise, either in the mother or the child, or secundines : these causes are very numerous, as, erronious treatment, rigid- ity of the parts of the mother, dryness, constric- tions, tumors, distortions, &c. In the child, from an increased bulk of the head, ossification of the sutures, the head not na- turally situated, broad shoulders, &c. If the labor be protracted by debility or weak- ness in the mother, so that the strength of the pains, are not suffic ient to expel the foetus, they should be allayed by an opiate; the effect of which will procure sleep, in which the parts will dilate, and the child measurably progress: strength will be restored to the patient, and vigor to the pains, sufficient to complete the intentions of na- ture with ease and safety. If a rigidity of the parts should be the cause of a lingering case, with a dryness, artificial means are to be employed, as lubricating with soft po- matum, hogs lard, or injections of warm oil, or such like common house glyster, of gruel, broth, or flaxseed tea may be thrown up into the intes- tines, which,will commonly procure discharge, of the contained hardened dried fceces> and assist to lubricate and relax the rigidity of the parts ad- jacent, and thereby forward the expulsion of the foetus : indeed, injections of this kind should not be omitted, to be occasionally thrown in in all lin- gering cases ; their advantages are too obvious, to every experienced practitioner to be denied. But if the woman is of a full plethoric habit. LINGERING LABOR. 145 with a hard pulse sufficient to bear the lancet, and the rigidity ot the parts do not readily give way to the above treatment, a copious bleeding, from twenty to twenty four, or thirty ounces of blood, ad deliquum an;mi, or until she becomes faint, will speedily and almost universally answer the purpose : the parts will be found most miracu- lously to relax and dilate and delivery follow very timely : I invariably do it where the pulse and constitution will permit, and am never disap. pointed. 1 had very lately a ca?e in point, the wife of Thomas Lloyd, shoemaker, the woman of a low 3tature, full habit and a rigid firm fibre, I found the mouth of the womb rigidly closed, and the child bearing against it: I proposed bleeding, gi- ving her a full assurance of success; nothing could induce her to submit, though I bad her arm tied up, and every thing prepared for the operation; this was about nine in the evening when I did not doubt but 1 should be able to retire timely wiih my family to rest; 1 bad to desist, the labor was violent, the throws vigorous and continued: 1 remained with her till about two, when tw advantage appear, ed to be gained, 1 tied up her arm again, it was in Vain, nothing could overcome her prejudice to bleeding, she would sooner suffer a whole night pf hard labor, than submit to it. I retired home and desired her not to disturb me, I called upon her about nine the uext morning, the labor as se- vere as last night and no apparent progress, I a- gain tied up her arm determined in my own mind to bleed to her, but I know not, if 1 persisted but she would have gone into fils, I had to desist, JVTKr.ERINCr T.ATiOlt. and left her and declared I would call upon her Ho more till sent lor, thinking the efforts of the system in the end would relax itself. 1 was sent for at nine in the evening, when her pains were excessive, but the rigidity still inflexible, I tied up her arm again, took the advantage of a pain, struck a vein, and it bled like a fountain : 1 took about thirty ounces of blood, when she began to change color and the pulse became soft, I stopped it, the parts dilated and the labor well and safely over in one hour; and I bad no further trouble with her. This case without any more, (which 1 could give if required) is proof pos.tive to the point, and admits of no controversy. In weakened action, the uterine contiactions are always much more effectually stimulated, by a draught of cold water, than by any spirituous or cordial liquor that may be offered : except the patient is very weak and faint, when they may be given moderately to advantage: otheiwise they -only serve to increase perspiration and ultimately weaken and relax the patient, reduce the efforts of nature, and destroy the strength of that ope- ration, they were intended to invigorate and sup- port. I am sorry to say, this deluded practice, is persevered in, and insisted upon by the deluded ofheionsness of ignorance; to the great prtjudice of the patient, and hindrance of parturition. These same objections cannot be opposed to cold water, which on the contrary, stimulates the womb to contract, invigorates and strengthens the patient. A free admission of air into the room in these cases is found highly requisite and beneficial: ant# LINGERING LABOIt. not more persons should be admitted to be present, than are required in the assistance of the mid- wife; for the attendance and officiousness of su- perfluous persons may arise Irom a laudable mo- tive of humane assistance, yet, when they are in- formed, that, so far from affording advantage, they very much retard the work, and increase the sufferings of the patient, they will surely be pre- vailed upon to withdraw, to at least an adjacent apartment where they may wait till their services are required : they are in the way of such as may be usefully employed, increase the heat of the room and of course the febrile disposition of the patient. Obstruct the admission and circulation of fresh air, so essentially necessary, and contami- nate the air in the room with putrid effluvia, iu shoit every way prejudicial. In common cases, I never require more than two assistants: in lingering and difficult cases a fourth person may be needful, but rarely, if ever, any addition to these is requisite; the patient’s- spirits are to be kept supported during the whole process, her mind as serene as possible and her confidence of the practitioner’s ability encouraged, on all occasions, for whenever a timidity or fear- fulness is observed, it is suspected to be from a consciousness of insufficiency on the part of the practitioner; her hopes and exertions immediate- ly flag, and the business is rendered difficult and lingering, which otherwise may have been time- ly and speedily over. However, let it not be un- derstood from this caution, that it is here advised to run into an opposite conduct, and to encourage that roughness and violence, bordering on brutal LINGERING LABOR. savageness; though when accompanied with the greatest knowledge and experience is always to be feared and condemned : but when ignorance, which is too often the case, goes hand in hand with obstinacy and otficiousness, a ferocious and untamed tiger i3 not more to be feared. There is a conduct and manner which steers between these extremes, and is the only one pos- sible to recommend the practitioner to the appro- bation of all, with or for whom be may be con- cerned: and this consists in mildness, gentleness, extreme delicacy, unwearied patience, a modest confidence to support your own efforts, and a sym- pathysing manner and language, to support the strength, confidence and patience of the patient; starting no difficulties or apprehensions of danger where none exist, with a view to enhance your own credit and engage an high opinion of your su- perior abilities, a common detestable empirical trick, which tiie man of sterling merit could not stoop to, it can serve only to alarm, and produce that danger which prudence would wish to avoid: as such an attempt is intended to impose upon those incapable to detect the artifice, such a re- putation is a talseand unmeritted one, and conse- quently, by no means permanent. Sometimes a rigidity or want of dilitation of the mouth of the womb, will cause a tedious and protracted labor : it is best in this case, to wait a while for nature’s own operations, which will fre- quently serve in due time, but if she fails in this, the head of the child is to be kept back, and the fore finger of the operator, being first well grea- sed, is to be carried around and under the edge of LTNGERINC LABOR. the ob uteri, which is found drawn over the head of the child like a cap, leaving only a small o« pening, you are then to carry the finger by re- peated gentle efforts over the head when the labor will commonly proceed; gentle nausea or sickness will also further promote the success of this at- tempt, but I am firmly of opinion there is no- thing equal to a free use of the lancet as before described where the case will admit. An increased accumulation of foeces on the in- testines, will sometimes measureably protract the progress of labor*, they therefore should be oc- casionally removed by injections and otherwise. The pelvis of the mother may be preteruatu- 7ally small, or the child’s head oversize and pitched upon the brim, which may cause a detention of delivery; und the head becomes apparently wedged in the passage, when the use of instruments are said to be absolutely necessary. This then leads me to a description of the various instruments, their use and manner of application, and afterwards to investigate proofs that (as I have long since asserted, in a former advertisement of this work) in natural cases they are not only to- tally unnecessary but prejudicial. The instruments commonly employed in mid- wifery have been divided into the distinguishing names of, safe and unsafe i. e. harmless and in«* jur qus. Of the first class, or such as are said to be em- ployed without injury to either mother or child, are the forceps, single blade and blunt hook, these have severally undergone much variety, but as I utterly disavow the use of them myself, in ail ON THE SINGLE BLADE. natural cases, and the parts favorably adapted, 1 shall only attempt a general description. Of the Single Blade—This instrument is said to have been the invention of the late worthy and celebrated professor of midwifery, Dr. Low- der, in London whose excellent lectures and in- structions I had the honor and good fortune to profit by, and from which I collected the princi- pal materials of this work, I blush not to own. The single blade, or as it is commonly called Lowder’s folding lever, approaches the form of one blade cr side of the forceps, with this dif- ference, the end or point to be introduced is more bent and open, and it has also near the handle a joint upon which it folds like a knife to a conve- nient size for the pocket. The doctor was so ex- tremely fond of it, as to carry it all times about him; but those who esteem these instruments to be sometimes necessary, I would not recommend this precept; tor like a man continually carry- ing, any injurious weapon, it is a strong incentive to frequent and imprudent use, and often leaves an irreparable injury only to be repented of, and be rebuked and disgraced for. Dr. Lowder, says much in favor of this instruj- meat, that introduced with expertness ar;d firm- ly applitd on the occiput or hind-head of the child, and antagonized by the fingers of the ope- rator, on the forehead, they form a kind of for- ceps and possess much power and purchase. And the head is further advanced in a face presenta- tion, it may be reversed and applied upon the chin, antagonized by the fingers as before. II# lays down; as a maxim, '* the head must be ad- OP TIIE FORCEPS. vanced, at least two inches in the pelvis before it cun possibly be applied.” Few may expect to arrive at the dexterity and expertness the amiable professor possessed in the use of this instrument; therefore, few, if any, should attempt it; I would be very sorry to men- tion my worthy tutor in any other terms than those of veneration, for I really loved him, and shall e- ver cherish and revere his memory : but this is a child of his own, and if l may presume, to take the liberty with his name, which l do with the greatest compuction of mind; he hud the weak- ness to nurture his invention, with a paternal fond- ness, his offspring, I think, little merited. Of the Forceps—having two blades have much greater power than the single blade, and may be considered as artificial hands, capable of being in- troduced when the hands cannot pass, and are said to assist delivery when the powers of nature are insufficient. It is recommended to introduce the blade in the left hand first, and always in the direction of the ear of the child, consequently this precaution presupposes a maxim “ the accoucheur is never to attempt the introduction of either of these instru- ments till the ears of the foetus can be distinctly discovered, and carried by the finger safe over it, otherwise there jests a danger of the instrument, escaping between the ear and head, and cutting the ear completely off,” when it ceases to be an in- efiensive assistant; and it is much to be feared this accident has happened more than once. After the blade in the left hand is completely introduetd, the ylhet blade is to be passed in the same OF THE FORCEPS. direction over the former, on the other side, and carefully directed by the fingers of the operator’s left hand between the head of the child and; womb: Otherwise the instrument may escape on the outside of the mouth of the womb, be- tween it and the vagina, and inadvertantly for- ced through, when spasms* convulsions, and death would soon be the inevitable consequences. Fause here! and consider well the above, before you advocate their use. After the blades are both properly introduced and placed in their true situations; they are to be locked : but great care is here also required that the locking of the blades be on the outside of the mother, otherwise some soft parts may be inclu- drd and excruciating pains, and irretrievable in- juries may be the consequences : After the blades are thus fixed, they are to be secured by a fillet being applied and fastened up- on their handles; you are to draw down during the continuance of pain, in the direction of the hollow of the sacrum, and during the intervals the fillet to be taken off or loosened, lest the continu- ed compression on the head, may be productive, of much injury to the child. If the woman has bo pains, you are to draw down, as long and as frequent, as common pains continue and. occur, and make also the regular intervals of nature. The head to be brought forward from under the pubes, in the direction of the hollow of the sa-* crum in a zigzag manner, drawing from blade to blade, and whenever it is found to bear against the perinceum and produce what is called the peri- uoeal tumor, an unctious substance is to be weU 153 REMARKS ON THE FORCEPS. applied, the part supported during the passage of the head to prevent laceration : when the instru- ments are to be taken off singly as they were ap- plied. The forceps may also be applied in a face pre- sentation, from the chin to the vertex, or crown : when the sides of the face are anteriorly and pos- teriorly, in which situations the blades must Ire applied in those directions; great care is requi- site that both bladder and intestine previously emptied, as thebludesof the forceps in this case ate found to press upon these parts. Having thus ingenuously given you a descrip- tion of the single blade and forceps, their methods of application and use, I have to acknowledge the account is taken from other authorities, and not from my own practical knowledge, having re- joicingly to declare, I never used them, though, I believe, I may safely say, at least one thousand children may have been born under my care, a- mong whom, doubtless many cases have occurred that others would have thought them indispensi- ble and accordingly introduced, and I believe the general run of my practice in this way, l ean with gratitude and heartful satisfaction declare has been as successful as most men. The blunt hook, being used only in preternatural cases, par- ticularly the breech presentation, it will necessa- rily receive a description under that head. Having now gone through a concise general description of the single blade, and forceps, their applications and use : 1 shall proceed next to prove, at least, to my own satisfaction, according REMARKS ON THE FOR«£PS. to my prorrrse, in natural cases, they are general- ly not only unnecessary but prejudicial. In a common case when the head is so far ad- vanced as to distinguish accurately by the touch, the ear of the child, I never found any great difficulty in applying the fingers to assist forward the remainder: but wait wiih patience it is as* tonishing how much is done by waiting patiently for nature’s own efforts, and she will commonly complete the business without your extraordinary assistance: but it may be urged, the extreme de- bility of the patient, brought on by long and com tinued pains and exertions, when the pains may die away, and the life of the child in danger from remaining so long in the passage; and preserved by timely assistance with instruments; assure yourself, in this case there is no such necessity for fear, though the child may remain twelve hours in this situation, the parts are relaxed by debility either habitually or brought on by the exertions of a delicate habit, suffer no compression, and the circulation through the funis no way impeded: it is only in the plethoric; and firm fibre, where the mouth of the womb and other parts are rigidly and obstinately contracted, and no disposition to dilate, w hich is opposed by the violent and ner- vous efforts of strong uterine contractions, that the child’s life may be endangered from its situa- tion which was the issue in the case of Thomas Lloyd's wife, before related, (which see) when I doubt not, had I been permitted the use of the lancet, as I wished, it may have been preserved: but iu this case a very opposite mode of treatment must be pursued, an opiate should be given, tin BEM*RKS ON THE FORCEPS- 155 room darkened, and undisturbed by noise or in- trusions, when after a sleep of a few hours, na- tore will be so much recruited as to finish the de- livery, with very moderate assistance. As I esteem my authority, by no means suffici- ent to discountenance the use of the forceps and single blade, 1 shall therefore add the opinions of such characters, of established abilities and exten- sive practice as will place my opinion of them, upon very firm ground, difficult to be displaced «r controverted successfully. The justly celebrated and ever memorable, Dr. Wm. Hunter, late professor of midwifery and anatomy, London, when treating on the forceps in his public lectures invariably sent for his man Jolrn, who served the doctor in some sort as a confident, as well as a servant, to seek for his for- ceps and bring them : the servant's long absence in seeking them, generally gave the doctor an op- portunity to enlarge an-d animadvert upon other subjects, which he seldom failed to do, to the sa- tisfaction and ed fication of his pupils: when af- ter a long and unsuccessful attempt the servant would return to declare his fruitless research, the doctor would request him to make a second at- tempt which would not be of less time, perhaps than the first, when he would, in some obscure place, probably find them, for the doctor never used them but upon these occasions, and on the uervant’s return, they would be exhibited nearly destroyed by tust, when the doclor would de- clare, “ there gentlemen, you are my witnesses, bj the state of my forceps, bow seldom 1 have used them,” then followed the precious conies- REMARKS ON THE FORCEPS. sion, I assure you gentlemen, in the course of my long and extensive practice, l never used them, but once in my life, and if you will forgive me that, I will promise you never to use them a- gain.” 1 wish not to be understood as stating this upon my own authority, as receiving it from the doctor himself, it was not so, he died before my time in London, but i heard my worthy tutor Dr. Lowder, repeat it in his excellent lecture, whose veracity L never once doubted. Dr. Wm. Hun- ter's name and character can receive no celebrity' from my notice, it is so well known and justly re- vered in the nodical world, as cotemporary, with Dr. Wm. Cullen, late professor in Edinburgh, and his rival in the profession, as to render my description of h:m unnecessary and impertinent; his great improvements in this and other branches of his profession, his invaluable and incompara- ble lectures and instructions can never cease to be the admiration of his students while living; of whom, the gentleman to whom I served my ap- prenticeship was one, and used always to speak of him with enthusiasm,and frequently wished, with, I believe sincerity, he may, for my advantage live to instruct me also; the f ather of mercies was pleased to remove him hence; before his wishes for me could be accomplished, however his seat was ably and successfully replaced by his succes- sor, my worthy and beloved tutor Dr. Lowder, for whom my affection would far be from throw- ing into the shade by comparisons, even with tliii great character. Those who are induced to doubt the high au« j| thority of this professional character, let their REMARKS ON THE FOItCEPT. 