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    LIBRARY.





 Section.....-.....--------------------


 no. us,  No.23.40_fil
W. D. S. 6.0.                3—613
NLM005809529 
 
 

GYNECOLOGY;
Treatise  on Midwifery
  PHYSICAL AILMENTS OF WOMEN AND CHILDREN;

              CONTAINING

AN EXPLANATION OF THE PHENOMENA OF REPRODUCTION;
  WITH REMARKS ON STERILITY; HOW TO CARE FOR AND
   PAISE INFANTS; PLURAL BIRTHS; CHLOROFORM, &c,
        IN CONFINEMENT; HYGIENE, &c, &c.
   JOSEPH THEOPHILUS HOWARD, M. D,
MEMBEE OF THE MEDICAL SOCIETY AND ASSOCIATION OF WASHINGTON, D. C.
f.'-" „<\ **     '"((fiici\Deus bene vertat
^^i^^^wASHINGioN CITY:
     \V. H. & O. H. MOEKISON.  M,J
               1871. 
VI Cl
 H84c?5
 mi
 Entered according to Act of Congress, in the year 1871, by


             W. H. & O. H. MORRISON,


In the Office of the Librarian of Congress, at Washington, D. C.
   m'gILL <fc WITHEROW,

PRINTERS AND STEREOTYPERS,

    WASHINGTON, D. C.
9 
       To  my  Patients,
                FROM WHOM,

AMIDST PHYSICAL SUFFERINGS AND SORROWS,
HAVE BEEN RECEIVED
SO MANY MANIFESTATIONS OF GRATITUDE, CONFIDENCE,
                 AND ESTEEM,

   This work is respectfully Jnscribed,
AN HUMBLE TESTIMONIAL OF AFFECTIONATE EEMEMBBANCB

          AND GEATEFUL ACKNOWLEDGMENT,
$g the §Mtlw*. 
 
PREFACE.
  Prom the fountain of every science and  art, beginning with
heaven-eyed astronomy, adown through all the mystical mazes
of others, to the last, though not least, earth-penetrating geology,
except that of medicine,  there flows a stream  refulgent  with
light  and knowledge, contributed  by the disinterested workers
therein, of which  every one who will can come  and partake
freely. Why should the exception exist?  Is there so little interest
felt in relation to their physical ailments on the part of individ-
uals generally, that they do not pause to make inquiry, to  some
extent, at least, in reference thereto?  Or is it right or proper
that they should continue to be the dupes of every imposter and
mountebank,  who are always ready to take advantage of  their
ignorance, credulity, and superstition, in  relation to medicine,
regarding which some even of the learned and wise in  other
branches  of knowledge are  ever so much so, without endeavor-
ing to release them from the  yoke of bondage?  It is thought
not.  Neither is it owing to a want of exertion on their part in
that direction; for it is well known that every book purporting
or pretending to give any information  relative to domestic medi-
cine is preserved and perused with avidity.  Therefore the real
facts of the case are, that there is now no  work extant adapted
 to  the present advanced state of medical knowledge, save some
 exclusively professional, giving or devising a proper plan where-
 by they  may become intelligibly informed in this, as  in the
 other sciences  and arts.  Hence  the present  work has  been
 undertaken  as  initial to others  that may follow; because we
                                                    5 
6
PREFACE.
believe the  general  diffusion of such information can be  pro-
ductive  only  of good to  the  profession  and  community  at
large.  The latter it will  impress with  the necessity of having
experience joined with knowledge to make it efficient; besides,
it will enable them to detect the barefaced assurance of charla-
tanism,  cause  them to have less frequent recourse to worthless
nostrums, and ultimately lead  them to  more highly appreciate,
honor, and esteem the science of medicine proper.  To fulfill the
indications before mentioned as lacking in other publications,
and to make this at once scientific and comprehensive, technical
terms, where possible, have been avoided;  but as they could not
at all times be ignored, without requiring  long-drawn sentences
or frequent tautology, a glossary has been appended, wherein
will be found definitions of those occasionally used.  There has
been no effort to make the work voluminous, either by verbose-
ness or the insertion of unnecessary matter.   On the contrary,
clearness of explanation, perspicuity and chasteness of style, and
accuracy of arrangement, have  been the chief and constant aim;
thus making it as well a book of reference  to the practitioner, aa
instructive to the student, and interesting to the general reader.
How  far success has been attained  in these respects  is for each
to judge.   Then in this, as
         " In every work, regard the writer's end,
           Since none can compass more than they intend;
          And if the means be just, the conduct true,
           Applause, in spite of trivial faults, is due."

                                         THE  AUTHOR.
   1126 Ninth Steket,
      Washington City, D. C, June 1,1871. 
TABLE   OF  CONTENTS.
Freface....................................   5
Introduction.............................   9
Abortion..................................  79
Affections of the eyes.............. 238
Air............................................ 242
Amenorrhoea............................  36
Anaesthesia.............................. 1G7
Anatomy..................................  21
    of the pelvis.......................  21
        ilium.........................  22
        ischium.....................  22
        pubis.......................-  23
        sacrum.....................  24
        coccygis....................  24
        foetal head.................  27
        female organs of gen-
           eration...................  29
        clitoris.....................  30
        womb........................  31
         fallopian tubes..........  32
         ovaries.....................  33
Anteversion of the womb.........  5G
Aphthae or thrush..................... 211
Blunt hook............................... 141
Burnett's disinfecting fluid...... 245
Cesarean section..................... 144
Cases in which forceps are  to
  be used ................................ 139
Cessation of the menses..........  45
Change of life...........................  45
Chicken pox, varicella.............. 220
Chloral...................................... 176
Chlorine gas..............................245
Chlorosis...................................100
Clothing.................................... 250
Colic.........................................189
Complications affecting child at
  birth......................................125
Convulsions, Puerperal............. 151
   Apoplectic........................... 154
   Epileptic........................... 152
   Hysterical.......................... 151
   of children......................... 202
Craniotomy.............................. 142
Croup, Simple........................... 227
   False membraneous........... 228
   Spasmodic.......................... 229
Dentition................................. 198
Deviations from vertex presen-
  tations ................................... 130
Diarrhea of children................ 200
Diphtheria................................ 230
Diseases of children................. 193
Dysmenorrhcea.........................  40
Dystocia or preternatural labor. 133
Enlarged nymphse.....................  91
Epispadias................................  91
Eruption of the teeth............... 198
Exanthematica......................... 213
Exercise................................... 254
Fertility and  sterility, or bar-
  renness.................................  84
Fillet or noose...........................142
Foetus, Development of the.......  02
   Dimensions  of the...............  69
   Circulation of blood in the..  73
   Indications of immature and
     mature.............................  71
   Pathology, signs of its death  78
Food.........................................249
Forceps, The............................137
Generation................................  58
Gestation, Period of..................  72
Hemorrhages...........................145
   Accidental...........................145
   after delivery.................... 148
                       7 
CONTENTS.
 Hemorrhages, Unavoidable...... 147
 Hydrocephalus........................ 208
 Hygienic................................... 240
 Hysteria................................... 165
 Hypospadias.............................  91
 Imperforate hymen..................  91
 Incontinence of urine............... 23G
 Infantile remittent fever.......... 204
 Iodine...................................... 247
 Labor in general...................... 107
    Classification of................. Ill
    Conduct of.......................... 11C
    Difficult or tedious............. 127
    Mechanism of.................... 108
    Preternatural................,.... 133
    Proper................................ Ill
    Stages of............................ 112
 Ledoyen's disinfecting fluid.... 246
 Leucorrhoea.............................  48
 Management of  ehild after de-
  livery.................................... 178
 Menorrhagia...........................  42
 Menstruation...........................  34
    Diseases of.........................  30
    Vicarious...........................  44
    Cessation of........................  45
 Milk leg, phlegmosia dolens.... 1G3
    blotch, porrigo larvalis___ 235
 Mumps, parotitis...................... 237
 Nursing, etc.............................181
    bottles................................188
 Nursery.................................... 257
 Ophthalmia tarsi....................... 239
    Purulent, of infants........... 239
 Ozone....................................... 246
 Positions.................................. 108
Pregnancy, its phenomena and
  treatment..............................  96
    Simulated........................... 105
Presentations........................... 107
    Deviations from vertex...... 130
    Forehead............................ 130
 Presentations, Face.................. 131
    Breech............................... 132
    of lower extremities......... 133
       upper extremities.....108-134
 Prolapsus or falling of womb...  53
    or falling of the cord......... 144
 Puerperal ehild-bed mania...... 155
    child-bed fever.................. 156
 Raising child by hand............. 186
 Retroversion of the womb......  57
 Rubeola or measles.................. 219
 Scarlatina or scarlet fever........ 214
    anginosa............................ 215
    maligna.............................. 215
    simplex.............................. 214
 Small pox, variola..................... 224
 Spasm of vagina  ......................  91
 Strophulus or gum................... 213
 Stye, hordeolum...................... 238
 Sulphate of iron........................ 247
 Sulphurous vapor......................246
 Suppressiomensium................  39
 Talipes, club-foot..................... 239
 Twins, triplets, and quadruplets 159
 Vaccination.............................. 221
 Vaginal fistula.........................  91
 Varioloid.................................. 223
 Vectis....................................... 141
 Version or turning the child.... 134
 Vicarious menstruation...........  44
 Vomiting.......................„....... 203
 Water....................................... 247
 Weaning................................. ioo
 Wet nurse................................. 155
 Whooping cough, pertussis...... 231
 Womb,anteversion of...............  56
    Retroversion of..................  57
    Falling of...........................  53
    Inversion of....................... 150
    Hysteralgia, irritable..........  51
    Inflammation, &c, of......... 156
Worms..................................... 233 
INTRODUCTION.
  The realities of that awful fiat pronounced by the
Almighty after the fall, when "unto the woman He
said, I will greatly multiply thy sorrow and thy con-
ception;  in sorrow thou shalt bring forth children,"
are too sadly experienced even unto this day by the
daughters of Eve to be for  one moment questioned
or ignored.  And as in all tbe distant past,  so it
would have been now and in  the still  more distant
future, down to the very end of time, had not the
Omnipotence that decreed been as powerful to mit-
igate the sentence He pronounced.  "For He know-
eth our frame:" therefore doth He temper the wind
to the shorn lamb: therefore from the beginning all
His  judgments are tempered with mercy.   How
manifest is  this property in all the  means and ap-
pliances God has given to man to assuage the paina
of suffering  woman in the sorrows of child-bearing,
judge ye all who read these pages.   For, conceived
in the sorrow, born in the pains, and nurtured into
life by the  necessities incident to and dependent
upon  the conception, parturition, and management
of the first child of our common parents, tho science
and art of midwifery originated and began its de-
velopment.  Though  long languishing and slow of
growth for many ages, it has at length attained unto
the perfectly ample proportions in which we now
behold it, and from which we propose, after a brief
                                       9 
10
INTRODUCTION.
review, of its rise and progress, to cull the most im-
portant subjects, suitable to the objects and aim of
this volume, and lay them before the reader.
  The term midwifery in the present day compre-
hends that branch of medical science which aids in
preparing, assisting, and preserving the female for
and during parturition, and provides for the proper
maintenance of both mother and child after deliv-
ery, and the treatment of all diseases and complica-
tions  incident to, occurring before, during, or after
labor.  The word midwife is  believed to be derived
from  the Anglo-Saxon mede-wif—a woman hired for
mede,  or reward, to assist in child-birth.
  Among the medical profession generally this term
has almost been discarded, or replaced  by others con-
sidered  more classic and  dignified, if not more ex-
pressive and relative.   Thus we have from the Latin
obstetrics, signifying almost literally the same as the
former term. From the Greek tokology, tokos—child-
birth, and logos—a  discourse; also, gynecology, from
gyne, gynaikos—a woman, and logos—a discourse; and
from the French accoucheur—used to indicate a male
practitioner.  This term was first applied to the art in
France during the reign of Louis XIV, when it was
conferred as a title  of honor  upon Julian Clement,
by La Valliere,  mistress to Louis: he having attend-
ed her in her first confinement.  The profession gen-
erally, of that period, it seems, were so pleased with
the title, that they adopted it to  designate the prac-
tice of the art altogether  among them then,  which
prevails even unto this day. Sequestered or confined
to those alone who  were immediately interested in
the matter for years upon years must have been all 
INTRODUCTION
11
efforts to aid, comfort, and relieve parturient women,
since there is no mention of them among the earlier
writers, that we know of, except it may be in a pas-
sive manner.
  From the following, and one or two other passages
in Genesis and Exodus, it will be observed that the
office of midwife was understood among the Hebrew
women, to some extent at least, in the early period
to which they refer:  "And it came  to pass, as she
(Eachcl) was in hard  labor, that the midwife said
unto her, Fear not; thou shalt have this son also."
At a still later period, among the Greeks and Eo-
mans, it is evident that the practice was entirely in
the hands of females—most prominent among the for-
mer was Phamerete,  the mother of the great teach-
er Socrates—and so continued until the time of Hip-
pocrates, who it seems was the first male practitioner
to give his attention to this branch of medical art,
and from whom it received that impetus with which
it has steadily, though slowly, advanced, "like the
sweet sound, giving and taking odor," or gathering
friends and strength from the support and comfort
it gives, until it may now be numbered among those
of Heaven's best  gifts to our race.
   Among the  Eomans, this art was now confined to
a few simple aids  or remedies, together with, in diffi-
cult cases, invocations to Ilithyia, sacrifices to Juno,
Lucinda, and other then recognized deities; and so
continued until the time of Celsus, called the Eoman
Hippocrates, who, it  may be said, was the first to un-
derstand and describe what is termed professionally
"the mechanism of labor."
   The practice of Hippocrates himself was compar- 
12
INTRODUCTION.
atively of a rude character, and not to be relished by
females of the present time: as he recommended that
in difficult cases the patient should be shaken whilst
standing erect, and if this  process failed to expedite
the labor, she was to be placed in a bath, and made
to undergo that ordeal.  Treatment like this would
be considered rather unpleasant,  if not dangerous,
under the circumstances, with the ladies at this en-
lightened period.  He also urges  that, if any other
part than the head should present, it must be pushed
back.
  This practice,  extending to  and becoming known
among the people generally, was conducted  by fe-
males in most instances: the physicians being called
upon only when the case  did  not seem to progress
favorably; when it  is to be supposed that, in most
cases, the patient was compelled to undergo an extra
course of shakings and douches.
  The art made no further notable progress until
about A. D. 100, when it Avas proposed by Moschion,
the author of the first Manual  of Midwifery, to open
the  mother  after her death, and  remove the child.
Sometime after this, several centuries perhaps, dur-
ing which period the Popes, whose authority was un-
limited, assumed control, and, it is said, confined the
professorships and practice of medicine to monks al-
most exclusively.
  In their hands the art,  extending to the peasants
generally, consisted in  the application of supersti-
tious remedies principally; and when these failed of
success, recourse was had to invoking the saints, rel-
ics,  and  images.  About A. D. 1000, Avicenna, the
renowned Arabian  physician and philosopher, who 
INTRODUCTION.
13
was mostly indebted for his knowledge of the Greeks
to the Arabic translations of their writers, appeared
upon the stage of action.  He adopted and pursued,
in this branch of the medical art, nearly the same
course  of practice as that of Hippocrates, without
any marked improvements on his part.
  In the fifteenth and sixteenth centuries, after the
discovery of the " art preservative of arts," works of
different merit upon obstetrics, by both Greek and
Eoman writers, began to multiply and become more
general, though the practice of the same throughout
all parts of Europe was almost solely in the hands
of females; it being considered by some disgraceful
for males to engage in it, aud was looked upon by
these as no less  than an abominable attempt upon
female virtue in  any of  the sterner sex who had
the temerity to undertake it.  So popular was this
singular prejudice, we learn, that  at  Hamburgh,
in 1521, one Yeities, a physician, was condemned to
be burned alive for assuming to practice this branch
of his  art.   A few years later,  1543, in  Italy, mid-
wifery began to be somewhat revived and improved
by the  study of  anatomy, which  at this time had
become more generally known, and in which Vesa-
lius, of Padua, was so distinguished, on account of his
opposition to Galen. Physicians and surgeons now
began to give more attention and study to the theory
and practice of midwifery; but the operations of the
latter extended only to the cutting away of the child
after the mother's death, as  was  required of them
by laws at  that  time made  and  provided  in  such
cases.   And it was not until 1581 that Eousset, of
Paris, who published a treatise upon the subject, in 
14               INTRODUCTION.
which he proposed and named the Caesarian opera-
tion, that it was performed upon the  living subject.
After this the section was frequently performed, and
in many cases, as we are told, when it was unneces-
sary and altogether uncalled-for.
  In other  not remote places, during  all this period
of time, midwifery, as  an art, stiil languished and
remained in an unimproved state, especially among
the larger  portion of Germans, with whom it was
confined to females principally, and  the  ignorant
classes  generally; though  Eucbarius Ehodion, in
1513,  had published at Worms a work called "The
Eose  Garden of Midwifery," which  afterward be-
came  very  popular  in England and other parts of
Europe.
  In France the  art was  steadily progressing and
improving,  by receiving the consideration and inves-
tigation of  the scientific and learned.   It was about
this time that Ambrose Pare, the renowned French
surgeon and father of modern surgery, first proposed
and performed the operation of turning the child in
certain  cases,  which operation  has  been  handed
down unimproved-upon even to this  day.  It  was
soon after  this important period that Madame La
Villiere, before referred to,  contributed so  much to
the establishment of the practice of midwifery among
males, by employing Clement in her first confinement.
This precedent was soon followed by other ladies of
high rank throughout France, and gradually extend-
ed to all, and through them to the lower classes or
peasantry.  The advantages derived from the change
were so apparent, both  in  the conduct of labor and
the management of the child, that it  was not long 
INTRODUCTION.
15
ere it spread over and became goneral throughout
the whole of Europe.
  In the meanwhile the physicians of England were
not altogether indifferent  to  the practice and ad-
vancement of the art, as evinced about this time by
the publication of a translation of Ehodion's work
in London  by Thomas Eaynold, under the title of
" The Byrth of Mankynde; otherwise named the woman's
book."  And it was probably about this time that Dr.
Paul Chamberlin  had discovered and used the double-
bladed forceps and vectis in difficult cases, though
the fact was long kept a  secret by him.  And it was
not until  nearly a century afterwards that the exact
nature of the instruments  was known, when they
were accidentally discovered and brought from their
hiding-place by a tenant occupying the house where
the Chamberlins had previously resided. These same
instruments are said to be now in the possession of
the London Medico-Chirnrgical Society.
  In 1G72 a treatise was published by Mauriceau. in
which he gives a very full  and detailed account of
the process  of labor.  This was for a long time the
standard  work upon the  subject.  In the  same year
it was translated  into English by Hugh Chamberlin,
and soon  became widely known throughout all Eng-
land.  It was about this period that men began to
engage in  the  practice generally:  Harvey,  the
Chamberlins, and others of more or less renown,
taking it  upon themselves to study and practice the
now popular growing art of midwifery.
  It had been discovered, in  1G68, by Camerarius,
that some of the  midwives in  certain parts of Ger-
many were in the habit of administering ergot for 
16
INTRODUCTION.
the purpose of accelerating parturition ; but it was
not until more than a century afterwards that this
medicine was brought into general use, and its action
fully understood.
  About the  beginning of the eighteenth  century
many efforts  were made to improve upon Chamber-
lin's instruments, by Gifford, Chapman, and others;
but, it may be said, with little or no important suc-
cess.  The latter is supposed to be the first public
teacher of the art of midwifery in London.  He was
followed in a few years afterwards by Sir Eichard
Manningham, who devoted all of his time and tal-
ents to the study and development of this branch of
medicine.  To him is attributed the establishment of
the first hospital for the reception of lying-in women
within the dominions of Great Britain.
  Midwifery  was now fully recognized as a lower
branch of the medical profession; but towards the
latter part of the last-named century it gradually
became more exalted  and dignified, by receiving
such accessions as  those  well-known contributors
to the art: Smellie, William  Hunter, Dennian, and
Blair, in  England; Astrue, Boudelocque, and  his
famous  pupils, Mesdames Boivin and Deschapelles,
in France.
  At  the beginning of the present century the pre-
judice of medical practitioners generally to this
branch  of the healing art  began to wane  and die
out.  The by-laws of the London College of Physi-
cians, which precluded its practitioners of midwifery
from  fellowship,  were  repealed,  and they received
into full communion; and it is believed that at this
time, in all the medical schools of Europe and in this 
INTRODUCTION.
17
country, there are professors or lecturers on obstet-
rics or midwifery.  In England a knowledge of this
branch of medical science is required of every can-
didate for the Degree of Doctor of Medicine.  Nor
is it required of them alone; but there the ignorant
midwives of the past are done  away with to a great
extent, and women engaging as nurses in these cases
are required by law to furnish a certificate, testifying
that they have regularly attended lectures on mid-
wifery, and that they have had personal charge of a
certain number of labors under the direction of prop-
erly qualified teachers.
  There are no special laws bearing upon the matter
in this countiy, "our free America," which is greatly
to be  regretted. And any that may desire, without
having received the least instruction, and who are
entirely ignorant of the first  principles of the art,
can and do engage in the practice  of it.
  Another cause of greater regret  is that, until very
recently, there has been no general means  whereby
females,  who may desire to properly qualify them-
selves as midwives, and nurses at  least, if not  to
practice  the art, could do so.
   This great desideratum, it  is hoped, by suitable
legislation or otherwise, will  soon in some manner
be more  amply supplied and all other defects be effi-
ciently remedied.   As one step towards the accom-
plishment of such  an  end, and to  supply  at  the
same time a hand-book of reference for practition-
ers, and  one instructive to   students of medicine,
as  has been already stated in our preface, we have
here  devoted our best  energies; and, as a true dis-
ciple of  the healing art, we  will  not recognize or
       2 
18
INTRODUCTION.
be confined to any pent-up systems, as expressed by
such terms as alopathy, hydropathy, electropathy,
homeopathy, eclecticism, or any other one-idea-ism.
Every good physician, it is needless to say, must be
eclectic, i. e., to pick out or choose what he believes
best for his patient, whether it is claimed as belonging
to either of the systems above mentioned, the eupho-
nious titles of which may serve well enough the pur-
poses of the ignorant or wicked, as catering to that
sickly sentimentality among a class who, judgi ng from
their attainments in other branches of learning, ought
to be better versed in  that of medicine.   To contend
that the potency of a remedy consists in its almost in-
finite divisibility or dilution is the very quintessence
of absurdity.   As well may we conclude  that the in-
habitants of those planets of our own system remotest
from the sun experienced a greater degree of heat
from that luminary than Mercury or Venus, who are
millions of miles nearer him than ourselves; or that
the great fall of waters from above, filtering through
the earth's crust, or washing upon its surface from
thousands of rills, rivulets, and streams, contained
and carried back again all the concentrated  active
principles of the mineral, vegetable, and animal mat-
ters with which they necessarily must have come in
contact in their return to the source from which they
were eliminated in the form of vapor.  No, not thus
with the true physician; he, armed with  knowledge,
guided by reason, directed by wisdom, invokes them
all to aid in efforts to relieve the distress, alleviate
the pain, and restore to  health those who repose
such great  confidence in him.  At the  same time,
like Aaron of old, realizing the fact that ho is stand- 
INTRODUCTION.
19
ing between the living and the dead, he is too much
absorbed in his duties to his fellows  to carp about
this or that system, or make any invidious distinc-
tions of practice.
  Such is to be the spirit of this work—to inculcate
liberal  principles  and doctrines in the  branch  of
medicine to which  it is devoted.   With such an ob-
ject in view, it cannot but receive the sanction and
God-speed of all disinterested medical practitioners
and the wise and prudent of the laity.   Then—
    " With that same spirit that its author writ,
     Survey the whole, nor seek slight faults to find
     Where nature moves, and rapture warms  the mind."
  For—
    " Man, like the generous vine, supported lives;
     The strength he gains is from the embrace he gives.
     On their own axes, as the planets run,
     Yet make at once the circle round the sun:
     So two consistent motions act the soul,
     And one regards itself, ancl one the whole."
*. 
 
GYNECOLOGY.
                   ANATOMY.

