NATIONAL LIBRARY OF MEDICINE Washington Founded 1836 U. S. Department of Health, Education, and Welfare Public Health Ser»ice TREATISE ON THE MANAGEMENT OF FEMALE COMPLAINTS, AND OF CHILDREN IN EARLY INFANCY. BY ALEXANDER HAMILTON, M D. PROFESSOR OF MIDWIFERY IN THE PNIVEKSITY, EDINBURGH. REVISED AND ENLARGED BY HIS SON, DR. JAMES HAMILTON, "ROFESSOR OF MIDWIFERY IN THE UNIVERSITY OF EDINBURGH,' &C. PHILADELPHIA: Printed for JAMES WEBSTER. PREFACE. s THE author of the following pages was induced, iathe year 1780, to publish for the use of Mid- wives, a Treatise on the Management of Female Com- plaints, divested of technical terms. But as he found that that Work had been pretty extensively circulated among private families, he thought it incumbent on him to alter considerably the subsequent editions. He endeavoured to give such a description of the most r.dinary complaints to which Women are liable, as should be intelligible to the attendants, or the pa- rents themselves ; to point out the circumstances from whence the several disorders originate, for the purpose of guarding against their occurrence ; to distinguish those Cases which yield readily to the employment of simple means, from those which require complicated management, and of course the regular attendance of a Medical Practitioner; and to detail the means for checking or retarding the progress of such cases. He added Directions for the Management of Children during early Infancy. As the Author did not live to superintend the pre- sent edition, his Son has endeavoured, in fulfilling that duty, to accomplish as nearly as possible the favourite wish of his Father, that every subsequent impression 7 i\ PREFACE. of the Work might be rendered better calculated for general use. With this view he has introduced several additions in the chapters relating to the Diseases of Lying-in Women, and of Children ; and in order that the general bulk of the volume might not be increased, he has left out the cases which were detailed in the former editions ; and he has also retrenched the Ap- pendix. The following pages he therefore hopes are not only adapted to the use of Families, but are also calculated to recal to the minds of young Practitioners the Outlines of the material parts of the Editor's Lec- tures on the Diseases of Women and Children. EDINBURGH, ~) MAY 1st, I 804. 5 CONTENTS. Management of Female Complaints. Page Introduction, q PART I. Chap. 1. Sexual diseases, 59 Sect. 1. External sexual diseases, 60 ■---- 2. Bearing down and descent of the womb, 6z ---- 3. Protrusion of the vagina, 65 Tumours in the vagina and womb, 66 Cancerous affections of the womb, 67 Dropsy of the appendages of the womb, 70 Irregularities of the periodical evacuation, 74 r-'exual weakness, 80 Sterility, 83 ----10. Hysteric affections, 84 Pregnancy, 87 Changes produced on the womb by impregnation, ib. Contents of the womb during pregnancy, 90 nigns of pregnancy, 94 Circumstances which induce symptoms resem- bling those of pregnancy, 08 ----j. Diseases incident to the early months of preg- nancy, 101 ----6. Diseases incident to women during the latter months of pregnancy, III ----7. Convulsions during pregnancy, 117 ----8. Discharge of blood from the womb during preg- nancy, 119 ----9 Abortion, U2 ----10. Rules and cautions for the conduct of preg- nant women, iag vi CONTENTS. PART II. Chap. I. Natural labour, # I31 Sect. i. Of the circumstances which happen during na- tural labour, *32 ----4. Of the assistance necessary during natural labour, 137 Chap. II. Lingering and difficult labours, 143 Sect. 1. Labours rendered lingering by improper ma- nagement, 1D- ----2. Labours rendered lingering by the position of the child, 146 ____3. Labours rendered difficult by the particular structure of the child, 148 ----4. Labours rendered lingering by the form of the woman, 149 ----5. General observations on lingering and difficult labours, 153 Chap. III. Preternatural Labours, 156 Sect. 1. Preternatural labours where the life of the pa- tient is exposed to no danger, ib. ----2. Preternatural labours where the life of the pa- tient is exposed to danger, 158 Chap. IV. Labours where there is more than one child, 161 Sect. I. Means by which the existence of twins may be ascertained, l6z ----2. Management in cases of twins, 163 Chap. V. Labours complicated with circumstances pro ductive of danger to the child or patient, 165 Sect. I. Labours where the life of the child is exposed to danger, 166 ----2. Labours attended with convulsions, 167 —— 3. Labours attended with a discharge of blood from the womb, 168 ----4. Consequences of the retention of the after- birth, 170 PART III. Chap. 1. Treatment of women after delivery, 17a Sect. 1. Regulations respecting the diet of lying-in women, 175 ----a. Regulations respecting the dress, air, and exer- cise proper for lying-in women, 177 ----3* Regulations of the mind of lying-in women, 180 CONTENTS. vii , Management of the breasts, 181 Medicines necessary during lying-in, 184 Complaints which occur after delivery, i8<5 Injuries in consequence of delivery, ib. Faintings after delivery, 188 After-pains, igo Irregularities of the lochial discharge, iqi Diseases of the breasts, 104 , Pain about the lower part of the belly, and in the lower extremities, 198 Chap. HI. Fevers and inflammatory complaints in the . childbed-state, 201 Sect. 1. Irregular feverish attacks, 20a —— 2. Eruptive or rash fever, 205 -----3. Inflammation of the womb, 209 ■ ■ ■ 4. Malignant childbed fever, 21 z ■----5. Accidental feverish and inflammatory affections, 216 Chap. IV. Anomalous complaints incident to lying-in wo- men, 218 Sect. I. Spasmodic affections, ib. —— 2. Alvine fluxes, 220 • 3. Delirium, 221 ■ 4. Complaints aggravated by lying in, and dis- orders induced by nursing, 223 Management of Infants and Children. Introduction, 225 Chap. I. Ordinary management of infants, 229 Sect. I. Cleanliness, ib. ---- 2. Clothing of infants, 231 - 3. Nutrition of infants, 233 ---- 4. Air, exercise, &c. 237 Chap. II. Disorders of new-born children, 242 Sect. 1. Means to be used for the recovery of still- born children. ib. ■ 2. Retention of the meconium, 243 —— 3. Original imperfections, 246 1 ■—4. Injuries in consequence of birth, 251 ■----5. Ulcerations and excoriations, 253 -----6. Swelling of the breasts, 254 ---- 7. Sore eyes, 255 vm CONTENTS. Chap. III. Complaints which occur most frequently within three or four months after birth, 257 Sect. I. Red gum, *-*8 ----2. Yellow gum, *-£9 ---3. Thrush, \f ----4. Bowel complaints, . %°5 ----5. Milk blotches; »7* Chap. IV- Diseases which occur between three or four- months after birth, and the «nd of the second year, a.73 Sect. I. Teething, lb* ----a. Convulsions, a77 ----3. Eruptive complaints unaccompanied by fever, 281 ----4. Directions respecting the method of weaning children, *%2 Chap. V. Diseases common to infancy and childhood," 286 Sect. I. Croup, ib- —•— 2. Irregular fevers, 29* ----3. Hooping Cough, 293 ----4. Water in the head, »97 APPENDIX. Forms of Medicines, 3°3 INTRODUCTION. A SHORT sketch of the Anatomy of the Hu- man Body, it is presumed, will be considered a suitable introduction to the subject of the following sheets; as it will illustrate many of the remarks which must be occasionally made. The human body is composed of certain general principles, by a combination of which the various or- gans necessary for the purposes of life are construct- ed. These have been divided into Solids and Fluids. Of these it is proper to give some account, before we attempt to explain the structure of the body. SOLIDS. The solids consist chiefly of Nerves, Vessels, Fleshy parts, Bones and their appendages, and an insensible substance, which envelopes, con- nects, or enters into the composition of all the other solids, called, from its structure, Cellular Substanc*. Nerves.—The Nerves are white glistening cords, originating, and probably deriving their power, from the Brain, and its appendages. The motion and sensation of the different parts of the body depend so much on the nerves, that when the principal nerve of any organ is cut through, or very much compressed, the sensation of that organ is completely destroyed, and its functions are much impaired. Every part of the body, therefore, owes its sensi- bility to the nerves which it possesses. B 10 INTRODUCTION. Besides these general properties of the nerves, they have some particular powers ; for it is through their means that the actions of the senses are accomplish- ed. Thus, on the nerves of the eye and of the nose, the senses of Seeing and Smelling depend ; for those nerves being destroyed, the senses no longer exist. Vessels.—The vessels of the human body are very numerous ; they are of different sizes and forms, and have different uses assigned to them. Some are intended to convey to the blood what is necessary to supply its constant waste ; others carry the blood it- self to all the various parts, for the pui-poses of nu- trition ; some prepare it for that purpose, and others distribute it in a prepared state to the different organs of the body. All the vessels may therefore be arranged under the denomination of the Absorbent, Circulatory, Secretory, and Excretory. The Absorbent Vessels are extended over the sur- face and the cavities of the body ; they are of differ- ent sizes; many of them are scarcely visible ; they are very strong, although so thin as to be transparent. The absorbent vessels open on the surface of the body and of its several cavities, by extremities so small, that their structure cannot be ascertained. They are, however, capable of absorbing fluids, which they convey to a general reservoir, (to be afterwards described), and which are prevented from returning, by having, in their course, numerous valves, that allow the passage of the fluids in the direction of the general reservoir, and prevent their return. The absorbent vessels have been divided, from the appearance of their contents, into Lymphatics and Lacteals. The Lacteals are confined to the belly ; the Lymphatics are distributed over the rest of the body. In the course of the latter vessels, roundish bo- dies of a red or brown colour, larger in children than INTRODUCTION. 11 in grown persons, called Conglobate glands, are found. Their functions have not yet been satisfactorily ex- plained ; therefore it is unnecessary to describe their structure minutely. Circulatory Vessels are those which carry the blood to the different parts of the body, and return it from the same parts to its general reservoir, the Heart. Those which perform the former purpose are styled Arteries, and those designed for the latter, Veins. The Arteries are thick, strong, cylindrical tubes, possessing a power of pushing forwards their con- tents ; by which means an alternate contraction and dilatation takes place, which occasions that peculiar action, termed the Pulse. By this the arteries are distinguished from the veins in the living body. The arteries terminate principally in two ways, in Exhalents and Veins. The structure of the Exhalent vessels is so minute, that it is imperfectly known. Their uses, however, are evident; for they serve the important purposes of supplying a fluid which moistens all the internal parts of the body; and they assist in producing y change on the blood, by what is termed Insensible perspiration. The Veins are considered to be reflections of the arteries. They return the blood from the different parts, and generally accompany the course of the ar- teries. They are so transparent, that the blood can be perceived of a bluish colour through them. The) possess, like the absorbents, valves, which prevent the blood from turning out of its course towards the heart; and they have no pulsation. In other respects the veins resemble the arteries. The Secretory Vessels are those destined for pre- paring from the blood the various fluids which are ne- cessary for the preservation of the different functionr of the human body. \z INTRODUCTION. They are merely modifications of the blood-vessels, nerves, and lymphatics, known by the name of Glands. Some of these are simple in their structure ; for being hollow, and receiving a great quantity of blood-ves- sels, they seem merely adapted for the stagnation of the blood, which is either afterwards forced through an opening, by the pressure of some of the neigh- bouring parts, or taken up by a particular apparatus for that purpose. The more complicated glands, although they pre- pare different kinds of fluids, seem all to be of the same general structure. They are of different sizes, and consist of a vast number of blood-vessels, &c. wonderfully intermixed with each other, divided into very minute branches, and formed into numerous small inequalities. The Excretory Vessels proceed from these glands. Rising from innumerable small branches, they termi- nate in one or more trunks, and convey the prepared fluid to the parts for which it is designed. By its vessels, therefore, the body is nourished, and its unnecessary or worn-out parts are carried off. Hence every part of the body must be supplied with vessels ; though in some they are so very minute, as to be in- visible. Fleshy Parts.-—The fleshy parts of the body are divided naturally into po. lions cf various forms, called by anatomists Muscles. These are found to be composed of an amazing number of very minute threads, inteiTnixed with blood-vessels, by which they are generally of a red- dish colour, and with nerves, by which their actions are rendered obedient to the will. The fleshy parts arc destined for performing the different motions of the body ; for which purpose, they are of various forms and sizes, and in various si- tuations. INTRODUCTION. U The manner in which the fleshy parts perform their actions, is by the fibres or threads of which they arc composed becoming shortened. The actions of most of the-fleshy parts can be com- manded by the Will; and hence are called voluntary. The muscles not subject to the will are those on the actions of which life depends. With a power over these the Supreme Being has not thought fit to entrust man. These muscles perform the involuntary actions of the body. As, however, the will is capable of in- creasing or diminishing some of these actions, a third kind of muscular power has been termed mixed. Bones.—The bones are the hardest and most solid parts of the body. They determine its shape ; they support and move its various parts ; and they afford, by the cavities which some of them form, safe lodge- ment for several important organs. The bones are insensible ; they are, in the healthy state, of a whitish colour; though they have many small blood-vessels in their substance. The appearance of the bones differs materially in their external and internal parts ; for externally they are firm and solid, but internally they are hollow, and of a structure resembling sponge or honeycomb. In consequence of this texture, they are less heavy, and much more strong than if they had been solid. The bones are connected to the fleshy parts of the body, and to one another. Although the moticns of the body are perfoi-med by the Muulcs, these cannot act without having a proper support ; that, the Bones supply; while the Nerves communicate to the muscles the commands of the will. Ap/iendagc* of the Bones.—Cartilage and Ligaments may be considered as the appendages of the bones. CaniUigc, or Gris,L , is a white, solid, smooth, and insensible substance, generally serving to connect ti:« bones, and for the attachment of fkshy parts. U INTRODUCTION. The Ligaments are white, glistening, insensible cords, differing in shape and thickness in different parts. They serve to form, in some places to strength- en, the connection of the bones; and they also afford attachment to fleshy parts, where there are deficien- cies in the bones. Connection of the Boms.—The bones are joined to each other in such a manner, that between some of them motion is allowed, while others are firmly united together. Hence the Articulation of bones has been divided into moveable and immoveable. The Moveable Articulations are of various structures; for some are so formed as to admit of motion in every direction, some only backwards and forwards, and others from side to side. The Immoveable Articulations are formed in one of two ways : The two bones are indented into each other by cavities in one corresponding with protuberances in the other; or they are fixed firmly together by means of Cartilages or Ligaments. Cellular Substance. The various soft parts of the body are connected by an insensible substance, of a loose open texture, somewhat like net-work, hence called Cellular Substance. Every part of this substance communicates with the other; from which circumstance, air, or any fluid, having access to one part of it, may be easily extended over the whole*. FLUIDS. The fluids of the human body may be arranged under the following classes. 1. The fluid formed by digestion, called Chyle. 2. The Blood. 3. The Fluids prepared from the Blood. * Ir* will occur to readers who have a previous knowledge of anato- my, that in the :*l>ove description some of the solids are omitted, as the 1NTEGUMKNTS, HAIR, and NAILS. These are referred to the description of the PARTICULAR STHVCTURK of the BO»Y. INTRODUCTION. 15 Chyle.—The chyle is a white, milky-like, sweetish fluid, without smell or any active/sensible quality. By it the blood, which is continually wasting, is supplied. On a due proportion, therefore, of the chyle, the nourishment of the body must depend. Blood.—The common appearance of blood is fami- liar to every one. When taken from a living person, as in the common operation of blood-letting, it appears at first of an uniform consistence ; but after having re- mained for some time at rest, it spontaneously sepa- rates into two parts, a thin yellowish water, and a thick red jelly. The former is of a saltish taste, and can be jellied by heat; the latter is composed of red parts, and a substance which jellies whenever it is placed at rest. The proportion of these parts to each other differs in different persons, and in the same person, according to the state of health. From the blood all the fluids of the body (except the chyle) are prepared. Fluids prepared from the Blood.—These are pre- pared from the blood in two ways : either by simple separation, or by a certain power of the preparing or- gans, which cannot be referred to mechanical prin- ciples. These fluids differ materially from one another. Some are watery, some slimy, and others coagulable, or oily. They may all be comprehended under the five following classes. I. Watery Fluids.—Some of these fluids are thrown off from the body, as being useless or hurtful; and some of them are necessary for diluting the food and drink : the former arc the Urine and Perspirable mat- ter ; the latter are, the saliva or spittle, and the fluid prepared by one of the bowels, called Pancreas. To the watery fluids may also be referred the Tears. II. Slimy Fluids.—The slimy or mucous fluids dif- fer from the watery ones in being more viscid, and 16 INTRODUCTION. from the gelatinous fluids, in not being coagulable by heat. The slimy fluids are of a whitish colour, and are in- sipid to the taste. They serve to defend those organs which are adapted for the passage of air or fluids. Hence the nose, throat, Sec. are constantly moistened with them. III. Gelatinous Fluids.—The gelatinous fluids re- semble the mucous and some of the watery ones very nearly. They are distinguished from them by their becoming jellied when exposed to heat. The fluid which is found in the stomach and intestines belongs to this class. The whole cellular substance is moistened by a thin fluid, which has been imagined to be coagu- lable. Wherever this fluid is not furnished, the con- tiguous parts of the cellular substance grow together. The fluid in the stomach and intestines resembles in appearance the saliva, but differs much in its quali- ties : for it has a saltish taste, and possesses the power of curdling milk. This fluid is certainly a principal agent of digestion ; but its manner of action has not been ascertained. IV. Oily Fluids.—The oily fluids consist of the Fat. Suet, Marrow, and Ear-wax. ^ V. Mixed Fluids.—There are some fluids which differ in quality from all those already enumerated, and which, therefore, cannot be properly included in any of the above classes ; such are the Milk, the Bile, and the Fluid which lubricates all the joints of the body. J From the above slight sketch of the materials of which the human body is principally composed, it w ill be perceived, that the solids and fluids have a mutual dependence on each other. ^ Some of the solids serve to prepare and conduct the •>uhls; and these, in their turn, nourish the solids: INTRODUCTION. 17 hence ever)' part of the body must be supplied with vessels; and as these cannot perform their actions without nerves, they also must necessarily enter into the composition of every part. The fleshy parts of the body are all immediately or remotely connected with bones or cartilages : by this they have a firm support, and are rendered capable of performing the different necessary motions. All the various parts of the body are connected to each other by the insensible cellular substance ; conse- quently the external form of the body depends very much'On it. -These observations render it unnecessary to enu- merate particularly the vessels, nerves, fleshy parts, Sec. of the different organs of the body. " In describing their structure, therefore, the general shape, appear- ance, and functions, of each part, require only to be ex- plained, and this we now proceed to do. The human body may be divided into the Head, Trunk, and Extremities. All these parts, how-' ever, are contained within one covering, the Skin. Its structure ought therefore to be considered before that of any other part. Skin.—The skin is composed of the scarf and true skin. ■ The Scarf Skin is that fine, transparent, insensible membrane, which, covering the true skin, in its whole extent, forms the outer surface of the body. < :•* c■::, It is of different degrees of thickness in Idif&rent parts, and has ail infinite number of small perforations,; to admit of the passage of the hairs, and of the cxha- lentand absorbent vessels. Its use is to defend the true skin. . The scarf >skin is connected to the true skin by a jelly-like substtmce, on which the colour of theoutside of the' bodv principally depends: hence this substance- 18 INTRODUCTION- is of a white or dusky hue in Europeans, and of a black- er deep brown in negroes, mulattoes, &c This jelly-like substance, is probably intended to serve as an additional defence to the true skin, and also to coverits inequalities. ! ■> , The True Skin lies immediately under the jelly-like' substance. It is composed qf arnuxnber pf fibres, on* which its elasticity depends,, intermixed with..argrest many nerves, and different kinds of vessels. The outer surface of the- true skin is covered with' small inequalities, which exhibit thjpough the scarf skin. the appearance of furrows. These inequalities are oc- casioned by various substances^ as nerves, glands,'and roots of hair. The true skin is. highly sensible.:; It forms one. of the organs of the senses, that of Touch.- This sense is' more acute in the hands, and towards, the poin.tSf.of the fingers, than in any other part ; and is there defended by a transparent, horny -like substance, the nails. The true and scarf skin are peHorated by hairs : These arespread overall the outer surface, of thesfeod},, exception the palms of theivinds, and, the spies, j©fy£ie feet; tboagh their length is. considerable only-on par^ ticular parts. ,v.. The roots uf the hair.s arepkcedj.in thVt»j«i3kin, said are regularly organised parts, having minute .\fls> seis1;and nerves. ,' , •■> ■ , .: The dink; on some parts, as Qfr.the head, hiii tfibe, eye and nose ;. attd^oy-qr the surface ojl the body^t^^(^ly protect^ihfeisiiglgg^^^QfiJjQi skin. Over; the surface-.of the -fikia jfcijOjlieTable small giandsRoefounApIeome of whkh, prepare the suet aK seadjr -mentioned, whkh defeixh>,and; Softens tfee? *kfnV INTRODUCTION. iy and others are thought to contribute, along with th& minute extremities of the arteries, to throw off the per- spirable matter. All the cavities in the human body are covered with a substance which has been thought to be a continua- tion of the Skin. This view, from its simplicity, mav be adopted in a work of this kind, though it were not strictly conformable to the opinion of anatomists. The skin, therefore, deprived of its jelly-like sub- stance, consequently of a red colour, highly sensible, and furnished with an apparatus for pouring out slime to defend it from air and fluids, may be considered to enter into all the cavities of the body, and to form a lining for them. . Head.—The Head forms the uppermost part; of the human body. It is joined1 to the trunk by the neckl It may be divided info the Head and Face,- the limits of each of which are so familiarly understood, that they do not require being described. The Head properly so called, is merely an oval box, formed by a number of boftes closely connected to each other, containing the brain and part of its appen- dages. ; " To the base of this box the neck is joined, and to one end the face. Brain:—.The brain is a soft, pulpy, white-coloured substance, which is deemed the source of the nerves. It occupies all the fore and upper part of the hdad. Its figure is irregular, and as from its structure no idea can be formed of its uses, it is unnecessary in this workto describe its several parts. Appendages of the Brain.—-.The brain is connected by two continuations of its substance, in the form of cords, at its lower part, at the back part of the head, with a small organ, nearly resembling itself in sub- stance, called the Little Brain. The True and Little Brain unite at the base of the 20 INTRODUCTION. head, to form the substance from which all the nerves immediately originate. From this substance ten pair of nerves pass out, through small openings, at that part of the head to which the face is attached. The conti- nuation of the true and little brain then passes put at a large opening at the bottom of the head, to which the bones of the neck are joined, and constitutes what is called the Spinal Marrow. . Face.—-The form and situation of the Face require no particular description. The face of man exceeds that of every other animal, not only in the beauty of its colour, but in the variety of signs of the passions which it is capable of expres- sing. The upper part of the face is called the Forehead or Brows. It differs in form in different persons. The skin with which it is covered can at pleasure be made to contract in a remarkable degree, in order to express some of the passions. Eyes.—.The Eyes are placed under the forehead, on each side of the root of the nose, lodged in a hollow formed by bones, and rendered soft by a quantity of fat, &c. 13y these means they are guarded from external injuries, from which they are more immediately de- fended by the eye-lids. The upper half of the sockets in which the eyes are placed,is surrounded by the eye-brows, these consist chiefly of a certain regular disposition of short thick hairs, and contribute much to the expression and beau- ty of ;tl\e countenance. . The Eye-lids, which are continuations of the skin, rendered .capable of motion, and lined with a fine de- licate substance, terminate in the Eye-lashes, namelv, hairs placed in a gristly substance. .In each Eyelash, at.thc corner next the nose, there is a small opening, at which the Tears, after they have moistened the eye. enter, lobe conveved into the nose. INTRODUCTION. 21 At the opposite corner, under the eye-lash, the small body is placed that furnishes the tears. The eye-lids, besides defending the eye, serve to prevent the tears from being constantly poured over, the cheeks. Each Eye is constructed in such a manner, that the picture of the object seen, is represented in miniature on the inside of its bottom ; for the light entering at the Pupil, passes through a thin watery fluid, then through a small transparent body like chrystal, and lastly through a viscid glairy substance, like the white of an e^g, by which means it is collected in a small space, at the bottom of the eye. These Humours, as they are called, are contained within a strong covering, composed of three layers principally, which have been named Coats.. The outer layer is almost round, projecting a little at the forepart, which is quite transparent; in every other part this layer is of a.milky white colour. To this outer covering the eye-lids and the apparatus for moving the eye are attached. The second layer is of a dusky colour ; it lines the whole inside of the outer one, except at its transparent part, where it is turned back, and forms a ring of dif- ferent colours in different persons. This ring surrounds the pupil, and being very irrita- ble, and possessing a very active power of enlarging and diminishing the pupil, it serves as a curtain to pre- vent too great a quantity of light from passing into the eye. The third or inner layer is that en which objects are represented; it lines only somewhat more than the posterior half of the internal surface of the eye ; it is of a white colour, and when accurately examined, it is found to be formed by the branches of a large nerve, disposed in the form of net-work. This nerve, which is called Optic, passes in from the brain to the bottom of the eye. 22 INTRODUCTION. The eyes are rendered capable of very considerable motions ; and both being precisely of the same struc- ture, (except in cases of disease), the motions of each exactly correspond. When any object is viewed, both eyes are turned to- wards it; and although the object is represented on the bottom of each in an inverted position, yet it is seen only single and in its natural situation. The manner in which the idea of an object is transmitted to the mind is not understood. Nose.—The Nose is the organ of the sense of smell; by its form and situation it assists much in giving beau- ty and expression to the countenance. The inside of the nose is divided in its whole extent into nearly two equal parts, by a partition that is partly bone and partly gristle ; at the upper part it is covered by a bony arch, and below, it terminates in a gristly substance, which can enlarge or diminish the passage to the nose called the nostrils. The inside of the nose is lined and defended as other passages exposed to the admission of air are ; and over its back part the nerve which communicates the sense of smelling is spread in a beautiful manner. The cavity of the nose is of so irregular a figure that it cannot be easily explained ; at the upper p&rt under the bony arch, the cavity is small and of an unequal surface ; below that it is extended backwards over the roof of the mouth, and terminates in two openings above the root of the tongue. There are several small cavities in the bones which surround the nose, lined like it, and communicating with its cavity. Within the bony arch at each side there is a small iTOle by which the tears enter the nose ; hence, after having moistened the eyes, they are employed to di- lute-'the mucus that defends the inside of the nose, INTRODUCTION. 25 which might otherwise become too thick from its ex- posure to the air. The Sense of Smelling is thought to be the conse- quence of the air, in passing through the nose, carry- ing along with it the principles of smell from the sur- rounding bodies, and applying them to the nervous branches which are spread all over the back part of the nose. The Temples owe their flatness to the particular shape of the bones at that part; they assist in forming. the face into a regular figure, while they afford a large surface for the attachment of some of the fleshy parts which move the under jaw, Sec. Cheeks.—The Cheeks are formed by several mus- cles performing the motions of the lips and jaw-bone, properly covered; they have at their side next the ear a large gland between the muscles: This gland pre- pares spittle, winch is conveyed into the mouth through an opening in the inside of each cheek. From the situation of this gland, it is considerably compressed when the under jaw is moved. The cheeks contribute much to the beauty and regu- larity of the countenance ; they assist,speech, serve to keep the food within the mouth,, he The Ear,—The External Ear may be considered to be a funnel for collecting sounds. Though nature has furnished it with an apparatus fitting it for motion, very few people possess the power of moving it. The Internal Ear is situated within one of those bones which form the side of the skull; its structure is, so complicated, and its several parts so very minute, that it is difficult to describe it accurately. Tho sound CoUeeted by the external ear, is convey-: rd by a long winding narrow eanuli ('which is defended from external injuries by a soft liniment called'the £ar- wjix)»-,tp a small memb^ae spread overanitfregulafly shaped cavity :»asned the Drum, of'the'Ear. .-Within 24 INTRODUCTION. the cavity of the drum there are four very minute bones, connected by moveable articulations to each other. The Drum has several small openings, of which it is necessary to enumerate only three. Ohe of these, covered by the membrane already mentioned, is con- nected with the canal leading from the external ear ; another forms the entrance of a passage into the mouth; and the third, covered with a thin membrane, sepa- rates the drum from a very irregularly shaped cavity called the Labyrinth. One end of the range formed by the junction of the small bones is attached to the membrane of the drum, and the other end to the mem- brane which covers the opening into the labyrinth. The Labyrinth is of so irregular a form, that it iss impossible, in a sketch like this, to attempt a descrip- tion of it; its internal surface is lined with a-fine mem- brane, over which a great many very minute nervous threads are spread. • It is probable that the passage from the external ear and the drum, with its bones, serve the purpose of col- lecting sounds ; and these being applied to the nerves of the labyrinth, occasion the Senseof Hearing ; but the particular manner in which the idea of that sense is conveyed to the mind, is equally obscure with that of the other senses. Mouth.—The opening into the Mouth is surrounded by the lips. The Lips are covered by a fine delicate skin of a bright red colour. They are capable of a variety of motions, and are therefore admirably adapted to ex- press the signs of the passions, and to form the voice into the different modulations.that constitute speech. Below the under lip, the face is terminated by the Chin, which completes its symmetry. The inside of the lips and'ch*eks is covered by a fine 'kin, in which there are mo.ny mucous glands. These- INTRODUCTION. by lubricating the whole internal surface of the mouth, prevent its functions from being interrupted. The forepart and sides of the mouth are surrovinded by the upper and under Jaw; the former of these is immoveable, and is formed by bones connected to the cheek-bones and nose. The lower jaw is composed of one piece in grown persons, resembling in form a horse-shoe, connected by its ends to the sides of the head, below the eur, in such a manner, that it is capable of a very free mo- tion from above downwards, and of a considerable one from side to side. As the motions of the lower jaw are necessary for several purposes, it has many muscles attached to it, some of which are fixed to the temples and cheek- bones, and others to the neck. In each jaw there arc Sixteen Teeth, surrounded by a soft spongy substance, the Gums. The Teeth are of different shapes, some of them be- ing fitted for cutting, and others for bruising or grind- ing the food ; hence they are divided into cutting and grinding teeth. The Cutting Teeth are shaped like wedges, and have only one root. They consist of the six foremost teeth in each jaw. The Grinding Teeth, of which there are five on each side in each jaw, are much larger than the cutting ones. They have two, three, or four roots; and their surface on the upper part is unequal, rising into several small points. The Teeth are all covered, in that part which is not within the gum, with a fine enamel. In other respects they are merely bone, and, like other bones, are sup- plied with blood-vessels and nerves. All that space which the teeth of the upper jaw sur- round, is called the Palate, or Roof of the Mow*., It D 26 INTRODUCTION. has somewhat of the form of an arch, and is covered by the same skin that lines all the contiguous parts. The palate is formed of two bones, which separate the nose from the mouth ; and it is terminated by a kind of cur- tain, that hangs down from its back part over the root of the tongue. This curtain, which may he termed the Moveable Palate, is seen at the upper and back part of the mouth, in the form of an arch, divided in the middle by a small body, resembling a nipple, called the Pap of tlie Throat. At the termination of the moveable palate, at each side, an oval gland is situated. These bodies, from their appearance, are styled Almonds of the Ear. Their use is to furnish saliva. The moveable palate is placed before the openings of the nose into the mouth, by which mechanism knot only closes up these openings when any thing is swal- lowed, by covering them exactly, but it also conducts the superfluous mucus from the nose into the throat. The space surrounded by the teeth of the lower jaw is occupied by the Tongue, the appearance of which is well known. The Tongue is formed in such a manner as to con- stitute the principal organ of taste, and to be capable of a great variety of motions, in order to modify the voice into articulate sounds, and to perform the various func- tions preparatory to swallowing. The number of nerves with which it is supplied adapt it for the former, and the numerous fleshy portions of which it is composed, fit it for the latter, purposes. The tongue is bound down to the lower part of vhe mouth by a membranous cord, to prevent it from too great a degree of motion. At its root, the tongue is attached to the lower jaw, and to the windpipe ; but more especially to a small bone, resembling in miniature the under jaw-bone. INTRODUCTION. This bone, which may be called the Bone of th? tongue, by its outer surface, allows of the attachment of the tongue and the muscles that move it, and by its in- ner surface, it permits the top of the windpipe to be securely lodged, and serves as a basis for many of the powers by which the windpipe is acted on. The bone of the tongue is attached to the under jaw bone by gristly portions. On looking into the mouth of a living person, a pretty large opening is observed beyond the moveable palate and root of the tongue : This part in common language is called the Throat. The upper part of the throat is more arched than the roof of the mouth. It is formed by part of the base of the skull, properly covered, and the moveable palate. The back part and the sides of the throat are formed by the upper bones of the neck, somewhat flattened, and the ends of the lower jaw-bone, covered with the same sort of substance which lines the inside of the mouth. That part of the throat which can be seen in a living person may be said to resemble a membranous bag. It forms the superior part of the Gullet. Between the tongue and the beginning of the gullet the top of the windpipe is situated. At its forepart a small moveable gristly body, like the tongue in minia- ture, is attached in such a manner, that when any thing is swallowed, it shuts up exactly the passage to the windpipe, while it allows the food and drink to pass over it to the gullet as over a bridge. Trunk.—The Trunk consists of the Neck, C/ust, and Belly. These are joined together at the back part by- a range of bones, which connects and supports them all, called the Spine. The description of ih.e structure of the spine must therefore necessarily precede that of the other parts of which the trunk is composed. 28 INTRODUCTION. S/iine.—.The Spine is a bony pillar, extending from the top of the neck to the rump, serving to support the head, and to connect the several parts of the trunk, while at the same time it affords a canal through which the Spinal Marrow passes down, to furnish nerves to the trunk and extremities. The Spine or Back-bone is divided into True and False. The former extends from the top of the neck to the bottom of the loins. The remaining part of the bony pillar constitutes the False Spine. The True Spine is composed of twenty-four pieces of bone, resembling each other in their general struc- ture, though they become gradually larger and thicker as they proceed downwards. Seven belong to the neck, twelve to the chest, and the remaining five, with the false spine, to the belly. Each of these pieces is rounded before, and at its back part has several projections ; one particularly pro- minent in the middle, one at each side, and a smaller one above and below each of the side-projections. Be- tween the forepart and these projections there is a hole large enough to admit a finger. The upper and under surfaces of these bones are flat. All the pieces of which the True Spine is composed, are connected to each other by a gristly layer between them, and strong ligaments fixed to their projections at the sides and back, in such a manner that the hole in each forms a continued canal for the reception of the spinal marrow. The bones of the True Spine are all capable of mo- tion backwards, forwards, and to a certain degree from side to side. From the particular structure of the True Spine, it is adapted for allowing the different motions of the head and t-"»unk, without injuring the spinal marrow, any compression on which would induce palsy of the parts below. • INTRODUCTION. 