157 examine his works where he still lives, which are numerous anti invaluable, his incomparable plates on the gravid uterus, and then they will no longer hesitate to declare, thia authority is sufficient. But lest more may be required, I will add a quotation from a work on surgery, by Benjamin Bel!—vol. B, page 444. “ The necessity, however, of using these in- struments, 1 believe to be a rare occurrence; they are indeed frequently employed ; hut this pro- ceeds, in a great measure from impatience on the part of practitioners; who often force the delive- ry of the child, when nature, if left to heiself, ■would effect it in a much more easy manner. This fact is so certainly well founded, and is of such general importance, that practitioners of every description, and more especially those who are newly entering on business, innuld never lose sight of But not meeting with that attention which it merits, both the forceps and crotchets are daily employed with too much freedom, to the disgrace of the art, and often with irreparable in- jury both to the mother and child.” As it is generally allowed that all forceps are li- able to slip or lose their hold, a variety ot d ffer- ent forms have employed the inventions of their advocates, and each contend for the superior ad- vantages of his own : but none have yet been dis- :overgd, 1 believe, infallible in this respect, al- though employed by the most expert operators: however, such as admit the application of the most points in contact with the parts to which they are employed, indisputably hold a preference, 3ut that this objection may no longer exist, Dr, 158 REMARKS ON THE FORCEPS. Leake, a professor in London, has invented a pair of forceps to which he has added a third blade, he contends positively for its superior advantages, in not being liable to slip when well applied : and who, in the name of reason doubts it ? a child’s head in a monstrous invention like them must be as secure as the man’s in the pillory : but the ap- plication of them is the difficulty : what practiti- oner among us, dare make the attempt? I freely confess, I should shrink from it, if 1 was ?.n advo- cate for the use, nor do I conceive it can be done with safety by Dr. Leake himself, but if he will shew me a case he will effect wilh safety with his hand-vice, 1 am disappointed in my own views, it I could not have completed it, with probably more safety, if 1 had taken more time without any instrument at all, if left to my sole manage-; merit. This then :ny sisters is a consolation to you, but they are his invention and he must sup-( port them, at the risk of life, reason and experience,; It would be almost endless for me to attempt to enumerate, much more so as to describe the various inventions of this nature, this then may suffice: Let it be remembered I am writing for youth and inexperience, the aged and established in the practice, are free to exercise their own judgment, and if they are found in opposition to mine, 1 am no way offended. What may be safe in the cau- tious hands of age and experience, may be very destructive in the rashness of youth and imbecili- * See Dr. Leake’s description annexed to his introduc- tory lecture. LINGERING- LABOR. ty : to these, therefore, I conclude this subject with my friendly advice, and especially to those who have learnt to be theoretically advocates for their use. To be careful they have a profound knowledge of the subject anatomically, and mechanically, a never erring expertness in their applications, accompanied with an extreme delicacy and tender- ness, a great serenity of mind and unwearied pa- tience. 1 shall proceed next to examine a few more of the causes of retarded parturition, and modes of management. A distortion or diminution of the cavity of the pelvis will sometimes cause a protracted labor (see pelvis distorted) nature sometimes in these cases, may be insufficient to finish the work with- out extraordinary assistance, this however, l believe to be a very rare case, as a full sized head, if time be given will mould to and pass a very small and distorted pelvis : and much injury has been repeat- edly done both to mother and child by an olfici- ous interruption, when nature is always disarran- ged and retarded in her operations. \ thickness of the membranes which renders them so tough as to require much force to break, although the mouth of the womb may be suflici- ently dilated co admit the band of the operator, and n\ay thereby cause a lingering case : the wa- ters in these cases will sometimes escape from between the membranes and head of the child to the fundus or bottom of the womb, when the membranes become spread upon the head of the foetus like a cap, which prevents it sometimes. 160 PROTRACTED LABOR. being immediately detected, which is best done by examining for the hair of the head, when you will discover tlie smooth slippery surface of the membranes ; which is to be divided with the nail of t lie operator’s (ore finger as before directed, and the labor will proceed afterwards in its regular or- der and the waters escape with or immediately alter the child. There are sometimes causes of protracted par- turition which are not to be discovered, till the child is in part n the world : as the iunis being short or winded once or more times around the neck or body of the child; the passages in this case may be free and the soft paits perfectly dilated, and the. pains of sufficient strength, and ) et tne child makes little or no progression : or it may be stopped alter he head is in the world : in these cases, the string is put upon the stretch and from the firm attachment of the placenta or alterbirtli to the fundus or bottom of the womb, the resis- tance is equal to, or greater than the propelling force, of the throws of the uterine contractions, the use of the forceps, would then necessarily he suggested and employed by their advocates; and in this case, if the efforts of the operator to ex- tract, were continued and violent till the resistance be overcome, what would be the piobable conse- quences? the cord must give way, the afterbirth be prematurely detached, or the womb inverted: The first accident would probably produce the death of the child, and either of the last would e- minently endanger that of the mother. Sometimes in case of the funis round the child's neck and the child detained in its progression, PROTRACTED LABOR. 161 after the head is born the lungs may he brought into action, the change in the circulation of the blood in the child have taken place in this situation, and it cries firmly ; when the resistance draws the string so tight as to endanger suffocation. If it should appear impracticable to pass the string over the head with safety, which should al- ways be first attempted, with moderate exertions to this effect, but no great force to be used, for fear of increasing the danger, and producing the fatal consequences above noted. A ligature may be applied, in an eyed probe or bodkin upon that portion of the string round the child’s neck by passing it underneath, between it and the skin, securely tied and carefully separated, or cut through on the maternal side, anil the child then given into the hands of the nurse and the comple- tion of the labor proceeds as in common cases.* * A case of this hind was verbally communicated to me for my opinion, b v Kezia Norris, (a scientific and judicious female practitioner, in this city) when she half promised me, she would oblige the public with her own observations on this and other cases : 1 would be far from purloining her practical observations, or unfairly to anticipate her pros- pects, as I am abundantly convinced of her abilities ; to give them to the world from her own pen, in a much more acceptable and elegant manner, than I am capable of. 1 merely wish to encourage her to the attempt. The public are now in possession of her prospects, her powers generally, well known, and her friends will be anxiously expecting a grat.fication of their wishes to se* the completion from her own pen, OF PRETERNATURAL PRESENTATION. Or when the child presents with any part or member of the body (the vertex or crown of the head excepted) it is justly esteemed preternatural, or contrary to the genera! order of nature: these presentations have been divided into three distinct class fications, v:z. The first comprehends the lower extremities. Second, comprehends the middle. or where some part of the body or trunk presents. Third, comprehend all those parts above the axilla or arm-pit. Of one or both feet presenting, or as it is com- monly7 called a footling case: in this presen- tation, if the toes of the child are found to pre- sent, in the direction of the bark of the mother, there will no necessity remain for art to alter the posit on, and vice versa : we proceed then first to descube the management of this case. When the membranes have given way, and the waters escaped, and both feet are obtained, we recommend them to be taken bold of with a nap- kin, and to be gently drawn down, during the continuance of pains ; these interferences of the a couchieur, w 11 be considered merely as assist- ing theefioris of nature, rather than hurrying, or wishing to complete the delivery without her con- currence; which would he productive of many serious ai*d perhaps fatal effects: this then neces- FOOTLING PRESENTATION. sariiy with a prudent operator, will prevent hur- ry or violence ; which would leave perhaps, dis- located orfrartuved limbs with the child, and la- cerations with the mother: after the child has pas>ed the knees, we are to go on in the same ea- sy and cautious manner, shifting the napkin oc- casionally, to obtain a better or firmer hold, till the breech and hips are passed also: when we may wait the return of the next pain, as there will generally be found, a short interval or respifeat this period; during which the womb is recovering its energy and contracting to the diminished con- tents; when the pain will return and evidently press forward the child ; we are now to direct the palm of the left hand, to support the body of the child, and soft parts of the mother, when we shall soon detect the navel string; directed along the belly of the child, towards its face : if this should be found much upon the stretch, it may be well to introduce the fore finger, occasionally between it and the belly ot the child, and thereby relieve it, by drawing it a little down, till the child is ad- vanced as far as the armpits: when I generally give the feet (still surrounded in the napkin) loan assistant, requesting her merely to support them in that situation, while the arms are extracted ; which are to be done in the same easy and cauti- ous manner, as the parts already described: for, asytt, 'there a e no reasons to be alarmed far the safety of the child, by the compression of the str.ng and the check of the circulation of the blood through it, as it will still go on sufficiently free; when I tr.ke hold of the child with both hands, encompassing the chest, as l would were it lying f OO'i’LIJsG PitesentArTION. on the floor on its belly, with its arm over its beau, and 1 intended merely to raise it up or support it; the fingers being directed over the paps, and the thumbs upon the shoulder blades; when the fore finger of the right or left hand, it is immeteria! which first, but only, one at a time, is to be directed along the side of the neck, on the same sale, pressing or drawing down the shoulder, which is to be continued along the up- per arm, till we arrive at the elbow joint; then pressing forward along the fore arm, till the hand escapes; during this process, it may be well to remember, the natural formation of the joints, •and proceed accordingly, in a slow and cautious manner, bearing in mind, that a dislocation or fracture may be the effect of rashness; which the women are generally officious enough to detect and disseminate to our disadvantage : this being completed, the hand of the operator, is to be res-j tored to its original situation, of supporting the breast of the child, with its arm included ; when he is to proceed, in the same regular and cautious manner, with the other extremity : this being ef- fected also ; the assistant continuing to support the feet, we are to pass the finger of one hand, which ever is most convenient to the operator, (I gene- rally use my left) along the breast of the child, ta- king care now to avoid every accident of com- pressing the string, to discover the chin, which if a little too much to one side, is to he pressed with the fore finger, on the side of the jaw, into its most desirable and correct situation ; when the finger is to be past over the front of the chin and mouth, to obtain if possible, a purchase FOOTLING PRESENTATION. 165 upon the nose : and by moderate pressure bring the chin down upon the breast: it is by some re- commended, to pet the finger into the mouth for this purpose: but I should always prefer the for- mer, if practicable, there being a danger of dis- locating the jaw, or drawing it quite off: as now the siring begins to suffer material compression, and the circulation of the blood obstructed, it is requisite we should be more alert, but still no way rash in completing the delivery; or the life of the child will soon be lost : we are then to request a second assistant, with her hand well greased to come on the opposite side (the operator being be- tween the two assistants) and support the perince- um, while the fust assistant with the feet,' bends thorn at the knees, and raises them towards the belly of the mother : the operator places the first and second finger of tile other hand, against the occiput or hind head of the child, presses it back- ward and downwards against the supporting hand of the second assistant, with his antagonizing hand with the fore finger on the nose of the child, brings the chin downward and outward, comple- ting the delivery in a sort of segment, or semicir- cular turn of the child towards the belly of the mother, which will he further assisted, by occa- sional and moderate efforts, of the first assistant with the feet, as she may receive her instructions from tl\e operator, she being entirely passive, as to any will or act of her own; for violence or hurry on her part, may destroy as well as assist every precaution of the operator, and lacerate the perinceuin of the mother, or injure the body or limbs of the child ; which she will not hesitate to FOOTLING PRESENTATION. throw, if possible, the censure upon the opera- tor’s head, and draw herself out clear at his cost-. In this last division, or extraction of the head, the navel string being on its side sutlers entire compression, and the circulation of blood through it, for the time being perfectly stopped : if there- fore the child be not born in about fifteen min- ub s, from ihe head first entering the pelvis, its life must necessarily be the forfeit: we shall dis- covei this in its expiring struggles ; a convulsive drawing up of its shoulders, spasmodic actions of the body and extremities, and a cessation of pul- sation m the string, &c. Having now gone through a concise view of this case, we proceed to its variations. When only one foot can be discovered and ta- ke n hold of. we are to bring that down, secure it by a fillet, bein« fixed over the ancle, then seek for the other, after which proceed as above : but sometimes the second foot is continued up along side the head, in which case the delivery must proceed without it, as in a breech case. Another variation is, where the toes present for- ward, towards the pubes of the mother; in which situation the child could never be born safe, un- less it was infinitely below the standard, and the pelvis of the mother above it: let it he remem- bered, the extraction would go on perfectly well, till we come to the head ; when the chin would be locked upon the share bones, the convex pro- tuheianceof the hind head, hooked into the hol- low of the os sacrum, and the womb contracted close upon it, in which case, it would be imprac- ticable to attempt to force it back ; andimpossi-| BRF.ECH PRESENTATION. 167 »le to Teduce it to its proper situation, because he longest axis of the head would have to turn in he smallest diameter of the pelvis, therefore in his unfortunate situation, the only thing left to he lone for the safety of the mother, is to use the ratchet, and bring away the head by piece meal; vhich may have been prevented, and safely cou- luded, by the following timely precautions: vhen the child is advanced as tar as the knees, one eg is to be crossed over the other, which will give he child an easy inclination to one side, which nclination is still to be assisted, as the child ad- ances, and the complete change effected, by the ime the delivery is progressed to the navel in vhich case the head will safely follow the turning •f the body. The footling case is subject to be confounded vith the hand only: in which case the distin- guishing marks of the heel, which the hand vants, and the toes which are much shorter than he fingers, together with the‘space between the liuiub and fingers, which is found wanting in the oes : I will not suppose any so ignorant as to be ncupable ot distinguishing the right foot from he left, and therefore shall not attempt its ex- ilanation. The Breech Case—which if accurately exam- ned, is not easy to be confounded with any other iresentation: its softness in comparison with the lead, the fissure between the buttocks, the parts if geneiation, and anus, together with the coming iway of the meconium, or the contents of thd ntestines, which are of a dark tar like appear- ance i this coming away of the meconium, some- BUEECII ERESENTATIOfc, times occurs in a natural presentation and when unaccompanied with the other distinguishing cha- racteristics, is no proof of a preternatural case, but rather that the child is dead, and the power of retention destroyed : in this case when the child is favorably situated, with its belly towaids the back of the mother and the teet in contact w ill] the head, there requires no change in Us position by manual assistance: we are to wait till it is progressed so far, as to be able to introduce the large curve of the blunt book, into *one groiu; when we are, in the time of pain to draw down, af- ter wii t il an attempt may be made, to introduce it into the other groin and bring that forward; ai d soon alternately in a zigzag nmnutr, till we area* bie to get in the forefingers, when we may lay a- side the instrument and draw down regularly and togeiher, till the teet fail out: when the labor must be finished as before described in the foot- ling case. I'he breech case affords some variati- ons, which will require distinct illustrations, as where the belly of the child is tuiward, towards the belly of liie mother: and where one or both feet presenf with the breech, being bent at the knees and the heels in com act with lilt buttocks: When the back of ihe child is 10 the back of the mother, and the feet extended along side the head, as in the first variation in this presentation, we are to begin to turn the child as we advance with it in this donbfe position, so as to get it complete- ly turned upon its face, Wien we arrive at the arm-pits; when the feet will tail out, and the la- bor be completed as before. *REEC*I PRESENTATION. 