   In order to have a full and proper understanding
 of the  subjects herein presented, some knowledge
 of anatomy and physiology is absolutely necessary,
 as is also some acquaintance with the doctrines of
 conception, impotence, and sterility.  These, with all
 other subjects treated upon in this work, will be found
 under their proper heads.
   That portion of anatomy  which more properly
 belongs to this branch of medicine only will  be de-
 scribed in this work, beginning with—
   The  Female Pelvis, or, as its  name implies, a
 basin.  By the French it  is called le bassin,  or  the
 basin.  In the adult it consists of four separable parts
 or bones—the two os innominata, or bones without a
 name; the os sacrum* or sacred bone, so called from
 a  belief among the Jewish rabbins that this part of
 the skeleton resisted  decay, and  became the germ
 from which the body would be raised into life  again;
 and the coccyx, which derives its name from its re-
 semblance to the cuckoo's beak.  A general descrip-
 tion of these separately and afterwards together will
 be required to  fulfill  the  purpose  in view.  Each
 innominata, during the period of intra-uterine  life,
 or before  birth, consists of cartilage, or  gristle only,
in which deposition of bony substances subsequently
 ♦According to some, from sacer, sacred, because it protects the genitals,
which were deemed sacred; also from its being offered in sacrifice.
                                          21 
22
GYNECOLOGY.
takes place, which become united soon after birth,
forming three bones—the ilium, ischium, and pubes.
The formation of bone continuing, these three meet-
ing in the acetabulum, or cup-shaped cavity formed
for the reception of the head of the thigh  bone, in
adult life become firmly joined together, forming the
os innominata.   As each of these bones performs an
important part in the mechanism of labor,  and will
be frequently referred to hereafter, it is necessary to
notice them separately, and describe some of their
peculiarities.
  The ilium is familiarly known to every one as the
hip bone.   It is the largest of the three. Its outer
surface is called dorsum,  or the back; it is irregular-
ly convex, and marked with projections and depres-
sions, from which arise the  glutcei muscles.  These
muscles, three in number, pass down and are inserted
into the thigh bone, forming the cushion or buttocks.
The inner surface is concave and smooth. It is call-
ed the venter, or belly.  Its surface has a ridge run-
ning horizontally across it, denominated the lineailia,
or line of the ilium, which forms a part of the brim of
the pelvis.  The belly is occupied by a layer of flesh,
known as the internal iliac muscle.   The lower por-
tion of the bone is  termed the  base.   This  forms a
greater part of the acetabulum.   Immediately above
the base is its neck, from which it begins to  diverge
outwards and upwards, becoming fan-shaped, forming
the hip bone, the edge of which can be  easily felt in
any person.  It  is called the crista ilii, or crest of
the ilium.   This crest gives attachment to the mus-
cles of the abdomen and back.
  The ischium is next in size.   It has a base, body, 
THE FEMALE PELVIS.
23
 spinous process, tuberosity, and ramus.  The base forms
 the  lower and thickest  portion of the acetabulum;
 below the base, where it  is narrowed to some extent,
 is its neck; from just below which is a projection, the
 spinous  process.   A correct understanding of the
 location  and position of  this is of great importance
 obstetrically, from the resistance it will sometimes
 offer to the advancement of the child's head during
 parturition. Its tuberosity (tuber ischial) is formed and
 descends from the neck a short distance, after which
 it turns upwards, at  an acute angle, forming the ra-
 mus. The tuberosity is commonly known and readily
 recognized as the seat or  buttock bone.  The ischium
 is smooth on its inside, and forms one of the inclined
 planes of the pelvis; the  outer side is rough, for the
 better attachment of its  ligaments and muscles.
   The pubis, commonly known  as the share-bone,  is
 the smallest of the three bones, and is located ante-
 rior to those previously described. It has a horizontal
 and  descending ramus, a spinous process, and sym-
 physis, or articulating surface.  Its base is to the
 front, and is the thickest, though the smallest, part
 of the acetabulum, from  which it proceeds, becom-
 ing narrower, forming the horizontal ramus, which,
 spreading out, terminates in a wider sheet, as it were,
 at its edge, the  point of juncture (the symphysis pu-
 bis) with its fellow bone. From the lower part of
 the symphysis, the  descending ramus proceeds to
 meet the ascending  ramus of the ischium, forming
 with it one side or a half of the arch of the pubis.
Inside and upon the upper margin of the horizontal
ramus is  a prominent ridge, the crest of the pubis.
This, with the linea ilia, forms  the linea ilio-pectinea, 
24
GYNECOLOGY.
which, together with the promontory of the sacrum,
makes up the brim of the pelvis.  The outer edges of
the bone give  attachment to the abdominal  mus-
cles—the transverse, oblique, and rectus.
  The sacrum terminates  the vertebral column, or
backbone.  It is triangular in shape, with its apex
downwards.  In comparison to its size it is the light-
est bone in the body, being of a cellular or  spongy
texture.   It has four  surfaces: the internal and
external, and two articulating or lateral.   Its  usual
length is about four or four and a half inches; in
width it is about fou* inches; and about  two and a
half inches in its greatest thickness.  Its outer or
posterior surface is rough, having spinous processes
corresponding to  those  of the vertebrae.   Its  inner
surface, the hollow of the sacrum, is smooth and
concave, being crossed by four perceptible white
lines, which mark the former divisions of the bone
by cartilage.  It has four pairs of holes, for the exit
of filaments to form the great sciatic nerve.   The
upper inner edge  forms  the promontory of the sac-
rum, which, with the linea  ilio-pectinea, completes the
brim of the pelvis.   The lateral surfaces are rough
and uneven;  they are joined to the ilise, forming the
sacro-iliac symphysis.
  The coccygis is  composed of three or four bones,
attached by its base to  the apex of the sacrum.  It
is  of  considerable importance in the study of mid-
wifery, from  its position, as  it forms one portion of
the boundary of the inferior strait of the pelvis.
  With this brief description of the separate parts or
bones of the pelvis, we next proceed to consider it as
a whole. 
THE FEMALE PELVIS.
25
   The pelvis is divided into the true and false, or up-
per and lower, or greater and lesser, pelvis: all that
portion lying above the  brim of the pelvis, before
described as being formed by the line crossing the
ilia to the promontory of the sacrum, and passing
along the upper edge of the horizontal ramus of the
pubis, and which together are known as the linea ilio-
pectinea, or comb-like line, being the greater, upper, or
false pelvis; whilst all below this line is denominated
the true, lower, and lesser pelvis.  The upper pelvis is also
termed the pavilion.  It is formed by the two last lum-
bar vertebras, the ligaments passing to and from them
to the ilia and the muscles of the abdomen. The low-
er or true pelvis is of the greatest importance in mid-
wifery. It is divided into brim, cavity or excavation,
and outlet.   The brim  is formed by the line before
mentioned. Upon looking into the cavity from above,
it presents a shape similar to the heart upon the or-
dinary playing-card.  It has three unequal diameters :
An antero-posterior, from before backwards, extending
from the symphysis pubis to the promontory of the
sacrum, which measures usually about four inches;
this is also known  as the conjugate or straight di-
ameter. The next is the transverse diameter, which is
at right, angles to the former, and crosses the widest
part of the pelvic strait; it is about five and a quar-
ter inches in length.  The third is the oblique diame-
ter, extending from the junction of the sacrum with
the ilium  to  a point opposite, on either side of the
brim, immediately above the acetabulum; its length
is about five inches.  These measurements being that
of the bone divested of the soft parts, as a matter of
course  they are  somewhat diminished in life.   The 
26
GYNECOLOGY.
true pelvis is the cavity between the brim or supe-
rior strait and  the  outlet or inferior strait  of the
pelvis.   Its shape may be likened to that of a bent
cone, its base looking upwards and forwards; its apex
downwards and forwards.  It is about an inch and a
half deep in front, three and a half at the sides, and
about five inches from the promontory of the sac
ru-m to the tip of the coccygis.
  The outlet, inferior, or lower strait, is irregular and
rather oval-shaped; it is bounded by the tip of the
coccygis, by the tuberosities of the ischium, and the
symphysis pubis.  It  has usually two equal  diame-
ters: From the tip of the coccyx to the arch of the
pubis is its antero-posterior diameter, and is about
four inches in length.  Its transverse diameter, ex-
tending from one tuberosity to the other, is generally
about the same—four inches in length.  The axes of
the pelvis are two, one of the upper and one of the
lower strait.   An acquaintanee with these axes  is
of the greatest importance in the practice of obstet-
rics, as by a knowledge of them we are often enabled
to place the patient in a position most favorable for
an easy and expeditious labor, thus offering a ready
descent for the presenting part of the child through
the brim into the cavity of the pelvis.  The axis of
the brim is a line drawn perpendicular to its  plane,
extending from about the region of the umbilicus or
navel to the coccygis.  The axis of the outlet or
lower strait is a line perpendicular to its plane, ex-
tending from the promontory of the sacrum to a point
about midway between the tuber ischia.  These axes
form an obtuse angle with each other, from which it
will be readily discerned that the pelvic canal must be 
THE FG3TAL HEAD.
27
a curve in form, its concavity looking forwards.  The
position of the pelvis, regarding the body in the liv-
ing subject, is oblique, falling from behind forwards.
There is some difference between the female and male
pelvis, as there is also in the whole skeleton of the
sexes, the bones of the latter being  more firm and
heavier  than in the former, though not apparent to
the superficial observer in their general aspect; but,
if  examined  closely, it will be found that  those of
the female,  though longer,  are  somewhat lighter
and more delicately formed than in the male; in the
former the aim or wings of the ilia are  more ample
and wider spread out to either side than in the lat-
ter, which are converged and rise suddenly upwards.
There is also a great difference in the  long diame-
ters as well as in the shape of the brim: that of the
female being from side to side, whilst in the male it
is from before backwards; besides, the cavity is small-
er, straighter, deeper, and more tapering towards the
outlet, the arch of the pubis being more of an acute
angle and the tuberosities of the ischia closer togeth-
er; whilst in the female the whole disposition of the
outlet is of a nature to afford, easy facility for the pur-
pose it was originally formed by the great Creator, i.
e., to give ample and free course to the advancement
of the child's head during parturition: the  bones of
which demand our consideration next.
   The Fatal Head.—A knowledge of the number of
bones and the general conformation of the festal head
are essential, in order to properly understand partu-
rition and the mechanism of labor.  The bones are
the frontal, which at this period, just before or at
birth, are divided into two, and may be more readily 
28
GYNECOLOGY.
known as the front or forehead bone; the two parie-
tal, forming the arch, which arise from either side
of the head and unite upon the top; the two tem-
poral, which are located immediately below the last
named,  on either side of the head, and afford at-
tachment for  the ears,  and then  extend forwards
to form the temples—hence their name; and the oc-
cipital, or that opposite to the frontal, forming the
back part of the head.   These bones, in the adult,
are united to each other by a kind of doye-tailed
arrangement called sutures;  but in the foetus, this
union not having taken place, they admit of over-
lapping one another during the descent of the head
in parturition; thus, by diminishing its size, afford-
ing easier facility for progress through  the  pelvic
strait.  At either end, before and back where the
parietal bones come together at the top of the head,
are spaces, commonly called moles, which are scien-
tifically termed fontanelles, from it having been for-
merly supposed that they eliminated a moisture; that
in front is called bregma, from the Greek, brecha, to
moisten; whilst that  behind  is termed vertex, from
verto, to turn; they are denominated, from their posi-
tion, anterior and posterior fontanelles.  They are of
considerable importance in obstetrics, as they afford
ready means of determining the position of the head
during labor, being distinguished from one  another,
by the touch,  by their different shape.   The anterior
is the largest and is quadrangular; it  is formed by
the rounding of the corners of  the two frontal and
parietal bones.  The posterior is triangular-shaped,
and is formed by the posterior ends of the parietals
and the occipital bone.  It will be observed that this 
THE ORGANS OF GENERATION.         29
arrangement, besides the advantages above referred
to, affords greater opportunity for the growth and de-
velopment of the brain than if the cranium had been
solid and unyielding.  As a general circumstance,
the skull of the male child will be found larger than
that of the female, the average circumference in the
former being about fourteen i nches, whilst in the latter
it varies from thirteen to thirteen and a half inches.
Measuring  the arch from ear to ear, over the crown
of the head, it is usually found to be about seven and
one quarter inches in males, and about  seven inches
in females; which difference, though slight, is import-
ant, in  consideration of the pelvic cavity through
which it has to pass.
  The Female Organs  of Generation are divided
into external and internal; the former, as a Avhole, are
usually  called the pudenda and sometimes the vulva.
A brief consideration of these  divisions  will suffice
the purpose of this work.  The external are sub-
divided  into the mons veneris, situated at the lowest
part of  the abdomen, and usually covered with hair
in the adult; the labia externa, or external  lips, which
are two  folds of skin, and mucous membrane, extend-
ing from the symphysis pubis  to unite at the per-
ineum, so called because it surrounds the two great
outlets of the body.  The point where this union takes
place is  called the posterior commissure, whilst that
in front is termed the anterior commissure.  These
labia are, it seems,  intended to protect the organs
behind and between them.  The labia interna, or in-
ternal lips, are called minora or smaller lips; also
nymphse, or the nymphs. They extend from the an-
terior commissure  to about an inch  downwards, 
30
GYNECOLOGY.
when they become lost in the folds of the labia ex-
terna.
  The Clitoris*—a name  signifying to hide—is con-
sidered to be analogous to the male penis.  It is situ-
ated just within the juncture of the nymphse.   It is
the seat of sensuality in the female.  Below this is a
triangular space called the  vestibule, in the lower
part of which is found the orifice of  the urethra—
the canal communicating with and  is the outlet of
the bladder; it is about an inch and a  half in length.
Immediately within  the  vagina is  found most fre-
quently in the virgin a fold of membrane, usually of a
crcscentic shape, called the hymen.  The absence of
this is not of itself an evidence of loss of virginity.
It is ruptured at the first sexual intercourse, and, con-
tracting, forms small  granulations, which, from their
supposed  resemblance to the  myrtle, are  termed
caruneulsB myrtiformis, or myrtle-shaped flesh.
  The internal organs are the vagina, the uterus, and
its appendages.  The vagina, or sheath, is a short sac,
extending from the vulva, coursing backwards and
upwards to the uterus.  Ordinarily it is about four or
five inches in length, and about  three inches in cir-
cumference, but becomes shorter and more capacious
in those who have frequent sexual intercourse or have
borne children.   Its mucous membrane, or the lininp*,
is rather of a pinkish hue in health. Besides the
mucous membrane, it has two other layers of flesh,
called its coats—the  muscular aud cellular;  the for-
mer of these is sometimes denominated the middle,
and the latter the external, whilst  the mucous is
known as the internal coat.   This  is covered with
  *From the Greek kletor, a servant who invites guests.—Dunglison. 
THE UTERUS.
31
rugae, or wrinkled folds, in its circumference, along
its whole length;  from which circumstance it admits
of great distension and elongation during parturition.
A collection of muscular fibres is found surrounding
the external orifice or mouth of the vagina, which
acts upon  the  same principle as a draw-string in a
lady's old-fashioned reticule to reduce its size. Com-
bined, they form the sphincter vaginae.
  The Uterus, or womb, is a  pear-shaped,  hollow
body, situated at the inner terminus of the'vagina,
which receives and overlaps the pendent and smaller
portion about half an inch from its mouth.  This
arrangement will be  better understood when the
womb is considered in detail. For this purpose anato-
mists divide it into four parts, viz: the fundus, body,
cervix,  and os  tincae, or tench-mouth.  The first, or
fundus, is  the upper and longest portion; just below
this commences  the  body; whilst  lower still, and
tapering considerably, is the cervix or neck; and still
lower is its mouth or os tincae.  Perhaps a more cor-
rect idea of the shape,  position, and the above-named
divisions of the womb, may be obtained from a well-
formed inverted pear.   The lower or narrow portion
would represent the neck; the swelling part the body;
and all above this the fundus; whilst the point where
the stem is inserted would indicate  the  os tincae or
mouth. The usual size of the virgin womb is about
from two  and a half to three inches in  length, two
inches in width, and one inch in thickness. Its cavity
is triangular in shape, the base being upwards;  its
angles are the points giving entrance to the tubes of
Fallopius,  whilst the lower angle communicates with
the vagina through the canal of the neck of the womb. 
32
GYNECOLOGY.
This canal is from a half to three quarters of an inch
in length; it is cylindrical in shape;  its inner orifice
is termed the os interna or inner mouth, in contradis-
tinction to the outer or os externum. Like  the vagina,
the womb has three coverings or coats: the internal,
middle, and external.  These are technically denomi-
nated, in the order as above mentioned, the mucous,
muscular, and serous coats.  It is also covered before
and behind by the peritoneum, a membrane which
forms the lining coat of the walls of the abdomen, and,
by being reflected upon the womb, serves to keep it
in position;  being continued  to each side, it is in-
serted into the pelvis near the union of the sacrum
and ilium, to form the broad ligaments of  the uterus.
It is this membrane that is so easily affected, some-
times during parturition, and the inflammation of
which is known as puerperal peritonitis—a complica-
tion often so fatal to women. Within these ligaments
are situated  the ovaries and  Fallopian tubes.  Two
cords arise from the upper sides of  the womb, and,
emerging from the abdominal  cavity through the
abdominal rings, they become lost in the areolar or
cellular tissue of the groin, mons veneris, and labia
majora.  They are known as the round ligaments of
the womb.
  The Fallopian tubes are so-called from the anatomist
Fallopius, who, it is no doubt justly alleged, was the
first  to describe them.  When speaking of the cavity
of the womb, it was mentioned  as being triangular
in form, the angles of the  base being  the  points
of entrance  therein of these tubes.  They are no
larger in diameter than to barely admit  a common-
sized hog bristle, and arise obliquely from the womb 
THE OVARIES.
33
on either side.  They are about four inches in length,
extending to the ovaries, which they receive in a
trumpet-shaped expansion, termed fimbrio, or fringed-
like process.   The peculiar manner in which they
connect with the ovaries  has induced some anato-
mists to call it the  morsus diabola, or devil's bite.
They are the excretary ducts of the ovaries.
  The ovaries are two in number, and correspond to
the testes in the male.  They are situated upon the
posterior face of the broad ligaments of the womb,
and have, besides these, ligaments of their own, by
which they are attached  to the uterus.   They are
termed  the  ligamentum ovarii, or ligaments of the
ovaries.  The ovaries  are oblong and flattened in
form, about an inch and a half in length, three fourths
of an inch in breadth, and nearly a half inch in thick-
ness.  They have two, coats or coverings, interior to
which is the true substance of the ovary, termed the
stroma.  In  this stroma are found numerous  little
vesicles, varying in  size, the larger generally being
nearer the surface. These vesicles are called Graafian
vesicles, from Regneir de Graaf, a German physician,
to whom is  attributed the honor of having first
discovered  them.  Upon close examination  they
are found to have two coats also, within  which is a
cavity filled with albuminous fluid. Floating in this
fluid is the  ovum or egg, corresponding in  all its de-
tails with the ordinary hen egg, but, as a matter of
course,  very much smaller in  size.  It contains a
yolk, and in  the center of the yolk a small vesicle,
termed the germinal vesicle. Upon the covering of this
vesicle is found its nucleus, called  the macula germ-
inativa, or germinal spot.  Having now given a gen-
      3 
34
GYNECOLOGY.
eral description of the anatomical structure of the
parts immediately concerned in or belonging to mid-
wifery, the necessity of giving them careful consid-
eration and study cannot be too earnestly impress-
ed upon  the novice;  as, without being somewhat
familiar therewith, all that follows, in reference to
menstruation, gestation, parturition, and diseases of
females, would be but vague, ambiguous, apparently
unmeaning, and  perplexing to the mind.

              MENSTEUATION.
  The term menstruation is derived from the Latin
mensis, a month, and is used to indicate that period-
ical condition peculiar to females, commonly de-
nominated by them "monthly periods," "sickness,"
" courses," " flowers."  It is most often termed among
the medical  profession caiamenia, from  the Greek,
meaning literally into or through a month.
  The discharge usually makes its first  appearance
when the  female is between  thirteen  and sixteen
years of age in  this country, though  instances are
not wanting where it has occurred  much earlier
than the first or has  been delayed beyond the last-
mentioned period;  but the above, being the average
of its commencement, is generally received as the
age of puberty.  Besides the discharge at this period,
nearly the whole female form  undergoes somewhat
of a change: the pudendum begins to be covered
with bair; the breasts increase in size and fullness;
the pelvis  begins to spread out  to either side more
than  formerly, thus  giving to this portion  of the
body that peculiarity of development characteristic
of the sex. 
MENSTRUATION.
35
  For some two or three days before the flow begins
the patient is apt to complain of a general fullness or
heaviness of the head, accompanied with a dull head-
ache, pains in the back and loins.  The face is usually
flushed, and  the eyes more brilliant than  at other
times.   All of these symptoms vary in  different in-
dividuals, and in the same at different times, being
frequently very severe in some and  not at all no-
ticeable in others.  As the time for the emission to
begin draws near, the indications of its approach
 nore  or  less subside, and  in  most  cases  almost
entirely vanish  with  the appearance of the  dis-
charge, which usually  continues three or  four and
sometimes five or  six  days, and then, becoming
thinner and  paler, entirely ceases  until the  next
period,  or about  twenty-eight days, when it may
occur without any or very few and slight  premoni-
tory symptoms.
  The amount commonly emitted is from about four
to eight ounces, but may vary according to idiosyn-
crasy, the constitution, and temperament of the in-
dividual.  Thus, in a healthy, full habit, or plethoric
person, it will attain to as much as twelve or more
ounces without detriment to health, whilst in one of
an opposite or weak constitution and habit of body
—anaemic—even a discharge of four ounces may cause
considerable weakness, lassitude, and uneasiness.
  There is a marked difference existing between the
menstrual fluid and ordinary venous blood: the for-
mer being somewhat of an acid character, possessing
a peculiar odor, and docs not coagulate; whilst the
true blood is alkaline, and readily forms a cressemen-
tum or clot  upon being exposed to the atmosphere. 
36                GYNECOLOGY.
  There have been numerous theories advanced re-
specting the cause of menstruation. The principal one
is, that about every twenty-eight days the Graafian
vesicles arise to the surface of an ovary, which, by
becoming enlarged, impinges upon and irritates the
tunica  albuginea, (or covering of the ovary,)  there-
by determining a greater flow of blood to the ovaries
and womb, which blood, being discharged  into the
latter,  escapes through its cavity into the vagina.
  The  difference in the time before mentioned of the
advent of the menstrual discharge may and does de-
pend to a great extent upon certain  peculiar condi-
tions of constitution of some, and  in others upon
occupation, habit of life, and temperature—such as
frequent exposure  to warm atmosphere, an idle or
sedentary life, or being exposed to circumstances
calculated to excite sensual feelings, or continued
Bensual indulgence: all of these  favor and will fre-
quently hasten the approach of puberty, whilst cir-
cumstances of an  opposite character are calculated
to postpone it for a greater length of  time.  The
period  which this aptitude for procreation or men-
strual  term continues  is about thirty or thirty-five
years, or until the female has attained her forty-fifth
or fiftieth year.  As this subject will be referred to
again, when considering that condition denominated
" change of life," we will leave it for the present, and
pass to the consideration of the

           Diseases op Menstruation.
  Amenorrhea.—This term, signifying  absence of
or without the menses, comprehends two conditions:
one which is termed emansio mensium, and relates to 
DISEASES OF MENSTRUATION.        37
that in which they have never appeared; and the
other suppressio mensium, to that in which the dis-
charge may have  appeared one or more times, and
then ceased, from some direct or indirect cause.
  The first of these frequently depends upon a want
of vigor in the system about the age of puberty, re-
sulting, it may be, from previously depraved health,
by which the power of any new action  arising  in
the womb is impaired, or it may depend upon some
malformation or absence of the ovaries, an imperfect
formation of the Fallopian tubes, or an imperfect
condition of the os uteri and hymen.
  The symptoms that  generally present themselves
under these circumstances are a loss of appetite and
former natural liveliness. The patient neglects or has
little care to perform ordinary or even necessary duties
of life.  She  becomes peevish and restless, with no
power to concentrate the mind upon one subject for
any length of time.  She is continually weary, debili-
tated, and after a while begins to Avaste in flesh, with
morbid appetite or desire for indigestible substances,
such as charcoal, chalk, slate-pencils, plaster, and fre-
quently the common earth.  After some time, if not
arrested, the  result of the disease will probably be
dropsical effusions in the lower extremities and ab-
domen.  These usually become very much  swollen
or enlarged,  particularly towards  evening, though
the enlargement  of the latter may and frequently
does depend upon the bowels being distended with
flatus, which  should not be confounded with the for-
mer or dropsical condition.  The urine becomes very
scanty, high-colored, or it may be more copious, and
paler than formerly.  The bowels are generally con- 
38
GYNECOLOGY.
stipated, accompanied with continuous headache and
cold feet, even in warm weather.  Whilst in  some
these symptoms may  create  considerable anxiety
and alarm about their situation, in others they may
frequently excite no uneasiness, and, if allowed to go
unchecked, will produce moroseness or melancholy,
with little  or no interest in regard to themselves,
relatives, friends, or in fact any person or thing at
all, until the system at last is  compelled to yield to
the continued inroads made upon it, and the vital
spark soon begins to wane, and  presently goes entire-
ly out:  the natural result to be expected from the
cough, expectoration, and morbid  deposits, racking
and vitiating the body and blood; whilst seemingly
the patient is but too glad to embrace  that  sleep
from which she is aware there can be no awaking
in this world; but she longs to be relieved from all
pain, sorrow, trouble, care, and distress forever and
ever,  in "that undiscovered  country from whose
bourn no traveler returns."
   The treatment of this condition or disease depends
upon the variety and intensity of the symptoms just
enumerated.  Of these the experienced ph3Tsician is
best qualified and capable of determining, as the dis-
ease may result principally from one  of the anoma-
lies before mentioned—imperforate os uteri or hymen
—which a painless surgical operation would readily
remove. But it is in this disease, probably,  above
all others, that young females or their mothers are
liable to give trial to all the various nostrums usually
advertised  to cure this and all other female com-
plaints before they mostly—often when it may  be too
late—call upon those who 
DISEASED OF MENSTRUATION.         39
         "Could have the sovereign balm infused
          That Chiron gave and ^Esculapius used."
  But  which, instead of relieving the  interesting
and tender patient, the nostrums she has taken have
only added to her misery and danger by delay;  the
disease the meanwhile breakingup entirely an already
weak and debilitated constitution. How many have
thus found early and  premature graves, who might
have lived to the full period of womanhood, orna-
ments  alike to themselves and the  circle in which
they would have moved, enlivened  and  enriched
by their graceful mien,  industry, and  intelligence,
time alone can, as it  certainly will, unfold.   There-
fore, patient and parents, when you or your child
shall have arrived at that period of life when this
discharge ought to occur, and any of the symptoms
before  mentioned make their appearance unaccom-
panied or not soon followed  by the discharge, or if
it docs not make  its appearance in four or five days,
after using the usual remedies here set forth  in these
cases, such  as the tepid  hip-bath, aloes, and  iron*
with injections of warm water into the vagina, do
not hesitate to seek the advice of your physician, as
the cause perhaps may be removed in a few minutes,
as before  indicated, which all the medicines in  the
pharmaccepia, singly  or combined, would not effect,
but prove deleterious  and dangerous from delay.
  Suppressio  Mensium.—This of itself may  occur
under two forms: first, when the discharge has set
in at the usual periodical return,  and been suddenly
      *Take sulphate of iron...........................  6 grains.
           pulverized aloes.......................... 30   "
Mix, and divide into 20 pills.  Dose: take one 3 times a day. 
40
GYNECOLOGY.
arrested from any cause, such as exposure to cold,
powerful mental emotions, or undue excitement of
any kind.  It is then called acute, and is accompanied
with pain  in the back, violent headache, throbbing
of the temples, and considerable fever.   As a general
thing this form will readily yield to the administra-
tion of gentle laxative medicines, cold applications
to the head, followed or accompanied by the tepid
hip-bath and  cupping or bleeding, if necessary, with
an occasional anodyne.
      Take pulverized opium....................  1 grain.
              "     camphor.................  10   "
  Mix, and  divide into 6 powders  or pills.  One to be taken
every 4 hours, or until quiet is restored.
  If it does not yield to these means, it may assume
the second variety, or
  Chronic form, resulting from the system having
received such a violent shock as  to impair some of
the functions  of the womb  or its  appendages; or
this variety may depend upon a gradual failing of
health,  resulting  from  a morbid condition of the
bowels, lungs, or liver.  In this case the object of the
treatment should  be to remove the cause, by  proper
remedies directed  to the organ involved. Having
succeeded in this, the discharge will continue uninter-
rupted as before.   Another cause of the cessation of
the menses must always be borne in mind, in order
that it  may not bo confounded  with either of the
other causes mentioned, as serious and unhappy re-
sults  might ensue therefrom, and a pregnancy, as
will after a while be learned,  destroyed.
  Dysmenorrhea.—The term  dysmenorrhoea sig-
nifies difficult or painful menstruation.  It may and 
DISEASES OF MENSTRUATION.         41
often does take place at the very commencement of
menstrual life, but frequently does not occur until
after marriage, or it may be not until after the birth
of the  first child.  But some individuals, it seems,
are liable to  it at any time during  the  menstrual
period.
  The  indications of the  approach  of the menses
under these circumstances are  more or less severe
for a day or two before their appearance.  The pa-
tient, in  most cases, is seized with acute and even
terrible pains in the lower part  of the abdomen, ex-
tending around to the back and loins, accompanied
by more  or less general fever and  excitement until
the discharge appears, which is usually scanty, and
consisting of a shred-like membraneous substance and
mucous tinged with blood, when the pain becomes
more aggravated and intense.  From  the peculiarity
of this discharge it is apt to be  supposed, as is often
the case  with the married, to be a  false conception,
especially if they (as it is possible they may) have
passed through one or more monthly periods with-
out the usual indications of its approach.
  The disease is attributed to an organic affection of
the womb, or a want of nervous energy in the same,
resulting from exposure to cold  and dampness,  or it
may be sometimes from excessive venery.  How far
this latter may be instrumental, as a cause of this
complaint, may be inferred from the  fact that those
mostly affected with it are generally of an unusual
amorous  tendency.  Dr. Macintosh, of Edinburgh, an
old but, it is thought, agood authority, contended that
dysmenorrhoea, in most cases, depends upon an un-
natural narrowness of the canal of the cervix or neck 
42                GYNECOLOGY.
[ of each 1 ounce.
of the womb; for which condition he recommends
distension by the introduction of bougies, beginning
with a small-sized one at first, and gradually increas-
ing until he arrives  at No. 10, at intervals of from
two 1o several days.
  The treatment,  during the attack, must be palli-
tive;  for this purpose nothing can answer better than
the "solution of the bimeconite of morphia," * in doses
of from ten to fifteen  drops, at intervals of from three
to four hours; or—
      Take hydrate of chloral 1 drachm.
           sirup of ginger,
           orange-flower water,
  Give a teaspoonful every hour until relieved.
  The hip-bath,  or the application of a fly-blister to
the sacrum, will  be  found  useful in mollifying the
attack.  In the  interval of an attack, moderate in-
dulgence in the veneral congress must be strictly
enjoined;  say once a month or once in two or three
weeks, is, or ought  to  be, sufficient to  satisfy the
appetite of those who desire to have children  like
olive branches growing up around them, and become
entirely cured of the painful malady.
  Menorrhagia, or  an immoderate flow of the men-
ses, paradoxical as  it seems, may result from  two
opposite conditions,  viz: a plethoric or full habit of
body, or from a  general debilitated, weak, and re-
laxed condition of the same, extending to the womb
and  its blood vessels; or  it may be. as not unfre-
quently is the case, from ulcerations of the mouth of
the womb.  In the former condition of the system it
is not apt to produce any uneasiness, except from the
*Beasley in Griffith's formula. 
DISEASES OF MENSTRUATION.          43
inconvenience it causes, and may be easily arrested,
sometimes by a counter-bleeding or the  administra-
tion  of saline purgatives and astringent injections.
The  best  for this  purpose is a solution  of the  per-
sulphate of iron—Monsel's salt—forty  grains to a
pint of rain-water, to  be retained some minutes in
the vagina.  In the second and third instances mon-
orrhagia is accompanied with a weak pulse, dizzi-
ness of the head, especially when changing from the
recumbent to the erect posture, singing  in the ears,
more or less palpitation  of the heart, and consider-
able nervousness, with pains in the back, loins, and
lower part of the abdomen.
  The object to bo obtained, under these circumstan-
ces,  is the arrest of the  flow at once, by exhibiting
acetate of lead, combined with opium.
      Take sugar of lead......................... 12  grains.
           pulverized opium....................  1   "
  Mix, and divide into 6 pills or powders.  Dose: 1 every 4 hours,
and repeat if necessary.
  It is not advisable to continue beyond more than
24 grains of the lead without an  intermission of at
least twenty-four hours.   If there is not much pain,
the pulverized myristica  (powdered nutmeg) in five
to ten-grain doses, may be substituted for the opiate,
as the latter is cumulative.  Tonics, such as Peru-
vian  bark, wine, and iron may be given to restore
tone  to the general  system.   The secale  cerale—
spurred rye, or ergot—has of late been found to prove
efficient in stopping the flow when  all other means
have failed.  The author has, at this writing, a case
just  recovering, which is attributed  to the ergot,
combined  with the ferri pulvis  (iron  by hydrogen) 
44
GYNECOLOGY.
and a small portion of opium.  The following is the
formula:
      Take pulverized ergot...................  6 scruples.
             "    iron by hydrogen... 12 grains.
             "    opium..................  1   "
  Mix, and divide into 6 powders.  One to be given about 3
times per day.
  There has  been no discharge for five or six days,
and the patient is able to go about her usual duties
without anticipating further trouble.  The per-sul-
phate of iron before mentioned, or the per-chloride
of iron in solution, will be found useful as an astring-
ent injection.  It is requisite, during the treatment,
to enjoin the strictest quiet, by rest in the  horizontal
position.  The discharge may cease for a day or two,
and  the patient, thinking herself well, is apt, unless
otherwise advised, to undertake duties too arduous
for her prostrate condition, and thereby provoke the
return of the discharge; therefore it cannot  be too
strenuously enforced upon her to undertake as little
business as possible  that may require much moving
about during convalescence.

             Vicarious Menstruation.
  Sometimes, when the  menses  do  not  appear at
the expected period, or if they have appeared one or
more times  and  they cease from any cause, hem-
orrhage  may occur from  some  other  organ or part;
as,  for instance, the nose, gums, lungs, or stomach.
This is called vicarious menstruation, which, though
often causing much uneasiness, is not necessarily dan-
gerous, and seldom ever leaves  any serious complica-
tions behind it. 
CESSATION OF THE MENSES.         45
 Cessation  or the Menses, "Critical Period,"
               "Change of Life."

  All of these terms  are  applied to that period,
before referred to, at which the menses altogether
cease.   About  this period usually, and for  some
months prior thereto, either one or all of the condi-
tions we have just considered may exist  in differ-
ent persons, according to circumstances, constitution,
and temperament.  The discharge becomes irregu-
lar, disappearing altogether for a while, and then re-
appearing, inducing the belief in some, from the phys-
ical indications sometimes attending at this time—
such as an enlargement of the abdomen and tender-
ness of the breasts, accompanied with nausea and
vomiting, especially in the morning—that pregnancy
exists, during this transition state which the constitu-
tion is undergoing.  Not unfrequently there is  con-
siderable pain about the loins, in the back, and womb,
which, as usually expressed by the patient, are of a
"dragging"  character, accompanied  with violent
headache, coated tongue, great thirst, and general
fever, attended with  a bloody discharge from the
womb.  If  the  patient has a predisposition to any
organic disease, it is apt to become aggravated and
excited at this time, and may soon terminate in death.
Whilst some may have to endure all these symptoms
and sufferings, many more pass through the period
without any trouble or inconvenience whatever.  In
fact, with these it is an end of all trouble, especially
with those who have been afflicted with that painful
complaint dysmenorrhea.  These now begin to enjoy 
46
GYNECOLOGY.
better health, the form becoming more rotund, and in
some extending to corpulency and portliness.
  The treatment in this, as in the other diseases of
menstruation, must be varied according to the con-
stitution, condition, and temperament of the patient.
General attention  to the bowels, with warm  cloth-
ing, proper diet, and sufficient exercise, with care
not to be exposed to damp or unwholesome air, will
usually  be all that is  necessary to  bring about a
favorable result.   If any complications should man-
ifest themselves, they are to be treated upon general
principles, according to the  indications and  the
organs affected.
  It is in the vicissitudes, anxiety, and trials incident
to the  aggravated forms of this period of life that
women  generally are  apt to seek relief in the nu-
merous nostrums which purport to give relief in and
cure these cases, when in most iustances, as above
intimated, all that is necessary is to be governed by
the means we have pointed out,  and nature will do
the rest and finish the work of cure in ample, good,
and duo time.
  It is  very natural that every female should  feel
some anxiety about herself, and  it is that  very anx-
iety that is  apt  to urge her to  do that which  she
should not,  and which is unnecessary and hurt-
ful'; for in every instance where recourse has been
had to quack remedies the testimony of every phy-
sician will bear record to  the  statement they have
only been productive of harm.  As the author has
taken occasion when upon the  subject of amenor-
rhea to warn the  reader against this class of medi-
cines, and as he has upon all occasions, in private 
            CESSATION OF THE MENSES.          47

practice, when opportunity offered itself, deemed it
a duty to patients to warn them of their utter use-
lessness, he would here reiterate his  unqualified op-
position to them  in whatever form they may present
themselves.   And to that class who may think that
this opposition, which is general among and is the
sentiment of every good and intelligent physician,
arises from  anything of  a jealous, envious, sinister,
or selfish motive, it may be necessary to say, they
are greatly—most decidedly—mistaken, and thereby
deceiving themselves, and nurturing, as it were, in
their own bosoms the poisonous asp, which will grad-
ually and now is, perhaps, infusing into them a venom
that is impinging upon, vitiating, and hastily crowd-
ing out the vital spark in their own mind and body,
and perpetuating it as a heritage to their children's
children.  Because he is aware of this fact, that is the
reason, the only  reason, why the good physician, my
dear reader, would warn you against them; and be-
sides he knows that ninety-nine out of a hundred of
these preparations do not contain  any of the ingre-
dients  they  purport, or are not in any respect what
they are represented to  be;  for the originators of
them are mostly enthusiasts or designing men—such
as broken-down, incompetent doctors, circus, and
menagerie followers, who possess no knowledge of
the properties of medicines or therapeutics, and,
as a matter  of course, can have no experience as to
their effects upon the  system.  Just for a moment
consider the assurance, not to say folly, of the author
of one of these nostrums giving out that his medi-
cine will cure all of those conditions supposed  by
many to exist in themselves during this " change of 
48                GYNECOLOGY.
 life"—such as consumption, liver complaint, womb
 and kidney diseases, etc.—who not only does not
 understand the true function of these organs, but
 has no idea of their form, size, or position in the
 human body,  much less the diseases peculiar to
 them, or, if shown them, could not tell if they were
 in a healthy or diseased state; when sometimes, from
 various  causes, depending upon peculiarities  and
 idiosyncrasies  of the individual affected, a  disease
 will baffle the skill of those who  have grown old
 and gray-headed in the service, and whose  knowl-
 edge and experience necessarily  make  them ac-
 quainted  with  every organ  and every tissue in the
 human frame  even to  their utmost  minutiae,  with
 their physiology and functions.  In view of all these
 facts, beholding an intelligent being so thoughtless,
 so reckless, we are ready  to exclaim with  one of
 old—
  "Can such things be, and overcome us like a summer cloud,
   Without our special wonder?"