29- The False Spine consists of a large bone, and a range of small ones. The former of these, called the Sacred Bone, is joined to the lowest bone of the true spine, in the same manner as the bones above it are connected to each other. The Sacred bone is a large triangular immoveable bone. It is broad at the part which joins the true spine, and becomes narrow as it approaches the small range of bones attached to it below. The outer surface of the Sacred Bone resembles that of two or three bones of the true spine joined together, by which it affords room for the attachment of strong ligaments, that connect it to the J launch Bones at the sides, and of some of the muscles that move the thighs, kc. The bony canal for the spinal marrow is continued along the Sacred Bone, till within a little of its lower end : it terminates there by a large^opening, that is co- vered by a strong ligament. The inside of the Sacred Bone is smooth. It is per- forated by four or five holes on each side of its middle part, through which nerves pass. The small range of bones that terminates the spine is called the Rump-Bone. It consists of three or four pieces joined together by gristle, capable of motion for- wards and backwards. These bones becoming very small .at their krvver end, make the spine terminate in a point. The Rump-bone affords room for the insertion of some of the muscles, which close the lower part of the trunk, and supports some of the parts within the belly. The Spinal Marrow is named improperly ; for it differs very much from the oily substance called Mar- row. It is a large thick nervous cord continued from the brain, furnishing nerves to every part of the trunk and extremities. The spinal marrow is so essential to life, that wounds of it generally prove fatal. It is 30 INTRODUCTION. therefore defended very securely by being lodged in a bony canal. In its course within the spine, the spinal marrow sends off, through openings between the sides of the bones, and through those of the sacred bone, thirty- pair of large nerves. It terminates in the lower part of the sacred bone, by being divided into a great num- ber cf branches, which go to the lower extremities. Neck .—The Neck connects the head and the trunk. Its external appearance, from being familiar to every one, requires no description. Within the forepart of the neck the Windpipe, and behind it the Gullet, pass along in their course from the mouth to their respective terminations within the trunk. The Windpipe is the canal through which the air passes from the mouth to the lungs. It is composed of a gre?.t many gristly rings, having their back part membranous, joined together by ligaments and fleshy fibres, lined with a fine, delicate, and highly sensible skin, which is defended from injury by many mucous glands. The upper forepart of the windpipe is covered by a large gland, the use of which has not yet been ascer- tained : along each side of it the large vessels are situated, that convey blood to and return it from the head. The Gullet is placed behind the windpipe, between it and the bones of the neck ; it is a membranous fleshy tube, that leads from the throat to the stomach, and that is capable Of contracting strongly. The inside of the gullet is lined with a fine skin, similar to that which lines the mouth, and defended like it with mucus, poured out by glands placed on its surface. Bones of the Neck.—The seven uppermost bones of the spine form the bones of the Neck; the first of INTRODUCTION 31 these is attached by an immoveable articulation to the head ; the other six are capable of motion, backwards, forwards, and from side to side. The bones of the neck are less, and have a more considerable motion, than the other boYies of the spine; they are also somewhat flattened on their forepart, to allow room for the gullet and windpipe. In other re- spects they resemble those of the spine. The Spinal Marrow sends off seven pair of nerves from between the bones of the neck. Some of these are distributed to the sides of the head, muscles of the neck, the windpipe, and gullet, and some run down to part of the bowels situated within the chest. The rest of these nerves running under the armpits, join with other nervous branches to supply the arms. The remaining part of the neck is composed of glands and muscles, with branches of blood-vessels and nerves, covered by common skin. The Muscles of the neck are those which perform the different motions of the head, neck, gullet, and windpipe. Chest.—The Chest is alarge cavity, in which some of the organs most essential to life are lodged : it is joined to the neck above, and the belly below. The Chest externally is covered with skin, beneath which several fleshy portions are situated. These perform a variety of functions ; for some of them move the supe- rior extremities, others assist in the action of breathing, and a few on the back part are employed to move the trunk of the body. • On the forepart of the chest the Breasts are placed. The Breasts of women are of a glandular structure, supplied with many lymphatics, blood-vessels, and nerves, mixed with fat and cellular substance. In the unimpregnated state, they may be said to be merely ornaments ; but at the end of pregnancy, they furnish milk for the nourishment of the child. 32 INTRODUCTION. The Milk is prepared by the glandular structure of the breasts from the blood. It is taken up by a great many minute tubes, that terminate in several small vessels, which carry the milk to the nipples. These vessels are surriunded by a tough elastic substance, and have their ends corrugated, by which the milk, except it be accumulated in great quantity, is prevent- ed from flowing out spontaneously. By the operation of sucking, these vessels are drawn out, so as to become straight, and therefore no longer impede the egress of the milk, which is propelled into them by the function. When the breast is no longer sucked, the vessels re- gain their former situation, by means of the tough elas- tic substance which surrounds them. The breasts have a very remarkable connection with the womb, as they suffer considerable changes when it is affected. This circumstance cannot be altogether explained by the anatomical structure of the breasts. The cavity of the chest is formed by part of the spine, the ribs, and the breast-bcne. Twelve Bones of the Spine, continued from the neck, belong to the chest; they have at their sides in- dentations, into which one end of the ribs is received. The Ribs consist of twelve on each side. Of these the first seven are called True Ribs, because they join the spine and breast-bone. The remaining five be- come gradually shorter as they proceed downwards. They are fixed by one end to the spine. Their other end affords support to fleshy parts. These are named Bastard or False Ribs. The True Ribs become gristly at their end next the breast-bone. They are articulated with it and the spine in such a manner, that they have motion upwards and downwards. In performing these motions, the ribs turn obliquely, by which they are pushed a little for- wards. By this mechanism the cavity of the chest can INTRODUCTION. 33 be enlarged. These ribs are joined to each other by fleshy portions, which perform their motions. The nerves and blood-vessels that supply the fleshy por- tions, rim along the under edge of each rib. Breast-Bone.—The situation of the Breast-bone is well known. It is a long flat bone, consisting of two or. three pieces. At its upper part it is broad ; and it ter- minates in one or two narrow points, which project into the belly. The breast-bone is articulated with the fore-ends of the true ribs. It is moved in a certain degree backwards and forwards in consequence of breatiiing. By means of the bones of the chest, a kind of cage is formed, which is narrow above and broad below. The Chest is separated from the Belly by a fleshy partition, called the Dic./ihragm or Midriff". It is at- tached to the ends of the false ribs, the lower part of the breast-bone, the under edge of the last true rib, and to the spine at the loins. From the situation of this partition, the lower part of the chest slopes gradually from the end of the breast- bone to the bones of the loins. The side of the Mid- riff next the chest is convex; that next the belly is hollow. The Midriff, by its structure, is capable of enlarging or diminishing the cavity both of the Chest and of the Belly. By its actions on the first of these cavities, it assists in breathing, speaking, laughing, coughing, &c. and by those on the latter, it promotes the course of the food through the intestines. The Chest contains the Lungs with part of the wind- pipe, the continuation of the gullet, a canal called Thoracic Duct, and the Heart with its appendages. The whole cavity of the Chest, and the outside of all its contents, are lined with a very fine, delicate skin, which is kept moist by a fluid furnished by the exha - lents on its surface. o4- INTRODUCTION. i This skin divides the Chest into two cavities, by be- ing doubled, and fixed to the spine and breast-bone. The cavities thus divided are not perfectly equal, for the right one is generally the larger. By this contrivance, accidents affecting one side of the chest do not communicate to the other. Windpipe and Lungs.—The Windpipe continued from the neck enters the chest at the upper part of the breast-bone. It proceeds along within the duplicative of the partition of the chest, till it arrives at about the fourth back-bone. It then divides into two branches, one of which is sent to the right, the other to the left side. These branches entering the lungs are divided into innumerable small ramifications, which go to every part of the lungs, and which terminate in small cells capable of admitting the air, and also communicating , with each other. The structure of the Windpipe has been already de- scribed : the gristly rings keep it open for the constant admission of air, and the membvanoi's part modifies the proportion necessary on various occasions, as in speak- ing, singing, S:c. This is effected by numerous small muscles placed on its upper part. The Lungs occupy almost the whole cavity of the chest. Thev consist of two large portions called Lobes, placed in different sides of the chest, and rendered per- fectly distinct from each other in the partition already described. The lungs are of a greyish colour, except in children and old people. They are formed of the ramifications of the windpipe, a number of cells, and a great quantity of blood-vessels, and are also supplied with lymphatics, blood-vessels, and nerves, for their own particular cccrieinv. The important purposes which the Lur.»s serve can- not be explained till the structure of the he-'rt be exhi- bited. INTRODUCTION. Gullet.—After passing along the neck, the Gullet enters the chest, and goes down in the middle of the spine behind the partition. At one part it inclines a little to the righfside, and then somewhat to the left. At last it advances forward, and penetrating the mid- riff, it proceeds towards the stomach. Thoracic Duct.—A thin, [transparent, narrow canal enters the chest from the belly. It extends along the right side of the back-bone as high as the fourth or fifth rib. It then crosses over to the left side, and forming a turn, terminates in a large vein between the first and second rib of that side. This canal is called the Thoracic Duct. It is the reservoir of the chyle, that is conveyed by it into the vein in which it terminates. Gland of the Chest.—The partition which divides the chest, separates the. one side from the other in a small degree at the upper part. In the cavity thus formed a gland called Thymus, larger in children than in grown people, is placed, the uses of which have not been discovered. Heart-Purse.—The two layers of which the partition above described is formed, leave between them a large cavity extending from about the middle of the breast- bone to the midriff. In this cavity the heart is situ- ated. The opening thus made is termed.the Pericardium or Heart-Purse. It surrounds the heart nearly on all sides, and serves to retain it in the proper situation, as well as to defend it from injuries. The Heart-Purse is constantly moistened by a thin lubricating fluid. Heart.—-The Heart is the great reservoir of the blood. It is placed within the partition of the breast in such a manner that it lies in a slanting direction, hav- ing its base towards the right, and its point to the left side, touching the sixth rib. G6 INTRODUCTION. The heart is fixed to its purse at the base and at the under side, by which means it lies nearly on the mid- dle of the midriff. The largest portion of the Heart is formed by two strong fleshy bags joined closely together, called Bel- lies or Ventricles. These possess the power of con- tracting and dilating; by this they expel the blood from their cavities, which are quite distinct, being separated by a strong partition. The Ventricles are placed in an oblique manner towards the breast-bone and spine ; that which is next the former is called the Right, and the other the Left Ventricle. At the broad end of the heart two small fleshy sub- stances, resembling the ears of a quadruped, are at- tached to the Ventricles. These are called the Auri- cles. The situation of the Auricles corresponds with that of the Ventricles. Like them too they are hollow, and possess the power of contracting and dilating. Blood-vessels of the Heart.—The Heart, like other organs, is supplied with blood-vessels and nerves for its own economy. Besides these, some Blood-vessels gq directly into the cavities of the Heart. Of these the Veins belong to the Auricles, and the Arteries to the Ventricles. Circulation of the Blood.—All the Blood collected from every part of the body is brought, by a large vein, into the right auricle, which, contracting, pushes it for- wards into the corresponding ventricle. A large artery, leading from the right ventricle, and dividing into two branches soon after it leaves the heart, conveys the blood (forced into it by the contraction of the ventricle) into each lobe of the lungs. The branches of this artery form a great many mi- nute ramifications within the lungs-,'" corresponding nearly with those of the windpipe. By these means the blood is distributed over the whole substance of the INTRODUCTION. 37 lungs, and exposed to the air which is received within the windpipe and cells. The blood is returned from the lungs by veins. These at last form only one large vessel, which enters the left auricle. The left auricle contracting, forces the blood into the ventricle with which it is united ; from this, by the same means, it is pushed into a very large artery, destined for conveying it to every part of the. body. At each opening through which the blood passes into the Heart, a particular apparatus is placed, that fa- vours the passage of the blood in the course just de- scribed, but prevents its return. The Great Artery leading from the left ventricle. crosses over the fourth bone of the back, in an oblique manner, towards the right side. It then rises, and forms a curvature or arch at the second bone, and turning down, is continued along the left side of the spine, till it passes out of the chest through the midriff. From the arch of the Great Artery, three or four large vessels.carry blood to the head, face, organs of the senses, the upper extremities, breasts, Sec. The blood is returned from these parts by veins, which terminate within the breast, on the right side of the spine, in the large vessel that enters the right auricle of the heart. This vessel, which may be called the Great Vein, lies on the right side of the great artery, at the back of the partition of the chest. It is joined, where it enters the heart, by a similar vessel, which penetrates the midriff, from the belly, and returns,the blood from the lower parts of the body. Uses of the. Lungs.—.The Lungs perform the impor- tant function of Respiration. By this operation the blood is supplied with something necessary to life, and also deprived of its useless parts. For this purpose it is that the blood is distributed through the Lungs in ;Treat quantity. 38 INTRODUCTION. Respiration is accomplished by the air being, by turns, received into and forced out of the Lungs. The midriff and ribs, by alternately enlarging and dimi- nishing the cavity of the chest, are principal agents in this operation. The particular circumstances, how- ever, on which this necessary action depends, are not yet clearly understood. By respiration also the voice is formed. The modu- lation of sounds, which constitutes speech, is probably produced by the action of the upper part of the wind- pipe on the air which passes from the lungs. BELLY.—AH that part of the trunk below the mid- riff is called the Belly. Its general external appear- ance requires no description. The form of the cavity of the Belly is irregular. At the upper part, it slopes from before backwards, by the particular situation of the midriff; behind, it seems di- vided into two parts by the jutting in of the spine ; and below, it is surrounded by a bony ring, which gives it somewhat the form of a bason, hence called Pelvis. The Pelvis or Bason is a bony zone, composed of the sacred and rump bones, and two large irregularly shaped ones, called Nameless Bones. The two former are pla- ced at the back part, and the two latter make up the sides and the forepart. The Sacred Bone is joined to the last bone of the true spine, in such a manner, that its upper part pro- jects forwards, while the rest of it, along with the rump-bone., inclines backwards. The Nameless Bones, one at each side, are fixed to the upper half "of the sacred bone by an immoveable articulation ; they are firmly glued together, and their union secured by strong ligamentous bands, at the forepart, in a line directly down from the navel. These bones, therefore, form a ring, no part of which is capable of motion. INTRODUCTION. 59 Each of the nameless bones is divided, in children, into three portions, joined by gristle. Though these become united in grown people, the names by which they are distinguished in their original state are re- tained by anatomists ; hence the nameless bones con- sist of the Haunch, Seat, and Share bones. The first of these is that which is articulated with the sacred bone, the second is that on which the body rests in the sitting posture, and the third is that portion placed between the groins. The Haunch-bone, at each side, spreads upwards and outwards, and forms the sides of the lower belly. Its upper edge is somewhat semicircular. It affords room for the insertion of many muscles. At the forepart, above the top of the thighs, its edge becomes irregular, having two projections, to which fleshy portions are attached. The under part of the Haunch-bone only belongs to the pelvis properly so called. It forms a ridge, which is continued from the top of the sacred bone, below which it is scooped out to make a large notch. Through this opening a great nerve and blood-vessels pass to the lower extremities. The Seat-bone extends from below the forepart of the Haunch-bone, to the bumpy part on which the body rests in sitting. This part is defended by gristle. At its back part the Seat-bone has two projections, to which ligamentous cords, extending from the sacred and rump bones, are fixed. The Share-bones of each nameless bone, joined toge- ther as already described, occupy the space between the groins. By their upper edge the line formed by the sacred and haunch bones is continued, and constitutes a ring of an irregular figure, called the Brim of the Pelvis. This ring differs in male and female, both in shape and 40 INTRODUCTION. At the forepart of the upper edge of each share-bone there is a projection, to which the extremity of the Meshy portions fixed to the projections of the haunch- bone is attached. The Share-bones, at their lower part, gradually se- parate from each other as they proceed downwards to join the seat-bones. By this means an angle or arch is formed between them, which is called the arch of the Share-bones. At the inner side of the top of each thigh a large oval hole is formed, surrounded by the seat and share bones. This is covered by a strong membrane, through which a nerve and blood-vessels pass. In the middle of the outside of each nameless bone a large round deep cavity is placed, for the reception of the head of the thigh-bone. All the portions of which the nameless bones consist contribute to form this cavity. From the description of the constituent parts of the Bason, it will appear evidently that it is of a very irre- gular shape. Its Brim lies in a slanting direction when the body is erect, the top of the sacred bone being con- siderably higher than that of the share-bones. Its Outlet, if the bones alone be considered, is a wav- ing line ; but when the ligaments which extend from the sacred and rump bone to the seat-hones are reckon- ed, it has nearly the same figure as the brim. - The great purposes which the deficiencies of bone at the lower part of the bason serve, are to lessen the general weight, and in the female to afford a safe pas- sage to the child during labour. The Pelvis supports the body, allows of the firm at- tachment of the thigh-bones, and lodges securely with- in its cavity several organs. A number of fleshy portions, stretching from the ribs, and attached to the haunch and share bones, covered with skin, form the forepart and sides of the INTRODUCTION. 41 Belly. By the manner in which these are inserted in the bones of the bason, an opening is left at each side immediately above the share-bones, and another be- tween the projection of the haunch-bone and that of each share-bone. These afford room for the passage of the blood-vessels, Sec. " The back part of the Belly is made up of the lower bones of the spine, and part of the fleshy pdrtions which move the trunk, covered in the common man- ner. The lowest part of the Belly, or outlet of the bason, is filled up with fleshy portions properly covered, which leave openings for the passage of the common discharges, Sec. The Bason in women is more shallow than in men; the sacred bone is broader and more hollow; the rump- bone, though it projects considerably forwards, is very moveable, and can be pushed back to a line with the extremity of the sacred-bone. The haunch and seat bones are also at a greater distance from each other in women than in men, and the arch at the forepart, be- low the junction of the share-bones, is much wider. The Brim of the female bason is of an oval figure ; it measures in the greatest number of women, from the back to the forepart, nearly four inches, and from side to side about five ; but as a thick fleshy portion is extended along its side, the greatest width of the brim in a living person is in a slanting direction between these two. The Bottom of the pelvis has naturally no regular appearance ; but in certain circumstances during par- turition it acquires nearly the same form and dimen- sions as the brim ; for it measures about five inches from the back to the fore-part, and four from side to side. The widest part of the bottom, however, is exactly opposite to the narrowest part of the brim, for the brim INTRODUCTION is narrowest between Pubis and Sacrum, and the bot- tom is widest in that direction. The depth of the female pelvis varies in different parts. Behind, v/hen the rump-bone is pushed back, it measures six, at the sides four, and before, nearly two inches. When the body is erect, the brim of the bason lies in a more slanting direction than that of the male, for the upper part of the sacred-bone is almost three inches higher than that of the share-bones. The child passes through the cavity of the bason in parturition ; and for that purpose the part which gene- rally passes down first, the head, is admirably adapted to the particular shape of that cavity. The head of a child is oval, and its dimensions cor- respond nearly with those of the pelvis ; it possesses, moreover, a power of being diminished by compres- sion, in consequence of the bones which form the skull being connected to each other very loosely. When the head passes, it in general occupies the least possible space ; and therefore the part at which the hairs go off in different directions, is always in na- tural labour forced foremost, and the largest part of the head is uniformly applied to the widest part of the bason. The head therefore enters the bason in such a man- ner that the ears are placed obliquely towards the sa- cred and share-bones, and is pushed down in the same direction till it arrives at the bottom of the bason. The longest part of the head being then applied to the nar- rowest part at the bottom of the pelvis, the position must be altered before it can proceed farther. This actually takes place ; for the face is turned into the hollow of the sacred-bone, and the back-head towards the share-bones ; the arch of the share-bones then re- ceives the back-head, while the face gradually passes along the sacred-bone till the whole is protruded. INTRODUCTION. 4 -, When the head of the child is at the bottom of the bason, before it is turned in the manner described, the widest part of the shoulders are applied to the nar- rowest at the brim, by which means the child could not pass out in that direction, even although the bottom were wide enough for the passage of the head. When, however, the head is adapted to the bottom of the pelvis, the shoulders accommodate themselves to the dimensions of the brim, and then, when they arrive at the bottom, they make the same turn which the head does. The structure of a child is such, that every part of the body readily passes through an aperture which can admit of the passage of the head and shoulders. . The Bason, therefore, is admirably well adapted for parturition. The manner in which the child passes through it is a circumstance with which prac- titioners ought to be intimately acquainted, before they can attempt to afford assistance during delivery. Many dreadful accidents have been the consequence of ignorance of this subject. Words alone cannot convey such an idea of it as is necessary in practice. The whole cavity of the belly is lined with a fine, strong, soft skin, lubricated in the same manner with that which lines the chest. Like it also, it covers the surface of all the parts within the cavity. The belly contains the Organs of Digestion, of Urine, and part of those employed for the continua- tion of the species. The two former of these alone belong to this sketch. Organs of Digestion.—The Liver,. Stomach, and Intestinal Canal, the Spleen, and Pancreas, are the organs by which the food is digested. The Liver.—The Liver is a large mass of a pretty firm consistence, and a dark red colour, somewhat tinged with yelfow. It is divided into two unequal ii INTRODUCTION. portions, called Lobes. The smallest of these is si- tuated on the left side. When viewed in its natural situation, the Liver seems to form half a circle below the midriff, placed obliquely from the" right to the left side, extending in the former direction to the right kidney, and in the latter to the second false rib. The Left Lobe of the Liver lies above the stomach, between it and the midriff. At its back part it is thick. It gradually becomes thinner towards the forepart, which can be felt under the breast-bone. The Right Lobe is much larger than the left. It occupies the greatest part of the space formed by the midriff and false ribs on the inside. It is rounded on the upper part, and hollow below: the back part is very thick: the forepart terminates in a thin edge. The Liver is composed of a great many blood- vessels, lymphatics, and some nerves, disposed in such a manner as to prepare the Bile from the blood, which is brought to it from the lower parts of the body for that purpose. Gail-Bladder.—In the concave part of the right lobe of the liver, a small bag, somewhat like a pear in shape, termed the Gall-Bladder is situated. The in- side of this bag is wrinkled. It is lubricated by a de- fending mucus, and it contains the fluid called Bile. The Bile in the liver is collected in a great many small tubes which are united, and form a large canal immediately above the Gall-Bladder. This is joined by a similar one from that organ. These two canals make a single conduit, which is inserted into the intestine a little below the stomach. By this means the bile is conveyed from the liver and gall-bladder. The Stomach.-The Stomach is a large membra- nous and fleshy pouch, resembling in shape a bag- pipe. It is placed in the superior part of the belly, INTRODUCTION. 45 between the large lobe of the liver and the spleen, somewhat obliquely, more to the left than to the right side. The small lobe of the liver separates the greatest part of it from the midriff, immediately below the point of the breast-bone. The Stomach has two pretty large openings, the one in the left, the other in the right side. The for- mer of these is about two or three inches higher than the latter. The Gullet, penetrating the diaphragm from the chest, opposite the lowest back-bone, enters the left opening; the beginning of the intestinal canal is at- tached to the right. The inside of the Stomach has a number of folds over its whole surface. These increase towards the left opening, by which, probably, the food is prevent- ed from passing too quickly into the intestines. The Gastric Fluid, or Fluid of the Stomach, for- merly described, is furnished by an apparatus within that organ, the structure of which has not yet been clearly explained. • The Stomach is supplied with blood-vessels, lym- phatics, nerves, &c The nerves of the Stomach are so numerous, and have such an extensive influence, that by means of them it has an intimate connection with many of the other organs. From this circumstance the effect which blows on the head, and disorders of many of the organs within the belly, produce on the Stomach, can be understood. The operation of many medi- cines, which, by being taken into the Stomach, occa- sion certain changes on the body, in so short a time, that they cannot be applied by the vessels to the parts which they affect, must be attributed to the actions of the nerves of the stomach. Intestinal Canal.—From the right opening of the stomach, the Intestine or Gut proceeds. This con- 46 INTRODUCTION. sists of a membranous fleshy canal, generally six cr seven times longer than the body of the person to which it belongs, terminating at the part through which the coarse part of its contents pass out, called the Anus. The intestinal canal, from being wider in some parts than in others, has been divided into the Small and Great Guts. The former of these occupy the upper and forepart of the belly, the latter the lower part and sides. The intestinal canal, that it may be contained within the belly, makes a great many turns, which are pre- vented from interfering with each other, by being all bound down to the back bone, by a thin mem- branous substance. Through this also the blood- vessels, lymphatics, and nerves are transmitted to the intestines. A portion of the intestinal canal passes along the inside of the false spine, nearly in a straight line, hence called the Straight Gut, or Rectwn. This gut terminates in the Anus, which is surrounded by seve- ral fleshy portions, some of which prevent the con- tents of the intestines from passing out at all times, while others force them forward when necessary. The internal surface of the intestines, like that of the stomach, is highly sensible, and has a number of small folds. A great many absorbent vessels open into every part of it; and it is defended by mucus, furnished by minute glands. The intestinal canal possesses a power of contract- ing, by which it propels its contents. It is very strong, in proportion to the layers of which it is com- posed. A* the same time its outer surface is so irritable, that, if exposed to air, it is very much disordered. The Spleen.—The Spleen is a bluish oval body, five or six inches in length, and four or five in breadth. INTRODUCTION. 47 It is situated under the midriff, in the hollow made by the false ribs of the right side, and is connected by ligaments to these parts, to the stomach, and the pancreas. The Spleen has some nerves and lv mphatics. It owes, howeveV, its principal bulk to a great number of blood-vessels. The Pancreas.—Behind the stomach, between it and the back-bone, a small body, not unlike the tongue of a dog, called 'Pancreas, or Sweet Bread, is situated. This body lies in a transverse direction, one end being connected with the beginning of the intestinal canal, the other with the spleen. Its breadth is about two or three inches, and its length seven or eight. The Pancreas prepares a fluid similar in quality and appearance to the spittle. This is poured into the in- testine, through a tube, at the part where the conduit from the liver and gall-bladder enters. A firm, delicate, transparent membrane, composed of two layers, interlarded with fat, and supplied with many blood-vessels, is attached to the lower part of the stomach and spleen, and the upper part of the intes- tines. From this it hangs down quite loose, nearly to the bottom of the belly, covering the forepart of all the guts. This membrane is called the Cawl or Omentum. Digestion.—By the process of Digestion, food is changed into the fluid formerly described, called chyle, on a due proportion of which the nourishment of the body depends. The sensations of hunger and thirst remind man of the necessity of taking occasionally meat and drink, and excite dreadful feelings where their summons is not obeyed. Drink seems more immediately neces- sary to life, as the body can be supported much longer without meat than without it. The food taken into the mouth is broken down by the teeth and mixed with the spittle, by which it acquire? 48 INTRODUCTION. a soft pulpy consistence. It is swallowed by the action of the tongue and several muscles, and conveyed along . the gullet by the successive contraction of the different parts of that organ. When received into the stomach, the food, (consist- ing of meat and drink) is mixed with the gastric fluid already described. After it has remained for a certain time, the different parts of which the food was com- posed become intimately united, and form a thick fluid of a greyish colour and sweetish taste, without smell. This passes through the under orifice of the stomach into the intestinal canal, by the action of the stomach, assisted by the motions of the midriff and the abdomi- nal muscles. After it has proceeded about three or four fingers breadth along the intestine, the bile and fluid from die pancreas are added, by which it is rendered more liquid, and the different parts of which it consists are , more intimately combined. In this state it is conveyed through the whole extent of the intestinal canal, by means of the contractions of that tube, assisted by: the midriff, Sec. During this process the thin and fine parts of this fluid are absorbed, while the thick coarse parts are , pushed downwards, and thrown out at the anus. These coarse useless parts are expelled by the com- bination of several powers ; for by the action of the diaphragm and the muscles of the belly, which com- press the intestines on all sides, aided by the successive contractions of the intestines themselves, they are forc- ed down to the anus, the muscles of which being sti- mulated by their acrimony, give way, and allow them to pass. ' " The immediate manner in which the important function of digestion is performed, has given- rise to many disputes, arid; is still involved in obscurity. It INTRODUCTION. cannot be compared to any artificial process which the industry of man can contrive. Organs of Urine.—The organs of Urine consist of the Kidneys and Urinary Bladder. The Kidneys are two pretty large bodies, resembling in shape a kidney bean, though very much- larger. They are situated on each side of the bones of the loins, between the false ribs and the haunch. The structure of the Kidneys is like that of glands. In each Kidney there is a cavity, to which the urine is conveyed by several small tubes after it is prepared from the blood. From this cavity the urine is sent into two long narrow canals called Ureters, which pass down in a curved direction to the bladder. Two bodies, supposed to be glands, and hence called Renal Glands, are situated at the upper part of the Kidr: neys, between them and the large blood-vessels. These bodies are larger in children than in grown per- sons, in whom they are shrivelled. Their use has not been satisfactorily explained. The Urinary Bladder is placed in the bason imme- diately behind the share-bones and before the straight gut. It is a pretty large pouch, somewhat oval, ter- minating in a narrow part called the neck. It is fixed at the lower and forepart to the contiguous parts. The Urinary Bladder is composed of several layers, one of which being fleshy, gives it the power of con- tracting strongly. The internal surface of the bladder is very sensible, and defended from the acrimony of the urine by mu- cus. The neck of the bladder is surrounded by a number of small fleshy portions, which adapt it for re- taining the urine. The Ureters pass down in a curved direction from the kidneys, and enter the back part of the bladder, nearly at a finger's breadth from each other. Thejurine is conveyed by them into the bladder drop by drop. :-.0 INTRODUCTION. The mine is expelled from the bladder by the.con, tractions of that organ itself, - assisted by the action of the midriff and abdominal muscles, .a. The Bladder is probably- stimulated to;.contractual two different ways, by beingdistended,andby the acri- mony of the urine ; for when it is very full the desire for-making water-is urgent, and this also often happens when there is only a small quantity of high coloured acrid urine- -V Distribution of the Blood in the lieih.—The. ■.Great Artery, after having penetrated the midriff, runs down along the left side of the backbone till it arrives at the lowest bone of the true spine, where itdivides into two branches, which divaricate as they go down, and form a pretty large angle. In its course* it sends branches to-the stomach, spleen, liver, andintestinesxand also to the other contents of the belly. Each of the branches mto which itdivides at the lower partis subdividedints two, which aresent to opposite sides of the bason; one of these on each side called Hy/toga.stric, supplies with blood-the consents of the bason, and some of the neigh- bouring parts externally. The other pair goes out un- der the passage-made by. the muscles at the top-of the thigh, to furnish the lower extremities. The Great. Frin lies exactly in the same direction: with and on the right side of the Great Artery ; it re- ceives1 the'■ blood- from the organs of urine and other contents of the bason by separate branches. The blood. of the stomach, spleen, and intestinal canal, is carried to the liver, after circulating through which, it is taken up by a vein that conveys it to the Great. Vein immeri tuately Uruderthe.midriff, at the rightside.: ..;:::■ The blood of the organs of digestion,- therefore* un- dergoes a double purification beforeitis carried to the left side of the heart,ifirst through the liver„and second- ly through the lungs, .... joay;d«. ... vi'WvU ■qc ^vu p-.r . .Jwc;^iJ.cJnini:J;i;v; . ,rjVffi»7 O " INTRODUCTION. 51 The Thoracic Duct receives chyle firona: the absor- bent vessels of the lower extremities, and of the ori- gans within the belly. It lies at first under, and then to the right side of the Great Artery, till it penetrates the midriff, as formerly described.* The Uterine. System.^ consists of the Uterus or Womb itself, and its Appinxlag.es. . ■-.!•• The Womb is a small hollow organ, shaped some- what like a pear flattened, placed in the cavity of the bason, between the straight gut and bladdefv i It is di- vided into the Bottom, the Body, the Neck, and the Mouth. The bottom is the fine between the two upper corners ; it is placed somewhat below the brim of the bason, and is about two inches in extent, . The mouth is the lowest part of the Womb, when, the .body is in the.erect postvrrc ;,it consists of a small.ppening, sur- rounded by two pretty thick lips: the 'appearance;, however, of this part varies in different vyomen. .