169 one or both feet present with the breech, with the knees up and bent upon the bel- ly ; it is best to leave them in their situations, and proceed as in a breech case only; they will not impede the delivery, and injury will probably be dune to the mother in attempting to bring them down, and reduce it to a footling case, by the sweep the knees will require, if a full grown child, and the pressure they must necessarily make upon the solt parts of the mother, which may produce contusion, inflammation, mortitica-> tion and death may close tiie scene. Some have recommended a fillet, to be passed in at one groin and brought out at the other, be- tween the thighs and belly of the child, this is a very good and sate method, and affords a perma« nent purchase, but it is not always practicable. In applying the blunt hook, be careful the bend of it is something more than right angle, and the point smooth, blunt and straight; or there may be a danger of forcing its point into the belly or groin ; or at least a disagreeable excoriation and inflammation may eusue : whic h once happened to myself, in consequence of which, I Had the point of my blunt hook filed off and polished, and its extremity somewhat straightened. This perhaps, is as far as a prudent midwife ought or is justifiable to go : as in the remaining classifications, the child will require to be turned, or so far altered in its position, by the interfer- ferance of art, as to reduce them to footling ca- ses; after which, we are to proceed in the same manner, as before directed in these cases. ON TURNING. On Turning—which is the operation of art, to change the position of the child, while it is yet in the womb, in order to reduce it to a situation, in which it may be extracted. It may be uttes- sary in almost every position of the child ; but ge~ nerally the presei tations of the head, inferior ex- tremities and the breech are admitted to be ex- ceptions. When the expediency of turning is de- termined upon, it will be requisite first to have the bladder and intestines periectly emptied, by attemp- ting the introduction oi the catheter, and admin- istering warm lubricating injections: as these parts are necessarily much exposed to sutler, by pres- sure in turning the child, and when ei larged by their contents, seive only, to rob the operator of that room or space, he will fit d so indispensibly necessary. Y\ hen the position of the child is ac- curately ascertained, whether of the back or bel- ]y, lying cross ways or either hand: the back is known, by the spine presenting with a large pro- truberauce to each side, h imed by the head and breech: the belly is detected by the navel string and sc iintss of its surrounding parts, this posi- tion is further discovered by the inclination of the Tibs pointing to the breech. The hand is distin- guished from the foot, by the marks already des- cribed ; w hen it is ascertained precisely, whether the hand be right cr left, of which a mistake one would think not possible to be made by a person of any discernment, and yet men ol experience, doubtless have done it, and thereby been expo- sed to be, tor a time foiled in their attempts; gi- ving themselves much additional trouble, and the woman much additional pain, which in itself, tc ON TURNING. asympah.ysingmind, is always painful and desi- rable to avoid. By deciding correctly as to the hand, analogy leads us to discover the further situation, per ex- ample. If the woman lying upon her back, and the child presents its right hand, and I take hold of it, as I would the hand of my friend, I am assured the back of the child, is towards the back of the mo- ther; which situation will reqiure to be changed, in the turning for reasons above exemplified. If the child gives me the back of its hand, w.th the thumb pointing to the left side of the mother, I am assured the belly of the child is towards tha- back of the mother; and shall have nothing to do but to bring down the feet, and finish as in the footling case. The shoulder is discovered by its prominence, the axilla or arm pit, &c. The manner of Turning.—When the presenta- tion and situation of the child has been finally set- tled, the mouth of the womb sufficiently relaxed and dilated ; the operator is to take off his coat and roll up the sleeve of his shirt of that arm pro- per to be used ; being determined by the confor- mation of the child : the hand is to be well lubri- cated with sweet oil, hog’s lard, pomatum or some such like unctious matter: I stop here to query, as to the manner of proceeding thus far, remember not to strip in public, or so that the patient may see you, there is a method or delica- cy to he observed in this and all your movements, which are narrowly watched by the attendants, and severely commented upon, if improper or in- delicate : can it be necessary Ishould instruct you, 172 ON TURNING. how you should take rff the coat? You surely would not proceed in the rude and boisterous manner of a bravado, going to box!! the impro- priety and cruelty of such a conduct, cannot other- wise (even while you are reading the observa- tion) b ut strike you with a sense of compunction for the error: the effect of such an indelicacy, would perhaps be the death of the woman. All things being prepared, and the right time arrive i in which we are to proceed, the membranes are to be broke, if not already given way of themselves, {which is rather an unfortunate circumstance) and the hand introduced somewhat in a conical form, the points of the fingers bting first steadily and gradually introduced, endeavoring, at the same time to prevent the escape of the waters, by the band forming a sort ol plug :i the whole hand be- ing passed, we are to carry it along the inner smooth suiface cf the womb, rather than the rough unequal surface of the child, when you are to seek tor the feet, take a firm hold of them and bring them down, reducing the hand to as small a compass as possible, and extract carefully and steadily; if it should so happen, that both feet are not to be obtained, (which we should not too easily give up) we are to bring down the one we have obtained possession of, and seek for the oth- er afterwards, by a second introduction : the foot of the first being secured by a fillet passed over the ancle. The hand is tube introduced during the inter- val or cessation of pain, when the stimulus pro- duced try its introduction, w 11 cause pain to come on and the womb to contracti when you must rest ON TURNING. 173 till the pain is over, still keeping possession of the progress the hand has made : and afterwards pro- ceed as before directed. When th: hand is introduced and the womb by its contractions presses upon it, rest, but never upon the parts of the mother: you will not al- ways succeed in the first attempt; when you have made an effort, and cannot turn for the spasmo- dic actions of the womb, give a full dose of lau- danum and the spasms will cease : therefore seta resolution, if you may be foiled the first attempt, you may succeed the second, if not the fiftieth, for 1 wont say how many efforts may he required: but however observe well to preserve strength e« liough to the fiftieth, to act further ; for if you exert all your efforts in the first attempt, and ex- haust your strength, your reason will sink in pro- portion, and you are no longer tit for action, when a second practitioner will have to be called in to finish what you may have completed, by a pru- dential reserve. In turning we should always bear in mind the mechanism of ihe child’s frame, and formation of the joints; and always avoid the back, and endeavor to make the breast or belly, and proceed on till you come to the feet, or other- wise you will he foiled : in passing backward a- Yoid the protuberance ol ttie sacrum. If the child has been long dead in the womb and in a statfe of putridity, which is 3omentnes tjie case, the foot may come oft in the attempt to ex- tract it, in this case also, when the child is ex- tracted all but the head, take care it doth not stick upon the pelvis, but remember to have it iu the most favorable position before you attempt to 174 ON TURNING. extract, lest from its putrid state, it may come off, when perhaps there may he work enough for half a doztn practitioners to perform or women to bear. Sometimes the head presents obliquely, or is pitched up< n the edge of the share bones, and cannot be altered in its position by the efforts of nature: in the exertions of art in this case, we have no alternative but to turn; hut this being the greatest alteration in the position of the child We can possibly make, great caution is requisite. Sometimes there are parts which fall down be- fore the head, as the navel string, am;, &c. some practitioners in the first case would always turn, and others again would never proceed to this ex- tremity . The defence of turning in these cases, is the preservation of the child : this has been by some designated a preternatural case, however we must hear in mind the additional danger the mo- ther mav he exposed to! therefore, in my judg- ment we ought to possess every favorable circ um- stance t<> justily such a proceeding, as to author- ise us to endanger the life of the woman, for the chance of the preservation of her offspring: my worthy professor admits, without turning one child only, out of ten may be saved ; when with it live out of ten are preserved : this is turning by choice and not necessity, when we do this, the woman should be in a good state of health, a suf- ficiency of room, the womb globular, the water recently escaped, and the feet near to the mouth ot the womb : but if there should be any fever,in- DROPSICAL ACCUMULATION. 175 fiammation of th»' genitals, or rigidity in the soft parts, we should never attempt to turn. The Piles, a stone in the bladder, or a morbid thickness of the substance of ttie womb, are ail very great obstructions to turning : The belly, breast or bead of the child may be so distended by air, water, or some putrid fl nds col- lected, as may render them expedient to be eva- cuated before delivery can be performed, as these children are generally dt ad, or very soon would die, if alive, iheie need he no great hesitation to perforate them for that purpose. A dropsical belly may be perforated with a common trocar, or pair of scissors, or the finger forced in at the na- vel, if the tenderness from putridity he sufficient to admit of it: the bieast is to be managed pretty much in the same way : But the hydrocephalus, or water in the head, is a much worse disease, and .pioje difficult and disagreeable to manage. OF A PLURALITY OF CHILDREN", TWINS, TRIPLETS, &c. These are suspected by the size of the woman during pregnancy, and before labor: by the groove or gutter in tiie centre of the belly, and an en- Jargement on each side : by quickening a second or a thud time, according to the number of chil- dren; distinct and separate motions at the same time, indifferent parts of the body; but these signs are difficult of application, and not to be de- pended on : Those who wish a more minute des- cription of these signs, may find them in La Mott, TWINS, TRIPLETS, &€. a French author translated by Tomkinson, an old publication highly valuable for its practical re- marks and applications. The most certain time, and manner of discover- ing a second 01 third child, is at the time of labor, after the birth of the first; when the pains gene- rally are renewed, or continued : a fresh water bag is detected, and he child may be distinctly felt, by passing the hand over the surface of the belly, when it is as evident as though 1 pul two children into a bag, took out one and examined on the out- side whether it contained a child or was empty: when soon after, I’ne head or whatever part may be presenting, will soon be distinctly felt by the touch, and the labor should be permitted to prm ceed, as in a single child, agreeable to the rules, before laid down, observing that the afterbirth of one child should, on no account be attempted tube extracted till the last child be born: and in ail cases, never before an examination has been made, and the operator’s mind perfectly satisfied of the existence of a second child or not: as, in the case of a second child, a most faial flooding would be the consequence, the womb not being capable of contraction, and closing the mouths of the vessels, pouring out their contents on its inner surface. In Europe, in case of estate, descending (accor- ding to law) to the eldest son: where there are a plurality ot children, it is expedient to distinguish the first born by a bit of rtbbond being fastened to his wrist: but in this republic of liberty where e- very child has a child’s claim, such a precaution may not be necessary. MONSTEIIS—CJESARTAN SECTION. 177 I Monsters.—We shall not consider these philo- sophically, hur as they relate 10 midwifery: there may be a redundancy or deficiency of parts, but the latter we shall entirely throw aside, for sup- posing a child wants a head, its delivery would be no way obstucted by this, or any other mere deficiency, but rather facilitated ; only it some- times confuses our practice in determining the pre- sentation, but in these case3, we are to continue our finger higher up, till we discover a part we know. These monstrous productions of nature, are generally of the female sex. Some have at- tempted to separate two grown together, but they certainly did not consider their conformation; they are generally in this ci6e born prematurely : but sometimes it has happened, that two well formed children have toeen joined together, by the breast 01 hack : if this should he the case they must be delivered either bv separating or taking them away piece-meal; this operation is called embryotomy. The Ccusarian Section.—Or as history reports, one of the Caesars nemg laken out of nis mother’s side, the opeiat’on has received his name : and is esteemed necesv.iry, w hen the pelvis is so distort- ed and i/arrow as to render it impossible to bring away the contents of the w omb by the natural passages. Dr. Oshome, late a professor of m dwifery in London, has laid down as a rule, that a child cannot be born in less room, than one inch and a-half 'I bis operation is divided into the complete and incomplete- and is sometimes performed upon the living subject, with a view to save both mother CJESARIAN SEC7ION* and child : and sometimes upon the dead subject, with an intention of saving the child only : which should be done immediately after the death of the woman, if the child cannot be brought away by the natural passages which should be always first attempted, in which case we should be certain of the death ol the woman, before we attempt to o* perate. The operation is performed, by making an in- cision through the linea sem lunarce (or a tendi- nous line, found about midway between the hip and f about eight inches in breadth, drawn moderately tight round her as low' down as the hips, and share bones, and secured with four or five strong pins, or strings prepared and sew ed on for the occasion : and she be permitted to rest, half an hour upon her left side, with her legs kept close, to secure AFTER-MANAGEMENT. 181 the greased cloth firmly in its situation ; and if she ppears weak or much exhausted she may take a little weak warm wine and water, or cau- dle made ol oatmeal or fine Indian meal; her cloathing at this period, must be regulated by the season, the temperature of the room, &c. howe- ver as many as will keep her from being chilly will In quite sufficient, by this it maybe understood, 1 would v> isli her rather cool than otherwise ; too high a temperature of heat would endanger fever, flooding or some other such-bke disagreeable con- sequence : alter she is pretty well recruited, her linen, peiicoais, &c. that may be wet, and are wished to be changed, may he drawn down carefully over her teef,or fresh ones properly pre- pared tie ap| lied >n their place: the woman at this time must keep herself perfectly passive and permit ths to be done, without the hast exertion on her pan : when she n ay he replaced comfort- ably m her bed, and be permitted to rest ; unless the greased cloth applied to the passages should ha\e become wet by the discharges, when ano- ther well warmed and greased as before, may be prepared and applied in its place, the swath or napkin may also be examined, and it found to be loo>e, may he tightened or reapplied ; over which a wann double doth may be applied, upon the surtace of the belly : the intention of this tight bandage, is to compress the viscera and the relax- ed punetit s ot ihe body, topnss the womb to- wards it- orig tial siiuution under the pubes, and pr« v< tit the blood which has bieu forced by the compression ot the enlarged womb, into the head and upper parts of the body, rushing with too 182 ACTE It-MANAGEMENT. much violence and rapidity (after this compression being so sudd* nly removed) into its nrginal chan- nels whose relaxed s des would receive an over proportu n, and that in the head too considerably and suddenly robbed of its due quantity, which revulsion would he apt to produce faintinga, con- vulsions and perhaps death.—Some people make use of a hai kerchief c, sab p &<:. Chicken and veal broths, which tiie women generally have an idea are rather opening, theiefore, when we or- der them it may be said to be in part with that intention. After the woman has had a good sleep, and ap- pears refreshed, the child should be permitted the breast, though the milk may not become, the child's sucking will solicit and help it forward: the that milk is both food and medicine to the child, a* it possesses an opening quality, which is not found afterwards, and is of essential service to the child, in purging oil the black stools, or matter calhd me- conium. which has been colhcting in its bowels, during the greater part of gestation : but if t! milk is found not to produce this effect in twent • four hours after the birth, it will be highly prop it to give the child a little magnesia and rhubarb sy-1 up, manna, castor-oil, or some such-like m « cathartic, that the bowels may be opened; fort »t meconium by being too long retained, becon s acrid; producing sharp griping pains, convi siotisj &c. DfET. flooding;. The women generally expect, and wish sonx medicine to he given, after they are in bed ; and the most approved of, is spermaceti, in some form or other; it is a medicine highly proper, as ft possesses balsamic, restorative and nutritious pro- perties; and its innocence leaves no objections to t, therefore it is advisable and prudent to admin- ster it: in short, the women are generally so pre- possessed in its favor, that if you omit it they .villtake it mixed with sugar candy, the yolk of in egg, or in some other form. Flooding—\ certain quantity or discharge of red blood, after the separation ot the afterbirth, is xnmnon and requisite: from half a pound to a )ouud and upwards, but if it much exceed this, ind the woman become weak and faint, and the lischarge still continue to flow, it is time some- hmg should be done, as the patient may be con- idered in great danger of soon falling into con— ’ulsions, which may terminate in death: and are ireceded by cold extremities, and a pale counte- lauce : This may lie occasioned by too sudden a lelivery, in which the w< mb lias not had sufficient ime to contract, and close the mouths of the deeding vessels. Great debility and relaxation irought on bv floodings or other debilitating cau- es during pregnancy—large dodders of blood or lart of the afterbirth being retained, or a partial nvertion, by iw<> great exertions being used, in xtracting the afterbirth. TV atineiit.