                LEUCOBRHCEA*

  This disease, commonly called whites, is a mucous
discharge  from  the vagina and womb.   When from
the former only, it has somewhat the appearance of
thin starch,  both in color and  consistency; and the
same when from'the womb,  except that the color is
of a yellowish green or  a brownish hue.  If any ul-
ceration of the os uteri exist, which is often the  case
when the  disease is protracted from neglect, it is at
times tinged with streaks of blood.
* From the Greek leukos, "white," and reo, "I flow." 
LEUC0RRHO3A.
49
  Females are liable to this disease in some form at
all ages, even in childhood.  The author has treated
one case in a child on\j two years of age, which other-
wise apparently had enjoyed previous good health. In
this case the discharge was evidently from the vagina
alone.  It was  considered to be and treated as an
exaltation of secretion  only.   To explain, for the
benefit of the  novice: the mucous or lining mem-
brane of the vagina and womb, in health, eliminate
from their surfaces a sufficient amount of moisture
to lubricate the parts, so that where they impinge
upon each other they can do so readily, without pro-
ducing undue irritation or inflammation.  In health
this  mucus  is  a  natural secretion;  therefore any-
thing occurring to cause an urTusual excitement of
the  membrane may increase the  secretion to such
an extent as may be unnecessary for normal  pur-
poses ; consequently it is freely discharged* Hence
in simple  cases it is said to be  a mere  exaltation of
secretion, which  may be looked upon as the  first
stage of an  inflammation, or a simple irritation of
the parts.  This condition, it will  be perceived, can
be brought about by various causes, but it is gener-
ally  in women who have borne children that it pre-
sents itself in its most formidable aspect, that being
one  of the  greatest causes tending to excite and
thereby weaken the parts; others being excessive
venery, exposure to extreme  heat or  cold, general
debility, and one or more abortions.
  In its incipiency the disease  is painless, and goes
frequently unnoticed, except from the inconvenience
arising from the slight discharge at first; but, by
being neglected, the irritation, extending along the
       4 
50                GYNECOLOGY.
 vagina up to and into the womb, these organs soon
 assume a low form of inflammation, followed by de-
 cided ulcerations of the mouth of the womb; and if
 still further neglected, as sometimes is the case, even
 at this stage, the  whole of the  internal organs of
 generation may become involved, and  then it is that
 the patient, whose symptoms were hitherto so slight,
 by their being aggravated, begins to complain of a
 sense of weight in the lower part of  the abdomen,
 pains in the back, and soreness between the hips,
 extending down into and along  the thighs to  the
 knees.
  The discharge usually increases in  quantity just
 before the lime for the return of the monthly flow,
 and, upon the  appearance of the menses, subsides
 or becomes lost in that fluid, then appearing again
 immediately upon the cessation of the same. It is
 mostly owing to a want of attention and treatment
 in the early stages  that this disease becomes so
 formidable in opposition  to the means used  to sub-
 due and eradicate it from the now broken-down and
 debilitated system.
  Treatment.—If attended to in  its incipiency, the
 disease will  yield to proper local remedies—such as
 washing  the parts with warm water  and Spanish
 soap two or three times per day, after which, on
 each occasion, with  a strong solution of sulphate of
zinc,  (white vitriol,) say about two drachms of the
sulphate to a half pint of rain or river-water.  When
the disease has further advanced  a strong solution
of nitrate of silver (lunar  caustic) will  be required:
about forty  grains to the  ounce of water,  or the
stick caustic  itself applied  through  a speculum to 
HYSTERALGIA.
51
the abraded parts of the vagina and womb.  In the
meantime the general system should be supported
with tonics—such as iron, quinine, and a little wine,*
in debilitated persons ; in those of a plethoric or full
habit of body, leeches to the perineum or lower part
of the  abdomen, with a proper  attention  to the
bowels, keeping  them well opened  by means  of
saline purgatives, such  as  magnesia, epsom salts,
cream of tartar, or the free use of Congress water,
will be all that is necessary in most cases.   A blister
to the sacrum will often relieve the pain in  the back
and loins, and prove useful  by acting as a counter-
irritant and assisting in the cure.

  HYSTERALGIA, OR IRRITABLE UTERUS.

  This disease, though sometimes met with  in young
females, most  commonly occurs not until about the
period of middle  life.  It is characterized  by pains
in the loins, extending around and through the pel-
vis, and down the thighs to  the knees.   The pain is
sometimes  acute and shooting; at other  times it
amounts to merely a soreness, which is relieved for
the time being by  external pressure,  but  becomes
more aggravated by excitement of any kind, or by
the touch of examination per vaginum about the
body and neck of the womb.  The patient is apt to
describe the sensation of pain as if a knife had been
plunged into the womb.
  It is accompanied generally with a dry,  hot skin,

 *An ounce of yellow cinchona bark  in a pint of good Madeira wine,
if allowed to stand a day or two, will be found an excellent tonic, in doses
of a wineglassful three times a day before or after meals. 
52
GYNECOLOGY.-
frequent pulse, and some irritability of the stomach,
bowels, and kidneys.
  The causes of this disease may be divided into
predisposing and exciting.  Among the former may
be enumerated temperament, education, or an undue
yielding to the demands of fashionable life, and not
unfrequently prolonged nursing.  The exciting causes
are abortion, over-exertion, falling of the womb, and
too free exposure of person during menstruation.
  The treatment consists mainly in the administra-
tion of anodynes, and endeavoring at  the same time
to improve the general health by tonics, baths, (med-
icated,) proper exercise, good diet, and cheerful com-
pany.   The best, simplest, and safest anodynes and
soporifics  in this disease are the solution of the bi-
meconate  of morphia, about 25 to 30 drops, or the
hydrate of chloral in 8-grain doses,  every two or
three hours until relieved, and the local application,
by means of lint saturated with a mixture composed
of deodorized tincture of opium, 2 drachms to 1 ounce
of glycerine.  The wad of lint should not be too large,
or it may  prove painful. It must be well pushed up
against the mouth of the womb and retained there
to be effectual.
  In atonic or debilitated cases the following may be
given:
      Take extract of taraxicum...............  12 grains.
            "     leptrandrin..............  2   "
            "     gentian...................  6   "
            "     hyoscyamus.............   2   "
            "     St. Ignatius'  bean.....  1   "
           quinine.................................  8   "
  Mix, and divide into 12 pills.  Dose: one to be taken every 4
hours. 
PROLAPSUS UTERI.             53
    The formula for the hydrate of chloral may be as
  follows:
        Take of chloral............................  1 drachm.
              simple sirup...........)
              orange flower water } of each * 0UBCe'
   Mix. Of this mixture a teaspoonful may be given every two or
  three hours until pain ceases.

  PROLAPSUS UTERI, OR FALLING OF THE
                      WOMB.

    The above terms are applied to that condition where
  the womb gravitates below its natural position, and
  remains low down in the vagina.  When it protrudes
  beyond the external lips, it is called procidentia uteri.
    If  we consider the manner in  which the womb is
  suspended by its ligaments in the abdominal cavity,
  (as shown in the anatomical portion of this work,)
  it will be readily perceived that  any force operating
  from above, auxiliary to gravitation itself, will ma-
  terially assist in bringing about  this and the other
. misplacements, as they are  frequently termed, by re-
  laxing and prolonging its cords.  To tight lacing,
  therefore, probably more than any other cause, may
  be traced this unhappy condition or disease.  By it
  the chest and abdominal cavities are diminished and
  circumscribed, the liver, spleen, and intestines forced
  lown upon the womb, and it in turn compelled to
  occupy a place considerably below  its  normal posi-
  tion, and from which it is unable to rise during the
  short interval of undress, or that  in which the corset
  is laid aside.   If our lady readers would only bear
  these facts in mind, and govern  themselves accord-
  ingly whilst yet young, the physical suffering they 
54                GYNECOLOGY.
may thereby escape can only be realized by witness-
ing those of an unfortunate one whose folly has en-
tailed this dreadful complaint upon herself.
  The disease in some individuals is unattended with
any suffering more  than the inconvenience experi-
enced by the protrusion and the discharge, always
present, from the relaxed state of the womb; whilst
in others, in addition to the above, there is constant
pain in the back and lower part of the abdomen, ex-
tending down the whole length of the lower extrem-
ities to the toes; or the symptoms may be still more
aggravated, with greater pain while standing or mov-
ing about, or in the  necessary efforts to evacuate the
bowels and bladder, both of which  may be very ir-
ritable, accompanied with  a general debilit3T of the
whole system and loss of appetite, furred tongue, and
accelerated pulse.  Besides the above causes, operat-
ing to produce prolapsus of the womb, there may be
an undue  heaviness of the organ itself, which is in-
creased, and consequently may occur during the first
months of pregnancy  ovarian  and  other tumors;
relaxation of the  ligaments of the womb, from too
early getting-up after confinement, or from neglect-
ing to apply the usual bandage after delivery; un-
usual bodily exercise,  such  as dancing,  running,
romping;  and also  excessive  coughing or straining
of the bowels, as in dysentery and diarrhea.
  The treatment consists in anointing the hand and
dependent parts with olive oil or lard, then gently
pushing the womb upwards into its proper location,
after which, for sometime, rest in the horizontal po-
sition, and the  use of astringent injections: For ex-
ample, a solution of alum in strong red-oak bark tea; 
PROLAPSUS UTERI.
55
or sugar of lead and  sulphate of zinc, in the same
menstruum or rain-water, with mechanical support
by means of pessaries.  These are of various kinds,
shapes, and sizes.  The manner of introducing them,
generally, when of an oval shape, is to place the pa-
tient upon her back, and then, after well anointing
the pessary with olive oil or unsalted lard, introduce
its long  diameter first,  until  it has reached the de-
sired height, just above  the tuber ischia, when it must
be turned, so as to lie transversely across the outer
or lower strait of the pelvis, with its long diameter
from before backwards.
   The globe pessary can be easily introduced, as it re-
quires no turning.  A proper-sized rubber  ball will
answer the purpose of a temporary or even perma-
nent pessary.  These should be  removed,  washed,
anointed, and replaced at least once a day.  Besides
these internal, there  are various external supports
known as abdominal supporters. These vary in mer-
it almost in proportion  to their different styles and
shapes.  There are two supports or corsets, named
respectively after their patentees, which are deemed
of special merit, and for no other reason are they
referred to here.  They are Mrs. Moody's abdominal
corset  and Mrs. Willis's abdominal support.  They,
as well as  the  different trusses,  pessaries, and  sup-
ports, can be obtained from any surgical-instrument
maker, or from druggists and apothecaries gener-
ally.
   The constitution in the mean time must be attend-
ed to, and, if  weak and  relaxed, as generally is the
case, must be supported  by good diet, Peruvian-bark
tea, or quinine, wine, and iron. When, after protract- 
56
GYNECOLOGY.
ed persistence therein, these means fail, it may become
necessary to have recourse to surgical operation, by
which a portion of the vagina is removed.  The parts,
by being brought together, heal and contract its size,
which may act as a bar against further protrusion.

      ANTEVERSION  OF THE WOMB,
Or, as the name indicates, an inclination of the fun-
dus of the womb forwards, thus occupying a trans-
verse position in the pelvis.
  The indications of this displacement are a sense of
weight or dragging in the loins and pelvis, with pain
in the lower part of the abdomen, increased by  ex-
ertion.  Upon examination per vagina, this channel
will be found blocked up, by the womb lying across,
with the mouth directed towards  the sacrum, and
the fundus towards the symphysis pubis.
  Treatment.—If no adhesion or growing together,
as it is commonly termed, has taken place, resulting
from previous inflammation of the parts, the os may
be drawn  down by the finger of one hand, and  the
fundus at the same time pushed up with the other.
The patient should be kept quiet upon her back for
some days after this operation, or until the parts in-
volved have regained their former tone.  Sometimes
a cure may be induced  by directing the patient to
keep the bladder full and distended, and the rectum,
to such degree as may be possible, continually empty.
The cause of this tilting forwards of the womb may
result from a continued reversed state of the organs
just mentioned, or excessive expulsory efforts, cither
during or after urinating, together with falls, blows,
or the contraction of the  round ligaments  of  the 
RETROVERSION OF THE WOMB.        57
womb; also chronic diarrhea, and from the general
relaxation of the body produced by it.
  Anteflexion is applied to that condition in which
the womb is bent upon itself. The term is generally
used synonymously with anteversion.

      RETROVERSION OF THE WOMB

Is the reverse of the former condition, or a  bend-
ing backwards of the fundus of the womb, or  an in-
clination in the same direction of the whole organ.
It is termed retroflexion in the first instance, retrover-
sion in the latter.
  Retroversion of the womb  generally occurs be-
tween the third and fourth month of pregnancy, and
is accompanied with more violent pains than  in the
other varities of displacement.  The bearing-down
pains are more severe, with a sense of fullness and
distension about  the sacrum, accompanied with  a
partial inability to evacuate the bowels or bladder,
on account of the fundus pressing  against the rec-
tum and the os against the neck of the bladder: the
former being usually found, upon examination, with-
in the hollow of the sacrum, and the latter thrust up
behind the symphysis pubis.
  The treatment is first to empty the bladder by
means of a catheter, and the rectum by injections;
then, after placing the patient upon her hands and
knees, pass the finger up into the latter until the
fundus is reached, which should be pushed upwards,
at the same time with one finger of the other hand
in the vagina  the os may be  hooked and brought
down. Not unfrequently the mere  emptying  of the 
58
GYNECOLOGY.
bladder and rectum will be all that is necessary; as
the womb, from being  impacted  between them, be-
comes liberated, it will sometimes rectify itself by the
natural contraction of the round ligaments.  It will
be required, perhaps,  at times, to rupture the ovum
and allow the womb to  contract; but, as a matter of
course, this should not be resorted to until all other
means  have failed.  The  after treatment is rest in
the horizontal position and keeping the bladder and
rectum empty. Pessaries may be used to retain the
womb in  situ in all displacements, if necessary.
  Cause.—The womb is liable to this displacement,
during the first months of pregnancy, from any sud-
den impulse backwards, or b}1- a distended bladder,
long standing, or a sudden expulsory effort at stool.
It may also result from falls, blows, sudden  shocks,
or straining in lifting, or by tumors in the neighbor-
hood of the fundus of the  womb.

                GENERATION.
  "I am fearfully  and wonderfully made;  marvel-
ous are thy works; and that my soul knoweth right
well.  My substance  was  not hid from thee,  when I
was made in  secret,  and  curiously wrought in the
lowest parts of the earth.  Thine  eyes did  see my
substance, being yet unperfect; and in  thy book
all my members were written, which in continuance
were fashioned, when as yet there was none of them."
  If that remarkable man, whose language we have
just quoted, could thus sing, with the limited knowl-
edge of the mechanism of man possessed by man-
kind in his time, what would be  his amazement,
wonder, love, and praise  to  the great "I Am," did 
GENERATION.
59
he live in our day, in the contemplation of his frame,
when the intricacy and working of the human ma-
chine has been examined and exposed in all its most
minute and important parts—whilst its development
can be traced  step by step from away back into the
very beginning  of its being in the parent womb!
Alas! we cannot even attempt to portray the elo-
quent strain of adoration that would burst from his
overflowing soul of love,  but we may content and
console ourselves by singing with another the appro-
priate lines:
          " Thy amazing works, Almighty God,
            My  rising soul surveys,
           Transported by the gaze, I stand
            In wonder, love, and praise."
  By the term generation is meant that vital process,
resulting from the union  of the opposite sexes, by
which the species are reproduced and continued from
one to another of the same kind.  What is to be said
here will bo confined to our own species.  Having
already shown (see Menstruation) that the power
of procreation is not present in the female until she
has arrived at  the age  of pubescence, it  may be
proper to  state here that, except in very few in-
stances, the same power does not exist in the male
until he has reached his fourteenth or fifteenth year,
at which period the  instinctive desire to exercise
the prerogative  manifests itself, and continues, to a
greater or less extent, until he has reached his three-
score and ten  years.   As certain circumstances and
mental emotions tend to hasten or prolong the period
in the female,  so may the  same operate to expedite
or delay it in the male. 
60
GYNECOLOGY.
  The human spermatozoa has a diminutive  oval-
shaped flattened body, varying in size from the one-
six hundredth to the one-eight hundredth of a line,
(a line is the one-twelfth part of an inch,) from which
proceeds a gradually tapering tail, about one-fortieth
or one-fiftieth of a line in length, by which they are
enabled to propel  themselves in the seminal  fluid,
in which, after emission,  especially when lodged in
the generative organs of  the female or in the urine,
they  may retain their vitality several days.  The
ova has already been described.  (See Anatomy.)
There are two general theories in regard to genera-
tion, which will be but briefly noticed:  one is called
epigenesis, or that in which each parent  is instru-
mental  in contributing to  the development of the
new being; the other is called evolution, in which it is
contended that the first creation of each species con-
tains  within itself all the individuals of that species
in miniature that shall ever exist.  It has also been
called the emboitment or insertion theory, or that in
which the female supplies the essential matter neces-
sary for the development  of the offspring, attributing
to the male the  power only of arousing that innate
but hitherto dormant tendency to reproduction in
the female.
   The former is the most  plausible  as well as the
most  rational, and it is the generally accepted theory,
although the exact point at which conception  takes
place, it seems, is not so easily determined or under-
stood.  One physiologist contends that it is in the
ovaries themselves; another, not until the ovum has
been  discharged from the ovaries into the womb,
where it is acted upon by the spermatozoa, which 
GENERATION.
61
at the same time has found its way into that cavity.
It is the opinion of Coste and some others, that dis-
integration of the ovule takes place within twelve
hours after it is given up by the ovary, which process
may have commenced far  up in the Fallopian tube,
or near its uterine extremity,  or not until it has
entered into the womb. It does not matter materi-
ally where the exact point .of contact takes place;
but it is very certain that actual contact of ovule and
spermatozoa is necessary to effect fecundation; the
former  opening itself, as  it were, to receive the
larger  portion of the latter.  The  result of this
union of ovule and  spermatozoa is  a great irrita-
tion in the womb, Fallopian tubes, and all the adja-
cent parts, from the transitory action taking place
in the  ovum;  which process continuing, the ovum,
by drawing nutriment from the material  immedi-
ately surrounding it, begins to  develop itself; the
womb, in the meantime, increasing in size in the
same ratio, whilst upon its  inner surface there  is in
process of formation a lining called the deciduous mem-
brane or caducous.  There is a difference of opinion
existing among physiologists as to the exact manner
of the formation of this membrane: some, explaining
it, maintain that the whole interior wall of the cavity
of the  womb becomes covered  over with a plastic
substance, eliminated from its surface, which after
a while becomes somewhat hard, resembling coag-
ulated  lymph, when  it is  denominated the decidua
vera.   The ovum, in its efforts to  make  its  way
into the womb, pushes before it that portion of the
decidua vera covering the mouth of the Fallopian
tube, which portion  becomes the decidua reflexa, 
62
GYNECOLOGY.
from its being reflected over the ovum and still cov-
ering it, now that it is entirely within the cavity of
the womb.  Other investigators consider that the de-
cidua vera is the normal lining of the womb, which
has undergone a considerable change from the ex-
citement before  spoken of produced therein.   Dr.
Reid, upon examining the inner surface of a recently
impregnated womb, discovered upon its free surface
a tubular structure, which tubes were found to con-
tain  a lining of white epithelium, and, inasmuch as
the decidua reflexa is found, as contended, to differ
somewhat in structure from the  decidua vera, ap-
parently believes that the latter must be the more
plausible and correct view in the premises.  In either
case, however, that portion covering the ovum must
retain the title of decidua reflexa for the time being.
  When the ovum has become fecundated  and ma-
tured within the womb, it is called viviparous genera-
tion—from vivius, alive, and pario, to bring forth—
and  is applj^d generally to all animals that bring
forth their young alive, and of course is the same
that takes place in the human female.  With  this
brief allusion to  it (for it would take more space
than could  be allowed in a work like this to fully
consider the subject) we will now pass to the  con-
sideration of the process of the

           Development of the Foetus.
  Fecundation or conception having, under the cir-
cumstances above described, taken place, the  first
noticeable  change that occurs  is in the yolk itself,
which divides and subdivides  itself, first into two,
then into four, and then again into eight  separate 
DEVELOPMENT OF THE FOETUS.        63
 segments or parts, each of which contains a vesicle.
 These vesicles are supposed to be the descendants of
 the primary cell.  This subdividing  process contin-
 ues, until after awhile the whole yolk cavity becomes
 filled  with  cells, forming a mass somewhat resem-
 bling  the mulberry in appearance; hence it is termed
 the mulberry mass.  Each segment of the mass is in-
 closed in an envelope or covering, which converts it
 into a vesicle, the portion within each forming its
 nucleus.  This process, beginning with the outer ves-
 icles, or those upon the surface of the yolk, forms
 something of a membrane, which becomes thicker as
 the process continues inwards, and, new cells being
 formed,  results  in  the formation of what is called
 the germinal membrane, or covering surrounding  the
 whole of the yolk, wherein is contained the neces-
 sary material for the  future  embryo, denominated
 the blastodermic, or budding vesicle.   Accumulating
 upon a part of this vesicle a number of diminutive
 cells soon present themselves.  They are collectively
 termed the area germinativa, from which is developed
 all the structure of permanent organism; whilst the
 germinal membrane divides itself into  two layers,
 the inner being  mucous, and the outer serous tissue,
 between  which  two layers soon  after is developed
 another,  called the vascular layer.  The first of these
 subsequently becomes  the  digestive  apparatus, the
 second  the integument or skin, and the third or mid-
 dle the vascular  system.
  At the  point where the main portion of the embryo
is being developed the outer or serous layer spoken
of forms into two folds, which arise simultaneously
on each side of the embryo to form the inner mem- 
64
GYNECOLOGY.
brane or lining of the ovum.   This membrane, as
after a while will be discovered, is known  as  the
amnion.   The folds  continue to rise  and approach
each other until they meet, and, as each fold con-
tains two layers of tissue, they form a double cover-
ing for the embryo.  The outer layer subsequently be-
comes attached to the chorion, or outer membrane of
the ovum, whilst the other forms a distinct shut sac.
This membrane—the amnion—at first is a continua-
tion of the common covering of the embryo, and em-
braces it quite closely. Afterwards it becomes dis-
tended, and is separated therefrom by a fluid, which
is eliminated from its surface, and therefrom denomi-
nated the liquor amnii.  It is also reflected upon the
funis, or umbilical cord, forming its outer covering,
which terminates at the umbilicus, or navel.  Its tex-
ture  is transparent, and, though very thin, is quite
tough, and not so easily torn as the other membranes.
  The liquor amnii, just spoken of, inclosed  within
this membrane, and in which the foetus is suspended,
not only  nurtures the embryo in its earlier stages of
formation, but protects it from the jars and concus-
sions it would be exposed to if it  rested upon the
solid tissues, during the ordinary movements of the
mother, and  which,  though performed apparently
with  the greatest ease and regard  for the  child,
would probably result in its early death.  This fluid,
though usually in quantity not more  than a pint or
a pint and a half, sometimes, but rarely, amounts to
two quarts or even more when the foetus has becomo
fully developed.
  The  inner or mucous layer, before spoken of, by
doubling up under the abdomen of the embryo, forms 
DEVELOPMENT OF THE F03TUS.         65
a little cavity, the umbilical vesicle, in which is in-
closed the remaining portion of the yolk: upon  this
the embryo subsists until it is all absorbed—the cavity
in the meantime  becoming  contracted until a small
opening only remains, which is soon closed and be-
comes entirely detached.
  The yolk having been all taken up as nutriment,
the embryo has advanced to  that stage wherein it re-
quires nourishment of a different character.  This is
supplied also from the mucous layer, by a very thin
and transparent membrane, arising from the lower or
what may be termed the caudal  extremity of the
embryo, passing up between  the amnion and chorion,
carrying with it an artery and vein, and coming in
contact with that portion of the chorion where its villi
are most numerous, to which  the vessels within attach
themselves, to form, at a later period, the placenta.
This  membrane,  in its  turn, becomes absorbed or
shrivels away, with the  exception of that portion
near its origin, which afterwards becomes the urin-
ary bladder. The former of these developments from
the mucous  layer results in  what is termed the um-
bilical  vesicle, whilst the  latter forms the  allantois,
traces of both of which may be found upon  the  um-
bilical cord at an advanced stage of gestation.
  Outside and surrounding  the whole of the ovum
is formed the chorion mentioned above.  It is a tough
fibrous membrane, similar in  construction and corres-
ponds  to that which  presents itself upon breaking
the egg-shell of the common chicken, lying immedi-
ately under it and forming its lining, as it were,  and
sometimes adhering to it.  In our species it  incloses
the ovum, and is situated between it and the walls
       5 
j66                gynecology.
of the womb;  upon a portion of it is formed, layer
upon layer, little villi, which  serve, in this  stage of
development, in the same capacity as the umbilical
vesicle and allantois, which it has succeeded for the
purpose of furnishing proper nutriment to the foetus.
These villi, as the foetus advances to maturity, are,
in part, absorbed, whilst the remainder undergo a
change, which ultimately results in the formation of
the umbilical cord and the placenta, by and through
which the foetus receives the required nourishment
from the parent during the remainder of its intra-
uterine life.  The formation of this organ—the pla-
centa—commences  about the middle or the latter
part of the second month, and continues to increase
in proportion  to the growth of the foetus  and the
consequent demands upon it until it attains its usual
circumscribed size, which is from about six to seven
inches in diameter and eighteen or twenty in circum-
ference.  It communicates with the foetus through
the umbilical cord, which arises in most cases from
its center, and is composed of two umbilical arteries
and one vein.  The whole is invested with a reflexion
from the amnion.  The average length of the cord is
about eighteen inches, though often much shorter—
someti mes so much so as seriously to interfere with the
progress of labor. Instead of arising from the center,
at times the cord is found attached to the edge of the
placenta:  in such instances it  is termed the battledore
placenta.
  Having now traced out the development  of the
means whereby the foetus must depend for its sub-
sistence and growth, we now return to the develop-
ment of the foetus itself, where we find, in the cluster 
development of the fcetus.        67
 of cells, before mentioned as the area germinativa, first
 making their appearance the spinal cord and verte-
 bral column, (chorda dorsalis.)  At the same time,
 and  now  to be seen in the  middle layer of the
 germinal membrane before spoken of, is the vascular
 laj-cr, which is formed, as it were, for the very pur-
 pose of taking up tho  nutriment supplied  by the
 yolk and conducting it to the tissues of the embryo,
 and  forming a delicate net-work of vessels.  The
 vascular area, immediately surrounding the embryo,
 then gradually extending, soon covers the whole of
 the germinal membrane.  It will now readily be per-
 ceived  that  this is the  agency through which the
 nutritious matter of the  yolk  is introduced into the
 embryo These vessels terminate in two large trunks,
 which are called amphola mesenterica, from their ex-
 tending at once to the intestines and umbilicus;  they
 are  also termed vitelline  vessels.  The fluid, or,
 what it really is, the blood of the parent, first moves
 toward the embryo before the formation of its heart.
 This latter is also formed in the vascular layer by a
 distension of the trunk, wherein the union of blood
 vessels takes place.  The heart appears, at the begin-
 ing of its formation, as a mere excavation, but after
 awhile its walls  become gradually  developed and its
 cavities fully formed.
  Synchronous, or along with the formation of the
vascular system, the digestive cavity  makes its ap-
pearance in that portion of the yolk-bag  tying im-
mediately under the embryo,  there separating and
doubling in upon itself to form a cavity, which after-
wards becomes elongated t<- form  the stomach and
intestinal canal. 
68
gynecology.
   At this period the trunk of the embryo has become
 considerably developed in length, breadth, and thick-
 ness.  At its upper extremity a small depression may
 be now seen, just beyond which, and swelling from
 it, is a small prominence.   The former of these rep-
 resents the neck, and the latter the embryotic head,
 which portions now begin to be more rapidty devel-
 oped and matured in proportion to the other parts.
 These stages of formation embrace the whole of the
 first month of intra-uterine life.
   At the beginning of the second month the  head
 has  reached a  size nearly equal to one-half of the
 body;  whilst the extremities—arms and legs— begin
 to be formed;  the former of these or upper  making
 their appearance first by a little protuberance jutting
 out from the shoulders, upon which, on close exam-
 ination, will be found a fully developed, though very
 diminutive, hand: this part being the first  portion
 of the  extremities formed,  and then,  as it  were,
 pushed out from the trunk, as the adjacent portions
 of the arm are being successively formed behind it.
 The  same succession takes place in  the formation
 of the  lower extremities.  The foot  is first formed
upon the lower portions  of the  main  trunk, and
pushed out, as it were, in  the same manner as the
hand and arms, until the  prescribed length is at-
tained.
  Next the nose, mouth, ears, and external organs
of generation are formed, and the miniature human
being soon,  by its  motions, gives  unquestionable
evidence of the life that is within it.
  The  whole, having now passed from  embiyo to
foetus, goes on  maturing, obtaining sustenance from 
DIMENSIONS OF THE FCETUS.         69
its parent through the mediums before pointed out,
until it is prepared to subsist upon almost the same
material, though presented to it in a different form
and received by it through different channels, when
it shall have been ushered into this life, which "is
made up of such stuff as dreams  are made of, and
bounded only by a sleep," where, after a brief exist-
ence, in which it was intended should be received
that manna which cometh down from heaven, to fit
it for the life that is to come.

      " The life of man has a thousand springs,
         And dies if one be gone;
       'Tis strange that a harp of a thousand strings
         Should keep in tune so long."


            Dimensions op the Fostus.

  The  ovum exists before impregnation.  It is called
embryo until  the third month, after which foetus
whilst  it remains in the womb, and child or infant
after delivery.
  About the third week it is from two to four lines
in length, and weighs about  two grains.  In color
it is of a grayish white, and of a gelatinous consist-
ency.   Its  shape is oblong,  and curved forwards.
The head appears as a small pimple, separated from
the body by a little notch.  The abdominal cavity is
open, beyond which can be seen the heart, with one
auricle and ventricle.
  Fifth week. The eyes are seen as two dark specks
in the head, which has greatly increased in size, and
the upper extremities begin to appear like two teats; 
70
GYNECOLOGY.
the lower as two  pimples.  The vertebrae can now
also be distinguished;  lungs seen as five lobules;
weight, fifteen grains; length, two-thirds of an inch.
  Seventh week.  Ossification seen in clavicle and
lower jaw; kidneys begin to appear; the intestines
extend into cord;  the anus closed; length of embryo
one inch.
  Second  month.  Organs  of  generation  appear;
eyes not covered  by lids; the head comprises one
third of the whole mass; nose, with nostrils  sepa-
rated, appears;  mouth open; forearm and hand vis-
ible ; embryo one and a half to two inches in length;
weight, six drachms.
  Tenth  week.  Eyelids cover the eyes ; walls of
chest seen, behind which the heart  disappears; fin-
gers appear, though webbed; lips developed; length
of embryo, two and a half inches; weight, about
one ounce.
  Third month. Eyeballs distinguished through the
lids; sex apparent; the nails appear; skin of a rosy
hue; length, six to seven inches; weight, three or
four ounces.
  Fourth month.  It is now fwtus;  fontanelles and
sutures large; hair appears; tongue and chin well
defined; down seen upon skin ; some motion ; quick-
ening; length, six or eight inches; weight, seven or
eight ounces.
  Fifth month. Continues maturing; weight, eight
or eleven ounces;  length, nine or ten inches.
  Sixth month. Hair longer and thicker; scrotum
small, empty, and red; nails heavier; weight, one
pound; length, eleven to twelve and a half inches.
  Seventh month.  Descent of testicle begins; eye- 
DIMENSIONS OF THE FG3TUS.         71
 lids partly open; all parts more fully developed.  It
 is now about fourteen inches in length.
   Eighth month. Weight, four or five pounds; length,
 sixteen or eighteen inches.
   Ninth  month. Full term.  Length,  eighteen  to
 twenty-two or twenty-four inches ;  average weight,
 six  to eight pounds,  though sometimes ten, twelve,
 and even fourteen or fifteen, according to  some ac-
 coucheurs.
   The secretion of bile begins at  about  the  fifth
 month, and continues.   The bladder is seldom  or
 never filled with urine at birth; consequently there
 is no passage of water for several hours afterwards
 in most cases.
   The indications of full development  are  abil-
 ity to cry; quick motion; mouth, nostrils, ears, and
 eyelids open; hair, eyebrows, and nails developed;
 body's color clear red and warm;  ability  to suck;
 and the discharge of  meconium shortly after birth.
   The indications of immaturity are feeble  mo-
 tions; small size; great redness of skin, with streaks
 of blue; down only upon the head; bones soft; nails
 not formed; eyelids, mouth, and nostrils closed; in-
 ability to  suck.
  The above are important in a medico-legal point
 of view, and for that reason principally are detailed
 here, and  should receive  careful consideration from
 the legal as well as the medical student.  Of course
 the weight and  dimensions may vary some little in
 different individuals, but the above are the average,
 culled from different authors, and may be generally
relied upon. 
72
GYNECOLOGY.
        THE PERIOD OF GESTATION.

  The whole period of gestation occupies about two
hundred and eighty days, or ten  lunar months, or
forty weeks.  There is no certainty as to the exact
period, as one may go from one to two weeks be-
yond this, whilst others may not unfrequently re-
quire even less time; but this variation can be partly
accounted for by considering the exact time between
the catamenial periods that conception takes place.
Thus, if impregnation occurs immediately after #the
menses  have ceased, the womb will have attained
such a state of dilatation and weight of contents
by the time the ninth catamenial period approaches
as to be unable  to  pass through the usual excite-
ment peculiar to it, without contracting and ex-
pelling  its  contents.  On the other hand, if the
conception has taken place immediately before the
expected menstrual period, as contended  by some it
may, the womb may pass through  the ninth and go
to the tenth period before  it gives out its contents.
But  these variations may sometimes depend  upon
the state of development  the uterus has attained,
together with the weight and size of  its contents,
and the degree of sensibility peculiar to itself or the
individual possessing it.   The surest method is to
compute from a time immediately between the men-
strual periods, which in either case will  not be far
out of the way; or a very correct computation may
be arrived at by counting from the  time of quicken-
ing, which, as has already been  shown, takes  place
in about four and a half months.  For convenience
the following table is annexed, which explains itself: 
        FC3TAL CIRCULATION.             73

Calendar for Calculating the Period of Gestation.
Nine Calendar Months.		Days.	i [ Ten Lunar M'ths.	Days. 280 280 280 280 280 280 280 280 280 280 280 280
From January.......1 February 1 May............1 June............1 July............1 August.........1 September....! October........1 November ....1 December 1	To September...30 October 31 November...30 December...31 January 31 February ...28 March........31 May..........31 June.........30 July..........31 August 31	273 273 275 275 276 273 274 273 L273 273 273 274	To October.........7 November 7 December 5 i January........5 February 4 j March...........7 April............6 May.............7 June............7 July.............7 August.........7 September 6	
   According to the above table, if a patient cease to
 menstruate July 1st, at the earliest, her confinement
 may be expected about March 31st, the end of nine
 calendar months, or. at the latest, April 6th, the end
 often lunar months; or, if she cease to menstruate
 the 15th or 20th of the same or any other month, the
 time may be found by adding the date to the figures
 opposite in the second column.