-<; The body and neck, each contributing almost, equal proportions, form the space between the bpttpm-and mouth. : .. The. substance of the Womb is fleshyj but it is more; compact than that of any Other fleshy part; it is sup- plied with a number of blood-vessels, lymphatics, arid nert.es* which are so much compressed, that then- course cannot be traced. ..'-I-■.:.'. ' ;. The inside of the. Womb is lined ;fyith,a. very fine skin, which is sPmewhat wrinkled..in. young women, particularly towards the neck. , The structure, of this skin is not perfectly understood. The extremities of many very minute vessels can be perceived on its sur- face ; and between the wrinkles there are small mu- cous glands. < •-■ ' • See page 35. t 1 his description of the Uterine System relates only to those, or- gans in the unimpregnated state. 52 INTRODUCTION. From the inside of the Womb the periodical eva- cuation proceeds. ' In the natural unimpregnated state there is scarcely any cavity in the Womb,for the sides of its internal surface are every where nearly in contact. There are three openings in the Womb, two (one at each •corner) at-the bottom, and one at the mouth : the former are always very minute, the latter varies in dif- ferent women. ' ■■'■' :'• A/>/>ett'tia'g*8-' of> the' Womb.**—The ■ mouth of the Womb harigsinto a canal which serves as the passage to that organv This canal, called Vagina, being attach- ed to the-hfee-k of the Womb, higher at the back than the fore^aW:,'forms an angle,with '\U~y- ■ The Vagina-fe a membranous,, fleshy canal, com- posed'of Several layers, capable of-being considerably lengthened and enlarged on different occasions. -Its or- dinary length is about four-' or fiv<£ inches, ;and its breadth between one and two. "•-• • fo .. The layer which constitutes the inside of the ragina bemg much longer than th&Other,Torms a number of small folds, which are obliterated after frequent child- bearing, &c. This layer has many mucous glands'over its Surface, and is exquisitely sensible^ ■ :; ' The ro.gina, connected to the-wombiin the manner already -described; passes down between the straight gut and bladder under the arch'pf the share-bones. It is united'with -the'bladder and the'passage leading to that organ, at the fdrfe-p art in its whole extent, and in a certain degreerat the back part with the straight gut. From this circumstance, disorders iri^any'of these parts wflPbe;readily'communicated to the others. ■-. •. The skin which'covers the external surface of the womb (the same with that which lines the whole belly) forms at each side a broad doubling, named Broad These doublings connect the womb .to tlie sides of INTRODUCTION. s:. the bason ; in so loose a manner, however, that they do not prevent it from occasionally changing its situa- tion. They afford also support to the blood-vessels, nerves, and lymphatics of the womb. from each corner of the bottom of the womb two smi'.ll narrow fleshy canals run along the upper part of the broad ligaments in a curved direction, and termi- nate at the sides of the bason in a fringed substance, which hangs loosely in the cavity of the belly. These ai'c the Falloj'-ian Tubes. The Fallopian Tubes communicate with the womb at the minute openings of its bottom. In their course they gradually enlarge, but at their fringed extremities they again have a very small orifice. , „ About one inch from the womb, at each side, pvo small bodies are placed in the broad ligaments, resem- bling a nutmeg flattened, called.Ovaria. They are plump, large, and rounded in young healthy, women, and become shrivelled and small in those who have had many children. v , . , The structure of the ovaria, though certainly glan: diilar,is imperfectly known. At the fore-part of the womb,: below the beginning of each Fallopian tube, a round cord, composed of ves- sels, nerves, Jkc. intimately interwoven, passes down to each.groin. These are named the Round Ligaments. They .seem to be. principally useful in retaining the wombin its proper situation.* Extremities.—.The extremities consist of Supe- rior and Inferior, the former constituting the Shoulders, Arms, and Hands ; the latter the Thighs, Legs, and Feet. . , . . 'In the former editions of this work, the Uterine System was ininutely described. The author, however, with a view to render the present edition more generally acceptable, has placed the former description in a short Syllabus, which he has printed for the sole us« ef his female pupils. 54 INTRODUCTION. Superior Extremities.—The Shoulder-blades are two large, flat, triangular bones, joined to the back-part of the chest. They extend from the first to the se- venth rib, and accommodate themselves to the particu- lar shape of the ribs. They are attached to the chest by fleshy bands, in such a manner that they have a considerable degree of motion from above downwards, and from side to side;- hence, though in'their natural situation theyare separated by the back-bone, they can touch each other when the arm is moved in a particular direction. At their upper and outer part they have a hollow space, which receives the head of the first bene of the arm. .-,... The Shoulder-blades are prevented from rising too far upwards by a curved bone, which on each side ex- tends from their upper and'outer comer to the top of the breast-bone. This is called the the Collar-bone. Both ends of the Collar-bone are capable of motion, by which it is not liable to be injured by sudden or vio- lent actions of the arm. This bone, besides regulating the motions of the shoulder-blades, provides by its incurvation a safe pas- sage for the blood-vessels going to and coming from tbeVJiead. ■':;.'.v ' ..-_•!... ; • The Arm extends from the top of the shoulder to the elbow. It consists of a single long bone joined to the shoulder-blade, so as to possess a very free motion on all sides. This connection is strengthened bv the fleshy portions which extend to it -from the back and breast, and perform its various motions. These, co- vered with skin, and supplied with blood-vessels and nerves, give the external form to the Arm. The space included between the Elbow and the \\ nst is called the Fore-arm. It is composed of tfro long bones tied to each other at both ends. These bones are joined to the lower end of the bone of the INTRODUCTION. 55 arm, in such a manner, that, like a lunge, they have only motion backwards and forwards, while at the same time one of these bones has a rotatory motion. The V, rist consists of eight small bones placed in two rows; the first of these is connected with the bones of the fore-arm, by a moveable, hinge-like arti- culation ; and the second is joined to the hand in such a manner, that a slight degree of motion only can take place between them. The Wrist serves as a basis to the hand, and affords it a large free motion. .'>... The Hand consists of four long small bones,: four fingers, and the thumb. . . The four long small bones are articulated with the wrist and the fingers, the latter of which they support. They are joined together at each end, and are hollow where they form the palm, and convex at the back of the hand. The four fingers, each composed of three bones, are capable of a great variety of motions. The thumb, consisting also of three bones, is arti- culated with one of-the bones of the wrist. It serves to. regulate the motions of the fingers. A number of muscles, covered, with skin,, and supplied with nerves and blood-vessels, make up the figure of the fore-arm, and perform its motions. The wrist and hand, besides these, have a great many liga- mentous cords that facilitate the Complicated motions of which they 'are susceptible. Inferior Extremities.,->—The Inferior Extremities are divided into the Thighs, Legs, and Feet. The Thigh is formed by a very large long bone, covered by a numbei'.of fleshy portions, which perform its various motions. Those on the back part.attached to the thigh, and the bones of the bason, constitute the buttocks. .,;. • The Thigh-bone has a large round extremity, by 56 INTRODUCTION. which it is fixed in the cavity formerly described in the nameless bones, in such a manner that it has very ex- tensive motions. The other end is articulated with the leg. The Legs consist of two long bones, situated nearly in the same manner with respect to each other as the bones.of the fore-arm, and possessing a similar degree of motion. The Bones of the Legs are articulated with the thigh-bone, nearly' as those of the fore-arm are with that of the ana, A thick roundish bone, called Knee- pan, is placed at the fore-part of this articulation, hav- ing a very free motion upwards and downwards. This bone regulates the motions of the legs. ■ The articulation between the thigh and leg forms the Knee. The inferior extremity of each bone of the leg pro- jecting somewhat outwards constitutes the Ankle. The Foot is composed of a variety of bones, seven of which form the back part of the foot. They are ar- ticulated with the bones of the leg, and with one ano- ther, so as to allow the various motions of the foot, while their back part, composed of one large piece, the Heel-bone, affords attachment to a strong tendon, which strengthens the articulation. Five long bdnes are placed between these and the toes. They have no motion between themselves, but are joined together in such a manner as to form an arch along with the bones behind them. By this means a tery-firm support is afforded to the body, while the blood-vessels and nerves which supply the foot are protected from injury. The Toes, like the fingers, are five in number. The great toe consists only of two pieces of bone ; the others have three: The toes, though they have not so extensive a motion as the fingers, are of great use in walking;" • ' ' .■'•'. . INTRODUCTION. The inferior extremities arc supplied, like the supe- rior, with blood-vessels, nerves, muscles, ligaments, See. The skin on the soles of the feet is thicker and more insensible than in any other part of the body. This Introduction cannot be better concluded than by a few general observations on the structure of the body. All the parts of the human body, admirably con- nected with each other, form a general assemblage of powers, by which every purpose in life is wonderfully performed. The Head affords a situation for the organs of the senses, which adapts them for the important office of serving as centinels to announce the approach of dan- ger from surrounding bodies, and which renders their influence extensive. The Superior Extremities act as servants and de- fenders of these organs, and are therefore placed near them. The Chest is excellently constructed for the safe lodgement of the powers by which the blood is purified, and sent to every part of the body. The Belly contains those organs which supply the new materials of the body, and carry off the worn out ones. The Inferior Extremities serve as beautiful pillars to the whole human fabric, while they bestow on it a power of moving from place to place. The Whole Body may be considered as the habita- tion of an unknown principle, which animates and re- gulates every part of it. The instruments of this prin- ciple are the nerves. The necessary actions of the body after a certain pe- riod induce a degree of lassitude, which terminates in a total inability of performing the ordinary functions of H if 58 INTRODUCTION. of life. Sleep is therefore provided for recruiting the body. ' The Involuntary Actions of the body are continued during sleep, but in a slower succession. The think- ing principle, except in cases of disease, is quite sus- pended. MANAGEMENT or FEMALE COMPLAINTS. PART I. CHAPTER I. SEXUAL DISEASES. OMEN are subject to many diseases in con- sequence of peculiarity of sex. Some of these, by inducing troublesome symptoms, render life un- comfortable; and many, by affecting the general health, prove the source of the most dangerous symp- toms. It is of importance to explain the nature of all those diseases, that those afflicted with any of them may be enabled to apply proper remedies, or have recourse to proper advice before it be too late. w 60 MANAGEMENT OF SECTION l.m EXTERNAL SEXUAL DISEASES. WOMEN have sometimes Peculiarities in their External Form, which may proceed from ori- ginal mal-conformation, or be the effects of other diseases. When there is any thing uncommon in external appearance, that false delicacy, so natural in women, which often prevents them from consulting practi- tioners, should be immediately overcome, otherwise they may be subject to many inconveniencies which might easily be avoided. Although women be apparently properly formed, the passage of the periodical evacuation is sometimes obstructed by a firm membrane, which closes it up. This preternatural appearance, at a certain period of life, produces the most painful and troublesome complaints ; for a tumour or swelling is gradually formed, by the accumulation of that fluid which ought to be discharged. From the confinement of the fluid, and the push which it makes at the accustomed pe- riods, the most violent bearing down pains are occa- sioned. These bearing down pains increase in violence ac- cording to the duration of the complaint, and at last, in the advanced stage of the disease, resemble so much the throes of labour, as to have often occasioned mis- takes. The disease may be suspected by this circumstance, that the painful symptomsdisappear during the inter- val of the accustomed periods. But it is chiefly ascer- tained by there being no opening into the passage of the womb. It is a %ood general rule, when the pe- FEMALE COMPLAINTS. 61 riodical discharge does not appear at the usual time of life, to determine this point. The cure of this disease, which is very simple, con- sisting- only of an incision through the obstructing membrane, must be trusted to a practitioner. The external form of women is apt to become changed, by the cohering of contiguous parts, in con- sequence of excoriations, or of previous inflammation. Every part of the body becomes excoriated if ex- posed to moisture, and not kept clean ; the most de- licate parts are more particularly liable to this acci- dent. The great advantage, as well as necessity, of the frequent use of the Bidet, is therefore very obvious, as it affords the best means for preventing excoriations, and their disagreeable consequences. When excoriations do happen, their treatment ought to be simple. If they are slight and superficial, the application of cloths dipt in Fort wine, or a weak solution of sugar of lead*, will remove the complaint; but if the excoriations have a fiery appearance, and be deep-seated, they ought to be dressed with sperma- ceti ointment, very thinly spread on linen. Inflammation affecting women externally, if accom- panied with heat, throbbing pain, swelling, and ten- sion, from having a very great tendency to terminate in extensive suppuration or mortification, ought to be always particularly attended to in the beginning ; wo- men should not therefore, in such cases, delay having recourse to proper assistance. If, however, this cannot be procured, violent pain must be prevented by doses of laudanumt, and a poultice consisting of soft bread * Viz. ten grains ditsolved in half an English pint of rose-water. t The ordinary dose of laudanum for gruivn persons is from twenty to thirty-five drops, according to the temperament and strength. 62 MANAGEMENT OF soaked in alum water, or a strong solution of sugar of lead*, should be applied to the inflamed parts. In cases where the inflammation is very violent, blood should be taken from the arm, and also, by means of leeches, from the part. A particular kind of inflammation is attended with a very troublesome, though not dangerous symptom, an excessive degree of itching. This complaint, however, is the effect of several causes, which cannot be ex- plained to those who are ignorant of the practice of physic. If, therefore, it be not removed by low living, and repeated doses of cooling salts, along with the liberal use of ripe fruits, proper advice is required. The disease may often be palliated by frequent doses of laudanum, and the application of simple camphor- ated ointment, or Goulard's cerate, to the affected parts. Where itching takes place at the period of life when the monthly discharge ceases to return, if it be attended with occasional deep-seated pain about the bladder, it requires the most serious attention. SECTION II. BEARING DOWN AND DESCENT OF THE WOMB. THE connections of the womb, it was formerly ob- served!, are so loose, that it readily changes its situation. From this circumstance it may be understood, that if the vagina be very much relaxed and enlarged, the • Vix. a drachm dissolved in! a gin of vinegar and half a pint of rose- water. t Page 53, 53. -.- . FEMALE COMPLAINTS. 63 womb will fall lower into it than it naturally does. When this happens, it presses on the neck of the blad- der and the lower part of the straight gut, and hence tfhose parts are irritated. The symptoms of this complaint, in its incipient state, arc, bearing down pain, especially when using exercise, frequent desire to make v/ater and go to stool, and a discharge of a slimy fluid from the vagina, together with pain in the back. When these symptoms are'disregarded, the disease continues to increase in proportion to its duration. In many cases the womb protrudes entirely without the vagina, and then becomes highly troublesome and painful. It also in that state, from its connection with the bladder, renders the subject of it unable to make water, without lying down and pushing up the pro- truded tumour. The causes of the descent of the womb ought to be universally known, as it is certainly often in the power of women to escape entirely from the miserable and uncomfortable state to which they must be reduced if subject to that complaint. Every disease which induces weakness of the habit in general, but more especially of the passage to the womb, will lay the foundation for the bearing down or descent of the uterus. Irregularities of the periodical evacuation, frequent miscarriage, improper treatment during labour, and too early or violent exercise after lying in, are the most common circumstances to which this disease is to be attributed. The cure of Bearing down of the womb, if attended to early, may often be easily accomplished. The tone of the vagina must be restored by the cold bath, and astringent lotions thrown intoit three or four times a- day, while at the same time internal strengthening re- medies should be taken, and the patient ought to be confined very much to a horizontal posture. 64 MANAGEMENT OF When, however, the disease has proceeded so far that the womb descends, the cure is attended with con- siderable difficulty, and requires time in proportion to the duration of the complaint, and the state of the pa- tient's general health. Young married women, troubled with descent of the womb, may expect to be entirely relieved from it if they become pregnant, provided they be properly treated after delivery. In cases where there is no probability of pregnancy, the womb should be kept up by means of a piece of sponge adapted to the passage, moistened with any mild astringent liquor, and the remedies advised for bearing down of that organ should be carefully em- ployed. When, however, the descent of the womb is very troublesome, and has continued for a considerable time, the only relief which can be obtained is to be procured from the use of an instrument called Pessary. Women in general are prejudiced against such in- struments, and many practitioners have recourse to them with great reluctance : some indeed have abso- lutely prohibited their use, and have alleged, that they can never answer any good purpose, but that, on the contrary, they always increase the malady, and pro- duce other bad effects. That pessaries have often been the cause of many very troublesome, as well as dangerous symptoms, cannot be denied ; but this can only happen when they are improperly managed ; for these instruments, when judiciously employed, always contribute very mate- rially, at least to the ease and comfort of the patient, and can never do any harm. The Author of this Work knows at present many women who are enabled, by the use of a pessary, to make every exertion necessary in active life, without Ieehng the smallest pain from the instrument; while FEMALE COMPLAINTS. 63 the few who, in the course of his practice, have refused to try that expedient, suffer all the disagreeable effects which can originate from a weakening disease and want of exercise. SECTION III. PROTRUSION OF THE VAGINA. T3ROTRUSION of the vagina is not so frequent as X descent of the womb ; but when it occurs it is fully as troublesome. It appears most commonly in the form of a tumour hanging out without the passage, with the mouth of the womb at the upper and fore part of it, which distinguishes it from the protrusion of the womb. When the vagina is very much relaxed, and at the same time narrow, the weight of the womb bearing- down on it pushes out that part of it which is most loosely connected to the contiguous parts,* and conse- quently occasions the appearance already described. The cure depends on the protruded part being replaced, and the weakened state of the vagina re- medied. These purposes may be accomplished by the means recommended in cases of descent of the womb. As however, protrusion of the vagina is often the consequence of general weakness of the habit, tlie Peruvian bark, and mineral waters, with steel, should be taken internally, and a suitable plan of diet and exercise ought to be followed. * See- Page 52. I 66. MANAGEMENT OF SECTION IV. TUMOURS IN THE VAGINA AND WOMB. THE Vagina and Womb are subject to fleshy ex- crescences called Polypous Tumours, in com- mon with some other parts of the body. These in many cases are soft as clotted blood ; in others they resemble flesh ; and sometimes they are found of a hard consistence. They are of different sizes and shapes. Little inconvenience is felt from these excrescen- ces when they are small, except from their occasion- ing irregular discharges of blood from the womb or vagina. But the most troublesome, as well as danger- ous symptoms occur hi the progress of the disease, when the tumour becomes bulky. Violent bearing-down pain, frequent discharges of blood, and the constant draining of a fetid, ill-coloured fluid from the vagina, along with inability to make wa- ter, and imitation on the straight gut, inducing conti- nual desire to go to stool, are the symptoms of a large excrescence in the womb or vagina. When the dis- ease has continued for some time, the tumour hangs at last1 without the passage of the womb. These excrescences have often been mistaken for tlescent of the uterus, and sometime's even for the head of a child. A surgeon in Lyons actually tore away, by the utmost exertion of force, the womb, along with an excrescence, having imagined that the imfortunate patient was in labour, and that he pulled by a part of the child. FEMALE COMPLAINTS. 67 If this disease be long neglected, the pains increase in violence, and the patient becomes emaciated from the continual discharges. In the treatment of excrescences in the vagina, &c. it is of very great importance to form an accurate idea of the disease. The symptoms, therefore, which dis- tinguish it from other complaints ought to be well known. Fxcrescences of the womb differ from descent of that organ, in being attended with frequent discharges of blood, and when felt, in being broad and bulky, and having no orifice like the protruded womb, and in being easily moved or twirled round as it were, by the finger. If the disease produced by such excrescences be early attended to, in many instances it can be removed without danger, or occasioning much pain. But when the excrescences have acquired a great size, the danger is proportionally increased. The cure depends on a surgical operation, which ought only to be attempted by those who have had op- portunities of treating such cases, as it requires a very accurate knowledge of the structure and situation of the contiguous parts, to avoid those errors in perform- ing it which have proved fatal to many women. SECTION V. CANCEROUS AFFECTIONS OF THE WOMB. ULCERATED Cancer of the Womb is perhaps the most dreadful disease to which the human body is subject. o3 MANAGEMENT OF This disease commonly begins at the decline of life, though cases, from time to time, occur where it at- tacks young women. Its approach is in general gra- dual. At first the patient feels an uneasy weight in the lower part of the belly, with the sensation of heat or disagreeable itching. By degrees irregular shoot- ing pains, darting across from the share bones, take place. The pain at last becomes fixed in the womb, and is described to occasion a constant gnawing burn- ing sensation. A discharge of ill-coloured, fetid, acrid matter from the vagina attends this pain; and not- withstanding every attention to cleanliness, excoriates the neighbouring parts. If the patient have the mis- fortune to linger long in this situation, her condition be- comes shocking in tlie highest degree, both to herself and to those about her. Under such circumstances, death loses its formidable appearance, and is anxiously wished for both by the unhappy sufferer herself, and by all her friends. Such symptoms require the most serious attention; for the woman's comfort must depend on their proper treatment; and therefore recourse should be had, on their first appearance, to the advice of a practitioner. By a continued perseverance in a milk and vege- table diet, with a total abstinence from animal food of all kinds, and every fermented liquor, and by occasion- al blood-letting, and the establishment of one or two issues in the arms or above the knees, together with frequent doses of cooling laxative salts, the progress of the disease may be retarded, if the complaints be attend- ed to at the beginning. Cancerous complaints, in their advanced stage, pro- duce such deplbhible effects', that it cannot be consider- ed wonderful that women subjected to them should, with .eagerness, have recourse-to every impudent quack who pretends to have discovered a nostruniibr their cere. The author of these pages,* however, FFMALE COMPLAINTS. 69 deems it his duty to caution women against spending that time in listening to the pretensions of empyricks, which may be so advantageously employed at the be- ginning of such complaints, in adopting suitable means to check their progress. Were any medicine discovered which should possess the power of removing cancer, the fortunate discover- er certainly would not long conceal his success : and hence such unequivocal evidence of the fact would soon be furnished, as should put the matter beyond a doubt. At present, however, quacks found their pre- tensions to merit on the successful event of single cases. Delusive pretensions 1 Were any single case of cancer cured by internal medicines, every cancer- ous complaint, wherever situated, should yield to the same means ; just as (what is well known) the parti- cular disease for which mercury is a certain remedy, although it appears in a variety of forms, and in differ- ent parts of the body, is uniformly removed, by the same mineral.* Many shocking cases have occurred within the ob- servation of the Author of this Work, where women have neglected pursuing with steadiness the sugges- tions of regular practitioners, in consequence of the false confidence they were induced to place in the dis- honest promises of the discoverers of nostrums. A simple recital of the agony of such women previous to death, might appear incredible. The interference of the legislature, in checking this species of robbery, is certainly required, since not only is money stolen, but also is life destroyedj and that in a way of torture too, which the severity of law has never yet exercised on, the most flagitious criminals. - ..- re . MANAGEMENT OF SECTION VI. DROPSY OF THE APPENDAGES OF THE WOMB. THE Womb itself has been imagined to form the seat of collections of a watery fluid, like other cavities of the body. This, however, can never pro- bably happen, except where the' fluid is contained within white-coloured bladders of various sizes, re- sembling green grapes when too ripe, called Hydatids, The nature of these bodies is not yet fully understood. At first I was inclined to suspect, that when hydatids were situated in the womb, they were formed by the retention of part of the after-birth, or of a blighted conception. But the following case overturned this opinion. A Lady, at the cessation of the periodical evacua- tion, complained of symptoms which indicated the ex- istence of a polypous tumour in tlie womb: And, on examination, this was found to be really the case. The tumour was easily removed; and the patient recovered perfectly. About ten years afterwards she began to feel an uneasy weight at the lower part of the telly, and sus- peGted th&t her former complaintihad returned. The mouth of the' womb, however, was found quite closed up ; but the. uterus appeared bulky ArKkheavy.- This appearance continued for? some time, attended with no other inconvenience than what originated from the sen^ sation of a considerable weight, whieh produced a de- gree of bearing-down. At last, in the 62d year of her age, she was seized with very strong forcing pains in the womb; and a large mass, weigliing above two pounds, consisting of FEMALE COMPLAINTS. 71 a quantity of hydatids, joined together by a membra- nous substance, wjs passed. During the violent pains which preceded the ex- pulsion of this mass, the patient lost so great a quantity of blood from the womb, that faintings were induced, and she became very much weakened. After a few weeks, however, by proper management, she recover- ed perfectly. The appendages of the womb, called Ovaria,* arc very frequently the seat of dropsy. This disease most commonly occurs at that time of life when the peri- odical discharge naturally becomes irregular, though it sometimes appears in young women. At first, dropsy of the ovarium is very small, and attended with no disagreeable symptoms. It increases gradually in bulk, and is originally confined to one side only, most frequently, the left one. The patient en- joys usual good health in most cases till the tumour has acquired a considerable size ; it then induces pain and numbness in the thigh corresponding with the side in which the swelling is situated, and by degrees the body,becomes wasted, the appetite bad, and the strength impaired. When the swelling has increased so much as to enlarge the wholebelly, breathlessness,and cramps of the thighs and legs, are produced, which at last termi- nate the woman's life. The progress of this disease; however, is not equally rapid in all casts. Some women have had dropsical ovaria upwards of twenty years, without feeling much inconvenience from them. Of this I once saw a very remarkable instance : the patient was at last suddenly carried off by the fluid bursting into the cavity of the • See p. <* 72 MANAGEMENT OF belly. In others, the dangerous symptoms proceed with rapidity to their fatal termination. Every thing which tends to retard the action of the vessels of the body proves a cause of dropsy. It was observed, that a thin fluid is furnished by the arteries, which lubricates the surface of every cavity of the body. If the proportion of this fluid be too great in any of the cavities, either from being supplied in too large quantity, or from not being regularly absorbed, it will gradually accumulate, and form dropsy. Although the ovaria in their natural state have no cavity, as they are of a spongy texture, they are cal- culated for allowing the stagnation of fluids, while their outer covering is capable of a very great degree of dis- tention, and hence readily becomes a sac for contain- ing the accumulated fluid. Every circumstance, therefore, which is apt to im- pede the circulation of the blood, or to weaken the general habit, but more especially tlie uterine system, may occasion dropsy of the ovaria. Consequently, too tight lacing, with a view to acquire a fine shape, seden- tary life, frequent discharges of blood from the womb, and injuries during labour, lay the foundation for this disease. Dropsv of the ovaria ought to be carefully distin- guished from general dropsy, and from pregnancy; if it be mistaken for the former, the patient may be teased with medicines, which will rather aggravate than relieve the disease ; and if the latter be taken for this complaint, tlie most fatal consequences must follow. Many women have lost their lives by such mistakes. Dropsy of the ovarium is in general seldom disco- vered early enough to admit of a complete cure. The great aim, therefore, in most cases, ought to be to pre- vent its progress. FEMALE COMPLAINTS. 73 For this purpose, every means which can promote general health ought to be employed. Diuretic medicine, and gentle laxatives, should also be taken from time to time. Nitre, cream of tartar, anci, an infusion of juniper-berries or of broom-seed, seem to be the best diuretics ; and any of the laxative cooling salts may be used to keep the belly gently open. These remedies are serviceable only in pre- venting the watery fluid from increasing in quantity, for there is little probability that it can be evacuated by the power of any medicine. While this plan is pur- sued, the belly should be firmly compressed by a flan- nel roller, or proper bandage. When the symptoms of breathlessness and very great debility become urgent, the water may be taken off by the operation of tapping. A temporary relief only, however, will in general be obtained by this means, for the fluid is commonly soon again accumu- lated in increased quantity. In some rare cases, where the general health of the patient remained unimpaired, by the use of strength- ening remedies the disease has been prevented from returning after tapping ; and hence patients, under such circumstances, should not altogether despair. The fluid in dropsical ovaria, however, is more often contained within hydatids than vvithin a single sac, and therefore much less can be expected from medicine. This may be known from the inequality of the tumour, It is of consequence to discover the existence of hyda- tids, as in such cases little benefit can be procured from an operation. K ~4 MANAGEMENT OF SECTION VII. IRREGULARITIES OF THE PERIODICAL EVACUATION', IT is well known, that those women are most healthy who have the periodical discharge most regularly ; and, on the contrary, that those who have bad health, either have it excessively, sparingly, irregularly, or want it altogether. Hence it has been supposed to be so much con- nected with health, and so essential to the female con- stitution, that irregularities of that evacuation prove tlie source of most of the diseases incident to the sex. In general, however, these are more frequently the effecU of something faulty in the habit, than the cause of the bad health which at that time occurs. Women in the higher ranks of life, and those of a delicate nervous constitution, are subject to sickness, head-ach, and pains in the back and loins, during the periodical evacuation. Those of "the lower rank, inured to exercise and labour, and strangers to those refinements which de- bilitate the system, and. interrupt the functions essen- tial to the preservation of health, are seldom observed to suffer at these times, unless from.general indispo- sition, or a diseased state of the womb. Women subject to pain, &c. while out of order, should be cautious what they eat or drink at that pe- riod. They should frequently repose on a bed during the day, when oppressed, languid, or pained. They ought to drink moderately any warm diluting liquor which is most grateful to the stomach, as gruel, weak white-wine whey, cow-milk whey, penny-royal or balm tea, a weak infiision of saffron, he. and must FEMALE COMPLAINTS. :, carefully guard against cold,fatigue, and night irregu- larities. The pains with which many women are so much distressed during this period are best relieved by opiates. Fifteen drops of laudanum may be taken in a cupful of warm tea in the morning, and twice that quantity in weak negus, white-wine whey, or gruel, at night, immediately before bed-time. The tendency to constipation which opiates induce, must be Counteracted by the use of gentle laxatives, or emollient glysters. Along with the pain, some women discharge small fleshy Or thin skinny substances, which always indi- cate some diseased action of the womb, and require most particular attention. The periodical evacuation sometimes, in young wo- men, suddenly disappears for a period or two, and in some cases much longer. This circumstance always occasions much appre- hension, and every medicine which is imagined to pos- sess the power of restoring the discharge is therefore very eagerly had recourse to. As many causes may put a stop to the periodical evacuation, the method of cure must be varied accord- ing to circumstances. If the complaint seem to have originated from exposure to cold, errors in diet, or passions of the mind, the warm bath should be used for several nights preceding the time when the dis- charge should appear, and a gentle vomit or laxative ought to be taken. If the woman has evident troublesome symptoms of fulness, blood-letting, frequent doses of cooling laxa- tives, and spare living, will prove the most effectual remedies, and are certainly safe, as the same treat- ment would be proper though there were no obstruc- tion. A very different plan ought to be pursued when 76 MANAGEMENT OF there are symptoms of great weakness. Nourishing diet, the moderate use of wine, gentle exercise, the Peruvian bark, a course of steel, mineral waters, and the cold bath, are in such cases necessary. A table spoonful of white mustard seed evening and morning, or a small cupful of a weak infusion of horse-radish, on such occasions, sometimes produce very good effects; an infusion of chamomile, tansey, balm, or penny-royal, may be employed with the same views. From the great variety of causes of sexual obstruc- tion, it is certain that many medicines which possess very opposite powers, may in different cases produce the same effects ; for the same reason a remedy which in one case may prove mild, inoffensive, and success- ful, will in another apparently similar one, occasion the most violent disorders. Medicines, with a view to restore the periodical evacuation, ought therefore to be employed with the greatest caution. No remedy applicable to every case can possibly be discovered ; and many cases yield to a proper regulation of diet and exercise, after having resisted all the ordinary remedies. All forcing medicines should be carefully avoided, as they act by stimulating other pails, and hence their effects are often dangerous, and never certain. Electricity has frequently been found a powerful re- medy in cases of obstruction ; but as it may often be productive of the very worst effects, it should never be had recourse to without proper advice. The periodical discharge often becomes irregular merely from change of residence. Such irregularities are merely temporary. When the periodical evacuation is sparing, the best palliative treatment is to guard against exposure to cold at that period, and by the use of the wa. Tibath to pro- mote the discharge. Women who are nervous and delicate, whose health FEMALE COMPLAINTS. 