- :;;;:mrsr:
 

*w%.*
NLM 0055.06^4 3
iinffBF.
ARMY MEDICAL LIBRARY
FOUNDED  1836
iUWS»:
inim*
WASHINGTON, D.C
NLM005808943 
        RETURN TO
NATIONAL LIBRARY OF MEDICINE
  BEFORE LAST DATE SHOWN
lr
FEB 04 m 
 
 
 
Guernseys  Obstetrics. 
 
                      THE



            APPLICATION


                     OF THE



 PRINCIPLES AND  PRACTICE OF HOMEOPATHY


                       TO




       OBSTETEIOS


                     AND THE


DISORDERS PECULIAR TO WOMEN AND YOUNG CHILDREN.



                       3Y

          HENRY N. GUERNSEY, 'M.D.,

 FOR EIGHT CONSECUTIVE YEARS PROFESSOR OF OBSTETRICS AND DISEASES OF WOMEN AND
  CHILDREN IN THE HOMOEOPATHIC MEDICAL COLLEGE OF PENNSYLVANIA J FOR THREE
    YEARS PROFESSOR OF MATERIA MEDICA AND INSTITUTES IN THE HAHNEMANN
     MEDICAL COLLEGE OF PHILADELPHIA, AND DEAN OF THE FACULTY AT THB
      SAME TIME; HONORARY MEMBER OF THE HAHNEMANNIAN MEDICAL
       INSTITUTE OF PHILADELPHIA; MEMBER OF THE AMERICAN INSTI-
         TUTE OF HOMOEOPATHY; HONORARY MEMBER OF THE CUMBER-
          LAND COUNTY MEDICAL SOCIETY IN PENNSYLVANIA ; COR-
           RESPONDING MEMBER OF THE MASSACHUSETTS SUR-
            GICAL AND GYNAECOLOGICAL SOCIETY ; HONORARY
             MEMBER OF THE HAHNEMANNIAN SOCIETY
              CF MADRIS DE TULIO; PRESIDENT OF
               THE PENNSYLVANIA HOMOEOPATHIC
                 MEDICAL SOCIETY, ETC., ETC.



     WITH NUMEROUS ILLUSTRATIONS.
      THIRD  EDITION.

REVISED, ENLARGED AND GKEATLY IMPROVED
         PHILADELPHIA:

HAHNEMANN PUBLISHING HOUSE.

             1891.

JtUim.
I 
G333u
 1831
        Entered according to Act of Congress, in the year 1873, by
                    H. N. GUERNSEY, M.D.,
        In the Office of the Librarian of Congress, at Washington.

Copyrighted in 1886 by J. C. GUERNSEY, M. D., Executor for H. N. GUERNSEY, M. D.
  WZSTOOTT &  TH0M80N,
Slereotypers and EUctrotypers, Philada. 
PREFACE  TO  THE  FIRST  EDITION.
  In preparing this work for the press, I need  not remark
upon the great interruption a large practice and the  great
labor of lecturing one hour or more every day in the  week
for six months out of the twelve upon some  medical subject,
and many other duties at the College besides, have occasioned.
Very  many physicians  can  testify to the all-engrossing of
almost every moment of time in  conducting  a large practice.
Add to this the labor as above indicated, and most physicians
can understand that it  is  an easy matter for many imperfec-
tions to creep into a work of this size, prepared under such
nressing circumstances.  No one can be more  conscious of
these imperfections than myself.   This  being the pioneer of
all works of this kind ever published, it will be an easy mat-
ter to  offer  criticisms and to improve on the issue of future
editions.
  The same reasons have compelled the long delay in the
publication of  the work, due entirely to the impossibility of
more rapidly supplying the copy.  Nor indeed could the work
have made  its  appearance so promptly, but for the assistance
rendered by my friend and colleague, J. H. P. Frost, M. D.,
in preparing the physiological parts, description of diseases,
etc., and in carrying the whole through the  press.
  Both the author and publisher desire to  acknowledge the
liberality of Messrs. Lindsay  & Blakiston  in  furnishing  a
considerable part of the illustrations employed in this work.
  The plan of treatment may seem to some rather novel, and
perhaps on its  first view,  objectionable, inasmuch as it may
seem like prescribing for  single symptoms;  whereas such  is
                                                5
17/7/4- 
6              PREFACE TO THE FIRST EDITION.

not the fact.   It is only meant to  state some strong charac-
teristic  symptom, which will  often be found the governing
symptom, and on referring to the Symptomen Codex all the
others will surely be there  if this one  is.   There must be a
head to everything;  so in symptomatology—if the most in-
terior or peculiar, or key-note, is discernible, it will be found
that all the other symptoms of the case will be also found
under that remedy that gives existence to this  peculiar one,
if  that remedy is well proven.  It will be necessary,  in order
to  prescribe efficiently, to discover  in every case that which
characterizes one remedy above another in every combination
of symptoms that exists.   There is certainly that, in every
case of illness, which pre-eminently characterizes that case, or
causes it to differ from every other.   So in the remedy to  be
selected, there is  or  must be a combination of symptoms—a
peculiar combination, characteristic, or more  strikingly key-
note.   Strike  that  and  all  the  others are  easily touched,
attuned or sounded.   There is only one key-note to any piece
of music, however complicated, and that note governs all the
others  in  the various parts, no matter how many variations,
trills, accompaniments,  etc.
   Such a work as the present was needed, indeed urgently
called for, and I have spared no pains to render it useful  to
students and to the junior members of the profession, for
whom it was especially designed, and to whom it is respectfully
dedicated by
                                     THE AUTHOE.
   Philadelphia, 1866. 
PREFACE  TO  THE SECOND  EDITION.
   In placing before  the  profession  a second edition of his
work the  author desires to call attention to the fact that he
has endeavored to make it more acceptable and valuable by
a thorough revision of the entire text of the first edition; by
rewriting  parts, and even whole chapters, wherever  it was
deemed necessary to do so  ; by a free  consultation of the most
recent authorities, thus bringing it up to the advanced opin-
ions of the day; and especially by the addition of much new
material, chiefly gathered  from the writings of experienced
homoeopathic practitioners, from the valued verbal communi-
cations  of numerous esteemed professional friends, and from
personal  experience.   While,  however, new  measures of
practice have been introduced, nothing has been recommended
that has not fully borne the test of practical experimentation.
Thus, for  instance, in the  use of the forceps in breech pres-
entations, mentioned  on  page  260,  while it may  seem to
many  a novel and problematical  procedure, yet it has re-
ceived the endorsement of Dr. James Kitchen, of Philadel-
phia, one  of the most experienced and skillful of accoucheurs,
of the author, and of other practitioners.
   It is proper that the author should here place on record an
expression of his  increased  confidence in the methods of
practice strictly medical  which  were laid down in the first
edition of the work, and which  were  regarded  by  certain
critics as  chimerical.   Increased experience has only served
                                                   7 
8            PREFACE TO THE SECOND EDITION.
to add to the author's faith in the efficiency of homoeopathic
medication in the greatest exigencies of life, and this faith
has been additionally strengthened by the related experience
of many of the most eminent and skillful practitioners of the
homoeopathic school.
   The Clinical Index, it is hoped, will prove a great help to
the busy practitioner.  By it the therapeutical parts of the
work may be read " cross-wise," as  Dr. Hering expresses it,
which will facilitate the selection of the remedy at the bed-
side.  A copious General Index has been supplied  to this
edition, a glance at which  will indicate  the additions and
improvements that have been made.  The complete Glossary
at the end of the volume is intended to aid the novitiate.
   The  author  desires to express  his thanks to the many
friends who have kindly made suggestions for the improve-
ment of this edition, and to  acknowledge  his special obliga-
tions  to Dr. R. J. McClatchey, of Philadelphia, editor of
the Hahnemannian Monthly, for valuable  assistance in pre-
paring the  material for, and  carrying the  work through, the
press.

  1423 Chestnut Street, Philadelphia,
             August 1,1873. 
PREFACE  TO  THE  THIRD  EDITION.
  The call  for a Third Edition of my work on Obstetrics,
at the present  time, affords me much gratification,  and I
feel well assured the improvements in this, over previous
editions,  will be satisfactory to the profession.
  Since publishing the First Edition my knowledge  of the
opinions  and wants of our school has been constantly in-
creasing, and it  is exceedingly gratifying to know that the
mass  and strength  of  the  profession  demand  more  know-
ledge, more remedies,  fuller indications,  and all  other im-
provements  that have  stood the test of the increasing light
of science.   It  has been my aim to satisfy  these demands,
but to specify  every improvement would  be tedious and
difficult.   Suffice it to say, that all through the work  matter
that could  be dispensed with has been expunged, and more
useful material inserted.  New remedies and  their indica-
tions  have  been given, while old ones have been amplified
and verified.  New and valuable manipulations  have been
described, and  an Appendix added, the  intrinsic value of
which will greatly enhance  the  value of the entire volume.
It is a matter of congratulation that the Homoeopathic school
is making such  rapid strides in the science and art of Thera-
peutics.   An increased confidence is expressed universally
in the methods of  practice, strictly medical, which were
laid down in the First Edition, and which were regarded by
                                               9 
10           PREFACE TO THE THIRD EDITION.
certain critics  as chimerical.  On the contrary, daily expe-
rience has only served to increase the  faith of the profession
everywhere  in the efficiency of Homoeopathic medication in
the most trying exigencies of life.
   In  the obstetric art, when mechanical  means become ne-
cessary, the  new  ideas  advanced  in former  editions are
growing in  favor, such as applying forceps to the  breech,
the management  of  placenta prsevia, etc.  From  the first,
my work  has been  based upon the principles of  Samuel
Hahnemann's  Organon of the Healing Art,  and the cura-
tive measures  adopted  are all in harmony with that greatest
of text-books.  The  more the profession  read and apply the
teachings  of this  great book in  their daily  rounds among
the sick, so much the  more will they value my work  on
Obstetrics and Diseases of Women and  Children.
   I am indebted to my son,  Joseph C. Guernsey, M. D.,
for his assistance in making many important corrections and
for carrying the entire work through the press.

                                     THE AUTHOR.
  1423 Chestnut Street, Philadelphia,
            January 1, 1878.

  In this continuation  of the Third Edition some important
corrections and additions  of remedies which  were prepared
by  my late father, Dr. H. N. Guernsey, for a new edition
have been duly incorporated.
                    JOSEPH C. GUERNSEY,  M.D.
  1923 Chestnut Street,  Philadelphia,
            February, 1886. 
A   Treatise   on  Obstetrics.
                        CHAPTER  I.

               THE BONES  OF THE  PELVIS.

   OBSTETRICS, as a science and as an art, has relation to the phe-
    nomena of pregnancy and parturition considered as physiological
processes.  Its study naturally includes a consideration of the develop-
ments necessary to the occurrence of pregnancy, the period of preg-
nancy itself, and  the conditions which, succeeding  parturition, may
be regarded as its  consequences.   At the same time,  however, all
inequalities in form and function,  and  all difficulties and disorders
attendant upon, connected with, or following after these processes,
with their proper  treatment, must be thoroughly understood, in order
that  the student  may  become  an  accomplished and successful  ac-
coucheur and physician.   The anatomy and physiology of the pelvis,
therefore, and of  the parts of which it  is composed, of the  organs
which it contains, and of those  which are functionally associated with
them, demand the first attention.   And  it is to be  remembered that
no mere description  of these several organs and regions  can alone be
sufficient to impart a knowledge of  them adequate to the purposes of
the obstetrician, for  the bones of the pelvis and their relations to each
other, the pelvis as  a whole and its  relations to the  mechanism of
pregnancy and parturition, and  the soft  parts in situ, must be care-
fully and scrutinizingly studied, on  the skeleton and on the cadaver.
   In describing the anatomy of these parts and  organs, a well-formed
adult—having passed through the successive stages  of  progressive
development, from the  embryonic formation to that of maturity—is
taken as a standard.
  The  Pelvis is composed of  four bones—viz.,  the  sacrum,  the
coccyx, and  the ossa innominata.   The sacrum and coccyx form  the
posteri( r part of the pelvis, and are placed on the median line, Avhile
                                                    i] 
12
BONES OF the pelvis.
the ossa innominate form the sides and front.  These bones unitedly
form a cavity or basin (-s/y£, a basin), which gives general support
to the contents of the abdomen,  and the surfaces  of which  afford
places of attachment to numerous  muscles.   In the  adult it occupies
the centre of the body, and is interposed between the lower end of the
vertebral column, to which it gives support, and the inferior extremi-
ties, upon which it rests; articulating superiorly with the last lumbar
vertebra, and inferiorly with the femoral bones.  In the erect position
it is placed obliquely with regard to the trunk of the body;  the inner
surface of its  anterior wall—the symphysis  pubis—looking upward
and backward, while  the  inner surface of its posterior  wall—the
sacrum—looks downward and forward.
  A brief description of the several bones which compose the  pelvis
will prepare the way for a more particular account of it.
  The Sacrum  is the largest bone of the series of vertebrae, and  is
situated at the lower  part of the spinal  column and at the superior
and posterior part of the pelvis, presenting the appearance of a  wedge
forced between the ossa innominate.  It is concave in front and con-
vex behind, and is curved upon itself from above downward and for-
ward.  Superiorly it articulates with the last lumbar vertebra.   This
articulation, owing to  the projection forward of the anterior part of
the articulating surface of the sacrum, and to the projection backward
from this point of the body of the bone, forms a considerable promi-
nence called the sacro-vertebral angle, or promontory of the sacrum, the
angle being obtuse relatively with the lumbar portion of the vertebral
column.   Inferiorly the sacrum articulates with the  coccyx.   It  is
from four to  four and a  half inches in length and of nearly equal
breadth, but in consequence of its  spongy texture and the numerous
foramina by which it is perforated, it is the lightest bone, for its size,
in the skeleton.   It is  triply wedge-shaped, as will  be shown by the
following description:  In the first place, it is wider at its base, supe-
riorly, than at its  apex, having a breadth above  of four and a half
inches, from which it  rapidly tapers toward its coccygeal extremity;
secondly, it  is broader on its anterior than on its posterior surface;
and, thirdly, while the  anteroposterior thickness of the bone at its
base is two and a half inches, that of the apex is  usually not more
than two lines.  It presents for examination  an  anterior and  a pos-
terior surface, two lateral  surfaces, a base, an apex,  and  a central
canal.
  The anterior surf'ace is comparatively smooth and concave.   This
concavity is an important feature in the  construction cf the pelvis; 
the sacrum.                        ]3
 varying in degree in different subjects, being usually estimated at from
 one-half to three-fourths of an inch.  In the middle of this depres
 jion there are four transverse ridges, which show the lines of  union
 of the five segments of bone of which the sacrum is originally com-
 posed.  At the  ends  of each of these ridges  are  the anterior  sacral
 foramina—eight in number—through which pass the anterior branches
 of the sacral nerves.  These foramina are rounded in form, the supe-
 rior being the largest and the inferior the smallest.  Opposite to the
 extremities of the ridges above described, the margins of the foramina
 are beveled to form  a  groove, which runs toward the lateral mar-
 gins of the bone, so  that on their outer side  the  nerves transmitted
 are in a great measure protected from pressure  by the descending
 head, during parturition, by being thus sunk below the surface of the
 bone.  On  the  inner side, the transverse ridges themselves answer a
 similar purpose  of  preventing undue pressure upon the nerves, which
 pass as it  were beneath  them.   External to these  foramina, on either
 side, are  the lateral masses of the bone, which complete its anterior
 surface.
  The posterior surface is very rough, irregular,  convex and  much
 narrower  than the anterior  surface.  Along  the median line it is
 studded with  eminences—rudimentary spinous processes—which af-
 ford greater surface  and security to the muscles that originate from,
 and that are inserted  into, the sacrum.  These processes and tubercles
 form an  irregular bony ridge, whose projections afford  greater firm-
 ness of attachment to the  numerous ligaments which unite this bone
 to the  os innominatum  of either side; while the  general contour of
 the ridge  itself  renders the convexity of this  posterior  surface even
 greater than the  corresponding concavity of the anterior surface.  This
 convexity presents in both directions, longitudinally and laterally;
 so that the slope from the posterior surface inclines toward each lateral
 border, as well as toward the base above and the apex below.  At the
 base of the spinous ridge, and immediately external to it, are the lamina?,
 broad and well marked  superiorly, but narrower and less pronounced
 as the apex is approached; while external  to  the  laminae are a series
 of indistinct tubercles which  correspond to the articulating processes
of the lumbar vertebrae.  The first or upper pair  are  large and well
developed, the second and third more indistinct,  and the fourth and
 fifth, which are usually  blended together, are called the sacral comua,
and articulate with corresponding processes of the coccyx.  External
to these proc<sses on either side are  four posterior sacral foramina,
tlirough which are  transmitted the  posterior  branches of the sacral 
14
BONES OF THE PELVIS.
nerves.   On the outer side of these foramina, a second series of indis-
tinct tubercles will  be found, which constitute the rudimentary pos-
terior transverse processes of the sacral vertebrae.
  The sacral canal extends centrally throughout the  greater part of
the bone.   In its lower portion it is often incomplete in consequence
of the non-development of the spinous processes and laminae.   It is
triangular  above, follows  the curvature of the sacrum, and is  both
narrowed and flattened from before backward in  its descent toward
the apex.  It gives lodgment to  the  sacral nerves, which  pass out
through the anterior and posterior sacral foramina by which the canal
is perforated.
  Each lateral border is divided into two distinct parts, a superior or
iliac and  an inferior part.  The superior,  auricular or ear-shaped
part is covered by cartilage for articulation with the ilium.   Posteri-
orly it is marked by irregular  impressions, to  which the  posterior
sacro-iliac  ligaments  are  attached.  The inferior part of the lateral
border is thin and curved, and gives attachment to the greater and
lesser sacro-ischiatic ligaments and  to  some portions of the gluteus
maximus  muscle.   The anterior  branch  of the fifth sacral  nerve
passes through a small  indentation at  the lower edge of this  border
and at its angle of junction with the coccyx.
  The base is  directed upward and a little forward, and is largest in
its  transverse  diameter.   In the middle and anteriorly it is sur-
mounted by a  transverse oval surface, placed obliquely, to correspond
with the body of the last lumbar vertebra, with which it is articulated
by the medium of intervertebral cartilage.  Upon each side  of this
articulating facet, a smooth surface is observed, concave transversely,
convex from before backward, inclined forward, covered in the recent
subject by the anterior sacro-iliac ligaments, and continuous with the
iliac  fossa.  The anterior margin of these  surfaces  is formed of  a
rounded lip or border, which separates them from  the anterior sur-
face, and forms  the posterior part of the superior  strait, as will be
hereafter shown.   Behind the  articulating  surface  is observed the
orifice of the sacral canal, and the two articular processes of the upper
segment of the bone.
  The apex is directed downward  and a little forward, and presents
a transverse oval surface by which it is articulated with the coccvx.
  In  the female the sacrum is broader than in  the male;  less curved
especially in its  upper part;  and directed more obliquely backward :
thus at the same time increasing the projection of the promontorv 01
the sacrum, and the capacity of the cavity of the pelvis. 
THE ILIUM.
15
  The pyriformis and coccygeus muscles are attached to the sacrum
on either side;  the gluteus maximus and erector spinae behind.
  The Coccyx corresponds to the sacrum in general appearance,
shape, and  mode of formation.   From the gradual  diminution in
size, from above downward, of the four or five  pieces of which  it
is composed, it presents the form of an inverted triangular pyramid.
Its anterior surface is concave, and marked by three transverse grooves.
It gives attachment to the levator ani muscle, the anterior sacro-coccy-
geal ligament, and affords support to the lower portion of the rectum.
The posterior surface is convex, marked by similar grooves, and pre-
sents on each side a row of tubercles.   The superior and largest pair
of these—the  cornua  of the coccyx—project upward to  articulate
with the cornua of the  sacrum; by which articulation the fifth sacral
foramen is formed, for  transmitting  the posterior  branch of the fifth
sacral nerve.   The posterior  surface of the coccyx is covered in by
and  gives attachment to  the posterior  sacro-coccygeal ligament, and
has attached to it some fibres of the gluteus maximus muscle.  The
borders of the  bone are thin, and give attachment to the  coccygeus
muscle and  the sacro-sciatic ligaments.  To the rounded  apex is at-
tached the tendon of the  external sphincter ani muscle.   The only
articulation of  the coccyx is with the  sacrum above, by means of an
oval articulating surface.
   The Os Innominatum is so called from the impossibility of giving
it a truly descriptive name.  The bone is developed from three primary
centres of ossification, and in early life consists of three separate pieces,
which are then regarded  as distinct bones, and named the ilium, the
ischium and  the pubes.   These subsequently become united to form a
single bone, and in the maturer subject the same names are employed
to designate the respective portions of this large, irregular and anoma-
lous bone.
   The ilium occupies the side, the ischium the inferior and posterior
portion, and the pubes the anterior part of the pelvis.  These three
bones coalesce on either side, uniting at the acetabulum or cup-shaped
cavity for the reception of the head of the femur, and at the ascending
and descending ischio-pubic rami, and  thus form the os innominatum.
   It will  be more convenient first to describe by  itself each of these
constituent bones; afterward to consider them as they unite to form
one single bone.
   The Ilium, the largest of the three, presents an external and aD
internal surface, an anterior and a posterior border, and a crest.
   The external surface, or dorsum of the ilium, is  bounded nbove by 
16
BONES OF THE PELVIS.
the crest; below by the acetabulum; and in front and behind by the
anterior and posterior borders.   It is alternately convex and concave,
broad and smooth, forms the external iliac fossa, and is crossed in a
curved direction  by three lines—the  superior, middle and inferior
curved lines.  It gives attachment, principally, to the gluteus maximus,
medius  and minimus muscles,  which make up the  full and rounded
contour of the hip.
  The internal surface is bounded above by the crest, below by a well-
marked ridge called the ilio-pectineal  line, and in front and behind
by the anterior and posterior borders.  It may be divided  into two
parts.   The anterior  part is a smooth and  concave surface, of con-
siderable extent, called  the internal iliac fossa, or venter  of the  ilium,
and gives  lodgment and attachment to  the iliacus internus muscle.
The posterior portion,  lying behind the iliac fossa, consists of two
portions; a superior, which is rough, uneven and irregularly shaped,
gives attachment  to  the sacro-iliac ligaments; and an  inferior  or
auricular portion, which  is uneven, is covered with cartilage  in the
recent state, and articulates with the corresponding ear-shaped portion
of the lateral border of the sacrum.
  The crest of the  ilium, longer in the  female than in  the male, is
thick, convex, and arched.  Its  terminations in  front  and behind
form prominent eminences, which  are termed respectively the anterior
and posterior superior  spinous processes.   The former,  or anterior
superior spinous process, gives attachment to Poupart's ligament, and
to the sartorius and tensor vaginae femoris muscles.  Into the  latter,
or  posterior superior spinous process, are  inserted strong ligaments
which aid in firmly uniting the ilium to the sacrum.  The outer edge
or  lip  of  the crest gives  attachment  to the tensor vaginae femoris,
obliquus externus abdominis, and latissimus dorsi muscles, and the
fascia lata—a dense fascia which  covers in, and by its inner surface
gives attachment to, the muscles of the hip and thigh.  The inner  lip
has attached to it the transversalis, quadratus lumborum, and erector
spinae muscles; while  between the two, attachment  is given  to the
obliquus internus abdominis  muscle.
   The anterior border of the ilium extends from the anterior superior
spinous  process to the ilio-pectineal eminence.  It presents two de-
pressions, which are separated by the anterior inferior spinous process.
To the edge of the upper depression,  which is a lunated notch, some
fibres of origin of the sartorius  muscle  are attached, while the external
cutaneous nerve passes across it.   The  straight tendon of the  rectus
femoris muscle arises from the anterior inferior spinous process.  Be- 
THE PUBIS.
17
low this process  is a  shallow notch or groove, which completes the
anterior border of the ilium, and across which  the iliacus muscle
passes.
   The posterior border, which is  shorter than the  anterior, extends
from the posterior superior spinous process above to a deep notch be-
low—the great sacro-sciatic notch—its termination being marked by
a  projecting process of bone, the posterior inferior spinous process.
The upper portion of this border corresponds with that portion of the
dorsum of the ilium which gives attachment to the sacro-iliac liga-
ments ; the lower portion  to  the  auricular surface which  articulates
with the sacrum.
   The Ischium, the second in size and lowest in position of the bones
forming the os innominatum, is divided into a base or body and a
ramus or branch.   The base is the  thickest part,  and forms a larger
portion of the acetabulum  than does the ilium.   From  the posterior
border of the bone arises  the spinous process of the ischium, which
marks the inferior boundary of the great sacro-sciatic notch.  This
process gives attachments to  the  gemellus superior, coccygeus, and
levator ani muscles, and the lesser sacro-sciatic ligaments.  Below it
will  be  found a  smaller notch, the lesser  sacro-sciatic  notch.  The
outlet of the pelvic cavity is sometimes materially affected by the ab-
normal length and internal inclination of the spinous process or spine
of the ischium; which hence becomes an important  element in deter-
mining the obstetric  capacity of the pelvis itself.   The tuberosity of
the ischium  forms the part upon which the body rests in the sitting
position.   It gives attachment to  numerous muscles, and to some of
the ligaments of the  pelvis.   The ramus of the  ischium, thin and
flattened, extends  from the tuberosity upward and inward to join the
ramus  of the  pubis.   Its lower border forms part of the outlet, and
its inner surface forms part of the anterior wall of the pelvis.
   The Pubes, the smallest of the three divisions of  the os innomina-
tum, with  its fellow of the opposite side, forms  the  pubic arch  or
anterior portion of the pelvis.  It may be divided for  the sake  of
description into a body or horizontal ramus and a descending ramus.
The  horizontal ramus  presents at its inner extremity the  symphysis,
marked on its surface by a number of transverse ridges  separated by
grooves, which serve  for the attachment of the interarticular fibro-
cartilage placed between the two pubic bones.  The upper surface of
this ramus is bounded posteriorly by a sharp ridge of bone, the linea
ilio-pectinea, which marks the brim of the true pelvis.   The internal
surface of the horizontal ramus is smooth, and forms a portion of the
       2 
18
B NES OF THE PELVIS.
anterior w all of the pelvis.  The descending ramus is that portion of
the bone  which extends outward and  downward to join with the
ascending ramus of the ischium;  the  point of  union is generally
marked by a  slight ridge.  It becomes thin and narrow as it de-
scends ; is smooth on its inner surface,  and rough externally for the
attachment of muscles.  The pubic bones are not in actual contact at
the symphysis, but are separated  by fibro-cartilage, as  mentioned
above.  These cartilages are remarkably adapted to promote elasticity
of the pelvis.  In some instances the state of this inter-pubic fibro-
cartilage is such as to admit so much lateral movement between the
pubic bones as to greatly impede locomotion.  This is particularly the
case during pregnancy, as this state favors softening of the tissues.
   The acetabulum, or cotyloid  cavity of the os innominatum, is the
circular, cup-shaped depression for the  reception of the head of the
femur.  The ischium forms something more, and the ilium something
less, than two-fifths each of this depression, and the pubes the remain-
der.  Thus the acetabulum forms the  centre of union of the three
bones which compose  the  os innominatum; and  these three original
bones, which, for distinction's  sake,  have  thus been separately de-
scribed, unite  to form the os innominatum, which latter must there-
fore be regarded as one bone.
   The obturator, or thyroid foramen, or  foramen ovale, as  it is some-
times termed,  large and irregularly oval in  the  male, but smaller and
triangular in  shape in the female, is a large aperture situated between
and formed by the ischium and  the pubes.  Formed  on the same
principle of the double arch which is seen on  a larger scale in the
construction of the pelvis, it gives lightness to the bone, with strength.
Its margins,  which are thin and  uneven,  have attached to them a
strong membrane, the obturator ligament or membrane,  which covers
in the entire foramen excepting at its  upper and outer part, at which
point, by  a  notch in  the  bone and  a  corresponding  hiatus  of the
membrane, a  foramen is formed through which are transmitted the
obturator  vessels and  nerve.   A  portion  of intestine  may  descend
through this opening and become strangulated.   It will  be perceived
that the obturator membrane forms a part of the wall of the pelvis;
and by its elasticity more room may  be provided for the descending
foetal head during parturition.   It may  be remarked, that the combi-
nation of osseous and  membranous constituents of the pelvic parietes
serves, at the same time, to relieve the fcetal head and the soft parts
of the mother from the danger of undue compression.
  The great sacro-sciatic notch  is a deep, lunated depression, formed 
THE PUBIS.
19
by the ilium and ischium, extending from the posterior inferh r spinous
process of the ilium superiorly to the spine of the ischium inferiorly.
In the recent state this notch is converted into a foramen by the lesser
sacro-sciatic  ligament.  Through  it  are  transmitted the pyriforrais
muscle, the  gluteal vessels and  nerve, and the internal pudic vessels
and nerve.
  The os innominatum is formed by the union of the three bones thus
separately described;  and this bone, considered now as a unit, presents
for study an external and an internal face, an anterior, a posterior, a
superior and an inferior border.
  The external face of the os innominatum is occupied, in its upper
and  posterior portion, by the external  iliac fossa.   In its respective
convex and  concave  surfaces, this fossa gives origin, insertion  and
attachment  to  the  gluteus maximus, medius and  minimus muscles.
Anteriorly and superiorly appears the acetabulum or cotyloid  cavity.
Still more directly in front and beneath is found the obturator fora-
men, already described as being nearly subtended  by the obturator
ligament.
   The internal face of the os innominatum is occupied, in its superior
portion, by the internal iliac fossa and the auricular facet for articula-
tion with the sacrum.  Beneath is found the triangular surface which
corresponds to the acetabulum and  body of the ischium.   Anteriorly
appear the inner surface of the obturator foramen and membrane, and
the internal faces of the ischio-pubic  rami and symphysis pubis.
   The anterior border is concave,  oblique above and horizontal in
front;  marked by the anterior superior and anterior inferior spinous
processes and ilio-pectineal  eminence,  and terminated  by the spine
and angle of the pubes.
   The posterior  border is irregular  in shape, oblique  from  above
downward   and  from without inward;  marked  by the  posterior
superior  and  posterior inferior spinous processes, great sciatic notch,
spine of the ischium  and lesser sciatic notch, and  terminated by the
tuberosity of the ischium.
   The superior border, or crest of the ilium, is convex  and sinuously
curved, being bent outward anteriorly and  slightly inward posteriorly.
It is terminated by the anterior superior spinous process in front,  and
by the posterior superior spinous process behind.
   The inferior border, shorter than  either of the  others, is marked
above by the oval articulating surface which forms the symphysis
pubis, below by the tuberosity of the ischium, and  between ^he  two
we find the ischio-pubic rami. 
CHAPTER  II.
   THE ARTICULATIONS OF  THE  PELVIS,  AND THE
                   PELVIS AS A  WHOLE.

   THE four bones which compose the pelvis are united by five articu-
    lations—the junction of the coccyx with the  sacrum; the sacro-
vertebral junction; the symphysis pubis, and the sacro-iliac symphyses.
Each of these articulations is a true amphiarthrosis,—by some authors,
however, classed as arthrodia,—a species of articulation in which cor-
responding surfaces of bones are United  together by an intermediate
substance, yet admitting limited  motiom   These joints are each sup-
plied with a partial synovial  membrane, and it is supposed that dur-
ing gestation the secretion from  these membranes is more abundant.
During this period, also, all shocks to either or all these pelvic bones
are expended upon their elastic interarticular fibro-cartilages and syno-
vial membranes, and the contents of the  pelvis are thereby preserved
from serious injury.
   In the Coccygeal Junction, or connection of the coccyx with the
sacrum, there are found fibro-cartilages which cover each articulating
surface.   Between these cartilages  is placed the synovial  capsule.
Thus  the sacro-coccygeal articulation admits of  free motion,—espe-
cially backward,—by means of which the  inferior outlet of the pelvis
may be enlarged at least one inch in its antero-posterior diameter.
This movement of the coccyx, so important in obstetric practice, is
facilitated by the minor articulations of the small bones which com-
pose the coccyx itself.  In some rare instances these  fibro-cartilages
become  completely ossified;  as  well  at  the junction  of the coccyx
with the sacrum, as at the points of union of the minor bones of the
coccyx.   In such cases the coccyx forms  one  continuous bone with
the sacrum, greatly  extending its curve,  and constituting a formid-
able obstacle to the passage of the head through the inferior strait in
parturition.  But ordinarily the mobility of the  coccyx as a whole
and of the parts which compose it, increases during pregnancy;  and
so affords an additional advantage in labor.
   The  anterior  and posterior sacro-coccygeal ligaments support  this
articulation in front and behind.
20 
THE SYMPHYSIS  PUBIS.
21
  In the Saoro-Vertebral Junction, or articulation of the base
of the  sacrum with the lower articulating surface of the last lumbar
vertebra, is found the wedge-shaped interarticular fibro-cartilage com-
mon to the inter-vertebral articulations.  This fibro-cartilage is much
thicker anteriorly than posteriorly, and assists in the formation of
the sacro-vertebral prominence.  The oblique processes of the sacrum,
in conjunction with similar  processes of the vertebra, complete  the
articulation, and at these  points a  synovial  membrane is supplied.
The movements common  to the true spinal articulations may be
accomplished, but to a Raited extent only.  The lumbar curve, which
begins with the last dorsal vertebra, terminates at the sacro-iliac junc-
tion,—the pelvic curve commencing at the same point, and terminating
at the  extremity of the coccyx.  The sacro-vertebral ligament and the
ilio-lumbar ligament are  those which more immediately connect the
spine with the sacrum and pelvis.
   The Symphysis Pubis,  or articulation of the pubic bones in  front,
is formed by means of two dense oval-shaped fibro-cartilaginous plates,
which cover the articulating surfaces of the pubic bones.  The surfaces
of these plates lying  next to the bones  are  firmly connected to the
bones  themselves by nipple-shaped  processes which fit within corre-
sponding depressions on the osseous surface  before described;  while
their opposing surfaces are connected by an intermediate fibrous elastic
tissue, especially where the opposing  convex surfaces of the  pubic
 bones  recede from each other.  The  interarticular fibro-cartilages vary
greatly in thickness in different subjects, and project somewhat beyond
 the surface of the bones, especially behind.  An  interspace is  left
 between them at the upper part of the articulation, which  is larger in
the female than in the male, and especially so during pregnancy and
parturition.   At this  point  the surfaces of the plates are  lined by
 epithelium.  This  articulation is strengthened by  several ligaments
 which traverse it in front and behind, above  and below.   These are
termed, respectively, the anterior and posterior pubic ligaments, and the
superior pubic and the sub-pubic ligaments.  Their names are indicative
 of their positions and associations.   The inferior surface  of the sub-
 pubic  ligament forms  the upper boundary of the pubic arch.
   The strength and  variety of these  ligaments, which  combine to
strap the pubic bones together in every direction, and in  the firmest
possible manner, afford sufficient proof of the error of those obstetric
 writers who  have supposed the symphysis  pubis was intended to
separate for the sake of enlarging the diameter of the pelvis in par-
turition.  Except in  cases of serious  deformity, the head is capable 
22
the sacro-iliac symphyses.
of being moulded (elongated) in its descent, so as to accommodate itself
to the size and shape of the  pelvis.  But neither  in  such cases of
serious deformity, nor in any other, does  disarticulation of the  pubic
or sacro-iliac symphysis enable the pelvis  to adapt itself to the size
of the descending head.
  The Sacro-iliac Symphysis, of either side, is formed by the union
of the superior, ear-shaped portion of the lateral border of the sacrum
with the inferior, auricular portion of the posterior-border of the ilium.
Each of these articulating surfaces  is covered with a layer of cartilage;
the sacral layer being much thicker than the iliac.  And both the sacral
and iliac cartilaginous surfaces are  covered by a delicate synovial mem-
brane, which, in the female,—especially in the pregnant state,—secretes
a true synovial  fluid.  Thus, as in the symphysis pubis, so in the sacro-
iliac symphysis, a limited motion is  provided for.
  The sacro-iliac symphysis is strengthened  by several important liga-
ments, which, without entirely preventing the motion just mentioned,
assist in enabling these joints to sustain in safety the whole weight of
the body.   The anterior sacro-iliac ligament, composed of numerous
thin bands, connects the anterior surfaces of the ilium and sacrum.
The posterior sacro-iliac ligament occupies the depression between the
sacrum and ilium, behind the edges of  the cartilaginous surfaces, and
forms the  most powerful  bond of  union between  these  two bones.
This  ligament  consists of numerous short interlacing fasciculi,  which
pass in every direction from the sacrum to the ilium, and which from
their fibrous and elastic nature are admirably fitted to maintain the
necessary  stability  of this important  articulation.   In  this general
name of posterior sacro-iliac  ligament  are  included also those  which
by some writers are described as superior and inferior sacro-iliac liga-
ments.  In addition  to these, the greater and  lesser sacro-sciatic Uga-
ments, which change the greater and  lesser sciatic notches of either side
into foramina, at the  same time serve to  bind the ilium and ischium
still more firmly to the sacrum, and contribute to the construction of
the walls of the pelvis.
  It  is doubtless true, as has  been  asserted by a number of writers,
that during pregnancy there occurs  an  increased afflux of fluids to all
the parts concerned in that process, inclusive of those which  constitute
the articulations of the pelvis; and these articulations or symphvse«
become in  consequence  relaxed during the period of gestation, and do
not  return to their normal condition  for a longer  or  shorter  period
after parturition.   To so great an extent, indeed, may this relaxation
and softening of the tissues and joints occur as to  seriously interfere 
THE PELVIS AS A WHOLE.                  23
with locomotion, which can only be performed with  grei.t difficulty
and  at  the  expense of considerable  suffering.  Dinicult  labor, too,
may have a  damaging effect upon the symphyses of the  pelvic bones
while in this  relaxed condition, to the extent that standing or even
sitting up in bed is rendered well-nigh impossible.   The treatment of
these disordered conditions, and of others  arising during pregnancy
and after parturition in consequence of the softening and  relaxation of
the pelvic joints, will be indicated in another chapter of  this work.

                   The Pelvis as a Whole.
  Having thus studied  the separate bones which compose the pelvis,
and examined the manner in which they are united and strengthened,
and  observed  the nature of their articulations, we come to  the con-
sideration of the pelvis  as a wThole.
  In general, the pelvis may be divided into an external and an inter-
nal surface,  each of which needs to be studied by itself.
  The External Surface of the pelvis presents four regions.   The
anterior region extends from the symphysis pubis, on the median line.
to the edge of the acetabulum on either side, and  is principally cov-
ered by the  obturator externus and adductor muscles laterally, and in
front by cellular tissue and  the  integument of the pubes.  The pos-
terior region is marked principally by the  ridge formed by the spinous
processes  of the  sacrum,  the posterior sacral  foramina, the inferior
opening of the vertebral canal, the union  of the sacrum  with the coc-
cyx, and the posterior surface of the coccyx itself.  Each lateral region
is formed superiorly by  the  external  iliac fossa, mediately by the
acetabulum, and  inferiorly by the external  surface of the tuberosity
of the  ischium.   In  this  situation, likewise, is  found the  great
sacro-sciatic  notch.   In  the  whole  extent  of its lateral surfaces
the bones  of the pelvis are separated from the integument by. thick
muscles.
  On its  Internal Surface  the pelvis  is  divided into the upper
and  larger or false pelvis, and the lower and  smaller or true pelvis.
The line of division extends on a level with the superior  border of the
symphysis pubis throughout the extent of  the linea ilio-pectinea to
the promontory of the sacrum.   Thus, the  superior pelvis is under-
stood to include all that part above, and the  inferior pelvis all that
part below,  the ilio-pectineal  line.   The inferior pelvis  is that which
is principally concerned in  parturition,  and  which the  accoucheur
should therefore fully understand in all its parts and relations.   Both
the superior and inferior pelvic  divisions  are again divisible into four 
lil             inclined  planes OF  THE  pelvis.

distinct regions.   In the superior pelvis the anterior region is formed in
the living subject by the muscular parietes of the abdomen.  The in-
terior presents the  sacro-vertebral  symphysis and promontory, and
extends to the sacro-iliac  symphysis on  either side.   Each lateral
region is constituted by the internal iliac fossa, covered by the iliacus
internus and psoas muscles.
  In the lower or smaller pelvis the anterior region is composed of  the
posterior surface of the symphysis pubis; the posterior region consists
of the anterior surface of the sacrum and coccyx.  Each lateral region
of this division  of the pelvis may be again  divided into an anterior
and a posterior portion.   The  anterior portion is  composed of  the
bony structure of this part of the pelvis, and corresponds to the  inner
surface or back part of the acetabulum, and to the interior surface of
the body and tuberosity of the ischium.  The posterior portion is rep-
resented by the greater and lesser sacro-sciatic ligaments, and by  the
inner surface of  the greater and lesser sciatic notches, which, by these
ligaments, are converted  into pelvic walls.
  The Inclined  Planes of  the Pelvis.—Inside  the pelvis are
found four inclined planes,—one anterior and one  posterior on each
6ide.   These inclined  planes  may  be  demonstrated  by dividing  the
pelvis itself  into two  lateral halves  by vertical section through the
symphysis pubis and median line of the sacrum; and by again divid-
ing each of these lateral  portions into anterior and posterior quarters
bv  a  transverse  vertical  section on the ilio-pectineal line, a  little in
front of the sacro-iliac symphysis, and terminating in the spine  of the
ischium.
   Each of the four quarters thus formed of the pelvis will be  found
to  represent an  inclined plane.  And  each  of these inclined planes
will be found to  look in  the same general  direction.  Thus each of
the anterior inclined planes,—that is, the right and the left anterior,—
will be seen to look  from without inward, from above  downward,
and from behind forward.  In like manner both the right and the
left posterior inclined planes will look  from without inward, from
above downward, and from  before backward.  It was formerly sup-
posed that these several inclined planes, by influencing the rotation
of  the head of the foetus, through successive changes of direction, ex-
erted a powerful influence  on the mechanism of labor.   But, in point
of fact, the rotation occurs principally after the head has so far  passed
through the  inferior strait as to engage the soft  parts and  distend the
perineum.  And it may be now stated that these inclined planes serve
in  part to prevent the too rapid descent of the  head,  and in part to 
THE SUPERIOR  STRAIT.
25
cause it to assume and maintain the most natural and favorable posi-
tion  in its course.
  In its general appearance the interior of the pelvis may be said to
resemble the inner surface of  an  irregularly-shaped and truncated
cone, tapering  downward; although from  the strongly-marked  de-
pression of the hollow of the sacrum  the cavity of the pelvis seems
larger than either the entrance above or the outlet below.  The  ilio-
pectineal  line—already described as dividing the greater from  the
lesser pelvis—together with the spine and crest of the pubes in front,
and the anterior margin of the base of the sacrum and sacro-vertebral
angle behind, constitute what  is called  the margin of the superior
strait; and the corresponding border of the apex, bounded  by  the
point of the coccyx posteriorly, by the inferior surfaces of the tuber-
osities of the ischia laterally  and by the pubic arch anteriorly, consti-
tutes what is  known as the inferior strait.   The superior strait corre-
sponds to what is by  some termed the brim, as the inferior strait cor-
responds to the outlet; while the intervening internal portion of the
pelvis is indifferently named its cavity or  excavation.   The  engage-
ment of the head in the superior strait, its passage through the cavity
or excavation, and its subsequent  emergence through the  inferior
strait or outlet, constitute the most important events in the process of
parturition.  Hence the axes  and dimensions, and in fact all the parts
and  relations of these straits and their intervening cavity, should be
thoroughly understood.
  The  Superior Strait.   The superior strait or brim of the pelvis
presents the shape of a curvilinear  triangle with rounded angles,—
saving  its base behind and  its apex  in  front.  The sacro-vertebral
promontory, jutting in, as it were, gives a heart-shaped appearance to
what might otherwise  have been nearly oval.  The psoas muscle on
either side, by diminishing the transverse diameter, causes the superior
strait to assume a more triangular form in the living subject than it
presents in the skeleton ; but by flexing the thighs upon the trunk, as
during  parturition, these muscles are relaxed, and the superior strait
thereby becomes  more nearly oval in shape and the descent of the
foetal head is  facilitated.   The boundaries  of the superior strait are,
the sacro-vertebral angle, the anterior border of the wings of  the sac-
rum, the linea ilio-pectinea, and the spine and crest of the pubes.
  The very great obstetric importance of  this superior strait arises
from the fact that it forms the first  part of that bony canal through
which the fcetal head  must be transmitted, and through the somewhat
contracted opening of which it must pass,  almost before  i* acquires 
26               ARTICULATIONS OF THE PELVIS.
any of that elongated shape which it so often presents on emerging
subsequently from the outlet or inferior strait.

                               Fig. 1.
  c h, the plane of the superior strait prolonged beyond the pubes; c e, the  plane
of the inferior strait prolonged beyond the pubes; c d, shows the departure of this
plane from the horizontal line;  a b, the axis of the superior strait; h f, the axis
of the inferior strait.

  The plane of the superior strait, its axis  and its dimensions,  form
the most important points for consideration  respecting it.  The plane
or surface of the superior strait may readily be demonstrated by cut-
ting a piece of paper to fit it,  making it  extend antero-posteriorly
from the sacral promontory to the superior  border of the symphysis
pubis, and transversely from the ilio-pectineal line of one  side to that
of the other.  And when the female is in the erect position, it will be
found that this plane presents an inclination of from fifty-five to  sixty
degrees to the horizon.
  The axis of this plane will of course be a line which shall fall at
right angles upon its centre.   Thus the axis of the superior  strait
must form  the same angle with the  vertical line that  the  plane of
the strait forms with the horizontal line.   And upon examination it
is found that this axis extends from a point on the linea alba a little
below the umbilicus to the articulation of the second bone of the os
coccyx with the third. The inclination of the plane of the superior strait,
and of course  the direction of its axis, must vary with the  changing
position  of the female;  the inclination being diminished when  the
trunk  is  bent  forward,  as  in  stooping over, and becoming least in
the recumbent position.   But  it is greatly  increased when, in the ad-
vanced stages of pregnancy, the female straightens up, and even leans
backward as  it were, in order to maintain her equilibrium.   So in 
THE SUPERIOR STRAIT.
27
parturition, as will be more particularly explained subsequently, the
position and  flexure of the trunk will greatly affect the entrance  of
  In the dimensions of the superior strait we note its different diame-
ters  and its circumference.  The irregular shape of the figure of this
strait renders  its various  diameters unequal.   Different authors have
enumerated quite a number; but the three principal diameters are all
that are really of practical importance.  These are, first, the antero-
posterior diameter, which extends from the sacro-vertebral angle to the
superior border of  the  symphysis pubis.  This, which is also called
the sacro-pubic or conjugate diameter, measures four and a half inches.
The second, the transverse diameter, or long diameter, extends  across
the pelvis  at its widest part, and at right angles with the antero-pos-
terior diameter.  This, which is also called the iliac or lateral diame-
ter—since  it extends  from the middle  of the  rounded border of the
iliac fossa of one side  to that of the other—measures five inches.  The
third is the oblique  or diagonal diameter.   This extends from  the
sacro-iliac  symphysis to the ilio-pectineal eminence of the opposite
side, and measures four  inches and three-fourths.  In consequence
of the space occupied  by the soft parts, these dimensions are somewhat
less  in  the  living body;  and  we may allow at least one-quarter of
an inch in the antero-posterior diameter, and one-half an inch  in the
transverse diameter.
  The  circumference of the superior strait—bounded anteriorly by the 
28
THE INFERIOR STRAIT.
inner margin of the horizontal rami of the pubes, laterally by the ilio-
pectineal line, posteriorly by the promontory of the sacrum—measures
from thirteen and a half to seventeen inches.
  The  Inferior Strait.—The  inferior  strait is smaller than the
superior, and  in the skeleton much more  irregular in form.   This
latter circumstance arises from the projection of the coccyx behind,
and of the tuberosities of the ischia on each side.   These projections
form three deep notches, one on each side of the coccyx, and one im-
mediately beneath the symphysis  pubis.  Thus  this irregular border
or periphery of the inferior strait  is made up by the  symphysis and
descending rami of the pubes, by the tuberosities and ascending rami
of the ischia, by the lower border of the posterior sacro-sciatic liga-
ments, and by the extremity of the coccyx which projects inward.  In
parturition,  however, the  coccyx  is usually pushed back, rendering
the actual obstetric outlet  nearly oval.  This oval figure of the outlet
may  be demonstrated  by placing the  apex of the pelvis on a sheet
of paper  and  tracing  its outline  with a pencil.  And the  figure
thus  obtained, compared  with that of the brim of the pelvis, wTill
show a gradual inclination of the walls of the pelvis downward and
inward.
  The two  lateral projections, the tuberosities  of the ischia, extend
somewhat beneath the extremity of the coccyx, and, being unyielding,
alone support the entire  weight of the  body in the sitting posture.
Hence it happens that transverse contractions of the pelvis at the in-
ferior strait  are more common than antero-posterior.  The deep notch
found anteriorly on the inferior strait corresponds to  the summit or
inferior margin of the  arch  of  the pubes.  This notch forms an im-
portant  feature in obstetric  practice, and it is much  broader  in the
female pelvis  than in  the male.   At  its base this arch is from three
and a half to three and a quarter inches broad, but only from one and
a quarter to one and a  half inches wide at its apex; its height is from
two to two and' a  half inches.  As will  be afterward  noticed  in de-
scribing the process of parturition, this notch  has very important
relations to the foetal  head,  affording  to it a more ready exit  in the
first position.
  The still  deeper notches which appear posteriorly on each side of
the coccyx are subtended  by the sciatic  ligaments, whose elasticity is
capable of materially adding to the pelvic  dimensions at the moment
of the final passage of the fcetal head.  By the combination of double
arches,  both anteriorly and  posteriorly, and from above downward
the greatest possible strength has  been preserved to the pelvis, with- 
the inferior strait.
29
out too much  increasing its weight; while at the same time the head
is enabled all the sooner to emerge from its bony prison, by reason
of these three important notches or arches in the periphery of the in-
ferior strait, while  the anterior notch—that of the pubic arch—also
affords inestimable advantages to the accoucheur, in the introduction
of the hand, the forceps or other instruments, when, from irregularity
or contraction of the pelvis, from abnormal  size of the head, or from
other reasons, manual or mechanical interference becomes indispensable.
  The plane of the inferior strait may be demonstrated by applying a
sheet of paper in the following manner.  Upon  an inverted pelvis in
which the sacro-coccygeal articulation  is still flexible, and  in which
the coccyx is retracted as far as possible, we place a piece of paper
narrow enough to pass between the tuberosities of the ischium and be
closely fitted to the summit of the pubic arch. This paper, thus rest-
ing in front upon the inverted surface of the arch of the pubis and
posteriorly upon the retracted extremity of the coccyx, will accurately
represent the proper plane of the inferior strait.  Hence it will be at
once obvious that this plane is by no means  parallel with that of the
superior strait, the angle of inclination of the latter being from fifty-
five to  sixty degrees,  and that of the former but from ten to eleven
degrees.   And as the planes of the two straits are  not parallel, so
neither will their axes be in the same line.
                               Fig. S.
  c d, the horizontal line; c e, the plane of the inferior strait (during labor) ; a b,
the axis of the inferior strait.

  Thus, as is shown in Fig. 3, the plane of the inferior strait, with the
coccyx retracted  as it  is  in the last stage of labor—the only stage in
which either the  coccyx  or in fact the inferior strait itself is particu-
larly involved—inclines backward and downward at a very small angle 
30
the inferior strait.
below the hoiizontal line, while, as shown  in Fig. 1, the  plane of
the inferior strait, in the ordinary condition of the pelvis—with the
coccyx not retracted—inclines at a correspondingly small angle above
the horizontal line.  And the prolongation of the planes of the supe-
rior and inferior straits to  their  point of union beyond  the pubes
shows that,  instead of being parallel with each other in the human
pelvis, they  form an angle  of not far from 45°, especially when the
point of the coccyx is pushed back, as it is  by the foetal head in its
passage  through the inferior strait.
  The great advantage which must arise from this apparently  irregular
arrangement of the pelvic planes and axes, will be evident from a mo-
ment's consideration of what must otherwise be the effect of gravity
in the upright position, especially in the advanced stages of pregnancy.
Even if the head and entire foetus were not impacted in the cavity of
the pelvis, premature delivery must necessarily result from  the  con-
stant and directly downward tendency of the uterus and its  contents.
This is  still  further illustrated by comparison with the almost perfect
parallelism which  appears in the planes of the superior and inferior
pelvic straits of quadrupeds.  Here the gravid uterus is entirely sup-
ported  by the abdominal parietes, and the planes  of the superior and
inferior—or, more accurately speaking, anterior and posterior—straits
are nearly parallel, and their corresponding axes nearly identical with
each other and parallel with the trunk itself.
  The axis of the inferior strait is the line which, drawn perpendicular
to its plane, falls  upon it midway between the  symphysis pubis  and
the extremity of the coccyx.   When the coccyx is in its usual posi-
tion, this  line, extended,  will strike the promontory of the sacrum;
but when the  coccyx is retracted, as in the advanced stages  of labor,
this line will  fall upon the articulation of the first with  the second
bone of the sacrum.   The  axis of the inferior strait forms  the  same
angle with that of the superior  strait that the plane of the inferior
strait forms with the corresponding plane of  the superior strait.
  The diameters most important to be observed in the inferior strait
correspond in  number and in name to those of the superior  strait.
First, the antero-posterior or coccy-pubal  diameter—rextending  from
the extremity of the coccyx to the summit of the pubic arch—meas-
ures four and three-quarter inches with the coccyx pushed back in
labor, but only four and a quarter inches when it is not thus  retracted.
For practical purposes, therefore, the antero-posterior diameter of the
inferior strait—taken at any period of labor when the head has not
so engaged  in that strait  as to push back the coccyx—must be  con 
the cavity of the pelvis.
31
sidered  as  half  an inch longer  than the measure shows.  The only
exception to this will be in those cases in which, from complete ossi-
fication  of  the coccygeal and sacro-coccygeal articulations, the coccyx
forms one continuous curve and one solid bone with the sacrum.

                               Fig. 4.
  A A, the antero-posterior or coccy-pubal diameter; B B, the transver.se or bis-
ischiatic diameter; C C, the two oblique diameters.

  The second diameter of the inferior  strait  is the transverse, con-
jugate,  or bis-ischiatic.  It  extends  from  the inner margin of one
ischiatic tuberosity to the corresponding point on the opposite side,
and measures four inches.
  The third diameter of the inferior strait  is the oblique.  It extends
from the point of junction of the rami  of the pubes and ischium to
the middle of the  great sacro-sciatic  ligament of the opposite side,
and measures about four inches.   As  previously stated, from the dis-
tension  of the ligamentous portions of the pelvic parietes the capacity
of the inferior strait may be somewhat enlarged in this direction; and
some  authorities  estimate the oblique diameter as practically equal,
therefore, to four and a half  inches.  Naturally there are two oblique
diameters to the inferior strait, the right and left oblique; but it is
usually  mentioned as one diameter, because—except in some not very
common forms of pelvic distortion—the one will  be exactly equal to
the other.
  The circumference of the  inferior strait is very irregular, owing to
the projections of the coccyx posteriorly and the tubers of the ischia
laterally.   It measures about twelve inches.
  The  Cavity  of the Pelvis.   That  part of the canal of the
pelvis which consists of the space between  the superior and inferior
straits is known as the cavity of  the pelvis,  or  the  excavation.   From
its situation, and consequent relation  to the movements of  the foetal 
32
THE CAVITY OF THE PELVIS.
head during parturition, it will be obvious that a thorough knowledge
of this cavity, of its axes, planes and dimensions, is not only important
in all ordinary cases of labor, but indispensably necessary to the suc-
cessful management of all those  of serious difficulty.   This cavity is
irregular in shape, contracted  in its superior and inferior orifices, and
greatly enlarged  posteriorly by  the concavity of the  sacrum.  The
depth of the  pelvis  at the symphysis pubis in front  is but one inch
and  a half; at the  side,  from the tuberosity  of the  ischium to  the
linea ilia, it- is three inches and a half; and  posteriorly, from  the
promontory of the  sacrum to  the extremity of the coccyx, the depth
is four and threc-fb\rths inches or five inches, according as the coccyx
is in its natural position or retracted as in  labor.   If the curvature
of the sacrum  and coccyx  be followed, this measurement will equal
five and a quarter inches.
  The diameters of the excavation, taken at its centre; correspond in
number and  in name to  those of  the  superior and inferior straits;
and  they are all of very nearly  the same length of four inches and
three-fourths.   The antero-posterior diameter, extending from the sub-
pubic ligament,—that is, from the summit  or under surface of the
pubic arch to  the  middle of  the sacrum,—measures four inches and,
three-quarters.  But the line drawn from the  sub-pubic ligament to
the promontory of  the sacrum  will  be found to measure but four
inches and a half.   The  transverse and oblique diameters  are each
four inches and three-fourths  in length.  It should be borne  in mind
that the long diameter of  the superior strait is  the transverse,  but that
the antero-posterior is the  long diameter of the inferior strait.
  The common plane  and axis of  the pelvic cavity ought to- be well
understood, as  they represent the gradual change  from  the  primary
plane and  axis of  the superior  strait above to the final plane and
axis of the inferior strait  beneath.
  Owing to the concavity of the sacrum, and to the slight convexity of
the posterior surface of the pubic wall, the passage through the pelvic
excavation represents  a curve, which, if continued, would produce a
circle.   Consequently  the plane which commences at the  superior
strait is constantly changing as Ave pass  from  above  downward.
Amd as the plane changes, so  also must the  axis of the plane, to cor-
respond  to  it.  Thus the general  plane of the  excavation  will  be
represented only by a  succession of  differently inclined planes.  So
a corresponding series of  axes must represent the general axis of the
excavation.   This general series of planes, and corresponding series
of axes, is well illustrated in Fig. 5:  thus  a b represent the plane 
THE CAVITY OF  THE PELVIS.
33
of the superior strait;  i  o, the  plane of the  inferior strait; c, the
point of union  of these two planes, if prolonged; then p q r s  t—c,
will represent  the successive  planes which  must  result  from the
curvature of the sacrum.   It being borne in mind that the axis  must

                               Fig. 5.
  a b, the plane of the superior strait; i o, the plane of the inferior strait;  e, the
point where these two planes would meet, if prolonged; m n, the horizontal line;
ef, the axis of the superior strait; g k, the  axis of the excavation; p q r s t, various
points taken on the sacrum to show the plane of the excavation at each point.

always  be regarded as perpendicular to (that is, at right angles with)
its plane, the axis of the first plane,  or that of the superior strait, will
therefore be seen to be at right angles with its plane.  And since the
sacrum  at this upper part of  the  pelvis forms a straight line, so the
plane of the superior strait  will form a right angle with it;  and the
axis of  this plane  will consequently  be  parallel  with the  sacrum.
And so in fact in each successive  instance; the plane of  each succes-
sive point of the cavity must be at right angles  with the opposite
point of the sacrum ; and the axis of each successive plane must  be at
right angles with  the  plane  itself,  and of course parallel with the
corresponding portion of the sacrum.   These successive axes, thrown
into a single line, will  therefore form a curve exactly corresponding
to the opposite curve of the sacrum.  This general axis of the exca-
vation,  g,  k,  represents the  line  of direction which the foetal  head
must necessarily pursue in its course through the canal of the pelvis.
And as  this line, in a  geometrical  point  of view, is the result of a
union of successive lines, so in  a  physiological point of view the
course followed by the  foetal  head  is the result  of a combination of
various and  successive  vital  forces, whose  progressive development
       3 
34         THE  MALE AND FEMALE PELVIS COMPARED.

can take place only in  the  direction rendered possible by the form
and construction of the  internal surfaces of the pelvic cavity.
  It has been remarked elsewhere that a change of position of the
individual will effect a change in the direction of the planes and axes
of the  superior and of  the inferior straits; but it is to be borne in
mind that no change of position can in any degree affect the general
axis or central curved line of the  pelvic excavation.   This is an im-
portant obstetric fact which should be remembered, inasmuch as it is
through this excavation and in the direction of its general  axis that
the foetus passes during the process of parturition, becoming  curved
upon  itself in  the  passage;  and the  convexity  of  its  curvature
corresponds with the concavity of the sacrum, its  concavity  with
the pubes.
  The Differences between the Male and Female Pelvis.—
The  pelvis of the male  is smaller,  narrower, deeper in its cavity, and
more circular  in its brim;  the bones composing it  are thicker and
stronger, and the muscular impressions and eminences on their sur-
faces more decidedly marked.   The symphysis pubis is nearly double
the depth of that of the female; the sacrum is straighter, and the sacro-
sciatic  notches and foramina smaller; the obturator foramen larger
and more oval; the pubic arch is straight, much narrower, triangular
in shape; its walls  and the tuberosities of the ischia are less widely
separated; the coccyx is more immovably attached to the sacrum; and
in general the articulations are sooner anchylosed than in the female.
  The pelvis of the female is much wider;  the acetabula are  farther
apart, although the knees approach each other even more than in the
male, giving to the movement and gait of the female some distinguish-
ing peculiarities.   The iliac fossae are broader than in the male pelvis,
and the spinous processes of the ilia more widely separated, hence the
greater breadth of the hips in the  female; and here Nature seems to
have sacrificed the facilities of motion to the advantages of pregnancy
and parturition.  The superior strait  is larger and  more  elliptical;
the curve of the sacrum is deeper  and more regular;  the symphysis
pubis is but half as deep as  in the male; and the pubic arch is broader,
more rounded, and its lateral walls more widely divided.  The entire
pelvis is larger and more capacious, and  so constructed, in its  several
arches  and ligaments, as to combine the  greatest possible lightness,
elasticity and strength with the most  suitable form  and dimensions
for sustaining  the  gravid  uterus above its brim, or enabling the full-
grown foetus to be transmitted through its canal.
  In early childhood the pelvis seems disproportionably small.  It is 
the uses of the pelvis.
35
narrow and  long, and the abdominal protuberance which is seen in
the foetus and  in  newly-born infants, and even still later in the case
of rachitic children, is due to  its thus forcing  upward some of the
parts which should be contained within it.  But as the female child
advances in life the pelvis becomes gradually,  although slowly, de-
ve.oped, until, at the period of  puberty, it experiences, within a short
time, an  alteration so extensive and  so  strongly marked as to change
perceptibly the form and contour of the hips.   At nine years of age
the antero-posterior diameter measures two inches and seven-eighths,
and the transverse diameter, two and three-fourths; while at fourteen
years of age the antero-posterior diameter measures three inches and
three-fourths,  and the transverse, four and a half.
   The Uses of the Pelvis.—The pelvis of the female, as in the
male, affords a general support to the abdomen and its contents.   In
the pregnant female it especially supports the gravid uterus upon its
anterior  arch  and iliac wings.   Within the  cavity of the pelvis the
uterus of the  unimpregnated female, the ovaries and Fallopian tubes
are safely enclosed, while  the  delicate and sensitive external organs
of generation are securely protected beneath.   From its relation  to
the lower portion of the spinal  column, and from the manner in which
it is placed upon its femoral supporters, the pelvis may be regarded
as the structural  base or foundation  of  the human body; while, from
the study of the functions which it performs in connection with the
organs which  it contains, it will  no  less obviously be seen to  be the
true physiological centre of the entire human system.  From improper
management in childhood and  youth, from too long and too frequent
indulgence  in unnatural positions, from habitual over-exertion of a
particular kind, from accidental  injuries, and especially from disease
and softening of the bones, the  pelvis may become contracted, strained
and distorted in every direction, and  so more or less  incapable of
performing its most important  uses in the support of the body  and in
parturition.   So also,  from similar and  corresponding causes, the
organs which it contains may become more or less disordered and in-
capable  of performing  their vital  functions.    In the former  case
mechanical difficulties  and  obstructions embarrass  the accoucheur.
The consideration of these difficulties, and of the appropriate  means
for overcoming them, we reserve as a sequel to the normal process of
parturition. •  In the latter  case the physician  has  to  contend with
various forms of functional disorder or structural disease.  The con-
sideration  of these disorders and of their appropriate remedies we
shall take up  hereafter. 
36           THE MUSCULAR TISSUES  OF 1 HE PELVIS.
                      CHAPTEK  III.

        THE  MUSCULAR TISSUES OF  THE PELVIS.

TPHE study of the bony skeleton of the  pelvis forms the only true
-L basis for understanding this most important part of the body, as
it exists in life; and it is only now, as we come to  the examination of
the pelvis clothed with muscular and other living tissues and supplied
with organs, that its real study begins.  Occupying the middle ground
between the upper and lower part of the  body, the  pelvis affords at-
tachment to two classes of muscles.
   The first class is for completing, enclosing and perfecting the abdo-
men.   The muscles of this class, by their great power of distension,
afford  every needful  facility for the  development and support of the
foetus in the pregnant state.  These muscles, which  form the anterior
abdominal parietes, by yielding to the pressure exerted from against

                               Fig. 6.
PELVIS, WITH SOFT PARTS, SEEN FROM ABOVE.
  A, section of the aorta;  B, the vena cava inferior ; C, the internal iliac artery, aris-
ing, together with D, the external iliac, from the primitive iliac trunk ; E, external
iliac vein ; F, the iliacus internus, and G, the psoas magnns muscles ; H, the rectum .
I, the uterus with its appendages; K, the bladder, the fundus of which is depressed
po ns to bring the womb into view.

the rigid posterior walls, cause the gravid  uterus to project over the
arch of the pubes, and thus hinder it from settling downward through
the superior strait.
  The'muscles  of the  second class  are  those which,  connecting the
pelvis with the lower extremities, are concerned in locomotion.   There 
             THE MUSCULAR  TISSUES OF  THE PELVIS.          37

are but four sets of these  muscles on the  inner  surface of the pelvis.
The  principal of these are the  iliacus internus and psoas magnus;
next in size and relative importance come the pyriformis and obturator
internus muscles.  The iliacus and psoas magnus, while being them-
selves  protected by the iliac fascia, serve  to line and cushion the iliac
fossae and bones of the upper pelvis, thus preventing the uterus from
receiving injury in the latter months of gestation from the shocks and
concussions  inseparable from  active exercise.   These two muscles, as
they become conjoined in passing over the lateral parts of the superior
strait to be inserted into the lesser trochanter of the femur, have the
effect to change the base of the curvilinear triangle of the pelvis from
the rear  to the  front, and to  lessen the  transverse diameter half an
inch; these two being  the  only muscles  in the pelvis that do lessen
any of its diameters.   The iliacus,  however, from its thinness, neither
too much encroaches upon the concavity of  the  iliac fossae, nor indeed
does it, so much as the psoas, diminish the  size of the pelvic cavity.
And the shortening of the transverse diameter may be in a great mea-
sure obviated  by flexing the thighs upon the abdomen in labor, thus
relaxing the psoas muscles and reducing  the diminution of the pelvic
cavity  to the smallest possible amount.
   The pyriform muscles, which arise principally from the outer mar-
gins of the sacrum, pass  immediately out of the pelvis through the
great sacro-sciatic foramina of  either side to be  inserted into the great
trochanter of the femur.   Tue internal obturator muscles arise from
the margin of bone which forms the inner side  of the obturator fora-
men, and from  the internal surface of the  obturator membrane, and
leaving the pelvis through the lesser sacro-sciatic notch, or more
properly foramen, are  likewise inserted  into the  great trochanter in
front of the pyriformis.  These muscles are thin and flattened and
project so slightly beyond the bony surface which lies adjacent to them
as to encroach but slightly, if at all, upon the capacity of  the  pelvic
cavity.   This  may be said also of the coccygei muscles, which, arising
from the spines of the ischia  and lesser sacro-sciatic  ligaments and
inserted into the margins of the coccyx, do not encroach laterally upon
the diameters of the pelvis.
   Thus we  have the entire pelvic cavity covered by fascia and suffi-
ciently supplied with muscular tissue for  all its  uses, without so much
diminution of its size as to obstruct the foetus in its descent.  Indeed,
the obturator internus and pyriformis  muscles, covering the obturator
and  sciatic foramina, afford increase  of  room  by giving way as the
bead makes pressure upon them in its  descent. 
38
THE PERINEUM.
  The antero-posterior diameter is slightly diminished by the attach-
ment of the bladder to the posterior surface of the arch of the pubes,
and  the  cellular tissue which everywhere lines the  pelvic  parietes
slightly diminishes the general capacity of the pelvis.   AVhen  this
cellular tissue  becomes loaded with fat, as is the case with  fleshy
women, it may offer a serious  obstacle in parturition.  The rectum,
in passing down over the anterior surface of the sacrum and to the left
of its promontory, does not materially hinder the process of labor, un-
less loaded with indurated fecal matter, and the uterus, although occu-
pying  a  middle  ground between  the  bladder and  rectum, does not
diminish any diameter of the pelvis in  labor, for  at such times  it is
usually entirely above the superior strait.
  The Perineum may be said to  form the floor of  the pelvis.   It is
composed of muscular tissue, fascia, and intervening areolar and  adi-
pose tissue, and is exceedingly elastic and distensible.  The female
perineum  extends laterally between,  the  tuberosities  of the  ischia
and  antero-posteriorly from the apex  of the  coccyx to the posterior
commissure of the vulva.   The anus divides the perineum into  two
portions; that extending between the coccyx and the anus constituting
the  posterior perineum; that  extending from the anus  anteriorly to
the  vulva being the anterior  perineum, or  perineum  proper.  It is
larger in the male than in the female.   The muscles entering into the
composition of the perineum are  arranged into two layers, the upper
of which is  concave  superiorly and comprises  the  levatores ani  and
coccygeal muscles, while the lower, which has  its  concavity looking
downward, comprises principally the trans versus  perinei,  sphincter
ani  and  constrictor vaginae  muscles.  Of these muscles, the levatores
ani  are the  most important  in an  obstetrical  point of view.  They
are  broad and  thin muscles, which arise anteriorly from the posterior
surfaces  of the bodies and rami  of the pubes; posteriorly from  the
spine  of the ischium; while the  intervening portion  arises between
two layers of the descending  pelvic fascia.   The posterior fibres are
inserted  into the  sides of the  lower portion of the coccyx, while  the
middle and anterior fibres pass  downward, converging toward  each
other, to be inserted  into a  central line  or raphe at the centre of the
perineum.  In addition to  these points.of insertion, numerous fibres
are  blended with those of the sphincter ani, transversus perinei and
constrictor  vaginae muscles.   It will  be seen, from this description,
that these levator muscles exert  a powerful influence by their  con-
traction upon the entire  perineum, and might very  properly be called
levatores perinei.  In a condition of rigidity they may offer a  very 
                          TIIE PERINEUM.                        3!J

serious  obstacle to the descent of the  child, the presenting part  of
which in its passage downward  impinges upon this muscular floor,
and  must push it downward and forward in order to effect delivery.
Fortunately, however, these tissues are  usually softened and yielding,
and admit of enormous prolongation and distension;  otherwise lacera-
tion  would be a common accident.

                               Fig. 7.
MUSCLES OF THE PERINEUM.
  1, tuber ischia; 2, sphincter vaginae; 3, its origin from the base of the clitoris;
4, vaginal  ring of the same muscle, wliich receives a part of the fibres of the levator
ani; 5, intercrossing of the sphincter ani and sphincter vaginae at the perineal centre;
6, erector clitoridis; 7, clitoris; 8, transversus perinei; 9, sphincter ani;  10, levator
ani; 11, gracilis; 12, adductor magnus;  13, posterior part of gluteus magnus.

  The extent of the perineum from the point of the  coccyx to the
anus is about an inch and three-quarters, and from the anus to the
vulva about an inch and a quarter; making three inches in  all in its
ordinary condition.  But at the  instant of the passage of the child's
head into the external world at full term, it becomes so distended and
prolonged downward and forward as to  measure about five inches
and three-fourths.
  It must now be evident that  the  terminal outlet of the  obstetric
canal in  the living subject is not  represented by the symphysis pubis
and the  point  of the coccyx, but rather by the symphysis  and the
anterior  commissure of the perineum;  and the plane of this outlet
7703 
40
THE PERINEUM.
will be represented by a line drawn from the lower part of the sym-
physis to the commissure.  But, in the last moment of labor, as the
head  is emerging through the vulva, the perineum is prolonged in a
forward direction to the  extent of passing beyond the  lower  part  of
the symphysis pubis, and the  plane of the outlet at this moment will
be represented by a line drawm from the symphysis to the edge  of
the distended perineum.
                               Fig. 8.
POSITION OP THE PELVIS AND THE DIRECTION OP ITS AXIS IN THE DORSAL ATTITUDE
                ASSUMED BY THE FEMALE DURING  LABOR.
  a b, total axis of the excavation, being a continuation of d b, the axis of the superior
strait; c v, perineum as distended at the moment of the passage of the head ;  r, anal
orifice ; e v, terminal plane of the obstetric canal.

   The direction taken by the foetal  head in its passage through the
excavation of the bony pelvis is indicated by the  axes of the various
planes representing the  curvature  of  that  osseous  canal.   Now, if
another series of planes be made,  commencing at  the  plane of the
bony outlet, and extending  from the symphysis to various points
upon the curvature of the distended perineum—the final plane ex-
tending from the symphysis to the anterior perineal commissure—and
the axes of these planes be ascertained, and prolonged  so as to form
a  complete axis  continuous with that of the excavation of the  bony
pelvis, the  line thus indicated will represent  the axis  of the  entire
obstetrical canal and  the course traversed  by the foetus from its en-
trance into the  superior strait until  its final emergence at the vulva.
This is well represented in Fig. 8.
   It will thus be seen  that,  in the  recumbent posture of parturition,
the  foetus, in following  the axis of the obstetric canal, takes a course 
              EXTERNAL ORGANS  OF GENERATION.             41

fi rst downwai d and backward, then downward and forward, then al-
most directly forward, and finally, at the moment of delivery, upward
and forward.
                       CHAPTER  IV.

              THE  ORGANS OF GENERATION

            The External Organs  and  Vagina.
n^HE genital organs of the female, when closely studied and com-
-L  pared, will be found to bear a very strong  resemblance to those of
the male.  And in addition to this particular similarity in the struc-
ture and functions of some of the parts of the female to those of the
male, there will be seen to be a universal  and essential correspondence
of all the sexual organs of the one sex to those of the other.   For as
all the sexual organs  of  the male are structurally and physiologically
adapted and intended for giving, so all the sexual organs of the female
are, in like manner, structurally and physiologically adapted and de-
signed for receiving.  Thus they bear to  each  other the relation of the
two halves which are requisite to constitute one complete  physiologi-
cal whole—of two equally  indispensable means  for the accomplish-
ment, physiologically, of the  final end of reproduction.   This dis-
tinction of structural difference  and similarity  and of physiological
correspondence is the type of the  adaptation of the man to  the woman
in the married state;  the highest condition of human life.   And this
distinction  should  be steadily borne in mind  in  all  our study of the
genital organs and reproductive system of the female.
  These genital organs, which as well in structure as in function are
much more complicated in the female than in the male,  may be
divided  into  external parts, or those without the pelvis, and internal
organs, or those situated within the pelvis.   The former are the mons
veneris, the perineum and the vulva with its appendages.   The latter
are the vagina, the uterus, the Fallopian tubes and  the ovaries.  We
will proceed  to study their anatomy and physiology in the order in
which they have just  been named.
  The Mons Veneris.—The mons veneris is  situated at the lower
margin of the abdomen, just on or above the centre of the symphysis
pubis.  Its diameter is usually about three inches; it is half an  inch
thick at its centre,  and  tapers off to a thin  edge at  its circumference 
42
THE MONS VENERIS.
It is principally composed of dense cellular or adipose tissue, covered
by thick elastic  integument, and  abundantly supplied with sebaceous
follicles.  The hair, which makes its appearance at puberty as one of
its characteristic signs, is said to  diminish in quantity, in many cases,
on the cessation of the menses.  The growth of the hair varies remark-

                              Fig. 9.
EXTERNAL GENITALS.
  A, mons veneris; B, labia majora ; 0, clitoris; D, labia minora; E, orifice of urethra;
F, orifice of vagina ; I, posterior commissure of the vulva; H, perineum; J, anus.

ably in different individuals; and in some cases, where it is very white
and scanty, it is supposed to indicate sterility.  The excessive growth
of the hair is sometimes accompanied  by pruritus, and  in those who
are subject to the plica polonica this disgusting  disease attacks also
the hair on the mons veneris, which becomes agglutinated and attains
an  enormous length.  The mons veneris may become the seat of in-
flammation and abscess, which should be treated promptly in the same
manner that would be appropriate to similar conditions elsewhere.
  The perineum  has already been described  in connection with  the
soft parts of the pelvis.  From its peculiar structural formation it  ad-
mits of very great distension during labor, but is prompt to resume its
usual condition when the pressure  of the  child  has been removed.
When the last expulsive pains of labor are very violent and the perin-
eum is from some cause or other unyielding, or when the woman in the
throes of these last expulsive  pains straightens herself out instead of
remaining in a semi-flexed condition, the perineum may undergo lace-
ration.  The treatment to be adopted when such  an accident occurs
will be indicated hereafter. 
THE VULVA AND ITS APPENDAGES.
43
  The  Vulva and  its  Appendages.—The vulva or pudendum is
the longitudinal opening between the projecting parts of the exter-

             Fig. 10.                              Fig. 11.
  Fig, 10. Hymen in the form of a crescent.—A, clitoris; B, labia externa; C, labia in-
terna ; D, orifice of the urethra; E, hymen; F, orifice of the vagina; G, posterior
commissure of the vulva; H, perineum.
  Fig. 11.  This figure exhibits the Hymen in, the form of a circle.—E, the hymen;  F, the
central opening somewhat enlarged.

nal organs  of generation, which,  situated immediately  beneath the
mons veneris,  is bounded laterally by the labia majora and terminated
posteriorly by the perineum. It constitutes the external opening com-
mon to the vagina and  to the  urinary bladder.  A more particular
description of the vulva will be involved in that of its  appendages.
These are the labia majora, the  labia minora or nymphae, the clitoris,
hymen, carunculse myrtiformes,  fossa navicularis, fourchette, vestibule
and urethra.
   The labia majora or labia externa are two prominent folds consisting
externally of integument arid internally of mucous membrane, which,
commencing immediately beneath the mons veneris, diverge from each
other,  extending downward and  backward  to again converge and
terminate at the perineum.  Their junction at the mons is termed
the  anterior commissure,  and  that  at the  perineum the  posterior
commissure.  Between  the integument  which  constitutes  the  outer
surface of these folds, and the  mucous  membrane which forms  their
inner lining,  will be found a  large quantity  of areolar  tissue, fat,
glands, an  interlacement of vessels and  nerves, and  a peculiar tissue
which resembles the dartos of the  scrotum in appearance and general
74 
44             THE VULVA  AND  ITS  APPENDAGES.
construction.  The skin of the labia majora is usually soft and deli-
cate, and is studded with hair after  puberty.  The mucous lining is
continuous with the mucous lining  of the  genito-urinary apparatus.
It is  moist and smooth  and of a rose-color in  young women, and
well supplied with  sebaceous glands  and  mucous  follicles.   These
glands secrete an oleaginous fluid which serves  to moisten the parts
and protect them  from injury by the  motion of the adjacent  parts;
while the mucous follicles likewise provide abundantly their peculiar
secretion—stimulated and increased by exercise—which serves to guard
these delicate surfaces, which are not only in apposition but in more
or less constant movement upon each other, from the irritating effects
of friction and from subsequent adhesions.  But although these  glands
usually pour out a healthful and bland fluid, yet under the influence
of some  morbid  conditions  of  the  system their secretions may be
exceedingly acrid and irritating, to  the extent of  causing  severe
excoriations and unbearable pruritus;  and this acrid secretion, when
occurring in a married woman, may  produce in her husband a disease
analogous  to gonorrhoea; a circumstance which  should be borne  in
mind.  The arteries of the labia majora are derived from the perineal
artery, which is usually  a branch of the internal pudic.   The veins,
which are  numerous and often become enlarged during  pregnancy,
generally accompany the arteries.  The nerves proceed from branches
of the lumbar plexus.  The areolar  tissue, or cellular structure of the
labia  majora,  is more loose and spongy than in other parts  of the
body.  Thus the labia frequently become the seat of serous infiltration
by which they are enormously tumefied.  Sanguineous and purulent
engorgements, hernial  protrusions, varicose veins, and other abnormal
conditions  may likewise occur in these parts.  In girls and unmarried
women the external  labia are rounded, thicker above than below, and
their inner surfaces are closely approximated; but in married women,
and especially in those who have borne children, they are more  widely
separated, irregular, pale  and flaccid.   The  labia majora are usually
regarded as analogous to the scrotum of the male.   And, indeed,  by
careful comparison this  is readily appreciable.   The  existence of a
tissue in the labia bearing a marked resemblance to  the dartos of the
scrotum; the termination of the fibrils of the round ligament within
its  tissues—as  the spermatic cord  enters  within the scrotum—the
presence within the labia of a pouch or cul-de-sac between the  dartos
like tissue  and  the inner  surface of  the labial integument, which ad-
mits the passage of hernial protrusions or  serous infiltrations  resem-
bling scrotal hernia or hydrocele, together with numerous other point" 
               THE VULVA AND  ITS APPENDAGES.             45

of resemblance which might be cited, all  go to prwe  the  striking
similarity between the labia majora and the scrotum.
  The fourchette is  a small, transverse  fold of mucous membrane
found  just  within the  posterior commissure  of the vulva.  It  is
usually ruptured in the  first labor.  The email space lying  between
the fourchette and  the posterior commissure is termed the fossa
navicularis.   Its  distinctive  presence is usually lost by  the  rupture
of the fourchette.
  The labia minora, labia interna, or nymphce, are two lateral  folds of
mucous membrane, interior and parallel to the labia majora, by which
they are concealed in the virgin.  They are continuous externally
with the  mucous lining  of the labia  majora; internally with that of
the vagina.   Superiorly  they commence at the clitoris, and extending
from thence downward and outward on each side  of the orifice of the
vagina, are  gradually lost.  As each labium converges toward  the
clitoris to join its  fellow, it is divided into  two folds, the  anterior of
which unite and pass in front of or superior to the clitoris,  forming
a minute fold which has been termed prseputium clitoridis, while the
posterior divisions unite with the clitoris itself and constitute, as  it
were, its  frsenum.  The  nymphse are  composed of mucous membrane
having a thin epithelial  layer, beneath which are numerous  sensitive
papillae.   They are likewise  supplied with  blood-vessels  and nerves,
and a large  number of  mucous follicles  which secrete an abundance
of sebaceous matter.   They are very extensive, and after frequent labor
are generally found  to project beyond the  labia externa.  Their  use
appears to be, chiefly, to enfold and  protect the clitoris, meatus uri-
narius and superior part of the vaginal orifice.
   The clitoris arises  from the union beneath the pubic  arch of two
cavernous bodies  which spring from the ischio-pubic  rami;  and  its
free extremity appears  at the  superior  part of the vulva,  a little
beneath the  anterior commissure of the labia majora.   In its  internal
structure and erectile nature it resembles the  corpora cavernosa  of
the male penis,  to which organ  it  corresponds  in sensational and
passional function.  At its anterior extremity, almost entirely covered
and concealed by the prepuce formed by the folds  of the nymphae,
appears a minute gland which is analogous in texture and use to the
glans penis.   The clitoris is supplied with  blood from tne  perineal
artery, and  with  nerves from the perineal  branch of the  internal
ptidic nerve.  Like the male penis, the clitoris has a suspensory liga-
ment and an erector muscle.   Occasionally it becomes greatly elongated,
to the extent, in some instances, of four or  five inches, and it then bears 
*
46             THE VULVA AND ITS APPENDAGES.

a very marked resemblance to the penis of the male.   Most of the
cases of so-called hermaphroditism are referable to an extraordinary
growth of this organ.
  The vestibule is a triangular smooth surface situated at the  upper
part of the vulva.  It is bounded laterally by the  labia interna, and
extends from the  clitoris backward to the orifice of the vagina.
  The meatus urinarius, or orifice of the urethra, is situated at the back
part of the vestibule, just  above the orifice of the vagina and about
an inch below the clitoris.   It is surrounded by a prominent elevation
of the mucous membrane.  The determination by touch alone of the
exact  location of the  urethral orifice is  important as enabling the
physician to introduce  the  catheter in the  most delicate manner where
this operation is  required.  It may be  effected in this way: the
patient being placed upon  her  back, the point of the forefinger of
the right hand should  be  placed just within the orifice of the vagina,
the palmar surface looking upward and  resting against the anterior
vaginal wall.  In this position the finger serves as a guide, along the
palmar surface of which the catheter should be slidden until it reaches
the tubercle formed  by the mucous membrane and which marks the
entrance  to the urethra; then, by slightly depressing the  shaft of the
instrument, it may readily be made to pass over the elevation at which
it has been arrested and   to  enter the urethra.   Another and very
satisfactory method of catheterizing the female is, to find  the clitoris
with the  point of the forefinger, and then to pass the finger from this
point downward  over  the surface of the vestibule  until an elevation
is met with, which is the  urethral orifice, into which the  instrument
may without difficulty be inserted.   It may sometimes happen that
where great  difficulty is experienced in passing the female catheter
the use of the male catheter  may be successful.   The  finger  having
been  introduced  as  before directed, the instrument, with its concave
surface upward, should be slidden along the  finger, when the desired
object will  be accomplished by the point of the instrument dropping,
as it were, into the orifice of the canal.  Where cystocele exists this
is the only method that  can be crowned with success; it must be
remembered, however, that in these cases as  the  instrument enters
within the  orifice it must be turned with its  convex surface upward.
Sometimes in women who have  borne many children, or where great
tumefaction of the adjacent parts  exists, it is impossible to find the
urinary meatus  by  the sense of touch alone; and in such cases it
becomes  absolutely necessary to expose the \ulva and  introduce the
catheter guided by sight as well as touch. 
THE VULVA AND ITS APPENDAGES.             47
  The urethra itself is larger than its orifice, and may be desciibed
as a membranous canal about an inch and  a half in length, slightly
curved, with its concavity looking upward,  passing obliquely upward
and  backward  beneath the  symphysis pubis, to which it is attached
by loose cellular tissue. I More interiorly it passes between the crura
of the clitoris  and just beneath their junction.   It is susceptible of
very great dilatation, and opens  interiorly  into the urinary bladder.
It is composed  of three tunics—a muscular coat continuous with that
of the bladder and composed of circular fibres; a thin layer of erectile
tissue intermixed with numerous elastic  fibres:  and a mucous coat,
which is  continuous  externally with the vulva  and internally with
that of the  bladder.  It is surrounded also by the muscular fibres of
the compressor urethras, which assist in  controlling the flow of the
urine.   In the various displacements of the uterus, the urethra, by
reason of its structural connection  with  the vagina,  is liable to be
changed from its natural direction.   This should  be especially borne
in mind if called upon to perform catheterism to relieve retention of
urine caused by such uterine displacements.   It is very distensible, in
some cases  becoming greatly enlarged.  Calculi have been  removed
from the  bladder through the urethra, and  large-sized pessaries have
been passed through it into the bladder.
   Orifice of the Vagina.—Immediately below the  meatus urinarius is
found the much larger and irregularly shaped opening which constitutes
the orifice of the vagina.  The extent of  this opening varies greatly
according to the sexual  condition of the female.   In those who are
virgins, and in some exceptional cases in  persons who are not, the
orifice of  the vagina is very small, oval, or  crescent-shaped, as repre-
sented in Figs.  10 and 11.  It is more or less closed in the virgin by a
membranous fold called the hymen.
   The hymen is the delicate membranous structure which covers the
greater portion of the orifice of the vagina, and which  is  usually
ruptured  at the  first successful attempt at  sexual intercourse.  The
rupture of this structure  ordinarily occasions a slight flow of blood,
and  sometimes leads to no inconsiderable haemorrhage.  The minute
reddish tubercles found  near  the  orifice of the  vagina, and  called
carunculoz myrtiformes, are regarded as the remains of the rupti.red
hymen.  Sometimes this membrane, instead of being thin and easily
broken, is dense and  firm, requiring to be opened with an instrument
before coition can be accomplished.   In other instances the hymen is
found  entirely  imperforate in childhood.  And  in these cases, unless
the abnormal  condition has been attended  to in childhood, when the 
48
THE VULVA AND ITS APPENDAGES.
period of puberty  is reached it may become necessary to resort to
operative interference in order to allow of the escape of the menstrual
discharge.   When it is suspected that the  hymen is imperforate  and
menstrual fluid is retained behind it, an examination should be made,
which may be conducted in the  following  manner: Place the female
upon her back, with the  shoulders elevated  at an angle of 30°, and
the thighs flexed and separated.  Then, with the index finger well
lubricated, carefully  explore the vulva.   If no  entrance into the
vagina can be effected with the finger, a very small blunt probe may
be substituted  and the exploration very carefully continued.   If, on
this  latter  attempt, no orifice can be found, and  an accumulation of
menstrual fluid be suspected, hold the  palmar surface of the index
finger against the centre of the hymen with gentle  force, and with
the left hand make sudden and  forcible downward pressure upon the
abdomen immediately over the region of the womb,  and if fluid be
present  within  the vagina, it will be made appreciable to the index
finger applied against the  hymen.  If the  presence of the menstrual
fluid should be made out, operate at once.  But if the patient be un-
married and not in good general health, an effort should  be made to
restore the general  health by careful medical  treatment.  This done,
if the hymen still remains imperforate, and  the menses consequently
do not  flow,* an operation  should  be  resorted to in the  following
manner: The patient should lie  on  her back, with the lower limbs
well flexed and separated,  care being taken that as little of the person
is exposed as possible.  Then,  with  the index finger and thumb of
the left  hand, separate the external labia,  and with  a  bistoury or
scalpel make an incision in the mesial line, extending  from about one-
fourth of an inch  below the meatus  urinarius downward  for about
three-fourths of an inch.  A suitable  vessel should  be at hand for
receiving the flow which will follow the incision  of  the  hymen and
the consequent separation of the vaginal walls.
  The hymen  is usually crescentic in shape, the concavity looking
anteriorly.   It occasionally  presents a  central perforation, or there
may be  a number of minute holes through it, like those through the
top of a pepper-box.   It is usually a thin  and fragile  membrane, and
is readily ruptured, as before remarked, during first coition.  Sometimes,
  * I once examined a young unmarried lady, whose hymen was  found perfectly im-
perforate, but the presence of menstrual fluid  could  not be detected.  She was in bad
health, and her symptoms called for the exhibition of Silicia, a single dose of which
was given in a very high potency. This was followed by a rapid recovery of her
general health, and about two months  after the administration of the dose of Silicia
ehe menstruated freely and regularly. 
           THE  FOLLICULAR  AND GLANDULAR SYSTEM.         49

however, it is dense and thick, and when this occurs and there is an
opening through its anterior part immediately posterior to the meatus
urinarius, a grooved director should be introduced through this orifice,
and carried down behind the hymen to the posterior wall of the vagina;
then a probe-pointed bistoury  should  be carefully introduced until its
blunt point lies within the groove of the director, and a careful divis-
ion of the hymen by cutting downward and outward  should follow.
Sometimes  the hymen lies high up in the vagina.  If it  be  found
imperforate in this situation,  and section  has to  be resorted to, the
speculum must be used and the cutting instrument introduced through
it.  When a division of the hymen is necessitated by the presence of
menstrual fluid within the vagina, the fluid should be allowed to run
o£° gradually, for fear  of shock to the system and subsequent irritative
fever.  The section of the hymen can be  completed when the whole
quantity has been evacuated.  The presence of the hymen is commonly
regarded as the evidence of virginity, but it is well known that the
membrane  has been found intact by the accoucheur at the  setting in
of labor, and, on the other hand, that its absence may be attributable
to a variety of causes  other  than coition.  Rough nurses may de-
stroy the delicate membrane in the babe, while washing the external
genitals.
   The follicular and glandular system of the external organs
of generation require particular attention.  They may be divided into
two  classes:  the first consisting  of the piliferous  bulbs, sudoriparous
glands,  sebaceous glands,  and  muciparous glands and follicles; the
second including the vulvo-vaginal glands or glands of Bartholine.
   The piliferous bulbs nourish and  support the hair  which appears
more or less abundantly upon  the mons veneris and labia majora.
   The sudoriparous glands are quite numerous upon the labia majora.
They are mingled with the sebaceous glands and surround the pilifer-
ous follicles.
   The sebaceous glands are more numerous than the rest, and in some
situations, as on the mons veneris for instance, are of remarkably large
size.  They are found on the mons veneris, the external and internal
labia, the fourchette, and the  glans of the  clitoris, but have not been
discovered  in  the vestibule or  around the urethral  orifice.   They se-
crete an unctuous substance, thinner than that from sebaceous glancte
situated elsewhere, which shields the delicate organs from  cold, keeps
them moist and supple,  and prevents them from being injured by the
perspiration, urine, or vaginal  or uterine secretions.
  The muciparous organs  are placed at different situations  on the
       4 
50        THE FOLLICULAR AND  GLANDULAR SYSTEM.
external parts, and are divided into isolated or agminated follicles and
the vulvovaginal glands.
situation.  The vestibular follicles, some  six or eight in number, are
found in the vestibule. (Fig. 12, A.)  These are very minute; and
their small and  rounded  openings  are so oblique to the plane of the
mucous membrane as to give them the appearance of being covered
by a thin valve.
  The urethral follicles  are  situated in the cellulo-vascular tissue of
the urethra.  They are placed beneath  the mucous membrane in a
line  parallel to  the canal  of the  urethra,  and  discharge  upon the
inner margin of  its orifice. (Fig. 12, B.)   Their function is evidently
to prevent the orifice of the urethra from  becoming  dry,  and  from
being irritated by the streams of hot urine which pass  over  it.
  The lateral urethral follicles appear on either side, and at some little
distance from the orifice of the urethra. They have a common opening
at the mouth of a peculiar  conical  depression.   They  are not alwavs
to be found, and are small and shallow.  (Fig. 12, C.)
  The lateral follicles of the orifice of the vagina (Fig. 12, D, E), three
or four in number  and comparatively large, are  found  usually upon
the lateral parts of the vaginal orifice immediately below the hymen
or carunculse myrtiformes.  They are irregular in their number situa-
tion  and arrangement, and are not to be found in all females.
  The vulvo-vaginal glands  or glands of Bartholine, one on each side
are true conglomerate glands, having a bulbous body and an excretorv 
THE FOLLICULAR AND  GLANDULAR SYSTEM.         51
duct   They are situated at about the lower third of the orifice of the
vagina, just inside its lateral margins.  The bulb (D) and excretory

                              Fig. 13.
VULVO-VAGINAIi GLAND.
  A A, section of the labia majora and of the nymphse, showing the excretory duct
and its orifice; B, the gland ; C, excretory duct; I), its glandular extremity ; E, its vul-
var extremity and orifice; F, bulb of the vagina; G, ascending ramus of the ischium.

duct (C), in size and exact position, are on one side, well represented
in Fig. 13.   These glands are comparatively small, acquiring  full
development only at puberty;  are often unequal in size on  the  two
sides; as sympathizing with the ovary, the larger one is found on that
side  in which the ovary may be more voluminous.  The diameter of
these glands, when largest, is from four-eighths to five-eighths of an inch.
Their secretion is intended  principally to  lubricate the parts during
sexual intercourse, and  they are especially active at such times  and
under the influence of lascivious emotions.  During coition the muscles
of the perineum and vulva are excited, and the seoretion of their glands
is discharged  in jets.  There is a coincidence of  action between them
and  the other muciparous follicles; and the secretion which so abun-
dantly supplies the vulva and vagina, especially during  sexual inter-
course, is the joint production of both glands and follicles

                          The Vagina.

  The vagina  is the membranous canal which  leads from the vulva
to  the uterus.   When distended  it is cylindrical in shape, and  it is 
52
THE VAGINA.
curved  in  its natural position, with the concavity  looking toward
the symphysis pubis.   Extending from the vulva, or outlet of the in-
ferior strait, to the superior strait, the direction of its  curvature is the
same as that of the general axis of the pelvis.  It is capable of great

                              Fig. U.
VERTICAL SECTION OF PELVTS, WITH ORGANS IN SITU.
dilatation, but ordinarily its  anterior and posterior walls remain  in
apposition.
  Anteriorly, the vagina is in relation with the  base  of the  bladder
and  the urethra, with which it  is  connected by condensed  cellular
tissue.  Posteriorly, it is in relation with  the rectum, to which  it is
attached by a considerable thickness of looser cellular membrane for
the lower three-fourths of  its extent, its upper fourth beino- separated
from  the rectum by the recto-uterine fold of peritoneum.  Thus  in
displacements of the uterus, which necessarily affect the vagina the
rectum  is seldom involved, while  the bladder, being  more  firmly
bound to the vagina, is always disturbed by such  changes in the posi- 
             THE INTERNAL ORGANS OF  GENERATION.          53

tion of the uterus.  Hence the incessant calls to pass water, with pain-
ful micturition or more or less complete retention of urine, so often
seen  in cases of anteversion or prolapsus uteri.
  The length of  the vagina differs in different persons, and in differ-
ent states of the  same person.  It is much  longer  posteriorly' than
anteriorly, and may be stated to be from  four to five inches long on
its anterior wall,  and from  five to six inches long on its posterior
wall.  It is very elastic, and  is capable of being distended longitudi-
nally, as well as of being  laterally dilated.  In some instances it ap-
pears very much shorter than the natural standard.  This shortening
of the vagina may be accidental, merely the result of partial prolapsus
of the uterus, or it may be congenital  and permanent.  In the former
case  the womb may be pressed upward and  restored to its  natural
position, when the shortening of the vagina will at the same time dis-
appear.  But in the  latter case the uterus  cannot be thus pushed  up
by the  finger, and  this  circumstance conclusively  determines the
nature of the difficulty.
   Extreme  shortness of  the vagina has  been put  down  by  some
authors amongst  the causes of sterility; but it cannot be regarded as
necessarily a cause, inasmuch as there is  abundance of testimony to
prove that conception  has taken place from the  semen coming into
contact with the mucus lining of the vulva and orifice of the vagina.
   The vagina is narrowest at its orifice, most capacious midway in its
course, and  again contracted at its uterine extremity.  In  these  re-
spects it resembles the superior strait, cavity and outlet of the pelvis.
In women who have borne many children its midway capacity is very
great; its ordinary circumference is about three inches.
   The parietes of the vagina consist of an external or muscular coat,
an internal mucous lining, and an intervening layer of erectile tissue
enclosed between  two  layers of fibrous membrane.   The  muscular
layer is composed of longitudinal muscular fibres, which are continu-
ous with the superficial muscular fibres of the uterus.   These surround
the vagina, and are more abundantly and powerfully developed in some
females than in others.  The erectile tissue, which appears to be com-
posed mainly of several superposed layers of venous network, is  more
abundant at the lower than at the upper part of the vagina.   The  in-
ternal or mucous  coat is continuous above with the mucous  lining of
the uterus, and below with that of the vestibule and vulva.  This
mucous  coat of the  vagina is thrown into numerous transverse or
oblique folds, called rugae,, which are  more frequent and distinct near
the orifice of the vagina, particularly in women who  have not borne 
54
THE UTERUS.
children.  These folds evidently constitute a provision for the dilata-
tion of the  vagina, to allow the  passage of the foetal head.  The
mucous membrane is covered with conical and  filiform papillae and
numerous glands.  These latter, which  are especially numerous at
the upper part of the vagina and around the cervix uteri, pour out a
profuse secretion more abundant during coition, and still more in par-
turition.
  The vagina is  abundantly supplied with blood-vessels, absorbents
and nerves.   The arteries are derived from the hypogastric; the veins,
which are very numerous and plexiform, communicate with the vesi-
cal  plexus in front and the hemorrhoidal plexus  behind, and its nerve
plexus, which contains a large proportion of spinal nerve fibres, arises
from the inferior hypogastric or pelvic plexus.
  The superior  portion of the vagina enfolds the neck of the uterus
in a manner similar to the attachment of the Zouave pants to the legs,
forming an anterior and a  posterior cul-de-sac, of which the latter
is much the deeper.
  In  its use the vagina constitutes the chief copulative organ of the
female,  affords an outlet for the escape of the menstrual fluid, and be-
comes the channel through which the foetus passes from the uterus
through the cavity of the pelvis into the external world.  After par-
turition it very  speedily decreases in calibre and nearly resumes its
natural size.

                          The Uterus.
  The uterus is the organ of gestation in which the fecundated ovum
is received, nourished, and supported till the proper period of its ex-
pulsion at parturition.  In its virgin state the uterus,  under the influ-
ence of the  ovaries, constitutes the pivot around which play all the
physical and nervous energies of  the female organism; and  its func-
tional perfection exercises a  powerfully controlling influence upon the
physical health and  social and moral happiness.  The generative or-
gans  constitute the  grand  centre  of the female economy.   All the
other organisms and functions of the woman are more or less in sym-
pathy with  these.  And from the full,  healthy, and  harmonious de-
velopment of the sexual system come the ruddy cheek, the elastic step,
the buoyant, womanly spirit, and all that constancy of love and affec-
tion which  so pre-eminently characterize, beautify and ennoble the
female sex.   And the  impregnated uterus becomes at once one of the
largest  and certainly the most important organ in the body of the
female in her highest state of physical development, it being  then the 
THE UTERUS.
55
true physiological centre of the most excited vital activity—the repro-
ductive seat of life within life.
  This distinction of the virgin from the impregnated uterus not only
underlies  the  whole character and  constitution and function of the
organ, but affects also the entire physiological, social, moral, and even
spiritual, nature and condition of the female herself.  Both the organ
and the individual  in the one  case are totally different in structure,
function and being  from the organ and individual in the other.  The
virgin or unimpregnated uterus  has  a structure and functions and dis-
orders peculiar to itself.  The impregnated  uterus also has structure,
functions, disorders, difficulties and  dangers peculiar to it.
  We give then, in  the first instance, an account of the virgin uterus,
describing its  shape, size, structure, position, relations, appendages
and functions, and afterward pursue a similar course with reference to
the gravid or impregnated uterus.  Subsequently, and in the appro-
priate place, we will detail the various dangers and disturbances to
which the uterus—impregnated and  unimpregnated—is liable, to-
gether with the chief characteristic indications for the principal reme-
dies required in their treatment.
  The virgin  uterus is  a hollow, pear-shaped conoid  organ,  with its
base  or larger part turned upward and  forward, and  its apex  or
smaller extremity looking downward and  backward.   The great im-
portance of this organ, and the consequent minuteness of description
requisite for its thorough study, have caused it to be divided, nomi-
nally and externally at least,  into five parts.  Of these, the  base or
upper third is called the fundus ;  the middle portion or that  part be-
tween the fundus and the cervix is called the body ; the lower third is
called the cervix or neck; the lower extremity of the cervix is called
the apex; and the orifice or opening of the cervix is called the os ex-
ternum, os uteri, or mouth of the womb.
  It  has also, externally, an anterior and a posterior face; the  anterior
being more flat and  looking toward  the bladder and symphysis pubis,
while the  posterior face is more extensively covered by the peritoneum,
more convex, and looks toward the rectum and promontory of the
sacrum.   There are also three borders  or margins—one  superior
border, which  bounds the summit of the  fundus, and one right and
one left lateral border.  To the two latter are attached the broad and
round ligaments of the corresponding sides.  Finally, the cervix and
body of the womb  have also  an internal  surface lined with mucous
membrane, which is supplied  with numerous follicles and glands.
  The fundus or base of the womb is convex, looking upward and 
56
THE UTERUS.
forward, ordinarily inclining toward the arch of the pubis, its summit
never rising above the margin of the  superior strait, while the supe-
rior two-thirds of its anterior and the whole of its posterior surface is
covered by the reflected folds of the  peritoneum.  Its superior sur-
face is in apposition with the convolutions of the small intestines.
THE INTERNAL GENITAL ORGANS.
  A, the uterus, seen on its anterior face; B, the intra-vaginal portion of the neck
of the uterus; C C, the Fallopian tubes; D, the pavilion or fimbriated extremity
of the tube; E E, the ovaries; F, the ligament of the ovary; G G, the round liga-
ments ; H, the vagina laid open.
  On the right, the fimbriated extremity of the tube is seen applied to the ovary.

  The body of the uterus gradually narrows from above downward to
terminate in the cervix.. At the points on either side which mark the
junction of the body with the fundus an angle is formed, which indi-
cates the positions of the two Fallopian tubes.   A third angle is formed
at the junction of the  body with the  cervix, and hence  the uterus has
been described as being of triangular shape.   The anterior surface of
the body is somewhat flattened, and  is  covered by peritoneum in its
upper three-fourths, while its lower  fourth is connected with the bas
fond of the bladder by areolar  tissue.   This connection of the uterus
with the bladder accounts in  a  great degree for the derangements of
the urinary functions almost always attendant  on displacements of the
uterus; as well as for the change in position of the urethra which
attends the enlargement and  elevation of the uterus during the pro-
gress of pregnancy.   Between the upper portion of the body and the
bladder some  coils of the small  intestines are interposed.  Posteriorly
the body of the uterus is convex, separated from the rectum by portions 
THE UTERUS.
57
of the small  intestines, and covered throughout  by peritoneum.   Its
lateral borders are slightly concave, and give attachment to the Fal-
lopian tubes and the broad and round ligaments.
  The cervix is. about one inch in length,  and is slightly constricted
at its point of union with the  body of the  uterus.  At this point take
place the flexions which sometimes  occur  in connection with change
of position of the body and fundus  of the womb.   Thus, in cases of
anteflexion, retroflexion and lateroflexion the body of the uterus forms
nearly a right angle with the neck.   The usual position of the virgin
uterus is with the fundus inclined toward the symphysis pubis.  This
causes the cervix to incline toward the superior portion of the coccyx
(see Fig. 14), and  the os uteri to look posteriorly toward the rectum,
instead of looking directly downward in the direction of the axis of
the inferior strait.
  The vagina embraces the cervix at  its upper third, and hence divides
it into two portions—an upper or uterine, which  lies above  the point
of junction of the vagina, and a lower or vaginal portion, which pro-
jects into the vagina as a free extremity  of the womb.  The anterior
face  of this free extremity is somewhat shorter than the posterior face,
on account of the oblique manner in which the vagina surrounds the
cervix. Before puberty the cervix is  small, dense and conical in shape,
while at puberty there  is a considerable increase in its size and a dimi-
nution of its density. Pregnancy and parturition still further and very
markedly modify the conditions of the cervix in all particulars.
  From a description of the outer surface  of the uterus we naturally
come to  a description  of its cavity  and  internal surface.   And first
the cavity of the cervix engages our attention as the  entrance to the
greater cavity of the body of  the womb.   The entrance to the cavity
or canal of the cervix is termed the os uteri, or, from a fancied resem-
blance to the mouth of a tench, the os tincce.  In the fully-developed
virgin uterus the os uteri presents two lips, separated by a transverse
fissure.  These two lips are of nearly the  same  length, although the
anterior is the thicker and descends a little lower than the other.   In
young girls the os is quite small, and  sometimes almost undiscoverable.
But where it thus seems wanting or imperforate, gentle pressure of
the finger will detect a slight depression which will indicate its exact
situation.  In women who have borne children,  on the contrary, the
os uteri is sufficiently open to admit  the point of  the finger,  while the
lips of the os  are  unequal in size and present a  number of irregular
depressions or notches.
  The canal of the cervix  is from three-fourths of an inch to an inch 
58
THE UTERUS.
long, extending from the os externum to the os internum which marks
the entrance into the cavity proper of the uterus.   In its course  from
the external to the internal os, it first widens and then grows narrower
as it merges itself with the os internum, which latter is in a measure a
strait or intermediate portion connecting the canal of the cervix with
the cavity of the body of the womb.  The mucous membrane lining
the canal of the cervix is  arranged in radiating folds, or rugae,, on
either side; the united radiations of both sides, having an appearance
resembling somewhat the arrangement of the branches of a cedar tree,
have been called arbor vitee.  (See Fig. 16, C, and Fig.  18, A.)
   The cavity of the body of the womb, into which that of  the cervix
CAVITY OF THE UTERUS AND THE FALLOPIAN TUBES.
  A, superior border or fundus of the womb;  B, cavity of the womb; C, cavity of
the neck of the womb; D, the canal of the Fallopian tube cut open ; E, the fimbri-
ated extremity or pavilion, likewise laid open; F F, the ovaries, one-half of which
has been removed so as to bring into view several of the Graafian vesicles ; G, the
cavity of the vagina; H H, the ligaments of the ovaries; G G, the round ligaments.

leads, and with which it is continuous,  is covered with mucous mem-
brane,  and abundantly supplied with  muciparous follicles, although
these are far  less numerous in the  body than in the  cervix.   In the
virgin  womb the walls are nearly in apposition, there being ordinarily
but little cavity in the empty womb.  At the same time the walls are
much more vascular than the parietes of the canal of the cervix.  Still,
the cavity of  the womb, such as  it is (Fig. 16, B), is triangular  in
shape,  its  inferior  angle corresponding to the  os internum, the two
superior and lateral angles  being situated at the  orifices of the Fallo-
pian tubes.   In Fig. 17 appears a profile view, which conveys a more
correct idea of the manner in which the walls  of the virgin uterus
are approximated in their  ordinary condition.  At the times of the
menstrual excitement they are somewhat more distended.
  The external dimensions of the uterus vary in different persons__be- 
THE UTERUS.
59
iug larger or smaller, to correspond with the totality of their physical
constitution.   We give what may be considered the average admea-
surements of the fully-developed uterus at puberty.  The. entire length
                              Fig. 17.
  This profile view gives an exact idea of the dimensions of the cavity of the body
and of the neck of the womb in a state of vacuity.  A, mucous membrane; B, tissue
proper; C, cavity of the body ; D, cavity of the neck.

of the uterus, from  the  inferior margin of the cervix to the superior
border of the fundus,  is about three inches, its greatest breadth is
about two inches, and its thickness from the anterior to the posterior
face is one inch.  As the uterus increases in size from childhood to
puberty, so from the cessation of the  menses it begins to diminish in
volume till it becomes more or less atrophied in the second childhood
of advanced age.   And as  in the impregnated  condition the womb
becomes very greatly and permanently enlarged—that is, during  the
continuance of pregnancy—so at the accession of each  of the monthly
periods,  in  many  females,  it  becomes  temporarily enlarged.   The
weight of the virgin uterus may be set down as about an.ounce to an
ounce and a half, but after child-bearing it remains two or three times
as heavy.
   The structure of the uterus forms a very important element in study-
ing its  nature and functions.  Three distinct tissues, coats or tunics
—each possessing a different constitution and performing totally  dif-
ferent functions—make  up this complicated structure.   These are the
external or  peritoneal  coat, the middle or muscular coat, and the in-
ternal or mucous coat.
   The external or peritoneal coat.—This membrane is reflected from
the posterior  surface of the bladder  upon the  anterior face  of  the
uterus, extends upward, and, covering the fundus, is o mtinued down 
CO                        THE UTERUS.
upon the vagina a short distance below the cervix, and is then finally
reflected  upon the rectum.   The peritoneal  membrane  or serous
tissue is thus seen to  be identical and continuous with the ^common
lining membrane of the abdomen.  The fold of peritoneum reflected
from the bladder to the uterus is termed the vesico-uterine or anterior
ligament, and that which passes  from the posterior  surface of the
uterus to the rectum is termed the recto-uterine or posterior ligament.
These, however, are mere subdivisions made for the sake of descrip-
tion, of the  broad ligaments of the uterus, which are formed by pro-
longations on either side of the folds of peritoneum which pass from
the bladder  to the anterior uterine wall, across the fundus and down
the posterior wall, and  from thence to the rectum.  These prolonga-
tions are reflected from each lateral border of the uterus to the corre-
sponding side of the pelvis, in the direction of the sacro-iliac symphy-
sis.  Taken as a whole, they form what are called the broad ligaments
of the  uterus, and  contain the Fallopian tubes, the ovaries  and the
round ligaments.
  The middle or muscular coat forms the  principal part of the sub-
stance of the uterus.  This tissue is dense, firm, and grayish in color.
It is thickest upon  the middle  of the body and fundus, thinnest at
the orifices of the Fallopian tubes.  It consists of bundles of unstriped
muscular fibres,  disposed in three layers,  intermingled with  areolar
tissue, blood-vessels, lymphatics and nerves.   The external  layer ap-
pears principally upon the anterior and  posterior surface; its fibres,
converging  at each superior angle of the uterus, are continued upon
the Fallopian tubes, the round ligament and ligaments of the ovary—
some few running backward from the cervix uteri to connect with the
recto-uterine ligaments.   The middle layer of this coat is composed
of longitudinal, oblique and  transverse muscular fibres.  The internal
layer consists of circular fibres arranged in the form of hollow cones,
whose apices surround the orifices of  the Fallopian tubes, their bases
meeting and intermingling at the  middle of the  body of the uterus
The fibres of this layer are  disposed  transversely or circularly in the
cervix uteri.  The womb is a muscular organ of very great power, and
a thorough knowledge of  the nature and arrangement of its  muscular
fibres in the cervix, and especially in the  fundus, and of their relation
to the broad and  other ligaments, is essential to a correct understand-
ing of its wonderful action in parturition.
  The mucous coat of the uterus is so closely adherent to the subjacent
tissue that, from the difficulty of separating and demonstrating it, its
existence has been  denied by many authors.  But by the aid of the 
THE UTERUS.
6 i
microscope this mucous coat has not only been clearly distinguished.
but shown also to consist of epithelium, basement membrane, fibrous
tissue, blood-vessels and nerves, like other mucous membranes.   This

                               Fig. IS.
  This figure represents the arrangement of the mucous membrane, and of the tissue
proper of the  uterus, as also their relative dimensions.  A, cavity of the neck and
arbor vitse ; B, cavity of the body; C, mucous membrane; D, intervening membrane;;
E represents the marked thinning off of the mucous membrane toward the neck.

internal  mucous coat of the uterus is continuous  with that  of the
vagina, and also with the peritoneum  above,  through the fimbriated
extremity of  the Fallopian  tubes.  It  abounds in follicles,  whose
secretion lubricates the interior surface of the uterus.  And the  abnor-
mal, catarrhal and leucorrhcaal secretions and other morbid products,
to be subsequently considered  as disorders of  the cervix and even of
the fundus,  conclusively show the mucous character of this innermost
tissue of the uterus.   Numerous follicles, glands and papillae  appear
in the mucous  lining  membrane  of the cervix, the secretions from
which  serve to maintain the mouth of the virgin uterus in a healthv
condition.   Much the larger portion of the mucous secretion from the
womb  is in  reality the  product of  the innumerable glands of the cer-
vix.  This secretion in its normal  state is whitish, very viscid,  almost
transparent, and gives  an alkaline reaction.    It adheres to the crypts
and ruga? of the cervix, and occupies its canal.
  The blood-vessels of the womb are numerous, and largely developed
in comparison with the size of the organ.  This has reference not only 
62
THE UTERUS.
 to the nutrition of the wTomb in its ordinary condition, and to its con-
 gested state at the periods of menstrual excitement, but is provisional
 also for the necessities of that impregnated  condition for which it is
 designed.   The arteries which supply the womb form  two distinct
 systems, according to the  sources  from which they are  derived and
 the parts to which they are finally distributed.  The first, or superior
 system, is composed of the ovarian arteries, which correspond with the
 spermatic arteries of the male, arise from the aorta, and descending
 along  the sides of the womb in a serpentine course are distributed to
 its upper part, to the Fallopian tubes and to the ovaries.   The second,
 or inferior system, is composed of the  uterine arteries, which are de-
 rived from the internal iliac arteries.  These also pass along the sides
 of the womb, to be finally distributed to the cervix and upper part of
 the vagina.   These  arteries pursue a remarkably tortuous course in
 the substance of the uterus; thus provision is made  for their great
 elongation without danger of rupture in the advanced stages of preg-
 nancy.   The  numerous  branches of these two systems freely anasto-
 mose with each  other.
  The veins of  the virgin uterus are of large size, possess no valves,
 correspond  in name with the arteries, and follow their course.   The
 right spermatic  vein terminates in the inferior vena cava, the left in
 the renal vein; the uterine veins empty into the internal iliacs.  They
 are capable  of very great increase in pregnancy, and are  then known
 as uterine sinuses.
  The lymphatic vessels of the  uterus, invested by delicate coverings
 of peritoneum, are distributed upon all  the  external surfaces of that
 organ.  They are very numerous, and, in the virgin uterus, very small.
 Some of these ascend, in a serpentine course, from the cervix to the
 body and fundus of the uterus.  Others pass less tortuously, in vari-
 ous directions, over both these surfaces, communicating with branches
ascending from  the vagina and with those from the Fallopian tubes
and  ovaries.  The internal as  well as the external surfaces of the
uterus, Fallopian tubes and  ovaries  are abundantly supplied  with
these absorbent vessels. Those of the former, from the interior struc-
ture of these organs, communicate with the lumbar ganglia; those  of
the  latter, from  their external surfaces, communicate with the pelvic
or inguinal ganglia.  This latter circumstance is important to be borne
in mind, since this  anatomical and physiological connection is fre-
quently the index to pathological  appearances.   In addition to the
general division of the lymphatics of these  organs to correspond  to
their external and their internal surfaces, the mode in which they are 
THE UTERUS.
63
originally distributed to follow the course of the arteries,  arranges
them all in two distinct systems of lymphatic circulation.   With the
exception of the proper menstrual secretion, there is no discharge from
the interior of the female organs of generation in their normal condi-
tion, tjie lymphatics  sufficing to reabsorb the natural secretions of
their internal surfaces, so that no accumulation occurs.
   The nerves of the uterus and its connecting structures of the gene-
rative  system are derived, either directly or indirectly, from all three
of the great nervous centres of the body, and  by their  union and
concentration serve to  render the sexual system  of  the  female the
great physiological centre of her entire organism.  The nerves which
are distributed to the uterus are,  in part, derived from the great
sympathetic, and  in part from the spinal  nervous, system.  But these
latter,  as branches of the third  and  fourth sacral  nerves given off
from the cerebrb-spinal axis, are, indirectly at least, derived also from
the cerebral nervous centre, as well as from the spinal, although they
are not under the  immediate control of the will.
   The nerves which are distributed to the uterus from the sympathetic
system are derived from the aortic and from the hypogastric plexus.
The former—variously named as the  renal, the  spermatic or ovarian
plexuses, according to their more immediate relations—are all derived
from the great  solar or epigastric plexus, and are intimately connected
with all the other pelvic, abdominal and thoracic nervous centres.
Hence the powerful  sympathy which  exists  between the womb itself
and all the other great organs of the female.   Hence, too, the intense
pain felt at the pit of the stomach in cases of uterine neuralgia, and
the nausea and vomiting which are so often associated with peculiar
conditions of the impregnated womb.
   The nerves which are distributed  to the uterus from the hypogas-
tric plexus come directly from the pelvic portion of the sympathetic,
and have associated with themselves the filaments from the third and
fourth sacral nerves,  which connect the womb with the general mus-
cular apparatus of the body—the former class of nerves having espe-
cial relation to the two great functions of nutrition and reproduction,
as in the growth  of the womb itself and of the ovum which it may
contain in the  impregnated state; the latter  having relation to those
muscular powers of the womb by which it is enabled to exert itself
so wonderfully to expel the product of conception at full term, and
to combine with its own efforts the muscular powers of all  other parts
of the body.
   Unlike other muscular structures, the  nervous filaments penetrate 
64
THE UTERUS.
into  the  substance  of the womb, and  during the period of  utero-
gestation all the uterine nerves are very greatly enlarged.
  The uterus  appears as if supported or  suspended in the midst of
the pelvis, and is  sustained in this position  by certain  ligaments,
which  are  processes given off from its own  substance or from the
enveloping peritoneum, and by the peritoneum itself.   The ligaments
are arranged in four pairs, and are known as the anterior, the posterior,
the round and the  broad ligaments.  The anterior and posterior, to-
gether with the broad ligaments of which they are a part, have already
been described.  Stretching laterally from the sides of the uterus  to
those of the pelvis, they form a partition wall  or septum in the cavity
of the  pelvis, which divides it into an anterior portion, containing the
bladder, urethra and vagina, and  a  posterior  portion, containing the
rectum.
   The round ligaments, continuous with the proper tissue of the  womb,
are produced  from the anterior and  superior part of its body.   They
are four or five inches long, situated between  the layers of the broad
ligament, and attached to the superior angles of the uterus, one  on
each side, a little in front of the Fallopian tube.  (Fig. 16, G.)  From
this  point the  ligament proceeds outward and forward to pass through
the  inguinal canal toward the symphysis pubis, where its expanded
fibres are distributed  to the subcutaneous cellular tissue of the groin,
mons veneris and dartoid pouch of the labia.   The tubular process in
this  ligament, called the canal of Nuck, is analogous to the peritoneal
pouch which accompanies the descent of the testes in the male.
   The womb  is apparently maintained  in its  oblique  position by the
co-operative agency of all its ligaments, assisted  by the support fur-
nished by the vagina and the pressure of the intestines.   But when
we come to consider the subject carefully, it undoubtedly appears that
it is to the folds of peritoneum the  maintenance of the uterus, in its
position between the pubes and the sacrum in the ever-varyino- move-
ments of the woman, is mainly if not wholly due.  For, if we consider
that nearly all the viscera within the abdominal cavity are invested and
supported  in  position by the peritoneum, and that this  membrane,
reflected from the bladder, covers the entire upper and anterior three-
fourths of the uterus, and is thence reflected over its fundus and down-
ward upon its entire posterior length, it will be seen that the oro-an is
invested by, and lies  between, as it were, two layers of peritoneum
riding upon the anterior and  inferior layer, and covered in  and held
down by the posterior superior layer, the whole being anchored in situ
to the sides of the pelvis by the reflected broad  ligaments.   Thus 
THE UTERUS.
65
while the broad ligaments, the round ligaments, the vaginal walls and
the superimposed intestines contribute to keep the uterus in its oblique
antero-posterior position, its main support is derived from the investing
layers of peritoneal tissue, which almost entirely cover it.
   These supports of the uterus are not merely extensible, but possess
contractile  power, due to the presence of muscular  fibres.  Thus a
large degree of motion is allowed the womb, particularly in an antero-
posterior direction.   If the bladder be distended, the uterus will be
pushed  backward toward the rectum, and if, on the contrary, the
bladder be empty and the rectum distended, the viscus will be cor-
respondingly pushed  forward,  the  contractile power of its ligaments
serving to  replace the organ when its normal position has been dis-
turbed.   When  these circumstances are borne in mind, and it is like-
wise  remembered that displacements of the uterus must frequently
occur in consequence of the relaxation  of these supporting processes
of peritoneum resulting from some  constitutional  disordered con-
dition, the  rationale of their cure  by medication alone becomes per-
fectly obvious.
   " During and  after menstruation the uterus is enlarged and more vas-
cular, its surfaces rounder;  the os externum is  rounded, its  labia
swollen, and the lining  membrane of the body thickened, softer and
of a darker color.
   " During pregnancy it increases in weight from  one pound and a
half to  three pounds.  It becomes enormously enlarged, and projects
into the hypogastric and  lower part of the  umbilical regions.  This
enlargement, which continues up to the sixth month of gestation, is
partially due to increased development of pre-existing and new-formed
muscular tissue.   The  round ligaments are enlarged, and the broad
ligaments  become encroached  upon  by the uterus making its way
between their lamina?.  The  mucous membrane becomes more vascu-
lar, its mucous follicles and glands enlarged; the rugse and folds in
the canal of the cervix become obliterated; the blood-vessels and lym-
phatics, as  well  as the nerves, according to the researches of Dr. Lee,
become greatly enlarged.
   "After parturition the uterus nearly regains its natural size, weigh-
ing from two to  three ounces, but its cavity is larger than in the virgin
state; the  external orifice is more marked  and assumes a transverse
direction;  its edges present a fissured  surface; its vessels are tortu-
ous,  and its muscular layers are more defined.
   " In old  age the uterus becomes atrophied and  paler and denser in
texture; a  more distinct constriction separates the body and cervix.
       5 
66
THE OVARIES.
The ostium internum, and occasionally the vaginal )rifice, often be-
comes obliterated, and its labia almost entirely disappear."—Gray.

                     The  Fallopian Tubes.
  The Fallopian tubes are  the oviducts through which the ovum is
conveyed  from the ovary to the uterus.  They are two in number,
one on  each side, about four inches  in  length, and extend  from the
superior lateral angles of the uterus, lying in the free  margin of the
broad ligament, outward toward the sides of the  pelvis, where they
terminate  in fringed  borders  or fimbriated  extremities*   The canal of
these tubes is exceedingly minute.   The internal  orifice, that within
the cavity of the uterus, is termed the ostium internum, or uterinum,
and is so small as scarcely to admit the  introduction of a fine  bristle.
From this orifice the tube  widens until it is  finally developed  into a
trumpet-shaped extremity,  the pavilion.  At  the base of the pavilion
a contracted circle, the ostium abdominale, forms the  termination of
the tube proper, and  from this  circle  radiate the fringes which com-
pose the pavilion or fimbriated extremity itself.
  The Fallopian tubes are composed of three distinct coats or tunics.
The outer coat is derived  from the peritoneum.   The  middle coat is
muscular, and consists of two layers of fibres,  an outer or longitudinal,
and an inner or circular layer, both of which are continuous with the
muscular  fibres of the uterus.   The inner coat consists of mucous
membrane, which  is  continuous at  the inner extremity of the tube
with the mucous lining of the uterus, and at its fimbriated extremity
with the  peritoneum. Toward the outer extremity of the tube the
mucous coat is thrown into folds, wliich indicates  its adaptability for
dilatation.   It is covered with columnar-ciliated epithelium; the cilise
being arranged in such a way as to facilitate  the passage of ova from
the ovary to the uterus.   The  ovules  discharged at  the  menstrual
periods pass through  the tubes to the uterus.

                          The  Ovaries.
  It is  only in a practical  or obstetric  point of view that the  uterus
ran be regarded as the most important  of the  generative organs.   The
ovary, though constituting  but a small  part,  anatomically considered,
of these organs, is really the  part to which all others are subservient,
inasmuch  as it furnishes  the element which is essential to  the repro-
ductive act.   And not only can it be claimed for  the ovary that it is
the essential part of the reproductive system, but that in a very great
degree it regulates the growth of the whole female organism__as the 
THE OVARIES.                       67
testes do in the male—and determines the  distinctive characteristics
of the sex.   " It is the organ upon the presence of which depends the
sexual passion  and the function of menstruation, whose congenital
deficiency is indicated by the absence externally  of all  signs  of a
secondary sexual  character, whose artificial removal  entirely unsexes
the individual, and the decline of whose functional activity, as age ad-
vances, is the cause of the generative faculty being lost in the  female
long before the ordinary term of life has expired, and at a much  earlier
period than that at which the power of procreation ceases in the other
sex." *  In a physiological sense, therefore, the uterus, as  well as every
other part of the generative apparatus, must be regarded as an  ap-
pendage of the ovary, and the common formula, " Uterus and its Ap-
pendages," might be  superseded most  appropriately by the title,
" Ovaries and their Appendages."
  The ovaries  are the analogues in the  female of the  testes  in the
male.  They are two in number, lying deeply in  the lateral and
posterior part of the cavity  of the true pelvis, one on  each side of
the uterus, with which they are so intimately connected as  necessarily
to take part in  all changes of position of that organ, whether normal
or abnormal.   They lie within  the  folds of the broad  ligament, or,
more accurately, within a fold of peritoneum derived from the pos-
terior lamina of the broad ligament, and each ovary is in part covered
by the Fallopian tube of the  same side.  In addition to its connection
with the uterus by means of the broad ligament, each ovary has an-
other and more direct attachment to that organ by means  of its own
proper ligament of the ovary,  which serves as a cord to bind it more
securely to the uterus.   It is likewise attached by a cord-like process
to the fimbria? of the Fallopian tube.  In shape, the ovaries are oval,
elongated and flattened from above downward.  Each ovary is about
an inch and a half in length, three-quarters of an inch in  width, and
about a third of an inch in  thickness.   They are not usually fully-
developed until some time  after the  establishment  of  puberty,  but
vary in  size, weight and situation  in  different conditions of  the
system,  increasing in volume at the monthly  periods, and in most
instances becoming more or less atrophied after the final cessation
of the menses.
  The ovary is composed of protecting parts  or tunics, of proper
secreting structures containing the ova,  imbedded in a parenchyma
or stroma, and of vessels and  nerves.   The  tunics of  the  ovary
correspond with those of the testicle, and  consist of the peritoneal
           * Todd's Cyclopaedia  of Anatomy and Physiology, vol. v. 
68
THE OVARIES.
covering derived from the posterior lamina of the broad ligament, and
the tunica propria or special covering of the ovary.  The peritoneal
covering of the ovary is intimately connected with the gland, except
at its base.  It does not in any way differ from the peritoneal covering
of the viscera generally.  The  tunica albuginea or  tunica propria ia
the covering  proper of the ovary, and serves to give it form, as well
as to pi itect the  stroma and ova from injury.   This tunic, which is
very toiigh, forms  a  complete investment for the ovary except at its
lower border, where the fibres are  either few or altogether wanting,
leaving  a longitudinal space or fissure—the hilum—through which
the vessels  and nerves are admitted to the gland.
   The parenchyma or  stroma of the  ovary lies immediately beneath
the tunica  albuginea, with which it  is in  contact,  and fills up all
the intermediate space between the ovisacs, thus giving form to the
ovary.   It  acts as a soft bed for the ovisacs, protects the ova  from
injury, and serves as a vehicle for the conveyance of the minute blood-
vessels to the ova.   It is of a pale-pink or bright-red color, owing to
the numerous blood-vessels by which it is permeated.
   The  Graafian vesicles,  or ovisacs, are numerous small,' round, trans-
parent  vesicles, in various stages of  development,  imbedded in the
stroma,  and  themselves  containing the ova.   The  number of well-
developed  vesicles contained within each  ovary, and visible to the
naked eye, varies  in different subjects.   They are usually computed
to be from twelve to twenty, and  it was commonly supposed that
when these were exhausted  by repeated  conceptions the  power of
procreation of necessity ceased.  But a more careful  and  accurate
examination of the contents of the stroma has shown that the number
of these vesicles greatly exceeds  the above  computation.  During the
early development of the ovary the Graafian vesicles are small, and
are deeply seated within the substance of the stroma, but as develop-
ment progresses they enlarge and approach  nearer to the surface; and
finally, when  mature, they form projections on the surface of the ovary
beneath the peritoneal covering.  Each Graafian vesicle consists of an
external coat, which is fibro-vascular, and which is in  connection with
the surrounding stroma  by means of a vascular network, and an in-
ternal tunic, the ovi  capsule,  which  is lined by a very delicate mem-
brane, the  membrana granulosa.  AVithin these walls is contained  a
transparent albuminous fluid, in which is suspended the ovum.
   The human ovum is exceedingly minute, measuring from the ^ to
y-i-g- of an inch, and is made up as follows: an external transparent
capsule  or envelope, the vitelline membrane, within which, and in con- 
OVULATION AND MENSTRUATION.
69
tact with it, is the vitellus or yelk, and lying in the  substance of the
yelk is  a small  vesicular body, the germinal vesicle^  which contains
the germinal spot.
  The vitelline  membrane  is thick,  colorless  and transparent, and
corresponds to the chorion of the impregnated ovum.  The vitellus
consists of granules of various sizes  lying in a more or less viscid
fluid.  The germinal vesicle is about y^ of an inch  in diameter, and
consists of a delicate transparent membrane containing a watery fluid.
The germinal spot is opaque, of a yellow color, and granular in struc-
ture, measuring from -^^j to ^Vir of  an inch.  The  ovary derives its
supply of blood chiefly from the ovarian, but in part also from the
uterine arteries, between which vessels there is a  very complete and
free anastomosis.  The veins are very numerous, and form immediately
outside the ovary, and between folds of the broad ligament, a plexus
termed  the pampiniform plexus.  The nerves are derived from the
spermatic plexus, and enter the ovary through the hilum, along with
the blood-vessels.
                        CHAPTER V.

             OVULATION AND MENSTRUATION.

   THROUGHOUT the  entire  scale of creation the ovaries  form the
    ultima ratio of generation.   The uterus derives its stimulus from
the excitation of the external organs of generation, but the final cause,
the true physiological and vital reason of  its existence and  action, is
to be found in the ovaries. It has been amply  shown by the success-
ful experiments of modern observers that the ovaria are the essential
organs of reproduction, and that in them originate the greater propor-
tion of those sympathies which have been so long generalized as
uterine; and furthermore, that the development of the pelvis, of the
uterine system and of the mammae, the function of menstruation and
all the peculiarities of the human female, depend upon the ovaries.
These  supply the ova  which, through the stimulus of the life-impart-
ing principle contained  in the semen of the male, may be developed
into an individual similar to its progenitors.  In fulfilling their appro-
priate  and primary function of ovulation the ovaries determine also
that of menstruation, which is secondary and consequent.
  The  ovaries  have already been described as  containing  at puberty 
70              OVULATION AND  MENSTRUATION.

the germinal vesicles in different states of de\ elopmcnt.  But these ova
are discoverable long before the  accession of the period of puberty.
They may be seen in the ovaries of the new-born babe, and even in
those of the foetus in utero.   They form, therefore, an integral part  of
the ovarian tissue.   The ante-pubertal life of the  female is one  of
preparation, of growth in stature and in strength, with especial refer-
ence to the perfect fulfillment of the function of the ovaries.  Many
of the lower orders  of the animal  creation arrive at maturity much
earlier than man.  The human female is longer in arriving at the full
measure  of her development, as  her being and destiny are higher.
The  same general principle  of  greater length of  preparation and
greater results  is seen in the  more particular instances of those indi-
viduals who commence to  menstruate at a period later than the aver-
age.  Those later in assuming the evidences of maturity are  said to
be more  steadfastly regular in menstruation, and to continue it longer;
the converse is  still more evidently  true.   For, as in general all those
whose precocious growth, even of the intellectual  faculties, attracts so
much attention, are seen to become  exhausted almost before they enter
upon the race of life, so in the particular instance under consideration
of premature development  of the  sexual  system, the earlier young
people arrive at puberty so much the  earlier do they grow old.  This
also is as  manifestly true  of  nations as of individuals.   Those races
in which, like  the Hindoo, the women arrive at sexual maturity  at
the earlier periods, as  in the  twelfth  year, are effete, emasculate and
doomed  to be  conquered by those  in which the  period  of puberty is
longer delayed.  This is true  independently  of those influences of
climate or temperature which may apparently seem to have conduced
to such premature development.
  Thus the female, after a preparatory period of constitutional incuba-
tion, becomes so highly developed  in her  entire system  in general,
especially in her sexual organization, and  more  particularly still  in
her ovaries, that these minute seminal vesicles, these ova or eggs, ma-
ture and begin  to burst through the outer covering of the ovary itself.
Previous to the final accession  of the period of puberty the ova have
been but imperfectly developed,  and have  in consequence remained
comparatively dormant.  But at this time a new life and vigor spring
up  in the  ovaries, which rapidly develop the external form of the
female herself in general, and  all the organs of  her sexual system in
particular   For, as  the  soul  animates the body, so by the interior
vital change, and new life and vigor of the ovaries, the lank and lean
awkward and   boyish form of the school-girl  is transformed into that 
OVULATION AND MENSTRUATION.
i I
full development of neck and  bust, that rounded contour of the  hips
and  loveliness of the features which the poet exalts as "beautiful
exceedingly."
  The period  of the accession of puberty varies, according to climate
and race and hereditery and social  circumstences, from the thirteenth
to the sixteenth year.  But if we teke the fourteenth year for the
average, as is  probably the case in this  country, half as many more
years must be  spent before the young woman's constitution and sexual
organization will have acquired its fullest development—that is, be-
come capable  of bearing the most  healthy children in the easiest and
most  healthy manner.  Some young women indeed arrive earlier at
their  highest maturity, as some also do at a still later  period ; but in
general the average age of the first ovulation being at fourteen, we
may assume the period of the most perfect and complete development
of this function to be at about the twenty-first year.
  Ovulation, or the functional  action of the ovaries, consists in the
maturation of the ova and in their extrusion through the ovarian sur-
faces.  This functional activity occurs in  the normal state at regularly
recurring periods, usually once in twenty-eight days.   And  in many
women this period returns with great exactness at the same day of the
week and even in some instances at the same time of the day.   This
increased activity of the ovaries is not far removed from a congestion
of these organs, and in many cases the  entire system sympathizes in
this disturbance of the ordinary sanguineous and nervous circulations.
The manner in which the process  of  ovulation takes place is so ad-
mirably described by Dal ton* that we quote it in full, and  copy the
accompanying very elegant illustrations.
  " In the earlier  periods of life, in man and the higher animals, the
egg is contained in a Graafian follicle which closely embraces its ex-
terior, and is  consequently hardly larger than  the  egg  itself.   As
puberty approaches, those follicles  which are situated  near the free
surface of the  ovary become enlarged by the accumulation of a color-
less, serous fluid in their cavity.   We then find  that the ovary, when
cut open, shows a considerable number of globular, transparent vesi-
cles, readily perceptible  by the eye, the  smaller  of which are deep-
seated, but which increase in size as they approach the free surface of
the organ.  These vesicles are the Graafian follicles, which, in conse-
quence of the  advancing maturity of the eggs  contained in them,
gradually enlarge as the period of generation approaches.
  " The Graafian follicle at this time consists of a closed g'obular sac
                         * Physiology, p. 567. 
72
OVULATION and menstruation.
or vesicle, the external wall of which, though quite  translucent, haa
a fibrous  texture under the microscope, and is well supplied with
blood-vessels.   This fibrous and vascular wall is distinguished  bv
the name of the ' membrane of the vesicle.'  It is not very firm in
texture, and if roughly handled is easily ruptured.
  " The membrane of the vesicle is lined  throughout by a thin layer
of minute granular cells, which form for it a kind of epithelium,
similar to the epithelium of the pleura, pericardium and other serous
membranes.   This  layer is termed the membrana granulosa.   It ad-
heres but slightly to the membrane of the vesicle, and  may easily be
detached by careless manipulation before the vesicle is  opened, being
then mingled, in the form of light flakes and shreds, with the serous
fluid contained in the vesicle.
  " At the most superficial part of the Graafian  follicle, or that which
is nearest the surface of the ovary, the membrana granulosa is thicker
than elsewhere.   Its cells are here accumulated in a kind of mound or
' heap/ which has received  the  name cumulus proligerus.  It is some-

                              Fig. 19.
           GRAAFIAN FOLLICLE NEAR THE PERIOD OF RUPTURE.
  a, membrane of the vesicle ; b, membrana granulosa ; c, cavity of follicle; d, egg;
e, peritoneum; /, tunica albuginea; gg, tissue of the ovary."

times called the discus proligerus, because the thickened mass, when
viewed from above,  has a  somewhat circular or disk-like form.   In
the centre of this thickened portion of the membrana granulosa  the
egg  is embedded.  It  is  accordingly always  situated  at  the most
superficial portion of the follicle, and advances in this way toward
the surface of  the ovary.
  " As the period approaches at which the egg is destined to be dis-
charged,  the Graafian  follicle becomes  more vascular, and enlarges
by an increased  exudation  of  serum into its cavity.   It then  begins
to project from  the  surface of the  ovary, still covered by the albu-
gineous tunic and the peritoneum.  The constant accumulation of 
ovulation and menstruation
ft.lid, however, in the follicle, exerts such  a  steady  and increasing
pressure  from within  outward, that the albugineous tunic and  the
peritoneum  successively  yield  before  it, until the Graafian follicle
protrudes from the ovary as a tense, rounded translucent vesicle, in
which the sense of fluctuation can  be readily perceived on applying
the fingers to its surface.   Finally,  the process  of effusion and disten-
sion still going on, the wall of the vesicle yields at its most prominent
portion, and the  contained fluid  is driven out  with a gush by the re-
action and elasticity of the neighboring ovarian tissues, carrying with
it the egg, still entangled in the cells of the proligerous disk."
              OVARY WITH GRAAFIAN FOLLICLE RUPTURED.
       At a, egg just discharged, with a portion of membrana granulosa.

  During the earlier  life of the female,  the  ova, or rather their
rudimentary  and incompletely-developed  germs, are  formed  in  the
ovaries.  But at the full constitutional and sexual development called
puberty,  with each return of the menstrual period, or ovarian nisus,
one, or more, of the  complete ovules bursts through the enveloping
membranes of each ovary in the manner just described, and is received
into the  upper portion of one of the oviducts, called  the Fallopian
tubes.  The fimbriated extremities of these tubes are applied to  the
ovaries—not, as is supposed by some, under the stimulus  of sexual
intercourse, but  under the wonderful  reflex influence of the process
of ovulation itself—by wliich these extremities are led to apply them-
selves firmly over the exact portion  of the ovaries from which  the
ova are about making their appearance.  This must  necessarily be  the
case, since the ova are conveyed to  the uterus  whether impregnated
or not.
  At each menstrual period, it is  believed  that at least one ovum is
transmitted through the Fallopian tubes, which  passes off and is lost.
A t the same time "uhose remaining in the ovaries  are a I vanced in their 
74
ovulation and menstruation.
development.  Of the particular manner and time of the transmission
of the impregnated ova we shall  speak in treating of  conception.
Suffice it  to say here, in general, that the ripening and discharge of
the ovum in menstruation is called ozstruation.
  Menstruation requires to be particularly studied in this connec-
tion, since it usually forms an important  attendant and  consequent
portion of the process of ovulation, although it is not always present,
even in apparently perfect health.
  Ovulation we have found  to consist in the maturation  of the ova,
and  in their extrusion from the ovaries.   By the Fallopian tubes
these ova are taken up and transmitted to the womb.   The uterus
becomes  then immediately and directly connected with the ovarian
nisus, and at the same time it partakes in a most remarkable manner
of the ovarian congestion.   In fact, all  the other parts of the gene-
rative  apparatus, the vagina and the external organs, and  even  the
entire  sanguineous  and  nervous  circulations, sympathize  in this
congestion and excitement;  although thus involving the  whole sys-
tem, the  menstrual  orgasm  is entirely  dependent upon the ovarian
nisus.  AVhere there are no  ovaries, there are neither sexual desires
nor  menstrual  periods.   In a remarkable  case, in which both ova-
ries  were extirpated in removing a painful tumor  from  each groin,
a woman who before had always menstruated with great regularity,
immediately  and permanently ceased to menstruate; while  in some
other cases in which the womb was either wanting  naturally or had
been removed on account of disease, the mammary development and
sexual desires remained unabated, and the menstrual discharges took
place from the vagina.  As  long  as the  ovaries  remain intact  the
woman is a  woman  still  in external form and inward  desires,
although, from absence of the uterus or vagina, she may be incapable
of conception or even of sexual  intercourse.   But let the ovaries be
removed,  and the woman loses at once all the distinguishing traits of
the female character; her breasts diminish in size, and she  becomes
masculine in  features, form and voice.
  Relation of Menstruation to Ovulation.—Thus  far we have shown
that menstruation is essentially dependent upon the functional action
of the ovaries; that it is not  an original action of the uterus, since it
always fails where the ovaries are  wanting, but does not necessarily
fail where the uterus is  absent;  and  that, although there can be no
menstruation except in connection with ovulation, there may be ovula-
tion without menstruation.  This latter fact may be, and probably is
in consequence of the menstrual fluid being  reabsorbed,  instead  of 
OVULATION AND MENSTRUATION.
75
passing off as ordinary ovulation occurs and the usual and consequent
congestion ensues, but for some occult cause the  fluid is again taken
up, and this without detriment to the general health.   Cases are re-
corded of women  who have conceived and borne children without
ever having menstruated.
  Let us now examine the physiological relation which menstruation
or the quasi function of the womb  bears to ovulation or the primary
function of the ovaries.
  The orgasm of the ovaries at the period of the maturation and ex-
trusion of the ova, and the  consequent congestion of the womb and
other dependent parts  of the  sexual  apparatus, have already been
described  as very intense and as  involving the entire system.  This
intense orgasm  having  accomplished its primary purpose in the ma-
turation and extrusion of the riper ova, and having at the same time
also advanced others to a proportionate degree of development, requires
a larger basis for its own critical  ultimation.   The intense congestion
of the  blood-vessels and the no less intense excitement of the nervous
centres must be  relieved, and this relief is obtained through the men-
strual discharge, wliich is simply the excessive  blood  congested in the
uterus and in its  mucous membrane, and which oozes from the free
surface of the membrane and  passes  down through the canal of the
cervix in greater or lesser quantities into the vagina, and finally through
the vulva.  And not only does the  congestion consequent upon ovula-
tion fill  the uterine vessels with blood in excess, but the  Fallopian
tubes likewise  partake of the orgasm, in consequence of which their
fimbriated extremities approach'and are  accurately applied over the
ovaries, upon that part of the ovarian surface from which the ripened
ovules are extruded, and thus receive  the ovules, which pass through
the Fallopian canals and are discharged into the  cavity of the uterus.
   The first menstruation usually takes place about the fourteenth year.
In some  individual cases it comes  earlier, and in others much later.
Delicate and luxurious habits of living, especially in large cities, tend
to render the menstrual  period earlier in its first occurrence, but less
constant and regular in its subsequent appearance.  Hereditery consti-
tution exerts a powerful influence in determining the time of the first
menstruation.   For, while  in Calcutta, India, the  native  females
usually begin to menstruate between the twelfth  and  thirteenth years,
the  children of  British  residents, although born in the city, average
about the sixteenth year. And different conditions in life, and  resi-
dence in  the country rather than in the city, exert an important influ-
ence in determining the period of first menstruation.  Thus,  in  Den- 
"6              OVULATION AND MENSTRUATION.

mark-, in the women  born in the country, the average period of first
menstruation will be found to be  at sixteen years and five months;
those  in the larger towns, fifteen  years and four months; those in
Copenhagen, the largest city, fifteen years and seven months.   So in
Russia, in fifty-three cases of the noble and rich the average was found
by De Boismont to be thirteen years and eight months.  In one hun-
dred and thirty-five women of the well-to-do classes the average was
fourteen years and five months.   And in one hundred and seventy-
one of the poor  the average was set down  at fourteen years and  ten
months.   In London, of sixty-seven women of the opulent class  the
average was thirteen years and about six months, while in seven hun-
dred  and seventy-five women of  the  well-to-do working class  the
average was fourteen years and four months.
  The cessation  of the  menses usually takes place between  the fortieth
and the fiftieth years, about forty-five being considered to be the aver-
age time of the change of life.   But this may and often does vary in
individual cases  to a considerable extent.   Some women cease to men-
struate soon after thirty, especially  those who began early, while others
have  borne children after they were  fifty years of age, and regularly
menstruated to  their sixty-second year.   Others again cease to men-
struate  at the  usual  period, but experience a return of the periodic
flow after some years.   In some instances  this protracted menstrua-
tion or return  of the flow may be  dependent upon ulceration or other
disease  of the  womb.   But in most cases late menstruation, especially
if unattended  with much suffering or other morbid symptoms, may
usually  be regarded as evidence of remarkable constitutional strength
and longevity; since, in general, life is longest  and the health most
assured  in those females who commence to  menstruate later, and who
continue in the exercise of this function later than the ordinary term.
[n many cases the cessation of the menses does not occur at once, but
is arrived at gradually through from one to three or even more years
of menstrual irregularities. And  the  cessation  may be by a gradual
diminution of the flow, by alternate copious and scanty menstruation,
or by changes in the character of the discharge itself.  The general
average duration of the function  of menstruation  may be stated at
about thirty-two years.
  Symptoms.—" The  menstrual  discharge consists  of an abundant
secretion of mucus mingled with  blood.   AVhen the expected  period
is about to come on, the  female  is affected  with a  certain  degree
of discomfort  and lassitude, and sense of  weight in the  pelvis  and
iiore or less disinclination to society."  In some instances these symp- 
OVULATION AND MENSTRUATION.               77
toms are but slightly pronounced, while in others they are more de-
cided.   If the individual be in a state of perfect general health, there
will  be, most likely,  no premonitory  symptoms whatever, and  but
slight derangement during  the continuance of the period; but when
the general organism is in an unsound condition, the premonitory and
the concurrent symptoms of menstruation  may be very severe, and to
these may be superadded the suffering arising from obstruction of the
canal of the uterine cervix or other abnormality of the uterus.
  "An unusual discharge of vaginal mucus then begins to take place,
which soon becomes yellowish or nearly brown in color, from the ad-
mixture of a certain  proportion of blood,  and by the second or third
day the discharge has the appearance of nearly pure blood.  The un-
pleasant sensations which were at  first manifested then  usually sub-
side, and the discharge, after continuing for a certain period, begins to
grow more scanty.  Its color changes from a pure red to a brownish
or rusty tinge, until  it finally disappears  altogether, and the female
returns to her ordinary condition."—DAlton.
  The original menstrual flux, as  it issues from the uterus, is nearly
pure blood; but in its passage through the vagina it becomes mingled
with  the  acid mucous  secretion  from the  vaginal  surface, which
changes its quality and appearance.  The menstrual discharge returns
with great regularity in perfectly healthy women, but varies in quan-
tity in different individuals, being quite free in some, and scanty in
others.  Each menstrual period  occupies from two or three to five or
six days, and the whole amount of the  flow may vary from three
ounces to eight, according to the temperament and idiosyncrasy of the
individual; some plethoric  persons  having a very scanty flow, while
in others, who seem to have no blood to spare,  the discharge  is much
more free;  and in some exceptional cases of persons apparently en-
joying  good health the catamenia may differ from the normal stand-
ard in every respect.  Those irregularities which are properly termed
morbid will be considered in a separate chapter.   During utero-gesta-
tion and lactation the menses are usually wanting; there are, however,
exceptions,  some women  menstruating with their  usual  regularity
while enceinte and while  nursing;  in many others the menses return
after the first few months of lactation.
  The causes of menstruation must be  identical with those of ovula-
tion, from  the intimate connection of these two functions, and from
the essential dependence of the former upon the latter.   The causes
of ovulation must be found in the  nerves which supply the  ovaries.
These  form part of the ganglionic system, and are immediately de- 
78              OVULATION AND  MENSTRUATION.

rived from the solar plexus, which is the great centre  of vegetative
life.
  All the actions of the human body may be considered as voluntary,
as involuntary, or as partaking of the nature of both these conditions.
Thus the  bodily actions may be distinctly referred either to the cere-
bral  or voluntary nervous system,  to the ganglionic or involuntary
nervous system, or to the spinal nervous centre, which is more or less
influenced and controlled  by each  of the others.  The involuntary
functions, with which alone we are at present concerned, may all be
classified as belonging either to the nutrition of the individual or to
the reproduction of the species.   Thus the ante-pubertal period is
almost exclusively devoted to the nutrition of the individual, but not
without reference to future reproduction, as is seen in the existence
and even extrusion of the premature ova during all this period.  Dur-
ing the child-bearing period the nutrition of the individual is rendered
unusually active and vigorous in order that it may subserve the repro-
duction of the species, and when both cannot  be at the same time
provided  for, it is the former which gives way to the latter.  This is
seen in cases of consumptive women who become enceinte; the child
flourishes at the expense of the mother and is born  comparatively
healthy, while the mother dies from inanition.
  Thus menstruation, as  dependent upon the action of the ovaries,
must find its immediate cause in the ganglionic nerves wliich supply
these organs.   And as  forming, with ovulation, one of the important
processes  preparatory to conception,  menstruation must find its final
cause in that grand function of reproduction of the species, to the per-
fect accomplishment of which all the energies of the individual  life
are devoted. 
 
  The above engraving, an improvement upon one found in the Anatomia of Thomas Bartholiniana
1G77, Plate 46, page 273, represents the union of the extremes of the sexes.
  The male, in all respects, is created for giving, even from his very inmost, the female, for receiving,
even into her inmost.  Hence the fecundating principle, secreted in the testicle from the bosom of
his blood is transmitted,—as shown by the dotted line,—to her ovary;  where it is  received into the
ovule, and becomes conjoined with that which is secreted from the bosom of her blood.  Thus the
extremes meet in the ovule, within the ovary; and the male and the female principles which are
immediately concerned in the first act of reproduction, thus conjointly united, become  at once and
forever a new creation, a new human being in embryo.

                 U.—The Uterus,
                 T.—The Testicle and Appendages.
                 O. O.—The  Ovaries.
                 L. L.—The Ovarian Ligaments.
                 V.—The Vagina.

  The dotted line represents the passage of the fecundating principle—not the visible material semen,
but the semen's invisible fecundating principle, on its way from the testicle, through the vagina,
uterine walls and ovarian ligaments, to the ovaries.  The material semen  is merely a vehicle  for
placing the electrifying life-force of the male within the reach of the ovule, by a continuous route. 
REPRODUCTION.
79
                       CHAPTER  VI.

                     REPRODUCTION.

    REPRODUCTION forms one of the three most general divisions
     of the  functions of organic life, nutrition and innervation con-
stituting the others.  It includes therefore the aggregate of the more
particular functions which concur  in  organized  beings for the repro-
duction of their kind.   Provision is made in the constitution of the
individuals of the human race, as in other orders of the animate crea-
tion, for the perpetuation of the species.   This is  effected  by means
of generation, which results from the union of the male  and  female
sexes.   The act by which this union  is effected  is termed copulation.
The two sexes are differently constituted in the various characteristics
of their mental  and  moral being, and this difference of interior con-
stitution becomes the foundation of corresponding differences  in ex-
ternal  form and in sexual  organization.   The respective mental and
moral characteristics of the male and of the female are so constituted
as to correspond to  each other, so that from the conjunction of man
with woman in the married state there results a perfect  union, a
complete man.  Apart, each represents an incomplete moiety—together,
they form a whole.  In  like manner, the sexual organs of the man
and of the woman  are adapted  to  each other, and through their
conjunction the spiritual and affectional  union of man with woman
is confirmed and consummated.  And through  this conjunction, in
the holy state of matrimony, is accomplished the procreation of off-
spring, the perpetuation of the race.
   In their mutual adaptation  to  each other,  in general and  in par-
ticular, the male is formed for  giving  and the female for  receiving.
Thus the  male and  the  female  are seen to correspond, to be adapted
and yet opposite to each other.   During the act  of copulation the
male deposits,  in the vagina of the female,  the semen from which
the fecundating principle arises; and  this principle, entering certain
ducts specially arranged for that purpose, passes up through the walls
of the uterus,  out through the ovarian ligament  to the ovary, and
there impregnates an ovule.
   In the plate  opposite this  page the fecundating  principle is repre-
sented as passing from the testicle  through the penis into the vagina,
and from thence upward  through the uterine  parietes and ovarian
ligaments to the ovary of either side. 
80
REPRODUCTION.
   It  will  here be observed  that  it  is claimed  that the vitalizing
principle of the male semen finds its way to the ovary of the female
through the uterine walls and ovarian ligaments—a route not generally
acknowledged as the true one by physiologists; and that impregnation
of the ovule occurs within the ovary,  which is a point yet in dispute,
and by no means  agreed  to  even by a majority of writers.   Having
prepared an article on the subject of  reproduction, as an elaboration
of views concisely set forth  in the first  edition of  this work,  and
which was published  in the Hahnemannian Monthly, December, 1868,
I  take  occasion to  transfer from that article such arguments as
were  in it adduced as evidence of the truth of both  of the  above
propositions:
   " Many years ago  Jean Bohn published a work on physiology, in
which he defended De Graaf.   He was  decidedly of opinion that the
aura  seminalis transmitted through the porous structure  of the  uterus
reached  the ovary  and fertilized the ovum, which  then descended
through the Fallopian tube.....
   " Another position assumed  by  De Graaf, which had been  main-
tained previously by Warton,  and afterward  supported by Haller
and almost all preceding physiologists, was  that impregnation  was
accomplished always in the ovaries.*
   " Under the head of  ' Impregnation of the Ovum while still  in the
Ovary,'  J. Miiller says:  'This is  the place of impregnation,  at all
events in man  and mammiferous animals.  In all  cases of  extra-
uterine pregnancy, in which the ovum is  developed in the  ovary
itself,  or escaping into the abdominal  cavity is developed there, it
cannot be doubted  that the ovum was in these instances impregnated
in the ovary.'f
  " A constriction (of a Fallopian tube) may prevent the arrival of
the fecundated ovule into the uterus, and may thus give rise to  a
pregnancy of the tube.!
  "Haller found  it possible  to produce artificially an  extra-uterine
gestation, by tying  the  corona of the womb of a mammalian animal
three  days after conception.   The result of this operation was that
two foetuses were discovered in  the  tube between  the uterus and
the ovary.§
  " Cazeaux, referring to the experiments of Nuck and Hoighton, and

     * Ritchie's Ovarian Physiology and Pathology, pp. 4, 97;  London, 1865.
     f Muller'a Elements of Physiology, London,  1842, Vol. II., p. 1491.
     X Scanzoni, Diseases of Females, New York, 1868, p. 370.
     \ Ritchie, Op. cit., p. 165. 
REPRODUCTION.
81
the later observations of Bischoff, says:  ' Such results evidently prove
that fecundation sometimes takes place in the ovary.' *
  "Ritchie—already quoted—mentions cases of ovarian pregnancy.
Mr. Stanley has published an account of a case of ovarian pregnancy
[British Med. Trans., Vol. VI., Art. 16]; and Dr. Granville a more
extraordinary example, the foetus being perfect and four months old
[Phil. Trans., 1820].  The celebrated Tyler Smith says:  ' Of the occa-
sional occurrence of ovarian  pregnancy, there can be no doubt.' .  .  .
In  the admitted cases the entire foetus has  been found within the
(ovarian) sac, or escaped from a perforation of the ovarian cyst.f
  "The instances adduced from these  authorities amply prove the
fact of the occasional occurrence of true  ovarian  conception.  Now,
while no  cases can be brought forward  to show that conception ever
occurs  in  any other place than in the ovary, I offer  the following
reasons, among  others,  for believing that it never does occur  any-
where else.
  " I.  Extra-uterine pregnancies, whether ovarian, tubal, or  inter-
stitial, all show that the ovule must have been impregnated within
the ovary,  but failed to  be  transmitted  by  the  Fallopian  tube to
the uterus.
  " II.  No  embryologist has ever yet found either the germinal spot
or  the germinal vesicle in an impregnated  ovule, even at  its first
entrance into the Fallopian tube.   Both must have been obliterated,
as the effects of impregnation, before leaving the ovary; while  its
gradual and progressive course  down  through  the tube is  always
marked by  a corresponding  development looking  toward the pro-
duction of a new human being.
  " III. The length of time occurring after  conception before the
ovule can be found in the uterus  becomes a  still  more .convincing
proof.   ' In the present record of  our  science/ says Cazeaux, ' there
is no one conclusive fact that proves the ovule to have ever  been
seen in the  womb  of a woman  prior to the  tenth or twelfth day
after her conception.'
  "IV. The preparation made in  the uterus itself, in  the shape  of
the decidua, for the reception of the  impregnated  ovule, becomes
additional proof when considered from the true physiological point
of view.  In accordance with the most  beautiful economy of nature,
this preparation commences  immediately  and only  upon the com-
pletion  of the  impregnation in conception, and occupies the  entire
time consumed  by the product of conception in  passing from the
  * Midwifery,  Philadelphia, 1857, p. 97.    f Lectures on Obstetrics, Am. ed., p. 343.
       6 
82
REPRODUCTION.
ovary to the uterus.  Thus the impregnated ovule is preparing for
the decidua, and  at the same time the decidua for the impregnated
ovule, each vital process being influenced by the other.
  "V.  It  is well  known  at the  present day  [see  Cazeaux, third
American edition, foot-note, p. 98] that the ovule which causes the
menstrual  flux  is never  impregnated.   After the cessation  of the
menses, at  any time prior to the succeeding nisus, impregnation of
an ovule now lying within  the stroma of the  ovary may be effected.
This is proven from the preparation made within the uterine cavity,
as stated in IV.  This preparation  could not be effected  otherwise
than by the evolution of  the  impregnated ovule.  The  attendant
physiological process proves the event, and the  whole is confirmed
when we consider the length of time  occupied by the ovule in passing
from the ovary to the uterus after effective coitus.
  " These considerations  will, perhaps, suffice to convince the  un-
biased mind that the ovary is the seat  of conception.
  " An answer is now demanded to the second question—viz.:  What
is the course of the fecundating principle in its passage to the ovary ?
  " I am aware that, according to the  opinion commonly entertained
and supported  by the greater weight of  authority, this  course is
through the Fallopian tubes.  But while the positive determination
of  this question is at once impossible, yet, as I have felt entirely
dissatisfied with  the solutions of the vexed question already offered
in obstetrical authorities,  I  have  been led to believe, as above stated,
that the fecundating principle passes through the walls of the uterus
and out through the ovarian ligament to  the ovary.   And if the fol-
lowing  reasons for this belief appear  less convincing to others than to
myself, it should be  remembered  that the  whole question  is still a
rinatter  of opinion rather than of  actual demonstration.
  " I.  In numerous cases  of extra-uterine pregnancy the  cause of
;the non-transmission of the impregnated ovule  into the uterus has
,been found to be an  imperforate  condition of the  Fallopian tubes.
In these cases there could  be discovered no sign of  an opening ever
having  existed through which the semen might  have passed to the
.©vary.  The only natural  channel which  otherwise  appears  is  that
through the ovarian ligament.
  "II.  Normal uterine pregnancies have been found where the 03
uteri was  entirely wanting,* and where not the slightest  trace of its
•ever having existed could be detected.  In these  instances,  as well as
  * The records of  obstetric science furnish several cases  of complete absence or
occlusion .of (the .os .(congenital).   The  following paragraph, from a source rredil/ 
REPRODUCTION.
83
in those of an imperforate condition of the tubes, the semen certeinly
could not pass  up to impregnate the  ovum through the Fallopian
tubes.
  " III. This modified doctrine of absorption is descriptive of the most
simple process  that nature could adopt for conveying the fecundating
principle to the ovary; and while it is true that the assertion that the
fecundating principle is  conveyed  "through the  walls of the uterus
and out through the  ovarian ligament to  the ovary' is not predicated
upon any anatomical discoveries  of  ducts or passages that have been
made in the human uterus, such  ducts or passages—being  smaller
than the smallest capillaries—are probably quite  invisible.
   " IV. The correspondence of the general affection of the whole fe-
male organism to that of the male requires that, even as the fecundating
principle is given from the inmost of the  male, so it shall be received
into the inmost of the female, even into the ovaries, and there perform
its vitalizing function.  And  here I wish to remark, that while it is
admitted that the actual  reception of some portion of the semen into
the ovule is necessary in order to impregnate it, still  this portion need
be no more than the minutest particle,  which  in  organized bodies
corresponds to the elementary or primary  atom of the inorganic world ;
and that, in addition to this, the old  doctrine of the universal  im-
pregnation  of the blood of the  female by means of the  seminal aura
of the male seems to be confirmed  rather than refuted by the later
discoveries  of  modern physiological science.  The  entire system  of
the female  is influenced most powerfully, and in a direction highly
favorable to reproduction, both by  the  general  magnetic sphere  of
the male, and  by that richly-endowed  secretion which is given off as
the representative of his  energetic vitality.
   " V.  It is to be remembered that the  ovaries are encompassed  by,
first, the serous peritoneum, and secondly, by the  tunica albuginea, a
highly-organized  and  dense  fibrous tissue,  impervious in a much
greater degree  than the comparatively porous  textures of the uterine

accessible to all [Churchill, Theory and Practice of Midwifery, Philadelphia,  1851,
p. 256], places beyond cavil the existence of such instances.
  " Lastly, a  few cases are on record  of total absence of the os uteri, as  in a case
which came under the care of my friend, Dr. Ashwell, and which he has  described
in Guy's Hospital Reports: 'it was found necessary to make  an artificial opening
with the knife; the labor terminated favorably.'
  A single well-authenticated instance of pregnancy occurring with  an  absent or
occluded os entirely uproots the theory of the passage of  the semen to the ovary
via the Fallopian tube. 
84
REPRODUCTION.
walls and the ovarian  ligaments.  Thus, though it may be true, as is
claimed, that sjiermatozoa have  been observed on  the ovary, it does
not follow that impregnation of the contained ovule is effected through
the passage of these spermatozoa through the Fallopian tube.  The
ovules are within the ovary, at one end of an uninterrupted porous chain,
and it is reasonable to  argue that the vivifying principle is conducted
to the ovule by that way.
   " Again, it is to be remembered that the Fallopian tubes (oviducts),
being lined by ciliated epithelium, have the cilia? in a direction to aid
movement from the ovary and toward the uterus, and to retard move-
ment in the opposite direction."
   The  semen of  the  male is  principally and in the first instance
secreted by the testes.   In its passage  it is commingled with the
secretions of the corpus Highmorianum, the epididymis and vasa def-
erentia.  To this  are  superadded the secretions  of the prostate, of
Cowper's glands and of the vesiculse seminales. The latter additions
appear to protect, and perhaps modify, the original product of the testes.
.In its mature condition,  semen principally consists of an extremely
small quantity of a viscid  fluid,  and of innumerable minute linear
corpuscles  having a peculiar movement, which are  termed the sper-
matic filaments, or spermatozoa.   As the semen  is  found in the vas
deferens—that is, before admixture with the secretions of the above-
mentioned glands and follicles, which give it its peculiar odor—it is
whitish, viscid and inodorous,- and  consists almost entirely of sper-
matozoa and connective fluid.   In the pure semen these spermatozoa
exhibit no movements, or scarcely any  when  it  is  concentrated.   A
peculiar lashing motion of the tail  of the spermatozoa is  visible  in
the semen found  in the vesiculae seminales.   But these  bodies, once
deemed essential to the procreative  function  of semen, are now be-
lieved to be the products of the formative action of the  organs  in
which they are  found, and cannot therefore  be ranked in the same
category with animalcules.
   The semen, as finally imparted to the female in  copulation, consists,
then, of three distinct portions: first, the original vital  secretion  of
the  superior  portion of the testes;  secondly, of  the delicate  fluids
which are  associated with this secretion  as it passes through the sec-
ondary structures  of the epididymis and vasa deferentia; and thirdly,
of the  more voluminous  mucous  secretions of the subsequent glands
and  follicles, which  envelop  the whole as  with a natural  body.
These  three diverse and  yet harmonizing elements are essential to 
REPRODUCTION.
85
the healthy condition of the  semen; for neither the spermatozoa nor
the delicate secretions of the vas deferens, nor the grosser products
of the various glands, can accomplish fecundation of the ovum sepa-
rately.  Nor is it to be regarded that the semen, viewed according to
its physical qualities or chemical constituents as a liquor seminis, can,
as such, effect fecundation and the primitive organization of a distinct
and vitalized being.  But it  is upon the vital essence  or spirit, so to
speak, of the semen that its power to impart life depends.  The gross
liquor carries with it a part of the  essential life of its  giver, which,
meeting a  similar vital essence of the female  organism in the ovum
of the ovary, the conjunction of these two vital essences or principles
is the process  of fecundation by and  through which  a new being
results which partakes of the life  of the man and woman, and which
is in that instant made a living soul.
   The three constituent  elements of the semen  correspond to  the
body, soul  and spirit.  Within the inmost of each seminal  nucleus
is contained  the  very highest soul and  life  of the parent; the deli-
cate fluids  which immediately surround it are inspired by the animal,
spirits, while the more gross and  exterior mucous  envelopments cor-
respond to  the animal body.
   This organization of the seminal globule, which makes it correspond
to a representative of the body, soul and spirit of  the  parent, finds in
the female ova a corresponding threefold organization, equally repre-
sentative of  the  female constitution.   And the semen of the male
therefore unites and  combines with the ovum  of the  female, in each
one of these three constituent and  representative  forms, in more or
less perfect harmony, according to the more or less perfect adaptability
of the male parent to the female.   And as in the mingling of different
races  the stronger takes the  lead  and  predominates in the  offspring,
so in  the union of the seed of the different  individuals, the stronger
predominates in  the  moral,  mental and physical  characteristics  im-
pressed  upon the child.   Thus as the lower, more gross and material
portion  of  the male semen meets its counterpart in the grosser organi-
zation of the ovum, with which  it unites and  which it vitalizes with
its degree  of life, so each of the other constituent forms of the semen
necessarily unite with and  inspire  the corresponding, representative
organization  of the  ovum.   The  ovum then receives, cherishes and
nourishes the vitality imparted to it by the male semen, and the living
form  which is the result of  such reception partakes of the qualities
of the ovum on the one part and of the semen on the other, even as
these  are but faithful representatives of the various qualities,  whether 
86
REPRODUCTION.
orderly or disorderly, of the male and female individuals from which
they spiing.
  And even as it was stated in general at the beginning of this chap-
ter, that  all the sexual organs of the male were for giving and all
those of  the female were for receiving,  so here now it is particularly
seen how the  female ovum becomes receptive of the semen of the
male.  And at the moment of this vital reception the  entire female
organism feels its influence, and prepares forthwith to provide for the
protection, sustenance, growth and development of the  new creation.
This impregnation and fecundation of the ovum is called Conception.
And this product of conception usually remains  quiet within the
ovary for about the space of five days.  During this time the first
initial  stages of subtle and  mysterious  vital organization and growth
are taking place—processes too minutely recondite for successful ex-
ploration by the eye of man.  Wonderful arcana of nature!  in which,
after all  our profoundest scrutiny  into the mystery of life,  we can
discern only the means and the ends, but not the  manner.   We see
the minute representative  forms of two lives combined to produce
a third, in which shall appear, during all the possible threescore years
and ten of its subsequent life,  the general characteristics of the human
race as distinguished from those of other forms of animate nature; the
general characteristics of  the  nation or tribe to which its progenitors
belong;  the characteristics of the family as distinguished  from those
of other families in the vicinity; and lastly the personal peculiarities
of each of the immediate parents,—all of which are impressed upon
the embryonic germ, grow with its growth  and strengthen with its
strength.
   During this  time, in which the fecundated ovum remains quiet in
the ovary, the  interior surface of the uterus is being prepared for its
reception.   Under the influence of the  impetus imparted to the entire
system by this  event of conception,  the mucous  lining membrane of
the uterus  becomes deeply congested,  as  in spontaneous ovulation.
This  congested uterine condition is due to the natural evolution of
the fecundated  ovule, and  while the  physio-pathological congestive
condition is similar to that occurring with spontaneous  ovulation, yet
a different evolvement is  now to be effected, and, instead of the con-
gestion being relieved or carried off in the form of a menstrual flux,
the decidua is  formed as a step in  the process of prospective utero-
gestetion.  Very rarely indeed does the congestion after fecundation
result in the discharge of the  menstrual blood.
   Thus, by the time the fecundated  ovum bursts through its original 
REPRODUCTION,
87
seat in  the ovary and reaches the uterus, it finds prepared for it  a
thick, rich, soft, vascular and velvety lining, quite different from that
which  is  to  be found  in the unimpregnated  uterus.  This  hyper-
trophied development of the mucous coat of the uterus  forms a sort
of bed, into  which the impregnated ovule is  received  immediately
upon its escape from the Fallopian tube.   This, which is the original
mucous lining membrane of the uterus, forms what is termed  the
decidua vera,  while  the subsequent  extension  of the same growth,
which  completely envelopes the ovum, is called  the  decidua refiexa.
The decidua thus constituted and developed form a  sort of nidus or
nutritious nest, in which the villi of the ovum teke root, and from
which  the development of the ovum  itself, already  quite advanced,
now progresses still more rapidly.
  Here, then, will appear the contrast between spontaneous ovulation
and  that which  occurs  in  connection with impregnation.  In  the
former instance the disengaged ovum passes from the ovary through
the Fallopian tube,  only to be swept  away by the menstrual flood,
which  forms  the crisis of  the menstrual  molimen.   In the latter
instance the fecundated ovum, reposing for a few days in its original
bed  in  the ovary, emerges at length  from the ovary, and passes  into
the uterus, to find, as the result of the uterine congestion attendant
upon its fecundation, the beautiful provision already described for its
reception under the  name of decidua vera.  Under the influence of
this  same congestion the Fallopian tubes become erect, and fix their
fimbriated extremities upon the  exact portion of the ovaries from
which the ova are about to issue.   The stimulus which arouses these
tubes to their almost instinctive action  is  to  be found  not  in  the
orgasm  of copulation, as is alleged by many authors, but in  the
reflex action of the emergence and escape of the ovum  itself.   The
same reflex action of the first birth of the ovum, of its escape from
the ovary, causes  the exact and timely application of the  fimbria? of
die Fallopian tubes  to  the ovaries;  and in the case of  spontaneous
ovulation results  only in the critical discharge of the menses, which
relieves the uterine  congestion;  while in  the case  of impregnated
ovulation, conception,  it ultimates  itself in  that congestion of  the
mucous membrane of the uterus  which forms the alma mater of  the
descending ovum.
  Hitherto we have attempted to explain the nature of generation, or
the reproduction of the species; the nature of the semen of the male
and  of  the ova of the female; their  representative  character;   the
mode of their union in  copulation; the results  of that union in con- 
88                       REPRODUCTION.
ception; and the natural history of the product of conception from
its  first development and  brief stay in the ovary to its arrival at its
more permanent but still temporary resting-place in the uterus.  There
will be seen an analogy between the repose and primary growth of
the impregnated ovum in the ovary and its much longer residence
and final development in  the uterus.   The  first is the era of concep-
tion, the latter is the period of gestation or utero-gestation, to which
we  now invite your attention.
  Gestation, the act of bearing the  product of conception, strictly
speaking, begins at the moment of conception.  As already explained,
during a very small portion of this period the  fecundated  ovum is
still retained within the ovary.  But  after a few days consumed in
the vital organization of the ovum  itself and in preparing the  uterus
for  its reception, the ovum usually descends into the uterus  through
the Fallopian tube of that side. From this moment the general term
gestation is replaced  by  the more  particular  one of utero-gestation.
The cases of the so-called  extra-uterine pregnancy  occur from the
failure of the impregnated  ova to  be properly transmitted  through
the Fallopian tubes to the  uterus.  In  such cases  the  ovum may
increase in size and development,  being nourished  in a  manner to
be  subsequently described, wherever  it  may finally  be deposited,
whether  in  the Fallopian tube, in the adjacent folds of the peri-
toneum, or even in  the ovary itself.
  The more general  term of gestation  will, however, continue to be
used here, since it  is more  convenient, and  more applicable in some
respects,  such as in speaking of its period, which,  reckoning from
its  commencement at the  moment of conception to its close at partu-
rition, is two hundred  and seventy days, or  nine  solar monilis.  This
period is, however, by no means  invariable.  For, not to speak in
this place of those abortions, miscarriages  and premature deliveries
which are the results of accident or of disease more or less palpably
developed,  there are many  instances recorded of persons who from
some individual peculiarity  have much prolonged this period; while
in other instances there seems to have been a disposition to shorten
it, independent of any apparent morbid condition.  Generally speak-
ing, the shorter the period of gestation the less viability has the child
after birth.
  As already explained,  conception always takes place within the
ovary; and where  the embryo, the product of conception, descends
regularly into the uterus  and  there becomes developed, it constitutes
what is termed  a good, normal or  uterine pregnancy.  But  when  it 
reproduction.
89
does not thus  descend  and become developed  in the womb, if it
remain and is developed in the ovary, if it fall into the cavity of the
peritoneum, stop in  the  Fallopian  tube, or become engaged  in  the
substance of the womb  itself, it forms  a bad, extraordinary or extra-
uterine pregnancy.
  Uterine Pregnancy may be simple when the uterus contains but
a single ovum; double, triple, quadruple or compound, according as
there are two, three, four or more foetuses;  and complicated where, in
addition to the foetus, there is also found  a tumor, polypus, dropsy or
other pathological formation in the abdomen.
  Extra-Uterine  Pregnancy may  consist of one or the other of
the four following varieties, according  to the location  of the fecun-
dated ovum:  1.  Ovarian,  where the ovum continues its growth in
the ovary itself;  2. Peritoneal, where the ovum fails to be received
by  the fimbria of the Fallopian tube, and thus becomes  lodged in
the folds of the surrounding peritoneum; 3.  Tubal, where the ovum
is arrested in its passage through  the Fallopian tube, and is there
developed; 4.  Interstitial, where the  ovum penetrates the parietes
of the uterus  instead of attaching  itself to its interior surface.  In
either of these varieties extra-uterine pregnancy must sooner or later
terminate disastrously, unless relieved  by the Csesarean section, since
normal parturition is impossible, except perhaps in the last.
  What, by some authors, is termed false pregnancy,  consists in an
enlargement of the abdomen from the  presence of hydatids or other
tumors, when  in reality no living foetus is present.
  Simple  Uterine Pregnancy.—Upon  the  occurrence  of preg-
nancy we have to do with two different living beings, which although
still united, the one within the other, present two different subjects
for our consideration and two different classes of phenomena for  our
study.  The woman, the prospective mother, represents one of these,
and the embryo, the future child, represents the other.   We will  first
study the influence of pregnancy upon the  woman, and observe the
various changes which  it introduces into the entire economy.  The
manner in which the  anatomical structure,  the  physiological func-
tions and  the intellectual  and  moral  states  and  sensibilities  are
affected  by this new  condition of pregnancy  must be  carefully
explained.   This account of the natural history  of  pregnancy  will
be  succeeded, in a subsequent chapter, by a description of the  dis-
orders incident to pregnancy, and a detail  of tl e principal remedies
required for their successful treatment. 
90
pregnancy.
                      CHAPTER  VIL
                         PREGNANCY.
          Physiological and Anatomical Changes.
     WHEN fecundation follows copulation, the congestion and  tumes-
      cence of the uterus and Fallopian tubes become continuous, and
numerous physiological and anatomical changes are esteblished.  Some of
these are local, some more general; some are transient, while others en-
dure throughout the whole period of gestation; some affect the physical
economy only, others in a remarkable degree disturb the mental states
and moral sensibilities; and finally,  some of these changes are purely
healthy and normal.  These we shall consider in the present chapter,
while others, being accidental morbid conditions, or the developments
of inherent morbid  predispositions, will be subsequently described.
  The Uterus becomes the seat of the most  remarkable and first
apparent of these changes, in which both the cervix and fundus par-
take.  Those which occur in  the neck are  separate from, although
simultaneous with,  those  occurring in  the  body;  the  former also
resulting from the latter.   Thus, the cervix softens and enlarges from
below  upward, as the body softens  and enlarges from above down-
ward, during almost the entire period of pregnancy.   And the altera-
tions affect  this organ in every respect—principally in  its  volume,
form, situation, structure  and functions.  Let us first examine  the
changes in the body  of the uterus.
  As explained in a previous chapter, the congestion attendant upon
a menstrual crisis  produces a  temporary increase in  the  uterine
parietes.  A similar and more permanent result attends fecundation;
the congestion attendant on the evolution of  the  ovum in that case  is
in some measure  perpetuated, and a permanently hypertrophied con-
dition of the uterine walls becomes esteblished.
  Volume, Size.—The mucous lining membrane becomes congested
and almost double in thickness;  and in consequence of this develop-
ment of its vessels, as described by Cazeaux, and  especially of the
minute glands of which it is partly  composed, it has  its thickness so
much increased in proportion to the size of the uterine cavity as to
be thrown, in a great many subjects, into soft, projecting  folds or cir-
cumvolutions, which are so  pressed together as  to  leave no vacant
place in the cavity of the uterus.  This, as will  be  subsequently ex-
plained, constitutes  the decidua or enveloping membrane into which
the  fecundated  ovule  is received upon  its entrance  into the uterus 
PREGNANCY.
91
from  the  Fallopian tube of the  side corresponding  to  that of  its
ovarian birthplace.
  Immediately upon its reception of the embryo, the uterus com-
mences to increase in size—not uniformly, but in a ratio proportioned
to the larger development of the foetus—that is, the larger the foetus
the more rapid the enlargement of the uterus.   This growth of the
uterus takes  place  in every direction, and is not a  mere mechan-
ical distension, as if arising from the outward  pressure of the in-
creasing ovum, but it is proved  to  be a true physiological develop-
ment, in which both ovum and uterus partake simultaneously and in
unison.
  Form.—The uterus, instead of remaining flattened on its two sur-
faces, becomes rounded and then  pyriform in the earlier stages  of
pregnancy, while in the later  months  it  becomes spheroidal, and
finally assumes the  form of an ovoid which is slightly flattened from
before backward, and has its point looking downward.  " Of dimen-
sions  nearly equal in every direction, about the fifth or sixth month
the uterus exhibits the figure of  a  spheroidal vase terminated  by a
very short neck; it might be compared to a hog's  bladder, with the
urethral extremity surrounded with threajd for an inch or two;  sup-
posing some one  should unwind  the thread by degrees, from above
downward, while another  blows into the bladder  from the fundus, so
as to distend it, we  should acquire a pretty clear  idea of the gradual
effacement of the cervix of the womb."—Velpeau.
  In the latter months of utero-gestation the shape of the  uterus is
modified by the exact relative position of the foetus.   That side of the
fundus which is occupied by one of its extremities is sometimes more,
elevated than the other.   And  since in the most  usual presentations
the trunk of the foetus is found to incline to the  right side, this por-
tion of  the fundus of the womb will often be found most  elevated.
These general statements as to the  shape of  the gravid  uterus are,
however, liable to exceptions, which  may arise from  the  number of
the foetuses, or from the varieties in the original  shape of the uterus
itself.
  In its situation  the  gravid uterus is subject to  important changes.
These changes arise in the first instance from the change in size of the
organ itself.   Remaining in the  pelvic cavity during the first three
months  of gestation, the uterus sometimes becomes at first slightly
depressed, so that its cervix  approaches nearer to  the vulva.  This is
especially the case in those  in whom the  pelvis is  large.   Still, this
depression of the uterus, when it does occur, is but temporary, and at 
92
PREGNANCY.
three months the position is in all respects almost exactly the same aa
before impregnation.
  From the third and a half to the fourth month, the uterus, finding
itself more and more incommoded as it increases in size, gradually
forces itself upward from the excavation of the pelvis, rises above the
superior strait, then to  the level of the  umbilicus, and toward  the
close of pregnancy it reaches the epigastric region.   But during the
last two weeks of gestation the uterus commences to sink down some-
what;  and this,  which  is regarded as one  of the earliest signs  of
approaching  parturition, is  in fact almost the commencement of this
process, since in most instances it results from the approximation of
the foetal head toward the cavity  of the pelvis, and in some cases from
its actual entrance into the cavity itself.
  Direction.—The changes in the direction of the womb in pregnancy
are no less remarkable than those of size and form.   While still re-
maining within the pelvic cavity, the uterus, from the greater weight
of the posterior portion of the fundus or upper portion, inclines back-
ward, as in partial retroversion, and the os uteri looks forward  toward
the pubic  arch.   But this is not  always the case in the earlier or first
three months of  gestation. #In many such cases the  fundus will  be
found  inclining  forward  more in its natural  position,  while  the  os
tincse will be reached' only  by the farthest  extension  of the finger
toward the hollow of the sacrum.
  As the  uterus in the fourth and fifth months rises above the level
of the superior  strait, two remarkable directions are  assumed and
maintained,  usually till  the close of gestation.   These  are—the in-
clination  forward, as if leaning over the arch of the pubes, and the
inclination to one side, usually the right  side.  The  forward inclina-
tion of the gravid uterus is the necessary result of the hard, unyield-
ing  nature  of the  lumbar  vertebrae  behind, and of the less rigid
structure of the abdominal parietes in front, in combination with the
constant pressure from above of the contents of the abdomen itself.
The line of motion which alone is possible for the gravid uterus on
emerging  from the pelvic cavity  being  the axis of the superior strait,
as guided by the projecting promontory of the sacrum, will even from
the  first have given it a decided  inclination forward.   The lateral
inclination to one side or the other is the necessary result of the pro-
 jecting ridge of the lumbar vertebra?, as it  would be little less than
impossible to  balance the  uterus  on this high-raised  median  line.
The proportion of cases in which the uterus is found  inclining to the
right side is stated by various authorities to be as  high as eight out 
PREGNANCY.
93
of ten.  But there is less unanimity of opinion as to the causes wliich
produce such a result.  Among the various causes proposed to account
for  this  general  tendency, no one seems entirely sufficient, nor do
many of them unite with any degree of constancy in a given number
of cases.  Thus,  if the inclination  is to  be  attributed to the greater
weight from the  attachment of the placenta, it is found  that the
placenta is far from being always on the side toward which the uterus
is inclined.  The same is true of the relation of the colon loaded with
fecal matter—of the position of the female while at rest on the right
or left side.   For the present, the most plausible  opinion  appears to
be that of Madame Boivin—that the round ligament of the right side
is shorter, stronger and contains more muscular fibres than  that of the
left, and that to the more powerful action of this ligament is to be
attributed the usual  inclination of the uterus to the right side.   Still,
there  is no doubt that the more active physiological influences do much
to determine this  matter of the lateral inclination of the gravid uterus;
and in confirmation of what is here implied  it may be sufficient  to
state  that, according to  the observations  of some authors, the uterus
inclines to the left  in women who are left-handed.
  The thickness and density  of the uterine parietes form  two of the
most  remarkable  changes of  pregnancy.   The  non-gravid  uterus has
already been described as having very thick walls.  After fecundation
these  walls maintain usually the same relative  thickness, although, as
the uterus itself  increases in size, its parietes become less  dense, and
instead  of being hard  and fibrous, are said by Cazeaux  to have a
clammy  softness  closely resembling that of caoutchouc softened by
ebullition, or that of an cedematous limb.   " It is  now known that
the womb preserves nearly  the same  thickness  during  the  whole
course of pregnancy as it had when unimpregnated.  This  thickness,
which is greater at the insertion of  the placenta, generally  diminishes
from  the fundus toward  the cervix, where it  is  frequently found to be
not more than two or three lines or even  less.  It increases a little in
all  parts  of the  organ at the same time, until the third or  fourth
month, and then  remains rather  below its primitive  limits, to exceed
them  again in the last stages of pregnancy, except the cervix, which
at that period especially grows thinner."
  Structure.—The immense enlargement  of  the womb, from its non-
gravid size up to that capable of enclosing one foetus or even more at
full term, can only be the result of a very great increase in its entire
mass.  But this great development  in substance—in which  the weight
of the uterus comes to be reckoned  by pounds instead of by ounces— 
94
PREGNANCY.
is accompanied with  a corresponding  development  of its  proper
organization.  In  its non-gravid condition  the uterus  exhibits only
the type of the wonderful development which it acquires in pregnancy,
and which is essential  to the proper performance of the important
functions  with which it then becomes  charged.   "Its fibres,  which
were pale, dense and inextricably tangled, soften, become redder and
soon represent layers and bundles easy to detect and to follow.   The
cellular tissue, which was before so firm, dense and elastic, relaxes,
becomes supple, and indeed resembles the common cellular tissue, and
in this way permits the  other elements which it held in bondage, as it
were, to follow the impulse that animates the whole womb.   The
arterial branches, folded upon each other like the vas deferens, and
bridled in this condition by dense elastic laminse, yield to the general
relaxation, and gradually become lengthened; their angles, at first so
sharp, with their doublings, grow blunter, enlarge, and at last exhibit
only certain zigzags of greater or less depth—tortuosities which do not
impede the circulation.
   " The veins undergo the same metamorphosis : already in the natural
state larger  and less tortuous, they are enlarged and developed  still
more rapidly than  the arteries;  afterward they are  observed to furrow
the fleshy layer in every direction,  and form a  network which in
some measure separates it into two planes.  They are  large enough
to admit  a goose-quill, and  in some instances the end of the little
finger;  near  the  mucous membrane they dilate  so as to constitute
cones with inverted bases, which were first termed  uterine sinuses, but
which are now called venous sinuses."—Velpeau.
   The lymphatic vessels and the nerves are also  enlarged in a cor-
responding manner in pregnancy.  The great change in the texture
of the mucous lining membrane of the uterus has already been re-
ferred  to  in describing  the formation of the decidua.  All the com-
ponent  tissues of the body  of  the uterus receive  accessions  both in
structure,  size and  physiological activity, to correspond with the new
and most important  functions which this organ  is  called upon to
discharge  in pregnancy and gestation.
   The Cervix Uteri is also subject to certain changes during the
period of  gestation.  These  occur simultaneously with those already
described  as  affecting the body of the womb,  and  are the results of
the physiological action by which the entire uterus becomes  adapted
to its new functions.  In the consistence of its tissue, 'n its volume,
form, situation and direction, the cervix uteri  becomes  changed in a
remarkable manner; and these changes, so far as they are appreciable 
pregnancy.                        95
afford valuable indications for determining the fact and the stage of
pregnancy.
  Softening of the tissue constitutes the principal modification of the
actual structure of the cervix uteri.  The change from a firm, fibrous
structure to that of a soft, fungus-like substence begins at the lower
border of the  interior surface of the os tincse in the first month of
pregnancy, and increases from within outward, and from below up-
ward, till at the sixth month this softening embraces the whole thick-
ness of the lips of the os tinea? and the lower half of the sub-vaginal
portion of the cervix.  This softening of the tissue is always  from
below upward, and proceeds also pari passu with the development of
the fundus.  And so exactly is  this proportion maintained that an
experienced examiner can always determine with very great accuracy
the advancement of the pregnancy by noting the extent of this upward
softening in the cervix uteri.  It must  be  borne in mind, however,
that in those who have had several  children the sub-vaginal portion
of the neck of the  uterus  loses a considerable portion of its length;
otherwise the  briefer extent of the softening in such cases  might mis-
lead the examiner to conclude that the pregnancy was less far advanced
than it really was.  So  also in  cases of first pregnancy, since  this
softening of the cervix uteri is less strongly marked and  more slow
in its development,  and therefore  more  difficult of detection, these
circumstances  should always be  taken into consideration in forming
a conclusion in such cases.
  The increase in volume of the cervix  uteri goes on in  equal  ratio
with the decrease in the density of its substance.   But the cervix
does not shorten:  the description given from Velpeau, on a previous
page, of the development of the  fundus at the expense of the cervix,
is applicable only to the  last  fortnight of utero-gestation.  On the
contrary, the length of the cervix may begin to increase a little after
the commencement of the  fifth  month; and this elongation, which
previously had been rather apparent than real, is continued till the
final absorption of the cervix itself in the fortnight  immediately pre-
ceding parturition.   At this period the whole neck, having become
softened  and  thickened, becomes more  easily distensible, and the
development of the body of the  uterus from above  downward meets
the softening  and development of the neck from  below upward at
this juncture,  which is at  the  os internum,  and the complete fusion
of the fundus with the cervix takes place, and the cavity of the womb
is one from the fundus  to the os tinese or os externum.  This fusion
causes  the  sinking down of the fundus from  the pit of the stomach 
96
PREGNANCY.
so often  observed in the last weeks of gestation;  the fundus must
sink as the walls and lower segment of the uterus  are expanded.
And upon the occurrence of this depression the female breathes freer
and feels better in all respects.
  The form of the cervix uteri differs in the  multiparas from what is
observed in the  primipara?;  this difference is principally to be noted
in the varying size and shape of the os tinea? and of the cavity of the
cervix itself.  In the  primiparse the os tincae changes from a simple
transverse  fissure  to a circular  depression.   The cavity, from  being
conical, becomes  spindle-shaped, and the softening  of the externally
constricted os will not allow the finger  to penetrate  into the cavity.
The os tinea? never having been ruptured by parturition, its mucous
lining membrane rounds it off very nicely, and  none  of the  in-
equalities, fissures or puckerings so common  in the  multipara? are to
be found here.
  A section showing the neck of the uterus;, the anterior and posterior lips are seen
in situ, being separated from each other by the fusiform cavity in the neck.

  In the multipara? the numerous cicatrices and indentations render
the os tinea? more originally patulous;  and the most noticeable effect
of the pregnancy upon the  orifice in such cases is to cause  it to be
more easily dilatable.  And as the  gestation  progresses  this dilata-
bility of the os tinea? becomes an  actual spreading out of the inferior
portion of the cervix, until it reaches  the middle part of the cervix
uteri about the  seventh month, and  nearly gains the internal orifice
by  the  ninth  month.   The  cavity of  the cervix goes on enlarging
simultaneously with the softening of its walls  and the  advance of
pregnancy, and  the  opening and  cavity  become  thimble-shaped,
admitting  the finger  farther and farther into  it as the pregnancy
advances.
  The gradual  change in the opening  of the os  tincse and dilatation
of the cavity  of the cervix  may  be seen in the accompanying  cuts
upon the next page.   In the  preceding account of the changes in
the neck of the uterus incidental to pregnancy we  have principally 
PREGNANCY.
97
followed the very excellent  and  in  some  respects entirely original
account given by Cazeaux;  and for the following summary of these
changes we are indebted to the same author.
  Summary.—From the statements made in the preceding sections
we may draw the following conclusions :
  I. The tissue of the neck begins to soften at the very commence-
ment of pregnancy, and the  softening, although not very apjparent in
the early months, and limited  to the  most inferior part,  gradually
ascends, so as to invade successively the whole  neck from below up-
ward, though it is much less marked and  less rapid  in its progress
in primipara? than in other women.
  II. The cavity of the neck dilates simultaneously with the soften-
ing of its walls;  and, further, this enlargement  causes it to be spin-
dle-shaped  in  primiparse, and  in women  who have already borne
children to resemble a thimble, the finger of a glove, or a funnel with
its base below.
  III.  The external orifice remains either closed, or else very slightly
open, in primiparse up  to  the  very term of  pregnancy,  whilst  in
others it is widely open, and constitutes the base of the funnel.
  IV.  The whole length  of  the neck disappears in the last fortnight,
being lost in the cavity of the body.
  V. Contrary to the opinions  hitherto generally adopted, the neck
preserves its whole length until the last fortnight;  it does not shorten
from above downward during the last four  months, but the fusion  of
the neck with the body takes place only within the last few weeks  of
gestation.

           Fig. 22.            Fig. 23.               Fig. 24-
  These three figures give an idea of the gradual dilatation which the cavity of the
neck undergoes at various periods of pregnancy.

  This final fusion of the cervix with the body of the uterus  causes
or is accompanied by a manifest sinking downward of the uterine
tumor  from  the  epigastric  region,  and  a  corresponding  expansion
laterally of the abdomen; which  phenomena are usually accompanied
       7 
98
PREGNANCY.
with greater freedom of  respiration  and other  evidences  of relief
from pressure upon the stomach, diaphragm  and thoracic contents.
  The Texture and Properties of the Uterus  are also greatly
modified by the condition of pregnancy.  These changes affect the
different tissues and structures of which the  uterus is composed.
  The serous coat or peritoneum, which constitutes the external tissue
of the uterus,  like the entire substance  of the uterine walls,  is ex-
tended without being diminished in  thickness.  Just as the  uterus
itself grows with the growth of the ovum  it contains, so its perito-
neal covering absolutely grows, and in proportion  to the whole growth
of the uterus which it envelops.
  The mucous coat of the uterus, as already stated in  speaking of the
formation of the decidua, becomes much more highly developed in
pregnancy, and this  development belongs to the  glands  as well as to
the mucous tissue itself.  This is also  the case with the mucous glands
of the cervix; these secrete a peculiar dense, semi-transparent, almost
insoluble  mass of mucus, which fills and closes the  entire cavity of
the neck during pregnancy.
  The muscular coat of the uterus also  becomes developed in a cor-
responding manner during pregnancy; so that the various layers of
muscular  fibres are much more  easily demonstrable at this time than
in the unimpregnated condition, and the actual muscular character of
this middle coat of the uterus is  positively ascertained.   The  various
muscular  fibres are  now seen to cross and intercross  in  such  a man-
ner as to secure the greatest possible amount of strength;  and the
arrangement of the layers and fibres is such  that at every orderly con-
traction they all act upon  one common centre, the centre  of the womb
itself.
   Tlie vascular apparatus of  the uterus also  undergoes very important
changes in connection with the advance of pregnancy.  These consist
in augmented development, which embraces the arteries as well as the
veins.   Through these vessels the blood flows into and through the
uterus in greatly  increased  quantities,  and this blood  supplies the
nutrition  for the growth of  the  uterine walls, and of  the foetus which
they enclose.
   " The augmentation in the size of the arteries only becomes con-
siderable  as they approach the uterus.   Whilst advancing between the
peritoneum and the  external  face of the organ, and before giving off
their first divisions, they dilate  and  swell up,  and then they furnish
branches  to the  anterior and lateral parts, which  ramify  ad infinitum ;
they are not situated immediately below the peritoneum, but are sepa- 
PREGNANCY.                         9£i
rated from it by a delicate layer of muscular tissue.   All these rami-
fications anastomose freely, and penetrate through to the internal sur-
face, where  they generally terminate; but  a large number of those
corresponding to the  placental insertion traverse  the mucous  mem-
brane and enter the placental deciduous membrane."—Jacquemier.
Through  these enlarged arteries  is conveyed the blood requisite for
the growth of the uterine parietes and appendages, and for the supply
of the placenta, and consequently of the foetus.  The arterial branches
become  lengthened with the increasing size of the uterus, but do  not
lose their original tortuosities, which, however, do not appear to impede
the circulation through them.   The veins undergo similar and no  less
extensive  changes.   This will be evident from examining them as
they emerge from the uterus;  the ovarian veins are nearly as large as
the external iliaes, and the uterine veins are but little less in size.  In
the original state, before pregnancy, they are  larger and less tortuous
than  the  arteries;  during gestation  they  become enlarged and  de-
veloped still more rapidly;  and at term  they furrow the muscular
tissue in every direction, and form a network which lies intermediate
between its external and internal face.   This muscular tissue or coat
of the uterus is traversed by a great number of venous branches run-
ning in  every direction, which anastomose  and  form large  sinuses at
their  junction.   Some of the canals  of this  plexus  or network  are
large  enough to admit a goose-quill, or in  some  instances even  the
end of the little finger.
  This  is particularly the case at that part of the interior surface of
the uterus to which  the placenta becomes adherent.  Opposite  the
insertion of the placenta these venous trunks  are largest, and they
diminish in size  as they recede  from this vicinity; and in the sub-
stance of the mucous  membrane, immediately beneath which  the
placenta is situated, these vessels form, through an enormous dilata-
tion of their branches, the long sinuses which exist at  the adherent
surface of the placenta.   These sinuses communicate freely  with each
other, so as to form a reservoir of blood divided and kept in place by
numerous partitions.   At intervals may be found a small number of
orifices through which this mass of blood  communicates  with cor-
responding sinuses in the muscular walls  of the uterus.   The veins
as well as the  arteries are lengthened, growing thus with the growth
of the uterus, since even in their greatest extent, in the last months
of pregnancy, they still maintain their tortuosities.  The areolar  tissue
which envelops  the uterine arteries is not  found on the veins, these
latter being placed in  immediate relation  with the  muscular  tissue 
100
PREGNANCY.
through which they pass.   Neither are there any valves to be found
in these veins; probably their numerous convolutions and sinuosities
may serve to answer  the  purposes secured by the  valves  in  other
venous trunks.
   The lymphatic  vessels of the uterus also  acquire an extraordinary
development in pregnancy and gestation.  These vessels form several
distinct layers or  planes in the uterine walls, the superficial  being the
most  fully developed; and, as previously  described, they belong to
two distinct  groups, those  of the cervix  communicating  with  the
pelvic ganglia, and those of the body of the womb terminating in the
lumbar ganglia.  The  lymphatic system forms, with the arteries and
veins, a third and no less indispensable set of vessels; and the neces-
sities of the circulation, of the nutrition (reparation and growth) of the
uterine tissues and their contents, require that the augmentation of the
lymphatic vessels should be in some proportion  to the increase of those
of the arterial and venous systems.
   The nerves of the uterus during the period of gestation necessarily
partake of the same  increased activity as the other  uterine structures,
and it was once  supposed  that  they received also a corresponding
augmentation in  development.  But the more recent researches of
physiologists have shown that the proper nerve-tissue  itself remained
unaltered  during pregnancy, and  that  the  apparent  increase in size
of the nerves is due to the augmentation of the tissue composing the
neurilemma—a tissue  which is  almost entirely fibrous, and exhibits
no structure specially nervous, its  office being to support,  protect and
bind  together  the  nerve-tubules and ganglionic  nerve-corpuscles.
Those arising from the ovarian plexus are distributed to the angles
of the fundus; those  arising from the hypogastric  plexus are dis-
tributed to the cervix and lower  portion of the body, these, by
branches from the third and fourth sacral nerves, being connected with
the spinal  nerves; and finally,  those  arising  from the great sympa-
thetic accompany the uterine arteries, and are  lost upon the neck and
lateral parts of the womb.   Thus the entire structure of the uterus is
sure to be  supplied with nerves from the  nervous system of organic
life, a portion only of the nervous filaments distributed to the cervix
being in immediate relation with the spinal nervous system.
   The complicated arrangement of the various tissues and organized
structures which  make up the substance of the womb renders it ex-
ceedingly difficult to demonstrate the full development of the nervous
system of this organ.   But there can be no doubt of the fact that the
uterus is so abundantly supplied with nervous  substance in itself, and 
PREGNANCY.
101
so intimately connected with the great ganglia in its vicinity, that it
is endowed, especially in the gravid state, with a vitality peculiarly
its own, through which it is enabled not only to support the nutrition
of the embryo, but also to exert a controlling influence upon the entire
economy of the  woman herself.
  These changes in the structures composing the uterus must occasion
corresponding changes in  the  physiological and  sensitive  conditions
of this organ.
  The.physiological properties of the gravid  uterus, as to sensibilitv,
irritability and  contractility, are very different from  those exhibited
in the non-gravid  condition.   The common sensibility of the  uterus
in the non-gravid  state is but  slight, but in consequence of the more
active development of the nerves of organic life and of their connec-
tion, in  the cervix, with the spinal  nerves, this sensibility is much in-
creased  during  pregnancy.   And yet in many individuals  the uterus
shows in this respect a most astonishing power of endurance—a won-
derful tenacity which enables it to retain and preserve the embryo in
the midst of the greatest dangers.  Near akin to  this increased sensi-
bility appears the peculiar irritability  of the uterus.  This may be
defined  as a certain  morbid sensibility, or a sensibility attended with
weakness  rather than  with strength.   In the former instance  the
woman can bear with impunity the active movements of the  foetus in
utero;  in the latter,  these  movements  induce  the  most  poignant
anguish, or may even threaten  a premature delivery.
  Contractility is but a still farther advance in the direction of sensi-
bility and irritability, or, raiher, the  former is  the crisis or  reaction
which results from the  latter.  The most important  function of con-
tractility is, of course, peculiar to  the gravid as  contrasted with  the
non-gravid uterus.   It belongs to the increased muscular development
of the uterine  parietes, nourished as they are by the augmented blood-
vessels, and inspired by the more active influences of the nerves.   This
contractility may be excited by the reflex action, from irritation, of the
cervix;  thus, a common cause of abortion is  to be found in repeated
and  violent coition,  and in other disturbances  of the os and cervix
uteri.   The menstrual  molimen,  in  the unimpregnated  condition,
seems to have  the power of exciting all the contractility of  wliich the
womb is then capable.  And even in the impregnated state the same
influence is still to be  traced in the remarkable tendency to abort at
menstrual periods, especially at the third.   And it is thus that many
drugs which are capable of so irritating the uterus  or the adjacent
sympathizing structures  as to produce a congestion which may simu- 
102                       PREGNANCY.
late that of menstruation, are also capable of directly producing abor-
tion.  But the  grand  physiological functional contractility  of the
gravid uterus is seen only at full term.   Then this organ arises in its
might in the fullness of time, spontaneously casts off in the most vio-
lent  manner, even at the blind risk of destroying the mother where
deformity may be present, the ovum which it has cherished, protected
nourished and vivified through nine long months.  And to the accom-
plishment of this contractility the nerves of the uterus summon not
only all the various curiously-arranged and powerful muscular tissues
pertaining to that organ, but through their connections with the cere-
brospinal nervous  system they compel the co-operation of all the
involuntary and voluntary muscular apparatus of the entire body, and
of all the determined energies of the mind.
  The efforts of the will, co-operating with the  involuntary muscular
contractions, exert no small influence in maintaining  the  labor-pain.
In some  rare instances the contrary  has been  observed.   Mrs. C,
living  five miles from the city, at a time when the traveling was very
bad, was taken in labor, and  felt as if she would be  confined before
her physician could reach her.  Her  pains were frequent and vigor-
ous,  but by  a  determined effort of her will  she had  entirely  sup-
pressed them, and her physician was obliged, after waiting in vain for
some time, to restore them by exhibiting the appropriate remedies.
This was not a case of  fear, but the lady said she exerted herself all
she could to suppress  the  pains.  The favorable influence of good
hope of a speedy delivery is so  well known that the physician instinct-
ively encourages his patient  all he possibly  can.   In the state  of
nature in animals and among the savage tribes this function of con-
tractility, even  at its final result in the expulsion of the foetus at full
term, is  attended with  little or no pain.  But  this is very far from
being the case usually in civilized life.
  That function of the  uterine  tissues by which the womb, after being
thus emptied, is restored to  its  original state, is by some authors con-
sidered to be distinct from contractility, and termed  elasticity.  But
this  seems nothing  more than a continuation, into  the minute struc-
ture, of the same contraction which, in the first instance, had affected
the entire organ.  In the latter instance, the minutest  filaments of the
muscular and other tissues  seem affected,  as in the former the entire
muscles and muscular parietes.
  This identity of contractility with what is termed elasticity will be
more certainly  demonstrated by the consideration of the very  similar
effects of the same physical and even moral agents in  producing or in 
PREGNANCY.
103
arresting their development.  Thus, ergot, which is one of the most
efficient agents in producing powerful contraction of the muscular
parietes, is no less active in arresting  the hemorrhage subsequent to
parturition which arises in consequence of a want of the proper inter-
stitial contractility or elasticity wliich  should close the open  mouths
of the bl )od-vessels.   In the same manner, fright, from  being  told
there was " something wrong" about the presentation, has been known
instantly to arrest the labor-pains and  change the labor itself from a
natural to an instrumental one.  So  fear has been seen  to stop the
normal  contraction of the uterus after  child-birth, and  thus admit
alarming  hemorrhage.  The reflex  stimulus of friction to the abdo-
men may indifferently produce the pains  of labor,  or those after-
pains by which the continued contraction and final restoration of the
womb to near its original size are secured.  The uterus may be  so worn
out in the actual  labor, even if its  involuntary contractions have not
already ceased before  delivery, that it has no longer any tone,  and,
like an overstretched  piece of india-rubber, appears incapable of re-
suming its natural form.  Such also may easily be imagined to be
the case in those in whom, whether from  failure of the vital forces in
general or from organic exhaustion, the  foetus  has to  be removed  by
force.   Nor  is it unknown for the last, most violent and successful
expulsive efforts of the womb  to  be followed by  entire paralysis of
the organ.
   But, in general, the interstitial contraction would seem to keep pace
with the organic, and as the fundus closes in upon the foetus as the
head emerges from the os uteri, so the minute interstitial contractility
(elasticity) of the tissues already follows on and aids the organic con-
tractility in separating and expelling the  placenta.
   Position.—The changes in position of the gravid uterus have already
been referred to under the head of direction.  But it will not be amiss
to again refer to them here, and it will be interesting to note in what way
the  addition of so  large a body as the uterus to  the already occupied
abdomen is  provided for, without  any of the  viscera suffering  inju-
rious pressure,  and without that impediment  to the  circulatory  and
respiratory systems, which, in the absence of such a  provision,  must
inevitably take place.
   " The oblique direction of the uterus upward and forward is deter-
mined, firstly, by the corresponding obliquity of the pelvis, the plane
of whose brim  forms with the horizon an angle of 60°.   But as the
fundus gradually, after three months,  emerges from the pelvic cavity,
the  oblique  direction of the uterus is maintained by the symphysis 
104
PREGNANCY.
pubis in front and the sacral promontory behind.  Between these, the
superior portion of the uterus continues to ascend, supported most by
the abdominal walls anteriorly and the spine posteriorly.  The intes-
tines, being bound down by the mesentery, cannot be displaced, and
will therefore occupy a position midway between the spinal  column
and the posterior uterine wall.   The pressure of the sacral promontory
and of the lumbar vertebrae will still  give to the uterus a forward
tendency, which, on the other hand, will be prevented from becoming
excessive by the elasticity of the front walls of the abdomen. If these
have not been previously much distended, the fundus glides upward,
and ultimately fills the epigastric hollow;  but if the  abdominal walls
have been much relaxed, as by frequent child-bearing, or if the pelvis
is much deformed, the fundus uteri is usually turned  directly forward,
or even downward.
  " At the end  of pregnancy the whole of the fore part of the abdo-
men is  occupied by the uterus; on either side lie  the ascending and
descending colon; the transverse  arch, together with the omentum
and stomach, fill the space  between the fundus of the uterus and the
diaphragm, while the rest of the abdominal viscera  lie  laterally and
posteriorly to its hinder wall.
  " Thus it results that in pregnancy, and especially  in its last  stages,
no  injurious  pressure is exercised either  upon the great vessels, the
aorta and vena  cava, or upon the  intestines, liver or stomach,  whilst
the descent of the diaphragm, and consequently the act of respiration,
is not materially impeded, and  space is left for the bladder and rec-
tum to perform their appropriate acts."—Dr. Far re, in Todd's Cyclo-
paedia.
  Changes in the Uterine Appendages and Adjacent Organs.
—Next to  the changes which are induced by pregnancy in the neck
and body  of the  uterus,  those which are  wrought in the  uterine
appendages and adjacent organs need to be considered.   The vagina,
Fallopian  tubes, round and broad ligaments, the bladder, the rectum,
various  parts of the  trunk, and, finally, the mammae, are all more or
less affected  in  structure  or in development  during the period of
utero-gestation.
  The vagina becomes  shortened with the descent of  the uterus in the
earlier stages of  pregnancy, and lengthened as the uterus subsequently
arises above the superior strait.  The  veins of the vagina experience
an enlargement somewhat corresponding, although less in extent, with
tne dilatation of the uterine veins; and these veins sometimes become
varicose. Toward the end of pregnancy the finger will often encounter 
                          PREGNANCY.                        105

these varicose enlargements, and certain nodosities described by French
authors under the name of thrombus.  On the superior portion of the
vagina, and especially on the infra-vaginal part of the uterus, arterial
pulsations may also  be detected.   This vaginal pulse has been con-
sidered an important diagnostic sign of pregnancy.  The mucous mem-
brane of the  vagina also  experiences an extraordinary development
                             Fig. 25.
POSITION OF THE UTERUS AT THE END OF PREGNANCY (AFTER MAYGRIER).
in pregnancy, analogous  to  the  hypertrophy of the  mucous  lining
membrane of the uterus.  This is shown by the innumerable granules
or enlargements of the mucous follicles, which about  the seventh or
eighth month are found covering  the  interior surface of the vagina.
and which are also to bo found upon the exterior and interior surface 
106                       PREGNANCY.

of the cervix uteri.  An increased mucous secretion accompanies this
follicular development.  This increased secretion of mucus is the nor-
mal  condition in pregnancy, especially  in its  advanced  stages; and
it should never be suppressed  by injections.  In such cases even cold
water injection does harm, since, from the suppression of these vaginal
mucosities, the labor is rendered more lingering and  severe;  what is
called dry labor may result.
  The Fallopian tubes and ovaries are drawn nearer to the body of the
uterus; the former, instead of being on  a level with the fundus, now
correspond to the upper  fourth, or even  to the  middle,  of the uterus.
This results from the ascent of the womb above the pelvis, by which
the folds of the peritoneum, called the broad ligaments, prolonged into
the pelvic cavity to reach and support the uterus, are  shortened and
caused to disappear.  The round ligaments are  carried forward by the
greater development of the anterior than of the posterior wall of the
uterus, so  that their insertions, instead  of being at the  sides of the
womb, are now found at the point of union of the anterior fifth with
the posterior four-fifths of the antero-posterior diameter.
   The bladder,  during  the early months of pregnancy, is gradually
pushed above the superior strait;  the urethra is  elongated, and its
orifice concealed behind the  border  of the symphysis pubis.  The
anterior  projection of the bladder  renders  the line  of the urethra
much more curved; so that its  course will be more  readily followed
by the male catheter, with its convex surface backward and its con-
cave  surface  forward, than with the nearly straight  one  ordinarily
used  for females. The  gravid  uterus rests down  upon the posterior
surface of the urethra,  and by compressing it against the  arch of
the pubis  often causes  an obstruction in  its circulation.   This may
be known by the  tumor to be  found in such  cases behind the  sym-
physis, and  by the  severe and painfully distressing  tenesmus, and
even  strangury, which not unfrequently arise from such compression
and  irritation of the meatus urinarius.
   In some of these cases  the catheter  is  requisite in  order to afford
temporary relief, until, from quiet and rest in the horizontal position,
the cause may be removed long enough  to allow the irritation to sub-
side or the proper medicines to  be applied for its relief.
   As pregnancy advances,  and  the bladder is gradually encroached
and pressed upon by the  increasing gravid uterus, it becomes  more
and more flattened, and its capacity for containing the urine is con-
siderably lessened : hence the more frequent and more urgent calls to
urinate. 
PREGNANCY.                       107
   The rectum is pressed upon in a similar manner posteriorly; hence/
 in part from the mechanical obstruction, there results the constipation
 so common in pregnancy.  A similar obstruction of the blood-vessels
 and lymphatics in  some cases tends to develop  hemorrhoids  and
 oedema of the vulva and of the lower extremities.  These deviations,
.partaking of a pathological nature, will  be more particularly consid-
 ered, with the other morbid conditions of pregnancy, in a succeeding
 chapter.
   The relaxation of the various pelvic  symphyses, especially that of
 the  pubes, which during pregnancy occurs in some peculiar constitu-
 tions, and which renders locomotion difficult, if not impossible,  also
 results from a morbid condition subsequently to be considered.
   The abdomen becomes very much  enlarged as pregnancy advances,
 its parietes being thinned, and on the inferior portion often marked
 by broad or bluish streaks, which form parallel curved lines, with the
 convexity toward the pubes.   On the median line, from the pubes to
 the  umbilicus, may be  observed a brownish  streak, which in primi-
 parse has been deemed a certain sign of pregnancy; a  similar dark-
 colored  line has been seen, however, in non-gravid females and in
 males.   After  delivery an oblong tumor is sometimes  seen on  the
 median line, especially during any severe exertion.  This results from
 the  projection of the bowels where the abdominal parietes have been
 permanently thinned and weakened  by the separation of the aponeu-
 rotic fibres.  With  each subsequent pregnancy this enlargement be-
 comes greater, until, in some  instances, it becomes necessary to band-
 age it.
   The thorax, with the upward ascent of the large volume of the
 gravid uterus, experiences important changes.   Its base is enlarged,
 the  diaphragm is pressed upward  and distended by the stomach  and
 contents of the abdomen; sometimes the crowding together obstructs
 the  circulation  of the heart and great  vessels,  respiration is visibly
 affected  in  such cases, and sometimes the irritability of the distended
 diaphragm occasions a more or less constant cough.
   The mammce, both from original sympathy with the genital organs
 and in preparation for the performance of their own future function,
 exhibit remarkable changes during gestation, which may also become
 diagnostic of the pregnancy itself.  These changes are of two kinds—■
 those relating to  increase in size, and those which affect the  color of
 the  areola  surrounding the nipple.   Very soon  after the commence-
 ment of pregnancy in many women,  the breasts become more full  and
 somewhat  tender; they have evidently  assumed  a more vigorous 
108
PREGNANCY.
physiological activity.   This increase in the volume of the mamma?
will sometimes diminish toward the fourth or fifth month, but to re-
turn again and  become  still greater toward the  close of gestation.
The nipples  also become turgid  and more prominent; the same in-
creased  activity  already mentioned  as  apparent in the mammae  in
general  is particularly evident in  the nipples; their erectile tissue be- t
comes more permanently developed, as if in sympathy with the corre-
sponding hypertrophy of the mucous coat of the uterus.
  The areola around the nipples  becomes much darker.  And in the
centre of the areola, immediately surrounding the base of the  nipple,
may be  seen  quite a  number of  minute glands, from which may  be
squeezed a serous, and  in the advanced stages of pregnancy a sero-
lactescent, liquid.  These changes in the size of the  nipples,  in the
color of the  areola and in  the development of the glandules make
their appearance in the course of the third month.
  About the  same time with  these,  blue veins begin  to make their
appearance over  the  surface  of the  bosom, from which  numerous
branches are given  off to  the  areola.   In  connection  with these
venous  trunks may sometimes be seen  certain shining silvery lines,
linea albicantes;  both the  enlarged veins and the  silvery streaks are
more prominent in the breasts of primiparse.   The change of the areola
from the delicate pink tinge of the virgin to a more or less  darker
shade in the first pregnancy remains permanent thereafter, the color
becoming darker at the accession of each subsequent pregnancy.  But
a more  particular statement of the changes  in  the structure and ap-
pearance of the mamma? will  be  given when we come to study them
in the chapter on the Diagnosis of Pregnancy.
  Generally  speaking,  these  changes in the external  form  of the
woman in pregnancy but partially disappear after parturition.   Where
the  abdomen  has been so greatly distended, certain folds or wrinkles
will still remain  as  consequences.   So the  hernia-like protrusion of
the  bowels along the  median line below the  umbilicus, which has
been mentioned as resulting from the separation of the fibres of the
aponeurosis on that  line, unless remedied by appropriate treatment,
will tend to  increase rather than to  diminish.  Neither does the dis-
coloration of  the  areola ever entirely fade away; it ahvays remains as
evidence that pregnancy has existed;  and yet not as of itself affording
conclusive evidence, for this  discoloration may be the result of uterine
irritation in women who have never been enceinte, just as the  breasts
may enlarge  from sympathy with enlargements of the  uterus which
are  caused by the development of tumors or other morbid growths. 
THE DIAGNOSIS OF  PREGNANCY.
109
                      CHAPTER  VIII.

             THE DIAGNOSIS OF PREGNANCY.

rnHE determination of pregnancy at  the earliest possible period
-1-  forms one of the most frequent,  difficult and important problems
in the practice of medicine.   The physician will often be called upon
to decide this question where strong  feelings are  awakened and great
interests  are at stake of the  most opposite character.  u The honor,
and therefore  the happiness, of a female may depend upon his decis-
ion ; the peace of families may rest upon it, and the inheritance of
propcrtv be controlled by it."  For  some to be enceinte is  the grati-
fication of their highest  hopes and most ardent desires; by  others it is
regarded as a most serious inconvenience—as something to be dreaded
on account of health, or, in the unmarried,  as threatening a disgrace-
ful exposure of their want of chastity.   All these different states of
mind and various social relations must  always be considered in esti-
mating the value of evidence for or against a supposed pregnancy,
since those earnestly desirous of children  will naturally magnify every
new sensation, while in  some other cases  there may be a disposition to
suppress  or overlook the signs of an actual  pregnancy.   " In all such
cases the physician  must remember that he may not merely be re-
quested to investigate a case of doubtful pregnancy where no shame is
involved, but  that he may be  consulted in cases where  pregnancy is
concealed by unmarried women, or by married women  under certain
circumstances, to avoid  disgrace, and on the other  hand, where  it  is
pretended in order to secure an inheritance,  to  extort  money  or to
delay punishment."   And the  very circumstances which tend to ren-
der the question more  difficult to decide, at the same time seriously
increase  the  responsibility  attached  to  such  decision.   Hence, the
physician can never be too cautious or too discreet in these matters,
especially where the question relates to the unmarried;  his acknow-
ledging himself to have been mistaken will afford but a poor repara-
tion for  shocking the feelings and insulting  the virtue of the pure-
minded and the innocent.   Such a blunder were worse than a crime,
and its consequences  might  be irreparable  as well  for the physician
himself as for his patient.
  The signs  of pregnancy may  be  divided into two classes—those
earliest observed, which are  called  rational or presumptive signs, and
those subsequently appreciable, which are termed sensible  or positive 
 110             THE DIAGNOSIS OF  PREGNANCY.

 signs.   From one or more  of the first class a presumption of preg-
 nancy may arise, and from all that the case affords in its early stage
 a rational conclusion may be drawn;  but this is not positive know-
 ledge : this can be derived  from the positive or sensible signs alone,
 and of all these there is but a single one that is entirely incapable of
 being mistaken, and that is  the beating of the foetal heart.   The signs
 of pregnancy increase in number and become accumulative in value as
 the case advances.  Thus, the diagnosis which in the first instance had
 been possible pregnancy becomes presumptive, probable, and, finally,
 certain or  demonstrable pregnancy.   We  will study, therefore, these
 signs as they arise in order of succession, proceeding from the rational
 to the  sensible.
  Rational Signs are derived from the circumstantial history of the
 case, from  the related experience and sensations of the  woman, and
 from our own observations  of such changes as may appear.  Among
 these may be classed the  general effects observed  in the female econ-
 omy—such  as  greater rapidity of pulse and of respiration; greater
 activity of the circulation and secretions, especially those of the genital
 organs; greater sensibility of the nervous  system.  But from indica-
 tions so general as these no rational inference can be drawn; they are
 only important when taken  in connection with other more  particular
 signs.
  Suspension of the  catamenia is generally the first indication which
 leads the  woman in whom impregnation  has been possible, to con-
 sider herself enceinte.  But the importance of this symptom will very
 greatly depend upon the  attendant circumstances:  if the woman has
 been very regular, and if the cessation of the menses promptly occur
 after some  particular  sexual  intercourse,  the  presumption of preg-
 nancy will be very strong indeed.  But if she has always  been very
 irregular, the mere fact of the menses failing to make their appearance
 at a particular monthly period  will carry with it but little  weight.
 Where the entire absence of  the menses for  two or three months occurs
 from no other assignable cause, and where this suspension is attended
 with good health and appetite, and some perceptible increase in the
size  of the  abdomen, the rational conclusion of pregnancy may be
considered  +o be well founded.   And yet even these circumstances
are far from affording infallible evidences of pregnancy, since they
have been known to arise in this  combination from other causes.   In
newly-married  women the catamenia are sometimes suspended from
irritation of the sexual organs where no conception has  taken place;
and  at the same time there may be an increase  in  the size of the 
THE DIAGNOSIS OF PREGNANCY.
Ill
abdomen and in the sensibility of the breasts; so that even this very
strong combination of symptoms cannot be positively relied upon.
  The attendant circumstances must be borne in mind in other re-
spects ; for while conception may take place in women who have never
apparently menstruated, so the catamenia may still  continue  even
after conception and through all the months of utero-gestation.  Cases
have  been recorded in  which menstruation appeared  only  during
pregnancy; but  such cases  are  anomalous.   Thus while the cessation
of the menses, under favorable circumstances,  becomes the first and one
of the most important signs of  pregnancy,  it  is by no means decisive,
since on the one  hand the catamenia may be  suspended without preg-
nancy, and on the  other pregnancy may occur without the suspension
of the catamenia.   The general rule will be all the more valuable, if
we  constantly bear in  mind the possibility of the  exceptions which,
though far from  being common, may occur in any given case.
  Morning sickness forms  in very many  women the  next sign of
pregnancy.  As  its name indicates, it  is a morbid symptom, but on
that account none the less  valuable as a  diagnostic sign.  It arises
from sympathy of  the cceliac or solar plexus with the organic nervous
system of the uterus.   This morbid irritability  may  commence im-
mediately after  conception, but it generally sets in about the fifth
or sixth week, and ceases soon after the third month.  It may become
in individuals a positive indication of  their being  pregnant,  since
these  persons  learn by experience that  these symptoms occur  with
certainty and regularity at  a particular time  after conception.   Thus
in different persons the  presence or absence of morning sickness will
have a very different diagnostic value.   In those who have had  it in
former pregnancies, its non-appearance will  be tolerably  conclusive
evidence against the existence of pregnancy; while in primipara? its
non-appearance would scarcely be considered  worth noticing  as an
evidence that they were not enceinte.   Still, where  morning sickness
makes its appearance persistently attended by suppression of the  cata-
menia, and in circumstances where  there is a liability to impregnation,
it can scarcely be attributed to any other more  probable cause  than
pregnancy.  And this indication will be strengthened by the character
of the  sickness itself.  The appetite improves and is good through
the  day,  in spite of the nausea, vomiting of a peculiar watery  fluid
and sinking at the  pit of the stomach, which occur and continue  for a
short time only on first rising in the morning.  The sickness and the
fluids  vomited up  are  different from those accompanying any other
disorder, such as  gastric or bilious fevers, for example.   While morn- 
112              THE  DIAGNOSIS OF PREGNANCY.
ing sickness, from its peculiar character, brief daily appearance, usual
temporary continuance and final  sudden and perhaps unexpected dis-
appearance, becomes, where  it occurs, a valuable  indication of preg-
nancy, its absence is  hardly to be regarded as  a negative sign,  as
functional or organic disturbances of the uterus apart from pregnancy
may occasion it, and it sometimes follows suppression of the monthly
flux from other causes than conception.  The morning sickness which
exists during the earlier months of pregnancy is a physiological occur-
rence, whereas  that which occurs during the latter months is due to
mechanical causes.
  Certain other derangements of the digestive organs, such as eructa-
tions, heartburn, remarkable longings for some particular  article of
food or other substances not used as food, and corresponding aversion
to some  one  or- more  of the common varieties of food, which occur
separately or in  connection with morning  sickness, or even subse-
quently to it, may also pe regarded as among the rational signs of
pregnancy.
  The same may be said of salivation, which.occurs in some women
about the fourth  or sixth week; in such  cases the frequent  spitting
will be equally diagnostic whether the quantity  be large or small.
This  salivation,  differing from  that  which results  from  mercurial
influences by the absence of the fetid breath, sore gums,  and great
prostration,  becomes  truly  characteristic  of pregnancy, just  as the
morning  sickness above described  does,  by reason of its being a
sympathetic rather than a primary and idiopathic affection.  Spitting
of " feathers" or " fippenny bits" is with some women a  marked signal
of the existence of pregnancy, and  with such women is of course of
greater diagnostic value than with others.   There is in some cases an
irresistible  impulse  to spit at any time and under any circumstances
when pregnancy is advancing.
  The abdomen, by its changes in size and form, affords some rational
signs of pregnancy even in the early stages.   The enlargement of the
abdomen may  indeed  occur from many other causes; but no other
cause can simulate the shape  and manner of development  of the
enlargement of pregnancy.   A  careful study of all  the  successive
appearances of the abdomen in  pregnancy will therefore  enable the
practitioner to estimate at their  proper value the  changes which may
present in any given  case.  Sometimes  even in  the  first  month the
abdomen will seem larger than it  does in  the second, which  arises
from  the co-operation of two  distinct  causes.   First  the abdomen
seems larger because it is rendered tympanitic by the reflex influence 
THE DIAGNOSIS OF PREGNANCY.              113
of the  newly-begun pregnancy itself.  After three 01  four weeks this
tympanitic condition passes off, and the abdomen loses its apparent
increase in size.  In  cases in which this  tympanitic condition has
disappeared, as well as in those in which it had not  occurred, the
abdomen becomes flattened.  This flattening of the abdomen is usually
attended with a drawing inward  and  downward of the umbilicus.
These  appearances, the very opposite  to  what  might naturally be
expected, are due to the sinking of the  uterus a little  lower down in
the pelvis, as described in the preceding chapter.   And in connection
with these changes there may be more frequent calls to urinate.   But
after the second month the uterus begins to rise within the cavity
of the pelvis, and  the abdomen soon  recovers  from this depressed
condition.  About the third month the  abdomen is seen to be visibly
enlarged, and  the enlargement steadily  goes on till toward  the  close
of pregnancy, the uterus still continuing to ascend within the pelvis.
After the third, fourth or fourth and a half month, according to the
capacity of the  pelvis to give it  room, it rises  above  the superior
strait, either suddenly or gradually, according as  it has  been more or
less impacted in the pelvis.
   This rising out of the cavity of the pelvis into the abdominal cavity
constitutes what is called quickening, and sometimes it occurs so sud-
denly as to quite alarm the mother.  It was at one time erroneously
supposed  that no life was present in the foetus till  the occurrence of
quickening, but it is now well known  that at the very earliest mo-
ment of conception a living human soul is there.  Motion probably
takes place at a much earlier period  than  it is perceptible  to the
mother, but it is not usually sensibly recognized till the uterus has
finally risen from the smaller into the larger or abdominal  pelvis.
Usually after the beginning of the third  month the enlargement begins
to show itself just above and behind the  symphysis pubis, being always
more considerable on the median line.  After the commencement of
the fourth month, if the woman be not too corpulent, by placing her
upon her back with her thighs flexed upon the abdomen, the enlarged
uterus can be felt like a half moon rising behind the symphysis pubis;
and this ascent of the uterus goes on regularly, and usually at the rate
of about two fingers' breadth per  month, until within two weeks of
the full term.   But this enlargement is not always so regular  in its
development,  since it may be varied  by dropsical  accumulations,
multiple pregnancies, a greater or less projection of the spinal column,
oreadth of the pelvis or other individual peculiarities.
   An important means of distinguishing the enlargement of the abdo-
       s 
114
THE DIAGNOSIS OF PREGNANCY.
 men  wliich  results  from pregnancy" from  that  caused by  dropsies,
 tumors or other morbid* conditions, will be found  in  observing the
 manner  in which this  enlargement is developed, very nearly on the
 median tine and always proceeding from below upward.   Just above
 the symphysis pubis the tumefaction  begins to show itself, at first
 being more considerable on the median line than elsewhere;  the sides
 are flattened  and the middle  portion projects considerably.  And the
 constant, steady and uniform  enlargement of  the  abdomen, in the
 manner just  described, and under  favorable attendant circumstances
 as to  health,  appetite, etc., affords substantial ground for a conclusion
 in favor of the existence of pregnancy.
   The umbilicus also  affords some indications of value among: the
 rational  signs of pregnancy,  since the  changes which occur  here are
 almost always present and can always be observed.   During the first
 two  months of pregnancy the depression of the  umbilicus is greater
 than  usual, owing to the descent of the  uterus  into the pelvis and to
 its dragging down the fundus of the bladder, by which tension is-made
 upon the urachus. This umbilical depression continues  and gradually
 increases  during the  continuance of the descent of the  uterus, and
 during this period the woman may be seen to walk stooping, in order
 to relieve the dragging sensation experienced by this strain upon the
 umbilicus.  This descent of the uterus upon  the  bladder occasions
 frequent micturition, and the dragging  upon the urachus sometimes
 gives rise to a  distressing pain at the umbilicus, which  disappears,
 together with the too frequent urination, when the. uterus commences
 its ascent.  As  soon  as this sinking downward is  arrested, and  the
 uterus begins to rise again, the umbilicus is gradually restored to its
 normal condition.  It  next  begins to  lose its  depression,  growing
 decidedly superficial  during the fifth and sixth months, becoming
 entirely flattened out in the  seventh month and on a level with the
 surrounding integuments, and during the last two months the umbili-
 cus really pouts or protrudes beyond the general surface of the abdo-
 men.   This course of changes in the umbilicus  during pregnancy is
•the general  rule;  there may be  some deviations, but  usually  the
 phenomena afforded by the umbilicus are regular and of  great value.
 Tumors or ascites may cause  appearances somewhat similar, but these
 do not arise in the same regular order of time.   When the three suc-
 cessive and well-defined stages of umbilical depression, restoration and
 projection occur as above described, they constitute a rational sign of
 pregnancy very  easily observed and of very great value.
  The mammai, about  two months after conception, begin to afford 
THE DIAGNOSIS OF  PREGNANCY.
11 0
indications of much  value.   Although from various causes some of
these  indications, except in  primiparous women, are less reliable in
the early stages  than many others,  still,  taken in connection  with
other  signs, they cannot but have some weight.  As described  by
Tyler Smith,  these indications consist in  a certain sense of fullness
and weight and shooting pains in the breast; subsequently the circu-
lation becomes more  active, and there is an actual increase of volume;
the gland becomes hard, knotty  and tender to the touch, and large
blue veins  may be seen meandering over its surface just beneath the
integument.  About  the end of the second month  the  nipple  swells,
becomes  more erectile, sensitive  and projecting;  its  color is  also
deeper.   The  surrounding  skin assumes an emphysematous appear-
ance, and becomes also a little  darker.   By  the  end  of the fourth
month a dark-brown areola is seen  to surround the nipple in every
direction, at a distance of three-quarters of an inch  from its base.   In
blondes,  or in feeble, delicate women, this appearance  is not so well
marked as  in those who have black hair and  eyes and in brunettes.
"As pregnancy advances, especially if it be a first pregnancy, the de-
posit of pigment in the areola? increases, the areolae themselves become
moister,  and  the  follicles studding their surface are prominent, dis-
tended and bedewed with  transuded fluid.  These follicles or little
glandules which appear near the  base of the nipple* within the areola
attain an elevation of one or two lines above the surface of the skin.
Each  little gland has an excretory  duct,  and by  pressing  upon  its
base a little  serous  or  sero-lactescent fluid is made  to  escape.   In
several instances I have seen this fluid flow in considerable quantities
during  lactation."   Sometimes  these glandules  become very sore,
when Calendula will effect  a speedy  cure.   About the fifth month a
sort of shadow of the first areola makes its appearance outside the first,
very pale,  although  quite similar to  the first; and outside of these
again,  somewhat  later, or about  the  seventh  month,  are often  seen
dark veins running across the breasts in various directions.   Minute
streaks, glistening like silver threads, are also observed running  near
these darker vessels.
   These appearances of the  mammae,  occurring in regular order,  par-
ticularly when taken in connection with other rational signs, afford
almost conclusive evidence  of the existence  of pregnancy.  But it
should be  borne  in  mind that the discoloration of the areola?, from
never entirely disappearing  when it has once  taken place, is of little
value as  a sign of pregnancy except in primipara?, and also that both
the enlargement of the  mammae  and  the discoloration of the areolae 
116              THE  DIAGNOSIS OF PREGNANCY.
may be occasioned by distension of the uterus from other causes than
pregnancy.
   Quickening, where it can  be distinctly recognized,  becomes  of
course a conclusive evidence of pregnancy; but it cannot be thus posi-
tively  determined except in those whose  previous  experience  leads
them to interpret aright the sensations which compose it.  The term
was  originally applied to the  supposed period at which the foetus in
utero first became possessed of the  living principle, or was united to
its physical soul, which  " quickening" of the foetus was believed  to be
the cause of the  changes and  unusual sensations experienced by the
mother at that time; but not only is it true that from the moment of
conception the embyro  is " a  living  soul," but equally a fact that it
may move within a few hours after the conception has taken place.  It
is curious to  note how the advance in physical  science is equaled by
that  in psychical knowledge—how physiology and psychology go hand
in hand.  Thirty years  ago Davis wrote, in this connection, " It  is
now well  known that the foetus in utero  possesses  some of the most
important attributes of life from the earliest pulsations  of the first
speck of organization called the punctum saliens."
  By quickening, therefore, we merely  understand those sensations
which indicate the escape of the  gravid  uterus  from the pelvic into
the abdominal cavity.  It is not the result, as formerly supposed, of
movements of the foetus itself,  but rather of the intrusion of the uterus
itself among the other organs of the abdomen, and perhaps of the
removal of the   pressure hitherto  exerted by  the  uterus upon the
large vessels in the pelvis.   "  The sudden intrusion of the volume of
the uterus among the abdominal viscera, organs of high sensibility,
accompanied by a sudden removal of pressure from the iliac vessels,
is  quite equal to the production of the sensation called quickening.
The  sensation is felt in the transit at the moment when the uterus,
upon quitting its residence in the pelvis, enters the abdominal cavity."
—Davis.  This  sensation, which occurs at various periods in various
women, is to  be distinguished  from  those arising from the actual
movements of the foetus in utero, which are only subsequently experi-
enced.  Quickening  may occur as early as the tenth week, or it may
not be observed  till  the sixteenth, the eighteenth or even the twenti-
eth week; the average period  is probably about  the sixteenth week.
   Changes in the  Urine.  Much valuable  time and a great amount of
labor have been  spent in attempting to render  the alterations of the
urine useful  as a rational sign of pregnancy; and while, for reasons
subsequently to  be stated, we attach even less importance to  these 
THE DIAGNOSIS OF  PREGNANCY.
in
chano-es in the urine than  do the Allopathic writers, we will  briefly
describe them, following principally the  account given by the cele-
brated Dr. Elisha Kent Kane.*
  These changes consist briefly in the formation of  a gelatino-albu-
minous product in  the  urine of pregnant females  subsequent to  the
first month of gestation, which is  separated  from  the other elements
of that fluid by rest alone, and to which is given the name of Kiesteine.
This consists of certain  globules held in suspension in the urine when
secreted, and which rise to the surface and there form a pellicle which
resembles  in appearance the thin scum of fatty substance covering
soup as it  cools.  When thick this pellicle is said to give off a strong
cheesy odor.   This pellicle usually  makes its appearance upon  the
second day, or in the course of the third; though it  is sometimes not
observed  till  the urine has  stood longer, even  till  the eighth day.
The experiments of Dr. Kane and others  prove that the Kiesteine is
by no means peculiar to pregnancy, but that it has  more especial rela-
tion to lactation, either prospective or actually present; since it makes
its appearance either where the milk is but imperfectly withdrawn from
the breasts, or in those cases in which,  as  in pregnancy, nature is pre-
paring for the future function of lactation.   Finally, Kiesteine can-
not be regarded as an unerring diagnostic of pregnancy, since it may
occur under other conditions of the system, and is  not always observ-
able where pregnancy actually exists;  but its presence in the urine of
an otherwise healthy woman is stated  by Cazeaux to be an important
rational sign.
  It remains now to  state why wre attach little  or no importance to
this phenomenon as an indication of  pregnancy in the homoeopathic
practice;  and  this  is from the fact that those  changes of the urine
which ultimate in the formation of this peculiar pellicle, if not purely
pathological, are at least but the consequences of the imperfectly per-
formed physiological processes.  These  imperfections are also mani-
fested in other more positive morbid symptoms, which being cured by
appropriate  homoeopathic  medication, the pellicle  entirely  fails to
make its appearance.  Still in cases of supposed pregnancy the experi-
ment  could  easily be made as a matter of curiosity.
  Sensible Signs.—The sensible signs of pregnancy are observed
through the medium of the senses of touch and hearing.  By the
touch we  examine  the  condition and  position of  the uterus and its
relations to  the adjacent parts, externally, through the vagina, and, if
necessary, through the rectum.   By  auscultation we  ascertain  the
  * See American Journal of the Medical Sciences, New Series, vol. iv., July, 1S42. 
US              THE DIAGNOSIS OF  PREGNANCY.
 probable  existence of pregnancy from hearing the bruit de souffle, or
 bellows murmur, and, at a little later period, its positive existence by
 detecting  the pulsations of the foetal heart.
   The term "touch" signifies  the means whereby knowledge is  ob-
 tained of the condition of the woman as to health or disease, or whether
 she be pregnant or otherwise—by vaginal or anal examination with
 the finger, or by external  examination with the hand, called  palpa-
 tion.  By vaginal touch we may be able to  diagnose the stage of
 gestation,  the stage  of parturition, or  whether the woman is  in  that
 state, the progress of labor, the presentation and position of the child;
 in fact  all  normal and  abnormal conditions wliich  have ultimated
 themselves  in material products.   In order  to  be able to use the
 touch with  certainty and advantage, the  finger must be educated to
 recognize  all the normal conditions, then  it will be able to readily de-
 tect disease  or any important change in material  or structural mani-
 festations.   The vaginal touch may  be  practiced with  the  woman
 standing, lying upon her back or upon either side.
   If she be standing the physician should place himself toward her
 left and upon his right knee,  his left hand upon her abdomen exter-
 nally, and his right hand, the  index finger being well lubricated with
 oil, should be carried under her clothes  and directly between her limbs,
 —great care being taken not to touch her skin—the back of the hand
 upward,  with all but the  index  finger  closed.   The index  finger
 should be slightly flexed, and  if carried  directly between the limbs
 without shocking her by touching the skin, the back of the finger will
 come directly in contact with the hairy  portion of the vulva; now
 press with a little firmness and straighten the finger and its point will
 pass  directly into the vagina.  Now drop the wrist and pass the finger
 upward and forward and it will exactly trace the  canal of the vagina,
 and by rotating the hand on the wrist the interior cavity of the smaller
 pelvis can be explored and all  the abnormities and deviations in that
 vicinity may be noted.
   If the woman be  lying  upon her left side, with her thighs  flexed
 upon  her  abdomen,  which is the  most usual  position for  the  exami-
 nation, the  physician will  sit  at  her back  and use his right hand.
In this case  also the thumb and all the  fingers should be closed except
the index, which should be well lubricated and slightly curved, as
before directed.  The hand  should be  carried to the parts with great
care to avoid touching the  bare skin unnecessarily.  As the back of
 the finger comes in contact with the vulva, press  firmly though care-
fully, straighten the finger and its point at once enters the vagina. 
THE DIAGNOSIS OF PREGNANCY.
119
Let the finger now be carried backward and upward and  the  eana?
of the vagina will be traced, and by rotating the hand as before, all
parts  of the canal can be  well examined.   If the patient be  lying
upon  her  right side, the  physician  will seat himself at her back  as
before, but will  touch with the finger  of the  left  hand.   Anointing
the finger with  lard  or oil not onlv facilitates its introduction into
the vagina, but serves to protect it from any disease that the woman
may have.
  The physician should accustom himself to examine with both hands;
since  it may be necessary sometimes to use the left hand  from the
peculiar condition of the patient herself, or  from experiencing a tem-
porary injury to  his right.   In like manner it may be desirable  to
examine both in the erect and in the horizontal  position.  In the
earlier months the recumbent position, with the extremities flexed and
separated, will give a greater degree of relaxation of the abdominal
muscles and  render the  uterus more completely accessible.  In the
standing position, ballottement may be more  readily  accomplished.
But in all doubtful or difficult cases, the woman should be  examined
in both positions.  When about to be examined standing, the patient
should be placed with her back against  the wall,  a chair should be
placed at each side to support her hands, and  the  upper part of her
body should be a little bent over and forward.
  When it becomes  necessary to make an examination per vaginam,
all the parts of the perineum, vulva, vagina and cavity of the pelvis
should be carefully explored, in order to detect any existing abnor-
mities  or diagnostic indications.  If the patient be a supposed primi-
para, the condition of the  vagina as constricted and presenting the
evidences  of increased activity of  the  circulation  will  be carefully
noted.
  The position and direction of +hc os uteri will  then be ascertained.
If in the early weeks of pregnancy, the uterus may be found some-
what settled down in the pelvis, and the os looking toward the hollow
of the sacrum.   Or the  supposed greater advance in the  pregnancy
will prepare him to find  the uterus in its usual position when unim-
pregnated,  or still higher,  above the superior strait.   Thus, on the
one hand, the indications given by the rational  signs will  be either
confirmed or invalidated by these sensible evidences; and on the other,
the rational signs and history of the case will  direct the  physical
exploration.  The impregnated uterus is heavier than in the ordinary
state;  and its lower segment, at about the third month, will be found
so distended as to occupy nearly the whole cavity of the lesser pelvis. 
120
THE
DIAGNOSIS OF PREGNANCY.
Its mobility is very slight; when, if unimpregnated, it would be verj
movable in every direction and much easier to raise on the point of
the finger.
   One of the surest of the sensible signs of pregnancy at this stage
consists in the softening of the extreme  point  of the  neck.  The
sensation is that  of a  sort of velvety  softness, only  deeper, beyond
which may be felt a certain hardness, as of a board.  No other  state
than pregnancy can either produce or simulate this feeling of softness.
And this softening, as well as a corresponding dilatability of the neck,
increases from below upward, from month  to month, in almost exact
proportion  to the  development of the pregnancy.
   Palpation is  a  means of obtaining knowledge of the condition of
the womb by placing the hands upon  the  abdomen externally; and
this method is much pleasanter to the woman than the former, although
not so satisfactory.  If the abdominal  integuments are not too thick
and fleshy,  by placing the patient upon  her back, with her head raised
and her thighs flexed, and pressing the  points of the fingers gently
downward and  backward  above the pubes, a hard, round  tumor will
be  found on the  median line rising out of the pelvis.  This can be
felt as early as the third  month, if the  walls of the abdomen are not
too thick.  In  two or four weeks later  the increase is  much  more
strongly  marked  and the true  state  of the case  more certainly  an-
nounced.   We  must bear in mind that, as pregnancy advances, the
tumor loses more and more of its hardness and  becomes  more and
more  elastic, like  a cyst filled with water.
   Percussion is also useful in deciding as to the existence of pregnancy.
In such cases the uterine tumor will  invariably afford a  dull sound,
unless a mass of intestines should intervene, while all around may be
distinguished the  usual clear abdominal resonance.  But, in pursuing
this method of examination, care must  be taken not to confuse all the
indications  by percussing over a full bladder.  Tumors of the abdomen
or womb wrould also give a similar dullness on percussion; but such
tumors are  irregular as to the time of their development.
   In  doubtful cases, where  decided enlargement  of the  abdomen is
present, the exploration per vaginam becomes of very great import-
ance,  since  the  softening of the os uteri  and even of the lower end
of the neck does not  occur  from any other cause than  pregnancy.
By the end of the sixth week this softening can  be  detected, like a
piece  of velvet drawn over a table.  But wdiere tumors occur in the
abdominal  cavity, unconnected with pregnancy,  they mav be  more
easily detected by simulteneous palpation and  vaginal touch.  This 
THE DIAGNOSIS OF PREGNANCY.
121
is accomplished with the finger  applied  to  the  cervix uteri, and the
omer hand placed upon the abdomen externally, in order to find the
fundus uteri.   The finger  may be  brought in direct apposition with
the  lower portion of the uterus, while the  other hand presses down
its upper portion, so that, with the  exception of  the abdominal walls,
nothing but the uterus itself intervenes  between the  two hands.   In
this  maimer a judgment may be formed  as  to the  size of the organ,
as well as of its relations to the surrounding parts.  And  thus, any
tumor wliich may have occasioned  the abdominal  enlargemant miy
be distinguished from the  uterus.  If unconnected with this organ,
the  tumor will' remain stationary when the  uterus  is  moved; if  it is
attached  to the uterus, moving the  latter will, of course, be attended
with corresponding movement of the former.  And, in addition to
any other tumor in the pelvis or rising above it, the actual size of
the  womb will  also be ascertained, since the  presence of any adven-
titious growth  in the pelvis,  whether connected with  the  uterus or
not,  by no  means precludes the possibility of pregnancy also.   The
greatest caution should be observed, as  well in making the exami-
nation as in giving a final opinion.   It is  not many years  since the
profession, in a certain city in New  England, were  greatly amused at
the denouement  of a case of uterine tumor in the wife of a well-known
practitioner.  The poor woman,  who  had sons grown up, and  was
supposed to have  passed the change of life, during a course of several
months  endured all the severities  of the most  orthodox allopathic
treatment at the hands of  her anxious husband, assisted by a much
older and more eminent practitioner than himself, in  which  injections
of solution of nitrate of silver and large and frequent doses of the
most powerful drugs performed  an  active part.   The case  advanced
in spite of the treatment; and, the  symptoms becoming more urgent,
a third  physician was  called in consultation, who  presently relieved
the  patient from her dangerous condition by delivering her  of a full-
grown child, which had finally succumbed to the tours deforce of the
latest injections. The patient had had no other disease than this tumor
(pregnancy);  but it required many months for her to recover from the
effects of the protracted treatment she had undergone.*
  During the first three or four months it is a dinicult matter to de-
termine the existence of pregnancy; up to this time the most certain

  * This statement is simple fact; the circumstances were well  known at the  time
to the public, as well  as to the profession, and are by no means forgotten now.  The
account is given  here simrly to show how men  of the Lirgest experience may nol
only be mistaken,but remain go. 
122
THE DIAGNOSIS  OF PREGNANCY.
sign is  the  unmistakable softening of the cervix or os tineas.   By
taking into consideration, together, all the rational and sensible signs
and the time of their appearance, we may in most cases be  able to
announce  pretty confidently the existence  of  pregnancy'by the third
or fourth month, but not with absolute certainty.   On the other hand,
from being able to ascertain that the uterus still retains its  natural
size we  can with  much  more positiveness determine that pregnancy
does not exist in a given case.  The uterus may, indeed, be enlarged
or distended by some other cause than pregnancy;  but if it is not
found enlarged at what should  be the third  month, we may be sure
there is  no pregnancy.
  During the  last five months  the active and passive movements of
the child reveal  the fact of pregnancy with sufficient certainty. The
active movements are felt by the  woman  at  about four and  a half
months, sometimes earlier.  In accordance with  the strength  of the
child  they are  at first  very slight and uncertain.  We  can easily
imagine how delicate must be the sensations experienced by the woman
from the  motions of a foetus  of four months, and trace them to the
bounding  and springing of a viable child of eight or nine months.  It
might be  imagined that these  sensations  experienced by the mother
would be quite infallible as indications  of pregnancy.  But  other sen-
sations,  the result even of morbid changes in the abdomen, have been
mistaken  by women for those occasioned by a foetus in utero.  In-
stances are given by Avriters in which the sensations produced by an
incipient dropsy, in connection with the enlargement of the abdomen
from the same cause, have  been mistaken in this manner, to the seri-
ous disappointment of all  concerned.   But the physician is not liable
to such  misinterpretation of sensations.   By placing his open hand
upon the abdomen the motions of the child may easily be  perceived
if the woman  be pregnant, and these movements  are  unmistakable,
since no pathological conditions can simulate them, although cases are
recorded in which foetal movements were simulated by persons who
had acquired complete  control  over the abdominal muscles.   When
from the  inactivity of the  child  it becomes desirable to provoke its
movement, this may be  done by placing one  hand upon one side of
the abdomen and with  the other hand gently striking the opposite
side; the  child will move  quickly as if to get out of the way.  By
some women the  motions  of the  foetus  are felt about the end  of the
third  month, usually at about four months and  a half.   Some are
conscious of these movements  only after six, seven, or eight months,
and some  do not experience them at all.   This, which is owing to the 
                THE DIAGNOSIS OF  PREGNANCY.             123

great  passiveness  of the child, is particularly apparent in women of
an inactive, sluggish temperament.   After the motions have been dis-
tinctly recognized  for some days, if they then evidently become weaker
and weaker, or entirely fail, the physician should at once understand
that there is danger.  All  the mother's  symptoms should be at once
sought out, for some condition threatens the destruction of the life of
the child.  The proper remedy will remove  this abnormal condition
of the mother and restore the motions of  the  child.  In plethoric
women aconite will often do this, but we must be guided here, as else-
where, by the symptoms.
  The passive movement, or ballottement, is obtained by the manipula-
tions of the examiner.  The foetus swimming in the amniotic fluid is
nearly of the same specific gravity; being a little heavier, it just swims
in the fluid, touching the lower internal surface of the amnion at inter-
vals.  Consequently; if we suddenly press upon the most dependent
portion of the uterus, and then retain the finger steadily at that point,
the foetus, having  been forced to rise in the  fluid by the sudden pres-
sure, will soon return, and its weight will be felt  as it again strikes
the finger of the  operator.  The proper method of performing this
operation by the vaginal touch is to place  the woman either  in the
sitting or the erect posture, then with the finger upon the wall of the
uterus, either in front  or behind the cervix,  curve the finger suddenly
upward and forward, hold it there for a moment, when the foetus,
having been displaced and made  to rise in the fluid, will rebound and
impinge upon the finger which displaced it.   There results an unmis-
takable  downward  shock, and a sensation  upon the  finger which no
other  condition of the woman can  possibly produce.  The same ex-
'periment with a stone  in the bladder might seem to simulate this, but
the sharp, strong  blow which would be  given by a stone would con-
vey a very different impression  from  that of the  gentle, momentary
touch of the foetus rebounding in the amniotic fluid.
   The accoucheur should be careful, in the effort to  detect ballotte-
ment, to press from below upward, and  at the same time from behind
forward.  Pressure simply from below  upward may not be sufficient
to cause the desired momentary  ascent of the foetus, and the experi-
ment  may therefore fail.   The force exerted upon the floating foetus
in utero should be  in  the direction, as nearly as  possible, of the axis
of the uterine cavity.
   The same ballottement sensation may also be obtained by placing the
woman upon her side,  with the palmar surface of all the fingers applied
to the most dependent part of the abdomen, forcibly flex them against 
124              THE  DIAGNOSIS OF PREGNANCY.

the abdomen and hold  them there; the foetus, thus suddenly displaced
will  rebound  from the  upper side  of the  uterine cavity, where its
movement may be felt against the other hand there applied, and settle
down again upon the  fingers with a certain gentle, subdued, unmis-
takable shock.  The most favorable time for obtaining this  sign of
pregnancy is at any time after the period of quickening and before
the first of the ninth month, for then the child  becomes too large to
be easily displaced  or  to descend upon the finger.  At six  months
and a half  or  seven months  is  the most satisfactory time for making
this diagnostic experiment.
  Where, from the  presence of the hymen or the partial obliteration
of the vagina, the examination per vaginam is inexpedient or impossi-
ble, it may be  made through the rectum.  But the unpleasantness of
the operation to the physician, as well as to the woman herself, would
prevent resort  to the rectal examination, except in cases where no other
method was available,  or where there existed an urgent necessity for
a positively correct  diagnosis, and the conjunction of  all other means
failed to afford a satisfactory result.
  Auscultation as applied to pregnancy consists in listening  for  the
beating of the foetal heart.  If the stethoscope be applied to the abdo-
men  with care  at any time after the  period of quickening,  the heart
of the  foetus may be heard to beat nearly twice  as  fast  as that of  the
mother, with a sound faint indeed, and muffled, but still  unmistakable.
These  pulsations generally become perceptible  in  the  course of  the
fourth  or fifth  month,  and they range from  one hundred and thirty
to one  hundred and sixty per minute.  They are sometimes faster and
sometimes  slower without any assignable  cause,  apparently not in
the least influenced  by the changes in the pulse  of the  mother.   The
foetal pulsations will be  most distinctly perceptible in that region of
the abdomen which corresponds  to  the dorsal  surface  of the foetus.
They are more frequently heard over the left iliac fossa than over the
right, less frequently on  the  median line above the symphysis pubis.
There  is always  a  point over which these  sounds  are  most distinct,
and they diminish in intensity as we recede  from this point.  In their
intensity these  pulsations vary with the age of the foetus, increasing
in strength usually  up  to the full term.  But the number of the  pul-
sations  is very much the same from  the period of  their being  first
distinguished  up to the full term, except in some anomalous cases.
When in the  progress  of  labor the membranes  are  ruptured,  the
escape of the  liquor amnii, by  bringing the ear still nearer the foetus,
renders the beating of the heart more distinct.  The pulsations  be- 
THE DIAGNOSIS OF PREGNANCY.
125
come  less regular as the labor advances, and they are more slow and
feeble during  the contractions.  Hence it becomes  evident  that the
           ©
health of the child must always be more or less seriously compromised
during difficult and protracted labors.
  When the dorsal  surface of the foetus is toward the abdomen of the
mother, the pulsations are more distinctly heard; but after the sixth
month they may be heard in  any position  of the foetus.
  There are two distinct sounds observable in the beating of the foetal
heart, corresponding to those of the adult heart—a first and a second
sound, of which the first, is more distinct.  In  those cases where  at
first but a single sound is heard, the other may often be distinguished
by examining  in some different position.
  As  a  sign of pregnancy the beating of tlie foetal heart is conclusive,
since no other conditions can produce a similar sound.
  Aneurisms  or other abnormal pulsations of the  mother  must be
synchronous with the  pulse at the wrist, which is never the case with
the pulsations of the foetal heart.
  Double or twin  pregnancies may be detected by hearing  the pul-
sations  of the foetal heart at two distinct parts of the  abdomen, the
sound  becoming more and more distinct as you  approach each part;
while at the same time there is a perceptible want of harmony between
the two sounds.  Still, the apparent absence of the sounds of two hearts
does not preclude the  possibility of a twin pregnancy, since one foetus
may be so directly behind the other as to mask its sounds.
  The position  of  the  foetus in the  uterus can  be  determined to a
limited  extent only by auscultation.   The pulsations heard most dis-
tinctly  on the left of the median  line,  low down, just  above the
horizontal ramus of  the pubis, indicate the first position.   When
they are heard in the same  situation on the right side, they indicate
the second position.  The sounds being heard on either side on a level
with or even above  the umbilicus indicate a breech presentation.   If
there be any truth at all in the  statement that Pulsatilla,  by reason of
its action upon the muscular fibres of the uterus, can produce a change
in the position of the foetus  from an  unfavorable  to a favorable one,
then the ascertaining  of the position of the foetus by means of the
stethescope becomes a  matter  of moment in all cases  of pregnancy, as
touching the welfare of both  mother and child during parturition.
  A careful study of  the  sounds of the foetal heart, both during the
continuance of utero-gestation and at its period in labor,  enables us
to determine  the health of the child.   Thus, after the  sixth month,
when  we have had  sufficient evidence of the existence of pregnancy 
126
THE DIAGNOSIS OF PREGNANCY.
the absence of the sound produced by the pulsations of the foetal heart
ascertained  by repeated  examinations  made  at different  times, will
prove the death of the foetus.   And during labor, if after the rupture
of the membranes the pulsations of the foetal heart become irregular,
more and more feeble and more and more rapid, with irregularity of
rhythm, absence of the second stroke, complete cessation of the beats
during the pains and slowness of their return after these have ceased,
the life of the child  is evidently threatened by further delay,  and the
labor should be terminated as promptly as possible.  Still, it should
be remembered  that just in proportion  as  from auscultation we have
reason to conclude  that  the child is no  longer living  or viable, we
should  give our principal  attention to the mother and govern  our
conduct by indications derived from her condition.  For  in many cases
of protracted labor,  in which  the pulsations can still be  distinguished
at the  moment of birth, the child  has  already suffered  so much that
respiration cannot be established.   While the positive  evidence of the
death of the foetus  in utero which may be afforded by auscultation,
leaves  us at liberty to resort to craniotomy  under circumstances in
which  it might not be justifiable if the child were still living.
  The  bellows  murmur,  bruit  de  souffle,  although capable of being
distinguished before any of the other intra-uterine sounds, before the
beating of the foetal heart can be heard, is here mentioned in the second
place, since it possesses little or no diagnostic value.  This sound may
generally  be heard  as soon as the  uterus has risen out  of the pelvic
cavity—that is, a little earlier  than the sound of the foetal heart can be
made out.  From the supposition that it was produced  in the utero-
placental  circulation, it has been called the placental murmur.   From
being supposed by others to be produced by pressure of the developed
uterus upon the iliac arteries and  aorta, in the  posterior plane of the
abdomen, it has been termed the abdominal souffle.  From being sup-
posed to  originate in the enlarged vessels which ramify in the walls
of the uterus, it has received  from others the name of uterine souffle.
The fact  that this sound  has been distinctly heard for  a short time
after delivery is conclusive against the placental theory.   The double
fact that this sound  is heard as distinctly in the same position, when
the pressure of the  gravid  uterus  must be supposed  to be  removed
from the  posterior  abdominal arteries, and that  it disappears  under
pressure made upon the  anterior of the uterus directly toward the
spine, proves no less conclusively that it is not  caused by obstruction
of or pressure upon  the iliacs  and the aorta.  There remains only the
hypothesis o' the uterine sinuses; and here the following  circumstances 
THE DIAGNOSIS OF PREGNANCY.
127
may be considered as decisive of the question :  the bruit is heard in the
earlier part of the second moiety of utero-gestation, nearer the pubes,
and it gradually ascends with the upward advance of the uterus; it is
most distinctly heard in that portion of the uterus where its vessels
are largest; and finally it may be heard through an instrument (the
metroscope of M. Nauche) applied to the cervix uteri, when it cannot
be distinguished by  the ordinary abdominal examination.
  The bruit de souffle, uterine murmur, then, is produced in the Avails
of the uterus itself and is synchronous with the radial pulse.   It can
be heard in chlorotic women  in whom no pregnancy exists, in cases
of fibrous tumor and vascular tumor of the uterus, and  in males.
As  a  sign of pregnancy its value  is  very differently  estimated by
different authors, some  giving  it much more  importance than others
do. It can only serve to render probable the existence of pregnancy,
since  it may exist independently  of pregnancy and  does not always
accompany it.  No proof of the life or death or position of the child
can be obtained from the uterine murmur, nor whether the uterus
contains one or more  than one  foetus.  Where we are certain  the
woman has no disease, the bruit de souffle becomes of some importance
as a sign of pregnancy.
  In  auscultating the  abdomen for the purpose of discovering  the
signs of pregnancy, it should be remembered that the uterine murmur
may be  first distinguished at about the fourth or  fifth  month, or at
whatever time the uterus rises out of the  pelvic cavity, and that the
beating of the foetal heart may be discerned in the course of the fifth
month, so that in most cases the  examiner may expect  to meet with
both classes of sounds.   The bruit de  souffle, coming first in order of
time,  may serve to render pregnancy probable, while the clearly dis-
tinguished beating of the foetal heart not only renders absolutely cer-
tain the presence of  a  living foetus, but affords some indications as to
its position in the womb and its healthy condition.
  Auscultation in the  earlier  months  of pregnancy can only be  ac-
complished by placing the woman upon her back; later she may lie on
her side, sit, or be examined standing.   It is  always best to  use  the
stethoscope, which should be placed at once, first on the  left side, low
down, then in the same  region on the right side  if  necessary.  Thus
by applying directly to the place where the pulsations are most usually
to be found, we escape annoying the woman by searching at random.
It is important for the physician to avoid  stooping  too  much, which
in many cases will cause such  a pressure of blood in his head as to
prevent him from hearing at all.   By using the stethoscope the exam- 
128              THE DIAGNOSIS OF PREGNANCY.
 iner will avoid all danger of confusing the uterine sounds by the fric-
 tion of his ear upon the abdomen, and at the same time  relieve his
 patient from the close  personal contact which  to  many women is  a
 very serious  annoyance.  In cases in which the mother has  already
 recognized the  foetal movements, the stethoscope should  be  applied
 exactly opposite to the side where these are most distinctly felt.  For
 the upper and lower extremities of the foetus which cause the " mo-
 tions" being  folded npon the abdomen, and the pulsations of the foetal
 heart being  most distinctly perceived from the back, it will  be evi-
 dent that if the motions are felt in the left side of the abdomen of the
 mother, the sounds of the foetal heart will be  plainest  on the right
 side, and vice versa.  Before the fifth month,  however, the pulsations
 are usually most plainly discernible  on the  median  line, from  the
 pubes to the umbilicus.
   In  addition to the uterine murmur, or uterine souffle, as it is more
 properly termed, and the beating  of  the foetal heart, certain " sounds
 of the displacement of the foetus" have been distinguished by auscul-
 tation, and at a  period even prior to  the uterine  murmur.   These
 sounds  consist of shocks, sometimes  quick, like a light tap, and at
 other times more like  a heavy plunge, and  there are also friction-
 sounds which are  evidently produced by  the gliding of the  surface
 of the foetus over the  inner surface of the  uterus.   Some  have even
 believed they could  distinguish the pulsations over the funis  itself—
 in cases where the parietes of the abdomen were extremely  thin.  But
 both these classes of sounds, while they possess at the least very little
 of practical diagnostic  value, require for their  successful  discovery
 more protracted opportunities for auscultating the particular case, and
 greater skill and more extended experience in  auscultation in general,
 than usually  fall to the lot of the young physician, at least in  private
 practice.

     Statement of the Principal  Signs in Pregnancy,
Showing the time and order of their appearance; condensed from Cazeaux.
  First and Second Months.—Suppression of the menses, usually
 from the first of conception, some exceptions, which  however are less
numerous in  the later months.  Morning sickness, nausea and vomit-
ing, and other gastric disturbances, sometimes  flattening of the hypo-
gastric region, depression of the umbilical ring.  Enlargement and
tenderness of the breasts, increase in the  size of the uterus. It slightly
descends and  becomes less movable.
  Third  and Fourth Months.—Toward  the close of the third 
THE diagnosis of pregnancy.
129
month the fundus uteri rises to the level of the superior strait.  About
the end of the fourth month it reaches midway in the space between
the umbilicus and the pubes.   Vomiting and  other gastric derange-
ments.  A small protuberance in the hypogastric region.  By abdom-
inal  palpation a round tumor may be detected of the size of a child's
head.  Less depression of the umbilical cicatrix.  Increased enlarge-
ment of the breasts; the nipple appears more prominent and  the areola
slightly discolored, especially in primiparse.  In the  fourth month the
cervix uteri  appears elevated  and directed backward  and to the left
side.  The orifice of the os tinea? is more  softened ; in multipara? it is
patulous, admitting the finger; in primiparse  it is closed and rounded.
Kiesteine in the urine.
   Fifth and Sixth Months.—Toward the close of the fifth month
the fundus, uteri is one finger's breadth below the umbilicus, and the
same distance above at the end of the sixth month.  The gastric dis-
                                                      ©
turbances generally disappear.  The sensation of " quickening" may
be experienced about the sixteenth or eighteenth week—that is, about
the beginning or middle of the fifth  month.  Then the movements of
the foetus itself begin to be noticed.   The  abdomen becomes still more
enlarged.  The  umbilical depression is nearly effaced.   The uterine
murmur may be heard, and-soon after the beating of the foetal  heart
may be distinguished.  Ballottement may be  detected.  The discolora-
tion  of the areola becomes deeper.  Kiesteine in the  urine.  The infe-
rior  half of  the intra-vaginal portions of the cervix uteri is softened.
In multipara the  finger can  penetrate the cavity of the  neck, which
in primipara? remains closed at its orifice, though softened.
   Seventh and Eighth Movths.—Increased size of the abdomen.
The  fundus uteri is four fingers' breadth  above the umbilicus at the
seventh month, and  five or six at the eighth.  Dilatation of the um-
bilical ring, pouting of the navel.  The movements of the foetus are
more sensibly felt.  The  sounds of the foetal heart  are  mores clearly
distinguished.  Ballottement, which  is easily detected  in  the seventh
month, becomes somewhat more obscure in  the eighth.   The soften-
ing of the cervix uteri extends above the vaginal insertion ; in primi-
para? the cervix is ovoid and  shortening; in multipara? it is conoidal,
and  so patulous as to  admit the whole of the first phalanx of the
finger, while at the upper portion of the  neck  it still remains closed.
The  mammary  areola? become  darker.   The  breasts  become  more
fully developed, and there is  a show of milk.  Kiesteine  still appears
in the urine.
   Ninth  Month.—First  Fortnight—The fundus  uteri reaches  the
       9 
130
DEVELOPMENT of the ovum.
epigastric regi on  and (on  the  right side) presses the inferior margin
of the false ribs.  Difficulty of respiration.   The  abdomen is  still
more enlarged, the skin is stretched and very tense.  The foetal move-
ments are active.  The sounds of the foetal heart are heard.  In primi-
para? the cervix is softened and its external orifice slightly opened.
In multipara? the  finger may penetrate its entire cavity to the os inter-
num, which remains closed.  Ballottement indistinct.
  Second Fortnight.—The fundus uteri sinks down a little, in conse-
quence of the body and neck becoming one and constituting the uterus
one rotund cavity.  Vomiting is less troublesome and the respiration
easier.   Walking  becomes  difficult.  Frequent and sometimes ineffec-
tual efforts to urinate.  In  multipara? the internal  orifice  is  dilated,
and the finger may reach  the naked membranes.  In primipara? the
entire cervix is expanded, the os externum remaining closed.  Hem-
orrhoids, varices  and oedema  of the  lower limbs,  and  even  of the
vulva.
                       CHAPTEK  IX.

              DEVELOPMENT  OF THE OVUM.

                 The  Unimpregnated  Ovum.

   THE ovary is principally composed of Graafian vesicles or follicles
    imbedded in areolar tissue and abundantly supplied with blood-
vessels.  Each vesicle contains  a  single ovule and consists of two
membranes, the  outer of which is  in contact with the  stroma of the
ovary, while the inner tunic, or membrana granulosa, forms the im-
mediate covering of the  ovule and of the liquid  in which it floats.
For the ovule  occupies but a very  small  part of the cavity of the
Graafian  vesicle, the remainder  being filled  with albuminous  fluid,
granules and oil globules, which, from their greater gravity, support
the ovule upon its surface near the  upper portion of the vesicle.  Here
the ovule comes in close  relation with the inner surface of the mem-
brana granulosa,  and at  this point there is found collected upon the
ovule a zone of granules  called the discus proligerus.
  The ovule is composed externally of an envelope, the vitelline mem-
brane,  sometimes called the zona pellucida, which after fecundation is
known as the chorion; internally the ovule is composed of the vitellus,
or yolk, a  spherical, semi-solid  mass, or granular, organized liquid. 
DEVELOPMENT OF  THE  OVUM.               131
The ovule is very small, measuring from the two hundred and fortieth
to the one hundred and twentieth of an inch in diameter.
  Within the vitellus, and situated almost immediately beneath the
vitelline membrane, is found  a clear, colorless, transparent vesicle of
a rounded form, called the germinal vesicle.   This may measure from
the eight-hundredth to the five-hundredth part of an inch in diameter.
Whether this vesicle is developed from the ovisac or exists before the
ovisac is formed is a point not yet decided.
  Upon the surface of the germinal vesicle may be seen a dark spot,
like a nucleus, called the germinal spot.  While the rest of the contents
of the vesicle is transparent, this  is  opaque; and its diameter may be
stated to  be  not more than  the two-hundredth or three-hundredth
part of a line.*
  Such is a succinct description of the human ovum in its unimpreg-
nated condition.  But if we examine the same ovum some three weeks
after it has become fecundated, we shall find it so wonderfully changed
that, were it not for the fact that all the various steps and stages of this
remarkable transformation may be  traced in the development of the
ova of fishes, of birds and of the lower orders of the mammalia, we
might entirely fail of being able  to  recognize and  prove the identity
of the  one with the  other.  In fact, as the human ovum  corresponds
with that of the chick, ovology may be conveniently studied compara-
tively.  By carefully breaking the egg of a chicken, it will  be found
that there exists a delicate transparent membrane  which contains the
fluid parts of the egg, and which constitutes  the vitelline membrane,
while the yellow portion or yolk is the  vitellus.  Upon this may be
observed a whitish vesicle—the germinal vesicle; and in the centre of
this the dark germinal spot.   The  albuminous fluid surrounding the
vitellus or yolk is similar in quality, though greater in quantity, to that
found in the  human ovum.  The external tunic becomes the chorion,
whose cellular surface is extended into a number of villous prolonga-
tions, which form the channel through which the embrvo is nourished
by the fluids  of the parent,  until  a more perfect communication is
subsequently formed.   The  internal  tunic,  above described as the
membrana granulosa, becomes separate  and distinct from  the  outer
one, and is called the amnion.   Between these two membranes now
intervenes some considerable  space, which is occupied by an albumi-
nous liquid, in the  midst of  which  is situated  the umbilical vesicle.

  * For a more complete elucidation of this interesting subject, see Dr. Arthur Fane's
article on the "Uterus and its Appendages," and  Dr. Allen Thomson's article on the
"Ovum," in Vol. v., Cyclopaedia of Anatomy and Physiology. 
132
DEVELOPMENT OF THE OVUM.
Within the amnion is found another fluid, the liquor amnii, in which
is  supported the ovum.  In  the  ovule itself  the germinal  vesicle
disappears, and a new cell, the embryo cell, arises in its place.   And
finally, the entire ovum, with its external covering, is enveloped by a
double covering, the deciduous  membrane, which  is developed  and
reflected from the inner  surface of the uterus.
  The manner of the escape  of the unimpregnated  ovule from the
ovary has already been  described, on page 73 of this work, to which
reference is now to be made.  The description of the manner in which
impregnation is effected will be found  on page 80 et seq., which see.
The changes which occur in the  uterus  immediately  after conception,
and the attendant condition of the ovary and Fallopian tubes, have been
recounted on pages 86  and 87 ; these should be  carefully reviewed.
It remains now to describe  the changes that occur in the ovum from
the first  possible moment  of  observation after  impregnation, to the
full development of the new being at the  period just preceding par-
turition.
   No change has ever  yet been observed immediately after fecunda-
tion, until the escape of the ovule from the ovary  into the abdominal
extremity of the Fallopian tube.  No ovule  has yet been observed in
the Fallopian tube still  presenting either the germinal vesicle or the
germinal  spot.   At what  time exactly these  features of the ovule
become transformed  has not  yet  transpired.  But it is  certain  that
the ovule, either while  still remaining in the ovary  or on its way out
from it, gradually loses both  the germinal vesicle and the germinal
spot.  It may be possible  that the spot disappears first, the vesicle
subsequently;  and  it  is certain  that  the space  occupied by  them
becomes  filled  with granules.   This  single circumstance  alone  is
sufficient to prove that conception must take place before the ovule
enters the Fallopian tube, and  that the ovules  that have just caused
the menstruation cannot be  the  same that are  impregnated.   The
same  circumstance also proves  that there  is one ovule for menstrua-
 tion and another for conception.
    The only change observable in the ovum during its passage through
 the first half of the Fallopian tube is  the thickening of the vitelline
 membrane.  During the passage of the ovum through the second por-
 tion of the tube, the vitellus evidently becomes more consolidated; and
 in concurrence with this  change a thin white  fluid escapes, entirely
 surrounds the vitellus, and fills the interval between the vitelline mem-
 brane and the vitellus,  occasioned by the condensation of the latter.
    Other,and very remarkable changes take place in the ovule  as  it 
DEVELOPMENT  OF THE OVUM.
133
descends through the second portion of the Fallopian tube.   One of
the more  remarkable of these  constitutes what is termed the segmen-
tation of the vitellus, which, with  its immediate consequences, may be
thus described.  The vitelline membrane  continues to  thicken, and
the vitellus becomes divided  into two distinct spheres, each of which
Fig. 26.                  Fig. 27.
A, the layer of albumen;  V, the vitelline membrane.
           THE FECUNDATED OVUM AT A MORE ADVAXCED STAGE.
  A, the albuminous layer surrounding the vitelline membrane V, which is seen to be
thickened, and to contain within its cavity the mulberry-like mass.

is  again divided  into two others; these again into others, and so on,
during the whole course of the descent into the uterus, each minute
sphere dividing and subdividing until the ovum reaches the uterine
cavity.  The vitellus is thus completely dissipated, and what in the
first instance was its exterior surface  comes to resemble a mulberry-
seed in its appearance; while its cavity or interior is filled with  a
liquid  containing an  infinite number of minute  granules.   (This
process of segmentation  is illustrated in Figs. 26, 27 and 28.)
   These are termed vitelline spheres; they have a somewhat firmer con-
sistency than the original  substance of the vitellus, and this consist-
ency appears to increase as they successively multiply in number and
diminish in size.  At last they become so abundant as to be closely
:rowded  together,  compressed  into polygonal forms  and  flattened 
134
DEVELOPMENT OF THE OVUM.
against the internal  surface of the vitelline  membrane.  They have
by this time become converted into true animal cells, which, adhering
together  by their adjacent edges, form a continuous organized mem-
brane, called the  blastodermic membrane.  This  constitutes the germ-
mass, or  plastic material, out of which the entire organization of the
foetus is gradually evolved.
  This blastodermic membrane is subsequently divisible into two dis-
tinct layers, which are known as the external and the internal layers;
and as the blastodermic membrane, as a whole, represents all the fcetal
organization  in its totality, so these two layers represent  the com-
mencement of all the particular organs of the foetus, and the subse-
quent division of all  these organs into  two distinct classes—those of
the vegetative life and those of the animal life respectively—finds its
foundation in this pre-organic stage of organization. For the internal
layer of the blastodermic membrane produces the intestinal canal and
all the organs of vegetative life; while the external  layer is developed
into the spinal column and the organs of animal life.
  As nearly as can  be determined, the time occujned by the human
ovum in  traversing  the Fallopian tube is twelve days, and the move-
ment is always much more rapid  in the first than  in  the second half
of its descent, when the nearer it approaches the uterus the slower it
moves, probably on account of the increasing narrowness of the tube.
The ovum is known to enlarge decidedly during  its  continuance in the
tube, during which time the product of conception must be nourished
by the granules contained in its interior fluid.   When the ovum ap-
proaches  the uterine  cavity, we find in it simply the vitelline mem-
brane much thickened and surrounded  by a  dense  layer of albumen
which it  has  collected in passing  through the tube, and  the vitellus
containing some granulations remaining  from  the decomposition of
the mulberry-like body.  The vitelline granulations, as  they disap-
pear, give place to  a perfectly white, transparent  liquid.  In their
disappearance these  granulations seem  to be condensed, and by ad-
hering to one another they form a  new vesicle  which lines  the first.
This fact may be easily demonstrated by macerating the  ovule in
water, when the new vesicle Mill be thrown off by the water percolat-
ing through the vitelline membrane, and be seen to lay corrugated in
distinct folds in the above-mentioned transparent liquid.   This new
membrane, or vesicle, is called the  blastodermic vesicle.   Whilst this
process is going on the albumen collects as above stated, becomes ab-
sorbed and the vitelline membrane is much thinned.  The ovule now
for th<: first time begins to be fixed. 
DEVELOPMENT OF THE OVUM.
135
  In  sixteen or seventeen days after fecundation a rounded, whitish
speck is perceptible on some portions of the blastodermic vesicular
Fig. 29.
         THE OVULE SHORTLY AFTER ITS ARRIVAL IN THE WOMB.
  A, the diminished albuminous layer; V, the vitelline membrane; B, the blasto-
dermic membrane.

membrane, and really stands out in relief; this is called the embryonic
spot.  This embryonic spot is composed of granulations, like those of
the blastodermic vesicle, only they are more numerous and more con-
crete.  It is very evident that the embryonic spot and the blastoder-
mic membrane are each developed from processes of a double lamina,
which may be separated by means of fine needles.   Fig. 30 portrays
the doubling of the blastoderm, the embryonic spot assuming an elon-
gated form.  Finally, the blastoderm exhibits a convex and a concave
surface, as in Fig. 32.   The concave surface is divided  into  two dis-

              Fig. SO.                            Fig. 31.
  Fig. 30. The blastoderm with the embryonic spot seen in front; V, the vitelline
membrane; E, the external layer of the blastoderm; F, the embryonic spot.
  Fig. 31. The same figure in profile, to show the two layers of the blastoderm; V,
the vitelline membrane; E, the external, and I, the internal or intestinal layer of the
blastoderm.

tinct portions, one embryonic, the other becoming the umbilical vesi-
cle.   The tache embryonnaire becomes the embryo.  The margin of
the embryo exhibits  a tendency to double over, leaving a cavity (as
well as the extremities) of considerable depth.  The extremity which
 
136
DEVELOPMENT OF  THE OVUM.
is most fallen  is called  the cephalic, the other the caudal extremity,
As  the development of the  embryo  goes forward, numerous minute
elevations appear scattered over the external  surface of the  ovum;
these become the villosities which subsequently appear on the chorion.
At  the same  time  the  external  layer of the blastoderm is raised in
Fig. 32.
Fig. 33.
              El                          C
                                             V E   T
  Fig. 32. A section of a more developed ovum, in which the two portions, the em-
bryonic and the umbilical vesicle, begin to appear; O, the umbilical vesicle;  I, the
internal layer of the blastoderm ; E, the external layer; V, the vitelline membrane.
  Fig. 33. A section showing the origin and first traces of the amnios; O, the umbili-
cal vesicle; I, the intestinal, and E, the external layer of the blastoderm ; V, the vitel-
line membrane; C C, origin of the cephalic and caudal amniotic hoods.

folds around  the central or embryonic portion. (See Fig. 33.) Figs. 34
to 37 exhibit the continuous approach of the embryo toward the cen-
tre of the ovum, until the blastoderm has become united over the dor-
sal surface of the embryo, their union absorbed, and the embryo sur-
rounded by a complete fold of the external  or serous surface of the
blastoderm, which seems to be a continuation of that upon the abdo-
men of the embryo.
   This fold gradually increases in size at both the cephalic and caudal
extremities, and between these points to form, as it were, hood-shaped
investments of the embryo.   To these Cazeaux has given the name of
amniotic hoods.
   The new membrane thus formed is called the amnion, and become-
distended and separated from the external surface of  the embryo by
the amniotic  fluid.   The external or serous  lamina now forms a ring
or membrane by itself, which surrounds the whole.   This contains
the liquid  in which the embryo, with  its amnios, swims, and which
as the foetus develops,  is forced onward to join the vitelline mem-
brane and  chorion.   Immediately after the formation  of the amnios,
the doubling in of the cephalic and  caudal extremities increases, and
forms more and more the abdominal cavity of the embryo, and finally 
DEVELOPMENT OF  THE OVUM.                137
a mere canal leading out of the abdominal cavity into a large vesicle,
called  the umbilical  vesicle, and  this  canal, as  it  finally closes up,
forms the umbilicus of the nine months' child.
             Fig. 34.                             Fig. 35.
THE AMNIOTIC HOODS MORE DEVELOPED.
  Fig. 34. O, the umbilical vesicle; I, the internal or intestinal, and E, the external
layer of the blastoderm; E/, a portion of the external layer converted into the am-
nios ; W, the embryo; C, the limit of the amniotic hoods; V, the vitelline membrane.
  Fig. 35. This figure shows the amnios almost completed, and likewise the origin
of the allantois.  O, the umbilical vesicle ; I, the intestines; E, the amnios ; W, the
external layer of the blastoderm, or the non-vascular chorion ; V, the vitelline mem-
brane; C, the amniotic hoods ready to close up; A, the allantois.
  In the cuts 34,  35, 36, 37 blood-vessels may be seen running  from
the embryo  into this vesicle and again returning, one artery from and
two veins returning to the embryo; these are called  the  omphalo-me-
senteric vessels.  As this doubling of the embryo goes on (see Fig. 35),
we find a slight elevation  springing up at the  spot where the rectum
and bladder are confounded in the earlier days of embryonic life, under
the name of cloaca.  This begins to teke place about the time the em-
bryo has nearly exhausted  all the nourishment contained in the  um-
bilical vesicle, and the embryo would inevitably perish at this stage
from want of nourishment but for this wise provision of nature, by
wliich a connection is  formed with the parent; for this little eleva-
tion  rapidly extends to the villi  of the chorion, passing out from the
abdominal canal  alongside of the umbilical vesicle, and is  called the
allantois.  The allantois is composed of two  arteries  and one vein, the
arteries arising  from the  primitive  iliacs, carrying  arterial  blood of
the embryo, seeking  a  fountain  for allaying its  thirst for material
wherewith to sustain  the little  being over which it presides; for the
blood always contains all  the material  elements for upbuilding and
for repairing tissue. 
138                DEVELOPMENT OF THE  OVUM,
  These arteries seem to compel the growth of the allantois, and with
the accompanying vein plunge into and  take root in the villous coat
of the chorion, when the desired nourishment is found in the blood of

            Fig. 36.                                   Fig. S7.
  Fig. 36. This figure shows the rapid progress of the allantois, and  how it spreads
over the foetus, the umbilical vesicle and the amnios. This latter begins to unsheath
the pedicle of the umbilical vesicle and that of the allantois in such a way as to form
a commencement of the cord.  According to some writers the vitelline membrane dis-
appears more and more.  O, the umbilical vesicle ; W, the amnios; E//, the external
layer of the blastoderm ;  C, the  point where the two hoods come in contact; V, the
vitelline membrane almost entirely atrophied; A, the allantois.
  Fig. 37. In this figure the allantois has spread over the whole internal  surface of
the ovum, and but very slight traces are left of the continuity between the amnios
and that part of the external layer of the blastoderm which formed the non-vascular
chorion ; the latter has a tendency to be confounded with the chorion, and the amnios
encloses the umbilical cord more and more.  O, the umbilical vesicle; E', the am-
nios; C, the point where the  two  hoods are fused into each other and  form but a
single membrane; E//, the external layer of the blastoderm;  A, the allantois; V, the
vitelline membrane.

the mother.   This  is quickly carried  back by  the  vein  to the famish-
ing embryo, and delivered through the liver, as will be seen farther on.
In the subsequent pages,  also, it will be shown that the first  circuit in
the embryonic  circulation  constitutes the  beginning of the  placental
mass to be afterward described.
   In some animals, and perhaps  in  the human female, the allantois in
its development spreads  out like an umbrella; but for  all  practical
purposes  it is sufficient to describe it as taking root in  a  single villus
of the  chorion, and spreading out more  and more as  more ample
means of  supply are  demanded till the full time is accomplished.
   The closing  up  of the  abdominal  or umbilical  canal brings  the 
DEVELOPMENT OF THE OVUM.
139
amnios in close juxtaposition to the remaining minute stem of the um-
bilical vesicle (as seen  in Fig. 37), and  as  this canal closes  up the
amnios sheaths over the allantois and the small stem of the remain-
ing umbilical vesicle, which vesicle is thereby forced out, and is found
finally to be a little yellow body lying between the chorion and the
amnion, next to the placental mass, and the allantois stem is found to
be one and  the same  thing as the umbilical cord entirely sheathed
over by the amnios.
  With this description of the development of the allantois concludes
the principal parts of  the ovum; which are therefore: 1,  The em-
bryo; 2, the liquid in which it swims; 3, the amnios, filled with the
liquor amnii, and forming a sheath over the umbilical vessels; 4, the
umbilical vesicle with the omphalo-mesenteric vessels still to  be seen
communicating with the embryo; 5, the  allantoid vesicle; 6, the
space between the amnios and the umbilical vesicle, filled with liquid;
and 7, the chorion, the outer envelope over  all.
  The Development of the Decidua.—The decidua, from first to
last, is simply the mucous  membrane of the uterus hypertrophied  by
the influence of conception and gestation.   This hypertrophied develop-
ment, which constitutes the deciduous  characteristic,  as previously
stated, has already commenced when the impregnated ovule is about
to make its escape from the ovary;  so that upon its arrival in the
cavity of the uterus, the ovule finds  a soft, velvety bed in  readiness
to receive it.  And as the mucous membrane of the  uterus is con-
tinuous with that of the Fallopian tube, so in cases of extra-uterine
fcetation, the deciduous development has  sometimes,  although not
always, been found in the uterus; and in one case of development of
the ovum in the  Fallopian tube, referred to by Muller, the decidua
was observed both in the uterus and in the tube.
  Into the vegetative  bed above described the ovule becomes  fixed
by the  villi  of the vitelline membrane (which becomes the  chorion)
taking  root  and growing into it in every direction.  The decidua at
the same time grows up all around  the ovum, which latter thus be-
comes implanted  in a  living cyst, attached to one  portion of the wall
of the  uterus,  usually  that of the fundus.  When  thus encysted the
ovum is  not only completely covered  by the mucous membrane, but
by means of the villi of its own membrane, the chorion, it becomes
attached  to  the decidua, growing into it whenever they thus come in
contact.
  In the earlier  months of embryonic development the decidua is
formed of two apparently distinct layers, the one  being in approxi- 
140
DEVELOPMENT OF  THE  OVUM.
 mation with the internal uterine surface, and the other enveloping
 (he embry3.   The uterine layer  has  been called the decidua vera, or
 parietal  decidua, while  the  embryonic  layer  has been  termed  the
 decidua reflexa.  The decidua vera presents upon its external surface
 a rough or shaggy appearance, with numerous projecting  filaments,
 which are doubtless due to  the  separation of the decidua-from  the
 proper  tissue of the uterus and the remains of uterine glands.   The
 internal surface of this  layer, however,  is  smooth and shining, and
 elevated, according to Dr. Arthur  Farre, into numerous projections
 which may be roughly compared  to the convolutions of the cerebrum.
 It contains numerous minute  apertures  which are continuous with
 similar apertures on the outer surface of  this layer.
  The inner layer, or decidua refi,exa,  which invests the embryo, is, so
 far  as histological  elements are concerned, composed of  the  same
 material as the decidua vera, and it is, indeed, but a part of the same
 structure.  It received the  name decidua reflexa from Dr. AVilliam
 Hunter, who believed  that it was formed by the ovum in its passage
 into the uterus from the orifice  of the  Fallopian tube thrusting it
 before it away from the uterine wall and enveloping itself, so to speak,
 in it as a covering;  in a manner similar to the investiture of the heart
 by the pericardium.  This view  of Hunter's  has been combated by
 other investigators, but the  mode of formation of the decidua reflexa
 may be regarded as a question still in doubt.
  If the intimate  structure of the decidua be examined at  about the
 sixth week  of embryonic life,  it will be found  to consist of  large
 round and oval cells, nuclei, fat granules  and elongated fibre-cells,
 the whole so bound up that if a  portion of the membrane be spread
 out and examined with the microscope, "it is  observed to  be readily
 separable into irregular portions  or fragments, with clear interspaces,
 very much, in fact, like a web  or network  formed by the superposi-
 tion of several layers of a cribriform membrane one  upon another."
 (Meadows, " Manual of Midwifery," p. 69.)
  There can be but little doubt now that the  opinion  of William
 Hunter in regard  to the formation of the decidua is correct—viz.:
 that it  is "an efflorescence of the  internal coat of the uterus itself,
 the internal membrane of the uterus."   It assumes in the first  in-
stance the triangular shape of the cavity of the uterus, and although
these are not constant, there are commonly three openings which cor-
 respond with the orifices  of the two Fallopian tubes and the internal
ox of  the cervix.  At parturition it is thrown off, either as a whole 01
 in part, as a useless appendage, and replaced by a new formation. 
DEVELOPMENT OF THE OVUM.
141
   The Further Development of the Ovum.—Havino- thu- de-
 scribed the provision made for the primary reception and support of
 the  ovum in  the changes which occur  in the interior surface of the
 uterus, we will  now proceed to the  more particular examination of
 the  further development.of the ovum itself.  We have briefly traced
 this development  from  the original ova  to  the production of the
 embryo, and noticed in a cursory manner the umbilical and allantoic]
 vesicles, the amnios and the chorion.  These  appendages to the em-
 bryo, which at the same time protect it and administer to its growth,
 require now to be more particularly  considered.
   The allantois, as before  partially  described, is usually observed to
 arise as a minute tubercle from the inferior portion of the canal about
 the tenth day; it then rapidly shoots forward and takes  root in the
 villi of the chorion.   This organ is also called the urachus, and  is
 accompanied by, or rather  principally composed of,  two arteries pro-
 ceeding from the iliacs and called the umbilical arteries, and one vein.
   The  allantoid vesicle, as such, disappears very rapidly;  after a few
 days no trace of it can be found, excepting a cord of no definite length
 which connects  the embryo with the chorion and contains the um-
 bilical vessels.   That portion of this vesicle which is contained within
 the abdomen of  the child is, however, more persistent in its duration,
 becomes converted into  the urinary bladder, and in the rudimentary
 state terminates  in the rectum and constitutes the temporary cloaca;
 all of which is capable of demonstration in the human subject.   It is
 here easy to understand what is meant by the urachus, which is really
 that portion of the allantois which extends  from  the bladder to  the
 umbilicus; hence anything  that is capable of causing descent of the
 uterus must drag on the bladder from this attachment, and  thus re-
 sults the dragging sensation felt in the umbilicus  in such cases from
 the attachment of the urachus to that part of the body.
   The umbilical  vesicle, when first seen, seems to  occupy the whole of
 the cavity of the ovum.  Subsequently  the embryo is seen on the
 blastoderm, its back corresponding to the serous external surface, and
 its abdomen to  the mucous or interior surface, of the blastodermic
 membrane. . Thus, at  this early period  the abdomen is open  to the
 entire umbilical  vesicle.  As development goes on the embryo seems
 to rise more and  more toward the umbilical vesicle, and to be devel-
 oped forward and  inward upon the abdomen.  In  consequence this
 vesicle loses more and  more of its bulk, and assumes the appearance
of a long narrow stem.   This vesicle contains a yellowish and highly
nutritious fluid,  which, through the intervention of a vascular appa- 
142               DEVELOPMENT OF THE OVUM.

ratus, serves to nourish the embryo until it can provide for itself by
other means.   This vascular apparatus is supplied with two trunks for
the transmission of blood—one venous, the other arterial;  both, how-
ever, accompany the pedicle and form an important constituent part of
it.  (See large figure on plate facing 143.)   " The first,  N, called the
omphalo-mesenteric vein, enters the abdomen, winds around the duode-
num, and then opens into  the umbilical vein at the point O, just as the
latter emerges from the liver.   As it passes the duodenum, branches
are given off to the stomach and intestines, and when it discharges
into  the umbilical vein it sends a voluminous trunk to the liver. That
portion which furnishes the  branches just described persists  in the
adult under the  name of ventral or hepatic-portal vein,  whilst all the
rest will disappear with the  umbilical vesicle and  its pedicle.  The
arterial trunk, P, accompanying  the pedicle, has been  designated as
the omphalo-mesenteric artery.   Arising from the aorta, it gains the
summit of the intestinal convolution, and gives  off branches to the
mesentery and to the intestine itself; then it reaches the pedicle and
follows the latter to  the  umbilical vesicle, upon which it ultimately
ramifies.  The part that supplies the mesentery is converted in the
adult into a mesenteric artery, all the rest being effaced.  From all
which it appears that the vascular system of the umbilical vesicle rep-
resents the primitive circulation in the embryo, corresponding in  it
to the sanguiferous apparatus of the yolk of fowls."—Cazeaux.
   The amnion, as before  stated,  becomes developed  by the embryo
rising into the  umbilical vesicle, thereby completely developing the
blastoderm about itself; when the doubled parts unite the bridge unit-
ing this new ring with the former becomes absorbed,  leaving two dis-
tinct circles  formed out of one—the former being the chorion, the
latter the amnion.  Now, as  the amnion becomes distended more and
more with liquor amnii, of course the  umbilical vesicle becomes en-
croached upon and grows smaller and  smaller;  at the  same time the
abdomen of the embryo curves up more and more, aud  the pedicle of
the  umbilical vesicle becomes longer and smaller, being now found
on the  outside  of the. amnion, between it and  the  chorion.  At the
end of six weeks after conception this is seen to be a small yellowish
point about as large as a  coriander seed.   The umbilical vesicle is of
vital importance to the embryo until after the formation of the allan-
tois and  its  union with the villi of the chorion; after  which it is no
longer of any particular account, and with the exception of the above-
 mentioned remnant of its artery and vein it becomes  entirely atro-
 phied. 
 