            FCETAL CIRCULATION.
   A knowledge of this process, though not essential
 to the study of midwifery, is here detailed for  gen-
 eral  instruction, and may not prove uninteresting  at
 this  point  to the miscellaneous reader,  and for the
 benefit of those who may be in quest of information
upon the subject.  It will  be better understood  by a
brief description of the circulation in  general, or  as
it  occurs in  the perfectly formed adult.   In 1619, 
74                GYNECOLOGY.
sixty-six years after  its probability  had been  in-
timated in France, Wm. Harvey demonstrated the
fact of this now well-known phenomenon.
  The female heart usually weighs about nine ounces,
and is considered, as a general circumstance, to be
about the size, in its natural state, of the closed hand
of the individual to whom it belongs.   It is cone-
shaped, though a little flattened, with its apex down-
wards, and contains four cavities, two upper and two
lower.  The former are called auricles, right and left,
according to their position on either side; the latter
ventricles, and designated according to position, as in
the former instance.
  The right  auricle  receives the venous  blood, or
that which has served to nourish the system, through
the large vessels, called the venae cavse,  or large
veins; one receiving the blood from the lower  ex-
tremity, the  other from the upper portion of  the
body—ascendens and descendens—into which all the
veins of the body converge and terminate.  The auri-
cle, through  these channels, being now filled, con-
tracts and  presses the blood into the right ventricle,
which, in  its turn, contracts and  forces the blood
through the lungs by means of the pulmonary artery.
Here the blood  parts with its carbon and receives
oxygen,  by being brought in contact with the  air
drawn into the lungs during respiration, which puri-
fies and changes its color at the same time from its
previously dark  to a bright red hue.  It is now ar-
terial—before it was venous—and is ready to be sent
out to build up, exhilarate, and nourish the body.
For this purpose it passes through the pulmonary vein
into the left auricle; thence into the  left ventricle; 
FGETAL CIRCULATION.
75
from whence it is forced out through the whole sys-
tem upon the errand just indicated.
  The cavities of the heart are estimated to hold
about two fluid ounces.  It is supposed that the ventri-
cles do not discharge the whole of their contents at
each contraction, consequently the}T would probably
not give out more than one ounce and a half.  Now,
if seventy-five contractions take place  in a minute,
there would be one hundred and twelve ounces, or
seven pounds of blood, pass through the heart in
that time.  The quantity of blood in the human body
is estimated to be about one-fifth of its weight, or
twenty-eight pounds, in a person weighing one hun-
dred and forty pounds.   This quantity would,  there-
fore, pass through the heart once in four minutes, and
would circulate about fifteen or twenty times in an
hour, and propelled with a force sufficient to sustain
a column of blood seven and a  half feet high, weigh-
ing about four pounds  six ounces.   The number of
contractions, with Avhich the pulse at the wrist con-
responds, varies in a good constitution from seventy
to seventy-five in a  minute.  They diminish in  fre-
quency  from the beginning to  the end of life.   So
that it may be truly said that  we begin to die from
the moment we enter into this  life.   Just after birth
the pulsations are about one hundred and forty to
one hundred and thirty; in the prime of life, seventy
to seventy-five; and in old age they range from sixty
to fifty, and even down to forty per minute.  They
are  more frequent in the female than the male, and
are  influenced  by temperment, emotions,  and  ex-
ertions; they are more frequent in the morning than
at night, and are accelerated by inflammations and 
76
GYNECOLOGY.
fevers.  In the decline of the vital powers they are
frequent but feeble; in nervous diseases with depres-
sion they become very slow and soft. With the above
general remarks in reference to the circulation in the
adult, we now return to the foetal circulation.
  It will be borne in mind, whilst speaking of the
placenta, it was  stated that it was  the medium
through  which, and  the cord,  the  foetus received
nourishment from the parent; therefore this  will be
the most convenient point from which to trace the
route of circulation.
  The newly terated or arterial blood of the mother
is taken up by the placenta and  collected in the um-
bilical vein, and carried through it to the umbilicus
of the child, where, passing through the abdominal
walls into the cavity,  it divides, one part going to
the liver through the vessel called the vena porta, the
other continuing  on through  the venous duct to the
ascending vena cava, where its contents mingle with
the blood from the lower extremities; and now, as-
cending still  higher, the blood that was sent to the
liver, and collected by the hepatic or  liver veins, is
received into it and carried on  to the right  auricle
of the foetal heart, where the ascending cava empties
or terminates.  Just here is where the great differ-
ence in the course of the blood  exists from that of
the adult.  In the latter, it will be  borne in mind,
the blood passed from  the auricle to the ventricle of
the right side.  In the foetus there is an opening be-
tween the two auricles, termed the foramen ovale, in
which is a valvular arrangement  called the eustachian
valve.  Through this the blood now passes into  the left
auricle, then  into the  left ventricle, from which it 
F03TAL CIRCULATION.
77
 passes through the aorta, to be distributed  to the
 foetal system at large.  That portion  of blood dis-
 tributed to the head  is collected by the descending
 vena cava, which enters with the ascending cava into
 the right auricle.  A portion only of the blood passes
 into the right ventricle.  This is carried through an
 artery, the ductus arteriosus, into the arch of the aorta,
 where, mingling with that coming from the left ven-
 tricle, they together pass on  to  the  common  iliac
 arteries, into which the aorta divides itself, and these
 again subdivide into the internal and external iliacs.
 Through the former of these, now the umbilical arter-
 ies, the blood  is returned to the placenta.  It will bo
 observed that the order of circulation in the foetus is
 the reverse of that in the adult.  In the former the
 veins carry arterial blood, and the arteries venous
 blood.  The liver of the foetus is the only organ that
 directly receives arterial blood from the placenta, in
 the distribution to  all other organs and the system
 generally:  it  is mixed arterial and venous  blood.
 J ust previous to birth,  but sometimes not until after-
 wards, the foramen ovale becomes closed; the ductus
 venosus and arteriosus shrivel  away, and the circu-
 lation is prepared to enter upon its wonted course,
 the pulmonary artery and vein having  now become
 sufficiently developed  to admit the flow of the in-
 creased current of blood through the lungs, which
 also now perform their natural functions-by the air
 being admitted  into them.   Sometimes, from some
 cause, the foramen ovale is not entirely closed, and
 the venous blood, in part,  continues to escape into
the left auricle, and soon gives rise to a fatal condi-
tion called cyanosis, or blue skin, in the infant. 
78
GYNECOLOGY.
PATHOLOGY OF  THE  FOETUS,  AND SIGNS
               OF  ITS DEATH.

  The foetus  in utero is liable to  many of the  dis-
eases that may attack the child  after birth, espe-
cially inflammation of the brain and its coverings;  the
lungs, its substance and lining membrane and covering;
the pleura; the peritoneum and mucous membrane of
the bowels; besides  other conditions—such as gen-
eral atrophy or hypertrophy, syphilis, dropsy, jaundice,
hernia, caries, ulceration of the bones; necrosis, mortifi-
cation of the bones, and rickets, softening of the bones;
or it may participate in any  acute diseases which
attack  the parent,  none of which can hardly be
discovered or treated during uterine life.
  The ireneral indications of its death are a  contin-
ued cessation of the foetal  heart, which can only be
ascertained by auscultation, (i. e., by applying the
ear or stethoscope to the abdomen,) or the cessation
of the movements of the child, previously felt by the
parent; which condition is usually  accompanied with
a sense of weight in the abdomen, a decrease in the
size of its tumor, and a rolling about of the now dead
weight as the patient turns from  side to side in the
horizontal position.   At the same time the  breasts
become soft  and flabby, after having been full and
tense;  all. of which symptoms, singly or combined,
if attended with an alteration of health,  may gener-
ally be relied upon as certain criteria of foetal death.
   The signs of death during labor are more evident
and easier detected.  The celebrated Dr.  Rigby in-
timates that the loose, flabby scalp, with a sharpness 
ABORTION AND EXPULSION.          79
  and grating together of the edges of the cranial
  bones, are certain signs of death.
   In face presentations the lips are flaccid, the tongue
  flabby, cold, and motionless.  In breech presentations
  the anus will be found relaxed, cold, and insensible.
  In presentations of the arm the limb is cold, livid, and
  flabby.  If the child  has been dead some time the
  skin will  easily peel off by slight pressure.  All or
  either of  these conditions manifesting  themselves,
  accompanied with  a  foetid liquor—amnii—during
  labor, can be relied upon as certain evidence of the
  death of the foetus.

 ABORTION AND  PREMATURE  EXPULSION
                OF  THE FCETUS.

   When from any cause the foetus is expelled from
 the womb  before it is sufficiently developed to main-
 tain a separate existence, which at least  is not until
 the seventh month of uterine life, it is called aborting
 or abortion.  If it occur after the seventh month, the
 child being considered viable, (or capable of inde-
 pendent existence,) at this period  it is  technically
 denominated premature expulsion.
  Its occurring under  either of the above  circum-
 stances may be the result of natural, accidental, or
 intentional  causes.  Enumerated among the first of
 these may be  an over sensitive  condition  of the
 uterus, peculiar  to some females, by which there is
 not a sufficient  tonicity of the organ to carry the
foetus beyond a  certain period, and they habitually
abort or miscarry at any time  between the third
and seventh  month;  but it  may occur  sometimes 
80
GYNECOLOGY.
 before the first-mentioned period, resulting from the
 frailty of the connection at that early period between
 the  ovum and decidua, before spoken  of, (see Gen-
 eration,) and may be  easily separated by any unu-
 sual mental  excitement—such  as excessive  anger,
 joy, fear, sorrow, or great depression of spirits from
 any cause.  These exciting causes cannot apply to
 those referred  to above  who  habitually  miscarry
 at the seventh month, as it may occur to them with-
 out  any apparent cause or premonition about this
 period,  except that already mentioned, as what may
 be termed a constitutional idiosyncrasy.  The acci-
 dental causes may be falls, blows, or undue exercise,
 either in walking, dancing, or jumping, or swinging
 by the arms, or great straining, as in dysentery and
 diarrhea.  The intentional causes—it is with  shame
 for our species that we chronicle the fact that there
 are  such—may result  from the introduction of in-
 struments into the mouth of the womb and ruptur-
 ing the ovum, or by  the administration of emmena-
 gogues—such as  savine,  ergot, pulegi,  aloes, and
 some of the  preparations of iron, which act  either
 directly by destroying the  life of the child  or  by
 causing an effusion of blood between  the  placenta
 and  womb, producing thereby a separation between
 them, thus arresting nutrition and respiration, from
 which death sooner or later results to the foetus, and
 consequently its  expulsion must ere long  follow.
  Abortion originating in  any of these causes, more
 especially the latter, or intentional, are  always  at-
tended with great danger to the woman, either from
the  hemorrhage that is apt to follow, or from inflam-
mation of the womb. 
TREATMENT OF ABORTION.          81
  The symptoms that present themselves, when a
woman is about to miscarry, are pains in the back
and lower part of the abdomen, accompanied with
languor, general uneasiness, and sometimes consider-
able hemorrhage, followed by severe expulsory pains,
even  more so, frequently, than those present in la-
bor at full time.
   Treatment.  Acting upon the supposition that the
child  is still alive, the  indications are to arrest, if
possible, the uterine action, that the woman may go
on to complete the pregnancy at full time.  If to ac-
complish this is evidently hopeless, it will then be
necessary to hasten the delivery, in  order  to limit
the hemorrhage to  as small an extent as possible.
The  first is met  with  rest in the horizontal  posi*
tion,  cold wet napkins to the vulva, anodyne injec-
tions, and the internal administration of opium.

      Take deodorized tincture of opium......... 1 drachm.
         camphor water............................ 1 ounce.
  Mix, and give a teaspoonful every 2 or 3 hours.

   In  case of much hemorrhage occurring,

      Take sugar of lead.............................. 15 grains.
         pulverized opium........................  1  "
  Mix, and divide into 6 pills; one to be given every 4 hours.

   If the above fail to arrest the bleeding, ice and the
tampon, or plug, may be inserted into the vagina, and
allowed to remain sometime, the patient still lying
down, when, after a while, in eight or a less number
of hours, it may be  withdrawn, when the ovum will
probably be found adherent to it with the coagulum,
After the contents are expelled, the womb, by its own
        6 
82
GYNECOLOGY.
contractions, will usually arrest the  flow of blood.
To those who habitually abort, it is  advised, when
conception has occurred, to scrupulously avoid all ex-
citement, either of mind or body, and by all means
abstain from over-indulgence of appetite in food or
stimulants, riding either in cars or in carriages, and
from purgative medicines.  It is well  to secure good
rest at night, by taking a few drops (ten or fifteen)
of laudanum at bedtime, or by an injection of a small
teaspoonful of the same in about four ounces of thin
starch-water; or what  will probably act better in
the same quantities is the solution of the bimeconite
of morphia.   The above directions, if strictly  com-
plied with, will generally prove efficient as prevent-
ives.
  It is useless for us to attempt any  evasion of the
fact of the frequency of premeditated abortions oc-
curring in some parts of this country among other-
wise honorable, high-minded, and respectable  mar-
ried people, such, perhaps, in some instances, as would
not knowingly take the  life of the most insignificant
insect that crawls beneath their feet, yet who, in this
respect,  seemingly, have no  conscientious scruples
whatever, neither in regard to  the enormity of the
crime, nor the least consideration of the dire effects
that may result to themselves physically therefrom.
Consequently, we have added to the other classifica-
tions what we term intentional causes  of abortion.
It is vain, however, to merely speak of this abomin-
able custom—for such it really seems to  have grown
to be—without offering  a remedy for  its total aboli-
tion.  Unfortunately, in  these cases, we have  none
to propose that may prove successful, save only that 
CRIMINALITY OF ABORTION.          83
 which may result from the reassurance of the truth,
 as stated above, in regard to its criminality and en-
 ervating effects upon the individual.  After a knowl-
 edge of  which, if persevered in, it is only a question
 of sin, pain, long suffering, and not unfrequently pre-
 mature death, to mother as well as foetus. In either
 case, then,  it is murder,  "foul and most unnatural
 murder;" for, as has already been shown, (see Gen-
 eration,) from the very moment in which fecundation
 takes place the ovum is a living human being, depend-
 ing upon its parent for subsistence  necessary to its
 growth and development, as much  so as at a more
 advanced stage of uterine life,  or when, after being
 born, its draws nutriment from its mother's breast.
 We have never seen or known of a case yet, no mat-
 ter how  much the party apparently detested having
 children, where any sane woman—save in very rare
 instances, among the most  abandoned, and even
 then we  doubt very much  their sanity—where a wo-
 man would consent to the killing of her infant;  on
 the contrary,  we think such  an idea  would be con-
 templated with horror and abhorrence of themselves,
 or any who would have the temerity to advance such
 a proposition.   By submitting to an abortion, at the
 very least calculation the chances are, if not fatal to
 the mother, that  the organs concerned will become
 so affected as to visit upon the party, as has already
 been  intimated, such  pain and suffering, compared
 with which the bearing, nursing, and raising of chil-
 dren were indeed an elysium.
  Let our women but ponder upon these facts, and
the reprehensible practice must needs be speedily
abandoned, or confined only to the  reckless, heart- 
84
GYNECOLOGY.
less, and  criminal.  There is  no  doubt that many
who submit to this practice do so innocently, believ-
ing it no  violation of  moral or physical laws at the
beginning of gestation.   Certainly, after what has
been above shown to be  the  facts in the premises,
any of this class who read their condemnation in
these pages must be saved from further criminality;
for if it was not before, now that they know the truth,
to them it is a sin, in open and direct violation of the
law divine that was  thundered  from  Sinai amidst
fire and  smoke, which says "Thou shalt not kill."
The operations of the other classes may be entirely
prevented or considerably abridged by the proper
officers of the civil law in our cities and towns fre-
quently visiting  and inquiring into the nature of
those establishments where the public are informed,
through the medium of some newspapers, that this
diabolical practice is unblushingly carried on.

FERTILITY AND  STERILITY, OR BARREN-
                    NESS.

   Marriage is a divine institution, and was ordained
by the Great Jehovah himself, recognized and pat-
ronized by the Son of Man in  his  day, and commend-
ed by the great Apostle of the Gentiles, who said unto
the Corinthians, "Let every man  have his own wife,
and let every woman have her own husband.  Let
the husband render unto the  wife due  benevolence:
and likewise also the wife unto the husband."  "And
unto the  married I command, yet not I, but the Lord,
Let not  the wife depart  from her husband."  And
thus to the Hebrews: "Marriage  is honorable in all, 
FERTILITY AND STERILITY.         85
 and the bed undefined; but whoremongers and adul-
 terers God will judge."
   It was originally instituted as a legitimate means
 of perpetuating the race of man;  wherefore it should
 not be entered into without due deliberation and ma-
 ture consideration of all the circumstances which may
 render it a blessing or a curse to the parties engaging
 in it.  To view it as a mere civil contract, to be vio-
 lated by either party with impunity upon the merest
 pretext, as it seems has grown to be the custom in
 our day, is one of the greatest evils of the times, and
 to this fact may be traced the evident  degeneracy
 and demoralization of so many of our young men
 and women.  But to follow out this train of thought
 wQuld carry us into a wondrous metaphysical maze,
 far beyond the confines of the object in view, as con-
 templated in the beginning of this  article; conse-
 quently we must rein  in our pegasus, and tread in
 the physical and sublunary ruts of the subject before
 us.
   It has already been shown, under the head of Gen-
 eration, that actual contact of ovum and spermatozoa
 are essential in order to a reproduction of the human
 species, and that  man, proud man, the paragon of
 animals, begins life a mere spec; a small vesicle filled
 with fluid; a simple cell; a monad.  The part  per-
 formed by male and female, looking to this union, is
 too well known to require details, though the ultimate
 mode of transmutation or assimilation of the elements
 of the to-be offspring is not so easily understood.  But
one fact is apparent: so important is the occasion in
which the ejaculation of the semen takes place, that,
as Borden says, "it seems at this moment as if nature 
86
GYNECOLOGY.
had forgotten every other function, and is occupied
only in collecting its strength and  directing it to
the same organs," i. e.. those engaged in forming the
new being.  It is held  by some that upon the spirit
which  animates the  contestants upon such an occa-
sion, and the  position they  assume, depends  the
power, to a great extent, of producing an offspring,
as well as to determine its sex, model its form, and
mold its features.  Consequently each of these, ex-
cept the latter, which arc deemed irrational, in turn
will receive due consideration at a subsequent period
of what may be remarked upon this subject.
  Probably no theme could be of more  interest to
females than the present; for, next to self-abuse and
excessive indulgence in connubial privileges, there is
nothing so fatal  to  health and longevity as child-
bearing at brief intervals.  Besides the shock to  the
system generally resulting from frequent labors, the
wear and tear of body from nursing, the  anxiety of
mind, sleeplessness, and the loss of appetite occasion-
ed thereby, all combined, soon change the well and
full-developed healthy wife into a weak, nervous, de-
bilitated, helpless mother. These facts indicate such
a course to be as contrary and as much an abuse of
nature  as those before alluded to.
  Therefore, to those who may have experienced  the
debilitating effects dependent upon  the  cause last
mentioned, and who believe themselves incapable of
restraining their desires within reasonable bounds, a
few Avords of advice are offered, which, if heeded,
will be attended,  in  most instances,  with the most
favorable and desirable consequences, and neither
compromise their conscience nor prevent a judicious 
FERTILITY AND STERILITY.          87
indulgence in connubial intercourse.  The most fa-
vorable position during coition for conception is that
most natural, or of the female being most prone.  It
necessarily follows, then, that the reverse of this, or
that of the male being inferior, is one step unfavora-
ble to such an end.
   These facts borne in mind, with another, now gen-
erally  recognized  to  be such among physiologists,
that a female is more liable to become impregnated
within a period of ten or twelve days just subsequent
to the menstrual  flow,  the probabilities are,  other
things being equal, that the desire to  conceive  or
not to  conceive can be regulated at will, and connu-
bial commerce indulged with or without having in
view fruitful results of  the coitus.  When fecunda-
tion does take place after the above-mentioned num-
ber  of days, and  previous to  the next menstrual
period, as contended that it does in some instances
by Hibbard, it is supposed that it is from the sperm-
atozoa having found its  way into the uterine cavity,
where  it lies dormant in some of the fissures of the
excavation until discovered by the next ovum dis-
charged. t It is upon this hypothesis that the varia-
tions in the period of gestation is also accounted for,
and, according to the same  authority (Hibbard) that
the difference of sex depends: he maintaining  that,
conception occurring  just before the menstrual pe-
riod, the offspring  would be a male; if afterwards, a
female child.  Others  contend that such is not the
case, and that the sex of child depends upon the posi-
tion assumed by the female during the veneral con-
gress, i. c, whether she lies upon the right or left side.
These argue that the right  ovary produces male and 
88
GYNECOLOGY.
the left female children.  The fact that twins of both
sexes frequently result from ova of the same sido
seems  to be fatal to this theory, and Hibbard, it is
believed, stands alone  and  unsupported in his own.
These  facts, as  well as the failure of so many acting
upon such advice to have their expectations realized,
are enough to consign them to oblivion.  However,
to those who wish to experiment in  such matters we
would  offer no  barrier, but let all try for themselves.
Undoubtedly each  has been successful in  some in-
stances at least, or else it  is thought they would
not have such ardent supporters. The Chevalier V.
Mondat, who made the study of this subject and ster-
ility a specialty, believes the sex depends upon the
force with which the dancean* shower is thrown upon
the orifice of the womb, and the vigor with which it
is received and drawn in by the suctional action he
attributes to that organ.  Quetelet  and M. Hofoeker
believe that where  the difference of age in either
parent amounts to eight, ten, or more years, the sex
of child will be governed thereby, i. e., male, if the
preponderance  of age is on the father's side; female,
if it is  on the side of the mother.  There may be and
are exceptions to this;  but in general it will be found
the more correct theory.
  The next  branch  of our subject will require a par-
tial review of what has already been said  above in
relation to the period at which the female is most
liable to become impregnated.   Of course this liabil-
ity presumes the female to be regular, by which term
is already understood  the monthly flow occurring
  * From Danes, the daughter of KiDg .fficrisiue of Argos, seduced by Ju-
piter in the form of a golden shower. 
FERTILITY AND STERILITY.
89
in females, resulting from the discharge of an ovum
into the cavity of the womb; for it is very generally
conceded that a woman who docs not menstruate
will not conceive, and  a  cessation  of the monthly
discharge in one who has been regular is received as
one of the first indications that conception has taken
place, other things being equal.  Menstruation in the
human female is no doubt analogous to that condition
which takes place in some of the lower animals, com-
monly known as heat in the cat and dog.  This  phe-
nomenon occurs only two or three times annually in
rabbits, but in the  domestic fowl more frequently;
whilst in the cow, horse, deer, elephant, and some birds
it appears but once a year.  From the fact that these
animals more readily conceive at these periods, we
may reasonably infer that the human female is more
apt to  become  impregnated within about ten days
just subsequent to the menstrual discharge.  This
fact seemingly harmonizes  with  the provision of
nature which makes the female more amorous dur-
ing this interval, and more desirous of entertaining
the opposite  sex in actual veneral intercourse. It
is not absolutely necessary, however, for the woman
to partake of pleasure to be productive; as is evinced
b}T some females having children who never experi-
ence the least excitement during coition, and  who
receive the  embraces  of  their husbands  in an en-
tirely passive manner.  This condition or coldness
may be the  result  of a natural indifference on  the
part of the female, or the  destruction of sexual ap-
petite from  excessive clitorism, an abuse of them-
selves to which some of the sex are unfortunately
addicted.  There are many instances where contin- 
90
GYNECOLOGY.
ual sexual intercourse for years has not resulted in
fecundity in  females  every way competent to con-
ceive, who, having acted upon the intimation above
given by advice  of their plrysician, were fully re-
warded with abundant-fruition for their pains.  One
case is  worthy of note, no less on account of  the
prominence  of the individuals concerned, than  as
illustrating  the sapiency of the physician advising
it at a period so remote from the present time.  Fer-
rel  informs us that Henry II and  Queen  Catherine
of France, acting upon  his advice in this particular,
were rewarded with  an heir after eleven years' bar-
renness on her part.
  Continued indulgence in clitorism, before alluded
to,  besides destroying sexual desire, also vitiates the
whole pystcm, and thereby affects the  ovaries,  so
that the ovum discharged is void of any fructifying
power.  A similar condition may result in man from
excessive masturbation, though in his case, besides
destroying the awakening power  of the spermato-
zoa, it renders him impotent from inability to pro-
duce an erection of the  hitherto virile member.
  The clitoris, it  will  be bGrne in mind, was spoken
of in the anatomical  portion of this work as being
analogous to the male  penis.  This organ may be
congenitally, or from continued excitement, so en-
larged as to  interfere  seriously with copulation, and
thereby become a cause of sterility.  A case has been
related  by Mondat and others of a Roman  soldier,
whose caresses could awaken  no  excitement in his
mistress, and who was consequently barren.  On one
occasion he came  upon her suddenly whilst engaged
in this self-gratification, and, being enraged at the 
FERTILITY AND STERILITY.
91
 sight, drew his sword and amputated without cere-
 mony what he discovered afterwards had been the
 destroyer of  his former pleasure and happiness, as
 well as having been  the  cause  of her barrenness;
 for the operation was productive of all he desired in
 both of these respects.
   Hypospadias and Epispadias. — These may  be
 causes of sterility in the male.  It is an abnormal
 condition of  the penis, in  which the urethra opens
 upon the member somewhat back of the corona, un-
 derneath in the first, and on the upper portion in the
 second instance, instead of, as usual, at the apex of
 the glans, and, as a matter of course, whilst  the ve-
 neral congress might  be enjoyed, the semen would
 be discharged in the lower part of or even exterior
 to the vagina: in either of which instances the sper-
 matozoa could not find its way into the womb.
   Enlarged  Nymph^e.—These members sometimes
 may be so  much enlarged as  to prevent the  accom-
 plishment of sexual intercourse.
   Imperforate hymen, spoken of in amenorrhcea,
 as an impediment  to  the  menstrual discharge, is
 also a cause of barrenness.
   Spasm of the Yagina.—This is an extremely sen-
 sitive condition of the vagina, in which it becomes
 violently and compactly contracted, from the mere
 touch of the penis or any other instrument, so as to
 preclude its entrance therein.  Whilst sifeh a condi-
 tion lasts, it is obviously a cause of sterility.
  Vaginal Fistula.—The vagina may terminate in
the rectum or bladder, in which case all  attempts
at fecundity must necessarily prove abortive, from
the semen finding its way into one or  both of these
/ 
92
GYNECOLOGY.
channels instead of the womb.  Mondat mentions a
case of this kind which came under his care.  Upon
examination with the speculum he found the womb
perfect, with the exception that its orifice was in the
direction of the axis of the  rectum.  The woman,
though  married several years, had been barren, and,
by  his  advice, sexual intercourse  was  attempted
through this organ,  (the rectum.)  The result was
she became pregnant, and at full time was delivered
of a child; not, however, without requiring, as he re-
marks, the dividing of the sphincter ani muscle.
  Anteversion, Retroversion, and Anteflexion
of the womb—conditions which have  already been
considered in another part of this work—as well as
Amenorrhcea, Menorrhagia, Dysmenorrhea, Leu-
corrhcea, and Prolapsus Uteri, all of which have
been duly mentioned under their proper heads, may
be causes of sterility.
  Treatment.—For the purpose first considered the
object is and has been to  make known the laws of
nature in this regard, in order to present, as far as
may be, a perfectly legitimate means of husbanding
the strength of the parents, and prevent  the mother
especially, who has to bear the heat and brunt of the
burden, from experiencing the consequences before
indicated, which must inevitably ensue from a con-
tinued succession of labors without a prudent  inter-
val of repose.  This we  believe we  have done in a
manner to satisfy the conscientious scruples of the
most sensitive and fastidious in relation to such mat-
ters.  For this purpose we could not and would not
advise the use of various appliances called prevent-
ives, used in sexual intercourse by many, but have 
FERTILITY AND STERILITY.           93
 chosen rather to point out the method provided by
 Nature herself; for in this, as in all other instances,
 if her laws be carefully observed, it will be found that
 she offers a safeguard against abnormal abuse, or, it
 may bo said, attempts at evasion of the same.
   The treatment  of sterility in either sex may be
 considered under three heads, viz: Moral, Medical,
 and Surgical.
   The cases  requiring moral  treatment are those
 originating in self-abuse, causing general debility,
 and an entire prostration of the virile organs and a
 vitiation  of the ovum  and seminal fluid.   The first
 step in this direction, then, is to cease the abomin-
 able practice, and endeavor to keep the mind en-
 gaged and interested in moral pursuits, seek cheerful
 society, shun  bad company, and especially immoral
 books.  Probably to the perusal of this kind of lit-
 erature more than any other cause  many young men
 and maidens owe the forfeiture of their health, inno-
 cence, and happiness, by having their sexual appe-
 tites excited to an uncontrollable degree.  Dante, in
 his imaginary journey through perdition, so appro-
 priately and delicately describes an instance of this
 kind in the fallen Francesca,  who, with her lover,
 Paola, were put to death for  adultery, that we can-
 not refrain from quoting  it here:  Upon his ques-
 tioning her as to the cause of her sin, she is made to
say:
                     "One day,
     For our delight, we read of Lancelot;
     How  him love thrall'd.  Alone we were, and no
     Suspicion near us.   Oftimes by that reading
     Our eyes were drawn together, and the hue
     Fled from our altered cheek.  But at one point 
94
GYNECOLOGY.
     Alone we fell.   *      *     *      *
     The booh and writer both
     Were Guilt's purveyors.  In its leaves that day
     We read no more."
  Young man  or  young woman, you thus behold
how you risk your innocency in perusing corrupt
books, or, what may be considered  equally as bad,
keeping evil company.   For remember that
       "Vice is a monster of so frightful mien,
        As to be hated needs but to be seen;
        Yet seen too oft, familiar with her face,
        We first endure, then pity, then embrace."
  The medical treatment of sterility, when dependent
upon amenorrhcea, menorrhagia, dismenorrhcea, leucor-
rhcea, anteversion, retroversion,  and prolapsus uteri, has
been pointed out under tho respective heads of these
subjects in another part of this  work
  When  there is  a loss of vitality  in the genitals,
dependent  upon general debility, in addition to the
moral regimen recommended above, baths, sufficient
and regular out-door exercise, with a course of ton-
ics,  with iron, and nutritious diet, will, in most  in-
stances, if persevered  in, result  in a perfect cure to
either sex.
  The following may be given to restore tone to the
genitals and the system generally:
     Take Vallet's (ferruginous mass) iron.........24 grains.
          extract of gentian..........................12   "
          extract of pulegi, (pennyroyal)......... 6   "
          extract of dulcamara, (bittersweet).... 4   "
          extract of lactuca, (lettuce).............. 6   "
          pulverized cantharides.................... 1   "
  Mix, and divide into 12 pills.  Take one 3 times a day, an
hour before meals; to be followed in about an hour after meals 
FERTILITY AND STERILITY.          95
with diluted phosphorous acid—about 20 drops in a wineglassful
of water.  It should be well stirred, and sucked through a glass
tube.
  Or,
of each 2 oz.
     Take muriated tincture of iron................ J ounce.
         fluid extract of ginseng............
         fluid extract of taraxicum.........
         fluid extract of sarsaparilla.......
         fennel water..........................
         pulverized chlorate of potassa......... 2 scruples.
  Mix.  Shake well.  Dose, a dessertspoonful 3 times a day af-
ter meals.
  The following  proportion of phosphorous, as pre-
scribed by Mondat,  may be used  in  some  cases  no
doubt with  happy results, though  the dose is much
larger than  is generally used in  this  country:
      Take essence of rosemary...................  1 ounce.
           phosphorous............................. 12 grains.
  Mix, and  hold over lamp until the phosphorous is  dissolved,
and whilst warm add 1 ounce of oil of sweet almonds.  Take
teaspoonful 3 or 4 times a day.
  He also considers benzoin, ginseng, boron, and amber-
gris potent remedies under such  circumstances.  As
antaphrodisiacs, or medicines to subdue and control
the animal desires, bromide of potassium,  camphor,
and peppermint may bo used.  Oysters and aspara-
gus will be found excellent aphrodisiac dietetics.
  Spasm of the vagina may be treated with injections
of tepid water, after which belladonna ointment is
to be applied for several days.  A fly-blister to the
perineum,  and the internal administration of tinc-
ture of cantharides two drachms, with six drachms of
muriated tincture of iron, of which twenty to thirty
drops may be given in water three or four times a day. 
96
GYNECOLOGY.
  The conditions requiring surgical treatment are
hypospadias, epispadias, phimosis, and paraphimosis
in the male;  enlarged nympha? and clitoris, imper-
forate hymen, and vaginal fistulas in the female.
  The manner of performing  these operations can
bo found fully described in any respectable work on
surgery, to which the reader is referred who may
desire to become further enlightened upon the sub-
ject; in taking leave of which we would say to the
reader, in the language of Cawthorn,

        "Pleasure, my friend, on this side folly lies;
         It may be vig'rous, but it must be wise;
         And when our organs once that end attain,
         Each step beyond it is a step to pain."