77 has been impaired by frequent miscarriages, or whose constitution is weakened by a sedentary inactive life, low diet, or any other cause of debility, are chiefly sub- ject to immoderate, long continued, or frequent men- struation. When the blood evacuated, instead of being purely fluid, comes off in large clots or concretions, attended with a considerable degree of pain, throbbing, or bearing down, the case is highly alarming and dan- gerous, for it indicates a diseased state of tlie womb, us the periodical discharge, in its natural state, never coagulates. Frequent or excessive evacuations are always at- tended with languor and debility, and loss of appetite, with pi.in in the loins, and sometimes faintings; and when they occur in a violent degree, anxiety, coldness of the extremities, and hysteric fits are occasioned. Universal weakness of the system, which brings on a train of nervous complaints, and swelling of the legs, and a disposition to hectic fever, which may at last ter- minate fatally, are the consequences of frequent or ex- cessive menstruation. The cure depends much on the cause, the consti- tution, and manner of life of the patient. More in general is to be expected from regular living and proper diet and exercise, than from medicine. When the discharge is excessive and dangerous, cooling diet, cool air, horizontal posture, and cold topical applications, are the principal remedies. The patient should be kept as cool as possible, and perfectly at rest, both in body and mind, as long as the discharge continues. Her food should at that time be light and nourishing, but not heating, and should be quite cold. When great anxiety, languor, and faintness occur, light nourishment must be frequently given, and now and then a little cold claret or cinnamon water, by way i»f cordv.d. 78 MANAGEMENT OF The discharge cannot be immediately stopped by any internal medicine; but it may be moderated, and hence the danger of the complaint may be ob- viated. With this view, if the patient be of a full habit, hot or feverish, the nitrous mixture* should be taken ; bu,t btherwise, rose-tea, agreeably sharpened with spirit of vitriol, is preferable. Alum-whey is also a powerful remedy, and readily procured. The eighth part of an ounce of alum will curdle an English pint of milk; the whey thus prepared must be sweetened to the taste, and a small cupful may be drank as often as the sto- mach will receive it. When there is much pain or anxiety, opiates may- be given with advantage. The state of the belly must be attended to ; it can be kept gently open by the use' of castor oilf, or any mild laxative. Clysters under such circumstances "are improper, from their tendency to increase the dis- charge. ' A light decoction of Peruvian or oak bark|, rendered acid to the taste by elixir of vitriol, is the best remedy to strengthen the general habit, and to prevent a return of the disorder. Irregular recurrence of the sexual evacuation may be occasioned by a variety of circumstances; but it most frequently happens from general indisposition, or in consequence of the particular period of life. Where symptoms indicating diseases of the habit, as weakness, loss of appetite, swelled legs, &c occur at the same time with irregular evacuation, they alone should be attended to, for on their, being remedied, the return of the sexual discharge depends. * See Forms of medicine at the end of this work. t The dose for a delicate woman is less than a table-spoonful. J See form? of medicine. FEMALE COMPLAINTS. 79 When irregularities take place about the forty-fifth or fiftieth year, they must be imputed to the natural decline of life, and ought to be treated as such. Many women on these occasions, averse to be thought old, flatter themselves that the irregularity is occasioned by cold, or some accidental circumstance, and therefore, very improperly, employ their utmost endeavours to recall it. When the periodical evacuation is about to cease, the symptoms which occur are extremely different in different women ; for in some it stops at once, without any bad consequence ; in others it returns after vague and irregular intervals, for several months or years preceding its final cessation. In such cases it has at one timethe appearance of little more than a shew; at another it comes on impetuously, .and continues for some time excessive. The symptoms of disease which in many women occur at this period of life, are to be ascribed rather to a general change in the habit, than merely to the ab- sence or total cessation of the sexual evacuation. Although this change is natural to the female con- stitution, if the many irregularities introduced by luxury and refined mode of living be considered, it will not appear surprising that this period should prove a frequent source of disease. Women who have never had children, or good re- gular health, and those who have been weakened by frequent miscarriages, are mostapt to suffer,at die.de- cline of life. It frequently happens, that wpmen who were for- merly much pained when out of order,, or who were troubled with .nervous and hysteric complaints, begin at .the cessation of the periodical, discharge fo enjoy a good state of health, to -which they had formerly been strangers. m • e If the evacuation should stop at an earlier.period of SO MANAGEMENT OF life than usual, and the woman be not pregnant, tlie nature of the symptoms will point out the proper ma- nagement. When no particular complaint occurs in conse- quence of the decline of life, it would be exceedingly absurd to reduce the strength by an abstemious diet, low living, and evacuations, as is unfortunately very often advised. If, on the contrary, headach, flushings of the fuce and palms, or an increased degree of heat, restlessness in the night, and violent ptans in the belly and loins, are occasioned at this period, there is reason to believe that a general fulness exists, in consequence of the stoppage of the accustomed discharge. When, therefore, these symptoms occur, or when the legs begin to swell, or eruptions to appear in dif- ferent parts of the body, spare living, with increased exercise, occasional blood-letting, and frequent gentle purgatives, ought to be recommended. SECTION VIII. SEXUAL WEAKNESS. WOMEN are very much liable to a discharge of a slimy mucus, from the passage leading to the womb, which varies considerably in appearance, consistence, and quantity, in different cases. This complaint is always disagreeable .and trouble- some, and frequently occasions great weakness, and a train of nervous disorders ; as it is also the disease to which women are most peculiarly subject, it must form an important object of attention. FEMALE COMPLAINTh. SI Sexual weakness, or Whites, as it is vulgarly called, proceeds either from the vagina or from the same source as the periodical evacuation. In the former case it ought to be considered merely as a local com- plaint ; but in the latter it is very much connected with. the general health. In the internal surface of the vagina, it has already been observed,* there are many mucous glands; these furnish a liquor by which that canal is constantly lu- bricated. When these glands prepare too great a quantity of mucus, the superfluous proportion is na- turally discharged, and constitutes the mildest species of sexual weakness. In this case, the fluid discharged has a glairy ap- pearance, somewhat like thin starch. It is attended with no pain, and does not affect the health in the smallest degree. This disease is troublesome only from the disagree- able sensation which it induces : it may be readily ro moved by proper attention. The cause of this complaint is an irritation or relax- ation of the mucous glands of the vagina : hence it is occasioned by the bearing down of the womb, and by every other circumstance which can irritate the vagina, such as polypous tumours, &c. or which can debilitate that organ. The cure is to be accomplished by removing the irritating cause, and by the use of the cold bath. When, however, the discharge is of a yellow colour, or is thin and fetid, it certainly is owing to constitu- tional disease. Too great a degree of fulness, in consequence of high living, inactivity, or the peculiar disposition to corpulency which some women have at a certain period * See page <2. L 82 MANAGEMENT OF of life, frequently occasions an increased action of the glands in the inside of the Womb. This may be known by the attending symptoms. If there be violent pains in the head, back, and loins, together with flushings in the face, and heat in the palms of the hands, and if the pulse be strong and full, there can be no doubt of the cause. The discharge under such circumstances can only be removed by repeated blood-letting, spare living, and general evacuations, by means of laxative medi- cines. In these cases the use of astringents would be pro- ductive of the worst effects. When a thin discharge of a greenish or dark co- lour proceeds from the vagina, chiefly a few days be- fore and after menstruation, and disappears during that evacuation, it then proceeds from the same source as it. WThen this complaint continues for a considerable time, it gradually weakens the general habhv and in a particular manner affects the stomach. It tends also very materially to impair the functions of the uterine system ; and hence women subject to this complaint are always barren as long as it continues. This species of sexual weakness will yield only to strengthening remedies, and the use of topical astruv gents. . With these views, the stomach must be emptied once or twice by vomits,* after which the Peruvian bark, either in substance or decoction, with elixir of vitriol, alternated with the use of tincture of steel, may be had recourse to with success. The cold bath, (in the sea when the season will permit), along with the topical application of astrin- gent liquors, by means of a womb syringe, ought also * See forms of medicine. FEMALE COMPLAINTS. 83 to be employed. The most convenient astringent lo- tions are, a strong infusion of green tea, port-wine and water, or the strong solution of sugar of lead already mentioned.* Along with these remedies, light nourishing diet and moderate easy exercise will be found beneficial. This particular kind of the disease sometimes hap- pens before the complete establishment of the periodical evacuation ; in such cases, it ought to be left entirely to nature, unless disagreeable symptoms attend it. When any discharge from the passage of the womb is accompanied with inflammation, burning heat, diffi- culty or pain in making water, troublesome sensation of itching, &c more especially towards the decline of life, women should not lose time in trifling, but should at once apply for proper advice. SECTION IX. STERILITY. IT is a mistaken idea, that nature has intended that all women should be mothers ; for some have ori- ginal imperfections in the uterine system, which can- not be remedied by any operation of art, and which often: remain concealed till after death. Sterility can be obviated only in those cases where it is the consequence of irregular menstruation, of im- proprieties in the manner of living, of long continued female weakness proceeding from the same cause, or • Page 62. is 4 MANAGEMENT OF w here it arises from such external imperfections as are capable of being removed by art. As the proper treatment necessary incases of steri- lity from such causes, is an object of great importance, since it must conduce to the re-establishment of the health of the woman, as well as to the advantage of mankind, recourse should always be had at once to the advice of practitioners. SECTION X. HYSTERIC AFFECTIOXS. WOMEN, it is well known, are more irritable than men. From this circumstance, they are subject to a disease which appears under very different forms in different persons, called Hysterics. In the regular hysteric fit, the patient is first seized with a pain in the left side, which gradually affects the whole belly ; this is sometimes preceded by or accom- panied with sickness and vomiting. By degrees a sense of suffocation is felt in the throat, which seems to be occasioned by the sensation of a ball mounting up to it from the stomach. These symptoms are commonly attended with violent sudden fits of crying and laughing;, the transition from the one extreme to the other being rapid and unex- pected, and by convulsive motions of the whole bodv. They are often followed by stupor and faintings, from which the patient gradually recovers, after having for a considerable time sighed deeply. After the fit* the patient is not conscious of what had happened. FEMALE COMPLAINTS. 85 This disease occurs most frequently about the time of the periodical evacuation. Women who are robust, healthy, and full, or inactive, and those who feed high- ly, and are subject to profuse menstruation, are most liable to this complaint. It generally attacks them from the age of fifteen to thirty-five. The cure of real hysteric fits can only be accom- plished by regular spare living, a careful attention to the state of the belly, and by the use of those means which have been recommended to promote the peri- odical evacuation. The symptoms which immediately constitute this disease may be removed, where violent, by blood-let- ting and a brisk purgative, along with the warm bath. The first of these remedies must be employed before the others. If the stomach seem loaded, or if the patient have any tendency to vomit, chamomile tea, with a few drops of hartshorn, or a dose of Ipecacuan, should be exhi- bited. Those who have been subject to this disease are often troubled with threatening symptoms of it, especi- ally when exposed to cold, or suddenly affected with any violent emotion of the mind. Bathing the feet in warm water, the horizontal posture, and drinking a little warm white-whine whey or negus, prevent the progress of the disease in many cases. Women who are of a very delicate irritable consti- tution, whose feelings are acute, and whose habit is weak, are often attacked with symptoms which resem- ble some of the hysteric ones. These symptoms differ from those attending regu- lar hysteric affections, by their being less violent, by their occurruig at vague irregular intervals, seemingly unconnected with the periods of menstruation, and by their affecting only women of weak irritable relaxed habits. 86 MANAGEMENT OF The treatment of these disorders must be very dif- ferent from that of regular hysterics ; for the reme- dies necessary in the former would prove highly improper in the latter. They require the employment of every means which can strengthen the system, along with variation of scene, and agreeable cheerful company. The use of opiates in these disorders is more bene- ficial than in the real hysteric affections: though in both they must be occasionally had recourse to, to pal- liate troublesome symptoms ; yet the habitual use of such remedies must be carefully guarded against. Valerian, camphor, musk, and the other medicines commonly styled nervous, are the suitable remedies for this disease ; but they ought never to be prescribed in a spirituous form. FEMALE COMPLAINTS. CHAPTER II. PREGNANCY. THE particular manner in which Pregnancy takes place has hitherto remained involved in obscu- rity, notwithstanding the laborious investigations of the most eminent philosophers of all ages. Although Pregnancy is a state which (with a few exceptions) is natural to all women, it is in general the source of many disagreeable sensations, and often the cause of diseases which might be attended with the worst consequences, if not properly treated. It is now, however, universally acknowledged, that those women who bear children enjoy usually more certain health, and are much less liable to dangerous diseases, than those who arc unmarried or who prove barren. SECTION I. CHANGES TUODUCED ON THE WOMB BY IMPREG- NATION. IN consequence of impregnation the womb suffers very considerable changes in Size, Shape, Situa- tion, and Structure. 88 MANAGEMENT OF These are very different in the early and latter months of pregnancy, and therefore require a separate description. In the early months the size of the womb is not much augmented, for about the fourth month it is not so large as. to be felt by applying the hand on the belly. Its shape is chiefly altered at the bottom, which be- comes rounded, and rises considerably above the broad ligaments. Between the fourth and fifth month its shape and size resemble pretty nearly an ordinary sized Florence flask, somewhat flattened. The situation of the womb during the early months is not materially altered, for it remains within the ca- vity of the bason till the fourth month, when it begins to ascend. Before that time, from its increased weight, it sinks rather lower iihan naturally, and hence produ- ces an irritation on the neighbouring parts, which ex- plains some of the complaints during that period. The structure of the womb in the early months is considerably changed; its mouth, from a very short time after impregnation, is closed up with a glairy sub- stance, which prevents any thing from passing out of or into it; and hence no woman can menstruate during pregnancy, as many have alleged. The substance of the womb at this time becomes spongy at the bottom, and the blood-vessels which en- ter at that part are gradually enlarged in size, though they are not so large, till after the fifth month, as to be capable of admitting much blood. After the fifth month the womb increases rapidly in size, and can then be felt plainly by the hand appli- ed externally. Between the eighth and ninth month it is so large as to be twelve or thirteen inches in length, and eight or nine in width at its broadest part. The shape of the womb, in the latter months, is somewhat oval. It acquires this form, however, by 1'EMALE COMPLAINTS. 89 degrees ; for till the sixth month its neck remains nearly as in the unimpregnated state ; after that time it gradually becomes enlarged, and at last its former appearance is entirely obliterated. As the womb is attached to the sides of the pelvis only to the extent of about three inches above its mouth, by far the greatest part of it is fixed to none of the surrounding parts, and is therefore quite unsup- ported. The round ligaments seem to be very much stretch- ed in the latter months. The situation of the womb after the fifth month va- ries considerably. It ascends by degrees as high as the pit of the stomach, at which it arrives a little after the eighth month ; and then it again sinks in such a manner, that immediately before labour comes on, in many cases the belly appears quite lessened, or flat. The changes on the neck, and on the situation of the womb, have been considered as marks by which the exact period of pregnancy can be ascertained ; but as the neck undergoes more rapid changes in some caj ses than in others, and as the womb rises higher in first than in subsequent pregnancies, and varies also ac- cording to the shape of the woman, little dependence can be placed on such circumstances. When the womb rises as high as the pit of the sto- mach, it occupies nearly the whole cavity of the belly, and by pushing the intestines behind and to the sides, it compresses them very much, which occasions many complaints at that period. The structure of the womb in the latter months is very different from what it is in the unimpregnated state. It is of a very lax spongy texture, easily torn ; .and hence there is the greatest necessity for the most cautious management during labour, otherwise the child, under certain circumstances, may readily be pushed through the substance of the womb into the ca- M 90 MANAGEMENT Ol vity of the belly, an accident followed by the most a- larming consequences. The blood-vessels of the womb, after the fifth month, increase very considerably in size, especially at one part ; and therefore a discharge of blood from the womb after that period is always extremely dangerous, as the vessels are then capable of pouring out a very great quantity. SECTION II. CONTENTS OF THE WOMB DURING PREGNANCY. THE child would be exposed to many hazards, in consequence of the various exertions which wo- men must necessarily make during pregnancy, were it placed in the womb without any defence. Nature has, however, provided a most beautiful apparatus for protecting it from such dangers. The child, when in the womb, is included within a bag formed by three membranous layers, and is sur- rounded by a watery fluid, which prevents it from be- ing affected by external injuries. The outer of these layers, although pretty thick, is easily lacerated ; it is attached to the whole internal surface of the womb, and receives blood from that organ. The other two layers seem to belong exclusively to the child, as they are found to envelope it in cases where it is not contained within the womb. They are transparent and strong, and have no visible blood- vessels. The child is connected with the mother by a thick FEMALE COMPLAINTS. 91 spongy mass, which differs in size and shape in differ- ent cases, called the placenta, cake, or after-birth. The cake lies between the outer and the two inner layers of the bag in which the child is contained : its surface next the mother is covered with the former, and its other surface with the latter. The external surface of the cake is very spongy, and receives blood from the arteries of the womb, which penetrate into its substance. The blood is returned to the womb by large veins. The internal surface of the cake is quite distinct from the external; it is composed of a very great number of blood-vessels, which divide into exceedingly minute branches, interwoven with each other, and with cellu- lar substance. These vessels receive blood from and return it back to the child. The cake, therefore, consists of two parts, which, though intimately connected with each other, have a distinct system of blood-vessels ; for the one* belongs exclusively to the mother, and the other to the child ; and no blood has ever been proved to pass directly from the one to the other. The child is connected to the cake by a cord called the umbilical cord, or navel-string ; this consists of two arteries, a vein, and a quantity of a jelly-like substance, covered by skin, the external part of which seems to be formed by the two internal layers of the bag containing the child. The Umbilical Cord varies in length and thickness in different cases. One of its extremities is attached to the cake, the other to the child. The former of these is fixed at no particular part of the after-birth in ' every case, for it is sometimes connected to the middle, sometimes to the edge, but more frequently to some part between them. The latter is generally inserted into the middle of the belly of the child. It was formerly observed, that each branch into which 92 MANAGEMENT OF the Great Artery is divided at the lower bone of the spine, is subdivided into two ; the internal of these in the child before birth being extended, run up along each side of the urinary bladder, pass out at the centre of belly, and form the Arteries of the umbilical cord. These arteries are divided into a very greatnumber of minute branches, and terminate, as usual, in veins, which uniting, form one large vessel, the vein in the umbilical cord. This vein returns the blood to the child, and conveys it in the most expeditious manner to the heart by pecu- liar canals, which are shut up soon after birth. In grown people, it was formerly remarked, all the blood returned from every part of the body is distribu- ted over the substance of the lungs, before it be again circulated through the system. This takes place in children immediately after birth : before that time, however, a small portion of the blood only is sent to the lungs, but the whole is distributed over the cake. From this circumstance, and from the child being ■Very soon killed when the cord is so much compressed that the blood cannot pass through it, the cake, it is pro- bable, serves the same purpose to the child before birth which the lungs do afterwards. The substance by which the child is connected to the mother is not attached to any certain particular part of the womb ; for it is sometimes fixed to the neck or orifice, but fortunately more often to the bottom, or near it. The water contained within the layers which sur- round the child is somewhat heavier than common wa- ter. It has a saltish taste, does not coagulate, like the white of an e^%, but seems to approach in its properties to the nature of urine. This fluid is seldom, except in the early months of pregnancy, quite pure, for it is lia- ble to become polluted by impurities from the child. This water, therefore, cannot, from its nature, be in- FEMALE COMPLAINTS. 93 tended for the nourishment of the infant; a fact which is confirmed by the circumstance of its being in much greater quantity in proportion to the size of the child, in the early than in the latter months. This fluid serves several valuable purposes. It de- fends the child from external injuries; it affords it an equable temperature, not liable to the extremes of heat and cold, to which the body of the woman must neces- sarily be subject; and it has other important uses, to be afterwards explained. The position of the child in the womb merits atten- tion, as it explains the causes of some of the dangers to which women are sometimes exposed during partu- rition. The child, during the early months of pregnancy, floats loosely in the fluid by which it is surrounded; but after it has increased to such a size as to occupy nearly the whole cavity in which it is contained, it is folded into an oval figure, so that it takes up almost the least possible space. One or other extremity of this oval figure which the . child forms is commonly placed at the mouth of the womb, and in by far the greatest number of cases it is that made by the head; sometimes, however, the other extremity is in that situation. It happens also in very rare cases, that the extremities are placed towards the sides of the womb ; a circumstance which must render delivery difficult and hazardous. The contents of the womb increase in size at first ve- ry slowly, and afterwards rapidly; for after the first eight or nine weeks the bag which contains the child is seldom larger than a hen's e^ ; but from that time it becomes perceptibly enlarged every week or two. As children at the full time differ in size and weight in different cases, it is probable that the same degrees of difference take place in the early months : therefore no particular proportions can be ascertained respecting 94 MANAGEMENT OF the dimensions of children at the various periods of pregnancy. A child born at the full time generally weighs from six to ten pounds, which latter it seldom exceeds ; and every child that does not weigh more than five pounds, may be considered to be premature. When more than one child is contained within the womb, each is included in its own proper membranes, and is attached to the mother by a cake peculiar to it- self. In many cases, however, the cakes are contii guous to, or entirely blended with each other : but the navel-string, which belongs to each child, points outthe distinction between them, and proves that a single cake cannot serve two or more children. In some rare cases, the blood-vessels belonging to the child of each cake communicate with each other: hence a par- ticular precaution in tlie management of the delivery of twins becomes necessary. SECTION III. SIGNS OE PREGNANCY. "'"T^HF Signs of Pregnancy arise from the changes JL produced on the womb by impregnation, and the effect which these communicate to the general sys- tem ; for the womb has a very extensive influence over many parts of the body. They may be divided into those of the early, and those of the latter months. During the first fourteen or fifteen weeks, the Signs of Pregnancy are very ambiguous ; for as they proceed from the influence of tlie womb on other parts, they FEMALE COMPLAINTS. 95 may. be occasioned by every circumstance which can alter the natural state of that organ. The first circumstance that renders pregnancy pro- bable, is the suppression of the periodical evacuation, which is generally accompanied by fulness in the breasts, headach, flushings in the face, and heat in the palms. These symptoms are commonly the consequences of suppression, and therefore are to be regarded as signs of pregnancy in so far only as they depend on it. As, however, suppression of the periodical evacua- tion often happens from accidental exposure to cold, or from the change of life in consequence of marriage, it can never be considered as an infallible sign. The belly, some weeks after pregnancy,' becomes fiat, from the womb sinking, as formerly explained ; and hence drawing down the intestines along with it. But this cannot be looked upon as a certain sign of pregnancy, because an enlargement of the womb from any other cause will produce the same effect. Many women, soon after they are pregnant, become very much altered in their looks, and have peculiarly irritable feelings, inducing a disposition of mind that renders their temper easily ruffled, and incites an irre- sistible propensity to actions of which on other occa- sions they would be ashamed. In such cases the features acquire a peculiar sharp- ness, the eyes appear larger, and the mouth wider than usual, and the woman has a particular appearance, which cannot be described, but with which women are well acquainted. These Breeding symptoms, as they are called, ori- ginate from the irritation produced on the womb by impregnation ; and as they may proceed from any other circumstance which can irritate that organ, they cannot be depended on when the'woman is not young, 96 MANAGEMENT OF or where there is not a continued suppression for at lest three periods. The irritations on the parts contiguous to the worn!) are equally ambiguous, end therefore the signs of pregnancy in the first four months are always to be considered as doubtful, unless every one enumerated be distinctly and unequivocally present. From the fourth month, the signs of pregnancy are less ambiguous, especially after the womb has ascend- ed into the cavity of the belly. In general about the fourth month, or a short time after, the child becomes so much enlarged, that its motions begin to be fert by the mother ; and hence a sign is furnished at that period called Quickening. Women very improperly consider this sign as the most unequivocal proof of pregnancy ; for though when it occurs about the period described, preceded by the symptoms formerly enumerated, it may be looked upon as a sure indication that the woman is with child ; yet when there is an irregularity, either in the preceding symptoms or in its occurrence, the situation of the wo- man must be doubtful. This fact may be easily understood ; for as the sen- sation of the motion of the child cannot be explained, or accurately described, women may readily mistake other sensations for that of quickening. I have often known wind pent up in the bowels, and the natural pulsation of the great arteries, of which people are conscious only in certain states of the body, mistaken for this feeling. After the fourth month, the womb rises gradually from the cavity of the bason, enlarges the belly and pushes out the navel; hence the Protrusion of the Navel has been considered one of the most certain signs of pregnancy in the latter months. Every circum- stance, however, which increases the bulk of the belly, FEMALE COMPLAINTS. ar occasions this symptom: and therefore it cannot be trusted to unless other signs concur. The progressive increase of the belly, along with suppression, (after having been formerly regular), and the consequent symptoms, together with the sensation of quickening at the proper period, afford the only true marks of pregnancy. These signs, however, are not to be entirely de- pended on ; for the natural desire every woman has to be a mother, will induce her to conceal, even from her- self, every symptom that may render her situation doubtful, and to magnify every circumstance which can tend to prove that she is pregnant. The situation of practitioners in such cases must be very embarrassing and distressing. It ought, how- ever, to be adopted as a general rule, that where any irregular symptoms give room for suspicion, if strong proofs are offered in support of the alleged pregnancy, the woman should for a certain period be treated as if pregnant, in order to ayoid those unfortunate conse- quences which have too often occurred from an oppo- site line of conduct. Beside quickening and increase of bulk of the belly, another symptom appears in the latter months, which, when preceded by the ordinary signs, renders preg- nancy certain beyond a doubt. It is the presence of milk in the breasts. When, however, there is any ir- regularity in the preceding symptoms, this sign is no longer to be considered of any consequence. As every woman must naturally wish to distinguish pregnancy from disease, the disorders which resem- ble it form the subject of the next section. It is, how- ever, necessary to remark, that wherever any circum- stance occurs which affords the most distant reason to doubt the case, recourse ought to be had to the advice of an experienced practitioner, and every symptom should be unreservedly described to him. N MANAGEMENT OF SECTION IV. CIRCUMSTANCES WHICH INDUCE SYMPTOMS RESEM- BLING THOSE OF PREGNANCY. EVERY woman would certainly wish to avoid the sneers to which those are generally exposed who improperly imagine themselves with child. It must be an important object, therefore, to exhibit a view of the circumstances which occasion symptoms resem- bling those of pregnancy. These vary much in their nature ; for some are oc- casioned by morbid effects on the uterine system, which are sometimes the consequence of pregnancy ; some originate from diseases affecting the womb, and others occur merely from the natural change at the decline of life. It is now universally known- that after impregnation, the child, in its original minute state, passes from one or other of the Ovaria, along the corresponding Fallo- pian Tube, into the womb. Sometimes, however, the child remains in the ovarium or tube, or falls into the belly, and nevertheless is nourished, and increases in size for a certain time. These cases are named Ex- tra-Uterine Cojiceptions. For the first four or five months, in such cases, the symptoms of breeding appear regularly. After that time, however, the breasts lose their enlarged ap- pearance, and become flaccid ; the belly no longer in- creases in size, and a weighty and cold sensation is felt in one side. The usual term of pregnancy at last elapses without any symptom of labour. Cases of extra-uterine conceptions have terminated FEMALE COMPLAINTS. 9» variously. In some irritable constitutions, the inflam- mation which must unavoidably be produced on the neighbouring parts, from the unusual presence of a large body, ,is so violent as to occasion death ; but in other cases, suppuration is brought on, which furnishes an outlet for the confined conception ; and in some rare instances, the extra-uterine child has remained, wiihout exciting very disagreeable complaints, for many years. Proper advice, in every case of this kind, should be had recourse to as early as possible, as it will be the means of preventing many of those dangerous symp- toms which often are the consequence of inattention. It is to be recollected, however, that cases of extra- uterine conception are so very uncommon, that for forty years not above six have occurred in this city. Every disease which, affecting the womb, tends to increase the size of that organ, or any of its appen- dages, produces symptoms nearly resembling, for the first three or four months, those of pregnancy. Such are collections of blood, or hydatids, or tumours in the womb, and dropsy of the ovaria. These may be distinguished from pregnancy by the symptoms peculiar to themselves, already described, and are to be treated in the manner formerly advised. Another circumstance, by increasing the size of the womb, may cause symptoms like those of breed- ing, the presence of what is called a ALle in the womb. Women were formerly much imposed on by inter- ested practitioners respecting the nature of moles. The most dreadful apprehensions were excited in con- sequence of these being alleged to be occasioned by faults in the general habit, which it required the most vigorous employment of the powers of medicine to counteract. Moles are however merely blighted conceptions, iOO MANAGEMENT OF which, from retention in the womb, lose their orga- nized form. They are generally expelled in the same manner as miscarriages, and are preceded by the same symptoms, and hence require nearly a similar treatment. Women who are married at a late period, anxious to have a family, naturally mistake the circumstances which appear at the decline of life for the signs of pregnancy. Such cases are highly troublesome to practitioners ; for the patient, with great care, acquires the most accurate description of the breeding symp- toms, and with wonderful facility imagines that she feels every one of them. The suppression of the accustomed discharge first furnishes hopes for what is anxiously wished. Her supposed situation affords an excuse for indulgence in inactive life, and for the gratification of every appetite: of course the natural disposition to fulness, which strong healthy women have at that time, is so much increased, that the belly becomes enlarged, while idea had formerly suggested the sensation of quick- ening. In many such cases a fluid, resembling milk, is found in the breasts, and this never fails to confirm the delusions of the patient. It is probable, that such a fluid can be produced by mechanical pressure on the breasts ; and perhaps some other circumstances may also contribute to its formation, that have not yet been fully explained. FEMALE COMPLAINTS. lei SECTION V. DISEASES INCIDENT TO THE EARLY MONTHS OP PREGNANCY. IN consequence of the change produced by Preg- nancy on the womb, many disagreeable complaints occur in the early months, which, though not imme- diately dangerous, may, if neglected, occasion the loss of the child, and lay the foundation for a train of disorders, that may materially impair the health of the patient. The principal diseases incident to the early months are, sickness and vomiting, heartburn, disordered state of the bowels, unnatural craving, swelling and pain of the breasts, fainting and nervous fits, and preter- natural change of position of the womb. Sickness and vomiting.—.The most healthy women are as much subject to sickness and vomiting during the early months of pregnancy as those who are weak or delicate. The symptoms require, however, very different treatment in these two cases. When sickness or vomiting is attended with violent strainings, bleeding at the nose, pain or giddiness in the head, flushing in the face, increased heat in the palms of the hands, with other symptoms of fulness and disturbed rest, blood-letting, with an open belly, and a spare diet, afford the greatest relief. When, however, the vomiting occurs in weak deli- cate women, and when it is attended with great weak- ness and languor, with a disposition to sweat on using moderate exercise, or during the night, a very oppo- site plan of management must be pursued. In such cases, bleeding should be carefully avoided, 102 MANAGEMENT OF and a light nutritious diet ought to be recommended. The moderate use of wine is also necessary. Small doses of any light stomachic bitter, as Co- lumbo, Peruvian bark, or the bitters, the preparation of which is described in the forms of medicine at the end of this work, should betaken every day during the early months by those who are delicate. The powers of digestion being impaired, the sto- mach becomes readily loaded with crude indigested food ; and hence sickness and vomiting are occasioned. Women in the early months seem to have a natural tendency to this cause of sickness ; this may probably be owing both to the particular change in the system, and to the inactive sedentary life in which many think themselves obliged to indulge at that time. The stomach may be known to be disordered, if, along with violent retchings, the tongue be foul, and there be an ill taste in the mouth, attended with fetid breath or belchings. When such symptoms accompany the sickness or vomiting, the stomach should be emptied once or twice a-week, by means of fifteen or eighteen grains of Ipecacuan, which are found to affect the body much Jess than natural straining in vomiting, and often pro- duce the happiest effects. In many cases however, the breeding sickness con- tinues, notwithstanding every remedy, till the womb rises into the cavity of the belly, and the motion of the child be distinctly perceived, when in general it ceases. When the sickness is excessive, and the stomach at the same time is not disordered, opiates often afford temporary relief. The plaster with opium, described in the forms of medicine, applied to the pit of the stomach, has often moderated the sickness, when every other means had been tried in vain. Many practitioners recommend FEMALE COMPLAINTS. lo.l plasters composed of various stimulating and heating materials, to be applied in the same manner ; but as they are frequently productive of very disagreeable complaints, in consequence of the violent irritation which they induce, if they ought not to be entirely exploded, at least they should be employed with much caution, and only by the advice of a practitioner. Heartburn.—.The uneasy sensation produced by heartburn, though commonly confined to the early months, sometimes accompanies every stage of preg- nancy . This complaint often originates from less degrees of those causes which occasion sickness and vomiting ; hence, in different cases, it requires a variety of treatment. When the heartburn is attended with a constant de- sire to hawk up phlegm, the stomach should be emp- tied by a vomit, the state of the belly attended to, and small doses of the Peruvian bark and vitriolic acid ought to be taken once or twice a-day. If this complaint be accompanied with a sour taste iii the mouth, and acid eructations, lime-water, pre- pared chalk mixed with water, or magnesia, afford the best palliatives. The belly should be kept gently open by means of magnesia and rhubarb. Gross food of every kind ought to be avoided, and the stomach should never be overloaded. When, however, the uneasy-burning pain produced bv this disease is not attended with an inclination to hawk up phlegm nor acid eructations, a little fine Gum- Arabic, or a spoonful of a fluid prepared by mixing the white of an egg with a little sugar and water, so as to make it of the consistence of thin syrup, taken occa- sionally, will in many cases moderate the pain. If the patient, with such symptoms, have any marks of ful- ness, she should lose blood. Disordered state of the bowels.