—Applications of cloths wet in cold inegar ami sp rits applied lo the pubes and back, he fire taken out, and all the bed ploaths remo- ed, except the sheet, to bring on cold to the 186 AFTER-PAINS. ;>■ , whic h assist in constringing and closing the '•I ing vessels: linen rags or sponge wet v\ith a so on of sugar of lead, allum or vinegar, in the iorfn of a plug and introduced into the vagina, or even ice wrapt up in a rag, and introduced as above, and procure sleep by an opiate, which in- variably cheeks it, if obtained, and pressure on the belly, to promote the contraction of the womb. Give internally some red wine, with jel- lies, soups, broths, &e. in small and frequently repeated quantities: utter which the constitution is to be restored, with bail:, wine, cordials, a light nutritious diet, &c. Evacuations\ woman, for the most part, should have an evacuation, or discharge from the bow els in twenty-four, or at least th rty-six hours after delivery, if not, some mild opening medi- cine should be given, as castor-oil, electuary of senna, or .such-like; and if this is found not to procure the effect desired in six or eight hours, a warm emollient injection may be given. Stranguary, ora suppression of urine—A wo- man ought to pas* watt r in twelve hours after de- livery, if not she should beass sted by kneeling over the steams of warm water, warm emollient fo- mentations, of mallows, mullen, &c. warm wa- ter applied to the part, in a bottle or bladder, and if these fail, recourse must be bad to the introduc- tion of the catheter. After-pains—are caused by dodders of coagula- ted blood, which are retained in the womb after delivery* and produce irritation in the nerves and fibres of former coals, which create r. n actions or repulsive actions to throw them off, and there- AFTER-PAINS. 187 by partake of a degree of labor-pain, the moi ■ ot the womb being closed, rather opposes tin c- tion of the womb, and increases the pains, w however are treater or less, according to the of the coagulum. J he woman involuntarily presses upon the sur- face of the bolly, which assists the contractions of the womb, and its mouth is forced to give way, when tin v escape, and site is re lieved : more will afterwards frequently be formed, when the pains and exertions for their removal, will return ; these however are more trifling titan the former, on ac- count of the wotub continual!) contracting and lessening its cavity. Women with their first children, are rarely troubled with them on account of the nervous e- nergy and c uitiactile power of the womb, being greater than at any succeeding iabor, by which they are forced off, before they ate well formed, and it becomes closed too quick for future collec- tions. When the womb contains a large quantity of coagulum, after the extraction of the after- birth, it may be felt through the parieties of the belly externally, as large as a child’s head, so as to lead the woman to suspec t there may be a se- cond child, but of lb s we cannot be mistaken, for if the afterbirth, w.is to be delivered hav- ing a second child within its .cavity, a pro- fuse flooding would be the immediate and inevita- ble consequence: beside the inequalities of the watnb in this c; sc, would direct our decision; wh rcas in a collection of coagulum, the womb is diot nctly felt to be round, and of a less size : we should always be ceituin no disease accom- 188 OF THE LOCHIA. j it, but we may take it as a maxim, if there be »:< fever, there is no danger, and vtce\ersa. / gnosis 'Idle after-pains are distinguished frb' flammation, and the child-bed lever, by t* t ns being movable : The pains seldom con- tinue longer than thirty-six or forty-eight hours after delivery. The expansion of the intestines, after the con- traction of the womb, will sometimes cause a little uneasiness, in which case, opium is the best remedy we can give, but never give it in too large doses, except there exists some very urgent necessity. Castor, and salt of amber, are very good substitutes tor opium, when it cannot be ta- ken. Dr. Low dor used to recommend the fol- lowing draught, for the relief of the after pains: cordial confection, twenty glams; spiritous tinc- ture of rhubarb, two tea-spt onfuls; laudanum fif- teen or twenty drops; syrup, a tanle-spoonful, penn\ royal water, three table-spoonfuls, mixed and t. kcn. Flatulency—or wind in the bowels will some- times iaust a woman to suspect, there may be a second child ; but the directions given on the last subject, will readily detect that error: when we ma\ give castor oil, caibart salts, with pepper- mint w.'er, injections, &(. Of the Loch a.—It hath been observed already, thai immediately aft' r the separation of the pla- centa, there is always a gush or two of blood ; which is f und to dimmish both in color and quan- tity, till it becomes a mere serum, after which it entirely disappears: this takes place in some, woaien ia about two weeks, while in others it con- OF THE LOClIIl.. 189 tinues three, nr even through the month: It should nevt r be interfered withexet pt it be in ex- treme casts, and symptoms of inanition or weak- ness are the consequences; when it may be chock- ed with an irdusion of red rose leaves acidulated moderately with vitriolic acid, or lime juice; and if deficient in qua itity (wh-cb I am always soli- cilous to guard against) n should be encouraged by warm flannels applied to ibe region ot the belly, the leet steeped in warm water, a little pennyroyal, motherwort or catnip tea, taken Warm, it these are insufficient and the pulse be- come hard, the breathing©ppiessed with evident affections of the brain, as head ache, a sense of flashing in the t \ es and threatening delirium, blood must he taken, and if necessary repeated, the bow- els purged, and saline in the state ol ef- fervescence or (Vrment,fr. quently gven : If it he attended with fever and tenderness or extreme sen- sibility to the touch, it points out inflammation of the womb, which suggests the necessity ot our strii te.-t attt is t ion, and most judicious conduct. Iu n Humiliation, fevers, &c. we use repeated bleeding, injections, cooling regimen, and the di- luting plan generally, as far as the urgency of the ndse wdl allow. In moroid symptoms, this plan vould be highly prejudicial, end would end in Jeath; an opposite treatment is therefore indicated the bowels to be gently op* ned by the mouth md giyslerwise, the feet immersed in the vv«im r,ath, and antitnouials are sometimes very benefi- cial, with bark, steel, &<■. It the morbid symp- toms do not speedily give way to the above treat- 190 CHrLD-BUD F£V£K. ment, we should call in the assistance of another practitioner, The symphysis pubis, or the junction of the share bones w ill be brought into a state ol inflamJ mat ion, occasioned by delivery wlienitw.il l>e-i come so thickened, as to leave the bones immo- vable upoi ea.' h other, and render the patient in- capable of standing, walking, &c. Jn this case give bark, steel, &.*. with cold bathing, and eve- ry nn thod ol s.lengthening the general system; With proper band iges to support the alien ted part; some practitioners have been bold enough, when they have found matter formed at the,junc- ture ol the pubes, to introduce a lancet for its e- vacuation: tins however is an operation to be at- tempted by the most expert only. THE PUERPERAL OR CHILD-BED FEVER. This disease has been differently described, by d.fferent authors : This fever is ushered in by shi- vering and chiils, a violent pain in the head, < pecially over the eyes, which is succeeded by the hot fir, and this terminates in a profuse perspyw tion which seems to give a temporary relieflto the disease, when in fact, it is only prepar n way fora second and perhaps moresevere Je the belly becomes swelled and excessively so e, ul so much so, that the slightest touch is product * g of excruciating pain ; before we pronouno I;'1 presence of the disease, we should be certai . the bladder and intestines are emptied ; as a viol* CUIILD-BEB FEVER. listenlion of these parts, n ay be productive of jearly tht same symptoms. This painful soreness of the belly, needs not be ;onfoundtd wuh after-pain, they being subject to ntermissions, this is permanent: they are varied n their situations, this is fixed : the pulse at hist ire hard and lull, and the breathing oppressed, aur afterwards the pulse becomes weak. The lochia and milk, are in the first instance unintenopted—the sk n in some cases remains na- ural, in others it is v, ry hot and dry, which is jueceed> d by a clammy moisture over its sur- face. The bladder and intestine appear to partake of the disease, and tlie urine is passed with difficul- ty and pain, or perhaps suppressed altogether; it is found of a daik coior, and leaves a sediment in tht ves'd. Toe bowels are costive at first but succeeded h) a looseness, wh'ch gives a temporary relief: af- ter whicn the passages become excessively loeted, the p dse increases in quickness, the extremities become cold, and death terminates her suffer- ings- The prevention of this formidable and fatal dis- ease, is to permit the woman to have her regular rest, with her head raised moderaiely high, and rot to disturb her in the night season with the ' ood or drinks, except she hersell requests •i . equeut change of well aired linen, the 1 ui ipt moderately cool, and occasionally well tfee..til eed with pure air, and not more visitors 'i . jd than are absolutely necessary for tiie pa« CHILD-BED FETFK. tients use, * let her sit up in bed with something thrown over the shoulut in, w hen she takes nourl ishjnent, and kneeling over the steams of ward vater, whenever she attempts to pass urine wlmlj shomd be frequently done: o< tasionally to atl tempt the erect posture; these precautio s enroui rage the lochial discharges, and assist the bind* derand intestines to throw otl their contents I which prevents them remaining till they become too pulr d, and impart this tendency to the won b and its appendages The drinks should be sum pie and cooling, and drank perfectly cool, as toast and water, bt this degree is not the same in all ersons, nor in the same person at all times, but that it ra- aer differs according to the difference of constitutional eat, and other circumstances.*’—Experimental Essays? age, 166. CHILD BED FEVER. this point, or the body oveiheatcd by bed clothes a hot room, and strong hot liquors, the conse] quence is, weakness ai d relaxation, an increase! pulse, and the patient pre, ared tor another ana a w- rse fn hnh may terminate the case Mfdicine—Vomits in small repeated doses oi tartar tnn tic, ipecacuanha, James’s powder, &c. and these should be continued, till the stomaof and bowels aie perfectly cleansed: if the last are not sufficiently acted upon, some of the sanni purgatives may be advantageously given, as rocln el, or glauber salts, soluble tar ar, &c. Aftel which the saline draughts m a slate ot ctferves* cence may he given and frequently repeated with excellent effect ; some professors are partial to embrocating ttie belly with camphorated oil and laudanum. Dr. Saunders recommends blisters, o| applying twenty or thirty leeches to the p‘ai-1 ai more effectual. If the vomiting or purging should continue, beyond what is wished, and the vitiated bile discharged then the Colombo ro t m a state of infusion would be seasonably administer* d : II nmibid sy mptoms appear, we must have imnre* diate recourse to tne baik and vitriolic acid in large and frequently repeated doses, to which yeast may be added with sometimes the b< st ef- fects. This disease sometimes terminates in pe« ripneumony, ant) gives the same tenderness io the breast, as was in the abdomen, when ihe tonics are of no seiviee ai d the disease is generally fatal, j When symptoms of gangrene or mortification come on, the patient looses all sense of pain, ilie pulse becomes natural, or ntarly s«», and the com- posure and confidence of recovery the pauenl MILK FEVER. 195 takes on, may deceive you when she is dying, and has done many very eminent men. There is a disease which in many respects is so similar to firs as fo be confounded : but varies in being accompanied with stupidity, a glassy e\e, and a;i enormous swelling of the belly, which contains a cheese like matter.* The Milk Fever.— Poe secretion of the milk is found generally to be formed about tile third or fourth day after delivery ; though in some much sooner, even at the time of the birth, it is ushered in with rigor followed by febrile action, thirst, a dry tongue, a sense of trickling along the armpits, followed by a distention of the breasts; which if not immediately relieved by the application of the child, become turgid and painful ; when the head partakes of the affection, and a slight delirium succeeds. The lorhial discharges are found to diminish, at the commencement of the formation of the mdk; discharge the contents of the bowels by an'einoli* ent injection, after which a mild cool purgative may he given, as castor oil, electuary of senna, ro- chel salts, with manna, See. the patient to be re- stricted to a thin cooling regimen, the loclual dis- charges endeavored to be restored, by warm ap- plications to ttie pubes and feel: warm drinks, or herb teas tnay betaken, to encourage perspira- tion, which may be assisted by small and repeated * For a more minute account of puerperal fever, and most other femalecompla nts, sJe ‘ L)r. (_ iiarl-*s White, of Rlancheatcr, in his most excel'ent treatise on the manage- ment o. pregnant and lying in women &to, a work 1 am ftu- Jer coniide; able obligations tc.’* 196 milk fever. doses of antimonial wine, Dr. James’s fever-pow-4 d( r, &c. If the patient be of a full pleihoric habit! and the febrile action run high, blood may be ta- ken, arid occasionally repealed, according to the strengh ol the patient, and urgency of the sympj terns: The breasts may be lightly embrocated w ith camphorated oil, and the leaves of the red cabbage welted very soft may be applied over it, which act as resolvents, or thinners of the milk] and possessing something of an anodyne property] assuage the tendon, and allay the pain : The ge- neral practice of applying acids with a view to red pel the milk, is imprudent and injudicious and, serves only (on the contrary) to inspissate the milk and retain it in the breasts: in case the milk does not flow freely, which is often the case, more es- pecially with the first child, the lactiferous nr milk vessels never having been brought into that action, afford a greater resistance than afterwards: in this case the fluid should be frequently and mildly solicited, rather than employ any vio* lent exertions, in sucking, or using the air pump, which serves only to bruise the tender sur- face of the breast, increase the turgidity, or bring on tumefaction, and lay the foundation fer inflammation, suppuration and a train of painful and tedious suffering, which prudent management may have effectually avoided: for this purpose a common black porter bottle or decanter, washed out with warm water, and immediately applied close upon the breast, including the nipple, is found to possess as much power of suction, as prudence in this case would prescribe; to which the continued embrocating, with a warm light THE SUPPURATED BREAST. 197 hand, will be found to be a powerful auxiliary; after which, the breast should be covered with a rabbit or lambskin, dressed with the fleece on, and this side applied the breast : a moderate te aperature should be carefully kept upon the breasts, as cold and very cold applications, con- stringe the mouths of the lactiferous and respira- tory vessels, stagnate the contained fluids, and thereby increase the accumulation : whilst on the other extreme too warm clothing, 01 overheated appl cations, increase the inflammatory action, and hasten the suppurarive process : T he tempe- rature then which I should prefer, would be that of the blood of a person in good health, without varying if it were possible, one degree under or over; the warmth of the room, to be kept moderate andregul.tr, which may be more precisely adjusted by having (where it may be convenient) a thermo- meter or weather glass always in the patient’s a- partment: if hard indurated lumps appear in the body of the breast, the best resolvent 1 have ever met with is an ointment made of the common Jemston leaves, or thorn apple, bruised and boil- ed in hog's lard, in the mmner ointment of elder is made, 1 have rarely known this fail, to prevent the threatened suppuration, or as it is commonly called the mamiary abscess: but if in opposition to our best endeavors, the breast will suppurate, it must be encouraged by the application of warm soft bread and milk poultices, w'ith a little sweet oil or soft grease over its surface, this should be repeated three or four times in the twenty four hours: »he suppurative process will be further pro- moted by a more generous regimen, and occasion. OF SORE NIPPLES, ally a little porter and water warm, with a little] sugar and nutmeg; if very painf d give occasion- ally a mild opiate, and when the abscess is com- plete if it does not soon break of itself, a puncture may be made in the most dependent part with the point of the lancet, and the wound cleansed and healed, as a common glandular tumor: If after the wound is healed, an induration or hardness remain, the camphorated oil must be again em- ployed in embrocation, three or four times every day, and keep warmly covered; if however it still continue, the mercurial plaster must he had recourse to; during all which time the bowels must be kept soluble. In the early suppressions! of the milk or throwing it back upon the con- stitution, it is absorbed and carried along the course of the lymphatics, and deposited in the lower ex- tremities, and causes them to swell and form what is called a milk dropsy : in this case opening me- dicines, saline draughts and bleeding—and at be d ‘ime a dose of Dover’s sudorific powder, or Dr- James’s fever powder, should be given and promote the secretion of urine bv Celsea water, and old- hock, or cider and Lisbon sugar. Of Sore Ripples—They being covered or de- fended by so very thin a skin, are very liable to become excoriated or raw, after a tew re peated suckingsof the child, especially the first, the fric- tion produced in this aelion, between the mouth and the nipple, which soon removes the slimy mu- cus separated for its defence, by a number of lit- tle glandular bodies, f und situated around the base of the nipple, for this express purpose. .OF SOKE NIPPLES. 