   PREGNANCY:  ITS  PHENOMENA  AND
                 TREATMENT.

   Fecundation having taken place in the female, the
first thing that leads her to  suspect the situation is
the non-appearenceof the menstrual discharge when
the time for it shall have arrived; but if impregna-
tion has taken place immediately after the menstrual
period, other  indications may present themselves in
the intervening space of time, such as slight nervous-
ness in some, with an irritable or unusually sensitive
condition of the stomach, or an uncomfortable feel-
ing of fullness in the abdomen, morning sickness, i. e.,
nausea and vomiting upon rising to enter upon the
duties of the day, all of which prepare her to expect,
when the usual time has arrived for the discharge,
that it may not occur; when, according to the circum-
stances of the case, she is full of rejoicings at the pros- 
PHENOMENA OF PREGNANCY.         97
pect before her, or sad and depressed at the unhappy
change her indulgence has wrought.  That this last
condition should obtain, alas, is too often the case of
late, and we chronicle the fact with sorrow and regret:
sorrow, that the holy alliance of matrimony should
be entered into for any other purpose than  that for
which it was ordained, the perpetuation of our race,
and regret  that  its offices  should be so  often per-
verted to mere sensual indulgence; for it is to this
mostly that may be attributed the many separa-
tions  that take place between husband  and wife,
which our courts are invoked  by their decrees  to
confirm.   The  slave  to  passion,  the worshiper  at
the shrine of pleasure,, soon becomes surfeited with
lust, and "the appetite may  sicken, and  so die,"
whilst the unsuspecting dame or unwary swain too
late realize that their cup of bliss, but now "full to
the brim, without running over full," has been sud-
denly drained to the  dregs, and either of the twain
is now left to drag  out a miserable existence  in
tribulation and distress, whilst it may be that their
Venus or Adonis, in seeking other sources to make
new conquests, are unceasing and unweary, forget-
ting the  while that—
    " Like leaves on trees the race of man is found,
      Now green in youth, now withering on the ground,
      Each year a new generation supplies,
      They fall successive, and successive rise"—
and that, as surely as their physical powers will visit
upon  them the consequences of the violation of the
natural laws, so will  the Creafor of all  hold them
responsible  for their  temerity  in  usurping  the law
divine.
       7 
98                GYNECOLOGY.
   But to return to the changes  remarked previous
 to this digression.  They continue more  or less ag-
 gravated, according to temperament and idiosyncra-
 sies  of the individual,  for sometime, until other
 manifestations of a physical character begin to pre-
 sent themselves.  There is  considerable nausea and
 vomiting, especially upon rising,  from which circum-
 stance it is termed morning sickness.  The  breasts
 now become enlarged and  tender, the nipples more
 prominent, and beginning to be surrounded by a dark
 circle. The abdomen is now more  flattened, caused by
 the womb sinking lower in the pelvis from its increas-
 ed size and weight, the mouth  of which may be felt
 within a short distance from the external labia of the
 vagina, where it will be found soft, round, and regular
 in those who have not borne children, (primipare,)
 whilst in those that have (multipare) it is somewhat
 irregular in its circumference, and more or less open.
 The above symptoms and signs, having set in during
 the first month, extend  into the third and fourth,
 with other more manifest accessions. A condition
 called ptyalism, or an  increased flow of saliva, may
 take  place  about this time in some, and continue
 during the whole period of pregnancy; also anorexia,
 (loss of appetite,) whilst a substance called kiesteine
 will likely be found voided with  the urine.  If the
 latter  is allowed to stand sometime, it will be  found
 floating upon its surface in globules, like the fat upon
 soup after it is allowed to cool, and exhaling an odor
 similar to that  of .cheese.   Kiesteine may at  other
 times be found in the urine, but  it  is estimated to be
present about ninety-five times in a hundred in preg-
nancy, and is considered by some,  in the absence of 
PHENOMENA OF PREGNANCY.         99
any other signs, as a sure evidence of that condition
existing.  Hence its name, from Greek, kuein, "to be
pregnant," and esthes, "a garment or pellicle."
  If the mouth of the womb is now  examined, it
will be found somewhat elevated, more soft and pli-
able than before, thougb still closed in primipare and
open in multipare.  The fundus, now enlarged, begins
to manifest itself outwardly, by a small tumor pre-
senting itself upon the abdomen just above the mons
veneris, a circumstance which produces a correspond-
ing depression about the navel.  It is about the latter
part of this period, or the middle of the fifth month,
that the foetus gives sure evidence of vitality by its
movements, before spoken of, and known as "quick-
ening."  About this time the nausea and vomiting usu-
ally cease, though either may continue to  a greater
or lesser extent through the  whole course of gesta-
tion in some, and not occur at all in others.
  During the remainder of the fifth and  sixth months
the abdominal  tumor becomes increased, the move-
ments  of the foetus  more active, the circle  around
the nipples darker and more  enlarged; the  os con-
tinues  closed in primipare, but in multipare open wide
enough to admit the extremity of the  inde^ finger.
  If desirable,  or should any doubt  exist as to the
true condition, the process  called ballottement may
at this time be successfully practiced.  It is per-
formed by placing the patient in the erect position,
and, by putting one hand upon the  abdomen, over
the fundus of the womb, to steady it, then with the
index finger of the other introduced into the vagina
and continued gently upwards until the neck of the
uterus has been reached, then, by a sudden gentle 
100
GYNECOLOGY.
jerking of the finger upwards, a sensation of some-
thing rising and presently settling down again will
be felt.   It is the foetus, which, from  the impulse
given, rises in the liquor amnii, and after a moment
falls to its former position.   This can only be done
successfully about this period of pregnancy, as  the
foetus soon  afterwards becomes too much  enlarged
to admit of the up-and-down motion.  In the sev-
enth and eighth month the  maternal abdomen  be-
comes much  increased in size, the navel pouting,
the areola  or dark circle around the nipples, now
very  prominent,  is more  discolored,  and  milk in
some  cases  so abundant as to dripple or even to spurt
from the  mamma, or breasts,  to such an extent as to
require the constant use of nipple-glasses to protect
the clothing.   By this time the fundus of the womb
is at least two or three inches above the umbilicus,
and by the end of the eighth month has risen to the
epigastrum,  or region of the  stomach.  In primipare
the os uteri is still closed, but the neck is somewhat
shortened, and of an ovoid shape.  In multipare the
outer orifice of the womb may be sufficiently dilated
to admit  half of the index finger, whilst the inner os
remains closed.
  About  the  first two weeks of the ninth month the
vomiting may reappear, caused by the fundus press-
ing up against the diaphragm  and stomach.  The
abdomen has now reached the climax of its enlarge-
ment, which is attended with considerable difficulty of
breathing, from the fundus interfering with the  bel-
lows-like movements of the  diaphragm or  muscular
partition separating the abdominal  from the thoracic
cavity. 
PHENOMENA OF PREGNANCY.        101
   The pulsations of the foetal heart,  which were
 first manifest in the seventh month, now keep up a
 continual throbbing, and can  be  sensibly felt by
 placing the hand upon the abdomen, as can also the
 general movements of the foetus.  The os in primip-
 are is now slightly open, but not to the extent it is
 at this time in multipare.  In the next  half of this,
 the last month, the womb begins to lower itself in
 the cavity, when the breathing becomes freer and
 vomiting ceases, but may be replaced by a constant
 desire to  go to stool, either for the purpose of evac-
 uating the bladder or bowels.   There is  now some
 difficulty  in walking, owing to the womb sinking low
 down into the excavation of the pelvis, where, in mul-
 tipare, as  a general circumstance, the os is found so
 much dilated as to admit of the membranes envelop-
 ing the foetus being felt by examination per vaginum.
   The foregoing is an enumeration of what are call-
 ed the rational and sensible  signs of pregnancy; of
 course, they are more or less aggravated in  some
 and  extenuated in others, causing complications, as
 before mentioned, according to constitution, tem-
 perament, and general peculiarities of the patient.
 Some will  pass the whole period of gestation with-
 out any untoward symptoms presenting themselves,
 whilst others will suffer with headache more or less,
 asthma, palpitation of the heart, backache, consti-
 pation of  the bowels, or  diarrhea, constant pain or
 a tingling in either of the lower extremities,  with
 tumefaction or swelling of the same, extending down
 into  the ankles and toes.  Besides these, there is fre-
 quently a  change in the color of the skin,  it assum-
ing a sallow, jaundiced hue, accompanied with an 
102
GYNECOLOGY.
eruption and  an intense  itching.  Also, a general
fullness of the whole body, especially about the face,
neck, and shoulders;  an alteration of or perverted
appetite and taste, with what are called "longings."
If the patient is not gratified in these, she is apt to
become fretful or peevish, or so depressed in mind
as to give vent to her feelings in frequent outbursts
of crying, which are  soon followed by an unusual
buoyancy and elasticity of  spirits, which in turn
may be early succeeded by  a state similar to the
previous dejection.
  It would occupy too much time and space even to
attempt, in a work like this, to notice all the peculi-
arities indigenous to the period of pregnancy; con-
sequently the  above may be considered a mere out-
line  of  the  most prominent physical and  mental
manifestations; as in this respect it may be further
said, that every woman is a law unto herself; and
to treat her properly it is  as  necessary to study her
closely, in order to appreciate and relieve her men-
tal anomalousness, as it is to understand and palliate
her physical sufferings.
  In the former, generally, the opportunity, power,
and duty rest with those who immediately and con-
tinuously surround her, by charity, which is kind-
ness, long suffering, and sympathy, with condolence
in grief, whether real or imaginary; by cheerfulness
in her periods of exhilaration and vivacity, as well as
those of depression and despondency.  Whilst any
physical derangement, not violent or threatening,
may be. relieved by the  ordinary domestic remedies
common to  all households, great  caution must be
exercised in administering purgatives of any kind, 
TREATMENT OF PREGNANCY.        103
as by these abortion has been innocently and unin-
tentionally produced, when worlds, were it possible,
would have been given could it  have been to the
contrary.
  The constipation usually attending pregnancy may
be relieved by from a tea to a tablespoonful of castor
oil, best taken upon an empty stomach, and repeated
if it does not act in six or seven hours.  This is the
gentlest and at the same time the safest aperient that
can be used at this or perhaps any other time, when
the physical  condition of the  patient is over-sensi-
tive or weak and enervated.  The tendency to griping
it possesses may be neutralized by adding from four
to six drops of laudanum.  A most excellent vehicle
in which  to  take  it is  simple sirup,  flavored with
vinegar, orange, or lemon-juice, or combined  with
an  equal  part of the aromatic  sirup of rhubarb.
If thus prepared and given, the presence of the oil
will  hardly be  detected by the most fastidious or
prejudiced in relation to this drug, if  they have not
been previously informed of its presence.
  If  diarrhea or looseness of the bowels  occurs, it
may be checked by a teaspoonful of paregoric or ten
or  fifteen drops of laudanum, two or three times
per day, in a tablespoonful of chalk-mixture or lime-
water.
  For the inward burning, mostly present after eat-
ing, a little vinegar and table sirup, mixed to the
taste, or half a wineglassful of lime-water, will give
speedy relief.
   Since writing the above we have had occasion to
use  some of the salts of sulphurous acid and the
crystallized carbolic acid itself, alone or in combina- 
104               GYNECOLOGY.
 tion  with the former,  with the happiest  results,
 either for the burning just  alluded to or to check
 the vomiting in pregnane}7.  We will not now stop
 to consider their modus operandi, but suffice it to say
 that  they will be  found far more expeditious and
 certain for the  above purpose  than the  oxalate of
 cerium or anything that we are acquainted with
 generally recommended in such cases.
   The following formula is proposed:  .
 Take sulphite of soda.......................................  12 grains.
     carbolic acid..........................................   4   "
     sirup of orange, (or any aromatic sirup)... \   *   , ,
     fennel water........................................J
  Mix. Dose:  A teaspoonful once in 4 or 5 hours, or more fre-
 quently, if necessary^.  To be well shaken before taken.
  For the nervousness and  palpitation,  a mixture
 composed of bromide of potassa two drachms, to two
 ounces of simple  sirup and two of orange-flower
 water, taken in doses of a dessertspoonful every four
 hours, is a most excellent remedy.  To avoid these
 palpitations,  to some extent, the diet should be light,
 and consist mainly  of easily-digested food.
  The extreme flatulency or colic sometimes present
 may be relieved by one and a half teaspoonful of spir-
 its of camphor with six drops of laudanum in a wine-
 glassful of water.   This dose may be repeated, if ne-
 cessary, at intervals of four or five hours.   The mix-
 ture of soda and carbolic acid, given above, will pre-
 vent this flatulency to a great extent by  the power
it exercises in arresting fermentation of any kind.
  A species of psoriasis, or eruption  of the skin, ac-
companied with an intense itching, before mentioned,
occurs mostly about the last months of gestation. 
SIMULATED PREGNANCY.         105
This may be relieved by sponging the parts in a
tolerably strong  solution  of common washing soda.
Other complications may arise sometimes, more or
less aggravated, and will require  proper scientific
aid, and are to be treated according to indications
that may present themselves, which will hereafter
be referred to.

             Simulated  Pregnancy.
  This is a peculiar anomalous nervous affection of
females, termed  by  the  French physicians nervous
pregnancy, under the influence of which the catame-
nia ceases, the  abdomen and breasts become en-
larged, attended by morning sickness,  and all other
usual accompaniments of pregnancy  that present
themselves to the  superficial observer supervene,
and  continue until  the  whole period  of gestation
has come and gone, without the expected offspring
making its appearance, which fact will have a tend-
ancy to open up to  the understanding the true na-
ture of the case, when all other efforts may have
been unsuccessful.
  It is  not rare that the symptoms  as above de-
scribed, backed  up  as  they  sometimes are by the
assurance of the patient that she is  certainly en-
ciente, mislead the most  experienced  obstetrician.
Indeed, some of these cases require minute investiga-
tion and study, and even  then they may be mystify-
ing and extremely difficult of diagnosis.   Under these
circumstances the patient herself may reach  such a
high state of nervous excitement upon the subject
as to strongly maintain  that she  is  enciente, not-
withstanding all attempts that may be made to 
106
GYNECOLOGY.
convince her such is not really the case.   Such an
example is given by Froude in the well-known in-
stance of Queen Mary, as related by him.
  This class of patients was long ago described by
Aristotle as those who, being embarrassed whilst eat-
ing in company, swallow wind.  We may not give his
language exactly, but this is the idea.  Flatus in
the intestines is always abundantly present  in the
old, nervous, weak, and debilitated.   It  is most fre-
quently the result of indigestion, and is supposed by
some to be excreted from the mucous membrane of
the bowels, inducing that well-known condition sci-
entifically termed borborygmus, from Greek borboruzd,
"I make a dull noise," recognized by a continual rat-
tling of the bowels, caused by flatus shooting from
one part of the intestines to another.  Persons are
sometimes  affected in this way to such an extent as
to prevent their mingling in society.  We call to
mind the case of a lady some two j^ears ago who
declared she wasenciente;  upon being assured that
all the circumstances did not justify such a conclu-
sion, she said, "Surely,  then, something must have
got in me, as I can feel it continually throbbing and
moving about."  The affection may extend to other
organs, and is, no doubt, a kind of hysteria.
  This condition  can be successfully treated by the
administration of carminatives, nervous  stimulants,
tonics, and by prescribing a light, and at the same time
nourishing  and easily-digested diet.  Turpentine will
be found a  most excellent remedy in most cases.
     Take oil of turpentine...................... 2 drachms.
         mucilage  )                  .  ,  1
           . , °   }........................... of each 1 ounce.
         mint water )
  Mix, and give one teaspoonful every 3 or 4 hours. 
PRESENTATIONS IN LABOR.         107
  It may be necessary in some instances to coincide
with the views of the patient, and proceed to treat
her as if such a state of things really existed as she,
for the time, believes to be the case.

            LABOR  IN GENERAL.

  Under this  head will  be  included  and first con-
sidered  some of the different presentations and the
mechanism of labor.

                 Presentations.
  By presentation  is understood that part of the
child that, upon examination, is found offering itself
at the brim or superior  strait of the pelvis, which
most frequently is the head, but may be any other
part of the child's body, and are classified by obstet-
rical writers accordingly.
  The classification duemcd most simple and suitable
to fulfill the purposes of this work is  that of Dr.
Churchill, and is briefly as follows:
  Cephalic, including  any part of  the head, which
may  be recognized by its sutures, fontanelles, gen-
eral  shape, and hardness, compared with the other
parts.  The top (bregma) may be known by the shape
of the fontanelle, (which, it will be remembered, in
describing the head, was stated to be the largest,
and quadrangular in shape;) the vertex, by the  tri-
angularity of its fontanelle; the face, by its  irregu-
larity—by  the nose,  mouth, eyes, or superciliary
ridge at the base of the forehead.
  The breech, which includes the hips and loins, by
its being soft  and yielding—by the tuberosities of 
108               GYNECOLOGY.
the ischium and coccyx, the organs of generation,
and fundament.
  The lower extremities.  The knee, by its  roundness
and the projections on either side of the bone, known
as its condyles.
  The foot, by its position regarding the leg—by its
length, shape, heel, and  by the toes.
  The upper or superior extremities. The hand, by
its shape—by the thumb and fingers; the elbow, by
its pointedness, hardness, and smallness, compared
with  the knee; the  shoulder, by the  collar bone,
(clavicle,) the  shoulder blade, (scapular,)  and the
ridge upon it, called the spine of the scapular, and
by the ribs.

              Mechanism of Labor.
  By this  term is understood the rotary motion
and the different positions therein  assumed by the
child's head, regarding the parts of the pelvis, in its
passage through the latter from the womb.  The
terms used in the  description thereof will,  in some,
perhaps, necessitate a frequent reference to  the ana-
tomical part of this work.  It is based upon the fre-
quency of head presentations at the superior strait
of the pelvis; as in cases where the other parts pre-
sent there is no exact rule governing the motion of
exit.   The process is included, and will be described
under the following heads:

                    Positions.
   The head presentations, for convenience, are di-
vided into  various positions  by obstetricians.  The
classification of Baudelocque, of France, is consid- 
POSITIONS IN LABOR.           109
ered to be the most simple and acceptable for gen-
eral  instruction,  and consists of six divisions, which
will  be taken up and described in the order of their
most frequent occurrence.
  First, then, and occurring as often nearly as three
to one of the succeeding, is when the occipital pro-
tuberance of the child's head is over against the left
acetabulum of the mother, when the opposite part,
or bregma, will be against that part of the pelvis
where the sacrum  and  ilium  bones  are joined to-
gether upon the right side.
  The second in  frequency is the occiput at the right
acetabulum, and bregma at the left sacro-iliac sym-
physis.
  The third is where the occiput is  at the symphysis
pubis, and bregma at the promontory of the sacrum.
  The fourth is  the reverse of the first, or occiput
at the right sacro-iliac junction, and bregma at the
left acetabulum,
  The fifth is the reverse of the second, or occiput
at the left sacro-iliac junction, and bregma at the
right acetabulum.
  The sixth is the opposite of the  third, or occiput
at the promontory of the sacrum, and bregma at the
symphysis pubis.
  It will  be borne  in mind that these all are what
are  termed vertex presentations.   The greater fre-
quency of these may be easily accounted for when
the position of the child in the womb is considered:
it being suspended  in the liquor amnii by the cord
which  is  attached, as  we have  already learned,
nearer the lower part  of the abdomen  than the
upper.  The result is that the head must be, as it 
110
GENERATION.
really is, the most dependent part; hence this posi-
tion is brought about by the first contraction of the
womb impinging upon the trunk of the child, press-
ing it down, and causing the head to bend forward,
with the chin inclined to the breast.   The next con-
traction, the first position being  considered, causes
the  head to rotate, and  brings the  vertex to the
symphysis pubis.   In the next movement the chin
separates from  the breast, the head in the meantime
gliding into the excavation of the pelvis,  and con-
tinuing the rotary  motion produced  by the succes-
sive uterine contractions until the vertex is turned
to the same side of the  pelvis  as  it was at the be-
ginning, but now below the inferior strait, and nearly
ready to make  its entrance into the world.  This is
termed "restitution" from the head having performed
a complete revolution in  its descent through the pel-
vic cavity.  The uterine contractions continuing, the
head is forced out, allowing  the shoulders to occupy
the  pelvic cavity, which  continue to perform the
same rotary motion until the expulsion of the foetus
has been completed.
  The same process occurs in the other positions of
this classification.  They will be understood, and can
be traced out,  by allowing  for that portion of the
head which regards the pelvis  in  their  different
parts at the superior strait.  The rotation in the
first position would be from left  to  right; in the
second, from right  to left; and in the third, which
is  a very rare  position,  there  is no  restitution at
all.  In the remaining three positions, the rotation
would be the reverse of their counterparts given
above. 
LABOR PROPER.
Ill
  The above classification of positions belongs prop-
erly to what are termed natural labors.

           Classification of Labor.

  Labors are usually considered under two general
heads: First, eutocia, (from the Greek, eu, "good," or
"proper," and tokas, "delivery,") which comprehends
natural, difficult, or tedious labors; second, dystocia,
(from the Greek, dus, "badly," and tokas, same as in
the former case,)  which includes all preternatural
cases, or those in which active interference becomes
necessary to preserve mother or child, or both; whilst
in the former no more than ordinary assistance may
be required.  Each of these classifications and sub-
divisions will  be considered in detail after awhile:
our object now is to  gradually unfold the whole
phenomena of labor in such portions  and in a  man-
ner that will prevent the mind becoming confused.
Therefore, our attention will first be directed to

                  Labor Proper.

  By this term is  understood the efforts by which
the womb begins and  successfully completes the ex-
pulsion of its contents, the woman  having fulfilled
her time, which, as has been before stated, is accom-
plished, at  the longest, in about ten lunar months,
or two hundred and  eighty days, or forty weeks.
The womb, by its  contractions, assisted b}r the ab-
dominal muscles and diaphragm, are the principal
agents in the  expulsory process.   The manner in
which the uterine  contractions are brought about is
variously  accounted  for.  Some attribute the phe- 
112
GYNECOLOGY.
nomena to an  inability on the part of the womb to
longer sustain the distension to which it  has  been
subjected; others, to the struggles on the part of the
foetus in its efforts to have breathed into its nostrils
the breath of  heaven.  Whatever  may be the ulti-
mate cause, it is certain that the action is altogether
involuntary, and  is entirely beyond  the  control of
the parent,  and,  having once  begun, it   continues
until the child and placenta are expelled,  and  then
afterwards until the womb has resumed its normal
size.  All through the process the sufferings are se-
vere in some  individuals, whilst in others they are
apparently slight.  The duration of labor  differs in
different persons,  and in the same individuals in dif-
ferent labors.

               Stages of' Labor.

  Labor is again divided into three distinct periods,
called "stages of labor."
  The first stage  properly begins with the dilating
or opening of  the os uteri, and terminates with the
completion of the same.
  For several  days previous to the commencement
of this stage there are indications of a premonitory
character that give unmistakable evidence that the
labor is about to be inaugurated.  Some of these are
a diminution of the abdominal tumor, caused by the
womb gravitating or settling down into the pelvis.
This phenomenon is soon  followed  by rigors  or a
chilliness suddenly darting through the body, with
a tingling numbness of the lower extremities, and a
general irritability of the whole system, which con- 
                STAGES OF LABOR.             113

 tinue until it may be, as mostly is the case, at night
 the patient is awakened with slight pains in the back
 and lower part of the abdomen.  These are caused
 by the contractions of the muscular fibres in the up-
 per part of the fundus of the womb, which press its
 contents down upon the  os  uteri,  creating, at the
 same time, a  slight dilatation of the  os.  The  first
 stage has now fairly begun, and the pains  continue
 at greater or  less  intervals, becoming more severe,
 until they assume  a sharp, cutting, or grinding char-
 acter, causing the  patient to become somewhat anx-
 ious, more irritable, and perhaps alarmed as to the
 consequences of her situation.  The cry during a pain
 being sudden, sharp, and piercing, is chacteristic of
 this stage, and, from its being forced in spasmodic
 mutterings through the clenched teeth, the pains are
 denominated "grinders."  Nausea and vomiting may
 now set in.  If so,  it may be looked  upon as a favor-
 able circumstance, especially in a plethoric patient,
 as it produces a relaxation of the  general system,
 and  insures the  early completion of the dilatation
 of the os and termination of the first stage.   In  one
 of an opposite or  weakly temperament vomiting
 should not be  allowed to continue long, if possible,
 as it may  cause such depression as to retard  the
 subsequent stages of labor.  An  examination of the
 mouth of the womb at  this time and  the passages
 leading  thereto will enable the  attendant  to form
 some idea of  the  probable duration  and  probable
 result of this stage.  If the passages are soft, moist,
not above the ordinary temperature, and the os in
the same condition, and dilatable or dilating,  the
prospects are that  it will be early terminated.   On
      o 
114
GYNECOLOGY.
the contrary, if the parts are unusually dry or hot,
the os hard and  unyielding to the touch, and not
dilating, the  probabilities are that the  stage will
be  protracted and tedious.   The  duration of this
stage varies in different persons, and may continue
from four to twelve hours or longer.  It is usually
longer in primipare than in multipare.  Its approach
to a termination  is announced by streaks  of blood
in the  mucus  discharge, commonly  denominated
"the show," and by the  protrusion of the  bag of
waters that ensues, which, upon  examination, will
be found soft and  yielding to the touch during the
interval of repose, but  becoming hard and tense as
the pain is  renewed.  The  object of the pains in
this stage may be looked upon as merely prepara-
tory on  the  part of the womb for  the expulsion of
the foetus, which takes place in and completes the
next stage.
  In the second stage  the pain assumes a  different
type.  The patient no longer cries out during the
paroxysm, but at  the beginning of each is forced to
close the mouth and conrpress the lips, and muster
all her strength to aid,  by the action of the abdomi-
nal muscles, the expulsory efforts of the womb.
  She is apt to seize upon anything within reach,
which she drags  towards her with almost super-
human  strength,  until the  pain  has reached  its
greatest height, when, after an interval of a  mo-
ment, it begins to subside, and the muscles, every
one of which in the body has been called into ])lay,
commence to relax, and gradually resume their for-
mer tranquil lit}-, preparatory to another pain, which
follows after a greater or lesser period of repose, and 
STAGES OF LABOR.
115
in which the same phenomena are manifested, until
presently they assume a twofold character;  for as
the head advances great pressure is borne by the
soft parts of the mother, and they  in turn  forced
against the  bony and unyielding pelvis, subject her
to endure pain  of a  most excruciating  character,
which  extends down the whole length of the lower
extremities, and, though moderating as the bearing-
down pain passes off, from the head slightly receding,
it is continuous and more severe with each uterine
contraction, until the  child's head is born.  This is
generally accomplished  by one  long, lingering, or a
quick succession of short pains, in which the child
is propelled onwards  and outwards, seeming, as it
were, determined to break through  every  obstacle
that opposes it, until the mother, exhausted, is about
to give up,  and  she would no  doubt if she  could,
when,  with  one loud, long,  characteristic cry, she
melts away.  The head in the meanwhile is ushered
into this "cold world of ours," and the mother, so
great is her relief upon realizing the situation,  either
bursts  into  an involuntary flood of joyful tears, or
manifests the great relief she enjoys by earnest ex-
clamations of thanksgiving and praise unto Him
who hath declared, "though with great pain and
travail she should be saved in child-bearing."   With
a few more expulsory  pains—it  may be but one, and
is usually or ought to be accomplished in less time
than it takes to record it here—the body is expelled,
tbe child is  born, and the second stage of labor com-
pleted.
  The  third stage terminates with the  delivery of
the placenta, or, as it is commonly called, " the after- 
116
GYNECOLOGY.
 birth."   The time in which its expulsion takes place
 varies.   It is not unfrequently expelled with the
 child, but sometimes, from various causes, it is re-
 tained for a shorter or longer period afterwards; but
 generally, after a repose of from five to thirty min-
 utes, the contractions of the womb are revived, when
 the placenta becomes detached and forced into the
 vagina  or  entirely through  it.  The labor is now
 completed, but the womb, by what are called "after-
 pains,"  continues its  contractions  until it assumes
 the character of  a firm ball, which can  be felt for
 several days just above the symphysis pubis by slight
 pressure upon the abdomen at that point.

             The Conduct of Labor.