—The natural func- 104 MANAGEMENT OF tions of the stomach are very liable to become disor- dered in the early months of pregnancy ; hence loose- ness of the belly is a common complaint at that time. This disorder proceeds from various causes; and therefore it requires, in different cases, different modes of treatment. When looseness of the belly is attended with symp- toms of disordered stomach, it can only be remedied by a vomit and gentle doses of magnesia and rhubarb, while at the same time every irregularity in diet must be carefully avoided. When there is no sickness, two or three doses of magnesia and rhubarb will be suffi- cient. In these cases the use of opiates, or any restringent medicine, with a view to remove the complaint, must prove highly injurious ; for they tend to increase the disordered state of tlie stomach and bowels. If, however, looseness of the belly proceeds from the irritation produced by the increasing bulk of the womb on the straight gut, to which it has been ob- served it is contiguous, small doses of opiates will then prove beneficial. This cause may be suspected if the looseness be not accompanied with any symptoms of disordered stomach. In this case, when the straining at stool is violent or very frequent, occasional Lax>e- mens made of thin starch, with fifty or sixty drops of Laudanum may be had recourse to with great safety. Unnatural cravings.-—Pregnant women have often unnatural cravings, or what are termed longings, which, however absurd they may appear on some occasions, are frequently entirely involuntary. Where they are confined to articles relating to diet, this may always be considered to be the case. These cravings seem to proceed from the state of the stomach, for they often occur in men whose sto- machs are disordered. The peculiarly irritable state ^f the mind during pregnancy, already taken notice oft FEMALE COMPLAINTS. w. probably increases the violence of cravings, that might, under other circumstances, be only felt as transient desires. Longings should, unless where 'the indulgence might be followed by disagreeable consequences, be in general gratified; for when the appetite is fee- ble, and the powers of digestion impaired, the stomacli often rejects particular substances, and retains others, which, though seemingly whimsical, are suggested by a kind of natural craving. Although, therefore, unlimited compliance with every desire might be improper, yet the wished-for substance, where it can be easily procured, should be allowed, as it may perhaps agree better with the sto- mach than any other substance, and as disappointment in the irritable state of early pregnancy might induce passions of the mind that would be productive of many disagreeable circumstances. Women often claim indulgence in their longings, by an argument well calculated to insure success, the dangers which might happen to the child from their cravings being neglected. Although at present the idea, of the imagination of the mother having the power to produce marks on the body of the child, does not so universally prevail as it did formerly; yet many people, judicious and well informed in other respects, still seem to favour this op nion. Many cases might be adduced, where children were born with marks on the skin (vulgarly called/ FFMALE COMPLAIN Th. 19 . siruction of that discharge may be occasioned by sud- den exposure to cold, or by irregularities in manage- ment, and is then an original disease. This may be distinguished from the former complaint, by the vio- lent symptoms of fever which attend, and by the histo- ry of the previous state of the patient. In these cases, the return of the evacuation is pro- moted by the application of warm fomentations to the belly, by the use of warm diluent drinks in small quan- tities often repeated, as gruel with a little wine, white- wine whey, &c. When the symptoms of fever are alarming, doses of saline julep, with the addition of four or five drops of antimonial wine, every two or three hours, or three or four grains of genuine James's powder, repeated at the distance of seven or eight hours, afford the best means of relief. The importance of Cleanliness, as long as the Lo- chial discharge continues, does not require being- pointed out; but when the evacuation has a bad smell, common attention in that respect is not alone suffici- ent ; for unless the most scrupulous regard be paid to prevent its stagnation in the passage of the womb, excoriations, or inflammation with all its formidable consequences, will ensue. The nurse must on such ^occasions be directed to wash that organ, by means of a proper apparatus, twice or thrice a-day with warm milk and water, or with an infusion of chamomile flowers. Bb 194 MANAGEMENT OF SECTION V. DISEASES OF THE BREASTS. HnilE structure of the Breasts, already explained,* JL renders them the frequent seat of disease. Some of the disorders to which they are liable, can be readi- ly removed when they first appear; but if neglected, become painful to the patient, and troublesome to the practitioner. Others can be more easily prevented than cured. In a work of this kind, although the nature of all these diseases ought to be explained, the treatment of many of them must be necessarily passed over, as it should be referred to the care of medical practitioners, and ought never to be undertaken either by the pa- tient herself or the attendants. When, along with the symptoms which are occa- sioned by the determination of milk to the breasts, any hardness or painful swelling is felt in either of these organs, if these do not subside after the child-has been applied, and the treatment formerly recommended has been pursued, immediate attempts ought to be made to prevent the progress of inflammation, by the use of a large poultice, formed of soft bread, and the preparation of sugar of lead, described in a former part of this work.f If the feverish symptoms be very violent, and the patient hz of a full habit, blood should be drawn from the arm, and some ger.tle cooling laxative ought to be prescribed. The child should be applied when neces- sary, with the precaution of previously washing the • IUge 31. t See Page 63. FEMALE COMPLAINTS. 19j affected breast or breasts with a little warm milk and water, to prevent the infant from being injured by the medicine. When, notwithstanding a continued perseverance in this plan, the swelling or inflammation increase, along with hardness, throbbing pain, and heat in the affected part, and general fever, a soft poultice of bread and milk, or of linseed, sufficiently large to cover it, ought to be applied, and renewed as often as it may be sup- posed to be cold ; the breast should be supported by a handkerchief suspended from the neck. Suppuration will in this manner be speedily promot- ed, (when that circumstance cannot be avoided); and the matter, as soon as it is well formed, should have an outlet by the use of the lancet; which, though ap- parently formidable, causes much less pain, than if the opening were trusted to nature. The sore may be afterwards dressed by a pledgit formed of Basilicon or Spermaceti ointment, spread on soft charpee ; and while pain, inflammation, or hard- ness continue, the poultice should be applied over the dressings. It must not be concealed, that the cure of boils in the breasts will always be more or less troublesome, according to the seat of the disease; for when they are situated deep, they are generally'tedious in their progress to suppuration, exceedingly painful, and at- tended with a considerable degree of fever, by which the constitution is often impaired, and great weakness induced, 'n such cases, the patient is unable to con- tinue to nurse her child. But if these boils be quite superficial, they soon sup- purate, commonly burst spontaneously, and affording a free exit to the matter, heal kindly and speedily ; and not only do not impede sucking, but often occasion little uneasiness. The Nipples, from the delicacy of their structure, i^G MANAGEMENT OF are very liable to be injured by the action of the child's mouth in sucking, along with the irritation which the stagnant milk occasions, unless they be kept very dry. The most simple and favourable disease proceed- ing from these causes, is excoriation, or great degree of tenderness in the nipples ; which, although the source of considerable pain, ought not to prevent the patient from giving suck. Women are subject to this complaint more frequently while nursing their first or second child than afterwards ; for the nipples lose much of their sensibility by use. In the treatment of this disease, the great object to be attended to, is, to remove, as much as possible, every circumstance which can tend to irritate these parts. With this view, the nipple ought to be washed fre- quently with any gently stimulating liquor, which can diminish its sensibility ; as brandy and water, a weak solution of alum, or of sugar of lead in rose water, he. The milk should be prevented from wetting these parts, by the application of broad breast glasses, or rings of boxwood, ivory, or lead : The latter of these are commonly used in this country ; they are well adapted for keeping the nipples cool, as well as dry, and for defending them from injuries from the wo- man's clothes. All these rings should be constructed in such a manner, as to allow the nipple to protrude through them. An artificial nipple, covered with a prepared cow's teat, has been lately invented, as a protection to the sore nipple ; and where the child can suck through it, which is not always the case, it proves exceedingly useful, and saves the woman a great deal of pain. The sore breast ought to be favoured as much as possible ; and if both be affected, the same purpose may be accomplished, by procuring the assistance of FEMALE COMPLAINTS. 197 a milk-nurse, to take care of the child during the night. Whenever any medicine is applied to the breast, it must be carefully washed off with a little warm wa- ter before the child be allowed to suck. When, instead of pursuing these means with pro- per perseverance, sore nipples are neglected at first, they often prove distressing in the highest degree to the patient, and it becomes very difficult to stop the progress of the disease. Deep sores are occasioned, which resist the power of every remedy in many ca- ses, as long as the woman gives suck, and which may terminate in the total destruction of the nipple, if she persevere in nursing. These sores or chops require very particular man- agement. When the mother is anxious to nurse, if they be not very deep, although a cure cannot be soon obtained, the disease may be rendered supportable, and the pain considerably lessened, by proper dress- ings, till the sensibility of the parts be diminished, and a favourable turn given to the complaint. The art of dressing these chops consists in apply- ing to the sores a small strip of charpee, dipped in a solution of sugar of lead, or alum, and covering the whole with a piece of old clean linen, spread with a liniment, composed of white wax, spermaceti, and oil of almonds, or the common spermaceti ointment. The dressing should be continued as long as pos- sible, and ought to be removed only two or three times a-day, in order to allow the child to suck ; before which, the precautions already suggested must be ob- served. When the chops do not heal by these means, the child ought to be removed, and given to a milk-nurse, otherwise the whole breast may be destroyed.-----In obstinate cases, the sores should be touched by means of a fine hair pencil, with tlie liiument described in the Forms of Medicine, which often produces a cure 198 MANAGEMENT OF in a very short time, after every other method has failed. Women who have been subject to sore nipples should endeavour in future to diminish the sensibility of these parts, by applying to them, for several weeks previous to delivery, cloths dipped in alum-water, in strong spirits, or in the pickle of salted meat boiled; which latter has been recommended as an infallible speciHc for that purpose. When little sores appear in the brown circle sur- rounding the nipple, and correspond with similar ap- pearances in the child's mouth, or other parts of its body, a medical practitioner should be immediately consulted. The case is more urgent, if hard swell- ings in the arm-pits of the nurse have already begun to appear. SECTION VI. PAIN ABOUT THE LOWER PART OF THE BELLY, IN .THE LOWER EXTREMITIES, &C. PAIN about the bones and fleshy parts at the bot- tom of the belly, and in the thighs, originates from rheumatism, separation of the share-bones, and an affection of the glands within the groin. Rheumatic Pairs—occur principally about the hips, the back part of the pelvis, and the thighs. They ar^ known by the gnawing burning sensation which attends them, by their being most violent during the night, and by their not brin^ invariably aggravated by mov- in v. They arc sometimes accompanied by feveri b symptoms. FEMALE COMPLAINTS. 199 These pains are the effects of cold, and prove only of temporary duration. Different modes of treatment are required in different cases, such as bleeding, medi- cines which promote perspiration, and blisters. In every instance, rubbing the affected parts with Ano- dyne or Opodeldock balsam, and covering them with soft flannel, must prove beneficial. Separation of the S ar -Eaies—is the effect of some former accident, of severe labour, or of inflammation within the joint winch connects these bones. This affection is distinguished from every other, by the pain being uniformly increased or excited upon the slightest motion of the lower part of the body, and by feeling the share-bones rasp against each other when either leg is moved. The treatment must depend upon the cause. Where these bones have been separated by a blow or a fall, at a former period of life, they only require being held together by means of a broad belt, till the patient have regained strength. The cold bath, vvl encver it is proper, should be used evening and morning, as it tends greatly to the accomplishment of that object. Where the separation is the consequence of a hard labour, a variety of means must be adopted in differ- ent cases. Suppuration within the joint is a very rare occur- rence. Its progress is tedious, and its termination un- certain ; and therefore very particular attention ought to be bestowed upon the case from tlie beginning. The patient always continues lame till the bones be re-united. Affection of the Glands within the Grcin.—This con sists of a swelling and inflammation of the glands near the flank, which'arise from injuries during labour, or exposure to cold, or the inflammation of some neigh- bouring part, or the irritation of the cleansings. This disease takes place at different periods after de- 400 MANAGEMENT OF livery, from the fourth or fifth day to the seventh week. It is ushered in with pain in the back, smart fever, and painful stiffness in one groin. Soon after these symptoms the thigh begins to swell, and gradu- ally the swelling is extended to the whole limb, so that in a short time it is double the size of the sound limb. It is rather pale-coloured than red ; and hence in some parts of England it is called the white leg. It is hot, shining, very painful on being touched or moved; and at first it does not pit when pressed upon by the finger. When left to nature, this complaint generally proves tedious and distressing. The swelling begins to sub- side at the upper part of the thigh ; hard knotty bumps can then be felt along the back part of the limb; many weeks elapse before the patient can use the leg; and most commonly great weakness of it remains for years. Some women have been rendered hectic, and others dropsical, by the long continuance of this disease. By active treatment at the beginning of the com- plaint, its progress may be certainly stopped. The application of flannels soaked in hot vinegar, or of leeches, or of a blister, to the groin, brisk laxatives, friction with Anodyne balsam, &c. when the swelling begins to subside, the continued use of certain diuretic medicines, and attention to the state of the cleansings, are severally necessary, according to circumstances, of which a medical practitioner can alone be the pro- per judge. Crampish Pains—in the thighs and legs, sometimes attend after-pains, and sometimes arise from bilious cholic. The treatment of them must therefore be va- ried, according to the nature of their cause. FEMALE COMPLAINTS. 2®: CHAPTER III. FEVERS AND INFLAMMATORY COMPLAINTS IN THE CHILDBED-STATE. IV the management during labour, and after deli- very, which has already been fully pointed out, be carefully observed, there is little hazard that fevers, from any cause, (unless the temporary symptoms in- duced by the milk be so styled), shall occur to inter- rupt the progress of recovery. But when, by imprudent treatment, the patient is exposed to any exciting cause of fever or inflamma- tion, it can be easily understood, that from her pecu- liar state after delivery, the danger arising from a dis- ease, the event of which is always uncertain, must be proportionally increased. In this chapter, the nature of the Fevers and Inflam- mations which originate from improper management is explained ; but as their treatment should be entrust- ed to skilful practitioners alone, the means for prevent- ing their occurrence or progress, are more fully de- tailed, than the method of cure. C «■ 202 MANAGEMENT OF SECTION I. IRREGULAR FEVERISH ATTACKS. OMEN are subject, for two or three weeks after delivery, to irregular feverish attacks, if they happen to be imprudently exposed to cold, or have not paid sufficient attention to those regulations in their management with respect to diet, repose, 8cc already explained. These feverish fits, styled in this country Weeds, differ from other fevers in duration, for they seldom continue above twenty-four or thirty-six hours. They begin with universal cold, and violent shiver- ing, accompanied with headach, pain in the back, and sometimes with sickness. After these symptoms have continued for some time, a great degree of heat suc- ceeds, followed at last by a copious sweat, which termi- nates the disease, but leaves the patient considerably weakened. Irregular fevers of this kind are seldom productive of any immediate danger ; but from the disposition to future attacks which is always induced, a foundation is laid for subsequent complaints, especially if proper \ treatment be not pursued. i Symptoms resembling these irregular feverish at- \ tacks precede inflammation of the breasts, or of some of the organs necessary to life, and have often been , mistaken for them. There is, however, an obvious I distinction between these disorders ; for when inflam- mation has taken place, there is always a fixed pain j in the affected part, and the state of the pulse is very different in the irregular feverish complaints, which form the subject of this section. w FEMALE COMPLAINTS. 203 In the treatment of weeds, little aid from medicine is in general necessary ; for proper attention to the following simple management will commonly be suf- ficient to overcome the disease, and prevent its re- turn. During the cold fit. the endeavours should be direct- ed towards restoring warmth to the patient; but the means usually pursued for this purpose are highly im- proper ; for ignorant attendants, with this view, heap on great loads of bed-clothes, and pour in ciuantities of heating and stimulating drinks, byj way of cordials, which readily induce violent delirium, or a more ob- stiuate fever, ivo real advantage can be derived from additional bed-clothes ; because, by their weight, diffi- cult or oppressed respiration may be occasioned. If the shivering be excessive, warm flannels should be applied to the stomach and belly, and the same, or bottles filled with warm water, ought to be put to the feet. Warm diiuent drinks, as orange-whey, barley-wa- ter, gruel, weak wine whey, Sec. may be freely drank, and should be always prescribed. When the patient is very weak or low, a small proportion of wine is ne- cessary ; but that ought to be avoided, if possible. It there be reason to believe that the stomach is disor- dered, which may be discovered by the appearance of the tongue, and by the sickness that attends, gentle vomits are necessary. When the hot fit begins, the drinks should be con- tinued, a free circulation of cool air in the room must be encouraged, and the pMent should be lightly co- vered with bed-clotnes. It is vulgarly imagined on such occasions, that heat is absolutely requisite to pro- mote perspiration : but the very contrary is the case ; for when the pulse is very quick, and the body hot, sweat can only be induced by lessening the quickness of pulse, and heat of the body. This is to be accom- 04 MANAGEMENT OF plishedby a strict observance of the cooling regimen; and for this purpose, along with cold drinks and ripe fruits, the saline or nitrous julep will be found bene- ficial. By these means, the burning heat and thirst of the woman will be removed, the pulse will become re- gularly moderate, a gentle moisture will appear over the whole body, and a complete relief from all uneasy sensations will be felt. The perfect recovery of the patient, however, ought not to be considered as completely established when the sweat comes out; for unless careful and judicious treatment be still pursued, a return of the disease may- take place. For if excessive perspiration be protract- ed too long, or checked suddenly, the effects will be equally hazardous. In the former case, nervous com- plaints or eruptive fevers may be dreaded ; and in the latter, a second and more severe attack of the fever- ish symptoms may with reason be expected. The sweating, when moderate, ought therefore to be encouraged, by warm diluent drinks, for six or eight hours ; and then if it do not stop, the drinks should be given in small quantity, very seldom, and made less warm. The bed and body linens must be shifted, and dry clothes (previously warmed, but not much heated) substituted in their stead. When costiveness occurs during the course of the complaint, it may be obviated by gentle laxative Lavc- nens. The return of this disorder is to be prevented by an attention to proper management, and especially by guarding against those circumstances which probably occasioned the disease. The diet should therefore be suited to the constitution of the patient: food ought in general to be very light, and of easy digestion. Wherd a disposition to nervous affections prevails, and where the patient has been accustomed to a full FEMALE COMPLAINTS. 205 rich diet, the food must be more solid and nutritious than in other cases, and a moderate proportion of wine should be allowed. The Peruvian bark, or preparation of myrrh, when any strengthening remedy is necessary, ought to be prescribed. In the irritable state of lying-in women, passions of the mind prove a frequent cause of irregular feverish attacks : they may be moderated by opiates. Many women are subject to these complaints, from the interruptions in their nights rest which arise from nursing. When this happens, the means for curing and preventing the disorder obviously consist in re- linquishing a task for which such women are very SECTION II. EKUl'TIVE OR RASH FEVER.* rT^HE improved method of treating lying-in wo- JL men, now almost universally adopted in this island, fortunately renders the appearance of the Rash Fever much more uncommon than formerly. This disease varies in its symptoms in different wo- men, and even in the same woman on different oc- casions, where the repetition of improper treatment subjects the patient to another visit of the complaint in a subsequent lying-in. The most rare form of the disease is ushered in with the following symptoms, viz. shivering, head- • This complaint is styltJ in Medical language the MILIARY FEVER. 20G MANAGEMENT Or- ach, sometimes vomiting, cold extremities, dull eyes, disturbed sleep, weak quick pulse, and an almost to- tal stoppage or great diminution of the usual excre- tions. These complaints continue for a considera- ble time, and are attended with remarkable dejection of spirits, and excessive desponding anxiety, and at last are followed by a sudden and vicient sour-smell- ing sweat, pricking of the skin, and an eruption. Some time before tliis appears, the pulse becomes more full and strong. The eruption or rash is at first confined to the neck, breast, and arms, but it soon spreads over the whole body, and seidom affects any other part of the face than the brc.v. The appearance of the eruption va- ries according to the constitution of the patient, or ra- ther according to the situation in which she is when the disease takes place : it most generally occurs in the form of red distinct very small pimples, which can be felt to be prominent, and are more percepti- ble to the touch than to the eye ; but sometimes these are white or yellow, except at the base. The former of these eruptions, (commonly distinguished by the name of Ruih*) is more favourable than the latter, which affects only those patients who are much weak- ened, and have a disposition to complaints attended with symptoms of putrescencv. The duration and consequences of this fever are as various as the con situ ions of the patients whom it at- tacks. In the mildest species of the disease, the erup- tion and feverish symptoms continue three, four, or five days, and are followed by a considerable degree of weakness, which, however, yields in a short time to proper management. But when the pimples are white or yellow, they often continue a long time ; for as one crop disappears, another, after some interval, is produce!, even to the third or fourth succession : FEMALE COMPLAINTS. 207 In such cases, the weakness is much greater than in the other species of the eruption. The event of Rash Fever may always be expected to be favourable, when the distressing symptoms abate on the appearance of the eruption ; but if this do not happen, if the pulse continue small and weak, if fre- quent cold fits occur, if fetid stools be passed involun- tarily, and if convulsions attend, much danger is to be dreaded. The cure of this disease, depending on a variety of circumstances, cannot be restricted to any particular method. In the beginning of the fever, if sickness attend, a vomit should be prescribed ; and in every case, gen- tle laxatives are necessary and beneficial: Where the cold fits are very frequent, or there is reason to dread delirium, fomentations, by means of flannels, wrung out of warm water, applied to the legs and thighs, arc often of service ; they should also be employed where the eruption suddenly recedes. These fomentations must not be used too hot, ncr continued so long as to force out profuse sweats. Every means which can moderate the heat of the body and the quickness of the pulse, ought to be used when the eruption comes out; a free application of cool air is therefore particularly necessary : If the wo- man have been previously kept very hot, the change must be made in a gradual manner. The nitrous mixture, cool acid drinks, ripe fruits, and a light diet, should be recommended. When the patient is much weakened, and the rash is white or yc How, the Peruvian bark ought to be giv- en in suitable doses. If the pulse continue weak after the eruption, wine, along with the bark, in a quantity proportionate to the state of the patient, will be found useful. The most common varieties are, where the erup- 20S MANAGEMENT OF tion follows continued sweating, or the sweating stage of the milk -fever, or some disease productive of great weakness, or where it is preceded by violent lever, pain in the head, chest, or bowels, and evident symp- toms of some internal inflammatory affection. 1'he circumstances which occasion these varieties of the disease, certainly originate from improper treatment after delivery ; for whenever a woman in such a situation is confined within a heated room, op- pressed with a great quantity of bed-clothes, and forc- ed to drink stimulating liquors, with the view of promot- ing a sweat, according to the absurd and pernicious customs formerly observed in the treatment of lying- in patients, she is almost always seized with Rash Fe- ver. A disease of the same nature, it may be menti- oned, in confirmation of this opinion, sometimes suc- ceeds the same treatment of men who have been weakened by profuse evacuations. These varieties of Rash Fever can therefore be ge- nerally prevented, though when they have taken place, they are not easily remedied. If any arguments in addition to those already adduced, were necessary to enforce the observance of the plan formerly suggest- ed, for the treatment of women after delivery, the his- tory of this complaint would furnish some very pow- erful ones. In some rare cases, Blood-letting is necessary ; but much judgment is required to distinguish the propri- ety of having recourse to such a practice ; because, if it be employed where the symptoms of inflammation are not violent, it is a very dangerous expedient. The fulness of the pulse when the eruption appears, is apt to impose on inattentive practitioners, and to lead them into much error. The Peruvian bark, opening medicines, cordials, blisters, and a variety of other means suited to the ex- \rCncy of the particular case, must be had recourse to. P EM ALE COMPLAINTS. 209 SECTION III. INFLAMMATION OF THE WOMB. INFLAMMATION of the womb commonly oc- curs at some time between immediately after delivery and the fifth day, though in some cases later. It is generally preceded by shivering, which is follow- ed by intense heat, quick hard pulse, great thirst, &c. A violent pain in the womb is felt from the begin- ning : it gives the sensation of fulness and weight, with throbbing and burning heat in the part. The immediate seat of the pain depends on the particular part of the womb which is affected. In some cases, therefore, it extends towards the navel, or is confined to above or below the share-bones ; in others, it strikes backwards, or down both thighs ; and when that part of the uterus in contact with the bladder is the seat of the disease, great pain and difficulty in making water are felt, and sometimes even a total suppression is oc- casioned. When inflammation of the womb takes place dur- ing the red-coloured lochial evacuation, that discharge is soon sensibly diminished, or ceases entirely This disease is distinguished from after-pains, by the pain being constant, and not, as in that complaint, alternated with intervals of ease ; and by the sensa- tion occasioned being very different from that of after- pains ; for along with these, no throbbing pain, at- tended with burning heat, is felt, but merely grind- ing-pains, like the throes of labour. Many .causes tend to induce inflammation of the womb; such as, difficult or tedious labour, artificial efforts to contract the child and its appendages impro- Dd no .MANAGEMENT OF perly conducted, the exhibition of heating and stimu- lating drinks, &c. during or after labour, exposure to cold after delivery while the woman perspires freely, or the immediate application of cold to the womb while the cleansings flow. Inflammation of the uterus terminates as the same disease in other parts of the body ; but from the great sensibility of the womb, and its extensive influence on other parts, together with the state of the contiguous organs in the belly after delivery, its event must be always very precarious, even where suppuration takes place. When mortification is the consequence of this formidable complaint, the fatal termination happens within a short time from the beginning of the disease. As the progress of inflammation of the womb is al- ways rapid, if not stopped when it first appears, the life of the patient must often depend on the original symptoms being properly understood. If the fixed throbbing pain, along with hard quick pulse, increased heat, thirst, Stc. be disregarded at first, it will not be easy even to moderate the distress, or lessen the danger of the woman. Nurses and at- tendants should be therefore taught not only to guard ! against the exciting causes of this disease, but also to dread the occurrence of these symptoms, and to take the earliest opportunity to mention them to the medi- cal assistant. When the practitioner is called in at the beginning of inflammation of the womb, its progress may be not unfrequently stopped by blood-letting, the injunction of a very spare diet, plentiful dilution with cool acid drinks, by clearing out the bowels by means of gentle ] laxative medicines, or Lavemens, and by fomentations applied to the belly. When this treatment is success- ful, an universal sweat takes place, with an evident remission of the painful symptoms. , But if this do not happen, and on the contrary, i FEMALE COMPLAINTS. 21 i the pain become more acute, with increased throbbing, and a greater degree of fever, together with sickness, delirium, or much restlessness, the inflammation may then be expected to terminate either in mortifica- tion or suppuration. In the former case, the languid state of the pulse, the low delirium, and clammy sweat, will sufficiently indicate the event: But in the latter, the pulse continuing firm and full, and the throbbing pain becoming more violent, shew that sup- puration will ensue. Mortification most generally occurs where the bo- dy has been previously much weakened, or where the habit is very bad. Practitioners who are not called till the disease have continued for some time, should pay much attention to the situation of the patient. If they mistake the fulness of the pulse which takes place while the suppuration is going on, and order blood-letting at that stage of the complaint, the suppu- rative process will be cither interrupted, and gangrene induced, or from the weakness that will unavoidably en- sue, the unfortunate woman will be rendered unable to resist the debilitating effects of the discharge of matter. The best outlet for the matter, is by the passage of the womb : But this favourable event does not always happen ; for sometimes it is discharged through the straight gut, but more often by an abscess in the groin, in which case the cure is tedious, and a consi- derable lameness for a long time is frequently the con- sequence. During the discharge, the Peruvian bark, in sub- stance or decoction, should be taken twice a-day ; nourishing diet, with plenty of ripe fruit, ought to be recommended ; the belly must be kept open ; and if the matter come off by the yagina, that organ must be often washed, in the manner already mentioned, in order to prevent excoriaticr/ 212 MANAGEMENT OF SECTION IV. MALIGNANT CHILDBED FEVER. PRACTITIONERS differ much in the description of this disease, and in the method of cure which they adopt. That this fever frequently occurs in consequence of mismanagement, there can be no doubt; but not- withstanding the opinion of many respectable authors, there is reason to believe that it does not always ori- ginate from improper treatment after delivery. In opposition to this opinion, it may be urged with much plausibility, that the malignant childbed fever does not take place so often in patients who are under the care of judicious practitioners, as in those who are unfortunately committed to the charge of unskilful persons. This circumstance, however, can be perhaps ex- plained in a manner which will confirm, instead of re- futing the opinion. For it is more than probable, that by proper attention to the first symptoms of this fever, the progress of the disease may be often completely prevented. Every woman, therefore, should be acquainted with the symptoms which indicate the approach of this disease ; for it is only by calling in proper assistance at the beginning, in many cases, that the fatal effects can be obviated. The malignant childbed fever generally occurs about the evening of the second or third day after de- livery ; but in some cases,'later : The woman is com- monly seized with shivering, attended with prin in the head, especially above the eye-brows. This i^ FEMALE COMPLAINTS. 213 followed by a hot fit, succeeded sometimes by a partial moisture on the skin, but much more frequently by several loose stools, which seem to relieve all the symptoms; this however is often a delusive appear- ance, for a second attack ensues, and the slight remis- sion is only a prelude to an increase of complaints. After the shivering, the belly becomes universally sore to the touch, which in many cases renders the weight of the bed-clothes intolerable : The soreness is frequently more considerable in one part than another; no swelling nor hardness can generally be at first per- ceived. The breathing of the patient, although not oppress- ed nor interrupted by wheezing or coughing, is very uneasy ; for as she feels the pain in the belly always sensibly increased every time she breathes fully, she endeavours to obtain relief, by only half-breathing as it were. The pulse is quick, in general full and strong at first, but afterwards weak. These are the principal characteristic marks of this disease; but in every case, other symptoms attend, which vary according to the constitution of the patient, and many other circumstances. On some occasions, this fever begins with violent sickness and vomiting, or severe looseness ; and in other cases, the belly is quite bound for the first day or two. When vomiting occurs, the matter thrown up at the beginning is yellowish ; but when this symptom takes place towards the fatal termination of the com- plaint, it is somewhat like coffee-grounds ; the stools, commonly loose, are always very fetid. The urine is at first passed with difficulty, or totally suppressed till after a stool or two ; it is of a dark co- lour ; and on being set at rest, a sediment appears half floating near the bottom of the glass. In many cases the Mi.k and Lochial discharge ap- 214 MANAGEMENT OF pear to be natural for the first day or two of the dis- ease. Sometimes there is no secretion of the former; but the latter is very seldom suddenly stopped. The skin in some patients is in the ordinary state ; both with respect to. heat and moisture ; but in others it is very hot and dry at first, and afterwards in the up- per parts of the body is covered with a clammy sweat. The face is commonly flushed, the eyes sunk, and the patient seems remarkably dejected. She has usu- ally thirst, and is so uneasy that she can only lie on her back. After a day or two, the belly begins to be swelled, and becomes tense. If the woman have been costive at first, the loose- ness which succeeds generally occasions much imme- diate relief. But the ease is merely temporary ; for the pulse continues quick ; the pain of the head, un- easy breathing, soreness of the belly, soon return with increased violence ; the teeth become covered with a black or brown crust; and sometimes delirium super- venes. Little white spots, too, sometimes appear in the mouth and throat. These symptoms, or many of them, continue for some days ; tlie patient at last passes several fetid stools, usually involuntarily. She then imagines that she is free from all clanger, as she feels completely re- lieved from all pain ; but the increased quickness of her pulse, cold extremities, &c announce to the prac- titioner the approaching fatal termination of this dan- gerous disease. When this happens, it takes place at different periods of the fever, most commonly from the fifth to the twelfth or fourteenth day. But when the malignant childbed fever dees not prove fatal, although all the complaints are milder, yet there is no distinctly-marked critical termination, as in other fevers ; for the symptoms abate very gra- dually, and the patient can never be pronounced out FEMALE COMPLAINTS. 213 of danger for a great many days. She is at last left in a state very much weakened, but relieved from all the uneasy sensations which she formerly suffered. The nature of this disease cannot be explained, nor the means of cure detailed, in this work. As the complaint is always attended with much danger, and as the treatment in such cases depends on the general principles of cure of fever produced by extensive in- flammation, occurring in a state of weakness of the system, it is obvious, that the most skilful practitioner who can be procured ought always to be had re- course to. The malignant childbed fever occurs frequently in hospitals, when the wards are. not kept sufficiently ventilated: On these occasions, the symptoms of the disease are somewhat different from those observed in private families ; the event is more generally fatal; and, till the wards be completely purified, every wo- man delivered in them is seized with the fever. In every lying-in hospital, therefore, one or more spare wards should be provided, in order to prevent that particular vitiated state of air which originates from a room being occupied by a number of persons for a long continuance of time, even although every precaution with respect to the usual method of ventila- tion be adopted. 