-    '*--
 
       EXPLANATION OF  THE FIGURES IN  PLATE OPPOSITE.
  No. 1, the human ovum, of its natural size, at about the thirtieth  or thirty-sixth
day.
  No. 2, the same ovum, of its natural size, laid open to show its constituent parts.
  A, A, the chorion ;  B, the amnion; C, the foetus ; D, the umbilical vesicle.
  No. 3, the same ovum highly magnified  and opened in such a way as to exhibit
the principal relations existing between the embryo and  its appendages.  The walla
of the  abdomen and  chest have been cut away so as to bring the viscera into view,
and the umbilical cord has also been split up for the purpose of showing how the ap-
pendages of the foetus are brought into relation with this  latter.
  A, A, the chorion,  consisting of two  layers,  placed  back to back, and confounded
with each other, but which have been dissected apart for a limited extent at A/ A'.
  B, B, the amnion laid open  so as to show how it is continuous with the umbilical
cord, along wliich it is reflected, thereby forming a sheath which, under the form of
the canal B/ B', is directly continuous with the umbilicus or the umbilical walls C C
of the embryo.
  D, the umbilical vesicle, and D', its pedicle.
  D'7, the point where this pedicle communicates with the intestine E.
  E, the loop of the intestine prolonged into the cord.
  F, the urachus,  continuous by one extremity, g, with the chorion, and by the other
with the rectum at the point H.
  iij the umbilical arteries.
  j, the umbilical vein.
  j', the part of the right auricle from which the umbilical vein comes off.
  K, the vena cava inferior.
  M, the inferior  surface of the liver.
  N, the omphalo-mesenteric vein.
  0, the point where this vein  empties into the umbilical vein.
  P, the omphalo-mesenteric artery.
  ], the heart; 2, the arch of the aorta; 3, the pulmonary artery ; 4,  the lung of the
right side;  5, the  Wolflian body; 6, the branchial fissure which is converted into the
external  ear; 7, the  lower jaw; 8, the upper  jaw; 9, the nostril of  the  right side;
10, the nasal canal still forming a kind of fissure, which extends from the eye to the
nostril; 11, the caudal extremity, or coccyx,  projecting like  a  tail; 12, the upper
extremity;  13, the lower extremity.
                                                                  143 
L4I
DEVELOPMENT OF THE OVUM.
  The amnion is thus seen to  be the most internal  membrane of thr
embryo, and that it is formed by folding the blastoderm over the era-
bryo in every direction, which latter is accomplished  apparently by
the rising of the embryo toward the centre of the  umbilical vesicle.
When  the  folding over is complete, and both portions have  grown
together so as to form a complete shut sac  around  the embryo, then
we have the amnion containing the embryo, the umbilical vesicle, and
a quantity of fluid, thick and gelatinous, between the amnion and the
chorion, wliich becomes less and  less as the amnion itself becomes dis-
tended with its own proper fluid.  This fluid  sometimes exists up to
the period of parturition, and is called spurious liquor amnii, or liquor
allantoidis.  Its  escape at an  early period  of  labor gives rise to the
opinion, sometimes, that the membranes have ruptured.  The amnion
consists, structurally, of a fibrous membrane, covered with a layer of
oval nucleated epithelial cells,  but contains neither vessels nor nerves.
Its  inner surface resembles a serous membrane, and  in the opinion of
many authors it secretes the liquor amnii; its outer  surface  presents a
rough  and reticulate  appearance.  The doctrine, however, that the
amniotic fluid is a secretion from the surface of the amnion appears to
be a mistake, since this  liquid is most likely an efflux from the em-
bryo itself.  From the moment of the complete formation of the am-
nion as a shut sac, there is no  longer any outlet for  the escape of the
efflux from the embryo; and that there must be such  an efflux must be
evident, since there are  certain portions of the nourishment flowing
into the embryo that are not entirely assimilated—some material  car-
ried thither from the mother, wliich, although it has served the pur-
pose for which it had been imbibed, must be in part rejected  in the
form of sensible or insensible perspiration.   In  fact, there can be little
doubt that there is enough of what we may call offal from the embryo
and foetus to account for the quantity and quality of the liquid found
within the amniotic membrane.
  As the embryo develops and the liquor amnii increases, the amnion
is forced to recede more and more from the foetus;  of course it must
eventually be forced to join the outer membrane or  chorion, and thus
form a covering to the umbilical cord  all  the  way from the navel of
the foetus to  the outer membrane or chorion, into which its maternal
end is  inserted, and all the parts  thus enclosed constitute what is called
the umbilical'cord.   Consequently the whole abdominal cavity must
be  in  connection with the canal represented  by  this  cord, that the
foetal appendages may communicate with it through the opening thus
prepared for them.  It  is in this manner that the pedicle of the um- 
DEVELOPMENT OF  THE  OVUM.              145
bilical vesicle becomes united to the ileo-csecal fold of the intestine,
while the  allantois connects with the rectum  by the  intervention of
the urachus.
  The liquor amnii itself varies in appearance with the time at which
it is examined.   At  the  earliest period it is clear, transparent and
limpid; at later periods it  becomes thicker, more opaque, sometimes
flaky, green, yellow, or of almost any other color, according to certain
states of the foetus itself, which it derives  from corresponding condi-
tions of the mother.  Its odor varies also; sometimes it is like that of
spermatic  fluid, with saline taste.   The proportionate quantity of the
liquor amnii also varies according to the time; in the earlier periods
it is much greater than the weight of the foetus.  At the middle of
the term  the relation  may  be  about equal, and after  that time the
liquid lessens  in proportion as the foetus increases;  so that  at full
term the  quantity of  water is usually about a pound and a  half,
sometimes more and sometimes much less.
  Its specific  gravity  is somewhat above  that of water, and it pre-
sents an alkaline reaction.   Careful examinations have shown that
in addition to water  it consists of a small quantity of albumen and
gelatine, with  traces  of chloride of sodium, ammonia and phosphate
of lime.
   The formation of the embryo involves the formati n of the amnion
as a matter of course, as a reservoir for the reception of effete matters
from the  foetus.  The amnion also affords  protection to the foetus by
surrounding its body with an aqueous shield,  impervious to  blows
and shocks, since the embryo floats freely in its centre.   The  foetus,
thus floating in the liquor  amnii, is at liberty to accommodate itself
to  all the movements and  varying positions of the mother,  and  to
yield, with the least possible disturbance, to all   the influences of her
mental  and moral states.   The accoucheur finds in the ballottement
practiced  by the aid  of  this fluid an important diagnostic  sign of
pregnancy; and at the period of parturition is able to correct any
malpositions with greater ease before than after  the waters have been
discharged.   Again, it serves other useful purposes during labor, by
diminishing and equalizing the pressure of the foetus upon the womb,
and by distending the membrane into an  elastic and conical plug or
wedge affords material assistance in the dilatation of the os uteri.
   The  chorion lies next in order  to the decidua, between it and the
amnion.  " The chorion begins to be  formed in the Fallopiai: tubes
as an albuminous layer enveloping the  ovum; but as soon as it reaches
the uterine cavity a number of small tubular projections, the chorion
        10 
146
DEVELOPMENT OF  THE  OVUM.
 villi, start from every point of its outer surface.  At this  time no
 vessels exist in it, but at about the second  month the vascular sac of
 the allantois comes into contact with the inner sur'face of the chorion,
 forming its  inner layer,  or endochorion, and then capillary twigs are
 sent into  the hollow villi; these now take on a rapid development;
 they  become compound  branching tufts,  enclosing capillary  vessels,
 which are brought into  closer interdigitating communion with the
 capillaries ramifying  in  the  decidual  membrane.  During the first
.three months of gestation every part of the chorion remains covered
 with  villi, giving it the appearance, when placed in water, of a beauti-
 ful white shaggy or woolly membrane.  After this time, however, a
 great number of the villi begin to disappear, so that a large portion
 of the external  surface becomes smooth, except within the  site of the
 placenta,  where they increase  enormously, becoming at the  same time
 more convoluted, and constituting the foetal portion of that organ,
 their  trunks  helping to form the umbilical vessel."
   The Placenta, or After-birth.—In order to obtain a proper
 idea of the placenta, so named by Fallopius from its fancied resem-
 blance to a flattened  cake, it is necessary to commence  its description
 at the very commencement of its formation.  It will  be recollected
 that the allantois shoots  from the embryo at a very early period of
 its  existence, and very soon  takes root in the villi of the chorion.
 Examination and experiments prove  that this process is adapted to
 furnish nourishment to the embryo  by means of arteries and one
 vein passing from the embryo to the mother and back.   The arteries
 carry the impoverished  arterial blood from  the foetus toward  the
 mother, seeking aeration  and nourishment in the  mother.  The vein
 brings it back, purified and  laden with all that the embryo needs for
 its  growth and  nourishment.   In this  first circuit there is made the
 beginning of the placenta,  or the placenta itself so far.  The next
 circuit adds to its size by the  larger demand made  by the  increasing
 embryo;  and so it goes on, constantly enlarging,  circuit after circuit,
 until  it has attained a full and sufficient size.
  The placental mass, at its full  size,  is about six inches in diameter,
 three-fourths of an inch thick in  its centre, tapering to a thin edge at
 its  circumference.  In different persons  the placenta  will often be
 found to vary in form and size; but the above are about the average
 dimensions.    The cord is usually attached in the centre, but it is
 sometimes found attached to  one  edge, constituting what is termed  a
 battledore placenta.   The placenta presents an internal or  foetal sur-
 face, and an external, materna1 or .uterine surface,  and a border.  At 
DEVELOPMENT OF THE OVUM.
147
full term  the  internal surface  is found  covered by the chorion  and
the amnion.   The foetal surface  is smooth and shining, from being
covered with the amnion—concave and transparent, showing the rami-
fications of the blood-vessels of the cord most beautifully at full term.
Immediately beneath the amnion is found  the  chorion, which enters
largely into the formation of  the  placenta, giving  it  strength  and
transmitting the ramifications of the placental vessels.  The maternal
surface is convex, rough, and subdivided  into a variable  number of
lobules, held together by an albuminous tissue, which is so easily  torn
off that it is very difficult to retain it in separating the placeirta.  These
lobules, or cotyledons, are the original villi of the chorion very much
enlarged and  compacted together, although even these  are also very
easily ruptured and separated into loose, disorganized masses.

              Fig. 38.                          Fig. 39.
Fig. 38, the internal or fetal surface of the placenta.
Fig. 39, the external or uterine surface of the placenta.
  The villi have been described  as  compacted  together; this results
from  their having grown into the mucous membrane of the  uterus,
between that organ and the ovum.   At the same time the mucous
membrane has also grown into the villi and the chorion ; so that there
is a  mutual growth  of one into the other,  each supplying its own
share in the  formation of the  placenta; the villi and their growth
forming the foetal side, and the mucous membrane  and  its growth
lorming the maternal .or  uterine side of the  placenta.  Thus, in the
very first circuit of the foetal blood in its vessels on the inner side of
these  villi, it becomes  aerated  and supplied with all things needful
from  the maternal blood  on the  outer  side of these villi.   In this
way the process goes on, hour  after hour, day after day, the demand
and the supply alike increasing, till large quantities of blood are formed 
148              DEVELOPMENT of the ovum.

on each side;  their banks, however, never breaking, while the foetei
blood constantly communicates, but never commingles, with the ma-
ternal blood.   This is  proved by injecting the vessels  on the foetal
side;  not a particle, even of the finest material^ is ever found to pass
beyond  the foetal side,  while  on the other hand it is found equally
impossible to cause a particle of the finest injection to pass  from the
maternal to the foetal  side.
  The foetal portion of the placenta, that to which the umbilical cord
is attached, receives the  branches of the two  umbilical arteries, each
of which divides into two branches  at the point of juncture with  the
placental surface, and these branches again divide and subdivide until
the vessels are reduced considerably in size, and thus pass through  the
chorion and ramify within the substance of the foetal portion of  the
placenta.   The blood is taken up by the venous radicles and returned
by sixteen chief venous  branches, which follow the course of the main
arterial subdivisions,  and finally form  the single umbilical vein of
the cord.
  The maternal  or uterine  portion of the placenta is  divided into
lobules or cotyledons as before described.  Over these is spread a thin
and pulpy membrane, the placental decidua, or decidua serotina, which
dips down into the sulci of the cotyledons in a manner similar to  the
dipping down of the pia mater into the sulci of the brain.   In exam-
ining  a placenta cast off during  parturition  " numerous  valve-like
apertures are found upon all parts of its  surface (uterine).   They  are
the orifices of the veins which have been torn  off from the  uterus.. A
probe passed into any of these, after taking an oblique direction, enters
at once into the placental substance ; small arteries, about half an inch
in length, are also everywhere  observed imbedded in this layer. After
making several spiral turns  they  likewise suddenly open  into  the
placenta.   These are  the uterine  vessels which carry the maternal
blood to  and  from  the interior  of the placenta."—Dr. Arthur
Farre.
  It will  thus be seen that the placenta is covered  upon its maternal
or uterine surface by a membrane (decidua serotina), and on its foetal
surface by another membrane (the amnion).  These give firmness and
consistence to the placental mass, and at the edge or circumference
they unite and spread  out to form the envelope of the foetus and liquor
amnii.
  In regard to the manner in which  nutriment is conveyed  to the em-
bryo through  the  maternal  blood  without a commingling of that
fluid with the  blood of  the embryo, we  quote  the  following passage 
DEVELOPMENT OF  THE  OVUM.
149
from Dr. John Reid: " When the blood of the mother flows into the
placenta  through the  curling arteries  of the  uterus, it passes  into a
large  sac formed by the inner  coat of  the vascular  system of the
mother, which is intersected in many thousands of different directions
by the placental tufts projecting into it like fringes, and  pushing its
thin walls before them in the form of sheaths, which closely envelop
both the trunk and each  individual branch  composing  these tufts.
From this sac the maternal blood is returned by the utero-placental
veins, without having been extravasated, or without having left her
own system of vessels.  The blood of the mother contained in  this
placental sac, and  the  blood of  the foetus contained in the umbilical
vessels, can  easily act and react  upon each other through  the spongy
and cellular walls of the placental vessels and the thin sac ensheathing
them, in the same manner as the blood  in the branchial vessels of
aquatic animals is acted upon by the water in which they float."
  Thus it will be perceived that there  is no direct vascular intercom-
munication between the foetus and the  mother, and hence all changes
which take place in the blood of the foetus, whether of depuration or
of nutrition, must take place by endomosis.  There is  probably no
nervous connection between the foetus and the mother, since no nerves
have been discovered in either the placenta or the umbilical cord.
  The placenta is usually attached to the fundus of the uterus—more
frequently to the left than to the right side—but it may be implanted
upon  any part of the interior uterine surface, and is sometimes  found
near to or even over the os itself.
  The umbilical cord, or funis, connects  the foetus  in  utero with the
placenta, and is the bond of union between the mother and her child.
The product of a somewhat advanced  state of development,  it  is not
found in the early weeks of pregnancy.  The umbilical cord  takes its
origin in the embryo, in the form of the allantoid vesicle.   And as
soon as this vesicle has taken root in the villi of the chorion, it is
found  to consist of two arteries arising  from the bifurcation of the
abdominal aorta in the embryo, and of one accompanying vein which
arises from  the vena cava ascendens  and the  hepatic  portal vein.
The arteries  carry the  embryonic blood  away, to be replenished  and
nourished by that of the parent.  This is accomplished through the
medium of the placental villi, as above  described.  From  them the
blood is returned by the vein to the embryo;  and thus.is established
the living connection of the foetus with the mother.
  As the abdomen of the foetus closes  up with the  advancing de-
velopment, it is found that the stem of the allantoid vesicle  and the 
150
DEVELOPMENT OF THE OVUM.
umbilical vesicle are embraced in one common sheath, the  amnion
And when the abdomen fails to close up firmly and tightly around
the cord, there remains what is  called a congenital umbilical herniaj
which  continues till  the  child is  perfectly  formed.   The  urinary
bladder is formed on the abdominal  portion of the urachus or allan-
toid vesicle.   Hence it appears  that the bladder is on a line with the
cord; and when the child has  been  separated from the mother and
the foetal circulation cut off, the two arteries arising from the  bifurca-
tion of the aorta  are  converted into suspensory ligaments of the
bladder, which terminate in the umbilicus.
   The umbilical cord  at  full term  differs very much in length in
different cases;  it may be  but a few inches, or  even five or  six feet
in length, but it is usually from twenty-one  to  twenty-three inches.
The existence of nerves  has  not been  demonstrated  in the  cord,
but lymphatics  have recently been discovered.  Thus, as the waters
of the amnion serve  to protect the  foetus as far as  possible  from
external violence, by allowing  it easily to float away and evade any
direct attack, so the entire absence of direct  nervous connection be-
tween  the  foetus and the  mother prevents the  former from being
too injuriously affected by any sudden mental emotion  or moral ex-
citement of the latter.  The child must indeed be powerfully affected in
such cases, but through the circulation only; and thus  not so rapidly
or so violently as if there were direct nervous communication.

                              Fig. 40.
An anomaly, described by Benckiser: a division of the cord, just within the mem-
                     branes, into five or six branches.

  The greater part of the body of the umbilical cord  is made up of
the arteries and vein, which  are imbedded  in a gelatinous material
consisting of a very delicate cellular structure infiltrated with albu-
minous matter; but, what  is very curious, the arteries wind  around
the cord from left to right through its whole length, the vein con- 
DEVELOPMENT OF  THE  FOETUS.
15i
stituting the central axis of this regular spiral.  The cause of this—
for it must have a determinate  cause—has' not been satisfactorily ex-
plained ;  a similar phenomenon may be observed  in pouring fluids
through a funnel; they will always gyrate in a single direction.
  It is very common to  find the cord wound  round the child's  neck
at parturition, requiring to be slipped off upon the emergence of the
head; in such cases there is probably an abnormal length of the  cord.
Other cases  are reported in which the cord is  tied in knots, but not
so tightly as to compromise the foetal life by impeding the circulation.
The umbilicus usually constitutes the  point of origin of the cord, but
it has been known to arise from the head, the chest, the shoulder, etc.;
such anomalies result from some peculiarly disordered  condition of
the mother  during  this period of the incipient development of the
embryo.  It will be observed that as the interior or abdominal  portion
of the blastodermic membrane represents the organs of the vegetative
life, so  the umbilical cord,  arising from this very portion of the
embryo, and connecting with a corresponding portion of the mother,
through  the placental mass  attached to  the uterine  walls, directly
unites the vegetative organization of the mother with that of the
child; this organization being thus seen to underlie the whole  organic
life, and thus to involve  all that we understand  by hereditary con-
stitution.   The same ideas are also no less plainly suggested by the
fact that the whole  life of the child is absolutely dependent upon the
vital  circulation of the mother, the  movement of which  is entirely
under the  control of the vegetative, organic or ganglionic nervous
system.
                       CHAPTER  X.

             DEVELOPMENT OF  THE  FCETUS.

    HAVING thus described the primary development and organiza-
     tion of the ovum with its appendages, we now come to the study
of the  foetus as a whole, with particular reference to its safe delivery
from its  gestative world to a  more independent  state of existence.
But before  proceeding to trace the intra-uterine  life to the full term,
it will be proper to review the ground already surveyed; this will be
best done by a careful examination of the Plate (after Cazeaux) facing
page 143, in which are delineated- the embryo and appendages up to
the already described state of development. 
152
DEVELOPMENT OF THE  FOETUS.
  Successive Dimensions and Weight of the Fcetus.—The first
indications of the formation of a new human being that it is possible
to discover, even by the help of a microscope, consist  in  an oblong
figure, obtuse  at one extremity, swollen in the  middle,  blunt-pointed
at the  other extremity.   This rudimentary embryo is slightly curved
forward, is of a grayish-white color, of a gelatinous consistence, from
two to four  lines long, and weighs one or two grains.   Here a slight
depression, representing the  neck, enables us to distinguish the head;
the body is marked by the swollen centre, but there are no traces of
the separate extremities.   So much can be observed about the end of
the third week after conception.
  At about the fifth week the embryo is found much  more  distinct.
The  head is very large  in proportion to the rest of the  body; the
eyes  are represented by two  black spots; and the upper  extremities
are represented by small protuberances on the sides of the trunk.  The
embryo is  now nearly two-thirds of an  inch  in  length, and weighs
about fifteen grains.  The umbilical cord can now be  distinguished
in its rudimentary stage, and  the  lower  extremities begin to appear
in the  shape of two minute  rounded tubercles.   Minute  depressions
may now  be discerned between  the vertebrae, and the  embryo  is so
much curved forward that its caudal portion very  nearly approximates
the head.   Till about this time a straight artery has  been observed to
beat with the regularity  of  the  pulse,  but now it  appears  doubled
somewhat in the shape of an adult heart, although as yet  it has but
one auricle and  one ventricle.  But as the time advances we find at
length the  perfect heart, with its two auricles and two ventricles, all
developed from the original straight artery.  The division of the first
cardiac cavity into  others is effected  by partitions thrown up, or by
contractions accomplished in the  course of the same natural  and
orderly development.   The  septum which divides this  primary ven-
tricle into two is developed from the apex toward the  base  between
the pulmonary artery and the aorta, so that we  shall open the pul-
monary artery from the  right ventricle,  and  the  aorta  from the left
ventricle.
  At this  period the lungs  appear to  exist in five or six  different
lobes, and we can barely distinguish the  bronchial tubes, terminating
apparently in minute  cul-de-sacs.   Along the vertebral column may
be perceived two large glandular structures, which extend from the
lung  to  the bottom  of the  pelvis.  These structures, termed the
Wolffian bodies,  are  constituted by an  excretory canal which  runs
through their whole length, and perform the functions of the kidneys 
DEVELOPMENT OF  THE  FCETUS.
153
until the latter are developed.   By means of numerous caeca which
appear on one side only of their surfaces  they secrete  a fluid which
is  poured into the canal  and thence transmitted into the temporary
cloaca.  The Wolffian bodies disappear upon the development of the
kidneys, and leave no traces of their former existence.—Cazeaux.
  A second  canal, perfectly distinct, although lying alongside of that
of the  Wolffian body, is also  to  be discerned, which presents in the
adult, and, according to  the  sex, becomes  either the oviduct or the
vas deferens.  At about  the  same  period  of embryonic life may be
distinguished four transverse fissures  upon each side  of the neck,
which  open into  the pharynx.   These are separated by fleshy par-
titions that  correspond with  the  branchial arcs  of  fishes, and  they
may for a time serve some similar or corresponding purpose.  In the
course of the subsequent  development these fissures are dispersed and
disappear, with the  exception of  one  on  each side (see the  Plate),
which are converted into  the external ears.  At about the same period,
upon what appears to be  the face appear two isolated tubercles, which
gradually approach the mesian line as development goes on, and form
the upper jaw.  The  double hare-lip, so often seen in children, results
from the failure  of  development of the upper jaw and nose, as the
nostrils originally constituted one cavity  on  a mesian  line with the
mouth.
   At about the seventh week the  first centres of ossification appear in
the clavicle, and  subsequently in the lower jaw.  The intestines still
extend some distance along  the interior  of the  umbilical cord; the
omphalo-mesenteric  canal is  nearly obliterated,  although it may still
be traced as far as the umbilical  vesicle, where it is reduced  to a mere
thread.  The anus is not yet opened  or formed.  The  kidneys now
begin to be  formed, and  soon after the genital organs.   The urinary
bladder is first seen in the form of a small tumor continuous with the
urachus.  The embryo is about one inch in length.
   At two months the  rudiments of the extremities become more promi-
nent.  The forearm  and  hand can be distinguished,  but not the arm ;
the hand is larger than the forearm, but it is not supplied with fingers.
The cord has not yet become  spiral, and still contains a large quantity
of intestine; it is four or five lines in  length, and is found tc proceed
from the lowest point of the abdomen.   The formation of the placenta
commencing, a minute tubercle may be distinguished between the cord
and the termination of the spine, marking the locality of the genital
organs, but  the  sex cannot  yet be determined.   The  length of the
embryo is now from one  inch and a half to two inches, and it weighs 
 154             DEVELOPMENT  OF THE F(ETUS.

 from three to five  drachms.  The eyes are  discernible, but still un-
 covered by the rudimentary lids.  The nose forms an obtuse eminence,
 the nostrils are rounded and separated; the mouth is gaping, and the
 epidermis can be distinguished from the true skin.
   At ten weeks the embryo is from one and a half to two and a half
 inches long, and  its weight is one ounce or one ounce and a half; the
 eyelids are more developed  and descend  in front of the eyes; the
 puncte lachrymalia are visible, and the mouth begins to be closed  by
 the development of the lips.  The walls of the thorax are now more
 completely formed,  so that it is no longer possible to  see  the  move-
 ment of the heart.   The fingers become distinct, and the toes appear
 like small projections, webbed together like a frog's foot.   The um-
 bilical cord now assumes the spiral form, still contains a  portion of
 the intestine in  its base, and  its place of attachment appears higher
 up in the abdomen.
   At the end of the third month the weight of the embryo is from three
 to four ounces, and its length from four to five inches; the eyeballs
 are seen through  the lids, the pupils of the eyes can be discerned, the
 forehead, nose and  lips can be clearly made out.   The neck now ap-
 pears between the head and shoulders;  the cord contains no intestine,
 and its spirals are more numerous and apparent;  the' finger-nails re-
 semble thin membranous  plates;  the cerebro-spinal axis is divisible
 into its leading parts; the ventricles of the heart are separate, the pla-
 centa is separate, and the allantois and umbilical vesicle  have dis-
 appeared.  The skin shows more firmness; although apparently with-
 out fibrous structure, it is still rosy-hued, thin and transparent.
   At the end of the fourth month the product of conception is no longer
 called  the embryo, but the  foetus.  The body is from six  to  eight
 inches in  length  and weighs six or seven ounces.  The sutures and
 fontanelles are now very large,  and little  white  hairs  may be seen
 scattered over the scalp.   The development of the face is still imper-
 fect.  The eyes are now closed by their lids, the nostrils are well
formed, and the  mouth is shut in  by the  lips.  The  sexes  are now
 distinguishable, and meconium is present in the upper bowel.  The
 tongue may be observed far back  in the buccal cavity, and the lower
angle of  the face is rounded off by what a little later  will be a well-
 formed chin.  The umbilical cord is attached to the abdomen still
higher up, though as yet much below the centre of the body.  A foetus
born at this time may survive for several hours.
   At the end of the fifth month the body of the foetus is from seven to
nine inches  long, and weighs from  eight to eleven ounces.   The skin 
DEVELOPMENT OF  THE  FOETUS.
155
has now a fairer appearance and is more consistent;  the eyes can no
longer be distinguished  through the lids,  owing to the  increasing
thickness of the latter.   The head, heart and kidneys are large and
well developed.  The movements of the foetus are usually plainly felt
by the mother.
  At the end of the sixth month the foetus is from eleven to twelve and
a half inches in length, and weighs about sixteen ounces, more or less.
The hair upon the scalp is thicker and longer, the eyes remain closed,
and very delicate hairs may be seen upon the margins of the eyelids
and upon the eyebrows.  The nails are solid, the scrotum small and
empty; the surface of the skin appears wrinkled, but the dermis may
be distinguished from the epidermis.  The liver is large and red, and
the gall-bladder contains fluid.
  At  the end of the seventh month the length of the foetus is from twelve
and a half to fourteen inches, its weight is about fifty-five ounces, and
it is both well defined and well proportioned in all  its parts.   The
bones of the cranium, hitherto quite  flat, now appear a little arched,
and as the process of ossification goes on the arching increases till the
vault is quite complete.  The brain presents greater firmness, and the
eyelids are opened.   The  skin is much firmer and red.   The gall
bladder contains bile.
  At  the end  of the eighth month the foetus seems to thicken up rather
than  to increase  in  length, since it is only from sixteen to eighteen
inches in length,  while  its weight increases  to  four  or five pounds.
The skin is  red, and characterized  at this  period  by a  fine downy
covering, over which  is spread a quantity of thick viscous matter,
called the sebaceous coat, which has been forming since the latter part
of the fifth month.   The  lower jaw has  now become as long as the
upper one,  and in the male the left testicle may be found in the scro-
tum.   Convolutions  appear in the brain structure.
  At  nine months the anxious time has arrived; the foetus is  from nine-
teen to twenty-three  inches  in length, and weighs from  six to eight
pounds, on an average.  Some children weigh very much  less; some
as much as fourteen pounds; but  such extremes are very rare.  In
most  instances  the child is covered with a whitish, sebaceous matter,
which is really a secretion from the child's skin, which may be dis-
solved and removed  from the surface after birth by rubbing with some
unctuous material, such as oil or lard.
  At  this  period  the  white  and gray  matter  of the brain are dis-
tinct,  and  the convolutions  are well marked;  the  nails assume  a
horny consistence:  hair is more or less abundant; the  testes  are 
156
DEVELOPMENT OF  THE  FCETUS.
hi the scrotum; the umbilicus is  situated midway between the head
and feet.
   Upon a careful review of the preceding account of the growl h and
development of the  foetus, it will  be seen that this growth is much
more rapid in the first and in the last three months of its intra-uterine
life than during the  middle of this period.
   The following brief though graphic account of the development of
the different parses and organs of the foetus  is taken from Meadows'
Manual of  3Iidwifery, condensed by the  author  from  Carpenters
Physiology :
   " The alimentary caned is formed from the  vitelline sac or umbilical
vesicle, with which a communication  is kept up for some time.   At
first it  exists as a narrow straight tube, having no division of parts
and no orifices ; subsequently, the mouth, oesophagus, stomach, large
and small intestines are formed;  and it is at the junction of the two
latter that the vitelline duct exists.
   " The liver is  formed upon  the  small intestine, and makes its ap-
pearance first, at about the third week, by the  aggregation of a num-
ber of cells  at the spot where the hepatic duct afterward opens; this
increases, and gradually removes farther from the canal;  ducts begin
to appear in it, starting first of all from the  intestinal wall; and so
rapid is the growth  that by the  fifth week  the organ is about one-
half the weight of the embryo itself.   The subsequent changes which
take place consolidate it and adapt it  to what we see at birth.
   " The pancreas and salivary glands are  similarly developed as
offshoots of the alimentary canal.   It will  be remembered that all
the organs of vegetative life arise from the original inner or mucous
layer of the area germinativa.
   " The lungs arise at about the sixth week, as  a  pair  of bud-like
processes, from the oesophageal portion of the alimentary canal; their
surfaces soon become covered  with numerous  little  wart-like projec-
tions, caused  by corresponding enlargements  of their cavity.  This
goes on increasing;  the parenchymatous tissue is developed  in the
spaces between the bronchi, vessels are deposited in it, and by degrees
these organs separate from the tube from which they spring, and as-
sume more and more the natural state.
   " The urinary organs begin  as two  large tubes situate one on either
side of the spinal column;  little csecal appendages, the corpora Wolff-
iana, ave developed  on their  outer sides; the  ducts then enter the
allantois, there being at present no proper urinary bladder; this takes
place about the fifth  week,  and by the end of the second  month they 
DEVELOPMENT OF THE FCETUS.
157
have  disappeai ed.  These take no part whatever in the development
of the kidneys, which begin to form at about the seventh week, behind
the Wolffian bodies.  At first as separate lobules, they afterward coa-
lesce : for some time the supra-renal capsules equal in size the kidneys,
but at the sixth month the  former rapidly decrease, while the latter
as quickly increase in  growth.  The ureters  at first open, with the
duct of the Wolffian bodies, into  the  allantois; but as  these bodies
disappear a portion of the allantois is nipped off, and thus the urinary
bladder is formed.
   " The  generative organs are developed later than the other vegeta-
tive  organs, and at first they present no essential  sexual  difference.
This  applies to both the internal and external organs until at least as
late as the fourteenth week.
   " The internal generative organs appear first at the inner side of the
Wolffian bodies.   As development advances, the testes become round,
thick, vertical in direction, and are united to  the vasa deferentia ; the
ovaries, on the contrary, become  long, flat, transversely situate, and
remain unconnected with the Fallopian tubes; the former subsequently
enter the scrotum, beginning the descent about the middle  of preg-
nancy ; the latter descend into the pelvis.   The uterus is formed by a
coalescence of the inner extremities of the Fallopian tubes; it remains
bifid or bihorned (the normal condition of  some animals) up to about
the fourth month.
   " The  developmental changes of the externcd generative organs are
interesting, from the light they throw on some malformations incident
to these parts.   So early as the fifth or sixth week a common cloaca
exists for the termination of the intestine, the urinary and generative
organs.  At about the tenth week the former is separated from the
two  latter by a  band,  and  subsequently these are shut off from one
another by a similar band.  Then the labia majora or the two halves
of the scrotum, as the case may be, are developed on either side of the
orifice of the genito-urinary canal; and  above and between these  a
small body protrudes, being surrounded with  a glans and fissured on
its under surface.  This becomes  the clitoris  in the female, and, by
future growth, the penis in the male.  The margins of the fissure are,
in the former, developed into  the  nymphce; in the latter they unite
and form the urethra.   It will now be readily understood  how, by
arrested or morbidly augmented development of these parts, herma-
phrodism or other deformities may  result.
   " Turning now to the organs of animal  life, a few words  upon the
development  of  the cerebrospinal axis may fitly terminate the  con- 
158
DEVELOPMENT OF  THE FOETUS.
sideration of the embryological  changes affecting individual organs
This, as has  already been stated, takes its  origin  in the externa]
serous or animal layer of the  germinal membrane by a contribution
from each side of the primary groove formed  by the rising up of the
laminae dorsales; it is, in fact, from a portion of these latter, at first
separate, but afterward united, that the central nervous system arises.
The encephalic  portion consists at first of three vesicles : out of the
first is  formed the greater  portion of the cerebral  hemispheres,  the
corpora striata, optic  thalami and  third ventricle; out of the second,
the corpora quadrigemina and  crura cerebri ; and out of the third, the
pons varolii, the medulla and fourth ventricle.   At first, all  these vesi-
cles are arranged in a straight line, very much like the  permanent
condition  of the brain in fishes,  but  a  curve is  formed about  the
seventh week, the hemispheres arching over the thalami and corpora
quadrigemina.   The lateral sinuses are formed about the third month,
the corpus callosum in the fifth,  and convolutions appear at the fourth.
The membranes of the brain are formed at about the sixth or seventh
week,  the  arachnoid rather  later.   They are developed  from  the
primary encephalic mass."
   Ossification sets in in the embryo at an early period, commencing
about the sixth week at a point of the clavicle; nearly simultaneously
with this primary point of ossification  bony formation commences in
the inferior maxilla;  then follow, successively, the vertebrae, humerus,
femur, ribs and occipital  bone.   At the commencement of the  third
month it  occurs in the superior maxilla, frontal  bones, radius and
ulna,  tibia and fibula, and the scapula; and toward  the close of.the
third  month it  has  commenced in the  metacarpal, metatarsal and
phalangeal bones, and the remaining bones of the  cranium.   During
the fourth month the bones of the pelvis and the sacrum  begin to
ossify, together  with the  minute  ossicles of the inner ear.   During
the fifth, sixth and seventh  months the astragalus and  os calcis, the
ethmoid bone, the  pubis  and the  ischium commence to ossify.  At
the eighth month ossification sets  in in the last bone of the sacrum.
At full term  many of the bones still remain in a cartilaginous con-
dition, as the carpus, the smaller bones of  the tarsus, part of  the
coccyx, the patella, the epiphyses of the long bones, and usually the
os hyoides.
   The Foetus  at Full Term.—It must be evident that all  the
mechanical difficulties attending childbirth increase with the develop-
ment of the child; hence the necessity of particularly  studying  the
most voluminous portion, in order that we may intelligently adapt it 
DEVELOPMENT OF THE FOETUS.
159
to the passage  in  the  pelvis through which it must pass.  The most
voluminous, the least yielding and compressible, and  by far the most
difficult part to manage in parturition, is the head, and  of course where
this may pass, the  remainder of the body can follow with comparative
ease.
  The shape of the foetal head  is ovoidal, the  posterior part being
larger than the anterior.  The  cranium, with which  as accoucheurs
we are principally  interested, is composed of the os frontis, the occipi-
tal, the two parietal and  the two temporal bones.   These are articu-
lated  by means of  sutures, which in the foetus at full term are usually
cartilaginous.   Angular spaces, called fontanelles, are left at the cross-
ing of these sutures.   Each  suture and fontanelle has its particular
designation.
  The sagittal  suture arises from the* root of the  nose, dividing the
frontal bone  on the mesian line, runs across the top  of the head  to
the occipital bone,  and sometimes divides that bone to its very base.
  The cvroiial suture crosses the sagittal at right angles,  uniting the  os
frontis to the parietal and temporal bones.
  The lambdoidal  suture also crosses  the sagittal, although at a more
acute angle, uniting the  occipital bone to the parietal  and  temporal
bones.  Where the coronal suture  crosses  the sagittal suture there is
left a large quadrangular space  called  the anterior fontanelle.   The
crossing  of the lambdoidal  suture with the sagittal  leaves  a  three-
sided space, smaller than  that of the anterior  fontanelle, and  called
the posterior fontanelle.   There  are  other  sutures and  fontanelles,
formed in  a  similar manner, between the bones which compose the
foetal head, but those mentioned  above are the only  ones  of  prac-
tical  importance to the accoucheur.  By means of these sutures and
fontanelles the head may be compressed so as to require less  space
during parturition, thus  rendering this function  less frequently in-
jurious to  both mother and child than must otherwise be the  case;
and these  sutures  and 'fontanelles serve  as guide-marks for  deter-
mining the exact position of the  foetal head relatively with the cavity
of the pelvis during labor.
  The diameters of the  foetal head at term may be  reduced, for all
practical purposes, to seven in  number.   The occipito-mentcd  (a  b,
Fig. 41), extending from  the occipital protuberance  below  the  pos-
terior fontanelle, to the chin, is five and one-fourth  inches. The longi-
tudinal or occipitofrontal, d e, extends from the occipital protuberance
to the frontal protuberance, and  is four and one-fourth inches.   The
sub-occipito bregmatic,  c f, extends from  the  central point  between 
160
DEVELOPMENT OF THE FOETUS.
the foramen magnum and the occipital protuberance to the anterior
fontanelle, and measures  three inches and three-fourths.   These are
called antero-oosterior diameters.   The  transverse diameters are, the

                  Fin. 41.                  Fig. 42.
 bi-parietal, a b (Fig. 42), extending from one parietal  protuberance to
 the other, three inches and three-fourths;  the other, the bi-temporal,
 c d  (Fig. 42), extending from the zygomatic  process of one side to
 the  same point on the other,  measures three  inches.  Finally, there
 are also two vertical diameters: First, the vertical diameter, i g (Fig.
 41), extending perpendicularly from the highest point of the vertex
 to the anterior  boundary  of the foramen magnum,  measures  three
 inches and  three-fourths.   Second, the fronto-mental, d a (Fig. 41),
 from the frontal protuberance to the lowest point of  the chin, meas-
 ures three inches.
   While it is absolutely necessary for the accoucheur to have a perfect
 knowledge of these various and varying diameters of the foetal head,
 yet the most important in  an obstetrical  point of view  undoubtedly
 are,  the occipito-mental, five  and  one-fourth inches;  the  occipito-
 frontal, four and one-fourth inches; the bi-parietal, three  and three-
 fourths inches.
   Now, it will be readily seen that the antero-posterior diameter is
 quite too long to pass any diameter in the well-formed pelvis, even in
 the dried state, where the largest diameter is only five inches.  Hence
 it  must be  apparent that in order for the head to be capable of pass-
 ing in parturition, the longest diameter must lead the way—that is,
 the long diameter  of the head must be  made  parallel to the axis of
 the pelvis  by making either  the  occiput  or the chin lead the way.
 When  this  is accomplished it is evident that  all the  other diameters
of the  head will be  permitted to  pass through a well-formed female
pelvis.  And the more perfectly the antero-posterior diameters of the
head are made parallel with the general axis of the pelvis, the easier
 —other things being equal—will the child be  born.
   A great  difference exists between the heads of male and  female 
DEVELOPMENT OF THE  FOETUS.
161
  children, in the greater size and  more complete ossification which are
  found to obtain in the former.  As a proof of this we may adduce the
  one  observed  fact, that the proportion of stillborn boys to stillborn
  girls is one hundred and fifty-one of the former to one hundred of the
  latter.   And even of those born alive a much  larger number of boys
  than of girls die in infancy from injuries received during birth.  And
  finally, of the mothers who succumb  to  consequences of childbirth a
  majority have given birth to  boys.  Thus, it appears that the growth
  of the male portion of the race costs much more suffering and a greater
  loss  of life than docs that of  the female portion.
     One more fact needs to be studied in this connection, and this is the
  articulation of the  child's head  to its trunk.   The occiput is articu-
  lated with the atlas in such a manner as to admit of great flexion and
  extension, while at the same time the atlas is so  placed upon the axis
  as to admit of great rotation—much  more  freedom of movement in
  either  articulation  than  is possible  in the adult.   Hence it makes
  little difference, so far as the child's  neck is  concerned, whether the
  occiput or the chin lead the way in parturition.  It is, however, much
  better, as is usually the case,  for the  occiput to lead the way; for, as
  the chin thus rests upon the sternum of the foetus, the long diameter
  of the head corresponds more exactly with the  long diameter of the
  body of  the foetus, and consequently the whole long diameter is  more
  in harmony with the axis of the cavity of the pelvis.  Thus, the direct
  force of  each  contraction of  the uterus is received by the propelled
  body in a mass, none of the  force being lost, as would necessarily be
  the  case if  the chin were to lead the way.  For  here every contrac-
  tion would  tend to throw the occiput back upon the spine, in wliich
  case it would  not find a firm base, as  in the natural position of the
  chin upon the sternum.
     The Presentation  and Position of the  Fcetus at Full
.  Term is a thing of much interest, and the true causes wliich influence
  and determine these must now be stated and explained.  At the earli-
  est period at which the embryo is seen, it has always been observed to
  be curved forward, and in all orderly developments this position con-
  tinues as the growth increases, until at full term of gestation the head
  is found flexed so that the chin nearly touches the sternum, the  arms
  are flexed upon the chest, and the forearms upon the arms, so that the
  palm of each hand is applied to its side of the face  and chin.   The in-
  ferior extremities are also flexed in a similar manner, the thighs  upon
  the  abdomen and the legs upon the thighs;  the  feet lying  together
  and within the thighs, the  knees and elbows  touching  each other.
         n 
162
DEVELOPMENT OF  THE FOETUS.
This is found  to  be the  position most economical of space; it forms
the body into a compact and ovoidal mass, similar in shape to that of
the head, and  most convenient for expulsion from the pelvis.
  Upon a little reflection it must be  evident that the same influences
that give shape to the embryo and foetus  must also shape its position
in utero.   And furthermore, that the  same influences must also deter-
mine the presentation of the foetus, not at once, but as it is gradually
developed so it is gradually made to assume its best possible position
and gradually to present itself at the superior strait with  its head
downward, the occiput turned  to the left ilio-pectineal eminence, its
back—relative to the  mother—to the  left and in  front, and its face
looking back to the mother's right.   This position and presentation is
assumed by means of the all-pervading influence of the mother more
frequently than all the others put together, simply because  it is the
most favorable for an easy expulsion from the generative organs, and
is consequently the most orderly and natural one.  When the foetus
deviates from this it assumes the next  most favorable position for an
easy delivery,  and so on ; the  greatest number of presentations and
positions being by far  the best-, and  the least  number  being the most
difficult.   The causes of all these different presentations and positions
may be  much more rationally accounted for  by referring the whole
matter to Nature's formative process  than by attempting  to explain
them as the effects of gravity or of any other mechanical influence;
since the same result is obtained where  women maintain the  horizon-
tal  position during the entire period of utero-gestation.  If the forma-
tive powers of Nature in the mother are adequate to the folding of the
limbs in the  compact  and symmetrical manner just described, why
should they not be deemed sufficient to  determine the presentations
and the precise position ? It is contended by  many writers, however,
that the fact of the foetal head being usually found at the outlet of the
uterus is due to gravity.  "The reason," says  William Hunter, in his
work on the Human Gravid  Uterus, " why the child's head is  com-
monly downward may be supposed to be this: the child is specifically
heavier than the liquor amnii, and therefore  in the various attitudes
of the mother is always in  contact with and supported upon the de-
pending  part of  the uterus.   This in the more common attitudes is
the cervix uteri.   The child's head and upper part of the trunk con-
tain more matter in proportion to their  surface than  the  lower part
of  the body; hence the head will more generally fall down to the
lower part of the uterus."
   It may be asked, Why, then, are there so many different presenta- 
DEVELOPMENT OF  THE  FOETUS.
163
tions and positions?  The head is sometimes extended upon the back,
as in the face  presentation, and sometimes the lower extremities are
thrown over toward the back.  All  these various attitudes, presenta-
tions and positions result from corresponding variations  in the vital
energies of the mother.  Should she  be well, in an orderly and happy
condition, both  mentally  and physically, her  child will  have  only
natural and orderly presentations and positions.   The truth of this is
proven by daily experience in practice. For women who, for instance,
invariably have face presentations of their children, and who  have
always been ill  in some particular manner themselves, after the  re-
moval of their malady have as invariably had  their children present
naturally.  Hence the great importance of making the most strenuous
and  persevering efforts to remove the various disorders  with which
women are afflicted, and to advise happy and orderly modes of life in
order that the distresses of childbearing may be entirely overcome;
which  indeed  is not only possible, but under  the prevalence of  the
homoeopathic regime quite probable in the course of time.  It should
be remembered here that the embryo or foetus is not suspended in  the
uterus by the  umbilical cord, but that it floats in  the  liquor amnii;
hence it is free to  obey any influence brought to  bear upon it by  the
mother.
   By presentation we mean the part that presents at the superior
strait, as the vertex, the  face, the  breech, etc.  By position we  mean
the particular posture in  presentation, as the occiput in the left half
of the pelvis, anterior, transverse or  posterior.   But the further con-
sideration of this subject will be  postponed until we come to  treat of
the mechanism of  labor.
   The development of the foetus needs also to be studied with especial
reference  to the three great functions of Nutrition, Respiration and
 Circulation, by which this development is accomplished.  Each  of
these functions is  evidently maintained during intra-uterine  life in a
manner altogether different from that after birth.
   Nutrition.—At no instant in  the history even of the unimpreg-
nated ovule is it without the  support of the mother, from the earliest
moment of its existence within the ovary till it  is ruthlessly washed
away by the  menstrual flux  or broken and destroyed  by some other
means.   But when impregnated the ovule becomes still more  espe-
cially the object of the particular care of the mother.   Hence, imme-
diately upon the occurrence of conception the entire natural, spiritual
and  vital organism of the mother is aroused to  provide  for what is
really a new creature, already  a new human being.   From this moment, 
164              DEVELOPMENT OF  THE  FCETUS.
 therefore, commences the nutrition of the embryo.   And at the very
 first this is accomplished in a manner similar to the nutrition of a seed
 in the earth; which, although in a general manner supported by the
 external influences of the mother-earth, is in a still  more immediate
 and particular manner sustained by itself, the sprout  flourishing upon
 the remaining  substance of the seed till that is  consumed.   So the
 impregnated ovum, even after it has left the ovary,  is sustained in a
 general way by a sort of endosmosis from the mother, but in a more
 immediate and particular manner its  primary development is main-
 tained by, and the embryo itself subsists upon, the vitellus; a substance
 most nutritious and especially provided for this very purpose.  When
 this original resource is exhausted, the  embryo throws out the allan-
 toid vesicle in search of other supplies.  These are found by comin^
 in contact with the mother's blood in the villi of the chorion.  In this
 great  life-fountain the embryo finds  a bountiful supply of all things
 needful for its present wants and future growth and development.  The
 vitellus is indeed very small, but the embryo itself is correspondingly
 minute; it wants but little.
  Sufficient proof of these statements  may be  found in the fact that
 the umbilical vesicle is  entirely constituted from the  vitellus, or from
 what remains of it after the formation of the blastodermic membrane,
 and in the further  fact  that the omphalo-mesenteric vessels are found
 to circulate blood  to and from the embryo in a manner altogether
 similar to that in which it is  subsequently done in the umbilical cord.
 And,  finally, the umbilical vesicle and the  omphalo-mesenteric vessels
 soon become obliterated after the nutritious root has  become well es-
 tablished by  means of the allantoid vesicle, its arteries and veins.
  Pure arterial blood contains all the  needful materials for growth,
 and for the separation of the waste and  decomposition of tissue; these
 must  be first accumulated in the blood, then distributed as needed.
 For  this  supply  of the elements necessary for growth and repair
there  is  a  constant yearning, of which the blood, as a living body,
 is conscious, and to which it continually seeks to respond.  Blood is
 found  in the embryo at the  earliest possible period of examination;
a circulation has  already been established  in the  embryo and in the
omphalo-mesenteric vessels by the time  the supply is exhausted which
was contained in the umbilical vesicle, into which these vessels ramify
in search of nourishment for the blood  itself.
  Upon the  failure of the supplies from the umbilical vesicle a new
route  must be opened up to furnish the  demand.  This is done by the
embryo throwing out the allantois supplied with the two arteries aris- 
DEVELOPMENT OF THE FOETUS.
165
ing from the internal iliacs, and containing impoverished blood which
must be renovated and returned to the embryo.   These arteries are
accompanied by a vein.   The whole apparatus soon takes  root in the
villi of the chorion, and forthwith a return of nourishment is  made
to the already famishing embryo.   The impoverished blood  from the
embryo, by endosmosis through the coats of the villi of the chorion,
is renewed and regenerated from the maternal blood. And  the arteries
anastomosing with the vein, the aerated and revivified blood  is imme-
diately returned to the embryo for its especial benefit.  Now is formed
the first nucleus of the placenta; and in this manner is accomplished
the continued nutrition of the foetus, by its  famished  and exhausted
blood being thus supplied with all  things needful by endosmosis  from
the maternal blood, through the blood in and about the  villi of the
chorion.  From this time the foetus, the cord and  the  placenta grow
pari passu till the completion of the full term.  And by  no  other
means is the nutrition of the embryo and foetus provided.  All the
plants, and, indeed, the whole animate creation, is nourished by a  kind
of endosmosis from the parent earth, or mother; but the material thus
supplied is appropriated by each receiver in its own way, in accordance
with its  own form of life.
  A positive proof that the  nutrition is  supplied  by  means of the
cord, anjd in no  other  way, is  found in the well-known  fact that
compression of the cord so as to arrest the circulation, although but
for  a  very short space of time, is certain death to the  child.  What
change the nutritious material  obtained  from the  mother undergoes
before it is  fitted for appropriation by the foetus, or where that pre-
paratory change  is made,  whether in the foetal placenta or in the
foetal  liver, is not yet known.   Nor is it known  where  or how the
plant transforms the nutriment derived from the earth into  its peculiar
sap, fibre and bark.
  Respiration.—This function is essential to the existence of all the
animals  of creation, and  for  every individual  thereof;  for this is
the process by which the effete  blood becomes aerated, and  gives up
the excess of carbon and other useless matters with which it is loaded.
This,  as  just above  described,  is  accomplished by the foetal blood
coming  in  contact with the maternal, in  a manner not unlike that
in which the blood  of fishes is decarbonized  by being exposed, by
means of the gills, to the  air  contained in the water which passes
through them.  The  blood of the mother  serves  exactly the  same
purpose for that  of the foetus that the water  does  for the blood of
fishes; the water  contains an appreciable amount of air, or rather of 
166
DEVELOPMENT OF  THE FOETUS.
oxygen, and so does the mother's  blood.   In proof of this, it is only
necessary to compress the cord so as to prevent the blood of the foetus
from being exposed to that of the mother, and  the child turns black
and dies, as from asphyxia.
  Secretion.—As development advances all the secretions are suc-
cessively established.  The liver secretes bile, the gall-bladder is found
full, and there  is reason to believe that bile is steadily supplied to the
intestines.   Even prior to the fifth month the  alimentary canal con-
tains  a substance called meconium, which  is  principally  composed
of biliary matter and the detritus of the mucous  membrane.  There
is no positive evidence  that this meconium is ever evacuated into the
amniotic sac, but it sometimes  passes off freely during labor, and in
other cases not long after  delivery.  Urine is secreted, and usually
passes in considerable quantities after birth; and it is thought by some
that the foetus  in utero discharges the urine  into the amniotic cavity.
But we have no positive evidence  that the  urine is ever discharged
from the bladder till after delivery.
   Circulation.—The lungs of the foetus in utero not being employed,
are small and  collapsed, and bear a striking resemblance to the liver
in appearance.   A very small portion of blood passes through them,
and that which does so p:iss neither gives up impurities  nor receives
vivifying material, as  after birth.   In consequence of this- the pul-
monary arteries  are  small, and the  passage  of blood from the right
side of the heart would  be impeded in consequence of their lack of
development were it not for the existence of the foramen  ovale, or
foramen of Botal, as it is likewise termed, an opening in the septum
of the  right and left  auricle and through which a proper  quantity
of the blood  flows  from the right into  the left auricle.  But not-
withstanding the fact that a portion of  the blood received by the
right auricle is thus conveyed away, there is still too great a quantity
to be  transmitted through  the  minute pulmonary artery; and hence
a supplementary short and thick vessel is provided, the ductus arte-
riosus, which passes between the pulmonary artery and the aorta, and
•rives  free escape from the  right ventricle.   The right and  left ven-
tricles thus become in  a measure one, and the blood from each enters
directly into the aorta;  while it will be seen that the right and  left
auricles are likewise one through the medium of the  foramen ovale.
Now in the pelvis of  the foetus the common iliac arteries divide into
two branches,  an external and  an internal.  The latter go to supply
the extremities of the  foetus, while the former pass directly upward
co the  umbilicus as the umbilical  arteries, and  reach the  placenta 
ANOMALOUS PREGNANCY.                  16'J
through the medium of the cord.   Here the blood receives its vivify-
ing properties from the maternal blood, as has been already described,
and  is returned by the  venous branches which unite  to  form  the
umbilical vein.   The  blood thus changed and purified enters  again
the body  of the  foetus  at  the  umbilicus, passes upward along  the
anterior edge of the suspensory ligament of the liver, and supplies
that organ with blood.  The current then passes onward to be emptied
into the ascending vena cava by means of another short supplementary
trunk, the ductus venosus, and is conveyed to the right auricle of the
heart.
  The course of the foetal circulation, then, may be thus stated :  start-
ing from the placenta, the  blood passes  through the umbilical vein,
along the cord, into the foetus at the umbilicus, and thence  to  the
liver;  part goes  to that organ,  and the remainder passes onward
through the ductus venosus  into the ascending vena cava, and through
it to the right auricle.  Part of the blood received by the right auricle
comes through  the descending vena cava, and of this a portion  passes
into the left auricle through the foramen ovale, and thence to the  left
ventricle,  Avhile another portion passes  into  the right ventricle, is
forced by its contractions  into the pulmonary  artery,  and into  the
ductus arteriosus, which conveys  it to the aorta.  The blood  in  the
left ventricle is also forced into the aorta, and through the aorta the
blood passes upward to the head  and  superior extremities and down-
ward to  the  trunk and inferior  extremities.   Having reached  the
internal iliacs in its downward course, it passes through the umbilical
arteries of the cord to the placenta again.
                       CHAPTER  XL
                 ANOMALOUS  PREGNANCY.
                     Multiple Pregnancy.
    HAVING described normal  pregnancy, the product  of which is
     a single  foetus, we now advert briefly to that form of gestation
in which there are two or  more.  It is by no means an uncommon
occurrence for a woman to give birth to twins; triplets are produced
less frequently;  and  yet  there  are well-authenticated  instances on
record  in which four and even five children have been brought forth
during a single labor.  Twin pregnancy occurs about once in seventy- 
168
ANOMALOUS PREGNANCY.
five cases.  Madame la Chapelle records that in 37,441 births there
were 444 instances of twins and but five of triplets.  Churchill states
that  in 257,935 births  recorded  by British practitioners there were
3431  cases of twins and 43 cases of  triplets.   A great variety of
theories  have been  promulgated by various writers regarding the
causes of multiple pregnancies.  These theories,  however, may be
summed up into the general opinion that the cause  lies in an extra-
ordinary reproductive  power,  possessed in some instances  by the
male and in others by the female.
  As a general rule, in plural  pregnancies each foetus has its own set
of membranes  and its  own placenta, although there may be an inos-
culation of the blood-vessels of the placentae.   It sometimes happens,
however, that there is but  a  single placenta.   This may be, and
doubtless is, attributable to there being but a single ovule impregnated,
which has  contained two yolks and two germinal vesicles, as is some-
times observed in the eggs of birds.
   Twin pregnancy is, as is shown above, the most frequent  form of
multiple pregnancy.   The foetuses  in  such cases  are usually smaller
than where there is but a single product of conception, and in after
life they are usually marked as " delicate " children; but this is by no
means the case in every instance, for twin children are frequently fully
and largely developed at birth, and are quite as healthful in after life
as are other children.
   The signs of plural gestation prior to delivery may be regarded as
uncertain and unsatisfactory.  The disproportionate size of the abdo-
men, as compared with the  period  of  gestation, which has been ad-
vanced as a sign of twin pregnancy, may be due to other causes, such
as an excessive quantity of liquor amnii, an unusually large develop-
ment  of the foetus, dropsy, either  ovarian or abdominal, tumors, etc.
The appearance of the abdominal tumor as though it were divided
into halves is  equally  untrustworthy as a sign, for it may be  due to
other causes, such as those enumerated  above.  The only sign that can
be regarded as at all reliable is that derivable from auscultation.  If
two distinct foetal pulsations, not synchronous, can  be detected  in dif-
ferent parts of the abdomen, almost conclusive  evidence is afforded of
the existence of more than one foetus.
   Extra-uterine Pregnancy.—Impregnation  is  effected  within
the ovary, as  has been described in a preceding chapter.  But where
the  fecundated  ovule  fails to  reach the cavity of the uterus, it may
lodge, adhere and become  developed in some other place, constituting
extra-uterine pregnancy—a  very disastrous and  happily infrequent 
ANOMALOUS PREGNANCY.
169
occurrence.  Of the causes of this failure to  reach the uterine cavity
we  know but little; the most plausible view being that it is due to a
constriction or other morbid condition of the Fallopian tube.
  Sometimes the impregnated ovule remains in the ovary and is there
developed, constituting ovarian pregnancy.  The autopsy of a woman
dying suddenly has revealed, as the cause of her dissolution, an en-
larged ovary rent in twain by a foetus of four and a half months.
  Sometimes the ovule is  arrested in its progress through the Fallo-
pian tube, becomes  attached to its walls, and development there pro-
gresses.   This is called  tubarian pregnancy, and is the  most frequent
form of  extra-uterine gestation.  The ovum may be arrested in any
part of the tube, the walls of which, becoming distended around the
ovum, envelop it in a sort of sac or cyst.
  In other instances, on account of some abnormality of structure, the
ovum slips in between the interstices of the uterine tissue in that part
where the  Fallopian tube traverses  the uterus.   This  anomaly  is
termed interstitial pregnancy, and is the rarest of all the forms of mis-
placed gestation.   Owing to the yielding and distensible character of
the uterine walls, gestation may here go on for a longer period than  in
other abnormal  situations, and even exceed  full term; but in such
cases labor sooner or later sets in, with disastrous consequences to the
woman.  In some recorded cases of this  form of extra-uterine  preg-
nancy the placenta was found to be normally attached  within the
uterine cavity.
  In some instances the impregnated ovum either does not enter the
Fallopian tube at all, or, having entered it, drops out again and falls
into some part of the abdominal cavity, fastens to some portion of the
peritoneum and develops there for a longer or shorter period.   When
the foetus dies shortly after  conception in these cases,  it may remain
within the abdominal  cavity in the form of a cyst for years, or an ab-
scess may form and discharge either externally or internally.  In the
latter case this would necessarily result fatally; not so, however, should
the contents of the abscess discharge externally, or even into the  intes-
tines, uterus, bladder or vagina.   This  form of extra-uterine  preg-
nancy has been termed ventral or abdominal.
  The mode of development in these  abnormal  cases is similar to that
in others.  Internally, the ovule goes on developing  as  in normal
pregnancies, in  the formation of the  amnion, chorion,  placenta, um-
bilical cord, etc.   It is doubtful, however, whether a true decidua is
formed in these cases, though a substitute for that membrane exists.
Externally, to whatever point the ovule may become attached,  it be- 
170
ANOMALOUS PREGNANCY.
comes so attached  by means of the villi of the chorion growing intc
whatever structure they are  brought into contact with.  Simultane-
ously with this growth  on the part of the ovule, the maternal struc-
ture grows to correspond and to furnish  its  part in the reproduction,
by growing upon  these villi and  throwing out blood-vessels to meet
those coming from the embryo.  Thus  the  placenta  is formed  pre-
cisely in a similar maimer here as in the uterine cavity—only with
far less present security to the embryo, and with almost certain fatal
consequences to the mother.
  After the ovule has thus become fixed in its unnatural bed for de-
velopment, its  growth goes on for a longer or shorter  time, according
to the strength of the  membranes—usually till  about the middle of
the ordinary term  of utero-gestation—sometimes even to the full term.
At last, the membranes, from want of sufficient protection, burst and
their contents are  poured out into the abdominal cavity, and there re-
sults a rapidly fatal inflammation of the peritoneum  of the ill-fated
mother.  Sometimes the  maternal surface  of the placenta becomes
ruptured, so  as to  produce fatal hemorrhage.  In other instances the
first shock is withstood, the contents of  the  cyst become absorbed or
again encysted—as any foreign body may be—and the woman not only
survives, but may even enjoy good health for  years.  In some cases
the foetus itself perishes at about the full term, and  makes its exit by
means of fistulous openings through the abdominal  parietes or other-
wise.
   The diagnosis of these cases will be most easily effected  by observ-
ing that in vaginal examination the os and  cervix uteri will be found
little, if at all, altered  in size, and generally higher than usual.  A
tumor may also be felt above the vagina, either  in  the recto-vaginal
pouch or on one side of the uterus.   This tumor generally pushes  the
uterus against the pubes or to  one side of  the pelvis, or draws it up
into the pelvis almost beyond reach.  Little satisfaction is derivable
from auscultation, but palpation may reveal the foetal outlines if  the
abdominal parietes be sufficiently thin and relaxed.  Where the preg-
nancy is of the interstitial, variety, the uterus will be found irregularly
enlarged.
  Super-Fgstation.—The  question as to  whether  conception can
take place while the uterus is carrying the product of a previous con-
ception has given  rise to a vast amount of argument pro and con.  At
one  time a belief in  the  possibility of super-fcetation occurring was
almost universal;  but a careful  scrutiny  of the so-called facts of  the
case, together with the plausible arguments advanced  in  opposit  on, 
LABOR.
171
succeeded in engendering an almost universal disbelief in the doctrine.
Now, however, there appears to be no  bar offered to a belief in the
possibility of the  occurrence of conception  during the earlier months
of embryonic life by any anatomical or physiological  fact connected
with gestation.   Dr. Matthews Duncan  is of the  opinion  that, while
ovulation is suspended during the greater part, if not the whole, of
pregnancy,  yet there may be exceptions  to this rule, particularly dur-
ing the earlier months.  If, then, ovulation be not suspended, it is of
course possible  for  super-impregnation to take place.   It is difficult
to understand in the ordinary view of the case how impregnation can
occur while the uterine cavity is filled with an embryo and the decidua
is closely adherent to the inner uterine wall.   Dr. Duncan  says that
the " decidua reflexa does not become adherent to the decidua vera
till after the third month, prior to which sufficient space exists to ad-
mit of the passage of the semen, and consequently  to allow of a subse-
quent conception."  This special pleading is not demanded to explain
the occurrence of super-fcetation if the views entertained by the writer
in regard to the passage of the semen to the ovaries, as laid down in a
previous chapter of  this work, are taken into consideration.
                      CHAPTER  XII.

                            LABOR.

   LABOR, or parturition, completes the grand function of reproduc-
    tion, and by it, either by nature, by art, or by both conjoined, the
new being is ushered forth to  assume  an  independent existence with
all other isolated existences.
  Labor is considered natural when it is accomplished by the unaided
powers of nature, and unnatural when manual  or other assistance is
found necessary.  Labor is also considered at term when it occurs at
about the expiration of the ninth month of utero-gestation, and prema-
ture when it occurs at any time between the first part of the seventh
month  and  full term.  Provoked labor  is one which  has  been pro-
duced by some mechanical cause, either accidental or designed.  A re-
tarded  labor is  one that is delayed beyond nine and a  half or ten
months of gestation.
  Premature Labor.—Premature labor  may result from a great
variety of causes—accidents of any kind, diseases incidental to the 
172
LABOR.
pregnant condition, etc.  For the precautions and remedies to be em-
ployed in case of threatened premature labor we refer to the chapter
on Abortion.  It may be stated here, however, that all women should
use extra precautions at about the seventh month of gestation.  In
premature labors the  first stage is usually longer in proportion than
the second, which latter is generally longer than a labor at full term.
Also vertex presentations are far less frequent than in natural labor at
term, and cross, breech or  irregular  presentations are much more fre-
quent.  There is great danger from  hemorrhage in premature labors,
consequently more need of quiet  rest, from the first symptoms and
ever after till all danger is past, and so much the more need of care-
fully selecting the proper remedy.
  Retarded Labors.—The ordinary time for gestation is two hun-
dred and seventy-five days, but as there  are exceptions to all other
rules, we  might naturally  conclude  they  would be  found here also.
Accordingly, investigation  has been  made, and out of forty-three in-
stances of conception after  a single coitus, collected by Dr. Reid—all
of them resting upon testimony as  credible as can be obtained in such
cases—of which the  average duration of gestation was two  hundred
and seventy-five days—three were  delivered at the 280th day, two on
the 283d day, one each on the 284th and 286th days, two on the 287th,
one on  the 291st, two on  the 293d, and  one each  on the 296th and
300 th days.
  Natural Labor at Term.—In the  study of  this subject two
orders of  facts must be separately considered—the  one regarding the
physiology of labor on the  part of the mother, the other consisting of
the movements which the child  must execute in order to promote its
passage from the  uterus  through the organs  of generation.   The
former is to be regarded  as purely functional, the other as simply
mechanical.  Let us first consider  the subject functionally with refer-
ence to the vital action of the mother.
  Causes of Labor.—The causes  of labor have been divided into
the efficient and the determining causes.   The efficient causes are un-
questionably the vital energies of the mother, brought to bear in every
possible manner upon the child  for its  expulsion, and at the same
time to open up  the way as much as possible for its exit.   The uterus
itself, acting involuntarily, is an agent in the expulsion, aided more
or less by the voluntary efforts of the mother, while at the same time
an involuntary dilatation is effected of the os uteri, vagina and exter-
nal  organs. •  All these processes on the part of the mother are purely
functional and involuntary—as much so as  are the processes of concep- 
labor.
173
tion, gestation, digestion, nutrition,  etc.  The efficient cause of the
labor is in fact only the last part of the grand function of reproduc-
tion.  How important, then, that this most sacred function should not
be disturbed  by any influences whatever, but should be sedulously
watched over by a careful and skillful homoeopathic physician, ready
to administer the proper remedy for whatever deviation from the nor-
mal condition may occur!  How different when the blood is poisoned
and  the senses stupefied by anaesthetics ; how  impossible then for the
mother  to give the alarm, or for nature to respond and  furnish the
symptomatic  signs of danger till it is too late!
   The  determining cause may be any influence by which the efficient
cause is set in motion.  At the full  term, when the woman should be
delivered, the determining cause becomes spontaneous, the grand func-
tion of reproduction is about to be completed ;  and here, as in all other
vital processes, there is no delay; the work  constantly advances till
parturition terminates and completes to the very last the great process
of reproduction.  At the full term, or even a few days before, various
kind of accidents, diseases or mechanical  means  may become the de-
termining cause by arousing the efficient cause in'the contractive and
expulsive action of the uterus; but this  function of parturition will
not be so safely or so easily accomplished when thus excited by exter-
nal influences as when it begins in a perfectly natural and spontaneous
manner.
   As to what it is that immediately excites labor, however, very little
is definitely known.   Various speculations have  been indulged in by
obstetrical writers.   By some  it has  been attributed to the direct ac-
tion of  the foetus; others have thought it due to the uterus having
attained its utmost limit of distension; while still others have thought
that labor sets in at that period at which a menstrual period would
have occurred had conception not taken place.  Sir James Simpson
believed it to be due to the disintegration of the decidua at full term,
and a consequent  separation between that membrane and  the uterus.
It is undoubtedly referable to a natural  law  which at present is not
understood or explainable.
   The  Physiology of  Labor.—The phenomena of labor may be
arranged  in  three  distinct groups  or  successive stages—the  first
including the  whole period from the commencement of the labor to
the complete  dilatation of the os uteri; the second extending from the
dilatation of the  os  uteri to the expulsion of the child; the third
terminating with the final delivery of the placenta.
   1.  The First Stage.—The approaching  termination of gestation is 
174
LABOR.
indicated usually by various symptoms called precursory or premonitory
signs of labor.  About the last two weeks a change becomes percep-
tible in the form of the abdomen.  Its sides  become more projecting
as the uterine tumor sinks from the region of the stomach and epigas-
trium,  so that respiration becomes  easier and  food can be taken with
less discomfort.  And in many respects the woman feels lighter, better
and easier.  This change  results from the cavity of the body and of
the neck of the uterus being blended  into one by the softening and
giving way of the os internum uteri, and by the sinking downward
of the  uterus, the  fundus of which is  now found to  lie midway be-
tween the ensiform cartilage of the sternum and the umbilicus;  at the
same time the uterus  is projected forward.   The calls  to urinate now
become rather more frequent, owing to  increased  pressure on the blad-
der and its lessened capacity; sleep is more broken by restlessness, and
walking  becomes more difficult.   The woman becomes more clumsy,
and a little later  glairy discharges take place from the vagina, which
simply show an increased action of  the muciparous glands  prepara-
tory to the final act of parturition.
   Finally, the first stage is ushered in by painless contractions, which
after a while become somewhat painful, and finally more and more
so.  The mucous  discharge often becomes more or less tinged with
blood from the rupture of small vessels about the cervix, due to com-
mencing dilatation and separation of the membranes.  This, in the
parlance of the lying-in chamber, is called a " show."   The os uteri
dilates more and more with every orderly contraction, the parts be-
come bathed with  moisture, and the upper portion  of the vagina
gradually dilates  simultaneously  with the  os  uteri.   During this
stage the woman may walk  about, sit or lie down, as  she finds most
comfortable.   Her  respiration is usually continuous with every  pain;
there  may be a sort of shivering-like respiration; at times violent
shiverings and shudderings seize upon  her, although she does not feel
cold, and she wonders why it is she shakes so.  This shivering is one
of the phenomena most usually witnessed during  an orderly first stage
of labor.
   The pains of this stage of labor are of a "cutting" or "grinding"
character, and although they are of shorter duration than those wliich
occur when labor is  more advanced, they are, in many women, less
easily borne, and  give occasion to expressions of impatience.   They
usually begin in the back, extending around into the abdomen, but
are unaccompanied  with  any bearing-down effort on the  part of the 
LABOR.                          175
rt*oman.  Vomiting sometimes occurs at this stage, but is usually re-
o-arded as a favorable sign.
  These  pains  indicate the gradual dilatation of the os uteri.   This
dilatation of the os is due not only to the pressure  downward of the
membranes and the presenting part of the foetus, but chiefly, according
to Dr. Rigby,  to  the contraction  of  the longitudinal  fibres  of the
uterus, which,  overcoming the action of the  circular fibres, have a
tendency by their action to open  the os in every direction.
  This state of things continues for a longer or shorter period  until
the dilatation of the os uteri is completed, which marks the termination
of the first stage of labor.  "As a general rule, it may  be stated that
regular and genuine contractions of the uterus  sufficiently powerful to
produce  pain seldom  require  more than six hours to  effect the full
dilatation of the os .uteri; in many cases a much shorter time will  be
sufficient; whereas, in others the first  stage  of  labor  may last for
more than quadruple this period before it is completed; in neither can
it be considered abnormal, and we usually find that where the pains
of the first stage have been slow and lingering, they become remark-
ably quick and active during the second stage."—Dr. Rigby.
  If the  hand be placed upon the abdomen during the continuance of
a pain, the uterus will be found to be  hard and tense, as though  it
were drawn up into a knot.   An examination per vaginam will re-
veal a greater or less dilatation of the os, which will be found during
a pain to be hard, tight  and  circular, while the membranes protrude
through the aperture,  arc tense, and communicate a feeling of firmness
to the finger, which passes away and they become relaxed again as
the pain  subsides.   Usually in primiparse, at this stage, the os will be
found to be high up, while in women who have already borne children
it will be lower down and nearer to the pubes.  At the same time, if
any considerable progress has been made, the vagina will be found to
be flaccid and  dilatable, hot and moist.
  II. The  Second Stage.—The  os uteri is  now fully dilated, and a
marked  change takes  place in the character of the pains and in the
condition and appearance of the  patient.   Generally at the completion
of the first stage, or quite  early in the  second stage, the  membranes
are ruptured and  a portion of the liquor amnii is discharged.   This
fluid still farther moistens the parts, and its escape gives rise to a sense
of relief to the woman, which is very grateful to her.   There is  quite
frequently at this  time a suspension of active  uterine operations for a
longer or shorter period, which  likewise adds materially to her com-
fort, and gives her an opportunity to gather her strength  for the try- 
176
LABOR.
ing ordeal she has yet to encounter.   Soon, however, pains return,
and those are of a different character and serve a different purposr
from those that preceded them.  The efforts of the uterus are increased,
the pains are longer, and the intervals between them are shorter; and
yet, although there is absolutely greater suffering at this period than
during the first stage, the  woman bears up more heroically and gives
less evidence of suffering.  This  is doubtless, due to the fact that her
attention  is directed  to  the bearing-down  effjrts which  attend the
pains of the second stage of labor.  These pains have been termed
voluntary, but it is a question whether they are entirely so, for there is
an undoubted sympathy between the uterus and vagina on the one hand
and the muscles of the abdomen and other parts on the other, which
gives  to them an involuntary or irrestrainable character.  To aid this
bearing-down or expulsive effort the woman holds her breath, generally
grasps something to aid her in bringing into play the necessary muscles
of the trunk and extremities, her face becomes red or even dusky-hued,
the respiration' is  quickened, the voice is hoarse, and she replies to
questions in a short and spasmodic manner.  When this is noticed in
a woman  in  labor, it is certain that the second stage has set in and
that the os uteri  is fully dilated.
  As  the  pains come on the presenting part of- the foetus advances,
and as they go off it recedes ; thus, by this wise provision,  the vagina
is gradually distended and dilated, acted upon and relieved.  An ex-
amination per vaginam now reveals the disappearance  of the os uteri,
the cavity of the uterus and the vagina constituting a single channel,
in the lower part of which the  foetal head is found  completely filling
up the  passage-way.  Occasionally the finger will encounter the an-
terior lip  of the os uteri,  for it is sometimes forced dowm  by the ad-
vancing head and becomes distended over it.
  As  the  pains  and  the quasi-involuntary muscular efforts continue
the head advances more and more, and as it passes along the utero-vagi-
nal channel  pressure is made on the rectum, the contents of which are
expelled, and even a part of the intestine itself in  some instances.
Finally, the floor of the pelvis is reached, and pressure upon and dis-
tension  of the  perineum  and  dilatation of  the vulva follow.  The
head advances still farther under the operation of the combined  mus-
cular  exertions, the perineum and vulva are distended, while the head
of the foetus is moulded  to accommodate  itself to the channel and
outlet, and  begins to be extruded through  the  vulva.  Finally, at
the moment when  the expulsive  efforts are at their greatest, and the
woman  is in a condition of intense mental  excitement, the head is 
LABOR.
177
born.  This is usually followed  by a moment of relief and  rest, but
frequently the efforts of the uterus are continued,  and the child is
forced into the world, one shoulder coming out under the pubic arch,
and the other passing over the floor made by the distended perineum.
As soon as the body of the child is born the remaining portion of
the  liquor amnii, that which  was dammed up by the occupancy of
the channel by the foetus, is discharged, and the uterus contracts upon
itself.  This completes the second stage of labor.
  III.  The Third Stage.—After the termination of the second stage
of labor in the birth of the child there is usually a lull, as though the
uterus  were resting from its  exertions.  Soon, however,  there is  a
return of pain, which is slight and excites no bearing-down effort on
the part of the mother.   This usually marks  the detachment of the
placenta and its extrusion  into the  vagina, or even its  expulsion
through the vulva.   This is commonly followed by a slight gush of
blood.   The uterus will then be found low down in  the pelvic  cavity,
hard and globular, and  contracted to about the size of a foetal head.
The subsequent pains—or after-pains, as they are called—serve the im-
portant purpose of  completing the contraction of the  uterus, and by
thus closing the mouths of the uterine sinuses, rendered patulous by
the detachment of the placenta, preventing hemorrhage which would
otherwise occur.
  A pain, in labor, signifies the contraction of such  muscular fibres
as are  concerned in giving birth to the  child, and the sensation of
pain produced  in  such contractions  results from pressure upon the
nerves distributed  in  the tissues, especially of  the  uterus  itself, thus
contracting, the forcible distension  of the  os, and  the  dilatation of
the utero-vaginal channel.  The sensation of pain is felt in the back,
abdomen  and elsewhere by virtue of reflex  action,  by which the seat
of the pain is  located at the central origin of the nerves themselves,
rather than at their peripheral terminations.  During the entire coursa
of the parturition the child takes no part  in its delivery ; it is entirely
submissive, as it has been during its entire stay in the uterine cavity (
it is entirely neutral and passive, and is expelled entirely by the last
act of reproduction on the part of the mother.
  The  more active the muciparous  glands  in this vital act the more
easily  is  the  child brought  forth,  the  abundant  glairy discharges
rendering the labor a moist one and comparatively easy.  Where little
or none of this mucus is secreted the labor is  called dry, and  is con-
sequently more painful and tardy.
  The bag of waters, known as such, is  simply the amnion  and cho-
       12 
178                          LABOR.
rion distended in advance of the presenting part of the chdd by the
bulging of the liquor amnii in consequence of the pain.
  The  Duration of  Labor  is exceedingly variable—even when
no obstacle seems to oppose the delivery—lasting from one  hour to a
week, and between  these two  extremes there is  every intermediate
grade.   In general,  labor is longer in primiparse than in those  who
have had many children or are  nearer the climacteric period of life.
As  a general rule, the average length of time may be set down at from
«ix  to twelve hours.   The duration of the labor is expected to be an-
nounced as soon as an examination is made per vaginam.   But much
caution  should be used in this  matter, for it  is discouraging to the
patient to overrun the specified time.  After the first stage is passed,
the second will be two or three times shorter, other things being equal,
the diameter of the straits all being- normal and there being- no undue
rigidity of the soft parts.   In other cases the time will vary according
to the changed conditions.  It is, after all, utterly impossible to  pre-
dict the time of delivery with certainty.
  The Effect  of Labor upon the  Mother and Child.—On
the part of the  mother there is often  much despondency at the  com-
mencement of labor, and during the first stage there is apt to be  more
or  less  distress  of  body and mind—a  feeling of despair,  as if she
could not endure to the end, or a feeling of fretfulness or irritability.
But as soon as the second stage sets in the patient nearly always is in
better spirits; she becomes more hopeful and bears her pains, and vol-
untarilv exerts herself,  with greater confidence that she will be deliv-
ered all right.   She often  perspires profusely and becomes much
exhausted during labor.   The whole process  of parturition is apt to
be  a great shock to  the nervous  system, and there is danger of great
prostration during  delivery, similar  in effect to that produced in
persons sustaining a severe mechanical injury; even a complete col-
lapse may sometimes occur.  Great care is needed, immediately after
the completion of this  great event, that the patient  get quiet sleep as
soon as possible.  She  should  not be allowed to talk, and much less
should  the accoucheur  try to have a little pleasant conversation with
her after the labor is over.   Such a course cannot be too severely cen-
sured since it may be attended with fatal consequences.  A little  sleep
goes very far toward making all safe.
  On the part of  the  child the  effect of the labor varies  with its
severity and  its  duration; and the  shock of the  compression of
the  uterine  contractions is  more  severely felt upon  male than upon
female  children, as before  stated.   In many cases the sad effects are 
LABOR.
179
immediate;  in others  more  remote and proportionally  more  in-
jurious.
  In regard to the force possible to  be  called  into operation during
the progress of labor, the experiments and calculations  of Professor
Haughton are certainly very interesting.   He has  shown that the  ex-
pulsive  force of the uterus during the first stage of labor in accom-
plishing the dilatation of the os amounts to about 3.4 lbs. on the square
inch,  hi addition  to this, Dr.  Haughton has calculated  the  force
capable  of being  exerted by the mother in her expulsive efforts to be
equal to 38.6 lbs. to the square inch.  So that, taking the uterine and
abdominal forces together,  we have a total of 42.0 lbs. to the square
inch as representing the force capable of being exerted in the expulsion
of the foetus.   It ts  not to be supposed that this great power is neces-
sary, or  that it is  brought into operation in any stage of labor.  The
immense power dependent upon the action  of the muscles of  the
woman apart from those of the uterus, is more  or less dependent on
the will, and  hence, it will be perceived, the  use of chloroform  must
interfere with labor to the extent that  it lessens  the  power to cause
voluntary muscular effort.

                  The Mechanism of  Labor.
  The mechanical phenomena of labor have relation strictly to  the
child.  It is very evident, from the knowledge we  possess of the form
and mechanism of the pelvis and also of the child, that there must be
a mechanical  adaptation of the  latter to the former, in  order that it
can be born, and that in order to  secure this  result  there must be
certain presentations and positions at the superior strait.
  Almost any part  of the child  may present at the superior strait,
making  almost an infinite variety of presentations, but for all prac-
tical purposes it  will be sufficient  to describe  only five;  for when
the accoucheur recognizes  either of these he will be able to deter-
mine what,  if any,  mechanical  means may be needed to produce
relief.
  These five' presentations are:  I. Vertex Presentation;  II. Facial
Presentation;  III. Presentation of the Pelvic Extremity;  IV^Pres-
entation of the Right Lateral Plane of the Trunk; V.  Presentation
of the Left Lateral  Plane of the Trunk.
  Each  of these five presentations may have one  of six positions—
as, for instance, in vertex presentations the occiput  must  lead the way
in labor, for it is, as it were, one end of the head.   Then the occiput
Is  described as being  in the left iliac region, anterior,  transverse or 
180
LABOR.
   posterior; or  in  the right iliac region, anterior, transverse or poste-
   rior.   That is to say, the position is left occipito-iliac anterior, left oc-
   cipito-iliac transverse  or left occipito-iliac posterior, according as  the
   occiput is in the  left half of the pelvis and at the ilio-pectineal emi-
~  nonce, transversely across the pelvis, or  at the sacro-iliac symphysis.
   And  the position is  right occipito-iliac  anterior, right occipito-iliac
   transverse or right occipito-iliac posterior, according as the occiput is in
   the right half of the pelvis and at the ilio-pectineal eminence, trans-
   versely across the pelvis, or at the sacro-iliac symphysis.
     In  facial  presentations the chin would lead.  Then the position
   would be styled right mento-iliac anterior, right  mento-iliac transverse
   or right mento-iliac posterior, if the chin were  in  the right half of the
   pelvis and at the right ilio-pectineal eminence, traifsversely  across the
   pelvis, or at the sacro-iliac symphysis.  And they would be  styled the
   left mento-iliac anterior, left mento-iliac  transverse or  left mento-iliac
   posterior, if the chin occupied corresponding positions in the left half
   of the pelvis.
     In  presentations of the breech the  sacrum is regarded  as the point
   determining  the  position, and the positions are  called, according to
   circumstances, the right sacro-iliac anterior, right  sacro-iliac transverse,
   right  sacro-iliac  posterior,  or left  sacro-iliac  anterior, left sacro-iliac
   transverse, left sacro-iliac posterior.
     In  presentations of the trunk, when the right lateral plane presents,
   the head must be either in the right or the left half of the pelvis, and
   hence we have the right cephalo-iliac anterior, right cephalo-iliac trans-
   verse or right cephalo-iliac posterior, and  the left cephalo-iliac anterior,
   left cephalo-iliac transverse or left cephalo-iliac  posterior positions.   In
   presentations  of  the left lateral plane the  same terms, according to
   circumstances, must express the positions with sufficient accuracy for
   practical purposes.  Each of these presentations will now be particu-
   larly  explained.
      The Vertex Presentation.—This  occurs very much more frequently
   than all the others put together; as, for instance, of twenty-two thou-
   sand five hundred and thirty-seven carefully observed cases, only eight
   hundred and fourteen were found to  be of any other presentation.
   And  of the  vertex  presentation the very much larger proportion of
   cases  is  found to be in  the  left occipito-iliac anterior position.  This
   position, which occurs the most frequently, is found to be the most
   natural of all, and  the one  by which  delivery is most easily accom-
   plished.
     The  diagnosis of the vertex presentation is made out by feeling a 
labor.                          181
large, round,  hard,  smooth  tumor, while  examining per vaginam,
either at the  superior strait or  descending into the  cavity of  the
pelvis.  The stethoscope  will  also  reveal  with much certainty  the
presentation of the vertex, by the beat of the foetal heart being heard
low down in the abdomen.  The vertex presentation being  made out,
it remains to define the position by means of the position of the fon-
tanelles and sutures.
  By carrying the finger a little backward  and upward on the head
the sagittal suture will be  encountered,  and if it runs  from before
backward,  from left to right, and if the anterior fontanelle  is toward
the right sacro-iliac symphysis, the position  must be left occipito-
iliac anterior.  But if the anterior fontanelle is found to be at the
left ilio-pectineal  eminence, the  position  must  be right occipito-iliac
posterior.  Either fontanelle, anterior or posterior, may be ascertained
by tracing along on the  sagittal suture each way, backward or  for-
ward.   In this  manner are all the positions of the vertex presenta-
tion ascertained.
   The  mechanism of labor where  the position is with the  occiput in
the  left half of the pelvis  is usually the same  in  all cases.   The
occiput being left anterior,  transverse or  posterior,  the contractions
having begun and the liquor amnii having partially escaped, the first
effect upon the child is to flex  the head more perfectly upon the chest,
which constitutes the first stage in the mechanism of  labor.  This has
the effect to bring the long diameter of the head in harmony with the
axis of the superior strait.  The second stage is completed when the
head descends into the cavity of the pelvis  till its crown presses upon
the floor of the pelvis.  The third stage and rotation is accomplished
from left to right till the progress of the head is arrested by the back
of the neck resting  upon  the symphysis pubis.  While the  third stage
is in progress the  shoulders rotate into the  long diameter of the supe-
rior strait  and engage therein.   During the fourth stage the shoulders
and chest  descend to the floor of the pelvis, extension of the head
upon the neck takes place, and the head is born by the occiput slip-
ping up in front of the symphysis  pubis  and the perineum retracting
from over the forehead,  face  and  chin  of  the child.  (See Fig.  43.)
Now the fifth and  last stage  in the  mechanism of  labor is  accom-
plished  by the  shoulders  rotating into the long  diameter of the
inferior strait, wliich produces external  rotation of the head, and the
child is delivered.
   It will  be observed that the external rotation of the head is not an
 i-olated fact, but that it  is in consequence of the shoulders rotating 
182                           labor.
into the long diameter of the inferior strait, and that this corresponds
to the  previous rotation of the shoulders into the superior strait sim-
ultaneously with the rotation of the long diameter of the head into the
inferior strait.  The face  in  these  positions always  appears on  the
right thigh of the mother.  The right or anterior shoulder is the first
to appear in the fissure of the vulva, but the left or  posterior shoulder
is the first to be set free by means of the  perineum  retracting from it,
and it  is thus in reality born first.
                              Fig. 43.
  In Figure 43 the relative positions of the head are seen in the various degrees of
disengagement and extension, the nape of the neck resting first behind and then under
the symphysis pubis.

  The mechanism of labor, the occiput being in the right half of the
pelvis, whether it be anterior, transverse or posterior,  is all the same
usually as that just described.  The same stages are  passed through,
but the rotations are now all  from right to left, and consequently the
face will appear at the left thigh of the mother instead of the right as
in the former case.   When the occiput is at the right  sacro-iliac sym-
physis it should always rotate to the front and appear under the arch
of the pubes, precisely the same as when it is at the left sacro-iliac
symphysis;  wliich it sometimes fails to do, but slips  into the hollow
of the sacrum  and  remains behind till  the completion of the labor,
when the forehead appears under the arch and the occiput  is first dis-
engaged at  the posterior  commissure of the vulva.   (See Fig. 44.)
It may happen that when  the occiput is in the hollow of the sacrum
the head becomes gradually extended by the vertex being detained in
the sacral depression, and the presentation becomes converted into one
of the face. 
LABOR.
183
  Inclined or irregular vertex  presentations are usually aided in re-
covering a regular presentation by changing the mother's  position
upon the same side as the inclination; thus, if the sagittal suture is
inclining far upon the right side, by turning the patient upon the right
side the child's body will  fall  down upon that side and the inclina-
tion will be rectified  at once; and if inclined upon  the left side, by
turning the patient upon that side a similar result will be attained.
  In Figure 44 is portrayed the disengagement of the head, it having failed to rotate
to the front, as usual, to come under the symphysis pubis.

  After the birth of the child, if inspection  is  made  at  once, it  is
always easy to tell the position it occupied from the sero-sanguineous
tumor  upon that part which presented; for the  presenting part not
being in contact with anything and  pressure  being  made upon all
other parts of the child,  the  fluids  are  forced  into this  part; all
of which soon subsides after the birth of  the  child.  This sero-san-
guineous tumor need not be mistaken for  cephalhematoma, for the
former exists at birth, the latter  does not appear for some hours after;
the former is large and purple, the  latter smaller, the  skin not dis-
colored; it is  fluctuating or pulsating and has an osseous  border.  The
sero-sanguineous tumor does not exist if the child  perishes long before
birth ;  from which fact a medical jurist can draw an important infer-
ence in fixing upon the time of  death of a newly-born child.
  Facial Presentation.—According to standard authorities this pre-
sentation occurs  about once in three hundred  labors.   The head, in-
stead of being flexed upon the chest, is extended upon the neck,  so
that the  face looks right  down into  the  superior strait.   In vertex
presentatk ns the occipital  end of the  long diameter  leads the way  in
parturition;  now in  facial presentations the other end of the long
diannter must  lead the way—that is, the chin;  of course, then, the 
184
LABOR.
 chin  must become the point of departure.  Then we  have the left
 mento-iliac, anterior, transverse or posterior;  or the right mento-iliac,
 anterior, transverse or posterior.
   The cause of this unnatural presentation, except when  it is produced
. by the accidental exchange  of  other  presentations,  can only be ac-
 counted for as the result of some  previous conditions of the mother,
 which may be beyond our power to  designate exactly.
   This presentation of the face  is diagnosed by feeling the  depression
 of the eyes, the prominence  of  the nose, the mouth and the chin, and
 more  especially by feeling the  upper and lower gums and the inter-
 vening tongue.  The relative position of the  chin will also determine
 the exact position in this presentation.
   Mechanism.—As the  right mento-iliac transverse position is the
 most frequent of any of the  facial presentations, we will describe the
 mechanism in this for all  the others—since they are similar—only it
 should be remembered that  the rotation will  be from right to left, or
 the reverse, according as  the chin is in the right or  left iliac regions.
 After the liquor amnii has been discharged and  the expulsive pains
 begin to operate, the first effect  is to produce  forced extension of the
 head upon  the trunk, so  that  every pain has a strong tendency to
 throw the child's neck backward.  (See Figs. 45 and 46.)  Descent
 now goes on, the chin leading the way, till its farther progress is ob-
 structed by the breast coming in  contact with  the superior strait.
 Now, rotation must commence and continue till the chin comes round
 in front sufficiently for the length  of the neck  to span the depth of the
 pelvis, and  the chin  to  pass under  the arch.   By this time complete
 descent and rotation  have taken place, for the depth of the pelvis is
 here  so  shallow as to allow the neck  to span it completely, and the
 crown of the head rests upon the  floor of the pelvis; and  this is the
 only  point at  which such a result can be obtained.
   Flexion now begins to take place slowly around the  symphysis as
 a centre, and finally the chin rises up in front of the  symphysis pubis,
 and the crown of the head descends  on the anterior face of the sacrum
 and coccyx, and is finally disengaged at the  posterior commissure of
 the vulva.    (See Fig.  43.)   External  rotation is effected  by the
 shoulders rotating  into  the  inferior strait.   Internal rotation causes
 the shoulders to place themselves in the long  diameter of the superior
 strait.  By no other means can a viable child be  born  in facial pre-
 sentations than that rotation shall  bring  the chin under the arch of
 the pubis, unless the presentation itself should be changed into one
 of the vertex  or some other.  Sometimes  this actually does spoil tan- 
LABOR.                            l£5
eously take place by the chin, when it is posterior,  engaging in the
sciatic notch; the progress of the child continuing gradually flexes the
head  upon  the trunk, and the vertex appears under the  arch of the
pubis, as in original vertex presentations.  Inclined or irregular facial
presentations—when  the chin or one cheek  is found  in  the centre of '
the superior strait—by  continued  contractions gradually regain the
normal face presentation.
Fig 45.                            Fig. 46.
  Figure 45 exhibits the face in the right transverse mento-ilinc position, after the
forced extension.
  Figure 46 shows the face in the same position, although more fully engaged.
  Figure 47 exhibits the passage of the chin under the symphysis, the head descend-
ing on the anterior face of the sacrum and coccyx, and the occiput departing more
and more from the shoulders.

  Facial  presentations are by no means so safe for mother or child as
are those of the vertex,  yet in a very large majority of the cases they
terminate favorably to both.   The position is such that at every con- 
186                           LABOR.
traction the expulsive force upon the child is much diminished by the
rolling back of the head upon the spine.   Dilatation and  rotation are
not effected so rapidly on this account, and  the child must of course
remain, as a general thing, much longer in the pelvis.
  Presentations of the Pelvic Extremity.—We class as such presenta-
tions all those of the feet, knees and breech, since in labor the same
mechanism pertains  to all alike.   In  the  breech  presentation  the
sacrum  forms the  point  of departure for  determining the relative
position;  the anterior face of the tibia in presentations of the knees;
and the  heels in  footling cases.  As in the vertex or face presenta-
tions the positions may be left sacro-iliac or right sacro-iliac, and of
the anterior, transverse or posterior varieties.   Presentations  of the
breech are much more frequent than those of the face, and very much
less frequent than those of the vertex; thus, of sixty thousand  four
hundred and twenty-two cases reported, two thousand and eighty-two
were breech presentations.
  A breech presentation  may be recognized, on digital examination,
by feeling  the cleft  between the nates, instead  of  the sagittal  suture
as in the vertex;  in addition we find in the anus  with  its sphincter,
instead  of the fontanelles, a positive and not to be mistaken charac-
teristic.   The coccyx and sacrum will enable us to  decide as  to  the
part of the pelvis  they occupy, and consequently to determine  the
position  exactly; when the feet or one  foot presents,  the heel  will
enable us to decide as to  the position.   It must be recollected that a
foot is articulated at right angles with the  leg, which fact alone will
enable us to decide between the hand and foot, since the hand is in a
straight  line with the  arm.  The knees  seldom  present, but when
they do  it is  easy to make  them out by  recognizing  the popliteal
spaces.
   Tlie Mechanism of Breech  Presentations.—The  position being  the
left sacro-iliac anterior, and the membranes ruptured, the first stage is
one of descent to  the floor of the pelvis, the child's legs, arms and
chin being folded  in the same position as in the vertex presentation.
The next stage is one of internal rotation,  where the left hip conies
under the arch of the pubes, and at the same time the shoulders are
made to come into the long diameter of the  superior strait.  The next
stage is  the expulsion of the breech, during which time the child is
strongly flexed upon its left lateral border, to correspond to the curve
in the excavation of the pelvis.  As the  breech is delivered the body
descends with the arms folded up, and  the chest and shoulders rotate
into the long diameter of the inferior strait; the long diameter of the 
LABOR.                              187
head passes through that  of the  superior  strait, and  finally  rotates
itself into the long diameter of the  inferior strait; and the  head is
born with the chin still  strongly flexed upon the chest, and the back
of the neck and  occiput under the pubic arch.  (See Figures 48, 49
and  50.)
                Fig. 48.                              Fig. 4$.
  Figure  4S  exhibits  the presentation of the breech  in the left sacro-iliac anterior
position.
  Figure  49 exhibits the same position after internal rotation is accomplished.
Fig. 50.                              Fig. 51.
  Figure 50 illustrates the delivery of the breech.
  Figure 51 exhibits the delivery of the head in the sacro-iliac posterior position.
The faint outlines show the successive stages of  the flexure of the chin upon the
already delivered chest, which may  be greatly assisted, if need be, by the pressure
of the operator's finger introduced into the child's mouth. 
188
LABOR.
   If the breech is in the right sacro-iliac posterior position, the mech*
anism is  the  same, only rotation occurs from right  to  left.   If the
feet appear  first, or the knees, the mechanism is  still the same as in
the former breech  positions.   Sometimes it occurs that rotation is re-
versed, so as to bring  the  occiput into the hollow of the sacrum, in
winch case the face will appear  under the  arch of the pubes, and  if
the chin remain  flexed upon the chest all will go on well.   If not,
the ohin may be flexed by placing a finger in the  child's mouth and
pulling it downward.   (See Fig. 51.)
   Presentations of the feet,  knees or breech are more tedious, and con-
sequently rather harder for the mother, than are those of the vertex.
The largest part escaping first, the  smaller quite  easily  follows; but
the smaller  escaping first, there  is less remaining in the uterus with
which to force  out the most difficult part.   For  instance, if all but
the head  escapes, it often becomes a difficult matter to expel that for
want of leverage or purchase-power in the  uterus itself.
   The child itself is much  safer  in vertex presentations.   This is true
in the  first place on account of the cord, which is  more  likely to be-
come compressed and strangulated in  breech presentations—an acci-
dent from which the child necessarily perishes.  For  after the breech
and abdomen are born  up to the navel, the cord must be more or less
compressed till after the delivery of the head, since the placental ex-
tremity of the cord extends of course far above the head, even to the
fundus of the uterus.  Another  danger to which the child is exposed
in breech presentations  arises in this manner: the smaller part escap-
ing first, the uterus  becomes sufficiently emptied to allow the contrac-
tions  to  detach  the after-birth before  the  head is expelled, and the
child perishes  from asphyxia.  Thus, it is evident that it is very much
safer for the child to have the head expelled first.
   It is not safe for the accoucheur to leave a breech presentation, even
for a brief period, after the os is well dilated, as it may happen that
during an expulsive pain the cord is prolapsed and expelled  beyond
the vulva.  In such a  case delivery at once  is necessary to save the
life of the child.
   Presentations of the Trunk.—These are all comprised under present-
ations of the right lateral plane or of the left lateral plane, either an-
terior or posterior.   The head is always taken as the point of depart-
ure, it being either in the left or in the right half of the pelvis, consti-
tuting the left cephalo-iliac anterior or left cephalo-iliac posterior, or the
right cephalo-iliac  anterior or right cephalo-iliac posterior.   In each
case the back is either anterior or  posterior.  It is quite common to find 
LABOR.
180
the hand or the hand and arm in the vulva in either of these posi-
tions ; but this is of no account, as it neither alters nor complicates the
matter at all.  This  presentation occurs rather more frequently than
do those of the face;  many estimates have been made, but a fair aver
age would be about one in one hundred and fifty cases.   A failure on
the part of Nature to place the child  in a more auspicious position is
the only assignable cause for so unfortunate a condition.
  The shoulder is  usually the first point touched  in making a digital
examination.   The acromion process  is distinctly made out, and then
the clavicle, the spine of the scapulae and  the axillary space, all com-
bined and always within reach of the finger, confirm the presentation
to a certainty.  All these being made out, we can tell the position of
the child, for the  axillary spa'ce always looks away from  the head,
and the clavicle will also tell where the face is, as the scapula will tell
where is the dorsal region of the child.
  When  the  elbow alone is accessible  to the finger, it can be  recog-
nized by three protuberances, the olecranon process and the two con-
dyles, and also by  Xhe transverse space in the bend of the elbow, and
by the vicinity of the chest and the intercostal spaces, for the arm is
always found lying  upon the chest.  The elbow always points away
from the head, and the forearm is always on  the anterior plane; thus
we  at once know where  the head and face are when we diagnose an
elbow.
  If the forearm is not doubled up, but lies in the vagina,  by turning
the palmar surface upward and  in front, the thumb will always indi-
cate which hand it is by its being next to the corresponding thigh of
the mother, and  then to determine where the head is it will be neces-
sary to slip the finger up to the axillary space.
  When the hand conies  out of the  vulva its dorsal surface  will
always correspond  with the direction of the head, and the little finger
with the dorsal  surface of the child.
  The presentation of the trunk at the superior strait is always  an in
dication for manual  treatment.  Still, under certain circumstences a
spontaneous delivery may teke  place, and this  is  effected either by
spontaneous version  or  by spontaneous evolution.   Of spontaneous
version there  are two varieties—one cephalic, the other pelvic.  In the
former, where the shoulder presents, the trunk ascends  under the in-
fluence of the uterine contractions and the vertex comes into the supe-
rior strait; in the  latter the head ascends into the  fundus under the
same  influence, and the trunk comes  into the superior strait; and in
either case of course  a spontaneous delivery is effected. 
190                          LABOR.
  Spontaneous Evolution.*—" The mechanism of spontaneous  evolu-
tion is much better understood, and in its description we shall find all
the divisions of the mechanism of natural labor in the  presentations
of the vertex  and face.   M. Velpeau admits a spontaneous cephalic
and a spontaneous pelvic evolution.   But since we can conceive of a
spontaneous cephalic evolution only in  abortions, or in cases where
the foetus is completely putrefied, we shall speak of the  pelvic evolu-
tion alone.
  "Take, for example, the first or left cephalo-iliac position of the right
shoulder.   In this variety we find the cephalic extremity is placed in
the left iliac fossa, the breech in the right iliac fossa, the dorsal plane
of the foetus being in  front, the sternal plane behind;  so that its long
axis is almost exactly in  the direction of the transverse diameter.
  " Immediately after the rupture of the  membranes the waters  almost
entirely escape;  the  uterus  forcibly  contracts, and pressing  in every
direction upon the trunk of the foetus tends to engage the presenting
part in the excavation.
  " A.  Under the influence  of the uterine contractions the foetus in its
long axis is strongly flexed upon  the side opposite to that which pre-
sents ; in  the case proposed the  head is turned toward the left side
and the breech toward the hip of the same side.  This first change in
the situation of the foetus may be designated as the movement of lateral
flexion.
  " B. Then begins a second period, which we may term the period of
descent; that is to say, as the contractions are renewed  the  shoulder
tends more and  more to approach the inferior strait, and the  trunk,
bent double, engages itself deeply in the excavation.  But here appears
the same difficulty as in presentations of the  face (see position of the
face),  that it is  impossible  for the  shoulder—the trunk  being thus
placed transversely—to reach the inferior strait unless the head at the
same  time engages with it in the excavation, or unless the neck  should
be long enough to reach the whole length of the lateral wall of  the ex-
cavation, which  we have already seen to be impossible.  The descent
of the shoulder  is governed, then, by the length  of the neck.
  " C. Then follows a movement of rotation, by means  of which the
long  axis of the child, originally transverse, assumes almost exactly
an antero-posterior direction, so  that the head rests above the hori-
zontal ramus of the  pubis  near  its spine, and the breech above, or
rather in front of, the sacro-iliac symphysis.   The movement of rota-
tion being accomplished, that of descent  may  now be completed, since
               * Translated from the French of M Cazeaux. 
LABOR.
191
the side of the neck is placed behind the symphysis pubis, equaling
its whole length.   Thus the forearm and arm make their appearance
at the vulva, the arm  and shoulder having passed under the arch of
the pubis.
  " D. Under the powerful efforts of the uterus the trunk, bent double,
is pressed  into  the  excavation,  but the shoulder can descend no
farther, because  it is arrested by the shortness  of  the neck.  The
expulsive force acts  upon the pelvic extremity, forcing it  more and
more  toward the floor of the pelvis, and causing it to traverse the
anterior  face of  the sacrum, till finally  it reaches,  depresses and
drives the perineum before it.  Presently the vulva dilates, and—the
acromion remaining fixed under the symphysis—the superior and lateral
portion of the chest,  the  inferior part, the loins of that side, the hip,
the thighs, and finally the whole extent of the lower  limbs, success-
ively  make their appearance at the posterior commissure of the vulva;
and the head and left shoulder  only  remain in  the excavation, and
these  parts are extracted or expelled without difficulty.   This  last
movement may be considered the fourth stage of  the labor, and may
be named the stage of deflexion or disengagement.  This  movement
has for its centre the shoulder engaged  beneath the "symphysis; and
if from this centre we extend lines to all the points of  the side of the
foetus, we shall  have here  the radii which subtend the antero-pos-
terior diameter of the inferior strait.
   " This is, very exactly, the mechanism of the spontaneous evolution
in those cases in which the posterior plane ot the  child was primarily
in front;  that is, in the first position of the right  shoulder, and in the
second position of the left.   For in this latter there is this difference
only, that the movement of the rotation must be in the opposite di-
rection, that is, the head must turn from the right to the left, and from
behind forward; and the  breech  must turn from left to  right, and
from  before backward.
   " But where the sternal plane of the foetus is originally turned for-
ward—as in the first position of  the left shoulder and in  the second
position of the right—the movement is somewhat different.   M. P.
Dubois, who had  an opportunity to see two such cases, states that at
the moment of  the  disengagement of  the  breech at the anterior
perineal commissure the entire  trunk of the child  experienced  a
movement of torsion that brought the dorsal plane of  the  foetus still
farther forward and  upward, which, without this movement, would
have  been directed toward the anus.  Thus it happens—and we cannot
but declare it a very remarkable circumstance—that even here  we find 
192        THE CARE OF THE WOMAN DURING LABOR.

the same  general  law that we have already seen to regulate every
natural labor, that whatever may be the primitive situation of the pos-
terior plane of the foztus, it ultimately places itself in relation with the
anterior parts of the pelvis.
   " As was observed at first,  it is  easy to  submit the mechanism of
spontaneous evolution to  the same divisions as the delivery by the
face.   We have, in fact, a first period of flexion  of the trunk of the
foetus toward  the side opposite to  that which presents; a second one
of descent, interrupted by the third movement or stage of rotation; a
fourth period  of deflexion or disengagement; and according to the ob-
servations of M. Dubois for the dorso-posterior positions, we may add
a fifth movement, or period of exterior rotation."
   Such is the account given by M. Cazeaux.  Of  course no one at
the present day would think of allowing any of these unnatural pres-
entations to continue for the sake of observing a possible spontaneous
evolution.  Speedy interposition should be instituted for  the humane
purpose of saving both mother and child.
                      CHAPTER  XIII.

   THE  CARE OF  THE  WOMAN AND  OF  THE  CHILD
                DURING AND AFTER LABOR.

          The  Care of the Woman During Labor.

     HEN summoned to attend upon a case of labor, it is  better to
     go provided with a male and a female catheter, a pair of forceps
and a blunt hook.   Emergencies may arise requiring in haste the use
of one or more of these instruments, and no time should be lost in
sending for what might  so easily be taken  in the first instance.  A
case  containing medicines should likewise be taken to meet any emer-
gency  demanding  the exhibition  of the appropriate homoeopathic
remedy.
   Before entering the room our arrival should always be announced,
that  we may not shock our patient by our unexpected  entrance.   We
should take especial  care to appear in  an  easy, unaffected  manner;
and  we should have  no other  thought in our mind  than to attend
strictly to our business in as agreeable a manner as possible.
w 
          the care of the woman  during labor.       193

  First we  should  inquire into the nature of the pains, with a view
to prescribe for any abnormality that may appear in the sufferings of
our patient.
  When this grand function commences, the pregnant woman comes
into a new physiological state, and if harmony exists throughout her
entire organism, her labor will be comparatively free from suffering,
and parturition will be accomplished as  speedily as is consistent with
safety. If  a want of harmony should  exist, symptoms will be  devel-
oped and manifested in some way, by means of which the follower of
Hahnemann will be guided to  make that selection  from the  great
storehouse of the Materia Medica which shall at once relieve and  re-
move the disarray and re-establish harmonious action.  Anaesthesia
should not be resorted to ; oblivion should  not be courted at the risk
of  safety;  for the  symptoms  masked  and suffering  suppressed,
crushed  under the ponderous action  of chloroform  or  ether, what
guide has the  physician to the selection of a remedy for disorder, or
to a knowledge even that disorder has  arisen ?
  After observing attentively, without seeming to look at the woman,
the nature of her pains, we may, when we think it necessary, propose
an examination per vaginam, in order  to observe the condition of the
internal  organs, the presentation, etc.    This  vaginal  examination
should be conducted in the following manner: The woman should
lie  on her  left side upon a couch or  bed, with the thighs drawn  up
toward the abdomen.  The forefinger of the right or left hand of the
accoucheur should then be introduced  into the vagina, and passed up-
ward and backward in a  direction toward the promontory  of  the
sacrum, to reach the uterus  and detect the os.   The finger  and even
the hand used  in making the examination should be anointed with
lard or some other  innocuous  grease, for the double purpose of facili-
tating the  examination  and protecting the hand  against possible
poisoning.
   It  may not  seem out of place to observe  that the first  object of
search will be to see if the woman be pregnant, for it has sometimes
happened that every preparation has been  made for parturition when
no pregnancy existed.  The writer has met with such cases where  the
real facts were not revealed until  examination was made per vaginam
as if  to ascertain the presentation.
   Having, then, determined the existence of pregnancy, which may be
ascertained by noting the condition of the os and cervix, and other
Bigns of  pregnancy laid down in a preceding portion  of this work,
the next thing is to learn if the  patient be in  labor, or whether  she
       13 
19-4        THE CARE OF THE  WOMAN  DURING LABOR.

have not, instead, certain abdominal or lumbar pains called " false
pains."   If she be really in  labor, we shall find, on retaining the
finger in the  os  uteri during a few pains, a rigidity and tenseness of
the os accompanying every contraction, and followed, after  the pain,
by a corresponding looseness and state of relaxation. Or if the mem-
branes are entire and  become tight and firm under the contraction,
relaxing as it passes off, the  woman is certainly in labor.
  The next step  is to inquire if she is  at  full term.   This" inquiry
will of course be settled in our own  minds affirmatively if we find
the neck  of  the  uterus  absolutely blended or spread out into the
globe of the uterus.   The  internal os will not be  felt, the orifice
leading  to the  membranes  now being simply that of the  os tincse.
If the internal  os still remains closed or partially  so, and the cervix
uteri be found still capable of being distinguished, the full term has not
arrived; and we  must hasten, as in threatened  abortion or premature
labor, to arrest  all further  progress by  means  of  quietness and the
exhibition of the proper homoeopathic remedy]
  The accoucheur should determine the  position and presentation as
early as possible; and  if it be one of the usual  and natural ones, he
has little to  do but watch and  wait—watch the conditions, note the
symptoms, and  apply  the homoeopathic remedy when needed; and
wait for Nature to complete  the  process she has incepted, in her own
best manner.  It is well to cheer the patient at this period  by telling
her that "all is right" (if so it really be), as  such a communication
rarely fails to add to  her comfort  of mind  and her  contentment to
bear the pangs to come.
  The next question to determine is, Are the membranes ruptured ?
And this is  not always an easy task, since they  are sometimes so
closely drawn over the scalp as to deceive a novice.   But during a
pain, unless the head  has already descended low down in the excava-
tion, so  much water will  be forced down between the membranes and
the scalp as to make it quite apparent that the former are still intact.
And besides, there is  a certain greasy smoothness  perceptible in the
touch of the  unruptured  membranes which differs from the  sensation
experienced in  feeling the  hairy scalp of the child.   Bearing these
things in mind, we never need be mistaken if we press firmly down
upon the scalp, for the rough, hairy condition of the uncovered scalp
is never simulated by the unbroken membranes.
  Next we wish to determine how far the labor  has advanced and
what part of the  child presents.  In primiparoz particularly it is not
always easy to find the os  uteri, for sometimes  it is not discoverable 
          THE CARE OF THE WOMAN DURING LABOR.        195

till we carry the finger far  upward and backward upon the  anterior
face of the sacrum, nearly  up to its promontory.  In  such cases  it
may be  necessary for  the woman to lie on her  back till the  anterior
obliquity disappears;  and this can  be aided by the accoucheur elevat-
ing the  fundus with one hand applied  externally, and with a finger
of the other hand in the os to draw it down.
  If it  now appear that we have  a timely labor to  treat, it will be
necessary  to  provide  for it accordingly.   Where we can have our
choice the woman should be placed in a large, airy chamber, exposed
to the sunny  side of  the house, and as much  retired as possible,  if
the above more important points can likewise be secured.  The tem-
perature of the room should be about sixty-five degrees during labor,
about seventy degrees afterward; the covering should be sufficient for
the comfort of the patient.   While labor is at its height the covering
should be reduced as  much as possible, according to  existing circum-
stances, thus  compensating in some degree for the accumulating  heat
of labor.  Bright light should not be permitted to strike the eye,  as
being liable to induce nervous irritation.   Particular care should be
taken that the feet are comfortably warm, not  alone  for the sake of
personal comfort, but the pains of labor will  be  more apt to be
natural.   A strict adherence to  these rules may prevent fatal or  at
least dangerous accidents, such as hemorrhages, chills, metastases, etc.
If the bowels have not  been freely evacuated  within  twelve  hours,
she had better take a large injection at once,  that no accumulation of
feces  remain in the rectum.  She should now be suitably dressed for
the occasion.  Let her be arrayed  in the dress  she intends to wear  in
bed, but so adjusted that it cannot slip down below the waist.   Next
to this let an old sheet or  something of the  kind be pinned around
her, so as  to cover all  the lower part of the body, hips and legs.  Next
the bed must be  suitably prepared for its own  protection and for the
comfort of the patient.  An india-rubber sheet about one yard wide
should be placed  across the middle of the bed upon the mattrass.   A
clean sheet  should now  be spread over the  whole bed.  Across the
foot of the bed an  oil-cloth  or  another piece of india-rubber a yard
wide  should be placed, and this  covered with a thick doubling of
blanket.  The patient should lie upon this, on her left side, with her feet
placed against the foot of the bed as a purchase during the expulsive ef-
forts of labor.  She should  lie with the breech near the edge of the bed,
with  her thighs flexed at right angles with her  abdomen, and the legs
at the same angle with the thighs.  During the expulsive pains an
assistant may hold her hands, or a towel may be so  attached that she 
196       THE CARE OF THE WOMAN DURING LABOR.

can assist herself by drawing with her hands  in the direction of the
support of her feet.
   The rule to observe in relation to attendants is to have in ordinary
natural labors only the nurse and the doctor.  The doctor should be
in  and out  from time to time, as his judgment may  dictate.   It is
better to be absent as much as possible, und keep due surveillance over
the case, till  toward  the  close of the labor.  In the first stage the
woman may make herself as comfortable as  she  best can by walking
about, sitting in her chair, or changing from the one to the other.
Unless the labor be very protracted, cold water or other beverage of
a cooling and refreshing nature is  the only refreshment required.
   When the head has commenced descending into the cavity of the
pelvis, and  the os uteri is  fully  dilated, the accoucheur should not
absent himself from the patient long at a time.  It will be better for
him to take his seat at the patient's bed, in a position to watch the
appearance of her face, place the finger on the presenting part, mark
well its progress, and be ready for any emergency that  may arise.
Some women  are troubled with a  terrible shivering during the early
part of labor  or at its commencement, and  sometimes  it follows im-
mediately afterward, but it  is  of  no account.  When it occurs  as a
first symptom the labor is apt to be quick.
   No obstetric apothegm carries with it greater weight of truthfulness
than this, that " meddlesome  midwifery is bad" when applied to
natural labor.  All fingering and  manoeuvring, with the  hope of
bettering the process of nature, is  uncalled for and injudicious. Parts
that under the severest tax  laid upon them  by a provision of nature
quickly rally  to a normal condition and tone, may  be  seriously in-
jured  and give  rise  to much after suffering  by being subjected to
" manipulation."  Interfere judiciously where interference is neces-
sary, but trust to Nature where she is sufficient of herself, seeking aid
from homoeopathic remedies where aid seems requisite.
   Women in  labor are  apt  to  be  frightened at the noise of the  rup-
ture of the bag of waters, so that  it  is best to forewarn  them in time
to prevent  any alarm.  When the labor seems delayed by the tardy
discharge of the waters, and the os  is fully dilated, and yet the head
is evidently kept back by something, it is  better to  rupture  the sac
luring a pain and let the waters escape; then the labor will advance
much faster.   When the membranes are tightly  drawn  over the head
they can be scratched through by means of  the finger-nail, and  then
they may be  torn up each way by forcing the finger between them
and the scalp.   Care should be taken, however, during the  examina- 
           THE CARE OF THE CHILD  DURING LABOR.        197

tions made in the earlier part of the labor, when the os uteri is not fully
dilated, not to rupture the membranes, as  such a mischance  as the
premature discharge of the liquor amnii is apt to render the labor
more tedious than it otherwise would be.
  Sometimes  the child is very movable at the superior  strait, "and
several portions present in alternation;  in such cases when the head
presents the membranes may be ruptured and the head thus  caused
to engage  in the superior strait.  AVhere there is evidently an over-
distension of the uterus by excessive  amount of liquor amnii, weak-
ening the contractions, the membranes may be punctured at any time
we are certain of such a complication.   If  the membranes should be
found to be too dense to be ruptured by the finger-nail, a probe may
be introduced into  the vagina, carefully guarded  by the finger,  by
means of which a puncture can easily be made during a pain.
  During the first stage of labor the woman should never bear down,
since her strength must be exhausted in making such useless  efforts.
It is only in the second stage, when the expulsive pains  occasion a
sort of involuntary forcing, that advantage can  be taken of this effort,
for then only is it useful.  Too much voluntary exertion  should not
be used at the very last, for  fear of lacerating the perineum.  Nor
should a woman be allowed to rise to the chamber near the close  of
the second stage, for fear of accidents, however much she  may desire
to evacuate the bowels, for it is far  easier to remove  such  discharges
from the bed  than to  extricate a new-born  child from the chamber,
as has sometimes been necessary in such  cases.
  As  the  head is about to escape  from the  vulva  the accoucheur
should bear his right hand  upon the perineum, in  such a  manner as
to encircle the labia as much as possible with his thumb and fingers;
and while he is  drawing down with  these upon the labia, he must
press  gently forward and upward upon  the perineum with the palm
of the same hand.
  The Care  of the Child during  Labor.—Immediately after
the  expulsion of the head we should  feel  with one finger about the
child's neck to ascertain if the cord is around it; if this is the case,
a slight elevation of the cord upon the finger will  cause the placental
extremity to yield; thus the loop will become large enough  to slip
over the  head.   Should the cord prove too short for this purpose,
when  the  next  pain occurs  it may still be loosened sufficiently to
enable the child to pass through it in safety without beccming  stran-
gulated.
  When the head is delivered it should be carefully supported and 
198         THE CARE OF THE CHILD DURING LABOR.

protected from  the  clots and  other  discharges  from the uterus, the
accoucheur  patiently waiting for the subsequent contractions of the
uterus to complete  the delivery.  The more we trust to nature in
this respect, the better it will be for the mother, and the less will she
suffer from subsequent  hemorrhage and after-pains.  No interference
should be attempted at this stage unless demanded by the child seem-
ing to be in danger  of strangulation  or apoplexy, which will be evi-
denced  by its face becoming livid, congested  and swollen.  In such
cases the child should be delivered at once, even at the risk of hem-
orrhage  from want of uterine  action.  Gentle traction may be made
by the head; or, better still, if the  finger can be passed up and hooked
into the axilla, traction  may be made  in that way.  When the occiput
remains  posteriorly, we should not interfere  any more  than when it
rotates to the front, all the instructions of other  accoucheurs to the
contrary notwithstanding.
  After the expulsion of the child  it is better  to turn its back to the
mother and let her  covering fall between  the child  and herself, thus
at the same time bringing the child  to our full view and completely
protecting the mother from cold or exposure.   A soft napkin  should
now be used to wipe the child's  face, eyes and mouth.   It usually cries
lustily as soon  as it  is born, but it  should  be permitted to  lie undis-
turbed for some five minutes, or until respiration is fully established.
By that time, in most cases, the cord  will have ceased to pulsate until
within three inches  and a half of the abdomen.  It should then be
cut  about three inches from the  abdomen, care being taken that the
blood does not spurt over  the  bed  or  one's own clothing if pulsation
still continues.   The child should  then be permitted to  lie for  about
five minutes longer,  to allow the remainder of  the effete  blood to ooze
away—just  such quantity as would otherwise have been returned to
the  placenta.  This  blood is loaded with effete and noxious material,
and on its way to the placenta for  such purification as it could there
receive was  arrested in its course,  and if  permitted to enter into the
general circulation of the child, or  to lie congested in that part of the
cord between the ligature—when applied—and the bifurcation of the
iliac arteries, may do great harm to the general health  of the  child,
and I am convinced often does.   In one minute the flow from the
cord will have ceased.   For the sake of cleanliness during the wash-
ing  of the child, it will be more satisfactory to apply a ligature to the
cord after  the  gush of effete  blood  has fairly  ceased;  for in some
cases  blood  continues to ooze for some time, thus keeping the child
corstantly , oi  d during wash'ng.  The child should then be handed 
           THE CARE OF  THE  CHILD DURING LABOR.         199

to the nurse, wrapped in a blanket.   This may be  neatly done  by
seizing the feet with one hand and placing the other under its shoul-
ders and neck, and thus  depositing it  carefully in its blanket, whicL
should be handily laid for its reception.  It is the best plan to simply
anoint thoroughly the newly-born babe with olive oil instead of im-
mediate washing.   After which the  oil should be carefully wiped off
and the child dressed.  This cleansing  will suffice for the first twenty-
four hours.  Should  the cord seem large and tapering from the abdo-
men, care should be taken  not to wound the intestine, a  portion of
which may be within  it.   In such a case the cord should be cut beyond
the extruded intestine, and the gut should be returned into the  abdo-
men and retained  there  by  means  of the belly-band.   After  it has
been properly cleaned and thoroughly dried, a piece  of raw cotton or
cotton batting of the size of the  palm of the hand should  be laid on
the abdomen just above the navel, the remnant of the cord laid  on it
with its cut end pointing upward, and  another piece of cotton of the
same  size placed over the cord,  the whole being kept in place by the
usual belly-band.  So well  convinced  am I that this is the best plan
of treatment  for the  navel  that  I do  not think I shall  ever change
my practice to  go  back to  old methods.
  When the  breech  presents great care  should  be observed not  to
interfere further than to watch  the condition of'the cord after the
lower part of the  body is born.  We  should take  hold of the cord
with the thumb and finger, and draw it  down a  little to prevent it
from being dragged upon at the  navel.   Then it should be examined
to ascertain if pulsation still continues; if not, try to disengage it from
compression by slipping it  sideways or by drawing it a little lower
down;  for as long  as the  cord pulsates there  is  no danger to the
child.   But there is  danger in this  breech presentation of making so
much traction upon   the child  as to  pull the body away from the
flexion of the head, and thus cause the chin to hang upon the superior
strait or to become  fixed in the cavity of the pelvis.    Great care
should be observed till the head has descended into the pelvic cavity,
and then, if there is need to hasten delivery, the finger can be intro-
duced  into the child's mouth, by wdiich means extension may be pre-
vented and the child delivered at once.
  The death of the child in breech presentations is nearly always due
to the compression  of the  cord; therefore when its pulsations are
seriously interfered with  it will  be  better to make  traction upon the
lo"rer extremities during a pain, but  with great care;  and as soon
as he finger can be introduced into the child's mouth a good deal of 
   200        THE CARE OF  THE  WOMAN AFTER LAB )R.

   pressure can be applied to keep the chin down upon the chest, and
   then  almost any amount of force can be exeited upon the shoulders
   with  safety.  As already stated, it is better as far as possible  to avoid
   manual interference either with mother  or child  during  labor.  The
   more perfectly Nature can be helped by the use of homoeopathic reme-
   dies where assistance is required, the better will it be for both parties
   —much less suffering will be entailed and much better health will be
   enjoyed in after life.
     Diet  and Regimen of the  Woman in Labor.—Cold water or lemon-
   ade is all the refreshment usually required during labor.   The use of
   fermented  liquors of any  kind  should  be  dispensed with.   If the
   patient is in the habit of taking tea, a small quantity, either cold or
   warm, will sometimes be found very refreshing.   A  little broth or
   some other light food may be allowed in case the labor  proves tedious,
   but no spices.
     It is necessary that the enema should not be forgotten where it may
   be needed, in order that the rectum  may be as free from obstruction
   as possible, and  for other obvious reasons.   The  patient should be
   encouraged to evacuate the bladder occasionally during labor, and if
   there be reason to apprehend an accumulation of urine which  she can-
   not void, the male catheter should be at once employed. Much danger
   and  inconvenience is avoided by such precautions, the over-distended
   bladder often becoming so  paralyzed that the urine cannot be volun-
   tarily passed for days.  Therefore always beware of an over-distended
   bladder during parturition.  After the discharge of the liquor amnii
   a  distended  bladder can be detected by the  fluctuation  between the
   pubes and  the  umbilicus.  In order to introduce the  catheter the
   patient should  lie flat on her back, and the presenting portion of the
   child should be pressed backward and  upward  as much as may be
   necessary.

   On the Attentions to the Woman Immediately after Labor.
                    Delivery of the Placenta.
     After the child has been handed to the nurse the next care of the
   accoucheur should  be for  the  delivery of the placenta, for until it is
   removed and the uterus has contracted firmly the woman cannot be
   regarded as altogether free from the danger of flooding.   In most
•   cases there is a momentary suppression of the pains immediately after
   the expulsion of the child; upon which  the  pains  return in a dimin-
   ished degree, and the placenta usually becomes entirely detached from
   it« uterine  connections, and either lies free in  the vagina or is  expelled 
delivery of the placenta.
201
without the vulva.  It often happens, however, that the detachment
of the  placenta and its extrusion into the vagina follows immediately
after the expulsion of the child.  If upon introducing the finger into
the vagina the insertion of the cord into the placenta can be reached,
it may  be taken as evidence that the placenta is detached and  that it
may be extracted.  Should  the  placenta be found to be still attached
to  the uterus after a delay of about  twenty minutes, or should hemor-
rhage occur, proper remedies should be administered to promote the
expulsion of the placenta, when the hemorrhage will  be arrested by
the normal contractions of the uterus.   This may be aided  by  apply-
ing the palm of the hand to the abdomen immediately over the fun-
dus uteri,  and  making gentle pressure  upon  that  organ as though
attempting to clasp it.
   If the placenta has been detached and is found lying in the vagina,
its  delivery may be facilitated  by  making gentle traction  upon  the
cord, in a direction toward the lower part of the curve of the sacrum,
and afterward toward  the  outlet  of  the vulva,  guarding the cord
against being ruptured  by  being drawn over the symphysis  pubis.
Especial care should always be observed, however, not to draw too
forcibly or too violently upon the  cord,  for fear  of tearing it away
from the placental mass.  Traction  is facilitated by wrapping the cord
several times around the fingers or  by enclosing it in a napkin.  (See
Fia;. 52.)
                             Fig. 52.
MODE OF EXTRACTING THE PLACENTA.
  Sometimes the placenta is entirely detached from its uterine adhe-
sions but is detained in the mouth of the uterus.  In such a case the
forefinger should be passed up into the vagina so as to pass above the
edge of the placenta; the finger then being hooked into the placenta,
it is easily drawn downward, and aided by traction on the  cord  is
readily delivered.
  Should  the placenta remain  attached  to the  uterus, the question 
202        THE  CARE OF THE WOMAN  AFTER LABOR.

arises, Should any mechanical  measures be resorted  to  to secure its
detachment?  According to my personal experience, I should say quite
decidedly, No !  The placenta may remain attached for hours without
doing any actual harm to the woman.  Such cases should be carefully
watched, the indicated remedy selected and administered, and the result
is usually a speedy detachment and expulsion of the mass.  Cases must
be very rare, indeed, in which other means than the above need to be
resorted  to.  Friction over the uterus or pressure upon that organ
may bring about uterine contractions and the expulsion of the placenta,
but if the end can be secured through homoeopathic medicines it must
be much more satisfactory.   Nevertheless, should there be hemor-
rhage—which may  result from a partial adhesion—which we cannot
control, we  must  not wait till our patient is hopelessly sacrificed, but
after relying upon the selected  remedy as long as we  may feel safe in
doing so, the hand  should be  introduced into the uterus and the at-
tempt carefully made to insinuate the fingers between the  placenta and
the uterus until the placenta is, if possible, entirely separated  from
the uterine surface (see Fig. 53), when it should be carefully scooped
out.
                              Fig. 53.
       THE MODE OP BREAKING UP THE ADHESIONS OF THE PLACEN'TA.

  Sometimes the placenta is found to be retained by a spasmodic con-
traction of the neck of the womb, so that it is impossible to extract it
until this spasm has abated.  Sometimes, again, and more frequently,
we find wdiat is called the hour-glass contraction, as shown in Fig. 51.
Other  abnormal  contractions may occur which  will  render utterly
impossible the delivery of the placenta until the proper remedy has
been given to relieve the morbid  irritability which gave rise to the
abnormity.  All  these anomalies have  a vital  origin, and we have
only to interpret rightly the symptoms  which they present,  exhibit
the corresponding remedy, and the whole difficulty will be removed. 
           THE CARE OF THE  WOMAN  AFTER LABOR.        203

The  remedies  most usually  appropriate  for these occasions  will  be
mentioned in the therapeutical portion of this work.
                             Fig. 54.
             THE HOUR-GLASS CONTRACTION OF THE WOMB.

  When  some portions  of the placenta are retained and cannot  be
removed, we must treat the symptoms as they  arise, and thereby ward
off any danger that  may accrue from putrid absorption.
  When  any difficulty appears in relation to  the delivery of the pla-
centa, we should always  examine through the abdominal walls in
order to  ascertain whether the uterus  presents  its regular globular
form, or whether there may not be a depression in its fundus, show-
ing a tendency to inversion; for it sometimes occurs that a complete
inversion takes place in this manner.
  If a tendency  in this direction be discovered, and if a  remedy can-
not be found which will  cause a  return of the uterus  to its natural
condition, the hand must be  used for this  purpose.    If there  be
discovered already a  complete inversion, with the  placenta attached, the
latter should first be peeled off, and the uterus  returned  by seizing it
with both hands and very carefully and  steadily pressing  it  upward
and  backward until within the vulva; then  with  one hand  press it
gently upward, and finally upward and forward.
  " An unfailing test by which we may judge when the placenta has
become detached from the uterus, and consequently when it may be
removed, even though still in the uterine cavity, is the presence or ab-
sence of pulsation in the  cord, for while  it remains attached to the
uterus pulsation  will still be felt; the cord will also be full and elastic
under pressure between the finger and thumb.   When, however, sepa- 
204        THE  CARE OF THE WOMAN  AFTER LABOR.

ration has taken place, the elasticity and  fullness disappear, the cord
gets flabby, limp and cold, and no pulsation can now be detected  in
it,"—Meadows.
  When the  placenta  finally  begins  to  emerge  from the vulva  it
should be  received into the  palm of the  left hand, and rotated with
the right hand, in order to secure the twisting  up and  removal, with
it of the membranous shreds,  since even a small portion left behind
may occasion serious annoyance to the  patient, even if it does not give
rise to more serious complications.  When any shred thus left behind
afterward appears at the vulva, it may be  removed by being seized
with a dry napkin and extracted.   The placenta, with  its  cord and
attached membranes, should then  be placed  in  a vessel  conveniently
placed to receive  it, and removed from the lying-in chamber as soon
thereafter as possible.
  Other Attentions to the Woman.—The woman should then be made
comfortably dry, and  a  soft  dry  cloth  should  be applied  to the
vulva.  She should then be straightened out a little in bed, and in all
respects made as  comfortable as possible.   No bandage should  be ap-
plied.  Since this doctrine is  so entirely opposite to the usual practice,
it will be proper to state the reasons which have led to the adoption of
this method.  First: It will be evident,  from a moment's consider-
ation of' the natural position of the fundus  uteri, inclining  forward,
that the application of a bandage could not but change this  position,
so as to render the uterus itself nearly perpendicular to the plane of
the superior strait.   This must of course  bring the uterus  into a line
with the axis  of the superior strait; this position must evidently be
more favorable to prolapsus, and it may even lead to  retroversion.
Second:  The great object intended to be secured by the bandage is  to
promote the contraction of the parietes of the  abdomen, both for the
safety of the patient  and for the  symmetry of her form.   Now, we
believe not only that this is better accomplished by Nature in her own
way, uninterfered with by mechanical and compulsory appliances, but
that such  appliances actually weaken the  walls  of the abdomen, and
so in reality  tend to  defeat the very object sought to be secured.
Third:  The omission  of  the  bandage, as  we have found by much
experience,  by allowing  free circulation in the  adjacent parts and
avoiding unnatural  compression of the  peritoneum and  uterus,  in
many cases removes much  of the danger  from peritoneal  inflam-
mation, and greatly  facilitates the  speedy recovery of the patient.
There is also  less liability to  prolapse of the womb occurring after
the  woman  gets  about,  or of leucorrhoeal discharge.  An  abundant 
           THE CARE OF  THE  WOMAN AFTER  LABOR.         205

personal experience of the superiority of this non-use of the bandage
or binder since the first edition of this work appeared, coupled with
the assertions  to the same  purport of numerous  medical men in all
parts of the country who have adopted it, warrant me in emphasizing
the direction above given.
  The mother should be enjoined to remain perfectly passive, and she
should not be subjected to a disturbing influence of any kind.  A
pleasant  chat with the  patient after " all is safely over" is very enti-
cing, and apt to be indulged in by the nurse and friends, and some-
times even by the physician ;  but too much cannot be said  against this
most  cruel and  injudicious practice,  and it is almost  impossible to
calculate the amount of mischief that has  been done by  a deviation
from the rule enjoined.   It is to be remembered that the  mother has
just emerged from  a condition  of the  highest mental and  physical
excitation, and if this be borne in mind  the necessity for  perfect pas-
sivity  becomes at once  apparent,   The room  should be darkened
somewhat more  than during parturition, and talking and whispering
should not be allowed.  Perfect quietude  should be maintained, if
possible, in order that  she  may sleep, which will prove very advan-
tageous and  refreshing.  Additional covering should at  once be ap-
plied, and if she desires water she should be allowed  to have it in
plentiful quantities.  After an hour or two, when she  may have thus
rested, the nurse may  safely proceed to place her in  bed by gently
moving her up to her position, rolling the soiled clothes up into a lump
and removing them.  Thus the patient will be at the same time ren-
dered  neat and comfortable, her clean  clothes being  brought down
from her waist as the others are removed, and her lower  limbs made
dry and  warm.   The  nurse will, of  course, understand her  duty of
keeping  the  patient clean  and comfortable by constant  attention to
the lochia and in other respects; but the physician should exercise
the greatest  care in seeing to it that the  nurse  does her duty fully
in  this particular, as very serious  complications have arisen solely
through  the  carelessness of nurses  in not giving proper  attention to
cleanliness.
   If all goes perfectly well with the patient, there is no need  to resort
to  medicinal  means.  A dose of arnica may be given,  however, in
case the woman complains greatly of soreness or a bruised feeling,
resulting either  from the extrusion of the child or from the general
 muscular effort incidental to parturition.  The accoucheur should not
 leave his patient for at least a half hour after the birth of the child,
 until he  is assured  that there is no danger of subsequent  flooding 
206        THE CARE OF  THE  WOMAN AFTER LABOR.

He should  carefully note the patient's pulse, watch  her countenance
without exciting observation, and be governed accordingly.
   The relief experienced immediately after parturition is  in a great
majority of cases truly remarkable;  according to her own expression,
the patient  feels " as though she were in heaven."   Afterward, it is
no uncommon occurrence, however, for the patient to be seized with a
shivering or chattering of the teeth.  With the addition of a little
covering this  soon passes off;  she begins to feel a glow of heat, her
skin becomes  moist, and there is  no more trouble.   After a little
sleep—which, as already suggested, she should seek to obtain as soon
as possible—she seems to recover from the shock of delivery and once
more appears in a natural, healthy condition.
   The woman should be visited again within from twelve to twenty-
four hours.  At this visit  the following  points demand attention:
First. The  condition of the pulse.   Second. The condition of the
bladder and whether urine has  been voided or  not.   TJiird.  The
degree of uterine pain  or  abdominal tenderness.   Fourth.  The cha-
racter of the lochia.   The  general condition of  the patient, the pres-
ence or absence of headache, and whether she has had a nap or not,
are likewise matters of importance to be ascertained.   The pulse of
the lying-in woman  should not reach a hundred beats per minute.
If it goes beyond that number there is something wrong, and  if it
greatly exceeds  one  hundred, rising  to one hundred and twenty or
higher,  active measures  will be  necessary to secure  a  restoration to
health.   These  active  measures will  consist in  the prompt adminis-
tration of the  appropriate and homoeopathic remedy; and it is some-
times almost marvelous with what benignity and with what prompti-
tude the remedy thus selected acts in  restoring the lost equilibrium of
the system.
   If no  inclination  to urinate has been felt, the bladder is probably
semi-paralyzed  and  needs  help to resume its proper  function.  This
help  it will get from  arsenicum,  causticum  or hyosciamus,  accord-
ing to the  indications  for  each,  as  given  elsewhere.  All  other de-
rangements from the  line  of the  true  physiological lying-in state
should be met with  the proper homoeopathic remedy.
   At this second visit directions  may be given for having the child
applied to the  breast, should all be going on well.  This procedure not
only serves  to stimulate the mammary glands into  action, but it fur-
thers the  necessary uterine  contractions.  Dr. Rigby advises that the
child  should be applied to the breast very shortly after delivery.  He
says: " Even if the  child sucks  fairly well for  only five minutes, we 
           THE CARE OF THE WOMAN  AFTER LABOR.        207

feel satisfied, for we cannot call to mind a single case of hemorrhage
after the effects of this operation."   There does not seem any necessity,
however, for subjecting the mother in her weakened and exhausted
condition at this early period to what must of necessity in most cases
prove an annoyance.
  Unless spontaneously moved, the patient's bowels should not in any
way be disturbed  for eight  or nine days.   The  custom—-formerly
much more general than now in allopathic practice—of giving a pur-
gative  on the  second or  third day after  confinement, is exceedingly
pernicious, and sometimes gives rise to very serious consequences.
  Until after the secretion of milk has been well established the diet
should be very simple and the room should continue to be well shaded.
During convalescence, commencing after the secretion of the lacteal
fluid has been well established, the diet may be made more generous
in both meats and vegetables (eggs, oysters and fish being strictly pro-
hibited), and the light of day should be allowed to enter the chamber
freely, rejoicing the woman's sight and strengthening her  in every way.
The bed-covering  and her own clothing should provide  a sufficient
degree of warmth, and  yet be  so light  as not to be  burdensome.
Heavy, close  and  thick material not only weighs down and swelters
her, but prevents the carrying off of the  effluvia arising chiefly from
the profuse transpiration of the effete material, so desirable to be got
rid of at this period.  Let the accoucheur,  at a subsequent visit, turn
down the covering in cases where he finds the patient heavily blank-
eted, and the  heat and stench escaping from the bed will  suggest to
him its occupancy by some  offensive carrion, rather than  by a  living
human being,  and  perhaps  by two—the mother and  her child.   Can
it be wondered at if  such cases make a slow recovery?
   The room  should  be ventilated every day, the thermometer  never
rising above 70° Fahr.  The patient should be allowed plenty of pure
cold water to drink, and  her lavements should  be sufficient for  clean-
liness, but always performed under cover.  The feet should be sponged
almost daily, one foot at a time, which should be rubbed perfectly dry
and covered before the other foot is touched.   The water for external
use should be tepid,  and free from alcohol, bay rum, cologne or any-
thing of that kind.
   The patient's clothing and the bed-linen  should  be changed  fre-
quently,  having been previously well  aired before a hot fire in an-
other room than the lying-in chamber.   For two weeks  she should
keep the recumbent posture, using a bed-pan when required, changing
frequently from one side of the bed  to the other to rest herself  and 
208        THE  CARE OF THE WOMAN AFTER LABOR.

permit the vacated side to be shaken up and prepared for her return
to it with increased satisfaction; or she may be transferred to another
bed or a lounge for a few hours daily after the first  few days.  At
the end of the third week she will  be the stronger and better for hav-
ing spent the first  two weeks in  a recumbent  posture.   Physicians
should be particular in urging this point, as very much of the comfort,
health and happiness of a woman's after life depends on the care she
takes of herself during convalescenc3 after parturition.
   After the second week, other things being equal, the woman may
take a sitz-bath, the water being at a temperature of 65° or 70° Fahr.
While sitting in the tub, water may be poured over  her shoulders and
washed  down for a few moments, which should then  be rubbed dry
and covered while the limbs are being Washed and rubbed dry.  The
process  being completed, she should "go at  once to bed.  In no case
should she go out immediately after  a bath.   Extra caution must be
observed in bathing in cold weather. During the third week she may
drive  out  in fine  weather—in cold weather  during the fourth week,
other things being equal.
   During the entire nursing period the diet  should  be plain and sim-
ple, but abundant and nourishing.  All abnormal  conditions should
be carefully attended  to and the proper remedy given.   The room of
a lying-in woman should be light and airy, and when the proper time
comes she should walk out every day in  the air and  sun when the
weather is suitable,  riding being entirely insufficient.
   The underclothing should  not in any instance be allowed to hang
upon the hips, but should be suspended from the shoulders.  No
woman can hope to remain well who allows the weight of her skirts
to drag  upon her hips and loins, and complaints of great magnitude
may arise from this  apparently trivial cause.
   If a woman should feel weak " after she gets about the house," she
should not be recommended or permitted to fly to stimulants of any
kind for relief, but the physician, being consulted, should seek the ap-
propriate remedy, which may be found under the law of the similars.

              The  After-Pains and the Lochia.
   The uterus by alternations of contraction and repose gradually re-
turns after parturition from its enormous distension  to its natural size.
Its complete restoration in size and position  generally occupies about
six weeks.   Sometimes, on the contrary, it suddenly grows larger
from  some abnormal condition, and may be felt rolling from side to
side as the patient turns in bed.  This condition need excite no alarm 
           THE CARE OF  THE WOMAN AFTER LABOR.        209

—since  the  uterus will soon  subside to  its normal size—except  in
some  few instances in which it still remains large, with a sensation
of bounding as if it contained a foetus; in such cases a dose of crocus
will soon set all things to rights.  As the uterus regains  its normal
size, the new mucous membrane becomes completed, and the spot from
which the placenta was peeled off is also supplied with a new mucous
membrane by a process of granulation.
  As  the uterus  returns to its normal  state the vagina  also grows
shorter,  its transverse rugse return, and in the course of six weeks it
is in all  respects as before pregnancy, except that the subvaglnal  por-
tions of the neck may be more or less permanently shortened on ac-
count of the extreme  stretching upward during gestation.
  The uterus and vagina return to their usual condition by virtue  of
the elasticity of their tissues, and where this is sufficient the process is
unattended with pain.  But if necessary, organic contractility is also
brought to aid, and this is always  attended with more  or less pain,
constituting what are  called the after-pains.
  During all this time a discharge from the vagina is taking place—
first of pure blood for a day or two, which grows paler and paler till
finally it appears  as a sero-purulent liquid, often of a pinkish color;
then it becomes lighter, watery, and at last entirely disappears.  This
discharge is called the lochia.

                      The After-Pains.
  Of the after-pains it is proper to state  more  particularly that they
are really the  organic contractions  of the uterine  fibres, where  the
elasticity of the general uterine tissue is insufficient to expel the liquids
with which the walls of the uterus are engorged,  or the clots or shreds
of membrane which are contained within its cavity.  When they make
their  appearance at all—which is sometimes not the case—these pains
usually  come on soon  after delivery, and continue with greater or less
severity from two to eight days.  Fluids ar coagula, in greater or less
quantity,  are discharged with each pain.  It is very  important  to
diagnose  between  the after-pains and those which indicate the acces-
sion of  puerperal inflammation; but this is an easy thing to do, since
the former contract the uterus, while the latter do not,  and in the
former case there is usually considerable abdominal tenderness, which
increases, while in the latter this is absent.
   After-pains are commonly absent in primiparse, but almost always
present  in a greater or less degree in  multipara?.  They are generally
salutary, as before remarked, but sometimes they become excessive,
       u 
210        THE CARE  OF THE WOMAN  AFTER LABOR.

unbearable, and give  rise to  distressing accompanying  symptoms.
When they assume this character, they should be  checked by the ad-
ministration of the appropriate remedy as laid down under its proper
heading in the portion of this work devoted to therapeutics.

                           The Lochia.
   The lochia constitute the  discharge  from the genital  organs which
commences  soon after the  expulsion  of the placenta, and continues
until the complete  restoration of the  uterus to its normal condition.
This discharge results  from  the disgorgement  of the uterus in  its
return to its usual  size, and it is principally derived from that por-
tion of the uterine  surface to  which the placenta had been adherent.
During the  first twenty-four hours  the lochial discharge is quite san-
guineous, and  sufficient in quantity to  soil ten or  twelve napkins.
A_fter  the first few hours  this discharge gradually becomes less and
less, as it passes through its four or five successive stages: first, san-
guineous ; second, serous;  third, milky; fourth, puriform: and when
it  has  nearly subsided  it is not an uncommon  occurrence for it  to
freshen up and assume a pinkish hue, and then, resuming the appear-
ance of a delicate, limpid pus, rapidly disappear.
   In about six  days after parturition the sanguineous discharge should
disappear entirely, and in two or three weeks more the patient should
be completely well.   In severe cases the  lochia will cease sometimes
earlier, sometimes later, either as a natural consequence of the attend-
ant conditions or as an exception merely to the general rule;  and  in
all such variations the accompanying sensations and conditions of the
patient will indicate the treatment.
   During the  milk fever the  lochial  discharge lessens or ceases en-
tirely,  and  returns more abundantly as the fever subsides.  In quan-
tity  this discharge varies  in  different individuals; some have very
little, others have much ;  in  either case no  interference is  necessary,
unless  symptoms arise which  show that the unusual quantity results
from some  abnormal state.   The lochia  has a peculiar  odor, differ-
ing in  individuals  both in character and intensity.   The presence
of even a small shred of the membranes, which  may have become
detached and left behind in delivering the placenta, may render the
lochial discharge exceedingly  offensive.  In  all cases the fetid nature
of the  discharge, or any other  deviation from  its normal  character,
will go far  to indicate the proper remedy for the general morbid con-
dition of which this peculiarity is one of the evidences.
  Throughout  the  lying-in period the  condition  of the lochia, if 
           TREATMENT OF THE CHILD AFTER  BIRTH.        211

abnormal, forms one of the surest and soundest indications for treat-
ment.  The selected remedy must always  cover  the condition here
manifested.  Every day the  physician should inquire of the nurse as
to the state of this discharge, and the first abnormal condition should
place him on his guard against other serious disturbances which may
result.   We should always be watchful for the beginning of mischief,
but this one of abnormality of the lochia should be especially guarded
against, since it  is very apt to be overlooked till a late hour.  In such
cases all the symptoms should be carefully collated and the remedy
selected in accordance, but it must always cover the abnormal  condi-
tion of the lochia.
  In the treatment of cases in  which  there is  derangement  of the
lochial  discharge such medicines should be carefully studied  as are
recommended on page 428.

Hygiene and  Treatment of the Child immediately after
                           its  Birth.
  After the cord has  been cut and the  child has  been given  to the
nurse, it should be washed and dressed as soon as may  be convenient.
Some unctuous matter, such  as lard or oil, should be rubbed into all
those places covered with the caseusa, which latter will then be entirely
removed upon  being  washed with tepid or warm water  and  soap.
The navel  should then be dressed as directed on page 199, and the
belly-band applied;  then may be added the diaper,  the shirt, the
flannel petticoat and the outer dress or slip.  This constitutes the babe's
dress for the bed; when it is taken up it should also  have a shawl or
blanket piovided for that purpose, to be laid aside upon its return to
the bed.  During the process of washing and dressing—which should
be conducted with as much expedition  as possible—the child usually
becomes quite cold and blue.   It should therefore be quickly placed
in bed and covered to that degree that  warmth will soon return.  At
his  daily visits  the physician should  observe that the infant  is not
smothered while lying in bed, but has an  opportunity of breathing
like other human beings.   Its pillow  should not be more than two
inches and a half thick, and it should be made of hair, untufted, so
that it may be pulled apart and made light and airy every few  hours.
  Should the child be troubled with retention of urine, aconite will
be the  remedy most likely to afford relief.  (See Dysuria.)  If the
meconium does  not pass off naturally, mercurius, nux  v., bryonia or
Pulsatilla may be resorted to.  (See Constipation.)
  The child is no" always  born in so healthy a condition as to  be ca- 
212         treatment of the child after  birth.

pable of undergoing promptly the treatment above described.   Some-
times it comes into the world  in a state of apparent death.  This
condition may result from  three distinct classes of causes, and may
present corresponding differences in the appearance of the child.
  I. Apparent death of the child may result from shock to its ner-
vous  system in general, or  from some special  lesion of  a particular
portion of it.   In the former class may be  instanced the severe com-
pression which the  brain undergoes in  certain cases of contracted
pelvis, and from the application of the forceps under difficult circum-
stances, especially  in the  superior strait; in  the  latter class  may be
instanced the still more  serious lesions of  the  medulla oblongata
which may  result  from extreme rotation of the  head,  from undue
traction  upon the  head after  it is delivered,  or from too much force
applied to the body in order to deliver the head still detained within
the pelvis.  This  latter is  one  of the most  frequent causes of the
fatality so  commonly attendant  upon  breech presentations.  The
injury to  the  brain, not necessarily preventing respiration, may pass
away and the life of the child still be preserved.   Such, however, is
not the case with  serious  lesion of the medulla oblongata, which
renders respiration impossible.   However,  as it may not be known
that such injury exists—unless  the child's neck should have been
distorted by some remarkable violence—every case of apparent death
in the new-born babe should  be treated as  if there were  a possibility
of recovery.
  II. Injuries of the placental  circulation  may have been the cause
of the apparent death of the child.  These may variously arise from
compression of the umbilical cord between the sides of the pelvis
and  the head or body of the child;  from winding of  the cord  so
tightly around the neck as to obstruct the circulation in the umbilical
vessels;  from the premature  separation of the placenta, which may
occur in cases of delivery by the breech  when all but the head has
been  delivered,  or from great retraction of  the  uterus  itself when
only the head  remains within it, such retraction preventing the admis-
sion of fresh blood  into the uterine sinuses  in sufficient quantity to
supply the child.   By either of these  causes  a real asphyxia  may be
produced.  A similar condition may result from such  an accumulation
of mucus in the nose and mouth as will  prevent  the introduction of
air into the bronchia.  In addition to the breathlessness this condition
will  be indicated  by discoloration of the skin, which may exhibit a
violator blackish-blue  color; the muscles  are motionless, the limbs
flexible and  the body warm;  but the pulsations  of  the  cord, of the 
treatment of the child after birth.        213
radial artery, and  even those of the heart, are faint or impercep-
tible.
  III. Lesions of the foetal circulation constitute a no less dangerous
class of causes of apparent death.  These may consist in rupture  of
the placenta or of the umbilical cord, which affects the life jf the child
while yet unborn;  or if the hemorrhage should be arrested  in any
way before proceeding to so fatal an  extent, the child  may be born
alive, but in a state of syncope.  In these cases the child is very pale,
the muscles are  relaxed; it may make  a few short respirations and
utter  some feeble cries, but unless saved by the administration of the
proper remedy, it soon perishes.
   Treatment.—From whatever cause the apparent death or suspended
animation of the  child should result, no time  should be lost in making
proper efforts to  establish respiration.  In cases where the breathing
is simply deficient, and there  is not a complete suspension of animation,
one or the  other of the following  remedies may be administered in
accordance with  the given indications:
   Aconite.—The child is hot, purple-hued, pulseless and breathless,
or nearly so.
   Belladonna.—The face is very red and the  eyeballs  are  greatly
injected.
   China.—In cases where profuse hemorrhage has been the apparent
cause.
   Tartar Emetic.—When the child is pale and breathless, although
the cord still  pulsate;.
   Camphora may be given a few minutes  after tartar emetic, if  the
latter should  fail.
   If the child does not soon respond to internal remedies, or in cases
of so grave a nature that it  is apparent that these remedies can have
no effect, it  should be immersed suddenly in very cold  water, or,
better still, cold  water, even iced water, should be poured over it.  In
some pale and  apparently lifeless  children  pouring cold  water upon
the head  and allowing it to run down  over the  body establishes  the
"circulation and respiration;  the  child should then be at once wrapped
 in woolen blankets until quite restored.  Of course in  all those cases
 where respiration  is prevented  by an  accumulation of mucus in the
 nose and mouth these obstructions should be at once removed.  Any
 or all of the above methods failing, artificial  respiration  should at
 once be resorted to  by either Marshall Hall's  or  Sylvester's methods,
 which are so  well known that they need not be described here; or the
 lungs may be filled directly from the accoucheur's lungs, ly his closing 
214       treatment of  the  child after birth.

the child's nostrils between the thumb and forefinger of his hand, ap-
plying his  mouth accurately to the  mouth of the child, blowing air
into  the  child's  lungs, and, when filled, by  gradually  and carefully
compressing  the  thoracic walls,  emptying  the lungs  again.   This
manoeuvre should be repeated  again and again,  as often as  every half
minute.  This artificial respiration, and all other methods  resorted to
to restore suspended animation, should be persevered in for  sometime,
life having  returned after even an hour had elapsed, from judicious
and continued treatment.*

                   Secretion of  the  Milk.
   This function is one of the  most interesting and  at the  same time
one of the most  remarkable of the phenomena transpiring  during the
lying-in  period.   While the child is still  in  utero the maternal prin-
ciple and all that pertains to  the  mother unite to  effect its nourish-
ment,  growth and  development there.   Suddenly all  this is inter-
rupted : the child is expelled  from the little world within,  and has to
find nourishment elsewhere.  It is supplied as before from  the mater-
nal blood through the  medium of the  mammary glands.  The reac-
tion  upon the organism from this  change from the uterus to the
breasts causes wdiat is called the milk fever, in consequence of which
there results a disturbance in the  system more or less well  marked
according to the obstacles to be overcome.  Hence appear  chills,
fevers, headaches and  a great variety  of pains  and sufferings; even
intermittent fevers  are  sometimes developed  in consequence  of this
great physical change.
   Some women appear to have milk before the babe is born or at its
birth, but this is not the real milk, since it is  devoid of the  true milk-
globules, and is  called colostrum.  The change already referred to
has yet to be made, and presently the real milk comes, exhibiting the
true, full and plump milk-globules.
   The quantity  of milk varies greatly; in some women  it  is quite
scanty but rich  in  quality, while  in others it  is poor in quality but
abundant in quantity.   Every woman in a perfectly healthy state will
yield nourishment enough for  her own babe,  and when this is  not the
case remedial agents must be  administered to bring about this much-
to-be-desired result, for no  child can possibly do so  well as  when sup-
plied with its own maternal aliment.  As a general thing, all the dis-
turbances incident to the coming of the milk are less when the child
is  applied to the breast as  soon after delivery as practicable.   Much
advantage is gained both  to  the mother and babe by this method,
              * For further directions see Appendix, Note 1. 
DYSTOCIA.
215
since it serves to lessen the  suffering of the one from  hunger and the
danger of the other from fever.
  When the foetus perishes  near the full term the child is still carried
for a while—it may be till term.   In general no  milk secretes in such
cases, certainly not till after the delivery of the dead child.
  At no time should the  milk flow from  the  breasts except when
drawn.   In those cases in  which it is constantly flowing spontane-
ously remedies should be sought to remove the abnormality.
  In order to relieve the  disorders incident to lactation we should
always rely upon homoeopathic medicines.  No  bathing or even rub-
bing of the breasts should be resorted to.  Rubbing the breasts in
in order to "rub out lumps" often  bruises  the  breasts and  lays the
foundation for  abscesses.   External applications  are  altogether un-
necessary.  The remedies to be given  for these  varied disorders will
be pointed out under an appropriate heading in the latter part of this
work.   (See Disorders of Lactation, pp. 464 and 467.)
                      CHAPTEK XIV.

                          DYSTOCIA.

   BY dystocia  is meant unnatural,  " laborious, morbid or  difficult
    labor."   Labor does not always take place in what may be re-
garded as a truly normal manner.  It may become, by a combination
of circumstances, difficult, dangerous, and even impossible.   In such
cases the intervention of art is demanded.  These circumstances are
exceedingly various and numerous, and they give rise to three dis-
tinct classes of difficult fabor, viz.:  1. " Those rendered difficult, dan-
gerous  or impossible by a defect or an excess in the action of the ex-
pulsive forces.  2. Those rendered difficult, dangerous or impossible
by obstacles to the expulsion of the foetus.  3. Those  complicated by
accidents liable to endanger the life or health of the mother and
child." *
  In respect to  the first of these classes, it should be observed that the
pelvis,  as well as the organs of generation, may be perfectly natural,
and the diameters of the child  may  all  be in harmony with the pas-
sage, and yet the expulsive force may be wonderfully deficient, and at
length  may cease to act entirely.   In deciding on the duration of
                            * Cazeaux. 
216                         DYSTOCIA.
labor,  it may be adopted as  a general rule that where more than
twenty-four hours have elapsed since its commencement serious acci-
dents may be feared either to the mother or child, and these should
be anticipated by removing the cause of the excessive slowness.  The
fact which requires particular  attention  in  the prognosis is, that the
period of dilatation of the cervix is to that of the expulsion  as two or
three to one.  Now, the  delay may occur either  in  the first or the
second  of these stages.  The  first stage may be  prolonged without
danger either to the mother or  the child  unless there be hemorrhage
or convulsions, but when the second stage, or the period of expulsion,
is extended beyond ten or twelve hours, the uterine pains may become
irregular in their return and  intensity, and  the foetus seem to  retro-
grade rather than advance—there is no expulsion.   The condition of
the patient at this crisis is thus described by Cazeaux:
  " The local disorder is accompanied, or at least soon followed, by a
violent trembling; the patient  has an inclination  to vomit,  and even
throws  up bilious matters; she is  uneasy,  excited and changes her
position every moment; the skin is hot and dry , the pulse runs up
to a hundred or a hundred and fifty  per minute  the tongue is dry,
and  both it and the  teeth are covered with a dark coating.  The
vagina and cervix are hot and sensitive to the touch,  and a yellowish
liquid  escapes from  them, which occasionally has a  fetid odor; the
pressure of the child's head on the  cervix vesicae  prevents the emis-
sion  of  urine, and the  parts that line  the superior strait  and the pel-
vic excavation being compressed for a long time by the head, may
become inflamed or even  gangrenous, which complications  may sub-
sequently prove a source of the most serious accidents.
  " If the woman still remains undelivered, these symptoms increase
in intensity in a frightful manner; the vomitings become more fre-
quent and the  abdomen  more distended;  the  excitability of the
patient  knows  no bounds; the pulse is more and more feeble and
frequent, and she falls  into a  half-stupid or a semi-delirious condi-
tion, which is  soon  terminated by death.  It is  scarcely  necessary
to remark that  in the latter  case the life  of the  child is also most
seriously compromised."
  There are numerous causes which may operate to bring about this
condition,  some of which are vital, while others  are mechanical.
Among the former may be mentioned  general debility, plethora of the
uterus,  inflammation  of  the uterus,  mental emotions,  various dis-
eases, etc;  among  the latter,  over-distension  of the uterus by an
excess  of liquor amnii, too  early rupture of the membranes, etc. 
DYSTOCIA.
217
When the cause  appears to be a vital one, the pains, too weak from
the first, grow weaker, are irregular or cease entirely, the appropriate
homoeopathic remedy will almost always bring about  a normal con-
dition, and labor will  go on to its completion  in a proper manner.
The  medicines to be  resorted to  under  these  circumstances will be
mentioned, together  with their indications, in a subsequent chapter.
  A woman who has  had a difficult labor from deficiency of uterine
action in  consequence of some  general disease, such as gout, rheuma-
tism, disorder of the  digestive organs,  etc., and has again become
pregnant, should be  very carefully treated during pregnancy, that  the
cause may be abated or removed, in which case  she will  not be apt to
have a return of the  uterine atony when she is again taken in childbed.
  Mechanical  Causes of Dystocia.— Over-distension of the  Uterus
from Excess of the Liquor Amnii.—Cases of this kind can be  recog-
nized from the fact  that the membranes do  not bulge into the  mouth
of the uterus as it  dilates; during  the  contractions  the membranes
are felt to be tense and to retain the globular form of the uterus.  In
this case the only plan of relief and of rendering the pains efficacious
is to rupture the  membranes, which may be readily done by plunging
the finger through them during a  uterine contraction.
   Premature Rupture of the Membranes.—In cases of this kind  the
early escape of a small portion  of liquor amnii allows the head to
descend upon the undilatcd mouth of the uterus, so as to  hinder  the
escape of any more  of that fluid, and of course it is all retained in
the fundus above the child.  The contractions gain nothing by forcing
out more fluid either through the ruptured membranes or by causing
the bulging of a pouch; consequently, the pains are liable to become
more and more feeble.   The  mode of action now to be adopted is to
introduce a finger and in  the  absence of a  pain raise  the head and
hold it up during a pain,  when the liquor amnii will  escape  freely.
Repeat this process,  if necessary, again and again, and the pains will
strengthen rapidly.
  Sometimes the child's head becomes engaged in the lower segment
of the membranes and they fit close to it, and there is no opportunity
for the membranes to bulge through the  os, the consequence of which
is  that the liquor amnii is all retained  above the body of the child
and in the fundus of the uterus.   In this case the membranes must be
stretched through and the  head elevated, in the absence of a pain, and
held there until the  next pain,  when the  waters will gush out and  the
l^ains will gain in strength.  This process may be repeated again and
kgain if necessary, and the pains will become more and moie effective. 
218                         DYSTOCIA.
   Impaired action of the  abdominal muscles, occasioned by the exist-
ence of some disease, such as asthma, pneumonia or dropsy, may like-
wise be the cause of  difficult or retarded labor.   In such cases, should
it become evident that nature  is entirely, unequal to the task of emp-
tying the uterus, resort must be had to mechanical means for effecting
delivery.
   The  pains may be  rendered  inefficacious from  an  over-distended
bladder, the reflex from which painful condition will cause the uterine
contractions to  cease.  This may be determined by the history of the
patient's case, and by great sensitiveness of the bladder when pressed,
or by a dullness on  percussion if she has not voided urine for a long
time.  In this case a catheter  must be used, the male being preferred,
for obvious  reasons.  A loaded rectum  may have the same effect as
the bladder in  the  state  above described, in which case it  must be
washed out with injections.
   In precipitate labor the  chief danger lies in  a liability to the rup-
ture of the uterus from too powerful contractions, or of the vagina
or perineum.  The umbilical  cord may be torn asunder by the child
falling on the floor, or the child may receive other injuries consequent
on sudden and violent  action.  Some  women are always troubled with
too rapid labors, and, knowing from experience what to expect, should
adapt themselves to  this condition by preserving a recumbent posture
from the first pain, and restraining themselves  as much as possible.
In some cases the disposition to too slow or to too rapid labor seems
to descend hereditarily from mother to daughter.
  The  treatment  of  precipitate labor is  usually unsatisfactory, inas-
much as it generally  occurs in the absence of the accoucheur.  Should,
however, the accoucheur be  present, and the force and rapidity of the
pains be in  excess of what  may be regarded safe, they may be miti-
gated by the administration of coffea, secale, belladonna, conium, nux
vomica or chamomilla.   The patient should likewise be  cautioned to
refrain from expulsive efforts.

        Dystocia from  Malformation of the  Pelvis.
  We  next come to  the second group of  causes which render labors
difficult, dangerous  or impossible.  The causes are  mechanical, and
refer themselves to the mother or the child.  We shall  first treat of
those wdiich depend on the  mother, and  the first of these which we
shall notice are  the malformations of the pelvis.  A pelvis is malformed,
in the  sense in which we  here use the word, when  it too greatly ex-
ceeds or falls short of the average size.   Excess of amplitude or of 
dystocia.
219
retraction, too great size  or narrowness, are productive  of notable
obstacles in the exercise of the child-bearing function.   If the ampli-
tude is too great the woman  is exposed to serious accidents in all the
three states, the non-gravid,  the pregnant and the parturient,
  In the non-gravid, because the uterus, being free and movable in an
over-spacious cavity, is much more liable to the various displacements
of descent, anteversion and retroversion.
  In the pregnant, because " during gestation the womb, finding more
space than isual in the pelvic cavity, remains there until a  much more
advanced period of pregnancy, and the volume of the organ, by com-
pressing  the  rectum and  the bladder,  often  occasions  an excessive
tenesmus in these parts, which proves very distressing to the patient;
sometimes even  the discharge of the urine and fecal  matters is  im-
peded ; besides which varices, hemorrhoidal tumors, and a considerable
infiltration of the lower parts are found to be developed in conse-
quence of the mechanical obstacle to the circulation of the  inferior
extremities."*
  In the parturient state, because during  labor the too great amplitude
of the  pelvis  exposes the patient to all the dangers  resulting from  a
too rapid delivery, which we do not propose to treat of here.  A
woman subject to this malformation should be kept  in the recumbent
posture during labor, and she should  be instructed not to aid the pains
in any way, and not to bear down until  the os uteri is fully dilated;
and even then as little  voluntary effort should be made as possible.
  But  the most  terrible deformities of the  pelvis  are  those  arising
from its  contractions;  for it must at once be obvious that a just pro-
portion must  exist between the  dimensions of the canal and those of
the body which is to traverse it, and that where this relation does not
hold, either through the contraction of the pelvis  or the abnormal
size of the child, delivery by any natural process becomes  impossible.
  The contractions of the  pelvis, according  to Velpeau, are either
absolute  or relative—absolute when, although greatly retracted in all
its dimensions, it notwithstanding is  properly formed and  presents no
irregularity in its exterior aspect;  relative, when only one  or more of
its diameters  is affected by the  contraction (the others  preserving, or
very nearly so,  their  normal length),  and  the  form  is  completely
changed by this partial alteration.   The last group of contracted pelves
—viz., the relative—is the only one which will  engage our attention
in this  place.  This deformity is referred by M. Dubois to  one of
three principal types—viz., either to a flattening from before backward,
                            * Cazeaux. 
220
DYSTOCIA.
to a compression on  the sides or to the depression of the anttrior and
lateral parts.
   The flattening from  before backward, or shortening of the antero-
posterior diameter, results from a more or less marked approximation
of the anterior and posterior pelvic walls; and of this species of mal-
formation there are several  varieties, all resulting from the extent of
contraction  either in height or width.  An example of this kind  is
presented when the superior strait alone is contracted, the excavation
retaining its normal capacity.   This phenomenon is due to an unusual
curvature of the sacrum, which sometimes makes an obtuse angle at
A PELVIS IN WHICH THE CONTRACTION OF THE SACRO-PUBIC DIAMETER IS PRODUCED
       BY THE UNUSUAL PROMINENCE OF THE SACRO-VERTEBRAL ANGLE.

its middle  part, so that the sacro-vertebral angle is increased to an
unusual  degree.  Sometimes the reverse happens,  and the sacrum,
instead of affording an anterior cavity, is quite plane, or even convex
in front, and then the antero-posterior diameter of the excavation is
contracted  simultaneously  with  that of the  superior strait, and the
sacrum seems to  lose its natural curvature and project forward in its
whole length.
  Sometimes the shortening  of  the antero-posterior diameter of the
superior strait is accompanied by an enlargement of the corresponding
one at the inferior strait.   This  indeed is the arrangement most  usu-
ally met with, and this  is  what generally happens when the sacrum,
yielding to the weight  of  the trunk, transmitted to it by the spinal
column, tilts—that is, projects forward its base—while pushing back-
ward its coccygeal extremity.
  Sometimes the coccy-pubic and the sacro-pubic diameters are short-
ened at the same time.  This happens when the sacrum, instead of 
DYSTOCIA.
221
performing the tilting movement just mentioned, yields in such  a
way that its tw j extremities are thrown forward, and two consequences
are the result of this action—viz., the anterior  curvature is greatly

                             Fig. 56.
    THE SHAPE OF THE SUPERIOR STRAIT IN THE FIGURE-OF-EIGHT PELVIS.

increased, and there is an enlargement of the corresponding diameter
of the excavation.
  Another case of  pelvic contraction is thus described by Cazeaux:
" In the approximation  of the  antero-posterior walls the sacrum is
nearly always the displaced bone; but, although much more rare, a
flattening of the  anterior wall  is also  met with, and then the  sym-
physis pubis, instead of presenting a convexity in front, is perfectly
flat, or even (as in one instance  represented by Madame Boivin) pre-
sents  a depression, which seems  to  protrude  inwardly toward the
prominence of the sacrum.  This double inclination of the pubis and
sacrum toward  each other gives to the superior strait the form of a
figure of eight—that is, its plane is divided into two rounded portions
on the sides, corresponding to the iliac  fossa?, and is  separated in the
middle by a  restricted part of variable width.   If the depression is
considerable, the antero-posterior diameter of both straits  and of the
excavation must evidently be affected by it."
  Or again, the extent of the symphysis pubis  may be much greater
in its vertical  direction than usual, giving rise to what is termed the
bar pelvis, or it may have an excessive inclination backward  at its
lower end; in both these cases the pelvis is narrowed.
  Sometimes the coccyx is elongated, and it takes a nearly  horizontal
direction.  This,  as well as an immobility  of the   sacro-coccygeal
articulation, may, it is alleged,  contribute to the shortening of the
coccy-pubic diameter.
  Compression of the lateral walls, by which the transverse diameter is
shortened, is the rarest of all pelvic malformations—that is, so far as
the  superior strait and upper part of the excavation are  concerned.
As regards the inferior  strait, the approximation of the two ischial 
L>22
DYSTOCIA.
 tuberosities, by which this species of deformity is produced, is quite-as
 frequent as the shortening of the coccy-pubic diameter.   The  pubic
 arch, in this case, assumes the triangular form peculiar to the male
 sex.  Moreover, the inward projection of the spines of the ischia may
 produce a sensible diminution of the lower part of the excavation in
 the transverse direction.
   "Another variety of transverse contraction is owing to the fact of
 the pelvis  being less developed in one of its halves than in the other,
 and consequently to its exhibiting a less  degree of curvature in that
 part than upon the opposite side.  In this case the articulation of the
 spine with the  sacrum no  longer  corresponds to  the middle of the
 pelvis, and the vertebral column is found nearer to the hip of the con-
 tracted  side; the transverse diameter is likewise diminished at the in-
 ferior strait by reason of the obliquity of the entering part of the  coxa!
 bone.   The antagonism before alluded to as existing between the an-
 tero-posterior diameters of the superior and the  inferior straits, whereby
 the elongation of one most frequently coincides with a shortening of
 the other, rarely exists in the transverse direction ; the deformity pro-
 duced by a congenital  displacement of the femurs is probably the only
 condition  in which the transverse diameter of the inferior  strait aug-
 ments at  the  same  time that the  bis-iliac one  diminishes, the en-
 largement  in  the lower  part of the pelvis  in this  instance  being
 marked by an  unusual width in the  pubic arch, a great obliquity of
 the ischio-pubic ramus, a separation of the ischial tuberosities, etc."—
 Cazeaux.
   Depression of the Antero-lateral Walls.—The effect of this depres-
 sion is the diminution of the oblique diameter?.   It occurs more fre-
 quently than the preceding, but not so frequently as the first variety.
 The essential  characteristic of this deformity  is the flattening or the
 inward  projection of the coxal bone at the part corresponding to the
cotyloid cavity and the junction of its three constituent pieces, where-
 by the curve described  by the pelvic circumference  is more or less
diminished, even when  carried to a  high degree  to the reversal of
the curvature, its  convexity being turned toward the sacrum, and the
pubis pushes almost directly forward, the coxal bones assuming the
form of an italic S, instead of presenting a regular arch.
   We next proceed to describe the  oblique-oval pelvis, a  malforma-
tion produced by an arrest  of development on the  part of one lateral
half of the pelvis, while the other maintains its normal condition.  The
effect of this, as will readily be seen, is to throw the symphysis pubis
to one side of the mesial line of the  body, while the sacrum seems to 
DYSTOCIA.
223
be on the other side.  The consequence of this is, that the  cavity of
the pelvis will be oval, and will occupy one or the other lateral half.
  A very rare form of pelvic deformity is the funnel-shaped pelvis, in
                              Fig. 57.
K PELVIS IN WHICH THE SINKING IN OF THE ANTERO-LATERAL WALLS EXISTS ON
                            BOTH SIDES.

which, while the brim is normal, the cavity and  outlet are contracted
gradually from above downward  in all diameters.

                              Fig. 58.
A FIGURE TAKEN FROM M. NAEGELE'S WORK, WHICH EXHIBITS THE CHARACTERS
            OF THE OBLIQUE-OVAL PELVIS IN A HIGH DEGREE.

  The influence of these deformities on the pregnant state is rather un-
favorable, from the fact that in the latter half of pregnancy the gravid
uterus is not so easily and safely supported, and  in the  earlier period
it is often  more  easily displaced, or it  more slowly rises above the
superior strait.  These  and other similar circumstances have a con-
stant tendency to  produce abortion or premature labor.
  It is of the  utmost importance that distortion of the  pelvis be de- 
224                         dystocia.
tected as early as possible.   Naegele" gives the following conditions as
presumptive evidence of the existence of malformation: " The lower
jaw projects  beyond the upper, the chin is very prominent, the teeth
are grooved  transversely, unhealthy appearance,  ashy-pale color of
the face, diminutive stature, unsteady gait; when the woman walks
the chest is held  back, the abdomen projects, and  the  arms hang  be-
hind;  there  is deformity of the  spine and breast, one hip is higher
than the other, the joints of the hands and feet are remarkably thick;
curvature of  the extremities, especially the inferior, even without dis-
tortion of the spine, is a very important sign; wherever the lower ex-
tremities are curved  the pelvis  is mostly  deformed.   It is well to
ascertain also if, when  a child, it was a long  time  before she could
walk alone;  whether she had any fall on the  sacrum; whether, as a .
girl, she was  made to carry heavy weights  or to work in manufac-
tories."
   If, in  making an examination  per vaginam, the top of the sacrum
can be reached with the index  finger, there  is good reason for believ-
ing that there is  deformity  at the brim of the pelvis;  which may be
the case elsewhere, however.  But it does not follow that because the
top of the sacrum cannot be thus reached there is no  deformity.   If
the deformity exist at the brim, and is great,  the foetal head cannot
engage  in the  inferior strait; but the brim may  be normal  and the
deformity may exist in the cavity, in which case the head may enter
the cavity and be unable to proceed farther ; or, again, the outlet alone
may be deformed, in which  case it  is obvious  that the head  may de-
scend to the  outlet, and then remain  fixed until  extricated  through
mechanical measures.
   In  regard  to deformity at the brim, Dr. Rigby writes: "Besides
the general  appearance of  the patient, we frequently find that the
uterine contractions are very irregular; that they have but little effect
in dilating the os uteri; the head  does not  descend  against it,  but
remains  high up; it shows  no disposition to enter the pelvic cavity,
and rests upon the  symphysis pubis, against which  it presses very
firmly, being pushed forward by  the promontory of the sacrum."
   A great variety of circumstances are to be taken into consideration
in regard to  the course to  be pursued by  the accoucheur where he
meets with pelvic deformities  during  labor;  for  it must be evident
that unaided  nature  is able  to do very much more in some cases than
in others; and in addition  to this, the period  of pregnancy at which
labor takes place, the size of the child's  head, its  compressibility  and
its degree of  ossification, the presentation, etc.,  should  all receive due 
DYSTOCIA.
225
consideration before resorting to  any measures  to  effect delivery by
artificial means.  It is a good rule, and one that holds good in a very
laro-e  majority of cases of this kind, to give  nature a fair chance to
effect  expulsion  unaided.   At the same  time it should be borne in
mind  that there  is great danger in waiting until symptoms either of
exhaustion of the vital forces or of powerless labor  have shown them-
selves.  The mode of treatment where cases of deformity occur does
not differ in the first stage from that pursued in the case of well-formed
women.  Where the os uteri is  sufficiently dilated or dilatable, so as
to permit the escape  of the  head, the experienced accoucheur, by a
careful comparison  of the presenting part with the passage, will be
able to decide on  the possibility of a spontaneous delivery.  When
the vertex presents itself, sufficient time  should be allowed  for its
engagement, descent and final expulsion.  The contractions  should
be supported by means of such remedies as the  case may seem to
require.  But should  no advancement be perceptible, the forceps may
be applied  and extraction effected  if possible; but if there is  no
reasonable hope of delivery by this means, craniotomy must be re-
sorted to.  And should  the distortion of the pelvis be so  great that
even  craniotomy would not avail, the Cesarean  section must of neces-
sity be resorted  to.
   When the pelvic extremity presents, the  same  rules  apply as in
 natural labor; but if the deformity is too great to allow a  sponta-
 neous expulsion, the  blunt-hook must  be used, as hereafter to be
 described.   When  the body is  in the act of being delivered, intro-
 duce as soon as  possible  the index finger into the mouth of the child,
 and force the chin down upon the sternum as much as possible whilst
 traction  is  being made upon the shoulders.   In this way the  longest
 diameter of the head will be made to  occupy the shortest possible
 space in the pelvis.   If then it is not found possible to deliver the
 head, the forceps must be applied.
   When the face presents an effort should  be made to convert it  into
 a vertex presentation, as described hereafter; and  then, if necessary,
 apply the forceps.  Every effort should  be made to change the  face
 presentation to  one of the vertex, as it would greatly increase the
 chance of the child's  life, afford  relief to  the mother and  contribute
 to our satisfaction.
   When the child  presents by the trunk, an effort should  always be
 made to convert this into a presentation of the  vertex;  and if we
 discover that one part of the deformed  cavity is  broader  than  any
 other, the occipital diameter should be directed to that part as much
        15 
226
DYSTOCIA.
as possible.  If the labor has already continued so long as to make
it  impossible  to  bring the vertex into the superior strait, the foot
must be seized  and the  malpresentation  converted into one of the
breech, when we may proceed as in all breech presentations.
   It may be stated in  general terms that if there be an antero-poste-
rior diameter of not less than three and one-fourth inches, the forcepg
mayT be  successfully used.  If this diameter, however, should  be less
than the above, the forceps would not be likely to avail, and if it should
be very much less, their use would be altogether out of the question.
With an  antero-posterior diameter  ranging between three and one-
fourth inches down to two and one-half inches,  it is possible that by
turning and bringing the lower part of the wedge that the foetal head
forms—according to Sir James Simpson and Tyler Smith—down first,
the thicker part of the  head may be  extracted.   If this diameter
should be less than two and  one-half inches, but should exceed one
and three-fourths, craniotomy is available, and may be resorted to with
a good  hope of success;  but craniotomy  need  hardly be performed
with a smaller antero-posterior diameter than one and three-fourths
inches, and in such cases the  Csesarean section alone remains.  It is
to be borne in mind,  however, as before remarked, that much more
may be done  by nature in some cases  of pelvic  deformity than in
others.
   If we could secure a full knowledge of the existence and the extent
of pelvic  deformity before gestation has gone  on to the  full term, it
is obvious that a resort to the Csesarean section and craniotomy could
be prevented by inducing premature labor.
   To determine the existence and extent of pelvic deformity has led to the
invention of a great variety of instruments, termed pelvimeters, for the
purpose of measuring these deformities.  French  accoucheurs have
been especially prolific of these inventions, some of which are quite
complicated and  apparently useless.  A very simple instrument, the
invention of an English practitioner, Dr. Greenhalgh, is thus des-
cribed :  " It is intended  for  measuring internally the antero-poste-
rior  diameter at  the brim.   The principle of the  instrument is to
assist the  finger in measuring this diameter.  It consists of a band
of flexible metal one inch broad, wdiich forms a ring.  This band en-
circles the hand, passing across the centre of the  palm, the size of the
nng being adapted to different-sized hands by a piece of elastic india-
rubber webbing.   On  the surface of the band, corresponding with the
centre of the  palm  of the hand, is a projecting pivot perforated sc 
DYSTOCIA.
227
as to allow a small metal rod to traverse it.  Thfe rod is seven and a
half inches long, graduated along  its central third;  at iis distal  ex-
tremity it  is bent at right  angles  into a form which admits of its
gliding along the index or  examining finger.  It is to be thus used :
The right hand having the instrument fitted to  it, the forefinger or two
first fingers are to be introduced so as to reach  the sacral promontory.
The curved extremity of the rod  lies  now on the radial side^f the
index finger.  The promontory hiving been reached, the rod  is drawn
outward until  the ring-shaped extremity is arrested  against the arch
of the pubis.   The distance at which the rod is thus stopped is shown
in the index, and when the hand is withdrawn, the  antero-posterior
diameter of the  pelvis can be obtained by measuring the length be-
tween the  end of the finger and the extremity of the  rod."
   If the hand alone be employed, the tip of the index finger should
be  made to touch the promontory of the  sacrum, and the  distance
from that  point to the posterior surface of the pubes can be estimated,
although no very accurate measurement can be  taken in this way.  Or,
again, the index and second finger may be introduced, and while the
palmar  surface of the index finger is placed against the pubes, the
second finger may be stretched  across toward the sacral prominence
and an effort made to touch it.  Yet a third  plan is to introduce the
 four fingers within the cavity of the pelvis, and place them on a line
 between the  pubes and the  sacrum.   The  necessity  of  overlapping
 these fingers or  extending  them to fill up the space, Will give a fair
 idea of this diameter.   The greater the deformity the more  readily is
 it made out, and hence when there is great difficulty in ascertaining
 the existence and the extent of the malformation, in  skillful hands, it
 may be accepted as negative evidence of a favorable  character.

                Causes of Pelvic Deformities.
    We now pass to the causes and  mode of production of the pelvic
 deformities.   For a long time these, together with other deformities
 of the  skeleton, were referred to  a single cause—viz., rachitis—but
 modern researches have clearly proved that the pelvis may be de-
 formed in the absence of rachitis,  and from purely mechanical causes,
 operating at a time when,  on account of tender age  or feebleness of
 constitution, they could meet but little resistance.   From this view of
 the causes which produce changes in the form of the  pelvis, we might
 collect deformed pelves into three  groups—viz., (1)  Those which are
 deformed from a softening of the  bones, either by rachitis or mollifies
 ossiura;  (2)  Those deformed in consequence of a previous  deformity 
228
DYSTOCIA.
of some other part of the skeleton;  (3) Those deformed  by absolute
narrowness.
  (1) The Pelvis deformed by Rachitis or Mollities ossium.—These two
diseases,  however  differing from each other, yet produce  the  same
result—viz.,  they  soften  the  osseous tissue and thereby weaken its
power  of resistance.  But the mere  fact of softening the bones, and
their consequent weakness, is not of itself sufficient to account for the
various deformities presented  by the pelvis;  for it is very evident
that the bones, unless reduced to  a gelatinous state, would  maintain
their general conformation unless acted  on by some external  force,
for  rachitis diminishes the solidity  of the bones, but does not of
itself produce any alteration  of shape.   This exterior force may be
looked for in the  muscular action, and still oftener  in the weight of
the parts which  the pelvis has to support;  for the pelvis, interposed
between the spine which it supports and the lower extremities on which
it rests, is most favorably conditioned for  the  action of deformity.
The weight of the trunk  in its erect position being transmitted  from
the lumbar vertebra? to the heads of the femurs in the direction of
two lines intersecting the sides of the superior strait, evidently tends
to increase the  curvature of the posterior  part  of the ilium, and to
depress the osseous circle of the pelvic cavity.  In this way the sacrum
receives a  tendency,  by almost insensible degrees, to  push forward.
By  considering the action of the pubic bones  under this pressure we
may see how if  is that the superior strait  is  oftener affected by the
contractions of the pelvis than other parts, and  why at this strait the
antero-posterior and  oblique  diameters and the sacro-cotyloid inter-
vals are more frequently  contracted than the transverse ones.
  When the  weight acts  more particularly on one side of the pelvis,
the collapse is  more  marked in that direction,  because in this case a
change in the centre of gravity takes place from  the inclination of the
spine;  and there is also a very unequal pressure of the weight of the
body on the two sides of  the pelvis, where, on account of  a difference
of length in the lower extremities,  one  of the  coxal bones is more
depressed than the other.   In this way the acetabulum of one side is
thrown almost directly under the sacrum, and at the same time receives
the weight very obliquely.  The customary attitude of the individual
and the nature of  her occupations must be taken into account in con-
sidering the irregularity of figure in the pelvis.
  Sometimes there is a complete fusion of the sacrum and ilium, and
the sacro-iliac  articulation on the contracted side disappears.   We
simply state this fact without attempting  any explanation of it. 
DYSTOCIA.                         229
  In estimating the respective influences of mollities ossium and rachi-
tis on the bony tissue, the distinctive characteristics of each should be
carefully noted.   Mollities ossium affects all  parts  of the skeleton
indifferently,  and  it occurs in the adult only.  The softening pro-
duced by this disease is very distinctly marked, and the most consid-
erable retractions  must be  referred to it.  Rachitis affects the bones
of the lower extremities and ascends gradually to the upper parts;  it
proceeds from below upward, so that a  deformity  of any part  by
rachitis  almost necessarily implies a deformity below.  It is peculiar
to infancy, and its effects on the skeleton  are twofold—it softens the
bones and it arrests their development; and as this arrest of develop-
ment particularly affects the  lower extremities, it is a  necessary con-
sequence that the ossa innominata should be much less developed in
those ^subject  to this disease than in others,  and the limits  of the
pelvic cavity  more or less contracted by it.
   It is here that we may see the difference again between rachitis and
mollities ossium, or rachitis adultorum, as it is sometimes called; for
the first, exerting its influence at an early age of the patient, at a period
when the pelvis has not yet reached its full development, permanently
arrests  the growth of this part of the skeleton; but the last, not
occurring until  after puberty, at a time  when  the  ossa  innominata
have reached their full development, may soften the  bones, but can-
not arrest their growth.  Moreover, the development and growth of
the bones of  the skeleton are not only arrested absolutely by rachitis,
but their growth is retarded, even after a cure has been effected, dur-
ing the whole term of development.
   (2) The Pelvis deformed in consequence of a previous Deformity of some
other part of  the Skeleton.—These deformities are:
   (a) Deviations of the Vertebral Column.—Rachitis  is not the only
cause of this  deformity.  It is now admitted  that several other dis-
eases may produce abnormal  curvatures  in this column.   It  is thus
we establish  a  line  of  distinction between  those  deviations  which
nearly  always attend pelvic  malformations and  those  which  often
exist when the pelvis is well  formed.  The former must be referred
to rachitis, the latter to some other affection.   The shape and direc-
tion of the pelvis  are subject to  the influences of other deviations of
the spine  than those which depend on rickets, but it is only in sub-
jects of an advanced age  that curvatures occurring after the age of
infancy exert an  influence of this kind.  Curvatures produced by
 rickets, even when not the essential  cause of deformity in the pelvis,
 heighten the degree of contraction and affect the shape of the pelvis. 
230                         DYSTOCIA.
 The aged and the young are alike affected by the  spinal deviation,
 but the effects are brought about more rapidly with the young thau
 with the old.   The  malformation is more or  less similar to that de-
 scribed under the name of the oblique oval pelvis.
   (b)  Congenital Luxations.—These may cause an arrest of develop-
 ment and subsequent pelvic deformity.
   (c) Non-congenital Luxations.—A luxation  remaining  unreduced,
 and which occurred early in life, is  sufficient cause for an atrophy of
 the iliac bone corresponding to the dislocated femur ; and it is evident
 that the malformation of the pelvis will  be proportionately great as
 the luxation occurred at an early age.
   (d) Lesions  of the Inferior  Extremities.—The  curvatures  of the
 lower  limbs do not always diminish in length equally, and the pres-
 sure which they make on the bottom of the cotyloid cavities is not the
 same for 'both  sides; the consequence of this is that the pelvis may
 be affected on that side where the pressure is the greater.  The  lower
 extremities may often be curved without injury to the pelvis, provided
 they maintain the same length, and  where they are unequal in length
 there must result pelvic deformity.
   The pelvis may be deformed  by a shortening of  one of the legs from
 any cause, particularly if the accident occur in early  life, when the
 pelvis  is  but  partially  developed.   Where  one leg  is  affected with
 chronic disease, and the person is obliged to use crutches, bearing the
 whole  length  of  the body on one  leg, or where  the thigh has been
 amputated in early childhood, the pelvis  is in either case liable to
 deformity.
   (3) Pelvis Deformed by Absolute Narrowness.—The most generally
 accepted opinion  on  this topic is,  " that we have no positive data con-
 cerning the causes that give rise  to  the  general narrowing of the
 pelvis;  and that  such pelves, as well as unusually large ones, should
 rather be considered as a freak  of nature, belonging to the same cate-
 gory as a want of proportion in the head, which  is not unfrequently
 found too large or too small relatively to the rest  of the body."
  The practitioner of homoeopathy should bear in mind, in consider-
 ing these various pelvic deformities and their proximate or remote
causes, that a majority of them  commence very early in life—some of
them perhaps even before birth—and  that they are due to a morbific
influence which lies even beyond the apparent causa occasionalis, per-
haps beyond our ken.  But, taking into consideration the gravity of
these cases on the  one hand, and the wonderful efficacy of homoeopathic
medicine on the other, it becomes a solemn  duty  of  the practitioner, 
DYSTOCIA.
231
in treating  such cases in infancy or childhood, to spare no efforts to
bring about a complete effacement of the dyscrasia, if such it be, that
has given rise to the abnormal manifestation, as well as a removal
of that  local manifestation itself.   The so called " antipsorica"  of
Hahnemann act with a benignity almost divine in the various  forms
of scrofula, and by affecting a radical cure through their instrument-
ality in these .cases, not  only is present good done, but prospective
suffering and even death in childbed may be averted.

Dystocia  from  Malformation's of   the   Vulva,  Vagina
                         and  Uterus.
   Adhesions of the vulva may occur, hindering the expulsion of the
child.  In  a case of  this kind  it  is only necessary to  divide  the
adhering portion with the scalpel at the moment that the presenting
part is pressing down upon the  adhesion, if the pressure of the pre-
senting part is not of  itself sufficient to break up the  adhesion.
   The hymen also may be so persistent as to hinder the  expulsion;
this also should be divided with the  scalpel if it does not give way
under the repeated manual examinations or from the pressure of the
presenting part.
   Contractions and  rigidity of  the vulva quite 'frequently  delay  the
expulsion very much,  but I have never  found it necessary to operate
in cases of this kind.  Aconite  most usually, or some other remedy,
has aided the dilatation, and a little patience has always sufficed, and
I believe always will suffice, in such cases.
   Rigid perineum.—Remarkable cases of resistance on the part of the
perineum are met with  when  the labor   has  been much delayed.
Aconite  or  some other remedy has invariably supported the contrac-
tions and aided in the dilatation, and the delivery has been satisfac-
torily accomplished.    In some cases the whole perineum has appeared
to fit in such a manner the child's head, and to sink down so low, that
it  has been found necessary to apply the forceps  and simply lift the
head directly out of the little sulcus it has  seemed to make for itself
there.
  There may be cases, however, in which  interference would be  ab-
solutely required  to  admit of expulsion of the head taking  place
without laceration of the perineum.  It has recently been advised to
make small  incisions a little on either side  of the median line, upon
the principle that an incised wound will  heal more readily and nicely
than a laceration will.  It is barely possible that such a procedure
might be necessary.   If the perineum be properly supported, and the 
232
DYSTOCIA.
downward pressure of the head be thereby delayed somewhat, it will
be found  that the perineum will yield gradually and the danger of
laceration will be averted.
  The vagina may be found malformed or adherent, or the hymen may
be double or triple, and thrown across high up in the vagina; or there
may be a  complete septum in the vagina.  These cases should all be
treated  with  the knife  if necessary, and according to  circumstances
present; these will indicate the proper treatment.
   Vaginal cicatrices offer a  formidable bar to  the progress of labor.
These may exist from previous disease of the vagina or in consequence
of operations performed thereon.  They are hard and unyielding, and
seldom give way to the pressure of the head. If their existence is known
prior to labor, they may be relieved by the use of sponge tents, etc.,
but during labor, if they exist in any degree,  recourse must  be had
to the knife.   The knife should be well guarded, and should  only be
used on such parts as are on the stretch during a pain, and but little
cutting at a time should be done.   It  may be necessary finally to use
the forceps to effect delivery.
   Inversion of the vagina  sometimes takes place during labor, when
the protruding portion from prolonged pressure becomes gangrenous.
When  this is likely .to occur, the forceps should be used at once and
the expulsion accomplished.  When this condition  is apprehended
or observed in  its incipiency, the  accident can  be averted by  care-
fully crowding  the descending parts  back continually as the labor
progresses.
   QZdema of the labia  and  nymphce,  so  far as  my experience  goes,
presents  no formidable obstruction to the progress of  parturition.
Patience and  the administration  of remedies  will   assist the work
of nature, and surgical interference will not be required.   The  parts
are liable to  become  inflamed  and  slough  if puncturing  be re-
sorted to.
   Tumors are also liable to obstruct the passage, so as to cause great
and  even fatal  delay.  These may be osseous tumors  or they may
belong to  the soft parts.
  Exostoses may exist, and form some of the most formidable obstacles
to a safe delivery.  These usually arise from the anterior face of the
sacrum, sometimes from the ischium and the  pubes.  They  may be
recognized by hardness, immobility, roughness  and adherence to the
bone.  These  forms  of tumor continue to grow in size from  year to
year, and  consequently to become more and more formidable at every
successive pregnancy, unless cured by the proper homoeopathic reme- 
^
                           DYSTOCIA.                         233

dies.  The only plan of treatment is that to be  pursued in deformed
pelvis.
  Osteosarcoma is another type of malformation, quite similar to the
one just mentioned.  The only difference is that it is somewhat com-
pressible, a mixture of the osseous, fibrous and  cartilaginous  matter.
Even the  osseous crepitation can be felt on pressure.  The plan of
treatment  is the same as that in the last case.  Fortunately, the exist-
ence of both these forms of  tumors is of rare occurrence.
  Other bony formations are sometimes met with in the pelvic cavity,
obstructing  the  progress of labor.  These  arise from the imperfect
coaptation of fractured  bones, or from  the  head of the femur being
forced in  upon  the acetabulum.   If the resistance offered by these
should be very great, the plan of delivery  must be conducted  as  in
similar cases of pelvic deformity.
   Sanguineous tumors sometimes form in the soft parts—in the labia,
among the muscles of the pelvis, or even in the neck and  lips of the
 uterus.  If the size of these  tumors increase  gradually, the case should
 be treated by the administration  of aconite, hammamelis,  erigeron  or
 any other remedy strongly indicated by characteristic symptoms, which
 will then  be sure to arrest the difficulty and facilitate parturition.
    Various other  tumors are found in  and about the track which the
 child must  pursue in its passage to the light of day;  many of which
 need no  attention during parturition if they are not obstacles to the
 expulsion of the child; if  they are, they may need to be punctured,
 incised or  removed,  as the nature of the  case may  indicate.   It  is
 always best to wait and allow Nature to do her own work, if possible.
 Many of these tumors  are  not discovered until the hour of parturi-
 tion arrives, and note should be made of them and the proper treatment
 resorted to  after the lying-in period has passed.
    Ovarian tumors sometimes offer a very serious obstacle to parturition,
 and at other times do not.  Numerous cases  are recorded in which
 labor occurred  naturally, the tumor occasioning  no  serious  accident
 either to mother or child.   If their presence is detected  early in the
 first stage of labor, and the size  be not too great, the tumor  may be
 pushed up  above the brim  of the pelvis, and kept there until the head
 engages in  the superior strait.  Under such circumstances labor may
 terminate naturally and  without  further trouble.   Or if this cannot
 be done,  and the size of the tumor admits, it may be pushed to one
 side and  the forceps applied to the head.   If the tumor contain fluid,
 a  trocar  and canula may  be pushed  into it through the vagina  or
 rectum,  and the fluid  contents drawn off.  If the tumor should  be 
234
DYSTOCIA.
large, however, and the above methods should  fail, craniotomy o±  die
Csesarcan section will have to be performed.  Sometimes, though rarely,
the soft character of these tumors allows of their giving to the pressure
of the foetal head in its descent, and labor is terminated  without diffi-
culty.  Mr. Spencer Wells writes, in the Obstetrical Transactions:  "I
know one woman who during the slow progress of an enlarging ovarian
cyst, has gone through five pregnancies, has borne five living children
without unusual difficulty,  and has never yet had the cyst tapped, nor
has labor ever been prematurely or artificially induced. . . .  Another
patient, upon whom I performed ovariotomy with success in the fourth
month of pregnancy, after rupture of the  cyst and peritonitis, had
borne  six living children during  the progress of the cyst before  its
rupture."  These cases are of  course to be regarded as exceptional.
  Polypi and  other uterine growths are sometimes  found obstructing
labor.  They are usually recognizable by their pyriform shape, and
are generally found attached to  the os or cervix  by a pedicle.  The
safest and simplest course  to be pursued  in such cases  is to remove
the growth.  This may be done  by  torsion if the polypus  and  its
pedicle be not too large,  or a ligature may be thrown around  the
pedicle and secured, and the growth removed with scissors; or again,
the ecraseur may  be  used  and the polypus removed at once.  The
hemorrhage is not usually great.
THIS FIGURE, TAKEN FROM RAMSBOTHAM S WORK, SHOWS THE SITUATION OF THF
      POLYPUS PRESSED DOWN BY THE ADVANCING HEAD IN PARTURITION.

  Ramsbotham  mentions what he  terms scirrhous glands  as a cause
of obstructed ^abor.  They are found  in the hollow of the sacrum,
and are to be recognized  by " their situation, irregularity and hard-
ness; by  their being very sensitive; by their  forming a chain  of
indurated tubercles, external to the vaginal coats; and by their being
more or  less firmly attached to the surrounding structures."  They 
DYSTOCIA.
235
are not likely to form any serious obstruction, and snould they do so
may  be pushed out of the way, or the forceps may be applied.
  Abscesses situated within the pelvis may likewise obstruct the descent
of the foetal hea/1 and retard labor.   The evacuation of their contents
might be necessary.
  Accumulations  of feces in the  rectum  may sometimes seem a very
formidable  obstruction to labor, but an injection or two of tepid
water soon  dissipates them.   Sometimes, however, it is  necessary to
use a scoop or spoon.
   Vaginal hernia, which consists in the descent of a portion  of the in-
testine into the cul-de-sac behind the uterus, is mentioned by  Churchill
as a  cause of delay during parturition.  If it be possible, it should
be pressed up above the brim of the pelvis; long-continued pressure
upon the  intestine should not be allowed, however, if this  cannot be
done, and the forceps should be  promptly resorted to to effect a speedy
delivery.
   Over-distension of the bladder may usually be remedied by the catheter,
and when it is prolapsed  it must be crowded up into its place.  If
stone, in the  bladder exists, an effort should be made to push it up out
of the way  should  it prove an obstacle  to  labor.   This  may be done
with greater facility in the early stage of labor, before the child's head
has  advanced.  If this  should  not  succeed, the  choice will then lie
between vaginal lithotomy and  craniotomy.
   Vesical hernia, or cystocele, is occasionally found during  labor.   It
 gives rise to great  suffering if the  bladder is full of urine, and the
                               Fig. 60.
             VAGINAL CYSTOCELE, TAKEN FROM RAMSBOTHAM.

pressure of the child's head may occasion its rupture, with fatal results.
The male catheter must be introduced at once, and after the urine has
been discharged  the  bladder must be crowded up  into its place, and
kept there until  the  head descends and forms a support for it.  The 
236
DYSTOCIA.
tumor will be found posterior to the pubes, fluctuating and free except
at its pubic side, and the os  uteri will be found above, in its natural
place.   The introduction of the catheter makes the case cle*ar  and
unmistakable.  Its correct diagnosis is important.

     Dystocia  from Morbid  Conditions of the Uterus.
   Tumors  of the Neck and Body of  the Uterus.—If encysted tumors
prove an obstruction to delivery, they may be punctured and the con-
tents  drawn off, or if they  contain  cheesy matter an incision will
allow it to pass out, especially from the pressure during a pain.  But
unless their size prevent the expulsion of the child they need not be
interfered with.
   Pedunculated fibrous tumors, or polypi, have already been treated of.
(See page 234.)
   Cauliflower Excrescences.—These cancerous or syphilitic  growths
seldom cause delay, unless their  size is very considerable.   But when
they are large the condition is much more serious.  Several cases are
quoted by Cazeaux from  Puchelt: " In one it was necessary to make
incisions upon  another part of the hard or  scirrhous neck, so as to
secure the  introduction of the hand;  and in  a second, to  remove the
tumor that was attached to the anterior lip and occupied all the vagina
by the scissors;  gastrotomy was resorted to  in a third, on account of
a rupture of the womb, and not even the child was saved ; in another,
the extraction of the  child was  impossible, notwithstanding the per-
foration of the  cranium,  and the woman died before delivery.  Only
a single mother survived."  As  these fungous  growths are  liable to
bleed freely, they may be mistaken for placenta prcevia.
   Carcinoma Uteri.—In  this complication  much depends on whether
the child be alive or dead.   The mother has a necessarily fatal dis-
ease, and if the child be living all care should be bestowed upon pre-
serving  its life; although the mother should be spared from suffering.
Either incisions should be made  into  the os,  turning may  be resorted
to, or the forceps may be applied.  In case the child should be dead,
the mother may be saved much  suffering by resorting to  craniotomy
or other procedure to  reduce  the size of the head.

      Other Abnormal Conditions of the Uterus affecting Labor.
   Rigidity of the Os Uteri.—When this exists it may offer a formidable
bar to the progress of parturition if not removed by proper treatment.
It occurs more frequently in primiparse than in multipara?.   The orifice
becomes dilated to a certain  limited  extent,  and beyond that it does 
DYSTOCIA.
237
not yield, notwithstanding the continuance of the proper pains;  and
hence the  strength of the patient becomes gradually exhausted  and
untoward symptoms set in.   It usually depends upon some functional
derano-ement inducing a spasmodic action, but it may be due to organic
lesions of  the cervical tissues.   In the latter  case the measures to be
resorted to have already been  pointed out.   Incisions will probably
be required, which may be made by  using a probe-pointed bistoury
carefully guarded by the fingers from injuring  the surrounding tis-
sues;  and  if after these have been made, if dilatation does not progress,
india-rubber dilating bags may be used to effect it.   But in the ordi-
nary form of rigid os arising from some functional disturbance, homce-
opathv furnishes a certain relief, and the measures  resorted to by the
old school of practice—such as bleeding, opium, chloroform and topi-
cal applications—are rendered altogether unnecessary.  The properly-
selected homoeopathic medicine  restores  order to the disordered  sys-
tem, the parts are relaxed and softened,  dilatation proceeds as usual,
and  a happy termination to the labor is the reward.  The remedies
called for  in such cases will be laid  down in  a subsequent  chapter of
this volume, in treating of the therapeutics of Labor.
   Obliquity of the uterus would  throw the  orifice of the neck to one
side of the axis of the pelvis—either too far posteriorly, anteriorly or
yet to the right or to the left laterally.  In such cases the first and possi-
bly the only thing the accoucheur has to do is to wait patiently on the
operations of nature.   Should it be evident that parturition will not
be accomplished unaided, the woman  should  be subjected to "perfect
rest on the back when the obliquity is anterior, or on the side opposite
to the one occupied by the fundus uteri when  it is  lateral, and the
employment of the  hands to support and maintain the deviated organ,
or of a large bandage properly applied  to  produce the same effect.
The patient should be advised not to bear down until after the dis-
placement is  remedied.   If these means are not sufficient, it will be
necessary while thus operating externally on the body to act at the same
time  on the neck, for that purpose  introducing two fingers into the
uterine orifice and taking advantage of an  interval between the pains
to draw it gently toward the centre of the pelvis, while the  other hand
is employed in pressing the fundus of the organ in the opposite direc-
tion."—Cazeaux.  In the posterior obliquity the woman ought to re-
main seated or standing, or, if possible, even inclining a little forward.
   Agglutination of the external uterine orifice sometimes occurs, even
at the hour of labor.   Such a state will  be recognized by feeling the
outlines of the lips apparently covered over by a thin membrane. 
238
DYSTOCIA.
 At every contraction the line  of demarcation between the lips will
 become more and more apparent, and allow the thin membrane  to
 sink a little  between the lips.   Now during a pain the thinnest and
 most yielding spot must be found out, and the finger forced without
 much violence through the membrane.  If the finger is not sufficient,
 a more potent agent  must be used, great care being taken not to wound
 the child or the mother needlessly.
   Tlie swelling and elongation of the anterior Up is  a frequent cause of
 delay in  labor.   The  anterior lip from some cause  may  not dilate.
 Tt may swell  and become paralyzed, and hang down upon the head of
 the child, whilst  the posterior lip kindly dilates,  and the  presenting
 part is ready  to pass  through but for the stubbornness of the anterior
 lip.  Great and often immediate relief is obtained  by pushing up with
 the finger this anterior lip, and holding it firmly,  and even crowding
 it  up farther during a pain.  It then slips up sooner or later above
 the head, and the distress  of  the patient is  relieved and the labor
 progresses  finely  to its completion.  It will sometimes be  difficult to
 distinguish between  the elongated or swollen lip and a fold of the
 vagina.   In  some cases we may find both.   The  uterine lip will be
 found hard and unyielding, while the vaginal fold is soft and pliable.
 In these cases the fold of the vagina must be pushed up first, and  kept
 up as well as possible  out of the way.  Then the  uterine lip can be
 made to  follow more readily.  Sometimes considerable time will be
 expended in making these manipulations.
  Induration and hypertrophy of both lips are found in some cases,
 when the distress of the patient during labor will furnish  the symp-
 toms necessary for the  indication of  the remedy which will effect the
desired dilatation. Incisions may have to be resorted to.
   Complete obliteration of the cervix uteri, it is admitted by all medical
writers at the present day, does sometimes occur.  Of course no os,
in this case,  can be found by exploring in  any  direction far back
 toward the promontory of the sacrum and in other  directions;  but
 much care is  necessary here, for sometimes it is found at an  incredibly
distant point toward the promontory of the sacrum.   When  not the
faintest line of demarcation of an os can  be  discovered, one must be
 made at the lowest or most pendant point of the uterus.
  Hernia of the womb, it is admitted, sometimes  takes place by the
 inguinal  or crural rings becoming  so  much  dilated  as to allow the
escape of the  uterus.   Pregnancy may continue to the full term, when
a reasonable  time should be allowed for spontaneous  delivery, but it
 is most likely that a  Coesarean section will be found necessary. 
DYSTOCIA,
239
  A prolapsed womb may become pregnant, or the womb may pro-
lapse suddenly after conception, and the full term be accomplished;
a slow and difficult labor will result, but it may take place fairly, and
the uterus return to its place.

           Rupture of the Uterus and Vagina.
  Rupture of the uterus  is one of the most  serious complications  or
accidents which  can possibly occur during  the puerperal state.  It
may occur  at any time during labor,  but is  much  more frequent
in the  latter  stage than in the former.   Primiparae  are  much less
liable to the accident than multiparas.   It may occur in the body or
in the neck:  when it occurs in the neck, it almost always involves
a rupture of the vagina also.  The entire  thickness of  the uterine
parietes may  be  ruptured, which  is the most common  form; or the
peritoneum may  not be involved; or again, the peritoneum may alone
be torn.
   The  cause  of  so unfortunate an accident may be referred to many
circumstances: great thinness, a softening or a diseased  condition  of
the walls, mechanical injuries, the administration of  ergot, or too
violent contractions may all  be enumerated among the circumstances,
especially too violent contractions with an undilated os.
   When this accident occurs, a sharp, tearing  pain is  felt, and that
so  suddenly and severely as to cause the  patient to scream out with
great force.   Sometimes  the patient will  complain  of something
having given way, followed  by a cessation  of uterine action.   Cold
and clammy  sweats break out, the pulse is very small and quick, the
presenting part of the child recedes beyond the reach of the hand, and
if it escapes  into the abdominal cavity,  it can be felt through the ab-
dominal  walls.   Collapse sets in, and there  may be convulsions;
 vomiting follows; breathing becomes quick and labored, the  pulse
 more accelerated; and unless reaction sets in, death shortly  occurs from
 collapse.  Hemorrhage  to a greater or less extent always occurs.
   " Of all  these symptoms, the peculiar sharp and sudden pain, the
 cessation of all uterine action, the recession of the child, and the being
 able to feel it easily by  the abdominal wall, the  hemorrhage and the
 collapse,—these  together make up a total which are almost certainly
 indicative of ruptured uterus.  Of course there is not only hemor-
 rhage  per  vaginam, but a good deal of blood  may also  escape into
 the peritoneal cavity—so much, indeed, that this  alone causes death
 in some cases "—Meadows.
   When this accident occurs at an early stage of gestation, before the 
240
DYSTOCIA.
 uterus contains much to be discharged through the rent, the product
 of conception may dam up the  passage  and cause the contents of the
 uterus to be retained for some days; so that when  a reaction ensues
 after the first shock, a calm precedes a more violent set of symptoms
 after the final escape of the product of  conception  into the cavity of
 the  abdomen.   In the  later  months of conception the diagnosis is
 easier to be made, as described above.
  Should the patient survive the immediate consequences of a lacerated
 uterus, after some hours reaction sets in, and the symptoms of col-
 lapse are succeeded by those  of inflammation of  the peritoneum and
 womb, which is usually very severe, and consequently presents symp-
 toms of peculiar aggravation.   If this should abate without destroy-
 ing  life,  it  may  be followed by the formation of abscess or by cellu-
 litis, etc., which will probably carry the patient off.  There are cases
 on record, however, in wliich recovery has taken  place even when the
 foetus has not been delivered, but has become encysted in the abdom-
 inal  cavity.
  Terrible as this accident is, therefore, it is  evident that nature
unaided  has been able  in  some cases to overcome the tendency to
death, and  much more may be  done by proper manual and instru-
mental interference and by well-directed after-treatment.
  The first step to be thought of in cases of  this kind is, the delivery
of the  child where that is  at all practicable, for  it is to be remem-
bered that it is alive and may be born alive.   If the os be either dila-
ted or  readily dilatable, the forceps  should  be promptly resorted to
if the head  can  be reached.  But if the child has passed upward, so
that  the head cannot be reached, or if the condition of the  os contra-
indicates the use of the forceps, turning should be resorted to and the
child delivered with promptness.  It is  humane to the mother to de-
 liver the child as soon  as  possible, for her  best chance of recovery
rests on  that.   Care  must  be taken, in  effecting delivery either by
the forceps  or by version,  that no  part of the  intestines  be drawn
through  the rent  in the uterus, or that it be not allowed  to remain
thus constricted  after extraction  has  been  accomplished.  If  nei-
ther  of the above methods is applicable, then the Csesarean section
should  be   resorted to.   This operation has been successfully per-
formed  and the mother has  recovered  even under such unfavorable
circumstances.
  During the condition of  collapse, the use  of stimulants is perfectly
admissible  and  perhaps necessary.  The after-effects will be all the
 more successfully combated  by a strict adherence  to  homoeopathic 
DYSTOCIA.
241
medication.   (See  the remedies  under  Puerperal  Fever, Metritis,
etc.)
  Rupture of the vagina may likewise take place independent of any
laceration of the uterus.  A similar condition prevails in all respects
as in rupture of the uterus, except that the pain is not so severe and
other symptoms may not be  so intense.  The treatment to be pursued
is similar to that recommended in case of rupture of the uterus.

                  Rupture of  the Bladder.
  This can only occur from injudicious management, culpable neglect
or ignorance.  The laceration may take place either upon the perito-
neal or the vaginal side of the viscus.  In the  former case, urine  is
extravasated  into the peritoneal  cavity, and  violent inflammation  is
induced which  may destroy  life.  In the latter case, while the imme-
diate effects  are not so serious, yet the consequence, in the shape of a
vesico-vaginal fistula, is very severe and distressing.
  The evidences of rupture of the bladder will be similar in many
respects to those of rupture of the uterus or vagina, but there will be
little or  no  hemorrhage per vaginam;  uterine contractions will be
continued, the presenting part of  the child and the uterine os will be
found in their proper places, and the evidence of the child having
escaped into the abdominal cavity will be wanting.
   This possibility of rupture of  the bladder  may be  averted  if the
aqcoucheur sees to it that during a protracted  labor  the  bladder  is
properly evacuated.  Should the natural  efforts of the woman fail of
accomplishing this, the catheter should be used.  If the accident does
happen, however, from any cause whatever, delivery should be effected
by  the forceps or by turning, unless it be apparent that the child will
soon be born without mechanical  assistance.  If urine is poured into
the peritoneal cavity,  the resulting  inflammation should be  treated
according to the general principles of homoeopathic-practice, and may
thereby  be  successfully  combated.   Should vesico-vaginal  fistula
result, on the contrary, the  niceties  of the surgeon's art  will be re-
quired to relieve the suffering woman from  her horrible situation.

               Laceration of the Perineum.
   Laceration of the  perineum is  more liable to occur in primiparse
than in women who have already borne children.  The extent of tha
injury varies  a great deal.   It may be a mere nick in the anterior
thin border of the perineum, may extend from the fourchette to the
sphincter ani, or may involve the sphincter and in some cases the entire
    16 
242
DYSTOCIA.
 recto-vaginal septum.  Again, the anterior part of the ptrineum may
 remain intact, and perforation of the  perineum take  place, the child
 being actually driven through the perineum from mal-direction of
 the  uterine expulsive force,  from disease of the perineal tissues or
 from deformity of the pelvic outlet.
   Sometimes the perineum is preternaturally broad, and in such cases
 the head pressing downward forcibly distends it in every direction, and
 becomes,  as it were, invested by a perineal  cap.   Laceration or per-
 foration will be pretty sure to take place unless the head be lifted out
 of the investing perineum by means of the vectis or blade of the for-
 ceps and  supported thereby, care being taken that no pressure is made
 on the perineum by the instrument, the hand of the operator  serving
 as a fulcrum for the lever.   Laceration of  the perineum may be caused
 by too speedy delivery, by rigidity of the perineum itself, by narrow-
 ing of the pubic arch, or by the use of instruments to effect delivery.
 It may also be  occasioned by degeneration of the tissues of the peri-
 neum, or  by the woman straightening  herself out at the last  moment
 when the head is emerging from the  vulva.
   The  treatment of ordinary cases  of lacerated perineum, when the
 sphincter ani is not involved, is very simple.   Indeed, the  natural
 restoration of the parts after labor will reduce what at first appeared
 to be a formidable laceration to a very insignificant one.  Rest upon
 the back  for  a number of days,  and  keeping the  limbs in  constant
 apposition,  combined with perfect cleanliness, will  suffice to restore
 these simple  cases.   It may be necessary to  draw off  the  urine with
 a catheter, but as the bowels are  not generally moved  until the ninth
 day, fecal matter is not likely to disturb the healing of the wound.
   The  more  serious cases  require surgical interference.   The torn
 surfaces are to  be coaptated  and held in place by sutures—quilled,
 interrupted or twisted  sutures, as may be selected—and perfect rest
 enjoined.   The operation should be performed immediately after labor,
 for obvious reasons.
  No serious  case of laceration of the perineum  should be neglected
 by the accoucheur, as prolapsus or procidentia uteri, or non-retention
of the fecal matter,  may  give rise  to serious trouble in  after life,
unless the structures are restored to their normal condition.

   Labor Complicated by Previously  Existing Disease.
  There are certain diseases which may complicate  labor that require
special and particular attention.   Of  this kind  are Jmmoptysis and
fui'mateynesis.  In these cases the remedies must be  resorted to which 
DYSTOCIA.
243
are usually employed in treating such diseases.  As a general rule,
hemorrhages will be controlled and labor will  terminate in a regular,
natural  way.    But if we are not thus fortunate, the labor must be
terminated as soon as possible by artificial means.   In asthmas, pal-
pitation and diseases of the heart, we should be governed in our action
by the principle stated  above.   In aneurism, where there is  a great
danger  of rupture at any pain, immediate resort should be had  to
artificial means of  delivery.
   When hernia exists it should be reduced as soon as possible, and
when it is utterly impossible to reduce it, the best practice is to resort
to artificial means of delivery, in order that the hernial protrusion
may not be strangulated longer than necessary.   AVhen the hernia is
liable to  return after  reduction, it may be kept  back  by constant
pressure.  Syncope is curable by using the proper  medicines.   (See
 Therapeutics of Labor.)   When there are great exhaustion and debility,
and they  cannot be relieved by the proper medicines,  resort to arti-
ficial means for delivery.

 Labor  Complicated by Convulsions, Hemorrhage and Placenta Prcevia.
   These terrible complications of parturition are fully treated of in
 the latter or  therapeutical portion of  this volume, under the proper
 headings.

     Dystocia from Abnormal Conditions  of the  Fcetus.
   We now commence the study of those obstacles to its ready expul-
 sion  which depend  on  the foetus  and its appendages, the  passage
 being in a normal condition and  the expulsive force sufficient.
   Hydrocephalus.—Some disease of the foetus may  develop a true
 hydrocephalic  condition, in which the head  becomes  so large as to
 make it impossible for it to pass  through the cavity.  This state may
 be known from the cranial bones being separated far from each other,
 and each seems to  swim, as  it  were, in water when  pressing upon
 them;  there is also a wide suture between the bones of the cranium.
    The treatment in such cases  depends  on  circumstances.  Degen-
 eration of the foetal  head may have  occurred to the extent that it re-
 sembles a membranous bag, and under such condition it may be ex-
 pelled  without operative interference.  Such cases are of course rare.
 Again, the scalp may be ruptured and the fluid contents of the cranium
 expelled.  But should it become evident that  labor cannot be com-
 pleted  without assistance, the head should be punctured  and its con-
 tents discharged.   For this purpose  an  ordinary trocar and canula 
214                         dystocia.
or Braun's long obstetrical trephine may be  used.   The operation
should  not be delayed too long, as there is  danger of rupture of the
uterus occurring, or the pressure of the  head upon the soft parts of
the mother may give rise to very serious inflammation and sloughing.
   In some cases the  breech or inferior extremities are born first, and
a hydrocephalic head is found to be impacted either within the pelvis
or above the brim.   It would naturally be more difficult to correctly
make out the condition of the  foetal  head under such circumstances
than when the vertex presents, the neck and shoulders preventing to
some extent a free  examination.  But by patiently  forcing the finger
upward to the head the condition may be made out.  Here the trocar
may be pushed  into the base of the head with similar results.   The
instrument of Braun  will perhaps be safer and more efficient.
  Hydrothorax may exist.  This disease may be diagnosed after the
expulsion of the head or breech by the arrest of progress, by the in-
tercostal spaces being  extended, and by the  fluctuation  of water
between the ribs.
  Ascites  may  occur and arrest the further progress of the child.
When this is the case fluctuation and enormous distension solve the
mystery.   In the last two or  in similar cases the trocar is the  only
remedy.  A small trocar should be used  in these cases, as the abnor-
mal conditions are not necessarily fatal to the child.
  An emphysematous. condition  may occur when the foetus has been
long dead and  has become so distended with gas as to hinder its ex-
pulsion.  The trocar  is to be used also in this case.  Upon  using this
instrument large quantities of offensive air escape.
   Tumors  of the foetus  may  also cause a delay until the tumor is
removed if solid, or punctured if containing fluid.
  We must be on our guard  against accidents, and be duly prepared
for every exigency which may arise.
  Anchylosis of the foetal articulations has been known to exist, causing
great delay.  On the application of the forceps and making forcible
traction the child will be delivered.
  Excess of volume on the part of the child may be a cause of delay;
the volume may be so  much in excess,  indeed,  as to constitute the
child a  monster.  The application of the forceps or blunt-hook is the
remedy in cases of this kind,—that is if the vital forces are inadequate
to effect delivery.
  Multiple and adherent foetuses and other monstrosities constitute a very
formidable cause of dystocia.  We can often ascertain before the  time
of delivery the fact of the presence of two or more foetuses in utero, 
dystocia.                          245
but we cannot ascertain whether  they are separate and  independent
jntil the hour of delivery has actually come.   If two bags of water
are found to be present, it is necessary to rupture the membranes twice.
The same must be done if we have evidence of there being two distinct
gushes of liquor  amnii.   We may then  be assured that two pouches
have ruptured, and it is made certain that there are no adherent foetuses
present; for adherent children are  always  enclosed in a  single  set of
membranes, and perfect twins are seldom enclosed in a single amnion.
If, moreover, the head and feet appear at the superior strait, and par-
ticularly if we can draw upon the feet  without causing the head  to
ascend, we may be sure that there  is no adhesion.   If three or four
feet appear at the vulva at the same  time, and  on pulling at one
another moves simultaneously, but the others  remain at  rest, we may
be sure of the foetuses being detached from each other.   If all move
simultaneously, we can only ascertain this fact  to a certainty by carry-
ing the hand up into the uterus.
   In all cases, whether there is  an adhesion or  not, sufficient time
should be  allowed for nature  to operate  unaided, but efficient aid
should be rendered  the moment that there  is reason to believe it to
be called  for.   Whether the union  takes  place at  the  head or the
breech, the expulsion  takes  place, the  one after  the other, without
difficulty.   But if the  union be at the occiput and the  full term has
expired, craniotomy will probably have  to be resorted to.
   Where there are two heads to one trunk, one  head will  engage after
the other, and the body will descend subsequently.
   Where each head has its body, and the union  takes place at any point
of the trunk, one head may be born first;  the  feet belonging  to this
head may be brought down ; next the feet of the  other child may  be
brought down, and lastly the head of this same child.
   When there is but one head to two bodies, the head  may be born
first, and the two bodies simultaneously with each other.   If  the
breech of one  body comes first, the hand may be introduced and  the
feet of the other child brought down.
   But it is impossible to lay down positive rules for all the anomalies
which  may arise.  In special cases the accoucheur, in deciding on his
course, must be led by general principles.
   Multiple and independent  foetuses, twins, triplets, etc.,  are often  de-
livered one after the other, promptly and with'but  little delay, but
usually these cases are more tedious.  The child first presenting can-
not be acted on as efficiently as if there were  but one, for the uterine
contraction must force one by acting upon the other 
246
dystocia.
   Moreover, the over-distension of the uterine walls serves to weaken
the contractile powers for the first child. When the first child presents
by the breech, there is likely to be  more difficulty in the  birth of its
head on account of the remaining child's hindering the direct applica-
tion of the uterine contractions upon it.  Hence we must not overlook
the importance of introducing a finger into its mouth in order to flex
the chin upon the  chest, and make sufficient and prompt traction for a
safe delivery.   Soon after the birth of the first child, in the course of
twenty minutes, the contractions  return, feebly at first, but soon more
efficaciously, and the next child and the next are promptly expelled.
The accoucheur, as soon as one child is born, should always place his
hand on the abdomen  of the  mother, to ascertain whether others  are
present there, and  so on successively until  all the births are effected.
If another remains, the abdomen will  seem to be but a little smaller
for the expulsion of one or two:  the presence of more will be unmis-
takable to both sight and touch.  Sometimes, after one child has been
born, a rest of  some hours seems necessary before the exhausted fibres
are sufficiently  recovered to renew their contractions.  Sometimes even
days elapse before  labor is renewed.  The accoucheur should not inter-
fere in such cases  unless it  be absolutely necessary to do so.  Nature
is generally competent unaided.  All troublesome symptoms, such as
flooding, fainting,  etc.,  may be relieved by the proper homoeopathic
remedies, according to  the principles already mentioned.  If the pains
are delayed very  long, they may be reproduced  if necessary by  re-
sorting to  the  remedies referred  to under the  head of Therapeutics
of Labor.   Sometimes it may be necessary to rupture the membranes
for the passage of the second child, in order  to excite contractions,
and sometimes to  tickle the  os with the finger in  order  to excite a
reaction.
  Sometimes both heads incline to present at the same time, in which
case one must  be  pushed aside to  allow the other to descend.  The
same course must be adopted in case the breech presents.  If either
child presents by the shoulder, and version is determined  upon, great
care must  be exercised to  seize the feet of the child to be turned;
this is an  easy matter  by constantly keeping the hand on the child
whose shoulder presents.
  When  two  feet  appear at the vulva, and it  should seem advisable
to  interpose assistance, but one foot should be drawn upon, and that
very gently at first, in order  to ascertain whether the other  moves
simultaneously as belonging to the  same body; and if this is found
not to be the case, every effort should  be  made to return that which 
dystocia.
247
does not.  A good and perhaps the only way to accomplish this is to
suspend the patient by the feet, at the same time holding on to a leg
of one of the children; the others would  then  return into the uterus,
to be extracted after the expulsion of  the first.
   No attempt should be made to deliver the placenta of the first child
before the second  is expelled, as hemorrhage would certainly result;
and  care should be taken that  no traction is made  upon the cord for
the same reason.
   Prolapsus of the cord is a serious complication for the child, whilst
it brings no  harm to the mother, the life of the child being alone en-
dangered : Fig. 61 exemplifies a case of this kind.  The first evidence
Fig. 61.
THE RIGHT POSTERIOR OCCIPITO-ILIAC POSITION COMPLICATED BY A FALLING OF
                            THE CORD.

which the accoucheur has of this  accident is actual  presence of the
cord with the presenting part  of  the child.  The fold of the cord
hanging may be of different lengths, simply hanging below the superior
strait or it may be six inches long or more.   If the child  is living, the
cord will be felt to  pulsate one  hundred  and twenty to one  hundred
and  forty beats a minute, and it will be felt to  be firm and like a
living tissue.  But if dead there will be no pulsation, and  the cord will
feel shriveled, soft and lifeless.
  The treatment of this complication  needs  to be very prompt, lest
the presenting part descend and cause strangulation  and consequent
death of the child.   The only plan  of safety possible is to take a piece
of wet sponge, about twice  the size of a hen's egg, and cut entirely
through its centre  a hole  large enough  to receive the fold of cord.
Then pass a string'through the loop of cord,  and next pass the  same
string through  the  sponge.   Now by  holding on to  the  string and
slipping the sponge upward the fold of cord is drawn  into the sponge. 
248
DYSTOCIA.
Slip the sponge well up, so as to secure a full introduction of this fold
into the sponge.  Then with the fingers crowd the sponge and all well
above the superior strait. The sponge will dilate and retain all above
the presenting part safely.  It may be well to be always prepared with
a small piece of sponge ready for the occasion.   If the presenting part
of the child has become so  firmly engaged in the superior strait as to
render the return of the cord impracticable, the labor should be termi-
nated either with the forceps or the blunt-hook.  Should the shoulder
present, and podalic version become necessary, the cord should be carried
up with the hand used for this purpose.  When the  breech presents, it
may become necessary to hold the sponge at the superior strait until
the part becomes so engaged  as to retain the sponge without further
effort.   A little thought and  reasoning will  enable  the accoucheur to

                              Fig. 62.
THE LEFT OCCIPITO-ILIAC POSITION STRONGLY INCLINED ON ITS POSTERIOR PARIE-
                            TAL REGION.

quickly adapt himself to any variation which may occur.  He should
always  endeavor to adapt himself quickly to circumstances as  they
arise.
  Shortness of the cord may occur as a complication, and delay the
labor very much.  It has  been known to be  not more  than  four
or five  inches  in length.  The strongest  symptoms of this state of
things are found in the  continued retraction of the child, time  after
time, after the cessation of each pain,  without any perceptible ad-
vancement.
  If this condition of the patient continues too long, so as to endanger
the welfare of the  mother or child, the aid of instruments must be
invoked.   When the presenting part has advanced so far as to expose
the cord, it should  be severed at once, about an inch and a half  from 
DYSTOCIA.
249
the child's  body.  It may be tied, or held tightly between the fingers
of an assistant, until a complete delivery takes place.   There is danger
of a rupture of the cord or of a separation of the placenta, exposing
the child and mother to a severe loss of blood before the  child is
sufficiently  far expelled to expose the cord; in this  event the treat-
ment is still the same; apply the instrument necessary for hastening
the expulsion of the child.
   Inclined position of Hie foetus constitutes another cause on the part
of the child of its tardy birth.   Fig. 62 illustrates a case of this kind.
In making an examination per vaginam, one ear, the  side of the head
and the neck are felt.  In all similar cases it is only necessary to turn
the patient so that she shall lie on the side opposite to the place where
we feel the neck of the child.  The body falls down on the same side,
and soon rectifies the inclination.
   Inclined  breech positions can be managed on the same principle, the
mother being always turned in such inclinations upon the same side
as the anus points to.

                              Fig. 63.
 THE LEFT POSTERIOR MENTO-ILIAC POSITION COMPLICATED BY A DESCENT OF
                          THE LEFT FOOT.

  Inclined facial positions should  always be  managed  in  the same
way  as  any facial presentation;  they should be  converted at once
and without  delay  into  vertex presentations,  as  will  hereafter be
described.
  Inclined positions of the trunk must also be interfered with at once,
and converted into vertex presentations or  delivered by the feet, as
directed a little farther on.
  Complicated presentations, something similar to Fig. 63,  must be
managed by the  application of general principles.
  The child is  forced  quite  closely down  into the  superior strait. 
250
OBSTETRIC OPERATIONS.
Now, it is evident the trunk cannot go back and the head be brought
down, because one foot has advanced too far.  If the feet were far-
ther up, the forceps might perhaps be  applied, and the head hi ought
down, and the cord would be less  liable to become  compressed.   All
things being considered, then, it is  very evident that the best course to
be pursued is to use a linen handkerchief as a fillet on the foot most
advanced.  An assistant should  make powerful but steady and care-
ful  traction upon it, whilst the  accoucheur steadies the uterus with
both hands placed upon the abdomen.   The labor will then terminate
in the most favorable  manner.  The  exercise of sound judgment is
called for in all these unusual conditions.
                       CHAPTER XV.

                  OBSTETRIC OPERATIONS.

                            Turning.
TTERSION,  or  turning, is that  manual operation by  which we
 »   change one presentation for another more favorable to- delivery.
It is, when carefully  performed, a great  saving of life in difficult
labors.  There are two kinds of version :  the podalic, which consists
in introducing the hand into the uterus, seizing one or both feet and
delivering by the inferior extremities ; and  the cephalic, which consists
in changing the head in such a  manner as to bring a more  favorable
part of it to present, and thus facilitate delivery.
   It is proper to be  remarked here that when the history of a given
case of parturition indicates  a probable malposition in a future preg-
nancy, the woman  should be subjected to  careful medical treatment,
with a view to curing that  abnormal condition of the system which
led to the previous difficulty. If a malposition be detected near the
close of gestation by means of auscultation or palpation, it is claimed
—and  has been often verified  by  Mercy  B.  Jackson,  M. D.—that
Pulsatilla will so affect the  uterus  or the  foetus, or both, as to bring
about a change to the normal situation of the foetus  in utero.   Con-
siderable evidence has been given as to the  truth of this assumption—
to the extent, indeed,  that a mere  negative theoretical opinion  does
not suffice to disprove  it.  It is, at all events, worthy of careful  trial. 
OBSTETRIC OPERATIONS.
251
  Podalic Versiox.—When it is deemed necessary to change the
presentation of the child by -bringing down the feet, there are certain
rules which under all circumstances must be observed :
  1.  The patient  should by all means be apprised of the nature of
her case, and  as  simply and kindly as possible be made acquainted
with the nature of the operation to be performed.   When she is once
made to understand that the  proposed operation is for her safety and
that  of her child, she will the more cheerfully submit;  her  free con-
sent must in the first place be obtained.
  2. Her  position must be upon the back, with the  breech  near the
edge of the bed, her feet  also near the edge of the bed, the thighs
flexed at right angles with her body; the head and shoulders must
be elevated to a reasonable height.
  3. The accoucheur should slip off  his coat as gently as possible, in
such a manner as  not to make a great flourish and thereby alarm his
patient.   The  hand and wrist to be  used in the operation  should be
rubbed with lard  until perfectly smooth,  that hand always to be em-
ployed whose palmar surface corresponds with  the face of the  child.
For obvious reasons care should be taken not to lubricate the palmar
surface.
  4. The os uteri must be sufficiently dilated or dilatable to  admit of
the free introduction of the hand  and the passage of the  child.  If
there is the least rigidity of the fibres, we must defer the operation a
little longer, otherwise we incur the  risk of rupturing the uterus or
of badly injuring the patient in other respects.
  5. The  introduction of  the hand can be easily effected by placing
first the fingers and then  the thumb within  the  vulva, at  the  same
time bringing  them all together into the  form of an elongated  cone.
Now press carefully, slowly and steadily from  before backward and
from  below upward, and  the hand will  enter the  vagina and soon
come in contact with the child.   Great care must be exercised in pass-
ing the  vulva and  entering  the vagina, especially in primiparas, as
this is sometimes the most painful  part of the whole operation.  The
fingers should  be straightened as the  hand passes the os externum, to
prevent the  knuckles giving  unnecessary pain,  and this may have to
be observed likewise in passing the vulva.  The palmar surface must
be spread out and kept upon the anterior surface of the child  until
we  come in contact with  one foot.  If there  is difficulty in finding
the foot, carry the hand upward  to the thigh, and then the  hand can
follow the thigh and leg along to the foot.  Having ascertained that
it i?,  really the  foot, make a  firm grasp about the ankle close down 
252
OBSTETRIC OPERATIONS.
to the foot.   If action is taken before the rupture of the membranes,
the hand  should be insinuated gently between the membranes and
the uterus, and passed upward until the foot can be felt.  The mem-
branes should then be ruptured by scratching with the nail, and the
foot  seized.   By this means we gain the advantage of having  the
foetus floating  in  liquor. amnii, for that  fluid  cannot  escape  in any
quantity when  ruptured in this way.  Care  should  be  taken that the
membranes  are not ruptured  prematurely.   All  this  stage  can be
accomplished from time to time  during the intervals  of the pains.
During each pain the hand should remain  perfectly  quiescent and
Fig. 64.                               Fig. 65.
  Fig. 64. In tl'iis the head has been pushed up into the left iliac fossa, and one
aand takes hold of the foot while the other supports the organ externally.
  Fig. 65. The same position, in which the version is commenced by drawing down
the foot.
spread out flat upon some part of the child, any part being prefer-
able to the abdomen.
  The surest  way  to suceeed  in finding a foot, especially when the
liquor amnii has been discharged, is for the hand to traverse the body,
thigh and leg.  Never feel for the foot until the body, thigh and leg
lead on to it.  The free  hand  must be placed upon the abdomen in
order to  steady the uterus, or this  office may be  performed by an
assistant.   Having secured a foot, then, during the absence of a pain,
the hand should  be gently and carefully withdrawn.   If we have
been careful to carry the hand upon the anterior surface of  the child
and secured  a foot there, we  shall succeed in turning the  child by
doubling it more  and more  upon its anterior  surface.  By  doubling 
OBSTETRIC OPERATIONS.                  253
the child upon its anterior plane we run no risk of breaking its back
or neck, as in doubling it backward.  Moreover, by bringing down only
one foot and allowing  the other to remain  in its usual position, we
leave the breech to occupy a bulk nearly as large as the head, so that
as it passes through the organs  more dilatation is effected, which the
head requires in order to pass freely, and with less compression upon
the cord, and of course with less danger of strangulation.
Fig. 66.                                 Fig. 67.
  Fig. 66. The version is here completed, and the occiput, which was placed in the
left iliac fossa at the commencement of the operation, will now come down behind the
right acetabulum.
  Fig. 67 6hows the mode of management of the cord.
  Further, as one leg is left distended upon the abdomen of the child,
it serves to protect the cord during the  passage  of the body.   This is
a self-evident fact.
  After the turning of the child is fairly accomplished, the labor may
be effected by the natural process alone, or wre may continue to act as
occasion requires.  Wait, by all means, if it will seem to answer to do
so, but if not make traction upon the leg, but act only in concert with
the pains.  " The pains sometimes  do not return for a whole hour,
but then so powerfully and quickly that the child is born in full vigor
and activity."—Wigand. Do  not  draw down the other leg; wait
until it is fairly expelled, foot and all, for it may be the saving of  the
child's life to do so, the cord being in  this manner protected.   Now 
254
OBSTETRIC #OPERA TIONS.
 the chief danger arises from the strangulation of the cord by its being
 compressed between the  head and the bony walls  of the pelvis.  So
 long as we can feel the pulsation of the cord all is well.  Should the
 pulsation  cease, a slight effort may be made to draw it down a little.
 If this can be done, pulsation will often become  re-established, and,
 all things being equal, we can still wait.  If  it cannot be drawn down
 and pulsation ceases, we must hasten delivery as  much  possible by
 making careful traction upon the  body of the child.  As soon as pos-
 sible we must hook down the arms by placing the  index finger in the
 bend of the elbow, and then  as soon as possible hook the same finger
 into the mouth of  the child and flex the head as  strongly forward as
 possible; hold it thus while with the other hand placed upon the shoul-
 ders  make steady and  strong traction, and the patient will  soon be
 delivered.   Manage all breech presentations  in this way when inter-
 ference appears  necessary in order to save the child or mother; other-
 wise trust  to nature.
   It  sometimes  happens that the arms slip up by the  sides of the
 head, when it will be necessary to  disengage them before the head can
 engage.  This can be done by slipping two fingers  up from the shoul-
 der along  the humerus, and allowing these fingers to lie along on its
 whole length ; we can pass them forward and downward on the child's
 face, and in this manner run no risk of fracturing its arm.  The pos-
 terior  arm should be disengaged  first, and the sub-pubic afterward.
 In all cases of  difficulty  in the introduction  of the hand  to perform
 this operation from rigidity of the uterine neck, the difficulty can be
 overcome by the administration of the proper remedies for rigid os.
 It should be  further observed that complications from hemorrhages,
 etc. can all be controlled by suitable medication, and in this way time
 can be obtained for dilatation and  other necessary advantages without
 resorting to brute force  or allopathic measures.  Let it not be forgotten
 that version must never  be attempted until the os uteri is, fully dilated
 or freely dilatable. It can then be safely performed, both to mother and
 child,  whether the membranes are  ruptured or not; but the fittest
 moment for the operation is when  the os uteri is fully dilated and the
 membranes are  still unruptured.  The operation becomes the more
 difficult the longer the time that has elapsed after the membranes have
 been ruptured and the less the quantity  of liquor amnii contained
within the  uterus, for then the uterus more closely envelops the child
and the hand  is passed with greater difficulty.
  Some obstetric writers—Dr. Robert Barnes more  especially—insist
that  the knee rather than the foot should  be seized and  brought 
                     OBSTETRIC OPERATIONS.                  255

down.   On  this point Dr. Barnes says: "There ought  to  be some
3-ood reason  for going past the knees to the feet, which are farther off
and more difficult to get at.   Now, I know of no reasons but bad ones

              Fig. 68.                          Fig. 69.
  Fig. 68. Delivery of the posterior arm first.
  Fig. 69. The mode of flexing the head by drawing down the chin and pushing up
Lhe occiput.  (This mode is several times mentioned or referred to in the text.)

for taking this additional trouble.  You can turn the child much more
easily and completely by seizing one knee."  (Barnes' Obstetric Opera-
tions.)  While it is true that the knee is reached sooner than the foot,
and while there are cases in which the seizure of the knee would not
only be more  easily accomplished, but would be  equally satisfactory
with a  seizure of a foot, still, in a majority of cases where turning is
required, grasping one foot and bringing it down is, in  my opinion,
the safest and  most satisfactory procedure.
  " Combined  internal and external version may be practiced in cases
where  the os only admits the forefinger, provided the membranes be
entire or the uterus be not  too rigid.  It depends for its efficacy upon
the mobility of the child in utero by mere external palpation, and has
the advantage of being simpler, less  dangerous and difficult, and of
being applicable  in cases where  ordinary version  could  not be per-
formed."—Rigby.
  The simplicity and efficacy of this  combined procedure  in arm,
shoulder, neck or transverse positions, when detected at an early stage
of labor, will  be apparent.   The operation consists in introducing one
or two fingers of  the  left hand within the os uteri, in order to reach a
 
256
OBSTETRIC OPERATIONS.
 finger's length within the cervix.  The position of the child havinc
 been made out, and  it having been ascertained to  which side of the
 os uteri the head lies, the right hand is placed on the abdomen of the
 patient over the  fundus, and an effort should be made to make out
 the position of the child's breech by palpation. With the hand on the
 abdomen, gentle  but  firm pressure is to be made against the breech to
 push it over  toward  the right side, following it by a gentle glidino-
 movement of the hand over  the abdomen as it recedes; while at the
 same time the hand within the vagina pushes up the  head in the oppo-
 site  direction, so as to gradually raise it above the brim.  Thus, it
 will be perceived, by pushing the different extremities of the child in
 opposite directions by the two hands employed, the child will gradually
 be turned around within the uterus, until finally the knee or the foot
 is opposite  the os and may be brought  down.  As the head passes
 from reach under pressure of the fingers within the uterus, and  the
 shoulder,  body and  breech successively come within  reach, they are
 to be  "moved on" in the same  manner, until the knee or foot is
 felt.
  This method might be resorted to in securing a cephalic rather than
 a podalic presentation where the neck or the trunk presents under
 favorable circumstances.   Dr. Braxton Hicks, who  has written more
 fully on the subject than any other author, says:  " We should first of
 all  endeavor to induce cephalic presentation, and then, should there
 be any difficulty in accomplishing it, to change our plans to podalic."
 And he thus describes the modus operandi of inducing cephalic pres-
 entation:  "Introduce the left hand into the vagina  as  in podalic
 version; place the right hand, on the outside of the abdomen, in order
 to make out the  position  of the foetus and the direction of the head
 and feet.  Should the shoulder, for instance, present, then push it with
 one or two fingers on the top in the direction of the feet.  At the same
 time pressure by the o.uter hand  should be exerted on the cephalic
 end of the child."
  In regard to the question as to what limb of the child should be seized
 in effecting podalic version, Sir James Simpson has  laid it down as a
 rule that the limb should  be chosen which is on the opposite side to
 that of the presenting part.  By so selecting, the action upon the pre-
 senting part is more decided, and it readily recedes as  the  limb upon
 which traction is made is  drawn down.  On the other hand, if that
 foot be chosen which belongs to the  same side as the presenting part,
there is danger that the  limb may be drawn down without causing a
corresponding retrograde movement of  the presenting part, and thus 
OBSTETRIC OPERATION'S.
257
complicate the presentation still more.   This is a good  rule, and its
force is more apparent in shoulder and arm presentations.
  It is possible that an arm may be seized and brought  down, to the
great confusion of the accoucheur, who supposes he has an  inferior
extremity within his grasp.  In other words, a hand may be  mis-
taken for a foot or an elbow for a knee.  To distinguish  between a
hand and foot we have the  following points:  The  fingers are longer
and of more uniform length than the toes.  The thumb is much more
apart from the fingers than is the great toe from its fellows,  and the
thumb is more movable laterally than the great toe.  The fingers can
be folded  upon  the palmar  surface of the hand, whereas the toes
merely admit of being curled upon themselves,  as it were, and not
flexed upon the plantar surface of the foot.  The hand comes off
from the arm in a line with it, whereas the foot comes  off from the
leg at a right angle.   To distinguish between an elbow and  a knee we
have the following points: The knee  is larger, rounder and appa-
rently more of a square than the elbow, while the elbow, on the con-
trary, is sharper  and smaller than the  knee.  Again, in the knee we
find  the movable patella,, which caii readily be distinguished from the
olecranon process of the  elbow.  " We distinguish a knee from an
elbow by there being two round prominences (condyles), with a de-
pression between them; the elbow presents also two  similar promi-
nences, but there is a sharp projection (olecranon) between them."—
Rigby.  The  outer and inner hamstring, with the popliteal space
between, is also a good point in making out a knee.
   Dr. Rigby lays down the following  excellent  advice: " When the
arm  presents, we should pass our hand, if possible, along its inner sur-
face, as this will guide us to the breast and abdomen of the child.  If
the hand protrudes, the palm is almost certainly turned  in the same
direction as the abdomen of the child.
   "If you can just reach the extremity of the foot, hold it still dur-
ing a pain; you  will find that you can get further hold of  it when
the pain has ceased."
   Cephalic  version is seldom practiced, although it  may  be  very
useful in some malpositions of the head.  It consists  in substituting
a more  favorable presentation of the head for one not  so favorable.
The  different steps of this operation must necessarily vary with every
case  in wliich it is resorted to.   In all cases the patient should lie on
her  back with her  limbs, drawn up, in order that as  much muscular
relaxation as possible may be gained.   Manipulation with the fingers
within the os may be aided by the hand applied to the abdomen, and
        17 
258                  OBSTETRIC OPERATIONS.
used after the method described in the combined method of effecting
podalic version.

 General Directions to be Observed in all Cases where the Head, Face,
                     Breech or Trunk presents.
   When the head presents do not change it for the feet.  If hemor-
rhage  occurs  and there be  placenta prsevia, manage as directed  for
that condition.  If there  is not placenta prsevia, control the hemor-
rhage by medicines.   (See Uterine Hemorrhage.)
  Remove all other difficulties by medicine if possible.  If not, apply
the forceps or resort to craniotomy, as the case may seem to demand.
It is a very unsafe plan to  exchange the head for the feet  if it can
possibly be avoided.  It is much safer in all respects for the child, as
well as for the mother, to deliver  by the aid of the forceps.  In case
of malformation  of the pelvis, the advice of Simpson to turn and
bring  down  the  lower side of the fcetal cephalic wedge, upon  the
ground that the head can thereby be  more readily delivered,  should
be taken with a good deal of caution, and his proposition  should be
regarded as  problematical.  As a principle, then, worthy of all confi-
dence, never exchange the head for the feet.
  If the face presents, and we are called  before it  has become fairly
engaged in the cavity of the pelvis, if it be in the right mento-iliac
position, we must introduce the  left hand, when the face will rest in
the palm, and by proper manipulation with the fingers the face can be
rotated upward so as to flex the chin upon the sternum, and thus bring
the vertex, into the superior strait, when the labor can be abandoned
to nature.
  If the position  be one  of the left mento-iliac, the right hand is to
be used and the same result brought about.
  If the face has become too much engaged to  admit of a reason-
able doubt as to  final success, resign the case to nature, at the same
time warding  off hindrances  and  complications,  as in vertex pre-
sentations.
   In these facial  presentations we must wait with great patience, sup-
porting in the mean while the  vital energies for expulsion with such
remedies as each individual case may seem to require.  We must wait
until rotation is effected, bringing the chin under the arch of the pubes.
When the chin is even found  exactly posterior, by waiting  and pre-
scribing such medicines as  may be  indicated the  chin will  rotate to
the front and spontaneous expulsion take place.  Ramsbotham says of
all  face presentations  that  there  is little doubt that originally they 
OBSTETRIC OPERATIONS.
259
were presentations of the head which have been changed by the action
of the uterus.
  It does sometimes occur, however, that when the chin is posterior,
instead of being transverse or anterior, it seems as descent takes place
to lodge in the great sciatic foramen, and be retained there  until  the
presentation is  converted into one of the  vertex; this should be re-
garded as a very happy event.   When it becomes  necessary to offer
instrumental aid to  facial  presentations, the forceps must be  applied
in such a manner that the  chin may be in harmony with its concavity.
This would favor the rotation which brings the chin under the pubic
arch.  After the chin has  engaged under the pubic arch very great
assistance is often  afforded by applying the forceps in such a  manner
as to gently aid the  process of flexing.  It will be  recollected that at
this stage the occiput is lying back in the cavity of the sacrum, and
the expulsive  forces are so applied as to  render the flexion  of the
head very tedious, so that  the life of the child may  often be saved by
producing flexion of the head by artificial means.
                             Fig. 70.
     THE MODE OP USING THE BLUNT-HOOK IN BREECH PRESENTATIONS.

   Vixen the breech presents it may be  allowed to descend, turning
being rarely admissible in these cases.  If artificial means are thought
necessary, the blunt-hook may be used.  It can be applied by putting
one finger on the presenting part as a guide to the pcint of the hook, 
260                  OBSTETRIC OPERATIONS.
the handle being held in a perpendicular posture.   Now, whilst this
point is kept in contact with the breech, the handle should be de-
pressed until  the hook  is slipped over the  thigh and into the groin.
Before  traction  is  made one finger must be slipped up between the
thighs of the child and placed upon the  point of the hook, where it
must be kept during each traction, for fear of accidents.   The hook
miist be kept closely applied to the groin, for fear of fracture to the
femur if  it slips down  upon the  thigh.  However, later experience
proves  most conclusively that it is much safer and  better practice to
apply well-curved forceps such as Bethell's, instead of the blunt-hook;
well-curved forceps apply to the breech very nicely, and will not slip off.
   When the trunk presents we always know at  once that the inter-
vention of  art is inevitable, and we must at once  determine  where
or in what position is the anterior surface of the child, so that we may
be able to choose which hand is  to be used, always remembering to
use that hand whose  palmar surface corresponds to the face of the
child.   In these cases we should generally  resort to podalic version
by introducing the  hand into the  uterus, seizing  a foot and bringing
it  down.   Version by the  combined method may, however, in some
cases, be  effective.   If the child's  arm  be  found hanging from the
vagina, we must attempt to turn the child at once by introducing the
proper  hand.   Seizing  a  foot  very gently, withdraw  the  hand as
before directed.  No attention  need be paid to the arm hanging in
the vagina.
   If the arm is not hanging externally, the shoulder being felt in the
superior strait merely, introduce the proper  hand and make an effort
to  push up the child, so  as to allow the head to fall  into the superior
strait in place of the shoulder.  We may be aided  in this operation
by gravity.  If the head is found to occupy  the right iliac fossa, after
crowding up the child as much as possible allow the patient  to lie
over upon her left  side,  whilst the accoucheur is  still holding up the
child, and the head will be aided  in its descent  to  its proper place.
The hand may then be partially withdrawn, and at the same time aid
in  placing the head in the  proper position.   If we  succeed, the case
can then be abandoned to nature, aided, when requisite, by the forceps.
If we fail, the hand should  not  be withdrawn, but should pass on
upward, and, seizing a foot, bring down the breech.   All we have to
think of in any position is to diagnose the child's relative  position,
select the hand accordingly, and proceed as above directed.
   In those very difficult cases where the body is so crowded into the
superior strait as to make it almost impossible to  introduce the hand, 
OBSTETRIC OPERATIONS.
201
and quite impossible  to  hold on to the foot, when  once secured, to
produce version, we must hold the  foot, form  a slip-noose with a
strong handkerchief around the arm  holding the foot, and  then slip
the noose up  little by little with the other hand, on to the ankle,

          Fig. 71.                                 Fig. 72.
  Fig. 71. Introduction of the hand in the second position of the right shoulder.
  Fig. 72. Mode of seizing the foot in the same position.

taking care to secure the noose properly and firmly, when powerful
traction can be made and version produced.   All these manipulations
should be slowly and very carefully performed.

                         The Forceps.
  We now come to treat of the forceps.   Of  all the  artificial  means
resorted  to for the relief of women in childbed, the use of forceps
is the most effective and results in the greatest saving of life to both
mothers and  children.  Although the  instrument has  undergone  a
great variety of modifications since its invention by  Chamberlen, its
general principles remain unchanged.  Its power is exerted in three
different ways—as an extractor, compressor and lever.
  Forceps are commonly described as being of two kinds, Long and
Short Forceps, though the difference in length of the two varieties lies
more in the handles than elsewhere.  They consist of  two branches or
blades, each of which is divided into three portions—viz., the handle,
wliich allows of their easy introduction and the tractive efforts of
the  accoucheur, and which is variously  constructed and shaped; the
cephalic portion, which is intended to grasp the foetal head, and  which
is curved  in two  directions—one  to  accommodate the  blade  to the
fephalic globe, and the other to accommodate the blade to the curve
 
262
obstetric operations.
of the pelvic axis;  and an intermediate portion or shank which joins
the other two portions, and which  usually furnishes  the "lock'' by
which the two blades are held in apposition Avhen adjusted.  Straight
forceps are such as have only the cephalic curve.   These are preferred
by some practitioners, but we are at a loss to understand how they can
be preferred in a  high position of the head.
  The short forceps are used to  deliver the head only when it is low
down  in the pelvis—the long forceps when  it is situated high up.
Many obstetricians, however, use only the long forceps, as the instru-
ment is adapted to all cases where the use of forceps is indicated, how-
ever low or high the head may be.  " The long forceps possess a more
scientific adaptation to the pelvis throughout the whole canal than the
short forceps; and if the long forceps is found in practice capable of
taking the head through the pelvis from brim to outlet, it follows that,
since the whole contains the parts, the long forceps is qualified to take
up the head at any point below the brim."

                              Fig. 73.
Fig. 74.
Fig. 75.
  The short forceps in most common use, and undoubtedly the best
instrument of its kind, is Davis's (Fig. 73).  Of long forceps, Hodge's
(Fig. 74), or Hodge's  as  modified by Wallace (Fig. 75), can be very
highly commended.   Bethel's  forceps,  likewise  a modification of
Hodge's  instrument, I  have long used with great  satisfaction.  The
"St. Louis  forceps" (Fig. 76), the invention of Professor T. G. Corn-
stock of St. Louis, appears to be  constructed upon sound  principles,
and has been highly spoken of by those who  have used the  instru-
ment.  Each  blade is  numbered—the left or male  blade, which is to 
OBSTETRIC OPERATIONS.
263
be introduced first, is marked plainly No. 1, and the  right or female
blade, which is to be introduced last, is marked No. 2.  They may be
applied in all cases where the long forceps are required, and  conse-
quently where the short forceps are required also.  This instrument

                             Fig. 76.
Fig. 77.
is very nicely  made by Mr. J. J. Teufel of  Philadelphia.   Elliot's
forceps (Fig. 77), the invention of Professor Elliot of New York, by
means of an adjuster in the handle gives the  advantage, if it be an
advantage, of  lessening the amount of compression  exerted by the
instrument upon the foetal head.
  When  the forceps are required to be used  the  woman should be
apprised of the fact, though in as gentle a manner as possible.   The ,
accoucheur  might speak of having artificial  hands in his posses-
sion which  would enable him to reach the child's head and hasten
its deliverance, thereby relieving her more speedily of her sufferings,
as well as rendering the saving of her child's life  more certain.  At
all events, her  full and free consent to their use should be obtained.
  Application  of the forceps having been decided upon, and the con-
sent of the patient having been gained, she should be placed in the
following position: She should lie upon her back,  with her hips well
down to the  edge  of the bed  (if the child's head  is  in the superior
strait, the mother's breech should be brought down quite to the edge of
the bed, so that the handles of the forceps when locked may hang over
the side of the bed); the thighs and legs should be flexed, separated
and supported on two  chairs or by two assistants; one hand of each
assistant  should be placed upon  a knee while  the  other holds a foot.
The accoucheur takes  his place between the  separated limbs of the
patient, and  stands,- kneels or  sits as he may prefer.   Care  should be
taken that the  position of the  patient is made as comfortable to her as 
264
OBSTETRIC OPERATIONS.
 circumstances will  permit.   The forceps  may be applied while the
 woman is lying upon her left side in the usual  position of parturition,
 but the  dorsal position  is for all reasons by far the? best.   When the
 forceps are applied to the head at the outlet, ii may not be necessary
 to  subject the patient to the inconvenience of being  placed on her
 back and moved  to the edge of the  bed,  but  it will be  found in a
 great majority of cases, even of this  character, that  an adherence to
 the above directions in regard to position will be  most conducive to
 the proper use of the instrument.
   Before applying  the  forceps each  blade should be dipped in  hot
 water, that it may  be warmed  to  blood  heat, and  the external or
 convex surface should be anointed with lard.
   The operation of using the instrument  may be divided into four
 stages—viz., introduction of the blades; locking; traction and lever-
 age;  removal of the blades.   They  are applicable  in the following
 cases: 1. When the os uteri is either  dilated or is  soft and yielding,
 and there is -a proper degree of moisture of the parts, but the action
 of  the uterus appears to have subsided or ceased altogether, and the
 patient is becoming  exhausted.   In such cases, after a reasonable use
 of homoeopathic remedies without avail, the child should be delivered
 either altogether or partially by the forceps.  It may  not be necessary
 to continue the tractive  force so as to complete the labor, for Nature
 sometimes seems to rouse from her sluggishness under a moderate de-
 gree of traction by the instrument,  and is able  to complete the act of
 parturition without further assistance.   2. In some  cases of  facial
 presentation, where the diameters of the head are opposed to those of
 the pelvis—the long diameter of the head lying in the short diameter
 of  the pelvis, for instance—and  a  reasonable  waiting  on the efforts
 of  Nature or other  measures have failed to bring about a favorable
 change.   3. Where  there exists disproportion between the cephalic
globe and the maternal pelvis, yet not to  a degree requiring crani-
 otomy or other more serious operative interference.   In these  cases
 the compressive power of the blades reduces the size of the head, while
 tractive  efforts draw it  through the pelvic cavity.   4. Where the
 hand, foot or  cord presents with the head, the forceps may be needed
to bring  down the head  and effect delivery.  5. When certain emer-
gencies which complicate the  labor occur, such as convulsions, rup-
 ture of the uterus, etc., and  it is  necessary to effect a speedy delivery
 to save the life either of mother or child.   6. When the after-coming
head  in  breech presentations is compressing the cord, and the  head
cannot be delivered  by manual  aid  alone.  Here the  forceps must be 
OBSTETRIC OPERATIONS.
265
promptly applied and delivery quickly effected, or the life of the child
will be sacrificed.
  The use of the  forceps is contra-indicated -when the os  is undilated
and the soft parts are rigid and unyielding, and again when the dis-
proportion between the foetal head and the pelvis is so great as to give
no reasonable hope of effecting delivery, either from  the  amount of
compression the instrument is capable of exerting or the amount of
traction that may  be applied.   In serious malformations of the pelvis,
or where bony tumors  obstruct the pelvic passage-way, its use is out
of the question.
  The mode of application of the forceps varies slightly in different cases,
although the general principles regulating the introduction  and adjust-
ment of the blades are the same in all cases, whether long or short for-
ceps be used.  The  position of the patient has already been described.
Now, having placed her in this position, and the forceps having been
warmed and greased as directed, the accoucheur takes his position, and,
having ascertained the position of the fcetal head and its relation  to the
surrounding parts of the mother, proceeds to introduce the male blade
first—that is to say, that blade the convexity of the cephalic curve of
which will adapt itself to the concavity of the left iliac fossa of the
mother.  This he does in the following manner:  The blade is to be
held in the left hand and in a perpendicular position; two fingers of
the right hand should then be inserted into the vagina and passed up
for a short distance within the cervix uteri, between the uterus and the
fcetal head;  then the point of the blade should be  laid  against  the
inside of the fingers thus introduced and slipped along them until the
blade reaches the fcetal head.   Now the blade is to be introduced still
farther, and in such  a manner that its concavity will be adapted  to the
convexity of the foetal head,  and this will be executed by laying the
blade flatwise upon  the head and gradually lowering the handle, while
at the same time the blade is gently pushed onward, or rather allowed
to glide onward, until the convexity of the head is  well  grasped by
the fenestrated portion of the blade.  This done, the handle should be
pushed back still nearer to the perineum, in  order to  get it out of the
way of the second blade.  The second or female blade is to be held in
the right hand and in a perpendicular position, while two fingers of
the left hand are insinuated  between the cervix uteri and the fcetal
head.   The blade  is then to be slipped along the inner surface of
these fingers until  the  head  is reached, when its further  introduction
is accomplished in the same manner as before described.
   Both blades having been thus introduced, they are to be locked by 
 266                 OBSTETRIC OPERATIONS.

 lightly seizing a handle in each hand and  gently bringing the blades
 into apposition, being careful at the same time to guard  against en-
 tangling the hair or any of the soft parts of the mother with the lock.
 It may be regarded as an axiom that if the blades do not readily lock
 one or both have been improperly introduced.  In such a  case one or
 both should be withdrawn and reintroduced, for no  force should  be
 exerted in locking.
   It is absolutely necessary in introducing the blades to proceed with
 the utmost gentleness.   Force is altogether uncalled for, and great in-
 jury may be done by a disregard of this admonition.  It may generally
 be taken for  granted that when  the blades  are introduced easily
 they are introduced properly.  " The rule, then, is this: hold  the
 blade lightly; let it feel its way, as it were; let it insinuate itself into
 position.  It will be  sure to slide into the space where there is most
 room."
   Unless the  necessities of the case compel  us to  resort to the most
 prompt  measures to effect delivery, the blades should  be  introduced
 only during the  absence of pains, and extractive force should be  ex-
 erted only during the presence of and  with the pains.
   The general direction is given to apply the forceps to the sides of
the child's head, over the ears.  This is not necessary, nor is it always
practicable.   On this point Dr. Ramsbotham  says:  " In  employing
the short forceps I lay it down as a rule that the blades should be
passed over the  ears; the head is more  under command when  em-
braced, laterally,  and  there is less  danger of injuring  the soft parts
during extraction.  But I confess that I  have  for many  years been
accustomed, however low the head  may  be, to introduce  the blades
 within each ilium,  because they usually pass up more easily in  that
direction." It will  be seen from this that this distinguished  accoucheur
regarded more the  parts of the mother than  the position of the fcetal
head.  The above description of the manner of introducing the for-
ceps applies more particularly to the short instrument, but the mode
of introducing the  long forceps does not differ from it in any great
degree.   In using the short forceps the position of the fcetal head is
to be taken into  account, and in some degree regulates the position of
the blades, but in the introduction of the long forceps the pelvis only
is to be  considered.  " The position of the  head  may be  practically
disregarded.  The pelvic curve of the blades indicates that these must
be adapted to the  curve of the sacrum in order  to  reach the brim.
They must therefore be passed as nearly as  may be in the transverse
aiameter of the  pelvis.   One blade will  be in each ilium, and  the 
OBSTETRIC OPERATIONS.
267
 head, whatever its position in relation to the pelvic diameter, will  be
 grasped between them.  The universal force of this rule much sim-
 plifies and facilitates  the use of the  instrument.  Not only does it
 apply to the  position of the  head in relation to the pelvic diameters,
 but also to all  stages of progress of the head, from that where it
 lies above the brim down to its arrest at the outlet."—Dr. Robert
 Barnes.
   In  introducing the  long forceps when the head  is in the superior
 strait, the position of the patient is the  same as already described,
 except that the breech must be brought to the edge  of the bed, so that
 when  the  forceps are applied  and locked their handles  may hang over
 the side of the  bed, for here the traction at first  is downward and
 somewhat backward.   The blades are to be introduced in the same
 manner as described  for the  introduction of the blades of the  short
 forceps.   As a blade  penetrates  farther and  farther within the pelvic
 cavity to  grasp  the  head, the handle sweeps from  before backward
 through a curve extending from  an imaginary line prolonged  upward
 from the anterior surface of the symphysis pubis to an imaginary line
 representing  the prolongation of the axis  of the  superior strait or
 of the coccyx; and conversely, as the head  is extracted the  handles
 again  sweep through this same curve from behind forward, while the
 head itself is traversing the " curve of Cams."  If the  os uteri should
 lie unusually high up, extra care will be necessary to insinuate the
 points of  the blades within the  cervix.  If they should slip off into
 the cul-de-sac between the vagina  and cervix,  very  serious injury
 might be  done by pushing them through the vaginal wall into the
 cavity of  the peritoneum.   When the blades of the long forceps have
 been introduced, an easy  locking indicates  not only that they have
 been properly adjusted, but that  the case is one suitable for their use;
 for their  not locking without a resort to force shows either that they
 have  not  been properly applied, or that there  is pelvic deformity tc
that extent that the blades cannot  lie opposite to each other in the
same diameter of the pelvis.  Being firmly locked, pressure should be
made  upon the handles, and  if this occasions no pain to the  patient,
we may feel assured that no part of the soft  parts is included between
the blades.
  Traction should then be made with a view to accomplishing delivery.
The direction of the handles will  to a great extent indicate the direction
in which the  tractive force is  to be applied.   When the head is in the
superior strait and the instruments are locked, the handles will always
be at the extreme posterior commissure of the vulva, which shows (the 
 238                  OBSTETRIC  OPERATIONS.

 woman lying on her back) that the tractive force is to be made down-
 ward and backward, just as the handles point.  As the head descends
 into the cavity more  and more, the handles will elevate themselves
 more and  more, till at the instant of the disengagement of the  head
 from the vulva the handles will  point almost or quite directly up-
 ward.   While operating, then, it is wise, after any tractive effort, to let*
 go the grasp, that the handles may point in what direction the  next
 effort should be  made.   But the accoucheur  should  always  bear in
 mind the curved  axis of the  pelvic canal  through  which the  head
 has to  be  brought to  be delivered.  Traction should be made  with
 every pain, and only  then.  The tractive efforts should imitate the
 uterine contractions as  nearly as  possible,  resting when the uterus
 rests, and drawing as carefully and gently as possible when the Uterus
 exerts its  expulsive force, yet with sufficient force  to  be effectual.
 And we should, at the same time, relax the grasp upon the  handles
 between the expulsive  pains, to relieve  the foetal head from the con-
 sequences of continuous  compression.  " Continuous  compression is
 opposed to the course of Nature, which intermits the expulsive act,
 giving periods of rest, during which it  is presumed  that  the brain
 may better adapt itself and its circulation be maintained.  Hence the
 law that we ought in forceps labors to imitate this intermitting action
 by interposing intervals of rest, endeavoring  so to time our efforts
 as to be simultaneous with and in aid of the natural expulsive efforts."
   Great care should be used not to wound the soft parts by swaying
 the instrument sideways or upward and downward, as all these move-
 ments are unnecessary.  As the perineum becomes distended we should
 proceed very slowly and  cautiously, giving the parts time to dilate, so
 as not to endanger a rupture or laceration of the perineum.
   The use  of anaesthetics in these operations is  particularly objection-
 able, since their use tends to  increase the danger; for when  pain is
 produced by pressure  with the forceps we know  all is not right, and
 hasten to correct the error; but where the patient is rendered  uncon-
 scious by the use of anresthetics, this valuable indication  is lost.
   The direction to keep the blades of the forceps in introducing them
closely applied  to the child's  head is of considerable importance.  It
 sometimes happens that the cord lies close down to the occiput, and it
 is  possible for  it to fall between the point of  a blade and  the f rtal
 head, and it would in that case naturally be compressed and the child's
life endangered when  the two blades were locked.  If upon making
 traction the  child should  be  felt  to jerk about  or struggle  (as the
3quirming  of a fish is felt by the angler), this untoward  iircum- 
OBSTETRIC OPERATIONS.
269
=tance may be suspected  to have  occurred, and the blades should be
instantaneously  loosened  and  withdrawn, to  be reapplied.   It  is
sometimes necessary to exert very powerful tractive force  to effect
the delivery of the head.  Should the accoucheur have satisfied him-
self that the  case  is one adapted to the use of forceps, and that the
instrument has been properly applied and locked,  this may be resorted
to without serious detriment to mother  or child,  provided  traction is
made steadily in the right direction, and only at the  right time; that
is,  during the expulsive  uterine efforts, even though these may be
feeble.  The vis a fronte exerted by the  forceps supplements the defi-
cient vis a tergo exerted  by the uterus.   Fortunately, cases requiring
a great  expenditure of muscular effort are of infrequent occurrence.
   The  forceps may be applied to  deliver the after-coming head—in  "
breech  presentations, for instance—where the hands alone and  flexing
the head by pressure with the finger  in  the  child's mouth are not
sufficient to secure expulsion.  Should the cord be compressed by the
retained head, very prompt  action within a few minutes will be re-
quisite to save the child's life.  The best method of using the  forceps
in these cases is as follows :  The body of the child should be  drawn
well forward toward the symphysis pubis, and held there by an assist-
ant; then pass the left hand into the vagina and insinuate two fingers
between the  cervix uteri  and the child's head on the left  side of the
pelvis; slip the  forceps blade up the palmar  surface of these two
fingers  to its proper place on the head,  then  introduce the  right hand
into the right side of the pelvis, slip  up two fingers as before,  and let
the blade for that side glide into its place, guided by these two fingers;
then lock the blades.  Then exert tractive force first in the direction
of the axis of the superior strait, gradually  changing the direction of
the handles from behind  forward as the head comes down, and finally,
as  the  occiput appears under  the  pubic arch, carry  the handles well
forward, so as to take off the strain from the perineum as the face and
forehead sweep over it.
  The late  Dr. Casanova was in the habit of using, in cases where
other practitioners would  resort to ordinary metallic forceps, an instru-
ment which  he termed a " Tocological Flexible  Forceps" of his  own
invention.   Dr. Tuthill  Massy of England  published an  article on
the use of this instrument and of Casanova's " Flexible Cephalo-ex-
tractor," in the " British Journal of Homoeopathy," vol. xxix., p.  327,
with  two plates exhibiting the  instruments and their application. 
270                    OBSTETRIC OPERATIONS.

The plates are here reproduced, together with their  description and
that 01 the use of the instruments as given by Dr. Casanova:

                                  Fig. 78.
                                                 No. 1.

  " Fig. 1.—Eepresents the head seized with the double forceps, and the manner in
which it is extricated from the pelvic strait.
  " No. 1. A single forceps seizing the head round the middle and inferior part of
the chin.
  " No. 2. A single forceps seizing the head round the occiput.
  " No. '6. A frontal safety check-band, to prevent the forceps from receding and
choking the infant.
  " Each of these forceps is composed  of a piece of whalebone about three feet long,
three-tenths of an inch in breadth, and one-tenth of an inch in thickness;  of two
silver rings at their extremities, well fastened, and the whole well polished. 
OBSTETRIC OPERATIONS.
271
  "The frontal safety check-band ought to be placed at about four inches from the
centre of the forceps  No. 1 on each side, and it must be well secured.   A piece
of silk or any otlier smooth cloth  will answer.  Its length is from seven  to eight
Inches.
                                   Fig. 79.
                                                        C
FIG. 2,
  " Fig. 2.—Eepresents  the cephalo-extractor seizing tht head of the infant after
its deatli and separation from the body.
  "This instrument is made of two pieces of whalebone of the same dimensions
in every respect, as those of the  forceps, without rings in their extremities.  These
two pieces are fixed by their centre with a silver pin riveted on both sides, flat and
        id 
272
OBSTETRIC  OPERATIONS.
 smooth to allow the pieces to move or open and close as the blades of a pair of
 scissors. (See Fig. 2.)  When closed and held by the two extremities, they represent
 one of the forceps.  When opened, and holding the four extremities in one hand
 (see a), they represent Fig. 2.
   "Fig. 3. Represents the head  seized  in a different manner; as  the diameter is
 generally found to be less from  A to B than from C to D, I have found it much
 easier to  seize and extract it in that way (when such a difference is clearly mani-
 fested) than otherwise.
   " Fig. 4. Represents a plain silver plate of an oval shape, with three holes in itd
 centre, to allow the four extremities of the cephalo-extractor to pass when it has
 seized  the head.   The lateral extremities pass through holes Nos.  1, 1, one by
 each,  and the anterior and the posterior both pass  through the hole No. 2.  (See
 Fig. 2, a.)  This plate renders the instrument open and immovable, and it serves
 to press the head as much as may be required  to extract it, without injury to the
 mother.

   Dr. Casanova was led to the use of the flexible forceps for effecting
 delivery, through the success he  met with in a difficult case where
 metallic forceps could not be had, and where he used  successfully a
 pair of loops or fillets made of rattan shaved down smooth and thin,
 and applied under  the chin and  occiput respectively.   He thus de-
 scribes their mode of use, for which we are likewise indebted to  the
 article by  Dr. Massy:
   "Flexible forceps should be applied  as follows: The patient  lying
 on her left side over  the edge of  the bed or on her  back,  as circum-
 stances may  require,  you should bend  one of the branches of  the
 instrument and hold the two extremities together  with your  right
 hand; the bent part, being  pressed  and guided by the left, will be
 introduced  over the  face of  the child or over the occiput, according
 to its position, that you  may reach the  inferior part of the chin or
 that of the occiput.   The head being thus  seized, you will  be able to
 extricate it by  pulling toward you  in the most favorable  direction.
 Should one branch be not sufficient, introduce the other on the oppo-
 site side of the  former; and when you are assured that both branches
 are properly placed, you  can move them in any direction you please,
and  perform  the  necessary  rotations to  extract it  with safety. (See
 Fig. 1.)   The simplicity  of  this instrument and its flexibility render
 its application much more easy and  more safe than the old iron for-
ceps.   There is no force required to accomplish  this  operation, nor is
any compression exerted  on the child's head laterally.  If you be
patient and watch a favorable opportunity when pain is  present, you
will  succeed in  bringing forth the infant without any injury to  it or
to the mother.
   " For  more than twenty years  I have been in the habit of using 
OBSTETRIC OPERATIONS.                  273
this kind of forceps  exclusively, and  the experience of that time has
taught me to appreciate its utility from the successful results  I  have
obtained with it."
  Doubtless skill acquired in the use of the above-described  instru-
ment  enabled the eminent Casanova  to do  with it  what other men
would do with metallic forceps.  But it is to be remembered that the
only force  capable of being exerted  in any marked degree  by the
flexible forceps is that  of extraction; while compression and lever-
age, which enter so largely into the valuable forces  capable of being
brought into use through the metallic forceps, are almost entirely want-
ing to a flexible instrument.  Nevertheless, it is apparent that there
are many cases in which such forceps as Casanova used could be made
available in very many cases of immovable head  in the inferior strait
or at  the vulva, with less  of suffering to the mother and  less detri-
ment  to  the infant than sometimes results from  the employment of
the ordinary instruments.   They are referred to here  as worthy of
trial,  and especially so as they are  so highly praised  by their in-
ventor,  a  man  who deservedly stood high  in the  esteem  of  all
practitioners of the homoeopathic school of medicine.

                          The Vectis.
  The vectis is an instrument Avhich might  be used  to  advantage
much more frequently than it is.  It resembles somewhat a blade of
the forceps, and may be used as a lever, or even, to a  moderate de-
gree, as a tractor.   The ordinary instrument is about  twelve inches
in length, one-half of which are taken up in the  handle.  It may be
readily  applied over  the occiput, face or sides of the  head, and  by
making a fulcrum of one hand  considerable leverage  can be made
with the other hand, and at the same  time a moderate degree of trac-
tion may be exerted.  In some cases of facial presentation, where the
head  is impacted, it might  be made  very useful, and again, in brow
presentations, by bringing down the vertex  by means of the vectis, a
facial  presentation will be prevented.  It  should  be warmed' and
greased before  being applied, and is  to be  introduced much in the
same manner as a blade of the forceps.  If it is  intended to pass the
instrument within the cervix uteri, the same precautions  should be
observed to ensure its  going in the right direction as were laid down
for introducing the forceps blade—viz., two  fingers should be  insinu-
ated between the cervix and the foetal head, and  the blade  of the
vectis should slide  along their palmar surface until wrell  within the
cervix.   After  its introduction, and before any power of any  kind is
       18 
274
OBSTETRIC OPERATIONS.
exerted, the free hand should be placed at the vulva in such a manner
as to afford a fulcrum  for the instrument.  In no case should the
maternal parts be used as a fulcrum for the play of the instrument.

                          Craniotomy.
  The operation of craniotomy is dictated by  that natural law of
humanity which  commands us to  save the  life of the mother if pos-
sible, even  if it involve the sacrifice of  the child.   It consists in
making an opening into the cavity of the foetal cranium, discharging
its contents, and  thereby securing a diminishing of the  bulk  of the
head, either -by the compression exerted upon it by the soft parts of
the mother under the  force of uterine  contraction, or by additional
instrumental resources, thereby rendering  possible its  expulsion or
extraction.  It is indicated in cases  where the  child cannot be de-
livered with safety to the mother either  by  the forceps or by version,
and yet there is reasonable ground for believing that it  might be if
the bulk of the head were reduced.   If no such hope can be enter-
tained,  the Caesarian  operation alone  remains  to  be  resorted to.
Obstetricians have  variously  stated  the minimum pelvic measure-
ments for the performance of craniotomy. It may be stated, however,
that if  the antero-posterior diameter at the  brim or  the transverse
at the outlet measures less than two  inches,  delivery by craniotomy
could not be  accomplished.   But there are cases requiring crani-
otomy in which there is no abnormality of  the pelvis or soft parts of
the mother.  Here  the difficulty is due  to  the enlarged condition of
the foetal head,  as by  hydrocephalus.  If  the head  in  such  a case
is not sufficiently moulded by the maternal parts, or cannot be suf-
ficiently  compressed by the obstetric forceps,  craniotomy  must be
resorted to.
  It is impossible to lay down any fixed rule  in regard to the time at
which the operation should be performed.  If, however,  its  necessity
is apparent from  the first, the sooner it is resorted to after the os uteri
is sufficiently dilated' the better it will  be  for  the patient.   The os
uteri  should be dilated  at least sufficiently to admit  the  instrument
used in effecting perforation.   If it be dilated more than this it is an
advantage.
  A variety of instruments have been invented for effecting perfora-
tion of the cranium.   Of these probably the best in skillful hands is
the modified  "Smellie's Scissors"   (Fig.  80).    Braun's Perforator
(Fig. 81) is likewise a valuable instrument,  and may be used  with
great advantage,  particularly when cranotomy is required to deliver 
obstetric operations.                  27o
the after-coming head.   The proper method of using the  last-named
instrument is suggested by the instrument itself.

                             Fig. 80.
   If craniotomy is to be performed, perforation is the first step, and
 Smellie's scissors being selected, the operation should be conducted in
 the following manner: The  bladder and rectum  having been  emp-
 tied, as before other obstetric operations, the patient should be placed
 in the same position as when  forceps are applied.  Two fingers of the
 left  hand are then to be passed up  to the  head, keeping the cervix
 uteri upon their dorsal aspect.  The instrument should then be intro-
 duced  very carefully along the palmar surface  of the fingers, which
 should serve not only as a guide, but as a guard to protect the  parts
 of the  mother from injury.   In this way it is to be passed up to the
 head, great care being taken  that its point does not touch  anything
 until it strikes the foetal head.  The most depending part of the head
 is usually  selected  as  the  site of the  operation.   This reached, the
 instrument by a combined boring and pushing movement is made to
 pierce the cranium; if a bone is to be  perforated, extraordinary care
 will  be requisite to prevent the point of the blades  slipping off and
 doing serious injury to the mother.   The  instrument is then  to  be
 pushed into the head, up to its shoulder, which is about an inch  back
 of the point of the cutting  blades.   While  this is being  done an
 assistant  should support the  uterus  externally, making firm  down-
 ward pressure, to force the head of the child downward, and keep it
 fixed, and thus prevent its rolling about or retreating from the pres-
sure  of the instrument.   The  blades  are  now to  be opened,  when
their outer cutting  edges will  enlarge  the aperture, and  if they are 
276
OBSTETRIC OPERATIONS.
then closed, turned at right angles  to  their first position, and again
opened,  a crucial  incision  will  be made  which  will  not  readily
slose, and which will be  sufficiently large to  discharge  the  cou-

                               Fig. 82.
MODE OF INTRODUCING AND USING SMELDIE's SCISSORS.
tents  of the cranium, as well as break up  the  cranial arch.  The
brain should  then be broken up by the perforator, which  not  only
facilitates its extrusion, but at once destroys the suffering of the child.
The instrument  should  then be carefully withdrawn, guarded  as
before.   The  second  step  of the  operation consists  in  extraction
of the child.  Uterine action alone  may now be sufficient to  accom-
plish  this.   At  all  events, should  there be  no reason for effecting
immediate  delivery, it will  be well  to  wait for the "pains" and see
what  they  can do.   One  authority says: "After  perforation wait  an
hour or two for the pains;" and  indeed this may be done if no unfa-
vorable signs be present to indicate a more  expeditious delivery.
  Should nature not be able to accomplish  the expulsion of the child,
instrumental aid  must be sought.  The craniotomy forceps, the crani-
oclast or the crotchet are instruments  devised for this purpose.  By
their aid the accoucheur effects compression and traction.  The great-
est  care is  to be exercised in their use to guard against injury of the
maternal parts, either by the instruments themselves or by  pieces  of
the cranial bones that may be broken off and brought away.
  The most generally useful of all these instruments is the craniotomy 
OBSTETRIC OPERATIONS.
277
forceps; of wliich  those invented  by Professor Meigs (Fi^s. 83 and
81) fulfill all that will be required of such  instruments.   By  the
craniotomy forceps the perforated head may be seized and extracted
or, where that cannot be accomplished, portions of the cranial bones
may be removed and  extraction accomplished afterward.   If  the
vault of the cranium be removed,  so  that its  base  and the face  are

                             Fig. 83.
alone bft behind, the head thus reduced can be seized by the forceps
and  drawn through a comparatively small opening.  But  if this  re-
moval of the cranial bones should not be necessary, traction may be
made by introducing one blade within the cranium while the other
passes on the outer side and a hold is thereby taken.
  Simpson's cranioclast (Fig. 85) is justly regarded as a most excellent
craniotomy forceps.  It has  separate blades, which are  to be  intro-
duced much in the  same manner as the obstetric forceps, and locked
after  their  introduction.   Professor  Elliot of New York considers it
the best craniotomy forceps.  With this instrument, one  blade being
passed into the  cavity of the cranium and the other on its outside, the
bones of the cranium, particularly the occipital hone, may be broken
up, and the size of the head thereby considerabJv reduced.   Traction
may  then be made by means of the instrument.
  The crotchet  is a  dangerous instrument, even  in skillful  hands.
The  principle  of its application is, to  pass it  into the  perforated
cranium and by means of its  hooked process to obtain a purchase 
278
OBSTETRIC OPERATIONS.
upon the head.  The hook takes hold of some part of the cranium,
or it may be passed through the foramen  magnum.   The danger tc
the mother  is very great from the liability of this  instrument to slip
and produce laceration.  To  guard  against  this  accident, a  finger
should be  passed  up on  the  outside of the  cranium, to serve as  a
guard  and support to the sharp point of the crotchet, which is  fixed
into the bone inside the  cranium.   The instrument is now constructed
with a second blade, which passes up on the outside of the foetal head,
and takes the place of the finger in acting as a guard.  If a firm hold
can be taken on any part  of the cranium, very powerful traction can
be exerted  through the crotchet;  but, unfortunately, however firm
the hold may seem to be,  it is possible for  the parts to give way, and
the greatest  care therefore  should be exercised in its use.
   Cephalotripsy is  an operation to effect delivery by means of crush-
ing or breaking up the fcetal head and reducing  its  diameters very
considerably by means of an instrument through which great crushing
power can be exerted.  This instrument is termed the ceplmlotribe.
It has two blades which have some resemblance to the blades of the
ordinary forceps, while there is a screw-power in the  handles by
which the crushing process is regulated.   The blades  are introduced
in the same manner and  with  the woman  in the same position as
when  the obstetric forceps  are used, and when locked the crushing
process should be  commenced.   Before  the cephalotribe is used, per-
foration of the skull and evacuation of its contents  should be effected,
to ensure a more  successful compression.   This operation, however,
can only be regarded as a substitute for the ordinary method of crani-
otomy, to be resorted to in extreme oases.
   Where there is  very great pelvic deformity, after perforation and
evacuation have been accomplished, it is recommended, in some cases
where efforts at extraction  have failed, to wait  for some time until
incipient decomposition has rendered the parts more yielding and
capable of collapsing.

                           Embryulcia.
   This formidable obstetric operation consists in perforating  and
eviscerating the thorax or  abdomen  of the  child, or  both.  It may
be demanded in cases  of extreme pelvic deformity, where, the head
having been perforated  and delivered, the delivery  of the trunk in its
natural condition  is impossible; or it  may be called for when the
thorax or  abdomen  is  greatly enlarged  by dropsical  effusions.
Smellie's scissors  is the best instrument to employ for this  purpose. 
OBSTETRIC OPERATIONS.
279
The instrument should be pushed into the thorax through one of the
intercostal spaces, and if necessary one or more of the ribs should be
divided; or it should be pushed  into the abdomen where that is re-
quired; in both  instances the instrument should be used with great
care and the mother carefully guarded against possible injury.
  It has been stated  that "this  operation is required sometimes in
cases of arm presentation, where  the membranes have ruptured, the
liquor amnii  escaped,  and where the uterus is so firmly contracted on
the child, which is thus jambed  down into  the  pelvis, that turning
has become impossible."  I am by no means willing to coincide with
this opinion,  for I  do not believe that turning is impossible in any of
these cases  under the manipulation of that  most important  obstetric
instrument, an educated hand.

                         Decapitation.
  I am not able to conceive of any case in which  a resort to  this
operation would be an  absolute necessity.  If any such  case should
arise, a pair of strong, sharp-pointed  scissors would  be the best instru-
ment for the  purpose.   AVith these the neck should be penetrated, the
spinal  column and cord  should  then  be severed, and the soft parts
subsequently divided.   The head can be removed  afterward by the
forceps or other means.

                   The Cesarean Section.
  This operation consists essentially in delivering a child through an
opening made by  dividing the abdominal parietes and the uterus of
the mother.   Its intent is to save the life of one or both when delivery
per vias naturales  is regarded as impossible.   Concerning this opera-
tion, Dr. Robert Barnes writes as follows:  " The Csesarean section
occupies a  doubtful place between conservative  and sacrificial mid-
wifery.   It is conservative in its design, in  its  ambition;  it is too
often sacrificial in fact.   It is resorted  to with a feeling akin to de-
spair for the fate  of the  mother, which is  scarcely tempered  by the
hope of rescuing the  child.   It is looked upon by  the great  majority
of obstetricians as the  last desperate  resource, as  the most forcible
example of that kind  of surgery which John Hunter regarded as the
reproach of surgeons, being a confession that their art  was baffled.
On the other hand it is regarded by some enthusiastic practitioners,
dazzled  perhaps by its false brilliancy, as an  operation deserving to be
laised into competition with turning, craniotomy or cephalotripsy."
  It is impossible  to  lay down such rules as will  serve  as infallible 
280
OBSTETRIC OPERATIONS.
guides to the obstetrician  in  making up an opinion for or against the
operation, but we may state  broadly our conviction that it should he
regarded as  a  dernier ressort.  "The  Csesarean  section is  the last
refuge of stern  necessity."  While, however, statistics of the operation
show quite a large rate of loss, both of  mothers and  children—about
two-thirds  of the former and one-half of the latter—it is to be borne
in mind that the recent great advances  made in operations upon the
abdomen give a much better chance for recovery of the mother and
of a safe extraction of a living child than formerly.
   The Csesarean section may be regarded  as indicated where there is
pelvic deformity to the extent that the channel through  which the
child must pass does not exceed two inches in diameter.   Again, it
may be called for in some cases of ruptured uterus, where the child is
known to be alive,  where the mother's life is threatened in cases of
extra-uterine pregnancy, or where the mother has died suddenly un-
delivered.   In  the last-named case the operation has to be resorted to
promptly, and very expeditiously performed, probably not more than
eight or ten minutes after the mother's death, in  order to secure the
extraction of a  living child.   It is questionable whether the Cesarean
section should ever  be performed when the child is known to be dead.
   The operation  should  be performed in the following manner:  The
rectum and bladder  having  been evacuated, the woman  should lie
upon her back, with head and shoulders slightly elevated and the
pelvis supported  and likewise slightly raised.  An  assistant should
give firm and equable support to the sides of the abdomen, to prevent
extrusion of the bowels  through  the incision.   An incision should
then  be  made  in the linea  alba, extending from the umbilicus to
within a short  distance of the symphysis  pubis—about eight inches.
The linea alba  is selected as the proper place for the  incision, because
there will necessarily be less  hemorrhage, and because also the uterus
will be found  lying immediately beneath, uncovered by intestines.
After this first  incision—which should not extend into the abdominal
cavity—has been  made,  an  opening  into the abdomen  should be
secured, through which  the  finger  or a grooved  director should be
introduced, and the  abdominal incision  then  completed  by cutting
from within outward, to  avoid inflicting  injury to the intestines or
cutting unnecessarily the uterus.   This incision completed, the uterus
is seen.  Before making  the  uterine incision, the  location of the pla-
centa should  be  made out,  that it  may  be avoided.  Th:s may be
done, according to Dr.  Pfeiffer, by placing the hand flat upon the
uterus, when a peculiar thrill or vibration communicated to the hand 
OBSTETRIC OPERATIONS.
281
will mark the position of the placenta, and, in connection with this,
the slight bulging of the part, " as if a segment  of a smaller globe
were seated on a large spheroid," will likewise serve  to indicate  the
place  of  attachment of  the  placenta.  The uterine incision shoull
then  be made, four or five inches in  length, on a line with  the  cut
through the abdominal parietes.  Neither the  fundus  nor the cervix
of the uterus should  be involved in the  incision, which should be
limited to the body of the organ, as by dividing either of these por-
tions  the subsequent  contraction of  the viscus would be interfered
with.   Then " an assistant  hoo'ks the forefinger of each hand in  the
upper and lower angle of the uterine wound, and, lifting them  up,
fixes them in contact with the corresponding angles of the abdominal
wound.  This shuts out the intestine  effectually, and tends to prevent
the blood from running into the abdominal cavity."  The membranes
should then be ruptured  and the child carefully extracted, by seizing-
it, if possible, by the  feet.   Should the head  of the child be caught
and firmly held  by the lips of the wound, it will be better to enlarge
the incision  rather than attempt to extract the head  by force.   The
placenta  and membranes should then be removed, together with all
coagula, and the operator should  ascertain that the os  is free  to admit
of the passage of the lochial discharge.   Dr. Barnes directs that  a
probang  be  passed through  the  os uteri and  vagina to ensure this.
Should the uterus  now  contract, the incision will be reduced to  a
small slit, and the hemorrhage from its divided vessels or  from the
mouths of the uterine sinuses made patulous by the detachment of the
placenta  will soon  cease.  If it  should  not thus spontaneously con-
tract, direct  pressure  should be made upon it with the hand, or ice
may be applied directly to it, and a piece be left in the uterine cavity.
Should these measures fail to induce contraction, galvanism must be
resorted  to,  and a proper apparatus should  be  at hand in case  it
should be needed.
   In regard  to  securing the  uterine  wound, authorities appear to be
divided  as to whether  sutures should be used or  not.  If the con-
traction  of the  uterus be firm, they  will probably not be required;
but on the other hand, in fatal cases  autopsy has revealed the uterine
wound  in a gaping  condition where sutures had  not been  used.
Barnes states the case as follows: " If the patient is operated upon at
a  selected time, if  the danger of vomiting  is  lessened by not taking
chloroform, and if the  uterus contracts well after the operation, the
sutures may be dispensed with; but under the opposite circumstances
it would be better to  stitch the uterus."  If sutures  are used, either 
282
OBSTETRIC OPERATIONS.
 the uninterrupted silk suture or interrupted sutures of silver wire may
 be employed; or any other that may be thought most suitable.
   Before closing the abdominal wound, blood or other foreign mate-
 rial that has found its way into the abdominal cavity should be re-
 moved.   The lips of the wound should be brought together and held
 together  by  means of silver-wire sutures, introduced  pretty closely
 together, and passing  through the  divided  peritoneum as  well as
 through the  abdominal wall,  so  that  there  may be two peritoneal
 surfaces opposed to each other on the inside of the wound.  Adhesive
 inflammation is soon  set up, and  union is speedily effected.  Broad
 bands of adhesive plaster should be applied across the  abdomen as a
 means of support, and over these a soft compress should be laid.  A
 broad flannel body-bandage  should then  encircle  the abdomen to
 secure uniform  support.  The compress and the bandage should be
 saturated in the  region of the wound with a solution of equal parts of
 calendula and water.
   The dangers  arising from  this  operation are: immediate  shock,
 hemorrhage,  peritonitis and septicemic puerperal fever.   Should  any
 of these  arise,  they should be treated strictly in accordance  with
 homoeopathic principles;  an adherence to which  will  greatly lessen
 their  dangers.   The patient should be  kept very quiet  after the ope-
 ration, and for some hours'should  be allowed to take little or nothing
 into the  stomach save  cold  water, which may be freely allowed.  To
 excite vomiting  is to add an additional and  unnecessary risk.  The
 danger  arising  from vomiting contra-indicates the use of chloroform ;
 ether  will be preferable.  Local anaesthesia by means of rhigolene or
 ether  spray has  been recommended, and is free from the danger of
 exciting vomiting.  Where this  operation is performed  under the
 most  favorable  circumstances  there is a very great probability that
 the lives of  both mother and  child will be saved; but  where ex-
 haustion from protracted labor or  other unfavorable conditions exist.
 the probabilities run strongly in the opposite direction.

       The Sigaultean  Operation, or  Symphyseotomy.
  This operation has been performed with the same object in view as
 in the Csesarean section—viz.,  the extraction of a living child which
could not be born by the natural passages.  It consists  in  cutting
 through the fibro-cartilage which con-titutes the symphysis pubis, so
as to  separate the pubic bones, and by that means  to increase the
diameters of the  pelvis  sufficiently to allow of the passage  of the
foetal  head through  the pelvic canal and vagina.  As it has  been
t 
OBSTETRIC OPERATIONS.
283
abundantly proven that the pubic bones, when their symphysis is thug
divided, admit of but slight separation, and that this separation  adds
but very little to the diameters of the pelvis, the operation has fallen
into discredit, and is seldom or never resorted to.

              Induction of Premature Labor.
  The induction of premature labor is  admissible under certain cir-
cumstances.   By premature labor  we  mean  that only which  may
take place  after the viability of the child  is  established beyond  a
doubt.  This period first occurs immediately  after the close of the
seventh month.
  In all cases where the excavation of the pelvis is so obstructed by
any cause, either by pelvic deformity or by tumors of any kind  that
cannot be reduced  or pushed  above  the  superior strait,  which  will
prevent the passage of the child  at full term, premature labor may be
effected; provided always that such a course will give a reasonable
assurance of saving the life of the child, and at the same time of pre-
venting greater sufferings and danger to the mother.
  Should the history of  the patient prove that she cannot give birth
to a child  at term, and  should  the smallest diameter be about two
inches and a half, premature labor should be resorted to immediately
after the completion of the seventh month.  If we could be assured
that the smallest diameter is three inches, we may delay the operation
till about the eighth  month; if three and a half inches, two weeks
before full term would suffice.
  Under judicious  homoeopathic treatment no diseased condition of
the patient would ever render necessary a premature delivery.  Neither
would it ever prove admissible to induce premature labor because the
previous history goes to show that the child  perishes at the eighth
or eighth and a  half month ; for all such cases are perfectly curable
by medicines.
  Various  methods of inducing premature labor have been resorted
to.  The author regards the following as the safest and best:  The
patient to be operated upon may  assume the same position  as in labor.
The bed should  be protected with oil-cloth  or india-rubber cloth,
arranged so as to guide a stream of water from the vulva into a pail
or tub placed near the bed.  Another pail must be provided, contain-
ing tepid water: with a  common syringe  the warm water should ,be
thrown directly upon the  os uteri.  This operation irritates and softens
the neck of the uterus, so that contractions set in in the course of an
hour or two, and thus labor is provoked and takes place in the  most 
281
OBSTETRIC OPERATIONS.
natural manner possible, except when it occurs in Nature's own way
at full term.  The operation will  fail  unless the stream is so directed
that it shall fall directly upon the neck of the uterus.  It should be
repeated in the course of two hours, unless the first experiment is
successful.   The common pump-syringe is the  best for this purpose.
The quantity of water used at each operation should be about  ten
quarts.   Another  method, and one  very highly commended  by Dr.
Barnes, is to pass an elastic bougie or catheter six or seven inches into
the uterus, avoiding the placenta  and  taking care not to  rupture  the
membranes.  The remainder of the bougie should be coiled up within
the vagina, and this  will serve to keep the instrument in situ.  Sooner
or later uterine action will set in.  The  os  may then 'be dilated by
means of Barnes's dilators, the membranes ruptured, and  the rest left
to nature if it is  found  that expulsive pains  come on  sufficiently.
If not, the forceps or turning may be resorted to.
  Premature labor should never be  induced without grave considera-
tion  of the  case, and professional advice should be sought  by the
accoucheur in all such cases, as well for the  advice as for a division
of the very  great responsibility.
  Of the production of abortion we  have this to say: Can it be right
under  any circumstances whatever?  Is it right to commit  willful
murder under  any circumstances whatever ?   If not, then it is never
right to produce abortion under  any  circumstances whatever, for is
not abortion murder ?
  We have  abundance of proof that  under  homoeopathic treatment
no state or condition of health demands the production of abortion—
that is, premature delivery before the product of conception is viable—
for the subject of such a malady as might be thought to necessitate it
under allopathic resources may be cured by homoeopathic  medication,
not only of  the ills  immediately occasioned by pregnancy, but of all
ailments reducing the standard of general health.   Abortion, there-
fore, under such circumstances would  be a terrible mistake; and not
only does it destroy the life of the embryo, but it lowers the standard
of health and endangers the life of the mother.  Cases in which the
least diameter of the pelvic excavation is below two and a half inches
had  better be allowed to go to term, and then submitted to operative
interference.  If the Cesarean operation should then be performed
and under favorable  circumstances, the lives of both mother and child
may  be saved; the  chances  in favor  of  which are undoubtedly in-
creased  by the after-treatment being  conducted in accordance with
homoeopathic principles. 
DISORDERS INCIDENTAL TO PREGNANCY.          285
                      CHAPTER XVI.

        DISORDERS INCIDENTAL  TO PREGNANCY.

   IN a state of perfect health all the functions of the body are so har-
    moniously carried on—each receiving its proper  portion  of the
 vital  force in due season—that no  one preponderates over another.
 But where, as in cases of excessive  intellectual  development in chil-
 dren, any one structure obtains more than its just share, the others
 must suffer  in equal  ratio.   Gestation is  indeed a normal condition,
 but the remarkable development of vital  action in the uterus renders
 it an exceedingly difficult task  for nature perfectly to  adjust the bal-
 ance.  But while in  general a similar increase of vital action seems
 to  pervade  the  entire system, the health  remaining perfect, there are
 numerous and sometimes  most distressing exceptional cases.  The
 greater number of these  appear in connection with the nervous sys-
 tem, and at first take the form of sympathetic irritation.
   There are other  disorders in the pregnant state which arise from
 mechanical pressure, and even displacement of the abdominal organs,
 by the gravid uterus.  And there  is still another class of disorders,
 severe functional derangements, and even  deeper-seated derangements
 of  the elementary constituents of the blood, which seem to be the re-
 sult of some of those before mentioned.
   All these sympathetic irritations, structural difficulties and derange-
 ments of the constitution of the blood, acquire a still greater import-
 ance from the fact that they become the occasion for the development
 of  every constitutional weakness  and hereditary taint.  The way is
 long and tedious; what wonder then that the heavily-laden system of
 the pregnant woman sometimes stumbles?  How  much greater the
 wonder if the nine  months of gestation, even before being concluded
 by  perhaps twice as many hours  of almost convulsive effort, should
 not expose and  aggravate  every inherent debility and fully develop
 every latent miasm!
  There is yet another class of difficulties, which, if they  do not actually
 make their first appearance during gestation, then at least for the first
 time become seriously troublesome; this class  includes disorders con-
 nected with the uterus itself and with its appendages.   Some of these
are structural diseases of the vagina, os or cervix  uteri, unnoticed be-
fore, now rapidly developed.   And even if  there were no morbid
 conditions, the suspension of the regular catamenial flow could not bur 
 286         DISORDERS  INCIDENTAL  TO PREGNANCY.

 exert an important disturbing influence upon the m :>re delicate female
 constitution.
   But from whatever cause they arise, and to whatever class they may
 be referred, all the disorders of pregnancy require the most patient
 and careful attention on the part of the homoeopathic physician.  The
 season of gestation  is the time given  him for sowing the  good seed
 from which his patient may reap a rich  harvest of improved health
 during all  her subsequent life.   The  fact just  mentioned, that  the
 almost herculean labors of nature tend to develop and ultimate all the
 hitherto latent, hereditary predispositions to disease, renders this period
 of gestation at  once of the greatest value to the true physician and of
 the most serious importance to the patient.  For even as an  hereditary
 tendency to phthisis pulmonalis may be most readily and radically
 cured when its temporary development in  a  bad cold, or  even in a
 severe attack of pneumonia, renders its  characteristics more apparent,
 so the exaggerated manifestation of her constitutional disorders which
 in one form or another  so afflicts the pregnant woman, may be made
 the opportunity for radically purging them  from her own system, and
 at the same time of purifying the constitutions of all her children.
   As already intimated, the tremendous strain upon the  constitution
 during  pregnancy finds  its  crisis  in  the agonizing labors of par-
 turition.  These are  rendered all  the  more terrible, are sometimes
 followed by the most  disastrous  consequences,  and  even rendered
 immediately fatal,  by  the culmination of the disorders  developed
 during gestation.  Thus,  the same sedulous attention on the part of
 the true physician which will relieve her from  present  sufferings
 during the  long months  of pregnancy, will also render her confine-
 ment much more  safe  and easy,  and  entirely prevent those  conse-
 quences which  so  often fiU  her subsequent life with wretchedness.
 And the invaluable means and methods committed to the homoeopathic
 physician will  often enable him  not only to ameliorate the unfortu-
 nate condition  of his suffering and despondent patient, but in many
 instances to secure for her the preservation of the fruit of her womb.
 In the homoeopathic jurisprudence, morning sickness and  all other
forms of gastric derangement must be  entirely  stricken  from the
list of justifiable causes for inducing premature delivery.   The most
distressing  of these  cases are relieved  and the offspring preserved,
where under allopathic regime  the health  of  the  mother  was  often
rendered permanently wretched, and the  child inevitably  sacrificed
 at an earlier or later stage of pregnancy.
  And in many instances in which  the mother had  suffered  for many 
DISORDERS INCIDENTAL TO  PREGNANCY.         287
months from the disorders  of pregnancy incidental to her constitu-
tion, and had in consequence greatly deteriorated in her own vital
nutrition,  the child, if not actually destroyed, became of necessity
greatly enfeebled.  Such results are too common in allopathic  prac-
tice to attract much attention, and  such  offspring go  far to  swell
the bills of mortality to the frightful  extent of one-third of all who
are born dying within  the first three years.  Contrast with this the
fine healthy child born  after the mother has been relieved of her dis-
tressing disorders of pregnancy, and  in a great measure at the same
time cleansed of her constitutional  impurities by homoeopathic medi-
cation, and you have a picture of what has been done in thousands of
cases, and of what it is now the duty of the homoeopathic physician
at least to attempt to do in every case of the  kind.   He  is the true
physician who seeks not only to relieve the present suffering, but at
the same time to remove its cause in the constitution itself, and thus
prevent the return of the evil.  He is truly a benefactor of his kind
who,  not content with curing  the  generations  with whose  successive
portions he mingles, thus  seeks to improve his present opportunities
in the light of an advanced and  beneficent science, in such a manner
that the race may be  rendered  more healthy in all  the years  to
come.
   Our object in these remarks is  simply to call attention to the pro-
 found importance of most carefully treating  the  disorders incident
to pregnancy;  even in cases where their severity  does not  entail
suffering, they may thus be seen to afford most precious  opportunities
for permanently improving the  health of the mother, and of render-
ing  her confinement comparatively  comfortable  and perfectly safe,
and  of ensuring the preservation and health of the offspring; and
finally, of securing  the comfort of both mother and child during the
season of lactation.   We would state that, for reasons rendered obvious
 by the preceding remarks, the most valuable  and efficient remedies
•for the disorders incident to pregnancy will be found among the anti-
psorics; and that in some cases the higher these are given the more
good  they will do.    Such  is my  own  experience in very  many
cases.
   The disorders which appear during gestation vary in almost every
 possible. respect in  different women; each individual, however, usu-
ally suffering in the same manner whenever  enceinte, and with  the
same  comparative severity, unless relieved by appropriate homoeo-
 pathic medication.   In  some  women these disorders  appear with but
slight intensity, and soon pass away;  while others declare they never 
288         DISORDERS INCIDENTAL  TO PREGNANCY.

have  such good health as they enjoy when pregnant.   Others, again,
dread this condition as bringing with it for them a long train of vari-
ous and distressing sufferings, by which their health  is deteriorated,
their  strength exhausted, and their prospects in confinement rendered
gloomy in the extreme.   In some  instances these disorders  appear
very soon after conception, and in different forms continue during the
entire  period of utero-gestation;  in others  they are relieved  by the
third, fourth or fifth month; while in other cases the difficulties make
their  appearance only during the later  months, and continue to in-
crease in severity till confinement.
  An 1 while the disorders of pregnancy principally affect individual
cases  in one or more of their various forms, the entire range of these
forms, as  collected from the records of many cases, is found to cover
every function and particular organized system in the female economy.
The principal of these disorders may be classed under the following
heads:  Disorders of the digestive system  and  of  the  secretions and
excretions;  of  circulation and  respiration; of the  uterus  and  its
appendages; of  locomotion  and innervation;  and of  the affections,
emotions and feelings.