  As stated  in  the  introduction, this  work is in-
 tended  for the guidance of  the young and inexpe-
 rienced accoucheur or midwife; consequently it will be
 our effort, in  considering this branch of the subject,
 to lay before the reader all  of the necessary details
 of the functions appertaining to this office.  For this
 purpose it will be presumed  that the reader, for the
 first time, is called upon to attend  a patient, who is
 also (as she believes)  about  to commence her first
 labor, having some premonitory symptoms to that
 effect, and  is anxious to know if such  is the case.
 You will at once proceed to  satisfy yourself if such
 is  the fact, which a careful study of the  preceding
 subjects has now or ought to  have enabled you to do,
 and inform  her accordingly, at the same time endeav-
oring to dispel any fears that may be apparent on her
part, whether from real or any imaginary cause.  This 
THE CONDUCT OF LABOR.         117
you will be able to do, first, from considering her tem-
perament, by which you may be able to ascertain the
degree and cause of her solicitude, whether proceed-
ing from a natural contemplation of the trial through
which  she is to pass,  or from fears awakened by
the unhappy fate, under similar circumstances, of
some near  relative or friend, which may have been
unfortunately, as not unfrequently  is the case, im-
pressed upon her at this important  period by some
very communicative visitor.  This may be done by
putting the most favorable aspect upon the case that
circumstances will  admit,  and patiently awaiting
further developments.  It will be well  to advise a
light, spare diet, that the stomach and bowels may
not become overloaded, which may save a multitude
of trouble; also  a small dose of  castor oil or some
other  light or gentle aparient, to be taken  at the
proper time, in order to have the rectum  cleared of
faeces, which will then  afford  easier facility for the
advancement of the head  in  the second stage of
labor, and besides tend  to greater safety and cleanli-
ness in the same.
  She  may now also be  advised  in regard  to  the
preparation of her bed, which should be  so arranged
that in lying upon  her left side the back may be
near the  edge of the stead.  It is usually prepared
by placing over the sheets, upon that side  of the bed
just mentioned, a piece of oil  or gutta-percha cloth,
over which may be smoothly laid an old quilt or
blanket, which  are  to  serve the purpose  of absorb-
ing and  circumscribing the fluid  discharge always
attendant upon delivery.
  As the symptoms increase and assume a more defi- 
118               GYNECOLOGY.
nite character, giving unmistakable evidence that the
first  stage of labor has set in, it will be incumbent
upon you to propose  an examination of the parts,
which should  always bo done with  delicacy and a
proper regard for the sensibilities of the patient.  The
object of the examination is to ascertain the true con-
dition of the organs; the probable length of the stage;
the capacity of the pelvis and vagina.   And as it is
not to be repeated oftener than is actually necessary,
it should be thorough and satisfactory as to the con-
dition  of these parts,  and also as to that  of the os
uteri—whether it is hard, dry, and hot, or cool, moist,
and soft; if it is dilatable, dilating, or already dilated.
If the latter state  has obtained, and even if not fully
so, the membranes may be felt by passing  the finger
into  the os, and the nature of the presentation deter-
mined through them.   In making this examination,
the hand should first be well anointed with olive oil
or lard, and the operations or movements of the hand
governed by the uterine pains.  The hand should be
introduced during a pain, and the investigations con-
tinued during the same, pausing therein as the pain
goes  off, and beginning again with another pain, until,
having accomplished what  was intended,  the  hand
should be withdrawn during a pain.  If everything
has been found in a favorable condition, the patient
should at once be so informed, and after having pre-
pared the necessary ligatures, which should consist
of two pieces of cord, (saddlers'silk is the best,) about
six inches long, and made inquiry about the neces-
sary  bandage for  the  patient, which, together with
a pair of scissors,  must be put in a convenient place
against the time they may be called into requisition, 
THE CONDUCT OF LABOR.         119
and after having given such other directions as cir-
cumstances may require, it will be  unnecessary to
remain longer in the lying-in room, unless prevailed
upon to stay.
  After an interval of such length as your judgment
commends, if not called upon before, you should again
enter the chamber, when, from the character of the
pains, you will be enabled to determine at once how
the labor is progressing.  If they are now found to
be of a forcing or bearing-down character, she has en-
tered upon the second stage of labor, and will require
your constant attention at the perineum.  In order
to prevent the tossing about of the hands and arms,
as well as the twisting of the whole body, a sheet or
any strong fabric may be rolled or twisted into a
hawser, and fastened to that side of the head of the
bed farthest from the patient, and extending to with-
in her reach, that she may take hold of it to sustain
herself during a pain; or an assistant may perform
the same duty by holding the patient's hands in her
own. All your power and energy may now be taxed,
both during the pains and in the interval of the same,
to encourage  the patient to bear her trouble philo-
sophically, by assuring  her that it will shortly be all
and well over.
  She should be induced to hold the breath and close
the mouth during a pain, which will assist materially
in shortening the stage, by aiding the expulsory ef-
forts of the womb.  She should also be required to
keep the thighs well flexed upon the abdomen, with
a pillow folded and placed between the knees to keep
them well apart. This arrangement, by relaxing the
muscles, admits of a considerable enlargement of the 
120
GYNECOLOGY.
 passage from the womb.  She may be supported in
 this position by placing a chair or box at the foot of
 the bed, between it and her feet, for the latter to rest
 against.
   Another examination may now be made whilst the
 pain is on.  If the membranes  be found  much pro-
 truded and tough, the pains long and severe, and the
 labor not  making a proportionate progress, they may
 be, with due caution, ruptured, by allowing them,
 during a pain,  to press  against the finger nail, pre-
 viously sharpened  or notched for the purpose. If the
 pains are  feeble, with long intervals between them,
 much assistance may be derived from the ergot of
 rye, which is best given in powder, of about twenty-
 grain doses; some prefer the tincture of ergot, in doses
 of fifteen to twenty drops, mixed with water, and re-
 peated in an hour or two, if necessary; one dose of the
 powder will usually be found sufficient to excite the
 necessary uterine  action. It can always be given
 with  safety after  the os becomes dilated, but  not
 otherwise in such" cases.  Besides expediting the de-
 livery, it insures an early contraction of the womb
 after its contents have been expelled, thus acting as
 a barrier to unnecessary hemorrhage.  As the head
 advances  and  begins to distend the perineum, the
 latter should be supported by  gently yet  steadily
 pressing it with a  soft napkin, to prevent its being
 torn, as sometimes may be the  case.  As the head
 escapes it should be received into the open hand and
 supported in the  direction corresponding with  the
 curve of the pelvis, at the same time allowing it to
perform the necessary  rotary  motion.   The neck
should now be examined, to see if the cord is around 
THE CONDUCT OF LABOR.         121
 it, as is often the case; if so, it should be liberated by
 gently drawing it over the head.  By the time this
 is accomplished another contraction of the womb,
 perhaps, has expelled the child  entire.  In  a mo-
 ment, respiration being established, the child begins
 to cry.   It should now  be laid in as comfortable a
 situation as circumstances will allow, the cord exam-
 ined, and, if  pulsation in it has ceased, bound with
 one of the ligatures, about an inch and a half or two
 inches  from  the navel,  and then  with  the other
 about an inch from this, and then it is to be divided
 between the  two with a pair of sharp scissors.   The
 child should now be well wrapped in a blanket, care
 being taken that the air has free access to its lungs,
 and handed over to the nurse, or laid in a  comfort-
 able place for awhile.
  The open hand may now be  laid upon the abdo-
 men of the  mother to ascertain if there is another
 child, or if the womb  has well contracted.   If there
 should  be another, its safety has been insured by
 the second ligature on the cord.  The mother should
 be informed of the fact, and it received and treated
 as in  the preceding instance.   If there is  but one,
 or, in either case, if the  placenta is  not expelled at
 the same time or in a few moments  afterwards, the
 cord may be  gently drawn, when, in most  cases, it
 will easily come away, if there are no  adhesions or
growing to the womb, as it is commonly called, or if
it has been extruded into the vagina.  If it does not
easily respond to this gentle traction on  the cord,
it may be let alone for awhile, and thapchdagc put
upon the mother.   The bandage should be made of
strong muslin, about eight or twelve inches broad, 
122
GYNECOLOGY.
and long  enough to go well around the body over
the abdomen, drawn, and  pinned tolerably  tight.
This, besides acting as a support to the now relaxed
and flabby walls of the abdomen, serves to keep the
womb secure in its proper place.
  By this time, perhaps, the child is washed, which
should have been done, and well done, in tepid wa-
ter, with Castile soap.  It may be necessary, in order
to remove the vernix  caseosa, sometimes thickly
adherent  to the child, to anoint it well with  olive
oil  or  lard  previous to washing  it.  The  child
is now ready to have the navel dressed.  For this
purpose a piece of soft linen, folded once, and about
six inches square, with a hole in the middle, and
well anointed, will be necessary.  It is applied to
the abdomen  by drawing the navel-string  through
the hole, and carefully folding the linen over it, with
its extremity looking upwards.  A  soft flannel band-
age is to be applied over this, to retain it  in place.
The dressing  may now be completed  by the assist-
ant, whilst your attention is turned to the mother.
If the placenta  has not by this time come away of
itself, the cord may be held  in one hand, whilst the
other is passed along it into the vagina to its inser-
tion into the placenta, which  may be then  seized
and gently drawn away.   If  it does not readily
yield to this,  the hand  may be continued  inwards,
until its edge is felt, around  which  the hand may be
passed; if there is any adhesion, it should be care-
fully  broken  down or p&eled off, and the  placenta
drawn out trYjng with the hand.
   The labor is now completed.  After a few minutes'
repose the wet  blankets may be removed, and the 
THE CONDUCT OF LABOR.          123
patient  placed, with the child by her side, in the
most comfortable position that  circumstances  will
allow, to obtain quiet and sleep.  If nothing unusual
occurs, and everything looks favorable to the accom-
plishment of that desired end, she may be safely left
for a few hours to the care of the nurse, having first
prescribed the necessary diet, which, for a few days,
must consist of merely weak tea and toast, or pan-
ada made with crackers soaked in  sweetened water,
and directing that the patient must not be allowed
to leave her bed or assume any  other position than
that of lying down for the same length  of time.
Ere long, usually from a half to one hour, but some-
times not for six hours, the contractions of the womb
become very painful. These are termed "after-pains."
It is  considered  a good  indication if  they com-
mence early after labor, and there need be no fears
of flooding  under such  circumstances.  They may
last a day or two,  but  grow gradually less severe.
Each  pain  is followed by a discharge  from the
vagina,  called the lochia.   These pains are so severe
at times as to be almost intolerable, when  an ano-
dyne should be given to obtain relief for the patient.
Laudanum,  in doses of about six or  eight drops in
Bweetened water, repeated about every four hours,
will generally answer this purpose; or the chloral,
in five or ten-grain doses, in the  same intervals, will
serve perhaps better, as it does not leave  any un-
pleasant effects behind, nor does it interfere at all
with the secretions.
  About the third da}' after delivery, sometimes in
the second, there  is usually slight fever, induced by
the flow of milk distending the breasts.  It will be 
124
GYNECOLOGY.
necessary to administer a gentle aperient to open
the bowels.   For this purpose castor oil is the best,
principally on account of its acting without weaken-
ing the patient.  Where there is a decided  antipa-
thy to this medicine, Ellis' citrate of magnesia may
be given, or an  infusion of senna  substituted.  In
some cases stewed prunes will act as well, and may
be given for the same  purpose.  After the  bowels
have been evacuated the fever usually subsides.
  The infant should be placed to the breasts  as soon
as the mother has sufficiently recovered from the
fatigue of the labor.  This serves to excite the secre-
tion, develops the nipples, and  learns the infant to
suck before the flow of milk commences.
  If the secretion is abundant, and the  breasts re-
main distended after  the child is satisfied, the resi-
due  may be drawn off by artificial  means, and the
breasts rubbed with some stimulating lotion, such as
spirits of camphor or tincture  of arnica.  If, after
a few  days, there are evidences  of suppuration or
gathering of the  breasts  having commenced, the
process may  be encouraged by  the continued appli-
cation of warm flaxseed-meal poultices.  When the
abscess shall have  fully  formed, it should  be freely
opened and the puss discharged, after which the
pain will cease and the breast soon become perfectly
cured.
  The mother should keep her bed until about the
ninth day after delivery, when  she may be allowed
to go about her room, using due and necessary cau-
tion against over-exertion until she has fully gained
her wonted  strength.  The lochia  may continue
from two to four weeks.  After a few days it ceases 
        COMPLICATIONS AFFECTING CHILD.     125

to be blood, and assumes a light, sometimes a green-
ish, tint.   This discharge comes from the open ves-
sels at that part of the womb to which the placenta
was attached; as the contractions of the uterus con-
tinue they become closed, and the discharge after a
while ceases altogether.

  Complications Affecting the Child at Birth.
  Not unfrequently, when all is well with the moth-
er, the child  will  require some  additional attention
at birth, which complications may now be  consid-
ered, though  belonging  more properly to  the next
subdivision, or tedious labors.
  Occasionally, from some peculiar cause, the child
may be subjected to a considerable loss of blood whilst
still in the womb, or it may not have been properly
nourished therein.  When it is born under such cir-
cumstances it will be found to breathe feebly or not
at all, with very weak and irregular pulsations of its
heart.  In this case the  cord may be tied and cut at
once, without waiting for its pulsation to cease, and
the child immersed in a warm bath for a few moments,
then taken out, and briskly rubbed along the spine.
If these means prove ineffectual in producing a re-
action, artificial respiration may be attempted.  This
is done by closing its mouth, and, with your own to
its nostrils, blowing into them until the lungs are.
inflated, then press gently upon the breast to expel
the air again.  This should be repeated several times,
or until it is successful or evidently useless.
  Sometimes, from pressure on the cord, or from
being too long in the passages,  the child may be as-
phyxiated, when the cord should not be tied or cut 
126
GYNECOLOGY.
until respiration is fully established.  In the mean-
time, it may be sprinkled with a little cold water and
briskly rubbed along the back and over the chest, or
gently slapped upon the buttock. A case wherein this
condition had obtained after expulsion, resulting from
pure negligence, which accidentally fell into the hands
of the writer, is worth relating, both on account of its
being caused by the apparent atrocity of one parent
and the success which attended the efforts at restor-
tion, which, it is hoped, may lead to like  persever-
ance, with the same result, by others: The woman
had been confined, and given birth to an eight-months'
male child, without any attendant whatever, though
the husband was not at all in indigent circumstances.
The child was suffered to remain  in  the position in
which  it was expelled from the womb, with its face
downwards, and lying in the  blood and excrement
discharged with  it, when at last it seems that the
man (?) had sufficient compassion to summon aid.
Happening to be near at the time, we were called in,
and learned from the mother that the child had  been
born quite an hour.  The whole surface  of its body,
although of white  extraction, was nearly the color
of black ink.  The pulsations  in the cord had en-
tirely  ceased, or were at least imperceptible,  and
those of the heart were so feeble that success in any
efforts  at  resuscitation  were  almost despaired of;
nevertheless to attempt it  was a duty.  The  cord
was tied, cut, and the child  placed on its side, upon
a dry part of the bed, and briskly rubbed and rolled
from side to side for half an hour, when signs of life
returning became manifest.  The process was  con-
tinued  for another  half hour, when  the breathing 
          DIFFICULT OR TEDIOUS LABORS.       127

became regular and natural, though very slow.  As
soon as the  child  was able to swallow, a  little
brandy and water mixed were given it occasionally.
Under this regimen it was not long before it was
quite revived and cried heartily, after which, having
been wrapped in a blanket,  it was given to tho
mother, who  was made as comfortable as the sur-
rounding  circumstances would  admit.  The unfor-
tunate child had been in this asphyxiated condition
so long that it was three days ere it resumed its
wonted color.  At this time it is still alive and doing
well, and the unworthy disciple of St. Crispin is now
apparently satisfied with his offspring.
  Another complication to which the child is liable,
after the head has been delivered, arises from the body
being retained for an unusual length of time, induc-
ing a condition like cerebral apoplexia, or conges-
tion of the brain.   It may be prevented, partly, at
least, by withdrawing the child at once—by passing
the hand  into the  vagina, with one  finger placed
under the arm of the child, then  gently withdrawing
it; after which the same treatment may be adopted as
in the preceding case.  Some writers recommend that
the cord should be cut and about a tablespoonful of
blood allowed to escape in such cases. Natural labors
are usually completed  in from twelve to twenty-four
hours.  When from any cause they are protracted be-
yond this last-mentioned period, they are termed diffi-
cult or tedious, and come under the next subdivision—

          Difficult or Tedious Labors.
  The first stage of labor may be protracted and
tedious from  the rigidity of  the os uteri, when the 
128
GYNECOLOGY.
   pains, though regular and severe, seem to have no
   power against it, until the patient becomes "tired
   and almost worn-out," as she  is apt to express her-
   self.  This condition may be relieved by bringing
   about a relaxation of the general system.  Tartar
   emetic or ipecac, given until nausea is produced or
   till vomiting is excited, will usually serve the  pur-
   pose.  General bleeding from the arm  is recom-
   mended by some authors; also the application of
   belladonna ointment to the mouth and neck of the
   womb; and others even the Hippocratic bath, men-
   tioned in the  introduction to  this volume.  A more
   simple and often as effectual a remedy is the injection
   of warm water into the vagina, which may be at least
   tried before proceeding further.
     Another cause  of delay in  this stage  sometimes
   arises from that lip of the os uteri nearest the sym-
   physis pubis  being  pinched between the head and
   the symphysis.  This may be remedied  by endeav-
   oring to push the lip, with the  ends of the fingers,
   over the crown of the head, as the pain comes on,
   and holding it in that position  until  another and
   another pain has taken place, or until it has been
   released.
     A premature rupture of the membranes may some-
   times occur, which is apt to cause delay in this stage,
   and will require nothing* but  long patience to  wait
   until the  dilatation  is accomplished by the head,
   which will be the only agent to perform this service
   in the absence of the wedge-shaped amnion  bag.
     An excess of liquor amnii,  apt to be  present in
   weak and feeble patients, may be the cause of delay
.   at times.  When the os  is sufficiently dilated to 
DIFFICULT OR TEDIOUS LABORS.      129
justify it, the membranes may be ruptured, and the
water allowed to escape.
  In  the  second stage a condition not unlike that
spoken of in the natural labor may arise, but more
exaggerated, in which  the same treatment may be
instituted, i. e., the administration of ergot, provi-
ded the os is sufficiently dilated to admit of it, and
the passages are of a capacity to allow the free ad-
vancement of the head.  These circumstances are to
be first considered in all cases when the administra-
tion of ergot is contemplated.
  Toughness of the membranes, also spoken of in
natural  labor, are  to be treated as therein  recom-
mended.  They are so tough at times as to admit of
their  being expelled with the child inclosed, without
being ruptured. This is what is termed being "born
with a caul"—a condition in which the child must ne-
cessarily perish from suffocation if not speedily extri-
cated therefrom.
  Rigidity of the soft parts is a very formidable cause
of delay in some women; the pains,  though  strong
and frequent, add nothing to the advancement of the
labor, and if not relieved the patient is apt to become
irritable, excited, and much exhausted.   The same
treatment, nearly, as  recommended  for rigidity of
the os, is to  be adopted under these  circumstances,
with the addition of small doses of opium, to control
the action of the womb and mollify the pains until
the desired softening has obtained.  The hydrate of
chloral, in doses the same as recommended for after-
pains, may be  used as  a substitute  for  the  opiate
with like happy consequences.
  Obliquity of the womb may be a cause of tedious
      9 
130
GYNECOLOGY.
labor.  If the inclination is to either side, it can be
remedied by placing the patient upon  the opposite
side to that to. which the womb is inclined.  If it bo
to the front, the patient may lie upon her back, the
womb in the meantime  supported in a direction to
conduct the head into the lower pelvic strait. Every
one of any great experience in obstetrics has noticed,
perhaps, that a change of position by the patient will
often  hasten the advancement of the  head, which
hitherto seemed to make  little or no  progress for
hours, even if they did not detect the cause of delay.
Therefore it is advised to allow the parturient woman
to have some little freedom in this respect, and not
keep her upon her left side in a state of trepidation,
or fearing to move a muscle, as not unfrequently is
the case with many.
  Hardened faeces in the  rectum, or  an over-dis-
tended bladder, may prove to be a cause of tedious-
ness; hence the necessity of their being early at-
tended to  and evacuated.   The  bladder is to  be
relieved by the introduction of the catheter;  the
faeces  removed by injections  of  warm water and
lard, or they may be taken away with the  handle
of a teaspoon or other convenient and  suitable im-
plement.

  Deviations from the Vertex Presentations.
  Departures from the  vertex presentations obvi-
ously operate to make labor more or less tedious or
difficult.  The first of these to be considered is the
top of the head, (bregma,) the forehead, and the face.
They are dependent upon the departure of the  chin
from the breast in the beginning of labor, the head 
deviations in presentations.       131
being flexed backwards instead of forwards, and thus
sinking down into the pelvic strait.   Without occu-
pying our  time and space with the details of the
classification of these deviations from vertex pres-
entations, it is sufficient to state that the positions
are six in  number,  and are named  as the forehead
and vertex regards  at the same time this or that
part of the pelvis of the mother.   The position is
easily determined by the anterior fontanelle, which,
it  will be  remembered, is quadrangular in shape.
This is the most dependent part, and will be found
about the center of the dilated passage leading to it.
   The treatment, if interference is resolved upon,
is  to  endeavor to throw the  head  more upon the
chest, that the vertex may descend.  This may be
done, if discovered  before  the head  has reached the
excavation of the pelvi3, by cautiously, gently, and
steadily pressing  upon the brow during a pain to
retain it in  that position.   It must be borne in mind
that no attempt should be  made to  push it  up.  By
thus allowing the vertex to come down, the  delivery
becomes comparatively simple and easy.
   Face presentations usually resolve  themselves into
two positions:  the  right  mento iliac (chin to the
right ilium)  and  left mento  iliac (chin to the left
ilium.)   In the first, the  right side of the face is
toward the sympysis pubis. In its descent, the chin
rotates until it  passes under the   pubic arch, and
the forehead into the hollow of the  sacrum.  When
the chin emerges, it rises toward the abdomen of the
mother, whilst the forehead, bregma, and occiput in
succession  pass down  the  plane of the  coccyx and
perineum.  In the second position the left side of the 
132
GYNECOLOGY.
face is toward the pubic arch, under which, as before,
the chin rotates, and completes the delivery in  the
same position.  This presentation and the positions
are determined by the nose, mouth, and eyes. From
the fact that the head deviates from the line in which
the womb ordinarily acts, the first stage of this pres-
entation is always protracted and severe, as is also
the second stage, from the unyielding character of
the bones of the face, and their non-conformation to
the passages from the womb.  These cases are always
as aggravating to the attendant  as they are painful
to the  patient, and require all the powers that  can
be brought to bear in the premises to cheer, console,
and support her in her sufferings until the delivery
shall have been completed.
  Breech presentations are usually attended with great
danger to the child, from the pressure of the head
upon the cord, which is liable to take place under
these circumstances, and may produce asphyxia,  and
consequently death, ere the child can be born.  They
are also very trying  to the mother.  The means of
determining this presentation are by the softness of
the parts—by the anus and organs of generation.
  All  attempts to  draw down the limbs  are  to be
avoided, as, if successful, it would result in diminish-
ing to that extent the now well-dilated parts,  and
thereby serve  to protract the labor.  Therefore the
case is to be left to nature until the breech has been
delivered, when it should be supported in a line coin-
ciding  with the axis of the pelvis, at the same time
allowing it to  perform the necessary rotary motion,
produced by the head becoming engaged in the  pel-
vic cavity.  When the cord makes its appearance, it 
             PRETERNATURAL LABOR.         1G3

may be gently drawn down and placed in a position
at either side, where it may receive as little pressure
as possible.  If the thorax or upper part of the body
emerge without  the arms being down, that nearest
the anus of the mother may be brought down first,
by passing the finger over the shoulder and  draw-
ing the  arm  down over the face, then securing the
other, and drawing it down in the same manner over
the face.  If the delivery of the head is long delayed,
introduce one hand, placing one finger in the child's
mouth, and two  fingers of the other hand on  either
side of the neck from behind, then gently withdraw
the head. If this  cannot  be done without injury to
the child, by too great a strain upon it, the perineum
may be pressed  back, so as to  allow the air to enter
the child's mouth, or a tube of some kind (even a clean
pipe-stem or quill) may be introduced into the same,
and the child thus sustained alive until it is expelled
by the womb's contractions.
  Presentations of the lower extremities are  easily de-
termined, and are to be treated  in detail the same
as breech presentations.

       Dystocia, or Preternatural Labor.

  Under this head, as has already  been stated, is
included all cases of labor in which interference be-
comes absolutely necessary, without regard to pre-
sentations, positions, or other complications.
  The causes that operate to produce these  labors
are either accidental or pre-existing, and may depend
upon some peculiarity of either mother or child, or
of both at the same time. 
134
GYNECOLOGY.
     Among the accidental causes may be enumerated
   inflammation of the brain or its coverings, pleurisy,
   peritonitis, metritis,  (inflammation of the womb,)
   and  pneumonia, all  occurring during  labor;  also
   convulsions, hemorrhages, syncope, or fainting, tear-
   ing of the womb, prolapsus, or falling down  of the
   cord, or from an alteration of position after the pains
   become exciting.
     The pre-existing causes are  malformations of the
*  pelvis, organs of generation, and of the foetus, stone
   in the bladder, tumors in the cavity of the pelvis, &c.
     From any of these complications arising during
   labor one of three operations may become necessary,
   viz:  turning the child in the womb, delivering with
   instruments, (forceps,) or craniotomy.
     The presentations which mostly require  the  ope-
   ration  of turning, or version,  as it  is technically
   termed, are  those of the upper extremities.  They
   include the hands, elbows, and shoulders, and are to
   be determined by the peculiarities of each part.
     Without considering the various theories and  con-
   jectures as to the cause of these presentations, which
   for the most part are very unsatisfactory, we will pro-
   ceed at once to describe the work necessary to be done
   and how to do it, as if the case was now before us.
   There are three varieties of turning:  First, version
   by the  head, in which the  presenting part is pushed
   away and the head substituted for it, and the labor
   left to complete itself.  Second, version by the breech,
   in which  this part is drawn  down to occupy the va-
   cated position, thus becoming converted into a breech
   presentation.  Third, and  that most frequently per-
   formed, is  version by the feet, in  which, without 
OPERATION OF TURNING.
135
regard to the presenting part, the hand is  intro-
duced into the cavity of the womb until the feet are
reached, and then, by drawing them down, causing
the child to perform a complete evolution.  Although
it  is not without danger to the child, it is usually
safest for the mother.   In  order to perform  the
operation, the best position for the patient is that
most convenient for the  operator.  Some prefer to
place the patient upon her back, and then draw her
buttock near the edge of the bed, the knees  being
supported by assistants;  or, in the absence of these,
a couple,of chairs may be drawn to the bed-side, and
her feet allowed to rest upon them; or she may be
placed in position upon the  hands and knees; or, if
preferred, left in the ordinary position upon the left
side: but  the first described is probably the best,
most convenient, and favorable.  As a general rule,
that hand should be used whose palm can be easiest
directed toward the abdomen of the child. It must,
with the arm, be  well warmed and anointed with
oil or lard, then during a pain  introduced into the
vagina, with  the fingers  and thumb drawn close to-
gether in a conical form.  Then, with the other hand
placed on the abdomen of the mother, to steady the
womb, as soon as the pain subsides pass the former
into the mouth of the womb. If the membranes have
not been ruptured, continue it up, between them and
the walls of the uterus, until the feet are reached, bear-
ing in mind that you must pause and open the hand
when a pain ensues.  Having made sure it  is the
feet you have reached, rupture the membranes, and,
during  an  interval of pain,  gradually draw  them
down over the abdomen of the child into  the pelvis. 
136
GYNECOLOGY.
By this method the arm acts as a tampon, prevent-
ing the escape of liquor amnii, in which the turning
is easily accomplished.   The presentation, whatever
it may have been previously, is now converted into
that  of the feet, and is to be treated as if it had been
so originally.  These same rules apply to version by
the head or the breech.
  Turning may be performed in other presentations
when it becomes necessary from any cause to hasten
the delivery, such as convulsions, syncope, and hem-
orrhages before  delivery.   Sometimes  it is impossi-
ble, from numerous causes, to perform the operation
of turning, as, for instance, when the head has sunk
low  down in the pelvis, or if it has become engaged
in the pelvic  cavity, when other  means are to be
adopted, presently to be pointed out, requiring the
use of obstetrical instruments. A general description
of them, and the cases in which they  are required,
will  conclude what is necessary to be said in regard
to preternatural labors.
  It  is not to be presumed from  the  following de-
scription of instruments, or from what has been al-
ready said upon  this classification of labors, that the
inexperienced is prepared to undertake and  man-
age  cases  of  this kind;  for  the  responsibility of
assuming sole control in such cases is considered too
great  for even  the most  proficient to undertake
without properly-qualified assistance.  Neither is it
proposed  by these remarks to dissuade the student
in cases of emergency  from using all efforts neces-
sary io afford  such relief as the circumstances may
demand, which a careful  study of  these pages will
enable him to do, until proper assistance may be 
                 THE FORCEPS.               137

procured, thus becoming the means of saving much
unnecessary suffering and perhaps many a life, not
so much by doing ignorantly this or that thing, but
by knowing what ought not to be done,  and if  any-
thing is to or can bo done, when and how to do  it.
That it may be useful in many instances of this  kind
occurring in the country or on shipboard, or even in
cities and towns, among the poor, is obvious enough,
and  is one of the principal missions of this volume,
that of alleviating the suffering and saving the  lives
of parturient women and children in the absence of
proper scientific aid.

                 The Forceps.

   As stated  in the introduction  to this work, the
honor of this important  invention to assist in par-
turition belongs to Dr. Paul Chamberlin, an English
physician. These instruments have undergone vari-
ous  modifications since they were first discovered, in
the  different countries into which they have found
their way, and at this day none who  may desire
them need be in want of inplements of this kind,
as they  may be obtained  in almost any city, and
are of various sizes and shapes, deriving their names
from the country in which they were improved.
The most popular in this country are the "Eclectic"
forceps, of Dr. Hodge, of Philadelphia.  It is believed
they combine all the advantages of the English,
French, and  German forceps. They consist of two
curved blades, sixteen inches in length, presenting
three prominent points for description:  the handles,
the  lock,  and the clam, or blades.  The first of these 
138
GYNECOLOGY.
are smooth and round, terminating in the blunt hook.
The second is formed by a notch in the female blade
to receive the button or screw occupying the snme
intermediate position upon the male blade.   When
brought together the screw or button  acts upon the
same principle as the rivet in a pair of shears. The
clam is thin,  broad, oval-shaped, fenestrated, and
curved in  a degree to coincide at  once with the pel-
vic strait  and the child's head, which  it is intended
to grasp.  The whole instrument is highly polished
and composed  of fine  steel, and  made  as light as
the purposes for which it is to be used will admit.
   The following, taken from  Dr. Hodges' own de-
scription of his instrument, may be  of further  in-
terest :
   Whole length of  instrument, in a direct line, six-
teen inches; from the joint to  blunt hook, (handles,)
six and  eight-tenths inches;  from joint to  clam,
(shanks,) three  and five-tenths  inches; length of
clam, six  inches. When the handles  are in  contact
the outer terminus of the  clam is  separated one-half
of an  inch; at  about midway its greatest breadth,
two and  five-tenths inches.    The breadth of one
blade forming the clam is one and eight-tenths inch,
slightly tapering to one and  seven-tenths inch near
the extremity;  breadth of fenestra,  one and one-
tenth  inch; thickness  of blade, two-tenths  of an
inch.
   The perpendicular elevation of the outer terminus
of the clam, when  the instrument is lying upon  a
horizontal surface,  is three and four-tenths  inches;
the elevation of the handles  at the same time near
the joint, is one and three-tenths inch. 
              USE OF THE FORCEPS.           139

  The principal  object of the forceps is for the de-
livery of the child's head, when from any cause it
becomes impacted, and the labor thereby retarded
or protracted.  They possess the power of grasping
and at  the same time diminishing to some  extent
the size of the child's head, without damaging it in
the least, if properly manipulated: thus proving an
efficient means of safely extricating the child; and
they will undoubtedly continue to be in the  future,
as they have been  in  the past, the means of pre-
serving many an infantile life, of  shortening  the
mother's sufferings,  and prolonging  her life to take
care of and nourish her child, both of whom other-
wise may have found an untimely grave.  Then God
bless the Chamberlins, and let  all upon whom  the
use of the forceps may become necessary say, Amen.

   Cases in  which the Forceps are to be Used.

  The forceps may  be used when the mother is
much exhausted and  the pains too feeble to expel
the child, or when from some malposition  of  the
head, either at  the  upper strait or in the cavity of
the pelvis, or whenever they can be used to expedite
the labor when the safety of the mother or child is
endangered.  It must be  ascertained  before they
can be  used  that the mouth  of the womb is fully
dilated, the membranes ruptured, and the first stage
of labor comp eted.
  The  manner of applying them  is  by placing  the
patient  in cither of  the several positions  most con-
venient, as directed  for turning the child.  Then,
alter  well warming over the  furnace  and anoint- 
140
GYNECOLOGY.
ing the instrument and the vagina with olive oil or
unsalted  lard,  and having  ascertained  the exact
position of the  head, the male or left-hand blade of
the forceps should be first applied, by taking it in
that hand, between the fingers  and thumb, in the
same manner as is commonly taught for  holding
the writing-pen.  Having introduced the fingers of
the right hand between the vagina and side of the
head, keeping in mind the curve of the vaginal passage,
the blade is gently introduced during the interval of
pain, until  the  fenestra is exactly  adjusted to the
side of the  child's head and face over the ear.  The
handle may now be given to an assistant  to hold
exactly in  that position.  Then take the female or
right-hand blade in the right hand, using the fingers
of the left, as directed for the right hand  in the first
instance, as guides or directors between the vagina
and head on the opposite side.  Then introduce this
blade in the same manner, taking care to have the
fenestra  applied exactly  to this side of the  head
and face, as with the first blade.  The instrument
is now to  be locked, by  crossing the handles,  so
that the notch in the one may receive the button of
the other.  Having been successful in this, turn the
button down until the  blades  are firmly  fastened
together.  Now carefully examine with  the hand,
by  passing the fingers  along the  instrument  to
where  it grasps  the head, to discover if any  of
the soft parts of the mother are inclosed  between
the blades.  If so, they must be relieved by relax-
ing  the  hold  on the  handles.   Afterwards  the
handles may be again brought together and slightly
pressed toward  one another, as it were, to try them, 
BLUNT HOOK.
141
and then await a pain.  As one comes on, both blades
together in the grasp  may be moved from side  to
side, at  the same time drawing them  steadily and
gently upwards and towards you, discontinuing these
efforts as the pain subsides, and renewing them again
as the pain comes on, until the head shall have been
completely extracted, when the instrument should
be instantly removed and the labor allowed to com-
plete itself in the natural way.   Due  caution is  to
be used during the extraction to  guard the perineum
as much as possible against  injury, to which it is
more liable by the presence of the forceps.

             The Yectis, or Lever.

  Sometimes it may be  only necessary to correct
some malposition, or assist the head in rotation and
flexion.  For this purpose another instrument, called
the vectis, or lever, will  be necessary.  This is an in-
strument  with a  straight handle, usually about
twelve inches or more long,  terminating  in a tri-
angular fenestrated  blade. One blade of the forceps
wili, in most cases, serve the same purpose, and the
same rules govern its introduction as given for one
blade of that instrument.   It  is passed over the
head, using one hand to  operate, whilst the other,
and  not the soft parts of the  mother, must act as a
fulcrum.
                 Blunt Hook.