216 MANAGEMENT OF SECTION V. ACCIDENTAL FEVERISH AND INFLAMMATORY AFFEC- TIONS. THE common low fever sometimes accidentally happens during lying-in. It is distinguished from other fevers by pain in the head and back, fre- quency of pulse, foulness of the tongue, and great ge- neral weakness, without any affection of the belly or of the lungs occurring at the beginning of the disease. Notwithstanding the delicate state of women after delivery, low fever appears most commonly in them in its mildest form ; and therefore hectic or dropsical symptoms are more to be dreaded as the result of the disease, than any immediate danger, though some- times, as in other cases, it proves fatal. The treatment must be regulated according to the particular circumstances of the individual case. Anomalous feverish symptoms are on some occasions the consequence of accumulations of bile, and are known by the attending symptoms of nausea, oppres- sion of the stomach, distention or pain of the belly, &c. The symptoms are merely temporary ; but they are always productive of much uneasiness to the patient, and of considerable anxiety to the attendants. The cure of these complaints depends upon the ex- pulsion of the bile, and on the adoption of proper means to prevent its being again accumulated. Inflammation of the Bowels is very apt to occur during any period after lying-in. It is attended with violent pain in the belly, particularly about the navel, striking towards the back, sometimes relieved by the expulsion of wind, and always increased on being I FEMALE COMPLAINTS. 217 pressed upon by the hand, with sickness, thirst, fever- ish heat, and generally with costiveness. This is one of the most alarming diseases which at- tacks the human constitution, as it sometimes runs through its course to a fatal termination within a few hours ; and even where its progress is not so rapid, it often baffles every exertion of professional skill. Immediate assistance should therefore be procured whenever this disease even threatens, and the most ac- tive treatment, to allay the inflammation, ought to be pursued. Inflammation of the Lungs, or of the parts lining the Chest, is also a very common occurrence in the lying-in state. It generally begins with some degree of shivering, followed by fixed pain in the chest, ina- bility to take in a full breathing, commonly frequent cough, and great heat and restlessness. This, as well as inflammation of the bowels, is a most fatal complaint. Both are occasioned by expo- sure to cold, or irregularities of diet. The treatment of this disease requires the most seri- ous attention, and the most active exertions. If bleed- ing, and the other means necessary to check the pro- gress of the inflammation, be delayed for even a few hours, the patient may be irrecoverably lost. Several slight feverish and inflammatory complaints, besides those above enumerated, are from time to time met with in lying-in women, the treatment of which must be conducted upon general principles, and ought to be confided to regular practitioners. Ee 118 MANAGEMENT OF CHAPTER III. ANOMALOUS COMPLAINTS INCIDENT TO LYING-IN WOMEN. FROM the description already given of the condi- tion of women after delivery, it may be readily understood, that various anomalous complaints may take place. In this chapter, those which most usually occur, or which are particularly deserving of attention from their alarming nature, are detailed. Butfor very obvious reasons, their symptoms and causes are chiefly explained. SECTION I. SPASMODIC AFFECTIONS. s^iHQLIC is one of the most common diseases of L* lying-in women. It is distinguished from in- flammation of the bowels, by the pain being alternated with intervals of ease, or being aggravated by fits ; by the belly being much distended, and by the pulse being (commonly at least) regular. It must at the same time be remembered, not only that it often requires much attention and practical knowledge to distinguish the two diseases, but also that the one sometimes pre- FEMALE COMPLAINTS. 219 cedes the other. The safe rule therefore is, that wherever what appears to be cholic is very violent, me- dical assistance should be immediately had recourse to. Cholic is generally the effect of previous costive- ness, though, like inflammation, it certainly is some- times produced by exposure to cold and irregularities of diet. Laxatives, emollient Lavemens, fomentations of the belly, medicines calculated to expel wind, and where inflammatory symptoms threaten, blood-letting, with a variety of other means, must be employed. Cramp of the stomach or bowels is most apt to take place within ten or twelve days after delivery. It is always occasioned by drinking cold or acid liquors. This disease is so fatal, and so rapid in its progress, that it has been known to destroy life within little more than an hour from the first attack. It ought to be universally known, that the longer it is allowed to continue, the more difficult it is to check its progress. . If cramp of the stomach be attended with deadly sickness, a large dose (i. e. two tea-spoonfuls) of spirit of hartshorn, mixed with some hot water, ought to be instantly swallowed; and if that prove of no avail, seventy or eighty drops of laudanum ought to be given, while flannel soaked in hot spirits should be applied to the pit of the stomach. These means may be em- ployed until medical assistance be procured; for al- though in some cases the cramp is relieved by this practice, it sometimes proves so violent as to require the most active medicines in the most powerful doses, and consequently any delay or trifling may render the situation of the patient desperate. Cramp of the bowr-ls is seldom so suddenly fatal as that of the stomach, but it ought to be treated in nearly a similar way. 220 MANAGEMENT OF SECTION II. ALVTNE FLUXES. j OOSENESS and Cholera sometimes attack lying- J—t in women. The former of these complaints is to be regarded as serious, only where it has been preceded by costiveness, of where it is attended with pain in the back, and al- ternated with excessive discharges of blood from the womb. In either case the disease requires the utmost atten- tion, as its removal must depend upon the cause being ascertained and counteracted. Many deplorable cases have occurred, where inattention to this obvious prin- ciple has occasioned the loss of valuable lives. When costiveness has preceded the looseness, pain generally attends every stool, and a continued irrita- tion is kept up. In such cases, laxative medicines, glysters, and mucilaginous drinks, furnish the best means of cure. If violent discharges of blood from the womb be alternated with looseness, the cause will be found to be some great irregularity in the diet or conduct of the \ patient. As the utmost danger is to be apprehended, every possible attention ought to be paid from the be- ginning. Cooling laxative salts dissolved in a very large proportion of water, and given in frequent doses, with weak nourishment, great quiet, and firm com- pression of the belly, by means of a flannel roller, sometimes have the effect of stopping the progress of this alarming complaint. But more active and varied treatment is often necessary. FEMALE COMPLAINTS. 221 Notwithstanding the great quantity of bile formed during the latter months of pregnancy, Cholera is a very rare occurrence during lying-in. The violent vomiting and purging of bilious matter, with the great pain in the bowels and cramps in the limbs, and ex- cessive weakness which attend this disease, character- ise it from every other complaint. Cholera in weakly constitutions is always precarious in its event; but in general, during lying-in, it is more alarming than really dangerous. Diluents, consisting chiefly of weak beef or veal, or chicken broth, and opiates frequently repeated, are in general sufficient to allay the violence of this disorder. SECTION III. DELIRIUM. DELIRIUM, or wandering of the mind, some- times accompanies the milk fever, or the weed, and is then only a temporary symptom, which ceases upon the original disease being removed. But some- i times it is tlie effect of phrensy, or what is vulgarly called Brain fever, or of real mental derangement. Phrensy is not a common occurrence in this climate. • When it does happen, it takes place within two or three days after delivery, and is preceded by restless- | ness, pain in the head, hurried mode of speaking, great susceptibility of impression in the eyes and ears, and very frequent pulse. Outrageous raving follows, wliilc the appearance of the cour.tcnance remains quite natural, and the ordinary excretions go on as usual. 222 MANAGEMENT OF In this, as well as in all serious inflammatory or fever- ish complaints, the breasts soon grow flaccid, the milk being no longer formed. 'litis disease proves fatal about the third or fourth day after the attack ; but sometimes its progress is not so rapid, though it is equally mortal. Before death, the raving ceases, the features shrink, the eyes seem glazed, clammy sweat covers the upper parts of the body, the lower extremities grow cold, stertorous breathing supervenes, and convulsions commonly close the scene. The great circumstance which distinguishes this alarming disease from madness, is, that the ideas are quite incoherent, the patient being incapable of at- tending to, or comprehending any connected reason- ing, and appearing quite unconscious of surrounding object >; w hereas in madness, she can always be awed for a time at least into calmness, and seems to com- prehend whatever is going on among those about her. The threatening symptoms of phrensy can cer- tainly be discovered by an attentive practitioner, and their progress may be checked by active means. But where this disease has been allowed to take place, it has, hitherto at least, baffled all human art. .Mental Derangement, although a most serious afflic- tion, is of short duration when it occurs in lying-in women, if proper management be adopted. It seldom happens sooner than eight or ten days after delivery, and then appears in the form of a fright from a dream, or some accidental cause of alarm, or in that of some incongruous wish or action. It is com- monly unattended with fever, and very rarely at first (unless the wishes'of the woman be much thwarted) with outrageous raving. "Where this latter circum- stance takes place, the violence of temper is exerted against some particular object, andnot indiscriminately against whatever presents itself. The reasoning, too, FEMALE COMPLAINTS. 223 is rather founded upon erroneous principles, than in- consistent or incongruous. In some constitutions, very trifling irregularities of diet, or in-the regulation of the mind, are apt to occa- sion this most deplorable malady ; and it is not easy to specify any obvious marks .by which this tendency can be discovered. But where the patient has been formerly afflicted with this visitation, there is little doubt, that certain means may be adopted to prevent its recurrence. Where madness has actually happened, the treat-. ment must be varied according to the circumstances of the case. The most soothing mild conduct ought to be observed towards the patient, and every means calcu- lated to restore good health, and particularly to re- move the increased susceptibility of impression of the nervous system, must be carefully adopted. SECTION IV. COMPLAINTS AGGRAVATED BY LYING-IN, AND DIS- ORDERS INDUCED BY NURSING. EVERY disease productive of great weakness, is increased by the state of the system which fol- lows childbearing. Of this description are consump- tion, dropsy, vitiated condition of the fluids, Sec. Where any of these complaints have certainly pre- ceded delivery, there is every reason to dread their fatal termination before the end of the month. But sometimes symptoms resembling them,arising merely from nervous affections, occur in lying-in women. It is of great consequence, therefore, to distinguish such 224 MANAGEMENT OF cases, in order that complaints which may yield te suitable treatment, may not be neglected, from being considered desperate. Nurses are liable to two disorders in consequence of the drain of milk proving too weakening for their con- stitution, viz. constant weakness of the back, excessive languor through the day, violent sweating during the night, gummy eyes, and total loss of appetite; and actual inflammation of the eyes. These complaints are in some women the natural effects of attempting to give suck ; but in general, they may with propriety be attributed to some inattention on the part of the woman ; such as allowing the infant to sleep with the nipple constantly in its mouth, not studying regularity in the hours of rest, not adapting her food to the supply of milk which the child may require, &c. Delicate women, for the purpose of guarding against such disorders, should employ an assistant to give suck i to the child during the night, for at least two or three months. It is a mistaken notion, that two kinds of j milk are hurtful to the infant. ' But where these affections have actually happened, they can only be removed by giving up all attempts at nursing. MANAGEMENT OF INFANTS AND CHILDREN. INTRODUCTION. THE Child, when in the womb, surrounded by a fluid which defends it from external acci- dents, and supplies it with an equable degree of heat, nourished by a somewhat which its own organs do not prepare, and furnished with the vivifying princi- ple of air, by a beautiful and wonderful machinery, maybe said"to vegetate only. But when separated from the mother by the pro- cess of delivery, it undergoes a great and important revolution. The supply of heat, and protection from injury, must depend on the attention of others ; nou- rishment must be prepared by the digestion of food received into its own stomach ; and the benefits of air can be obtained by the operation of breathing only. Had not Nature bountifully provided for these changes, the human race must have become extinc1. 226 INTRODUCTION. The bodies of infants differ from those of grown . j persons in many respects, besides the size and exter- j nal form. A knowledge of these will elucidate the manner of treatment of children in health, and dur- ing disease, and ought therefore to be acquired be- fore that subject be considered. In infants, the nerves are in larger proportion: their powers also are greater : hence many circum- stances, as cold, heat, he. have considerable influ- ence on. them, which do not seem to affect grown persons. All the vessels are much more numerous ; their action is more frequently repeated ; and therefore the pulse of infants is always very quick, and all the secretions and excretions are more speedily perform- ed, and in greater quantity. The fleshy parts are more soft, and less distinctly marked ; their actions are consequently net so pow- erful. The bones are soft, spongy, and imperfect. Those which are afterwards single are generally divided ; into several portions ; and almost all the bones have their extremities or edges in the state of gristle. The bodies of infants, therefore, have not an exact regularity of shape, and are not well supported. Their different parts are not so steadily moved ; and the organs lodged in the cavities are not so well de- fended. The appendages of the bones are in much larger proportion: hence the moveable and immoveable articulations are less firm. The cellular substance is also in a greater propor- tion, which occasions the irregularity in the shape of the spft parts. All the fluids are more mild and watery, and fur- nished in greater quantity. The chyle and blood are INTRODUCTION. 227 more nutritious, and this latter is less acrid. The slimy arid gelatinous fluids are more bland ; the bile and urine have very little acrimony. • The skin is more delicate, and beautifully colour- ed: it is more sensible to external impressions, for the scarf skin is very thin and soft. The head is-large in proportion to the bbdy. Its bones are hot indented.into' each other, but connected by membranous layers: hence the brain, which is very soft, may be readily Compressed and injured. The face has not the expression whichat after- wards assumes. The eyes at first have no, power of distinguishing objects. They, and their appendages, are remarkably delicate;, and therefore suffer from the slightest accidents. The nose, from the state of its bones, is also much more exposed to injuries ; and the sensibility of its nerves renders it highly irritable : but the bad effects which would often be the consequence of this structure are probably coun- teracted by the mucus with which its inside is con- stantly lubricated. The ears for some time, like the eyes, do not appear to possess much power. The mouth is not usually supplied with teeth till some months after birth ; for although formed, they re- main under the gums till that time. The lower jaw- bone is divided by a portion of gristle into two pieces. The trunk of the body is not so firm as to support properly the superincumbent parts, nor to defend the organs contained in it; for a great part of the spine is gristly, and the breast is entirely so. The ribs indeed are more perfect than many of the other bones ; but they can easily be made to yield from the state of the breast: and the fleshy parts, Sec. which surround the belly, being soft and delicate, cannot afford resistance to any circumstance that may injure the bowels. 228 INTRODUCTION. The lungs, hitherto small, collapsed, and supplied with little blood, immediately after birth begin to perform the operation of breathing, and to receive the whole blood of the body ; which functions con- tinue during life. These organs are at first weak and irritable. The heart acts with considerable force and quickness. The liver is of a remarkably large size in propor- tion to other parts, and is not so well defended as af- terwards. The gall-bladder is nearly in the same proportion. The stomach differs only in size, and in delicacy of structure ; and the same may be said of the intestinal canal. But in the great guts, a sub- stance different from what is observed in grown per- sons is lodged: it is a black, viscid, tenacious matter, called in medical language the Meconium. The kid- neys are lobulated ; and the renal glands are larger in proportion. The urinary bladder, and other or- gans in the bason, are differently placed, as that ca- vity is very imperfect, from the gristly state of the bones of which it is composed. The extremities are weak, and almost useless. The condition of the articulations, and quantity of gristle on the superior and inferior extremities, ren- der them incapable of performing their proper func- tions for a considerable time, The changes by which the size and strength of every part of the body are increased, and the perfec- tion of the several organs is completed, proceed gra- dually, and are not fully accomplished till the period of puberty. MANAGEMENT, 8cc. 22° CHAPTER I. ORDINARY MANAGEMENT OF INFANTS. FROM the view which has been exhibited of the state of infants after birth, it will be obvious that much attention must be paid to circumstances which in grown persons almost escape notice. The great mortality of children that prevails among the.poor in large cities may perhaps be attri- buted chiefly to the neglect of the treatment recom- mended in this chapter ; and therefore it cannot be too minutely detailed, nor too implicitly followed. The circumstances chiefly to be attended to in the ordinary management of infants, relate to cleanliness, clothing, food, air, and exercise. SECTION I. CLEANLINESS. THE skin at birth is covered in many places with a thick glutinous matter, which may per- haps be cb signed to defend the infant from injuries during its residence in the womb. The first washing should be performed with very great gentleness and caution, by means of warm wa- ter, which is preferable to any of the washes often employed. Spirits are highly pernicious ; and grea- 239 MANAGEMENT OF sy substances can never be useful, and may perhaps prove hurtful. The neck, arm-pits, and groins, commonly require more attention than any other part, because the scurf is thicker on them ; and rough rubbing, especially on the latter parts, might be very injurious. Long continued attempts to bring off every supposed impurity, however gentle, should never be allowed ; for what remains will readily yield to the next washing. The most scrupulous attention to, cleanliness in other respects, not only after birth, but during the whole period of childhood, cannot be too strongly in- culcated. For the first two or three, weeks, the in- fant should be bathed, morning and evening, in tepid water, and afterwards in cold water. T.he whole body ought to be washed in the morning, and the lower half at night. Tiie advantages of the cold bath have been long almost universally understood in Great Britain ; and in this part of it at least, children are very properly bathed in it every morning till two or three years of age. Speculative philosophers only have objected to a practice which is highly beneficial to health. Every part should be kept quite dry ; and all acci- dental impurities, as wet cloths, Sec. must be removed as soon as discovered. By a very little attention, infants may be taught to make water and to expel the excrements at stated times ; and therefore, except in cases of disease, the cloths should never be wet nor dirty. A little timber pot may be employed to receive the natural discharges from within a fortnight after birth. I INFANTS AND CHILDREN. SECTION II. CLOTHING OF INFANTS. THE unnatural tight swathing in which children were formerly incased is now fortunately ex- ploded ; and long established custom has in this re- spect happily yielded to the suggestions of reason and experience. The stricture of bonds and rollers must not only be painful, but hazardous ; for by these means the circulation is interrupted, and the growth in some parts is suddenly checked ; while in others it is improperly directed. Perhaps, however, theoretical reasoning might lead into an opposite error to what is now abolished ; for the wish to allow the child all the ease possible, may make those precautions in the dress which the experience of nurses teaches them, appear unneces- sary or improper. The disposition, therefore, which infants usually have to rub their eyes with their little hands, renders the simple contrivance of the women to prevent this circumstance essentially requisite, otherwise the eyes may be much injured. The cries of the child are very apt to occasion a protrusion of the intestines at the navel. This dis- agreeable accident may be often prevented by the ap- plication of a soft broad piece of thin flannel, in the form of a roller. It should never be made too tight, otherwise it may not only hurt the bowels, but per- haps induce ruptures at the lower part of the belly. With these precautions, the clothing of infants should be light and simple, constructed in such a 232 MANAGEMENT OF manner that it may be easily and readily applied. It ought to be suitably adapted to the climate and season, and should always be at first made to afford a considerable degree of warmth, that the change from the warm situation in which the child was formerly placed, to the comparatively cold one in which it is after birth, may not be so sensibly felt as to occasion pain. Tape should be used as much as possible, instead of pins; and the whole dress ought to be so loose, that the child may have free liberty to move and stretch its little limbs, as far as that is consistent with its welfare. The linens, next the skin especially, should be often changed ; and the infant ought never to have on the same dress for twenty-four hours continued. The night-clothes must not be equal in quantity to those which are worn during the day ; otherwise the child will be continually disposed to be affected with colds, See An unnatural custom has been introduced by nurses which ought to be guarded against by every parent wrho regards the future health of his offspring, the practice of confining the limbs of the child much more strictly by the clothes during the night than in the day. By such means the purposes of rest are de- feated, and sleep is even often interrupted. The night-clothes ought therefore to be quite loose, and as much lighter than those which are put on during the day, as the difference of situation shall render necessary, so that the infant may be placed in nearly the same aegree of heat at all times. For the same reason, when t;ie child sleeps in his day- clothes, he should be very slightly covered. INFANTS AND CHILDREN. 233 SECTION III. NUTRITION OF INFANTS. THE experience of many ages, as well as the ar- guments which may be adduced from analogy, have proved to the conviction of every candid inquir- er, that Milk is the most natural and wholesome food for children in early infancy. The attempts which speculative philosophers have from time to time made, to substitute other kinds of food to that prepared by Nature for the purpose of nutrition, have only furnished many melancholy proofs of their errors, or shewn that the powers implanted in the human constitution sometimes overcome even the dangerous effects of inconsiderate prejudice. The important advantages which result from nurs- ing, both to the mother and child, have been so often explained, and are so generally understood, that they do not require any illustration on this occasion. It has been improperly imagined, that all mothers ought to be nurses. By this opinion, many children have been destroyed, and a greater number have only lived to regret their existence ; the weakness of their frames having made them incapable of enjoy- ing the comforts of good health. The luxuries which refinement has introduced in the manner of living, although they do not prevent every woman from being a mother, certainly render many very unfit for the office of a nurse. A delicate woman, necessarily involved in the dissipations of hi eh life, and confined to a crowded city, cannot be 234 MANAGEMENT OF supposed capable of furnishing milk in due quantity, or of a proper quality. Her child must either be almost starved, or the deficiencies of his mother's breast must be supplied by unnatural and hurtful food. These are not the only disadvantages which arise from such ladies becoming nurses; for they them- selves, as well as their children, suffer considerably. Obliged to submit to the regulations with respect to the hours appropriated to recruit the body by food or sleep, that fashion and long custom must have rendered habitual, while at the same time they at- tempt a task for which the delicacy of their frame ill adapts them, their health must be impaired. When, therefore, ladies of this description wish to suckle their own infants, they ought to retire to the country, where, remote from the impure air of crowded cities, and removed from the allurements of fashionable amusements, they should endeavour, by the most scrupulous attention to regularity in diet, and hours of rest, and to moderate exercise in the open air, to repair their constitutions, and to fulfil the duties which they owe their offspring. Women in high rank, however, are not the only mothers who ought not to become nurses ; for some diseases, although originally induced by improper modes of living, are hereditary in families. The prejudices of the bulk of mankind are so much against women who seem to have any hereditary dis- ease, that in the choice of a hired nurse they are al- ways carefully avoided. A pretended discovery has led many medical practitioners to disregard such opinions; and the belief that these diseases, from being seated in the solids, cannot be communicated by the fluids, has induced them to imagine, that such disorders can never be derived from a nurse. But if the state of the fluids have any effect on that of INFANTS AND CHILDREN. 235 the solids, if, in other words, the condition of the body depend on that of the juices which supply the continual waste of its various parts, the common sense of the uninstructed multitude will be found far superior to the refined theories of dreaming philo- sophers. It is therefore incumbent on every practitioner to advise seriously parents who unfortunately are afflict- ed with any hereditary disorder, to send their infants to be nursed in the country by a healthy woman, and to .protract the period of nursing for some months-be- yond the usual time. When, however, the mother is of a robust heal- fliy constitution, she is certainly the most proper nurse, and ought to be advised to undertake the task, on account of her own health, as well as that of her infant. The infant should be put to the breast as soon after birth as the situation of the woman will allow ; by which the black viscid substance contained in the in- testines will be better evacuated than by any means which art can furnish. The pernicious practice of giving infants purging medicines as soon as born, cannot be too much reprobated ; for the retention of the meconium for some hours after birth certainly produces less inconvenience than is occasioned by the acrimony of the substances which the child is often forced to swallow. The most simpje artificial means for removing this matter, are Lisbon sugar dissolved in water, or a solu- tion of manna. Although those infants are most healthy and thriv- vihg who are least restricted, and who are permitted, to take the breast at pleasure ; yet every woman should avoid becoming the slave of her child, as many unguardedly"do". The infant ought therefore never to be .allowed to sleep at the breast, nor accus- :S» MANAGEMENT OF tomed constantly to overload the stomach by sucking till vomiting ensues. A disposition to regularity in the periods of sucking will soon be observed in infants and ought to be encouraged. Women should always remember, that the mode of life most conducive to health will afford the best milk, and the'most plentiful supply; and therefore nurses ought never to eat at irregular times, nor in a quantity which the appetite does not demand; and they should guard equally against abstinence and over-feeding. Fatigue, indolence, or inactivity, and every irregularity, must be carefully avoided.* Although Nature seldom renders any other food than milk during early infancy necessary, yet, with the view of introducing a change of diet by degree^, the practice of early beginning to give the child dahy a little pap or panada, appears to be rational; for when it is neglected till the time of weaning ap- proaches, the habit is with difficulty established ; and here is great hazard that the infant may suffer from the sudden change. At first, food should be given only once a-day ; by degrees it may be increased to two meals; and before Weaning three ought to be allowed. . ,~ Many women" begin to give spoon-meat to the in- fant a few hours after birth : A practice which sel- dom fails to occasion sore mouth, violent bowel-com- plarnts, Sec. and which therefore should never be en- couraged, 'notwithstanding the arguments of dry nurses. If bad effects follow the use of such apparently harmless materials as bread and water, what must be the consequence of the pernicious custom of giv- ing infants spirits in the form of toddy, with the sup- posed view of preventing gripes.? Such liquors, » Fortfie qualifications'of a Hire.l Nurse, see the Apptndix. INFANTS AND CHILDREN 237 however diluted, applied to their tender digestive organs, must unavoidably destroy or impair their functions, and may lay the foundation for a train of the most dangerous complaints. It may indeed be urged in favour cxf this horrid unnatural practice, that many children are accustomed to weak toddy from a few days after birth, and that they continue to thrive uninterruptedly. But such arguments only tend to prove, that the vigour of constitution in these children is so great as to resist the usual effects of strong liquors. Although the panada or pap be now almost univer- sally used for the first food of infants, as a substitute for the mother's milk ; yet some more suitable meat may perhaps be given with more advantage, such as eow-milk, mixed with a little water and sugar, to which a small proportion of rusk biscuit may be add- ed. The arrow-root, or patent sago, prepared with water and milk, is an excellent food for infants ; and after two or three months, weak beef or chicken tea, may be occasionally given. SECTION IV, AIR, EXERCISE, &C IF grown persons, who have been many years ac- customed to impure air, often feel themselves sick in a crowded room, it must be very evident, that a much less degree of bad air will affect children, whose lungs are weak and irritable. The infant ought not to be carried out of the house, unless during very fine weather, for the first month, 238 MANAGEMENT OF as its tender lungs may be irreparably injured by the cold air. When the child has acquired so much strength as to be able to withstand exposure in the open air, he should be carried out every good day, at the time the sun has most influence. At first he ought only to be kept without doors for a very short time ; and the person who has charge of him should walk slowly and gently, and avoid standing, especially in a cur- rent of air. By degrees, he may be sent abroad twice a-day, when the weather is favourable, and may be kept out gradually for a longer space of time. The importance of pure air to children cannot be better illustrated, than by comparing the health of those who are nursed in great towns with that of those reared in the country. " In the year 1767, in consequence of the humane suggestions of Mr. Jonas Hanway, an act of parliament was passed, obliging the parish-officers of London and Westminster to send their infant poor to be nursed in the country, at proper distances from town. Before this bene- volent measure took place, not above one in twenty- four of the poor children received into the work- houses lived to be a year old ; so that out of two thousand eight hundred, the average annual number admitted, two thousand six hundred and ninety died; whereas since this measure was adopted, only four hundred and fifty out of the whole number die ; and the greatest part of those deaths happen during the three weeks that the children arc kept in the work- houses."* ;..■:-; ■*. Although certainly other circumstances besides impure air, such as carelessness, &c must have con- tributed to this dreadful mortality; yet the prefer- • Examination of Dr. P;rice'i Essay on Population, by the Reve- rend John Howlet, A. B. INFANTS. AND CHILDREN. 239 ence of the country air over that of large cities is clearly proved by this fact, and may be confirmed by the meagre looks, sallow complexion, and feeble limbs, of children reared in town, even where the greatest attention has been paid. On the proper Exercise of children, more depends than superficial observers would imagine ; for by in- attention to this circumstance, a foundation is often not only laid for deformities that may destroy the beautiful symmetry bestowed on the human body by the Author of nature, and consequently may injure the health, but also, for diseases which, though their first approaches be slow and gradual, terminate suddenly in a fatal manner. During the first week or two after birth, the infant sleeps naturally more than two-thirds of his time ; and therefore the fatigue which he undergoes, from be- ing washed, dressed, &c. morning and evening, and occasionally raised to be cleaned during the day and night, may be considered as sufficient exercise at that period. The remarkable delicacy of infants, and the gristly state of their bones, would render any violent agitati- on of the body for the first weeks highly dangerous ; but in proportion as the child advances in age, the bones become gradually more complete, and the other solid parts more firm : hence a gentle degree of mo- tion, by promoting the free circulation of the fluids, will be highly beneficial. Every* restriction to one particular position, in whatever situation the child may be, ought to be con- stantly guarded against; for as the softness of the bones renders them easily moulded into an improper shape, deformities which may destroy the health, or prove the source of much future distress, will, if this aREN. 259 by violent, affections., of j.tjie .bowels, attendee! witii, streamings),and eve# in sotasie cases with fits! -,\ The cause of ReiGum is a determination of blood! totiifcrp^pjillje of the skin.; but the circumstances oc- ca6iotait>g-th,i$ haye not yet been ascertained .,;.-. In. the management,of :t&is disease, thecliicFobject ought to be to guard against the eruption being repell- ed; for which purpose, the bowels are: to be.-kept moderately loose, the. skin is to be frequently washed; withmUk-warm water, and: exposure to cold:is to be particularly avoided. The nurse's, diej: too„ should be propenly regulated. :..-' ...i r ;'Sfeould> the eruption by, any (accident recede, the wartri bath, and in some, cases an emetiG, .cOTCRals, and even,blisters, must behati recourse to. ,, , :< SECTION II. - i:-rh ..... YELLOW GUM. . T, Hj^HE Yellow Gum is a disease which.requires JL much more attention than the Red Gum, as it is frequently fatal. ,,.l , The appearance of children affected with this com- plaint at once points out the nature of the disorder. They are yellow over the, whole surface of the; body ; and the same colour is observed in the eyes* In some cases,'no symptoms but the yellow tinge indicate any thing uncommon; but on other occasions, the great derangement in the several functions of the infant proves incontestibly that the whole system is in disorder. Thus sometimes the child is unable to suck, sleeps constantly, and all 1 is functions appear to be suspended. 260 MANAGEMENT OF In other cases, the most violent colic pains, or fright- ful convulsions, are occasioned, which carry off the infant in the course of a few hours. The causes of the Yellow Gum are various and nu- merous ; a circumstance which, it may be easily ex- plained, depends on the particular structure of chil- dren. The bile, it has been remarked, is conveyed from the liver and gall-bladder, by a single conduit, into the intestinal canal a little below the stomach. Any obsta- cle which may prevent the passage of the bile in this manner, induces a yellowness of the skin, &c. termed Jaundice. In grown people, the liver is pretty well defended from external injuries ; but in infants, it has been observed, it is larger in proportion, and not so well protected. The intestinal canal in them also is more readily deranged than afterwards: hence the flow of bile in children may be interrupted by external pressure on the liver, by distention of that portion of the intestine into which the bile passes, or by any of the causes that occasion the same accident in grown persons. The retention of the meconium, it has also been alleged, is a very frequent cause of this disease ; but may it not rather be considered to be merely a consequence of tiie particular state of the system which induces the Yellow Gum ? There is no doubt that this'complaint is often occa- sioned by the nurse's milk. This may proceed from its noti proving sufficiently laxative, or from other cir- cumstances that have not yet been clearly explained. The mode of cure of the Yellow Gum must be re- gulated by the symptoms-and causes of the disease; and therefore cannot be minutely described in this work. When the child seems to suffer no uneasiness, although his skin is quite yellow, if his bowels be optr>. it would be absurd to prescribe any medicines. INFANTS AND CHILDREN. 261 But if he be unable to suck, and have a disposition to constant sleep, then the most active means should be adopted, otherwise the disease may soon prove fa- tal. Vomits, consisting of a grain or two of Ipeca- cuan, rubbed finely with a little sugar and water, and brisk laxatives, as a dose of calomel, and frequent doses of the solution of manna, will then be found necessary; and their effects may be much promoted by the warm bath. .If the infant be nursed by a woman whose milk is old, a change of nurse will, in many cases, alone cure the disease. When violent colic pains or convulsions accompany the Yellow Gum, u. practitioner ought to be imme- diately sent for, as it requires a: great deal of judgment to determine the proper means which should be em- ployed in such cases. SECTION III. THRUSH.