                    Hygiene of Pregnancy.
  A few words  on this subject,  which  is quite  as  important as  the
medical treatment  of the  disorders of pregnancy, inasmuch as it is
intended to prevent such disorders from occurring.
  In order that this period may be gone through with in a thoroughly
physiological manner, all unphysiological and unphilosophical habits
must  be  laid aside and all  pernicious  practices  abandoned.   The
pregnant  woman  should strive to cultivate for  herself the  utmost
cheerfulness and tranquillity of mind ; she should strive to be at peace
with all the world and  at peace with herself, for her mental and
moral  state will surely be engrafted upon her offspring, the education
of the future being commencing while yet in utero.  And in this effort she*
should be seconded by her husband, whose responsibility is very great
at this period—whose conduct toward  the  wife of  his bosom at this
period, acting upon her mental  organization, will  be  transmitted to
their joint offspring, for weal or for woe.   Medical men cannot be too
particular in urging this point on all suitable occasions, as it  falls to
their  lot  not alone to cure diseases, both mental and  physical, when
they exist, but as  well to prevent their occurrence when it is at all
possible to do so.
  A pregnant woman, during the whole course of her pregnancy, will 
             DISORDERS INCIDENTAL TO PREGNANCY.         289

 require more sleep than at other  periods, and an ample allowance of
 "tired  Nature's sweet restorer" should always be indulged in.   And
 yet, at the same time, habits of slothful ness are to be deplored and
 decried.  "Early to bed  and  early to  rise" applies with additional
 force at this juncture, and nine, or at the  latest ten, o'clock at night
 should  always find her in bed, and six, or at the latest seven, o'clock
 in the morning should find her up.  Habits of regularity in all things
 should  be cultivated—regularity as to hours for sleeping and waking
 —regularity as to  meals, exercise, stool, etc.  As much  exercise in the
 fresh air as is possible should be taken.   Walking is indispensable,
 and every day should  find her taking a walk  leisurely and with the
 mind at ease;  and this  rule  should be observed even in cold and,
 cceteris  paribus, unpleasant weather, excepting  when the  walking is
 dangerous from snow or  ice.   A walk is often an excellent remedy
 for the  slothfulness and heaviness that sometimes steals over the preg-
 nant woman like  an  incubus—a much  better remedy than taking  a
 nap, or  even than a prescription from the doctor.  Useful employment,
 reading or useful and agreeable conversation should engage the waking
 hours not otherwise employed.   In fact, the physician should enjoin
 upon his pregnant patients the  importance of cultivating  a proper
 condition of mental vitality as well as physical.   How important is
 it that the expecting mother, as  a  new thread  of life  is being  spun
 within  her, should think and do  that alone which is good and right,
 for of a certainty her  offspring  will have woven into the tissue of
 its existence the resultant  of what she is and does during her preg-
 nancy.
   It is  a fact worthy of  notice that as pregnancy advances the fluids
 of the body are increased  in  quantity, and of course an increase of
 circulating capacity is demanded.   This has, in connection with other
 points, a decided bearing on the question of dress during pregnancy.
 Unusual looseness about the waist is requisite, and as well about the
 neck, wrists and lower extremities; even an elastic garter spanning
 the leg may be injurious,  and everything that can retard or in any
 way interfere  with free  circulation should be, if possible,  avoided.
 The proper warmth of the  clothing should be studied with great care.
 Il should  be  composed  of such fabrics as combine lightness with
 warmth, so that proper heat of body may be maintained  without the
 discomfort of oppressive clothing.  In the later months, particularly,
 the clothing should not be tightened about the  waist at all.   The
 dress  should be allowed to fall loosely and gracefully from the neck
and shoulders, showing but little waist; and this will be found not
       19 
290         DISORDERS INCIDENTAL TO  PREGNANCY.

only most becoming, but far better for the mother and the fruit of hei
womb.   One  fact in connection with this question  of dress is  here
noteworthy—viz., that women  in the  later months  of  pregnancy
often complain of, and really suffer from, coldness of  the abdomen, the
protruding abdomen causing the  clothing to set off to the extent of
almost completely exposing that  part of the body to direct contact
with the air.   In view of this, the clothing  should be so adjusted, or
an  extra garment worn, to obviate the difficulty.  Physicians  will
greatly benefit their patients by giving strict directions in regard to all
these matters, which  are so apt to be regarded as minor  and insig-
nificant points.   *
  The diet during pregnancy should be generous in meats, vegetables
and fruits, and at the same time simple.   The less tea and coffee are
indulged in the better for both mother and foetus, as these have a tend-
ency to produce nervousness and  even convulsions.   Sugar, salt and
spices should be taken in moderation.  Stimulants of all kinds  should
be most strictly and religiously avoided.
  Very many of the discomforts arising at this period may be promptly
relieved or removed by a strict conformation to the laws of a rational
mode of life.   If, however, they should persist, and help seems neces-
sary to adjust and properly balance the deranged vital forces, help is
to be sought within the pale of homoeopathic medication, and the law
of the similars—here, as elsewhere, applicable—should be  brought to
exercise its wondrous health-giving powers.  Thus pregnancy judici-
ously managed prepares the way for the act of parturition, and, it may
be remarked, just as pregnancy has been free or freed from sufferings
and from complications, will, cceteris paribus,  the  act of parturition
and its post partum consequences  be  likewise free  from dangers  and
disorders.*

             Disorders of the Digestive  System.
  The disorders of  the digestive function and apparatus may be
enumerated under the heads of variations of appetite and taste, gastric
disturbances and intestinal affections.  Under the first of these heads
will be found anorexia, malacia  or longing, and bulimy;  under  the
second, nausea, vomiting and pyrosis; under the third, constipation,
diarrhoea and fissure of the  anus and  rectum.

               I. Variations of Appetite and  Taste.
  Anorexia, or want of appetite, and even disgust for food, very fre-
  *  From a pamphlet by the author, entitled "Before, During and After Parturition." 
VARIATIONS  OF APPETITE  AND TASTE.
291
quenl .y makes its appearance at the commencement of gestation ;  less
often it is seen only toward its close.   In some cases there is a loath-
ing for some particular kinds of food, especially meats; in other cases
there seems to be simply a general loss of appetite.  These symptoms
are usually supposed to  be the results of the sympathetic relations
existing between the stomach and the uterus, but their deeper meanjng,
already referred to, will be particularly stated in connection with that
of the other variations of appetite.
  Malacia or  longing, another not uncommon affection  of pregnant
women, consists in a depravation of taste, in which an almost univer-
sal loathing is combined with an exclusive longing for some particular
article of food.  Where something injurious or not used  for food is
desired, the abnormity is termed pica.  Chalk, charcoal, pepper, salt
food, acids,  alkalies, are sometimes  very strongly and persistently
craved  and eaten.   The  desire for particular articles of food should
be gratified to a reasonable  extent.  " The common tendency of the
appetite in pregnancy is  to prefer fresh vegetables, fruits and cooling
drinks, and to avoid stimuli of all kinds.  In this the taste of preg-
nancy accords  very well with all its requirements."—Smith.
  Bulimy, or inordinate and insatiable hunger, is another affection of
pregnant women ; which  here, as in other persons, generally indicates
some disorder of nutrition or assimilation, although it may be  due
simply to sympathetic nervous irritation.  All these morbid condi-
tions of the appetite are but indications of the various hitherto latent
dyscrasise,  developed now by the pregnant state.   And the careful ex-
hibition of the appropriate remedies will not only relieve the suffer-
ings of the patient, but will also greatly improve her general health,
as already stated.
  We  give the  various remedies  which  have been  found useful in
these complaints.  These should be  compared with those  more fully
stated  under  Gastric Derangements, and carefully studied  in  the
Materia Medica, in order to  determine which is  the appropriate
remedy in each individual case.
  Note.—In  arranging  these  remedies  for study,  they  have  been
classified and arranged  in groups.   Those in  group 1  are most
strongly indicated for the particular symptom  or  condition  under
which  they are found.  Those in group  2 come next in importance,
and those in group 3 occupy the lowest scale of relative importance.
  But  while these indications of the relative prominence of particular
symptoms in the confirmed pathogeneses of particular remedies are of
great value, they will be found  infallible only when they  lead to the 
292          DISORDERS INCIDENTAL TO  PREGNANCY.

determination of a medicine in accordance with the totality of the
symptoms.  And yet the totality of the symptoms will often be indexed
by the characteristic symptom on the side of the patient and by the corre-
sponding key-note on the side of the remedy.
  Finally, and as elsewhere observed in the present work; the charac-
teristic symptom of a particular  case may not be the most prominent
or even the  most distressing  symptom: especially is this  seen to be
the case where it consists in the  time  of aggravation or other similar
circumstance: nor yet will the key-note often be the most violent and
painful of the pathogenetic results of the drug.   The deepest streams
are the most still  and silent, and the true vital currents of the human
frame are far more subtle, profound and spirituelle than the noisy rivers
that rush through the arteries and the  veins.

Table of Remedies  for Variations of Appetite and Taste.
Anorexia—Want of Appetite.—1. Chin., Cycl., Nux v.,  Rhus
    tox., Sep., Sil.   2. Ant. cr., Arm, Ars., Bar. c, Bell., Bry., Calc.
    c, Canth., Cic, Con.,  Ignat., Lye, Merc,  sol., Natr. m., Op.,
    Plat., Puis.,  Ruta., Sabad., Sulph., Thuj.
Bulimy—Inordinate Appetite.—1. Calc. c, Chin., Cina, Jod.,
    Lye, Nux v., Puis., Sil., Verat. a.  2.  Ang., Aur., Bell., Bry.,
    Cocc, Kali c, Hell., Natr.  m., Oleand.,  Nux m., Petrol., Phos.,
    Puis., Rhus tox., Sabad., Stann., Staph.
Hunger without Appetite.—1. Natr. m., Op., Rhus tox.  2. Agar.,
    Ars., Bar., Bry., Chin., Dulc, Hell., Magn.  m., Sil., Sulph. ac.
Thirst—Too  great. — 1.  Acetic  ac, Aeon., Ars.,  Bry., Calc. c,
    Cham.,  Chin., Merc, sol., Sulph.   2.  Amm. mur., Ant. cr., Arm,
    Bell., Colch., Cupr. m., Hep., Hyos., Natr. m., Nitr. ac, Nux v.,
    Rhus tox., Sec. corn., Sil., Stram., Veratr. a.
------  Want of.—1. Apis,  Hell., Merc sol., Nux m.,  Puis.  2.  Agn.,
    Ars., Asaf.,  Camph., Con.,  Cycl.,  Euphorb., Mang., Oleand.,
    Sabad.,  Samb., Sep., Spig., Staph.
------with aversion to  drink.—1. Bell., Canth., Hyos.,  Nux v.,
    Stram.   2. Agn.,  Lach.,  Natr. m., Rhus tox., Samb.
Aversion to Acid Things.—1. Bell.,  Ferr., Sabad.,  Sulph.   2.
    Cocc, lgnat., Nux v., Phos. ac.
------Beer.—Bell., Cham., Chin., Cocc, Nux v., Phos., Stann.,Sulph.
------Brandy.—Ignat, Merc. sol.
------Bread.—1. Natr. m.  2. Con., Kali carb., Lye, Magn., Nitric
    ac, Nux v., Phos.  ac, Puis., Rhus, Sep., Sulph. 
"VARIATIONS OF APPETITE AND  TASTE.          293
Aversion to—Broth.—Arn., Ars., Bell., Cham., Graph., Rhus.
______ Coffee.—1. Bell.,  Bry., Calc. c, Cham., Lye, Nux v., Phos.
------Fat Food, Butter, etc.—1. Petr., Puis.   2. Ang., Ars., Bell.,
  Bry., Carb. an., Carb. veg., Colch., Cycl., Hell., Natr. m., Sulph.
------Solid Food.—Aug., Bapt., Ferr., Staph.
------  Warm Cooked Food.—l.  Bell., Calc. c, Graph., Lye, Petr.,
  Sil.  2. Cupr., Ignat., Lach., Magn. c, Mere., Verat.,  Zinc.
------Fish.—Graph., Zinc.  ------Fruit—Bary. e
------Meats of all kinds.—1. Mur. ac, Petr., Sil., Sulph.   2. Ars.,
  Calc. e, Carb. veg., Graph., Lye, Plat., Puis., Rhus,  Sabad., Sep.,
  Zinc.
------Meal and Flour (dishes made of).—Ars., Phos.
------Milk,—JEthusa,  Bry., Calc. e, Guaj., Puis., Sep., Sil., Sulph.
-----  Breast Milk.—Cina, Mere, Sil., Stram.
------Pork,—Ang., Colch., Dros.------Salt.—Carb. v., Graph., Sel.
------Sweets.—!. Caust,, Sul.  2. Ars., Merc s., Nit, ac, Phos., Zinc
----- Vegetables.—Hell., Magn. m. ------Sauer Kraut.—Hell.
------Water.—Bell., Calad., China, Nux v., Stram.
----- Wine.—1. Merc,  sol., Sabad.  2. Ignat., Lach., Rhus., Sulph.
Longing for—Acids.-^-l. Verat,  2. Ant. cr., Arn., Ars., Bry., Cham.,
   Chin., Hep., Kali, e, Lach., Phos., Puis., Squill., Stram., Sulph.
 -----Beer.—l. Bry.,  Mere, Natr. e, Nux v., Petr., Puis., Sabad.,
   Stront. 2. Aeon., Caust,, Cocc, Lach., Op., Phos. ac, Spig., Sulph.,
   Zinc.
 -----Bitter Things.—Dig., Natr. m.
 -----Brandy.—1. Lach., Op.   2. Ars., Hep., Nux v., Sel, Sep., Sul.
 ------Bread.—1. Ars., Plumb., Puis.   2. Aur., Natr.  m., Stront,
 ------ Cake's and Confectionery.—Plumb.   ------ Cheese.—Ignat.
 ------ Chalk, Coal, Slate-pencih, etc.—Cicuta,  Nitr.  ac, Nux v.
 ------ Coffee.—-1. Ang.  2.  Arg. n., Aur., Bry., Chin., Con., Selen.
 ------Fat Food.—Nitr. ac, Nux v.  ------Fruit—Verat., Ignat.,
   Phos. ac, Sulph. ac
 ------Liquid Food (soups, etc.).—1. Staph., Sulph.  2. Aug., Ferr.
 -----Lemonade.—Sahm. -----Meat—Hell.,Mage,Meres.,Sul.
 ------Meal and Flour (dishes made of).—Lach., Sabad.
 ------Milk.—\. Aur., Chel., Merc, sol., Sabad., Sil.   2. Ars., Bov,,
   Bry., Calc. e, Nux v., Phos.  ac, Rhus, Staph., Stront.
 ------ Oysters.—Lach.   ------Raw Potatoes and Flour.—Calc c.
 ------Refreshing Tilings.—Caust., Phos., Phos. ac, Puis., Valer.
 ------Salt Things.—Calc. e, Caust., Con., Nitr. ac, Thuja, Veratr,
     ---Smoked Things.—Caust, 
291         DISORDERS INCIDENTAL  TO PREGNANCY.

Longing for—5Wr Kraut.—Carb. a., Cham.
-----Sweet Tilings.—1. Amm. c, Arg., Chin., Kali, c, Lye, Natr.
   c, Rhus., Sabad.  2. Calc c, Ipee, Magn. m., Rheum., Sulph.
----- Vegetables.—Alum., Magn. e
----- Warm Food.—Aug., Cye, Ferr., Lye
----- Wine.—1. Cie, Hep.,  Sep., Sulph.  2. Aeon., Bry., Lach.,
   Spig., Staph.
                             Taste.
Taste, Bitter.—1. Bry.,  Cham.,  Merc,  sol., Nux v., Puis., Sep.,
   Veratr. a.  2. Aeon., Arn., Ars., Calc. c, Chin., Con., Dros., Ignat,,
   Lye, Magn. m., Natr. e, Natr. m., Sabad., Stann., Sulph.
------Diminished or Lost—1. Puis., Sil.  2. Calc. e, Sec. corn., Sulph.
------Metallic.—1. Cupr., Rhus tox.   2. Agnus e, Cocc, Nux. v.,
   Ran. bulb., Zinc.
 -----Putrid or  Offensive.—1. Arn., Merc, sol., Puis.   2. Ars., Bell.,
   Bry., Calc. e, Carb. veg., Cham-., Con., Jod., Merc, sol., Nux v.,
   Rhus tox., Sep., Stann., Staph., Sulph., Valer., Zinc.
------Saltish.—Merc, sol., Phos., Puis., Sep.  2. Ars., Carb. veg.,
   Chin., Jod., Lye, Natr. c, Rhus tox., Sulph., Tart, em., Veratr. a.
 ------Sour.—1.  Bell., Calc. c, Chin., Nux  v., Phos., Puis., Sulph.,
   Tarax.   2. Cham., Ignat., Kali,  c,  Lactic  ac,  Lye, Mere sol.,
   Natr. m., Petrol.,  Stann.
------Sweetish.—1. Phos., Plumb., Puis., Sabad., Squill.   2. Aeon.,
   Alum., Dig., Stann., Zinc.

                  II. Gastric Derangements.
   Nausea and Vomiting—Morning Sickness.—In many women
nausea and vomiting set in at an  early period of pregnancy, and are
simply the result of a peculiar reflex irritation of the stomach : in these
cases this  affection usually continues but a short time.  Those forms
of nausea and vomiting which  principally appear in  the later months
result, not from sympathetic irritation or reflex action, but from the
direct irritation of the stomach, and perhaps also of the diaphragm, by
the upward displacement.   Next to the cessation of the catamenia,
and especially in conjunction with it, morning  sickness becomes one
of the earliest as well as one of the most reliable original signs of
pregnancy;  while  for all those who have ever before  experienced it
there is little room for mistake in regard to  its nature; for  in each
individual in whom  it occurs it has a uniform type and well-remem-
bered  character.
  The nausea may occur at an  early period in the morning with un- 
GASTRIC DERANGEMENTS.
295
varying regularity, or in the evening, or at any period of the day, or
even of the night.  For each individual it maintains also its uniformity
as to the date of its first appearance: in some it begins very soon after
conception, in  others it appears toward the third or fourth  month,
and  in others again it comes on only toward the close of gestation:
in these  latter cases  it  may  have  appeared also for  a short time
soon after conception.  In the duration of this affection there is also
the same general variety and individual uniformity.  Thus in some
women it lasts but a few weeks, from six to eight at most; in others
it continues for four or five months; while in some few most distress-
ingly severe cases this  difficulty assumes the form of a formidable
disease, and persists  through the entire period of utero-gestation, un-
less  relieved by art.  And this unfortunate condition has sometimes
been still more fully developed and aggravated  by sea-sickness, so
that even life  itself has been lost where  the  voyage  was tedious,
homoeopathic treatment not being accessible.
   The nausea and vomiting of pregnancy, as already stated, are most
apt to occur on first rising in the morning ; sometimes these symptoms
disappear in a few minutes, sometimes they last through the  greater
portion of the day.  In some  the vomiting is very easy; in others it is
attended  with very severe retching, and even with other painful symp-
toms.  Those who vomit  upon waking or rising  in the morning
usually throw  up some viscid,  glairy  matters, which are generally
colored with a little  bile, especially if the retching has been very
severe.   Others vomit only after eating, occasionally after only one of
the daily meals, but sometimes after all of them.  Again, in some un-
fortunate cases  the vomitings continue even in the intervals of the re-
pasts, everything taken into the stomach, whether liquid or solid, being
immediately rejected.   There are  cases, finally, in which the  mere
thought of food, or the sight  or the smell of it, is sufficient to induce
the vomiting.—Cazeaux.
   In  some cases nearly all  the food ingested seems to  have been
thrown up, even  for months  in  succession, and yet  a good delivery
succeeds at full term; the repeated and  severe vomitings seeming to
exert comparatively little influence upon the general  health.   In like
manner, pregnant women may rise from the breakfast-table, vomit and
return to their food as if nothing had happened.  Such characteristics,
so different from vomiting arising  from any other cause, almost con-
clusively indicate the presence of pregnancy.  Important complica-
tions, however, arise in the greater number of more  severe cases, and #
the health of both mother and child is often greatly injured through 
296          DISORDERS INCIDENTAL TO PREGNANCY.
the marasmus  and cachectic  conditions which ensue.   Among the
most serious of the symptoms which appear in connection with severe
emesis is to  be reckoned the sense of tenderness at  the epigastrium.
This  may be  attended  by considerable  pain, which  is increased b)
pressure.  This epigastric soreness and tenderness, whether observed
in the earlier or in the  later stages of pregnancy, is  due to  the pro-
found irritation of the ganglia or plexuses of the sympathetic nervous
system which are  located in this vicinity.   And in this centre of
organic life, in the very constitution itself, are planted the psoric ele-
ments whose active development in pregnancy occasions these suffer-
ings and innumerable others, whose duration and severity but too well
indicate the gravity of the sources from which they are derived.  The
stomach itself is in no such direct sympathetic relation with the uterus,
but the latter organ is in profound sympathy with the organic nervous
system which is centred near the stomach, and which entirely controls
the compound  functions of digestion  and nutrition.  Hence the  ma-
rasmus and cachexia which  succeed severe cases of morning sickness
in the old practice; hence, too, the brilliant  successes  which in the
new school  follow  the  exhibition of  arsenicum and other powerful
and particularly indicated antipsorics.  Hence, too, while under the
allopathic regime these cases became worse and worse with each suc-
eeeding pregnancy, under homoeopathic treatment they become better
and better, until the woman finds she can pass through the formerly
so much dreaded period of  gestation with  little  or no suffering,  and
terminate her labor in a delivery as easy as it  formerly was difficult
and painful.
  Some of the remoter  consequences of the nausea and vomiting, or
rather of that morbid condition of the constitution itself which pro-
duces these symptoms—such as chlorosis, anaemia and albuminuria—
will be more fully described  in  a subsequent section.  In the same
connection it will be shown how the  disturbance of digestion, nutri-
tion and assimilation is followed by important changes in the consti-
tution and character of  the blood and  of some of the most important
secretions; and  how dropsies and other forms of structural disease
necessarily supervene.
  The diet and regimen of  the pregnant woman should be carefully
attended to: such articles as best agree should be advised in each
individual case, and equal  care taken to avoid every unwholesome
or irritating  influence.   It has sometimes been found that the exces-
sive irritability of the stomach  in pregnancy is due to the  presence
of fumes from  some neighboring manufactory, which, although  in- 
GASTRIC DERANGEMENTS.                 297
sufficient to induce any unpleasant symptoms in the ordinary condition
of the  woman, very  powerfully affect her when enceinte.  Homoeo-
pathic  remedies  may antidote the effects of these noxious vapors if
they are not too  powerful, but in the greater number  of such cases
a temporary removal from the neighborhood may be necessary.
  The  following medicines will be found to cover the principal forms
of gastric  derangements of pregnancy; and the  indications given
should  be confirmed by finding in  the Materia Medica a full corre-
spondence with the totality of  the symptoms  and accompanying con-
ditions.
  Aconite.  Nausea and perhaps vomiting,  with thirst;  fear of being
in crowds  or  of being in busy places; fear of death, or  fear that
something  untoward  will  happen.   Everything tastes  bitter  except
water.   Pain  in the  stomach  after every meal, headache, burning
sensation extending from the stomach all the way to the mouth.  De-
cided tingling  in the tongue or fauces, or in other parts.   Especially
adapted to  young, full-blooded and active women.
  Acetic acid.   Intense thirst,   Burning in the stomach; frequent
vomiting;  sensation as if the contents of the stomach were in  a state
of ferment. Abundance of pale urine.
  Agaricus. Gastric derangements, with itching, burning and  redness
of various  parts of  the  body, as  if frost-bitten—of the ears, nose,
cheeks, fingers or toes.  Much hunger, but  no  appetite.   Constipa-
tion ; the first  part of the  stool is very hard,  the latter part liquid.
  Alumina. Gastric, derangements with inactive state of the rectum,
so that even a  soft stool has to be  urged with much force to  cause it
to pass off; at the same time a condition often prevails in the oesopha-
gus, somewhere in its course, it may be in the chest, as though it were
constricted, even small portions of food are swallowed with  difficulty.
She has to strain at stool in order to urinate.  Tingling itching on
the tongue; she must scratch it.  Potatoes particularly disagree with
her. Loss of  taste; heartburn; eructations.  The peculiar alumina
constipation may characterize the whole case.
  Angnstura. Nausea when walking, as if she would faint; she has to
sit down   Stitches in the tip  of the tongue, painfully aggravated on
moving it.
  Antimonium  C. Nausea and vomiting,  or only nausea, with  white-
coated  tongue.   Watery stools, with occcasional hard lumps.   Fright-
ful vomiting, with convulsions.  Belching, with taste of what has been
eaten.   Thirst at night.   Painful sense of fullness of the stomach,
which  is sore on pressure. 
298          DISORDERS INCIDENTAL TO  PREGNANCY.
  Apis mel.  Irritable heartburn, extending up into the throat.  Sen-
sitiveness of the pit of the stomach to pressure, and burning therein.
Dyspnoea, with feeling that each breath drawn will be the last,  Very
scanty secretion of  urine.  Constipation or diarrhoea.  Absence of
thirst or great thirst.  Pains like bee-stings.
  Argentum n.   The head sympathizes with the gastric disturbance,
and  there are pain, vertigo, etc.  Time seems to  pass  very  slowly.
The stomach seems  as if it would burst from flatulence accumulated
therein, accompanied with great desire to belch, which is accomplished
with difficulty and the flatus is emitted with great violence.   Belching
after every meal.  Belching affords great relief.
  Arnica. The derangement is the result of concussion.  The motion
of the foetus gives rise to pain.  Bruised and sore feeling throughout
the stomach and abdomen.  Belching, as of rotten eggs.   Frequent
eructations.   Vomiting of blood.  At night the head  is  very  hot,
while the trunk and extremities are cool.
  Arsenicum. Very  great debility and exhaustion;  the least effort
causes exhaustion.   Very pale, white  look.   Bitterness in the  mouth,
particularly after eating  or drinking; sensation as of a stone in the
stomach.  Cold water seems to lie in  the stomach as if it did  not as-
similate,  therefore  she cannot drink it,  although she  desires it.
Nightly vomiting.   Vomiting of fluids as soon as she takes them.
Lienteria; exhausting diarrhoea.  Feels cold, and  wants to be in a
warm room, or to be covered up warmly.  Very uneasy and restless.
Fluids do not agree  with the stomach, and cause nausea.  Vomiting
of blackish or greenish matter.
  Belladonna.   Face flushed or very pale, eyes red ;  throbbing of the
carotids;  dread of light and of noise.  A putrid taste arises from the
fauces, also while eating  and  drinking, although the food  testes  nat-
ural.   Nausea  in the throat.   Vomiting of  bile.  The symptoms
become worse in the afternoon and evening.   Sour vomiting.   Thick
coating on the tongue.
  Borax. Dread of  a downward motion.   Everything tastes bitter,
even the saliva.   Distension of the stomach after every meal.   Vom-
iting of food and mucus.  Symptoms  are worse in very warm weather.
  Bryonia. Nausea on waking in the morning.  Her nausea is usually
relieved by keeping quiet. Dry, parched lips, dry mouth and tongue.
Splitting headache.  Vomiting of food immediately after eating.  She
desires to keep still.  The gastric derangement is ameliorated by keep-
ing quiet.  Stool of hard dry feces as if burnt.  Worse on sitting up,
even  sitting  up in  bed,  after being angry, in warm air, from warm 
GASTRIC DERANGEMENTS.                 299
weather or from warm  food.   Better in cool weather or from taking
cool food.
  Calc. carb. She cannot sleep after three in the morning.  Heartburn
and food eructations.  Vertigo  on running up stairs  or ascending.
Leucophlegmatic temperament.  Soreness  of the tongue, either on the
tip, sides or dorsum, so that she can scarcely talk or eat.   She can-
not bear tight clothing around the hypochondria.  Stitches in the liver
during or after  stooping, or at other times.   Sensation  as if the feet
were cold and damp.  Vomiting of sour  matter.  Feels better from
warmth, and cannot bear cold  air.
  Cantharis. Gastric difficulties, accompanied with very  frequent mic-
turition,  with  cutting  and burning pains,  only a few drops  being
emitted at a time, and sometimes with  blood.  Sensation of fullness,
extending into  the chest and abdomen, after taking coffee.  Burning
in the region of  the pylorus.   Vomiting with violent  retching and
severe colic.
  Carbo veget. She has to eructate frequently, which affords only tem-
porary relief of her many sufferings.   Sensation as if the oesophagus
were contracted or entirely closed.   Even  the most innocent kind of
nourishment disagrees with her.   Sensation  as if the stomach and ab-
domen would burst when eating or drinking.  Varices of the rectum,
vagina, vulva or lower extremities.  Itching of the genitals, perineum
and anus.
  Causticum. Phlegm in  the throat, which she is unable to hawk up,
and which sickens her.  She  sits down to the table with some appe-
tite, but can  eat  scarcely a morsel.  Constant  sensation as of lime
being burned in the stomach, with rising of air.   Stitches in the liver
for hours in  the  afternoon.  Haemorrhoids, which cause great suffer-
ing on walking.   Her upper eyelids  are nearly paralyzed, she cam
hardly keep them open.  Fatty taste.  Constipation.  Stools  tough
and shining, or hard and in pieces at first  and afterward soft.
  Chamomilla.  The existing pain is increased by eructations.  Nausea
as if  she would faint.   Great irascibility of temper—she can hardly
return a civil answer.  Burning across the .stomach  into each  hypo-
chondria.  The epigastrium is painfully bloated in the morning, with
a sensation as if its contents were passing into the chest.  The belch-
ing of wind  is painful.   She cannot  compose herself  to sleep; she
imagines she hears the voices of absent persons.
  Chelidonium. There is a constant pain under the lower inner angle
of the right shoulder-blade;  this pain  may extend into the chest or
stomach, or even cause severe  gastralgia, nausea and vomiting.   Her 
300          DISORDERS INCIDENTAL TO  PREGNANCY.
n^isea  causes great heat of the body.   Great desire  for  milk,  the
drinking of which ameliorates all her symptoms.
  China. The abdomen feels full and tight as if stuffed—eructations
afford no relief.   There may be diarrhoea and dejection of much flatus,
but no relief is obtained.   In connection  with the tightness about the
abdomen, she often  feels as if her garters were  too tight, and loosens
them, and  as if her waist were  too  tight; she  must loosen that,  etc.
Bitter taste in the back part of the throat, bitter taste of everything.
She craves dainties, but hardly knows what.   Flat or sour taste.
  Cina.  Grinding of the teeth,  tumbling and  tossing during sleep.
Diarrhoea always after drinking (compare Arsenic).  Inclination to
vomit, with  a weak, hollow,  empty  feeling in the head.  Constant
pressure in the stomach at night, causing  restlessness.  Itching of the
nose, occasioning boring or rubbing of it.  Always hungry.  Cross
or peevish.
  Cocculus. Burning in the oesophagus extending into the fauces, with
a taste of sulphur in the mouth.  She is scarcely able to raise herself
in the morning from nausea and inclination to vomit, it makes her so
faint.  Metallic taste in the mouth.   Sensation  in the abdomen as if
sharp stones  rubbed  together on  every movement, and  the  lower  ex-
tremities seem almost  paralyzed.  Yellow-coated  tongue, with aver-
sion to food.   Fetid eructations.  Worse  from riding in a carriage or
from sailing.  Painful  sensation of fullness in the stomach.   Frontal
headache.  Nausea which is felt in the head.
  Conium. Vertigo, particularly on turning over in bed.  The urine
intermits  at  every emission.  Stinging in  the  neck  of the  uterus;
scirrhus of any part.  Terrible nausea and vomiting during pregnancy
in women having scirrhosities.  The patient always feels worse after
going to bed—so much so that  she is obliged  to sit up or to walk
about to get relief.  Bitter taste.  Eructations with heartburn.
  Crocus.  Sensation  of fermentation in the stomach, or of  motion
upward and  downward, hither and thither.  Feeling of nausea in the
chest and throat as if she would vomit.   Very violent heartburn.
  Cuprum  ars. Constant, nausea.  Vomits everything.   Very weak.
Pulse quick and full.  Spasmodic uterine pains.
  Cuprum met. Violent vomiting of frothy mucus.  Sometimes green.
When-drinking the  fluid descends with a gurgling noise.   Sensation
in the &tomach  as if  she had something bitter in it.  The violent
nausea and vomiting  are relieved  by drinking cold water.   Intense
coppery taste.  Profuse salivation.
  Cyclamen. After eating the least quantity, disgust and nausea in  the 
GASTRIC DERANGEMENTS.                 301
mouth and throat.   Much dimness of vision, with fiery specks and
sparks before the  eyes.   Intermittent thirst.   Violent  hiccough.
Fattv taste ; fat food disagrees.  AVants no breakfast,
  Digitalis.  Nausea, faintness or sinking at the stomach, as if she
would die.  Very slow pulse.  Light-colored stools.  Very persistent
nausea and vomiting—nausea even after vomiting.  Burning in the
stomach extending  up  the oesophagus.  Want of appetite, with clean
tongue and empty stomach.
  Drosera. Nausea  after eating fat.  The nausea is worse after mid-
night till  morning.  The mouth seems in a bitter state when eating.
Nausea with inclination to vomit.   Vomiting of slimy matter.
  Dulcamara. The sufferings are made worse by every cold  change  in
the weather.  Empty eructations, with throbbing as  from disgust.
Frequent  eructations while eating.   Sensation of retraction in the pit
of the stomach,  with burning.
  Ferrum  acet.  ATomiting of food,  with a  fiery red  face.  Renewed
vomiting  after eating.  Vomiting at midnight. Everything she vomits
tastes sour and acrid.   Vomiting of blood.   Nervous erythism.
  Gossypium.  Great distress, weakness  and prostration.  Has been
useful in  very bad cases.  Nausea  particularly before breakfast.
  Graphites. Itching blotches here and there over the body.  Vesicular
eruptions, from  which oozes  a glutinous watery fluid.   Sore  varices.
Constipation or  diarrhoea.  Feces very large and difficult of passage.
Nausea with vertigo, so that she is afraid to walk.  Rancid heart-
burn, particularly after eating.  Taste in the mouth as of rotten eggs
every morning, wdiich  nauseates her.  Much headache.
  Helleborus. Urine scanty, dark and depositing a coffee-ground sedi-
ment,  Nausea,  yet hungry;  still  the food is repulsive  although the
taste is natural.   Intensely painful burning in the stomach, extending
into the oesophagus.
  Hepar. Itching rash  in the bend of the arms and under the knees in
the popliteal space.   Frequent  and momentary attacks of nausea.
Vomiting every morning.   Inclination to vomit, with flow of saliva
from the mouth. Constant sensation of water rising in the oesophagus,
as if she had eaten sour things.
  Ignatia. Great sense  of emptiness at the pit  of the  stomach, with
sighing and great depression  of spirits.   Full of suppressed grief as it
were.  Sensation as if she had  been fasting a long time, with flat taste
and languor in the  limbs.  Hiccough.  Flat, sour or bitter taste.
  Ipecac. One continual sense of nausea all  the time—not a moment's
relief.  Vomiting of large quantities of mucus.   D/arrhcea and colic. 
302          DISORDERS INCIDENTAL TO  PREGNANCY.
Disgust for food, empty retching; vomiting of food, slime or blood;
sour vomiting.  Cutting pains about the umbilicus.
  Jodium.  Continual empty eructations from morning  till  evening,
as if every particle of nourishment were turned into gas.   Nausea
and vomiting  of saltish-tasting substances.  A continual taste of salt
in the mouth.  Offensive taste.  Symptoms relieved for a short time
by eating.   Does not gain strength from her food.
  Kali bich. Discharge from the stomach, throat or mouth, or from
any of the mucous membranes, of a tough, stringy mucus, inclining
to stick to  the parts and drawing out in long strings.
  Kali carb.  Very sleepy  during a meal.   Nausea as if she would
faint, relieved by lying down.  Vomiting, with  a swoonlike failing
of strength; much colicky pain  in  the abdomen of a stitching cha-
racter.  Disgust for food.  " Sickness of pregnancy without vomiting,
coming on  only during a walk, feeling as if  she  could lie down any-
where and  die."
  Lactic acid.  Nausea and vomiting of sour substances.  Sour taste.
  Laurocerasus. Attacks of suffocation, with palpitation and a sort of
gasping for breath ; must lie down sometimes to  find relief.  Eructa-
tions tasting of bitter almonds or prussic acid.   Violent pain in the
stomach, with loss of speech.   Disgust for food.
  Lycopodium. Much rumbling and working in the abdomen;  gurg-
ling in the left hypochondrium.   Sensation of satiety, on account of
which she  cannot eat.  Red sand in the urine.  Great pain before
urinating, and relief as soon as the urine begins to flow.  Immediately
after  a meal sensation as of fasting, but no hunger.  Much  heat  in
the face after  eating, particularly in the left cheek.   Heartburn from
the stomach, the  acidity rising into  the throat,   After eating pain  in
the region  of the liver and palpitation of the  heart.  Vomiting of
sour matter or of bile.  Aversion to  bread.  Bitter, fatty or sour taste.
Varices in  lower extremities or vulva.
  Magnesia carb.  Much sour taste and sour vomiting.  All her symp-
toms are aggravated every  third week.   Much roughness or stinging
or burning in the throat, with desire to vomit.  Much loathing with-
out desire to vomit,  Eructations tasting of rotten eggs.
  Magnesia mur. Constipation of large  difficult stools, which crumble
as they leave the verge of the anus.  A  continual rising of white froth
into the mouth.  ElMctations tasting like onions.  Fainting nausea,
succeeded  by  coldness and  weakness in the  stomach and gulping up
of water.   Loss of taste, or bitter taste.
  Mercurius.  Much salivation, ulcerated  gums,  sore and  elongated 
GASTRIC DERANGEMENTS.
303
leetii.  Mucous stools, followed by tenesmus.  Rancid heartburn after
a simple supper.  Heartburn all night.   Ptyalism with nausea, wak-
i g her from sleep, particularly after twelve at night.   The pit of the
 tomach is very tender to the touch.  Taste bitter, offensive, saltish
or sour.  Eructations and heartburn, vomiting of bile or of food.
  Moschus. Violent eructations tasting like musk, sometimes of o-arlic
The sight  of food makes her sick.  Eructations with hot saliva in the
mouth.  Heartburn with palpitation.
  Natrum  mur.  Waterbrash  like limpid mucus, profuse and constant.
She always awakens in the morning with  headache.   She craves salt.
Has a strong aversion to bread.  Clawing  in the pit of the stomach.
Feeling of great hunger, as if the  stomach were empty, but no appe-
tite.   She always has heartburn after eating.   Very much nausea,
particularly in  women using  much  salt  food.   Dreams at night of
robbers being in the house; she must have the house searched in order
to be satisfied.  Loss of taste or flat, bitter or sour taste.  Much belch-
ing.   Heartburn and  palpitation of the heart.  Vomiting of food.
  Nitric acid.  Much nausea  and gastric trouble,  relieved by moving
about or riding in a  carriage.   Constant nausea with  heat in the
stomach, extending to the throat.  Fat food causes nausea and acidity.
 Exceedingly strong and offensive urine, smelling like  that of horses.
  Nux mosch. Mouth, tongue and throat very dry, so that  they " stick
to one another," particularly at  night.  Sensation of fullness of the
stomach, with  tightness of breathing; very useful for this symptom
in the last months of pregnancy.  Disposition to faint.  Great sleepi-
ness.
  Nux vom. Thinks she would feel better if she could vomit.  Nausea
and vomiting every morning, with constipation;  large, difficult feces.
Putrid taste low down in the pharynx when hawking  up  mucus.
Food and  drink have a fetid smell to her.  She  cannot  bear the odor
of tobacco.  Stools very small and frequent,  with frequent and pain-
ful urging.  Not much appetite; restless sleep, particularly after three
A. M., with nausea and vomiting in the morning and great depression
of spirits.   She cannot enjoy reading or  conversation.   She is irrit-
able  and wishes to be  alone.  Canine hunger; aversion  to water  and
bread.  Longing for beer, brandy, etc  Bitter or sour taste.   Belch-
ing, eructations, hiccoughing, heartburn.   Vomiting of food, of bile,
of black or sour matter.
  Opium. Constipation. Stool consists of round, hard, black balls.
Longing for brandy.
  Petroleum. In women affected with diarrhoea only in  the daytime; 
304         DISORDERS INCIDENTAL  TO PREGNANCY.

nausea when riding, she cannot ride in a carriage.  Flat or sour taste.
Vomiting  of bile.   Aversion to  fat food and to meat.   Particularly
applicable  in all gastric troubles of pregnant women.
   Phosphorus. Constipation with  narrow, long,  hard,  drv feces, dif-
ficult to evacuate.  Very weak feeling in the abdomen.   Heat up the
back.  Profuse watery diarrhoea, pouring away as  if from a hydrant.
Sour eructations  and  sour vomiting.   Saltish, sour or sweetish taste.
Vomiting  of blood or of sour matter.  Vomits water or food soon as
it gets warm in the stomach.
   Phosphoric acid. Sensation  as  if the  stomach were being  balanced
up and down.   Bread tastes  bitter.   Nausea, as if in  the palate  or
throat.  She frequently rises at night to pass large quantities of color-
less urine.   Much debility.   Great indifference.
   Pulsatilla.  Pulsations  in the  pit  of the  stomach.   Vomiting of
mucus.   Bad taste in the mouth every morning on awaking;  she has
to wash it  out soon,  it is so bad she  cannot bear it.  Nothing tastes
good to her.  Absence of thirst; she does not relish as much water as
usual.   Nightly diarrhoea, stools very changeable.  Loss of taste,  or
bitter, fatty, saltish,  sour or sweetish taste.  Eructations.  Nausea.
   Rhus tox. Putrid taste after the first mouthful.   Pain between her
shoulders on swallowing food.   Very restless at night, particularly
the latter part of the night; she must turn frequently in order to find
an easy position.    No appetite, or  hunger without  appetite.  Un-
natural or  metallic taste.  Eructations and nausea,  with  inclination to
vomit.  Cramps in legs at night very severe.
   Sabadilla. No relish for food  till  she takes  the  first morsel, when
she makes  a good meal.   A kind of heartburn, the heat commencing
in the  abdomen and extending upward to the  mouth.   Much nausea
and  vomiting, with  heat in  the abdomen.   Vomiting of ascarides.
Horrid  burning in her stomach, as if it would burn  up through into
her throat.  Aversion to meat.   Sweetish taste.  Salivation.  Fre-
quently spitting insipid  water.
   Selenium. Violent beating  of  the pulse  in the  whole  body after
eating, particularly in the abdomen.  Longing for brandy.
   Sepia.  Vomiting  of  milky  water  or milky mucus.  Sense  of
emptiness at the pit of the stomach; the thought of food sickens her;
a sense of weight in the anus.  Eructations tasting like spoiled eggs.
Taste as of  manure.  Aversion  to  meat.  In the morning, nausea
as if all the viscera were turning inside out.  Inclination to vomit in
the morning when  rinsing her  mouth.   She cannot take her accus-
tomed ride in the morning on account of nausea.   Want of appetite. 
GASTRIC DERANGEMENTS.                 305
Taste bitter or saltish.   Eructations.  Disgust for all  kinds of food.
Vomiting of  food and bile.   Smell of food nauseates.
  Silicia. Hungry, but she cannot  get down food, it is so nauseous.
Prolonged  after-taste of food.   Nausea, with violent palpitation  of
the heart.  Nausea after every exercise that raises the temperature  of
the body.  Constipation, as if from inactivity of the rectum, the stool
receding after partial  protrusion.  Taste of  blood in the morning.
Aversion to meat.   Loss of taste.   Nausea and vomiting.
  Staphysagria.  Sensation as if the  stomach were  hanging down
relaxed.   Shortly after  a full  and substantial meal she feels very
hungry.  Extreme  hunger even  when  the  stomach is full  of  food.
Flat taste.  Constant accumulation of water in  the  mouth.  Very
sensitive to all moral or physical influences.
  Stramonium.  Troublesome thirst,  even with  very  much saliva.
Every kind  of  food tastes  like straw;  in  fact, she has  no  taste.
Nausea, with flow of very saltish-tasting saliva.  Fears solitude.
  Sulphur.  Profuse  salivation, the taste of which causes nausea and
spells of  vomiting.   All the  trouble seems to be  caused by  the
nauseous salivation.   Flashes of heat; heat on the top of the head ;
cold feet; short sleep at night—she wakes very frequently.  Profuse
waterbrash.  Aversion to meat and  craving for brandy.  Bitter,
saltish or sour taste.  Belching;  eructations;  sour vomiting.
  Sulphuric acid. Coldness and relaxed feeling in the stomach; loss
of appetite and great  debility.   Belching;  eructations;  vomiting.
Tremulousness;  the weaker she feels  the greater  the sensation  of
tremulousness.  Is impelled to  do things hurriedly.
  Tartar em.  Vomiting  of large quantities  of  mucus.   Belching;
disgust for food ; nausea; salivation.
  Valerian. Heartburn, with gulping up of rancid fluid, which, how-
ever, does not rise into the mouth.  Nausea, as if a thread were hang-
ing in the throat, exciting  attempts  to vomit,  She feels nauseated,
faint, with white lips and body icy cold.  Fatty and offensive teste;
heartburn; risings into the throat; nausea in the throat.
  Veratrum.  Much thirst for cold  drinks.   Craves fruits and  juicy
articles of food.  Wants everything cold.   Violent retching.  Canine
hunger.  Craving for  acids  and salt  food.   Taste  bitter or saltish.
Eructations;  heartburn; nausea; inclination  to vomit.  Violent
retching and vomiting; vomiting  of bile.  Cold sweat on the fore-
head, with all the sufferings.  Feels very weak and faint.
  Zinc.  Taste of blood  in the  mouth  and sweetish  risings  from  the
stomach.   Terrible  heartburn  after taking  sweetish  things.  Great
       10 
 306          DISORDERS INCIDENTAL TO PREGNANCY.

 greediness when eating;  she cannot  eat fast enough, from canint
 hunger.   Much nausea  and vomiting.   Fidgety feet.  Aversion to
 meat.  Metallic taste.

   Pyrosis—Acidity—Heartburn.—These distressing  forms  of
 gastric disturbance sometimes make their appearance soon after con-
 ception,  while in other cases they may not appear  until after the
 fourth month.  Some women  are  remarkably subject to these symp-
 toms when enceinte ;  in others they are manifested with less violence ;
 in others not at all.  There  may be merely a burning sensation—
 heartburn in  the throat—which indicates sympathetic irritation; or
 the severer forms of  pyrosis, with acidity, which  arise from more
 fully-developed  gastroses.  As in the nausea and vomiting of preg-
 nancy, so in pyrosis,  heartburn and acidity, every degree of intensity
 and variety of manifestation and complication may be seen in different
 individual cases.  Sometimes  these disturbances are found  accom-
 panied with  and greatly aggravating the nausea and vomiting;  at
 other times they seem to appear instead of the vomiting.
   As in ordinary cases of dyspepsia, these sufferings are worse after
 taking particular articles  of food  or drink,  such as meats, fat meats
 or gravies, milk, fruit.   In the more severe  cases nearly everything
 that is  ingested  becomes  but an added  fuel to the burning of the
 pyrosis  and acidity.   Still, a careful  avoidance of  all those articles
 which, whether  solid or liquid,  are found most to disagree, and a
(areful  administration of the truly-indicated homoeopathic remedy,
 will, as in cases  of nausea and vomiting, go very far to remove  the
most distressing  symptoms, and eventually to secure a great improve-
ment in the general  health.   For these difficulties,  when not merely
the aggravations by pregnancy of  already existing  forms of  chronic
gastritis, are but the developments of constitutional dyscrasise hitherto
latent, as explained in the case of morning sickness.  And while the
classes of hereditary dyscrasise are  but few, still, modified as they are
in their  actual developments  by individual peculiarities, they require
a great variety of remedies for their proper treatment.   Not  indeed
many remedies  for each  individual case—for the more skillful  the
physician the fewer will  be the remedies which he will be obliged to
administer in  any given case, and the greater the  number of cases
which he will cure with a single remedv, sometimes even with a single
dose—but a, variety of remedies will be necessary to  correspond to the
 variety of disorders which result in different persons, even from the
same cause. 
                    GASTRIC DERANGEMENTS.                 307

   The doctrine of individual specifics  is based upon the most pro-
 found analysis of the human system and of the law of cure, and  is
 confirmed by the radical and constitutional  improvement—an im-
 provement which is  found  to  be the more radical  and  permanent
 the higher the potencies of the remedies  which  are  administered.
 The doctrine  of individual  specifics is therefore truly scientific, since
 it harmonizes the  results of practical experience with well-established
 principles, and even with those profounder explorations of our being
 in which matter is seen to fade into  spirit, and physiology to be re-
 placed by psychology.  The doctrine of general specifics leads to just
 the reverse of all  this, as well in principle as  in the ratio and extent
 of actual success.   For our allopathic and eclectic brethren, and even
 those  of the so-called physiological school  among the homoeopaths,
 are so manifestly blind that they totally ignore in therapeutics that
 predominance of  mind  over matter  which they do  not hesitate to
 admit in all other branches of scientific inquiry.   They prove them-
 selves materialists and  chemists—anything but true physiologists;
 while as to psychology, or the doctrine of the connection of the body
 with the soul, and of the  influence of  the latter over the former, they
 seem to regard it as entirely beneath their attention.  Hence, what do
 we see in the practice of all these classes alike but temporary expe-
 dients—which often result in manifest disaster, and  wliich always oc-
 casion more injury than  they are capable of discerning—instead of
 radical cures?   We see chemical antidotes which, if they sweeten the
 streams,  do it at the  expense of the fountains  ; and  mechanical ap-
 pliances  which not only fail to assist Nature, but in  many cases effect-
 ually prevent her from  helping herself.   Those  who  thus  pride
 themselves  in indulging in allopathic  and eclectic modes  of thought
are greatly to  be pitied;  they know not  what they do.   AH  the
advancing progress  of modern scientific thought  is against them,
and the  more  enlightened of  those  whom they  profess  to admire
despise them as foolish rejecters  of the  higher light held up before
them.

      Table of Remedies for Gastric Disturbances.
(Compare with the General Indications given on pages 292-294, as
                 well  as  with the Materia Med,ica.)
                 Belchings  or Eructations.
  Am.,  Bell., Bry., Cocc, Con., Merc sol., Natr. m., Nux v., Phos.
 Puis., Rhus tox., Sarsap.,  Sep., Sulph. ac, Sulph., Verat a., Tart. em. 
308         disorders incidental to pregnancy.

                         Hiccoughing.
  1. Amm. mur., Cycl., Hyos., Ignat., Nux v.  2. Agar., Bell., Bry.,
Puis., Ran. bulb., Veratr. a.

                     Pyrosis—He artburn.
  1. Calc. c, Con., Caust., Croc, Nux v.   2. Amm. c, Caps., Carb.
a., Carb. v., Chin., Jod., Lye, Merc, sol., Natr. m., Phos., Puis., Sep.
Valer., Veratr. a.  Lactic acid.

                  Risings into the Throat.
  1. Asaf., Merc, sol., Lach,, Plat.  2. Con., Phos., Spig., Valer.,
Veratr.  a.
                      Disgust for Food.
  1. Ipec, Kali e, Sep.   2. Ant.  cr., Bell., Bry.,  Puis.,  Sil., Tart.
em.
                 Nausea ("Sick at the Stomach").
  1. Ars.,  Caust., Cham., Hell., Ipec, Natr. m., Nux v., Puis., Rhus.,
Sil., Sulph., Sulph. ac, Tart, em., Valer., Veratr. a. 2. Aeon., Angust.,
Ant. cr., Argent, nit.,  Asar., Bell., Bry., Caps., Cham., Cyclam., Calc.
e, Carb. v., Chin., Con., Cupr. m., Graph., Kali e, Lye, Merc, sol.,
Mosch.,  Natr. m., Nitr. ac,  Phos., Squill., Sep., Stann., Sulph., Sulph.
ac, Valer., Tart. em.
  ------felt in the Throat.—1. Cycl., Phos. ac, Stann.  2. Ars., Bell.,
Chin., Cupr. m., Oleand., Puis., Staph., Valer.
  ------felt in the Chest.—Aeon., Bry., Croc, Merc, sol., Rhus tox.
  ------felt in the Abdomen.—Agn., Bell., Bry., Cupr., Cycla., Mang.,
Puis., Rheum.,  Samb., Tart.
                  Empty  Retching, Gagging.
  1. Bell., Ipec, Veratr. a.  2. Arn., Asar., Bry., Chin., Nux v.,
Puis., Sulph.
                           Vomiting.
   Vomiting of  Bile, Bitter  Vomiting.—1. Ars., Bry., Cham., Ipec,
Merc, sol., Nux v., Puis., Sep., Veratr. a.   2. Aeon., Ant. c, Arn.,
Bell., Bism., Calc c, Cann., Chin., Colch., Coloc, Con., Cupr., Dulc,
Ignat., Lye, Petrol., Plumb., Sec. corn., Stann., Sulph.
  ------of Black Matter.—1. Ars., Chin., Nux. v.,  Secale.  2. Ipec,
Lye, Petr., Phos., Plumb.,  Sulph. ac, Veratr. a.
  ------of Blood.—1. Arn., Ferr., Ipec, Phos. 2. Aeon., Argent, n.,
Canth., Chin., Nux v., Plumb., Puis., Sep., Sulph. 
INTESTINAL affections.
309
   Vomiting of what has been Drunk.—1. Ars., Phos., Veratr. a.   2.
 Aeon., Bry., Cham., Chin., Dule, Ipec, Nux v., Sil., Tart. em.
   ------of what has been Eaten.—1. Ars., Bry.,  Ferr.,  Nux  v.,
 Squill.  2. Amm. e, Ant. cr., Calc. e, Cina, Cupr.,  Dros., Hyos.,
 Ignat.,  Ipec, Lye,  Natr. m., Phos.,  Plumb.,  Puis., Sep., Stann.,
 Sulph., Veratr. a.
   ------of Fetid Matters.—1. Sep.  2. Ars., Cocc, Cupr. m., Ipec,
 Nux v., Op., Stann., Sulph.
   ------of Slimy Matter.—1. Dros., Puis., Tart, em.  2. Aeon., Ars.,
 Bell., Bor., Bry., Cham., Chin., Cin., Con., Dig., Hyos., Ignat., Ipec,
 Merc, sol., Nux v., Sec. corn.,  Sulph., Veratr. a.
   ------of Sour Matter.—1. Calc. e,  Chin.,  Lye, Nux  v., Phos.,
 Sulph.  2. Ars., Bell., Cham., Ipec, Lactic ac, Puis., Veratr. a.
   ------of Watery Matter.—1. Bry., Caust., Veratr. a.   2. Aeon.,
 Arm, Ars., Bell., Cann., Chin., Con., Cupr., Ipec, Nux v., Puis., Sil.,
 Stann.,  Sulph.,  Sulph ac.
   ------of Worms.—1. Aeon.,  Cina,  Ferr., Sabad.,  Sec corn.   2.
 Hyos., Sil., Spig., Veratr. a.

                  III. Intestinal Affections.
   Constipation.—This is so frequent an attendant of pregnancy that
 by some it has been deemed almost its natural consequence.  But it is
 much more  apt to occur, and is at the same time much more trouble-
 some and inveterate,  in pregnant women who from habits of life and
 constitutional peculiarities are predisposed  or  subject to it in their
 ordinary condition.
   The mechanical pressure  exerted upon  the rectum, by which its
 calibre is diminished and its action paralyzed, and  the habits of inac-
 tivity in which many  pregnant women  indulge, especially in cities,
 combine to produce costiveness.   And as a final result of the consti-
 pation, haemorrhoids, either blind or bleeding, appear in many cases.
 And the very great amount of vital force consumed in the womb may
 also tend to draw away from the intestinal  canal some of the energy
 that might have sustained its regular and daily evacuations.
   The indications for  hygienic  treatment  will be suggested by  the
 more apparent  causes of the difficulty.   Not only will  the  constipa-
tion itself be avoided in many cases by suitable and active exercise
 in the  open air, but many of the attendant complications and conse-
quences, such as headache and  rush of blood to the head, may in  the
same way be escaped.   The remedies will be indicated by the nature
of the discharges and by the accompanying symptoms and totality of 
310           DISORDERS INCIDENTAL TO PREGNANCY.
 the patient's condition.  The constipation being but one of the forma
 of development of the constitutional dyscrasia in many instances—
 whether the  most prominent symptom or not—requires a careful,
 radical treatment, by which not only will the present difficulty be re-
 lieved, but the general health improved, so that this  trouble will not
 appear in  succeeding  pregnancies.  The following remedies, as well
 as those detailed under  gastric  disturbances,  should be  carefully
 studied and compared  with the totality of the patient's symptoms:
  Aconite.  Where there is much thirst, a general dryness of the skin,
 a constant restlessness, and where  the same fears appear that are men-
 tioned in this remedy under gastric disorders.
  Alumina.  Constipation  from inactivity of the bowels; much effort
 must be employed for the  expulsion even of a  soft stool, so great is
 the apparent inaction of the rectum.  Absence of desire to evacuate.
  Agaricus m. Loud rolling and  rumbling in the  bowels.  The stool
 is very hard and knotty at first, then it becomes soft, and finally diar-
 rhoeic, especially if there are red,  itching and burning frost-bite look-
 ing places on the feet,  hands or face.
  Anacardium. Frequent and ineffectual urging, the rectum feeling as
 if stopped  up with a plug; if the stool does not  pass soon, she feels
 colicky pains in the abdomen.  Inactivity of the bowels.
  Antimonium C. Sensation  as if a copious stool were going to pass
 when only  flatus comes forth, but finally a very hard  stool  is evacu-
ated.   Incarcerated flatus.
  Apis. Stools seldom  and very difficult, with stinging pains and sen-
sation in the abdomen, as if of something tight, which  would break if
too much effort were used.  Heartburn.  Scanty urine.
  Arnica.  In cases where  an obstinate constipation  has remained ever
since some  severe concussion.  Inactivity of the bowels.  Flatulency;
colic;  loud rolling and  rumbling in abdomen; foul-smelling flatus;
stool seems to be unsatisfactory and insufficient.
  Belladonna.  Flatulency.   Obstruction of the  bowels.   Much tend-
ency of blood to the head; flushed face; red eyes; throbbing of the
carotids; heat in the head ; intolerance of noise and of light.  With
belladonna, high, I have succeeded in cases like this, when the most
violent doses of the allopathic school had utterly failed.
  Bryonia.  The stool is mostly dark, dry and hard as if burned, and
is evacuated with much difficulty.  The lips are  parched and  cracked;
much thirst.   Stinking flatulency  ; rumbling and rolling in the abdo-
men.   Obstruction of the bowels from hardened stool.  Stool too large
to be evacuated  without pain. 
CONSTIPATION.
311
  Calc c. Indicated in leucophlegmatic temperaments.  Stools very
large, hard; sometimes in part undigested.   She does not sleep after
three A, m.  Stinking flatulency.   Constipation from indurated stool,
which is too white.   Sour-smelling stool.
  Carbo v. Tough, scanty,  not properly cohering stool; it seems to
break off, and  in  consequence to become interrupted- and rendered
more  difficult of expulsion.  Stinking stool.  Flatulency, with colic
and rumbling of  gas in the bowels.   Incarcerated flatus, smelling
very badly when emitted.  Patient attributes all her troubles to " the
wind."  Obstruction from inactivity of the bowels.
  Causticum.  Constipation,  in which  the  effort  to effect  a passage
causes heat, redness and perspiration on the face.   Flatulency, loud
rolling and  rumbling in the bowels.   Obstipation of hardened feces.
Stool  knotty like sheep-dung, too small in size.   Stool  shining like
grease.
  Chelidonium.  In  cases  accompanied  by pain  under  the  inner
and lower  angle of the right shoulder-blade.   Stool  like  sheep's
dung.
  China.  Hard,  intermitting stool,  with  sensation  of tightness and
fullness  in the abdomen; also with burning  and heat in the head.   «
Flatulence with colic; loud rolling and rumbling;  black stools; ob-
struction from inactivity  of the bowels.
  Cocculus. Hard stool every other day, expelled with great difficulty.
The lower extremities are nearly paralyzed.   Incarcerated flatus; ob-
struction of the bowels.
  Conium. Frequent and ineffectual urging, or a  small quantity  is
evacuated each time;  much vertigo, particularly on turning in bed.
The urine intermits  in its flow at each emission.  Flatulency; colic
from incarcerated flatus.
  Graphites.  Large, hard, knotty stool, the knots  being  united by
mucous  threads, and  much mucus after the stool.   Itching blotches
about the body, which emit a glutinous fluid.  Sometimes the stools
are  only the size of lumbricoides.  Incarcerated  flatus;  colic; obsti-
pation from hardened stool or from inactivity of the bowels.   Stool
knotty and too large.
  Hepar. Constipation resembling that of alumina: hepar may be
given in preference wdiere the skin-symptoms or others seem to indi-
cate it more particularly ;  for instance, if  eruptions  appear  on the
bend of the elbow and on the popliteal space.
  Ignatia. Difficult stool, causing prolapse of the  rectum.   Empty
feeling at the pit of the  stomach; sighing and full  of grief.   Flatu- 
312         DISORDERS INCIDENTAL  TO PREGNANCY.

lency, incarcerated, rumbling and rolling about.   Constipation from
inactivity of the bowels.
  Jodium. Constipation with ineffectual  urging, but the stool passes
with great facility soon after drinking some cold milk.
  Kali c. Unsuccessful  desire for stool, with a sensation as if the rec-
tum were too weak to expel it.  She feels very strangely and badly
an  hour before stool.  Itching pains in and about the anus and rec-
tum during and after stool.  Flatulency.  Obstipation from hardness
of stool or from torpor of the bowels.
  Laurocerasus. Frequent attacks of suffocation about the heart, so
that she must gasp for breath.  Simple obstruction of the bowels.
  Ledum.  Great want of vital heat;  she can hardly keep warm even
with much wrapping; in constipation, where this state of the system
prevails, this remedy will be found useful.
  Lycopodium.  She  says  her abdomen is like a yeast-pot, so great a
fermentation goes on there.  Borborygmus and  gurgling, especially
in the left hypochondrium.  Much red sand in the urine.  Distressing
pain in the back before  urinating.  Incarcerated flatulence; sharp,
shooting pains  from right  to  left  across the abdomen.   Constant
feeling of satiety;  but a  small quantity of food  seems to fill  to
repletion.
  Magnesia mur.  Large stool, passed with difficulty, and crumbling
as it passes the verge  of the anus.  Obstipation, of hardened feces.
Knotty, crumbling, insufficient and unsatisfactory stool.
  Mercurius.  Constant and ineffectual desire for stool.  Scorbutic con-
dition of the gums.  Salivation, sore  throat, soreness of the gums and
other mercurius symptoms.   Constipation from hardness of the stool,
blood with the  stool.
  Natr. m. Hard, difficult stool, and inactivity of the rectum.   Bad
headaches always on waking in the morning.  Craves salt.  Aversion
to bread.  Very vivid and fearful dreams.  Sore places in the mouth,
which  are very painful, sensitive even to liquids.  Constipation from
inactivity of the bowels.   Rumbling and incarceration of flatus.
  Nitric acid. Hard, difficult, scanty  stool.   Urine exceedingly offen-
sive, like horses' urine.  She sleeps  badly  in the latter  part of the
night.   Great feeling of weakness  after a stool.   Much flatus, incar-
cerated, stinking when  emitted.   Bloody stool.
  Nux mosch. Great dryness  in the  mouth  and tongue, which sticks
to the palate.   Slow and difficult stools.  Colicky pains from incar-
cerated  flatus.    Constipation from  inactivity  of the bowels.   For
women disposed to faint or who " bolt" their food. 
CONSTIPATION.
313
  Nux vom. In w jmen of sedentary habits, accustomed  to the use of
much coffee, wine and rich and high-seasoned food generally.  Stools
large and difficult, or small, frequent and painful.  Flatulence, colicky
pains, incarcerated flatus, or loud rumbling and rolling in the bowels.
Constipation from torpor of the bowels, or in persons who have been
in the  habit of using cathartic pills  or  other purgatives.  Knotty or
bloody stools.   Insufficient stool.  Rush of blood to the head during
stool.
  Oleander. First diarrhoea, then hard, difficult stool.
  Opium. Stools always in round, black, hard balls;  in such cases
opium in the higher preparations never  fails.  Constipation occurring
either  from accumulation of hard, dry feces or from torpor  of  the
bowels.
  Phosph. Stools narrow, dry, long, and difficult to  expel—very like
a dog's stool.   Blood  with the stool.  Rumbling  in the  abdomen.
Constipation from hardened feces.
  Phosph. acid. She is  obliged  to rise frequently at  night to pass  off
large quantities of colorless urine.  The stools are hard and in pieces.
Flatulency.
  Phytolacca dec. Constipation  habitual; the patient says the bowels
will not move without the aid of purgative medicines.  Feeling of
fullness in the abdomen before stool, which remains  after stool  as if
all  had not passed.  Constipation from torpor of the rectum.  Per-
sons who are subject to rheumatic pains on  change  of weather, espe-
cially in the hips and thighs.
  Platina. The stools adhere to the parts like soft clay, and pass  off
with difficulty on that account.  Obstinate incarceration  of flatus.
  Plumbum. Constipation, with violent  colic.  The stools are usually
composed of little balls, compacted together  like sheep's  dung.  Sen-
sation  as if of a string  drawing the abdomen in toward  the  back.
Flatulency, colic, commotion in the abdomen.
  Pulsatilla. Obstinate constipation  in  mild, gentle, tearful women,
with very nauseous, bad  taste in the mouth in the morning—so very
bad that she must wash her mouth immediately on  waking.  Gastric
disturbance; cannot bear the smell of food.   Hard, bloody stools.  In-
carceration of  flatus, emissions of foetid  flatus, borborygmus.
  Ratanhia.  Most  obstinate  and  long-continued  constipation, with
urging feelings in the small of the back, as if a stool would come
down.
  Rhododendron. She is rheumatic, and all her  pains reappear at the
approach and  during  the  continuance  of rough, stormy and  windy 
314           DISORDERS INCIDENTAL TO PREGNANCY.

weather.  The stool is not so hard, but it is very tardy, requiring a
good deal of urging.   Flatulent and colicky patients.
  Rhus tox.  She is rheumatic, has  restless  nights  on  account of not
being able to lie long  in one position, although she feels quite com-
fortable for a short time after every change.  She has almost constant
tenesmus, with nausea  and tearing in the intestines.
  Ruta. Difficult expulsion of stool, with  a  large protrusion of the
rectum;  in fact, the rectum is very liable to protrude  before the stool
immediately  on attempting to go to stool.   Constipation from either
inactivity of  the bowels or from impaction of feces.
  Sabadilla. Very difficult stools, with much burning in the abdomen,
and a sensation as of something alive in the abdomen.  Colic, with
violent urging to stool and borborygmus.
  Sabina. Hard,  difficult, painful  stools, with  pain extending from
the back directly to the pubes.
  Sarsaparilla.  Obstinate  constipation, with  violent urging  to  uri-
nate.   Great desire, with  contraction of the intestines and excessive
pressure from  above downward, as if the bowels would be pressed
out, when a small stool is passed, and then the same phenomena recur
again.
  Sepia.  Sensation of a weight or of a heavy lump in the anus; this is
a very characteristic indication.  The stool is very difficult, covered
with mucus,  and  sometimes impossible to  pass even with terrible, in-
voluntary strainings.   Flatulency,  with loud rolling and rumbling in
the abdomen.  Obstipation from hardened stool.   Knotty and insuf-
ficient stool.  Sepia200  was stated many years ago to be specific in the
constipation of pregnant women.
  Silicia.  Very much  urging, the  stool often receding after having
been partially expelled.  The stool is composed of hard lumps.  In-
carcerated and  offensive flatus.
  Stannum. It exhausts her to talk  much or to read aloud.  It is more
difficult and  tiresome for her to descend than to ascend, to sit down
than to rise up.  Although the stool has been fully accomplished, she
does not feel  relieved.
  Staphysagria. The more trouble  she has with her  gums and teeth
the more constipated she becomes.   Colic  from incarcerated flatus in
the bowels,  offensive  flatus.   Constipation  from inactivity of the
bowels or from impaction.
  Sulphur. The first effort to stool is often very painful, compelling
her to' desist,   Flushes of heat, heat on the top of the  head, coldness
of the  feet, faintness from eleven to twelve at noon, she can scarcely 
DIARRHCEA.
315
 wait  for her  dinner.  Bloody,  knotty,  hardened, insufficient stool.
 Loud rolling  and rumbling in the abdomen, with emission of offen-
 sive flatus.
   Sulph. acid. Hard stool, consisting  of small black  lumps mixed
 with  blood, accompanied  by such violent prickings in  the anus  that
 she has to rise  up on account of the  pain.  Sensation of tremor all
 over the body, without trembling.
   Thuya. Very violent pain  in  the rectum  during stool, so violent
 that she can hardly pass the stool, with sensation as if she could not
 live any longer.
   Veratrum a.  Flatulency, colic and borborygmus.  Costiveness, owing
 to the hardness and size  of the feces, as well as to the inactivity of
 the rectum.  Cold sweat on the forehead during the movement of the
 bowels, with exhaustion and faintness afterward.
   Verbascum.  Stool like sheep's dung, scanty, very hard, and expelled
 with great  effort.
   Zinc. This  remedy is particularly indicated where there is  remark-
 able dryness of the stools, which  are insufficient and difficult of expul-
 sion,  and when  the bowels,  particularly the rectum, seem  to be so
 very inactive,  as if all peristaltic and expulsive power Avas lost.

   Diarrhcea may be developed during pregnancy, like constipation
 or haemorrhoids, from some constitutional dyscrasia, which is called
 into action by  the profoundly vital  function of  gestation.   Or it may
 be developed in  consequence of some imprudence of diet or by taking
 cold.
   The condition of the bowels in which diarrhoea makes its appear-
 ance is more  like actual  disease than where constipation is present.
 The diarrhcea may alternate with  constipation, and  this is quite a
 common complication.   Or it may  be  of that character which natu-
 rally accompanies acidity of the stomach and great weakness of the
 digestion.   Sometimes  it assumes the form of lienteria or discharge
 of undigested  food.  In other cases the b'ver  seems involved, and the
 stools have a bilious appearance;  such  attacks of diarrhoea may occur
 in consequence of violent  emotions of the mind,  to which pregnant
 women are peculiarly liable.  The  discharge may be easy and pain-
 less, or accompanied by severe suffering, soreness, cutting pains and
even tenesmus, as if of actual dysentery.  This latter form, approach-
ing inflammation of the bowels, is apt to come  on after exposure to
 the night  air,  especially if the  woman  be not clad  with sufficient
 warmth. 
til6          DISORDERS INCIDENTAL  TO' PREGNANCY.
   It is not necessary to detail all the symptoms of the various forms
 of diarrhoea which may  appear in pregnant women; the most im-
 portant of them may be found  among the indications and character-
 istics of the various medicines.
   There are three directions which should be insisted upon in  pre-
 scribing for cases of diarrhcea in pregnancy :  First, the patient should
 carefully abstain from  every unsuitable  article of food; those which
 are  found by  experience to  be indigestible  or to occasion distress,
 whether immediately followed by aggravation of the diarrhcea or not,
 should be particularly interdicted.  Second, the  patient should  take
 care that her whole body is amply protected from  the cold and damp,
 but especially her  feet  and abdomen.  The  former should  be warm
 and dry as a matter of  course ;  the  latter will often—from becoming
 so prominent—require  extra covering, as of flannel.   Third, perfect
 quiet is absolutely essential in cases of diarrhcea in pregnancy.  This
 condition should  indeed  be  always enjoined in the treatment of
 diarrhcea, whether  it extend  to  dysentery  or  inflammation of the
 bowels or not.  But in the case of pregnant women  it is  if possible
 still more indispensable.    Rest,  repose, especially  in a  horizontal
 position, will enable the patient to  recover her health and strength,
 under  the influence of the homoeopathic remedy, in a  very short time,
 when if she continued  moving  about those cases  of diarrhoea which
 at first were mild  and  painless  might become inveterate and greatly
 aggravated in character.
   Again, it is to be borne in mind that a diarrhoea long continued may
 bring  about abortion or premature labor, and hence the  importance
 of early and judicious treatment and of the due observance of dietetics
 and rest.
   Sometimes the diarrhoea, not very severe and apparently of no great
 consequence, which makes  its appearance in pregnancy,  is but the
 insidious forerunner of phthisis pulmonalis, otherwise held in abey-
 ance by the influence which the state of pregnancy exerts upon the
 entire economy of the female system.
   We  give the chief indications for the  remedies which are oftenest
 called for in the diarrhoea of pregnancy.   The remedy should always
 be made to correspond to the totality of the symptoms; and if the
simile  is not found in one of those here given, a more extended search
 must be  instituted  in the Materia Medica.  Compare the  indications
 here given with those laid down for the same  remedies  in gastric
derangements and constipation.  By such comparison a remedy may
 be chosen with  great accuracy. 
DIARRHCEA.
317
   Agaricus m. The diarrhoeic  stools are accompanied with abundance
of flatulency, with painful  drawing in of the abdomen.  The itching,
burning  and red  places upon the skin fade away as the  diarrhcea
improves.
   Aloes.  Sensation of weight or heaviness in the rectum, and frequent
passage of accumulations of mucus of large or smaller size, sometimes
with very distressing tenesmus.  Morning diarrhoea, which necessitates
expedition in  attending to  the call, not so  much on account of the
urgency,  as because of a feeling as if the stool could not be retained,
but  must drop involuntarily.  Rumbling and rolling in the bowels
previous to stool.  Pure mucus is discharged in masses.
   Alumina. Diarrhoea with tenesmus; stools bloody and scanty.   She
has to strain at stool in order to pass water; she cannot pass  her urine
without straining at stool.
   Ammon. mur. Diarrhoea, with soreness of the anus, several pustules
are discovered near it.
   Angustura. Diarrhcea, with  shivering over the face and goose-flesh.
   Antimonium c. Diarrhoea  at night and early in the  morning, with
white tongue.   Watery diarrhoea, containing hard lumps.  Acrid
diarrhoea.
   Arnica. Involuntary stools, with sore and bruised feeling all through
the body.  Mucous, offensive  or purulent stools.
   Argentum nit. Very offensive  evacuations, with very profuse emis-
sion   of  flatus, sometimes  with  noise.   Stools watery or  of  green
mucus.   Often there is much colicky  pain.  The diarrhoea  occurs
more frequently at night.   Grass-green flaky stool.
   Arsenicum. Exhausting diarrhoea, the stools containing undigested
food.  The patient is very weak, the least motion occasioning a sense
of great  fatigue.  The diarrhoea  is renewed after eating and drink-
ing.   Very offensive diarrhcea.    Sharp, cutting or  burning  pains
with  the diarrhoea.    Painless  diarrhcea.   Stools acrid, bloody or
involuntary.   The pain  is  greatest during the stool, and is relieved
after stool.
  Asafoetida.  Watery, liquid  stools  of the most disgusting  smell
imaginable.  (Also the same in infants and  children.)   Colic with the
diarrhoea.
  Aurum. Nightly diarrhcea, with much burning in the rectum.   Of-
fensive, painful diarrhcea.
  Belladonna. Involuntary diarrhcea.  The diarrhoeic stool is followed
by frequent urging, no more stool  being passed.   Flushed face; red
eyes; throbbing carotids, etc. 
318         DISORDERS  INCIDENTAL  TO PREGNANCY.

   Borax.  Frequent, soft, light yellow, slimy stools, with.faintness and
weakness
   Bryonia. Burning diarrhcea.  The diarrhoea is worse or aggravated
by warm weather. Lips dry and parched; thirst;  nausea after eating;
nausea  on sitting up in bed.  The patient wishes to remain very
quiet, as every motion aggravates her symptoms.
   Calc c. Much crawling  and itching, as  from ascarides, in the anus.
Leucophlegmatic temperament.  Does not  sleep after three  in the
morning.
   Cantharis.  A constant desire to urinate, with cutting, burning pain.
Dysenteric diarrhoea.   Stools which resemble scrapings of the intes-
tines or water in which meat has been washed.
   Capsicum. Much burning and smarting  in the anus, as if from cay-
enne pepper.  Pain in the back continuing after the stool.
   Carbo V. Much flatuleney, with belching,  which affords only tem-
porary relief.
   Causticum. Ha3morrhoids or  fissures,  rendering  walking  almost
intolerable.   Much suffering after each  evacuation.
   Cham.  Hot diarrhoeic stool, smelling  like  rotten eggs.   The stools
excoriate the parts.   Painless, green, watery diarrhcea, a mixture of
feces and mucus.  Nightly diarrhoea with colic, causing her to bend
double.  In all chamomilla cases the moral  symptoms are about the
same—i. e. quarrelsome, obstreperous.
   Chelidonium.  Diarrhoea, with pain under the inner and  lower angle
of the right shoulder-blade.
   China.  Diarrhcea of yellow, watery stools, undigested, and with
much flatulence.   Sensation of distension in the  abdomen, which  is
not relieved by eructations or dejections.   Painless diarrhcea.  Lien-
teria.   Very offensive black  or yellowish-brown stools.  Prostration
after each evacuation.
   Cocculus. Diarrhcea, with a  sensation in the abdomen as of sharp
stones  rubbing together.   Vomiting of bilious matter.  Numb sen-
sation in lower limbs, as if paralyzed.
   Colocynth. Diarrhoea, with colic drawing one double, and which  is
very distressing,  causing  restlessness, writhing and  twisting about;
pain is relieved somewhat by bending nearly double, and  by making
hard pressure upon the abdomen. The abdomen and thighs must often
be approximated as much as  possible during the stool.   Aggravation
after eating or drinking.
   Conium.  Heat  and burning in  the rectum  during the  stool, and
tremulous weakness afterward.   Frequent stitches in the anus between 
DIARRHCEA.
319
the stools.  Painful diarrhcea.   The urine  intermits during its flow.
Vertigo, particularly on turning in bed.
  Crocus. Long, dull stitches near the anus from time  to time, con-
tinuous, and  painfully  affecting the whole nervous system.   The
stool contains dark stringy blood.
  Cuprum met. Violent diarrhcea, with  cramps  in  the  stomach and
chest, the cramps extending upward.   Much  flatus  escapes  with
the stool.
  Digitalis. Violent diarrhoea, the stools being  ash-colored or very
light. Very slow pulse.  Accompanying the diarrhcea is violent beat-
ing of the heart—not  rapid, but too violent.  Nausea.  Despondency.
Vomiting of food.  A very depressing sensation of sinking at the
stomach.
  Drosera.  Loose  stool  almost continually, but rather worse  after
midnight.  Bloody, mucous or offensive stools.
  Dulcamara.  Stools yellowish, greenish, whitish, mucous  or bloody;
often attended with prostration or with colicky pains around the um-
bilicus.   Worse after every cold change of the weather.
   Elater. Dull olive-green discharges.
  Euphorbium. Stools  like glue prepared for use,  painful and flatulent.
  Ferrum. Frequent diarrhoeic  stools, corroding the anus, the face
being fiery red.   Lienteria.   Painless diarrhoea.  Vomiting of food
soon after eating.  Debility and emaciation.
   Gelseminum. Diarrhcea occasioned by  fright.   Disposition to go to
stool whenever anything startles her.
   Graphites. Diarrhoea, with  varices,  and  a  smarting, sore  feeling
after  the stool when  wiping.  Stool brown, very fetid, often undi-
gested.   In the morning taste in the mouth as of spoiled eggs.  Ab-
domen distended,  often with  a sensation of fullness and hardness.
Much flatulency.  Much white mucus with the stool.
  Helleborus.  In cases of diarrhcea in which the urine is found to be
scanty and to contain a deposit like  coffee-grounds.  Stools of white
mucus, often tenacious or jelly-like.
  Hepar. Diarrhoea, with  tenesmus, and an itching rash in the benda
of the elbows.   Stools of a lightish color,  often undigested and of a
sour smell.  Sour regurgitations of food.   Empty  sinking  feeling in
the stomach,  relieved by eating.  The diarrhcea is worse during the
day, after eating, or after drinking cold water.
  Hyoscyamus. Diarrhoea, with involuntary jerks of the muscles im-
mediately before, during or immediately after the stool.   Involuntary
stools.  Yellow, watery, painless diarrhcea. 
320          DISORDERS INCIDENTAL TO PREGNANCY.
   Ignatia.  Empty, weak feeling at the pit of the stomach, with dispo-
sition to take a long breath frequently, a sort of sighing inspiration. •
   Ipecac.  Diarrhoea, with one continual  sense of nausea—not a  mo-
ment's respite.   Fermented stools, looking like yeast.  Sometimes the
diarrhcea is  accompanied with vomiting of mucus or of grass-green
substance.   Stools frequent, of greenish mucus.
   Iris versicolor. Gastric  disturbance  and headache.  Severe burning
at the anus during and after  liquid stools.  Burning extending from
the mouth to the stomach.   Diarrhoea worse at night.  Emissions of
very fetid  flatulence, accompanied with slight discharge of liquid fecal
matter.  Very soft, yellow stools, with rumbling in bowels.
   Jodium.  Diarrhoea of watery, foaming, whitish mucus, with pinch-
ing around the navel and pressing pain in the vertex.
   Kali C  Diarrhoea, with sharp shooting  and stitching pains all over
the abdomen.  Stools  of a light gray-color.   Persistent stitching pain
in the region of the liver.   Suitable to cachectic persons with sacculated
swellings over the eyes.  Diarrhoea 3  or 4 o'clock a. m.
   Lachesis. Diarrhoea  always worse  after sleeping,  and with frothy
urine.  Diarrhoea in the evening, preceded by pain in ano.
   Laurocerasus.  Diarrhcea, with peculiar suffocating spells about the
heart.   She  is  often obliged to  lie down on account of this peculiar
sense of suffocation.   Green,  liquid stools.   When drinking the fluid
rolls down the oesophagus with a peculiar rumbling noise.
   Ledum. Diarrhoea, with a sensation  of great coldness; she has great
want of vital warmth,  and can hardly keep warm.   Between the anus
and coccyx a red humid spot, smarting, sore and itching.
   Leptandria. Black, fluid stools;  great urging, with difficulty of re-
taining the stool.  Cutting  about the umbilicus after stool.   Stools
like tar in color  and  consistency, very fetid, and worse in the after-
noon and evening.
   Lycopodium. Diarrhcea, with a constant sensation as of fermentation
in the abdomen  like yeast working.   Sensation  of fullness up to the
throat after  eating even a  small quantity.   Rumbling  of flatus re-
sembling a loud croaking.
   Magnes.  c.  A green, watery diarrhoea  occurs  regularly every three
weeks.  The stools appear sometimes  like the green scum covering a
frog-pond.   Sometimes white masses, like pieces of tallow, are found
floating in the green stools.   Sharp pain  in the abdomen before stool.
   Mercurius.  Morning diarrhcea, composed mostly of slime and fecal
matter, with  tenesmus before and during the  stool.   Diarrhoea  pre-
ceded by a faint  sickish pain in  the abdomen, entirely relieved by 
DIARRHCEA.
321
stool.   The stools are often mixed with slime and blood, and are at-
tended with tenesmus.  Yellow stools of the color of sulphur.  Saliva-
tion, sore, ulcerated gums, loose and sore teeth, aching of the jaw-bones,
etc.  Frequent urging to stool, a small  quantity only being passed at
a time, often  of green  or bloody  mucus.  Mouth and tongue moist,
and plenty of saliva, yet great thirst  for  cold water.  Disposition to
remain at stool, as if she " could not get done."
  Mezereum. Diarrhoea, with prolapse of the rectum; the anus becomes
constricted  about the prolapsed rectum, which is very painful to the
touch.
  Muriatic acid. Diarrhoea,  with intolerable itching of the anus, which
is  sometimes  so sore that  it can  scarcely be touched.   Dark purple-
colored varices,  excessively painful to the  touch.   Very weak and
languid.  Great tenderness of the anus after stool—so great that the
slightest touch or pressure is very painful.
  Natr. mur.  Diarrhoea, like water.  Disgust for bread.  Severe head-
ache on waking in the morning.   Very vivid dreams; they seem like
a living reality.
  Nux mosch. Chronic diarrhoea during pregnancy, with unusual slug-
gish flow of ideas, so much so that it takes her a long time to auswer
any simple question.  Diarrhoea,  with fainting.
  Nux vom. The  stools are very frequent, but small in quantity, with
sore pain in the anus.   She often feels as if something yet remained
to pass, although a fair quantity may have  been evacuated.  Stools
usually dark.  Alternation of constipation and  diarrhoea.  Irritable,
morose and sullen ; apt to be quarrelsome if disturbed.  Sleeplessness,
particularly toward morning.  Want  of appetite.
  Opium. Black,  watery diarrhoea, sometimes frothy. « Diarrhcea in
consequence of a fright.  Drowsiness, but refreshing sleep  cannot be
obtained.
  Petroleum.  Diarrhoea only in the day-time.
  Phosph. Watery  diarrhoea,  pouring away as from  a  hydrant,
with great  sense of weakness  in  the  abdomen,  and general debility.
Stools of green mucus or  of  whitish  fluid;  little grains like boiled
kernels of rice are seen with the  stools.   Sharp shooting pains in the
abdomen.
  Phosph. acid. White,  gray diarrhcea; copious, yellow, watery diar-
rhcea,  with rumbling in the abdomen.  Diarrhoea  painless, but not
exhausting.   Mental state characterized by decided indifference to ex-
ternal influences or surroundings.
  Podophyllum. Morning  diarrhoea,   or diarrhcea  occurring in  the
      21 
322          DISORDERS  INCIDENTAL  TO PREGNANCY.

latter part of the night; profuse, frequent, gushing, and painless or not
very painful.
  Pulsatilla.  Watery diarrhoea-, only or usually at night—sometimes
unconsciously evacuated.  She has no thirst; a bad taste in the mouth,
nothing  tastes  good.   Blue eyes,  tearful disposition.   Stools  very
changeable in appearance, so that no two are alike.
  Rheum. Sour diarrhoea, with  cutting and colicky  pains about the
navel.  The  emanations from the body are all sour-smelling.  Rf
pugnance to food as soon as a small quantity has been eaten.
  Rhus.  Diarrhoea, with drawing and tearing down the legs with every
evacuation.   Stools  reddish, bloody.   Restlessness, frequent  change
of position, with'temporary relief.
  Sabina. Diarrhcea, with pain extending from the back to the pubes.
  Secale  C Painful diarrhcea, with great prostration.  Putrid, fetid,
and  colliquative diarrhcea.   The patient does not wish to be covered
up warm or to  be near the heat, but prefers to be  in the air or wishes
to be fanned.   Involuntary  diarrhoea.
  Sepia.  Sense  of weight in the anus, and an empty, sore feeling at
the pit of the stomach'; much burning at the anus and rectum.  The
diarrhoea soon  becomes exhausting.   Jerking pains  from the  anus
upward through the rectum.
  Stramonium.  Diarrhcea, the stools having a cadaverous smell; great
thirst; food  tastes  like straw.  The mental symptoms are worse in
darkness and solitude.  Great loquacity.
  Sulphur. Diarrhcea in the morning, driving  her out of  bed; has to
hurry, and barely escapes soiling  her clothing.   Very hungry about
eleven o'clock in the morning; she cannot wait for her dinner, she is
so faint  and hungry.   Very sleepy during  the  day-time;  awakens
often during  the night; gets wide awake, as though she had  not  slept
at all.
  Sulphuric acid. Diarrhoea, with great debility; sensation of general
trembling without any actual trembling.  Cannot do anything delib-
erately, hurries as if impelled to do everything hastily.
  Tabacum. Diarrhoea, the stools consisting  of yellowish or greenish
slime; sudden  attacks of extreme  faintness, often with cold perspira-
tion.   Beclouded  condition  of  the mind, she cannot read  or study
satisfactorily.  Feeling of oppression around  the  cardiac  region.
  Tartar em. Colliquative diarrhoea, with meteorism.  Nausea,  with
faintness;  warm perspiration on the  forehead and head from effbrta
to vomit and vomiting.
  Veratrum alb. Very exhausting diarrhoea, she feels very weak  after 
            REMEDIES FOR INTESTINAL  AFFECTIONS.         323

every movement of the bowels, with cold  sweat on the forehead, and
sometimes cold general perspiration.

      Table  of Remedies for Intestinal Affections.
                 Incarcerated Flatulency.
  1. Carbo veg., Cham.,  Cocc, Graph.,  Ignat., Kali e, Lye, Nitr.
ac,  Nux v., Plumb.,  Puis., Staph., Tart.  em.   2.  Ant. cr., Arn.,
Asar., Canth., Chin., Coloe, Con., Natr. c, Natr. m., Nux ra., Phos.,
Phos. ac, Plat., Rheum., Squill., Veratr. a.

                        BORBORYGMUS.        t
  1. Caust.,  Chin.,  Hell., Lye, Nux  v.,  Phos., Phos.  ac, Puis.,
Sulph.   2. Aloes, Agar., Arn., Bry., Canth., Carb.  veg., Cham.,
Ignat.,  Natr. m., Plumb.,  Sassap.,  Squill.,  Sep., Spig., Staph., Tart.
em., Veratr. a.
                      Flatulent Colic.
  1. Carb. veg., Chin., Lye, Nux v., Puis., Rhod., Staph., Veratr. a.
2. Anae, Arn., Asaf., Aur., Cham., Con., Graph., Hyos., Ignat., Nux
m.,  Phos., Plumb., Rheum., Squill., Tart.  em.

                     Constipation (Simple).
  1. Bry., Calc.  c,  Cocc, Lye, Nux v., Op., Phytol., Plumb., Sil.,
Graph., Sulph.   2.  Alum., Bell., Canth., Carb. veg., Con.,  Creos.,
Dule, Graph., Kali e, Laur., Meny.,  Merc  sol., Nitr. ac, Phos.,
Plat., Sabad'., Sep., Stann., Sulph., Sulph. ac, Veratr. a., Verbas.
  -----from Inactivity  of the Bowels.—1. Alum., Hep., Kali  e,
Natr. m., Nux  v.  2. Anae, Arn., Camph.,  Carb.  veg., Chin., Cocc,
Staph.,  Ignat.,  Natr. e, Nux m., Op.,  Phytol., Petr., Puis.,  Ruta,
Staph., Sulph., Thuj., Veratr. a., Zinc.
  -----from Induration of the Stools.—1. Bry., Magn. m.,  Op.,
Plumb., Verb.   2. Amm. e, Aur.,  Carb.  an.,  Caust., Chel., Graph.,
Kali c, Magn.  c, Merc, sol., Nux v., Petrol., Ruta, Sep., Sil., Sulph.,
Sulph. ac, Thuj.
                     Diarrhcea (Simple).
  1. Ant. cr., Cham., Chin., Merc, sol., Phos.,  Phos. ac, Puis., Rhus
tox., Sulph., Veratr. a.  2. Aeon., Amm. mur.. Ars., Asaf., Bor., Bry.,
Calad., Calc. c, Carb. v., Dig., Hyos., Lach.,  Natr. m., Nitr. ac, Petr.,
Rheum, Sep., Sil.
  -----Painful.—1. Rheum, Rhus tox.  2. Ars., Bry., Caps., Cham.,
Dule, Merc, sol., Nux v., Petrol., Puis., See corn., Sulph., Veratr. a. 
 324          disorders incidental to  pregnancy.

   Diarrhcea, Painless.—1. Chin., Ferr., Hyos., Lye, Phos., Phoa.
 ac, Podoph., Stram.   2. Ars., Bell., Cham., Chel., Op., Plat., Sulph.

                             Stools.
   ------Knotty, like Sheep's Dung.—1. Magn.  m., Mere  sol., Op.,
 Plumb., Sulph., Verb.  2. Amm. c, Carb. an., Caust., Chel., Graph.,
 Nux v., Sep., Sulph. ac, Thuj.
   ------Aerid.—1. Ars.,  Chin.,  Ignat., Merc,  sol., Puis., Sulph.
 2. Ant. cr., Cham.,  Dule, Ferr.,  Graph.,  Kali e, Lach., Nux v.,
 Phos., Staph., Veratr. a.
   ------Bilious,—1. Cham., Puis.  2.  Ars., Dule, Ipec, Leptand.,
 Merc, sol., Podoph., Veratr. a.
   ------Black-colored.—1. Ars., Bry., Chin., Leptand., Sulph. ac.
   ------Bloody.—1. Canth., Merc, sol., Ipec, Nux v., Puis., Sep.,
 Sulph.   2. Apis., Arn., Ars., Asar., Bry., Calc. e, Caps., Carb. veg.,
 Chin., Dros.,  Ferr.,  Led., ,Lyc, Merc  sol.,  Merc, corr., Nitr. ac.
 Phos., Rhus tox., Sabin., Sassap., Sil.
   ------Frothy.—1. Chin., Coloe, Magn. m., Merc, sol., Rhus tox.
   ------Green.—1. Cham., Phos., Puis., Rheum, Sulph.  2. Arg. n.,
 Dule, Elat., Mere sol., Phos. ac, Stann., Veratr.  a.
  ------ Whitish.—1. Dig.  2. Calc. c, Lach., Spong., Sulph.
   —-----Involuntary.—1. Phos., Phos. ac, Veratr. a.  2. Ars., Bell.,
 Mur. ac, Natr. m., Sulph.
   ------Mucous.—1.  Asar., Bor., Caps.,  Cham., Nux v., Phos.,
 Puis., Sulph.  2. Arn., Ars., Carb. veg., Graph., Hell., Ipec, Kali c,
 Magn. in., Merc, sol., Petrol., Rheum., Rhus tox., Ruta, Sep., Spig.
   ------Purulent.—1. Merc, sol., Sil.   2. Arn., Canth., Lye, Puis.,
 Sulph.
   ------of a Sour Smell.—1. Calc c, Cham., Graph., Hep., Lactic
 ac, Merc, sol., Natr. e, Rheum, Sulph.
  ------Stinking, or  of a  Putrid Smell.—1. Ars., Asaf., Carb. veg.,
 Puis., Sil., Sulph.   2. Arn., Aur., Bry., Calc. c, Cham., Chin., Dule,
 Graph., Nitr. ac, Nux v., Oleand., Plumb., Squill., Staph., Stram.
   ------too Large.—1. Bry., Kali c  2. Graph., Ignat., Veratr. a.
   ------too Small.—1. Caust.,  Graph., Merc sol., Phos., Sep., Sulph.
  ------ Undigested.—1. Ars., Chin., Ferr., Oleand.  2. Acetic ac,
 Ant. cr., Bry., Meny., Phos., Phos.  ac, Sulph ac.
  ------Insufficient.—1. Arn., Cham., Magn. m., Natr. c, Nux v.,
Sulph.   2. Alum., Colch., Hyos., Sabad., Sep., Staph.
  ------Tenacious.—1. Merc, sol., Plat.  2. Asar., Caust., Plumb.,
Sassap. 
FISSURE of the anus.
325
  Stools, with Ascarides.—1.  Calc. c,  Chin., Cina,  Ferr., Ignat.,
Sulph.  2. Asar., Merc, sol., Nux v., Phos., Plat., Squill., Sil., Spig,,
Spong.
  -------with Lumbrici.—1. Cina, Sabad., Sil., Spig., Sulph.   2.
Aeon., Anae, Calc. c, Cham., Cic, Graph.,  Natr. m., Ruta, See corn.
  ------with Tamia.—1. Calc. c, Graph.,  Plat., Puis.,  Sabad., Sil.,
Sulph.  2. Carb. veg., Chin., Kali c, Nux  v., Petr., Phos., Sep.

                    Fissure of the Anus.
  This very painful and distressing disorder occurs more frequently in
women than in men, and is often an accompaniment  of pregnancy.
In milder cases the fissure is limited to the mucous membrane, but
in the severer forms it involves  also the  sub-mucous tissues.   The
fissure is usually about a quarter of an inch in breadth and from a
quarter of an inch to an inch in length, situated  immediately within
the  anus, with its inferior extremity corresponding  to the margin of
the sphincter ani.  In recent cases the edges of the fissure are soft and
pliant, but in cases  of long  standing they are  indurated and promi-
aent.
  Fissure of the anus should  be distinguished  from haemorrhoids,
though they often coexist in the same individual.   Haemorrhoids are
almost always  attended with constipation, which acts as  a provoking
cause, but fissure of the anus is as often accompanied by looseness of
the bowels as otherwise.  The fissures are always very painful during
and after an  evacuation—sometimes even  before.  They are accom-
panied by a constriction of the sphincter  ani in many  cases, which
renders the evacuation of the bowel still more difficult and  painful,
and in some instances almost impossible.  The pain is increased by
forced expirations, as in coughing, sneezing, and by urinating;  every
effort to discharge flatus or feces  is attended  with excruciating torment,
which continues  for one or more  hours, attended with violent spasm-
odic  action of the sphincter ani: so violent is the  agony that  most
persons thus afflicted put off the calls of nature and retain the recum-
bent position.
  This diseased  condition results from some constitutional dyscrasia.
Its  cure  should  not be  attempted  by surgical means.   Its homoeo-
pathic treatment  results  in  a cure; while its surgical  treatment  is
merely temporizing, and may be followed by disastrous consequences;
just as the cure  of anal  fistula by operative procedure is sometimes
followed  by pulmonary disease.   What have been termed rhagades or
cracks of the anus appear to be a  milder form  of fissure of the anus. 
326          DISORDERS  INCIDENTAL TO PREGNANCY.

  JUsculus hip. This remedy has been successfully employed in some
cases.  The  bowels are costive, although they are moved daily.  Face
pale and  haggard, as though from great suffering.   Lameness  of the
back  and hip, so that walking is not only painful, but wellnigh im-
possible.  Itching, stinging, burning and  feeling of fullness  at the
anus.  Haemorrhoids.
  Arsenicum.  On going  to  stool painful constriction  immediately
above the anus, which extends  towards the sacrum.  After stool the
anus burns like fire, causing intense agony, restlessness and exhaustion.
Heat and pain in the rectum, with a kind of tenesmus, ass in dysentery,
with continual pressure.
  Causticum. There is great difficulty in walking, for the pain in
the anus  and rectum becomes  intolerable.  Much pain in the perin-
eum.   Large, painful  pustule near the anus, discharging pus, blood
and serum.   Bowels are usually very costive.
  Gratiola.  After stool, painful pressure in the abdomen  when walk-
ing, relieved by sitting down.   Sticking  pain  about the umbilicus.
Tearing in the rectum or  prickling in the anus.  Painful cramps in
the os coccygis.
  Ignatia.  Painless  contraction  of  the anus for many days.   Soon
after  stool,  pain in the anus, shooting far up into the rectum, or con-
striction and smarting like touching a wound.  Very easy prolapsus
of the rectum.  Pain in  the anus returning at the same hour each
day;  worse  walking and  still  worse standing, but relieved on sitting
down.
  Lachesis.  On going to  stool the anus feels as if closed.  Internal,
cramp-like  pain in the anus  before and after passage.  Prolapsus of
the rectum, which is thick and tumefied, and when it returns it con-
tracts spasmodically.   Obstinate constipation.   Mind depressed.
  Mezereum. Painful constriction, tearing and drawing at the anus,
in the perineum, and  from thence through the  urethra.  After stool
the anus  contracts upon the prolapsed rectum,  which remains stran-
gulated, causing, when touched, a pain like a wound.
  Natrum mur. On going  to stool the rectum seems contracted, then
is voided, after great effort, only a small quantity of hard feces, with
tearing, bleeding and smarting at the anus, and finally some soft mat-
ter.   Ripping-up sensation in the anus  after stool.   Much sticking
and  sharp pains in  the anus  and rectum between the stools, and at
night in bed.
  Nitric acid.  This  remedy is  used  more  frequently than any other.
The symptoms which indicate it are: On going to  stool, pain in the 
FISSURE OF THE ANUS.
327
rectum as if something were torn away, or twitchings in the rectum
and  spasmodic contraction  of  the  anus many hours afterward.
Smarting  more in the rectum than  in the  anus immediately  after
stool, and continuing two  or three hours.  Sometimes prolapsus of the
rectum or discharge of much blood accompanies some of the above
symptoms.  Fear of stool, as it is so painful.
  Nux vom.  Painful stools, either much too large and difficult or too
small and insufficient, with a sensation as if something remained in the
rectum still to be discharged, but with an entire inability to void'it.
  Phosphorus. The pains for phosphorus are mostly lancinating, -in
the  anus  and up the rectum—sometimes attended  with smarting.
After stool, strong desire to  urinate.. Acute smarting pains after a
soft stool, extending into  the abdomen, with empty feeling.
   Plumbum.  A  sensation as  if  a  rough  body  were traversing the
 rectum during stool.  Sensation as if the  anus were drawn strongly
 upward.  Much trouble  in not being  able to void the urine; the will
 to  do so  cannot effect it, as if from  paralysis.  Drawing pain from
 abdomen  to back.
   Sepia. Constrictive pain in the rectum, extending to the  perineum
 and into the vagina.  Pain in the rectum on  going to stool,and which
 persists  for a long time after  sitting  down, and  finally an imperfect
 stool is voided with sore, smarting pain.  There is  a sense of weight
 in  the anus, like a constant drag.
   Silicia. Painful effort  to stool  for  some time, and finally the stool
 recedes into the rectum; such efforts  are repeated several times before
 a passage is effected, with sore, sticking, shooting pains.
   Sulphur.  Tenesmus for an  hour after having been to stool.  On
 attempting to sit down  for  stool the pain in the anus prevents her
 from doing so.   After stool a pulsating pain continues m the rectum
 the whole day.   Lancinating pains from the anus upward after stool,
 so violent as  to cause syncope.  At night there is much difficulty  in
 lying in bed from  lancinations and  uneasiness in the rectum, tenes-
 mus, etc,  Itching about the anus with heat.
    Thuya OC. During an attempt at stool the pain in the anus and rec-
 tum is so great that she  has to desist.  Violent contraction in the anus
 and rectum, following by tearing as if in the bowels.  Burning prick-
 ing in the anus between stools.  Violent burning in the  anus whiie
 walking  Anus  very sensitive to touch.
    The  remedies  laid down under the head of haemorrhoids, varicose
 vein?, constipation and  diarrhoea, with their indications, should like-
 wise be coi suited.  Head-symptoms often help to decide. 
 328         disorders  incidental to pregnancy.

           Disordered  Secretions and Excretions.
                            Ptyalism.
   The profuse flow of saliva which  sometimes occurs in the earlier
 months of pregnancy usually lasts but two or three months, although
 cases are recorded  in which it continued during the whole period of
 gestation.
   Where this discharge is  excessive it must necessarily prove very
 exhausting.  Its source must be found in some peculiar constitutional
 dyscrasia, which ultimates itself in this direction under  the stimulus
 of pregnancy.  Hence the homoeopathic remedies are found to relieve
 the difficulty, and  at the  same time benefit the whole system of the
 patient.   This  is just the reverse of the experience derived  from the
 allopathic use of astringent gargles.  Two  cases are referred to by
 Cazeaux, in one of  which the sudden suppression of  the ptyalism was
 followed by apoplexy, in the other symptoms of suffocation appeared.
 This eminent authority is unwilling to admit that these  results were
 the  actual consequences  of such  suppression,  but the intelligent
 homceopathist would expect  nothing less.
   The salivation,  if unattended by  other  symptoms,  may require
 mercurius, but  in  most cases there are other gastric disturbances,
 all of which must be duly considered.  For  remedies, therefore, con-
 sult  those mentioned in the preceding sections.
  Spitting of  blood sometimes exists  in connection with pregnancy, but
 in ordinary cases need give rise to no alarm.   It is usually due to the
 general congestion consequent on the condition of pregnancy, and con-
 sists of a mere exudation from the mucous membrane of the air-pas-
 sages or fauces.   Such remedies  as  Aeon., Bell., Creos., Hamam.,
 Ipec, Lachesis. Elaps.,  Mur. ac, may be indicated.

          Urinary Difficulties and  Derangements.
  As gestation advances, the increasing size of the uterus causes it to
 press more and more upon the bladder.   Thus the capacity of  the
 latter organ is diminished by the lateral pressure, which necessitates a
 much more frequent discharge  of urine.   The same frequent mictu-
rition results  also from the direct irritation of the neck of  the bladder.
Thus there may be hourly calls to  pass  water, which are sometimes
 out partially  relieved by the flow of a few drops only at a  time, or
the irritation may amount to dysury, an actual strangury, or even to
a complete retention of  urine.
  These  difficulties  may arise in the earlier stages of pregnancy, espe-
cially where the unusual size of the pelvic cavity allows  the foetus to 
          URINARY  DIFFICULTIES  AND DERANGEMENTS.       329

remain tjo long  within  it, or they may appear  in  consequence of
some displacements,  such as prolapsus, anteversion or retroversion of
the uterus. Where some displacement appears to be the cause—which
may sometimes be known by the suddenness of the onset of the diffi-
culty, especially if it follows some accident or over-exertion—the case
should receive the treatment recommended in a succeeding chapter for
uterine displacements.  If it prove to be retroversion, the use of the
elevator may be necessary to  replace the organ.   The other varieties
of displacement scarcely  ever require manual assistance, since perfect
rest in the horizontal position  and the exhibition of the  homceopathi-
cally indicated  remedy will, in most cases, readily relieve the uterine
and the urinary difficulty at the same time.   The  catheter may some-
times  be required, in order at once to relieve the  patient of the great
distress under which she may be laboring from enormous accumula-
tion of urine.
  Incontinence of urine sometimes appears, especially  in  the later
stages of pregnancy.   When it appears in the early months it may re-
sult in part from the pressure of the womb upon the neck of the blad-
der before it rises out of the  pelvic cavity,  causing a loss of tone of
the part.   This difficulty will  often yield to the indicated remedy, but
if not, where it comes on in the early stage of pregnancy,  it may be ex-
pected to disappear upon the emergence of the uterus from  the cavity
of the pelvis.
  For the medical treatment of these  difficulties the following reme-
dies should be carefully studied  according to  the indications  here
given, and compared in  the Materia  Medica with reference to any
concomitant and constitutional symptoms which  may also be present
in the case.  It is to be noted, likewise, that these remedies should be
consulted,  and may be required for urinary difficulties occurring  not
only  during pregnancy, but before, during,  and  after parturition  as
well.

  Aconite. Retention of urine, with stitches in the region of the kid-
neys.   Difficult and scanty emission, with pinching around the um-
bilicus.  Bright-red, hot  urine. Enuresis, accompanied  with profuse
perspiration.  Desire to urinate, accompanied with great distress, fear
and anxiety.   Worse from exposure to cold dry  air.
  Apis. Burning smarting pain before and after urination.  Stitching
pain in the urethra during micturition;  must urinate often.
  Arnica.  After passing a little urine she wishes to pass more, but is
unable to  do so at that time.   Brown urine  with  biick-red  sedimeui 
330          DISORDERS INCIDENTAL TO PREGNANCY.

Sense of fullness of the bladder, with inability to urinate  A bruised
and sore feeling exists if haemorrhoids complicate the case.
  Arsenicum. Considerable  burning is experienced  at the commence-
ment of the flow; restlessness, cold  sweat,   Sometimes  the urine will
not flow, and, although the bladder be full, there is no desire to uri-
nate.   Discharge of mucus and blood with the urine.
  Belladonna.  Great difficulty in passing a small quantity of urine; it
flows in a very feeble  stream or in  drops.  The urine  is often of a
golden-yellow color.  Constant involuntary dribbling of urine.  Enu-
resis with profuse perspiration.  The region over the bladder is very
sensitive to pressure, the slighest jar causing pain.  Blood-red  urine.
Urine, at first clear, becomes turbid  on standing.   Retention of urine.
  Berb. vul. Much pain in region of the kidneys, extending upward or
downward; copious slimy sediment, urine looking badly. Great debility.
  Camphor. Retention of urine, with constant pressure on the bladder
and desire to urinate.  Burning in the  urethra  during emission of
urine.   This remedy will  prove very useful if the urinary difficulty
is the  result of the injudicious use  of cantharides, balsam copaiba,
turpentine, etc.  Red urine, small thin stream.
  Cannabis.  Burning  during and  after  emission,  particularly  after
cantharis has  failed to relieve.   Urethra feels very sore.
  Cantharis.  Very frequent urination, even sixty times  an hour, with
violent cutting pain, so severe as to make her scream.   The urine is
often bloody.  Strangury, with  frequent urging.   The urine does not
flow in a stream, but dribbles away  or passes drop by drop, with cut-
ting and burning.   Cutting and burning pains in  and through the
bladder.  Tenesmus of the bladder, which  is agonizing in severity.
  Capsicum.  Burning smarting after micturition,  as  from the applica-
tion of cayenne pepper; often unsuccessful urging.
  Causticum.  Frequent  desire to urinate,  a small  portion passing in-
voluntarily.  Involuntary  passing  of urine at  night.   Also  where
there are signs of paralysis of the bladder  from prolonged  retention
of urine and over-distension.
  Coccus cacti. The urine  does not form the  usual jet, but runs  down
over the surrounding parts.  Does not cut or burn.
  Colocynthis. Tough mucous sediment in the urine which can be
drawn out into strings.   Urine like  brown beer.
  Conium. The urine flows and stops, and flows  and stops again, and
so on.   There are cutting pains during the flow, and  burning or smart-
ing afterward.   Strangury, with vertigo, particularly on lying  down.
On  turning over in bed great vertigo. 
          URINARY DIFFICULTIES AND  DERANGEMENTS.       331

  Dulcamara. The urine on standing and becoming cooled, has an oily
consistence, with a jelly-like sediment, internllxed with specks of blood.
The urinary difficulty is increased at every cool change of the weather.
  Graphites. Urinary troubles, with burning in  the urethra between
the  acts of micturition.  Very frequent nightly micturition.   Pain
in the  sacrum when urinating.   Cutting and downward pressure in
both kidneys before urinating.  Much headache.
  Helleborus nig. In bad cases where the irritation at the neck of the
bladder threatens to run into inflammation.   Almost constant desire
to urinate, very little  being passed, of a darK color and depositing a
coffec-ground-like sediment;  the bladder at length becomes paralyzed
and greatly distended.   On straining to pass a small quantity of urine
some  drops of blood  come away.  Nausea and distended  abdomen
sometimes  attend.   Often dropsical symptoms.
  Hepar. Intense soreness in the urethra during the emission of urine
Very slow but painless emission of urine, apparently from feeble con-
traction of the bladder.  Greasy and opalescent pellicle on the urine.
Blood-red urine.  Painful micturition.
  Lachesis.  Stitches in the kidneys, extending downward and appar-
ently  through the ureters.  Frequent emission of a foamy urine, some-
times dark and scanty, sometimes profuse.   Dull pain in the  bladder,
occasionally with a sensation as of a ball rolling about in there.  Great
mental depression, particularly in morning.
  Laurocerasus. Acrid  urine, corroding the labia.   Urinary difficulties,
with palpitation of the heart and gasping  for breath, coming on by
spells.   Very slow flow of urine; sometimes the  bladder seems to be
completely paralyzed, so that not a drop can be voided.  Thick, red-
dish or mahogany-colored sediment, with white jelly-like flocks float-
ing through it.  Pain in the region of the stomach when urinating.
  Lycopodium.  Much  pain in the back  previous  to  the emission  of
urine, so that she even  screams out.  Itching in  the urethra  during
and after micturition.   Violent jerking,  sharp-shooting, tearing or
cutting pains  in the urethra not long after urinating.   Red crystals
are  deposited in  the urine,  the urine  itself being clear.  Foaming
urine.  Stitches in the bladder, neck of the bladder and anus at the
same time.  The flow is delayed, with pain in the back, which, however,
is relieved as soon as the flow begins.  Urine turbid, milky, deposit-
ing  a thick sediment of a nauseating odor.
  Merc. sol. Constant desire to urinate,  the desire not lessened by
urinating.   Pieces of filaments, flocks and hard  pieces of mucus re-
sembling pieces of flesh are passed in the urine.   Burning and scald- 
332          DISORDERS INCIDENTAL TO PREGNANCY.
 ing sensation of  the urine  as  from  raw  surfaces.   Sour-smellinc-
 urine,
   Natr. mur.  Stitches in the urethra during the intervals of urinating
 with violent tenesmus vesica and  passing large quantities  of mucus.
 Urine  intermits.
   Nitric  acid. Painless retention of urine.  Desire to urinate,  with
 cutting in the abdomen.   Urine with an intolerable odor.   Very thin
 stream, as if  from contraction of the urethra.  Stitching pain in the
 abdomen when urinating.   Burning in the urethra, and desire to uri-
 nate  with the hope  of relieving the burning, which, however, is in-
 creased by the act.  Brown urine,  leaving brown spots.
   Nux  vomica. She wishes to  urinate very frequently, only a little at
 a  time  being passed, with a sore  burning pain, usually accompanied
 with constipation.  Stangury.  Bloody  urine.  Spasmodic  retention
 of urine, only a few  drops passing at a time, with  scalding sensation;
 reddish brick-dust sediment.   Frequent desire for  stool.
   Phosphoric  acid.  Frequent calls to urinate at night, a large quantity
 of colorless urine  being passed each time.   Creeping in the urethra
 between the acts  of micturition.   White, jelly-like  flocculi in  the
 urine.  Whitish  urine, like milk.
   Pulsatilla. Retention of  urine, with redness, heat and soreness of the
 vesical region externally.   Desire to urinate, with drawing in the abdo-
 men.  Involuntary emission of urine when sitting or walking.  After
 urinating, spasmodic  pain  in the neck of the bladder, extending to the
 pelvis and thighs.  Frequent and almost ineffectual  urging to urinate,
 with cutting pains.   Great urgency of the call; it seems impossible to
 delay.  The urinary difficulties are increased by taking cold, and  at
 ■such times the urine may deposit a tough, slimy sediment,
   Rhus tox. Involuntary urination, particularly  when at rest.  Dysu-
 ria, with discharge of drops of bloody urine.  Snow-white sediment
 in the urine.  Retention of urine,  with great  restlessness and uneasi-
 ness, no position being comfortable except for a few moments.  Belch-
 ing of wind while urinating.   Urine scantv.
   Ruta. At every  step after micturition  she feels as  if the bladder
were  full and moved up and  down.  She feels as  if she could not
retain the urine, so urgent is the  desire,  although  she  can pass but a
very small quantity.   Involuntary emission of urine, whether at rest
or in motion.   Green-colored urine.
   Sepia. The  urine deposits a sandy, sometimes  pinkish sediment,
which becomes firmly attached to the vessel and is with difficulty re-
moved.   Frequent urging at night, the urine voided  often having a 
ALBUMINURIA.
333
putrid odor in the morning.  Sensation as though urine were passing
through the urethra, which  is not a fact.  Burning and smarting in
the urethra.  Violent itching about the vulva.   Blood-red urine.
 .  Stramonium. The urine dribbles away very slowly and feebly.   Re-
tention of urine, or it  flows feebly or in drops, though painlessly, as
though there existed a spasmodic stricture of the urethra.
   Sulphur. Very frequent desire to  urinate, almost constant urging;
the pain caused by the act of micturition scarcely ceases until the pa-
tient is again obliged to urinate and the pain returns.  Fetid  urine,
with a greasy pellicle on its surface.   The urine is emitted with great
force.  The urine occasions an acrid or corrosive sensation when void-
ed.  Cutting in abdomen before urinating.
   Terebin.  Urine bloody, scanty, dark bloody sediment, sweet smelling,
heavily loaded with albumen.   Patient weak ; pale skin.   Epistaxis.
Vomiting of food.

                         Albuminuria.
   Albuminuria, or the presence of albumen in the urine, constitutes
one of the  most interesting of the pathological changes  induced by
pregnancy.  Healthy urine contains no albumen, and the urine of
healthy women in  the pregnant  state  is   equally destitute of this
element,   This change in the urine is not always constant or equal in
amount:  in proportion as women  are constitutionally healthy, they
will be found free from albuminuria in pregnancy. And in proportion
as their systems are affected by some dyscrasia, the derangement of
the vital  fluid will be  greater; for it must be  borne in  mind that
albumen must be diminished in the  blood  in the same ratio that it is
increased in the urine.   Cases of albuminuria might be cited  illus-
trating all  the  different degrees, from the  slightest and scarcely per-
ceptible trace of albumen which appears in the urine for a brief period
only of pregnancy,  up  to those  forms  of anasarca which  involve the
entire  system, and in  which the urinary secretion, almost totally
suppressed, is so  loaded with albumen as to become entirely solid on
boiling.*
   Albuminuria may  be either  temporary or  permanent.   In the
former case it may arise  from a great  variety of morbid  influences
and in connection  with various forms of  disease.   And  it may be
occasioned  by pregnancy, which, although  not itself a morbid con-
dition, seems to develop in some form or  other any latent dyscrasia
which  may have  been lurking in  the system, just as scarlatina de-
                   * Am. Horn. Review, vol. v., p. 492. 
334           DISORDERS INCIDENTAL TO  PREGNANCY.

velops any  scrofulous taint which  may belong to the  constitution
of children whom it attacks.  And, in  fact, scarlatina does actually
develop an  albuminuria in  post-scarlatinal dropsy,  which  must be
deemed a purely psoric affection, since it appears only in a particular
variety of constitution, although the presence of the  albumen is par-
tially accounted for by the temporary failure of the functional  action
of the skin during desquamation.
  Permanent  albuminuria is principally found in connection with
chronic disease of the kidneys, whether in the pregnant or in the un-
impregnated  condition.   In  that form of hypertrophied degeneration
in which the kidneys become white and  enlarged, the urine is greatly
diminished in quantity and contains a large amount of albumen.  This
nephritic affection never proves fatal without the previous occurrence
of dropsy, which is  one of its most usual and  prominent symptoms.
Such cases belong to strongly-marked psoric diatheses, of which in-
stances have been observed  in three successive generations in wliich
the albuminuria, morbid affection of the  kidney, almost total suppres-
sion  of the  secretion of the  urine and general dropsy were the un-
avoidable attendants of every pregnancy.   This intimate connection
of albuminuria with psora is well illustrated in the report, by an allo-
pathic physician, of  the treatment with arsenic of this disease compli-
cated with psoriasis  and lichen.*  The arsenic chanced to be the true
homoeopathic  similimum  to  the  entire  case, and, although given in
allopathic doses, both albuminuria and skin disease were thoroughly
cured.
  The prompt disappearance of the albuminuria at the termination
of pregnancy in many cases, gives rise to the belief that some local in-
fluence, such as pressure of the gravid uterus upon the emulgent veins,
may be an important cause of this condition.  But, as  already stated
in the case of varices and haemorrhoids, such results can occur from
local pressure only in persons constitutionally predisposed to this  af-
fection.  Thus, in the milder cases particularly, we see all the abnor-
mal  symptoms removed by the recuperative energy of nature alone on
the discontinuance of the provoking cause.  Thus, too, even during
the continuance of pregnancy, the homceopathically indicated remedies
are so far capable of antidoting the  constitutional  dyscrasia that the
albuminuria in many instances may be made to disappear-entirely in
spite of the persistence of the provoking cause.  And these  remedies
may even then have been selected under the prevailing influence of
other  (sensational)  symptoms—remedies perhaps in which  we have
                * Brailhwaite'8 Retrospect, July, 1862, p. 95. 
ALBUMINURIA.
335
hitherto discovered neither pathogenetic nor clinical evidences of their
adaptation to albuminuria.
  The important relation which albuminuria  bears  to puerperal in-
sanity and convulsions  ought not to be overlooked in this connection.
"Albuminuria  precedes and attends the first access of puerperal in-
sanity in a large proportion of cases, but not perhaps so  frequently
nor so constantly as it precedes and attends upon attacks of .puerperal
convulsions.  The coagulability of  the  urine generally  disappears
within a short time after an  attack of puerperal insanity commences.
When the  insanity recurs in the form of successive  attacks or explo-
sions, each attack is connected with a new attack or advent  of albumi-
nuria."
  The albuminuria mostly appears in the later months of pregnancy,
and  its  presence, especially if accompanied by anasarcous  conditions,
will  serve to place the physician on his guard against puerperal con-
vulsions.  And while on  the one  side the  albuminuria Seems to pre-
dispose  to severe nervous affections, on  the other excessive nervous
excitement  appears to cause albuminuria.
  Where from collateral  symptoms  there is reason to suspect the
presence of albumen  in the urine of a  pregnant woman, the urine
should be subjected to the usual qualitative tests, that its presence or
absence  may be ascertained with certainty, and the presence of albu-
men having been discovered, its quantity should likewise be made out.
At the same time in treating the case the attention of the practitioner
should not  be diverted from the general symptoms by the presence of
the albumen, but, as in  all  other cases, the subjective symptoms should
have equal  weight with  the objective symptoms,  and  the remedy
chosen should be as  nearly  in accord with the totality of  the case as
possible.  These cases are  amenable to treatment, and it is feared that
failures  to cure sometimes  result from the entire attention, in choosing
the remedy, being directed to the albuminuria.
  Uraemia, or retention of the urea in the blood, which usually forms
a part of the albuminuria, is probably the direct cause of the convul-
sions and other nervous affections that sometimes result.   And it is
remarked that these  difficulties are more apt to  occur in  primiparaa
than in  multiparas.                                       •
  This affection has been mentioned as a powerful and frequent cause
of abortion, of premature labor  and of the death of the foetus.  This,
however, is more apparently than really correct;  for the presence of
albumen in the urine  forms but a single one of the symptoms of a
general dyscrasia which pervades the entire  system, the radical cure 
336          DISORDERS  INCIDENTAL  TO PREGNANCY.

of which  forms one of the most gratifying results of homoeopathic
practice
  The anaemia, oedema, ascites and anasarca which appear in connec-
tion with  albuminuria will be subsequently considered.   The follow-
ing medicines, together  with  those  mentioned  under the  head of
urinary difficulties and of dropsy, should be considered, as well as the
general table of remedies appended to this section, and, above all, the
Materia Medica should be carefully studied.
  Allium cepa., Amm. carb.,  Apis.,  Ars., Aurum mur.,  Bell.,  Bry.,
Cinnab., Cobalt, Colch.,  Cupr. m., Dig., Dule,  Eupat. purp., Glon.,
Lachesis, Natr. mur., Ononis sp., Phos., Phos. ac, Squill., Terebinth.

  Remedies for Urinary  Difficulties and Derangements.
   Urine acrid.—1. Hepar., Mere sol.  2. Cann., Caust., Clem., Par.,
Rhus tox., Thuya. 3. Calc. c, Canth., Graph., Kali c, Natr. m.
   ----— smelling like ammonia.—1.  Asaf.  2. Mosch., Nit. ac, Phos.
   ------hot or scalding.— L.  Ars., Canth., Hepar.  2. Aeon., Caps.,
Cham., Colch., Dig., Merc, sol.,  Phos. ac, Squill.
   ------bloody.—1.  Canth.,  Puis.   2.  Ars., Calc. e,  Caps.,  Con.,
Ipec, Lye, Merc, sol., Mezer., Nux v., Phos., Sassap., See corn., Sep.,
Sulph., Terebinth., Uva ursi,  Zinc
   ------with greasy or variegated pellicle on its surface.—1. Paris.
2. Calc e,  Hepar., Jod., Lye, Petrol., Phos., Puis.
   ------dark.—1. Aeon., Bell., Bry., Colch., Merc,  sol., Sep., Tart.
em.,  Veratr. a. 2. Ant. cr., Arn., Calc.  c, Canth., Carb. veg., Dig.,
Hell., Hepar., Ipec, Puis., Selen., Staph., Sulph.
   ------flaky.—1. Canth., Mezer.  2. Cann., Cham., Sassap., Zinc.
   ------frothy.—1. Lach., Lye, Seneg., Spong.
   ------greenish.—1. Camph.  2. Jod., Kali e,  Rheum, Ruta, Verat.
   —----milk-colored.—1. Aur. mur., Cina,  Phos. ac.
   ------mucous.—1. Natr. mur., Puis. 2. Ant. crud., Canth., Coloe,
Dule, Merc, sol.,  Valer.
   ------pale.—1.  Con., Nitr. ac, Phos. ac.   2. Agar., Alum., Ang.,
Am., Bell., Colch., Coloe, Ignat.,  Puis., Rhus tox., Sassap., Squill.,
See corn., Stram., Stront.
   -----*- purulent—1.  Canth.,  Clem.   2. Cann., Con.,  Lye, Nitric
ac, Puis., Sabin.,  Sep., Sil., Sulph.
   ------stinking.—1. Dule  2.  Ars., Carb. veg., Natr. mur., Nitr.
ac, Phos. ac, Puis., Sep., Viol. tr.
   —-----sweet-smelling.—Lactuca, Nux mos., Terebin.
   ------with urinous odor in excess.—1.  Benz.  ac 
            REMEDIES FOR URINARY  DERANGEMENTS.         337

  Uiune  turbid or cloudy when voided.—1.  Cina, Con., Mere sol.,
Sabad.   2. Ambr., Cann.,  Chin., Dule,  Ignat., Phos., Puis.,  Rhus
tox., Sep.   3. Bell., Canth., Dig., Phos. ac, Plumb.
  -----becomes turbid or cloudy on standing.—1. Bry., Cham.,  Phos.
ac.   2. Acetic ac, Caust., Mere  sol., Seneg., Valer.
  -----sticky or viscous.—1. Coloe  2. Arg., Canth., Creos.,  Cupr.
met., Phos. ac.
  Sediment reddish.—1.   Canth., Natr.  mur.,  Puis.,  Sep., Valer.
2. Aeon.,  Ambr., Ant. crud., Arn., Chin., Lye, Nitr. ac
  -----whitish.—1. Phos., Rhus  tox.   2. Coloe, Con.,  Hepar.,
Nitr. ac, Oleand., Petrol., Phos. ac,  Sep., Spig., Sulph., Valer.
  -----yellow.—1.  Cham., Phos., Sil.,  Spong., Sulph. ac, Zinc.
  -----bloody.—1.  Canth., Phos. ac, Puis., Sep.   2. Aeon., Dule,
Hell., Lye, Phos., Sulph., Terebinth., Uva ursi, Zinc
  -----clay-like.—1. Anae, Sassap., Sep., Sulph., Zinc.
  -----cloudy.—1.  Bry., Nitr., Phos. ac, Seneg., Thuj.
  -----flaky.—1. Berberis, Canth., Merc,  Mezer., Zinc.
  -----like flour.—1.  Calc. c, Graph., Merc, Natr. mur.
  -----like pus.—1. Canth., Cham., Lye, Puis.  2. Calc. c, Con.,
Kali e, Nitr. ac, Sep., Sil.
  -----mucous.—1. Dule, Natr. m., Puis., Valer.   2. Ant.  crud.,
Aur., Berberis, Bry., Caust., Coloe, Con., Mere sol., Natr. c,  Phos.
ac, Sassap., Seneg., Sulph., Sulph. ac.
  -----sandy, gravelly.—1. Ant. crud., Calc. c, Lye, Phos.,  Ruta,
Sassap., Sil., Zinc.   2. Ambr., Arn.,  Chin., Meny., Natr. m., Nitr. ac,
Nux m., Nux v., Puis., Thuya.
  Desire  to Urinate ineffectual.—1. Aeon., Canth., Dig., Sassap.
2. Arn., Camph., Caust., Coloe, Hyos., Kali e, Nux v., Phos.,  Phos.
ac, Plumb., Puis., Stram.,  Sulph.
  Discharge too copious.—1. Arg. nit.,  Mur. ac, Rhus tox., Squill.,
Verb.   2.   Acetic ac, Agnus., Bar.  c, Bism., Canth., Guaj., Ignat.,
Merc, sol., Nitr., Phos. ac, Seneg., Tarax., Viol. tr.
  ------scanty.—1.  Canth., Colch., Dig., Graph., Hell., Op.,  Ruta,
Staph.   2. Aeon., Apis., Arn., Arum tri., Bell., Bry., Caust,, Chin.,
Dule, Hep., Hyos., Kali e, Lach.,  Laur., Nitr. ac, Nux  v., Phos.,
Plumb., Puis., Sulph., Terebinth., Veratr. a.
  ------too frequent—1. Agar., Bar.,  Canth., Caust., Mere sol.,
Nitr. ac,  Rhus tox.,  Squill., Staph.   2.  Bry., Creos.,'Ferrum phos.,
Ignat., Kali e, Lach., Mur. ae, Natr. c, Phos. ac, Selen., Spig.,  Thuj.
  ------seldom.—1.  Canth.  2. Aeon.,  Arn., Ars.,  Aur., Camph.,
Hepar., Hyos., Laur., Nux v., Op., Plumb., Puis., Ruta, Stram. 
338          DISORDERS INCIDENTAL TO PREGNANCY.

  Discharge  by drops, dribbling.—1.  Canth., Sulph.   2, Arn.
Camph., Clem., Dule, Petrol., Staph., Stram., Thuya.
  ------involuntary.—1. Caust., Puis., Rhus tox.  2. Am., Bell.,
Calc. c, Carb. v., Chin., Cin., Dule, Graph., Kreos., Lye, Merc sol.,
Natr. m., Petrol., Ruta, Sep., Sil., Spig., Sulph.
  ------involuntary at night, " wetting the bed."—1. Ars., Bell., Bry.,
Caust.,  Cham., Mere sol., Op., Puis., Rhus tox., Sep., Sil., Stram.,
Staph.   2. Aeon., Arn., Bar. e,  Calc. e, Chin., Cina, Dule, Hep.,
Hyos., Ignat., Kali e, Kreos., Lye, Natr. m., Nux  v., Petrol., Phos.,
Phos. ac, Rheum, Ruta, Spig.,  Zinc.
  ------interrupted.—1. Clem., Con.  2. Agar., Caust., Dule, Phos.
ac, Sulph., Thuya, Zinc.
  Retention.—1. Aeon., Arn., Ars., Canth., Hepar.,  Hyos., Laur.,
Lye, Plumb., Puis., Ruta., Stram.  2. Aur., Bell., Caps.,  Caust.,
Chin., Cie, Coloe, Con., Cupr. m., Dig., Graph., Nux v.,  Op., Sec.
corn., Sulph., Veratr. a.
  Complaints before urinating.—1. Bor., Coloe, Lye, Nux v., Puis.
2. Arn., Bry., Dig., Phos. ac, Rhus tox., Sulph., Tart,  em.
  ------when beginning to urinate.—1.  Canth., Clem., Merc. sol.
  ------while urinating.—1.  Cann., Canth.,  Hepar., Lye, Merc.
sol., Phos. ac, Puis., Thuj.  2.  Acetic ac, Aeon., Clem., Colch., Con.,
Ipec, Nitr. ac, Nux v., Phos., Sassap., Sep., Sulph., Veratr. a.
  ------on cessation of flow.—Bry., Canth., Sassap., Sulph.
  ------after  urinating.—1.  Canth.,  Coloe, Hepar., Merc,  sol.,
Natr. m., Sassap., Thuj.  2. Anae, Arn., Bell.,  Calc. c,  Cann.,
Caps., Chin., Con., Dig. Natr. e,  Nux v., Par., Puis., Ruta., Staph.,
Sulph.,  Zinc.
  Remedies  acting especially on  the Bladder.—1. Canth.,
Hyos.,  Lye,  Nux v.,  Puis., Ruta.  2.  Aeon.,  Ant.  crud.,  Arn.,
Bell., Berb., Calad., Caps., Dule,  Hell., Merc, Mur. ac, Petrol., Sas-
sap., Squill., Sep., Staph.
  Remedies  acting especially on  the Urethra.—1.  Cann.,
Canth.,  Caps., Clem.,  Mere sol., Phos., Thuj.   2. Aeon., Bry., Calc.
e, Caust., Chin.,  Colch., Con., Mezer.,  Natr.  m., Nitr. ac, Nux v.,
Phos. ac, Puis., Sabin.,  Sep., Sulph., Zinc.

                  Disorders  of Respiration.

                     cough and  dyspncea.
  These are the principal forms of disorders of the respiratory organs
which occur in connection with pregnancy.  There may also be oppres- 
DISORDERS OF  RESPIRATION.
339
sion of the chest, palpitation of the heart, and other similar symptoms;
but these belong rather to disordered  circulation than to disordered
respiration.  Yet  so  intimate is the connection  between  these  two
vital functions  that  it would be difficult  in  any given  case to de-
termine  whether the disturbance of the respiration  affected the cir-
culation, or  whether the disturbance  of the circulation affected the
respiration.  For  our purpose it  is sufficient  to remember  that both
these functions are under the immediate and  absolute control of the
nervous  system of organic life, which, as has already been explained,
is  most  intimately connected with  the uterus and  sustains all the
development of utero-gestation.
  From reflex, sympathetic irritation  of the pneumogastric,  either
in connection with gastric disturbances or in lieu of  them, the  cough
of pregnancy may arise in the earlier  months, or it may be the
direct result of irritation of the diaphragm from the upward displace-
ment in  the later .months.   In either case the cough is short, frequent,
irritating, and it may be perfectly dry or attended with some expecto-
ration.   Influenza  may also set in  as  a complication, in which  case
prompt attention should be rendered and a  cure effected at once, since
otherwise abortion itself may result.
  A certain spasmodic form of cough sometimes makes its appearance,
resembling hooping-cough, and arising from  an apparently similar
irritation of  the pulmonary nerves.  Such cough as may be connected
with  a tuberculous condition of the  lungs, as in cases of incipient
phthisis, is more apt to disappear under the influence of pregnancy.
Should  the pulmonary difficulties  be so far developed  that a purely
phthisical cough maintains itself during the period  of gestation, the
state of  the patient will require the most serious attention, since the
phthisical symptoms usually appear with  far greater intensity after
delivery.  Another most  important indication of this  condition in
pregnancy is to be found in the chills, which have been known to
occur every day, and which in the  entire absence of cough or expec-
toration were believed to be due to  some miasmatic  influence.   Such
a patient was readily delivered of an apparently healthy and full-sized
child-,  but was  herself  found  upon examination to be in the last stage
of consumption, never being able to leave her bed or  scarcely to speak.
She lived but a few weeks after her confinement.
  Dyspnoea  in  its various forms, panting  respiration,  shortness of
breath, oppression  of the  chest, is a not unfrequent accompaniment
of pregnancy.  The symptoms of  this  class, as well  as those con-
nected with  cough, are more apt to appear in persons whose  chests 
 340          DISORDERS INCIDENTAL TO PREGNANCY.

 are  naturally weak, who are constitutionally predisposed to phthisis
 pulmonalis, or who have a similar predisposition to hydrothorax.  A
 very sad  case of a fatal complication of all these difficulties recently
 came under observation.  A  young  woman, aged about thirty,  of
 scrofulous constitution, rather short in stature, inclined to hydrothorax,
 who  probably had some small  accumulation  of water  about the
 heart for a considerable time, was  married in  the fall, and  found
 herself enceinte in the winter; she consulted her physician, at a dis-
 tance, for a  severe  cough  with great  shortness  of breath.   She
 reported  herself very  much relieved by the remedies advised, but
 soon after taking, as was stated, " a cold on her  lungs," she died in a
 few days, suffocated by the copious pulmonary effusion.
   Plethora  has also been mentioned as one of the causes of dyspnoea
 in pregnancy, for  which of course  venesection  is  the  allopathic
 remedy.  But a  more  sound  physiological  view, which  denies that
 there is ever too much pure  blood, leads also  in this instance to a
 more accurate pathology, which attributes the dyspnoea to irregularity
 or obstruction of the circulation—to  congestion  perhaps in the more
 aggravated cases—but never to plethora.
   The local congestions which arise in such cases from the obstruction
 of the general circulation, or even from constitutional predisposition
 to pulmonary apoplexy, are  connected with palpitation of the heart
 and  rush of blood to the face and  head.  These local  difficulties,
 whether dependent  upon constitutional dyscrasia or not, are insepa-
 rably connected with the other forms of disorder which occur in the
 pregnant condition ; since every part of the  system sympathizes with
 the whole and the whole with every part, the remedy which will cure
 any one  must also be the one which more  or less accurately corre-
 sponds to them all.  Hence, too, the radical cure of such cases is seen
 to be a work of time; the disturbance of the harmony of the system
 by pregnancy becomes gradually relieved, as the circulation and  play
 of the vital forces  are equalized  by eliminating  from the interior of
 the organization those  subtle hereditary miasms which  poison the
 springs  of life in their original fountains.
  For the treatment  of the  cough, dyspnoea,  and  other disturb-
ances of the respiratory system  in gestation, we recommend there-
fore  no  particular  medicines, but advise  the  thorough  study of
those already detailed under  the various forms of gastric disturbance,
and more particularly a reference to the most copious and reliable
 works on  Materia Medica that can be procured.   The leading symp-
toms  of the case may be found  in  connection  with the pulmonary 
DERANGEMENTS OF  CIRCULATION.             341
difficulties, with the gastric derangements,  or with some abnormal
condition of the secretions or excretions;  and the remedy at first in-
dicated  by the  principal symptoms, if it do  not in time  remove the
entire train of morbid conditions, will remove some of them ; at which
time a new prescription may require to be made for the case as it then
presents itself.  But it will sometimes be found that the remedy which
is indicated at the first, being homoeopathic to the particular form of
constitutional dyscrasia in the patient, and given at intervals and in
higher potencies, will  eventually remove all the various forms  of
trouble and restore the patient to complete health.*

Derangements  of Circulation  and of  the  Circulatory
                          Apparatus.
              plethora, hydremia, an.emia, etc.
   Plethora, in pregnancy, means  principally that increased activity
of the circulation which corresponds to the  increased activity of the
nervous system.  The  volume  of the  blood may be increased, and
this increase may sometimes be obtained at the expense of the quality
of the blood itself.   Thus, as the bulk of the circulating fluid is aug-
mented, it becomes more ^hin and watery.  And this condition is ex-
pressed by the term hydrozmia or watery blood.
   Plethora alone is  insufficient to  account for the vertigo, giddiness,
flushes of the face, dimness of  vision, ringing in the  ears, flashes of
heat all over the body and attacks of fainting which often annoy
pregnant women.  Some of these conditions it  should, however,  be
remembered, may arise from the opposite or anaemic condition of the
blood.  Even in plethora, while some few of the symptoms may be due
to the pressure of the apparently augmented quantity of the blood, the
greater part must doubtless arise from the  influence of the vitiated
character of  the blood  itself rendered  more serous, since it is evi-
dent how similar symptoms, as of debility, may appear to spring from
too much  and also from too little blood.   The same thing is seen in
cases  of severe haemorrhage, where the other fluids in the body are
rapidly called upon to  replace the quantity which is requisite for the
flow of the current.  The intimate connection of this  hydremic con-
dition of the blood, which often appears in the latter part of the period
of gestation, with the various forms  of dropsical accumulation, will be
obvious.  It is sufficient to remark  here that the common source of
all these morbid conditions of the blood, and of the subsequent effu-
  * Consult also Dr. Carroll  Dunham's Bonninghausen on Hooping-Cough, and Dr. B.
Simmons' Cough Repertory. 
342          DISORDERS INCIDENTAL TO  PREGNANCY.
sions and ©edematous infiltrations is to be found in the psoric dyscra-
sia developed and aggravated  by the constitutional excitement of
pregnancy.

   Anaemia constitutes a still greater degree of depravation of the
blood under the prolonged influence of many of the other morbid con-
ditions of pregnancy.  The failure of nutrition from the  severe nausea
and vomiting which sometimes persist even through the  whole course
of pregnancy, and from other gastric disturbances and intestinal diffi-
culties, in addition to  some original  morbid tendency in  the  system
itself, sometimes reduces the pregnant  woman to a very feeble, almost
cachectic condition.  This condition is still further aggravated by the
constantly-increasing demand made upon  it for the  support  of the
growing  foetus.   And the exhaustion  in  such cases may prove fatal,
either before or after delivery, unless the very root of the difficulty is
reached and removed by the appropriate remedy.
   Among the more active consequences of such  impoverished  condi-
tion of the blood in pregnancy—as in chlorosis—should be noticed
certain local congestions.  These are  developed in different parts of
the body, according to the direction of the constitutional weakness;
thus in some persons we see epistaxis,  in others haemoptysis, in others
still haematemesis,  and in others,  finally, certain forms  of uterine
haemorrhage, to be afterward described  more particularly in connection
with the other principal causes of abortion.  For each of these forms
of local congestion the  appropriate remedy must be selected in accord-
ance with all the conditions present.

   Uraemia, or the retention of the urea  in  the blood, has been men-
tioned in connection with albuminuria, with which it is usually a com-
plementary  symptom.   All these forms  of dilution,  depravation or
poisoning of the blood  may be cured  by the exhibition of the reme-
dies indicated  by all the attendant circumstances, symptoms and con-
ditions ; not by any means failing to consider the mental  and moral
states and symptoms, which latter  may constitute the  most important
indications to  guide us in the selection of the curative  remedy even
for such pathological  changes.   The same deep-seated constitutional
influence that disturbs the harmony of the circulation and the propor-
(ions of the constituents of the blood, most powerfully and much more
palpably affects the intellectual faculties, the sensibilities, and even the
affections. 
CEDEMA.
343
                 (Edema—A nasarca—Ascites.
   Thae various forms of dropsical affections may occur during preg-
 nancy, either resulting entirely from the condition of pregnancy itself,
 or complicated and  in great part  caused  by serious diseases  of the
 heart, kidneys or liver.   Some women when  pregnant are  invariably
 more or less dropsical, while others, on  the contrary, do not show
 even the slightest evidence of simple oedema.   And again, a dropsical
 condition of considerable  magnitude  may give rise to  no  inconveni-
 ence during pregnancy save that of causing clumsiness, and disappear
 promptly after parturition, while  in another case it may  be very
 fruitful of suffering and of peril, not only to  health, but even to life.
   What at the first is merely an cedematous  enlargement of the  feet
 and ankles may be  developed  as  gestation advances  into a general
 dropsy, the primary infiltration into  the  cellular tissue being finally
 accompanied by extensive effusion into the great serous cavities.

   (Edema of the  Lower Extremities is a very common attend-
 ant of  pregnancy, often  occasions no  great inconvenience, and  is
 usually confined to the seventh,  eighth and ninth months.   It is sup-
 posed to arise in  most instances  from  mechanical  pressure  alone,  and
 to be entirely independent of  constitutional disease.   This may be
 true in those cases where  it is not accompanied by other dropsical af-
 fections. Standing and walking serve to aggravate this condition;  it
 becomes worse towards evening, gradually  increases  as   pregnancy
 advances, and is often combined with a varicose state of the veins.
   In  some  instances  the oedema becomes very great, the integuments
 of  the  lower  limbs  become enormously  distended, and  a certain
 angry redness appears, as  if erysipelas would set in.   In  such cases
 there is reason to  suspect the presence  of some  more deeply-seated
 cause than mechanical pressure upon the veins,  or  even upon  the
 lumbo-sacral  nerves, nor will the  dropsical infiltration be restricted
 to the inferior extremities.
   QEdema of the vulva will nearly always be present when that of the
 lower limbs  is so largely developed; and  this will of+en cause  much
 suffering in the  latter months  of gestation, and even render  the
 patient unable to lie on either side.   Cases are on record in which the
 oedema  of the external genitals was so enormous that the  patients
 were obliged to  lie  on their backs with their  lower  limbs widely
separated.  In the  worst forms  of this affection the tumefaction may
occasion considerable difficulty in the dilatation of the perineum and
passage  of the child's  head.  Acupuncture has sometimes been re- 
 341          DISORDERS INCIDENTAL TO  PREGNANCY.

 sorted to in advance of parturition, with considerable  relief of the
 pain arising from the excessive distension of the delicate and sensitive
 tissues.

   Anasarca represents the extension of the oedema from its original
 local seat in the lower extremities over the  entire surface  of the body.
 Both oedema  or  partial dropsy of the cellular or areolar tissue, and
 anasarca or general  dropsy of the  same tissue, belong to the class of
 infiltration, as  contradistinguished  from  ascites  and  hydrothorax,
 which are effusions  respectively into  the abdominal and thoracic
 cavities.
   The  more  the oedema comes  to resemble anasarca, the more we
 realize the existence of general constitutional  causes of the affection,
 and are thus  led to look for the  means of  curing  it in corresponding
 constitutional remedies.  The attendant symptoms in each case will
 aid us in the selection of  the  remedy, since we  must prescribe for
 the patient, not for a particular pathological condition alone, however
 distressing it  may be, or however thoroughly we may understand it.
 Much experience proves the truth of this.

   Ascites, or dropsical effusion  into the cavity of the abdomen, may
 make its  appearance in the first half of  pregnancy, although  it ia
 more usually developed about the fifth or sixth month, and then con-
 tinues during  the remainder of the period of  gestation.
   This  affection is attended with more or less oedema of the  inferior
 extremities, of the  labiae, and  infiltration of the abdominal walls.
 The accumulation of fluid  in the abdomen  may be slow and gradual,
 or it may be very rapidly effused, especially after a certain degree of
 general  cedematous  infiltration  has  been reached.  In pregnant
 women  this disorder cannot fail to  cause much greater inconvenience,
 and even positive suffering, than in other persons, since it will cause
greater obstruction of the movements of the  thorax.  So great is the
 dyspnoea in the advanced  stages of pregnancy from this cause  that
 the respiration becomes as difficult  and distressing, and the erect posi-
 tion is  almost as necessary, as  in ordinary  cases of hydrothorax.
 There are frequent attacks of faintness and a constant sense of suffo-
cation from the insufficient  aeration of the blood.  And these suffer-
 ings are often aggravated  by difficulty of sleeping, headache, thirst
and disgust for food.
   The presence of water in the  abdomen may be determined  by per-
cussion, the fluctuation being usually  more  perceptible  in the left 
ASCITES.
345
 hypochondrium just below the false  ribs.   The existence  of any
 large accumulation of water in the cavity of the abdomen will usually
 prevent conception, by impeding  the action of  the  fimbriated  ex-
 tremities of the Fallopian tubes ; and the same cause tends to prevent
 the full and healthy development of the foetus, although women with
 dropsy are said to have had often very lively and  healthy children.
 Ascites  should be treated by homoeopathic physicians  with medicines
 alone if possible, since  tapping, either in the  earlier or in the later
 months of pregnancy, is very apt to be followed  by the expulsion of
 the foetus.   The  severity of the  dropsy itself, and the  consequent
 danger  of its interfering with  gestation, may be measured by  the
 earlier or later period  in which it makes  its appearance.  AYlien the
 effusion is evident in the first  half of the pregnancy, if its increase
 cannot be arrested or the disease removed by the use of the appro-
 priate remedies, it may even be necessary'to resort to paracentesis.
  The causes of ascites, and in fact of all forms  of dropsical dis-
 order, except perhaps  the most trifling, which may be considered to
 result from pressure and general  weakness, must  be found  in  the
 constitutional  dyscrasise that have already been  referred to  in con- "
 nection  with disorders of the blood and  its excretions.  The mor-
 bidly serous  condition of the blood forms  but a single link in the
 chain that terminates in cellular infiltration and dropsical  effusion.
 Still farther back we may trace the fault  of nutrition, by which the
 blood is impoverished, rendered watery and the receptacle of uraemic
 poisons.
  It is  important to be  familiar with these pathological changes so
 far as they can be detected, and some of their objective manifestations
 may afford valuable aid  in selecting the appropriate remedy.   Espe-
 cially, if not only, is this true where the pathogenesis of the remedy
 has furnished us with  similar pathological symptoms.  But that
 physician will be most successful  in his prescriptions who carefully
 avoids  encumbering his mind  with theoretical generalizations, most
 patiently studies  his Materia Medica, and never allows himself to rest
 satisfied till he has found the remedy which constitutes the most com-
 plete simile to the mental, moral, sensational and physical symptoms
 of the case.
  For the  remedies which  may be  indicated in the  various forms of
dropsical  affections liable to appear  in pregnancy, consult those de-
tailed in the article on Dropsy of the Uterus.
  Dropsy of the  Amnion and  Hydrorrhcea  are treated  of under the
 head of Disorders of the Uterus and its Appendages. 
346           DISORDERS INCIDENTAL TO PREGNANCY.
                    HEMORRHOIDS, OR PlLES.
  Haemorrhoids may make their appearance in the earlier or in the
later months of pregnancy.  In the  first instance they may result in
part from pressure exerted directly upon the  internal iliacs by the
expanding uterus before it has emerged from the pelvis. In the latter
case the gravid uterus exerts pressure upon the  common iliacs.   Still
this affection of the haemorrhoidal veins is by no means entirely caused
by such mechanical  pressure, otherwise it would be much more com-
mon than it now is, if not indeed universal.
  In women predisposed  to constipation, or in whom some dyscrasia
develops itself in such obstruction of the bowels, haemorrhoids are an
almost necessary  consequence  of this condition in  pregnancy; and
the inactive habits that aggravate the constipation at the  same time
augment the haemorrhoidal enlargements.   But whether  due to the
inactive state of the  circulation, which is a necessary attendant of in-
active habits, to mechanical  pressure, to constipation, to dyscrasia, or,
as is generally the case in  greater or less degree, to all these influences
combined, the piles  constitute a very painful condition in pregnancy.
They may be blind,  that is, never bleed, and inward,  never protrud-
ing, and still occasion  much  suffering.   They may protrude  with
each evacuation, sometimes  become strangulated and  difficult of re-
placement, and by their exhausting haemorrhages may greatly weaken
the strength.  The constipation greatly aggravates the haemorrhoidal
condition, and at the same time the pain accompanying an evacuation
is so great that the woman dreads going to stool, and hence by delay-
ing causes increased atony of the bowels and aggravates the constipa-
tion.  This circumstance should be borne in mind by the practitioner,
and should  lead  him to  urge  upon  his patient the necessity of not
neglecting the alvine  evacuations, and at the same time lead him to
suggest  a suitable diet, such as would  have a tendency to produce
rather a relaxed condition of the bowels.  Most of these cases are en-
tirely amenable to treatment, and even the worst may  be so modified
that the suffering may be almost entirely removed.
  Under allopathic treatment the constipation  is attacked by purga-
tives, which are incapable of removing either the cause or the conse-
quences ; while the indicated homoeopathic remedy exerts a beneficial
influence equally upon the obstruction of the bowels and upon the en-
largement of the haemorrhoidal veins.  The following medicines should
be studied, and that one selected which best corresponds to all the con-
ditions and symptoms of the patient, who should carefully abstain from
coffee, wines and  liquors, and  from  food too much concentrated, and 
HEMORRHOIDS, OR  PILES.                  347
take as  much daily exercise as her circumstances and situation will
allow with comfort to herself.  The medicines mentioned under Con-
stipation may likewise be consulted with advantage.

  Aconite. Shooting and constant pressure at the anus, pain in the
back and  sacrum as  if bruised, feeling of fullness of the abdomen,
colicky pains, great uneasiness;  the piles occasion great annoyance.
  iEsculus hipp.  Sensation in the lower portion of the back, across the
sacro-iliac symphyses, as of great weakness; she "gives out" there when
walking.  Bleeding piles, or purple-colored piles which do not bleed;
constipation, great pressure in the rectum.   Sensation of sticks.
  Aloes. The varices  protrude and  resemble  clusters of grapes; fre-
quently feel  hot and sore.   When urinating, sensation as  though
something had passed or would pass  from the bowels.  Feeling  of
heaviness  or  weight within the pelvis.   Large masses of mucus are
sometimes discharged per anum.   Involuntary solid stool.
  Alumina. Evacuations look like  laurel-berries, and are passed with
much difficulty  and  with cutting pains.   Occasional discharge  of
blood from the  rectum, followed by  sore  pains.   The urine cannot
sometimes be passed  except when straining  at stool.
  Amnion, carb.  The varices protrude during  stool, and even between
the evacuations,  and feel raw as  if excoriated.  Burning and  itching
in the anus, and so  painful after stool she cannot walk.
  Ammon. mur. Continual  sore  smarting in the haemorrhoids.  Sore
pustules on the verge of the anus.   Pain in the perineum,  especially
when walking.  Particularly useful if haemorrhoids occur after the
suppression of a leucorrhoeal discharge.
  Antimonium C.  Diarrhcea and constipation alternate, the evacuations
while diarrhoea exists consisting of a watery fluid with  hard lumps.
General gastric  disturbance with  the haemorrhoids.  Excretion  of
large quantities of mucus, with burning, tingling  and itching so great
that she can scarcely keep still.
  Apis.  Constipation.   Scanty urine.   Much stinging  pain in the
anus and  rectum ;  the  stinging  is  followed  by severe burning sen-
sation.  Restlessness at night, no position comfortable.
  Arsenicum.  Burning,  like fire, and  shooting pains in the varices;
heat, agitation, and sometimes a feeling of great  weakness  and rest-
lessness.   Fissures  in the anus, Avhich  burn and render urination dif-
ficult.   Pain  or a painful stiffness in the back, making stooping diffi-
cult.  Corrosive  itching of the parts.
  Belladonna. Bleeding piles, accompanied with a sensation as if the 
348          DISORDERS INCIDENTAL TO  PREGNANCY.
back were breaking or would  break.   The varices sometimes  become
strangulated from spasmodic constriction of the sphincter ani, at which
time they are excessively sore  and sensitive.  Dysuria and congestion
of blood in the head are frequent accompaniments of the haemorrhoidal
condition when this remedy is indicated.
  Calcarea C  The piles often bleed profusely, to  the extent of blanch-
ing the patient.   The pain occasioned  by the piles is aggravated  by
walking.  Very great pain in the anus after stool.  Sleeplessness in
the early part of the night.  Acrid and offensive sweat from the feet,
which  makes them raw and sore.  Feet  are  cold, as if  from damp
stockings.  When not pregnant the  patient menstruates too frequently
and too profusely.   She is very sensitive to cold air.
  Capsicum.  Burning  and smarting in the varices, as though  pepper
were sprinkled on them.  Bleeding piles,  the flow of blood causing a
burning pain in the anus.
  Carbo veg.  The haemorrhoidal tumors are large and blue, with shoot-
ing pains in  the loins, stiffness in the back, burning and rheumatic
pains in the limbs.  Burning feces.  Frequent congestion to the head;
epistaxis; flatulence.  There may also be much burning mucus from
the rectum.   Discharge of an acrid, offensive humor from the anus,
particularly at night.   Much itching about the anus and perineum.
  Cascarilla. The bowels are  evacuated with difficulty, and the feces
are covered with much  mucus, or the feces are mixed with quantities
of mucus.  Frequent and profuse bleeding from the anus during or
after stool.
  Causticum.  Large  and  painful haemorrhoids, which  burn when
touched  and  seem to hinder  the passage of the feces; the suffering
is  much increased by walking.  Sometimes in connection with the
haemorrhoids we find a large and painful ulcer near the anus, con-
stantly discharging blood and  pus.
  Chamomilla. In painful,  bleeding, burning  haemorrhoids; but the
mental symptoms will particularly indicate this  remedy.  She is rest-
less, can hardly control herself; gives short answers;  she can hardly
endure her slight sufferings.   Irritable and spiteful.
  China. Haemorrhoids, with  burning,  itching,  tingling or creeping,
extending into the  urethra.   They sometimes bleed profusely.  The
patient  is very sensitive and debilitated, and the piles and her  general
symptoms are worse every other day.
  OoUinsonia. A jagging  sensation is felt in the lower  part  of  the
rectum  and  anus, as though sticks or gravel had lodged  there.  The
symptoms get worse in the evening, and continue so till late at night. 
HEMORRHOIDS, OR  PILES.
349
 Blind or bleeding piles.  Constipation or diarrhoea.   "Weight or pres-
 sure in the rectum, with intense irritation or itching there.
  Colocynth. Pricking at the anus, with constant discharge of mucus
 D.irting in the rectum, alternating with stitches through the bladder.
 Blood  flows  continuously  from  the  haemorrhoids  for a  long time.
 Emission  of large quantities of flatus per  anum.   Persons who are
 subject to violent attacks of cramp colic
  Graphites. Easy prolapse of the rectum, as though the parts had lost
 their tonicity; it becomes  prolapsed  without even a desire for stool.
 Swelling of the anus.  The varices feel very sore after an evacuation.
 Painful burning fissures between the varices.  The patient menstru-
 ates  scantily, and has itching  blotches on the face and other parts of
 the body.
  Hamamelis. The varices  bleed very  profusely, with  sensation  of
 soreness, weight  and burning  in the  rectum.  The varices  protrude,
 and  the anus feels  sore  as  if raw.   The stools  are covered  with
 mucus; the back feels  as  if it would  break; restlessness at night;
 dryness of the mouth.
  Ignatia. When the piles  are attended with pains shooting  deep into
 the rectum, seemingly up  into the abdomen.   Itching  and tingling
 in the anus, and prolapsus recti during an evacuation.  Sensation of
 excoriation and contraction in  the rectum.   The  pain in the anus and
 rectum continues for hours after an evacuation.
  Kali  carb. Stitching and cutting  pain in the varices, which become
 greatly swollen and enlarged.   The feces are large and hard, and the
 stools are followed by bleeding from the varices.
  Lachesis. The  anus feels as if it were entirely closed by the varices,
 and as if nothing could pass;  the bowels are very costive, apparently
 on this account.   (Haemorrhoids, which make their appearance at the
 climacteric, when the menstrual flow becomes scanty.)
  Lycopodium. Much  rumbling in the  abdomen; red  sand or  red
 sediment  in  the urine; itching eruption  around  the  anus;  great
 tendency to excoriations, which bleed easily.   The  varices protrude,
 and  are  particularly  painful  when sitting.   Cutting»in the rectum
and  bladder.  Tearing in the rectum,  so  sharp that it arrests  the
 breathing.  Accompanied  with varices in extremities.
  Mercurius sol.  Piles which bleed during stool and while urinating.
 The bloody stool causes an  acrid, painful sensation in the anus.  Pro-
 lapsus of the rectum, the fallen gut having a dark and bloody appear-
 ance.   Inflammation and  suppuration of the haemorrhoidal tumors.
 The  anus feels raw. 
350
DISORDERS
INCIDENTAL TO PREGNANCY.
   Muriatic acid. Exceeding tenderness of the parts; she cannot beai
 the  least touch  upon  them, not even of the sheet.  The piles bleed
 profusely; there is much itching of the parts, which  is not relieved
 by scratching.  Great debility.  Prolapse of the rectum  when  uri-
 nating.  Involuntary discharge of a  small quantity  of feces while
 urinating, which seems unavoidable.
   Natrum mur. A moisture constantly oozes from the varices, which
 are  very painful, stinging, smarting and throbbing.  Herpetic erup-
 tions about  the  anus, with  itching  and  burning.  Stitches in the
 rectum  from below upward  occasionally  during the  day.  Hard,
 difficult and  painful stool followed  by a liquid stool, the pain lasting
 a long while afterward.   Ripping sensation during stool.
   Nitric acid. Old haemorrhoidal tumors, secreting much slime and
 bleeding profusely at  every fecal evacuation.   Smarting in the rec-
 tum a long time  after a stool;  also sharp cutting pains,  which last a
 long time.  The patient dreads an evacuation.
   Nux vom.  This remedy should be thought  of for  all persons of
 sedentary habits, and  for those who use spirituous liquors or coffee in
 excess.   It is especially indicated when there are shooting and shocks
 in the loins; contused pains  which hinder from rising up;  consti-
 pation, with frequent and ineffectual effort to evacuate, and  sensation
 as if the anus were closed or contracted; no appetite; sleepless in the
 latter part of the night;  headache; loss of energy.  Sensation in the
 rectum  after  an evacuation,  as though something remained which
 should  be passed;  or a frequent  or  even continual inclination to
 stool, with  a sensation  as  though the rectum   contained a  small
 quantity of feces which must  be passed, although  nothing passes.
   Petroleum.  Haemorrhoids, with itching about the anus, which compels
 her to rub and scratch  till the  part becomes  raw and sore.  A moisture
 constantly oozes from  the vulva, with violent itching.
   Phosphorus. The  haemorrhoids are accompanied .with a  sensation
 of weakness  or  sinking in the abdomen;  they protrude very easily,
 coming down even during the emission of flatus.   Relaxation of the
 sphincter ani; constant discharge of mucus from the varices.
   Podophyllum. Piles,  with prolapsus ani; prolapsus uteri;  consti-
 pation or  morning diarrhoea;  too  frequent  but  natural  passages.
 Pain in the  lumbar and sacral regions, worse during  a  stool and
still  worse afterward.  Constipation with  headache.   She  is subject
to "  bilious attacks."
  Pulsatilla. Discharge of blood and mucus during stool;  pallid coun-
tenance and disposition to faint; dysuria; tearful disposition,  mild and 
HEMORRHOIDS OR PILES.
351
 trontle; bad taste in the mouth in the morning.  She cannot bear to be
 in a close or warm room; generally feels worse in the evening, and is
 better from  going into the fresh open air.   Feels worse after partak-
 ing of rich or greasy food.  Absence of thirst.
   Rhus tox.  Protrusion of blind haemorrhoids after every stool, which
 feel sore.  Drawing  in the back from above downward, which sensa-
 tion seems to be due to the  piles, and with a feeling as though every-
 thino- would come through the rectum.    Constant  restlessness and
 fidgetiness.  Relieved by change of position.
   Sabina. The piles discharge bright red blood, and cause pain in the
 back from the  sacrum to the pubes.  Biting, sore pain in the varices,
 especially during the morning stool.
   Sepia. The patient is subject  to a painful sensation of emptiness in
 the epigastric region; has delicate and sensitive skin.  Protrusion of
 the varices  and of the rectum, attended with  difficult micturition.
 Heat, burning and  swelling of the anus when the  piles do not pro-
 trude, and defecation  is then  excessively painful,  the  stool  being
 rather small, narrowed down by the diminished calibre of the anus.
 Sometimes  the fecal  mass is triangular in form and very  painful.
 Constant oozing of moisture  from the anus.  Stitches and jerkings
 from the anus  upward into the rectum  and abdomen.  The symptoms
 are usually aggravated by partaking of milk.
   Silicia. If the varices protrude ever so little they are apt to become
 strangulated and painful, and  are  returned with  much difficulty.
 Difficult stool, the fecal mass receding into the  rectum several times
 when on the point of being discharged.   The haemorrhoidal tumors
 inflame and  suppurate easily.
   Sulphur. Much itching and soreness of the anus on account of the
 varices, which bleed during stool.   Prolapse of  the  rectum during a
 hard stool.  The indications for this  remedy are to be found rather
 in general characteristics than  in  local symptoms.   Heat on the top
 of the  head, general flushes of heat, weak, fainting feeling; very
 hungry and  faint about eleven o'clock A. M.; awakens frequently at
 night, and feels very weak and faint in the morning; very cold feet,
 sometimes burning in the soles of the  feet at night in bed.  Inclina-
 tion to stoop forward when walking, or even when sitting.  Desire to
 sleep late  in the morning.   Despondency and sluggishness of the
 mind; she finds it difficult to do anything.
  Thuja occ. The haemorrhoidal  tumors are excessively sensitive to
even the slightest touch.  Fig-warts around the anus or elsewhere are
an accompaniment. 
352          disorders incidental to pregnancy.

                         Varicose Veins.
   Varicose veins often appear during  the latter months of utero-ges-
tation, and  are  commonly supposed to be caused by the pressure of
the gravid  uterus upon the iliac vessels and  inferior cava.  But this
local  pressure can be but a  single one of the exciting  causes, since
varices are seen in some who are not pregnant, and they do not make
their  appearance in the  larger proportion of those who  are.  If the
pressure were the main cause, all or nearly all pregnant women should
have  more or less of this varicose condition  before they are confined,
which is far from being the case.
   The constitutional condition of the system in general, and perhaps
of the organs of venous circulation  in particular, which gives rise to
varices under the  influence of exciting causes, is no doubt similar to
that which produces  haemorrhoids.   In each affection,  constipation
seems to exert no small provoking influence, although it may be that
the same deep-seated disorder of the constitution may at the same time
cause the varicose  and  the constipated condition.   The varicose and
the haemorrhoidal enlargements are alike  liable to rupture and to
occasion serious haemorrhage.   And both these disorders are equally
amenable to homoeopathic medication.   The appropriate remedies,
taken in season, will entirely  cure  the varicose condition, or, if re-
sorted to only after the enlargement has already become very exten-
sive in the latter  months of utero-gestation, will at least prevent its
further increase.  And as on the one hand homoeopathic treatment
perseveringly employed will entirely  remove the constitutional pre-
disposition to varix,  so,  on  the other hand, the highest  allopathic
authority states  that " this condition of the veins gradually increases
in amount and severity with every succeeding gestation." *
  The various and severe pains, and all the attendant  symptoms and
conditions of varices below the knee, in the thighs, in the labia, vagina,
and even in the os uteri  itself, the appearance of the  enlarged veins
themselves, their color, inflammation or rupture, and the  concomitant
and constitutional symptoms and seasons and occasions of aggrava-
tion, will enable the  attentive  physician to  prescribe  in such cases,
with the certainty  of greatly ameliorating the general health, and so
of improving the prospect in  parturition, as well  as of removing the
varicose diathesis itself.
  The vascular nature of much of the substance of the external geni-
tals predisposes them to varices.  They may  occur in the veins of the
vulva or in  those of the vagina.
                * Churchill, Diseases of Women, chap. vi. 
VARICOSE veins.
353
   These  enlargements of the veins are scarcely less common during
 pregnancy than are haemorrhoids, but, except they appear in tne vulva
 or vagina,  are  usually less  painful.   They should  be treated upon
 general homoeopathic principles, all the attendant and  constitutional
 symptoms being taken into account in prescribing.   The following
 medicines are more  particularly useful, and the indications given for
 their use under the head of Haemorrhoids or Piles, together with those
 of the other medicines there given, may be consulted with advantage:

   Apis mel. Burning and stinging pains in the varicosed veins, either
 with or without constipation.
   Arnica. The varices are very sore, with a bruised feeling.   Espe-
 cially useful for varicose veins of the vulva or vagina.
   Arsenicum.  If they burn like fire.
   Carbo veg.  Painful discharge or complete suppression of urine at-
 tends the varicosed condition of the vagina.   The varices have a blue
 appearance and are very hard.
   Causticum.  They become much more painful while walking.  In-
 voluntary urination on coughing or making a false step.
   Ferrum met. In weakly persons, with fiery-red face.
   Fluoric acid. In obstinate cases and in those of long standing, espe-
 cially in  women who have borne many children.
   Graphites. The varicosities itch very much, and have little pimples
 on the surface  of the  integument over them.  Itching blotches on
 various parts  of the body.
  Hamamelis. The  varicose veins are  hard,  knotty,  swollen and
 painful.
  Lycopodium. Varicose veins of the lower limbs, extending nearly to
 the feet;  they seem very large and hard under pressure of the finger.
 Red sandy sediment  in the urine.  Borborygmus and constipation.
  Nux vom. In women who habitually use wine and rich and highly-
 seasoned  food, who  keep late hours  and  suffer from habitual consti-
 pation.
  Pulsatilla. Especially suited to women of mild disposition, wTho are
 easily moved  to tears.   The pain  from the varicosed veins  and the
 general symptoms  are  aggravated toward evening.   The varices pre-
sent a blue appearance.
  Sulphur. This remedy will often be found useful when indicated by
its well-marked and well-known characteristics.  It will be especially
useful to women who suffer from haemorrhoids  as  well  as  varicose
veins of the extremities or vulva.
       23 
354         DISORDERS INCIDENTAL TO PREGNANCY.

  Zinc.  Varicose veins which give rise to fidgetiness of the feet and
limbs.

  External  treatment for this affection, such as bandaging, is of far
less value  than internal medication.   In  extreme cases, however
where there appears to  be  danger of rupture of the vessels, a roller
or a laced stocking  may be  applied  to support  the veins until the
remedies have  time to  act.  In  such cases, also, placing  the limbs
when  they are the seat of the affection upon a stool  or chair relieves
the  over-distended  vessels  from  the  downward pressure of gravity.
Perfect rest and quiet are indispensable in the treatment of these worst
forms of varicose veins until decidedly better.
                      CHAPTEH XVII.

DISORDERS INCIDENTAL TO PREGNANCY—CONTINUED.

      Affections of the Uterus and its Appendages.

   THE  morbid affections to which the uterus is liable in the pregnant
    state may be arranged in three  classes:  I. those which are prin-
cipally sensational, such  as cramps,  pains and excessive sensibility;
II. displacements;  III.  abnormal  secretions, such as  leucorrhcea,
dropsy of the amnion and hydrorrhoea.
  I. Pains ; Cramps ; Sensibility of the Uterus.—The uterus
in pregnancy, even if it does not experience an enlargement of its
nerves corresponding to that of the  arteries and veins, still partakes
in a remarkable  manner  of the increased  sensibility of the nervous
system in general. Hence all influences, from within or from without,
are very acutely  felt—many of them very  painfully—which  in the
unimpregnated condition  would scarcely be noticed.  In addition to
this excessive sensibility, there are actual uterine pains, seated appar-
ently  in the walls of the uterus, which are doubtless the result of the
contraction of the uterine muscles.  These may appear at any time
after the first three  months of  utero-gestation; they may return at
intervals in  paroxysms,  and increase  in severity as the pregnancy
advances.   These pains may even become so severe as to resemble
uterine cramps.   The excessive sensitiveness of the uterus renders the
ordinary motions  of the foetus very painful to the mother, while at the 
      AFFECTIONS OF  THE  UTERUS AND ITS APPENDAGES.    355

same time the morbid irritability of the mother's state in general ren-
der* the movements of the foetus much more active and violent.  All
these morbid conditions may be greatly ameliorated by the exhibition
of appropriate homoeopathic remedies,-thus rendering the patient more
comfortable, and at the same time removing influences  which might
otherwise terminate in abortion.
  II. Displacements of the Uterus.—Conception may occur in
women who are subject to prolapsus uteri  in cases where the womb
is temporarily  replaced, or the  already gravid  uterus  may become
subject to either of the different forms  of displacement under the
influence of accidental causes connected with its own weight or  with
the  disproportionate size of the pelvis.   In the former case the pro-
lapsus, while it affords no bar to conception, greatly endangers the
safety of the  foetus until after it is established above  the  superior
strait.  In the latter case the already gravid uterus may be projected
so far over the pubes as to constitute anteversion,  or turned back* in
such a manner as to undergo retroversion by its fundus being lodged
beneath the promontory of the sacrum.
  Prolapsus uteri in  pregnancy, as in the unimpregnated condition,
may come on gradually or suddenly; it may also be a partial descent
or a complete procidentia.   This is especially apt to be the case when
the  pelvis is unusually large.   In all cases of prolapsus uteri in preg-
nancy, whether the result of  a previous habit or  of  more recent
influences, it is simply necessary for  the patient to remain quiet and
take the remedy indicated, according to the conditions and symptoms
of her case.  The  appropriate  remedy, together with the increasing
size of the ovum, will in a short time remove the prolapsus and render
its return impossible.
  Anteversion chiefly occurs in the more advanced stages of pregnancy
when  the uterus has become very heavy, although some few instances
are  recorded in which this accident happened in the second and third
months  of pregnancy.  In the slighter  forms of this displacement
the  term obliquity is more applicable, while in complete anteversion
the  fundus uteri may even be  engaged  below the symphysis pubis.
Perfect quiet, a recumbent position, and  the judicious exhibition of
the  remedy indicated by the symptoms of each case,  will almost always
suffice to  effect a complete cure.   In cases where the fundus is actually
engaged beneath the symphysis, manual  assistance will be needed  in
order to secure reposition, the patient lying on her back.
  Retroversion, in the pregnant as  in the  unimpregnated condition
of the uterus,  forms a very serious complication, whether  it occur 
35G          DISORDERS  INCIDENTAL TO PREGNANCY.

suddenly or slowly.   In many cases the symptoms will scarcely lead
us to  suspect the presence of this form of displacement until  the
fundus is actually engaged beneath  the  promontory of the  sacrum.
In this condition the use of the uterine elevator, described in another
chapter, may be found necessary.  Retroversion is  most apt  to occur
in the  third and  fourth months, but it may occur in the fifth, or even
as late as the seventh month, of gestation.   It may take place very
slowly, so as to  become complete by the third month of pregnancy,
aided  very much by the  gravity of the ovum  when once it  has  be-
come deflected from its  proper  position.   This first beginning of
the  mischief may result  from a too great and  too long-continued
distension of the urinary  bladder.  The complete or partial retention
of the urine forms  one of the most characteristic indications of the
retroversion itself.
  In order to  facilitate the restoration of the retroverted uterus it
may be necessary to place the patient prone upon her face;  thus, as
soon as the  fundus uteri is disengaged  from beneath the promontory
of the sacrum, its own gravity  will enable  it to resume its proper
place in the pelvis.   It will be necessary to distinguish this  form of
displacement from extra-uterine pregnancy, since very disastrous con-
sequences must  otherwise speedily result.  And  this  will  be best
accomplished by a careful study of the conditions and  symptoms of
the case, and of the  causes which have  apparently produced the mis-
chief, in addition to the most careful exploration per  vaginam, and, if
necessary, per anum.  Retention of urine in the bladder, from want of
opportunity to discharge it, as sometimes in traveling, violent strain-
ing to  lift a heavy weight, a fall backward, blows or other accidental
pressure upon the navel, may  occasion the retroversion.
  A previous retroversion is no doubt the most frequent cause of the
retroversion of the uterus in pregnancy.  In such cases the trouble is
at first entirely unsuspected,  as  in the first weeks  of gestation  the
increased size of  the uterus scarcely occasions any more inconvenience
than before  conception.  But after a while  the cervix uteri begins to
press upon the bladder and hinder its evacuation.  Then the sudden
and severe symptoms, which are really the consequences of the gradual
enlargement of a previously retroverted uterus, are supposed to result
from a sudden displacement.  Careful attention to the calls of nature,
as well in respect to  the bowels as to the bladder, will be important,
in order to  obviate  any disposition to this  displacement, particularly
in persons who  have suffered from it  in former pregnancies.  And
where  retroversion  has either suddenly set in, as in consequence of 
      AFFECTIONS OF THE UTERUS  AND ITS APPENDAGES.    357

an accident, or gradually developed from partial displacement of this
kind existing previously to conception, it may be necessary to evacuate
the bladder and rectum before any progress can be made in restoration.
Then, after the womb has been replaced, perfect rest  in a  recumbent
posture, for a longer  or  shorter time, according to circumstances, will
greatly aid the proper remedy to effect a complete  cure.  The various
pessaries proposed and  used in such cases we consider  entirely unne-
cessary, and in  many cases positively  injurious.  With the aid of the
appropriate remedies, and of such favorable circumstances and hygienic
conditions as are indispensable under any plan of treatment, Nature
may be enabled to hold the uterus up; which she can never learn to do
as long as it is propped up and  the muscular structures are thereby
weakened.
  The medicines appropriate for  these various  forms of uterine dis-
placements existing  during pregnancy,  as well  as explicit directions
for  their treatment, will be found elsewhere, in the  chapter on Dis-
placements of the Uterus.
  III. Abnormal Secretions.—Leucorrhosa may exist during preg-
nancy, especially in persons constitutionally  predisposed to this  affec-
tion.  The discharge is usually of a mild character,  thick and white
in its appearance, and sometimes  profuse in quantity.   The increased
activity of the circulation of the uterus and its appendages, incident to
pregnancy, extends to the muciparous  glands of the vagina and cervix
uteri,  and an excess of the secretion wdiich  closes  the cervix  may
occasion  a constant  discharge.   In  connection with  the  discharge
may occur irritation, itching, heat and  burning  in the  vulva and
parts  adjacent.   Where the leucorrhcea  is very  profuse, symptoms
of debility may follow.
  The treatment required for  all  these  cases will be  found  under
appropriate headings in  another part of this work.
  Hydrorrhcea is the name given  to such discharges of water from the
womb as occur in the course of gestation without rupture of the mem-
branes.   It is probable  that this  accumulation of fluid—false  waters
—takes place between the  inner  surface of  the uterus  and the mem-
branes, the latter being stripped off as  the fluid accumulates and forms
for  itself a pouch.  This pouch  gradually increases in size in  the
direction of the os, and when that outlet is reached the flow of false
waters takes place. This phenomena may deceive the accoucheur, and
lead him to believe that the membranes are ruptured and that labor
is about to set in, whereas careful  examination will discover the mem-
branes intact, and there  may be no signs of labor present. 
358          DISORDERS INCIDENTAL TO PREGNANCY.

   In the  later months of pregnancy this affection is not uncommon,
the uterus from time to time relieving itself of the undue accumula-
tion without special muscular effort,  very much as the urinary blad-
der does.   An examination of the  os uteri in such cases will  satisfy
the practitioner that the discharge does not come from within the true
water-sac, and that therefore there is no cause for alarm as from a
threatened miscarriage.  The flow appears at irregular intervals, and
without any especial provoking cause; neither does it occasion any re-
markable symptoms.
   The concurrence of other dropsical conditions, such as oedema of
the limbs, the fact that the discharge arises spontaneously, and the
almost entire absence of pains or uterine contractions, will enable the
physician to diagnose the  hydrorrhoea with sufficient certainty.  , The
false waters may make their exit without any  noticeable provoking
cause, and without  any more than the very slightest constitutional dis-
turbance; while the membranes which enclose the true amniotic waters
can only be broken  by some great bodily exertion, some special acci-
dent or positive effort, and their discharge of these waters cannot but
be followed by strongly marked symptoms indicating the approach or
actual existence of  labor.   Perfect  quiet, freedom  from excitement or
anxiety, and the exhibition of the remedies indicated  by all the at-
tendant symptoms and conditions,  will be all that is requisite to pre-
vent  serious  mischief  from this  condition, and to remove as  far as
possible its constitutional causes.
   Dropsy of the Amnion.—The determination of the existence of this
disorder of pregnancy is not so easy as that of hydrorrhoea, since there
may be an excessive amount of amniotic liquid without any very re-
markable distension of the abdominal  parietes,  and since  also the
normal  amount of the liquid itself  is capable of very considerable
variation.  But generally speaking, dropsy of the amnion is an acute
disease, and the rapidity of its  development, together with the dis-
tressing constitutional  symptoms, affords our best means of diagnosis.
This  is the  more especially the  case  since also  ascites almost always
complicates this affection.
  There does  not seem to be any change in the specific gravity or con-
stitution of the liquor amnii, only an excess of production.  The nor-
mal quantity may be estimated  at three  or four pounds, according to
the state of pregnancy, but from forty to fifty pints have been found
present in dropsy of the amnion.  Thus at the fifth or sixth  month
the uterus may be more  distended than usually at full term.   The
uterus is  rounded; fluctuation is more  obscure;  there is nut  much 
DROPSY OF THE AMNION.
359
thirst* the urine is natural except in cases complicated with general
dropsy, and there is sometimes little or no cedematous enlargement of
the inferior extremities.  Among the  most important diagnostic signs
are to be found, therefore, the disproportionate size of the  tumor to
the period of pregnancy, the feebleness of the movements of the child,
and the great size of the abdomen, evidently dropsical, which is less
apt to be accompanied by oedema of the thighs and legs than in ascites.
  Dropsy of the amnion may occasion severe suffering to the mother,
sensations of suffocation and hindrance of the circulation;  these are
probably due in part to  the rapidity of the enlargement  itself, and
in part to the general constitution of  the patient.   But this  difficulty
very rarely becomes  dangerous, since  its  very excess tends to  self-
relief by producing abortion.
  The  most important results of this dropsical affection are found in
the injury to the foetus, whose nutrition is enfeebled by such excessive
secretion; in the total destruction of the  foetus, which is sometimes
almost entirely dissolved in the  amniotic fluid;  and in the premature
expulsion of the foetus at a period when its insufficient age, its enfee-
bled condition, or both together, render it incapable of viability.
  As has been already remarked, ascites  usually accompanies  and
complicates dropsy of  the  amnion.   But  ascites  may exist  during
pregnancy without amniotic dropsy, and  the reverse may  likewise
occur.  It is therefore a matter of importance to be able to make a
correct diagnosis.  Cazeaux gives the following points  for their differ-
ential diagnosis:  " In ascites complicating pregnancy the urine is small
in quantity, whitish and turbid, the thirst great and constant, and the
lower extremities and  genital  parts mostly much  infiltrated.  It  is
difficult, and sometimes even impossible, to distinguish the shape and
fundus of the  uterus, on account of  the irregular form of the  belly
and the enormous distension of the hypochondriac  regions.  Percus-
sion  produces  an undulation or sort  of fluctuation, which is much
more perceptible at the upper than at the lower part of the abdomen.
  " In dropsy of the amnion the size  of the belly approaches much
more nearly that of a uterus at term, although the pregnancy may not
have existed more than five or six months.   The uterus is so rounded
as to be almost spherical.  Fluctuation is more obscure, thirst slight
or absent, urine natural, and in some cases little or no infiltration of
the lower extremities.  The umbilical  tumor is  rarely present, and
when it exists has not the transparency observed in ascites."
  The  treatment of dropsy  of the amnion  must be principally pro-
phylactic, and based  upon  attendant  symptoms and such constitu- 
 360         DISORDERS INCIDENTAL TO  PREGNANCY.

 tional indications of predisposition to general or particular forms  of
 dropsy as may be discovered, aided and confirmed by the sensational
 symptoms  which may especially characterize  the individual  case.
 For when  dropsy of the amniotic  cavity has  become so extensively
 developed  as  to  be clearly diagnosed, there will be small hope  of
 eventually saving the product of  conception.  But even if  perfect
 success may not be  thus obtained in the first instance, there will still
 be  reason  to hope  that in  a subsequent pregnancy a constitutional
 treatment begun at an earlier period, and more intelligently directed
 by ampler  knowledge of the case, its tendencies and its dangers, may
 enable the  practitioner to obtain a decided improvement in the health
 of the mother, and  at the same time secure the safety and the health-
 fulness of  her child.  Dropsy of the  amnion is  always the result
 of some  constitutional dyscrasia, which, under the  stimulus of preg-
 nancy, develops itself  usually in other directions and in other forms
 also.  For  the remedies for this affection consult therefore those men-
 tioned under  other  varieties of dropsy, and  such as  may be  par-
 ticularly  indicated by the sensational symptoms, such, for  example, as
 the sense of suffocation.   With regard  to the propriety of inducing
 premature  delivery  in extreme cases of this kind, see the subsequent
 chapter on Abortion.

       Affections  of the Appendages of the Uterus.
  Pruritus of  the vulva forms one of the most distressing disorders to
 which women  are liable in pregnancy.   This affection consists in an
 incessant and  intolerable  itching  of the external  genitals.    The
 immediate  cause  may  be found sometimes in an  irritated, inflamed
 condition of the parts involved, or, as described by another, " it com-
 monly depends on  follicular irritation  of the vulva, which,  if un-
checked,  passes to aphthous  ulceration."  Sometimes there may  be
 found no abnormal  appearance of the vulva, except such as must arise
from the  violent rubbing and scratching to which they have been  sub-
 jected ; but on examination,  congestion and even superficial granular
 ulceration of the  cervix uteri may be detected.
  This affection  is  most apt to occur in young women.  Churchill
relates a case  the  symptoms of which are  very  strongly marked:
when about four months  pregnant she was  attacked  by the most
 intense and incessant itching of the vulva; she had no  rest, day or
 night; could scarcely  ever sleep, but was obliged to walk up and
down all night;  she was  kept in such an irritated condition by this
distress and loss of sleep that she became very cross and irritable. 
PAINS.
361
 In  this case no relief was  obtained  until  after delivery, when the
 pruritus disappeared of itself.   In all such cases  as describ«d above
 our constitutional treatment  is of the greatest importance.  Some re-
 lief is afforded at once, and the improvement continues as pregnancy
 advances till she  becomes perfectly free from the trouble ere the trv-
 ing hour of parturition is reached.   This affection is sometimes accom-
 panied by sexual excitement, or it may have a periodic character, com-
 ing on or being aggravated at certain times of the day; all of which is
 perfectly amenable to our treatment.
  The homoeopathic treatment  of this  disorder  should  always  be
 constitutional rather than local;  for,  whether the pathological seat
 of irritation be  found in the parts immediately  affected or  in the
 cervix uteri, the true  cause  of it  must consist in the disturbance of
 the  system which is  occasioned  by pregnancy.  For the remedies
 consult those mentioned in a future chapter under Pruritus.

                             Pains.
  Pains, fixed  or wandering, irregular or  constant, are often experi-
 enced by women during pregnancy, and are frequently so severely
 felt as to  cause  them  to  become  the  subject  of  complaint to their
 physicians. These pains are principally felt in the  abdominal, lumbar
 and inguinal regions;  they  may be considered as myalgic, whether
 characterized by  cramps or  not, when they result from  fatigue of
 the  muscles; and they may be deemed purely neuralgic  when they
 are caused by (reflex) irritation of the nervous centres.
  The pains which are experienced in the  lumbar and inguinal  re-
 gions, especially  in  the early stages of pregnancy, when they cannot
 be attributed to  the size or  weight of  the  gravid  uterus, are usually
 the  manifestations of some disordered condition of the  uterus itself
 Pains felt in the loins in the advanced stages of gestation  may  be
 purely myalgic, or the result of strain of the  muscles so constantly
exerted to maintain the equilibrium by bearing the body backward.
Pains felt in the breasts, and the excessive tenderness  and sensibility
of these organs, are due to sympathetic  nervous  irritation, and are
 therefore properly  called neuralgic.   Those  which  are felt  in the
abdominal  parietes usually  appear in the  more  advanced  stage  of
pregnancy, and may be attributed  to  over-distension  of the  muscles
and tension upon the  nerves.  Certain pains  in  the  interior of the
thighs, numbness and cramps of one or both legs, have been supposed
to result from pressure upon the sacral nerves.  But even these may
be caused by the severe dragging upon the various  ligaments, and 
 362         DISORDERS INCIDENTAL TO  PREGNANCY.

 consequent irritation of the nervous centres in different parts of the
 abdomen and back.
   Where these pains are aggravated by exercise or movement, perfect
 quiet should be  enjoined.  But it  is believed that with  the help of
 the appropriate homoeopathic remedies  these pains can be so far re-
 lieved as to admit of as much exercise as may be necessary for the
 general health of the mother, and  consequently for the greater vigor
 of the child.  There is no doubt that the greater susceptibility«to these
 various pains witnessed  in some individuals, like the predisposition to
 many other morbid affections in pregnancy, is in a great measure due
 to constitutional peculiarity, just as we see in certain constitutions a
 remarkable facility of straining and laming the muscles and  tendons
 and of suffering dislocation  of the joints  from comparatively slight
 causes.  At  any rate, the following remedies, or others that may be
 especially  indicated, are capable  of affording  very marked relief in
 these  cases,  whether  the symptoms  appear in the  earlier part of
 gestation, and so threaten to result in abortion, or whether they occur
 principally in the latter part of pregnancy, and tend to increase the
 immovability and helplessness of  the patient.   The same may be said
 of those pains regarded as the results of a certain constitutional weak-
 ness of the muscular  organs  or of a corresponding irritability of the
 nervous system.
   Aconite.  If the sufferings seem to be developed immediately after
 an exposure to cold air  or to a draught.  Sensation of  soreness, with
 restlessness and uneasiness, although each movement causes pain.  Fear
 of approaching evil.  Distressed and unhappy.  Thirst, with more or
 less feverishness.
  Argentum nit. Almost constant  belching of wind after eating, which
 continues until the time for the next meal has nearly  arrived.  Pains
 in the back and lower extremities.  Time seems to pass very slowly.
  Arnica. Very great soreness, as  if from a bruise.  The motions of
 the foetus cause a  bruised and sore feeling in the abdomen, and the
 woman feels as if her child  were lying crosswise, which position hurts
 her constantly.
  Belladonna. If  the pains  appear suddenly, and after a time as sud-
 denly cease.  The  bed feels very  hard to her.  She cannot bear the
 slightest jar of bed or chair.  The back feels as if it would break.
  Bryonia.  The sufferings are rendered more severe by motion;  even
 the slightest motion aggravates, taking a full inspiration, for instance;
she desires therefore to keep quiet and to rest in a recumbent position.
Stitching pains. 
PAINS.
363
   Calcarea c. Cramps in the toes  or  soles of the  feet.   The  feet feel
 cold and damp.  Feels badly on ascending an eminence or going up
 stairs.   Sensation of crackling  or  crepitation in the joints, as though
 they were dry.  She is a long time in getting to sleep at night.
   Camphor. Cramps, with inability to remain covered.   The surface
 becomes cold at night—as  cold as marble—and  yet covering is in-
 tolerable.
   Chamomilla. Abdominal pains, with frequent emission of pale, color-
 less urine in large quantities.  Feels disagreeable and unhappy.  Spite-
 ful irritability.  Whatever  pains she may have she feels very keenly,
 and regards them as unbearable.   Sleeplessness.
   Chelidonium. A great deal of pain under the inner inferior angle of
 the right scapula,  sometimes extending into the  chest;  this  pain is
 frequently  accompanied with gastric or hepatic disturbances.
   Cimicifuga. Cramps in the extremities, and even intermitting spasms.
 Especially  suitable for  women who  have  a tendency  to hysterical
 attacks.
   Cocculus. A paralyzed feeling in the limbs, which are very weak.
 Nausea,  with vertigo and  tendency to faint.  Spasms, which occur
 frequently  at midnight.
   Coffea. Often indicated when there is much excitement and sleep-
 lessness.  The pains she experiences are continuous and very distress-
 ing, so that she feels as if she would " go distracted."
   Colocynth.  Frequent attacks of colic, which draw the  patient nearly
 double.  The pains she has cause great restlessness, so that she writhes
 and twists herself in every direction, yet without obtaining relief.
   Cuprum.  When there  are cramps in the fingers and  toes or in the
 pit of the stomach; violent  cramps.  Coppery taste.  Restlessness.
   Gelseminum.  Pains in the abdomen, which run  directly upward or
 backward and upward, which are very severe and resemble the pains
 of commencing labor. Feeling as if the muscular power was weakened,
 which arises  from  a weakness of the will-power, which is unable to
 command muscular movements as in health.
   Ipecacuanha. Sharp, colicky,  coiling  pains around the umbilicus,
 with nausea; clutching and  squeezing in the abdomen.
  Lycopodium. Cutting pains running from  right to left across  the
abdomen.  A great deal of  commotion  and borborygmus in the  ab-
domen.   The foetus is unusually active.  Red sand in the urine.
  Nux v. Sufferings  from high living or from  a sedentary life; con-
stipation of large, difficult stools as an accompaniment.   Aggravation
in the morning at four o'clock; she is obliged to get out of bed at 
364          DISORDERS INCIDENTAL TO PREGNANCY.

that time, on account of a pain in the back, and  she finds relief from
rising and walking about.   She cannot turn over in  bed on accouut
of the pain in the back.
  Plumbum. A sensation in  the  abdomen at night  in  bed,  which
causes the patient to stretch violently for hours together; sometimes
she must stretch in every possible direction, or she feels that she must
do so, and this  inclination is almost uncontrollable.   Feeling as if
there  was not room enough  in the abdomen, or as if the abdomen
and back were  too  close together.  Sensation  as  if the  abdominal
walls  were pulled inward.
  Pulsatilla.  She cannot sit long at a  time;  she must walk about to
relieve her pain.  A close or warm room is very oppressive, and she
feels as  if she must  be in the open air, which is extremely grateful
to her.
  Rhus  tox. Cramps in the legs, causing her to rise and walk.  Cramps
in the legs every night, causing her to jump out of bed.  She is very
restless  at night, and  can find ease  but for  a short  time in any
position.
  Secale c.  Frequent and prolonged  forcing pain  in  the abdomen,
particularly in thin and ill-conditioned women.
  Sepia. Frequent bearing-down pain in the  back and abdomen.
Sense of weight in  the anus  as an accompaniment.   Painful  sen-
sation of emptiness in  the pit of the stomach, which  makes her feel
miserable.
  Sulphur. Cramps in the lower  extremities, with hot flushes and
weak, faint spells.  Burning in the soles of the feet; she must put
them  outside  the bed-covers or into a cool place.  Feels hungry and
faint at  about eleven A. m. ; she cannot wait for  her dinner.   Cannot
walk  or sit erect.  Always  feels worse  before  a storm.  Pains are
mostly on the left side.
  .Veratrum a.  Cramps in the extremities,  with cold  perspiration.
Very great feeling of distress in the pit of the stomach  after eat-
ing, lasting for  an hour or two.   She feels very weak, so  much so
that  she is obliged to lie down.   Violent retching, with  cold sweat
breaking out.

       Disorders  of  the  Apparatus  of  Locomotion.
         inflammation of the pelvic articulations.
  This  not very common form  of inflammation is  sometimes seen
during pregnancy, but less rarely after parturition.  The affection ap-
pears  spontaneously, with  severe,  acute  and sometimes lancinating 
     RELAXATION OF THE ARTICULATIONS  OF THE PELVIS.   365

 pains in one or several  of the pelvic articulations.   These pains are
 necessarily aggravated by pressure, by standing and by attempts at
 walking, which the inflammation  may render  impossible.  In  some
 cases, probably those which were strongly predisposed to suppuration,
 the inflammation has taken this course, the articular surfaces  becom-
 ing denuded of cartilage.  In two instances referred to by M. Cazeaux
 this affection terminated fatally.
   Perfect quiet must of course be observed in such inflammation of
 parts which are not only immediately engaged in locomotion, but
 wliich have to sustain also all the superincumbent weight of the body.
 The character  of the pains themselves, together with their conditions
 of aggravation as to time and circumstances, will  readily suggest to
 the homoeopathic practitioner the  remedy applicable to each particu-
 lar case, by the  timely  exhibition of which much suffering  will be
 saved to the unfortunate patient.

      Relaxation of  the  Articulations of the Pelvis.
   In certain constitutions there appears during pregnancy a consider-
 able amount of relaxation of the  ligaments which unite the bones of
 the pelvis, and a consequent mobility of the pelvic articulations.  This
 change occurs  in different degrees in different persons, being scarcely
 perceptible in some and rendering walking impossible in others.
   The precise cause of this affection it may  not be easy to designate,
 although those who suffer in this manner usually appear to  possess
 what is  termed a scrofulous  constitution.  And indeed this  tempo-
 rary relaxation and displacement is in no small degree analogous to
 the chronic  scrofulous  disease which goes by the  name  of rachitis.
 The immediate cause of the relaxation is found to consist in a soften-
 ing of the ligaments by which the pelvic articulations are usually so
 firmly bound together.   And in this respect this affection differs from
 the rachitic softening of the bones which so often produces distortion
 during the period of childhood, and also from the corresponding soft-
 ening of the bones in  adult years, malacosteon, which occasions so
 many varieties of pelvic deformity.  A certain enlargement of the
synovial bursae,  and  corresponding hypersecretion of the synovial
fluid, have been noticed in the more aggravated cases of pelvic re-
laxation.
  This  spontaneous  relaxation and dislocation from the very  first
occasions such an amount of instability in standing and insecurity in
attempting to walk as to indicate  at once the  nature of the difficulty.
The pains which  accompany the affection, being felt principally from 
366          DISORDERS incidental to  pregnancy.

motion or pressure, such as standing or walking, might be incapable of
being distinguished  from those of inflammation of the articulations,
but for this remarkable sense of instability which  appears in the in-
cipient stages,  and which is  subsequently aggravated to exceeding
difficulty of standing and  impossibility of walking.  In such cases
the sensation experienced on attempting  to stand is that which so
strongly characterizes belladonna, as if her whole body  would sink
down between her thighs.
  This relaxation of the pelvic articulations may, when not too much
developed, render delivery  less easy and  speedy by  destroying the
firmness and stability of the point d'appui  which the abdominal mus-
cles derive from the bones of the pelvis.  But when farther advanced
this relaxation, by enlarging the pelvic cavities, may facilitate the ex-
pulsion of the child's head,  thereby rendering spontaneous a delivery
which would otherwise have been very difficult on account of the dis-
proportion between the size of the head  and  the  dimensions  of the
pelvis.  After delivery the relaxation has been known to continue for
several months, or even for years or the whole lifetime.
  In all cases of relaxation of the  pelvic  articulations in pregnancy
the most perfect quiet, and even absolute rest, should  be enjoined, in
order to prevent the increase of the  difficulty which must result from
moving about,  and in order to obviate the danger of inflammation
arising from undue irritation of tissues already morbidly affected.  A
careful study should  be made of all the indications and symptoms, in
order to reach the constitutional dyscrasia which lies at the bottom of
the difficulty, and thus at the same time  arrest the progress  of the
present mischief, prevent future trouble,  and  radically and perma-
nently improve the patient's health.
  A disposition to fall sometimes greatly troubles the pregnant woman.
That which arises from  sudden attacks of syncope is not referred to
here, but rather that want of firm balance  in walking,  that danger of
stumbling  and  that general  sense  of instability which often  prove a
constant source of annoyance.  The equilibrium of the body in mo-
tion in the natural state  is only preserved  by the incessant although
entirely unconscious  effort of the muscular apparatus, which  as in-
stinctively regulates the movement and position of the body in accord-
ance with  the law of gravity as the muscles of the  eye adapt the size
of the pupil to the various degrees of light.  In persons afflicted with
hereditary muscular weakness, which is but the particular manifestation
of some general aud constitutional dyscrasia, the constant task  of main-
taining the proper centre of gravity, aggravated by the awkward dispro- 
      relaxation of  the articulations of the  pelvis.   367

 portion in size and large addition of weight in front which characterize
 the advanced stages of pregnancy, is  entirely beyond their strength.
 Hence the severe myalgic and  neuralgic pains already described as
 affecting the  abdomen, breasts, back and lower limbs; hence, too, the
 difficulty of walking, the unsteadiness of gait and the danger of fall-
 ing with which such persons are afflicted.
   A careful  collection  of all the  symptoms of such  cases, and  an
 equally careful comparison of them with those belonging to the  fol-
 lowing remedies, and to others which may be indicated in the rarer
 forms of lesion of the locomotory apparatus in pregnancy, will enable
 the homoeopathic  physician to  prescribe for these various  difficulties
 with confident hope of affording to these  sufferers  both present and
 permanent relief.

   ^Isculus h. Where  the sacro-iliac  symphysis is  the  point  of  the
 trouble.   She cannot walk  because that part of her back  gives out,
 and it fatigues her so that she must sit down, and she feels better still
 when lying.
   Aloes. Where a sense of weight and pressure into the pelvis seems
 to cause the lameness.   Solid stools pass involuntarily.
   Arnica. Where a sensation of  soreness as of a bruise prevails.  She
 can' hardly move about at all from the  soreness in the symphysis pubis
 or in the sacro-iliac symphyses.
   Calc. carb.  Will be indicated in leucophlegmatic constitutions; great
 fatigue*on walking even but a short distance, from  a general feeling
 of lameness in the pelvis.  Cold, damp feet.   Vertigo  on  ascending.
 Does not sleep  after three A. m.   She  is  clumsy.  She  stumbles and
 falls very easily.
   Calc. phosph.  She is very much worse after taking a little cold.  She
 is liable to rheumatic pains in all her joints after taking cold.
   Gelseminum.  This remedy will be found useful in cases  where the
 difficulty of walking or the inability to stand appears to be due to an
 inability to control muscular movements.
   Kali carb. The  back aches so  badly while she is walking that she
 wishes to  lie  down at once, and says " she feels as  if  she  could  lie
 down in the street" at such times, to obtain immediate rest and relief.
 Cannot walk  farther;  must sit down.
  Manganum.  The  limbs are affected, and  are very tender  and sen-
sitive to  the  touch.  The  point or part affected, and to which the
lameness is ascribed, is sensitive on pressure.
  Pulsatilla.  She cannot walk so well toward evening.   She feels 
368          DISORDERS INCIDENTAL TO  PREGNANCY.
worse when warm in bed.   She can  hardly find  an easy position
through the night, owing to the pain in the pelvic articulations.
  Rhus tox. A sense of stiffness in the pelvic articulations on first
attempting to walk; better after getting warm in  walking.   At night
she must change her position frequently, feeling quite easy for a while
after every change, but she must shortly change again.
  Silicia. In cases where ulcerations take  place with fistulous  open-
ings, which are  very tender to the touch.  If pimples make their
appearance around the ulcerations, hepar may be indicated.
  Sulphur.   With  her pelvic  sufferings she  has flushes of heat and
weak, fainty spells.  She is weak and  faint from about eleven o'clock
till noon.   Could walk with a firm roller around the hips.
  Thuya. The sufferings are greater in the left sacro-iliac articulation,
the pains running into the  left groin.   The pain  from walking is so
insupportable that she must lie down.

  Derangements and  Affections  of the Xervous System.
  The sympathetic nervous disorders which affect young girls in dif-
ficult  menstruation are but the prototypes of those  affections which
occur during pregnancy in  women of corresponding unhealthy consti-
tutions.  Hence, in addition to the more strongly-marked disorders of
pregnancy just described, we find disturbances of the nerves of special
and of general sense, abnormal conditions of  the intellectual faculties,
and various depravations of the moral and  emotional  sphere.  The
more  important of  these  various  disturbances will  now  be briefly
considered.
                       Loss of Hearing.
  Davis mentions having seen two cases of entire deafness which came
on  during  gestation.   In the one case the abolition  of the sense of
hearing came on suddenly during one of the earlier months, and very
gradually returned after delivery; whilst in the other it came on by
imperceptible degrees in the seventh and eighth months of gestation,
and returned suddenly and with painful  acuteness on the  sixth day
after delivery, when the  lochia entirely ceased to  flow.   From Paul-
lini the same author quotes the case of the wife of a  citizen who was
subject to be seized with  an entire  loss of hearing about four or five
days before being taken with labor-pains,  the deafness going off after
delivery.   Indeed, such  cases  are by  no  means  uncommon, particu-
larly where the deafness is  not complete, but  is merely an impairment
of the sense of hearing in a greater or less degree.  And there may be
accompanying the deafness, or occurring with but little or no deaf- 
affections  of the eyes.
369
ness whatever, various and  most distressing noises  in the  ears, tinni-
tus aurium, etc  Where these sounds are heard, however, the practi-
tioner before prescribing any medicament should  ascertain whether
they are not due to impacted cerumen making  pressure upon  the
membrana tympani.
  The following remedies  should be consulted, as well as others not
here enumerated:

  Capsicum. The petrous portion of the ear is much swollen, red and
painful.  A pressing pain deep in the ears.
  Carbo. an. She is  able to hear, although faintly, but cannot tell ac-
curately from whence the  sounds proceed,
  Causticum.  Reverberation of all sounds, even of the  patient's own
voice, in the ears.  A constant roaring before the ears.
  Graphites. Great dryness in the ears.  The deafness is better when
riding in a carriage.
  Lachesis. The cerumen is too hard,  too pale and insufficient.
  Mercurius.  Sensation of coldness in the ears continually.
  Nitric acid.  Much swelling of the internal ear; it  is nearly closed,
and sometimes there is much pain within it. Secretion superabundant.
  Phosphorus. Difficulty in distinguishing the human voice.
  Pulsatilla. Sensation as if the ears were stopped up.
  Silicia. Partial relief is obtained by blowing the nose.
  Sulphur.  Aggravation for a while after eating or blowing the nose.
  Compare, also, Calcarea c, Petroleum, Hepar, Staphysagria, etc

                   Affections of  the Eyes.
  The eyes sometimes become the seat of a still more painful affection
in pregnancy.  Dr. Bezard * relates the case of a lady who, in  the
fifth month of her ninth  pregnancy, was  suddenly and without any
known cause seized with a deep-seated pain in her right eye.  There
was no external sign of disease, except that there was no secretion of
tears; there was, however,  a sensation of strong pulsation at the bot-
tom of the orbit, accompanied by acute and frequently repeated lanci-
nating pains, by appearances  of rapidly-darting specks before the eyes
and by errors of the vision.  Pain of the forehead  and at the root of
the  nose, together with a sense of weight and oppression about those
parts,  aggravated the patient's distress.  In  a short time the rays of
light ceased to irritate the retina, the eye became insensible to the con-
tact of the finger, and the patient could intently stare  at the sun with-
               * Journ. de Med., par Leroux, xxxiii., p. 72.
      24 
370
DISORDERS INCIDENTAL TO  PREGNANCY.
out producing any painful excitement.  Inability to sleep accompanied
this local affection for several weeks.   The delivery was happily ac-
complished, and  in  the  course of some days  subsequently the lady
found that she could perceive light with the eye which she considered
as lost to her, and after some days she could clearly distinguish objects
with it.  She gradually improved in this respect for eighteen months,
when she became enceinte for the tenth time.  At about the fifth month,
at the same  time as in  the former pregnancy, she was seized with
similar  but much more intensely severe pains in the same eye.   In
this pregnancy the difficulty extended to the left eye also, which after
delivery in great measure recovered  its functions, but the right eye
remained permanently insensible to light.
   According to  Beer,* amblyopia or  amaurosis,  accompanied with
nausea  or with vomiting which cannot be  quieted, sometimes occurs
early in pregnancy  and ceases after parturition.  He saw a young
Jewess, who  in  her  first three pregnancies, which  followed in quick
succession, began to  grow blind in the early period, and became quite
amaurotic  in the third or  fourth month.   On the first two occasions
she continued blind until after parturition, and the third time her
sight never returned.  Desmarres also mentions pregnancy among the
indirect causes of amaurosis.f   Exactly opposite to this is the  case
quoted  by Cazeaux,  of a young woman whose imperfect vision  had
compelled  her to use spectacles from childhood, but whose sight had
so much improved immediately after the beginning of her pregnancy
that she had  no longer need of magnifying-glasses.
   In affections of the eyes study the following  remedies :|

   Aurum. Objects appear as if divided horizontally.
   Belladonna. Objects appear dim.  As if inverted or double.
   Calc.  c. All objects appear as if seen through a mist.
   Causticum.  Sudden and  frequent loss of sight, with  sensation  of a
film before the  eyes.  The  dimness  of vision is greater after every
h eadache.  Paralysis of the  upper eyelids, so that they hang down.
   China. She can only  distinguish the outlines of distant  objects.
vVhen reading, the letters  appear pale and surrounded with  a white
>o rder.  She sees better after sleeping.
   Cicuta V. The letters seem to move about when she is reading.
   Cina.  She can see  more clearly for a while after rubbing the eyes.
                 * Lawrence on the Eye, p. 612.
                 f Maladies des Yew, Paris, 1847, p.  715.
                 J Berridge's Repertory on the Eyes. 
HEADACHE  AND NEURALGIA.               371
  Hyoscyamus. Frequent spasms  of the eyelids.  Strabismus.   All
objects appear of a red color, or larger than they are.
  Natrum mur. Frequent spasmodic closing of the eyelids.
  Nux V. Heaviness and contraction of the lids.
  Phosphorus. All objects appear to be covered with a gray veil.
  Pulsatilla. Sensation as if the eyes were  covered  with a mist, or
as if the dimness could  be removed by rubbing something off from
the eyes.
  Sulphur. Dimness of vision and the  gas- or lamp-lights appear to
be surrounded by a halo.
  Compare, also, Cyclamen  e., Drosera, Glonoine, Lithium c, Mercurius,
Ruta, Senega, Sepia, Tijanium, Veratrum, etc.
                          Headache.          >
                      •
  This forms one of the most common and most painful affections of
pregnancy.  It may arise in part from sedentary habits, especially in
the  more advanced stages  of pregnancy, and for similar reasons  it
may be  both complicated with  and aggravated  by constipation.   In
persons  who are usually subject to  headache the condition of preg-
nancy may serve to increase the difficulty.   The cephalalgia of preg-
nancy may attack those of an anaemic habit and nervous temperament,
or it may appear in connection .with a  plethoric condition, indicated
by flushing  of the face  and giddiness  aggravated by stooping.  Or,
again, the headache may accompany nausea and other gastric disturb-
ances, with paleness of the  face and general debility.
  The treatment will  usually be very simple, since the indications can
hardly fail to be plain.   When  the disorder appears in  connection
with constipation, increasing in severity upon each  occasion till the
bowels are moved,  and seems  also to result in some measure from
the  sedentary mode of life to which so many women addict themselves
even when not enceinte,  exercise in  the open air should  be  strongly
advised, to be taken in the manner best suited to the  circumstances of
the  patient.
                          Neuralgia.
  Facial neuralgia  in pregnancy differs but little from headache in
its causes  and requisite mode  of treatment, except that  while  like
headache it may  arise  in connection with  constipation, it  is otherwise
more apt to occur in persons of a pale, anaemic  or nervous tempera-
ment than in those of a ruddy, plethoric habit of body.   According
to Tyler Smith, "facial neuralgia  from uterine irritation is a very
common affection of pregnancy.  It generally affects the dental nerves, 
372          DISORDERS  incidental to PREGNANCY.

particularly those of the upper jaw.   In many subjects acute caries of
the teeth occurs; in some child-bearing women a tooth or two is lost
in each pregnancy."   In neuralgia of the face in  pregnant women,
without disease of the  teeth, the same author says a generous diet is
called for, and  he advises also wine and porter.*   The latter articles
we think can hardly ever be  needed in this country, unless perhaps
temporarily in  cases of great privation from suitable nourishing food;
in such instances a little  wine may aid  in restoring the  system  from
its enfeebled condition, and thus enable it  the more readily to  avail
itself of a wholesome and nutritious diet.   Great care must be taken
in cases of severe neuralgia in pregnancy—cases which may constitute
a true spinal neuralgia—lest from loss of sleep, inability  to assimilate
suitable food and the depressing influence of long-continued suffering,
the system may become so  much reduced  as to induce abortion, and
even fatal marasmus.
   In selecting a remedy for the cure of the headaches and neuralgias
of preguancy the practitioner should bear  in mind  the importance
of the concomitant symptoms, as well as of  those especially of the
disorder itself.  The following medicines may be studied among others
for these painful and distressing affections :

   Aconite. In headache or neuralgia,* accompanied by vertigo on rising
up in bed.   Crampy sensation in the root of the nose.   Sensation as
if the whole brain would press out at the forehead.   She fears to be
in a  place of excitement or  confusion.
   Belladonna. Flushed  face and injected eyeballs.   Cannot bear noise
or bright light.  She seems to be in a stunned or stupid condition.
   Bryonia.  A splitting headache; she wishes to keep very still.   Dry-
ness of the lips and mouth.  Nausea on rising in  bed.
   Calc. C Headache, with an unusual accumulation of dandruff on the
scalp.  Headache is aggravated  by ascending, as in going up stairs;
the  blood seems to be forced into the  head on ascending, causing a
burning sensation.  Vertigo on ascending.
   Cocculus. Her head  feels worse  after eating or drinking.  Head-
ache, as if the' eyes would be torn out, particularly on  motion, with
vertigo.
   Cimicifuga. Lancinating pain over either eye or in the eyeball, which
is worse every other day.  Heat, sense of fullness and throbbing in the
head.  The pain is relieved  in  the  open air,  and aggravated by the
beat, of the stove   Throbbing in the head when ascending.
                 * Braithwaite's Retrospect, xxxiii., p. 252. 
HEADACHE  AND NEURALGIA.               373
  Coffea. Intense pain, the head  feeling contracted or as if too small.
Nervous excitement, with sleeplessness; or  drowsiness, yet with in-
ability to go to sleep.
  Gelseminum. Sharp shooting pains through the face, eyes and head,
which feel  like rheumatic  pains; the face  is congested and of a dark
or dusky hue.  The headache commences  in the neck quite suddenly,
and spreads from thence over the head,  or vice versa; dimness of
vision; heaviness of the head; vertigo; stupor;  dull expression of
the countenance.   Powerlessness of the muscles.
  Glonoine.  Whirling in  the  head,  with  giddiness;  sensation as of
expansion  of the  brain, the head feeling  as though  it would burst.
Confused feeling in the head;  perceptible throbbing of the carotid
and temporal  arteries.   The headache or  the neuralgia has been
brought on by exposure to  the rays  of  the  sun,  or is  aggravated
by such exposure.  Can't bear the head covered.
  Ignatia.  Headache confined to one  side of the head; clavus; un-
bearable pain, as of something sharp being  forced into the brain; weak
feeling in the stomach; suitable for women of  melancholy disposition
who are given to sighing, or to hysterical women.
  Magnesia c.  The pains are aggravated by talking or by mental ex-
ertion.   She feels sad and disconsolate.  Constipation.
  Nux v.  This medicine is especially  suitable  for headaches or neu-
ralgias of pregnant women who are addicted to high living, the use
of wine and  spirits or coffee,  and to keeping late hours, or who
lead a too sedentary life.  Constipation of  the bowels or haemorrhoids
habitual.   The head feels as if it would split, and  the scalp is sore  to
the touch;  pressure with the hands  on the head  relieves the pain.
Nausea; accumulation of gas in the stomach after a meal, and other
symptoms  of dyspepsia.  Very  inanimate.
  Pulsatilla. Hemicrania,  occurring in women of  mild  and  gentle
disposition, given to weeping.  The suffering, whether from headache
or neuralgia, is much worse in a warm or  close room, and is  relieved
by going into the fresh, open  air.
  Sepia. Headache, with aversion to all kinds of food, a  feeling of
emptiness  or goneness  in the pit of the stomach, which  is very dis-
tressing.   Headache occurring  every  morning, with nausea, vertigo,
epistaxis.  In women  who have " moth-patches" on  their foieheads,
who are of sallow complexion, or who have a yellow streak across the
bridge of the nose and  under  the eyes.  Smell  of food repulsive.
  Spigelia. Facial neuralgia, generally of the left side of the face, and
of very severe type.  The parts supplied  by the fifth pair of nerves 
374          DISORDERS  INCIDENTAL TO PREGNANCY.

are especially affected.  The pain involves the eyeball and orbit  and
sometimes the eye of the  affected  side is very much congested.   The
pains are lancinating or lacerating,  and  are somewhat relieved bv
firm  pressure.   Verbascim thapsus, on the contrary, is indicated when
even the slightest pressure greatly aggravates the suffering.
   Sulphur. Heat on the vertex, habitually; frequent flushes of heat
all over; cold feet;  spells of faintness.   Feels worse from 11 to 12.
   Veratrum a. Headache  causing  delirium, dementia, and cold sweat
on the forehead.

                           Toothache.
   Toothache is a common and very distressing accompaniment of
pregnancy, being in  fact only a particular form of neuralgia.  Leadam
strongly advises against extracting the teeth in such cases, since abor-
tion  has been known to follow the operation.  Tyler Smith states  that
they ought only to be extracted with caution under such circumstances,
But those having in their hands the homoeopathic remedies, and blest
with even  a  moderate  amount of skill  in administering them,  will
never be tempted to  resort to a practice at once barbarous and danger-
ous.   Still, it must be borne in  mind that neither local applications
nor remedies selected with reference to the teeth alone will suffice, in
many cases, to remove an affection which  is at  once painful, sympa-
thetic  and constitutional—that is, connected with some individual
idiosyncrasy.  Here, as in all other cases of disease, the remedy should
be selected in accordance with the totality of symptoms.
   One or the other  of the following remedies will  usually be found
useful:

   Alumina. Drawing toothache, extending to other parts, as down the
larynx, neck or shoulders, etc.
   Arsenicum.  Periodical toothache, occurring most frequently at night,
however; it is then unbearable and drives the patient almost to frenzy.
She is  unable to remain in bed, and must get  up.
   Belladonna. Pains  as if caused by ulceration, worse after lying down
at night or when in the cold  air.  Pains  mostly on the right side of
the face, extending to the eye and its orbit.  The pain causes moan-
ing and weeping.  Throbbing pains.
   Calcarea c. The pain is  aggravated  by the slightest change, as from
a current of air, whether warm or cold, drinking anything warm or
cold, noise, mental excitement, etc.
   Chamomilla.  The pains are perfectly unbearable, and  give rise b> 
TOOTHACHE—CHOREA.
375
much irritability of temper and impatience;  redness of one iheek,
while the other is normal or pale; jerkings in the teeth.
  Gelseminum. General  nervous excitement or weak  and trembling.
The  pains come in paroxysms, are decidedly  neuralgic, and  dart
through the jaws and face.  Congestion of the head and face.
  Hyoscyamus.  Violent tearing and pulsating pain, causing spasmodic
jerks of the fingers, hands, arms,  facial  muscles.   Spasms  in  the
throat, etc.   Often delirious with the pain.
  Magnesia c. Insupportable pain during repose; she must get up  and
walk about,
  Mercurius sol. The teeth  feel sore to the touch—so much  so that
pressing them  together, as in eating,  increases  the suffering.  The
teeth feel elongated and as if loose.
  Mezereum.  Pains extending to the bones of the face and temples,
particularly when they run along the left malar bone to the temple.
  Nux m. Pains in the front teeth on inhaling cool  air or taking warm
drinks; feeling as if the teeth were grasped to be pulled out.
  Nux v. Toothache occurring in women  of  irritable  disposition, or
who  are high  livers and  are troubled with constipation or haemor-
rhoids.  The pain makes her feel cross and morose.
  Phosphorus. The pain is of a jerking or  twitching character.  The
periosteum of the tooth is inflamed and tender of pressure.
  Pulsatilla.  The pain is better when taking cold food  or drink or
upon exposure  to cold air, and is worse from warm food or drink and
in a warm room.  Inclines to tears; can't  lie down.
  Rhus tox. Rheumatic  toothache, or toothache  occurring from  get-
ting wet. The pain is relieved by applying warmth to the face.
  Staphysagria. The teeth  grow black, become carious and  brittle.
She is very sensitive to either mental or physical impressions.

                            Chorea.
  Where this  affection occurs in  connection  with  pregnancy  the
spinal system of nerves is affected secondarily through the ganglionic.
The symptoms  of this  disorder are too strongly marked and too well
understood to need to be repeated  here.   The following conclusions,
arrived at by Dr. Lever twenty years ago, fully  represent the present
state of our knowledge in respect to most of the  points mentioned.
  " In conclusion," says this writer, " I venture to  submit the follow-
ing propositions: 1. That pregnancy is occasionally associated with cho-
rea or convulsive movements; with paralysis of various parts of the
body, of the extremities and of the nerves of special sense;  and with 
376          DISORDERS INCIDENTAL TO PREGNANCY.

mania.   2.  That the varying  symptoms of such complications  may
be produced at any period of pregnancy, but when produced, although
modified by treatment, are rarely removed during the existence of
gravidity.   3.  That the patients  in  whom these complications exist
are women of a highly nervous temperament, of great irritability, or
whose constitutional  powers have been reduced  by some  long-con-
tinued but  serious cause of exhaustion.   Lastly: That  although in
most instances the symptoms will continue so long as pregnancy exists,
yet in a majority of cases we are not justified, in inducing  a prema-
ture evacuation of the uterine contents."
  To these views of an  old-school author let us add what our own
school teaches in one  most important respect.  In  those  cases in
wdiich chorea or epilepsy appears for  the first time during pregnancy,
we  must regard this latter state as having sufficed to develop a certain
morbid element  of the constitution  which  had hitherto  remained
latent; and we should  seize upon the opportunity thus afforded to
endeavor, by the exhibition of the appropriate remedies, to radically
cure this morbid taint, and  thus, at the same  time, prevent the con-
tinuance of  the convulsive disorder after delivery, and  provide against
its  return in a succeeding pregnancy.  In those cases in which wo-
men become pregnant who have been subject  to either of these ner-
vous  affections, the pregnancy  may either  render  the convulsive
attacks  less frequent, cause  them during  the continuance of  this
state to cease  entirely, or even tender them of much more frequent
occurrence than before.   But while  it is believed that no instances
are  recorded of epileptic patients  having been permanently benefited
by pregnancy, M. Malgaigne *  cites a singular  case in which the first
attack of epilepsy was developed during pregnancy in an unfortunate
young woman, who retained this fearful malady through all her sub-
sequent life.   Similar is the  case  quoted from a  German author by
Dr. Davis,f of a lady twenty-six  years  of age, of a bilious constitu-
tion, and the  mother of three  children, who was  attacked with  a
periodical epilepsy  whenever  she conceived, and who sustained  a
paroxysm of this malady once a  fortnight  during the whole of her
gestation.  But as soon  as she was delivered the disease left  her.  Its
occurrence, therefore, was always a sign to her that she had become
pregnant.
  Chorea,  whether  occurring during pregnancy or at any other
period, is amenable to homoeopathic treatment.  The subjoined reme-
dies are  presented  as those  most  likely to be  required, while the
    * Traite Theoretique et Pratique, etc., p. 368.         f Obstetrics, ii., p. 900. 
                      CHOREA—HYSTERIA.                    377

remedies and their indications given under the article on Chorea in
the portion of this work devoted to the consideration of diseases of
children may be studied with advantage:

  Belladonna. When the  tongue is partially  paralyzed.  Difficulty
of articulation.  Right side  more  particularly affected.   Red eyes.
Much debility.  Rather stupid.
  Calc. C Chorea from  a fright.   In leucophlegmatic temperaments.
  Causticum. If the  upper eyelids  are  particularly affected, so that
they hang down—can't keep  them up.  She  is worse in the  open air
and in the evening.  Involuntary urination on coughing.
  Cocculus.  She is always  worse for a while after  drinking,  eating,
sleeping or talking.
  Crocus. She  is worse every evening,  with  alternations  of  excessive
happiness, affectionate tenderness and rage.
  Cuprum. When  the spasms come  on in paroxysms, grouped  with
other symptoms which always appear grouped with these paroxysms.
Or when the paroxysm commences  in one part—the finger  or limb,
for  instance—and gradually extends till the whole  frame is involved.
  Hyoscyamus. Twitching and jerking of all the  muscles,  including
those of the eyes,  eyelids and face.
  Ignatia. When  there is much  deep  sighing  and  sobbing, or when
the disorder is the result of a long-suppressed grief..
  Nux V. Very fond  of  high living; troubled with constipation.
Chorea is worse in the  morning or in the early  part of the day.
  Stramonium. Full of  strange, inconsistent fancies.   The attacks are
brought on by fright or care,  and are very violent, especially at night;
excessive jactitation of  the muscles.   ■
  Study  also Apis mel.,  Asafcetida, Arsenic,  China, Cicuta,  Cimicif.,
Coffea, Dule, Opium, Puis.. Sabina, Sepia, Silicia, Veratrum v., Zinc.
  Psorine or Sulph.  In  exanthematous complications.

                           Hysteria.
  This affection is a frequent accompaniment of pregnancy.   But in
this place we need do little more than refer the reader to the  very full
discussion of the subject of hysteria in the succeeding portion of the
work, similar indications  being present and similar remedies called
for in the pregnant as in the  non-pregnant condition.  Still, in cases
of pregnant women the remedies should be selected, if possible, with
still greater care, since,  for obvious  reasons, much greater importance
must be attached  to the hysterical  condition in the pregnant state. 
378           disorders  incidental to pregnancy.
 Dr. Burrows  states  that he  has seen two cases  in  which hysterical
 symptoms attended  during pregnancy, and the patients in each case
 became insane almost immediately after delivery.   Romberg instances
 among the debilitating influences which are the most fertile sources
 of hysteria, " repeated  miscarriages and a rapid succession of preg-
 nancies and lactations."  In most cases of women subject to hysteria,
 or any other form  of  general  disorder of the nervous centres,  the
 occurrence of pregnancy serves rather to aggravate than to ameliorate
 the pre-existing morbid condition.

        Disturbances  of the Intellectual  Faculties.
   Pregnancy  is sometimes  accompanied  with  a  partial  mental
 derangement,  which may become complete insanity.  Esquirol men-
 tions the case of a young woman  of a sensitive habit who had an
 attack of madness in two successive pregnancies, commencing. imme-
 diately after conception  and lasting fifteen  days.  Montgomery states
 that he knew a lady who was  attacked with  insanity  in  eight suc-
 cessive pregnancies;  and another  who was similarly affected  three
 times soon after conception, and  remained so until within a short time
 after labor, when she became sane and continued so until the next
 pregnancy.
   It should be observed that insanity in pregnancy, whether arising
 in  connection  with the  hysterical condition or not, has two distinct
 sources; in the  one,  the disturbance of the intellectual faculties
 appears to  result rather from  the physical  condition,  and  to  be
 dependent upon pregnancy  physically considered;  in the other, the
 mental powers manifestly give way and the reason loses  its  balance
 under  the depressing influence of the  melancholy and settled  gloom
 which  belong entirely to the moral  sphere.   And at the same time it
 should be remembered that a certain constitutional  dyscrasia may be
 the real cause of the physical condition which leads up  to insanity
 on  the one hand, and  even  of the profound moral and spiritual
 dejection which leads down to it on the  other.   There are, however,
 numerous unfortunate cases, especially of young women who become
 pregnant while yet unmarried,  in  whom the  agony of disappointed
hopes,  of affections  misplaced and  cruelly abused and  betrayed, the
present scorn  of society, and  the apprehension of  a still  increasing
shame, suffice to hurl reason  from  its throne, to destroy the better
judgment, and  induce  such  madness  as  finds  its necessary  crisis
in suicide.  These are cases in which  the grief of irreparable afflic-
tion, the mental'anguish  and moral  suffering, can scarcely fail to 
  DISORDERS OF THE AFFECTIONS, EMOTIONS  AND FEELINGS.  379

 derange the soundest mind in the soundest body, and  destroy both
 together.
   But while time alone can effectually mitigate  the  more poignant
 forms of  affliction, the  homoeopathic  remedies are yet  remarkably
 efficacious in " ministering  to a mind diseased," whether the mental
 derangement result from physical dyscrasia, from  moral suffering, or
 from -both combined.  The physician should most carefully explore
 all the symptoms, circumstances  and conditions in  respect  to  the
 physical  system, to the  sensorial, the intellectual,  and the affectional
 faculties, in  order to discover in the  Materia Medica the exact simile
 of his patient's case.   The serious  responsibility which rests upon the
 physician to do all that human science can accomplish in such cases
 is not limited to the present condition or future well-being of the
 mother;  regard must also be had to the unborn child, to prevent the
 predisposition to insanity from being perpetuated in the infant, and in
 a still greater degree developed in succeeding generations.
   To give indications for remedies  for  the various and varying dis-
 turbances of the intellectual faculties would be a task of great magni-
 tude, and, we might  add, a work of supererogation, inasmuch as all
 the  remedies comprising the  Materia  Medica  would  have  to be
 recorded.  Reference may be made with advantage, however, to those
 especially recommended for

   Disorders  of the Affections, Emotions  and Feelings.
   In addition to the disturbances of the intellectual faculties already
 mentioned as incidental to the condition of pregnancy, there  are fre-
 quently seen certain  anomalous variations  of the  spirits, temper  and
 affections, for which  the  physician will be called  upon to prescribe,
 either in connection with physical symptoms or in  their absence.  The
 special adaptability of the homoeopathic  Materia Medica to abnormal
 conditions of the sensational, intellectual, emotional  and affectional
 faculties gives the homoeopathic physician an immense advantage in
 this class of  cases.
  The settled gloom,  the profound melancholy to  which allusion  has
 already been made as occasionally productive of insanity is some-
 times seen to  appear without any other  assignable cause than the
general one of pregnancy.   When this depression of spirits  assumes
some particular phase—as, for example, that of a disposition to commit
suicide—the appropriate remedy is at once  suggested.  The limits of
the present work restrain us from doing more in this connection than
merely to mention some of the most prominent forms  of  mental  and 
380          disorders incidental to pregnancy.
moral derangement, and to indicate the principles upon wliich they
should all be  treated.   For a fuller exposition of the various mental
and  moral diseases, and a more  detailed statement of the  numerous
homoeopathic  remedies  applicable to them, the reader is referred to
Dr. G. H. G.  Jahr's very excellent work on Mental Diseases*
  Remarkable changes of temper also  appear, and  in a still more nu-
merous class of pregnant women.   " Few women are quite as self-
possessed  or in as even spirits during pregnancy  as at other times;
little things annoy them, trifles  depress them.   Sometimes  the most
sweet-tempered women become irritable, cross and quarrelsome.  The
husband of  a patient of mine, whose wife was remarkably good-tem-
pered and attached to him, told me  that  the earliest symptom  of
pregnancy in  her  case was a disposition to quarrel with him espe-
cially.   Dr. Montgomery mentions  the case  of a  lady who, for the
first  two or three months of her pregnancy, was so irritable that, to
use her own words, 'she was a perfect nuisance  in  the house.'"—
Churchill.
  Sometimes women whose ordinary  dispositions  have been soured
by the trials  of life, or  who are characterized by a habit  of fault-
finding and complaining, experience a very happy change of temper
on becoming pregnant.   But  more often those usually of a cheerful,
lively disposition  become  sad, depressed and even morose, refuse
all comfort or  encouragement, and persist in the fixed belief of a fatal
termination  of their labor.   Except in a very few  and remarkable
cases, such gloomy anticipations of impending evil are happily dis-
appointed by  a successful delivery, which is therefore  succeeded by
the restoration of  the accustomed cheerfulness.  And  in those few
instances in  which the foreboding of a fatal  termination of the labor
proved prophetic, it is  believed that  some deep-seated dyscrasia of
the physical system gave rise to this  instinctive  fore-consciousness,
such as is  sometimes seen in a similar fulfillment of  such predictions
in cases of ordinary illness.
  •The feelings and affections in  many  instances undergo a distressing
transformation in pregnancy.   It is related of one young woman that
she was seized at about the  fifth  month  with  an  unconquerable aver-
sion  to  her  apartment;  so  that, after much  effort of reasoning and
persuasion had  been tried  in vain,  it became necessary to leave her
in the country  during the remainder  of her  pregnancy.  Another
  * Special  Therapeutics, according to  Homoeopathic Principles, by Dr. Franz Hart-
mann. Third volume, Mental Diseases, written  by Dr. G. H. G. Jahr.  Translated
by J. M. Galluway, M. D., Manchester; Henry Turner, 1857. 
  DISORDERS OF THE AFFECTIONS, EMOTIONS AND FEELINGS.  381

case is recorded of a young lady, for the first time pregnant, whose
former love for her  husband was replaced  by an  almost  invincible
antipathy to him.   Similar to this is the moral  state of those  who,
from imagining, in their  hypersensitive, nervous  condition, that they
do not receive proper  and necessary attention from  their husbands
and their friends, turn against them  and conceive for them a strong
dislike.   In  most cases all such  morbid changes  of the  affectional
sphere disappear with the termination of  the pregnancy under the in-
fluence of which they were developed.   But it becomes no less im-
portant for the physician to do all in his  power to relieve such moral
disorders, not only on  account  of the present suffering  and distress
to all concerned, but also because in some instances, at least, these dis-
orders may become permanent,  and even ultimate themselves in dis-
turbances of the intellectual faculties, in subsequent puerperal mania,
and finally in some dangerous forms of physical disease.   These dis-
orders of the feelings, emotions  and affections may be connected with
an hereditary predisposition to insanity, or with some deeply-seated and
even malignant dyscrasia, which, if not remedied  at  its incipient
appearance, may develop the most serious mischief in  the present and
in future generations.   Happily, these disorders are usually amenable
to careful medical and hygienic  management.  In selecting a remedy
for any of the above-described conditions, even the most trifling symp-
toms, as well as those  of apparently more  grave import,  should  be
taken into the account which makes up the totality of the  individual
case.  And while individualizing  is the touchstone of  successful treat-
ment in all cases, it is through it only that success can be attained in
treating any of the  varied affections of the mind.  A few of the
medicines most frequently called for in  these cases are herewith sub-
joined :

  Aconite. Fear and  presentiment of approaching death; she fixes the
time of her death.  Fears to go out of doors, etc.
  Aurnm. She has no  confidence in herself, and  thinks others  have
none in her; this makes  her unhappy.   She looks on the dark side
of everything; weeps and prays;  thinks she is not fit  to live, and has
a strong inclination to suicide—to jump out of the window  or from a
height.   Sleepless at night.  Often very costive.
  Anacardium.  Estrangement from individuals and society, with fear
of the future.  Strange temper; she laughs at serious matters; is grave
over laughable occurrences. Swears; thinks herself a demon.  Loss of
memory, dullness of  the mind and inability to think.   Dyspepsia. 
382         DISORDERS  INCIDENTAL  TO PREGNANCY.

   Arsenic. Periodical  attacks of anguish, inquietude, tossing and in-
ability to lie in  bed; fear of death;  excessive dread of death; she is
sure she will die.   Easily exhausted; looks pale and haggard.  Puffed
and waxy appearance of the face.
   Arnica. Thoughtless gayety;'  great frivolity and mischievousness.
   Belladonna. Great distress with inquietude.  Frightful visions; she
wishes to hide herself.  She has a wild  look, a stunned appearance.
She wishes to strike, bite  and quarrel.  Difficult deglutition.
   Calc. C. Excessive mischievousness, with obstinacy.  She thinks and
talks about murder, incendiarism, rats and mice.   She imagines people
think she is insane.  Feels as if she were going crazy.
   China. She thinks she  is very unfortunate and constantly harassed
by enemies.  The symptoms appear to be paroxysmal, and are worse
every other day.   Sensation in abdomen of distension.
   Hyoscyamns. She fears  she will be poisoned or betrayed or injured;
she wishes to run away.   Wishes to go naked.
   Ignatia. She wishes for solitude; sighs  and sobs; she will not be
comforted.  She is full of grief.   Broods over troubles.
   Lachesis. Excessive loquacity, with  rapid  change of subject, talks
of one thing, then of another, etc.  Jealous, proud, suspicious.
   Lycopodium. Very reproachful and overbearing.   Restless at night,
and complains of not sleeping well.  Worse  after 4 P. M.
   Moschus. She complains much, but of nothing in particular.
   Natrum C. Estrangement from individuals and society, even from her
husband and family.   See also Anacardium, Conium and Natrum  in.
   Nux V. Loss of  mental power; can't read  or calculate, because she
loses the connection of ideas; she thinks she will lose her reason.
Worse in the morning or.  early part of the day.
   Opium. Thinks  she  is not-at  her home; this is continually in her
mind.   Constipation, inactivity of  rectum; stools  round balls.
   Phosphorus. Great  sadness with tears, alternating with gayety and
laughter.  Suitable especially for tall and slender women; thin, hard
and dry stools, evacuated with difficulty.  Abdomen feels weak.
   Platina.  Past events trouble  her.   Contempt  for other persons.
She thinks all persons are demons.   Thoughts horrify her.
  Pulsatilla.  Much weeping, even at answering  a question.   Most
suitable for mild and gentle women, who are easily controlled.
  Sepia.  She is very uneasy about the state of her health; constantly
worrying, fretting and crying about her real  or imagined illness.
  Silicia.  She is occupied with pins—counts them, hunts for them, etc
She is always worse during the increase of the moon. 
  DISORDERS OF THE AFFECTIONS, EMOTIONS AND FEELINGS.  383

  Staphysagria is very  similar in some respects to Sepia.  The pa-
tient is very sensitive to either mental or physical impressions.
  Stramonium. She  is worse in the dark or  in solitude.  Full  of
strange, ridiculous ideas.  Talks or prays earnestly and constantly.
  Sulphur.  She is very happy, and  imagines she is in possession  of
beautiful things.  Awakens at night singing, she is  so happy; she
dreams very happy  dreams,  etc.
  Veratrum. A desire to  wander  about the house.   Erroneous and
haughty notions.  Disposed to be very taciturn.
  Asafoetida, Gelseminum,  Cimicifuga, Cocculus,  Cypripedium, Moschus,
Nux moschata,  Phosphoric acid and  Zincum may likewise be consulted.
  The patient should  receive the  best advice from her physician in
regard to the  necessity  of self-exertion in assisting to overcome the
tendency to a disordered mental state.   She should be urged to bear
up  bravely, and to resist, to the full  strength of her ability, 'those
feelings  which are unnatural and  are harmful.  And those who sur-
round her should likewise  be  instructed, if  necessary, to  treat her
with the utmost kindness  and consideration.  If these conditions are
not fulfilled, it is possible  for the homceopathically selected  medicine
to effect a cure; but there can be no doubt that its effects will be power-
fully aided by a proper  attention to  mental discipline and hygiene
on the part of the patient, and a proper degree of kindness, yet withal
firmness, on the part of  her  friends.

  In  concluding  the  general subject of disorders  incident to  preg-
nancy, it may be proper to remark—
  I. While  pregnancy serves in many cases to develop in  some form
—physical, mental or  emotional—whatever latent tendency to disease
had existed in the system, it does not render the body more  liable to
be attacked by external  diseases; and  in some instances,  as is often
seen in the  phthisis of those enceinte, it actually retards  the develop-
ment  and  prevents the fatal  termination of  pre-existing  disorders
until after delivery.
  II.  The disorders of  the mental and moral  or emotional and  affec-
tional spheres  which so  often  accompany pregnancy will ahvays
speedily disappear with the successful  delivery of the  child,  unless
based  upon  and representative of some profound constitutional dys-
crasia.   In  this latter  case such affections not only tend to perpetuate
themselves  after parturition, but to become developed  in puerperal
mania, and  even ultimated in some malignant form of bodily disease. 
384
THERAPEUTICS OF LABOR.
                    CHAPTER  XVIII.

                THERAPEUTICS  OF LABOR.

                    The Pains of Labor.

   PAINS ceasing.—1. Bell., Kali c, Op., Puis., Sec. corn.  2. Cham.,
    Natr. m., Nux  v., Ruta, Sep.  3.  Aeon.,  Arn.,  Bor., Camph.,
Carb. veg., Caulophyllum, Chin., Cocc, Graph., Ignat., Lye, Magn.
m., Nux v.,  Plat., Sulph., Thu*.
  ------distressing.—1.  Cham., Gelsem.,  Kali c, Sep.  2.  Aeon.,
Arn., Aur., Bell., Cimic, Coff.,, Con., Lye,  Nux v.,  Sec. corn.
  ------spasmodic.—1.  Cham., Gelsem., Hyos.,  Puis.   2. Bell.,
Cimic, Cocc, Cupr. m., Ipec, Lycopod., Nux v., Sep.
  ------too weak.—1. Bell., Cann., Cauloph., Cimicif., Gelsem., Kali
c, Op., Puis., Sec. corn.   2. Cham., Natr. m., Nux v., Ruta, Sep. 3.
Arn., Bor., Camph., Carbo veg., Chin., Cocc, Graph., Ignat., Lye,
Magn. m., Nux m., Plat.,  Sulph., Thuy.
  ------too strong.—Bell., Cham., Coff., Con., Nux v., Puis., Sec. corn.

  Aconitum.  Great distress, moaning and  restlessness during every
pain.  She fears that she will not be delivered, that she will die, or
that something will certainly go  wrong.   The vulva,  vagina and os
are dry, tender and undilatable.   It hurts her so there.
  Arnica.  With each pain there is great flushing of  the face and heat
of the head, while the rest of the body may be  cool.  The pains are
so violent as to drive her almost distracted, yet  little good is  accom-
plished.   Frequent desire to change  position.   She feels unaccount-
ably sore and  bruised  in  any position.   The pains are very feeble,
with a desire to change the position frequently.
  Aurum. The pains make her desperate, so  that she would  like to
jump out of the window or dash herself down ; with congestion to the
head and chest and palpitation of the heart.
  Belladonna. The pains come on suddenly, and disappear after a  time
as suddenly as they came.  Spasmodic  contractions  of the os, which
is hot, dry and  tender.   Very red face  and injected eyeballs,  with
pain ; labor slow and tedious.   Throbbing  headache, with great sen-
sibility to light and  noise.  The os  uteri does not dilate readily in
proportion to the pains.   Jarring the bed annoys her.
  Borax. The pains are accompanied by violent and frequent eructa- 
THE pains  of labor.
385
tions.   She fears a downward motion.  She is very sensitive to the
slightest noise, as the rumpling of paper, fall of the door-latch, etc.
  Chamomilla. Her pains are  spasmodic  and • distressing. # She can
hardly bear them; she wishes to get away from  them.  She  is very
fretful, peevish and cross; can't return a civil answer.  Tearing pains
down the legs.  She is spiteful, or shrieks  out sharply.
  Camphor. Her pains have  ceased, and  her skin is cold, dry and
shrunken; she  does  not like to be  covered, and is  restless.   Cam-
phor200,  or  higher, will warm the  patient,  restore  the pains, and,
other things being equal, produce spontaneous delivery.
  Caulophyllum. Extraordinary rigidity of the os uteri.  Spasmodic
and severe pains, without progress being  made.   The pains  become
very weak and flagging from exhaustion, on account of the long con-
tinuance of the labor.  Thirst and feverishness.   False pains.
  Causticum. She complains mostly in her back of a sore, distressing
pain.   Her suffering  is principally in the back.   When the unnatural
condition of the pains is attributable to debility from night-watching,
grief, or other depressing influence.
  Carbo veg.  The pains are  too weak, or cease from great debility.
Particularly indicated where there is a varicose condition of the vulva,
or when there has been a great loss of animal fluids, or the woman is
laboring under the debilitating effects of previous or existing disease.
  China. Where much blood has been lost or there have been fainting
fits, convulsions, etc.  Cessation of pains from the loss of blood, a pro-
tracted  diarrhcea, etc.; her skin may even be cold  and blue.   She
can't bear to be touched during the pains,  not even on her hands.
  Cimicifuga.  The woman  complains  that  the  pains  do not  seem
to be located properly to  effect  expulsion, but they are  of a  tearing
and distressing character.   Suitable to women of a  rheumatic tend-
ency.   The pains are very violent and  spasmodic, and there is  great
nervous excitement.
  Cocculus. Her pains are  of a spasmodic,  irregular and  paralytic
character.  She will  have one hard  one, and then, after a longer  in-
terval,  several light ones, etc  Much headache.   Numb or paralyzed
feeling of the lower limbs.
  Coffea. Labor-pains insupportable to  her feelings; she feels  them
intensely, weeps and laments fearfully.  Although the  pains are severe,
they are not efficacious.
  Conium. If there are scirrhosities in either the breasts or uterus and
labor does not progress normally—pains spasmodic;  vertigo, particu-
larly on turning in bed; rigidity of os uteri.
       25 
386                 THERAPEUTICS  OF LABOR.
  Cuprum. Violent spasmodic  pains appearing at irregular intervals,
often with violent cramps  in  the lower  extremities, or the cramps
may be confined to the fingers and toes.  Great restlessness between
the pains.
  Gelseminum. Cutting pains in the abdomen from before backward and
upward, rendering the labor-pains useless; these come on with every
pain.  These  pains  are very distressing, and  may be felt throughout
the abdomen.
  Gossypium. In cases  of lingering almost painless  labors, where the
uterine contractions are feeble or entirely inefficient.  The case pre-
sents negative rather than positive symptoms.
  Graphites. In large  and  corpulent women of venous constitution,
who are subject to tettery eruptions, which itch and emit a glutinous
fluid.  The pains are weak  or have ceased entirely.
  Hypscyamus. There is delirium, startings and jerks in various parts
of the body, in the face, eyelids, and sometimes all over.
  Ignatia. Deep sighs and  sadness; she must take  a deep  breath in
order to breathe at all.   The labor does not progress.
  Ipecacuanha. One  constant sense of  nausea,  not a moment's relief.
The pains are distressing by reason of a sharp cutting about the um-
bilicus, which darts off toward the uterus; this distress hinders the
proper action of the uterus.
  Kali c. The  pains begin in the  back, and instead of coming round
in front like a regular  pain, pass off down the buttocks or the glutsei
muscles;  or they  are  sharp and  cutting  across the lumbar region,
arresting contractions.   She is sometimes  greatly disturbed by sharp
stitching pains.  Often much belching with relief.
  Lycopodium. During the  paroxysms  of  her  pain  she  is obliged to
keep in constant motion, with weeping and lamenting; there may be
even spasmodic contraction of the os, with the  above symptoms.  She
finds relief by placing one foot  against a support and  pressing and
relaxing alternately, so  as to agitate her  whole  body.
  Magnesia m. The labor-pains are interrupted by hysterical spasms.
(See Hysteria, same remedy.)
  Natrum C Anguish, tremor and perspiration with every pain, dur-
ing which she desires to be gently rubbed; this rubbing affords relief.
She  often says, " Rub me, rub me."
  Natrum m. Very, very sad and  foreboding—so much so that labor
goes on very slowly, from feeble pains.
  Nux m.  She is very drowsy, sleepy and disposed  to fainting spells,
the pains being correspondingly slow and feeble, or quite suppressed. 
THE PAINS OF LABOR.
no"
O0(
   Nux V. Every pain causes an inclination to go to stool or to urinate.
 Every pain causes fainting, and thereby interrupts the progress of the
 labor.   Retarded and painful labor in women accustomed to a seden-
 tary life, and to those accustomed to high living and an inactive, in-
 dolent life.
   Opium. The pains  have been suppressed by fear or fright.   She is
 in a soporous condition, with red face, injected eyes and stertorous
 breathing, and there  is twitching  and jerking of the muscles.
   Phosphorus. Tall and  slender  women  of phthisical  diathesis, the
 pains being distressing and of but little use.  Very weak and empty
 feeling in the abdomen, sometimes with cutting pains.
   Platina. The contractions are interrupted owing to the very painful
 sensitiveness of the vagina and external genitals.   Very painful though
 ineffectual, spasmodic labor-pains.  Her thoughts horrify her.
   Pulsatilla. Suitable to  mild, tearful women, who  are  in an appar-
 ently healthy condition,  yet the  uterus seems almost inactive.  The
 pains excite palpitation,  suffocating  and  fainting spells, unless  the
 doors and windows are wide open ; she feels that she must have them
 open, as she wishes for  cool, fresh air.   Absence of thirst.  Labor
 progresses very slowly.
   Rhus tox.  Very restless, must change positions often, with relief for
 a short time.
   Ruta. Lameness and soreness all over;  weak,  feeble contractions.
   Secale C. Particularly in weak, cachectic women, or in women de-
 bilitated from venous haemorrhages.  In  such cases it  is particularly
 efficacious for weak, suppressed or distressing pains.   Fainting fits in
 such cases; small or suppressed pulse.
   Sepia.  Shuddering  attends the pains, and she rather  wants  to be
 covered up more,  because  she can bear the pains easier.   Indurations
 are felt upon the neck of the  uterus.  Shooting pains  in the neck,
 extending upward.   Spasmodic contractions of  the  os in these  cases,
 when fine needle-like pains fly  up  the os.
  Stannum. The pains seem to exhaust her very  much,  and make her
speech difficult from weakness in the chest.   She cannot answer ques-
tions ; she is all out of breath ; the labor  does not progress.
  Sulphur. She has flushes of heat, frequent weak and fainty spells,
wants more air.  Cold feet, heat on top of head.
  Thuya. In  some cases of complication  with  syphilis, which hin-
ders the proper contractility, this  remedy  will do much good  imme-
diately.
  Veratrum.  The pains are accompanied with cold sweat, particularly 
 388                THERAPEUTICS OF LABOR.

 on the forehead, fainting on the least motion, the pains  exhaust hei
 much, and she feels completely done over after every pain.

                   Rigidity of the Os Uteri.
   Where rigidity of the os uteri in labor depends on organic lesions
 of the cervical tissues the treatment to be resorted to is laid down on
 page 236.  But where, as is commonly the case, the rigidity or spas-
 modic contraction is due to mere  functional disturbance, one of the
 following remedies will be found to be sufficient to produce a gradual
 relaxation and dilatation.  Rigidity of the vaginal walls, dependent on
 a similar cause, may likewise be removed by the same remedies.

   Aconite. When there is  great dryness of the vagina; much moan-
 ing, restlessness, feeling of discouragement; fears she will not do well;
 the parts feel  contracted, rigid and  undilatable.   Aconite, in water,
 every half hour till better.
   Belladonna.  There is heat of the parts, with great tenderness; moan-
 ing; flushed face; injected  sclerotica; throbbing  of the carotids; all
 her motions are quick;  pains come suddenly and disappear suddenly.
   Caulophyllum. The pain is spasmodic; it appears in various parts
 of the abdomen;  patient seems much exhausted  and the pains very
 inefficient.
   Chamomilla. AVhere there is  great irritability of a spiteful nature;
 she seems scarcely able to bear the pains; she moans, laments, calls
 for assistance, sometimes screams out, and  the  pains appear as if too
 severe to be endured.
   Cimicifuga. The pains  seem intensely severe, but spasmodic and in-
 effective.  The patient is of a rheumatic diathesis and subject to rheu-
 matic pains.
   Gelseminum.  The pain extends, in the abdomen, from before back-
ward and upward; this pain is  a false pain, and is so severe as to in-
terrupt the true labor-pain.   The fa6or-pain  seems utterly inefficient.
The pain is  sometimes cramping in various parts  of the  abdomen.
The os is rounded and hard, and feels as though it would  not dilate.
   Lobelia inflata. When the respiratory organs  sympathize in the
trouble, as in violent dyspnoea, with every uterine contraction, which
seems to neutralize the pain.
   Any remedy in the Materia Medica may be useful in these cases, as
the rigidity or contraction is but the result of some morbific influence
working upon the system; therefore see remedies for difficult labor. 
HOUR-GLASS CONTRACTIONS.
389
          Hour-Glass Contractions.   (See page 202.)
  The medicines most suitable for this  condition  are:  Belladonna,
Chamomilla, Kali carb., Platina, Secale  cornutum and Sepia.  Next
best:  Cocculus indicus, Conium,  Cuprum ars., Hyoscyamus, Nux
vomica, Pulsatilla, Rhus tox, Sulphur.

  Belladonna. Almost constant moaning, which seems to afford relief;
injected eyeballs; flushed  face; can't bear light or noise; pulse full
and bounding; very hot skin.
  Chamomilla. Distress which it seems she can  hardly endure;  a spite-
ful  irritability; thirst; desires fresh air; restless;  more or less  dis-
charge of dark blood from the vagina.
  Cocculus indicus. Terrible  pain in the small  of the back; lower
limbs feel paralyzed; frequent vomiting.
  Conium.  Great vertigo when  turning the head; very sensitive across
the  abdomen.
  Cuprum. Violent and distressing  cramps  in  the uterine  region;
cramps in the extremities, hands and feet.
  Hyoscyamus. Delirium; jerking  and twitching of muscles; bluish
color of the face.
  Kali  carb.  Distressing pain  in the back, running down into the
glutsei muscles; stitching pain in the abdomen; abdomen bloated with
wind; restlessness and thirst.
  Nux vomica. Sore aching pain in the region of the uterus;  a very
frequent inclination to stool;  great mental depression and nervous
irritability.
  Platina.  Very great sensitiveness of the organs;  severe cramping
pains in the region of the  uterus;  constant oozing of dark, grumous
blood from the vagina.  Horrified  by her thoughts.
  Pulsatilla.  In very mild, tearful women; desires fresh air; very rest-
less ; absence of thirst.
  Rhus tox.  Occasional paroxysms of pains extending down the pos-
terior surface of the limbs;  restless, with relief after every change of
position;  must change frequently.
  Secale cornutum. A  sensation of a constant tonic pressure in the
uterine region;  this causes great distress; wishes fresh air; don't like
fo be covered much.
  Sepia. Numerous  little darting  pains, shooting  upward  from the
neck of the uterus;  flushes of heat; cold feet.
  Sulphur. Frequent weak and fainty  spells; wishes  to  be fanned;
flushes of heat and cold feet. 
390
THERAPEUTICS OF LABOR.
   In the preceding cases the remedy should be repeated every fifteen
minutes or half an hour till improvement sets in.


                 Fainting, Swooning, Syncope.
   These are synonymous terms, but perhaps  syncope represents the
complete stage of swooning.  In treating this abnormal manifestation
much will depend upon the correct observation of the practitioner,
and much care is needed that a proper prescription be made.
   If the patient is not already lying down, she should  be placed in
that position, and an abundant quantity of fresh air should be allowed
to enter the room.  All applications are usually injurious, excepting
perhaps a little cold water applied to the face  by sprinkling or gentle
bathing.  The homoeopathic remedy is the safest dependence.  The
remedies herewith mentioned  are suitable  for  attacks of  syncope
occurring before, during or after parturition:

   Aconite. When there is violent palpitation of the heart; congestion
of blood to the head; buzzing in the ears;  pale face on  assuming an
erect position  from the recumbent; after a fright.
   Arnica. From  injuries of any kind; from fatigue;  from stitches
about the heart;  when the head  is  very hot and the body cool.
   Arsenicum.  Result of debility  or prostration, when the least effort
causes fainting;  thirst for  frequent  sips of cold  water;  wishes to be
wrapped up warmly;  pale bloating of  the face.
   Carbo vegetabilis. Fainting from weakness caused by loss of animal
fluids;  after sleeping; after rising  in the morning; much belching of
wind or eructations.
   Chamomilla. Where  there is great irritability  of  a  spiteful  kind;
she is very sensitive to the pains, which  cause fainting, with vertigo,
dimness of vision, dullness of hearing and  nausea;  must have fresh
air and  fresh water.
   China. After loss of blood particularly or other animal fluids, with
ringing  in the ears,  coldness of the  skin, loss  of pulse, and cold
perspiration.
   Coffea. In highly sensitive persons after a fright, if aconite fails.
   Digitalis.  Where the pulse is very slow and irregular; cold sweat ■,
deathlike appearance of  the countenance.
   Nux vomica.  As the result of over-indulgence, as from over-eating,
etc.; aftei  vomiting;  after every labor-pain;  after  stool; with con-
gestion  of the blood to head or chest, with trembling. 
               WEAKNESS, DEBILITY, EXHAUSTION.            391

   Ignatia. When  the  fainting  seems  to  result  from  grief;  much
 trembling; sighing and sobbing.
   Sepia.  Feet and hands cold as ice; flushes of heat; a distressed,
 empty feeling in pit of stomach.
   Stramonium. Fainting spells occurring every day or several times a
 day;  the person suddenly falls, with pale face and  almost insensible
 breathing; sometimes face is  bloated red; the fainting  may continue
 a long time.  Talks in an imploring and beseeching manner.
   Veratrum album. Fainting  from the slightest exertion, turning in
 bed, straining at stool, retching as  if to vomit, etc.; cold  sweat upon
 the forehead.
   Bryonia. When the fainting fits  occur from the least motion, even
 when no effort is required ; sighing respiration; thirst  for cold water
 and drinks large quantities.
   Camphor.  Where there is a marble coldness of the surface of the
 whole body; very weak pulse.
   Cocculus indicus. Paralyzed feeling in all the limbs, with trembling;
 paralytic weakness, particularly in the lower extremities; spasmodic
 pains in  the uterus, with nausea and vomiting,
   Lachesis. Fainting fits, with great and almost unconquerable sadness
 and gloom ; dreads society and company;  great and persistent consti-
 pation, with a sensation as though the anus were closed.
   In  all these cases during the attack it  is better to  administer the
 remedies every five or ten minutes till consciousness is restored, and
 then wait for the next attack.

              Weakness, Debility, Exhaustion.
   Arsenicum. From any cause when there is sense of great exhaustion
 after every effort, however small; chilly, wants to be wrapped warmly;
 cold water disagrees;  waxy paleness of skin ; may be bloated;  going
 up stairs is  very exhausting;  great  restlessness,  particularly after
 twelve o'clock at night.
   Calcarea carbonica. In leuco-phlegmatic temperaments; much per-
 spiration about head and upper part of body;  every exertion is fatig-
 uing;  ascending causes vertigo; cold, damp, clammy  feet; the least
 cold air is almost unendurable.
   China. Particularly when haemorrhages or loss of animal fluids are
 the cause; ringing in the ears like bells; vertigo;  cold perspiration ;
'feeble pulie ; almost insensibility.
   Ferrum. Frequent attacks of tremor, alternating with a sensation of
 weakness, is if very weary;  trembling of the  whole body;  feeling 
392                 THERAPEUTICS OF LABOR.
        very weak;  feels very weak even  from talking; wishes to lie do.vn,
        face and lips very pale, or the cheeks may be fiery red.
          Iodine. Pulsation in all the arteries at every muscular effort; great
        prostration  of strength,  so  that  even  talking  causes perspiration.
        Food does not seem to  nourish  her.
          Kali carb.  When  one  feels the  pulsation of all the arteries  even
        down to the tips of the toes; feeling of emptiness in the whole bodv,
        as if the body were hollow; the whole body feels heavy and broken
        down, so that it is only with the greatest effort that  one can make
        any exertion.
          Lycopodium. When lying in bed she  feels as if she would die from
        weakness; the lower jaw drops,  not being able to keep the mouth
        shut; the breathing is slow  and through the mouth; the  eyes half
        open; when walking she is obliged  to let her hands hang down, and
        the bones of her lower extremities are painful; sudden  weakness com-
        ing on even when sitting; red sand in  the urine; flatulency.
          Muriatic acid.  Great debility, with haemorrhoids so sensitive they can
        hardly be touched, and they often  bleed ;  so weak cannot lie up on the
        pillow, but constantly slides down into the bed.
          Nux vomica. Debility from abuse of  coffee, wine, spirituous  liquors
        Dr  narcotic  substances, from the abuse of  highly seasoned food;
        night-watching;  cannot walk on account of giving out of  lower ex-
        tremities; knees knock together; wishes to  lie  down  all the time;
        cannot sleep well after three o'clock  in the morning; great sensitive-
        ness  to external  impressions, noise, talking, strong scents and odors,
•       or bright light;  trifling  ailments affect her almost beyond  measure;
        blue margin around the eyes; nose looks sharper and more pointed
        than usual;  the  face shrunken.
          Rhus tox.  Restlessness characterizes  the use of this medicine; she
        is very restless, and is always relieved for a short time by a change of
        position,  when she must  move  again; loss  of appetite; cold water
        disagrees.
          Sepia. Sepia debility is usually characterized by a painful sensation
        of emptiness at  the pit of the stomach; icy coldness of feet  and
        hands; urine deposits a very hard, crusty sediment; flushes of heat;
        loss of appetite.
          Stannum. Characterized by  great  sense of weakness  in the larynx
        and chest, thence all over the body, from talking or reading aloud.
          Sulphur. Weak, fainting spells coming frequently during the day;*
        feels very faint  and weak  from  eleven to  twelve every  morning;
        flushes of heat;  cold feet;  heat on top of the head. 
HAEMORRHAGE.
393
  Veratrum. Excessive weakness;  is obliged to move very slowly; so
weak she can  hardly raise her hand, and every motion  seems to in-
crease the debility;  even a movement of the  bowels causes great de-
bility ; very weak, almost imperceptible pulse; cold sweat, particularly
on the forehead;  thirst for icy cold water.
  The above treatment, it need hardly be remarked, is suited not only
jo the weakness which sometimes manifests itself during the progress
of labor, especially  of tedious labor^  but as well  when occurring
either during pregnancy or after parturition, or, in  fact, at any other
period of the woman's life.   Stimulants do positive  harm.
                     CHAPTER XIX.

                       HEMORRHAGE.

rTIHE  haemorrhage that may occur in  non-pregnant women will
 J-  hereafter be considered under  the head  of Metrorrhagia, while
that wliich arises during the earlier months of pregnancy will  be dis-
cussed  in  connection  with Abortion, in  which  it  tends to  result.
Puerperal haemorrhage, our present theme, includes the flooding which
occurs during the latter months of pregnancy, just previous to parturi-
tion, during its progress or subsequent to  the  delivery of the child.
No complication  of labor is  more justly dreaded  by the practitioner,
since there is none capable  of  proving  more  rapidly fatal  unless
promptly arrested.   Nor indeed can this  indispensable result be pro-
duced unless the  physician so completely retains his presence of mind
in the most trying moments as to be able to ascertain the cause of the
mischief, institute  the requisite  procedure where direct interference
is needed, and select the proper medicaments when operative interfer-
ence is not called for.   Fortunately,, uterine haemorrhage is not a fre-
quent  complication of  pregnancy  and  parturition.  According  to
Churchill, out of 170,221  cases, haemorrhage occurred 1370 times,
or nearly 1  in 124.  The  mortality of mothers and children is  in
frightful proportion, however, to the number of cases, for, according
to the  same author, out of 782 cases, 126 mothers died, or about 1 in
6; while of 944 cases, 288 children perished, or about 1 in 3.  These
results  occurred  in  cases treated by practitioners who knew nothing
uf the efficacy of medicines applied homceopathically for  controlling 
394                       HEMORRHAGE.
haemorrhage.   The  extent  of the  modifying  effect  homoeopathic
treatment has upon the mortality of mothers and  children in these
cases  is truly wonderful and diminishes  fatal cases almost to none
at all.
   It may be laid down as a general proposition that nearly all forms
of haemorrhage connected  with child-bearing are  due to a partial
separation of the placenta, by which the  utero-placental  vessels  are
torn and their uterine orifices left patulous through the non-contraction
of the  uterine muscular fibres.  (Post-partum  haemorrhage, either
before or after the  expulsion  of the placenta, may depend upon a
variety of causes otlier than that just stated.)
   When haemorrhage occurs before or during delivery it is due either
to an accidental separation of the placenta, which may be properly im-
planted at the fundus of the uterus, or to an unavoidable separation, in
consequence of its being unnaturally located at the cervical extremity
of the uterus and implanted more or less centrally over the os, so that
the placenta  beyond a certain point cannot grow nor the uterus  ex-
pand, nor can delivery be effected without a more  or less extensive
separation of the placenta.   From these circumstances haemorrhages
occurring before or during  labor  have been  termed  Accidental and
Unavoidable.

                   Accidental Hemorrhage.

   This form of haemorrhage occurs when from any cause the placenta
becomes partially detached  from the uterine wall; and generally the
danger is  proportionate to the  extent of the detachment, though this
is not always the case, for a fatal result may follow a slight separa-
tion.  The flow of blood may show itself  externally if there be room
for it to descend between the uterus and the epichorion, and generally
this is the case;  or, on the other hand, it may be  concealed, going on
insidiously even to a fatal extent, and can only be known by its effects
upon .the  system.  The usual causes of this separation of the placenta
are—shocks  or blows or violence of any kind, fatigue, over-exertion,
straining  from lifting  or reaching, jolting in a carriage or on a rail-
road, etc   It may likewise be produced by mental emotions, which,
by exciting uterine action, may produce a  separation of the placenta.
In some constitutions, plethoric or  susceptible, the slightest influences
suffice to  bring on  the  detachment and haemorrhage, and in certain
cases it seems to arise, as it were, spontaneously and without traceable
cause during the course of labor.   And again, there appears in some 
ACCIDENTAL HEMORRHAGE.
395
cases to be an acquired tendency to accidental haemorrhage, which the
history of the case reveals to the practitioner.
  When the flow of blood  is external the case is plain enough, and
even when the haemorrhage is concealed its effects are so pronounced
that a diagnosis is easily made.   The most marked and characteristic
symptoms are—acute pain, which occurs at the seat of injury, gener-
ally the fundus;  collapse; great distension of the fundus of the uterus.
In addition  to these there may be  rigors, tension and sensation  of
weight and fullness in the abdomen,  and fainting.  The pulse will be
qiick and feeble, and if the loss of blood be considerable there will
be pallor of countenance, great agitation, partial or total blindness,
noises in the ears or complete deafness.
  In an article on " Concealed Accidental Haemorrhage " in the Amer-
ican  Journal of  Obstetrics, August,  1869, Dr. William  Goodell  of
Philadelphia gives the histories of one hundred and six cases.   From
this article we quote a portion of his  summing up of the most marked
indications of the occurrence of this  unfortunate  complication :
  "An analysis of the foregoing one hundred and six tabulated cases
shows that  by far the most frequent  symptom is  an alarming state of
collapse, carrying dismay into the heart of the bystander.  Every de-
tailed example, without exception, presents most of its characteristics,
such as  coldness of the surface, excessive pallor, feebleness of the
pulse, yawns, sighs, dyspnoea, restlessness and retching.
  "Pain holds the second rank in  frequency.  Out of these cases,
sixty-four exhibit every grade of suffering, from the ' queerish feeling'
to the ' greatest  torture' and ' agonizing shrieks.'  ... In the great
majority the pain was referred to the site of the placenta,  and was of
a bursting character.  . . .
  "The third most constant symptom is the absence or extreme feeble-
ness of the pains of labor.   Of  the former, twenty-eight examples are
tabulated, of the latter, fifty-six;  but of these  the majority presented
no labor-pains until the membranes were ruptured, either naturally or
artificially.   In only twelve were the pains normal from the  outset.
  "Next follows a marked distension of the uterus,  which  produces
those painful sensations of ' bursting,' that burden of every  cry  of
the  sufferer.  Out of the one  hundred  and six examples, forty-two
presented this symptom, although rot always  recognized  during the
life of the patient. .  . .
  " Very often, before the lapse of many hours, a show of blood, rang-
ing from ah  ooze to a gush, will clear up all obscurity; but this trust-
worthy symptom  does  not usually occur at the outset  of the attack, 
396
HEMORRHAGE.
but at  a time when it may be  too late to interfere.   A  diagnosis
should not, therefore, depend upon its presence, but simply be affirmed
by it."
  The occurrence of such grave symptoms as these during the course
of a labor should always excite strong suspicion of internal haemor-
rhage ;  and if there  be a history of  a  fall, a blow, or any other me-
chanical injury having been  inflicted,  the diagnosis is  strongly con-
firmed.   Should  accidental  haemorrhage occur during the progress of
labor, and the pains are not arrested thereby, it will  be' noticed that
during  a pain the flow nearly  or  entirely ceases,  in consequence
of the closure of the mouths  of the  bleeding vessels by that natural
haemostatic uterine contraction.   The opposite of this  is the case in
unavoidable  haemorrhage (placenta  praevia), where the flow occurs
during a pain and nearly or entirely  ceases during the intervals.
  The diagnosis of accidental from unavoidable hoemorrhage is essential
to its proper treatment, and  it may be determined by means of the
following distinctions:
  I. Accidental  haemorrhage before labor  or  during  its progress
usually results from some  definite and ascertainable cause, such as
mechanical injury, while in placenta praevia there is no such history,
and the flow  of blood commences, as it were, spontaneously, perhaps
while the woman is at perfect rest or asleep in. bed.
  II. In accidental haemorrhage the discharge takes place freely in
the intervals  between the pains, and is arrested during the continuance
of the pains; while in  unavoidable haemorrhage from placenta  prae-
via the  conditions are exactly  opposite, the flow  occurring during the
pain, which expands  the os uteri.
  III.  In accidental haemorrhage the  os  uteri  is free,  and  closed by
the membranes only, which  may be tense or flaccid, and the presenting
part of the foetus  may  be made out  by the finger; while in placenta
praevia  the placenta, as a soft, spongy mass, may be detected within
the os, and in all probability the  presenting part of the foetus cannot
be touched or made out.
  IV. In cases in which accidental haemorrhage occurs the lips of the
os will not have more than their usual thickness; while in placenta
praevia  they  will be  thick,  and  active pulsation will be strongly
marked.
  V.  " In accidental haemorrhage the blood, before being discharged,
having  to find its  way some  distance  to the os, deposits its fibrin, so
that coagulation does not occur in the vagina, which is free from clots;
whereas the blood in placenta praevia comes directly from the uterine 
ACCIDENTAL HEMORRHAGE.                397
or placental vessels, or both, into the vagina, and is there discharged
as blood, leaving coagulations behind in the vagina." *
  The treatment of cases of accidental haemorrhage  must be  directed
entirely by the circumstances of each case.   If the woman  has not
advanced  to  full term  and the haemorrhage  is slight, which may be
known  by its effects  upon the  system, there is reason for believing
that placental detachment has not taken  place to  any great extent.
In such a case, by perfect rest in the recumbent posture, the  allaying
of all excitement or anxiety, cool drinks,  and the  administration
of the appropriate and homoeopathic medicaments, the haemorrhage
may  be arrested, and  the woman delivered  at term without  any
further untoward circumstances  arising.  At the close of this chapter
the medicines appropriate in all cases  of uterine haemorrhage are
given, with their indications in detail; and  to these remedies the reader
is referred.   The nicest discrimination is needed in  effecting a proper
selection of the remedy, and when the truly homoeopathic remedy has
been selected in accordance with the totality of symptoms, subjective
and objective, the practitioner will often be surprised by the  happiest
results in very gloomy cases.  The use of plugs of any kind, or the
resort to  other mechanical measures in such  cases, will almost cer-
tainly bring on labor.
  Even in the worst cases  of accidental haemorrhage a fair  trial
should be given to the homceopathically indicated medicament before
proceeding  to  operative  interference;  this being  warranted by the
well-ascertained haemostatic power of such specific medication, and by
the success which has attended such efforts.
  In cases, however,  where the flooding  is very great, the danger is
imminent, the woman is at her full term and the haemorrhage is accom-
panied with pains; or, again, in the above-described milder cases, where
the measures recommended have failed, and labor has come on sponta-
neously or in consequence of the irritation produced by plugging the
vagina, the object of  treatment  must be to bring on labor, to induce
uterine contractions, and to secure the expulsion of  the child. These
indications will be best fulfilled by rupturing  the membranes, by wdiich
means the bulk of the uterus is diminished  by the evacuation of the
liquor amnii, its walls more  effectually contract upon the placenta, at
least temporarily arresting the  flow  from the uterine sinuses, and at
the same time facilitating the  expulsion  of the foetus.  This being
done, a period of rest should be allowed to  the patient, giving her
time  to rally, and at the same time giving opportunity to the natural
                * Dr. Calthrop, in Braithwaite's Retrospect.. 
398
HEMORRHAGE. '
forces to complete the labor; and if dilatation of the os uteri pro-
gresses  and expulsive pains come on and increase, the case should be
left without further interference.   Should the os be dilating naturally
though  slowly, and the flow be great, the vagina may be  plugged if
medicine fails  to arrest the haemorrhage while the dilatation is com-
pleted.  Should the pains be feeble  and the os not dilating,  remedies
suited to the existing  condition in these respects must be selected-
remedies which will  render available such  desultory and inefficient
pains as may be present.
  If, however, the case is  such as to demand  prompt  delivery to
secure safety for the mother, and the os fails to dilate, Barnes' dilators
must be used for the purpose of effecting dilatation; and when that
has been sufficiently  accomplished labor may be  completed by the
long forceps, by podalic  version or  the bimanual mode of  turning,
according to circumstances.
  After the delivery of the foetus, which  is  generally born dead in
consequence of the collapse  of the mother, the placenta usually comes
away as in ordinary cases; if it does not, the course of treatment to
be pursued  will be similar to that  laid down for retained  placenta
under other circumstances.
  The  after-treatment of the woman must  be conducted with the
utmost  care, in order to  secure a reaction of the vital forces.  The
remedy  homoeopathic  to her deplorable  condition should be chosen,
and such a remedy may be found in  China or some other medicament
mentioned  hereafter.

      Unavoidable Hemorrhage—Placenta Previa.
  Placenta praevia occurs  when the ovule has descended after concep-
tion, and has become  fixed to some spot  in  the lower part or cervical
region of the uterus, so that the placenta becomes developed very near
the internal os, overlaps a portion of  it, or covers it completely, centre
for centre.   Such malposition of the placenta is by no means of fre-
quent occurrence, happening about once out of every five hundred cases.
  In cases  where the placenta is thus misplaced, it is obvious that, as
the uterus develops from above downward to the internal os, the dis-
proportion between the rapidly developing placenta and the  slowly
developing  cervical  region must become  greater  and greater, and
about the  sixth month it is  very considerable: hence a rupture or de-
tachment usually takes place at this period of pregnancy, and haemor-
rhage—unavoidable haemorrhage—occurs,  more or  less abundantly,
and is repeated from time to time. 
       rxavoidable hemorrhage—placenta previa.    399

   In explanation of the phenomena which occur  in cases of praevial
 implantation of the placenta, Dr. Robert Barnes writes thus lucidly:
 " The inner surface of the uterus may be divided into three zones or
 regions  by two latitudinal circles.   The upper circle may be  called
 the upper polar circle.  Above this is the fundus of the uterus.   This
 is the seat of fundal  placenta, the  most natural position.   It  is the
 zone or region of safe attachment.  The lower circle  is the  lower
 polar circle.   It divides the cervical zone or region from  the  merid-
 ional zone.   The meridional space  comprised between the two circles
 is the region of lateral  placenta.  This placenta is not liable to pre-
 vious detachments.  Attachment here may, however,  cause  obliquity
 of the uterus, oblique position of the child, lingering labor, and dis-
 pose to retention of the placenta and post-partum haemorrhage.
   " Below the lower circle is the cervical zone, the region of danger-
 ous placental attachment.   All placenta fixed here, whether  it consist
 in a flap encroaching  downward from the meridional zone, or whether
 it be the entire placenta, is liable to previous detachment. The mouth
 of the womb must open  to  give passage to  the  child.  This  open-
 ing, which implies retraction or shortening  of the cervical zone, is
 incompatible with  the  preservation of the adhesion  of the placenta
 within its scope.   In  every  other part of  the  womb there  is an
 easy relation between the  contractile limits  of the muscular  structure
 and that of the cohering placenta.   Within the cervical region this
 relation is lost.  The diminution in surface  of the uterine tissue is
 in excess.
   " The lower polar circle is, then,  the physiological line of  demarca-
 tion between  praevial and lateral placenta.   It is  the boundary-line
 below wliich you have spontaneous  placental detachment and haemor-
 rhage; above  which,  spontaneous placental detachment and haemor-
 rhage cease."
   Haemorrhage seldom occurs until after the sixth month, and then
 comes on suddenly, without admonition or apparent provoking cause.
 The flow may commence  while  the woman is  sleeping, sitting at her
 sewung, at the  piano,  or elsewhere,  and will as  suddenly cease.  The
 first haemorrhage is not apt to be so profuse as subsequent attacks, and
 as a general rule  the nearer the woman is to  full term the greater
 will be the discharge.  " The suddenness of the attack, the profuse-
 ness of the discharge, and its coming on without any evident cause,
are peculiarly suspicious."  In  a longer or shorter period  after the
first attack the haemorrhage is repeated, and is liable to become more
and more profuse  at every attack;  for the disprojiortion between the 
400
HEMORRHAGE.
 placenta and the development of the lower segment of the uterus be-
 comes greater and greater as the time for delivery approaches.
   When these haemorrhages occur prior to the eighth month, and sub-'
 side spontaneously without bringing on labor or doing serious damage
 to the system of the mother, the best treatment is to keep the patient
 as quiet as possible  and to prescribe such  medicines as seem to be in-
 dicated by her symptoms.  This course may be pursued from time to
 time till the arrest of the haemorrhage or the prevention of labor seems
 no longer possible.  Indeed, if from the first the haemorrhage is great,
 and the mother  is reduced to so miserable a condition that it would
 seem unadvisable and almost impossible for  her  to go to  full term,
 labor may be induced as the best procedure.
   " It may be laid  down as a rule of general application, and one
 which ought to be  rigidly observed,  that, no  matter what the period
 of gestation, any large loss of blood demands  the termination of preg-
 nancy ; for to leave a patient to be subjected to another attack, coming
 on, as  it would do,  without any warning, is in truth to place her life
 in imminent danger.  The only justifiable ground  for a temporizing
 policy is the concurrence of  the following conditions—that the dis-
 charge  is slight, the period of pregnancy short  of six  months, the
 absence of pain, and an undilated os.   If, on the  contrary, the dis-
 charge  is excessive, that  alone justifies  interference;  and if at the
 same time there is pain, the result of uterine contraction, and the os
 is beginning to dilate, so much the better, as  the  chance of a speedy
 delivery is greater;  but if the two latter conditions are not present,
 the chief object of our treatment will be to secure them."—Meadows.
  On making an examination  per vaginam, the finger passed into the
 open os will detect the presence of a thick, soft, spongy mass, having
 the feel of  a clot of blood, but with more firmness and consistence,
 quite unlike the  smooth surface of the membranes, and blocking up
 the entrance to the uterus.   It may be judged that the placenta in
 such a case is  centrally implanted over the os  uteri.  If the placenta
 but partially  cover  the os uteri, then  only one  lip or side will be
 thickened; and the  condition will  be shown by the inability to carry
 the finger up within  the uterus on that side, and by the ability to carry
 it up on the other side, and to feel there the smooth membranes or the
 presenting part of the child.   If labor has set in, and there are pains,
 the haemorrhage will always be worse during the pains, and will lessen
 or cease when they subside.  The cause of this circumstance is as fol-
 lows : The object of the pain,  or contraction of the uterus, is to dilate
the os, so as to complete the  first stage of labor; and of course the 
      UNAVOIDABLE HEMORRHAGE—PLACENTA PREVIA.    401

more the os dilates the more its adhesions with the placenta will  be
broken up; and as it cannot expel a bag of  membrane full of water,
so the greater the pains  the greater the haemorrhage during their
continuance.
  By far the best method  of  treating such  cases—of lessening the
haemorrhage and causing it to cease, of securing uterine contractions,
and of bringing about dilatation of the os uteri—consists, in my opin-
ion, in puncturing the membranes through the placenta and evacuating
the liquor amnii.   By this means the bulk of the uterus is lessened ; it
contracts upon itself,  and the haemorrhage is  controlled.   As the con-
tractions take place, the os js dilated without tearing up the adhesions
of the placenta.  And as dilatation is effected  the placenta separates
between  its cotyledons, and the presenting portion of the child is per-
mitted to  pass  through it.   The placenta itself  is finally delivered
after the birth of the child,  as in ordinary cases.
  The method of operating is as follows: The finger  must explore a
sulcus between the cotyledons of the placenta, and  with the same hand
a female catheter, previously concealed in the palm,  must be forced
through  the placenta  and the membranes during a pain.   The liquor
amnii now passes off freely through  the catheter; the bulk of the uterus
begins at once to shrink and the haemorrhage ceases.   The finger may
be used  instead  of a  catheter, but  much care is needed in this event,
in order  that the waters do  not discharge themselves too rapidly, and
thus produce  atony from too sudden relief, for  then the haemorrhage
would not  cease.  The liquor  amnii  must  drain off slowly;
and as surely as it thus flows, so  surely will the haemorrhage cease.
After the waters have pretty much escaped, the finger  may take the
place of  the catheter and aid in tearing the orifice larger, so that the
presenting  part can descend.  Should the presenting part be the head,
which is not always the case, its engagement in the os acts as a plug
against any possible flow of blood, and  gives further security if any
is needed.   If  the shoulder is  found presenting, or there be any
other malpresentation, the case must then be  treated in accordance
with the directions laid down for  such cases occurring  under other
circumstances.
  I have not heard of a single case of loss of the mother where this
method of procedure has been  followed, and the child is almost in-
variably saved.   It must be remembered to evacuate the liquor amnii
very slowly.  Every  accoucheur knows what bad effects follow the
emptying of the uterus rapidly under such circumstances : the atony
thereby produced is more to be dreaded than the former state.  V\'hen
        26 
402
HEMORRHAGE.
 the placenta is only partially over the os, even if it be but the ed^e of
 it, the same principle and practice hold good.
   Almost invariably after  placenta praevia has been thus  treated the
 os uteri dilates in a natural manner, until it is sufficiently  enlarged to
 admit of  the  passage of the child.  Should, however, a case occur in
 which dilatation does not take place, Barnes' dilators may be used to
 effect dilatation, provided  the  homoeopathic remedy carefully chosen
 fails of its purpose.
   Some obstetricians  have recommended, in cases of placenta praevia,
 that the hand be insinuated between the placenta and the uterus, the
 membranes reached and  penetrated, and the child delivered by turn-
 ing.  This is especially taught in  cases where  the placenta is placed
 centrally over the os.  The suffering entailed upon the woman by this
 method, and the very great mortality of both  mothers and children
 following its practice, sufficiently condemn it.
   Another plan  of treatment has been recommended, especially by
 Sir James Simpson—namely, that of separating the placenta from the
 uterus entirely, and then trusting the case to nature.  This procedure
 doubtless  was suggested by the fact that in cases of placenta praevia,
 where the placenta was spontaneously cast off and expelled previous
 to the expulsion of the child, the rate of mortality of mothers and
 children was  less than  under  the ordinary methods resorted to by
 accoucheurs.   In regard  to  this  method Dr.  Robert Barnes  very
 justly remarks  as follows: " But it  is contended that clinical ob-
 servations prove that haemorrhage has stopped on the total detach-
 ment of the placenta.   These observations are partly true, partly fal-
 lacious.   The true observations are  those in which the placenta has
 been spontaneously cast off and expelled before the birth of the child.
 These cases are  not numerous.  They do  not justify the  conclusion
 drawn,  that the  artificial  total  detachment of  the placenta will be
 equally followed  by arrest of haemorrhage.   There is a fundamental
 physiological  distinction between the two cases.  When the placenta
 is cast off spontaneously, it is because the uterus contracts powerfully.
This  contraction stops the  bleeding.   When the placenta is detached
artificially, there  may be, and  probably is, defective uterine contrac-
 tion.   The bleeding will be likely to continue.  There is no inde-
pendent virtue in the mere detachment of the placenta, as post-partum
haemorrhage abundantly proves."
  Dr. Barnes offers a modification of Simpson's plan, which consists
in  separating  from the uterus  as  much of the placenta as adheres
 within the orificial or cervical zone, and no more.  He directs that one 
                  POST-PARTUM HEMORRHAGE.               403

 or two fingers be passed within the os uteri and swept round in a cir-
 cle, so as to separate the placenta from the uterus as  far as the finger
 can reach.  " Commonly," he says, " some amount of retraction of the
 cervix takes place after this operation, and often the hcemorrhage ceases.
 You have gained time.  You have given the patient the precious op-
 portunity of rallying from the shock of previous loss, and of gather-
 ing up strength for further proceedings."  Notwithstanding, however,
 the dictum of so eminent an authority, I am still  fully persuaded that
 the puncture of the  membranes  and the gradual evacuation  of the
 liquor amnii, as directed, is altogether the best method  of treatment
 for cases of placenta praevia.

               ' Post-Partum Hemorrhage.
   Haemorrhage following  the delivery of the child  may occur either
 before or after the delivery of the  placenta.  In the natural  course
 of labor the child is delivered, while the placenta still retains more  or
 less perfectly its connection with the uterus.   In  such cases little  or
 no haemorrhage takes  place up to this time.   But with the first pains
 which occur after the expulsion of  the  child  from  the  uterus the
 placenta begins to separate from  its  adhesion to the uterine parietes;
 and from  this moment until the uterus has considerably contracted
 upon  itself after the discharge of the placental  mass  there is some-
 times  considerable loss of blood, sometimes almost none at all.  Where
 all  goes well, and the  placenta is delivered, as  it usually  is,  within
 fifteen or twenty minutes after the birth of the child, the haemorrhage
 that does  take place proves  beneficial  rather than  injurious  to the
 mother, by relieving the engorgement of the  uterus and  enabling the
 system in general more readily to adapt itself to the  new condition.
 But just in proportion as this haemorrhage becomes prolonged, it be-
 comes more and more dangerous, whether it arise from causes which
 hinder the progress of the labor in the first instance, or prevent the
 subsequent contraction of the uterine parietes.  Hence, in order to be
 able intelligently to employ the requisite means, it is absolutely essen-
 tial to learn what are the efficient causes of the flooding in each indi-
 vidual case.   This knowledge is to be obtained from the history of
 the case, from  the conditions and symptoms obviously  present, and
 from digital examination.
  If the haemorrhage be due to retention of the placenta, and the re-
tention of  the placenta be  due to a want of tonicity of the uterus, in
consequence of which it fails to contract, to close the mouths of the ute-
rine sinuses and to expel its contents, the remedy appropriate to the con- 
404
HEMORRHAGE.
dition should be chosen and administered; and if the placenta is de-
tached and lying within the uterus, it should be removed, as directed
on page 201  of  this work.   From the list of remedies mentioned at
the conclusion of this chapter the appropriate medicament may be
selected.   If, however, the  placenta  is adherent, and  does not come
away after a  reasonable lapse of time and the administration of such
remedies as  Pulsatilla, Caulophyllum or Secale, which have a tend-
ency to excite uterine contractions, or if  haemorrhage should occur in
consequence of the adherence of more or less of the placental mass, the
hand must be introduced within the uterus, and  the placenta must be
carefully and guardedly peeled from its  attachments,  in the manner
directed on page 202, care being taken that neither too much nor too
little is done, that the uterus is not injured by the fingers of the ac-
coucheur, and on the other  hand that no  portions of the placenta are
left behind, to occasion subsequent haemorrhage or oozing of blood,
septicaemia or other troubles.   When the attempt is made to  detach
an adherent placenta in this manner, while the right hand of the ac-
coucheur is engaged within  the uterus the left hand should be placed
over the fundus uteri, to steady that organ in  its place;  and  as the
right hand and  the placenta are withdrawn, firm compression should
be made with the left, following down the retreating uterus, to secure
its  complete and  tonic contraction.  If  this is skillfully done the
haemorrhage  will cease.
  " You may suspect morbid adhesion  if there have been unusual
difficulty in removing  the placenta in previous  labors ;  if, during the
third stage, the  uterus contract  at intervals firmly, each  contraction
being accompanied  by blood, and yet, on following up the cord, you
feel the placenta still in utero; if, on pulling on the cord, two fingers
being pressed into the  placenta at the root, you feel the placenta and
uterus descend in one  mass, a sense of dragging pain being elicited;
if, during a pain, the uterine tumor  do not present a globular form,
but be more prominent than usual at the place of placental attach-
ment."
  The other  form of post-partum haemorrhage, occurring after the de-
livery of the placenta, is frequently  very alarming, and may even be
followed by a fatal  termination.  It is due to atony and relaxation of
the uterus, whereby the mouths of the utero-placental sinuses remain
open and pour forth a flood of blood, which continues until firm ute-
rine contraction is  secured.   Sometimes  this comes on  immediately
after  the  delivery  of  the placenta, and  continues without cessation
until arrested by appropriate treatment.  At other times it comes on 
POST-PARTUM HEMORRHAGE.
405
more insidiously;  the uterus contracts apparently well after the deliv-
ery of the placenta, and is found as a hard ball above the pubes, when
suddenly the attention  of the accoucheur is attracted by the woman
declaring that she is flooding, or he sees by her countenance that her
life-blood is wasting.   The  hand  placed on  the  abdomen discovers
the uterus distended and relaxed, high up in the abdomen and tender
of pressure; and  an examination  per vaginam discovers  a more or
less copious flow of liquid  blood,  and  perhaps the vagina, and  even
the uterus, filled with clots.
   It is evident that prompt and  efficient measures are necessary in a
case  like this,  not only with the  view  of  saving  life, but with the
view also of saving blood, for ft a pint of blood saved, and a pint of
blood lost to the patient, may make all the  difference between a rapid
and a tedious convalescence—may make all the difference  between a
successful and  a  fatal issue."  The most prompt  and most efficient
measure in such cases, according to my experience  and that of a very
large  number  of  able homoeopathic practitioners, is, to  apply that
remedy which  is  homoeopathic to the totality of the case.   This can
be done as quickly as can  any other procedure, and will be found
efficient even in  those cases where  the blood flows pleno rivo  and
threatens almost  immediate dissolution.  The remedies appropriate
for such occasions will be found laid down, with their indications, at
the end of this chapter; and let me here remark that  every  practi-
tioner should be as familiar with these indications as with  the alpha-
bet, and being so he will stand  prepared in such emergencies with an
armamentarium equal to the vanquishing of  the most dangerous and
desperate cases.
   It has been  recommended to give brandy in unsparing  doses, but
this I regard as unnecessary.  The pillow should be removed from
beneath the woman's head, and the foot of the bedstead may be elevated
a few inches higher than the upper part.  Vomiting is not an unfavor-
able indication, as it may excite uterine contraction; but if it  occurs,
the woman's head should not be raised, but merely turned to one side.
   Firm pressure  or grasping with  the hand upon  the womb is com-
mended as  a method  of inducing contraction, and no  doubt it  is a
measure of very great efficacy; but  since the  haemorrhage  can be
arrested by the administration  of homoeopathic  medicines alone,  it
may be regarded  as unnecessary to thus compress the tender womb,
and perhaps thereby give rise to serious and even dangerous after-
effects.
  The use of cold or  hot water  injections, pieces of ice  within the 
406                      HEMORRHAGE.
vagina and uterus, pouring  cold or hot water from a height upon the
abdomen, colpeurysis, and  other similar measures  for arresting the
haemorrhage, all of which are recommended by old-school authorities
are doubtless of more or less efficiency; and the homoeopathic prac-
titioner would be justified in their use if the similar remedies failed to
produce a prompt and satisfactory arrest of the flooding; but these
do  not  fail  when intelligently selected and  applied, and a resort to
them is avoided and a reliance on them condemned, a priori, by those
only who have more faith  in  the above-mentioned appliances, or
rather  whose faith  in the law of cure becomes faint when they are
in the presence of a bad case of post-partum haemorrhage.

             Remedies for Uterine Hemorrhage.
  The medicines here mentioned are those most commonly indicated
in cases of uterine haemorrhage, whether occurring before, during or
after parturition, or during the non-pregnant period.   Special  indica-
tions, however, are given for the remedies useful in cases of threatened
Abortion under the article on that subject, as well as for cases of ex-
cessive menstruation under the article on Menorrhagia.   The  practi-
tioner will do  well to refer to these indications in connection  with
those given below.  It is recommended that the  indications for the
remedies appropriate to all these forms of flooding  be very carefully
studied, that  they may be indelibly impressed upon the memory and
ready for instant use at the bedside.

  1. Bell., Calc. c, Cauloph., Chin., Ferr., Ipec, Nux v., Sabin.
  2. Bry., Cham.,  Croc, Erig., Hamam.,  Hyos., Lye, Merc, sol.,
Nitr. ac, Phos., Puis., Sec. corn., Sep., Stram., Sulph., Trill.
   3. Aeon., Ant. cr., Amm. c, Apis, Apocyn. c, Arg. n., Ars., Canth.,
Carb. veg., Coff., lod., Nux m., Plat., Sang., Sil., Sulph. ac.

  Aconite. In active  haemorrhage, with fear of death and much ex-
citability.  She cannot sit up even in her bed.  She seems so giddy
she falls  over.   Particularly suitable  to  women of full,  plethoric
habit.
  Antimonium crud. Uterine  haemorrhage, with a distinct pressure in
the womb as if something  would  come out.   Somewhat rheumatic.
White tongue.   Nausea and vomiting.
  Apis. Profuse uterine haemorrhage, with heaviness in the abdomen;
faintness. Great uneasiness and yawning.   Red spots like bee-stings 
REMEDIES for uterine  hemorrhage.          407
upon the skin, and sensation as if stung by bees in the abdomen and
in different parts of the body.
  Apocynum  cann. There  is  great  irritability of  the  stomach and
vomiting; the blood  is expelled in large clots, sometimes, however,
in a fluid state;  the vital  powers are much depressed, and there is a
disposition to faint.
  Argentum nit. Much trouble in  the  head; confusion, dullness and
much pain, greatly aggravated by the least movement.  A short time
seems very long to her, and everything done  for  her seems done  so
very slowly.   She has, for instance, been  flowing an hour, and to her
it seems hours;  we work rapidly for her safety, and she thinks we are
very slow.  Belching wind affords marked relief.
  Arnica m. In cases  from a fall, a shock to the system or a concus-
sion.  Blood bright red or mixed with clots.   Nausea  in  the pit  of
the stomach.   Warmth about the head and the extremities cool.
  Arsenicum. Haemorrhage, with lancinating burning pains; in low
states of the  system,  when aphthae appear.
  Belladonna. Profuse discharge of bright red, hot blood, with press-
ing  or forcing  (outward) as if  all would escape  the vulva,  or pain
in the back  as  if it  Avould break.   The  blood sometimes has  a bad
smell.  Sometimes a vascular excitement prevails; throbbing of the
carotids; flushed face, red  eyes and full, bounding pulse.   This remedy
is very frequently indicated in uterine haemorrhage, particularly in that
occurring after labor.
  Bryonia. Haemorrhage of dark red blood, with pain in the small  of
the back, and headache as if it would split.   Dry mouth and lips.
Nausea and  faintness on sitting up in bed, or even on raising the
head from the pillow.
  Calcarea carb.  The  history of the case  shows that she has always
menstruated  too often, too  much and  too long.   Leucophlegmatic
constitution.  Cold, damp feet.   Swelling at the  pit of the stomach,
like a saucer bottom up.  Vertigo on stooping; worse on rising again
or going up stairs.
  Cantharis.  Uterine  haemorrhage,  with  great irritation in the neck
of the  bladder.   Urinating often, smarting, cutting  and burning in
passing only  a few drops.
  Carbo veg. Passive metrorrhagia, with  much itching of the  vulva
and anus.  She  wishes to be fanned very  hard.
  Caulophyllum.  Haemorrhage occurring  after  labor,  especially  hasty
labor;  the flow  is very profuse,  and is  due to a want of tonicity of the
womb, which is relaxed and contracts very feebly. 
408
HEMORRHAGE.
   Chamomilla. Metrorrhagia  of dark,  coagulated blood, with tearing
 pains in the legs and violent labor-pains in the uterus.   Haemorrhage
 of dark blood, with pressure toward the uterus and  frequent discharge
 of colorless urine.   Great irascibility and of  spiteful speech.
   China.  Haemorrhage from the abuse  of Chamomilla.   Haemorrhage
 from atony of the uterus.   Discharge of clots of dark blood.  Uterine
 spasms.   Desire to urinate.  Colic.  Also after miscarriage or hibor, or
 at any other time when there has  been  much  loss of blood.  Coldness
 and blueness of the skin.  Twitching and jerking  of single  muscles.
 Heaviness of the head, ringing in the cars, loss of sight, and fainting.
 In the most desperate cases of this type China will  be found of very
 great service.  A dose in water every three or five minutes.
   Coffea.  Haemorrhage, with excessive  sensitiveness  of the organs and
 voluptuous itching; she  would like to scratch, but there is too great
 sensibility.
   Creosotirm. Discharge of a large  quantity of dark blood;  then for
 a  few  days  bloody ichor with pungent odor, corrosive itching and
 smarting of the parts;  then the discharge recommences and the same
 phenomena occur again.
   Crocus. Frequently called for after  miscarriage  or  labor,  or after
 dancing or a long  walk during the catamenia, with or without pain,
 when there is a discharge of a dark, stringy blood; it comes away in
 dark or black strings.   Often there is a sense  of rolling and bounding
 in the abdomen or in the stomach.  Violent cephalic throbbings.
   Ferrum.  After parturition or miscarriage a frequent discharge of
 partly  fluid  and partly black clotted  blood,  with  violent labor-like
 pains, full, hard pulse and  frequent short shudderings; headache and
 vertigo; constipation and hot urine.  Fiery-red face.
   Hamamelis. In uterine haemorrhage occurring at any time, where the
 flow is steady and slow; the blood is  dark-colored, and there are no
 uterine  pains.
   Helonias.  Flooding on  lifting a weight and on the  least exertion.
 Face sallow, having an expression of suffering.  Menses too frequent,
 too abundant;  pain  from the back to the uterus.
   Hyoscyamus. Haemorrhage  after accouchement, miscarriage,  or at
 any  time when there  are general spasms of the whole body,  inter-
rupted by jerks or by twitching of single limbs; the bright-red blood
continuing to flow all the time.
   Ignatia.  Haemorrhage after the abuse of Chamomilla.   Heavy sigh-
 ing and sobbing, with empty feeling at  the pit of the stomach.   Great
 despondency. 
REMEDIES  FOR  UTERINE HEMORRHAGE.          409
  Iodium. Uterine haemorrhage occurring at every stool, with cutting
in the abdomen, pains in the loins and small of the back.
  Ipecacuanha.  Constant flow of bright-red blood, with cutting about
the umbilicus, constant nausea and vomiting.  The woman feels  cold
and is very pale; complains of dizziness and headache.   Very fre-
quently used after parturition or miscarriage.
  Lachesis. Pain in  the right  ovarian  region, increasing more and
more until relieved by a discharge of blood.
  Lycopodium.  Haemorrhage, with cutting pain  across the abdomen
from right to  left.   Great fermentation in the abdomen, with much
flatulence.  Sensation as if " full up to the  throat."   A rumbling
begins in upper part of the abdomen,  and descends  to  lower part,
when a flow of blood follows, and so on successively.
  Mercurius S. Metrorrhagia in aged  females, scorbutic gums, saliva-
tion.  Mucous or muco-sanguiiiolent stools, with tenesmus.
  Nitric acid. After miscarriage or confinement, with violent pressure
as if everything were coming out at the vulva; with pain in the small
of the back, through the hips and down the thighs.
  Nux mosch. Thick and dark blood ; intolerable dryness of mouth and
tongue; tongue so dry it sticks to the palate;  fainting; sleepiness.
  Nux vomica. Metrorrhagia as a precursor of the critical age;  also
after parturition, if  there be constipation of large,  difficult stools, or
frequent call to stool, with small and painful stools, or without result.
She leads a sedentary life, drinks much  coffee, wine or other liquors,
and lives on highly-seasoned food.   She is dyspeptic, and cannot sleep
after three or four a. m.  Frightful dreams; does not sleep well.
  Phosphorus.  After difficult labor, between  the  monthly periods, or
during pregnancy.   Particularly in tall and slim women.  Weak and
empty feeling across the abdomen.   Constipation of narrow, dry, dif-
ficult stools.   Much  belching of wind after eating.  Feeling of intense
heat running up the back.
  Platina. Metrorrhagia of dark, thick blood, with pain in the small
of the back, which penetrates  into both groins, with  excessive sensi-
tiveness  of the genital organs.  Metrorrhagia, with the sensation as
if the body were growing  larger  in every direction.  Haemorrhage
during pregnancy.   Horrifying thoughts.
  Pulsatilla.  Metrorrhagia,  profuse  at times, at other  times intermit-
ting and mixed with clots—most profuse in persons given to reveries.
Also at the critical age.  In women of mild, tearful temperament.
  Rhus tox. Metrorrhagia in pregnant women of a rheumatic diathe-
sis, worse on change of weather. 
410                       HEMORRHAGE.
    Sabina.  Haemorrhage at the menstrual periods, after miscarriage,
  after parturition.   The blood is  dark, having blackish clots mixed
  with thin, watery blood.  The pain extends  from the back  through
  to the  pubes.  Atony of  the  uterus.  Painless loss of  dark-red
  blood immediately after delivery.   Sabina is used next in frequency
  to Ipecac  Discharge of fluids and clots  with each pain.
    Secale corn.  Passive* haemorrhage of very fetid or dark blood.  Sal-
  low face.  General debility, insensibility and  feverish pulse.   Passive
  haemorrhage  in feeble, cachectic women, particularly when the weak-
  ness is not caused by previous  loss of fluids.  Haemorrhage, with strong
  and spasmodic contraction of the uterus, every flow being preceded by
  such contraction or by strong bearing-down pains.  Haemorrhage from
  atony of the  uterus, especially after protracted labor.   The  patient
  is prostrated, cold and with pinched face; although cold, she does not
  wish to be covered.
    Sepia. Chronic  metrorrhagia,  when  it  is  excited from the least
  cause.   She has yellow spots  on the face, and a yellow saddle across
  the  bridge of the  nose.  She has icy cold paroxysms, icy cold  feet,
  and has flushes of heat.   Painful sense of emptiness at the pit of the
*  stomach.  Urine fetid; it has a sediment as  if clay were burned on
  the  bottom  of the vessel.   Constipation.  Stools mixed with mucus.
  Sense of weight in the anus.
    Silicia.  Metrorrhagia, with  terribly offensive sweating of the  feet.
  Constipation,  of difficult lumps, which  the  rectum has  not action
  enough to expel, and  which sometimes recede after being  partially
  expelled.
    Stramonium.  Metrorrhagia, with excessive loquacity, singing, prayers
  and praise.  Full of strange and absurd ideas.
    Sulphur. Chronic haemorrhage.  She seems  to get almost well, when
  it occurs again and again, day after day, for weeks.  She is weak; has
  weak and fainting spells, flushes of heat,  heat on the top of the head,
  and cold feet.   Sleep very light; often gets awrake, wide awake. Feels
  very weak in the morning ;  gets  hungry  spells, when she cannot wait
  for her  food, especially for her dinner.
    Sulph. acid.  Metrorrhagia, with tremulous  sensation  in the whole
  body, without trembling.
    Trillium pend. Profuse flow of dark, thick  and clotted  blood, con-
  tinuing at intervals for several  days.   Suitable  for women who in-
  variably flood after parturition. 
PUERPERAL CONVULSIONS.
411
                      CHAPTER  XX.