  Another instrument  combined in the handle  of
the Hodge forceps is the blunt hook.  It can be used
in breech presentations, by applying it to the groin
or under the arm, when necessary, to hasten the 
142               GYNECOLOGY.
delivery of those parts.  It can also be placed in the
child's mouth or in the orbit of the eye, whenever it
is desired, to produce flexion of the  head after, the
body shall have been born.

               Fillet, or Noose.

  Another means sometimes used to hasten extrac-
tion is by the fillet, or noose.  It may be made of
muslin, silk, or leather, whichever is most  readily
at hand,  formed into a running knot, to be applied
around the arm or other convenient parts.  The
blunt  hook will usually  serve the  same purpose
whenever its use is indicated.

                  Craniotomy.

  Fortunately  unfrequently, but sometimes it be-
comes necessary—either from an undeveloped pelvis
or deformity of the same on the part of the mother,
or from an abnormal size of the child's head, tumors
of the abdomen or of the chest, on the part of the
child,—in order to save the mother's life to sacrifice
that of the child, by perforating the skull, removing
the brain, and by piecemeal extracting it.   This op-
eration is called craniotomy, cephalotomia, embry-
otomy, and embryulcia.
  Two kinds of instruments are required for  this
operation: perforators and crotchets.  The first are
for  the purpose of perforating the skull and break-
ing up the brain, and the latter for  extracting the
remainder of the child.
  Having duly considered the case and  ascertained
that this operation is  necessary, it  should  not be 
CRANIOTOMY.
143
delayed a moment, else both mother and child may
be forever lost to this world at least.
  The indications on the part of the mother justify-
ing this operation, besides  those above  mentioned,
are when, from long and protracted efforts at expul-
sion, she becomes nearly exhausted, with the tongue
brown, dry, and hard, the  pulse at the same time
frequent, quick, and  small,  with vomiting  and shiv-
erings or rigors.
  To operate, the patient is to be placed  in the same
position as for the operation of version or extracting
with forceps.  Then, by introducing the instrument
called a perforator, between the fingers as a  guide,
and directing it to that part of the head to be open-
ed, upon reaching it  the instrument is to be pressed
onwards with a turning motion until the bones have
been punctured and the brain broken up, after which
this instrument may be withdrawn, and the crotchet,
a doublc-bladed, curved-pointed instrument,  intro-
duced, in the same precautionary manner, with which
the head is seized and the remnant of the child with-
drawn.   Great care is to be used to protect the soft
parts of the mother from injury by the sharp pro-
jecting edges of the bones.  If the child  cannot now
be extracted, it will  become necessary to  introduce
the craniotomy forceps, by which the bones  are to
be broken entirely up, and, as before stated, the child
taken away by piecemeal.
  Both  during and  after this operation,  which of
course must be very painful and  exhausting  to the
mother, she will require constant watching.   Occa-
sion ally a stimulant—French brandy or good whiskey
and water—may be given, to counteract the exhaus- 
144
GYNECOLOGY.
tion, and afterward opiates to relieve pain; or chlo-
roform and ether, equal parts, may be given  the
patient by inhalation during the operation, unless
decidedly objected to by herself or friends.

              Cesarean Operation.

  This operation is performed when complications,
as in the preceding case, arise, and it is desirable to
give both the mother and  child a chance for their
lives.
  The operation is performed by making an incision
in the medium line of the  abdomen of the mother,
and through its walls down to the womb, about seven
inches long;  the womb is then cut into and opened,
the child and placenta removed, when the womb will
contract  and sink into the pelvis. The incision in
the abdomen afterwards should be properly brought
together, and its lips sustained in opposition by sut-
ures and  bandages, after which opium and stimulants
may be administered, as in the preceding cases. For
further information in regard to this and other ope-
rations herein referred to, see any standard work
upon obstetrical surgery.

             Prolapsus of the Cord.

  As before spoken of, prolapsus of the cord may oc-
cur from  various causes.  Under such circumstances
the life of the child is greatly endangered from pres-
sure thereon preventing the flow of blood through it.
  The best means to be adopted  in such cases are,
when the head is  in a favorable situation, to deliver
at once with the forceps; or, if the head  has not en- 
HEMORRHAGES.
145
 tered the cavity of the pelvis, then turn the child and
 hasten the delivery.
   Other means have been  recommended by some,
 such as  pushing back the cord or hooking  it over
 the child's limbs, inclosing it in a bag and returning
 it to the womb by means of a small rod, after which
 the latter is to be withdrawn.  If pulsation has en-
 tirely ceased in the cord, it is deemed by some use-
 less to interfere, as the probabilities are the child
 is lost.  However, patience and perseverance to the
 end are advisable in all things, especially these cases.

                  Hemorrhages.

   The most formidable, intractable, as well  as the
 most fatal, complications of labor, are uterine hem-
 orrhages.  They present  three varieties: accidental,
 unavoidable, and hemorrhage after delivery.  The first
 may occur before or during labor, and is usually de-
 pendent upon a partial separation of the placenta and
 the consequent laceration of its vessels.  It may be
 the result of falls, blows, great muscular exertion, ex-
 traordinary mental excitement, a full habit of body,
 or from over-straining at stool.
  This variety, though very troublesome, is not ne-
 cessarily dangerous. A case—a fair type of this kind
 —came under the writer's charge sometime since, in
 which the bleeding commenced  about the fourth
 month of pregnancy, accompanied  by slight pains
 through  the region of the womb  and in  the back.
It was arrested, by the usual  means indicated in
such cases, for a short time, when it appeared again,
and continued more or  less during the remaining
       10 
146
GYNECOLOGY.
period of* gestation, resisting all attempts to pre-
vent it. As there were no signs of exhaustion in the
mother, it was feared the child would be still-born;
but such was not the case, for at full time the patient
gave birth to a healthy, robust child, and as soon as
the womb was allowed to contract, the hemorrhage
ceased altogether.  In  this case the bleeding evi-
dently proved to  be  the salvation of the  child, as
the mother was of a full-blooded temperament or
plethoric habit of  body, thereby furnishing all that
was necessary for the child's subsistence, independ-
ent of what escaped through  the  safety-valve for
both mother and child provided by Nature herself.
   Sometimes the hemorrhage may occur and be re-
tained in  the cavity  of the womb  by the blood
finding its  way  into the  membranes, or  between
them  and  the walls of the uterus, and  thus  prove
fatal, without any external signs of its  presence.
Such a condition of things may be suspected if any
general symptoms of the loss of blood are present:
such  as weakness, faintness, with swelling or ten-
derness in any part of  the womb, and pains  in the
back.
   The treatment is to keep the patient strictly quiet
upon her back, at the same time administering small
doses of opium, combined with sugar of lead. If this
proves unsuccessful after a  fair trial  and the case
clearly determined, the membranes may be ruptured,
the womb allowed  to contract, which in all proba-
bility will close the vessels, and the bleeding cease.
If, after doing this much, the  contractions should
not take place, they may bo encouraged by the ad-
ministration of erjjot and friction of the  belly.   If 
                  HEMORRHAGES.              147

 these means should fail to excite the womb to action,
 all that remains to be done is to turn the child and
 deliver, then extract the placenta at once.  The great
 enervation  resulting from  the  labor  must be  met
 with slight stimulants: milk punch  or wine whey,
 beef tea, and an occasional dose of opium—about one-
 fourth of a grain every four or five hours.  The stim-
 ulants are to be used very cautiously, and not carried
 beyond exciting a gentle reaction, or they may prove
 hurtful and dangerous.
   Unavoidable hemorrhage may depend upon the pla-
 centa becoming partially or entirely  detached from
 the fundus of the womb, falling down over and cov-
 ering the mouth of the same; from which  circum-
 stance it is termed placenta prcevia, or the placenta
 first.  It may occur three or four weeks  before full
 time for labor has arrived, and manifests itself by
 slight bleeding at first, which may suddenly disap-
 pear and return again after a day or two. If an
 examination of the womb be made, the placenta
 will bo  found covering its orifice.  Having once
 become familiar with  the peculiar rugated feel of
 this organ, it can always after be very easily distin-
 guished from any other part of the mother or child
 or from a blood clot.
   Treatment.— If the period of gestation is not com-
 pleted, and the discharge but very small in quantity,
 the patient should be put to bed and there kept quiet
 for a lew days, in  the  meantime  carefully watched,
 administering  small doses  of  opium  (never  over a
quarter of a  grain at a time, unless there  is  consid-
erable pain; in these  or any other cases always re-
membering that this drug is cumulative, lying dor- 
148
GYNECOLOGY.
mant sometimes  in  the system for a while, and
suddenly  manifesting its  deleterious  properties)
with sugar of lead, three to five grains, every four
hours.   If the hemorrhage be profuse, the indica-
tions are  to  deliver at the earliest moment; and if
the presentation be any other than that of the feet,
the child should be turned  and delivered at once, by
introducing  the  arm, pushing  aside the placenta,
(some  advocate the delivery of the placenta  first,)
and rupturing the membranes high up: a rule to be
followed in all cases of turning when the membranes
have not been previously  ruptured.  The  placenta
is to bo delivered as soon after as possible, and all
available  means used to stop  the bleeding.  Ice in-
troduced  into the cavity  will be very serviceable,
but probably a solution of the perchloride or per-
sulphate of iron, by means of a sponge, introduced
into the  cavity of the womb and brushed  over its
surface, is the most reliable means that can be adopt-
ed in cases of such extreme emergency as these, and
may prove  successful; but, alas, it is too true, in
many  cases,  all that science, art, and the anxiety of
friends can do may prove  abortive, and the patient,
in most instances, soon sinks,  and dies from exhaus-
tion.
   Hemorrhage after delivery.—After all labors, wheth-
er natural or otherwise,  there is some loss of  blood,
which varies in quantity in different individuals, ac-
cording to   peculiarities of  constitution, which is
natural and to be expected from the very nature of
the case, and therefore requiring nothing to be done
for it,  as it will in due time cease of its own accord.
But sometimes a great  discharge may take place 
HEMORRHAGES.              149
either immediately after the completion of the sec-
ond stage of labor, or it may not be for an hour or
two  after the third stage has been  completed, or
perhaps it may not come on for several days there-
after, as sometimes is the case, owing to a partial or
total inaction of the womb, which, instead of con-
tracting  towards its natural size after having ex-
pelled  its contents, remains dilated to a greater or
lesser extent, the blood  in the meanwhile streaming
from its  numerous open-mouthed vessels, which, if
not closed, must very soon result fatally to the un-
fortunate patient.
   In addition to  the womb remaining distended,
the fact of which may be discovered by applying the
open hand over the abdomen of the patient, when the
womb will be found distended nearly the  same as
before its contents  were discharged.  There will
also be a weak, tremulous pulse, accompanied by a
dimness  of  vision, restlessness, sighings, shiverings,
and fainting.
   In the treatment of this condition, the principal ob-
ject is to excite  the womb to action, which of itself
will stop the  bleeding.  Yarious means  have been
proposed for this purpose.  Frictions over the abdo-
men or kneading the same with  the closed fists, as
in preparing dough; by ice thrust into the cavity of
the womb, or by squeezing the juice  of a fresh-cut
lemon  into  the same.  All of these may be tried in
succession, at the same time administering by mouth
ergot, ten (10) grains; of sugar of lead, five (5) grains;
opium, one-eighth, (£,)  made into a  powder, and
given every hour until  four shall have been taken,
or until the discharge ceases.  But the principal re- 
150
GYNECOLOGY.
lianee must be upon the local means recommended
for quick results.  A tolerably strong solution of
Monsel's salt of iron may be injected into the womb;
it is probably the  best styptic that can be used in
such cases.
  A portion of the  after-birth  may sometimes remain
attached to the womb, by which the latter is pre-
vented  from condensing  itself, except below the
fundus.  This phenomenon is termed the hour-glass
contraction, from the womb assuming the shape of
that instrument in its efforts  to expel the remaining
cause of irritation.  In  this case  the hand is to be
introduced into the womb, and the adhering part of
the placenta peeled off, when  the former will resume
its regular and wonted mode  of contracting.

             Inversion of the Womb.
   Too much caution and gentleness cannot be used in
extracting the placenta, or the womb may be turned
inside out, owing to a want of power in the organ to
maintain its natural condition, when but very little
force will be required to induce this unhappy state
of things;  or it may be sometimes so weak, flabby,
and relaxed as to do so spontaneously at the time of
expelling its contents.  In either case it is indicated
by the absence of the tumor usually produced by the
womb immediately after delivery just above the mons
veneris, and more decidedly by the appearance of  a
livid protuberance  found in the vagina upon exami-
nation;  the patient at the same time complaining of
great pains in the lower part of the abdomen, accom-
panied with some considerable straining, vomiting,
and sometimes fainting. 
PUERPERAL CONVULSIONS.         151
  If the placenta remains adherent it should bo
detached, and the fundus of the womb gently and
steadily pushed back, until it assumes its natural
shape and position.

            Puerperal Convulsions.
  There are three varieties of convulsions that present
themselves for consideration as complications, which
may occur either before, during, or after labor.
  They are, first, the hysterical, which usually  occurs
in those of a very nervous temperament or previous
hysterical tendency, mostly at the beginning  of ges-
tation, and is not so dangerous as the other varieties.
It is recognized by being accompanied with alternate
crying or laughing,  with great  contraction  of the
muscles of the back, and  by the absence of entire
insensibility.
  This variety may usually be cut short by applying
cold water or ice to the head of the patient, to be fol-
lowed by antispasmodics, such as valerian, camphor,
and asafcetida.
  In severe and protracted spasms it may be neces-
sary to apply leeches to the temples, in order to break
up the attack.
  They may be avoided to a great extent, by persons
subject to them, by taking, two  or three times per
day, a  bromide  of potassium mixture, according to
the following formula:
Take bromide of potassium............................2 drachms.
    sirup of ginger......... i
          n      ,   }........................of each 2 ounces.
    orange-llower water.. J
  Dose, from a dessert to a tablespoonful,
taking care to  keep  the bowels  well opened by an 
152               GYNECOLOGY.
occasional dose of castor oil, or some other gentle
aperient.
  The second variety, epileptic convulsions.  The pre-
monitory indications of the approach of an attack of
epileptic fits are headache, dimness of sight, ringing
in the ears, rigors, nausea, and sometimes vomiting,
soon followed by loss of sensibility, with the face pur-
ple, turgid, and convulsive movements of its muscles,
especially those of the eyelids and lower jaw, in which
the tongue is apt  to be severely bitten, the breath in
the meantime being forced through the vibrating
teeth in short and peculiar hissings, which, if once
heard or  seen, can rarely afterwards be forgotten
There is also foaming at the mouth, and, as frequently
is the case, involuntary discharges from the bowels
and bladder.
   The spasm may last but a few moments, and cease
or be followed in quick  succession by another and
another, for hours and sometimes days.  If the attack
comes on  before labor, contractions of the womb are
apt  to be provoked by the muscular excitement of
the whole system, in which the child is usually born
dead.  If the  attack occurs during labor, and that
far advanced, it will continue as before, and the child
perhaps be saved.
   When the  convulsions take place not until after
delivery, it may be owing to some injury received
by the  brain  during the expulsory efforts, which
does not manifest  itself for a greater or lesser period
after they have subsided.
   In those who have an  inordinate swelling of the
limbs and a  general  unusual enlargement of the
body during gestation there is seemingly a tendency 
PUERPERAL convulsions.         153
to these convulsions, and they may be anticipated or
prevented to some extent by proper precautionary
measures—such as attention to diet, which should
be sufficient, but light, avoiding indigestible  sub-
stances, keeping the  bowels well cleared, and by
taking suitable and  sufficient, at  the  same  time
moderate, exercise. It  is sometimes the case with
young and  inexperienced married ladies, just  pre-
vious to lying-in, that they will persist in indulging
in strong food sufficient to  last them  through the
siege, as they  term it—a circumstance not  unfre-
quently attended with serious consequences. By all
means the patient should avoid eating much of any-
thing just previous to lying-in, as a loaded stomach
at this period is generally the most frequent cause
of these attacks, although they may be the result of
fright or of  over-anxiety of mind  as to the result of
the labor itself.
   The treatment is to  relieve the  brain from its en-
gorged condition, by general bleeding from the arm,
ice to the head, and  cups (never less than ten or
twenty) to the back of the neck and  along the spine.
It is  best to shave the head, and apply the ice by
means of a bladder  continually.  A purgative of
calomel and jalap, ten  grains of each, or what is
more speedy in its action, Croton oil  combined with
olive oil—two drops of  the former to a  teaspoonful
of the latter. If the spasms occur before labor, noth-
ing more can  be done to assist it until the os uteri
becomes  sufficiently dilated to admit of the  mem-
branes being ruptured, when the operation should
be performed  without hesitancy.  If they do  not
come on until the labor has advanced somewhat and 
154
GYNECOLOGY.
the head within reach, the forceps should be applied,
and the child delivered.  If the head be immovable
by these instruments, and the indications are  that
the child is not  alive, then, and not until then, the
head should be punctured and the child taken away.
As the probabilities are in favor of the convulsions
ceasing after  deliveiy,  in  all cases, when feasible,
the child may be  turned and  delivered, and  thus
possibly both saved.  Great  caution  and patience
are advised in these complications, notwithstanding
the frequent urgings and expectations of anxious
relatives or friends that something  extraordinary
should be done.  It is here that young practitioners,
especially by these importunities, are apt to become
worked up into  such a  state of  excitement, or have
their sympathies  so wrought upon, as to do  that
which they would not and should not have done;
that is, to have unnecessarily interfered, and proba-
bly sacrificed the life of the child, "Whilst  there was
no hope that the life of the parent could have been
saved.  Therefore  these extreme measures  are  to
be  adopted only  after due  deliberation  and ma-
ture consideration  of all  the circumstances  in  the
case.
  The third variety, apoplectic  convulsions, may  be
preceded by symptoms  similar to those of epilepsy.
It occurs most frequently during  labor, and is  the
result of the shock received by the brain in the great
excitement  to the  general system dependent upon
the expulsory efforts of the  uterus.  There is no
distortion of the face or body in this  form of  con-
vulsions, except at the beginning there is a throwing
about of the arms, as in efforts to rise up.  These are 
puerperal mania.             155
soon followed by a general relaxation of the whole
body, with stertorous breathing or snoring.
  The treatment is the same  as  in epilepsy.  The
object is to save the  child, if possible, by rupturing
the membranes, by turning, or by the forceps.  In
all these attacks the  patient will  require the imme-
diate and constant watching of the attendant, so that
any  favorable circumstance occurring may be taken
advantage of that may prove efficient in  restoring
to life and friends a patient under these unfortunate
circumstances.

     Puerperal Mania, or Child-bed Mania.

  This condition may be the result of the great pros-
tration and debility succeeding the convulsive attacks
just considered, or it may be from great debility or
depression occurring during gestation.   It is a degree
of mental derangement, assuming the form either of
dementia, monomania, or general mania.  Whichever
of these varieties or forms it may assume, when ap-
pearing under these circumstances it is called puer-
peral mania, and is characterized by great depression
of spirits,  langor, and indifference, or extreme excite-
ment and violence, in which the patient is apt to have
a decided antipathy to her relatives or friends or even
her infant child.
  The treatment in these cases is to keep the patient
quiet in a  dark room, and removing or keeping away
from her all sources of irritation, whether of objects,
relatives, friends, or even her child, that may for the
time being appear obnoxious to her.  She should bo
constantly watched, and prevented from doing her- 
156
GYNECOLOGY.
self harm.  Under this restraint, with attention to
the general condition of the body, a speedy and com-
plete recovery will usually result in most cases.

                Puerperal Fever.
  This is also  called  child-bed fever, peritoneal fever,
puerperal peritonitis, and fever from inflammation of the
womb.  Some believe the cause of this fever to be an
inflammation of the womb or its appendages, others
that it is dependent upon  a vitiated condition of
the blood.   It is not necessary, in an elementary
work of this kind, to discuss  the probabilities of
either one of these theories being the right one, for it
would occupy too much time and space; but will refer
the reader who may desire to investigate the subject
further to Scanzoni, one of the highest German au-
thorities, who  advocates  that of the blood poison;
also Rokitansky, who advocates the same,  and be-
lieves the disease contagious.
  Dr. Fergurson and other  English  and American
authorities consider  that the disease is capable of
being divided into  four different varieties.  And as
this is the most probable, as well as the generally
accepted hypothesis, and best accords with our own
experience, we adopt  it for our present purpose.
  The first  is  that which most frequently occurs,
commencing with a chill and immediately followed
by fever, pain,  and  great tenderness over the whole
abdomen, especially in the region of the womb; the
skin is hot, pulse quick and small, considerable head-
ache, and confusion of ideas.  These manifestations
at least point to the fact that in this variety the womb
and peritoneum are mostly involved. 
puerperal fever.
157
  The  treatment usually prescribed, if the patient
be of a full habit, is general bleeding from the arm
and leeches to the abdomen, followed by warm fo-
mentations to the same.  Afterwards give a purga-
tive, to have a free evacuation of the bowels, followed
by Dover's powder and a small portion of calomel,
together with sweet  spirits of nitre and liquid ace-
tate of ammonia, and very light diet: beef tea, veal
broth, panada, arrowroot, and  milk.
   The  second variety somewhat resembles that of a
mild typhus fever.  It commences with a chill or rig-
ors, followed by fever, attended with nausea, vomit-
ing, and diarrhea; the tongue soon changes from a
white to a red color, and the skin assumes a dusky
hue; at  the same time there is  violent headache,
confusion of mind, cessation of the lochial discharge,
and the secretion of milk.
   The treatment is the same in the beginning  as in
the first variety, except this will not admit of gen-
eral bleeding, and will require to be treated  with
stimulants so soon as the active stage has passed off.
Give milk punch, wine whey, quinine, and Dover's
powder, to secure rest, or the hydrate of chloral, as
recommended in another part of this work.
   The third variety is  more decided from the very
beginning, and the whole force of the disease seems
to concentrate itself upon the nervous system.   The
patient,  at  first delirious and greatly excited, soon
becomes comatose or stupefied, and may so continue
until the disease terminates in death, which is too
apt to be the case in this variety.
   The treatment must  be  active from  the outset.
Blisters  to  the back of the neck, warm  purgatives 
158
GYNECOLOGY.
and laxative injections are about all  that can be
done in most cases; but every other available means
may be tried, whilst  the patient in the meantime
is  to be made as comfortable as circumstances will
admit.
   The fourth and  last variety is  the worst form
of all.  It is in this  that there seem  to be  unmis-
takable manifestations of blood poisoning.  The pa-
tient soon becomes exhausted, the  abdominal pains
and shiverings are intense, the  eyes glassy,  the
skin  dusky, the pulse quick and feeble, the  breath
laborious and foetid, attended with a husky cough.
These last of themselves are sure evidence  of morti-
fication having already begun in the lungs.
   The treatment consists in the application of leeches
to the abdomen, blisters to the nape of the neck, and
the internal administration  of calomel and  opium,
in the beginning of  the attack; stimulants, tonics,
and beef tea in the latter stage.  This variety, it is
needless  to  add, soon runs  its course, terminating
fatally.
   It cannot be urged too forcibly upon the attend-
ant, especially the young practitioner, that in all
these complicated conditions consequent upon partu-
rition, too much care and attention cannot possibly
be given to the patient, nor can too much caution bo
exercised in making  up a prognosis, as the patient
may apparently be doing well in the morning or at
night, and in twelve hours therefrom become a corpse,
the result of some internal lesion, caused by the vio-
lent excitement and the consequent strain upon every
organ of the body; and though several days may
elapse ere it becomes manifest, it has then completed 
TWINS, TRIPLETS, ETC.           159
its ravages, and death may soon or quite suddenly
close the scene—
  "Or ever the silver cord be loosed, or the golden bowl be bro-
ken, or the pitcher be broken at the fountain, or the wheel bro-
ken at the cistern, then shall the  dust return to the earth as it
was: and the spirit shall return unto God who gave it."

       Twins, Triplets, and Quadruplets.

  It is universally known  that in our  species, as a
general thing, but one ovum of the female becomes
impregnated at a time; and  it is also well  known
that sometimes, from some peculiar circumstance,
more than  one—two, three,  and even four ova—are
simultaneously, or very nearly so, fecundated.  The
frequency with which this  may occur, in the first
instance, or twins, is estimated to be about in the
proportion of 1 to  77|; in  the second instance, or
triplets, it is about  1 in 5,840; and in the third, or
quadruplets, it is estimated  to be about 1 in  129,172
times.
  Labor under these circumstances is often  prema-
ture, and consequently attended with a little  more
danger to parent and child than in ordinary or single
labor.  To the former, or mother, the danger is about
1 to 20; whilst to the latter, or offspring, it is esti-
mated  to be about  as 1 to  3J.  Each child  usually
has a separate set of membranes or envelope and
placenta, although sometimes during the whole pe-
riod  of gestation they are  nourished through one
common  placenta;  especially when  the  offsprings
are not separable after birth, as instanced in the pop-
ularly-known Siamese twins, and the double-lieaded girl 
160
GYNECOLOGY.
on exhibition in this city recently: undoubtedly in
each of these cases but  one set of membranes in-
closed both embryos.
  The children in plural  are obviously smaller than
in single births, though there have been casesreported
of twins weighing each as much as eight pounds. At
times they  are  unequally  developed, and it is be-
lieved that twins of opposite sexes are the  most
common; in which case  it  is also supposed by some
that the female is apt to be sterile: a conclusion im-
 properly determined no doubt from the fact that this
 condition obtains in some  quadrupeds: the cow, for
 instance, from which circumstance they are termed
 free martens.  But it is very generally conceded that
 such is not always the  case in  the human species.
 The indications pointing to the presence in utero of
 more than  one foetus are not usually manifest from
 a superficial examination,  as a mere increased size
 of abdomen in the mother is not an indication of it-
self, because this may be the consequence of a drop-
sical effusion in the abdomen, ascites, or an increased
size of  ovary, an excess  of liquor  amnii, or from an
unusual prominence or projecting inward of the lum-
bar vertebra?, inducing the condition known as sway-
backed, and from  an increased fatty deposition in
the omentum.
  The actual presence of more than one  foetus can
only be ascertained by auscultation, i. e., by placing
the ear  upon the abdomen  of the mother, when the
pulsation of two foetal hearts may be recognized and
distinguished by their separate sounds in  different
localities.
  Labor with plural births  is generally slower than 
TWINS, TRIPLETS, ETC.           161
in ordinary cases, owing to a want of direct concen-
trated action of the uterine forces upon the cervix
and os uteri, which is exerted by the  single wedge-
shaped bag  of water when the contraction at the
fundus takes place, although the pains may be long-
er, and occurring at regular  intervals.  After the
birth of the first  child there is a greater or less pe-
riod  of time, ranging from a few minutes to ten
hours, and sometimes extending to eight days, and
even  six  weeks, before  the  birth of the  second.
There  are several conditions  that may  occur, and
give rise  to the  suspicion of a second child  being
present, when probably it is not really so; therefore,
it is not well to be in too great a hurry to impart
such a suspicion to the mother; wait, at least, until
the fact is determined by  a per vaginum examina-
tion, as the presence of another child may be simu-
lated by the circumstances before mentioned,  or by
an enlarged placenta, kidney, ovary, or spleen.  It
is well  to satisfy the mind fully upon all occasions
in this  relation, as it has  sometimes  happened, on
the other hand, that the  accoucheur has gone off
and unconsciously left a second child in the womb
to perish, and he to bear the obloquy.
  In the  treatment of plural labors, the main  ques-
tion is as to bow and when to interfere for the safe
delivery of  the second child,  which question  must
be decided by the general  circumstances governing
the case at  the time.  It is well to give the womb
ample opportunity to complete its work of expulsion
ere active interference is commenced.  By  way of
filling  up a  part of the time, the usual bandage
may be applied  to  the  mother, with  the  view of
       11 
162               GYNECOLOGY.
tightening it  after the labor shall have been com-
pleted.  If half an hour elapse without uterine con-
tractions occurring, they may be partly provoked by
briskly rubbing the abdomen of the mother and by
the administration of ergot,  as recommended in or-
dinary labors.  In the event  of these means failing,
after  waiting  a reasonable  time, the membranes
may bo ruptured at once, especially if the presenta-
tion is a natural one, and the delivery accomplished
as speedily as may be.
  The same  directions will  apply to triplets and
quadruplets.  Always exercise great care about mak-
ing traction upon the cord of the first child, as the
rupturing of  it may produce  hemorrhage and  prove
fatal to the second.
  If the upper extremities present, it is best to turn
and deliver.   If the hea'd present, and it is within
reach, it is recommended to use the forceps, if neces-
sary, in order to expedite matters.  Whenever inter-
ference has been indispensable to  assist in  the  de-
livery of the first, it will, as  a matter of course, be
required  with the second child.
  It is stated by some, that  if three  or four  hours
intervene before the birth of the  second child,  the
probabilities are that it will be still-born. We  know
that such is not always the case.
  The presentations in plural parturition, to use a
common phrase, become very much mixed up  some-
times: as, for instance,_the right foot of one  and  the
left foot of the other foetus, and vice versa,  may bo
the most pendent; or the same may occur with  the
hands, or the  head of one and the foot or feet of  the
other; or it may bo that the feet or heads of both at 
PHLEGMOSIA DOLENS.
163
 once may present.  From all these,  and other cir-
 cumstances which  may arise, plural  are frequently
 followed  by more dangerous consequences than sin-
 gle labors;  besides, hemorrhages, convulsions, or in-
 flammation of the womb may follow; all  of which
 complications, if either arise, are to be treated as
 pointed out for ordinary labors.

               Phlegmosia Dolens.

   "Milk  leg," "oedema  lactum," "metastasis lactis,"
 "crural phlebitis,"  "oedema dolens."—The true  char-
 acter of this peculiar disease, though long known to
 physicians, has not until  recently been well under-
 stood. Mauriceau supposed it was the accumulation
 of those fluids in the limb that should have passed
 off in  the lochia.  By others  of his countrymen it
 was held  to be a deposit of milk; hence it was  term-
 ed by them "depot du  lait."  Subsequently it was
 attributed to the rupture of lymphatic glands at the
 brim of the pelvis, and again it was considered  to be
 an inflammation of the absorbents. To Dr. Davis, no
 doubt, is justly due the  honor of detecting the true
 pathology of this disease, which he fully describes
 in a work, published in 1823, as  an  inflammation
 of the veins of the leg;  a fact that was verified in a
 few  years afterwards by  Dr.  Lee, who traced  the
 inflamed veins into the womb.  From him it received
 the appellation of crural phlebitis, or an inflammation
 of the veins of the thigh.
  The premonitory symptoms of the  disease  are, a
great depression of the system generally, attended
with considerable  irritability or uneasiness in the 
164
GYNECOLOGY.
lower part of the abdomen,  extending down into
the W, until about the twelfth  or fifteenth day.
There is considerable swelling and tenderness of the
whole  limb.   The bowels are costive, the  stools
light and clayey, no appetite, terrible headache, ac-
companied by a great depression of spirits.
  The swelling may begin at the calf and ascend to
the thigh, or begin at the latter and extend  down-
wards to the calf.  The pain is acute, and increased
by  any efforts to  change the position, and  even
more so if the leg is allowed to become  pendent.
The color of the limb at this stage is usually white,
though  sometimes it is red and shiny from the ten-
sity of the skin, induced by swelling.   The femoral
or thigh vein feels hard, and is movable under the
fingers by making slight pressure directly over it.
Direct pressure with the point of the fingers on any
part of the swollen limb, when performed at the be-
ginning or decline of the disease, is attended with a
pitting, which remains sometime wherever the fin-
gers have been  placed; when the disease  is at  its
height, the pitting is not so easily produced, from
the tension of the skin before spoken of.
  Both limbs may be attacked at once, though such
is not often  the case.   The left is  most frequently
the seat of disease, which in  its acute form contin-
ues about two weeks, and  then subsides; or it may
assume  a  chronic form, wherein  the swelling and
lameness  may continue for months and even  years,
though  generally  it terminates  favorably  in from
two to four weeks.
  The treatment is  to  open  the bowels by the ad-
ministration of a mild cathartic. 
HYSTERIA.                 165
    Take calomel................................. 6 to 8 grains.
         extract of leptandrin................ 1 grain.
         extract of colocynth compound... 6 grains.
         extract of hyoscy am us.............. \ grain.
  Make into 3 pills.  Take one every 4 hours, until the de-
sired effect is produced.
  After which, at bedtime, it will be necessary to
give a small portion of calomel, with Dover's pow-
der—eight grains—to secure rest at night.  Leeches
may be applied along the whole length of the affected
limb, followed by the continued application of warm
fomentations—such as the infusion of poppies, poul-
tices of bran or flax-seed meal.  The patient must
be kept in the recumbent position, with the affected
limb elevated somewhat higher than the body; the
suppression of the lochia, which sometimes occurs,
may be treated by injections of warm water into the
vagina.
  In  the chronic form of the  disease use  frictions,
stimulating lotions, and fly-blisters.  Keep the limb
well bandaged with strips of woolen blauket.  Good
diet and tonics will be necessary also to support the
patient in the latter stage of the disease.