* THE Thrush is so common a disease in early in- fancy, that many have imagined it to be a salu- tary effort of Nature to expel some hurtful matter from the system, which might ctl.eivise be produc- tive of many complaints at a future period. This opi- nion, however, is merely a vulgar prejudice, founded neither on reason nor experience. « This is termed, in 'noctici! language, APUTmE. 262 MANAGEMENT OF As the Thrush is in some cases very mild, and in others very unfavourable, the symptoms and danger attending the disease vary on different occasions. This complaint appears in the form of small .white spots on the corners of the lips, tongue, and insice of the cheeks and throat, resembling little pieces of co- agulated milk. These spots begin in the mouth, and gradually spfe'ad oyer the lips, palate, &c.; and it lias been alleged with apparent probability, that in some cases they, are continued from thegullet through the stomach, and the. whole tract of tlie intestinal canal. When the disease is favourable, the spots are few in number, and" are confined to the mouth ; and the child seems to suffer Ihtie inconvenience from them. But in the more malignant species, of Thrush, the spots are so close, and numerous, that they run into each other, forming one uniform tenacious.crust, co- vering the whole mouth, palate, and throat; and hence they render the infant incapable of sucking. In such cases, before the spots appear, the child is generally much depressed, and disposed to sleep ; his pulse is almost imperceptible, his extremities cold, and he ap- pears at the point of death. When the spots are per- ceived, the pulse gradually rises ; feverish heat, and increased action of the blood-vessels succeed, attended with great restlessness; and the mouth becomes so tender, that the infant is incapable of grasping the nip- ple, or of swallowing the mildest food ; and in making the attempt, fits are sometimes induced. In the progress of this disease, the spots change their appearance considerably. In favourable cases, they gradually become yellov.-, and the intermediate parts have generally an inflamed red colour; but when the disease is of the malignant species, the spots have a purple or livid hue, 'which commonly teratira.tes in a gangrenous or mortified appearance. INFANTS AND CHILDREN. 263 When the Thrush is to be considered as a disease, it is usually preceded or attended by complaints in the stomach and bowels, as vomiting, colic, and violent looseness. The nature of this disorder is different in different cases.' When the infant suffers little uneasiness except what proceeds from the soreness in the mouth, it may be looked upon as a local disease, induced by some irritation applied to the delicate parts which are affected, as very warm spoon-meat, &c. But when disorders in the stomach and bowels, or feverish symptoms, precede or accompany the Thrush, it may then be considered as the effects of a general derangement of the system ; and its termination may be expected to be more or less favourable, according to the degree of strength of the infant, and to the vi- olence of the attending symptoms. The exciting causes of the Thrush are various, as improper nourishment,* confinement in impure air, in some cases specific contagion, and exposure to cold or moisture. The means of cure in the mild species of this com- plaint, although simple and obvious, require some at- tention ; for as the spots are quite superficial, they may be readily removed by the application of any astringent medicine ; but if they be forced off prema- turely, a second crop, in greater quantity, more obsti- nate in duration and more deeply seated, will suc- ceed ;.and if the same improper treatment be repeat- ed, a new series of spots will invariably recur, attend- ed with increasing violence, in proportion" to'the .fre- quency of repetition. , No astringent lotion or powder ought therefore to * Children who are brought up by the hand, as it is called, are very much<*ubj«j:t to this disease; and in them it often proves fatal. „>64 MANAGEMENT. OF . be employed, till the spots, change from a vvhite to a yellow colour, when the common remedy of borax, mixed with sugar or honey,* may be safely allowed. The ordinary practice of washing the spots with a rag-mope is always productive of bad consequences. It is in this species of the complaint alone that a so- lution of currant-jelly, in water,, or syrup of roses, with spirit of vitriol, Sec are admissible. Bad conse- quences often follow the indiscriminate use of jelly and chalk, which many prescribe. In the treatment of the malignant kinds of Thrush, the great object to be aimed at should be, to support or restore the strength, and to correct the disorders in the stomach or bowels. With these views, when the infant cannot suck, he should be fed with weak beef-tea; and thm panada with a small proportion of wine, or beef-tea with a little bread broken down in it, ought to be given, by way of lavement, every three or four hours. Jn the most malignant species of the disease, Peruvian bark, in decoction, or mixed with thin starch, should be ex- hibited frequently in the same manner.. Blisters applied to the back and legs", in succession, are useful in some cases. For the purpose of correcting the disorders in the stomach and bowels, magnesia and prepared crabs eyes, in the forms recommended in the Appendix, must be prescribed. When the stools are very loose, have the appear- ance of dirty water, or are fetid, opiates should be had recourse to. The particular state of the system in'these cases often renders the. fluids in all the passages highlv irri- tating, which tends much to aggravate the complaint. eighth or sixteenth part of Borax, >ney. INFANTS AND CHILDREN. 265 lo remedy this, some means should be used, such as putting into the mouth, from time to time, a tea- spoonful of thin mucilage of Gum Arabic, or of liquor prepared wkh the white of an egg, beat up with a little water and sugar, to which a single drop of oil of anise may be added. :' In these cases, nothing should be applied to the spots, till they become yellow, and the strength of the child be restored. When there is reason to consider the milk of the nurse to be the exciting cause of the Thrush, she ought to be immediately changed. The nipples of the nurse are often injured by the sore mouth of children, if they be not defended with a little mucilage before the infant is allowed to suck, and washed with weak brandy, or spirits and water, immediately after he is taken off the breast. SECTION IV. BOWEL COMPLAINTS. INFANTS and children, from the delicate structure of their digestive organs, are much subject to dis- orders in the bowels, which frequently assume the most alarming appearances. Nature has very fortunately rendered the stomach of infants so irritable, that when it is overfilled, or loaded with indigestible substances, vomting is usually induced ; but as habitual vomiting gradually impairs the vigour of the stomach, every precaution which can be suggested should be employed to guard against 1 the causes of this complaint. LI 266 MANAGEMENT OF For this reason, infants, as has been already ad- vised, ought not to be permitted to suck too much at a time ; and large quantities of spoon-meat should never be given in the early months. The intention of spoon-meat at that period is not to appease hunger, but to accustom the infant to a gradual change of diet. A small proportion only, therefore, ought to be allowed, till towards the period of weaning; and al- though it must necessarily be given when the infant is hungry, to induce him to take it, his appetite should never be completely satiated. When the infant appears much oppressed, is unable to suck, has a heavy eye, and a strong-smelling breath, there is reason to believe that his stomach is disorder- ed ; and therefore, if he do not vomit naturally, a simple emetic should be given ; and even although he do vomit spontaneously, in many cases a small dose of Ipecacuan will be beneficial. After the stomach is in this manner emptied, the contents of the bowels should be evacuated by proper doses of any gentle laxative. Infants are liable to Colic Pains, which often occa- sion the most threatening symptoms; for in some cases the child suddenly cries incessantly, or by starts loses his colour entirely, has oppressed breathing, coldness in the extremities, and a variety of other alarming complaints. If in these cases the infant draw up his little limbs to his belly, or wreath his body, if his belly be swelled, and he have a partial looseness, the cause of his sufferings is readily discovered to pro- ceed from colic. The delicacy of the bowels of infants renders them affected by the most apparently trifling causes • and hence many circumstances induce colic pains in them Exposure to cold, inattention to changing the cloths when they become wet, too great a quantity of spoon- meat, too large doses of magnesia, a collection of acid INFANTS AND CHILDREN. 267 slime or of air in the stomach or bowels, and some fault in the milk, may severally be productive of this complaint. The cure of colic is by no means so simple as many have imagined ; for not only must the exciting cause of the complaint be removed, but also the effects which are communicated to the whole system from the derangement of the digestive organs. When this disease proceeds from exposure to cold, or from the long continued application of wet cloths from carelessness of the nurse, the infant should be put into warm water up to the arm-pits, and kept there for ten minutes, or a quarter of an hour. He ought then to be well rubbed, till he be quite dry, wrapped in warm flannel, without the intervention of linen, and laid in bed. By this treatment, if the complaint be not complicated with disordered stomach or bowels, he will soon fall asleep, and awake in perfect health. The impatience of nurses induces them to have re- course to spoon-meat whenever the infant is fretful, instead of employing other means, which would in- deed give themselves more trouble. The consequence of this is, that the stomach, unable to digest it, be- comes filled with air and sour meat. It is therefore painfully distended, and the bowels are irritated by the acid contents of the stomach passing into them. In such cases, the cure must consist in the exhibi- tion of vomits and gentle laxatives ; and after the stomach and bowels are emptied, the warm bath, as already directed, will contribute greatly to restore to the general system its former regularity. Many infants have their stomach and intestines often painfully distended with air, where nothing but the mother's milk is allowed them. It has been long the custom to give spirits and water, or Carminative medicines-, in these cases ; but although the latter, as a little anise, sugar, Sec. may be necessary on some oc- 268 MANAGEMENT OF casions, yet the former should be had recourse to with great reluctance ; for by proper exercise the process of digestion is much better promoted than by any arti- ficial means applied to the stomach ; and flatulencies never take place where that important function is duly performed. Many women, from the best motives, but the most improper views, torment their infants with the fre- quent exhibition of magnesia ; because that medicine has little taste, they foolishly imagine that it can do no injury. But the operation of Magnesia depends on that substance undergoing a change in the stomach or bowels, which gives it the same properties as the laxative salts ; and therefore, if too large a dose of these occasion colic pains in grown persons, the Mag- nesia must, when given in too great quantity, produce the same effects in infants. If the colic be discovered to proceed from this cause, a tea-spoonful of weak beef-tea should be given from time to time, and a small quantity of Laudanum, by way of Lavement will generally relieve the pain. The internal surface of the stomach and alimentary canal is constantly lubricated with slimy fluids, which defend it from injuries, and accomplish the digestion of the food. Any irritating substance applied to the delicate parts that furnish these fluids, increases the quantity ; and hence the digestion is interrupted, because the collection of slime prevents the due preparation of the tood, by constantly exciting the action of the organs in which that process is carried on. Nothing contributes more to increase tlie quantity of slimy fluids than the common pernicious habit of giving much sugar in the meat of children. A little of that substance is proper and necessary; but the meat ought never to be what can be termed sweet; for the taste of the sugar should scarcely be perceived INFANTS AND CHILDREN. 269 In cases where slime is accumulated in the stomach or bowels, it soon becomes acid, and consequently the stools have a green colour and sour smell. The cure of colic originating from this cause may- be effected by the exhibition of what are styled ab- sorbent medicines, after the stomach has been emptied by a vomit. Magnesia, prepared crabs eyes, &x. may be occasionally used, singly, or united, with these views.* When colic occurs along with violent fever, and constipated state of the belly, the event is often pre- carious. The warm bath, emollient Lavemens, gentle laxatives by the mouth, sometimes bleeding with leeches, and a variety of other means, must be had recourse to; but as these cases ought always to be committed to the charge of a practitioner, it would be unnecessary to detail in this work the particular circumstances which require the use of'each of these remedies. The milk of the nurse sometimes causes gripes. The common opinion, that passions of the mind affect the state of the milk, seems well founded. The ob- vious cure of this kind of colic is, to prevent the infant i from sucking when the mind of the nurse is agitated, and where gripes are induced, to put him into the warm bath. Looseness of the bowels in children frequently oc- I curs, independent of colic, and sometimes proceeds from the same causes. When the health of the infant is not injured by this circumstance, and what is passed has a natural ap- pearance, it is not to be considered as a complaint, and is often a salutary and critical evacuation. But when the child becomes emaciated, his flesh flabby, his colour pale, and his vigour impaired, the * For the forms in which absorbent medicines may be given, see the APPENDIX. 270 MANAGEMENT OF looseness, whatever the appearance ofrthe discharge may be, ought to be moderated, but not suddenly checked. For this purpose, in most cases, a vomit should be first exhibited, and then absorbents, or, according to the circumstances of the case, medicines calculated to correct the irregular action of the bowels, may be given ; while at the same time proper precautions are adopted, to prevent the recurrence of the same cause 'which originally induced the complaint. When the stools are very watery, of a blackish co- lour, and having an offensive smell, Lavemens, con- sisting of thin starch or rice gruel, with laudanum, prove the best palliatives. But in these cases, the dis- order frequently continues till the child is exhausted, unless proper attention be paid to his diet. Many de- licate puny infants have been saved from threatening death by the use of weak veal or beef tea, given twice a-day, without any bread. Country air and the cold bath are on such occasions highly beneficial. Astringent medicines ought never to be prescribed to children without the greatest caution, as the worst effects have often followed their use. From the view thus exhibited of the disorders in the stomach and bowels to which infants are liable, it must be obvious, that much judgment is in many cases necessary to distinguish the source of the com- plaint, and to determine the method of cure ; and therefore it is incumbent on parents to pay the greatest attention to such diseases, and never to delay consult- ing a practitioner till the general system be so much deranged as to render his assistance ineffectual. INFANTS AND CHILDREN. 271 SECTION V. MILK BLOTCHES.* A WHITE or dusky scabby eruption, principally affecting the brow, or some part of the head or face, in many cases appearing in different distinct patches, in others spreading considerably in one con- tinued crust, is known to nurses by the name of Milk Blotches. These scabs are always superficial; consequently never leave any scar, unless they be improperly treat- ed. They are attended with no fever, nor obvious derangement of the system, although they often con- tinue for weeks or months. Eruptions of this kind generally only occur in gross children, and seem to proceed from too rich milk. The cure, therefore, commonly depends on the ab- stinence of the nurse from much animal food, and from all fermented liquors. The anxiety parents and nurses often express to have these ugly appearances removed, has induced many practitioners to interfere unnecessarily and im- properly. It should always be remembered, that these erup- tions are critical and salutary ; and therefore, when • This complaint is called, in medical language, the LACTUMEN, or CRUST A LACTEA- 272 MANAGEMENT OF from excessive itching it becomes necessary to apply to them a weak solution of sugar of lead, or what is preferable, the weak astringent lotion, formed by a solution of white vitriol, the bowels should be opened, and a looseness occasioned. Every active medicine, such as large doses of sweet mercury, waters impregnated with sulphur, &c. ought, if possible, to be avoided ; but in some cases, it must be admitted, medicines of that nature afford the only- means of cure. INFANTS AND CHILDREN. CHAPTER IV. DISEASES WHICH OCCUR BETWEEN THREE OR FOUR MONTHS AFTER BIRTH, AND THE END OF THE SECOND YEAR. THE diseases included in this chapter do not com- prehend every complaint to which infants are liable during the period mentioned ; they are only the most common that occur. As the duty of medical practitioners consists as much in the prevention as the cure of diseases, a few directions respecting the proper method of weaning children, and the age at which that important change should be madef, form the last section of this chapter. SECTION I. TEETHING. INFANTS seem to feel a variety of complaints in consequence of i eething. Many suffer much less than others ; but all are affected in some degree. It appears very wonderful, that pain should attend a natural and necessary operation ; and therefore the circumstance has been denied. But no reasoning can overturn matters of fact; for the experience of every M m 274 MANAGEMENT OF nurse proves, that the most vigorous and healthy children feel much uneasiness during the period of Teething. Although infants are sometimes born with two or four teeth, these generally continue within the gums, as was formerly remarked, till five, six, or seven months after birth, wrhen the two middle fore-teeth of the lower, arid then, in a few days or weeks, the corres- ponding ones of the upper jaw appear. After this ah interval of several weeks commonly takes place, before the remaining fore-teeth, which usually are cut in the same order as the former, suc- ceed. During the ordinary period of sucking, children seldom cut more teeth than these ; though at the end of the second year they have ten in each jaw. The symptoms which precede and accompany the eruption of the teeth are more or less violent, accord- ing to the succession in which the teething proceeds, Co the resistance which the gums make, to the irrita- bility of the infant's constitution, Sec. In the most favourable cases, the pressure of the teeth on the gums occasions some pain, and causes an increased flow of the fluids furnished by the mouth: hence the child is fretful, restless during the night, frequently thrusts bis little hands, or whatever he can get hold of, into lis mouth to rub his gums, slavers continually, and from the passage of some of the spit- tle into the stomach and bowels, he has occasionally sickness, gripes, and looseness. At last the corner of a tooth is perceived ; but the uneasiness still continues for some days, when a se- cond one is cut- During the interval between the eruption of the lower and upper teeth, the child recovers his strength and usual good health ; but is soon again subjected to the same uneasiness. -L INFANTS AND CHILDREN. 275 Were these the only ccmiplaints which attend Teething, little danger might be apprehended; but sometimes, instead pf these, a train of .the most for- midable symptoms ^occurs.In strong robust children, a vipjent, fever frequently precedes the'eruption of t every tooth; the gums are swelled and inflamed, the , eyes rmich affected, tlie belly bound, the skin hot;.and ' the infant cries incessantly, is unable to suck, and never enjoys uninterrupted sleep for any length of time. Weakly children, where teething is painful and difficult} are oppressed with sickness, loath all kinds of food, lose their colour, fret perpetually, have a con- stant looseness, and become quite emaciated. Irrita- ble infants, under the same circumstances, besides these symptoms, are subject to convulsiqns, which recur from time to time, till the tooth or teeth are above the gum. . AH the .symptoms in children of every description are much aggravated, if several teeth cut at once, or in immediate succession; cases which sometimes hap- pen. The treatment of the ordinary complaints attending teething should consist in moderating the pain, p re- gulating the state of the belly, and in the continued employment of every means calculated to promote the general health of the infant. With these views, small quantities of anodyne bal- sam should be rubbed on the back-bone at bed-time, when the child seems greatly pained. He ought to be fed with beef-tea twice a-day, if weakly and if his bowels be very loose, and should be kept as much as possible in the open air, when the weather is favour- able. The cold bath ought never to be laid aside in these cases, as nothing is more conducive to strength- en the child. I,ooscnesc, if excessive, must be mo- MANAGEMENT OF derated, and if the belly he. bound, should be artifici- ally induced by gentle laxative medicines. Children feel an urgent desire, during teething, to rub their gums ; and, under certain regulations,, it may be safely indulged. But the common substances put into their hands for this purpose, as coral, Sec. byhruising the gums, may occasion violent inflamma- tion in these parts; and therefore the softest materials should be selected, such as a small piece 0f fresh liquorish root, or, as the vulgar employ, a piece of wax-candle. The management where alarming symptoms occur is more complicated, as it must be varied according to circumstances. When fulness and quickness of the pulse, increased heat, flushed face, frequent startings,-oppressed breath- ings, immoderate fits of crying, Sec. indicate a violent' fever, the application of leeches becomes indispensa- ble ; after which the warm bath is useful. The belly should be opened by laxative medicines and emollient Lavemens; and every means ought to be pursued which can diminish the action of the heart and arteries. In these cases, however, unless the irritation on the gums be removed, the feverish symptoms often re- sist every treatment which can be suggested. The most effectual method to accomplish this desi- rable object is, to cut the gum down to the teeth. This should be performed with a gum-lancet, and .not by the nails of a nurse, nor by a sixpenny-piece, nor by a thimble, as many female practitioners of mid- wifery advise. This operation ought never to be delayed, when the infant is^ seized with convulsions about the period of" teething, even although the protrusion of the gum do not announce the approaching eruption of the teeth. On these occasions, the under jaw must be first cut; and if, by dividing the gum at that part where the first INFANTS AND CHILDREN. 277 teeth commonly appear, the lancet be found to rasp against a hard substance, the removal of the fits will shew, that the practice has been successful. But if no teeth be felt, and the convulsions recur, then the upper jaw should be cut in the same manner. I have often known fits which had daily attacked infants for many weeks', and had resisted the power of every other remedy, disappear entirely after cutting the gums. As no danger can follow this simple1 operation, it ought to be had recourse to more frequently than practitioners seem willing to allow. When troublesome cough, soreness of the eyes, he. attend teething, they can seldom be perfectly cured, till after the painful stage of that process. As children are always exposed to much danger when the symptoms of teething are violent, proper assistance should be had recourse to; for parents ait not capable of directing the management in such cases. SECTION II. CONVULSIONS. THE nerves in children are in greater proportion, and more easily affected, than in grown people : hence infants and children are more liable to con- vulsions ; for as these complaints depend on an ex- citement of the nervous system, causes which can pro- duce no such effect in adults occasion it in children. Convulsions, at all times ahnnir-.g and hazardous, cri-tinate from many different causes, and require a 278 MANAGEMENT OF very great variety of treatment: therefore proper as- sistance should be always procured in such cases. But although it be inconsistent with the design of this book to explain minutely the principles on which the cure of convulsions ougntto be conducted, yet it may be Of great importance to point out the nature of the disease, that many of the occasioning causes may be avoided. As the event is often very sudden, it may also prove useful to direct the means which may be employed with advantage before the practitioner can be had.----With these yiews the following observa- tions are offered. . In some cases convulsions come on suddenly, in others the attack is gradual, and the first symptoms not easily discerned by the attendants. In the former, the infant, from being in the most perfect health, turns in a, moment livid, his eyes and features are con- , torted, and his limbs .and whole frame are thrown into violent agitations. These symptoms are succeeded by a suspension of vital powers, as in faintings, from which the child gradually recovers, or which may be fatal. In the latter cases, the infant shews some de- gree of uneasiness : he suddenly changes colour, his lips quiver, his eyes are turned upwards, and he unex- pectedly, as it were, stretches himself out, or his hands become clenched. Sometimes the child has a rapid and continued suc- cession of violent or trifling fits, and sometimes they recur at distant intervals. Convulsions in infants are induced by every circum- stance which can affect the nervous system in general, or which can produce a violent irritation on any parti- cular nerve. The sudden repulsion of an eruption, or stoppage of an habitual evacuation, confinement in impure air, pressure on the brain, and the particular state oftthe body previous to some eruptive diseases, as the small- INFANTS AND CHILDREN. 279 pox and measles, act in the former way ; and irritat- ing substances applied to the stomach or bowels, as improper food or medicines, worms, 8cc. the cutting of the teeth, as it is termed, and wounds in any sensible part, he. operate in the latter manner. The necessity for the most guarded caution in the treatment of children cannot be too strongly incul- cated ; for on many occasions the most trifling neglect will produce frightful convulsions. Infants are often seized with this disease, from having received a small quantity of spirits and water, or from being permitted to swallow improper substances ; and in many cases the cause can be traced to the prick of a pin. The danger in every case of convulsion is in pro- portion to the violence of fits, and also depends on the cause which induced them. When they precede eruptive disease? j, they generally go off when the erup- tion appears ; and when they occur in consequence of repelled rashes, or suppressed evacuations, their re- turn is prevented by the eruptions being made to re- cUr, or by the substitution of artificial discharges. But when the fits are violent/and frequent, and when they proceed from pressure on the brain, or any cause which tends to keep up the irritation in the system, they generally terminate fatally. The same event often follows a single fit, by whatever Cause the disease is occasioned; and when one attack has be-^n long continued, and attended with alarming symptoms, much may be dreaded from its recurrence. As the cure of convulsions must be necessarily very different in different cases, it is impossible to describe any means which can be successful on every occa- sion. When an infant is siezed with a violent fit, without any previous complaint, he ought to be exposed freely to the open air. After this, if his pulse be strong and quick, blood-letting, by the .application of leeches to 280 MANAGEMENT OF the temple or feet, will be found useful; but if he ap- pear sick and oppressed, loath the breast, or exhibit anv signs of a disordered stomach, a vomit should im- mediately be given, and the bowels ought to be opened by an emollient Lavement. In cases where there are no symptoms of increased action of the blood-vessels, nor of any derangement of the stomach or bowels, the cause of the fit must be searched for, otherwise no probable means of relief can be adopted. For this purpose, the infant ought to be made quite naked, and placed in the warm bath, while every part of lis body should be carefully ex- amined, that any wound or ether injury may be dis- covered. The precaution of stripping the child should be ob- served on every occasion where the cause of the con- vulsion is not very obvious, as the fits may originate not only from a fall, which the nurse endeavours to conceal, but even, as has already been remarked, from the prick of a pin. Where, from the previous indisposition of the in- fant, there is reason to believe that the convulsions precede some eruptive disease, he should be immedi- ately put in the warm bath, after having been exposed for a minute or two to the open air, and then ought to receive from time to time small doses of any gentle cordial.* By these means the eruption is usually soon promoted, and the child consequently is reieved from the fits ; but in some cases a blister on tne back or legs must be applied before this favourable event can be effected. , The treatment when convulsions depend on the cutting of teeth, has been already directed. When a child seems to be suddenly deprived of life by one or two fits, if he appeared preriously in good * Sec in the APPENDIX the proper Cordials for Children. INFANTS AND CHILDREN. 281 health, he ought on no account to be considered as ir- recoverably lost; but the common means for restoring suspended animation should be carefully employed as long as his colour is not entirely changed ; and in every case of apparent sudden death from this cause, these means ought to be continued with patient perse- verance for some time. SECTION III. ERUPTIVE COMPLAINTS UNACCOMPANIED BY FEVER. INFANTS during teething, and in many instances til! a later period, are liable to various eruptive affections, which resemble in some cases the itch, in others the small-pox or measles, in others scarlet fe- ver, and in others the dusky pustules, styled in grown persons scorbutic. Although some derangement of the general health generally precedes the appearance of the affection of the skin, those symptoms are merely temporary, so that infants and children commonly enjoy most excel- lent health during the continuance of the eruption ; a circumstance which sufficiently riistinguisbes such complaints from many of those imitated by them. The only certain method of ascertaining the itch is, by observing that it is communicated to those accustomed to handle the child. The causes of those anomalous eruptions (a very °-ood description of which is contained in Dr. Under- * N n 282 MANAGEMENT OF wood's Treatise, vol. 1. page 89.) have not hitherto been discovered. The only danger tb be dreaded from them is the sudden repulsion of the eruption, (as in the red gum); for that accident is always followed by alarming fever, or affections of the bowels, or great inflammation of the eyes, or even convulsions. During the course of the eruption, all which seems necessary is to keep the bowels in a state of moderate looseness, to regulate carefully the diet, to wash the whole surface of the skin twice or thrice sa-day with tepid water, and to guard against such exposure to cold, as may probably repel the eruption. In obsti- nate cases, sea-bathing, washing the skin daily with lime-water, or with a weak solution of potash ; giving small doses of calomel, or antimonial wine, and esta- blishing an issue in some convenient part of the body, or putting a burgundy pitch plaster between the shoul- ders, are severally found useful, according to circum- stances, Of which the practitioner can alone judge. If at any time the eruption be suddenly repelled, a little warnv wine and water, the warm bath, opening the bowels, and the application of blisters, must be had recourse to. INFANTS AND CHILDREN. SECTION IV. DIREeTIONS RESPECTING THE METHOD Of WEANING CHILDREN. " ,ff EANING forms an important iserarin the life of.an infant, as.on thd proper regulation of this great revolution in his. mode of livingyliis future health often depends. Although different countries adoptdiffenent prac- tices with respect to weaning ; yet it is. a rule almost universally established, never to deprive a child of the breast if he dd not thrive, unless his indisposition seem to originate from the milk. This is not an uncom- mon occurrence ; for when women give suck too long, a natural change takes place in their system, which renders the milk no longer possessed of quali- ties proper'for nourishment. The time of weaning must be influenced by a va- riety of circumstances besides the health of the child, ■ as, season of the year, constitution of.^parents, pe- riod-of teething, Sec The. winter, for obvious reasons, is a.very improper time for this purpose. When the parents haye a scrophulous habit, the child-should be sent to a healthy country-woman, as already recommended; and he ought not to be wean- ed till at least eighteen months old. It-the nurse be- come unfit for her duty before tiiab. time, another should be procured. With these exceptions, infants may in general be weaned at any time between nine and twelve months after birth. Too early and too late weaning should be equally guarded against. w 284 MANAGEMENT OF Many errors are daily committed in the method of weaning children. Some women deprive the infant of the breast at once ; and others, by the application of mustard, or any nauseous substance, to the nipples, endeavour to make him desert the breast of his own accord. Both practices are equally cruel and improper. A change in diet should be introduced by slow degrees ; and therefore, for some time previous to weaning, the child, fought- to receive an increased quantity* of spoon-meat, ando should- be allowed: a smaller'proposi- ti^ ofrmlilk. But unless the latter precaution be at- tended to, the former practice ought not to be adopted. ■When anVihfanb' is weaned, it is too common for nurses tot give doses, ofiaudanum, or syrup of poppies, (whidh hasithe same effects), every night foraconsi- derable time, with the plausible view of obviating rest- lessness.) But these medicines:should neverbe: allow- ed-} where restlessness occurs, a little.anodyne bah sam may be^nibbed on the back-bone. The indiscri- minate iusec of;laxatives is also a prevalent custom among women, and cannot be condemned in strong eHoaghteitinsti If the bowels benot sufficiently opoh, lafs&tivesmustbe.hadre'course to-; but ofcherwisecthey ought not tajbe prescribed; .-"., . Theinfivnti should be accustoihed^when weanad^to receive food or drink at stated;periods,.and not/ac- cording to'the caprice of nurses. ;" Although this'task will at firstirer somewhat difficult), it:can always beiac-v compHshed by>perseverance'; andthe-benefits which the Childi (himsdlif, and his attendants, derive from this circumstance,:jwilF more than' compensate for rthe trouble attending the attempt. As. little drink or food ought to be: given durirtg the night as: possible ; for a bad habit may be induced, which may: lay the founda- tion for many future complaints. ;, INFANTS AND CHILDREN. 285' The impropriety of indulging infants with spirits and water, wine-whey, See. has already been ex- plained. After weaning, the food of children should consist of weak beef-tea, panada, light- puddings, and the va- rious preparations of milk. Rusk biscuit ought ge- nerally rto be- used,rinstoad of-ordinary bread. The common preparation of" oat-meal, (called pottage or porridge), till within these few years much used in this part of Great Britain, is undoubtedly too difficult of digestion for infants,* unless: aproportion-of barley- meal be mixed with the oat-meal. , Frequent exposure; in the open air when the wea- ther is favourable, and an increased degree of exercise* are highly beneficial to newty-rweaned children. -}>:■> r..' :i;HT:\ 286 MANAGEMENT OF CHAPTER V. ,: DISEASES COMMON TO INFANCY AND CHILDHOOD. THE diseases.described in the following sections,1 with the exception of the eruptive disorders at- tended with fever, are perhaps the most frequent to which infants and children are liable. Withrespfectto the eruptive affections accompanied with fever, viz. the small-pox, chicken-pox, measles, and scarlet fever, the limits and object of this work do not permit any detail. Directions for inoculating the small-pox were inserted in the former editions; but the introduction of the cow-pox, the utility of which is now completely established, not only supersedes the old practice, but also holds out to mankind the reason- able expectation of eradicating a disease which has for some centuries proved so extensively destructive. SECTION I. CROUP. OF the diseases incident to infancy and childhood the Croup is perhaps the most alarming, for it often proves fatal within thirty-six hours from the first attack. INFANTS AND CHILDREN. 287 This disease may be said to be peculiar to marshy countries, and those situated in the neighbourhood of the sea, so that in the inland and dry situations of this island it is quite unknown. Although it has certainly prevailed in this city and its neighbourhood from time immemorial, the first accurate description of it was published by Dr. Francis Home about forty years ago. It occurs most frequently during winter and spring ; but it is found to take place at any season of the year, when damp cold easterly winds prevail. It has been by some practitioners supposed to be contagious; for two or three children in the same family have fallen victims to it within one week. But this should be attributed to their having been all ex- posed to the same exciting cause of the disease. The true croup is preceded commonly for some days, and always for a day or two, by a hoarse cough ; but the first symptom that proves alarming to one un- acquainted with the disease, is a difficulty of breath- ing, which comes on towards night. The breathing is very hurried, and in many instances so noisy that it can be heard at the distance of several yards. After this state of the breathing is observed, the fits of coughing become more frequent, and have a very peculiar sound, resembling the loud crowing of a roupy cock. Generally the coughing occurs in re- doubled fits, the second fit being more violent than the first. Some viscid phlegm is forced up by the cough; but it reaches no farther than the mouth, being re- tracted when the cough ceases. If the countenance of the child be examined at this time, it will be found flushed and swelled, in a degree proportioned to the constitution of the individual; consequently, in some cases the eyes appear bloodshot, watery, and swelled as it were, and the whole face is very red, except that round the mouth there is an evident whiteness ; but in other cases there are only 288 MANAGEMENT OF watery eyes, and an obscure blush over,the face, with a slight paleness round the mouth. The child sleeps during the intervalsbetween the fits of coughing ; but there, is no material alteration in ■the' state of breathing while it is asleep. Those in whom the face is very much .flushed seem over- powered by a heavy sleep, from which they are rous- ed only by the violent fits of coughing. Food and drink are readily swallowed without difficulty, and the natural evacuations go on as usual. In proportion as* the disease continues, the fits of coughing return more frequently, and are attended with an uncommon degree of agitation throughout the whole frame ; and in some cases the breathing be- comes more and more noisy. At last the appearance of the countenance changes, the lips growing livid, the pallidness round the mouth more striking, and the whole face pale. Where the child unfortunately dies, that event is occasioned by a fit of suffocation; and this often happens quite unexpectedly to the atten- dants. During the whole course of the disease the child is extremely fretful ; but when irritated it seldom cries for any length of time. This seems to arise partly from the uneasiness in breathing being aggravated by the fits of cry in ?:, and partly from the child being un- able to direct its attention to.any object whatever above a few minutes at a time. The progress of the disease is very different in dif- ferent cases, for it sometimes runs through its course in twenty-four hours, and sometimes it is protracted even to the tenth day,- The progress seems to cor- respond with the frequency and violence of the fits of coughmg. When a child happily recovers from this disease* it continues for some time extremely liable to a return of the disorder; and if a second attack should occur INFANTS AND CHILDREN. 