199 The excoriation or soreness of the nipple is a very painful, and generally a very tedi mis uni ob- stinate aill ction, for which a great v;uiet\ of re- medies have been recommended, which would be vam to attempt to enumerate, much less to inves- tigate ; btfing multiplied almost to infinity, as so- lutions ol of lead, white vitriol, allurn &e. in rum or brandy ; hut these being all prejudicial to the child if taken in, the nipples require to be well wiped before the child can be pe mittedto suck, orgripingand perhaps obstinate costiveness is produced, which soon brings on fever and a train of much suffering, which may perhaps ter- minate in convulsions and death: I have at this moment an infant of seven weeks old under my care, wiih fever and a paralv i ie afiV r tion of t he left arm, which it d>es not use; the mother has sore nipples, and has probably used some preparations of lead, whose sedative quality, may luive been the source of the disorder; a ring of hees-wax worn round the nipple, of sufficient thickness to take in the whole, has been recommended; this I think excellent, in healing and difending the part from the frit tion and pressure of the linen, bedclothes, or any foreign body ; in addition to this, a large nutmeg hollowed out and applied o- ver the nipple, this completely covers it from the cold air, and its warm aromatic quality, constrin- ges and braces its relaxed and excor.a ed sur- face : such a contrivance is at all times convenient to come at, and may he worn pretty coiMaut'y, with but little incommoding; and should be had recourse to, as soon as the nipples are found to become tender: The best application, (a? re- OF soue nipples: commended by Dr. Underwood author of the diseases of children) is an astringent solution, pre- pared by burning green vitriol to whiteness and disolving in pure water, the strength regulat- ed by the taste, and applied three or lour times every day, from the pom' of the fingers or with a camel hair brush, afterwards to be covered with the patient’s hand, or some other con rivance to prevent its being wiped off, and after it is become dry, apply the hollowed nutmeg or wax ring, as before described If any deep chaps exists, that the solution cannot conveniently come at, a little white cerate simmered with brandy, may be afterwards applied, or a little finely powdered gum dragon sprinkled on. The solution is best used first very weak, and may be afterwards ap- plied with strength: he observes, “It has stood the test of the British lying in hospital, where it has a long time been used at my request, and with the expected success: though there are al- ways in the hospital, many women thus affected, and out of such numbers, it is probable, a'l the various kuids of sore nipples, must have taken place.” I have frequently used the remedy in my own practice, and have found its efficacy, equal to the doctor’s recommendations. This solution being a preparation of Iron it is perfectly harmless, and on the contrary rather salutary, and ihertfore need not the caution of wiping the Nipple, wiien the child isappludto the breast. The doctor continues. I iie first symptoms of such an unfavorable turn, are usuuU ly a deep lancinating or acute pain, hardness and tumor in some part of the breast, and a consider- OF SORE NIPPLES. 201 tbie dimunltion of the customary discharge of he milk by the nipple.” “ 7Ins is th( moment o prevent the (apprehended mischief, as a very short delay rend*is the intans unfitdual; the kin soon becoming discoloured, and the breast jreatly enlarged. To remedy this, immediately •ecourse should be bad' to bleeding and to the axative, and anodyne medicines: but above all o the sedative applications, which are usually bund to be the most powerful d scutienta.— sometimes however, solutions of crude sal ar— lioniae, with the addition of a good quantity of pirit; compresses of linen cloths, wetied ih luch o liquor, made moderately warm, and re- lewed as often as they become dry, are abundant- y preferable to heating and relaxing fomenla- ions, or poultices, to which surgeons have usual- y had recourse.” When the above means are made use of in proper time, the inflammatory jymptoms will soon disappear, the pa:n be en_ irely removed, and if the milk runs freeiy again from the nipple, there will be no further danger of suppuration: on the other hand, if there be not a very early and considerable abatement of the first symptoms, however slowly the process may go on, the breast will seldom fail to suppu- rate; iu this state, therefore, the plan ought to be changed, iu order to forward the woik of ma- turation. The whole breast should now he covered with a mild suppuiative poultice,* till the matter be * A very good poultice of this kind, is that formerly made u>e of by PUmket, and is preferable to the linseed OF THE MILIARY FEVER. felt, and discharged—when the ulcer should be' deterged, and healed as bef-re described. The Miliary fever—takes its name from the eruptions, which are small and very numerous, from tlje supposed resemblance of millet seed, or perhaps from the latin word, mille, a thousand : It appears to be a disease of a putrid tendney, and is generally brought on by too much heat and perspiration, produced l>y hot liquors, and an over load of clothes, together with every measure that h is a tendency to increase heat and moisture, on the body of the patient ; there appears to lie no particular pathognomonic or distinguishing symptoms which are not common in most other putrid diseases. Dr. White has said, * Alli mius a physician of eminence at Turin, has treated of this disorder more fully than any other writer, and from his account the following circumstances are extracted and prove the affinity of the miliary fever, with putrid diseases in general.” “It may he traced to the same causes, which produce putridity in general, and the diseases consequent upon it. “ A miliary eruption often accompanies putrid and other eruptive fevers.” cake To half a pint of milk should be put three table spoonfuls of finely powdered linseed : after boiling a few minute? aid a small quantity of crumbs of biead, sufficient to bring t to the condstencc of a poullice, to which >s to be added, on taking :t off the fne, the volk of one egg. Th's will make a very smooth poultice, and much 1 ghter than mere bread and milk ; an advantage, in the case of much esp daily n the glandular paits, toe obvious to be particularly insisted cm, • F MILIARY FFVER. 203 “Though women in child bed are generally first, aiiii most universally attacked by it, it ia not confined o th'inaloue.” “Must tilings that are ad noxious in putrid fevers, are the same in tins.” It is attended, I ke oth r putrid diseases, with oppression of me breasts and spn ns, great a< x tty to whirl) are som> nines added swelling and ten- sion of tin b«lly; by which it may becontounded for, or compounded with child hed tever. The patient if obliged to continue the cans s ot (his Complaint, and may l»e subjected to co > suc- ceeding crop, but tliis by a judicious mode of treatment, may be pievcnttd; these eruptions first appear m small vesicles ui biaaders in winch is deposited, a soil ot limpid serum, which atrer- wards become opake or piaily: Sometimes they are red, and aie then called a rash, and some- times both exist in an miernnxed way, at the sau e p* riod. ’iieatwcnt Give small repealed doses of tartar emetic orantimonial wine, nil vomiting is excit- ed, which may he repeated as occasion may re- quire; .is the stomach and bowels may become loaded, with phlegm and saliva: it they do not act upon the bowels, an injection of an emollient natuiemay be u, and daily repealed ; alter which the neutral, or saline drauglns m a state ol effervescence, should he given and Ire- queiitiv repeated; or mmdcitru.s’s spirit cornumed with aiitimoiiials : All kinds of ex.renn evacua- tions are to be taiefully avomed ; as biecd ig, purging, & c. as t In se frequently and irrecuvi lably sink the patient, mciease tile putr.d diathesis, and render the case desperate, which otherwise,; if properly managed, may have been easily and safely removed. The urine in this d.scase is generally pale and copious, ana invariably weak- ens the patient: all medicines tbtn that have a tendency to increase this evacuation, are highly prejudicial, a id are to be carefully avoid, d. The patient’s linen should be frequently changed, and the room slowly, progressively and thoroughly ventilated; and the sweating gradm ally lessened. Toe diet should be lignt and nourishing, carefully avoiding animal tood either in a solid or fluid state, as tending to increase putrescency; but rice, milk, light pudding, jel- lies, &c, are most excellently adapted. Drinks—Jellies disolved in water, toast and water, butter milk, tamaiind tea, orange and lemonade, ike. If purging supervenes, tire light astriage ts may be given, as rose leaves, brier leaves, pomegranate, &c. afterwards restore and strengthen the system, by bark, stee', exercise on horseback, &c. If this disease appears to take an unfavorable disposition, and putrid symptoms rapidly increas- ing; the baik and cordials must be given, in large and frequently repealed doses; the a) thojs affection m themouth cleaned \iM» deteigent aci- dulated gargles, in which boiax may be to bill- ed; if the pulse sink, blisters applied and re- peated (as soon as they cease to discharge) on the same place, or dressed w ith strong fl\ omt. ment: mustard poultices to die feet and hand! and wine and stimulents must be freely enji tied! OF MILIARY FLYER. l’ROLATSUS UTERI. if the bark does not agree well with the stomach, it maybe given advantageously in glisters. Of the Prolapsus Uteri—or falling of the womb, the vagina, or intestine. A predisposition to this troublesome disease is brought on by every thing that tends to a general relaxation of the system, in which the tone or contractile powers of the muscular fibres, is diminished, and they rendered incapable of preserving the gravity of the womb and appendages, from falling trom their natural situations ; to which hard and lingering labors, falls, blows and hurts, seldom fail to increase or bring on the disease; mismanagement or too much rough interference during the time of la* bor, may frequently be another source ; a practice too frequently, and much too generally persisted in, especially by midwives, to the great injury of the woman afterwards, by producing inflamma- tions, excoriationsaud ulcerations, and the retard- ing the progress of nature, during the period ot labor, the very circ umstance they alkdge as a reason for doing it is to inform, themselves of it; a most monstrous mal-practice, that ought in ever}' case and circumstance, to he cried down: I have illustrated (in a former section on natural labors) bow well, the exper enced and discriminating practitioner, may ascertain the progress and state of tin labor almost without it ; and in my opi- nion, till this experimental knowledge (for it is not learnt in theory) is m a good degree acquired, the practitioner ought not to be trusted alone. In a common ease, i would not v. ish to touch my patient more than three times, till l was actually engaged in her assistance, though I PROLAPSUS UTERI. know, the good women expect something may, all times be done for the patient’s relief: our own sympathy and anxiety for the sufferer, spurred up by the importunities of her friends, may sometimes cause us to do more, than our better judgment justifies; they may accuse us of being cold and unfeeling, and not enough alive to our patient’s welfare; but let not this cause us to run into the other injurious extreme, just now treated of, at the same time we must not observe a sullenness, and a haughty disdain to condes- cend to lower our own self propriety, or the vain imaginations of our own superior knowledge, to a level with the interested sympathysing friends; £his condescension, permit me to say, fn my opinion is the maik of a great and a culti- vated mind, and never tails to secure their tran- quillity and resignation, in a full and endearing confidence of your correct and better judgment: give them an entire explanation of the why and wherefore, and their importunities vanish, I ke a mist before the effulgent rays of the rising sun on a summer’s morn. The mouth of the womb will sometimes project out beyond the os externum or outlet, and bring a portion of the vagina along with it; this is often brought on by hard forcing pains, before the mouth of the w omb is sufficient- ly dilated; b> voluntary and unnecessary strain- ing, a very large pelvis, may also predispose the woman to this complaint: When the womb becomes gravid in the early months, while it is contained within the cavity of the pelvis, it is caused to sii k lower into the va- gina, and increases the complaint; but alter its prolapsus uteri. 207 enlargement, when it arises above the pelvis, in- to thecaviiy of the belly, it carries the mouth of til* womb and vagina along with it and the dis- ease disappears; this circumstance takes place alter the fourth month. During the labor of a wo- man w’Uh this complaint, the womb should be carefully supported by the fingers of the accou- cheur, ai.d the horizontal posture scrupulously preservt d and persevered in beyond the usual confinement, with a view to a cure, which will b\ these means, be sometimes happily < fleeted. If however, alter her getting up, she discovers a return of the prolapsus, the horizontal posture should be again resumed, and an attempt be made to reduce it to its proper situation, the parts to be frequently washed with a sponge moistened in some astringent liquor, as oak hark, pomegran- ate, brier leaves, tormental, &c. to which a little spirits or vinegar may be added: or if the sponge may be found insufficient, the womb syringe may be employed; these injections need only the chill to be taken off them; and after a few times using, are better applied perfectly cold : after- wards a tent of soft linon or sponge wet in some of the above liquors should be introduced into the vagina, over which apply a compress, and pre- serve it there by proper bandage. This applica- tion should be removed, and renew'ed at least night and morning, and if persisted in for a con- siderable time may eventually establish a cure. If however the protruded portion is not easily returnable, and assumes an inflammatory ap- pearance, emolient fomentations, of mallows, mullen, &c. 6rc. sitting over the steams of the 208 swelled LE93. liquor in which these herbs have been boiled ; solt poultices, the bowels to be opened by the cooling catharticsand if the inflammatory action does not appear to subside, recourse must be had to bleeding, and afterwards to be re- duced. If the above plan is not found to be sufficient, recourse must be hud to the use of the pessary; of which there are various kinds, some of wood and some of cork cut Tound with a perforation through them, the latter kind dipt in melted sealing or common wax, being more pliant and soft than the wood ones, 1-think are to-be preferred : after- wards the geneia! tone of the system is to be res- tored, by balk, steel, cold and shower baths, mineral waters, a change of air, to the most! ;>ure, moderate exercise in an easy carriage, a*| light nutritious diet, &c. Swelled Legs—Will sometimes occur after de-j livery, from the absorption of putrid or noxious] matter, whifch generally take the course of the; absorbent vessels : great pain and tention is dis— ! covered along the whole course of the leg, a1 great depression of spirits, oppression of the pre—3 cordiae or region of the stomach, excessive ten- drrness and sensibility of the part, febrile ac- tion with its concomitant symptoms, of foul tongue, restlessness, anxiety, quick pulse, and turbed urine. Tile intentions of cure are, in steeping the af-* fected extremity in warm water, embrocating it with camphorated oil, and covering it with warm flannels. SWELLED LEUS. Give gentle purgatives, as rochel, or poly- chrystal salts, and anodynes combined with su- dontics as opium and ipecacuanha. Dr. James’s fever powder, tartar emetic and calomel, to which camphor may be combined, &o. (bleeding, vio- lent purging, blisters and all excessive evacua- tions are to be carefully avoided); after the febrile action is abated, the constitution must be sup- ported, with wines, cordials, &c, SECTION VI. ON THE PRIMARY DISEASES OF INFANTS. An ill conceived opinion has been for centuries established, that the diseases of infants admit but of little relief, from their incapability to describe their symptoms and sufferings, and thereby, (it is to be feared) many have been consigned to a premature grave, whose diseases may have been arrested and obviated, by a timely and judicious mode of treatment: even physicians till a late pe- riod, have suffered themselves, to be bushed into inaction on their behalf; and thereby, withheld that assistance, it was so amply in their power to afford ; while they would hang with sympathy- sing grief, over the little sufferer, declaring their own ignorance and incapability to afford them any assistance, lest they should form an erroni- ous opinion, of what, they thought, the hidden disorder and its real cause, pursue a wrong mode of treatment, and thereby only render the case worse, and consequently leave a higher proba- bility of its fatality; and thus insignificantly trifle, till death has removed the cause of their anxiety: however, more is not to be expected ON THE DISEASES OF CHILDREN. rom man or medicine, than they really possess; for in some cases, apparently slight in the at- :ack, and managed by the most vigilent and ju- jicions physicians, the terminations may he in ieath ; of which there were hut little apparent reasons to fear, or symptoms to cause alaim. It is no wonder then, under this contented and icknowledged ignorance in physicians, that the *ood women, with their simples had supplanted nearly in this practice, and assumed to them- selves that prerogative, over the management of diseased infants, which, it is certain, it was not their province to assume, nor to the honor of the profession for them to possess: however, as their diseases are generally simple, and not complicat- ed with others, the administrations of simple remedies, therefore, are generally crowned with success: this vail of ignorance is now happily re- moved from this important part of the medical profession, by the successful and erudite labors of Doctors Harris, Armstrong, Hunter, Under- wood and others; whose works I would recom- mend, to be consulted by all, who wish a more minute and correct knowledge of the diseases of children, than I have either room or abilities to afford: this little treatise being intended as a compendium only, of the most simple and com- mon place diseases, to which early infancy is subjected; more, I trust will not be expected, than is presumed. When better opinion or au- thorities are obtained, mine, like the pale light of the moon, retires peaceably and unhurt into obscurity, before the refulgent and more glorious rays of the risiDg orb of day. I proceed 212 FtLTA L CIRCULATION. then first, to investigate the fee * . I circulation of the blood, before biith, to shew afterwards, the* important change which takes place, on the* first inspiration in the lungs; rhe most prudent measures to be pursued, to tavor this change,' which sometimes by haste and mismanagement is interrupted, and the life ot the infant, bud- ding as it were into a second existence, is for- ever nipped ’ere it has blown. On the feet a! circulation before birth.—By the circulation of the blond is understood its passage' from the heart, its fountain into the arterial sys-' tern ; which distributes it, by its infinite branch- es and ramifications, into every, the most ex- treme partsof the body, and it is returned by the corresponding veins; the arteries or beating ves- sels, have a continuation ot that contractile power which the heart possesses, to force their contents onward, into the most extreme ramifications; and these motions are called, the pulsations or pulsatory motions of the heart and arteries; the veins possess no such actions. The feetus possesses a number of blood vessels, which are not to he found in the adult, viz. The umbelical cord or navelsiring, is general- ly composed of one vein and two arteries; though in this respect is subject to variety, and i he in- terstices filled with an elastic gelatinous like substance: the termination of the vein is into the venaporlarum of the liver, and those of the ar- teries into the placenta or after-birth. If we ex- amine the arteries, they will be found to run a- long the cord, without giving off a single branch, and are continued along the posterior part of the E (ETA L CIRCULATION. 