                PUERPERAL  CONVULSIONS.

   THE convulsions which occur during  the first eight  months of
    pregnancy are usually hysterical, although in some persons  orig-
inally predisposed  or actually subject to  epileptic attacks, convul-
sions would be liable to appear during pregnancy, even in its earlier
stages, and they would of course partake of the same epileptic nature.
But in general only those convulsions which arise during the last
month, and especially during the last weeks of gestation, are allied to
epilepsy; and  they are properly  termed puerperal, because of  their
precise similarity in character to those which occur during labor and
after parturition.   Still, in common language all convulsions of preg-
nant women may  be termed  puerperal, whether they appear in the
earlier or in the later stage of gestation, during labor or subsequently.
And in fact such convulsions may arise in all  these various conditions
of the same individual.   The hysterical form of convulsions appear-
ing in persons of a nervous or  hysterical  constitution may be consid-
ered rather as an  aggravated  kind of hysteria, and studied in the
article on that disorder.   In the present section we shall  have refer-
ence rather to the so-called epileptic form of convulsions, or the true
puerperal eclampsia—to  those which  precede, accompany or  succeed
labor,  and shall consider their causes, symptoms and treatment
   Causes.-—The causes of puerperal convulsions may be  most conve-
niently studied by first dividing them  into two general  classes—the
Centric, or those which arise from direct irritation of the great nervous
centres; and Eccentric, or those which arise from more external influ-
ences affecting the extremities of the incident nerves and reflected back
upon the centres.
  The Centric  causes are either physical, acting  as material  irritants
of the nervous centres, or psychical, consisting  in mental emotions.
The physical causes may  be either intra-cranial,  such as act primarily
upon the brain and medulla oblongata, or they may be intra-vertebral,
acting upon the membranes of the spinal cord and  upon the substance
of the spinal centre itself.
  The most prominent of the physical intra-cranial causes consists in
that derangement of the sanguineous system incidental to many cases
of pregnancy, and  known by the old term of plethora.  " Pregnancy
is  usually and very justly considered a state of plethora;  and it may 
412                 PUERPERAL CONVULSIONS.
 be readily presumed that the balance of such plethora may determine
 toward the head, inasmuch as the great vessels of the abdomen must
 be supposed, during the latter weeks of gestation, to be liable to much
 impediment to their action from the pressure of the gravid uterus."—
 Davis. Any agent which, like a clot of blood,* serous effusion or full-
 ness of the  cerebral circulation, causes undue or unusual pressure on
 any part of the  brain, by causing also a  counter-pressure on the me-
 dulla oblongata, may  occasion convulsions.  And the derivation of
 the accustomed  pressure  on the brain and on the spinal cord must
 necessarily  be attended with  similar results.   Thus, cases  of  con-
 vulsions arise  either in plethoric conditions with red, bloated face and
 projecting eyes, or in anaemic conditions characterized  by  excessive
 pallor and debility.   In cases of excessive  and fatal uterine haemor-
 rhage, convulsions always appear before death from this very cause.
 The psychical  class of causes of convulsions  consists in sudden and vio-
 lent emotions  of fear, of joy or of grief,  or in deeper and more  pro-
 tracted influences, such as the  sense of  shame  inseparably connected
 in many instances with pregnancy in unmarried  females.
   The intra-vertebral causes of puerperal convulsions have reference
 either to the  quantity or to the quality of the blood.   Too large a
 quantity relatively, exerting an undue pressure upon the spinal cord
 —either directly or by means of serous effusion—may  give rise to
 puerperal convulsions; and  a similar result, as already stated, will
 follow the opposite or anaemic condition.  The abnormal  character of
 the blood itself may cause  convulsions.   This  may arise from defi-
 cient oxidation of this fluid, on account of the  hindrance to respira-
 tion due to the encroachment of the abdomen upon the thorax; from
 that state of the blood which corresponds to albuminuria; from a true
' toxaemia or  poisonous state of the blood, due to  its double function of
 eliminating  the debris of the fcetal as well as of the maternal system;
 and from the  fever connected with the first secretion of  milk.  Gen-
 erally speaking, '•' the immediate  causes of  puerperal convulsions are
 often  very obscure.  They appear sometimes to depend upon a loaded
 state of the  brain;  at other times the  brain appears to be influenced
 by some distant irritation, either in the  uterus  or  digestive organs;
 and again in some cases puerperal convulsions are induced apparently
 by a peculiar irritability of the nervous system.   It has been remarked
 that there has  been a greater disposition to puerperal convulsions in
 those  patients  who have been in early life subject to convulsive attacks.
 particularly of an epileptic character, and also in those who  have suf-
             * Komberg, Diseases of the Nervous System, ii., p. 188. 
                    PUERPERAL CONVULSIONS.                  413
                            >
 fered similarly  in  former labors, and have  omitted  those  measures
 usually employed as precautions."
   " A remarkable relation appears to exist between albuminuria  and
 dropsy and puerperal  convulsions, but how far these  two conditions
 are related as cause and effect it is difficult to determine.  Some sup-
 pose that the condition of the urine is simply the result of reflex irri-
 tation starting from the uterus, and that the convulsions are brought
 about in the  same way;  others believe that  the albuminuria  is the
 result merely of pressure on the kidney, and that the convulsions have
 no relation to this condition of the urine;  while others, again, regard
 both conditions as due to ' a pathological state of the blood, to the
 occurrence of which pregnancy may some way dispose/  It is very
 doubtful whether either of these opinions be true, while it is certain
 that albuminuria often exists without convulsions: I have  seen sev-
 eral cases of this kind myself.  On the other hand, convulsions may
 occur  without any preceding albuminuria.  The same may also be
 said in regard to anasarca, which has no  necessary connection  either
 with convulsions  or with albuminuria.  In cases where albuminuria
 exists the  urine  is  found  also  to   contain  less  than its normal
 amount  of urea, while the blood  has it in excess; hence it has been
 surmised that the convulsions resulted from the influence of the uraemic
 poisoning in the central nervous system. The German observers, Fre-
 richs and Lehmann, on the other hand, believe that it is not the urea
' itself, but its  decomposition in the blood,  and the formation there of
 carbonate of ammonia,  which  can undoubtedly be detected in the
 breath and perspiration, that is  the chief cause of the convulsion."—
 Meadows.
   The Eccentric  causes of puerperal convulsions consist in irritation
 of the  extremities of the incident nerves.   The  greatest and most
 frequent and important of all these are  found in direct irritation of
 the uterus itself and of the uterine passages.  This may be caused by
 the  pressure of the head or of any  other presenting  part  upon the
 incident spinal nerves of these organs.  In some excessively nervous
 or epileptic conditions, the convulsions may be brought on by the
 changes  of position of the foetus  in  the first stages of labor, by the
 irritation resulting from  over-distension of the uterus by  excessive
 quantity of liquor amnii, and by the presence of a dead foetus within
 the  womb.  The introduction of the hand into the uterus for the
 sake of  removing  an  adherent placenta has  sometimes immediately
 thrown  the  woman  into  convulsions.  The same result   may  also
 follow the irritation caused  by indurated faeces, by purgative medi- 
414                 PUERPERAL CONVULSIONS.
 cines, by irritability of the bladder,  the  stomach, and even of the
 mam nee.
   Symptoms.—The symptoms of puerperal convulsions may be  divi-
 ded into premonitory and actual symptoms.  And  by a careful atten-
 tion to the former, when they occur some  days  or  even weeks before
 labor, we may be able to avoid the frightful complication of convul-
 sions in child-bed.
   The premonitory or predisponent symptoms may sometimes consist
 in a sense of fullness in the head, even to  vertigo;  of intense pain in
 a part or in the whole of the head; confusion of the understanding;
 a sense of ringing and of other noises in the ears; temporary confu-
 sion or the loss of power of vision, and temporary abolition of the
 power of thought, and even of sensation.  For such symptoms, which
 may appear at any time in the later stages  of pregnancy, Dr. Davis
 recommends the  abstraction  of  blood, but a  no  less decided and
 much more beneficial result may  be secured  by the exhibition of the
 appropriate homoeopathic remedy.  For convulsions threatened  dur-
 ing labor the same  author  gives  the  following predisponent symp-
 toms :  an excited  state of the circulation;  a  gradual accession of
 cephalic  symptoms,  such as those  above enumerated, with  rigors,
 nausea,  and even  vomiting;  a great excitement  of the heart and
 arteries; immense irritation and  restlessness; a great development
 of heat, unaccompanied by  adequate moisture  on the surface of the
 body; unusual strength and fullness of the pulse; engorgement of
 the vascular structure of the face, producing much turgescence and
 flushing; an approach to or actual delirium; great  fullness and wild-
 ness of the  eyes, often accompanied by an expression of extreme dis-
 tress, or else of a  state approaching to fatuity; perception of scintil-
 lations of light or the fancied- presence of divers other bodies; and
 in  many cases a  sudden  seizure with violent pains in the abdo-
 men, differing in character from those of labor.  Severe pain in the
 stomach and an intense pain in the forehead have been mentioned as
 premonitory of the  worst kind  of cases of convulsions.  A tumid
 state of the hands  and face sometimes precedes an attack ; a dropsical
 swelling of  the face  alone, or face and  upper extremities, is not un-
 commonly followed by  convulsions, and if the urine is at the same
time albuminous this condition should excite strong apprehension of
such a catastrophe.   Sometimes,  however, there are no  precursory
symptoms;  and  however similar  such attacks may be to  epilepsy,
they differ fiom this  disorder in seldom or never being preceded by
 the aura epileptica. 
PUERPERAL CONVULSIONS.
415
   The actual symptoms of puerperal convulsions are indeed scarcely
 to be distinguished from those common to epilepsy itself.  They are
 thus described by Churchill:  " During  the attack the face is swollen,
 of a dark red or violet color, and distorted by spasmodic contractions;
 the eyes are agitated, the tongue protruded, and the under jaw re-
 peatedly closed with force, so as to wound the tongue.  A quantity
 of froth is ejected from  the  mouth, which is generally drawn more
 to one side of the face  than to the  other.  The muscles of the body
 are thrown into violent and irregular action; the limbs are jerked in
 all directions,  and with  such force  that  it is  sometimes difficult to
 keep  the patient  in  bed.   The respiration is  at first  irregular, and
 being forced through the closed teeth and the foam at the mouth, has
 a peculiar  hissing sound ; it subsequently becomes nearly suspended.
 The pulse is quick, and at the beginning full and hard, but afterward
 small and  imperceptible.   The body participates in the purple color
 of the face.  The  urine and faeces are often passed  involuntarily.  This
 terrible paroxysm, however, is not  of very long duration.  After  a
 period varying from five  minutes  to  half an hour, the convulsive
 movements become less violent, and gradually subside;  the counte-
 nance is less distorted, and assumes a more natural and placid appear-
 ance ; the eyelids  close, the respiration becomes more regular, though
 still sibilant, and  the circulation is restored, the pulse becoming more
 perceptible, though still  very  weak; the patient  rests quietly in bed,
 and the paroxysm has terminated for the time.
   " During the interval the patient's condition is very variable.  She
 may partially recover consciousness, so as  to recognize persons around
 her, and to be aware of something  extraordinary having happened,
 without knowing what, and  without being  able to express herself
 clearly.  In other cases the return of intelligence (without recollection)
 may be complete until the approach of the next fit, accompanied with
 great weakness, headache and  confusion.  In the more unfavorable
 cases  the patients  remain in a state of total  insensibility, almost ap-
 proaching to coma or asphyxia, with sibilant or stertorous breathing,
 and without muscular motion, or with a restless throwing about of the
 body  and extremities.  The calm is, however, of no very long dura-
 tion;  it may be half an  hour  or two hours, but sooner or later the
 paroxysms return, to be  succeeded  by an interval, which in its turn
 gives place to a paroxysm."
  Under the head- of eclampsia parturientium, puerperal convulsions
are thus described  by Romberg: *  The  convulsions coming  under
               * Diseases of the Nervous System, ii., p. 187. 
416
PUERPERAL  CONVULSIONS.
 this denomination break out suddenly, and the patient is at once de-
 prived of consciousness.  The face and neck swell  and become red
 and livid.   The carotid and temporal arteries pulsate violently, and
 the jugular veins swell; the eyelids  are  distended,  the eyeballs are
 elevated, or stare rigidly, and their vessels are congested, or they roll
 about under the closed eyelids.  The tongue projects and is bitten bv
 the grinding teeth, causing  it to  bleed, and bloody froth issues from
 the  mouth.  The  facial muscles twitch, the  limbs are curved or
 stretched, and again contract with  lightning-like rapidity.  The whole
 trunk is at one  time  rigid,  immovable, drawn backward to one side;
 the next moment it is  thrown about  by twitchings  and convulsions
 so violent  that  the patient  can scarcely be restrained.   The muscles
 of respiration, and especially the diaphragm, are implicated; there is
 danger  of suffocation.   Vomiting supervenes, and urine and excre-
 ments escape involuntarily.   The  temperature is raised, the face drops
 with perspiration.  The pulse is  very frequent,  full and  strong, or
 weak and hard.   The abdomen is tympanitic; the uterus is hard, and
 this hardness increases as often as  convulsions are renewed.
  These attacks are  more apt to  occur in primiparae, although they
 are by no means confined to them.  Some  women even have the mis-
 fortune to be seized with them at each succeeding pregnancy; in such
 cases they are very apt to result in premature  delivery.  In different
 individuals these attacks terminate differently : some remain in a state
 of half stupor and great exhaustion for hours or days, and  gradually
 recover; others  become maniacal,  and may even remain so for a long
 time, and eventually recover.   In some cases  the patient continues
 comatose, gradually passes into a state resembling apoplexy, and dies.
 In these cases the danger is  said to be greater during the last months
 of pregnancy than during and after parturition.   When the  convul-
 sions are  originally associated with  profound  sopor and  stertorous
 breathing, they are  said to  prove almost  invariably fatal under the
 old-school  treatment.   Plethoric  and  robust women are in greater
 danger  than weak and  hysterical  subjects.  And when  the  interva's
are very short between the paroxysms, or become imperceptible, death
 is at hand.
  Dr. Hodge * states  that " after much anxious experience and reflec-
tion it  is evident to my mind  that there is no essential  pathological
difference between the usual form  of puerperal convulsions  and those
which occur in the non-parturient state in  hysterical women.  I have
seen so many cases in  the  latter  precisely similar, as  regards their
                   * Diseases Peculiar to Women, p. 126. 
PUERPERAL  CONVULSIONS.
417
 phenomena at the time and after the attack, to those of the former,
 and so many of the puerperal form resembling those of the hysteric
 as to the precursory, attendant and consecutive symptoms, that I must
 believe that pathologically they are virtually the same.  The only real
 difference is the degree of congestion, this being comparatively trifling
 in the unimpregnated  state,  very great during  gestation,  and  still
 more so during labor.  The engorgement in this  case arises from the
 almost universal plethoric state of pregnant women, which during
 labor is enhanced, particularly as regards the brain, by the " pains "
 and the bearing-down efforts ; these include, of course, the holding of
 the breath, the temporary suspension of respiration, and the  conse-
 quent passive congestion  in  the lungs, right  side of the heart, the
 brain, etc.  Hence the danger and fatality of puerperal convulsions.
 The original nervous irritation  is aggravated  by this congestion, so
 that effusion  of serum or blood may ensue, and the patient become
 comatose and die."
  When this affection appears in  the last  months of pregnancy the
.infant'almost always  perishes, but  it may be saved when the convul-
 sions appear  during  parturition;  in these  cases  the fits will usually
 be found synchronous with the uterine contraction—that is, each pain
 is attended by a convulsion.   But if there have been no pains  before
 the fits come on, the os uteri most frequently  begins to dilate in ali
 cases of puerperal convulsions of this kind—that is, during parturi-
 tion: the condition of the os uteri,  as dilated,  dilating or as rigid, will
 afford important indications as to  the course to be pursued and the
 remedies to  be employed.   In connection with these convulsions the
 uterine contractions  are usually feeble and irregular; sometimes they
 either pass  into the  spasms  or  alternate with them.   In  some in-
 stances,  according to  Leadam, the opening of the os  is the signal for
 the manifestation of convulsive action, each parturient effort being ac-
companied by a convulsion; in others, every paroxysm seems to cause a
firm, spasmodic contraction of the os, and so interferes with and  delays
the progress  of the  labor.  The convulsions  sometimes continue at
intervals until the birth, which, therefore, is an event looked forward
to with great anxiety; and it has happened that labor has proceeded,
even to the  expulsion of the child and secundines, without the  sur-
rounding attendants being aware of it, in consequence of the convul-
sions so obscuring the parturient  efforts that there was no outward
manifestation of the  labor, and also from the fact that uterine  action
is sometimes  very powerful, and the labor is proportionately quick in
some cases.   This shows the duty of ascertaining without doubt the
        27 
418
PUERPERAL  CONVULSIONS.
 actual condition of the uterus by a proper  and timely examination.
 If delivery—whether it be at the full time or not—be inevitable, and
 if, in spite of the application of appropriate remedies, the convulsions
 continue or increase, then it will  be a matter of serious  consideration
 whether the birth of the child can be expedited by manual or instru-
 mental interference with safety to the mother.   The  sooner the child
 is  born, the sooner  may we reckon on the probable cessation of the
 convulsions and the safety of the mother, although they do not always
 terminate when that desirable object is accomplished.
   The proper course to be pursued under the different conditions of
 Convulsions in Parturition will  now be indicated.
   First. Ascertain,  by examination, if any  loaded condition of the
 rectum or of the bladder offers  any impediment to the progress of the
 labor or predisposes to the convulsions.
   Second.  Remove  any such obstructions by  the use  of the enema
 syringe or catheter.
    Third. Administer the  similar remedy according to the indications
 given at the close of the chapter—either  one of those  mentioned 01
,any other which may be more homoeopathic to the case.
   Fourth.  Should the convulsions not be relieved, it will be necessary
 to induce artificial delivery as soon as the os uteri is  found to be suf
 ficiently dilated or dilatable.
   The course to be pursued in convulsions of pregnant women before
 the close of  term at first corresponds  to that necessary in severe cases
 of hysteria, of  which,  in fact,  these convulsions are usually but an
 aggravated variety.   The exceptional cases will consist principally of
 those who have either had epileptic attacks in  early  life, or whose
 parents  had been troubled with this affection, or of those in  whom
 the pregnancy itself has  evidently developed the epileptic condition.
 In each of these cases the remedy homoeopathic to the existing condi-
 tion should be administered in as high potency and at  as long intervals
 as may coincide with the judgment of the physician.  If the treatment
 fails, the convulsions grow more frequent and severe, and evidently
 threaten to produce miscarriage, the case must be treated as one of
 abortion from this cause.
   The convulsions which make their appearance after parturition are
 generally believed to be far more dangerous than those which precede
 and accompany labor,  since they are usually the result of profound
 exhaustion of the patient's system.  This  exhaustion may be princi-
 pally nervous, and  analogous to the " shock" which constitutes the
 most fatal form of puerperal fever; or it may be vascular, resulting 
PUERPERAL CONVULSIONS.                 419
from excessive haemorrhage during  and immediately after the labor
itself.  The in lividuals most liable  to the former class of exhaustion
are those of a weak, nervous temperament, while the full-blooded and
plethoric are most apt to suffer from severe losses of blood.  In either
case the condition is one of exceeding gravity ; and unless the physician
is  sufficiently master  of his business to enable  him to give the right
remedy without loss of time, he may have the mortification of seeing
the convulsions become constantly more violent until the little remain-
ing vitality is at last expended in futile efforts to maintain the respira-
tion and circulation, and the patient is relieved by death.
  It  should always be remembered that there is  still another influence
to  which the puerperal  woman is  remarkably  sensitive,  and which
may  prove as efficient and as fatal a cause of convulsions after labor
as  either the nervous  or the sanguineous  exhaustion just  mentioned,
and which comes with tenfold force  if brought to bear upon  patients
already so exhausted.  And this is  fright, fear, or a sudden  emotion
of grief, or even of joy.   The least  intimation  to the mother during
labor that there was  something wrong has been known instantly to
stop all pains, and  necessitate the use of instruments, resulting in the
final  destruction of mother and child.   How much more, then, should
we carefully  avoid shocking the  feelings and wounding the sensibili-
ties of our patient in  her  enfeebled  condition at the close of a labor,
which may have been far more exhausting than  is apparent, by rudely
announcing the death or the deformity of her  child!   These trying
circumstances, through which the young physician may at any time be
called to pass, demand from him not only the most entire self-control
and presence of mind under the most critical circumstances of labor,
but also, and no less absolutely, the most careful  and tender  con-
sideration for the personal feelings and moral state, as  well  as for the
physical condition, of his patient afterward.  In all  these alarming
conditions the homoeopathic remedies, properly  selected  and adminis-
tered, will be found  endowed with  an efficacy vastly superior to the
debilitating or stupefying  means employed by old-school practitioners.
And  however discouraging the symptoms may be, especially to the
young physician, let  him be  sure neither to "lose his  head" nor to
give up in despair;  but let him patiently and perseveringly administer
the proper remedies,  and leave the event with Him who doeth all
things well,  remembering, at the same time, that  very many cases
are thus saved, even of those which he might deem not only desperate,
hut perfectly hopeless.
  Treatment.—The prodromic  symptoms should  be  met  by  such 
420
PUERPERAL CONVULSIONS.
remedies as are appropriate, carefully selected from the Materia Medica.
A nervous and excitable condition  of the  mind, persistent and con
gestive headache, insomnia, persistent pain  in  any part of the body
local anaesthesia, when occurring in  pregnant women, should receive
special attention.  Where oedema  exists the case should be carefully
treated;  the urine should  be subjected  to  a careful examination  for
the presence of albumen and  the absence of urea.   " Although there
are exceptional cases in which dropsy occurring in pregnant women
is not followed by puerperal convulsions,  yet  the  rule is quite  the
reverse.  Hence you will  be on your guard whenever it occurs, and
more especially if the oedema began  in the face and upper extremities.
For in most cases of dropsy, whether  incident to gestation or not, if the
infiltration begins in this manner, we take it as a hint of renal disease
or embarrassment of some kind.  So your patient may have had a
latent form of Bright's disease, which has been aggravated by her con-
dition, or she may  be suffering for the first time from an attack of
acute desquamative nephritis, from congestion of the kidney or from
uraemia, due to direct pressure of the gravid uterus upon one or both
the ureters, the earliest token of which may be seen in the puffy and
bloated face and eyelids.   If you act upon this suggestion you may
avert the threatened eclampsia—always providing the degeneration of
the kidneys has not gone too  far already, and that the pressure upon
the ureters does not cause a complete retention and reabsorption of the
urine."—Ludlam.   Let it be the first duty of the physician to make
sure that no ligatures or other encumbrances obstruct the  circulation
or in any manner aggravate the existing difficulty; that there be pure
and fresh air; that the light be not  too bright; and that all the at-
tendant circumstances  and conditions  are  rendered as favorable as
possible for his patient.   If the room is crowded, as is often the case,
with friends, anxious, distracted and rushing about in confusion, let
hini at once restore the room to order ;  otherwise he may chance to find
himself inextricably involved in the same hopeless confusion.   Then,
if not before, let him administer the remedy which seems to him most
homoeopathic to the symptoms and  conditions of the case.   Let him
calmly and patiently wait for the  action of the  first dose, and  before
repeating it let him be  fully satisfied not  only that  it is the right
remedy, but that the beneficial action of this first dose is  exhausted.
If no improvement arise,  and the appearance  of new symptoms or
the further development of the old ones should convince ftim that the
right remedy bad not been chosen at first, let him en leavor to select
another in  accordance  with the present  condition of the case.  And 
PUERPERAL CONVULSIONS.
421
in  al1  cases let him remember that the  more  violent the symptoms
the less should he expect instantaneous relief—that the gradual sub-
sidence of the nervous  excitement  and  the  corresponding gradual
abatement of the spasmodic action are not only the best  methods by
which the patient may improve, but that they are also the only methods
possible.  In addition to the remedies already  mentioned under Hys-
teria, the following may be studied with  reference to the convulsions
which precede or  accompany labor,  and  to those which  arise subse-
quently :

  Aconite. In those cases where, in their incipiency, there is a hot,
dry skin, thirst, restlessness, fear of death,  more  or less cerebral
congestion,—in such cases a dose of Aconite once every  half hour acts
like a charm.  In primiparse, where at the outset of  labor  there is
evidently great fear and anxiety, restlessness, feverishness  and thirst—
symptoms that might be the precursors of puerperal eclampsia—a dose
or two of Aconite very frequently has a  very calming influence.
  Argentum nit. She  has a  presentiment of the  approaching  spasm.
She is in constant motion from the time she comes out of one spasm
till she goes  into another.  The  spasms are violent, and  are preceded
by a sensation of expansion of the whole body, especially of  the face
and head.  Sometimes the  woman  lies  quietly for some time after a
spasm has ceased, but becomes very  restless before another begins.
   Arnica. When the  pulse is full and strong, and during every pain
the blood rushes violently to the face and head; symptoms of paral-
ysis of the left side; loss  of consciousness; involuntary discharge of
stool and urine;  while the head is very hot, the body is  nevertheless
cool or of a  natural temperature.
  Belladonna. She has the appearance of being stunned; a semi-con-
sciousness and loss of speech; convulsive movements in the limbs
and muscles of the face; paralysis of the right side of the  tongue;
difficult deglutition;  dilated pupils; red or livid  countenance.   She-
may have paleness and coldness of the face, with shivering;  fixed or
convulsive eyes; foam at the mouth ; involuntary  escape of the  faeces
and urine.   Renewal of the fits  at  every pain;  more  or less tossing
between  the  spasms, or deep  sleep, with grimaces,  or starts  and
cries, with fearful visions; violent pulsation of the carotids; jerking
and twitching of muscles between the spasms; sound sleep or uncon-
sciousness after a paroxysm.
  Bryonia. Is often indicated after  the  spasms have been controlled,
and there remain fullness of the pulse, abdominal tenderness and per- 
422                 PUERPERAL CONVULSIONS.
epiration, dry, parched lips and  thirst.  The woman does not wish to
move, and cannot bear to be moved.
  Cantharis. Dysuria belonging  to Cantharis.  The presence of bright
objects, the sight, the drinking  or the sound  of water, and touching
the larynx, seem to reproduce the spasms, which are usually violent.
   Caulophyllum. Convulsions, with very weak and irregular  labor-
pains.   She feels very  weak.
  Causticum.  When  the  paroxysms are complicated  with screams,
gnashing of the teeth, and violent movements of the limbs, etc.
  Chamomilla. The  spasms have been excited by a fit of anger,  or
she has one  red  cheek while the other is pale.  Starts  and shocks
during sleep.  Great impatience and disposition to anger.  Spiteful
excitability.
  China.  The loss of a large quantity of blood is the exciting cause of
the eclampsia.
  Cicuta. Strange contortions of  the upper  part of  the body and
limbs during the paroxysms, with  blue face, and frequent interruptions
of breathing for a few moments.
  Cimicifuga. The  spasms are preceded by great  mental excitement
and perturbation, with visions of  objects which are not present, and
are followed by  languor or relaxation  of the  entire system.   The
paroxysms are very violent.
  Cocculus. Spasms  following difficult labors, and those which  are
developed by changing the position of the patient.
  Coffea. To  quiet  the  extreme excitability  of the nervous system
when spasms are apprehended, or  if spasms  have actually been  de-
veloped, attended with cold extremities and grinding of the teeth.
  Cuprum.  Spasms complicated with violent vomiting.   Opisthotonos
with every paroxysm, with  spreading out of the limbs and opening
of the mouth.  The spasms  begin in  the shape  of cramps in the fin-
gers and toes or in the whole of the extremities.
  Gelseminum. This  remedy  bids  fair to  become  one of our most
useful agents in this fearful disorder.  It seems  indicated  by the pre-
monitory  symptoms, where the head feels very  large, or in  those
cases in which the spasms occur as the first  symptom of  the os uteri
being unchanged or perhaps  rigid.  Distressing pains running from
before backward  in the abdomen, but more especially when the pains
run upward.
  Helleborus. A shock passes through the brain, as if from a shock
from electricity, followed by considerable movements in the body.
  Hydrophobin. The spasms are  excited  whenever she attempts  t<; 
PUERPERAL CONVULSIONS.
423
drink water, or if she hears it pouring from one vessel into another.
This remedy may also  be indicated by the  sight or sound of water
affecting the patient unpleasantly, even though she desires the water.
  Hyoscyamus. When there is  a bluish color in the face, and twitch-
ings and jactitation of  every muscle in the  body—those of the face,
eyelids and all.  Almost constant delirium.
  Ignatia  Deep sighing and sobbing,  with a strange compressed feel-
ing in the brain.   The  convulsions  commence and  terminate with
groaning and  stretching of the limbs.   The  paroxysms are accom-
panied with vomiting.   Fright, with grief, may have been the excit-
ing cause.
  Ipecac. One  constant sensation of nausea the whole time, with occa-
sional convulsions.   Such  symptoms—convulsions characterized  by
continuous nausea—are always relieved by Ipecac alone.
  Kali C The  spasm seems to be relieved or to -pass off by frequent
eructations.
  Lachesis. The  convulsions are  particularly  violent  in the lower
limbs, with coldness of the feet, stretching backward of the body and
crying out.
  Laurocerasus. She is conscious of a shock passing through her whole
body before the spasm.
  Mercurius. Much salivation,  a  constant driveling from the mouth;
convulsions, mostly in the extremities.
  Nux mosch.  Particularly when there is a convulsive motion of the
head from behind forward.
  Nux V. Great torpor of the intestinal canal;  in persons who are of
an irritable disposition, and in  those who are accustomed to wines and
high living generally, and who lead a sedentary life.
  Opium. Sopor, with  stertorous respiration;  the stertorous respira-
tion continues  constantly from  one spasm till the next, and so on.  In-
coherent wandering and convulsive rigidity  of the body, with redness,
swelling and heat of the face; hot perspiration and insensible pupils.
Suppression of the pains  of  labor  may have been the proximate
cause.
  Phosphorus.  Previous to the convulsion a sensation of heat rushes
up  the back into the  head.   This was several times  perceived  as a
forerunner of the first convulsion.
  Pulsatilla. The countenance  is cold, clammy and pale.  Loss of con-
bciousness  and of motion;  stertorous  breathing and full pulse.   The
labor-pains are deficient, irregular or sluggish—otherwise she is  in
good condition ;  mild and tearful; the patient demands fresh air. 
424
POST-PARTUM DERANGEMENTS.
  Secale C  In scrawny, illy-nourished women, with too feeble labor-
pains.   " Ergotismus convulsivus."
  Stramonium. This   medicine  is  particularly indicated  where the
patient shows such signs  of fear as to cause her to look frightened
and  to shrink back from the first objects she sees after opening her
eyes.  If she has had no spasms, she soon will  have after betraying
such symptoms, unless Stramonium be  immediately administered.
The  same  frightened appearance  occurs also after the convulsions
commence.   Sardonic grin.  Stammering or  loss of speech.  Puffed
and red face ; loss of consciousness and sensibility.  Cries;  frightful
visions; laughter; singing; attempts to escape.  The fits are renewed
by the sight of brilliant objects, and sometimes by contact.
  Verat.  viride. Great activity  of the  arterial system.  Convulsions
or mania, or when the mania  continues  after the convulsions have
ceased.
  Zinc. Particularly if eruptions have  recently disappeared, even old
eruptions.  Zinc has been known to cure obstinate puerperal  convul-
sions after Phosphorus, apparently indicated, had failed.
                      CHAPTER  XXI.

               POST-PARTUM DERANGEMENTS.

             Retained  Placenta.   (See page 201.)

   BELLADONNA. Redness of the face and  injected sclerotica; great
    distress and moaning; great heat and dryness of the vagina; dry-
ness  and heat of surface; profuse flow of  hot blood, which speedily
coagulates; the slightest jar of the bed causes suffering.
  Cantharis. Swelling of the lips of the os;  burning pain in the pel-
vic portion of the abdomen and in the back;  feverishness; vomiting;
great deal of anguish and distress, with predominantly burning pain.
  Cimicifuga. For women who are subject to  rheumatic affections;
there is a distressing, tearing pain in the uterine region;  there appears
to be no uterine action.
  Gelseminum. When, with  the  retained placenta, there are cutting
pains in the lower part of the abdomen, usually running upward, or
sometimes upward and backward. 
          RETENTION OF  URINE AFTER PARTURITION.        425

  Pulsatilla. This remedy is more frequently indicated and more gen-
erally useful than  all others.   It is  indicated  equally  for  retained
placenta from want of expulsive power of the uterus, and for the spas-
modic retention.  The symptoms presenting must decide for or against
its use.  The patient is of a mild and yielding disposition;  inclined
to weep because her labor is  not completed; intermittent flow of blood ;
restlessness; she  cannot bear the heat  of the room, of which she com-
plains, and demands that fresh air be admitted.
  Sabina. Pain, or  an uneasy, bad feeling, extending from the sacrum
to the pubes;  a slight sensation as of motion in the abdomen ; intense
after-pains,  notwithstanding  the  retention, with discharge  of fluid
blood and clots, in  about equal proportion, with every pain.
  Secale C Constant sensation as of bearing down; it seems to her too
constant and too  strong to be effectual; passive haemorrhage; the parts
feel to her  as  if relaxed, and there is an absence of  uterine action;
especially suitable for thin,  scrawny women.
  Sepia. She complains  of little  sharp, shooting pains in the cervix
uteri, sometimes  with burning.
  Caulophyllum and  Gossypium have been  commended for  retained
placenta.

          Retention of  Urine  after Parturition.
  Arnica. Retention  of urine, with urging to  urinate, there  being a
sore, bruised feeling prevailing.  Mechanical injury is the apparent
cause of the difficulty.
  Arsenicum. There is no sensation as of desire to urinate; it is time
the bladder should be evacuated,  but  there is a want of disposition to
urinate, as well as a want of desire or urging to do so;  in fact, there is,
so far as the urinary organs are concerned, an entire want of sensation.
   Belladonna. The urine can be passed only in drops at every effort,
without pain.  Very sensitive to jars  of the bed.
  Cantharis. Great desire  to  urinate, with cutting, burning  pains in
the bladder or in the urethra;  complete strangury, or the urine may
dribble or drop,  with cutting, burning pain.
  Causticum. Retention of  urine, with frequent and  urgent desire to
urinate, but occasionally a few drops or a small  quantity passes away
involuntarily; the desire may be frequent and urgent, but unsuccess-
ful, as only a  little flows involuntarily.
  Hyoscyamus. Retention of urine, with constant pressure in the blad-
der ; apparent paralysis of  the bladder.
  Lycopodium. Retention of urine, with much violent pain in the back, 
426               POST-PARTUM  DERANGEMENTS.
coming on in paroxysms, or the flow is suddenly interrupted, with in-
creased pain in the back at every interruption.
  Nux  vomica. Painful  and  ineffectual  desire to  urinate, the pain
being  burning and tearing;  retention of urine, with frequent urging
to stool.  Irritable, morose and scolding.
   Pulsatilla. Retention of urine, with  redness, heat and soreness of the
external region of the bladder, which is painful  to the touch; mild,
tearful  women.  Great pressure on the  bladder.
  Stramonium.  Retention of  urine, with a sensation as if the urine
could not be passed on account of the  narrowness of the urethra; after
straining a while a few drops are passed, no  stream being formed in
spite of all straining;  retention without any painful sensation.


                  After-Pains.   (See page 208.)
  Arnica  should  be  administered  immediately  after  delivery, un-
less contraindicated;  and this  remedy is particularly  called for by
the bruised condition of the genital organs and the strain of  the gen-
eral muscular system.   It aids in restoring the parts to their natural
condition, thus preventing severe after-pains by removing the causes
which otherwise would have produced them.
  Belladonna is indicated when the pains come on suddenly, and after
a time disappear with corresponding  suddenness;  or if the pains be
severely forcing, as if the  contents  of  the  pelvis would be  forced
through the vulva.   A  jar of the  bed is  very  unpleasant.  The
lochial discharge seems to her to  be hot.   The head and  eyes are
congested.  Flow  increased with each pain.
  Bryonia. The after-pains are excited by the  least motion,  even by
taking a deep inspiration; she wishes to lie perfectly quiescent.  Head-
ache as if the  head would split.  Thirst for large draughts of cold
water;  parched lips and dry mouth.
  Caulophyllum is particularly suitable after  protracted and  exhaust-
ing labor.  Pains which  are apparently spasmodic across the lower
part of the  abdomen or in other parts, sometimes  extending into the
groins.
  Chamomilla. The pains are very distressing, and  she  feels  that she
cannot bear them.  She wishes to get away from herself.   She is ir-
ritable and ill-natured.  The lochia is dark colored.  Thirst.  Desire
for fresh air.
  Cimicifuga. The  patient is very low-spirited, sleepless,  restless and
very sensitive to impressions; she feels her pains very acutely. 
AFTER-PAINS.
427
  Coffea. She is sleepless ; the pains are very distressing, and she feels
 them acutely.  Or, desire to go to sleep but unability to do  so.
  Cuprum acet. Terrible cramping  pains; pains which often produce
 cramps of the extremities, including the fingers and toes.  Particu-
 larly indicated  in multiparae.
  Ferrum. Violent pains in the loins and abdomen, like  those  of
 labor, with discharge of partly fluid  and partly clotted  blood; full,
 hard pulse;  frequent short shuddering, headache and vertigo.   Espe-
 cially suitable for feeble women with fiery red face.  •
  Gelseminum. The pain is severe, and inclines to run upward or upward
 and backward.   Seems unable  to regulate her muscular movements.
  Hyoscyamus. Much jerking and  twitching of various  parts of the
 body; she is delirious; the pains are spasmodic
  Ignatia.  Much sighing,  sadness  and despondency  with the after-
 pains.
  Kali carb.  The pains  are stitching and shooting,  or they are in the
 back, shooting down into the gluteal region or hips.
  Nux v. Aching pains.  Every pain  causes a feeling of desire to go
 to stool, or there is a constant sensation as though there was something
 in the rectum which should be  evacuated.  A sore feeling  in the region
 of the uterus, to the extent that she dreads being moved  or  disturbed
 in any way.   Inclined  to be  irritable.   She  likes to have  the room
 warm and to be well covered.  Fainting after every pain.
  Pulsatilla.  For women  of mild and tearful  disposition;  the pains
 become worse toward evening; thirstlessness ; bad taste in the mouth.
 She feels uncomfortable if the room  be warm, and complains of its
 warmth; great desire for fresh air, and she feels better if the room be
 cool. Restless and changeable in her feelings—now  better, now worse.
  Rhus tox.  The pains are always worse at night, with great restless-
 ness; they last sometimes throughout the night, while  there is not
 much pain during the day.  Frequent desire to change  her position,
 which change gives some relief for a short time.  Likes a warm room
 and to be covered warmly.  Sometimes cramps in calves.
  Sabina. The pains run from  the  sacrum to the pubes.   With every
 pain—the pains being generally severe—fluid and clotted  blood is dis-
 charged.  The pains  sometimes extend from the back and sacrum to
 the uterus and down the thighs.
  Secale corn. This remedy is especially adapted  to  thin, scrawny
 women.   The pain is prolonged, as though pressing and forcing the
womb.   Brown, thin lochia.   Although she may  feel cold,  yet she
does not wish to be covered. 
428
POST-PARTUM DERANGEMENTS.
   Sepia. Constant sensation of weight in the anus; pain shooting up-
 ward in the vagina.  Pain which is  felt  mostly in the  back;  severe
 bearing down or forcing  in the back,  occurring  in  regular par-
 oxysms.
   Sulphur. Pains which are located especially in the uterus.  The
 lochial discharge seems to be scant.   She  complains of feeling badly
 in the abdomen.  Bleeding haemorrhoids, which itch very much and
 are sore.  Flushes of heat;  Aveak and faint spells;  feet either cold
 or burning hot, especially the soles.
   Sulphuric acid. Great sense of general weakness, or a sense of tremb-
 ling all over,  without actual  trembling.   (Consult also the medicines
 for disordered conditions  of  the lochial discharge.)

    Disordered Conditions of the Lochia.   (See page 210.)
   Aconite.  A  suppression of the lochia, or too scanty discharge, occurs
 soon after confinement, with distress  in the abdomen, chest and head,
 apparently from congestion of blood in  these parts.   Feverishness,
 with thirst; uneasiness; fearfulness; she feels that something unfortu-
 nate will occur.  Sharp  cutting pains in the abdomen, which is very
 tender of pressure.  Offensive lochia, other symptoms agreeing.
  Baptisia. The lochial discharge is very acrid and very foetid, and
 there is great  debility, with prostration.
  Belladonna.  Offensive  lochia, feeling hot to  the  parts.   Flushed
 face and injected  eyeballs; delirium  and frightful visions.  Pain in
 the region  of  the uterus, which comes and goes  suddenly.   Drowsi-
 ness, or she is half asleep  and half awake; does not sleep soundly,
and is not  refreshed  by her sleep.  She is very sensitive to even a
slight jar of her bed; great tenderness of the abdomen.
  Bryonia.  Suppression  of  the  lochia, with  sensation as  if the  head
would burst.   The least motion  aggravates  her suffering.   Dryness
of the lips  and mouth.   The lochia may be too profuse, with burn-
ing pains in the region  of  the  womb.  Thirst, with desire for large
draughts at a  time.
  Calcarea carb. The lochial discharge lasts too long, in women who
ordinarily  menstruate too profusely,  or  the  discharge has  a milky
appearance.   Suitable especially to women  of leucophlegmatic  tem-
perament.
  Caulophyllum. The lochia lasts too  long  and  remains bloody too
long; it seems to ooze passively from the relaxed uterine vessels, and
there is great  exhaustion.
  Chamomilla.  Suppression of the lochia, followed by  diarrhcea, colic, 
DISORDERED CONDITIONS OF  THE  10CHIA.         429
 toothache;  irritable  and impatient;  thirst;  redness of one cheek,
 while the other is pale.
   Coffea. The discharge is too profuse, with an  exalted nervous sensi-
 bility and great wakefulness.
   Colocynth. Suppression of the lochia, with violent colic; suppression
 arising from anger; suppression with  tympanitic abdomen  and diar-
 rhoea.  She feels worse after taking food or drink.   Great restlessness.
   Carbo animalis. Lochia too  long continued, thin, offensive, excoria-
 ting, with numbness of the limbs.
   Creasote.  Very offensive lochial discharge,  which produces excoria-
 tion.  The  lochia  almost ceases  to flow, when  it  freshens  up  and
 becomes more profuse  and bloody, and again almost disappears, to
 freshen up again.
   Crocus. The lochial discharge appears in  dark strings.   Sensation
 of motion in the abdomen,  which becomes much distended.
   Dulcamara.  Lochia suppressed by cold  or dampness, and the quantity
 of milk is greatly diminished.
   Erigeron. In cases where  the least motion excites  afresh a return of
 bloody lochial discharge, which is relieved by rest.
   Hyoscyamus. Much delirium and jerking of the  muscles; she  says
 she is being drugged or poisoned.  Very suspicious.
   Ignatia. Derangements from the abuse of Chamomile tea.  In some
 cases  Nux v.  Or if produced  by fright  or grief,  with sighing and
 sobbing.
  Merc. sol. The discharge is  worse at night, with some inflammation
 and swelling of the genital organs.   Swollen and sore groins.
  Nux v.  The lochia are scanty and offensive  in women accustomed
 to highly seasoned food, coffee and wine;  or the patient has  an  irri-
 table rectum, calling her to  stool  frequently.  Frequent calls  to  uri-
 nate, the urine producing a scalding sensation.  Sensation of soreness
 in the uterine region; she does not  wish to be  moved or disturbed in
 any way.   Prefers to be warm.
  Opium.  Suppression of lochia from fright, writh sopor.
  Platina. A  little discharge will remain, but it will  be black and
 clotted.  The genital organs will  be very tender.  On account of the
 excessive sensitiveness  she  cannot bear  the  napkins usually applied.
The discharge becomes intermittent, occurring in gushes.  Very  change-
able in her sensations.  Cannot bear a warm room.
  Pulsatilla. In cases where the milk has suddenly disappeared from
the breasts.   The scanty lochial discharge remaining is milky  ; she is
feverish, but has no thirst. 
430
POST-PARTUM DERANGEMENTS.
  Rhus. The lochial  discharge  lasts  too  long, is  thin and  offensive,
It has wellnigh exhausted her; it is  thin, ichorous and offensive, or
it occasionally becomes bloody.  Shooting pains up the rectum.  Rest-
lessness at night.  Must change often, with relief.
  Secale c.  In thin, scrawny women; very offensive and thin lochia;
the discharge may be  scanty or profuse. It may be painless or accom-
panied by prolonged bearing-down pains.  Very dark discharge.
  Sepia. Where the foetid odor is the most characteristic symptom.
Offensive  lochia, excoriating, with little sharp  shooting pains  in the
region of the neck of the uterus. Distressing bearing down  in the
back.
  Silicia. Pure blood  is  caused  to flow every time the infant nurses.
The discharge is sometimes excoriating.   After-pains in the hips.
  Stramonium.  Her mind is full of strange and absurd, but strongly
marked ideas.  Lochia having a cadaverous odor.
  Sulphur.  The discharge causes  a sensation of  weakness, and she
has hot flushes; perspiration;  heat in the soles of the feet, or her feet
feel  cold all the time.   She has  bleeding piles, which are sore and
itch.
  See also remedies under Nymphomania, Metrorrhagia,  Constipation,
Diarrhoea and After-Pains.

                     Pendulous Abdomen.
  Belladonna. When there is much sensitiveness to touch, to pressure
or to jarring while riding in a carriage or when walking.  Under the
influence of Belladonna the tenderness ceases, and the size of the ab-
domen will  be greatly reduced gradually.
  Crocus. There is a sense of motion, as of something alive bounding
and leaping in the abdomen.
  Platina. Occasional  sensations of cramp in the uterine region; ten-
derness to touch; everything seems strange and  horrible to her.
  Podophyllum. Much nervous irritability and sleeplessness.  She feels
as if weak and unable to move about.  Stools too frequent,  but natu-
ral in appearance.
  Sepia. Sensation of painful emptiness  in  the pit of the stomach.
Little darting, shooting  pains in the  region of the cervix uteri; con-
stipation.
  Secale corn.  In women  of very lax muscular fibre, and who  are of
a thin, scrawny appearance.  Study also Calc. carb., China, Coloeynth,
Kali carb., Nux vomica. 
PUERPERAL fever.
431
  For Rhagades and Cracks on the Surface of the Abdo-
men, study Hepar, Sepia, Silicia, Sulphur.
  For Ulceration of the Umbilicus, Arsenicum generally  suf-
fices. Study also Apis, Lachesis, Lycopodium, Sepia, Silicia, Sulphnr.
                     CHAPTER  XXII.

     POST-PARTUM DERANGEMENTS.—CONTINUED.

           Puerperal Fever (Child-bed  Fever).

   THE multiform disease which goes by the various names of Child-
    bed Fever, Puerperal Fever and Puerperal Peritonitis has this
double characteristic,  that  it  attacks only  pregnant and lying-in
women, and involves in various degrees  the genital organs and the
viscera more immediately adjacent.   Scarcely any disorder which the
physician is called upon to treat is more insidious or more dangerous;
certainly there is  none which runs a more rapid course or which may
prove more suddenly fatal.   And when we reflect that this frightful
malady is not necessarily confined to individual  cases, that it may be-
come epidemic, and even most virulently contagious, it will be evident
that a thorough understanding  of the disease, as  essential to its suc-
cessful treatment, will at once assume a tenfold importance.
  " The breaking out of an  epidemic child-bed  fever, or even the oc-
currence of a single case, commonly excites a feeling of sharp interest
and alarm as far as ever the rumor of it extends: the public curiosity
becomes speedily aroused, and among many physicians whose opinions
are taken, how wide is the diversity of their sentiments!  If the pub-
lic do become greatly alarmed on these  occasions, it is because they
know that any one  of our women seized  with  child-bed fever is  at
once placed in a most perilous  position;  and we know it even better
than they; and half our distress and anxiety arises from this, that we
are ourselves uncertain what we have to do, what to contend with and
by what principles  to be guided."  These very candid confessions of
Dr. Meigs will at once serve to  show the  dangerous character of this
disease, and the necessity which therefore exists for a thorough acquaint-
ance with its essential nature and proper treatment.
  No  single form  of disease, or  class of diseases, has given rise  to 
432               POST-PARTUM DERANGEMENTS.

greater differences of opinion among medical men as to its nature and
causes, and in no others have serious  physiological and  pathological
errors so manifestly led to erroneous and destructive methods of treat-
ment,  And although the homoeopathic physician, from general princi-
ples  avoiding  some of those untimely interferences which have been
seen  to lead immediately to child-bed fever, and  from selecting his
remedies  under the direct guidance of the existing conditions, rather
than  under that of a supposititious and often mistaken diagnosis has
in general far  greater  success than  his allopathic neighbors, he will
none the less require, for the sake of his students,  if not for his own
a clear exposition  of  the Natural History, Essential  Nature, Causes,
Symptoms, Diagnosis,   Course and Tendencies,  and Treatment of this
disease.
  I.  Natural History.—Under this  title we consider  child-bed
fever, or the disease commonly so termed, in a general manner only.
This  disease may be sporadic, appearing in one or more isolated cases,
which are supposed to arise in consequence of influences inherent in
the constitution of the individual, or from  such as are  additionally
developed  by  the  incidental circumstances of her confinement.   In
general, the cases of puerperal fever which appear as sporadic are less
difficult of cure than those met with in epidemics.
  In  different countries and at different times  child-bed  fever has
assumed an epidemic form,  raging with great virulence and fatality,
and attacking  almost every puerperal woman, but neither  including
any very extended  range of territory, nor lasting more than a few
months on any one occasion.  Watson * states  that puerperal peri-
tonitis  "is observed to reign as an epidemic especially in lying-in
hospitals, and that it occurs  at irregular  intervals,  sometimes  leaving
them  quite exempt from its ravages for years together."  The mortal-
ity  of child-bed fever in private practice among old-school practitioners
has always been very great,  and in the lying-in institutions and hos-
pitals this disease has sometimes proved so dreadfully fatal as to ren-
der these  public charities a curse  rather than a blessing  to the com-
munities in which they were situated.  Of the one hundred and sixty
cases  of severe inflammation of the uterus  and its  appendages which
occurred to Dr. Lee in London from March, 1827, to the end of
April, 1835, and of which he gives a tabular view,f eighty-eight, oi
a little more than fifty per cent., recovered.   In another author men-
  *  Practice of Physic, p. 819.
  +  Lectures on the Theory and Practice of Midmfery, by Robert Lee, M. D., F. E. %
p. 478. 
PUERPERAL fever.
433
tion is made of thirty-one cases being lost out of thirty-two, or 96|
per cent., while of twenty women in child-bed in Hotel Dieu Hospi-
tal, Paris, in February, 1746, affected with  puerperal  fever, scarcely
one recovered.
  The question as to the contagious or non-contagious nature of child-
bed fever has given rise to the most violent disputes and to the most
opposite conclusions among medical men.   A frightful array of facts
may be collected from the works of innumerable authors, which seem
to prove in the most incontestable and overwhelming manner  not only
that this disease is contagious, but that in many remarkable instances
it has been confined to the practice  of a single physician, every woman
whom he attended during a course  of weeks  or months being stricken
down with this fell disorder.*  Dr. Churchill writes as follows : " It
seems impossible to doubt that contagious matter capable of  exciting
puerperal fever may possibly be conveyed by a  third party unaffected
by it; for example, in the cases on record following the services of med-
ical men and nurses who were in attendance upon erysipelas  immedi-
ately before.  The instances  are too Temarkable and too numerous to
be regarded as coincidences, nor would even the prevalence of an epi-
demic of puerperal fever at the same time invalidate our conclusions;
it might certainly  render  the cause more influential."   Dr. West of
Philadelphia states that " seven  females delivered by Dr. S. Jackson
in rapid  succession were all attacked with puerperal fever, and five
of them died.  These were the only cases  that occurred in that dis-
trict, for the women became alarmed and sent for  other assistance."
Dr. Ramsbotham has  known the disease to spread through a particu-
lar district, or to  be confined to the practice of  a particular person,
almost every patient being attacked with it, whilst other practitioners
had not a single case;  and he considers the distemper as being capable
of conveyance  not only in common modes, but through the dress of
the attendants on the patients.
  At a  meeting of the College of Physicians  in  Philadelphia, Dr.
Warrington stated that " after assisting at an autopsy of puerperal
peritonitis he was called to deliver three women in rapid succession.
All these women were attacked with different forms of what is com-
monly called puerperal fever."   "  A young surgeon, shortly after ex-
amining the body of  a sporadic case that had died, delivered three
women, who all died of puerperal  fever."   Mr. Davis  states  "that in
  * Vide Puerperal Fever as a Private Pestilence, by O.  W. Holmes, M. D., Boston,
1855; Boston  Med. and Surg. Jour., vol. Hi.,  pp. 95,  410; Kamsbotbam's Obstetrics,
p. 530.
      28 
434               POST-PARTUM DERANGEMENTS.
the autumn of  1822 he met with twelve cases, while his medicai
friends in the neighborhood  did not meet with any, or at least with
very few.   He could attribute this  to no otlier cause than his  havin<'
been present at the examination of two cases, and his having conveved
the infection to his patients, notwithstanding every precaution."  Dr.
Roberton  of Manchester states that between  the 3d of December
1830, and January 4th, 1831, a midwife attended thirty patients of a
public, charity, sixteen  of whom had puerperal fever, and all died.
Other midwives of the same  institution attended three hundred and
eighty women during the same time, and none  suffered from it.*
  Hitherto we have only adduced proof of the  direct communicability
of puerperal  fever by physicians or nurses who have been in  attend-
ance upon  previous  cases of the disease, or by physicians going to
women in labor from autopsies of persons dead with the same com-
plaint.  But there are still other modes by which the poison which is
capable of exciting this disease in puerperal women has been conveyed
—modes which are necessary to be known in order to a full under-
standing of the natural history -of the disease itself.  A practitioner
had been attending cases of typhus fever.   Within the space  of four
days he delivered five women.  All these women were attacked with
puerperal fever, and  all  of them died.  This was in a country prac-
tice, and the cases were  remote  from each other.  Different practices
intersected  the practice of this medical man at various points, but no
other cases were known to have occurred in the  neighborhood.  Again,
a patient suffering  from typhus fever was admitted into a lying-in
hospital, where she remained for a  few hours  only.   In the beds on
the right and left of this patient were two lying-in women; both were
attacked almost immediately with puerperal fever, and both died.  A
medical man  was in constant attendance upon a patient suffering from
gangrenous erysipelas, and between the 8th  of January and the 22d
of March he  attended  the • labors of ten women; all had  puerperal
fever, and eight of the patients died.   This was in a town of moder-
ate size, and no other patients in the place were known to  have had
puerperal fever.  " It has been made out very  conclusively by Semcl-
weis and others that the miasms derived from the dissecting-room
will excite  puerperal disease.  Exposure of the puerperal woman to
the poison of  scarlatina will give rise to puerperal disease in patients
proof  against the reception  of scarlet  fever itself.   The mortality
amongst child-bed women seized with  smallpox is  well  known, and
such persons  die with the symptoms of puerperal disease in addition
                 * Churchill's System of Midwifery, p. 549 
PUERPERAL  FEVER.
430
to the variola." *   The mode in which these several similar or differ-
ent poisons develop the disease called  child-bed fever  will  be ex-
plained when in a subsequent section we consider the essential nature
of this disease.
  But since, as already stated,  the  opposite opinion, or  that of the
non-contagiousness of puerperal fever, is strongly maintained by many
able physicians, it is but proper that we allow them also to speak.  The
most powerful and influential among these is Dr. C. D.  Meigs, who
writes as follows.  We quote: "I have  practiced midwifery for many
long years; I have attended  some thousands of women  in labor, and
passed through repeated epidemics  of child-bed fever, both  in town
and in hospital.  After all this experience, however, I  do not upon
careful reflection and self-examination find the least reason to suppose
I have ever conveyed  the disease from  place  to place in any single
instance.   In the course of my professional life I have made many
microscopic researches of child-bed fever, but did never suspend my
ministry as accoucheur on that account.   Still, I  certainly was never
the medium of its transmission."  This statement is indeed  remark-
able, but it is difficult with any conceivable amount of negative testi-
mony of this kind to  disprove the positive affirmative  evidence  of
many other equally  intelligent and no less trustworthy observers.
The following words  of  Spallanzani  are very much  to the point:
"It is the custom of certain dabblers  in  philosophy to deny facts,
however particularly described, and though related by persons of the
highest authority,  merely because their own endeavors (in the  same
direction)  fail  of success.  But they do  not reflect that this is acting
in direct opposition to the principles of sound logic  by wliich we are
taught that a thousand negative facts  cannot destroy a  single positive
fact."  Thus  the  entire sum and substance of  Dr. Meigs's testimony
is perfectly expressed in the last phrase  quoted from him:  he certainly
was not " a medium  of  transmission" of  such poison; but  this
amounts to nothing in disproof of others being such mediums.
  The full elucidation of this  most important practical subject  re-
quires an  additional  statement in  this connection.   The statements
already given—mostly in the veryT words of the unfortunate actors
in these domestic tragedies—which prove the  direct communication
of poison sufficient to cause child-bed fever, comprise but a very small
portion of those recorded in medical works;  these  prove what may
be  termed common communicability, by means  of which the poison
may be directly conveyed from  a variety of sources and under a great
               * Tyler Smith's Lectures on Obstetrics, p. 630. 
43G
POST-PARTUM DERANGEMENTS.
variety of circumstances.  The testimony of Dr. Meigs (and that of
others similar, if any such there be) must be regarded as anomalous
and as furnishing an example of most uncommon incommunicabilitu.
But as nature is never  one-sided, we shall find  in the recorded evi-
dence of medical men some corresponding anomalies on the opposite
side—some  still more remarkable instances of most uncommon com-
municability !   Thus, Dr. Merriman* states that he was present at the
examination of a case of puerperal fever at two P. m.  He took care
not to  touch the body.   At nine o'clock the same evening he attended
a woman  in labor; she was so nearly delivered that he had scarcely
anything to do.   The next morning she had rigors, and died in fortv-
eight hours.   Dr. Gooch relates the case of a general practitioner in
large  midwifery practice  who lost so many patients from puerperal
fever that he determined  to deliver no more for some time, but that
his partner  should attend in his place.   This plan was pursued for
one month, during which not  a case occurred in  their practice.   The
elder  then, being sufficiently recovered, returned to his practice, but
the first  patient he attended  was attacked by the disease and died.
Very  similar was the experience of the unfortunate Dr. Rutter, for-
merly  of  Philadelphia, as related  by Dr.  Meigs.f   This gentleman
" seemed to be tracked by the cause of the disease, to judge from the
numerous attacks of it in his lying-in patients.  He was charged with
being a carrier of contagion.   Worn  out with fatigue, and wounded
in spirit by his cares for the unfortunate victims of an epidemic dis-
ease, Dr.  Rutter left  the city for the purpose  of regaining  some
strength,  and to escape  from the repetition  of such disheartening
labors."   He spent ten 'days rusticating at a distance of thirty-five
miles  from the city, and on his return he caused his head  to be close
shaved, took a warm bath, dressed throughout in clothes entirely new
—leaving behind him even his pencil and his watch—and " went out
to attend  a lady in  labor, who had  a favorable  parturition, yet was
next day assailed by a horrible child-bed  fever, of which  she died!"
" Dr.  Rutter repeated this attempt at personal disinfection at a subse-
quent period, which was  two  years later, and met with the same ill
success."  Dr. Gordon of Aberdeen,  Scotland, one  of the earliest
writers on child-bed fever, says :  " I have abundant proofs that every
person who had been with a patient in puerperal fever became charged
with an atmosphere.of infection, which was communicated to every preg-
uant woman who happened t "> come within its sphere."   And  he ac-
          * Lancet, May 2, 1840.            f Child-bed Fever, p. 105. 
PUERPERAL  FEVER.
437
 knowledges that he was  himself the  means of carrying the infection
 to a great number of women.
   Reference has already been made to puerperal fever arising  from
 the poison of erysipelas; a few facts will  show the constant relation
 of these two forms  of disease.  The explanation of the cause of this
 relation will appear when we come to consider the essential nature of
 puerperal fever itself, in  the following section.   Dr.  Drake, in  his
 analysis of the several accounts  of epidemic erysipelas in the interior
 valley  of North America, states that pregnant, and  especially lying-
 in, females  Mere peculiarly liable to the erysipelatous inflammation,
 and the most fatal cases were the puerperal.  Dr. Corson,  describing
 a severe epidemic  of erysipelas which occurred in Norristown, Pa., in
 the autumn  of  1847, says: " Old and young, male  and female, fell
 before it, and yet there seemed to be one class that it preferred.   The
 mother, as she lay helpless and  exhausted  from the labor and agony
 of giving birth to her child, was marked as a victim.  The deadly
 poison  was  infused into  her  veins, and in many instances a few hours
 sealed  her  doom."   In  the latter  part of March,  1852,  epidemic
 erysipelas made its appearance  in  Palmyra county, Pa.; " few lying-
 in women escaped its attack, and the ratio  of  mortality  was quite
 large."  Of a  similar epidemic occurring in Montgomery county in
 the same year,  Dr. Geiger states " that it spared  neither age, sex, nor
 condition.   It  marked the parturient woman for its especial  victim.
 Not a single woman living within  the range  of the  disease who was
 delivered during Us prevalence escaped an attack." *   In the erysipe-
 las which prevailed as an epidemic in Dayton, Ohio, it was found  that
 women advanced  in  pregnancy were especially prone to  premature
 labor, and the period of  accouchement was looked to  by both patient
 and physician with the deepest anxiety and solicitude.  But one  par-
 turient woman within the range of Dr. Sutton's  information escaped
 an attack of puerperal fever; and every one that was attacked died.
  Thus we have  shown—1. That puerperal fever  may be directly
 communicated  from  one to another, through  the medium of a third
 person—especially the nurse or physician.   2.  That  it is very  sure
 to be thus transmitted by persons who have recently been engaged in
 making autopsies  of such as have died of puerperal fever and of
 peritoneal or erysipelatous inflammation.   3.  That it may  be caused
 by the  effluvia  from dissecting-rooms, from typhus fever, from  gan-
grenous and epidemic erysipelas and from  scarlet fever.  4. That no
amount of personal  ablution, changing clothes, etc., will always  pre-
               * Trans. Penna.  State Med. Soc, vols. ii. and iii. 
438              POST-PARTUM DERANGEMENTS.

vent such communication of poisonous influence, since even the blood
of the person acting a~ a medium is affected, and by the  breath a cer-
tain infectious influence is given out, which acts upon the blood of the
puerperal woman through her  lungs, and thus  carries to her svstem
the germs of the disease.  5.  From the various  facts of the  personal
experience of different physicians  it will  be  seen that some  persons,
like Dr. Meigs, seem to be incapable of thus absorbing and conveving
this kind of  infection, while others possess in a most remarkable de-
gree this unfortunate  faculty of retaining and imparting the poison
for months, and even years.
  These facts might be deemed to have been introduced with needles
prolixity, did they not suffice to exert a controlling influence  over the
conduct of the physician in such cases, and afford ground for the fol-
lowing admirable advice by Dr. Copland: "A  physician or  surgeon
engaged  in obstetric practice, upon the occurrence of puerperal  fever
in any of his cases, should either explain the matter to her friends,
and call  in a physician  not engaged in this practice, to whose care she
ought to be committed; or he should relinquish  the care of puerperal
females during his attendance  on cases of this form, or  even of ery-
sipelas;  or he should change all his clothes and  wash his hands after
seeing  cases  of either of these  maladies before proceeding to a puer-
peral female."  (This latter precaution would prove almost always
unavailing, as shown by the  cases above  given: fumigating himself
and his clothes with chlorine gas, and washing his hands,  even beneath
the finger-nails,  with  a solution  of chloride  of zinc or  carbolized
soap, would be more effectual.)
  " An obstetric  practitioner  should not  make  an autopsy of a case
of puerperal  fever, or of erysipelas, or  of peritonitis, or of diffusive
inflammation of the cellular tissue, of diseases occasioned by the ne-
croscopic poison, nor even attend, dress or visit any such cases, with-
out immediately afterward  observing the  precautions just stated, and
allowing two or three  days to elapse between  such attendance and
conducting engagements or visits to puerperal  females." *  In this
last paragraph the prohibition should  be deemed absolute,  since, if
they are violated, the  subsequently advised  precautions may  prove
most disastrously unavailing.
  Puerperal  fever runs a very rapid course, sometimes terminating
fataliy in a few hours;  in other instances, in  which the  uterus itself
is less  immediately involved, and the disorder assumes  more closely
the form of  a peritonitis, its duration is much  longer,  according to
                 * Dictionary of Practical Medicine, part xiii. 
PUERPERAL FEVER.
439
rhe treatment adopted.  But it  is important to be able to detect the
first symptoms of the disease, and to apply the appropriate remedies
in its earliest stages and on the very first appearance of the evil.
   II.  Essential Nature.—Although possessing a various and re-
markable local development, child-bed fever no less truly involves the
entire body in its  course,  since,  indeed,  it must  have  originated
from causes no less universal in their influence upon the economy of
the system.  Since  it appears  in persons of dissimilar  constitution,
and is developed under various  influences, it must necessarily assume
very different  forms, the principal of which  are briefly  mentioned
here in order to present a  clear view of the essential nature of the
disease, reserving their  more complete description to the subsequent
section on Symptoms.
   In child-bed fever, then, there may be—
   1. Inflammation of the peritoneal covering  of the uterus and of
the general peritoneal sac, constituting what is usually termed puer-
peral peritonitis.
   2. Inflammation of the  uterus, or  metritis; this may be either
inflammation of the  inner  wall of the womb,  endometritis, with or
without uterine phlebitis;  inflammation of the whole mass  or mus-
cular coat of the uterus, with ramollescence, and even putrescence of
its entire texture; or, finally, inflammation of the external peritoneal
stratum.
   3. Inflammation of and suppuration in the  uterine sinuses, whose
canals are converted into abscesses filled with pus.  In some of these
cases of  metro-phlebitis  the womb itself seems wholly  to escape,
while the suppurative process becomes very rapidly and insidiously
developed.
   4. Inflammation  of the  ovaries and Fallopian  tubes.   In  some
instances these uterine appendages have been  found very  much  dis-
eased, while the uterus  itself remained comparatively unaffected.   In
one remarkable case pus, discharged  into the abdominal cavity from
the free extremity of the Fallopian tube, was found to have occasioned
fatal peritonitis.
  That these varieties  of inflammation may occur  independently of
each other, has been proved by repeated post-mortem examinations,
but they are most frequently met with in different forms of combina-
tion.  Puerperal peritonitis seldom occurs without some degree of in-
flammation of the uterine appendages, but both these structures  may
be severely affected, while the muscular coat of the uterus and the veins
and absorbents remain wholly exempt from  disease.  In a similar 
440               POST-PARTUM DERANGEMENTS.
manner the vascular and muscular  tissues  of the womb are lij)le to
severe attacks of inflammation, without any corresponding affection
of the peritoneum  by which they are covered, although it more fre-
quently happens that inflammation excited  originally  either  in  the
veins, absorbents or  muscular  coat involves also  the peritoneum.
This form of inflammation  in the  vascular  and muscular tissues of
the uterus may be so  malignant as  to become fatal  even before thus
extending to  the peritoneal  membranes.  This  is important to  be
borne in mind, since absence of pain and  of tenderness in the abdo-
men does not preclude the possibility of a dangerous attack of child-
bed  fever.  In  cases  of uterine phlebitis, purulent matter may be
deposited not only in the veins of the womb, but in different parts of
the body, and even iu the lungs;  and in puerperal peritonitis  the
pleura and other serous membranes may sympathize with the perito-
neal inflammation.
  There can be but little doubt  in the mind of any one that the severe
and  varying phenomena which mark its inception, course and termin-
ation are  due to blood-poisoning—the  absorption into  the blood  of
some poisonous matter, whether animal or vegetable; and it seems to
be equally clear  and reasonable that this blood-poisoning  is first of
the  series of  phenomena, if not their real cause, and not secondary
and  consequent.  Dr. Stevens remarks  that  " this morbid condition
of the blood is decidedly the first link in the chain of those phenomena
which constitute  fever, for even before the attack every drop  of the
vital current is changed in its properties; and wherever  this deranged
blood  can circulate, there fever extends its  empire; for  the cause
which produces this disease is not confined to  a part, but  acts on every
fibre and in  every tissue of the living system; it disturbs every func-
tion  of the body and deranges every  faculty of the mind."  The blood
drawn in some cases resembled  that found in  severe cases of typhoid
fever.  The quantity  of fibrin  is increased, although the solids  are
generally  diminished in quantity; the red  blood-cells are decreased,
while the  white cells are  increased;  the extractive matter, lactic acid
and fat are increased, and there  are traces of bile pigment.
  Very strong ground has been  taken by some writers regarding the
identity of puerperal  fever and erysipelas, and Dr.  Churchill states
that  he has  observed that the children of mothers who have been at-
tacked by child-bed fever during the prevalence of epidemic erysipe-
las are very liable to be attacked by that disease.  The late Sir James
Simpson contended for the identity of puerperal and  surgical fever.
  III. Etiology.—The causes of  child-bed fever  may seem suffi- 
PUERPERAL  FEVER.
441
 ciently obvious  in many cases, but in numerous  other  instances they
 are decidedly obscure.  A natural and easy labor does  not necessarily
 preclude an attack, nor indeed are the majority of difficult labors fol-
 lowed by this disorder.   The particular influences which singly or in
 combination may lead  to  puerperal fever in any given case are not
 always assignable.   Sometimes this disease appears  to rise spontane-
 ously, and without our being able to attribute it to any causes what-
 ever.   In such cases, therefore, we are driven back to first principles,
 and compelled to seek in  some profound dyscrasia of  the individual
 constitution, or, in what may be nearly the same thing, some  hitherto
 unmanifested exhaustion of the patient's system,  for the efficient cause
 of an attack wliich may prove as rapidly fatal in its  termination as it
 was sudden and unforeseen in its onset.
  As shown in a previous chapter, all the various forms of constitu-
 tional dyscrasia may develop  themselves  during pregnancy, so also
 may they—till then held as it were in reserve—finally ultimate them-
 selves in still more dangerous manifestations  of disease immediately
 after parturition. There are cases in which these morbid influences  es-
 tablish themselves, even before the full term, in the form offebris gravi-
 darum (fever of pregnant women), which by its continuance after de-
 livery becomes entitled to the additional designation of et parturientium,
 and of those lying in.  Sometimes these morbid influences terminate
 the pregnancy before term, and thus destroy the child at the same time
 that they threaten the life of the  mother.  The  influence which epi-
 demic, traumatic and gangrenous  erysipelas, and the peculiar miasms
 of typhus and scarlatina, may exert in causing fever of lying-in women
 has already been sufficiently indicated in the examples  previously ad-
 duced.   And the epidemic influence of puerperal fever itself  in ex-
 tending its ravages is but too well understood.  And  all that is  meant
 by contagion, by the personal  transmission of the poisonous effluvia
 of child-bed fever by physicians and nurses from one  patient to an-
 other, is but a more direct and perhaps more highly concentrated de-
 velopment of what in its  diffused  form corresponds to  the same epi-
 demic influence.   Every animal poison  of a putrid  nature, like that
 from post-mortem examinations of persons who have died from puer-
 peral fever, as well as that from dissections  in  general, seems equally
 capable of establishing this peculiar fever in lying-in women.
  In some  cases  it  is evident that the direct  application of  such
poisons to the genitalia of parturient women by means of the  hands
of accoucheurs, or even the presence of such infected  persons  in the
lying-in room, has been followed in a very few hours ly the most nialig- 
442               POST-PARTUM DERANGEMENTS.
 nant attacks of puerperal metritis and metro-phlebitis.  Not less fatal
 were those cases of puerperal disease which resulted from receiving the
 infection of this malady imparted through the respiration of  persons
 who had indeed been exposed to the influence of this  disorder, but
 had not visited such  cases for days  or months, or even years, as in
 the case of Dr. Rutter and in the  instances above quoted from Drs.
 Merriman and Gooch.  In these cases certain individuals are shown
 to have been  endowed with the most unfortunate faculty of retaining
 and perpetuating in their own persons a  sort of concentrated miasm
 exactly corresponding to the general epidemic influence of this  disease.
 And even as the raw utero-placental surface  possesses  a wonderful
 faculty of absorbing the subtle poison locally approximated to it, so
 the tissues of the  peritoneum in the puerperal state seem endowed
 with a remarkable  susceptibility of becoming specifically inflamed by
 means of the  absorption into  the general system of the epidemic influ-
 ence of the same particular  poison, or of its personal influence as  im-
 parted by the respiration  of a person  whose  system has once  been
 charged with  it.
   Suppression of the lochia has been regarded as one of the most fre-
 quent  causes  of child-bed  fever.   But of the two most distinct  and
 most common forms  of this disorder, metritis and peritonitis, the
 former alone appears to be any more than incidentally connected with
 such suppression.   In cases of pure puerperal peritonitis the  lochial
 discharge will sometimes continue undisturbed, while in cases of in-
 flammation of the uterus, either in that of its interior surface or of its
 muscular  tissue, or of both, the  lochia  may be much diminished, or
 even entirely  suppressed.   And  yet in these latter cases the young
 physician will be most woefully deceived who  allows himself to  believe
 there is no child-bed  fever because he finds no particular swelling or
 tenderness of the abdomen.  Still,  suppression of the lochia by cold
 applications or by  styptic injections administered in cases of  uterine
 haemorrhage may very rapidly bring on phlebitis, and even gangrene
 of the uterus.  It would scarcely seem possible that styptic or  even
 cold injections could fail to  produce such a repulsion of the  lochial
 discharge as  would in effect  be  equivalent  to  its reabsorption.  In
 damp,  moist weather puerperal fever is found to  be much more preva-
 lent—in part  perhaps  from the more ready and penetrating diffusibil-
 ity of  the poison, and in part no  doubt from the general  debilitating
 influence of such weather upon the lying-in women themselves. Over-
distension of  the bladder, long-continued pressure of the fcetal  head
against the particular parts of the interior of the pelvis in difficult 
PUERPERAL  FEVER.
443
 labors and compression and even rupture or laceration of the uterus
 itself have been mentioned by different authors  as  capable of produ-
 cing child-bed fever.  " The presence of inflammatory ulceration of
 the cervix during the first stage of the puerperal period has appeared
 to me powerfully to predispose the patient to puerperal  fever.   The
 uterus seems to  retain a predisposition to inflammation in the  puer-
 peral state, even  in  the cases  in  which ulceration,  having existed
 (lurino- pregnancy, has been cured  (allopathically)  before parturition
 occurred.   I  have met with  repeated  instances of  puerperal  fever
 under these circumstances."—Bennett.  But such a result can hardly
 ever arise from these accidents unless there is present some additional
 miasmatic influence.
   Fragments of the placenta still adhering to the uterine parietes  and
 there decomposing may occasion utero-phlebitis.  In like manner the
 open  mouths of the uterine sinuses  may become the receptacles of
 poisonous matters originating in the uterus itself; or even the form
 of adhesive inflammation by which these sinuses are naturally closed
 may, under certain conditions presently to be mentioned, lead also to
 phlebitis, and even to  gangrene of the uterus.   But since in  many
 cases  the influences exist without producing such results, since even
 the decomposition of portions  of the membranes and of the placenta,
 occasioning an offensive lochial discharge, is  not always followed  by
 inflammation of the womb or any other form  of child-bed fever,  and
 since, as  already abundantly shown, this disorder will spring up ap-
 parently  from the slightest cause or from  no obvious cause at  all,
 the question arises, How are these discrepancies to be accounted  for ?
  With regard to those cases which arise from epidemic influence, or
 from any form of poisonous effluvia from without, nothing here  needs
 to be said, since evidently the puerperal state is one which renders the
 patient remarkably susceptible to all these influences.   But do we not
 even here approach the solution of the mystery of the sporadic origin
 of this disease?   That condition of a mass which  requires  but  the
 addition of a little external warmth in order to  set it on fire is  in no
 very remarkable manner different from that which presently leads to
 spontaneous combustion.   The exhaustion of the vital  forces, that
 which in  surgical language is  technically termed " shock," affords  the
 real clue to much that is  obscure and anomalous in puerperal  fever.
 Nature always puts her  best  foot foremost, especially in this matter
 of gestation and  parturition—the former a long-continued  and  all-
absorbing function, of which the latter may be an equally exhausting
crisis.  In some of these cases, where child-bed fever arises from no 
444
POST-PARTUM DERANGEMENTS.
external cause, and  proves rapidly fatal, we see  reason to believe in
such profound exhaustion of the vital forces as may lead to ramollisse-
mcnt, putrescence and gangrene  of the womb, when such  fatal degen-
eration has been only developed within a very few hours after dehyery.
To this final act of the grand function of reproduction are summoned
all the remaining energies of the entire system; the work is indeed
accomplished, but the instrument  is destroyed and the worker is  no
more!  The womb has been compelled to expend an amount of vital
force in a few hours which ordinarily might have supplied the whole
system for years.  Or is  it that these vital forces bear so near a rela-
tion to  electricity  that  their  excessive  development, through  the
nerves and muscles  and blood-vessels of the womb, is followed by a
disposition to  putridity similar  to that which is seen to take place
when lightning strikes the whole  body ? *  Such are the ideas asso-
ciated with the shock of lightning, and  not unlike  are the conse-
quences which follow such nervous " shock " as we have attempted to
portray.  What is most remarkable of all  is, that in some  of these
cases nature gives no signal of distress till she thus hauls down her
colors in sudden despair.  Similar  indeed is the case in some instances
of paralytic shock, in which the apparently strong man is struck down
in an instant and without a moment's warning.
   Such is the extreme pathological view  of what fortunately takes
place but seldom.   The  physiological condition which we  now pro-
ceed to describe is that which occurs in other cases in which the above-
described profound   exhaustion  does not  obtain.   Toward  the  one
great end of  sustaining the foetus in utero all the vital energies of the
mother's system have been for months determined.   In the fulnllmenl
of  this high use her own  health may  have been perfect  and hei
strength not overcome.  And even through the last critical act of tht
drama, that of parturition—in which  all  the muscles of her body and
all the nobler powers of her system are  called into action—she may
pass with comparative ease.  True, she is fatigued  and weakened by
such tremendous exertions.  But a few days of rest would make am-
ple amends for this, if this were all.  But it is not, for hitherto we
have given but a superficial picture of the physiological reality.  All
the mother's circulation and the entire economy of her nutrition have
been made to  assume one single  direction, and the great currents of
her life have but flown in unison with the lesser currents of the living
  * " In the most rapidly fatal cases nothing has been met with beyond non-coagulabil-
ity, thinness and blackness of the blood.  The blood in these cases resembles that of,
persons killed by lightning or by hydrocyanic acid."—T. Smith. 
PUERPERAL  FEVER.
445
 rorm within her.  At once all this is stopped, the vital union between
 the two is rudely severed, and the living streams, flowing as before  to
 supply the unborn babe, find  in their place only the emptiness of
 desolation, and are themselves wasted.
  The whole physiological life of the mother receives a shock which,
 if less fatally destructive than that already described as resulting from
 exhaustion of  the vital forces, still profoundly disturbs  her entire
 system.  But a few brief hours  before all her vital  energies moved
 on in vigorous  harmony, as a fair ship moves  on under the influence
 of a strong and favorable breeze.  But now all  is changed, the  cur-
 rent of her life is suddenly arrested, and her entire system, so far  as it
 had been engaged in  supplying the  young life within her,  comes to a
 sudden stand-still—in this respect resembling the condition of a  ship
 taken  aback in her course  by failure of the wind, or  rather when on
 the tack she  loses the wind and  the empty sails flap  idly against the
 masts, leaving her helpless and at the mercy of any adverse influence.
 The " shock" from exhaustion is as  if a  vessel struck upon a rock;
 this " shock " from sudden arrest of the great function of  nourishing
 the foetus in utero is like  that experienced by a vessel which, losing
 the wind and having no longer steerage-way, drifts  helplessly upon
 the waste of waters.  In the former class  of cases sporadic child-bed
 fever may be spontaneously developed in  the most malignant form of
 metritis and metro-phlebitis;  in  the latter, the slightest  breath of
 epidemic peritonitis, erysipelas, or of any  other of  the animal poisons,
 may suffice to kindle at once the  flames of puerperal fever.
  Having thus  at length shown  how subject the puerperal woman is
 to influences from without or from within her own body, which  may
 develop child-bed fever, it remains  only  to state what may  already
 have been foreseen, that in her helpless and peculiarly delicate period
 of transition from the energetic performance of the great function of
 nourishing the foetus  in utero, in  which she is safe as a ship at anchor,
 to that other and equally safe condition  into which she subsequently
 comes of nourishing her babe, as in  lactation,—during the whole of
 this transition state she is liable to be thrown into a fever which  may
 prove  a malignant puerperal metro-peritonitis, or assume any other of
 the  various forms common  to child-bed fever,  by any of the influ-
 ences above enumerated.  And the  same result  may also follow vio-
 lent mental  or moral  emotions.   This  latter class  of influences  is
 especially apt to be efficient in unmarried women,  and particularly in
cases of abortion.  In  such cases either  the violence of  the means
employed to bring about the abortion, or  the unsuitable t xternal  con- 
446               POST-PARTUM DERANGEMENTS.
 ditions and attendant circumstances, or the profound disturbance of
 the moral sphere by fear and grief, or  all these  combined, very often
 lead to fatal uterine and peritoneal inflammation.
   IV.  Symptoms.—The causes, phenomena and post-mortem results
 of puerperal fever have led  authors  to divide the disease into three
 forms—viz., 1. The inflammatory;  2. The contagious,  zymotic or
 malignant; 3. The  gastro-enteric.   These  divisions,  however, can
 scarcely avail in the treatment, especially to the homoeopathic prac-
 titioner, and it is even doubtful whether the last mentioned is entitled
.to be called puerperal fever at all.
   Yet while the homoeopathic physician will ahvays  seek  to give the
 remedy which most faithfully represents the totality of the symptoms,
 still, it will somewhat  conduce to  a  clearer understanding of this
 frightful  malady  if we  arrange its  more prominent symptoms with
 some reference to the three most common and. often distinct forms of
 the disease in which they may be expected to appear; taking note also
 of the  order of their  appearance, as  near  as  may  be, in the rapid
 development of the disease.
   The symptoms  may be local or constitutional; and in most cases
 the latter are the first to  make their  appearance.   And  their general
 character will usually indicate either the one or the other of the three
 principal  forms of child-bed fever—that in which the womb  is prin-
 cipally affectedy that in which the peritoneum seems to be the primary
 and  chief seat of the disorder, or that which is known by the name
 of uterine phlebitis.  In some  cases,  however, the symptoms, from
 whichever source first arising, appear  to involve all these structures
 as well as their adjacent organs nearly in an equal manner.
   In puerperal metritis, or that form of child-bed fever in which the
 uterus is  principally affected, the symptoms may vary in intensity
 and  malignancy in  the  most remarkable manner,  and  the  disease
 itself may rapidly involve also the uterine appendages  and adjacent
 peritoneal tissues.  The attack may begin before delivery or almost
 immediately after;  such attacks  are usually exceedingly malignant
 in character, and  inclined to run with  great rapidity to  a fatal ter-
 mination.   Usually, however, the disease begins on  the second, third
 or fourth day, although  it may occur  still later.  It may begin with
 distinct rigors,  or there may be merely an imperfect and  scarcely
 noticed chilliness.   The  pulse is very  rapid, full and  soft,  varying
 from 120 to 150, or even more.  In some  instances there is  neither
 pain, distension nor  tenderness of the abdomen;  in others the pain is
 very  acute  throughout,  the  distension enormous, and the tenderness 
PUERPERAL FEVER.
447
exquisite.  There may also be pain and tenderness at the epigastrium,
with nausea and even vomiting.  " Profuse sweating is a very com-
mon and distressing  accompaniment of this disorder.   In some cases
this is so strongly marked and constitutes so large a part of the disease
that Dr. Blundell described it as a distinct form of puerperal fever,
under the  name of  hydrosis.  The  sweat and the breath  arc very
often accompanied by a sweetish, pus-like odor.   The sweating  cf
puerperal fever does not diminish the secretion of urine, nor does it
abate the quickness of the pulse.  An intolerable thirst prevails, and
the patient drinks immense quantities of  whatever fluid she may be
allowed.  Dark  spots or ecchymoses  appear  upon the -wrists or other
parts of the body."  At first the lochia may be unaffected; they may
even be increased  in quantity, but more commonly they are entirely
suppressed.  The tongue is flabby, broad  and slimy, and covered  by
a mucous or creamy  coating.   The countenance is pale and inexpres-
sive, or, where the pain  is acute, anxious  and  covered  with  perspira-
tion.  As the disease advances, usually about the third  day,  diarrhcea
may supervene.  The  patient is nervous,  depressed and  fearful;  the
pulse is soft, small and increasing in rapidity;  the  respiration quick,
hurried, high and often  panting.  And where this latter symptom
occurs  in connection with excessive distension of the bowels, it must
be regarded as a very  bad indication, since the impossibility of prop-
erly oxygenating the blood where the lungs have so little play, and
the very rapidity of their movement—attempting to  compensate  by
the number of the respiratory motions for what they lack in amount—
combine to degenerate the physical organization and exhaust the vital
forces with the greatest speed.   The  abdomen  in many cases is swol-
len, tympanitic  and painful;  sometimes,  from the extension of the
inflammation  to the peritoneum, it is universally tender, sometimes
tender in a particular part only.  The lochia, if not entirely arrested,
are generally, after a  day or  two, changed  in  quality and become
foetid.  The flow of  milk is almost invariably checked ;  in the worst
cases sometimes it is entirely prevented; in other cases it is repressed
after the secretion has  taken place.  When any of the appendages of
the uterus are involved, such  as the ovaries or the Fallopian tubes, the
patient will describe a particular portion of the abdomen, on  one side
or the other, as  the  seat of special pain or sensitiveness to  pressure.
An examination per  vaginam will serve to point out these complica-
tions likewise.
  In an epidemic  of puerperal fever described by Dr.  Gooch  the
cases began a few days after delivery, and  the leading symptoms 
448               POST-PARTUM DERANGEMENTS.
were "diffused pain and tenderness, with some swelling of the abdomen
a quick pulse, which was generally at first full and vibratino-.   Some-
times it was small, but still hard and incompressible;  the skin was hot
though not so hot as in other fevers; the tongue was  white and moist
and the milk suppressed.   As the disease  advanced the belly became
less painful, but more swelled, and  the breathing short; toward the
end the pulse  was very frequent and tremulous, and  the skin covered
with a clammy sweat; even  in this  state the tongue continued moist
and the mind  clear, and death took  place  about the fifth day."  In a
subsequent epidemic which appeared in Paris the symptoms assumed
the typhoid form  from the  first,  beginning with  a  long and severe
rigor, often a few hours  after delivery;  pain very  intense over the
whole abdomen,  which rapidly became swollen;  pulse feeble, com-
pressible, undulating, often 150 ; respiration hurried,  anxiety extreme,
severe frontal headache;  countenance  sunk, pale, and  covered with
clammy sweat; constant  vomiting of green matters; purging, stools
foetid.  The patients sank rapidly at the end of a few days, or even hours.
There was  no  regularity in either lochia or milk."  In the commence-
ment of this form of child-bed fever the nervous svstem of organic life
and the blood * appear to be suddenly and seriously affected, as shown
by the general loss  of vascular tone and of nervous power, by the
disturbance of all the vital functions, by the rapid exhaustion of the
powers of  life, by the sudden  death which often  ensues, and  by the
accompanying softening and putrescence  of the womb, as  shown by
post-mortem  examinations.  " Inflammation  of  the muscular tissue
and lining  membrane of the uterus is characterized by great disturb-
ance of the nervous system, distressing cephalalgia, and is attended by
fever of low type.  Occasionally the cerebral symptoms are so  intense
as entirely  to  mask the uterine disease.   It is ushered in by the same
symptoms, as regards rigors, acceleration  of the pulse and state of
the tongue, as those which attend  the other varieties  of puerperal in-
flammation.   Its tendency is to produce  softening,  suppuration and
gangrene of the  substance of the uterus, and it is  one of the most
fatal of all the puerperal  inflammations."—T. Smith.
   In puerperal peritonitis, or that form  of child-bed fever in which the
peritoneum appears to be primarily  and principally involved, the dis-
ease may commence before delivery, but it is more apt to arise in from
twenty hours  to three days afterward.  Sudden rigors  usually consti-
tute the first obvious symptom, or there may be instead severe pain, but
  * " In some of the worst examples, pathology has found no other change than
fluidity and altered color of the blood."—T. Smith. 
PUERPERAL  FEVER.
440
rising of the pulse generally precedes them both; then follow heat of
the skin, thirst, flushed face and hurried respiration.  Next there may
be nausea, vomiting—which, by its spasmodic  contraction of the ab-
dominal muscles, greatly heightens the sufferings of the patient—pain
in the head and increased sensibility of  the abdomen.  In some  cases
the tenderness of the abdomen is contemporary with the rigors, or im-
mediately succeeds them.  The  weight of the bed-clothes is insupport-
able, and the  least movement of the  body is attended with exquisite
suffering.  Sometimes there are pains,  either slight or severe, contin-
uous or paroxysmal, which, beginning in  the hypogastrium or in one
of the iliac  regions, gradually extend over the whole abdomen.   But
while the excessive sensibility of the abdomen, aggravated by pressure
and motion, is characteristic of the peritoneal.form of child-bed fever,
the other distinct pains are not so constantly present.  As the disease
advances the  abdomen  becomes  still  more tender  and sensitive to
movement or pressure;  not only is the weight of the  lightest covering
intolerable, but the patient lies  on her back  with her  knees drawn
up, in order as much  as  possible to avoid tension and pressure of the
abdominal parietes.   As the disease makes still further progress the
abdomen becomes tumid and tympanitic.   This may be followed by
effusion into the cavity of the peritoneum indicated  by a  peculiar
doughy feeling.
  The  lochia are variously affected;  in  many cases this discharge
continues undisturbed, or  it may become  foetid, or diminished in
quantity, or entirely suppressed.  The  secretion of the milk  is much
more positively affected; if the attack begins before  the flow is estab-
lished, it is prevented; if afterward, the secretion is suspended and the
breasts become flaccid, and the patient may at the same time become
entirely indifferent to the fate of her infant.  Rapidity of pulse is cha-
racteristic of this disorder ;  its range varies from 120 to 160, and the se-
verity of the attack will be well measured by this symptom, since as the
disease advances  the pulse  becomes contracted, thready, intermittent
and toward the last almost imperceptible.  The tongue generally has
a whitish coating in the centre, with red around the edges;  sometimes
it is dry and brown in the  centre, with yellowish or white fur at the
edges.  There  may be nausea and vomiting of the ingesta, of bilious
green, brown or  black fluids;  and there  may also be diarrhcea, with
dejections dark and foetid toward the close of bad cases.   The urine is
generally turbid or high colored, scanty, and in some  cases passed with
difficulty.  The heat of the skin may often be not much  more than is
natural, but toward  the last the skin may become cold  and  clammy.
       29 
450
POST-PARTUM DERANGEMENTS.
The countenance will usually mark the advance of the disorder by
features  drawn up and expressive of great distress.  The dark areola
surrounding the eyes, the dilated pupil, the glassy surface and blood-
less  conjunctiva give a lustrous and unearthly appearance to the eyes
in all  cases of puerperal fever, whatever the special  complication
whenever the disease is fully formed.   The intellectual faculties often
remain unaffected  to  the last.
  Such are some of the most prominent symptoms which will appear
in different cases of this disorder, in different forms and combinations;
for while their variety is so great that all  do not appear in any single
case, scarcely any are constant, if we except the rapidity of  the pulse
and the abdominal tenderness.  This abdominal tenderness,  when the
substance of the uterus—metritis—alone is involved, is only  made out
under  such firm pressure as will bear  down the abdominal parietes
and make the pressure direct upon the uterus,  which is then found to
be extremely sensitive;  but in peritonitis  the slightest pressure upon
the abdomen gives  intense pain.
  In this, as in the  form of child-bed fever more immediately affecting
the uterus, the disorder runs a rapid course, and the vital forces are
manifestly  very weak, even in cases which do not appear to assume
the  lowest  or typhoid  symptoms.   In some cases, as already stated,
this disorder is transferred or extends to the pleural sac; still more
rarely  does  it involve the  serous membranes of the brain;  in either
case  the invasion of the inflammation will be  marked- by sharp, lan-
cinating pains, worse on motion.
  In uterine phlebitis, or at least in its earlier stages, the symptoms do
not seem to vary remarkably from those common to other forms of
puerperal metritis; in some cases there maybe a greater freedom from
pain, the pulse alone, ranging from one hundred  and ten to one hun-
dred and fifty, indicating the great danger.  This form  of disease, in
the  common and gross  pathology of the schools,  has been attributed
to reabsorption of purulent matter from the  utero-placental surface.
But, even if this be possible, it is probable that the mischief lies far-
ther  back and still  deeper, in a primary  disordered state of the blood
itself.  Puerperal  fever,  as  described  in its  more  malignant form
under  the  head of puerperal metritis, may destroy patients  in a few
hours,  even before there has  been  sufficient time  for the occurrence
of phlebitic inflammation; and in such cases, as already stated, no
pathological changes are  met with beyond a diseased state of the
blood.   And it is  to  this morbid  condition :>f the blood in a milder 
PUERPERAL  FEVER.
451
 form, and not to reabsorption, that we should  look for the real  cause
 of uterine phlebitis.
  Before this form of disease is so far advanced as to be indicated by
 objective symptoms, by external suppuration, it may be recognized,
 according to the following observations of Dr. Meigs, by the (subjec-
 tive) moral symptoms: " In peritonitis, pure and simple, the mind is
 clear, the nervous system not being  disturbed by the presence of pus-
 corpuscles in the blood; the woman recovers or  dies without  those
 hysterica], or rather  hysteroidal and even  maniacal, symptoms that
 invariably mark a purulent infection of the blood.   The alarm I wish
 to awaken in your mind  is one connected with the very great proba-
 bility that hysterical or  hysteroidal  affections,  in women recently
 delivered  and assailed with fever, are  really the exhibitions  of that
 curious  influence that  pus in the blood, or pysemia, exerts upon the
 nervous system.   In all the individuals, male or female, that I have
 attended in mortal illness from  wounds of veins in venesection, I
 have invariably noted this kind of hysterical  intoxication, caused by
 purulent infection of the blood.  As  the disease advances the  more
 palpable phenomena attendant upon the formation of  pus in the veins
 are developed  by the  deposit of purulent matter in various parts of
 the body, especially in  the vicinity  of the large joints.   We  find  in
 such cases swellings in  the  neighborhood  of the  articulations, ery-
 sipelatous blushes, and  large  suppurations in  the  vicinity of the
 joints, or patches of  slough or gangrene  form  at the  sides of the
 erysipelatous blushes."
  V.  Diagnosis.—There can be little real difficulty in distinguishing
 child-bed  fever,  in any of its various forms, from  any other disease.
 Its occurrence soon after delivery, the gravity of the symptoms and
 their rapid progress present a tout ensemble found in no other malady.
 And while the homoeopathic physician  will  always prescribe accord-
 ing to the symptoms and conditions present, without depending  upon
 the name by which the affection may  be characterized, still it  is of
 the highest importance that he should  recognize a case  of child-bed
 fever at the earliest  possible moment.   And  to  this he  will be im-
 pelled by the gravest considerations, that he may from the very first
afford to his patient that devoted and intelligent  attention which such
a case  requires,  perhaps more  than any other;  that he may make
sure himself of not becoming the medium of transfer of the puerperal
poison from  one  patient to another; and that he may secure himself
from suspicion of ignorance and incompetency.
  In most cases  of child-bed fever, as shown  in the preceding pages, 
452               POST-PARTUM DERANGEMENTS.
the disease will be ushered in either by rigors more  or less distinct
or by serious acceleration of the pulse.  For the appearance of either
of these symptoms the physician  should  therefore be  on  his guard
especially  if he has reason to suspect the possible  presence of the
epidemic influence of puerperal peritonitis,  of erysipelas,  or of any
other of those  influences already described as  capable  of developing
fever in the puerperal state.  He should make sure that the nurse is
intelligent enough to inform him at once if rigors, or even chilliness
appear;  and he should himself carefully observe the pulse  at every
visit.   As long as this is below one hundred the patient is compara-
tively  safe, but  when it suddenly rises above one hundred  there is
serious reason to apprehend the onset  of child-bed fever, if it be not
already  insidiously at work within  the pelvis.   And in fact any
severe symptoms arising  in  the  puerperal  woman should  at  once
command the  most careful attention.  The pains of peritonitis may
be distinguished from the  after-pains  by observing that the latter are
attended  by a  perceptible contraction of the  uterus,  and that the
after-pains  are diminishing about the time—the  third day—when
the pains of puerperal peritonitis  make their  appearance; and that
the last are particularly aggravated by  pressure and  motion, and that
they become more  and  more  severe.  In  like manner it  will be
observed  that  in child-bed fever  the  constitutional disturbance and
hypogastric tenderness, and even the acceleration of the pulse, con-
stantly  increase day by day,  instead  of subsiding, as  would be the
case were these symptoms dependent  upon after-pains or hysteralgia
alone.
  VI. Course and Tendencies.—Child-bed fever in either of its
forms runs a very rapid course; it is capable of terminating life in a
few hours, or it may continue for several days, more or less, according
to the nature of the patient's system, to the particular character of the
attack, and  to the kind  of  treatment employed;  that form of the
disease  proving  most rapidly fatal in which  there  is a profound
" shock " of the nervous system; that in which the vascular system is
so disorganized as to induce softening and putrescency of the uterus
coming next in order of  sudden  fatality; then the low, adynamic
form  of metritis or  malignant  child-bed fever; then the  primary
puerperal peritonitis ;  and finally uterine phlebitis.
  The general  tendency of the disease is to a fatal termination, unless
arrested by  efficient treatment;  but this tendency pursues in different
cases a variety  of courses:  in some the nervous system is " shocked "
and destroyed; in others there is  " dissolution of the blood," which 
SPURIOUS PERITONITIS.
453
may destroy life at once; in others there is  disorganization of the
tissues; in others, finally, the vital forces are exhausted by the intense
suffering, by the gradual loss of oxygenation of the blood inseparable
from excessive tympanites, and  by the general  severity of  all the
symptoms.
  VII. Treatment.—In treating cases  of puerperal fever it is of
the greatest importance to regard the moral state of the patient, both
in the selection of the remedy  and with  reference to securing her
against all disturbing emotions.  The room should be as quiet and
as cheerful and  pleasant as possible; the diet should  be carefully
regulated; cooling  drinks should be  freely allowed ; and the utmost
cleanliness and purity of the patient's person,  her clothing  and bed-
clothing, and the atmosphere,  should be  observed.   The medicines
specially adapted to the treatment of this grave disease will be found
laid down under the article on Metritis.

                    Spurious Peritonitis.
  Some authors have described under the title of false or spurious
peritonitis an affection occasionally met with in puerperal women,
which in  many of its symptoms bears a  close resemblance to child-
bed fever, and more especially to the peritonic form of that disease.  It
occurs mostly in women of nervous temperament, who are " delicate "
and inclined to hysteria.   The pain, which  is or appears to  be very
severe, is located by the patient in the  region of the. womb and its sur-
roundings,  but  is probably seated in the muscular wall of the ab-
domen, or  in the musular fibres of the  intestines.   Although  there
may be evidences of a febrile condition, such as dry mouth, quick and
jerking pulse and dry skin, yet the affection is evidently unconnected
with inflammatory action,  and  is  probably entirely neurotic in its
character.   The pain is described as unbearable and excruciating,  so
that the patient cannot  bear  even  the   most gentle touch  or the
pressure of the bed-coverings, and  there  is great mental excitement
accompanying.
  It is important that this affection should be  distinguished from true
puerperal peritonitis.   Its nervous  and hysterical character is made
apparent if, by withdrawing the patient's  attention from the  seat of
pain by persuasive conversation or other means, considerable pressure
can be made upon the abdomen by the hand without exciting  remon-
strance or increasing the suffering, and upon directing  the woman's
attention to her trouble the extreme pain and sensitiveness to pressure
returns.  Dr. Rigby thus writes: " If by soothing words and prom- 
45 4               POST-PARTUM DERANGEMENTS.
ises of cautious proceeding we induce her to let us apply our hand
upon the abdomen so gently that it does not even rest its weight upon
it, we  shall find that we may now  gradually increase  the pressure
until by degrees it becomes considerable, not only without her feelino-
any increase of pain, but with complete relief, the pressure of the
hand appearing, as it were, to benumb the pain.  If we withdraw the
hand in the same gradual manner, no pain will  be produced, but if
we remove it suddenly, a spasm of the  muscles, with intense pain, is
instantly excited."   It  is stated that this disorder may pass into a
grave form of  inflammatory disease, but this  can scarcely happen
under judicious homoeopathic treatment.
  A great variety of remedies may be indicated by the symptoms
belonging  to  this strange  disorder, and principally Apis., Acon,,
Bell., Cham., Coff.,  Cimicif.,  Coloc,  Cup.,  Gelsem., Hyos.,
Ignat., Ipec, Kali  a, Lach., Nux v.,  Opium,  Phos., Puls.,
Spigel., Verat. vir., Zinc val.   The article on Metritis may be
consulted with advantage.
                     CHAPTER  XXIII.

      POST- PARTUM DERANGEMENTS.—CONTINUED.

                      Puerperal Mania.

    ALTHOUGH puerperal mania is of itself seldom a fatal disease,
     there is none in the catalogue of maladies to which the pregnant
and parturient woman is exposed more varied or more distressing, and
at times alarming, in its phenomena.  It is  liable to  occur during
pregnancy, to set in suddenly and  without any apparent cause during
labor, or to  manifest itself subsequent to  delivery.   There are, how-
ever, two periods during which the child-bearing woman is especially
liable to its occurrence—viz., immediately  after parturition and before
the system  has  had time to  recover its  tone, and  secondly, during
lactation.  Esquirol*  observed that of  ninety-two women affected
with puerperal  insanity who were  admitted into the Salpetriere, six-
teen were attacked from  the  first to the fourth day after delivery;
twenty-one  from the  fifth to  the  fifteenth day; seventeen from the
                        * Des Maladies Mentales. 
PUERPERAL  MANIA.                     455
sixteenth to the sixtieth; nineteen from the sixtieth day to the twelfth
month of lactation; nineteen after weaning.   In regard to the  fre-
quency of its occurrence, Dr. Haslam reports eighty-four cases out of
sixteen hundred and forty-four insane women admitted at Bethlem
Hospital; Esquirol  reports  ninety-two cases out of eleven hundred
and nineteen admitted at the  Salpetriere;  Sir James Y. Simpson
states that " the  statistics of insanity appear to  show that about ten
per cent, of all the females found in lunatic asylums have become the
inmates  of these institutions in consequence of puerperal mania." " Of
eight hundred and eighty-one women admitted  to the Dixmont Hos-
pital for the  Insane at  Pittsburg, Pa., the  cause of insanity in  one
hundred and eight cases is ascribed to the puerperal state, constituting
about twelve  per centum of all the females who became inmates of
this institution from 1856 to December 1, 1871.  Of two thousand
one hundred  and thirty-three women  admitted to the Pennsylvania
Hospital for the Insane at Philadelphia, the supposed cause of insanity
in one hundred  and eighty-five cases, or about nine per centum,  was
conditions superinduced by the  puerperal state." *
  The  pathology of  puerperal  insanity is   quite  obscure.   Some
authors  have regarded it as a  true phrenitis—inflammation of  the
brain and its meninges—while others maintain  that it is due solely to
exhaustion and the irritation consequent on the puerperal period.   It
is probable that there are various causes, both remote and proximate,
which give rise to this disorder, the system being peculiarly suscept-
ible to impressions  during the parturient and post-partum  period in
consequence of its general depression ; the discrepancies of the various
writers being accounted for by a want of proper discrimination  in the
results of their necroscopical researches.   Amongst the predisposing
causes we may  mention  hereditary disposition to insanity, frequent
child-bearing,  anaemia  and  exhaustion, albuminuria,  excitation  of
the sexual system, puerperal convulsions and  puerperal  fever.   The
proximate causes may  be divided  into physical, such as  prolonged
and difficult labor, injuries  from instrumental delivery, flooding, etc.;
and such moral  causes as have a tendency to  excite  or depress  the
mind,  as  fright, fear,  joy,  grief,  anxiety, etc.  It often  happens,
however, that cases  of insanity occur in which no  cause, either occa-
sioning  or exciting, can be  fairly made out.   Many  authors, Gooch
more especially, contend  that the  probability of a recurrence of the
insanity in future labors is very  remote, while others, on the con-
trary, assert that an attack, instead of giving immunity against  future
   * Dr. J. C. Burgher, in Transactions American Institute of Homoeopathy, 1872. 
456
POST-PARTUM DERANGEMENTS.
attacks, seems rather to render the woman more liable to a recurrence
of the malady.   The writer is cognizant  of an  instance in his own
practice in which four consecutive pregnancies were followed by puer-
peral insanity of varying duration.
  Cases of puerperal mania may be divided into two classes, each of
which may vary as to time and cause of its appearance. These may
be termed acute mania  and melancholia, the first being characterized
by  a high degree  of fever, violent delirium,  great  general disturb-
ance  of  the  system and  all  the  indications of acute inflammation
while the other is marked rather by a depressed  physical and mental
condition.  " The former occurs either immediately after delivery or
at the commencement of lactation; the  latter more often after  suck-
ling has been continued some time, and where the patient is becoming
debilitated by it.   The one is  acute, both in its onset and progress,
the  other  insidious  and  protracted.  Death  is  not  an  infrequent
result of the  one, but it seldom happens in the other."—3Ieadows.
  Symptoms  of Acute Mania.—The  symptoms of this disorder are
very variable and run through all the varied phases of insanity.  The
attack is usually ushered  in by premonitory symptoms.  Dr. Haslam
asserts that " the first symptoms of its approach after  delivery  are—
want of sleep, the countenance  becomes flushed, a constrictive pain is
often felt in  the  head,  the  eyes assume a morbid lustre and wildly
glance at objects  in rapid succession;  the  milk is  afterward secreted
in less quantity, and when the mind becomes more violently disor-
dered it is totally suppressed."  This succession of symptoms is, how-
ever,  not observable in every case; and the patient  may even jump, as
it were, from a condition of sanity to  one  of insanity without any
noticeable warning.  Insomnia, irritability  of temper, pain in the
head, restlessness, anxious expression  of countenance, occasional loss
of memory and  consciousness, may be enumerated  as amongst the
most constant symptoms of the earlier stage.  The patient may either
sink into obstinate sullenuess, occasionally  interrupted by violent out-
bursts of passion, or she may become furiously maniacal and threaten
destruction to all around  her.  " The face is  pale, features pinched,
pulse small, irritable and  usually  accelerated;  the temperature of the
body rather below  the  normal standard;  skin often clammy; with
great debility  she  is blatantly noisy; stares wildly at imaginary
objects;  instead  of  answering a question she  repeats  it, or she
talks incoherently,  uttering  her   words  with  great rapidity.  She
picks at the  bed-clothes,  grasps at anything or any one about her;
curses and swears; objects to being confined  to bed; complains oft 
PUERFERAL  MANIA.
457
 being watched, and tries to escape.   Occasionally obscene  language
 and  lascivious actions are  indulged in to  an extent that excites our
 amazement.   Masturbation is  sometimes noticed, but probably more
 from a wish to allay irritation  than a desire to excite it.   The obscen-
 ity of word  and manner often continues until  convalescence  is well
 advanced. She imagines that some calamity has befallen her  husband,
 or that her babe is dead or has been stolen ; and if brought to her she
 says it is not hers, refuses to nurse it, and  even attempts to  kill it if
 left  within  her  reach.  Sometimes  she is impressed  with  the idea
 that her husband is unfaithful, and has conspired with others  to poison
 her.   Confidence and  affection  give  place to suspicion and hatred.
 Sometimes she will manifest great anxiety with regard to herself—fears
 that she will die, thinks that she has been poisoned, that she is flood-
 ing  to death, that her blood  has turned to water,  etc.  Suicide is
 often attempted by violently throwing herself on the floor, attempting
 to jump from a window, strangle herself with a handkerchief or cap-
 string, etc.;  the evident result of an abstract impulse without method
 or premeditation. She refuses  to eat;  the tongue is coated; the bowels
 usually constipated, the secretion of urine  diminished and the lochia
 sometimes suppressed." *
   The Diagnosis of this form of puerperal  mania is readily made.
 Gooch very properly observes  that the history of the case is  essential
 to the forming of a correct diagnosis, but when this  history is taken
 into  consideration, and the phenomena above described, or other symp-
 toms indicative of insanity, are  observed, the nature of the disorder
 becomes apparent.  Nevertheless, the disease  may be mistaken for the
 delirium occurring during fever or acute phrenitis, or even for that
 of mania-a-potu.  In cases,  however, where any doubt as to the nature
 of the malady obtrudes itself,  a very searching examination and com-
 parison  of symptoms and  conditions will  set the matter in its true
 light. The Prognosis is not unfavorable. Dr. Burrows had thirty-five
 recoveries out of thirty-seven  cases, while Esquirol had but fifty-five
 out of ninety-two.  The statistics furnished by old-school practitioners
 show about seventy-five per cent, of recoveries from this form of the
 disease.
  Symptoms of Melancholia.—This form of puerperal insanity differs
 very  materially from that just described.   It  is usually characterized
 by debility  and anaemia,  and is generally occasioned by the  drain
 upon the  system in consequence  of profuse  haemorrhage during or
subsequent to labor, or of lactation.   The  face is pale, and the coun-
                      * Dr. J.  C. Burgher, loc. cii. 
458
POST-PARTUM DERANGEMENTS.
 tenance has  an  expression  of the deepest  dejection.  Tin  patient
 usually sits quietly, and although she will speak when spokei to, and
 answer questions, generally originates  no  conversation and o-i fes ex-
 pression to no wants or desires.  The pulse is usually nearly i. ormal •
 the temperature somewhat below that of health ; the tongue is gener-
 ally coated, the bowels  constipated and digestion impaired.  The de-
 rangement occasionally takes  the  form of religious melancholy  in
 which case she deplores her sinful condition  and speaks in the most
 despondent  manner of her  soul's salvation.   "In a case recently
 occurring  in my own  practice," writes  Dr. Burgher, "the patient
 argued that her own damnation was necessary to secure the salvation
 of the  other  members of her family; and yet she manifested an in-
 difference  toward her husband and a dislike toward her children,
 whom she would order  from her presence, and even refused to uursi
 her babe."   There is usually an  entire absence of anything like ex-
 citement, the patient, on  the contrary, being in a state  of decided
 mental  depression.  Gooch  says  that there is an incipient stage,  in
 which the mind  is  wrong, yet right enough to recognize that if is
 wrong;  and in these respects it differs from acute mania.
   The  course of  this form of mania is generally more tedious than
 that of the acute form, and there is  some danger of its becoming
 chronic; but this  sad termination very seldom  results, the  restoration
 of the best physical health and strength  being followed by the res-
 toration of mental and moral health.  It seldom or never ends fatally.
 Women who have an hereditary tendency to  insanity are most ob-
 noxious to this disease;  and it is  likewise  apt to occur where hysteria
 has manifested itself during  pregnancy, especially during the  latter
 months.                                       ,
   The Treatment of  puerperal mania requires  the  exercise  of a great
 deal of  common sense and sound judgment. All sources  of irritation
 should be removed if possible;  appropriate medicines should be given
 according to the indications afforded, and such diet and regimen pre-
 scribed  as  would  be best calculated to support  the  strength of the
 patient  and bring her  into the  most favorable physical  condition.
 Especially in the second  form of the disease—melancholia—the patient
 being in a condition  of anaemia and debility, a good and nourishing
 diet is of great importance; and  in both  forms of the disease  every
effort should be made to  secure for the afflicted patient such surround-
 ings as have a tendency to calm the disordered nervous system.  She
should  have a suitable  attendant, and  should never be  left alone;
and everything by which suicide might be effected should be carefully 
PUERPERAL  MANIA.                    459
 kept  from her.   It  may even be necessary to  resort to forcible re
 straint, but this should be avoided if possible.   If absolutely required,
 the "strait-jacket" should be used.  Out-door exercise, other things
 agreeing, should be taken daily during favorable weather, and will be
 found beneficial, as will appropriate baths.
   The following  medicaments will  be found  of service, according to
 the indications given, though many others not here enumerated may
 be used, either for the disordered mental condition or its accompanying
 physical  derangements.  The remedies with their  indications men-
 tioned in the articles  on Nymphomania, Hysteria and  Metritis may
 also be consulted with advantage.

   Aconite. AYhere there is  much fear manifested—fear  of death, of
 strangers, of getting up; if caused by a fright.
   Aurum. Very  unhappy; continual thought  of suicide;  manifest
 weakness of memory and intellect;  great sleeplessness day and night.
   Belladonna. Desire to escape or hide herself; paroxysms of rage and
 fury; sleepless nights; fear of ghosts ; sometimes desires other people
 to kill her, that she may be out of her misery; much moaning.
   Hyoscyamus. Indomitable rage and  horrid anguish ; does not know
 her relatives; complains of having  been poisoned;  complete loss of
 sense; desires to be naked; constantly throwing off  her bed-covers or
 clothes; entire loss of modesty; fear  of being poisoned.
   Kali carb.  Great sadness; weeps much, and is afraid she is going to
 die; great absence of mind;  seems  at a loss to know how to begin to
 say or do what  she wishes to do;   makes  several attempts, but is
 finally obliged to  give  it up;  can't  express  herself; abdomen dis-
 tended with flatulency;  thirst, restlessness and tossing.
   Petroleum. Full of strange delusions, as—thinks  there is another
 baby  in bed  with her  requiring attention, or that she has a third
 leg or arm; has  sharp pains shooting up the dorsal spine into the
 occiput.
   Platina. Has a sort of voluptuous crawling up and about the genital
 organs; very haughty; looks down very disdainfully upon her attend-
 ants ;  black, tarry discharge from the  vagina.   Horrifying thoughts.
   Pulsatilla.  Sad, weeping mood; taciturn; very mild and gentle in
 all her ways; weeps very easily.   When closing her  eyes sees pictures
 and all sorts of strange sights; hears all kinds of operatic airs. Sleep-
 lessness during early part of night.
  Stramonium. Nymphomania, with obscene  gestures  and language.
Desires light and  company;  much  worse  in  darkness and solitude; 
460               POST-PARTUM DERANGEMENTS.
 very loquacious, in a prayerful, beseeching,  imploring  language • face
 often red and bloated.   She is fearful and full of strange notions.
   Sulphur. Disposition to meditate on religious  subjects, with despair
 of salvation; forgets the names  and words  she wants  to use; flushes
 of heat; weak,  fainty spells and cold feet;  sleeps very lightly.
   Veratrum.  Religious melancholy or nymphomania,  with  desire  to
 embrace everybody, and even inanimate substances;  much thirst for
 very cold water; constantly craving cool and refreshing things.
   Zincum.  A  marked degree  of melancholy, with fear of thieves,
 demons and other frightful figures.  It seems to be impossible for her
 to keep the feet still;  they are in almost constant motion.
   For other  remedies see Nymphomania, Hysteria and  Metritis.

                      Phlegmasia  Dolens.
   There is no disease in Che catalogue of those to which child-bearing
 women are liable  concerning  the aetiology  and pathology  of wliich
 greater diversity of opinion has  been expressed by various writers,
 and  even  at the present  day no  satisfactory conclusions have  been
 arrived at.  It  was  formerly  regarded as  peculiar to  the  lying-in
 state, but this view is by no means  correct, for it not unfrequently
 occurs at other times than after  childbirth,  attacks even men, and  is
 not confined to the lower extremities, the upper being occasionally the
 seat  of the disease.  Necroscopical  research has shown  that there  is
 usually free serous effusion into the limb, inflammation  and sometimes
 suppuration of the lymphatics, and occasionally a plugging up of these
 vessels by  plastic lymph, and inflammation  and obliteration of some
 of the larger veins of the extremity.  This last-named is apparently
 the most important  and certainly the  most constant  condition, and
 has given rise to the opinion that the disease consisted essentially  in
 an inflammation of the crural veins, proceeding, as Dr. Robert Lee
 believed, from the  uterine branches of the  hypogastric veins.   This
view, however, has been stoutly  combated by Rigby, Mackenzie and
 others.   It occurs after easy as well as difficult labors ; sometimes re-
sults from  puerperal  fever;  most frequently attacks the  left leg, and
 occasionally recurs  many times in the same person.
   When fully developed  in parturient women, it usually consists in a
swelling of the affected extremity, especially of the thigh, the  skin
being somewhat whiter  than usual, tense and shining, and  very sen-
sitive of even slight pressure;  but the swelling is not anasarcous and
does not pit on pressure.  An attack is usually ushered  in  by slight
 rigors and  febrile phenomena;  pain in the lower part of the abdomen 
phlegmasia dolens.                   461
 follows, which extends to the hips  and back, passes  under Poupart's
 I i'--anient, and thence down the thigh and into the calf of the leg.  It
 frequently, however, proceeds from the calf of the leg upward.  The
 whole  extremity becomes  excessively swollen,  hot and  painful, but
 not red, and hence the term phlegmasia alba dolens.   The lochia and
 milk may or may not be suppressed;  the constitutional disturbance
 and fever become greatly increased.   The  tenderness on pressure is
 most marked along the course  of the femoral vein, and  the veins  of
 the affected  region, together with the associated  lymphatics, may be
 felt to be hard and cordlike, and are sometimes marked out by a faint
 red line.   Denman describes  the on-coming of  the disease in the fol-
 lowing terms:  " Before the appearance of any swelling or sense of pain
 in the limb about to be affected, women become very irritable, with a
 sense of  great weakness, and  grievously oppressed  in  their spirits,
 without any apparent sufficient reason, complaining only of transient
 pains in the region of the uterus;  and from these the approach of the
 disease has  been  frequently foretold.  After a  short time they are
 seized with an  extremely acute pain in the calf  of the leg, extending
 to the inside of the heel,  and then, observing the course of the lymph-
 atics, stretching up to the ham, along the internal part of the thigh to
 the groin, occasioning a slight soreness on. the lower part of the abdo-
 men."  It occasionally happens, however, that there are no premoni-
 tory symptoms, but the pain  in the leg is the first indication of the
 disease, which rapidly becomes swollen, tense,  stiff and excessively
 sensitive to the touch.
  As before  remarked, the swelling does not pit on pressure, and if
 it be punctured  little or  no  fluid escapes.  Although  the pain is
 greatly increased if the limb  be allowed to hang down, the swelling
 is not affected  by position.   The  progress  of the disease is usually
 very rapid, especially as regards the swelling, which frequently arrives
 at its height, doubling the  size of the limb, in twenty-four hours, or
 even in a shorter period of time.   As the disease advances the parts
 lying within the pelvis become more and more irritable; there is often
 difficulty  in evacuating the bladder and rectum, and the constitutional
 disturbance  is  very  great.   The  glands in the  groin are sometimes
affected, and become swollen and even suppurate, and abscesses may
 form in very bad cases in different parts of the limb.
  This condition of the parts and of the system  may continue  for a
longer or  shorter period.   Sometimes after two or three days the con-
stitutional symptoms subside, the  pain is greatly lessened  or almost
entirely disappears,  while  the limb remains swollen, though  softer 
462               POST-PARTUM  DERANGEMENTS.
and  apparently cedematous, as it now retains the impression of the
finger.  Sometimes this does not take place for one or more weeks.
Even after this subsidence of acute symptoms, however, the  limb
remains for a long time stiff and powerless, and occasionally does not
return to a  normal  condition for  months, and even years.  Burns
remarks that it is not generally a fatal disease, " but it is tedious and
often accompanied with  hectic symptoms.  Death, however, may  be
caused by suppuration or gangrene; or by exhaustion proceeding from
the violence of  the constitutional disease; or by exertion made by the
patient, which has sometimes suddenly proved fatal; or, after the lew
appears to be getting better, daily shivering with vomiting, pain in other
parts, and rapid pulse, with delirium  (pyaemia), precede death."  The
prognosis,  however, may  be regarded as favorable  especially under
homoeopathic treatment, the remedies used  being specifically adapted
to the whole condition, and the strength of the patient not wasted
by severe medication and depletion.
  The older writers associated this disease  with a disappearance and
"translation" of the lochia or  milk.  Dr.  Hosack regarded it as an
inflammatory disease, affecting not only the limb but the whole system,
proceeding from suppression of the  natural excretions, the effect  of
cold stimulating drinks  aijd  other  causes, and not connected  with
the lochia.   Dr. Tilbury Fox  is of the opinion that both veins and
lymphatics are obstructed, which is due  simply to  extrinsic pressure
or to inflammatory changes  in the coats of the vessels,  leading to
coagulation and depending upon virus action.
  Treatment—The diet should of course be low and non-stimulating
during the period of high inflammatory action and great constitutional
disturbance,  but when resolution has fairly  been  established more
generous food may be given with advantage.  If abscesses form, they
should not be treated according to ordinary surgical rules.   No lah-
cing.  The following are the most frequently  indicated medicines for
the treatment of this disease, with their indications:

  Apis. Fever, with constant  restlessness and tossing without relief'
absence of thirst; scanty urine; the  swelling has a whitish, transpa-
rent look;  the pain is usually stinging or there  are sharp  plunging
pains.
  Arnica. If  the disease  sets in immediately after  a  very  difficult
labor, particularly if she  feels  bruised and  sore.
  Arsenicum.  Great  restlessness, every motion producing a sensation 
phlegmasia  dolens.                    463
of exhaustion; thirst for frequent sips of cold water; cold and chilly ;
wishes  to be  covered  up warm;  burning  pains;  swelling pale and
cederaatous.
  Belladonna.  Cutting  pains as if with knives; sensation of heaviness
in the thighs,  hypogastrium and sexual parts; the least jar of the bed
or floor is painful; fever, with burning thirst;  cannot bear to  be
touched; much moaning and sleeplessness; throbbing of the carotids;
injected eyeballs;  cannot bear noise or light.
  Bryonia. Drawing or  lancinating pains  from  the hip to the foot;
aggravation from touch or the least motion;  copious perspiration
without relief; pulling in the abdomen and down the legs as if the
menses would appear; a pale  pink  swelling of the leg; dry lips and
mouth, with desire for large quantities of cold water;  aggravation in
the evening and early  part of the  night.
  Calcarea carb. A whitish swelling of the  foot and leg, with a sensa-
tion of coldness, as though covered with a cold damp cloth; suppres-
sion  of milk, with a sensation of coldness  all through  the  body;
leucophlegmatic temperament; menses have always been too frequent
and too profuse.
  Kali  carb. Swelling of the foot and leg, with stitching and shooting
pains;  shooting and stitching  pains in  the abdomen;  abdomen dis-
tended  with flatulency; distressing pain in the back, extending down
into the glutei muscles;  restlessness, with tossing and thirst.
  Nux  vomica. Red swelling of the leg  with dark, painful  spots; a
powerless, bruised sensation in the leg; a bruised, sore sensation low
down in the abdomen, with frequent  desire to urinate and  frequent
inclination to  stool;  loss of appetite;  aggravation  after three o'clock
in the morning; great depression of spirits.
  Pulsatilla. Pale swelling in the  foot and limb;  suppression  of the
milk;  mild, tearful, gentle disposition;  a warm room aggravates all
her sufferings; craves the  fresh, open air; thirstless;  a  very offen-
sive clammy taste in the mouth, particularly after sleeping.
  Lycopodium. Swelling  of the foot and limb; the  saphena vein is
swollen very large, and it is very tender, and can be distinctly traced
all the  way up; there is much loud  rumbling and moving of flatu-
lency in  the  abdomen;  red  sand  in the urine;  pain in the back
before urination;  much  restlessness and tossing at night.
  Rhus tox. At the very outset of the disease there is a marked  de-
gree of powerlessuess in  the limb; cannot draw it up;  there is often a
red streak running up the  course of the saphena vein; great restless-
ness,  relief being found  for a short time after every change of posi- 
464
DISORDERS OF LACTATION.
tion;  worse after  twelve o'clock  at night; worse from water  and
wetting the part; usually wants to be covered up warm.
  Sulphur. Frequent flushes of  heat;  weak,  fainty spells; short
sleeps, from which she starts  up wide awake;  little papular eruptions
on the leg and over the body.  (For other remedies see Metritis.)
                     CHAPTER  XXIV.

                DISORDERS  OF LACTATION.

   THE only injurious effect of pregnancy upon the milk of the nurs-
    ing mother is to render it less nutritious; consequently, the nurs-
ling must suffer for want of that nourishment which would otherwise
be devoted to its support; it feeds, as it were, upon the  husks, and
of course it becomes sickly and loses flesh.

                          Sore Nipples.
  It is best to make preparation for nursing, so that the nipples shall
not be troublesome  by becoming tender, cracked or ulcerated.  If they
become tender or  painful during pregnancy,  some such remedy as
Graphites, Lycopodium, Petroleum, Pulsatilla, Sepia, Silicia  or Sul-
phur will cure them, so that no trouble will be experienced during the
nursing period.   All these troubles of sore nipples arise from some
dyscrasia developed by pregnancy and nursing; hence they are espe-
cially curable even  while nursing.

  Agaricus. If the patient be troubled with chilblains, which itch and
burn very much and are red;  or if the nipple itches and burns much
and looks red.
  Arnica. When in  the first days of nursing  the nipples only feel sore,
as if bruised.   It is often indicated, and often cures in  a few days
when early applied.
  Calcarea c.  An ulcer appears  on the nipple, discharging pus; the
patient is otherwise a subject for this remedy.
  Chamomilla.  The  nipples are much  inflamed  and are very tender.
She can hardly  endure the pain of nursing.  She feels irritable and
cross, with impatience. 
SORE  NIPPLES.
465
  Castor equorum. In neglected cases, where the nipple is nearly ulcer-
ated off;  it only hangs as it were by small strings.
  Croton t.  Every time the  child draws at the  nipple a  pain runs
through to the scapula of that side, which is excruciating.   The nip-
ples are very sore to the touch, but the chief suffering is the pain run-
ning to the scapula.
  Graphites. The nipple seems to have little vesicles on it; at least it
oozes out a thick, glutinous fluid, which forms a crust that is removed
by nursing, when the same formation again occurs, and so on.
  Lycopodium.  The nipple bleeds very much and is very sore, and the
child draws so much blood from the nipple  that when it vomits it
seems to  be vomiting blood.  Lycopodium given to the mother will
soon cause the  nipples to heal.
  Mercurius. The nipple  feels very raw and  sore.   Sensitive  gums,
sore teeth, enlarged cervical glands, and other mercurial symptoms.
  Phosphorus.  The nipples are hot and sore;  the abdomen feels weak
and empty; much heat in the lower part of the back across  the  region
of  the kidneys.
  Phytolacca. Nipples cracked and scabby, and exceedingly sensitive.
  Pulsatilla. In mild, tearful patients, who  weep  at every nursing.
The pain from nursing often extends into the chest, up into the neck,
down the back, and  often changes from place to place.
  Sepia. The nipples  crack  very much across the  crown in various
places; deep cracks; very sore.
  Silicia.  The  nipple ulcerates very easily, and is  very  sore and
tender.
  Sulphur. After nursing  the nipple smarts and burns very much.
It chaps badly about the base and bleeds.  Constitutional  symptoms
will sometimes determine the selection of this remedy in order to cure
the  nipples.
  The proper mode  of administering the remedy is to give one dose
dry on the tongue, and to dissolve a few globules  of the same remedy
in water,  or water and brandy,  and apply the solution to the  nipple
immediately after nursing.  In this manner all sore nipples .may
be cured more speedily and certainly than by any other means.
  As before remarked, the child should be put to the breast soon after
being born.  After  being washed and dressed, it may be allowed to
sleep for a while, but when it awakens it should  be put to the breast,
and not otherwise fed, unless it is not satisfied with the breast.   In
this case  it may be fed with  milk, or cream and water, two parts  of
the  latter  to one of the  former.  The child  should  be educated tc
      30 
466                DISORDERS OF LACTATION.
. regular periods of nursing;  it should not be put to the breast or fed
 every time it cries; let it be turned over or its position changed, and
 be patted and quieted, till the period has expired, say two hours two
 and a half, or three hours :  some definite period of interval should be
 decided upon and most rigorously adhered to.   If the mother has
 sufficient nourishment for her babe, no other need be added, provided
 she be sufficiently strong and healthy for the occasion.
   If from any cause it becomes necessary that the child should depend
 in part or entirely upon other nourishment, that should be provided
 which  most nearly resembles the mother's milk.  Cream diluted with
 water is the best.  After  five or six months, when the child  requires
 more nourishing food, one of the most suitable articles is readily pre-
 pared as follows: Take a  quantity of flour, tie it very tightly  in a bac
 or cloth, then dip it  quickly into water just to moisten the surface,
 and then roll it in dry flour, then dip it in again, and  so on till it is
 quite  thickly coated with  a sort of paste; now put this into boiling
 water and let it boil for four or  five hours.   The contents  of the bag
 will  then be  thoroughly  cooked, when  it may be  grated  and made
 into pap as required  for use; for this  latter purpose water  or  milk
 may be employed.   A small pinch of salt and perhaps  a little sugar
 will be useful.  Wheat bread thoroughly baked, dried in the oven,
 reduced to a powder and made into a pap, is also very useful.  As the
 child gets more and more  teeth,  its diet  may be more and more varied
 and liberal, but until its  first dentition is accomplished a meat diet
 should be as much as  possible avoided.
   Sometimes  children will not take milk; then cracked cocoa, made
 as ordinarily for table use, and an equal quantity of milk added, with
 a  little bread, forms a very acceptable article of diet,'both healthy and
 nutritious.

       Remedies for  Abnormal  Secretion of  the Milk.
   The subject of the  secretion of milk has been treated of  on  page
 214, to which the reader is referred.  It sometimes  happens that milk
 is secreted more or less abundantly, but,  owing to some derangement
 of the  maternal system, it is of a quality not calculated to afford
 sufficient nourishment for  the child, or even  causes decided sickness.
 In such cases the mother should be carefully treated  in accordance
 with homoeopathic  principles, when it will be found that as health is
 restored the lacteal fluid improves, no longer disagrees with the child,
 and nourishes it as it  should do.  The  child should not be deprived
 o** its  natural sustenance for any light reason, nor until homoeopathic 
     remedies for abnormal  secretion of  the milk.     467

 medication, acting on both mother and offspring,  has utterly failed to
 bring about the secretion of a natural and healthful milk on the one
 hand, and a normal receptivity on the other.  In all cases where it is
 suspected that the quality of the milk is not good, it should be  care-
 fully examined  and tested; and in conducting this examination the
 microscope will be found a very efficient aid.
   The following remedies are confidently recommended :

   Aconite  should be administered when there is  hot, dry skin, much
 thirst, restlessness, discouragement, anxiety; breasts hard and knotted.
   ^Ithusa cyn. The  child takes the breast with avidity; nurses plen-
 tifully, then vomits  copiously and is exhausted, but soon rallies and
 cries for a fresh supply.   The child's bowels are either costive or loose;
 it cries much, and  does not thrive.  The  mother  is not  well; the
 lochia is too thin and watery; she is very nervous;  has a bitter  taste
 in her mouth; milk disagrees with her;  the abdomen is swollen and
 hard.  In such  cases iEthusa should be  administered to both mother
 and child.
   Agnus castus.  The mother  is very sad and depressed; frequently
 says  she will  die; the milk is very scanty.
   Belladonna.  The breasts feel  heavy, and appear hard and red, the
 redness  often  running  in radii; flushed face and injected eyeballs;
 full,  bounding pulse; drowsy, throbbing headache;  sensitive to noise
 and light.   From taking cold.
   Borax. The milk is too thick and tastes badly; often  curdles  soon
 after it has been drawn.  Nausea  as of pregnancy in the morning.
   Bryonia. The  breasts  feel  heavy, a sort of stony heaviness—rather
 pale, but hard;  dry lips and mouth ; constipation  of burnt, dry fieces;
 splitting headache; nausea and  faintness on sitting up.
   Calc. c. The breasts are distended, the milk scanty;  she is cold;
 feels  the cold air very readily; there  seems to  be a want of vital
 activity to  bring the milk forward; leucophlegmatic constitution.
  Carbo an.   Painful nodosities of the mammae.    Nursing  causes
 stitching pains  in the  mammae,  which  arrest the  breathing.   She
 cannot  bear to  have the breasts  touched or handled.   The milk is
 thin,  and has  a saltish taste.  Gets tired  on taking food.
  Causticum.  The milk has almost  disappeared  in  consequence of
over-fatigue, night-watching and anxiety.  It is especially suitable for
delicate, light-complexioned women.  Generally  constipation.  Sen-
sation in the stomach as though lime were slacking.
  Chamomilla. The breasts are very tender; the nipples inflamed and 
468
DISORDERS OF LACTATION.
 swollen;  she is restless; thinks she can hardly endure her sufferings
 is fretful, sleepless and cross; when caused by a fit of passion.
   China.  The woman is  very weak in consequence of loss of blood
 during labor, or too profuse lochial discharge.  She feels worse everv
 other day.  Feeling of fullness in the abdomen.   The milk is scanty,
 thin and  watery.
   Cina. Gnawing  sensation  in the stomach, as from hunger, which is
 constant.   Itching of the nose;  does not sleep well; feels cross and
 irritable,  and is not easily satisfied.
   Croton  t.  The breasts may or may  not be  swollen, but the pain
 extends from the nipple through to the shoulder-blade every time the
 child draws at the breast; the suffering is excruciating.  An excellent
 remedy, even if the breasts are hard and swollen.
   Dulcamara.  The milk fails of being secreted, apparently in conse-
 quence of the patient having taken cold, which  has settled in the
 breasts; the mammae are swollen, inactive, painless," and itch.
   Kali bich. The milk as  it flows from the breast has the appearance
 of being composed of stringy masses and water.
   Lachesis.  The milk is thin and blue, and  is  rejected by the infant.
 She  feels  disconsolate  and  sad on awaking  in  the  morning, and
 throughout the day has a dissatisfied and unhappy feeling.   The whole
 disorder may  be the result of some long-standing mental  trouble.
   Mercurius. This remedy is especially suitable if there be a syphilitic
 taint of system.   The breasts are swollen and  hard, with a feeling as
 if they were  raw and sore; ptyalism;  scorbutic appearance of the
 gums, and other symptoms indicative of  mercury.
   Nux V.  Especially suited  to  women  who use  habitually highly-
 seasoned and rich  food, wines, etc., or if the disorder arises in conse-
 quence of an error of diet.  Constipation and disordered condition
 of the lochia.
   Pulsatilla.  The breasts are much swollen, and rheumatic pains  ex-
 tend to the muscles of the  chest,  shoulders, neck, axillae, and down
 the arms, etc.  She is feverish and tearful, but not thirsty.   Feels
 better  in  a cool room. The milk  is thin and watery, and the true
 milk-globule  is  almost entirely absent.   Bad taste in the mouth in
 the morning.  Fatty rich food disagrees.  Craves  cool, fresh  air;
the warm, close room causes her to feel very badly.
   Rheum.  Sour-smelling diarrhoeic  stools, with colic and shuddering
during stool.  The  milk causes a similar diarrhcea in the child;
almost immediately  after nursing  the  babe has a loose  evacuation,
 which is sour-smelling, and is accompanied with colic. 
           FAILURE OR  SCANTY SUPPLY OF THE MILK.       469

   Rhus t. The breasts are painfully distended and red in streaks, and
 there is. a  rheumatic condition of the whole body.  Stiffness of the
 joints; the first movement is painful and  stiff, but  she can  move
 easily  afterward.  She cannot lie  long in  one  position;  she muse
 change in order to find an easier place.
   Sepia.  In women of very delicate and sensitive  skin.  Flushes of
 heat; painful sensation of weakness in the epigastric  region;  cold
 hands and feet;  she is disgusted at the smell of food.
   Silicia. The infant refuses the breast or  vomits immediately after
 nursing.   It often refuses to nurse at first,  but  afterward  takes  the
 breast  with hesitancy, and then vomits; it does not grow as it should.
 The mother is not well; she has the silicia constipation, or other symp-
 toms indicative  of that remedy.
   Zinc. She is very fidgety, especially in the feet, which she  cannot
 keep still.        ,

          Failure or Scanty Supply of the Milk.
   When the mother has not  a sufficient quantity of nourishment for
 her infant,  the deficit is often owing to some  unnatural state  of her
 own system, and the proper  homoeopathic remedy should be sought
 to change that  condition, so  th it a  natural supply may be afforded.
 The habit  of forcing  a supply by  means of porter or other similar
 stimulant is alike injurious to the mother and to the child.  The prop-
 er remedy will  develop a healthy condition, and  consequently a good
 supply of milk.   Where  there is a scarcity of milk from any cause,
 study the following medicines, and consult likewise those mentioned
 in the section immediately preceding :

  Aconite. The  mammae  are  congested, burning  hot,  hard and dis-
 tended, with little or no milk.  Anxiety and restlessness.
  Agnus C.  Frequently indicated, particularly Avhen a despairing sad-
 ness is  the predominant symptom.
  Asa f. When  there  is excessive sensibility of  the vital organism,
 and  the veins are unnaturally  distended.  More  or less frequently
 indicated.
  Belladonna.  The breasts feel large  and heavy.  Headache, and the
eyes are congested. She does not sleep well;  she lies half sleeping
and half  waking—between the two.
  Bryonia. Dry,  cracked lips, dry mouth, constipation,  as  if the lleces
were burnt.  No appetite;  nausea after eating.
  Calcarea c. In  leucophlegmatic  constitutions.  Rather of a  chilly 
470
DISORDERS of lactation.
nature.  Menses had  been too  often and too profuse; usually subieci
to leucorrhoea.
   Causticum. When, as an  attendant symptom, threatened amaurosis
exists.  Pulsations and noises in the ears.  Anxiety and despondency •
the woman has been subjected to night-watching, care, trouble, etc.
   Chamomilla. When the mammae are hard and tender to the touch
with drawing pains.   Insulting,' cross and uncivil in temper.
   China. Where  there is  debility  from loss of animal fluids—par-
ticularly blood—or from diarrhcea or leucorrhoea.  Much pain be-
tween  the shoulders.
   Coffea. Much excitability and sleeplessness.
   Dulcamara.  Particularly  when  there has  been  suppression  from
exposure to the cold and damp  air.   The milk is  scanty, the skin is
delicate and sensitive  to  cold, and liable to eruptions  from being
exposed to the cold.
   Merc. sol. Milk  scanty,  with scorbutic  gums,   swelling  of the
glands, etc.
   Phosph. acid. Scanty milk, debility and great apathy.
   Pulsatilla.  In mild  and  tearful  women,  in apparent good health,
who have  but little milk.   This remedy is often  called for in this
affection.
   Rhus t.  Entire want of appetite,  mental derangement and thoughts
of suicide.   Vitiated  lochia, lasting too long, and powerlessness of
the lower extremities.
   Secale C  In women wdio are  much exhausted from venous haemor-
rhage.   In thin,  scrawny women.   The breasts do not properly fill
with milk; there is much stinging in them.
   Sulphur.  Flushes of heat, weak and faint spells, heat on the top of
the head, cold feet, very faint and  hungry at about noon, she cannot
wait for her dinner, etc.
   If the milk seems abundant,  and yet the child does not thrive, the
fault may be in the mother, or  it may be in the child.  Administer,
according  to your  best judgment,  such remedies  to the mother  as
Calc. c, China, Cina, Mercurius or  Sulphur; or to  the child, Calc. e,
Silicia, Baryta c,  Borax, or whatever may  seem  most appropriate,
according to the  particular indications and  conditions; or  the  same
remedy to both at the same time.

         Galactorrhea and Excessive Lactation.
   In cases  of spontaneous flow of milk, keeping the breasts constantly
wet, relief  from such an uncomfortable state may be obtained by the 
          GALACTORRHEA AND EXCESSIVE LACTATION.       471

 appropriate remedy, according to the  indications given below.   The
 function of lactation being one purely physiological, and provided for
 in the economy by suitable forces under the stimulus of the maternal
 instinct and  affection, most women enjoy  perfect health during its
 continuance.   Man^y indeed are never so well as when giving suck to
 their children.  Under the influence of this process there arises a greater
 activity of all the assimilative functions at the same time, and in con-
 junction with a greater strength  of appetite  and corresponding energy
 of the digestive powers.  The process  of  conversion of food is un-
 usually rapid, the  excess going to form the milk.   Where a greater
 amount is thus formed than is  required, the system becomes gradu-
 ally exhausted, even in health, just as the preparation of a less  amount
 may overtask  the  system when in a  condition  already enfeebled.
 This over-production  in the former  case may be due simply to excess
 of vitality, while in the latter case it may result from a  corresponding
 effort of nature to supply the required  material  support, even under
 difficulties.
  But  there are cases  in which an excess of the secretion of the milk
 6eems just as  much the result of  some interior morbid condition as its
 more or less  complete failure would  be.   This is especially  seen in
 the intimate relation which such  excessive flow of milk—or what for
 all  practical  purposes amounts to the same thing, undue lactation—
 bears to insanity.   And in the following extract from the excellent
 work of Tyler Smith the reader will see the injurious effects which
 may arise  from excessive lactation of  either sort, and learn to antici-
 pate the mischief from the first symptoms :
  "The cases  of insanity which occur as the result of undue lactation
 are very similar to cases of puerperal  insanity, only that their symp-
 toms come on in a more gradual manner. When nursing women com-
 plain of loss of sight or hearing, or headache, either their nourishment
 and stimulus  should be increased, or suckling  should be at once dis-
 continued.  Where there is any predisposition to  insanity, mothers
 should not, if possible, be  allowed  to suckle their  children.   In all
 cases of this  kind the dependence  of the  mania upon  exhaustion  is
 abundantly evident.   It is especially likely to happen when pregnancy
 and lactation are allowed to proceed simultaneously.
  "There  are in the subjects of this form of disease the same suicidal
and homicidal tendencies as in puerperal insanity.  I once met with
a case in which a  mother delivered of twins became affected in her
 mind from suckling, and a wet-nurse was procured in the person of a
young  girl who had given birth to an illegitimate child.  She had 
472
DISORDERS OF  LACTATION.
nursed her  own infant for some time, and then, while  being drained
by the twins, again  became  pregnant.   Signs  of insanity manifested
themselves, and she was one day found dead, hanging behind the door
of her room.   This  form of  insanity comes on weeks or months after
the close of lactation.  I have no doubt that the woman Brough, who
killed, two or three years since, several of her children at Esher, and
who is now  a confirmed lunatic at Bethlehem, had suffered from over-
lactation.   She had weaned a child not long before the  dreadful trag-
edy, had complained of loss of sight and severe nervous disorder, and
had suffered in her head in previous lactations.  The preventive treat-
ment in this form of insanity consists, of course, in weaning as  soon
as any marked signs of nervous disorder are perceived.   In the man-
agement of such cases  great care in guarding the patient is necessary,
and the treatment of this disease must be a supporting and stimulating
one, combined with perfect rest, and the avoidance, as far as possible,
of all moral and physical excitement."
  Thus galactorrhcea,  or  excessive or undue lactation, is seen to  be
capable of producing the most destructive  results  in the mental and
physical  economy.   The  symptoms which  indicate that lactation is
morbidly affecting the  mother  are:  " A sinking and fainting at the
epigastrium, with a sense  of  emptiness, which  lasts a long time, and
soon returns even after food has been taken; a general weariness and
fatigue; a want of refreshment from sleep ; an aching and dragging in
the loins, and  pain between  the blade-bones or in the side beneath
the left breast; distressing exhaustion after the infant has been at the
breast; the pulse is quick and feeble; the extremities cold; there are
dyspnoea and palpitation on making the least exertion or ascending
the stairs.   If the cause is continued, headache and vertigo, noises in
the ears,  numbness of  the extremities, impaired vision,  exciting  fears
of amaurosis, loss of memory, irritability and despondency, with thirst,
dryness of the tongue and night perspiration, ensue.  Pulmonary con-
sumption  may be  developed;  the  general  appearances  of anaemia,
menorrhagia,  leucorrhoea, oedema  of the face  and extremities, and
neuralgic affections  of various kinds supervene, and mania has not
unfrequently formed the sequel.   Thus  organic disease of the brain,
lungs and uterus may be added  to the evils  attendant on undue
lactation."—Leadam.
  Except in the most extreme  cases of exhaustion from  excessive flow
of milk, or protracted  lactation, we do not advise the use of any other
stimulus than the appropriate remedy.   There may be cases in which
a little wine may be temporarily useful,  but  rest, cessation from nurs- 
          MASTITIS—INFLAMMATION OF  THE  BREASTS.       473

ing, and, if necessary,  from all the care of the child in any way, suit-
able food and the true homoeopathic remedy, will  do all that art can
accomplish to restore exhausted nature.
  In cases of galactorrhcea, or excessive spontaneous flow of the milk,
use  according to the particular attending  symptoms  and conditions,
Belladonna, Bryonia, Borax, Calcarea  c, China, Conium,
Phosphorus, Pulsatilla, Rhus or Stramonium.
  In cases of deterioration of health from  nursing, undue or protracted
lactation, where appear debility, loss  of  appetite, hectic  fever, night-
sweats,  etc.,  study Calcarea carb.,  Calcarea  phos., China,
Lycopodium, Phosphorus, Phosph. acid, Sulphur, Silicia, etc.
  Cramps  in the  stomach from nursing  may require  Carbo an.,
Carbo veg., China or Phosphorus.
  For great sense  of emptiness in the pit of the stomach from nurs-
ing, study Carbo an., Sepia, Ignatia and Oleander.

         Mastitis—Inflammation of the Breasts.
  Inflammation  of one  or both  breasts, with a manifest tendency to
suppuration, is apt to be of  frequent occurrence  in  nursing women.
And in some persons  this difficulty,  originally arising from constitu-
tional predisposition,  becomes almost a confirmed habit,  since they
seldom or never can nurse a child without  experiencing the exceeding
distress and annoyance of a gathered  breast.
  The inflammation may be located principally in the external mamma,
affecting particularly the areolar  tissue and partaking of  the nature
of erysipelas.  Or the  inflammation may be seated more deeply in the
substance of the breast.  Or, again, the inflammation may be developed
principally and  especially in the mammary  gland  itself.   Finally,
there are cases in which the inflammation seems to involve the entire
substance of the  breast and structure of the organ  in one indistin-
guishable mass.   More  often, however,  the pains scattered through
the breast,  and the various diverging painful indurations, lead to the
conclusion  that the gland with its ramifications is the particular seat
of the disease.
  And in thus determining the nature of  the  affection, the cause of
it, or the manner in which it  arises, will often be of  service.  For if
the  breast  evidently became  inflamed from  undue exposure to cold
air in the delicate state of early lactation, a general inflammation may
be expected to ensue, while difficulties belonging to the process of the
secretion and discharge  of the contents  of the lactiferous  tubes may
sometimes be seen plainly to precede  inflammation in those tubes and 
474                 disorders of  lactation.

in the gland itself.  Much is due also to previous history and consti-
tutional  diathesis; influences  which in some would prove perfectly
innocuous,  in  ethers  rapidly develop inflammation, which no less
rapidly tends to suppuration.  In such cases the greatest care, assisted
by a dose or two of the antipsoric which seems most suited  to the
patient's constitution, will go  far to prevent the suffering inseparable
from a gathered breast.
   Where the milk is copiously secreted, and either from inability on
the part of  the  child, in its  absence, or from  obstruction of the
milk-tubes, or from deficiency  of the nipple, the milk cannot be freely
drawn in the natural way, every effort should be made without loss
of time to secure this  end by such  other  means as may be possible.
Sometimes the breast may be drawn by another child, or by a friend,
or by young puppies; the proper remedy in the mean time should be
carefully selected  and faithfully administered, in order as rapidly aa
possible to remove all difficulty wdiich may be amenable to such medi-
cation or which  may be resulting  from  the  obstruction.   In cold
weather the inflamed breasts should  be kept warmly protected; and
besides  this  the less external application is made to them the better.
If the inflammation is  caused and kept up by a tender and ulcerated
state of the nipples, let these be particularly attended to in accordance
with the directions already given.   Properly used, homoeopathic rem-
edies may be made effectual  in resolving the inflammation and avert-
ing suppuration, in a great majority of cases that are  attended  to at
once.

   Aconite.  When  a chill  in dry, cold air has been the exciting cause,
and  a true synochal fever prevails.   There is fear, anxiety and rest-
lessness, thirst for cold water, etc.
   Belladonna. When the breasts feel heavy; there are red streaks run-
ning like radii  from a central point;  she is occasionally chilly; a dull
and stupid feeling prevails.
   Bryonia. Her breasts have a stony heaviness in them;  they are hot,
hard and painful, but not very red.   She feels  sick on first sitting up
in bed or in  a chair, and  still more sick on standing up.  Rough, dry
lips, thirst and constipation; stools dry, looking as if burnt.  She feels
worse when moving, and keeps very still.
   Carbo animal.  Darting  in the  mamma, arresting the breathing and
aggravated  by pressure.   She  can scarcely tolerate the application of
the child to the breast; it takes  her breath away to apply it.
   Cactus.  Particularly indicated in  scrofulous  subjects, where  there 
          MASTITIS—INFLAMMATION OF THE BREASTS.        475

is the greatest sensibility to cold  air.  Inflammation and suppuration
of the breast, with a sense of fullness in the chest.
  Graphites.  In all cases where there are so many old cicatrices  from
former ulcerations  that the milk  can scarcely flow.   This  remedy,
liio-h, will now cause the milk to flow easily and ward off the impend-
ing abscess;  it has proved perfectly efficacious in many such cases.
The same success is claimed for Phytolacca in similar cases.   I have,
however, the greatest confidence in Graphites;  this remedy, although
many times tried, has never failed me in a single case.
  Hepar. When suppuration  seems inevitable, and there is  no other
particularly  characteristic symptom.   Give a  single dose, high, and
await the result, either in resolution or in  suppuration.
  Lachesis. When the breast has a bluish  or purplish appearance, and
Bhe has chills at night and flushes of heat by day.
  Mercurius sol. Hard swelling of the breast, with sore  and raw sort
of feeling; the milk is not good, so the babe refuses it.   She has scor-
butic gums and other general symptoms of Mercury.
  Phosphorus.  Inflammation of the mammas,  even threatening ulcera-
tion, with stitching or cutting pain.   (Hectic fever and night-sweats.)
In fistulous ulcers with blue appearance.
  Phytolacca dec. Particularly where the  hardness  is very  apparent
from the first.  Very sensitive nipples or breasts, which are more or
less painful; even after  suppuration has  taken place  these character-
istics continue.
  Silicia. In  fistulous ulcers  particularly,  the  discharge  being  thin
and watery,  or thick  and  offensive.   The substance of the  mamma
seems to be discharged  in the pus;  one  lobe after another  seems to
ulcerate and discharge into one common ulcer, often with  pain; or
there may  be several orifices,  one for each lobe.
  Sulphur. Inflammation running in  radii from the nipple.   Suppu-
ration profuse, with chilliness in the fore part of the day, and heat in
the  after part.  Some  haemorrhoids in complication.   In old ulcera-
tions, where  the breast has raw places on it.   The breasts  feel hot.
She has night-sweats, flushes of heat, weak and faint spells, irresistible
hunger at 11 a. m.
  Croton tig.  When nursing,  a  pain runs directly from, the breast
through to the back; a sore drawing pain,  very severe.
  Kali c. Tearing, stitching pains on the flow of milk.
  Rhus tox.  Restless; must change position often or walk about. 
476
DISORDERS OF LACTATION.
                   Directions for Weaning.
  Weaning ought not to  be attempted under  ordinary circumstances
until the child has become accustomed to other articles  of diet.  See
in this connection the article on the Nutrition of Infants.
  If the  mother's  health cannot be  kept  strong and vigorous, the
child  may be gradually taught to depend upon other sources at the
age of six months; and in a short time it may thrive while receiving
but little  from the  mother  for the three  or  four  subsequent months.
The mother should never allow the child from the first day to sleep
at the breast.   Once let the child acquire this habit, and it will terri-
bly exhaust the mother by  lying on  her breast all night.  For this
reason it  is important that  children  never begin  to acquire the habit
referred to.   Other things being equal, it is better that the child should
not be weaned until it has six or eight teeth.
  The process of dentition  is accomplished  in groups, and the child
should never be weaned during the evolution of one  of these  groups.
The first  group  consists  of the two middle  lower  incisors; these
usually make their  appearance at  about the sixth or seventh  month,
and within from one to fifteen days  of each other.  Then  the child
usually rests from four to six weeks.   The  second group cons^ts of
the  two middle  upper incisors, and after their 'appearance there is
another interval of rest for a few weeks.   From the sixth to the tenth
month the lateral incisors appear, the two lower first, and after a brief
interval the two upper ones.  Now a  longer period of rest intervenes
—nearly two months and from the twelfth  to the fourteenth month
the  anterior molars appear, two below first, then two  above.
  There is now another and still longer period of rest, and from the
fifteenth to the twentieth  month the canine  or  stomach and eye-teeth
come  forth—the  two lower first,  then the  upper two.  And again,
after another period of rest, and by the time the child is twenty-four
or thirty  months old,  the  last four  molars are cut—making in all
twenty  teeth.  This work  being  fully accomplished, the period of
infancy is completely passed, and the limit of this period of teething
ended.  Yet if we are  tempted to look a little farther, we shall see
that childhood properly ends with the casting of the  deciduous teeth,
youth extends to  the complete establishment of puberty and adoles-
cence, and manhood and womanhood follow after.
  From the above review it appears how necessary it is that we select
for so important an event as weaning one of these periods of rest from
the evolution of teeth.  For the infant  to be  deprived of its mother's 
ABORTION.
477
breast is a great change, morally and physically;  and this change is
much less shocking to the infant's system, and much more easily borne
ir all respects, if imposed when it is not cutting teeth.
                     CHAPTER  XXV.

                         ABORTION.

    ABORTION is said to  consist in the separation and expulsion of
     the immature ovum from the uterus.*   This very comprehensive
definition covers the whole period from  the moment of fecundation
up to any time short of the complete fulfillment of the entire time of
normal utero-gestation.  In  its  more general acceptation the .term
abortion is made to refer to such degree of  immaturity of the ovum
as necessarily ensures its destruction  on expulsion;  in this sense the
use of the term would be restricted to the period  of non-viability.
" An abortion may be  possible at any time  from the commencement
of pregnancy to the end of the  sixth month."  But since there are
successive stages of development, which exactly correspond to definite
periods of time in  gestation, it becomes desirable to assign more
definite terms which may  serve  to indicate  the  particular period in
which the abortion itself occurs.   Accordingly, the abortion  is prop-
erly called ovular  when the expulsion takes place in the first three
weeks, or before the embryo can be distinguished in the ovum.  The
term effluxion was applied by the ancients to those  cases in wliich the
product  of conception  passed off or  flowed  away  in the first week.
The abortion may be termed  embryonic when it takes place  prior to
the third month, as if before quickening.   When the abortion occurs
after this time, and before  the period  of viability, or before  the  end
of the  sixth month,  it may be termed foetal.  After  the period
of viability the expulsion  of  the foetus, although more or less liable
to be followed  by  its  destruction according as  it occurs at  a period
more or less remote from full  term, is  still not necessarily fatal.
Hence the expulsion which occurs at any time after the period of via-
bility, and before the completion of the full terra, is called premature
delivery.  The term miscarriage is popularly applied to any expulsion
or premature delivery which results in the destruction of the product
of conception.
                   * Tyler Smith's Obstetrics, p. 177. 
478
ABORTION.
  Abortions are more frequent in the first two  or three months than
in those subsequent: thus, of 602 recorded cases,  275 occurred at
three months and 147 at four months.   It is believed that many cases
of ovular abortion * or effluxion occur unnoticed and unsuspected as
well in those who have borne children as  in thosp  who are always
sterile.
  Causes.—The influences which are  capable of producing abortion
include almost the  entire range of those which injuriously affect the
female  economy.  These causes of abortion may  be from Avithout
or from within;  external or internal; originating in the system of the
woman herself or  approaching her from the outer  world.  But in
either  case and in  every instance they derive no small  part of their
efficiency from the delicate and sensitive nature or psoric  condition
of the constitution itself.  Thus  it is well  known that some women
undergo the  severest  forms of chronic  and even  of acute disease, and
the rudest accidental  or intentional violence, without  aborting;  while
in others this misfortune  will often occur either spontaneously or from
the slightest  provoking cause, such as a  misstep or strain in  lifting, f
  Since  abortion consists  in the  separation  and  expulsion of the
ovum, as in  ordinary labor, this  must result from contraction of the
uterus itself.   This contraction of the uterine fibres is therefore to be
considered as  the  immediate cause of the  abortion in every case.
All other causes may be termed  either  predisposing  or exciting, and
for convenience  in study they may be  classed under three heads: I.
Pre-existing  Conditions;  II.  Conditions principally Developed by tlie
Pregnancy itself; III. Independent Influences.
  I. Pre-existing Conditions.—In this  class must be enumerated all
those disorders which in any given case may seem to determine the
abortion, although the same causes may fail to be followed by this
result  in other instances.   The great  majority  of cases of abortion,
from whatever cause  or  combination of causes  produced, occur  from
the second to the fourth  month of pregnancy.
  Disorders  of the uterus  or of  its appendages, which were existent
before pregnancy, often become causes of abortion.
  Displacements  to which  the uterus  may be subject, and  which do

  * Abortion is properly  restricted to the loss of the  product of conception;  and it
seems to be an  unnecessary and useless complication  of the subject to include under
this head such discharges of unimpregnated ovules as may occur in women to whom
sexual intercourse is a thing unknown, and such as have already been described under
Ovular Menstruation.
  f Mauriceau, quoted by Davis, ii., p. 1031. 
ABORTION.                         479
not prevent conception, may occasion the subsequent separation and
expulsion of its product.   In cases of habitual prolapsus uteri  the
gravid  uterus  may become  impacted  in  the  pelvis  before rising
above the sacral promontory at quickening, and the irritation con-
sequent upon  such impaction will  necessarily  be followed by  abor-
tion.  The same is true of retroversion, the most serious of  all ute-
rine  displacements, and  which becomes  all  the  more formidable
when complicated with "pregnancy. .  Retroversion  in  the  preg-
nant state  may be gradual  in  its development, or may  have  ex-
isted to some  extent unnoticed  till  the increasing size  of the uterus
at the  third or fourth month  occasions serious difficulty.  Or  the
gravid  uterus may become suddenly retroverted  by accident or over-
exertion, but this  accident can  hardly ever result  during pregnancy
unless a predisposition to it had been  established by  former retro-
version.  Anteversion, by irritation  of the  neck of the bladder, may
lead to abortion.
  Inflammation, ulceration and cancerous disease of the uterus may  be-
;ome the efficient cause of abortion.  Severe leucorrhoea (especially that
sdiich results from chronic inflammation of the cervix], ulcerations of
the cervix, fissures  and induration of the cervix, phagedenic, syphilitic
and cancerous ulcerations of the  cervix or of the parietes of the uterus,
(vhile they do  not always prevent conception,  will, in the great ma-
jority of cases, powerfully tend to  produce abortion.   Syphilis in  the
mother, whether recent or  chronic, whether  present as an  ulcerative
affection on any part of the  genitalia or existing as a  constitutional
taint in the system, will  more  or  less  invariably  lead to  abortion ;
while if the syphilitic poison be imparted  to the ovule by the fecun-
dating  semen  of the  male alone, the result may be seen in offspring
born alive,  indeed, but destined to wither and perish, decreasing in
weight from  the  moment  of their birth.   In  either  case it seems
an admirable  provision  of Providence  that, in  its severer forms at
least, ths awful malady should become  self-limited, instead of  being
permitted to extend its  destructive influence through all succeeding
generations.
  Scrofula is stated by some authors to be an efficient cause of abor-
tion, but this  must needs be taken with some qualification,  since it is
well  known that  many women  of  most remarkable scrofulous habit
are no less remarkably fruitful, raising in some instances large fami-
lies of children, all of whom show evident  marks of the same scrofu-
lous  diathesis.   When the scrofulous influence has resulted in a con-
dition bordering on cachexia, abortion may result from  general debil- 
480
ABORTION.
ity.   And yet it should  be remembered  that tubercular consumption
the most common and  fatal form of scrofulous disease, neither indis-
poses to conception nor predisposes to abortion.
   Plethora, or a  remarkably full  habit  of body, and obesity, or an
abnormal accumulation of fat, may be considered forms of scrofulous
development, and  either  of these  conditions may  lead to abortion.
Plethora  may promote abortion by  inducing local and  destructive
congestion.  This congestion may be either simply uterine, as seen in
the menstrual  nisus and in the greater tendency to abort at the men-
strual periods, especially the first, second  and third; or it may be
placental, as in placental apoplexy or  placentitis;  or it may be um-
bilical congestion, and destroy the fcetal life, as it were, by  strangulat-
ing its circulation.
   Nervous irritability or sensibility of the uterus may be the determin-
ing cause  of the abortion.  The irritability is  so called because il
forms a part of the constitution;  such women will abort from sympa-
thy with affections of the  bladder, rectum, kidneys, stomach and paro-
tid, thyroid and  mammary glands, or from disorders in other  parte
which in  other persons would be followed by no such consequence-
Ovarian irritation in women who have been subject to dysmenorrhcea
has a  strong  tendency to produce  abortion at the  catamenial dates.
Lactation usually serves  to prevent conception, but where  it does not
the irritation of the mamma? from constant suckling, like any other
long-continued irritation of these glands, may produce abortion.  And,
finally, a  pre-established  habit of  aborting may of itself become a
powerful  cause of  abortion in each succeeding pregnancy, women
having been  known to abort in twenty or  more  successive pregnan-
cies.   If,  however,  the history of such cases be carefully  inquired
into,  some efficient cause, such as  syphilis, retroflexion, etc., will be
discovered.
   II.  Conditions principally Developed by Pregnancy itself—Both the
first-mentioned and the  present  class of causes of abortion are in-
cluded  by Dr. Whitehead under the general head of predisposing
causes.  "By predisposing  causes  are  meant  certain morbid  con-
ditions, local  or constitutional, already in the system, or a particular
susceptibility to morbid action during pregnancy, by the operation of
which the process is liable to be prematurely arrested."*
   In some constitutions  any one of the various  disorders incident to
pregnancy may threaten to lead to  abortion, and in some cases sev-
  * On the Causes and  Treatment of Abortion and Sterility: By James Whitehead,
F. E. C. S.  London, 1847. 
ABORTION.
481
 eral of these seem  to combine to  produce this  result.   Among these
 may be mentioned the different forms of gastric and intestinal disorder,
 from nausea and vomiting to the most obstinate constipation.  Al-
 though it is not probable that these affections would result in abortion
 unless there were  present some abnormal irritability  of the uterus
 itself,  and although they  may have  their origin in the  same psoric
 miasm that occasions the uterine irritability,  still these affections are
 entirely developed under and by the condition of pregnancy.
  Similar in their origin and influence are those local disorders of the
 uterus and its appendages which appear for  the first time in connec-
 tion with the state of pregnancy; among which  may be  enumerated
 dropsies of the uterus, fibrous  and  polypous tumors, and  all  the
 uterine displacements  which  result  from the pregnant condition.
 Placenta  prosvia may  be  the cause  of abortion,  although  this  is
 doubted by Cazeaux.  Whitehead says:  " When the placenta hap-
 pens to be  implanted with  its  centre over the os uteri, abortion is
 inevitable;  and this almost invariably takes place before  the  end of
 the fifth month."
  Disorders of the ovum itself in its different stages of development,
 and of its  immediate  appendages, may  also be enumerated in this
 place as causes of abortion, since almost all of them are directly and
 necessarily the results of morbid conditions of the mother.  The im-
 portant exceptions to this general remark are  found in certain cases in
 which the morbid condition of the ovum is derived from the fecunda-
 ting principle of the male.  The mother, for example, may  be perfectly
 healthy; while yet in  every instance the  product of conception be-
 comes blighted in  its earliest development or destroyed  by abortion
 resulting from disease inherent in  the ovum itself.   In such cases the
 source of  the mischief will be found  in  some taint  in the system of
 the husband—syphilitic, for instance—which may thus be  imparted to
 the ovum  through the semen; sometimes also the wife becomes in this
 manner infected with constitutional disease.   Suitable  treatment di-
 rected  to  the  husband  will  remove this cause of abortion,  and the
 subsequent conceptions  may terminate in healthy offspring.
  Disease of the ovum may excite the uterus to contraction before
 the actual death of the ovum has occurred.  Moles, hydatids, and in
 fact every possible form of blighted ova, necessarily involve abortion.
 And the death of the ovum, rendering it a foreign body in the uterus,
will be followed by its expulsion sooner or later,  except in those not
very uncommon cases in which the ovum is entirely reabsorbed.
  Diseases of the placenta, such as syphilitic or fatty  degeneration,
      31 
482
ABORTION.
inflammation,  hypertrophy,  induration,  tubercular deposition,  and
apoplectic congestion and haemorrhage, are the most fruitful causes of
abortion acting through the foetus.   The length of time elapsing after
the establishment of the diseased placental condition and the on-com-
ing of the abortion  will depend greatly upon the extent and rate of
progress of  the disease itself.
   III.  Independent  Influences.—By this expression we mean simply
those influences which appear subsequently to and independent of the
pregnant condition.
   1.  Physical  over-exertion of any kind, riding on horseback or in
carriages over rough  roads, railway traveling, laborious occupations,
fatiguing exercises,  long walks, violent efforts, such as lifting, run-
ning, jumping, by exciting the  circulation or straining the  parts, may
occasion uterine haemorrhage or pains, or both, which  unless arrested
will inevitably produce abortion.
   2.  Accidental or  intentional  violence, directly applied to the geni-
talia, leads to a similar result, by causing  such rupture or separation
of  the  membranes  or disturbance of the ovum  itself,  or by reflex
irritation, as arouses the contractile and expulsive action of the uterus.
"On the other hand, though there seems in some persons  a remark-
able liability to  abortion  through  the influence of reflex  action, yet
in others violent mental emotion, serious accidents, diseases, injuries,
and  operations even of great  magnitude  and on parts which would
(1 priori be thought  to be  specially dangerous in this respect—such.
for instance,  as the breast,  the uterus, vagina,  and even the ovaries, as
in ovariotomy—are endured without producing the slightest ill effects."
Meadows.
   3.  Various drugs, administered  intentionally, for other purposes,
or accidentally, occasion the same result, either by direct action upon
the uterus and neighboring organs,  or by indirect action through the
spinal cord.    Among the most  remarkable are Secale c, Cimicifuga,
Sabina,  Caulophyllum, Apis, Aloes,  Cantharis, Borax, Quinine, Mer-
cury.  There are many  others, which  in  larger  or smaller quan-
tities are said  to have produced abortion.   Violently acting emetics
and purgatives of any kind may lead to the same result from uterine
sympathy with the gastric and intestinal irritation.   ■
   4.  Excessive indulgence in coition, especially in the  earlier months,
by tne passional excitation of the uterus and its -appendages, disturbs
the ovum and occasions its expulsion.
   5.  Moral over-excitement of every kind, paroxysms of sudden and
violent anger, sudden  surprises or affright, horrible sights, situations 
ABORTION.
483
 of imminent danger, violent emotions of grief or despair for the de-
 parture or loss of friends, may produce abortion.
  6. Local diseases of contiguous organs, such as diarrhcea and dys-
 entery, may produce abortion from sympathetic irritation.
  7. Gonorrhceal inflammation  of  the  uterus,  where  pre-existing,
 should be classed  in the first order  of causes  of abortion.  In such
 cases it may give rise to the  severest form of purulent uterine leucor-
 rhoea, to erosion, induration, ulceration, and even fissures of the cervix
 uteri—conditions from which, if they are  not remedied by  appro-
 priate treatment,  abortion will almost necessarily result.  In other
 instances gonorrhoea may have been contracted during the existing
 pregnancy, and may occasion, especially in strong plethoric women,
 a high degree of excitement and symptoms  of inflammatory  fever,
 which may lead to abortion.   Whitehead mentions some remarkable
 cases illustrative of the influence of gonorrhoea in producing repeated
 miscarriages.   Syphilis  as a  primary infection may also  cause abor-
 tion ;  its powerful influence  as a constitutional affection in destroying
 the product of conception has already been noticed.
  8. Certain  general  disorders are  very sure  to produce abortion,
 often with  very great danger to the mother.   This  is the, case with
 intermittent fever,  especially in its  severest  forms, the  abortion
 which it causes being almost invariably fatal.   Variola becomes a no
 less certain and dangerous cause of abortion.  The same may be said
 of yellow  fever and  spotted  fever.   This is true principally  of the
 allopathic practice: so far as  these terrible diseases are made to yield
 more  readily to their appropriate homoeopathic remedies, just so far
 the danger may be averted both from mother and child.
  Symptoms.—The symptoms which may indicate an impending abor-
 tion may be as numerous as  are those of the various general or local
 disorders which have been mentioned as  its possible  causes, and they
 will necessarily correspond in constitutional character and intensity to
 the nature and violence of the influences by which the abortion is im-
 mediately occasioned.   In the earlier stages of gestation, the amount
 of disturbance  of the system is less in proportion to the comparatively
 trifling amount of force expended  in  producing  the abortion  itself.
 ^Vhen this results from pre-existing influences, chronic disease  or bad
 health in  the  mother,  there  may be shiverings succeeded by heat,
 anorexia, nausea, thirst, spontaneous lassitude, palpitations, a sense of
 coldness in the abdomen, coldness of the extremities,  pallid complex-
 ion, sadness, tumefaction and lividity of the eyelids or dark discolor-
ation beneath the eyes, a sense of sinking at the epigastrium or an in- 
484
ABORTION.
 describable deathly  feeling, recession  of the milk  and  consequent
 flaccidity of the breasts, from which a serous fluid somttimes exudes
 and general malaise and profound melancholy.   The more immediate
 and positive symptoms of abortion are—
   I. A  sanguineous discharge, together with pains in the loins, the
 abdomen and the sacrum.  The pains which precede abortion are very
 much like those which precede or accompany  a catamenial period.
 They may also precede the haemorrhage in cases  of threatened abor-
 tion, and may subside and the danger pass away before haemorrhage
 appears.   But after the occurrence of this latter symptom, abortion
 will  almost always result sooner or  later, unless the progress of the
 mischief is arrested by suitable treatment.
   II. Bearing-down sensation, or  feeling of weight in the abdomen
 and pelvis.  These  sensations  may be  independent of the more posi-
 tive pains; some women abort without  having suffered much if any
 decided  pain.
   After the rupture of the membranes by accident, by instruments and
 other artificial means, after the placenta or membranes become sepa-
 rated from the walls  of the uterus, or  after the death of the foetus,
 chills or rigors make their appearance, the pains become more frequent
 and decided and the haemorrhage more free.  But before the expulsion
 of the foetus  the haemorrhage is seldom very profuse.  The placenta
 almost always remains after the expulsion of the foetus, and then, as
 in natural labor, the loss of blood may be severe until arrested by the
 removal of the placenta and  subsequent  more complete contraction of
 the uterine walls.   Instances have been observed, however, in which
 the placenta or membranes have remained for weeks after the extru-
 sion of the embryo, occasioning an almost constant loss of blood during
 the entire period.
   In some instances  the  placenta remains in the uterus till decom-
 posed ;  pyaemia, uterine  phlebitis  and  death  may result from the
• reabsorption of particles of the putrefying mass.   In embryonic abor-
 tion, however, after  the  expulsion of the embryo itself, the mem-
 branes  may remain  without danger of the  putrefactive decomposi-
 tion which usually attacks the retained placenta of later months.   In
 other cases, after the gradual death of  the  embryo from imperfect
 nutrition, organic  ovular disease,  or other constitutional cause, the
 placenta  enlarges,  assumes unusual  forms and  a singular structure,
 exhibiting a cavity in which the remains of the foetus can scarcely be
 found; or the entire ovum becomes transformed into a fleshy mole or
 bydatiginous  mass. 
ABORTION.
485
  Diagnosis. — An  abortion  may be   deemed possible, probable,
threatening or inevitable in any given  case, according to the nature
and intensity of the  influences present and  capable  of more or less
rapidly producing such a result.   But it is necessary first to determine
the  existence of  pregnancy; and when, as in the first two months, it
becomes difficult or even impossible  to ascertain this with  absolute
conclusiveness, the question arises whether the pains and discharge of
blood result from a return of interrupted menses or from an approach-
ing  abortion.   And this question is the  less  easy to decide in advance
since the pains and other consequences of an impending abortion at
this early  period greatly resemble those  of irregular and  difficult
menstruation.*
  In general it may be stated that in abortion the  os uteri  is  open
the  haemorrhage  precedes the pains, and that the pains themselves arc
not  sensibly relieved  by the  flow;  while  in difficult  menstruation
the  pains usually precede the haemorrhage, the mouth of the  uterus is
closed,  and the pains either entirely cease or sensibly diminish  when
the  discharge is well established.   In some instances of dysmenorrhea
the  pains continue during the  entire period  of the flow, but the fact
of the  occurrence  of  such severe dysmenorrhcea as a habit of the
individual either removes  at  once the  suspicion of her being  preg-
nant at any particular period,  or entirely neutralizes this  exceptional
symptom as  a sign indicative of pregnancy.   Xor, indeed, is it essen-
tial  for the  homoeopathic physician to determine with certainty the
exact condition  in any given  case in order  to do  for his patient all
that her case requires or all that  it is  possible  to accomplish,  since,
prescribing carefully and accurately  for the existing symptoms,  he
will moderate the violence of the suffering  in  dysmenorrhcea;  or if
the  case is  one of pregnancy and threatened ovular abortion, the same
remedies will  be the  best  to  subdue  the  violence  of  the abnormal
action,  and thus  preserve, if possible, the product of conception.
  It is of course unnecessary  to recount here the indications already'
fully stated in a preceding chapter by which the existence  of  preg-
nancy is  rendered probable  in the  earlier months.  If these  are
present in number more or less conclusive, especially  if the patient,
having formerly been  very  regular,  and  having  now  missed her
courses for one  or two  or  more periods, experiences a return of the
discharge,  accompanied  with  pains which rather increase than  abate

  *" Les douleurs qui accompagnent la menstruation difficile, surtout  apres une
suspension, de plusieurs mois resemblent beaucoup, par leur siege, leur intermittence,
a celles de 1'avortement."—Cazeaux, p. 343. 
486
ABORTION.
 as the flow continues—the  flow  itself being  more profuse  than was
 usual with  her in menstruating—and the mouth of the uterus suffi-
 ciently dilated to admit the end of  the finger, there is every reason
 to believe her suffering from abortion rather than dysmenorrhea.
 And this conclusion will'be greatly strengthened or otherwise by the
 comparison of this attack with her usual monthly periods, and by con-
 sidering whether, in case she were actually enceinte, she had been sub-
 jected to any influences capable of producing an abortion.  If the patient
 knows herself to have menstruated while pregnant on former occasions
 this circumstance, while it might to some extent predispose to abortion
 would require a more  particular  examination of the condition of the
 os and cervix uteri, and  of  the  coagula or other matters discharged.
 And the final detection of portions of an aborted ovum in such cases
 would become an important  point of reference in the future conditions
 of the patient.
  So much for the diagnosis of abortion in the earlier months, as
 distinguished  from dysmenorrhcea, where  the  existence  of pregnancy
 bad not been  definitely ascertained.  The diagnosis of abortion, in
 the more advanced  stages, where there is no doubt of the  existence
 of pregnancy, is a very  different matter.  Here an opinion must be
 given, usually, with the same caution that  we should  employ as to
 the recovery of a sick person in critical  circumstances, the question
 being, not whether  it  is  impending or  actual abortion  or dysmenor-
 rhcea, but whether  the threatened abortion must  necessarily become
 absolute  destruction of the  product of conception.  Here, except in
 cases already  very far advanced, we should never  affirm an abortion
 to be inevitable until we have  faithfully employed all the means
 within our knowledge to arrest the  destructive process.  Dr. White-
 head relates some remarkable  cases of successful treatment in wliich
 the abortion seemed necessarily inevitable;  one of them,  a woman
 who had aborted in  six successive pregnancies, and who was enabled
 to go through the seventh successfully, in spite of repeated attacks of
venous congestion to the  pelvis, with  apparent death of the foetus, by
repeated  bleedings and the employment of extract of hyoscyamus and
camphor.  And  when  such apparently desperate  cases are rescued
 under the allopathic regime, how much more ought we  not to expect
 with the  more varied and efficient resources at our command ?   " When
the pain comes on  at regular  intervals, with  hardness  of the uterus
and dilatation of its  mouth, this is a  serious symptom, for it shows that
the  uterus will no longer retain its contents, but is preparing to expe]
them."—Dr. Rigby. 
ABORTION.
487
  A certain dilatation of the internal orifice of the uterus, in which,
under the influence  of the uterine contractions, the  cervix  gradually
tapers from the os externum up to the body of the uterus, and can no
longer be distinguished from the uterus, is mentioned by Cazeaux as
having  been  originally observed  by him to be  a sign  of  inevitable
abortion.   Pain may set in  at the first with but little or no loss of
blood.  This absence  of haemorrhage  may  be due to  a separation
taking place high up, and the blood  being effused between the mem-
branes and the  ovum.   In such cases the loss of' the foetus is almost
inevitable.  On the other hand,  if the separation takes place near the
os there is a chance for the escape of the  blood, which  does not
remain  to excite uterine action.   Davis says, " Separation  at or near
the os uteri will not be so dangerous, and in all probability there will
be haemorrhage without pain,  which  is the contrary when  it takes
place near the fundus."
  But,  generally speaking, abortion  is only inevitable when the foetus
is  already dead, or when the separation of the placenta is so great
that the remaining  utero-placental attachments are incapable of sup-
porting the fcetal life.  Thus the  diagnosis of abortion  in the earlier
periods of gestation is dependent upon the determination of two "un-
known  quantities"—that of pregnancy on the one side, which may or
may not be actually present; and that  of the power of the remedies
used to arrest the progress  of the mischief—remedies whose success
or failure in any given  case can  only be determined by the  experi-
ment.   But in  the more advanced stages of pregnancy  we escape, in
many  instances, both these  sources of doubt, since the existence of
the pregnancy  itself is undoubted on  the  one hand, and  the deter-
mination of the death of the  foetus—which  is often possible with
sufficient certitude—on the  other hand removes all hope  of change
from the action  of medicines.  In  all  cases of threatened abortion,
however violent the symptoms, we may still find some ground of hope
in the administration of the  indicated  remedies so long as the foetus
continues to live.   But the condition is manifestly different Avhere the
symptoms either result from or  indicate the death of the child.   The
principal circumstances  which indicate the death of the fostus are—
1.  The diminution instead of the increase of the size of  the abdomen.
2.  The flaccidity and shrinking of the breasts, the dragging sensa-
tion in the loins and sense  of weight in the hypogastrium.   3.  The
cessation of motion formerly perceived in the uterus.  4. The impos-
sibility of hearing the  sound  of the fcetal heart becomes, after the
fifth month, an almost infallible sign of the death of the foetus.  And 
488
ABORTION.
where this  death occurs as a consequence  of disease or failure of
nutrition  on the  part of the mother, and  so takes place  in a o-radual
manner, the danger which the foetus  is undergoing may be detected
by observing the gradually increasing faintness of the beating of its
heart.   But this means of judging of  the  health  and death of the
foetus, since it is  hardly applicable before  the  fourth month of preg-
nancy, is of no use in the  majority of cases of threatened abortion.
  Prognosis. — The  prognosis  will  depend very  largely  upon the
period of pregnancy at which  it  takes  place,  the previous condition
of the patient, to some  extent upon the producing cause,  but  more
especially upon the amount of  blood wasted during the attack.  As a
general rule, the  earlier it  takes place the less danger to life; but this
is  not always  borne out, for  fatal  results have  followed  abortion
occurring within the first  month  of pregnancy.   The danger results
principally  from  the  haemorrhage, and thus it will be seen to  what
extent the previous condition of the patient may influence the result;
for a woman in robust condition may  withstand a loss of blood  that
would prove very serious, and perhaps fatal, to one in a weakly and
delicate condition.  It should be  borne in mind that until the ovular
membranes  and the placenta are  expelled there is a liability, and in
fact almost a certainty, of the continuance of the flow of blood, which
if prolonged will produce  such a disturbance in even the strongest
woman  as may be dangerous to life, not only by its  immediate but by
its after effects.  Moreover, abortion, and especially repeated abor-
tions, may give rise to a variety of diseases of the uterus, which grad-
ually undermine health, and will lead to loss of life  if not judiciously
treated and  cured.

   The Induction  of Abortion or  Premature Delivery.
  The practice of abortion  in some so-called Christian  nations, and
not the  least in our  own country, is as  extensive as infanticide  ever
was  among the  most  degraded  heathen  nations.  And  while the
former custom is in reality no less wicked than the  latter, and should
be no  less  revolting to the maternal feelings, it obviously exerts a
much more  destructive  influence, often upon the  life, always upon the
health, of the mother.
  The civil law, in making a distinction  between the criminality of
the production of abortion before  and after the period of quickening,
opened the  door  for a  very low estimate  of the moral turpitude of
the former act.   And while in  fact the spirit of the law seems now to
be improving, the tendency of the practice of many otherwise most 
  the induction of  abortion or premature  delivery.   489

 estimable physicians, and of some recent publications on this subject,
 serves rather to lower than to elevate the standard of moral sentiment
 in this respect.  But since we are  permitted to look into  the mosl
 secret recesses  of reproductive  vitality, and  to  understand  the  true
 nature of conception 'as tlie wonderful marriage  union of two distinct
 living forms into one, which,  though still dependent, is not more so  at that
 moment than it is after  the period of quickoting,  and since we  realize
 that this new creation will,  if undisturbed by the ruthless hand of the
 destroyer, become a new creature, we must reverence the higher  law,
 and assume for ourselves, in this most important respect, the highest
 ground.
  These were noble words of our colleague: " From a child still-born
 we  can hope nothing,  but a child born  alive, however feeble, may be-
 come a man !" *  " Modern physiological researches  have left us in
 no doubt as to the precise point and time where and when the work
 of independent organization begins which constitutes the distinct indi-
 viduality  of the new being.   It is  from the fusion or junction  of
 the male  and  female  principles, represented by the ovule and  the
 spermatozoa.   From that hour, soul and body, the subjective and the
 objective, in their mysterious union, are being created.  The pure
 instinct  of primal  Christianity  voiced itself in the  grand  words
 of  Saint  Augustine: Homo  est qui futurus  est—AY hat will  be a
 man is one.   The old civil  laws taught it in  their axiom:  Infans
 jam conceptus pro  jam  nato habetur—A child conceived  is to  be
 considered  a child  born.   Modern science teaches  it  beyond  all
 doubt. The British Parliament, in the new Salmon Act, discarding
 the old absurdities about quickening and viability, declares concep-
 tion to be the proper date  from which human life, in its entire sanc-
 tity, is to be estimated." f   These remarks and quotations are intended
 to show that  there  is  the same moral guilt, as there is  the same
 destruction of  a  living child, in the improper production of ovular,
 embryonic and  fcetal abortion, as there  is in  such unjustifiable  induc-
 tion of premature labor as would be acknowledged to  be equivalent
 to infanticide.
  The moral aspect of  the question of induction of abortion is thus
 forcibly presented by the same writer; and we transfer to our pages
 Dr. Holcombe's own words, not only because they  so admirably ex-
 press the sentiments we wish to convey, but also from the hope that
the  name of one so widely known and so much esteemed in the homce-
  * Dr. C. Ilering.
  t Dr. W. II. Holcombe, United States Medical and Surgical Journal, vol. i., p. 390. 
490                         abortion.
opathic ranks may promote the adoption of principles which we tan-
not but  regard  as alike  essential to the true dignity of the medical
profession and to the best good of mankind :  " The true  moral posi-
tion is this: The destruction of the ovum is always homicide—justifi-
able, perhaps, under a few extraordinary and  painful conditions, after
the failure of all reasonable medical and surgical means; and then
imposing such solemn and fearful moral responsibilities that it should
only be  accomplished after  the  mature deliberation and concurrent
advice of several respectable members of the profession."—Holcombe,
" The procuring of abortion  under all circumstances is a direct viola-
tion of the  laws of the  physical constitution, and almost alwavs a
violation of that holy commandment, ' Thou shalt not kill.'"—Pro-
fessor  A. E.  Small.   The only  substantial ground upon which  the
conscientious  physician  can  justify the induction  of  abortion or
premature labor to himself and to the moral sense of his  fellow-men,
is to be found in the necessity which may exist of saving the life of the
mother by this as the only feasible means.
  And the legal aspect of the question is not different.   " If the foetus
be already and from the very outset a living human being, and exist-
ing independently of its mother, though drawing its substance from
her, its destruction in  every  stage of pregnancy is murder.  Every
act of procuring abortion, rules  Judge King of Philadelphia, con-
trary to the usual  interpretation of the law, is murder, whether  the
person perpetrating such  act  intended to kill the woman, or  merely
feloniously to  destroy the fruit of her womb."*  Without undertak-
ing to give the various forms of law and practice in the different  na-
tions of Europe  and States of our own country—many of which may
be found in the treatise of Dr. Hale already referred to—suffice it to
say that the induction of abortion can only become legally, as it is only
morally justifiable,  when it becomes the only means for the  preserva-
tion of the mother's life.
  The conditions which-may require the induction of abortion at any
stage  of  pregnancy, and the means  by which such a result may be
secured with least danger to the mother, have been considered on page
283, under the heading, The Induction of Premature Labor.

    Treatment  of Anticipated or Threatened Abortion.
  The anticipative  treatment of abortion will consist in  the removal
by  the appropriate  medication of  those constitutional  dyscrasias—
sometimes apparently local,  but  always in reality constitutional and
               * Vide Dr. Hale's Treatise on Abortion, p. 315. 
  treatment of  anticipated  or threatened  abortion.   491

often hereditary—which  either have before existed or have become
developed under  the influence of the  pregnancy itself.   In this con-
nection  therefore we   have  but to  refer to  the  chapters  on  the
Diseases  Peculiar to Women  and on  the  Disorders  of Pregnancy.
These include the'first and second divisions of our classification of the
causes of abortion.  Those cases of still  more imminently threatened
abortion  which arise under the operation of the third class, or inde-
pendent influences, will in like manner require  treatment especially
adapted to each particular exciting cause and to each individual case.
  Those cases which arise from physical violence,  nervous irritability
or moral excitement, will of course require the most perfect quiet both
of body and of mind.  When the symptoms of an  impending abor-
tion result from the operation of drugs, they should be remedied by the
exhibition of such  antidotes as are most  strongly  indicated by the
symptoms themselves.  The removal of the cause as rapidly as possi-
ble will  be found the best  method of arresting the tendency to abor-
tion which may arise from  the attacks of diseases primarily local, or
of those  more general  fevers of  infectious, zymotic or  malarious
origin.
  The principal object of the physician, of course,  should be to remedy
the abortive tendency,  to anticipate and prevent the  attack, and, when
for the first time consulted at a more advanced  period, to arrest if
possible  the disorganizing  and destructive  process.  But when the
physician is called in too late, and it is evident that abortion must
take place, he should  treat the case very much  as  if it were one of
labor requiring especial attention.   For abortion, particularly when
resulting from any of the  wide range  of causes enumerated  above
under the head  of independent  influences, is much more dangerous
than ordinary labor.   And  in those most critical cases in which the
mischief to the ovum is already irreparable, the careful administration
of the homoeopathically  indicated  remedies  will  go far to moderate
the violence of the symptoms, diminish the loss from haemorrhage, and
preserve the life and subsequent health of the mother.
  In abortion,  as  in  labor,  the  principal  danger—which  is  from
haemorrhage—arises after the expulsion of  the  foetus, and from the
retention of the  membranes or placenta.  In these cases the efforts of
nature must be assisted  by the appropriate  medicines,  or the finger
may be used to  remove the membranes  or placenta;  or, failing that,
resort may be had  to  the placental forceps,  of  which those invented
by the late Professor Joseph G. Loomis are the best.   It is desirable
to remove the ovum  entire if possible, both from the greater ease 
492
ABORTION.
with which this is accomplished by nature, and on account of the mis-
chief which will  inevitably result from the retention within the ute-
rine cavity  of any  portion  of the ovular membranes.  But  "as  a
general rule the membranes  remain after the expulsion of the  foetus
and the  earlier the  abortion, the longer the placenta or membranes
have  a tendency  to remain.  This  is  probably owing  to the ex-
tended adhesion of the ovum to the internal superficies of the uterus,
and the feeble power  of the uterus to contract on its contents."—T.
Smith.  Sometimes the  membranes of  an  early  ovum will remain
for weeks, keeping up  a  more or less constant haemorrhage, as  before
stated; and for this  condition China has proved a most efficient rem-
edy,  being  indicated  by the very  considerable loss of blood, and
serving in a remarkable  manner to arouse the expulsive action  of the
uterus.   This indication for the selection of China has been strongly
confirmed by the prompt results which followed its exhibition in some
cases  of long-retained membranes and consequent haemorrhage in twin
pregnancies.
   The following remedies  should  be carefully studied, and  if the
proper homoeopathic simile  to  the  case in hand is  not to be found
among them, the search should be extended through the whole Materia
Medica, for  the medicine which presents the most perfect picture of
the tout ensemble of  the case  will not only do the  most good, but will
usually be the only  one  which—in bad  cases especially—will do any
good.  And both the  dose itself, and  the frequency of its repetition,
should be made to conform  to the nature and exigencies  of the case,
according to the best judgment and experience of the attending phy-
sician.  The rule of Hahnemann, to wait for the exhaustion  of the
action of one  dose before administering another, is  as  sound as it  is
universal in its application.   But it is  the particular  application of
this rule to  each individual  case wliich calls for  the exercise  of the
closest observation and  of  the wisest  discrimination, since it must
be evident that the  action of a  remedy adapted  to  relieve  the most
violent symptoms of  an actual abortion, will  be more  rapidly ex-
hausted than  that of  one calculated to cure in advance  the  consti-
tutional  taint  or  actual chronic disease  which  may predispose  to
abortion.

   Aconite. If a pregnant woman has fright and the fear remains, and
she seems to  not get over it, she must take Aconite at once.  Or  if
she have haemorrhage  and fear  of death, is sure she will  die, or she-
is very giddy on rising from a recumbent position, she has  to  lie 
  TREATMENT OF ANTICIPATED OR THREATENED  ABORTION.  493

down again, cannot remain up.  In many cases there is an  uncon-
scious  fear, which seems to control the patient; she is afraid to get
out of bed, to turn over or to move; or she is afraid to go from room
to  room,  or to  go  out,  and  fears that  something  untoward will
happen.
  Aletris far. Habitual  tendency to abort,  with a sensation of weight
in the  uterine region, and tendency to prolapse of the womb.
  Apis. Stinging pains occur in one or the  other ovarian  region more
and more frequently till labor-pains are produced; sometimes flowing,
and finally abortion. The urine is usually scanty, and there is absence
of thirst.  Prolonged  and difficult constipation  is often connected
with such  cases.  Apis will invariably relieve these  symptoms, and
pregnancy  may then continue to the full term.
  Arnica. In cases of shocks, falls, bruises or concussions a pregnant
woman should always  take Arnica at once, more particularly if she
commences  to flow, with or without  pain, or to have pains without
flowing.  She has a bruised feeling, so that it hurts her to move.   If
the period of quickening has passed the motion of the child hurts her;
she is  sure the child is lying across the abdomen.
  Asarum.  Indicated in threatened abortion from excessive sensibility
of all  the nerves, so that from even imagining something unpleasant
might occur, a disagreeable sensation thrills through her,  momentarily
arresting all her thoughts and functions.
  Belladonna.  A  pressing  toward the  vulva, as if all  the internal
organs would  issue therefrom.  Pain in the back as if it would break.
Flushed face, red  eyes,  throbbing carotids  and  heat in the head.
More or less discharge of blood from the  vulva, the discharge some-
times  feeling  very hot.   The least jar is unpleasant to her.   She
moans a great deal, which seems to afford relief.
  Bryonia. Discharge of dark red blood; pain in the back aggravated
by motion; burning pain in the uterus; head aches as if it would split.
Thirst  for a large quantity of fluid.   Pain all over, limbs and all;
lips and mouth dry;  thirst; desires to keep  still; nausea on sitting
up.  Constipation, the stool being dry as  if burned, and  difficult to
evacuate.
  Calcarea carb.  Leucophlegmatic constitution.  The  history of her
case reveals a disposition to haemorrhage;  menses too  often, too abun-
dant and too long; cold and damp feet; vertigo.  If  we now find her
threatened with  a  miscarriage, labor-pains, flowing, etc., we shall  be
likely to arrest  her troubles with Calc. c, unless there are more de-
cided symptomatic indications  for another  remedy. 
494
ABORTION.
   Camphor. Particularly  indicated in seasons of epidemic influenza
when  women  abort almost as  generally  as  the influenza prevails.
Especially if she have pale, loose and cold skin, with general disposi-
tion to catarrhal discharges.
   Cannabis. In  cases where women have been  or  still are affected
with violent gonorrhoea.
   Cantharis. The key-note for this remedy in such cases is an almost
constant desire  to  urinate,  sometimes ineffectual, but when successful
only a few drops are passed, with cutting and burning pain.
   Carbo veg. When the menses  are  usually too pale and too scanty
or too  copious and  premature, with a decided varicose condition of the
genital organs.
   Caulophyllum. Severe pains in the back and Iomis, tlireatenmg abor-
tion, with great want of uterine tonicity; the uterine contractions are
feeble, and are attended with but slight loss of blood.
   Chamomilla. She  has labor-pains, with  more  or  less discharge of
dark blood  and frequent urination, the urine being profuse and pale.
Her pains  excite  great  restlessness and agony, and irritability of
temper.  Spiteful irritability;  she is " snappish " when speaking.
   China. She has a sensation of distension in the abdomen, as if it
were packed full;  she wishes to  discharge flatus, but its  evacuation
either  upward or downward affords no relief.   If she has  haemor-
rhages, see this remedy under Metrorrhagia.
   Cimicifuga. Habitual abortion, where cold chills and pricking pains
in the  breasts are attendant symptoms.  Especially for abortions  oc-
curring in women of rheumatic tendencies.
   Cinnamon. After  a false step or a strain in the loins;  the chief
symptom is a profuse flow of blood, bright red.
   Cocculus.  Much  bilious vomiting;  paralytic pain in the back, ren-
dering the  lower extremities almost entirely useless.
   Conium. Much vertigo  on turning  over when lying down.  Urine
intermits at every micturition.
   Creosote.  Her haemorrhage seems to pass into a corrosive, ichorous
discharge, and then to freshen up again, and so on.
   Crocus. The discharge is  composed of black strings; as fast as  the
blood flows from the vulva  it is formed into black string-like masses;
and  if a quantity of blood  has been discharged and a portion of the
mass be raised on a slender instrument, it will present this  black and
string-like  appearance, though knotted together to some extent.
   Dulcamara. Where the threatened miscarriage has been induced bj
exp^ure in a damp, cold place, as in a milk-house or cellar. 
  TREATMENT OF ANTICIPATED OR THREATENED ABORTION.   496

  Ferrum. Flowing and pain, with a fiery red face.  She is very weak
and pale. Great nervous erythism.
  Gelseminum is a very valuable remedy, especially when the pains
arc inclined to run upward  or  upward  and backward, are  of sharp
character and are quite distressing.  Loss  of will-power  over the
muscles.
  Hyoscyamus. She is delirious and rather spasmodic, with rigidity of
the  limbs.  She loses her sight and hearing.  .She may at the same
time discharge bright red  blood with labor-like pains.
  Ignatia. Much sighing and sobbing; suppressed grief has been the
exciting cause; sensation of  " goneness " in the pit of the stomach.
  Ipecac. The key-note for  this remedy is one  continual  sense  of
nausea, without a moment's  relief, or pain about the umbilicus, pass-
ing off into the uterus, or a continued and profuse flow of bright red
blood.   Either of the above symptoms is  an almost positive indica-
tion, and when present this remedy will  nearly always cure the entire
case without resort to any other remedy.
  Kali carb.  If the labor-like pains commence in the  back and pass
off down the thighs, or if the  pains are more like stitches.  Much
backache when walking.  She feels that she must lie or sit  down. Con-
stipation ; the stools are large and are passed with difficulty.  Stitches
in the region of the kidneys;  pallor;  saculated swelling  over the
eyes.
  Lycopodium. The abdomen is in a constant state of fermentation, or
her pains are shooting from right to left  across the abdomen.   Or she
has  intolerable pain  in the  back before passing water, with almost
entire relief  as soon as the urine flows.   The  motion of the child is
excessive and tumultuous; red  sand in the urine; feeling of dryness
of the vagina; borborygmus;  weeping; sadness; leucorrhoea; faint
ness; itching about the vulva.
  Mercurius.  Where there is  phlegmonous swelling of the labia, swell-
ing of the inguinal glands, etc.
  Nux mos.  Suitable to hysterical women who are disposed to fainting
spells.  Mouth and throat are very dry; the tongue sticks to the roof
of the mouth.
  Nux v. Every pain produces a desire to defecate  and to urinate,
particularly the former; this is  an almost certain  indication.   Fre-
quent desire to  urinate, with burning and  scalding when urinating;
brick-dust sediment in the urine.  She is in a very irritable condition
from high living, drinking wine, etc. Constipation of large difficult
stools, or small and frequent stools, with pain in the anus.  Sore feel- 
496
ABORTION.
ing in the region of the womb;  she  dreads being moved, and  feels
cross about it.
   Opium. Abortion threatening after a great fright;  spasmodic labor-
like pains.  Especially suitable when occurring in the latter part of
pregnancy.
   Phosphorus.  Particularly applicable in tall, slender persons.  Great
sense of weakness in the abdomen.  Stools narrow, long, dry and dif-
ficult.  Profuse and long-lasting flow of blood.
   Platina.  Discharge of a quantity of thick black blood.  A  tremu-
lous  sensation extending from the vulva  into the  abdomen.  The
mons veneris and vulva feel cold  and  sensitive to the touch.
   Plumbum. Constipation, stools  in  balls  like  sheep's dung; much
depression of spirits; pain drawing from the abdomen to the backbone
as though  the abdomen were drawn upward by a string.
   Podophyllum. Pain in the region of the ovaries, especially at night,
disturbing sleep; she is very nervous  and restless.  This condition
may recur night after  night until  finally symptoms of abortion set in.
Prolapsus  uteri; the womb is disposed to fall very low, even painfully
so.  Stools too frequent, although natural; with prolapsus ani  with
stool.
   Pulsatilla. When the discharge  is arrested for a little, then returns
with redoubled violence; this cessation and renewal are frequently re-
peated.  Mild and tearful women of yielding temperament are most
easily affected  by this remedy.   Cannot bear a close or warm room,
and wants air.
   Rhus.  When the patient has been  wrenched  or strained, as when
she slips, and is strained in trying to  save  herself from falling, or in
lifting.   Her  pains at first are worse at night, particularly the last
part of the night; and she  is restless, and must move frequently to
find relief.  Cramps in calves;  metrorrhagia.
   Sabina. This  remedy seems  particularly  applicable  to cases of
abortion occurring habitually at the third month.  The  pain extends
from  the back directly through to the pubes.  The discharge  is  pro-
fuse, with  about equal  proportions of clotted  and of fluid blood, red
or dark.
   Secale C In feeble, cachectic women, having a wan, fearful counte-
nance, pulse  almost extinct,  fear of death,  copious flow of black
liquid blood, and convulsive movements.
   Sepia. She has yellow spots on  her  face; a yellow saddle across the
bridge of her nose.  She has a sense of  weight in the anus; constipa-
tion, stools mixed with slime; great urging and involuntary straining, 
ABORTION.
497
  often ineffectual.   This sense of weight like a heavy ball, when well
  marked, is almost an unfailing symptom, and is almost ahvays present
  when Sepia is indicated.  Abortion occurring especially from the fifth
  to the seventh month.  Frequent flashes of heat; motions of the foetus
  are feeble;  much itching  about the vulva;  inclines  to faint; painful
  sensation of emptiness in  the pit of the stomach.
    Silicia. Is particularly  indicated where there are spinal affections
  and constipation of difficult stools, as if  the rectum had not power to
  expel  them, and  where the stool recedes after having been partially
  forced down to the anus.
    Stramonium.  Threatened abortion,  with  unceasing loquacity;  she
•  talks,  prays, implores, sings, constantly uttering something in this
  line.
    Sulphur.  She has frequent flashes of heat, cold feet, heat on the top
  of the head; weak fainting spells; eruptions upon the face and other
  parts of the body; leucorrhoea.  Haemorrhoids, which bleed profusely,
  are sore to touch and itch very much.  She  sleeps badly, awaking
  often.   Faint and hungry about 11 a.m.  Vomits her food.   Is in-
  tolerant of noise.  A slight effort causes  great fatigue.
    Veratrum a. This medicine is indicated where there has been nausea,
  vomiting and diarrhcea at every menstrual period, or exhausting diar-
  rhcea.   With  every pain there is a  cold  sweat upon  the forehead.
  Retching.
    Zinc. There is  much restlessness of the feet and legs, or a sort of
  fidgety c< ndition  attending her symptoms of abortion.
    Nitric acid. Haemorrhages from the uterus  in  first half of  preg-
  nancy from over-exertion, with  mental depression.
    Viburnum. Threatened abortion, with very severe pains and discharge
  of clotted blood.
    Thuja. At the third month—commencing with a scanty discharge of
  blood for five days, then more  and more  profuse—the end threatened.
     32 
498                    DISEASES OF WOMEN.
                        CHAPTEE  XXVI.

                       DISEASES OF  WOMEN.

   TN describing the  forms of disease to which women are  peculiarly
   J-  liable, and especially in pointing out the remedies which may be
   required in their treatment, it will be seen that we do not attempt to
   give all the symptoms.  And this is true also of all the forms of dis-
   ease and of all  the remedies mentioned in this work.  And since in
   some instances, remedies are mentioned with scarce more than a single
   indication  for their use, it seems important at the outset to guard  *
   against the  serious error of supposing that we recommend a medicine
   from a single symptom—a practice especially deprecated by riahne-
   mann.  And it  might be  sufficient to state here that  in all  cases
   where remedies  are introduced, whether with one symptomatic indica-
   tion or with many, they are so introduced as remedies which should be
   studied in connection with the class of disorders under consideration—
   not as remedies  which should be given one after another till the pa-
   tient is relieved, by  death or otherwise.
    But some other considerations and explanations need to be intro-
   duced here.   In the different forms of structural or organic disease,
   some of which have  no direct counterpart as yet in the pathogenesis
   of our remedies, we are compelled to look for the great characteristic
   constitutional symptoms, the most prominent and peculiar features of
   the case, even apart, if necessary, from functional derangements and
   from structural  disorganization.  Such symptoms—which are purely
   constitutional, just the reverse  of the  local, since they may appear in
   connection with  any  form of disease—become the peculiar characteris-
   tics, the key-notes, of their respective cases.   Such symptoms must be
   prominently contained  in  whatever remedy is suited to  the  case.
   We believe that  each case has its head-symptom, which leads all the
   rest—its key-note, from which  all the others take their pitch.  And
   we  believe  also  that the remedy which  contains this characterizing
   head-symptom will invariably be found to contain all the other symp-
   toms of the case.   Thus, if this be true,  as  we  believe it  to be, the
   clue then given will afford us the means of extending the curative
,   action and  sphere of the medicine far beyond what it had reached,
   or could be expected to reach, by direct pathogenesis, as well as enable
   us to prescribe with greater certainty and facility.
    These distinguishing characteristics, these key-notes, which  form 
DISEASES  OF WOMEN.
499
  the individual and constitutional symptoms of the patient, are sensa-
  tional symptoms, rather than such as are known as functional derange-
  ments  or structural disorganizations.  And the method we pursue in
  relyinc upon these in the absence of other indications, and of attach-
  ing very great importance to them, even  where other symptoms  are
  not wanting, is  sustained by two substantial reasons:  First,  in many
  cases we can do no better, since, as already stated, few if any of  our
  remedies either have, or can ever be expected to have, direct patho-
  genetic symptoms to correspond to the innumerable ultimate forms of
'  structural disease which  we are often called upon to treat.  Second,
  this method  has been found reliable by much experience, the purely
* constitutional symptoms, such as those of  periodicity and the conditions
  of aggravation  and amelioration, strictly sensational symptoms, being
  found to  constitute infallible  indications in the choice of tlie remedy,
  where  all other guides are wanting.
    Of course, under such circumstances it  would be alike useless and
  impossible to repeat with the particular remedies, under the  different
  forms of disease in which they may be useful, a long  detail of patho-
  genetic symptoms.  Where the  characteristic symptoms  are present
  and recognized, they will suggest the corresponding remedies for more
  particular examination.
    So, on the other hand, we cannot attempt to give all the symptoms
  which  may occur under the particular forms of disease described.   The
  symptoms which may and even do arise  under some of these forms of
  disease, such as  hysteria, for example, would fill volumes.  For nearly
  every part of the female system will be found to sympathize with the
  more purely local sufferings connected  with uterine difficulties; and
  every possible kind of  distress, every imaginable  morbid sensation,
  and  even the simulated  appearance of every  form of disease,  may
  arise in connection with nervous disorders of the uterus.
    We  do not wish to be misunderstood as recommending a method of
  generalizing, by advising to pay particular attention to the constitu-
  tional symptoms, such, for instance, as aggravation at three o'clock in
  the morning.  That is indeed a very general  indication and a very
  common symptom in a  particular remedy.   But  in  the  individual
  case  of our  patient it is the  very particular forih of her system's  vital
  and  constitutional reaction against a special  morbific influence.   The
  local symptoms are the more common,  and are those which are alike
  common to many individuals and to many medicines; but the con-
  stitutional symptoms, as they are more remote, are also more especially
  the characteristic and individual symptoms, since they are confessedly 
500                MENSTRUAL DERANGEMENTS.
the indications of the profound reaction of the individual system itself,
These constitutional  symptoms, while thus reflecting the profoundest
reaction  of the system against  the morbid influence,  and so estab-
lishing their claims to be  considered as  of the very first importance
will also be found to  carry with them, as it were, all the more import-
ant local symptoms.  Thus the remedy which is found  to answer best
to such a form of periodic  aggravation as has just been mentioned, at
three  in the morning, will  also be found to cover the other symptoms
sufficiently.  And  if we do  not find  in our  pathogenesis all such
symptoms, it is because  the pathogenesis itself is  necessarily incom-
plete.  This is well illustrated by a case which came under my obser-
vation many years ago.  A young physician had charge of a case of
miscarriage in which the  subsequent haemorrhage proved very in-
tractable.   The  miscarriage  was at three months in  a tolerably
healthy young woman, and was  brought on by running to reach a
ferry-boat.  Every remedy known to the young physician was  tried
in vain.   At last he resorted to the tampon in the  latter part of the
evening,  in hope to save his patient's life, and remained during the
night to watch its effect.   This means proved effectual for some hours,
and he began  to hope the danger  was passed.  But at three in the
morning  the haemorrhage returned, with such violence as almost to
expel the tampon.  The remarkable character of the aggravation led
him to give Nux vom., which was  followed by immediate and  perma-
nent relief.

                   Menstrual Derangements.
  As has  been explained in a  previous chapter of this work,  men-
struation is a physiological process  appearing in the order of nature.
(See page 69, et seq.)   In those  cases in which it does  not take place
60 easily and so effectually as is therein described, the deviation occurs
because the condition of the patient is not that of  the right line of
perfect health  in other  and constitutional ways.   From ill health,
then,  in one form or another, arise all the various forms of menstrual
derangements.   And  in  treating such cases we seek but to obey the
call of nature for the re-establishment of good  health;  we  give the
proper medicament, sJhd the function becomes established, re-estab-
lished or properly established, as the  case may be, because we thus
cure the constitutional or  other  malady under which  the system is
laboring.
  It is proper to remark,  at this  point, that it is the duty of practi-
tioners of  medicine to instruct their female patients in regard to the 
AMENORRHCEA.
501
 importance of frequently changing the menstrual* napkin, concerning
 which the vulgar and erroneous notion prevails that frequent chang-
 ing increases or prolongs  the flow.   Changes  should be made  ofteu
 enough to secure cleanliness, wliich is essential to the preservation of
 health.

                         Amenorrhea.
  Amenorrhcea, or absent menstruation, may result from very differ-
 ent causes, and may occur, under one or the otlier of its various forms,
 at any period of the pubertal life of the female.  These various forms
 of amenorrhcea may be  arranged in  three  distinct classes:  First,
 emansio  mensium,  in  which  the  menses have never made  their ap-
 pearance.  Second, suppressio mensium, in which  the menses,  hav-
 ing made their appearance, have subsequently ceased.  And third,
 partial amenorrhcea, in which the menses are wanting, perhaps for
 months  in succession, but may appear occasionally and at irregular
 intervals.
  Each of these classes of amenorrhcea will need to be more particu-
 larly considered, with reference  to its nature,  causes, symptoms, con-
 sequences and treatment.

  Emansio mensium, or entire absence of the menses in women who
 have so long passed the first age  of  puberty that the case cannot be
 regarded as one of simple delayed menstruation, depends upon a very
 great variety of conditions  of the system, of which some are entirely
 beyond the control of art, some do not need to be interfered with, the
 remainder only being amenable to medication.
  I. The first of these conditions  is that which may be called congen-
 ital malformation,  in which the ovaries  are either entirely wanting or
 have remained imperfectly developed or become atrophied.  Similar
 to these are the  cases in which these  organs  have been destroyed
 before puberty  by accident  or  disease.   The  patients in whom this
 condition exists " may have the body  generally well developed and
 healthy, the circulation active and regular, and the organic functions
 (save one) fully performed.   But the breasts  are not prominent, the
 genital characteristics and sexual  propensities  are  not developed, the
 voice is deeper  than  usual, a slight beard  appears on the  upper lip,
 and there  is  a mixture  of masculine with  feminine peculiarities."
 Such cases are  evidently beyond the reach of art.
  There are other cases  of amenorrhcea  from  malformation of less
serious  nature, which may be relieved  by suitable treatment.   These 
502
menstrual  derangements.
 are  instance's in which the menstrual flow occurs  internally, but can-
 not appear externally by reason of an imperforate hymen, absence of
 the  vagina, adherence of its sides, or an impervious  os  uteri.  The
 periodical efforts at menstruation enable us to determine in such cases
 that the ovaries are not wanting.   And where the  menstrual nisus ap-
 pears without corresponding discharge, a  careful examination  should
 be made till the nature  of the difficulty is  satisfactorily  ascertained.
 The retention of the menses by an imperforate hymen  is by  no means
 dangerous, and admits of ready relief by a slight operation  when the
 diagnosis is  satisfactorily established.  The  retention which  results
 from adhesion of the parietes of the vagina or occlusion of the os uteri
 is far more  serious, since, if not relieved by an operation of  greater
 severity, it must lead to  fatal results.  Inspection  alone, or  the touch
 upon the vulva, will  discover the tumor  which indicates  menses re-
 tained by imperforate hymen.  But the  introduction of the finger
 within  the vagina, or even the exploration  by the rectum, will be
 requisite to determine whether the uterus  is wanting, its mouth sealed
 up, or whether  obliteration of the vagina be not the cause of  the re-
 tention.   Congenital atraesia  of the uterus, complicated by  retention
 of the menstrual blood,  may be suspected in those cases in which the
 hymen  and vagina  are pervious, but where at each menstrual epoch
 the sufferings increase in  intensity—where  the  menstrual molimen is
 most violent, but no  external  discharge  appears.  There may be a
 gradually increasing tumefaction of the abdomen,  and  with  the men-
 strual periods  real uterine colics, sometimes  accompanied  with chills,
 with  frequent vomiting, syncope and  convulsions.  And  if no arti-
 ficial  opening is made for the exit of the blood,  the  difficulty must,
 sooner or  later, become  fatal, either by the rupture of the  walls of
 the uterus, by  an  inflammation  of the peritoneum, which is being
 continually irritated and distended, or by  an attack of  general  maras-
 mus, exhausting the patient weakened  by  such severe  and prolonged
 sufferings.
  II. A. second class of  cases of absence of menstruation  consists of
 those which need no treatment.  And it is  important  to discriminate
 these cases aright, since the female will perhaps suffer more from med-
 ication where none is required than from want of it  where it really
may  be needed.  And these  cases, now stated to  be such as  do not
need treatment,  are the exact opposites  of those already described as
 being beyond all treatment.   For as those were cases of amenorrhcea
 from total absence of the ovaries and of ovulation, so  these  are cases
of amenorrhcea  in  which the ovaries are  present,  but  in  <vhich their 
amenorrhea.
503
 functional action  is so performed  as  to  produce no menstrual flow
 And to all appearance, and  in  fact so far as the present light of
 science and of  experience shows,  these cases are perfectly healthy,
 since many women have been known to conceive and bear healthy
 children and rear  families who never menstruated.  And in all those
 cases in which young women have entered  upon the age of puberty
 without having experienced the menstrual  flow, but still  remain to
 all  appearance in perfect health—whether we regard  them as cases
 of amenorrhcea  from incomplete development (that is,  retarded men-
 struation) or of ovulation without  corresponding  menstrual flow—all
 these need no medical treatment so long as they present no positive morbid
 symptom.  " In  some cases it constitutes  an  idiosyncrasy.   In certain
 families the establishment of this  function will in every instance be
 delayed until the  subject is fifteen or twenty years old.  Its first ap-
 pearance is greatly influenced by external circumstances  and surround-
 ings, education, exercise and associations.   But  more  frequently its
 delay depends upon a depraved condition of the general health.   In
 many cases there is  a  developing dyscrasia, as,  for example,  tuber-
 culosis, which interferes with and  interrupts  the coming  on  of the
 menses."—Ludlam.
  As we have already shown, those whose  sexual development, and
 consequent ovulation and  menstruation, occur late, may prove to be
 endowed with a corresponding longevity  and power of bearing chil-
 dren long after  the usual period of the  change of life.   This point
 should  be well understood, in order that the physician,  planting him-
 self on the ground of true physiology, may be able to  allay the fears
 of anxious mothers, who are alarmed if  their daughters fail to men-
 struate  in their fourteenth  year.   It  may be sufficient to  state here
 that there must  be other morbid  symptoms and conditions than mere
 non-appearance  of the  menstrual flow to justify medical interference
 in the case of young women ; but when such general or special disor-
 ders of the system do occur, apparently in consequence of the delay
 of this  function, then such treatment  should be resorted to as may
 be suitable for the  entire case, and  thus  serious disease may  be
 warded off.                                              • •
  III.  The third  class of cases of emansio mensium consists of those
 which are amenable to and which require medical treatment.
  The first class was composed of those malformations  in which ovu-
 lation, and of course menstruation, were simply impossible, by  reason
of the absence of the requisite organs.   These cases admit of no treat-
ment.   The  second class, in which the amenorrhcea  is  the  result 
504
MENSTRUAL derangements.
of some peculiarity of the system by which perfect ovulation may be
unaccompanied  with menstruation, or  in  which the amenorrhcea is
simply  the  result of incomplete development,  without morbid  symp-
toms (retarded menstruation), requires  no medical treatment.  But
in the  third  class,  the  amenorrhoea—whether accompanying com-
plete or incomplete sexual development—is a truly morbid condition
as shown by  the attendant constitutional  disturbances of the  entire
system.  This class of cases  is not only amenable to  medical treat-
ment, but affords some of the most brilliant illustrations of the truth
of the homoeopathic principles and of the  action of the homoeopathic
remedies.
  We have been thus  particular in  recapitulating, because it seems
of the  first importance  to understand the difference between that
form  of late development which may be the  result of constitutional
strength and which is unaccompanied by morbid symptoms, and that
which is  the consequence of constitutional dyscrasia, and which is
always  evidenced by symptoms indicating the anaemic or chlorotic
condition, or by painful and ineffectual attempts  at menstruation, or
rather ovulation.   For  as we have shown that ovulation is the pri-
mary and  menstruation the  secondary function, so amenorrhcea is
mostly to be considered  to  be the result of absence of ovulation, as
in those cases in which the ovaries are entirely wanting, or identical
with or the consequence of imperfect ovulation where these organs are
present.
  Symptoms.—Those cases  of amenorrhcea in young persons  which
are  unaccompanied  by any pain or other morbid  symptoms, and for
which therefore we  are not called upon to prescribe, are doubtless due
to incomplete development  of the  ovaries;  while those  cases of
amenorrhoea which are  accompanied with  periodical  but futile  and
painful attempts  at menstruation, and in which  the  general  health
evidently suffers, are  in  like  manner to be attributed to failure of
functional action on the  part of organs already sufficiently developed.
  And  this will  appear the  more  evident from the consideration of
the fact that the very late development of the ovaries, and consequently
late menstruation, is not only entirely painless, but may be an attendant
of more than  usual  health and  strength.   And this will still further
appear from the nature of the two entirely  opposite classes of sufferers
from amenorrhcea.
  Those comprising the first  of these two  classes  are  weak, pale,
delicate young women;  spare  and thin  or  fleshy and  leucophleg-
matic ;  in either case having feeble circulation, as  evidenced by gen- 
amenorrhcea.
505
era! chilliness  and sensitiveness  to  the  cold;  imperfect nutrition, us
shown by theii indifference to or disgust for food ;  or, still worse, im-
perfect assimilation,  as  shown  by  their insatiable appetite.  Those
composing the second class, on the contrary, show all the  appearance
of perfect and robust health ; they are plump;  their cheeks red, their
complexion florid and their habit plethoric.  In the former of  these
classes of amenorrhcea  the  sufferings are more  chronic  and  more
generally diffused over the entire system; in the latter they are  more
acute and severe, and more concentrated in the form of local conges-
tions.  "In both, the  attempt at menstruation may be  made  each
month, accompanied  by  shiverings, pain in the back and loins, weight
at the lower part of the abdomen, aching down along  the thighs,
general lassitude  and uneasiness, and sometimes  pain in the thyroid
gland."  These symptoms, after continuing a few hours or a day or
two, pass away without  any menstrual  secretion, to be repeated each
succeeding  month, or the proper  secretion may  be substituted by a
leucorrhoea.   " But the  effects of this abortive  effort  are not so tem-
porary ;  severe headaches occur occasionally, sometimes with intoler-
ance  of light  and sound; the patient complains of throbbing and a
sense of  fullness in the head ; pain is felt in the side; the stomach and
bowels become irregular in their functions, the countenance pale and
the strength  much reduced."   Paroxysms of dyspnoea and hysteria
and hysteralgia come on, artd the  patient has the  appearance of con-
firmed ill-health—is sometimes said to be  going into decline.  There
is general chilliness or disposition to attacks of fever, according to
the plethoric or  lymphatic temperament of the patient;  pain in the
chest; and if the patient be of the florid constitution her case may
easily terminate in quick consumption; while if leucophlegmatic the
same fatal termination may  be  reached by a somewhat more tedious
course.
  A careful study of the different remedies mentioned at the close of
this section will  enable  the physician to determine upon the medicine
to be administered.

  Suppressio Mensium constitutes the second form of amenorrhcea,
in which the menses having made their appearance have subsequently
ceased.
  This may be  sudden  in its onset (violent, accidental suppression),
or it may come on in a gradual manner.   In the  former case it may
lead  immediately to severe  and dangerous forms of disease;  in the
latter, it may precede  the development of some profound constitu- 
506
MENSTRUAL  DERANGEMENTS.
 tional disorder, such as  phthisis, or it may result from organic de-
 rangement of the uterus or of the ovaries themselves.
   Acute Suppression of the menses may result from exposure to cold
 and wet, or both, immediately preceding the appearance of the menses
 or during their flow; from violent shock to the nervous system as in
 cases of fright; from sudden  and severe mental distress; or from any-
 profound disturbing influences, whether physical  or  moral, received
 during the menstrual period.
   Clironic Suppression of the  menses may  result from any slowly
 operating debilitating influences;  from  too  close sedentary  confine-
 ment, as in young girls at school; from too severe mental application •
 from lack of sufficient nourishment; from leucorrhoea ; and, as already
 stated, from  the development  of some constitutional dyscrasia, such as
 consumption, etc., or from morbid growths of the uterus, ovaritis or
 endometritis.  It may likewise  accompany or  follow attacks of acute
 disease, especially inflammatory or  febrile affections, and has been
 known to be a consequence even of removal  from one place to an-
 other, emigrants being frequently thus affected.
  Symptoms.—The more sudden the  suppression and the more severe
 and  profound  the causes  which produce it, so much the more violent
 will be the resulting  symptoms.  In most cases there is more or less
 fever, headache, hot skin, quick  pulse, thirst, nausea, and other indi-
 cations of general constitutional disorder.   Or the ill effects of the
 suppression may be developed in local inflammation, as in inflamma-
 tion of the lungs,  uterus and  ovaries.  And in cases of nervous tem-
 perament and scrofulous diathesis there is often a remarkable disposi-
 tion to be attacked with inflammation of the brain from the menstrual
 suppression.   In such cases the return of the  menses would  usually
 be followed by a subsidence of the cerebral symptoms.  The  appear-
 ance  of the  menstrual flux in other severe illnesses, where there had
 been no previous suppression, is regarded as constituting a very grave
 complication.
  Hysterical affections, or even neuralgic sufferings, in other instances
 may result from suppression of the menses, and these may successively
 attack the head, lungs and stomach.  Sometimes the more profound
consequences of nervous debility and disorder, such as fainting, loss
 of vision, amaurosis, apoplexy, and even paralysis, make their  appear-
ance in connection with such suppression.  And the more violent dis-
orders that  follow acute,  sudden suppression  of the  menses are very
apt to terminate fatally.
  " Suppressed menstruation,  either sudden or  gradual, is not unfre- 
AMENORRHCEA.
507
jucntly followed, even when uterine inflammation  is not developed,
bv serious general symptoms, obstinate vomiting, severe hysteria, and
sometimes by the establishment in the  economy of a  supplementary
haemorrhage, to which the name of vicarious  menstruation has been
L'iven.  The mucous membrane of the  nasal  fossae, of  the lungs,
stomach and bowels is  the  most ordinary seat  of this haemorrhage,
which takes place in some  instances with  the  regularity of normal
menstruation,  and  in  others  at irregular  periods.   All  the  other
mucous membranes, and also the skin itself in various regions, have
been the seat of vicarious menstruation. It has not unfrequently been
observed from the surface of .wounds or sores-."—Bennett.
  This so-called vicarious menstruation constitutes a form of haemor-
rhage in general less grave than that from  other sources.   Where it
attacks the  lungs, for instance,  it does  not, like other haemoptysis, in-
dicate the presence of tubercles, but rather a state of the system which
may sooner or  later lead  to them, if not remedied.  The  manner in
which the chronic or gradual form of suppression takes  place should
also  receive consideration.  The  suppression may not occur all at
once, but be first preceded by more or  less  irregularity of menstrua-
tion  in respect to time.   One or more periods  may be passed over,
the  menstrual  flow returning  again in a diminished quantity, and
then finally ceasing.  Or the irregularity may be more with  regard to
quantity alone, the  menses with each preceding month becoming less,
until they  disappear altogether.  Or  the  discharge  for  some  time
before its total suppression  may have been  growing more and more
light-colored; this  is said to  be the most frequent manner  in which
chronic suppression occurs.  The menses may  be supplanted  by a per-
fectly white discharge, or  they diminish in quantity, become of a paler
color and with shorter intervals;  then a menstrual period arrives in
which the fluid excreted  is  perfectly colorless, while  the next period
may be characterized by discharge of the natural color.  Or, again,
the  leucorrhoea which so often causes  amenorrhcea encroaches more
and more upon the menses,  both in the time and in the quality of the
discharge, until it finally  completely replaces the menstrual flow.
  The same gradual diminution of the menses  mav  lead to  their
premature cessation, and  this  may be in  reality  the period of the
change of life.  In such cases, nature, after a few years of rest of the
sexual  organs,  sometimes restores their  activity;  and women who had
supposed themselves to  have finally passed the critical age are  sur-
prised to find a full and complete return of the menstrual flow.  All
this  but serves to show that the amenorrhcea, from whatever cause or 
508
MENSTRUAL  DERANGEMENTS.
combinati >n of causes it arises, is not in itself a disease, or even neces-
sarily a morbid  condition, as during pregnancy and after the change
of life the menses are wanting from causes which, although perfectly
natural, are entirely opposite, the person remaining in perfect health.
In  other  cases,  however, the  disappearance  of the  menses indicates
a disordered  state of the whole system, which  may be unimportant
and temporary or deep-seated  and  severe, according to the  nature of
the influences which produced it.  There are, however, cases of sup-
pression of the menses  which, arising from  influences  comparatively
slight, do not so profoundly affect the system, and in which, even
without particular treatment,  the  menses may  spontaneously  return
after missing but one or two periods, or may continue to be suppressed
for several years  even, without producing any apparent degree  of ill-
health.
   Treatment.—In all cases the treatment must be governed by the
causes, as in cases of suppression from wet, from fright, etc., and by the
totality of the symptoms.   In the  acute form of the suppression the
appropriate remedy  may be repeated oftener, according to the violence
of the symptoms and the severity of the suffering, taking care to allow
the first  dose to  exhaust its action before giving  the second; while
in the chronic form the remedy,  chosen for its adaptability  to the
whole  case, must be allowed to act for weeks, or even months, undis-
turbed in  its action  by a second dose so long as improvement can be
traced.  If no improvement appears, the dose may be  repeated or a
new prescription made, according to the circumstances of the case.
The proper treatment of the  gradual, chronic form will  result not
only in the restoration  of the menstrual  flow itself, but also in the
removal of the constitutional disorder of which the suppression was
but the forerunner, and  in the radical  cure  of  the  local, organic
affections of the sexual  organs by  which, in other instances, the sup-
pression may have been produced.   And the same  will  be found true
of the complications, such as leucorrhoea, haemoptysis, or other severe    t
affections which  may arise  in connection  with the  amenorrhoea.  Let
the diet and hygiene of the patient be  properly  attended to, and then
the less the attention paid  to  external  treatment the sooner will the
recovery be complete.  Give the  proper homoeopathic remedies, in
the proper manner,  in these cases,  and all the paraphernalia of hip-
baths,  foot-baths, tonics, stimulants  and misnamed emmenagogues
may be dispensed with as  worse than  useless; the real object being
not so much to compel the return of the menstrual flow  as to cure
the patient of that disordered condition of her system which led to its 
AMENORRHCEA.                       509
suppression.   In the words of Dr. William Hunter: "With regard to
the management of the menses, my opinion is, that you should pay no
regard to them, but endeavor to put her to rights in other respects.  If
you cure the other disorders, you cure the irregularity of the menses,
which is the consequence and not the cause of her complaints."

   Partial  Amenorrhcea, in which the  menses are wanting per-
haps for months in succession, but may appear  occasionally and at
irregular intervals, constitutes our third  form of amenorrhcea.   This
may also be termed irregular menstruation, in which the catamenia are
not suppressed, but occur irregularly as to quantity and  quality, and
especially as to time.
   In some cases of this  form of amenorrhcea the health  appears to
suffer very little  if any from the exceedingly irregular and uncertain
manner in  which the menses recur.  In other instances the irregu-
larity is complicated with more or less severe dysmenorrhcea.
   The  irregularity may consist in the shortening of the intervals be-
tween the menses, and in such cases the flow may also be too profuse,
allied to menorrhagia.  Or the irregularity may consist in the length-
ening of the intervals, the menses returning with great regularity, and
perhaps in normal  quantity.
   The  causes of such partial  amenorrhcea must  be similar to those
constitutional influences which result in gradual  suppression of the
menses, to  which, in  fact,  many  cases of irregular menstruation
finally  lead.   And where the protracted amenorrhcea is  complicated
with pale,  colorless menses, with too profuse menses or with painful
menstruation, it will be seen that all the morbid influences which may
be brought to bear upon the constitution of the young or elderly
woman may tend to produce a more or less  complete cessation of the
catamenia.
   Treatment—The treatment of such  cases requires a  careful ex-  .
animation  of the patient, an elaborate collection of all her symp-
toms, and  a faithful comparison of them with the pathogenetic effects
of our  remedies.  In  this manner, and  in this maimer only, the
physician may make  such prescriptions  as shall  result in cures  alike
honorable "to homoeopathy and  profitable  to himself.   The partial
amenorrhoea is but a  single one among other indications of the poor
health of the patient;  this and  other indications being met by the
corresponding remedy, there will result in time such complete restor-
ation to health  as  will at once surprise and delight the  patient and
her friends. 
510                MENSTRUAL  DERANGEMENTS.
                  Remedies for Amenorrhcea.
   Delay of First Menses.—1. Calc. carb., Caust., Graph., Kali carb.
Puis., Sulph.  2  Con., Magn.  carb., Natr. mur., Petrol., Sab.  3,
Agnus, Amm. carb., Bry., Chel., Cocc, Dig., Dule, Lye, Sil., Valer.
   Amenorrhoea in  general.—Cimicif., Con., Dule, Gelsem., Graph.,
Kali carb., Lye, Nux  mos.,  Puis., Sil., Sulph.   2. Aeon., Aletris,
Amm. carb.,  Apis, Bar. e, Bell., Calc. carb., Caust., Cham., Chin.,
Cupr., Ferr., Lilium tig., Natr. mur., Phos., Podoph., Sabad., Senecio,
Sep., Staph.,  Valer.   3. iEscul. hip., Agnus,  Alum., Apocyn. can.,
Ars., Asclep. syr., Aur., Borax,  Bry., Carb. veg.,  Coloe, Croc,  He-
deoma, Hell., Hyos., Ignat., Iod.,  Lach., Phos. ac, Phytolae, Magn.
carb.,  Magn. mur., Merc, sol., Nux v., Rhod., Ruta, Sang, Sassap.,
Strain., Verat. alb., Xanthox., Zinc.

   Aconite.  Amenorrhoea in young girls of sanguine temperament who
lead a sedentary life.   Tendency of blood to the head or  chest. Ver-
tigo or fainting on rising  from a recumbent position.  Amenorrhcea
from taking cold by getting the feet wet, or from fright or chagrin.
   .ffisculus  hip. Amenorrhcea, with great  general  prostration  and
malaise.  Great weakness  or  giving out of the back when standing
or walking, especially  across the hips;  constipation, with  ineffectual
urging to stool; haemorrhoids, of purple color and accompanied with
much burning.
   Agnus castus. Amenorrhcea, with drawing pain in the abdomen.
   Aletris far. Amenorrhcea, or  delayed  menses,  in consequence of
atony of the womb or ovaries.   Weariness of both body and mind;
fullness and distension of the abdomen, with bearing-down sensation;
general want of vigorous muscular action, with lassitude.
   Alumina.  Amenorrhcea,  with  abundant  leucorrhoea,  which flows
only in the  day-time, with weakness.  Much straining is  necessary to
evacuate even a soft stool.   Restless  sleep, always  awaking with  pal-
pitation of the heart.
   Ammonium  carb.  Colic,  and pain between  the  scapulae.  Violent
pain in the  small of the back, with great coldness.
   Apocynum cann.  Amenorrhcea  in young girls, attended with bloat-
ing of the abdomen and extremities.
   Apis mel.  Amenorrhcea, with general anasarca ; irritability and pain
of the ovaries, especially if the pain be stinging; cardiac distress.
   Arsenicum. White, waxy paleness  of the face  and great debility,
the least exertion causing fatigue.  Painful  lienteria.  Cold water lies 
REMEDIES  FOR AMENORRHCEA.
511
 like a load in the stomach.   Sleep full of tiresome dreams.   She is
 very chilly;  wants more clothing- on  her  or  to be  near the fire.
 Thirstless, or she wants little drink, but often.
   Aurum. Amenorrhcea, with great depression of spirits and  disposi-
 tion to commit suicide.   Inclines to jump out of windows.
   Belladonna. Throbbing headache, and throbbing of the carotid ar-
 teries.   Red face and eyes.   She cannot  bear light or  noise.  Much
 heat in the head.   Weight and pressure in the abdomen, especially in
 the uterine region.
   Borax v.  She cannot bear a-downward motion, as in  a swing, in  a
 rocking-chair or in running down stairs.   Pain in the  right  pectoral
 region.  She is very nervous; she does not sleep well.
   Bryonia.  Frequent bleeding of the nose, dry lips, thirsty and wants
 large quantities of drink; hard, dry stools, as if burnt.  She wishes to
 keep quiet, as motion is painful and disagreeable to her.
   Calc. carb. Leucophlegmatic temperament.    Vertigo on  going up
 stairs.  Her feet feel cold and damp.   Swelling at the pit of the
 stomach.  Spasmodic affections.  Worse on ascending.
   Carbo veg.  At  the time the menses should appear violent itching
 of old tettery eruptions.
   Causticum.  A  yellowish  complexion, weakly,  scrofulous.  Melan-
 choly ;  she looks on the dark side of everything.  Hysterical spasms
 and pinching pain in the  sacrum.  Leucorrhoea only at  night, or
 worse then.   Involuntary urination on walking or coughing.
  Cham. She suffers on account of a checked perspiration  or on ac-
 count of a fit of anger.  She  is  very  irritable  and disposed to be
 quarrelsome; she can hardly keep her  temper.  One  cheek is red,
 the other pale.  Pressing toward the genital organs; passing  of large
 quantities of colorless urine.
  Chelidonium. Constant pain under the inner and lower angle of the
 right shoulder-blade.  Biliary derangements  as a concomitant.
  China. Sensation of fullness and distension of the abdomen,  par-
 ticularly after eating, with desire to eructate,  which affords no relief.
  Cimicifuga.  Amenorrhcea in rheumatic  or neuralgic subjects.  Ner-
 vous excitability, bordering  on hysteria or  chorea; dullness of  the
 head and vertigo.
  Cocculus.  Much paralytic pain in the  small of the  back.   Leucor-
rhoea in place of the menses.  Discharge of a  few drops  of black
blood.  Whilst the effort is being made to menstruate she is so weak
that she is scarcely able to speak.   Hysterical symptoms very strongly
marked.  Headache, with nausea. 
512
MENSTRUAL DERANGEMENTS.
   Colocynth.  In cases where severe chagrin has been the  cause of the
suppression.   Colicky pains, causing her to draw up double, with great
anguish and  restlessness.
   Conium.  At every menstrual effort the breasts enlarge, become sore
and painful.   Much vertigo, particularly when, in a recumbent posi-
tion, an attempt is made to turn over.  The urine intermits in its flow.
Complicated with ovarian or uterine diseases and chlorosis.
   Crocus.  A  sensation of motion like that of a child in the abdomen.
A similar  sensation is  sometimes felt in the  stomach.   Epistaxis of
black, stringy blood.  Mental depression.   Menses in dark string.
   Cuprum. Particularly in cases arising in consequence  of suppression
of foot-sweat.  A strange tingling  pain in  the  crown of the  head.
Frequent nausea and fearful vomiting.   Convulsions, with painful
cries.  Cramps  in  fingers or toes.
   Dulcamara. Suppression in consequence of  exposure to cold and
damp.  She  has urticaria, or  some  other cutaneous affection,  every
time she takes cold.   Warts on her  hands;  her breasts are engorged
and hard.
   Euphrasia.  Ophthalmia, the eyes being  suffused  with  tears, and a
painful, dry ulcer on the right side of the bridge of the  nose, which
has been developed since the accession of the amenorrhcea.
   Ferrum.  In weakly, chlorotic persons, with fiery redness of the face.
   Gelseminum. Amenorrhcea, with sharp darting and  twitching neu-
ralgic pains in the face  and  head; headache which causes great dull-
ness of the head and  vertigo, and affects vision.   White leucorrhoea.
   Graphites.  Occasional  show of the  menses, which  are very pale
and very scanty, with  abdominal  pains  and  pains  in the limbs.
Swelling; in the hands and feet.  Itching blotches  here and there on
various parts of the body, from which oozes a gelatinous fluid.
   Hedeoma. Amenorrhoea, accompanied with intestinal  derangements,
nausea and retching to vomit.
   Helleborus. In  cases  accompanied  with  ascites, the  urine  being
scanty and dark,  depositing a sediment looking like coffee-grounds.
   Hyoscyamus.  Much loud  and boisterous  laughing at  every men-
strual effort.  Hysterical jerking and twitching; disposed to nakedness.
   Ignatia.  Much  involuntary  sighing and  sobbing.   Full  of sup-
pressed grief.   The suppression itself may have been caused by some
suppressed grief.   Weak, empty feeling at the pit of the  stomach.
   Iodium.  Very, very much out of breath on going up stairs.  Pale-
ness, alternating with redness of the face.   Frequent palpitation of the
heart.  Food does not strengthen her. 
REMEDIES  FOR  AMENORRHCEA.
513
  Kali carb. At every menstrual effort sour eructations and  swelling
of the cheeks;  oftentimes there are shooting pains all over the abdo-
men.  Organic disease of the heart.  Erysipelatous  eruptions.  Dis-
position to phlebitis.  Swelling over the eyelids.
  Lachesis. At every menstrual  effort there are cardialgia, oppression
of the chest and eructations.   Vertigo, with headache.   Discharge of
a few drops of blood from the nose.  Depression of spirits.
  Lilium tigrinum. Amenorrhcea, accompanied with cardiac distress, or
with ovarian pains of a burning or stinging character.   Amenorrhcea.
complicated with prolapsed or anteverted uterus.  Thin, acrid leucor-
rhoea, which leaves a brown stain on the linen.  Partial amenorrhcea;
the menses returning occasionally, to again remain  absent for  some
time.  Sensation as if an abdominal support were necessary.
  Lycopodium.  A fright may have caused the suppression.   Sour taste.
Sour eructations and sour vomiting.   A constant sense of satiety, so
that the least quantity of food causes a sensation of fullness up to the
throat.  Much borborygmus, particularly in the left  hypochondrium.
Sense of dryness in the vagina; wind from the vagina.
  Magnesia carb.  Every effort to menstruate is attended with a sore
throat,  which  only  subsides  with  the other  symptoms  or on  the
appearance of the menstrual flow.
  Magnesia mur.  She becomes very much excited  at every menstrual
nisus.  There is a pressing down  in  the iliac regions at every men-
strual nisus.   She is very hysterical;  and has constipation, with large,
difficult stools, which crumble as they escape from  the verge of the
anus.  A great deal of  sleeplessness.
  Mercurius.  Prolapsus of the vagina at every menstrual nisus.   She
has dry heat, and rush of blood to the head and congestion to  the
head at every menstrual nisus.  Pain in the mammae as if they would
ulcerate at every menstrual  period.   (Edematous  swelling of  the
hands, feet and face.
  Nat. mur. At  every menstrual nisus she feels anxious, melancholy
and qualmish  early  in the morning  for a  few  hours, with  sweet
risings from the stomach, and spitting of blood with the saliva.   She
awakens every morning with headache, which lasts a long time.   Con-
stipation of large, difficult stools;  the  anus being contracted, it  be-
comes fissured and discharges a quantity of blood.
  Nux mos. At every menstrual nisus the throat, mouth  and tongue
become intolerably  dry, particularly  when sleeping.  Amenorrhcea
from getting wet.  In women subject to  hysteria or  to fainting fits.
      33 
514               MENSTRUAL DERANGEMENTS.

Unconquerable drowsiness;  is sleepy all the time   Rheumatic pains.
Bloating of the abdomen after every meal.
  Phosphorus.  Particularly in tall, slender, phthisical women. Spitting
and vomiting of blood at the menstrual nisus; sometimes the haemop-
tysis  is profuse, or there is  haemorrhage  from the anus or urethra.
Stools small, dry and difficult.   Great sense of weakness across the ab-
domen.  The feet and legs are cold, and sometimes they are paralyzed.
  Phosph. acid. In cases with ineteoristic distension of the uterus.
  Phytolacca. Amenorrhcea,  complicated  with ovarian irritation or
disease.  Rheumatic  muscular  pains or chronic rheumatism.  Con-
stipation.  A hot feeling in the throat.
  Platina.  Particularly in emigrants.  Painful pressing down, as if
the menses would appear, with desire for stool, and pain in the small
of the back.  Constipation, with scanty, difficult stool; the stool often
adhering to the rectum and anus like soft clay.   Horrifying thoughts.
  Podophyllum. Suitable for  women who have frequent bilious attacks,
or who suffer  from  prolapsus  of the rectum  at stool, with  haemor-
rhoids; fatigue and depression; sallow complexion and general sickly
and wretched appearance;  foul breath ;  leucorrhoea.
  Pulsatilla.  Particularly suitable   in  mild, tearful,  yielding dispo-
sitions.  Pale  face;  difficulty in  breathing  after  slight emotions.
Constant chilliness, even in summer when warmly clad.  Leucorrhoea;
vertigo; throbbing headache; pressure in the stomach; pain in the
uterus, and dysuria.  In cases which come on in consequence  of wet
feet.   With  ophthalmia.  From nervous debility.   With morning
sickness, and  bad taste in the mouth in the morning; no appetite,
nothing tastes good.
  Rhododendron.  Her sufferings are particularly  aggravated  during
rough and windy weather, or  at the coming on of a thunder-storm.
Every menstrual nisus  is attended with fever and headache.
  Rhus tox.  In consequence  of a severe wetting, as in a rain-storm.
  Ruta grav. A corrosive  leucorrhoea  attendant, which is the conse-
quence of the suppression.
  Sabadilla.  The menses are suppressed immediately  on their appear-
ance, when they appear again, sooner or later, but are  again  sup-
pressed, and so on.
  Sabina. The sudden suppression is followed by a thick, foetid leucor-
rhoea.
  Sanguinaria. Amenorrhcea in consequence  of pulmonary  disease;
hectic flush of the face; noisy escape of flatus from the vagina.  In 
                  REMEDIES FOR AMENORRHCEA.               515
                 •
  women who are  subject to  sick headache,  with  stiffness  of the
  neck.  Pain running up the nape into head.
   Secale  corn.  Suppression of the  menses in thin, scrawny married
  women, who suffer much at  the  menstrual nisus with  a continual
  long-lasting, forcing pain in the uterus.
   Senecio. Debility of  the  system,  with nervous  excitability  and
  sleeplessness; lassitude;  gastric derangement  and  loss of  appetite;
  symptoms  as  though  the menses would appear,  but they  fail to
  do so.
   Sepia In feeble constitutions,  with delicate  skin.   Acrid  leucor-
  rhoea, with  soreness  of the vulva.   A yellow  saddle appears across
  the bridge of the nose.  Sensation as though the vulva were very large.
  Pressure  in the  abdomen at the  menstrual  nisus,  then  soreness of
  the perineum and swelling of the vulva.  Repeated shuddering the
  whole  day  during the menstrual nisus.  Coldness of the hands and
  feet, and frequent flashing of heat to the head and face.   Constipation
  and  sense of weight at the anris.   Painful sensation of emptiness at
  the pit of the stomach.
   Silicia.  Great costiveness at the  approach of the  menstrual  epoch.
 Smarting, acrid and corrosive leucorrhoea with the suppression.   Dis-
 charge of a quantity of white water from the  uterus, instead  of the
 menses.  Frequent attacks of momentary  blindness or obscuration of
 vision.
   Staphysagria. When  the amenorrhcea is the consequence of chagrin
 with severe indignation.   Much pain in  the  teeth  at the menstrual
 molimina.  She  is extremely sensitive to mental and physical im-
 pressions.
   Stramonium.  Extreme loquaciousness at the  menstrual  molimina;
 tears and prayers and  earnest supplications.  Her face is puffed up
 with blood, and  she  is very fearful, and  shrinks back with fear of
 objects on awaking from sleep.  She desires light and society.
   Sulphur. Stitching  headache; vivid redness  of the  face; violent
 pains in the uterine region and  itching pimples  on the chest at every
 menstrual molimina.  Haemorrhoids; flashes of heat; stitches in the
 side, and heat in the top of the head.   Coldness ojf the feet,  or burn-
 ing in the soles  of the  feet at night in bed.   Weak, fainting  spells.
 A ery short naps  at night, or very heavy, dead sleep the whole night.
She feels unusually hungry from eleven till twelve o'clock; she can-
not wait for her dinner.
  Valerian.  Especially suitable for  hysterical  women who Lave taken
too much Chamomile tea. Nausea, with desire to vomit, as if a thread 
516
MENSTRUAL DERANGEMENTS.
or something were hanging in the throat, coming from low down in
the abdomen.
  Veratrum alb. Nervous headache at every menstrual nisus, with cold
sweat  upon  the  forehead;   leaden  color of the  face, with  frequent
nausea and vomiting.  Also diarrhcea.
  Zinc. In those cases of amenorrhcea where alternate paleness and
redness of the face is a strongly marked symptom.

                         Dysmenorrhcea.
  Difficult,  painful  menstruation may be attended with profuse  or
with scanty  flow, the latter in the greater number of cases.  This
affection is seldom confined  to one or two menstrual periods.   When it
occurs it usually forms the principal characteristic  feature of the entire
menstrual life. The distress may be moderate and  last but a few hours.
and in these cases it is usually relieved by a tolerably free flow.  Or
it may be intensely severe, and  continue in the form  of a menstrual
colic for several  days; in such cases the flow is  almost always very
scanty.
  Dysmenorrhcea is capable of being divided into five  distinct classes,
according to the temperament  and constitution of the individual, or
to the  causes from which it originates.   These are the neuralgic, the
congestive, the inflammatory, the membranous, and the mechanical or
obstructive forms of dysmenorrhcea.

  Neuralgic Dysmenorrhcea is usually seen in persons  of a ner-
vous temperament, and is considered to be strictly a symptom of irri-
table uterus.   " The  sensations of fullness  and weight, the bearing-
down sensations  felt  at the vulva, the perineum,  the  rectum and the
coccyx, the frequent inclination to urinate, the fullness at the  hypo-
gastric region, the  pain in the * small of the back,' down the limbs,
in the  hips, around to the iliac and hypogastric regions, are all of the
same  type.   At  the  period these  symptoms of pain  and distress
become much aggravated and  often intense; the irritation extends
from the  nerves  to  the  muscles, hence  the  spasmodic pains, violent
cramps of the uterus, of the vagina and  of the  sphincters.  These
spasmodic pains are often of the most severe character, usually occur-
ring in paroxysms, for hours or even for days; and sometimes, although
then more moderately, during the whole period.   They simulate the
pains and agony of labor, and  they are equally  if not more agoni-
zing, for they are more protracted and the intervals are less decided t
sometimes, indeed, the pain is  almost continuous.   Usually, after the 
dysmenorrhcea.                     517
 first twelve or twenty-four hours, when the secretion of the menses is
 fully established, the pain and spasms moderate or cease.   Frequently,
 two or three days elapse before the  poor woman returns  to her usual
 state; and often the suffering is so severe and so prolonged that the
 whole interval does not afford  her sufficient time  for recruiting her
 prostrate energies.  The succeeding catamenial period brings renewed
 neuralgia and spasms, and so on even for successive years, depriving
 the sufferer of all social and intellectual happiness."—Hodge.
   This form of the disease may present itself in  persons  who may be
 said to be of the  neuralgic diathesis,  and who are subject to neuralgias
 of the other parts and organs;  or it  may be due to the opposite states
 of chlorosis and  plethora, or to  luxurious and enervating habits of
 living, or accompanying such diseases as gout and rheumatism.  It
 may likewise  exist in consequence of excessive sexual indulgence or
 masturbation.

   Congestive Dysmenorrhcea is seen in women of a full habit and
 of a sanguine temperament; both the  unmarried and those who have
 borne children are very liable to it.   Young girls of florid complexion
 and plethoric habit suffer  terribly in  many  cases  before their men-
 struation  is regularly established, and often in  such cases the same
 congestive attacks  follow them  occasionally  in after  life.    "For
 some time before and after the  catamenia appear  the suffering is very
 great;  the patient complains of pain  across  the  back, aching  of the
 limbs, weariness,  intolerance of light and sound; the face is flushed,
 the skin hot, the  pulse full, bounding and quick,  often upward of one
 hundred."  These  sufferings  are relieved by  the menstrual flow,
 which, although sometimes scanty, is often very profuse.
  This form of dysmenorrhcea  may result, as already remarked, from
 a plethoric condition of the system, or it may follow exposure to cold
 and wet,  or  arise in consequence of  exciting or  depressing mental
 emotions.   Again, it may be due to  displacements of the  uterus or to
 a variety of diseases of that viscus,  such as  subinvolution following
 labor,  areolar hyperplasia and  fibrous tumors.   " Any one of these
 causes, without exciting true inflammation, may keep up a state of
 hyperaemia in the uterine vessels, which,  being  augmented at men-
strual epochs, creates pressure upon the neighboring nerves, and conse-
quently pain."

  Inflammatory  Dysmenorrhcea.—This form of dysmenorrhcea
is usually due to inflammation of the mucous lining of the uterus, 
518                MENSTRUAL DERANGEMENTS.

whether of the cervix, of  the  body, or of both.   It may likewise
accompany and be caused  by inflammation of the ovaries  or of the
cellular tissue  lying around the uterus.   The  inflammatory condition
of these parts  may be such as  to give  rise to but little  or no pain
until, when the vascular erethism attendant on the  menstrual epoch
arrives, the additional vascular turgescence and general  local excite-
ment which occur give rise to  much pain  and suffering.  The pains
are not generally acute, but rather of a  dull, heavy and fixed charac-
ter ; and they may come on a day or two prior to the commencement
of the meustrual  flux, and continue with but  little  or no abatement
until its cessation, or even for a day or two longer.
   Inflammatory dysmenorrhcea may be distinguished from  the con-
gestive variety by the fact that  the inflammatory disease which gives
rise  to it will  cause pain during the intermenstrual  periods, and the
detection  of the existence  of these inflammatory diseases will aid in
effecting a correct diagnosis.   It may readily be differentia'ted from
the neuralgic,  the membranous or the obstructive varieties.

   Membranous Dysmenorrhcea  may appear in  connection  with
the neuralgic or with the congestive dysmenorrhcea.  This appears to
be a complication  of simple dysmenorrhcea, occurring in persons of
some peculiar  constitution, and  consists  in  the  expulsion at  the
menstrual period of the hypertrophied  mucous lining of the uterus.
These cases, not very common,  are extremely  painful, and  especially
where, as is sometimes the case,  the membrane is discharged whole in
the form of a sac,  it is liable to be mistaken for the product of con-
ception—a mistake that it might be very unpleasant for the physician to
make with reference to an unmarried patient.   In some instances this
expulsion appears to hold over,  passing the regular menstrual period,
the menses intermitting, and the female deeming herself enceinte. But
when thrown off in what was supposed to be an abortion,  nothing ap-
pears but the exfoliated mucous membrane of the womb.
   The peculiarity  of constitution which gives rise to  such a condition
is not definitely known.  If the membrane come away entire, it will
exhibit the triangular shape of the  uterine cavity, and there will be
found three openings, corresponding with the entrance to the Fallopian
tubes on either side and the os internum.  It usually is thrown off in
pieces, however.  The diagnosis of this rare form of dysmenorrhcea is
by no means easy or certain, especially in the case of married women,
where it may  be apt to be  confounded with conception and impend-
ing abortion.   But  an attentive  study and  comparison of all  the 
DYSMENORRHCEA.                      519
 symptoms will lead to a proper prescription:  indications for  mem-
 branous dysmenorrhcea will be found among the remedies at the close
 of this section.

  Mechanical  or  Obstructive   Dysmenorrhcea  is  the  name
 given to a class of cases in which the difficulty and consequent pain-
 fulness of the menstrual discharge arises from  some mechanical  ob-
 struction, such as  the partial closure, from stricture or  narrowing, of
 some portion of the cervical canal.  This narrowing of the calibre of
 the cervical canal is a very frequent cause  of obstructive dysmenor-
 rhea, and is itself often occasioned  by the use of nitrate of silver or
 other caustic in the treatment  of diseases of the cervix.  Or there may
 be actual obstructions lodged  in the  canal, such as coagula, thickened
 and hardened mucus, the formation of false membrane in the cavity
 of the body or neck of the  uterus, uterine polypus, or cervical fibroid
 tumor; or finally the obstruction may arise from flexion of the cervix
 uteri, as in retroversion of  the uterus, and this is no doubt the most
 frequent  and efficient  cause  of  mechanical dysmenorrhcea.  These
 various obstructions occasion painful spasmodic efforts to accomplish
 the evacuation of the menstrual blood.
  "When the menstrual nisus  has continued  for some time—hours or
 days—and a quantity of blood is collected  within  the cavity of the
 Uterus, in consequence of its ready flow being hindered by the obstruc-
 tion from whatever  cause, violent spasmodic and contracted pains are
 excited, which pass into violent expulsive efforts, such as occur during
 the progress of miscarriage; and by this means a greater or less quan-
 tity of the catamenial fluid is discharged, with more or less relief from
 suffering.  Such  attacks  as these are termed  " menstrual colic,"  and
 they constitute the principal  feature of membranous dysmenorrhcea.
 And this  phenomenon may repeat  itself again and again  during a
 menstrual epoch, as the uterus becomes filled and makes an effort to
 empty itself.
  In the treatment of this form of dysmenorrhcea, as in that of others,
 we  must  be governed by the symptoms  and conditions;  and if the
 cause  can  be removed entirely the  cure may be complete, as in the
 case of uterine flexions.   The other  mechanical causes  of dysmenor-
 rhcea, such as thickening and turgescence of the lining membrane of
 the cervix, may also be removed by the remedies selected in accord-
ance with the indications  present.   Nor do we believe that even " the
cautious introduction of elastic bougies " can ever be necessary or use-
 ful in order to remove stricture of the cervix uteri.  This  stricture. 
520                MENSTRUAL DERANGEMENTS.
 whether spasmodic or otherwise, is  the  result of inflammation ner-
 vous irritation or some other morbid condition amenable to medica-
 tion, and is capable of being completely removed  in time by the ex-
 hibition of the properly selected and  truly homoeopathic remedy to
 the case.   Such, at least, has been our own experience, as well as that
 of others.
   Dysmenorrhcea  from  displacements  will  be relieved under the
 proper treatment for Displacements (which see);  that from constric-
 tion, contraction, etc. of the cervix or os uteri will  also be cured by
 such constitutional treatment as is  indicated by the prevailing  symp-
 toms and  conditions.   All topical  treatment with  bougies, etc. is
 worse than useless.
   In the treatment of dysmenorrhcea it  is of great importance that
 attention be  paid to proper diet, exercise, the use  of baths, friction
 and  such  other  means as  have a tendency to improve the general
 health of the patient and add tone and vigor to her system.   A cure
 of the menstrual difficulty will  be greatly facilitated by a resort to
 these proper hygienic and dietetic measures; whereas, on the contrary,
 the most carefully selected and appropriate homoeopathic remedy may
 fail of producing good results from neglect of these important meas-
 ures.  And these directions do not refer merely to dysmenorrhcea, but
 to all other forms of menstrual  difficulties, and, in fact, to all other
 forms of disease.


                 Remedies for Dysmenorrhcea.
  Alumina. The menses delay, but finally appear, being too pale and
too scanty.   Before the menses she has  many  dreams, awaking from
which she has heat in the face, headache and palpitation of the heart.
Abundant discharge of mucus before the menses.   During an evacu-
ation of the bowels before the menses she has  pinching, writhing and
pressing like labor-pains.  Pressing to stool aggravates her symptoms.
During her menses corroding urine is  frequently passed, day and
night.   After the menses she is so much  exhausted in body and mind
that  a little exercise prostrates her.
  Ammonium carb.  Menses are premature and abundant, preceded by
griping, colic and want of appetite;  or the discharge is blackish, in
clots, and  passes off with pain in the abdomen;  constipation, tenes-
mus, paleness of the face, sadness and toothache.  Also colic, and pain
between the scapulae.   Sleeplessness during"menstruation.
  Ammonium mur.  Menses premature, with pain in the abdomen and 
REMEDIES  for dysmenorrhcea.
521
 small of the back, the flow being more profuse at night.   Passing of
 large quantities of blood at stool during the catamenia.
  Apis mel. When the dysmenorrhcea appears to be due to inflamma-
 tion or irritation of the  ovaries, with tenderness of the ovarian region,
 and severe pain on deep-seated pressure; frequent desire to micturate,
 with painful passage of  only  a few drops of urine at a time.
  Asarum. Violent pain in the small of the back at the  appearance
 of the menses, which scarcely permits her to breathe.
  Asclepias syr.  " Labor-like, intermitting  pains,  accompanied by
 pale  and profuse urination, headache, giddiness and nausea."
  Baryta carb. Menses  very  scanty.   Before the menses toothache,
 with swelling of the gums, or colic, with swelling of the limbs.  Dur-
 ing the menses a troublesome weight above the pubes in any position.
  Belladonna. Pressure downward, as if all the contents of the  abdo-
 men  would issue through the vulva.   Violent pains  come  on sud-
 denly,  and disappear as suddenly  as they  come.  Pains  that  cause
 redness of the face and eyes, throbbing of the carotids and in the head.
  Berberis V. The menses are scanty and very painful, flowing  much
 like grayish serum.   The pain is often in the kidneys or down the
 thighs  and calves of the  legs; again in the head, and sometimes all
 over  the body.
  Borax. Stitching pain in right pectoral region  before  the  menses.
 Pain from the stomach  to the small of the  back before  the  menses.
 During the menses lancinating pain in the groin.
  Bovista.  Before the catamenia diarrhoea and painful  bearing  down
 toward the genital organs.   Diarrhcea, with burning of anus.
  Bromine.  Violent  contractive  spasms during  the menses, lasting
 from six to twelve hours, leaving the parts  sore.   Emission  of large
 quantities of flatus during the menses, with slight pain in the  abdo-
 men.  Membranous  dysmenorrhcea.
  Bryonia. Tearing pains in the limbs during the menses.   Epistaxis.
 All her sufferings are  increased by the least motion.   Cannot  sit up
 from  nausea.  Membranous dysmenorrhcea.
  Calcarea carb. In leucophlegmatic constitutions.  Vertigo on  going
 up stairs.  Menses too  frequent and profuse.   Involuntary emission
 of urine on taking  exercise.  She  has cold, damp feet,  and is very
easily affected by the cold air.  A variety of pains during the menses,
with  the above  characteristic symptoms.   Bad toothache after the
menses.  Membranous dysmenorrhcea.
  Cantharis. Dysmenorrhcea, with the peculiar dysuria of this  remedy.
M embranous dysmenorrhcea. 
522
MENSTRUAL  DERANGEMENTS.
  Carbo  animal. During the menses violent pressing in the small of
the back,  groins  and  thighs, with unsuccessful desire  to eructate.
After the  appearance of the menses she  feels  so tired that she is
scarcely able to speak, with stretching and yawning.
  Carbo veg. Before the menses  much itching about the vulva: itch-
ing of old tetters or of the skin about the neck and shoulders.   Dur-
ing the  menses  cutting pain in the abdomen, pain in the back and
pain in the bones as if bruised.
  Castoreum. During the menses pain commences  in the middle of
the thighs, extending over the limbs, and in fact more or less over the
entire body.   Angry exclamations during sleep.
  Causticum. During the menses pain in the abdomen as if the parts
were torn, with pain in the small of the  back as if from a bruise, and
discharge of large clots of blood.  A sticking  pain  below the left
mamma.  Face very yellow.  Involuntary urination from cough.
  Chamomilla. Violent  labor-pains, and  tearing  in  the veins of the
legs, with discharge of dark, coagulated  blood.   Desire to pass water
frequently, it being  profuse and  pale.   Out of humor, even quarrel-
some.  Membranous dysmenorrhcea.
  China.  Feeling of distension and fullness, which is not relieved by
eructations.  In weakly persons who have lost much blood.  Ringing
in the ears and  fainting fits; convulsions, with rush of blood to the
head and chest, with throbbing  of carotids.   A  good deal of  colic,
particularly in the P. m., with eructations without relief.
  Chininum S. Griping and  tearing in the abdomen, extending to the
chest, with pressing toward the groin during the menses.
  Cicuta  V.  Tearing and  jerking  in the  os  coccygis  during the
menses.
  Cimicifuga. Neuralgic  dysmenorrhcea.   Great  excitability  of the
nervous  system;  headache; anxiety;  restlessness; gastric  disturb-
ances.  Spasmodic dysmenorrhcea, with pains like labor-pains and
menstrual  colic; heaviness,  weight and bearing down  in the abdo-
men.  Dysmenorrhea occurring in women of rheumatic tendencies.
  Cinnabaris. A few days  before the  appearance of the menses and
during their continuance tearing pain in the forehead, sensation of
weakness in the eyes, rending in the spine, tearing and cramp in the
bowels, with diarrhoea and great prostration.
  Cocculus. Dysmenorrhcea, always followed  by haemorrhoids.   Ab-
domen distended, with  sharp cuttings, or as  if sharp  stones were in
the abdomen, at every motion.   Her  sufferings  Dften  cause fainting. 
REMEDIES FOR DYSMENORRHCEA.
523
 Discharge fitful,  scanty and irregular.  Paralytic pain in the back
 and weakness in the lower extremities.
  Coffea.  Exceedingly painful  colic—so painful  as  to  drive her to
 desperation.   Continuous pinching pain in the iliac regions.   Cold-
 ness and stiffness, with profuse flow.
  Colocynth.  Cramping pain, causing her to draw her lower limbs up
 to the  abdomen, with restlessness, moaning  and lamenting.   These
 pains are sometimes increased by eating or drinking.
  Conium. Dysmenorrhcea, with shooting pain in the left side of the
 chest.   Pain  in  the mammae, which  often swell and become hard.
 Pressure  from above downward- and drawing in the legs during the
 menses.  Vertigo during menses, particularly  whilst  lying  down.
 Intermitting  urine  during micturition.  Painful abdominal  spasms
 during the menses.
  Creosotum.  Difficulty of  hearing before and  during  the  menses,
 with buzzing and humming in the head.  The menses are usually too
 frequent  and too profuse;  succeeded  by an acrid-smelling,  bloody
 ichor, with corrosive itching and biting of the parts; with more or
 less pain  during the flow, but much aggravated after it has ceased.
  Crocus  sativ. Dysmenorrhcea, with dark, stringy blood; sensation
 of bounding or rolling in the abdomen, with other  symptoms.  Sen-
 sation of commotion in  the stomach  upward and downward, hither
 and thither, during painful menstruation.
  Eugenia j.  Acn6, with pain extending for some distance around the
 acne;  the skin disease is worse during the  menstrual epoch.
  Euphrasia.  Menses last only one hour;  time regular.
  Ferrum acet. Pale face  and  lips, or fiery redness, with scanty dis-
 charge of pale blood, with violent colic.  The  menses  intermit  and
 then reappear.
  Gelseminum. Difficult menstruation, the period being  preceded by
 sick headache, with vomiting, vertigo, and  congestion  of blood to
 the head, with a  dark-red hue of the face.
  Graphites.  The menses delay,  are  scanty, thick and  dark,  or  else
serous and pale blood, with griping and abdominal spasms, headache,
nausea and pain in the chest.   Morning sickness during menses.  Con-
stipation  previous to and diarrhoea after the  menses.   Persons most
suitable for  Graphites are  rather corpulent and subject to  itching
blotches here and there.
  Gratiola. Darting in the right mammae when stooping, worse on
rising, during the menses.
  HeloniaS.  Is suitable to dysmenorrhcea occurring in delicate women, 
524
MENSTRUAL DERANGEMENTS.
of lax fibre, or who are chlorotic.  Sharp cutting and drawing pains
during the period, passing from the back through the uterus; swelling
of the mammae, with considerable tenderness  of the mamma; and
nipples;  painful soreness over the ovaries.
  Hyoscyamus.  Violent,  almost convulsive, trembling of  the hands
and feet  during the menses.  She is almost raging.  Enuresis and
sweat during the menses.   Severe headache, profuse sweat and nausea
at the appearance of the menses.
  Hypericum. Menses delay, with tension in the  region of the uterus
as of a tight bandage.
  Ignatia. Headache, with heaviness and heat in the head.  Photo-
phobia, contractive  colic, anguish, palpitation of the heart, languor
unto fainting during the  menses.   Weak, empty feeling at the pit of
the stomach, with sobbing and  sighing.
  Indigo.  Burning in the  mammae during the menses.
  Ipecacuanha.  Pain  about the  navel,  extending  toward  the  ute-
rus.   Sharp continued cutting  pain from left to right, with constant
nausea.
  Iodium. Flow at every  stool, with cutting in the abdomen; pain in
the back and loins.    Food does not nourish her.
  Kali bichrom.  Menstruation too soon, with vertigo, nausea, headache
and feverishness.  Obstinate suppression of urine, or small quantity
of red urine.
  Kali carb. A good deal of stitching, cutting colicky pain during the
menses.   She feels  badly for a week previous to the menses.  She is
costive, and feels a distress  an hour  or two previous to  a passage.
The  menses have a  bad, pungent odor, very acrid, excoriating the
thighs and  covering them with an eruption.   Headache, with great
heaviness during the menses  only in the  morning.
  Kali hyd.  Great urgency to urinate, which disappears at the erup-
tion of the menses.   Sensation as  if the thighs were tightly squeezed
during the menses.   Her abdominal sufferings extend into the groins
and thighs.  Drinking cold milk aggravates her  complaint.
  Kali nit. Menstrual blood black as ink, with much suffering.
  Kalmia. Pain in  the  limbs,  back and interior part of  the thighs
during the catamenia.  Pulse very slow.
  Lachesis. Before the menses vertigo, headache, and the nose bleeds
a few drops.  The  first  day of the menses tearing in the abdomen
beating in the head, pains in the small of the back and  bruised feel-
ing in the hips, all relieved by  a full flow.
  Lauroeerasus.  Colicky pains in the afternoon, and tearing pains in 
REMEDIES  FOR DYSMENORRHCEA.
525
 the vertex at night. Suffocating spells about the heart, with a sort of
 gasping for breath.
   Ledum. Great want of vital heat, and dysmenorrhcea.
   Lilium tig. The menstrual flow continues only when she is moving
 about, and ceases when she sits  or lies down.   Neuralgic pains in the
 uterus;  pains in the ovaries, extending down into the inside of the
 thighs.   Prolapsus or  anteversion of the uterus.  Cardiac complica-
 tions.  Feels as if the abdomen needed holding  up.
   Lobelia i.  Violent  pain, confined to the sacrum; sense of  great
 weight in the genital organs.
   Lycopodium.  Pain in the temples, as if they were being screwed to-
 ward each other, with a  sort of stupor and compression during the
 menses.  Much borborygmus, more in the left hypochondrium.  Sense
 of satiety;  the least quantity  satisfies,  or she is  insatiably hungry.
 Shooting pain from right to left across the abdomen.
   Magnesia carb. Flow only in  the absence  of the pain  and during
 sleep.  The  menstrual  blood  is dark, acrid and  thick;  is washed out
 with  much  difficulty.   Much  pain  in the head and in the  right
 shoulder.  She can hardly raise the arm.   The  knees are painful in
 walking, and the feet when lying  in bed.
   Magnesia mur. Pain  in  the small  of  the  back  and thighs during
 the menses.   More severe in  the back when  walking, and in the
 thighs when sitting.   Pressing  down in the  iliac region during the
 menses.
   Magnesia sulph. The menses  stop  for two days, then  flow again.
 Bruised pain in the small of the back, with pains in the groin when
 sitting or standing, less  when  walking.  Pain  in the thighs when
 walking.
   Manganum. Discharge of blood  between the periods, and pressing in
 the genital organs.
   Mercurius  sol. Before the menses  dry heat  and rush of blood to
 the head. During the menses anxiety, red tongue, with dark spots,
 saltish taste, scorbutic  gums,  teeth feel  sharp, breath of a mercurial
 odor and salivation.   Teeth  sore and  loose;  some  of them are too
 long.
   Moschus. Violent drawing  and pressing pain toward  the sexual
 organs till the menses appear.
  Murex p. Sere pain as if injured with  a cut in  the uterus, or violenl
pain  in the right side of the uterus, extending to the chest.
  Muriatic acid; Sad and silent during the menses as if she would die.
Varicc of the anus, so sore as scarcely to bear the least touch. 
526
MENSTRUAL DERANGEMENTS.
  Natrum carb. Pressing in the hypogastrium toward the genitals as
if everything would issue from the abdomen.   Menses preceded by
drawing in the nape of the neck and  headache.   During the menses
tearing headache; painful distension of the  abdomen in the morning.
relieved by diarrhcea.  Tearing and bruised pain  in right hip.
  Natrum mur.  Waking in the  morning with  headache.  Terrible
sadness  during the menses.
  Natrum sulph. Scanty menses,  with  hard, knotty stools, streaked
with blood, accompanied and succeeded by smarting in the anus.
  Niccolum. Menses  too  scanty and short, with  colic  and pain in
small of the back.
  Nitric acid. Violent cramp pains in the hypogastrium, as if it would
burst, with constant eructations during the menses.  Violent press-
ing in the abdomen, as if everything were  coming out of the vulva,
with pain in the small of the  back, through the hips  and down the
thighs.   Often has  fissures of the anus.
  Nuxjuglans.  Menses  preceded by violent pressing and drawing
pains in the womb;  finally an abundant flow of blackish blood, often
in large lumps.
  Nux mosch. Menses preceded by pain in the small of the back, as if
a piece of wood stretched across there were  pressing from  within out-
ward, with headache, pressure  in the  stomach, water-brash, pain in
the liver and discharge of thick, black blood.
  Nux vomica. Griping and digging in the  uterus, with discharge of
thick, clotted blood.  Nausea in the morning, with chilliness, fainting
turns at the appearance  of the menses, with spasmodic pains in the
abdomen.   Much headache; sometimes in the occiput, as if from an
ulcer in the brain ;  sometimes in the sinciput, as  if the eye would be
forced out.  Tearing in the left arm and right hip.
  Oleum animale. Menses preceded and accompanied  by cutting in
the abdomen  and small of the back, and sticking in the  left side of
the head and vertex.  Scanty menses, black blood, and languor in the
hands and feet.
  Petroleum.  Menses cause  an itching  in the genital organs.  There
is heat in  the soles  of the feet and  palms of the  hands; singing and
roaring in the ears;  tearing in the thigh, and spots on the legs painful
to the touch.
  Phosphorus. Very sleepy  during  the menses;  she can hardly keep
awake.  Constipation, with a narrow, stiff stool,  difficult to evacuate.
Stitches in the mammae, sour eructations and vomiting of sour sub-
stances.   Blue  margins  about the eyes.   Cutting "in the abdomen, 
REMEDIES  FOR DYSMENORRHCEA.
527
chilliness and  cold hands and  feet.  More  suitable  to  tall,  slim
persons.
  Phosphoric acid.  Meteoristic distension  of the  uterus.  Pain in the
liver during the menses.
  Phytolacca dec. Very painful menstruation  in apparently  barren
women when occurring in connection with rheumatism.  Shreds  of
membrane are passed with the menstrual flow.   Dysmenorrhcea accom-
panying erosion or ulceration of the cervix.
  Platina. Painful sensitiveness of the mons veneris and of the vulva.
Much threatening of the menses to come on.  Finally, they make
their appearance with pinching  in the abdomen and pressure in the
groins, alternating with pressure in the vulva.  Horrifying thoughts.
  Plumbum. Cessation of the  menses on the invasion of colic, but
they reappear after the paroxysm, or not again  till the next  period.
Sensation as of drawing  from the  abdomen to  the back, often  with
great depression of spirits.
  Podophyllum.  Bearing down in the abdomen  and back during the
menses; ovarian pain on both sides of the  abdomen, with a numb
and aching  pain running down into the thighs; prolapsus ani  with
stool.
  Pulsatilla.  Particularly  in  mild, tearful, yielding  temperaments.
The pain is so violent that she tosses in every direction, with cries and
tears.  The blood is thick and dark or pale and  watery; flows by fits
and starts.  She feels worse in a close, warm room.
  Rhus tox. Membranous dysmenorrhcea,  the rheumatic  symptoms
guiding the choice of this remedy; stiffness of the limbs,, relieved by
walking; stiffness  of the  limbs before a storm  or in damp weather,
relieved by a storm.   Restless nights; must turn often to find a few
moments' rest.
  Sabina. Dysmenorrhcea.   Violent  pain extending from the  back
through to the pubis.
  Sanguinaria C Dysmenorrhcea.  The pain rises into the head  from
the  nape of the neck, and finally into  the forehead, as if the eyes
would be pressed out,  the menses being scanty.
  Sarsaparilla.   Itching   eruption on the  forehead previous to the
menses.   Soreness in the  right groin, with desire to urinate at  the ap-
pearance of the menses.   Griping in the pit of the stomach in the
direction of the small of  the back during the menses.  Painful con-
clusion in urinating.
  Secale corn. Menses are too frequent and last too long, with  tear-
ing  and cutting  • colic,  cold  extremities,  cold perspiration,  great 
528
MENSTRUAL DERANGEMENTS.
weakness  and small pulse.  Especially useful  in  thin, scrawny wo-
men.
  Senecio. Dysmenorrhcea, occurring from want of tone and vi»or.
The patient  is pale and weak, drowsy in day-time; does not wish to
do anything or to think; irritable.
  Sepia. Before the menses violent colic, shuddering  all over the
body the wdiole day, acrid leucorrhoea; sensation as if the vulva were
enlarged,  with soreness in the perineum.   During  the menses tearing
iu the tibia, toothache and  obscuration of sight, violent pressure in
the forehead, with  discharge of plugs from the nose.   Constipation,
the stool being .hard, difficult, knotty, insufficient, and sometimes min-
gled with  mucus.   Sensation as of a heavy lump in the anus.
  Silicia.  Before  and  during the menses  she is costive.  Stool com-
posed of hard lumps,  remaining long in the rectum, as if it  had no
power to expel it.   Burning soreness of the vulva,  and an eruption on
the inner  side of the thighs during the menses.  Repeated paroxysms
of icy coldness over the  whole body at the appearance of the  menses,
and icy cold  feet during  the menses.
  Spongia. Violent drawing in the upper and lower extremities dur-
ing the menses.  Burning in the chest, with a dry  cough.
  Stannum.  The malar bone  is painful to the touch  before the menses,
and during their  flow  it  is painful even to move the muscles of the
face.  Dysmenorrhcea, with terrible  headache, the  pain gradually in-
creasing to its highest  point, and after remaining for a time  as gradu-
ally declines.   Weak,  faint feeling in chest when talking.
  Stramonium. Excessive  loquacity  during  the menses.   Drawing
pains in the abdomen,  upper and lower extremities.
  Sulphur. The menses  are thick and black, and so acrid as to make
the thighs sore.  Every  evening, just before the menses, she  always
has a cough.  Pain in the abdomen during the menses, as if  the in-
testines were strung up in knots by threads.   She has to take a sitting
posture for relief.   Worse from eleven to  twelve noon.
  Sulphuric acid.  Distressing nightmare before  the menses.  Is hur-
ried about everything she does, and cannot-go slowdy; acid  risings
and heartburn ; feeling  of trembling without actual trembling.
  Tart. e.  Pain in the  groins and cold creepings just previous to the
menses.  Nausea and  vomiting of mucus.
  Thuya.  Terribly  distressing -pain  in the left  ovarian  and iliac re-
gions, with scanty flow.  She has to lie down, the suffering is so great.
  Ustilago madis. Acute  pain in left ovarian region;  menses too soon
and too profuse; haemorrhage with clots ;  bearing  down as if every-
thing would be forced  out. 
F
                        MENORRHAGIA.                      529

  Veratrum. The sufferings during menses are attended with thirst for
icy cold drinks; nausea, vomiting and diarrhcea, or  simply diarrhcea.
Cold sweat on the forehead from the pain.   Great exhaustion.
  Zincum. During  the menses heaviness of  the limbs,  with violent
drawing about the knees, as if they would be twisted off.  Sore eyes.
Sudden oppression of the stomach, she has to loosen her dress.

                        Menorrhagia.
  Menorrhagia is  the term  now employed to signify an increased or
immoderate flow of the menses, or profuse menstruation.   Formerly
it was understood to embrace uterine haemorrhage in general, but it is
now very properly restricted as above, while by the term  Metrorrhagia
are designated those haemorrhages from the uterus which are not con-
nected with the catamenia.
  The following very general division of the varieties of menorrhagia
will simplify the whole subject, and at the same time render our brief
description more clear and comprehensive.
  I.  Functional Menorrhagia;   in  which  the flow is  increased in
quantity or in frequency, or in both.
  II. Organic Menorrhagia; in which the flow appears  in connection
with  some positive disorder of the sexual apparatus.
  III.  Sympathetic Menorrhagia; in  which the flow appears in con-
nection with severe forms of general disease.
  In Functional Menorrhagia  the  flow may  be perfectly  natural,
except in its quantity and in the frequency of its return, or it may be
occasionally mixed  with clots of blood.  In  either instance the causes
of this affection are to be found in  the more or less plethoric condi-
tion,  habits of life, or  even in the various  anomalies  of the  blood
itself.  These and similar influences, some of them  deeply seated  and
constitutional, may combine to produce such profuse discharge at the
monthly periods, or even oftener, without the intervention of any  dis-
tinct  disorder, either of the whole system in general or  of the sexital
apparatus in particular.  Only the earlier or milder forms of menor-
rhagia can be included in this  class—those which have  not been pre-
ceded by any actual disease, and in  consequence of  which  no organic
lesions have as  yet arisen.   And many cases which in their initial
stages would be classified here, subsequently become so complicated
as to belong rather to the second  class.   In this  same class of func-
tional menorrhagia must also be included all those cases which arise
from  general debility without positive disease, as  in persons who  fall
into this "weakly  way" from  having  too  many children, or from
      34 
530               MENSTRUAL DERANGEMENTS.

over-suckling them to  prevent the too  rapid  increase of the family.
And  cases arising from excessive  voition or any other form of over-
exertion, or from some inherent constitutional weakness (especially in
this respect), which may be aggravated and developed by various pro-
voking influences, are all to be included in this class.
   In  Organic Menorrhagia the flow appears  in connection with some
positive disorder of the sexual  apparatus.  In the order of time this
flow may precede or follow the appearance of the organic disease, but
in either case there is  such an established connection of the menor-
rhagia  itself with other disorders  as renders the case very different
from  what is described under Functional  Menorrhagia.  Nor is the
reality of this connection at all  affected by the view we  may take as
to the question whether, in any given instance, the menorrhagia is due
to the disease which may have preceded it, or to the structural change
which in another case may have followed it.   Thus in some instances
the threatened onset of some organic disease is preceded by congestions,
wliich, greatly aggravated at the menstrual  period, render the flow ab-
normally frequent and  profuse.  So the actual presence of structural
disorganization of the uterus or of any  of its  appendages, even when
not very far developed,  may produce such menorrhagia.   And finally,
these  forms of profuse  menstruation, whether too frequently or more
rarely recurring, may sometimes not only be caused by some hitherto
undeveloped change  in the  interior organism, but they may also re-
main  persistent as consequences of  former diseased conditions of the
various organs of the  sexual apparatus.  In the first of these three
categories might be enumerated a  very  great variety of the disorders
of the female organism, the majority of  which are, in many instances
at least, preceded  by increased catamenia;  in  the second  might also
with  equal  propriety be mentioned almost the  entire range  of such
diseases, from simple uterine congestion  up to polypoid and cancerous
tumors; while  in the third the  simple mention of  the  profuse
menstruation  which, unattended with any other disorder, sometimes
appears after the period of the change of life, may supply all that is
needed in the way of illustrative example.
   Some forms of uterine disorder  are  preceded or even caused by
amenorrhcea, but  it is  easy to see  that  the deep-seated physiological
tendencies toward active disease of the uterus and its dependent organs
must  to a certain extent consist in  congestion, which cannot  but be
greatly  aggravated by  the  menstrual nisus, and which consequently
leads  to a more profuse menstrual discharge.   The same is still more
plainly  true of the actual presence of structural disease in any of these 
MENORRHAGIA.
531
organs; the constant congestion must necessarily be seriou.dy enhanced
by the added influence of the catamenia, and from this combination
of pathological and physiological conditions a more than normal flow
results.  And in those cases  in which structural disorders have ex-
isted formerly, but have now subsided  to all appearance, the  proof's
of their former existence still remain, in many instances, in the form
of chronic congestion, which is capable of  producing menorrhagia,
often of the severest form, and even of keeping it up and reviving it
after the  change of life.  Of the various forms, of disease affecting
the several  organs themselves which induce  menorrhagia, and which
may be termed local causes, we may mention granular  ulcerations of
the os and cervix : cancer; inflammation of  the lining membrane of
the uterus;  retention of a portion of the secundines after parturition ;
congested condition of the ovaries and uterus; fibrous tumor or poly-
pus of the uterus;  and subinvolution.   Any of these may be sufficient
of themselves to prolong each menstrual epoch and to render the flow
profuse.  In regard  to the last named  of these local  causes—subin-
volution—menorrhagia in married women occurs from the incomplete
involution of the womb  after parturition more frequently perhaps
than from any other cause.
   We make these statements, not  from any desire to give  undue
prominence to pathological views, but to show the importance, the
necessity, of most carefully studying all the  symptoms, those preced-
ing as well  as  those attendant, in order to prescribe correctly in such
cases.  The menorrhagia which we  are called upon to treat is by no
means such a haemorrhage as that from an  open wound, which may
be stopped  as  soon as convenient;  we have, in fact, something to do
very different from arresting an active or even a  passive haemorrhage :
we have a sick person  to cure.  And just as  fast as  by our prescrip-
tions of advice and medicine  her general health.improves, just so fast
will she find her catamenia  approaching the normal standard. Nor
when we have done for our patient in such cases all that our art admits
and science requires, shall we have merely " set her courses right;" we
shall have so restored her health  that her courses will come right and
remain right, since by curing the patient herself we shall have removed
the causes of the menorrhagia.
   It is not intended  to assert  that all this can always be accom-
plished in every case, but nothing  less than all this  should  always
be the aim of the physician.  And even if he should  not  succeed
in restoring his patient to perfect health, he will have gone to work
in the right way to  do it;   and if his success be but partial and 
532
MENSTRUAL  DERANGEMENTS.
incomplete in a given case, even if it should disappoint both his owl
nopes and the expectations of his patient and her friends, how much
greater will it not be than if  he had gone to work in some other than
the best possible method!   How great is  the  difference, in chronic
cases especially,  between  even a small improvement and a positive
change for the worse !
   In Sympathetic Menorrhagia the flow appears  in  connection with
severe forms of general disease.  Examples of this variety of profuse
menstruation are seen in some cases of variola, scarlatina, erysipelas,
typhus, cholera, and during the appearance of certain acute inflamma-
tions, especially those of the  lungs.  "Although  experience has de-
monstrated that  during the course  of these diseases, especially when
they determine a draining of the mass of the blood, the courses are
often suppressed, still a  great  number of observations have proved
that when the flow persists, it may become so  copious that it  com-
pletely exhausts the already feeble forces of the patient, and may even
hasten a fatal termination.  This is especially the case with the ex-
anthemata.   We have  often  observed that the appearance of a very
copious  menstrual  haemorrhage during the course of  these diseases
is  almost always the precursor of  a fatal  dissolution  of the blood.
Sanguineous discharges   from  the  skin,  the  nose,   the  rectum,
etc. soon supervene, and death occurs sometimes even in a few hours
after  the startling  cerebral  symptoms  have come to complete the
picture  represented by the  rapid  decomposition of the blood."—
Soanzoni.
   This fearful complication  of disorders, already very  grave, may
well appall the allopath, the very  largeness of whose  experience in
such cases serves but to assure him of their utter hopelessness.  But
the homoeopathic practitioner, conscious  of  the wonderful virtues of
such medicines as  Arsenic, Carbo veg., China, Lachesis, Rhus, Secale
and  others, to  arrest even the rapid decomposition of the vital  fluid
itself, and mindful  of the special and characteristic indications, which
will enable him to give the right remedy with unerring exactness, can
face even these profound degenerations of the organism with a patient,
hopeful heart.  It is necessary  for the physician to realize the serious
gravity of such cases, especially that neither himself nor the friends be
taken unawares  by the  sudden and unexpected fall  of the curtain;
and then it is no less  necessary that he  should  faithfully and perse-
veringly study all  the symptoms of the  case, and never despair till
satisfied of the actual closure  of the scene;  since in typhus, and even
in  cholera, some such patients have been rescued, as it w»re, from the 
                 REMEDIES FOR MENORRHAGIA.               533

very jaws of death, who most  certainly would  not have received the
proper  remedies  up to the final turning-point of their apparently
fatal disorder had  not their physicians  been inspired by  the  most
patient  courage  and  by  the  most  hopeful  and  determined perse-
verance.
  The  coming on of the climacteric is frequently accompanied  with
menorrhagia.   The periods will be missed  for  several months, and
will then reappear in alarming profuseness, and often accompanied with
pains, give rise to the opinion that the menses had ceased on account
of pregnancy,  and that the flow was  the  haemorrhage of abortion.
Diseases of the heart  likewise give rise to  profuseness of  the  men-
strual flow, occasioned,  no doubt, by congestion, in consequence of the
retardation of the return of the blood to the right side of the heart.
In these cases the profuse flow seems to afford  relief.   Chronic  liver
disease  or congestion may  occasion menorrhagia; and so,  too, may
Bright's disease; in this latter case the blood, having been deprived of
its albumen, is in a  condition favorable to exudation through the
capillary walls.