289 within a few days from the cessation of the former, there is very great risk of its proving suddenly and rapidly fatal. The true croup occurs only during cold damp wea- ther, except in marshy places, where it is apt to hap- pen at any time when a foggy state of the atmosphere prevails. The ordinary subjects of the disease are those children who have enjoyed the best health ; and the most common period of life at which it takes place, is from the fifth month to the fifth or sixth year. The immediate cause of this disease is an inflam- mation of the membrane which lines the windpipe. In consequence of this, matter is formed, which con- cretes and choaks up the passage to the lungs. This concreted matter has been, on some rare occasions, thrown off by vomiting, and has relieved the child from threatening suffocation. There is an affection resembling this disease, which may be styled spurious croup, and which is very analo- gous to the asthma of grown people. It comes on suddenly, without any previous indisposition, in the form of very difficult breathing, occasioning fits of croupy coughing, unaccompanied with the appearance of tough phlegm in the throat or mouth. The coun- tenance is little altered during this affection ; and dur- ing the fits of coughing there is not that excessive agitation which is so strongly marked in the true croup. This disease attacks delicate, much more frequent- ly than robust children, and occurs during any state of the weather. Its duration is in general limited to a few hours ; and in many instances it ceases entirely for many hours, or even for a day or two, and then re- curs, so that a child may have several attacks within a short time. There can be no doubt that the spurious croup has on some very rare occasions proved fatal ; O o 290 MANAGEMENT OF but in general it is unattended with danger. It seems- to arise from a spasmodic affection of the wind-pipe. As it is extremely difficult in some cases to distin- guish, at the beginning, the true from the spurious croup, it is a fortunate circumstance, that the following method of treatment is applicable to both diseases. Immediately upon the attack, the child must be put into a tub of water, heated to the ninety-sixth degree of Fahrenheit's thermometer, (that is, to the degree which the hand immersed in it can easily bear), or must be wrapped up in a blanket wrung out of hot water. Whether the bath or the fomentation be em- ployed, it ought to be continued for at least ten mi- nutes ; and then the child should be carefully rubbed dry, wrapped up in warm flannel, and put to bed. A dose of calomel is now to be given, and repeated every hour till the breathing be evidently relieved; when it is to be gradually discontinued, allowing at first two, then three, and finally four or five hours to intervene between each dose, according to the state of symptoms. » This medicine commonly occasions both vomiting and purging ; and in true croup, the first alleviation of symptoms, generally follows the discharge of a great quantity of dark green coloured matter (like boiled spinage) by stool ; but if the attack have been that ,of spurious croup, the breathlessness ceases after vomit- ing has occurred. The dose of calomel is to be regulated principally by the age of the little patient. During the first year it should be from one to two grains, during the second two grains and an half, during the third and fourth years from three to four grains, and during the fifth and sixth from four to five grains. It may be given mixed with a little sugar as a dry powder, or it may be mixed with currant jelly, or honey, or treacle, or pottage, or panada, or light pudding, or with any INFANTS AND CHILDREN.' 291 ching which is thick ; but it cannot be given in drink. During the course of the disease, nothing else than liquids ought to be allowed to the child. These should consist of cow milk whey, very weak tea, thin barley gruel, fig tea, apple tea, milk and water, or toast and water. It may be unnecessary to remark, that if the child be not weaned, nothing but the nurse's milk should be given. The room in which the little sufferr er is kept ought to be moderately warm. When the disease has begun to yield to this treat- ment, nourishment suited to the habits and circum- stances of the chiid is to be exhibited in small quanti- ties, and often repeated. In some cases considerable weakness remains after the crouping has ceased, in consequence partly of the violence of the symptoms, and partly of the operation of the calomel. Under such circumstances, cordials, particularly weak white wine whey, and a blister to the breast} become neces- sary. But if proper attention have been paid to the precaution of lessening the number of doses of calo- mel, whenever the disease is in the least alleviated, the ordinary health of the child will be found restored within a very short time after the symptoms of croup have disappeared. For the cure of this formidable disease, practi- tioners formerly trusted chiefly to bleeding, with the use of vomits and blisters as auxiliaries ; but the result of the practice was, in the more favourable cases, a very considerable shock to the constitution, and in the majority of instances the death of the child. These circumstances rendered it fair to make a trial of the practice of giving calomel, first suggested by some American physicians. Accordingly, a very deserving- surgeon of this city, Mr. James Anck-rson senior, began it some years ago, and recommended it to the notice of the present professor of Midwifery in the I.'ni- 292 MANAGEMENT OF versity.' After two years most accurate and careful attention to its effects, he considers himself fully war- ranted in giving the above directions. He has had the happiness of seeing the disease yield where its vio- lence seemed to threaten almost immediate death; and among the little patients on whom it has been success- fully tried, he has directed to one of five months old, (the child of the Rev. Mr. Sydney Smith), thirty-two grains of calomel within twenty-four hours, and to another of the same age, the child of an officer of ex- cise, eighty-four grains within seventy-two hours. A girl, the daughter of a respectable tradesman in Col- lege Street, seven years of age, had within little more than sixty hours an hundred and thirty-three grains, and two days after appeared as if she had never had a complaint. In every case where he has employed it previous to the occurrence of lividness of the lips and other mortal symptoms, (amountingnow to seventeen), he has completely succeeded both in curing the dis- ease and in preventing any shock to the child's con- stitution. In three instances where the case seemed desperate, he thought it his duty to try its effects, rather than leave the patient to his fate. It neither aggravated nor mitigated the symptoms. SECTION II. IRREGULAR FEVEJ1S. r f^HE feverish complaints which attack children are JL generally merely symptoms of some other dis- ease. Their duration is seldom considerable ; and al- though violent while they continue, they are not fre- quently productive of clanger, if properly treated. INFANTS AND CHILDREN. 293 The causes of infantile fevers, therefore, are very numerous. Exposure to cold, disordered stomach or bowels, teething, and, in short, every thing which can excite an increased action in the heart and blood-ves- sels, readily induce them. The treatment of these complaints must depend entirely on the causes ; and the proper method for re- medying most of them has already been detailed. When the cause of irregular fevers, as sometimes happens, cannot be discovered, attention should be paid to moderate the symptoms. For this purpose, vomits, gentle cordials, the warm bath, or leeches, and blisters, must be occasionally necessary. Parents ought to be encouraged never to lose hopes of the recovery of children in these complaints ; for many cases have occurred, where the disease termi- nated favourably, after the most eminent practitioners had deserted the patients as lost. The most unre- mitting attention should therefore be constantly paid to infants affected with fever, as long as life continues. When food cannot be given by the mouth, a child may be nourished for many days by Lavemens, com- posed of panada and wine, or beef-tea. SECTION III. HOOPING COUGH. THE Hooping Cough, or what is called in Scot- land the Chincough or Einkcough, begins like a common cold, attended in some cases with fever, and frequently with little derangement of the system. Bv decrees the symptoms of cold cease, but the cough 294 MANAGEMENT OF continues, and is accompanied with circumstances which mark its nature. These are the suddenness of the fits of coughing : the great agitation the child feels during the cough, which leads him, at the instant it comes on, to lay hold of what is nearest, in order to support himself, the coughing being excited by emotions of the mind, and by any considerable exertion, and each fit of cough ending in vomiting or in hooping, (called also back- draught), which resembies threatening suffocation, and seems to arise from a convulsive action of the up- per part of the windpipe. In the favourable cases of this disease, there is no fever, no diminution of the appetite for food, no ap- parent deviation from the ordinary health; and the fits of coughing occur only twice or thrice during the night, and during the day take place only after a full meal, or violent exercise, or emotions of the mind. If hooping follow the cough, it is in a very trifling degree. But in the unfavourable cases, great fever and weak- ness, or feverish heat, with evident determination to the head, occur at the commencement of the disease, accompanied with various symptoms of derangement, according to the constitution of the individual. The fits of coughing are very frequent, of long continu- ance, sometimes preceded by breathlessness, but more often followed by that circumstance, and sometimes ending in excessive discharges of blood from the nose or from the bowels. The hooping in such cases ren- ders the face quite livid, and not unfrequentlv termi- nates in convulsions or in faints. It always seems to threaten instant suffocation. Nothing is more uncertain than the duration and event of this disease In the mildest form in which it occurs, it generally continues for two or three months ; ?nd often, after it has apparently censed, an accidental INFANTS AND CHILDREN. 295 exposure to cold occasions a return and an aggravation of the symptoms. In the violent degrees, many months elapse before the symptoms seem to be miti- gated ; and the return to strength where the child recovers is very tardy. It is almost impossible in any case to foretel with certainty the event; for in many instances the child has been suddenly carried off, after it had for several days, or even weeks, had the most complete mitigation of all the symptoms; while in other cases, every circumstance which commonly in- dicates approaching death, has been observed for a very considerable time, and yet the child has eventually struggled through. Where fatal event takes place,it is in consequence either of exhaustion, in which case the feet are commonly much swelled for some time before death, or of a fit of suffocation, or a convulsion. Some estimate of the danger may be formed by at- tending to the age, constitution, and symptoms of the patient, and the season of the year. Experience proves too, that it is more fatal in some years than in others. The Hooping Cough occurs only once during the life of the individual; but in some children, even for years after this disease, every common cold is attend- ed by a cough which seems somewhat like the Hoop- ing Cough. During teething too, there is sometimes a kind of crowing, which to a superficial observer seems to resemble the back-draught. Infants and children of every age and constitution are liable to this disease ; and contrary to what hap- pens with respect to other infectious diseases, the youngest infant is as subject to it as the oldest child. The cause of the Hooping Cough is a contagious matter, which, although so subtile as to elude the cog- nisance of the senses, may nevertheless be conveyed from one child to another, at a very considerable dis- tance, through the medium of a third person. Iufants, a few days after birth, have become affected with the 296 MANAGEMENT OF disease, in consequence of being handled by those who had been in a house where the Hooping Cough was prevailing. There is reason to believe, that after the original cause has ceased to have effect, the disease is continued merely from habit. In the treatment of the Hooping Cough, the great objects to be aimed at are, to remove the habit on which the duration of the complaint depends, to restore or support strength, and to palliate troublesome or alarming symptoms. If any medicine should be dis- covered, which could at once destroy the contagion of • Hooping Cough, all other means might be superseded; but hitherto no such discovery has been made. For accomplishing the first of the above purposes, vomits repeated daily, or oftener according to the exi- gency of the case, and frequent change of air, are to be chiefly trusted. It may be known when the air dis- agrees, by observing that the child is more and more fretful and restless during the night; and in many cases it is found necessary to change the child's resi- dence weekly. The strength is to be supported by suitable nourish- ment. Where inflammatory symptoms attend at the beginning, the diet should consist almost entirely of milk and vegetables; but when much debility takes place, animal food in various forms, and cordials adapted to the age and constitution, are indispensable. The Peruvian bark is in many of those cases ex- tremely useful. For palliating alarming or troublesome symptoms, a variety of treatment is required in different cases. In general, the chief symptoms of that description are the inflammatory and feverish affections, and the hooping. The inflammatory symptoms, excepting when very violent, are best moderated by regulation of diet and by keeping the bowels open. On some rarr occasions., bidding must be had recourse to; bnt INFANTS AND CHILDREN. 297 it requires much discernment.to judge of this, and irreparable mischief may be done by the subtraction of blood. The feverish symptoms are mitigated by fre- quent ablution with tepid water, by the use of emetics, and by the change of air. When they are attended with great debility, cordials, and occasional blisters, must be employed. The most formidable symptom of this disease is the hooping, as it always when violent threatens immedi- ate death. Where it is not alleviated by the means already recommended, particularly frequent emetics f and change of air, stimulant substances must be rub- .bed over the ribs, or breast, or belly, evening and morning. The rectified oil of amber answers for this purpose very well. Roche's royal embrocation is used with the same intention. Garlic ointment, rubbed on p the soles of the feet, seems particularly efficacious, ! where uneasiness in breathing continues during the in- tervals between the fits of coughing. Narcotic medi- cines, given internally, such as the Hemlock and Hen* bane, are sometimes useful in lessening the violence and frequency of the hooping ; but such means are too dangerous to be had recourse to, except by the special direction of a regular practitioner. SECTION IV. WATER IN THE HEAD. UNDER the title of Water in the Head, three ri eases, dilTerent from each other in their na- ture, tthhough simi—r in one respect, have been gene rally comprehended. P p 298 MANAGEMENT OF The first is an affection of the head, coeval with birth, which may be styled the Congenite Water in the Head. Of this disease the chief mark is, an evident enlargement of the head, with uncommon openness' of its sutures, or the connections between its bones. This is met with in various degrees ; for sometimes the size of the head is so great,, and the collection of water so enormous, that the infant cannot be born alive : in otiier cases, the enlargement is just percep- tible, arid seems to have little influence upon the health of the infant; and between these extremities every intermediate degree has occurred. In general, where the disease is quite evident at birth, the size of the' head continues increasing for ten or twelve months ; and then the child is destroyed by convulsions. But cases have occurred where life has been protracted for several years, notwithstanding this disease. Under such circumstances, the sufferer has dragged out a most miserable existence, having been incapable of any mental exertion, and also in most instances of any bodily exercise. This disease seems to be owing to some original im- perfection in the structure of the individual; and as far as human experience has hitherto evinced, it is quhe incurable Blisters to the head, issues in different parts of the body, the various preparations of mercury,- and other active means, have been often tried without any appearance of even mitigating the symptoms. The second disease known by this name, may be termed the Symptomatic IVater in the Head. It is the natural effeat of any weakening disease in infancy or childhood, just as swelling of the feet and ancles take place in grown persons who are much debilitated. In consequence of the large proportion of blood which circulates through the head of infants and chil- dren, every complaint which occasions any irregularity or inequality in the action of the heart and blood- INFANTS AND CHILDREN. 299 vessels, produces an effusion of watery fluid into the cavities of the brain, more readily than in any other part of the body. The effect of this effusion is com- monly stupor, and eventually convulsions. In this way, fevers, many inflammatory complaints, and in short all diseases which are protracted for any length of time, terminate ; arid as it is found after death, that water is accumulated within the brain, superficial ob- servers are apt to imagine, that what in fact is the ef- fect of the previous indisposition, had been the ori- ginal cause. Symptomatic water in the head has been often cured by supporting the strength, and at the same time em-, ploying the powerful remedies for dropsical affections. The means for both purposes ought to be exceedingly active, as there is generally no time for trifling. The third disease known by this title has been usu- ally called the Idiopathic Water in the Head, and more often takes place in childhood than in infancy, although instances of its occurrence in the latter are occasionally met with. When infants are afflicted with this disease, the first symptoms are commonly those of teething, after which a great degree of torpor, with obstinate costiveness, frequent startings, and in some cases convulsions, sud- denly come on. The fatal event often follows with great rapidity, so that an infant who had been observ- ed to be only a little indisposed, has been known to die of this disease within the course of three or four days. In children, the approaches of this formidable com- plaint are more gradual and more insidious. Slight headach, or pain about the shoulders, attended, with languor, dulness of the eyes, and costiveness, with disturbed sleep, now and then take place for many weeks, often while the general health does not appear affected ; so that the first circumstance which alarms 300 MANAGEMENT OF the attendants in many cases, is an aggravation of the headach, accompanied by sickness and constipation, or frequent screaming during the night, as if from being awakened by a frightful dream, or irregular fe- verish symptoms, with considerable dilatation of the pupils, and occasional squinting. Soon after this, the pulse becomes evidently affected, being either preter- naturally slow or intermitting. The child now com- plains almost constantly of pain in the head, commonly confined to one part, and of intolerance of light, and has also frequent retching, and most obstinate consti- pation. Some time after this, the inequality of the pulse ceases, and is succeeded by great frequency and feebleness ; the appetite for food returns, inso- riiuch, that whatever is offered is greedily swallowed ; the pupils of the eyeS are more and more dilated, and the vision proportionally impaired, till at last double vision, and finally blindness ensue. Stupor, with stertorous breathing and horrible screamings follow, and are terminated by convulsions, which soon destroy the child. The progress and combination of these symptoms are very different in different cases. Soriietimes the disease has proved fatal hi the course of a few weeks, and sometimes it has been protracted for several months. It is often extremely difficult to distinguish this dis- ease, for many of the symptoms resemble those occa- sioned by worms, or by irregular fevers. The only marks which can be depended on are, unusual slow- ness or inequality of the piilse, and excessive torpor of the bowels, for these occur iri every case. This disease is occasioned by an increased deter- mination of blood to the head ; and as.this is often the effect of very slight injuries from falls or blows, pa- rents, and those who have the charge of children, ought to attend most particularly to every accident of INFANTS AND CHILDREN. 301 that kind, however trifling it may appear at the time to be The application of leeches to the temples, opening the bowels by some cooling medicine, and keeping the child upon a milk and vegetable diet for some days, can almost never do any harm, and may often prevent the most serious complaints. In the treatment of Idiopathic Water in the Head, the most active means ought to be employed as early as possible ; for after a certain time the disease is quite incurable. Bleeding, blistering, preparations of mer- cury, and in some cases the foxglove, are severally necessary ; but as such powerful remedies ought ne- ver to be employed by any other than regular practi- tioners, it would be improper to detail the method of treatment in this work. When parents have unfortunately lost one or two children in consequence of this disease, it is a good precautionary measure to direct, that in future every child shall have, during the period of teething, an issue established on the head or back. APPENDIX, FORMS OF MEDICINES. OBSERVATIONS ON THE DOSES OF MEDICINES. MEDICAL practitioners commonly prescribe liquid medicines in the doses of table-spoonful, tea-spoonful, or drops. But an exact dose can never be given by these measures ; for table and tea spoons are very various in size ; and fluids poured from a phial fall out in large or small drops, according to the ■thickness of its edges or to the quantity of its con- tents. The doses of medicines recommended in this Work are regulated by a graduated glass-measure, which every family can procure for a trifle A. table-spoon- ful is supposed to contain half an ounce ; a tea-spoon- ful, a drachm; and the latter is considered to be equal to seventy drops. When therefore any medi- cine is regulated in the dose of ten drops, a drachm may be diluted with six times the quantity water, and a tea-spoonful will furnish the exact proportion ; and the same rule may be applied to every other dose of fluids by drops. The doses of the pills are always specified. The doses of powders and electuaries should be as- certained by weight, for which purpose every family ought to be provided with a set of apothecaries weights. 304 APPENDIX. When any of the following medicines is suited both to grown persons and to children, the doses proper for each are mentioned ; but when they are only de- signed for one or other, the dose for either alone is marked. ABSORBENTS. Magnesia—may be mixed with water ci' milk. The dose for grown persons is half a drachm every four or six hours, when necessary ; for children, twenty grains once in eight or ten hours. Prepared crabs eyes—may be given in the same manner as magnesia. The dose for grown persons is fifteen or twenty grains every nour or two; for children, ten grains every two hours. Lime Water.—The dose for grown persons is four ounces twice or turice a-day ; for children, two te ■-spoonfuls or a table-spoonful, (according to their age) diluted with common water. Absorbent I'.ixture.— fake of Refined -iu,ar one drachm, Prepared Crabs T yes, Ma;. nesia, of e .ch two drachms. Rub them well together into a fine powder. Then add of Simple innaraon-water two tea-spoonfuls, Common water five table-spoon fuls. APPENDIX. 305 Dose : For grown persons a table-spoonful, and for children a tea-spoonful, every two hours.* ANODYNES. Opium.—Dose, One grain for grown persons. Opiate pills.—Take of Pure Opium, and Powder of Cinnamon, equal parts. Form tnese, by means of Syrup, into pills of one grain each. Dose for grown persons, Two at bed-time, and in particular cases one in the morning. Laudanum —Dose for grown persons, thirty or thirty-five drops once in twenty-four hours. When it disagrees in the ordinary quantity, it may often be given with much advantage in doses of five drops every hour till the proper effect be produced. As Laudanum is extremely prejudicial to children,! it ought never to be prescribed to them except under very peculiar circumstances. Instead of its internal use, a little of it should be rubbed on the back-bone ; or the same effects will be produced by rubbing on that part a tea-spoonful o n anodyne balsam. When Laudanum is prescribed by way of Lave- men>, the proportion must be more than double what can be given by the mouth. Paregoric elixir.—Dose for grown persons, from seventy to an hundred and forty drops in a cup of water or gruel Russian castor.—This medicine must be always * This mixture should be kept in a phial in a cool place, and the glass ought to be well shaken every time it is used. t The Author has been consulted in two cases where four drops proved fatal to children some months old. Q q 306 APPENDIX. used fresh powdered.—.The dose for grown persons is twenty or thirty grains once in twenty-four hours, given in marmalade or jelly. Anodyne draught.—Take of Laudanum thirty-five drops, Common Syrup two tea-spoonfuls, Simple Cinnamon-water a table-spoonful. Mix them together. This medicine, to be taken at once, is only adapted for grown persons. Anodyne mixture.—Take of Laudanum one drachm, Tincture of Saffron a table-spoonful, Common Syrup two table-spoonfuls, Water four table-spoonfuls. Mix them together. Dose, two table-spoonfuls at bed-time and one every five or six hours while pained, for grown persons. Opium plaster.—To two ounces of the Stomach- plaster of the London Dispensary, add two drachms of pure Opium. To be spread on a piece of leather. ASTRINGENTS. For Internal Use. Oak bark (in powder).—Dose, twenty grains twica a-day. for grown persons, in jelly or marmalade. Peruvian Bark.—Dose, from half a drachm to two drachms twice a-day, for grown persons, in water, port-wine, in jelly, or in a piece of sheet-wafer.— For children, from ten to twenty grains. Elixir of vitriol.—Dose, fifteen or twenty drops twice a-day, for grown persons, in a glass of spring- APPENDIX. 3G7 water, taking care to rince out the mouth after every dose. Astringent Decoction.—Take of Cinnamon two drachms, Peruvian Bark one ounce, Spring Water three English pints. Boil these together till only one half remains ; then strain the liquor off clear after it has cooled, and add, Weak Acid of Vitriol one drachm, Nutmeg-water, or Dutch Cinnamon-water, one ounce. Dose, two ounces twice a-day, for grown persons. Strong astringent decoction.—Take of Canella Alba two drachms, Peruvian Bark, Oak Bark, of each half an ounce, Spring Water two English pints. Boil these till one pint remains, pour the liquor clear off, and add the same materials as to the former decoction. Dose, two ounces, twice a-day, for grown persons. Astringent infusion—Take of Dried Scarlet Roses a handful. Pour on these a pint of boiling water. After four hours, strain off the liquor, and add— Weak Acid of Vitriol one drachm, Syrup of Roses one ounce. Mix them together. Dose, one or two table-spoonfuls, for grown per- sons, every two or three hours, according to cir- cumstances. Astringent Mixture.—Take of Laudanum one drachm, Japonic Confection, Refined sugar, of each two drachms. Rub these together in a glass mortar, and add, Of simple Cinnamon-water one ounce, 308 APPENDIX. Spring Water three ounces. Mix them. Dose, a table-spoonful every three hours for grown persons, and for infants a tea-spoonful, diluted with as ' much water. ' Astringent powder.—Take of Powdered Ginger fifteen grains, Rock Alum half a drachm, Kino (Gum Kino) two drachms, Catechu (Japonic Earth) one drachm. Rub these together into a very fine powder. Dose for grown persons, ten grains every two or three hours, in marmalade or conserve of roses. i For External Use. Solutions of sugar of lead. See page 62. Weak astringent lotion__Dissolve half a drachm of White Vitriol in a pint of spring water. Strong astringent lotion.—Dissolve two drachms of Common Alum in one pint of spring water. Astringent decoction.—Take of Oak Bark two ounces, Spring Water two pounds. Boil into one pound ; to which, when strained, add, \ One drachm of Alum. BITTERS. Columbo powder.—Dose for grown persons, ten grains twice a-day, in marmalade. Infusion of Chamomile.—Take of APPENDIX. 309 Chamomile Flowers, dried, a handful, Pour on them a quart of sprintc cold water. After twenty-four hours, strain off the liquor. Dose for grown persons, a small tea-cupful twice a-day ; for children of five or six years of age half that quantity. Bitters for infusion in water.—Take of Dried Yellow Rind of Seville Orange two drachms, Root of Sweet-scented Flag, Peruvian Bark, of each half an ounce. Pour on these one quart of boiling water, and strain off, after thirty-six hours. Dose for grown persons, a small tea-cupful. Bitters for infusion in wine.—Take of Lesser Cardamom Seeds, bruised, one drachm, Peruvian Bark, Gentian Root, of each half an ounce. Pour on these a quart-bottle of red port wine, and filter off the liquor after four days. Dose for grown persons, a small wine-glassful twice a-day. CARMINATIVES. Anise sugar.—Dose for children, six or eight grains. Essence of peppermint.—Dose for grown per- sons, four or five drops on a small piece of sugar. For infants, half a drop on sugar dissolved in water. CORDIALS. tEther.—Dose for grown persons, a tea-spoonftd every hour or two, in a glass of spring water. 310 APPENDIX. Barley Cinnamon water.—Dose, a table- spoonful for grown persons, and for children a tea- spoonful, diluted in as much water, every hour. Cordial draught —Take of Volatile Tincture of Valerian thirty-five drops, Simple Cinnamon Water, Syrup, of each three tea-spoonfuls. Mix them together. To be taken at once for grown persons. Cordial drops.—Take of Paregoric Elixir, Volatile Tincture of Valerian, of each equal parts. Mix them together. Dose, one tea-spoonful in a glass of water for grown persons. Cordial mixture.—Take of Compound Spirit of Lavender, Tincture of Saffron, each one tea-spoonful. Syrup, Simple Cinnamon Water, of each half an ounce, Spring Water one ounce. Mix th'em together. Dose for grown persons, a table-spoonful every hour or two ; for children, a tea-spoonful diluted with water. Cordial mixture for children__Take of Aromatic spirit of Ammonia half a drachm, Simple Syrup an ounce, Rose-water three ounces. Mix them. Dose, a tea-spoonful every hour while awake. APPENDIX. 311 DIAPHORETICS. Antimonial wine.—Dose for grown persons, twenty drops every hour or two, in gruel, till the proper effect be produced ; for children, four or five drops every two hours. Dover's powder—Dose for grown persons, twenty grains in gruel or honey James's powder.—Dose for grown persons, seven or eight grains, divided into two parts the one to be given an hour or two after the other, in maiinalade or conserve of roses. Diaphoretic draught.—Take of Laudanum, Antimonial Wine, of each twenty-five drops, Simple Cinnamon Water, Syrup, of each three tea-spoonfuls. Mix them. To be taken at bed-time, for grown persons. Saline julep.—Take of Lemon Juice one ounce, Volatile Sal. Ammoniac, one drachm, or Salt of Tartar four scruples. After the effervescence, add, Syrup, two tea-spoonfuls* Simple Cinnamon Water half an ounce, Spring Water, three ounces. Mix them. Dose for grown persons, two table-spoonfuls every three hours. 312 APPENDIX. DIURETICS. Cream of tartar.—Dose for grown persons, half an ounce dissolved in a pint and a half of water, to be taken throughout the course of the day. It must be gradually increased as tlie stomach becomes accus- tomed to it. Oil of juniper.—Dose for grown persons, ten drops in gruel; for children, one drop on a little sugar, whicn may then be mixed with panada. Nitre.—Dose, ten grains mixed with sugar, and put into gruel, twice or thrice a-day, for grown per- sons. Dulcified spirit of nitre.—Dose for grown persons, a tea-spoonful, mixed with a small cupful of water. Dried squiLL.—Dose for grown persons, a grain three or four times a-day, in the form of pills. DRINKS. Almond emulsion.—Take of Sweet Almonds, blanched, four ounces, Refined Sur;ar two ounces, Beat them well in a marble mortar, and then add, by degrees, Simple Cinnamon-water three ounces, Spring Water a pint and a half. Dose for grown persons, a tea-cupful every two hours. Imperial drink.—Take of Cream of Tartar, Refined Sugar, each two drachms. APPENDIX. Outer Rind of fresh Lemon one drachm. Boiling water one quart. After it is cook- strain off the liquor. Dose, a tea-cupful every hour or two, for grown persons ; for children, a table-spoonful. Barley water. Jelly water. Lemonade. Rice-gruel. Water-g*ruel. White-wine Whey. The use of these is well known. EMETICS. Antimonial wine.—Dose for grown persons, two tea-spoonfuls ; for children, ten or fifteen drops. Ipecacuan (in Powder.)—Dose for grown per- sons, fifteen or twenty grains, mixed with sugar and warm water ; for children, from three to ten grains, mixed with syrup. Ipecacuan wine.—Dose for children, one, two, or three tea-spoonfuls, according to the age. Emetic tartar.*—Dose for grown persons, two grains dissolved in warm water. Vomiting mixture.—Take of Antimonial Wine one drachm, Squill Vinegar two drachms, Syrup one ounce, Spring Water three ounces. Mix them. • Emetic Tartar must never be given to infants ; for alarming Con- vulsions have often followed its use. R r 3'14 APPENDIX. Dose for children, two tea-spoonfuls, or a table- spoonful, according to the age.* , LAXATIVES Calomel.—Dose for children, from one to four grains, according to the age, mixed with sugar or any thing but drinks. Castor oil.—-Dose for grown persons, from two tea-spoonfuls to a table-spoonful every six hours, till it operate. To be given in a little cold brandy and wa- ter, or in coffee. Cream of tartar.—Dose for grown persons, two or three tea-spoonfuls at bed-time, with a little Nutmeg, in water or gruel. Laxative electuary.—Take of Powder of Jalap twenty grains, Chrystals of Tartar, Refined Sugar, each two drachms. Rub them well together in a marble or glass mortar, then add, Lenitive Electuary one ounce and an half, Syrup of Roses, as much as will make the whole into a soft consistence. Dose for grown persons, a drachm every two hours till it operate. Strong laxative electuary.—Take of Powder of Ginger ten grains, Powder of Jalap, in fine powder, one drachm, Cream of Tartar one ounce, Syrup, as much as will give the whole a proper consistence. is particularly w<*ful when children are trembled APPENDIX. 315 Dose for grown persons, two drachms in the morn- ing. Lvxative'pills —Take of Powder of Ginger ten grains, Socotorine Aloes in finest powder, Castile Soap, each one drachm. Beat them together in a stone mortar, and then add two or three drops of syrup, so as to form a mass, which is to be made into thirty-two pills. Dose for grown persons, two at bed-time. Strong laxative pills.—Take of Powder of Ginger ten grains. Calomel half a drachm. Castile Soap forty grains, Socotorine Aloes in the finest powder, one drachm and an half. Form these, as directed in the preceding receipt, ;.:rto forty-two pills. Dose for grown persons, one or two at bed-time, according to the state of the belly. Laxative powder.—Take of Calomel four grains, Powder of Jalap fifteen grains. Rub them well together in a glass-mortar. To be taken in the morning in marmalade for grown persons. Laxative draught.—To the above Laxative Powder add, Powder of Ginger three grains, Syrup half an ounce. Mix them. To be taken in the morning. For grown persons, Laxative Salts.—Of these the best are Fhos- phorated Soda and Brasil Salts, to be given in Soup in which no Salt has been put. Dose for grown persons, sir; drachms,or one ounce. .H'6 APPENDIX. Magnesia.—Dose for children, a tea-spoonful u> the morning. Manna.—Half an ounce, to be dissolved in three ounces boiling water.----Dose for children, Three or four tea-spoonfuls every two hours till it operate. Infusion of rhubarb.—Take of Turkey Rhubarb in rough powder one drachm, Refined Sugar a drachm and a half, Salt of Tartar five grains, Boiling Water two ounces. After six hours strain off the liquor, and add Simple Cinnamon Water a table-spoonful. Dose for children, two tea-spoonfuls, or a table- spoonful in the morning, according to the age. Infusion of sinna.—Take of Senna without the stalks three drachms, Tamarinds half an ounce, Boiling Water ten ounces. After eight hours strain off the liquor. Dose for grown persons, a small tea-cupful every hour and a half, till it operate. LAVEMENS.* F'or grown Persons. Emollient lavement.—Take of Common Salt, Coarse Sugar, of each a table-spoonful, Fine Olive Oil four ounces, Warm Water fourteen ounces. Mix them. • LAVEMENT in the whole of this Work has been used for the English word GLYSTER. APPENDIX. 317 Anodyne lavement__Take of Laudanum one drachm, Thin ^tarch moderately warm four ounces. Mix them. Restringent lavement.—Add to the preced- ing receipt of Catechu (Japonic Earth) two drachms, Peruvian Bark three drachms. Mix them. Strong xaxative lavement.*—.Take of Senna half an ounce, Spring Water two pints. Boil them till a pint only remams, and to the strained liquor add, Common Salt two table-spoonfuls, Fine Olive Oil four ounces. Mix them. For Children. Emollient lavement.—Take of Common ^alt a tea-spoonful, Fine Olive Oil a table-spoonful, Warm Water from three to six ounces. Mix them. Laxative lavement.—Take of Phosphorated Soda two drachms, Boiling Water four ounces. Add, when nearly cool, Castor Oil a table-spoonful, Mix them. * Nourishing Lavemens may be formed by adding to four ounces of beef-tea or thin gruel, five or ten drops of LAUDANUM. N. B. The laudanum is added to prevent the gJvster from being i rjr:ted. 318 APPENDIX. Anodyne lavement.—Take of Laudanum from five to twenty drops, (according to the age), Beef-tea half a small tea-cupful. Mix them. Restringent lavement.—-Take of Laudanum the same quantity as in the preceding receipt, Rice Gruel or thin starch half a small tea-cupful. Mix them. LINIMENT. For sore nipples.—Take of Litharge, Vinegar, each two drachms, Olive Oil six drachms. To be made into a liniment, by adding the vinegar and oil alternately in small quantities to the powdered litharge, and rubbing the whole together till the lini- ment be of a pale flesh colour, and of the consistence of cream. REFRIGERANTS. Acidulated drinks. Ripe acescent fruits. Nitrous mixture.—Take of Nitre one drachm, Refined Sugar two drachms, Distilled Vinegar a table-spoonful, Spring Water six ounces and a half. Mix them. Dose for grown persons, a table-spoonful every two hours when necessary. APPENDIX. 319 STRENGTHENING MEDICINES. BITTERS.—elixir of vitriol, Peruvian bark. See page 306. Tincture of bark.—Dose, a table-spoonful in a glass of wine, barley-cinnamon, or peppermint-water, twice a-day. Sugar of steel, called here by the confectioners Steel Carvey.—Dose for children, a tea-spoonful once or twice a-day, according to the age. Tincture of steel.—Dose, fifteen or twenty drops twice a-day, in beef-tea or veal-broth, for grown persons. Rust of steel.—Dose for grown persons, half a drachm twice a-day in marmalade. THE END. M WZ W £ lit r ISIS -aft.\f" -'-t