213 bladder, and inserted into the iliac blanches on >ach side. In the liver of the foetu9, is a peculiar vessel, ailed ductus venosus, which enters the venaea- in a right line with the utnbelical vein : but □ the adult it is found impervious, and degene- ated into a mere suspensary ligament oi the iver. The heart of the foetus, like the adult, is bund divided into four cavities or chambers ; the wo superior are called auricles, and the two in- erior ventricles; which are separated by a ten- linious division, calk'd, the septum of the heart; )ut in the foetal heart, there is found this pecu- iarity, between the auricles is an oval aperture viih a valve, called foramen ovale, through vhieh the blood escapes, from one side to the ;ther: and a vessel arises from the side of the pulmonary artery, which originates from the iight ventricle of the heart, and is distributed hrough the lungs, called the canalis or ductus irteriosus, which terminates in the aorta; so that 'iom this mechanism, may be seen, a very small portion of the blood passes to the lungs, merely i sufficiency for their support during the foetal >tate or before respiration. The blood in the foetal heart, is propelled for- ward by the contraction of the right auricle, into the pulmonary artery: but from the compact state of the lungs it meets with a firm lesistence to its passage, when it finds its way through the foramen ovale and ductus arteriosus, and from thence into the aorta or great artery which dis- tributes it through the system : from this, it may be seen, the foetal circulation pursues but one 214 FtETAL CIRCULATION. rou e, which wdl be found to be materially change*4 after inspiration, by vluch »tie lungt art dilated, the vessels m them set at liberty, by the compression being removed, their cavitu s are opened, and the blood forces its way through them: this circumstance generally causes the valve to close the foramen ovale, and the blood now takes a double course as will be hereafter touched upon. The blood is conveyed to the child by the tim- belical vein, and from it by the arteries : make a ligature on the cord, and in that part of it be- tween the ligature and the placenta, the vein will he found turgid, and the arteries flaccid; and between the child and ligature, the ar-eries tur- gid, and the vein flaccid, and the pulsation recede or gradually decrease, from the ligature to the belly of the child. The umbelical vein is divid- ed into two branches, one is continued to the vena porta of the liver, and the other to the vena cava, or large vein, and is called the canalis ve- nosus: The liver is the largest viscus of the fee;us, and is larger in proportion than in the adult; yet all the blood that is brought to the liver, does not circulate through its substauce, as a great portion is passed by the canalis veno- sus, which is situated directly opposite the um- belical vein, and conveys it directly to the vena cava, and from thence to the heart: 6 7 ths. of the blood of the placenta is returned by the umbeli- cal vein to the child, and 1-7th goes to the mo- ther. It has been supposed, that the vessels of the placenta and those of the uterus, auastomose* or FCETAL CIRCULATION. 215 unite; but by every trial that has been made, with injections and otherwise, the r«. verse opinion is confirmed, otherwise it would be perceived, bv the terminations of the vessels. It the arteries of the string art injected, the toetal portion of the placenta only will be tilled: Uie maternal por- tion, can be injected on.y tr<>m the uterine ves- sels. A either m the case of twins or triplets, where there are more placentas than one, are there any communications between them, tnough they aie found to adhere together; injections thrown in by tlie vessels ot one funis, will be found to till the foetal portion ot their own pla- centa only; heme arises the futility of the idea, of a second child bleeding to death, by the funis of the first, if it be not secured by a ligature, since no communications, that can tie discovered, ex- ist betveen it and tlie mother: as ttie child then is nourished in utero by ihe string, it may be urged, that it is derived from absorption Irotn the mother; but it so, what does it absorb? a fluid finer than blood; tins then, don’t militate against .bis doctrine, tor if*o, it cannot be blood: tile lien does not emit red blood into tile chick, who is posse>sed of the rud Hunts ol life in itself: those in lavor oi this doctrine, sa\ “if the wo- man has a local disordt r, the child will not be affected with it.” That the foetus is nourished in utero, there re- mains nit the shadow of a doubt; but by what means? S--rne sa) by the mouth, and others by the funis, and others t>y both: Hippocrates Says, “as soon as the child is bom it sucks, and how should it, if it had not been used to it?” WnyJ 216 rCETAL CIRCULATION. we cannot suppose any thing but instinct for tets, or nippies. As the ancients dissected only brute animals, where in many there are cotilydons or nipples, therefore they are to be excused. Heis- ter says, he found the naval string putrid, there- fore its noOrishment must have been received by the mouth, as no absorption could take place.— Another says, he found a knot upon the string, and therefore concluded the child must be nour- ished by the mouth ; this is but a vague argument, as we cannot suppose the child can recede so far, as to make the knot tight enough, to top the circulation through it: the similitude bv vween the liquor amuios or waters and the contents of the child’s stomach are found to be very dissimu- lar. There are sometimes found children, or rather monsters, without heads, consequently, sine oribus, or without mouths, therefore it must be concluded their nourishment must have been by the nav* I string, as their growth in other res- pects has been olten found to be perfect. After respiration a few times, the circulation of the blood becomes complete, as in the adult, and the child is enabled tocrv: ’her it has clone th is forcibly a few times, the navel string should be tied, and generally not tiil then, at which period Us pulsations will tie found to have ceased or nearly so which should be wait< d awhile lor, this important change in the system of the child, cannot reasonably, immediately take phpe: it must be obvious, that too great a burry in tying the funis, be tore the circumstances above mentioned have occurred, must tend, not only to impede, but perhaps totally prevent their ON SUSPENDED ANIMATION. 217 completion, when the death of the infant must be the inevitable consequence: the first respiring life of an infant, is like the glimmering of a fee- ble taper, which the least rudeness or assault may extinguish never to be restored. On suspended animation.—Causes : long pro- tracted and laborious labors, where the head has suffered much and long compression in the passage; from a small or distorted pelvis: the naval string compressed from any accidental cause, as presenting with the head, or passing withthehead in a footling case (as before describ- ed,) or its being winded once, twice or some- times, even three times round the neck, extre- mities or body : phlegm or mucus formed in the windpipe, &c. these, and other causes will some- times pioduce the chi'd apparently dead, or its animation suspended, and sometimes actually dead: however endeavors must be used, as I will proceed to describe, even for one or more hours, as long as there exists the least piobability of the animal spark remaining; in short we should not cease from oui endeavors, tor re-sus— citation or returning life, till we are abundantly confnmed, the child is absolutely dead, and not be too easy, mere ly to save a little labor and ex- ertions to come too soon into this determination : for l have k own instances, where the women by their continued and inci> fatigable exertions, have ri stored an infant to life, when f have felt in u.y own mind, well satisfied to leave it to its fare: tins troth now so fiunly-established in my view, m. k< s me much more solicitous and per- severing; and wliai a leflecUon would it be, if 218 SUSPENDED ANIMATION. after we have left the patients (which sometimes is done much too soim) the child should be res- tored! how justly are we censured and rebuked for our unfeel'ng and insensibility: how s* vuely ought we to feel the remorse of conscience, for our remissness and inattention: trust me hut a man not afve to the most exquisite sensibility,] under the curtxot prudence, and a sympathy that can enter into all the mother’s hopes and fmx e- ties, ought never to intrude into the practice of midwifery, where all these emo,ions are so fre- quently and variously called into act':-n : think of the fond mother just relieved from ah *he ag- onizing tortures ot death, rasing her languid and anxious eyes, to behold for the fust time,! the lovely fruit of her sutb rings; and then to be- hold it, apparently in death! hear her heart rending shreak, see her head fall back upon her pillow and her hands clasped together, saying, < as it were, “O! my God, am l not worthy to enjoy the dear fruit of my saflertng, what have I done that my fond hopes are not allowed me, to sooth me in this trying hour?” can’st thou wit- ness this and not feel tor her? and is it possible these fe< lings will not stimulate thy best endea- vors for her relief in the restoration of the lo\e!y image of lies It? If thy feelings are not awaken, ed, even in leading this imperfect picture, (for [ acknowledge words fait me to describe it as 1 feel it, muen Itsa, as I have done to witness it) 1 pray thee shut my hook, my labor >s in vain for thee, thou art not fit tor the profession; go take the spade and b eakthesubborn earth, it is inyegita- tive productions, where the mother earth, suf* suspended animation. 219 »ers neither pains nor anxieties, and where fond cheering hope is not felt, that thou should’st practice. But by thy endeavors, to restore to her the prize of her heart, see how her countenance brightens her hopes (blended with maternal fear.') return, her every attitude and feature, (even if :hy endeavors fail) bespaka blessing for thee: thou wished me blessed in my child, thv anxious en- deavors for its restoration proved it to me, (tacitly at least,) declares the suffering mother, to the amiable practitioner, ‘‘ may’st thou be blest and it shall afford me joy.” Is not this exquisite de- light to the sympathysing breast? it is a beati- tude 1 would not part with for a diadem: but if thy endeavors are crowned with success! the child gasps, the little heart begins to throb, O! bow my ov/nbeata*iu unison, it cries, and its lit- tle life is in a< .ion; see then the gladdened mo- thers eyes, glisten with delight, her every nerve is strong to the joyous passion and she ii ready to spring (forgetful of herself) to clasp, the ob- ject of her love to her enamoured bosom; she re- ceives as it were, new life with her infant, she re- covers, and presses the fond charge to her heart, where it draws from her own breast of innocence and health, a support of that life she gave it ; pardon this digression, but the subject appears so inexhaustible, I know riot where to stop. Ishuil proceed to the mode of treatment. While there remains any pulsation in the string, let not the communication he destroyed by tying, &e. let the mouth of tlie operator be applied to the mouth ot the child, and blow with some force, dosing at the same time, the nostrils with the SUSPENDED ANIMATION. thu 1) and fingers of the left hand, while the right hand, wet with brandy or spirits of some kind, the breast of the child should be well rub-j bed with it, that if the lungs should be in au\ de» gree inflated by blowing in at tlie mouth, the compression and friction may assi't to bring on re-action; a large wash bowl of warm water, of the temperature of b'ood, in which the child should be immersed, and the frictions continued under the water, leaving the face of the child out for the advantage of respiration. The fauces may be Lidded with a fea her, the child, after a while, may be taken out of the water and receiv- ed into wai m 11 mnels, w here the frictions may he continued by the fire, the temples rubbed with vinegar or hartshorn, and snuff or hat {shorn ap- plied to the nose, the feet and hands may be rubbed with flour ol mustard, steeped in spirit: if these means fail, some of the more active, as recommended by the humane society in London, for the recovery of persons drowned or otherwise suffocated. I shall quote it in their own words, as it may be expedient, the public should he in possession of such directions and l will not sup- pose the practitioner (whether male or female) cannot accommodate them to the application of a still born infant.—viz. “ As soon as the person is taken out of the wa- ter, a great-coat or two of th byestanders should be wrapped round the body, which is to be carefully conveyed to tbe nearest, rtceiving house. In cold or moist weather, the body is to be laid on a matrass or bed near the tire, but in summer on a bed only ; it is then to he tho- SUSPENDED ANIMATION. roughly dried with warm flannels, and as pure air is essential to the return of life, not more than six persons are to be present. “ Apply a pipe of the common size to the nos- tril and blow with some force, closing the other nostril and mouth, whilst a third person presses tile chest with his hands, as soon as the lungs are inflated, other assistants are to rub the body gent- ly with salt, warm flannels sprinkled with ruin or geneva, and foment the breast, &c. with hot brandy ; a heated warming-pan (the body being surrounded with a blanket) may be lightly mov- ed up and down the back; bottles of hot water, heated tiles or bricks (covered with flannels) are to be applied to the soles of the feet, palms of the hands, &c. The temples may be rubbed with hartshorn, the nostrils tickled with a feather, and snuff, or eau de luce often applied. The fumes of tobacco should he often thrown up, as its good effects have been frequently experienced, if a fu- migator be not at band, the common clay pipe may be employed ; but if it should be inconveni- ent to employ the tobacco, then glysters of this herb, or other acrid infusions with salt, &c. may be thrown up advantageously.” “Agitation is to be employed, as it lias proved a powerful auxiliary to the other means of recove- ry; therefore, the assistants are to take hold of the legs and arms, particularly of boys, and well shake their bodies for a considerable time, and if a child has been drowned, it should be wiped dry and placed in a bed between two healthy persons,” SUSPF.MDDD ANIMATION. “ When these various means have been em« ployed for a considerable time, without success, the warm bath should be used, or the bodies should be surroundt d with warm ashes or grains, for three or four hours.” v ‘ If there be convulsions, sighings, gasping, or other signs of returning life, a small quantity of brandy or wine may be given and frequently re- peated. Electricity may be early employed, as it will not prevent or obstruct the various means of re-suscitation, but on the contrary will ren- der the plan of recovery more expeditiously and certainly efficacious. Bleeding is never to be employed in such cases, unless by the direc- tion of one of the medical assistants who has paid due attention to the subject of suspended anima- tion.” “ The above methods are to be employed with vigor for three hours, for it is a vulgar and dan- gerous opinion to suppose, that persons are irre- coverably, be cause life does not soon make its ap- pearance; an opinion that lias consigned to the grave, an immense number of the seemingly dead, who might have been restored to life by resolution and perseverance.” Dr. Htrboltof Copenhagen, says, “ The cause of suspended animation in new born infants, is frequently from a fluid being collected in the tra- chea or air tube, which he has dicovered by dissec- tion,” and adds, *' If the child is fixed in a re- clining position, that this fluid may escape; it will restore nine out of ten:” this he confirms by his own experience. ON TYING THE FVNIS. I would suggest also, as a dernier resort, when every oilier means have proved ineffectual, tlie operation of trachiotomy or open ng the wind- pipe, then applying ihe fore finger of the ope- rator’s left hand lo the mouth of the child to c lose the epiglottis or valve of the windpipe and ap- ply the mouth to the incision and blow with some force to infate the lungs, when compression be made upon the chest outwardly and soon al- ternately ; a sort of mechanical respiration be produced, bv which the hlood is put into action, and perhaps life may yet be restored ; Vessanus, an ancient and celebrated experimental anatomist “ found by blowing with a pipe in the windpipe, that the heart again performed its actions,” (see my history of anatomy page 19, in the account of Vessalius.) I mention this operation as a mere suggestion, when every endeavor has failed, and ttie child given up as irrecoverable; having never dared myself to perform it in this case, on account of the opposition of prejudice, but as I am led to expect, as a last resource, life may sometimes be saved bv it: I should be glad to see the opi- nion of any medical gentleman on tins subject. 'file child having cried firmly, and the na- vel string securely tied and divided; the nurse is to have prepared, a warm soft flannel to re- ceive it: she will proceed with soap and warm water of about the temperature of new milk, and some sweet oil or fresh grease, and a piece of flan- ntl to clean off the scurf which is sometimes formed over a yreat part of the body: especially the head, armpits, and groins; however I would 224 ON TYING THE FUNIS. not be over solicitious, to remove more than what will come oft' with ease; as the friction re- quired in some cases, would be very liable to excoriate the tender surface of a new born infant. I will not suppose but every well informed wo- man, used to children, knows sufficiently how to manage this part of the service, being more im- mediately their province than mine. I shall therefore not insist upon it, only observing they should carefully examine if the string be securely tied, that the child is in no danger from its bleeding: if it is not, to have a fresh ligature properly and firmly applied before they proceed. I prefer narrow tape for this purpose, to the wax’d thread, for the operators hands being at the time of tying the string, generally wet with a slimy mucus, it is very apt to slip, m spite of his best endeavors, which L have found not to be the case with the tape: the string is next to he wrapt round several times with a piece of old singed linen rag, greased sufficient to prevent its coldness (it being now a dead useless extrane- ous body) trom affecting the child’s bowels; it is then to be laid along the breast towards the chin and secured with a belly band or body roller, which should be rather loose than otherwise, and care should be taken that the string should not be put upou the stretch, at the part where it aoht res to the body of the child : I would only observe it is best to dress the head first, and go on to the feet till the whole is done, when the child may be laid in an easy reclining posture covered over light and warm, leaving a small opening only for it to breathe freely ; it i» pre- ON DRESSING AND MEDICINE. supposed the accoucheur has examined and de- termined that tiie child nus suit r< d no 'injury in tire birth, as fractured or dislocated limbs, inden- tations of theskull exconaiions of the scalp, &c. which are first to be attended, and it found, managed according to arr, as will be in some measure explained hereafter; but as l am riot writing a system on surgery, fractuies, disloca- tions, &c. come not within my present plan, I would therefore n fer tlie curious enquirer to such authors as have written more immediately upon these subjects, as Benjamin and John Ball, De- sault, and others. It is usual to give the child something of an opening nature before it is laid down, as salt and water, molasses and water, a little sweet oil or such like, this 1 approve, as the meconium or blac k excremenlitious matter collected and con- tained in the child’s bowels, s on b conn s acrid* producing gripes, flatulency, or perhaps convul- sions; it is therefore a desirable event that it should be early evacuated ; but as the first milk of the mother possesses a purgative quality, which it generally soon looses, il it comes soon enough it answers every purpose of food and medicine, and certainly is the most proper that can be given: in ail things see the wisdom and mercy ol the first great cause ! but if the woman he very delicate and