                 Remedies for Menorrhagia.
  Aconite. In plethoric women particularly.   Vertigo  on rising from
a recumbent position ;  she has to lie down again.   She  is alarmed and
excited; is sure she will die, although there is no occasion for such
an alarm.  Is  in constant fear  lest she gets worse.
  Agaricus. Menses too profuse, with titillation in the genital  organs.
Itching, burning and redness of the toes, with titillation, as  if frozen.
Menses too profuse.   Burning, a strong characteristic of Agar.
  Aletris far. Menorrhagia, in consequence of a  congested  condition
of the  uterus  or ovaries; profuse discharge of dark-colored blood,
with coagula;  fullness and weight  in the uterine region.
  Ambra grisea.  Discharge of  blood between  the periods  at every
little accident; for instance, after a very hard stool or after a walk a
little longer than usual.  Swelling, soreness and itching of labia.
  Ammonium carb. Menorrhagia after a long drive in the cold air.
  Ammonium mur. The flow is  more abundant  at  night.  A quantity
of blood is passed at every stool during  the menses.
  Antimonium  crud. Menorrhagia, with  a  peculiar  pressing  in the
items as if something  would come out.
  Apis  mel. Menorrhagia, with  heaviness in  the abdomen,  faintness,
great uneasiness, restlessness and yawning.
  Apocynum cann. Very profuse flow of blood, preceded for a day or 
534
MENSTRUAL  DERANGEMENTS.
two  by a moderate discharge;  shreds  or pieces of membraut come
away with the fluid blood.
  Argentum nitric. Menorrhagia, with cutting pain in the small of
the back and groin.   The head feels  very much enlarged and the
lower extremities very weak.   Much belching, with relief.
  Arnica. Particularly after cases  of concussion, as from  a blow a
fall or riding over rough roads.  The flow is of a bright-red color.
mixed with clots.  Heat about the head, extremities cool.  Menor-
rhagia, with pain in the  small of the  back, extending into the groin
and down the inner side of the thigh and leg to the great toe.
  Arsenicum. Menorrhagia in feeble women; cachectic; affected with
rheumatism, disorganization  of the uterus  or  ovaries;  in  eruptive
fevers, and  when aphthae break out, indicating a low  state of the
system.  The least effort exhausts her.
  Belladonna.  The flow is bright red, imparting a sense of heat, with
a sensation of pressing outward.   Sometimes it has a bad odor, with
lumps.   Sometimes there is a congestion to the head, with throbbing
of the carotids.
  Borax. The menses are too soon, too profuse, and attended with
colic, nausea and pain, extending from the stomach to the small of the
back.  Too profuse menses,  and  she  is very nervous; starts at the
least noise, and  dreads a downward  motion, like  going  down stairs
or the downward motion of a swing or rocking-chair.
  Bovista.  Menses  too  often and too  profuse, flowing more  in the
morning and  less at night,  with discharge of blood between the
periods.   Sometimes  flows more at  night when lying down.
  Bromine.  Menses too often and too  profuse,  of bright-red  blood,
particularly in  women  with  affections  of the  chest, heart or eyes.
The flow is quite passive, and she only suffers from exhaustion.
  Bryonia. Menses too early and too profuse, of  dark-red blood, with
pain in the back and aching  in the  head, as if  it would  split; worse
on the least motion.  Nausea on sitting up and after eating.
  Cactus grand. Menses are premature, as well  as too copious; the
flow ceases on  lying down; cardiac  complications;  the menses are
dark-colored or black, and thick.
  Calcarea carb. Menses too frequent, too profuse and last too long.
She has vertigo on  stooping, worse  on  rising  or  going up stairs.
Damp,  cold feet.  Particularly  applicable to  leucophlegmatic  tem-
peraments.   Profuse  menstruation during lactation.
  Cannabis  s. Too  profuse menses, when dysuria attends, with sensa-
tion of soreness in the whole track of the urethra. 
REMEDIES  FOR MENORRHAGIA.
535
   Cantharis. Menses  too early and too  profuse,  of  blpek  tliod.
 Dysuria, with burning, cutting pain.  Frequent desire to urinate.
 More suitable to women who are sterile.
   Carbo animal. Menses too early, not too  profuse, but last too long.
 Great weakness of the thighs.  After  the  appearance of the menses
 she feels so tired that she is scarcely able to speak.
   Carbo veget. Menses too early and too profuse, preceded by itching
 of old tetters, or by an itching eruption on the nape of the neck and
 between the shoulders; also by a dragging pain "from the abdomen to
 the small of the back.   Wishes to  be fanned hard.
   Caulophyllum.  The uterus is  soft and relaxed, and the blood flows
 profusely.  Suitable for women who have  moth-patches on the fore-
 head  and face.   Sensation  of weakness.
   Causticum. She has  a very yellow face;  menses  too early and  too
 abundant, and after their cessation a little blood is passed from time
 to time for many days.  The menses smell badly, and excite an itching
 in the vulva.   She feels melancholy,  and  looks at everything upon
 the dark side.  Discharge only during the day; ceases on lying down.
   Chamomilla.  Menorrhagia of dark coagulated blood, flowing more
 in paroxysms.   There is great irritability  of  temper, so that she can
 hardly control herself.  Frequent  desire to urinate.   Urine pale and
 profuse.
   Chelidonium.. Menses  retarded,  but  continue  too long,  with pain
 under the inner and lower angle of the right shoulder-blade.
   China.  Menses too profuse, with a sensation of great distension of
 the abdomen, not relieved  by eructations or  dejections.  Ringing in
 the ears and fainting spells.   Losing of senses and sight.  Also after
 the abuse  of Chamomile tea; with flow of dark  clots and  frequent
 desire  to urinate;  pale urine; and in  weakly persons  from the loss
 of blood.   Pulse almost extinct.
   Cimicifuga. The  discharge is profuse, dark and coagulated ; great
 nervousness; pains like those of rheumatism in the back and  limbs;
 bearing down in the abdomen during the flow.
   Cinchoninum sulph. Menses too early and too profuse.
  Cina. Menses  too early  and too  profuse,  particularly  in women
 troubled  with  itchings  of  the  nose or nightly  restlessness.   She is
 constantly tossing, even during  sleep.  Diarrhcea, always worse after
 drinking.
  Cocculus.  Discharge  of blood from the uterus in pregnant women.
 Profuse menses, with a  sensation as of sharp  stones  in the abdomen
at every movement. 
536
MENSTRUAL DERANGEMENTS.
   Coccus cacti. Menses too early and too abundant, of dark, thick
blood, with a sensation of tension and constriction about the abdomen
and of something  ascending  toward  the  stomach,  which makes her
think she will vomit water.
   Coffea. Profuse  menstruation,  with excessive  sensitiveness  of the
organs, and voluptuous itching.
   Collinsonia. Congested  condition of the cervix uteri, with painful
haemorrhoids and aggravated  constipation.
   Creosotum. Menses too  early, too profuse and lasting  too long, but
inclined to  be intermittent; she thinks she is almost well, when the
discharge returns afresh.
   Crocus S.  Menorrhagia  of dark, stringy blood; as  it discharges  it
forms itself into long strings.   A sensation as if something alive were
rolling or turning  about  in the  abdomen.   In the  stomach a similar
sensation is sometimes perceptible.  Violent cephalic throbbings.
   Cyclamen.  Menorrhagia, with stupefaction of the whole head, and
obscuration of vision as if a fog were before the eyes.
   Erigeron.  The flow is so profuse  as  to be  alarming, and  consists
mostly of bright-red blood;  every movement of the patient increases
the flow.   Pallor  and weakness  in  consequence of the profuse dis-
charge.
   Ferrum. Menorrhagia in weakly persons, with a fiery red face.   It
occurs too frequently, is too profuse and lasts too long..
   Fluoric acid. Menses too early and too profuse,  thick and  coagu-
lated.   With an uncommon buoyancy of mind she fears nothing, and
is  well satisfied with herself.
   Hamamelis. Profuse discharge of dark-colored blood;  the discharge
ceases at night, occurring only in the day-time.
   Helonias.  Very profuse flow at every period, so that her strength is
exhausted, and she suffers from  debility.   Complexion pale, sallow,
earthy-looking.  Menorrhagia from  ulcerated os or cervix, the blood
being dark and bad smelling, and continuing  a long while; the flow
is  increased by the  least exertion.
   Hepar s. c. Menorrhagia in  women with chapped  skin and rhag-
ades of the  hands and feet.  A slight injury causes ulceration.
   Hyoscyamus.  Menorrhagia,  with  delirium.    She  has  uncommon
foolish manners.   Silly laughing, and inclines to uncover or undress
herself.
   Ignatia. Menorrhagia, with sighing and  sobbing, faint feeling at the
pit of the stomach, she seems full of suppressed grief. 
REMEDIES  FOR  MENORRHAGIA.
537
  Jodium. Premature and too copious menses, with greai weakness;
particularly indicated if she has goitre, or dwindling of the breasts,
or if she has acute pain in the breasts.   Food does not nourish.
  Ipecacuanha. Profuse menstruation, with a constant nausea; not a
moment's relief even after vomiting.
  Lachesis.  Menorrhagia,  with chills  at  night and flushes  of heat
durino- the day.  Feels much depressed  in  early  morning.
  Laurocerasus. Menses too early and  too profuse, with nightly tear-
ino- in the vertex.  Peculiar suffocating spells about the heart.
  Ledum p. Menses too early and  too  profuse, with a  great  want of
vital warmth; she can  hardly keep warm.
  Lycopodium. Menses  too long and too  profuse, with borborygmus,
especially in the left hypochondrium;  or  a sense  of satiety and full-
ness up to the throat on the  least quantity  of food being taken;  or
an aggravation at four  o'clock p. m.
  Magnesia carb.  Menses too  early and too profuse, flowing decidedly
more at night, and never during uterine pains.
  Mercurius sol. Menses  too  profuse,  with scorbutic gums.   Saliva-
tion ; teeth feel sore and as  if loose.   Mucous stools, with tenesmus
and oppression; strong urine.
  Moschus. The menses are too early and too profuse, with intolerable
titillation in the genital organs.
  Muriatic acid. Menses  too  early and too  profuse, with extremely
sore haemorrhoids, which sometimes itch terribly.
  Natrum carb. Menses too early  and last too long, aggravated  by a
thunder-storm, and may  even be reproduced by one.
  Natrum mur. Menses too soon and too profuse, with great heaviness
in the eyes, or intolerable sadness.  Craves  salt.   Has an aversion to
bread.  Dreams that robbers are in the house.
  Nitric acid.  Menses too early and too profuse, with urine emitting
an intolerably strong smell.  The blood  is very dark-colored and
thick.
  Nux juglans. Menses  too  early and abundant,  in  large, blackish
lumps.
  Nux mosch. Menses  too  early and profuse, with an intolerable dry-
ness of the mouth, tongue and throat.   Excessive disposition  to
laugh, particularly in the open air.
  Nux vomica.  Menses too early  and too  profuse, particularly as a
forerunner of the change of  life;  or attended with weak, faint spells,
often as a consequence of high living or a sedentary life.   Constipa-
tion of large and  difficult stools, or  with  frequent urging and dis- 
538                MENSTRUAL DERANGEMENTS.
charge  of small  pieces.  During her menses  she does not sleep after
three or four a. m.
   Opium. Menorrhagia, with  great sleepiness, yet she cannot sleep.
The sheets are so hot she  has to  change to a cooler place every little
while.  Constipation; stools black,  round and hard.
   Phosphorus.  Menses too  often, too copious,  and lasting too lono-.
More applicable to  tall, slim  persons.  Constipation; narrow, dry
hard stools, difficult to evacuate.  Sense of emptiness in the abdomen.
Much heat up the back, and cold feet and legs.
   Phosphoric  acid. Too early and too  long-lasting menses, with pain
in the liver;  or  rising frequently at night to pass large quantities of
colorless urine.   Meteoristic distension of the uterus.
   Phytolacca dec. Menses too often and too profuse, with a correspond-
ing increase of the tears, saliva, bile and. urine.   Hot throat.
   Platina. Too long and  profuse menstruation,  with pressing from
the groins to the genital organs.  The blood is dark, and comes away
partly fluid and partly in clots.   Horrifying thoughts.
   Plumbum. Menorrhagia, with the sensation of a string pulling from •
the abdomen  to  the back.  Constipation, faeces  composed of lumps
packed  together like sheep's manure.
   Pulsatilla.  Menorrhagia in delicate women of tearful disposition.
The least  circumstance  of joy or sorrow causes  weeping.  She feels
better in the open air, and worse  toward evening.  Bad taste in  the
mouth in the morning; no appetite, nothing tastes good.
   Rhus  tox. Menorrhagia from  a strain; if in rheumatic women,
worse at night, demanding constant change of position to find relief.
   Sabina.  Excessive, debilitating  menses, with  abdominal  spasms.
The blood is partly fluid and partly clotted, and  the  pain  runs from
the back through to the pubis.
   Sambucus. Menorrhagia,  with  stoppage  of the  nose with  thick,
tenacious mucus.  Can't breathe through the nose.
   Secale corn. The menses are too profuse  and too long-lasting, with
violent spasms.   All her symptoms are worse just before the menses.
Particularly applicable to thin,  cachectic women.
   Sepia.  Menorrhagia, with a  painful sensation  of emptiness  at the
pit of the  stomach, or with fcetid urine, or the urine  has a sediment
like clay burnt down upon the bottom of the vessel.   She has yellow
spots on her face, a yellow saddle across the ridge of the nose.
   Silicia.  Menorrhagia, with paroxysms of icy coldness over the whole
body.   The menses have  a very strong smell.  Constipation before
and  during the menses of hard lumps, which remain  long in the  rec- 
METRORRHAGIA.                       539
 turn, as if it  had no power to expel  them.  Sometimes, after long
 straining, the  protruding portion suddenly recedes again into  the  rec-
 tum.  Profuse menses occurring during lactation.
   Spongia. Menses too early and too  profuse, preceded by colic, sore-
 ness in the sacrum and  craving in the  stomach.   Chronic hoarseness
 and cough, the voice frequently giving out when  talking or singing.
   Stannum.  Menorrhagia in women having a weak  larynx.  They
 cannot talk much, read  aloud or  sing before  the larynx  aches; they
 hecome hoarse and cannot proceed.   The same sensation is sometimes
 perceived in the chest.
   Stramonium. Menorrhagia, with  drawing  pain  in  the  abdomen,
 thighs and limbs.  There may  be excessive loquaciousness and a mul-
 titude of strange and absurd ideas.    Afraid of everything.
   Sulphur. Menses too early, too profuse and lasting too long.  There
 are flushes of  heat, followed by weak spells.   Heat on the top of the
 head.   Cold feet.  Faintness from 11 to 12 o'clock.  She cannot wait
 for dinner.  Bleeding haemorrhoids.  She sleeps  lightly and  awakens
 very frequently, or she sleeps a profound sleep the whole night—dead
 and heavy sleep.
   Sulphuric acid. Menses too early and too profuse, always  preceded
 by a most distressing nightmare.  Tremulous  sensation in  the whole
 body, without trembling.   Much general debility.
   Trillium. Profuse menses occurring every two weeks,  and lasting
 a week or even longer;  yellow and thick leucorrhoea occurring in the
 intervals between the periods.   Menorrhagia occurring at the climac-
 teric, of thick, dark and clotted blood.
   Ustilago  maidis. Menorrhagia occurring at the climacteric period,
 with much pain in the top and side of the head.  Menses occur too
 frequently, are  too profuse and  last too long,  one  period  reaching
 almost to the commencement of another; flow lasts for two  or three
 weeks;  dark-colored  blood, with many clots; vertigo, especially ac-
 companying menorrhagia at the climacteric.
  Veratrum. Menorrhagia,  with  diarrhcea or with nausea,  vomiting
 and cold sweat on  the forehead.  Weak pulse.
  Zinc.  Menses  too  early  and  too  profuse.   Lumps  of coagulated
 blood, passing away mostly when walking.   Fidgety feet and lower
extremities.
                        Metrorrhagia.
  The term Metrorrhagia is meant to  signify haemorrhage from the
uterus unconnected  with   the  menstrual flow,  whether profuse  or
otherwise. 
540
MENSTRUAL  DERANGEMENTS.
   This  haemorrhage  may be  active—that  is,  composed  of brio-lit
arterial blood—or it may  be passive, consisting of the darker colored
venous blood.  It may arise from the general influence of predispos-
ing causes; from  accidents; from violence;  from excessive exertions
of body; Trom sudden shocks and violent emotions of mind • from
the presence of worms in  the intestines; from the presence of polypi
or otlier tumors within the pelvis;  from  cancer  or  ulceration of the
uterus; from  any of the causes which may produce  abortion or  mis-
carriage, and  from  the abortion  or  miscarriage  itself;  from reten-
tion  of the placenta  after parturition, or, otherwise, in consequence
of parturition  itself;   from the  cessation  of the menses after the
change of life; and from any of the causes mentioned in the  pre-
ceding  section,  whether local  or general,  as capable of  producing
menorrhagia.
  Those haemorrhages mentioned in the preceding section  under the
head  of Sympathetic  Menorrhagia  which appear during the course
of severe diseases,  even if  not  developed  at the usual catamenial
period, are still  considered as resulting,  in persons wrho have not
passed  the menstrual age, from the profound disturbance of the
sexual organism, and  are  therefore regarded as  menorrhagic rather
than as metrorrhagic.   And the same characteristic will be considered
as belonging to all haemorrhages occurring between the ages of puberty
and of the change of life,  unless some strongly marked cause, such as
one or  the  other  of those above enumerated, can  be discovered to
operate independent of the catamenial function. And  while every
individual case of metrorrhagia  must be treated with exclusive ref-
erence to the  symptoms  and  conditions found  in connection with
itself, a careful study of the causes of each case of such disorder must
be absolutely  essential to its  successful  treatment.  This  will be
made sufficiently obvious by recalling  for a moment the fact that the
most violent and dangerous forms of  uterine haemorrhage may result
from the most opposite conditions of body and of mind—from pleth-
oric congestion, or  from exhaustion and  debility; from the highest
emotional excitement,  or from the most sudden and profound nervous
and mental prostration.
  The Causes of Metrorrhagia require to be considered  a little more
in detail.
  And first, that most vague and  common one of general predisposi-
tion  should never be  lost sight  of.   Even  as we sometimes see in
ciiildren and others  a  remarkable disposition to haemorrhage from the
slightest wounds or other  causes, so in some women it  must always 
r
                        METRORRHAGIA.                      541

 be remembered there exists a corresponding predisposition to uterine
 hemorrhage.  And this constitutional peculiarity should be carefully
 studied with reference to  its connection with a psoric diathesis.  In
 such cases the characteristic  of the difficulty, and  of course the key-
 note of the only homoeopathic remedy, may really consist  in  some
 far-off  and  apparently unimportant symptom.   Our meaning here
 will be well illustrated by the instance of the picking of the nose as
 an indication  for  Cina in metrorrhagia  arising from the  presence
 of worms  in the  intestines,  which has  sometimes  been  known  to
 have kept up for many months a constant stillicidium of blood from
 the uterus.  Here we  can readily see  the relation  between the com-
 paratively trifling symptom of picking of the nose and the irritation
 of the bowel caused  by the ascarides, and  the consequent uterine irri-
 tation  and haemorrhage.   The fact that in many cases it  is entirely
 impossible to trace any such physiological connection between remote
 symptoms, which  still seem to be characteristic,  and  the disorders
 themselves, should not therefore induce us to conclude that such con-
 nection does not exist.
  The  manner in  which violence, accidents,  physical  and mental
 excitement, and  debilitating  mental and  bodily causes  act  in produ-
 cing metrorrhagia is very similar to that  in which in other instances
 the same influences result in menorrhagia.   But it is well  to bear  in
 mind that violence and excessive bodily and mental excitement tend
 to establish arterial  haemorrhage,  while  exhausting and debilitating
 influences upon the  physical  organism, and depressing mental emo-
 tions, tend to produce passive or venous  haemorrhage.  Mental and
 bodily excitement go together, and equally stimulate the arterial action,
 while  all  depressing influences,  whether  physical  or moral, tend  to
 paralyze the peripheral nerves, and thus arrest the  capillary circula-
 tion.  In  the former  case we may find  violent and dangerous me-
 trorrhagia of bright-red  blood; in the latter, a passive flow of dark,
 stringy or perhaps  clotted  blood, which  from its  intractable  per-
 sistence is no less  alarming,  since the greater the debility which re-
 sults from the flow, the  more difficult it becomes  to arrest the flow
 itself.
  In certain chronic diseases  or disordered conditions of the blood—
such as are  found in anaemic and  in  scorbutic patients; such as  are
seen to result from the excessive use of salt food,  as in scurvy; and
such as follow the long-continued  use of potash, as in  bread largely
prepared with salaeratus—the blood is thin and watery, loses its rich
color, its fibrine is dissolved, especially by the acticn of the potash, 
542
MENSTRUAL  DERANGEMENTS.
and passive haemorrhages readily make their  appearance.  This state
of  the  system, resulting in  many instances  from  easily discernible
causes, is analogous to the hereditary condition just referred to under
the names of constitutional peculiarity  and  psoric  diathesis.   In
either class of these  affections  the abnormal liquidity of the blood
favors the extravasation;  and it is easily understood  that the losses
of  blood, although replaced as  to quantity by the  absorption  of
water called  for by the intense thirst so commonly seen after severe
haemorrhages, do  but still further aggravate the disposition to me-
trorrhagia.
  In certain  constitutions there is. seen in connection  with the cata-
menia a  remarkable  disposition toward  violent haemorrhage.  And
the same thing is equally true  in other  cases  unconnected with the
menses.  This disposition may be termed a constitutional metrorrhagia
molimen, in which, under the influence of appropriate exciting causes,
the blood rushes to the uterus and flows  from it, just as sanguineous
congestion and haemoptysis result from corresponding  excitement of
the pulmonary organs.  Cases of metrorrhagia of this class are mostly
to  be seen in ^persons of a plethoric habit, who are thus almost ex-
actly the opposite of those above mentioned as anaemic, scorbutic and
scrofulous.
  The alarming,  frightful, and sometimes even fatal  metrorrhagias
which may arise from even very small polypi will  be  referred to in
the description of these forms  of uterine tumor.   In cancer of the
uterus the metrorrhagia is 'often  periodical, even in those who have
long passed the critical age; it is alarming both from its quantity and
from the frequency of its recurrence; it may be very sudden and severe
from the destruction of some  important blood-vessel; it may alternate
with a limpid, serous  or extremely foetid discharge; it may form from
time to  time a sort of crisis in the cancerous  disease and congestion;
it often augments  during the  whole course of the case, but may some-
times suddenly cease, leaving the patients entirely free during the lat-
ter  part of their existence.
  The metrorrhagias which arise from placenta prcevia, from retained
placenta, and  from other  causes  in connection with parturition, have
been already particularly considered in the description of the  difficul-
ties of parturition itself.
  Those which arise  rrom  abortion may be due either to the violence
or other causes of the abortion itself, or to the prolonged retention of
the  ovum and placenta. The latter has been known  to have remained
for  weeks, keeping up a more or less constant haemorrhage during the 
THE CHANGE OF  LIFE.
543
 whole time.   This subject, however, has already been fully referred
 to when treating of  Abortion and Premature Delivery.
   Still another most  important class  of metrorrhagias is found in
 those which appear after the change of  life.  These may arise in some
 instances from disorganization of the tissues of the womb  itself; but
 in most cases the haemorrhage is believed to be due to the real  metror-
 rhagia molimen already referred to, or to the continuance  of. the same
 scorbutic or psoric influences in the system which have been described
 as producing metrorrhagia in the earlier periods of the female life. In
 these cases the haemorrhage may be more or less  constant,  or it may
 alternate in various  ways with  a watery  or a  leucorrhoeal  discharge.
 For even  in those persons who have long passed the critical age a
 certain amount of periodicity is observable.  But the subject will be
 again considered in the subjoined article on the Change of Life.
   The attendant symptoms, although always to be taken  into  consid-
 eration in  prescribing  for a case of metrorrhagia,  need  not here be
 recited.  They are mostly symptoms of debility and prostration in
 various degrees and  forms; it should be borne in mind, however, that
 some patients bear very severe losses of blood with comparative im-
 punity, w bile others suffer very greatly  from every slight haemorrhage.
   Treatment—The  treatment  of  metrorrhagia  requires the utmost
 quiet on the part of the patient, and the strictest attention to  all the
 circumstances and conditions on the part of the physician.
   For  the remedies suitable  to the treatment of metrorrhagia the
 reader is referred to those given in connection with the chapter on
 Puerperal Haemorrhage, on p. 406.   The indications given for the use
 of remedies in the chapter on Abortion and the  preceding  article on
 Menorrhagia  may likewise be consulted  with  advantage.  Metror-
 rhagia in connection with polypus will  be hereafter treated  of  in con-
 nection with the treatment of these growths.

                    The Change of Life.
  The Change of Life, or menopause—by which is meant the cessation
 of the double function of ovulation and menstruation—does not usually
 occur all at once or  at any definite time.   The critical  age—another
 of the phrases employed  in this connection—may embrace a  period
 of several  months or extend over two years  or more.  During the
 whole  of this period the menses will occasionally make their appear-
 ance, being in many cases as disorderly in otlier respects as they are
 irregular in their periodical return.   It occasionally happens, however,
almost suddenly. 
544                menstrual derangements.

   Some women cease to menstruate, and consequently to be capable
of fecundation, as early as  their thirty-second  year, while others are
regularly " unwell,"  and even  bear  children, when  they are already
fifty or even sixty years of age.   But while such extreme cases are
rare on either side, the possibility of their occurrence in any given
instance should always be borne in mind.  There is  no rule absolute.
and nowhere do circumstances more remarkably alter' cases than in
these affairs of the  change of life.   It is observed, however, that
other things being equal, the average duration  of the  period of ovu-
lation  and  menstruation,  and  consequently  of the susceptibility to
fecundation, is about thirty-two years.   Still, those who commence to
menstruate early in  life do  not lose the function at exactly the  corre-
sponding  period,  since in  these it continues two years longer.  So
those who commence to menstruate quite late in life  are found to con-
tinue this function but little over twenty years.*  The average period
at which menstruation  first makes its appearance being  at about the
age of fourteen, the general average of the period of the change of
life will  be found  to correspond to the above statement, and  to be
therefore about the forty-fifth or forty-sixth year.
   But there are many influences, as well in health as in disease,  which
accelerate or retard the change of life in  individual cases.  There are
persons who seem  to have  a sort of hereditary idiosyncrasy in this
respect—to experience the change of life at a very early period, or to
menstruate to  an unusually advanced age.   Others, who have  borne
several children  in  rapid succession, seem to  have exhausted their
vital powers in this respect, and  to have fallen into a  sort of premature
marasmus, and consequently arrive at the change of  life much sooner
than is common to  those in health.  And very many forms of dis-
ease,  especially such as induce an anaemic  condition, and all that
large class of functional disorders and structural diseases of the or-
gans of generation and of those connected with them, exert a remark-
able influence in determining the change of life at an early age.
   On the other hand, those who commence to menstruate late in life,
as well as those who are naturally endowed with an unusual degree
of vitality and longevity, may  be expected to  retain the function of
menstruation to a much later period.  Those who—otherwise in per-
fect health—menstruate for the first time at twenty,  may be expected
to ccmtinue this function till they  are fifty, or even older.  And even
where we are unable to discern  any such particular reason to suppose
a patient is about experiencing the change of life at an earlier or later
   * E. J. Tilt, M. D.: Change of  Life in Health and Disease, London, 1867, p. 47. 
                    THE  CHANGE OF LIFE.                   545

period than is usual, we ought always to be on  our guard ;  for  many
cases of apparent change of life are in reality nothing more than  ir-
reqular  menstruation which we  may cure,  and  whieh  we ought  to
cure  therefore,  without first  subjecting our  patient unnecessarily to
the imputation  that she is  "an  old woman"—for which we should
receive but little thanks—and without subjecting  ourself to the odium
of being lacking in judgment.   For the physician who tells a patient
she is having the change of  life—she afterward  entirely recovering
and becoming regular, and even  bearing children, and such things
have  occurred—commits  a  blunder no  less palpable than that of the
dentist who pulls the wrong tooth.
  In  proportion as women  enjoy good health,  and especially in pro-
portion as the menses are  normal  in quantity and regular in their
recurrence, may we  expect  them to pass through the trying season  of
the change of life at about the  usual age or a little later, and  with
comparatively little  suffering;   while in  proportion as their health
has been  poor,  and  their menses imperfect  and   irregular, shall  we
have  reason to apprehend that for them  the  change of life will  prove
indeed a. critical age, and that it will  require all our care and skill to
bring them out  of it in  safety and  with health improved, instead  of
being rendered much worse.  For the change of life once well passed,
the woman settles dowm  with a new form of life, and it may be with
a new lease  of  life,  and has  a right to  look forward to a happy old
age;  while on the other  hand, if this critical  period is not thus suc-
cessfully passed, our  patient  may experience a long train of suffer-
ings,  which will either render her whole life  wretched and miserable
in the  extreme, or presently  develop some  rapidly  fatal  organic
disease.
  "Another  peculiarity  worthy of note  is, that many diseases are
cured or disappear in consequence of the climacteric.   The  ovarian
atrophy and  paralysis remove  a constantly  recurring  source of dis-
ease.  The monthly cycle, with its attendant excitement of the nervous,
vascular and glandular systems, is withdrawn.  A season of continued
quiet  and  comparative tranquillity supplies a favorable  condition  for
the restoration of health.   And when the critical period has passed it
is found  to  have been  the scape-goat  of a thousand  ills.   Slender
women  may  become  corpulent, and  even obese, bed-ridden invalids
get up and walk, and an entire  and radical change of physical  con-
dition is the consequence  in those who escape the  perils of this period.
They  enter upon a new phase of life, with  new  hopes and relations
toward the present and the future."—Ludlam.
     35 
546
M enstrual  derangements.
   In many cases the change of life comes on so gradually that the
system accommodates itself to the new order of things with no shock
to the nervous .system, and  without disturbing the accustomed har-
mony of the general circulation.  In such cases the intervals between
the  menstrual periods  become more and more prolonged, and even
the  menstrual discharge itself may gradually diminish in quantity.
" The most  frequent and least dangerous  symptom is  an irregular
return of the menstrual  flow every week, or every two or three weeks
or every  two, three or four or  six  months, and being more or less
irregular  as  regards the quantity or quality of the menstrual blood.
Serious and alarming haemorrhages  frequently set in, especially among
plethoric  and nervous  women, or such as  have indulged in sexual
excesses.   Sometimes these  haemorrhages alternate  with whitish or
yellowish  leucorrhoea, which  often  has  a foetid smell,  is acrid  and
extremely copious.   This leucorrhoea may continue long after the men-
strual discharge has entirely ceased to appear.  At this period we like-
wise  meet not unfrequently with colic, uterine  cramps, pains in the
sides, wTeight in the loins or distressing itching of the parts.  In some
cases the abdomen swells as during  pregnancy, with sympathetic de-
velopment of the breasts, until the swelling suddenly disappears after
the expulsion of a  mole, or after the emission of a quantity of gas, or
after a haemorrhage or a profuse discharge of serum."—Jahr.
  Symptoms of Change  of Life.—These vary in  different individuals,
according to  their respective temperaments; for in the change of life,
as well as in other conditions, women  present the plethoric, the
chlorotic or  the nervous type.  Thus, in those  of the plethoric type
the symptoms will  resemble those of congestion;  there may be flushes
of heat, rush  of blood  to face and head, uterine and other haemor-
rhages,  leucorrhoea, and  even  diarrhcea.   In  those  of  the chlorotic
type the symptoms which at or  near the  proper age would indicate
the approach of the change  of life  are the sallow complexion, semi-
chlorotic skin, weak pulse, and various other  indications of debility.
In those of a nervous type there is, as the change of life approaches,
an evident disturbance of the nervous equilibrium, not unlike that
which in  similar cases  precedes the original accession  of the men-
strual function.   Hence the over-anxious look, the brimful eye, the
terror-struck expression as if  apprehensive of seeing some frightful
objects, the face bedewed with  perspiration, and the remarkable tend-
ency to hysteria, which are sometimes to be  met with.
  The unusual development of hair on the chin and upper lip gener-
ally  coincides with  final  cessation of the menses;  so does an unusual 
THE CHANGE OF  LIFE.
547
 power  of generating heat, indicated by  the  habit  of throwing  off
 the clothing  and opening doors and windows.  There are a laro-e
 number of more or less  distressing  symptoms or  forms of disease
 which  in fact result from the change of life, and which thus cer-
 tainly  indicate  that the  system is either actually undergoing that
 change, or under the influence of causes  which if not  arrested will
 finally  bring it about, and that too in a manner by no means safe  for
 the patient,  xlmong  these   may  be mentioned  the long list  so
 admirably summed  up by Jahr: "Haemoptysis, bloody urine, piles,
 nose-bleed  and  other  haemorrhages;  pulmonary  phthisis  likewise
 takes a  fresh development, and  frequently  terminates fatally.  In
 other cases we  meet with diarrhcea, weakness  of the  stomach, flatu-
 lence, vomiting and  other derangements of the digestive canal, which
 are sometimes  accompanied  by  consumption  and profuse sweats.
 Some  women complain at this period of attacks of rheumatism of
 the shoulder or thigh, or a considerable swelling of the joints;  others
 experience attacks of hysteria, hypochondria, and even nymphomania;
 others  again are attacked with various eruptions,  such as tetter of
 the genital organs, acne rosacea  or  erysipelas.   The most distressing
 maladies  which break out at this period, and often terminate fatally,
 are ulcers and polypi of the uterus,  and carcinoma of this organ and
 of the  breasts."
  Temporary cessation or irregularity of the menses, when such symp-
 toms arise in connection  with chlorosis,  inflammation  of the  neck
 of the womb, uterine polypi, uterine fibrous tumors, uterine hydatids,
 uterine  cancer, and even pregnancy, have  all been  mistaken for the
 change  of life.
  Puberty, "pregnancy, parturition, lactation, are all critical periods,
 curing  some complaints and giving greater activity to  others ; and
 when, after having lasted thirty-two years, the action of the reproduc-
 tive organs is withdrawn from the system,  prolonged ill-health is the.,
 frequent result.   Then arises a series of beautiful critical movements,
 the  object of which is to endow the woman with a greater degree  of
 strength than she had previously  enjoyed."   Thus,  the floodings,
 leucorrhoea, diarrhcea  and  perspirations which occur in  the  great
 majority of cases of the  change of life are  eminently  critical, and
 restore  to health a  large proportion of  those  who are judiciously
 treated.    And there  are many women who have suffered  in various
 ways for  years with  general poor health, who, upon the occurrence
of the  change of life, may either spontaneously  recover,  or will
oftener  be entirely cured  by means  of the appropriate medication. 
548
MENSTRUAL
DERANGEMENTS.
What  is called by some authors the dodging time covers  the period
which  extends from the first beginning of declining and irregular
menstruation  till  the final cessation  of this  function.  This period
may vary  from a few months to six or seven years;  and wdiile it
affords  a most important season for the application of homoeopathic
remedies,  it will  be  very much abbreviated  by  their skillful em-
ployment.
  But  in addition to those forms  of disease which, as  purely critical,
may be regarded as the salutary results of vital  action, such as the
occasional  haemorrhages, leucorrhceas and diarrhoeas already referred
to, there are other and  more positive disorders, developed under the
general influence of the profound disturbance of the nervous and san-
guineous systems  which, in  many instances, is inseparable from the
abrogation of the long-accustomed nervo-sanguineous function of ovu-
lation and  menstruation.   All these require to be treated in the usual
manner by remedies carefully selected to meet  the  existing condi-
tions, and with strong hope  of success, even in the severest cases—a
hope all the greater from the fact of  the temporary nature of the in-
fluence which stimulates and sustains these forms of disease.  And this
remark applies even to those malignant and cancerous forms  of dis-
ease which are so  frequently developed at the critical age. Unless the
system has been previously exhausted by the hardships and sufferings
imposed upon a constitution  originally feeble, there is always hope for
success  in  the early application of homoeopathic  medicines in these
cases.
  Treatment.—In  this place it will  be sufficient to  refer to the differ-
ent disorders already described, such as Haemorrhage, Flooding, Diar-
rhcea, Cancer, etc., and to their corresponding medicines,.for the treat-
ment of the various forms of  disease that arise at the change of life.
Let the similar remedy he always found for the existing symptoms and
conditions  of the individual case; let it be given in the best form (not
too low); and let its full action be patiently awaited, and the physician
will have the unspeakable satisfaction of seeing permanent health take
the place of the most complicated, distressing and protracted forms of
disease  at the critical age.  The remedies most  frequently useful in
disorders of the critical age will be found indicated under the head of
Menstrual  Disorders and other affections, which may be the most prom-
inent of those which attend the change  of life.  The remedies which
are remarkably adapted to relieve the disorders incident to change of
life, and which therefore are found to be most frequently called lor,
are Lachesis,  Cocculus,  Pulsatilla,  Sulphur, Crocus  Conium, Sepia} 
NYMPHOMANIA  AND  HYSTERIA.
549
Ignatia and Sanguinaria.  But whatever remedy includes the symp-
toms of the patient in the most characteristic manner—i. e. has as its own
characteristics  the characteristics of the patient—will prove curative.
And in the more severe forms of tumors,  cancers or other  organic
disease which may be  developed  subsequent to or in connection with
the change of life, endeavor always to find the remedy which has  all
the constitutional and  characteristic symptoms and conditions'of the
patient, as well as those relating to the particular form of structural
disease which presents.
                   CHAPTER  XXVII.

            NYMPHOMANIA  AND  HYSTERIA.

                       Nymphomania.

   THIS formidable  disease may be  properly reckoned as one  of the
    disorders of the external genital organs, since its principal seat is in
the vulva, nymphae and clitoris, although  these organs may only be
thus affected in consequence of some morbid  condition  of those more
interior.  Nymphomania consists in an  uncontrollable passion for
sexual intercourse, which sometimes  overcomes all the restraints of
modesty, propriety and decency, and amounts to an actual insanity
or monomania  on this single subject.  Taking its rise in functional
disorders of the sexual system, or in more general constitutional in-
fluences, which are thus ultimated upon the external generative organs,
this disease changes  the entire moral character from  the most attrac-
tive modesty to the most shameless and  repulsive profligacy;  and it
may lead to  paroxysms whose violence rapidly exhausts the vital
energies, and  which terminate only in death.
  Nymphomania is to be distinguished from erotomania. The former
is a purely sensual passion, alike physical in  its origin, in its local
influence, in its development and in its much-desired  forms of grati-
fication.  The latter, although still to be considered sensual in a strictly
moral  point  of view, from a physical  point of view would seem
rather  spiritual, as neither requiring sensual means of  gratification nor
dependent upon physical ability.  Erotomania is a  psychical  state,
which  may find its highest  if not its only gratification in the reveries 
550
NYMPHOMANIA.
and  dreams of amorous  imagination and fancy  by dav or  by nio-ht.
Nymphomania is a physical disease, whose progress may  be traced
through a period of internal.incubation, of external,  reluctant and
partially restrained development, to a final condition of open, unre-
strained manifestation, characterized by a  most  intense, all-control-
ling sexual desire, and by an  equal unconsciousness  of shame and
of decency.
  This disease  has repeatedly appeared in strongly marked  cases
where there was one  constant  characteristic of the temperament or
constitution, and that was " an unusual susceptibility of the skin to
tettery affections."   In these cases the disorder is so profoundly con-
nected with the entire system  that it induces paroxysms of convul-
sions, which indicate that the entire cerebro-spinal nervous centre is in-
volved.  The actual monomania,  with entire obliteration of all feel in "■
of modesty and unconsciousness of all the duties and proprieties arising
from the domestic relation, indicates also an equally complete subjec-
tion of the purely cerebral functions and moral feelings to  the same
morbid influence;  while  the  spasmodic closure of the oesophagus
and  impossibility of deglutition, and consequent destruction of organic
life,  show also that the same disease has possessed itself of the or-
ganic nervous centre, and so  completely invested the  whole of the
organism.
  True nymphomania may be considered as a most remarkable illus-
tration of the psoric diathesis, as a most astonishing proof of the truth
of the psoric  principle; for if  we observe this malady  to arise from
the more immediate influence of ascarides or onanism, these  latter are
but intermediate steps in the chain of causation, being themselves the
results of the  same psoric  influence in the system.  The same may be
said of the enlarged, hypertrophic  condition of  the clitoris so often
seen in connection with this  disease.   The nymphomania is  more apt
to make its  appearance at either one or the other of those two epochs
of the female life in which the  constitution  is stirred up as it were in
its profoundest depths—that is, at the accession of puberty or on the
cessation of the menses, but more particularly at the former of these
two  periods.   And in addition to  the influences already mentioned as
constitutional  or provoking  causes,  and which will thus exert an im-
portant influence in determining the choice of the remedy, we may men-
tion  suppression or great disturbance of the menstrual function and
organic diseases of the  uterus.
  But in prescribing for this truly distressing complaint the various
attendant symptoms, as well  as  the peculiar constitutional indications, 
REMEDIES FOR NYMPHOMANIA.
551
 must be carefully considered.  It will not be necessary to enumerate
 here all the varied symptoms, and morbid moral, mental and physical
 conditions, which  may accompany a  case of  nymphomania.   As  in
 hysteria—and in fact what is this disease itself but a most violently
 aggravated hysterical affection or morbid  excitement of the entire
 sexual system of the female ?—so in nymphomania, an endless succes-
 sion and variety of symptoms may present.   There may be leucorrhoea
 of more or less peculiar kind; pruritus of the external organs; intense
 lasciviousness; inflammation  and excitation of the sexual parts; fever
 with foetid breath; nocturnal restlessness;  sleep with dreams  which
 renew the sexual excitement;  paroxysms of spasmodic closure of the
 oesophagus; general and exhaustive convulsions; diarrhoea, etc.  And
 these attacks and symptoms of the disease may appear in consequence
 of onanism, or  be attended  with irresistible  disposition  to  it;  they
 may accompany menstruation or appear in its absence;  and  finally
 may be relieved or brought on by pregnancy.   We have devoted  con-
 siderable space to this not very  frequent form  of disease, because the
 homoeopathic remedies—as in the somewdiat analogous case of delirium
 tremens—have been found capable of producing the most  salutary re-
 sults, and thus of  saving from destruction and of restoring to society
 some of  its most valuable and important members.  And the indica-
 tions given for the remedies may be  useful also in the  milder  and
 more common forms of amorousness and erotomania, for the relief of
 which the physician is often consulted.

                 Remedies for Nymphomania.
  1. Bell., Canth., China, Mosch., Nux v., Phos., Plat., Puis., Verat.
 2. Ant. cr., Calc. carb., Carbo veg., Coff, Graph., Lach., Merc, Natr.
 carb.,  Natr. mur.,  Op., Sabina, Sil.,  Stram., Zinc.   3. Agar., Ars.,
 Aur.,  Bov., Cann., Cocc, Coloe, Con., Dig., Dule,  Hyosc, Ignat.,
 Iod., Lye, Meny., Plumb., Ruta, Staph., Sulph., Thuy.

  Agaricus. Itching and irritation of  the genital organs, with  strong
desire for an  embrace.   Great selfishness.   The patient is subject to
chilblains, which are red and itch greatly.
  Antimonium c. Tenderness  over the ovarian  region, with nausea,
 vomiting and white tongue.  Excited sexual  desire.
  Arseii.  a. Sexual desire, with an involuntary discharge of mucus  as
a particular symptom.  Restlessness.   Thirst  for  cold water; a very
little satisfies  her.  Unhappy, fatiguing dreams;  nothing comes out 
552                      nymphomania.
right in her dreams.  She wishes to be in a warm room or to be coh-
ered up 'Warmly, and cannot  bear  the cold  air.  Symptoms become
worse after midnight.
  Auruill. Feeling  of  desperation;  hysterical  mood, laughing one
minute and crying the next.   Inclines to jump out of windows.
   Bovista. B-urning and voluptuous  feeling in  the sexual organs.
Lewd  dreams.  Leucorrhoea,  like white of  egg.
  Calc. carb.  Pale, leucophlegmatic   Much headache.  Swelling over
the pit of the stomach,  like a saucer turned bottom  up.   Menses too
often and too profuse.  Vertigo or a pressing headache, as if  some-
thing were pressing up  into the head, on ascending.   Sleeplessness  in
the early part of the night; she lies awake for hours.
  Cannabis  s. Great excitation of  the sexual instinct,  the  female
being sterile.  Aggravation of the  symptoms after midnight,  which
become still worse in  the forenoon.   Vivid lascivious dreams after
midnight.
  Cantharis.  Pruritus of the vagina, with  strong  sexual desire. She
must urinate very frequently, with cutting, burning pain.
  Carbo veget.  She is troubled much with varicose veins in the  vulva.
Itching  at  the same time of both the vulva and the anus.   Much
belching of wind, which affords relief for a short time only.
   China. Sensation as if the abdomen were too full after eating, with
desire  to eructate, which, however, affords  no relief.  Troublesome
itching and spasmodic contraction in the inner parts.  Nymphomania
of lying-in women.
   Cocculus.  Particularly in chlorotic females.   Shivering  over the
mammae.  Lower extremities very weak.  Bloody leucorrhoea.
   Coffea. Voluptuous itching  in the genital organs.  She is in  a state
of ecstasy.   Sleeplessness.
   Conium.  Shriveling of the  mammae, with  increasing  sexual  desire.
She is much troubled with vertigo, particularly when lying down and
when turning over in bed. The urine flows and stops, and flows again,
at each intermission.
   Digitalis.  Lascivious state  of the fancy day  and  night.  Remark-
ably slow pulse.  Stools of a very light color.
   Dulcamara. Heat and itching in the genitals, with desire  for an
embrace.  All her symptoms are aggravated by a cool change in  the
weather.   Hei  sexual desires are also increased by this change.
   Graphites. Inclination to obesity.   Enlarged ovaries, which become
more tender and more  enlarged every time she takes cold or gets  hei
feet damp.   Menses delay.  Itching blotches here and there over the
j 
REMEDIES FOR NYMPHOMANIA.               553
 surface of the body, from which oozes out a colorless, glutinous fluid.
 Much troubled with violent headache.
  Gratiola. Gnawing about the umbilicus, as if of worms.  Tingling
 in the hypogastrium and around the  umbilicus.  Gnawing at the pit
 of the stomach after eating, as if of hunger.  Irresistible drowsiness
 and involuntary closing of the eyes as the other symptoms abate.
  Hyoscyamus.  Excited sexual desire without excitement of the fancy.
 Lascivious furor without modesty.  She inclines to uncover and expose .
 herself.  Convulsive trembling.   Immoderate loud laughter.
  Ignatia. Strongly  inclined to solitude, and to  be  very secretive,
 and to be passive.   Sadness and sighing, with an empty feeling in the
 pit of the stomach.
  Jodium. Dwindling and falling away of the  mammae; they hang
 down heavily and lose  their fatness.  Heaviness of the mammae, as
 if they would fall  off.  All her symptoms are relieved by eating.
  hachesis. Tickling and jerking, extending from  the thighs to the
-genital organs, with sexual excitement.   Her symptoms are usually
 worse after sleeping.  She feels  extremely sad,  unhappy and dis-
 tressed in mind on waking in the morning.
  Lycopodium.  Much borborygmus in the abdomen,  or  gurgling in
 the left hypochondrium.   Discharge of wind from the vagina.  Sense
 of dryness in the vagina.   Red sand in the urine.  Delay, and severe
 pain in the back before the emission of the urine.   Sense of fullness
 up to the throat on eating a small portion.  Worse after four P. m.
  Mercurius.  The  symptoms  are  more  constitutional   than  local.
 Hence  this  remedy must be given rather from its general character-
 istic indications.   The symptoms are usually aggravated at night, and
 are still worse when in bed.
  Moschus. Violent  sexual  desire, with  intolerable  titillation in the
 genital organs.
  Nat.  carb.  Motion as from a foetus in the uterus.   She has a variety
 of sufferings, all of which are aggravated during a thunder-storm.
  Nat.  mur.  Falling off of the hair from the mons veneris and from
 the labia majora.   Much  itching of  the vulva.  She awakens every
 morning with  a bad headache.  Great  aversion to bread, of which
 she was once very  fond.   Longing for salt things.
  Nux  vom.  Burning in the vulva, with desire for an embrace.  She
 waken-* at three or four in the morning with sexual desire; does not
 sleep much afterward.   Constipation of large and difficult faeces.
  Opium.  Very sleepy,  but cannot go  to  sleep.   Constipation; the
 evacuations are composed of round, hard  black  balls.   The sex- 
554
NYMPHOMANIA.
ual excitement and other troubles  all disappear from a few doses of
opium.
  Phosphorus.  In a pregnant women at the seventh month nymph-
omania appeared, with spasms; the symptoms  were a weak, empty
feeling in  the  abdomen,  cutting  pains  iiv the  abdomen, a narrow
dry, long and difficult stool, like a dog's stool.  One dose of Phosph.
19 m.  completely cured the nymphomania:  she went her full time
and was happily delivered.
  Platina.  Excessive  sexual desire, particularly in virgin women.
Voluptuous tingling in the vulva and abdomen.  Stool difficult, be-
cause it adheres to the rectum and anus like soft  clay.   Hysterical
cough  from stifling beneath the upper fourth of the  sternum.
  Plumbum. Sensation of drawing from the  abdomen  to  the spine.
Constipation; stool like sheep's manure.  Severe stretching, proceed-
ing from the abdomen.
  Pulsatilla. In women with blue  eyes, very  affectionate, easily ex-
cited to tears,  and of a very yielding disposition.   She cannot sleep
in the  early part of the night; sleeps late in the morning.  No thirst.
All her symptoms are worse toward evening; they are relieved in the
open air, and worse on returning to a close and warm room.
  Sabina. An almost insatiable desire for  an embrace.  Sensation of
drawing or dragging from sacrum to pubes.   Intolerance of music.
  Silicia. She  feels nauseated during an embrace.   Spinal  affections
and constipation, with increased sexual desire as a consequence.
  Staphysagria. Extreme sensitiveness to mental and  physical im-
pressions.  She  feels  mentally and  physically,  very acutely, every
little circumstance.  The teeth turn black.
  Stramonium.  Excessive loquacity during the  menses.   This was
always the case.  Stramonium removes also abnormal sexual excite-
ment.   During the menses the smell of semen is very apparent.  Her
face is bloated with blood.   A great many strange  fancies come into
her mind.   Afraid of everything, and of solitude.
  Sulphur. A weak feeling in the genital organs.  Sore feeling in the
vagina during an embrace.   Sterility.  Also in cases which present
the general characteristic  indications for sulphur;  which  see under
head of Hysteria.  Worse from eleven to twelve noon.
  Tarantula. Itching of vulva; worse at night, with dryness and heat
in the genitals; must move lower limbs frequently.
  Thuya. Fig-warts, condylomata, or other excrescences of a similar
nature on or about the genital organs. Her symptoms are worse after
three p. m., and at night, preventing her from falling asleep.
  Veratrum. Nymphomania, particularly of lying-in women. Mama, 
HYSTERIA.
555
with lewdness and  lascivious speeches.   Thirst, with craving for the
coldest drinks.   Menses  preceded or accompanied by vomiting and
diarrhcea  or by diarrhoea  alone.   The  bed  aggravates  all the
symptoms.
  Zinc. Sexual desire  several times  at  night.   Irresistible desire for
onanism.  She always feels best during the menstrual  flow.   Boring
pain in the left ovary, requiring pressure for  partial relief, excepting
when the menses are flowing; then there is complete relief.
  Such diet should be prescribed in cases of this nature as is  perfectly
plain and unstimulating;  all  stimulants,  including  tea and coffee,
beino- positively prohibited.   Exercise in the open air will be of bene-
fit and  every effort should be made to  divert the mind of the patient
from the consideration of subjects of a  sexual nature.

                          Hysteria.
  Hysteria  is a purely nervous  affection, which  may  arise and con-
tinue without any functional  or organic derangement of the  female
sexual system on which  it  is based, and which does  not necessarily
produce  such derangement or disorganization.   Hysteria bears  the
same general relation to the nervous apparatus  of the  reproductive
system that chlorosis does  to  that  of  nutrition,  and has  no more
exclusive connection with the uterus or other particular sexual  organ
than chlorosis has with the  stomach  or  other  particular  digestive
organ.
  As a purely nervous affection,  not necessarily painful, hysteria must
be distinguished from irritable uterus on the one side  and from hys-
teralgia on the other.   In  irritable uterus, although there is neither
disorganization  nor structural change—except perhaps that of dis-
placement, which is the most frequent cause of the irritability itself—
the uterus  is excessively sensitive to pressure, or even to  the touch,
which is not necessarily the case in hysteria.  In hysteralgia  the pain,
sometimes  mild, lingering,  worrying, and sometimes  violent, severe
and acute, is always positive and decided.
  But in the location  of  the disease itself may be  found another  im-
portant  distinction between hysteria  and the  somewhat analogous
forms of uterine disease  with which it is so apt to be confounded.  In
irritable uterus and in hysteralgia, from whatever cause these  disorders
arise, their actual  location, principal seat and  ultimate  development
appear to be in  the uterus itself.   This, however, is not the case with
hysteria.   The  uterus indeed has usually been  considered the seat of
hysteria (hence  the name), but the ovaries,  as the centre  of the sexual 
556
HYSTERIA.
system, must now be regarded as the real fons et origo of a majority
of cases  of hysterical affections.*   Thus pressure upon the ovaries
will invariably bring on hysterical attacks  in persons predisposed or
subject to the disorder.   Hysteria extends its influence over the entire
sexual apparatus;  from its profound connection with  the sympathetic
system it may extend its influence to  all the involuntary organs, and
by  its final  extension  to the  cerebro-spinal nervous system it may
involve also  all the voluntary muscles.
  Hysteria, again,  has  been  found to co-exist with the  most perfect
performance of  all the  functions  of the uterus  and its  dependent
organs, such as menstruation, conception, utero-gestation, parturition
and lactation, although this is  perhaps true rather of the  milder
than of the severer forms of this disorder.  Still, as not necessarily
disturbing the  functions, still  less  involving the structure  of  the
sexual organs, and as  not being invariably painful, hysteria  estab-
lishes its claim to  be regarded as a purely nervous affection, capable
of  being distinguished  from  irritable uterus and from  hysteralgia,
both of which are also nervous  affections, although of quite another
sort.  This distinction will  appear  more strongly marked when we
come to  notice the differences in the nervous  systems principally in-
volved.   And this definition of hysteria is still  further strengthened
by  the well-known influence  of imagination and sympathy  in  ex-
tending this  disorder from one person to others, as  in the hospitals,
where many are simultaneously and  sympathetically affected from
seeing a single  one  attacked  by hysterical convulsions.  And it is
still more fully confirmed by the powerful influence of fear in pre-
venting  and allaying such convulsions.  In this respect, as well as
in  some others, hysteria bears  a  very remarkable  resemblance to
epilepsy.
  The neuralgic and the convulsive forms constitute two distinct varie-
ties of hysteria, but this distinction, although sufficiently well marked,
is one of degree rather than of kind.  In what is termed the neuralgic
form of  hysteria the symptoms " are merely manifestations of nervous
susceptibility," while in the  convulsive form they are more intense,
permanent, regular and periodic.  And the principal apparent distinc-
tion between this latter condition of periodic menstrual  convulsions
and that which presents  in uterine epilepsy is to  be found in the  loss

  *  It must not be forgotten  that  a corresponding irritation of  the  nervous system
belonging  to the sexual  apparatus of the male may sometimes occasion a similar
Hysterical  condition in men. 
HYSTERIA.
557
of consciousness, which manifests itself in the latter form  of disease,
but not in the former.
  A  corresponding distinction  may  be seen  in the  nervous centres
involved in hysteria.   For in the milder, so-called neuralgic form of
the disease, which yet may be of hereditary  origin, the ganglionic or
sympathetic  nervous  system seems principally concerned;  while in
the severer or convulsive forms of hysteria the original, predisposing,
hereditary influence is  by provoking  causes  extended to a  full devel-
opment in the cerebro-spinal nervous centre.  In this case, then, we
find the discordant influence extending itself to the muscular apparatus,
and in consequence we have occasional spasms or regular and period-
ically recurring convulsions.  And  it will  be observed that these
gpasms  first appear in those parts  of the  body and muscular tissues
which are in immediate relation with the  abdominal, the  cceliac  and
the thoracic ganglia.
  From these remarks  it may be  concluded that hysteria  is a purely
nervous affection, which, being to a great  extent hereditary  in its
origin, finds its primary seat in the ganglionic or sympathetic ner-
vous  centre; which finds its secondary and  ultimate development in
the cerebro-spinal nervous  system; which in this extended develop-
ment occupies the motor rather than the sensory nerve-filaments;  and
which thus finally results in spasmodic  contractions rather than in
poignant sensations.   And here is to be found perhaps the last, most
important and reliable distinction  between  hysteria and  hysteralgia.
In their constitutional origin,  in  their  primary  ganglionic seat of
development,  and in the provoking causes of their extension to the
cerebro-spinal sphere, they may show but little difference;  but here
they  diverge, for where hysteria  seizes upon the motor filaments of
the nerves, and so leads to convulsions, hysteralgia involves the  sen-
sory filaments, and occasions the intense  pain which characterizes  this
affection.  This distinction is exactly  the same as that between asthma
and angina pectoris, the former affecting  the motor  nerves, and the
latter the sensory nerves of the chest, so that in asthma we have severe
constriction, with little if any other pain, while in angina  pectoris we
find the most  poignant  distress,  but no constriction.
  Hysteria  thus becomes an  affection principally (although not exclu-
sively) of the female system, which, constitutional in its origin, and so
underlying the organic nervous system, is also capable of extending
itself over the entire nervous organization,  and of simulating almost
every form of disease, with the  single exception, perhaps, of accelera-
tion of  the  circulation; for  some of these states of hysterical excite- 
558                          HYSTERIA.
 ment can hardly be distinguished from inflammatory fever, except by
 ascertaining that the  rapidity of the pulse does not correspond with
 the other apparently febrile symptoms.
   Symptoms.—To attempt to enumerate all the legions of symptoms
 which  may appear  in hysterical  cases  would  be a hopeless task
 Hence our description of  this multiform affection must be confined to
 the statement of the more prominent symptoms only, and to a general
 division and classification of those which make up the principal forms
 of the disease.
   And the first and most general division of the symptoms of hysteria
 will be  into those which  belong to the mental and moral sphere, and
 into those which are purely physical sensations.  And in each of these
 two divisions there will be found the same variety and even diversity
 of conditions.   Thus among the moral symptoms there may  be great
 depression of spirits with involuntary tears, or equally great exaltation
 of spirits and meaningless laughter;  in these  cases the exaltation and
 the depression being alike incapable of being attributed to any appar-
 ent cause.   There may be sudden changes, and even frequent alterna-
 tions  from one  extreme to the  other, and always an uncertainty and
 want of fixedness, and  even positive mobility of character.   And these
 revulsions are not confined to the individual states of joy and sorrow
 in the persons affected; they extend also to their affections toward the
 members of their families and  toward others.   And in addition to
 those changes which arise from no perceptible cause, there is a remark-
 able susceptibility to  impressions,* many of which, although in reality
 of the most trifling nature, appear to exert a fixed and powerful influ-
 ence.   Other and  no less remarkable  changes in feeling and  in affec-
 tion arise from purely imaginary causes.  Thus, in hysterical  persons
 it is not uncommon  to see  personal  dislike unaccountably take the
 place of previous  affection, and  the most violent and furious parox-
 ysms of jealousy arise from the influence of imaginary and baseless sup-
 positions.  As in the personal condition of an  hysterical woman there
 may be  alternations  of gayety and  of gloom, of  frolicsome  levity
 and of  melancholy seriousness, so in her relations to others, and, if
 married, to  her husband especially, she will at  one time be full of
 affection aud devotion, while at others sentiments  of  aversion and
 positive  dislike obtain the entire sway.  One day  she will express
 herself as the  happiest of wives, and  assure her  friends that her
husband is as good as  he can be;  the next she pours into the gaping
ears of -all the gossips her peculiar condition gathers  around her long 
HYSTERIA.                        559
talcs of suffering, neglect and abuse, and represents  the man who has
die misfortune to be her  husband  as  the most detestable monster.
This form of hysteria is  a  real monomania with lucid intervals, but
which  may become a fixed insanity in relation to the married state,
and so not only destroy domestic peace, harmony and affection, but
even break up the family.
  But hysteria, in all its most aggravated moral forms, is distinguished
from insanity by the fact that the personal consciousness  is never lost
sight of.   There is always  a sort of alienation of the personality in
cases of insanity, a forgetfulness of self, which never appears in hys-
terical  cases.   In these latter, on the contrary, there is the most re-
markable  and persistent prominence of the self-love.  Egotism, espe-
cially in married women as opposed to  their husbands, is the most
prominent and the only  constant moral  symptom of hysteria.  Such
persons entertain their hearers with marvelous tales of the greatness
and exploits of their past lives, and of the richness and abundance of
their possessions, of the  number of their friends  and of the distin-
guished consideration they have  always  received in society in their
former places of residence.   These accounts are uttered with an air of
sincerity well  calculated to deceive the  honest listener; and such un-
bridled license of the imagination and total obliviousness in regard to
the truth, which are vulgarly attributed to entire want  of principle
and the most inordinate vanity, are in reality due to that morbid con-
dition  of the female organism which is  designated by the comprehen-
sive term hysteria—a condition which, if it were properly understood,
would  prove far less mischievous  in society and less frequently destroy
the family tie.
  The second part of our division of the symptoms of hysteria in-
cludes  all  those which have relation to  the physical  system.  These
physical symptoms may  be again divided into the sensational and the
convulsive.  Among the former  may be ranked all  those various un-
easy sensations which appear at different times in different parts of the
body, as in the abdomen, in the pit of the stomach and in the throat—
sensations  which are not very positively painful, but which are for
that reason perhaps all  the more distressingly  annoying, and which
in the  most aggravated forms become developed into actual spasmodic
contractions in those parts.  These sensations do not appear to exert
any direct influence upon the organic functions; still, they are attended
with disturbances of the  appetite, indigestion and general languor and
debility, which are no doubt the consequences of the nervous derange-
ment.  These sensations are innumerable, variable or fixed, and either 
560
HYSTERIA.
   constant  or excited  by the slightest influence, and even by the least
   touch.
     As there is a constant indecision, want of fixedness  or persistence
   in the mental sphere, rendering the mind liable to be swaved by the
   slightest breath of external influence, so  in the physical system there
   is a  corresponding want  of permanency in the animal spirits.  The
   same mobility that appears in the  mental and  moral  states, and in
   the  affectional  relations  toward others,  appears in a  corresponding
   degree  in all  the  bodily  conditions.  And  as the merest fancy will
   often bring on a  paroxysm of jealousy in hysterical  women, so  the
   slightest  direct touch, or the reflex influence from ordinary func-
   tional action, may give rise to a long train of hysterical sensations,
   or even occasion the most determined convulsions.   This remarkable
   sensitiveness of the physical system to external impressions, and no less
   remarkably increased reflex excitability, form the chief  characteristics
   of the first or sensational variety of the physical symptoms of hysteria.
     The convulsive symptoms of hysteria begin in the hypogastric region,
   and gradually pass up the abdomen like the ripple of a wave, through
   the chest  to the larynx and pharynx.  First  comes on a strange sensa-
   tion, as of pain, in the hypogastric and  ovarian regions, followed by
   suffocative  feelings in  the pit  of  the   stomach, and then by  the
   globus hystericus,  which is characteristic of the complete hysterica]
   passion.  These form the precursory symptoms of the true hyster-
   ical  convulsions, and are analogous to the aura which  precedes  the
   accession  of an epileptic attack.   And from appearing at the first in
   this  mild form  of semi-spasmodic contractions these  attacks  may
   momentarily or hourly increase  in  severity till trismus or lockjaw
   supervenes.   And  as the hysterical attack in its successive forms of
   development involves the different nervous  branches and ganglionic
   centres, corresponding symptoms  appear.  Thus, from the disturbance
   of the nerves of the pharynx there results dysphagia, globus hysteri-
   cus;  from the larynx, an  affection,  with  the most imminent danger
   of suffocation, not  to be distinguished  from  croup, except that there
   is no false  membrane, and  that  Nux vomica,  rather than Aconite or
   Spongia, may prove curative; from the bronchia, dyspnoea and cough;%
   from the heart, attacks of palpitation, irregular beating and sense of
   anxiety;  from the stomach, hiccough, retching  and vomiting; from
   the bladder, ischuria or dysuria.  And finally,  as the paroxysms  ex-
*  tend through the voluntary and involuntary  muscles, there are devel-
   oped tonic and clonic spasms  of  every kind  and degree of violence,
   from mere tremor or nervous quivering to the most convulsive move- 
HYSTERIA.
561
ments and contortions.   "The  masticatory and histrionic muscles of
the face take part; trismus, chattering of the teeth as in the rigor of
fever, the sardonic laugh and a rolling of the eyeballs upward, occur.
After a  duration  varying from ten minutes to  several hours,  the
paroxysm often terminates suddenly with a flow of tears or  a copious
discharge of urine, but not unfrequently it passes off  gradually." *
  The globus hystericus, which has already been mentioned, merits a
fuller description, since it forms one of the most characteristic symp-
toms of the invasion  of the hysterical  paroxysm.  It consists  in an
obscure sensation  as  of  a globular body, which gradually ascends
from the pelvic  cavity, or at  least from the  hypogastrium, to  the
throat, where it seems to be arrested, and  to  produce a most painful
sense of constriction and suffocation.  This causes a peculiar choking
sensation, which may be attended with  sobbing.  It is not confined
to women, but may sometimes  appear in those of the opposite  sex,
especially in young persons about the age of puberty, whose naturally
delicate and sensitive temperament is agitated in a particular manner.
Globus hystericus may arise from  mentally or morally caused  inter-
ruption of the delicate currents  of the nervous fluids ; and may, par-
ticularly in males, be at  once removed  by such relief and  revulsion
of these feelings as will again permit the  free and unrestrained flow
of these most interior and subtle fluids, of which  we know but little
more as yet than their hypothetical existence.
  Causes.—The causes of hysteria are as various as they are numer-
ous.  No doubt very many cases  of this disorder, especially of the
convulsive form and most obstinate kind, are originated and main-
tained by functional derangements, displacements  or  structural disor-
ganizations of the uterus  or  other parts of  the sexual system.   But
since in these instances  the hysterical  affections  are but the conse-
quences or attendant symptoms of other  and primary disorders, Ave
do not consider  them in  this place.  They require to  be studied in
connection with all the accompanying and causative conditions.  But
in all cases in which hysterical  symptoms appear  as  part of the  tout
ensemble of the  disease, the  remedies advised in the  present  chapter
for hysteria itself should  be carefully compared,  since these various
nervous,  mental and moral states  should always  be  covered by  the
medicine to be administered.
  To hereditary predisposition we may assign,  then,  the first  place
among the causes  of idiopathic hysteria.   This may exist in  the
form of (otherwise)  latent psora, which thus irritates the organic or
               * Romberg: Diseases of the Nervous System.
      36 
562
HYSTERIA.
  sympathetic  nervous system in  its relation to  the  sexual  system
  And  the connection  of  the  hysterical  affection  with  such  con-
  stitutional psora  may be  traced  in  the eruptions known to have
  appeared in  the parents, or which may have been  temporarily man-
  ifested in the  hysterical patient herself.  " A predisposition  to hys-
  teria is no doubt to  be ascribed in many cases to congenital inherit-
  ance of physical conformation and temperament.  The greater num-
  ber of sufferers from this disease, observes M. Georget, have descended
  from parents, or have been members of families, remarkable for their
  liability to nervous diseases in the several forms of hysteria, epilepsy
  maniacal affections, hypochondriasis,  nervous  headaches, deafness
  blindness, palsies," etc.*  This hereditary constitutional predisposition
  to hysteria is very greatly aggravated by the personal influence  of the
  mother if she still remains subject to similar affections.  And just in
  proportion as such predisposition exists in greater or less degree, will
  the patient be more  or less liable to have it developed by the ordinary
  provoking influences.
    The sexual organization itself, in its various conditions  and crises,
  exerts a powerful influence in producing ort developing the hysterical
  affection.   As long as the sexual organs remain undeveloped, hysteria
  does not  appear, except perhaps in persons wdiose constitutional incli-
  nation to this form of disease is so great as to retard the sexual devel-
  opment.   In like  manner, after  the cessation of the  menses, when
  the sexual organs return to  a second-childhood state of abeyance,
  hysteria does not appear, except as the result of some  organic disease
  of the uterus or ovaries.  But after the accession of puberty, the re-
  tention or tardy appearance of the  menses and all the various derange-
  ments  of  the   catamenial  function — the  excitement  incident  to
  coition,  conception,  abortion, miscarriage, utero-gestation and par-
  turition — may become  capable  of  developing the  constitutional
  predisposition  to  hysteria,  or perhaps of  originating  the  disease
  itself  where  such predisposition  did  not exist.   So  sensitive and
  delicately organized are some constitutions  in  respect to the sex-
  ual system   that  the enforced  continence  of  protracted virginity,
  the imperfect,  incomplete performance  of sexual intercourse  in the
  married,  and the  deprivation of such  intercourse in  those who sud-
  denly become widowed, are alike capable of giving rise to hysterical
.  affections; and even the moral sufferings of disappointed love, un-
  requited  affection  and  inconsolable  grief have  in many instances
  been known  to lead  to the same result.
                            * Davis:s Obstetrics. 
                   TREATMENT  OF HYSTERIA.                563

  The influence exerted in the production of hysteria  by the uterine
life of the female is  as unquestionable  as it is  unlimited.   And this
includes all the organs of the sexual system, but more especially the
ovaries, of which mention has already been  made  in this connection.
And even as inflammation will extend from  one serous or cellular tis-
sue to  another  with  great rapidity, even  where the tissues themselves
are not adjacent, so where the ovaries are in this chronic state of
irritability they exert by sympathy such an influence upon other  ner-
vous centres that the slightest irritation of their peripheral extremities
may induce hysterical paroxysms.   Thus in persons  subject  to  hys-
teria the reflex action from  irritation of  the gastric, the intestinal or
the uterine mucous surfaces, or even of the external cutaneous surface,
is often sufficient to throw them  into  the most  violent  hysterical
convulsions.
  Treatment.—Both  moral  and  remedial measures are necessary to
the successful  treatment of hysteria.  Scarcely  any disease that the
physician meets taxes in a greater degree  the energy and the resources
of the practitioner; and if he be  not equal to the exigencies of the
case in the moral view  of it, his remedies may fail  of  producing any
effect.   The disease  being  chiefly of an emotional nature, it is of
great importance to obtain  a controlling influence over the mind of
the sufferer and to secure her confidence, while she  assures herself ,of
her physician's sympathy.   " I am so confident," writes Dr.  Ludlatn,*
"that a lack of sympathy, a dearth  of feeling, a real incompatibility
of temper and taste between the physician and  his  hysterical patient,
may cause his  treatment  to result  in more of  harm  than of good,
that, in case this obstacle  cannot be otherwise removed, I think it
better  to withdraw and  to  let another  physician be called.....
Under similar  circumstances we would not  hesitate to discharge the
nurse whose every movement was  annoying to the patient and antag-
onistic to her comfort and welfare."
  During the occurrence of a " fit  of hysterics"  all tight clothing
about the patient should be  loosened, and she had better be laid upon
her back on  a bed, a sofa or the  floor.   Cold water has been recom-
mended to be dashed into the face, as by the shock  the  paroxysm will
be broken up; but it will  be better to  bathe  the face and forehead
with cold water, and allow her to have a plentiful supply of fresh air.
  The remedies which may  be  used in cases  of hysteria are  very *
numerous.   Indeed, there are but few in the Materia Medica which
nave not in their pathogenesis some  reference to this varied  and ever-
              * Lectures, Clinical and Didactic, etc., page 308. 
564
HYSTERIA.
 varying form  of disease.  Great  care should  therefore be exercised
 to  prescribe the proper  remedy at the  commencement  of the treat-
 ment ; then very great caution should be observed in regard to repeat-
 ing the dose, and still greater  in changing to another remedy.  The
 habit of changing the remedy to suit the  different phases of the disease
 is a most pernicious one, and  this is still more especially true in cases
 of  hysteria, where a single disorder of the system assumes at different
 times such an infinite variety of forms.   Some one or more of those
 grand characteristic  symptoms that  are  nearly always  present, and
 that are  observable by the patient herself or by her attendants, should
 govern the choice of the remedy.  And when  once thus  carefully
 selected, the medicine must be  allowed  to act  for days or weeks—or
 perhaps  even months in cases where the improvement continues so
 long—without repetition  of the dose, and still more  especially with-
 out changing the prescription.
  And in cases of hysteria, as also in epilepsy or other  chronic spas-
 modic affections,  never  prescribe  for the convulsive stage per se;
 rather let  it  pass off. by  itself without medication.  But  observe
 eiosely all  the symptoms, for  it may be  that here, in  the very last
 ultimation of the disorder, we  may detect the  symptom which shall
 conclusively indicate the  remedy for the entire  case.   The character-
 istic symptom of a case—that  which corresponds to  the key-note of
 the appropriate homceopathically indicated remedy—may appear in
 the course of the convulsive attacks or at their close; it may be the
 precursory herald of their approach, like the aura epileptica; it may
 appear only in the interval of comparative quiet;  or, as in those cases
 wliich have no positive spasms, it may be a  more or less constantly
 attendant symptom; or, finally, it may even be merely a condition of
 aggravation or amelioration of time, place or  circumstance.
  Only a few of the leading and more frequently indicated remedies
 for  hysterical  affections can be mentioned here.   The entire Materia
 Medica has sometimes  to be ransacked  to find the  true similimum
 for  some of the forms of  this disease—a disease whose  forms  are as
 numerous as the individual constitutions and temperaments of its sub-
 jects, multiplied by the innumerable physical,  mental and moral influ-
ences  which become  the  means of provoking, exciting or developing
the  original constitutional delicacy or hereditary predisposition.

                    Remedies for Hysteria.
  1. Aurum, Cocc,  Con., Natr. carb., Nux vom., Mag.  mur., Plat.,
 Valer.   2. Anae, Asaf.,  Bell., Caust.,  Ignat., Jod., Lye,  Mosch., 
REMEDIES  for hysteria.
565
 Xatr. mur., Nux  mosch., Phos., Puis.,  Sab.,  Sep.,  Stann., Staph.,
 sjdph., Verat. alb.  3.  Agnus  c,  Arn., Ars., Calc. carb.,  Cann.,
 Cham., China, Coff., Cycl.,  Euphr.,  Graph..  Hell.,  Hyos.,  Ipec,
 Lach., Merc,  Mezer., Palad., Rheum., Solan., Sil., Stram., Viol, od.,
 Zinc.

  Aconite. She has much fear—fear of going into places  of business,
 into crowds, or anywhere where many persons are actively passing and
 repassing. Vertigo on rising from a recumbent  position.   She dreads
 too much activity about her; she complains much of her  head; she
 is possessed with a great and distressing fear of death.  Predicts the
 day of her death.  Aconite will remove all these symptoms, and with
 them, probably, the whole train  of  morbid  sensations, if allowed to
 act a long time,  with occasional  repetitions when the improvement
 seems to have ceased.
  Anacardium. Where great  forgetfulness seems to  characterize the
 case.  Loss of memory.   Uses profane language.  Malicious.
  Arsenicum.  Where a real hysterical asthma  seems to be developed at
 every little excitement.  Worse  at night, particularly the latter part
 of the night.   She cannot lie down for fear of suffocation.   She wants
 a little water every few minutes.  Great fear of death.   She has many
 other troubles, but these seem to predominate.
  Asafoetida.  There is  much trouble about the oesophagus; every ex-
 citement that brings on hysterical symptoms  points thither.  Dryness
 and burning in the oesophagus.  Sensation of pressure, or as if a body
 or lump were ascending in the oesophagus, obliging frequent  deglu-
 tition to keep  it down.  This feeling  in the oesophagus often causes
 great difficulty in breathing.  Soreness in  the oesophagus, preceded by
 burning.  Dartings  upward  toward the oesophagus  from  the  chest.
 When the hysterical symptoms develop themselves in this direction
 Asafoetida will cure the case. Globus hystericus. Pulsations in stomach.
  Aurtun. The more her  hysterical  troubles are developed  the more
 her thoughts run on the act of committing suicide.  This act is more
 or less constantly and forcibly in all  her thoughts.   In such  cases,
 under the influence of Aurum, the patient will cease thinking of
suicide, and she will  get  well.   This remedy is also indicated  by a
fine eruption  on the lips  or  face  and forehead, and by thoughts of
suicide, with palpitation of the heart.   Afraid of open windows.
  Belladonna.  There is a general tendency of blood to the  head, with
redness of the  eyes and face, wliich is still more developed in the spas-
modic attacks. She moans very  much, even at night, without much 
566
HYSTERIA.
 sleep.   She is very despondent.   She will sit  and break pius  int0
 pieces  half a day at a time.  She is very much troubled with throb-
 bing headache, particularly  over the eyes.  She  has  a  wild look.
 Sleepiness, but cannot go to sleep.
   Calc. carb. This important remedy will  be particularly indicated in
 hysterica] as in other  affections, where the  symptoms correspond in
 persons of a leucophlegmatic treatment.   She has a  swelling at the pit
 of the  stomach, like a saucer turned bottom upward.  She has many
 spasms per day.  She is easily chilled.  She suffers from cold, damp
 feet.   Vertigo  on going up stairs.   Her menses are too frequent and
 too  abundant.   She is  often  unable  to sleep after three o'clock in
 the  morning.   Cold feet at night in  bed.  She  cannot go to sleep,
 her mind turning on the same thought all the  time.
   Causticum. One of her chief troubles is, she cannot keep her upper
 eyelids up; they are paralyzed or nearly so, and will fall  down over
 the eyes.  She is very apt to have piles, which are made almost intol-
 erable by walking.   Involuntary urination on  coughing.
   Chamomilla.  Great tendency to quarrel, to  speak in an obstreperous
 manner.   She  has to  restrain  herself much  in  order  to give civil
 answers to questions.
   China may be useful  in cases which are usually worse every other
 day, and in such as are attended with unusual strong appetite. Sen-
 sation of distension in the abdomen.
   Cocculus. In the  fullest  development  of this  disease this  remedy
 points to a choking constriction in the upper part of the fauces, with
 difficulty in breathing and an irritable cough or disposition to cough.
 Retarded menses, which  finally appear, with great weakness, so much
so that she can hardly talk,  or she feels nausea even to faintness.   A
sensation of roaring in the ears, as though there were shells before the
 ears.
   Coffea.  Great sensitiveness, with  general excitability; she  is in  a
state of ecstasy.  Headache, as if a nail were driven  into the brain, or
as if the brain were torn or  dashed to pieces, or contracted.
   Conium will  be particularly indicated where  much vertigo is devel-
oped, especially when in a recumbent position ;  she cannot turn in  bed
without occasioning distressing vertigo. During micturition her urine
alternately flows and stops.  The breasts swell, become hard and pain-
ful before the menses, when her  hysterical  symptoms increase very
much; the vertigo often  becomes very severe at these times, and  she
may also  have constipation, with constant and ineffectual urging to
stool.  Globus hystericus. 
REMEDIES  FOR  HYSTERIA.
567
  Euphrasia. In cases where there is dimness of vision as a result of
the hysterical condition, with  great suffering from profuse  laehryma-
tion.  Tears acrid.
  Hyoscyamus.  There is some  resemblance to epilepsy in the remark-
able jerking and twitching'of  her spasms;  still, they are less regular
in their form.  She is  disposed to uncover  herself and to be naked;
she indulges  in much silly laughter and many foolish actions.
  Ignatia. When a state of anguish is developed in which she shrieks
for help, with suffocating constriction of the throat; difficult deglu-
tition, and she finally comes out of the spasm with deep sighing.  She
frequently complains  of an  emptiness at the pit  of the stomach, with
frequent sighing and much despondency, simulating grief.  Mental
symptoms change very often—cheerfulness with great  despondence.
Silent grief.  Inclination to start.
  Ipecac. Every fresh development of the hysterical symptoms brings
on a sensation of continual  nausea;  there are many  other symptoms,
but the nausea is constant—she feels it every moment.
  Jodium. There is  a remarkable and unaccountable sense of weak-
ness and  loss of breath in  going up stairs.  Leucorrhoea, corroding
the linen.  Food does not  nourish  and  strengthen  her.
  Lachesis. Sensation as if  a  lump were rising  in the throat, which
does  not  particularly  incommode her, but merely feels unpleasant.
But she cannot bear  the least pressure externally about her throat—
she would suffocate—or even about  the chest, stomach or abdomen.
She is almost constantly relieving herself of the pressure.  She awakes
from sleep distressed and unhappy, as if from loss of breath.
  Lycopodium. She  has a constant sensation of satiety; she takes no
food, and  if asked why, replies  she wants  nothing because  she  is so
full, and that the least morsel  causes  a sensation of fullness up to the
throat. Cutting pains across  the abdomen  from right to left.   Much
borborygmus, particularly in the left hypochondrium.   She  becomes
worse at four in the  afternoon.   Red sand in  the urine.  Frequent
and  abundant micturition ; urine pale, especially during the night.
  Magnes. mur. This is one of  the most important remedies in hysteri-
cal conditions.   She has many spasms day and night,  with great sleep-
lessness.   Constipation  of large, difficult  stools,  crumbling as they
pass the verge of the anus.  Fainting  fits at the table, nausea and
trembling, relieved by eructations.                               *
  Merc. sol.  She  has a  profuse flow of saliva, and her  breath  has a
mercurial  odor.   The gums bleed, and  are inclined to  ulcerate about
the teeth.   She  is disposed  to perspire much;  the perspiration does 
568
HYSTERIA.
not relieve; it is cold and  clammy, particularly about the lower ex-
tremities.  She is very sensitive about the epigastrium or pit of the
stomach.  Tongue too large and thickly coated.
  Moschus.  Violent, long-continued, inveterate  scolding, until she
falls down  in a swoon.   Great anguish, as if she had  to die; she
talks of  nothing else except that she will die.  She exclaims, It is my
death,  and then falls down in a swoon.   Frequent swooning.   Great
desire for beer or brandy.   Constriction of the chest.
  Nat. mur. This remedy is indicated in  all  women whose  menses
delay and decrease more and more.   She awakes in the morning with
a bad  headache, vivid, painful  dreams during a light sleep.  Dreams
at night  of robbers  being in the house, so vividly that she will not
be satisfied till the house has been searched.   Somnambulistic rising
and  sitting  about in the  room.  Aversion  to bread.   All symptoms
relieved  as  soon as  she gets into a perspiration.  Debility, excessive
thirst, great inclination to weep.  Much mucus in the urine.  Haunt-
ed with thoughts that something unpleasant will happen;  this causes
sadness,  weeping and solitude.
   Nux mosch. Sudden change  from  grave to  gay,  from lively  to
serene;  excessive tendency to  laughter.   Enormous distension after
meals.   Vicarious  leucorrhoea  in  place  of the menses.   Excessive
dryness  of the tongue and  mouth  after sleeping.
   Nux vom. She seldom  sleeps after  three a. m., but after five A.  M.
and  late  in the morning; she feels worse in the morning.  Constipa-
tion of large, difficult stools.  Very dyspeptic  She is much excited
by coffee, spirituous liquors or highly-seasoned food.   She feels much
better on plain and  simple food.  Menses irregular, never at the right
time.  Sensation of constriction about hypochondrium.
   Palladium.  She imagines herself neglected ;  wounded pride.
   Phosphorus. Particularly  indicated in tall,  slender females.  The
stools are long, narrow, dry, hard  and voided with  much difficulty.
She feels a great sense of  weakness in the abdomen;  this distresses
and aggravates all  her other symptoms.  She eructates vast quanti
ties of wind after  eating.  She  is sleepy, particularly after dinner
Sexual desire very much increased.
   Platina. Self-exaltation, and contempt for  others.   Violent cramp)
pain at the root of the nose.  A strange titillating sensation extending
from the genital organs  upward  into the abdomen.   Stools  difficult,
adhering like soft  clay to the rectum and anus.  Spasms with wild
shrieks.   Menses in excess, dark and thick.  Chilliness predominates
 Thirstless.   Amelioration in the open air.    Horrifying thoughts. 
REMEDIES  FOR HYSTERIA.
569
  Pulsatilla.  The forms  of her symptoms are very changeable.  She
is easily moved to laughter or to tears.   She is very well one hour or
half hour, and very miserable the next.  She is timid and fearful, and
vet extremely mild, gentle  and yielding.   She is sometimes silent and
melancholy.   She has a bad taste  in her mouth, especially in the
morning.  Nothing tastes good to her, or she has no taste.
  Sabina. She is very nervous and hysterical, and if  she  becomes
pregnant she is  almost sure to abort about the third month.  Now if
Sabina is administered she will  not abort any more, and if kept a
long time under the influence of this remedy she will eventually and
entirely recover.
  Sepia. Paroxysms of something twisting about in her stomach and
rising toward the throat; her tongue  becomes  stiff;  she  becomes
speechless and rigid like a statue.   Painful sensation of emptiness in
the pit of the stomach.   Urine very putrid; it deposits  a clay-like
sediment, which adheres with great tenacity to the vessel.  Icy cold
hands and feet.  Sudden fainting, with profuse sweats and undisturbed
consciousness, without being able to speak or stir.  Involuntary fits
of weeping and laughter.  Sensation of coldness between the shoulders,
followed by  general coldness  and  convulsive twitchings of the right
side and difficulty of  breathing.
  Stannum. Great sensation  of faintness after  going  down stairs,
although she could  go  up  stairs well  enough.   She can hardly sit
down; she must  drop down suddenly; she can  get up  very well.
Very  much exhausted from talking or reading aloud.   All her pains
increase gradually to their highest point, and then as gradually dis-
appear.
  Staphysagria.  She is very sensitive to the least impression; the least
word that seems wrong hurts her very much. She throws everything
given  her in her hands away indignantly; pushes things away from
her.   The sound teeth, as  well as those  decayed, are very painful to
the touch of food or drink.  Teeth with black streaks.
  Stramonium. She is full of strange and absurd fancies.  She is  fear-
ful, so that she starts  back  and stares wildly at the first sight even of
familiar objects.   Very great loquacity.   She desires light and society.
Her face is puffed up  with  blood.  Praying and imploring.
  Sulphur. She  comes out of her spasms feeling  very happy, and
everything seems very beautiful to  her.   She discharges large quan-
tities of colorless urine at the termination of the spasms.  Her attend-
ants have learned to recognize this as a sign that her spasms are at an
end.   She has flushes of heat, coldness of the feet, heat on the top of 
570     DISEASES OF  THE EXTERNAL GENITAL ORGANS.

her head, and cannot wait for her dinner as  usual, she is so faint and
hungry.
   Valeriana.  A  sensation  as if something  warm were rising from
her stomach, arresting her breathing, with tickling deep in  the throat
and  cough.   She feels a  sensation  as  if a  thread  were hanging
clown the oesophagus from the pharynx.  Fearfulness, tremulousness
and  palpitation of the heart.   The intellect predominates over the
mind.
   Veratrum.  In addition to other symptoms she has cold sweat on the
forehead.   Cold sweat all over her, and a very weak pulse—so weak
that it can scarcely be counted.
   Viola odor. Much weeping, without knowing why;  distress in the
chest;  difficulty in breathing; anxiety and palpitation of the heart.
   Zinc. Incessant and powerful fidgety feeling in the feet or lower ex-
tremities.   She must move them constantly.
Among the new remedies  the following  may  be mentioned as likely
to prove useful in hysteria, according to  their indications:  Gelsemi-
NUM, ClMICIFUGA, CYPRIPEDIUM, CAULOPHYLLUM, SEXECIO.*
                    CHAPTER XXVIII.

   DISEASES  OF THE EXTERNAL  GENITAL ORGANS.

           Inflammation of the Vulva—Vulvitis.

    ALL the external parts are liable to attacks of acute inflammation.
     This  inflammation may be developed principally in the labia,
may be  confined  to  these  or some other particular parts,  as  the
nymphse, clitoris, etc., or  it may extend more or less generally over
all the connecting tissues.  This acute inflammation may arise from
sudden and severe exposure to cold air; it may be the result of acci-
dents or mechanical injuries, of violence;  or it may result from the
extension, downward and outward, of disorders primarily developed
in the internal genitals, or from irritation caused by morbid secretions
or by acrid and excoriating urine.
  From  the very delicate, sensitive and vascular nature of the tissues
composing  these external organs,  they are remarkably disposed  to
such forms  of disease, although very much protected  by their situa
             * For additional remedies, see Appendix, Note 2. 
          inflammation of the vulva—VULVITIS.        571

tion; and the same vascularity and delicacy of their structure renders
this acute inflammation very apt to terminate in the formation of an
abscess or in more diffused suppuration.  The abscess  or more  gen-
eral suppurative process may in all cases be cured by the appropriate
remedies.
  Acute inflammation of the external genitals, from  whatever cause it
arises, runs a very rapid course;  may be attended by remarkable ex-
citement of the sexual passion, especially where the clitoris is involved ;
the swelling, heat and redness in  the parts  may be very great, and the
pain severe in proportion.
  The most favorable termination of such  inflammation is, of course,
in resolution and subsidence of the local fever.   Next to this may be
regarded an abscess in one or the other of the labia.  But where the
disorder is the result of violence, such as contusions, the parts  may
presently assume a dark color; or if the violence  have been  very
severe, or where the constitution of the patient, the plethoric and vas-
cular nature and generally full development of the parts, and perhaps
other attendant and depressing circumstances, combine to produce such
a result, gangrene may make its appearance.
  It should  be remembered that in the greater prominence given to
some symptoms by the inflammatory action we may obtain a clue to
the true homoeopathic remedv for the whole case, at  least for the  rem-
edy most completely indicated at that time, and which, being given,
must be waited upon till its action is entirely exhausted before another
prescription is  made.  The proper remedy for each particular case of
acute inflammation, and also for the consequences of it, may be found
among the following, and should be selected in accordance with the
indications here given:
  1.  Ambra, Sepia, Thuya.  2. Calc carb., Carbo veg., Con., Creos.,
Ferr., Kali carb., Merc, sol., Nitr. ac, Staph., Sulph.   3.  Arn., Ars.,
Bell, Canth., Graph., Lye, Natr. mur., Nux vom., Petrol., Ehus.,
Sec. corn., Sil.,  Calend., Ledum.

  Arnica. For inflammation from mechanical injuries which are  con-
tusions merely.
  Ambra grisea. Pain as of  soreness and violent itching of the vulva,
with swelling.
  Belladonna. The  parts have a  hot, dry  sensation;  there is much
throbbing; they get worse at three in the afternoon.
  Calc. carb. Inflammation,  redness and swelling of the vulva,  with
purulent discharge.  Stinging, burning tubercles  on  the margin of the 
 572      DISEASES OF THE EXTERNAL GENITAL ORGAXS.

 labia.  Much moisture between the  labia and the thighs, with bitim'
 pain.
   Calendula. For those inflammations which result from  cutting or
 tearing the parts.
   Cantharis. Very frequent  desire to urinate,  with  cutting, burning
 pain on passing a  few drops  of  urine, or with  complete  strangury.
 Burning  in the vulva, with frequent desire  to urinate, and burning
 cutting in the urethra.
   Carbo veget. Simultaneous itching  of the  vulva and anus.   Heat
 and redness of the vulva.   Much soreness in the vulva in the evening.
 Aphthse of the vulva.  Sore places  about the vulva, itching without
 pain.
   Conium m. In all cases of indurations  from injuries.  Large pimple
 on the mons veneris, painful to the touch.  Cutting pain between the
 labia on micturition.   Severe stitches in the vulva.   Violent itching:
                                                                 a
 of the vulva.
   Creosote.  Corrosive  itching  within  the  vulva.  Violent itching,
 with biting, between the labia and the thighs, with soreness and burn-
 ing after urinating.
   Ferrum. In  weakly females with fiery-red face.   Erythism.
   Graphites. Itching, smarting; painful vesicles on the labia.  Painful
 soreness between  the  vulva  and thighs, the part being covered with
 pimples, vesicles and ulcers.  Much headache.
   Kali carb. Tearing in the left labium, extending through the abdomen
 to the chest.  Pinching pain  in  the labia. Stitches through the vulva.
 Soreness, gnawing, burning and itching in the vulva.
   Lycopodium. Darting in the  labia on  lying down, often  extending
 around  each labium.   A great deal of itching of the parts after the
 menses.   Much restlessness at night.
   Mercurius. Sensation of  rawness.    Lono--lastino; itching of the
 labia.   Terrible itching, which is made worse by the  presence of
 urine remaining on the parts  after urinating; it has to be washed
 off.  Worse at night.   Perspiration  affords no relief.   She may even
 be  worse during perspiration.  Salivation.  Soreness of the  gums,
 teeth, etc.
   Nat mur.  Pimples on the mons veneris.   Itching of the vulva and
 falling off of the hair.
   Nitric acid. Violent  itching  of  the entire  vulva toward evening;
dry burning heat of the vulva.
   Nux vom. Inflammation of the  labia, with frequent calls to go to
stool or to pass urine,  often with little or no discharge. 
        ERYSIPELATOUS INFLAMMATION OF THE  VULVA.      573

  Petroleum.  The labise perspire and itch excessively.
  Phosphorus. Dull tearing pain in the labise during and after a walk
 in the open air.  Heat extending up the back.  Feeling of weakness
 across the abdomen.
  Rhus tox. Inflammation of  the external  genitals,  with itching,
 burning and great restlessness.   Relief from change of posture.
  Secale. Suitable  for women who are scrawny and thin.
  Sepia. Violent stitches, sometimes extending  as far as the umbili-
 cus.  Severe itching  of  the vulva.   Swelling and  humid  itching
 eruption of the inner labia.  Foetid urine, depositing  a clay-colored
 sediment, which adheres to the chamber with great tenacity.   Trou-
 hlesome itching of the  vulva, with  pimples all  around.  Painless
 vesicles in the outer parts of the  vulva.  Also compare the  indica-
 tions given for Sepia in other diseases peculiar to the external genera-
 tive organs, such as varices, burning of the vulva, etc
  Staphysagria.  The  inflammation produces a stinging, itching or
 smarting sensation, or causes the formation of vesicles on the internal
 surface of the labia, which are  very tender to the touch.
  Sulphur. Where the predominant  symptoms of  the inflammation
 are those well-known characteristics of this remedy—flashes of heat,
 hot soles of the  feet, weak, faint spells, heat on top of the head, etc.
  Sulphuric acid.  Great  exhaustion.   Tremulous  sensation  in the
 whole body, without trembling.
  Thuya. Swelling of both  labise.  All  the itching,  burning  and
 pains are excited  and aggravated  either during or after a walk or
 from touching the parts.  Cramp pain in the vulva and perineum on
 rising from a seat.

  Erysipelatous Inflammation of the Vulva  may  result in
 certain constitutions  from  causes which in  other persons would pro-
 duce  only  the  simple form of inflammation  above described.   In
 phlegmonous inflammation the deeper  tissues  appear  involved; or
 where suppuration sets in—as it may very suddenly—instead of being
 confined to a single abscess, it may assume the diffused form common
 to erysipelas.   This variety  of inflammation is in reality a general
 erysipelatous affection, which is constitutional to the woman herself,
 but which some provoking cause  has sufficed  to  develop  locally in
 these parts.
  Both the skin and the subcutaneous  cellular tissue are involved;
and in whatever particular organ of the external  genitals the  disease
first makes  its appearance, it presently includes  them all, and even 
 074      DISEASES  OF THE EXTERNAL GENITAL  ORGANS.

 extends to the  inguinal glands.   The  parts  immediately affected
 become hot, swollen and red, with  severe throbbing pain, especially
 as  the suppurative  process extends through  the tissues.  All the
 neighboring organs sympathize more or less; and the pain is so great
 that it is almost impossible for  the  patient to  remain quiet, and yet
 the distress is severely aggravated by movement.   In the more rapid
 forms of this  variety  of inflammation the suppurative process may
 be  established in  from  twenty-four to forty-eight hours, and it  is
 usually ushered in and attended  by chills, which, if not very strongly
 marked, still  afford a  reliable  indication of  the progress of the
 disease.

         Remedies  for Erysipelatous Inflammation.
   1.  Aeon.,  Apis,  Bell., Croton tig.,  Graph., Merc  sol., Rhus tox.
 2. Amm.  carb.,  Am., Ars., Bry.,  Calc carb.,  Camph., Carb. an.,
 Hep., Jod., Lye, Nitr. ac, Phos., Sulph., Thuy.  3. Ant. cr., Baryta
 c, Borax,  Canth.,  Carbo veg.,  Hyos., Lach.,  Magn. mur., Natr. c,
 Petrol., Plumb.,  Puis., Ran. bulb., Samb., Sil., Spong., Stram.

  Aconite.  When real synochal fever accompanies the affection; rest-
 lessness, anxiety and fear; tingling and shooting pains, and great heat
 in the parts affected.
  Ammonium c. When there is an evident tendency toward gangrenous
 degeneration of the parts.
  Apis mel. Stinging pains through  the parts.   Absence  of thirst;
 scantiness of urine; great restlessness and sleeplessness.
  Belladonna.  Great redness of the parts; redness extending in radii.
 Heat  and throbbing.
  Calcarea carb. Hard and inflamed  swellings  in the affected parts,
 separate from each other, which are very sore and painful.
  Camphora.  Coldness,  paleness  and  sinking, with  aversion to being
 covered.
  Carbo an. Much burning, with induration of the affected parts.
  Croton t. Vesicles—very small—itching terribly.  The  itching  is
 partially relieved by slightly tickling  the vesicles.  These minute vesi-
 cles may extend far around on  the inflamed parts and those adjacent.
  Graphites. A vesicular eruption which is very painful, with itching
and oozing.
  Hepar s.  c.  Tendency to the formation of abscesses.
  Lachesis. Tickling  and  jerking in  the affected  parts.   Worse after
sleeping.   Bluish color of the affected parts. 
    cutaneous  affections of the external genitals.   575

  Mercurius. The parts  are  much swollen, with  raw, sore feeling,
and the sufferings are much worse at night.
  Pulsatilla. The erysipelatous  affection changes  from one part to
another, and Inclines to  spread far around on  the buttocks and
thighs.
  Rhus tox. The  mons  veneris is  most  affected, the  inflammation
extending downward;  intense  itching  and burning;  large vesicles,
which are not particularly troublesome.

  Catarrhal Inflammation may attack the  mucous lining mem-
brane of the external organs of generation.   This form of disease is
more apt  to appear in children, and  may be  attributed in most  in-
stances to  exposure to cold and wet, and perhaps to  want of cleanli-
ness.  The inflammation itself is of a mild form,  although, from the
well-known disposition  of disease in the mucous tissues to  spread, it
may extend to' the  vagina,  and thus a catarrhal  discharge may be
established in the vagina as  well as from  the  vulva.   The treatment
for this affection will  not be different from that for catarrhal  leucor-
rhoea.

    Cutaneous Affections  of the External  Genitals.
  Eczema—Pruritus.—Many and distressing forms of skin diseases
develop themselves  on  the external  organs of  generation  in the
female.  These are  either the  local  manifestations of  constitutional
taint, wdiich the  extreme tenderness  of the parts and the acrimonious
discharges and other  irritating influences  to which  they  are subject
cause to make their appearance in this vicinity, or they are the exter-
nal manifestations of some  severe, perhaps obscure, irritation  which
infests the internal organs.  The former come under the general head
of eczema, and,  like  some  forms of  leucorrhoea, may immediately
result from too  free indulgence in stimulating  and highly-seasoned
food.  The latter are commonly known as prurigo  or pruritus, and
may consist in a most intolerable itching, with little or no exanthema-
tous appearance, except  what is developed by  the  scratching itself.
In addition to the intense itching, there is usually present an equally
intolerable burning, stinging and pricking.  It  is  impossible to resist
rubbing the  affected  parts,  although  all  the sensations are  rather
aggravated than  relieved by such  friction.   The prurigo  is always
the result of some deep-seated  affection, usually in the internal gen-
erative organs, and in many instances it  is  one of the first indica-
tions of the invasion  of cancer of the womb.   Thus, a careful atten- 
 576      DISEASES OF  THE  EXTERNAL  GENITAL ORGANS.

 tion to this  severe irritation, and its cure by remedies suited to its
 special symptons and to those wdiich  are  attendant and constitutional
 may be the means of arresting and preventing the most painful  dis-
 tressing  and, in its  advanced  stages, incurable malady  which  can
 attack the female organism.   Pruritus is  also said to be the precursor
 as it may likewise  prove the developing cause, of nymphomania.
   From the  constitutional nature of the  eczema  or other actual erup-
 tions which appear on the external genitals, it must be evident that all
 attempts to remove them by  external applications must be injurious
 just  in  proportion  as  they  are  successful;  while as regards  the
 pruritus, in so far as  that may be  due to irritation caused by actual
 disease in the interior genitals, it must be  apparent that all  attempts to
 remedy it which do not  embrace the cure  of its provoking cause must
 be futile.  And in fact so it is found, in the  allopathic treatment directed
 against the prurigo  itself, that it  is exceedingly intractable, if not
 absolutely incurable, by  such  means;  while in the homoeopathic treat-
 ment, guided by these external forms and by the attendant constitu-
 tional  symptoms, we may often prevent or  remove  important  dis-
 orders, of  wdiose threatened onset or actual presence we were not posi-
 tively aware.
   These two forms are  the most frequent and the most severe of the
eruptions which attack the labia, vulva and adjacent external  organs.
But besides these may be more particularly mentioned—
   1. Erythema, which consists merely in diffused redness, more superfi-
cial than that of erysipelas,  but still connected with  constitutional
disturbance, either  directly or indirectly,  as the consequence of some
peculiarly  acrid and irritating secretion, such as leucorrhoea.
   2. Herpes,  in  which  the " vesicles leave behind them superficial
excoriations, which soon become covered with crusts," and  underneath
 which fresh vesicles appear.
   3. Lichen,  "characterized  by papulae  occupying an erythematous
 base; they cause an intolerable itching, which increases toward even-
 ing or at  night, and  which,  after  scratching, is  followed  by excori-
ations  that secrete a  bloody  serum  and  then become covered with
crusts."   Lichen  differs  from prurigo  principally  in its  papillas
being somewhat smaller, and  in the voluptuous itching being  less
 intense.

   Apis m.  Eruptions, stinging, like bee-stings.
   Bryonia a.  Hard, black pustule on  a swollen portion of  the labia.
   Calc. carb.  Itching and stitches  either  in  the  internal or external 
    CUTANEOUS  AFFECTIONS OF THE EXTERNAL GENITALS.   577

 vulva, or both at the  same time.  Also in cases which  present  the
 usual constitutional symptom of this  remedy.
  Cantharis. Burning and violent itching, particularly if there be the
 cantharis dysuria ; frequent micturition, with burning and cutting.
  Carbo veget. Itching at the vulva and anus at the same time.   Red
 and sore places about the vulva, with itching and leucorrhoea.
  Coffea. Excessive sensitiveness  about the vulva, with voluptuous
 itching. Would like to scratch or rub  the  part, but it is too sensi-
 tive.
  Conium m. Violent itching of the vulva, followed by pressing down
 of the uterus.   Violent itching, the urine flowing and stopping alter-
 nately at every emission.  Violent itching after the menses.
  Creasote. Corrosive itching of the vulva, with  soreness and burning
 after scratching.
  Croton tig. Intense itching, relieved by very gentle  scratching.
  Dulcamara. Herpetic eruptions  on  the vulva, aggravated by every
 cold change of the weather or by exposure in cold, damp situations.
  Ferrum.  Much itching of the vulva in delicate, weakly women,
 with very red  faces.
  Graphites. Itching  vesicles and pimples on the labia, which smart
 and are painful.   Painless pimples on the inside of the labia.  Itch-
 ing, smarting, painful vesicle on the vulva.  Itching pimples on the
 vulva.   Itching on the vulva, always before the menses.
  Kali carb. Soreness, gnawing, itching and burning of the vulva.
  Lycopodium. Great sense of dryness of the parts, and much itching.
 Itching of the parts during or after the menses.
  Mercurius. Long-lasting itching of the vulva shortly  before  the
 menses.  Itching of the  vulva aggravated by a single drop even of
 urine;  it has  to  be washed off.   Pimples or tubercles on the labia,
 which are more troublesome at night.
  Nat. mur; Itching of the vulva, particularly if there be much falling
 off of the  hair.   Itching of the  vulva,  with pimples  on the mons
 veneris.
  Nitric acid. Violent itching of the vulva, always worse toward even-
 ing.  Itching  of the  vulva when walking, with soreness.  Swelling
 and burning itching of one side of the vagina and of the nymphse.
  Nux vom. Cdrrosive itching eruption on the vulva.
  Petroleum. Itching in the meatus urinarius during micturition, pre-
ceded by an urgent desire to urinate.
  Platina.  Voluptuous  tingling  in  the  vulva  and  abdomen, with
oppression, anxiety and palpitation of the heart.
      37 
 078      DISEASES OF THE EXTERNAL GENITAL ORGANS.

   Sepia. Swelling and humid itching eruption on the inner labia.
 Very much itching of the vulva.   Weight in the anus.
   Silicia. Itching of the vulva, particularly if there be acrid leucor-
 rhoea.   Constipation, stool slipping back when partly evacuated.
   Staphysagria. Stinging itching of the vulva.
   Sulphur. Troublesome itching of the vulva, with pimples all around.
 Violent itching of the clitoris.
   Tart. em.  Pustules  from a variety of causes, mostly the result of
 translations from other parts.
   Thuya. Itching of the vulva when walking.
   Zinc. Itching of the vulva during the menses.
   Baptisia, Caulophyllum,  Collinsonia, Cornus cie, Cala-
 dium,  Hamamelis  and Hydrastis  may likewise  prove useful in
 eczema, pruritus or other similar affections of the external genitals.

                 Chancres, Syphilitic Ulcers.
   We  give no  special description of this form of disease, preferring
 to refer to other works on the subject.  The constitutional and attend-
 ant symptoms will prove the best guides in prescribing for such  cases;
 which, however, are always very amenable to homoeopathic treatment.
   The chief remedies to be employed in this class  of affections are
 the various preparations of mercury, such as Cinnabar, Mekcurius
 sol., jodat. or viv. Corralia  rub.,  Hepar., Nitric acid, Ja-
 caranda, Kali bich., Kali hyd., Nux juglans, Thuya, Phos
 phorus, Silicia, Sulphur, etc.

                         Condylomata.
   These may be regarded as local manifestations of a constitutional
 dyscrasia, and as such require constitutional  rather than local treat-
 ment.   They are frequently of syphilitic origin, but the  practitioner
 should not fall into  the  error of  regarding all such excrescences of the
 genitals as resulting from this poison.  The following are the prin-
 cipal medicaments required for  their treatment, but  others not here
 mentioned may be required :

   Euphrasia.  Stitches and itching of the condylomata, especially when
 walking.
   Phosphoric acid. Heat and burning in the condylomata.
   Sabina. Soreness and  burning of the condylomata.
   Thuya. Moist, suppurating, itching, stinging,  bleeding, painful con-
dylomata. 
TUMORS OF  THE  VULVA.
579
  Consult also Calc. C, Cinnabar, Lycop., Nitric acid,  Phyto-
lac. dec, Chromic acid and Staph.

  Excoriations.  Consult the remedies mentioned under  Prurigo
and Leucorrhoea.

  (Edema of the Vulva. Consult the remedies under Inflammation.

  Abscess of the Vulva.  Abscess of the vulva is to be treated in
the same  manner as abscess occurring elsewhere.   See the remedies
designated under Inflammation.

                  Tumors of the Vulva.
  Encysted Tumors.—These tumors  are  painless, and not very
common.  They are circumscribed, semi-transparent, and from being
scarcely perceptible may grow to the size of a fist.  They contain a
glairy, colorless or thick yellowish fluid,  or,  in  some instances, an
unhealthy sanies or dark-colored  purulent  matter.   Unless from the
inconvenience which may result from their  larger growth, they are
not of so  much importance of themselves as from the fact that they
indicate some  more serious  disorder in the interior organs of gen-
eration.
  From  hernia encysted  tumors  may be  distinguished by being
incapable of reduction, by their  not being changed in size  by the
different states  of the bowel, and  by their  affording no gurgling or
rumbling sound.  When  they break  spontaneously they show an
indisposition to heal,  but may continue to discharge an  irritating
matter.
  Encysted  tumors of the  external genitals of  the female seldom
require surgical interference from  a homoeopathic practitioner, their
reabsorption or removal, and at the same  time the radical cure of
the morbid  condition  from which  they originate, being usually quite
practical with  homoeopathic remedies.  Should they give rise  to a
great deal of pain and inconvenience, however, and prove intractable
to medication, they should be carefully dissected out  and  removed,
and proper means taken to secure  granulation and  cicatrization  that
will not afterward interfere with the performance of any Df the func-
tions of the  genital organs.
  The following remedies should be consulted :

  Baryta  carb.  Is especially suitable for dwarfish women.   Tearing 
 580      DISEASES OF  THE EXTERNAL  GENITAL ORGANS.

 in the  vulva or in the affected  parts—so  violent at  intervals  that
 she would like to scream.
   Calc.  carb. In leucophlegmatic  constitutions.  Menses too often and
 too abundant.   A constant aching  of the parts, made worse by pres-
 sure.  A sense of cold air passing  over the part.
   Graphites. There are  itching pimples on  the labia, itching blotches
 on  different places of the body.   Constipation; stools  large, lumpy
 difficult, with soreness in the anus.
   Hepar s. c. In cases where suppuration  has taken place.
   Kali  carb. Stitching  pains  pass  through  the cyst, or through the
 parts near the cyst.
   Nitric acid. In  cases  where a  syphilitic  taint is present.   Itchinc
 of the part when walking or otherwise irritating it, when it feels very
 sore.   A pricking pain  prevails.
   Sabina. The cyst becomes swollen,  red  and painful to the touch, or
 there is tearing pain during  rest.
   Sepia.  Throbbing,  burning and  itching  of  the part.  The urine
 deposits a clay-colored  or red sediment,  which adheres to the vessel
 very tenaciously?   Constipation.
   Silicia. The suppuration is increased by motion.  The part is very
 sensitive to the touch.   In cases  where the general characteristics of
 Silicia are present.  All her symptoms are worse at the  new moon.
   Sulphur.  In cases which present  the general  characteristics of this
 remedy.  A very  sore feeling, and  disposition of the affected parts to
 excoriate.   Both  the  flow of  urine and  the discharge of faeces are
 painful to the parts over wdiich they pass.

   Erectile Tumors, or enlargement and hypertrophy of the vascular
 tissues of the external genitals, require general and constitutional treat-
 ment.  Every exciting influence should be removed from such cases as
 far as possible;  then perfect rest;  and the remedies must be selected
 with especial reference  to all  the symptoms of the patient and to the
 whole history of her case, for these  delicate, sensitive and exceedingly
 irritable and exposed parts may be made the outlet of the constitu-
 tional dyscrasia.   Thus  difficulties  of this kind and  other structural
diseases  of the external genitals  sometimes  appear insignificant, and
yet absolutely incurable by all ordinary treatment.  To the homoeo-
 pathic practitioner the  method  is  plain, and in many  instances the
 means are at hand.  He will give" the  remedy appropriate  to the
 dyscrasia which infests his patient,  and all these minor,  but vexatious
and  sometimes painfully distressing,  local affections will vanieh 
TUMORS of the vulva.
581
gradually, instead of developing with advancing years into malignant
and incurable forms of disease.
  Arsenicum. The constitutional symptoms of this remedy will point
out its use, if the local symptoms do not.   The tumor may be painful,
with burning or lancinating pains, or it may be painless.
  Carbo animal. The tumor has a tendency' to  become indurated, with
a burning sensation.  Also  in cases which present the constitutional
characteristics of this remedy.
  Carbo veget.  The tumor has a  bluish look;  is very hard, with
shooting pricking pain.
  Creasote. The tumor has a corrosive itching and burning.  Spas-
modic pains extending from above downward.
  hycopodium.  Tearing  stitches  in  the affected  parts.  Sensation of
dryness.   Inclined to grow worse at four p. m., and to be better at
eight p. m.  Borborygmus in the left hypochondrium.
  Nitric acid. Much itching of the tumor, with sticking pain.
  Phosphorus. Stinging and burning of the tumor.   Worse during or
after a walk.  Suitable especially for tall and slender persons.
  Platina. Painful sensitiveness, with inward coldness of the vulva.
  Sepia.  Burning, itching, throbbing or jerking in the tumor.  Red-
dish sediment in urine, which adheres to the vessel with great tenacity.
  Silicia.  Violent burning and soreness of the part, with an eruption
on the inner side of the thigh.
  Sulphur. Troublesome itching of the part, with pimples all around.
General symptoms of sulphur.
  Thuya.  The sufferings are increased during motion and immediately
afterward.   The pain during motion is at times so severe that she is
compelled to lie down.

  Hemorrhage from these erectile tumors may require—

  Arnica. If the bleeding be the  result  of coition or of a blow or
other injury.   And the remedy that will  cure the hsemorrhage  may
also cure the tumor itself if allowed to act a long  time.
  Carbo veg. If the blood be of a venous appearance or very pale.
  Coccus cacti.  Pain in the vulva, so severe on going to bed that she
is obliged to sit up in bed and go  to sleep in that position.   The
tumor of the vulva increases, gets hard and  is sensitive to the touch.
Throbbing and burning in the tumor of the vulva, and excoriated
feeling on walking.
  Creosote. If the bleeding be continuous, with marked  intermissions; 
582
DISEASES  OF THE EXTERNAL  GENITAL ORGANS.
at times  becoming  pale and almost entirely ceasing, and then recom-
mencing afresh.
  Lachesis. The haemorrhage seems t« be vicarious;  the pain increases
in intensity until relieved  by the  flow of blood, then as the hemor-
rhage subsides the pain returns.
  Phosphorus. The blood flows profusely for  a while, and then ceases
for a time, when it flows again, and so on.
  Pulsatilla. The blood is very changeable in its appearance.  It is
more apt to flow in the day-time, when walking.  It is intermittent.
  Sulphur. Flushes of heat; weak, fainting spells;  hot feet; heat on
the top of the head; very hungry  from eleven till twelve in the fore-
noon—cannot wait for her dinner.

  For Inflammation  of  these Erectile  Tumors  study  the
remedies under Inflammation of the Vulva.

  Bloody or Oozing Tumors.—These  are most apt to occur in
persons who have passed the middle  period of  life, and who  may
have received constitutional and even  local injuries  from too frequent
childbirth or from similar  causes.  These tumors are not so  well
defined  and circumscribed  in size as are the encysted tumors;  they
seem  rather enlargements of some dependent portion of the labia or
vulva;  and they may arise even in virgins from accidental violence
to the parts.  From  their size  and situation they may occasion no
small suffering, and be made to exude a watery or even bloody dis-
charge, which  is much increased by walking.  For the treatment of
these  study the remedies  given in the preceding  sections, and also
those  under Vaginal and Uterine Tumors in  subsequent chapters.

   Varices of the Vulva (see page  352).

             Hernia 07 the  External  Genitals.
   Hernia of the Vulva, Perineal Hernia or Oystocele are generally asso-
ciated with  pregnancy, although they  may occur in women who are
not pregnant.   Vulvar or perineal hernia consists in the descent of a
portion of intestine, forcing its way downward through the areolar
tissue of these parts;  in cystocele it is  the bladder that is involved in
the descent and protrusion.
   In  Cystocele  the  protrusion will be  found in  the vagina or vulva.
The finger may be passed  beyond and above it, and the cervix uteri
made out, but it cannot be passed in  front of the tumor, for it seems 
ascarides of the vulva.
583
 to be attached to the inner surface of the symphysis pubis.   There
 will likewise be considerable irritability of the  bladder and frequent
 desire to urinate.  Cystocele complicating labor has  already been
 treated of, and the method to be  resorted to for its relief already
 laid down.   (See  page 235.)  Where pregnancy does  not exist the
 bladder must  be  evacuated by means of the catheter — the male
 catheter may have to be used — and the protrusion reduced and kept
 in place by means of a proper bandage or other support.  The patient
 should retain the recumbent position for a long time, and the urine
 should not  be allowed to accumulate  in  such  a quantity  as to cause
 vesical distension.  In true hernial  protrusion,  by placing  the patient
 in the horizontal position the hernia may easily be reduced; and the
 gurgling sound which accompanies  the reduction, as well  as  the re-
 duction itself, sufficiently indicates the nature of the difficulty.   Perin-
 eal hernia is  to be distinguished from  an encysted  tumor by  this
 facility of reduction.
   For the  strictly medical  treatment  required in these cases study
 such  remedies as are mentioned under Prolapse of the Vagina  and
 Uterus.
                  Neuralgia of  the Vulva.
   Neuralgia in the external genitals usually appears in  connection
 with a similar affection in the vagina.  Under  this latter head  we
 shall  speak more particularly  of the  causes  and treatment  of this
 painful disorder.

                  Ascarides  of  the Vulva.
   The Parasites which infest the external  genitals of the female
 are of two kinds—ascarides  and lice.   The former  may escape from
 the rectum, and, lodging in the folds  of the  vulva, cause there an
 intense pruritus, or  even nymphomania.   And even  where it  is
 impossible to detect their actual presence in the external genitals, so
 strong is the sympathy between the  mucous membrane of the rectum
 and vulva that the irritation in the  latter is equally  intense with that
 in the former organ, and  no less  distressing than that  which results
 from  their presence in the vulva itself.  The presence of ascarides
 within the vulva in little  girls often gives rise  to  a distressing leucor-
 rhoea.   The intense itching may lead to masturbation.  Lice  mostly
 ■nfest the roots of the hair upon the mons veneris and labia majora.

  Calc. carb. In leucophlegmatic constitutions.   Terrible  itching  of
the parts toward evening  or after going to bed. 
584      DISEASES AND DERANGEMENTS OF  THE VAGINA.

  Ferrum. Much itching, and a red, fiery face.
  Ignatia. A great deal of itching.  Much sighing, and empty, faint
feeling at the pit of the stomach.
  Nux vom.  In those whose complaints are attributable to or aggra-
vated by highly seasoned food, wines and liquors.  Constipation, with
frequent urging.   Frequent micturition, with scalding and brick-dust
sediment.  Worse after three A. m.
  Silicia. More or less itching and fever all night.  Emaciation and
gradual failing of health.
  Sulphur.  Much itching and crawling.  Flashes of heat; coldness
of the feet;  very short naps all night;  feels very weak  in the morn-
ing.   Weak and  empty from eleven till twelve; she  cannot wait for
her dinner—a very unusual circumstance for her.
  The free use of lard on the parts around the anus may be found to
be a great help in the treatment of these cases.

  Lice may be removed from the vulva and adjacent  parts by de-
stroying them with essence of bergamot, or with fine snuff made into
a paste with pure glycerine
                     CHAPTER   XXIX.

  DISEASES  AND DERANGEMENTS  OF  THE  VAGINA.

                 Prolapse of the Vagina.

   PROLAPSE of the vagina  is an affection resulting in general
     from a relaxed or weakened state of the vaginal  parietes.  It
may easily be  mistaken for prolapsus of  the womb, but  a  careful
attention to the history of the case and to the conditions present will
conclusively  determine the matter.   The  vagina may be wholly or
partially prolapsed.   Thus there are three forms of vaginal prolapsus
which  require  to be considered and  distinguished :  First, complete
prolapse or inversion of the vaginal canal; second,  prolapse of the
anterior wall  of the vagina; and third, prolapse  of the posterior wall
of the  vagina.   In connection with a  brief notice of each of these
three forms of  vaginal displacement  we mention the most active pro-
ducing causes and mode of distinguishing each from the  others. 
PROLAPSE OF THE VAGINA.                585
  I.  Complete prolapse or total inversion of the'vagina is, perhaps, the
least common of these  three forms, as it is also  the worst, especially
where the parietes are actually protruded.   This form may appear in
connection with parturition ; as the result of weakness or looseness in
the walls of the vagina ; of too great size or too rapid descent of the
foetal head;  of mechanical  interference, especially turning; or it may
come on gradually, from the combined influence of various similar
causes,  especially in women  who  have borne many children.   It is
important to understand clearly the nature of the change which takes
place in this displacement, and which is  properly called inversion,
although the term may fail to convey the  full idea.  Suppose a long
stocking to be suspended with the anterior part of the foot upward  ;
now let a heavy weight be laid upon its apex  (the toe of the stocking)
and allowed to sink down through the foot and leg of the stocking;
this will  cause an  actual  inversion,  and by the time  the inverted
point of the apex has  made its appearance at the open extremity of
the leg one-half of the stocking will have become inverted.    In
such a manner the vagina  may be prolapsed  and inverted where the
entire circle of its canal is involved, although the circle of inversion
may  not  begin at  the apex of the  vagina.   The puckered  orifice,
composed of the folds of the  mucous coat  of the vagina, which
appears in the centre of the projecting tumor, should be distinguished
from  the  regularly formed os uteri, which is narrower in structure,
and marked by a fissure which separates the anterior  from the pos-
terior lip.   In these cases of complete inversion  of the  vagina the
finger pressed upon either  side of the tumor will be arrested at the
bottom  of the cul-de-sac formed by the doubling of the wall of the
vagina  upon itself.  In  any event,  the  finger  introduced into the
orifice of the prolapsed vagina  may be made to  reach  the os  uteri
above, and thus remove all possible ground of doubt as to the exact
nature of the case.  This form  of prolapse of the vagina is usually
connected with some degree of corresponding displacement  of the
uterus.  There is also an  increased  discharge, which is the result of
the displacement itself and of its producing cause.
  II. Prolapse of the anterior portion of the vagina is usually connected
with  a  similar displacement of the bladder.  The  same influences
which weaken and  relax the anterior portion of the vaginal parietes
are exerted in a similar manner  upon the attachments of the urinary
bladder; and the undue accumulation of urine in the bladder, result-
ing from  its too  long-continued retention, suffices to cause the parts
to yield still more to the constant and i ncreasing pressure. 
 586     DISEASES AND  DERANGEMENTS OF  THE  VAGINA.

   This form of displacement is evidenced  by the sensation of weight
 in the  vagina, followed  by an actual  fullness and intumescence or
 swelling in the front of the vagina  just within the vulva.  At the
 same time there is a painful dragging sensation in  the lower part of
 the abdomen,  frequent and painful  micturition, in addition to the
 difficulty of passing water:  it may sometimes  be impossible to do so
 until the parts are in  some  measure  replaced.  On attempting to in-
 troduce the finger into the vagina immediately beneath the pubes it
 reaches the bottom of a cul-de-sac, while, if the finger be introduced
 behind the protuberance, the os and cervix uteri can be found nearly
 in their natural position.  These symptoms can hardly fail to deter-
 mine the nature of the difficulty.   The tumor formed by the anterior
 or vesical prolapse of  the vagina  presents a round,  elastic, fluctuating
 appearance at  the orifice of the  vagina, and  may usually  be much
 diminished in size by drawing off the urine with the catheter where
 there is any considerable  dysuria.  And as the water again accumu-
 lates  in the bladder the vaginal tumor becomes  at the same time
 larger  and more  painful.  This  last-mentioned circumstance alone,
 where it appears, will  of  course conclusively determine the nature of
 the difficulty.
   The prolapse of the anterior parietes of the vagina, attended as it
 usually is  by that of the bladder, may be distinguished from prolap-
 sus uteri by the fluctuating nature  of the  tumor and by its broader
 shape  at its apex—that of the uterus being hard, firm and pointed.
 The passage of the finger into the  vagina behind  to the tumor will
 distinguish it from prolapsus of the posterior wall of the vagina.
   This prolapse of the anterior portion of the vaginal walls, whether
 caused  or  merely accompanied by prolapse of the  bladder, is some-
 times called cystocele or hernia of  the bladder.
   III.  Prolapse of the posterior wall of the vagina.   In this form of
 vaginal displacement the rectum is usually involved, as the bladder is
 in the anterior form just described.  In some rare instances both these
 forms of prolapse of the  vagina appear in the same person and at the
 same time.
   The  sensations  attending  displacement of the posterior parietes of
the vagina are  similar to those which arise from that of the anterior
 wan, except that  they are rather referable to  the rectum and call to
 stool  than to the bladder and desire to pass water; and  the tumor
 diminishes after the evacuation of the bowel.
   The  finger  passed  up anteriorly to  the tumor  will reach the os
 uteri, and this  circumstance will distinguish this difficulty from that 
                  PROLAPSE OF  THE VAGINA.                587

iuvolving the anterior  wall of the vagina;  while the  tumor  itself,
although compressible,  has not the fluctuating  sensation discernible
in that caused by the descent of the urinary bladder.   The  relative
position of the apex  of this  tumor, as well as  its variable  size and
more yielding character, enables us to distinguish it from prolapse of
the womb, and in addition, by introducing the finger in front of the
tumor, the os uteri and  cervix may be found in their natural  position.
In this as in the other forms of the vaginal prolapsus the unusual ex-
posure of the delicate mucous surfaces and  their irritation from fric-
tion against the  adjacent  parts cause  leucorrhoea  and  more or less
inflammation  of  the  organs.  This displacement  of the vagina  is
termed rectocele.
  In the treatment of  complete  prolapse of the vagina the  prolapse
should be carefully reduced by manipulation, and the  recumbent posi-
tion strictly adhered to  for some time.   The general health should be
attended to.  In  prolapse of the anterior wall the treatment elsewhere
laid down for cystocele  should be resorted to.  In displacement  of the
posterior wall care should  be taken to prevent the accumulation of
faeces in the rectum.

  Arnica m. When it is the result of violent shock or concussion.
  Mercurius. When the  sufferings, such as pain, itching, smarting, etc.,
are worse at night, all night.
  Sepia. When burning with sharp-shooting  pain is experienced  in
the affected parts.  The sensations are worse while sitting  quietly,
particularly in the forenoon and  evening.   Sense of weight in the
anus.   She has to cross  her thighs, as  if to prevent the escape of the
inner parts.
  Stannum. Much inconvenience is felt during  a hard stool.   Great
lassitude when walking.  Great anguish and  melancholy during the
week previous to the menses; the  distress of mind ceases as soon  as
the menses begin to flow.  Contusive pain in the region of the  malar
bone during the menses.
  Sulphur.  Rectocele.   Stools flat or thin.  Other characteristic symp-
toms of sulphur are present.
  Veratrum alb. The fiscal mass is  flattened and  thin  like a ribbon.
  The article on Prolapsus  Uteri may be consulted for other remedies.

  Strangulation of  the prolapsed portion of the vagina, whether it
involve either  the bladder or the rectum  within the  stricture, is a
complication  worse  than  the original difficulty.   As  iu  cases of 
 588      DISEASES  AND DERANGEMENTS OF THE  VAGINA.

 strangulated hernia, the obstruction of the bowel  or of the bladder
 may very suddenly give rise to most distressing and alarming symp-
 toms.   These  are best relieved  by remedies  selected in accordance
 with the  constitutional symptoms, which, by removing as it were the
 spasmodic constriction of the parts, allay the inflammation, and enable
 the return of the circulation to take place in season to prevent mor-
 tification.

   Aconite. In  highly inflammatory constitutions with hot, dry  skin
 and intense thirst and restlessness.  Much mental distress.  She thinks
 she cannot get  well, that she will  die.
   Apis mel. The parts have a stinging like that of bee-stings as their
 most prominent sensation.
   Arsenic. The parts have a black look and burn like fire.   She has
 thirst  for cold water, but drinks   little at  a time and often.  Great
 anguish and restlessness.
   Belladonna. A constant sense of weight and pressure, as if the parts
 were falling out.   The parts have  a scarlet-red  appearance.
   Lachesis.  The  parts are of a  deep  purple color.  The patient
 wakens often in much distress.
   Nux vomica.  The patient wishes to urinate and defecate very often,
 but small quantities, if any, being discharged from the  bladder or
 bowels.
   Opium.  The patient is very sleepy.   She lies in a soporous con-
 dition.
   Plumbum has been highly commended in the treatment of strangu-
 lated  hernia.   It will be indicated by  the intense pain and other
 symptoms of the remedy.
   Sulphur. Frequent flushes of heat and weak, fainty spells.  IJeat
 in the  soles of  the feet.
   Sulphuric acid.  The parts have a greenish look.  They smell badly,
 and the patient is very weak.
   Veratrum album. An exhausting: diarrhcea attends the other troubles.
 There  is cold perspiration on the forehead.

     Spasms, Cramps and Constrictions of the Vagina.
   The muscular structure of the vagina may become subject to spasm
 in consequeuce of irritation arising in the vagina itself, or in conse-
quence  of the  extension to the vaginal walls of similar affections in
the neighboring organs.  And it  may be the result of local, vaginal
 irritation  in persons  of a general nervous temperament  or of an 
     spasms, cramps and constrictions of  the  vagina.   589

initable or hysterical constitution.   Or it may be  occasioned  by dis-
placements or organic diseases of the adjacent structures.
  Thus, in persons predisposed to such affections by a nervous irrita-
bility of constitution, spasms of the  vagina may arise from the local
irritation of coitus, from riding on  horseback or from walking.  In
hysterical  women these spasms may as readily be induced  by violent
mental  emotions or  disturbed moral feelings, and by  the  periodic
excitement of the menstrual  nisus; and they  are very  frequently
found among the spasmodic affections common to the  hysterical state.
A careful  study of all the symptoms, causative influences and attend-
ant conditions will be necessary in order to prescribe for this trouble-
some affection, a thorough  cure  of which  may well imply an entire
restoration of the general health.   For the  real  seat of  vaginal as
well  as of  uterine  spasms, and of all  their  intermediate  causes,
such  as displacements, ulcerations,  irritability  and  dysmenorrhcea,
may often be found  in nervous, functional  or  organic disease  of the
ovaries.   Hence, without an intelligent consideration of all the symp-
toms and conditions which  make up  the tout ensemble  of  our patient's
case, we shall find ourselves entirely unable  to  relieve her of those
which are most distressing, or for which she  more particularly seeks
relief at our hands.  And until the general irritability of the system
is remedied by  appropriate medication it will  be indispensable for
the patient carefully  to avoid all those local influences, such as coitus,
riding, walking, etc., which may tend to bring on the spasms.  For
while these spasmodic disturbances are the result of nervous debility,
either constitutional  and general or  local, or both, they tend also, by
still further weakening the parts, to perpetuate themselves.  Besides,
habit and  the frequent recurrence of such cramps or spasmodic affec-
tions no less powerfully combine to perpetuate them in the  system, by
making them a second, morbid nature, as fungous growths override
aud overpower the original normal structure.
  These strictures of the vagina may be cured without artificial dila-
tation, by  the aid of  the homceopathically indicated remedy.

  Belladonna. In plethoric individuals, disposed  to phlegmonous in-
flammations.   The symptoms often come on suddenly, and disappear
with equal suddenness.  A sense of heat and dryness is  felt in the
parts.
  Cocculus. Aggravation  at  every  menstrual   period,  particularly
when the periods are attended  by such weakness that she can hardly
talk. 
590      DISEASES AND  DERANGEMENTS OF THE VAGINA.

  Ignatia a. She is troubled with a weak, empty, gone  feeling at the
pit of the stomach, which is  not relieved by eating.  She is inclined
to brood over her troubles.  Full of grief.
  Mercurius. The parts have a strong tendency to excoriate,  to swell
and become inflamed.  A raw sensation is felt in the parts.
  Nux vomica.  In  women who indulge in  high living, wines  etc.
Habitual  constipation of large  and difficult stools, or small stools
with frequent urging.
  Platina.  In very nervous, spasmodic temperaments, and where there
is much tenderness of the vulva.
  Pulsatilla will often be indicated in persons of a very tearful, mild,
yielding disposition.

                  Neuralgia  of  the Vagina.
  This exceedingly painful affection of the vagina bears exactly the
same  relation to this organ  that irritability, or rather hysteralgia,
does to the  uterus.   As  in irritable uterus, so in neuralgia of the
vagina, the parts are exceeding sensitive to the touch.
  Neuralgia of  the vagina may  arise from any cause, such as exces-
sive coition or other influences  of that kind, which may weaken the
nerves of the parts, and so excite  in them an irritable and hyper-sensi-
tive condition ; or it may result from suppression  of external exanthe-
mata or of vaginal discharges;  or from injections of  cold water for a
particular purpose after coition.   In whatever manner this  affection is
directly caused,  it is of course necessary for the patient to  avoid  such
influences as the  first step toward  the cure.   So also in those cases
which may result indirectly from other morbid conditions of the in-
ternal organs of generation, all such primary diseases must be strictly
attended to, and this not exclusively or necessarily with reference to
the local symptoms alone.  All  the morbid conditions,  all the consti-
tutional  affections and  attendant  circumstances  must be carefully
taken into consideration when prescribing for this disorder. The neu-
ralgia of the vagina may  make  its  appearance, like many other
similar affections, in  other parts of the system, whenever the patient
becomes  fatigued; its pains  may be of a peculiar character, lanci-
nating or burning—worse from motion or touch or exposure to  cold,
or relieved by  severe pressure  or  friction,  as in  those cases which
appear connected with pruritus.
  For those persons who are subject to this  excessive irritability and
hyper-sensitiveness of the nervous system, it is important to inquire
if something  connected  with their diet,  habit  of  living or other 
         REMEDIES FOR NEURALGIA  OF THE VAGINA.       59]

external circumstances may not be instrumental in maintaining this
painful condition.  The use of coffee will often be found to cause the
excessive sensitiveness to pain, the neuralgic condition of the nerves,
in which  certain peripheral surfaces  (very  apt to be the  external
genitals in females) may become as sensitive  to pain and as  intoler-
able to the least touch as are the parts affected  in cases  of gout.   Tea,
on the other hand, especially if taken too strong, will more often  occa-
sion the excessive irritability of the nervous system in general, and
so lead  the way, as  in the  case of coffee, for local  exciting influences
to develop such an  affection  as neuralgia of  the vagina.  In  short,
whatever  influences tend to weaken and  depress the nervous system
may occasion irritability of the peripheral extremities of the motor
fibres, and a still more distressing neuralgic  condition of the corre-
sponding  sensory filaments; such  influences, therefore, should be as
carefully avoided as  possible,  in order to obtain a perfect cure by the
use of the appropriate medicines.
  Merely the local symptoms belonging to  each  remedy are  men-
tioned here, but as scarcely any two of them are alike, the indication
will in most cases be sufficient; in others all  the symptoms of the case
may have to be compared/

         Remedies for  Neuralgia of the Vagina.
  1.  Calc. carb., Kali carb.,  Sep.  2. Bell.,  Canth.,  China, Creas.,
Ferr., Lye, Merc sol., Nux  vom., Puis., Rhus.,  Sulph.,  Thuy.  3.
Ars., Aur.,  Carbo veg., Caust,, Cauloph., Cimicif., Cocc, Coff.,  Con.,
Cypriped., Gelsem., Graph., Natr.  m., Nitr.  ac, Petrol., Phos., Plat.,
Sab., Sec. corn., Staph.

  Alumina. Stitches in the left side of the vulva, extending  as far as
the chest.  Beating,  throbbing pain in the vagina.
  Arsenicum. Lancinations from the abdomen  into  the  vagina.
  Belladonna. Stitches in the vagina, with sensation of great  heat and
dryness.  Pains that come on  suddenly, continue violently, and disap-
pear as suddenly as they came.
  Berberis. Intensely painful vagina, burning  and soreness as  if ex-
coriated.  Sudden lancinating pain  in the vagina, causing her to
start, with soreness of the wall of the vagina to the touch.
  Bromine. Loud emissions of flatus from  the vagina.  Pain in the
vagina as if sore.
  Calc.  carb.   Aching  in  the  vagina.   Leucophlegmatic tempera-
ment.
# 
592     DISEASES AND DERANGEMENTS OF THE VAGINA.

   Cantharides.  Violent itching in the vagina.  Dysuria; sharp cutting
a few drops at  a time and almost constant desire to urinate.
   Caulophyllum. The vagina is excessively irritable, and the pain and
spasm are intense and continued.
   Chamomilla.  Burning in the vagina as if excoriated.   Very impa-
tient ; can hardly answer one civilly.
   Cimicifnga. Vaginal neuralgia, occurring in women who are subject
to  rheumatism.  The  pains are intense, but  intermitting, and are
attended with cramps in the lower limbs.  Complicated with hysteria.
   Colocynthis.  Sw-elling of the labia, wdth dragging pain and heat in
the vagina.
   Conium. Stitches in the vagina, and pressing from above downward.
The urine intermits during its flow.
   Creosote. Stitches in the vagina, coming from the abdomen, causing
her to start.  Voluptuous itching deep in the vagina.
   Cypripedium. Irascibility and fitfulness; hysterical symptoms; sleep-
lessness ; agitation.  Irritability of the  vagina.
   Graphites.  Smarting in the vagina.
   Kali carb. Pinching pains  in the vagina during an embrace.  Sore
pain in the vagina during an embrace.
   Lycopodium.  Violent burning in the vagina during  and after an
embrace.  Sensation  of chronic dryness  in  the vagina.   Itching,
burning and  gnawing of the vagina.
   Mercurius.  Inflammatory  swelling of the internal  surface of the
vagina,
   Muriatic acid. Pricking pain in the vagina.
   Natrum mur.  Dryness of the vagina and painful embrace.
   Nitric acid. Stitches in the vagina from without inward when walk-
ing in the open air.
   Nux  vom.  Internal swelling  of the vagina, with burning pain,
making; contact intolerable.
   Rhus tox.  Sticking pain in the  vagina, not  increased by contact.
Pain in the vagina, as if sore, shortly after an embrace.  Sore pain in
the vagina, hindering an embrace.
   Sabina. Severe stitches in  the vagina,  deep, from before backward.
   Sepia. One of the most frequently indicated remedies for  painful
coition.  Jerking  pain in  the vagina  from  below upward in the
morning on waking.   Contractive  pain in the vagina.  Almost con-
tinual stitches in the vagina.
   Silicia. Labor-like  pain  in the vagina, which is very tender to the
touch. 
VAGINISMUS.
593
  Sulphur  Burning pain in the vagina; she is scarcely able to sit
still.  Sore feeling in the vagina during an embrace.
  Thuya.  Burning and smarting in  the  vagina when walking and
sitting.   She is so  sensitive in the vagina that she  cannot possibly
bear an embrace.

                         Vaginismus.
  By this term is meant an extraordinary hyperesthesia of the nerves
supplied to the mucous membrane of the vagina, at  or near  the  site
of the hymen, resulting in spasmodic  constriction of the sphincter
vaginae muscle.  In its most severe form it  is doubtless  seldom met
with, but milder cases  are  of by  no means infrequent occurrence.
Owing to the  extreme  sensitiveness of  the  parts  and the spasmodic
closure of the vaginal  orifice  upon the slightest touch, sexual inter-
course becomes excessively painful, and in many cases impossible, and
even the attempt to introduce the finger or a small instrument within
the vagina arouses the resistance of the sphincter muscle and causes
intense suffering.   It occasions great distress to its  unfortunate vic-
tims, who are mostly  married women of highly nervous tempera-
ment or subject to hysteria.   Sterility  is frequently a result of this
painful affection.
  The causes of vaginismus are various.   It may arise from a general
hyperesthesia of the nervous system, such as exists in some hysterical
women, or it may be produced by some local derangement, itself of
insignificant character.   The principal causes may be enumerated as
follows: hysteria, fissures or excoriations of the anus or vulva, erup-
tions on  the  external genitals, chronic  endometritis  or vaginitis,
irritable tumors at the  mouth of the urethra,  etc  Its diagnosis is
easy, inasmuch as it differs from any other affection of the vagina.
Dr.  Marion  Sims writes concerning  it,  " The  super-sensitiveness is
diagnostic, the spasm pathognomonic"
  The treatment should be conducted  according to homoeopathic prin-
ciples.  The use  of the knife, formerly so freely resorted to, is now
generally denounced by old-school practitioners, while the very ques-
tionable procedure of dilating the canal by graduated dilators, although
claimed to be very successful, does not appear to be necessary.  Should
the vaginismus be dependent upon some local difficulty or disease, that
must be removed before we can hope to accomplish a satisfactory  and
permanent cure.   Coition should be strictly prohibited, and all  ex-
citation of the parts by motion should be avoided by  enjoining perfect
rest.  Lavements of tepid water will  be found very grateful.
      38 
594      DISEASES  AND DERANGEMENTS  OF THE VAGINA.

   For the  medicines suitable to this disorder  consult the remedies
laid down  under the foregoing article on Neuralgia  of the  Vagina
page  590, and, as well, those recommended for  Spasms, Cramps and
Constrictions of  the  Vagina, page  588.   The local affections  upon
which this  affection may depend should  be treated  in accordance
with  the  indications given for  each respectively, and their cure will
be marked by the abatement and final cessation of the vaginal hyper-
aesthesia and the  spasmodic stricture.
   In  vaginismus the diet should  be strictly attended to.   All use of
coffee, tea,  spirituous liquors,  stimulants  and  spices of all kinds
should be positively prohibited.   As  much out-of-door exercise should
be taken as  possible.

          Vaginitis—Inflammation of the Vagina.
   The vagina is subject to many influences which produce inflam-
mation, especially of its  mucous  tissue.  This inflammation, at  first
acute, unless promptly treated by the administration of appropriate
remedies,  almost  always  assumes  the chronic form.  Many cases of
chronic vaginitis, however, develop themselves so gradually  and in-
sidiously from the very first that they can scarcely be stated  to  have
originated in acute inflammation.  Married women, particularly those
who have borne children, are most frequently the subjects of acute
vaginitis,  while the unmarried, either in their earlier or in their later
years, are more liable to  suffer from the chronic variety.
   Vaginitis will  seldom  exist apart from vulvitis, as the inflammatory
process originating in the vagina itself is apt to extend sooner or later
to the vestibulum, and vulvo-vaginitis is the common condition. And,
indeed, the  cervix uteri   may be and often is involved, especially in
long-continued cases of chronic inflammation.  A variety of forms of
vaginitis may exist.
   Thus, erysipelatous and erythematous inflammation may occasion in
the vagina intensely red,  painful, elevated and more or less extensive
patches.   True vesicular   inflammation may result from the extension
of the eczema from  the  vulva to  the vagina, and thus  herpes phlyc-
tenoides may be developed in the interior of the vagina and upon the
cervix uteri.  In like manner, pustulous vaginitis may result from the
appearance  of pustules in the vagina of persons affected with impetig-
inous eruptions,  especially  when pregnant.   Papulous vaginitis  may
be considered present when the vagina and  the neck of the womb are
covered with papulae or follicles more or less developed, assuming the
shape of small spots of the  size of a pin's head, or resembling fleshy 
         VAGINITIS—INFLAMMATION  OF THE VAGINA.        595

granulations.  Finally, glandular vaginitis may  be diagnosed  when
th« follicles alone seem  affected, when the mucous membrane shows
no traces of change, and  when the secretion appears more copious and
of a yellowish-white or grayish color.   " It is generally dependent on
an inflammatory condition of the blood at this period, and the intense
irritation which it excites so often occupies the  mind  of the patient
that .it amounts to nymphomania.   Its  situation is  more  frequent,
upon the external  parts,  but it also exists  within the labia  and in the
neighborhood of the urethral orifice.  This  pruriginous affection  is
often symptomatic of serious disease of the uterus or its appendages,
in which case its removal can only take place in concert with relief to
the graver malady."
  An important distinction to be made in cases of vaginitis is, whether
the disease be a primary affection, or whether it be secondary to or a
consequence of some other disease; thus, for instance, violent vaginitis
may result from the pouring out of a virulent secretion from the inte-
rior of the uterus.  In  such a case it is evident that curative  means
should have in view the treatment and cure of the original lesion.
  These specific forms  of  disease in the  vagina seem  to be but local
developments of  constitutional or  psoric dyscrasia, and require for
their cure such remedies, for the most part, as are applicable to similar
forms of disease in other parts of the body; although it should not
be forgotten  here that those antipsorics should be preferred wliich,
in addition  to  possessing  such  specific  cutaneous indications, are
known to  possess also especial  relation to  the female  organs  of
generation.
  Symptoms.—The symptoms arising  from acute vaginitis are the fol-
lowing : A feeling of heat and burning in the vagina and vulva, the
latter especially if it be  involved  in the inflammatory process;  a feel-
ing of aching and sense  of weight in the perineum ; frequent desire to
urinate; pain and throbbing in the pelvic portion of the abdomen;
profuse leucorrhoea, which may be purulent, offensive  and acrid; ex-
coriation  of the vulva and external  parts adjacent.   In the chronic
variety the same set of symptoms exist in  a lower  degree, and in very
mild cases there may be only a slight burning, more  or less itching,
and leucorrhoea.
  Vaginitis  may  be confounded with endometritis, ulceration of the
eervix and gonorrhoea.   From the latter it is wellnigh impossible tc
distinguish it except by the history of the case;  but from endometritis
or cervical ulceration differentiation may readily be made by touch  or
the use of the speculum. 
596      DISEASES  AND DERANGEMENTS OF THE VAGINA.

  The leucorrhoea is the most marked symptom of vaginitis.  Indeed
the disease has  been described by numerous authors as Vaginal Leu-
corrhoea, Blenorrhoea and Blenorrhagia. Although not a disease per se
we shall now proceed to a description of it, in consequence of its im-
portance as an  index to the  disorder of which it is a consequence
as well  as an index to its treatment.

                     Vaginal Leucorrhcea,
  According to  the nature, the degree and the intensity of the vagin-
itis the  discharge will differ from the natural mucous secretion of the
parts, either in  increased quantity only, or  in color, consistence and
actual character. In color the discharge may be simply what its name
implies—a white mucus—or it may  be yellowish or greenish, or pre-
sent a mixture of both these colors.   Its consistency may be that of
pure mucus; it  may be much thicker, of a creamy nature; it may be
viscid, tenacious and  stringy, or very thin and watery.  In its actual
character it may be catarrhal, as  if  simply  an excessive flow of the
natural  secretion of the vagina; it may be  either mucus or pus or
muco-purulent,  presenting all  the  different  forms of variation  from
simple,  healthy  mucus, merely  increased in quantity, up to the unde-
niable pus from ulcerated mucous  surface.   Thus it may also be mild
in its influence  upon  the sensitive external  parts, or it may be  more
or less acrid and irritating, cause pruritus, and even corrode and blis-
ter  the  external surface with which  it remains  in contact.   In this
form the leucorrhcea is known to become contagious, and to develop
a similar inflammation and  consequent discharge in the parts of the
male  from sexual intercourse.  From this  cause innocent women
have been accused of infidelity to their husbands.   The  discharge
may be and usually is inodorous,  or  it may  be foetid and exceedingly
offensive.
  In quantity this discharge  may  vary from the smallest amount
that can escape the absorbents within the vagina  and  appear exter-
nally, perhaps for a few days only at a time, up to a flow so constant
and copious as  to render cloths indispensable, and seriously weaken
the patient.
  Symptoms.—At the first appearance of leucorrhcea there are usually
the  indications of acute  inflammation—pain, heat and redness of the
parts involved—which may subside  as the  discharge becomes  more
fully developed.  With this discharge,  whether acute  or chronic,
there will  usually be more  or less pain in the groins and hypogas-
trium, and in the sacral region and small of the back.   The uretlna 
VAGINAL LEUCORRHCEA.
597
will often become implicated, causing painful micturition, or even
dysuria, especially in  the more  severe acute forms and in the most
riiroravated chronic cases.
  The  morbid symptoms which appear  in connection with chronic
vaginal leucorrhcea are innumerable, and present  every possible vari-
ety in their intensity and in the parts of the system in  which they are
developed.  Very many of these attendant symptoms of chronic leu-
corrhcea should be regarded as the consequences of the primary dis-
order and  of the original  causes of that disorder, which combine to
break down in  succession the principal organic functions of the sys-
tem.  Thus,  the  menstrual irregularity  which so constantly attends
the more severe  forms of leucorrhcea, and especially  those cases in
which the discharge arises from the  cervix, and even  from the body
of the womb, is seen to be the natural and direct  result of the leucor-
rhcea and of the causes which produced  this discharge.  Or if such
menstrual  irregularity be not the immediate and  direct result of leu-
corrhcea, it can hardly fail to  become a final consequence  of the gen-
eral debility of the entire system which severe forms of this discharge
must sooner or later produce.  In like manner the appetite fails and
the  digestive  powers become  enfeebled,  and inveterate  constipa-
tion follows from such weakness of  the digestive apparatus, and from
the general nervous  debility, and still further complicates the case.
The circulation is  feeble, the respiration impeded, and the tempera-
ture of the whole  body reduced, as  indicated by constant and gene-
ral chilliness.  The nervous  system is  impaired, the  animal  spirits
depressed,  and the natural  buoyancy and cheerfulness of tempera-
ment and  disposition  replaced  by irritability, fretfulness and settled
melancholy.
  All these and other long trains of symptoms, whose name is legion,
are the  results of the  combined influence of the producing causes of
the leucorrhoeal discharge and  of the debilitating effect of the dis-
charge  itself.   And  this  important  distinction  should  always be
borne in mind, for if  we think  the  leucorrhoea alone causes all  these
innumerable and  various sufferings, we should naturally be disposed
to seek principally to remove the  discharge, expecting  the  conse-
quences would  then readily disappear; but such  expectations would
be disappointed even if we  could  succeed in curing the leucorrhoea
by attending to that alone, which is  not the case, as will  more plainly
appear when we come to study the causes and treatment of this dis-
charge.
  The constitutional predisposition to leucorrhoea  is but another name 
598      DISEASES AND  DERANGEMENTS OF  THE  VAGINA.

for psoric  diathesis or  scrofulous  taint in general.  This is much
more strongly manifested when it has become hereditary, not only as
a general predisposing influence, but  also by  previous local develop-
ment of this form of scrofulosis in the mother.  Thus, a young woman
of decided scrofulous  constitution may well be considered to  possess
a constitutional predisposition to leucorrhcea.  But this predisposition
will  easily be understood to be very much intensified if her mother
—and  still more her grandmother also—had leucorrhcea.  This heredi-
tary predisposition to scrofula in general,  and to leucorrhcea in particu-
lar, will require a greater or less amount of incidental influences to de-
velop it, according as it  is  thus more or less strongly marked in the
constitution itself.  And in proportion  as the vaginitis and leucor-
rhoea are the results of  such constitutional  predisposition they will
prove more inveterate and more difficult  to cure.
  The psoric taint in the system tends to develop and ultimate itself
either  on the external surface of the skin or in the superficial and
other glandular  structures, according as its original nature is analo-
gous to pure psora or to scrofula.   But in either case, after puberty,
and in many strongly marked cases before puberty, this psoric miasm
reverts from the cutaneous or glandular system to the mucous surface.
And in such as  have this constitutional predisposition still more re-
markably and specifically developed (as if from such local hereditary
influence as has just been mentioned)  the psoric and scrofulous taint
attacks the mucous surfaces of the female genitals in the first instance.
Such are the cases of young girls, and even  very young children, in
whom  the leucorrhcea seems to have developed itself almost spon-
taneously—that is, without  the co-operation  of  any particular inci-
dental  influences  that can be discovered.
  Among the incidental influences which may produce leucorrhoea may
be  enumerated almost  everything which is  capable of injuriously
affecting the female organism.   This remark,  however, applies rather
to the  chronic than to  the acute form of  the disease.
  The  causes which'  principally excite  acute vaginitis, and conse-
quently acute leucorrhcea, may all be embraced under a few general
beads.   Exposure to cold, from which many women suffer more than
they are aware or are willing to  acknowledge, may occasion a true
vaginal catarrh or acute inflammation, followed by a copious catarrhal
discbarge.   Violence of any kind may produce an inflammation, the
discharge from which will  exhibit  more of a muco-purulent appear-
ance.   A very similar effect may result  from excessive sexual  indul-
gence   As already stated,  inflammations from the vulva, and even 
VAGINAL LEUCORRHOEA.
599
 from the adjacent tissues, may extend themselves into the vagina.
 These, hi wever, are less apt to be followed by leucorrhoea.
   Among the  unpleasant sequela? of parturition, and especially of
 miscarriage, acute inflammation of the vaginal membranes and accom-
 panying  leucorrhcea  are the  most  frequently  observed.  This may
 result from the violence which these delicate tissues have experienced,
 and  also from  the impatience of the woman in attempting to get
 about too soon.
   Sudden and violent attacks of vaginitis and  leucorrhcea  have been
 observed to arise from causes which may be designated as  metastases.
 Such are those which follow  sudden suppressions, as of perspiration,
 of the hemorrhoidal discharge, of diarrhcea, of the lacteal secretion,
 of chronic suppurations, of cephalic or bronchial catarrh, of spon-
 taneous vomitings, and retrocessions of arthritic, gouty inflammations,
 and of recent or long-established cutaneous eruptions.  The gonor-
 rhoeal virus excites perhaps the  most violent acute inflammation and
 copious discharge of all.  But the discussion of this class of disorders
 is foreign to our  present purpose.
   The influence of cold, damp weather, or exposure to cold  and damp
 from the location of the residence in a marshy district, from the
 nature of the house itself (stone, with walls constantly moist on their
 inner surface), and from water standing in the  cellar, especially when
 long continued,  is a  powerful promotive of  leucorrhcea.  And in
 many cases resulting from such influences the physician will find all
 his prescriptions vain as long as he fails to explore  or remove the
 cause;  for in  very many  constitutions  the  susceptibility  to  such
 injurious influences is one of the principal features of  their case, and
 such  persons must cease taking  the poison before the  antidote can
 have the desired effect.  But aside  from the  absolute necessity of
 guarding against the depraving influence of long-continued exposure
 to dampness, especially from wet cellars or large open  cisterns imme-
 diately under the family sitting-rooms, where the leucorrhcea  is the
 direct result of  such exposure,  the true homoeopathic  remedy may
 easily be  overlooked so  long  as the cause of the  complaint remains
 unknown.
  An entirely opposite but not less  numerous  class of causes of this
 disease  may  be found  in the  high  living, stimulating spices, condi-
 ments and drinks  in which many women indulge.  As, on the one
 hand, in  cases  of exposure to wet  and cold, a  low form of mucous
 inflammation may produce a still more  constant  and  debilitating dis-
charge from the  vagina, so, on the other hand, in  those  persons wb i 
GOO     DISEASES  AND DERANGEMENTS OF THE VAGINA.

over-stimulate.  Kature seeks an outlet through the profuse vaginal
secretion, attended  of  course by a higher  range of inflammatory
action, for the surplus of unhealthy food and drink.
   Treatment.—Acute  vaginitis will  require such remedies as Aconite
Apis, Belladonna,  Cantharis,  Rhus tox., Pulsatilla, Sepia,
Veratrum viride, etc  Study the medicines recommended for the
treatment of vulvitis and the various  forms of inflammation of the
womb.   For chronic  vaginitis, and especially for vaginal leucorrhoea
study the remedies laid down  under the head  of  Uterine Catarrh,
where  may be found the constitutional and special indications for all
the medicines for leucorrhcea, whether arising from the mucous mem-
brane of the vagina alone, from  that of the uterus, or from both, as is
usually the  case in the  severer  and long-continued forms  of the in-
flammation of which the discharge  is merely  the consequence.

                 Indurations of the Vagina.
   Inflammation of the  cellular  tissue of the labia, vagina or other
parts of the generative apparatus may lead to induration, with  or
without  hypertrophy.  These indurations occasion adhesions, and
often result in contraction of the vagina, which may  interfere with
coition.  Induration of  the vaginal wralls sometimes appears in conse-
quence  of the extension of the  same morbid condition from the os
and cervix  uteri.  The simple thickening of the mucous membrane,
wliich  comes on gradually and  almost imperceptibly, in some  cases
may constitute the entire induration.  In others  it arises in connec-
tion with phlegmonous  inflammation and infiltration  of the deeper
tissues.   In others  still a syphilitic or schirrous taint  in the system
may be the cause, but in these latter instances  the indurated surface
is  very rough to the  finger,  sometimes ulcerated.  " Almost always
the patients complain of pain at the outset, of smarting, itching and
increase of heat, and in  proportion  as the affection develops  itself the
vagina becomes contracted, and sometimes almost obliterated."
   These indurations may be removed entirely by radically curing the
disorder from which they result, and without having recourse to dila-
tation,  as sometimes employed.  Observe carefully all the conditions,
circumstances and symptoms  of  the patient.  The true similimum of
the entire case may be found  under one of the following remedies:

   Belladonna. Sense of heaviness and of fullness, and bearing down in
the parts.  Sense of heat and dryness in the affected parts.  Sensation
of pressing  out of the internal parts.   Throbbing sensation. 
            extreme narrowness  of the vagina.          601

   Calc. carb.  Temperament leucophlegmatic  Calcarea  complexion.
 Her feet feel as if she had on  cold, damp stockings.
   China. The slightest contact causes darting, tearing pain, or tearing
 with pressure.  The  system has been debilitated by losses of fluids,
 especially of blood.
   Clematis erecta. Suitable to  torpid, cachectic conditions.  Swelling
 and induration of the glandular system.  Syphilitic taint.
   Conium m.  The induration is very hard.  The  urine intermits,
 stops and  flows again.   Particularly suitable  to women with  tight,
 rigid fibre, and easily excited, as well  as to those in the opposite con-
 dition.
   Lycopodium.  Borborygmus,  especially in the  left hypochondrium.
 Much pain before passing water.  Great delay in the flow  of the urine.
 Red sand in the urine.
   Magnesia mur.  Where there are present hysterical  symptoms and
 spasmodic  paroxysms.   Constipation, with large, hard stools, which
 crumble as they pass  the verge of the anus.
   Mercurius.  Will be required where we find the well-known indica-
 tions of the  mercurial  diathesis;  more or less salivation; scorbutic
 gums;  moist skin; soreness of the throat; soreness of  the inguinal
 glands.  The indurated tumor may have a raw, sore feeling.  All the
 symptoms are worse at night.   Perspiration, wdiich does not relieve.
   Petroleum.  Tenderness in  the  swollen  parts.   The labia majora
 perspire and itch very much.   Unhealthy skin; even small wounds
 ulcerate and spread.^
   Pulsatilla.  Mild temperament.  The patient is moved to tears in
 giving her symptoms.
   Sepia. Small, stitching, burning pains in the parts; great sensitive-
 ness of the parts; foetid urine;  putrid urine.  Sediment from  the
 urine adhering to the vessel like reddish clay burnt on.
   Sulphur. Flashes of heat; coldness of the extremities, especially of
 the feet.  Burning in the soles of the feet at night.  Spells of weak-
 ness and  faintness.   The  general, characteristic sulphur symptoms.
 These, like the other great indications for polychrest remedies, will
 recur again and again in many forms of disease.  Sulphur will always
 do good where it is indicated, and it  is very often indicated in chronic
 inflammations and other disorders which  may be  considered as  the
 ultimate developments of internal psoric taint.

  Extreme Narrowness of the Vagina from congenital anatomi-
cal malformation  may be best treated by the cautious use of graduated 
 602      diseases and derangements of the vagina.

 dilators, similar to  those recommended by Dr. Marion Sims for  the
 treatment of Vaginismus.

                        Vaginal  Fistula.
   Inflammation,  abscesses,  accidental wounds or the use of instru-
 ments may occasion fistulous openings through the walls of the vagina
 into some one or more of the adjacent organs.  Thus  there may be an
 opening  from  the  vagina  into the urethra—urethro-vaginal fistula;
 from  the vagina directly  into the  bladder—vesico-vaginal fistula;
 from  the vagina into  the  rectum—recto-vaginal fistula; from  the
 vagina into some other portion of the intestines—intestino-vaginal
fistula ; or finally from the vagina into the peritoneal cavity—perito-
 neo-vaginal  fistula.
   Recto-vaginal fistula is most frequently the result of violence from
 the  use of  instruments  in  labor, or it may arise  in  connection with
 rupture of the perineum.  This unfortunate condition will be at once
 recognized if the  patient complain  of the involuntary escape of half
 liquid fsecal  matter, of intestinal gas, or of both, through the vagina.
   In addition  to those cases which may arise from  mechanical vio-
 lence,  urethro-vaginal and vesico-vaginal  fistulas are  more frequently
 the result of the extension  of cancerous  or other ulceration to  the
 walls  of the bladder.  The same result may sometimes succeed  the
 strangulation of the parts by the long-continued pressure of the head
 of the foetus in labor against the inner  border of  the arch of  the
 pubes.  The involuntary and  constant flowing of the urine through
 the lower part of the vulva, and the  consequent  urinous  odor which
 is diffused from the  person,  but too  manifestly indicate the existence
 of one of the most serious and distressing misfortunes that can  befall
 the female.
  These distressing lesions  are neither very rare  nor are they  easily
or always susceptible of cure  by surgical means.  The failure here
arises  in  part from  considering these ulcers too exclusively as local
affections, when in fact they are often in their persistence as  much
dependent upon  a constitutional support as are ulcers in any other
portion of the body.   Fortunately, these fistulas are more amenable
under  homcepathic medication, which is capable of reaching the con-
stitutional taint lying at their foundation, and at the same time of
including within its influence all the morbid and symptomatic condi-
tions of the  system.  Thus  it happens  that some so-called hopeless
cases of vaginal fistula have been completely and permanently  cured
by medication.  But to secure this end perfect rest will in many cases be 
VAGINAL FISTULA.                   603
indispensably necessary, and the proper medicines should be carefully
administered before resorting to surgical means, which, however skill-
fully employed, are often insufficient, and leave the patient in  a worse
condition  than before.  The guides in the selection  of the  remedy
must be  found principally in the constitutional and  accompanying
symptoms, and in their  conditions of  aggravation and  amelioration.
These may seem but far-off and indirect guides, but in  many instances
they have been  proved amply sufficient.   And when the symptoms
are  found to  be improving  under the use of a  certain remedy, we
should wait patiently, and in a few weeks the fistulous  ulcer will  be
found to have taken on  the healing process.
  For the strictly surgical treatment of the various forms of vaginal
fistula we would refer the  reader to the more recent publication  on
Gynaecological Surgery.

              Remedies  for Vaginal Fistulas.
  1. Calc. carb., Lye,  Puis., Sil.  2. Asaf., Bell., Carbo veg., Con.,
Nitr. ac, Sulph.  3. Agaric, muse, Ant. cr., Aur.,  Caust.,  Creas.,
Hep., Lach.,  Petr., Ruta, Sep., Thuy.

  Asarum. The patient has a great want of vital heat.   She feels cold
continually.
  Belladonna. Will often be required in the case of women of delicate
skin and  red complexion.   Aggravation of the symptoms at three
o'clock in the afternoon.
  Calc. carb. Will  be found  especially indicated in leucophlegmatic
temperaments.   Feet constantly cold  and damp, as though  she had
on cold, damp stockings.   The least cold air chills her through and
through.  She cannot sleep after three o'clock in the morning.
  Carbo veg.  Burning  in the fistulous ulcer, with much belching  of
wind, which affords relief for a short time only.
  Conium. The urine when being  discharged flowrs  and stops, and
then flows again.
  Ledum.  Absence  of  vital warmth.  Still she  is made  very much
worse when warm in bc«d, or from  getting warm  by the fire  or over
the register.
  Lycopodium.  The ulcer bleeds  frequently.   Much  borborygmus,
particularly  in the left hypochondrium.   Red crystals  or red sand
in the  urine.   Always  feels worse  from four till eight o'clock in the
evening.
  Nitric acid.  The urine has  an intolerably strong smell, like that of 
 604     DISEASES AND DERANGEMENTS  OF THE VAGINA.

 horses.  May be suitable in cases where allopathic doses of mercury
 have been given.
   Pulsatilla. Tearful disposition.  Scanty urine and no thirst.  Slie
 has always a very bad taste in the mouth early' in the morning.  Craves
 fresh, cool air.   Xo  sleep till after twelve  at night, and then sleeps
 late  in the morning.
   Sepia. The urine is so putrid  that it cannot be suffered to  remain
 in the room.   The urine deposits a  reddish, clay-colored sediment,
 which adheres to the  bottom and sides of  the vessel as if it had been
 burnt on, like burnt clay.
   Silicia.  General scrofulous diathesis.  Much tenderness of the ulcer
 or of the parts adjacent to it.
   Sulphur. Constant  heat in the  crown  of the head.  Flushes of
 heat, passing off with moisture and  debility.  Burning in the soles
 of the feet at night.  Short naps of sleep  all night, and dead, heavy
 sleep.   Sense of  hunger and faintness daily from eleven o'clock till
 noon.
   Thuya,  Causticum,  Antimonium  crudum  and  Mercurius
 should  likewise  be carefully studied, as  they  may prove valuable
 where their characteristic symptoms are present.

   Concomitant Symptoms of Vaginal Fistulas.—For some
 of the most distressing of the concomitant symptoms  of these afflic-
 tions compare the following medicines :

  Aurum. Where there is much pain in the bones, day and night.  A
 sensation of internal emptiness and weakness of the whole body.
   Lachesis.  Where there is  much pain of  an aching character in the
 shin-bones only.   The  patient  feels  unhappy and  distressed after
 sleeping.
  Petroleum. If diarrhoea is apt to occur very frequently and through
 the day only.
                  Gangrene of  the  Vagina.
   Gangrenous  degeneration of  the  vagina  may be the result of
 pressure and contusion produced during difficult or  protracted  par-
 turition, or  from  the  pressure produced by a neglected pessary, and
 it may occur in the form of gangrenous eschar and gangrenou-s fusion
of the mucous and submucous layers.  The same form of destruction
of the tissues of the vagina is liable to occur in consequence of stran-
gulated hernia or prolapse of some portion of the vaginal walls.
   As in other  forms of tissue degeneration  and sloughing, homceo- 
morbid growths of the vagina.
605
 pathic remedies  are capable of exerting a most astonishing influence
 in aiding Nature to  get  rid  of the  decaying tissue  or  tw  arrest the
 gangrenous process and repair the loss of substance with new growth.
 The following remedies  should be carefully studied, and one  or the
 other of them will be found, without any doubt, sufficient to effect the
 requisite change:

   Arsenicum. The parts  burn  like  fire.  The characteristic  arsenic
 thirst is present.   Foetid smell.
   Apis meL  Stinging pains about the parts; no thirst.
   Belladonna. Throbbing about the parts and sense of weight.
   Calc.  carb. Leucophlegmatic  temperament.   The  cold air  strikes
 through her.  Her feet feel as if she had on cold, damp  stockings.
   China and Secale may be indicated, and should be studied in  such
 cases.
   Creosote. An offensive smelling ichor discharges from the part.
   Lachesis. Much distress after sleeping.
   Sulphuric acid. Much debility, with sensation of tremor all over the
 body.
   These indicating symptoms disappearing under the influence of-the
 corresponding remedy, there is reason to expect complete restoration.
 The course  of the improvement should be most carefully watched:
 we wait patiently till the improvement has  entirely ceased  before we
 repeat the dose  or  resort to  another remedy; and then,  the latter
 course being decided upon, make a new prescription according to the
 totality of the symptoms and leading indications  present.

             Morbid  Growths of  the Vagina.
  Morbid growths  in the  vagina are  not very frequent.   When
 present they almost  always  coexist with  similar growths  in  the
 aterus, as they spring from an  internal  dyscrasia  which pervades
 the entire system indeed, but which finds  its greatest facility of de-
 velopment on  the mucous membrane  of  the  genitals—a  dyscrasia
 which  is always of a very suspicious character,  and which in many
 instances appears nearly  allied to the cancerous.
  These so-called morbid growths are in reality but hypertrophies or
 overgrowth as  to  their structure, and therefore they are truly homo-
logous growths.  But they are animated by a perverted physiological
or vital  principle.  Thus  a purely  scrofulous tumor may be looked
upon as merely an enlarged gland, which is inspired by what we may
term the scrofulous  diathesis.   So a fibrous tumor, whether hard or 
 606      DISEASES AND DERANGEMENTS  OF THE VAGINA.

 soft, pendulous or adherent, is but the abnormal or unlimited devel-
 opment of fibrous or fibro-cellular tissue, with its accompanying secre-
 tion, but inspired by a morbid principle  which may be constitutional
 and possibly related  to that wliich appears in cancer.  In like man-
 ner serous cysts  appear to be  but hypertrophic glands, or  follicles
 even, which in their magnified  condition  still  retain their  former
 power of secreting serous fluid, and whose hypertrophic condition is
 due to the fact that some morbid principle—it may be the influence
 of  some neighboring tissue affected  with  cancer—has vitiated, per-
 verted its  normal vitality.  And even the so-called granular vege-
 tations will thus  appear to be  but  hypertrophic developments  of
 still more  minute anatomical structures, influenced by some specific
 poison, as   the sycosic   These  formations  may be briefly described
 under  the  heads  of fibro-cellular tumors,  including soft  polypi;
 fibrous tumors, iucluding hard polypi; serous  cysts, encysted tumors
 and granular vegetations.
  I. " The softer  kinds  of polypi (or of adherent tumors), growing
 from (or upon) the mucous membrane, consist of rudimentary or more
 nearly perfect fibro-cellular or connective tissue, which is made suc-
 culent by serous  or synovia-like infiltration in  its meshes." *   These
 tumors bear some resemblance to the serous cysts  to be subsequently
 described, and  also to the  soft or colloid cancerous growths  ("gela-
 tinous sarcoma ") with which they have  sometimes been confounded
 But they do not appear to originate  in  the  same  minute glandular
 structure with these cysts, nor yet do they present the same positively
 malignant  characteristics with  the colloid cancer.
  These fibro-cellular tumors take their  name  from that of the sub-
 mucous tissue  from which they spring, and of  which they are princi-
 pally composed, and  they retain their name  of tumor exclusively as
 long as they remain closely adherent to or embedded in the neighbor-
 ing parts.   But when they become outgrowths, pendulous, suspended
 by narrow  pedicles, they are termed polypi.  These morbid growths,
 of which the suspended or polypoid variety is much the more numerous,
 may appear upon  any part covered  by  mucous membrane.   " The
peculiar yellow'color of  the basis-substance of these tumors  makes
them  look  at first like fat; it is  due, however, not to fat, but to a
serous,  or   synovia-like,  or very  viscid fluid, which  is infiltrated
through the substance of  the tumor.  Among the most frequent seats
of these tumors in the female are the labia and  vagina." f
    * Paget, Path. Anal, Art. "Fibro-cellular Tumors."
    f For a full exposition and some examples of these tumors, consult Paget. 
VAGINAL POLYPI.
607
  II. The fibrous tumors are more exclusively pendulous, or polypi.
These are not unfrequent in the uterus, sometimes perhaps  in  the
vagina  and sometimes  even in the pelvis external to the vagina.
In this  latter situation  they  may consist  of cysts, fleshy or fibrous
tumors  which grow underneath the mucous membrane of the vagina,
in the cellular membrane behind the vagina, or they may  be more
immediately attached to  some part of the  osseous  framework  of tne
pelvis, whether the product of diseased  periosteum or not.*  These
interpelvic  tumors  may not  attract  attention until from their size
they impede the  free action of the rectum or  the  bladder, or render
parturition  difficult by occupying an  important portion of the pelvic
cavity.  In some instances these tumors are of the nature of fungous
or cancerous growths.
  But ordinarily the tumors of fibrous form  which appear  in the
vagina,  and still more  especially in the  uterus, are attended  with
serious  inflammation in  the adjacent tissues.   And the inflammatory
disease  which  arises in connection with uterine  fibrous tumors  or
polypi must be the great cause of the local and general painful symp-
toms and hemorrhages  which arise in such cases.  Thus, in the allo-
pathic practice it has been discovered, by the hard experience of the
ill-success which has so often attended the removal of these tumors of
the vagina  and uterus, whether  pendulous or still adherent, that the
tumor is  not the disease, but rather merely the result  of  it.  And
high authority cautions against removing  these tumors before first
curing the disease which causes them, if possible.  " In cases  in which
the polypoid tumor (which is the  easiest  of extirpation) can  be re-
moved the  patient is only half cured if extensive  inflammatory mis-
chief is allowed to remain."—Bennett.

                      Vaginal Polypi.
  Under the head of Fibro-cellular Tumors of the vagina  were de-
scribed  those  formations, usually vascular, which are principally
adherent to the  vaginal mucous membrane, but which sometimes
become  pendulous outgrowths, such as are termed soft polypi.  These
pendulous  growths, or polypi,  are  perhaps  more frequently found
within the vagina than  those  which continue adherent, although in
most cases they arise from the uterus ;  and in many instances  in which
they thus originate  in and still draw their support from the uterus,
they are found occupying the vagina, having been expelled  from the
interior of the uterus, to which, however, they still  remain  attached
                          * Churchill. 
 608      DISEASES  AND DERANGEMENTS OF  THE VAGINA.

 by their fibrous pedicle or stem.   Under the head of Uterine Polypi
 these tumors will be more fully treated of in a subsequent section.

   We herewith present, at one view, the principal indications for all
 the  remedies wdiich may be most  frequently called for in  the treat-
 ment of these various tumors or growths, whether arising from the
 vaginal walls, from the  peri-uterine cellular tissue, or from the cervix
 or body of the  uterus, for their treatment will depend not so  much
 upon their exact location as  upon the local and constitutional symp-
 toms presented in each case that comes under our treatment.

               Remedies for Vaginal  Growths.
   1.  Calc carb.,  Calc  phos.,  Conium, Phos., Staph.  2. Aurum,
 Hepar, Lye, Merc  sol., Mezer., Sil., Thuya.   3. Bell., Graph., Natr.
 mur., Nitr. ac, Phos. ac, Sulph., Sulph. ac, Petrol., Puis., Sep.

  Aurum.  The  mind is tending more or  less strongly toward  self-
 destruction.  She thinks much about it, even if she does not intend it.
  Calc. carb. Leucophlegmatic constitution.   The patient cannot sleep
 after  three a. m.  The  pit of her  stomach is convex, like a saucer
 turned up, instead of being concave.  Feet feel constantly as though
 she had on cold, damp stockings.   Menses too often and too profuse.
 Vertigo on walking up-stairs.
  Conium. Intermission in the flow of urine.   Soreness and swelling
 of the breasts preceding the menses.  Vertigo on turning in bed, or
 on turning the head when lying in  a recumbent position, or on going
 down stairs.
  Lycopodium.  Urine containing red sand as a constant symptom.
 Much borborygmus, particularly in the left  hypochondriura.  Aggra-
 vation of symptoms at four p. m. ;  amelioration  at eight p. m.
Varices of  the  lower extremities.   Also  in  cases in which sharp
pains are occasionally running round each labia.
  Mercurius. In cases where there  is evidently a mercurial  condition
of the whole system.  The mouth  and teeth show it—the glandular
system, the urine and the skin show it.  The symptoms are worse at
night.   They are worse also  in damp, cold weather.
  Mezereum. (Compare  with Mercurius.)  All  the  joints feel as if
 bruised ; they feel weary, as  if they would  give way.  She often has
violent toothache at  night.   A fearful  burning pain runs along the
left malar bone from the right to the left.
  Nitric acid.  Urine exceedingly  strong,  like horse urine.  Sleeps 
SEROUS CYSTS  OF THE VAGINA.
609
hadlv the latter part of the night.  Leucorrhoea of mucus which can
be drawn out.  Flesh colored, green leucorrhoea.   Pressing in the
abdomen, as if everything were  coming  out at the  pudendum, with
pain in the back, through the hips, down the thighs.
  Petroleum.   Much  diarrhoea  through  the day,  never  at  night.
Moisture and  itching  of the  hairy surface of the labia.   The  men-
strual blood causes an itching of the genital organs.
  Phosphorus.  Tall and slim  persons.  Occasional attacks of violent
haemorrhage.  Great sensation of emptiness and weakness  in the ab-
domen.  Constipation, the stool being slender, dry and difficult  to
evacuate.   Sour eructations  and belching of quantities of wind.
Feels very sleepy after meals, particularly after dinner.
  Phosphoric acid.  A remarkable state of indifference, from which she
cannot arouse  herself.  Great  sense  of  weakness.   (Compare  also
Phos., Sepia, Pulsatilla.)
  Platina. Constipation.   The stool  always being difficult, because it
inclines to  adhere  to  the parts  like clay.  Much tenderness of the
vulva.  Hysterical—spasmodic  The physical symptoms disappear
and the mental symptoms appear, and vice versa.
  Pulsatilla.  Very tearful;  she weeps at everything, whether it  is
joyful or sorrowful.   Menstrual irregularities, which see for further
indications characteristic of this remedy.
  Silicia. She always gets worse at every new moon.   See indications
for Silicia, as  given under the  head of Leucorrhcea and  Menstrual
Irregularities.
  Staphysagria.  The  patient is very sensitive to  the least mental
impression.  Her teeth turn black, and cannot be  kept clean by much
brushing. They exhibit black traces and streaks through their  middle.
She has much  trouble with her teeth.
  Teucrium marum verum. Irritated, tremulous sensation in the whole
body.  Frequent biting, as  if of insects, in the various parts of the
body.  Creeping sensation in the vicinity of the polypus.
  Thuya. The patient  often feels as  though  she could  not exist any
longer.   " Sensation as if the whole body were very thin and  delicate,
and could not resist the least attack—as if the continuity of the body
would be dissolved."

               Serous  Cysts of the Vagina.
  These  are comparatively rare  formations in  the vagina, or rather
they are developed in the cellular tissue external to the vagina. They
contain usually a thin or honey-like liquid, of a yellow,  brown, green
      39 
610      DISEASES AND derangements of  the vagina.

or other tint, and  they are  most frequently seated in  or near the
secreting glands or the vulvo-vaginal glands.   But whatever mav be
the exact appearance of the different fluids, they are all secreted by
the membranes which contain them.  These membranes mav be onlv
enlarged hvpertrophic glands, as in  the mammary gland, where the
cyst appears to be a portion of a lactiferous  duct enlarged and de-
generated as to its secreted contents.   And where these cyst? appear
in connection with cancerous disease they seem to be the result of the
disturbance of the natural growth and function of the minute gland?
in which they originate.  Like  other abnormal growths, serous cv-ts
may attain a  very great size.
   The following remedies  may be studied in these  eases, and others
which may appear to  be indicated by the  peculiar characteristics of
the case: Graphites, Lycopodium, Pulsatilla, Rhododendron,
Silicta, Sulphur.   These cysts are always the result of some internal
dyscrasia, which being removed the cysts  themselves will  presently
disappear.

           Granular Vegetations, Condylomata.
   These are new growths of cellular tissue  which  may occur upon the
mucous membrane of the vagina or vulva.  Some of them, the true
condylomatous  excrescences particularly,  are the results  of some
especial taint  of a syphilitic nature.  "Where there is reason to su-pect
this to be the ease, Thuya will be most strongly indicated.  Nitric
acid, Staphysagria, Calcarea,  Lycopodium, Mercurius and
Tartar emetic may also be studied.  Consult Condylomata of the
Vulva. 
       DISEASES  AND  DERANGEMENTS OF THE  UTERUS.      611



                    CHAPTER  XXX.

   MSEASKS  AND  DERANGEMENTS  OF THE  UTERUS.

              Displacements of the Uterus.

   AMONG the most  common  of the numerous derangements  to
    which  the  uterus  is  liable are  displacements  of the  organ.
Those displacements, in  all their different degrees  and varieties, may
be included under the five heads  of Prolapsus, Retroversion, Ante-
version, Lateroversion and Inversion.   As  falling of the womb  is
more or less complete, it is denominated prolapsus  or procidentia, the
latter term signifying the complete settling down of the womb,  so
that in some cases the whole viscus makes its appearance without the
vulva.  Again, the term retroversion of the womb is more properly
applicable to the turning backward toward the sacrum of the entire
womb, the fundus lying  in the hollow of the sacrum while the cervix
is forced upward behind the pubes, without any bending of the organ ;
while retroflexion is the term applied to that condition in which there
is a bending backward of the fundus alone, the cervix maintaining its
normal or nearly its normal position, the  flexion taking  place at the
juncture of the cervix with the body.  The same distinction  is made
between displacements in the forward direction—viz., into anteversion
and anteflexion—while displacements of the organ sideways are termed
respectively lateroversion and lateroflexion for the same reasons. Thus,
we may have the following displacements : Prolapsus, Procidentia, Ret-
roversion,  Retroflexion, Anteversion, Anteflexion, Lateroversion, Latero-
flexion, Inversion.  A displacement upward, or ascent of the unimpreg-
nated uterus, is of  rare occurrence, and is  always dependent upon the
presence of morbid growths.  The relative frequency  of occurrence of
some varieties of these  displacements, and other circumstances  con-
nected with them,  are  fairly  exhibited in a statement made by Dr.
Alfred Meadows, who thus writes:  "Referring to the cases of uterine
displacement of all kinds which have come under my care in  hospital
and private practice during the  last three years, to the end of 1867,
and of which I have careful  notes, I find that the total  number ob-
served was 84.  Of these 14 occurred in single  women,  70 in married.
Of the latter, 15 were sterile, and 55 had been pregnant; of these last,
27 had aborted.  The total number of abortions was 63, or an average
of 2' to each person who aborted. The total number  of children  born 
012      DISEASES AND DERANGEMENTS OF THE UTERUS.

was 171, or an average of 3^ to each mother, and the total number of
pregnancies was 234, or an average of 4£ to each of the fertile women.
The frequency of the several varieties of displacements was as follows:
Retroflexion occurred  34 times; in 8  the patient was single, in  2lj
married.  Retroversion was met with in 18  cases; 3 were single, 15
married.  Anteflexion occurred 20 times; only 1 of these was siinde
the rest were married.   Anteversion was noticed in 12 cases;  2  of
these were single, and 10 married." *
  We shall now proceed to give  a description of these forms of dis-
placement,  with an account of the symptoms, causes  and mode  of
treatment proper for each variety.  At the close of the chapter will
be found arranged in alphabetical order the remedies which are  prin-
cipally indicated for their medical treatment.

         Prolapsus Uteri—"Falling of the Womb.'".
  This  is one of the  most common forms of uterine  displacement.
It occurs in three different degrees, to each of which some writers  on
the subject have affixed a different name.  Thus, relaxation or simple
descent of the ivomb is  understood to indicate the first and least dis-
placement downward, and  to  consist only in a simple bearing-down
of the womb  upon the upper portion  of the vagina.   In prolapsus
uteri the organ comes still lower down, and may present at the orifice
of the vagina.  In procidentia uteri there is  actual protrusion of the
organ, even the entire  body of the womb being in  some cases ex-
truded from the vulva.   These are but different degrees of descent of
the uterus in the line of the vagina.  Upon examination of the same
displaced uterus at different times of the day, it may be found  to be
more or  less prolapsed, according to the condition of actiye exercise
or quiet in which the parts  may have been for some hours previous.
  Symptoms.—The principal and  primary symptomatic indications of
the  descent of the womb are:  dragging and aching pains in the small
of the back ; pulling and bearing-down pains in the lower part of the
abdomen; sensation as if something would  issue  from the vagina;
sufferings much worse from walking or other exercise;  the pains are
often remarked to have come  on  immediately after some exertion of
an unusual kind, and after some more than ordinary muscular effort;
frequent calls to urinate; dysuria, or even retention of the urine.  In
the  more fully developed forms of prolapsus the history of the case,
the  attendant circumstances, and  the external  appearance  of the  os,
cervix, and even of the entire body of the uterus itself, can hardly fail
                           * London Lancet. 
Fig. 86.
                NATUBAL  POSITION OF  THE  PELVIC  VISCERA.
  The above represents the  normal  relative position of the contents of the pelvis.
The plane of the superior strait is represented by a line  running from  the  superior
border of the pubes to the promontory of the sacrum.'  The plane of the inferior strait,
by a line from the superior arch of the pubes to  the point of the coccyx.  The other
lines are all  defined  in the cut.  The fundus of the uterus is on a level with the plane
of the superior strait, and its axis the same  as that of  said plane.   The peritoneum is
«'«'n sustaining the uterus by its anterior superior three-fourths, by its_ fundus and by
the whole of its posterior surface.  The succeeding engravings exhibit the uterus  in
its various displacements, making a striking contrast  with its normal position,  (Sec
also the cut on page 52.)
                                                                     613 
G14      DISEASES AND  DERANGEMENTS OF THE UTERUS.

to render the diagnosis at once easy and certain.  And if the falling
of the womb is  not  so far developed as to give any such  external
signs, the severe aggravation from walking and from "lifting, together
with the  relief experienced from  lying  down, render the case suffi-
ciently  clear.  Should there  be any  doubt, however, the vao-inal
touch will verify the diagnosis.
   Causes.—The causes of prolapse of the womb may be  regarded as
of two kinds—the more immediate, in which are included direct re-
laxation of the proper supports of the uterus, and the more remote in
which  are included  the incidental or constitutional influences whieh
result in such relaxation.
                             PROLAP3US.

  The peritoneum forms the  great suspensory ligament or membrana
i-ommon to the contents of the abdomen.  This  is the grand function
of the peritoneum, to sustain in their proper places and in their proper
relation to each other the various  organs which are grouped together
above and to 'some  extent within the pelvis.  The peritoneum is the
true uterine  supporter, the other ligaments tending rather to steady
the  uterus in its upright or inclined position than to prevent it from 
PROLAPSUS  UTERI—"FALLING  OF THE WOMB."      615
sinking down in the pelvic cavity.  This membrane, as already de-
scribed, is reflected from the bladder upon the womb in such a man-
ner as to sustain it  in  front from its anterior surface; and it is so
reflected from the uterus upon the rectum posteriorly as to  sustain it
iu that direction from its posterior surface.  Thus it is evident that
the uterus can sink  in the pelvis only so far as is permitted by the
relaxation  of the peritoneum,  its suspensory ligament.   And  this
relaxation may be due  to undue pressure from above, to  influences

                              Fig. 88.
PROLAPSUS WITH FLEXION.
2.\cited upon it from  beneath, or to its own inherent weakness from
disease.
  Next to the peritoneum, the broad ligaments, which in fact are but
processes of the peritoneum itself, are influential  in  supporting the
womb;  and they  will necessarily sympathize therefore with  any in-
herent or  constitutional  weakness  of  the parent membrane, and at
the same time be subject to the same  adverse influences  from above
and from below.   So far as the bladder, the rectum and the muscular
parts of  the pelvis are engaged in supporting the womb, it is evident 
616
DISEASES AND  DERANGEMENTS OF THE  UTERUS.
that such support is all derived through  the medium  of the perito-
neum and broad  ligaments by which the womb is connected with
them.
  The  inherent weakness  of  the peritoneum and broad ligaments
                                 Fig. 89.
  The above is an illustration of complete falling of the womb, the projection of the
organ out of the orifice of the vagina.  In these cases the vagina is completely in-
verted, thus forming a conoid pouch, containing the supra-vaginal portion of the neck
of the womb, its entire body, the ovaries, the Fallopian tube, a large portion of the
broad and round ligaments, of the small intestines, of the bladder, and perhaps some-
times of the rectum.  The os and the infra-vaginal portion of the neck alone are
seen, all the rest being covered by the "inverted vagina, although protruding beyond
the vulva. 
          PROLAPSUS UTERI—"FALLING  OF THE WOMB."      G17

 which seems one of the most prominent causes of falling of the womb,
 is usually such weakness only as corresponds to  the debilitated  tone
 of the rest of the system;  and hence  the  slightest additional strain
 brought to bear upon the womb from  above by  exercise, or unusual
 exertion, or by dress, once  causing these supports to give way, their
 stretched and  strained condition,  continually borne upon more and
 more  by  the  superincumbent  organs, allow little opportunity for
 them to  recover themselves.   Consequently, prolapsus  uteri  is rather
 apt to increase more and more than to  recover spontaneously.
   Subinvolution of the  uterus, or  intra-mural or other  enlargements,
 may  produce prolapsus  by increased  weight; and the presence of
 tumors within the abdomen may occasion  it by  their pressure  upon
 the organ either directly or indirectly.
   Chronic leucorrhcea is set down by  some authorities  as one of the
 causes of prolapse of the womb.   But this is  hardly correct, for in
 many cases the leucorrhoeal discharge  will  appear only after the oc-
 currence  of more or less serious displacement of the womb, and in
 other cases, of persons of lymphatic temperament—that is, of psoric or
 scrofulous constitution—the debilitating influence leads at the  same
 time  to the leucorrhoeal discharge  and to  the uterine  displacement.
 The same thing is true of constipation, which is  recognized as an im-
 portant and frequent cause of falling of the womb.   The same con-
 stitutional influence that renders the bowels incapable of expelling the
 faeces  renders the suspensory ligament and  membranes incapable of
 retaining the womb in its proper position;  and the violent action of
 purgatives, and the still greater weakness of all the connecting parts
 that invariably follows their use, still further aggravates the constipa-
 tion and the uterine prolapse.
   The pressure from above  of the organs contained in the abdomen is
 often  considered to cause descent of the womb.  But it is against just
 such pressure from above downward that the peritoneum is intended
 to sustain the  uterus.  And except perhaps in cases of great over-
 exertion  or undue violence it  is not  thought that the peritoneum
 yields to  such pressure, unless  previously weakened by some morbid
 influence.   This is especially seen in those cases of prolapse which
 appear in connection with ascites or ovarian dropsy.
  Thus it is that the  great majority even of the worst and most fully
 developed  forms of prolapsus uteri may be regarded  as  disorders
 properly amenabie to  homoeopathic  medication, rather  thau as mere
 local displacements to be remedied by'mechanical appliances.  The
ease of Mrs. O., which came under my care some years since, illus- 
618      DISEASES  AND  DERANGEMENTS OF  THE  UTERUS.

trates the principle here inculcated, and at the same time shows what
can be accomplished by the use of homoeopathic remedies.  This lady
had been  subject to  complete procidentia uteri for at least ten years.
The organ  would protrude entirely without the vulva, and  neither
pessaries,  supporters nor perineal  pads could prevent it from thus
making its  unwelcome appearance externally.  I  requested  her  to
take to  her  bed, carefully washed and  replaced the uterus, and gave
Conium.  A frightful leucorrhcea set in, but in the course of a single
week  this disappeared, and with the help of Platina the induration
of the womb and prolapsus were completely cured.   The organ came
down no more; in fact, she never  has  since had any trouble of the
kind.   She  has borne three children since and is a well woman  at
this day.  The Conium  and the Platina were all the medicines used
in this  case, and no bandages or  mechanical applications  whatever
were employed in the treatment or  subsequently used.
  The same principle holds true with reference also to  the vagina.
So  far as the descent of the uterus may be fairly attributable  to re-
laxation of  its walls, this relaxation is itself an evidence of morbid
weakness, requiring appropriate medication. And even in those cases
in which the prolapse  of  the uterus may seem to be owing to an un-
usually  large  pelvis, the natural  supporters of the uterus can by
proper attention be rendered capable of performing these functions  in
a far better and more  satisfactory manner than we can do it for them
by the aid of pessaries or supporters.   In like manner, all that large
and important class of cases of prolapse which come on after confine-
ment can be prevented by observing suitable directions, or cured by
appropriate  homoeopathic medicines.

                   Inversion of the Uterus.
  This  is the rarest as well as the most formidable and dangerous
form of uterine displacement.   It occurs principally as an accident  in
connection with delivery.  In sudden and unexpected descent of the
foetus through an unusually large pelvis, when the patient is walking
or at  the water-closet, or  from too violently drawing upon the cord,
the fundus of  the womb has been known to be inverted and brought
down with the placenta.   This accident and complication of labor has
been referred to in its  proper place in connection with delivery. In-
version  of the uterus is here described, because, although very unusual
in the unimpregnated state, it may occur in consequence of the pres-
ence of  polypus or other tumors of the womb.
  Inversion of the womb is  analogous in its appearance to simple 
inversion of the uterus.
619
prolapsus  of  the entire circumference of the vagina.   In either case
the change begin"? above, and consists  in the inversion and depression
of the affected part.   In the womb the  fundus is  at first simply de-
pressed, and in this first stage the inversion is comparatively slight,
and  may be difficult or incapable of detection.  But as the change in-
creases, the fundus sinks down more and more within  the body of the
womb; and in this second stage the inner surface of the fundus  may
be felt and recognized as a tumor by introducing the finger within the
os uteri. In the complete form of inversion the womb, entirely turned
inside out, may  be  protruded  without the vulva.  In this case the
mucous lining membrane of the uterus in its natural position becomes
its external covering.  Thus, as in the case of prolapsus of the vagina,
there are three different degrees of the inversion of the uterus, which
may be designated as simple depression  of the fundus; partial inver-
sion, in which, however, the tumor formed  by the  inverted  fundus
does not  reach the os uteri;  and  complete inversion, in which the
womb is entirely turned inside out and  protruded externally, consti-
tuting at the same time complete  inversion and entire procidentia.
This is a very serious complication of all the uterine  organs, for the
vagina must be more  or  less compromised,  and the  Fallopian tubes,
ovaries and bladder drawn down from their proper positions.  Here
not  only the actual  displacement  of the womb and its  appendages
forms a serious difficulty, but  the mere  dragging upon those append-
ages on the part of the womb must also cause  great distress and de-
rangement in the organs themselves, and profound depression of the
nervous system and vital strength.
  The presence  of a polypus  in the inverted womb  may render the
diagnosis comparatively  easy.    But it  must be borne  in mind that
the  inversion itself is due not  so much to the actual weight of the
tumor  as to  its morbid influence upon the womb, apd to the efforts
which the womb makes to free  itself by expelling the foreign body.
Complete cases  of inversion in connection with polypi constitute a
very grave form of disease, partly from the  occurrence of haemor-
rhages, and from the  severe  functional and constitutional derange-
ments to which this  condition  may give rise, and partly  from the
unhealthy nature of the cause itself.  For even if the polypus be not
considered a malignant growth, it takes its rise in some depraved state
of the system, and it  may be the index  of more serious forms of  dis-
ease yet to be developed from the original dyscrasia.
  Treatment—The inverted womb should  be  carefully reduced  and
the  whole organ replaced in the pelvis, with as little and  as gentle 
620      diseases  and derangements of  the uterus.

manipulation as possible.  The patient should remain in bed in such
position as is found most comfortable, receiving such medicines as are
best suited to the entire group of symptoms—sensational, functional
and structural.   So profound is the relation of the law of the similars
to the  human constitution that even  comparatively unimportant sen-
sational symptoms, which, however, are peculiar to and characteristic
of the case, may lead directly to the true homoeopathic remedy for the
entire disease.  This  simple fact, the stone which the  allopathic and
the chemical builders, and  even those of the so-called physiological
school, have rejected, bids  fair to  become the head of the corner in
homoeopathic therapeia.  And  this profound  principle, confirmed by
the constant experience of many  careful observers  and experienced
physicians, should encourage the  young physician to rely  upon his
Materia Medica, and not to  despair even  in  the presence  of serious
functional derangements, and  even structural  changes, for which he
can see no  direct and sufficient  homoeopathic analogue.   In  many
forms of disease the sensational symptoms, which occur first, are in-
tended as warning voices, forerunners of the evil to come; and even
in the more advanced  stages of disease these  sensations are still the
most unfailing  key-notes to the real remedies in the case—indices to
the remedies, not for  the severe sufferings alone, but  for the  func-
tional,  and  even structural disorders, which cause  them and  which
they represent.
   Select  the remedy  in accordance with all  the  symptoms present,
having reference also to the constitutional history of  the patient.

                Anteversion and  Anteflexion.
   Anteversion.—This is  a displacement comparatively rare in the
unimpregnated uterus, although it does occur, and  is even found in
nulliparous  women.  The natural position of the womb  is one of
slight anteversion, and this is always increased in degree in  the early
months of pregnancy.  But this  forward  inclination  may be so in-
creased as to constitute a morbid condition, and give rise to some very
unpleasant and painful  symptoms.  The uterus may be regarded as
in a condition of unnatural anteversion'when it lies in  its  long axis
across  the pelvis, with the cervix in the hollow of the sacrum, and
the fundus near the symphysis pubis and encroaching more or less
upon the bladder.   Anteversion may be combined with flexion  at the
junction of the cervix with the body;  and in this case the  fundus is
thrown still more  forward and downward, while the cervix  is not
directed so far  backward toward the sacrum. 
anteversion and anteflexion.
621
  Symptoms.—This  form of displacement may come on gradually ;
and  in this case it  can  be distinguished from simple  prolapse only
hvthe vao-inal touch.  On passing the finger up to the fornix vaginae,
the cervix will not be found occupying its usual position, but on ex-
ploring posteriorly toward the hollow of the sacrum  it will be found
occupying that  position, and higher  up  than natural.  From this
point the finger may trace the  body of the womb lying almost on a
horizontal line across the pelvis, until the fundus is found at the posi-

                            Fig. 90.
(ion just  mentioned, near the symphysis.   The  uterine probe, very
much bent, may be passed into the cavity of the uterus, thus verifying
the diagnosis;  but this procedure is  unnecessary, inasmuch  as it is
almost impossible to  mistake an anterior for any other form of dis-
placement. Anteversion may also occur suddenly; and in this  case the
symptoms very nearly resemble  those occurring  from falling of the
womb, but the  derangement may readily  be  made  out by the vaginal
touch.  This displacement may exist without giving rise to any symp-
toms that direct the attention of  the woman to  her condition, though 
622      diseases and derangements of the uterus.

such'cases are, in the nature of things, rare.  Pressure of the os ».gams(
the posterior  wall of the vagina  may occasion  dysmenorrhcea and
sterility.  The pressure of the fundus upon the bladder gives rise to
a variety of very unpleasant urinary symptoms, which differ greatly
in degree in different women, and which, in some  cases, are  so severe
as to simulate those of cystitis.   The pressure upward and backward
of the cervix  occasions more or less rectal irritation, constipation and
haemorrhoids.  In some cases locomotion is greatly interfered with,

                              Fig. 91. .
and even rendered wellnigh impossible.   But the disturbances of tin
urinary apparatus are  the most  marked symptoms of anteversion.
and  are those  which  generally  cause  the woman to consult  her
physician.
   Causes.—The causes of anteversion are predisposing and exciting.
The predisposing  causes are those which occasion a relaxation of the
uterine supports, such as parturition, indolent habits, improper dress,
etc.  The exciting causes are, direct violence or muscular effort; any-
thing which  increases the weight of the  uterus, such  as pregnancy, 
anteversion and anteflexion.            623
subinvolution, tumors, etc.;  abdominal  tumors,  pressing the uterus
downward and forward.   The  enormous accumulation of faeces may
sometimes operate as a displacing  influence, and  the combination of
other causes may then easily serve to throw the fundus of the womb
still farther down in the pelvis, or even press it beneath the symphysis.

  Anteflexion.—This form of displacement is of common occur-
rence.  It differs from anteversion in this, that while the fundus and
body of the  uterus are abnormally directed downward and forward,
the cervix retains its proper position or nearly so, although flexion
of the  uterus forward may comprise a  bending  in that direction of
both body and neck at the point of junction of the two, the  bending
being in some cases nearly at an acute angle.  Or, in other cases, wdiile
the body of the uterus retains its  normal position, or nearly so, the
cervix is bent and extended forward toward the pubic symphysis.
  Symptoms.—The symptoms produced  by anteflexion are similar to
those of anteversion, though usually rectal  and vesical irritation are
not so great.  In consequence,  however,  of the bending of the womb,
very serious symptoms may arise, which are the results of various
diseases which this abnormal position may give  rise to.  Dysmenor-
rhcea is an almost necessary attendant;  congestion of  the womb may
occur, and occasion a variety  of  diseased conditions; endometritis,
both corporeal and cervical, may be set up, and  by pressure or other
cause even peritonitis may result.
  Causes.—The same causes which occasion anteversion may operate
to produce anteflexion, previously existing weakness  of the  uterine
tissue at the junction of the cervix  and body of the uterus being
premised.
  Treatment of Anteversion  and Anteflexion.—In the  treatment  of
these forms  of displacement desire the patient  to remain  quiet, or
even, in severe cases, to keep her bed and lie on her back a few days;
administer the remedy best indicated by all the symptoms, and a com-
plete cure may be looked  for in a very short time.
  In those cases only in which the fundus is actually thrown beneath
the arch of the  pubes will there be any  necessity for'any manual in-
terference to remedy and cure this displacement.
  And  also  observe that the woman suffering with this form of dis-
placement should  not urinate too often, since  by moderately distend-
ing  the bladder it will assist in replacing  the womb; and when in
the recumbent position she should lie upon her back as much as pos-
sible, since  this position  will also aid the  reposition.  The genera] 
624      diseases  and derangements of the uterus.

health being restored by the proper internal  remedy, there will be no
more  trouble with the anteversion.

              Retroversion and  Retroflexion.
  Retroversion.—This is a form of displacement which probably
occurs next in frequency to prolapsus.   As a disease per se it is perhaps
of rare occurrence, but as an accompaniment of the various forms of
inflammatory disease of the uterus or of increase in its size and weight.
it is very frequently met with.  It may occur, however, as the result of

                              Fig. 92.
RETROVERSION.
vict nt succussion, and give rise to very urgent and painful symptoms.
The natural position of the uterus being with the fundus inclined over
toward the bladder and symphysis pubis, in retroversion it assumes di-
rectly the opposite direction.  By an exact examination by the touch the
fundrs will be found turned back toward the sacrum, and even pressed
down beneath its  promontory, and the os uteri  will be found turned
toward the  pubes.  As in simple prolapse  of  the uterus, so also in
retroversion, there may be three  different degrees or stages of dis-
placement, according as the fundus  is directed toward the upper, the 
retroversion and retroflexion.           623
middle or the lower portion  of the  sacrum.  In all cases  in which
the wombnas  been so depressed backward that its fundus is thrown
down beneath  the sacral  promontory this forms an insuperable bar-
rier against its return, unless  replaced by art.   And the best method
and the means of replacing it will be pointed out and described, to-
gether with the remedies which may be found useful in such cases.
PARTIAL RETROVERSION.
  Symptoms.—The most strongly marked symptom indicative of ret-
roversion  of  the  uterus is found  in the  difficulty of emptying the
bladder, accompanied with pain and tenesmus, which in greater or less
degree is always present in complete cases  of this displacement.   Next
to this is the  pressure on the rectum, and consequent more or less fre-
quent call to  stool, with great difficulty or impossibility of evacuating
the  bowels.  These two  complications, especially the retention of
urine, render  cases of complete retroversion of the womb dangerous
as well as painfully distressing;  while the retention and consequent
accumulation  of faeces serves to make the  restoration of the uterus to
its natural position a work of much greater difficulty.   A fixed gnaw-
ing  or other  variety of  pain in the back, backache and difficulty in
      40 
626     diseases and derangements of the uterus.

walking, with  inability to stand for any length of-time without suf-
fering,  are  also  common  accompaniments.   Nausea  and vomitino-
even  stercoraceous  vomiting,  may set  in,  and  unless the patient
is promptly relieved she  may sink  under the accumulation of her
sufferings.
   In  suddenly occurring  retroversion in. consequence of a fall or
other injury the symptoms are more marked and  severe.   "The
patient  falls to the ground and is unable to rise, experiences the
severest pelvic  pain, suffers from suppression of urine and fseces, and
is often in such agony that the face  is bathed with perspiration and
the pulse becomes weak and fluttering."
   Causes.—The fundus of  the uterus being  loaded as in pregnancy,
or in consequence of subinvolution, areolar  hyperplasia or other en-
largement, will readily tend to sink down, either anteriorly or poste-
riorly, more and more, when from any reason it has been turned from
its  natural  position.  As  occurring  most frequently in early preg-
nancy, the  chief cause of  retroversion must be an unduly disfended
bladder, which may gradually raise the fundus of the womb from its
natural  inclination forward, and  cause it to assume more nearly a
perpendicular position; then the still further  increase in  the size of
the bladder  from accumulation of urine, or some slight muscular ex-
ertion as in  coughing, or any  mechanical violence or pressure, may
suffice to throw the fundus of the womb still  farther  backward and
downward till it passes beneath the promontory of the sacrum.  This
result may come on suddenly, and be immediately made known by
very serious and painful and even alarming consequences.  Or it may
be much more gradual in its onset, and for a while unsuspected in its
nature.   Retroversion may  likewise occur in consequence of the use
of the obstetric bandage, which  has a tendency to press the womb
downward and backward at a time when its  muscular and peritoneal
supports are weakened and relaxed, and it is enlarged  and heavy
from uncompleted involution.  It may likewise occur from a variety
of other causes.  It is evident, from the consideration of the inclina-
tion forward of the fundus of the womb in  its natural position, that
it can be made to assume  such an inclination as to render it possible
for it to be thrown backward and  downward only by some mechani-
cal influences, and  by such mechanical method it must be replaced;
and the more  especially since the sacral promontory presents such
decided structural  hindrances toward its restoration.
   The  vaginal  touch  readily  discloses  this  form of displacement.
" The finger, being introduced into the vagina, discovers an absence of 
              retroversion and retroflexion.            627

the cervix  from its usual place, and upon further investigation finds
it near the  symphysis pubis.  Upon passing the finger backward to
the sacrum it meets a resisting ridge, which ends  in  a hard,  round
mass  resting  upon the rectum.  The  size, rotundity and distinctness
of this  will depend upon the degree  of the displacement.   In the
first degree the resisting line but no tumor will be felt; in the second,
a slightly rounded  mass; and in the third, the fundus with its charac-
teristic form will be perceived.  Should doubt remain as to the nature
of the mass thus felt, rectal touch, the uterine probe  and conjoined
manipulation will remove it."—Thomas.

  Retroflexion.—This form of displacement bears the same rela-
tion to retroversion that  anteflexion does to anteversion.  It consists
in a bending  backward of the fundus  and body of  the uterus toward
the hollow of the  sacrum, the womb being bent upon its own axis at
a greater or lesser angle, by which  the cervix is not removed  from its
RETROFLEXION.
normal position, or deviates from it but slightly.   It is generally the
re«uH of a weakness  of the uterine tissues, in consequence of which . 
628       diseases and derangements  of the uterus.

the body of the womb, either through  its inherent  weight, whether
natural or preternatural, or in consequence of some force or pressure
applied to it, is flexed at the junction of the body and cervix  Retro-
flexion occurs most frequently in women who have borne children, and
rarely happens to the virgin uterus.
   Causes.—The principal causes which occasion retroflexion are similar
to those which give rise to retroversion, such as pregnancy and partu-
rition,  hyperplasia, endometritis, subinvolution, tumors either within
the abdomen or upon the  uterus itself.  An habitual  distension of the

                              Fig. 95.
PARTIAL RETROFLEXION.
bladder from retaining the urine too long, or the accumulation of large
quantities of faeces above the fundus, may likewise be the occasioning
causes of retroflexion, the uterine tissues being weakened and yielding,
as above remarked.
   Symptoms.—Irritability  of the rectum is  one of the cjiief symptoms
of retroflexion, and  if the pressure upon the gut be great, retention
of stool will be  a  matter of course.  Neuralgia  of the womb may
occur as a consequence of the natural congestion and  nervous com-
pression, and so-called  uterine colic may result from a retention ol 
     treatment  of retroversion  and retroflexion.    62cJ

the secretion of the intra-uterine mucous membrane.   If the retro-
flexion  exist in a great degree,  so  as  to  occlude  the  uterine  canal,
dysmenorrhcea  and  sterility will  be  the consequences.   Vaginal and
rectal touch are the best means of diagnosticating retroflexion, and if
there be any doubt remaining, the careful use of the  uterine probe.
A resort to these means  of diagnosis will ensure  against  mistaking
retroflexion for impacted  faeces, an enlarged and prolapsed ovary or
uterine  tumors, with which it may otherwise be confounded.

     Treatment of Retroversion and  Retroflexion.
  These forms of displaced uterus  demand a resort to mechanical
measures to ensure  reposition in a grejat majority of cases, and espe-
cially in those occurring during pregnancy.   This  may be attained
by the following means :
  The Uterine Elevator for Retroversion.—This instrument,  of  which
an accurate representation is  given  below, is  composed of an ivory
ball, a steel rod and  an ebony handle.   The  diameter of  the ball is
about five-eighths of an inch ; the  rod, seven inches in length, and
curved as in the cut, is firmly inserted into the ball at one extremity
and into the handle at the other. Originally designed by the writer
and constructed for  him for use in retroflexion or retroversion of the
uterus, this little instrument has been found capable of affording very
valuable assistance in such cases.

                             Fig. 96.
  The very unsatisfactory manner in which these displacements have
g> nerally been  managed by physicians has led the writer to adopt a
new and very simple method of treatment, and to offer it to the pro-
fession in all such cases when an operation or mechanical interference
is necessary.  And for the following reasons:
 ■ 1st.  It is less painful and less disagreeable to the patient.
  2d.  It always ensures a  more  perfect reposition of the  organ,
which, consequently, is less liable to relapse. 
680
diseases and derangements of the uterus.
   3d. This plan will be found successful when all  others adopted by
skillful and experienced physicians have failed.
   4th. This plan will succeed in cases in which it has hitherto been
deemed necessary to produce abortion in order  to replace the  retro-
verted uterus.   In these identical cases reposition  is readily effected
by this  method,  and  pregnancy continues  until  the  full term of
gestation.
   As soon as a case of this form  of displacement is clearly diagnosed
if the urine or  faeces are retained the usual means  should be at once
adopted  for their evacuation.  The patient should then be placed on
the bed, near its  edge,  upon her knees and elbows, so that the force
of gravity may  assist in the reduction.  The ball  of the instrument,
well lubricated,  is to be brought to the anus, with the convex surface
of the rod upward, then gently pressed  till  within  the sphincter,
when the handle should be slightly elevated, so  as  to bring the ball
against the anterior wall of the  rectum.   The  instrument is now to
be firmly  and  carefully pressed  up the rectum, when  the ball will
elevate the fundus, care being taken to raise the  handle of the instru-
ment more and more as progress up the rectum is made, and presently
the uterus will regain its normal position immediately posterior to the
symphysis pubis.
   In cases of long standing-^-and the writer  has  recently replaced
one of fifteen and another of thirty years' continuance—the reduction
is not so quickly or so easily effected.  The  ball, engaging and' par-
tially elevating  the  fundus, will  slip  over and pass above it.   The
instrument must then  be sufficiently withdrawn to engage it again,
and, if necessary, the operation should be repeated until the work is
proved to have  been entirely completed by the  instrument's meeting
no obstruction as it is  pressed with some degree of firmness against
the anterior wall, and so passed up the rectum.
   After  the reduction  is effected the patient  should  be kept in a
recumbent position for a longer or shorter time—from  two to  twelve
days, according  to the more  or less j-cccnt nature of the case—that the
womb may become accustomed to its position;  such remedies  being
administered in the mean time as may be indicated.  The principal of
these are Nux, Belladonna,  Sepia, Sulphur, Calc. carb., Lycopodium,
Calc. phos., Kali carb.   We  give  for each of these medicines the prin-
cipal indications; each symptom being a key-note which may be found
a reliable guide.  These, and other remedies wdiich may be indicated
in particular complications of retroversion, may  be  found at the latter
part of this chapter, arranged in alphabetical order. 
treatment of uterine displacements.         631
            Lateroversion and Lateroflexion.
  These forms of uterine displacement are of rare occurrence, and do
not give rise, usually, to symptoms  of  any note.  They may be con-
 joined with ante and retro displacements.  They result either in con-
sequence of  inflammatory conditions of the womb,  unnatural weight
of that organ or direct pressure.  Vaginal touch and the use  of the
uterine probe are generally sufficient to detect  the nature of these
rare malpositions of the  womb.
   Treatment.—Study the remedies  mentioned at the close of this
chapter, in order to  learn which are best  adapted  to the attendant
symptoms.   As an  auxiliary to the medical treatment, the patient
should be instructed to lie as much as possible upon the side opposite
to that of the obliquity, and to keep at  rest as much as possible.

           Treatment of Uterine  Displacements.
  The medical treatment of these various  forms  of uterine displace-
ment will depend in a great measure upon the selection of remedies
according to their principal characteristics, and to the  corresponding
characteristics and  constitutional  symptoms of the  individual cases.
For this reason we have combined in one schema the principal reme-
dies for all the various displacements, believing that each variety and
case of this disease  will thus lead to its  own appropriate remedy.
  The uterus is held in its proper position in the centre of  the cavity
of the lesser pelvis, and  in a line with the axis of the superior strait,
simply by the round  ligaments and a double fold of the peritoneum.
When in a healthy  state  the round ligaments hinder its retroversion,
while  the peritoneum, which covers its superior three-fourths ante-
riorly and its entire posterior surface, serves principally to prevent it
from sinking down into  the vagina, and at the same time assists also
in preventing retroversion.  Thus, it  is very plain that the  womb
cannot become displaced so  long as the peritoneum and round liga-
ments are in a normal  condition, and these ligaments can only lose
their normal condition in connection with other disorders of the gen-
eral system.  Hence, the remedies  below—or others which may be
called for  in special cases  as  they are indicated—by restoring the
normal condition of these appendages, will cure  all  uterine displace-
ments, when no mechanical  obstruction, such as is necessarily present
in complete  prolapsus or complete retroversion, intervenes.  These
appendages  are usually relaxed in consequence of some constitutional
ailments, which are shadowed forth by the symptoms indicating the 
 632      DISEASES  AND DERANGEMENTS OF THE UTERUS.

 proper remedy.  The right interpretation of these symptoms, and tne
 consequent administration of the corresponding remedy, will usually
 be followed therefore by a radical cure.
  The practice of applying  pessaries, or uterine supporters of any
 kind, is  rapidly becoming obsolete.  A few years  more and all these
 barbarous appliances, as useless and degrading as  they are disgusting
 to the female  sex, will be finally laid  upon the  same  mouldy and
 musty shelves with the cups  and the  blisters, the  leeches, the lancet
 and the actual cautery.
  There is scarcely any remedy  in the  whole Materia  Medica that
 may not be found useful in these displacements, but the following are
 the medicaments most likely to be required:
  1. Bell., Cham., Kali carb., Nux vom., Plat., Puis., Sabina, Sepia.
 2. Aurum, Carb. an.,  Canth., Con., Croc, Ferr.,  Lil. tig., Op., Po-
 doph., Sec. corn., Sulph.   3.  Aeon., Ant. cr., Arn., Asaf., Bry., Calc.
 carb., China, Cocc, Coff., Creas., Graph., Hyos'., Ignat., Ipec, Magn.
 mur., Mosch., Natr. carb., Natr.  mur., Phos. ac,  Sulph. ac, Thuya,
 Zinc

  Aconite. If the prolapsus  has  occurred  suddenly, and  there  is in
 consequence great inflammation of the parts, with burning pain  as if
 from hot coals;  excessive sensibility to the least touch; bitter, bilious
 vomiting; anguish and cold  perspiration, or hot and dry skin;  fear
 of death.   Menses too late;  almost suppressed.
  Ammon mur.  A very characteristic symptom is discharge of a quan-
 tity of blood from the bowels at every catamenial period.   During
 the catamenia the discharge is more profuse at night.
  Arnica. Where the prolapsus has been  caused by a concussion, and
a bruised, sore feeling remains.  She cannot  walk erect on account of
a bruised, sore feeling in the uterine region.   Menses light color.
  Asterias rubens.  Sensation of pressure  on  the  lower abdominal
 organs, impeding locomotion.  General  feeling  of distress in the
 womb, as though something were pushing out.
  Aurum. Heaviness in the abdomen, with icy coldness of the hands
and  feet.  Drawing  pain at the pubes.  Quarrelsome disposition.
 Melancholy,  and thoughts continually running on self-destruction.
  Belladonna. Pressure as though all the contents of the abdomen
 would issue through the genital organs.   This is particularly felt early
 in the  morning.  Sensation of heat and drynes> in the vagina.  Draw-
 ing pain in the whole circumference of the pelvis.   Pains in the pelvic
 region, which come on  suddenly and  cease as suddenly, or feeling in 
           TREATMENT OF  UTERINE DISPLACEMENTS.          633

the back  as if it  would  break,  hindering motion.   Suppression of
stools and of urine.
  Bryonia. Pinching and  uneasiness in the distended abdomen, as if
the menses  would appear.   Frequent bleeding  from the nose when
the menses  should appear.  Constipation of hard,  dry  stools, as if
burnt.  Lips parched  and cracked, and thirst.  She desires to keep
still, she feels so much better.  Menses profuse and brown.
  Calc.  carb. This remedy  is  especially indicated  in  pale,  leuco-
phlegmatic  temperaments.   She feels  a sort  of  inward  coldness.
The least exposure to cold air chills her through and through.   She
feels as if  she had  on cold, damp stockings continually.   She  has
vertigo on going up stairs, and she is often all out of breath also, being
obliged to sit down even before she reaches the top.   The menses are
too frequent and  too  profuse;  the least excitement will often cause
their return.   Heaviness and painful weight in the limbs  and great
fatigue on walking.   Constant aching in the vagina.
  Calc. phos. When  every cold  causes rheumatic pains in the joints
and in various  parts of the body.  This is a positive indication, and
when this occurs the exhibition of Calc. phos. will at once remove the
rheumatic affection  and prevent the reappearance of the uterine dis-
placement.   Suffering from grief;  from stool or urine.
  Cantharis. Burning in the  vulva  and violent itching in the vagina.
Almost constant desire to urinate, with cutting, burning and passing
of a few drops of urine, sometimes bloody, sometimes followed by a
discharge of bloody mucus.  Great amativeness.
  Carbo animal. Great languor in the thighs, particularly before and
during  the  menses.   The menstrual function seems to exhaust  her
remarkably, so  that she is hardly able to speak during its continuance.
  Chamomilla.  Frequent pressure toward the uterus like labor-pains,
with frequent desire to urinate, often passing large quantities of color-
less urine.  Frequent discharge of coagulated blood,  with tearing pain
in the veins of the legs  and  violent labor-like pains in the uterus.
Contrary to her condition in health, she is always out of humor, par-
ticularly at  her menstrual periods, when she is  headstrong  even unto
quarreling.   She can hardly speak a pleasant word, and has to restrain
herself  in order to do  so.  Menses too early, dark, coagulated.
  China. In cases  where  the prolapsus and  attendant symptoms were
superinduced  by  losses  of  fluids,  particularly of  blood.   She  has
much ringing in the ears, painless lienteria and  leucorrhcea.   A sense
of distension in the  abdomen, which is not relieved by eructations.
Menses very profuse.  Metrorrhagia.
• 
DISEASES AND DERANGEMENTS  OF THE UTERUS.
  Cocculus.  Much paralytic pain in the small of the back, rendering
walking quite difficult and sometimes impossible.  Irregularity of the
menses, and at their appearance nausea and faintness.
  Colocynth. A  constant  heat and dragging  pain in  the  vagina.
Chronic and repeated attacks of  colic, drawing her double, with great
restlessness  and lamentation.
  Conium. Induration and prolapsus at the same time.   Much nausea
and  vomiting.  Vertigo, particularly when  in a recumbent position
and  in  turning over.   Intermittent flow at every emission of urine.
The  breasts become sore, enlarged and painful at  every menstrual
period.   Principally with Conium, fifteen years ago, I  cured per-
manently a case of prolapsus of six years' standing,  in which all
pessaries  and  abdominal supporters  had failed to  keep the uterus
within  the  vulva.  The prolapsus was complicated  with induration,
ulceration and profuse leucorrhoea.  This lady has since borne several
children, and has never experienced a return of the malady.
  Dulcamara. The patient has always, as a forerunner of the  menses,
a rash upon the skin.  All her  symptoms are aggravated when the
weather suddenly becomes colder, especially if the weather is  damp.
  Perrum. The  patient is weakly and  complaining, yet her face is
fiery red.  The menses intermit two  or three days  and then return.
Previous to the menses she  has stinging headache, ringing in the ears,
and discharge of long pieces of mucus from the uterus.
  Graphites. The menses always  delay.  They are too pale and scanty.
Before and  during the menses cough  throughout the day, fatiguing
the chest; no cough at night.  Constipation of large, difficult, knotty
faeces, and itching blotches  on various parts of the body, from which
oozes out a watery, sticky fluid.   Morning sickness during the  menses.
Pain in the epigastrium during the menses, as if  everything would be
torn in  pieces.   Much headache.
  Ignatia. Menses scanty, black  and of a putrid odor.   Cramp pains
in the uterus, with lancinations.   A very weak,  empty feeling at the
pit of the stomach, with sighing respiration.  She is full of suppressed
grief, with wdiich she seems to be weighed down.
  Kali carb. Very much heavy, aching pain in the small of the back.
Pain like a weight in the  small of the back  during  the  menses.
Violent itching  of  the whole body  during the menses.  Stitching
pains in and  about the  uterine  appendages.  Much distress in the
abdomen for about an hour or two previous to  an evacuation of the
oowels.   Sequence of parturition.
   Kali bich. More particularly indicated in fat, light-haired  persons. 
            TREATMENT OF  UTERINE DISPLACEMENTS.         635

 Often  where the prolapsus  seems to have been  produced by hot
 weather.  Especially suitable if there be also leucorrhoea so tough  as
 to be drawn out in long, ropy strings.
   Lachesis.  Pain  in the uterine region, as if  swollen.   The  uterus
 does not bear contact, and has to be relieved of all pressure.   The
 patient feels constantly as if she must lift her  dress from the abdo-
 men.  Suitable wdiere the displacement occurs  in connection with (or
 in consequence of) change of life.   Violent pain of long standing  in
 the right groin, extending either toward the genital organs or upward
 toward the liver or chest.   Painful  oblong swelling and induration
 in the right ovarian region, aggravated by moral emotions, rapid
 movements, prolonged walks and over-exertion.
   Ledum. Abundant leucorrhcea; pale face; abundant urination, even
 at night.   Ledum  is especially indicated where  the sufferings are
 greatly aggravated by warmth, as in  bed  or over the register.  Great
 sensation of coldness  all through  her; she cannot keep warm; she
 appears deficient in  vital heat.
   Lilium tigrinum.  Debility.  Sensation as if she were being dragged
 downward in the abdomen;  dragging from the  chest and shoulders.
 She feels as  of she wants to be held up.   Sense of weight and down-
 ward pressure in the abdomen.  Bearing down in  the region of the
 womb,  as  if the contents  of  the abdomen would  be pressed  out
 through the vagina if not supported  Anteversion, retroversion and
 prolapsus.   Crazy feeling on top of the head.
   Lycopodium. Sensation of pressure  through the vagina on stooping.
 Sensation of great dryness in the vagina.   Much borborygmus, espe-
 cially in the left hypochondrium.   Much red  sand in the  urine.   Ter-
 rific pain in  the back previous  to every urination, with relief as soon
 as the urine begins to flow.  Haughty, imperious, commanding.
  Magnesia mur. Hysterical complaints and spasmodic turns.   Much
 weakness in  the limbs.  Constipation of large, difficult stools, which
 crumble as they pass the verge of the anus.   Poor sleep.
  Mercurius. During every menstrual period anxiety, red tongue with
 dark spots, and burning, salt taste in the mouth, sickly  color of the
 gums and the teeth are set on edge.  This remedy is indicated in Pro-
 lapsus of the Vagina, which see.  It  is a very valuable remedy for all
 displacements wdiere it ia indicated.   Cold and clammy sweat upon
 the thighs every night.  Dissatisfied, fault-finding.
  Natr. mur. Pressing and pushing toward the genital organs  every
morning; she had to sit down to prevent prolapsus uteri;  she awakens
every morning-with violent headache, which lasts a long  time.  Con- 
636      DISEASES AND  DERANGEMENTS OF THE  UTERU?

stipation, with sensation of contraction of the anus.  Difficult expul-
sion of stool, Assuring the anus, with flow of blood, leaving a sensa-
tion of much soreness in  the anus.   Tearful, weeps easily.
   Nitric acid. Violent pressing, as  if everything were coming out of
the vulva, with pain  in the small  of the back, through the hips and
down  the thighs.  Very painful  stools,  with profuse discharge of
blood, the pain lasting a long time and exhausting her.
   Nux mosch. Enormous  distension of the abdomen  after every meal.
Greatly troubled with dryness  in the mouth and throat while sleep-
ing.  Great  pressure  in  the back' from within outward  during the
menses.   Menses profuse  and dark.
   Nux vom. Prolapsus uteri from  straining by lifting.  Pressure to-
ward the genital organs early in the morning, in bed, or during a walk,
with a sensation of contraction of the abdomen.  Constipation of large,
hard, difficult stools, or small stools with frequent urging.  Dyspepsia
from high living.   Cannot sleep after three a. m.   Pain in the small
of her back, preventing  her from turning over in bed.  Frequent
urination; she passes little and often, with much burning pain.  The
prolapsus of long standing is  often accompanied with dry cough and
a sense of constriction around the hypochondria.
   Opium. Among the weaknesses, even of long standing, produced by
fright, prolapsus uteri is one,  which is amenable  to  Opium, given
very high. Also in constipation of many years' continuance, if charac-
terized  by hard, black balls,  in connection with prolapsus, Opium,
high, will be found to be  the remedy.  Inclines to gayety.
   Petroleum.  This remedy will be indicated in cases where the pa-
tients have been reduced  in  strength, so that the prolapsus  seems to
result  from a chronic diarrhoea, which  occurs only in the day-time.
Seems anxious and irritable.
   Phosphorus. Great sense of weakness and emptiness in the abdomen.
Great sense of heat running up the back.  A long, narrow, hard, dry
stool, very difficult  to expel.   Sour stomach; belching up of great
quantities of  wind after eating.  Very amative or very indifferent.
   Platina. Painful sensitiveness and continual pressure in the mons
veneris and internal organs, with internal chills and coldness.   Scanty
stool, and difficult expulsion  on account  of its sticking to the anus and
rectum like soft clay.  Her thoughts horrify her.
   Podophyllum  pelt. Prolapsus uteri, particularly following  parturi-
tion.   Prolapsus ani  as an accompanying symptom.  The stools are
very frequent, several  daily,  but they are  natural and yet exhausting
stools.  Morning headache, with flushed face. 
            TREATMENT CF UTERINE  DISPLACEMENTS.         637

   Pulsatilla.  Pressure in the abdomen and small of the back, as from
 a stone, with disposition of the lower limbs to go to sleep when sit-
 ting, and attended with ineffectual desire for stool.   Menstrual colic,
 with  great  restlessness,  tossing in every  possible  direction.   Mild,
 tearful, yielding  disposition.  She cries at everything,  is  sad and
 desponding.  Very bad taste in the mouth in the morning;  nothing
 tastes good.  She is pale and feeble.  Menstruation late.
   Rhus tox. Particularly suitable for very rheumatic  persons;  worse
 before a storm and in damp weather.   She cannot lie long in any one
 position, but must shift about to obtain relief; the  relief lasts but a
 short time, when she must change  again.   Walking at first is diffi-
 cult, but as she proceeds she walks better and better.  The  Rhus in
 such cases will cure both the rheumatism and the prolapsus.
   Sepia. Painful  stiffness, apparently in the uterus.  Pressing  in the
 uterus, oppressing the breathing;  sensation as if everything would
 come out  of the  vagina;  she  had  to cross her limbs to prevent it.
 Prolapsus of the vagina and uterus.   Sensation of weight in  the anus,
 not relieved by an evacuation.   Great sense of emptiness at the-pit of
 the stomach.  The urine deposits  a clay^like -sediment, which it is
 difficult to remove from the chamber.   Menses too late.
   Secale corn. Prolonged bearing-dowm and forcing pain in the uterus.
 She is of a thin, scrawny formation.  Menstruation profuse.
   Silicia. A pressing-down feeling in the vagina.  Great  constipation
 before and during the menses.   Prolapsus in consequence of myelitis.
 Very difficult stools being an accompanying symptom.
   Stamram.  Great anguish  and melancholy the week previous to the
 menses, ceasing as soon as  the  menses make their appearance.   Old,
 neuralgic headache is an accompanying symptom.  Each attack begins
 lightly, and increases  gradually to its highest point, from which it is
 equally long in declining.  The larynx  and chest give out in talking,
 singing or  reading aloud; such exercise induces so great weakness that
 she is compelled to desist.   Mental irritability.
  Staphysagria. A feeling of weakness in the abdomen as if  it would
 drop.   She  is  weakly and  sickly, very  sensitive to  impressions; her
 teeth ache  much, and have  black streaks running through them.
  Sulphur.  Weak   feeling  in  the genital  organs.  Burning  in tht
 vagina; she is  scarcely able to keep still.  She  finds it difficult to
walk  erect; she must  stoop on  account of debility.  She  sleeps a
heavy, dead sleep, so  as  to exhaust her; or she  sleeps  lightly and
awakens frequently, and this weakens her.   She feels very weak and
faint  from  eleven  till twelve  in  the forenoon; she  must have her 
638     DISEASES AND DERANGEMENTS OF THE UTERUS.

dinner.  Heat on the crown of her head ; cold feet; hot and frequent
flushes.  Terrible sick headaches, which weaken her.
  Sulphuric acid. Great weakness, with sense of general tremulous-
ness, but without actual trembling.   She wishes  to do  everything ir,
a great hurry;  can scarcely get her work done rapidly enough, and is
dissatisfied with herself when she has finished.  Great deal of acidity
of the stomach.   Menstruation too early and too  profuse.
  Thuya. A terribly distressing pain occurs  in  the  left iliac region
when walking or riding;  she  must lie down to get relief.  The same
pain occurs  during her menstrual  periods, and extends into the  left
groin.  Very serious turn of mind.
  Veratrum alb. Dysmenorrhcea, with vomiting and purging, or sim-
ply an exhausting diarrhoea with cold sweat, in cases of prolapsus
uteri.  One dose of Veratrum is often sufficient to cause the  succeed-
ing periods to be comfortable and to cure the prolapsus.  Very ama-
tive, haughty, commanding.
  Zinc. During the menses heaviness of the limbs, with violent draw-
ing around the  knees, as if they would be twisted off.  Again, she is
never well except during t#e menstrual flow.  At other times she  has
boring pain in the left ovarian region, which is only partially relieved
by pressure.  Menses late.  Temper  variable.
  Caulophyllum, Cimicifuga, Helonias  may likewise prove of
service in cases  in which they are indicated.
                     CHAPTER  XXXI.

        DISEASES   OF  THE  UTERUS—CONTINUED.

              Acute and Chronic Inflammation.

    THE varieties of  inflammatory disease which  attack the uterus
     may  be subdivided in the first place into acute and  chronic.
Other subdivisions have been made by gynaecologists, however, which
are founded  upon the  locality of  the inflammatory action  and the
uterine tissue attacked.  Thus we have acute and chronic inflamma-
tion of the endometrium  or  mucous lining of the  womb, comprising
the following subdivisions : Acute  General Endometritis, in which in-
flammation affects the mucous membrane (and the tissue immediately
subjacent thereto) of the cervical canal and of the body of the womb; 
ACUTE ENDOMETRITIS.
639
Acute Cervical Endometritis, in  which  the inflammatory action  is
limited to the lining membrane of the canal of the cervix; and Acute
Corporeal Endometritis, in which the mucous lining of the body alone
is affected.  Of these three forms of disease, acute cervical endometritis
is most frequently met with,  and has been variously described  and
named by various authors, while acute general  endometritis is the
variety least frequently observed.   Chronic Endometritis is  likewise
subdivided into general, cervical and  corporeal.   Inflammation of the
parenchyma of the  womb, or Metritis properly so called, is almost
always an acute  affection when it occurs as an original disease.   It
commonly presents itself as a secondary affection, in  consequence of
the inflammatory process  of endometritis extending  itself to the
parenchyma of the womb.  Puerperal metritis is by no means  rare,
however, and, as has been already described, is a very serious disease.

                     Acute  Endometritis.
  This diseased  condition has been named by different writers Acute
 Uterine Leucorrhoza,  Internal Metritis, and Acute Uterine Catarrh.   It is
usually ushered in by  some precursory symptoms indicating a general
febrile condition, and  by others which point to the local development
of the disorder.   Thus we  find  general debility, headache, feverish-
ness, and even chilliness, followed by severe pains in the pelvic region
—" very low down," as it is sometimes expressed—which often extend
into  the surrounding  parts.  There is  pain, weight  and a dragging
sensation in the  back, and bearing-down pains ;  and  very frequently
vesical and rectal tenesmus, especially prior to  the establishment of
the discharge.  In the more violent cases the inflammation  involves
the vagina,  and  may even show evidences of its  presence in the
swollen and sensitive condition of the mucous surfaces of the external
parts.  The discharge, or uterine leucorrhoea, may make its appearance
in a very few days, or even hours, after the first onset of the precursory
and inflammatory symptoms.
  " At first the discharge is serous and  bloody,  but  it  soon  becomes
thick, yellowish  or greenish, ropy, fluid or purulent;  after drying up
it leaves yellow or greenish stains  on the linen,  and stiffens it as  if it
had been  starched;  afterward the discharge becomes whiter, milky
and mixed with  transparent pieces of thick mucus.   If this change
of the discharge  sets in, the inflammatory  condition is almost entirely
dispersed, which  may take place at the end of thirty-six or forty days,
or even sooner,  when  the  discharge  becomes chronic,  or reappears
again  at the time of the menses, after sexual excesses, over-eating or 
640      DISEASES  AND DERANGEMENTS OF  THE  UTERUS.

drinking, or even without any  apparent cause.  As a general  rule
the more acute the inflammation the thicker and darker the discharge!
In uterine leucorrhoea the discharge has  always an  alkaline reaction
wdiile vaginal secretions always react like acids.   Examined bv the
microscope,  the  discharge  looks  homogeneous,  thick,  containing
globules resembling those .that float in pus or  healthy mucus.
  " As regards the  course  of this affection, we may distinguish  four
periods.   The first period  sets  in with a rather slight itching at the
vulva, in  the interior of  the vagina, and  sometimes in the uterus
with a  sense of heat in the uterus, pains in the small of the  back
and in the back, increase of the sexual  desire, and frequent urgino-
to urinate.  In the second period, which may set  in about the third
or fourth day, a serous discharge takes place, which is at first scanty,
but soon  becomes  more  profuse, assumes  a greenish  or yellowish
rather dark appearance, and is  accompanied  with  increased burning
urination.   In the  third  period, which  generally  commences about
the ninth day, the inflammation becomes less  intense;  the  discharge
is still very copious,  thickens, becomes more and more whitish, and
then  decreases, with  diminution of flow of urine.  In the fourth
period, when the disease  inclines  to become chronic, the  discharge
disappears and  reappears  again repeatedly  and frequently, without
any known cause.'-'—Jahr.
  As  already remarked under the head of Vaginal  Leucorrhcea, some
constitutions are much more predisposed to the  catarrhal form of
disease  than others;  that is, in some it will make its  appearance
under  the influence  of provoking  causes  which  in  others would
have  no such effect.   Thus, all the influences which may directly or
indirectly lead to acute inflammation of, and consequent catarrhal
discharge  from, the mucous  lining  membrane of the wTomb, may be
regarded as  either predisposing or provoking.  Many of these causes
of either  class are identical with those which result in acute inflam-
mation of the mucous lining membrane of the vagina.   And indeed
very many cases  of this form of endometritis are nothing more than
the extension of the mucous inflammation  from the vagina to the
uterus.
  But as very many of  these morbid  influences  are so  gradually
developed as  to result in chronic  mucous inflammation or  uterine
catarrh, without  evincing any  very noticeable acute symptoms, we
reserve  a  more particular  enumeration of the causes of inflammation
of the mucous coat of the womb  in  general  till,  in the succeeding
section, we come to the consideration of  the chronic variety. 
CHRONIC  ENDOMETRITIS.
641
  Tin  discharge itself, which results from  the  inflammatior of the
mucous  surfaces of  the  cervix and fundus uteri,  is  easily distin-
guished  by its  alkaline  reaction  from  the slightly  acid  secretion
poured out by the  vaginal  membrane.  But while in  ordinary cases
of uterine leucorrhoea the cervix uteri constitutes the  exclirsive seat
of the disease, in the more severe cases, both acute and chronic, the
inflammation extends also to the fundus, and at the same time invades
also the mucous coat of the  vagina.   And  in fact very few cases of
leucorrhcea are  met with in which the vagina fails to  participate, so
that in general the  secretions which appear in leucorrhoea are  found
to be  composed of the products of both vaginal and uterine mucous
inflammation.  Should the discharge be very acrid, it  is apt to pro-
duce excoriation of the parts with which it  comes in contact, and to
give rise to intense  itching.   The irritation of the skin, together with
that engendered by scratching, from which the patient cannot refrain,
may give rise to extensive prurigo.
  The following are the physical  signs revealed  by an examination:
" An examination  by touch reveals the vagina hot  and dry or cov-
ered  by the  discharge.  The os uteri is found  gaping, the cervix
swollen  and very  sensitive to  pressure, the body slightly enlarged,
and the whole organ  lower  than normal in the pelvis.   Through the
speculum  the cervix is found  to look swollen, cedematous and red,
and from the pouting os  pours  forth either  a  clear albuminous-
looking fluid,  muco-pus,  or  long, tenacious   shreds  of  cervical
mucus."'
  This form of disease may affect the lining membrane of the entire
uterine canal, or it may be confined to that of  the cervix or of the
body alone.  In the latter case  it generally results from sudden sup-
pression of the menses, while  endometritis following  childbirth or
abortion is apt to attack the entire uterine mucous tract.
  Causes.—The disease may occur as a consequence  of direct injury,
or it may be an  extension  of inflammation of the vagina, whether
gonorrhceal or simple.  It often  occurs as  a consequence of taking
cold during menstruation, even  without suppression of  the menstrual
flux; and  may arise from excessive sexual indulgence or other causes.

                    Chronic  Endometritis.
  Chronic endometritis,  as before  remarked, may  be general, cor-
poreal or cervical.   General chronic endometritis  is usually associated
with chronic inflammation  of the  parenchyma of the womb, and  U
connected with areolar hyperplasia.   Chronic corporeal inflammation
      41 
642     diseases and  derangements of  the  uterus.

of  the endometrium  is of rather  infrequent occurrence, while chronir
cervical endometritis is one of the most frequently occurring diseases to
which the uterus is liable; and although not of a very serious nature
per se, yet it lays the foundation for, or has following in its train d'
neglected, numerous  other disorders of a more troublesome and even
dangerous  character, and  which render miserable  the lives  of their
unfortunate victims.   It frequently follows an attack of acute endo-
metritis—the  latter  subsiding into the  chronic form—but still more
frequently approaches insidiously, and may have  become a confirmed
disease  before any symptoms are manifested which call the attention
of the patient to the fact that something is  wrong with the womb.
This warning symptom is generally a leucorrhcea, or  it  may be a
severe dragging  pain in the back and loins, which is aggravated  by
walking and standing, or both these  conditions are conjoined. Men-
strual irregularity of one  kind or another soon shows itself; mental
depression, ill-temper and hysteria are  frequent accompaniments, or
all these symptoms and many more may exist  in a single case.
  The uterine discharge which forms the principal symptomatic in-
dication of chronic  endometritis, especially  cervical  inflammation,
varies  in quantity in  different persons,  and  at different times in the
same  individual.  Like vaginal leucorrhcea, it may be so scanty as
scarcely to become perceptible externally, or it may be so profuse as
to require the application of several napkins daily.  The discharge
varies also in color, character and general appearance and effects.  It
may be colorless and semi-transparent, or it may assume a greenish-
brown or even darker hue, as if, in the severer forms, it were mixed
with blood; or it may be  so thick and  tenacious  as to be with great
difficulty detached from the  mucous membrane to which it adheres.
In the same manner its character and  q'uality may be very different
in different persons,  or in  the  same  individual at different times.
Thus, it may be mild, bland and unirritating,  or it  may be acrid, and
so cause excoriation of the labia, or even of the skin of the surround-
ing parts.   So also  in its  direct effects it may vary in a remarkable
manner.  When very profuse it  becomes rapidly exhausting.  And
while in the first instance  due to some dyscrasia, some  morbid influ-
ence or diseased condition  of the system, it still further aggravates the
general ill-health by  the profuseness of  its flow, as well as by the im-
portant functional derangements which sooner or later follow in its
course.
  The  causes  of chronic endometritis  or  uterine leucorrhcea—for
these  terms are used  synonymously—may be divided into twro classes. 
chronic endometritis.
643
The first may be grouped under the head of constitutional predisposi-
tion; and in this  class also we include all those cases wliich result
from the influence of other forms  of  constitutional or  functional dis-
orders, such, for example, as menstrual  irregularities or organic dis-
placements.   From causes and morbid influences of this nature arise
the  great majority of the cases of uterine leucorrhcea which appear
either in young or in older unmarried females.
  The second class of causes of chronic endometritis we may term
the  provoking or special causes.   These  are  most numerous  in the
married  state, as arising  from the great excitements and sudden and
extensive organic changes to which the uterus  and its appendages are
constantly liable.
  The constitutional predisposing causes are in general similar to those
which result in chronic vaginal  leucorrhcea.   They are such  as are
implied  in  the  terms leucophlegmatic  temperament  or  scrofulous
diathesis.  Persons who come under this  description may be thin or
quite fleshy.  In  either case such persons are remarkably prone to
suffer from the least exposure to cold, damp weather, and the  imme-
diate consequence of such suffering and exposure appears in the form
of some blennorrhcea.  These two circumstances, of sensitiveness to the
cold dampness, and  blennorrhagic discharge in consequence of it, are
characteristics of  this particular temperament.  This  constitutional
predisposition is the  one which most frequently leads to leucorrhoea,
whether  vaginal or uterine, or both, in young girls.
  But after  the accession of puberty the same constitutional influ-
ences may,  and  indeed  constantly do, induce leucorrhceas, but in a
less direct manner.  The principal diagnostic characteristic of uterine
leucorrhcea  is its  relation to menstruation, those forms of  leucor-
rhcea which appear to be unaffected by the menstrual  function being
supposed to be purely vaginal, wdiile those which are greatly  aggra-
vated either immediately before, or during, or immediately after the
menses or menstrual period, are considered to  belong more especially
to the uterus.
  And there are  several varieties of uterine  leucorrhcea considered
with reference to the menstrual  function.  Thus, in young women of
a delicate constitution the  accession of the catamenia may be pre-
ceded by two or  three  monthly  attacks  of  leucorrhoeal discharge.
This may be considered as a forerunner, and a truly uterine if not a
vicarious  secretion.  Again,  in many cases of  suppressed menses the
proper menstrual  flow is replaced by a leucorrhcea, which  appears
regularly at the proper monthly periods, continues the usual number 
^44      DISEASES AND DERANGEMENTS OF THE UTERUS.

of days, and perhaps discharges about the quantity which would cor*
respond to natural menstruation.  Where the menses themselves  are
normal and regular a leucorrhoea may appear in the intervals, which
will greatly increase in quantity immediately before the appearance
or immediately after the subsidence of the menses.  In some of .these
cases the leucorrhcea encroaches more and  more upon the menstrual
flow, until  it  finally  supersedes it  altogether;  and in the severer
forms  of this  leucorrhoea it may produce menorrhagia, or true ute-
rine haemorrhage, which, like the  former variety of leucorrhcea just
mentioned, may also occupy the intervals and increase just before and
just after the monthly periods.  Again, as at the accession of  the
menses, so also about the time of the cessation of the menses, the few
last periods are often marked by the occurrence of leucorrhoeal dis-
charges, either alternating with or appearing in the place of the usual
menstrual flow.  In many persons of a chlorotic temperament, leucor-
rhcea replaces the menses entirely, and finally, after child-bearing or
after abortion a white, inodorous discharge  will sometimes  make its
appearance and continue for months.  In the case of spontaneous abor-
tion this  discbarge will either tend to prevent subsequent conception,
or, where that  takes place, it will  predispose to successive  abortions.
But this result will not  be so much due  to  the discharge  itself,
although apparently its immediate cause, as to the  morbid  condition
of the womb which produces the discharge.
  Those  forms of leucorrhoea which  appear under the above-men-
tioned conditions may  be considered as arising from the uterus, and
chronic  endometritis, whether general, corporeal or cervical, will be
discovered upon making an examination by means of the  speculum.
In the  great majority of  cases  the uterine leucorrhcea is complicated
with a  similar discharge from the vagina; and, on the other  hand,
those disorders of the vaginal mucous membrane  which induce ute-
rine leucorrhcea and chronic endometritis may be included among its
constitutional causes.
  Among the special or provoking causes of chronic endometritis and
uterine leucorrhcea are to be ranked principally those influences which
are incidental to the married state. •  Of these, excessive  sexual inter-
course is perhaps the most frequent and efficient.   Similar in effect
are the cold water and other injections resorted to by many for par-
ticular  purposes.   Child-bearing, abortions, and  in fact all  other in-
fluences capable of producing acute inflammation of the mucous coat
of the womb, and consequent acute catarrhal discharge, are also to be
classed as causes of similar chronic disorders.  This is equally true 
REMEDIES  FOR  LEUCORRHCEA.
645
 whether we consider the less violent and longer continued action of
 such influences to have resulted in a chronic inflammation, or whether
 this latter form of disease be but the continuation of the acute inflam-
 mation itself.   And in general all those influences—mechanical, func-
 tional or  sympathetic—which disturb  the womb  without  exciting
 inflammation  of its deeper tissues, may result in these varieties of
 subacute mucous inflammation, of which the leucorrhoeal discharge is
 at once the evidence and the consequence.

       Treatment of  Endometritis and  Leucorrhcea.
  The remedies herein  laid down will  be found applicable to the
 various forms of endometritis and leucorrhcea.   These cases are to be
 treated according to homoeopathic principles—the case examined in its
 totality, and that remedy selected which is the nearest simile  in its
 pathogenesis of the pathological and symptomatic array presented by
 the patient.

                 Remedies  for Leucorrhcea.
  1. Alum.,  Calc.  carb., Creas.,  Merc,  sol.,  Puis., Sep.   2. Amm.
 carb.,  Bov., Carbo veg.,  China,  Ferr.,  Graph., Lye,  Phos., Sabina,
 Sil., Sulph.  3. Agaric, Aletris, Aralia,  Ars.,  Borax, Canth.,  Carbo
 an., Caust., Cham., Cocc;.,  Erigeron,  Gelsem., Hedeoma,  Helonias,
 Hydrastis, Hypericum, I odium, Kali carb., Leptand, Lil. tig., Magn.
 carb.,  Mez., Natr.  c, Natr. m., Nitric ac, Phos. ac,  Podoph., Ruta,
 Stann., Sulph. ac, Zinc,  Zizia.

  Aconite  is  the  only remedy in those forms of this  disease where
 there is much  irritability of the system, with fever and fear, thirst and
 vertigo in rising or sitting up.   Menses  late and scanty.
  .ffisculus  hippo.  Leucorrhcea,  with lameness  in the back,  across the
sacro-iliac  articulations, and great fatigue from walking, because that
part of the back gives out in walking  even but a little way.
  Agaricus mus. Where  there is  much itching externally and  inter-
nally, with very profuse and dark-colored  leucorrhoea.
  Aletris far. General and local debility from protracted illness,  loss
of fluids or defective nutrition.
  Alumina. Where  the  leucorrhcea occurs either before or after the
menses;  it is acrid and  profuse.   Relieved by cold washes.   Trans-
parent and mucous, running down to the heels in large quantities.
  Ambra grisea. Leucorrhcea only at  night.  Stitches  in the vagina
hefore the discharge.  Leucorrhcea of  bluish-white mucus. 
646      DISEASES AND DERANGEMENTS OF THE UTERUS.

  Ammon. C. Violent acrid leucorrhcea; sometimes burning, watery dis-
charges from the uterus.   Menses short, scanty, dark.
  Ammon. mur.  Leucorrhcea, with  distension of the  abdomen.  Leu-
corrhcea  like the  white of an egg after  a pinching pain around the
navel.   Brown, slimy leucorrhcea after every discharge of urine.
  Anacardium 0. Great  loss of memory.   Leucorrhoea, with itching
and soreness.   Maliciously inclined.
  Antim. crud.  Discharge  of an  acrid  water from the vagina, which
causes a sensation  of biting down along the thighs.  Amative.
  Aralia.  Leucorrhcea of an acrid character and offensive odor.
  Arsenicum. Leucorrhcea whilst standing  and emitting flatulence;
leucorrhcea thick  and yellow,  corroding  the parts which are touched
by it.  Great  anxiety.   Menses  profuse.
  Baryta carb.  Sanguinolent mucous leucorrhcea, with beating of the
heart, pain in the  back and weakness even unto fainting.
  Belladonna.  Leucorrhoea, with  colic; the pains  come suddenly, and
finally cease as suddenly as they came.  Menses profuse, smell bad.
  Borax V.  White, albuminous  leucorrhcea,  with a  sensation as if
warm water  were flowing down.  Downward motion unpleasant.
  Bovista.  Leucorrhcea after the catamenia  like the  white  of an egg,
coming away whilst walking; or  it may be yellowish-green and cor-
rosive.
  Calcar. carb. Leucorrhcea like mucus or  like milk; it  may be dis-
charged  more whilst  urinating, and  there  may be heat  and itching
of the vulva.
  Cantharis. Discharge of bloody mucus  after urinating.
  Carbo  animal. Watery  leucorrhcea, particularly when walking or
standing.   It  may be burning  or biting, and may  stain  the linen
yellow.
  Carbo veget.  Profuse leucorrhcea only  in the morning when rising.
Milk-colored,  excoriating the  parts.   It may  be thick  and yellow-
ish, or white.   Rawness and soreness of  the vulva during the leucor-
rhcea.
  Causticum. Leucorrhcea, particularly at night.
  Chamomilla. Yellowish,  smarting leucorrhcea, particularly after  a
meal.
  China  off. Leucorrhcea  before the menses,  with  painful  pressing
toward  the groins and anus.   Bloody  leucorrhoea,  with  occasional
discharge of black clots or foetid, purulent matter, with itching and
spasmodic contraction in the inner parts. 
REMEDIES FOR  LEUCORRHCEA.               64/
  Cinnabar. Leucorrhcea, causing during its discharge a pressing in
the vagina.
  Coccus cacti. Leucorrhcea, consisting of mucus, preceded by draw-
ing and thrusting pains in the inguinal, vesical and pubic regions.
  Cocculus. Scanty, irregular menses,  with  leucorrhcea between the
periods, or leucorrhoea instead of the menses.  Leucorrhcea like serum,
mixed with a purulent, ichorous liquid.
  Coffea. Profuse discharge  of  mucus  and sometimes  blood from the
genital organs, which  are very sensitive and itch voluptuously.
  Conium m. Leucorrhcea of white, acrid mucus, causing a burning or
smarting sensation.  The  leucorrhcea  may be milk-colored and pain-
ful.  Excoriating leucorrhcea.
  Creasote. Leucorrhcea, with great debility, particularly of the lower
extremities.   It may be mild or acrid, causing much itching.
  Drosera. Leucorrhcea, with labor-like pains.
  Erigeron. Profuse, with spasmodic pains, and irritation of the blad-
der and rectum;  usually scanty menses.
  Ferrum.  Leucorrhcea  like watery  milk,  smarting  and  corroding
when first  appearing.
  Gelseminum. White  leucorrhoea; heaviness and fullness  in  uterine
region;  aching across bottom  of back.   In gushes day  and night.
Constipation.
  Graphites. Profuse leucorrhoea ; also great weakness  in the small of
the back.  Great lassitude.
  Hedeoma. Yellow leucorrhcea, causing itching, burning and ex-
coriation.
  Helonias. Leucorrhoea, with pain  in the  lower part of  the back,
soreness  and tenderness of the breasts  and nipples, particularly at the
catamenial period.
  Hydrastis. Yellow leucorrhcea, of a very tenacious character;  long
threads or pieces in it; sometimes offensive.
  Hepar s. c. Leucorrhcea, with smarting of the vulva.
  Hypericum  perf.  Leucorrhoea, with delayed  menses, palpitation  of
the heart, pressure in the small  of the back and heaviness in the lower
part of the bowels.
  Ignatia.  Violent labor-like pains, followed by a purulent, corrosive
leucorrhcea.   Low-spirited women, who  sigh  a  great  deal.  Weak
feeling at the pit of the stomach.
  Iodine.   Leucorrhcea, corrosive  even of the  thighs and  the linen.
The leucorrhcea.is aggravated at the menstrual period.
  Kali bi.  Leucorrhcea which may be drawn out  in long strings.  It
is often yellow, stiff and ropy. 
648      DISEASES AND DERANGEMENTS OF  THE  UTERUS.
  Kali carb.  Yellowish leucorrhcea, with  itching and burning in the
vulva.
  Kali hyd.  Thin, watery or acrid, corrosive leucorrhcea, with itching
in the vulva.
  Lachesis.  Leucorrhcea from three to eight days before  the menses
copious, smarting, slimy, stiffening the linen and staining it green ■
also in cases where the menses are too short and feeble, although they
appear at the regular time.
  Leptandria.  Leucorrhcea, with ulceration  of the os uteri; " it is
sometimes foetid, with shreds of mucous lining in it;  irritation of the
bladder  and rectum;  frequent pain at  the bottom of  the bowels;
general languor and prostration; heat and dryness of the skin."
  Lilium tig.  Thin acrid discharge, leaving  a brown stain.  Yellow
leucorrhoea  after the  menses.   It seems necessary to support the gen-
ital organs by pressing upward  with  the hand.
  Lycopodium. Profuse leucorrhcea at intervals;  it may be milky; it
may be blood-red, particularly before the  full moon.   The great cha-
racteristic is a cutting pain, attending the  leucorrhoea, across the hypo-
gastrium from right to left.
  Magnesia mur.  Leucorrhcea  immediately  after every stool, if the
btool be hard and crumbling as it escapes from the verge of the anus.
Leucorrhcea at intervals,  followed immediately by discharge of blood..
  Manganese. In women  whose bones are affected in a manner to be
very sensitive to the touch.
  Mercurius. Leucorrhoea ahvays worse at night; it may be itching,
burning,  smarting,  corroding,  with sensation  of rawness,  but the
symptoms are always worse at night.  Discharges of flocks, pus and
mucus as large as hazel-nuts.  Dissatisfied, fault-finding.
  Mezereum. Albuminous leucorrhoea, chronic and malignant.
  Muriatic  acid.  Leucorrhcea,  with  exceeding soreness  of the anus
Irom piles or from fissures.  Cannot bear  the slightest touch upon the
anus, wliich often itches violently, and is not relieved by scratching.
   Nat. carb. Leucorrhoea  yellowish;  putrid  leucorrhcea, ceasing after
urination.
   Nat. mur.  Leucorrhcea early  in the morning after colic; it may be
transparent, white, thick  mucus.  Greenish leucorrhcea,  particularly
when walking.
   Nitrum.  White leucorrhcea, with lameness in the small of the back.
   Nicolum.  Profuse, watery  leucorrhcea, particularly after urinating.
   Nitric acid.  Leucorrhcea consisting of mucus which can be drawn
out; flesh-colored ; leucorrhcea of greenish mucus; cherry-brown and
foetid leucorrhcea. 
REMEDIES  FOR  LEUCORRHCEA.
649
  Nux mosch. Leucorrhcea of women who always awaken with a very
dry tongue.
  Nux vom.  Foetid leucorrhcea, tinging the linen yellow.
  Petroleum.  Profuse  leucorrhcea  every day; also with  lascivious
dreams at night.
  Phosphorus.  Smarting  leucorrhoea, drawing blisters.   Profuse leu-
corrhcea,  with great sense of  weakness in the abdomen.   The leucor-
hcea is often corrosive.
  Phosphoric acid. Profuse, yellowish leucorrhcea, with itching, some
days after the menses.  Leucorrhoea after the menses.
  Platina. Albuminous leucorrhcea only in the daytime, particularly
in women who have difficult stools  from the glutinous nature of the
excrements.   Horrifying thoughts.
  Plumbum.  Leucorrhcea, with a continued sense of drawing in from
the  abdomen to the back.
  Podophyllum. Leucorrhcea  consisting of thick, transparent mucus.
Leucorrhcea, with constipation and bearing  down  in  the genital
organs.
  Prunus spinosa.  Leucorrhcea, making the parts sore and tinging the
linen yellow.
  Pulsatilla. Burning leucorrhoea, thin and acrid.  Milky leucorrhcea,
with swelling of the vulva, particularly after the menses.   Leucorrhcea
of thick, white mucus, especially when lying, or before and during the
menses, with cutting in the abdomen.
  Ranun  bulb. Leucorrhcea  at first mild, afterward acrid and  cor-
rosive.                                     •
  Ruta g. Corrosive leucorrhcea after suppression of the "menses.
  Sabina. Yellowish, ichorous, foetid leucorrhoea and painful discharges
of foetid blood every two weeks.  Leucorrhcea after suppression of the
menses, inclining  to  be  corrosive.  Leucorrhcea, with itching of the
pudendum.   " Corrosive  leucorrhcea, making  the thighs  sore, and
causing intense itching during pregnancy and after delivery."
  Sanguinaria c.   Leucorrhcea of the climacteric period;  it continues
after the menses have ceased.
  Sarsaparilla.  Leucorrhcea  on walking, particularly in  women who
have a sharp pain in the  urethra at the close of urination.
  Secale corn.  Leucorrhcea in  thin scrawny women with  prolapsus
uteri.
  Sepia.  Leucorrhcea, with stitches in the neck of  the uterus.  Leu-
corrhcea,  wiih  much itching  in  the vagina.   Sanguineous-mucous,
yellowish, watery  or mucous  leucorrhcea.  Discharge  of  green-red 
 650      DISEASES AND DERANGEMENTS OF THE UTERUS.

 fluid from  the vagina  during pregnancy.   Leucorrhcea  worse after
 urinating.  Leucorrhcea like pus, like milk, flowing only in the day-
 time, excoriating  the  thighs.  Profuse mucous  leucorrhcea, having a
 fcetid smell, with  drawing pains in the abdomen.
   Silicia. A painful smarting  leucorrhcea after taking acids.  Leu-
 corrhcea  during  urination.   Milky leucorrhcea in  paroxysms, pre-
 ceded by cutting around the umbilicus.
   Stannum. Leucorrhcea,  with  great  loss  of  strength;  it may be
 transparent mucus, it  may be yellowish.  Chest weak in talking.
   Strontiana.  Leucorrhcea while walking.
   Sulphur.  Leucorrhcea smarting like salt.   Leucorrhcea preceded by
 colic   Burning and painful leucorrhcea, making the vulva sore.
   Sulphuric acid.  Leucorrhcea of sanguineous mucus, with a sensation
 as if the menses  would appear.   Milky or transparent leucorrhoea,
 without sensation. Very weak, with sensation of trembling all over;
 the weaker she feels the more she trembles.
   Tabacum. Leucorrhcea of serous liquid after the  menses.
   Tart. em.  Leucorrhcea consisting of watery blood, liable to occur in
 paroxysms; worse when sitting.
   Trillium.  Leucorrhcea, " fcetid,  yellowish, of the consistency  of
 cream ;" often  excessive, and  weakening the patient.
   Zinc.  Leucorrhcea of bloody  mucus after the menses,  causing  an
 itching.   Cutting colic, succeeded  by leucorrhcea.   Leucorrhoea con-
 sisting of thick mucus for three days before and after the menses.
   Zizia. " Leucorrhcea, with retarded or suppressed menses; it may be
 acrid or bland and profuse;  the  menses may set in for one day, then
 stop, and be  followed by leucorrhcea, at first  acrid and afterward
 bland and copious; chronic leucorrhcea, attended by irritation of the
 spine or brain."

                             Metritis.
   True parenchymatous metritis, or inflammation of the deeper tissue
and substance of the womb, is a disease comparatively rare.  It must
be distinguished from endometritis, or inflammation of the mucous
coat  of the womb, which has  just been  described,  and also from
peritoneal metritis, or  more  properly puerperal peritonitis,  inflam-
mation of the peritoneal or serous  coat of the womb and peritoneum
generally.   This latter  disorder usually arises subsequent to  partu-
rition, and has received attention in its proper place.
   Inflammation of the womb may be acute or chronic, and in either
form may attack  the  uterus  in  each of the different conditions  of 
metritis.
651
 female life.  It maybe confined to the cervix uteri—as in fact it is in
 a great proportion of the cases, especially in the chronic form—or it
 may extend also to the fundus.  It may be restricted to the proper
 tissue  or substance of the  uterus, or  it  may also involve  either its
 serous covering or its mucous  lining, or both.  Acute inflammation
 of the uterus is seldom seen before puberty—never, perhaps, except
 as the consequence of mechanical injury.  It very seldom appears in
 the virgin uterus,  during pregnancy, or after the change of life.  It
 is much more common  in the  married state and in connection with
 parturition.  Rokitansky is  of the  opinion that in acute metritis the
 mucous lining is  affected primarily, and that "this is scarcely ever
 the case with the uterine tissue, as far as can be demonstrated by the
 pathological anatomist, with the exception of the reaction  following
 traumatic influences, especially of the  vaginal portion."
    The causes  of inflammation  of the womb  are  similar in  the acute
 and in the chronic form, and they are  here enumerated in common to
 avoid repetition.   Among the  most frequent causes—especially those
 which influence unmarried women—may be  ranked exposure  to cold
 while  menstruating, and consequent sudden suppression of the men-
 strual flow, and exposure to cold soon  after the monthly period, when,
 although the menses have subsided, the womb still remains in a highly
 congested and excessively sensitive condition.  Great physical exer-
 tion,  such   as walking,  during the monthly period  may  result in
 inflammation of the womb;  excessive  or violent sexual intercourse;
 the use of cold water or astringent or irritating injections; the exten-
 sion of disease from the vagina or from the ovaries; wounds, violence
 or mechanical injuries of any  kind;   foreign bodies in the  uterus;
 polypi, tumors or other adventitious growths may induce inflamma-
 tions of different degrees of violence in different constitutions and in
 the different conditions of female life.
   Exposure to cold and taking cold soon after child-bearing are the
 most  common  causes of acute metritis;  and the inflammation which
 results in such cases, especially if complicated with suppression of the
 lochial discharge, may prove rapidly fatal.  This  is  a much more
 severe and dangerous complication than suppression of the menstrual
 flow, since it may lead directly to uterine phlebitis.
   Still another form of exposure to cold—or rather the taking cold
 in another  variety of  cases—deserves .especial mention here,  both
 from  the frequency of  the  occurrence of such cases and  from the
•almost invariably fatal nature of their termination.   These  are cases
 —lamentably frequent in these times—in which what is called " an 
 652      diseases  and  derangements of the uterus.

 operation" has been performed  in  the  early states of pregnane* fut
 the purpose  of inducing abortion.   Here the violence offered to the
 parts, aggravated by exposure and  over-exertion in traveling—often
 unavoidable  in such cases—not unfrequently brings on inflammation
 whose approach is  marked  by  very severe chills, accompanied by
 intense  anguish, excessive  tenderness  of the abdomen, rapidly in-
 creasing prostration, and followed  by death, sometimes  in  seventy-
 two hours.   In such cases the inflammation involves the serous coat
 of  the  womb, constituting a true  peritoneal metritis of  the most
 violent  form, and of a character very closely allied to traumatic ery-
 sipelas.
  Such are the formidable dangers wliich attend this violation of the
 laws of God and man.  In her  hour of extreme peril, in the  midst
 of the most intense physical suffering and distress of mind, and in the
 immediate prospect  of eternity,  the dismayed  female confesses  her
 own crime and reveals the name  of the person,  often a practicing
 physician, but  sometimes a male or female abortionist, who, under-
 taking  to commit  infanticide only, becomes involved in a double
 murder; for in  the eye of the  law whoever engages  in a  criminal
 act  becomes responsible for all the  consequences of his undertaking, how-
 ever little some of them may  have been  expected or desired.
  There are  men who assume the sacred profession of physician,  not
 to save but to destroy life, who,  in  defiance  of all  human and of all
 divine law, strew their pathway,  not with living flowers, but  with the
 withered blossoms, the shattered  wrecks and crushed remains of em-
 bryonic life—monsters in  human form, fiendish ghouls, who devour
 little children, who  live by the slaughter of the innocents, and wdio
 qualify themselves for their future  and eternal  state  by this lifelong
destruction of  such  as are of the  kingdom of Heaven.  The mur-
 derer of a single  individual we execute or seclude for life, but before
such a  murderer by wdiolesale and by profession,  before such  a  de-
stroyer  of entire generations, human  justice stands  appalled, and,
 mournfully conscious of the  utter  insufficiency of  all human means
 to arrest or to  punish this gigantic  social evil, sadly and sternly bids
 the  unrepentant destroyer of "these little ones" fill up the  measure
 of his crimes and await the dread summons of the Eternal Judge.
  Symptoms.—The first  symptoms  which indicate the  accession of
 acute inflammation of the womb  are similar  to those of endometritis,
 but more  severe.  Thus we find  rigors followed by feverisbness, heat
 in the pelvic region, deep-seated pain  in the vagina, paroxysms oft
 pains in the back, which dart through  to the symphysis pubis, and 
metritis.
653
 extend to the groins, t.nd even down the thighs.  The constant pain
 is less severe, but  is aggravated  by coughing and  sneezing, and is
 accompanied by a sensation of bearing down ; there is  also usually a
 painful sense of weight in the pelvis.  The pelvic pain is usually accom-
 panied by vesical and rectal tenesmus.  These are the most prominent
 symptoms where the cervix is principally affected.
   But where  the  inflammation extends to the  fundus, there is also
 pain in the hypogastric region, which is tender to the touch.  In this
 case there is  often  a complication  of the  inflammation of the sub-
 stance of the womb with that of its  outer or peritoneal coat.   The
 hypogastrium is excessively sensitive, the painfulness is greatly aggra-
 vated by the least  movement or pressure upon the parts, and  the
 febrile condition is far more general and severe.  The disorder extends
 by contiguity or  sympathy to the  neighboring organs, and there is
 tenesmus of the rectum and difficult and  painful micturition.   The
 pains are of that sharp, lancinating character, and aggravated by the
 least  motion, which is  so peculiar to  inflammation of  the  serous
 tissues.  The pulse is quick, full and hard ; the skin hot and dry; the
 thirst may be extreme; the bowels constipated; the stomach irritable;
 the tongue dry and furred; and there is often a disposition to faint,
 especially on sitting up.   Headache may also be present, with redness
 of  the cheeks  and  flushing  of the  face, disposition to  delirium,
 twitching of the tendons,  and alarming collapse of the vital forces.
 This  accession  of what is called the typhoid condition  presents a
 formidable  group of symptoms, which may appear in  metritis  occa-
 sioned by sudden and severe repression of the menstrual  flux, with
 reabsorption, perhaps, of matters which should have .been eliminated.
 In  such cases the return of the menstrual flow indicates a favorable
 change in the condition of the patient.  But the appearance of  the
 menstrual flow  in inflammation  of the uterus  from  other causes,
 whether complicated with  peritonitis  or not, is not  regarded as a
 favorable sign.
  The physical signs of acute metritis are—sensitiveness to pressure
 on  the abdomen  over the  region of the womb; the cervix uteri is
 found, upon  examination with the speculum  of by vaginal touch, to
 be swollen and the os gaping;  pressure  upon the cervix or upon  the
 body of the womb, when made through the fornix vagina?, gives rise
 to excessive pain; the vagina is usually hot and dry, unless endome-
 tritis coexists, in which  case the  usual secretion consequent on that
condition will be found to be present.  Acute metritis may be con-
founded with active congestion  of the  organ, or with  pelvic  peri- 
654      DISEASES AND DERANGEMENTS  OF THE UTERUS.

tonitis, cellulitis  or endometritis.   It can only be diagnosed  from tne
first named of  these conditions  by the progress of the case.  It may
be known from  pelvic  peritonitis, according  to  Dr. Thomas, by
"mobility of the  uterus,  which  would  be fixed if it existed; by
sensitiveness  being confined  to  the uterus, and not existing over the
pelvis, and by the enlargement and tenderness of the os and cervix."
From cellulitis it may be known, according to the same authority
" by  absence  of a phlegmonous, tender mass in one broad ligament or
near the  uterus."  If the case be one of  endometritis, " it ,vill be
known by the  fact that the  uterus will not be  found so markedly
enlarged,  nor so  exquisitely  sensitive  upon pressure; the constitu-
tional signs will  not be so grave,  and there will  be  the peculiar dis-
charges marking  this disease."
  The very great amount of nervous organization connected with the
womb, and the intimate relation and profound sympathy of this organ
with the great nervous centres, render inflammation  of its substance a
very grave disease.  And the severe headache,  vanishing  of sight,
and even diminution of hearing, nausea, vomiting, excessive  debility,
fainting turns  and other important constitutional  symptoms which
may appear in  such cases, indicate the serious  nature of the affection
itself and the extent of its influence over the entire system.  In the
advanced  stages  of the more severe forms we find tympanitis, hic-
cough, low delirium, coldness  of the extremities and discharge of
offensive sanies from the vagina.  These symptoms, especially  if
developed  in  spite  of  proper  homoeopathic   treatment,  indicate
approaching  dissolution.
  Termination ov Consequences.—I. Acute metritis may terminate in
resolution  or simple  abatement of the  symptoms, and this mode of
termination is often seen under homoeopathic medication.  The fever
runs a rapid course, especially in  its  severer forms, and where its
progress  is not arrested by the  appropriate  treatment, it may destroy
life in three days, or even in two, or in cases of less intense severity
it may prove fatal  at the  end of  one week  or more.  In these con-
tinued uterine fevers the consequences of the fever may destroy life
after the  original  disease has  subsided.  Intermediate between the
prompt recovery and the fatal termination of the  case from the sever-
ity of the  primary inflammation are various forms  of  disease, which
may  be regarded  as the consequences  of the original disorder, and
which may either destroy life or  establish themselves as varieties of
chronic disease of the womb.   It may also terminate  in the forma-
tion of abscess. 
METRITIS.
655
  II. Hypertrophy, either with  or  without induration, we  find
among  the  immediate  consequences of  acute inflammation.   The
hypertrophied womb usually attains  to  twice its  natural size, or
even  more.   This  increase  in size is  of course  accompanied with
increased  weight, and of course affects  the  position of  the womb
in the pelvis, and  its relation with the  other  pelvic organs.  This
actual thickening of the substance of the walls of the uterus must not
he confounded with physometra or uterine tympanitis.
  A certain amount of induration usually appears in connection with
hypertrophy of the womb.   This is the common result of inflamma-
tion, particularly of the cervix, and especially where this part of the
uterus has been subjected to frequent inflammatory attacks.  Indura-
tion is said to be  simply the result of a bygone inflammation, but it is
usually the consequent of such inflammatory action as is accompanied
by hypertrophy or permanent thickening of the cervix, and so of those
cases which assume the  chronic  form of metritis.   This condition is
very rare in the young and unmarried, but not uncommon after mat-
rimony.  Induration may be, as above stated, the simple result of
repeated inflammation, or it may be the  primary  stage of scirrhous
hardening and cancerous ulceration.
   III.  Softening  of the walls of the  womb, or ramollissement, is
another and more grave sequence of inflammation.  This is sometimes
found to be the condition of the uterus in  women who  have diedTjf
acute inflammation of this organ.  The tissues of  the uterus in such
cases are found  dark-red,  swollen, softened  and  friable, with even
disposition to gangrene from decomposition of the unhealthy (puru-
lent) blood with  which these tissues are engorged.
   IV.  Gangrene  is a more rare but necessarily fatal termination
of acute metritis.  This may result directly from  violent  inflamma-
tion, and occurs at  any period from the third or fourth to the seventh
or eighth day.   It may result from such inflammation as occurs in
consequence of strangulation of the uterus in cases of procidentia,
from the  death and consequent decomposition of the foetus in utero, or
finally  it  may appear in connection with phagedenic ulcers which oc-
cupy the inner surface of the womb.   Only the former of these three
causes of gangrene concerns us at'present, but it seems best to give a
complete  picture of this rare form of uterine disorganization while
under consideration. This gangrene generally begins  in  the cervix,
and is confined to it.  According to the authorities, it is  impossible to
detect this form of disease before it terminates in death, since the ces-
sation of the pain  and of the fcetid discharge from the vagina may 
656      DISEASES  AND DERANGEMENTS OF THE UTERUS.

occur from other and independent causes.   But a careful study of the
symptoms  present, and a  faithful  application of the corresponding
homoeopathic  remedies, will enable  the  physician to do  all  that
human means can  accomplish to arrest the mischief, even if he docs
not certainly  know that  such  disorganization is imminent.  "The
pulse is low, quick, concentrated; the patients are seized with shiver-
ings, startings, and  even convulsive shakings of the body, without anj
apparent cause; and at the same time they cease to feel any pain in
the uterus, or  but a less degree; they fall into a state of oppression or
extraordinary  uneasiness, which is but little short of fainting, and the
extremities  become so cold that scarcely any Avarmth can be detected
in them."   Such is the description, given from actual observation, of
uterine  gangrene.  As the disease  advances  other and  still graver
symptoms  appear,  which  threaten the speedy  close  of life if not
promptly arrested : from the vagina is discharged a brownish liquid
of exceedingly fcetid odor, a cadaverous-smelling diarrhcea sets  in,
and  cold, clammy perspiration appears over the wdiole bodv, or on
some parts of  it only, the features change, and the patient sinks  into
a prolonged coma, with or without  delirium.   With symptoms so
strongly marked  the  physician would  have no difficulty in  selecting
the proper  remedy.  Whether this wrould prove sufficient  to arrest
the disorganization would  depend upon how much progress it had
already attained  and upon the constitutional strength  of the patient.
In some cases of gangrene of the uterus this  organ has been known
to become detached from the body, expelled through  the vagina, and
the patient nevertheless survive this terrible accident.*
  V. Pus may be infiltrated into the tissue of the uterus where the
inflammation  is  very severe; and  the reabsorption of this  purulent
formation, especially in cases of puerperal  inflammation, gives rise to
uterine phlebitis.^  In this  case both the  veins  and the  lymphatics
become the receptacles of the puriform   matter, which, lodging in
them in different places, leads to the formation of fresh abscesses.
  V. Effusion of coagulable  lymph  is another consequence of
acute metritis, especially in those cases in which the serous coat of the
uterus is involved.   The adhesions which result from the coagulation
of this serous  effusion, by confining the ovaries and especially the fim-
briated extremities of the Fallopian  tubes to the neighboring parts,
may become the  occasion  of sterility or of extra-uterine  pregnancy,
preventing these extremities from embracing the ovaries.
   Acute metritis, which occurs  in pregnancy from whatever cause,
   * Jahr on Diseases of Females.               f See Puerperal Peritmitis. 
          AREOLAR HYPERPLASIA—CHRONIC METRITIS.       657

 will  commonly result in the death of the foetus, and the secondary
 inflammation of a very low form which is  slowly  developed  in  the
 womb in consequence of  the retention of  such blighted embryos may
 even lead to the death of the mother.  So intimate and profound is
 the sympathy between  the life- of the mother and of the foetus in
 utero, that while the death of the former almost necessarily leads to
 the destruction of the latter, the death of and subsequent putrefaction
 of the  foetus, where  it  is not expelled  from the womb, may result in
 fatal gangrene  of that organ.  .A remarkable deathly look, sunken
 appearance of the eyes and  dark discoloration of the lids, together
 with a  peculiar deathly feeling—malaise—which pervades the entire
 system of the patient without any especial  assignable cause,  may be
 considered ground of suspicion  of the death of the foetus in utero.
 Cases have been known in which  the womb  retained within itself and
 preserved from decomposition a blighted foetus which had attained  the
 age of three months before its death.  In these cases the constitutional
 symptoms attracted attention  to the  examination of the  case before
 any specific indications were  given by uterine pains or vaginal dis-
 charge.   In  such cases the womb may seek to retain the product of
 conception till the full  period, and then throw it off.  Of course  the
 farther advanced  the ovum  is before its vitality  is  lost, the  more
 serious are the  symptoms which ensue if  it  is retained in the womb.
 In many instances  the  product of conception, blighted  in the first
 weeks,  is entirely reabsorbed, or at any rate disposed  of without
 being thrown off externally.

         Areolar  Hyperplasia—Chronic Metritis.
  Dr. T. Gaillard Thomas  describes  the condition known  as chronic
 metritis under the title "Areolar  Hyperplasia, or Diffuse  Interstitial
 Hypertrophy of the  Uterus."  It is a disease  of  nutrition, he says,
 "which very frequently  affects the uterus,  and is  characterized  by
 congestion, hypergenesis of the connective  tissue  of the  organ, and
 hyperesthesia of its  nerves."  This condition has been described  by
 various authors as engorgement,  infarct,  irritable  uterus,  inflamma-
 tory hypertrophy,  and by a variety of other  titles.   Either the entire
 womb may be involved, or, which is the most common form, the dis-
ease may  be limited to the cervical portion;  or, again, the  body alone
may be affected, while the cervix is  nearly normal.  The fact that
this disease occurs most frequently in the cervix may be accounted  for
by this  portion  of the  organ being more exposed to external influ-
ences than is the body or fundus.   It generally results from parturi-
      42 
 658      diseases  and derangements of the uterus.

 tion or  abortion, and is most frequent in  multipara?,  nulliparoua
 women being almost exempt, as well as virgins.
   The  causes of  chronic metritis, or hypertrophy of the connective
 tissue of  the uterus, are predisposing and exciting.   The first named
 are—constitutional taint; long-continued nervous or physical prostra-
 tion or general  debility;  childbirth, or  imprudence during convales-
 cence from childbirth ; and puerperal peritonitis.  The exciting causes
 are generally connected  with parturition or abortion.  The disease
 may result from the subsidence of an acute inflammatory attack of
 the lining membrane or parenchyma of the womb.
   The  symptoms of this disease are multiform.   They are not only
 due to the pathological condition of the uterus, per se, but very many
 of the  most troublesome features of such cases are due to a sudden
 blazing up, as it were, of the smouldering inflammatory fire with which
 the course of  the disease is occasionally marked;  to displacements of
 the organ, to  which its increased bulk and weight necessarily render
 it  liable; to  the  pressure  of the  enlarged  and  heavy womb upon
 the pelvic viscera and nerves.  Dr. Thomas gives the following enu-
 meration  of these symptoms, all of which, however, are not present
 in every case: " If  the cervix alone be affected there are—pain in
 back and  loins;  pressure on bladder or rectum ; disordered menstrua-
 tion ; difficulty of locomotion; nervous disorder;  pain on sexual in-
 tercourse; dyspepsia, headache  and languor; leucorrhcea from sec-
 ondary  endometritis, or granular degeneration of  mucous  membrane.
 If the disease be general or corporeal, the symptoms generally resem-
 ble very closely  those of corporeal endometritis.  The following are'
 especially indicative of the affection: A dull, heavy, dragging pain
through the pelvis, much increased by locomotion; pain on defecation
and coition; dull pain, beginning several days before menstruation,and
 lasting  during that  process; pain in the mammae before and during
menstruation; darkening of the areolae of the breasts; nausea and vom-
 iting ; great nervous disturbance; pressure on the rectum, with tenes-
 mus and haemorrhoids; pressure on the bladder, with vesical tenesmus.
  Vaginal touch  will  generally discover that the  uterus, in conse-
quence  of its  abnormal weight, has descended in  the pelvis, and  is
 perhaps lying  upon the muscles of the perineum.    The cervical por-
tion will  be found to be more or less enlarged and painful on pres-
sure, while the os is  usually gaping to the extent, perhaps, of admit-
ting the tip of the finger.   Pressure upon the cervix will give rise to
considerable pain, and if the finger be passed high up into the rectum
and  pressure  made  upon the body of the  -womb, an extraordinary 
         AREOLAR  HYPERPLASIA—CHRONIC  METRITIS.        659

decree of sensitiveness will be discovered ;  the pain produced in some
cases occasioning fainting.   The womb is  almost ahvays displaced—
usually retroverted.   The use of the uterine probe will  show with a
sufficient degree of accuracy the extent to which the enlargement of
the womb has progressed, as well as reveal the degree  of sensitive-
ness  of the  uterine walls.   In  some cases the cervix is enlarged to
such an extent as to act as  a foreign  body in the pelvis, giving rise to
treat inconvenience of locomotion, constipation, and rectal tenesmus
and vesical derangements of various kinds.
   It is important that this disease be distinguished from cancer in its
earlier  stages.   A careful examination and comparison of  all the
symptoms, subjective and  objective,  will  enable a differential  diag-
nosis to be made.   The cancer cachexia is not manifest in chronic
metritis; there is a tendency to amenorrhcea in this disease, while in
cancer  of the womb the  tendency  is to  menorrhagia  and  uterine
hemorrhage;  and again in chronic metritis  the enlarged cervix feels
like  dense fibrous tissue, while in cancer (scirrhus)  the cervical  tissue
feels like cartilage.   On this point of differential diagnosis Dr.  Lud-
lam writes: "I have several times resorted to an  expedient that has
helped  me  to settle the diagnosis between them.   You will  do no
harm by trying it.   It is  simply to  use the cotton tampon  saturated
with pure glycerine.   If the enlargement is due to plain,  uncompli-
cated cervicitis, the depletion by means of the glycerine will soon less-
en the  size  of the  uterine  cervix  very perceptibly.   If,  however, the
swollen state  of the  cervix arises from cancerous infiltration or from
an interstitial fibroid, the glycerine will not sensibly diminish its bulk." *
   The prognosis of this  disease is not very cheering.   It may con-
tinue for years, and be  relieved  at  the cessation of  the  menstrual
function, or  it may even  be cured spontaneously  before the  change
of life  sets  in.  On the other hand, a more serious  form of organic
disease may grow out of it when this period arrives.  It may occasion
serious cardiac, pulmonary or other forms of disease,  under which the
patient  may sink.    A proper  attention  to diet, position  and  other
hygienic measures,  and a careful selection of remedies, however, may
in very many instances, and especially where there are but few  or no
serious complications, bring about a restoration of health.  " It is quite
as important to prescribe the proper posture for this  class of patients
as it is in cases of acute cervical metritis.  Keep them in  a  horizontal or
reclining posture, and off their  feet, at the month  especially.   Shop-
ping, visiting,  party-going  are as injurious as a journey ly rail  or an
           *Ludlam's Lectures, Clinical and Didactic, ttc,  p. 572. 
660      DISEASES AND  DERANGEMENTS OF THE UTERUS.

excursion on  horseback.  Such a  patient should  let  her  sewing-
machine rest and her servants take care of themselves."—Ludlam.

         Treatment  of Acute and Chronic  Metritis.
  In cases  of acute metritis absolute rest in  bed,  upon the back
should  be  insisted upon.  The patient  should not be  allowed  to
get up  upon any pretext, not  even for  the  purpose of evacuating
the bladder or rectum.   In chronic cases, as is remarked above while
absolute continued recumbency is not necessary,  it should  be enjoined
during the menstrual period, and comparative quietude should be ob-
served at all other times.
  1. Aeon., Apis,  Bell., Bry.,  Canth., Cham., Coloe,  Kali  carb.
Lach., Nux vom., Puis., Sabina,  Sepia.  2. Ars.,  Carb an., Con.,
Hyos., Merc, sol., Lye, Rhus tox., Sulph.  3. Arn., Calc. carb., Carbo
veg., Chin., Cocc, Coff., Creas., Crocus, Ferr.,  Graph., Hep., Ignat,,
Ipec, Jod.,  Magn. mur., Opium, Phos ac, Sec  corn., Stram.

  Aconite. This remedy is useful where there is  a real synochal fever,
hard, rapid  pulse, hot, dry skin, intense thirst;  sharp shooting pains
in the whole abdomen, which is very tender to the touch.
  Apis  mel. Stinging, thrusting  pains, similar to  those arising from
the sting of a  bee.   Absence of thirst.   Urine scanty.  Dyspnoea.
  Arnica. In cases where the inflammation has been caused by a bruise
or a  concussion.
  Arsenicum.  Burning, throbbing,  lancinating  pains; burning like
fire.   Great restlessness  and anguish, with fear  of death.   She  is
sure she will die.  Thirst for frequent sips of water, only a little  at
a time.   Cold water aggravates  her  symptoms.  She wants more cov-
ering over her—wants to be wrapped up.
  Belladonna.  The pains  are sudden, coming on quickly, and ceasing
as quickly after continuing a longer or shorter time.  Or there are
clutching pains, as from  clawing with the nails.   Pressure as if all
the parts would issue through the vulva.  Throbbing headache, with
heat, red face  and eyes, and  throbbing of the carotids.  Involuntary
flow of urine.   Furious delirium.  The menstrual or  lochial dis-
charges  suppressed or very offensive.  The parts  are very sensitive;
she cannot bear the least touch or a jar of the bed even.
   Bryonia.  The  least motion aggravates  her sufferings.  Her head
aches as if it would split open.   Sitting up  (as  if in bed) causes
nausea  and fainting.  Lips  parched and dry;  mouth dry, and very
thiisty.  Constipation, the stools being hard and dry as if burnt. 
        treatment of acute and chronic  metritis.      661

  Calcarea carb. This remedy will often be found indicated in persons
of leucophlegmatic constitution.   The feet feel cold and clamp.   The
head and upper part of the  body are in a profuse perspiration; con-
stant aching in the vagina.   Thirst for cold water, worse at night.
Pulse tremulous, or full and  accelerated.  Stitches in the neck of the
uterus.   The history of her case shows that her menses have been too
profuse, and returned too often or too soon.
  Cantharis.  Frequent and  almost continual desire  to urinate, in-
effectual, or with cutting, burning pain, and passing a few drops only
at a time, which are often mixed with blood.  Burning in the uterine
region.   The urinary symptoms are of the greatest importance in de-
termining  upon the selection of this remedy.
  Carbo animal. In cases of chronic or subacute metritis.   Inefficient
urging to urinate, with painful pressure in the loins, groins and thighs.
Great sense of soreness in the pit of the stomach.  General sense of
lassitude.  Leucorrhcea, coloring the linen yellow.
  Carbo veg. Much soreness  about the vulva, with aphthm.  Aching
or pinching in the iliac regions.   Languor, weariness  and physical
depression  toward  noon,  with  faintness  and  hunger.   Flatulence,
momentary relief  from eructations or downward  emissions.   She
wants to be fanned.
  Chamomilla.  In cases of inflammation which come on in  connection
with a  fit of passion.   Heat all  over, with thirst and redness of the
face; one  side of the face red,  the  other being  pale.  Great  impa-
tience;  she can hardly restrain herself to patience and to treat people
with civility.  Urine abundant and light-colored.
  China. Tbe inflammation has supervened upon  great loss of blood.
She suffers from distension and oppression of the abdomen, wdiich is
not relieved by eructations.   Much  ringing in the ears.   The suffer-
ings are increased by the least touch.  Painless diarrhcea.
  Cocculus.  Much paralytic  pain in the back  and paralysis of-the
lower extremities.  Sensation as  of sharp stones  in the abdomen on
motion.   Head and  face hot,  feet cold.   Pulse hard  and small.
Metallic taste  in the mouth.   Intense  thirst or  aversion to drink.
Shivering over the mammae.
  Coffea. In cases where the inflammation  is  induced by excessive
joy; she is in a state of ecstasy,  and is very sensitive to contact.
  Colocynth. Inflammation, which comes on in consequence of violent
indignation.   Severe colicky pains, causing her to bend double, with
great restlessness.   Cutting  as  from knives in the  bowels, with great
distress,  distension of the abdomen; diarrhoea, whi di is aggravated by 
662      DISEASES AND  DERANGEMENTS OF  THE  UTERUS.

everything which is eaten or drunk.  Feeling in the whole abdomen
as if the intestines  were being  squeezed between stones.  Full, quick
pulse; great thirst; bitter taste in the mouth.
   Conium. Burning, sore, aching sensation in the region of the uterus.
The urine intermits in its flow.   Much vertigo, particularly on turn-
ing over while  lying down.  She  usually has a bitter taste in her
mouth, and  thirst.   The pulse  is  unequal.   Some  pulsations are
smaller than others.  The pulse is also irregular; sometimes it beats
slower, sometimes faster.
   Creosote. Stitches in the  vagina,  proceeding  from  the  abdomen,
causing  her  to  start at every pain.   Putrid, acrid, corrosive leucor-
rhcea.  A low form of fever.  Putrid fever.
   Crocus. Black, stringy discharge from the uterus, rolling and bound-
ing in the abdomen as from  a foetus.  Stitches in the abdomen arrest-
ing the respiration.
   Ferrum. Fiery red  face.   The  bowels feel sore on touching them,
as if  they had been bruised  or weakened by cathartics.  Leucorrhoea
resembling watery  milk.
   Graphites.  Particularly when the ovaries  are affected.  Eruptions,
tetters and excoriations on various parts of the body.   A tendency to
obesity.
   Hepar  s. c. Particularly where  there is evidence  of a tendency to
suppuration.  Burning, throbbing pain; chilliness.
   Hyoscyamus.  Especially if the  inflammation be developed by emo-
tional disturbances.  If there  appear spasmodic symptoms—-jerks of
the extremities, face  and eyelids, etc   In cases  which  hill into the
typhoid  state with  delirium; the patient throws off the bed-clothes;
she wishes to be naked.
   Ignatia. Cramps  with  lancinations;  the  pains  are aggravated or
renewed, particularly on  touching the parts.   The woman is appar-
ently full of suppressed grief.   There is  sorrow and sighing.  An
empty feeling at the pit of the stomach.
   Ipecac. The patient suffers  with a continual nausea; every move-
ment is  attended with  a cutting pain almost constant, running from
left to right.  Pain about the umbilicus, extending toward the uterus.
A continual  discharge of bright-red blood from the  uterus.  Rapid
pulse, with or without thirst.
   Jodium. Acute pain in  the mammae, developed  by the inflammation
of the uterus;   the mammae also become very sore.   There is a low,
cachectic state of the system, with feeble pulse.
   Kali carb. Intense  thirst  morning, noon and night continually, 
      TREATMENT OF THE ACUTE AND CHRONIC METRITIS.    663

and  very  rapid  pulse.  Distressing cutting,  shooting,  darting and
stitching  pain all  over the abdomen, the stitching  pains being  in
the ascendency;  the  more completely the  stitching  pains seem  to
predominate the more certainly will Kali  carb. be  the appropriate
remedy.
   Lachesis. She cannot  bear  any pressure, not  even of the clothes,
upon the  uterine region.   She wishes frequently to lift them—not
that the  abdomen is  so very tender, but that  the clothes cause an
uneasiness.  A sensation as if the  pains were ascending toward the
chest.  This remedy is especially indicated in  cases where the inflam-
mation is an  attendant symptom of the critical age.   The pain  in
the uterine region increases till relieved by a flow of blood from the
vagina; not long afterward the same symptoms are repeated.   Ex-
acerbation of the sufferings after every  sleep, whether  by  day or  at
night.
   Lycopodium. Cutting pains  across the  abdomen from  right to left.
Much rumbling  and working in the abdomen, particularly in the left
hypochondrium.   Red sand in the urine.   Much  pain  in the back
previous to the flow of urine.   Dryness in the vagina.  Discharge of
wind from the vagina.
   Magnesia mur* Hysterical complaints and  spasmodic  turns.   Ute-
rine spasms extending to the thighs.  Constipation of large, difficult
stools, which crumble  as they pass the verge of the anus.
   Mercurius. Lancinating, boring or pressing pains.   Much perspira-
tion, which, however,  affords  no relief.   Moist  tongue, often accom-
panied with intense thirst.  She is worse throughout the  night.
   Nux vom.  This remedy  is very frequently  indicated.   Pain  as  if
hruised in the neck of the uterus; frequent  desire to  urinate, with
pain.  Scalding  and  burning.  Frequent and ineffectual  desire  to
defecate, or passing a small quantity of faeces at each attempt.   Much
pain in the small of the back, which is  made worse by attempting  to
turn in bed.  Heaviness and  burning in the abdomen.   Much pain
in the forehead above  the eyes, and fainting spells.  The symptoms
are aggravated after four in the morning.  She  is despondent, sleep-
less,  or dreams frightful dreams.
  Opium.  In cases originating in fright; the  fear  of the fright still
remaining.  Flushed face;  delirium;  soporous.   In her  lucid  inter-
vals she complains of  the sheets being too hot for her. She is sleepy,
but cannot sleep.   Coldness of the  extremities.   Discharge of foetid
matter from the uterus.
  Phosp. acid. In  some  cases of great debility, with great  indiffer- 
664      DISEASES AND DERANGEMENTS OF THE  UTERUS.

ence to all about her.  Meteoristic distension of  the uterus.  Slo\i
fever.
  Platina.  Particularly after confinement if there be excessive sexual
excitement.  Painful pressure in the region of the  mons veneris and
genital  organs.   Voluptuous tingling  in  the  vulva and abdomen.
Profuse discharge  of thick black blood.  Constipation,  the stools
adhering to the anus and rectum.
  Pulsatilla.  In mild, yielding, tearful  temperaments.  Tension and
contraction in the abdomen as if the menses would make their appear-
ance, with  nausea and sometimes  vomiting of mucus.   Semi-lateral
headache;  bad taste in the mouth ;  nothing tastes good.  Absence of
thirst.   Nightly diarrhcea  and scanty urination.
  Rhus tox.  Particularly  after confinement.   Worse at  night, espe-
cially after midnight.   Restlessness; she cannot lie still, but must
change  her  position,  which affords a  few moments' relief.   Slow
fever,  dry tongue.  Powerlessness  of  the  lower limbs; she can
hardly draw them up.
  Sabina.  Especially after  confinement or miscarriage.  Metrorrhagia
of clotted  and fluid blood, with pain extending  from the sacrum or
lumbar region to the pubes.   Severe  stitching  in the vagina from
before backward.   Frequent urging to stool;  finally a liquid portion
is discharged, followed by  a hard portion.
  Secale C  Where there is a strong tendency to putrescence.  The in-
flammation seems to be caused  by suppression of the lochia or menses.
Discharge of thin black blood, a kind of sanies,  with tingling in the
legs  and great debility.
  Sepia. Burning, shooting and stitching  pains  in the  neck of the
uterus.  A constant sense  of pressing into the vagina; she feels that
she must cross her limbs to prevent a  protrusion.   A painful stiff-
ness in the  uterine region.   Sense of  weight in the anus.   Putrid
urine, depositing a clay-like sediment,  which is  difficult to  remove.
Icy coldness of the feet.   A great sense  of emptiness in the pit of the
stomach.
  Stramonium.  The face is bloated with blood.   She awakens with a
shrinking look, as if afraid of the  first object she  sees.  She desires
light and company.   She is disposed to talk continually.  Strange
fancies; she imagines  all sorts of  absurd things—that the bed is full
of creases, or that she is double and lying crosswise, etc.  The head is
often jerked from the pillow, and then falls back  again.
  Sulphur.  The vulva  seems  much  inclined  to become  excoriated
early in the attack.   Frequent flushes of heat, passing off in a little 
             IRRITABLE UTERUS—HYSTERALGIA.             665

moisture and  faintness.   Feet cold, or  with burning soles, so  that
she wishes to find a cold place for them or to put them  out of bed.
Sense of heat in the crown of the  head.  She feels  suffocated; she
wants the doors and windows open.  Very light sleep;  she awakens
very frequently. Weak, fainty spells, occurring frequently during the
day.  After having improved under  other remedies, she gets worse
again until she receives a  dose of Sulphur.  She feels unusually faint,
with strong craving for nourishment from eleven o'clock till twelve
at noon.
  The  remedies  mentioned under the articles on Endometritis  and
Leucorrhcea may  also be consulted with advantage,  more especially
those belonging to the category of  " New Remedies."   It should be
borne  in mind that in the treatment of a case of chronic  metritis a
remedy should be chosen with the utmost care, a due regard  being
paid to the totality of the  symptoms, and its administration continued
for some time, as no improvement can be perceptible at once, and the
rapid changing of medicines might possibly lose to the patient a good
chance  of recovery.

              Irritable Uterus—Hysteralgia.
  The nervous disorders  of the uterus, which in their various  forms
are included  under the  names of Hysteria,  Hysteralgia, Irritable
Uterus, Neuralgia of the  W^omb, etc., present a class  of  cases which,
although  neither structural nor  directly functional, are  no less  im-
portant, both  from the severe sufferings in  which  they principally
consist and from the complications to which they eventually give rise.
Hysteria  has  already  been treated  of in full.  We shall  now  call
attention  to that  painful disorder which is  known  as  Hysteralgia
or  Irritable Uterus,  offering  a  few preliminary remarks,  however,
upon the subject of

                     Nervous Irritation.
  The two different nervous systems of the  human body—the gan-
glionic  and the cerebro-spinal—although distributed to some consider-
able extent to the same  organic structures, possess entirely different
functions and susceptibilities.  Thus, the ganglionic  nervous system
is the one which supplies all the organic structures  and sustains all
the functions  of  the organic and involuntary life, wdiile the  cerebro-
spinal nervous system supplies  the same structures in  their various
degrees with the  still higher  powers  of voluntary action, sensation,
perception and sensibility.  The former has exclusive relation to the 
666     DISEASES AND  DERANGEMENTS OF THE UTERUS.

phenomena of nutrition  and reproduction, and  so  its filaments and
ganglionic connections are distributed more or less palpably to all the
substances and tissues of the body.  The latter has  more especial re-
lation to sensation, volition, perception and sensibility; hence also its
fibres are to be found in nearly all the structures of  the body, even in
those known as involuntary and not directly subject to the voluntary
nervous system.
  Thus,  while the nerves from each of these two great vital centres
are supplied alike to almost every structure or  tissue in the body
those from each  centre  have  their appropriate  and readily distin-
guishable functions.  And  the  disorders which may arise in connec-
tion with the nerves from the ganglionic system are  entirely different
from those which  may arise in connection with  the nerves from the
voluntary  or  cerebro-spinal  system.  In the  former  case we  have
inflammation, congestion, engorgement in  connection  with the circula-
tory apparatus, which is under  the immediate and absolute control of
the organic or involuntary nervous system.   This inflammation may
be active, and it  is then  usually considered to be more immediately
dependent upon excitement of the arterial circulation; or it may be
passive, and it is then supposed to be connected with arrest or stagna-
tion of the venous circulation.  Thus, organic nervous irritation gives
rise  to inflammatory congestion, both active and passive, acute  and
chronic.
  On the other  hand, the  cerebro-spinal irritation gives  rise  to  a
purely nervous congestion;  that is, to one which corresponds in the
nervous  system to the  inflammation  of the  circulation in organic
irritation.  Thus, in disorders which  arise in  connection with the
cerebro-spinal  nervous  system  we have  irritation,  irritability, in-
creased  and  excessive sensibility; and the  susceptibility to  this
painful  irritability is augmented just in proportion  to the extent of
this  form  of nervous development in the particular  structure.  As
where the tissues are most vascular there  may be the most active
inflammation, the most violent congestion,  so  where  the voluntary
and  sensitive nervous filaments are most abundant, there may be the
most excessive irritability, the  most distressing  sensibility.  Such  is
the case  in the most remarkable manner in the  uterus.  In addition
to its necessary relation to the ganglionic nervous system, the womb,
although  not immediately  subject  to the voluntary nervous system,
is alive  with  nervous filaments,  and most intimately connected with the
entire cerebrospinal  nervous system  and sensitive sphere of the whole
female body.   The womb and ovaries are the seat of the highest vital 
NERVOUS IRRITATION.
667
action and funMions  of the  female life;  the highest and holiest joys
and hopes are associated with the healthy condition of these organs
and the proper performance of their functions; and the profoundest
suffering and  the  most extensive and lifelong distress must  neces-
sarily result from the disorder of the nervous system connected with
them and from the impairment of their functional action.
  Inflammation, whether acute  or chronic, active or passive,  involves
some  structural  change, especially  some  more or  less  perceptible
derangement of the arterial  or venous circulation, and is essentially a
disorder of the ganglionic nervous system of organic life.   Irritation,
whether existing in the condition of excessive irritability of the nerves
or of  positive pain, as  in neuralgia, is essentially an affection of the
cerebro-spinal nervous  system,  the nervous apparatus of  animal life.
And as inflammation may exist, even very extensively, without pain,
so pain, or the disorder of the higher nervous system, may exist with-
out inflammation.  Inflammation necessarily involves a certain amount
of structural change of tissue, as in congestion;  but irritation does
not involve change of tissue, except  perhaps such modification of the
substance  of the  nerve itself as is  entirely  beyond  our minutest
scrutiny.  In inflammation the  development of the disorder is always,
perhaps, at the  originally affected part, while in irritation the  sensa-
tion of pain or other evidence of  nervous disorder may be at the
sentient extremity  of the affected nerve, or it may be in  some other
and remote  part.  Inflammatory  congestion leads to effusion or to
suppuration, according to the nature of the tissue which becomes the
seat of the  morbid  action  and  to  the  severity of the action itself.
Irritation  or nervous congestion  may result in irritability, excessive
sensibility,  intense pain, cramps  or spasms  wdiere  the nerves dis-
tributed to  the  muscles are affected, and  finally in paralysis from
exhaustion or collapse  of the nerve-power itself.
  As  too ready susceptibility to inflammation indicates a weakness of
the organic  nervous system, so excessive  irritability indicates  a cor-
responding debility of the cerebro-spinal nervous system. The weaker
the nerves the more sensitive  they  are, and the less can they bear
of opposing influence without being  thrown into a state of excessive
irritability or pure nervous  erethism.  But this form of nervous de-
bility, which leads  to excessive suffering, does  not seem incompatible
with a most remarkable power  of endurance of pain.  Women of deli-
cate constitution  and exceedingly irritable  nervous  system are  often
seen to endure for days and nights  such distressing neuralgias, with
entire loss  of sleep,  as  would  seem  capable  of destroying a strong 
668       DISEASES  AND DERANGEMENTS OF  THE  UTERUS.

man.   Such pains are often seen to come on with suddenness  to con-
tinue  with most intense severity for many hours, and  often finally tc
disappear with equal suddenness, and leave.no  mark or trace of their
long-continued presence.
  But as in those forms of disease which have been referred to as con-
nected with the organic  nervous system pain may precede the acute
inflammatory  action, so in those forms of  purely  nervous disorder
which have been described as irritation the  excessive  sensibility and
distressing irritability may  precede  such  nervous derangement  as
would actually impair the functional action of the  parts.   Thus, we
find in the first stage of a purely nervous  irritation of the uterus no
positive failure of its functions, but only an exceedingly great amount
of pain in their performance.  The menstrual function  may be neither
prevented  nor impaired, otherwise than by an intense and agonizing
pain preceding and  accompanying it; so in coition, especially if the
womb is touched; and so finally in pregnancy, the nervous irritation
may not at first prevent the fulfillment  of  the functions of the uterus,
only rendering them exceedingly painful.  But such irritation cannot
but cause all  these  functions to become more or less impaired in the
course of time.
  These nervous affections may be transitory and evanescent,  or they
may be permanent  and  lifelong, in  accordance with  the  nature of
their  causes.   But  as we have  shown that the irritability of the
nervous  system is  in proportion  to its weakness, so it  will pres-
ently  appear  that debilitating influences  are  among the most fre-
quent causes of this irritation of the uterus; thus complete recovery
can only be possible in those cases  in which  the patients can alto-
gether escape  from  these debilitating influences, and  also have their
dynamic effects entirely remedied and removed  by suitable medication.

Irritable Uterus—Hysteralgia—Neuralgia of the Womb.
  Irritable  Uterus.—In irritable uterus the womb is in a painful
and tender state, is morbidly sensitive and irritable, the least touch or
pressure producing the most exquisite pain, and yet there is no appar-
ent congestion, inflammation or induration.
  The principal symptoms which  may indicate this condition are—
deep-seated pain in the lower part of the abdomen, as if in the pelvis;
aching pain in the back and loins, always present, but sometimes much
more and sometimes less severe.   Upon examination by the touch, or
even  by the speculum where this is  practicable (which is  seldom the
case in this affection), the os and cervix  uteri are found in their normal 
IRRITABLE  uterus.
669
condition, excej it the  remarkable sensitiveness to the touch; and, as
remarked by Dr. Go(/ch, who first described this form of uterine dis-
order as distinct from inflammation, this painful and tender state of
die organ is neither attended by, nor tends to produce, change in its
structure.
  Late writers on female diseases have inclined to  consider irritable
uterus a very rare form of disease.  Thus, Tilt says: " Irritable ute-
rus, a?-  an essential disease independent of inflammation, can only be
hysteralgia, a rare  disease of which I have only seen two instances,
and Scanzoni  three." *  But even if this irritable uterus is but rarely
found as  an original disorder, it is  still  so common, being an almost
universal attendant upon displacements of the womb, and it exerts so
important an influence upon the entire female economy, that  there
is little danger  of  attracting too much attention to it.  And  in fact
under this  general head  are properly enumerated many  conditions
and symptoms  which nosologists might designate by  other names;
but these conditions  and  symptoms are  the very things which make
up the case  of  the patient for whom we wish to prescribe, and not
for  some nosological disease  by which  she may be supposed to be
affected.
  The pain is not confined to the sacral and pubic region;  it is  often
felt in the sides  of the abdomen, in the hips  or in other parts of the
body, or it  may  extend  from the back completely around t& the
groins, the hypogastric region and down the thighs.
  In its nature the pain of irritable uterus is as various as is its seat.
" It is  most frequently described as a duH, aching, wrong feeling in
the back, with more  or less sense of pressure, weight, dead feeling,
heaviness, fatigue  or debility.  Not  unfrequently in the abdomen  it
is a sore pain, a sharp, needle-like, lancinating pain.   With some  it
is mere soreness, and in very many, after the acute character has sub-
sided, soreness remains often so great that the weight of the bed-
clothes becomes troublesome.   In the hips  and down the limbs there
is often the same wrong and dull pain, with a sense of  fatigue and an
inability to move, but sometimes it is sharp, neuralgic and  toothache-
like, and occasionally excites spasmodic and painful action of the hips,
thighs,  etc.   The sensations  are often pulsatile, resembling  those pre-
ceding or accompanying the suppurative stage of inflammation.  This
beating, 'strumming.' vibrating pain is referred to the  womb, vagina,
bladder, rectum, etc., and is often very tormenting.  A burning  sen-
sation, or feelings of  moderate or severe degrees of heat, is not un-
          *  Uterine and Ovarian Inflammation, London, 1862, p. 228. 
670      diseases and derangements  of the uterus.

common in the vagina, the vulva, urethra, sometimes  in the sacral 01
hypogastric regions, over the whole lower part of the abdomeu, and
extending to all the anterior portions of the thighs.  This is  verv dis-
tressing, and sometimes so severe that patients have declared the burn-
ing could not be greater were they to stand perfectly exposed before a
hot fire or if coals of fire were placed within them." *
  In addition to pain, and very frequently where there  is no pain
whatever, there are numerous  sensations more or  less distressing
indicating an irritable state of the uterus and  the adjacent organs.
Some of these are very common, as sensations of weakness, debility
languor, often with  feelings  of fullness, pressure, weight;  a bearing-
down sensation  in the back, vagina,  rectum ; an open feeling, as if
there wrere no support and all the pelvic  contents must escape, or as
if the patient would " fall  in pieces " when in the erect position; a
sense of pressure on the rectum, as if the bowels must be moved, or
simulating the fullness and weight of haemorrhoidal tumors.  A great
sensation of  distress, of prostration, often  exists after  the bowels have
been moved.  Similar troubles are also experienced  about  the neck
of the bladder and the urethra, especially  at its orifice, with frequent,
sometimes almost  constant, inclination to urinate, and  then a burning,
scalding sensation.
  Such are some few of the multitude of  sensations which arise from
irritable uterus—sensations which vary in  different cases, both in kind
and  in  severity, some persons having some and other persons other
symptoms, which  may be so mild as hardly to be noticed, or so in-
tensely painful as to be almost unendurable.
  These sensations are very severely aggravated by every kind of
motion, such as  walking, sneezing, coughing, vomiting, and  by every
effort or movement  of the body which may cause pressure of the con-
tents of the abdomen upon the irritable womb.   They are also aggra-
vated  in  the most  remarkable manner by menstruation.  It may be
that a disorder of the ovaries was the original  cause, in part at least,
of the  irritability of  the uterus, and  that such ovarian disease also
tended to produce  what is termed dysmenorrhcea.   But even if this
were so, the irritable uterus could not but  render the function of men-
struation still more intensely painful.   When perfectly quiescent and
motionless, even the most irritable womb  may be comparatively easy.
But physiological stimulus, no less than mechanical violence, arouses
its  painful  irritability;  hence, both before and during menstruation
in such cases the pain is intense  and agonizing, and fron  whatever
                 * Hodge, Diseases Peculiar to Women, p. 55. 
HYSTERALGIA.
671
 cause the irritability of the  uterus arises, dysmenorrhcea is an invari-
 able result.
   Leucorrhoea of some kind  is also an  almost invariable attendant
 upon irritable uterus.   This discharge may be vicarious, as appearing
 in place of the menstrual flux, or it may appear as a temporary sub-
 stitute for the menses.
   As has been elsewhere shown, irritation of the organic nervous sys-
 tem leads to inflammatory congestion, while irritation of the cerebro-
 spinal  nervous system leads  to simple  congestion,  and  to  painful
 sensations or to spasmodic  contractions, according to the sensory or
 motor nature of the nerve-filaments which are principally involved.
 This irritability of the uterus, if it be supposed to involve each of the
 classes  of nerves distributed  to that organ and  its appendages, be-
 comes the initial stage of a great variety of disorders  of the  sexual
 apparatus and of the entire  organism of the female.   And this gen-
 eral conclusion  has been reached  by some who  certainly did  not
 understand the reasons which support it.   This is fully  implied in
 the expression of a .recent and able English author, where, speaking
 of irritable uterus, he  calls  it "that scapegoat of uterine pathologists
 in England." *   The whole  subject has been discussed in an extended
 manner and wuth  remarkable  clearness  and  ability  by Professor
 Hodge,  to  whom, in  the preparation of  the  present  work  and in
 common with the profession  at  large, we  are  greatly  indebted, and
 to whose workt we would refer all those desirous of a more thorough
              1                                                  D
 exploration  of this  and kindred subjects.   The  various disorders of
 the female sexual system Dr.  Hodge considers as the causes, the con-
 sequences or the complications of irritable uterus.

  Hysteralgia, or Neuralgia of the Uterus, needs  here  to be
 considered as connected with irritable uterus, and yet, as to a certain
 extent, distinct from it.  Irritable uterus is rather a negative condition
 of susceptibility or excitability from general nervous weakness in the
 organ, while hysteralgia is a more positively painful condition which
 may be considered to  be added to the irritable  state by some special
 provoking cause.  Thus,  in  cases of  irritability of the  uterus  the
 patient  may  be  comparatively easy when  perfectly at  rest, while any
 exertion, such as rising from the bed, walking, coition  or  menstrua-

  *Tilt,  Uterine and Ovarian Inflammation, p. 334.
  f On Diseases Peculiar to Women, including Displacements of the Uterus. By H. L.
Hodge, M. D., Professor  of Obstetrics, etc.  in  the University of Pennsylvania.
Philadelphia: Blanch-rd & Lea. 
672      diseases and  derangements of the uterus.

tion, may develop the most painful sensations.  " In dysmenorrhcea
or painful menstruation, the greater portion of the pain consists, I am
convinced, of neuralgia;  the  deep lumbar pain is decidedly ovarian
and not uterine."—Tyler Smith.  Here it is evident that both irritable
uterus and hysteralgia may depend upon some primary morbid condi-
tion of the ovaries.
  Symptoms.—" Neuralgia  of the neck of the womb often exists in-
dependently of any other lesion of this organ or of the body of the
uterus: the patients complain of pains that are seated high up in the
vagina, without any alteration being perceptible, even after the most
minute investigation.   Contact is always painful, and  sexual inter-
course often produces such agonizing distress that the patients would
rather bear any other torture."—Jahr.  " In real  uterine neuralgia
the pain  is situated in the  uterus  itself, to which it is referred by the
patient throughout the attack, or in the uterus  and ovaries  simul-
taneously.   This pain, generally speaking, comes on suddenly, with-
out being preceded by any premonitory symptom, unless  it be slight
numbness.   A few minutes before and after the attack the patient
may  be perfectly  well  and free from pain, whereas during its ex-
istence she is  often.rolling in agony on the bed or the ground.  Eeal
neuralgia is essentially intermitting in its character, returning for a
limited time at stated intervals during the twenty-four hours.   Some-
times the attacks only occur once in the twenty-four hours,  sometimes
oftener.  They last from  one hour  or two to ten  or twelve.  An
attack is composed of a  series of paroxysms, each  of which  is fol-
lowed by a  period of  comparative  freedom  of variable duration.
During the attack pains are  also felt in the lumbo-dorsal, ovarian
and other uterine regions, and there may be exquisite cutaneous sen-
sibility of  the entire abdominal  region.   All  these pains, however,
disappear along with the  uterine tormina, as  soon as the  attack
ceases, merely leaving for a time numbness and  soreness."—Rennet.
  " That affection  which we shall designate acute hysteralgia is some-
times the immediate  consequence of marriage.  The pains in such
cases, sometimes  of a burning nature, are more generally attended
with  a sensation of pinching  and of forcible pressure in  the hypo-
gastrium and  pelvic cavity, occasionally extending to the groins and
loins.  Like cramps  and colics, they are intermittent, leaving, how-
ever,  in  the  intervals a  tenderness  and sensibility  of the hypogas-
trium which render them liable to be  confounded with slight metritis.
In chronic  hysteralgia—the  real uterine neuralgia—the paroxysms
occur without assignable cause, and without anything of an inflara • 
    TREATMENT OF  HYSTERALGIA AND  IRRITABLE UTERUS.   67^.

matory character.  It appears  in  paroxysms, varying  in frequency
and regularity."—Boivin and Duges.
  The causes of hysteralgia, or uterine  neuralgia, may be  of two
kinds: First, those influences, termed provoking, which may develop
a positive neuralgic condition from an already existing negative state
of uterine irritability or excitability.  Second, those influences-which
are capable of developing a true uterine neuralgia where there was
no pre-existing irritability.   In the first class, as already mentioned,
every bodily exertion, the orgasm of coition, or the molimen of men-
struation, as in dysmenorrhcea, may easily  induce the neuralgic suffer-
ings.  In the second class, patients of general nervous  temperament,
subject perhaps to what is termed "spinal irritation," may experience
neuralgic paroxysms in various parts of  the body upon every over-
exertion.   Fatigue, too  severe and long-continued labor or any undue
exercise in which such persons go beyond their strength, will invaria-
bly produce neuralgia ; and it requires  only some special  local or
functional influence,  such as excessive coition, over-exertion while
menstruating, to cause the neuralgia to be developed as an hysteralgia,
rather than as a prosopalgia, a megrim or  a tic. douloureux.   And in
either class of patients there is no doubt  that the local irritation un-
avoidably arising from displacements of the uterus and its appendages
may occasion constant or periodically recurring neuralgic sufferings,
which may be felt in the womb itself, in its  immediate vicinity, or
developed in the epigastric or other region remote from the  real and
original seat of the disorder.
   Treatment.—For the treatment of  the various forms of the  more
painful nervous disorders of the womb and its  appendages, irritable
uterus, hysteralgia or uterine neuralgia and painful coition, study and
compare the following remedies :
  1. Bell., Cham., Kali carb., Plat., Puis., Sab., Sep.   2. Carb. an.,
Con., Croc, Ferr.,  Gels., Nux vom., Op.,  Rhus  tox., Sec. corn.,
Sulph.  3. Asaf., Asterias, Bry.,  Calc.  carb.,  Chin.,  Cocc, Coff.,
Ocas., Cypriped., Graph., Hyos., Ignat.,  Ipec, Lil. tig., Magn. m.,
Mosch., Natr. c, Natr. m., Nux raos.,  Phos. ac,  Thuya, Veratr. a.

  Asafoetida. May be indicated in decidedly venous systems  and ner-
vous temperaments.  Labor-like pains, with  cuttings  and  bearing
down.  Menses too frequent and too scanty.  Hysteria.  .Hypochon-
driac, anxious,  sadness  and  apprehension of dying; paroxysms  of
shuddering.  Fits of great joy, with occasional bursts of laughter.
  Asterias rubens. General feeling of distress in the womb, as though
      43 
674      DISEASES  AND DERANGEMENTS OF  THE  UTERUS.

something were pushing out.   Twitching in the uterus.  Feeling of
extreme anxiety,  as though some  misfortune were  impending—as
though some bad news were about to  arrive.  The  menses  are apt to
delay.
  Aurum. Almost constant thought, more or less intense, of suicide.
  Bryonia. The uterine sufferings are increased from the least motion.
Desire  for things which cannot be  had,  or wdiich are refused, or not
wranted when offered.   Frequent nose-bleed.
  Calc. carb. Pale, leucophlegmatic, weakly, fearful persons.   Fear of
going crazy.   Vertigo on going up  stairs.   Frequent spasms.  Sense
of weight and soreness in the uterus.
  Causticum.  Pains  in the  abdomen, causing her  to bend double.
Fullness and pressure in the abdomen, as if she would burst.  Con-
stant but ineffectual desire to eructate.  Violent increase of the pain
after the least nourishment, or after  tightening her clothes round her
waist.
  Cham. The  mental state  of the patient leads to  this remedy.   In
all  her sufferings there is a vein of ill-humor; she  can hardly speak
pleasantly;  feels  like  scolding about everything.  She often gives
vent to her ill-humor in spite of all  restraint.
  China. Much  singing in her ears.   A  sensation in the abdomen as
if it were packed full, which is not in  the least relieved by eructation.
Worse every other day.
  Cocculus. Painful pressure in  the  uterus, with cramps in  the chest
and fainting nausea.  Suppression of  menses,  or leucorrhcea in their
stead.   Feels too weak to talk loud.
  Coffea. This remedy also is chiefly  indicated by the mental symp-
toms.   Ecstasy.  Full of ideas.  Quick to  act;  no sleep on  this
account.  The physical system seems  exalted and almost transported
by the mental exaltation.
  Conium. Stitches extending from  the abdomen to  the right side of
the chest.  Vertigo when lying down  or turning over.  Intermission
in the flow of the urine.
  Crocus.  Sensation of rolling and tumbling in the  abdomen.  Great
mental dejection.  Menses suppressed, or dark and stringy.
  Ferrum. The  patient is weak  and nervous.  She  suffers much, but
has very red cheeks.
  Graphites. Itching blotches here and there over the body. Menses
delay or are  suppressed.   The  patient seems  bloated and inclines tc
obesity.  She is weak and irritable.
  Hyoscyamus.  She  inclines  to that kind of insanity which leads to 
    TREATMENT OF HYSTERALGIA AND IRRITABLE UTERUS.   675

nakedness—to throw off her dress or the bed-clothes.  Uninterrupted,
loud laughing at the approach of the menses.   She is very much in-
clined to spasm.  Uterine cramps, with pulling in the loins and small
of the back.
  Ignatia. Uterine cramps, with cutting stitches.  Great  sense of sore-
ness at the pit of the stomach.   Full of grief and sighing.   Brooding
over imaginary troubles.
  Ipecac. Much  pain about the umbilicus, extending toward the  ute-
rus.  The most of the distress  is about the navel, but it runs off  into
the uterus, the real seat of  the disease.   One continued nausea.
  Kali carb. Stitching pains about the tender uterus or  all over the
abdomen at times.  Always much  distress  in  the  abdomen an  houi
before stool.
  Magnesia mur. Sleeplessness, with difficult  stools, which crumble
as they escape the verge of the anus.   Frequent  hysterical spasms.
Uterine cramps, with pains extending down the thighs.
  Natrum mur. Very sad and gloomy during the menses.  Much  pal-
pitation of the heart and  morning  headache.   Frequent dreams of
robbers in the house, and  on awakening will not believe to the con-
trary till search  is made.  Great disgust for bread.  Uterine cramps,
with burning and cutting in the groins.
  Nux voiil.  Much sense  of soreness in the neck  of the uterus on
rising up or sitting dowm.   Wishes to urinate or to defecate  very
often,  but little at a time, attended with pain.   No sleep after three
A. m.  No appetite.  Has indulged in  high living, rich food, condi-
ments, etc.
  Opium. She is nervous  and irritable, and passes nothing but  hard
black  balls from  the  bowels.  Her bed feels  so  hot  that she can
hardly lie on it.   She is sleepy, but cannot go to sleep.
  Phosphorus. Sensation of great weakness and  emptiness  in  the
abdomen.  Sensation of great heat in the back, running up from the
coccyx.  Sharp cutting pains in the abdomen.    Sexual desire almost
irresistibly strong.  Much  flatulency.
  Phosphoric acid. The  uterus  is distended with gas.   Pain, univer-
sally, in the liver during the menses.  She must.often rise at night in
order to pass large quantities of colorless urine.  Is very weak,  and
indifferent to the affairs  of  life.  Listless, apathetic
  rlatma. A  voluptuous tingling in the genital  organs and abdomen,
with oppressive  anxiety and palpitation  of the heart.  Frequent sen-
sations as if the menses would  appear.   The mons veneris and vulva
are extremely sensitive,  feeling cold  at the same time.   Menses  pro 
676    .  DISEASES  AND DERANGEMENTS OF THE UTERUS.

fuse, with black clotted  blood.   Much anguish;  she feels as if she
would lose her senses and die soon.
   Pulsatilla.  With almost all her sufferings  there are sure to be tears
and cries.  She weeps very easily about this or that; she can hardly
give her symptoms for weeping.   Menses suppressed or flowing inter-
mittently.  She  has a bad taste in her mouth in the  morning, and
nothing tastes good.
   Rhus tox.  In  many cases  following parturition.   A  vitiated dis-
charge  continues from the vagina, with shooting upward in the parts,
and with  a bursting sensation in the head.   Much pain continues in
the right limb, with numbness from the  hips to  the feet, for weeks
after delivery.   General unhappiness of temper.
   Sabina. The pain extends from the sacrum to the pubes.  A slight
sensation  of motion in  the  abdomen, as  if something were alive.
Much irritability of temper.  Music is intolerable to her.
   Secale corn. This remedy is often indicated in  thin,  scrawny indi-
viduals, and in  those  who  are afflicted with melancholy, anguish,
dread of death.   A  constant sensation  of pressure or bearing down in
the uterus.
   Sepia. Great sense of emptiness  at  the pit  of the stomach.   The
uterine  region is  tender to the touch.   Little shooting, burning pains
in the neck of the uterus.   Sense of weight in the anus.  Must cross
her limbs, as if to keep the uterus from protruding.  Very sad and
fearful about her health; often weeps about it.
   Sulphur. Frequent flashes  of heat, which  pass off in a slight  per-
spiration with weakness.   Much sensation of heat in the crown of the
head.   She feels badly at the pit of  the stomach  from eleven till
twelve  in the forenoon; she is weak, empty at that time, can't wait
for her dinner.   Sleeps in very short naps, and is  easily awakened.
The most of the pain  is  in the left iliac region and in the left side
generally.  Much depression of spirits, or she is  very happy and
gay; everything  is very beautiful to her.
   Thuya.  Extremely scrupulous  about the least thing.   Walking or
riding brings  on such extreme  suffering in  the left inguinal and  iliac
region that she is obliged to go to bed.
   Zinc.  The flow of the menses always relieves all her sufferings, but
they return again soon after the cessation of the menses.  A constant
distressing boring pain in the left ovarium,  only partially relieved by
pressure or during menstruation, but returning again after the flow. 
UTOT7R\TTON
677
                   CHAPTER  XXXII.

       DISEASES OF THE  UTERUS—CONTINUED.

                         Ulceration.

   THE term ulceration as applied to the  cervix uteri  has given rise
    to many disputes amongst gynaecologists, which have  arisen in
consequence of the various definitions of writers on the subject.  Dr.
Arthur Farre holds to the view that the  term ulceration should be
applied only to cases in which there is a loss of substance, extending
beyond the mere abrasion of the cervical surface and extending deeply
into the tissues.  If this be accepted as a true definition of ulceration
of the uterus, then will such  cases  seldom be  met  with except in
connection with syphilis or other specific disease.  Bennet gives a
broader definition, and regards ulceration as "a solution of continuity
from which is secreted  pus or a puriform, sanious or  other matter."
This of course takes in all forms of so-called ulceration, from simple
epithelial abrasion to the malignant and deep ulceration, and for prac-
tical purposes is perhaps the best that can  be given.
  Ulcers of the uterus may be divided  into the following distinct
classes:  Granular, Follicular, Inflammatory\ Syphilitic, Corroding and
Cancerous Ulcer.   These  will  be  considered  in  the order in wliich
they are named.
  It seems  proper, however, to say a few words in advance regarding
the methods of examination to be pursued in order to secure a correct
diagnosis in such cases, as well as to refer  to the general principles
governing their treatment.
  In the forms of disease of the uterus hitherto treated of  in the
present work  the touch has  been  deemed generally sufficient to
enable the  practitioner  to  determine  with sufficient exactness the
nature of the difficulty.  And in  fact  the well-practiced touch  is a
surer guide to diagnosis in such explorations than is the speculum,
wliich must necessarily interfere more or less with the position  and
appearance  of the  vagina.   And the touch, whether per vaginam or
per rectum, or both, is usually fully competent to determine the  nature
of the various forms of displacement. But in the examination of cases
of suspected ulceration of the cervix, the speculum should be used to
confirm the indications  obtained by the touch, and to assist in  de'dd- 
678  .    DISEASES and derangements of the  uterus.

ing as to the simple, malignant or cancerous nature of the ulceration
itself.
  Still, from the very great reluctance of many women to submit to
such  ocular examination, even when  conducted in  the most delicate
manner possible, it seems better for the young physician to learn to
depend  as  much as possible upon the touch  in forming his  diagnosis,
and  only to resort to the speculum in doubtful or difficult cases or
perhaps in the first examination of such as come under homoeopathic
medication from allopathic  hands.  The  finger may be as truly edu-
cated to discriminate the different conditions of the uterine surface
and  substance as it may be to strike the strings of the harp or the
keys  of the piano.  And it is a subject of no small gratulation to
remember  that  not only the most eminent  homoeopathic physicians
but also the entire body of respectable  practitioners of our school,
have  set their faces against the disgusting  and disgraceful resort to
the speculum upon every possible pretence  and occasion.   However
fashionable the use, or rather abuse, of the speculum was at one time—
and we  are glad to say it is now so no  longer—such cultivation of
morbid  curiosity on the part  of  the  physician, to  give it no worse
name, and such  pandering to the prurient sensualism of some woman,
and such unnecessary wounding of the delicate sensibilities of others,
have never obtained currency in our  school.   And not only do all the
soundest principles of  medical exploration  dissuade from the indis-
criminate introduction  of the speculum, but the'whole tenor of our
homoeopathic therapia leads to a  more excellent way, by substituting
the subjective, the sensational, the constitutional and functional symp-
toms for the pathological details of structural changes as the basis for
medical treatment.
  Hence, we think that in most cases  the touch  alone  will prove
amply sufficient for the purposes of diagnosis, and far superior in cer-
tainty to the speculum   in the great  majority of cases.  In displace-
ments of  the womb and other organs it  may be necessary to  investi-
gate by the touch  the  situation of the parts; and in some of these
cases of malposition, as in retroversion of the uterus, manual assist-
ance may be needed in order to restore the parts to their proper place.
But in actual practice, so long as we do not give homoeopathic reme-
dies for diseases by name,  so long as we do  not wish to confine  our-
selves merely to the removal or palliation of the consequences of the
illness,  so  long  as we make it our great aim, as skillful physicians, tc
restore our patients to health, and so long as we consider the diseasf
removed only so far as  we  see  w-h restoration to health, just so long 
                         ulceration.                       679

shall we  seek to find  the remedy which shall correspond to all tne
symptoms of the case, and which  shall especially  represent  the  sub-
jective and constitutional symptoms, instead of relying mainly upon the
indications afforded by the speculum or the touch.
  And we believe that a careful  and attentive study of these symp-
toms  and of the attendant conditions  will enable the physician to
make the right, the best  possible prescription for his patient.  For
thus he regards the first elements, the dynamic causes, rather than the
ultimate  results  of the morbid  affection.   And  herein do we differ
from the so-called physiological  school, as well as from the patholog-
ical and chemical schools.   The method here inculcated is  in strict
accordance with  pure  homoeopathy, and it might perhaps  be deemed
the physiological method were not this  term already appropriated as
the designation of an entirely distinct  system.   This method, which
we may  perhaps  be permitted to call  our own, since we adopt and
advocate  it, may be termed the vital method.  It is  essentially the
method of Hahnemann,  of Bcenninghausen and  others, whose learn-
ing and skill have contributed to make homoeopathy an honor to the
medical profession.  In this method we realize that pains or subject-
ive (sensational) symptoms come before the functional derangements, as
these latter come before structural or organic changes, and that the two
latter forms of disease are but the extension and ultimate development
of the morbific influences shadowed forth in the former.  So that if
we pay strict attention to the  subjective, the sensational, the constitu-
tional symptoms, in addition to the local  manifestations and to the
attendant circumstances  and conditions (which are also constitutional
symptoms, and so  of the first importance), we shall come far nearer
the mark, and be far more sure of healing the sick, than if we directed
our principal attention to the more external  and ultimate symptoms
or forms of the disease.
  For purposes  of diagnosis, and especially to satisfy  the  patient
and her  friends, the  touch  may be resorted to, and  in  some  cases
the speculum even.  But for guides in the selection  of the remedy,
the indications afforded by the patient herself, those which we  have
designated as subjective, sensational,  constitutional and  functional,
afford us the greatest certainty and lead most directly to the  happiest
results.

  Granular Ulcer.—This form of ulceration  has been likewise de-
nominated, by various writers, erosion, abrasion and granular degenera-
tion of the cervix. It consists  essentially of a changed condition of the 
680
diseases and derangements  of the uterus-
mucous surface of the cervix surrounding and immediately within the
os.  It is of very frequent occurrence, but sometimes gives rise to but
few and very slight constitutional disturbances.  In other instances
however, various derangements of the system attract attention to the
difficulty.   It is usually accompanied with profuse leucorrhoea, which
may be  bloody or  purulent; a very annoying and fixed  pain in the
back and loins, of  which the patient principally complains, especially
when walking; disordered menstruation, the menses being generally
too profuse; pain during coition and sore feeling afterward; a variety
of nervous  disorders and hysteroid symptoms.
   Upon resorting  to  the vaginal touch, the cervix  will'be felt to be
deprived of its usual smooth surface, and a granular condition of the
parts or a  velvety  feeling  is imparted to the sense of touch.   The
speculum will show the cervix, and more particularly that part lying
adjacent to  the os,  and the  entrance  to the  cervical  canal itself, cov-
ered with pus, which, upon being brushed away, reveals a deeply red
surface having a granular appearance, and resembling the inner sur-
face of the  eyelids in the disease known as " granular lids."  The os
is usually  more or  less patulous, and  sometimes  everted.  There
appears  to  be little or no  destruction  of  tissue, and,  on the  other
hand, there  may  even be the appearance of  thickening of the epithe-
lium and consequent elevation of the diseased part.  In mild cases it
may be difficult to ascertain whether the parts involved are not simply
congested, or to perceive the limits of the ulceration  when ascertained
to exist.
   The most common causes  of this form of ulceration are found in
uterine displacements, in consequence  of which there is almost  con-
stant friction of the cervix  against the vaginal walls, or it may arise
from injury to the cervix during sexual intercourse, by wearing pes-
saries  or  by parturition.  It is  commonly associated,  in the worst
cases especially, with  endocervicitis,  and  may be  produced by any-
thing which occasions hypertrophy of the uterus, or  endometritis.
   Occasionally, these granulations in this form  of ulceration become
greatly enlarged, constituting what are known as cockscomb granula-
tions.    These  fungous  excrescences  spring up principally in  the
vicinity of the os uteri;  they are  sometimes found within the  canal
of the  cervix, are of a livid red color and very  vascular.   They dis-
charge an abundant purulent secretion, and are capable of giving rise
to copious haemorrhage from the least touch.
   Sometimes  the ulcerated surface takes on an aphthous appearance,
constituting what is known as Aphthous  Ulceration, or it may be the 
ulceration.                        ti$\
neat of diphtheritic deposit, and is then termed Diphtheritic Ulceration.
Again,  the  parts  involved  may  present numerous  congested  and
varicosed veins, and  under such  circumstances  the term Varicose
Ulceration has been applied to it.

  Follicular Ulcer.—This variety of uterine disorder consists in
inflammation and ulceration of certain mucous follicles of the cervix.
Dr. Farre says of these  that they are lined by epithelium and base-
ment membrane, and that those upon or near the margin of the os
may be sometimes observed  to  contain  short papillae.  The papillae
of these follicles become enlarged, and present the appearance of red
and elevated tubercules, which look as if ready to bleed at any time.
This form of uterine ulceration is not so frequently met with as the
granular ulcer, and indeed may be regarded as somewhat rare.

  Inflammatory Ulcer.—Of the " true inflammatory ulcer " Dr.
Thomas writes as  follows: " In procidentia uteri  of long standing  it
is'seldom absent, and the deep excavations, precipitous edges and in-
flamed bases of the spots leave no room for difference of opinion as to
their nature.  This form  of ulcer  is very rarely  met with, except as
the result of direct injury, with coexisting parenchymatous congestion
or inflammation.   Thus it may arise from the injuries resulting from
friction in procidentia and anteversion and retroversion, or from exces-
sive coition, where the cervix is much  enlarged  and its parenchyma
inflamed."

  Syphilitic Ulcer.—It seems to be a settled question that syphilis
may attack the uterus both primarily and secondarily.  It is not our
purpose, however,  to  treat of this class  of  affections, further than to
say that great care should be exercised in  making up the diagnosis
where syphilis is suspected, and that syphilis manifesting itself in this
locality, whether primarily  or secondarily, should be treated in the
same manner as syphilis manifesting itself elsewhere.

  Corroding, Phagedenic or Malignant Ulcer.—This form of
ulceration is fortunately uncommon, and its existence as distinct from
cancerous ulceration has been positively denied.  In its extent, malig-
nancy, in the rapidity of its course, as well as in the usual fatality o£
its termination, it is no less formidable than cancer itself.  Malignant,
non-cancerous ulceration  is  more  apt  to happen to women at the
middle period of life or  at  a more advanced age, but it sometime* 
682      DISEASES AND  DERANGEMENTS OF THE  UTERUS.

occurs in women wh -) may still be said to be young.  The ulcer gen-
erally begins in the cervix uteri, and the uterus is at the  same time
somewhat harder and larger than in the natural state.   It does not,
however, grow to any considerable size.  The ulcer spreads from the
cervix to the fundus, and it is not unusual to see the  greater part of
the cervix destroyed by it, and the rest changed into a tattered, ulcer-
ated  mass.   The ulceration is not always confined in its boundaries
to the uterus, but it sometimes  spreads into  the  neighboring parts, as
the vagina, the bladder and  the  rectum, making communication be-
tween  them and producing dreadful havoc.  " This disease attacks
females of the lymphatic temperament, and generally about the period
of the cessation of  the menses or soon after."
   Malignant ulceration of the womb is  attended by heat and pain in
the pelvis.   But the first  important symptom is the alarming haemor-
rhage to which it gives rise, and which may be mistaken for a profuse
menstruation.   There is also  a  foetid discharge, which varies from a
light straw color to dark brown.   That portion of the  uterus which
is not ulcerated is scarcely at all  enlarged, and  is free and movable,
thus differing from the true cancerous ulceration.  " In  cancer uteri
there is extensive deposition into the cellular membrane and glands
between the vagina and  rectum, as well  as into  the substance of the
uterus itself, connecting them so as to form one large mass, and ren-
dering the whole immovable; the finger on  being introduced into the
vagina finds very little space and no power of  moving the parts with
which it comes in contact;  whereas in corroding ulcer, no  deposition
having taken place, the uterus  can be moved by gentle pressure, and
parts of the pelvic contents having been destroyed by  ulceration there
is more space than  usual  in the cavity."  From simple  ulceration of
the cervix this  malignant form is distinguished by the excessive  fcetor
of its discharge, by the more intense character of the  pain and by the
rapid extension of the ulcerative process.   Corroding ulcer of the
cervix, which may also extend to the fundus of the womb, slowly eats
away the uterine walls, and in the allopathic practice is only hindered
and delayed in its  final and fatal termination.   But in  the  homoeo-
pathic practice we  possess  the  very important double advantage of
being enabled at the  same time to give remedies which shall promote
the healing of the local difficulty, and improve, instead of still furtner
injuring, the general health.  These  cases cannot be cured unless by
6uch means as shall eliminate from the system the dyscrasia which lies
at the foundation of the ulceration, and at the same time  remedy both
the bad health  which caused and that which followed  it. 
r
         treatment of ulceration of the  uterus.       683


    Treatment of the above Varieties of Ulceration.
  These forms of ulceration never exist alone,  and the  ulceration
 cannot be made to heal  permanently until the other morbid condi-
 tions of the womb are removed, and until the general health is more
 or less completely restored.  Non-malignant ulcerations  may heal
 spontaneously—that is, on the recovery of the general  health and  on
 the subsidence of the provoking cause or causes  of  the ulceration—
 but where the general  health is neglected or  grows worse,  where the
 ulcerations are left to themselves or aggravated  by improper treat-
 ment, they may continue to spread and  become  so extensive as  to
 destroy life indirectly by  undermining the constitution, or directly  by
 the haemorrhages which they may occasion.
  Simple ulceration of the womb is far  more amenable to  homoeo-
 pathic medication, and far more easily  and safely  treated by such
 gentle and  yet  constitutional means,  than  by  the  application  of
 caustics, either liquid or solid.   At the same  time, the general health
 is restored by selecting remedies  to suit all the constitutional indica-
 tions, and the  patient is  not only cured of  her  ulcer, but radically
 cured by the removal  from her system of the dyscrasia which, com-
 bined with incidental local causes, produced the ulceration.
  Hygienic and dietetic  measures are of  great importance  here as in
 other diseases.   Nourishing food should be taken  freely, but all stim-
 ulating food or  drink should  be avoided.  The disordered  diges-
 tion  and want of appetite  should be cared for.   Plenty of fresh
 air and sunlight  should  be insisted  upon  for the patient, and a very
 moderate degree of exercise allowed where  not  contraindicated.  It
 should be borne in mind that walking, or journeying by railway  or
 any other method of rough riding,  may be very injurious.

                           Remedies.
  1. Ars., Arg. nit., Asaf., Lach., Lye, Merc, sol., Nux vom.,  Puis.,
 Sep., Sil., Sulph., Thuy.   2. Bell.,  Bry., Calc. carb., Carb. veg., Con.,
 Hep., Phos., Phos. ac., Rhus tox.,  Staph.  3.  Ant. cr.,  Arn., Aur.,
 Carb. an., Caust., Cham.,  Chin., Creas., Graph., Hydrast., Mur. ac,
 Natr. carb., Ruta, Sab., Secale corn., Stann.

  Antim crud. Profuse discharge of acrid water, containing portions  of
 pus.  Gastric derangement with white tongue is  often present.   The
stools are often liqu;d  containing portions of  solid matter. 
684     diseases and  derangements of the uterus.

  Argentum nit. Bleeding ulcers, the haemorrhage  being of short dura-
tion.   She seems dizzy and cloudy in her head; the  headache  is not
severe, but dull and  constant.   The moral and nervous disturbances
come on in quite regular paroxysms every night, in the morning, or
at noon, more  particularly after dinner.  Great debility, particularly
in the lower extremities.   Much chilliness  and nausea  are often at-
tendant in  such cases.  This remedy, in substance, is often useful  in
the old practice, because of its frequent homceopathicity to the case, but
it is far more  useful in our hands in the two-hundredth preparation,
and for the same reason.
  Asafoetida. The menses are scanty; they are often too early, and last
but a short time.  The ulcer has high,  hard edges, and  easily bleeds.
The ulcer  is  sensitive and painful.  The  discharge is profuse and
greenish, thin  and offensive.  An hysterical condition  is  frequently
attendant upon such cases.
  Hepar s.  c. The ulcer has a bloody suppuration, smelling like old
rotten cheese.   Its edges are sensitive, and it often has a pulsative
sensation.  The discharge  is also corroding.  The ulcer itches very
much.
  Hydrastis.  For  simple  abrasion or other  forms  of ulceration, even
malignant and cancerous.  Much  gastric disturbance, flatulence and
constipation.   Sinking or weak feeling  in the epigastrium.
  Lycopodium.  Red  sand in the urine.   Great rumbling and commo-
tion in  the  abdomen.   Pain  in the  back.  Great depression  of
spirits.
  Muriatic acid. The  ulcer  has  a  piitrid discharge,  is sensitive and
attended with a great sense of weakness.   If the anus be very sensitive,
either with or without haemorrhoids, Muriatic acid is sure  to  be the
remedy.
  Phosph. acid. The  ulcer  has  a copious, putrid, bloody discharge.
There is an itching or corroding pain, or the ulcer is entirely destitute
of feeling.   The patient  is apt to  be quite indifferent to everything,
even to those things which used  to interest her most.
  Secale corn.  The  ulcer feels  as  though  it had  been  burnt.  It
discharges  a putrid  bloody fluid, and  is  sometimes  decidedly gan-
grenous  and painless.  It  is more frequent  in  thin  and scrawny
individuals.
  Zinc.  The ulcer has a bloody,  acrid discharge, but is of itself rather
destitute of feeling.   Her various sufferings, headache, etc., subside
during the menses.   An  excessively  violent and obstinate pain in the 
CANCER  AND CANCROID.
685
brain sometimes accompanies this ulcer.  This pain may even assume
the form of an intermittent.
  For other ulcerations, whether thought to  be  malignant or not, see
also the remedies recommended for cancer; since  the same  remedies
mav answer for either form of ulceration, the malignant as well as the
nou-malignant, the sensational and constitutional symptoms  being of
primary importance in making the prescription.
  For sensation of coldness in the ulcers the  following remedies  may
be consulted, they being placed  in the order of their importance in
this respect:  Bryonia,  Arsenicum, Silicia,  Mercurius,  Rhus
tox.

                    Cancer and Cancroid.
  Cancer  is an hereditary constitutional disease  which is character-
ized by the peculiarity of its several forms, by the progressive nature
of its development, by the intensity of its pain, and by its remarkable
tendency to terminate fatally.
  The hereditary nature of the cancerous dyscrasia is proved, in  part,
by statistics, from a variety of sources, of cases in which the relatives
of those subject to cancer have been known to have had the same dis-
ease.  Among the French authorities on this subject we may mention
Velpeau, who states that in one-third of his  cancer patients  he could
certainly trace an  hereditary taint.  Lebert's experience gives but one
in twelve as thus constitutionally predisposed. Among English authors
we find that Mr. Paget traces an  hereditary predisposition in this man-
ner in but one in four of the cancerous persons who have come under
his notice.   The statistics  collected by Mr. Libbey, at the Middlesex
Hospital, show an average of but 8f per cent, of the cases as  thus
proved to  be  hereditary cancer  cases.  In the  Cancer Hospital the
aggregate collection of the cases seen by the medical officers connected
with the institution  yields  an  average of one in seven who had  rela-
tions previously affected by this disease, while Mr. Cooke, from whose
recent work * on  this subject  I  have taken these details, states  that
one in four of  the cancer cases which have come under his observation
give evidence of the hereditary nature of the disease in themselves.
  But it may be urged that these statistics do but indicate that a large
proportion, still  a minority, of  the  cases  of cancer  appear directly
hereditary, as  having  relations  who  have  suffered with the  same
disease; and that therefore the proof of the hereditariness—that is, of
  * On Cancer: its Allies and Counterfeits.  By Thomas  Weeden Cooke, Surgeon  to the
Cancer Hospital and to the Royal Free Hospital, etc.   London, 1865. 
686       diseases and  derangements of the uterus.

the constitutionality of this disease—is  very far from being conclu-
sive ; and it may be affirmed that cancer may arise directly in persons
who have no hereditary or constitutional predisposition to this form
of disease.   This  conclusion  we  deem  entirely incorrect.   And we
attach the more  importance to a  correct statement of the matter be-
cause it involves some very interesting practical considerations rela-
tive  to Hahnemann's psoric theory on the  one side, and to the inter-
changeableness of different forms  of ultimate  disease on the other.
Thus, in reply to the objection of  the insufficient nature of the proof
of the constitutionality of cancerous disease, it may be stated  that
even as individual cases of disease often require a long time to incu-
bate before they develop  themselves, so the  cancerous affection  mav
have been increasing in  intensity for several  generations before  it
reached a sufficient amount of deviation from the natural state to be
able to ultimate itself in an actual cancerous growth.   Again, it may
be remarked that people  do  not  always know the history of their
families, and  especially may oversights of  this kind be considered
probable when we remember that the cancer, like other constitutional
diseases, may skip over an entire generation.
  But the main point to which attention is invited  in this direction is
the fact that this latent dyscrasia, extending from  one generation  to
another, may be developed in entirely different forms in different genera-
tions, and in  different  individuals of the same generation.  This  fact,
which has been in a great  measure  overlooked, we  regard as of great
practical interest and importance.   It is found  that there is another
distinct disease, no  less fatal, perhaps, and  certainly no less  surely
progressive in its  course, which appears  to be the constitutional com-
plement of cancer. And this disease is phthisis; which is, like cancer,
an ultimate,  organic, structural development of a constitutional  dys-
crasia—which is, like  cancer, a  tuberculous affection—and which,
attacking principally a younger class of persons, destroys its victims
in about  the same  average time that cancer does.  These two forms
of disease appear mutually interchangeable, since both their ultimate
and fatal  manifestations appear in different generations  and  branches
of the same  family, and in different individuals of the same genera-
tion.   Thus  it happens that cases  of cancer which cannot be  traced to
any cancerous affection in other members of the family may be referred to
a strongly-pronounced hereditary predisposition to phthisis; and, con-
versely, cases of phthisis  are seen  to grow out of  dyscrasia  winch in
other relatives, branches and members of the same family have been
developed as true, malignant, fatal cancer. 
cancer  and cancroid.
687
  In the peculiarity of its principal forms cancer differs remarkably
from all otlier organic diseases.  These forms  are three in number—
scirrhous,  lmrd or  Fibrous  Cancer;  Encephaloid,  soft  or Medullary
Cancer, and  Colloid or  Gelatinous Cancer.   In addition  to  these
varieties, when cancerous disease attacks the epithelial surface of  the
womb—or, in other words, is superficial—it has been termed Cancroid
or Epithelial  Cancer, although  its malignancy and  tendency to  de-
struction  and death are assured.   The scirrhous seldom or  never
appears before puberty, is moderate in size and slow in its develop-
ment.   The  encephaloid  variety is  the one which  most frequently
appears in infancy; it may  occur  in any part or tissue  of the body;
sometimes attains  an  enormous bulk; is the  form which  secondary
cancerous deposits  usually assume; is liable to very dangerous haemor-
rhage ; and when once ulcerated runs a very rapid course.  The colloid
iancer, itself firm and  resisting, contains  a peculiar jelly-like matter
—occurs  only in adults—most  commonly in the abdominal cavity;
may grow rapidly and to an enormous size; rarely proceeds to ulcer-
ation, and most commonly  destroys life  by encroaching upon  some
vital organ, and so  permanently obstructing its functional action. The
scirrhous  form is the most frequently seen, and  especially in the female
breast  and uterus,  and  is also  the  most difficult of cure.  The  en-
cephaloid variety comes next in frequency.
  These different  forms of cancer  have been  by some  supposed to
represent  merely the different stages of the disease, its different states
of development.  It may indeed be true that particular cases of cancer
may, in the course of their progressive development, successively rep-
resent, and with more or less accuracy, all these various forms.  But
in general such a  statement could hardly be  supported by the  facts.
From the difference in the degree and intensity, if not also in the kind,
of the cancer poison, as well as from the innate variety of the consti-
tutions in which it  is developed, the cancer itself naturally assumes a
variety of forms from the first.  Thus while scirrhous or hard cancer
usually softens in its advanced stages, others, like medullary cancers,
which may occur in a wider range of human life, in the young as well
as in the old, and which  are more malignant,  as being more rapidly
fatal, are soft from  their very commencement.
  Still, there does  not seem to appear in  these different forms any
essential difference in the elements which may  be deemed the  radical
constituents of cancer, or any other difference than that of proportion
in the manner in  which they are  combined.   The disease is charac-
erized by—1, proliferation  of areolar tissue:  2, excessive generation 
688      DISEASES AND DERANGEMENTS OF  THE  UTERUS.

of cells;  3, tendency  to  molecular death, invasion of neighboring
parts, and return if removed by surgical means, constitutional impli-
cation usually progressing until the death of the person affected.  All
these characteristics belong to every form of cancer we have men-
tioned.   Without stopping here to  enter minutely into the discussion
of the question as to whether there exists a true characteristic cancer
cell, histologically distinct from all other normal or abnormal forma-
tions—a question once supposed to be settled in the affirmative, but
rendered now more than doubtful by recent investigations—we merely
indicate the general elements of cancer structure.   These are the so-
called nucleated  cancer cell, a peculiar fibrous  structure, among the
meshes  of which the cells  are found, and a no less peculiar viscous
fluid, with which  the  two  former  elements are more or less abun-
dantly surrounded.  The  combination  of  these three elements  con-
stitutes  the cancerous growth, and the relative proportion of  these
elementary ingredients may be considered  to  determine the form of
the  cancer  itself.  Thus, if the  fibrous element predominate—as it
does in  the  earlier stages of the great majority of cases—we have the
scirrhous  form.   If the cells  are  more abundant, we  have the en-
cephaloma or soft cancer.  If the  viscous fluid be  in the ascendant,
there results the colloid or gelatinous cancer.
  Some  cases  are  anomalous, presenting   more the appearance of
fungous growths, others again  are  more like  bleeding tumors, hence
termed  bloody  cancers; and  it not unfrequently  happens, notwith-
standing the classification of these malignant affections, that a growth
will be  met with which cannot be  classified under any of them, and
which partakes of the  nature of two, or even of all, varieties. But an
attentive  study of all  the symptoms and  conditions will enable the
practitioner to decide as to the malignant nature of the disease.  But
such decision, independent of the data upon  which it is founded, is
of use rather with reference to diagnosis  and  prognosis itself  than
from any influence which it should be allowed to exert upon the selec-
tion of the remedy. For the remedy must  be selected at first hands—
that is, from the  symptoms themselves, wdiich will  guide aright—and
not from  our diagnosis of the  case, which maybe, and often is, wrong.
  As already implied, the  cells which were supposed to be the abso-
lute characteristics of cancer, and so called true cancer-cells, have  more
lately been deemed less positively determinate.  Virchow,* the latest
and highest authority  in cellular pathology, considers the dry or juicy
nature of the cells as much more decisively indicative  of the benig-
                  * Cellular Pathology, p. 530, et  seq. 
CANCER  AND CANCROID.
689
nant or malignant character than is their shape or form.  "The forms
which yield dryjuiceless masses are relatively benignant; those which
produce succulent tissues have  always more or less  of a  malignant
character." And  in deciding upon the benignant or malignant nature
of any growth, he says:  "In the case of all these  formations, every
one of which corresponds more  or less completely to a normal  tissue,
investigations  ought not to be  conducted with a view to  determine
whether they have a physiological type, or  wdiether they bear  a spe-
cific stamp impressed  upon them; our final decision depends upon
the answer to  the question whether they arise at a spot to which they
belong or  not,  and whether they produce  a fluid which,  when brought
into contact with the neighboring parts, may there, exercise an unfavor-
able contagious or irritative influence."
  We make  this extract in order to show how modern science is
finally compelled to pay tribute to the true  spiritual  doctrine,  rather
than to the more gross and  external theory which  it had  before  re-
ceived as a revelation from nature. The distinction  of cancerous from
other cells as a matter  of external form is no longer deemed reliable,
the form being, at least as  often as otherwise, homologous to the nat-
ural and healthy cell-forms.   The true distinction to which all must
finally come is, that as the cancer-cell  is itself the result of a morbid
deviation, so  it tends  to perpetuate the  same  morbid influence im-
planted Avithin it.  It  is a homologous growth as to form, and no less
truly homologous in its vital activity, in perpetuating its own disor-
dered vitality, exactly  as if a ball projected into space in a  curved
line and meeting no obstruction would complete  and  continue on in
the  original circle.  Thus, all  the elements of cancer are positively
homologous—that is, similar formations to other  and healthy tissues.
But they are heterologous in their composition—that is, in the propor-
tions in which they are combined to  form  a cancerous  growth.   In
like manner different chemicals  may be harmless or  poisonous, accord-
ing  to the different proportions  in which the same  ingredients  are
arranged,  or, as in the case of those called  isomeric, according to  the
different manner  in which the same ingredients are arranged, even in
exactly the same  proportions.
  The scirrhous and encephaloid forms are the most common cancer-
ous growths of the uterus, the former occurring much  more frequently
than the latter.   But whatever may be the condition which gives rise
to cancerous formation, " it is certain  that any form of  the affection
may arise from one and the same disorder.  This  is  proved  by  the
tacts that several  deposits of different varieties may coincident! v exist, 
DISEASES AND DERANGEMENTS OF THE UTERUS.
 that one  form may change into another, and that one being removed
 by surgical means, a different one may replace it."—Thomas.
   The progressive nature of its development forms another and import-
 ant characteristic feature of cancer.  All the different forms of cancer
 may sometimes be seen in a single case in its successive stages; they
 appear  to pass  into and succeed each other, the indurated forms be-
 coming softer, but the  soft  never, so  far as we are aware, becoming
 hard.   The development may be slow, it may occupy years, and for a
 season appear entirely stationary, although  this is scarcely  ever the
 case in cancer of the uterus.  Here the disease being usually found to
 seize primarily upon the vaginal portion of  the cervix, the alteration
 of the tissue will extend from the os externum to the os internum, and
 from thence it will gradually extend over  the interior  surface of the
 body and fundus.  At the  same time, the  softening and other degen-
 erations  of tissue extend from  within  outward.   But the progress of
 this fearful disease is not confined to the uterus  alone.  From the in-
 timate connection of this organ, through its  peritoneal covering, with
 the bladder, the rectum and peritoneum, and directly with the Fallo-
 pian tubes and ovaries, the cancerous affection is in due time commu-
 nicated  successively and in  different degree to all these organs, and
 even to the peritoneum itself.  In addition to the other and incidental
 sufferings which  must follow such extension, the cancerous ulceration
 sometimes occasions vesico-vaginal and recto-vaginal  fistulas, acci-
 dents which very  greatly  aggravate  the  pitiable condition of the
 patient.   From the nature of the disease itself as possessing an essen-
 tially progressive character, it cannot but go  on  extending its ravages
and increasing its tortures,  unless arrested  in its course by medical
 skill, until death closes the scene.   For as there are forms of disease
 which are self-limited in their course, extent  and duration, so this one
of cancer (so named  by the ancients from its  large surrounding veins
and general resemblance to the body and claws  of a crab) is just the
opposite.   It  seizes upon tissue after tissue and organ after  organ,
 hardening, softening, wasting away  all within its reach, till the ex-
 hausted system can endure no more.
  The intensity of the pain forms another and characteristic feature of
cancer.   This is a sharp, lancinating or stabbing pain.  It is similar to
that which occurs in felon or whitlow, and it is no less acute.  " It is not
constant, or the patient could not live, but comes  at uncertain intervals,
and is so startling as well as severe that it makes  the  sufferer  bound
 from her chair or couch, not infrequently with a sharp cry of anguish.
 It is as though a dagger had been thrust into the tumor."  This pain 
                    CANCER AND CANCROID.                  691

 comes in paroxysms  of varying duration, which are accompanied by
 an increased activity of the circulation, a turgescence of the enlarged
 veins which lead out from  the cancer;  and the paroxysm may often
 subside by a more or less profuse haemorrhage, which seems to relieve
 the pain.  Hence these paroxysms may be regarded as  periodic (or
 irregular) aggravations or acute attacks, superadded to the constant
 chronic affection.
  These intense stabbing pains afford an almost infallible diagnostic
 indication, especially when they thus recur in paroxysms.  Such pains
 appear only (except  in the case  of felon  already mentioned, where
 there could be no danger of mistake) in cancer and in acute inflam-
 mation of the' mammary gland.  But in the latter cases  the two ex-
 citing causes which lead to mammary abscess—lactation and mechanical
 violence—will suffice to prevent the pains which  attend  such condi-
 tions from being mistaken  for  cancerous; and besides in these cases
 of abscess the pains  come  on  much more rapidly, as in fact does  the
 whole inflammation.
  The  remarkable tendency to a fatal termination can never be over-
 looked in the  consideration of cancer.   In cancers of the breast and
 other exposed  parts of  the  body the mischief may be apprehended,
 and effectual means taken by the exhibition of the  appropriate homoe-
 opathic remedies to arrest its progress before it has too deeply seized
 upon the system.  But cancer of  the uterus may become very firmly
 established  before its presence  is  even  suspected.   Hence the  inva-
 riably fatal termination of  this form  of cancer.   Originating, as we
 have already shown, in a constitutional  dyscrasia,  by its presence, by
 its derangement of the  proper functions of the  organ upon which it
 seizes, and by  the serious injury  inflicted  upon the system  by  the
 severity of its pain, it  tends to reduce the vital  strength, and thus
 render  it more difficult to establish in the  system a vital reaction of
 sufficient energy to throw off the incubus; and this physical depress-
 ing influence  is greatly increased  by the moral  influence which the
 knowledge of  the terrible nature of her disease  must exert upon the
 patient herself.
  Causes.—These are either primary, predisposing, hereditary, consti-
 tutional influences, or secondary, exciting, provoking causes.  Of the
 former we have already said all that was necessary.  Of the latter we
 make brief mention here.
  And  in  the  first place, it should  be  remarked, in this  connection,
that nearly if not quite all the secondary or provoking causes  of
cancer  in the  woman, with  which  alone we  have to do in the pres- 
692      DISEASES AND  DERANGEMENTS OF THE UTERUS.

ent work, are  directly  or  indirectly  connected with  her sexual
system.  Cancers  of the womb and  of the  breast,  which form the
great  majority of  all that attack women, are evidently thus directly
related, while those which, however rarely,  occur  in other  parts
either  remote from the sexual organs or not in immediate physio-
logical relation to them, may be seen  to  result from  general depress-
ing influences, which, as in the case of  widowhood, or even of those
who remain  unmarried, have at least an  indirect  relation to the
sexual condition.
  And in  this connection  it is interesting to observe the condition
in life of a number of cases.  Of one  hundred and eight cases re-
corded by Scanzoni, ninety-one were married, seventeen were maidens,
thirty-six were sterile, seventy-two had had several labors.
  Excessive sexual excitation and immoderate coition form one of the
most prominent causes of cancer  of the womb.   In connection with
this, it must be remembered that constitutional predisposition plays a
most important part.   The insatiable  desire known  to be present in
some of these cases, which is of course the immediate cause of such
sexual excesses, is itself a  constitutional condition, existing before it
develops itself in this  voluptuous orgasm of the sexual apparatus.
  In like manner, disorders of the menstrual function, with leucor-
rhcea, which, by the author already referred to, are set down as the
provoking causes of one-half  of his cancer cases, must be deemed to
be dependent upon or  connected with  a true  cancerous dyscrasia.
Otherwise, why have not the same disorders resulted in cancer in the
thousands of other women who have suffered with them for years?
  The same thing again is  true of the cases  of cancer which are de-
veloped under the  influence of u emotions of grief, fretfulness, the cares
of life, affliction after some bereavement, etc."   All these powerful
depressing influences  are capable  of developing cancer only in those
women in whose systems are implanted  the seeds of a true cancerous
dyscrasia, or one wdiich may be interchangeable with it, complementary
to it.
  If  we examine  the age at which  the great majority of cases  of
cancer occur, we shall  find still further proof of their connection with
the sexual system.  The average age at which this disease makes its
appearance is  about the  forty-eighth year.   This of course  brings
the disease in immediate  relation with  the  change of life.  And  in
fact there is  little  reason  to  doubt that the various causes wdiich  so
afflict  the  female  economy as to  result in the development of this
disease find  their culminating point at this climacteric period.  All 
CANCER OF THE UTERUS.
693
of the provoking influences already mentioned may concentrate their
forces as it were at this period, and produce such cancerous disease at
or soon after the cessation of the menses as they could not have done
before.  And this  disease may be  developed  in the uterus or in the
breast or in some other part or organ, under the  influence of other
local provoking causes, or under the influence of what may be termed
a reduplicated hereditary predisposition.   For example, a woman of
cancerous  constitution  whose mother  had cancer of  the womb will
be so  much the more  likely to  have this dyscrasia in her own case
developed in the same organ;  and married  women are much more
likely  to have cancer of the womb at this time than  those who  have
remained single, although many cases of the latter sort are recorded.
And in this country this form of  disease  is  much more prevalent in
the Southern than in the  Northern States.   It has been observed that
at the South the same  constitutional dyscrasia  assumes the form  of
uterine cancer which at the North would,  at  an earlier period of life,
have been developed in the form of pulmonary phthisis.

                   Cancer of the Uterus.
  The preceding discussion  of  cancer in general will obviate the
necessity of any more than a very brief account of the particular forms
and varieties of this disease as  it attacks  the uterus,  breast or other
organs.  The most common  form  in  which cancer  appears in the
uterus is the scirrhous.   This form may be slow and insidious or very
rapid  in its  development, according  as  it attacks the  older or the
younger females, and it  is usually the least  amenable to treatment.
In fact, unless it can be diagnosed in its earlier stages, and properly
treated from the very first, the prospect of doing any more thau to
relieve and prevent suffering, and  so  perhaps prolong life,  is more
than doubtful.  Scirrhus of the womb passes through  two general
stages, and thus may appear to the physician  on his first examination
under either of its two forms.  These  are the primary form of indu-
ration and  the secondary form of ulceration.

  Indurated, Non-ulcerated  Cancer of the  Uterus.—This
disease almost invariably attacks the cervix, but in some rare cases it
is found primarily in the fundus or body  of  the uterus itself.   From
the view we have taken of the nature of the cancerous affection it will
be natural to conclude, as is taught by high authority on this subject,
that the disease does not spring from a previous and different form
of inflammation, with  or without  induration, but that cancer  is  sui 
 694      diseases and derangements  of the uterus.

generis—that it arises as it wTere on a general constitutional foundation
all its own,  seated, built up and developed under  the influences of
special  provoking causes.  And  from its remarkable tendency to a
fatal termination it becomes most important to  determine the exist-
ence of the disease at the earliest possible moment,  but this is no less
difficult than it is desirable; for  where the indurated form of cancer
attacks women at the critical age or more advanced period of life, its
onset is gradual and insidious,  and it is liable to be confounded with
the induration which may result from benign inflammation; and where
it attacks younger women it may develop itself in a much more rapid
manner, and  without any such severe local symptoms as would lead to
an examination of the affected organ.
   Disease of the uterus  of much less importance than cancer  may
give rise  to  much more strongly marked symptoms.  " I must again
repeat that my own experience,  as well  as the  analysis of that  of
others, leads  me to the conclusion that cancerous growths of the uterus
in the incipient or non-ulcerated stage of their development are ahvays
indolent, and give rise  to no syunptoms  sufficiently  decided to induce
patients to complain or to seek advice.  Thus we can explain how the
disease in its incipient stage  does not come under the notice of the
conscientious practitioner,  who  never  uses  the speculum  without
serious reasons for so doing."   Easy as it is, generally, to recognize
cancer of the uterus in  the advanced periods of the disease, it is often
very difficult to distinguish it  in the commencement* from a simple
induration of a benign  character in  the lower portion of  the uterus.
The diffused swelling of the affected part, with a considerable hard-
ness and complete absence of sensibility, the appearance of the disease
at the critical age, and the impossibility of referring the commence-
ment of the affection to an anterior labor, may be regarded as charac-
teristic signs  of the commencement of cancer.   And  there is no doubt
but that in many cases, especially of  women who still menstruate, the
cancer is  very rapid in  its growth  and progress, and so  may attain
considerable  size and present  extensive induration and adhesion to
the surrounding parts, before its existence is suspected; and even then
the results of vaginal exploration are said to be  insufficient to distin-
guish in a certain manner a chronic engorgement of the vaginal por-
tion of the cervix uteri from scirrhous induration.   A careful study
of all the symptoms and conditions of the  patient will be absolutely
essential in ordei  either to  determine the nature of the disease or to
decide upon the appropriate remedy.
  As it is of the utmost importance to distinguish cancer of the womb 
cancer of the uterus.
69o
at the earliest possible period, we gather from other writers the records
and summary of symptoms which may appear  before the cancer ad-
vances to the ulcerated  stage.  Among the earliest symptoms are:
" Leucorrhoea  alone  or combined with  menorrhagia; aching  in the
back  and sense of heaviness in the hypogastrium; dull pain in the
top of the thighs, with bearing down ;  then there occurs darting, lan-
cinating pain between the pubes and the sacrum, or in the  course of
the vagina, with a sensation of glowing heat, more or less frequently
experienced, and often  attended with  dysuria and  mucous deposi-
tion from the urine; itching  of the vulva, which is affected  with a
kind  of flabby swelling or with erysipelatous  inflammation; pain in
coitu; dyspeptic symptoms prevail,  such  as  flatulence, heart-burn,
sometimes vomiting, and  sympathetic  cutaneous eruptions."   Or the
appetite  may at first be very greatly increased  and the digestion  ex-
cellent, or  with attacks  of indigestion  from  over-eating.   " In  the
course of the  disease retention  of  urine frequently occurs, requiring
the use of the catheter, or incontinence of urine may take place."
  The first symptoms generally are:  menstrual irregularities; a tem-
porary increase of the menstrual flow; leucorrhcea, which is either
continued or  lasts for a  short time' only, white or yellowish, some-
times changing to a  reddish color after  intercourse or after any otlier
local irritation; sense of weight at the  hypogastrium, with pressure
on the rectum or on the  urinary organs; stool and emission of urine
sometimes more painful, and always more or less difficult;  disagree-
able  sensation during  intercourse;  occasional transitory  shooting
stitches, especially at the period of the  menses or  after physical  or
moral excitement; transitory pullings  in  the loins or groin, and
hysterical ailments;  haemorrhoidal  distress; alternate distension and
caving in of the  abdomen, etc.  Sometimes we discover even at this
period slight swellings or indurations of the womb, occupying rather
the neck than the body of the womb, with a sort of  irregularity in
the shape of the neck.  These symptoms  may remain  unchanged for
a long time, but  as  soon as cancer has openly set in, the neck, and
even  the body of the uterus, and likewise the lips of the  os tincae,
are swollen, hard, knotty, lobed and  more or less red, but smooth
and not sore,  covered with bloody  mucus or with pure blood, painful
to  pressure, and   sometimes  accompanied  by  engorgement  of  the
ovaries.  In some cases there is only a single clearly circumscribed
tumor, the seat and  extent of which may  be discovered by an exam-
ination through the  rectum; in most cases there are several tumors.
or  even, if the entire  uterus  should  be invaded, a group of  several 
696      DISEASES AND DERANGEMENTS OF THE UTERUS.

rounded irregularities at  the  surface.  These  tumors might  some-
times  be confounded with  fibrous  bodies  if  the  otlier  signs that
accompany  the  cancer did  not render  such a mistake  impossible.
Besides, in  its attacks upon the uterus, cancer  but very rarely com-
mences in the body or fundus, whilst these are the parts which are
especially selected by the fibrous tumor.   When cancer does involve
the body of the  uterus, it may be distinguished from fibrous  tumor
by its  presenting  a  hard swelling of the whole  uterus, and  by the
adhesions to the  adjacent parts  which  attend such malignant in-
durations.
  In attempting at the earliest possible  period  a diagnosis of a sup-
posed cancerous affection of the uterus, we should consider__
  I. The portion of the womb  affected, the vaginal portion of the
cervix being the most likely  to be attacked by scirrhus.
  II.  The extreme hardness and general insensibility of the tumor.
  III.  The  period  of life, the cancerous disease being most  apt to
occur at the cessation of the  menses.
  IV. The gradual  development of the tumor in such women, or its
more sudden appearance in those who are younger.
  V. The severity, lancinating, stabbing and paroxysmal character of
the pains.
  VI. The extension of the disease into the adjacent tissues, and con-
sequent adhesion  of  the tumor  to the surrounding parts.
  The Ulcerated Form  of Cancer  of the Uterus.—In its
second  or ulcerated  stage  cancer  of  the uterus is much more  easily
recognizable.  The ulceration itself, in connection with the surround-
ing induration and the peculiarly fcetid nature of the discharge, very
strongly marks the nature  of the case; while, as the disease advances,
the countenance assumes a  no less peculiar straw-colored complexion,
which  when once seen can  almost always be relied upon as an infalli-
ble indication of the presence of cancerous affection.   "As soon as the
cancer has broken out, the pains, wdiich until recently had been tran-
sitory, become  more permanent, with acute  lancinating pains, like
needles or knives thrust through the part; the loss of blood becomes
more frequent and  sometimes  habitual; a fcetid serous  or  bloody
leucorrhcea  sets in,  which becomes  fouler the more the  ulceration
progresses, being  sometimes mixed up  with small flocks of putrid
matter  of a brownish color, and  frequently having an excessively
pungent (offensive)  odor,  or also with  little  coagula  of blackish
olood.   If  the menses have continued  so  far, they often  increase
to a flooding; in women  where they have stopped they act as if 
CANCER  OF THE UTERUS.
697
 they would reappear;  others discharge  constantly a  profuse watery
 liquid without smell, or having  an insipid sickening odor; at the
 menstrual period this liquid becomes rose-colored.  This serous dis-
 charge generally indicates that the ulceration  has either  commenced
 or is imminent.  Pain now succeeds pain; the loins, small of the  back,
 hvpogastrium, iliac region, even the nates down to the thighs, become
 the seat of contusive tearing or clistensive  pains, sometimes  mingled
 with smarting pains or acute  stitches in the neck of  the uterus, and
 sometimes preventing sleep to such a degree that the patients dare not
 give themselves up to it."
   The mental functions remain unimpaired in spite of  all these dis-
 tresses, and  these  cancerous diseases do not  always  prevent concep-
 tion, although the  products of such conceptions seldom  survive birth
 or the full term, and  in most cases they perish at an earlier period.
 Neither is the cancerous disease communicable by contact, as is proved
 by the immunity of the husbands in such cases.
   As the disease advances  in its course the ulceration becomes  more
 extensive; the patient's strength is wasted  by the intense pain, which
 is now almost constant, with dreadful paroxysmal aggravations; the
 loss  of  sleep and the  repeated haemorrhages break down the system
 still  farther;  hectic fever makes its appearance daily,  or even oftener,
 leaving the sufferer, after each accession, weaker than  before;  the ap-
 petite fails, the digestion becomes impaired, assimilation is impossible,
 and the life itself is finally exhausted by a chronic disease which orig-
 inates in its  constitutional foundations, and which, wdiile ultimating
 in a  single organ, eventually involves every vital function within its
 fatal influence.
  This disease may reach its termination in from  five or six months
 to as many years;  in  its later stages it may be  attended with  most
 obstinate constipation or excessive diarrhcea,  or  both; the body  may
 be reduced by gradual emaciation  so as to resemble a  skeleton, or the
 lower limbs  may become infiltrated and the whole body bloated as
 with dropsy.   In this  latter case,  especially in those advanced in life,
 colliquative diarrhoea sets in with  putrid and dark-colored stools and
 horrible pains, which reduce the  patient to a state of  collapse  in a
 manner not unlifce that of the Asiatic cholera.
  The diagnosis of the more  frequently seen open or ulcerated can-
cer is comparatively  easy.   Here, in addition to the constitutional
symptoms and   conditions already referred  to   under   the  diagno-
sis of the non-ulcerated form of the disease, we have others, af-
forded by the touch, the diagnosis  being  made  more full and less 
698       DISEASES AND  DERANGEMENTS OF THE UTERUS.

liable to  be  mistaken by the indications  obtained  from the use  of
the speculum.
  I. The ulcerated surface is hard and  diversified by lobules, tuber-
cles and ridges.
  II. The peculiar pale, straw-colored complexion is very character-
istic of  this stage of cancerous disease.
  III.  The  odor  of the  discharge  from ulcerated cancer, so exceed-
ingly offensive and so persistent on the finger after examination, and
even in the whole room, is alone sufficient to determine the nature of
the disease in the great majority of cases.

  Encephaloid  or  Medullary Cancer.—This, known also as
haematoid cancer, melanosis, encephaloid disease, is the most common,
next to  scirrhus, and  may appear  in the womb  or in any part of the
system.   It runs a very rapid course, but is more amenable to treat-
ment than scirrhus.  It is composed, in great measure, of a soft white,
pulpy substance, in color  and consistence very closely resembling that
of the healthy brain, whence its name, encephaloid.  The fungus nema-
todes bears the same relation to  the medullary cancer  that the open
ulceration does to scirrhus—it constitutes its secondary stage.   When
the medullary disease advances  to  ulceration, red, ragged,  bleeding
growths sprout rapidly from the open surface; hence their  designa-
tion as fungus haematodes—bleeding fungus. The medullary  cancer is
far less  liable to form adhesions with the contiguous  parts than is the
scirrhus.

  The  Colloid or  Gelatinous Cancer is much more rare than
the encephaloid, and consists of a congeries of gelatinous cysts, gener-
ally of  the size of a hazel-nut, containing  serous fluid, and having an
investing envelope of delicate structure, which binds  the cysts into a
connected mass.   "This form may  exhibit the appearance  of small
portions of  greenish-yellow  transparent gum or jelly, arranged in
regular  cells; hence it  is sometimes denominated alveolar cancer."
The most common seat of this form of cancer is the abdominal cavity,
although  it has been known to occur elsewhere.  It grows rapidly,
often to a very gieat size, rarely proceeds to ulceration, but eventually
proves fatal by encroaching upon organs whose healthy action is essen-
tial to the prolongation of life.

  Mammary Cancer.—The female breast is  even  more frequently
than the womb the seat of cancerous disease.  In this  situation it is 
CANCER  OF the uterus.
699
much  more readily and much  earlier detected, and thus  an oppor-
tunity is  offered for  administering the proper remedies at  the very
onset of  the disease.   The  extreme  stony  hardness of a suspected
tumor in  the mammae, and the fact that it appears  already adherent
to the surrounding tissues,  will  greatly  aid in  deciding as  to its
malignant character.   Some  of  these apparently scirrhous formations
are developed  in  consequence of a blow upon the breast; many of
these, whether they might have  finally resulted in  open cancer or not,
are readily cured and  caused to disappear entirely by the  exhibition
of Conium.  (See the article on Mammary Cancer.)

   Cancroid or Epithelioma.—The special form of cancer known
as cancroid or epithelioma differs from  other varieties of cancerous
disease chiefly in this, that there is less parenchymatous involvement,
the disease being more superficial, and the systemic poisoning, usually
so rapid in true cancer, being much more  tardy of production.  Dr.
T. G. Thomas  writes thus lucidly concerning it: "Cancer of the ute-
rus, like the same disease in other parts of the body, has two distinct
stages—that of formation and that of destructive  ulceration.   In the
first of these a generation of  heterologous material takes place in the
interstitial portions of the structure affected, and as the second  period
becomes established a connection is formed with the surface hy ulcer-
ation.   In certain cases the  morbid influence, instead  of exciting in-
terstitial deposit, is exerted upon the  mucous  membrane itself, affect-
ing its production of epithelial cells.  In such cases less deposit  occurs
in the tissue underlying the mucous  membrane.   To this class the
names of epithelial cancer, corroding ulcer and cauliflower  excrescence
have been applied.  As Mr. M. H. Collis remarks, its special name
is unimportant, 'if its difference from cancer and its analogies to it be
kept clearly in view.'"
   Cauliflower excrescence, as above remarked, is one of the terms em-
ployed  in designating epithelioma, or, more correctly, it is a special
form of epithelioma.   It  appears at  first in the form of a  tubercle,
which increases in size with considerable rapidity, becomes fissured
and branches out, forming a soft, irregular  mass, which, when  well
advanced, bears some resemblance to a cauliflower—a  resemblance
which is  often wanting.   It gives forth a profuse and  watery dis-
charge, which is not, however, usually so fcetid as  the  discharge from
medullary cancer.  It sometimes becomes very large, filling the whole
vagina, and is  very vascular, giving rise to frequent profuse haemor-
rhages. 
700      DISEASES  AND DERANGEMENTS OF  THE  UTERUS.

  Volumes have been written in description  of the forms of cancer
but we do not deem it necessary to give more minute accounts of these
and the other less common varieties of this disease, since the symptoms
themselves will inevitably lead the homoeopathic physician to select the
most suitable remedy in each case.

                           Treatment.
                   Remedies for Cancer in general.
  1. Ars., Bell., Carb. an., Con., Graph., Hydrastis, Creos., Sep.  2.
Am ,Chin., Clem.,  Magn. mur., Merc, sol., Nitr. ac, Sep., Sil., Staph.,
Sulph.  3.  Apis, Calc. c, Cocc,  Jod., Lach., Lye, Murex p., Phos.,
Phytolac, Rhus tox., Sab., Thuya.

                       Remedies for Scirrhus.
  1. Bell., Carb. am, Con., Sep.   2. Aur., Chin., Magn. mur., Staph.
3. Clem., Cocc, Phos., Rhus tox.

  Arsenicum. Lancinating pain through the part.  Terrible dartings
and lancinatings, which burn like fire.   The more  like fire the burn-
ing sensation is, the more strongly does  it indicate Arsenicum.  Acrid,
corroding, burning  discharges.   The  discharge may be thin or thick,
brown or black.  The discharge is often extremely offensive.  The
sufferings are usually worse after twelve at night. The patient is very
easily fatigued.
  Aurum. The womb is discovered to be prolapsed and indurated.
The pain  is like that of a bruise, with shooting  and drawing.  The
mind  constantly dwells on suicide.
  Belladonna. The woman finds it difficult to stand, on account of a
pressing down as if the internal organs would pass out.  Occasional
pains, which come on suddenly and finally leave as suddenly.  Flow
of blood between the periods;  the blood often feels hot.  The blood
often has a very bad smell, and flows profusely.  Violent pain in the
back.   The parts feel dry and hot internally.
  Calc. carb. Pale, leucophlegmatic temperament.  The feet feel as if
she had on cold, damp stockings.   Vertigo on going up stairs.  The
menses flow too often and too abundantly.  Sore, bunrng feeling in
the internal genitals.   A constant aching in the vagina.   Very sensi-
tive to the least cold air, which goes right through  her.
  Carbo an. Violent pressing in the loins, the small of the  back and
the thighs during  the menses, with unsuccessful  desire to eructate, 
            TREATMENT OF CANCER OF THE UTERUS.         701

 with chilliness and yawning.   Great languor in the thighs before and
 during the menses.  After the appearance  of the menses she feels  so
 tired she can hardly speak, accompanied by yawning and stretching.
 Weak, empty feeling at the pit of the stomach.
  China.  This medicine will be  useful  when a profuse  and  long-
 continued haemorrhage has seemed to produce the suffering.  There
 is usually an ichorous  leucorrhcea and dysmenorrhcea.  The patient
 is worse  every other day.   Flatulency, wdiich is not relieved by dis-
 charges of flatus.
  Clematis.  For  softened  scirrhus,  with corrosive  leucorrhcea and
 lancinating pain, the other symptoms agreeing.
  Conium. There are burning stitches, stinging, nausea, vomiting and
 sadness.  The breasts  are relaxed, except  at the  menstrual periods,
 when they often swell and become sore and  painful.  The urine  in-
 termits in its  flow.  There  is much vertigo, particularly on turning
 her head when lying in a prostrate position.
  Creasote.  Shooting stitches in the vagina; burning and  swelling
 of the external and internal labia.  Profuse discharge of dark coagu-
 lated blood, or of a pungent bloody ichor, preceded by pain in the
 back.  Aggravation of the pains at night; fainting on rising from the
 bed.  She ahvays feels chilly at the menstrual period.  Complexion
 livid;  disposition sad, irritable.
  Graphites.  In  women inclining  to obesity, and whose  history
 reveals a disposition for the  menses to delay; swelling of the feet;
 itching blotches  in various  parts of the  body, which discharge a
 glutinous, watery fluid.  Now that she has symptoms  of cancer her
 skin is better.  The ovaries  are also affected.  She  has violent lan-
 cinating,  stitching pains through the uterus down to the lower ex-
 tremities.  Heaviness in the abdomen, with exacerbation of the  pains
 when standing.
  Jodium. Uterine  haemorrhage after every stool, with cutting  in the
 abdomen and pains in the loins and small of the back.   Great weak-
 ness during the menses, particularly on going up stairs.  Long-lasting
 uterine haemorrhages.   More  particularly indicated in scrofulous per-
 sons.  Dwindling and falling away of the mammae.
  Lachesis.  More particularly if  the  cancerous affection be developed
at the critical period or as  a consequence  of the change of life.  The
frequent haemorrhages  at that period may indicate the  approach  of
this disease.   Sometimes the pain increases more and more, until re-
lieved by a profuse discharge of blood;  and after the lapse cf a few
hours or days the same phenomena are again exhibited, and so on. 
702     DISEASES AND DERANGEMENTS OF THE UTERUS.

At times the pain is  as violent as if a knife were  thrust through the
abdomen, the pain itself resembling this sensation.
   Lycopodium.  Pains passing through the vagina on stooping.  Darting
pain in the labia.   Dischajge of wind from the vagina.  Much bor-
borygmus and  gurgling in the left hypochondrium.   All her suffer-
ings increase at about four p. m., and  abate at about eight or nine
in  the  evening.   The  urine deposits a  red  sand;  it is often very
frothy.   Pain  in the back before  the flow of urine, which  is much
delayed.
   Mag. m. If the  peculiar constipation of this remedy  be  present;
large, hard, difficult stools, which crumble as they come or to pass the
verge of the anus.  Let the action of the remedy be continued a long
while after the bowels become regular and comfortable, and the scir-
rhus will also disappear.
   Mercurius.  This remedy may be particularly indicated if there  be
prolapsed vagina.   The inguinal glands  sympathize with the cancer-
ous affection.  In  cases  in -which  there is  syphilitic  taint in  the
system, see the  most characteristic indications for  this  remedy under
Leucorrhcea and Prolapse of the Vagina.
   Murex pur. Has cured carcinoma  uteri where very great depression
of spirits, a sort of deep  hypochondria, prevails as the characteristic
symptom.
   Nitric acid. In cases where the  syphilitic taint is the basis of the
affection.   Tlie urine  is very offensive.   The inguinal glands are sym-
pathetically affected.   The patient  is  worse  after twelve  at  night,
Violent cramp-like pains, as  if the abdomen would  burst, with con-
stant eructations.  Violent pressing, as if everything were coming out
at the vulva, with  pain in the small of the back, through  the hips,
down the thighs.
   Phosphorus. In  tall, slim  women, with sense of emptiness in the
abdomen;  much heat up  the back, and a narrow, tough, dry. stool,
like a dog's.  Cutting pains through the abdomen, sometimes with
vomiting.  Very sleepy, particularly  after dinner.  Belching up  of
an  immense  quantity of wind after eating.   Frequent and  profuse
haemorrhages, pouring out freely, and then ceasing  for some hours or
days.
   Rhus t. Is  particularly indicated where repeated drenching in the
rain has deranged the uterine functions.  The menstrual  discharge
causes a violent biting pain in the vulva. Vitiated discharge, with
shooting upward  in  the  vagina.   Rheumatic pain and  stiffness,  re-
lieved by motion. 
r
           TREATMENT OF CANCER OF THE  UTERUS.          703

  Sepia.  Lancinating pains from the  uterus to the umbilicus.  A
putrid excoriating discharge from the vagina.   A  sense  of weight
and pressing down, wdiich causes her to cross her thighs lest the organ
should escape.   Sensation of weight in the anus, not relieved by an
evacuation.  Very cold  feet and  hands—icy cold.   Great sense of
weakness and emptiness  at the pit of the stomach.  Yellowness of the
face, particularly across the bridge of the nose, like a saddle.  Shoot-
ing stitches, with burning in the neck of the uterus.
  Silicia. Discharges of blood between the regular periods.  Increased
menses, with repeated paroxysms of icy coldness over the whole body.
Attacks  of melancholy ; anguish in the  pit of the stomach.   She
wishes to drown  herself.   Fcetid, brownish, purulent, ichorous  leu-
corrhcea.  Always great costiveness immediately before and during
the menses.  Momentary attacks of sudden blindness.
  Staphysagria. Particularly indicated where syphilis or mercurializa-
tion acts as an  exciting cause.  Flow of blood from the genital organs
occurring a long time after  the critical age.  Spasmodic pains in the
vulva and vagina.   The teeth  turn  black  or show dark streaks run-
ning through them.
  Sulphur. This  great polychrest will  be  found suitable  in  a  large
majority of cases  if we  are called early, and if we  find a  few of the
following  symptoms  prominently  developed:  offensive,  corrosive,
ichorous leucorrhoea;  sensation of  heat  in the crown  of  the head;
coldness of the feet, or  burning  in  the  soles  of the feet at night;
flushes of heat, -which pass off  in a perspiration, with faintness.   The
patient feels remarkably weak and  hungry at the pit of the stomach
from eleven in  the morning till noon; she cannot wait for her dinner.
She sleeps lightly at night, and awakens  very frequently.  Violent
burning  in the vagina,  with  painful  soreness during  sexual inter-
course.
  Thuya. This  remedy will be particularly indicated if  syphilis acts
as an exciting  cause of the disease.  Cauliflower excrescences, bleed-
ing easily,  having  an  offensive  pungent odor.  To  be  especially
studied,  and given in  cauliflower excrescences if the  other  symptoms
correspond.  "Warts, condylomata and  other excrescences  about the
rulva or anus.  Ulcers on the internal  surface  of  the  vulva.   The
vulva has a sore and smarting  feeling.  Pressing and contractive pain
in the vulva when sitting.  Cramp-like pain in the vulva and  peri-
neum when rising from a seat.  Cramp pain in the  vulva, extending
as far as  the abdomen.
  For other remedies and indications see Leucorrhcea, Amenorrhcea, 
704     DISEASES AND  DERANGEMENTS OF  THE  UTERUS.

Dysmenorrhcea, Menorrhagia, Inflammation  of the  various organs
and compare and study the various remedies there recommended.

Gangrene, Putrefaction or Ramolltssement  of the Uterus.
  These forms of degeneration of the womb arise only in consequence
of other primary disorders, and require no particular description in
this place.   The following medicines should be carefully studied, and
the remedy selected according to the individual characteristics of each
case :

  Aconite.  When the congestion and inflammation of  the part are ex-
treme.  Great anguish and  fear of death.  Dry heat of the skin and
intense thirst for cold water.  When  the pain has suddenly ceased,
the characteristic  discharges have  taken place, and  the febrile and
mental symptoms continue, Aconite is  unquestionably the  remedy to
be administered first and  in repeated doses.
  Apis. Absence of  thirst  and  scanty  secretion of urine.  Violent
stinging, plunging pains.  Great restlessness.
  Arsenicum. Rapid sinking; cold perspiration; extreme restlessness;
great fear of death.  Aggravation  after twelve at night.   Thirst for
little  water at  a time and  very often.   Undigested food passes the
bowels, with great distress  and  increase of prostration.  Repeat the
medicine frequently till better.
  Belladonna. The eyes are much congested with blood.  She rather
desires death than fears it.   There is a strong sense of heat about the
vagina; involuntary discharge of faeces  and urine.  The discharge  is
foetid.
  Carbo veg.  The patient  wants more air—wants to be fanned all the
time in the face.   Eructates frequently,  with momentary relief.
  China. Sensation of great distension in the abdomen, which distresses
her much.   Frequent eructation, which  affords no relief.  Ringing in
the ears.  The characteristic discharges  of China.
  Creasote. There is  very great fcetor;  excoriation and prostration.
The fcetor has a pungent  effect.
  Secale corn.  The  patient is of  a passive disposition, of a thin and
scrawny appearance, and  subject  to passive haemorrhages. 
DROPSY OF  THE  UTERUS.
705
                  CHAPTER  XXXIII.

       DISEASES  OF  THE  UTERUS—CONTINUED.

                  Dropsy of the Uterus.

   DROPSICAL accumulations in the uterus may consist of mucous
    or serous fluids.   In the former case they appear to be simply
the result of such closure of the orifice of the uterus as may prevent
the discharge of its natural secretions.  In the latter the fluids assume,
in quality and in quantity, rather the  character of ordinary dropsical
effusions.
  Displacements of the uterus, by producing flexion of the cervix, and
so bringing its walls in contact at the point of flexion,  may occasion
such an obstruction of its orifice as to cause the mucous accumulation.
The same  result may follow7 the pressure of a polypus  or tumor, or
other approximation of the walls of the cervix; and as amenorrhcea is
nearly always  associated with uterine dropsy, this mucous secretion
appears sometimes to take the place of the menses.  Cases  have been
recorded in which these mucous accumulations would occur from time
to time in the absence of the menses, and then  again disappear on the
return of the proper menstrual flow.
  This mucous form of dropsy of the uterus may thus be called recur-
rent, in contradistinction from the other,  serous variety, which is more
continuously persistent.  Mucus from the accumulation sometimes
appears to break away with more or less regularity, discharging itself
and again re-forming.  This variety  appears in  some instances to have
relation to  the menstrual nisus, aggravating about the time  of  the
usual monthly periods.
  In  many women the cessation of  the menstruation extinguishes the
inflammatory affection of the womb, which has been kept up by the
menstrual molimen. But in some cases the deprivation of the monthly
discharge increases the  inflammation and renders  chronic the conges-
tion, which before had  been but occasional and relieved by the men-
si rual flow.  In such cases, while the body of the womb becomes  the
seat of a persistent morbid activity,  its neck becomes atrophied, so as to
impede more or less the exit of the fluids contained within the cavity of
the uterus.  The result is, that the womb becomes more and more dis-
tended by a sero-sanguinolent, a muco-sanguinolent or a mucopuru-
lent fluid.  Severe uterine pains  of an expulsive character may re-
      45 
706      DISEASES AND  DERANGEMENTS OF  THE  UTERUS.

peatedly  occur, till at last the fluid is  ejected and  the  patient  is
relieved.   The  same  process  of formation  and expulsion of such
accumulations may be renewed again and again.
  But in the persistent form of uterine dropsy the fluid appears to
be of a much more decidedly serous nature, and to be connected with
a true  dropsical diathesis.  Reasoning from  the  analogy of similar
disorders in other  parts  of the system, we may suppose that in this
case there is considerable thinning of the mucous membrane of the
uterine walls, and  that this serous fluid  is secreted from  the sub-
mucous  cellular tissue,  or rather  from  the  vessels which it con-
tains.   This is the  idiopathic dropsy of the uterus, and the accumula-
tion may go on for  years, until  relieved by  art  or terminated by
death.
  Either of these forms of dropsy may  be associated with hysteria or
anaemia.  And  in  those  cases of dropsy of the uterus which appear
in consequence of structural disease of that organ the fluid is generally
mixed with purulent matter or blood; while in certain conditions of
the system the dropsical accumulations in the uterus, principally those
of the mucous variety, become decomposed, and so give rise to volumes
of gas, wdiich may  escape with a loud report.   This is termed physo-
metra; where  both water  and  gas are contained  in the womb, the
term pneumo-hydrometra is descriptive of this anomalous and unusual
condition.
  Dropsy of the uterus may be  recognized by the enlargement of the
uterus itself; by the sharp  pains which may be present;  by the sup-
pression of the menses by which it is attended ; by the displacements,
severe losses of  blood, and other and perhaps malignant disorders of
the womb which accompany or precede it; by the constant oozing or
occasional gushing of fluid from the uterus, or, where no such escape
of the fluid occurs, by the long continuance and gradual increase of
the enlargement of the uterus  itself.   Its diagnosis may be assured,
however, by dilating the cervical canal by means of tents if not suffi-
ciently dilated, and introducing an elastic catheter within the cavity
of the uterus.
  By a careful  observation of all the attendant symptoms and circum-
stances of the  case uterine dropsy may be distinguished from preg-
nancy, with which it is most apt to be confounded, and from physometra,
by the duller sound on percussion and greater gravity of the concom-
itant symptoms,  And  in cases where the catheter or  uterine sound
is  introduced, the discharge, whether  mucous, serous,  purulent or
bloody, will go far  to determine both the existence of the dropsy and 
DROPSY  OF THE UTERUS.                  707
the nature of its cause.  And where flexion of the cervix, as  in dis-
placement, or total occlusion of its canal from organic disease, prevents
the introduction of the sound, this circumstance will  prove scarcely
less certainly diagnostic.
  In cases, especially recent ones, principally dependent on occlusion
of the cervix resulting from flexion in displacement, the  removal of
the cause may at once relieve the complaint.   The  remedies should
always be selected  after a careful  comparison of all the symptoms and
conditions, as well constitutional  as organic and local.  And in cases
of more direct dropsical  condition (idiopathic dropsy), or where the
dropsy appears in connection with scirrhus or other malignant disease
of the uterus or its appendages  (symptomatic dropsy), the  evacuation
of the accumulated fluids may afford temporary relief, and give more
time and better opportunity to remedy both the organic  disease and
its consequences.
  Those forms of  dropsy which  occur  in connection with pregnancy,
whether the accumulation be formed between  the  membranes of the
ovum and the uterus, or consist in an excess of the liquor amnii itself,
have  been considered with the. other disorders accompanying the
pregnant state.
  Dropsy of the uterus, like that in all other organs  of  the  human
system, will cause a corresponding  sympathetic affection of the whole
body.

  Apis. Absence  of thirst is very  characteristic of Apis  in  uterine
dropsy.  Stinging  pains, as of bee-stings.  Abdomen very tender to
the touch.
  Arsenicum.  Very thirsty for small and often repeated portions of
water.  Water disagrees with her;  it does not pass from the stomach,
but seems to  remain there and distress her.  The lower  limbs  seem
almost paralyzed.   She  can hardly walk.  She is  very weak, and
easily wearied from exertion.   She wants to be in a warm place and
to be wrapped up warmer.
  Belladonna. The  characteristic sj^mptoms of pressure, as if all would
pass out of the  genital  organs,  particularly early in the  morning.
Urine dark and^%canty; sometimes it is as yellow as  gold.  She is
usually  worse after three in the afternoon.   The tenderness  of the
abdomen is aggravated by the least jar even of the bed or  chair upon
which she sits, and she is obliged to step with great care  in walking
for fear of a jar.
  Bryonia. The  swelling  increases during  the  day and  diminishes 
708      DISEASES AND DERANGEMENTS OF THE UTERUS.

during  the  night.   Her lips are dry;  she washes  to  moisten them
often.   She is thirsty for cold water.  The urine  is daru and scanty
although discharged frequently,  and it deposits a pinkish-colored
stain.  All her symptoms  are aggravated by motion.  Her stools are
hard and dry, as if burnt.
  Calc.  carb. In  persons  of  a  leucophlegmatic  temperament.  She
has been  menstruating too  often and too profusely;  she has some
amenorrhoea and dropsy of the uterus and adjacent parts.  She has
vertigo  on  going up  stairs; fluttering of the heart and faintness.
Damp, cold  feet.  Swelling at the pit of the stomach.   She is very
weakly  in general.
  Camphor.  Red urine, depositing a thick sediment, with much cold-
ness of the  external surface. The urine  is emitted very slowly, the
bladder being nearly paralyzed.  The urine is sometimes green.
  Cantharis.  More or less strangury.   Tenesmus of the cervix vesica).
Bloody  urine.   Pains in the limbs;  coryza.   There is much  swelling
of the uterus, pain in the abdomen, vomiting and fever.
  China. The dropsy has  been  developed  by profuse  haemorrhages,
or in aged women.  Uncomfortable distension of the abdomen; she
wishes to belch  up wind frequently, which, however, affords no relief.
Urine dark,  scanty and sandy.
  Colchicum. The urine is very dark, very* scanty, and  discharged
in drops, depositing  a whitish sediment.  Watery stools without sen-
sation.  The dropsy had  supervened upon  the  sudden suppression
of the menses,  which had but just  made their  appearance.  Much
flatulency.
  Conium. The mammae sympathize very much;  they enlarge,become
hard and painful.  The urine intermits.  There is vertigo when lying
in a recumbent  position, especially on turning over.
  Digitalis.  The heart sympathizes  very much;  the pulse is  acceler-
ated or  intermittent.  The stools are very light-colored..
  Dulcamara. This  remedy  will be  indicated  when  the dropsical
affection makes its  appearance after the suppression of perspiration
by cold, damp  air.  Every  cold change in  the  weather makes her
worse.
  Ferrum.  Dropsy  of the uterus,  with great debility and  fiery red
face.
  Helleborus. The secretion  of urine is almost suppressed; the urine
is very  dark, and deposits a dark, coffee-ground sediment.  Debility;
coma somnolentum; piercing pains in the limbs;  loose, gelatinous
evacuations. 
PHYSOMETRA—UTERINE  TYMPANITES.
709
   Kali carb.  Will  often  be found particularly  indicated  in  aged
 ffomen.
   Laotuca. Excessive swelling of the abdomen, feet and eyelids.
   Ledum. Pains in all the limbs;  the skin is dry; she feels very cold,
 and cannot keep warm.   Worse from warmth.
   Lycopodium. There  is  much  red  sand in the urine.  Borboryg-
 mus, particularly in the left bypochondrium.  Sensation of fullness
. clear  up to  the  throat on eating  even a little.   Constant  sense of
 satiety.
   Mercurius. Much perspiration, affording no relief.   Constant short
 and choking cough.  Anguish.
   Phosphorus. (Edematous  swelling of  the hands,  feet and  face.
 Cough, shaking and exhausting, with shortness of breath.  The urine
 contains quantities  of gray  sand.   The bowels are loose and  stools
 whitish.  Belching up of quantities of wind after eating even a little.
   Rhus t.  In cases  of dropsy resulting from amenorrhoea caused by
 being drenched in the rain.   Rheumatic stiffness.   Restless at night;
 she  must change  her position frequently.  Terrible cough, which
 seems as if it would tear something out of her chest.
   Sepia. Dropsy supervening upon a case of miscarriage.  The urine
 is very putrid, or deposits a clay-like  sediment which is difficult to
 remove from the vessel.   She feels as  if  she must cross her limbs to
 hinder the escape of some of the internal  parts through the vagina.
   Sulphur. In persons whose skin is full of pimples  and eruptions.
 Heat upon the crown of the head, with coldness of the feet.  Frequent
 hot flushes, with spells of faintness.   She is unusually hungry before
 noon, cannot wait for her dinner.   The soles of her feet are hot;  she
 must put them out of bed or find  a cool  place for them.  She walks
 all bent over forward.

             Physometra—Uterine Tympanites.
   Physometra or  Uterine  Tympanites  consists in  the formation
 and accumulation of gas in the uterus.   This is generally the result
 of the decomposition  of certain  substances—such as shreds  of the
 membranes, portions of a dead foetus  or of putrid coagula—which
 may be  retained within  the cavity of the  uterus.  It would seem,
 however, to be occasionally an  idiopathic  affection, in which the  gas
 is generated within the cavity of the uterus  by the mucous lining of
 that organ, and produces considerable distension  and discomfort.  Dr.
 Grooch, relates instances of this  kind.   In such cases it is  possibly
complicated with, and forms a part of, hysteria. 
710     diseases and derangements of the uterus.

   In the first variety the gas  results  from the  decomposition  of a
foetus, or of any extraneous  substances .remaining in the uterus  after
parturition; from the decomposition of the products of menstruationj
where, by sudden suppression  of the  catamenia by cold, they  may
have been retained in the womb; or from the decomposition of leu-
corrhoeal mucus  or  of cancerous discharges.  All the effluvia from
such putrefying processes are fcetid and offensive, and many of them
are inflammable.  In these  cases  there may be serious constitutional
symptoms, and even putrid fever.
   Symptoms.—The uterus distended with gas forms a round and more
or  less  extended tumor in the hypogastric region; in the idiopathic
variety of uterine tympanites there may be no constitutional symptoms,
nothing to attract attention save the increase in size or occasional dis-
charge of flatus per vaginam.   In the  symptomatic variety, which
results from decomposition, there  may be chills, a low form of fever,
with  symptoms more or less grave, according to the quantity of the
matter undergoing decomposition in the womb, and to the rapidity
with which  the process takes place.
   Diagnosis.—1. Idiopathic physometra may be distinguished from
pregnancy by the resonance of the tumor, by the absence of ballotte-
ment, of fcetal movement and of the  signs  afforded  by auscultation,
and by the occasional pain.
   2. From  hydrometra, or  dropsy of the uterus, by the greater  elas-
ticity of the abdominal tumor, and by its resonance.
   3. From  ascites by the defined shape of the tumor, by its resonance
and by the absence of fluctuation.
   4. From  scirrhous and steatomatous dispositions by the  elasticity
and resonance of the tumor.— Churchill.
   The objective symptoms,  noisy discharges of flatus, and  the cir-
cumstances  of the patient, as in  those cases succeeding parturition,
will greatly aid in determining the nature of the difficulty.  "You can
satisfy yourself  that the accumulation has been  in the womb by pass-
ing a small  canula or a male catheter through the os uteri.   Then, by
placing the  outer extremity  of  the instrument  under water, you can
evacuate the tumor  through it, and be assured of the  escape of gas
therefrom."—Ludlam.
   Treatment.—Idiopathic uterine tympanites may be radically cured
by one or the other of the following named remedies, selected accord-
ing to the indicating symptoms.   The symptomatic variety, inasmuch
as it depends upon  the decomposition  of foreign bodies  remaining
within the  cavity of the womb, may require special  attention to re- 
moles—hydatids.
711
move these decaying substances if possible, and  injections of warm
water  may be  employed  to  cleanse away the peccant matters.   By
means of sponge tents the  cervical  canal may be  kept open,  thus
allowing a free discharge of the noxious material as well as of the gas
that is generated.

  Bromine. Loud emission of flatulence from the vagina.  Aggravation
of the symptoms from evening till midnight.  Rest  also aggravates,
motion relieves.  The left side is the most affected.
  Lycopodium.  Discharge  of wind from the vagina.  Great sense of
dryness in the vagina.  The symptoms are worse or come on about
four  or  five P. m., and abate four or five hours later.  Much  bor-
borygmus in the abdomen and in the left hypochondrium.  Red  sand
in the urine.  Much pain before urinating.
  Phosphoric acid.  Meteoristic distension  of the uterus.  She  has
always a pain  in  the  liver  during  the menses.  She passes  large
quantities of colorless urine at night.   Indifference to all the duties
and concerns of life.
  For other remedies consult those mentioned under Cancerous and
Gangrenous Affections of the Uterus.

                      Moles—Hydatids.
  The  various  shapeless bodies which are  occasionally discharged
from the vagina are termed Moles.  These may consist of masses of
squamous epithelium from the vagina itself, of the membranous pro-
duct which is expelled in some cases of dysmenorrhcea, or of fibrinous
collections from the cavity of the uterus.  These  constitute  three
varieties of what may be termed false or spurious moles, as occurring
in the unimpregnated female.
  The flakes or tubular pieces of squamous epithelium exfoliated
from the vagina are easily recognized.   " The fibrinous masses  ex-
pelled from the uterus  resemble an almond in size and shape, being
to some extent casts of (the interior of) the uterus; they are  smooth
externally, and  possess a  very imperfect  central cavity.  The  dys-
mcnorrhceal product consists of the uterine mucous membrane, exfoli-
ated in a more  or less perfect form.  When entire it has the shape of
the cavity of the body of the uterus, is rough externally and smooth
within, having  a distinct triangular cavity, with two openings above
and one  below, at the sites of the Fallopian tubes and the canal of the
cervix uteri."—Smith.
  The true or genuine moles  are all the result of impregnation, and 
712      DISEASES  AND DERANGEMENTS OF THE UTERUS.

riieir different varieties  may be arranged under three classes—blighted
ova, fleshy moles, vesicular moles or hydatids.
  In the blighted ova, which compose the first class of these moles the
embryo itself early  perishes, while the ovum, being retained, increases
in size and solidity, not by the normal growth of regular pregnancy
nor even  as in cases of tumor and polypus, but by the  effusion of
coagulable lymph from inflammation of the lining membrane.   This
forms successive layers over  the surface  of the dead ovum, giviiio- it
eventually a great degree of consolidation.   Some of the masses, when
cut into, have no cavity, but the chorion and amnion are demonstra-
ble, although the enveloping  membrane may be one or two inches in
thickness.  It  seems somewhat surprising  that  the covering of the
foetus should be so carefully constructed when there is no embryo.
But  such  is the fact.*  In  such cases the foetus is undiscoverable,
because it has been dissolved  in the liquor amnii, but the  remains of
the umbilical cord may, however, be generally discerned attached to
some part of the  inner surface.  In  additioii the membranes may be
traced, with the placental development, on some portion of the periph-
ery of the ovum.
  The influences which cause the death of  the embryo transform the
ovum from a perfectly  normal development into a  more  or less dis-
organized  mass, which  is sooner or  later expelled as a foreign body.
The blighted ovum, if not expelled within two or  three months, degen-
erates  into a fleshy mole.f    The influences which  originally destroy
the embryo are usually supposed to consist in certain already-men-
tioned changes in the  structure of the  ovum itself.  But we  believe
the reverse to  be  the  case—that disorganization  of the ovum and
membranes results from  embryonic  death  in  the  first instance.
Whence then  come the fatal  forces ?  That on the  maternal side all
is comparatively well  is implied  in  the continuation of the original
growth of the  ovum considered externally.  That  the fatal element
may have been  inherent  in the more interior constitution of the
female  ovum  is indeed possible.   But in most cases we believe it is
originally contained in the seminal  aura of the  male, and thus im-
parted to the ovum in  fecundation.   In many instances in wdiich the
husband has been  affected with syphilis which has  been treated allo-
pathically, and so completely suppressed  externally as to  induce the
belief of a radical cure, the offspring come into the world wrinkled
as if with old age,  prove entirely incapable of independent nutrition,
and constantly decrease in weight from the moment of birth till that
           *Ashwell                            f Churchill. 
MOLES—HYDATIDS.                     713
 r>f their death.  These  received from the  paternal side the element
 which destroyed their vitality as soon as the support of the mother (in
 utero-gestation) was withdrawn, and the stores  laid up by her in the
 mass of the infant's  body were  consumed.   Just so in those cases
 where a still more  concentrated and active form of the fatal element-
 is imparted by the male; by the time the supplies originally furnished
 by the ovum are exhausted,  the  embryo  is  blighted, destroyed, and
 the vital forces which should have formed the foetal body are vitiated
 and perverted, till the mole is the only result.

  Fleshy Moles  appear to  be  but the  fuller development of  the
 perverted  process just  described  in  connection with blighted  ova.
 They remain three or four months, " until at length the degenerated
 ovum is expelled, consisting of the nest-like  membranes and a small
 embryo of two or three  weeks' growth, or  in  some instances the foetus
 may have disappeared, and traces  only of the umbilical cord remain."
 They may either consist of a solid mass, or they may contain a central
 cavity possessing a  distinct lining membrane, in which there yet re-
 mains some of the liquor amnii.   The solid moles are generally much
 larger  than the hollow ones, and of a more  irregular form.   The
 larger  ones are about the size of two fists.   If the texture be exam-
 ined, it will be found solid, but not very dense, spongy like the pla-
 centa, but  more filamentous in some parts; in others consisting of
 fibrinous clots, and  also portions  of the foetus, such as one or other
 extremity.   The limbs of  the foetuses  have occasionally, though very
 rarely,  been discovered.— Churchill.

  Hydatids,  or Vesicular  Moles, constitute what are  termed
 hydatiginous degenerations of  the  ova.  They have also been  termed
 "cystic degeneration of the chorion."  "The  hydatids themselves, in
 the recent state, are full of transparent fluid, and are either round,
 pyriform or oblong in shape, the size of the vesicles  greatly varying.
 Some of them  are borne upon pedicles, others are growing from the
 larger hydatids.  As a  rule, the activity of  the growth and the  in-
 crease of the villi (which degenerate  into  hydatids)  are greatest in
 early pregnancy, and it is  at this time that the  hydatiginous degene-
 ration is most prone to occur."  These hydatids  bear a very close ex-
 ternal resemblance to polypi or pediculated tumors—so  much so that
some of the latter-named growths occurring in the virgin female have
been considered to be hydatids.   But it is  now well  settled  that the
name hydatids  should be applied only to such formations as may arise 
714      DISEASES  AND DERANGEMENTS OF THE UTERUS.

in connection with  or subsequent to sexual intercourse and impreg-
nation ; although here it must be remembered that the death of the
embryo not  being  immediately  followed  by the expulsion  of the
ovum, the molar formation  may  be retained for months, and the
hydatiginous variety for years, and then be discharged without prej-
udice to the  character of the  female, who may have become a widow
in the mean time.
   The hemorrhage wdiich is apt to  occur at the period of the expul-
sion  of the hydatids  by successive installments renders them  more
dangerous than moles of other varieties.
   Molar pregnancy, which results  from the presence of the hydatid
variety, is  more strongly marked, since in this form the uterus  at the
fifth  or sixth month may be  as  large as it should be  at the end of
pregnancy.   It is not easy to determine the presence  of this disease
with absolute certainty, at least  in the  early months.   But the  dura-
tion of the abdominal enlargement beyond the term of utero-gestation,
the disproportion between  the size of the tumor  and the period  since
it was first observed, together with the absence of quickening,  of all
fcetal movements and of the sounds of the foetal heart, will conclusively
prove that a regular pregnancy is not present.  Then  the greater
weight of the abdomen and the absence of  resonance will distinguish
it from physometra.  The absence of the sense of fluctuation will in
like  manner  serve to distinguish molar  pregnancy from hydrometra.
The  occasional haemorrhages, and even the irregular  discharge of a
colorless, inodorous, aqueous fluid, are  relied upon by some authors
as unfailing diagnostic signs, but they are by no means sure to occur
in every variety of molar pregnancy; and even when they are present
they are far from being so characteristic of the existence of moles as
to afford any positively reliable indication.   The use of tents and the
introduction  of the uterine sound will  enable the practitioner to dis-
tinguish hydatids from uterine polypus, while from cancer it would
be known by the absence of the fcetid discharge and the general con-
stitutional disturbance.

                           Treatment.
   A careful  study of the  symptoms of the patient will be necessary
in order  to determine the  nature of the case and  to make the proper
prescription.   As abnormal growths, the womb seeks  to expel  these
moles sooner or later.  This is  effected by uterine contractions and
pains similar to those of ordinary  confinement, but more closely re-
sembling such as occur in cases of  miscarriage after the death of the 
UTERINE POLYPI.
715
 foetus.  The large quantity of water and sanguineous discharges which
 may attend such efforts at expulsion  sometimes render the case very
 serious; and it will be the object of the homoeopathic practitioner to
 promote this  expulsion, and so remove the cause of  the dangerous
 condition.
   But  few special  indications  for  the  selection  of  remedies can at
 present be given.   To prpmote  the expulsion, Pulsatilla,  Secale
 corn, or Caulophyllum  may be given.   The haemorrhage wdiich
 may follow such expulsion must be treated as are other haemorrhages,
 according to the indicating symptoms.
   Calcarea carb. and Silicia have been recommended to  remove
 a disposition to  the formation of moles.  Natrum carbonicum has
 been successfully administered in several cases.
   The  following remedies  have  been  recommended  for particular
 study in these abnormities: Calcarea  carb.,  Sulphur, Silicia,
 Mercurius, Aconite, Arsenicum,  China, Ferrum, Graphites,
 Belladonna, Hyoscyamus,  Kali  carb., Lycopodium, Sabina,
 Sepia.  And in general all  the  remedies mentioned  in this work
 under the various heads of Cancer, Tumors, Polypi and Dropsy should
 be  carefully studied  and compared,  for it is only by selecting the
 medicine in accordance with all the constitutional symptoms and con-
 ditions in such cases that we can hope  either to  promote  the expul-
 sion of these morbid growths or to prevent their recurrence.

                       Uterine  Polypi.
  On page 607 reference has been  made to Vaginal Polypi. We now
 come to treat of those peculiar and sometimes dangerous growths from
 the uterus known as Uterine Polypi.
  Polypi have  been  divided  into three  varieties, corresponding  to
 their general differences of structure;  these are  the Glandular, the
 Cellular and the Fibrous.   Glandular polypi consist in enlargements
 of the glandulae Nabothse in the canal  of the cervix.   They sometimes
 occur in clusters about the size of currants, and are  suspended by
 very fine pedicles.   Cellular,  mucous,  fibro-cellular,  gelatinous or
 vesicular  polypi are the  least frequent, grow  with  the  greatest
 rapidity, and  may  attain  the  most  considerable size:  these have
already been  sufficiently described  under the head of Fibro-cellular
Tumors 01 Soft Polypi.  The Fibrous  polypi constitute the most com-
mon variety, and may occur at the  same time in the uterus and in the
nasal fossae.
  These morbid growths received the  name polypus, or many-footed, 
 716      DISEASES AND  DERANGEMENTS OF  THE  UTERUS.

 partly from their fancied resemblance  to the Polypus marinus (a sea
 animal), and in part from  their being found  in some cases to take
 their rise from  more than one stem or foot.  They are generally round
 oval or pyriform, but may assume other shapes in consequence of the
 pressure of the surrounding parts.   The polypi  are covered by the
 mucous  membranes  of the  uterus or  vagina, from  which they arise)
 they may vary  from  the size of a filbert to that of a child's head •
 they are mostly insensible  to  the  touch,  but bleed from  the  least
 contact, as well as spontaneously.  They are attached to their base bv
 a  pedicle of variable  size, sometimes  being connected by  a slender
 stalk, like  that  of  a  leaf, at others by a fleshy attachment of con-
 siderable thickness.  The glandular polypi  are  soft in texture and
 may contain a  small quantity  of  mucilaginous  fluid.  The cellular
 variety is soft, and in great  measure composed of cells  which contain
 yellowish liquid.  The fibrous polypi  are  more  dense in  structure
 sometimes  hollow, and either empty or containing  blood, gelatinous
 or  fatty matter, and  hair.  And  whatever  may be  their structural
 consistence, hard or soft, vascular, mucous or fibrous, whatever their
 variety in  size, and  whatever the circumstances attending  their de-
 velopment,  all  polypi  have  these  two  general  characteristics:  they
 take their origin from cavities or outlets of the body wdiich are lined
 by mucous membrane,  and they are attached by a pedicle or stem.
   The polypi are made up of different constituents—vascular structure,
 fibrous tissue and mucous membrane—and these different tissues are
 but the prolongations  of  the mucous and sub-mucous organs from
 which  they spring; or they may be considered as hypertrophies of
 some  of the minute  glands  or mucous  follicles, attended by a corre-
 sponding hypertrophy of all the neighboring organic tissues, whether
 mucous,  cellular or fibro-cellular.  And  according  to the  different
 proportions of  these constituents and of the fluid  infiltrations, the
 polypus itself becomes  hard  or soft, fibrous or vesicular, as is the case
 in the formation of hard or  soft cancer.  As regards their exact seat
 in the genitals, polypi  occasionally arise from the vaginal walls, less
 often from  the mucous  membrane of the fundus, but more frequently
 from the interior of the cervix uteri, and even from the os.
   In addition to these  three most general varieties of polypus, some
authors enumerate also certain other  morbid  growths as polypoid,
 though we  think with hardly sufficient reason.
  The causes of  polypi  are not  very definitely ascertained.  Any
condition which tends to keep up a  congested condition of the uterus
may lead to hypergenesis of the constituents of the mucous mem- 
UTERINE POLYPI.                     717
  hrane, which may take the shape of uterine polypus, but of the deter-
  mining cause nothing is positively known beyond this—that they may
  take their origin from a certain  dyscrasia of the system which is less
  positively malignant than  that which is  developed in the  form of
  cancer.  As already stated in  treating of  the fibro-cellular tumors
  —which if pendulous are properly termed soft polypi—these growths
  sometimes appear in connection with actual cancerous disease.
    Polypous tumors may appear in single or married  women, mostly
  of the middle age;  they do not necessarily prevent  conception, but
  usually appear to destroy its product by abortion.
    The symptoms which  make their  appearance in connection  with
  polypi are very important.  These growths are not themselves par-
  ticularly sensitive or painful, but a very severe form of inflammation
  is almost always attendant upon their presence.   This  may arise from
  the same general influences which develop the  polypi themselves, or
  in consequence  of the  irritation wdiich the morbid  growths occasion
  in the lips of the os uteri and  other parts with which they come in
  contact.   Ulceration of  these irritated and  inflamed  surfaces is not
  uncommon.
    The other most remarkable and constant symptom of polypus  is
  the haemorrhage, which is hardly ever -wanting.  Haemorrhages which
  arise  in  connection with  polypi  are  irregular as to their time and
  quantity, but constantly  recurring, and by no means proportioned to
  the extent of the tumor.  A small polypus may occasion as great a
  loss of blood as  one much larger; and it is said that the very large
  polypi are  less  troublesome  in  this  respect than  those which are
  smaller.
    The reason of this liability to greater loss of blood where the polypi
  are small than where they are large will be found in the fact, now
  perhaps  for the first time stated, that the  haemorrhage itself is not
  from  the polypi  at all, but from the inflamed, congested mucous sur-
  faces  of the adjacent parts.  The small polypi especially have no such
  vascular  developments as would account for the alarming haemorrhages
  which often appear  in connection with them.
    The discharge which appears in connection with  polypus  is either
  mucous or muco-purulent.  In other respects the constitutional symp-
  toms  are very similar to those which arise in cancerous cases, even to
  the sallowness of the complexion; only the intense,  lancinating, stab-
  bing  or  burning*pains, singly, successively or in paroxysms,  which
•  are constantly the attendants of  cancer, do not appear to result from
  polypus.   Neither is the discharge so offensively fcetid.  As a general 
718       DISEASES AND DERANGEMENTS  OF THE UTERUS.

thing, the presence of uterine polypus is readily detected by touch 01
the speculum.   But  if the  growth  be small, and attached high up
within the cavity of the body, the use  of the probe will  be necessary
to make the exploration complete.  In  some cases it may be necessary
before introducing the probe to dilate the cervical  canal  and internal
os by means of tents.
   Treatment.—It occasionally happens that the womb of  itself throws
off a polypus, breaking its attachment and casting it out as a foreign
body;  or, again, that the growth becomes disorganized and broken
up, and is washed away gradually by the uterine secretions; but such
terminations are not to be expected, and, as  the drain upon the vital
forces by frequently repeated and profuse haemorrhages may produce
very serious constitutional effects, which may even  result fatally, it
may be fairly said that the sooner a polypus is removed after its pres-
ence has been detected the better it will be for the patient.
   Where these growths  do not give  rise to any serious  disturbances
it will  be well  to attempt their removal by means  strictly  medical.
In such a case the remedies laid down on pages  580, 581 and 608
may be consulted with great advantage. Again, there are many cases
in which any mechanical  means used to remove a polypus—especially
if it be intra-eorporeal, for  instance—may result  very disastrously;
whereas by  strict adherence  to  homoeopathic principles in the selec-
tion of  remedies to meet the symptoms and conditions of the patient,
not only are sufferings mitigated, but  the  best  means are being re-
sorted to to  bring about a spontaneous  cure, either by a casting off of
the morbid  growth or by its absorption.   When, however, the pres-
ence of the polypus absolutely endangers life, and there is good reason
to apprehend a speedily fatal result if it be not  promptly removed,
the removal may  be accomplished  either  by excision, torsion, the
ligature, ecrasement or the galvano-caustic wire.  If the polypus be
situated in the vagina, its removal  is  not difficult, or even  if it be
within the cervical canal  external to the os internum; but if its at-
tachment  be within the corporeal cavity, there  may be  considerable
difficulty attending its removal.  If it be necessary, the cervical canal
and os internum must be dilated  by means  of  appropriate tents, and
the growth drawn down as  much as possible with a tenaculum fixed
into  it.   If, from the situation  of  the tumor  or the extent of its
attachment, it cannot be safely removed entire, it  may be taken away
piecemeal, or freely incised, with the  hope that its  vitality will  be
thereby destroyed, and that it will then  slough  away and  be dis-
charged. 
UTERINE  FIRROID  TUMORS.
719
                  Uterine Fibroid  Tumors.
  These morbid growths may be developed in any part of the uterus,
 hut the body or fundus is most frequently their seat.  They consist essen-   •
 dally of hypertrophied uterine tissue, to which they are homologous.
 Asa general thing, they consist of connective tissue and hypertrophied
 muscular texture, and they present under the microscope an appearance
 of •' long, fine fibres, generally united in bundles; of fusiform fibre-
 cells analogous to fibro-plastic  elements, and of  round or  elliptic
 granules  of small size,  the whole being  bound together  by fine inter-
 cellular substance."  Sometimes these tumors are characterized by the
 formation of cysts within their  substance, and  when  this  condition
 exists  the growth is denominated a fibro-cystic tumor.
  These tumors vary  greatly in  size, in some instances  being very
 diminutive, of the size of  a pea, and in others attaining  a growth
 of almost fabulous proportions.   They have  been  divided into three
 varieties, according to their situation—viz., sub-peritoneal, sub-mucous
 and intramural or  interstitial  fibroids.  The first variety has  its
 growth from  the  surface of the peritoneum  attached to the womb,
 and may  be detected through the abdominal  parietes as a somewhat
 loose tumor within the  pelvic cavity.  The sub-mucous fibroid grows
 from the sub-mucous  tissue of the womb, and  either distends the
 mucous  lining, pushing into the  uterine cavity, or the muscular wall,
 pushing the tissues outward.  The  intramural variety grows within
 the uterine walls,  enclosed  in its  proper capsule or envelope, and  is
 generally very slow to increase in size.
  The causes which  produce these  tumors may be said to be  un-
 known.   They occur  most  frequently in women of the negro  race.
 It is highly probable that  they  are dependent, so  far as  a predis-
 posing cause is concerned, upon the scrofulous or some other systemic
 poisoning, excited into  peculiar action by uterine functional derange-
 ments incidental to pregnancy,  parturition or  menstruation.
  Uterine fibroids are  liable to various  changes of structure, such as
 fatty, cartilaginous, or even  calcareous degeneration.  They  are liable
 likewise to become inflamed and  to suppurate, and sloughing likewise
 occasionally occurs.  An  cedematous condition of  the  tumor may
 occur  by which its bulk  is  greatly increased, and the subsidence of
 this may give  rise to the opinion that the tumor itself  is disappear-
ing.  A  spontaneous  disappearance  is  possible, however, and  this  is
most apt  to occur at the  menopause, a retrograde metamorphosis  of
tissue occurring at that period  as a consequence of the subsidence 
   720      diseases and derangements OF THE UTERUS.

   of the .menstrual function with  its congestions and other accom-
   paniments.
    . The symptoms  developed by uterine fibroids are many and various
,   inasmuch as they embrace all those which result from a variety of dis-
   orders which they excite, such as uterine displacement, endometritis,
   cystic or rectal disturbances, pelvic peritonitis, etc. The most constant
   symptoms, however, are—excessive menstruation, or uterine haemor-
   rhage not connected with menstruation ; profuse leucorrhcea; more or
   less  pain through  the  pelvic region, and pain  extending  down the
   thighs from pressure on the crural nerves;  dysmenorrhcea; irritability
   of the bladder and rectum.  Most of these symptoms may be absent
   in some cases,  and this is particularly true of the sub-peritoneal
   variety.
     Diagnosis will not be difficult if the tumor be large, but if it be small
   or of medium size, its detection may be a matter of  greater difficulty.
   Abdominal palpation, rectal and vaginal touch, the  speculum and the
   uterine probe may all be required in effecting a differential diagnosis.
   Impacted faeces, solid ovarian tumors, pelvic abscess  or  haematocele,
   and  displacements  of  the uterus may  be  confounded  with  this
   disease.
      Treatment.—Consult the remedies mentioned on pages 580,581 and
   608.   Any remedy in the  Materia Medica may be  suitable in  these
   cases.  The violent procedures recommended by the gynaecologists of
   the old school have nothing to recommend them in the way of results,
   and the homoeopathic practitioner, by carefully choosing a remedy in
   strict accordance with the  principles laid down  by  Hahnemann, may
   do much better, and cannot do worse in these  cases, than the dominant
   school of medicine.  The physician should enjoin upon his patient the
   necessity of leading a regular life, of abstaining, as  much as possible,
   from coition and other sexual excitations, and of removing all obstruc-
   tion to free circulation by wearing her clothing loosely and supported
   from the shoulders.  Properly directed hygienic and dietetic measures,
   in these cases  as  in  all others, will be found to be great aids to the
   homoeopathic remedy. 
DISEASES  OF THE OVARIES.
721
                   CHAPTER  XXXIV.

               DISEASES OF  THE  OVARIES

rpHE nervous centre of the female organization has been described
 J-  as residing in the sexual  system, of which the ovaries constitute
the  ultimate foci.  Hence  it  might be  expected that these organs
would be subject to disorders,  both nervou's and inflammatory, similar
to those which affect the  uterus;  and such in fact proves to be the
case, notwithstanding their great dissimilarity of structure.  Thus, as
the uterus is found subject to nervous irritability, neuralgia, acute and
chronic inflammation, displacements, ulcerations  both  benign  and
malignant, dropsy, tumors and other forms of structural disorganiza-
tion, so the ovaries  are  in like manner liable to  nervous irritation,
ovarialgia,  inflammations,  displacements, tumors,  dropsies, and  a
great variety of organic degenerations.
  These disorders of the ovaries, even wdiile presenting  no apparent
change of structure, exert a controlling influence upon the other por-
tions of the sexual system, and so  upon the entire constitution.  Some
of the most important of these disorders, being comparatively obscure,
are  liable to be overlooked in the consideration of more obvious de-
rangements of which they are still the efficient causes.  By reason of
their situation the ovaries are  less  exposed than the uterus to external
injury, but from being as  it  were  the  centres  of the entire sexual
system, these structures are liable to have concentrated in them all the
morbid influences arising from functional obstruction in the dependent
organs.  And the fact that the ovaries are thus exposed to disorders
reflected from other  parts of  the generative apparatus, in addition to
those which may arise  from  their own functional  derangement and
structural disorganization, shows the primary importance of a careful
study of all ovarian disorders, not only by themselves, but still more
especially in their connection  with morbid conditions of other organs.
In the ovaries are implanted the seeds  of life and of death.  And
these  latter may destroy  the  impregnated ova while yet  contained in
the  Graafian vesicles; cause the product of conception to be  blighted
in  the womb, resulting  in a molar instead  of  a true  pregnancy;
produce abortion at three months, a still-born child at full term ; or
finally destroy life at any period short of the normal three score years
and ten.
      46 
722
DISEASES OF THE OVARIES.
  Some of the forms of  ovarian disorder are very common an 1 im-
portant, although not necessarily very  obvious; these  will be fully
described.   Others, wliich are rare, will  be briefly mentioned, so that
they may be recognized when they do appear.  In either case a care-
ful  study of all  the attendant symptoms will be equally essential in
order to make  a proper  prescription.   Nor  in many cases will the
pathological  details or diagnosis greatly aid  in making such  a  pre-
scription.  But the homoeopathic physician needs  to become familiar
with the possible forms and  terminations of such disorders  in order
to know how to  examine  such cases and to  anticipate  their natural
course.   And nowhere  is the superior advantage of the homoeopathic
practice  more obvious  than  in  the anticipative treatment of forms
of disease so obscure, so  deep-seated and so formidable as  are many
of those to which the ovaries are liable.  The single fact that ovarian
tumors seldom or never appear in persons who have  been brought up
under  homoeopathic treatment at once  illustrates and  confirms this
statement.
  The Fallopian tubes  no doubt very  strongly sympathize with the
uterus and  the  ovaries in their disordered  conditions,  but we have
not deemed it necessary to make  any particular mention of the various
morbid conditions to which these  organs are liable, partly from the
difficulty of distinguishing any separate affections of these  tubes,
partly from  the  fact that  those disorders which attack them from
sympathetic  connection with other organs will be  most readily re-
moved by treatment directed (in general) to the primary seat of dis-
order, and partly from the fact  that all the  symptoms must in any
event  be considered in prescribing for these disorders.   And this
totality of the symptoms may be just as truly and completely arrived
at in these cases whether we pay  special attention to the  Fallopian
tubes or not,

                       Ovarian Irritation.
  Ovarian irritation is  the analogue of irritability of the uterus.  By
some authors this affection has been termed sub-acute ovaritis, but wo
think without sufficient reason, since, as will be seen from the descrip-
tion,  the symptoms are not  inflammatory, but purely  nervous, and,
as already intimated, ovarian irritation  may be either the cause, th'
primary indication or the consequence of severe disorder of some other
organ  of the sexual  system.   It may  appear in women of all  ages
between the commencement  and cessation of menstruation.  Princi-
pally an affection of the  unimpregnated female, it is most frequent in 
ovarian irritation.
723
those of a delicate nervous temperament, although by no means  con-
fined to them.
  Symptoms.—A certain sense of uneasiness, which  may  become  a
very severe pain, in one or both iliac or  inguinal regions, but  most
frequently in  the  left, forms  one of the chief characteristics of this
disorder.   This pain may be either  a dull aching or a more  acute
sensation; it  may appear in paroxysms, especially after fatigue  or
over-exertion; it may be aggravated by gentle pressure, but is some-
times capable of being  relieved by severe  pressure, and may entirely
disappear in a state of rest, leaving no evidence of its  previous exist-
ence.  " The pain is much more severe than in chronic inflammation
of the ovarian tissues.  It  is  indeed often  intense, comes  on  in
paroxysms, is seldom aggravated, but is  often  moderated, by  firm
pressure from a hand, a  bandage or abdominal supporters constantly
worn.  It extends to the groin, to  the front and  inside of the thigh,
and sometimes  is  evidently connected with pain  in the back.   It is
unaccompanied  by any  enlargement which can be discovered by an
external or internal examination.   The patient has no fever (inflam-
matory or hectic), is  often not emaciated or anaemic, and frequently,
as regards her organic life, is perfectly well, with plenty of rich blood,
strength and physical development.  The pain may be very persistent
for  days, months and years, without  any local or general change en-
suing.   In many  patients  brought  to  my  care the  antiphlogistic
treatment  had been perseveringly and repeatedly resorted  to, in all
its modifications, by rest, leeches, fomentations, by blisters and other
revulsives, and had entirely failed to afford any permanent relief, but
had rather aggravated the sufferings by debilitating the patient, and
thus rendering her nerves more sensitive and her suffering greater."—
Hodge.  " When  the  irritation is great it may be extended to the
hladder, giving rise to a  desire to evacuate its contents frequently, and
causing great pain in doing so.   Hysterical paroxysms are by no
meaus unfrequent.  In twro of the  most violent cases of hysteria that
I have seen  for some time  there was  extreme  tenderness  of the
region of the left ovary, and pressure there aggravated the  hysterical
paroxysms."— Churchill.
  These sufferings from ovarian irritation are unaccompanied by any
sympathetic pain in the breasts or fever, as is the case in actual inflam-
mation  of the ovaries.  " Should the skin  on being lifted give great
pain, it cannot depend on  a  deep-seated lesion;  irregular variations
and the complete subsidence of pain point to neuralgia ^ovarialgia)."—
Tilt.  We  have given these fragmentary descriptions of this affection 
724
DISEASES OF  THE OVARIES.
from different authors  in  order to distinguish it from oiaritis \eve\-
sub-acute), and as containing pretty nearly all the symptoms by which
it is characterized.
   Various forms of disorder of the female organism appear in connec-
tion with ovarian irritation, either as its causes or  as its consequences.
These we will indicate without attempting  to  distinguish the  former
from the latter.   Nor indeed would it be essential to make this dis-
tinction, even if it were  always practicable, since we must  always
prescribe for the totality of the symptoms present.
   Causes and Connections.—Ovarian  irritation scarcely ever appears
entirely  alone; usually  it is accompanied by a corresponding irrita-
bility of the uterus, or  by some other morbid  condition  to which it
either gives rise or by  which it is  itself caused.   In many cases it is
impossible to  determine what  are  the exact relations, as  primary or
secondary, which these yarious  and concomitant affections bear to each
other.  Nor indeed is  it essential, for on the one hand they are all
alike caused no doubt by some profound constitutional dyscrasia, and
on the otlier hand they  are  all  alike to be taken into consideration in
our  prescriptions.   And in either case the symptoms present, as in
displacements  of the ovaries,  and  the conditions  of aggravation, as
worse from motion, will sufficiently  indicate  the requisite hygienic
directions.
   A certain amount of ovarian irritation is frequently found in  con-
nection with amenorrhcea.   The absence of the menses may be due
to the same  morbid  condition of  the  ovaries that  constitutes the
irritability itself, or the irritation may be the result of a sudden sup-
pression  of the  menstrual flux;  or other  deep-seated and constitu-
tional  causes  may at the same  time occasion an irregularity or total
absence  of  the  menstrual  discharge, and  an irritable state of the
ovaries and other sexual  organs.   The sudden  suppression of the
menses, as from cold, will almost necessarily result either in irritation
or in acute inflammation of the ovaries.  This  condition is not very
different from that in which there is a deficiency of action from some
latent  dyscrasia  or  organic imperfection in the  ovaries.   Here the
ovarian  nisus is incapable  of effecting its  normal development, but
only produces  an irritable condition of the  ovaries themselves;  for it
must always  be borne  in mind that as organic inflammation is the
result of congestions or obstructions of the arterial or venous blood-
vessels, so  nervous irritation is the  result of suppressed, imperfect or
excessive functional action.  In dysmenorrhcea  there is always more
or less irritation  of the ovaries, and  this general irritability will be 
OVARIAN IRRITATION.
725
found to be greatly aggravated at the period of the menstrual nisus.
The  importance  of carefully observing the  morbid  conditions  (irri-
tation, " congestion ") of the ovaries, even in their incipient stage, on
account of their  strong disposition to lead to serious disorder, is well
expressed by Dr. Duncan :  " The propriety of attending seriously to
the symptoms of congestion  (irritation) of one or of both ovaries, as
rendered evident by thrilling pain a little above  the centre  of Pou-
part's ligament, accompanied  by tenderness on pressure and increased
by the erect  posture, ought to  be  strongly insisted  upon.   Whether
the pain  be  constant or intermittent, returning  at or exacerbated
during the monthly crisis, accompanied by menorrhagia or co-existing
with amenorrhoea and chlorosis, it should receive our urgent consid-
eration ; for w hen an organ has  been congested  for any  length  of
time such a state is difficult of eradication ; morbid changes  rapidly
occur and irremediable mischiefs result,"
  Menorrhagia will sooner or later induce ovarian irritation, in con-
sequence of the  nervous weakness of the sexual  organs and of  the
whole system which follows such exhausting discharges.   In all  the
abnormal varieties of menstruation—in profuse  as  well  as in sup-
pressed menstruation—the ovaries are often the organs most severely
affected.  And even where the profuse flow originates in a  morbid
condition of  these organs, the reflex influence of  such flow is capable
of greatly aggravating the original morbid  condition.  In some  in-
stances ovarian irritation seems to be the result of erosion or  conges-
tion of  the cervix uteri;  in others the irritability  appears only on  the
repression  of such organic diseases by the barbarous surgical treat-
ment of the allopathic school.
  The relation of amenorrhcea to ovarian  irritation has already been
explained; and in those  forms of dysmenorrhcea which are due to im-
perfect or difficult ovulation it is easy to see that  the ovaries  must be
in an irritable condition.  Thus, the  entire absence  of  sexual inter-
course, its imperfect performance,  or excessive indulgence  in coition
may, in different ways, lead to the same  state of  ovarian  irritation:
and in many cases of sterility the only assignable  cause will be found
in a similar irritability of the ovaries.  Hysteria is  a no less invari-
able attendant upon this form  of irritation, but it must be regarded
rather as the consequence than as the cause of the  irritability, since,
as already stated in a  previous  chapter, hysterical paroxysms may
sometimes be immediately produced by pressure of the fingers  upon
the  ovaries.   For treatment  of Ovarian Irritation see  remedies  for
Inflammation of  the Ovaries. 
726
DISEASES OF THE OVARIES.
                         Acute Ovaritis.
  Acute ovaritis may be idiopathic or puerperal, according as it arises
directly from local or constitutional influences peculiar to the ovaries
or results  from  peritoneal inflammation succeeding to abortion 01
parturition.
  Description and Symptoms.—Idiopathic ovaritis is comparatively
rare, except where it is  the consequence of external injury.   It is
most  apt to occur just previous to, during, or  immediately after the
menses.  The ovaries themselves swell to three or four times their
natural size, and their  peritoneal covering usually becomes  tender
and inflamed.  Scattered through the substance of the inflamed ova-
ries will be found purulent matter, contained in cysts which  have been
supposed to be the Graafian cells filled with pus of their own secreting.
The patient suffers with severe, deep-seated pain in the pelvic cavity;
the pain is accompanied by a  burning sensation, and is made much
worse by motion.
  If  the peritoneal  covering becomes  involved, the pain is rendered
much more acute and lancinating, aggravated by pressure and by sud-
denly assuming the  upright position, while the  former tenderness on
pressure, instead  of being confined  to  the ovarian regions, will be
found to have extended over the whole surface of the abdomen.   In
the severer forms of ovaritis  the  fever and  other symptoms  will
greatly resemble  those constituting peritonitis; " the skin is hot, the
pulse quick and concentrated,  the stomach becomes disordered, and
nausea and vomiting occur."   The  inflammation usually  does thus
extend more or less  over the adjacent peritoneal  membranes, causing
dysuria and very frequent and  painful micturition, or the  inflamma-
tion may be directed more posteriorly, and the rectum rather than the
bladder become principally affected.   In this latter case there may be
frequent and ineffectual calls to evacuate the bowel, even with distress-
ing tenesmus.  " In the earlier stages of idiopathic ovaritis, nausea,
sickness, and sometimes constipation, are frequent  accompaniments,
depending  at first on the irritation of the visceral peritoneum and on
the temporary paralysis of the muscular coat of the intestines.  When
the tumor has increased and rests on the rectum, the patient is troubled
by a more  constant constipation and by tenesmus.   The pressure on
the rectum is sometimes  so great that the faeces are moulded into the
form  of a  ribbon.  Sometimes constipation is  so great that the case
is said to be one of ileus."—Tilt.
  Acute ovaritis may give rise  to nymphomania; " the mind is more 
ACUTE OVARITIS.
727
evidently affected in the sanguine, the irritable and the plethoric; the
desires  are  inordinately excited, so  as  almost to amount  to utero-
mania."  But this  exaltation of the  sexual feeling can only arise in
the earlier stages  of the ovarian  inflammation;  and  on the  other
hand "inflammation of the ovary decidedly occurs not only without
the slightest approach to  nymphomania, but it is  frequently attended
bv a directly opposite  state of feeling on the part of the patient."—
Lowenardt
  Diagnosis.—In  inflammation and in irritation of the ovaries an ex-
amination per rectum may be found  requisite.  " Without the aid of
an examination per rectum it would be exceedingly difficult to form a
certain  diagnosis; the finger per anum  easily reaches to the  side of
the uterus, where the swollen and generally painful ovary may be dis-
tinctly felt   Examination per vaginam  leads to  little or no certain
results."  And  by such exploration per ahum ovaritis  may be dis-
tinguished from all other affections, because  in no other affection is
the  ovary  necessarily enlarged.   A  careful study of all the symp-
toms and conditions will remove  any remaining obscurity in  these
cases.   The history of the case, the previous condition of the patient,
the  nature of the pain, as sharp, lancinating, aggravated by motion,
will all aid to determine  the origin and  extent of the ovarian  affec-
tion.  This must also be  distinguished from simple ovarian irritation
by that symptom  of aggravation on pressure  which is  common in
acute inflammation, but not in nervous or neuralgic conditions.
  Termination.—The  natural course  of  ovaritis,  like that of  other
acute inflammations, is to terminate in suppuration unless its progress
is arrested.  In the latter case, whether the  result be brought about
by art or by unaided nature, the termination is in resolution.   This is
but another name for the subsidence of  the inflammation itself.   But
a partial resolution or subsidence of the more violent inflammatory
symptoms  may  be supposed to have taken  place wdiere the chronic
ovaritis replaces the acute.  Here we have the commencement of an
ovarian tumor,  for the enlargement of the ovary which  appeared
under the acute  form of inflammation  may not  only continue, but
even increase more and more under the chronic form.
  Avhere suppuration occurs as the result of acute ovaritis, the pus is
generally diffused  throughout the substance of the ovary.   This pus—
whose formation may be  indicated by rigors, softness of the pulse and
mitigation of the general symptoms, with an increased sense of local
weight and throbbing—may be reabsorbed into the  system, and thus
a form of  resolution may succeed even  after suppuration;  or the 
728
DISEASES OF  THE  OVARIES.
abscess may burst and discharge its contents either externally throuu-h
the vagina, into the intestine, into the bladder  or into the cavity of
the peritoneum.   The discharge of the  matter  through the vagina is
the most favorable  of all, whether it be  transmitted through the Fal-
lopian  tubes  and uterus, or, as  is more frequently the case, directly
into the vagina itself.   The discharge of the product of ovarian sup-
puration through an intestinal or a vesical  opening may result favor-
ably  or unfavorably, according to the other circumstances of the cu^e.
But the effusion of ovarian pus in quantity, as  of any other purulent
matters, into  the peritoneum, is almost necessarily fatal.   In many
milder  cases  of ovaritis, in  which no structural  disorganization as
suppuration or tumor, appears, the organ may none the less effectually
become incapable of ovulation by the condensation of its tissues or
adhesions  may occur which may indirectly, but no less  certainly,
occasion sterility.
   Causes.—Idiopathic ovaritis may result from  external injury, and it
has been known  to follow sudden  suppression  of the  menstruation.
It has also supervened on the suppression of gonorrhoea by astringent
injections,  and it has occasionally occurred in connection with variola
and in pneumonia.  " A cold taken during menstruation, the suppres-
sion of the courses,  coitus during or immediately after this epoch, the
use of violent emenagogues, pediluvia or  hot baths at the same period,
are the principal causes likely to produce  ovaritis in the absence of
the gravid or puerperal state."—Scanzoni.
   Puerperal Ovaritis is  much more common, and is often merely an
extension of inflammation from  the uterus  or broad ligaments to the
ovaries.  As this is rather the consequence  of another morbid condi-
tion, of wliich it forms a  complication, we refer the reader to Puerperal
Peritonitis for a fuller description.

                        Chronic Ovaritis.
   Chronic ovaritis,  as already explained, is often but the continuation
of the acute in a less active form.   In other instances it is the result
of a  corresponding  inflammation of, the uterus and its appendages,
or it  may  arise, as  it were, originally and  spontaneously in the indi-
vidual follicles.   In either case there is more or less enlargement of
these  organs, their contour becomes irregular, their surface roughened
and their entire substance indurated.   This enlargement and indura-
tion  usually affect but one of the ovaries in  the first instance, the
other retaining its natural size, or only becoming  affected subsequently.
The enlarged ovary remains within  the  pelvis,  either freely movable 
CHRONIC OVARITIS.
729
or adherent, until its increasing size  causes  it (if  movable) to pass
into the abdomen entirely, or to extend its growth in the same direc-
tion, where, from  the formation of false membranes, adhesions have
bound the original tumor within the pelvic cavity.   Having risen up
into the abdomen, the enlarged ovary may still remain freely movable,
or become fixed by means of adhesions to the adjoining viscera, or
by completely occupying the cavity of  the abdomen itself.  In this
general manner do wdiat are called ovarian tumors spring from chronic
inflammation of the ovaries.
  The  symptoms  of  chronic inflammation of  the  ovaries, except in
those cases which follow the acute form, are not very strongly marked.
The pain, which in acute ovaritis had been very severe,  gives place to
a sensation rather disagreeable than painful.  There are a variety of
sufferings within the pelvic region which, in default of any other cause,
may be safely attributed to chronic ovaritis.   Such are " frequent need
of urinating, painful constrictions of the vagina, uterine colics, a very
painful  tenesmus, together  with  the  formation  of  haemorrhoidal
tumors."  The  patient complains  of an inconvenient weight in the
diseased  spot, which  increases when touched, when walking, by  re-
maining too long  standing, by coitus, and especially at  the menstrual
period.   Frequently we meet with various disorders in connection with
the menstruation,  without our being able always to  comprehend why
the courses are sometimes nearly or quite  suppressed, while at other
times they are much too abundant; as  the disease  very often affects
one ovary alone, the courses are not necessarily accompanied every time
by dysmenorrhceal phenomena ; we even see the catamenial flow occur
two or three times without particularly painful  sensations, which sug-
gests the inference that the matured ovum at  these periods belongs to
the healthy ovary.  At other  times each menstrual period is accom-
panied by a violent dysmenorrhcea, and then  either  both ovaries are
diseased  or  the  ovulation  affects in  a high degree the  diseased
organ.—Scanzoni.
  The pain, which is either limited to  the region  of the ovaries or
radiates  from thence, which has continued  for  some time, and which
is aggravated either before or during the menstrual period, will lead
to the belief that there may be  chronic  inflammation of one or both
ovaries; and this  belief will be  strengthened if we  find the vaginal
cul-de-sac painful to the touch on the affected side.
  Chronic  ovaritis,  whether  it follow acute  inflammation  of the
ovaries  or become imperceptibly developed  from some external in-
jury, constitutional dyscrasia, or even from excesses in sexual  inter- 
730
DISEASES OF THE OVARIES.
course or abuse of the sexual organs—as in females who lead vicious
lives or indulge in secret vice—is at the same time accompanied with
enlargement, and naturally tends  to  induration, softening or other
structural degeneration.

Treatment of Irritation and  Inflammation of the Ovaries.
  In acute and in chronic ovaritis  rest is of great importance, and is
especially demanded during the menstrual period.  Severe exercise or
fatiguing occupations should be avoided, and all influences calculated
to depress the patient, either mentally or"  physically, should  be re-
moved.

            Remedies which act especially upon the Ovaries.
  1. Apis,  Canth., Staph.,  Thuya.  2  Asaf.,  Aur., Bry., Carb. an.,
Chin.,  Lach., Lye, Plat., Ran. bulb., Sec. corn., Sep., Zinc.  3. Aeon.,
Ambra., Ant. cr., Ars., Bell., Carb. veg., Chel., Coloe, Con., Graph.,
Hep.,  Ignat.,  Merc, sol., Mez., Nitr. ac, Nux vom., Ran. seel.,
Sulph.

  Aconite.  Will be indicated  where the patient has been exposed  to
dry, cold  air, and has  been so chilled through as to  develop a real
synochal fever, or in cases  in which  this inflammation has resulted
from a fright.
  Ambra g. Stitches in the ovarian region  when  drawing in the ab-
domen or pressing upon it.   Discharge of bluish-white  menses from
the vagina.  During urination  there  is a  burning, smarting  itching
and titillation of the  vulva and urethra,
  Antim. crud.  Nausea and vomiting;  white tongue; tenderness over
the ovarian region.
  Apis m. Stinging pains in the ovaries.   Aggravation after  sexual
intercourse.  Enlargement of the  right ovary, and pain  in the left
pectoral region, with cough.   There is evidently a mutual sympathy
between the ovaries and the lungs.   Especially for the right ovary.
  Arsen. a.  Intense burning or tensive pain in the ovary, with great
restlessness, some relief  being afforded by constantly moving the feet.
Thirst with drinking little and very often.
  Aurum. Much depression of spirits.  Her mind dwells constantly
on  suicide.
  Belladonna.  The  right ovary  is  much   enlarged, and with every
menstrual period the pressure downward  was so great, as if every-
thing would be forced out of the vulva, that she was  compelled lo 
        treatment of irritation and inflammation.     731

keep her bed for several days.  This case was entirely cured in the
course of a year with but three doses of Belladonna.
  Bryonia.  Stitching pains in the ovaries on taking a deep inspiration.
The pains are made worse by motion.  She  can hardly bear the least
touch on the affected parts.
  Cantharis. Much  tenderness  and burning in the ovarian regions.
Dvsuria; cutting burning  in passing only a drop or  two, which is
often bloody, or complete strangury.   This remedy is  very often in-
dicated in this complaint.
  China.  In cases where profuse haemorrhages or too frequent  sexual
intercourse have produced the attack of inflammation.  She can  hardly
bear the least touch upon the affected  parts.
  Cimicifuga.  Inflammation of the ovaries, with irritable uterus ; hys-
terical  symptoms and  rheumatism; also with  suppressed, painful or
profuse menstruation ;  distress and dullness  of the  head; trembling;
sinking at the stomach ; frequent calls to urinate.
  Colocynth. Intense boring or tensive pain in the ovary, causing her
to draw up double,  with great restlessness.
  Conium. Induration and  enlargement of the ovary, attended with
nausea, vomiting, eructations of wind and  expectoration  of phlegm;
lancinating pains; acrid, wdiite and slimy leucorrhoea; labor-like con-
tractions ; pains in the iliac regions.
  Graphites. The inflammation is aggravated by every cold  she takes,
or from getting her feet damp.  Her menses delay.  Morning sickness
during the menses.   Itching blotches  on  the skin here and there,
oozing a glutinous fluid.
  Hepar. When suppuration is feared, and other remedies have failed,
Hepar  may prove to  be the medicine,  if no other is more strongly
indicated.
  Ignatia. In cases where  the  disease  has  seemed to  be developed
from disappointed  affection.   There is involuntary sighing,  great
despondency, and weak, empty  feeling at the pit of the stomach.
  Lachesis. If pus  has  already formed, Lachesis may be  the most
appropriate remedy to promote its escape externally or through the
intestines.  The right  ovary is affected.
  Lycopodium. Cutting or shooting pain, extending from  the right to
the left, across the ovary ; worse after four P. m., better after eight or
nine in  the  evening.
  Nux vom. When  the disease appears to have  been occasioned  by
rich living, highly reasoned food,  stimulating  drinks, or  by  a too
sedentary life. 
732
DISEASES OF THE OVARIES.
   Palladium. The right ovary is  swollen  and sore on pressure with
 bearing-down pains; heavy weight in the pelvis—worse when stanu-
 ing, better when lying on the left side.
   Platina.  In cases where the sexual passion is altogether too stron"-
 as an attendant condition.   The pain in the region of the ovary is of
 a burning character, occurring in  paroxysms, with stitches in the fore-
 head.   Hysterical condition strongly marked.   Has 'proved curative
 after the pus has been discharged  under Lachesis.
   Ranun. bulb. In chronic  cases where  rough, windy weather excites
 the symptoms.
   Staphysagria. In many cases,  particularly where the mind has been
 dwelling too  much  on sexual subjects  as an exciting cause.  Very
 sensitive to mental and physical  impressions.  Very sharp shooting
 pains in the ovary,  which is exquisitely sensitive to pressure.   Pains
 extending down into the crural region and thighs.
   Thuya OC.  In  cases  where the  left  ovary  is  more  particularly
 affected.  The  sufferings  are much  increased  at every  menstrual
 period ;  they even become almost intolerable.  The pain  extends all
 through the left iliac region into the groin, and sometimes into the
 left leg; the pain is sometimes  burning.  Sometimes the pain is ex-
 cited by walking or  riding, and becomes so severe that she must lie
 down.
   Zinc.  In chronic cases;  boring pain in  the left ovary, causing her
 to press on the part continually; but the pain is entirely relieved only
 during the flow of the  menses, and it returns with the same violence
 at the expiration of the menstrual period.

                        Ovarian Tumors.
   Ovarian tumors are by no means uncommon,  and  may be divided
 into three general classes—viz., Fluid Tumors, Solid Tumors and Com-
posite Tumors.
                       Solid Ovarian  Tumors.
   Solid tumors  comprise  those the  structure of  which is  solid, there
 being little or no fluid matter in their composition. They are of several
 varieties, and  are either external  and attached  to the ovary, or im-
 bedded  within its substance.  They are  similar in situation, structure
and variety to tumors of the uterus, and  oftei  occur  in the  ovaries
at the same  time that they do in  the womb, but are less intensely
painful.  The solid ovarian tumors of a non-malignant character are
'.omparatively rare;  they may be quite small, or vary from the  size 
OVARIAN TUMORS.
733
of a goose's egg to that of a man's head.  One of this kind, mentioned
by  Scanzoni—which,  however,  gave some  traces  of  a  cancerous
nature—was found to  weigh  nineteen  pounds,  the patient  having
died of Bright's  disease.   In their  general appearance these  tumors
are  correctly described  in  the words of Dr. Baillie: "The ovarium
is much  enlarged  in size, and  consists  of a  very solid  substance,
intersected  by membranes  Avhich  run   in  various  directions.   It
resembles  in  its texture  the tumors which  grow from the  outside
of the uterus,  and I believe has very little  tendency to inflame or
suppurate."
  In many instances the induration partakes of the nature of an en-
chondroma, in which the sub-peritoneal fibrous membrane of the ovary
itself assumes an  osseous or cartilaginous hardness.   Thus, in two ex-
amples mentioned by Kiwisch :  " Once these cartilaginous concretions
surrounded the ovary in the form of numerous plates or of rounded
protuberances,  more or  less  large, which gave to  the entire organ  an
aspect altogether tuberous.   At another time  the  right ovary was en-
tirely transformed into a tumor of the size of the fist, surrounded with
numerous false membranes, whose exterior  layers  contained large,
hard,  cartilaginous  nodules, while the interior of the tumor resem-
bled a cartilaginous hyaline mass of very great hardness."
  Very  rarely  the induration partakes of the calcareous or cretaceous
nature, or from  the presence of a  peculiar dyscrasia in the  system,
which may be  termed tuberculous, tubercles may be  deposited in the
substance of the enlarged, hardened and inflamed ovary, as  in pul-
monary  tuberculosis.  In such  cases the adjacent  organs will also
show traces of similar tuberculous deposits.   And thus, by almost
insensible gradations, the  non-malignant may be seen to  run into the
malignant form  of ovarian  induration.   The reciprocal relation  of
the  constitutional dyscrasia which produces tubercles to that which
results in genuine cancer  has already been explained in a previous
chapter,  on Cancer of  the Uterus, to which  the reader is here re-
ferred.
  The diagnosis of these solid tumors of the ovary will be assisted by
examination per rectum, by which such a tumor can be distinguished
from tumor of the uterus, and  by the  consideration of the  general
health of the patient, and  the less poignant and lancinating character
of the pains, by which such a tumor may be distinguished from cancer
of the ovary.  But this  is of consequence rather for the comfort and
encouragement of the patient than for our  own guidance in prescrib-
ing, since the medicine must always be selected from a careful study 
734
DISEASES OF THE OVARIES.
of the totality of the symptoms and conditions, never from our patho-
logical theories or conclusions.   The symptoms will surely lead us
right, while our pathological theories, by persuading us to generali
instead of individualizing, will assuredly preclude us from the suce
we might attain.
ess
                   Composite Tumors of the Ovary.
   In this class  of ovarian tumors are included all those the make up
 of which is both  solid and  fluid.   In some of these cases there is a
 preponderance of either the fluid or solid element, which makes it dif-
 ficult to draw a line  of distinction.  Thomas describes four varieties
 of these growths—viz., Cysto-adenoma, Cysto-flbroma, Cysto-sarcoma and
 Cysto-carcinoma.  These names are a key as it were to the quality and
 composition of the tumors themselves.
   The most common way in which tumors of the composite class are
 produced is by a solid tumor forming  cysts within its substance or by
 undergoing cystic degeneration.
   Cysto-sarcoma is the form of composite tumor  most frequently met
 with.  " By cysto-sarcomata," says Lucke, " those  large tumors are
 especially meant which consist of solid masses, papillary proliferations
 and numerous closed and open cavities, such as are  found  in the
 mammae, ovary and testicle."—Thomas.

            Fluid  Tumors of the Ovary—Ovarian Dropsy.
   The greater number of ovarian  tumors are fluid in their nature.
 And although in all cases  the  contained  fluids are  encysted, not dif-
 fused, there are  several distinct forms of such tumors.  Thus, there
 are simple serous cysts, which are merely attached  to the  surface of the
 ovary; tumors which consist in dilatations and dropsies of the  Fallo-
 pian tubes ; dropsies of the ovaries, which consist of unilocular, multi-
 locular or middle  cysts.  It is well to understand  these various  forms,
although it may not  always be necessary or  possible to distinguish
them in the living subject, and also to know that they  may be com-
plicated with more malignant forms of disease.  The unilocular tumor
consists of a single cyst developed within the ovary, wliich may be-
come  of enormous size.   It does not usually form  adhesions  to the
abdominal viscera, and is  for that and otlier reasons  more amenable
to treatment than are  the other varieties.   Multilocular tumors consist
of several sacs, which  maybe developed from a unilocular cyst.  These
various sacs do not communicate with each other except in case  of
 rupture of their walls.  Multiple tumors consist of a number of inde- 
OVARIAN TUMORS.
735
pendently developed cysts, growing side by side, contained within one
envelope and constituting but one tumor.
  The  encysted  dropsy of the ovary, either  consisting of  a  single
greatly enlarged  cyst or of several  smaller ones, is by far the most
common form of ovarian tumor.  " This consists of an enlargement
of one  or  more  of the vesicles of De Graaf, the coats of which are
thickened, greatly dilated, and become filled with a fluid, while the
intermediate structure  becomes  atrophied  as  the  vesicle or vesicles
enlarge, until the fibrous  tunic of the ovarium, covered by the peri-
toneum, forms the boundary of the tumor.  When the principal cyst
is  formed  of the entire ovarium, it  often  happens that the vesicles,
haying partaken  of the morbid disposition, form a  series  of smaller
cysts or cells, which are developed  within  the  parent cyst, and occa-
sionally communicate with each  other by considerable openings, the
tumor  attaining  an immense  size, so  as to  occupy almost the whole
abdomen.   The  thickness of the parietes  of the cysts differs much;
they are. often as thin as a bladder,  but at other times  of a substance
as thick as the hand."—Leadam.  " If there be a great variety in the
size of ovarian tumors, in the density of their external coverings and
in the  nature of their  contents, there  is scarcely less diversity in the
number of the cells and in the thickness of the septa  which separate
them.  In most  of these compound ovarian dropsies the number of
cysts is very considerable, as  the  larger cells  have series  of smaller
ones developed and in the course of growth on their internal surface,
so that when the disease has attained great bulk this creation of sub-
ordinate cysts is  almost interminable."—Ashwell.
   These tumors  may vary from  the  size of a  fist to that of a mass
weighing a hundred pounds.  " The fluid  secreted Avithin the cysts
may be serous, like  that  of  ordinary dropsy, or  mixed  with slimy
matter, or it may be a thick, ropy fluid or  gelatinous;  different cysts
in the  same  tumor will sometimes  contain different  sorts of  fluid.
Pus is  occasionally found in one  or more of the cysts, mingled with
the other  fluid, a consequence of inflammation having occurred in the
cyst."  The fluid contained  in multilocular   and  multiple ovarian
tumors is  not generally so clear  as  that of the simple or unilocular
variety.  It is often as tenacious  as honey  or white of egg—so thick,
indeed, that it will not flow through a large canula, and may assume
very dark hues.   At times it  is colored by cholesterine, blood or pus,
and is brown, red or like coffee-grounds.
  The  multiple cysts, as in multilocular cystic dropsy, are said by a
late authority to depend on a particular specific  alteration of the tissue 
736                 DISEASES OF  THE  OVARIES.
 which constitutes the normal parenchyma  of the ovary.   Some of
 them are filled with similar, some with different, substances.  Thus
 there may  be a purely  serous  liquid, or  one  mingled with blood
 resulting from  the  rupture of interior vessels.  In what are called
 composite cysts, in some rare cases, but usually in a  few isolated
 cavities  only, we  find a  mass of fat, of hairs, of cartilage, bones or
 teeth.
   Ovarian dropsies occur more  frequently in single than in married
 women,  and in the sterile rather than in the parturient of the latter
 class.  This form of disease never appears before puberty; it is most
 apt to occur in the middle age, when the generative organs are in full
 activity.  Usually but one ovary is  at first  or at all affected, even in
 cases in  which the tumor occupies  the entire cavity of the abdomen.
 The other ovary may have  become  atrophied by compression or the
 superior influence of the morbid processes going on around it.  The
 right ovary is more frequently affected than  the left.
   Symptoms.—During the first few  months, or while the dropsioal
 tumor continues in the cavity of the pelvis,  the  symptoms and sensa-
 tions are not to be distinguished  from those occasioned by a more
 solid ovarian tumor.   Its weight and size occasion uneasy, dragging,
 bearing-down sensations  in the pelvis, or  more or less  positively
 painful affections of the bladder and  rectum.  Upon vaginal examina-
 tion the tumor  may be  discovered between the vagina and rectum,
 and if the parietes be thin  fluctuations  may be  detected.  A similar
 exploration per rectum may be requisite fully to determine the nature
 and relations of the tumor, and to  distinguish it from retroversion of
 the womb.  After the tumor has  passed up from within the pelvic-
 cavity, the bearing-down  sensation, the pressure upon the rectum and
 bladder, and consequent retention  of faeces and  urine, will be re-
 lieved.   The disturbance of  the  organic action of the system will be
 shown higher up.   The position  and free movement of the intestines,
 stomach, diaphragm and  other organs will  be so interfered with, as
 the tumor increases in size, as to cause a  great  variety of nervous
sufferings and functional derangements, such  as  palpitation of the
 heart, dyspnoea, dyspepsia, heartburn, etc.   The  gradual  but con-
stant advance of the tumor, its  slow but  steady growth, even when
apparently the normal  quantity  of urine  is discharged, indicate the
nature of the case, independent  of the fluctuation, which if present
 is  of course a positive indication, while its absence may arise from
the excessive thickness both  of the external parietes of the tumor and
of the intermediate  septa.   There  may be  considerable fever, espe- 
OVARIAN TUMORS.
737
dally in the evening, with much thirst, or both fever and thirst may
be comparatively slight.  " In the  course of the  disease the patient
may have  pains  in the belly, with  fever, indicating inflammation of
part of the tumor, which may terminate in suppuration and produce
hectic fever; or the attack may be more acute,  causing vomiting, ten-
derness of the belly and high fever, proving fatal in a short time;  or
there may be severe pain, lasting for a shorter period, with or without
temporary exhaustion,  and these paroxysms may be frequently re-
peated ;  but in many cases these acute symptoms are absent, and little
distress is felt until the tumor acquires a size so great as to obstruct
respiration and cause a painful sense of distension.  By this time the
constitution  becomes broken, and dropsical effusions are (elsewhere)
produced.   Then the abdominal  coverings are sometimes  so  tender
that they cannot bear pressure, and  the emaciated patient, worn  out
with restless nights, feverishness  and want of  appetite,  pain and
dyspnoea, expires."—Burns.
  The  causes of ovarian dropsy  are not so  very definitely  stated,
except that they  may arise from a great variety of influences in per-
sons of a general dropsical diathesis.   These are stated by Leadam to
be injury during parturition, blows, falls, strains,  frights, sudden ap-
plications  of cold,  undue excitement, etc.  Hence  in general, next to
a careful consideration of the constitution, symptoms and indications,
it may be important to  bear in mind  those things which may have
resulted in such  abnormal developments; for so powerful is the in-
fluence of the mind  over the body that, even  in structural disorders
which have  thus resulted from such influences as terror and frisrht,
but little progress will be made toward a cure  so  long as we neglect
to take such circumstances into consideration.
  Ovarian dropsies may.also arise  in connection with suppression of
the  menses, as is the  case with all forms of ovarian tumors.   And in
the  former, as in the latter case, it may not always be possible to de-
termine which  is the primary and which the  secondary affection, at
least where both  ovaries are at the same time  affected, which, however,
is not common.   In ordinary instances one ovary will become diseased,
and the other still perform its function of ovulation, and conception
itself may result.  This  may be  the case until  the larger  size of
the  ovarian  tumor  interferes with  the  proper action  of the  other
ovary.
  Complications.— Dropsies of the ovaries  are very often complicated
with malignant disease, either of the scirrhous or of the medullary or
colloid variety, and during life it is sometimes impossible to distin-
      47 
738
DISEASES OF THE OVARIES.
guish between those  which are  simple and those which are thus
seriously complicated.  In  some  such obscure cases nothing but a
careful attention to the constitutional  indications and symptoms will
guide the physician  aright.  He may know of no remedies  capable
of curing the form of dropsical tumor before him, but he may be able
to select remedies which  shall greatly benefit, and even finally cure,
his patient.  Ascites, or even hydrothorax and  general anasarca, mav
become complications of ovarian dropsy, especially in its advanced
stages, thus greatly aggravating  the  sufferings of the patient, and
hastening the fatal result.   Inflammation may arise in the dropsical
tumor, which may lead to suppuration and a fatal  termination, espe-
cially after the operation of paracentesis has been performed.
   Diagnosis.—It is important, though not always easy, to be  able to
distinguish  dropsical  from other  ovarian  tumors, particularly with
reference to prognosis.
   From pregnancy inter-pelvic ovarian dropsy may be distinguished
by internal examination, by means of which this tumor may be sepa-
rately felt apart from the  fundus uteri.  And in a similar manner,  by
examination per  rectum,  as well as per  vaginam,  this dropsy, while
yet within the pelvic  cavity, may be distinguished from dropsy of the
Fallopian tubes.   From retroversion  of the uterus it may be distin-
guished by its slow growth, as compared with the  frequent suddenly
formed  tumor which  arises  from this displacement of the uterus,  by
the greater  mildness  of the symptoms, the  bowel  not being  at once
affected, and by examination per rectum.
   After the  dropsical  tumor  has so  increased in size as to have
ascended into the abdomen, it may be distinguished from pregnancy
by auscultation ;  by its being  one-sided  sometimes; by examination
per rectum  and per  vaginam showing the uterus not to be enlarged.
In those instances in wdiich pregnancy does  exist  in connection with
ovarian dropsy, it may not be possible to determine the facts of the
case until the  ear can catch the  sound of the foetal circulation, and
even then there may  be some obscurity.   Still, even here the consti-
tutional affections, the sensational symptoms, will lead infallibly to the
right remedies, and thus  the very  best that can be done will be done.
From ascites ovarian dropsy may be distinguished  by the well-defined
form of the tumor; by its  original or permanent  inclination to one
side; by its maintaining its situation  even while the patient is in the
recumbent position;  by the more  obscure  fluctuations; by examina-
tions per rectum and per  vaginam, which will also  enable it to be dis-
linguished from dropsy of the uterus; and by the  absence  of oedema 
               TREATMENT OF OVARIAN  TUMORS.             73S

 of the feet and ankles, which almost invariably attends ascites, but
 which  is less apt to accompany encysted dropsy, except in the last
 stages.  The constitutional symptoms are less strongly marked in this
 encysted form of dropsy than in ascites.  From solid ovarian tumors
 ovarian dropsies are to be distinguished  by the fluctuation and by
 their more rapid growth.   It must be borne in  mind, however, that
 there  are  cases of true ovarian dropsy wliich come on very slowly,
 which may remain dormant and stationary for a number of years.
  The prognosis in all cases of ovarian tumors,  whether solid or  fluid,
 since the great advancement in the true art of healing that has been
 made within the past few years, has been made  much  more favorable.
 The profession has come to  realize  that all  such growths are of dy-
 namic origin, and that the persistent use of a homoeopathic remedy
 to the particular case in question will certainly so counteract the dis-
 eased  condition as to make the tumor disappear.  Actual  experience
 demonstrates this theory, and  proves it to be practically true in nearly
 all  cases where the Art of Homoeopathy is  skillfully applied accord-
 ing to the rules of the master.  This advancement of the healing art
 brings good cheer to many a family whose mother, sister or  very dear
 friend  has an almost mortal  fear of the knife.  Even those tumors
 that seem to develop at the change of life prove to be amenable to our
 treatment.  At the present day no homoeopathic physician ever thinks
 of an operation for these various growths, called  tumors, till the very
 best skill and advice in our ranks have been obtained for reducing the
 same by careful and persistent medication by the  law of similars.

               Treatment  of  Ovarian  Tumors.
  Under this  head  may be  considered both the internal medication
 and operative interference.  The latter may be more readily disposed
 of first.
  Operations for  ovarian  tumors  are of two kinds—those wdiich are
 intended  to entirely remove the disease by  extirpation of the tumor
 itself,  and those wdiich attempt merely to relieve the patient by draw-
 ing  off the accumulated fluids.
  Tapping and Drainage.—Tapping is  resorted to in  some cases of
 ovarian cystic tumor for relief of the patient, but not with the expecta-
 tion of obtaining a radical cure of  the disease.   It is especially  indi-
 cated in unilocular cysts in which fluctuation  can be distinctly felt, and
 in which the patient experiences a great deal of suffering in locomo-
tion and respiration  from the large quantity of water accumulated in
the tumor.  "It should not, as a general rule, be performed so long
as the patient is comparatively comfortable, pxnerience having shown 
740
diseases of the ovaries.
that when it has once been done it will usually have to be done soon
again."
   Although comparatively simple, this operation should only be un-
dertaken with the proper precautions. The bladder should previously
be evacuated, in order as much as possible to avoid the danger of
puncturing this organ.  The patient may be placed on her side near
the edge of the bed, or  more conveniently, in some  cases where  it is
possible, sitting on  the edge of the bed.  The abdomen should be
supported by a bandage broad  enough to cover the space between the
superior border of the  mons veneris and the inferior margin of the
epigastrium, but not too broad, since it might thus impede the respira-
tion.   The  bandage should be divided at each end, to within a few
inches of its centre, into three or four strips, which are to be interlaced
as they cross each other behind.  An assistant is to be placed on each
side of the patient—the one on the left side holding in his .hands the
extremities of the bandage which are passed from the right side (behind)
to the left;  the one on the right side holding in his hands the extrem-
ities wdiich are passed from  the left side (behind) to the right.  In this
manner firm and uniform pressure  may be exerted  upon the abdomen,
which will at the same time promote the discharge of the  fluid  and
sustain the  patient, preventing the feeling of faintness  which would
otherwise  follow from  the sudden deprivation  of the accustomed pres-
sure of the tumor on the internal organs.
  Preparation having thus been made to protect and sustain the patient,
a couple of basins should be at hand to receive the fluid as it flows
from  the opening, and buckets, or even a tub, should be placed conve-
nient for. emptying  the basins. It will be found best to  have  two
basins, one to replace the other  as it is being emptied. A third assist-
ant will be liseful to attend to  these.   Should the patient show signs
of faintness or dyspnoea, the flow may be checked by placing the finger
upon  the canula until she feels better.
  All things being ready, the exact point for introducing the instru-
ment  is determined and marked by a slit in the bandage.  The instru-
ment is the trocar.  " Holding this firmly in the right hand, with the
thumb and index finger resting upon the canula, the  surgeon plunges
:t into the linea alba,  about three  inches above the  pubis, and  by a
steady forcible  pressure pushes it  through the  abdominal  walls.
" When the tumor occupies the side of the  abdomen, care must be
taken to puncture it external to the course of the epigastric artery,
otherwise this vessel mjght be wounded and the patient die of haemor-
rhage.  When the tapping is performed in  the multilocular variety of 
treatment  of ovarian
TUMORS.
741
dropsy, the puncture should be made in the most prominent and fluc-
tuating part of the tumor.   If one cyst does not yield the  requisite
supply, another is opened, an eye being always had to the situation of
the epigastric artery."—Gross.
  It is well to introduce the trocar with the handle a little depressed
and the point looking upward ;  thus the superior integument will form
a sort  of valvular covering over the wound and tend to prevent the
intrusion of air.
  The subsequent treatment requires that the patient remain quiet to
prevent peritoneal inflammation, the  abdomen being firmly  com-
pressed by  means of a thickly-folded cloth and  a broad  bandage.
Some  cases are reported in which this  operation  has been  repeat-
edly performed, on each  occasion  drawing off as much of the fluid
as would readily  flowr, sometimes  three or four pails full, and  this
during a  course of years.  But this constant drain  upon the system
sooner or later wears it out,  and  the  patient  finally perishes of
exhaustion.
  Ovariotomy.—The operation  for the removal of ovarian tumors has
of late years  been very  successfully performed by many men wdio
have become famous  for skill as ovariotomists.  The results warrant
a resort to  the  operation where other  measures  have  failed.   For a
description  of  this operation and  the method of performing it, to-
gether with a more perfect and complete account of the various forms
of ovarian tumors, we refer the reader to the recently published works
of Atlee, Peaslee, Thomas and Wells.
  The following remedies are recommended in the  treatment of ova-
rian tumors.   The practitioner  should select his  remedy  with the
greatest care in these cases, keeping before him always the possibility
of effecting a  cure by medicinal means alone, and  leaving operative
interference as a dernier resort.

  Apis mel. Stinging  pains, like bee-stings; sometimes  lancinating
pains.  xVbsence  of  thirst.  Scanty urine.  The  dropsical  effusion
may be trifling  and merely  local, or the patient may be completely
anasarcous and enormously swollen; the skin is  usually white and
almost transparent.  The bowels are often very costive, with large,
hard,  difficult passages, wdiich Apis also cures.
  Arnica m. If developed from a bruise, the Arnica symptoms remain-
ing, a sore, bruised sensation.
  Arsenicum alb. The tumor may  be large or small, and is  accom-
panied with a general anasarcous  condition and pale, wax-like skin. 
742
DISEASES  OF THE OVARIES.
Burning pains  in the tumor.  Water lies heavily and cold upon the
stomach  when drunk.
  Belladonna. The pains  coming  and  going suddenly.  Downward
pressure, as if all would issue through the genital organs.
  China. If the tumor can be traced as a consequence of loss of animal
fluids.
  Conium.  Much nausea and vomiting.  Vertigo whilst  in a recum-
bent position, particularly on attempting to turn over.   The urine in-
termits in its flow.
  Graphites. She has itching blotches here and there over her person.
Getting her feet a little damp aggravates her sufferings.  Obstinate
constipation of large, knotty faeces, with varices.
  Iodium.  In women of decidedly scrofulous diathesis.   Leucorrhcea,
which excoriates the flesh, and even corrodes the patient's clothing.
  Lachesis. Especially in cases where the left ovary was first affected,
with tendency toward the right.  Worse  after sleeping.   The pain is
often relieved by a discharge of blood from the vagina.
  Lycopodium.  The  right ovary is first affected, and  inclines to the
left.  Aggravation after four o'clock p. M.  Much borborygmus, par-
ticularly in the left hypochondrium.  An abundance of red sand in the
urine.   Much pain in the back before urinating, which is  relieved as
soon as the urine flows.
  Zinc.  The sufferings are entirely relieved during the catamenial  flow.
A sensation as of boring in the tumor, which requires  pressure and
shaking of the part  for relief.
   Study also Apocynum cann.,  Eupatorium  purp., Hydrastis
and Sepia, and the  remedies mentioned under Cancer  of the Ovaries.

                    Cancer of the  Ovaries.
   The  malignant and  the  non-malignant  may be stated to  com-
prehend all  the  varieties  of solid  ovarian  tumors;  of these the
latter—principally fibrous  tumors—have just been described; the
various  forms of scirrhus, cancer  and fungus haematodes make  up
the former.
   Fibrous cancer, or true scirrhus, more properly belongs to the class
of  solid tumors of the ovaries.   This  form  of ovarian cancer is
usually very moderate  in size, very slow in  its growth  and develop-
ment, and as a primary affection comparatively rare in its occurrence.
The more  frequent form of cancer of  the ovaries, however, is not the
scirrhous,  but the  cerebriform  variety, the  cysto-carcinoma  which
appears in connection  with  encysted  rather than with  solid ovarian 
CANCER  OF THE OVARIES.
743
tumors.  Both varieties, for the sake of simplicity and concise less,
will be considered in the present section.
  Cancer of the ovaries is less common than that of the breasts, and
not nearly as frequent as cancer of the uterus.  It appears to attack
principally  unmarried  women at  the  middle  period of  life, while
cancer of the uterus  more  frequently occurs in those of a more ad-
vanced age.
  Scirrhus of the ovary presents the  characteristic stony hardness  of
this affection in general; it  is uneven in its surface and  nearly homo-
geneous in its substance.  Its coexistence with cancer of other organs,
especially in the breast, greatly aids in determining the nature of the
difficulty.  In other respects the reader is referred to the symptoms as
described under cancer of the uterus.  The examination per rectum
will enable  the tumor  to be distinguished from  that of the uterus.
  The more common form of ovarian cancer is the cerebriform, which
is  also much  more rapid in its growth.  " We have the  ovaries or
Graafian vesicles swelled out into cysts whose walls are  like scirrhus,
or we have  them converted  into those bags  of  gelatiniform substance
which have obtained the name of colloid.  We  see also here  those
proliferous  cystic  growths  classed  by some authors  among the  non-
malignant tumors, but which  are, I believe, true cancer.  It appears
from the results of operation that the diagnosis of these tumors  from
the simple  cystic formations is  very  difficult, and also that very un-
favorable results have ensued whenever the ovarian  tumor which has
been removed proved to be cancerous."—Cooke.  It is desirable,  how-
ever, as above stated, to  be able to  distinguish at  as early a period
as possible  scirrhus from an ordinary and comparatively  innocuous
induration; and so also to distinguish a fibrous  from a cerebriform
or colloid  cancer  of  the ovary, since, while the  former may occupy
years in its  development, and even then attain to but a moderate size,
the latter runs a  very rapid course, and may acquire  an enormous
volume in a few months.
  As  fibrous  cancer of the ovary may become a softened, ulcerated
cancer, so these two forms of  the cancerous affection either present at
different periods of their development great differences of consistence,
or they combine in one and the same tumor, and at the same time, the
most opposite constituents.   An ovarian tumor was dissected by Veter
weighing fifty-six  pounds, and of  a consistence almost cartilaginous;
in three parts, however, it was softened, and resembled the substance
of the brain.  The encephaloid substance was more distinctly charac-
terized in a case of enormous cancer of seventy-five pounds weight, 
744
DISEASES OF THE OVARIES.
which occupied the left ovarium, and contained within a fibrous and
a fleshy mass and a fatty tissue.   It is this encephaloid disease which
has been termed cephaloma when  it is whitish, and hcematoma when it
is vesicular  and saturated with  blood; the same  that by others has
been denominated malignant or fungoid tumor of  the  ovarium *   A
similar fungous or cancerous cauliflower excrescence  has been described,
in which, in  connection with dropsy, both  ovaries  were changed into
a mass infinitely ramified with vessels in its substance  and granulous
at its surface.
   Many forms of encysted dropsy of the  ovaries  are  attended with
cancerous affections; here we  find colloid cancer, medullary cancer,
and what, for more exact definition, are termed cysto-sarcomata. For a
more thorough and complete view of the various structural disorders
of these  organs the  reader is referred to the works  of  modern gynae-
cologists.
   Symptoms.—Ovarian cancers are less painful than the uterine, but
the pain is of the  same lancinating character;  menstruation may con-
tinue so long as the disease is confined to one ovary, but it will neces-
sarily fail when both organs become  involved.  Conception has been
known to take place in persons laboring under malignant disease of
one ovary.   From their situation in connection with the rectum and
bladder,  the enlarged 'ovaries  must of course occasion more or less
irritation and disturbance of both these organs.  And in fact the most
painful symptoms which arise  in  connection with ovarian cancer are
those which occur either from its thus involving other and more  sen-
sitive organs, or from  its  escape  into the  abdomen and subsequent
softening, involving all the surrounding peritoneal  membranes in this
distressing inflammation.  "These diseases frequently lead to a rapidly
fatal termination, and are  accompanied by that extreme sense of de-
bility and bloodless appearance of the body so characteristic of malig-
nant disease."  " The malignant form of the disease may be recognized,
during life, by the want of nutrition, the broken health  of the patient,
the unceasing and rapid growth  of the tumor, the simultaneous en-
largement  of glands  in other  parts of the body, and  the occasional
recurrence of lancinating pains in the parte.   The  latter symptom is
not constant.  The  pulse  is quick and feeble, and  as the disease pro-
ceeds there is hectic fever, and often  aphthae  in the mouth, with an
inexpressible sense of debility."—Boivin and Duges.
   Diagnosis.—" From  ovarian dropsy both scirrhus  and encephaloid
may be distinguished by their  greater hardness and compactness, by
                      * Boivin and  Duges, page 47S. 
         MAMMARY CANCER—CANCER OF THE  BREAST.       745

the absence of fluctuation generally, and by their  lobulated, tuberous
surface.
  " From pregnancy,  by  the  hard,  lobulated  surface,  and  by the
absence of the audible signs of pregnancy.
  " From fibrous tumors of the uterus, by their greater size;  by their
not being pediculated,  but more movable, at least during the early
stages, and in an advanced stage by  the  lancinating pain and  con-
stitutional distress.
  "Scirrhus is of slow growth, gives rise to mechanical symptoms,
and to disturbance or irregularity of the catamenia, but to no pain  or
constitutional suffering.   Encephaloid disease, or  fungus haematodes,
on the contrary, gives  rise to fever,  emaciation, and other constitu-
tional symptoms."— Churchill.
  For other constitutional symptoms and affections see Cancer of the
Uterus, since cancer either in the uterus or in the ovary must affect
the system in a very similar manner.
   Treatment—For the treatment  of  cancer of  the ovary consult the
treatment under Ovarian Tumors and Cancer of the Uterus.

        Mammary Cancer—Cancer of the Breast.
  There are many forms of tumors occurring  in the mammae, some
of which are mild  or  innocuous, some malignant, apparently from
their outset, and  some, after, remaining stationary and harmless for a
long  course  of years, are  capable of suddenly assuming a malignant
form and character.  This latter circumstance is  owing  no  doubt to
the fact that in such cases the tumor  becomes the representative of a
more depraved or of a  cachectic condition of the  system.  And as in
a former chapter we have seen the reciprocal  relation of the tubercu-
lous to the cancerous diathesis  in different members of  the same family,
so here we see how at different stages  of  the same life the constitu-
tional miasm may assume a more malignant form.
  Of the actual cancerous affections of the female system the breast
becomes the seat of development of by far the  larger number.   And
the cancers  of  the breast—either those  originally so  appearing  or
those  subsequently  so  becoming—are  almost  all of  the scirrhous
variety,  and they all  occur  after  the accession of the period  of
puberty.  But  before  proceeding to the description of mammary can-
cers it will be proper to mention two  or three  forms  of  tumor wdiich
resemble such cancers, especially in their initial stages.
  These are glandular engorgements, " which have received the name
of adenoid tumors or adenocele.   Commencing as a small  almond- 
746       MAMMARY CANCER—CANCER  OF THE BREAST.

shaped tumor very  loosely attached to the surrounding tissue, and
gliding with  great freedom under the skin when pressed by the fin-
gers, it may grow to the size of a duck's  egg or even larger.   It ia
seldom solitary,  never attaches itself to the skin, and within mv ex-
perience never suppurates so long as it remains simply an adenocele.
This tumor is observed  more  generally in the  mammae of unmarried
females."—Cooke.   These tumprs,  or  glandular enlargements and
indurations, are  supposed to be of a scrofulous (tuberculous) nature
an  external  development of  what  might have become pulmonary
tuberculosis.  Some cases of tumors  of  this form  are believed  to
depend upon uterine irritation or sexual excitement, and tu be only
capable of being removed by the  removal  of the exciting cause.
Other cases of adenoid  tumors of the mammae are  those which may
remain for many years painless  and innocent, and finally assume a
cancerous form.   " It need not be denied  that cancerous growths may
occur in tumors  that were previously of an innocent kind."—Paget.
This is to be accounted  for from the fact that phthisical parents beget
cancerous offspring, and cancerous parents have phthisical children—
hence tumors of long standing, having none of the characteristics per-
taining to cancer, may suddenly assume an active cancerous condition.
These  statements are made particularly  to show the importance of
being guided in  all our  prescriptions for such tumors not by our diag-
nosis as to their  being  cancerous  or  otherwise, but by the symptoms
present.
  Still another class of  tumors of the female  breast is to be found  in
those which  arise from  external injury.   " A blow upon  the soft
tissues of the female breast may result in a diffused hypertrophy of the
gland and neighboring  structures, or in a circumscribed tumor which
obtains considerable hardness, and is attended with great pain, or  in
the development of cancer,"  the result  in either case being deter-
mined by the internal condition of the various systems, wdiich are all
alike externally affected by the  same exciting cause.  Thus, unless
one has in her constitution either the cancerous dyscrasia itself or its
complement,  the tuberculous diathesis, no cancer  can result  from an
external injury,  however severe.
  The various forms of non-malignant tumors  of the mammae hith-
erto  mentioned  are  indurated, solid.   But there  are  others, which
may become cancerous or not, which are  properly termed cysts in the
riammce.  These  arise from the distension of one of the lactiferous tubes
of which the gland is composed.   " When fully developed this cystic
tumor is so tense a/  to give rise  to  some  doubt whether it be a solid 
         MAMMARY CANCER—CANCER  OF THE BREAST.       747

or a fluid body."   They  may occur singly or  in numerous clusters.
In the former case, they are declared by Cooke to be innocent and
curable; in the latter, they may be either innocent or malignant.
  The cancers  of the female breast  have already  been stated  to  be
almost  entirely  of  the scirrhous •variety.   The medullary form  of
mammary cancer is so  rare that it is  sufficient to state that it some-
times does occur.   Scirrhus of the breast has been divided  into three
general classes:
  I. Scirrhus proper: a hard tumor  wdiich is felt beneath the skin,
generally movable, but in an advanced stage attached to the pectoral
muscle as well  as to the skin, very  heavy and incompressible, and
attended  with  severe stabbing pain.  These tumors may be  reab-
sorbed or become open  ulcerated cancers.
  II.  Scirrhus with cysts—cysto-scirrhus: a cancerous  tumor having
an indurated base,  in which  cysts have been developed.  This variety
in some instances  appears  to be but a further development of the
former.
  III.  Cuirass-form scirrhus: tegumentary scirrhus, wliich involves
both the  skin and  the gland, binding the whole  down by a  hard,
brawny, almost iron clasp, to the ribs themselves.  This peculiar indu-
ration of the skin frequently extends  over  the thorax, creeping  grad-
ually round to the  back, and anteriorly across the sternum to the other
breast.   It is the least  manageable of all the forms  of scirrhus, and
never at any time admits of operation with the slightest prospect  of
delaying its progress.   It is  in this form of scirrhus principally that
we have those nodules  or tubercles which are sometimes  seen  upon
the surface  of the  breast, and indicate generally the  hopeless nature
of the case; but these tubercles do also appear  in the advanced stages
of the other forms of scirrhus, and especially when the disease returns
after an operation.— Cooke.
  The history of the case, the  relation of the tumor to the adjacent
parts as first movable, then fixed, the  extreme, stony  hardness of the
tumor itself, and the stabbing, lancinating character of the pains, will
enable the  physician to give a qualified, guarded  diagnosis, even  in
the earlier  stages of the disease, and to express the hope that the
tumor maybe prevented from assuming the form of ulcerated cancer;
and that, if it is  not entirely dissipated by the exhibition of the appro-
priate  remedy  homoeopathic  to  the  whole  case, it may at least  be
arrested in its progress, and its further development finally prevented.
  With regard to the operation for  the removal of  cancer, we may
now state that the  results of surgery  go far to  confirm the  principles 
748       MAMMARY  CANCER—CANCER OF  THE  BREAST.

adopted  in  this  book and which are  common  to the  homoeopathic
school.   The  extirpation  of the  tumor, so  far from removing  the
disease, does, but  result in most cases in its more rapidly fatal devel-
opment.   All those cases in which the  surgeon would dare to operate
afford  still  greater prospect of a  radical cure from  the  use  of  the
homoeopathic  remedies.  And finally, if these remedies fail to arrest
the progress of the disease entirely, they can greatly retard its  ad-
vance, and  at the same  time do  much toward  relieving  the intense
pains which characterize almost every form of cancerous affection.
   Treatment.—Study the following remedies, and also the others men-
tioned under Uterine Cancer and  Ovarian Tumors.

   Apis m-  Indurations.    Scirrhus  or  open cancers,  attended with
"stinging burning" pains.
   Arnica m. Should be  employed immediately after a  contusion, or,
should  this not  be found  sufficient, Conium will most probably be
found  to be the remedy.
   Arsen. a.  Burning like fire.   Putrid  exhalations.   Waxy paleness,
and great debility from the cancerous affection.   Great loss of flesh.
The pains are relieved by  motion.
   Asterias  rubens. Cures  cancers, particularly  of  the  left  breast.
"Feeling as if the left breast were  drawn inward."   "Drawdng pain
in the breast."   " Swelling and distension of the breasts, as if before
the menses."
   Belladonna.  Red streaks, like radii, extend from the scirrhous in-
duration  or ulcer.  The pains come  on suddenly, and finally disap-
pear with equal  suddenness.   They are aggravated by  motion or the
least jar.
   Bryonia.  Where there is  a tensive burning and tearing pain, aggra-
vated by moving the limb  of the  affected  side.  She feels generally
better on keeping still.
   Calcarea carb.  In leucophlegmatic constitutions.  The  cancer is very
sensitive and painful to the touch.
   Calcarea  oxalata. Cancer of the  left  breast, with intense agonizing
pain.
   Carbo an. Burning and  tearing pains; dyspnoea and  anxiety; low-
spirited and desponding.   Faint, empty sensation at the pit of the
stomach.
   Cham.  Induration, with  drawing tearing; painful  to the touch—
she. feels as though she  could not possibly bear the least touch.   She
 becomes  almost  furious  about the pain; she cannot bear her clothes 
          MAMMARY CANCER—CANCER  OF THE BREAST.      74U

 to touch the part affected.   The pains are aggravated in the open air
 and at night.
   Clematis e. Cancer in the mammae, painful only on being touched.
   Colocynth. Will  be found indicated in some cases of very painful
 cancer.
   Conium  m. Is particularly indicated  in cases developed by means
 of an injury, or if aggravated at  every menstrual period.  Pricking,
 stinging pains.  She is roused from her sleep with pain.
   Creasote. The whole mammary  gland is hard, bluish-red and cov-
 ered with little  scurfy protuberances,  from  which blood oozes out
 whenever  the scurf is removed.
   Graphites. If developed from old cicatrices formed  from repeated
 abscesses in  the mammae.
   Hepar S. c. Cancer of the breast, with stinging, burning of the edges,
 and smell  of old cheese.   Little pimples  or smooth ulcers surround-
 ing the scirrhus or principal ulceration.
   Lachesis. The  cancer  has a bluish or dark-red  base, interspersed
 with black streaks of coagulated or decomposed blood.
   Lycopodium. Hard, burning nodosities  in the mammae.   Study the
 constitutional symptoms of this important remedy.
   Mercurius. The cancer has a sore pain,  a sort of raw feeling.
   Nitric acid. Hard knots in the mammae,  particularly of mercurialized
 women.
   Phosphorus. Inflamed indurations, very painful, much  aggravated
 by exposure to the air.   Stitching  pains striking through the  part
 affected.   Tall, slim, phthisical females.
   Pulsatilla. May be indicated in all lumps occurring  in the breasts
 of young girls.   They are sometimes very painful, and often affect the
 arm of the corresponding side.
   Sepia. Is a powerful remedy in these affections.  The urine is putrid,
 and deposits a sediment like clay burnt on the chamber.  Painful sen-
 sation of emptiness in the pit of the  stomach; yellow spots  in the
 face; burning pain in the cancer.
   Sulphur. The constitutional symptoms  are strong in this direction;
 flushes of  heat; burning in the soles of  the feet; heat on the crown
 of the  head; weak, faint spells.   Weak  and unusually hungry from
eleven to twelve A. m.
  Hydrastis, Phytolacca, Galium  aper., Hamamelis, Chima-
prtla, Cistus can., and the Iodides of Arsenic and Lime, have
likewise been recommended. 
750           DISEASES of infants and children.
                     CHAPTER  XXXV.

         DISEASES  OF INFANTS AND  CHILDREN.

      Physiology and  Lesions  of Infantile Nutrition.
    THE most  remarkable circumstance  connected  with the young
      infant is its rapid growth.  In  comparison with the very great
activity of its nutrition in a state of health, most of its other func-
tions seem  nearly dormant.  And  it follows that  most of the dis-
orders  of infancy are either direct lesions of nutrition or the conse-
quences of such lesions.
   A  brief notice  of the normal physiological growth and  develop-
ment of the infant will prepare the way for a more intelligible account
of the disorders which are but deviations from such growth, and at
the same time afford opportunity for explaining  the causes of such
deviations.  Just after the birth of her child, and  before  the secretion
and  flow of milk sufficient to nourish the babe, the mother is in a
condition of temporary rest.   The same is true of the corresponding
period in the life of the babe.  Before birth  it had been nourished
directly through the sanguineous circulation of the mother.  After its
birth conies that brief interval of repose  in which its system may be
supposed to consume all the last remaining elements supplied through
the mother's veins.  To this succeeds a state of hunger, in which the
system  becomes prepared to  receive  its  necessary  food in a form
entirely new and by means  of an organization equally different and
distinct.
  The  mother's milk is the simplest and most nourishing  form of
food,  and one  that requires to undergo the least  possible change in
order to be capable of assimilation by the child.  The milk contains
all the elements which enter into the composition of the blood, and of
course into  the construction of the body.  " It is very interesting to
observe that milk contains the three classes of principles which are
required for human food—the albuminous, the oleaginous and the
saccharine;  and it is the only secreted fluid in which all these exist to
any considerable  amount.  It is  therefore the food most  perfectly
adapted for the young animal, and is the  only single article supplied
by nature in which such a combination exists."—Carpenter.   In ma-
ternal lactation the milk is freshly prepared as  needed, and imparted
to the babe from time to time  in  small quantities, and under the
beneficent influence of physical and moral circumstances which in a 
infantile  nutrition.                   751
remarkable manner tend to promote its kindly reception into the
infant's system, its grateful assimilation, and the consequent exceed-
ingly rapid growth and development of the infant itself.  For the
animal heat of the mother's body imparted  to  the  babe in her arms
is not more necessary and more grateful to the infant's physical sys-
tem than is the moral influence of the cherishing kindness and tender
affection of the mother's love essential to the  whole spiritual, intel-
lectual and physical  growth of her  offspring.  The grosser material
life of the babe is indeed sustained by the abundant  supply of milk
which it receives from the  maternal fountain; yet even this material
supply will be found to have been deprived of a large part of its effi-
cient vitalizing force when it loses the indwelling spirit of the mother's
love, of which it naturally forms the material  body, and of which in
great part it constitutes the medium of communication between the
mother and her child.  This in some measure  accounts  for the great
mortality of those who are  attempted to be brought up by hand in-
stead of being nursed  by their own mothers, as intended  by nature.
" The infant whose mother refuses to perform toward  it  a mother's
part, or who by  accident, disease  or death is deprived of the food
that nature destined for it, too often  languishes and dies.   Such chil-
dren you may often see with no fat to give plumpness to their  limbs,
no red particles in their blood to impart a healthy  hue to  their skin,
their face wearing in infancy the lineaments  of  age,  their voice  a con-
stant wail, their whole aspect an embodiment of woe.  But give to
such children  the food that nature  destined  for them, and  if the
remedy do not come all too late to save them  the mournful cry will
cease, the face  will assume a look  of content,  by degrees the features
of infancy  will disclose themselves,  the limbs  will grow  round, the
skin pure red and white; and when at length we hear the merry laugh
of babyhood, it seems  almost as  if the  little  sufferer of some  weeks
before must have been a changeling, and this the real child brought
back from fairy-land." *
  The mortality  of infants in  foundling hospitals is vastly greater
than that of those who, although  deprived of their natural mothers,
are still brought up in private families.   And yet these extreme cases
will serve all the  more plainly to show the mischievous results pro-
duced by a violation of the laws  of nature in this most  important
respect.   The following statement of the course  pursued and results
obtained in the  three principal  foundling hospitals of France, com-
pared vith the subsequent statement of the almost universal mortality
                     * West, Diseases of Children. 
752          DISEASES OF  INFANTS AND CHILDREN.

in the largest foundling  hospital in America, will fully explain itself.
At Lyons each infant on its reception  is given  into the charge of a
wet-nurse, and its  stay in the hospital does not exceed a very feu-
days, after which it is sent to be nursed in the  country.  At Bheiras
the stay of the infant in the hospital is equally  short, but neither
while there nor afterward when at nurse in the  country is it brought
up at the breast.   At  Paris  the  stay of the children  in the hospital
is often very much longer, but they are usually, though not invariably,
suckled by wet-nurses.  The mortality under one year of the children
admitted into these institutions is,  at Lyons, 33.7 per cent.;  at Paris
50.3 per cent.; at Kheims, 63.9 per cent.  At the Foundling Hospital
on Blackwell's Island, New  York, the pastor in charge states " that
of the five hundred motherless  infants that he had baptized within
the two  years preceding January, 1867, only about twenty-five were
living, most of the balance  having been returned dead within about
twenty days after their admission.   Their  food  was cow's milk only.
Qn the first of November the same reverend gentleman informed me
that he had baptized one hundred and  sixty since the first of March,
of whom only six  remained living, the most  of them having died
within twenty days after  arriving at the hospital." *  These children
were fed upon milk obtained from  cows kept and fed upon the island.
   Other unfavorable  influences—of the  sea  air, the cold  and damp
east winds, in addition to the usual unhealthy  circumstances insepa-
rable from extensive hospital establishments—must have contributed
very largely to the  production of this almost universal  and unprece-
dented mortality.   Still, the remarkable and very early fatality itself,
after  making all due allowance, deserves  attention in part from its
relation  to the comparative viability  of infants brought up at the
breast and by hand, and in part from its relation to the quality of the
food best adapted to support life in these  little ones  when they can-
not be nursed.   And  the question  becomes a very practical and im-
portant one  in many cases in wdiich the poor health or the unsound
constitution of the  mother gives reason to conclude that if the child's
life can be preserved  in  its  tender months by other means, its whole
constitution and future  health  may be very much benefited by the
same method.  But this will be again  considered subsequently ;  and
yet it may be proper to remark here that, even in those cases in Avhich
\t  may be impossible or inexpedient for the mother to nurse her child
entirely, it is still  very important  for her  to suckle her child for a
while, however short the time in which she may be able to do so, and
                  *Hahnemannian Monthly, vol. ii., p. 357. 
                      INFANTILE NUTRITION.                    753

that her own milk should be the babe's only food during this period.
Although this is contrary to the opinion commonly entertained among
the people, the young infant will thus obtain a  start in  life  in the
right  direction, and be  better  able to be nourished  by  other  food
should that subsequently  become inevitable.  Just as the  mother's
milk is found to adapt itself to the changing condition of the babe as
it becomes  older and stronger, so during  the  first few days after the
infant's  birth the  colostrum  possesses  peculiar qualities,  and  not
merely abounds in fatty, saccharine and albuminous material, but pre-
sents its caseine in a more easily assimilable form than subsequently.
So delicate  and peculiar are the digestive  organs of the young infant,
and so especially adapted  is the mother's  milk to  their comparatively
feeble digestion, that  it becomes  no easy task to  provide a substitute
which shall in like manner be  constantly suited to the varying con-
ditions and wants of the infant's daily growth.
  But since there will always be cases, owing to the sickness  or death
of the mother, or  to  her inability to nurse  her children from  other
causes, in which it will also be impossible to procure a wTet-nurse, and
in which, therefore, it becomes necessary to provide the next best sub-
stitute, particular directions for this purpose will nowT be given.   The
milk of  cows is the most accessible, and in many  instances forms the
only substitute which can  be procured.*   But since the proportion of
caseine or cheesy matter is larger  in this, while there is less sugar and
generally less fatty matter than in breast  milk, it becomes necessary
to alter this in order to adapt it to the stomachs of infants, especially
of those quite recently born.  For this purpose should be  chosen the
milk of  a perfectly healthy cow, one that  is fed upon her natural diet
of hay or grass and pure water alone; a " new milch cow " is best.
  *The following table, from the most reliable authorities, will show the composition
of several kinds of milk :
Constituents.	Cow.	Ass.	Goat.	Ewe.	Woman.
Water.......................................	86.28 4.38 5.27 3.80 0.27	91.65 0.11 6.08 1.82 0.34	86.50 3.32 5.28 4.32 0.58	85.62 4.20 5.00 4.50 0.68	89.20
Butter.......................................					2.60
Sugar of Milk.............................					6.00
Caseine......................................					2.00
Various Salts..............................					0.20
					
Total.....................................	100.00	100.00	100.00	100.00	100.00
  As the mean of eighty-nine analyses of human milk, MM. Vernois and Becquerei
obtained the following result: Water, 889.08 ; solid matters, 110.92.  These solid con-
stituents are composed of—sugar, 43.64; caseine and extractive matter, 39.24; buttei,
2G.6C; incombustible salts, 1.38; total, 110.92.
      48 
754          DISEASES OF INFANTS AND  CHILDREN.

This milk  should be allowed to stand from  two to four hours aftei
being drawn from the cow; then the top part only, being the richest in
fatty matter, should be  dipped  off and diluted with an equal part of
pure warm  water; the whole to be sweetened with pure white sugar,
or sugar of milk* till its taste in this respect resembles mother's milk.
By this process  the  proportion of  cheesy matter is diminished, the
butter and  saccharine  qualities increased, and a  very excellent imi-
tation  of human  milk obtained.  Care should always be taken to
present the  infant's food at the proper temperature;  this should be as
nearly as possible the same as that of the mother's milk; and a ther-
mometer will be found  very  useful in  enabling the  food to be given
always at a uniform  and healthy temperature.  No  less important is
it to prepare the food often enough to secure it from becoming soured
in the least, either before  or  after it is consumed, for rancid milk is
even more  destructive to  these little ones  than is putrefying food to
adults.   And if the sugar of milk be employed to sweeten the infant
food instead of  common cane-sugar,  it will be very much less capable
of becoming sour in the child's  stomach, and of thus inducing serious
gastric  and intestinal  irritation.  The  utmost care  is requisite in
order to keep the nursing bottle and other utensils  used in  artificial
nursing in  a perfectly sweet  and cleanly condition.   The life of the
infant may  depend upon this  apparently trivial matter.
  As the child grows older the  proportion of  water may be gradually
diminished.  As the child becomes  still  older and  the teeth become
more developed, some portion of good, well-risen domestic bread may
be added to the milk.
  By carefully pursuing the  course  here pointed out, the new-born
babe may be fed without fatally deranging its digestive organs before
it has acquired any strength of  its own for assimilating suitable food;
and its food can be made  gradually  more hearty in  order to comply
with the increasing demands  of  its daily growth, and  thus prevent it
from becoming atrophied  by starvation or  diseased  from want  of
nutriment of the  proper  kind.   For these reasons also it  becomes
always the first duty of  the nursing mother to take care of herself, in
order that she may maintain her  own system in  a  state suitable for
sustaining the  young  and tender  life which  is dependent upon her.
This, indeed, unassisted nature  teaches  in  general; out art simply
requires that we see to it that such persons live on a plain, nutritious
  * Every homoeopathic physician should  furnish to his  friends this invaluable article,
and persuade them always to employ it in preparing food for infants, since, from being
jar less likely to become rancid, it  is found to be immeasurably superior. 
ANTIFSORIC PROPHYLACTIC TREATMENT,
755
diet, make use of no unsuitable  or  highly-seasoned  food, and in all
other respects observe all the hygienic rules which belong to the period
of lactation.
  Infants at the  breast require food sufficient in quantity, as well as
to receive it at  short intervals.  When the milk is secreted  very
abundantly, as is often the case, the child overloads its stomach; the
excess is rejected by vomiting, or rather by  regurgitation, with little
effort and no distress.   But if the flow of milk is scanty, the child
worries the breast in vain, and is  always unsatisfied.   The milk also
varies in quality in different women,  as well as in quantity, and in the
same mother under different circumstances and conditions.  Some
slight modification of the healthy standard of the milk can be borne,
for a while at least, without any immediate and apparent alteration in
the child's health.   But let this change  be more strongly marked, and
the child's health will begin to fail at once; its life may be exhausted
in a few hours  by  convulsions, or almost instantly destroyed by
nervous " shock," as in  cases of sudden and violent emotion on the
part of the mother.  These violent emotions, which sometimes prove
so suddenly fatal to the infant at the  breast, are evidently conveyed
into its  delicate  system  with  all their deadly force through the milk
which passes so rapidly into its circulation and poisons its blood.

            Antipsoric Prophylactic Treatment.
  From the treatise of Dr. Leadam  we quote the following excellent
remarks  on the  antipsoric  prophylactic treatment  of infants: u Dr.
Gastier of Paris has entered  largely into the subject  of the prophy-
lactic treatment of children, with the view of preventing the heredi-
tary dyscrasia which come under the  denomination of psora.  He has
also  declared that  the vaccine  virus does not usually take  effect in
those subjects whose constitutions have been acted upon by this treat-
ment, and that they are, a fortiori, unsusceptible of  the small-pox.
(With the greatest respect for the prophylactic treatment here recom-
mended, we still doubt whether it can be depended upon to do all  that
Dr. Gastier here claims for it.)  This  may be  open  to dispute, but
experience alone  can decide the question.  If observation should con-
firm  it, it will evidence a renovating and conservative power in the
homoeopathic remedies which Hahnemann himself could scarcely have
dreamt of.
  "The  plan recommended by those  who have paid particular  atten-
tion to the subject is to administer to the infant,  soon after birth,  two
globules  of a high  dynamization of Sulphur200, by placing them on 
 "56           DISEASES  OF INFANTS AND  CHILDREN.

 the tongue, and  to  repeat  the  same dose at the end  of four or five
 weeks if no morbid symptoms demand any other medicine.  After
 this, at about  the third  month, a similar dose of Calcarea  is to bo
 given, which has the advantage of facilitating in  a surpassing man-
 ner the  development of the  teeth.  Under this treatment the infant
 expands and thrives with a physical and moral  energy which indicates
 health, wdiile the root  of much bitterness has  been destroyed by the
 prophylactic treatment  above-named."   In addition to  the recommen-
 dation of Sulphur by Dr. Gastier, or rather  in place of it, in certain
 cases  we advise to use  a  high preparation of the remedy which is the
 exact homoeopathic  simile  to the  psoric miasm of the parent where
 any particular  indication of this  kind can be derived from either
 parent.  And this we think can be done in many instances;  Calcarea
 in some cases, in others Arsenicum, in others  Graphites, will be found
 in affinity with the  constitution of the parent, and a single  dose of
 the very  highest preparation of the remedy,  given  to the infant, will
 exert  a beneficial influence  in rendering much  less violent and dan-
 gerous all the  subsequent illnesses to which  children  and youth  are
 necessarily exposed.

               Atrophy of Infants—Marasmus.
   The atrophy of infants is the very opposite  to their healthy nutri-
 tion, and consists in a general marasmus or wasting away of the entire
 system.  This condition may result either from the unhealthy or un-
 suitable  character of the food with which they are supplied,  or from
their  own inability to  assimilate it on  account  of  some  inherent
 hereditary disease.   In reference  to  each case, therefore, it  is very
important to distinguish as to which of these two classes it belongs.
 In the previous  section  on nutrition full directions were  given  re-
specting the mother's and nurse's milk, and their substitutes when the
natural sources failed ; and in  the present  section our remarks will
principally apply to those  cases in which infants become gradually
atrophied from actual  inability to  digest  and assimilate the most
suitable food that can  be provided  for them,  whether this  be  that
furnished by their own mothers, by nurses, or, in  default of  both of
these, such artificiallj  prepared  food  as has previously been recom-
 mended.
   The nature of the difficulty will be best understood by reference
 to some extreme  cases, such as have already been referred  to.   In-
 fants  are  sometimes born into  the world in a remarkably wrinkled,
 w ithered and  shriveled condition, in whom the process of atrophic 
               ATROPHY OF INFANTS—MARASMUS.             757

 degeneration, even before their  birth, seems already to have  >ecome
 far advanced.   Such babes  never increase in weight, but rather con-
 stantly decrease till they die—in the course of from two or three days
 to as many months.   Some—it might perhaps be safely said, all—these
 eases  are the  victims  of  a  profound  scrofulous, syphilitic or other
 malignant dyscrasia, which so materially affects the organism that the
 function of the assimilation of food is. never developed into activity.
 These helpless  beings  pine  in  wretchedness as long as their meagre
 bodies can supply the substance for their own support, and then they
 perish, as many others do even before birth, from congenital lesion of
 nutrition.
   In other cases the atrophy, infantile marasmus or wasting away
 appears after the child  has  begun to thrive.  In these the symptoms
 are various;  sometimes the food  is rejected as soon as swallowed, or
 presently after; sometimes it passes from the bowels in an undigested
 condition;  and sometimes  there is diarrhoea  with  whitish-colored
 stools, indicating deficient action of the  liver.   But  in all  cases of
 infantile atrophy the child is  restless, peevish,  fretful, crying, as if
 continually  distressed,  and always growing   thinner and  thinner,
 whatever the other symptoms may be.
   In some instances the  mischief may be occasioned by the severe
 derangement of the digestive apparatus incidental to dentition.  Here
 the loss of sleep and the exhaustion of the nervous forces inseparable
' from difficult and  painful dentition cannot but weaken the stomach.
 Thus, the food is in part rejected;  in part it becomes sour and  cur-
 dled, and thus by its very presence and influence adds to the original
 gastric irritation ; and finally, in an imperfectly prepared condition it
 is transferred to the intestines, only to extend  the same distressing
 irritability throughout their entire tract.  The indigestion, thus com-
 menced in the stomach and continued through the intestines, becomes
 in the next stage of physiological  disorder a non-assimilation, and
 confirmed atrophy is the  necessary  consequence.   In other cases the
 seat of the difficulty may be an original disorder in some portion of
 the digestive apparatus, such, for example, as enlargement and indu-
 ration of the mesenteric  glands.   This is the most common form of
 atrophy in  scrofulous children.   And even  where this constitutional
 miasm is not present in sufficient force to develop such disease of its
 own accord, the irritation occasioned by diarrhoea from indigestion, or
 by worms, or  by the destructive  effects of calomel, may combine tc
 give rise to such tuberculous affection of these glands as shall become
 an actual phthisis inte$linafis, or fatal consumption of the bowels. 
758            DISEASES  OF INFANTS AND  CHILDREN.
  The following  are  given by  Leadam  as  the  principal symptoms
which precede or accompany atrophy:  "Frequent belly-ache,  with
irregular  bowels, the  motions being too frequent and  variegated or
clay-colored and watery; acid odor,  not only of  the evacuations, but
also of the breath and perspiration;  fickle appetite and much thirst •
the urine  often  turbid and white;  the child is fretful or quite sullen
and  indifferent, less playful  than usual, and cries peevishly.  The
countenance  changes color frequently, and the tongue is creamy or
morbidly  clean and  red.  There is swelling and hardness of the belly,
with emaciation;  sometimes  irregular small tumors  are to  be felt
through the parietes of the abdomen;  the skin becomes shriveled, the
complexion earthy, the appetite voracious; diarrhoea supervenes, if it
has not  existed throughout;  there  is  slow,  continued  or remittent
fever, augmenting toward evening, with flushing of the cheeks, a hot,
dry skin and incessant cough, extreme restlessness, increasing debilitv,
and  finally hectic.  In  this form of scrofulosis  the bowels and the
secretions poured into them require to be regulated, not by purgatives,
however,  but by remedies which are  consonant with the general  state
of the patient."
  The irritation occasioned by dentition is peculiarly apt to develop
the morbid enlargement of the glands just  described, in which the
little sufferer emaciates just in proportion as its abdomen grows larger
and its appetite more  voracious.  This affection, usually termed  tabes
mesenterica, is  indeed hardly  ever  fully  developed in the first few
months of infant life; still,  the foundation is  early laid  for it in the
profound  debility  resulting from insufficient food, and still more  from
injudicious  nourishment, from the close, foul air so common in the
sleeping rooms in  cities, and even in  the country,  and from the depri-
vation of light.  " Children confined in badly-lighted and  ill-ven-
tilated apartments are uniformly unhealthy;  so those  brought up by
hand in a city seldom do well; in the country their chance of living
and  thriving is much greater, because the purity of the air rentiers
their digestive powers more vigorous." *
   Treatment.—In the treatment of cases of  atrophy or failure of
nutrition  the very first indication will  of course be to seek the special
cause  of  the difficulty; and  if there is anything about the  diet,
regimen and care of the child itself,  or anything  in its habitation and
surroundings, which seems capable of  exerting an injurious influence,
this must be amended first of all.   Thus removing, so far as possible.
all the external causes of the marasmus, we shall the  more reachh
                         * Warren, On Scrofula. 
ATROPHY OF INFANTS—MARASMUS.
759
succeed in promoting that recovery of the  little patient whicl  might
otherwise defy all our skill.  Where the cause of the malady appears
in the quality of the food—whether it be that of the mother,  of the
nurse, or some  artificial substitute  and preparation  of cow's milk—
such change should  be advised as will secure  the most healthy nour-
ishment possible in the  circumstances.  Sometimes the mother's milk
is unwholesome,  the milk  of a particular  cow  may disagree,  or the
milk served  by the milkmen in  the large towns may be, and indeed
often is, adulterated with  lime or  soda.   The  long-continued use of
any of these  unhealthy articles of food cannot fail to develop,  sooner
or later,  what may easily  become fatal disorder of the digestive appa-
ratus.  Nor  is  the artificial food at all  improved by mixing lime-
water  in the diet,  as is  sometimes done in hospitals for foundling
infants, for wherever this course is long  pursued the little ones will
all die.  In  fact,  observation shows  in  this case just what the ho-
moeopath would predict—that these calcareous additions to the food,
while they may indeed  render  the  stomachs of the  infants  more
tolerant of it, do but cause still severer disorders in the bowels—just
such disorders  as the  homoeopath is accustomed to cure with the
dynamized preparation of the same drug.
   Finally, therefore, as  a  most essential adjunct to the appropriate
remedy in these cases—always serious, often apparently hopeless—the
utmost care should be exercised to give the little patient  every pos-
sible advantage in the way of light, fresh air, suitable  food, and,
what is often entirely overlooked, sufficient quiet to  enable it to take
its natural and  necessary rest undisturbed.
   Acetic  acid. Intense thirst, passing of extra large quantities of urine, and
great debility, burning dry skin, are characteristic.  No appetite; dry,
peeling lips; much pain in  stomach, like an ulcer; diarrhoea; restless and
sleepless; much emaciation.  Batching without vomiting.   Vomiting.

  iEthusa cynapium.  The  child throws up its milk soon after nursing,
with great force, suddenly, then  falls asleep  as  if from exhaustion, to
pwaken for a fresh supply.   Milk seems  to  not agree with  the  child,
riiich is  shown by colic, diarrhcea or constipation; it does not thrive.
Aphthous condition of the mouth and throat.
  Aloes.  The child  passes substances  looking  like jelly-cakes,  some-
times small, at other times  large, but  they  adhere together like con-
gealed mucus; they may be green-colored or transparent.
  Alumina.  The child strains greatly to  evacuate even a soft  stool,
soreness of  the anus ; colic ; the child  wastes away. 
7CO           DISEASES OF  INFANTS AND CHILDREN.

  Antimonium cr. Violent and persistent vomiting, with white-coated
tongue and absence of thirst.
  Apis mel.  Violent shrieking or screaming spells at longer or shorter
intervals; no appetite; emaciation; white and wax-like skin;  scanty
urine; swelling of the feet and ankles, of transparent whiteness.
  Argentum  nit.  Diarrhoea  of green  foetid  mucus, passing off wilh
much flatulency.
  Arnica. The  infant  has had  a  severe shock from  a fall, and has
not  been well  since;  it  becomes feeble and emaciated;  does not
sleep well, is restless,  has no appetite, and  is in great distress after
eating.
  Arsenicum. The stools are  painful, offensive, and contain quantities'
of undigested food; there is much debility  and a pale, Avaxy look.
The child is restless,  especially after  midnight; it seems to be cold
and chilled.
  Baptisia.  The  infant has almost  constant diarrhoea;  chokes  on
attempting to swallow anything not very fluid ; it can swallow nothing
but fluids.
  Belladonna. Especially suitable  for precocious children having blue
eyes and fair hair.   The child does not sleep much, though appearing
to be drowsy; it lies half sleeping and half  waking; moaning; jerk-
ing of the muscles.
  Benzoic acid.  The urine has a  strong ammoniacal odor, and leaves
a dark stain  on the diaper;  the diarrhoeic stools have an odor similar
to that of the urine.
  Borax.  The child dreads a downward motion;  is easily startled by
the slightest noise ; aphthae; sleeps badly, and awakens with screams as
if in affright, and clings to something as if afraid  of falling.
  Bryonia. The food is vomited immediately after being taken; con-
stipation ; the lips are dry and  parched, and the whole mouth is dry;
the child wishes to be  kept at rest, and prefers the recumbent posture;
it becomes worse at every hot spell.
  Calcarea C. Clay-like evacuations;  dry and flabby  skin; enlarge-
ment and induration  of  the mesenteric glands.   Large, open  fon-
tanelles ;  much  perspiration about the  head in  large drops, which
wets the pillow far around when  the  child is  sleeping.  Cough, with
rattling of mucus in the bronchia.  Leucophlegmatic temperament.
   Chamomilla.  The child must be carried all the time, for it is quiet
only then.   Diarrhcea, green and watery and slimy, or like chopped
eggs and spinach.  Odor like decayed eggs.   One cheek red, the other
pale. 
ATROPHY OF INFANTS—MARASMUS.
761
  China, Offensive, painless, undigested stools, with flatulency; abdo-
men distended with flatulency;  the child cries when it is touched.
  Cina. The child picks its nose very much; is very restless,  cries
and is  very unamiable; it  is hungry and wants food all the time; it
wants to be  in  constant motion—to  be  rocked all the time  when
sleeping, and  will not sleep without it.  Nothing pleases the child foi
a moment.
  Conium.  Hardness and distension of the abdomen, with frequent sour
evacuations; is worse during the night and better by day.
  Creosote.  Fcetid evacuations and excoriation of the mucous surfaces
generally ;  restless and sleepless at night; the skin is wrinkled.
■  Ferrum. Frequent  vomiting of  food ; stools undigested; redness of
the face; the child is very pale and delicate in appearance.
  Graphites. The child  has moist blotches  on its skin that exude a
transparent glutinous fluid;  chafing back  of the ears; diarrhcea or
constipation.
  Hepar. The child  has a  sour smell, and  white, foetid evacuations;
undigested  stools; seems to be better after  feeding; does not incline
to play or to amuse itself in any way; does not  laugh.
  Iodine. A brown color of the face, and copious and papescent stools;
seems to be better after  eating.
  Ipecacuanha. Nausea is the  most  predominant symptom, with fre-
quent vomiting; fermented stools.
  Lycopodium.  Much commotion,  rolling  and .rumbling  in  the
abdomen.  The  child  is worse  after four p.  M., and gets better
at eight or nine in  the evening.   Bed stain  or red  sand on the
diaper.
  Magnesia C. Green, watery, very sour-smelling diarrhoea, and  great
emaciation; stools of green slime, like the scum from a frog-pond.
  Mercurius.  Much  straining  at  stool, which is slimy, often bloody.
The  child is  never so well during damp weather.  Enlarged glands;
night-sweats.
  Nux V. Constipation of large, difficult stools; no appetite; does not
sleep after three  or four in  the morning.
  Oleander. The food passes off  unchanged in  a remarkable degree,
and very easily and  almost unconsciously.
  Petroleum.  Emaciation, with diarrhoea by day, and none  at night.
  Phosphorus. Copious stools, pouring away like water from a hydrant,
followed by exhaustion.
  Phosph. acid. Stools yellowish  and very offensive, and the child is
very listless—wants  nothing and cares for nothing. 
762          DISEASES OF INFANTS AND CHILDREN.
   Podophyllum p.  Emaciation;  many stools daily, all  of which are
natural.   Diarrhoea in the morning:.
   Pulsatilla. The diarrhoea  is worse  at  night;  no two stools alike
they are so changeable.  For a time the  child seems  much better
then it gets worse again without any appreciable cause.  The appear-
ance of the child changes in  this manner several times during the
same day, but it is usually  worse toward evening, and  always seems
better  in the open air.
   Rhus t.   The child  always gets particularly  worse after twelve
o'clock at  night; it has then more colic,  more diarrhoea, more rest-
lessness.
   Stannum.  The child is always relieved  in its abdominal  sufferings
by pressing hard upon the abdomen, leaning upon something.
   Sulphur.  The child frequently awakens from sleep with screaming;
great  voracity;  wishes  to  put into  its  mouth everything it  sees;
watches eagerly for everything—cups, tumblers, vessels of food;  it
wants  to swallow everything it sees.   Its passages  excoriate the anus.
The child jumps and starts and screams fearfully.

                           Indigestion.
  Sour Stomach—Vomiting—Colic.—The  infant, equally  with
the adult, is subject to attacks  of indigestion, and  the disorder in the
one case bears a certain general similarity to that in  the other, even
as the  same  general cause is common to both.  Stated  in the simplest
terms,  this cause consists in a want of harmony between the food and
the digestive force.  In an infant whose stomach is perfectly healthy
this faut de rapport may follow the introduction into it of food either
too abundant in quantity or unsuitable in  quality; or, on the other
hand, the  disorder may arise,  in spite of the utmost hygienic  care,
from some innate pathogenetic influence which finds an  easy form of
development through the high  physiological excitement of the diges-
tive apparatus.   Should neither of these two conditions—of digestion
primarily deranged  or of original dyscrasia  finding vent through a
digestive apparatus healthy indeed, but highly excited—be present in
force, the  indigestion will prove symptomatic of some other malady.
The vomiting which precedes an attack of scarlatina affords an excel-
lent illustration of this.
   When the stomach is simply overloaded, or rather  overfilled,  it
relieves itself of the excess by  vomiting, and this act takes place with
little  effort  and  no suffering, the process of digestion of the still
remaining  food  going on undisturbed.   But if, on the contrary, the 
indigestion.                        763
indigestion arises  from the unsuitable quality of the food, wdiether
this be due to the unhealthy character  of the  milk of the  mother or
nurse, or to the imperfection of its  substitutes, the mischief is not so
soon arrested.  In this case the food passes from the stomach into the
intestines in an imperfectly prepared condition, and occasions there a
still greater  irritation; an intestinal indigestion always succeeds to
that of the stomach.   In some rare cases,  but especially in the first
three months, this may give rise to constipation, but diarrhoeas of dif-
ferent kinds and  of greater or less severity more  commonly follow.
Where the indigestion is not due  to  excess  in nursing, and where
nothing  indicates an  original disorder  of the stomach itself, it  is
necessary to  understand that there  is something in the milk  of the
mother or  nurse, or  in the substituted food, which disagrees with the
child.  And besides this, it is often observed that change in the accus-
tomed diet on the part of the mother, violent mental excitement or dis-
tressing moral emotions, the return  of the menses or other temporary
causes, very greatly disturbs the character  of  the milk and results in
the sudden  and  severe indigestion of  the babe.  For such cases,
arising from influences usually unforeseen and  not always obvious, the
physician should be on his guard ;  nor, whatever conclusions he may
arrive at as the result of inquiries  more or less  direct, will it always be
proper or safe to avow them.   The  knowledge that the child wras suf-
fering from a severe fit of anger  or other passion of the mother will
enable the physician to give directly to the  babe—and perhaps, on
some pretence of soothing her nervousness, to the mother  also—such
remedies as will do good. But the simple consciousness on  the part of
the mother that the doctor knows the exact cause of the illness of her
babe will sometimes complicate the excitement, and render the case of
both patients still more difficult to treat in the  most successful manner.
The physician must always hear and see  and act with the greatest cir-
cumspection, but  sometimes the less he  says  the greater will be the
satisfaction of the parties more immediately concerned, and the more
gratifying  his own  professional  success.   When  the babe  is thus
suffering from  unusual  external  influences  conveyed  through the
medium of the milk from  the mother's disturbed nervous  system,
every effort should of course be made to  remove the  cause as rapidly
as possible, and at the same time alleviate  the morbid  symptoms
induced in the babe itself.   While  in any  state of undue  excitement
the mother should refrain from nursing her babe.  Prominent causes
of infantile colic  are  found in improper attention to cleanliness and
exposure of the  infant to cold.   It cannot be  urged with too great 
764           DISEASES OF INFANTS AND CHILDREN.
force upon mothers  that  if  they wish to have their babes in cr0od
health they must be kept most scrupulously clean ; they should be en-
joined to frequently look to the child's diaper, and to change it at
once when soiled.   A babe should never be laid down to sleep with a
soiled  diaper upon  it, and mothers should have  the importance of
keeping  their  babies warm  properly  impressed  upon their minds.
There is no point in the hygiene  of infancy more  important or more
neglected than this.   And a proper attention to cleanliness and warmth
will reduce*the frequency of occurrence of infantile colic very greatly.
  When indigestion, colic, constipation or diarrhoea arises from im-
proper food in babies raised  by hand—that is, from food which evi-
dently does  not  agree with the  child's  stomach—or  even  from
unwholesome maternal milk, the physician will frequently have to
encounter many difficulties before he can select a suitable article of
food that will agree  with the  delicate digestive apparatus of the babe.
He should endeavor to make a good  choice of food; and if, having
done so, he find his choice to have been a mistake, he should try again,
not despairingly, but remembering always that what is one  baby's food
may be another baby's poison.

  Treatment.—Aconite. The infant has a dry,  hot  skin, is sleepless,
restless, cries much, bites  its  fists, and suffers from green  and watery
diarrhoea.  A dose or two of Aconite cures all these difficulties in a
few days.
  JEthusa. See the indications for this remedy under Atrophy.
  Acetic acid. See  page 759.
  Arsenicum.  The food passes  undigested, the stools are offensive;
much crying during and after nursing, or as soon as the child begins
to take food.  Emaciation; restlessness.
  Baryta C. Useful in colic of dwarfish children, those who do  not
grow.
  Belladonna.  The child cries out suddenly, and after a while it ceases
crying as suddenly as it  began, and appears as if nothing had been
the matter.   Starting, with jerking of muscles; the child whines and
cries a great deal.
  Borax  V. The child cannot  bear a downward  motion, not even
during sleep.  It  caunot, be  put down  out of the nurse's arms; it
awakens and cries on the attempt being made.  It has much colic  and
indigestion.
  Bryonia. The child must evidently be kept very still in order to relieve 
INDIGESTION.
765
its colic aud )ther sufferings.  The stools  are dark, dry and hard, as
if burnt.
  Calcarea C. In children of leucophlegmatic temperament, with ^irge
fontanelles.  Profuse perspiration of the head; white chalk-like stools.
Long and continued crying.   Inguinal hernia  seems to be the cause,
which Calc. c. will remove.
  Chamomilla.  Very irritable and fretful—must be carried.  Distress
after nursing.  Sleepless; starting and jerking while asleep.  Stools
smell like rotten eggs, and are green, chopped, or consist of white and
yellow mucus.
  China.  Colic comes on at a certain hour every afternoon.
  Cina. The child is always  cross and troublesome when awake.   It
will not sleep unless it is kept in constant  motion.   It is seldom still
and quiet, whether sleeping or awake.
  Coffea.  Great restlessness and wakefulness, with nervous excitability;
much crying;  hot skin.
  Colocynth. The child  writhes  in every  possible direction, doubles
itself up, and seems in great  distress; it cries very hard.
  Dulcamara.  When the child gets worse at every cool change of the
weather.
  Hepar.  Colic, with dry,  rough, pimply  eruptions,  that itch very
much.
  Ignatia. When the trouble  seems to arise on account of grief of the
mother or nurse.
  Ipecacuanha. There is  much sickness of the stomach; the more con-
stant the nausea the more certainly will Ipecac, be indicated.  Fer-
mented stools.
  Iris versicolor.  Protracted  nausea  and  frequent vomiting of sour
water, the vomiting being accompanied  with pain;  belching up of
wind from  the stomach  with considerable  force, or profuse  emission
of flatulence;  colic and diarrhoea, with bilious stools and sick  stomach.
  Jalapa.  When the child is  "good" all day, but screams and is rest-
less all night.
  Lycopodium. The  child always  cries and screams  before passing
ivater, and is relieved immediately afterward.  Bed sand is  found in
the diapers.   Much rumbling and rattling  in the abdomen.
  Magnesia c.  Very much colic,  which is finally relieved  by a green
liquid stool.  This occurs  very many times day and night.
  Mercurius. Much  colic, which  is relieved by a slimy, bloody stool,
with straining;.
  Nux V.  Much  colic, with  constipation.   The  child cries much, 
766           DISEASES OF INFANTS  AND CHILDREN.
draws its  feet up, and then  kicks  them out  again, etc.  Its  mother
lives on highly-seasoned and  stimulating food.
   Opium. The wdiole trouble  seems to have arisen from fright of the
nurse.
   Podophyllum p.  An attack of  colic at daylight  every  morning.
Severe colic, causing an absolute retraction of the abdominal muscles.
   Pulsatilla. The child always gets worse toward evening, and remains
so till toward morning.
   Rheum.  Much colic, with very sour stools.
   Senna. The  child  cries terribly, and seems  full  of incarcerated
flatus;  it even turns blue all  over during its cries.  Sometimes it has
frequent and bloody stools.
   Silicia. Colic, with difficult stools; they slip  back  into the rectum
when nearly evacuated.
   Stannum. The child's colic is  relieved by pressing firmly upon its
abdomen.   When it is crying with colic, relief is at once obtained by
carrying it with its abdomen resting upon the point of the  nurse's
shoulder.
   Staphysagria, The child seems to be suffering  from  a fit of chagrin
or indisposition  of the nurse.   Indicated  in the sufferings of  pot-
bellied children, with much colic and  humid scald-head.
   Sulphur.  The child has a  tendency to excoriations  wherever  the
skin is folded upon itself.  Pimply eruptions filled with pus.  Red-
ness about  the anus after an evacuation.   This remedy very often
cures the colic and  derangement of the stomach of infants.
   Veratrum. Terrible colic, with coldness of the forehead.  Very  cold
feet with the colic.  The sufferings cause a cold sweat to stand upon
the surface, particularly upon the forehead.

                           Dentition.
   The development of the teeth in their regular order, although a
perfectly natural process, is  often attended  with  much  suffering.
When dentition is slow, retarded and  difficult it not only becomes of
itself a  serious disorder, but  it involves also a long train of morbid
symptoms  and actual  diseases, which may  exhaust  the  patient's
strength and  finally destroy its life.  The primary difficulty in such
cases is in the nutrition ; and as we often see in older children a remark-
able backwardness in the development of the osseous system in general,
so we often find in earlier periods of infantile life a corresponding slow-
ness m the  development of the teeth.   And  both these forms of imper-
fect development, c  ccurring, as they often do, successively in ^he came 
DENTITION.                        767
children, are to be attributed to some profound constitutional dyscrasia
which affects the nutrition.
  Even when the teeth are grown and cut through in the easiest and
most natural manner, there  is usually some constitutional excitement,
which may variously manifest itself in the forms of fretfulness, worry-
ing, restlessness, inflammation of the gums, heat about the head, and
more or less general fever.  Where dentition is difficult and retarded
there  is  prolongation  of all  the  constitutional  disturbance,  great
aggravation of the symptoms already mentioned, and the addition to
them of others still more severe, such as vomiting and diarrhoea.   The
still  increasing  debility of the system,  resulting from  the nervous
exhaustion  inseparable from  so much suffering  and  from such  de-
rangement of the digestive function, cannot but augment the original
constitutional  lesion of nutrition.   And unless the mischief is arrested
by suitable medication the patient may sink from inanition, from
colliquative diarrhcea, from  hydrocephaloid,  or  from  convulsions.
And perhaps  in no  other morbid  condition  of the  human system is
the homoeopathic practice more  evidently superior than in this, where
the medicines may relieve much of  the nervous suffering, and prevent
the injurious effects  ordinarily resulting from disorders of the diges-
tive apparatus, at the  same time that they promote the  growth and
development  of  the teeth by  remedying the primary and constitu-
tional lesions  of  nutrition.
  In order that the physician  may judge of  the  degree  of deviation
from the normal standard of dentition in any given  instance, we pro-
ceed to state here the mode and order of the  appearance of the teeth
in health.  It should first be observed, however, that there are anom-
alous cases  of dentition, but, as was previously observed with  regard
to the non-appearance  of the menses in  young women at  the  usual
time, delay in the appearance of the teeth should  not be  regarded as
requiring active interference unless  other morbid symptoms are also
present.   The non-appearance of the teeth at  the usual time, unless
accompanied  by symptoms indicative of constitutional  disturbance,
really furnishes less occasion for apprehension than their premature
appearance would.   Even  in  the condition  of apparently perfect
health, some  infants begin to cut their teeth very early, even  by the
third month,  while  in  others this process commences at  a very much
later period.
  In the early months the infant's mouth  is  naturally dry; this dry-
ness  is relieved  by  frequent nursing.  But usually  about the  fourth
or fifth month a very considerable change takes place in this respect, 
768           DISEASES OF INFANTS AND CHILDREN.

the mouth is now found  constantly full of saliva, and the child is
constantly driveling—or drooling, as it is vulgarly termed—"but no
other indication appears of the approach of the teeth to the surface
except that the edge of the gums becomes broader than it was before
No further change may take place for many  weeks, and it is generally
near the end of the seventh month, oftener later than  earlier, before the
first teeth make their appearance.  The  middle incisors  of the lower
jaw are generally the first to pierce the gum; next in order appear
the middle incisors of the upper jaw; then the lateral incisors of the
lower.  The  first molars next  succeed, and often without any very
definite order as to whether  those of the upper or of the  lower jaw
are first visible,  though in the majority of cases the lower  molars are
the first to appear.   The  four  canine  teeth succeed, and  lastly the
four  posterior molars—making in all the number of twenty deciduous
teeth."  There are, however, intervals of rest  between the successive ir-
ruptions of teeth; thus, a period of six or eight  weeks generally inter-
venes between the lower and  the  upper central  incisors; the lower
lateral incisors  come very soon  after.  But a pause  of three or four
months may occur before the first molar teeth make their appearance;
another of equal length may occur previous to the appearance of the
canine teeth; and still another before the first dentition is  completed
by the irruption of the  last molars.
  In  some few cases the teeth  come  through so readily as  scarcely to
disturb the  infant;  but more  frequently indeed the mouth becomes
hot and the  gums  look  tumid, tense  and  shining,  wdiile the  exact
position of each tooth is marked some  time  before its appearance by
the prominence  of the gum ; or the irruption of the teeth is preceded
or accompanied  by a somewhat different condition  of the mouth, in
which there is much heat and  intense redness of the mucous mem-
brane, an  extremely copious flow of saliva,  and a disposition to the
formation of small aphthous ulcerations on the tongue, at the  outer
surface  of the alveolae  or  at the duplicature of the  lips, though the
gums themselves may not be particularly swollen and painful.  Either
of these states is usually attended with  some  degree of febrile dis-
turbance,  and apparently with  considerable suffering to the infant,
who  is constantly fretful and peevish, or cries  out occasionally as if
in pain.   A third morbid  condition of the mouth is sometimes  seen,
which is  usually ushered in or  attended by very considerable  fever
and  disorder  of the chylopoetic viscera.   The  gums  then become
extremely hot and swollen, and unusually tender, especially over some
tooth or other in particular; and in that situation  we find the gum 
DENTITION.
769
swollen up into a kind of little tumor.  Small, unhealthy ulcerations,
with a sloughy appearance, often form upon  the  summit of the gum,
and especially around any tooth which  has partially pierced through
it.  To this affection, which is often very painful and difficult of cure,
the name of odontitis infantum has been applied.— West.
  As if  from a common  centre,  almost  all  the various disorders
peculiar to infancy and early childhood may be  seen to spring from
difficult dentition.   Especially is this true of those lesions of nutrition
already described under the head of Indigestion, Vomiting, Diarrhcea,
and of some of the diseases presently to be mentioned, such as Aphthse,
Convulsions and Hydrocephalus.   Thus, sooner  or  later, all cases of
protracted dentition  requiring  medical  assistance will be found com-
plicated with some one or more of these forms of disease.  In treating
such cases, therefore, regard must be had to these consequences of the
original disorder as of the one grand cause of all.  All these troubles
are developed  in a successive  series, and  at whatever  point of  the
series we  are called in, then we must begin  and  try back, as  it wrere,
and by thus carefully attending to all the successive development!?, of
vomiting, diarrhcea, aphthse, etc., seek  to find the one remedy which
shall  remove the whole train of symptoms by reaching its original
and  primary cause  in constitutional  lesion  of nutrition, and  its
secondary cause  in the protracted and difficult dentition.  And with
these views it will be seen to be requisite to consult and compare the
remedies  advised under Diarrhoea, where that condition obtains, and
those mentioned under Vomiting, Aphthae, etc., where these conditions
appear, as well as those more especially recommended at the close of
this article.
  A single word with reference to lancing the gums.  This operation
is in almost all  cases  unnecessarily performed, and in many it proves
positively injurious.   And yet it sometimes  affords the  most import-
ant and immediate relief.  Where the gums  are  red and inflamed, in
our opinion they never need to  be lanced, but only when in their very
slow growth they have changed to  a  dense,  firm and unyielding car-
tilaginous formation, thick and of a whitish  color, through which the
teeth  vainly attempt to make their  way, and  the irritation of  the
child's system threatens to destroy its  life  by sheer exhaustion  or by
inducing  fatal convulsions.
  Before  proceeding to indicate the remedies to  be employed in dis-
orders of dentition, we remark that the tooth does  not  mechanically
cut its way out of the gum, but its growth causes slight pressure  by
the  crown of the tooth—a pressure which excites the absorbents to
      49 
770          DISEASES OF INFANTS AND CHILDREN.

remove the impediment.  In this manner the absorbents do absolutely.
when the infant is in a perfectly healthy  condition, open up the way
for the tooth to escape without pain  or  suffering.   Now, the duty of
the physician is so to direct the course of events that the evolution of
the teeth shall become as painless as any other process of develop-
ment.   All the laws  of health should be rigidly enforced and every
prescription most carefully made, and finally,  when  the period of
dentition fairly commences, if suffering is experienced  or difficulty
arises, the following remedies should  be  carefully and  particularly
studied  and  administered,  or .others  whose  strong  characteristics
present the picture of the opposite of an orderly and painless process
of dentition.

   The subjoined indications for the use of remedies for the disorders
of dentition are taken from my paper on that subject, read before the
Philadelphia County Homoeopathic Medical Society, and printed in
the Hahnemannian Monthly:

   Aconite.  Constant restlessness, as from distress which no change of
posture or circumstance seems to relieve.   The child gnaws at its
fingers or  fists or something else; cries, whines or frets much of the
time.   Its sleep is very much broken, and there are  usually much  heat
about the head, and a dry skin, sometimes with cold hands and  feet.
Soon after, or whilst awaking from sleep, its cries of discomfort recom-
mence.   Accompanying this state of things, sometimes there is  con-
stipation, when the stools are hard and difficult to evacuate; more
commonly there is diarrhoea, when  the stools  are  watery and dark-
colored or bloody and slimy.  The child  is usually very thirsty, and
seems to be relieved very much by holding on to the  cup containing
cold water with its mouth, apparently for the purpose of cooling its
gums.
   Antimonium crud. When the stomach so  sympathizes as to present
prominent symptoms.  Tongue white; much vomiting; no thirst. Stools
composed of hard lumps and watery secretions, passing together.
   Apis  mel. Child screams out suddenly  and  sharply during sleep,
more  usually occurring  at  night.  If now the child can talk, and is
asked what is the matter or what hurts  it, the reply generally is,
"Nothing."  The urine is mostly scanty, but sometimes very profuse.
Sometimes there is prolonged constipation, more frequently diarrhoea.
Red spots scattered here and there over the skin, often  causing itching
and restlessness;  worse at night.   The gum covering  the developing 
DENTITION.
771
teeth sometimes has the appearance of a watery infusion or of a sac
containing water.   Painless diarrhcea, often bloody.
  Arsenicum alb. The  child has undigested, fcetid  stools, and is ema-
ciated; dry and shriveled skin; particularly restless after twelve  at
night.  It has paroxysms of anguish day and night, cl.iring which it
often  strikes its face  or head with its  little  hand, as though  that
afforded relief.  It often vomits all fluids soon after swallowing them,
particularly water.  It will only take a sip or two of water at a time,
but very often.  The  gum over the advancing tooth sometimes ap-
pears to be blistered,  or  to be filled-with a dark,  watery fluid.   The
whole scalp is occasionally covered with  a dry, scaly, milk-crust, and
the stools are of  very light color.   Sometimes  the  child has a very
pale and waxy look, and is very weak.  If constipation exists, it does
not positively contraindicate Arsenicum.   Apparent distress.
  Belladonna. The child  moans a great deal, as though the moaning
caused partial relief of suffering.   Violent starting or jumpiug of
parts or of the whole  body whilst sleeping or waking.   If the start-
ings occur during its  waking hours it  seems frightened at  them, or it
awakens from its sleep frightened with one of these starts.  Convul-
sions, followed by  a very sound sleep.  Face and eyes red, often with
dilated pupils and heat  of head.   Awakens from sleep  with fright
and staring eyes.   The skin is often very hot, so as to leave a sensa-
tion of burning to the palm of the  hand when removed from its sur-
face.  Aggravation every afternoon.   Very hot fever at night, often
lasting all night, with delirium.  The stools  are  often composed of
thin, green mucus  of sour odor, and the child is often seen  to shudder
during stool.  Sometimes the same  kind  of stool is involuntary.   The
gums are sometimes marked by numerous turgid arteries.
  Borax. The child is evidently afraid of a downward motion, even
during sleep.   If the nurse attempts  to lower it  from her arms in a
sleeping state it is  sure to cry out and to throw up  its hands as from
fear.  It is very sensitive to  the least noise, such  as the rumpling of
paper, of a silk dress,  or the click of a door-latch,  etc.  Whilst sleep-
ing it will sometimes  start, cry out and hold on to things—its nurse,
for instance,  or the sides of the cradle or crib—as though it were afraid
of falling.   Stools watery, yellow,  green  or brown.  Aphthous condi-
tion of the gums, and so sensitive  as  to shrink fron» the least touch,
even of the nipple when hungry, in many cases.
  Bryonia alb. Dry, parched lips;  dry mouth and  constipation, the
stools being  dark and  dry, as if burnt.  The  child  wishes to be kept
very quiet, and seems  to dread to  be  moved.  If it be raised to the 
'''2           DISEASES  OF INFANTS AND  CHILDREN.

perpendicular it often vomits, seems faint, and wishes  to  lie  back
again.   Vomits its nourishment soon after  taking it, unchanged.  It
seems eager for cold water, which seems to  be  preferred to its usual
aliment.   The swollen gums are hot and  dry, though pale or light
red.   Often diarrhoea, painful, bloody and offensive.
  Calcarea carb. The child has  large,  open fontanelles.  The  head
perspires  during sleep,  so  as to wet its pillow far around. Stools
large, hard  and of a chalky  appearance, or thin and whitish.   The
gums are often  pale and shiny when the tooth is a long time in com-
ing through.  The child's feet are often cold and damp.   The abdo-
men is in some cases  large, and cold tumors are found about the neck.
Loose, rattling cough; soft and flabby muscles.  Hydrocephalus some-
times threatens.   Stools often offensive.
  Calcarea phos. Peevish  and fretful children.   Often screaming and
grasping with the hands.  Fontanelles still open, or  had closed and
reopened; most in  the vertex.   Cold sweat on  the face; body cold.
They cannot hold the  head up; move it from  place  to  place;  head
totters.   Squinting, as it w7ere  from pressure; eyeballs seem  dis-
tended ; they protrude somewhat.  Coryza, running  in a cool  room,
stopped in warm air and out of doors.   Ears cold;  point of the nose
cold.  Swollen  under lip;  face  pale, sallow,  yellowish; gets  hot,
with other complaints.   During dentition, diarrhoea with much wind.
Greenish, thin stools.  Children refuse the  mother's breast;  the milk
has a saltish taste.  Children lose  flesh; will  not  stand any more;
do not learn to walk.  Backward in teething, also in closing of fon-
tanelles.   Skull soft,  thin;  crackling noise, like paper; crepitation
when pressed, most on the occiput.—Hering.
  Causticum. Children with delicate skin, when,  during the evolution
of a group of teeth, intertrigo makes its appearance, with occasional
convulsions.  Prolonged  constipation;  stools  tough, covered with
mucus, and  shine  like  grease.  The child has a yellowish, sickly-
looking face; ravenous hunger, and  takes its food in a hurried  man-
ner ;  frequent gulping up of the watery portion of its nourishment;
"pot belly."  The swollen gum sometimes suppurates.
  Cicuta virosa. " Grinding  of the  teeth (when any are  through the
gums), with pressing of the jaws  together, like lockjaw.  Convul-
sions, with limbs relaxed and hanging dowm, or unnaturally stiffened
and extended."— Williamson.
  Cina. The child rubs  its  nose  much, and  is unusually hungry.
Very restless in its sleep; must be kept in  motion  nearly all the time
by  rocking  or otherwise.  Hacking  cough,  followed  immediately by 
DENTITION.
773
an effort to swallow  something.  Diarrhoea; stools  occurring  imme-
diately after drinking.   Child wants many things, which are rejected
immediately or very  soon  after being offered them.   Even its most
choice  playthings or  articles  of food  are  repelled with violence.   It
does not like to be looked at, spoken to, or  even touched; in  fact, it
is  a very peevish child.  Its urine, when it can be  preserved in a
vessel or when seen  in  a puddle  on the floor, soon  turns white like
milk.   Restless at night;  frequent crying out  as from colicky pains,
and calling for water.
   Chamomilla. The  child  starts  and jumps  during  sleep.   When
awake  it must be  carried all the time, in order to soothe its sufferings.
Sometimes it will sleep  only  whilst being carried  in the  arms.   One
red cheek, the otlier pale.  Diarrhcea,  watery and  slimy, or  like
chopped eggs and spinach.   Stools the  odor of decayed  eggs.   Dry,
hacking cough.  Very thirsty ; likes to hold its mouth in cold water
a long  time wdien drinking.  The appetite not so  good as usual, and
there is frequent vomiting of thin, sour milk.   Gums'red  and tender;
much sleeplessness.   Wants to  be carried into the open air.
   Coffea cruda.  The child is very excitable and sleepless; it seems as
if  it could not sleep.  It frets and wrorries in an innocent manner; is
not cross, but sleepless.  It laughs one moment and  cries  the next; is
feverish for want  of sleep, which  it cannot obtain.
   Colocynthis.   When the  bowels  sympathize particularly;  much
colic, forcing one to  double  up, with writhing and  twisting.  Stools
watery, frothy  or bloody, with  pain, which  seems  to  contract  or
double up.  Sometimes the  pain is relieved  by pressing hard upon
the abdomen.   No'sy emission of flatus.
   Creosote.  In this we have  an invaluable  remedy  in difficult denti-
tion.  Very painful dentition.  The sufferings are usually aggravated
at  six p. m., and continue till near six A. m.   During all this time, by
rubbing,  and  patting,  and tossing, and worrying with  the child, a
very few short naps are obtained.  It is a little more  comfortable
during the day, but  the same  scene is enacted the  following  night.
The protruding gum seems infiltrated  with  a  dark, watery fluid.
Such teeth as  are through the gums are dark and show specks of
decay down to the gums.  Constipation is more frequent; stools hard
and dry.   When  there is diarrhoea the stools are dark-brown, watery,
and very offensive; odor rather cadaverous.  The stools seem to be
exhausting;  they  excoriate, and sometimes contain portions of undi-
gested food.   In such cases we  need  not despair of  so changing the
morbid condition of the system  as that  ether teeth  shall not turn 
  7~4           DISEASES  OF INFANTS AND  CHILDREN.

  black and decay;'and  even the affected teeth  will improve in their
  appearance.
    Cuprum acet. or met.  "Dryness of the mouth, with, colicky pains in
  the bowels.  Green,  bloody,  painful  stools,  and  efforts  to vomit.
  Convulsions,  beginning with  cramps in  the lower extremities, and
  drawing in of the fingers and  toes,  with much throwing about of the
  limbs, frothing at the mouth, and choking in the throat."—William-
  son.  Spasms preceded by  violent vomiting  of mucus.   After one
  spasm the child  screams, turns and twists till  another spasm occurs.
  All trouble seems inclined  to  be translated to the  brain, threatenim*
  that organ with paralysis or dropsy.
    Dulcamara.  The aggravations of dentition are all increased by every
  damp, cold change of  weather.   Not so  much that the child takes
  cold then, but that the  morbid condition of the child is such as to be
  so influenced  by that atmospherical change, upon the same principle
  as that the pains of Rhododendron  are all aggravated  by a storm of
  wind, although the patient be warm  and in bed.  If the child be
•  inclined to salivation, diarrhcea, eruptions upon the  skin.
    Ferrum. When a persistent diarrhoea is the result of morbid den-
  tition.  Stools composed  of mucus and  undigested food; sometimes
  excoriating and  exhausting, though painless.   The  face is often
  flushed, or has a red spot on  each side.  Often vomits its nourishment
  soon after taking it.   Dentition advances slowly.
    Graphites.  When the scalp, face, behind the ears  or  other portions
  of the surface  become  the seat of  an eruption  which  oozes  a clear,
  glutinous, watery fluid.  Sometimes the whole scalp, face, behind the
  ears or such other parts as may be  affected become  one complete raw
  surface, constantly pouring out this  peculiar fluid.  At the evolution
  of .each group of teeth  this  condition becomes aggravated.  Often a
  severe constipation of  large, difficult stools attends the above condi-
  tion.   Sometimes the affected parts  itch severely.
    Helleborus niger.   When  brain  symptoms   are  being  developed.
  Dilated pupils, drowsiness,  particularly  when  the stools  are white
  and  jelly-like.
    Hepar is the remedy when a dry  herpetic eruption is developed on
  some parts of the skin.   It often appears in the bend of the forearm,
  upon the  arm, in the popliteal spaces, upon the face or  scalp.   The
  itching is very troublesome.  A whitish, sour-smelling  diarrhcea often
  attends.   Aggravations occur  at  the approach of every fresh group
  of teeth.   The gums are sometimes ulcerated, very tender  and appa-
  rently T^ery painful.  Traumatic cerebritis. 
DENTITION.                        7 lb
  Hyoscyamus.  "Pressing of  the gums together,  with putting the
hands to the jaws, putting the fingers into the mouth, and other indi-
cations of pain in the jaws.   Difficulty in swallowing.  Convulsions,
beginning with twitching of the muscles of the face, especially about
the eyes.  Dilatation of the pupils.  Dark-colored, bloated appear-
ance of the  countenance, and deep sleep after the spasms go off."—
 Williamson.
  Ignatia amara. The child awakens from sleep with piercing cries, and
trembles all  over.  Convulsive jerks of single parts.  Frequent flushes
of heat, with perspiration. Spasms return at the same hour daily, with
trembling all over. Spasms, with cries or involuntary laughter.  Stools
usually of mucus or of bloody mucus, often attended with undue exer-
tion and prolapsus of rectum.   Sometimes  there is tenesmus and pro-
lapse of rectum without stool.  The child  has much sighing, sobbing
and crying;  sighing  aud sobbing continue  long after the crying.
   Ipecacuanha. Continual nausea, with occasional vomiting.  Diarrhcea.
Stools fermented and of many colors, or green as grass.  Face pale,
with blueness about the eyes.  More frequently useful if, to the above,
a variety of  catarrhal symptoms are added  by cold.
   Lachesis.  The  child  awakens in an unhappy  mood, and often in a
distressed condition.   At times convulsions will occur so sure as the
child goes to sleep.  If we  watch such children attentively, we will*
perceive the breathing to cease just prior  to  the convulsion, or just
before it awakens in  distress without  the convulsion. The protruding
gum is sometimes found to be dark purple.
   Lycopodium. The  child sleeps with its eyes partly open, throwing
its head from side to side, with moaning.  It cries and screams just
previous to  passing water.   Red  sand or a reddish stain is perceived
on its diaper after passing water.   Much rumbling, rattling and com-
motion  in  the abdomen.   If it passes flatus  it  is very  offensive.
Aggravations occur at four p. m., and relief at eight or nine.   Often
very restless all night,  like a Rhus restlessness.   It takes  but a small
portion of food at a time, and does not care much for that
   Magnesia carb.  The teeth do not come through.  A green  and sour-
Bmelling diarrhcea has continued a long time.  Emaciation.  Some-
times the stool has the  appearance of scum  on a frog-pond.  Frequent
vomiting of sour substances.   Sometimes there is loss of appetite and
sour breath, with constipation, and  frequent urging  to  evacuate a
natural-lot king stool.
  Magnesia mur. Slow  dentition, with distension of the abdomen and
constipation.   The region of the liver is enlarged and hard, and the 
776          DISEASES OF  INFANTS AND CHILDREN.

nurse or mother says " the child is liver-grown."   The stool is offer.
large and hard, and crumbles as it leaves the verge of the anus.  Some-
times the stool is green and pap-like.
  Mercurius sol. Copious salivation, and  sometimes little  blisters are
seen on the tongue, gums and  cheeks.   Quite large ulcers sometimes
are seen on  the protruding gum.   With  the above conditions the
nights are usually very troublesome.  Now  it occasionally happens
that the child takes cold and  the salivation becomes arrested;  then
convulsions occur.  The diaper  is often stained  with a  yellowish,
strong-smelling urine.  Abdomen  often hard and distended.  Stools
usually slimy, bloody, green  and accompanied  with  tenesmus.  A
single dose of Merc, is often sufficient to cure such cases.
  Nux  vomica. For teething  children being raised by artificial  or
mixed  feeding, or whose mothers  or nurses  indulge  constantly in
highly-seasoned food,  wines, etc.  Aggravations occur at  about four
in the morning.  Appetite becomes impaired, thirst increases and the
child becomes peevish and fretful.  Constipation, with large, difficult
stools, occurs, or  the  stools become small,  frequent, lumpy or fluid.
Bloody saliva often stains their pillows when sleeping.  The  mouth
sometimes becomes sore and the breath very offensive.
  Nux moschata.  Particularly when the stools are  very thin and yel-
low, soaking into the diaper as it were.  They are  very exhausting,
and the child is very sleepy.
  Podophyllum. Grinding of such  teeth as are already cut, with cry-
ing and worrying, often with painful diarrhoea.  Rolling of the head
from side to side, with  green stools.  Whitish, chalk-like  stools, very
offensive,  with frequent gagging  and  thirst.  Morning diarrhoea.
Frothy, undigested stools.   Prolapse of the rectum with every stool.
Sometimes the stools  are very  frequent all  day, all  of which are
natural.  Very worrying  and sleepless all  the  early part  of the
night, apparently from  nervous irritability.   Voracious appetite, with
other bad symptoms.   Diarrhcea immediately after eating or drinking.
Food sours soon after eating, when it is rejected.   " Gagging, and the
discharge of  foetid, carrion-like smelling stools.  The motion of gag-
ging is  made with the mouth, and not accompanied with the effort in
the stomach seen  in retching."— Williamson.
  Psorinum. These cases, at first view, resemble Sulphur.   On exam-
ining more carefully, if we find a dark fluid  stool having the smell
of decayed eggs, and eructations, or the child's breath having a similar
odor, we may feel very sure that Psorinum is the remedy.
  Rheum. Is particularly  indicated when a very sour-smelling dm1*- 
DENTITION.
777
 rhoea is developed, with much pain in the abdomen during stool.  The
 diarrhoea is aggravated by moving about.
   Sepia. Dry ring-worms make their appearance, or seem to brighten
 up at the evolution of every fresh group of teeth.  Bad smell from
 the mouth.  Aggravation of diarrhoea after taking boiled milk.  The
 diarrhcea appears to be very exhaustive.
   Silicia. In scrofulous children having worms, with profuse saliva-
 tion.   Frequent pulling at the  gums.  Fever toward evening and all
 night, with heat in the head.  Difficult stools.  The mother or nurse
 declares, from  observation, that the stool frequently recedes  before the
 child can  effect  its passage.  The feet smell badly, notwithstanding
 every effort to prevent it.   Profuse sour-smelling  perspiration upon
 the head in the evening.  The fontanelles are  large, and the head is
 larger in proportion than the rest of the body.  The protruding gum
 seems  blistered,  and  is  very sensitive.  Stools, when very loose, are
 usually very dark, and sometimes very offensive.
   Stannum. In some cases where it seems as if Cina should cure and
 it does not.  Particularly if the child is  more  comfortable by lying
 with its abdomen across some  hard  substance—the shoulder or knee,
 for instance.   Epileptiform convulsions, with clenching of its thumbs.
 If hernia  should protrude, with Stann. symptoms, this circumstance
 would strengthen its indication.
   Staphysagria.  The child is very sensitive to the least impression,
 whether mental or physical.  It winces and shrinks from  every wry
 look or harsh word, and cries from the least pain.  The gums have a
 pale white appearance, and are  very  tender to the touch.  Pot-bellied
 children.  Frequent desire for stool,  not relieved even by a free evacu-
 ation.   Such teeth as are cut  have a dark look or dark streaks run
 through  them.   Moist  scald  head, with  yellow  scabs,   and very
 offensive.  Colic, with diarrhcea, the last part mucus.
   Stramonium.  When the child's brain seems so affected as to  cause it to
 cease making its wants known except by motions.  Violent grinding
 of such teeth as are cut.   It seems to shrink from the sight of objects
 when first presented as if afraid.   The approach  of a bright light
 causes  spasms.   Blackish, thin stools, having a cadaverous  odor.   A
 very dry  mouth or  profuse  salivation.  " Grinding  of  the teeth.
 Moving of the fingers in sleep, as if searching for something.  Dis-
 position to stammer and  try to talk.  Often there is a  desire for
 more light, and at other times light brings on an aggravation, and
even  convulsions.  Convulsions, with cries as if from being fright-
ened  by the sight of hideous objects.   Much throwing about of the 
778
DISEASES OF INFANTS AND CHILDREN.
limbs, especially of the arms and hands, with motions of the nno-ers.
The motions are most violent in the upper portions of the body."—
 Williamson.   Desire for its mother  constantly.
   Sulphur.  White,  sour diarrhoea, with  redness  about the  anus.
Green or bloody stools, with crying and worrying, and rawness about
the anus.  Frequent vomiting  of nourishment.  Papulous eruptions
on the skin, wTith much itching.   The child does not like to be washed
any  more.   Very tender and red about the anus after every stool.  It
takes no more  long and refreshing sleeps.   Frequent waking; wide
awake.  Jumps in  its  sleep.  Seems to have  frequent weak and faint
spells.   Aggravations  come twice per day.
   Sulphuric acid. The  mouth and gums  are in an aphthous condition,
and seem very painful.  The  child is very irritable, restless, and cries
much of the time.   The stools are peculiar, the appearance being like
chopped mucus  of a saffron color.   Even if there is not aphthse, the
stools are sufficiently characteristic,  and may be regarded as the key-
note when  present.
   Veratrum a. Vomiting, with  severe retching, and. severe retching
without vomiting.   Cold sweat on the forehead.  Vomiting renewed
by the least motion.   Diarrhcea.  Each stool followed by great pros-
tration.  Cold, damp  feeling of the extremities in spite of all cover-
ing and wrapping.  Very  weak, faint  pulse.  The above condition
simulates cholera infantum, but difficult dentition may be the cause.

                        APHTHAE—THRUSH.
  .•As described  by Leadam,  the thrush often  attacks the infant in
the second  week, and is characterized by the mouth and tongue being
covered  with  minute  whitish blisters,  which are  rubbed off by the
action  of sucking; a  succession of these vesicles is constantly taking
place so long as the  disease lasts, which  is sometimes five  or six
weeks.   It is often preceded by a granular appearance of the  tip of
the tongue a  few days after birth, which is caused by enlargement
of the papillae.   The thrush often runs in families, and is a disease of
debility ; but it  is generally caused  by irritating secretions in the ali-
mentary canal, from bad digestion or improper food, or by the acidity
of the food in the stomach, as well as of that remaining in  the infants
mouth.  This affection generally traverses  the whole length  of the
digestive tract, and  develops a redness  and  excoriation at the anus
corresponding to that  originally appearing in the mouth. •
   Thrush may constitute a temporary and  comparatively  trivial dis-
order,  apparently unconnected  with any  constitute nal disturbance. 
APHTHiE—THRUSH.                    779
But more often it appears as one of the first of a long train of symp-
toms indicative of severe gastro-intestinal disorder.   And  finally, in
the last stage of such disorder, toward the close of life, the tongue,
the inner surface of the cheeks, and  even the margin of the lips and
corners of the mouth, may be covered by a whitish, paste-like forma-
tion, which being forcibly  removed  discloses a surface red or raw.
Thrush  is most  commonly  met with  amongst  the children  of the
poor.  It consists essentially in the growth of a fungus (oidium albicans)
upon the buccal mucous membrane,  and seldom  involves the tissues
lying beneath.   In public institutions for  children, such as children's
hospitals, it is very common, and  generally appears under  such cir-
cumstances in grave and even malignant form.  Microscopical research
has demonstrated its fungous origin.
  In all except the very mildest forms  of thrush the  disorder ren-
ders nursing a painful operation to the child; but as it usually appears
in connection with, or in consequence of, serious derangements of the
stomach  and bowels, such  as vomiting and  diarrhcea, the  proper
remedy will be found among those indicated for such conditions.  It
should always be borne in  mind,  however, that if the  child  is kept
constantly clean, and if it is not dressed too warmly, it will  seldom
or never be troubled with  the  thrush.   But where the thrush ap-
pears by itself, and is unattended as  yet by other morbid symptoms,
it may be removed, and the still deeper  mischief to which it would
lead anticipated  by the exhibition  of  Calcarea, Chamomilla, Borax,
Bryonia, Mercurius, Sulphuric acid, Arsenicum or Muriatic acid, accord-
ing to the character of the accompanying condition and to the partic-
ular appearance of the infant's mouth.   We give indications for a few
remedies:

  iEthusa.  The  aphthous condition causes  great  distress.  Profuse
salivation or dryness of the  mouth.  Vomiting of milk or  of a sub-
stance resembling milk.  Diarrhcea or constipation; sometimes undi-
gested stools.  Much crying, as if  from colic.
  Arsenicum. When the aphthse assume a livid or bluish appearance,
attended with great weakness and diarrhoea.
  Baptisia. Profuse  salivation.   Offensive stools.   The  child can
swallow nothing but  fluids; even a small lump  of thickened  milk
will occasion gagging.
  Borax V. The  child frequently lets go the nipple, showing signs of
pain in the mouth from nursing.  Downward motion causes fright.
  Bryonia. The  mouth is unusuaily  dry, with thirst; dry lips, rough 
780           DISEASES OF INFANTS  AND  CHILDREN.
and cracking; the child does not like to take hold of the breast, but
when once, its mouth is moistened, and it is  fairly at work, it nurses
well.
  Carbo veg.  The mouth is  very hot, the tongue almost immovable,
and a sanguineous saliva escapes occasionally.
  Chamomilla. When the child exhibits much uneasiness, and must be
carried all the time.
  Mercurius sol.  Much salivation, or  more than usual moisture in the
mouth.   There  is inflammation in the whole  buccal cavity.  Ulcers
upon the gums.
  Staphysagria.  When  the aphthous patches seem to bleed easily and
the gums  are spongy.
  Sulphur. The  child does not take its usually long sleep; it awakens
often.   The general appearance of the child indicates Sulphur.
  Sulphuric acid. The mouth appears very painful, and the child  is
very weak.   Ecchymosed spots  form on the skin.
  Pure molasses, applied by means of a piece of muslin or linen, or
by the finger, constitutes the best (healing) wash where  one seems to
be  needed.   Consult the  indications furnished under  the  head of
Disordered Dentition and Indigestion.

                          Constipation.
  Even very young infants are  sometimes affected with constipation;
in fact, during the first two months of infantile  life constipation  is
frequent, while  diarrhcea is  comparatively rare.  This may be occa-
sioned by some  hereditary predisposition, and be maintained by the
constantly imparted influence of a costive habit on the part of the
nursing mother.
  In most cases of infantile  constipation the difficulty consists,  so far
as the child is  concerned, in an inactive state of the bowel.  Some
mothers are in the habit of relieving this by the stimulating irritation
of a roll of paper or other small object anointed with lard and intro-
duced within the rectum.   The employment of purgatives of any
kind, as  indeed in all other  forms of constipation, is  worse than
useless.   In some cases the constipation may  be due to functional
derangement of the liver, as in  children affected with jaundice, where
the stools may be hard, dry and clay-colored, showing a deficiency in
the secretion of the bile, i
   There are also cases  of complete  inaction of the bowel and  reten-
tion of the fseces from  birth, which are due to imperfect development
or  actual malformation of the intestine.   In these  cases the rectum 
CONSTIPATION.
781
may be perfect, but with its canal closed by a false membrane, which
obstructs it either at its orifice or higher  up in the intestine, or the
canal of the rectum may be obliterated for a greater or less extent by
the adhesion of its  opposite sides.  These cases may be relieved by a
verv simple incision where the hard and protruding accumulation of
f»ces furnishes a sure guide to the operator.*  But there are othei
and more complicated  varieties  of malformation, such as those in
which the natural aperture of the bowel is absent, and the intestine
terminates  by opening into the urethra, bladder or  vagina, or those
in which the intestinal canal is  not only malformed, but altogether
absent for an extent more or less considerable.  All such cases require
in their treatment no small amount of surgical skill, and the particu-
lar directions for the operations they involve will be found in the best
works on practical surgery, or better  still in West's recent and elabo-
rate Treatise  on Diseases of Children.
   In the medical treatment of  the  constipation of  infants recourse
must always be had to the cause.   If  this is found  in the  nursing
mother,  the  proper remedies  should first be  administered to  her.
Should  there be anything in  her diet—such as the  use  of  coffee—
which may be capable  of  rendering either  herself or  her babe consti-
pated, this also should be  attended to.  With scarcely a single excep-
tion cases  of costiveness in nursing infants will be  found dependent
upon the influence  of diet, hereditary  and constitutional weakness
and inaction  of the bowel, or actual derangement of the liver.  The
remedy should, however, be selected  in accordance with all the symp-
toms, a  single  dose administered, and  allowed entirely  to  exhaust
itself before either repeating it or making a new prescription.

   Aconite.  Much heat about the  child's  head ; it is feverish, sleepless,
restless,  gnaws its fist, and its stools are hard and difficult.
   ^Ithusa. Constipation, with vomiting of the milk and other symp-
toms of  this  remedy.   Milk seems to disagree with the child.
   Alumina. There seems to be a want  of action in  the rectum ; the
child has to make a very great effort, even for a soft stool.
   Apis m.  The child is restless, screams out in its sleep, and has bright
 red pimples on its skin.   Urine  very scanty.
   Bryonia. The stools are very dry, as if burnt, and  of a dark color;
 dry lips and mouth.  Alternation of  constipation with diarrhoea.
   Calcarea c.  Hard, undigested stools of a light color.  Chalky.
  *See cases of this kind reported in the American Journal of Honweopathy for 1854,
p. 16, vol. viii. 
782
DISEASES OF INFANTS  AND CHILDREN.
  Graphites.  The stools are of an uncommon size, very large, and the
child has more or less humid eruption over its body, behind its ears
on its face, on the chin, in its groins.   This eruption exudes a watery
transparent, gelatinous fluid.
  Lycopodium. Red, sandy urine, the sand is seen in the diaper; much
flatulence; difficult stools, which it is almost impossible to evacuate.
  Mercurius.  When the general symptoms  of  mercury are present-
salivation, sore throat, glandular swellings, frequent efforts to evacuate-
all these symptoms become more prominent every time the child takes
cold.  Urine offensive and stains yellow.
  Nitric acid. This remedy cures many cases wdiere the pain of evacu-
ating is great during and after  the passage, as though the little sufferer
had  fissures of the anus.  It fears to have a passage.
  Nux V. Stools  large and difficult, or small,  frequent and painful,
with much colic.  When the  nurse takes much coffee or  highly-
seasoned food.  The child is quite sleepless and restless.
  Opium. The stools occur in hard, round black balls.
  Platina. The stools adhere to the rectum and anus like soft clay, so
that it  is difficult to discharge them.
  Plumbum.  The  stools are composed of  conglomerate balls,  like
sheep's manure.
  Sepia. The stools are very difficult to discharge; they seem .to  re-
main in the lower part of the rectum, and to require the assistance of
the nurse in  order to facilitate  their discharge.
  Silicia.  The stools are with difficulty forced to the verge of  the
anus, when they slip back again.
  Sulphur. The child has intertrigo, pimply eruptions,  swelling of
its skin, soreness  of the anus, so that it screams with every attempt to
evacuate the  bowel; it seems to have piles.
  Veratrum.  There seems to  be  a  paralyzed  condition of the  rec-
tum, requiring much straining, when a cold  sweat appears on  the
forehead, and the child  seems exhausted after stool.
  Collinsonia,  Hydrastis  and Phytolacca should likewise be
consulted, especially for habitual constipation.  See also the treatment
of Constipation of Pregnancy.

                            Diarrhcea.
  Infantile diarrhcea constitutes one of  the most frequent and serious
of all  the  diseases that occur in infancy and  childhood.  Of itself
alone,  diarrhcea  does not often prove directly fatal, but its long  con-
tinuance seriously weakens the patient and endangers the health; and 
DIARRHCEA.
78^
it constitutes, moreover, a very grave complication of other forms of
disease.
  Diarrhoea may appear  without fever or other  constitutional dis-
order ; this is usually termed' by medical writers  simple or catarrhal
diarrhaa.   Or it may be accompanied by more or less fever, and is
then properly termed  inflammatory diarrhoea;  this  may  become an
actual dysentery  or inflammation  of the bowels.   In its mildest forms
infantile  diarrhoea  corresponds  exactly  to  the  easy and  painless
vomiting already described as the means by which the  overloaded
stomach relieves itself.   This may be either a lienteria, in which the
food passes undigested, or a diarrhoea crapulosa, in which the excess
of food mixed with faeces  is passed in large  and  frequent quantities.
Or again, as is still oftener the case, the diarrhoea  may be of a purely
mucous character, a condition which results  from disordered (excess-
ive) action of the gastro-intestinal muciparous glands and  follicles.
In this latter form the mucus designed to facilitate the digestive  pro-
cess is secreted in such abundant  quantity and in such altered quality
that it exerts an  influence entirely different; for this primary derange-
ment of  the muciparous  glands  by sympathy affects all  the neigh-
boring organs  of  the gastro-intestinal  tract,  whose secretions  are
intended to promote the accomplishment of the function of digestion.
In some instances this mucous diarrhoea seems to become a real blen-
norrhoea, or catarrh of the  bowel.   This form  may arise from  cold
and dampness, from careless  exposure and  from want of sufficient
covering over the abdomen.
  The  causes of the principal forms of  diarrhoea may be arranged
under three general heads :  I. Those which are  connected with the
organism  itself;  II.  Those  which depend  upon the quantity and
quality of  the food;  III.  Those  connected with  atmospheric in-
fluences and changes in the weather.
  I. The diarrhoeas which spring from  interior  causes are such as
those .just described as catarrhal, arising from excessive action of the
muciparous glands.   To this form of diarrhoea many children are so
remarkably predisposed that the slightest change  of weather or per-
sonal exposure renders them subject to it.  The extraordinary activity
of the whole digestive apparatus in young babes renders the access of
diarrhoea of some kind the almost inevitable result of the irritability
induced by the process of dentition.  And in addition to these it should
be borne in mind that the  changes taking place  in all parts  of the
alimentary canal and of its dependencies, in  order to fit them for the
proper  reception of the varied food upon which the  infant will soon 
784           DISEASES OF  INFANTS,AND CHILDREN.
have to  subsist, cannot but render these organs still more susceptible
to this form of disorder.   The change which takes place in the mouth
during the  period of lactation is exactly equaled by a corresponding
change in all  the organs  of digestion* and  assimilation.  Hence it
happens that very few  children entirely escape the attack of diarrhcea
during their first dentition, while one-third suffer from it severely.
   II. The  manner  in  which food too abundant in quantity or un-
suitable  in  quality  occasions  diarrhcea has  already been explained
under the head of Indigestion.   In many of its forms, at least, diar-
rhoea itself  is little other than a symptom or consequence of intestinal
indigestion; and of course those external accidents  of food too pro-
fuse in quantity or disagreeable in quality but serve to aggravate the
pre-existing disposition to diarrhcea arising from the before-mentioned
internal or constitutional conditions.
   We have already  referred to the subject in the opening remarks on
the Lesions of Infantile  Nutrition  and in other parts of this work.
But the frightful mortality of infants and  children arising from bowel
complaints excuses us for quoting the following weighty paragraph from
Meigs's and Pepper's Treatise on Diseases of Children: "The system
of indiscriminate diet allowed to  children in this country is, it seems
to us, a fruitful  cause  of gastric and intestinal  complaints.   We
believe  that, as a  general rule, children over two and three years of
age  are allowed amongst us to eat of the food prepared for the  older
members of the family.   Now,  any one  who will reflect  upon the
variety of  dishes  habitually  placed  upon  an  American  table, ought
not to be surprised to see children permitted a choice amidst such
profusion, pale, thin, delicate, exposed to frequent indigestions, attacks
of  diarrhoea and enterb-colitis,  to  gastric  fevers and the  host  of
minor ills  attendant upon feeble digestive powers.....It has
been stated  that simple diarrhoea  sometimes  follows as a consequence
of indigestion.  We have known such a result to  occur in children
previously in fine health, and to continue for several weeks or months.
In these instances the disorder appears to  depend in good measure on
the loss of the digestive  power of the stomach.  This seems proved
by the great influence which the  character of the food has upon the
malady, which is always  aggravated by the use of any articles except
those universally acknowledged to be the  most digestible, and  also by
the frequent coexistence of lientery when the food is not of the lightest
kind."
   III. As to the third  class of diarrhoea, that dependent upon climatic
or atmospheric conditions, it will be sufficient to recall the immense 
DIARRHCEA.
785
 proportion of cases of this disorder which occur in particular seasons
 in order to realize how largely even  young infants are subject to such
 influences.   Thus, on a comparison of the  results of eight  years' ob-
 servation at the Children's Infirmary in London, Dr. West found that
 in the six winter months, from November to April inclusive, diarrhoea
 formed seventeen and three-tenths per cent, of all the cases  of disease,
 while in the six summer  months, from May to October  inclusive,
 diarrhoea  formed thirty-eight and three-tenths per cent, of the cases
 of disease.*  Exposure to  the night air will often occasion an attack
 of diarrhoea in young infants.   And  dysentery, or actual inflammation
 of the bowels, so  notably depends upon certain conditions  of the
 weather—either  magnetic or  atmospheric—that when  they recur,
 especially  in  the autumn, this disorder prevails as  an epidemic
 throughout the whole district.
  Symptoms.—The different appearances of the  stools in diarrhoea
 deserve careful attention, since in many instances they greatly aid in
 the selection of the appropriate  remedy.  Thus, at the onset of the
 disorder  the  discharges are at  first purely faecal; presently they may
 assume a bright-yellow color, like that of the yolk of an egg; often
 they are intermixed with  slime; and in other cases  they  present a
 frothy  appearance.  Under exposure to the air  the bright-yellow
 color of the evacuations often, though by no means always, changes
 to green.   In other  cases the  green and yellow colors appear inter-
 mingled  in the  evacuations, while the presence of the small white
 specks, the caseine of the undigested milk, shows that the function of
 the stomach is disturbed  by the same  cause that  produces  the  over-
 action of the bowels.  From the  admixture of the white and yellow
 in these cases the stools have the appearance of chopped-up eggs.   As
 the disorder advances the stools become more frequent, and they are
 attended with much  more distress, each motion  being evidently pre-
 ceded or accompanied by griping or other  pains.   The symptoms of
 simple diarrhoea are, however, very variable in their character, as well
 as in their intensity.  Sometimes there is much  suffering;  sometimes
 very  little,  even  in severe  cases.   In many instances  the child does
 not seem, for a while at least, to  be  much weakened by the disorder;
 in others  it very rapidly runs down.   But these latter are rather cases
of the severe or inflammatory form of diarrhoea, into which the simpler
variety is very often apt to run  if continued more than a few days.
  In the inflammatory diarrhoea,  so  called, we find all the symptoms
of true inflammation of the bowels, and sometimes also of the stomach,
            * West, On Diseases of Children, Phila., 1866, p. 508.
      50 
786           DISEASES OF INFANTS AND CHILDREN.
in different degrees of  violence;  there are fever, thirst,  tenesmus
colic;  abdominal  tenderness and heat;  frequent,  painful, slimv
bloody, or  even offensive discharges;  great and rapidly  increasing
exhaustion; and evident tendency to hydrocephaloid, coma or con-
vulsions.   Either the severity of the pain and  fever, the putridity of
the stools  or  the occurrence of tympanitis will indicate very great
danger.  When  the  attack  comes on  suddenly it often commences
with vomiting, and sometimes the  irritability of the stomach becomes
and continues so extreme that the least drop  of fluid is immediately
rejected, and frequent and distressing efforts to vomit occur when the
stomach is entirely empty.   Almost simultaneously with the vomiting
occurs the relaxation of the bowels, and the child may have twenty
or thirty, or even more evacuations in the  course of the twenty-four
hours.  These may be slimy and streaked with  blood, or greenish and
watery, or  serous, or they  may  consist of intestinal mucus inter-
mixed with faeces and more  or less streaked with blood.  Where the
stools are scanty there is usually much tenesmus, followed by the dis-
charge of a little mucus or a few drops of blood.  With all these
severe local symptoms  the  constitutional disorder is no less distress-
ing; the pulse is quick, the  skin hot and dry,  and the child is either
fretful and irritable when disturbed, or  lies sleeping, apparently, with
half-open eyes.   " The tongue at first  is moist, coated slightly with
mucous fur; its papilla? are often of a  bright red, as are also its tip
and edges, while if the disease continues the redness becomes more
general, and the tongue grows dry, though it is not often much coated.
The thirst  is generally intense, the  child craving for cold water, and
crying out for more the moment the cup is taken from its lips; and
the thirst is quite as urgent even in those cases where  the stomach is
so irritable that  it immediately rejects whatever  is swallowed."—West.

   Aconite.  The  skin is hot  and dry; restlessness and much excita-
bility ; stools watery and often of  a dark color.   After the fever has
subsided, we have but to  wait and the  diarrhoea  will also disappear
without the use  of  another remedy.
   .^Ethusa.  See the indications for  JEthusa  under Dentition and In-
digestion.
   Antimonium c.  White-coated tongue, some  nausea  and watery
evacuations; sometimes hard lumps of faeces with the water.   Absence
of thirst.
   Argentum nit. Much loud flatus passing with the stool.  Stools like
spinach, in  flakes.
   Arsenicum.  Much exhaustion and  rapid  emaciation ;  stools undi- 
DIARRHCEA.
787
  gested ; offensive and painful stools immediately after taking nourish-
  ment.   Stool and vomiting at the same time.
   Belladonna. The  child  is very  drowsy,  half sleeping  and  half
  waking; much moaning.   Stools involuntary.
   Bryonia. Diarrhoea from hot  weather, or it is aggravated by the
  return of every hot spell  of weather.  Stools bloody.
   Calcarea c.  In children who have large heads and open fontanelles.
  The head perspires much, so as to wet the pillow far around.   Mus-
  cles soft and flabby.   The  child awakens at three A. m.
   Carbo veg.  If Bryonia does not cure wdien indicated.
   Chamomilla. Stools  watery  or greenish,  or  like  eggs  beaten  up.
  The child must be carried; it is very feverish and  cross.  The stool
  has the odor of rotten eggs.   Very thirsty.
   China. Painless and undigested, putrid stool; very copious stool,
  worse every other day.
   Colocynth.  The passages  are small and frequent, with  very much
 pain, causing the child to writhe  and twist as if in great distress, and
 to draw itself double.
   Croton t. Colic and diarrhoea immediately after nursing.  The stool
 escapes suddenly, as if with an expulsive spasm.
   Dulcamara. Every cool change of the weather excites the diarrhoea;
 it is excited also by exposure in cold, damp places.
   Perrum.  Undigested stools,  with  easy vomiting of ingesta, often
 with a very red face.
   Graphites. Very frequent and small  stools,  with  eruptions  on the
 skin, from  which oozes a gelatinous fluid.  The stool  is often sour, and
 excoriates the external anus.
   Hepar. Fcetid stools, the child itself smelling sour.
   Ipecacuanha. Much nausea or  vomiting;  almost constant  nausea.
 Fermented stools, particularly indicated at the period of weaning,
 when food disagrees.
   Iris. Brown and very offensive diarrhoea, with cutting colicky pains,
 nausea and vomiting; emission of very foetid flatus.
  Lachesis.  Excessively offensive stools; the child always awakens in
 distress.  Some portions of  black blood are seen.
  Magnesia c.  Stools resembling  the scum  of  a frog-pond.  Stools
 green and slimy, or watery and sour.
  Mercurius sol. Much  pain  before the stool;  great relief immediately
after.   Stools frothy, slimy, bloody or dark green, with much strain-
 ing.  The child's thighs and legs are cold and clammy, particularly
at night.  Sometimes excoriations about anus. 
788           DISEASES OF INFANTS  AND CHILDREN.
   Nux V.  Alternate constipation and diarrhcea.   Indigestible food has
been the cause of the diarrhoea'; the passages are small and frequent
and painful; much fretfulness.   Worse at four a m.
   Opium.  Diarrhcea from fright.
   Phosphoric acid. The diarrhoea does  not seem to debilitate much
although of long continuance, and the mother wonders that the child
remains so strong  with it all.
   Podophyllum p.  Morning diarrhoea, green  or watery, or the stools
may be quite natural, only too frequent.   Prolapsus ani and diarrhoea.
   Pulsatilla. The  stools are very  changeable, no two alike; much
worse at night.
   Rheum.  Very sour-smelling stools, attended with much pain. Very
sour smell of the child, which cannot be removed by any amount of
washing and care in keeping it clean.
   Rhus t.  AVorse particularly after twelve at night; very restless aftei
that hour.
   Sepia. There is an almost constant oozing from the bowels.
   Sulphur. Particularly in children of delicate parents.  Much red-
ness  around the anus, or excoriation between the  thighs and  upon
the parts  adjacent.   Eruption of  pimples upon the  skin, or if the
child, after getting  better under other remedies, always gets worse
again.
   Veratrum a. Much exhaustion  after every passage, with cold sweat
upon the forehead and upon the skin in general.*

                      Dysentery—Colitis.
   Inflammation of the large intestines seldom occurs except in con-
nection more or less obvious with that of the small  intestines; and
the latter, especially in infants and little children, is usually connected
with a greater or less amount of gastro-enteric inflammation.  Thus,
dysentery,  or colitis,  as  it is  sometimes  termed, may come on as a
consequence of the extension of inflammation, wdiich, commencing in
the stomach, involves the  entire digestive tract in its  course.  There
are, however, many instances of pure idiopathic  dysentery which are
directly traceable to exposure of the child to the cool, damp air, espe-
cially at night, with its  abdomen  and  limbs insufficiently clothed.
According to  Dr. Condie, " Colitis would appear in  the majority of
cases to be the result of sudden transitions of  atmospherical  tempera-
ture, particularly the sudden change from warm and dry to  cold and
damp weather.  It is  most prevalent during the latter part of sum-
mer  or the commencement of autumn, when the days are hot, bul
              *For additional remedies, see Appendix, Note 3. 
DYSENTERY—COLITIS.
789
the nights chilly and damp.  It is apt to prove endemic in unhealthy
localities, especially those  favorable to the production of intermittent
and remittent fevers, and often  prevails epidemically with fevers of a
catarrhal character.  A few days  of cool, rainy weather occurring in
the  summer will  often cause  the  prevailing  bowel  complaints of
children to assume a dysenteric  character."
  Except when the result of such  endemic or epidemic influences,
aggravated perhaps by personal  exposure,  dysentery  is seldom met
with in children  before dentition has commenced.  In  these latter
eases it evidently  arises in consequence  or in continuation of  the
gastro-enteric inflammation which so frequently attends difficult den-
tition.
  Symptoms.—Dysentery sometimes commences as diarrhoea.  It is
usually attended with  considerable  fever, with evening  aggravation
and thirst; there may be vomiting, especially  of the copious drinks
or other ingesta, but usually the development of colitis tends to relieve
in some degree the previously existing gastric  irritation.  The abdo-
men is tense and tender to the touch, especially along  the  course of
the  descending colon.   But the most  characteristic  symptoms of this
disorder are the painful discharges per anum, which are very frequent,
but very small in quantity, and  either composed  of  bloody mucus,
pure blood or mucus alone, and the tenesmus which precedes, attends
or follows the discharges, or which  may very frequently compel an
abortive and exceedingly distressing effort at stool.  In some cases the
irritation is kept up by the  presence in  the bowel of retained fseces,
the  usual peristaltic action of the intestine having been suspended by
the  influence of sudden change in the temperature.  Such cases  are
marked by incessant  calls to  stool  and almost constant  tenesmus,
which  are  either  totally  ineffectual, or  result  in the  evacuation of
minute portions  of fiscal matter, with much slime tinged with blood.
But the symptoms of dysentery are so evident that there is no necessity
for enumerating them more at length.
  The anatomical  lesions  are very  grave, especially in severe cases.
They  are generally confined to  the large  intestine.  "The  mucous
membrane is  commonly found  thickened, swelled, red  and  softened ;
the  submucous tissue  sometimes presents  ecchymosed points;  the
follicles are often diseased, their orifices being enlarged and  ulcerated.
In grave cases, especially those occurring under an epidemic influence,
there are usually more  or less extensive ulcerations, which may impli-
cate only the  mucous,  or  extend  to the muscular or even peritoneal.
coat.  In such  instances  pseudo-membranous  exudations  are  often 
790          DISEASES OF INFANTS AND CHILDREN.

formed, sometimes in large quantity, and often covering the ulcera-
tions.  The  intestine contains  sanguinolent  mucus, or  at  times ;,
brownbh or greenish  material, which  is evidently the  result of a
gangrenous condition of the mucous membrane, pus, and lastly false
membrane.   In some rare cases perforation has been known to take
place."—Meigs and Pepper.
   Treatment—Select that one of the following  named remedies, or anv
other, which most exactly corresponds to the condition of  the patient,
and be particularly careful of exposure to the night air, not  only during
the continuance of the disorder, but even after  convalescence has set
in, for the relapse which  would otherwise be sure to follow might
prove more intractable than the original disorder.

   Aconite.  Much  fever; dry heat; restless  distress;  an  irritable or
inflammatory state of the  system.   This remedy is often  the specific
for the entire case.
   Aloes.  Stools  in consistence like jelly-cakes; a  quantity of clear
jelly, wdiich  may be green or white.   Sometimes there is  very severe
pain, with straining and tenesmus.
   Alumina. Has to. strain  at stool in order to  pass water;  can pass
water only while so doing.
   Apis. Frequent  bloody stools, without pain.  Xo thirst; restlessness;
sleepless, especially during  the  latter part of  the night.  Screaming
spells.    Urine very scanty.
   Arnica. Frequent stools  of clear  mucus,  with tenesmus.   Bloody
stools, or dark and bloody mucus, with sore pain.
   Arsenicum. Signs of  great  exhaustion; after any  effort, such as
turning over, having its diaper changed, etc., the little sufferer almost
sinks from  exhaustion.  Stools  very frequent, of dark-green  mucus,
or very dark and  watery  stools, looking like watered bile.  Stools
very offensive,  sometimes  corrosive;  drinks   little  but often; great
restlessness, turning and tossing, with exhaustion.  Aggravation from
eating or drinking.  Great and rapid emaciation. Often vomits water
as soon as taken
   Baptisia.  Stools preceded by terrible colicky pains, when bloody
mucus passes off,  followed by great relief.  Sometimes the stools  are
dark-brown, and apparently faecal.
   Belladonna. Much  tenderness  about the abdomen, so that even a
little jar is  painful.  Flushed face, red  eyes;  much bearing-down
pain.  Moaning, jerking of the limbs while asleep or awake; bright. 
DYSENTERY—COLITIS.                   791
 bloody mucus, then green mucus, smelling sour; tenesmus during and
 after stool.  Child wishes to drink little and often.
  Bryonia. When caused by cold drinks or by very hot weather.  The
 stools are thin and bloody; the child wishes to lie down and be quiet;
 when  sitting up there is nausea and disposition to faint; thirst, with
 desire for large draughts at  a time.   Vomiting  of  food soon after
 taking it.   Parched lips and dry mouth.
  Cantharis. The discharges  are apparently the scrapings from  the
 mucous membrane, streaked  with blood;  the urine  is  burning and
 very scanty, often passed in drops, and with much pain.   Sometimes
 there is complete suppression  of urine, with great distress.
  Carbo veg.  In  very advanced cases; coldness of the  breath;  heat
 about the head;  desire to  be fanned ; putrid evacuations; great de-
 bility ; a venous condition is gaining the ascendency.
  Chamomilla.  One  cheek red, the other being  pale; very cross and
 fretful; thirsty; bloody and   mucous  stools.  The child wants to be
 carried all the time.   The  difficulty has  been  caused  by checked per-
 spiration.   Often  vomiting of bile in the morning.
  China. The child is worse every other day;  much flatulency and
 distension of the abdomen, particularly in the afternoon.  Stools dark-
'colored, and having a cadaverous odor  which  is  terribly offensive.
 Great exhaustion, especially after stool.
  Colchicum. Autumnal dysentery;  passages like transparent mucus,
 or like jelly, or of bloody mucus.   Sometimes the pain in the rectum
 and anus  after stool  is perfectly agonizing, and  lasts  a long while,
 causing screams and crying.
  Colocynth. The  crampy pains are  very severe, causing the child to
 double up with every stool.    There is  little or no  straining.   The
 stools consist of pure  mucus or of bloody mucus.
  Dulcamara.  If  the  dysentery is caused  by exposure  to cold and
 damp, or if it becomes worse  as the weather grows cooler.
  Ipecacuanha.  Much nausea  and  vomiting,  or constant  nausea.
 Dysentery from eating sour substances or unripe fruit or  vegetables.
 Loathing of all food; loaded  tongue.   Slimy,  bloody  and offensive
stools, worse in the evening. Tenesmus during or after stools, or both.
Autumnal dysentery.
  Lachesis. Dark-colored stools of a cadaverous odor.  Abdomen very
hot; tongue  red and  cracked  at the tip,  or brown and bloody.  The
child awakes apparently much worse and as if in great distress.
  Mercurius cor. Very much pure blood is passed with the stool, with
much tenesmus. 
792           DISEASES  OF INFANTS AND  CHILDREN.

  Mercurius sol.  Not so much blood, more  bloody mucu.<, with tenes-
mus before and after stool.   Much relief immediately after siool
Moist tongue  and great thirst.  Cold feeling in  the abdomen, some-
times extending down the thighs and legs.   Cool perspiration.  Some-
times the child will sit on the commode for  a long while after stool, aa
if it had not quite finished or did not wish  to leave.
  Nux V. A small portion of natural faeces  is passed with every evac-
uation of blood and mucus; no appetite;  sleepless  toward morning.
Stools frequent but small.  Ineffectual urging.
  Phosphorus. Green  and bloody passages, the anus remaining  con-
stantly  open.   If able  to talk, the child  will complain of a weak,
empty feeling across the abdomen.
  Podophyllum p. Evacuations  of bloody and green mucus, with  toss-
ing of the head  from side to side.   (Worse  in the forenoon.)
  Pulsatilla. Mucus streaked with blood; worse  in  the  evening and
through the night; no thirst.   Great changeableness of the stools, so
that no  two are quite alike.  . The child is restless, and wants to be in
the open air;  seems to be smothered in  the  house.
  Rhus  t. Is almost, if not  quite, a specific where the pain runs' in
streaks  down the limbs with every evacuation.   Useful in cases  with
typhoid type.   The child is generally worse after  midnight.
  Sulphur.  The passages make the perineum red all around the anus.
I n scrofulous patients, and in those with eruptions more or less numer-
ous upon the body.  Frequent relapses; the child seems to be doing
well, when, without any apparent cause, it gets worse.
  Veratrum a. Great prostration after  every evacuation,  with  cold
sweat upon the forehead.

                      Cholera  Infantum.
  Much of what has  already been said under the head of Diarrhoea
will  apply to Cholera Infantum.   This disease very often proves
fatal, even  under the best of treatment, since it  appears usually in
the latter part of the summer, when  the  young infant's system is
already  somewhat exhausted  by the previous heat,  when  the air is
impure  and the  weather sultry, or warm  and  damp, and  since it
seems to spring  up as an epidemic  from  some  atmospheric miasm
which is little less than  malignant.   In this worst form of infantile
diarrhoea all the symptoms seem to vie with each other in intensity,
and the disorder  runs a very rapid course.  This course, however, is
not always marked by a steady uniformity; sometimes  the violence
of the gastric symptoms  will  temporarily  abate, and the  diarrhcea 
CHOLERA INFANTUM.
793
continue in intensity ;  at other times  the  diarrhoea appears to become
less frequent and painful, and  the stomach more severely affected in
proportion; and sometimes also a similar  lull may be observed  in
the force of the whole disease,  and the poor worn-out mother can
hardly realize that her child  is  not out of danger—can scarcely un-
derstand the physician who sadly explains to her that the improve-
ment should come in a gradual  decline,  and not in a sudden subsi-
dence of the symptoms.   The former condition  affords ground  for
hope, but the latter, in some  distressing  cases that  have come under
my observation, but preceded the onset of fatal convulsions.
   The causes of cholera infantum are predisposing and exciting.   Of
the former, the chief cause consists in an hereditary or acquired weak-
liness of constitution, which leaves  the child open to the attacks  of
various diseases.  Of  the latter,  we may enumerate summer heat, im-
proper food, exposure to an impure or poisonous atmosphere, and the
irritability of system  consequent on  dentition.  The  intense heat of
summer appears to exert a powerful  influence in promoting  the dis-
ease.  In  the  tabular statement prepared from  the records of the
Board of Health of Philadelphia by Dr. Pemberton  Dudley, and pub-
lished in volume seven of the  Hahnemannian Monthly, the  disease
appeared year after year  about the middle of June, and disappeared
about the middle of September,  rising to its height  during the hottest
days, and the mortality being apparently regulated day by day by the
temperature.
   Vomiting and diarrhcea form the most remarkable symptoms.  The
stomach is so irritable that it rejects immediately, and sometimes with
violence, everything which it receives.   At first  the  vomited matter.
consists  of the  ordinary  contents of the stomach, but this  does  not
continue long, and soon the characteristic  watery, sero-mucous material
is  poured forth in greater or less quantity and frequency, and with
greater or  less violence.   Sometimes the matter vomited is tinged with
bile and presents a greenish hue. In the advanced stages of  the dis-
order the vomiting becomes spontaneous, and the fluids ejected resemble
those thrown off from  the bowels. The discharges from the bowels are
ordinarily composed  entirely  of a perfectly  colorless  and inodorous
fluid, often containing minute mucous flocculi.  In other cases they are
still very watery,  but  the fluid is yellowish  or brownish in color, con-
tains rather a larger amount of  thin feculent  matter, and has a most
offensive odor—an odor which is peculiar for its extreme foetidity, a
fcetidity so great that we have  known it to cause vomiting  in those
exposed to it, and so  adhesive as to render it necessary to change at 
794           DISEASES OF  INFANTS AND CHILDREN.
once all the clothing and bed-linen of the child, and even then the
fcetor may cling to the body of the patient after repeated washings.
These stools are discharged without the least effort, sometimes uncon-
sciously, and they are generally large  in quantity, soaking not only
through the child's diaper and clothing, but the bed upon which it
lies.  In  some cases, however, they are very small in quantity, and
are squirted from the anus  as if from a syringe.  In such cases there
is  usually more or  less tormina  and tenesmus.   Eight, ten, twelve
twenty, or even more  stools may  occur  within twenty-four  hours.
It frequently happens that two or three movements will occur within
a few minutes of each  other, followed  by a cessation for an hour or
so, during which  interval  the  child lies  perfectly inanimate, as if
completely exhausted.  Sometimes the  stomach seems to lose its irri-
tability, and  to  allow  whatever food or drink is taken in to pass
through both it and the intestines unchanged, and to be  immediately
thrown off from the bowel  in the  same condition.  But the extreme
languor and prostration and rapid emaciation are as  characteristic of
this affection in infants and very young children as of the  corre-
sponding  Asiatic cholera in adults.
  As the  disease advances the discharge becomes  still more frequent,
involuntary, " profuse, dark-colored like dirty water  or the washings
of  stale  meat, and  very offensive.  The  emaciation  of the  patient
becomes extreme;  his eyes  are languid, hollow and glassy; his coun-
tenance pale  and shrunken; his  nose  sharp  and pointed;  and the
lips dry, thin and shriveled. The surface of the body becomes cool
and  clammy,  of  a  dirty  brownish hue,  and often  covered  with
petechiae.   The  tongue  is  dark-colored,  smooth  and  shining, or
covered,  as well as  the  parietes  of the mouth,  with  aphthae.  In
many cases the child lies constantly in an imperfect doze, with half-
closed eyes, and so insensible to external  impressions that flies will
frequently light upon the half-covered eyeballs without the patient
exhibiting the  least consciousness  of their presence.  The abdomen
becomes more or less tympanitic, and the hands and feet of a leaden
hue  or pallid and  oedematous.   The fauces becoming dry, causes a
sense of uneasiness, wdiich often induces the patient to thrust the hand
deep in the mouth, as if to  remove some offending substance. (Bella-
donna.) The patient, unless relieved from his sufferings by a judicious
treatment, becomes  daily more and more  exhausted, rolls his head
about when awake,  and utters  constantly  short, plaintive, scarcely
audible cries.  He  falls  at length into a  state  of complete  coma,
death being frequently preceded by a convulsive attack'.   Xot unfre- 
CHOLERA INFANTUM.
795
ouently, at an early period of the disease, the brain becomes affected,
and the child  dies with all  the symptoms of acute meningitis."—
Watson.
  The  child  has no  desire  for food in many  cases, but the thirst
appears to be extreme, and cold fluids are taken  with avidity, even
though discharged from  the stomach within a few minutes afterward.
The pulse rises rapidly in frequency as the disease advances, gradually
becoming more and more feeble and thread-like;  while the tempera-
ture  of the  body rises  gradually, and  in some instances the  little
patient becomes exceedingly hot.  Respiration becomes shortened and
anxious, which may even amount  to dyspnoea in  bad cases.   The
urine becomes more and more  scanty as the  quantity of fluid voided
by the  stomach and bow-els increases, and  may even be entirely sup-
pressed.  The tongue, as the  disease progresses, loses its moisture and
becomes dry and  pasty, and  in  some instances cold.  The abdomen
does not appear to be tender  of  pressure, but is  sunken, doughy and
inelastic, and the skin of the abdomen  may be  pinched into folds in
which  it will  remain for some  time.  If the disease is not checked
collapse  will set in.  It usually runs a very rapid course, and  will
terminate fatally in one, two, three or four days, or gradual restoration
to health will  occur.
  The prognosis  of  cholera  infantum depends upon the violence of
the attack, the ability of the patient to  withstand it, and the skill of
the physician  in  encountering  the  disease and  combating its unfa-
vorable  conditions.   In some  instances,  when  cholera infantum
attacks an infant, the physician  feels  that  the case is a hopeless  one,
from his knowledge  of the weakly constitution  of his little charge;
while in others he has the comforting  assurance  of considerable in-
herent strength to resist, and a  consequent  hopefulness as to the final
result.   As  a general thing, it may be  stated  the  prognosis  will
depend upon the severity of the symptoms.   " When the discharges
consist  merely of serous  fluid, and are copious and frequent; when
they consist of  small quantities of deep-green  matter mixed with
much mucus or  with blood; when accompanied by straining; when
they number from fifteen to twenty-five in  the  day; when they are
very foetid;  and  when, with these symptoms, the abdomen is  tense
and  tympanitic,  the countenance pinched, the expression languid, the
extremities cool, the  pulse rapid and small, and the child irritable
and  restless, or,  on the other hand, very still and subdued,"—then,
according to very high  old-school authority, the prognosis is exceed-
ingly bad.   And the truth of this  statement is in general terms ad- 
796           DISEASES  OF INFANTS  AND  CHILDREN.
 mitted, with some qualifying circumstances to modify it, such  as th»
 previous good condition of the child, both  hereditary and acquired
 the absence at the time of the attack of the irritation of dentition the
.fact that the child is nourished at the maternal fount, and has favorable
 atmospheric surroundings, together with the wonderful efficiency of
 homoeopathic medication.  Favorable symptoms are—an abatement of
 the  fever and the gradual restoration of an even temperature, with
 increased volume and decreased-frequency of pulse; cessation of vom-
 iting, and decrease in the number of the evacuations, with a gradual
 return  of the stools  to  a  more natural condition and appearance;
 natural and peaceful sleep;  desire for food; and a general improve-
 ment in the appearance  of the  child, together with a return of play-
 fulness, etc.
   Treatment.—Cholera infantum is almost peculiar to large cities and
 to  summer  heat, and a  child having an attack of simple diarrhoea is
 peculiarly susceptible to the producing influence  of this dread disease.
 It is obvious, therefore,  that it  is of great importance to remove the
 simple diarrhoea;  and one of the best methods  of securing that, and
 of  otherwise affording comparative immunity from cholera infantum,
 is to send  the  little  one away  into the  country to  some salubrious
 situation, wdiere pure  air may be breathed plentifully.  Should this be
 impossible  from any cause, then the physician should enjoin upon the
 parents the  importance of keeping the  child as  much as  possible in
 the open air, taking it into  the parks or public  squares, and making
 short  excursions with it upon the rivers  and into the  country places
 adjacent, taking great care not to fatigue or worry the child, and not
 to  expose it to  the hot sun.   Fresh aud pure air has saved the lives
 of many little ones.   The physician should see to it, likewise, that the
 child under his  care  is properly clothed and fed; many of the com-
 monest and most obvious laws of hygiene and dietetics will otherwise
 be  violated by parents, even in their  anxiety to  do the best they can
 for their children.  And the physician,  in case he is  called to a child
 suffering from  a diarrhoea  in  summer,  and especially if the  stools
 become copious and watery, should select his remedies with the utmost
 care and watch the case with great  solicitude, lest it slip into cholera
 infantum, and the child, having its  strength taken away by the pro-
 dromic diarrhoea, dies when  its  life might otherwise have been saved.
   Consult  the  following remedies and  their indications, as well  as
 those given under the headings  Atrophy, Diarrhoea and Dysentery:

   iEthusa.  The child lies stretched out  and in an unconscioui condi- 
CHOLERA INFANTUM.
797
 tion, with pupils dilated and a fixed and staring look.   Linea nasalis.
 Face  sometimes red and sometimes pale; mouth either moist or dry;
 vomiting of white, frothy matter.   Vomiting  and diarrha'a, with
 great prostration.  Pulse sometimes imperceptible.  Convulsions, with
 clenching of the thumbs  and turning downward of the  eyes.  Pro-
 fuse vomiting of the milk, which is thrown off as soon as it is taken.
 Milk in any form does not agree with the child, and excites  vomiting.
 Constant thirst and great prostration.  Vomiting of coagulated milk.
   Antimonium  C  White  coating  on the tongue.;  nausea,  retching,
 coughing;  vomiting and watery diarrhoea; absence of thirst.   The
 child  is fretful and peevish, turns itself away and  cries when looked
 at or  touched.
   Arsenicum. The child is very weak, and the slightest effort, such as
 vomiting, etc., seems  to exhaust  it.   Intense  thirst, with  vomiting
 immediately after drinking.  Although the child constantly wishes to
 drink, it takes but a sip at a time.   Simultaneous vomiting and purg-
 ing.  Coldness of the  extremities.  The face is pale  and cadaveric,
 and the  skin  is dry and  shriveled.  The child  is  very restless, con-
 stantly tossing  to and  fro.   All  the symptoms are aggravated after
 midnight.
   Belladonna. Great heat of the head and dryness  of the mouth and
 lips.  Tongue coated white, with red margins.   The child wakes from
 sleep  with a  start, and  is delirious, or is very sleepy and yet cannot
 sleep.  Sudden darting and twitching of muscles during sleep.
   Benzoic acid. "Fcetid, watery, white stools, very copious  and  ex-
 hausting.  During stool much pressing or straining.  Strong-smelling
 urine, mostly dark-colored.  Troublesome dry hacking cough.  Tongue
 coated with white mucus or ulcerated."
   Bryonia. When hot weather seems to develop the attack.  The child
 vomits its ingesta immediately.   Lumpy diarrhoea; colic, with much
 thirst and desire for a large quantity at a time; lips dry and parched.
   Calcarea C  In leucophlegmatic children during teething.  Swelling
 and hardness of the abdomen; flabby muscles; skin dry and shriveled;
 hair dry, looking like tow.  Profuse sweat of the  head when sleeping.
 Stools whitish, watery and undigested.
  Camphor. The skin is cold as marble, yet the child will not remain
 covered;  much prostration  and  diarrhoea.   Sometimes  these  cold
 spells  only come on at night and pass  off in the morning.   Occa-
sionally there is neither vomiting  nor purging, but coldness and great
prostration.
  Carbo veg.  Similar to Bryonia;  may  be used when that remedy 
798           DISEASES OF  INFANTS AND CHILDREN.
 appears to  be indicated, but fails to cure.   Involuntary stools, which
 are very offensive;  emissions of large quantities of flatus, either fcetid
 or inodorous.   Child likes to be fanned.
   China. Very flatulent diarrhoea, containing portions of the ingesta;
 stools foetid, and  occurring immediately after  eating.  Partaking of
 fruit  may have been the cause of the attack.  Great weakness and
 inclination to sweat or great prostration after a stool.
   Croton t.  The stool occurs suddenly—one gush and it is finished.
 The lips are dry and parched.  Great prostration after a passage.
   Dulcamara. Every cool change in the weather or an unusually cool
 night  causes a relapse, or such condition of the weather appears to
 cause the attack at its first onset.
   Gratiola.  Violent vomiting and purging  of  yellow substances, and
 much flatulency.
  Ipecacuanha. Mucli nausea and vomiting, or almost constant nausea;
 these symptoms predominate.   Watery diarrhoea, or green, or, still
 more particularly, fermented stools.
  Laurocerasus.  Pulse very  slow  and irregular  or imperceptible.
 When the child drinks  the fluid gurgles when passing through the
 oesophagus like the noise made by pouring fluid into an empty barrel.
  Mercurius sol. The child has  colic, slimy and sometimes  bloody
 stools, with  tenesmus, the colic being  relieved  immediately after the
 stool.   There is often much perspiration, particularly upon the thighs,
 where it is cold and clammy.  The child is worse in the early part
 of the night, and is very weak.
  Nux V.  In cases wdiere some marked error in diet has caused indi-
gestion ; or  we may think of Nux after Ipecac, has failed.
  Phosphorus. The child vomits its  drink as soon as it gets warm in
 the stomach.  The  stools are very watery, and contain little lumps
 which look  like tallow.
  Phosphoric acid. Great exhaustion; sunken eyes, with blue margins;
stools are generally painless.
  Podophyllum p.  Exceedingly offensive stools, which are most fre-
quent in the morning.   Prolapsus ani with stools.   Moaning during
sleep, w\th half-closed eyes, and  rolling the head from  side to side.
Gagging or  ineffectual retching.
  Secale C. Great debility, vomiting and diarrhcea; much thirst; pale
 face, sunken eyes, dry heat, quick pulse, restlessness and sleeplessness.
 Involuntary stools.   Great aversion to heat or  to being covered.
  Sulphur. When there  are repeated  relapses, or when the case seems
 to linger, with excoriations, redness  about the anus;  eruptions; weak 
VOMITING.
799
spells;  sleeps with frequent waking.   Worse in the early part of the
morning.
  Veratrum. The  least motion increases  the nausea.   Cold sweat on
the forehead, from vomiting, with great prostration.   Pulse almost
imperceptible.  The least quantity of liquid excites vomiting, wdiich is
followed by cold sweat on the forehead.   Prostration, with cold sweat
and cold breath.  Stools consist of greenish water with flakes.   Vio-
lent thirst for cold water.*
                           Vomiting.
  Vomiting in  infants and little children constitutes one of the most
obvious symptoms of indigestion.  This, as already  stated, may be
merely an  effort of nature to  relieve the overloaded  stomach.   But
in a large  number of cases the vomiting, while it forms but a single
one with other  symptoms, indicates a still more serious  disorder of
the stomach; and from the explanation already given of the nature
and progress of indigestion, it will be seen why vomiting should often
be accompanied with diarrhcea.  In the more severe forms of gastro-
intestinal  disease  this  is always the case;  and  this connection was
especially  shown in the consideration of Cholera Infantum in the pre-
ceding section,  where these two characteristic  symptoms were dis-
cussed  together.
  Vomiting differs in different cases, in accordance with the nature
and extent of the morbid influence upon which it depends.  Thus, we
may note several kinds of vomiting wdiich may occur in infants:
   First That simple regurgitation of food taken  in  excess already
sufficiently described.
  Second.  Acrid and sour-smelling vomiting, vomiting from indiges-
tion, and such as appears to result from gastric or general fever.
  Third.  Bilious  vomiting—vomiting of greenish  or bitter  fluids,
either  separately  or  mingled  with food.  This  form  may  imply
functional  disturbance of the  liver,  or  it  may  simply  result from
gastric irritation  and straining  to vomit, which causes an  actual
regurgitation of the bile.
  Fourth.  The  vomiting  which accompanies severe forms  of diar-
rhoea, as in cholera infantum, inflammatory vomiting  and diarrhoea;
the discharges from the stomach may be watery.
  Fifth. Vomiting of blood, a rare form of disease in very young
infants, occurring within a few days, sometimes within a few hours,
after birth, and accompanied  by purging of blood.   This seems to
result from engorgement of the liver  and abdominal veins, and may
             *  For additional remedies, see Appendix, Note 3. 
800           DISEASES OF  INFANTS AND CHILDREN.
arise from interruption of the  circulation by external compression in
difficult labor.— West.
  Sixth.  Fsecal vomiting, indicative  of obstruction of the  bowels  as
in cases  of most obstinate  constipation, of intussusception and of
strangulated hernia.
  Seventh.  Vomiting which occurs as symptomatic of other diseases.
Of these we mention that which appears as one of the most import-
ant symptoms  of incipient cerebral  disease: "Nausea and  vomiting
are seldom absent.   I am not acquainted with  any one  symptom
which should so immediately direct your attention to the brain as
the occurrence of causeless vomiting, and especially its continuance.
At first, perhaps, the child vomits only when it has taken  its  food;
but before long the stomach will  reject  even the  blandest fluid, and
then the  efforts of vomiting will come on when the stomach is empty,
a little greenish mucus being ejected with no relief, the retching and
vomiting soon returning."  This may continue for  several clays before
any other  indication  of cerebral  disease is discovered; and in this
connection the  bowels  are  usually, although not invariably, con-
stipated.   The persistence of intractable vomiting, in the absence of
any other cause, either in  the  quality of the food  or in the state of
the digestive apparatus, will occasion a very strong suspicion of  deep-
seated dyscrasia, powerfully affecting the organic nervous system, and
threatening to  develop itself  in  the form  of  hydrocephalus, either
acute  or  chronic.   The vomiting  wdiich so constantly precedes  the
attack of scarlatina is well known;  and in this case, as in that first
mentioned of incipient cerebral disease, the severity and persistence
of the symptomatic vomiting  bear some proportion to the gravity of
the subsequent  disorder.  For further consideration of this subject
see the article on Hydrocephalus.
   Treatment—In the treatment of vomiting, careful attention must
be given to all  the accompanying  symptoms and  conditions, even to
the observation of the state of the pupil of the eye, to the scrutiny
of the discharges  themselves, and  to  the absence or  presence of
known causes and attendant circumstances.
  When there is vomiting of blood, first  be  sure that the blood does
not come from  the nipple; if it does, a little pressure upon the neck
of this organ will cause it to appear.
  For the several kinds of vomiting study the following remedies:

   Vomiting of  blood:  See if it is drawn from the nipple.
  Arnica. May be needed if the child has been  injured. 
      LESIONS OF THE RESPIRATORY MUCOUS MEMBRANE.    801

  Arsenicum. The child seems weak and much exhausted.
  Ipecacuanha.  Persistent nausea, with vomiting of blood.
  Nux vomica.  Constipation.   Violent vomiting of bright-red blood.
  Regurgitation or vomiting of milk:
  iEthusa, Bryonia, Calcarea c, Cina, Jodium, Ipecacuanha, Lycopo-
dium, Nux vomica, Silicia, Sulphur.
   Vomiting of  ingesta:
  Calcarea c,  Cham., China, Ipecacuanha, Iris, Lycopodium, Nux
vomica, Phosphorus, Pulsatilla, Sulphur, Silicia.
  Bilious vomiting:
  Arsenicum, Bryonia, Cham., China, Ipecacuanha,  Mercurius, Nux
vomica, Pulsatilla, Sepia, Veratrum.
  Faecal vomiting:
  Belladonna,  Nux vomica, Opium, Plumbum.
                   CHAPTER  XXXVI.