reduced by her pregnancy and labor, it may be several days before the child can procure any milk; in this case, it will be highly necessary natuie should be medicinally assisted, by giving a tea spoonful of caMor or swoet oil, manna desolved m warm water, or a ON SUCKLING. simple injection: however I generally approve of the child being applied a few minutes to the breast after the mother lias had a good refreshing sleep and repeated three or tour times in the twenty four hours after; though the breasts may be flaccid, and hear no appearance of having in ilk: the child’s breath and moderately sucking "'ill solicit and bring the milk forward, as the mother will soon experience by a sense of trick- ling along under the armpits, leading to the body of the breast : here I would wish to cau- tion the mother to steer clear of t he opposite ex- treme, for a child (especially the first) lying long drawing upon an empty breast, will he very apt to excoriate the nipple and bring on a train of painful sufferings, of sore nipples, &c. as before explained : therefore all the attempts of the child to suck, that I should recommend or permit, would be more with a view to solicit, than force the coming of the milk. 1 dare say, I am now understood, and shall therefore leave the subject, with recommending the nipple to be bathed w:th sweet oil and brandy after every such application of the child, merely to sheathe and lubricate its tender surface, after the friction of the mouth and tongue. The breasts of the infant about the nipples will frequently appear indurated and swelled and a sort of serous discharge will sometimes be press- ed out: it is not. unusually, though improperly called milk, and is generally recommended to be squeezed out, which is sometimes done with too much violence and is productive of tumefaction, suppuration, &c, and is therefore art improper • N XCORIATED SCALPS, &C. .'node of treatment: The parts embrocated light- ly with camphorated oil: or brown paper, dipt in brandy, laid on, will generally be all that may be needful: if with these means it does not disperse, a soft bread and milk poultice may be advantageously substituted. The child’s head (after a long and severe birth) will be often found elongated and of a conical figure, approaching somewhat of the sugai loaf form; the loose attachment of the bones of the skull, overlapping each other, like the scales of a fi'ti: in this case it may he lightly embrocated with sweet oil or brandy, campho- rated spirits, or such I ke, leaving the restora- tion to nature, who will generally reduce the form of lire h ad to its ti u* shape in a tew days. Tin scalp w ill >< *;nei im< s, in these cases be much swelled and t onified; the ,ume applica- tions may be made as above, or a cloth wet with Gooiard water, t-r vinegar and spirits: but the applua iotis of hot fomeniati uis and poultices would In dangeious in favor ng a disposition to niortiti at on and tlartf re ought to be avoided. In the breech pieseutations, the private pails may sutler in ihe same way; the same applica- tions, of about the temperature oi the blood, will be an tnat will be necessary in this case. The blunt hi) k will also sometimes cause in thi s case>, exioriatioii, inflammation and sup- puration, n» Hie groin, apply any mild liniment, as wax and oil, sweet cream and such l:ke Indentations of sue >kull by pressure in the birth, should be endeavored to be elevated by 228 ON CUTTING THE TONGUE. the application of sticking piasters or cupping! glasses. Children are sometimes born with a tumor upon the head, as lar_e as a hen’s egg, with a deficiency of the skull bone, called hernia cere- brunt, it is best to leave it to be removed by ab- sorption, we may apply camphorated oil, opodel- doc, soap suds, &c. the deficiency in the bone generally soon becomes filled up. In large heads—-apply assarum and turpeths mineral m the form of snuff to the nose, which will bring on a discharge of a prodigious quantity' of glairy mucus, and geneially gives relief: we may also foment the head, and give mercurial cathartics, which will be found very serviceable in this disease, at a more advanced period — Children somei imes at birth have the eye lids or labia pudenda gr wn together, which should be put upon the stretch and carefully cut through. The licenum or bridle of ihe tongue, is some- times too long and extended to the apex or point Winch it draws down when the child attempts to suck or put it out, and therefore requires to he divided, w hich should be very earetull) done, as a fatal hemorrhage nny ensue by the d vision of the sublmguial artery, a considerable blood vessel very nearly situated. I have often wondered this accident has not more frequently happened, by this simple opera- turn, (as u is errone ously thought to be) being at- tempted by the m*»st ignorant old women, to vvh'c h the dangerous disadvantages of imperfect sight and unsteady hind are attac hed, the best sight, the most steady hand, with a correct OI? TliE [1ARK Lif*. knowledge of the parts are required in this opera- tion, 1 should therefore refuse the most correct anatomist if he wore spectacles. I generally con- sider it like the self-edge of a piece of linen which if divided, is sufficient; the child will tear the remainder completely itself in the action of sucking. Van Sweithen, mentions some children possessing too great a facility in the mo- tion of the tongue who had the power of swal- lowing it and producing suffocation: this may be discovered by the blackness of the face, and is re- moved by introducing a probe or a skewer to bring it out: be therefore adds, “ we should be careful in giving too great a facility to the motion of the tongue, in dividing thefroenum. Of the Harelip.—Sometimes this defect in the upper lip is single or confined to one side, and sometimes complete (like the animal whose name it bears) on both sides; it is also sometimes ac- companied with a defect in the palatine arch, which prevents the child receiving its due nou- rishment, in being incapable to suck, which act is upon the principal of the airpump, which in this case is destroyed by the admission of air through the nostrils: it is remedied by the application of a mechanical artificial palate, which conveys its nourishment beyond the defect, when the fauces carry it to the gullet and deglutition is effected. The operation should he early performed, which will cause the bone to become complete by an ossificor bony deposit, which will take place at an early period only. This operation is performed by removing the skin and unequal surfaces at an acute angle, un- 230 GN RUPTURE, &C. der the nostril, observing to make no waste of nnis* cular substance, bringing the raw surfaces in ex- a t contact., and securing them in their situations bv silver pins with steel points, which are to be taken of), being so purposely prepared ; a waxed thread or silk winded over the heads and points like the figure S, or as the hoys wind the string -of the paper kite upon the stick, over which a bandage is to be applied: in a young infant the pins may be dispensed with in this operation, the sticking plaster and bandage being alone sufli- eient. bee Bell’s operations in surgery, &c. The urethra, or water passage may be im- perforate or imperfect, which should be examin- ed for, in case the child does not soon pass water; "when an orifice must be made by art, by punct- uring, passing a probe or otherwise. The amis— or intestinal cutlet is sometimes imperforate, or has a membrane which passes over it, and shuts up and obstructs the passages which should be carefully punctured with the point of a lancet or small tiocar : but we should be careful to distinguish this case from a protru- sion of the intestine, which puts on a similar ap- pearance: sometimes this membrane is high up and therefore difficult to be operated upon. The rectum or last intestine, is sometimes wauling and sometimes unnaturally situated, as in the vagina, &c. which should be examined for. 'i he intestine sometimes protrudes through the navel, and also sometimes, portions of the liver, {■tomach, &c. which we should endeavor to re- turn, and secure by adhesive plasters, bandages, &c. but be very careful in using the knife, from a ON THE VENEREAL DISEASE. 231 supposition of an abscess, these children very seldom live. To the umbelical hernia?, or rup- ture at the navel, may he applied a piece of cork, cut round and dipt into melted wax, and confined with sticking plaster, or bandage. &'pina(>iJida—\$ an excrescence, of the spinal marrow of the backbone, with a deficiency of bone in some of the vertebra?: this tumor gener- ally soon bursts and carries oft the child. Icterificc, or the jaundice of infants, is a yel- lowness over the whole skin originating from some viscid matter obstructing the gall ducts and passages: an occasional emetic of antimonial wine and afterwards purged with rhubaib and repeated every seconder third day till thedisease disappears. This disease appears to be different from the jaundice of grown persons, except it be received from the milk of the nurse laboring undei the disease, when it is to be considered as such and treated accordingly : the nurse at the same time being put upon the method of cure, or otherwise the infant alone may be treated in vain. Lues veneiea, or venereal disease. Children are sometimes affected with this disease, in the most confirmed state, from infected parents : it generally makes it appearance a few days after the birth. Give internally calomel, and wash away any lodged jnucus which may be formed on the affected parts with a weak solution of w hite vitriol and mucilage of gum arabic, which will generally be found to effect a cure. The mother or nurse must also be put under the mer- curial plan, as well as the childs for the other alone will ayai! nothing. «N FEVElt. Opthalmia, or sore eyes, with inflammation ; this disease is sometimes prevalent to a violent degree in young children: and deposits a large quantity of acrid mucus, which if not removed or attenuated may soon destroy the tunics of the eyes and produce blindness. The cure consists in mild astringent injections and leeches applied to the eyelids or temples, the ears set a running with fly ointment, set ns or issues applied to the back of the neck, mild cooling purgative medicines, &c. All strong light which acts as a st'mulus and increases in- flammation should be shut out. The ears, are also subject to inflammation, ex- conation and suppuration; the cure consists in saturnine applications, a3 lead water, Goulards cerate, &<\ with cooling purgatives as above. ■ Fevers— In children is always much sooner and more accurately \mderstood by attending to the respiration, which becomes quick and laborious, the tongue and fauces dry and covered with a foul coate, sk n hot and dry, than to any leading mark upon the pulse, which in health are too nu- merous, to be numbered at an early period, be- ing commonly from 120tol6’0in a minute : this circumstance has led some, even eminent medi- cal characters, to pronounce an infant in a fever, when in fact it was in perfect health, this then therefore should always he kept in mind, when treating the diseases of very early infancy. The causes of fevers in early infancy, are vari- ous, as costiveness, obstructed perspiration, a- crid matter in the stomach and bowels which causes irritation, and increase of febrile action: ACIDITY* this is accumulated in infancy more abundantly than at mature age, from the well known super- abundance of glands and glandular secretions which they possess, continually pouring out their glairy contents into the fauces, stomach and the whole intestinal canal, their extreme irritability, becoming loaded and excited by these accumula- tions, are soon productive of febrile action and a train of the most painful diseases to which infan- cy is subjecced. The cure consists in first cleansing the first pas- sages, by a gentle puke of antimonial or ipecac- uanha wine, if this does not act upon the bowels, a dose of rhubarb and magnesia, manna or castor oil may be administered, to which a simple injection may be enjoined, as a little broth or gruel with a teaspoonful of salt in it or molas- ses and warm water, with castor oil or such like. Next, bathe them well in luke warm water for fifteen minutes, wipe them dry and wrap them in a warm blanket or flannels, occasionally giv- ing them four or five drops of antimonial wine to keep up perspiration, this will alone in most cases of febrile action be sufficient: if not, re- course must be had to mustard poultices to the feet, blistering plasters, or even a small quantity of blood may be drawn, from wherever it can be procured, if no vessel can be found to be operat- ed upon with the lancet we are to employ cup- ping glasses, leeches, &c. Acidity—s generally much abounding in in- fancy and is productive of many of their com- plaints, as gripes or dry belly ache, inward fits as they are called, flatulency, convulsions, &c. 234 ON INWARD FITS. it is the cause of much acrimony and pain, and should be treated by evacuentsand absorbents, as magnesia, rhubarb and chalk, and all the opening medicines of absorbing quality, with the anta- cids, as alkaline salt or salt of tartar, &c. The flatulency, or wind pent up in the first passages, if not removed by the evacuent plan, a little mint, pepper-mint or aniseed water may be given somewhat sweetened: The nurse should always well ruh the child every time it is undressed with the warm hand down the back upon the body and limbs: this helps the circula- tion of the blood, assists digestion, and envigo- Tates the actions of the whole viscera, it is of such general importance to the health of an infant, that mothers and nurses are always reprehensi- ble to omit it: Also, the child in feeding or sucking necessarily tukes in a great portion of wind with the nourishment, for it feeds with a kind of suction, and should never be laid imme- diately down to sleep, but should be dandled awhile up and down, patted on the back, rubbed down the stomach and bowels, when it will in- variably discharge wind upward or downward, after it has done this, two or three times, it may be laid to sleep, when it will be found to breathe, sweet, free, and regular, and its sleep will be re- freshing : but if this be omitted, the breathing is interrupted and irregular, it frequently starts, the eyelids not perfectly closed, and the eye9 themselves have tremulous convulsive motions, turned up under the upper eyelids, exposing only the whites of them. There is a sort of sim- per or smile on the face, these symptoms are in- OX T1JE III RUSH; cieased as the pain becomes more acute, till the features become distorted, the breathing stops for awhile, or much oppressed, thus it struggles with its pain, frequently starting, especially if touched or disturbed, till a sudden discharge of wind upward or downward, ora loud cry affords it relief and plainly shews the incautious nurse, how nature has been struggling to discharge the offensive cause, which she should have accelerat- ed by the timely and effectual precautions above recited. The apt ha, or thrush or sprue—is ushered in by drowsiness and inaction, a continuance of the symptoms before described from flatulency, and acidity, when they ought to decrease, or be med- icinally removed; a feverish action succeeds and the mouth and fauces become excoriated, and after a while covered with a buff colored matter terminating in sour, green, watery stools, much curdled in their consistence and of very griping quality, frequently called the watery gripes, which are sometimes so severe as to produce con- vulsions and death. These ulcers increase in size and number, and are sometimes continued through the whole alimentary canal, making the same appearance upon the anus, as they did first in the mouth: if these ulcers assume a brown or dark colored cast it is unfavorable, as it be- speaks mortification and approaching dissolution. Mode of treatment.—If the bowels are Costive, let them be opened, with rhubarb and magnesia, castor oil, or such like, puke the child with small and repeated doses of antimonial or ipe- cacuanha wine, 1 should prefer the first as it gen* 236 ON TMli it ED GUM. erally operates upon the bowels afterwards. A small quantity of molasses frequently put into the child’s mouth, or borax finely powdered mix- ed with honey or molasses, these things pos- sessing an adhesive or sticking quality, the child cannot get. immediately down* but rolls it about the mouth with its tongue, and thereby rubs it over the whole of the ulcers which are by these means much better cleansed, than any mode with a mop or severe rubbing can effect, which serves only to put the child to extreme and un- necessary pain, remove the encrustations and make a way for a second and more severe crop; after these means the fever generally subsides, the ulcers become clean and heal, and the child is restored. The red gum—Is an eruption of small red pimples sometimes all over the body, like the first eruption of the measels, or a nettle rash. The cure consists in keeping up the temperature of the body, and occasionally steeping the feet in warm water, to give the erupiion a disposition to the extremities) and divert it more from the vi- tals, keep the bowels moderately soluble, by mild aperients, and in a few days, if not expos- ed ocold, it totally disappears: the grand se- cret in most erupuve diseases, is to keep them upon the surface, by a regular and moderate temperature of the body, tin re is little to be feared from them, unless they are suddenly sup. pressed or drove back upon the system, by expo- sure to cold, wet, moist atmosphere, or some im- prudent conduct in management and care. CHOLERA MORBUSINFANTUM. Having now nearly completed my design I may have closed, but by my wish to be more ex- tensively useful, 1 am led somewhat into infancy more advanced, and as I canuot conceive my little work so complete without, I propose to close my labor with some, though imperfect il- lustrations, ot the cholera moibus infantum, or summer complaint of children, as it is called, the measles, the croup, chicken pox, worms, &c. Of the cholera moibus infantum,—the lax and vomiting, or the summer complaint of children. This is a complaint peculiar to warm climates and seasons. Symptoms. The child loses its appetite and playfulness, becomes fretful, a feverish diathesis prevails, afoul tongue and a dry parched skin, a sallow or livid countenance or sometimes bloated, having the appearance of dough; the eyes be- come sunk, with a dark livid circle or disk round them, a pukingor purging and sometimes both, attacks the patient instantaneously, and conti- nues almost incessant of a gieen watery acrid mat- ter, sometimts curdled ; this attack is frequently in the night season, and its riolence and conti- nuance so great, that the child in the morning from lassitude and the gueat privation of strength seems ready to expire: it refuses the breast or other nourishment, and putting the nipple into the mouth nausiates and brings on a disposition to vomit; the flesh of a tine firm child, in this short period, is reduced to flaccidness, and so weakened it is incapable to support itself, in short, it becomes every way passive, the articu- lations of the limbs pliant as a jointed doll and CHOLERA MORBUS INFANTUM like it remain in any situation they may he pla- ced ; the exertions ofihe nervous energy is pros- trated, and it something very shortly dots not transpire for its relief, its situation is the most critical and its dissolution may be expected. Causes. A moist, heated and impure atmos- phere, particularly the foul confined air of large cities: acidities abounding in the prima? viae, or first passages, acrid bilious master and other juices with which infancy so abounds; unripe, hard and indigestable fruits, drinking stagnant and olberwise had waters, cold and wet extremi- ties, imprudent washing, or standing the feet in cold water, while the upper parts of the body are in a state of perspiration, and the circulation of the blood (laboring under the action of increas- ed excitement) from the high temperature of the atmosphere and other causes, teething, Worms, &c. Treatment. If possibly practicable remove in- stantly some distance into the country, twenty miles from the city is better, I presume than a less distance. 