         DISEASES OF  CHILDREN—CONTINUED.

      Lesions of the Respiratory Mucous Membrane.

   THE great majority of the disorders incident to infants and young
    children consists  in  affections of the gastro-intestinal and res-
piratory mucous membranes.  The latter organs  especially  are  so
exceedingly delicate as to offer but inefficient resistance to the many
noxious influences  inseparable from atmospheric vicissitudes, and  at
the same time they form the seat of development for various  consti-
tutional dyscrasia, and actively sympathize with morbid  processes  in
other  organs.  It  is stated  on the authority of Professor Jorg  of
Leipsic that  the great sensibility  of  the lining membrane of the
respiratory apparatus does not exist in the same degree in the first
month or two of infantile life that it does  afterward.  "The exposure
of an  infant two or three weeks  old  to  a  low temperature or to a
vitiated air will be followed  by disturbance of the functions  of the
liver and the occurrence  of jaundice, or perhaps by such depression
of the muscular power as to  render the child incapable  of taking a
full inspiration, so that its lungs collapse, and it dies from disease  of
the respiratory organs, but without the cough or bronchitic symptoms,
      51 
802           DISEASES  OF INFANTS AND CHILDREN.
wdiich would not fail, if it were a little older, to announce the irrita-
tion  of the mucous membrane of the air-tubes."   To this  remark
however, coryza forms an  exception, since this affection is often seen
to prove very annoying at an early period of infantile life.   Catarrh,
Bronchitis and Pneumonia seem to follow in order, in unison  with the
development of the child's physical system, and each disorder pre-
pares the way for that wdiich may follow, the last  form seeming in
some cases  to be but the extension and development  of the first.

                             CORYZA.
   Coryza, snuffles or cold in the head is one  of the  earliest and most
common affections of the young infant.  It consists in inflammation
of the mucous lining of the nasal passages.  Sometimes the first that
is known of it is that the infant's nose is stopped up, so as to hinder
its respiration while at the breast.  The swelling  of the mucous mem-
brane of the nares,  and especially the accumulation of the  secreted
mucus, not  only  hinder the little sufferer from breathing through its
nose, as is  its wont in nursing, but occasion  also during its  sleep the
peculiar snuffling sound—similar to snoring in adults—which gives to
this disorder its popular name.  In some cases there is a considerable
flow  of  mucus, and all the symptoms  resemble those seen in the epi-
demic  influenza  of older children.   Here  the  Euphrasia  deserves
attention, in addition to the  remedies commonly used, since it will
often be found to correspond in a remarkable manner with the totality
of the symptoms.
  In other  cases there appears to be "something more than a simple
inflammation of the Schneiderian membrane, since it either secretes a
very tenacious mucus in extreme abundance  or becomes coated  with a
false membrane,  which sometimes extends  even to the  tonsils  and
palate.   Cases of this kind  are usually associated with extreme de-
pression  of the vital powers, and have received  on this account the
name of Coryza  maligna.   I have no doubt of their identity with
diphtheria, of which they constitute the form known as nasal diph-
theria."— West.   In addition to the Kali bi., those two more recently
proved  remedies,  Cubebs and Arum triphyllum* will be suggested to
the homoeopathic practitioner, to whom the totality  of the symptoms
of eaoh case is everything, while the name by which the disease may
be designated is of small account.
  Where the coryza tends to become chronic, and to  maintain itself in
spite of the indicated  remedies, we  must look  still deeper  into the
              *Hahnemannian Monthly, vol. ii., pp. -13 and  459. 
CORYZA.
803
nature of the case, if not before, since this very disposition to per-
sistence  evidences  some  constitutional  taint—either scrofulous  or
worse—which had not otherwise been discoverable.   Indeed, chronic
coryza, fully developed  and established, wants only  the intolerably
offensive odor  of the discharge  to  become a veritable ozcena.   This
latter will of course consist in an ulcerated state of  the mucous mem-
brane of the nares, and may  be purely scrofulous in  its origin, or
dependent upon some more or less remote  syphilitic taint in the sys-
tem. The history of the  case and the attendant symptoms will usually
show the nature of the  affection, and in his  diagnosis the physician
may sometimes be assisted by observing in spots the minute traces of
a characteristic copper-colored  eruption.  By thus adapting his reme-
dies to all the conditions and symptoms of the case, he may well hope
in a short space of time to remove the primary affection of the nasal
mucous membrane of the young infant, which if not thus early eradi-
cated will presently extend itself to the adjacent mucous surfaces, and
become a much more formidable and intractable kind of disease.
   Aconitum. This remedy is frequently introduced at first when there
are febrile  indications.   It will often cut  short an attack of catarrh
when promptly administered.
   Allium cepa.  The  discharge from the nose is  profuse, watery and
excoriating, and there is corresponding lachrymation.  Violent cough
accompanies the coryza.
   Ammonium c. Dry coryza, with stoppage of the  nose, especially at
night, and lachrymation.
   Arum triphyllum. Profuse coryza, the  fluid discharged being burn-
ing and ichorous, making the nostrils and lips sore; feverishness and
hot, dry skin.   Child picks at itself, even producing raw places.
   Calcarea  c.  This medicine may be appropriately given after Cham-
omilla when that remedy seems indicated, but fails.
   Carbo veg. If the coryza return in the evening.
   Chamomilla.  When there  is a  watery  or mucous discharge.  The
child is quieted, and in  fact  relieved, by  carrying it up and down the
room.  One cheek red,  while the other is pale.
   Dulcamara. The child gets worse at every cold change in the weather
or from exposure to cold air.  Dry cough.
   Euphrasia. Profuse fluent coryza  and acrid lachrymation; the eyes
are much involved.   Ulceration of the margins of the eyelids.
   Kali bi. An invaluable remedy when the discharge  from the nose is
tough and stringy;  sometimes it seems to extend to the throat, and to
cause choking. 
804           DISEASES OF INFANTS AND CHILDREN.
  Mercurius.  The nostrils  are red,  raw  and  ulcerated.   Frequent
sneezing and profuse fluent coryza.
  Nux v. The catarrh is worse at night, particularly toward morning
oi in the morning.   Through the night the nose is very dry.
  Pulsatilla.  Coryza much worse every evening, better every morning
Discharge  of yellowish-green, thick  and  sometimes fcetid  coryza.
Worse toward evening.
  Sambucus n. The nose seems perfectly dry and completely obstructed.
Very frequently indicated when the child " snuffles " constantly.
  Sticta p.  There is a constant irritation in the nose to blow it, but no
discharge.
  Sulphur.  Fluent coryza, like clear water, and very profuse.
  Tartar em. Obstruction of the nose, and at  the same time much
rattling in  the bronchia.

                          Bronchitis.
  The term Bronchitis is employed to express an inflammation of the
bronchial mucous membrane.   It is also known as Catarrh,  Catarrhal
Fever and Bronchial Catarrh, and is a disease of very common occur-
rence among infants and older children, especially during the spring
and winter months.
  The acute form of bronchial inflammation, that wliich is generally
understood by bronchitis, is confined to the larger bronchial tubes, and
displays  at first considerable fever, upon the subsidence of which the
catarrhal secretion may make its  appearance as a critical  discharge.
This form of disease is the  one which oftener attacks  children appa-
rently robust, and in some—whose constitutions are far from being so
good as they seem—the disorder runs a very rapid course, and is suc-
ceeded by a mucous secretion, dangerous in proportion  to  its abun-
dance, and abundant  in proportion to the plumpness and apparent
heartiness (and, real weakness) of the  child.
  The disease results from exposure to a low or damp temperature, or
from  a sudden transition from heat  to cold or from cold to heat;
sometimes  it appears  to  prevail  epidemically.  The style of dress
adopted by mothers  for their children is likewise a fruitful cause of
bronchitis.  It is distressing, and  at the same time absurd, to see the
tender infant exposed to cold and inclement weather clad in such
insufficient garments as to  render it liable  to "take cold" at any
moment—garments which its parents would consider entirely insuffi-
cient if they would take the trouble to compare them with their own
ample and comfortable clothing.   Sometimes also it appears as a com- 
BRONCHITIS.
805
plication  of epidemic  eruptive  fevers, especially  measles.  It com-
mences with  the  ordinary symptoms of  cold  in  the head, such as
sneezing, running at the eyes and nose, hoarseness, cough, dry, hot
skin and  accelerated pulse.   In fact, a  severe attack of bronchitis
usually consists in an extension into the air-passages of inflammation
originally commencing in the form  of influenza.  The child cries
when it is put to the breast or attempts to swallow; it is disturbed by
frequent  fits of coughing, wdiich is at first short  and dry, but soon
becomes wheezing and  rattling;  and it appears oppressed with tight-
ness of breathing.   In  mild cases slight mucous rales are heard, which
increase with the  extension of the inflammation.   As the inflamma-
tion extends more and more through the ramifications of the bronchia,
assuming then the form of capillary bronchitis, the febrile symptoms
become more developed and the skin burning, hot  and dry; the pulse
is rapid; there is  considerable  restlessness, panting  of  the  breath,
tossing of the head  about  from one side to the other, flushing of one
or both cheeks, the  cough being constant  with little or no expectora-
tion, and on putting the  ear to  the chest sibilant or whistling with
harsh mucous or sub-crepitant rales are heard at different parts, proving
the  extension of  the inflammation throughout the whole chest.   The
symptoms are aggravated  toward evening, the child having been com-
paratively comfortable during the day.  This evening exacerbation is
due, according to  Handfield Jones, " to a lowering of the nerve-power,
the  vaso-motor nerves partaking of the general  debility, and thus
allowing dilatation  of  the arteries, and causing increased hyperaemia
of the affected parts, with more abundant  exudation."  As the disease
subsides, the respiration becomes more free and the cough loose and
easy, the sound of the cough itself being the only guide in this respect
in young children, since the phlegm is always swallowed.   When the
disease occurs in the most acute form, the  catarrhal symptoms are fre-
quently absent and the attack sudden ; on the  other hand, a low form
of sub-acute bronchitis, which has originated in a slight catarrh or
influenza, often constitutes a protracted and dangerous variety of the
disease.
  Bronchitis arising from an extreme  and sympathetic irritability of
the  mucous lining  membrane of the air-passages constitutes a very
distressing complication in measles.  In such  cases, where the cough
is dry and almost spasmodic, incessant, accompanying every  breath.
with imminent danger of congestion, Ipecacuanha has given  imme-
diate relief.   In the severer forms of acute bronchitis the  subsidence
of the primary fever is succeeded by a profuse secretion of (tenacious) 
806           DISEASES OF INFANTS AND CHILDREN
mucus, which chokes the bronchial tubes and effectually excludes the
air from  a considerable portion of the air-cells and  blood-vessels,
The little sufferer  is in  great danger of perishing in such cases from
slow  suffocation.   The  countenance becomes  livid,  the extremities
cold and lead-colored, drowsiness supervenes, wdiich may be followed
by  coma, convulsions, and  finally by fatal asphyxia.  To  the above
description of bronchitis—drawn principally from Leadam—it  may
be sufficient to add that this disorder in its initial stages may be dis-
tinguished from pneumonia by the external  catarrhal symptoms,
subsequently by the distressing and paroxysmal nature of the dry and
almost spasmodic cough, by the wheezing  and whistling sounds, and
finally by the very copious, sometimes stringy and suffocative secretion
of mucus, which in the third stage of the disorder either concludes it
by a favorable resolution, or destroys the patient's life by suffocation.
   Capillary bronchitis—the acute  suffocative catarrh and congestive
catarrhal fever of some  writers—may occur either as an independent
disease, or may result from  the extension of the primary inflammation
of the larger bronchia to the smaller ramifications  of  the air-tubes.
The symptoms  are more violent and dangerous than in the ordinary
form  of the disease. The respiration becomes greatly hurried, and the
pulse rises to 150, or even  higher;  there is an anxious  expression of
countenance, great  restlessness;  the  cough is very troublesome, and
evidently gives  rise to pain.   " The resonance  on percussion is  not
modified.  Auscultation  reveals at  first  sibilant rales, mixed with
some mucous  rhonchus; but  soon a fine  sub-crepitant  rale is heard
over all the lower parts  of both lungs behind, and approaching some-
times over the bases of the  lungs, the character  of crepitus.  After a
time the sub-crepitant rale is heard over the whole, or nearly the whole,
dorsum of the chest, and to  a greater or less extent, though not so well
marked as behind,  over the anterior regions of the thorax.   This rale
is  audible at first both in inspiration and  expiration, and is very dis-
tinct, but at a later period it is heard only in the inspiration, or there
is substituted for it the mucous rale, while the sub-crepitant rale is now
heard only in the forced inspirations during coughing or crying. These
rales are fugitive and irregular, disappearing or changing from one to
the other after fits of coughing."—Meigs and Pepper.
   This form of the disease usually runs a very rapid course, lasting
from five to eight days, although it may terminate in death  or restora-
tion to a better condition in a much shorter time.  Favorable symptoms
are—less frequent and easier respiration, a  return of the natural respi-
ratory murmur  in  parts of the enest, a subsidence of the sub-crepitanl 
BRONCHITIS.
807
rales, and a diminished frequency in the beats  of the pulse.  Should
the breathing become more and more oppressed and exceedingly rapid,
80 to 90 per minute, with fan-like motion of the alse nasi, and an in-
creased frequency of pulse, wliich is small, thread-like  and irregular,
the case  may be regarded as very grave  and a fatal termination may
be apprehended.  As death approaches in fatal cases " the respiration
is uneven, irregular, stertorous,  and often slower than before;  the
cough  is smothered  and  less frequent; the restlessness generally
diminishes, and the child sinks into quiet, and often becomes comatose;
the paroxysms of suffocation  are  less frequently renewed and  less
violent, and death occurs in  a state of quiet  insensibility, or  is pre-
ceded by partial or general convulsive movements."
   Sub-acute and chronic bronchitis usually result from the subsidence
of an acute attack.   The symptoms vary in severity in different cases,
but are usually a mild type  of those presented above, the most con-
stant and distressing being the cough  and expectoration.   And chil-
dren suffering  from these  forms of bronchitis are liable, upon  any
exposure to unfavorable atmospheric influences, to a rousing up of the
inflammatory process, which results in an aggravation of all the symp-
toms, or, in fact, to an  acute bronchitis, either simple or inflammatory.
Such aggravations, it is claimed,  likewise frequently occur in children
who are teething at the irruption of every tooth.
   treatment.—It is important  that the  child  be kept  in  a well-
ventilated  room, of equable  temperature, and  free from exposure to
draughts and cold.   The following remedies should be consulted:

   Aconite.  When the fever runs very high; hot  skin ;  much distress
and great restlessness.   When these symptoms are present at the com-
mencement of an attack of bronchitis, Aconite will sometimes cut it
short.
   Arnica. The child cries every time it coughs, or even before cough-
ing, as though it dreaded it.
   Arsenicum. When there is  great  prostration;  restlessness after
twelve at night; it drinks little and often; suffocative attacks.
  Belladonna. The  mucous rales are   large   and crepitous,  hoarse
cough;  much  moaning;  moaning  at every  breath;  starting and
jerking of the  muscles.
  Bryonia.  Respiration much oppressed;  dry, cracked lips; cough
worse after drinking;  constipation of dry, black, burnt-like  looking
stools.   The child seems to desire rest; every motion seemingly aggra-
vates the suffering. 
808           DISEASES OF  INFANTS AND CHILDREN.
  Calcarea C  Much mucus in the chest.  In leuco-phlegmatic children,
large and open fontanelles; much perspiration on the head, so that tin-
pillow is wet far around.
  Chamomilla. The child is very cross and fretful; one cheek red, the
other pale; must be carried to be appeased.
  Cina. Vermiculous symptoms prevail,  such as picking the nose;
nothing satisfies the child;  it is always  hungry.
  Drosera. The  fever  and  the  cough—which  is  very hoarse—are
worse after twelve at night.
  Dulcamara. The disease has been induced by cold damp air.
  Hepar. The child seems  croupy, decidedly so, and  the phlegm is
loose and  choking.  It chokes in the cough.
  Ipecacuanha.  Much nausea and vomiting  of  mucus; the cough is
strangling and  suffocating, so much mucus seems to be accumulated
in the bronchial tubes; it turns blue in the face.
  Lycopodium.  There is much oppression of the chest, and the ah
nasi are seen to  dilate or spread out  wide, like the large end of a
trumpet, and then to contract, alternately.
  Nux V.  Always worse after four o'clock A. m.  Constipation;  loss
of appetite; cough is very tight and dry, and is sometimes relieved by
expectoration of a small quantity of mucus after much coughing.
  Phosphorus. Severe  and exhausting  cough, which the child dreads
and avoids as long as possible.   The case becomes worse in the even-
ing, and continues so during the night.   The fever is often very high
and the pulse very rapid.
  Pulsatilla.  The  cough  is  very loose, and with all the fever there is
but little or no thirst.   The child gets worse toward evening, and it
has more  difficulty of breathing when it lies  on  its side.
  Silicia.  In children who have large  bellies; perspiration about the
head; of a scrofulous constitution.
  Sulphur. The child  has  papular  eruptions upon its skin;  rather
inclined to excoriation; much rattling  of mucus in the chest; sleeps
in  very short naps, frequently awaking.
   Tartar em. Much thirst; wishes to drink little  and often.   When the
child  coughs there appears to be a large collection of mucus in the
bronchial tubes, and it seems as if much would be expectorated, but
nothing comes up.
   Verat. viride. Cough worse in going from warm to cold air.
                    Pneumonia—Lung Fever.
   As an  idiopathic disease, inflammation of the  lungs  is compara-
tively rare in  infants, never occurring, it may  be  affirmed, except in 
PNEUMONIA.
80S
those who have a decided  constitutional predisposition to such affec-
tions.   Such  predisposition  may be  traced  in little  children whose
parents, one or both, have suffered with pulmonary phthisis.  Infants
born from such parents, one of whom may have recently died with
consumption, when but a few months old have  been observed to fall
victims to pneumonia, developed in a very rapid manner and  under
the influence of scarcely noticeable external causes.
  It is not always easy to determine, at the first and with any degree
of positiveness, whether an  infant is suffering with  pneumonia or
with bronchitis; nor in  fact is it absolutely necessary for the homoeo-
pathic  treatment, since we carefully select the remedy which is the
exact simile of the existing symptoms  and conditions;  nor will the
prescription be properly influenced by our pathological interpretation
of these symptoms.   And indeed in  many cases  both forms of in-
flammation, that  of the  parenchyma of the  lungs  and that of the
mucous lining membrane of the  air-passages, run into each  other,
and the pneumonia of infants is as apt to be asssociated with bronchitis,
constituting broncho-pneumonia, as that of adults to  be complicated
with pleurisy.  The sputa,  alike characteristic in bronchitis and in
pneumonia, afford no aid  where the patient  is either  an infant or a
very young child, since these little folks never expectorate.   The ex-
istence of  the mucous rale, distinctly confined to one lobe of the lung,
and a  circumscribed  redness in the  cheek  of the same side, wrould
afford strong presumption of pneumonia.   In this latter disease, also,
the cough  is less violent, though frequent and short, and it is not so
much attended with rattling of mucus;  there is often a circumscribed
redness of the cheek of  the same side with  that of the inflamed lung,
and the child evidently prefers lying on the affected side.  Where the
pneumonia invades both lobes of the lungs—which, however, may be a
successive  development—there will  be still  more evidence of conges-
tion ; flushing of  the face  and hurried and short  respiration, and
rapidly increasing exhaustion.  The history of the case, and its rela-
tion to hooping-cough, to influenza or  to measles, either of which may
remarkably tend to develop  such phenomena, will greatly aid in the
diagnosis; and the same is true of the previous history of the patient
and of his hereditary proclivities.
  In pneumonia,  at its first  stage, or stage of engorgement, as  in bron-
chitis, the  fever  comes first, with  dry cough; then the  fever abates
somewhat as the cough becomes more  loose and catarrhal.   But in no
stage of the disease does the cough assume the paroxysmal and almost
spasmodic form so often seen in bronchitis,  and  which  results from 
S10           DISEASES OF  INFANTS  AND CHILDREN.
 the tenacious nature of much of the secretion in this latter disease, and
 the consequent difficulty of starting it from the bronchia.  The first staoe
 of pneumonia is characterized by nervousness, fretfulness and restless-
 ness; constipation of the bowels and sometimes vomiting; redness of
 the tip of the tongue, the lalter coated white in the middle; the child
 breathes through  the open  mouth, instead  of through the nose; or
 there is  an  unusual alternate contraction and expansion of the nos-
 trils—a symptom  which should always attract attention to the respira-
 tory organs when  seen in young children.  He sucks by starts, because
 he cannot breathe as usual through the nose while nursing; he " seizes
 the breast eagerly, sucks for a moment with  greediness, then suddenly
 drops the nipple, and in many instances begins to cry."
  In the second stage, or  that of red hepatization, the little patient
 becomes languid, sometimes drowsy ; the respiration is more  evidently
 hurried, " the alas nasi are dilated with each inspiration, the abdominal
 muscles are brought into play to assist in  its performance, and any
 change of posture renders the breathing  more labored and more hur-
 ried.  The cough  becomes much more frequent; it is still hard,  some-
 times evidently painful, so that the child cries at each  cough; at other
 times it is an almost constant short hack." As the disease still advances
 the bright flush of the face and the  florid  tint of the lips subside;
 the body remains  very hot, while the extremities  may become cool;
 the face may appear pale and the  lips assume a livid hue where the
 pneumonia is very extensive.  The babe becomes still weaker, vomits
 the food, which  it takes greedily from the severe thirst; and finally,
 through the  hurried  nature of the  respiration, becomes incapable of
 nursing at all.   Percussion  reveals a dullness over the seat of the dis-
 ease, wdiile there is  evident diminution  of  elasticity  of the  thoracic
 walls.  Auscultation reveals fine sub-crepitant rales, with well-marked
 bronchial respiration.   Death may suddenly occur in  this stage from
 exhaustion or from collapse of the lung.
  In the third  stage, or that of gray hepatization, the respiration  be-
comes more  labored and irregular, though less frequent.  The little
sufferer loses its voice, or becomes very hoarse  and  almost entirely
incapable of  coughing.   The face is sunken, the extremities cold,  the
pulse extremely small, and so frequent as  to be almost impossible
to count.   The  child is  restless  at  intervals, or  lies  in a  state of
half-consciousness, and suffers very much  from dyspnoea on  being
 moved.   The face and nails exhibit a livid  hue  if  the disease  ad-
 vances unchecked, and coma  and convulsions  close the sad  scene.
Abscesses sometimes form  in  this stage of  the disease, and if they 
PNEUMONIA.
811
 should discharge into the pleural sac, pneumo-thorax would be the
 result.
   During dentition,  under the attack  of measles and the prevalence
 of influenza, infants  are especially liable to become  subject to pneu-
 monia;  at such times, therefore, the physician will most  carefully
 scrutinize every symptom which might indicate the onset of a disease
 that is alike insidious and fatal in the aged and in the very young.
 The only other form of disease for which infantile pneumonia might
 be mistaken is incipient hydrocephalus; to this error the vomiting,
 the fever, restlessness and constipation—wliich are alike common to
 both diseases—might easily lead those not on their guard.   And this
 the more especially  since, according to  Dr. West, to whose work we
 are much indebted in the above description, the cough in some cases
 of pneumonia is at first so slight as scarcely to. be noticed, and even
 where it  is more strongly marked it might  easily be  mistaken for the
 sympathetic cough which is sometimes present in the early stages of
 hydrocephalus.
   Treatment.—The following  remedies will generally be found  suffi-
 cient  for the treatment of cases  of pneumonia, which  usually termi-
 nate favorably, especially  in  children over two or  three years old.
 Consult also the medicines mentioned under the head of Bronchitis.

   Aconite.  If the child has a truly synochal fever, is very restless, with
 much oppression of the chest and anxiety.   It can scarcely cough, the
 suffering is so  intense.  Short  and rattling breathing; constant cough;
 almost constant crying,  with anxious  countenance and great un-
 easiness.
   Belladonna.  Face  very red  and eyes  injected.  The child moans
 with  every breath.   Its  skin imparts  a  burning  sensation to the
 hand.  Jerking and  twitching of the muscles.
  Bryonia. The child cannot bear to be moved, the least movement so
 greatly increases its  sufferings.  Dry and parched lips;  mouth dry;
 constipation; fieces hard and dry as if burnt, usually of a dark color.
 The cough is aggravated by drinking, but the child nevertheless wishes
 to drink large quantities of fluids.
  Lycopodium. Decided flapping or fan-like motion of the alse nasi;
 they dilate widely and extremely, and  then  contract, alternately.
  Mercurius. Much fever;  thirst; salivation; a profuse  perspiration
 which affords no relief; a great deal of coughing, with great  distress.
  Phosphorus.  Particularly in tall and slender children; cough violent,
sounding dry or loose;  panting respiration; hoarse toward evening. 
SI2           DISEASES OF INFANTS  AND CHILDREN.
   Sulphur. Iii cases attended with pustular eruptions; skin rough and
scaly, and other indications for this remedy.
   Calcarea and Hepar should also  be studied, the former in very fat
children especially.

                              Croup.
   Croup is  an especial disease of little children, and it by no means
spares young infants.  Strictly speaking, it is an inflammatory affec-
tion of the  mucous membrane, first of the larynx, and subsequently
of the trachea also.   Under the  general name of croup are popularly
included two  distinct forms of disease—one,  the inflammatory or true
croup;  the  other, the spasmodic or spurious croup.  The inflamma-
tory or membranous croup is gradual in its onset and insidious in its
character, and unless arrested by the  appropriate medication it is pretty
certain  to terminate  fatally.   The  spasmodic or false croup is not
attended with formation of false membrane,  and, though much more
sudden and violent in its onset, it is far less  dangerous in its nature.
The true  membranous  croup has an element  of persistence, and the
great hoarseness may remain for a long time  unabated, as well as the
other symptoms, and give the  physician much anxiety about the ulti-
mate result, even when improvement is actually taking place as rapidly
and  favorably as possible.  And in no other disease is the triumph of
homoeopathy over  allopathic practice more evident or  more grateful
than in this.   Three-fourths of the cases of membranous croup con-
fessedly perish under allopathic  treatment, and no small proportion
of those of the spasmodic variety; while those who survive,  especially
an  attack  of true croup, have  been so  barbarously  treated with
blisters, cups, leeches, purgatives, emetics, et id omne genus, that they
remain for a long time  enfeebled.   In the homoeopathic practice, on
the contrary, a case of croup  is  very seldom  lost, even of the mem-
branous variety, and never, we  think, save from want of attention and
care on the  part of the  nurse, failure to call in the physician before
the disease has too  far advanced, or failure on the part of the physician
himself to administer the remedy  required by the exigencies of the
individual case.
  Etiology.—Croup is developed in  constitutions predisposed to this
disorder by a variety of causes which in  other persons  might have
resulted in simple catarrh or pneumonia.   The most frequent cause,
however, is  exposure to cold and damp.   We remember an  exceed-
ingly obstinate case  of croup occurring in a little boy in  consequence
of his sitting playing in the damp  snow.   It has  been remarked b) 
croup.                          813
the physicians of Edinburgh that the croup occurs among the poorer
classes in that city most commonly on a Sunday or Monday, and tht;
account for it by the fact that the cottage floors are usually washed on
Saturday afternoon, and remain very damp.  We  remember a  re-
markable case  of croup which resulted from a leak in the roof, by
means of which the  moisture penetrated the  ceiling  of the child's
sleeping chamber after a  heavy rain in winter, and rendered damp
the  papering of the walls  in the corner where his bed was placed.
Particular states of the atmosphere and wind sometimes seem to favor
an epidemic development  of  croup, and this may  be in dry, cold air,
as well as in the wet.

  Membranous Croup may begin with simple hoarseness, followed
by an occasional hoarse cough, which to uneducated ears has no par-
ticular significance, but which to the initiated announces the prelimi-
nary stage  of this  much-dreaded disease.  In some cases related by
allopathic writers the children thus  affected were stated to be already
past all  hope of recovery while yet able to play about the room!  This
hoarseness may continue, and  the hoarse cough become more frequent,
for two  or three days before the illness of the  child becomes so obvious
as to  seriously  alarm  the  parent.  But usually toward evening these
cases become very much  worse,  yet the next day the  child seems so
much better the fond mother allows herself to think the  danger is
past.  But the second and  third night soon undeceive her, when,
if unarrested by the  homoeopathic remedy, the gradual but sure  de-
velopment of the false membrane threatens to destroy her child with
slow suffocation.
  In many cases of true membranous croup, however, the symptoms
are much  more severe from  the first.   " The child, after retiring to
rest, suddenly  awrakes from  his sleep  with  difficult  and wheezing
respiration and frequent paroxysms of loud, ringing cough; his skin
is intensely hot, his face flushed, and his voice hoarse and indistinct.
In general, these symptoms after a short period gradually abate;  the
respiration becomes  more free, the  patient falls asleep again, and on
awaking in the morning, with the exception of some degree of hoarse-
ness and a slight cough, presents no symptoms of any serious disease;
the pulse, however, will, in  general, be found to be more frequent
than natural, the cough more hoarse and resonant.
  " On  the ensuing evening  the respiration  becomes again suddenly
difficult, loud and wheezing,  and the cough  convulsive and ringing,
the  patient  experiences a sensation of impending suflbcation,  and 
814
DISEASES  OF INFANTS AND CHILDREN.
carries his hand to his throat, as if to remove the cause of his suffer-
ing.  His face  becomes  swollen  and  flushed,  his pulse hard and
frequent, and his voice hoarse and almost inaudible."  These symp-
toms become more and  more  intense,  unless  the progress of the
disease  is arrested by appropriate medication,  while  the  remissions
become shorter and less distinct.   The cough loses its acute ringing
sound,  while the loud ringing respiration  of  the  patient is  heard
beyond the apartment he occupies.   The dyspncea becomes excessive •
the patient is in a constant state of agitation; his face is swollen and
livid, his  lips purple, and his forehead covered with  large drops of
perspiration.  The skin becomes cool, the pulse small,  feeble and
extremely rapid ; the thirst is often intense.  By the  cough, assisted
sometimes by vomiting, a  quantity of thick, ropy mucus, and even
fragments of the false membrane, are expelled.   If a tubular portion
of the false membrane is thrown off, great relief  may result.

  Spasmodic or Non-membranous  Croup.—In this form of  croup
the symptoms from the  first are  much more violent, and the onset of
the disease is correspondingly sudden.   The patient, who retired to bed
apparently in perfect health, is suddenly awakened from sleep with a
violent fit of loud, ringing cough; his  respiration is loud, wheezing
and oppressed, and attended with a feeling of immediate suffocation.
As in the former variety, the difficulty of breathing and the cough occur
in paroxysms, which as the disease advances become more and more
frequent, until there is  no longer any remission.  While the attack,
by its suddenness and violence, announces no small degree of danger,
still it gives  some reason to hope the case is rather one of the spas-
modic than of the membranous form of croup.  In the more advanced
stages of croup the evidences of the formation of the false  membrane
become  too positive to  be denied.  Still, the same great  symptoms
of hoarseness, peculiar ringing cough, and loud  wheezing  or sibilant
(hissing) inspiration, and dyspncea appear in both varieties of croup,
in different degrees of intensity according to the severity and  more or
less advanced stage of the case.
  A brief recapitulation of the symptoms of croup—that is, of those
common to both forms—will enable the physician the better to recog-
nize the disease and select the simile for each case.
  The hoarseness,  which  comes on  gradually  in the membranous
croup, and  more  suddenly in  the  inflammatory variety, in either
form remains during the remission.  The alteration of the voice gives
what  is recognized as the croupy tone,  but this sounds very differ- 
CROUP.
815
ently in different cases.  Sometimes it resembles the crowing of a
uock or the barking of a dog; in some cases it is hollow and deep,
in others screeching, lisping  or  wheezing; iu others again the voice
is entirely suppressed  as the disease  advances,  and  in  some rare
instances from the very first.
  The cough also has various sounds; it may be violent, short, shrill,
hacking, afterward  crowing, hollow and harsh ;  it may be simply
hoarse, or sound as if the child were coughing" into an empty pot or
metallic tube.  In general the cough is dry,  and it is followed by the
peculiar sonorous, loud-sounding or hissing  inspiration.  As the dis-
ease advances the  cough acquires a husky or even  muffled sound,
which would indicate the effusion of coagulable lymph.
  The  respiration becomes  short and difficult, in paroxysms, with
loud and wheezing, hissing  and sawing inspirations.  As the disease
advances the paroxysms become  more severe, the  dyspnoea  more
terrible; " the little  patients raise themselves up, want to leave their
beds, grasp at the larynx in  order to  remove the obstacle from  the
throat;  they  put out  their  tongues, throw their  heads back, and
breathe in this way with the windpipe pushed  forward; there is an
evident endeavor to elongate the  neck, and  to  stretch it upward and
backward.  According to Heim, this is a sign  of membranous exu-
dation  having taken place."—Hartman.  After these violent parox-
ysms of orthopncea, the sufferers fall back exhausted, and sometimes
sleep.
  The later stages  of  the disease  are  marked  by the blue or livid
color of the- skin, the result of deficient oxygenation  of the blood;
swelling  of the face  and   neck  from obstructed circulation; and
drowsiness, etc.  The fever, which from the first  is strongly marked,
becomes still more intense as the disease  advances; there  is great
thirst, and little or no difficulty of  swallowing; while  the  pulse
becomes irregular and  rapid in the  paroxysms, and more  and more
faint with the rapidly increasing debility.
  There are  numerous other symptoms, either common to croup or
peculiar to individual  cases, which it  is impossible, and indeed  un-
necessary, to enumerate here or among  the indications for the various
remedies.  But the  most remarkable  and  characteristic have been
mentioned in either case;  so that the practitioner, however inexpe-
rienced, need  be at no loss to know  on the  one hand wdiat he has to
contend with, or to  determine the  appropriate  remedy on  the other.
It should  be  remembered that croup  is one of the few  diseases in
which it may be  necessary to awaken the patient  in order to give the 
816           DISEASES OF  INFANTS AND CHILDREN.
 medicine regularly, for if allowed  to  sleep  too  long at a time  the
 disease makes very great  progress.  This  is, however* principally to
 be  observed by those who use the  lower homoeopathic preparations.
 In  badly-treated cases there may be noticed  sometimes a strong dis-
 position to the development of bronchitis, or even of pneumonia, as
 the successor of croup,  but  this will  very seldom  occur under  the
 homoeopathic regime.

   Treatment—Aconite. This remedy should always  be given at  the
 first; it will often prove  to be  the only one needed, if given right,
 unless some  other remedy is strongly, in fact I might say perfectly,
 indicated.   Aconite will be especially called for  if there is a high
 fever,  skin  dry,  much restlessness  and distress.   " Cough and loud
 breathing during expiration,  but not during  inspiration.   Every  ex-
 piration ends with a coarse hacking cough." *
  Arsenicum is always to be thought of when  there is great exhaus-
 tion ; the least effort seems to overcome the patient;  the child is cold
 and wants to be covered.   The cough is very exhausting, and becomes
 worse  after midnight.   The cough is  also worse  after drinking; is
 generally dry, but sometimes accompanied with expectoration of frothy
 mucus.  Croup before or after nettle-rash.
  Belladonna. If  the cough is hoarse, causing the face to flush and  the
 eyes to become red.   Is a very  useful  remedy in  croup when these
 symptoms are present.
  Bromine. Spasm of  the  larynx;  suffocative cough; hoarse, whist-
 ling, croupy sound, with  great  effort; rattling, wheezing, gasping:
 impeded respiration ; heat of the face; formation of a false membrane
 in the  larynx and trachea ; much rattling in the larynx when cough-
ing.  If this last symptom be present more especially, even in des-
perate  cases, Bromine will  cure if a cure be  possible.   It should be
given every hour or two, and continued  some  time  if necessary.
  Chamomilla. With this  unusual remedy I  once cured a very bad
case of croup, when all other medicines had failed to afford relief and
I despaired  of the  child's life, from observing  very strongly marked
in this case that characteristic symptom of  Chamomilla—the child
must be carried up and down the room for relief.  I was led to give
this remedy, which% much to  my delight, was followed  by speedy
recovery.
  Hepar. If there is a rattling, choking cough, becoming worse par-
 ticularly in the morning part of the night.   The croup comes on or
        * Dr. W. E. Payne, U. S. Journal of Homazopathy, vol. ii., p. 521. 
HOOPING-COUGH—PERTUSSIS.                817
gets worse during the after part of the night or early morning.  The
child chokes with every coughing spell.   Coughs into a choke.
  Iodine. Ahvays indicated when there is pain in the chest and larynx.
Membranous croup,  with  wheezing and sawing respiration.   If the
child is  too young to express its feelings, it will grasp these parts with
the hand.   The  child is pale.   Coldness of the face in very fleshy chil-
dren.  The voice has a deep, hoarse, rough sound.   Much mucus.
  Kali bi.  Croup, with expectoration of tough, stringy mucus.  Mem-
branous croup.  Especially suitable for light-haired, plump and fat
children. The air sounds as though it were passing through a metallic
tube.  The croup comes on insidiously.  Mucus very stringy.
  Kaolin. Promises to be a valuable remedy for croup.  Cough accom-
panied by suffocative attacks; the child is very hoarse and breathes
with difficulty.  It may be tried when other remedies have failed.
  Lachesis. This remedy has  cured very far advanced and apparently
hopeless cases of croup,  indicated particularly by very  distressing
aggravation  after sleeping, as if the  child  were dying.  Or the child,
as it were, sleeps into the croup and awakens  with an attack.  So
long as  the child is awake  it does very well, but on sleeping the attack
comes on  or gets worse, and it arouses with a paroxysm of choking,
almost loses its breath, and sometimes goes into convulsions.
  Phosphorus. When a hoarseness  remains after  croup,  and when
there is  a tendency to relapse.    Gets worse toward  evening.
  Spongia.  The  cough  is dry  and  sibilant, or it sounds like a  sa<*
driven through a pine board, each cough corresponding to a thrust
of the  saw.   Spongia  is  particularly indicated when  there  is no
mucous  rattle with  the croup.  The cough  is dry and hoarse,  and
causes pain in the throat, but no mucous rattle.
  Tartar e. When there is a sound as if a large quantity of mucus
were in the  bronchial tubes, while none is expectorated, and there
is apparent danger of suffocation.   This symptom, as if a quantity of
mucus were rattling in the Jarynx  at every coughing spell, while so
little is  expectorated, is characteristic of Tarter Emetic.

                  Hooping-Cough—Pertussis.
  Hooping-cough is  a contagious  and frequently  epidemic disease,
which at its  first onset appears as catarrhal, then  becomes nervous,
paroxysmal, spasmodic and convulsive, and  then again catarrhal.  It
particularly  attacks  little  children,  and seldom occurs twice in the
same individual.  Adults  are not always  exempt when exposed to its
influence for the first time, and it  constitutes one  of the  most  dan-
      52 
818           DISEASES  OF INFANTS  AND  CHILDREN.
gerous forms of disease  to which young infants  are liable.   At its
first appearance  this  affection  is  scarcely to be distinguished from
a  common  cold, but  when  fully developed  it is characterized by
a  convulsive cough in  which  the attacks,  occurring  at  longer or
shorter intervals, are composed of sudden, jerking and noisy expira-
tions, and followed by inspirations anxious, protracted and still more
sonorous.
   "\\ hen left to itself and uncomplicated, hooping cough runs a regu-
lar and progressive course, occupying about six weeks  in each of its
successive stages of development, persistence and decline.  But the
disorder in each case proves  more  or less  severe in  intensity and
various in manifestation  according to  the nature  of the individual
constitution in which it is implanted.  In some instances it takes no
very  severe  hold upon  the system, in others it seems to develop
organic pulmonary or bronchial  disease.   In others, again, it more
powerfully affects the  cerebro-spinal nervous  system, and terminates
in convulsions, which, arising in consequence of nervous exhaustion,
soon destroy what little strength remains.
   Like the asthma  of adults and the laryngismus stridulus of children,
hooping-cough appears to be primarily a nervous affection, which con-
sists in an irritation of certain of those motor filaments of the pneu-
mogastric which supply  the organs  of voice  and respiration.   And
the profuse catarrhal  secretion which appears in its more advanced
stage forms  a similar crisis in this  disorder and in asthma.   That
this affection is an  irritation of the motor  filaments, corresponding to
neuralgia of the sensitive filaments, and not an actual inflammation
of the nerve, may be seen from the severe functional disorders of the
parts supplied by this nerve on the one hand, and on the other from
the almost constant absence of organic lesion,  as proved by numerous
post-mortem examinations.  And, as will  appear in the  following de-
scription of  the  phenomena of hooping-cough, the nervous affection
may at the same  time produce, by spasmodic contraction, a temporary
occlusion of  the smaller  bronchial  ramifications,* and a  still more
severe contraction of the  rima glottidis.
   In spasmodic  cough spasm of the glottis forms a constituent part
of the affection.   At the onset of the attack " there is a feeling  of con-
traction and oppression of the chest, during wdiich the patient generally
seizes hold  of some firm  object; at  times there is nausea, and then
attacks of cough supervene, the expiration occurring in jerks, and in
a more or less rapid succession, introduced or interrupted by a  sudden
                   *Laennec, Diseases of the Chest, p. 101. 
HOOPING-COUGH—PERTUSSIS.
819
inspiration  with a lengthened  sound.   The respiratory muscles act
tumultuously,  the abdominal muscles  are drawn in and rigid, the
trunk is bent forward.   At times there are convulsive movements of
the extremities and startings of the whole body.  Suffocating attacks
are more violent and threatening the less the patient exhales.  The
impeded transmission of the air shows  itself in the absence of the
vesicular murmur, as well as in the phenomena attending a disturbed
state of the circulation—viz., lividity of the  tumid face, congestion of
the eyes, and ecchymosis  between the  conjunctiva and the sclerotic,
haemorrhage from the nose, the  cavity of the mouth and the bronchia.
The cough  is dry, and a little viscid mucus is expectorated with  diffi-
culty.  After a duration of from two to five minutes the paroxysm,
wliich  often consists of twro fits divided by  an interval, ceases;  it
generally terminates with  vomiting of  bronchial mucus  and of the
contents of the stomach, and at  times with syncopic exhaustion.  After
this comes a period of great repose."—Romberg.
   As the  disease advances the paroxysms  become  more protracted,
severe and exhausting; the infant becomes black in the face, and seems
to lose its breath entirely; and the characteristic whooping sound with
which the attack commences, which appears so frightful to strangers,
seems to call the attention of the mother or nurse if the child is for
the moment out of her  arms.  In the decline of  the  disease thf
symptoms may become less -violently spasmodic and more prominently
catarrhal, the catarrh becoming  in some cases so profuse as to threaten
suffocation.  In  other  cases,  from  hereditary  disposition  to  such
disease, the hooping-cough seems to  become complicated  with, or
to run into, pneumonia.   In these cases, instead of  intervals of per-
fect rest and natural respiration between the paroxysms, we find a
permanent acceleration of breathing, shortness of breath and dyspnoea,
the characteristic symptoms presented by auscultation or percussion,
a livid hue of  the lips and cheeks, incapacity for exercise or exertion,
and loss of strength.
   Hooping-cough is not a dangerous disease per se,  but it is  liable to
become complicated with certain other affections which may add to its
severity, and indeed lead to a  fatal termination, and this is particu-
larly true when the  cough  occurs in weakly and  cachectic children.
The chief  of  these  complications of  hooping-cough  are—convul-
sions, collapse  of the tissue of the lungs, bronchitis, pneumonia  and
emphysema, while tuberculosis is a  not infrequent sequent of the
disease, leaving the little  patients in miserable health, early to fall
victims to consumption.   Hence, hooping-cough is a disease requiring 
820          DISEASES OF  INFANTS AND CHILDREN.

nice and discriminating treatment.   Unfortunately, the want of suc-
cess of the allopathic school in  cutting short the disease  has led the
people to regard hooping-cough as an evil that must be endured with-
out remedy, except that afforded by time, and hence  too  many cases
are neglected.
   In children who are naturally predisposed to cerebral  disease the
tendency of the hooping-cough maybe to assume a still more strongly
marked convulsive form.   According to Watson, "when  the disease
occurs within the first two years of life it is usually attended by con-
vulsions, and many more  die within those periods than afterward."
And it is in this direction  especially that the homoeopathic treatment
will be found remarkably valuable.  The remedies greatly moderate
the violence of the disorder, even if they do not at once remove it, and
by thus shortening its paroxysms, and  rendering them less frequent
and severe, the little patient's strength  is saved.  And the remedies
carefully selected to meet the particular indications of each individual
case, at the same  time that they preserve the  strength as much  as
possible, and prevent the disease from assuming its most violent form
in general, hinder also its particular development and  complication in
new forms  of pulmonary or cerebral disorder.   In the treatment of
this affection, therefore, the homoeopathic physician should not expect
to find in   any remedy, however highly lauded, a complete  specific.
Still less should he  seek to  compel  the  disorder to succumb to the
massive doses of any such remedy.   Let him be satisfied to prescribe
for his patient, and adapt as accurately as possible the remedy to the
existing conditions.  A little extra pains  taken in this direction in the
first visit in ascertaining the totality  of the symptoms, and in finding
the true similimum for them in each case, will  save him a wrorld of
trouble in the end.   In some epidemics of hooping-cough the remedy
which is thus found suited  to the genus  epidemicus in one instance
may also apply in other cases,  but not absolutely in all, since always
and  in every instance the medicine must be made to suit the indi-
vidual patient rather  than the general form of the prevailing epidemic
disorder.

   Aconite.  If a  constant  febrile condition seems to prevail, or  if
the patient grasp at his throat with every cough, as if he were  in
pain.   In first stage,  dry and hacking.
   Arnica. Every coughing spell  is announced with crying; the child
not only cries during the coughing spell, but before its accession, as if
in dread of it.   Bloody  expectoration. 
HOOPING-COUGH—PE RT USS1S.
821
  Arsenicum.  When there is great prostration, with waxy paleness and
coldness of the skin.  Expectoration of frothy mucus, often accom-
panied with suffocative spells.  The cough is excited by drinking.
  Belladonna. The child gets very red in its face with every coughing
spell, or the cough has produced such congestion as to cause the
sclerotic to appear extremely reddened.   Sneezes after coughing.
  Bryonia. Cough worse after  eating or drinking, with vomiting of
the ingesta;  cough excited by the slightest motion.  Lips are dry
and parched,  and the child wishes to drink large quantities of water.
  Carbo veg.  Great exhaustion after every coughing spell, with  blue-
ness  of the skin, hot head and face.   Relieved by hard fanning.
  Causfcicum.  A dry cough  remains a long time; it does  not get en-
tirely well.   Especially adapted to feeble, delicate children.
  Chamomilla. The cough is dry; the child is very fretful; must be
carried in order to appease it; one red cheek.
  Chelidonium. When a very loose, rattling  cough remains a long
time, and does not improve any more.
  Cina. The  child  picks its nose  much, or  gets  perfectly rigid in
every coughing spell; ravenous hunger.
  Coccus cacti. Every coughing spell is terminated by  spitting of
large quantities of ropy mucus.
  Conium When violent fits of coughing  occur, mostly through the
night; the cough is always worse during night,
  Coralium rub. In some forms of violent spasmodic cough.   " Firing
minute guns  of short, barking cough, all day, and  for half an hour
or so toward  evening increasing to a violent spasmodic paroxysm." *
  Cuprum ac.  With every paroxysm,  the child coughs  itself into a
cataleptic  fit; it  appears as if  it were really dead.   Much mucous
rattling before each paroxysm.   Long-continued paroxysms of suffo-
cative cough.  The child wishes cold water after every coughing spell,
and seems to  be relieved by drinking the water.
  Drosera. When the child is worse, particularly after twelve at night,
with high fever ;  cough in violent spasmodic  spells  as  if it would
suffocate;  sometimes bleeding at the nose and mouth.
  Dulcamara.  The child is made worse by the changes of the weather
from warm to cold, or by exposure to  cold, damp air.
  Ferrum. Vomiting of the ingesta after every cough;  not so pro-
fusely as in a  Bryonia case, neither is there the parched lips and thirst,
but there is more palloi and weakness.
  Hepar.  When  the cough seems  complicated  with  croup;  worse
         *Dr. Richard Hughes, Brit. Jour, of Horn., No. c\., p. 501 
  822           DISEASES OF INFANTS AND CHILDREN.

. toward morning; the  cough sounds croupy, and it seems as if the
  patient would  choke  with the cough;  or choking  cough without
  having a croupy sound.  Coughs into a choke.
    Hyoscyamus.   The cough is always worse as soon as the child lies
  down, and is relieved by sitting up.
    Ipecacuanha.  Strangling  with  the  cough  till  blue  in the face.
  Much mucus in the chest.  Nausea and vomiting with  the parox-
  ysms.
    Kali bi. Choking  cough  and  spitting out tough, stringy  mucus,
  wdiich sticks to the throat, mouth and lips, and hangs down in strings
  from the lips.
    Kali C.  Sacculated swelling over the eyes in light-haired children.
    Lachesis.  The child  always awakens in a coughing  fit; it seems
  very faint and weak.
    Mephitis p. In some  forms of  spasmodic cough this remedy  is  a
  specific in many cases.
    Mercurius. The child sweats very much at night, and bleeds at the
  nose and mouth with every coughing spell.  Either by day only, or
  by night only, it has always double coughing spells, which are separated
  by an interval of perfect rest.
    Nux V.  Hard dry cough, with constipation ;  Avorse after four o'clock
  A. M.  The child becomes blue in the face, and bleeds at the nose and
  mouth.
    Phosphorus.  Much hoarseness;  almost total  loss of voice from the
  effects of the cough.  Worse toward evening.
    Pulsatilla. Cough very loose, with vomiting of mucus; diarrhcea;
  worse at night.
    Sepia. The cough is always much worse in the  morning, when it  is
  loose, and terminates in an  effort to vomit or in real vomiting.  This
  termination of a paroxysm  is characteristic of Sepia.
    Silicia.  May be useful in vermiculous  subjects, in whom Cina does
  not answer.
    Sulphur. There are frequent relapses  without  any known cause, or
  where the cause consists in exposure to cold  in  scrofulous subjects.
  Sulphur is a specific in a  sort  of suppressed cough—dry, suppressed
  and choking, without the cough being pronounced.
    Squilla. During the cough the child sneezes, waters at the eyes and
  nose; the child constantly rubs its eyes, nose and face with  its fists
  during the cough.
    Veratrum. After every fit  of coughing the child  falls over ex-
  nausted, with cold sweat on its forehead. 
LARYNGISMUS STRIDULUS.
82;l
        Laryngismus Stridulus—Asthma of Millar.
  Under the names of Asthma of Millar, Thymic Asthma of Kopp,
Laryngismus  stridulus, Child-crowing,  Spasm of the Glottis, Spas-
modic Croup and False  Croup, different  authors have described au
affection peculiar  to  infants and  very young  children, which is not
indeed very  common, but which for this  reason, from its apparent
resemblance, is apt to be confounded with croup.
  The difficulty consists  essentially in  spasm of the glottis, which
impedes respiration and occasions sonoi'ous dyspncea.   " Spasm of the
glottis occurs in paroxysms  of varying intensity, according as the
glottis is partially  or entirely closed.  The  milder attacks  are charac-
terized by a short attack of dyspnoea,  difficult  and often sonorous
inspiration, as in  apncea, accompanied  by restlessness and anxious
expression of the  face; such attacks are at first often unnoticed, as
the health of the child does not appear affected in the intervals.  A
trifling mucous rattle in the larynx sometimes  precedes.  In  the
more violent paroxysms the apncea approaches to suffocation, and the
respiration is interrupted  for  seconds, and  even  for one or two min-
utes.   The eyes are wide  open and staring, the face becomes livid and
cadaverous, the alse  nasi  and the  muscles  of  the neck act violently,
the arms are stretched out and rigid, asphyxia appears unavoidable,
when at last the air penetrates with jerks  and with a sonorous tone,
and the paroxysm  closes with a fit of crying and sobbing." *  These
attacks may terminate with  a loud sonorous inspiration, or by  a
long, deep-drawn inspiration, with a crowing  noise.   This particular
mode of termination will be seen to be  characteristic, and diagnostic
of this affection from croup, in wliich no  such  distinct remission  of
the dyspncea  can  be recognized, at least  not in true membranous
croup.
  Dr. Ley, in his very able treatise on  this disorder, f gives the fol-
lowing still fuller r§sum6 of its symptoms:  " The  essential symp-
toms, then, of laryngismus stridulus are,  sudden  attacks of breath-
lessness from partial or total  obstruction to the admission  of air into
the windpipe,  varying according to the   degree  of  closing  of the
glottis, and commonly succeeded, or at all events attended, by a sono-
rous inspiration.   Where  the  closure of  this chink is  not  perfect the
c did struggles for its breath, the respiration is hurried, the countenance
generally  bluish or  livid, the eyes staring, and each inspiration  is
attended with a crowing noise; where it is more complete—and this
   *Komberg, Diseases of the Nervous System.. [.,  p. 331.
   f An Essay on Laryngismus Stridulus, by Hugh Ley, M. D., London, 1336. 
824            DISEASES  OF INFANTS AND CHILDREN.
state at the commencement of the paroxysm, according to  my obser-
vation, is much more frequent—the function of respiration  is entirely
suspended for a while; there is an effectual  obstacle to the admission
of air, the child makes vehement  struggles,  by some termed convul-
sive, to recover its breath;  at varied intervals, from a few seconds up
to a minute, or, upon some  occasions, nearly two minutes, air is  at
length  admitted through the glottis, now  partially open, and this
rush of air, passing through a very narrow chink, produces the pecu-
liar sound.  To these symptoms not unfrequently  succeeds a fit of
coughing  or crying, which terminates the scene; or, if the glottis be
not even thus partially open, the child, at  the end of from two  to
three  minutes, at  the utmost, will die of asphyxia; pallid and ex-
hausted, it falls lifeless upon  the  nurse's  arm, and it is then that the
child is generally said to have died in a fit.
  " In the violent struggles for the recovery  of the breath to which I
have alluded  all the muscles supplied by the  respiratory system of
nerves are thrown into violent action; the eyes are often involuntarily
rolled  upward by the agency of  the trochlearis; the muscles of the
face are expressive of agony, or  occasionally convulsed; the head is
thrown back by the muscles  supplied  by the spinal  accessory nerve;
the serratus magnus is in violent  action;  the diaphragm and abdomi-
ral muscles contract vehemently, and even the  extremities  are  rigid.
With  all this, however,  the  face  is commonly pallid, and has that
lurid  tinge denominated cadaverous, and the external  veins, tinged
with highly carbonized  blood, form  long streaks upon the forehead
and temples, which continue long after the cessation of the paroxysms."
  The cause of this terrible  malady was long but imperfectly under-
stood.   Dr.  Ley,   wdiose description  of "child-crowing" we have
already quoted, published his very learned  and able monograph in
1836.  In this he attributes the malady to pressure exerted by enlarged
bronchial glands upon the pneumogastric and recurrent nerves.  This
opinion  he founded upon  actual post-mortem  examinations, and he
illustrated it  by  five lithographic  engravings from  these morbid
specimens, which show the nerves thus  flattened and compressed by
such enlarged  glands.   Dr.  F. Barrier of France, writing in  1844,
attributes  the  disorder  to  pressure  exerted directly upon the air-
passages.*  Laennec, writing in 1808, says inflammation of the bron-
  *"Bien que nous partagion l'opinion de M. Blache, qui attribute au spasme de la
glotte la dyspnee  decrite par des auteurs Anglois et Alleniiinds sous le nom d'asthme
thymique, nous dirons plustard qu'il nous repugnerait point de placer la cause de cet
asthme  dans la compression exercee par le thymus hypertrophic sur les voies aeri-
ennes."—Traite Pratique des Maladies de L'Enfance, par F. Barrier, D. M., Paris, 1845 
LARYNGISMUS STRIDULUS.
825
chial glands is very little known, and appears to be very rare.   He
6peaks of tuberculous affection of these glands, particularly in scrofu-
lous children.  Louis, in 1843, says of the bronchial glands, " These
bodies very frequently undergo  tuberculous transformation, not  only
in children in whom all accurate observers  coincide in regarding the
transformation of these organs as even more frequent than that of the
lungs."  And he states  that the  compression  of the trachea and
bronchi, causing difficulty  of breathing and swallowing,  impeded
circulation, and even fatal haemorrhage, is far from being a rare effect
of their enlargement.*
   Dr.  Marshall Hall states that the  disease may arise from affections
of the centre  of  the  excito-motory  system.  He regards it as  "an
affection of the excito-motory or true spinal system of nerves, produ-
cing in mild cases partial closing of the  glottis  and difficult inspira-
tions, while in more severe  cases the spasmodic disposition extends to
other parts  of the body—to  the eyeballs and to the flexors of the
.fingers and toes."
   From a careful study  of  the  different descriptions of the disorder
under  consideration, wdiich has indeed a great variety of designations,
but whicdi  is  commonly called  laryngismus stridulus, it will appear
that on the one hand the symptoms are so various that they are almost
capable of being distinguished into two or three different diseases, and
on the other it will appear also that the causes are no less various in
their seat and mode of action.   Thus, again, we have on the one hand
the paralysis of the trunk of the vagus and its branches, resulting from
the swelling and induration  of the parts exerting  pressure upon them:
"its conducting power is frequently impaired by scrofulous affections
of the cervical and thoracic  glands, and especially of the  bronchial
glands;" and on the other  hand spasm of  the glottis, which has  very
similar results, although under  somewhat different conditions.  That
is, it is more apt to occur in early infancy ; the attacks of spasm of the
glottis more  frequently appear  at night, on awaking from  sleep, or
from any sudden movement  or exertion;  they may often be traced to
hereditary predisposition.   This form  of  disease is  more frequent in
the city than in the country; in those who are brought up by hand or
prematurely weaned, instead  of  being  nursed; and  in  many cases it
may be seen  to  result, in some way, from  the influence  of  the  first
dentition.  In a note to one of his  lectures  Dr. West thus speaks of
this disorder:  " There is  a form of spasmodic affection of the larynx
which, under the name of thymic asthma, has attracted considerable
              * Researches in Phthisis, Syd. ed., pp. 91 and 92 
 B26          DISEASES  OF INFANTS  AND CHILDREN.

 attention among continental writers.  The spasm of the glottis, which
 is the most prominent  symptom in this affection, is  supposed to  be
 due to the pressure of the hypertrophied thymus upon the larynx, and
 the consequent irritation of its nerves."
   There can be no doubt that the  several forms of dyspncea more  or
 less variously described  under  the different names above given are
 due to pressure exerted by the  cervical glands, by the thymus o-land,
 or  by the bronchial glands, in a morbidly enlarged and indurated
 condition, either  upon   the  nerves, upon the  bronchia, or directly
 upon the larynx.  But whether in any particular case they act by
 producing direct spasm of the glottis,  through pressure upon the
 bronchus or  larynx, irritating  the peripheral  extremities of their
 nerves, or whether they cause  paralysis, by pressing directly upon
 the  vagus or one of its branches, the physician must determine for
 himself from the study of the symptoms present, Sufficient has  been
 here  stated to lead him  to a careful study of his case; to realize that
 he may have  to contend, not so  much with a temporary or accidental
 affection,  as with a disorder of a most important function—a disorder
 resulting  from  some  deep-seated,  even  hereditary dyscrasia, which
 may have been developing itself in those obscure glandular structures,
 and which only reveals itself to his observation  in its secondary con-
 sequences.
  Hypertrophy of the thymus gland  is no doubt the most  frequent  in
 earliest infancy, and this morbid condition may have originated even
 before birth.  The corresponding enlargement of the thyroid gland
 occurs later  in life, and constitutes the disorder known  as goitre or
 bronchocele.

  Arsenicum.  If there is much thirst and restlessness.
  Belladonna.  The face and eyes are very red ; the head is very hot.
  Gelseminum. Sudden and  severe  attacks of dyspnoea, with crowing
 noise, profuse perspiration and darkly flushed face.
  Ipecacuanha. If much nausea  prevails, or there is much strangling
as if from mucus.
  Lachesis. The paroxysms  recur  as  often as the  child  gets into a
sound sleep.
  Laurocerasus.  If the spells seem  to  be  excited by some abnormal
condition of the heart,
  Moschus. In cases similar to the above, but not so violent.
  Phosphorus. This remedy may be called  for in some cases of very
tall, slim  children. 
ATELECTASIS PULMONUM.
827
  Sambucus n. The child suddenly awakens, nearly suffocated; sits up
in bed and tui ns blue; gasps for breath, which it finally gets; the spell
passes off; it lies down again in bed, but to be aroused sooner or later
in the same manner.
  Stramonium. If the child seems quite delirious, does not know where
it is; as soon as it can speak it constantly calls for papa and mamma,
although they may be at the same time  present and trying to console
the child.
  In chronic cases, such as may be supposed to arise from enlarge-
ment of the cervical or bronchial glands, study  Calcarea c, Jodium,
Iodide of Mercury and Spongia.

                    Atelectasis  Pulmonum.
  The term atelectasis—derived  from  the  Greek  areX^, imperfect,
and £/fa<TfC, expansion—is  used to  express  a condition of the lungs
occasionally met with in infants, in which portions of them remain in
the  foetal  condition, having never,  from some cause or other, been
penetrated  by air.   This condition  may be due to the circumstances
attending the infant's birth, such as exposure to cold or to a vitiated
atmosphere; the casting off of the  placenta before the establishment
of the respiratory act, and a consequent lowering of the vital forces, etc.
But the disease  is usually congenital, and may be due to debility of the
infant in consequence of imperfect  nutrition in utero, or to the  dis-
eased and debilitated condition of the mother during her  pregnancy
from phthisis, typhoid fever or other exhausting disease, or from dis-
ease  of the father, such  as syphilis, which is  calculated to impress
itself upon the  child in the form of imperfect cell-development.
  The following are amongst the  most constantly present of the
symptoms that indicate the presence of atelectasis  pulmonum : " The
child  comes into the world feeble  and weak, and instead of crying
vigorously  and  loudly the moment or  very soon after it  is born, it
fails to cry at all, or the  cry is low and weak, or it is whimpering or
wailing; the color, instead of being  brick-red or dark red, is pale and
whitish, leaden  or  livid ; the muscular  movements, which in healthy
children  are strong and  vigorous, are in these languid and slow, or
there-are none or scarcely any, the  limbs being relaxed and motion-
less.   If the breathing is observed, it is found to be short, high and
imperfect, and it is  evident that the thorax is but imperfectly dilated
at each movement  of respiration.   When these symptoms  exist  in a
verv marked degree, the infant either dies soon  in a state of asphyxia,
or, the muscular force slowly increasing, the respiration gradually im- 
>28
diseases of infants  and children.
 proves, and the child is, after a longer or shorter  time, either out jf
 danger, or it falls into the same state as  that of one in whom the
 symptoms have been from the first less  severe.  Under the latter cir-
 cumstances the infant continues feeble and weak.  It breathes shortly
 rapidly and  imperfectly, but often without  any appearance  of labor!
 The cry is rare, and w hen heard is low  and  feeble, or there is a con-
 stant plaintive  moan, which is  very characteristic and  strongly ex-
 pressive of exhaustion, with each respiration.  The color continues
 pale and whitish, or it is bluish, and the temperature of the extremi-
 ties is lower than natural.  The child sleeps the greater part of the
 time, and is  unable to nurse  or nurses very feebly, but can swallow
 when food is poured into its mouth."
   In favorable cases and under proper hygienic and medicinal meas-
 ures these symptoms, after lasting a few days or  a few weeks, begin
 to improve, and the child assumes a more natural hue, breathes more
 freely and with  less difficulty,  and begins to nurse.   In unfavorable
 cases the respiration becomes quicker  and  more  imperfect, the evi-
 dences of insufficient oxygenation of the blood become more marked,
 it ceases to swallow,  muscular twitchings set in, and the child either
 dies in  convulsions or  sinks into a condition of  syncope, and  thus
 ends its life.  Dr. Rees of London, in  an  essay on atelectasis,  calls
 attention to the peculiar movement of the ribs during respiration, and
 regards it as a characteristic  symptom of the condition of the lungs:
 " During the inspiratory effort the ribs  are seen to move inward to-
 ward the mesial line of the trunk, instead of outward as in ordinary
 respiration,  thus diminishing  instead of expanding the transverse
 diameter of the  thorax.  The explanation of the altered movement is
 as follows : When the diaphragm descends the lung ought to expand
 in such a way as to  fill up the increased space produced in the thoracic
 cavity by the descent of that great muscle.   Instead of this being the
 case, however, the lung is collapsed and inexpansive, and cannot en-
 large sufficiently to fill  up the space alluded to, so that there would
 remain a vacuum in the chest were it not that the thoracic walls are
driven inward  by the pressure of the  atmosphere .upon their outer
surface."
   Treatment—In treating a case of atelectasis very much will depend,
 in securing a successful  result, upon  hygienic measures.  Everything
sin uld  be done  that will have a tendency to improve the general
health of the infant and to increase its ability  to breathe.  The room
 in which the infant is should be at all times of a temperature of about
 75°, thoroughly ventilated, and the child  should be warmly clothed and 
ATELECTASIS pulmonum.
829
covered.  Perfect rest or at most very gentle motion is very important.
It has been recommended that the infant should lie upon its right side,
with the head and shoulders elevated at an angle of 45°.   The nour-
ishment of the child is of great importance.   If breast-milk of good
quality can be obtained, and the child is  too  weak to  suck, the milk
should be drawn by means of a  pump and  given to the babe, fre-
quently and  in small quantities at  a time.   This failing, diluted cow's
milk—one part milk to two parts of water—may be used.
  Consult the following remedies:

  Aeon. Great difficulty  in  inspiring;  very restless and distressed;
easier with its head and shoulders  raised to a sitting posture.
  Bell. Face bluish-red,  or  alternating with  a  very pale face; eyes
seem injected ; respiration seems painful;  much whining and  crying;
the child seems afraid to  breathe.
  Bry. Color of the face is of a bluish-red ; great difficulty  in inspiring,
seemingly as if the lungs could not-expand, and the child is evidently
easier when lying down and when  kept very quiet.
  Camph. Bluish  color of face; the  child's surface feels very cold;
rather more  difficulty in making an inspiration; very great debility;
better when  lying down.
  China.  Face very pale;  the trouble all seems to be from the  loss of
blood.
  Cuprum. Color  of the  face bluish; difficulty of respiration; much
rattling of mucus, and rather inclined to spasms, wdiich are first seen
in the fingers and toes and extremities.
  Hyos. Bluish color of  face;  great  difficulty in inspiring;  must be
raised up; all  the muscles of the body and face incline  to jerk and
twitch.
  Phosph. Color of face is very changeable; the child is hoarse; long
and slender in its figure.
  Spong. Face reddish ; crowing respiration ;  no mucous  rattle; must
be raised up to be able to breathe.
  Tart emet. Very  pale  face; more difficulty in  expiration; head
hot and sweaty; rattling of mucus, more  in the throat-pit.
  Verat.  Face bluish; much exhaustion;  cold  perspiration  on fore-
head or other parts of the body; almost pulseless.
  Consult also  remedies  for Apparent Death, Laryngismus stridulus,
Croup, Catarrh, Bronchitis and Pneumonia. 
830          DISEASES OF  INFANTS AND CHILDREN.



                   CHAPTEE XXXVII.

          DISEASES OF  CHILDREN—CONTINUED.

                 Scarlatina—Scarlet Fever.

O CARLATINA is  an epidemic and  contagious exanthemata, cha-
*J racterized by a high degree of continued fever, a scarlet rash, and
inflammation of the tonsils and  mucous membrane of the mouth and
pharynx.   It forms  the  most terrible  and fatal scourge of infancy
and  childhood.   Its highest mortality is  said  to occur  during the
third year of life, and  under the old-school treatment entire families
of children have been swept away.   The  homoeopathic treatment of
this much-dreaded disease  renders it far less fatal.   In fact, from all
but the more malignant  forms of scarlet fever  the danger of a fatal
termination seems almost  wholly removed.   Still, the cases of this
latter variety, and even  others  of less original severitv, require  for
their successful  treatment the utmost patience and skill  on the part
of both physician and nurse.  This is due in  part to the unsteady
and even treacherous nature of the disease itself in the  severer cases,
and to the  serious complications  which may arise during its progress,
and in part to the sequelaB which may change an apparently favorable
convalescence, even in  milder cases, to a newr and still more dangerous
form of disease.
  Scarlet fever has usually been divided into three varieties—Scarla-
tina  simplex, Scarlatina anginosa and  Scarlatina maligna.  But this
difference in degree of the severity of the disease, whether confined to
particular cases  or extended  to  epidemics, is of little practical value.
A more  simple classification consists  in  a twofold division—viz.,
Scarlatina  Sydenhami and Scarlatina  miliaris.  Perhaps  the best
classification  of all would  be into  mild and grave cases, according
to the  degree of severity of the attack  and the character and extent
of its concomitants and complications.
   The scarlet fever  of Sydenham, the  true Belladonna scarlet fever
of Hahnemann, is now comparatively rare.  But it  is important to
distinguish it wdien it does appear from  the more common scarlet
fever, if for  no other  reason than because the prophylactic  use of
Belladonna, so  strongly recommended by Hahnemann and proved so
wonderfully  efficacious in  the former  variety, is  of no avail in  the
latter  form.   The  true  scarlet fever  of  Sydenham,  the Scarlatina
I 
r
                 SCARLATINA—SCARLET FEVER.               831

laevigata, or smooth scarlet fever of some authors, runs a compara-
tively regular course, and is much  less disposed to strike  in  and
occasion dangerous metastases than is the other variety.  This latter
and more  common form of scarlet fever is  at once  more insidious,
more treacherous and vastly more dangerous than the former.   In its
severer forms  it is always impossible to tell how much more of the
malignant element  may yet  remain behind  and  waiting  for the
favorable  moment—of  convalescence even—for development;  and
in the milder cases we  know  not what an hour may bring forth; the
eruption, apparently well out, may suddenly recede without apparent
cause, and the most  critical and alarming symptoms replace a  con-
dition which had been encouraging and satisfactory.
   Scarlet  fever is the popular name  of a disease  which is developed
from an epidemic and infectious  poison.  Children who have not had
the disorder will rarely escape taking it from visiting a house where
it prevails, or even where it has recently prevailed; and children in
houses miles away from any  others, with no direct communication,
are stricken down with the disease, the infection being  conveyed by
the wind  for  long  distances across the country.   This disease  con-
sists, then, in the development of a peculiar poisonous miasm, princi-
pally upon the skin, where  the eruption forms  a salutary crisis of
the fever.  With this  development upon the skin there  may also be
a development upon the mucous membrane, which becomes  more or
less deeply and extensively involved  in proportion to the malignancy
of the morbid influence by  which it is caused; and finally, failing
this sufficient development upon the  skin, in the fauces, nostrils, etc.,
or deserting  the skin, the disease may attack  the  meninges  of the
brain,  producing convulsions necessarily fatal  unless  relieved  with
the utmost promptitude.  As a  consequence  of the  ravages made by
this disorder in the system—ravages which  are dreadful just in pro-
portion to the amount  of pre-existing psoric dyscrasia which the
scarlatina poison  finds and with which it unites  itself—all the latent
psoric  miasm in  the system  is developed, and there results a post-
scarlatina dropsy or some form of "scrofulous" disease.
   Symptoms.— Vomiting or nausea is very frequently the first symp-
tom wdiich indicates the onset of  either variety of scarlet fever; and
we think a malignant form of the disease, and especially of the scar-
latina miliaria, may be apprehended when the vomiting is very severe
and persistent.  In other respects, the more generally the eruption is
developed over the entire surface of the skin the less apt is the throat
to become seriously affected;  for in all but the worst cases the disease 
832           DISEASES OF INFANTS  AND CHILDREN.
thus seems  in a measure to expend itself upon the exterior surface;
while the mucous  surface, the throat and nostrils  are  apt to become
the seat of the development of the disease in proportion as it fails to
be sufficiently developed  upon the skin.  And yet in  the malignant
forms of the disease the eruption  involves the entire surface, and in
the worst cases assumes a livid hue, while the  fauces and nostrils are
affected to the extent of ulceration, putrid exudations, gangrene, and
sloughing of the swollen and  compressed portions of the tonsils, etc.
This is the old scarlet fever and canker-rash, or Cynanche maligna.
  The fever which forms the continued  crisis of the eruption is cha-
racterized by being steady and  almost  uninterrupted  in its course,
gradually increasing till  the  eruption is well out;  continuing with
little or no abatement during its continuance, and in favorable cases
gradually subsiding as the  eruption itself gradually  fades awyry.
The pulse also  maintains a corresponding uniform height, showing
scarcely any of the  decline and aggravation, day and night, which is
common to  true synochal  fever.    Many of the other symptoms, as the
nervous restlessness, may be relieved by the accession of the eruption;
but  the  fever itself holds on its steady course of intensity, until at
the  full term  the  appearance and continuance  of the efflorescence
gives place to its decline.  And  even then, in badly managed cases,
instead  of sensibly  abating, the  fever may take a fresh start under
the typhoid form.
  The eruption in the smooth variety  is a mere blush of efflorescence,
a redness of the skin which, beginning about the face and neck, grad-
ually spreads over the whole  surface of the body and of the extremi-
ties.  This full development of the eruption is only arrived at by the
third day,  and a similar redness may  be seen  in the mouth  and
fauces, and even in the nostrils.   The eruption in Scarlatina miliaris—
the  more common  form  of the  disease—gives a  perceptible rough-
ness of the skin,  and a sensation  as if its surface  were  covered with
minute  granules.  This is caused  by an enlargement of the cutaneous
papillae, and is more evident on the extremities and  front of the
body.
   On the fourth day the eruption is at its height; and even after the
rash has extended  pretty  generally over the  surface of the skin,  it
will come out much more fully and assume more and more the boiled-
lobster  appearance,  both in color and in the  sensation  of roughness
which it imparts to  the applied hand.   On the fifth, sixth and seventh
davs the eruption declines, first  remaining  stationary  a day or so, or
commencing very gradually  to fade  away.  In  favorable  cases the 
SCARLATINA—SCARLET FEVER.               833
 decline corresponds to  its original  mode  of appearance, but in the
 reverse order, gradually disappearing in a uniform manner, and  from
 the extremities first,   Next  succeeds desquamation  of the cuticle, a
 process wdiich often occupies many  days before  it is  completed.  It
 generally commences about  the seventh  day, though it  may begin
 either  earlier or  later.   It usually occupies ten or twelve days, but
 may be  greatly prolonged.  During the stage of desquamation the
 urine becomes  more abundant, pale, and has a faintly acid  reaction.
 Albuminuria is also frequently observed during desquamation—more
 frequently in fact than during  the eruption.  Scarlet  fever is a  very
 uncertain and treacherous disorder.  All may be going on well when
 at once  some untoward change, some unlooked-for  and dangerous
 symptoms may arise.  Sudden fading away of the eruption in different
 parts of the body, its  partial recession, its premature decline or In-
 creasing lividity—symptoms wdiich may occur in apparently favorable
 cases, but wdiich are more apt to appear in  the malignant forms of the
 disease—will necessarily awaken the greatest anxiety, and the remedy
 should  be at once  most  carefully selected  to  meet the  imminent
 danger.
   The tongue affords some very characteristic indications in scarlet
 fever of either variety, since, as will subsequently appear also in the
 fauces, the mucous  membrane develops an appearance corresponding
 to that of the external skin.   We give Dr. Watson's concise descrip-
 tion of  what, in different degrees of intensity, may be always seen in
 this disorder: "The appearances of the tongue in  scarlet fever are
 also peculiar and characteristic.  In the  scarlatina simplex  and an-
 ginosa it is often covered at the outset with a thick white, cream-like
 fur, through which are seen projecting  the red  and exaggerated
 papillae, the edges of the tongue being likewise of a bright-red color.
 The red points gradually multiply, and the white  fur clears away, and
 at length the whole surface of the tongue becomes preternaturally red
 and clean and raw-looking, and after becoming thus clean, as well as
 red and rough, and like a strawberry, it will sometimes, when the
 disease goes on unpromisingly, get dry and hard and  brown, as  yon
 know it is apt to be in certain species and stages  of continued fever."
 In the milder as well as in the  severer  cases of the disease the tongue
 and fauces should always be inspected at each visit.
  The fauces present a still more striking resemblance to the eruption
 on the  external surface.  If  able to  speak, the patient will complain
of soreness of the throat, and upon examination will be found a greater
or less amount of  swelling, with redness  of  the tonsils, uvula  and
       53 
834           DISEASES OF INFANTS  AND  CHILDREN.

palate, either smooth and bright red, corresponding to a similar erup-
tion on the skin, or rough and granular, of a darker color or dusky
hue, corresponding to the accompanying external scarlet rash.   After
the first day or two the tonsils and uvula may be seen to be covered
with a whitish exudation, or gray, aphthous  formations, like  false
membranes, which, being removed, leave an ulcerated or sloughy sur-
face.  The tonsils,  uvula and palate are  very  much  inflamed and
swollen,  but  the  aphthous  or false-membrane-like formation which
covers  them, although it  may extend to the nares, and even in some
measure  involve  the oesophagus, does not affect the  larynx; in this
important respect differing from the more firmly organized exudations
of croup and  diphtheria.  Frequently, as  an accompaniment of bad
cases, we have inflammation and swelling of the submaxillary glands
and considerable oedema of the surrounding cellular tissue.  This en-
largement sometimes becomes very great, and  of course adds to the
already existing  difficult deglutition,  and,  in  such cases, where the
pressure  is great,  to difficulty of breathing.
  The  skin becomes dry and hot in proportion to the  intensity of the
fever;  the pulse is quick and hard, varying from one hundred to one
hundred  and fifty per minute, according to the  severity  of the case
and the age of the patient. The thirst is  not remarkable; the appetite
is of course lost, and the bowels are usually bound up, or, if they are
opened, the stools are  observed to be of a much  darker color than is
natural.
  The  temperature  in  scarlet fever is not nearly so high as might be
supposed, ranging between 100° and  106°.   " In  thirty cases reported
by Ringer {Med.  Times and  Gaz., Feb. 15,  1862) the temperature
remained at the  same point throughout the day in the more severe
attacks;  in slighter  ones  it fell in the morning and rose during the
day, being most frequently at its highest point between two and eight
p. m.   When the morning remission was marked,  it indicated the ap-
proach of a favorable termination.  The first decided fall  of tempera-
ture, coinciding with a diminution of the  eruption, occurred in the
majority  of cases  on the fifth day, or if not  on the fifth day it usually
was deferred  until the  tenth or fifteenth.   In these latter  cases, how-
ever, a  fall of varying extent had occurred on the preceding fifth days.
After the marked fall on the fifth, tenth  or  fifteenth day the tempera-
ture  remains from 99° to 101° for  a variable time, coinciding when
persistent with continuance  of the angina  or some one of the other
lesions of the disease.  If at any time after the  complete fall of the
temperature there is any considerable  elevation again, it indicates the 
                 SCARLATINA—SCARLET  FEVER.               835

development of some sequel, either an affection of the kidneys, throat
or one of the serous membranes.  It is thus seen that the temperature
in scarlatina tends to  form  arcs  or cycles, usually of  five days'
duration."
  The preceding account of  the natural history and principal  and
most characteristic symptoms  of scarlet fever has reference rather to
those  cases of the ordinary severity.   In those which run a  regular
course and terminate favorably, the eruption consumes three  or  four
days  in reaching its height, remains  apparently stationary a day or
two, and then in the course of  three or four days more gradually fades
away, so that by the eighth or ninth day the period of desquamation
will have been reached, and this may consume an equal or still greater
amount of  time  in proportion  to the severity of the case.   And until
this process is entirely completed, and  the old  cuticle, destroyed by
the intense cutaneous inflammation, is replaced by new skin, it will be
absolutely essential to have the patient very carefully watched over to
guard him from any  exposure, which  even  in comparatively mild
cases  might be  rapidly followed by a new and still more dangerous
disease  in  the form  of some  one of the  various sequelae of scarlet
fever.
   In  that  condition  of the disease which  has been designated Scar-
latina anginosa  the principal  force  seems  to  be expended  in the
throat,  Hence  all the throat  symptoms  are rendered much more
intense  and painfully severe than in  the simpler and more common
form  of scarlet fever.  The general fever, and especially the eruption
upon  the skin, are much less strongly marked.  "Almost from the
commencement  of the attack  soreness  of  the throat  is  experienced,
attended with difficulty  of deglutitfcm, and often with considerable
stiffness of the neck, and pain and difficulty in moving the lower jaw,
clue in part to the swelling of  the submaxillary glands.  On examin-
ing the throat, it is seen to be intensely red, and the  tonsils  are red
and swollen.   The swelling of the tonsils increases rapidly, until  they
almost blocl^up the entrance  of the pharynx, and thereby render the
attempt to swallow so difficult that fluids are  often returned by the
nose.   An adhesive mucus collects about the back of  the throat, and
often  seems to cause great annoyance  to  the patient, and specks or
patches of  lymph form upon the tonsils, and look like sloughs cover-
ing ulcers.   In some  of the severest  cases a very troublesome coryza
comes on, and an adhesive yellowish matter is  secreted in abundance
by the mucous membrane of the nares, whence it runs  down upon the
upper lip, excoriating the skin  over which it passes, and causing still 
836
DISEASES OF INFANTS  AND CHILDREN.
more serious suffering by the obstacle that it presents to free respira
tion."— West.
  In addition to these symptoms  the  ears also become  affected from
the extension of the severe  inflammation along the course of the
Eustachian  tubes;  there is very great deafness, followed by copious
and  acrid discharge from  the external  meatus.  Even  the mastoid
process of the temporal bone becomes  carious.
 " When the throat thus becomes  the principal seat of the disease the
eruption does not appear so regularly or so seasonably  upon the ex-
ternal  surface.   It  is often delayed till the third or  fourth  day, and
generally comes out in scattered patches on the chest and arms.  In
some cases it is wholly confined to the back of  the hands and wrists,
and sometimes  entirely vanishes the day after its  appearance, and re^
appears partially and at uncertain times.   About the fifth  or  sixth
day it.  begins to decline,  following the same order in its decline which
it had  previously observed in its appearance, subsiding first  on  those
parts which it had primarily occupied.   Desquamation of the cuticle
follows the disappearance of the rash, unless the latter has been very
slight; and the fever and inflammation of the  throat begin to  abate
with the fading of the eruption, though sometimes the sore throat and
some degree  of fever continue for a week or ten days after the rash
has entirely disappeared.  All these symptoms, in their severity and
persistence, are capable of being  very much modified by the use of
the appropriate remedy.  Our object  here is  simply to portray the
natural order and  the progress  of the disease when not interfered
with, and yet it  must be remembered that they naturally present a
very great variety,  in different persons, as  regards their severity and
their mode of combination.     •
  In Scarlatina maligna all the  symptoms may be  said in general
terms to be simply much more severe than  in the milder forms of the
disease, the principal distinction being rather of degree than of  kind.
Still, a brief account of such cases  may be useful.   The rash is ex-
tremely irregular, both in the time of its appearance and in its duration,
and also in its extent.  It often comes out at a later period of the dis-
ease, disappears after a few hours, or  suddenly vanishes, to be  again
and  again renewed  in the course  of the disorder.  Its color may be
paler than in milder cases, or in irregular patches it may assume a
livid hue;  in the course of the disease in its worst varieties  petechiae
may also appear on the  skin.  Soon after its  first onset " the  fever
assumes a typhoid form, the heat of the skin is  less intense, and there
is  great disorder of the functions of  the  sensorium, with small, fre- 
                 SCARLATINA—SCARLET FEVER.               837

quent and often irregular pulse.  There  is at the same  time a dull
redness of the eyes, with a dark-red flush on the cheeks ; the patient
is restless, fretful, and at times delirious; tht delirium is sometimes
violent,  but more generally it  is  of a  low,  muttering  kind.   The
tongue quickly becomes dry and brown, or red, dry and  glazed, and
often so tender and chapped that a slight touch causes it to bleed ; the
teeth  and lips  are covered with sordes, and the  odor of the  breath
is extremely foetid.   The throat  has a dusky-red appearance;  there is
not much swelling, but dark incrustations form on the velum, uvula
and tonsils, which are not, as has  been  generally supposed, sloughs,
but merely exudations of  lymph or false membranes.  In some cases,
however, there is a gangrenous inflammation of these parts, which are
destroyed by the  sloughing which succeeds.   There is at  the same
time acrid, excoriating discharge from the nostrils, and a viscid secre-
tion  from the fauces, impeding  respiration and producing a rattling
noise.  In severe cases  the  inflammation  extends to the posterior
pharynx,  which, though  not  much swollen,  is so irritable that on
attempting to swallow fluids they are rejected through the nostrils.
The inside of  the lips and cheeks is frequently covered with aphthae,
and the cervical and  submaxillary  glands  become inflamed, abscesses
occasionally forming in them and in the  surrounding cellular tissue."
in many cases  of this malignant form a fatal termination  comes on
the third or fourth day, the  little sufferers appearing to  sink under
the general malignant influence.  Scarlet fever without the eruption, in
which the entire force of the disorder  is  expended upon the  mouth
and fauces, is of no uncommon occurrence; some  instances have been
known in which those who have thus had the throat affection without
the eruption have subsequently had the scarlet fever eruption without
the throat affection,  the same poisonous influence appearing  capable
of developing  either the one or  the  other affection exclusively or
both together, according to the state of the patient's system.  But in
this, as in the other forms or varieties of  this disorder, the true phy-
sician will seek to adapt the individual remedy to the particular condi-
tion of each individual patient.
  Treatment.—Select the remedy to meet the condition of each indi-
ridual patient according to the indications given below, and com-
pare also the  medicines  subsequently indicated  under  the Various
Sequelae.

  Aconite. When there  is much distress, restlessness,  heat, thirst and
sleeplessness ; the rash is not smooth.  Aconite relieves the excitement 
 O'M           DISEASES OF INFANTS AND CHILDREN.

 of the  system, both  nervous and  sanguineous, and  at the same time
 promotes the development of the eruption.   Miliary rash, of a dark-
 ish hue;  there is evidence or expression of fear.   The patient does
 not wish  to be alone; red  face, which turns pale on rising.
   Ailanthus gland. The rash is of a brown  appearance and is miliary,
 covering  the entire body or appearing in patches here and there; well-
 maiked delirium; more or less stupor; great debility, the patient bein<*
 easily exhausted; great thirst, the tongue and lips being more or less'
 cracked;  the teeth are covered  with a  brown slime, or  sordes; the
 skin  may be very  hot or feel rather cool to the touch;  pulse very
 rapid and small.   The color of the rash and the exhaustion are the
 most characteristic symptoms oF  this valuable remedy.
   Ammonium carb.  When the rash continues  out longer than the or-
 dinary  period, and there  is tendency to  gangrenous ulceration of the
 tonsils, or enlarged tonsils, of a bluish appearance, and  accumulation
 of  much  offensive mucus there.   The rash is only faintly developed,
 with drowsiness,  stupor, dry mouth and burning pain in the throat.
   Apis. At  the onset, when there are stinging pains in the sore throat,
 absence of thirst;  the rash is characterized  by red spots or points dif-
 fused here and there  over the body; scanty  and high-colored urine;
 considerable  dyspnoea; great restlessness  and  uneasiness;  sudden
 sharp outcry during  sleep; squinting;  skin  has a  bloated, swollen
 appearance,  and may be either hot or cold;  the  rash may have dis-
 appeared  suddenly, leaving the above-described red  spots or points;
general dropsy seems  imminent,
  Argentum nit. Bluish or  blackish  eruption, with convulsions, with
great restlessness and  tossing about preceding every convulsion;
emission of a large amount of flatus,  which passes off, together with a
quantity of  greenish slime.
  Arnica.  In  typhoid  states, with epistaxis, or haemoptysis, aggra-
vated by coughing; or when ecchymoses of various colors appear on
different parts of the  body, or even small boils.
  Arsenicum.  The rash may be pale or  petechial and  attended with
dyspncea.   The eruption  has disappeared  too quickly, and there is
rapid prostration and sinking, or the throat becomes putrid with the
same  circumstances as  under Aconite.   Thirst for  frequent sips of
water;  great  restlessness and marked exhaustion after every move-
ment.   The surface is usually  cool;  sometimes there is  a cold sweat;
the patient does not wish to be covered.   Pulse weak.
  Arum tri.  The lips, corners of the mouth and perhaps the nostrils
 are raw and  bloody, and there is an  apparent tendency  for this state 
                 SCARLATINA—SCARLET  FEVER.               839

of things to increase in depth and circumference.   There may also be
a profuse (acrid) discharge from the nose.   The throat  becomes ex-
tremely sore and excessively  putrid, and  the fever  very persistent.
In such cases (of Scarlatina, maligna) the Arum is the only remedy.
  Aurum.  Fcetid discharge of mucus from the nose;  or  for otorrhcea
of a similar nature, especially if bones,come from the ear.
  Baryta c. Where  the  sore  throat is pale,  instead of  having the
bright redness of Belladonna; the submaxillary and parotid glands
are swollen and  tender; the  breath is putrid; the child scrofulous
and dwarfish.
  Belladonna. In the true Sydenham scarlet fever, where the eruption
is perfectly smooth  and truly scarlet;  or  scarlet fever in any form
with the following symptoms :  Eyeballs red and injected;  the skin is
so hot that it imparts  a burning sensation to  the  hand; much de-
lirium; the child jumps up in the bed, and often wants to walk about
while yet asleep; jerking of the muscles;  throbbing of  the carotids ;
bending of the head backward ; lips, mouth and throat very red; dif-
ficult deglutition; the child moans, whimpers and worries.
  Bryonia.  The rash does not come out fully—it seems pale; there are
frequent attacks  of dyspnoea; nausea and faintness on  sitting  up;
constipation; parched lips.  There is great thirst;  the  child grasps
the glass  and drinks with great  eagerness and  in  large  quantities;
although somewhat restless, the child is disposed to keep still, because
it then feels better.   The  rash may have receded and left the above
symptoms.
  Calcarea  C. In cases of scarlatina where  the temperament is  leuco-
phlegmatic, the nose sore and  obstructed; the glands of the neck arc
sw'ollen; slow fever, especially worse in the  evening; the child ap-
pears pale and languid—does not  seem  to  convalesce.   The  face
seems bloated and free from the rash.   The throat is much inflamed,
with patches on the tonsils; great anxiety and oppression, as  if the
lungs were giving out, with loud mucous rattling.
  Camphor. Extremities  cold  and blue; rattling in  the throat; hot
breath; hot sweat  on  the forehead,  and  the  child refuses  to be
covered.
  Carbo veg. This remedy should be considered when the soreness of
the thropt continues after the disappearance of the eruption.  Putrid
sore throat; sloughing away of some, of the swollen parts of the fauces.
Rattling in the throat;  rapid sinking of strength ;  cold breath; cold
extremities, covered with a sticky sweat, yet the  child may wish to be
fanned. 
   840          DISEASES OF IN FA MS  AND CHILDREN.

     Chamomilla. The child is exceedingly troublesome, and  must be
   carried up and dowm in order to be relieved.
     China. In  cases threatening to become anaemic, with diarrhoea or
   lienteria and other symptoms  of the remedy in a marked degree.
     Cina. The  child bores with its fingers in its nose;  ib very fretful,
   so  that  nothing  pleases it;  the  urine  turns  milky on standing;
   colicky pains;  the child is almost constantly hungry.
     Coffea. In  some cases of extreme wakefulness it may aid in  bringing
   out the eruption, where, from the predominance  of the symptoms of
   nervous excitement  over those  of sanguineous excitement, it may
   appear indicated, rather than Aconite.
     Colchicum.  In cases where there is  bloody  urine, or urine looking
.   very black and containing albumen.
     Conium.  In cases where the  parotid and submaxillary glands are
   swollen and hard as a stone; the lips and teeth are covered with black
   crusts; the skin is hot, and the  patient delirious or senseless.
     Cuprum acet. When repercussion of the eruption or metastasis of
   the disorder to the brain has  occurred, and there are convulsions,
   vomiting or  gagging; face pale and twitching; much restlessness,
   tossing and  turning;  stupor  and delirium, threatening paralysis of
   the brain.
     Dulcamara. This remedy may  be called for when suppression of the
   eruption has been caused by exposure to cold and damp air, unless
   some particular symptoms should require another medicine.
     Gelseminum. Great nervous  excitement; cold hands  and feet; crim-
   son flush of  the face;  the tonsils are swollen and very red;  the pulse
   is very rapid.  There is  not the heat of surface nor  the jerking of
   muscles indicative of Belladonna.
     Hellebore.  When a dropsical condition attends the scarlatina, and the
   urine is  scanty and dark-colored, and  deposits a sediment resembling
   coffee-grounds;  terrible headache; dilated pupils.
     Hyoscyamus.  There may be  stupidity, drowsiness or  vacant staring;
   indistinct speech, answering  no questions; or there  may  be great
   nervous excitability,  illusions of the  imagination, indistinct mutter-
   ings;  mouth dry and red, inability to swallow; the abdomen is tym-
   panitic ; the  stools pass involuntarily and unnoticed; rolling of the
   head from side to side; twitching and jerking of single muscles  here
   and there over the body,  indicative of oncoming spasms.
     Ipecacuanha. Constant nausea and occasional vomiting.
     Kali carb.  When the right parotid gland especially is swollen ; high
   fever  and restlessness; the symptoms are aggravated about  three 
SCARLATINA-
.—SCARLET FEVER.
841
o'clock  in  the morning; dryness  of the  skin;  sacculated  swelling
above the upper eyelids; stitching or sharp shooting pains.
  Lachesis. Scarlatina  maligna, with  external swelling: of the neck
and glands, and great sensitiveness to pressure of these swollen parts,
so that ths slightest touch  seems to be perfectly unbearable; even a
light and thin cloth cannot be tolerated about the throat; the sore throat
and the  membranous deposit, if there be any, commence in the  left
tonsil and spread toward the right; the urine is very dark-colored.
  Lycopodium. This medicine is sometimes indicated at the commence-
ment of the disease when the sore throat begins on the right side and
spreads toward the left.  Stuffing of the nose; rattling in the throat;
stupidity;  the  child is very unamiable on getting awake; it kicks
off its coverings and behaves in an angry manner;  the eruption is of
a dark-red color, and is sometimes found  only on the hands, face and
back ;  urine scanty, dark-colored and frothy.
  Mercurius sol.  The mouth is sore and studded with small vesicles.
Ulcerated throat; the mouth and tongue are very moist; dirty-yellow
coating on  the tongue; the  breath is  excessively foul-smelling; great
thirst; swelling of all  the  glands of the neck; ptyalism: hawking
and spitting;  itching and  restlessness;  the  perspiration  seems  to
make the child feel worse.
  Mercurius prot. Useful in some  cases  where the angina is very
intense;  or where it does not suit to give Merc. sol. or viv., although
indicated;  or, again, where  there has already been an abuse of mer-
cury.   It also  follows well after Lachesis, after the efficacy of  that
remedy appears to be spent.
  Muriatic  acid.  The rash assumes an intense redness all over  the
body, accompanied with great  drowsiness;  or the eruption may  be
scanty and interspersed with petechise; the face is of a dark-red  hue,
the rest of  the body purplish ;  great anxiety and restlessness; aggra-
vation of the symptoms in the evening.  The fauces have a dark-red,
or rather bluish-red, appearance, and are extremely sore; foul breath;
acrid discharge from the nose, excoriating the nostrils and upper  lip;
much sighing  and groaning; the patient has a constant tendency to
slide down in the bed, getting lower and lower down toward the foot.
  Nitric acid. The eruption  presents  a fine miliary appearance;  the
skin is very hot; the breathing intermits;  the tonsils are swollen and
very sore,  and  there is great difficulty in  swallowing; the angina
seems to  extend up into the nares and nostrils, and a thin purulent
matter is discharged therefrom; the tongue is dry and  cracked.
  Nux vom. The mouth and fauces are full of small and fcetid ulcers; 
 842           DISEASES OF INFANTS AND CHILDREN.

 the mouth is  particularly sore, with  flow of bloody  saliva and diffi-
 cult deglutition.
   Opium. The brain  seems to be  oppressed; extreme drowsiness •
 stertorous  breathing;  vomiting; convulsions, with coma and stertor-
 ous breathing continued between the spasms.
   Phosphorus.  Indicated when the eruption suddenly disappears with-
 out apparent cause.   It is likewise  useful after Muriatic acid, when
 the  chest  symptoms become very alarming.   The  patient seems to
 sink into an apathetic mood, wants  nothing  and cares for nothing;
 nevertheless there is much restlessness.
   Rhus tox. When the rash  itches violently, and there is much rest-
 lessness at night;  or when there is  an ichorous or thick and yellow
 discharge from the nostrils, with swelling of the glands of the throat.
 Rhus becomes especially serviceable in some cases after the third day,
 when perhaps the fever is still rising or increasing; the tongue gets
 red and  smooth, and the patient becomes drowsy and delirious; must
 change  the position every few minutes, especially during the night;
 the scrotum and penis become swollen; swelling of the parotid  gland,
 which suppurates  and discharges  profusely, often on the left side at
 first, and subsequently on the right.
   Silicia. Where there is marked glandular involvement and suppura-
 tion.  (See indications for this remedy under Scrofula.)
   Sulphur. Is especially adapted to children of psoric diathesis who
 are prone to  skin  affections.  The patient  lies quietly, in an uncon-
 scious condition, and apparently sleeping.   The rash appears faintly,
 and the skin is sometimes hot and itching; the heat seems to come in
 flashes, when the clothing is thrown  off.
   Zinc. Retrocession of the eruption; the child lies motionless and
 unconscious;  involuntary  jerking  and twitching  of the muscles;
 grinding of the teeth; screaming spells ; loss of speech ; occiput very
 hot and  forehead  covered  with a cold perspiration; the  face is dis-
 torted ;  body  and  limbs are cold and of a bluish-red hue;  pulse
 thread-like and difficult to count.

                Dropsy after Scarlet Fever.
   The most common  of the sequelae of scarlet fever  is the dropsy,
thence called  post-scarlatinal dropsy.  This affection is  remarked to
succeed as  often to the mild as to the severer forms of scarlatina, and
sometime6  forms a disorder  more dangerous  than the original affec-
tion.
   The dropsy usually appears  first  in  the  face, eyelids,  hands and 
DROPSY AFTER  SCARLET FEVER.              843
lower extremities, but gradually becomes  a complete anasarca, and if
not arrested in its progress involves  the different serous  cavities.  In
these  latter it may cause  copious effusion—a condition  more or  less
imminently dangerous according to the particular cavity which is thus
affected.
  The post-scarlatinal dropsy generally comes on in ten or twelve days
from  the disappearance of  the rash, but its approach  is sometimes
earlier and sometimes later.  The appearance of the disorder, in some
cases, may be announced by a certain paleness of the countenance, in-
creasing languor, loss of appetite, furred tongue, costive bowels, scanty
and turbid  urine, and considerable  gastric disturbance.  But in  the
majority of cases the dropsical appearance in the face attracts atten-
tion before any complaint is made of the other symptoms. The swell-
ing, beginning on the face and hands, may be confined to these parts,
but in most instances it  gradually extends  till  the whole  body  be-
comes cedematous.  A puffy or swollen appearance in the lumbar re-
gion,  over the kidneys, should  be regarded as  indicating a  very seri-
ous form of the disease.   So long as the dropsical effusion is confined
to the subcutaneous cellular  tissue, there  is little immediate danger,
but when the effusion has taken place into the cavity of  the abdomen
[ascites), into the cavity of the chest {hydrothorax), or into  the ven-
tricles of the brain {hydrocephalus), the danger will be  very great, and
successively greater in a constantly increasing ratio in these successive
states.  In the  last-mentioned stage of the dropsy, that in wliich  the
head has become involved, we find drowsiness, coma or convulsions.
These fatal symptoms  may result from  the simple  pressure of  the
effused fluid in  the  ventricles upon  the cerebral substance,  from
ursemic  poisoning, the result of a suspension of  the function of  the
kidneys, or from  the combined  influence of both these causes.
  The condition and appearances  of  the urine are very  strongly
marked  and important in  this disorder.  In the  milder  cases  the
urine  will  usually be found  albuminous; this condition may be  de-
tected by boiling or by the addition of nitric acid.  " If the attack
be  more severe, the urine, which  is very scanty, is of a brown  or
smoke color, deep red or coffee-colored,  and  throws down  a deposit
chiefly of  a reddish-brown color,  which,  however, does not  entirely
disappear when  heated, while albumen is present' in it in  extreme
abundance.  It is to the presence of the coloring-matter  of the blood
that this dark hue of the  urine is to  be attributed, but in some  in-
stances blood is present in great abundance, and for a season the case
b strictly  one  of hsematuria.  Usually,  though  not invariably,  the 
844           DISEASES OF  INFANTS AND CHILDREN.
presence at any time of a large quantity of blood  in the urine indi-
cates a very serious disturbance of the'functions of the kidney, and
forebodes a slow and  imperfect convalescence.   On the other hand
extreme degrees of anasarca and hsematuria are by no  means gene-
rally associated, nor docs the  complete disappearance of the blood
from the urine constantly imply a corresponding improvement in the
patient's  general  condition."—West.  Urine  copious  and  red  as
madder  dye  may be  a  critical  symptom  of  convalescence  under
the severe and  aggravating action of  large doses  of homoeopathic
medicines.*
  The causes of post-scarlatinal dropsy are usually supposed to be
found in some undue exposure to the air, or in some similar influence
of a change of the  weather upon the tender skin.  The desquamation
of the cuticle itself, by interfering very considerably with the excretory
action  of the skin—if not  for the  time  totally suppressing it—no
doubt throws upon the kidneys a  double burden—a burden  greater
than they can bear; hence the serous accumulations in the cellular
tissue,  and subsequently  in  the great (serous)  cavities of the body.
With this the constitution, as psoric  or otherwise, of the  individual
patient, has doubtless  much  to  do;  and since this  sequela makes its
appearance more frequently after the milder than after the more ma-
lignant cases of scarlet fever, it  is supposed by some that it constitutes
an ultimate and necessary development  of the poison, which had not
been sufficiently eliminated by the  eruption upon the skin and by the
accompanying affection  of  the mucous membranes.  But, however
this  may be, there  can be no doubt  that in most  cases the  careful
treatment of the original disorder with the appropriate homoeopathic
remedies—especially the antipsoric—will almost entirely remove the
disposition to the subsequent dropsy.  It should not be forgotten in
this  connection—and it may be offered in support of the above-men-
tioned  opinion—that the  post-scarlatinal dropsy is but an after-part
of the original fever in some cases—that some epidemics of scarlet
fever are  remarkably characterized by a disposition to be followed by
dropsical effusion;  yet the physician  cannot be  too  particular  in ex-
plaining the importance of keeping a child convalescing from scarlatina
sufficiently clothed  to  keep  it warm, and insist upon  it that  such a
child shall be kept from  all exposure to cold, damp }r  draughts of
air.  Many little ones, recovering nicely from the disease, have been
absolutely killed by the  carelessness of  parents or the  neglect of
  * See Am. Horn. Review,  1860, vol. ii., pp. 337 and 433, for detailed  cases of this
disease. 
DROPSY AFTER  SCARLET FEVER.
845
physicians in warning them of the dangers resulting from exposure
to cold under such circumstances.
  Treatment.—This affection, except in the very last  stage, when not
only has the worst form  of effusion  taken place, but when even the
kidneys themselves have already become disorganized, yields to the
homoeopathic remedy in  the most grateful  and admirable manner.
This assertion will be seen to be amply sustained  by examining the
cases reported in the American Homoeopathic Review, referred to above.
The medicine  should be carefully selected in accordance with all the
symptoms, and, if the true  simile be not found among those indicated
below, compare also those given under Hydrocephalus, or administer,
without hesitation, any remedy called for by the characteristic symp-
toms of the case, for these latter, belonging exclusively to the idiosyn-
crasy of the patient, may be different from  any before observed in
other cases.

  Arsenicum.  General  anasarca of a waxy paleness;  thirst for water
in small quantities,  but very  frequent; great  restlessness, particularly
after twelve at night; much  exhaustion  after the  least effort; undi-
gested  stools; sense of suffocation on lying down;  palpitation of the
heart.   Albuminuria.
  Apis  m. Very  scanty  urine;  waxy paleness of  the feet and legs,
which  are much swollen; absence of thirst;  stinging pains here and
there over the body; dyspncea, with feeling as if "every breath would
be the  last;" the child must sit perfectly erect in order to breathe.
  Apocynum cann. General  dropsy;  hydrothorax;  urine high-colored
and very scanty; considerable  gastric disturbance; pulse weak and
irregular.  Albuminuria in some cases.
  Baryta C. Swelling  of  the  cellular tissue of the  neck; also of the
submaxillary and parotid glands.
  Belladonna. Great paleness  of the face,  much moaning and grinding
of the  teeth.   Stupidity, half sleeping and waking.
  Hellebore. The  urine is scanty, and deposits a dark, coffee-ground-
like sediment; pain in the  back part of the head; dilated pupils.
  Kali C. The dropsy commences with a sacculated swelling above the
upper eyelids, which continues to characterize  the case throughout; the
face is  enlarged, pale  and bloated;  the child is worse about  three
o'clock in the morning.   Albuminuria.
  Lycopodium. The  urine deposits red sand,  while  the urine itself is
clear; it may be red or reddish, however; great commotion in the ab-
domen from rolling and  rumbling of flatus;  the  child begins to feel 
846          DISEASES OF  INFANTS AND CHILDREN.

worse  about four o'clock in the afternoon, and begins to feel bettu
again about eight in the evening.   Albuminuria.
   Phosphorus. Urine deposits  a gray sandy sediment.  The scrotum
and penis are enormously swollen, together with general anasarca,
which  compels the patient to sit erect.   Albuminuria.
   Pulsatilla.  There is much pain in one ear or the  other, and some
deafness; the urine is very scanty;  there is a bad taste in the mouth,
and nothing the patient takes  has  a good taste; the child is worse
toward evening and throughout the night.  Albuminuria.
   Rhus tox. The eyelids present  a  bladder-like appearance and the
child is very restless at night, particularly the last part.   The patient
is  scarcely able to see in consequence of the bloating of  the eyelids;
great thirst, with dry tongue; general dropsy.  Albuminuria.
   Squilla. Great  desire  to urinate, with  copious emissions of urine,
which  is as clear  as water; great itching of the eyelids, which causes
the child to rub  the  eyes, producing profuse lachrymation;  sneezing
and profuse coryza, which sometimes  excoriates the nostrils; general
anasarca and hydrothorax.
   Veratrum.  Vomiting and purging, with much prostration.
   See also the treatment of other  dropsical affections.

             Other Sequelje of  Scarlet Fever.
   Post-scarlatinal Rheumatism.—Among the most important, although
perhaps not the most common, of the sequelae of scarlet fever should
be  recorded  the  intense painfulness, icith swelling  of the back of the
hands,  wrists, and  even  of the feet, which sometimes appears as the
eruption is going off.  The  back of the hands and wrists seems to
have some especial  relation  to scarlet  fever, for in some cases the
original eruption, and in others even the subsequent dropsical affec-
tion, are entirely confined to them.  This is a very dangerous sequela,
unless  arrested by the proper  remedies, to which,  however, it yields
svith great promptitude, and is thus described by  a  recent observer:
" This  (sequela) is seen in the inflammation, shining, swelling, and in-
tense pains in the (wrist and ankle) joints, which  sometimes appear
as  the eruption  subsides and  desquamation commences.  By allo-
pathic  writers this is termed scarlatinal rheumatism, and it may be
said to resemble simple  arthritic inflammation also in its  disposition,
so  much greater in children than in  adults, to metastasis to the heart.
But it  differs from all ordinary arthritic inflammation by an almost
equally marked tendency to purulent effusion into the affected joints,
This form of disease, though  fortunately rather  rare, is sometimes 
SEQUELS OF SCARLET  FEVER.
847
epidemic.   Sometimes also it is complicated with great swelling in
the neck, enlargement of the sub-maxillary glands, and other indi-
cations of acute scrofulosis." *   " We meet now and then with sec-
ondary inflammation of the joints, which may even go  on to the
formation of pus.  I saw the hand  thus affected in a child who died
on the sixth day of the disease.   The wrist and the back of the hands
are the parts usually affected.   The symptom is always a very ill-
omened  one, even  though it should be but evanescent," etc.— West
" I have several times, when the rash of scarlet fever was  disappear-
ing, known pain  and  swelling  of the larger joints to supervene,
simulating  very closely the local phenomena of sub-acute rheuma-
tism."— Watson.
  The remedies for this painful affection, especially where it appears
by itself as the principal symptom, may be found in Apis, Belladonna,
Bryonia, Lachesis, Rhus  tox.  or others,  where other complications
present.

  Neuralgic pains in extremities and  other parts.—Study Lachesis,
Colchicum, Merc, sol., Arsenicum, Digitalis, Cannabis, Rhus tox., Gelse-
minum and others.

  Scrofula, in  the form of enlarged and even  suppurating  cervical
and submaxillary glands, in many cases forms an important sequela
of scarlet  fever.   This  affection may  begin  in the  course  of the
original  disorder, especially of the anginose variety,  or  it may  be
subsequently and more  gradually developed.   Dr.  Condie's descrip-
tion of this affection, as  it appears in  the course of the scarlet fever
itself, with  slight modification  will apply equally well to its subse-
quent development in other cases:  " One of the most common and
remarkable accompaniments of scarlatina anginosa  is an  inflamma-
tory intumescence of the submaxillary ganglions, which in  general
presents itself  the day subsequent to that'in which the swelling occurs
in the pharynx.   There then takes  place a swelling painful  to  the
touch, and  sometimes tense and red.   The inflammation  is at first
confined to the glands,  but in  many  cases soon extends to the sur-
rounding cellular tissue, often  producing an enormous tumefaction,
reachino- around the front of the throat from ear to ear, and prevent-
iug the jaw from being  opened  wider than just to permit the tip of
the  patient's tongue  to  be  protruded.   Ordinarily, the swelling is
produced by an cedematous condition of the cellular tissue  of the
                     * Am. Horn. Review, ii., p. 438. 
848
DISEASES  OF INFANTS AND CHILDREN.
 throat, and quickly disappears as the inflammation  of the  glands
 diminishes.   Occasionally, however, a  suppuration  takes place, com-
 mencing  either in the glands  or  in the cellular  membranes, and an
 abscess results."  Sometimes two, or even three or four, abscesses may
 be seen running at  the same time in the slow convalescence after a
 severe attack of scarlatina in scrofulous children.
   The remedies needed in  such cases may be found indicated under
 Scrofula in a succeeding chapter, to which  reference  may be made.
   Silicia, Graphites, Hepar, Baryta  c, Calcarea c, Calca-
 rea phos. and Merc. iod. may be mentioned  as worthy of especial
 study in this connection.

   Otorrhoea may be a very serious sequel of scarlatina.  It is dne to
 the inflammation of the mucous lining of the throat  extending up the
 Eustachian tube, and if not cured may result in destruction of the
 organ of hearing and permanent deafness.   Such remedies as Calca-
 rea c, Bovista, Pulsatilla, Mercurius sol., Silicia and Sul-
 phur  may be  studied with advantage.  But that remedy should be
 chosen and administered which bears in its pathogenesis  the totalitv
 of symptoms presented by the individual case.

                 Rubeola  Morbilli—Measles,
  In frequency measles constitute the first, and  in importance  the
 second, of the eruptive fevers of childhood.  Like scarlet fever, this
 disorder  arises from  a  specific epidemic  and infectious miasm, and
 usually occurs  but once.   The  nature of the miasm itself, as in the
 case of other endemic, epidemic, infectious  and contagious diseases, is
 by no means satisfactorily  settled.  A certain mould or fungous growth
 on damp straw or other decaying vegetable matter has been observed
 to give  rise to the  measles in  newly-enlisted soldiers lodged in bar-
racks.  In a similar manner,  decaying animal  matter—putrescent
fish—has been known to cause the severest  epidemics of this disorder.
In  both  these classes of cases, in which many  lives were lost, the
development of  the  measles  as a malignant disorder seems to have
been favored by the impurity of the air and low and damp tempera-
ture of the climate.*  Unlike  scarlet fever, this disease is  apt to be
 much more severe when it occurs later in life than when it appears
in early  childhood.   The  epidemic character of measles  seems also

  * Compare Carpenter's Human Physiology, Chapter III., and Pereira's  Treatise on
 Food and Diet.  New York, 1843, p. 43. 
MEASLES.
849
rather more strongly marked than that of scarlet fever, and its con-
tagiousness possibly a little less so, for its epidemic influence is much
more universal in the districts where it breaks out than  is the scarlet
fever, and the disease itself is  at  once much more universal and  far
less dangerous.
  Diagnosis.—From scarlet fever, with which the measles is most  apt
to be confounded, it cannot always be certainly distinguished in spor-
adic cases before the  appearance of the eruption.   But the absence of
vomiting (although  even this  symptom may sometimes precede  the
appearance  of measles) and  of the sore throat, and the presence of
catarrhal symptoms,  such as injection of the sclerotica, coryza, sneez-
ing, hoarse and scraping cough, will usually be sufficient to prevent
the inexperienced practitioner from giving a wrong diagnosis, while
the prevalence of one epidemic or the other will in most cases greatly
assist him in his determination of their nature.   In the early stage of
the eruption it may be confounded with small-pox, but the papules
of measles are larger, softer and less elevated, and have not the shot-
like feel of the papules of variola; and in variola there is an absence
of the catarrhal symptoms  which belong to measles.   At any rate,
where  there  is room for doubt  it  is far better  to give  a guarded
diagnosis, and thus avoid the imputation of ignorance or inexperience
which would arise in case of a mistake.
  Symptoms.—After  a period of  incubation of thirteen or fourteen
days the eruption of measles makes its appearance;  but about  the
tenth  day after the  exposure  to  the infection the introductory fever
arises.   This  fever is often severe, attended with lassitude, shivering,
thirst, dry cough.  " The eyes become vascular and watery, the eye-
lids heavy,  turgid and red.  The membrane which lines  the nasal
cavities, the  fauces, the larynx, trachea and bronchial tubes is affected.
Hence we have generally as symptoms much sneezing, as well as lach
rymation, a copious defluxion from the nostrils, soreness of the throat
and an  obvious redness of the fauces,  and most  commonly a dry,
hoarse, peculiar cough ; so that the  symptoms which usher in an attack
of measles are the symptoms of coryza and catarrh.  In  some instances
there is diarrhoea also, indicating a simultaneous affection of the mucous
membrane of  the intestines, and not unfrequently vomiting ; but  the
vomiting, as in small-pox, ceases on  the coming out of the eruption."
— Watson.
  The  eruption usually makes its  appearance on  the fourth  day,
sometimes much later.  It comes  out first upon the face, whence in
the course of a couple of da5*s it extends over the body and extremi-
      54 
550           DISEASES OF  INFANTS AND CHILDREN.

ties.   The eruption of measles consists of a rash made up at first of
minute  papillae, slightly elevated, which, as they multiply, coalesce
into blotches that  have more or less a horseshoe or crescentic shape,
and leave the intermediate portions of the skin of their natural color.
"On  the third  or fourth clay of the disease the skin begins to be
covered with an eruption of small distinct  red  spots, these first be-
coming visible about the throat and face.  The blotches or eruptions
are of an irregular circular  or semicircular figure, and continue for
the most part distinct from one another.   The several spots or points
in them rise slightly above the general level, and are felt to be rough
and uneven under the fingers." *  After about forty-eight hours from
its appearance, and by the time it is at its  height on the trunk, the
eruption begins  to disappear from the face, and by the ninth or tenth
day it will have disappeared entirely, thus making its whole duration
about six  days.  The desquamation of measles,  less  constant and
noticeable  than  that  of scarlet fever, takes place in minute branny
scales, instead of the larger  portions  of cuticle which are sometimes
thrown  off after the latter disease.  In severe cases  of measles, how-
ever, as in scarlet  fever, the  desquamation is  more extensive;  and in
some  instances  even the nails of  the fingers  are  similarly thrown off,
and replaced by new  growths.
   The cough often becomes most distressing, violent and incessant,
and the fever itself more severe, after the appearance of the eruption;
but this aggravation is  but temporary, and will  readily yield  in a
short  time to the properly indicated remedy; and in favorable cases
convalescence may be pretty well established in twelve or fourteen
days from  the commencement of the illness.   The homoeopathic treat-
ment, while it may not very materially abridge the  natural duration
of this  or other eruptive disorders, will very greatly moderate the
severity of their symptoms, prevent, in a good measure, the accession
of troublesome and even dangerous complications, and in almost all
cases  either entirely preclude the  appearance of  the  usual sequelae, or
render them the occasions of effecting a more radical and permanent
improvement of the subsequent condition.
   Complications and  Sequelae.—Diarrhcea sometimes makes it appear-
ance  upon the  decline  of the eruption, if  it has not existed at an
earlier period.   This has been regarded  as exerting no unfavorable
influence upon  the  convalescence.   The  mucous membrane  of the
bronchia affords a seat for the development of measles, corresponding
to that of the  fauces and  nasal  fossae in scarlet fever.  Hence the
* Illustrations of Cutaneous Disease, London, 1841. 
MEASLES.
851
 cough, at first dry, but at the last loose,  which  in  greater or less
 degree accompanies the measles, aud whose aggravation, above referred
 to, forms a most distressing complication.  Under the old forms of
 treatment this irritation of the bronchial mucous membrane was apt
 to  be  developed into a true  bronchitis.  But  under homoeopathic
 treatment this tendency  may almost  always  be  entirely  averted.
 Pneumonia  forms the severest and most dangerous complication of
 measles,  and also the most important sequelae to be guarded against.
 The revulsion of the eruption from exposure to cold  is always liable
 to  be followed by this result at any stage of the original disorder.
 And in children of delicate constitutions and scrofulous habit may be
 observed a strong  disposition  to  pneumonia, no less decided than the
 disposition to external scrofulous disease which is developed by scarlet
 fever in the same  class of patients.  And it may be remarked  here,
 that in attending young people—and by this we mean also those par-
 tially and quite grown up-^who are attacked with measles, the most
 sedulous care should be taken lest through  its imperfect treatment
 and unfavorable convalescence this disease should lay the founda-
tion for  confirmed ill-health,  or even of actual  pulmonary consump-
 tion.   And  perhaps this remark may be more applicable to girls and
 young women  than to those  of the other sex,  although these latter
 are by no means  exempt from the danger.  We  believe  that  more
 cases of  this  serious "poor  health"  may  be  traceable  to  badly-
 treated and  badly-managed measles than to all the other exanthemata
 combined.
   Rubeola maligna, Rubeola nigra,  or Black Measles may occur either
 as an epidemic or sporadically.  Its existence  as an  epidemic is not
 very common,  and  its cause  is inexplicable.   The  occurrence of
 sporadic  cases of black measles must depend upon some deep-seated
 dyscrasia of the individuals  thus  affected.   The symptoms usually
attendant upon measles assume an exaggerated type, and  the whole
course of the disease exhibits  an adynamic or typhoid and  malignant
character.  There is great feebleness of pulse, general  depression and
weakness, and difficulty of breathing, and frequently either delirium or
stupor.   Petechiae make their appearance, the skin presents a darkened
or livid  appearance, there  is sore throat, bleeding from the nostrils,
and sometimes  an exhausting diarrhoea or dysentery sets in.    The
eruption  comes out  slowly and imperfectly, and is dark-colored or
even black, in consequence of the exudation of blood into the papules.
This form of the  disease frequently terminates fatally; otherwise the
prognosis-of measles is almost always favorable. 
852           DISEASES  OF INFANTS AND  CHILDREN.

   Treatment.—The room in which the patient is confined should be
kept at a comfortable temperature, say from 70° to 75°, without ex-
cluding fresh air; the patient should be kept as quiet and undisturbed
as possible, and the remedy should be carefully  selected  to meet  all
the symptoms and conditions.

  Aconite.  Dry, hot skin; heat in the head, with restlessness.  Aconite
is the most suitable remedy in a large majority of cases for the fever,
the catarrhal  symptoms, the cough, even  though  croupy, and  the
stomach and bowel symptoms.
  Antimonium c.  If there be  pain in the ears, white  coating on the
tongue and much vomiting.
  Apis  mel. Absence of thirst; scanty urine;  great restlessness and
inability to sleep;  stinging in the skin: dyspnoea; the measles do not
come out properly.
  Arsenicum.  When  there  is much prostration;  thirst for water,
wishes to drink often, but  little at  a  time; great heat of the skin.
Too sudden disappearance of the eruption; pallor; great restlessness;
vomiting  and diarrhoea  at the same  time; exhausting  cough;  the
child vomits water after drinking it; worse after  midnight.
  Belladonna. Difficulty in swallowing; severe coughing spells, causing
much redness  of the face, constant moaning and  drowsiness; evident
congestion of the head, with red eyes.
  Bryonia. The eruption  does not fully develop itself; it appears pale,
and there  is much dyspnoea and  violent cough, or there may be a
partial  retrocession, with similar symptoms;  motion  aggravates  the
symptoms.  Vomiting of all nourishment.
  Camphor. When there  is much coldness and blueness of the skin;
the face is pale, the child does not wish to be covered; the eruption
does not appear.   In these circumstances Camphor will bring out the
eruption and relieve the patient.  Dysuria.
  Coffea. When there is excessive sensitiveness of the skin and of the
senses  to  every impression;  weeping, irritability; great wakefulness,
and much excitement.
  Dulcamara. Retrocession of the eruption  from exposure to damp,
cold air.
  Drosera. Very hoarse  cough  accompanies or  follows the disease,
which  is worse after midnight.
  Euphrasia. There is much lachrymation,  coryza and extreme pho-
tophobia. 
MEASLES.
853
  Hepar.  Choking and croupy cough, which is worse  after midnight
or in the  morning.
  Ipecacuanha. Much nausea; short, hurried breathing. Incessant and
most violent eough with every breath; this symptom, sometimes fright-
fully severe in delicate children suffering with measles, Ipecac, relieves
like a charm.  The measles do not come out properly.
  Kali bich. In those rare cases in which the cough  is accompanied
with tough and stringy expectoration.
  Mercurius. The glands of the throat are much  swollen, and there is
difficulty in swallowing; slimy stools streaked with blood ; tenesmus.
  Hyoscyamus. YV nen the cough is very racking  and exhausting, and
is worse  on lying down and relieved by sitting up.  The rash does
not come out wrell.  Much spasmodic action.
  Lachesis. The  measles do  not come out.  When the child goes  to
sleep it is troubled with dyspnoea and cough until it gets awake; there
seems to  be a struggle between difficulty of breathing and coughing.
  Phosphorus. For  symptoms indicating bronchitis; violent and very
exhausting cough.  (Compare Ipecac.)
  Pulsatilla.  Very loose and rattling cough; lachrymation; photo-
phobia;  thick and yellowish coryza; absence  of  thirst; very bad
taste;  nightly diarrhoea; the  rash is very slow to  make its appearance;
the child usually gets worse  toward evening.
  Stramonium. The rash does not make its appearance;' the child seems
afraid of all objects when first seen, and shrinks  from them; inclina-
tion to spasms, or the child lies in  an apparently natural sleep, with a
red face and an occasional raising of the head from the pillow.
  Sulphur. The eruption fails to make its appearance, and the catarrhal
symptoms become worse, with other Sulphur symptoms.

       Treatment of the Complications and Sequelce of 3feasles.
  Diarrhcea.—For the diarrhoea which  attends  or  follows the
measles,  consult  Bryonia, Mercurius, Pulsatilla and Sulphur.   (See
Diarrhoea.)
  Bronchitis.—For bronchitis study Bryonia, Ipecacuanha, Phos-
phorus, Pulsatilla, etc.  (See Bronchitis.)
  Pneumonia.—For pneumonia compare Belladonna, Bryonia,  Phos-
phorus, Sulphur, etc.   (See Pneumonia.)
  Rubb:ola  maligna.—In the  congestive and malignant variety,
which, although  very rare,  may  appear—the   so-called black  mea-
s(es—compare Arsenicum, Hamamelis, Lachesis,  Phosph. ac, Pulsa-
tilla, Rhus. 
854          diseases of  infants and children.
  Itching of the Skin.—In those cases in wdiich the itching is ex-
cessively annoying, study Dolichos pruriens,KRhus tox and Sulphur.

                    Roseola—Scarlet Rash.
  This  disease, which has  also  been  denominated the French measles
and Rubeola sine catarrho,  is occasionally epidemic, but is not usually
regarded as a contagious exantheme.  The eruption of roseola, which
is preceded by febrile  symptoms, makes its appearance as irregular-
shaped patches of a rose-colored hue, and which are unaccompanied
by elevations  or papulae.   When not epidemic, it seems to  depend
chiefly upon derangements  of the digestive  apparatus as a producing
cause, though  it may likewise be due  to  sudden changes of tempera-
ture, violent exercise, taking cold drinks while the body is warm and
perspiring, etc.
  The eruption may appear suddenly during the night, and cover the
entire body with its rose-colored patches, situated closely together, yet
distinct.  " In another and rather more violent form, occurring  espe-
cially during  dentition,  the eruption appears after  vomiting, fever,
diarrhoea  and slight nervous symptoms, or possibly  after slight con-
vulsions, with the characters above mentioned, except that the rash is
deeper in color, greater in  extent, and that  it lasts generally a longer
time—two, three, or four days.  Again, in a yet more  marked form,
the Roseola  cestiva  and autumnalis, the disease is preceded by certain
symptoms which it is important to note.  It begins with more or less
chilliriess, alternating with  heat, with  loss of strength  and spirits, with
headache, restlessness,  sometimes mild delirium, and  even, it  is said,
with slight convulsive phenomena.  At the same time there is  some
febrile reaction, marked by accelerated pulse,  heat and dryness of the
 kin, thirst and loss of appetite;  the digestive function is shown to be
deranged by the presence either of constipation or diarrhoea.  After
these  symptoms have continued for  twTo, three, four, or  even six or
seven days, the eruption appears first upon  the face and neck, whence
it extends in twenty-four or forty-eight hours to the rest of the body."
—Meigs and Pepper.
  The rash of roseola sometimes bears  a strong resemblance to that
of measles, and fades away gradually  in two or three days; but it
sometimes comes and goes for a week  or two after  the first appear-
ance.   Sometimes the rose-colored spots are arranged in the form of
rings, with healthy skin within the circumference of each ring.  When
tin's phenomenon presents  itself the disease has been termed Roseola
annulata.  There can be no very great difficulty in distinguishing this 
                   PEMPHIGUS—POMPHOLYX.                 85b

affection from scarlet fever or measles when the prodromic  z rid cha-
racteristic symptoms of  these latter diseases are taken into considera-
tion.  The prognosis is always favorable.
  Treatment.—The treatment of roseola is a very simple matter.  The
child should be kept in a suitable temperature and its diet corrected.
Such medicines as  Aconite, Belladonna, Bryonia, Mercurius
sol., Pulsatilla,  Rhus tox. and Sulphur may  be  administered
to suit the presenting symptoms.  Consult the remedies laid  down for
the  treatment of Measles and Scarlet Fever.

                 Miliaria—Miliary Fever.
  This eruption consists of clusters of minute red and white pimples,
like the smallest millet-seeds, which from being elevated give a rough
feeling to the hand.  The neck, chest and back are the principal seats
of this eruption, which appears in successive crops, and is usually the
result of excessive heating of the body.  This overheating may be
caused  by the too great abundance  of clothing, or it may be the nat-
ural result  of the summer temperature.
  A slight fever often precedes the eruption, which, however, like the
eruption  itself, is sometimes  quite violent.  From measles, which the
miliary fever and eruption somewhat resemble, it may be readily dis-
tinguished  by the absence of catarrhal symptoms, and also by the tem-
porary nature of the affection itself.  The  symptoms, even  in  the
severer cases,  yield very  readily  to  the appropriate homoeopathic
remedy.

  Aconite.  Affords prompt relief when indicated by the restlessness,
heat and  peculiar nature of the eruption.
  Bryonia.  May be required in very warm weather;  the child is bet-
ter  when kept  perfectly quiet.
  Chamomilla.  The  child  is  very  fretful, and  is relieved  by being
carried.
  Hepar.  The eruption comes out in circles.  Sepia is also indicated
by this peculiarity.
  Sulphur.  In  the more inveterate cases;  the skin is rough and scaly.

                   Pemphigus—Pompholyx.
  This eruption appears in the form of large bullce—vesicles like blis-
ters—in which a watery fluid separates the cuticle from the  skin.  It
is usually believed to indicate an unhealthy condition of the system ;
sometimes  it shows  a disposition to assume  a typhoid character, and 
85(5           DISEASES OF INFANTS AND CHILDREN.
in the worst cases it seems to have many features in common with the
gangrenous form of infantile erysipelas.
   The approach of the disorder is sometimes thoroughly denoted by
a livid suffusion, like that of erysipelas, slightly elevated.   More fre-
quently, however, the complaint comes on in apparently perfect health.
The bullae or blisters are oval, filled with a yellowish serum, which soon
becomes  turbid, of a dark brownish-red color, and  the  bulla either
dries up and is transformed into  a dark thin scurf, surrounded by a
narrow border, or  else it breaks, leaving a flat excoriation, which is
likewise soon covered with a thin scurf.  This eruption often appears
soon after birth; sometimes, however, it is congenital.   It does not
seem to be confined to any particular part of the body, but breaks out
behind the ears, on the neck, chest, back, inner surface of the thighs,
on the groins, on the extremities, and on the palms of the hands and
soles of the feet.
   Treatment.—Attention should be paid to  the diet, and the digestive
organs should be regulated  by appropriate  medication.  One of the
following remedies may be administered :

  Arsenicum.  May be required in the more  malignant cases, especially
where Rhus seems indicated, but fails to arrest the disease or cure the
cachexia by which it is supported.
  Rhus t. Where each bulla is surrounded  by a red,  inflamed base.
  Thuya. Cures most all cases, particularly  if painful.
   Camphor, Ranunculus bulb., Sabina or Secale  c. may also
prove useful in the treatment of this disease.
   Belladonna, Carbo veg. or  Lachesis may be required if the
bullae  become  darkened  from  the  effusion of bloody  serum into
them.

               Variola—Small-Pox—Varioloid.
   Variola is the natural small-pox, as it appears in those who have
not been vaccinated.   Varioloid, or modified small-pox,  is the corre-
sponding disease, as it appears in those who are  more or less protected
by  vaccination, by inoculation  or by a previous attack of variola.
Variola runs through a regular course of three distinct stages: 1, that
of incubation ;  2, that of development and maturation ;  and  3, that of
decline.  Varioloid differs little from variola in the first stage;  a severe
attack  of the  former may be a much  more dangerous illness than a
mild attack of the latter.   The principal difference is found  in the fact
that in modified small-pox the  erupticn is  usually much  less  copious, 
               VARIOLA—SMALL-POX—VARIOLOID.            857

and that it sooner begins to decline.   In other respects the two forms
of disease may for all  practical purposes be considered as identical.
Since the infection from the mildest case  of modified small-pox is
capable of causing the severest form of confluent variola in those un-
protected,  under  suitable circumstances either disease may  develop
the other.  In distinct small-pox, Variola discreta, the pustules admit
of being counted, being  placed at such  distances from each  other as
not to coalesce or run into one another, even when fully matured.  In
confluent small-pox, Variola confluens, the pimples are set  so  close as
to run into each other  on the third or fourth day of the inflammation.
In general, the latter  variety is by  far  the more severe, and in this
consists the only real difference.
   Symptoms.—I.  Stage of Incubation and  Initial  Fever.  The usual
duration of the period which intervenes between the reception of the
infection of variola  and its  initiatory development is from twelve to
fourteen days.  This has been called by nurses th«  period  in which
the disease is breeding.  In  some instances, children, and older per-
sons as well,  are sensibly affected, and experience a very considerable
degree of languor, lassitude and fever during this period ; in others no
particular inconvenience is perceived.
   II.  The Stage of Development and  Maturation. The first part of this
period  is occupied by the initiatory or eruptive fever.  And as it is
important to determine, if possible, the onset of this disorder, even
before the eruption makes its appearance, we will endeavor to portray
this fever  in such a manner  that it may be recognized, even  in cases
of children too young  to speak of the intense, unusual and  long-
continued pain in the back, which  in  older persons at once excites
suspicion of this disease.   There are  three strongly-marked symptoms
which  precede and accompany the  eruptive fever  of small-pox in
children,  and by means of which we think  the disease may always be
strongly suspected,  if not absolutely determined, in advance of the
eruption;  and these are the  vomiting, the coma, and  the convulsions.
The sickness with  wdiich the eruptive fever of small-pox sets in is in
general very  severe, and  the disorder of the stomach  often continues     •
for forty-eight hours, during which  time vomiting frequently recurs.
The cerebral condition is often one rather of stupor than of delirium,
although  in milder cases this latter symptom prevails.  In the severer
cases convulsions sometimes  take place and continue, alternating with
coma, for as  long a  period as  twenty-four or  thirty-six  hours.
The persistence of the vomiting will readily distinguish the case from
scarlet  fever.  Nor is the skin so hot  and  dry as  in scarlet fever. 
858
DISEASES OF INFANTS  AND CHILDREN.
The stupor or coma, in connection with the vomiting  on the one side
and the convulsions on the other, will serve to enable  the practitioner
to distinguish the case from one  of incipient cerebral  affection, in
which indeed there  may be  even prolonged  vomiting, but in which
neither  the  coma  nor the  convulsions are  so  rapidly developed.
Should there be severe diarrhoea, it  is generally regarded as a dan-
gerous complication;  constipation generally  lasting  throughout the
disease.   There is generally great thirst, with loss of appetite.   The
urine is scanty and high-colored.
  The second part of the period of development of variola is occupied
by the appearance of the papular eruption.  This never occurs in less
than forty-eight hours  from the commencement of the actual illness,
and it may be delayed somewhat longer.  These  papula? are at  first
slightly red, somewhat acuminated elevations, quite minute, and capable
of being overlooked in a hasty examination, and yet conveying a dis-
tinct sense of irregularity to the finger as it passes over them.  "They
increase in size, and  in the course of forty-eight hours  assume a vesic-
ular character, and contain a whey-like fluid, while instead of a coni-
cal  form they now  present  a central depression.  During another
period of forty-eight  hours, or thereabouts, these vesicles go on en-
larging, their central depression grows more  and more apparent, and
their contents become white  and opaque; they are no  longer vesicles,
but have become  converted  into pustules, each of  which, if  they be
distinct, has an areola of a red hue around its base.  As the size of the
pustules  increases they lose  that central depression which they had
presented while  vesicles;  they assume a spheroidal form, and  even
become  slightly conical.  The next change observable in them is an
alteration of their color from a white to a  dirty-yellow tint, which
they continue to retain  until the desiccation of the eruption commences.
The maturation of the pustules  usually occupies from  the commence-
ment of the fifth to the commencement of the  eighth day of the erup-
tion, or from the eighth to the  eleventh day of the  disease, when the
process of desiccation begins."— West.
  The pustules are  generally most numerous on  the  face, neck  and
limbs, and less on the trunk  than elsewhere.   Indeed,  the eruption on
the face and neck may  be of the  confluent form, and yet discrete on the
chest, abdomen and  extremities.  In almost all cases  of variola, and in
severe attacks of varioloid, the mucous membrane of the mouth, fauces
and nares is likewdse covered with the eruption. It here begins "with
more or less  vivid redness of the membrane, which is  followed by the
production of little elevations, the real nature of which, whether papu- 
               VARIOLA—SMALL-POX—VARIOLOID.             859

lar or vesicular, seems not to be clearly determined.  About the second
or third da)- these elevations assume the appearance of small, whitish,
rounded and umbilicated pseudo-membranous  points, which last gen-
erally about five clays, and are then detached, leaving usually a little
ulceration or erosion, which heals without leaving a cicatrix.  Some-
times the gums become inflamed, swollen and spongy, and there is
generally more  or  less inflammation of the pharynx, with  difficulty
of swallowing,  and  swelling and tenderness of  the  submaxillary
glands.   When the eruption extends to the mucous membrane of the
larynx, which it sometimes  does, the voice becomes hoarse and low,
and  there is considerable  hoarse or barking cough.  During  this
stage of the disease the fever generally subsides, if  it has not done so
before, and the  pulse falls  considerably in the number of its beats,—
from 130 or 140 to 100 or 80.
  After the  eruption has continued for five or six days, and matura-
tion  of the pustules is going on in the face and extremities,  there is a
renewal of the fever—secondary fever or the fever of maturation—the
pulse rises again, and this  fever continues for four  or five days more,
and then gradually declines.
  III.  The stage  of decline and the formation of the  pustules into
scales generally commences between the  sixth and ninth  days,  and
terminates between the tenth and the fourteenth days.  It commences
upon the  face,  as  does  the  eruption, and thence spreads to the ex-
tremities and trunk, and from the eleventh or twelfth-to the  twentieth
days, and even  later, the process of -desquamation goes  on,  the scabs
or scales dropping off and leaving red blotches upon the skin, which
do not fade for  a  long  time  afterward.    When there  has  been
ulceration and loss of substance  of the  derma during the process of
maturation, there is left beneath the scale a pit or depression, which
is, in fact, a cicatrix—the small-pox pit—and which remains through-
out life.
  The  above description of the three stages  of small-pox suffices for
the disorder as it  almost  always appears, but there are many  cases
occurring during the .prevalence  of an epidemic  of the disease—and
this was noticeably the case during the malignant  epidemic which pre-
vailed in Philadelphia during the years  1871 and  1872—in which the
disease runs an  irregular course in any or all of its stages, or is accom-
panied  with phenomena unusual  to variola.   In these irregular  cases
any of the stages may be lengthened or shortened, or increased or de-
creased in the severity of their attendant symptoms.  The initial fever
does  not usually subside, as in ordinary cases, but rather increases, the 
860
DISEASES OF INFANTS  AND CHILDREN.
pulse being full and reaching to  160 or 170, the skin being hot and
dry.  The eruption presents in different cases  a varied appearance,
differing in  some  cases  very greatly  from  the ordinary  variolous
eruption.   It may be pale, uneven, and destitute of the usual  areola.
" In other  instances the papules and areolae are of a purple-red color
and the vesicles, instead of being transparent or whitish, are also red-
dish, and appear to be filled with a bloody serum.   The pustules  in
these cases also contain a sanguinolent fluid, and when broken their
contents escape and form  bloody scabs.  In this variety of the disease,
which is called  hemorrhagic {Purpura variolosa, black small-pox), the
papules and vesicles are  very small;  they are developed slowly, and
remain  flat and uudistended as  a  general rule,  whilst in a few cases
they are of a large size,  but remain almost always flattened in shape
and  unfilled."   This  form  of the disease, indicative  of a profound
alteration of the blood, has a tendency to terminate unfavorably.  The
mortality from  small-pox differs in different epidemics, but it may  be
stated that in the ordinary form of the disease  occurring  in patients
over five years  of age, and who were in a  fair  state of health previous
to the variolous attack, a favorable  termination may be looked for,
whether the eruption  be confluent  or discrete.  The younger the
patient  attacked, cceteris paribus, the  greater the danger.   Complica-
tions may arise in connection with  ordinary variola which  may make
what would otherwise have been a favorable case assume a  very grave
aspect.   When the disease runs  an irregular  course, such as has just
been  described, death very  frequently results, and the hemorrhagic
variety, as previously remarked, has a strong tendency to terminate
fatally.
 ■  Treatment.—The patient should be placed in  a cool and well-ventilated
room, and  be sufficiently  covered to be kept warm.   The diet should
be plain, yet nutritious and digestible, and cooling drinks should  be
allowed plentifully.  In the more severe attacks, where there appears
to be considerable  loss of strength, a yet more nutritious diet may be
given, carefully avoiding meat in every form.

   Aconite.  Is  absolutely  demanded in some  cases, especially in the
first and early part of the second stage.   There is  great  fearfulness
and apprehension  of an unfavorable termination;  high  degree  of
fever; great restlessness; especially suited to full-blooded and active
children.
   Ammonium mur.   In cases where the  eruption  is  sufficiently well
developed  upon the trunk and upper extremities, but upon the lower 
               VARIOLA—SMALL  POX—VARIOLOID.            861

limbs it is thinly scattered, out of all proportion.  Sore throat, with
swelling about the neck;  haemorrhages
  Antimonium  c.   A great deal of vomiting;  the tongue  is covered
thickly with a white coating.
  Apis mel. Apis  may be useful  in the earlier stages: there are  ery-
sipelatous  swellings, with  stiuging  pains;  soreness of the  throat;
absence of thirst.   It may also be used at a later period, when there
are great dyspncea, to the extent that the patient  fears each breath he
draws will be  the last; great restlessness; scantiness  of urine; very
annoying stinging in the throat;  the pustules seem to be retrogressing.
  Arnica. Partially  developed eruption, Avith  ecchymosed  spots here
and there; great restlessness; a bruised  and sore feeling is markedly
complained of; involuntary stools, passing while  the patient is sleep-
ing ;  the head is hot, while the body is comparatively cool.
  Arsenic.  Hsemorrhagic  small-pox, black  small-pox, and in other
forms of irregularly developed  variola with  typhoid tendency; the
pustules fill with  a dark-colored bloody fluid;  the pustules are too
flat; the patient is very restless,  and yet is greatly exhausted;  thirst,
but drinking of only small quantities at a time.
  Baptisia tinct. Typhoid symptoms; foetid breath; scales on the teeth
and lips; profuse  salivation;  the pustules appear thickly in the nasal
cavities, and in no other part; imagines himself disjointed and cannot
bring the pieces together.
  Belladonna.  This remedy is  especially adapted to plethoric, thick-set
patients.  The patient is  dull and sleepy; the skin is  very hot; the
eruption does not  appear;  flushed face, injected eyes, throbbing of the
carotids, and all the evidences of determination of blood to the head ;
bleeding from the mouth or nostrils.
  Bryonia. Headache  as  though the head would burst;  thirst, with
desire for water in large quantities;  great nausea, faintness and even
vertigo  on raising from a  recumbent position ; dry and parched lips;
the  patient lies perfectly still,  because motion aggravates the pains and
other symptoms; a pale eruption may be seen under the skin.
  Gamphora. Where coldness  of surface and collapse set in suddenly ;
the  pustules seem to shrink away  at once;  the patient does not wish
to be covered  and  is  exceedingly weak.  The  dose  must  be very
frequently repeated until reaction is being established.
  Cantharis. Dysuria and bloody  urine, with cutting and burning pain
on voiding it;  very distressing headache  and pain in the back; the
eruption is not properly developed, or, being developed, assumes the
luemprrhagic hue. 
862           DISEASES OF INFANTS  AND  CHILDREN.
  Carbo veg. The pocks fill up with a dark and bloody serum; the
breath becomes cold, and there is very great exhaustion and depression
of the vital forces.   It  differs from Arsenic by  the absence of the
characteristic thirst of that remedy.
  Chamomilla. May be required in some cases to allay the fretfulness
of the little patient, which is quieted only by being incessantly carried.
  China.  The pustules fill with a black fluid; exhausting and painless
diarrhoea;  the child cannot bear to be touched.
  Cimicifuga. The muscular pains are unusually and peculiarly severe,
partaking of a rheumatic character.
  Hamamelis. Haemorrhagic small-pox, with passive venous haemor-
rhages.
  Hepar s.  c.  A croupy cough  is developed during the progress of the
disease, with choking during  each coughing  spell.  Hepar should
then be given as an  important remedy,  to ward  off the threatening
complication.
  Hydrastis can. When the pustules are dark-colored and there is great
prostration; the face is very red, itches and tingles, and there is facial
oedema quite marked;  the throat is very sore.
  Hyoscyamus. Great rage, anguish, delirium, coming on in paroxysms;
the  patient constantly wants to get out of bed or to be uncovered; the
eruption does not come out at the proper  time.
  Ipecacuanha.  The disease is  characterized by continuous nausea.
  Lachesis. The child's  symptoms are all worse  after sleeping;  it
wakens in great  distress,  becomes more comfortable after getting
wide awake, and is worse again after another nap,  and so on.
  Mercurius sol.  Is especially  indicated during  the  stage of matura-
tion.   The tongue is very  moist; salivation;  great thirst; swelling
of the tongue; the mucous membrane of the  eyes, nose and mouth
looks red and raw;  diarrhoea or dysentery, with tenesmus, and other
symptoms of Mercury.
  Phosphorus. Is  especially  adapted  to  tall  and  slender persons.
There  is a dry  and exhausting  cough,  accompanied  with pain or
feeling of rawness in the chest;  haemoptysis; weak  feeling  across the
abdomen;  the pustules begin to fill with blood.
  Phosphoric ac. The pustules do not fill properly; they  look  like
blisters, burst  and  leave a raw  surface.  The  patient is dull  and
stupid, cares for nothing, wants nothing  and notices nothing.   \\ hen
asked a question in a loud tone of voice, the patient opens his eyes,
gazes stupidly and steadily at the questioner, and then answers slowly,
but otherwise will not talk. 
               VARIOLA—SMALL-POX—VARIOLOID.            86tf

  Pulsatilla. Want of thirst; the patient  constantly craves fresh air;
changing sensations, the  patient feeling now  better and  now worse;
weeping mood; bad taste, the food does not have a good taste.
  Rhus tox.  The  disease is  disposed to assume a  decidedly typhoid
type.  The patient  is excessively restless, constantly tossing about to
find a rest which is  only momentary; sordes  on  the teeth and lips ;
the tongue is dry  and cracked; great debility; the eruption seems to
shrink and has a livid appearance;  confluent small-pox.
  Sarracenia purp. Has been highly lauded as  a remedy for small-pi x,
but no reliable characteristic indications  for its administration have
been evolved.   It is probably overestimated in value.
  Secale com.  The patient cannot bear to  be covered;  is very thirsty;
lies very quietly; the pocks have  an unnatural and unhealthy  ap-
pearance, and  either fill with a bloody serum or dry up too soon.
  Silicia. The stage of maturation is too long-lasting and exhausting;
the pustules seemingly do not begin to dry up soon  enough, and the
stage of desiccation  is delayed.
  Stramonium. The   eruption  does  not   make its  appearance;  the
p-itient lies quietly in an apparently natural sleep, but always wakes
with an expression   of fear;  the face is  red  and bloated; there  are
frequent convulsions; retention of urine.
  Sulphur.  May be  indicated  during any stage of the disease, under
certain circumstances, to  facilitate the appearance of the eruption, the
maturation, or the  desquamation.   It is  particularly suitable also if
there  be  threatening cerebral  involvement or metastasis to other of
the noble organs.   The pustules fill with  a pale bloody serum.
  Tartar em. Nausea and vomiting; thirst for  small and frequent
drinks of water; the  rash  is  slow in making  its appearance;  the
patient is very drowrsy, and vomiting commences  again after sleeping.
The eruption  has been suppressed.  The disease assumes a typhoid
and putrid type.
  Thuya. May be found useful in  ordinary cases, after the eruption
makes its  appearance, especially if the  pustules  are painful  to  the
touch.
  Vaccininum  and Variolinum  have been  employed with  apparently
good results in some cases.

                            Summary.
  "When there is  hcemorrhagic  complication: 1. Bell., Canth.,  Chin.,
Ipec,  Merc, sol.,  Phos., Puis., Sulph.  2.  Aeon.,  Ant. cr.,  Arn., Ars., 
864           DISEASES  OF INFANTS  AND  CHILDREN.
Bry., Cajrbo veg., Cham., Hyos., Rhus tox., Sec. corn., Sil., Stram.
3. Amm. mur., Bapt., Hamam., Hydrast., Phos. ac, Thuya.
   When the pustules look dark and bloody: 1. Apis, Ars., Carbo veg.,
Hamam., Lach., Rhus.  2.  Bell., Can., Chin., Hydrast., Phos.

                          Vaccination.
   In performing vaccination, either  the  cow-pox lymph or human-
ized virus in  the form of crusts  is used.  In making use of the
tubed lymph,  slightly scarify the arm by means of the sharp point
of a lancet, break the end of the lymph tube and insert into it a fine
needle, to the  point of wdiich a sufficient quantity will adhere to com-
plete the  operation.   When  humanized  crusts are used, a portion of
the crust should be moistened with  a drop or two of  water  or gly-
cerine, and the material thus prepared reduced to a creamy pulp by
being compressed and ground between two flat pieces of glass.  The
arm should be scarified as before, or  the epidermic layer scraped off,
and a portion  of the pulp laid over the spot and pricked in with the
point of a lancet.  Great  care should  be taken in performing this
operation that the scarifications are  not  made  so deep as to draw a
quantity of blood, or the vaccination will not  succeed.  If the vac-
cination be successful, on the third  or fourth day after the  operation
a small rose-colored blush or  erythematous redness will be noticed,
and on  the fourth  day, on  running the  point  of the finger over the
spot, a small kernel will be felt.  The process then goes on,  gradually
developing the vaccination until it  is  completed finally  by the falling
off of the scab, which takes place sooner  in some cases than in others.
A dose of Sulphur should be given on the fourth day after the opera-
tion.  If any unpleasant symptoms, such as eruptions—the offshoots
of  latent psora—are developed, give  a single dose of a high potency
of  Silicia.  Psorinum may be needed, or even some other remedy,
according to  the  presenting  symptoms, such  as  Graphites, Petro-
leum, etc.
   The  first vaccination should be performed  as early as the fourth
week after birth in favorable cases—that  is, if  the child is well estab-
lished in the way of  living.   In general, it is safer to vaccinate  again
at the sixth  or  seventh year, and  repeat twice  afterward.  Vaccina-
tion is a true  prophylactic  against small-pox.  It is useless  to go into
any extended  argument to prove this, as  the statistics of the efficacy
of vaccination  are  so abundant  and convincing as to be  entirely
irrefutable. 
VARICELLA—ERYSIPELAS NEONATORUM.          865
                   Varicella—Chicken-Pox.
  Varicella,  or chicken-pox, is  a mild, febrile, vesicular  eruption.
This affection seems to bear  a similar relation, though in  a far less
degree, to varioloid that this latter eruption does to variola itscdf.  If
varioloid  be  taken for a bastard or spurious  form of variola, then
varicella may be  considered a bastard or  spurious form of varioloid,
but with this difference (and this  is the very thing which  proves its
hybrid nature), varicella is alike incapable of producing either variola
or varioloid,  or of propagating itself.
  Varicella occurs much  more frequently in  those who  have  been
vaccinated than in others, but its symptoms differ materially in dif-
ferent cases;  in some  the  vesicles, wdiich  look like water-blisters or
bullae, desiccate early,  the  scabs leaving no  cicatrices, while in other
cases the vesicles are more or less fully maturated, the scabs adhere
for a longer time, and leave indelible pits in the skin when they finally
fall of.   Still, while this disease has been the occasion of much dispute
among medical men as to its relation to natural and to modified small-
pox, its treatment with homoeopathic medicines is at once simple and
very successful.   Study the following remedies :

  Aconite.  When much fever prevails.
  Belladonna. If there be very red face and eyes, headache, etc
  Coffea. Very much restlessness and sleeplessness.
  Mercurius sol.  Salivation ; some thirst. The water-blotches turn yel-
low and maturate; blisters form in the mouth.
  Rhus tox.  The  eruption assumes the form  of spreading blisters,
itches very much,  and  the  child is very restless.
  Sulphur. The  pocks  do  not heal; they are inclined to itch and to
ulcerate.   Hartmann recommends this medicine with reference to the
local symptoms.
  Tartar e. The eruption fails to  appear, and convulsions complicate
the case.
  Belladonna, Sepia, Dulcamara  and  Clematis should be carefully
studied.
  Mercurius,  Sulphur,  Hepar, Graphites,  Calcarea and  Sepia should
be carefully compared in cases that degenerate, and where  the  bulla?
change to ulcers.

                   Erysipelas  Neonatorum.
  Infantile erysipelas  is said to  be  of  very unfrequent occurrence in
this country in private  practice.  Its appearance, when it does occur, is
       5.i 
 866           DISEASES OF INFANTS AxVD CHILDREN.

 usually only a few days after birth, in which case it may take its rise
 in  umbilical  phlebitis.   Sometimes also it  is  congenital,  of intra-
 uterine origin.   It may attack the face, scalp and ears, and even the
 back part of the neck.  In any case, this disorder must be regarded as
 very dangerous, and by the old school it is set down as almost invaria-
 bly fatal, even when arising so late as the fourth month.
   Symptoms.—The erysipelas may  be preceded by  fever and other
 symptoms  of constitutional disturbance,  but  in  most cases the first
 evidence of the peculiar disorder appears in a certain suspicious red-
 ness, which, commencing  upon  the pubes  or about the umbilicus,
 gradually spreads over the abdomen and thighs, the parts occupied by
 the  inflammation being swollen, hard and extremely tender to the
 touch, as indicated by the movements and cries of the child, who can
 scarcely bear to be touched.  After twenty-four hours a few scattered
 vesicles make  their appearance  upon the inflamed  surface, with in-
 flamed livid bases, which rapidly terminate in gangrenous ulcerations.
 " When the redness extends to the hands and feet, these parts acquire
 a degree of redness and swelling far greater than that of any other
 part.  The genital organs in some cases sphacelate, in consequence of
 the local inflammation, and  in many acquire an emphysematous ap-
 pearance.   In place of appearing upon the pubes first, the  erysipelas
 has been known to extend from the areola of a vaccine vesicle; less fre-
 quently from an accidental laceration of the skin, or from the excora-
 tions so common in the cutaneous folds of the groin and other parts."
 Sometimes the disease begins in the form of a dark-red, shining spot,
 which quickly extends in size and becomes of a purplish color; there
 is little swelling,»but the skin becomes tense and hard.  (See Induration
 of Cellular  Tissue.)  When the erysipelas commences  in the abdo-
 men, vesications, destruction of the cellular tissue and  gangrene of
 the skin quickly follow; the genital parts are not  unfrequently de-
 stroyed altogether.   In  such cases the fever is of a typhoid kind, and
 the whole disorder exceedingly malignant and capable of carrying off
 the child in a very short time.   In this disease, even  under its milder
 forms, it is easy to see that the  vital forces are so greatly depressed,
and the blood in such a depraved condition, that there is little power
or hope of recuperation.  Still, much may be done, even in malignant
disorders, if we can remove  the  constantly sustaining cause.   Where
 there is reason to think  that  the bad state  of health of the mother or
 her general enfeebled condition  is  the cause  of  difficulty, the child
should be provided with nourishment from other sources.  Study the
 following remedies, and others which may be indicated: 
               URTICARIA—NETTLE-RASH—HIVES.            867

  Aconite, When a high state of febrile excitement prevails—a real
synochal fever—this remedy alone will prove sufficient.
  Apis.  When  the child screams  out suddenly, as  if from stinging
pains; sleepless nights; the eruption inclines  to spread  all over the
child, or to become gangrenous.
  Arnica. When the disorder seems to result  from bruises, or from
rough handling of the umbilical cord.
  Belladonna. The eruption is very red, and extends in radii from a
centre; jerking, twitching  and moaning;  the  skin seems to be very
hot; delirium;  evidences of cerebral involvement.
  Bryonia. The inflamed parts seem indurated, pale and tender. Lips
dry and parched.  The least motion aggravates  the suffering.
  Graphites.  The  eruption assumes a  vesicular appearance,  or  it
exudes a transparent, glutinous fluid.  Or the disease may assume a
chronic form, and the  child be very costive, with  stools  large and
almost impossible to evacuate.
  Kali carb.  The  symptoms are aggravated at or about  three o'clock
in the morning.
  Lachesis. The affected part assumes a purplish hue;  the patient
talks deliriously on going to  sleep; the  erysipelas spreads from left
to right.
  Lycopodium. Erysipelas which spreads from the right to the left side
of the body;  the child gets worse every afternoon about four o'clock;
red sand in the urine.
  Mercurius.  In cases of syphilitic origin; salivation ; thirst.
  Phosphoric ac. When the disease seems to be produced by injury to
the  periosteum.  The child appears to be perfectly apathetic.
  Pulsatilla.  This  remedy  is  often required when the disease appears
about the buttocks, and inclines to spread all over the body.
  Rhus tox.  The erysipelas spreads, with a red margin;  vesicular
erysipelas or any  other form  of the disease; the erysipelas spreads
from the left to the right side of the body.
  Rhus rad.  Phlegmonous  erysipelas, spreading in the deeper tissues
from below upward.
  Ruta may be useful in erysipelas arising from  wounds.
  Sulphur. Useful in cases  of strongly-marked herpetic constitution.

               Urticaria—Nettle-rash—Hives.
  The characteristics of this eruption upon the skin are  found  in the
elevation of  the patches, and in the burning, stinging nature of the
pains, in their dependence upon some recent disorder of  the stomach 
868           diseases of infants  and children.
or heat of the weather, in their usual sudden appearance and frequenl
equally sudden retrocession.   By Dr. Condie urticaria is described a*
" an eruption of red inflamed patches (they may,  however, be  like
white  wheals) irregularly distributed upon  different  and often  dis-
tant parts of the  body;  sometimes small in extent and number, at
other  times  occupying a considerable portion  of  the  skin."  This
eruption,  both in external appearance and in the sensations which it
occasions, remarkably resembles that produced by the application of
stinging nettle, Urtica urens, to the skin.  In such cases this medicine
will be found capable of affording immediate and very sensible relief
to the  distress of the little patient.   When  the eruption seems to be
principally brought out by the heat of summer, the warm bath will be
found  very useful in relieving the intense burning itching.
  In some instances the eruption  disappears from one part of the
body to reappear almost immediately in another and quite distant part.
Most cases of urticaria are comparatively trifling and evanescent, but
with some appear concomitant  symptoms of more gravity, such as
burning fever, diarrhoea, etc   These symptoms may be found enume-
rated under the various medicines.
  Mild cases of urticaria go  by the common name of hives {Lichen
urticatus,  essera).

  Aconite. Much fever, restlessness and anxiety.
  Apis. Red, inflamed, raised  patches, with  burning, stinging pains;
valuable and curative in many of the severest cases.
  Arsenicum.  Eruption worse  at night, with much tossing.   May be
particularly suitable when the disorder is caused by unsuitable food.
  Belladonna. Red  face and  eyes;   the  eruption  is  also very red;
moaning and starting in sleep; head hot.
  Bryonia. The eruption  has  been  partially suppressed, so  that it
looks very pale, and there is oppression of the chest  and  difficult  and
rapid breathing.
  Calcarea C  The  eruption  is white and  elevated  quite above  the
skin; it is hard  and seems  to itch very much, causing the  infant
great uneasiness.
  Dulcamara.  The eruption appears every time the babe is exposed to
the damp  cold air.
  Hepar.  Catarrh of the chest, head, etc accompanies the eruption.
  Nux V.  Urticaria accompanied  by gastric  derangements,  constipa-
tion, etc.
  Pulsatilla.  Urticaria with diarrhoea, worse  at night. 
ECZEMA CAPITIS.
869
  Rhus t. When rubbing the parts affected seems  to  increase  the
eruption.
  Sepia. The eruption makes its appearance, in the  cold air, and dis-
appears in a warm  room.
  Sulphur.  The child appears  to  suffer from  a suppression  of  the
eruption.
  Urtica urens.  When the  eruption looks pale, like  the stings  of
nettles, and requires to be rubbed all the time.

     Eczema Capitis—Crusta Lactea—Porrigo Larvalis.
  This eruption has been variously named by different authors, being
termed Porrigo larvalis, Impetigo larvalis, Eczema impetiginodes, Tinea
muciflua or granulata, etc.
  Description and  Symptoms.—This eruption is called larvalis when
it involves the face  aiid  covers it like a mask.   It usually occurs
during teething, and appears to be much connected with that process.
It commonly commences on the forehead and cheeks by the breaking
out of a number of small yellowish pustules, confluent and crowded
together upon a red surface.  These pustules excite great itching,  and
are quickly broken, discharging a viscid fluid that subsequently con-
cretes into  thin,  greenish-yellow  scabs.  The  scabs are  frequently
rubbed  off, but form again; fresh crops of pustules appear  around
the scabs, wliich quickly extend to  the scalp and even the face.  When
the  scalp becomes engaged, the lymphatic glands at the back  and
Bides of the  neck  enlarge and sometimes suppurate.  The eruption
appears upon or behind the  ears,  and patches will sometimes appear
also upon  the  neck  or  breast.  The discharge  from the pustules is
caught by  the hair upon the  head, and concretes into small, irregular,
friable  masses, which  may  resemble the bruised yolk  of a hard-
boiled egg.  The pustules, or achores, as the small superficial ulcera-
tions which they form upon  the skin are sometimes called, have an
acuminated form, contain a str.iw-colored  fluid,  rest upon an  in-
flamed base  and  are succeeded by a thin, brown or yellowish scab.
There is  much irritation, heat of the scalp  and itching;  the  dis-
charge is very  profuse,  and with so much itching that it is rubbed off,
leaving the surface raw and excoriated.  Wherever this  discharge is
brought in contact with the skin—in the face, where it trickles down,
upon the breast, where it falls, and upon  the backs of the hands,
violently used  by  the child to rub  with—it proves so acrid as to pro-
duce there a fresh  eruption.  The same is true even of the arms of
the nurse upon which the child rests its head at night. 
870           diseases of infants and children.
  The itching and burning acridity of the eruption  and discharge
are much worse at night.  All external applications should be sedu-
lously avoided, even  water.  The application  of water to the parts
affected aggravates the  case  and delays cure.   The recession of the
eruption should thus  be carefully guarded against, since it might be
followed by hydrocephalus or phthisis pulmonalis.
  Treatment.—Study  the  following  remedies, and any others which
may more accurately cover the symptoms and conditions present.
  Indications will also  be found among these medicines for various
other forms of chronic  cutaneous disease which have not been partic-
ularly described.

  Aconite. Where we  find much fever, restlessness,  anguish, the parts
much inflamed, Aconite may remove every vestige of the complaint,
if we wait  patiently  upon  its  action as long  as  the improvement
continues.
  Arsenicum. Eruption  very dry and scaly; it even seems sometimes
to cause the destruction  of  the hair  in such places as are affected,
leaving the scalp  rough  and dirty-looking.
  Baryta C  Particularly when the cervical, submaxillary and parotid
glands become swollen and hard, as a concomitant.
  Bryonia.  In cases complicated with  some other affection which is
always made worse by motion.  The scalp is very tender to the touch;
the child cannot bear  even a soft brush upon it.
  Calcarea  c. In  children of leucophlegmatic temperament, eruption
with thick  scales  and  yellow pus underneath.  Stools having a chalky
appearance.  Sometimes the eruption appears in the form of  a ring-
worm.
  Chamomilla. When  the  child  has  been kept  too warm; it  is very
fretful; must be carried more than usual.
  Cicuta V. Thick, whitish scurfs appear on the chin and  upper lip;
they secrete a dampness; sometimes scurfs from the nose.
  Clematis e. There appears  a dark,  burning miliary  eruption, with
violent itching; a dampness  constantly exudes from this, which dries
into scurfs  as the disease spreads onward.
  Dulcamara. Indicated in thick brown herpetic crusts  on the  face,
forehead, temples and  chin, with reddish borders, bleeding when
scratched.
  Graphites. The eruption exudes a transparent, glutinous  fluid, which
causes the  crusts to fall off, when more form, to fall  again in turn ;
meanwhile the eruption extends over a still larger surface.  It appears 
    *

                     PITYRIASIS—DANDRUF1                   8 71

more particularly on the chin and  behind the ears, although no  por-
tion of the surface is entirely exempt.
  Hepar. The  eruption  spreads  by means  of new pimples  appearing
just beyond the main disease, which finally become incorporated with
those which came first.
  Lycopodium. When the  eruption has a bad  smell and bleeds very
easily; the disease seems to spread from the right side toward the left.
  Mercurius sol.  Much salivation and scorbutic gums.
  Phytolacca dec. Moist, fearful  itching, with little  raw tubercles on
scalp, face and arms.
  Psorinum. This remedy should  be studied in seemingly intractable
cases.   Intolerable itching, scratching till it bleeds.
  Rhus t.  A bright edge of inflammation surrounds every portion of
the eruption, and there  is  much  itching, particularly at night.
  Sarsaparilla. The entire base of the eruption is much inflamed; the
child cries much and is very uneasy; also the crusts become detached
in the  open  air,  and the skin adjoining becomes chapped.
  Sepia. Eruption  very moist, almost constantly  discharging  pus-
like matter; the child often jerks its head to and fro, seemingly from
the itching.
  Staphysagria.  When  the scales  are yellow, moist, offensive and itch
violently.
  Sulphur. Where the  eruption extends more  or less  over the whole
body, with  much itching, although the main  affection appears  upon
the head.
  Viola tri. Thick  incrustations, pouring out a large quantity of thick
yellow fluid, which agglutinates the hair.
   Violently itching eruption, worse every night, and urine smelling
like cat's  urine.

                     Pityriasis—Dandruff.
  This is a superficial,  scurfy,  bran-like  eruption  which  appears
sometimes  on the  forehead, but principally upon the hairy  scalp
of  infants.  The minute  scales,  exfoliation of the external  cuticle,
fall off, leaving temporarily a white  surface, to  be  replaced  pres-
ently by  a  similar scurfy formation; this process  occurs  again and
again.
   Treatment.—Study the following medicines, as well  as  those pre-
viously mentioned under Eczema  capitis.  Be  careful in cleansing the
child's  head not to try to wash  or rub off the dandruff.   Cure the
child, and that will disappear of itself. 
872
diseases  of infants and children.
.   Arsenicum.  Eruption dry  and  scaly;  scurf  or sculcG constantly
 falling off, often destroying the hair.
   Bryonia. When the  scalp is extremely sensitive and the dandruff
 rough and uneven.
   Calcarea c. The dandruff accumulates  evenly  all over the scalp,
 which is smooth and seems to become thickened.   This remedy alone
 cures the most of such cases.
   Dulcamara.  Marked  aggravations in the child's general symptoms
 occur with every cool change in the weather.
   Graphites. Occasionally there is seen a transparent, glutinous exu-
dation upon the scalp.
   Lycopodium. The head smells very badly.
   Mercurius. When there  are 'general  mercurial symptoms in con-
nection with the dandruff.
   Psorinum. This remedy will sometimes be required when Sulphur or
Calcarea fails to cure.
   Sepia.  The  dandruff seems  to come  in circles  like ring-worm
(annular herpes).
   Silicia. This remedy is indicated in cases similar to those cured by
Calcarea, but the child has less of the leucophlegmatic temperament.
   Sulphur.  General  Sulphur symptoms with the dandruff.

          NiEVi Materni—Mother's Marks—Moles.
   These  spots are congenital, as  their  name indicates; and  they are
not only hardly  ever  amenable  to surgical treatment, but  have in
many cases been  rendered much worse  by such injudicious  inter-
ference.  Some remarkable naevi  reproduce  upon  the skin of  the
child while yet unborn the vivid  impression made upon the mind of
the mother. Another and more profound influence of the same kind,
or one exerted in an  earlier stage of pregnancy, results in actual
deformities and  monstrosities.  Ncevi  materni may  be  arranged in
three distinct classes, in the order  of their gravity :
   I. Moles, the most common  of  all, whose character and harmless-
ness are well known, and which are generally attributed to some altera-
tion in the  structure of the rete mucosum.
   II.  Venous Aneurisms—Anastomosis of Venous  Capillaries.—These
form a dark-red circumscribed stain, which generally appears on  one
side of the face,  and  is sometimes  of considerable extent.  These
" marks," which appear to be simple dilatations of the sub-cuticular
capillary vessels, may increase in extent till puberty, and then remain
stationary. 
          N^EVI MATERNI—MOTHER'S  MARKS—MOLES.        87u

  III. Aneurisms and Dilatations of the Arterial Capillaries.—These
form the most important of the naevi; they are apt to enlarge in after-
life, especially when stimulated  by external irritation, and  they may
give rise to dangerous haemorrhage if improperly meddled with.  They
form slightly elevated spots,  with well-defined margin and a granular
surface, which consists of an erectile vascular tissue.  These granulated
tumors, raised above the skin, may in fact be constituted of venous or
of arterial vessels.  In the former case they may be of a dark-blue
or livid color; in the latter,  of a brighter red.
   Treatment.—The following remedies should be carefully studied, in
order to find the simile in each  case: this  being found, it should be
given sufficiently high and at long intervals, in order  to remove as
rapidly as possible from the system the morbid condition which sus-
tains  these irregularities  of  the  circulation, and to  enable  nature to
remedy the  deficiency in  structural organization from which perhaps
they originally sprung.

   If the arterial  capillaries are involved :
   Belladonna. Will be indicated by  red  radii  extending  from the
centre.
   Calcarea c. In  leucophlegmatic temperaments.
   Lycopodium. In hypertrophied  capillary  tumors, both  venous and
arterial.
   If  the venous capillaries are involved:
   Carbo veg. Particularly when the  slightest  irritation  causes free
haemorrhage.
   Phosphorus. "Small wounds  bleed  much;"  this may  be  either
venous or arterial.  Study also Nux v., Sulphur.
   Fluor ac. Most important of all, if they itch much.
   Encysted Tumors.—For these tumors study the  constitutional
and concomitant symptoms and conditions  of the  patient, and select
that remedy which is homoeopathic  thereto.   The most frequently
indicated are: Baryta  carb., Calcarea carb., Hepar, Graph-
ites,  Phosphorus, Silicia and Sulphur.

   Warts, Wens.—In the treatment of these excrescences  the  same
plan  should  be  followed as in  encysted tumors, and will  be  found
efficient.  Amongst the  remedies that will  be found to be  most fre-
quently called for are:  Calcarea carb., Causticum,  Dulcamara,
Lycopodium, Nitric acid,  Psorinum, Rhus tox., Sepia, Sulphur
and Thuya.  Fig warts.—Thuya, Lyc, Dulc 
874          diseases of infants and children.

    Cephal^matoma—Sanguineous Tumor  of the Head.
  Of the sanguineous  tumors sometimes developed upon the pericra-
nium and bones of the head of new-born children, the writer has met
with  quite  a number,  and he has always been  successful in curing
them in a few days with a single dose of Calcarea c, high. Hartman
recommends Arnica or Rhus30.
  If there should result an ichorous discharge and caries of the bone
and  prostration, the same author  prescribes China,  and afterward
Silicia.  But in my opinion Calcarea c, given at the  first, will save
any further trouble.

  Ecchymoses on the surface of the  scalp of young infants are the
result of contusion of the cranium in parturition.   They disappear by
absorption, but their removal may be  hastened by  the application cf
Arnica lotion.
                            Ranula.
  This  swelling under the tongue consists in an enlargement of the
sublingual bursae mucosae, or  of a dilatation of Wharton's duct from
previous obstruction.   The cyst contains usually a limpid or thick
albuminous  fluid, although  there  have been  instances  in wrhich the
contents were more solid  concretions.  The puncture of the tumor,
although evacuating the contents, does no good, and should in no case
be resorted to.  The disease takes its rise in some  scrofulous (or pos-
sibly syphilitic) dyscrasia, and can only be radically cured by remedies
capable of removing such taint from the system.

  Ambra g.  Is  recommended  by Jahr.
  Calcarea c.  Should always  be studied in connection with cases of
this  kind occurring in  leucophlegmatic temperaments.
  Mercurius.  Much salivation.  Suspicion of a syphilitic taint.
  Natrum mur. In  the opinion  of Hartman  deserves the preference
over Ambra.
  Rhus t. Has  cured several  cases under my care—a greater number,
in fact, than any other remedy.
  Sulphur.  May also be studied when it appears to correspond to the
disposition  of the patient  and to the cause of the disease.
  Thuya. When the tumor is  decidedly of a blue color or  compli-
cated with synhilis.
                      Intertrigo or Chafing.
  Excoriation,  soreness  or chafing  frequently occurs in those parts of
the  skin of infants which are  either  rubbed together in the natural 
INTERTRIGO or chafing.
875
movements  of the limbs, or are liable to be fretted by friction of the
diaper or other articles of clothing.  Thus, the groins, the surfaces
between  the genitals and the  thighs, between the  nates, behind the
ears, the axillae and even  the folds of the neck in fleshy children, may
become the seat of these excoriations.
   Such tenderness  of the skin is  due in the first instance, in great
part at least, to a psoric dyscrasia in the constitution, and for its com-
plete removal it will require, therefore, a suitable antipsoric remedy.
But this original disposition to such excoriation will be greatly in-
creased by want of proper attention  to the state  of the skin, and by
neglecting to remove as soon as possible all those excretions from the
bladder and bowels, and from the skin itself,  which alone are capable
of  originating such irritations and  of  causing them to proceed to
ulceration.  Very fat children  are particularly liable to be troubled
in this manner.   The use of the gum-cloth diaper will also produce
chafing, pustular eruptions and other infantile  troubles.  Physicians
should caution mothers ag-ainst its use.
   Treatment—Directly contrary to the general custom, no powder  or
other external application should ever be used to keep the skin from
chafing.   It will be far better  to pay strict attention to cleanliness, to
wash clean  and  dry the skin  carefully and as perfectly as possible
with  soft towels, never  using  the  first  particle of powder.  If the
parts become very  sore, omit washing entirely; use no external  ap-
plication of any sort whatever, not even dry linen; but with the great-
est care select the most appropriate  medicines, and do not wash, or wet
the part even, till well.
   Calcarea C. Will be suitable  in  leucophlegmatic constitutions;  in
very fat and fleshy infants.
  Carbo v. If there is much rawness  of the parts opposed, and a gen-
eral disposition to excoriation, particularly in very warm weather.
  Chamomilla. If the child is very  irritable, cries much, and  requires
to be carried continually up and down the room.
  Graphites. The affected parts discharge a  quantity of transparent
glutinous fluid, especially behind the ears and between the thighs.
  Hepar. The intertrigo seems  to extend by means  of pimples which
arise just beyond the raw surface;  these become  involved  in the ex-
coriation, and new pimples appear a little farther beyond.
  Lycopodium. The excoriation becomes offensive and bleeds much;
worse after four p. M., and better after eight in the evening.
  Mercurius  sol.  The  excoriation is much worse at  night;  it is very
raw and bloody; the child does not sleep much. 
876
DISEASES  OF INFANTS AND  CHILDREN.
   Pulsatilla or Ignatia may be indicated and are  recommended where
much chamomile tea has been taken by the nurse.
   Sepia.  The  skin  is very delicate; the least injury tends to ulcera-
tion.
   Sulphur. There is much itching of the skin in general and of the
parts affected.

             Induration  of the  Cellular Tissue.
   This is more common in foundling hospitals than in private prac-
tice. It chiefly attacks the children  of persons suffering from impov-
erished nutrition, and usually appears in the first five or ten days after
birth.  The infants in whom the induration of the cellular tissue is
developed are weakly and often premature, and the difficulty is thought
to result from imperfect expansion—Atelectasis pulmonum—or from
subsequent collapse of the  lungs.  In many instances  a livid redness
of the whole surface  is obvious  from birth, but the appearance of a
circumscribed hard spot on one  or  the other  extremity, or  on  some
prominent part of the face, as the end of the chin or the cheek-bone,
is the first sign of the commencement of this affection.  Otlier  spots
of a similar  kind are soon discovered on different parts of the surface,
and the body generally and the hardened spots in particular are found
to present a temperature much below the natural warmth of the body.
" The skin which covers the diseased part is slightly rose-colored, or
purple, violet, or livid.   If the  disease runs a rapid course  the tem-
perature of the body decreases rapidly, the pulse  is scarcely percepti-
ble, the breathing becomes  more  and more labored, the child's  cries
diminish and gradually cease altogether; the face becomes livid, and
the little ones die as of suffocation, generally on the third day. Some-
times the disease is  more chronic, and passes off again from the fourth
to the eighth day, but these cases are exceedingly rare, and under the
old treatment most  children die in a few days."—Jahr.
   In this country, as in Great Britain, this disease is  comparatively
rare; its  occurrence in the ill-ventilated wards of foundling hospitals
in large cities on the Continent,  especially  in Paris, is  more common.
Jahr, who seems to have  had better  opportunity for  observing this
disease than any other writer of  our school, affirms that it is readily
cured under homoeopathic  treatment, and he recommends Aconite,
Bryonia  and  Sulphur, to which  may be added  Calcarea c, Conium
and Dulcamara. 
SYPHILIS neonatorum.
877
         Induration and Swelling of the Breasts.
  The breasts of female infants are liable to swelling, inflammation
and induration, or suppuration, in consequence of the absurd practice in
vogue with some nurses of squeezing them, on pretence that unless the
milk is squeezed out of them they will subsequently prove useless for
lactation.   Such notions, remnants of old wives' fables and the fruits of
erroneous views in physiology, cannot be too strongly discountenanced.
But unless  the physician is on  the watch  such  things may be done.
Such a course of procedure as squeezing the child's breast, should it
result in suppuration, as is  not unlikely, may, by causing structural
disorganization of the gland, produce the very mischief it was  in-
tended to  prevent.   In  these cases Hepar or Silicia, or even Phos-
phorus, may be needed.  But  the  disorder may arise  without  any-
apparent cause, such as  mechanical injury, and in  such  instances is
doubtless due to constitutional  taint thus  manifesting itself;  just as
we see, in after life, when the woman conies to the  process of lacta-
tion, sore nipples and a gathered breast in spite of the utmost care
and the  most skillful  medication—the cropping out of the latent
psora.
  Treatment—The  disorder  must  be  treated  with reference to  its
cause and to the totality of the symptoms  present.

  Aconite.  If there be  much  fever  at the outset, this remedy may
dispel the whole difficulty.
  Arnica. If the breasts are merely hard, with no  apparent  inflam-
mation, or  if the redness has not yet appeared.
  Belladonna. The inflammation is of an  erysipelatous kind;  it runs
in radii as  it extends to the adjacent parts.
  Bryonia.  The breasts are quite hard, and of a pale red  color.
  Calcarea  c.  This remedy will  be found  indicated in some cases of
leucophlegmatic temperament, with  very  large fontanelles, light, fair
complexion ; breasts hard, but not red.
  Chamomilla. The child is very fretful; it must be carried in order to
be appeased; the breasts are very tender to the touch.
  Hepar. Will be useful if matter or pus has already formed.
  Silicia. This remedy will be needed  sometimes after Hepar, par-
ticularly to heal the ulceration.

                    Syphilis  Neonatorum.
  The  syphilis of new-born  infants requires the  nicest care  for  its
management.  The following remedies are  mentioned because they 
878
diseases of infants and children.
are most frequently called for  in  the  treatment of this saddening
affection; but the practitioner should gather together the symptoms
and conditions which make up the totality of the case, and select a
remedy in accordance therewith; the remedy being  well chosen, its
action should  be continued,  and  not  interfered with  by another
remedy.

  Aurum. If  the nasal or palate bones are affected.  Ozssna syph-
ilitica.
  China or Phosph. acid. When the child appears very weak, and has
great coldness of the skin.
  Hepar. This remedy will be found useful when the mother has been
allopathically treated with poisonous doses of Mercury.
  Mercurius.  When chancrous ulcers appear about the child.
  Nitric acid.  When the child has aphthae or ptyalism.

  Syphilitic Ophthalmia.—In  this affection may be indicated
Mercurius, Thuya, Nitric acid, Carbo veget. and Phytolacca
dec.  Study also the remedies under Inflammation of the Eyes

  Syphilitic Cutaneous Affections.—These various forms vf
eruptive disease require, according to  their accompanying symptoms
and conditions, Nitric acid, Hepar, Thuya, Sulphur, Phosph.
acid, Dulcamara and Phytolacca dec.

   Condylomata.—In their severer form these  excrescences present
a red  surface  and hard base, and discharge an acrid, purulent, conta-
gious matter.

  Mercurius sol. When there are general mercurial symptoms.
  Nitric acid.  This remedy may be indicated in some cases  where
there is evidence of mercurial influence in the constitution.
  Thuya. Indicated in a majority of cases.
  Phytolacca dec. Itch fearfully.

                 Comedones—Acne  Punctata.
  These appear like little black points, in consequence of obstruction
and enlargement of sebaceous follicles  on the  nose, chin or forehead.
The following remedies may be studied in such cases:
  Eugenia jambos, Bryonia, Calcarea c, Natrum m., Graph-
ttes, Saiuna, Sulphur and Thuya. 
cyanosis.
379
                   CHAPTER  XXXVIII.

          DISEASES OF  CHILDREN—CONTINUED.

                            Cyanosis.

    THE patency of the foramen  ovale, or imperfect closure at birth
     of the opening through which the blood in the foetal circulation
had passed directly from the right heart to the left, was formerly sup-
posed to occasion a partial mixture of the venous blood with the arte-
rial, and hence the cyanosis  or blue disease.  But more recent research
has shown that this  diseased condition may be due to a great variety
of lesions of the  circulatory apparatus, especially of the heart and
principal vessels, such as obstruction of  the pulmonary artery, mal-
formation of the heart cavities, some of which are wanting; transposi-
tion of the pulmonary artery and the aorta, etc.  A cyanotic condition
may likewise result from any cause that interferes with  or prevents
the proper oxygenation of the blood ; as, for instance,  in atelectasis pul-
monum.   The  cyanotic hue  is  frequently seen in  croup, laryngismus
stridulus and hooping cough.
  In cases of cyanosis there is a  general  bluish or blue color of the
integuments, but it is principally  marked in situations where the skin
is delicate and highly vascular, and in the extremities. The blue tint,
when limited  to certain  spots, is  a result of local congestion.  A
transient blueness of  the skin has also been noticed in a few cases in
various parts of the surface,  but its internal cause is unknown.*
  The term chronic cyanosis is used by Virchow to express the gen-
eral venous congestion which is consequent upon chronic affections of
the heart and lungs.   Acute cyanosis, he  states, occurs in acute affec-
tions of the lungs; as, for example, in pertussis.  This eminent patho-
logist affirms, contrary to the opinion formerly entertained, as stated
above, that cyanosis, even when produced by congenital malformation
of the heart, does notarise from a commingling of arterial and venous
blood, but from obstructions to the venous circulation.!  This,  how-
ever, would appear to depend  upon the  occasioning cause; in  some
instances,  doubtless, it is due to  venous  congestion, while  in others
there is a mixture of  the venous with the arterial  blood;  and, again,
in a third  class of cases there is both venous obstruction  and admix-
ture of venous  and arterial blood.
     * Rokitansky, iii., p. 71.                f Cellular Pathology, p. 372. 
880
diseases  of infants  and  children.
   This affection generally destroys  life at an early period, but  sol-*-
 times the adult age may be reached, with some distress  and impair^
 health.  A very large proportion, however, die within a few weeks or
 months, or at most within a year or two  after birth; some such dis-
 ease as hooping cough or one of the eruptive fevers attacking the cya-
 notic patient is  very badly borne, and is apt to terminate fatally.
   Treatment—An important part of the treatment"of cyanosis  is hy-
 gienic.   Good  nutritious food, plenty of fresh air, and  in older chil-
 dren moderate exercise, will do much to correct the disordered  circu-
 lation.  In cyanotic infants the position recommended under laryngismus
 stridulus may be resorted to, because the action of the heart may be
 more free and unincumbered if the child lies upon its right side, with
 its trunk elevated at an angle of about 45°.   One of the following
 medicaments  may prove useful.  Consult also  the indications  for
 remedies under  Laryngismus  stridulus, Croup and  Atelectasis
 pulmonum.

   Aconite.  If at any time there should be much vascular excitement,
 heat or restlessness, this remedy may be  needed;  if so, let  it act aa
 long as the improvement continues, and it may entirely cure.
   Arnica. In  cases where there  is  haemorrhage  from  the nose and
 mouth, and great strangling  and suffocation.   The case seems almost
 hopeless.  In such cases a few doses of Arnica will do much good.
   Arsenicum. The symptoms are much aggravated by the least  exer-
 cise.  Much emaciation ; cold sw^eat; great debility.
   Calcarea C. This remedy may be indicated in leucophlegmatic chil-
 dren, with large, open fontanelles; the head perspires very much.
   Carbo v. The  veins stand out very full, and are remarkably blue.
   China. In some collapsed  stages,  with waxy paleness  and coldness
 of the skin.
   Digitalis.  The child can hardly be turned or its position  changed
 without causing fainting, or nearly so, and  almost always causing
 vomiting.   The  eyelids, lips,  tongue  and nails become  very  blue;
 pulse unequal, or very slow.
   Lachesis.  When the suffocating spells and  the  increased  blueness
 become worse after sleeping.   Great tenderness of all the flesh; it is
exceedingly difficult to handle the child at all;  the least touch seems
to hurt it, and to leave a deeper blueness, like a bruise.
   Laurocerasus.  This  remedy, in my practice, has cured  permanently
some very bad cases of this disorder, with the following indications.
 A little exercise produces gasping for  breath and increased blueness. 
ICTERUS  neonatorum—jaundice.            881
The  ends  of the fingers  and  toes  are  knobby,  and  larger  than
any portion  of  these  extremities; the  child  is  better when lying
still.
  Phosphorus. In very tall and  slim  children, with much oppression
of the respiration and swelling of the feet.
  Secale c.  In very  thin,  scrawny  children  with  shriveled skin:
especially wdien  there are spasmodic twitchings, sudden cries, fever-
ishness, etc.
  Sulphur.  This remedy will be found  useful in many cases  charac-
terized by the real sulphur constitution.

                Icterus Neonatorum—Jaundice.
  The jaundice of new-born babes  is scarcely to be considered an
actual and  distinct disease.   It  may indeed be caused by undue and
prolonged  exposure  to  cold  of  the tender and unprotected body of
the infant  immediately  after birth.   Often, however, it  is the result
of a more  interior, physiological shock, which the system receives in
changing from intra-uterine  life to independent existence.   From the
second to  the fourth day after  birth the entire surface of the skin,
and also of the  conjunctiva, may assume the yellow hue peculiar to
this affection ;  this, continuing two or three clays, gradually  fades
away,-until by the  eighth  or tenth  day the  natural, rosy-white color
returns.  The absence of other morbid  phenomena, and the frequency
of icterus among new-born babes, proves that this is not really a state
of disease.    Such at least is the opinion generally adopted,  confirmed
by the transitory nature of the  affection itself,  Seemingly it results
from  a slight interruption  in the physiological action  of the liver,
or from the temporary hesitation which  this organ  experiences in
adapting itself to the new order of things in the independent  state of
existence;  for it may  result from  a  temporary disturbance in  the
hepatic portion  of the  foetal circulation  from the  same cause; and
this condition will of  course be  particularly aggravated, as  already
stated, by exposure of  the surface of the body to the cold  air.   The
small amount of exercise that pregnant  women take, and the  costive-
ness  that  so frequently attends their condition,  may have  some
influence in  causing Icterus  gravidarum, and in consequence in  pre-
disposing to the same  condition  in  the new-born  infant.    Watson
accounts for some supposed cases of this disorder in  the  following
manner: " The  Icterus  neonatorum occurs, they say, a few days after
birth; is not attended  with  any suffering  or obvious disturbance of
the bodily  functions, and soon disappears.   Now there seems reason
       56 
882           DISEASES OF INFANTS  AND CHILDREN.
to believe that this is  not icterus at all, and has no relation to the
biliary organs.  The surface of the infant at its birth is frequently
of a deep red, from hyperaemia or  congestion of blood, presenting a
condition which falls little short of  a mild but universal bruise.   By
degrees the redness fades, as bruises  fade, through shades of yellow
into a genuine flesh-color.  Such,  I  am  assured by those who are
more conversant with these  matters than  myself, is the pathology of
the Icterus infantum."
   It has been claimed that, by allowing the effete  blood, contained
within the body of the child at the time of severing the umbilical
cord after birth, to escape from the vessels—not ligating  the  cord—
infantile jaundice will not occur, or rather is not nearly so likely to
occur.   We believe that non-ligation of the funis has some of the
effect claimed  for it in this  direction,  but there are not sufficient data
as yet upon which to found an opinion.
   Treatment.—If anything should  be required,  which is  not always
the case, a single dose of Aconite will  in the  majority of cases set all
right.   Should  the case  prove a true jaundice, and  be complicated
with constipation or other morbid symptoms, the remedies appended
to this article  should  be attentively studied.   Cases sometimes occur
in which, from the  unhealthy nature of the  mother's milk, it proves
so poisonous as to derange the liver of the babe, as well as  its stomach
and bowels.   In such cases, however,  by administering  the proper
homoeopathic  remedy, this disordered  condition in the mother will be
overcome, and the  secretion of good, healthy milk  will be secured.
Should the mother  become  seriously ill, it may become necessary to
remove the  child from the breast, and  have  it committed to  another
nurse,  or brought up  by hand upon such diet as has previously been
recommended  in this work.   Care must be taken to ascertain  posi-
tively that it is the milk which disagrees with the child, as very  often
this appears to be the case when not so in  reality.   Then the child
will, of  course, require treatment.

   Aconite. The infant is hot, restless, sleepless and in distress.
   Arsenicum.  Undigested, light-colored, offensive stools;  dry scald-
head ;  yellow skin.
   Bryonia. Vomiting of food  soon after  taking it;  the child wishes
to keep perfectly still.  Skin yellow.
   Calcarea C. Yellowness of the skin;  other symptoms similar to  those
put down for  this medicine under Dentition (which see).
   Chamonilla. A cold seems to have been the cause  of the difficulty; 
HEPATITIS—CHRONIC DISEASE OF THE LIVER.       883
light-colored and offensive stools; the child is very fretful; wishes to
be carried.
  China.  There is tenderness in the region of the liver; distension of
the abdomen.   Undigested and painless stools in large quantity.
  Colocynth. Much colic, with writhing, twisting and doubling up.
  Digitalis.  The stools are almost white; scanty  brown  urine;  fre-
quent and empty retching; much debility.
  Dulcamara.  The  child gets worse at every  cool  change  of the
weather.
  Hepar.  In children with dry, pimply eruptions.  .
  Ignatia. The child is inclined to spasms as a prominent symptom;
frequent  sighing.
  Ipecacuanha.  Almost constant nausea.
  Mercurius sol. General mercurial symptoms, such as salivation,
swelling  of the glands,  slimy stools, abundant and  strong-smelling
urine.
  Nitric  acid.  Urine scanty and strong-smelling;  very restless  after
twelve o'clock at night.
  Nux v. Constipation;  sleeping toward morning;  colic; the nurse
is a high-liver or takes much coffee.
  Pulsatilla. Entire  loss  of appetite; vomiting  of mucus; no thirst;
very changeable in appearance; worse toward evening.
  Sulphur.  The child wakens often;  it inclines to intertrigo  and to
general papular eruptions.

         Hepatitis—Chronic Disease of the Liver.
  Hepatitis, or acute inflammation of  the liver, may be developed,
especially in those constitutionally predisposed thereto, in connection
with derangement in other portions of  the digestive  apparatus, or it
may arise  and assume the  intermittent form in consequence of the
miasm which develops chills  and fever.  Fever, restlessness, loss of
appetite,  constant nausea, constipation, and a yellowness of the scle-
rotica  and  skin, constitute some  of the principal symptoms  of this
condition.   Palpation  will  discover  enlargement and tenderness in
the hepatic region; young  infants  will  shrink  from the pressure
and cry.

  Chronic Disease of the Liver may be the result of the long-
continued influence which causes the acute form.  Or the liver may
become enlarged by fatty deposit in its substance—fatty enlargement
or degeneration—or  it may become the subject of albuminoid enlarge- 
884           DISEASES OF INFANTS AND CHILDREN.
ment.   Such chronic diseases of the liver will always be found asso-
ciated with, and measurably dependent upon, corresponding disordei
in the stomach and intestines, and especially the glandular and tuber-
cular diseases of the latter organs.

   Chills and Fever—Intermittent Fever, may occur in young
children, either in connection with liver complaints  or independently
of them, particularly after undue exposure to the night air in mias-
matic regions.  Under favorable  circumstances these affections  will
be  speedily removed by a single dose of  the remedy (not too low)
which is suited to all the symptoms of the  chill and the fever, to the
concomitant  symptoms, such as thirst, pains  in limbs, perspiration,
etc., and to  the  attendant conditions, such as the  aggravations or
amelioration of time, place, circumstances, etc.
   Treatment.—The following remedies will be found adapted  to meet
any of the above-mentioned conditions:

   Aconite.  Much fever;  dry heat;  restlessness and anguish.
   Belladonna.  Much moaning.   Can't bear  to be  moved.   Short
breath;  flushed face; red eyes; if able to explain its sufferings, there
will be much pain in the right shoulder complained of.
   Bryonia.  Very short breath; cannot bear the least motion ; dry lips
and mouth; stools dark, dry and hard as  if burnt.
   Calcarea c.  Leucophlegmatic  temperament; perspiration about the
head; stools like chalk.
   China. The region of the liver  is swollen and hard; much flatu-
lency; undigested stool.
   Digitalis.  Stools very light, almost white; much debility; nausea;
slow or  irregular pulse.
   Lachesis. Always worse after sleeping;  awakens in distress.
   Lycopodium. Much flatulency and rattling in the abdomen; this is
a very characteristic symptom of this  remedy in this as also in other
forms of disease.
   Mercurius.  Tenderness  of  the  abdomen;  it is  hard  and tense.
Mucous  stools, or  stools too light and  very offensive.   Salivation.
Strong-smelling urine.
   Nux v. Constipation  of large difficult  stools; no appetite; sleep-
lessness, particularly after three a. m.
   Pulsatilla.  In children  of  mild, gentle  dispositions;   pale  face;
blonde hair and blue eyes ; no appetite.  Or the case may be clearly
traced to some gastric disturbance from eating rich or fat food. 
SCROFULA.
885
  Sulphur.  The patient partially recovers, and then relapses; or there
is  a tendency of  the patient to get worse, without any  previous
improvement.

                            Scrofula.
  Scrofula is a general name for various forms of d.sease arising in
children of a psoric constitution.  In the previous chapters we have seen
how persons of  a strumous  or  scrofulous or psoric constitution are
peculiarly liable to suffer severely from the different disorders  inci-
dent to  infancy and childhood—how children of this  class suffer far
more than others in dentition and in all the accompanying disorders of
the gastro-intestinal system, in those which affect in various ways the
respiratory mucous membrane and adjacent organs, and finally in the
eruptive fevers of all kinds.  Many of the forms of cutaneous disease
to wliich we have referred are but manifestations  of the  same psoric
element in the system, and as such are properly as well as popularly
termed  " scrofulous humors."
   In different families this psoric or " scrofulous " diathesis tends to
develop itself  in different ways, and the same is true of  the different
ages of  life.   Thus, not  to repeat what has already been said of otlier
external developments of  scrofula, the  same element in early child-
hood affects the glandular system which  in other families, or in other
individuals of the same  families, and even in the same individuals at
different periods of life,  results in tuberculization.
   " Scrofulous children  are broadly divisible into two classes—those
of dark, dusky,  coarse features, heavy and sluggish in  their move-
ments,  intellectually  dull;  and those  of bright rosy  complexion,
fair, with fine skin and hair, highly nervous, susceptible, sharp  and
precocious.  Both are easily  fatigued by exertion or excitement; soon
take cold; the stomach  and  bowels are  easily deranged; the appetite
is fitful and capricious; they rapidly lose flesh;  soon get pasty and
flabby,  and they do not soon shake off any ailment of which they are
the subjects."
   The  term scrofula  as used in  this  section refers  principally to
disorders  of the glandular  system.   The cervical glands are those
most frequently affected—enlarged and  ulcerated.  Sometimes these
produce deformity similar to goitre, but show  no disposition to sup-
purate.   The  corresponding disorder of the mesenteric glands con-
stitutes  Tabes  mesenterica, and their  ulceration  "consumption of the
bowels."
  The causes of scrofula—that is, of  this especial development of the 
886          DISEASES OF INFANTS  AND CHILDREN.

inherited psoric diathesis—are to be found in scanty, unsuitable and
too uniform food; in defective ventilation; in deprivation of light; in
over-exertion, and in exposure to cold and dampness.  Young infants
imbibe  the  disease from their  nurses' milk,  or have it developed in
them by other and unsuitable substitutes for  it.  Scrofula is, however,
a very general  term, and among what may be properly termed scrof-
ulous diseases may be mentioned a large part of those to which the in-
fantile life is heir.  Some of these, such as Rachitis, Hydrocephalus/
Spasms, etc, will be more particularly described.

  Arsenicum. Great emaciation; waxy paleness; great fatigue on the
least  exertion;  nocturnal  restlessness.  Can  hardly go  up stairs.
Scrofulous atrophy.
  Baryta C  Painful glandular swellings  and indurations in the  neck
or near  the articulations of the lower jaw.  The mesenteric glands be-
come affected, and atrophy commences to show itself.
  Belladonna. Bleeding of the  nose;  distended abdomen; the throat
frequently becomes sore; the eyes are often  inflamed; bloated  face;
no good sleep; hears all that is going on at night.
  Calcarea C Head large; fontanelles  open, or are unusually slow in
closing; much perspiration about the head.  Sympathetic swelling in
the neck arid in other places; enlargement of the abdomen.
  Cina.  I  deem it not a little  remarkable, and a fact that  disproves
many theories of old-school origin, that Cina1000 so often cures  scrofu-
losis in children who  are continually boring with the finger in the
nose,  who are  cross and exceedingly  unamiable, wdiose urine turns
milky on  standing, whom nothing pleases, who are constantly turn-
ing and twisting at night, with frequent calls for water, and who are
often ravenous for food.
  Hepar.  Is  also suitable in many cases, as indeed are  many other
remedies,  according to their characteristics.   Compare Rachitis.
  Iodine.  This remedy is very  frequently indicated  when  there are
glandular swellings. Compare all the symptoms.  Bromine is closely
allied to Iodine.
  Mercurius sol. Cold  and  clammy sweat upon the lower extremities
at night.  Night sweats; swollen and inflamed  glands, with  a  tend-
ency to  ulceration.  Salivation.   Scorbutic gums.   All the symptoms
are always worse in cold, damp weather.
  Mezereum. May be  indicated when  there is constant excoriation of
the nose, and often of  the throat also.
  Psorinum. In many  respects this remedy is similar to Sulphur. 
RACHITIS—RICKETS.
887
  Silicia. Useful  in children with  large bellies, weak ankles,  much
perspiration about the head, and inclination to uncover.
  Sulphur.  In children who are exceedingly sensitive to the open air
or wind; they do not like to be bathed, to touch water, to have their
hair combed or brushed, or made to look nice.  Skin rough and scaly.
Burning heat in the soles of the feet; short naps of sleep at night;
papular eruptions.

                       Rachitis—Rickets.
  Scrofulous disease affecting the bones—called rickets, curvature of
the bones—is an affection of early childhood, being noticed usually
toward the end of the first dentition,  if not before.  It presents itself
in a great variety of degrees and forms.   The disorder seems to con-
sist in an excessive preparation for  the process of ossification, which,
from  deficiency of assimilative force, fails to be completed.  The bones
of the skull  seem to  be the first affected, and with this is invariably
associated some enlargement of the  ends of the long  bones. With this
species of. deformity of particular  bones  may also be  found in some
cases  a general deformity of shape, as seen in those who are pigeon-
breasted or affected with curvature  of the spine; and in fact some of
these  latter deformities of general structure naturally grow out of the
first-mentioned deviations in  particular osseous formation.   Besides
these  direct deformities  there are others, such as bending  or  curving
of particular bones, which arise indeed from mechanical pressure, from
gravity or from muscular contraction, but which are in reality due to
softness or incomplete  osseous development in the bones  themselves.
The one general and sufficient cause  for the innumerable variety of
deformities which may be described under  the  head of Rachitis, in-
cluding very slow development of the teeth, inability to walk, easy
fracture and spontaneous luxation of the  bones, is to be found in im-
perfect nutrition and unhealthy food,  developing in these forms some
dyscrasia  inherent in  the  system, some  weakness inherited from
parents.
  "The softening of  the bones  is fully accounted for by the diminu-
tion in the proportion of their calcareous salts.  Thus, Jenner states as
the mean of the analysis of several observers that the bones of healthy
children yield about thirty-seven parts of organic and sixty-three of
inorganic matters: whereas  those  of rickety children yield  about
seventy-nine parts of organic to twenty-one parts of inorganic mat-
ters.  In addition to this, it would  appear that the  inorganic matters
themselves undergo change." 
888
DISEASES OF INFANTS  AND CHILDREN.
   The characteristic  deformities of  the  bones are not produced ai
 once, but are preceded, for a longer  cr shorter period, by a general
 cachectic condition of the system.  This  shows itself in various dis-
 orders of the digestive system, such as  capricious  or voracious appe-
 tite;  diarrhoea;  general  sore feeling of  the  body, so  that the child
 dislikes  to be touched or moved;  profuse  sweating  about the head
 during sleep or  after every exertion; heat  and dryness of the skin
 the slightest covering being oppressive.  In some cases there is a pre-
 cocity of intellect, while in others there is more or less  mental dullness.
 After  these symptoms have  lasted  for some time  the osseous system
 shows that it is being affected, and  the various  deformities of the
 bones  present  themselves, differing  greatly in degree in different
 cases—such as  bending of the femora and  deformities of the head.
 spine,  thorax and pelvis.
   Rickets  is  not a fatal  disease per  se, but the condition  of system
 which leads to  it, and the depressing effect upon the vitality of the
 child  produced  by the rachitic condition,  leave it liable to  the super-
 vention,  in a severe  form, of some secondary disease,  such as chronic
 hydrocephalus, convulsions, laryngismus  stridulus, and (particularly
 where the thorax is badly implicated) to diseases of the lungs and air-
 passages.
   Treatment—In no  disease  is it  more  important that the  patient
 should have nutritious and easily digestible  food than in rickets.  If
 it be suspected that  the mother's milk is  not  of suitable quality for
 the infant,  it should be provided with a wet-nurse, or fed upon good
 cow's milk where that is  not possible.  The diet  of  larger children
 should contain a  large -proportion of  animal food.  If the teeth are
 defective, the food taken by the child  should be chopped very finely.
 Plenty of pure, fresh air is also essential.  Select one of the following
 remedies, or such other as may be indicated:

  Baryta c. Will be found suitable to many cases in dwarfish children,
i. e., in those of imperfect development.
  Bryonia.  Lips dry and parched; vomiting  immediately after eating;
constipation, with stools dry and hard, as  if burnt.  Wishes to keep
 very quiet.
  Calcarea c. In those children whose  temperament, figure and symp-
 toms correspond  to  this  remedy it  may be  repeated once a week or
 month, according as the condition of the patit nt may require.
  Ipecacuanha. Indicated by constant nausea. 
OPHTHALMIA.
889
  Nux v. Sleepless, particularly toward morning; constipation, large,
difficult stools.
  Phosphoric acid. When there is a pale, sickly look; great debility;
painless diarrhcea; tottering gait.
  Ruta graveolens. Tottering gait, as if the  thighs  were weak, and
there is much pain in them in walking.
  Silicia. Much like Calcarea, only the  temperament is less  strongly
marked and  leucophlegmatic, and the osseous system  is  better de-
veloped.
  Staphysagria.  When  the teeth turn black and crumble, with the
progress of the disease, into little fragments.
  Sulphur.  Indicated when the child is  subject to intertrigo,  pimples,
short naps at night, etc.
  Veratrum.  In cases complicated with diarrhcea or constipation, with
cold sweat on the forehead.

                           Ophthalmia.
  New-born  infants and older children are subject to purulent ophthal-
mia, or inflammation of the eyes.  The disorder is always serious,
for, unless speedily cured—which it is not always easy  to effect—the
inflammation will result in opacity of the cornea, impaired vision, or
even  total blindness.  And in  neglected cases, especially those in
which  the  necessary  attention  to cleanliness has not been enforced,
ulceration of the cornea may take place, and the contents of the eye-
ball be discharged, causing permanent deformity as  well  as  hopeless
blindness.
  " The first indication of the disease is generally the  eyelids becoming
glued together  during the night,  with swelling and redness externally.
When the lid is raised there occurs a gush of tears, and its  conjunc-
tiva is found to be uniformly red, and slightly thickened, and covered
often  with a  purulent, tenacious, transparent coating.   As the disease
proceeds the lids become  more constantly agglutinated, and an  in-
creased secretion from the  surface of the inflamed conjunctiva  takes
place  of a thick, purulent matter, a portion of which exudes  from
between the  lids, but the greater part is retained, causing a considera-
ble bulging of  the palpebrae, the integuments of which assume a dark
red hue."—Condie.  With the continuance of the disease the discharge
becomes still more copious, and must be constantly wiped away from
the exterior surface of the lids.
   Gonorrheal and syphilitic ophthalmia are the most rapidly destruc-
tive, and their treatment will  require all the skill,  caution  and dis- 
*
890           DISEASES OF INFANTS AND CHILDREN.

cretion  of the physician,  who must,  however, avoid wounding the
mother's feelings by suspicions, the statement of which, whether they
are justly founded or not,' can afford little help in prescribing.
  So many cases of purulent ophthalmia occur iu babes whose mothers
are affected  with leucorrhcea that we must conclude a discharge from
the genitals  of the mother is a very frequent cause of purulent oph-
thalmia in new-born infants.  The matters discharged are very apt to
be highly contagious, and  it is but a dictate of prudence always to
consider them so.
  Scrofulous ophthalmia is  one of the developments of the scrofulous
diathesis. It generally attacks both eyes, going from one to the other.
There is intense  photophobia with this  form of the  disease, and the
symptoms are consequently mitigated as night comes on, and aggra-
vated during the  day.  Pressure  upon the  eyeballs, which the child
often resorts to, seems to afford some relief.   It is a disease very diffi-
cult  to eradicate, and requires the most patient and accurate treatment
to bring about a happy result.
   Treatment—The most scrupulous attention should be paid to clean-
liness of the affected organs and of the whole body;  let the tempera-
ture  of the  room be made perfectly comfortable; avoid fatiguing the
inflamed eyes with too much light; carefully look after the health of
the mother  or nurse, and  no  less carefully select  the  remedy best
suited to all the symptoms, circumstances and conditions.

  Aconite. Where from  exposure  to  cold  air there arises  a high
state of inflammation;  general  fever, with  restlessness, distress and
sleeplessness.
  Belladonna.  The eyes look very red; cannot bear the light, opening
the eyes only when in a dark place.   Bleeding from the lids.
  Calcarea C  In  leucophlegmatic  temperaments;  excessive secretion
of mucus in the eyes.
  Chamomilla. Discharge of blood  from the  eyes; the lids are closed
in the morning.  If the inflammation be caused by exposure to cold,
damp atmosphere, or if aggravated  by every cold change in the
weather.
  Euphrasia. Great lachrymation, almost continuous.
   Hepar. Little pimples surround  the inflamed eye.
   Ignatia. Inflammation of the eyes, something like that of Belladonna.
but not so intense, with much sighing.
   Lachesis.  The eyes are always worse for a while after sleeping.
   Mercurius. The eyelids are much swollen, and contain, underneath 
PAROTITIS—MUMPS.
89!
them, much purulent matter, which pours out in quantities on opening
the eyes.   Compare Nitric acid.
  Nux V. The eyes are always worse in the morning.
  Pulsatilla. The  eyes  are  always worse  toward evening; better in
open air.
  Rhus t.  The lids are principally affected; they look red and fiery,
like  erysipelas, and seem to itch much;  protruding conjunctiva when
shut.
  Sulphur.  There are pimples more or less diffused over  the body;
short naps; the  eyes seem to itch  very much, and to  contain  much
mucus; the canthi appear raw.
  Thuya. Hard inflammation of the eyelids; they seem indurated.

                       Pa rotitis—Mumps.
  This acute inflammation of the  parotid gland, which has likewise
been termed  Cynanche parotidea, differs from  an ordinary glandular
swelling in being epidemic and  contagious, and in not tending to sup-
puration.   The disease  appears  in the form of an external swelling,
which occupies the gland  of one side, and, as the inflammation de-
clines in the  one first  affected,  it commences to develop itself in the
other in many cases, but not in  all.  The  swelling, which was at first
remarkable and  circumscribed,  soon becomes  extensive and diffused,
often involving the maxillary glands in the inflammation, and continu-
ing to increase till the  fourth day.  The pain is very considerable—a
steady and severe aching, as stated by those old  enough to express their
feelings—but the general fever is  comparatively unimportant.  The
duration of the swelling is variable—from five or six days in some cases
to a  fortnight in others.  The metastasis of the disease from the parotid
to the mamma, testicle or brain—rare in proportion to  the tender age
of the patient—would seem scarcely possible under judicious homoeo-
pathic treatment.

  Baryta c. If the swelling becomes very  hard.
  Belladonna.  In  cases  characterized  by red eyes and  face; fever in
the afternoon; tendency to erysipelatous inflammation; lethargy and
delirium, and pain in  head  on  disappearance  of  the tumor.  The
swelling is red  and shining, the  redness running in  rays from the
centre; especially when the right parotid is affected.
 ' Carbo veg., Conium and Coccus  cacti are very useful  in these cases.
Carbo veg. if the swelling is bluish or purple;  Conium if it be exces-
sively hard. 
S92           DISEASES OF  INFANTS AND CHILDREN.
  Lachesis. If the swelling commences on the left side, and afterward
affects the right gland.
  Lycopodium. Commences in the right side and goes to the left.
  Mercurius.  This is the remedy in the majority of cases, particularly
if they are apparently caused by a cold, and in cases where there are
chills and fever and thirst at night; sweat at night; no appetite;  can-
not open the jaws; difficulty of deglutition; some salivation.
  Pulsatilla.  If metastasis to the mammae or testicles takes place. Nux
or Mercurius may also be suitable for  this condition in some cases.
  Rhus. Where there is much restlessness at night, and in cases com-
plicated with erysipelatous inflammation.
  Hepar, Silicia, Arsenicum or Rhus may  be required if suppuration
takes place.

                            Hiccough.
  Singultus, or hiccough, belongs to the class of inspiratory convul-
sions, and has usually been deemed an affection  of  the diaphragm
alone.  But Romberg affirms that its cause not unfrequently  resides
in the central nervous  organs;  this, however, is most probably  true
rather of adults  than  of new-born infants.  • Hiccough  consists of
attacks of sudden jerking inspiration with a peculiar sound, followed
by a  short expiratiou.   And in each of these respects it is exactly
opposite to  hooping-cough,  in  which  the  expirations  are  quick,
noisy and jerking, while the  inspirations are anxious, protracted
and still more noisy.
   This affection  may be very readily relieved sometimes by  giving
the child the breast  or by a few teaspoonfuls of warm water.  The
following remedies have been recommended, and that  one which is
most indicated will certainly relieve the little ones suffering from this
form of nervousness, except in those cases in which it  results  from
exhaustion of the vital powers, and is thus evidently symptomatic of
approaching dissolution :

   Belladonna. Flushed  face;  red  eyes;  crying on  account of  pain
from the hiccough.
   Hyoscyamus. Twitching and jerking of the limbs as an accompany-
ing symptom.
   Ignatia. Frequent sighing as an  attendant symptom.
   Ipecacuanha. Much and constant nausea with the hiccough.
   Nux V. Constipation attends or causes the hiccough.
   Pulsatilla. Hiccough occurring mostly at night. 
HERNIA.
893
                            Hernia.
  Infantile  hernia  may be congenital or developed  subsequent to
birth, and a predisposition to this affection  may sometimes  be ob-
served in children whose parents are similarly affected.  The hernial
tumor may occur on either side, constituting inguinal hernia: this, de-
veloped to its fullest extent, becomes scrotal hernia in males, while in
female children the corresponding tumor appears  in the labia pudendi.
Exomphalos (umbilical hernia) is  also a common form of infantile
rupture: in such cases the tumor appears at the navel, as indicated
by the name.   Besides, there may be  femoral hernia,  which  appears
more frequently in female than in male children.
  It is very important for the physician to detect an infantile hernia
at as  early a period as  possible, especially before it occasions serious
mischief by becoming strangulated.   This latter accident indeed but
seldom occurs in very young children, except in consequence of severe
fits of crying in those already ruptured, or in cases of hooping-cough,
in which the violent paroxysms may have induced the rupture in the
first place.   Thus, when, either from its own observation or from that
of the mother or nurse, any tumor or unusual formation is detected,
the child should be as carefully examined as an adult would be in case
of suspected hernia.  The most difficult to detect, and at the same
time one of the most  common  forms of hernia, is that which  may be
developed  in the scrotum of the male infant not long  after its birth.
In these cases of congenital hernia " the intestine or omentum passes
out of the abdomen, accompanies the testicle in its descent, and be-
comes lodged in the pouch of the peritoneum, which accompanies the
tunica vaginalis testis, before its communication with the general per-
itoneal  cavity has become obliterated.   In  the encysted variety of
congenital hernia the communication between the cavity of the tunica
vaginalis and  that of the abdomen is closed at its upper part, but the
former is unusually large and  continues high on the cord, containing
more or less serous fluid; behind this  the hernia  descends invested by
the ordinary  peritoneal sac." *  In  the femoral variety the hernia
appears in  the  groin, where  it  may  readily be  distinguished  from
tumors  resulting from  other causes by accompanying symptoms and
by the condition  and history of the case.  Besides these varieties, the
intestine may effect its passage through the  parietes of the abdomen
at other points, constituting ventral hernia.
  The strangulation of the protruded intestine will give rise to si iiilar
                     * Helmut! 's Surgery, p. 571. 
894           DISEASES OF INFANTS AND CHILDREN.
symptoms of pain, colic, vomiting and obstinate constipation, or ob-
struction of the bowels, in young infants as in adults.  And wliilt
such strangulation is far less apt to occur, it can always be traced to
some  definite  cause, such as violent straining in crying or in severe
paroxysms of coughing.  And  both  the hereditary predisposition to
rupture and  the congenital  or  subsequently developed hernia may
be entirely remedied by the  administration of the appropriate  medi-
cine in single doses,  and not too often repeated.   And even in severe
cases of strangulation the physician will have the satisfaction of wit-
nessing the happiest effects from the homoeopathic treatment.   By ex-
tensive observation  I  am persuaded that it  is  never useful to  apply
bandages or trusses in these cases, whether the hernia be congenital or
otherwise.   The properly selected homoeopathic remedy is always suf-
ficient to cure the case.*  Study the following remedies:

  Aconite. There is a  constant fever; uneasiness  and  distress  by
spells; the parts are very tender to the touch.
  Antimonium C. A  great deal  of crying; white tongue; vomiting;
diarrhcea;  cough.
  Borax V. The child cannot bear a downward  motion; it is very
nervous;  cries much day and night.  Even when it is sound  asleep
the downward motion of putting it into the  bed or cradle will  surely
awaken it.
  Calcarea C.  In children of leucophlegmatic  temperament, with large,
open fontanelles; much perspiration  about  the head ;  the child cries
much.  It may have two or three ruptures, yet in  such cases Calca-
rea alone will effect  a perfect cure in a few weeks or months.
  Chamomilla. The child is very fretful, and finds quiet and comfort
only  in  being  carried  about  up and down  the  room.   Constant
diarrhcea.
  Cina. Very restless even during sleep.  It will not lie awake five
minutes without crying.  It must be rocked, carried or dandled upon
the knee constantly, day and night;  the  mother and nurse  are worn
out taking care of the  child till it gets Cina,  when it  becomes quiet
and the hernia subsequently gets well.
  Lycopodium. Much croaking, rattling and commotion in the abdo-
men  day and  night;  colic  and crying.   Red  sand  in  the  urine;
screaming when passing water.   Always worse soon after 4 p. m.
   Nux v.  The child has much colic; it draws up  its  feet, and then
thrusts them down  again.   Constipation, the stools being large and
                * Vide  Hahnemannian Monthly, vol. ii., p. 8. 
               WORMS—VERMICULAR AFFECTIONS.            895

difficult.   Poor appetite ; crying much at night.  The hernial tumor
looks blue.  Nux is indicated oftener than any other remedy.
  Opium. Redness  of the face;  abdomen hard  and  distended; the
child is soporous.
  Silicia.  Frequent  colic, relieved  by  the  discharge of  offensive
flatus. Tenderness about tne  hernial  tumor;  vomits much  milk
after nursing.
  Stannum. The child is  relieved  by pressure of the knee, shoulder
or hand upon the abdomen.
  Sulphur.  Scurfy skin, which is easily abraded; sleeps only in short
naps; other Sulphur symptoms generally.  Is very frequently called
for in these derangements.
  Sulphuric acid. When some general, deep-seated dyscrasia prevails,
and the child is weak and exhausted, and there are no other more par-
ticular symptoms.
  A great variety of other remedies may be indicated in these cases.
The Materia Medica should be carefully scanned.

                          Tongue-Tie.
  This deformity, which  differs greatly in degree, is produced by the
insertion  of the fraenum  being too far forward toward the tip of the
tongue, which  it sometimes reaches.  It interferes with lactation very
greatly when extensive, and  in such case should  be  removed at once.
But where the tongue-tie is  slight, it will be better to wait until the
child is two, three or more months old  before resorting to operative
procedures.  In order to  remove the deformity the tongue should be
raised and  the fraenum transfixed  by a bistoury, which should then
cut outward toward the child's gums and away from the tongue.  Or
a suitable instrument, having a groove to accommodate the  fraenum,
snould be passed under the tongue and the organ raised.  Then with
a pair of scissors cut through the fraenum a sufficient distance, cutting
in a direction a little downward and backward toward the floor of
the mouth. In this way no  blood-vessels  of  consequence will  be
wounded.

               Worms—Vermicular Affections.
  " Worms," in popular  language, constitute one of the most  com-
mon disorders  of children, and people imagine that if the worms are
expelled their children will be cured.   This, however, is a great mis-
take, for  children are not ill so much because  they have worms, as
they  have  worms  because they are ill.  Consequently, the violent 
896          diseases  of infants and children.
medicines, drugs, and even  mechanical means—such as dolichos and
tin filings—used  to destroy and expel the worms, either entirely fail
of their object, or, in effecting it, inflict still greater injury upon the
health.
  The indications afforded by the symptoms enable the homceopathic
physician to prescribe the remedy  for the  entire disordered condition
which leads to the development of the symptoms themselves.  Besides,
in many cases of supposed " worms," they in reality cUo not produce
the sufferings, or they may even be entirely absent.  Hence is seen the
importance of prescribing for the patient to restore him to health; not
to attempt to destroy worms by means which in  many instances but
add to the existing disorder.
  There is a very great variety of animal parasites  infesting the human
body, both entozoa and  ectozoa, and there is scarcely a tissue  of the
body that has  not  been invaded  by  one  or more  of  these.   Those,
however, which especially attract attention as " worms," and are by
far the most common, occupy the intestinal canal, and are of three
varieties—viz.,  Oxyuris vermicularis,  or   small  thread-worm; the
Ascaris  lumbricoides,  or long  round worm;  and the Taenia, or
tape-worm, less common than  the other  varieties,  and very rarely
affecting children until after the third year.
  The Oxyuris vermicularis, which was formerly called Ascaris ver-
micularis, and is  sometimes denominated  the " maw-worm," usually
occupies the rectum, is thread-like, white, from one-sixth to one-half
inch  in length, the male worm being  much  smaller than the female.
It gives  rise to an intolerable itching and  burning about the  anus
and rectum, which  prevents the child from sleeping sometimes, and
makes it very cross and fretful, and almost beside itself; constipation
and tenesmus; depraved appetite ; rubbing and picking of the nose ;
foul  breath, etc  The  local irritation may spread  to  the vagina  in
little girls, or the worms themselves may crawl there, and give rise to
inflammatory state of the parts and a mucous or bloody discharge ; or,
by crawling into the urethra, may occasion severe urinary symptoms,
such as urging, scalding and strangury.  When these parasites either
directly or indirectly attack  the genital organ, the itching and titilla-
tion  they sometimes occasion may lead to masturbation.  The Trico-
cephalus dispar, or long thread-worm, is usually found  in the  csecum
and large intestines, is about twro inches  in  length, and gives  rise to
few or no symptoms by which its presence can be known.
  The Ascaris lumbricoides bears  some resemblance to the common
earth-worm, but is  generally longer, and  sometimes of a much paler 
WD RMS—VERMICULAR AFFECTIONS.
897
color.   It  inhabits chiefly the small intestines, but  sc metimes visits
the stomach and is vomited up, or the lower bowels  and is  voided
with the stool, and even visits other situations, such as the gall-blad-
der, oesophagus and the air-passages.   It varies in length from six to
twelve inches.   The  following symptoms  indicate approximately its
presence:  Disturbed  sleep, with  tossing about, groaning, and  grind-
ing of the teeth; foetid breath; great thirst; pallor  of the face and
general unhealthy appearance of the  skin; enlargement of the abdo-
men, which is  usually tense and hard; falling away  of  the  limbs;
depraved appetite—now voracious  hunger and now aversion to food;
diarrhcea, with slimy stools, or  constipation, or alternation of these
states ; itching of the  nostrils, which occasions rubbing and picking at
them; tenesmus; itching of the anus.   Sometimes nervous symptoms
likewise present  themselves,  even chorea  or  convulsions.  A dry
and hacking cough is a not infrequent accompaniment of the other
symptoms.
   The Taenia, or tape-worm—the principal varieties of which are the
Taenia solium and Taenia medio canellata,  the latter being the most
common—exists in the small intestines, and varies in  length from five
to thirty feet, being from  one to five lines  broad.   It consists princi-
pally  of a series of jointed segments.  It does not produce any very
marked symptoms by which its presence may be certainly known, and
in fact its existence is usually not suspected until portions of the worm
are passed with the evacuations.  There are in some cases, however,
constant craving  for  food, pain in  the  stomach, loss  of flesh and de-
bility, and  itching about the anus and nose.   The  Taenia solium is
said to be  the mature form of  the  Cysticercus cetlulosce  or pork
" measle," wdiile the  Taenia medio canellata  is the mature form of the
Cysticerus bovis, or beef and veal " measle."  The Bothriocephalus lotus,
or broad tape-worm, is a variety met with in special localities, such as
Switzerland, Sweden, Russia, Poland and Ireland.
   Treatment.—The diet of the child affected with worms should be
carefully regulated, the food chosen being easily digestible  as wTell as
nutritious.  Pastry and sweetmeats  should be especially avoided.  Se-
lect one of the following remedies:

  Aconite. When a real synochal fever prevails, or there is much itch-
ing of the anus; worse at night; much fear manifested, the child being
even afraid to go to bed.
  Argentum nit. In many cases of taenia and thread-worms; the latter
particularly wheif there is much and violent itching of the anus.
       57 
898           DISEASES OF INFANTS AND CHILDREN.
  Asarum.  The child passes shaggy masses of mucus full of oxyuri.
  Belladonna.  Involuntary  discharges of  faeces  and urine; violenl
startings; flushed face;  red eyes; moaning; delirium.
  Calcarea  c. In leucophlegmatic children; the itching at  the anus
becomes  very great toward and in the evening.  Also  causes tape-
worm to  disappear when indicated by the symptoms.
  Carbo  veg. When  a peevish wrathfulness becomes developed; the
child wishes to vent itself in rage; it strikes, kicks, bites,  etc.; nightly
fear  of ghosts; the weakness  of the limbs  becomes more and moie
developed.
  China.  Painless diarrhoea.   Abdomen much distended, particularly
after every meal; tremor and debility.
  Cicuta  virosa.  Fever,  colic and convulsions, with the other symp-
toms of worms.
  Cina. Boring at  the nose; exceedingly unamiable, nothing pleases
the child.  Short, hacking  cough;  frequent swallowing, as if to swal-
low down something. The urine turns milky.  Tossing during sleep.
Is often sullen and unwilling to play during the day.
  Digitalis.  Stool in  the evening, passing great quantities of thread-
worms.
  Ferrum aceticum.  Much  itching  about the anus, and  slimy stools
with worms.  Vomiting of food,  and  a flow of water  from the
mouth.
  Filix mas. Has been highly lauded as a remedy for tape-worm.
  Ignatia. In many cases where there is itching of the anus at night;
the child is nervous and spasmodic.
  Ipecacuanha. Itching of the anus; nausea and retching.
  Lachesis.   Itching  of  the anus  in  the  morning or  always after
sleeping.
  Lycopodium. Worms, with much rumbling in the  bowels or red sand
in the urine.   Itching about the anus.
  Mercurius sol. Wrorms creep  out of the anus, and can be seen on the
perineum and buttocks, even at night in bed.   Lumbricoides escape
easily and freely; the abdomen is bard and distended.
  Nux V. Picking  at the nose; loss of appetite; constipation; sleep-
lessness in the latter  part of the night; pain in the abdomen.
  Phosphorus. Itching in the anus, and at times sharp shooting pains,
causing the child to scream  out.  These troubles come on worse toward
evening.
  Pulsatilla.  The child  has vomiting of mucus;  bad smell from the
mouth; slimy passages from the anus; eructates a  watery fluid. 
                      URINARY DIFFICULTIES.                89S

  Sabadilla.  Itching  of the anus, nose and  ears;  much  pain in  the
abdomen.   Worse every fourth day.
  Silicia. When worm  fevers  assume a slow, chronic  form in scrofu-
lous children with large bellies and much perspiration  about the head.
Worse with the change of the moon.
  Spigelia. When the  child refers to the navel as the most painful
part.  The action of its heart seems unusually violent.   Very pale
face, and a yellow margin around the eyes.
  Stannum. The child  has  spells of abdominal pain, during which it
wishes to lean over  on something hard for relief;  there are  many
other symptoms,  but this  condition forms a  reliable  key-note  for
Stannum.
  Stramonium. Abdominal spasms  and frequent desire for stool.  On
awaking the child shrinks from the sight of objects, even from those
with which it is perfectly familiar.
  Sulphur. When there is redness  and rawness about the anus much
of the time; papular eruptions  on the skin; the skin  has  a rough 01
scaly  look.
  Teucrium m. v.  The irritation produced by the thread-worms cornea
on at regular periods  every day, and is  followed by nightly  restless-
ness and sleeplessness.
  Urtica urens. Loss  of appetite; itching of the anus; itching of the
nose; nocturnal restlessness. Stinging, burning  sensations in any part.
  Valerian. Nightly  itching;  muscular spasms; sleeplessness.
  Veratrum album. Attacks of vomiting and purging,  with cold sweat
on the forehead, and  symptoms  of worms.  Selected from these symp-
toms, this remedy has cured tape-worm.
  Viola odorata. May  be given in  cases calling for Cina when this
remedy  fails to relieve.

                    Urinary Difficulties.
  There are not  uncommon  in babes and young  children a variety
of urinary difficulties.  These various disorders are so obvious as to
need but little description.  Their  most prominent symptoms will be
found stated in their proper places under the indicated remedies.  In
some  cases  the  babe passes no water during the first few days after
birth.

  Dysuria.—Young infants and little children frequently suffer with
difficulty of  urinating.   This is very easily  recognized, and  will be 
900           DISEASES of women and children.
greatly relieved by the timely administration  of the  most suitable
remedy.

  Retention or Suppression of Urine.—This difficulty will be
less easily observed in very young children.  The bladder may be
unusually distended, and  there  may  be evident distress, and even
convulsions.  The mother or nurse should of course be able promptly
to inform the attending physician if there is any difficulty of  this
kind—i. e., if the child's urine is scanty or suppressed.  If there is no
malformation the proper remedy will afford prompt relief.

  Aconite. This medicine may be given if the babe passes no water in
the first few days after its birth.
  Arnica.  If the difficulty—ischuria  or retention—appears to have
been caused  by an injury, such as a fall or a bruise.
  Belladonna. If there is much moaning, distress, a sudden crying
out, in retention of urine.
  Cantharis. If a few drops only flow, with much screaming.
  Colocynth. Dysuria; ineffectual straining; worse before, during  and
after urination; urine is scanty.
  Dulcamara. The retention is caused by damp, cold air.
  Ipecacuanha. Ischuria, with convulsions.
  Lycopodium. Dysuria, with  much rolling and rumbling of flatus,
and a reddish and sandy deposit with the urine.
  Nux V. When there are retention and constipation.
  Opium. The child is very drowsy and sleepy, the face is bloated.
  Pulsatilla. If Aconite or Nux fail to relieve.
  Sulphur. In scrofulous children in whom the retention occurs every
time the child takes cold.
  Compare  the patient's symptoms, in case  they do not seem to be
met by either of  the above, with Stramonium, Hyoscyamus, Can-
nabis s.,  Arsenicum, Apis  m., Petroselinum,  Mercurius sol.,
Rhus tox., Sepia, Plumbum, Nitric acid, Causticum, etc.

                 Diuresis—Profuse Urination.
  Muriatic acid.  Passe? large quantities of  urine,  accompanied each
time with a  small stool.
  Phosphoric acid. When the trouble is worse at night, and the urine
is rather offensive.
  Rhus tox.  Very restless  at night. 
                  URINARY  CALCULI—GRAVEL.               901

  Silicia.  In large-bellied  children, who perspire much about the
head.                               *
  Study also Argentum nit., Spigelia, Squilla and Verbascum.

         Incontinence of Urine—Wetting the  Bed.
  Calcarea c. In leucophlegmatic temperaments, with open fontanelles;
much perspiration about the head.
  Causticum. In weakly, feeble constitutions.
  Cina.  In those affected with vermiculous symptoms,  picking at the
nose, etc
  Creasote. In children who are very hard to awaken.
  Lycopodium. Red sand is found on the sheets or in the diaper.
  Phosphoric acid. Very large quantities of urine are passed at night;
the bed is literally flooded.
  Sepia. The bed is wet almost as soon as the child goes to  sleep—
always during its first sleep.
  Silicia. In children with enlarged abdomens (pot-bellied) and other
symptoms similar to those of  Calcarea.
  Thuya. The  child has fig-warts or condylomata.
  Study also  Arsenicum, Belladonna,  Benzoic acid,  China,
Conium,  Carbo   veg.,  Gelseminum,   Pulsatilla,  Sulphur,
Graphites, Hepar,  Rhatania,  Sarsaparilla,  Phosphorus,
Cantharis, etc.  There is hardly a remedy in the  Materia  Medica
but may be useful in this complaint if the other symptoms  correspond;
all the symptoms must be collated and the prescription made accurately.

                 Urinary  Calculi—Gravel.
  Sometimes children  appear to be attacked with a severe colic, in
paroxysms or  in continued distress, which may last for hours.  This
may be from an actual wind-colic, from indigestion, from the  passage
of gall-stones through the hepatic duct, or from the passage of gravel
or calculi through the ureters or urethra.   When the difficulty arises
from the last-mentioned causes the fact will  usually be evident from
the  attendant symptoms, and  great relief will be  derived from the
exhibition of the appropriate  remedy.   The following have most fre-
quently  been indicated in such cases:

  Lycopodium  Much  pain, even to screaming, before passing water.
Red sand or gravel upon the diaper or in the urine.
  Phosphorus.  Much gray sand in the urine.
  Sarsaparilla.  Much pain at the conclusion of passing water. 
302
diseases  of infants and children.
   Silicia,  Berberis  vulg.,  Calcarea  c,  Phosphoric  acid
 Alumina should also be studied in these cases.

          Inflammation  of the Brain—Meningitis.
   By this term is understood a simple inflammation of the brain and
 its membranes wdiich is not produced by tuberculosis.  It occurs most
 frequently in  children between the first and  ninth  year, and for  that
 reason  has  been associated with  the  process  of dentition.  It  also
 occurs more frequently in boys than in girls,  wdiile  strong and hearty
 children are more likely to be attacked by this form  of cerebral disease
 than are more delicate children ;  the  latter being more liable to be-
 come the victims of tubercular meningitis.
   The  causes of the disease are rather  obscure.   It may be due in
 some instances, as above remarked, to  the irritation produced by den-
 tition, to injuries, to exposure to the rays of the sun, and it may result
 as a  complication  of some  other  form  of disease.  It occasionally
 appears as an epidemic.
   Sometimes this disease sets in very suddenly, a prolonged convul-
 sion being the first  intimation the parents of the child  may have that
 anything is wrong,—the slight malaise which precedes scarcely excit-
 ing the attention.   The convulsions are accompanied or followed bv
 a high degree of fever and quickness of respiration,  and, if the patient
 be old enough to describe symptoms,  severe  headache  will be com-
 plained of.  " After a wdiile  the  convulsions  cease, and  the child
 remains  for the  time in a state of quiet  somnolence or coma, when
 they return with  renewed violence.  The returns of the convulsions
 generally take place at intervals of one  or two hours  or more.  In
 the intervals between the crises the child is restless or drowsv, or  in a
 state of partial stupor, attended with tremulous movement of the ex-
 tremities ; there is  strabismus, contraction of the pupils, trismus,  and
sometimes hemiplegia.   The  skin   retains its  warmth, the pulse is
accelerated, irregular and unequal; the  face is pale; the  stools are
spontaneous.   It is unusual to see the  child  regain  its  consciousness
so as to recognize objects in the intervals  between the convulsions, or
after the appearance of coma and other cerebral symptoms.  This form
of the disease  has been termed the  convulsive.
   In other cases  the disease  shows itself quite as  suddenly, but the
 convulsions  come on at a later stage.   Here the first symptoms are—
 fever, with shortness of breath, almost constant drowsiness, followed
 by a high degree of nervous excitement, staring eyes,  loud  cries or
 screams, dilated pupils and sometimes vomiting. 
       TUBERCULAR  MENINGITIS—ACUTE HYDROCEPHALUS.     9 13

   Another  form of the disease, which has been termed the phrenitie,
 commences  usually with a chill, followed  by fever, violent  frontal
 headache, great sensibility to light and noise, profuse bilious vomiting,
 loss of appetite  and  great thirst.   u About the end of the first day
 generally, or, in rare  instances, after two or three days, appear  various
 disorders of the intelligence.   The first symptom of this  kind is ob-
 servable in the expression of the face, which becomes  a little  wild or
 wandering, and sometimes grimacing. Soon afterward  occurs restless-
 ness, which is sometimes extreme, and in  succession delirium,  somno-
 lence, and, late in the attack, coma.  The restlessness and somnolence
 often alternate early in the case, though the former  generally predom-
 inates, and soon passes into delirium, which is usually violent.   When
 in this condition  the child seldom recognizes any one,  and either re-
 fuses to answer  questions or  answers  incoherently.   In  connection
 with the disorders of  the intelligence there exist also trismus, grinding
 of the teeth, subsultus tendinum, partial convulsive movements, stiff-
 ening of  the extremities or trunk, retraction  of the head, strabismus,
 contraction first and then  dilatation of the pupils, and in some cases
 violent convulsions,  followed  by  deep coma. Frequently  at  this
 period death relieves the little patient  of  suffering, but in other
 instances the disease  goes on,  developing other and more profound
 symptoms, some of those which first appeared subsiding or disappear-
 ing, until the child falls  into a state of collapse, and  thus dies, or a
 violent convulsive fit  ends the scene."
   The prognosis of this form  of cerebral disease  is of course very
 grave,  but is far from being hopeless.
   Treatment.—On page  909 et seq. are given the  indications for  a
 great variety of remedies suitable  for the treatment of the various
 forms of meningitis and hydrocephalus, from  one of which the  appro-
 priate remedy should  be selected.  In this special form of disease the
 following medicines are most  likely to  be  appropriate:  Aconite,
 Apis m., Belladonna, Bryonia, Cimicifuga, Gelseminum, Cam-
 phor,  Cuprum  aceticum,  Hellebore,  Hyoscyamus, Opium and
 Stramonium.

      Tubercular Meningitis—Acute Hydrocephalus.
  " This  disease  is characterized by violent cerebral symptoms, de-
 pendent  upon the  existence of tubercular granulations  in the  pia
 mater,  as  the essential anatomical lesion, accompanied, in the great
 majority of  cases, by coincident inflammation of that  membrane, by
softening  of the central parts of the brain, by effusion  of serum into 
904           diseases of infants and children.
 the ventricles, and in many instances by tubercular deposits in other
 organs."
   That portion of the pia mater which lines the ventricles is the most
 frequent seat of the disease at its onset, but in some instances it is de-
 veloped at the base of the brain, and is  termed basilar  meningitis.
 Children of  a scrofulous (tubercular) diathesis are most  frequently
 attacked, especially  between their first and eighth years, and in  such
 children there are generally to be found evidences of tuberculous dis-
 ease elsewhere.  The disease may be excited by a blow or fall, by the
 systemic irritation of dentition, in consequence of the repeated cerebral
 congestion induced by paroxysms of hooping-cough, or by some of the
 exanthemata, such as measles or scarlatina.
   The disease may come on  either  insidiously  or suddenly,  and in the
 majority of cases the former is the  case, there being  usually well-
 marked prodromata, lasting variously from ten or fifteen days to two
 or three months.  During this prodromic period there appears to be
 a general running down of  health; the child  loses  its appetite, or it
 becomes capricious, grows thin and pale and does  not care for play;
 complains  of being tired or weak, the debility  sometimes becoming
 excessive ;  is very restless at night; complains of headache, and some-
 times of pain in the abdomen.   These symptoms having lasted for a
 longer  or shorter period, others set in which are  more  marked and
 alarming, and which are usually the first to which the attention of the
 physician is called.  Many of these symptoms  are common to  the
 various forms of cerebral disease, such as headache, squinting and grat-
 ing of the teeth during sleep, sensitiveness to light and noise, twitch-
 ing of the muscles.   Other symptoms are—" Vomiting, not  after eat-
 ing, but especially on being raised up, with constipation of the bowels;
 the  abdomen is hard and sunken in; the pupils are generally contracted;
 the pulse is hard and quick.  After exudation has taken place we ob-
 serve a very peculiar piercing shriek {cri hydrencephalique), which is
 repeated occasionally, and which, if heard once, is scarcely ever for-
 gotten.   The head is bent backward into the cushions, and is rolled
 from side to side.  In this stage of the disease convulsions frequently
 occur, and  the children  bring their hands frequently and  automati-
 cally to their  heads; they become  insensible to light and noise;  the
 vomiting ceases ; the pupils dilate;  the eyes squint; the pulse becomes
 quite slow, falling down to  sixty or less in a minute; respiration is
 irregular; sometimes the breathing seems to cease altogether,followed
 by  a deep,  long, sighing inspiration.  The  face frequently changes
color—now  pale, and again red—and sometimes  one side is  pale and 
CHRONIC HYDROCEPHALUS.               905
ihe other red.  The  blood-vessek of the eyes  become injected, espe-
cially those of the inner canthi.   The anterior fontanelle, when not
closed, protrudes."—Raue.
  As a general thing, there is little or no disturbance of the intellect-
ual faculties  during  the first  few  days of the disease; the child  is
either dull or irritable by turns ; shuns the light; is unusually sharp
of hearing.  Diplopia is occasionally present in the earlier stages, and
excites marked  attention.   Convulsions rarely occur in the'first days
of the disease, and delirium does not set in until about the sixth or
seventh day, or even later.   Trousseau refers to a red line which will
remain upon  the skin of the abdomen or forehead after the finger has
been  drawn across it, and to which he gave the name of " tache men-
ingitique " or  " tache cerebrate," which may serve as a diagnostic mark
of the disease.
   The  duration  of  this  disease differs  greatly in different  cases,
although it seldom lasts a shorter time than ten or a  longer time than
thirty days ;  yet in some cases it  is  very lingering.  The prognosis
is decidedly unfavorable.
   Treatment.—This disease will require  for its treatment such rem-
edies as Aconite, Apis mel., Apocynum cann., Argentum nit.,
Arnica,  Belladonna,  Bryonia,  Calcarea carb.,  Calcarea
phos., Cuprum  met.  and acet., Hellebore, Opium,  Silicia,
Sulphur and Zinc.   Refer to the indications  for  these and other
remedies on page 909.

                   Chronic  Hydrocephalus.
   The term chronic hydrocephalus is applied to a disease characterized
by the accumulation, either within  the ventricles of the brain or the
sac of the  arachnoid  membrane, of a larger or smaller quantity of
serous fluid in excess of that which  is normal.  It may be either con-
genital or acquired, and has been divided into external and internal;
the former term  indicating that the fluid has accumulated within the
sac of the arachnoid, and  consequently lies exterior to the brain sub-
stance ;  while in the latter the effusion takes place  within the brain
—into the ventricles.
  The most marked of the symptoms of this  disease is the enlarge-
ment of the head, which in some  cases appears  even monstrous, its
circumference measuring as much  as twenty-three  inches or more
When the disease sets in before the  ossification of the sutures has well
advanced, the bones of the cranium are separated by pressure of the
accumulatino- fluid, the parietals are pushed  outward,  th»  occipital 
906           diseases  of infants and children.
bone  backwaid  and the frontal  bone forward, so that the forehead
projects beyond and overarches the face, which is usually pinched and
diminished in size in consequence of the general atrophy which usually
accompanies the disease.   In such cases  fluctuation may be detected
in the track of the sutures  and under the fontanelles, and the scalp in
these  situations very frequently projects beyond its natural  level.   As
a general thing, the hydrocephalic condition is preceded by symptoms
of disordered nutrition, such as impaired digestion, debility and wast-
ing, and by nervous disturbances of  various  kinds.  Some of  the
symptoms of chronic hydrocephalus depend upon the impaired condi-
tion of the system which gives rise to the watery effusion, while others
again are due to the pressure exerted upon the brain  by the effusion
itself.   When the disease is congenital there are evidences  of cerebral
derangement noticeable at birth or shortly afterward, such as strabismus,
convulsions, etc   In acquired cases either the intelligence ofthe child
remains unaltered, or is even increased, while  in others there is a
gradual decline of intelligence  and  derangement of  vision.   Some-
times the patients are troubled with attacks of laryngismus stridulus;
in others there is more or less complete paralysis or tonic contraction
and rigidity of the wdiole  or a  part  of the extremities.   The suffer-
ings of children afflicted with this disease do not appear to be very
great, or, at all events, not very acute;  but it is difficult to pronounce
positively upon this point.
   " Children born with this complaint frequently die  during birth or
shortly afterward.  Others show in the first weeks no signs of this
malady ; even during the whole of the first year it may be overlooked,
until  the inability of the child to hold  up its  head calls attention to-
rt.  But even then there may be no  enlargement of the head visible,
yet the child is slow in all its mental developments; it does not make
any attempt to talk  or walk ; it remains uncleanly  and  its actions
look  strange; when in joy or fear it  makes antics and struggles with
its extremities;  frequently  such children are thrown  into  convul-
sions."—Raue.
   u The general condition of children suffering from chronic hydrocepha-
lus varies greatly.   In some cases they preserve their appetite and diges-
tion,  and  appear well-nourished and strong  to a late period in the
attack,  but more frequently they present marked  evidences  of  im-
pairment of nutrition. The appetite may  indeed remain, but the child
loses  both flesh  and strength ; the bowels are  irregular, usually con-
stipated, but alternating with temporary attacks of diarrhoea.   In the
majority of cases, perhaps, these symptoms are not sufficiently pro- 
CHRONIC HYDROCEPHALUS.
907
nounced to establish the character of the attack until the increasing
size of the head becomes manifest and the  child  acquires the distinc-
tive physiognomy of hydrocephalus.   Even after marked enlargement
ofthe head has occurred, however, the advance ofthe case is far from
being uniform.  In almost every instance there are pauses of the most
variable frequency and duration, during which  the  child seems free
from  pain, improves in general condition, and  the  development of
the head is temporarily arrested."—Meigs and Pepper.   Tanner thus
sums  up the symptoms and course of this  disease, in addition to the
enlargement of the head:  " Subsequently emaciation, great  appetite,
dullness, peevishness, disordered digestion, muscular weakness, squint-
ing, rolling of the eyes, weak sight, great weight of head, staggering
gait, screaming and  grinding of the teeth  occur, to  be followed by
stupor, alteration of the pupils,  great prostration, convulsions, par-
alysis and death in the one instance, or an abatement of the symptoms
when recovery is about to take place in the other."
  It is wellnigh impossible  to diagnose this disease during its earlier
stages, the prodromic  symptoms being of  that  character common to
almost all forms of cerebral lesion, and,  indeed, to other  diseases
having reflex  action  through the nerve-centres;  but when effusion is
advancing, and the  head  begins to  enlarge and the face to look
smaller, it is almost an  impossibility that any error of diagnosis should
be made.   The prognosis is decidedly unfavorable, especially where
there  is evidence of large serous accumulation and of serious cerebral
lesion; but where the  accumulation is not so great, and the functions
of the brain remain unimpaired, hopes of recovery may reasonably be
entertained,  especially in  children  who  exhibit a  good  degree of
vitality and  strength, and more especially under homoeopathic  treat-
ment.  Death often takes place in  consequence of some  intercurrent
malady which apparently has  no connection with the brain disease;
in other instances the children  die of marasmus  and exhaustion ;
while in others, again, they  die suddenly from convulsions or a  sharp
aggravation  of the disease.
 CO
  Treatment—The same remedies  as have been mentioned as most
likely to prove useful in the treatment of acute hydrocephalus may be
required in this disease, but the reader is especially referred  to the list
of remedies on page 909 et seq.   We must here especially enjoin, how-
ever, that in a disease  of this  nature, which has its origin in the dys-
crasia of the mother, and  is implanted in  her offspring as disease, or
as disease-germ, so to  speak, the  practitioner  must not limit himself
in cboosino- remedies to the simple  array we  have presented, but the 
 908           diseases  of infants and children.

 whole Materia Medica should be scanned rather than a prescription be
 made that is not strictly homoeopathic to the tout ensemble of the in-
 dividual case.  And  we may remark that this is also true regarding
 the treatment of all other forms of cerebral disease and of all diseases.

                    Hydrocephaloid  Disease.
   Hydrocephaloid, or hydrencephaloid  disease, was first described  by
 Dr. Marshall Hall.  It is a secondary brain  affection, resulting  from
 exhaustion of nervous vitality  and anaemia of the brain, the results
 of debilitating diseases, such as cholera infantum, diarrhcea,  or any
 other malady  which  severely drains  the system.   Its  symptoms
 resemble to a very great extent those of hydrocephalus, and the con-
 dition may  be divided into  two  stages—viz., first, the stage  of irri-
 tation, and second, the stage of torpor.
   The stage of irritation, or the premonitory stage—which sometimes
 comes on insidiously  and lasts for  some time, and at others appears
 suddenly, and is very soon followed by the stage of torpor—is  charac-
 terized  by restlessness, feverishness, sudden starting from noise or  on
 being touched ; bloating of the abdomen; diarrhoea ; starting suddenly
• from sleep and  giving utterance to a piercing cry;  grinding of the
 teeth ; quick pulse; hot and dry skin.
   The stage of torpor sooner or later follows the first stage, and has
 the following distinguishing symptoms:  Apathy; pallor of  counte-
 nance, with coldness;  the eyes are half  closed, frequently "turned  up
 in the head," and unsteady; they  are unmoved  by the approach of
 light or  of objects, such as flies; the breathing becomes irregular and
 sighing; the voice is weak and husky, and there is sometimes a trouble-
 some cough;  the pulse  is  quick  and small, gradually  becoming
 weaker  and more wiry; coldness gradually  spreads  over the body,
 commencing in the face; and if the disease runs on to  a fatal termi-
 nation complete coma and collapse supervene.
   The disease is one of cerebral anaemia, the cerebral circulation being
 lessened.  The fontanelles are depressed, instead of being elevated as
 in hydrocephalus.
    Treatment.—In this disease there is a marked necessity for proper
 nourishment and an abundance of  fresh air.   The effect of these im-
 portant  hygienic measures is very noticeable in some  cases, and many
 children's lives are  saved by a resort to them.  Indeed, we have seen
 the condition of a child changed from one of apparent hopelessness to
 one in which there was good reason for making a favorable prognosis,
 by merely changing the foul and heated air of a pent-up city neigh- 
REMEDIES  FOR DISEASES OF THE  BRAIN.
909
 borhood for the bracing atmosphere  of the  river, the  parks or the
 sea-shore.   Such remedies as China, Phosphorus, Calcarea carb.,
 Calcarea phos., Phosphoric acid, ZixcuMand others are suited
 to this condition.  Consult  the remedies below.

             Remedies  for Diseases  of the Brain.
   Aconite. This  remedy  will be  indicated especially  in the earlier
 stages of these diseases, when there is marked  febrile excitement, great
 heat  and dryness  of surface, nervousness, particularly  fearfulness,
 restlessness  and distress.
   .iEthusa cyn. Where the disease seems to have supervened upon long-
 continued indigestion, especially that  form in  which "milk does not
 agree with the stomach, and the child almost invariably vomits  soon
 after taking the breast or the bottle.   Great  irritability, or the little
 patient  lies  stretched out in  a semi-comatose condition; pupils dilated
 and insensible to light, as are the  eyes to the approach of objects; the
 features are expressive of great anguish; pulse very feeble; mouth
 very dry or very moist;  the child is very weak and cannot hold up
 its head.
   Apis  mel. This remedy is  especially suited to cases of hydrocephalus.
 There is great restlessness at night; the child screams out very sharply
 and shrilly during  sleep or when awake—cri cerebrate—especially
 during  the latter part of the night;  the urine is generally scanty,
 though  it may be quite profuse.
   Apocynum cann. "Sutures opened;  forehead projecting;  sight of
 one eye totally lost, the other slightly sensible; stupor; constant in-
 voluntary motion of  one leg  and arm; urine  suppressed."—Raue.
 Hydrocephalus, especially acute hydrocephalus.
   Argentum nit. This remedy has been recommended by von Grauvogl
 for the last  stage of  hydrocephalus.   Convulsions, with great restless-
 ness between the attacks, or every successive  spasm is  announced by
 a very marked degree of  restlessness.
   Arnica. This  remedy is indicated by the fact that the brain disease
 has originated in a blow, fall or other mechanical injury.  A charac-
 teristic symptom is,  that  while the head is hot the rest of the body is
 comparatively cool or even absolutely cold.  Traumatic cerebritis.
  Arsenicum. Great depression ofthe vital forces, manifested by great
prostration; emaciation;   pallor;  the face, and  sometimes the whole
body, has a  waxy look; thirst, the child desires cold water often, but
drinks but little at a time;  sometimes the child strikes its head with
its fists,  as though for temporary relief 
910
DISEASES OF INFANTS  AND CHILDREN.
   Artemisia vulg.  While the left side is paralyzed, the right is in a
 state of clonic spasm; the  child lies in a sleepy or dreamy state, and
 yet will drink large draughts of water without being entirely aroused;
 the surface of the body is cold; the child passes stools involuntarily.
   Belladonna. This  remedy is  suited to all forms  of  brain  disease
 during certain of their stages.   It is especially useful in inflammation
 of the  brain, and  if given  early enough—i. e., during  the cerebral
 congestion—will often cut  off the attack.   Great headache; redness
 of  the face and sparkling  eyes; throbbing  of the carotid arteries;
 dilated pupils; injection of the sclerotica; great heat of the head and
 of the  surface of the body, from which the heat  seems to radiate;
 almost constant  moaning; the child lies in a drowsy or semi-comatose
 state, is constantly starting and jumping, bores its head backward into
 the pillow, or tries  to bend  its body backward.
  Bryonia. Almost constant  motion of the jaws, as though the child
 were chewing something; the lips  are dry and parched; the bowels
are constipated, and the stools passed are very dry and hard; the child
evidently  desires to be kept still, and when  it sits up or is held erect
 it is attacked with nausea and a faint feeling.
  Calcarea carb.  This remedy will be indicated in cases of brain disease
originating  in, and apparently  depending  upon, a  "scrofulous"  or
" psoric" diathesis.   Children of leucophlegmatic  temperament, whose
fontanelles are unusually large  and are very slow to close, and  who
sweat very heavily  about the head and upper part  of the body; the
child has frequent spells of  screaming without apparent  cause.
  Calcarea phos. The reader is referred to the very full indications for
the use of this remedy given under the article on Dentition.
  Camphora.  Great coldness of the skin,  and  yet  the  child cannot
bear to be covered.
  Carbo veg.  Great prostration and collapse; Hippocratic countenance;
cold breath and coldness ofthe limbs, especially  the knees; the patient
wishes to be fanned all the time.
  China. Hydrocephaloid, or any other form of cerebral disease, which
has grown out of a severe  drain of  fluids  from the body, such  as
diarrhoea,  summer-complaint,  loss  of  blood,  etc.   The symptoms
appear to  undergo  an exacerbation  every other day; offensive, pain-
less stools, or lienteria, with much distension of the abdomen.
  Cimicifuga. Delirium and  wild fancies; intense  pressing and throb-
bing in the vertex and occiput;  feeling as if the brain w^re too large,
and as if the top of the head would be forced off; pain  in the eyes.
  Cina. The  child  gives indications of being troubled  with worms 
REMEDIES  FOR DISEASES OF THE  BRAIN.
911
picks its nose  or picks  at  the  bed-clothes, has  a  bloated  abdomen,
passes  milky-looking urine, is cross and  peevish, vomits frequently,
although its tongue is quite clean, and wants to be in motion almost
constantly—to  be rocked or carried about.
  Cuprum acet. Convulsions and cramps  are marked features of the
case requiring Cuprum.   The cerebral disease is the result of metas-
tasis during an attack of catarrhal or exanthematic fever.  The spasms
and cramps commence in the extremities,  and especially in the fingers
and toes.   Inability to hold the  head up.   Grinding of the teeth.
  Digitalis.  The characteristic slow pulse  of this remedy, or irregular
pulse;  white evacuations from the bowTels; bilious vomiting.
  Gelseminum.  Feverishness; dark-red  hue of face; vertigo,  drowsi-
ness, stupor or  apathy; convulsions; occurring during dentition.
  Hellebore. The urine is scanty  and dark-colored, and deposits a sedi-
ment looking like coffee-grounds;  involuntary throwing  or whirling
about  of one  arm  and one leg;  rubbing of the  nose;  strabismus;
dilated pupils ;  wrinkled forehead, which is bathed in a cold sweat;
great irritability; soporous sleep, with  screaming spells; dryness of
the nostrils; the lower jaw hangs down,  or there is a motion of the
jaws similar to that of chewing; the child, drinks water greedily.
  Hepar S.  C. In many cases this remedy is superior to Arnica in  tris-
mus of infants and  children, arising from traumatic cerebritis.  Also
convulsions from the same cause.
  Hyoscyamus.  Delirium; jerking of limbs; watery diarrhoea; red face;
wild, staring look; throbbing of the carotids; drowsiness and uncon-
sciousness;  muttering, indistinct speech,  picking at the  bed-covers;
distorted eyes, with diplopia, convulsions, frothing at the  mouth.
  Ignatia.  The child sighs and sobs frequently.  (See Ignatia indica-
tions under Spasms and Convulsions.)
  Ipecacuanha.  The case is characterized by an almost constant nausea,
from which there is scarcely a moment of relief.
  Kali  carb. There is a daily aggravation of the symptoms at three
o'clock in the morning; the hair is dry and brittle; swelling above
the upper eyelids; the child cannot bear to have  its feet touched.
  Mercurius SOL Scorbutic condition of the gums ; salivation ;  glandu-
lar  enlargement; slimy or clay-colored evacuations; cold and  clammy
sweat  upon the thighs and legs, especially during  the night; moist
tongue, with great thirst; grayish ulcers on the mucous lining of the
cheeks, lips, gums, tongue and palate; the child is very sensitive to
pressure on the lower abdomen and epigastric region.
  Nux vomica.  The child has been having too much meat and  highly- 
 VI*           DISEASES OF  INFANTS AND CHILDREN.

 seasoned food;  it sleeps badly, and  is particularly wakeful and rest-
 less after three o'clock in the morning; there is an aggravation of all
 the symptoms in the morning; frequent calls to stool;  the child is
 very irritable and wishes to  be alone; it  constantly passes its hand
 over its face, as though trying to brush something off; spasms, which
 are renewed when the feet are touched.
   Opium. This remedy is sometimes  called for in the early stages of
 cerebral disease, though usually indicated at a later period. The child
 goes  off into a heavy and stupid  sleep, with red face, or it seems to
 be dull and drowsy, as though under the influence of  morphia or
 laudanum;  the child is stupid  after waking.;  the hearing in some
 cases is inordinately acute; the child seems to be afraid of something,
 and starts as if in affright:  the  bowels are constipated, the fieces
 passed resembling little black balls.
   Phosphorus. The child is dull, and  inclined to  sleep almost all  the
 time; is no sooner roused  than it wants to  go to sleep again, there
 being nothing unnatural in  the  character of the  sleep;  after  the
 water which it drinks  remains  in the stomach  long enough to  get
 warmed it  is vomited; coldness of the feet  and legs;  green-colored
 stools, or white stools, which are sometimes watery, and  gush out like
 water from  a hydrant;  loss of hearing; hydrocephaloid  disease.
   Phosphoric acid.  The  child is perfectly listless and apathetic, does
 not want to do any thing or to talk, will hardly answer questions, and
 having done so, relapses into  its apathetic mood;  passes large quanti-
 ties of colorless urine, especially during the night.
   PulsatiUa. The child  whimpers  and is ready to cry  at any little
 annoyance,  shedding tears  copiously;  the  child  is of  a  gentle and
yielding disposition ;  the symptoms are somewdiat changeable, and  the
child seems occasionally better and then worse; the symptoms are aggra-
vated as evening approaches; the  child seems  to have  a craving  for
fresh  air, and cannot bear warmth; scanty urine;  absence of thirst.
   Sepia.  The child is in a torpid condition, with great depression of
the vital  power; the urine has a  putrid odor, and deposits a clay-
colored sediment, which adheres to  the vessel or the diaper.
   Silicia.  The child grasps at its gums continually, as though they
were painful; profuse sweat about  the head at night; the child is of
the scrofulous diathesis.
   Sqnilla. The child rubs its face and eyes  a great deal, especially its
eyes,  as  though to relieve  itching; profuse  urination;  passes much
 urine.
   Stramonium. The child, when it awakens, seems to  be afraid of 
           CEREBRO-SPINAL MENINGITIS—SPOTTED  FEVER.    913

the objects near it, or it does  not notice surrounding objects at all ;
stupor; great loquacity;  merry delirium; desire  to  escape  from the
bed and room; grinding of the teeth; glittering eyes; staring  look;
the stools  are dark-colored or  black;  during a convulsion  the head is
jerked up from the pillow and falls back again alternately.
  Sulphur. In  cases  when the  suppression  of an  eruption  or of
otorrhoea  has  preceded  the disease;  scrofulous  or psoric dyscrasia,
which not only has  led  to the disease, but  overshadows  the  little
patient, and seems to prevent  his convalescence; flashes of heat; the
child gives evidence of having occasional sinking spells, and these
come on with great regularity about the middle of the day;  great
hunger; redness and excoriation around the anus;  the child  sleeps
almost all the time, although only in short naps.
  Veratrum alb.  The child's forehead is constantly covered with a cold
and clammy sweat, and  the general  surface is cold  and damp; the
pulse is very small and  weak,  and the child is greatly debilitated; the
child is very thirsty, and desires only ice-cold water  or  ice;  great
prostration after a stool.
  Veratrum vir. Cold sweat on the face, hands and feet;  the skin is
shriveled; the child bends  its body  far  backward,  amounting  to
opisthotonos during a spasm ;  very quick pulse ;  nervous symptoms.
  Zinc. The child has its feet in constant motion; distension of the
abdomen; constipation, with  hard and  dry faeces; on  awaking the
child gives evidences of fear,  and rolls its head from side to side; it
cries out,  starts and jumps during sleep.

        Cerebro-spinal Meningitis—Spotted Fever.
  Natural History.—As to its scientific determination, Cerebro-spinal
Meningitis, or inflammation of the meninges of the brain  and spinal
cord, is comparatively a new disease.   Although described by Syden-
ham as Typhus petichialis novis more than two hundred years ago, it
was originally designated  as  a distinct epidemic  disorder by Vieus-
seux as late as 1805.  Its first appearance in America was  in  Med-
field,  Mass.,  in  March  of the  following year.  And  since then, in
Europe, in Africa and  upon  this  continent, it has  prevailed  as an
epidemic  at intervals of a few years—sometimes in successive years;
besides the numerous sporadic cases which  may or may not have been
recognized as such by the attending physicians.   It has been chiefly
observed  in young persons and males, although not confined to any
ao-e or to either sex.   Infants are often seized with this disorder, wdiich
destroys life  'in  many cases almost before the  physician has time to
       58 
914            DISEASES OF INFANTS AND CHILDREN.
 ascertain the  nature of the affection or notify the parents of the ex-
 ceeding danger.  In some children, and  adults even, it has proved
 fatal in from  six to forty-eight hours.*  Fortunately, it is neither in-
 fectious nor contagious.
   Etiology.—The exact nature of the cause or causes of cerebro-spinal
 meningitis is unknown, as well as its period of incubation.  Niemeyer
 affirms  its miasmatic character  from  observation  and experience  in
 Europe, f   According to  Dr. H. M. Paine, this disorder  is especially
 prevalent  in warm and damp seasons; this, together with other simi-
 lar facts, points to a malarious origin.   It appears in the latter part
 of winter  and spring much  more frequently than in any other seasons
 of the  year.   In Alabama  a  very large proportion  of all  the cases
 occurred in low, moist localities and during wet weather.   In Mis-
 souri it prevailed with great fatality in  a  region that had previously
 been overflowed  by the river; and  in many places in New York State
 its origin  was  clearly ascribable  to  miasmatic  influences.!   Dr.
 Kempf, of Indiana, observed  that  it seemed  to be checked  by mild
 weather—that is, as a  spreading epidemic—but reappeared  upon the
 occurrence of  a  damp, chilly atmosphere.§
   Drs. Watson ||  and Woodward  Tf discountenance the idea ofthe mala-
rious nature of the cause of this disorder. But the two following practi-
cal observations  may be deemed sufficient to sustain the opinion already
advanced :  First, the disorder is developed in hot and dry tempera-

 ■ * Dr. Armstrong  (allopathic) states that in his very extensive observation of the
disease among the soldiers and  laborers in and around Mobile, he never saw a single
case recover.—Am. Jour. Med. Sci., 1866, p. 280.
  Of over one hundred cases of cerebro-spinal meningitis which occurred in  Lewis,
Clay county, Indiana, in the spring of 1873, only thirteen recovered, and these were
saved, not by the " regular" practice, but "by a sweating process with boiled corn."
  In  a report made to the Boston Medical  Society in  1866, it is stated that  in two
hundred  and seventy-eight  cases  allopathically  treated, one  hundred and  seventy
proved fatal.
  Per contra, Dr. S. Lilienthal  reports having treated, during  the winter and  spring
of 1872,  ten cases of this disorder,-  of which only  one  was fatal.—Trans. Am. Inst.
Horn., 1S72, p. 330.
  Dr.  J.  H. Baker reports the care of about sixty cases in all stages and in all degrees
of malignancy during the past seven years in Western New York, losing none.—
Hahnemannian Monthly, vol. viii.,  p. 42.
  t Text Book of  Practical Medicine, New York, 1870, vol. ii., p. 219.
  % Trans, of N.  Y. Horn. Med.  Society, 1864, p. 132.
  \ Am.  Jour. Med. Sciences, July, 1866, p. 55.
  || Trans, of N.  Y. Horn. Med. Society, 1864, p. 127.
  If U. S. Med and Surg. Journal, July, 1872, p. 401. 
          CEREBRO-SPINAL  MENINGITIS—SPOTTED  FEVER.       dlh

 tures as well as in those warm and moist,* and this is equally true of
 diseases  confessedly malarious.  Second, the almost invariable  com-
 mencement of the disorder with a chill, the more or less constant re-
 currence of the chills  in  protracted cases, and  the seat  of  the chill
 itself—taking its rise in the posterior spinal nerves, and finding much
 of its ultimate development in the liver—would seem to afford  suffi-
 cient cumulative proof of  the malarious nature of this form of menin-
 gitis.  And it has  often been the experience of the writer to see in
 malarious districts  cases of this  kind which were at first mistaken for
 simple intermittents.   This great similarity of the two diseases—
 which goes far to prove the miasmatic origin  of the former equally
 with  the  latter—has  been  remarked  by many observers.  Says the
 Indiana physician already quoted, "  I have  visited  patients in whom
 the analogy between  intermittent fever and*the disease under con-
 sideration  was  so  perfect that  the  most circumspect  would  be de-
 ceived.   The  intermittent character  of the  disease, the herpes about
 the mouth, and the 'spots'  or petechiae which appeared in the epidemic
 intermittent fevers of  the  summer and fall  of  1865, would  seem to
 indicate  some  kind of relation  between the two  diseases—cerebro-
 spinal meningitis and intermittent fever." f  One more circumstance
 which  should be borne in mind in considering the etiology of this
 form of meningitis we  state in the language  of  Dr. Comins  of Mas-
 sachusetts: "I have found, on  careful examination  of about one  hun-
 dred cases, both by personal observation and the assistance of others,
 that about  ninety-five per cent,  of  the cases in  New England  were
 of strumous diathesis." J
  Course.—In  those cases  which are  sufficiently protracted to allow a
 progressive development of the symptoms, the orderly course of this
 disease very much resembles its analogue, simple  meningitis, the more
 remarkable difference consisting in the earlier addition of cervical and
 spinal affections, such as tenderness  and opisthotonos, which, indeed,
 may appear almost  from the very first,   Cerebro-spinal meningitis is,
 however, so much  more  immediately  violent  and  prostrating  that
 many of  its symptoms of the first forty-eight hours equal in severity
the  corresponding symptoms of pure meningitis of a  whole week's
duration.   In its simplest  form, cerebro-spinal meningitis is a  conges-

  * According to Dr. Wolford, spotted fever prevails most extensively when the atmos-
phere is unusually clear and dry.—North Am. Journal of Horn., xiii., p. 145, quoted by
Dr. S. Lilienthal, Trans, of Am.  Institute of Horn., 1872, p. 328.
  \Am. Jour, of Med. Sciences, July, 1866, p.  62.
  I Trans, of N. Y. State Eclectic Med. Society, IS 39-70, p. 492. 
916
DISEASES OF INFANTS AND CHILDREN.
 five fever, ushered in by a chill, and resulting in effusion with its ulti-
 mate consequences.   The reaction, like that of other fevers, may be
 of higher or lower grades—simulating the inflammatory, the typhoid
 or the typhus form—according to the quantity and quality of its pro-
 ducing cause, and to the  nature of  the individual constitution in
 which it is developed.  Hence the immense variety of the symptoms,
 far exceeding what may come within the observation of a single physi-
 cian—exceeding even the totality of those presented in any particular
 epidemic.
   This variety—which we have endeavored adequately to  represent
 by collating the reports of many observers, in addition to  what we
 have ourselves  witnessed—is rendered  still greater by the  extension
 of the disorder through a nervous centre  that involves the entire sys-
 tem.  The manner in which this extension naturally produces symp-
 toms so various and  universal is well  illustrated by those  resulting
 from pressure artificially applied  to  different portions  of the affected
 spine.  " Pressure made upon the cervical  portion of the spine pro-
 duces pain in the head, frequently darting to the forehead,  eyes and
 temples, and  also to the top of the sternum.  Pressure on the dorsal
 vertebrae produces pain in the middle  of the sternum, at the epigas-
 trium or  in the abdomen, according as the pressure is exerted at a
 higher  or  lower portion of the  spine."*  Whatever section of  the
 meninges  is primarily affected, it would  seem that the posterior or sen-
 sory spinal nerves are implicated—producing hyperesthesia and  in-
 tense pains—before the disturbance of the anterior or motor spinal
 nerves  results in muscular  contractions,  spasms or  paralysis.  And
 in this direction is observed much of the analogy between  intermit-
 tents  and cerebro-spinal meningitis  which  so strongly indicates  the
 malarious origin of the latter disorder.
   Complications.—Hahnemann has shown that two dissimilar diseases
 cannot exist together in the same system ;f but in later times we have
 seen the combination of different disorders,  which, however unlike in
 their original cause, have a similar  development.   Such is  the case
 with scarlatina  and diphtheria.   And just as two dissimilar  and even
antagonistic  chemicals will combine in  the presence of a neutral ter-
iium quid, so may these two  diseases,  and  others,  in  like  manner,

  *Wm.  H. Watson, A. M., M. D., Trans, of N.  Y. Horn. Med. Society, 1864, p. 127.
  f The Hom&opathic Medical Doctrine, or Organon of the Healing Art.  A System of
 Physic.  Translated from  the German of S. Hahnemann, by Charles H. Devrient,
Esq., with notes by Samuel Sutten, M. D., Dublin, 1833, pp. 121-126 (first English
edition of the Organon). 
         CEREBRO-SPINAL MENINGITIS—SPOTTED FEVER.      917

find simultaneous entertainment and development in a scrofulous con-
stitution.  But whether in the case of some great disease the concomi-
tant  presence  of another  disorder be owing to  dissimilarity of cause
or to similarity of development, it becomes important in such cases to
be aware not  only of the complications most likely to  arise, but also
of all that may appear.
   In addition to the particular morbid affections and conditions whose
tout ensemble makes up the disorder  called cerebro-spinal  meningitis,
and which we have arranged under the head of "Symptomatology,"
there are other distinct  groups of symptoms or forms  of  disease,
which  may  have existed in the system previous to the accession of
this disorder,  and  so  continue  on with it, or which may arise during
its course. These additional affections cannot but complicate the whole
case  in such a manner as to render the diagnosis  more difficult, the
prognosis more doubtful and  the treatment itself more  dangerous;
for in  these severe and  mixed diseases  the conscientious physician
finds  himself embarrassed at  every step, lest the remedy, however
carefully selected to suit the  whole case, should mitigate one  class of
symptoms only to intensify and render fatal another.
   The pre-existence of ague, which in some instances  seems to run
into  this form of meningitis, leads to a very troublesome complication.
Difficult dentition, whether considered as a cause  or as a concomitant
merely of the disease in question, by reason of its persistence is still
more to be dreaded.   Of ninety-eight hospital cases reported  by Dr.
Githens,* four were complicated with bronchitis, of which  one proved
fatal ; three with pneumonia, two of the right side, of which  one proved
fatal;  one with pleuro-pneumonia of the right side, fatal; one  with
pneumonia and free epistaxis, fatal; one with pre-existing pneumonia
of the right side  and puerperal convulsions, fatal;  one with double
pneumonia  and pericarditis, convalescent on the thirteenth day; two
with puerperal peritonitis, both fatal; one with  scrofula (white swell-
ing of the knee), fatal; one with pharyngitis, convalescent on the four-
teenth day;  one with circumscribed pneumonia, coining on in the second
week, convalescent on the twentieth day; and two with delirium tre-
mens, one convalescent on the fourteenth  day, the  other in  four weeks
—deafness remaining for both.
   Diagnosis.—The diagnosis of cerebro-spinal meningitis varies  in
difficulty  and in  the  indications  upon  which  it  depends according
to the age of the patient and the stage of the disorder  itself.   In the
case  of young infants, especially when first attacked, there  may be
              * Am. Jour, of Medical Sciences, July, H67, p. 17. 
918           DISEASES OF  INFANTS AND CHILDREN.
little  else than the excessive  painfulness on being touched or moved
and the constant moaning and distress, to show the exact nature of
the disease.   But these symptoms will  suffice to excite suspicion, par-
ticularly wdien the case is otherwise obscure, and to render the physi-
cian doubly cautious in his prescription.   To start right is obviously
of the first importance, or else by the time the error is discovered it
may be too late to save the little sufferer.   In  children and older per-
sons there are but two symptoms wdiich, taken by themselves, may be
considered as pathognomonic"; these are the peculiar soft white fur on
the tongue, with clean tip and edges, and the opisthotonos or torticollis.
But with  either of these symptoms will  usually be found plenty of
others corroborative;  while both  of them maybe wanting in  cases
wdiere the totality ofthe symptoms leaves no room to doubt the nature
of the disease.  The remarkable violence of the primary attack, con-
joined to the great obscurity of the whole case or total absence of any
sufficient  cause, may lead to the apprehension of the disorder in ques-
tion.   When the initial  symptoms are  still  more pronounced  and
severe, although no one  or even two of  them may determine  the
nature of the disorder, the whole will  speak in  language too plain to
be  misunderstood by  any physician, however inexperienced in  this
kind  of pestilence, who shall  have perused the resume" of symptoms
presented in  a subsequent  portion of this article.
   From  diphtheria, which resembles cerebro-spinal meningitis in its
prostration and certain cervical  symptoms, the latter  disease may be
distinguished by the absence of false  membrane in the fauces;  from
typhoid fever by the petechial eruption  appearing  very much earlier
in the former disease than  in the latter ;* and the same early and even
sudden onset of the gravest symptoms  which  characterizes severer
forms of  this disorder will also  serve to distinguish it from the more
gradually-arising simple  meningeal  or  cerebral  affections.   The
unusual  sensibility  and rigidity of the  cervical spine will  preclude
the possibility of mistaking the nature of any cases presenting these
symptoms.   Of course there  is little danger of such a mistake during
the prevalence of the  epidemic disorder.    Indeed,  so powerfully does
the epidemic cerebro-spinal  meningitis  influence the general health
(bat,  in the language  of Dr.  O. P. Baer, " From the commencement
of this disease to the present  time all our diseases of whatsoever type

  * In cerebro-spinal meningitis the eruption may appear in the first two or three
days,  seldom before the third  week in typhoid  fever.  Dr. William Cole, London,
1702, mentions a case of epilepsy reported by Dr. Hobart, in  which "the  paroxysm
ends in a great many red spots upon the forehead, which in a day or two turn black." 
         CEREBRO-SPINAL  MENINGITIS—SPOTTED FEVER.      919

or order have had more or less of its marked characteristics, such *aa
sudden attacks of stupefying, paralytic pain in the nape of the neck
and  down  the spinal column, accompanied with violent, throbbing
headache extending from  the occiput to the coronal region,  often
sending radiating  pains around the whole chest, and  even down the
arms." *
  The real need  of accurate  diagnosis  is for those  sporadic  cases
which, arising unsuspectedly, occur in constitutions most predisposed
to this kind of disorder, and therefore most liable to succumb to its
influence. It is in order to provide against such contingencies that we
have  arranged in a schedule, corresponding  to that of the Materia
Medica, the symptoms compiled from more than  two hundred cases
hitherto  recorded or occurring in our own practice.  From cases re-
ported by allopathic physicians those symptoms alone are taken which
presented themselves before any treatment was commenced.  In some
few instances, as  will be observed, mention  is made of the  day on
which the particular symptom first made its appearance.   This plan,
if carried out, might show the progressive development  of the dis-
order in the  less  violent  class of cases, but it  would be found of
little  practical utility on  the whole,  since  in  many instances the
gravest symptoms, those apparently  of  the  most advanced stages,
appear on the first day or two, sometimes even from the very onset of
the disease.
  Prognosis.—The  prognosis  of cerebro-spinal  meningitis should
always be  very guarded.   Much will depend upon the skill and ex-
perience  of  the  attending physician.   The  extremes of allopathic
mortality and homoeopathic success may be found stated in notes at
the beginning of this chapter.  Recently we were called to treat a babe
of nine  months who  had  vomiting  and diarrhcea, cough, excessive
sensibility of  the  abdomen and  whole body, intense  thirst, bending
backward of the head, stiffness of the neck and spine,  petechial  erup-
tion and convulsions; these latter, however, were not very  prominent,
and seemed to result from debility; the mother could not lift the child
from the cradle without bringing them on.   As convalescence set in
the little patient was tormented, especially at night, with a bad cough
and soreness in the lungs,  but at the  end of the second week he was
able to be placed on the floor by himself.   This case is given to show
the possibility of recovery even under hopeless circumstances.   We
add another, reported by Dr. J. F. Baker of Batavia, New York:
  '  A lad of eight years, when  at school, suddenly grasped his knee
                   * Medical Investigator,  vol. ix., p. 530. 
   ^20           DISEASES OF INFANTS AND CHILDREN.
                                            #
   with  his hands and  screamed fearfully.   Immediately  afterward  he
   was seized with convulsions and insensibility, the head  being perma-
   nently retracted.  There were high  fever, vomiting, dilated pupils,
   double vision, ashy paleness of the face, one diarrhoeic stool, and.then
   constipation.    Cicuta  \.2c,  once in two  hours to  once  in twenty-
   four hours, cured in four days." *
     Pathology.—From  notes of ninety-eight cases of epidemic cerebro-
   spinal meningitis,! reported by Dr. Githens, we take the following pa-
   thological resume: "The post-mortem examination  of  several cases
   revealed  marked evidences  of blood-poison, with inflammatory tend-
   ency.  The  membranes  of  the  brain were congested,  there  was
   serum in large quantity in the subarachnoidean spaces, at the base of
   the brain and within  the membranes  of the spinal cord.  Fibrin was
   deposited along  the margins of  the longitudinal  fissures  of the brain,
   about the commissure of the  optic nerve, in  fact, freely all over the
   base of the brain; and  in one  case  it could  be  separated  in masses
   weighing from three to five grains from within the fissure of Sylvius,
   where it had firmly glued the two surfaces together.  The quantity
   of this deposit of fibrin, its color, consistence  and strength  of attach-
   ment, were influenced chiefly by two causes observed during life.   In
   some cases where the inflammatory symptoms were  of an  active cha-
   racter, as shown by the congestion of face and eyes, the  character of
   the pulse and the violence of  the delirium, death occurred early, and
   an autopsy showed little or no  deposit of solid lymph, but a large
   quantity  of serum, and in one case pus, in all  the serous cavities con-
   nected with  the brain and  spinal cord, with  turgescence  of all the
   vessels of the pia  mater and nervous substance.   If, on  the other
   band, death did  not intervene  so quickly, there were deposits of fibrin,
   becoming larger, firmer and more adherent in  proportion to the grade
t   of inflammatory action and the time allowed for its coagulation.  The
   deposits were ofthe same character as those found in the cavity of the
   abdomen after an attack of peritonitis.  No  particular lesion of the
   cord itself was noticed ; the membranes were congested, and there were
   small deposits of fibrin  about the roots  of the  spinal  nerves.  The
   erector-spinse muscles were  darker than normal, and softened.  The
   blood was fluid,  of the color and appearance of port-wine lees; under
   the microscope the  corpuscles were shriveled  and crenated, and there
   was a space apparent between them, as they were arranged in rouleaux.
   There were, in two cases, white, firm fibrinous heart-clots  extending
              * Hahnemannian Monthly, vol. viii., p. 42, August,  1872.
              t Am. Jour, of Med. Sciences, July, 1867. 
         CEREBRO-SPINAL  MENINGITIS—SPOTTED  FEVER.       921

through  both ventricles and  auricles, and into the vessels leading to
and from the heart."
  The particular results of post-mortem examinations  in three cases
are thus  summed up by the same author: 1.  "Very extensive deposits
of fibrin and  about five  ounces of serum at the base  of the brain ;
spinal cord congested, with deposit of fibrin beneath the arachnoid;
a small quantity of pus round  the cord in  the cervical region."  2.
" Large masses of closely adherent lymph at the base of the brain and
on the medulla oblongata."   3.  " Large quantities  of tough, adherent
lymphy deposits at the  base of the brain."
  " I  have ascertained,"  writes Dr. J. H. Bennett, " that what is
generally called a recent layer of coagulable lymph covering the con-
volutions in meningitis is in point of fact a  layer of pus." *
  Sequelae.—In  order to bring the "symptomatology" in closer prox-
imity  to the  "therapeutics"  of cerebro-spinal meningitis, we  place
both  the "pathology" and the "sequelae" out of  the natural order.
  Parotidis, pneumonia, and even bed-sores, have been  mentioned as
among the consequences of this disorder.   But the more direct and
constant sequela?  may  be arranged in three classes:  The first,  in-
cluding all paralytic symptoms—of "the lower limb," "left  foot" or
other parts—reminds one of the analogous effects  of diphtheria.   The
second {deafness) is equally suggestive of typhoid  fever.   The  third
{loss of memory), as a permanent result of acute disorder, is  believed
to be peculiar to the disease under consideration.
  Symptomatology.  — Sensorium. — Delirium.   Muttering  delirium.
 Wild raving  delirium.  Wild  and at times uncontrollable delirium,
with  jactitations, startings and   incoherent cries.   Constant delirium
(first  day); seems  terrified with  fearful apprehensions  of  impending
evil.   Wakes delirious;  her mind  wanders; she  is apparently  de-
lirious, but on  being  questioned rouses up and answers  correctly.
Slightly delirious  all  night, talking quietly about  his family and
business.  Talkative  delirium.   Walking  and   talking  delirium.
Delirium on the evening ofthe  first day, with frequent spasms during
the night.  Violent  mania the second  day; constant  moaning and
talking  for forty-eight hours;  the spine was completely arched, the
hands thrown wildly about,  and  he screamed so that he could be
heard some blocks  away.  Mind perfectly clear in an adult, although

  * Clinical Lectures on the Principles and Practice of Medicine.  Third edition.  Edin-
burgh, 1859, p. 345.
  For further discussion of the various products of disease  in the base of the brain,
see Hahnemannian  Monthly, vol. iv., pp. 194-197. 
922         ' DISEASES OF INFANTS  AND CHILDREN.
there is a slight deafness; face  wears a peculiar anxious  expression ;
the corners of the  mouth are drawn down;  eyelids widely open,
giving the eyes a staring appearance; the patient watches very nar-
rowly the motions of his attendants, moving the eyes to keep them in
view, although the  head remains in one position.  Delirium, usually
cheerful, singing or laughing, occasionally, however, screaming loudly,
then relapsing for a short time into low muttering; he had many
short lucid intervals, and then was  usually free  from  paiu.   Gentle,
wakeful  delirium, or comatose, with low muttering.  Stupor; never
speaks except  to  answer  questions, and then  quite slowly.   Sight,
hearing and  consciousness are evidently seriously impaired, and ho
appears to be  verging  upon a  complete comatose  and  tetanic con-
dition.   Muttering and talking aloud all night until 9 a. m., fifth day
—a  patient that  finally recovered.  Stupid;  answering slowly when
spoken to; perfectly indifferent to all surroundings; half conscious;
moaning  while asleep;  complains of general malaise;  pulse  weak;
expression stupid and heavy.  Stupor, with low muttering delirium;
sensitive to light and noise.  The child  screams from  the violence of
the pain.  Trembling  as  if the  child  were frightened  and on the
verge of spasms.  (Verat. viride.)
  Loss of memory and deafness as sequelae.
  Head, Neck and Back.—Headache; obstinate headache;  violent head-
ache ; headache increasing during the day; became almost insupportable
toward evening;  the pain is constant, very severe, lancinating, "jump-
ing," in  all parts of the head,  especially in  the region  of the ears.
Frontal headache; stupefying headache, with pressure in the eyes. In-
tense cephalalgia, with  a feeling in the frontal region as  if the head
would burst; the pain  was continuous and increased by light and
sound.   Fulness in the  occiput—the veins feel as if ready  to burst; no
pain in the foichead. Sensation in the occiput as if he had received a
blow.  Headache sharp and neuralgic, varying in location at first, but
soon becoming settled in the occiput, followed by the backward draw-
ing of the head ;  severe chill;  terrible headache, extending from the
occiput all over the  brain, especially severe in the temporal regions;
inability to bear the least noise or light;  head, drawn backward; com-
plained of headache, and was delirious;  head drawn back upon the
shoulders. Violent spasi is ; head drawn back upon the shoulders.  The
pain in his head, he said, resembled the compression of a band of  iron.
Pain and tenderness in  the neck along the back; pain in  the head de-
scribed as very intense, and located  in the occipital and  temporal re-
gions ;  continued intense headache ; vertigo. 
         CERIBRO-SPINAL MENINGITIS—SPOTTED FEVER.      923

  Pain at the first  cervical vertebra, with sensibility to touch ; tonic
spasms of the muscles of the neck, drawing the head back, and great
tenderness of the cervical region of  the spine; muscular pains in the
neck  and back, with stiffness  of  legs and back.   Neck rigid.  Neck
stiff and sore ;  pain on pressure over sixth cervical and second dorsal
vertebrae; hips very painful and drawn back.
  Rigid spine.-  Pain on pressure over the lumbar vertebra?; pain in
the head, back, shoulders and legs on pressure over third dorsal ver-
tebra ; muscular pains in limbs, back and neck ; head, neck and back
involved; the disorder  commences with a violent chill, darting  pain
through the head, pain along the spine and bilious vomiting ;  pain on
pressure along the entire length of the vertebral column ; the whole spinal
column stiff and  immovable, and  severe pain in the  head; pain and
soreness in the back of the neck and occiput;  neck rigid and drawn
back  upon the spine; strongly inclined to opisthotonos; the face is
turned to the right  side, and  cannot be moved without greatly aggra-
vating the pain (fourth day).  Opisthotonos, in various degrees in differ-
ent cases.   Slight opisthotonos with subsultus.  Marked opisthotonos,
body forming an arch.  Opisthotonos so marked that the body formed a
bow, resting on the head and heels.  Torticollis, neck stiff and sore; face
turned to the left side and back upon the spine, strongly tending to
opisthotonos (seventh day).   Pain commencing  in the back and pro-
gressing  upward toward the head; lies almost constantly upon  his
back; is unwilling to be moved (fifteenth day).  He lies on his back
with his face turned to the left side, and his head cannot be moved to
its natural position  or raised  from  the pillow without producing great
pain; his right arm describes almost a complete circle several times a
minute ;  it is raised from his side to his head, the dorsal surface of his
hand passing across his  forehead, and then down to his side, where it is
allowed to remain  for  a few seconds; his right  lower extremity is
almost incessantly in motion; it is flexed, then extended outward, ren-
dering it extremely difficult to keep him covered or in bed (third day).
  Picture of  a closing scene,  a  man who died on the 22d  day :
"at three P. M., unconscious since  morning; head thrown b%ck; ret-
roversion of the eyes ; sclerotica much inflamed ; left side paralyzed ;
right  hand in constant  motion; would swallow to  7  P. m. ; hiccough
constant;  breathing stertorous; vomiting  and  subsultus tendinum; *
death at 11 A. M.   Face and body became spotted all over soon after
death." *
  Eyes.—Intolerance of light.   Eyes congested.  Eyes injected, with
             * U. S. Med. and Surg. Journal, July, 1872, p. 497. 
   924           DISEASES  OF INFANTS AND  CHILDREN.

   a brilliant and wild look; pupils contracted and very sensitive to the
 •  light.   Eyes  injected and rolling  about the sockets,  with vacant ex-
   pression.   Chemosis of the right eye, ecchymosis of the left.   Con-
   junctiva injected, and the whole surface ofthe body acutely sensitive.
   Conjunctiva deeply congested, with  photophobia and a secretion  of
   pus around the corner of the right eye; beneath the conjunctiva occur-
   red a  large  effusion of blood, disappearing on convalescence.  Pus
   flowed from the eye on the third day.
     Eyes closed; pupils  contracted.   Eyes tightly closed ; marked pho-
   tophobia, pupils very much contracted.   " Pin-head pupils."  Pupils
   contract and  dilate  unequally.  Pupil  contracting and dilating by
   turns; on  the approach of light it  would contract for  a moment, then
   immediately dilate again.  The right pupil contracted, the left dilated,
   and appeared to dilate  more under the influence of  light.   Eyes wild
   and injected; the pupils contract, but oscillating.  Pupils dilated, and
   next contracted on  exposure  to  light.  Double  vision.  Pupils fully
   dilated, but contract upon  the application of strong  light, to  which
   the eyes are quite sensitive (first day).   Pupils largely dilated, but
   there is no  photophobia (second  clay).   During the first  week the
   patient was excessively annoyed  by double vision;  one or both eyes
   were most ofthe time turned toward the inner canthus. Photophobia
   so great that he kept his eyes closed almost constantly.   Relief from
   keeping the eyes closed.   Double  vision;  eyes  have a  peculiar vacant
   look (sixth day).   Sight and  hearing both much impaired.   Eyes
   prominent and staring,  and corners ofthe mouth drawn down.   Wild
   look of the eye.   Eyelids partially closed;.  eyes injected and  rolling
   about the sockets; pupils contracted.  Twitching of the muscles of the
   eyelids—not of the eyeballs.   Bright spots before the eyes; disposi-
   tion to become frenzied with headache, with pricking  and  numbness
   of the hands and  feet.   Strabismus, indicating an advanced stage or
   very severe form of the disease.  Loss of vision; eyes no longer sen-
   sitive to the light.  Total blindness and deafness several days before
   death.
     Ears.—Intolerance of sound in the earlier stage.  Partial deafness
   (sixth day).  Total  deafness in the last  stage of the disorder.  Con-
   siderable pain in the right ear, rather more than in the other parts of
*  the head.  Left ear deaf (eleventh day).  The parotid  glands were
   inflamed and suppurated;  the right opened spontaneously into thp
   ear; the left was  lanced, very free discharge; deafness.   Deafness  is
   a not 'iucominon sequela.
     N(>*f_-— Epistaxis, two or three  times in the night  Uhird day). 
         CEREBRO-SPINAL MENINGITIS—SPOTTED  FEVLR.      925

Repeated epistaxis.   Frequent and constant epistaxis.   Epistaxis and
pneumonia as a complication.
  Face.—Face flushed.  Expression dull and anxious.   Countenance
stupid and heavy, and seems indicative of pain.   Eruption of erythema
and petechia? on the face only.  Petechial spots on the face and thorax,
on the face and other parts.   Ashy paleness of the face.
  Mouth,  Tongue,  Teeth and, Jaws.—Corners  of the  mouth  drawn
down.   Lips dry and cracked.  Tongue red in the centre, white on
the borders.  Tongue feels so sore that she cannot  eat.  Vesicles on
the tongue.  The  tongue is at first clear, moist and enlarged, and
covered with a white skin ;  soon it becomes coated  with  a black, dry
crust; sordes form on the teeth.   Constantly grating his teeth (second
day).   Tongue coated with soft white fur. but clean on the tip and edges.
Tongue coated,  with  moist white fur, but  clean at tip  and edges; after-
ward dry and brown (age 46; pulse 125; died on the third day after
admission to hospital).   Tongue brown and dry,  with  clean edges.
Tongue dry and  brown  in  a  case resembling typhoid fever, but
with eruption which was petechial in character from the  very first.
Tongue pointed, dry, cracked and tremulous, but coated  with a thick
tenacious mucus.  Tongue brown, dry  and bleeding.   Tongue brown
and pasty.  May be fissured or cracked.  Tongue and  breath cool,
the former swollen  and  slightly coated.  Tongue slightly coated and
yellow.   Tongue first whitish, then thick, brown and dry.  The jawTs
were set firm part ofthe time, then they could be pried open.*  Pain
in the inferior maxillary bone.   Does not articulate distinctly; speech
slow and thick.  Dumbness.  In the more grave and malignant form
of the disease the tongue may be broad and flabby, and indented round
the edges  by the pressure of the teeth.  Tongue coated brown in the
centre;  brown  and  flabby;   broad  and flabby.   When  requested  to
put the tongue out, did so,  but allowed it to remain without return-
ing it.   Tongue, previously  clean, is covered on the third day with a
light-brown coating in  the  centre,  with white edges.  Large, flabby
tongue.  Tongue coated light brown ;  increased flow of viscid saliva.
Tongue coated white, moist, quite swelled and sore on the right side,
as if it had been injured.  Excessive flow of viscid saliva.  Consider-
able secretion  of  thick, viscid  mucus from the mouth (nineteenth
day).
   Throat  and  Larynx.—Sore throat  is frequently  a  premonitory
symptom.  Dysphagia.   Dryness in the  throat with dysphagia. He
         * H. F«nnett, M. D., N. A. Jour, of Horn., August, 1867, p. 9. 
926           DISEASES  OF INFANTS AND CHILDREN.

complained of sore throat, and on inspection a deep blue color of th*1
whole mucous surface of the pharynx was discovered.
  Severe dry cough, often a precursory symptom.   Cough, with pain
in the hypogastrium.  Cough excited by irritation in the chest.  Cough
and headache, with high  fever  in the early stage of the disease.  Cough
aggravating the pain in the head  and neck.   Coughs more at  night.
Cough with expectoration of  blood, at first  coagulated, then  bright.
Expectoration of mucus  and yellowish matter streaked with blood.
  Appetite—Thirst.—Loss of  appetite.   Appetite very good at inter-
vals of the unconscious state, even in the advanced stage of the disease
and in hopeless  cases.*   Thirst.—Slight but continual  thirst  which
water would not relieve.   Severe thirst.  Insatiable thirst.
  Stomach.—Distress in the stomach, nausea and bilious vomiting.
Vomited  (first  day)  every hour  or  two  during the  night,  until
8 a.m., a green watery fluid; vomiting of very  green fluid  com-
menced in the P. m. ofthe second day.   Vomiting all day.   Frequent
vomiting.  Daily vomiting.   Nausea,  with  severe chill.   Nausea on
motion.   Occasional  vomiting  of bilious  matter, with pain  com-
mencing in the  back  and progressing upward  towTard  the  head.
During the night  he  vomited occasionally  a green bilious  matter.
Vomiting of dark-colored matters (toward the last).
  Abdomen.—Abdomen, chest and thighs thickly covered with  a red-
dish-brown petechial eruption.  Abdomen covered with an eruption
consisting of small round reddish-brown spots about one-quarter of an
inch in diameter.   Petechial  mottling on the abdomen and  thighs.
Slight hyperaesthesia over the  abdomen.  She complained of pain in
the head and  lower part of the abdomen—the  latter not very acute.
Marked abdominal hyperesthesia.   Abdomen rather sunken in.  " Ab-
domen caves in."   " The belly is sunken."  Bowels perfectly flat and
shaped like a boot.
  Stool.—Constipation.   Constipation,  although diarrhoea preceded
the vomiting at  first.   Five small but thin  and dark-colored stools
daily.   Diarrhoea.  Involuntary evacuations.
   Urine.—Urine normal.   Urine scanty and high-colored, and re-
tained in  some cases.   The urine continues  to be secreted, but the
bladder becomes insensible to  its presence, necessitating the use of the
catheter.  Urine dark, sufficient in quantity (fifth day).  Suppression
of urine (fifth day).   Eleventh  day,  dysuria,  milky, scanty  urine.
The third and  fourth   weeks were marked by entire inability to
  * Compare a similar condition in  meningeal tuberculosis, Hahnemannian Monthly
vol. vii., p. 207. 
         CEREBRO-SPINAL MENINGITIS—SPOTTED FEVER.      927

urinate;  the  secretion was abundant, however, and was removed by
means of the catheter.  Incontinence of  urine from paralysis.
  Chest—Respiration increases to thirty or forty per minute.  Res-
piration  irregular and very laborious.   Respiration labored and very
noisy.  Mean range  from twenty-four  to  forty per minute.  Very
irregular in  many  cases; sometimes slow.   A  few  rude  and moist
rales in  different parts of the chest.  Complicated with bronchitis ;
death on the  twelfth day from choking up of the bronchial tubes with
thick mucus.   On applying the ear to the chest the bronchial sounds
were dry and metallic.  Most violent bronchial  cough, with expec-
toration and  blood, in an old man.   Irritation of the chest, exciting
cough.   Complicated with double pneumonia  and  epistaxis.   Bron-
chial complication  in many cases.  Coma, with labored, stertorous
respiration.
  Female Sexual Organs.—Great and distressing bearing down.  Men-
struation comes on, from which she had but just recovered the week
before. *
  Extremities.—Pain in one or  more of the extremities of a violent
character.  Some hyperesthesia of the  upper  limbs, but no  impair-
ment of  motion.   Hands constantly clasped together.  His right arm
describes almost a complete circle several times a minute;  it is raised
from his side to his head incessantly. (See  "Head, Back," etc.)  Sub-
sultus tendinum lasting for a week in a man who recovered.  Great
sensibility of the lower extremities and pain in them; some sensibility
of the upper  extremities; moans.   Extreme sensibility of the lower
extremities;  cannot bear the slightest touch on  any part of them;
screams when they are touched.  Muscular pains in legs and arms.
Pains in the  calves of the legs, gradually  traveling upward through
the thighs and  back until it reaches the  head.   Extremities cold, ex-
cept in the exacerbation of fever.  Coldness ofthe lower limbs; coldness
of the  surface; hands cool;  skin  cold and clammy; hands and feet
cold.  (See "  Fever "  and  " General Symptoms.")   Very restless, con-
stant motion of the arms and limbs; rapid movement from  side to
side (third day).  Spasmodic twitching ofthe extremities while asleep.
Slight twitchings of the extremities.  Paralysis, with pain and  sore-
ness of the feet and limbs, from the fourth  to the eighth week.  The
child grasps or pulls at its hair with its hands.f   Frequent picking at
the bed-clothes and  reaching  after imaginary  objects (third  day).
Paralysis of  the left  foot as a sequela.   Constant picking at the bed-
    *Chas. H. Carpenter, M. D., Trans,  of N. Y. Horn. Med. Soc, 1869, p. 768.
    fH. F. Adams, M. D., Trans. N. Y. Horn. Med. Soc.,. 1868, p. 379. 
928           DISEASES OF INFANTS AND CHILDREN.

clothes and other clothes and whiskers of her husband while near her-
seems to be reaching for something. *
  Sleep.—Slept uneasily, moaning wdiile asleep;  when aroused would
grasp her sister with a sort of spasmodic movement, then become quiet
and fall asleep again  (when first taken).  Complains of being unable
to sleep day or night.  Sleep comatose, or very distressing and exhaust-
ing on account of frightful dreams.  Morbid vigilance, ending in coma.
Coma, wuth labored, stertorous respiration. Convulsions and coma alter-
nated (third day).   Stupor and coma were constant several days before
death. Appears to be asleep, but if spoken to opens her eyes and replies.
  Fever—Pulse.—High fever, pulse 130 and small.  Pulse increases
from  95 in the A. M. to 110 P. M.   Pulse 140 to 150.  Pulse slow
and  of little volume—not over  50 per minute.   Temperature low.
Pulse very slow, sinking  sometimes to  48  or  50 per minute.   Pulse
perfectly normal (when comatose, blind and deaf), a very unfavorable
symptom, f  The pulse is at first slow, then accelerated, but diminished
in volume and strength;  respiration is slower than natural in  many
cases ; the skin has almost always at the beginning an abnormally low
temperature.   Pulse  strong and irritable, varying from  116  to 120.
Pulse 100 in A. m., 112 p. m.  Pulse entirely imperceptible.  Pulse-
less,  with unconsciousness and cold surface.
  When  first taken he was suffering  from a very intense and pro-
longed chill, his  teeth were  chattering, and he  was trembling with
cold  ; the whole  surface of the body was blue.   Chill every second
day,  followed by high fever; then fever followed  by sweat.  Frequent
recurrence of chills in the course of a protracted case; chill in the p. m.
ofthe 7th, 16th, 18th and  24th day in a patient who recovered.! This
disorder may follow and apparently result from  intermittent or ma-
larious fever.  Some  cases, however, which were  at first supposed to
have  originated  in ague,  are found  to have been in reality spotted
fever from the first, the chill being no  more than belongs to this lat-
ter disorder.
  Great coldness of the surface.  Remarkable coldness of the lower limbs
(afterward of the whole body), and yet the child will not bear to be
covered;  if the clothes are drawn over her, even  when she is ap-
parently asleep, she immediately becomes restless and  kicks every-
thing off.
  Skin.—Purple spots on the legs; dark, petechial eruption in pretty
         * J. T. Wallace, M. D., Trans. N. J. Horn. Med. Soc, 1870, p. 442.
         t Am. Jour. Med. Sci., July, 1866, p. 56.
         t H. M. Paine, M. D., Trans, of N. Y. Horn. Med. Soc., 1867, p.  132. 
          CEREBRO-SPINAL MENINGITIS—SPOTTED FEVER.       929

large spots  all over the body.   Early in the disease, in some cases,
the first symptoms pointing to  a grave form of the  disease are the
appearance  on the face and thorax, also on the extremities, of pete-
chial spots,  varying in size and number; in some instances there are
but few spots, and these rather  obscure; in  others the whole surface
is covered.  In a few cases this eruption was absent until after death,
and in one or two cases it was not observed at all.* The eruption ap-
pearing only  after death  will  mostly occur in  the  case  of  young
infants, whose delicate systems succumb to the disorder before its ulti-
mate pathological changes  are  manifested.  The petechial  spots are
due to the failure of nerve-powTer to carry on the capillary circulation.f
   Eruptions of bright cherry  spots  over  the  whole surface of the
body, more numerous on  the  hands  and  arms;  chest and abdomen
thickly covered with  an eruption consisting of small round, reddish
spots about one quarter of  an inch in diameter;  chest, abdomen and
thighs thickly covered with a small petechial eruption, not at all raised,
or disappearing on pressure.  Eruption of erythema and urticaria in a
case in which the  other symptoms were well marked.   Eruption of
erythema, and petechiae.  Copious eruptive exanthem, changing to pete-
chias.  Surface cool, and mottled with purple spots, some as large as
a split pea,  others again as large as a  fifty cent piece;  surface bluish,
presenting a mottled appearance; cool and  bedewed with damp per-
spiration.   "Dark spots like bruises would appear on the  body and
limbs, and in some cases  in twelve  or twenty-four hours  the  attack
would terminate  in apoplexy and death."!  The surface may be dry,
or moist as  if with some little perspiration.
   "On the  morning of the ninth day, the  third after  the  chill, nu-
merous irregular, deep-red spots were observed on the whole surface
of  the body.   They varied in  size from a pin's head to half an inch
in diameter, and were more numerous on the hands and arms than on
any other part of the system.  The  color did not disappear on pres-
sure, neither were  the spots sensitive to the touch.  They remained
four or five days, gradually turning  to a  deep mahogany color, and
finally disappeared."  This case proved fatal on the twenty-first day. §
   General Symptoms.—Complains of feeling sore and tired in all parts
ofthe system (third day).   " So tired" (fourth day).   Profound pros-

  * B. F. Joslin, M. D., Trans. N. Y. State Horn. Med. Society, 1870, p. 430.
  f Hahnemunnian Monthly, vol. iv., p. 251.
  X L. Stanton, M. D., " Spotted Fever" of Carthage, Jefferson  co., New York, of
1865 : Trans,  of  N. Y. Eclectic Med. Society, 1868-69, p. 483.
  ? H. M. Paine, M. D., Trans. N. Y. Horn. Med. Soc, 1867, p. 134.
       59 
930
DISEASES OF INFANTS AND  CHILDREN.
tration, much greater than the other symptoms would seem to warrant.
Utter prostration and  terrible  headache.   General feeling 'of uneasi-
ness, with thirst and loss  of appetite.  Hyperaesthcsia  general or in
particular places, sometimes confined to one side or limb. Anaesthesia.
Complains of general  malaise.   Every movement is  painful.  Great
suffering,  frightful  screams and groans almost continuous.  Suffers
from pains, a buzzing in the  head and soreness.  Feels cold; skin
cool.   No pulse to  be  felt; great prostration  and great sensibility to
the touch.   At intervals the child would appear perfectly well  and
free from any distress  or morbid symptom.   Symptoms ofthe most
formidable character may present themselves at the very outset ofthe
disorder, and intermissions of a periodic nature—apparently complete
relief from all sufferings—are not uncommon in its course.   Involun-
tary twitchings ofthe muscles and  wrant of prehension.   Restlessness,
with much tossing.   The child has constant crying and restlessness;
hoad hot, extremities cold; clonic  spasms.  Aggravation from being
moved.  Cannot be  moved  on account of extreme  sensitiveness to the
touch.   Remarkable coldness  of the lower extremities, subsequently
extending over the  w hole body.  Spasms.   Unconscious; face flushed;
cold extremities, with drawing back of head to right side; spasm about
every ten minutes, during which the head would be drawn completely
down on the shoulder, also rigidity of the whole body.   Opisthotonos,
with hands clenched and occasional cramps of the extremities. Marked
opisthotonos, the body forming an  arch.  Paralysis. Vital force worn
out; death from exhaustion.
   Characteristics.—As already stated,  some few of the symptoms of
cerebro-spinal  meningitis  are  pathognomonic almost  individually.
Such  are the peculiar white furred tongue with clean  tip and edges;
tongue swollen, broad and flabby, the early appearing petechia?,, opisthoto-
nos and torticollis.
   Of the following, no one or  two would  necessarily indicate this dis-
order, but several  occurring  together would do  so  very strongly:
Headache.  Delirium.   Sensibility at  the  base of the brain and pain-
ful stiffness of the cervical spine.  Eyes congested, staring, double
vision, early loss of sight.   Deafness.  Tongue brown and dry,  with
clean tip and edges.  Sore throat.   Cough.  Bilious vomiting.  Ab-
domen sunken.  Constipation.  Great coldness of the lower limbs.
Pulse  slow or very  quick.  Commencing chill. Severe pains.  Hyper-
esthesia excessive, general  or local.  Aggravation from being moved,
not from self-movement. Prostration.  Restlessness; constant motion.
   Paralysis, deafness and  loss of memory as sequeloe. 
          cerebro-spinal meningitis—spotted fever.      931

                           Treatment.
   Aconite. At the onset of the disease,, when there is  much fear mani-
 fested, restlessness, no position is satisfactory, thirst for cold water, act-
 ive  inflammatory symptoms, particularly  in plump and full-blooded
 patients.
   jEthusa. Very  nervous.  Delirium, particularly with visions  of
 dogs and cats.  Lancination and throbbing in the occiput.  Feeling
 of contraction of the  hairy scalp.   The  head  inclines  to  fall back-
 ward ; brilliant, injected eyes; fixed look; lancinating pains down  the
 back.   Linea nasalis.   Features  express  great anguish; face  puffed
 and spotted with red.   Aphthae  and pustules  in the throat.  Violent
 vomiting of  frothy matter, sometimes white.  Abdomen  tight  and
 hard.   Constipation;  anxious respiration;  dark  spots more or less
 numerous all over the body.  Great prostration.  Irregular or imper-
 ceptible pulse.
   Apis mel.  Great restlessness  and  tossing which affords no  relief.
 Crying out and  screaming loudly as from stabbing pains-  Irritable
 disposition ;  great pain  in the occiput.  Sensation of stiffness in the
 neck and back.   Scanty urine;  great  dyspnoea, and  sensation as if
 every  respiration would  be  the  last;  seldom  any thirst; numerous
 spots or little elevations all over  the body,  red or purplish.  Smoky
 opacity of the cornea  and obscuration of sight.   Constipation.  Stu-
 pefaction  and stertorous respiration, with an  occasional ^Start as if
 from a sharp pain.   Aggravations at night,  especially after twelve.
   Argentum  nit.  If there be epileptiform convulsions, each one  of
 which is preceded by great restlessness.
   Arnica.  Great heat of the head, wdiile  the  body is comparatively
 cool.   Very  restless ;  sensation of soreness as  if bruised.  Diarrhcea,
 often involuntary.  Purple spots appear here and there.  Frequently
 awakens with much heat in the head.   A low state of the system.
   Arsenicum.  Great restlessness  and  frequent calls  for cold water,
 only a sip of which is taken ; aggravations at night, after twelve par-
 ticularly ;  much exhaustion  after  every  movement;  cold,  chilly,
 wishes to  be  covered, even when very  warm.   Purple  spots appear
 on the skin.   At night the delirium, the tossing and  the expressions
 of anguish are truly alarming.  There is  often cold perspiration and
 sometimes cold breath.
  Belladonna.  Face is flushed;  eyes injected; throbbing of the caro-
tids; skin hot, so as to impart a burning sensation to the hand;  great
muscular  jerking and twitching during sleep;  grinding  of the teeth;
inclination to  bite.. 
 932           DISEASES OF INFANTS AND CHILDREN.

   Bryonia.  Aching all over;  head aches as if it would burst; desire*
 to keep very still;  dreads motion, because it hurts, though he must move
 occasionally.  Very thirsty for  large drinks of cold water; worst in
 the evening till after twelve at night.   Pain in back  of neck, in the
 back,  at  the  shoulders and under the shoulder-blades, particularly
 the right.   Purple spots appear on the skin.   Constipation of hard,
 dry, black stools.
   Bufo sah. Great anguish ; lancinations in the occiput inclining the
 head to  fall  backward.  Beating of the heart  reverberates in the
 ears.   Red or purplish streaks in the neck, back,  or in other parts.
   Camphora. When there  is  great coldness and paleness; the  skin
 seems  cold as marble, yet the  patient does not desire covering; often
 cramps in stomach, and the pulse small, weak and slow.
   Cicuta vir. Moaning and complaining; pupils dilated or contracted;
 dumbness; deafness; dysphagia; ashy paleness or bluish face; cramp
 in the  muscles of  the neck, with  inability to move or turn the head;
 head drawn back, with  stiff neck.   Trembling or starting and jerking
 af limbs; irregular respiration  ; starting at the least  noise; violent
 jerks  in  any part  or throughout the wdiole  body;  rigidity of the
 spine; strangulation on attempting to drink; violent convulsions, after
 which  the patient lies  as  if  dead for some time; trismus in some
 cases.
  Cantharis* Paroxysms of rage and  fury; pain deep in the brain,
 with an expression of great suffering in the countenance; the  base of
the brain is  the chief  point of pain.   Urine dribbles or passes in
drops,  with burning, cutting pain.
  Cocculus Indicus. Violent headache with persistent vomiting;  ver-
tigo and semi-consciousness; painful stiffness of the neck when mov-
ing it; complete paralysis of the lower limbs.
  Cuprum. When the  convulsions commence  distinctly in the ex-
tremities.
  Gelseminum. When the attack is ushered in by blindness, then head-
ache and a feeling as  if a band were around the  head; hardness of
hearing ;  loss of speech or very weak voice; trembling and weakness
of limbs; drowsy; itching of head, face  and  neck;  if perspiration
sets in, it relieves the symptoms.
  Glonoine. Pains  seem  to ascend from the chest and neck to the occi-
put ; pain the whole  length if the spine; oppression  of the chest;
blindness, with faintness and nausea; congestion to the head with sense
of expansion.   Can't bear heat about the head.
  Hydrocyanic acid. Insensibility, with half-open eyes, dilated, immova- 
         CEREBRO-SPINAL  MENINGITIS—SPOTTED FEVER^      933

ble pupils; roaring in the ears; bloated and bluish face; tongue paraly-
zed and sometimes  protruded; loss of speech; rattling, slow respira-
tion ; heat in the head ; general coldness of the body ; great prostration.
  Hyoscyamus. Indomitable rage, horrible anguish ; complains of hav-
ing been poisoned ;  loss of consciousness;  loquaciousness; staring and
distorted eyes;  cannot see; bluish or brownish-colored face; trismus;
foam at the  mouth;  inability to swallow;  retention of urine; stiff
neck, sometimes with  torticollis;  brown  or black spots or vesicles on
the surface of the body.
  Lachesis. Great depression  of  spirits and apprehension of death;
aggravation of  the  symptoms as  soon as sound sleep  is obtained; the
neck is stiff, and so  sensitive that the least  touch is painful; blue spots
or blue blisters on the skin;  epistaxis ;  haemorrhage from the bowels,
of decomposed  blood; great prostration, and very great weariness.
   Lycopodium. Desire for company; irritable and peevish'on awaken-
ing from sleep; headache, with pain extending down the neck;  great
weakness, lower jaw often  hanging down ;  acuteness of hearing and
smell; swelling of tongue;  much flatulency; red sand in the urine;
pain in back before urinating.
   Nux vomica. Tendency to  paralysis of  the limbs;  fear of sleeping
on account of the  frightful character of  the dreams; -sudden shocks
from some one portion of the body to the brain; hypochondriasis, with
irritability of temper.
   Opium. Stupefaction ;  eyes fixed and half closed, immovable pupils ;
staring, glassy  look;  face bloated; twitching of the lips; stertorous
breathing; intense  thirst; abdomen hard  and bloated ; opisthotonos ;
hot sweat; twitching and jerking of the limbs.
   Plumbum.  Great  sinking  of  the pulse,  even down  to 40, and early
paralysis of  the limbs.
   Phosphorus.  Where there are pneumonic combinations indicating
this remedy.
   Pulsatilla.  Mild, gentle disposition ; inclined to weep;  very restless;
no thirst;  wishes  to  have the doors  and windows open; pain in the
back on swallowing;  stiffness in back of neck; much pain in turning
the head to either side; sleeplessness with great desire to sleep ; almost
constant crying out or moaning;  cough,  with pain in the back;  pain
in the back at every motion.
   Rhus tox.  Great  restlessness, wdien every  change of position affords
temporary  relief;  feels very tired;  bleeding  of the ears and  nose;
pain in the back as if sprained;  tearing pain down  the  legs;  feeling
of stiffness in muscles and joints; eruptions, with itching. 
                                     «
934            DISEASES OF INFANTS AND CHILDREN.

  Stramonium.  The patient is either in a supplicative mood, pleading
for help, or is very irritable, with  raving and disposition to strike,
bite, or injure others;  staring eyes; shrinking look, as if from fear;
raising of the head from the pillow and falling back again ; desire for
light and company; loss of voluntary motion, stiffness of the whole
body, or there may be  violent motion of  the limbs.
  Sulphur.  When patients are very  liable to relapse.
  Tartar emetic. Great  drowsiness; nausea; cough with much rattling
of mucus;  pulse full, hard, quick and trembling.
  Veratrum album. Cold sweat all over the body, vomiting, with cramps
in the stomach; great  thirst for icy cold  water; muscles of the neck
too weak to support the head.  Pulse  irregular, very weak and slow;
coldness predominates; great debility persistent; there  may be also
cramps in  the legs; wants to escape from the bed; heavy, comatose
sleep.  Consult also the remedies, and  their indications, laid down for
Diseases of the Brain, page 909.
  In this grave disease I have the best  success from using remedies
ranging from the 200^ to the 40m> always withholding the remedy at
every amelioration, and usually repeating at every aggravation.

                  Chorea—St. Vitus's Dance.
  Chorea is a disease  characterized by irregular  spasmodic  contrac-
tions of different muscles  or  sets of muscles, especially those of the
upper  and lower extremities; these irregular movements being  not
altogether  involuntary, while they  exhibit an inability  to properly
co-ordinate muscular movements.  It occurs  most frequently  in chil-
dren from five to twelve years old, and in girls much more frequently
than in boys.  The generally  rapid growth and the accession of second
dentition within the above years are  supposed  to be, and no doubt
are,  the chief predisposing  causes of chorea.   It occurs, however, most
frequently  in connection with, or as a consequence of, rheumatic fever.
" M. See asserts, after  much examination of this subject, that one-half
of the cases of chorea are  dependent upon the rheumatic  poison.
Thus,  of one hundred  and  nine cases of rheumatism admitted into the
Hopital des Enfants, he found that sixty-one were  complicated with
chorea.  Trousseau also states that in his experience rheumatism was
undoubtedly  the  most marked cause of chorea.   M. Henri Roger
asserts .their connection even more strongly, and states that ' the co-
incidence of choiea and rheumatism is so common a fact that it ought
^o be regarded as a pathological law, just as  much as the coincidence
of  heart  disease and  rheumatism.'"  Exciting  causes  are—terror, 
CHOREA—ST. VITUS'S DANCE.
935
irritation, violent mental  emotions, such as  anger,  onanism, dys-
menorrhcea of puberty, injuries to the head, worms, etc.  The disease
has also been known  to occur during, or to follow after, attacks of
various acute diseases, such as typhoid fever, pneumonia, etc.   Preg-
nancy is a not unfrequent  cause of chorea, but the disease thus occa-
sioned has been referred to elsewhere.
   The pathology of chorea is very obscure.  As yet there has been no
anatomical lesion determined with sufficient accuracy to be acceptable
as a solution of the  singular phenomena presented  by the disease.
The general results of post-mortem  examinations, so far as ascertain-
ing the cause ofthe disease is concerned, have been decidedly negative.
   Symptoms.—The agitation of the muscles is generally  confined to a
group, usually amongst those ofthe upper part of the body;  sometimes
but one side is affected ; sometimes an arm of one side and a leg of the
other.   Sometimes the jerking and twitching, which commences with
a single group of muscles,  extends until the whole body  becomes vio-
lently agitated.  The patient loses control over the affected arms and
legs;  cannot convey food to the mouth ; walking is more or less diffi-
cult, and sometimes even impracticable.  The child often  falls while
walking, or runs  in an irregular  and  zigzag  direction, as though by
fits and starts.  " The convulsive movements of the face and head are
not less singular than those of the limbs.  The face is distorted into
all kinds of expressions, so that it assumes by turns that of the most
opposite emotions—sadness, terror, joy  or grief.   The  mouth is
opened and shut, or its corners drawn apart, with the greatest  irregu-
larity ;  the tongue  is  occasionally protruded  between  the  teeth, and
sometimes moved rapidly  in the mouth, so as to cause a clacking
sound; the lower jaw is depressed and elevated, or moved in a lateral
direction, and with such violence perhaps as to injure the tongue and
teeth.   In consequence of the  irregular motions of the tongue  and
mouth, articulation becomes difficult, and the child either stutters or
speaks slowly and badly, or can pronounce  only monosyllables. .  . .
While the face and limbs  are contorted, the head is moved rapidly
from  side to side, or backward and forward, or undergoes constant
rotation.  In severe cases  the  choreatic movements affect the  trunk
also, so that the patient cannot lie upon a bed, but rolls and  twists
about the floor with  such  violence as to bruise and excoriate the
skin."—Meigs and Pepper.
  The above account describes a well-developed case  of chorea, but
in  some instances the symptoms  are developed in a milder degree,
while in others they are much worse than those described. 
936           DISEASES OF INFANTS AND CHILDREN.
   Chorea, as ordinarily developed,  will  run along for a  longer 01
shorter period if left to  itself, until it reaches its  height, when the
symptoms will gradually  subside, and  finally disappear.  Under
homoeopathic treatment, however, the disease is  greatly mitigated and
health is restored, while in others, again, the attack  is cut off  short
by the appropriate medicament, and a cure  effected  in a  few  days.
Relapses are quite common.   It is sometimes a fatal  malady, however,
especially when  attacking very delicate  children, or  when there is
serious cardiac or other involvement.  " In fatal cases the symptoms
are constantly  aggravated;  the movements become so violent  as to
make  it necessary to  secure the child in bed or in  a strait-jacket;
the patients, deprived of sleep, become feeble and emaciated ; the res-
piration becomes  difficult;  intelligence is abolished;  the pupils are
contracted, and the child dies."
   Treatment—The  following remedies are  especially useful in the
treatment of chorea, but the practitioner should not confine himself to
the list here given:

   Aeon. After a fright and the child remains unnaturally timid; un-
usual fatigue may have been the  cause;  much  trembling of the ex-
tremities ; it  may have resulted  from exposure to  a  very cold, dry
atmosphere.
   Agaricus m.  Itching spots on the skin like chilblains; a variety of
involuntary movements in the  waking hours; perfect freedom  from
them during sleep.
   Bell. The motions of the  body are generally  backward, sometimes
quite extreme;  boring of the head into the pillow; grinding of the
teeth;  moaning;  injected eyeballs;  flushed face usually  attends the
development of other symptoms.
   Calc. C.  In  leucophlegmatic children; after a  fright  the child falls
down easily ; during second dentition.  '
   Caust.  Child  not exempt  at night; often prevents sleep;  right side
of face and tongue often paralyzed; twisting and jerking of limbs;
constipation.
   Cina. Very peevish and irritable;  picking of nose;  ravenous appe-
tite; urine turns  milky on cooling;  child loses its  playfulness, and
has no pleasure in anything.
   Cicuta. The attacks twist  the child into  the most curious and some-
times frightful  contortions, sometimes causing it  to scream out.
   Cimicifuga.  Besides the twitching and  jerking  there  are nervous
tremors apparent; the motions are constant, but omfined to one  side; 
                  CHOREA—ST.  VITUS's  DANCE.               937

all quiet during sleep;  great difficulty in swallowing; often confined
to left side, particularly  wdien following rheumatic fever.
  Cocc. Right arm and right leg principally affected; all  quiet during
sleep; legs become more and more useless.
  Crocus. Jumping, dancing, laughing, whistling;  very affectionate,
wants to  kiss everybody; nose-bleeding,  of dark stringy blood.
  Cuprum.  The twitchings and jerkings  are often perceived to  com-
mence in the fingers ;  cramps often attend ;  often affect only one side;
the attacks are often painful; attacks one side, and then  spreads over
the whole body.
  Hyos. Seems  very silly and laughs at everything, sometimes immod-
erately ;  head seems to fall from side to side; don't care to be dressed
or covered.
  Ignat.  After fright with grief;  worse after eating;  relieved by lying
on the back; sighing and sobbing are often characteristic.
  Laurocerasus. The child seems violent and destructive in its motions;
the speech becomes indistinct when the child seems angry because not
understood;  it can neither stand, sit nor lie on account  of the inces-
sant  motion ; gasping for breath ; wasting away.
  Lycop.  Red sand in the urine or the urine stains everything red;
very feverish and fretful, particularly on waking from sleep.
   Mygale.  Regarded by many as specific in all cases, acute  or chronic,
in old or young persons.
  Nat. mur.  Paroxysms of jumping up high; jerkings ofthe right side
and of the head;  from a fright or the suppression of eruptions of face.
   Nux V. No appetite; constipated; worse in early morning; despondent.
  Opium. Convulsive movements of one  or the other arm to and fro;
the left arm trembles in  paroxysms ; constipation of round black balls;
the twitchings continue  during  sleep.
  Phosph. During rapid growth tall  and  rather  slender; walks like
one paralytic; very weak.
  Secale.  The muscular  twitchings usually commence in the face and
spread thence all  over the body, sometimes increasing to  dancing and
jumping.
  Sepia.  Ringworm eruptions on the skin;  stammering speech; con-
stant desire to change from place to place.
  Sticta.  The disease seems to develop itself mostly in the feet, causing
one to dance and jump around; even when lying down the feet move
about in  the air.
  Stram.  The motions are rather  violent and crosswise; inclination to 
938           DISEASES OF INFANTS AND  CHILDREN.
 pray and beseech;  stammering speech, or loss of speech, often  puta
 the hands to the genitals.
   Sulphur.  Particularly after suppressed eruptions, or if the skin is
 full of eruptions itching much on warmth;  faint, hungry spells.
   Tarantula. Chorea,  when  the  movements are very  irregular  and
 violent—sometimes cannot speak,  swallow, sit,  stand or walk,  bit
 must lie constantly.  Sometimes only right side is afffected.
   Veratrum viride.  Unusual  twitchings and  contortions of the body,
 unaffected by sleep;  a little  froth constantly at the lips; chewino- of
 the teeth during sleep; difficulty in swallowing.
   Zinc Fidgety condition of  the  feet  whilst lying  in bed; jerks
 through the whore body during sleep,  sometimes with screaming.

                 Infantile  Remittent Fever.
   That form of disease long known as infantile remittent fever might
 more properly be designated  typhoid fever.  It is,  at all events, a fever
 having a typhoid type and tendency, whatever may be its occasioning
 cause, but differing greatly in degree in different cases.  It is a disease
 very  frequently met  with, particularly during the fall  and spring
 months, seldom  attacking children  under  two  years of  age,  and
 proving, in some  instances,  very intractable,  even under the most
 careful management.
   The disease commences with languor  and  debility;  the child com-
 plains of feeling tired, and will leave its play to lie down on  the  sofa
 or floor; there is general malaise and want of childish cheerfulness, loss
 of appetite, more or  less  coating upon the tongue, and in some cases
 there is diarrhoea, while in others constipation exists. After these symp-
 toms  have lasted for a few days or a week or more, febrile symptoms
 are ushered in, frequently commencing with flushes of heat, alternating
 with  coldness and  shivering;  the pulse is  quick  and full, there is
 nausea  and sometimes  vomiting, headache, drowsiness, red eyes or a
 heavy appearance of the eyes;  moaning, starting and crying out dur-
 ing sleep;  muttering delirium ; the urine  voided is dark-colored  and
 scanty, and if there be  diarrhoea the  stools are usually dark-colored
and offensive, sometimes worms being passed with the  stools;  the ab-
domen  is distended, and sometimes tender of  pressure;  the tongue
 usually becomes  red at the tip, and dry.   As the fever runs higher the
 body  becomes very hot, the heat being especially great in the palms
of the hands, and often in the soles of the feet, and the respiration is
short  and quick.  Sometimes  a  slight moisture may be perceived upon
the skin, which, however, lasts but a short time, and there are frequent
remissions  of  the  symptoms, especially the  fever, and  then  a  con- 
INFANTILE  REMITTENT FEVER.
939
tinuance for some time longer, to be followed by other temporary re-
missions or gradual recovery.  These remissions do  not amount to  a
complete apyrexia, but during their continuance the child seems better
and brighter in every wray, although  in some  cases there is more irri-
tability during these  periods, with  picking at the lips, tongue and
ringers, and picking and boring at the nose until it Weeds.   After the
disease has lasted for  ten days or two wTeeks there may be a more de-
cided period of remission, which will continue  into convalescence, or
the fever wall return with its  former force, together with  the other
symptoms, and  the   disease will  run on again.  If convalescence
sets  in, the pulse runs  down gradually from 160 or  120  beats per
minute until it approaches the normal  standard; the skin becomes
softer and moist with perspiration ;  the tongue gradually cleans off';
the urine  loses its high  color and begins to  deposit a sediment, and
there is a general cooling ofthe  body.  The thermometer will be very
useful in  determining the degree of remission, as well as  heralding
the onset of convalescence.  If the disease lasts for any great length
of time, the patient becomes very much emaciated.
   Frequently cases presenting most,  if not all, of the above symptoms
in a much milder degree are met with, in which there is a remission
almost  amounting to complete  apyrexia every day, generally  in the
morning, and the child may be comparatively well and as cheerful and
playful as usual during the morning, until toward noon, when  it will
begin  to  droop  again,  the fever will  come on  and run  very high
until after midnight or toward  morning  again, when another amelior-
ation and remission of symptoms will occur.   This form of fever  is
especially associated in the minds of the people with the presence  of
" worms " in the intestinal canal, and in such instances  the common
opinion  is generally  correct.   Such a  fever—worm fever—may  be
mild or otherwise, even  reaching to the intense degree we  have first
described.
   This disease may  not only  be complicated with the presence  of
worms in the alimentary canal, but with other diseases,  such as aph-
thous sore mouth, violent  and prostrating diarrhoea, inflammation  of
the lungs or bronchia;  and symptoms resembling hydrocephalus may
arise during its course, increase its gravity, and render a fatal termina-
tion not unlikely.
   Its (y.uses are of course both  predisposing and exciting.  Children
of a scrofulous diathesis, and whose organs of digestion give evidence
of being weak, are most liable  to be attacked by the disease.  Living
in a clamp house or  in  a neighborhood exposed to  the  influences of 
 940          DISEASES OF INFANTS  AND  CHILDREN.

 marsh miasmata or of stagnant water  is also a predisposing, and may
 be an exciting, cause.  Worms and other forms of intestinal irritation
 and exposures to cold and wet are the  chief exciting causes.
    Treatment—In  most cases  this  disease, especially when it sets  in
 mildly, may be cut short by judicious medication.   The following
 remedies are most frequently required for  its treatment, from which
 that one should be selected which is homoeopathic to the case:

   Aconite. Hot, dry  skin; thirst; sleeplessness; restlessness and dis-
 tress during the febrile stage.
   Antimonium C. Wnite tongue; frequent vomiting and watery diar-
 rhoea,  or lienteria.
   Apis. Red points  scattered  over  the body here and there; absence
 of thirst.
   Arsenicum Much  restlessness and tossing  after twelve at night;
 putrid, undigested stools; symptoms of nervous exhaustion set in, with
 unquenchable thirst; great heat in the  bowels; aphthse.
   Belladonna.  Much  moaning, starting and jumping; very  flushed
 face;  red eyes; great heat of the head, and  other symptoms of cere-
 bral congestion.
   Bryonia.  Parched  lips; dry mouth;  dry and burnt-looking stools,
 which are passed but seldom; wants  to be kept very still; cries if
 mpved ; the symptoms are worse at night; the child gets giddy and
 sick if raised up; there is a typhoid tendency.
   Calcarea C. Leucophlegmatic constitution; open fontanelles; swell-
 ing at  the pit of the stomach, like a saucer turned  bottom up; profuse
 sweat about the head.
   Chamomilla.  Wants to be carried  all the time;  one  cheek red, the
 other pale; cross and irritable;  stools  smell like rotten eggs, or are
 green and yellow; very sensitive to pain; dyspnoea ; bilious vomiting.
   China. Worse every other day.
   Cina. Picks  its nose; desires  many  things, which it refuses when
 they are offered;  nothing pleases or satisfies  the child; after standing
 a while the urine turns like milk; cerebral symptoms, with dilated
 pupils, shrieking out  during  sleep;  squinting;  alternate paleness and
 redness ofthe face; colic, costiveness and vomiting;  worm symptoms.
   Colocynth.  Spells  of  colic  pain,  in  which the  child curls up
double, and writhes and cries very hard.
   Gelseminum.  The symptoms  are worse at  night;  the face is dark
red or  has a dusky hue;  there  is a great deal of nervous restlessness;
vertigo, the child complains that it is  falling; sensitiveness to light 
DIPHTHERIA.
941
and sound;  defectiveness of sight and  hearing; inability to move the
limbs in obedience to the will.
  Ipecacuanha.  One constant nausea, not relieved by the  vomiting;
loss of appetite ; general gastric derangement.
  Magnesia c.  Constant, sour, rather whitish, watery  diarrhoea.
  Mercurius.  Tenderness  of the pit of the stomach and  abdomen;
green, slimy stools,  with tenesmus;  is not much relieved by perspira-
tion ;  yellowish tinge of the countenance; the urine is dark and of-
fensive ; sore mouth.
  Muriatic acid. The fever assumes a low type ;  the patient  is very
much prostrated, and sinks down in the bed ; there  are evidences of
intestinal ulceration.
  Nux V.  Always  worse toward morning, and in the  morning;  no
appetite at any time; the  child is very cross and  irritable;  flatulence
and pain in  the abdomen ; better in the morning; constipation, large,
difficult stools.                                  *
  Pulsatilla.  Vomiting of  mucus; stools variable  in color;  worse
toward  evening ; no thirst; the child refuses the  breast.
  Phosphorus. When there  is  much cough and rather a typhoid type
seems to threaten ; diarrhoea; distension of the abdomen.
  Rhus t. The  tongue appears dry and brown,  and the child seems
very weak,  and very restless through the  night;  trembling of the
hands ;  pains in the back and limbs.
  Sulphur. The fever seems to exacerbate  in alternate flushes  and
paleness; the child  has weak spells;  the skin is scaly; intertrigo is
easily provoked.
  Tartar e.  Much  nausea and vomiting, day and night, with drowsi-
ness ; red, itching rash over the body, developed by the fever;  diar-
rhoea.
                           Diphtheria.
  Diphtheria  is an  epidemic  specific  disease, and is to some extent
infectious.   It runs a very rapid course; is characterized by remark-
able prostration, the formation of a false membrane  on the tonsils,
uvula, palate, the nares and  other parts of the body, and in  some
cases with remarkable nervous symptoms.  In  some  epidemics of this
disorder there is an equally characteristic external  eruption, " which
appears in the form of a rash and is sometimes of a  dark or purplish
color, bearing a close  resemblance to  that of  measles;  at  others,
bright and scarlet, as in scarlet fever."*   There  may be considerable
swelling in the external throat and sides of the neck; such cases are
                       * Ludlam on Diphtheria. 
942          DISEASES OF INFANTS  AND CHILDREN.

usually severe, if not malignant.  Diphtheria is a disorder which may
be very mild or  exceedingly malignant, and almost  universally fatal.
To what extent this disease is infectious and  contagious does not vet
appear to be. a settled question.  It occurs at  all seasons of the year.
but is particularly prevalent  during the fall and winter months, the
minimum of cases occurring in Philadelphia in June.
   Bretonneau, who wTas  one  of the earliest writers on diphtheria, re-
garded the disease as a local  affection, and the constitutional disturb-
ance manifested  during its course  as  secondary.  It is, however, now
generally admitted that  diphtheria is a "blood disease,"  with very
decided systemic disturbance, which  is very generally of a decidedly
asthenic  character.  Bouchut, in his treatise on diseases  of  infants,
divides diphtheria into two varieties,  one of which he regards as false
and  non-infectious, or  a  mere pseudo-membranous  sore throat, while
the other he regards as true diphtheria, which is a constitutional dis-
order,  involving the entire system, having infectious powers.
   The pseudo-membrane of diphtheria, which is one of its most con-
stant and remarkable phenomena, is a fibro-plastic membrane, which
commences as a  sero-mucous, transparent and viscid exudation, wdiich
gradually acquires color and consistence until it becomes a somewhat
dense  and  strongly adherent  membrane, wdiich is,  however, very
friable.  The color is variable, according to the seat ofthe deposit and
the length of time which  has elapsed since its formation ; it is, however,
generally of a white,  grayish-white  or  yellowish  hue.  "In severe
cases there is usually a bloody sanious fluid effused wdiich  imbues the
pseudo-membrane, discolors it and promotes its decomposition, so that
it forms  dark-colored shreddy patches, exhaling a  fcetid gangrenous
odor.  Sometimes the mucous membrane of the throat is seen to be
reddened and swollen  before an exudation takes place, and when the
membrane is detached it  has the appearance of being raw and somewhat
bloody.   In most cases the mucous membrane itself is not ulcerated,
but  only inflamed and swollen.  There are cases, however, in which
very extensive ulceration and sloughing of the throat-tissues occur.
   All cases of diphtheria may be divided into  those which are mild
and those which are malignant.  Fortunately the mild cases are most
numerous, and  yield  readily  to  appropriate treatment.   They  are
characterized by slight membranous  deposit and a mild form of con-
stitutional  disturbance,  with more or less  difficulty  of deglutition,
pain in the throat, pains  in the  limbs, etc.  It generally comes on
insidiously; the fever sets in, but the appetite remains good and the
strength is not impaired.  Sometimes,  in these mild cases,  there  ia 
DIPHTHERIA.                       943
very little  or no  complaint of difficult deglutition  or pain in the
throat, and this the physician should bear in mind, otherwise  mild
cases of diphtheria may be allowed to assume malignant proportions
or to run into diphtheritic croup, with perhaps a fatal termination.
These  cases are generally very amenable  to  treatment, and the  only
danger  arises from  the  possibility of the exudation extending intc
the larynx in consequence of the true nature of the disease not having
been detected in time to prevent  it.  Beware of taking cold.
  The more  malignant form of diphtheria is ushered in with severe
rigors  and high fever, vomiting, and sometimes  purging, great  rest-
lessness, anxious expression of countenance  and great prostration.
Soreness of the throat, with difficulty  of swallowing, is complained
of, and upon examination the diphtheritic condition is detected.  The
fever subsides, leaving the surface of the  body pale and of an un-
natural coolness, the  pulse  remaining quick, but  weak  and  com-
pressible; and there is a general appearance of a profound depression
of the vital forces.   The child's  mental condition is usually not much
disturbed, although  it  may be dull and indisposed  to  play; during
sleep there may be muttering delirium.  There are few symptoms in-
dicative of gastric disturbance excepting loss of appetite.  The urine
is generally scanty, and often albuminous.  The submaxillary glands
usually become enlarged, sometimes to a very great extent, but do not
often suppurate;  salivation is  generally  present, the saliva being
somewhat offensive; or there may be a discharge from the  nostrils,
which  is sometimes acrid and makes the slun wdiich  it touches  sore,
and it  is sometimes offensive.  The voice may be husky and nasal, or
even hoarse, although  the  larynx  may not be  involved;  cough may
be present, and, as before remarked, an eruption resembling that of
scarlet fever  may make its  appearance upon the skin.   It has  been
thought that in this  latter  case  the poisons of diphtheria and scarlet
fever were acting conjointly upon the system.
  " The further course of these cases varies widely.   If the  result is
to be unfavorable, the depression  and loss of strength increase rapidly;
the surface grows  pale or  sallow, and  is below the natural  temper-
ature; the pulse becomes exceedingly frequent and feeble; the fauces
assume a gangrenous  appearance, from decomposition of the  false
membranes ; the swelling  of the  cervical glands increases,  and the
patient often refuses to make the effort to swallow, though deglutition
is still  generally possible.   There is  a constant fetid discharge from
the mouth and  nostrils; the breath is  horribly offensive, and death
ensues amid the most profound prostration.  Or at  a  much earlier 
 944          DISEASES OF INFANTS  AND CHILDREN.

 period  of the disease the fatal event  may be precipitated by the
 extension of the exudation to the  larynx.   If, on the other hand,
 the  case  tends  toward  recovery, the false membrane  becomes de-
 tached  and thrown off, the strength  improves, the  pulse  becomes
 fuller and stronger, and the appetite returns."
   A very quick and  feeble, or, as is  sometimes found,  a very slow,
 pulse, persistence of the vomiting,  drowsiness and delirium,  bleeding
 from the nose and suppressien of the urine may be regarded as symp-
 toms indicative of danger, whether they supervene upon mild attacks
 or occur in those of a  more severe character.
   This disease presents itself occasionally in a more malignant form
 than has yet been described, in which  the  symptoms are of the most
 asthenic type.  Occasionally epidemics of this character have appeared,
 in which a very large proportion  of all those attacked died.   In  these
 cases, " the anginose affection, though it may be severe, rarely attracts
 much attention.  The pseudo membranes  in the fauces  are  soft ana
 pulpy, and  wdien  examined microscopically highly corpuscular and
 granular; they soon decompose and become discolored by the blood
 which  exudes from  the  mucous  membrane.  There is, moreover, a
 strong disposition for  the exudation to extend to the posterior nares,
 or to appear on  various portions of the external cutaneous surface.
 The breath and the discharge from the mouth and nostrils are indes-
 cribably fetid.  In some cases true ulceration, and even gangrene, of
 the fauces occurs.  There is, however, less pain complained of, and
 less indisposition to swallow, than in many lighter cases, owing prob-
 ably to  the depression  of the nervous centres from the poisoned state
 ofthe blood.  There may be high fever during the first few days, but
 this  soon  disappears, and is replaced  by a deadly pallor of  surface; ,
extremely feeble, running pulse, and at times low muttering delirium.
 Passive haemorrhages from the mouth, nostrils, rectum or other mucous
 passages are of frequent occurrence.  The result of these cases of pro-
 found diphtheritic infection is  almost invariably fatal, death result-
 ing quietly  from pure exhaustion, without the development of any
complications."—Meigs and Pepper.
  The prognosis  of diphtheria is generally favorable in its milder
 forms;  though no case, however mild, is entirely free from danger,
 iuasmuch  as a fatal termination  may be reached either  by the  false
membrane extending into the larynx  and bronchial tubes, by diph-
theritic  croup, by heart-clot, or  by the supervention of some sequela
which may have a fatal termination.  But even in the more malignant
p^es, and even in these we have last described, a favorable result may 
DIPHTHERIA.
945
be attained by careful  and judicious medication, especially under
homoeopathic  treatment.  Usually, under the most favorable  circum-
stances, the disease will last five or six days or a week, or it may con-
tinue for ten days or two weeks, or be prolonged for a much greater
period,  through its sequela?.
  The complications and sequelae of diphtheria are not very numerous,
but are all of a very serious character.  We have  already referred to
albuminuria as a possible complication.  Heart-clot may be the means
of taking the life of a diphtheritic patient otherwise favorably situated.
Endocarditis may complicate  diphtheria, and continue as a serious
malady long after all other symptoms have disappeared.
  Paralysis is one of the most common and most important of the
sequelae of diphtheria.   It does not usually show  itself until all the
anginose and other  symptoms have disappeared, and is progressive,
affecting first the muscles  of the parts  that were  involved by the
disease, and thence  spreading  to the face and finally to the extremities
unless arrested.  There is frequently impairment  of vision, deafness.
" The paralysis is rarely confined to loss of motion, but, in a  majority
of cases, sensation is either much  modified or lost; and indeed in some
instances there  has  been no loss of motion, the sentient nerves alone
being affected.  In other cases the sensibility has been found exalted,
or there has  been  in the same case hyperesthesia in the  upper, with
anaesthesia in the lower extremities."   In some  cases this post-diph-
therial  paralysis takes the form of progressive locomotor ataxia, in
which,  while  there is little or no loss of muscular power, there is a
partial  or  complete  inability to co-ordinate muscular  movements,
especially  when the patient is in the dark.
   Paralysis after diphtheria is very rarely fatal.   It generally yields,
though oftentimes slowly, to  appropriate treatment.
   Treatment.—Local  applications are always  inadmissible.   Avoid
 fatiguing  the  patient by too  much treatment; do not force food  upon
 the  child, but try  to  please  its appetite; allow as  much ice or iced
 water as  may be desired.   Select the remedy with the greatest  accu-
 racy, and good results may be looked  for in most cases, and often will
 be met with in even the worst forms of the disease.

   Apis mel. Great debility characterizes the case even from the onset;
 absence of thirst; scantiness of urine; the membrane has  a dirty-gray
 color; the pulse is very quick—at least 140; puffiness about the eyes;
 an eruption appears upon the skin, which itches and stings.
   Arsenicum. The  membrane is  dry-looking and wrinkled, and may
        60 
946           DISEASES  OF INFANTS AND  CHILDREN.
cover the entire fauces; very foetid breath ; great dysphagia; very great
prostration; the child frequently wants water, but in small quantities
at a time; great restlessness, particularly after midnight; warm drinks
are sometimes desired instead  of cold drinks.
  Belladonna.  The throat has a highly inflamed  appearance, is very
red and shining; drowsiness; the  eyes are  very  much injected ; the
face is flushed, there is  throbbing of the carotids; the pulse is very
rapid; the child complains  of chilliness occasionally; great difficulty
in swallowing, with pain running up into the ear.
  Bromine.  When the  disease commences in  the larynx and comes
up into the fauces, and  in some cases in which it  runs down  into the
larynx and produces a croupy cough, with  much rattling of mucus.
In either case  there is  rattling of mucus in the larynx on coughing,
and the cough  has a croupy sound.
  Capsicum. When—if a description can be given—the throat smarts as
if from Cayenne pepper; the  diphtheritic deposit  covers  a considera-
ble portion of the fauces.  There  is a sensation of constriction on
swallowing.
  Cantharis. There is marked  disturbance of the urinary organs; fre-
quent desire to urinate, with burning and cutting pain; the membrane
appears in  patches upon the posterior wall of the throat, with  burning
in the throat.
  Kali bi.  The disease  extends into the throat (and  bronchia), pro-
ducing a croupy cough, in  paroxysms, Avith  expectoration of viscid,
tough mucus,  which may be drawn  out into long strings; tough and
stringy discharge from the nostrils; pain in the left ear; swelling ofthe
parotid and submaxillary glands; eruption upon the skin which looks
like that of measles; the tongue is red, raw and shining.
   Lachesis. When the  disease first  makes its appearance in the left
side of the throat, and there  remains, or extends from thence to the
right side.   The throat is very sensitive to touch or pressure.
   Lachnanthes. If the child has a very stiff and painful neck, drawn to
one side, with  diphtheria.
   Lycopodium. When it appears first on the right side, and from thence
inclines  to spread  to the left, or it  begins  in the nose  and extends
down into  the throat.
   Mercurius sol. Profuse salivation; profuse  perspiration;  offensive
breath;  swelling of the submaxillary glands.
   Mercurius prot. Great difficulty in swallowing, with  great pain in
the  throat; the salivary glands are very much swollen  and  painful; 
SPASMS—CONVULSIONS.
947
 very offensive  smell from the mouth, and foetid discharge from the
 fauces and nares; swelling of the cervical glands.
   Sulphur. The whole back part of the throat, posterior to the palatine
 arch, appears to be in a condition of ulceration and sloughing; very
 quick pulse; flashes of heat; frequent sinking spells.
   Phosphorus, Phytolacca  dec,  Croton tigl., Cubebs, Mu-
 riatic acid, Carbolic acid, Permanganate of  Potash, Bap-
 tisia tinct. and Ammonium carb. have likewise been recommended
 in the treatment of this disease, and may prove useful when indicated
 by the symptoms.*

                      Spasms—Convulsions.
   Even  in very young infants spasms, or general convulsions, are of
 frequent occurrence.  They are present at the commencement of many
 diseases-of children, and they attend the fatal termination of nearly
 all.   Convulsions may be occasioned by morbid conditions of the ner-
 vous system—idiopathic convulsions—or they may be merely  sympa-
 thetic, symptomatic  of disorders in other organs, especially in those
 of  the alimentary  canal.  Among the  former  may be  enumerated
 those which arise from primary disease  of the brain, or other large
 nervous  centres,  and those which result from general exhaustion of
 the vital forces,  as in cases of difficult dentition and in the advanced
 stages of whooping-cough.  Among the latter class, or sympathetic con-
 vulsions,  may be enumerated  those cases which arise from the irrita-
 tion of intestinal  worms, from  the presence of unwholesome  food,
 such  as curdled milk, and from  the  influences  which are about to
 develop eruptive disorders, or typhoid fevers.  The convulsions, or
 rather local spasms of the glottis,  which constitute laryngismus strid-
 ulus,  seem to result either from direct  pressure  upon the trunk  of
 some nerve or from irritation of its peripheral extremities.
  Convulsions or spasms  may be tonic, where the muscles are  perma-
 nently,  involuntarily  contracted,  or  clonic.,  when  the  contraction
 more or less rapidly alternates  with the  relaxation.   Tonic  spasms
 are called tetanus; and  if confined to  the  muscles which raise the
 lower jaw, they  are  called trismus.  Spasms of separate muscles are
 called subsultus tendinum; these  are clonic, and may be seen in severe
 nervous fevers.   Clonic spasms are more frequently observed and less
dangerous than  the  tonic.   Convulsions which  appear immediately
after  nursing, and  especially if there is vomiting of curdled milk,
 may be attributed to the unsuitable  character of the  milk.   Such
cases  occur in the children even of mothers perfectly healthy, if they
             * For additional remedies, see AprENDix, Note 1. 
948           diseases of infants and children.
give suck while in a state of high physical excitement or moial dis-
tress.  In cases which come on suddenly and without apparent cause,
especially if the convulsions are associated with  fever, stupefaction,
and vomiting, there may be reason to apprehend the accession of some
eruptive disorder, such as scarlatina,  variola, etc.; and this opinion
will  be strengthened by the prevalence of one or the  other of these
epidemics at the time.   Many cases of encephalic disease commence
with vomiting and convulsions; in such instances, upon minute inquiry
it will always be found that some indications of cerebral disorder have
been present for several days, and there is usually severe pain in the
head immediately before the attack.
  In general, clonic convulsions may  be  considered dangerous when
the paroxysms become more and more prolonged, when they return
after shorter intervals, and when, from the gradual development of
opisthotonos or of emprosthotonos, the irritation is seen to extend itself
along the entire course of the spinal cord.  In most cases it will not
be difficult to find  out the exciting cause of the spasms, which may
be suppression of some cutaneous eruption or its too  tardy appear-
anoe in the  first instance, direct injury of the head or some portion
of the nervous substance, fright of  the child, or even of the nurse, a
feverish  condition of the mother's  milk, the  influence of some epi-
demic miasm, the onset of some form of cerebral disease, etc., etc.
  Treatment.—Remove as far as possible the exciting cause, whether
it exists in the nurse or in the child  itself; do not place the child in
a warm bath; avoid every excitement, and keep the child perfectly
quiet  and  free from every disturbing  influence of noise, light, etc.,
and very carefully administer the remedy which appears to be indi-
cated by the nature of the case and  by the attendant conditions.

  Aconite.  The febrile excitement is very great; hot,  dry skin, anx-
iety and  anguish.
  Arnica. Where the spasms arise  in  consequence of a fall or other
injury.   (See Hepar if Arnica fails.)
  JUthusa  cyn. Spasms, with stupor,  delirium; turning of the eyes
downward.
  Agaricus mus. Spasms, with tremor of the body.
  Arsenicum. The child lies as if dead; pale but warm; is breathless
for some time; finally it twists its mouth  first to one side, then to the
other; a violent jerk appears to pass through the whole  body, and
its respiration and  consciousness gradually return.   These  spasms 
SPASMS—CONVULSIONS.
949
return at longer or shorter  intervals, unless  relieved by this remedy,
until death closes the scene.
  Belladonna. Starting  from sleep with a wild look, dilated pupils,
heat of the head and hands, red eyes and flushed face;  soporous after
the spasm.
  Bryonia. When the spasms recur  from the repercussion of measles.
  Camphor. When the  spasms result from suppressed  catarrh,  either
of the head or chest.
  Causticum.  Convulsive motions of the upper part of the body, with
feverish heat and coldness ofthe hands and feet.   Convulsive motions
ofthe extremities in the evening when the child is sleeping, with dis-
turbed eyes and icy coldness of the  body.
  Chamomilla. One cheek red, the other pale ; very cross and fretful;
jerking and  twitching in  its sleep; or the nurse may have had a fit
of anger which causes  the convulsions in the child.
  Cicuta vi. Violent shocks through the  head, arms and legs,  which
cause them to jerk suddenly.  Spasmodic rigidity of the body,  either
opisthotonos  or emprosthotonos. The child seems well and in great
spirits, when  suddenly  it becomes rigid ; then relaxation sets in, with
much prostration.
  Cina.  The child exhibits  vermiculous symptoms; discharges worms;
picks its  nose  or  anus; has a hacking cough,  continually making
attempts at deglutition, as if to swallow something down; is very
difficult to be pleased with  anything.
  Coffea. The attack has been brought on by excessive  laughing and
playing.  The  child is very excitable and weakly, and in consequenec
frequently suffers with- spasms.
  Cuprum met.  The  spasm is often preceded by  violent vomiting of
phlegm.  After the convulsion the child screams and turns and  twists
in all directions till  another spasm  occurs;  the spasms commence in
the extremities.
  Cuprum aceticum. When  the spaSms result from retrocession of the
eruption in scarlet fever.
  Helleborus. The urine is very dark and has a  sediment like  coffee
grounds;  intense and intolerable pain in the head.
  Hydrocyanic acid. When  the muscles of the back, face and jaws are
principally affected, and the body assumes a bluish tint.
  Hyoscyamus.  Every muscle in the body is  convulsed—the eyes, the
eyel'ds,  the muscles  of the face, and all—and there is frothing  at the
mouth.
  Ignatia.  The spasms return at the same hour every day.  Screaming 
950          DISEASES OF INFANTS AND  CHILDREN.

and violent trembling all over.   Single parts seem to  be convulsed—
the muscles or single limbs.
  Ipecacuanha. Much nausea and vomiting, either before, during or
after the spasm;  the child is spasmodically drawn in some direction.
  Creosote.  When the convulsion occurs from the  swelling of a gum
over a tooth which is not quite through.
  Lachesis.  Spasms come during sleep.  Trembling of protruded tongue.
  Laurocerasus. There is  much gasping for breath, either before, dur-
ing or after the spasm, and there may also be a bluish tint of the skin.
  Mercurius sol.  Much salivation;  swelling  of the gums; hard, dis-
tended abdomen.   May generally be relied upon when spasms occur
from suppressed salivation.
  Nux v. The spasm appears to  result from indigestion; there is con-
stipation,  or the  nurse  lives high, making  use  of coffee, wines  and
rich food.   The spasms are reproduced whenever  the feet are touched.
  Opium. If the  spasms occur  from fright, or if in new-born babes
there is screaming before or during the spasm.
  Secale C  Twitching of single muscles; twisting of the head to  and
fro; contortion of the hands and feet; labored and anxious respiration.
  Silicia. Spasms which  return at the change of the moon.
  Stannum.  In some form of vermicular affections (see also Spigelia),
when  neither  Cina nor Silicia seem indicated.  There  is more excita-
bility,  more disturbance of the brain and more fear.
  Stramonium. Suppression of an eruption is the cause,  or the eruption
does not come out sufficiently.   The child seems afraid, and shrinks
back from objects on first seeing them.
  Tart. e.  Spasms caused  by repelled eruptions, with paleness of the
skin and much difficulty of breathing.
  Veratrum a. When a cold sweat appears  on the forehead after or
during the spasm.
  Zinc.  The child cries out during sleep, and if awakened expresses
fear, and rolls its head anxiously from side to side.   The  child has
been cross  and irritable for days previous, with hurried motions, dis-
tended abdomen and more frequent passages of urine than usual.
  Amyl. nit. Unconsciousness and inability to swallow.
  Apis. Boring head into pillow; piercing shrieks.
  Lycopod.  Spasms from incarcerated flatus.
  Platina.  In anaemic  children;  tonic spasms without loss of con-
sciousness.
  Also, Indigo;  Veratrum  vir., etc. 
APPENDIX.
   Note 1, page 214: Suspended Animation of Newly-born Chldren.
   One of the best  methods of promoting the return of animation is
as follows: Seize an ankle of the child with the left hand in such a
manner as to  turn the palmar surface of the  foot upward, and  with
the right hand slap it powerfully and rapidly for a few times;  then
take the other foot and operate upon that in the like manner; proceed
in the same way on each hand, and then return to the feet.  So alter-
nate with hands and feet for some  time.  The  sympathy of the entire
nervous  system with these palmar surfaces is well  known.  I  have
succeeded in this manner when  the chances seemed almost hopeless,
and  it is now  my  favorite  operation in  such cases.

   Note 2, page 570 : Hysteria.
   Gelseminum. Hysteria from grief, from fright or from mental shocks.
When there is blindness or great dimness of vision.
   Graphites. Great  indifference  toward everybody  and everything.
Great sense of fatigue.   Obstinate constipation, stools very large  in
size.  Frequent attacks of violent hemicrania.

   Note 3, pages 788 and 799: Diarrhoea and Cholera Infantum.
  Elaterium.  Dull olive-green  stools.  Discharges of dark masses of
bilious mucu-;.   Constant nausea and disposition  to vomit.
   Gumm. gutt.  (Gamboge).  Stools  thin yellow  or  greenish  watery,
mixed with mucus or blood.   Strong urging, causing  stool to  pass
quickly and all at  once.
  Leptandria.  Very profuse, black, fetid  stool that runs in a stream.
Verv profuse black stool, the consistence of cream.

               Treatment of Ovarian Tumors.
  Much of practical worth has been brought to  light within the past
twenty years  in the treatment of ovarian  tumors.   A  great variety
of remedies has been applied to  an equal variety of these complaints,
and  with the result of cure  in all cases reported.   Apis, Ars., Bell..
                                                      951 
952
APPENDIX.
 Bryonia, Calc. c, Carb. an., Colocynthis, Creosote, Graph., Kali bro.
 Kali  carb., Lachesis,  Lilium, Nat.  sulph., Platina, Podoph.  pelt.,
 Rhododendron  and Rhus  tox. have  all been  successfully used.
   Arsenicum. The patient feels worse after twelve at night;  is easily
 fatigued ;  ascending fatigues.   Scanty urine.  Drinks water frequent-
 ly and little  at a time; a reasonable  amount of cold water disagrees
 with her.   May be sense of burning in tumor.
   Bry. Feels best when keeping very still.  A  deep inspiration causes
 pain.   Unreasonably anxious  about her condition.   Toward evening
 there is more swelling and the  tumor seems larger than in the mornino-.
   Calc. c.  Leucophlegmatic temperament.   Menses too frequent and
 too profuse.  Sensation as of a ball in the ovarian region, causing her
 constant pain.  Sleeps with the arms stretched  over the head, which
 position is quite unnatural to  her.  Feet feel as if cold, damp stock-
 ings were  on them.   Fatigue and  loss of  breath and vertigo on run-
 ning up stairs.
   Colocynth. When the paroxysms of pain are so  severe  as  to cause
 her to bend double.  Can't walk erect or properly assume the upright
 position without pain.
   Graph. Has been used successfully when prescribed  quite empiri-
 cally, simply because it has cured enlarged testicles.  This  is not a
 sufficient reason; it will cure when its pathogenesis  corresponds with
 the symptoms of the patient.   It may  be thought of when there are
 delaying menses, accompanied with terrible headache  and constipation.
   Kali carb. The case is characterized  by much  flatulency, the passage
 of which affords great relief.   Stitching and shooting pains  in abdo-
 men.
   Lach. When these tumors are developed at the critical age  or when
 they appear soon after this period  of life. Sufferings are always worse
 on awakening from sleep.  Chills at night and flushes of heat by day.
 Feels very forlorn and dispirited on awakening in the morning.   Se-
 vere constipation.
  Lilium tig. Sensation as  if the abdominal contents were dragging her
down even from the chest and shoulders.   Feels the need of a sup-
port to hold up the abdomen.  Abdomen  exceedingly tender to the
touch.
  Platina.  Horrifying thoughts.  Painful  pressing  as if the menses
would  appear, ceasing in the evening,  but  returning  in the morning;
this  troubles  her much.   Sometimes  causing   inclination to  stool.
Stools  are  inclined to stick in and about the anus like clay, and on
this account are discharged with  difficulty. 
APPENDIX.
953
   Rhus tox. The  case can  be traced  to  a strain.   Restless at nigdit.
 Change of position affords relief for a time.
   In the management of these cases  we should  allow one dose and
 one remedy to act just as long as possible before repeating or making
 a change.

   Note 4, page 947 : Diphtheria.
   Ignatia. Much swelling of  the glands  in  the neck.   Soreness and
 pain in  the throat worse between the acts of deglutition.   Frequently
 complains that the throat hurts.  In sleep at night there  is  much de-
 lirious  manifestation and calling for help.  Breath  quite fetid.   Dif-
 ficulty in swallowing either solid or liquid food.   Stitches from throat
 to the ear.
   Lac. cann.  In malignant cases particularly, with great prostration
 and entire  loss of appetite.
   Phytolacca. Particularly when a sensation as if a hot  substance were
 in the throat continually ; as though a red-hot ball of iron were lodged
 there.   Cannot take hot fluids.  Much frontal headache.   Great pros-
 tration.   Pains all over and feels very weak.
   We are perfectly satisfied  that  no  sequelae of any kind will follow
 cures of this disease when the highest potencies are  used.

              Diet during Sickness of any Kind.
   So many distressing cases of malpractice in the  way  of diet have
 come to my notice that I cannot refrain from making mention of the
 subject in this  edition of my Obstetrics.   I consider  the proper course
 of diet to be fully  as important as medicine itself.
   In sickness kind Nature usually restrains the desire for food; in fact,
 sometimes renders the simplest article of nourishment  absolutely dis-
 gusting, that the organism may be protected from such injurious in-
 fluences.  Under circumstances like these the stomach is  utterly incapa-
 ble of digesting, and the  assimilative function is equally impaired.  It
 is very apparent, then, that nourishment should not  be  urged in these
 cases, as it would certainly oppress the stomach like a  foreign substance,
 fermenting and causing incalculable mischief.  Persons tolerably well
 refuse food sometimes for this very reason;  they need  a  proper  rem-
 edy, not food.   The patients are the  proper judges  in  these matters,
 and  it is my invariable custom  to consult and adopt their wishes as
 far as possible.   If nothing but pure cold water is desired,  it is allowed
ad libitum., and all other nourishment forbidden—no wine, brandy or
spirituous  liquors of any kind wdiatever.   Next to water, milk  is the 
954
APPENDIX.
least objectionable article of diet in all forms of illness, and especiailj
in febrile diseases.  Meat and meat food in any form are the most ob-
jectionable, particularly in fevers of all kinds.  Fruit, vegetables and
farinaceous foods may almost universally be allowed.  In affections of
the brain, and  also in diseases where there is delirium or loss of con-
sciousness, cold water is always the safest  and most appropriate nour-
ishment, and should be frequently and plentifully given, as it absolutely
favors recovery.  If patients want and enjoy food, and if it seems to do
them no harm, moderate quantities of the proper kind may be allowed,
but never urge or force one morsel.   I am perfectly satisfied that great
and irreparable injury is often done by pressing food upon unwilling
stomachs.   I have many times  been called in consultation where pa-
tients, though in an unconscious state, were  being literally crammed
with all sorts of fanciful nourishments—were really being killed by
malpractice  in diet  For convalescing patients desiring  animal food
beef and mutton  are decidedly preferable  to  all other kinds.   Prepa-
rations of broth,  tea, soup  or essences may be made, or the  meat may
be broiled, and partaken  of judiciously.   Oysters,  clams,  fish and
eggs should be used with care, and universally prohibited to lying-in
women.

                    Diet  during Pregnancy.
   I know from ample  observation and experience that diet is a mat-
ter of much importance during pregnancy.   There is  a small work,
entitled Parturition without Pain, that gives some very valuable hints
upon this subject; and, though I do not  agree with all  the theories
which are therein advanced in regard to the effect such diet has upon
the osseous  structure of the offspring, yet I believe proper diet has a
very beneficial  effect upon the  mother, and  also upon the child in
general  healthfulness.  Pregnant females who subsist mainly  upon
fruits and vegetables, lemonade, water and milk—no wines, tea, coffee
or highly-seasoned food—certainly get on very much better than those
who eat indiscriminately,  paying  no regard to diet.   Fruits should
be taken  abundantly  every morning,  particularly, and  lemonade as
a general drink.   This plan of diet also  ensures  a much easier labor
than  when  subsisting upon the ordinary  diet.   In  lying-in  women
oysters  or  clams are very apt to produce a fearful cholera-morbus,
with much pain ;  fish  is nearly as  bad.   Eggs produce an  obstinate
diarrhoea.   Very many observers  make  the  same report as to the
deleterious  effect of the above prohibited  articles of diet on lying-in
won.en.  They seem to be really poisonous during this state. 
APPENDIX.
95,5
                    Sterility—Barren ntess.
  This  state is one of dread  in all its different aspects and significa-
tions.  A waste,  barren piece of land, an  unfruitful vine  or  tree,
literary productions barren of  ideas or sentiment, inability to  produce
young in animals or to  bear children  in human females,—all seem to
produce at first thought a worthless idea of the non-producer.
  It  is  of the  human female particularly we  wish to speak in this
connection.  Her sterility may be due to very many different circum-
stances.    Among perhaps the most frequent causes are  uterine dis-
placements and  flexions.   Of some forms of displacement,  though,
we need  not remark, because,  as they do not cause impingement upon
the uterine neck so as to interrupt the minute capillary tubes running
to the ovaries, many a woman can readily conceive and bear children,
though  troubled  in this manner.   Membranous dysmenorrhcea, leu-
corrhcea, ulcers, contraction of the os,  engorgements or elongation of
the cervex,  hypertrophy, induration, polypus, fibroids, vitiated secre-
tions  of the vagina, do not, per se, cause sterility.   In all these cases
the cause is dynamic, and the remedy  wdiich cures the patient, so that
the effect ceases, will  place the  sufferer in  a condition  to conceive.
Rheumatism, neuralgia, strangury,  nervous or sick  headache, may,
upon  the same principle, be  said to  cause sterility.  Not so;  there
are disorders in the vital forces causing all the above appearances of
disease.   During a woman's menstrual life she ought to be  well enough
to conceive and bear children, and the more healthy she is, the better
will  be her offspring if her husband is healthy.   Therefore, the first
duty a wife  owres  to herself, her husband and the community she lives
in, is  to seek to be as thoroughly well as possible by employing the
advice of a pure-minded  homoeopathic physician.   If the husband is
not in perfect health, he too should seek the advice of  the best homoe-
opathic  physician he can find,  lest he be the cause of his wife's morti-
fication  in not  bearing  him a child.  It often occurs that this is a
fact when the  young wife bears the  odium of barrenness.
  Sterility or  barrenness is not a disease; it is but the effect or resub1
of morbific  disturbances which are to be especially treated that con-
ception  may occur.  The following remedies have been known to cure
diseases causing barrenness, and pregnancy to follow:  1. Bell., Borax,
Calc.  c, Cann. s., Lilium t., Merc, Nat. carb., Phos., Puis.   2. Am-
mon.  c, Caust,, Con., Gossypium, Graph., Lycop., Nat, m., Plat., Sep.,
Sulph.,  Sulph.  ac.   3.  Agn.  c,  Cie, Croc,  Dule, Ferrum, Hyos.,
Podoph. pelt.,  Ruta,  Zinc.  Nat. carb., particularly  indicated when
the cervix is hard  and the os out of shape, other  symptoms agree- 
956
APPENDIX.
ing, has been known to cure this condition and conception to follow.
Conium, Plat, and Sepia when there was hardness and other symptoms
agreeing.   The profession is now awake to this important subject, and
more numerous observations will forthwith be noted.  The above list
of remedies is far too small to cover all cases;  the whole materia med-
ica  may  need  to be consulted; and  when the remedy is selected it
must  be  allowed to act  a long while.


                     Diseases of the  Nails.
  Women  and children are particularly liable to diseases ofthe finger-
and toe-nails, which may appear in a great variety of forms.  The
disorder may be  confined to a single finger- or toe-nail, or  it may at-
tack several, one after another, or  nearly all  at the same  time  may
show evidence of a  morbific influence.  They become discolored,  turn
blue, yellow or spotted; may become brittle, crumbling off, deformed,
split, thickened, falling (coming) off, growing ofthe nails into the flesh;
may become painful in  general, jerking  pains in, sensitive, as if a
splinter were under the nail, ulcerated and painful  as if ulcerated;  or
they may become rough with hang-nails.  It is more than likely that
all these  various  forms of disease are as  much of parasitic origin as
are the various forms of diseases of the hair.   Be this as it may, one
thing is certain: if health reigns supreme,  no troubles of this kind can
ever appear.  It is absolutely  necessary that some constitutional dis-
turbance should  exist  that  any of the above  forms  of disease  may
arise.   When they do  appear, each  and all  of them are but the  out-
croppings of some dyscrasia, and are  but symptoms of said constitu-
tional disturbance.  Diseases in the head, chest or abdomen may be
cured by a medicine whose  deciding symptom might  be found in or
about the  nails  of the fingers  or toes.
  Diseases of  finger-nails and  toe-nails often demand treatment ap-
parently on their own account, and few  or no symptoms  appearing
except in these localities.  Even then no  local treatment of  any sort
becomes necessary.  So far  as  external circumstances  are concerned,
place the diseased member or members in a  favorable position, apply the
art of healing according to Hahnemann's Organon, and the work will
be done, and well done.   This  has  been the experience of the author
in hundreds of cases, many of them of the most aggravated and pain-
ful  form.   I hereby subjoin a  list  of remedies for the treatment  of
these complaints, most  of which I take from Bosnninghausen's Thera-
peutics, and have been thoroughly tested by myself and others: 
                           APPENDIX.                        957

  Nails getting blue.—Aur., Chel., Cocc, Dig., Nat, mur., Nux vom.,
     Sil.
  ------brittle.—Alum.,  Calc. c, Graph., Merc, Sabad., Sep.,  Sil.,
     Sulph.
  ------crumbling off.—Alum., Calc c, Graph., Merc, Sabad., Sep.,
     Sil., Sulph.
  ------deformed.—Alum.,  Calc e,  Caust., Graph., Sabad., Sep.,
    Sil., Sulph.
  ------discolored.—Ant, c, Graph.,  Nitr. ac,  Sulph.
  ------falling {coming) off.—Ars., Caust,, Hell., Squill., Sec. corn.
  ------grovnng into the flesh.—Arg. nit., Graph., Hep., Merc, Nitr
     ac, M. austr., Mar., Sil.,  Sulph.
  ------jerks, with sensation as  of.—Calc. c, Caust.,  Graph., M.
     austr., Natr. mur., Nux vom.,  Puis., Rhus.,  Sep., Sil.
  -----painful in general.—Ant. c, Caust.,  Graph., Hep., Mgs.,
     M. austr., Mar., Merc, Nitr. ac, Nux vom.,  Puis., Ran. bulb.,
     Squill., Sil.,  Sulph.
  ------sensitive.—Alum., Calc. c, Graph., Hep., Mgs., M. austr.,
     Natr. mur., Nux vom., Squill., Sep., Sil., Sulph.
  ------as if a splinter were under the.—Arg. n., Hep.,  Hura. b.,
     Nitr. ac, Petrol., Ran. bulb., Sil.,  Sulph.
  ------splitting.—Squill., Sil.
  ------spotted.—Alum., Nitr.  ac, Sep., Sil., Sulph.
  ------thickening.—Alum., Caust., Graph., Sabad., Sep., Sil., Sulph.
  ------ulcerated about the.—Alum., Ant.  c,  Ars., Calc. c, Con.,
     Graph., Hep., Lach., Lycop., Merc, Nitr. ac, Puis., Ran. bulb..
     Squill., Sil., Sulph.
  ------painful as if ulcerated.—Amm. mur., Caust,, Chin., Graph.,
     Hep.,  Kali c, Merc,  Natr. mur., Nux vom., Puis., Rhus., Sep.,
     Sil., Sulph.,  Thuya.
   -----yellow.—Ambr.,   Aur.,  Bell.,  Bry.,  Canth.,  Carb.  veg.,
     Cham., Chin., Con., Ferrum, Ignat.,  Lycop., Merc,  Nitr. ac.
     Nux vom., Op., Plumb.,  Sep., Spig., Sulph.
  Hang-nails.—Calc. c, Lycop., Merc,  Natr.  mur., Rhus., Sabad.,
     Stann., Sulph.
  Of course the remedy must be  selected according to the totality of
symptoms.

                 Chancres,  Syphilitic Ulcers.
  Cinnabar is especially indicated in these ulcers when they are very
red  or have a very red margin.
t 
958
APPENDIX.
  Corralium rub. Exceedingly sensitive.  Can't bear the least touch.
  Hepar.  Sensitive.   Look like lard.   Itch very much, and  hav«
many small ulcers or pimples  surrounding the margin;  these lit-
tle  ulcers or pimples gradually become incorporated with  the  main
ulcer.
                       «
  Merc. sol. or Vivus.  Ulcers not red; look more like lard or tallow.
Sensitive to touch, and painful.
  Merc, jodatus or Biniodide. Particularly ulcers not painful nor sensi-
tive.  Sometimes hard.
  Nitr. ac.  Sensation as if sticks  or slivers were in the ulcers, and they
look lardy.
  Silicea.  Ulcers open again after healing.  Sensitive;  itch and look
like lard.   If they look dark on reopening, Lachesis is the remedy.
  Sulph. The ulcer feels hot and pulsating.
  Thuya.  Condylomata—raised up with little necks.
  Giving high potencies repeatedly  in chancres usually aggravates.
If the right remedy be selected and a single dose given, the common
chancre will be cured  thereby  in two, the  hard chancres in four
weeks.

 Albuminuria as  a  Sequela to  Scarlatina, Diphtheria,
   Rheumatism  and other Forms of Diseases  in Children.
  Properly speaking, there are  no sequelae to diseases of any kind,
nor should there be any.   When a disease is  properly cured there is
an end to it for ever.  Sequelae come in consequence of improper treat-
ment of the physician, or exposure or want of care on the part of the
patient.  Then the diseased condition may become translated  to, and
apparently spend  its force upon, other organs or parts.   When there
is the least sign of dropsical effusion in any portion of the cellular
tissues, the urine should at once be submitted to the ordinary tests for
albuminuria;  even when there  is no  sign of such effusion, but  the
patient does not rally  from the debility consequent upon some form of
illness as soon as  is usual, we should not delay applying said tests;
for the kidneys may then  show  what is going on in  the system, and
admonish  the physician  of a train of  symptoms that  he might  not
otherwise discern.   The fact of finding albumen in the urine does not
by  any means give us the  remedy wdiereby to cure the patient, but it
gives us the knowledge of a very important factor in the totality of
the symptoms, and one  which we must watch with  anxious care  till
the disease is  thoroughly eradicated.   Now, too, we must examine
with  equal  care into  the condition of the heart, for there is a likeli- 
APPENDIX.                        959
hood of sympathy between these very important organs.  The totality
of the symptoms must be carefully collated from all parts.  The al-
buminous condition of the urine is only one symptom that pertains to
this fluid.  Its color, its sediment, its odor and the manner of voiding,
each and all have an influence upon the prescriber in determining the
remedy whereby a cure is to be effected.  Great care should be observed
that the patient takes no cold, for then the case would  become  much
aggravated.  A few months  since I was called in  consultation to  a
little child, whom I found in  the following  condition. It had recently
experienced a severe attack .of scarlatina; the child's lower extremities
were swollen; great and universal pallor of skin ; frequent attacks of
epistaxis ; bleeding of the gums sufficient to produce a dark coating on
the teeth ; lips slightly cracked, with a little exudation of blood  there-
from ; vomiting of food; very weak and easily exhausted; sleep very
much broken with restlessness ; urine very scanty, about a tablespoon-
ful in the course  of twenty-four hours, dark brown in color, with a
dark-brown sediment, and of  a sweetish  smell like  violets;  when
boiled, one half was found to be solid albumen; heart's  action about
normal.   This  state of things  had been going on from bad to worse
for about ten days, during which time many remedies had been given.
Terebinth, was the only remedy which seemed to be indicated and sug-
gested by the condition of the urine.  This remedy in  the 2C potency
was therefore prepared in water, and a teaspoonful of the solution ad-
ministered every three hours for  about two days, when there  was a
marked improvement observable  in the urine and in the sleep.  No
more medicine was given at all, and the child made a rapid  recovery.
The epistaxis was the last symptom to abate, for which we were several
times tempted  to prescribe another remedy;  but as there was a con-
tinuous and satisfactory improvement in all other respects, we thought
it best to obey our master, Hahnemann,  and we wrere amply  repaid in
the end  for our allegiance.   So in all cases  of albuminuria.  When
the albumen lessens, make no change in the remedy, and beware of
repetitions when the important point is  gained in lessening the albu-
men.   We are reminded of the following remedies particularly, when
wre discover the symptoms of albumen in the  urine:  Apis, Apocynum,
Ars. (Ars. phos.), Aurum, Bell., Bry., (Calc. ars.), (Calc. phosph.), Cann.,
Colch., Cuprum, Dig., Dule, Eupatorium pur., Kali c, Phos.,  Phos.
ac, Puis., Rhus tox., Squill., Sulph., Terebinth.  All  the above are
certainly important remedies  in this relation, and a few  years more of
observation will probably add many others.  The  symptoms in each
case alone must decide the remedy. 
960                        APPENDIX.
              Admixture of Pus with the Milk.
   " Engorgements  of the breast, whether spontaneous or consequent
upon fissures and excoriations of the nipple, are exceedingly common
with nursing women, and have a great tendency to end in suppuration.
These abscesses, the history of which belongs to the pathology of the
female,  will claim  our  attention only in respect to  the alterations of
the milk which they are liable to produce.  In reference to this, it is
very important to distinguish from all others the parenchymatous ab-
scesses, seated in the tissues of the gland itself, and those which, com-
mencing by a true  lacteal engorgement, begin  in a milk-duct, wdiose
walls, inflamed and distended into a sort of cyst, secrete pus.  In these
only can the pus become diffused in the  milk.  The superficial or sub-
mammary abscesses, which do not open into the proper milk-ducts, do
not affect this fluid by admixture  of pus  and alter  its  composition,
except by the reaction which a morbid condition of the  kind exerts
upon  a  neighboring organ.
   " When the glandular abscess is apparent, the presence of pus in the
milk should be suspected and nursing relinquished; but, as M. Donne
remarks, it often happens that  suppuration has taken place in  some
deep-seated parts of the gland,  without  being indicated by any exter-
nal sign.  The slowness with which the suppuration is accomplished
sufficiently explains this insidious course. Therefore, if the breast was
affected  at the outset with simple engorgement, attended  with deep-
seated lancinating pains, we should be  on  the watch and subject the
milk to  microscopic examination.   If it is impossible to  make this
examination—which is the only possible way of removing all uncer-
tianty—prudence would  dictate the relinquishment  of nursing, for
there  seems  to be  no doubt  that it would prove injurious to the
child."—(Cazeaux.)
   That  the admixture of pus with milk  would be as injurious to the
nursing infant as the adulteration of food with putrid substances would
be to  children of larger growth, there can be no  doubt; but to  wean
the infant for conditions of the  breast as above  described will be
neither  necessary nor advisable in our  mode of practice.   The  child
should nurse  from a bottle till we cure the troubled  breast, when there
will be no more pus.  Then we should  return the  child to so great a
boon as  a mother's  breast flowing with  delicious milk laden with her
love.  During the interval the  breast should be kept drawn by a care-
fully managed breast-pump or by the nurse, in the latter case the milk
of course being spit out.
   Erosions, excoriations, chaps, fissures and cracks ofthe nipple afford 
APPENDIX.
961
another source of contamination by means of pus.   All of these con-
ditions present an unhealthy surface for the child's mouth, which will
draw scabs, pus or blood, or all three, and really contaminated milk.
Infants frequently  vomit blood  or pus drawn  from the  nipples so
affected, and  sometimes pass the same into the diaper, thus affording
a source of alarm to the nurse or mother.   In  these cases a proper
nipple-shield  must at once  be provided, and the mother subjected to
treatment till the nipples be perfectly cured.*  If no  defect can be
discovered about the nipple on inspection, but if pain is experienced
when the babe nurses, the nipple shield should be used till the trouble
is cured;  it is not always possible to detect the difficulty, as it may be
just inside and may be secreting deleterious pus.   Out of the many
nipple shields offered to the profession, one should be selected which
can be used without causing the mother any pain.  The shield should
have a black  rubber nipple.
  These troubles with the nipples are often caused by exposing them
to the  air  immediately  after nursing.   The  breast should  always be
covered whilst nursing  to prevent its  being chilled, thereby obstruct-
ing the milk-pores, and the nipple should be  covered warmly imme-
diately after leaving the child's mouth; a well-worn pocket handker-
chief or a piece of cotton batting would be a suitable covering. When
the nipples seem healthy and do  not stand in need of  medical treat-
ment, it is always  better during  the  last month of gestation to  rub
them well  with alcohol and water morning and night, for the purpose
of hardening them  preparatory  to  nursing.   This often does much
good as a prophylactic  to  sore nipples.
  Altered quality of the milk is often a source of hinderance  to a thriv-
ing condition of  the child.  When the milk  is poor in globules or
cream, is watery, and does  not contain a proper amount of nutritious
elements, the child of course languishes and does not prosper.  Now,
the mother should  be carefully  treated with well-selected medicine
and a more nourishing diet  recommended.   Cure the mother, and her
milk and the child will of course correspond with her improved  state
of health.
  The  effect of the extreme richness of the  milk is another drawback to
the well-doing of the infant.  Frequent vomiting, diarrhoea, eruptions,
crusta  lactea, excoriations,  etc often  seem to result from it.  Then
the mother or nurse should be enjoined to  partake of a less nutritious
diet, to take  more exercise in the fresh open air, and  enforce upon
herself all the known laws of hygiene.
                    * See Treatment for Sore Nipples.
     61 
9G2
APPENDIX.
  In all cases  of supposed deviations of the milk from the healthy
standard, the only test whereby to determine this question with cer-
tainty is the use  of  the  microscope or the  lactoscope.   Thus will Ave
become acquainted with the true cause of numerous disorders or mor-
bid conditions  of the  new-born child, which otherwise  might remain
inexplicable.   The number, size and  regularity of the  globules will
establish the diagnosis either of the too poor or too rich condition of
the lacteal fluid.
  When it  becomes advisable  to  feed the infant for a time, a very
convenient formula,  and one that gives us a preparation very like the
mother's milk, is thus stated :  In half a teacupful  of  boiling water
dissolve a heaping teaspoonful  of sugar of milk, and  mix  with an
equal quantity of  fresh  unskimmed cow's  milk.  When  condensed
mi'.k is used, take one  teaspoonful of condensed milk and add twenty-
sir  ^easpoonfuls of boiling water.

               Plica Polonica—Matted  Hair.
   Plica, from plico,  nXexco, "to fold."  This disease is characterized
by the  interlacing, twisting and  agglutination or  matting of the hair.
Sc me authorities regard the affection as a  real  disease, while others
regard  it as resultant from a want of proper cleanliness.   In truth,
however, this  tangling or matting of the hair is  a real  disease, symp-
tomatic  of an  affection, sui  generis,  of  the dermoid system.   In its
essential or dynamic nature this disease is analogous to  common ring-
worm, and " is a state of granular degeneration of the hair, the gran-
ules being turgid with a viscous sanguineous fluid." * The symptoms
are as  follows: Inflamed and excessively tender scalp,  hairs  swollen
and imperfectly formed, and are tinged with  a viscous and reddish-
colored  fluid.    This fluid, secreted  copiously by  the hair-follicles,
agglutinates the hairs  and binds them firmly together in masses.  The
scalp may be  so  excessively tender that the lightest touch of a single
hair causes  pain.- The odor from  such a scalp is  exceedingly unpleas-
ant, and the matted  hair sometimes becomes alive with  parasites.   In
those wearing the  hair short,  as men,  numerous  locks are matted
together separately, either  in straight or in twisted meshes, causing
Plica multiformis; or  if the hair forms a single mass or coil, it is called
Plica  caudiformis;  or it  may  form a large, irregular  and shapeless
mass, as is generally the case with  women wearing long  hair.   As this
matted hair has been found half an inch or an inch from the integu-
ment, some authorities have supposed the affection* to  exist  separate
                 * Erasmus Wilson on Diseases of the Sk:.n. 
APPENDIX.                        963
from  and independent  of the  scalp.  This  is not so.   The truth in
such cases is, that during the curative progress of the disease the mor-
bid mass of hair has grown away from the surface of the scalp.  The
causes, as stated above, are probably analogous to those of ringworm.
We find this disease in all  classes, high  or low, and in adults or chil-
dren.   It generally occurs on the banks of rivers, in marshy districts,
etc   Change of air, improved  diet and proper hygienic  measures are
adjuvant in the cure.  The disorder may appear in other parts than
the hair of the head, as in  the beard, in the axillaries, on the pubis,
chest, etc.
   It  is found  in every degree, from its fullest formation and of the
worst  description  to  the very mildest appearance.   We frequently
meet with it in girls  and young  women, the roots  of wdiose hair are
cemented in patches  about the scalp, or  the whole  scalp may be cov-
ered with this  matted hair  in one solid mass.   As the cure advances
this  cemented  hair raises  in  masses  larger or smaller, leaving  the
scalp  and hair-follicles  perfectly healthy.  The best remedies so far
as known  are  Borax,  Branca, Clematis, Dule, Fluor, ac, Graph.,
Hep., Lycop., Mezer., Natr. m., Nitr. ac, Oleand.,  Rhus tox., Sassap.,
Staph., Thuya, Vinca minor, Viola od., Viola tr.
   A few years since I saw a very  bad case  of  the  plica caudiformis
in a  young  girl  cured perfectly with Viola tr.   The constitutional,
subjective and  objective symptoms must always decide the choice of
the remedy.

COCCYODYNIA—XOXXOZ, COCCYX, AND 0 dovrj = PAIN IN THE COCCYX.
   This painful affection  is found so  frequently  among  girls .and
women that we feel fully justified in placing it among the diseases
of females.   It is a disease very frequently met with  in practice, and
is now treated  quite satisfactorily, so much light having been thrown
upon  its  .management within a  few years.
   The pathological condition of this kind of suffering may be classed
as neuralgic,  rheumatic!  or gouty, idiopathic or  from traumatism.
Probably the latter is by far the most frequent cause.  One may slip
and  fall upon this part of the body—i. e., the coccyx—and think
nothing  of  the accident at  the time, yet  the  shock after the lapse of
weeks or months may give rise to  this troublesome affection.  A bad
cold may, for instance,  be the immediate exciting cause of the suffer-
ing.   If the accident should be  followed by persistent and prolonged
sufferings for two or three  days,  an examination should be instituted
without further delay, with a view to  reduce a dislocation  or to set ? 
964
APPENDIX.
fractured bone.  So after a case of parturition we may find dislocation
or fracture.  Even months  after parturition a  chill may develop a
fearfully painful affection of this sort, due entirely to an injury then
received.
   Treatment.—When the disease can  be distinctly traced to traumat-
ism, though received months  previous, Arn/0"1 or a very high potency,
and  repeated at long  intervals, say once per week, will often make a
perfect cure; more particularly if it be  from a shock, as slipping or
falling down.
   Calc. phos.  If crepitation be discovered in the coccyx, or a sensation
as if it were broken.
   Cicuta. Coming  on  for the first time during catamenia after a par-
turition.
   Fluoric ac.  A continued bruised pain in the part in any position.
   Hypericum.  Particularly if the part is excessively sensitive.
   Lachesis. Many years  since I  cured a series of cases where all the
suffering was  experienced  on rising from a sitting posture, when the
pain would  be excruciating.  I  related  this fact to the  college class
of students to which I was then  lecturing, at least fifteen years since.
It has always proved a true keynote to my students and to myself.
   Phosph. Pain in the  coccyx  or sacrum  after  confinement, with or
without heat in the part.
   Rhus tox. If  there  be great stiffness about  the  parts—worse in
damp weather, and feels much better when thoroughly warmed up in
walking.
   Ruta. If the  periosteum seems to be bruised and the pain extend
from the coccyx to the sacrum.
   The following  are a few remedies from an article on this subject,
published by W. S. Searle, M. D., which I fully endorse:
   Bell. The ischia feel sore, as if there were no  flesh on them, yet she
feels better when  sitting on something  hard than on cushions.   In-
tense crampy pain in  the small of  the back and  the os coccygis.   She
can sit only a short time.  Sitting  makes her stiff and unable to rise
again from  pain.   Cannot lie dowm well;  wakes often at  night, and
has to  shift her position; unable to lie  at  all upon  the back, and  is
most relieved by standing or walking slowly.
   Cannabis sat. Pressure, as if with  a sharp  point, on the  coccyx.
Pain in the middle of the back,  as if it were being pinched, the pain
gradually extending toward the abdomen.
   Cantharis.  Lancinations and  tearings in the coccyx, causing the
natient  to start. 
APPENDIX.
965
   Carbo. an. Pain in the coccyx, which  becomes a burning pain when
the parts are touched.   Pressing, bearing-down  pain in the coccyx, a*
if the  parts were bruised.  Pain  as from subcutaneous ulceration in
this region, mostly when sitting or lying 1 )wn.  Pressing,  drawing
or stiffness in the lumbar region, as if the back were broken.
   Caust. Dull, drawing pain in the region of the coccyx.  Darting
pain in the  coccyx.   Pain as from bruises  in  the coccyx.   Every
movement of the body gives a pain in the small of the back.   Pinch-
i\ g, crampy pain in the lumbar region and buttocks.
   Cicuta. Tearing, jerking in the coccyx.
   Cistus canadensis.  A burning, bruised  pain in the coccyx.
   Creosote. Drawing pains along the coccyx down to the rectum and
vagina, where a spasmodic,  contractive pain is felt.   Better when
rising from her seat.  Subsequent  milky leucorrhoea.
   Drosera.  Itching stitch in the coccyx when sitting.
   Graphites. Dull drawing in  the coccyx in the evening.  Violent
itching of the coccygeal region, the part being moist with scurfy for-
mations.
   Gummi gutti. Repeated gnawing in the  coccyx.
   Kali C. Violent gnawing in the coccyx, both when  at  rest and in
motion.   This remedy has many back symptoms, and  may be  fre-
quently indicated, but the above  is the  only symptom  recorded  in-
cluding the coccyx.  (To be thought of when coming on long after
parturition as a cause.)   Aggravation at 3 a.m.
   Kali hyd. Pain in the coccyx as  from  a  fall.
   Lachesis. Continual pain in the sacrum and coccyx.  Drawing pain,
or pain as if sprained, in the small of the back* hindering motion.
   Lactuca.  Pain, as if in the spinal marrow, extending through the
coccyx.
   Magnesia. Sudden piercing pain in the coccyx.   Sudden, violent,
concussive, tearing, stitching pain in this  region, as if  the spine were
bent back.
   Mercurius.  Tearing pain in the coccyx,  relieved  by  pressing the
hand against the abdomen.  Pain in the sacrum, as if one had been
lying on too hard a couch.  Pricking,  itching in the sacrum when
walking.
   Muriatic ac. Drawing, burning  along the back,  beginning at the
coccvx, as  if under the  skin.  Burning stitch in the sacrum, causing
one to  start.
   Paris quad. Tearing in the coccyx when sitting.  Pulsative stitches
in the coccyx. 
966
APPENDIX.
   Petroleum. Pain in the coccyx while sitting.  Great uneasiness and
stiffness in the small of the back and coccyx in the evening.
   Phosph. Pain in the coccyx, as if ulcerated, hindering motion, and
followed by painful  stiffness in the nape of the neck.
   Phos. ac. Itching  stitch in  the coccyx.  Fine stitches in the coccvx
and sternum.
   Platina. Numb  feeling in the coccyx, as from a blow.
   Ruta. Pain extending  from the coccyx to the sacrum, as if caused
by a bruise.
   Thuya.  Painful  drawing in the sacrum  and  coccyx, and  in the
thighs when sitting.   After having been  seated a while the drawing
hinders standing erect.  Sudden cramp-like pain in the lumbar region
after long standing and when  attempting to walk.   It seems as if she
would fall.
   Valeriana. Bubbling pressure above the  anus in the region of the
coccyx.
   Zincum. Pain in the coccyx, sometimes pushing, aching, and some-
times pinching.   Lancination in the  sacrum; pressure, tension and
weakness  in the lumbar and sacral region; cracking in the  back when
walking.
   We will close  this important  subject by adding a valuable and
thoroughly practical  extract from the chapter on Coccyodynia from
the Analytical Therapeutics by C. Hering, M. D. (soon forthcoming):
   Sore feeling, as  if sprained: Lach., Sulph.; as from a blow, numb,
tensive, tight, while sitting, Platina ; as from a fall, Crocus, Kali hyd.,
Ruta; sore and stiff while sitting, Petroleum; as if beaten, Alum.,
Caust.,  Sulph. ; with urging,  Carb. an.; as if bruised, pressing, Carb.
an. ; burning, Cistus;  extending to the sacrum, Ruta.
   Like  an ulcer:  Colch.; w hen sitting or  lying down, Carb. an.;
hinders motion, Phos.
   Aching: Bell., Carb. an., Caust., Graph., Ignat.,.Kali hyd., Lach.,
Magnes. carb., Nitr. ac, Petrol., Phos., Silicea, Zincum ; feels tired,
Petrol.; from spinal  marrow to coccyx, Lactuca; with uneasiness and
stiffness, Petrol.
  'Pressing: Cinchona, Hepar., Merc sol., Phos., Phos. ac, Valer.;
as if  with a  dull  point,  Cannab., Carb. veg.; boring,  digging, Ar-
nica;  pinching, Calc.  carb.;  pushing, Zincum; with bearing down,
Carb. an.; urging, Zincum; cramplike squeezing, Bell.; increases and
decreases  in sacrum,  etc., Jod.; bubbling sensation, Valer.
   Drawing, tearing: Ant. cr., Arn., Calc. carb., Canth , Carb. veg.,
Caust,  Cicuta, Graph., Magnes. carb.,  Merc, Mur. ac ; when sitting. 
APPENDIX.
907
Paris,  Rhus, Zinc; dull in  the  evening,  Caust., Graph.;  tearing,
Cicuta; from sacrum down to coccyx and  thigh, Thuya; along the
rectum to the vagina, Creos.; relieved by pressure on the abdomen,
Magnes. carb.; sudden, startling, tearing, Calc. phos.; often repeated,
Canth.
  Shooting,  lancinating: Ammon. c, Canth.,  Colch., Magnes.  carb.,
Niocol., Paris, Rhus.
  Stitches, stinging: Agnus, cast., August., Argent., Colch., Phos. ac,
Veratr., Zinc.; along the sacrum to the anus, Asaf.; like a needle,
Rhus;  itching, Phos.  ac.; jerking, Carb. veg.; while standing, Ve-
ratr. ; or sitting,  Drosera; repeated lancinations, Canth.; pulsating,
Paris; beating, Ignat.
  Jerking, shrugging: Calc carb., Caust., Cicuta, Cinchona, Carb. veg.
(Magn.), Rhus, Sulph.;  pain  in the point of the coccyx, Alumina
(Sep.).
  Sudden: Magnes. carb., Thuya; startling,  Mur. ac, Calc phos.;
as if from the spinal marrow, Lactuca;  extending to the  back, Mur.
ac.;  as if the spine were bent back, Magnes. carb.
  Rest and motion: Cannot find a comfortable position, Phos.; has to
shift the position, Bell.; cannot lie down well, not on the back, Bell.;
can  sit but a short time, Bell.;  while sitting, aching pain,  Petrol.,
Platina; stitches, Dros.; after sitting unable to rise, Bell.; cannot
stand straight, Thuya;  cannot walk quickly, Bell.; impeded  motion,
Lach., Phos.; better when rising, Creos.; when standing or  walking
slowly, Bell.; followed by a stiff neck,  Phos.; by milky leucorrhoea,
Creos.
  Heat (around coccyx  below sacrum): Agar.,  Alum., Arn.,  Ars.,
Borax, Calc. c, Carb. an., Carb.  veg., Caust., China, Colch.,  Graph.,
Hepar., Ignat., Lauroc, Ledum,  Merc, Mur. ac, Phos., Phos.  ac,
Plat., Rhus, Spigel., Staph., Sulph., Zincum.
  Burning: Cistus, Colch., Lauroc, Staph.; corroding,  Canth.; to
the  right of the coccyx, Fluor, ac.;  and drawing up the back, Mur.
ac;  wdien touched, Carb. an.
  Itching:  Agar., A lum.; has to scratch, Borax, Bo vista; with burn-
ing, Fluor, ac.; ciuwling, Borax, Lye ; gnawing, Agar., Alum., Gam-
bog., Kali c, Phos. ac.; better when scratching, Alumina.
  Oozing: Graph., Ledum; offensive, Nitr. ac; getting sore, Ledum;
scurfy, Borax, Graph.; nodules as if swollen, Hepar.; eruptions, Merc.
eol. 
 
CLINICAL    INDEX.
Acetic acid.  Nausea and Vomiting, 297,759,764.
Aconite.  Treatment of Child  aftor Labor, 213;
    Nausea and Vomiting, 297 ;  Constipation, 310;
    Retention  of  Urine,  329;  Haemorrhoids, 347;
    False Pains, 362;  Neuralgia, 372;  Hysteria,
    381;  Labor-Pains,  384; Rigidity of the  Os,
    388;  Syncope, 390; Uterine Haemorrhage, 406;
    Puerperal Convulsions,  421; Disordered  Condi-
    tions of the Lochia, 428; Puerperal Mania, 459;
    Secretion of Milk, 467 ; Scanty Supply of Milk,
    469 ; Mastitis,474; Abortion,492;  Amenorrhoea,
    410;  Menorrhagia, 533; Hysteria, 565; Erysip-
    elatous Inflammation,  574;  Strangulation of
    Prolapsed Portion of  Vagina, 588 ; Uterine Dis-
    placements, 632 ; Leucorrhoea, 645 ; Metritis,
    660;  Gangrene of  the  Uterus, 704;  Hydatids,
    715;  Inflammation of the Ovaries, 730; Indiges-
    tion, 764;  Dentition, 770;  Constipation, 781;
    Diarrhoea,  786;  Dysentery, 790;   Coryza, 803;
    Bronchitis, 807;  Pneumonia, 811; Croup, 816;
    Pertussis,  820;   Atelectasis  Pulmonum,  829;
    Scarlet Fover, 837 ; Measles, 852 ; Roseola, 855 ;
    Miliaria,  855;  Small-pox, 860; Varicella, 865;
    Erysipelas, 867 ;  Urticaria, 868 ;  Eczema Capi-
    tis, 870; Induration of the Cellular Tissue, 876;
    Induration of the Breasts, 877 ; Cyanosis, 880;
    Jaundice, 882; Intermittent B'ever,  884;  Oph-
    thalmia, 890;  Hernia, 894; Worms, 897;  Reten-
    tion of Urine, 900;  Meningitis, 903; Acute Hy-
    drocephalus, 905  ;  Disease of the Brain, 909 ;
    Cerebro-spinal  Meningitis, 931;  Chorea, 935 ;
    Remittent Fever. 939 ;  Spasms, 948.
/Esculus hip.   Fissure of the Anus, 326 ; Hem-
    orrhoids, 347; Lame Pelvis, 367;  Amenorrhoea,
    610;  Leucorrhoea, 645.
/Ethusia cyii.  Secretion of Milk, 467; Child
    Vomits the Milk soon after Nursing, 475; Ma-
    rasmus, 759;  Indigestion, 764;  Aphthse, 779;
    Constipation, 781  ; Cholera Infantum, 796 ; Re-
    gurgitation, 801; Disease ofthe Brain, 909: Cer-
    ebro-spinal Meningitis, 931; Spasms, 948.
Vgaricus.  Nausea and Vomiting, 297  ; Constipa-
    tion, 310;  Diarrhoea, 317; Sore  Nipples, 464;
    Menorrhagia, 533; Nymphomania,  551;  Leu-
    corrhcea, 645 ; Chorea, 936; Spasms, 948.
Agnus  castus.  Secretion of Milk, 467;  Scanty
    Supply of Milk, 469 ; Amenorrhcea, 510.
Ailantlius gland.  Scnrlet Fever, 838.
Aletris far.  Abortion, 493; Amenorrhoea, 510;
    Metrorrhagia, 533 ; Leucorrhoea, 645.
Alium cepa.  Coryza, 803.
Aloes.  Diarrhoea, 317; Haenr .-rhoids, 347;  Lame
    Pelvis, 367 ; Marasmus, 759; Dysentery, 790.
Alum. Nausea and Vomiting, 297 ;  Ooustipation,
    310 ; Diarrhcea, 317 ; Hemorrhoids, 347 ; Tooth-
    ache, 374; Amenorrhoea, 510; Dysmenorrhcea,
    520;  Neuralgia of Vagina, 591 ; Leucorrhoea,
    645; Marasmus, 759; Constipation, 781; Dysen-
    tery, 790;  Gravel, 902.
Ambra  grisea.  Menorrhagia,  533;  Vulvitis,
    571; Leucorrhoea, 645;  Inflammation of the
    Ovaries, 730 ;  Ranula, 874.
Ammon. carb.  Haemorrhoids, 347;  Amenor-
    rhoea, 510; Dysmenorrhcea,  520;  Menorrhagia,
    533; Erysipelatous Inflammation, 574; Leucor-
    rhoea, 646; Coryza, 803; Scarlet Fever, 838.
Ammon. mur.  Diarrhcea, 317 ;  Haemorrhoids,
    347; Dysmenorrhoea, 520; Metrorrhagia, 533;
    Uterine Displacements, 632; Leucorrhcea, 646 ;
    Small-pox, 860.
Anacardium.  Constipation, 310;  Hysteria, 381,
    565; Leucorrhcea, 646.
Aiigustura.  Nausea and Vomiting, 297; Diar-
    rhoea, 317.
Antimonium c.  Nausea and  Vomiting, 297;
    Constipation, 310;  Diarrhoea,  317;   Hfemor-
    rhoids, 347 ; Uterine Haemorrhage, 40C; Menor-
    rhagia, 533; Nymphomania, 551; Vaginal Fis-
    tula, 604; Leucorrhoea, 646; Ulcerations of the
    Uterus, 683; Inflammation of the Ovaries, 730;
    Marasmus, 760; Dentition, 770; Diarrhoea, 786;
    Cholera Infantum, 797 ;  Measles; 852 ; Small-
    pox, 861;  Hernia, 894; Remittent Fever,  939.
Apis mel.   Nausea and Vomiting, 298;  Constipa-
    tion, 310; Haemorrhoids, 347; Varicose Veins,
    353; Uterine  Hajuiorrhage,  406; Ulceration of
    the Umbilicus, 431;  Phlegmasia Dolens, 462;
    Abortion,  494;  Amenorrhcea, 510;  Dysmenor-
    rhoea, 521; Menorrhagia, 633; Erysipelatous In-
    flammation, 574; Eczema and Pruritus, 576;
    Strangulation of Prolapsed Portion of Vagina,
    588; Gangrene of Vagina,  605;  Metritis, 660;
    Gangrene  of the Uterus,   704;   Dropsy of
    the Uterus, 707; Inflammation  of the Ovaries,
    730; Ovarian Tumors, 741;  Mammary Cancer,
    748; Marasmus, 76);  Dentition, 770; Constipa-
    tion, 781; Dysentery, 790; Scarlet Fever, 838;
    Dropsy after Scarlet Fever, 845 ; Post-scarlatinal
    Rheumatism, 847;  Measles, 852;  Small-pox,
    861; Erysipelas, 867 ; Urticaria, 868; Retention
                                 969 
970                               CLINICAL  INDEX.
    of Urine,900; Meningitis, 903; Acute Hydroceph-
    alus, 905; Disease of the Brain, 909; Cerebro-
    spinal Meningitis, 931; Remittent Fever, 939;
    Diphtheria, 945.
Apocynum cann.   Uti rine Haemorrhage, 407 ;
    Amenorrhcea, 510; Menorrhagia, 533; Ovarian
    Tumors, 742; Dropsy after Scarlet Fever, 845;
    Acute Hydrocephalus, 905; Disease of the Brain,
    909.
Aralia.  Leucorrhoea, 646.
Argentum n.  Nausea, and Vomiting, 298; Diar-
    rhoea, 317; False Pains, 362;  Uterine  Haemor-
    rhage, 407; Puerperal  Convulsions, 421; Men-
    orrhogia, 534;  Ulcerations of the Uterus, 684;
    Marasmus, 760; Diarrhoea, 786; Scarlet Fever,
    838; Worms, 897; Diuresis, 901; Acute Hydro-
    cephalus, 905; Disease of the Brain, 909; Cer-
    ebro-spinal Meningitis, 931.
Arnica.  Nausea and Vomiting. 298; Constipation,
    310; Diarrhoea, 317 ; Varicose  Veins, 353 ; False
    Pains, 362; Lame  Pelvis, 367;  Hysteria, 382;
    Labor-Pains, 384; Syncope, 390; Uterine Haem-
    orrhage, 407; Puerperal Convulsions, 421:  Re-
    tention of Urine after Parturition, 425,; After-
    Paius, 426; Phlegmasia Dolens, 462; Sore Nip-
    ples, 464;  Abortion, 494;  Menorrhagia, 534;
    Vulvitis,  571;  Haemorrhage from  Erectile  Tu-
    mors, 581; Prolapse of the Vagina, 587; Uterine
    Displacements, 632; Metritis,  660; Ovarian Tu-
    mors, 741; Mammary  Cancer, 748; Marasmus,
    760; Dysentery, 790; Vomiting of Blood, 800;
    Bronchitis, 807;  Pertussis, 821; Scarlet Fever,
    838;  Small-pox, 861;  Erysipelas, 867;  Ceph-
    alaematoma, 874; Ecehyinosis, 874; Induration
    ofthe Breasts, 877; Cyanosis, 880;  Retention of
    Urine, 900; Acute Hydrocephalus, 905;  Disease
    of the Brain, 909;  Cerebro-spinal  Meningitis,
    931; Spasms, 948.
Arsenicum. Nausea and Vomiting, 298; Diar-
    rhoea, 317 ; Fissure of the Anus, 326;  Retention
    ofUrine,330; Haemorrhoids, 347; Varicose Veins,
    353; Toothache, 374; Hysteria, 382; Syncope,390;
    Debility, 391;  Uterine Haemorrhage, 407 ; Re-
    tention of Urine after Parturition, 425; Ulcera-
    tion of tho Umbilicus, 431; Phlegmasia Dolens,
    462;  Amenorrhoea, 510; Menorrhagia,  534;
    Nymphomania, 551;  Hysteria, 565;  Erectile
    Tumors, 681; Strangulation  of Prolapsed Por-
    tion of Vagina, 588; Neuralgia of Vagina, 591;
    Gangrene of  Vagina,  605;  Leucorrhcea, 646;
    Metritis, 660; Sensation of Coldness in  the Ul-
    cers, 685;  Cancer of the Uterus, 700; Gangrene
    of the Uterus, 704; Dropsy of the Uterus, 707 ;
    Hydatids, 715;  Inflammation of  the Ovaries,
    730; Ovarian Tumors, 741; Mammary  Cancer,
    748; Marasmus, 760; Indigestion, 764; Denti-
    tion, 771; Aphthae, 779; Diarrhoea, 786; Dysen-
    tery. 790; Cholera  Infantum, 797;  Vomiting of
    Blood, 801; Bilious Vomiting. S01; Bronchitis,
    807 ;  Croup,  816 ;  Pertussis,  821;  Asthma of
    Millar, 826; Scarlet Fever, 838;  Dropsy after
    Scarlet Fever, 845 ; Neuralgic Pains in Extrem-
    ities and other parts after  Scarlet Fever, 847;
    Measles, 852; Rubeola Maligna, 85V, Pemphigus, |
    856;  Small-pox,  861;  Urticaria, 86S;  Eczcmi
    Capitis,  870;  Pityriasis, 871;  Cyanosis, 880;
    Jaundice,  862;  Scrofula, 886;  Mumps, 892;
    Retention  of  Urine,  900;  Incontinence  of
    Urine, 901; Disease of  the Brain, 909; Cerebro-
    spinal Meningitis, 931; Remjttent  Fever, 939;
    Diphtheria, 945;  Spasms, 948.
Artemisia vulg.  Disease of the Brain, 910.
Arum tri. Coryza, 803; Scarlet Fever, 838.
Asafoetida.  Diarrhoea,  317;  Scanty Supply of
    Milk, 469;  Hysteria,  565;   Hysteralgia, 673;
    Ulcerations of the Uterus, 684.
Asarum.  Abortion, 493;  Dysmenorrhcea, 521;
  Vaginal Fistulas, 603; Worms, 898.
Asclepias syr.  Dysmenorrhcea, 521.
Asterias rubens.  Uterine Displacements, 632;
    Hysteralgia, 673; Mammary Cancer, 748.
Aurum.   Diarrhcea, 317;  Impaired Vision, 570;
    Hysteria, 381;  Labor-Pains, 384;  Puerperal
    Mania, 459; Amenorrhcea, 510 ; Nymphomania,
    552;  Hysteria, 565;  Concomitant Symptoms of
    Vaginal Fistulas, 604; Vaginal Growths, 608;
    Uterine Displacements, 632; Hysteralgia, 674
    Cancer ofthe Uterus, 700; Inflammation of tho
    Ovaries, 730 ; Scarlet Fever, 839 ; Syphilis Neo
    natorum, 878.

Baptisia. Disordered Conditions  of  the  Lochia,
    428;   Eczema and  Pruritus, 578;  Marasmus,
    760;  Aphthae, 779; Dysentery, 790; Small-pox,
    861.
Baryta carb.  Dysmenorrhcea,   521;  Tumors
    of the Vulva, 579; Leucorrhoea,  646;  Indiges-
    tion, 764;  Scarlet  Fever, 839;  Dropsy after
    Scarlet Fever, 845 ; Scrofula after Scarlet Fever.
    848;  Eczema Capitis, 870; Encysted  Tumors
    873;  Scrofula, 886; Rickets, 888 ; Mumps, 891.
Belladonna.  Treatment of Child after  Labor.
    213;  Nausea and Vomiting,  298; Constipation.
    310;  Diarrhoea, 317; Retention  of  Urine, 330;
    Ha?morrhoids, 347 ; False Pains,  362; Impaired
    Vision,  370;  Neuralgia, 372; Toothache, 374;
    Chorea, 377 ; Hysteria, 382,  Labor-Pains, 384;
    Rigidity of the 0s, 388; Hour-glass Contractions,
    389;   Uterine Haemorrhage, 407;  Puerperal
    Convulsions, 421; Retained Placenta, 424;  Re-
    tention  of Urine after Parturition, 425; After-
    Pains, 426 ; Disordered Conditions of the Lochia,
    428 ; Pendulous  Abdomen, 430 ; Puerperal Ma-
    nia, 459 ; Phlegmasia Dolens, 463 ; Secretion of
    Milk, 467; Scanty Supply  of Milk, 469; Galao
    torrhoca, 473;  Mastitis, 474; Abortion, 493;
    Amenorrhoea,511;  Menorrhagia, 533; Hysteria,
    565 ;  Vulvitis, 571; Erysipelatous Inflammation.
    574;  Strangulation of  Prolapsed Portion of Va-
    gina, 588; Spasms of Vagina, 589; Neuralgia
    of Vagina,  591;  Indurations of Vagina, 600;
    Vaginal Fistulas, 603 ;  Gangrene of Vagina,605 ;
    Uterine Displacements, 632; Leucorrhcea, 646;
    Metritis, 660; Cancer  of the Uterus, 700; Gan-
    grene of the Uterus, 704; Dropsy of the Uterus,
    707;  Hydatids, 715 ; Inflammation  ofthe Ova-
    ries,  730; Ovarian Tumors, 742; Mammary Can-
    cer,  748 ;  Marasmus, 760;  Indigestion, 704 ; 
CLINICAL  INDEX.                               971
    Dentition, 771; Diarrhoea, 787 , Dysentery, 790;
    Cholera  Infantum, 797 ;  Fcecal  Vomiting, 801;
    Bronchitis,   807;   Pneumonia,   811;   Croup|
    816;  Pertussis, 821;  Asthma of  Millar, 826;
    Atelectasis  Pulmonum,   829;  Scarlet Fever,
    839;  Dropsy  after Scarlet  Fever,  845;  Post-
    scarlatinal  Rheumatism, 847;  Measles, 852;
    Pneumonia  after  Measles, 853 ;  Roseola, 855;
    Pemphigus, 856; Small-pox, 861; Varicella, 865;
    Erysipelas, 867; Urticaria, 868 ;  NaBvi  Materni,
    873;  Induration of the Breasts, 877 ; Intermit-
    tent  Fever,  884;  Scrofula,  886;  Ophthalmia,
    890;  Mumps, 891;  Hiccough, 892;  Worms,
    898;  Retention of Urine, 900; Incontinence of
    Urine, 901;  Meningitis, 903; Acute Hydroceph-
    alus,  905; Disease of the Brain, 910;  Cerebro-
    spinal Meningitis,  931; Chorea, 936; Remittent
    Fever, 939;  Diphtheria, 945;  Spasms, 948.
Benzoic acid.  Marasmus, 760;  Cholera Infan-
    tum,  797; Incontinence of Urine, 901.
Berberis  v.    Dysmenorrhcea, 521;  Zfeuralgia
    of Vagina, 591; Gravel, 902.
Borax.  Nausea and  Vomiting, 298; Diarrhcea,
    318;  Labor-Pains, 384; Secretion of Milk, 467;
    Galactorrhoea, 473 ; Amenorrhoea, 511;  Dysmen-
    orrhcea,  521 ; Menorrhagia,  533;  Leucorrhcea,
    646 ;  Marasmus, 700; Indigestion, 764 ; Dentition,
    771;  Aphthae, 779; Hernia, 894.
Bovista.  Dysmenorrhcea, 521; Menorrhagia, 533;
    Nymphomania,  552;  Leucorrhcea, 646; Otor-
    rhoea, 848.
Bromine. Dysmenorrhoea, 521 ;  Menorrhagia,
    534;  Neuralgia of  Vagina,  591;  Physometra,
    711;  Croup, 816; Diphtheria, 946.
Bryonia.   Nausea and  Vomiting, 298 ;  Constipa-
    tion, 310;  Diarrhcea, 318;   False  Pains, 362;
    Neuralgia, 372 ; Syncope, 391;  Uterine  Haem-
    orrhage, 407 ; Puerperal Convulsions, 421;. After-
    Paius, 426 ;  Disordered Conditions of the Lochia,
    428;   Phlegmasia Dolens,  463;  Secretion of
    Milk, 467 ;  Scanty Supply of Milk," 469; Galac-
    torrhoea, 473;  Mastitis, 474;  Abortion, 493;
    Amenorrhoea, 611; Dysmenorrhcea, 521; Men-
    orrhagia, 534; Eczema and Pruritus, 576 ; Uterine
    Displacements, 633 ; Metritis, 660;  Hysteralgia,
    674;  Sensation of Coldness in the Ulcers, GS5;
    Dropsy of the Uterus, 707 ; Inflammation of the
    Ovaries, 731; Mammary Cancer, 748 ; Marasmus,
    760;  Indigestion,  764; Dentition, 771; Aphthae,
    779 ;  Constipation, 781;  Diarrhcea, 787 ;  Dysen-
    tery, 791;  Cholera Infant»m, 797; Regurgita-
    tion, 801; Bilious Vomiting, 801; Bronchitis,
    807 ;  Pneumonia,  811; Pertussis, 821; Atelec-
    tasis Pulmonum, 829;  Scarlet Fever, 839; Post-
    scarlatinal   Rheumatism, 847;  Measles, 852;
    Diarrhoea after Measles, 853; Bronchitis after
    Measles, 853; Pneumonia  after Measles, 853 ;
    Roseola, 855; Miliaria,  855;  Small-pox, 861;
    Erysipelas, 867 ; Urticaria, S6S ;  Eczema Capitis,
    870; Pityriasis, 872; Induration of the Cellular
    Tissue,  876;  Induration of  the Breasts, 877:
    Comedones, 878;  Jaundice,  S82;  Intermittent
    Fever, 884; Rickets, 888 ; Meningitis, 90.3 ; Acute
    Hydrocephalus, 905; Disease of the Braiu, 910;
   Cerebro-spinal Meningitis, 932; Remittent Fe-
    ver, 939;  Spasms, 948.
Bufo.   Cerebro-spinal Meningitis, 932.

Cactus grand.  Menorrhagia, 534.
Caladium.  Eczema and Pruritus, 578.
Calcarea carb.  Nausea  and  Vomiting, 299;
    Constipation, 311;  Diarrhcea,  318;  Haemor-
    rhoids, 34S;  False Pains, 363;  Lame Pelvis,
    367; Impaired Vision,  370;  Neuralgia, 372;
    Toothache, 371; Chorea, 377;  Hysteria, 382;
    Debility,  391;  Uterine Haemorrhage, 407;  Dis-
    ordered Conditions of the Lochia, 428 ; Phleg-
    masia Dolens, 463;  Sore Nipples, 464; Secretion
    of Milk, 467 ; Scanty Supply of Milk, 469; Ga-
    lactorrhoea, 473; Deterioration of Health from
    Nursing, 473 ; Child Vomits the Milk soon after .
    Nursing, 475; Abortion, 493; Amenorrhoea, 511;
    Dysinenorrhoea, 521; Menorrhagia, 534; Nym-
    phomania, 552;  Hysteria, 566;  Vulvitis, 571;
    Erysipelatous Inflammation, 574; Eczema and
    Pruritus, 576; Condylomata, 579 ; Tumors of the
    Vulva, 580 ;  Ascarides of the Vulva, 583; Neu-
    ralgia of Vagina, 591; Indurations  of Vagina,
    601; Vaginal Fistulas, 603; Gangrene of Vagina,
    605  ; Vaginal Growths, 608 ; Granular Vegeta-
    tions, 610 ; Uterine Displacements, 633 ; Leucor-
    rhoea,  646;  Metritis, 661;  Hysteralgia, 674;
    Cancer of the Uterus. 700; Dropsy of the Uterus,
    70S  ;  Hydatids, 715 ; Mammary  Cancer, 748 ;
    Marasmus, 760; Indigestion,  765;  Dentition,
    772; Constipation, 781; Diarrhoea, 787 ; Cholera
    Infantum, 797 ; Regurgitation, 801;  Vomiting
    of Ingesta, 801; Coryza,  803;  Bronchitis, 808;
    Pneumonia, 812 ; Asthma of Millar, 827; Scarlet
    Fever, 839 ; Otorrhoea, 848 ; Scrofula after Scar-
    let  Fever, 848; Varicella, 865;  Urticaria, 868;
    Eczema Capitis, 870; Pityriasis, 872; Naevi Ma-
    terni, 873; Encysted  Tumors, 873; Warts, 873 ;
    Cephalaeinatoma, 874; Rauula, 874;  Intertrigo,
    875;  Induration  of  the Cellular Tissue, 876 ■
    Induration of the Breasts, 877 ; Comedones, 878;
    Cyanosis, 880 ; Jaundice, 882 ; Intermittent Fe-
    ver, 8S4; Scrofula, 886 ; Rickets, 888; Ophthal-
    mia, S90; Hernia,  894;  Worms,  898;  Inconti-
    nence  of  Urine, 901; Gravel, 902 ;  Acute Hy-
    drocephalus, 905; Hydrocephaloid Disease, 909;
    Disease of the Brain, 910; Chorea, 936; Remit-
    tent Fever, 939.
Calcarea oxalata.  Mammary Cancer, 748.
Calc. phosph.  Lame Pelvis, 367 ;  Deterioration
    of Health from Nursing, 473; Uterine Displace-
    ments, 633 ;  Dentition, 772 ; Scrofula after Scar-
    let   Fever, 848;  Acute  Hydrocephalus, 905;
    Hydrocephaloid Disease, 909;  Disease of the
    Brain, 910.
Calendula.  Vulvitis, 572.
('amphora.  Treatment of Child  after Labor,
    213 ; Retention of Urine, 330; False Pains, 363 ;
    Labor-Pains,  385;  Syncope,  391;   Abortion,
    194 ; Erysipelatous Inflammation, 574 ; Dropsy
    of  the Uterus, 708;  Cholera Infantum, 797;
    Atelectasis  Pulmonum,  829;  Scarlet  fever,
    839;  Measles,  852;   Pemphigus, 856; Small 
972
CLINICAL  INDEX.
    pox, 861; Meningitis, 903; Disease of the Brain,
    910;  Cerebro-spinal Meningitis, 932; Spasms,
    948.
Cannabis.  Retention of  Urine, 330;  Abortion,
    494;  Menorrhagia, 534;  Nymphomania, 552 ;
    Neuralgic Pains in Extremities and other Parts
    after Scarlet Fever, 847; Retention  of Urine,
    900.
Cantharis.  Nausea and  Vomiting,  299; Diar-
    rhoea, 318 ; Retention of Urine, 330; Uterine
    Haemorrhage, 407; Puerperal Convulsions, 422;
    Retained Placenta,  424;  Retention of Urine
    after Parturition, 425; Abortion, 494; Dysmen-
    orrhcea, 521; Menorrhagia, 535; Nymphomania,
    552;  Vulvitis, 572;  Eczema and Pruritus, 576;
    Neuralgia  of Vagina, 592;  Uterine Displace-
    ments, 683 ;  Leucorrhoea, 646 ;  Metritis, 661 ;
    Dropsy ofthe Uterus, 708 ; Inflammation of the
    Ovaries, 731;  Dysentery, 791;  Small-pox, 861;
    Retention of Urine, 900;  Incontinence of Urine,
    901; Cerebro-spinal Meningitis,932; Diphtheria,
    945.
Capsicum.  Diarrhcea, 318; Retention of Urine,
    330;   Haemorrhoids, 348;   Impaired Hearing,
    369;  Diphtheria, 945.
Carbo animalis.  Impaired Hearing, 369; Dis-
    ordered Conditions of the Lochia, 429 ; Secretion
    of Milk,467; Cramps in Stomach from Nursing,
    473 ;  Great Sense of Emptiness in Stomach from
    Nursing, 473;  Mastitis, 474;  Dysmenorrlicea,
    522;  Menorrhagia, 535;  Erysipelatous Inflam-
    mation, 674;  Erectile Tumors, 581; Uterine
    Displacements, 633;  Leucorrhoea, 646; Metritis,
    661;  Cancer of the Uterus, 700 ;  Mammary Can-
    cer, 748.
Carbo veg.  Nausea and Vomiting, 299; Consti-
    pation, 310; Diarrhcea, 318; Haemorrhoids, 348;
    Varicose Veins, 353; Labor-Pains, 3S5; Syncope,
    390;  Uterine  Haemorrhage, 407;  Cramps  in
    Stomach from  Nursing, 473;  Abortion,  494;
    Amenorrhcea, 511; Dysmenorrhcea, 522; Men-
    orrhagia, 535;  Nymphomania,  552;  Vulvitis,
    672; Eczema and Pruritus, 577 ; Erectile Tumors,
    681; Haemorrhage from Erectile Tumors, 581;
    Vaginal Fistuias, 603;  Leucorrhcea,  646; Me-
    tritis, 661; Gangrene of  the Uterus, 704; Aph-
    thae,  780;  Diarrhoea,  787;  Dysentery,  791;
    Cholera Infantum, 797 ; Coryza, 803;  Pertussis,
    821; Scarlet Fever, 839; Pemphigus, 856; Small-
    pox,  862; Naevi Materni, 873; Intertrigo, 875;
    Syphilitic  Ophthalmia,  878;  Cyanosis,  880;
    Mumps, 891;  Worms,  898;  Incontinence  of
    Urine, 901; Disease of the Brain, 910.
Cascariila.  Haemorrhoids, 348.
Castor  eqnorum.  Sore  Nipples, 465;  Dys-
    menorrhea, 522.
Caulopliyllum.  Labor-Pains, 385;  Rigidity of
    the Os, 388;  Uterine  Haemorrhage, 407; Puer-
    peral Convulsions, 422 ; Retained Placenta, 425 ;
    After-Pains, 426; Disordered Conditions of the
    Lochia, 428;  Abortion, 494; Menorrhagia, 535;
    Hysteria, 570;  Eczema and Pruritus, 578 ; Neu-
    ralgia of Vagina, 592; Uterine  Displacements,
    638;  Hydatids, 715.
Causticum.  Nausea aud Vomiting, 299; Consti
    pation.311; Diarrhcea, 318; Fissure of the Anus
•    126; Retention of Urine, 330;  Haemorrhoids,
    o48; Varicose Veins, 353; Impaired  Hearing,
    369; Impaired Vision, 370; Chorea, 377;  Labor-
    Pains, 385;  Puerperal Convulsions, 422 ;  Reten-
    tion of Urine after Parturition, 425; Secretion
    of .Milk, 467; Scanty Supply of Milk, 470; Amen-
    orrhoea, 511; Dysmenorrhoea, 522; Menorrhagia,
    535; Hysteria, 566; Vaginal Fistulas, 604; Leu-
    corrhoea, 646; Hysteralgia,674; Dentition, 772;
    Pertussis, 821  ; Warts,  873; Retention of Urine,
    900; Incontinence of Urine, 901;  Chorea, 936;
    Spasms, 948.
Chamomilla.   Nausea and Vomiting, 399; Diar-
    rhoea, 318;  Haemorrhoids,  348;  False Pains,
    363; Toothache, 374 ; Labor-Pains, 385; Rigidity
    of the Os, 388; Hour-glass  Contractions, 389;
    Syncope, 390; Uterine  Haemorrhage, 408 ; Puer-
    peral Convulsions,  422; After-Pains, 426;  Dis-
    ordered Conditions of  the  Lochia, 428; Sore
    Nipples, 464;  Secretion of  Milk, 467;  Scanty
    Supply of Milk, 470;  Abortion, 494;  Amenor-
    rhoea, 611;  Dysmenorrhoea,  522 ; Menorrhagia,
    535; Hysteria, 566; Neuralgia of Vagina, 592;
    Uterine Displacements, 633;  Leucorrhcea, 646;
    Metritis, 661; Hysteralgia, 674 ; Mammary Can-
    cer, 748;  Marasmus,  760;   Indigestion, 765;
    Dentition, 773; Aphthae,  780;  Diarrhoea, 787;
    Dysentery, 791; Vomiting of Ingesta, 801;  Bil-
    ious Vomiting, 801; Coryza, 803; Croup, 816;
    Pertussis, 821; Scarlet Fever, 840;  Miliaria,
    855; Small-pox, 862;  Eczema Capitis, 870;  In-
    tertrigo, 875;  Induration  of  the  Breasts, 877;
    Jaundice, 882; Ophthalmia, 890s Hernia, 894;
    Remittent Fever. 940 ;  Spasms, 948.
Chelidonium.   Nausea   and Vomiting, 299;
    Constipation, 311; Diarrhoea, 318;  False Pains,
    363;  Amenorrhcea, 511;  Menorrhagia, 635;
    Pertussis, 821.
Cliimaphila.  Mammary Cancer, 749.
China.  Treatment of Child  after  Labor, 213;
    Nausea and Vomiting, 300; Constipation, 311;
    Diarrhoea, 318; Haemorrhoids, 348; Impaired
    Vision, 370;  Hysteria, 382;  Labor-Pains, 385;
    Syncope, 390; Debility, 391;  Uterine  Haemor-
    rhage, 408;  Puerperal Convulsions, 422; Secre-
    tion of Milk, 468; Scanty  Supply of Milk, 470;
    Galactorrhoea,  473; Deterioration  of  Health
    from Nursing, 473; Cramps in  Stomach from
    Nursing, 473;  Abortion, 494; Amenorrhcea, 511;
    Dysmenorrhcea, 522;  Menorrhagia, 535; Nym-
    phomania, 552;  Hysteria,  566; Indurations of
    Vagina, 601;  Gangrene of Vagina,605 ; Uterine
    Displacements, 633; Leucorrhcea, 646; Metritis,
    661; Hysteralgia, 674:  Cancer of the Uterus,
    701; Gangrene of the  Uterus, 704; Dropsy of
    the  Uterus, 703; Hydatids, 715; Inflammation
    of the Ovaries, 731; Ovarian Tumors, 742; Mar-
    asmus,  761;   Indigestion, 765; Diarrhoea, 787;
    Dysentery, 791; Cholera Infantum, 798; Vomit-
    ing  of Ingesta, 801;   Bilious Vomiting, 801;
    Atelectasis Pulmonum, 829;  Scarlet Fever, 840;
    Small-pox, 862; Cephalhematoma, 874  Syphilis 
CLINICAL  INDEX.
973
    Neonatorum, 8781 Cyanosis, 880 ; Jaundice, 863;
    Intermittent Fever, 884; Worms, 898; Inconti-
    nence of Urine, 901;  Hydrocephaloid Disease,
    909;  Disease of the Brain, 910; Remittent Fever,
    940.
Chininum.  Dysmenorrhcea, 522.
Chromic acid.  Condylomata, 679.
Cicuta  vir.  Impaired Vision, 370;  Puerperal
    Convulsions, 422;  Dysmenorrhoea, 522; Denti-
    tion,  772; Eczema Capitis, 870; Worms, 898;
    Cerebro-spinal Meningitis, 932;  Chorea,  936;
    Spasms, 948.
CimUifnga. False Pains, 363; Neuralgia, 372 ;
    Labor-Pains, 385 ; Rigidity or the Os, 388 ; Puer-
    peral Convulsions, 422;  Retained Placenta, 424;
    After-Pains, 426 ; Abortion, 494;  Amenorrhcea,
    511;  Dysmenorrhoea, 522;  Menorrhagia,  535 ;
    Hysteria, 570; Neuralgia of Vagina, 592; Uterine
    Displacements, 638; Inflammation ofthe Ovaries,
    731;  Small-pox, 862; Meningitis, 903; Disease
    of the Brain, 910;  Chorea, 936.
Cina.   Nauseaand Vomiting,300;Impaired Vision,
    370;  Secretion of Milk, 468 ;  Menorrhagia, 535;
    Marasmus, 760;   Indigestion, 765;  Dentition,
    772;  Regurgitation,  801; Bronchitis, 808; Per-
    tussis,  827; Scarlet  Fever, 840; Scrofula, 886;
    Hernia, 894:   Worms,  898;  Incontinence  of
    Urine, 901; Disease  of the Brain, 910; Chorea,
    936;  Remittent Fever, 940;  Spasms, 948.
Cinchoninum sulph.  Menorrhagia, 535.
Cinnabaris.  Dysmenorrhoea,  522;   Chancres,
    578 ;  Condylomata, 979 ; Leucorrhoea, 647.
Cinnamon.  Abortion, 494.
Cistus c.  Mastitis, 474; Mammary Cancer, 749.
Clematis erec. Induration of Vagina, 601; Can-
    cer of the Uterus, 701; Mammary Cancer, 749 ;
    Varicella, 865; Eczema Capitis, 870.
Cocculus.  Nausea and Vomiting, 300;  Constipa-
    tion, 311;  Diarrhcea, 318;  False Pains,  363;
    Neuralgia, 372; Chorea, 377 ; Labor-Pains, 385;
    Hour-glass Contractions, 389 ;  Syncope,  391;
    Puerperal  Convulsions, 422;  Abortion,  491;
    Amenorrhoea, 511;  Dysmenorrhcea, 522; Men-
    orrhagia, 635 ; Nymphomania, 552;  Hysteria,
    566:  Spasms of Vagina, 589; Uterine Displace-
    ments, 634; Leucorrhcea,  647;  Metritis, 661;
    Hysteralgia. 674; Cerebro-spinal Meningitis,932;
    Chorea, 936.
Coccus cacti.   Retention of Urine, 330; Menor-
    rhagia, 636; Haemorrhage from Erectile Tumors,
    581;  Leucorrhcea,  647;  Pertussis, 821; Mumps,
    891.
CoflFea.   False Pains, 363; Nenralgia, 373 ; Labor-
    1'ains, 385 ; Syncope, 390 ; Uterine Haemorrhage,
    10S;  Puerperal Convulsions, 422;  After-Pains,
    427 ;  Disordered Conditions of the Lochia, 429;
    Scanty Supply of Milk, 470; Dysmenorrhoea,
    522;  Menorrhagia,  536;  Nymphomania,  652;
    Hysteria, 566; Kczema and Pruritus, 577 ;  Leu-
    corrhoea, 647; Metritis, 661; Hysteralgia, 674;
    Indigestion, 765; Dentition, T3; Scarlet Fever,
    840;  Measles, 852; Varicella. 465; Spasms, 948.
Colchicum.  Dropsy of  the Uterus, 708 ; Dysen-
    tery, 791 ; Scarlet Fever, 840; Neuralgic Pains
    in  Extremities  and other Parts after  Scarlet
    Feyer, 847.
Collinsonia.  Haemorrhoids, 348 ; Menorrhagia,
    536;  Eczema and Pruritus, 578; Constipation,
    782.
Colocynthls.  Diarrhcea,  318;  Retention  of
    Urine,  330;  Haemorrhoids, 349; False Pains,
    363 ;  Disordered Conditions of the Lochia, 429 ;
    Amenorrhcea, 511; Dysmenorrhcea, 523;  Neu-
    ralgia of Vagina, 592; Uterine Displacements,
    634;  Metritis, 661; Inflammation of the Ovaries,
    731;  Mammary  Cancer, 749; Indigestion,  765;
    Dentition, 773 ; Diarrhcea, 787 ; Dysentery, 791;
    Jaundice, 883; Retention of Urine, 900;  Remit-
    tent Fever, 940.
Conium.  Nausea and Vomiting, 300; Constipa-
    tion,  311«j Diarrhoea, 318; Retention of Urine,
    330;  Labor-Pains, 385; Hour-glass Contractions.
    389 ;  Galactorrhea, 473; Abortion, 494;  Amen-
    orrhoea, 512; Dysmenorrhcea, 523; Nymphoma-
    nia, 552; Hysteria, 566 ; Vulvitis, 572; Eczema
    and  Pruritus, 577; Neuralgia of Vagina, 692-
    Induration  of  Vagina,  601; Vaginal  Fistulas,
    603;  Vaginal Growths,  608;  Uterine Displace-
    ments, 634; Leucorrhcea, 647;  Metritis,  662:
    Hysteralgia, 674; Cancer of the Uterus,  701 •
    Dropsy of the Uterus, 708; Inflammation of the
    Ovaries, 731; Ovarian Tumors, 742j Mammary
    Cancer, 749; Marasmus,  761; Pertussis.  821;
    Scarlet Fever, 840; Induration of the Cellular
    Tissue, 876; Mumps, 891; Incontinenco of Urine,
    901.
Cornus cir.   Eczema and Pruritus, 578.
Coralia rub. Chancres, 578; Pertussis, 821.
Creasotum.   Uterine Haemorrhage, 408;  Dis-
    ordered Conditions of the Lochia, 429; Abor-
    tion,  494 ; Dysmenorrhoea, 523 ;  Menorrhagia.
    536;  Vulvitis, 672; Eczema and Pruritus,  677 ;
    Erectile Tumors, 581; Haemorrhage  from Erec-
    tile Tumors, 581;  Neuralgia  of  Vagina,  592,
    Gangrene ofthe Vagina, 605; Leucorrhoea, 647,
    Metritis, 662; Cancer of the Uterus, 701;  Gan-
    grene of the Uterus, 704;  Mammary  Cancer
    749 ;  Marasmus, 761; Dentition, 773 ;  Inconti-
    nence of Urine, 901; Spasms, 949.
Crocus.  Nausea  and  Vomiting, 300; Diarrhoea,
    319;  Chorea, 377;  Uterine  Haemorrhage,  408 j
    Disordered Conditions of the Lochia, 429 ; Pen-
    dulous  Abdomen, 430; Abortion, 494; Amenor-
    rhcea, 512; Dysmenorrhoea, 523;  Menorrhagia,
    636 ; Metritis, 662 ; HysteYalgia, 674; Chorea, 936.
Croton tig.   Sore Nipples, 465;  Secretion of
    Milk, 468;  Erysipelatous Inflammation,  474;
    Eczema and Pruritus,  577;  Diarrhoea,  787 ,
    Cholera Infantum, 798.
Cuprum. Nauseaand Vomiting,300: Diarrhoea,
    319; False Pains, 363 ; Chorea, 377 ; Labor-Pains,
    386;  Hour-glass  Contractions, 389; Puerperal
    Convulsions, 422; After-Pains, 427;  Amenor-
    rhoea,  512;  Dentition,  774;  Pertussis,  821;
    Atelectasis Pulmonum, 829; Scarlet Fever,  840 ;
    Meningitis, 903 ; Disease of the Brain, 911 ;  Cer-
    ebro-spinal   Meningitis,  932;   Chorea,  937
    Spasms, 949. 
974
CLINICAL  INDEX.
Cuprum acet.  Spasms, 949.
Cyclamen.   Nausea and  Vomiting, 300; Menor-
    rhagia, 536.
Cypriped ium.  Hysteria, 570; Neuralgia, of Va-
    gina, 592.

Digitalis.  Nausea and Vomiting, 301; Diarrhoea,
    319; Syncope, 390; Nymphomania, 552; Dropsy
    of the Uterus, 708; Neuralgic Pains in  Extrem-
    ities  and other Parts after Scarlet Fever, 847;
    Cyanosis, 880;  Jaundice, 883;  Intermittent
    Fever, 884;  Worms, 898; Disease of the Brain,
    911.
Doliclios p.   Itching of the Skin after  Measles,
    854.
Drosera.  Nausea and Vomiting, 301; Diarrhoea,
    319: Leucorrhoea,  647; Bronchitis, 808 ; Pertus-
    sis, 821; Measles, 852.
Dulcamara.  Nausea and Vomiting, 301; Diar-
    rhcea, 319;  Retention of Urine, 331; Disordered
    Conditions of the Lochia, 429; Secretion of Milk,
    468; Scanty Supply of Milk, 470; Abortion, 494;
    Amenorrhcea, 512; Nymphomania, 552; Eczema
    and Pruritus, 577;  Uterine Displacements, 634;
    Dropsy of  the Uterus, 708;  Indigestion, 765;
    Dentition, 774; Diarrhcea, 787;  Dysentery, 791;
    Cholera Infantum, 798; Coryza, 803; Bronchitis.
    808; Pertussis, 821; Scarlet Fever, 840;  Measles,
    852;  Varicella, 865; Urticaria, 868;  Eczema
    Capitis, 870; Pityriasis, 872 ; Warts, 873 ; Indu-
    ration of the Cellular Tissue,  876;  Syphilitic
    Cutaneous  Affections, 878; Jaundice, 883;  Re-
    tention of Urine, 900.

Krigeron. Disordered Conditions of the Lochia,
    429;  Menorrhagia, 536;  Leucorrhcea, 647.
Eugenia.  Dysmenorrhcea, 523; Comedones, 878.
Eupatorium,  Ovarian Tumors, 742.
Euphorbinm.  Diarrhoea, 319.
Euphrasia.   Amenorrhoea, 512 ; Dysmenorrhcea,
    523 ;  Hysteria, 567 ; Condylomata, 578 ; Coryza,
    803;  Measles, 852;  Ophthalmia, 890.

tTerrum.  Nausea and Vomiting, 301;  Diarrhcea,
    319;  Varicose Veins, 353; Debility, 391; Uterine
    Haemorrhage, 408; After-Pains, 427 ; Abortion,
    495;  Amenorrhoea, 512;  Dysmenorrhoea, 523;
    Menorrhagia, 536; Vulvitis,  572;  Eczema  and
    Pruritus, 577;  Ascarides  of  the  Vulva, 5S4;
    Uterine Displacements, 634; Leucorrhoea, 647;
    Metritis, 662; Hysteralgia, 674; Dropsy  of the j
    Uterus,  708; Hydatids, 715; Marasmus, 761;]
    Dentition, 774; Diarrhcea, 787;  Pertussis, 821; I
    Worms, 898.
Filix mas.   Worms, 898.
Fluoric acid.  Varicose V%ins, 353;   Menor-
    rhagia, 536.

Galium aper.  Mammary Cancer, 749.
Gelseminum.  Diarrhoea, 319; False Pains, 363 ;
    Lame Pelvis, 367; Neuralgia, 373; Toothache,
    375;  Labor-Pains,  386; Rigidity of the Os, 338 ;
    Puerperal Convulsions, 422 ; Retained Placenta,
    424;  After-Pain», 427; Abortion, 495;  Amenor-
    rhcea, 612 ,  bysmenorrhoea, 523,  Hysteria, 570;
    Leucorrhoea, 647;  Asthma of Millar, 82H ; Scar-
    let Fever, 840; Neuralgic Pains in Extremities
    and other Parts after Scarlet lever, 847 ;  In-
    continence of Urine, 901; Meningitis, 903; Dis-
    eases ofthe Brain, 911; Cerebro-spinal Meningi-
    tis, 932 ; Remittent Fever, 940.
Glonoine. Neuralgia, 373;  Cerebro-spinal Me-
    ningitis, 932.
Gossypium.   Nausea and Vomiting, 301: Labor-
    Pains, 386;  Retained Placenta, 425.
Graphites.   Nausea and Vomiting, 301; Consti-
    pation, 311; Diarrhoea, 319; Retentiou of Urine,
    331;  Haemorrhoids,  349; Varicose Veins, 353;
    Impaired Hearing, 369; Labor-Pains, 38* ; Sore
    Nipples, 465; Mastitis, 475; Amenorrhcea. 512;
    Dysmenorrhcea, 523 ; Nymphomania, 652; Vul-
    vitis, 572;  Erysipelatous  Inflammation,  574;
    Eczema and Pruritus, 577; Tumors of the Vulva,
    680 ;  Neuralgia of Vagina, 592; Serous Cysts of
    the Vagina, 610;  Uterine Displacements, 634;
    Leucorrhcea, 647;  Metritis.  662; Hysteralgia,
    674; Cancer of the Uterus, 701; Hydatids. 715 ;
    Inflammation of the Ovaries, 731; Ovarian  Tu-
    mors, 742;  Mammary  Cancer. 749;  Marasmus,
    761;  Dentition, 774;  Constipation, 782; Diar-
    rhoea, 787;  Scrofula after  Scarlet Fever, 848;
    Vaccination, 864;  Varicella, 865;  Erysipelas,
    867;  Eczema Capitis, 870;  Pityriasis, 872; En-
    cysted Tumors, 873;  Intertrigo, 875;  Come-
    dones, 878;  Incontinence of Urine, 901.
Gratiola.  Fissure of the Anus. 326;  Dysmenor-
    rhoea, 523; Nymphomania, 553; Cholera  In-
    fantum, 798.

Hamamelis.  Haemorrnoids, 349; Varicose Veins,
    353;  Uterine Haemorrhage 408; Menorrhagia,
    536;  Eczema  and Pruritus.  578;  Manmiary
    Cancer, 749; Rubeola Maligna, 853; Small-pox,
    862.
Hedeoma. Amenorrhoea, 512; Leucorrhoea, 647.
Helleborus.   Nausea and Vomiting, 301; Diar-
    rhcea, 319;  Retention of Urine, 331; Puerperal
    Convulsions, 422; Amenorrhcea, 512;  Dropsy of
    the Uterus, 708 ; Dentition. 774;  Scarlet Fever,
    840;  Dropsy after  Scarlet J'ever. 645 ; Meningl
    tis, 903; Acute Hydrocephalus, 905; Disease of
    the Brain, 911; Spasms, 949.
Helonias.  Dysmenorrhcea, 623;  Menorrhagia
    536;  Uterine Displacements,  638; Leucorrhcea
    647.
Hepar  8.  Nausea and Vomiting, 301; Consti-ia-
    tion, 311; Diarrhoea, 319; Retention of Urine,331;
    Rhagades, 431; Mastitis, 475; Menorrhagia, 536;
    Erysipelatous Inflammation, 574; Chancres, 578;
    Tumors  of  the Vulva, 580;  Leucorrhcea, 617;
    Metritis, 662; Ulcerations of the Uterus, 6S4;
    Inflammation of the Ovaries, 731 ; Mammary
    Cancer, 749; Marasmus, 761; Indigestion, 765;
    Dentition, 774; Diarrhcea, 787 ; Bronchitis, 808;
    Pneumonia, 812;  Croup, 816; Pertussis, 821;
    Scrofula after Scarlet Fever, 848; Measles, 863;
    Miliaria, 855;  Small-pox, 862; Varicella, 865;
    Urticaria, 868; Eczema Capitis, 871; Encysted 
CLINICAL  INDEX.                               975
   Tumors, 873: Intertrigo, 875 ; Induration of the
   Breasts, 877; Syphilis Neonatorum, 878;  Syph-
   ilitic Cutaneous Affections, 878; Jaundice, 883;
   Scrofula,  8^G;  Ophthalmia,  890; Mumps, 892;
   Incontinence of Urine, 901.
Hydrastis.  Eczema and Pruritus, 678 ; Leucor-
   rhoea, 647;  Ulcerations  of the  Uterus, 684;
   Ovarian Tumors, 742; Mammary  Cancer, 749;
   Constipation, 782 ;  Small-pox, 862.
Hydrocyanic  acid.  Cerebrospinal  Meningi-
   tis, 933: Spasms, 949.
Hydrophobin.  Puerperal Convulsions, 422.
Hyoscyamus.  Diarrhoea, 319 ; Impaired Vision,
   371; Toothache, 375; Chorea,  377;  Hysteria,
   382; Labor-Pains, 386; Hour-glass Contractions,
   389 ; Uterine Haemorrhage, 408 ; Puerperal Con-
    vulsions, 423; Retention of  Urine  after Parturi-
    tion, 425 ; After-Pains, 427; Disordered Condi-
    tions ofthe Lochia, 429 ; Puerperal Mania, 459 ;
    Abortion, 495 ; Amenorrhoea,  512; Dysmenor-
    rhoea, 624: Menorrhagia, 536;  Nymphomania,
    553; Hysteria, 567; Metritis, 662; Hysteralgia,
    674; Hydatids, 715;  Dentition, 775;  Pertussis,
    822 ; Atelectasis Pulmonum. 829 ;  Scarlet Fever,
    840; Measles,  853; Small-pox,  862; Hiccough,
    892; Retention of Urine, 900 ;  Meningitis, 903;
    Disease of the Brain, 911;  Cerebro-spinal Men-
    ingitis, 933; Chorea, 936; Spasms, 949.
 Hypericum.  Dysmenorrhoea, 524; Leucorrhoea,
    647.

 [gnatia.  Nausea and Vomiting, 301; Constipa-
    tion, 312; Diarrhcea, 320;  Fissure of the Anus,
    326: Haemorrhoids, 349 ; Neuralgia. 373 ; Chorea,
    377; Hysteria, 382; Labor-Pains, 386;  Syncope,
    391; Uterine Haemorrhage, 408; Puerperal Con-
    vulsions, 423; After-Pains, 427 ; Disordered Con-
    ditions of the Lochia, 429 ;  Great  Sense of Emp-
    tiness  in Pit of  Stomach  from  Nursing, 473;
    Abortion, 495 ; Amenorrhcea, 512; Dysmenor-
    rhcea.  524; Menorrhagia, 536; Nymphomania,
    553; Hysteria, 567;  Ascarides of the  Vulva,
    584; Spasms of Vagina, 590;  Uterine Displace-
    ments, 634;  Leucorrhcea,  647;  Metritis, 662;
    Hysteralgia, 675; Inflammation of the Ovaries,
    731;  Indigestion, 765;  Dentition, 776; Inter-
    trigo,  876; Jaundice, 883;  Ophthalmia, 890;
    Hiccough, 892;  Worms,  898; Disease of the
    Brain, 911; Chorea, 936 ; Spasms, 949.
 Indigo.   Dysmenorrhcea. 624.
 Iodine.  Debility, 392; Leucorrhoea. 647; Cancer
    of the  Uterus, 701; Marasmus, 761 ; Regurgi-
    tation, 801; Croup, 817; Scrofula, 886.
 Ipecac.  Nausea and Vomiting,  301;  Diarrhcea,
    320; False Pains,363; Labor-Pains,386; Uterine
    Htemorrhage, 409; Puerperal Convulsions, 423;
    Abortion,  495;  Dysmenorrhcea,  524;  Menor-
    rhagia, 537 ;  Hysteria, 567 ; Metritis, 662 ; Ilys-
    teralg" -  675; Marasmus, 761; Indigestion, 765:
    Dentitf n, 775; Diarrhcea, 787 ; Dysentery, 791;
    Cholera Infantum, 7l»8 ; Vomiting of Blood, 801;
    Regurgitation, 801; Vomiting of Ingesta, 8ol;
    Bilious  Vomiting,  801;  Bronchitis, 808; Per-
    tussis, 822; Asthma of Millar, 826; Scarlet Fever,
    840;  Measles,  853:  Bronchitis  after Measles,
    853;  Small-pox, 862;  Jaundice, 883; Rickets,
    888 ; Hiccough, 892; Worms. 898; Retention of
    Urine, 900; Disease of the Brain, 911: Remittent
    Fever, 940; Spasms, 949.
Iris  vers.   Diarrhoea,  320; Indigestion, 765;
    Diarrhoea, 787 ; Vomiting of Ingesta, 801.

Jacaranda.  Chancres, 578.
J a cea.  Eczema Capitis, 871.
Jalapa.  Indigestion, 765.
Jodium.  Nausea  aud  Vomiting, 302; Constipa-
    tion, 312; Diarrhoea, 320; Uterine Haemorrhage,
    409;  Amenorrhea,  512; Dysmenorrhcea, 524;
    Menorrhagia,  537;  Nymphomania, 553; Hys-
    teria, 567; Metritis, 662; Ovarian Tumors, 742;
    Asthma of Millar, 826.

Kali b.  Nausea and Vomiting, 302;  Secretion of
    Milk, 468; Dysmenorrhoea, 524; Chancres, 578 ;
    Uterine Displacements, 634; Leucorrhcea, 647;
    Coryza, 803; Croup, 817; Pertussis, 822; Measles,
    853; Diphtheria, 945.
Kali c.   Nauseaand Vomiting, 302; Constipation,
    312; Diarrhcea, 320; Haemorrhoids, 319; Lame
     Pelvis, 367; Labor-Pains, 386;  Hour-glass Con-
    tractions, 389; Debility, 392; Puerperal  Convul-
    sions, 423; After-Pains, 427;  Puerperal  Mania,
    459}  Phlegmasia Dolens, 463;  Abortion, 495;
    Amenorrhcea, 513;  Dysmenorrhoea, 524; Vul-
    vitis, 572; Eczema and Pruritus, 677;  Tumors
    of the Vulva, 580;  Neuralgia of Vagina, 592;
    Uterine Displacements, 634; Leucorrhoea, 648;
    Metritis, 662; Hysteralgia, 675; Dropsy of  the
    Uterus, 709;  Hydatids, 715;  Pertussis, 822;
    Scarlet Fever, 840;  Dropsy after Scarlet Fever,
    845 ; Erysipelas, 867 ;  Disease of the Brain, 911.
 Kali hyd.  Dysmenorrhoea, 524; Chancres, 578 j
    Leucorrhoea, 648.
 Kali nit.  Dysmenorrhoea, 524.
 Kalmia.  Dysmenorrhoea, 524.
 Kaolin.  Croup, 817.

 Lachesis.  Diarrhoea, 320; Fissure of the Anns,
    326;  Retention of  Urine, 331;  Haemorrhoids,
    349;  Impaired  Hearing,  369;  Hysteria, 382;
     Syncope, 391; Uterine Haemorrhage, 409 ; Puei-
     peral  Convulsions, 423 ; Ulceration of the Um-
     bilicus, 431; Secretion of Milk, 468; Mastitis,
    475;  Amenorrhoea, 613;  Dysmenorrhcea, 524;
     Menorrhagia, 637 ;  Nymphomania, 553 ; Hys-
     teria,  567 ;  Erysipelatous  Inflammation, 574 ;
     Haemorrhage from Erectile Tumors, 582; Stran-
     gulation of Prolapsed Portion  of Vagina, 588;
     Concomitant Symptoms of Vaginal  Fistulas,
     604;  Gangrene of  Vagina, 605;  Uterine  Dis-
     placements, 635;  Leucorrhoea, 648;  Metritis,
     663; Cancer of  the Uterus, 701; Inflammation
     of the Ovaries, 731;  Ovarian Tumors, 742 ; Mam-
     mary  Cancer,  749;  Dentition,  775; Diarrhoea,
     787;  Dysentery, 791;  Croup,  817 ; Pertussis,
     822;  Asthma of Millar, 826; Scarlet Fever, 841 ;
     l'ost-scarlatinal  Rheumatism, 847;  Neuralgic
     "ains in Extremities and ether Parts after Scar- 
976                              CLINICAL  INDEX.
    let Fever, 847; Measles, 853; Rubeola Maligna,
    853; Pemphigus, 856 ; Small-pox, 862; Erysipe-
    las, 867;  Cyanosis, 880;  Intermittent  Fever,
    884;  Ophthalmia, 890;  Worms, 89S; Cerebro-
    spinal Meningitis, 933; Diphtheria, 946; Spasms,
  .  949.
Lachnantes.  Diphtheria, 946.
Lactuca.  Dropsy of the Uterus, 709.
Laurocerasus.  Nausea and Vomiting, 302; Con-
    stipation,  312;  Diarrhcea,  320;  Retention  of
    Urine, 331; Puerperal Convulsions, 423; Dys-
    menorrhcea, 524;  Menorrhagia, 537; Cholera
    Infantum, 798; Asthma of Millar, 826; Cyanosis,
    880; Chorea, 936; Spasms, 949.
Ledum. Constipation, 312; Diarrhcea,  320; Dys-
    menorrhcea, 525;  Menorrhagia, 637; Vaginal
    Fistulas,  603;  Uterine  Displacements, 635;
    Dropsy of the Uterus, 709.
Leptandria.  Diarrhcea, 320; Loucorrhcea, 648.
Lilium t.   Amenorrhcea, 513;  Dysmenorrhcea,
    525 ; Uterine Displacements, 635.
Lobelia inflat.  Rigidity of the Os, 388 ; Dys-
    menorrhoea, 525.
Lycopodium.  Nausea and Vomiting, 302 ; Con-
    stipation,  312;  Diarrhcea, 320;  Retention  of
    Urine, 331; Haemorrhoids, 349; Varicose Veins,
    353;  False Pains, 363;  Hysteria, 3S2;  Labor-
    Pains, 386;  Debility, 392; Uterine Haemorrhage,
    409;  Retention of Urine after Parturition, 425 ;
    Ulceration of the Umbilicus, 431;  Phlegmasia
    Dolens, 463;  Sore Nipples, 465; Deterioration
    of Health  from  Nursing, 473; Abortion, 495;
    Amenorrhoea, 513; Dysmenorrhcea, 625; Men-
    orrhagia, 537; Nymphomania, 553;  Hysteria,
    567;  Vulvitis, 572; Eczema and Pruritis, 577 ;
    Condylomata, 579; Erectile Tumors, 6S1; Neu-
    ralgia of Vagina, 592; Induration  of Vagina,
    601 ;   Vaginal Fistulas, 603; Vaginal Growths,
    608 ;  Serous Cysts of the Vagina, 610; Granular
    Vegetations, 610;  Uterine Displacements, 635;
    Leucorrhcea, 648;  Metritis, 663; Ulcerations  of
    the  Uterus, 684;  Cancer of the Uterus, 702;
    Dropsy of the Uterus, 709 ; Physometra, 711;
    Hydatids,  715;  Inflammation  of the  Ovaries,
    731;  Ovarian Tumors, 742;  Mammary Cancer,
    749; Marasmus,761; Indigestion, 765; Dentition,
    775;   Constipation, 782;  Regurgitation, 801;
    Vomiting  of Ingesta, 801;  Bronchitis, 808;
    Pneumonia,  811;  Scarlet Fever, 841;  Dropsy
    after Scarlet Fever, 845; Erysipelas, 867; Eczema
    Capitis, 871;  Pityriasis, 872;  Naevi  Materni,
    873; Warts, 873;  Intertrigo, 875; Intermittent
    Fever,884; Hernia,894; Worms, 898; Retention
    of  Urine,  900;  Incontinence  of  Urine, 901;
    Gravel, 901;  Cerebro-spinal Meningitis, 933;
    Chorea, 936; Diphtheria, 946.

9Iagnesia c.  Nausea and Vomiting, 302; Diar-
    rhoea, 320;  Neuralgia, 378; Toothache, 375;
    Amenorrhoea, 513 : Dysmenorrhcea, 525 ; Men-
    orrhagia, 537; Marasmus, 761; Indigestion, 765;
    Dentition, 775; Diarrhcea, 787;  Remittent Fe-
    ver, 940.
Magnesia mur.   Nausea  and Vomiting, 302; I
     Constipation,  312;   Labor-Pains,  386;  Amen-
     orrhcea,  513;  Dysmenorrhoea, 525;  Hysteria,
     667; Indurations of Vagina, 601;  Uterine Dis-
     placements, 635;  Leucorrhcea, 648; Metritis,
     663; Hysteralgia, 675; Cancer of  the  Uterus,
     702; Dentition, 775;  Diarrhoea, 787.
 Magnesia  sulph.  Dysmenorrhoea, 525.
 Manganum.   Lame Pelvis,367 ; Dysmenorrhcea,
     525; Leucorrhcea, 648.
 Mephitis.   Pertussis, 822.
 Mercurius cor.  Dysentery, 791.
 Mercurius jod.  Chancres, 678; Asthma of Mil-
     lar, 827 ;  Scrofula after Scarlet Fever, 848.
 Mercurius prot.  Scarlet  Fever,  841; Diph-
     theria, 946.
 Mercurius sol.   Nausea and  Vomiting, 302;
     Constipation, 312; Diarrhcea, 320;  Retention of
     Urine, 331; Haemorrhoids, 349 ; Impaired Hear-
     ing, 369 ; Toothache,375;  Uterine Haemorrhage,
     409;  Puerperal  Convulsions, 423;  Disordered
     Conditions of the Lochia,  429; Sore Nipples,
     465; Secretion of Milk, 468 ; Scanty Supply of
     Milk, 470; Mastitis,475; Abortion,495 ; Amen-
     orrhoea, 613; Dysmenorrhcea, 525; Menorrhagia,
     537; Nymphomania,  553;  Hysteria, 567; Vul-
     vitis,  672; Erysipelatous Inflammation,  675;
     Eczema and Pruritus, 577 ; Chancres, 678 ; Pro-
     lapse of  the Vagina,  587;  Spasms of Vagina,
    590; Neuralgia of Vagina, 692; Induration  of
     Vagina, 601;  Vaginal Fistulas, 604; Vaginal
    Growths,  608;  Granular  Vegetations,  610;
     Uterine Displacements, 635; Leucorrhcea, 648;
    Metritis, 663; Sensation of Coldness in  Ulcers,
    685 ; Cancer of the Uterus, 702; Dropsy of the
    Uterus, 709;   Mammary  Cancer, 749;  Maras-
    mus, 761; Indigestion, 765;  Dentition,  776;
    Aphthae,  780;   Constipation,  782;  Diarrhcea,
    787; Dysentery, 792; Cholera Infantum, 79S;
    Bilious ATomiting, 801; Coryza, 804; Pneumo-
    nia, 811;  Pertussis,  822 ;  Scarlet  Fever, 841;
    Neuralgic Paius in Extremities and other Parts
    after Scarlet Fever, 847; Otorrhoea, 848; Measles,
    853; Diarrhcea after Measles, 853 ; Roseola, 855 ;
    Small-pox, 862; Varicella, 805;  Erysipelas, 867;
    Eczema Capitis, 871;  Pityriasis, 872; Ranula,,
    874; Intertrigo, 875; Syphilis Neonatorum, 878 ;
    Syphilitic Ophthalmia, 878;  Condylomata, 878 ;
    Jaundice,  883; Intermittent Fever, 884 ; Scrof-
    ula, 886; Ophthalmia, 890; Mumps, 892; Worms,
    898; Retention of Urine, 900; Disease  of the
    Brain, 911 ; Remittent Fever, 940; Diphtheria,
    946; Spasms, 949.
Mercurius viv.  Chancres, 578.
Mezereum.  Diarrhcea, 321; Fissure of the Anus,
    326; Toothache, 375; Vaginal Growths,  608;
    Leucorrhoea, 648; Scrofula, 886.
Moschus.  Nauseaand  Vomiting, 303; Hysteria,
    382 ; Dysmenorrhcea, 525;  Menorrhagia,  537 ;
    Nymphomania, 563; Hysteria, 668 ;  Asthma of
    Millar, 826.
Murex.   Dysmenorrhcea, 625;  Cancer of the
    Uterus, 702.
Muriatic acid.  Diarrhcea, 321; Haemorrhoids
   360; Debility, 392; Dysmenorrhcea, 625; Men 
CLINICAL INDEX.
977
    orrhagia, 637; Neuralgia of Vagina, 592 ; Leu-
    corrhoea, 648 ; Ulcerations  of the Uterus, 684;
    Scarlet Fever,  841;  Diuresis, 900; Remittent
    Fever, 940.
Mygale.  Chorea, 937.
Natrum c.   Hysteria, 382;  Labor-Pains,  386;
    Dysmenorrhcea, 526; Menorrhagia, 537;  Nym-
    phomania, 553 ;  Leucorrhcea, 648;  Hydatids,
    715.
Natrum  mur.   Nausea and  Vomiting,  302;
    Constipation, 312;  Diarrhcea, 321;  Fissure of
    the  Anus, 326;  Haemorrhoids, 350; Impaired
    Vision, 371; Labor-Pains, 386; Amenorrhcea,
    513;  Dysmenorrhoea, 526;  Menorrhagia, 637 ;
    Nymphomania, 553;  Hysteria, 668 ;  Vulvitis,
    572;  Eczema and  Pruritus, 577; Neuralgia of
    Vagina, 592; Uterine Displacements, 635;  Leu-
    corrhoea, 648 ; Hysteralgia, 675; Ranula, 374;
    Comedones, 878;  Chorea, 936.
Natrum sulph.   Dysmenorrhoea, 526.
Niccolum.   Dysmenorrhcea, 526; Leucorrhoea,
    648.
Nitric acid.  Nausea  and Vomiting, 303;  Con-
    stipation, 312; Fissure  of  the Anus, 327; Re-
    tention of Urine,  332;  Haemorrhoids, 350; Im-
    paired  Hearing,  369;  Uterino Haemorrhage,
    409;  Dysmenorrhcea, 526; Menorrhagia, 537;
    Vulvitis, 572; Eczema and Pruritus, 577; Chan-
    cres, 578; Condylomata, 579 ;  Tumors of the
    Vulva, 580; Erectile Tumors, 581;  Neuralgia
    of Vagina, 592; Vaginal Fistulas, 603;  Vaginal
    Growths,  608;   Granular  Vegetations,  610;
    Uterine  Displacements, 636; Leucorrhoea, 648;
    Cancer of the Uterus,  702; Mammary Cancer,
    749;  Constipation, 782;  Scarlet  Fever, 841;
    Warts, 873; Syphilis Neonatorum, 878;  Syph-
    ilitic Neonatorum, 878;  Syphilitic Cutaneous Af-
    fections, 878; Condylomata, 878; Jaundice, 8S3;
    Retention of Urine,  900.
Nitrum.  Leucorrhoea, 648.
Nux juglans.  Dysmenorrhoea, 526; Menorrha-
    gia, 637 ; Chancres, 57S.
Nux mosch.  Nausea and Vomiting, 303; Con-
    stipation, 312 ;  Diarrhoea, 321; Toothache, 375 ;
    Uterine  Haemorrhage, 409 ; Puerperal Convul-
    sions, 423; Abortion, 495;  Amenorrhoea, 613;
    Dysmenorrhcea, 526 ; Menorrhagia, 537 ;  Hys-
    teria, 568; Uterine Displacements, 636; Leucor-
    rhoea, 649;  Dentition, 776.
Nux vomica.  Nausea and Vomiting, 303; Con-
    stipation, 313 ; Diarrhcea, 321;  Fissure of the
    Anus, 327 ; Retention of Urine, 332;  Haemor-
    rhoids, 350; Varicose Veins, 353;  False Pains,
    363; Impaired Vision, 371;  Neuralgia, 373;
    Toothache, 375;   Chorea,  377 ;  Hysteria, 382;
    Labor-Pains, 387 ; Hour-glass Contractions, 389 ;
    Syncope, 390;  Debility, 392;  Uterine  Haemor-
    rhage, 409; Puerperal Convulsions, 423; Reten-
    tion  of Urine after Parturition,  426;  After-
    Pains, 427; Disordered Conditions of the Lochia,
    429 ; Phlegmasia Dolens, 463; Secretion of Milk,
    468; Abortion, 495; Dysmenorrhoea, 626; Men-
    orrhagia, 537 ; Nymphomania, 653; Hysteria,
    668 ; Vulvitis, 572; Eczema and Pruritus, 577;
          62
    Ascarides ofthe  Vulva, 584; Strangulation of
    Prolapsed Portion of Vagina, 588   Spasms of
    Vagina, 690; Neuralgia of Vagina, 592;  Uterine
    Displacements, 6"fl ; Leucorrhoea, 649 ; Metritis,
    663;  Hysteralgia, 675;  Inflammation of the
    Ovaries, 731; Marasmus, 761; Indigestion, 765 ;
    Dentition, 776;  Constipation, 782; Diarrhcea,
    788 ;  Dysentery,  792 ; Cholera Infantum, 798 :
    Vomiting of Blood, 801:  Regurgitation, 801;
    Vomiting of Ingesta,  801; Bilious Vomiting,
    801; Faecal  Vomiting,  801; Coryza, 804; Bron-
    chitis, 808;  Pertussis, 822; Scarlet Fever, 841;
    Urticaria, 868; Naevi Materni, 873;  Jaundice,
    883;  Intermittent  Fever,  884;  Rickets, 889;
    Ophthalmia, 891; Hiccough, 892 ;  Hernia, 894 ,
    Worms, 898; Retention of Urine, 900; Disease
    of the Brain, 911; Cerebro-spinal Meningitis,
    933; Chorea, 937 ; Remittent Fever, 940; Spasms,
    949.

Oleander.  Constipaticn, 313;  Great  Sense  of
    Emptiness in Pit of Stomach, 473; Marasmus,
    761.
Oleum  anim. Dysmenorrhcea, 526.
Opium. Nausea and  Vomiting, 303 ;  Constipa-
    tion, 313; Dianhcea, 321;  Hysteria, 382; Labor-
    Pains, 387;  Puerperal Convulsions,  423;  Dis-
    ordered Conditions of the Lochia, 429 ; Abortion,
    496;  Menorrhagia,  538;   Nymphomania, 553;
    Strangulation of  Prolapsed Portion of Vagina,
    688;  Uterine Displacements, 636; Metritis, 663 ;
    Hysteralgia, 675; Indigestion. 766; Constipa-
    tion,  782;  Diarrhoea,  788;  Faecal Vomiting,
    801;  Scarlet Fever, 842; Hernia, 895; Retention
    of Urine, 900; Meningitis, 901; Acute Hydro-
    cephalus, 905; Disease  of  the Brain, 912;  Cere-
    bro-spinal Meningitis, 933; Chorea, 937 ; Spasms,
    949.

Palladium.   Hysteria,  568;  Inflammation  of
    the Ovaries, 732.
Petroleum.   Nausea and  Vomiting, 303; Diar-
    rhoea, 321;  Haemorrhoids,  350;   Puerperal
    Mania, 459; Dysmenorrhoea,  626; Vulvitis,
    573;  Eczema and Pruritus, 577;  Indurations
    of  Vagina,  601; Concomitant Symptoms  of
    Vaginal Fistulas, 604; Vaginal Growths, 609;
    Uterine  Displacements, 636 ; Leucorrhcea, 649 ;
    Marasmus, 761; Vaccination, 864.
Petroselinum.  Retention of Urine, 900.
Phosphorus.  Nausea and Vomiting, 304; Con-
    stipation, 313; Diarrhcea, 321; Fissure of the
    Anus, 327 ;  Haemorrhoids, 350; Impaired Hear-
    ing, 369 ; Impaired Vision, 371; Toothache, 375 ;
    Hysteria, 382; Labor-Pains,387; Uterine Haem-
    orrhage, 409; Puerperal Convulsions, 423; Sole
    Nipples, 465 ; Galactorrhcea, 473; Deterioration
    of  Health from Nursing, 473; Cramps in Stom-
    ach from N ursing, 473; Mastitis, 475 ; Abortion,
    496;  Amenorrhoea, 514;  Dysmenorrhoea, 626;
    Menorrhagia, 538; Nymphomania, 554;  Hys-
    teria,  668;  Vulvitis, 573;  Chancres, 578;  Erec-
    tile Tumors, 681; Haemorrhage  from Erectile
    Tumors, 582; Vaginal Growths, 609;  Uterine 
978
CLINICAL  INDEX.
    Displacements, 636; Leucorrhcea, 649; Hyster-
    algia,  675; Cancer  of the Uterus, 702; Dropsy
    cf  the Uterus, 709; Hydatids, 715;  Mammary
    Cancer, 749;  Marasmus, 761;  Dysentery, 792;
    Cholera Infantum, 798; Vomiting of Ingesta,
    801; Bronchitis, SOS ; Pneumonia, 811; Croup,
    R17;   Pertussis, 822; Asthma of Millar, 826;
    Atelectasis Pulmonum, 829; Scarlet Fever, 842 ;
    Dropsy after Scarlet Fever, 846; Measles, 853;
    Bronchitis after Measles, 853; Pneumonia after
    Measles, 853;  Small-pox, 862; Naevi  Materni,
    873; Encysted Tumors, 873; Induration of the
    Breasts, 877;  Cyanosis, 881;  Worms,  89S; In-
    continence of Urine. 901; Gravel, 901: Hydro-
    cephaloid Disease,  909; Disease  of  the Brain,
    912;  Cerebro-spinal Meningitis, 933; Chorea,
    937 ; Remittent Fever, 940.
Phosphoric  acid.   Nausea and Vomiting, 304;
    Constipation, 313 ; Diarrhoea, 321; Retention of
    Urine, 332;  Scanty Supply of Milk, 470; Deter-
    ioration of Health from Nursing, 473;  Amenor-
    rhoea,  514 ;  Dysmenorrhoea, 527; Menorrhagia,
    538; Condylomata, 578; Vaginal Growths, 609;
    Leucorrhcea, 649;  Metritis, 663;  Hysteralgia,
    675; Ulcerations of the Uterus, 684; Physometra,
    711; Marasmus, 761; Diarrhoea,  788 ; Cholera
    Infantum, 798 ; Rubeola Maligna, 853 ; Small-
    pox, 862; Erysipelas, 867 ; Syphilis Neonatorum,
    878 ; Syphilitic Cutaneous Affections, 878 ; Rick-
    ets, 8S9 ; Diuresis,  900:  Incontinence of Urine,
    901; Gravel, 902; Hydrocephaloid Disease, 909 ;
    Disease of the Brain, 912.
Phytolacca dec.  Constipation, 313, 782; Masti-
    tis, 475 ; Amenorrhoea, 514 ; Dysmenorrhoea, 527;
    Menorrhagia, 538;  Condylomata, 579;  Mam-
    mary Cancer, 749 ; Eczema Capitis, 871.
Platina.  Constipation,  313;  Hysteria, 382 ; La-
    bor-Pains, 387 ;  Hour-glass  Contractions, 389;
    Uterine Hsemorrhage,  409;  Disordered Condi-
    tions of the Lochia, 429; Pendulous Abdomen,
    430;   Puerperal  Mania,  459;  Abortion, 496;
    Amenorrhoea, 514;  Dysmenorrhoea,  527 ;  Men-
    orrhagia, 538;  Nymphomania, 554; Hysteria,
    568; Eczema  and  Pruritus,  577;  Erectile Tu-
    mors,  581;  Spasms of Vagina,  590; Vaginal
    Growths, 6U9;  Uterin.e  Displacements, 636;
    Leucorrhcea,  649;  Metritis,  664; Hysteralgia,
    675; Inflammation  of  the  Ovaries, 732; Con-
    stipation, 782.
Plumbum.  Constipation, 313;  Fissure of the
    Anus,  327;  False  Pains. 363;  Abortion, 496;
    Dysmenorrhoea, 527 ; Metrorrhagia, 538 ; Nym-
    phomania, 554 ; Strangulation of Prolapsed Por-
    tion of Vagina, 588 ; Leucorrhcea, 649; Consti-
    pation, 782;  Faecal Vomiting, 801;  Retention
    of  Urine, 900: Cerebro-spinal Meningitis, 933.
Podophyllum. Diarrhoea, 321;  Haemorrhoids,
    350; Pendulous Abdomen, 430; Abortion, 496;
    Amenorrhoea,514; Dysmenorrhcea, 527 ; Uterine
    Displacements, 636; Leucorrhcea, 649; Maras-
    mus,  762;  Indigestion, 766; Dentition, 776;
    Diarrhoea, 788; Dysentery, 792 ; Cholera Infan-
    tum, 798.
Primus spinosa.   Leucorrhoea, 649.
Psorinum.  Dentith n,776; EczemaCajritis,871 ■
    Pityriasis, 872; Warts, 873; Scrofula, 886.
Pulsatilla.  Nausea and Vomiting, 304; Consti-
    pation, 313; Diarrhoea, 321; Retention of Urine,
    832; Haemorrhoids, 350;  Varicose  Veins, 353;
    False Pains, 363; Lame Pelvis, 367; Impaired
    Hearing, 369 ; Impaired Vision, 371; Neuralgia,
    373; Toothache.  375;  Hysteria, 382;  Labor-
    Pains, 387; Hour-glass Contractions, 389; Uter-
    ine Haemorrhage, 409; Puerperal Convulsions,
    423; Retained Placenta,425; Retention of Urine
    after Parturition, 426,  After-Pains, 427; Dis-
    ordered Conditions  of the Lochia,  429;  Pner
    peral  Mania, 459;  Phlegmasia Dolens, 463;
    Sore Nipples, 465;   Secretion  of  Milk, 46S;
    Scanty Supply of Milk, 470; Galactorrhoea, 473 ;
    Abortion, 496; Amenorrhcea, 514; Dysmenor-
    rhoea, 527 ; Menorrhagia, 538 ;  Nymphomania,
    654; Hysteria, 668; Erysipelatous Inflamma-
    tion, 575; Haemorrhage from Erectile Tumors,
    582; Spasms of  Vagina, 590;  Indurations of
    Vagina, 601; Vaginal  Fistulas, 604;  Vaginal
    Growths, 609; Serous Cysts of the Vagina, 610;
    Uterine Displacements, 637 ; Leucorrhoea, 649;
    Metritis, 664;  Hysteralgia,  676;  Mammary
    Cancer, 749 ; Marasmus, 762 ; Indigestion, 760 ;
    Diarrhoea, 788;  Dysentery, 792; Vomiting of
    Ingesta,  801; Bilious Vomiting, 801; Coryza,
    804; Bronchitis,  808;  Pertussis, 822;  Dropsy
    after  Scarlet Fever, S46;  Measles, 853; Diar-
    rhoea  after  Measles,  853;  Bronchitis  after
    Measles, 853; Rubeola Maligna, 853; Roseola,
    855; Small-pox, 863; Erysipelas, S67; Urticaria,
    668; Intertrigo,  876; Jaundice, 883;  Intermit-
    tent Fever, 8S4; Ophthalmia, 891; Mumps, 892;
    Hiccough,  892;   Worms,  898 ;  Retention of
    Urine, 900; Incontinence of Urine, 901; Disease
    of the  Brain, 912;  Cerebro-spinal  Meningitis,
    933; Remittent Fever, 940.

Rannnc. bulb. Leucorrhoea, 649; Inflammation
    of the Ovaries, 732; Pemphigus, 856.
Ratanhia.  Constipation, 313; Incontinence of
    Urine, 901.
Rheum.  Diarrhoea, 322; Secretion of Milk, 468;
    Indigestion, 766;  Dentition, 776;  Diarrhoea,
    788.
Rhododendron.  Constipation, 313; Amenor
    rhcea, 514; Serous Cysts of the Vagina, 610.
Rhus rad.  Erysipelas, 867.
Rhus tox.   Nausea  and  Vomiting, 304; Con-
    stipation, 314;  Diarrhcea, 322; Retention of
    Urine,  332;  Haemorrhoids, 350;  False  Pains,
    363; Lame Pelvis, 368 ; Toothache, 375; Hour-
    glass Contractions, 389; Debility, 392 ; Uterine
    Haemorrhage, 409 ; After-Pains,  427 ; Disordered
    Conditions of the Lochia,  4"0:  Phlegmasia 1)..-
    lens, 463; Secretion of Milk, 46."; Scanty Supply
    of Milk, 470; Galactorrhoea, 473; Abortion, 496.
    Amenorrhoea, 514; Dysmenorrhoea, 527; Men
    orrhagia, 53S ; Vulvitis, 573 ; Erysipelatous In-
    flammation,  575;  Neuralgia of Vagina,  592;
    Uterine Displacements, (557; Metritis, 664; Hys-
    teralgia, 676; Sensation of Coldness in Ulcers 
CLINICAL  INDEX.
979
   685; Cancer of the Uterus, 702;  Dropsy of the
   Uterus, 709; Marasmus, 762; Diarrhoea, 788;
   Dysentery, 792;  Scarlet Fever,  842;  Dropsy
   after Scarlet Fever, 846; Post-scarlatinal Rheu-
   matism, 847; Neuralgic Pains in Extremities
  - and other Parts after Scarlet Fever, 847; Rube-
   ola Maligna, 853; Itching of the  Skin  after
   Measles, 854;  Roseola, 855;  Pemphigus, 856;
   Small-pox, 863; Varicella, 865; Erysipelas, 867;
   Urticaria, 868; Eczema Capitis, 871;  Warts, 873;
   Cephalaematoma, 874;  Ranula, 874;  Ophthal-
   mia, 891;  Mumps, 892; Retention of Urine, 900;
   Diuresis, 900; Cerebro-spinal Meningitis, 933;
   Remittent Fever, 940.
Ruta.  Constipation, 314; Retention of Urine, 332;
   Labor-Pains, 387; Amenorrhcea, 514; Leucor-
   rhoea,  649; Erysipelas, 867; Rickets, 889.

Sabadilla.  Nausea and Vomiting, 304; Consti-
   pation, 314; Amenorrhoea, 514; Worms, 899.
Sabina.   Constipation, 314; Diarrhcea, 322; Haem-
   orrhoids,  350; Uterine  Haemorrhage, 410;  Re-
    tained Placenta, 425;  After-Pains,  427 ;  Abor-
    tion, 496; Amenorrhcea, 514; Dysmenorrhoea,
   o27;   Menorrhagia,  638; Nymphomania, 554;
   Hysteria, 569;  Condylomata, 578;  Tumors of
   the Vulva, 580; Neuralgia of Vagina, 592; Leu-
    corrhoea,  649;  Metritis, 664; Hysteralgia, 676;
    Hydatids, 715;   Pemphigus, 856;  Comedones,
    878.
Sarracenia purp.  Small-pox, 863.
Sambucus.  Menorrhagia,  638;  Coryza, 804;
    Asthma of Millar, 827.
Sanguinaria.  Amenorrhoea, 514;  Dysmenor-
    rhcea, 527;  Leucorrhcea, 649.
Saisaparilla.   Constipation,  314;   Dysmenor-
    rhcea, 527;  Leucorrhcea, 649; Eczema Capitis,
    871; Gravel, 901; Incontinence of Urine, 901.
Secale c.  Diarrhoea,322; False Paius,363; Labor-
    Pains, 387 ; Hour-glass Contractions,389; Uterine
    Haemorrhage, 410; Puerperal Convulsions, 424 ;
    Retained Placenta, 425; After-Pains, 427; Dis-
    ordered Conditions of the Lochia,  430; Pendu-
    lous Abdomen, 430; Scanty Supply of Milk, 470;
    Abortion, 496;  Amenorrhoea, 515; Dysmenor-
    rhoea, 527 ; Menorrhagia, 538; Vulvitis,  573;
    Gangrene ofthe Vagina, 605; Uterine Displace-
    ments, 637;  Leucorrhoea, 649; Metritis,  664;
    Hysteralgia,  676; Ulcerations  of the Uterus,
    684;  Gangrene of the Uterus,  704; Hydatids,
    715;  Cholera Infantum, 798; Pemphigus, 856 ;
    Small-pox, 863; Cyanosis,  881;  Chorea,  937;
    Spasms, 949.
 Selenium.  Nausea and Vomiting, 304.
 Senecio.  Amenorrhcea, 515; Dysmenorrhcea, 528;
    Hysteria, 570.
 Senna.  Colic or Indigestion, 766.
 Sepia.   Nausea and Vomiting, 304; Constipation,
    314*  Diarrhoea, 322; Fissure of the  Anus, 327;
    Retention  of Urine,  332; Haemorrhoids, 350;
    False Pains, 364; Neuralgia, 373; Hysteria,383;
    Labor-Pains, 387 ; Hour-glass Contractions, 3S9 ;
    Syncope, 391; Debility, 392 ; Uterine Haemor-
     rhage 410; Retained Placenta,425; After-Pains,
   428 ; Disordered Conditions of the Lochia, 430 j
   Pendulous Abdomen, 430;  Rhagades, 431; Ul-
   ceration of the Umbilicus, 431; Sore Nipples,
   465; Secretion of Milk, 469; Great Sense of
   Emptiness in Pit of Stomach from Nursing, 473;
   Abortion, 496; Amenorrhoea, 515;  Dysmenor-
   rhcea, 528;  Menorrhagia,  538;  Hysteria, 569;
   Vulvitis, 673;  Eczema and Pruritus, 578; Tu-
   mors of the Vulva, 580; Erectile Tumors, 581;
   Prolapse of the Vagina, 587; Neuralgia of Va-
   gina, 592; Indurations of Vagina, 601; Vaginal
   Fistulas, 604;  Uterine Displacements, 637; Leu-
   corrhcea, 649;  Metritis, 664; Hysteralgia, 676;
   Cancer of the Uterus, 703; Dropsy of the Uterus,
   709; Hydatids, 715; Ovarian Tumors, 742; Mam-
   mary Cancer, 749; Dentition, 777; Constipation,
   782;  Diarrhcea, 788;   Bilious  Vomiting, 801;
   Pertussis, 822; Varicella,  865;  Urticaria,  868;
   Eczema Capitis,  871;  Pityriasis, 872;  Warts,
   874; Intertrigo, 876; Retention of Urine, 900 ;
    Incontinence  of  Urine, 901;   Disease of  the
   Brain, 912; Chorea, 937.
S ilicia.  Nausea and Vomiting, 305; Constipation,
   314; Fissure of the Anus, 327;  Haemorrhoids,
   350; Lame Pelvis, 368; Impaired Hearing, 369;
    Hysteria, 382; Uterine Haemorrhage, 410; Dis-
    ordered Conditions ofthe Lochia, 430; Rhagades,
    431; Ulceration  of the Umbilicus, 431;  Sore
    Nipples, 465;  Secretion of Milk, 469 ; Deteriora-
    tion of Health from Nursing, 473; Mastitis, 475;
    Child Vomits the Milk soon after Nursing, 475 ;
    Abortion, 497;  Amenorrhcea, 515; Dysmenor-
    rhcea, 528;  Menorrhagia, 638;  Nymphomania,
    554 ; Eczema  aud Pruritus, 578 ; Chancres, 578 ;
    Tumors of  the Vulva, 580;  Erectile Tumors,
    581; Ascarides of the Vulva, 584; Neuralgia of
    Vagina, 592; Vaginal Fistulas, 604;  Vaginal
    Growths, 609; Serous Cysts of the Vagina, 610;
    Uterine Displacements, 637 ; Leucorrhcea, 650 ;
    Sensation of Coldness in Ulcers, 685; Cancer of
    the Uterus, 703; Hydatids, 715;  Indigestion,
    766; Dentition, 777; Constipation, 782; Regur-
    gitation, 801; Vomiting of Ingesta, 801;  Bron-
    chitis,  808; Pertussis, 822; Scarlet Fever, 842;
    Scrofula  after Scarlet Fever,  848; Otorrhoea,
    848; Sinall-pox,  663:  Vaccination,  864; Pityri-
    asis, 872;  Encysted Tumors, 873:  Cephalaema-
    toma, 874; Induration ofthe Breasts, 877; Scrof-
    ula, 887; Rickets, 889; Mumps, 892;  Hernia,
    895; Worms, 899; Incontinence of Urine, 901;
    Diuresis, 901; Gravel, 902; Acute  Hydroceph-
    alus, 905; Disease of the Brain, 912;  Spasms,
    949.
 Spigelia.  Neuralgia, 373;  Worms, 899; Diuresis,
    901.
 Spongia.   Dysmenorrhcea, 528;  Menorrhagia,
    539; Croup, 817 ; Atelectasis Pulmonum. 829.
 Squilla.  Pertussis, 822;  Dropsy after  Scarlet
    Fever, 846 ; Diuresis, 901; Disease of the  Brain,
    912.
 Stannum.  Constipation, 314; Labor-Pains, 387 ;
    Debility, 392; Dysmenorrhoea,  528; Menorrha-
    gia, 539; Hysteria, 569 ; Prolapse of the Vagina,
    587; Uterine Displacements, 637 ; Leucorrhcea, 
980                              CLINICAL  INDEX.
    650; Marasmus, 762;  Indigestion, 766;  Denti-
    tion, 777 ; Hernia, 895; Worms,  899; Spasms,
    949.
 Staphysagria.  Nauseaand Vomiting, 305; Con-
    stipation, 314;  Toothache, 375; Hysteria, 383;
    Amenorrhcea, 515;  Nymphomania, 554; Hys-
    teria, 569 ; Vulvitis, 573; Eczema and Pruritus,
    578; Condylomata, 579; Vaginal Growths, 609;
    Granular Vegetations, 610;  Uterine Displace-
    ments, 637; Cancer of the Uterus, 703; Inflam-
    mation of the Ovaries, 732;   Indigestion, 766;
    Dentition, 777; Aphthae, 780;  Eczema Capitis,
    871; Rickets, 889.
 Sticta p.  Coryza, 804; Chorea, 937.
 Stramonium.  Nausea and Vomiting, 305; Diar-
    rhoea, 322; Retention  of  Urine, 333; Chorea,
    377;  Hysteria,  383;  Syncope, 391;  Uterine
    Haemorrhage, 410; Puerperal Convulsions, 424;
    Retention of  Urine after Parturition, 426; Dis-
    ordered Conditions  of the Lochia, 430;  Puer-
    peral Mania, 459; Galactorrhoea, 473; Abortion,
    497; Amenorrhcea,  615;  Dysmenorrhcea, 528;
    Menorrhagia, 639 ; Nymphomania, 554;   Hys-
    teria, 569; Metritis, 664; Dentition, 777; Asthma
    of Millar, 827;  Measles, 853; Small-pox, 863;
    Worms, 899;  Retention of Urine,  900; Menin-
    gitis, 903; Disease of the Brain, 912; Cerebro-
    spinal  Meningitis, 934;  Chorea, 937 ; Spasms,
    949.
Strontiana.  Leucorrhoea, 650.
Sulphur.  Nausea and Vomiting, 305; Constipa-
    tion, 314; Diarrhoea, 322; Fissure ofthe Anus,
    327;  Retention of Urine,  333;  Haemorrhoids,
    350;  Varicose Veins,  353;  False  Pains,  364;
    Lame Pel vis, 368; Impaired Hearing, 369; Im-
    paired Vision, 371; Hysteria, 383; Labor-Pains,
    387;  Hour-glass  Contractions, 389;  Debility,
    392;  Uterine Haemorrhage, 410;  After-Pains,
    428; Disordered Conditions of the  Lochia, 430;
    Rhagades, 431;  Ulceration of the Umbilicus,
    431; Puerperal Mania, 460 ; Phlegmasia Dolens,
    464; Sore Nipples, 465 ;  Scanty Supply of Milk,
    470; Deterioration of Health from Nursing, 473;
    Mastitis, 475;  Child Vomits soon after Nursing,
    475 ; Abortion, 497;   Amenorrhoea, 515 ;   Dys-
    menorrhcea, 528 ; Menorrhagia, 539 ; Nympho-
    mania,  554; Hysteria,  569;  Vulvitis, 573; Ec-
    zema and Pruritus, 578; Chancres, 578; Tumors
    of the Vulva, 6S0; Erectile Tumors, 681; Haem-
    orrhage from  Erectile  Tumors, 582;  Ascarides
    ofthe Vulva, 584;  Prolapse of the Vagina,  587;
    Strangulation  of Prolapsed Portion of Vagina,
    588; Neuralgia of  Vagina, 593; Indurations of
   Vagina, 601; Vaginal Fistulas, 604; Serous Cysts
   of the Vagina, 610; Uterine Displacements, 637 f
    Leucorrhcea, 650;  Metritis, 664;  Hysteralgia,
    676 ; Cancer of the Uterus, 703; Dropsy of the
   Uterus, 709; Hydatids, 715; Mammary Cancer,
   749; Marasmus, 762 ;  Indigestion, 760; Denti-
   tion, 778;  Aphthae,  780;  Constipation,  782;
   Diarrhoea, 788 ; Dysentery, 792 ; Cholera Infan-
   tum, 798;  Regurgitation, 801;  Vomiting  of
   IngeBta, 801;  Coryza, 804;  Bronchitis,  808;
   Pneuir"uia, 812; Pertussis, 822 ; Scarlet Fever,
     842; Otorrhavi, 848 ;  Measles, 853;  Diarrhoea
     after Measles, 863;  Pneumonia after Measles,
     853; Itching of the Skin  after Measles, 854;
     Roseola,  855; Miliaria, 855; Small-pox, 863
     Vaccination, 864;  Varicella, 865;  Erysipelas
     867; Urticaria, 868 ; Eczema Capitis, 871; Pity-
     riasis, 872; Naevi Materni, 873; Encysted Tu-
     mors, 873; Warts, 873; Ranula, 874; Intertrigo,
     876;  Induration of the Cellular  Tissr.6, 876;
     Syphilitic Cutaneous Affections, 878;  Come-
     dones, 878 ; Cyanosis, 881; Jaundice, 883; Inter-
     mittent Fever, 885 ; Scrofula, 887; Rickets, 889 ;
     Ophthalmia, 891;  Hernia, 895; Worms, 899;
     Retention of Urine, 900; Incontinence of Urine,
     901; Acute Hydrocephalus, 905; Disease of the
     Brain, 913;  Cerebro-spinal  Meningitis, 933;
     Chorea,937; Remittent Fever, 940; Diphtheria,
     946.
 Sulphuric acid. Nausea and  Vomiting, 305;
     Constipation,315; Diarrhoea,322; Uterine Haem-
     orrhage, 410 ; After-Pains, 428; Dysmenorrhoea,
     528; Menorrhagia, 639; Vulvitis, 573; Strangu-
     lation  of Prolapsed Portion of Vagina, 588;
     Gangrene of the Vagina, 605; Uterine Displace-
     ments, 638; Leucorrhoea, 650;  Dentition, 778;
     Aphthae, 780; Hernia, 895.

 Tabacum.  Diarrhoea, 322; Leucorrhoea, 650.
 Tartar emetic.  Treatment of Child after Labor,
     213; Nausea and Vomiting, 305 ; Diarrhcea, 322
    Dysmenorrhcea, 528 ; Eczema and Pruritus, 578
     Granular  Vegetations, 610;  Leucorrhcea, 650
     Coryza, 804; Bronchitis, 808;  Croup, 817; Ate-
     lectasis Pulmonum, 829 ; Small-pox, 863; Vari
     cella, 865; Cerebro-spinal Meningitis, 933;  Re-
     mittent Fever, 940;  Spasms, 950.
 Teucrium marum verum.  Vaginal Growths,
     609; Worms, 899.
 Thuya.  Constipation, 315; Fissure of the Anus,
    327; Haemorrhoids, 350; Lame Pelvis, 368;  La-
    bor-Pains, 387 ; Dysmenorrhoea, 528; Nympho-
     mania, 554; Vulvitis, 573; Eczema and  Pruri-
    tus. 678;  Condylomata, 678; Chancres, 678
     Erectile Tumors, 581; Neuralgia of Vagina, 693
    Vaginal Fistulas, 604; Vaginal Growths, 609
    Granular Vegetations, 610;  Uterine  Displace-
    ments,  638; Hysteralgia, 676;  Cancer of  the
    Uterus, 703; Inflammation of  the Ovaries, 732 ;
    Pemphigus, 856; Small-pox, 863; Warts, 873;
    Ranula, 874 Syphilitic Ophthalmia, 878 ; Syph-
    ilitic Cutaneous Affections, 878; Condylomata,
    878; Comedones, 878; Ophthalmia, 891; Incon-
    tinence of Urine, 901.  Abortion, 497.
Trillium pend.   Uterine  Haemorrhage, 410,
    Menorrhagia, 539; Leucorrhoea, 650.

Urtica urens.  Urticaria, 868; Worms, 899.
Ustilago.  Menorrhagia, 539.

Vaccininum.  Small-pox, 863.
Valerian.  Nausea and Vomiting, 305; Amen-
    orrhcea, 615; Hysteria, 570; Worms, 899.
Variolinum.  Small-pox. 863.
Veratrum.   Nausea and Vomiting, 305; Consti- 
CLINICAL  INDEX.                              981
   pation, 315; Diarrhoea, 322; False Pains, 364;
   Hysteria, 383;  Labor-Pains, 387 ; Syncope, 391;
   Debility, 393 ; Puerperal Mania, 460; Abortion,
   497 ;  Amenorrhoea, 516 ; Dysmenorrhoea, 529 ;
   Menorrhagia, 539;  Nymphomania, 654;  Hys-
   teria, 570; Prolapse of the Vagina, 577; Strangu-
   lation of  Prolapsed  Portion  of  Vagina, 688;
   Uterine Displacements, 638; Indigestion, 766;
   Dentition, 778;  Constipation, 782;  Diarrhcea,
   788; Dysentery, 792; Cholera Infantum, 799;
   Bilious  Vomiting, 801; Pertussis,  822;  Atelec-
   tasis Pulmonum, 829; Dropsy after Scarlet Fe-
   ver, 846; Rickets, 889; Worms, 899; Disease of
   the Brain, 913; Cerebro-spinal Meningitis, 933;
   Spasms, 950.
Veratrum viride.  Puerperal Convulsions, 424 ;
   Mastitis, 475; Disease of the Brain, 913; Chorea,
   937.
Verbascum.  Constipation, 315; Diuresis, 501.
Viola  odor.  Hysteria, 570; Worms, 899.
Viol, tricol.  Eczema Capitis, 871.

Zinc.  Nausea and Vomiting, 305; Constipation;
    315; Varicose  Veins, 354;  Puerperal Convul-
    sions, 424; Puerperal  Mania, 460; Secretion of
    Milk,  469; Abortion, 497; Amenorrhcea, 516;
    Dysmenorrhcea, 529;  Menorrhagia, 539; Nym-
    phomania, 555; Hysteria,  670; Condylomata
    578; Uterine Displacements, 63S ; Leucorrhcea,
    650 ; Hysteralgia, 676; Ulcerations of the Uterus,
    684; Inflammation of the Ovaries, 732; Ovarian
    Tumors, 742; Scarlet Fever, 842; Acute Hydro-
    cephalus,  905 ;  Hydrocephaloid Disease, 909;
    Disease of the Brain, 913; Chorea, 937; Spasms
    950.
Zizia.  Leucorrhcea, 650. 
 
INDEX.
 Abnormal secretions during pregnancy, 357.
    secretion of milk, remedies for, 466.
 Abortion, 284, 477.
    induction of, 488.
    induction of, criminality of the, 488.
    treatment of anticipated or threatened, 490.
 Abscess a cause of dystocia, 235.
    of the vulva, 579.
 Absence of menstruation, 501.
 Accidental haemorrhage, 394.
    aud unavoidable  haemorrhage,  diagnosis  be-
      tween, 396.
 Accumulation of faeces a cause of dystocia, 235.
 Acidity of the stomach during pregnancy, 306.
 Acute and chronic inflammation of the uterus, 637.
    and chronic inflammation of the uterus, treat-
      ment of, 660.
    endometritis, 639.
    uterine leucorrhcea, 639.
    uterine catarrh, 639.
    inflammation of the ovaries, 726.
    suffocative catarrh of children, 806.
    hydrocephalus, 903.
 Acne puuctata, 878.
 Adhesions of the vulva, 231.
 Affections, disorders of the, during pregnancy, 379.
    alienation of the, during pregnancy, 380.
 After-birth, the formation of tho, 146.
    delivery of the, 200.
    mode of extracting, 202.
 After-pains, 209.
    remedies for, 426.
 Agglutination ofthe os a cause of dystocia, 237.
 Agminated follicles, 50.
 Albuminuria during pregnancy, 333.
    in its relation to puerperal convulsions, 413.
    in children.  (See Appendix.)
 Allantois, the, 142.
 Amenorrhoea, 501.
    remedies for, 510.
Amuion, the, 142.
Anaemia during pregnancy, 342.
Anasarca during pregnancy, 344.
Anaesthetics during labor, use of, 268.
 Anchylosis of foetal articulations a cause of dystocia,
      244.
Aneurisms occurring in infants, 872.
Anomalous pregnancy, 167.
Anorexia during pregnancy, 290.
Anticipated or threatened abortion, treatment of, 490.
Anteversion of the uterus, 620.
    of the uterus during pregnancy, 355.
 Anteflexion of the uterus, 623.
 Anterior commissure, 43.
 Antipsoric prophylactic treatment, 755.
 Anus, fissure of the, 325.
 Apparent death of the new-born child, 2U.
 Appendages of the uterus, 43.
 Apex of the uterus, 55.
 Aphthae, thrush, 778.
 Appetite and taste, disorders of, during pregnancy,
      290.
 Arbor vita? of the uterus, 58.
 Areolar hyperplasia, 657.
 Arm, presentation of the,  general directions in, 260.
 Arnica after parturition, 205.
 Arteries of the uterus, 62.
 Articulations of the pelvis, 20.
 Ascarides infesting the external  genital organs, 583.
 Ascites as a cause  of dystocia, 244.
    during pregnancy, 344.
 Asthma complicating labor, 243.
 Asthma of Millar, 823.
 Asphyxia of the new-born babe, 212.
 Atelectasis pulmonum, 827.
 Atrophy of infants, 756.
 Auscultation in the diagnosis of pregnancy, 124
 Aversions, 292, 293.
 Axis of the superior strait, 26,
    of the inferior strait, 30.
    of the pelvic excavation or cavity, 32.

 Ballottement, 119,  123.
 Bandage after labor, the, 204.
 Black measles, 851.
 Bladder, over distension of,  as a cause of dystocia,
      218, 235.
    rupture of the, 241.
    hernia of the,  686.
 Blood-vessels of the uterus, the, 61.
 Blood-spitting during pregnancy, 328.
 Bloody or oozing  tumors  of the external genitals,
      582.
 Blue disease, 879.
Blunt hook in breech presentations, tne, 259.
Body of the uterus, the, 56.
    of the uterus, cavity of the, 58.
Bones of the pelvis, the, 10.
Bowels, derangements of the, during pregnancy 309
Brain, diseases of the, 902.
    diseases of the, remedies for, 309.
    inflammation of the, 902.
    dropsy of the,  acute, 903.
    dropsy of the,  chronic, 905.
                                  983 
984
INDEX.
 Bra n, anaemia of the, 9o8.
 Breasts, inflammation of the, 473.
     of infants, swelling and hardness of the, 877.
 Breech presentations, mechanism of, 186.
     presentations, general  direction in, 259.
     presentations, use of the blunt hook in, 249.
     presentations, use of forceps in, 260.
 Broad ligaments, 60.
 Bronchitis of children, 804.
     of children, sub-acute  and chronic forms of, 807.
 Bronchial  catarrh of children, 804.
 Bulimy during pregnancy, 291.

 Caesarean section, the, 279.
 Canal of the cervix, the, 57.
    of Nuck, the, 64.
 Cancer, 685.
    of the uterus, 693.
    of the uterus, indurated, 693.
    of the uterus, ulcerated, 696.
    of the uterus, encephaloid, 698.
    Of the uterus, colloid,  698.
I   of the uterus, treatment of, 700.
    of the uterus as a cause of dystocia, 236.
    of the breast, 693, 745.
    'of the ovaries, 742.
Cancroid, 699.
Capillary bronchitis of children, 806.
Carunculoe myrtiformes, 47.
Carcinoma (see Cancer).
Care of the woman during labor, 192.
    of the child during labor, 197.
    of the woman after labor, 200.
Casanova's tocological flexible forceps, 267.
" Catarrh on  the breast," 804.
Catarrh, acute suffocative, 806.
    acute uterine, 639.
Catarrhal inflammation of the external genitals, 575.
    fever of children, 804.
    fever of children, congestive, 806.
Catheter, introduction of the, 46.
Cauliflower excrescences, 699.
    excrescences as a causo of dystocia, 236.
Causes of menstruation, 77.
    of labor, 172.'
    of pelvic deformities, 227.
Cavity of the pelvis, 31.
    of the body of the uterus, 58.
Cephalaematoma, 874.
Cephalic version, 257.
    presentations, general  directions to be observed
      in, 258.
 Cephalalgia during pregnancy, 371.
Cephalotripsy, 278.
Cerebritis traumatica, 909,  911.
Cerebro-spinal meningitis,  913.
Cervix uteri, the, 65.
Cervical canal, the, 57.
Cessation of  the menses, the, 76.     •
 Chancres on  the external genital organs, 678.
 Change of life, the, 542.
 Chafing of infants, 874.
 Chicken-pox, 865.
 Child, treatment of, after birth,  211.
    apparent death of the, 212.
I Child-crowing, 823.
' Child-bed fever, 431.
 Children, diseases of, 750.
 Chilis and lever in children, 884.
 Cholera infantum, 792.
 Chorea, 934.
     during pregnancy, 375.
 Chorion, the, 146.
 Chronic liver complaint of children, 883.
     hydrocephalus, 905.
     endometritis, 641.
     metritis, 657.
     ovaritis, 728.
 Cicatrices in the vagina, 232.
 Circulation of the foetus, 166.
 Clitoris, the, 45.
 Coccyx, the, 11.
 Coccygeal junction, the, 11.
 Cold in the head, in children, 801.
 Colic of infants, 762.
 Colitis, 788.
 Colloid" cancer of the uterus, 698.
 Combined internal and external version, zd5.
 Comedones, 878.
 Complicated presentation a cause of dystocia, 249.
 Commissure, Anterior, 43.
     Posterior, 43.
 Concealed accidental haemorrhage, 395.
 Conception, 86.
 Condylomata, syphilitic, of infants, 878.
     of the external  genitals, 678.
     of the vagina, 610.
 Congestive dysmenorrhcea, 517.
 Constipation during pregnancy, 309.
     of infants and children, 780.
 Constrictions  or spasms of the vagina, 588.
 Contraction and rigidity of the vulva, 231.
 Convulsions, puerperal, 411.
     puerperal, remedies for, 421.
     of infants and children, 947.
 Cord, prolapse of the, 247.
     shortness of the, 248.
 Corroding ulcer of the uterus, 681,
 Coryza of children,  801.
 Cough and dyspnoea during pregnancy, 338.
 Cough, Hooping, 817.
 Cracks on the abdominal walls after child-oirtn, 431
 Cramps of the vagina, 588.
     and pain during pregnancy, 354.
 Craniotomy, 274.
 Croup, 812.
     spasmodic or false, 823.
 Crusta lactea, 869.
 Curve of Carus, 267.
 Cutaneous affections of the externa; genital organs
       675.
 Cyanosis, 879.
 Cynanche laryngea, 812.
 Cystocele, 582, 686.
     as a cause of dystocia, 235.
 Cysts of the vagina, 609.
     of the ovaries, 734.
 Cysto-sarcoma of the ovaries, 734.
 Cysto-adenoma of the ovaries, 734.
 Cvsto-fibroma of the ovaries. 734. 
INDEX.
985
Cysto-carcinoma of the ovaries, 734

Dandruff, 871.
Debility during labor, 391.
Decapitation of the foetus, 279.
Decidua, development of the, 139.
    vera, 87.
    reflexa, 87.
Deformity, pelvic, method of determining, 227.
Delivery of the placenta, 200.
Dentition, 766.
Derangements of the circulation dnring pregnancy,
      341.
    of tho nervous system during pregnancy, 368.
Deterioration of health from nursing, 473.
Development of the ovum, 130.
    of the decidua, 139.
    of the foetus, 151,156.
    of tho temporary teeth, 767.
 Diameters of the pelvis, 27.
    of the superior strait, 27
    of the inferior strait, 30.
    of the pelvic excavation, 32.
 Diagnosis of pregnancy, 109.
 Diarrhoea during pregnancy, 314.
    of infants and children, 782.
 Diet and regimen of women in labor, 200.
 Difficult labor, 215.
     menstruation, 516.
 Digestive system, disorders of the, during pregnancy,
      290.
 Dimensions of the pelvic excavation, 32.
     of the uterus externally, 58.
     and weight of the foetus at different periods, 152.
 Diphtheria, 941.
     sequelae of, 944.
 Directions for weaning, 476.
 Discus proligerus, 72.
 Diseases of women, 498.
     of women,  general remarks  on  the treatment
       of, 498.
     of the external genital organs, 570.
     of the vagina, 584.
     of the uterus, 611.
     of the ovaries, 734.
     of infants and children, 750.
     of the brain, 902.
     of the brain, remedies  for, 909.
  Disorders incidental to pregnancy, 285.
     of the digestive system during pregnancy, 290.
     of secretion and excretion during pregnancy, 328.
     of respiration during pregnancy, 338.
     of locomotory apparatus, 364.
     of the affections, emotions  and feelings  during
       pregnancy, 379.
     of lactation, 464.
 Displacements of the womb, 611.
     of the womb during pregnancy, 355.
  Diuresis of children, 900.
 Dropsy during pregnancy,  343.
     of the amnion, 358.
     of the uterus, 705.
     of the ovaries, 734.
     of the brain, acute, 903.
Dropsy of the brain, chronic, 905.
    of the brain as a cause of dystocia, 243.
    of the chest and abdomen of the foetus as a cause
      of dystocia, 246.
    after scarlet fever, 842.
Duration of labor, 178.
Dysentery, 788.
Dysmenorrhoea, 516.
    neuralgic, 616.
    congestive, 517.
    inflammatory, 517.
    membranous, 518.
    mechanical or obstructive, 519.
    remedies for, 520.
Dyspnoea and cough during pregnancy, 338.
Dystonia, 216.
    causes of, 215.
    mechanical causes of, 217.
    excessive liquor amnii a cause of, 217.
    premature rupture of the membranes  a cause
      of, 217.
    impaired action of the abdominal muscles  a
      cause of, 218.
    overdistension of the bladder a cause of,  218,235.
    from malformation of the pelvis, 218.
    from  malformation of  the vulva, vagina  or
      uterus, 231.
    from morbid conditions of the uterus, 236.
    in consequence of previously existing disease,242.
    from abnormal conditions of the foetus,  243.
 Dysuria of children, 899.

 Ecchymoses of the scalp, in infants, 874.
 Eclampsia parturientium, 411.
 Eczema of the external genitals, 575.
     capitis, 869.
 Effects of labor upon mother and child, 178.
 Effusion of lymph into the uterine tissues, 666.
 Emansio mensium,601.
 Embryulcia, 278.
 Emotional disorders during pregnancy, 379.
 Emphysema as a cause of dystocia, 244.
 Encephaloid cancer  of the womb, 698.
 Encysted tumors occurring in iufants, 873.
     tumors of the vulva, 580.
 Endometritis, acute, 639.
     chronic, 641.
 Epithelioma, 699.
 Erectile tumors of the vulva, 580.
     of the vulva, haemorrhage from, 581.
 Erysipelatous inflammation of the external genital
     organs, 573.
 Erysipelas neonatorum, 865.
 Erythema of the external genital orgies 676.
 Essera, hives,  868.
 Evolution, spontaneous, 190.
 Excavation of the pelvis, the, 31.
 Excessive menstruation, 529.
 Excoriation of the external genitals, 679.
      of infants, 874.
 Exhaustion during labor, 391.
 Exostosis of the pelvis a cause of dystocia  234-
 External surface of  the pelvis, 23
      os, the, 55. 
986
INDEX.
External dimensioLS of the uterus, 58.
    genital organs, diseases of the, 570.
    genital organs, cutaneous disease of the, 575.
    genital organs, erythema of the, 576.
    genital organs, herpes of the, 676.
    genital organs, lichen of the, 576.
    genital organs, excoriation of the, 579.
Extracting the placenta, mode of, 201.
Extra-uterine pregnancy, 89,168.
Eyes, affections of the, during pregnancy, 369.
    inflammation of the,  in children, 889.

Face  presentations, general  directions  to  be ob-
      served in, 258.
    presentations, mechanism of, 183.
Fainting during labor, 390.
Fallopian tubes, the, 66.
Falling of the womb, 612.
False'pregnancy, 89.
    waters, 357.
Fever, remittent, of children, 937.
    typhoid, of children, 937.
Fibroid tumors of the uterus, 719.
Fibrous  tumors of the vagina, 607.
Fibro-cellular growths of the vagina, 606.
First menstruation, 75.
Fissure of the anus, 325.
Fistula, vaginal, 602.
Fluid tumors of the ovaries, 734.
Fcetal heart, sounds of the, 125.
Foetus, development of the, 151.
    successive dimensions and weight of the, 152.
    development of the parts aud organs of the, 156.
    at full term, the, 158.
    presentation and  position of the, at full term,
      161.
    abnormal conditions  of the, complicating labor,
      243.
    inclined position of the, a cause of dystocia, 249.
Fcetal circulation, 166.
Follicular system of the external organs of  genera-
      tion, 49.
Follicles, agminated, 50.
    vestibular, 50.
    urethral, 50.
    vaginal, 50.
Follicular ulcer of the uterus, 681.
Forceps, use of the, to the breech, 260, 261.
    method of applying the, 261, 265.
    long and short, 262.
    cases in which they are applicable, 264.
    cases in which they are not applicable, 266.
    locking the blades of the, 266.
    general directions for applying the, 266.
    long, method of applying the, 267.
     Dr.  Casanova's tocological flexible, 269.
 Formation and development of the placenta, 146.
     and development of  the funis, 149.
 Fourchette, the, 45.
 Full-term foetus, the, 158.
    presentation and position of the foetus at, 158.
 Fundus, the, 65.
 Funis, formation and development of the, 149.
    prolapse of the, 247.
Funis, shortness of the, 248,

Galactorrhoea, 470.
Gangrene of the vagina, 604.
    of the uterus, 655.
    of the uterus, treatment of, 704.
Gastric derangements during pregnancy, 294.
Gathered breast, 473.
Gelatinous cancer of the uterus, 698.
Generation, 79.
Generation, organs of, 41.
Genital organs, external, 41.
    organs, external, diseases of the, 570.
    organs, external, eczema of the, 575.
    organs, external, erythema of the, 576.
    organs, external, herpes of the, 576.
    organs, external, lichen of the, 576.
    organs, external, condylomata of the, 578,579
    organs, external, excoriation of the, 579.
    organs, external, oedema of the, 579.
    organs, external, abscess of the, 579.
    organs, external, tumors of  the, 579.
    organs, external, varicose veins of the, 582.
    organs, external, hernia of the, 582.
Germinal vesicle, the, 69.
    spot, the, 69.
Gestation, 88.
Glandular system of the external genital organs, 18
Glands, sudoriparous, 49.
    sebaceous, 49.
    vulvo-vaginal, 50.
    of Bartholine, 50.
Gonorrhoeal ophthalmia, 889.
Graaffian vesicles, the, 68.
Granular ulcer of the uterus, 677.
Gravel, 901.

Haematemesis complicating labor, 242.
Haemoptysis complicating labor, 242.
Haemorrhage during labor, 393.
    accidental, 394.
    unavoidable, 398.
    post-partum, 402.
    uterine, remedies for, 406.
    from erectile tumors of  the external genitals,
       581.
Haemorrhoids, 346.
Head, presentations of the, general directions to be
       observed in, 258.
Headache during pregnancy, 357.
Heart disease complicating labor, 243.
 Heartburn during pregnancy, 306.
Hearing, loss of, during pregnancy, 357.
 Helminthiasis, 895.
Hepatitis, 883.
Hernia, vaginal, a cause of dystocia, 235.
    vesical, a cause of dystocia, 235.
    of the uterus, 238.
    of the external genital organs, 582.
    perineal, 582.
    of the bladder, 586.
    in infants and children, 893.
 Herpes of the external genital organs, 576.
 Hiccough, 892. 
INDEX.
987
Hives, 867.
[looping cough, 817.
Hour-glass contraction, 202, 389.
Hydrocephalus, acute, 903.
    chronic, 905.
    as a cause of dystocia, 243.
Hydrocephaloid disease, 908.
Hydrothorax as a cause of dystocia, 244.
Hydraemia during pregnancy, 341.
Hydrorrhoea during pregnancy, 357.
Hygiene of pregnancy, 288.
    and treatment of the babe afterbirth, 211.
Hymen, the, 47.
Hyperplasia, areolar, of the uterus, 657.
Hypertrophy of the uterus, 655.
Hysteralgia, 671.
Hysteria, 555.
    treatment of, 564.
    during pregnancy, 377.

Icterus neonatorum, 881.
Ilium, the, 15.
Impregnated uterus, the, 64.
Impaired action of the abdominal muscles a cause
      of dystocia, 218.
Inclined planes of the pelvis, 24.
    position of the foetus a cause of dystocia, 249.
Incontinence of urine in children, 901.
Indigestion of infants and children, 762.
Induction of premature labor, 283, 488.
Induration of the vagina, 600.
    of  the cellular tissue of infants, 876.
    and swelling of the breasts of infants, 877.
Indurated cancer of the womb, 693.
Infants and children, diseases of, 350.
    and children, antipsoric prophylactic treatment
       of, 755.
     milk as a food for, 750.
     atrophy of, 756.
     sour stomach of, 762.
     vomiting of, 762, 799.
     aphthae of, 778.
     constipation of, 780.
     diarrhcea of, 782.
     dysentery of, 788.
     coryza, cold in the head, of, 801.
     erysipelas of, 865.
     swelling of the scalp of, 874.
     ecchymosis of the scalp of, 874.
     chafing, excoriation of, 874.
     induration of the cellular tissue of, 876.
     swelling and hardness of the breasts of, 877.
     jaundice of, 881.
     ophthalmia of, 889.
     hernia of, 893.
     remittent fever of, 937.
 Infantile nutrition, physiology and lesions of, 760.
     indigestion, 762.
     colic, 762.
     hernia, 893.
      remittent fever, 937.
 Inferior strait of the pelvis, 28.
 Inflammation of  the  pelvic articulations  during
        pregnancy, 365.
Inflammation of the vulva, 570.
    erysipelatous, of the vulva, 573.
    catarrhal, of the external genital organs, 576.
    of the vagina, 691.
    of the uterus, 637.
    of the ovaries, 726.
    of the lungs in infants and children, 808.
    of the liver in infants and children, 883.
    of the brain in  infants and children, 902.
Inflammatory dysmenorrhcea, 517.
    ulcer of tho stomach, 681.
Infiltration of pus into the tissues of the uterus, 666.
Insanity after child-birth, 454.
    resulting from excessive lactation, 475.
Intertrigo, 874.
Intermittent fever of children, 884.
Internal surface of the pelvis, 23.
    metritis, 639.
Intestinal parasites, varieties of, 895.
    affections during pregnancy, 309.
Intellectual  faculties,  disorders  of, during preg-
      nancy, 378.
Introduction of the catheter, 46.
Inversion of the vagina, 232, 685.
    of the uterus, 618.
Irregular menstruation, 509.
Irritable uterus, 668.
Ischium, the, 17.
Itching ofthe external genital organs, 675.
    of the skin after measles, 854.

Jaundice of infants, 881.

Kiesteine, the, 117.

Labia majora, 43.
    minora, 45.
    oedema of the,  232
Labor, 171.
    premature, 171.
    retarded, 171.
    natural, at term, 172.
    causes of, 172.
    physiology of,  173.
    first stage of, 173.                       ,
    second stage of, 174.
    third stage of,  177.
    duration of, 178.
    effects of, upon mother and child, 178.
    mechanism of, 179.
    care of the woman and child during, 192.
    diet and regimen of the woman during, 200.
    care of the woman after, 200.
    no bandage to be used after, 201.
    arnica to be used after, 206.
    delay in urinating after, 206.
     difficult, 215.
     precipitate, 218.
     complicated by previously existing disease, 242.
     premature, induction of, 283.
     therapeutics of,  384.
     pains of, remedies for, 384.
     rigidity of the os during, 388.
     rigidity of the vaginal walls during, 388. 
988
INDEX.
 Labor, fainting and swooning during, 396.
     weakness, debility, exhaustion during, 396.
     haemorrhage during, 393.
     complicated by accidental haemorrhage, 394.
     complicated by placenta praevia, 398.
     complicated  by  concealed  accidental haemor-
      rhage, 395.
     complicated by convulsions, 411.
 Laceration of the perineum, 241.
 Lactation, disorders of, 464.
     excessive, 470.
 Lancing the gums during dentition, 769.
 Laryngismus stridulus, 823.
 Lateroversion, 631.
 Lateroflexion, 631.
 Leucorrhoea during pregnancy, 357.
     vaginal, 596.
     uterine, 639.
 Lesions  of the respiratory  mucous membrane  in
      children, 801.
 Lichen of the external genital organs, 576.
     urticatus, hives, 868.
 Lice infesting the external genital organs, 584.
 Ligaments of the  uterus, 60, 64.
     broad, the, 60.
     round, the, 64.
 Liquor amnii, the, 144.
    amnii, excess of, a cause of dystocia, 217.
 Liver, acute inflammation of the, 883.
     chronic inflammation of the, 883.
 Lochia, 210,428.
 Locomotion,  derangements of,  during  pregnancy,
      364.
 Longings during pregnancy, 291, 293.
 Lung-fever of children, 808.
 Lungs, inflammation of the, in children, 808.
 Lungs, non-development of the,  827.
 Luxation a cause  of pelvic  deformity, 230.
 Lymphatics  of the uterus, 62.

 Malaria or longing during pregnancy, 291.
 Male and female pelvis compared, 34.
 Malformation of the pelvis, dystocia from, 218.
    of tho vagina, 232.
 Malignant ulceration of the womb, 681.
 Mammae, alteration of, in pregnancy, 114.
 Mammary cancer, 693.
    cancer, 745.
    glands, inflammation of the, 473.
 Mania, puerperal, 454.
Marasmus of infants and children, 756.
Mastitis, 473.
Mastodynia apostematosa, 473.
Measles,  848.
    black, 851.
    sequelae of, 853.
    itching of the skin after, 855.
 Meatus urinarius, 46.
Mechanism of labor, the, 179.
    of vertex presentations, 180.
    of facial presentations, 184.
    of breech presentations, 186.
    of transverse presentations,  188.
Mechanical or obstructed dysmenorrhcea, 619.
 Medullary cancer of the womb, 698.
 Melancholia during pregnancy, 379.
    after child-birth, 454.
 Membrana granulosa, the, 68, 72.
 Membrane, the vitelline, 68.
 Membranes, premature rupture of, a cause  of dyn
      tocia, 217.
 Membranous dysmenorrhcea, 618.
 Meningitis, 902.
    tubercular, 903.
    cerebro-spinalis, 913.
 Menopause, the, 542.
 Menorrhagia, 529.                               !
    functional, 529.
    organic, 530.
    sympathetic, 632.
    remedies for, 533.
 Menstrual derangements, 500.
 Menstruation, the uterus during and after, 65,69,74.
    in its relation to ovulation, 74.
    first, 75.
    cessation of, 76.
    symptoms of, 76.
    causes of, 77.
    treatment of the disorders of, 500.
    absence of, 501.
    suppression of, 505,
    vicarious, 507.
    premature cessation of, 507.
    irregular or partial, 509.
    absence of, remedies for, 510.
    suppression of, remedies for, 510.
    difficult, 516.
    painful, 516.
    excessive,  529.
Metritis, internal, 639, 650
    chronic, 657.
Metrorrhagia, 406, 539.
Miliaria, 855.
Miliary fever, 855.
Milk-leg, 460.
Milk, secretion of the, 214.
    remedies for abnormal secretion of the, 466
    failure or scanty supply of the, 467.
    spontaneous running of the, 470.
    excessive supply of the, 470.
    as food for infants, 750.
Miscarriage, 477.
    criminality of producing, 489.
    treatment when anticipated or threatened, 490l
Molar pregnancy, 714.
Mollities ossium a cause of pelvic deformity, 228.
Moles, 711, 713.
    on infants, 872.
Mons veneris, 41.
Monstrosities a cause of dystocia, 244.
Morbilli, 848.
Morbid growths of the vagina, 605.
Morbus, 879.
Morning sickness of pregnancy, 111, 294.
Mouth of the womb, the, 55.
Mother's marks, 872.
Muciparous organs, 49.
Mucous coat of the uterus, 60. 
INDEX.
980
Multiple pregnancy, 167.
    pregnancy a cause of dystocia, 244.
Mumps, 891.
Muscles of the perineum, 39.
Muscular tissues of the pelvis, 36.
    coat of the uterus, 60.

Naevi materni, 872.
Narrow'ness of the vagina, 601.
Natural labor at term, 172.
Nausea and vomiting  during pregnancy, 294.
Neck of the uterus, 55.
Nerves of the uterus,  63.
Nervous system, disorders of, during pregnancy, 368.
    irritation, 665.
Nettle rash, 867.
Neuralgia during pregnancy, 371.
    of the vulva, 583.
    of the vagina, 590.
    of the uterus, 671.
    after scarlet fever, 847.
Neuralgic dysmenorrhoea, 516.
Nipples, soreness of the, 464.
Nocturnal enuresis, 901.
Non-ulcerated cancer of the uterus, 693.
Nuck, the canal of, 64.
Nursing, disorders of the period of, 464.
    loss of health from, 473.
    insanity occurring during the period of, 471.
    cramps in the stomach from, 473.
Nutrition of embryo  and foetus, 163.
Nymphae, 45.
    oedema of the, 232.
Nymphomania, 549.
    treatment of, 651.

Obliquity of the uterus a cause of dystocia, 237.
Obliteration of the cervex uteri a cause of dystocia,
       238.
Obstetric operations,  250.
Obstructive dysmenorrhoea, 519.
(Edema of the labia and nymphae, 232.
     of the lower extremities  during pregnancy, 343.
     of the^ulva during pregnarcy, 233.
QSstruation, 74.
Odontalgia during pregnancy, 374.
Old age, condition of the uterus in, 65.
Ophthalmia, syphilitic, of iufants, 878.
     of infants and children, 889.
Organs of generatiou, 11.
     muciparous, 49.
Organic menorrhagia, 530.
Orifice of the urethra, 46.
     of the vagina, 47.
 0s lacrum, 11.
     coccygis, 11.
     innominatum, 13.
     externum, os uteri, os tincse, 55,57.
     uteri, rigidity of, a cause of dystocia, 236, 388.
     uteri, rigidity of, during  labor, 388.
 Osteo sarcoma a cause of dystocia, 232.
 Otorrhoea after scarlet fever,  848.
 Ovarian turners a cause of dystocia, 233.
     irritation, 722.
Ovarian tumors, 732.
    dropsy, 734.
    cysts, 734.
    tumors, treatment of, 739.
Ovaries, the, 66.
    diseases of the, 721.
    acute inflammation of the, 726.
    chronic inflammation of the, 728.
    tumors of the, 732.
    cancer of  the, 742.
Ovaritis, acute, 726.
    chronic, 728.
Over distension of the bladder a cause of dystocia,
      236.
Ovisacs, the, 68.
Ovum, the, 68.
    development of the, 130.
    unimpregnated, 130.
Ovulation, 69, 71.

Pains of labor, the, 177.
    of labor, significance of, 177.
    and cramps during pregnancy, 354.
    experienced during pregnancy, 361.
    of labor, remedies for, 384.
Painful menstruation, 516.
Palpation in the diagnosis of pregnancy, 119.
Palpitation of the heart complicating labor, 243.
Paralysis  after diphtheria, 944.
Parenchyma,  the, 68.
Parasites  infesting the external genital organs, 583.
Parotitis, 891.
Partial menstruation, 509.
Parturition, 171.
    the uterus after, 65.
    no bandage to be used after, 204.
    arnica to be used after, 205.
    delayed urination after, 206.
    retention of urine after, 425.
    after pains of, remedies for, 426.
    pendulous abdomen after, 430.
    rhagades or cracks on the abdomen after, 431
    ulceration of umbilicus after, 431.
 Pavilion, the, 66.
 Pelvic presentation, 186.
     deformities, to determine the existence and ex
       tent of, 227.
     deformities, causes of, 227.
     deformities from  rachitis, 228.
     deformities from mollities ossium, 228.
     deformities from deviation of spinal column, 229.
     deformities caused  by luxation,  230.
     deformities  caused  by lesions  of  the inferioi
       extremities, 230.
     deformities from absolute narrowness, 230.
     articulations, inflammation of, during  preg-
       nancy, 364.
     articulations, relaxation of, during pregnancy,
       365.
 Pelvis, the, 10.
     bones of the, 10.
     articulations of the, 20.
     as a  whole, the, 23.
'     external  surface  of the, 23. 
990

Pelvis, internal surface of the, 23.
    the inclined planes of the, 24.
    the straits of the, 25.
    the cavity of the, 31.
    differences between male and female, 34.
    the, in childhood, 34.
    the uses of the, 35.
    the muscular tissues of the, 36.
    malformation of the, dystocia from, 218.
    absolute narrowness of the, 230.
    exostoses of the, 232.
Pemphigus, 855.
Pendulous abdomen, 430.
Percussion in the diagnosis of pregnancy, 120.
Perineum, the, 38, 42.
    the muscles of the, 39.
    rigidity of the, 231.
    laceration of the, 241.
Perineal hernia, 582.
Peritoneal coat of the uterus, 59.
Peritonitis, puerperal, 431,
    spurious, 453.
Pertussis, 817.
Phagedenic ulceration of the womb, 681.
Phlegmasia dolens, 460.
Physiology of labor, 173.
    and lesions of infantile nutrition, 750.
Physometra, 706, 709.
" Pica "  during pregnancy, 291.
Piles, 346.
Piliferous bulbs, 49.
Pityriasis, dandruff, 871.
Placenta, formation of the, 146.
    delivery of the, 200.
    mode of extracting the, 202.
    breaking up adhesions of, 202.
    retention of, remedies for, 424.
    praevia, 398.
    praevia, diagnosis of, 396.
Plane of the superior strait. 26.
    of the inferior strait, 26.
    of the pelvic excavation or cavity, 32.
Plethora during pregnancy, 341.
Plica polonica, 962.
Pneumo-hydrometra, 706.
Pneumonia of children, 808.
Podalic version, 251.
Polypus as a cause of dystocia, 234.
    of the vagina, 507.
    of the uterus, 715.
Pompholyx, 855.
Porrigo larvalis, 869.
Position affecting the axis of the pelvic cavity, 34.
    and presentation of the foetus at full term, 161.
    of the woman in applying the forceps, 263.
Positions and presentations in labor, 179.
Posterior commissure, 43.
Post-partum haemorrhage, 402.
    derangements, 424.
Post-scarlatinal dropsy, 842.
    rheumatism, 846.
Pot-belly after parturition, 430.
Precipitate labor, 218.
Pregnancy, 90.
INDEX.


      Pregnancy, the uterus during, 65.
          extra-uterine, 89.
          uterine, 89.
          false, 89.
          simple uterine, 89, 90.
          physiological and anatomical changes in, 90.
          changes in the uterine appendages in, 104.
          diagnosis of, 109.
          signs of, 109.
          morning sickness of, 113.
          alterations of the mammae in, 114.
          the changes in the  urine in, 116.
          statement of the principal signs of, 128.
          anomalous, 167.
          multiple, 167.
          extra uterine, 168.
          disorders incidental to, 285.
          hygiene of, 288.
          disorders of the digestive system during, 290.
          variations of appetite and taste during, 290.
          gastric derangements of, 294.
          morning sickness of, 294.
          heartburn during, 306.
          table  of  remedies  for gastric   disturbances
            during, 307.
          intestinal derangements during, 309.
          constipation during, 309.
          diarrhoea during, 314.
          table of remedies for intestinal affections during,
            323.
          disordered secretions and excretions during, 328.
          ptyalism during, 328.
          spitting of blood during, 328.
          urinary difficulties and derangements during,328.
          albuminuria during, 333.
          uraemia during, 355.
          table  of  remedies  for urinary derangements
            during,  336.
          disorders of respiration during, 338.
          cough and dyspnoea during, 338.
          derangements of circulation and of the circula-
            tory apparatus during, 341.
          plethora, hydraemia and anaemia during, 341.
          oedema, anasarca and ascites during, 343.
          haemorrhoids during, 346.
          varicose veins during, 352.
          affections  of the  uterus and its  appendages
            during, 354.
          pain and cramps during, 354.
          sensibility "of the uterus during, 354.
          uterine displacement during, 355.
          prolapsus uteri during, 355.
          anteversion during, 355.
          retroversion during, 355.
          abnormal secretions during, 357.
          leucorrhoea during, 357.
          hydrorrhoea during, 357.
          false water during, 357.
          dropsy ofthe amnion during, 358.
          affections ofthe appendages ofthe uterus during,
            360.
          pruritus of the vulva during, 360.
          pains experienced during, 361.
          disorders ofthe locomotive apparatus during,364 
INDEX.                                        991
Pregnancy  inflammation  of  pelvic  articulation
      duri jg, 364.
    relaxation of pelvic articu.Sition during, 365.
    disposition to fall during, 366.
    derangements and affections of nervous system
      during, 368.
    loss of hearing during, 368.
    affections ofthe eyes during, 369.
    headache during, 371.
    neuralgia during, 371.
    toothache during, 374.
    chorea during, 375.
    hysteria during, 377.
    disturbance of intellectual faculties during, 378.
    disorders of the  affections, emotions and feel-
      ings during, 379.
    melancholia during, 379.
    molar, 714.
Premature labor, 171.
    induction of, 283.
    rupture of the membrane a cause of dystocia, 217.
    cessation of menstruation, 607.
Presentation and position of foetus at full term, 161.
    and position in labor, 179.
    facial, mechanism of, 183.
    of the pelvic extremity, 186.
    of the breech, mechanism of, 186
    of the trunk, 188.
    complicated, 249.
    of the trunk, general directions to be  observed
      in, 260.
Procidentia uteri, 612.
Profuse urination, 900.
Prolapsus as a cause  of dystocia, 239.
    of the funis, 247.
    uteri  during pregnancy, 355.
    uteri, 612.
Prolapse of the vagina,  584.
    of the womb, 612.
Promontory of the sacrum, 11.
Prurigo ofthe external genital organs, 575.
Pruritus vulva during pregnancy, 360.
    of the external genital organs, 575.
Ptyalism  during pregnaucy, 328.
Pubis, the, 17.
Pudendum, 43.
Puerperal convulsions, 411.
    convulsions, remedies for, 421.
    fever, 431.
    mania, 454.
Pulsatilla in malposition of the foetus, 250.
Purulent  ophthalmia, 889.
Pus, infiltration of, into the uterine tissues, 656.
Putrefaction of the uterus, treatment of, 704.
Pyro is during pregnancy, 306.

Quickening, 113,116.

Rachitis,  887.
    a cause of deformed pelvis, 228.
Ramollissement of the  uterus, 704.
Ranula, 874.
Rational  signs of pregnancy, 110.
Recto-uterine ligament, 60
Rectocele, 587.
Relations of menstruation to ovulation, 74.
Relaxation of the pelvic articulations  during preg
      nancy, 365.
Remittent fever of children, 937.
Reproduction, 79.
Respiratory organs, diseases of, in children, 801.
Respiration of the foetus, 165.
    disorders of, during pregnancy, 338.
Retained placenta, remedies for, 424.
Retarded labor, 172.
Retention of urine after parturition, 425.
    of urine in  children, 900.
Retroversion of the uterus, 624.
    ofthe uterus during pregnancy, 355.
Retroflexion of the uterus, 627.
Rhagades of the abdominal walla  after child-birth,
      431.
Rheumatism after scarlet fever,  846.
Rickets, 887.
Rigidity  of the perineum, 231.
    of the uterus as a cause of dystocia, 236.
    of the os uteri during labor, 388.
    of the vaginal walls during labor, 388.
Roseola,  854.
Round ligaments, the, 64.
Rubeola, 848.
Rugae, 53, 58.
Rupture  of the uterus, 239.
    of the vagina, 239.
    Of the bladder, 241.
    in infants and children, 893.

Sacrum,  the, 11.
    function of the, 21.
Sacro-vertebral angle, the, 11.
Sacro-iliac symphysis, the, 22.
Sanguineous tumors a cause of dystocia, 233.
    tumors of the head, 874.
Scarlatina, 830.
Scarlet fever, 830.
    fever, dropsy after, 842.
    fever, rheumatism after, 846.
    fever, neuralgia after, 847.
    fever, scrofulous affections after, 847.
    fever, otorrhoea after, 848.
    rash, 854.
Scirrhus of the mammae, 747.
Scrofula, 885.
Scrofulous affections after scarlet fever, 847.
    ophthalmia, 889.
Sebaceous glands, 49.
Secretion as a function of the foetus, 166.
    of milk, 214.
Second stage of labor, 174.
Sensible signs of pregnancy, 117.
Sensibility ofthe uterus during pregnancy, 354
Serous cysts of the vagina, 609.
Shortness of the cord, 248.
Sigaultean operation, the, 282.
Signs of pregnancy, 109.
Sinuses of the uterus, 62.
 Size of the child a cause of dystocia, 244.
Skin diseases, syphilitic, of children, 878. 
992
INDEX.
 Snuffles, the, 801.
 Softening of the uterus, 655.
 Solid ovarian tumors, 732.
 Sore mouth of infants, 778.
     nipples, 464.
 Sour stomach during pregnancy, 306.
     stomach of infants and children, 762.
 Sounds of the fcetal heart, 125.
 Spasms, cramps and contractions of the vagina, 588.
     of infants and children, 946.
 Spasm ofthe glottis, 823.
 Spinal deviation a cause of pelvic deformity, 229.
 Spitting of blood during pregnancy, 328.
 Spontaneous evolution ofthe foetus, 190,
 Spotted fever, 913.
 Spurious peritonitis, 453.
 Statement of the principal signs of pregnancy, 128.
 Sterility, 644, 688, 955.
 Stomach, derangements of, during pregnancy,  294.
 Straits of the pelvis, the, 25.
 Strangulation of the prolapsed vaginal wall, 587.
 Stroma of the ovary,  the, 68.
 Structure of the uterus, 59.
 St. Vitus' dance, 934.
     dance during pregnancy, 375.
 Sudoriparous glands, the, 49.
 Superior strait of the pelvis, 25.
 Super-foetation, 170.
 Suppression of the menses, 505.
     of urine in children, 900.
 Suspended animation, 212, and Appendix, 951.
 Swelling and elongation of the anterior uterine lip,
       a cause of dystocia, 238.              '
 Swooning during labor, 390.
 Sympathetic menorrhagia, 532.
 Symphysis pubis, the, 21.
 Symphyseotomy, 282.
 Symptoms of menstruation, 76.
 Syncope complicating labor, 243.
     during labor, 390.
 Syphilitic ulcers of the genital organs, 578.
     ulcers of the uterus, 68.
     affections of children, 877.
     ophthalmia, 889.

 Table of remedies  for variations of appetite and
       taste during pregnancy, 292.
     of  remedies  for  gastric  derangements during
      pregnancy, 307.
     of intestinal affections during pregnancy. 323.
     of  remedies  for  urinary  derangements during
      pregnancy, 336.
 Taste and appetite during pregnancy, 290.
 Temper, change of, during pregnancy, 380.
 Term of gestation, tho, 88.
 Teeth, mode of development ofthe, 767.
 Teething, 766.
 Therapeutics of labor, 384.
 Third stage of labor,. 177.                 •
 Thrush, 778.
 Tocological flexible forceps of Casanova, 269.
 Touch, the, in the diagnosis of pregnancy, 118.
 Tongue-tie, 895.
 Toothache during pregnancy, 374.
Traction to be made with the forceps, 2G7.
 Transverse presentations, 188.
 Traumatic cerebritis, 909, 911.
 Trismus, 947.
 Trunk, presentation of the, 188
    presentation of the, general directions to be ob-
    served in, 260.
 Tubercular meningitis, 903.
 Tubes, Fallopian, 66.
 Tumors as a cause of dystocia, 232, 236.
    ofthe vulva, 579.
    of the vulva, encysted, 579.
    bloody or oozing, of the external genitals, 582.
    of the vagina, 605.
    of the uterus, fibroid, 719.
    of the ovaries, 732.
    encysted, of infants, 873.
 Tumefaction  of the vulva, 579.
 Tunica albuginea, 68.
    propria, 68.
 Turning, 250.
    by the bi-manual method, 255.
    cephalic, method of effecting, 257.
 Twin pregnancy, 168.
 Typhoid fever of children, 938.

 Ulcerated form of cancer of the womb, 696.
 Ulceration ofthe umbilicus after labor, 431.
    of the uterus, 677.
    ofthe uterus, granular, 679.
    ofthe uterus, follicular, 681.
    of the uterus, inflammatory, 681.
    ofthe uterus, syphilitic, 681.
  ,  of the uterus, corroding, phagedenic or malig-
      nant, 681.
    ofthe uterus, treatment of, 683.
 Umbilical vesicle, the, 141,
    cord, formation and development of, 149.
 Umbilicus, ulceration ofthe, after labor, 431.
 Unavoidable haemorrhage, 398.
 Uraemia during pregnancy, 335, 342.
 Urethral orifice,  46.
    follicles, 50.
 Urination, delay of, after labor, 206.
 Urinary difficulties and derangements during preg
      nancy, 328.
    derangements of pregnancy, and remedies, 336.
    difficulties of children, 899.
    calculi in children, 901.
Urine, changes in the, in pregnancy, 116.
    retention of, after parturition, 425.
Urticaria, nettle rash, hives, 867.
Uses of the pelvis, 35.
Uterine elevator  for retroversion, 629.
    arteries, 62.
    veins, C2.
    sinuses, 62.
    lymphatic vessels, 62.
    nerves, 63.
    pregnancy, 89.
    displacements during pregnancy, 25ft.
    haemorrhage, remedies for, 403.
    catarrh, 639.
    tympanitis, 709.
    moles, 711.
    hydatids, 713. 
INDEX.
993
Uterine polypi, 715.
    fibroid tumors, 719
Utero-gestation, 88.
Uterus, 54.
    virgin, the, 55.
    impregnated, the, 54.
    body of the, 66.
    cervix of the, 55.
    neck of the, 55.
    apex of the, 66.
    external  dimensions of the, 58.
    structure of the, 59.
    muscular coat of the, 60.
    mucous coat of the, 60.
    blood-vessels of the, 61.
    during and after menstruation, the, 66.
    during and after pregnancy, the, 65.
    after parturition, the, 65.
    in old age, the, 65.
    hour-glass contraction  of the, 203.
    inversion of the, 203.
    tumors of the, as a cause of dystocia, 236.
    obliquity of the, as a cause of dystocia, 237.
    rupture of the, 239.
    and its appendages, affections of, during  preg-
      nancy, 354.
    sensibility of the, during pregnancy, 354.
    prolapsus of, during pregnancy, 355.
    anteversion of, during pregnancy, 355.
    retroversion of, during  pregnancy, 355.
    displacements of the, 611.
    prolapse of the, 612.
    inversion ofthe, 618.
    anteversion of the, 620.
    anteflexion of the, 623.
    retroversion of the, 624.
    retroflexion of the, 627.
    lateroversion and lateroflexion of the, 631.
    remedies for the displacements of the, 631.
    inflammation of the, 637.
    hypertrophy of the, 655.
    induration of the, 655.
    ramolissement of the, 655.
    gangrene of the, 655.
    infiltration of pus into  the tissues of the, 656.
    effusiou of coagulable lymph into the tissues of
      the, 666.
    chronic enlargement of the, 655, 657.
    irritable, 668.
    neuralgia of the, 671.
    ulceration of the, 677.
    cancer of the,  693.
    indurated form of cancer of the, 693.
    ulcerated form of cancer of the, 696.
    cancer of the, encephaloid form of,  698
    cancer of the, medullary form of, 698.
    cancer of the, colloid form of, 698.
    cancer of the, gelatinous  form of, 698.
    epithelial cancer of the, 699.
    cauliflower excrescence ofthe, 699.
    cancer of the, treatment of, 700.
    gangrene of the, treatment of, 704.
    dropsy of the, 705.
    accumulation of gas in the,  706, 709
            63
Vaccination, 864.
Vagina, 41.
    orifice of the, 47.
    the, 51.
    malformation of the, 232.
    inversion of the, 232.
    rupture of the, 239.
    diseases and derangements of the, 584.
    prolapse of the, 584.
    inversion of the, 685.
    spasms, cramps and contractions of the, 588
    neuralgia of the, 690.
    inflammation of the, 594.
    induration of the, 600.
    extreme narrowness of the, 601.
    gangreue of the, 604.
    morbid  growths of the, 606.
    tumors of the, 606.
    morbid  growths of the, remedies for, 608.
    serous cysts of the, 609.
    condylomata of the, 610.
Vaginal follicles, 50.
    cicatrices, 232.
    hernia a cause of dystocia, 235.
    walls, rigidity of, during labor, 388.
    leucorrhoea, 596.
    fistula, 602.
    polypi, 507.
Vaginismus, 593.
Vaginitis, 594.
    treatment of, 600.
Variations of appetite and taste during pregnane;
      290.
Varicella, 865.
Varicose veins, 352.
Variola, 856.
Varioloid, 856.
Vectis, the,  273.
Veins uterine, 62.
    varicosed, 252.
Vertex presentation, mechanism of, 180.
Vertebral column, deviation of, a cause of pelvic a*
      formity, 229.
Version, 250.
    by the feet, 251.
    by the bi-manual method, 256.
    cephalic, 257.
Vermicular affections, 895.
Vestibule, 46.
Vestibular follicles, 60.
Vesicles, the Graafian, 68.
    the germinal, 69.
Vesical hernia, a cause of dystocia, 235.
Vesicular moles, 713.
Vesico uterine ligaments, 60.
    vaginal fistula, 602.
Vessels, uterine, sympathetic, 62.
Vicarious menstruation, 507.
Virgin uterus, the, 55.
Vitelline  membrane, the, 68.
Vitellus, the, 69.
Vomiting during pregnancy, 294.
    in infants and children, 762, 79^
Vulva, the, and its  appendages, 43. 
994                                       INDEX.
Vulva, adhesion of the, 231.
    contraction and rigidity of the, 231.
    pruritis of, during pregnancy, 360.
    erysipelatous inflammation of, 573.
    catarrhal inflammation of, 675.
    cutaneous affection of the, 575.
    oedema of the, 679.
    tumefaction of the, 579.
    abscess of the, 679.
    tumors of the, 579.
    erectile tumors of the,'580.
    hernia of the, 582.
    neuralgia of the, 683.
    ascarides infesting the, 583.
Vulvitis, inflammation of the vulva, 570.
Vulvo vaginal glands, 50.

Warts and wens of infants, 873.
Admixture 0f pus with the milk, 960.
Albuminuria, 958.
Albuminuria as a sequela, 968.
Altered quality of the milk, 961.
Animation, suspended, of newly-born children, 951.

Barrenness, 955.

Chancres, 957.
Cholera infantum, additional remedies for, 951.
Coccyodyuia, 963.

Diarrhoea, additional remedies for, 951.
Diet during pregnancy, 954.
Di-t during sickness of any kind, 953.
Diphtheria, additional remedies for, 953.

Hysteria, additional remedies for, 961.

Matted hair, 962.
Milk, altered quality of, 961.
Milk, extreme richness of, 961.
Warty excrescences of the external genitals, 678
    excrescences of tho vagina, 610.
Wasting disease of children, 756.
Water in the head, 903.
Weakness during labor, 391.
Weaning, directions for, 476.
Weight of the foetus at different periods, 152.
Wetting the bed, 901.
Whooping cough, 817.
Womb, mouth of the, 55.
    hour-glass contraction of the, 203.
    displacements of, during pregnancy, 356.
    falling of the, 612.
    inflammation of the, 637, 650.
    enlargement of the, 665.
    gangrene of the, 655.
    chronic enlargement of the, 657.
Worms, 895.
Milk, mixed with pus or blood, 960.
Milk, formula for preparing, for infants, 962.
Milk condensed, formula for  preparing, for infants
    962.

Nails, finger or toe, diseases of tne, 956.
Newly-born children, suspended animation of, 961.
Nipple shield, 961.

Ovarian tumors, treatment of, 951.

Plica caudiformis, 962.
Plica multiformis, 962.
Plica polouica, 962.
Pus, admixture with the milk, 960.

Sterility, 955.
Suspended animation of newly-born children, 951.
Syphilitic ulcers, 957.

Ulcers, syphilitic, 957.

Vomiting of infants of pus or blood, 961.
INDEX   TO   APPENDIX. 
GLOSSARY.
Abdomen.  The cavity between the  thorax and
  pelvis—the belly.
Abnormal.   Not natural; unhealthy.
Abrasion.  Loss of skin or membrane by scraping,
  etc.; excoriation.
Accoucheur. He who practices  the art of Mid-
  wifery.
Acetabulum.  Cup-like cavity, receiving the head
  of the femur at the hip-joint.
Acne  punctata.  Red pimples upon the  face and
  nose of young people.
Acne  rosacea.  Same as above, but are more bright
  red.
Acrid.  Corrosive; pungent; irritating.
Acromion.   A process,  or part, of the scapula.
Acupuncture.  Plunging of  needles into the soft
  parts.
Adenockle.  Glandular tumor.
Adenoid.  Resembling a gland.
Adipose.  Pertaining to fat—as adipose tissue, fatty
  tissue.
Adynamic.  Attended with great debility, prostra-
  tion.
Aeration.  Transformation of the venous  blood and
  chyle into arterial blood  by respiration ;  forma-
  tion of blood in general.
.Etiology.   Doctrine of morbid causes.
After-birth.  See p. 146.
Apter-pain.  See p. 209.
Agglutination.  Adhesion;  gluing together.
Ague.  Chill.
Aim nasi.   Wings of the nose.
Albugineous.  Term applied  to  textures, humors,
  etc. which are perfectly white.
Albumen.   An organic element of  the blood, etc.,
  found almost pure  in the white of an egg.
Albuminuria.  See p. 333.
Alimentary.  Connected with food.
Alkaline.   Substance  which neutralizes acids.
Allantois.  See p. 137.
Alveoli (alveolar).   Bony sockets of the  teeth.
Alvine.  Pertaining to the stomach  or intestines.
Amaurosis.   Paralysis of the optic nerve.
Amblyopia.  Dimness  of sight.
Amenable.  Governable.
Amenorrhcea.  See p. 601.
Amnion.  See p. 136.
Amnion, Dropsy of.  See p. 368.
Amphiarthrosis.  A mixed articulation, in which
  the corresponding  surfaces of bones are united by
  an  intermediate body, allowing some slight mo-
  tion—as the junction of the vertebral by the in-
  vertebral  cartilages.
Anemia.  See p. 342.
Anesthesia.  The taking awaj of sensation, usually
  done by inducing sleep.
Anasarca.  Dropsy of the cellular tissue. A species
  of dropsy between the skin and flesh.
Anastomosis.  Inoscultation of vessels.
Anchylosis.  Stiffness of a joint; adhesion of artic-
  ulating surfaces.
Aneurism.  Morbid enlargement of an artery.
Angina.  Inflammation of the air-passages of the
  throat.
Anomalous.  Irregular; unnatural.
Anorkxia.  See p. 290.
Anteflexion.  See p. 623.
Anterior.  Before; in front.
Antevebsion.  A bending forward.  See p. 621.
Antiphlogistic  Preventives of inflammation; cool-
  ing remedies.
Antipsoric.  Opposed to the itch.
Anus.  External opening  of the rectum.  Funda-
  ment.
Aorta.  The great artery of the body.
Apathy.   Insensibility; indifference.
Aphtha.  Roundish, whitish vesicles  found in sore
  mouth.
Apncea.  Absence of respiration.
Aponeurosis.  Fascia; tendinous expansion of mus-
  cles.
Apyrexia.  Intermission of febrile paroxysms.
Arachnoid.  Membrane of the brain; tunic of the
  eye.
Areola.  Circle, as around the nipple.
Areolar Tissue.  Cellular tissue.
Arteries.  Vessels conveying the blood from the
  heart.
Arthrodia. A movable joint formed by the head of
  a bone in a shallow socket, so  that it can execute
  movements in  every direction.
Articulation.  The union of bones with each other,
  and the manner of union.
Ascarides.  Small intestinal worms; pin-worms;
  thread-worms.
Ascites.  Abdominal dropsy.
Asphyxia.  Suspended animation, as by suffocation,
  etc.
Assimilate.  To convert into a similar nbstance, as
  food is assimilated byconversion into animal sub-
  stances, flesh, chyle, blood, etc.
Asthenic.  Debilitated; applied to disease, low.
Asthma.  Violent oppression of breathing.
Astragalus.  Upper bone of the tarsus, on which the
  tibia rests.
Astringents.  Medicines used to contract musculai
                                 995 
996
GLOSSARY.
  fibre, and  to  constrict  vessels to  restrain  dis-
  charges.
Atelectasis pulmonum.  S(ep. 827.
Atlas.  First vertebra of tl e neck.
Atony. Relaxation, want cf energy or tone.
Atresia.  Congenital imperforation of the intestinal
  canal.
Atrophy.   Wasting away of the system from func-
  tional disturbance.
Auricle.  A cavity of the heart.
Auscultation.  See p. 124.
Autopsy.  Ocular evidence.
Axis.  Second vertebra of the neck.

Rao of Waters.  See p. 177.
ballottement.   See p. 123.
Bas-fond.   The lowest region of the bladder.
Basilar.  That which  belongs to the base.  This
  name has been given to several parts which seem
  to serve  as bases to others.
Belching.  The throwing off,  or  ejecting, of wind
  from the stomach.
Biliary.  Pertaining to the secretions of the liver.
Bistoury.   A small knife having a curved blade.
Blastodermic Membrane.  See p. 134.
Blastodermic Vesicle.  See p. 134.
Borborygmus.  Rumbling of wind in the bowels.
Breech.  The lower part of the body, from the mid-
  dle down.
Bronchia.  Air-passages.
Bronchitis.  See p. 804.
Bruit de Soutfle.  See p. 126.
Buccal.  Belonging to the  cheeks' pertaining to
  the mouth.
Bulimy.  See p. 291.
Bulla. Blisters.
Bursa. Bags.

Cachectic. Adjective of Cachexia.
Cachexia.   Vitiated constitution;  morbid cvi lition
  of the body characterized by deficient digc.tion,
  nutrition and assimilation.
Cadaverous.  Resembling a corpse.
Cacum. A portion of the intestines.
Casarean.  See p. 279.
Calcareous.  Containing lime.
Calculus.   Stone; gravel.
Callous.  Hard.
Cancer.  A scirrhous, livid tumor, intersected by
  firm, whitish, divergent bands.
Cancer.  Colloid, gelatinous.  See p. 687.
Oancer.  Fibrous, hard, scirrhous.  See p. 687.
Cancer.  Soft, medullary, encephaloid.  See p. 687.
Cancroid.   That which assumes a cancerous  appear-
  ance.
Canula.  A small tube, metallic, wooden or rubber,
  used in surgery.
Capillaries.  Hair-like, minute bloodvessels.
Capsule.  Membranous sac.
Carcinoma.  Cancer.
Cardiac  Pertaining to the heart.
Caries. Ulceration of the bone.
Carious.  Adjective of Caries.
Carotids.   Two large arteries of the neck
Cartilage.  An elastic and flexible substar ce found
  at the joints aud at the extremities of tie ribs.
Caseine.  Cheesy.
Cabeosa.  A soft cheesy substance found ot the skin
  of a newly-born  babe.
Catamenia.   Menses.
Catheter.  A hollow  tube, used to insert into the
  bladder to draw off urine.
Caudal.  Tail.
Cell.  A small cavity.
Cellular Tissue.  Net-like formation, composed of
  cells.
Cellulitis.  Cellular inflammation.
Cephalamatoma.  A sanguineous tumor  found on
  the heads of new-born infants.
Cephalalgia.  Headache.
Cephalic.  Pertaining to the head.
Cephaloma.   A tumor resembling brain.
Cephalotribe.  See p. 278.
Cephalotripsy.  See p. 278.
Cerebral.  Pertaining to the brain.
Cerebriform.  A morbid substance commonly form-
  ed by scirrhous or cancerous tumor.
Cerebro-spinal Meningitis.  See p. 935.
Cerebrum.  Upper and front part of the brain.
Cerumen.  Ear-wax.
Cervicitis.  Inflammation of the neck of the womb,
Cervix.  Neck.
Change of Life.  See Climacteric Period.
Chemosis.  Inflammatory swelling of the conjunc-
  tiva.
Cholesterine.  A substance forming the crystalline
  part of certain biliary calculi.
Chlorosis.  A disease affecting young females, more
  particularly those who have not menstruated.  It
  is characterized by a pale, livid complexion, lan-
  guor, depraved appetite and digestion.
Chlorotic Pertaining to Chlorosis.
Chorea.  See p. 934.
Chorion.  See p. 131.
Chronic  Of long standing.
Chyle.  A nutritive fluid.
Chylopoetic.  Relating to the formation of chyle.
Cicatrix (pi. cicatrices').   Scar  left after  the heal-
  ing of a wound.
Cilia. The hairs on the eyelids.
Clavicle.  Collar-bone.
Clavus.  Kind of tumor.
Climacteric Period. Cessation of menstrual func-
  tions, usually occurring about the forty-fifth year.
Clitoris.  See p. 45.
Cloaca.  The pouch at the extremity of the Intesti
  nal canal.
Coagulum.  Clot of blood.
Coccyx.  See p. 15.
Coins, or Coition.   Sexual intercourse.
Colitis.  See p. 758.
Collapse.  Failure of vital power.
Colliquative.  A term applied to various dlschnrgn
  which produce rapid exhaustion.
Colon.  The large intestine.
Colostrum.   See p. 214.
Coma.  Lethargy; stupor; collapse.
Comatose.  Pertaining to Coma. 
GLOSSARY.                                    997
Comedones.  Little black spots on the nose.
Commissure.  See p. 43.
Conception.  The impregnation of the ovum by the
  male sperm, whence results a new being.
Condylomata.   Wart-like excrescences on the pu-
  denda or anus, or on face.
Condyle.  A knob at articulating joints.
Congenital.  Hereditary; existing at birth.
Congeries.  A  collection of several  particles or
  bodies in one mass.
Congestion. Over-fullness of the blood-vessels.
Constipation.   See Costiveness.
Contagion.  Propagation of disease by contact.
Contusion.  Bruise.
Cornea.   Horny, transparent coat of front part of
  the eyelid.
Corpus luteum. Cioatrix of the ovarium after the
  escape of an ovum.
Corpuscle.  Globule.
Coryza.  Discharge from the nose.
Costiveness.  When  evacuations from  the  bowels
  do not take  place as frequently as usual;  or are
  unnaturally hard and voided with difficulty.
Cotyledon.  A  hollow cavity in a bone which re-
  ceives the head of another bone.
Cranioclast.  See p. 277.
Craniotomy.  See p. 274.
Cranium.   Skull.
Crepitus.   Crackling; grating
Cretaceous. Containing or relating to chalk.
Crochet.  See i>. 277.
Crural.  Belonging to the upper part of the inner
  side of the thigh.
Crusta lactea.   See p. 869.
Crypt, or Follicle.  A small hollow, roundish body,
  situate in the substance of the skin or mucous
  membranes.
Curuncula myrtiformis. See p. 47.
Cutaneous.  Pertaining to the skin.
Cuticle.  Outer skin.
Cycles. A period ofa certain number of days or years.
Cyst.  A bladder.
Cystocele.  Hernia, or rupture, of the bladder.

Decidua.  See p. 139.
Decidua reflexa.  See pp. 87 and 139.
Decidua vera.  See pp. 87 and 139.
Defecation.  Stool; alvine evacuation.
Deglutition.  Act of swallowing.
Deltoid.  Muscle of the shoulder.
Dementia. Insanity; idiocy.
Dental.   Pertaining to the teeth.
Dentition.  Process of cutting teeth.
Dermis.   True skin.
Desquamation.  Peeling off of the skin.
Desiccation.  Drying up.
Diagnosis. The discrimination of diseases.
Diaphragm. Muscular partition between the thorax
  ani abdomen.
Diathesis.  Constitutional tendency.
Dietetics. Pertaining to diet.
Digital.  Belonging to the fingers.
Diphtheria.   Sio p. 941.
Diplopia.   Double vision.
Dislocation.  Displacement, as of a joint.
Diuresis.  An abundant secretion of urine.
Dorsal.  Pertaining to the back  or posterior pari
  of anything.
Dorsum.  The back;  the posterior side of anything.
Dropsy.  An  unnatural collection of a watery fluid
  in any part of the body.
Ductus venosus.  A vein in the liver.
Duplicature.  Folding of a membrane upoAitself.
Dura mater.  The outer membrane of the brain.
Dyscrasia.  Abnormal composition of the fluids.
Dysentery.  A  disease of the intestines attended
  with frequent bloody  and mucous stools.  See
  page 788.
Dysmenorrhcea.  Painful menstruation.
Dyspepsia.  Weakness of digestion.
Dysphagia.  Difficulty of swallowing.
Dyspncea.  Difficult breathing. See p. 339.
Dystocia.  Difficult labor.  See p. 215.
Dysuria.  Painful micturition; difficulty in making
  water.

Ecchymosis.   Extravasation of blood under the skin,
  as in bruises.
Eclampsia.  Puerperal convulsions.
Ecrasement.  Pertaining to the Ecraseur.
Ecraseur.  A surgical instrument, very like a chain-
  saw.
Eczema.  Eruption of small vesicles on various parts
  of the skin, usually close or crowded together, with
  little or no inflammation round their bases.
Eczema capitis. See p. 869.
Efflorescence.   Redness of the skin.
Effluvium.  Ati impure exhalation.
Embryo.  The foetus in its earliest stages of develop-
  meut.
Embryonic Spot.  See p. 139.
Embryulcia.  See p. 278.
Emetic  Medicine to produce vomiting.
Emmenagogue.  A medicine that promotes the men-
  strual discharge.
Emphysematous.  Pertaining  to the effusion of air
  into the cellular tissue.
Empirical.  Practice based on experience alone.
Emprosthotonos.   Spasms  in which  the  body is
  drawn forward.
Emulgent.  A name given to the renal  artery and
  vein.
Emulsify.  To soften.
Enceinte.  Pregnant.
Encephalic  Pertaining to the brain.
Enchondroma.  A cartilaginous growth proceeding
  from bones.
Encysted.  Covered with a membranous sao.
Endemic.  Peculiar to a circumscribed locality.
Endocarditis.  Inflammation of the internal parts
  of the heart.
Endocervicitis. Inflammation of the lining mem-
  brane of the neck of the womb.
Endochorion.  See p. 146.
Endometritis.  Inflammation of  tho lining mem-
  brane of the uterus.
Endosmosis.   The action by which fluids pass from
  without to  within organic membranes. 
998
GLOSSARY.
Enema.   Injection.
Eneuresis.  Incontinence of urine.
Epichorion.  One of the fcetal membranes.
Epidemic.  A  generally prevailing disease among
  human beings.
Epidermis.  The true skin; the outside coat on the
  whole body.
Epidydimis.  Parts of the testicles.
Epigastric  Pertaining to the region of the stom-
  ach.
Epilepsy.  Disease of the brain,  characterized  by
  unconsciousness, convulsive fits, etc.
Epistaxis.  Bleeding from the nose.
Epithelium.  Cuticle of the mucous membrane.
Erosion.  Destruction by ulceration.
Erotomania.  Love-madness.
Eructation.  Belching;  rising of wind from the
  stomach.
Erysipelas.  Inflammatory cutaneous disease cha-
  racterized by extreme redness.
Erythema.  See p. 576.
Ethmoid Bone. One of the bones of the head.
Etiology.  History of the causes of disease.
Eustachian Tubes.  Leading from the throat to the
  inner ear.
Euthesia.  The ready return of a rupture or a dis-
  location.
Evanescent.  Vanishing; passing away.
Exacerbation. Aggravation of a disease or symptom.
Exanthema.  Cutaneous eruption.
Excito-motory.  A term applied to a division of the
  nervous system, comprising the gray matter  of
  the spinal marrow, with the affereut and efferent
  nerves  connected  with it; all of which are con-
  cerned in reflex actions.
Excrement.  Everything which is discharged from
  the body as superfluous, such  as faecal matter,
  urine, perspiration, nasal mucus, etc.
Exfoliation.  Peeling off  in  thin layers, as of the
  bones or nails.
Exostosis. A morbid  enlargement or tumor of a
  bone.
Extravasation.  Effusion of blood into a structure.
Exudation.  Passage of fluid through a membrane.

Facet. A small face;  a small, circumscribed por-
  tion of the surface of a bone.
Facal.  Pertaining to stool.
Fallopian Tube.  See p. 66.
False Pains.  Pains like, or resembling, labor-pains.
Fascia.   Fibrous membrane arranged in  the form
  of an inextensible  texture, and constituting a
  sheath  for muscles.
Fasciculus (p\. fasciculi).   Bundle.
Fauces.  Throat.
Fi brile.   Pertaining to fever; feverish condition.
Fecundity.  Fruitfulness.
Felon. Very painful tumor found on the flngers or
  toes.
Femoral.  Pertaining to the femur.
Ffmur (pi. femora).  Thigh-bone.
Fenestra.  Aperture.
Fibrils.  Fibres.
Fibrin.  V»e filamentous portion of the blood.
Fibula.  Small bone of the leg.
Filament.  Same as fibril.
Filiform.  Thread-shaped.
Fimbria.  Fringe-like extremity of a structure.
Fissure.  A chap; crack; opening.
Fistula.  An ulcer, found usually in the anus.
Flatulent.  Pertaining to wind.
Flatus.  Wind.
Flexion.  Bending.
Flocculi.  Cloudy sediment
Flux.  Flow.
Fcetor.  Stench; disagreeable odor.
Fcetus.  The young babe in the womb before it ii
  born.
B'ollicle.  Fold; small  sac.
Fontanelle.  Aperture in the infant skull  at the
  junction of the sutures.
Foramen.  An aperture;  a hole, as in bones.
Fossa.   Groove; shallow cavity.
Fourchette. See p. 45.
Franum.  Bridle, as of the tongue or prepuce.
Fungus.  Spongy, fleshy excrescence; proud flesh.
Funis.   See Umbilical Cord.

Gallactorrhcea.  Inordinate flow of milk.
Gall-stone. A stone formed in tho gall-bladder.
Ganqlion (pi. ganglia).  A knot-like enlargement in
  a nerve.
Gangrene.  Mortification.
Gastralgia.  Pain in the stomach.
Gastric  Pertaining to the stomach.
Gastro-enteric  Relating to the  stomach and in-
  testines.
Gastro-intestinal.  See above.
Gastrotomy. The cutting into the abdomen.
Gelatiniform.  Having the form of gelatine.
Genital.  Pertaining to generation; sexual.
Genus  epidemicus.  The  prevailing type  of a dis-
  ease.
Germinal Spot.  See p. 132.
Germinal Vesicle.  See p. 131.
Gestation.  See p. 88.
Glands.  Small secretory bodies met with in various
  parts of the system.
Globus hystericus. Choking sensation in hysteria.
Glottis.  Opening  into  the windpipe at the larynx.
Gluteus.  A muscle on  the buttocks.
Graafian Vesicle. See p. 68.
Grancla.   A small grain or drop.
Granular. Composed of, or containing, email grains.
Gravid.  Pregnant.
Groin.  The depression lying between the belly and
  thigh.
Grumous.   Clotted; dark-colored.

Hamatemesis.  Vomiting of blood.
Hamatocele. Swelling of the scrotum from effusion
  of blood.
Hamatoma.  A  bloody tumor, especially of the
  scalp of the new-born.
Hamaturia.  Haemorrhage from the bladder.
Hamoptysis.  Spitting  of blood.
Hamorrhage.  Morbid  flow of blood.
Hamorrhoids.   See Piles. 
GLOSSARY.                                    99c,
Hamorrhoids, Blind.  See Piles, Blind.
Hamostatic.  Pertaining t( the stoppage of blood.
Heartburn.  Impaired appetit6  with gnawing or
  burning pain in the Btomach.
Hectic  Debilitating and emaciating fever.
Hemicrania.  Half-side of the head.
Hepatic  Pertaining to the liver.
Hepatitis.  Inflammation  of the liver.
Hepatization.  Change  in the lung by which  it
  assumes the appearance of liver.
Hermaphrodite.  One who possesses the attributes
  of male and female; a term applied to one who  is
  at the same time male and female.
Hernia.  Rupture.
Herpes.  See p. 676.
Heterologous. Differing.
Uilum.  The fissure  of the  spleen, kidney, lung,
  ovary, etc.   Also, a small blackish tumor in the
  eye.
Homologous.  Similar.
Hooping Cough.  See p. 817.
Humerus.  Bone of the upper arm.
Hybrid.   A thing  produced  from  two different
  species; mongrel.
Hydatid.  Species of intestinal worm; serous vesicle.
Hydramia.  See p. 341.
Hydrocele.  Dropsy  of the scrotum.
Hydrocephalus.  Water on the brain; dropsy of the
  head.  See pp. 903  and 905.
Hydrometra.  A  disease characterized by circum-
  scribed  protuberance  in the hypogastrium, pro-
  gressively enlarging,  without  ischuria or preg-
  nancy.
Hydrorrhea.  See p. 357.
Hydrothorax.  Dropsy of  the chest.
Hydro8I8.  Perspiring.
Hygiene.  The science of preserving health.
Hymen.  See p. 47.
Hyperasthesia.  Excessive sensibility.
Hypergenesis.  The excess of formative power which
  gives occasion to monstrosities by excess of parts.
Hyperplasia.  Excessive formation of tissue.
Hypertrophy.  Morbid enlargement of an organ.
Hypochondriac   One who is morbidly melancholy.
Hypochondrium.  The region under the false ribs.
Hypogastrium.  The lower anterior part  of  the
  abdomen.
Hysteralgia.  See pp. 555  and 671.
Hysteria.  See p. 555.
Hysteroid.  Resembling Hysteria.

Ichor.  Foetid, watery discharge from wounds, ul-
  cers, etc.
Icterus.  Jaundice.
Idiopathic  Primary, original disease.
Idiosyncrasy.  Individual peculiarity of constitu-
  tion.
Ileum.  The longest  of the small intestines.
Iliac  Pertaining to the ilium.
Ilium.   See  p. 15.
Impregnation. Fecundation of the ova.
Inanition.   Exhaustion from want of nourishment.
Incarcerated.  Imprisoned;   strangulated;  con-
  stricted.
Incisor.  See Tooth.
Incontinence.  Involuntary passage of urine; in-
  ability to retain semen, etc.
Incubation.  The period  that elapses between th«
  introduction of a morbific principle into the sys-
  tem, and the development of the disease.
Incubus.  Nightmare.
Indices.  Signs.
Indigestion.  Dyspepsia.
Induration.  Hardening.
Infection.  Propagation  of  disease by miam.  or
  contact.
Inferior.  Lower.
Infiltration.  Flowing of fluids into the cellular
  tissue.
Influenza.  Epidemic catarrh.
Ingesta.  Food.
Inguinal.  Belonging to the groin.
Innervation.  The nervous influence necessary for
  the maintenance of life and the functions of the
  various organs.
Innocuous.  Harmless.
Innominatum.  See p. 15.
Inosculation.   Connecting of the extremities of
  the blood-vessels.
Insomnia.  Sleeplessness.
Interstitial.  Space between.
Intertrigo.  See p. 874.
Intramural.  Within or between walls.
Intra-uterine.   That which takes place within the
  womb.
Intumescence.  Increase of size in a part or in the
  whole of the body.
Intussusception. A portion of the intestine falling
  into the adjoining part and choking up the open-
  ing, producing strangulation,
Ischium.  Hip-bone; lower part of the pelvis.
Ischuria. Retention or impossibility of discharg
  ing the urine.
Isomeric. A term applied to different bodies which
  agree in composition, but differ in properties.

Jactitation.  Tossing about; restlessness; twitch-
  ing.
Jaundice.  A bilious disease, inducing yellowness of
  the skin, etc.
Jugular.  Large vein in the neck.
Jurisprudence.   Embodied laws and regulation!
  that relate to the teaching and practice of med-
  icine.  Legal medicine.

Kiesteine.  A peculiar albuminoid pellicle which
  forms on the  urine of  a pregnant female wher
  allowed to stand for a few days.

Labia majora or  externa.  See p. 43.
Labia minora or  interna, or nympha.   See p. 46.
Labor.  Parturition.  Child-birth.
Labor-pains.  See p. 177.
Laceration.  Tearing.
Lachrymation.  Discharge of water from the eyes.
Lactation.  Secretion of milk.
Lactiferous.  Milk-carrying vessels.
Lamina.  Thin, flat part of a bone. 
1000                                  GLOSSARY.
 Laryngismus stridulus.  See p. 823.
 Larynx.  Upper part of the windpipe.
 Lees.  Liquor potassae.
 Lesion.  Hurt or  injury caused by violence or dis-
   ease.
 Leucophlegmatic  Torpid or sluggish temperament.
 Leucorrhosa.  Whites.  A discharge of a white, yel-
   lowish or greenish mucus from the vagina.
 Lichen.  A papular  cutaneous eruption.  See p.
   676.
 Lienteria.  Diarrhoea consisting of undigested food.
 Ligament.  Inelastic, tendinous cord.
 Ligature.  Cord tied around a bleeding vessel.
 Linea albicantes.   See p. 108.
 Linea nas*lis.  A lino extending from the wings of
   the nose to the corners of the mouth.
 Liquor amnii. Fluid by which the foetus is surround-
   ed in the womb.
 Lithotomy.  The removal of stone from the bladder
   by surgical means.
 Lobulate.  The dividing of an organ into lobes.
 Lochia. See p. 210.
 Lumbar.  Pertaining to the loins.
 Lumbrici.  Round worms in the intestines.
 Luxation.  Dislocation.
 Lymph.  A transparent fluid found in the lymphatic
   vessels and thoracic duct.

 Malacia. See p. 291.
 Malacobteon.  Softening of the bones.
 Malaise.  Indisposition.
 Malik.  Pertaining to the cheek.
 Malformation.  Unnatural formation.
 Malignant.  Term used to deuote great severity of
   a disease.
 Malposition.  Wrong position.
 Mamma.  The femalo breasts.
 Mammary.  Relating to the breasts.
 Mania.   Madness.
 Marasmus.  Wasting away of the body; emaciation.
 Mastitis.  Inflammation  of the  breasts.
 Mastoid.  A process  connected with the temple
   bone.
 Masturbation.  Excitement of  the genital organs
   by hand; self-abuse.
 Maturation.  Ripening;  full development of mat-
   ter.
 Meatus urinarius.  See p. 46.
 Meconium.  Excrement discharged from the bowels
  of a newly-born infant.
 Median Line.  An  imaginary vertical  line through
  the middle of the body.
 Medication.  Treatment by medicine.
 Medulla oblongata.  Part of the brain within the
  cranium.  Nervous system of the senses.
 Membrana granulosa.  See p. 68.
 Membrane.  A thin, supple,  more  or less  elastic,
  web.
Menopause.  Cessation of the menstrual flow; change
  of life.
 Menorrhagia.  Excessive menstruation;  excessive
  haemorrhage.
Menses  or Catamenia.  Monthly courses of women.
Menstruation.  See Menses.
 Mesentery.  The investing  and supporting mem
   brane of the small intestines.
 Mesial Line.  An imaginary " middle line " in th«
   body.
 Metacarpal Bones. Five parallel bones forming the
   back of the hand externally, and the palm of the
   hand internally.
 Metastasis.  Transfer of a disease from one part
   to another.
 Metatarsal.  Five bones on the back of the foot.
 Metritis.  Inflammation of the womb.
 Metrorrhagia. Discbarge of blood from the womb;
   uterine haemorrhage.
 Miasm.  Poisonous influence in the atmosphere.
 Micturition.  Urination.
 Miliaria.  See p. 855.
 Molar.  See Tooth.
 Mole.  False conception.
 Molimen.  An attempt; a struggle; the courses.
 Mons veneris.  A projection on the lower part of
   the abdomen, over the vulva, covered with hair.
 Morbid.  Diseased; unhealthy; unnatural.
 Morbili.  See p. 848.
 Morning Sickness.  See p. 111.
 Mother's Marks.  See p. 872.
 Muciparous.  Mucus-producing.
 Mucous Membrane. The lining ofthe cavities com-
   municating with the  external air,  as lining of
   the mouth, intestines, etc.
 Mucus.  Fluid  discharged from the mucous mem-
   branes.
 Multiform.  Having many forms.
 Multilocular.  Having many cells or small cavities.
 Multipara.  One who has borne several children,
   used in contradistinction to Primiparse.
 Mumps.  See p. 891.
 Myalgia.  Cramp.

 Navi materni.  See p. 872.
 Nares.  The nostrils.
 Nates.  Two projections ofthe body on which we sit.
 Nausea.  Sickness of stomach.
 Neonatorum.  Newly-born.
 Nephritis.   Inflammation of the kidneys.
 Nettle Rash. See Urticaria.
 Neuralgia.   Pain of the nerves.
 Neurilemma.  See p. 100.
 Nisus.  The monthly courses of women.
 Normal.  Natural; healthy.
 Nosology.  Classification of diseases by name.
 Nucleus.  Any body about which  matter is col-
  lected; the germ of a new cell.
 Nulliparous.  Having borne no children.
 Nutriment.   A substance capable of nourishing and
  repairing the losses of the system.
Nutrition.  That function by which the nutritive
  matter already elaborated by the various organic
  actions assumes the nature of the different living
  tissues, to repair losses and maintain their strength.
Nympha.  See Labia interna.
Nymphomania.  An intense desire  in  females  foi
  sexual intercourse.

Obesity.  Abnormal accum llation of fat.
Obturator foramen.  See p. 18. 
GLOSS
Occiput.  Back part of the head.
CEdema.  Dropsical swelling.
Oesophagus.  Gullet; passage from the pharynx to
  the stomach.
(Estruation.  See p. 74.
Oleaginous.  Oily.
Olecranon.  Elbow-bone.
Omentum.  Caul; peritoneal covering of the bowels.
Onanism.  Masturbation.
Opalescent.  Reflecting a colored lustre.
Ophthalmia.  Inflammation of the eye.
Opisthotonos.  Spasmodic bending backward.
Orbits.  The circular cavities which contain the eyes.
Orgasm.  A strong impulse or desire for something.
Orthopncea.  Difficult respiration.
Os.  Mouth.  Also, bone.
Os calcis.  Bone of the heel.
Os tinca.  Mouth of  the womb
Osseous.  Bony.
Ossification.  Conversion into bone.
Ostium.  An opening.
Otorrhcea.   Running from the ear
Ovale foramen.  See p. 18.
Ovarialgia.  Pain in the ovary.
Ovariotomy.  Operation for removing the ovary.
Ovaritis.  Inflammation of the ovary.
Ovary.   See p. 66.
Oviduct. Tube, Fallopian.
Ovisac  See p.  68.
Ovology.  Description of the ovum.
Ovulation. See p. 17.
Ovule.  A  small egg.
Ovum (pi. Ova).  An  egg.
Oxyurl  Species of intestinal worm.
Ozcena.  Ulcerative destruction  of the Schneiderian
  membrane.

Palpation.  See p. 120.
Palpebra.   Eyelids.
Pampiniform.  See p. 69.
Pancreas.   A gland in the abdomen,  secreting  a
  juice, the use of which is to emulsify fatty matters.
Papescent.  Thin; pap-like.
Papilla.   Eminences on the tongue, skin, the inner
  coat  of the bowels, etc.
Papular.  Abounding in pimples.
Papulous.  See Papular.
Paracentesis.  Tapping for the relief of dropsy.
Parenchyma.  See p. 68.
Parenchymatous.  Pertaining to parenchyma,
Parietes.  Walls or sides, as of  the vagina, etc.
Parotid Glands.  Salivary glands beneath the ears.
Parotitis.  See p. 891.
Parturient.  In labor.
Parturition.  The act of  child-birth.
Pathology.  Doctrine of the nature of diseases,
Patulous.  Spreading, open.
Pectoral.  Pertaining to the chest.
Pediluvia. Baths for the feet.
Pellicle.  A thin skin.
Pelvis.  See p. 11.
Penis.  The male orgafcof generation.
Percussion.  See p.  120.
Pericardium.  Sac containing the heart.
IARY.                                  1001

 Pericarditis.  Inflammati"'i. of the pericardium.
 Pericranium.  The  periosteun. which covers tin
   cranium externally.
 Perineum.  See p. 38.
 Periosteum.  Membrane enveloping the bones.
 Periphery.  Circumference.
 Peristaltic Motion.  Alternate contraction and dila-
   tation.
 Peritoneum.  Serous membrane lining the abdomen
   and enveloping its contents.
 Peritonitis.  Inflammation of the peritoneum.
 Pertussis.  See p. 817.
 Pessary.  An instrument to insert into the vagina
   to support a prolapsed uterus.
 Petechia. Purple spots on the skin.
 Phagedenic  Corroding, ragged sores.
 Pharynx.  Throat; upper part of  the gullet.
 Phlebitis.  Inflammation of the veins.
 Photophobia.   Intolerance of light.
 Phlegmasia dolens.  Milk  leg.
 Phlegmonous.  Pertaining  to inflammation in the
   cellular tissue.  Inflammation with swelling.
 Phrenitis.  Inflammation of the brain.
 Phthisical.  Consumptive; pertaining to consump-
   tion.
 Phthisis.  Consumption.
 Phthisis pulmonalis. Consumption of the lungs.
 Physiology.  Science of life in health.
 Physometra.  A circumscribed protuberance in the
   hypogastrium, with occasionally noisy discharge
   of wind through the os uteri.
 Pica.  See p. 291.
 Pigment Cell.  Dark cell.
 Piles.  Painful tumors around or  within the anus.
 Piles, Blind.   Those which do not bleed.
 Piliferous Bulbs.  See p. 49.
 Pityriasis.  See p. 871.
 Placenta. See p. 146.
 Placenta pravia. In child-birth,  when the placenta
   precedes the child.
 Planes, Inclined.  See p. 24.
 Pleno rivo.  Full stream.
 Plethora. Over-fullness of the blood vessels;  re-
   pletion.
 Pleura.  Lining membrane of the thorax,  covering
   also the lungs.
 Plexus.   Network of nerves or vessels.
 Plexus, Cceliac.  Formed of numerous nervous fila-
   ments, and is situated in  the abdomen.
 Plexus, Solar.  Network of nerves lying upon the
   vertebral column, the aorta and the pillars of the
   diaphragm.
 Plica polonica.  A disease characterized  by  inter-
   lacing, twisting and agglutination or matting of
   the hair.
 Pneumogastric  Belonging to the lungs and  stom-
   ach.
 Pneumonia.  Inflammation of the lungs.
 Pneumo-thorax.  Air in the pleural cavity.
 Polychrest.   Having  many virtues.  Medicines
   useful in many diseases.
 Polypoid.  Pertaining to, or similar to,polypus.
 Polypus.  Soft tumor in the nose, utirus, etc., at-
   tached by u pedicle. 
1002
GLOSSARY.
Popliteal.  Pertaining to the ham.
Porrigo larvalis.  See p. 869.
Posterior.  The back part of anything.
Post-mortem.  After leath.
Post-partum.  After child-birth.
Precursory.  Forewarning.
Pregnancy.  The state :>f  a female who is with
  child.
Pregnancy, Uterine.  See p. 89.
Pregnancy, Extra uterine.   See p. 89.
Primipara.  A woman about to bear her first child.
Procidentia.  Complete falling of the  womb, so it
  protrudes from the vulva.   See p. 612.
Prodromic.  Immediately preceding the attack of
  a sickness.
Prognosis.  Art of foretelling results in disease—how
  long it will last, what will be the end, etc.
Progressive locomotor ataxia.  Inability to walk
  steadily.  See  p. 612.
Prolapsus.  Falling, as of the womb or rectum.
Proliferous.  To be prolific; to abound.
Prophylactics.  Means used as preventives against
  disease.
Prostate Gland. Situated around the  neck  of the
  bladder in the male.
Prurient.   Itching; uneasy with desire.
Prurigo.  Itching disease of  the skin.
Pruritus.  Itching of  the skin.  See p. 575.
Psoas Muscles.  In the loins.
Psora.  Itch.
Psoriasis.   Cutaneous disease, with a rough  and
  scaly state of the skin.
Ptyalism.  See p. 328.
Puberty.  The  period when  childhood  ends  and
  adolescence begins.
Fuwc Arch.  The arch at the front  part  of the
  lower circumference of the pelvis.
Pubis.  See p. 17.
Puerperal.  Pertaining to child-bed.
Pulmonary.  Pertaining or belonging to the lungs.
Puriform.  Pus-like;  resembling pus or corrup-
  tion.
Purulent.  Composed of pus or corruption.
Pus.   Cream-like  matter  produced  in  abscesses,
  etc.
Putrescence. Rottenness;  decay.
Pyloris.  Lower orifice of the stomach.
Pyriform Muscles.  See p. 17.
Pyrosis.  See p.  306.

Qu'CKEning.  See pp. 113 and 116.

Rachitis.  Inflammation of the spine.
Rad» -js.  Upper bone of the fore arm.
Rale.  Peculiar rattling sound in the lungs.
R4K<fication.  Division of arteries, nerves or veins
  into branches.
Ramollescence.  Softening.
Ranula.  Sue p. 874.
Rectocele.  See p 587.
Rectum.  Straight gut, terminating at  the anus.
Regurgitation.  Return of food or drink from the
  stomach.
RBNiL,   Belonging to the kidneys.
Respiration.  The act of breathing.
Rete mucosum.  Mucous tissue beneath the cuticle
Retina.  A very thin membrane found in the oye.
Retention.  Stopping of natural discbarges, as of
  urine, etc.
Retrocession.  Retirement of symptoms.
Retroflexion.  Bending backward.
Retroversion.  A bending backward.  See p. 624,
Rhagades.   Chaps or cracks of the skin.
Rhonchus.   Wheezing or rattling sound.
Rickets.  See Rachitis.
Rigor.  Coldness.
Roseola.  See p. 854.
Rouleaux.   Rolls.
Rubeola.  See p. 848.
Ruga.  Wrinkles; folds.

Sac.  Bag.
Saccharine.  Partaking of the nature of sugar.
Sacrum.  Posterior bone of the pelvis on which th«
  spine rests.
Saculate.  Bag-shaped; bag formation.
Saliva.  Spittle.
Salivary Glands.  Gland secreting saliva or spittle.
Salivation.  See p. 112.
Sanguineous.  Consisting of blood.
Sanguinolent.  Tinged with blood.
Sanies.  Ichor. ■
Saphena.  Vein in the leg.
Sarcoma.  Fleshy tumor.
Scalpel.  One of  the smaller sized surgical knives.
Scapula.  Shoulder-blade,
Scarify.  To make a slight scratch.
Scarlatina.  Scarlet-fever. See p. 830.
Schneiderian.  The mucous membranous lining of
  the nose.
Sciatic  Pertaining to the hip.
Scirrhus.  Indolent, hard  tumor, a form of  cancer.
Sclerotica.  The  hard coat of the eyelid; white of
  the eye.
Scorbutic.  Pertaining to scurvy.
Scrofula.  A morbid  state of the system  charac-
  terized by indolent, glandular tumors; they sup-
  purate slowly,  heal  with difficulty, leave' scars,
  etc.
Scrotum.  Bag holding the testicles.
Sebaceous.  See p. 49.
Secretion.  A flowing or discharge.
Secundines.  All that remains in the womb after
  the birth of the child—viz., the placenta, a por
  tion of the umbilical cord, the membranes, etc.
Segment.  A portion.
Semen.  The generating  fluid furnished  by  thr
  male.
Septicamia.   An  unhealthy condition of the blood
Septum.  A partition.
Sequela.  Consequences resulting from disease.
Sero-mucous.  Partaking of serum and mucus.
Serous.  Thin; watery.
Serum.  Fluid portion of the blood.
Serratus magnus. A muscle situate at the sides of
  the thorax.              ^
Sibilant.  Hissing.
Sigaultean Operation.  See p 282. 
GLOSSARY.
1003
Similimum.   The remedy that corresponds most
  nearly to the existing symptoms.
Sinciput.  Fore part of the head.
Sinus.   A cavity or hollow.
Slough.  The part which separates from a foul ulcer,
  decaying bone, etc.
Soporous.  Sleepy state.
Sordes.  Dark-colored deposit on the teeth.
Spasms.  Severe, morbid contractions of the muscles.
Spermatic  Pertaining to the male sexual organs.
Spermatorrhea. An involuntary emission of semen.
Spermatozoa.  Animalcules in the semen.
Sphacelated. Struck with gangrene or mortification.
Sphincter.  Circular muscles to close the rectum or
  bladder.
Sporadic  Scattered; not epidemic.
Sputa.  Spittle.
Stercoraoeous.  Vomiting of faecal matter.
Sternum. The breast-bone.
Stertor.  Noisy respiration.
Stethoscope.  A hollow cylindrical instrument used
  ia examining tho  chest, the beating of the heart,
  etc.
Stillicidium.  The flow of any fluid,  particularly
  the urine, drop by drop.
Stomach.  Situate beneath the  diaphragm, and is
  the first receptacle of food.
Stool.   Faecal matter.
Strabismus.  Squinting.
Strait, Inferior. See p. 28.
Strait, Superior.  See p. 25.
Strangury.  Painful or suppressed urination.
Stroma.  See p. 68.
Strumous.   Scrofulous.
Stupor.  Drowsiness;  sleep.
Styptic A substance employed to arrest haemor-
  rhage.
Sub.  A  term signifying " under" or  " in a lower
  degree."
Subacute.  Not severe.
Subcutaneous.  Beneath the skin.
Sublingual.  Beneath the tongue.
Submaxillary.  Belonging or pertaining to the lower
  jaw.      #
Subsultus tendinum.  Spasmodic twitching of the
  tendons.
Sudoriparous Glands.  See p. 49.
Sulcus.  A furrow;  a groove.
Superior.  Upper.
Suppuration.  Production of pus.
Supra.  Above.
Suture (Anatomy) of Bones.   A kind of immovable
  articulation in which the  bones unite, are dove-
  tailed into each other.
Suture, Coronal.  See p. 159.
Suture, Lamboidal.  See p. 159.
Suture, Sagittal.  See p. 159.
Suture (Surgery).  The sewing up of a wound.
Suture, Interrupted.  This consists  in  passing a
  ligature through  the lips of a wound previously
  brought into contact, and  then tying the  ends
  of the ligature all the stitches being made in
  this way.
Buture, Quilled. Same as previous, except the liga-
  tures are tied over two quills, rolls of plaster or
  bougies,  which are laid along the sides of the
  wound.
Suture, Twisted. A pin is passed through the edges
  of a wound to keep them together, and a piece of
  thread is then wound around the  pin in the
  form of the figure 8.
Sycosis.  Fig-wart, a venereal disease.
Symphysis.  Union of bones.
Symphyseotomy.  See p. 282.
Symptom.  Any unnatural change perceptible to the
  senses in any organ or function.
Synchronous.  Occurring at the same time.
Syncope.   Fainting.
Synochal.   Inflammatory fever.
Synovia.   The unctuous fluid which  lubricates the
  joints.
Syphilis.  A venereal  disease communicated  by
  sexual intercourse.

Tabulate.   To shape with a flat surface.
Tania.  Tapeworm.
Tarsus.  Bones which connect the leg with the foot
Tenaculum.  A fine hook used in  surgery to seize a
  blood-vessel.
Tendon. The white, tough extremity ofthe muscles.
Tenesmus.   Painful, ineffectual urging to stool.
Testes.  See Testicles.
Testicles.   Two glandular organs of  the male con-
  tained in the scrotum, whose  office is to secrete
  semen.
Tetanus.  Lock-jaw.
Tetter.  Herpetic eruption.
•Therapeutics. Relating to the cure of disease  ly
  remedial agents.
Therapia.   Therapeutics.
Thorax.  The chest.
Thrush.  Aphthae.
Thymus Gland.  Gland behind the sternum.
Thyroid foramen.  See p. 18.
Tibia.  Large bone of the leg.
Tonsils.  Glands on each side of the  thorax.
Teeth, Canine.  Eye teeth.
Teeth, Incisor.  The sharp, cutting teeth.
Teeth, Molar.  Grinding teeth; jaw teeth.
Tormina.  See p. 790.
Torticollis.  Twisted or wry neck.
Toxamia.  Poison in the blood.
Trachea.  Windpipe.
Traumatic  Resulting from wounds or injuries.
Trephine.   A  circular instrument for  perforating
  the bones of the skull.
Trismus.  See p. 947.
Trocar.  An instrument used to evacuate fluids from
  cavities,  as in dropsy, etc.
Trochanter.  Tuberosity on the thigh-bone.
Trochlearis.   Muscle of the eye.
Trunk.  The principal part of  the body, to which
  the limbs are joined.
Tubercle.   A  tumor in the substance of organs,
  from the production of new matter; no sensation;
  slow growth.
Tuberculosis.  The morbid condition which gives
  rise to tubercles. 
1004
GLOSSARY.
Tuberosity.  A rough eminence or tubercle on a
  bone.
Tuberous.  Knobbed.
Tumefaction.  Swelling.
TilMOR. A swelling, larger or smaller, developed by
  a morbific cause in some part of the body.
Tunica.  A membranous coat or covering.
Tunica albuginea.  See p. 68.
Tunica propria.  See p. 68.
Turgescence.  Swelling up; growing large ; disten-
  sion  of the blood-vessels.
Turning.   See p. 250.
Tympanitis.  Flatulent distension of the abdomen.

Ulceration.  The formation of an ulcer.
Umbilical Cord or Funis.  See p. 149.
Umbilicus.  The navel.
Unilocular.  Having one cell or cavity.
Urachus.   See p. 141.
Uramia.  See p. 335.
Urea.  A  compound of the urine, existing in large
  quantities.
Urethra.   See p. 47.
Urticaria.  See p. 867.
Uterine Prolapsus.  See p. 355.
Uterus.   See p. 64.
Uvula. The fleshy,  cone-shaped  body hanging in
  the mouth.

Vagina.  See p. 61.
Vaginismus.  See p. 593.
Vaginitis.  See p. 694.
Varicella.  Chicken-pox.
Varices.  Dilated veins, with knotty,  livid tumors.
Varicose.  Dilated.
Varix.  See plural, Varices.
Vascular.  Pertaining to  vessels, particularly the
  blood-vessels.
Vaso-motor.  The force which controls the circula-
  tion of the blood.
Vectis. See p. 27b
Veins.  Vessels for the conveyance of black blood
  from every part of the body to the heart.
Velum.   A veil or cover.
Vena cava.   Veins returning the blood to the heart
Venous.  Pertaining to veins.
Ventricles.  Cavities in the brain or heart.
Vermicular.  That  which resembles a worm.
Version.  See p. 250.
Vertebra.  Bones of  the spine.
Vertex.  Crown of  the head.
Vertigo.  Dizziness;  giddiness.
Vesical.  Pertaining to the bladder.
Vesication.   The formation of blisters.
Vesicle, Germinal.  See p. 69.
Vesicula seminales.  Two small membranous sace
  which serve as reservoirs for the semen.
Vesicular.   Containing small vesicles or cells.
Vestibule.   See p. 46.
Viable.   Capable of living.
Villi.  Minute processes on the  surface  of some
  membranes  constituted of blood-vessels, nerves
  and absorbents.
Virulent.   Highly  Doxious.
Viscera.  Entrails.
Viscid.   Sticky.
Vitelline.   See p. 68.
Vitellus. See p. 69.
Vomit. To throw up the contents of the stomach.
Vulva.  See p. 43.
Vulvitis.  See p. 570.

Waterbrash.  Regurgitation of a watery fluid Iron
  the stomach.
Whitlow. Felon.
Wolffian Bodies.  See p. 152.
Womb. See Uterus.

Zygoma.  Cheek-bone.
Zymotic   A  term used to characterize the ei.d"t
  class of epidemic, endemic and contagions d.*
  ejwiea. 
 
 
 
7*K

55^
^1
 ' ;rJ$7a,
NATIONAL LIBRARY OF MEDICINE
NLfl  QD5flDflTM  3
NLM005808943