1 should advise a Hiountanous situation, well wooded aud where there is good light water ; the diet for the most part of milk and prepared fruit, in pyes, tarts, &c. the less animal food the better, as all these have a tend- ency to putressency, which is a peculiar charac- teristic of the disease; this is the first of all modes of treatment, the only one to be depended upon, or that promises a permanent restoration, all else are mere palliatives, and who ever attempts to delude parental solicitude and affection into a se- curity and dependence on medical powers, from CHOLERA MORBUS INFANTUM sinister or other motives, (in the majority of eases) my experience warrants me todeclaie, only robs their purses and leaves them in return (for what but a few days before, was a promising bud of sweetness and health) a tenant for the silent, grave. An omission then ofthese advantages in the affluent especially, and all others who can possibly procure the means and opportunity to obtain them, become criminal; remember! then all, into whose hands this may fall, 1 have this day set my sea! of testimony honestly to this truth : I have candidly and unequivocally warned you of the danger, plead then therefore no longer ig- norance, nor lay any future charges to profession- al deceptions, but fly with all speed to ihe change of pure air: to this class, I have cleared myself on this subject: to the necessitous poor, whose indigent circumstances shuts them out from the possibility ofthese benefits, it is requi- site they should he put in possession of such as- sistance as we can afford them, which though feeble, may sometimes be blessed with success. Medicine. It is one invariable axiom in the practice of physic, “remove the cause, (in due time, i. e. while the system retains energy suffi- cient to obviate or contend with the consequen- ces) and the effects must necessarily, though per- haps gradually give way.” The principal cause of this affection apptars to be a heated atmosphere contaminated or saturated with miasma or impure exhaltations, from the large body of people ion- centruted in a confined space, as a ci«y ; together with the various collections of animal and veg.ta* ble bodies of matter, which are continually 240 CHOLERA MORBUS INFANTUM. throwing off putrid affluvia, incorporating with the common mass of air, and rendering it unfit for the support of animal life, especially in infan- cy ; this cause medicine cannot remove, must be obvious to common sense, we are not in the situ- ation of a besieged city that we cannot escape out of it, it then necessarily follows, as we can- not remove the cause from us, that we leave it, and fly into the mountains of health and safety; but for those with their tender offspring whom dire necessity rivets to the spot and must remain and abide the cunsequences, I would recommend a gentle purge of rhubarb and magnesia, senna and manna, castor oil or such like, to cleanse the first passages, the bov/els embrocaied with sweet oil and brandy, the feet steeped in warm 'water and a poultice of bitter herbs sprinkled with bran- dy applied to the belly, after which a mixture' of prepared chalk, gum arabic and Colombo root, mixed with mint or aniseed water to which a little cinnamon may be added with small repeat- ed doses of laudanum, the slippery elm bark, isinglass, mallows, or flaxseed, in the form of tea, sweetened, and with milk may be given as common drink which may be varied occasionally for brier leaf, mint or parsley teas, any of the above slimy ingredients with laudanum may be frequently given, new milk warm as injections ; if the principal cause should be worms, treat them lor worms (which see) the patient should be kept clean and frequently changed with fresh linen: The cold or shower bath may be used the first thing in the morning by placing the child in ft tub and pour a pint of pure water through WORMS, &c. a cullender or basket upon the head, afterwards to be wiped dry with a warm towel and put to bed between blankets: it not disposed to sleep, a portion of the chalk mixture with laudanum as betore directed may be given : It a sweet uninter- rupted sleep and a warm glow or moisture super- vene, we are assured the bathing will hare a good effect, and m iy be repeated in the same way every morning: but if the child remains restless, fretful and chilly, we are apprised of its being injurious and it must be discontinued. After the complaint has given way, the watery green griping, foetid stools, are become less of- fensive and less frequent and the passages assume tlu ir natural appearance, i. e. yellow and uncur- dled ; the patient may be restored by a contmu- ence of the chalk mixture, to which bark, steel, &c may be added, fresh air, exercise on horse- back, &c. If the disease should be unfavorably disposed, the vis vitae or vital energy sinking, the belly swelled, the extremities cold, mustard poultices with garlick may be applied to the soles of the feet, palms of the hands, and the body rub- bed with turpentine in which mustard lias been infused, electricity, &% Worms.—Symptoms of, fever of the hectic type, heat in the palms of the hands and soles of the feet, circumscribed red spots on the cheeks, the countenance sallow and pinched, breath foe id, a picking of the nose, the eyes sunk and dark underneath, moaning and starting in sleep, grinding the teeth, gnaving pains in the sto- mach and bowels, nausia, irregular appetite, sometimes voracious, at other times refuses all ON WORMS. nourishment, swelled tense belly, the body otherwise emaciated, especially the lower extre- mities which appear insufficient to support the body, sometimes, faintings and convulsions are the effects; sometimes etysipelas or St. Antho- ny’s fire, dropsy, in short a variety of diseases mav be produced by worms. Treatment Worm seed, in oil or substance, tin filings with calomel, jEthiop’s mineral oroiher mercurials at bed time, followed ly a brisk purge in the morning, cowitch, the down ol one pod given in molasses, syrup or honey for a dose. Carolina pink root, in infusion or substance, bears foot leaves, cabbage tree bark, a poultice of bitter herbs, as rue, wormwood, chamnionnle, &c. with garlick and wet with spirits applied to the region of the stomach and belly, or what may answ er as well, a beef’s gall, hung in the smoke of the chimney a few days when it will become thick as a soft ointment, to which garlick may be mixed and applied in a plaster as above. The above remedies may also be advantageously given in injections, to which tobacco Isas been some- times advantageously combined, and also in the external applications of bitter herbs to the sto- mach. On which the late ingenious Dr. Barton, professor of botany in Philadelphia has the fol- lowing observations. “ i obaeco. There is a particular mode of employing the leaves of common tobacco in case of worms, which I cannot avoid mentioning, es- pecially as it basin many instances produced very Trappy effects: ON THE CROUP. “The leaves are pounded with vinegar and applied in the shape of a poultice to the regi n of the stomach and other parrs of the abdomen: In constquence ot this application worms are often after powerful anthelmintics, (worm medicines) have been administered in- ternally m vain. “ We ought not to he summed at this effect of the tobacco, since we know, that the same vegitable applied externally is often efficacious in inducing vomiting : accordingly, 1 have, for several years, been in the habit of applying to- bacco leaves to the region of the stomach of per- sons who have swallowed opium or other singu- lar substances, with the view to destroy them- selves. “ It is well known that in these cases the sto- mach is often extremely torped, insomuch, that the most powerful emetics have little effect in rousing the organ into action. “ Here is an auxiliary at least, the tobacco used in the manner I have mentioned, is certainly very useful and in many instances ought not to be neglected.” Cynanche Trachcalis,—or croup, is a disease much more common in this country, than any other I w as ever in, in short. 1 never witnessed a case of it till I arrived in Baltimore, and neces- sarily, in the commencement of my practice here 1 have been more than once unsuccessful. The symptoms characterising this disease, I shalluot attempt to describe, words, I consider inadequate to convey a correct knowledge of it, it is only to be obtained by visiting patients la- ON THE CROUP. boring under it, it is, I believe, unlike every thing else, it is of a nature so peculiarly distres- sing, that a nice observer need only witness a case, never to forget it : I would therefore advise every one, more especially parents to visit the little sufft rers, if it be only fur information; for the fatal mistake of ignorance, supposing it to be only an unusual hoarseness, from which it essen- tially differs, has consigned numbers to a prema- ture grave, that might have been restored by a timely assistance. It is, I think evidently, of an inflammatory kind, from the efflorescence or redness observed on the amygdala and fauces of the throat, and also a continuation of this appearance discovered by dissection, on tne internal surface of the tra- chia or windpipe, from which is given out, by small glandular bodies, a viscous, clammy mu- cus which forms ulollicular membranous coating and constitutes the disease. I remember some time since, a physician in Virginia recommended, in the most confident manner, the u e of the lancet or bloodletting, even unto syncope or fainting: In two cases lately, one of which was in my own house, I have pursued tli s plan and to my astonishment and gratification, 1 found the effects to exceed my warmest expectations : The laborious breath- ing and the disease itself evidently gave way, previous to the evacuation being stopt, and in my opinion, from observation, the system is pre- pared fni a more favorable acceleration of the ef- fec's of the medicines afterwards administered, which witn me, invariably aretaitar emetie and ON THE CROUP. 245 calomel conjointly, in large and frequently re- peated doses, till the stomach is brought into action: an effect hitherto with me difficult to be obtained, from the universally allowed torpor, that suffers in all these cases: to this, I add as auxil.tries, the warm bath, blisters and the oxymel < f seneka or squills : The seneka is de- serving in a great measure the praise the “Arch- ers” have bestowed upon it, but 1 never should venture to depend upon it alone; a;d as an im- provement upon experiment, 1 am induced to prefer the oxymel to the syrup ot this drug, i. e. to be boiled in vinegar instead of water and sweetened with h >ney or molasses. In a former case, nearly two years since of my own child, I preserved a quantity of this mem- branous mucus, and took a portion, to which I added a solution of alkaline salt, viz. salt of tar-* tar, but found it no wav changed in its texture: to another portion I added some vitriolic acid and the consequence was, a complete decompo- sition, I could drop it with as much ease and ac- curacy as clear water; and this suggested the idea of combining the seneka root with an acid in the form of an oxymel, and have since found it to be an essential improvement to the medi- cine. The above account was published more than two years ago in the Federal Gazette of this city. I have since had every reason to he confirmed in my observations. Some practitioners use the sweet oil with ipe- cacuanha. 246 ON THE In EASELS. Rubeola or measeh.—'This eruption like most other, is preceded with chills, febrile action, sickness and pain in the head, tension, inflAni- mation and pain in the eves, with a discharge of watery or acrid humour, and also from the nostrils, sneezing, pain and soreness in the breast, attended with cough and difficult respiration. About the third day the eruption appears, in small eminences not unlike flea bites, upon the head, breast and superior extremities, and con- tinues progressing till it is foynd over the body and lower extremities, which however no way relieves the fever and peripneumonic affections of the breast. Treatment. Bleed plenti'ully, if nothing for- bid, and repeat till the breast and breathing are relieved, give cooling febrifuges combined with mild purgatives, as senna and manna, with sweet spirit of nitre, pectorals and expectorants for the r ough, as syrup of squills, garlick or onions, if it docs not give way, blistering plasters may be ap- plied to the breast and between the shoulders, and mustard poultices, with garlick combined to the soles of the feet, palms of the hands, &c. oc- casionally a little antimony wine and syrup of squills in sufficient doses to produce vomiting, and throw oft’ the-phlegm, and mucus, and af- terwards a gentle opiate, at night to allay the irritation of the cough, of paregoric elixef, God- freys cordial, syrup of poppies, &c. if these means fail, and there remain a danger of the lungs being affected, a gentle spitting or saliva- tion excited by a mild mercurial course, and kept up till the symptoms disappear will haye ON THE CHICKEN I'OX. 247 the most happy effect, the system is afterwards to be restored by bark, steel, &c, combined with restorative pectorals, as spermaceti, almond e- mulsion, &c. It is requisite to continue the warm clothing for some time, and very cautiously indulge ex- posure, as every fresh cold strikes immediately at tlie lungs and brings on the whole train of peiipneumonic affections, which are much more dangerous than in the beginning, inasmuch as the system has suffered and become debilitated, being thereby further reduced to an incapability to withstand the attack, or the means requisite to be employed for its removal. Varicella—or chicken pox, have most of (he precursory symptoms of fever, as mentioned in the last, and about the third day the eruption comes forth, I ke the small pox, but the pustles are found to contain a mere turbed fluid, like dirty water, and not puss or matter, and turn about the fifth or sixth day. Treatment. Cooling febrifuges, as cream of tartar, nitre, or saline draughts, in a state of ef- fervescence of ferment, steep the feet at night in warm water, and purge after the eruptions dis- appears, with jalap and calomel. An excellent method to physic children, with their own consent and gratification, is by keeping jalap ginger bread in buttons, of which one or two may be at any time given, when needful, alone or with others. To make them, m x one ounce ofjalap powdered, with a pound of flaur, and make it into gingerbread buttons, with mo- lasses, &c, according to art, only observing not to 248 CONCLUSION. overbake them, lest the fire should destroy the action of the jalap. The swine pox is nothing more than a larger or more gross kind of chicken pox, and requires tile same mode of treatment. Conclusion.—It may be presumed by some that I am an enemy to the practice of midwifery, bung so generally established in the hands of females : but I am led to hope my endeavor to simplify the science and render it more easy of access to every well informed woman, (and surely no others ought to be admitted) will acquit me of this charge: if we wished to hold ourselves lords of this practice, the only effectual way would be to keep it locked up in the mysteries of technical science, where none but the scientific could pos- sibly gain admittance, hut I think in addition to my feeble attempt, the erudite labors of Hamil- ton, Bard and othus, sufficiently demonstrate the liberality of the profession in this way. We wish the females to be raised equal to the important charge, and while, bv our labors wTe endeavor to accelerate this laudable advance in fun le practitioners, it is a duty we owe toour- stives and to the world, strenuously and firmly, to oppose the presumptions of murdering igno- rance: let a scientific board be established, let them give proofs of their ability, and receive its licence, and their practice will then be an honor to thtmselves and to the profession at large, and an incomparable utility to the public, in that true and greatest source of public wealth, viz. increasing population, which by the murdering hands ofignorance in the practice, is checked to 249 GONCTUSION. an amount, sensibility would not bear accurate- ly to investigate. Dr. Bard, of Nevr-York, having published a work of this kind though not exactly upon the same plan, may have superceded the necessity of the present, had it c<>me timely to hand, it is excellent and elegant, learned and correct, and much superior to any thing 1 have any preten- tion to, it is in but a few hands, and those prin- cipally physicians, and not likely to become generally sought for in this city ; and also, as each contains it author’s own particular piactice, thev may serve lor the elucidation of each other. He has my thanks, doubtless accompanied by hundreds, for his philanthropic endeavors to cor- rect the errors of ignorance, and benefit man-* kind. T'INIS. THE TABLE OF CONTENTS. Preface - - page 3 Introduction - - - 5 Section I.—On Anatomy - - 9 The pelvis - - - 10 Foetal head - — - 19 Sutures - «■ 21 Distorted pelvis - - - 25 Female organs of generation internally 29 "Womb and its appendages - 32 Female organs, externally - 35 M ensturation - "38 Seition II.—On female diseases - 42 menstruation obstructed ibid immoderate flux of 47 Fluor albus. or whites - - 53 D iseases of the genital system - 50 Hysteric affections - - 70 Sterility - - - 72 Section III—On pregnancy - 76 Symptoms of - 78 WTomb retroverted — - 80 On the use of the catheter - 32 Maiks of the progress of pregnancy - 85 Diseases of the stomach and intestines 86 On vomiting - SO Indigestion - » 88 Heart burn - * - 89 Costiveness - - 90 Hcemorrhoids, or piles - 92 Pregnancy advanced - - 9i Stranguary ■» - 96 Dropsy - - -98 Rupture » - 101 Venereal disease « 103 « ONTENTS. 251 Erratic pains - - 110 Cramp - - - HI Sickness - - iig Epileptic firs - - ibid False conception - - 115 Abort ion and miscarriage - HQ Section IV — Practical midwifery l-ji On labor and its divisions - ibid Presentation - - •» 124 The navel string - - 125 Placenta, or after birth » 127 M> (libraries - - 12S Lnjuor amnii, or waters - 129 iNaiural labor - - 13Q Div.ding the funis, or navel string 139 Extrac tion of the afterbirth - 141 The case of Thomas Lloyd’s Wife - 145 On the use of instruments - I49 Single blade - - loO Forceps - - 151 Remarks on the forceps - - 153 do. of Dr. Wm. Hunter - - 155 Lingering labor (toutmued) - I 9 Pu ternaiural presentation - 1Q2 F ei presenting - - ibid B eech presentation - - igy Turning - - 170 Twins, triplets, &c, - I75 Monsters — «■ - 2717 Caesarian section - - ibid Section IV.—On after management IgO On tlie lacerated permcei.m - I33 Pi rspiration, air, d el, sleep, &e. I84 Flood ng - - 185 Evacuations, stranguary and afterpains lg$ 252 CONTENTS. Flatulency and Lochia ■ 138 Child bed fever - - • 190 M-.k fever - - - 195 Suppurated breast - - 197 Sore nipples m m m 198 Miliary fever - ■ - 502 Falling of the womb - - 505 Swelled legs - 208 Section VI—On the diseases of infants 210 Foetal circulation - 212 Suspended animation — 217 Dressing and medicine • - 223 Sucking - ■» ■ 225 Inju nes of the head, &c. - 2' 7 Enlarged heads - ■ 228 Cutting tbe tongue •» — ib;d Haiellp mm mm m Qi Q Imperforate urethra - - 230 do. Anus - - ibid Rupture - ■ • ibid Spinibifida - « - 131 Jaundice - ibid Venereal disease - - ibid Inflamed eyes - - 232 Fever - - ibid Acidity • - - 233 Inward fits - - 234 Thrush - - - 235 Red gum - - 23(> Cholera morbus - - 237 Worms, &c. - • 241 Croup mm m 243 Measles - - • 24(5 Chicken pox - - 247 Conclusion «• • 248