                    Hysteria.

  This disease has already been considered in its re-
lation  to gestation and the puerperal state.  As it is
sometimes present in unmarried females during the
whole period of pubescence, we now'propose  briefly
to consider it exclusively in this relation.
  It occurs at irregular intervals in what  are com-
monly called fits, and may depend upon a partial or
total suppression  of the menses, especially in indi- 
166
GYNECOLOGY.
viduals of an irritable and nervous temperament. It
manifests itself, without any apparent cause at the
time, by the patient suddenly bursting into a fit of
weeping, which may soon be followed by convulsive
laughter.  These paroxysms may follow one another
for sometime, and terminate in a series of loud sobs,
after which the patient usually falls into a doze of
sleep. Mostly, in its inception, it is attended with
palpitation of the heart, and a sensation like unto a
ball rising up in the wind-pipe, (globus hysterica,) pro-
ducing a feeling of suffocation.  In more confirmed
or chronic cases, the fit or spasm is more marked,
and is accompanied  with convulsive  movements of
the hands, lower limbs, and the muscles of the face,
■with dilated pupils.  In all other respects the disease
resembles that already described as attendant upon
the  period  of  gestation  and parturition, and  the
general treatment is the same as therein  pointed
out.

          Chlorosis, or Green Sickness.

  The general circumstances operating to induce this
condition, as well as the disease itself, have been con-
sidered under the caption Amenorrhcea, the  absence
of the menses apparently being the principal cause
of the complaint, or vice versa. But, as it is recognized
as a disease  of itself  by some, a special reference to
it here may not be out of place.  The patient has a
pale, lurid complexion, with general languor, listless-
uoss,  lassitude loss of appetite, depraved digestion,
and palpitations of the heart.  The blood is thin and
light colored, from its  being  deficient  in coloring 
                  ANESTHESIA.               167

matter or iron; in a word, the patient  is ancemic.
The disease may be dependent upon  an  absence of
the menses.  When by proper remedies that discharge
has been established, the former may continue from
an excessive loss of the meustrual fluid.  The symp-
toms and treatment of the disease under these cir-
cumstances  have been pointed out in the article on
Menorrhagia, which see.


       Anesthesia. (Gr., icithout sensation.)

   * * "There is no danger, in that show of death it makes,
   More than the locking up the spirits a time,
   To be more fresh reviving."—Shakspeare.
  From time immemorial, or from that " whence the
memory of man runneth not to the contrary," among
all peoples, nations, and tongues, and  even  some of
the lower animals—so far as they are able  to make
intelligible the fact—there is and has ever been a
natural aversion to that peculiar sensation common-
ly denominated pain; consequently the mind of man
has  in all ages been directed towards some means
whereby to prevent,  assuage, or neutralize this great
enemy to the peace and comfort of animal life.  The
ancients  sought the coveted  prize, and found it ex-
isted to' some extent in the  well-known Cannabis
Indica, (Indian  hemp.)  This drug was prepared
to be taken by them either in  substance in  the
stomach  or by inhaling the vapor evolved from the
boiling plant.   It  has  been stated somewhere (cor-
rectly, no doubt) that this hemp was first used for
the purpose of deadening sensation by the Chinese, 
168
GYNECOLOGY.
nearly two thousand  years since, and was known
among them, in their peculiar tongue, as ma-yo.
  Mandragora, (Greek anthropos, "man," and morphe,
"form,") our  common mandrake or May-apple, at a
more subsequent period perhaps, was a popular anaes-
thetic among the Greeks and  Romans.  As a speci-
men, indicating how far they had succeeded in their
investigations to this end in the thirteenth century,
we give the following  recipe, proposed by Theodoric,
a pupil  of Hugo, in Italy, at that period of time:
"Take," says he, "opium, juice of the unripe mul-
berry, hyoscyamus, hemlock, mandragora leaves, ivy-
wood, forrest mulberry, lettuce-seed,  dock-seed, of
each one ounce.  To  be mixed  (with water, it is
supposed) in  a  brazen vessel,  with a large  sponge,
and let it boil long as the sun  is up in the dog-days.
Let the sponge  absorb the whole, and put it away."
When it was  to  be used, the sponge was  soaked in
warm water, and held to the patient's  nose until
the desired  effect was produced.  This  continued
to be the  most favorite, if not the  only  known,
anaesthetic  for nearly  three centuries, as Bulleyon,
in 1579, speaks  of it as  being used to put patients,
who were to be operated upon  for stone, " in a trance
or a decpe, terrible drcame." This compound, it seems,
had now about served its time, and was objected to
on account  of its deleterious effects  upon some, the
violence of the convulsions, and, no  doubt, numer-
ous deaths which it must have produced  in others.
In the year A. D. 1597 a Neapolitan, Baptista Porta,
published a work upon natural magic, in which he
speaks of a quintessence extracted from  medicines
by somniferous  menstrua.  What the nature of this 
ANETHESIA.
169
substance was we are unable to define, but we are
told "it was kept in leaden veslels, tightly closed,
lest the aura should escape, and the medicine vanish."
When  used, the cover was removed, and the vessel
applied to  the nostrils of the patient, "who draws
in the  most subtle power of the vapor by smelling,
and so blocks up the fortress of the senses that he
is plunged into a most profound sleepe, and cannot
be awaked without the greatest effort; which things
are plain to the skillful physician, but unintelligible
to the  wicked."  Dr. Snow supposed that  the sub-
stance  above referred to must  have been sulphuric
ether.
  Dr. Moore, of London, in 1784, suggested and used
compression of the nerves of the limbs as a means
of preventing pain in  amputations.   It is obvious
that such a method of itself must have been almost
as painful as that produced by the operation of am-
putation, and the doctor no doubt found few aiders
and abettors in his new theory, and probably, it may
be added, fewer patients.  Besides, it  had  more the
appearance of retrograding than  advancing toward
the desired goal.  Whilst all those who were fondly
hoping that some alleviating means would sooner or
later be  suggested began to despair of ever attain-
ing the desired  end, a few years afterwards, A.  D.
1800, Sir Humphrey Davy  came to the rescue, and
proved by experiment  the  anaesthetic property of
the nitrous oxide or laughing gas.  This discovery,
owing to the  attention that was  now given to the
beautiful science of chemistry, was soon, A. D. 1828,
followed by the suggestion of Dr. Hickman of the
probability of there being  an ansesthetic virtue  in 
170
GYNECOLOGY.
carbonic acid gas, a fact that all now know to be
dreadfully true; but it was important  then, and is
mentioned as an evidence of the zeal  with which
the idea of discovering some reliable anaesthetic was s
pursued  by  men of scientific  attainments  at that
time, and whose efforts were so soon to be rewarded
by success.   To  this end our own countrymen can
justly lay claim  to  the honor, for in 1822 Dr. God-.
win had already discovered  that sulphuric  ether
was capable of  suspending sensation,  a fact that
was verified by  Drs. Mitchell  in 1832; Jackson in
1833; Wood and Bache in 1834. But to Dr. Morton,
of Boston, in 1846, the world is indebted for having
turned the discoveries of these gentlemen to account;
for he, by experiment, demonstrated the fact that
the long-looked for  secret, hid away in  the hitherto
unfathomed  recesses of mysterious  nature  for so
many ages, had now revealed itself to the persistent
interrogatories of this bold, fearless, and intrepid son
of science, who,  with temerity and daring, pursued
his inquiries down almost to the very doors of death,
and there wrenched from its hiding-place that boon
which otherwise, probably, would not yet have been
given  us to alleviate the pains that  had so  sorely
afflicted our race from the time of Adam and Eve.
The success which attended the painless dental ope-
ration of Dr. Morton soon spread throughout the
whole of our land and across the Atlantic.  In En«--
land the news of his success for a time caused great
consternation among the surgeons; but they were
swift to  verify  Morton's experiments by those of
their own.   Foremost  among  these was the cele-
brated Surgeon  Liston, whose operations under the 
ANESTHESIA.
171
influence of ether were followed by the same success
that had attended Morton's.
  It was now believed that the  same anaesthetic
property resided in other like substances, and Dr.
(also  Sir) J. Y.  Simpson, of Edinburgh,  who had
turned his attention to the subject, soon after (1847)
discovered that chloroform was capable of producing
the same effects that were attributed to ether, and
used this agent in his hospital and private practice
to alleviate the sufferings of parturition, the  result
of which he has given us  in  an elaborate and ex-
haustive article upon the subject in his truly excel-
lent and complete work on  midwifery.
  In  the month of February, 1848, Drs. Channing
and Perkins, of Massachusetts, the former of whom
has also published a most excellent and ample work
upon the subject of chloroform and ether, frequently
experimented with these agents upon frogs, the re-
sults of which are detailed in the work just referred
to.   The effect of small doses,  as observed  in the
webbed-foot of the frog, was not to interrupt the cap-
illary circulation, whilst larger doses caused a com-
plete stagnation of the blood therein: these minute
channels remaining full and distended, but the blood
in them perfectly quiescent, and so continued until
the effects of the anaesthetic began to wear off, when
the motion was gradually renewed, and the  blood
pursued its wonted course.  These experiments aro
important, inasmuch  as they undoubtedly illustrate
the condition present in the human subject  under
the influence of chloroform and ether.  The success
that has  attended the use of  these agents in mid-
wifery,  and the great relief afforded by them, espec- 
172               GYNECOLOGY.
ially in preternatural cases, when in  the hands of
conscientious and capable physicians, has been such
as to preclude all objection to their use, on any rea-
sonable grounds, even in natural cases, where the
patient is extremely sensitive to pain, or when it is
earnestly desired by  herself or friends.   However,
some object to the use of anaesthetics upon several
grounds, which we will briefly consider.
  What are termed moral objections to their use, i.
e., that there is danger of their being too freely used
where there is no  occasion for them, or that  they
will be indiscriminately used by the vile  for sinister
purposes, might  as reasonably be applied to any
other soporific  medicine, and are  almost too super-
ficial and groundless, either  in probability or  even
possibility, to be worthy of notice, as also are the ob-
jections that they may prove injurious to the child;
for there is no instance of the kind yet known among
the many cases in which they have been successfully
employed.   The other objections, that the pains of
labor are so slight or trifling, as contended by some,
as not to require  their use, or that these agents are
uncertain and unsafe in their effects,  are alike, to
our mind, feeble, preposterous, and childlike.
  Without entering upon a theological discussion of
what has been advanced as the religious  objections
to the administration of anaesthetics in midwifery—
that it is an interference with the decree of the Al-
mighty, as quoted in the introduction to this work,
when " unto the woman he said, I will greatly mul-
tiply thy sorrow in conception; in sorrow shalt  thou
bring forth children"—we may ask if the same ex-
ception would not as justly apply to all other means 
ANESTHESIA.
173
used to alleviate the sufferings of parturition, and
other branches of the healing art?  Indeed, it is not
too much to say that such an idea is at variance
with the progress of science and civilization, not to
say the infinite mercy of God himself, who, although
He "created man uprightly,"  has allowed him  to
"seek out many inventions," necessitated by the fall,
for his comfort, convenience, and relief, whilst pass-
ing through this temporary sublunary existence.
   We  do not  advocate the general and indiscrimi-
nate use of these powerful agents, nor are they to
be used without great circumspection, upon occasions
wherein  they may be strongly indicated or urged by
the patient, and then only by those fully competent
to the task, and always in the  presence of proper
assistants, or at least a third party.
   The best compound to be used is that of equal parts
of chloroform and ether—about a half to one ounce
of each will answer every purpose in most cases—as
the object is to keep within reasonable bounds, i. e.,
not to go beyond the loss of sensibility, as entire
etherization is never necessary in midwifery, except
in instrumental or other difficult cases; and then a
competent person must constantly watch the pulse,
in order to know which correctly,  its nature and
frequency must be fully tested and ascertained be-
fore administering the anaesthetic.   The  effects  of
these agents upon the.pulse are first to excite above
normal, and afterwards to quiet; as the inhalation
continues, it sinks below natural down to forty  or
fifty per minute. At this poiet the desired object has
been attained ;  the inhalation should cease.   There
is  now no pain with  the patient.   All is composed, 
174
GYNECOLOGY.
 calm, and serene.  What is to be done, must now be
 done well and quickly.  Just before the patient passes
 into entire unconsciousness there is sometimes con-
 siderable nausea and  even vomiting, accompanied
 with, no doubt to the patient, a sensation similar to
 that of being under the influence of alcohol, or when
 an individual is said to be " dead drunk."   All that
 is now needed to restore the patient to consciousness
 is to allow a plentiful supply of fresh air, accom-
 panied by, if necessary, friction to the surface of the
 body, flipping it with  a wet  towel, or the applica-
 tion of heat to the same, with the internal adminis-
 tration of stimulants by the mouth or rectum. The
 gradual inhalation of ammonia (hartshorn) we have
 found a most speedy restorative under these circum-
 stances.
-  There are various modes of administering chloro-
 form and ether.  The most simple  means, as afford-
 ing  a  plentiful  supply of pure air, which  should
 always  be allowed as  a dilutant,  is by pouring  a
 small quantity at a time  upon a handkerchief, and
 holding near the mouth and nostril, taking care not
 to allow  it to touch the lips or face.  Dr. Channing
 proposes an inhaler, composed of pasteboard molded
 into a conical shape, near the open apex of which
 is placed a sponge to hold the liquid;  between the
 sponge on the  upper side and the base or mouth-
 piece is a valve for the  escape of expired air.  There
 is nothing to prove the advantage of this compli-
 cated apparatus over the simple method before
 mentioned.
   The sensation produced by inhalation is different
 in different individuals, but  the general effects at 
ANESTHESIA.
175
first, as we have partly experienced upon ourself, are
a tingling in the whole body, similar to that pre-
sented when the foot or arm is asleep, accompanied
by a dizziness  and rumbling noise in the head, like
that of an  approaching railroad train under full
headway; or like unto the noise of a cotton factory
or flour-mill when all the machinery is in  motion.
At first the patient  is more or less amiable  or bois-
terous, until presently she becomes perfectly quiet,
calm, and easily  managed.  The most  appropriate
time for administering the anaesthetic,  if requested
by the patient  or otherwise when it is  indicated, is
not until the second  stage of labor has fairly set in,
for it is in  this  siage, as has been already taught
under the head of Labor, that-the pains are most
severe from pressure of the advancing head upon
the soft parts, besides that accompanying the ute-
rine contractions.
  If possible so to arrange  matters, the anaesthetic
should never be given upon a full stomach, or when
the patient has become very weak and faint from too
long fasting, as in either case it may be accompanied
with  considerable trouble that would  gladly have
been avoided.
  The general  circumstances  indicating the use of
anaesthetics  in  labor cases are—
  1st. When the pains are severe, short,  and  ineffect-
ual, such as  to  restrain the voluntary bearing-down
efforts of  the patient. Here the anaesthetic blunts
sensibility, and thus  allows  the contractions to go
on, continuing  longer, steadier, and more effectual,
to the speedy termination of the labor.
  2d.  When  the patient is of a rigid muscular body, 
176
GYNECOLOGY.
in which the dilating of the soft parts is usually at-
tended with the most excruciating, aggravating, and
thoroughly penetrating pains.
  3d. When the patient is nervous, delicate, and in-
capable of enduring much fatigue.  In  these cases,
by suspending sensibility, she is allowed to pass the
ordeal of labor without pain or comparatively the
least enervation.
  4th. It is now almost generally used in convul-
sions, and in hour-glass  contractions of the womb.
Some contend  that  chloroform has entire control
over and is powerful to neutralize both of these con-
ditions.
  Where  there has been unusual  hemorrhage in
previous labors, or  whenever it is indicated to ex-
cite  uterine contraction,  ergot  may be  given, as in
ordinary cases, without  regard to the  anaesthetic.
Dr. Channing thinks the infusion of ergot the best
preparation  to  be used along with chloroform and
ether.
  Hydrate  op  Chloral.—This now popular medi-
cine  may be recognized by its  being  a white solid,
somewhat resembling loaf sugar, though possessing
granules somewhat finer, and having a sharp pungent
taste and odor, in both of which it is nearly like that
of the ripe melon.   It is very soluble in  water, with
an equal proportion.of sirup, the usual  menstruum
in which it is administered.   This softens down its
pungency and renders it more tolerable to be taken.
It is  gradually coming into general use  as a substi-
tute for opium and its salts—morphia, narceia, mech-
onia, &c —on account of its having almost the same
effects upon the system, except that it leaves no un- 
CHLORAL.                177
\ t'easantness  behind, as is the case with the opiate
id most instances.  It has, comparatively speaking,
been  but little  used  in this country yet awhile,
though in  the Maternity Hospital of Edinburgh it
is used quite extensively to mitigate the  pains of
labor, and some attribute to it anaesthetic powers.
   Chloral may be obtained by the prolonged action
of chlorine upon alcohol, in which the former takes
the place  of the hydrogen  of  the alcohol; conse-
quently it comes under the head of what are termed
in organic  chemistry aldehytfs.
   Though  long known, chloral, until quite lately,
was not used  as a medicine, having hitherto  had
none  of  the  peculiar  properties attributed to it for
which it is  now so  famous, for the discovery of
which and its introduction to the medical world we
are indebted to Liebriech, of Berlin.  It does seem
strange that after so  many years of faithful service
we should be required, in  obedience to advanced
chemical knowledge, to lay aside our  old "sheet
anchor," which possibly ultimately may be the case,
and rear the chloral in its stead.
    "Oh, thou Parnassus!  whom I now survey,
     Not in the frenzy of a dreamer's eye,
       *****
     What marvel if I thus essay to sing?
     The humblest of thy pilgrims passing by
     Would gladly woo thine echoes with his string,
     Though from thy heights no more one muse will wave her
       wing."
  Having had some experience  with the chloral in
the treatment of diseases, generally  when  an ano-
dyne or soporific was indicated,  as well as those for
       12 
178               GYNECOLOGY.
which it is  recommended in this work, with the
happiest results, it is well worthy and seemingly
requires the  special notice we have here given it.

     Management op Child after Delivery.

  Having reviewed  the various  complications  to
which the mother may be liable, both during labor
and after delivery, we next proceed to the consider-
ation of others, that  may occur to the child under
these circumstances.
  It is an axiom in obstetrics, and  a good one, that
meddlesome midwifery  is bad;  by which is meant offi-
cious interference when none is  indicated, and the
labor, if left to itself, would  terminate  favorably to
both mother and child, without any more aid than
that ordinarily  and  peculiarly necessary in such
cases. Therefore it is  evident that a thorough knowl-
edge of  the subject is as  essential in order to know
when not to interfere, as  it is to  know when inter-
ference is required.  But  sometimes it may and does
happen, even to those possessing all these qualifica-
tions, and who upon other occasions may be remark-
able for their gravity, though now, from allowing
themselves to be worked upon by the cries and anx-
ieties  incident to parturition, they lose their usual
calmness, and, by becoming sympathetically excited,
go to work, thinking it a crisis in which something
ought to be done to hasten the delivery.  Others,
from a natural (it may be an affected) habit of head-
shaking innuendoes,  will seek to impress upon  the
patient or those around  her  "that I must do so and
so," and, "if it had not been for this or that,  nothing 
MANAGEMENT OF CHILD.          179
but fatal consequences awaited the mother or child."
Thus,  by continual unnecessary interference, per-
haps, is brought about the very condition which of
all things should have been, and which they gladly
would have, avoided, could they have foreseen  the
trouble they were  brewing;  that is, an alteration
of position, thereby prolonging the labor or injuring
the  child, either by disfiguring  it in some  way, or
perhaps dislocating or fracturing some of its  limbs
in their premature efforts to extract it.  Happily it
may be said of the latter class there are now but
very few of such San Grados and  Gil  Bias in  the
profession at large.
   From whatever  cause,  if  either  of the above
conditions shall have obtained, they ought to be
discovered at once to the  mother, and the proper
means adopted to overcome them.  If it be  the lux-
ation of a joint, it should be reduced, and the usual
means applied to retain it; if a fracture, light splints
and necessary bandages put on; and any other dis-
' figuration of the child must be treated according to
the  nature and condition of the part and the indica-
tions present.
   In face presentations there is likely to be  a slight
turgescence of that side which presented.   A mild,
stimulating lotion (French brandy or the tincture of
arnica) will cause this to disappear in a short time.
   The tumor sometimes found  upon the head, caused
by an  effusion  of serum or extravasation  of  blood
under the scalp, and called caput succedaneum, will
generally go away of its own accord, by being ab-
sorbed, in a few days; but the  same means indicated
above  may be used if it is desired to hasten its de- 
180
GYNECOLOGY.
parture.  Spirits alone, either whiskey or brandy,
will  answer the purpose very well, applied two or
three times per day.  Swelling of the scrotum, or
bag,  in male children, may be treated in a similar
manner.  This last condition, however, is not to be
confounded  with hernia,  or rupture, which may
sometimes  be the  cause of an enlargement in this
region.  If there is hernia, it should be reduced, and
a bandage  or compress applied to prevent its re-
currence.   The rupture is easily distinguished from
the turgescent scrotum by being less firm, and pre-
senting to the hand a feeling as if it were  a bag of
worms; whilst in the latter instance it is tense and
translucent.
  The child should be carefully examined, to ascer-
tain  if there are any imperfections—such  as imper-
forate anus or urethra.   These require surgical opera-
tion, and should be remedied at once, if possible, as
the safety of the child is jeopardized by their con-
tinuance;  as also  should  the deficiency known as
hare-lip and tongue-tie, especially  if they  interfere
with or prevent sucking.  If they do not, the opera-
tion  may be delayed until  the infant has sufficiently
recuperated the better to undergo the operation.
  Hemorrhage from the navel may occur sometimes
after it has  been  tied and the child dressed.  It
should be examined to ascertain the cause. If the
cord  has been cut into by  the ligature, or the latter
become loosened, another must be applied behind it.
If from other causes, astringent lotions, or,  what
is  better, perhaps,  a solution of the perchloride of
iron  or plaster of Paris, (gypsum,) either of which
may  be applied to  the navel, the latter allowed to 
NURSING, ETC.
181
remain  and harden.   In cases where the above
means fail to arrest the bleeding, another and more
decided measure may be  necessary, by passing two
needles at  right angles to each other close to the
abdomen, and then  applying the ligature  behind
them.
  At  all times the navel should  be examined and
frequently  anointed, or at least every time the child
is dressed.   It usually drops off within three to five
days,  though sometimes  not for nine  or ten days.
At the later period generally it is only adherent by
a mere thread of tissue, which may be cut, especially
if it is very offensive; but no harm will result from
waiting until it drops off. It may be that after the
string has been detached the navel will continue to
weep  a thin offensive fluid.  In this case it should be
well examined, and the cause removed, which is likely
to be  a portion of decaying tissue retained within its
folds.   Afterwards wash it out well with tepid water
and Castile soap.   If inflammation has been excited
within the folds of the navel, in addition to the wash-
ing it may require the application of a solution of
sugar of lead,  sulphate of zinc, or  nitrate of silver;
the latter about the strength of from eight to twelve
grains to the ounce of water.

                  Nursing, etc

  It is customary with some, particularly nurses, im-
mediately after the  child is dressed, to commence
feeding it,  or giving it castor oil, or butter rubbed
up with sugar, or sage or catnip-tea; none of which
are necessary, and therefore should be avoided. 
182
GYNECOLOGY.
  The best thing for the child, and mother too, is,
when she becomes sufficiently rested, to  put  the
child to the breast, from which a three-fold advan-
tage is derived.  The child at once takes hold of the
nipple, thereby learning to  suck, and at the same
time obtains a fluid—./irs£ milk—called^ also colostrum
and protogala.  This is  composed of numerous yel-
lowish granulated corpuscles of butter, serum, and
casein, which will have  the desired  purgative effect
upon the infant, removing the meconium, a greenish
or deep black-colored viscid substance, made up of
mucus and bile.  Besides, it  insures the early devel-
opment of the nipple, and at the same time excites
the milk gland to the performance of its function of
furnishing subsistence for the child, which it usuall}
does abundantly in from twenty-four to seventy-twc
hours from the time of delivery, during which period
the healthy infant, other things being equal, will pass
most of  the time in sleep.  If it  should  rouse up,
and become peevish, fretful, and dissatisfied with the
breast, it may be  necessary to allow something to
pacify it, when  a little  warm sweetened water  will
answer the purpose.  This  should  be administered
by dipping the  finger in the menstruum, and not a
spoon, as is customary, and then placing it into the
child's mouth, allowing it to suck the fluid from it;
then repeat the process as  often as may be neces-
sary.  A spoon, it is true, is a very useful, smooth
instrument, and as harmless, perhaps, as anything of
a hard texture that can be used for feeding upon or-
dinary occasions; but it must be remembered at the
same time that very few things are more tender and
sensitive than the tongue, lips, and lining membrane 
NURSING, ETC.
183
of a new-born infant's mouth, through the portals of
which  nothing but what  has been compounded in
the laboratory of nature ought to pass.  And until
it has become somewhat hardened  by contact with
the fleshy nipple of the mother, even the spoon, by
its free use, at least, may and often has been  the
cause of great trouble in bringing about that condi-
tion usually denominated thrush, or sore mouth.
  Drenching the infant, too, with castor oil, or other
unsavory purgatives, may serve very well to give it
a foretaste of  the nausea it may have to experience
through the life upon  which  it has  just entered.
But we question very much its propriety or philoso-
phy as a hygienic measure, when  the infant's organs
are all  tuned  to health, and if let alone would con-
tinue to work in that beautiful  harmony designed
by nature to attend them in the performance of
their respective functions.
   To stimulate the new-born child with ardent spirits,
when there is nothing to indicate their use, but the
whole  periphery of the body is redolent and glowing
with the active vitality within, can only be destruct-
ive to the tender tissues through  which already
         The heart with natural vigor sends
         The ruby liquid to each artery's ends.
   Therefore all of these should be avoided, as they
are altogether superfluous and unnecessary, and more
apt  to  induce a worse condition than that which
apparently they are intended to allay. Besides, their
necessity, if there be any, is obviated by putting the
child early to the  breast, where and when, as  has
already been stated, it will receive all the  stimulus
and all that is required to purge and prepare it to 
184
GYNECOLOGY.
receive that other nourishment—the all-sufficient—
which in due time will be ready, that it may par-
take freely thereof;  and from that font alone, other
things being equal, it can obtain all the nutriment
it will require until it has attained its third or fourth
month, after which period it may not be out of place
to allow it some additional simple food, such as milk-
crackers, soaked in sweetened water, or fresh cow's
milk, and  arrowroot, or whatever simples of the
same nature may be fancied by the mother or careful
nurse. This, besides affording rest for the mother, the
need of which, perhaps, by this time she may begin
to feel from nursing so frequently, will prepare the
child to some extent for the change that is  to oc-
cur when it is to be separated from the breast en-
tirely.
  Few things can be more trying and troublesome,
besides calculated to weaken and break  down the
constitution of the mother, than to have her infant
tugging at the breast all the night as well as all the
day through; yet many submit to it, and allow them-
selves to be "dragged to  death," as they sometimes
express it, when  it could have been easily avoided if
proper means had been instituted at the right time.
For no creature  is more docile than the human off-
spring in its infancy, and it  can be so taught as at
regular  intervals—say four,  six, or eight hours, or
longer if necessary, as it becomes older—to expect
the breast; and  when so taught it will, with the
utmost precision, soon learn  to give  notice of the
arrival of  the period, if there be no preparations
looking towards the approach of the same on the
mother's or nurse's part. 
WET-NURSE.
185
  Thus the child can be used to having its last ap-
plication to the breast just before the mother retires
for the night, with which, after awhile, it will learn
to be satisfied until early morn, thereby allowing her
an opportunity to obtain refreshing and reinvigor-
ating sleep—
             " Tired nature's sweet restorer,
              Balmy sleep."
  Sometimes, from general debility, weakness of body,
or from an extremely sensitive or nervous tempera-
ment, the mother's milk may be poor or vitiated, or
the glands may not secrete a  sufficient quantity to
satisfy the child's hunger.
   In either case it will be necessary to secure a nurse,
or "raise the child by  hand," as  it is termed.  In
all cases, if circumstances will admit, the former is
preferable, when a robust and healthy one can be ob-
tained.
                   Wet-nurse.

   In the selection of a  "wet-nurse," her general ap-
pearance and temperament, together with the age of
her child, and its general appearance, condition, and
health, will usually  be a sufficient criterion, other
things being equal, by  which to judge of the qualifi-
cations  necessary in a  good nurse.  She should be
entirely healthy, her breasts full and ample, and her
confinement should have occurred about the time, or
very nearly thereto,  with that of the mother whose
child she  is to  nurse.  She should be free from any
scrofulous, syphilitic, or consumptive taint. Besides,
she should have a gentle, amiable,  and self-sacrific-
ing disposition,  willing to  enter upon  her duties 
186
GYNECOLOGY.
with zeal, and  not as  if from necessity,  or with a
disposition to impress  the mother of the child that
she is to have in charge with her own independence,
or that she, the mother, is to any extent dependent
upon  her, the  nurse.  If she possess these accom-
plishments, with the necessary physique,  she  is one
greatly to be desired, and can always find  a  pleasant
home whenever such services are required.
  But sometimes it may be, and it is frequently the
case, that such a one cannot bo found, and the mother
is afraid to trust her darling to a nurse not having all
or some of these qualities to recommend her, or from
other causes she prefers to  trust to  herself the care
cf—
           Raising the Child by Hand.

   When this is the case, the object should be to pre-
pare the food for the child  in such a manner as that
it may approximate as near as possible to the  mother's
milk.  This may be done very  nearly by preparing
cow's milk, which differs only from the human milk
in the quantities of some of its constituent elements,
as may be learned from the following table of MM.
Yernois and Becquerel:
                              Woman's milk.  Cow's milk.
Specific gravity.................................. 1032.67    1033.38
Water..............................................  8S9.08     864.0G
Solids..............................................  110.92     135.94
Sugar..............................................   43.64      38.03
Casein.............................................   39.24      55.15
Butter.............................................   26.66      36.12
Salts................................................    1.38       6.64
   It will be observed from this table that the human
milk is  of a lesser specific gravity;  that it is com- 
RAISING BY HAND.
187
posed of less solids, principally in  casein, and has
more sugar than cow's milk;  therefore, in order to
make the latter approximate  more to the former, it
will be  necessary to  dilute it with  water, and add
sugar of milk, or crushed sugar, lime-water, or water
in which the carbonate of potash, in the proportion
of one-half to a whole grain to the ounce, has been
dissolved.  The latter have a tendency to neutralize
the redundancy of casein in the cow's milk, which,
on  account of its being almost  indigestible,  is the
principal objection to it in feeding infants.
  This  mixture—a sufficient quantity, about four
ounces,  enough for one time  only—should be pre-
pared by putting in a bottle, previously well-washed
and scalded, which should then be put into a warm-
water bath until it reaches the temperature required,
or that of the milk when it first flows from the breast.
With this the infant may be fed, at intervals of every
three Or four hours,  during the first two months.
If the child should be satisfied  before the four ounces
be consumed, the  bottle may  be removed, emptied,
well-cleaned  and scalded, and put away until again
required.   It may be best kept in cold or tepid
water during the interval of repose, to insure clean-
liness and freshness.
  The following formula  for preparing  the cow's
milk for infants is suggested for simplicity and con-
venience:

      Hake fresh milk, from a good cow...... 2 ounces.
           lime water, (clear)...................  1  "
           water that has been boiled........  1  "
           sugar of milk and loaf  sugar, a sufficient quantity
            to sweeten. 
188
GYNECOLOGY.
  The  sugar of milk  can be obtained  from any
apothecary.   If located where it  cannot bo found,
the loaf  sugar alone may  be  used in all cases in
preference to any other kind.  If desirable, this mix-
ture can  be improved at times  by the addition of a
little cream.
  Sometimes the milk of one cow will disagree with
the child, and another will be quite wholesome.   In
this case a change may be made in the milk or cow,
until that which will agree with it can be found.
Not unfrequently, from some cause, to some children,
cow's milk  apparently is not at all wholesome.  To
know if this is the case the diet may be changed for
a day or two, by giving beef tea, veal broth, gum-
arabic, or barley-water, and then resume the milk
diet.  If it still continue unwholesome, why then the
change should be made from cow to cow, as above
mentioned, until a suitable  one has been obtained
from which to get the necessary supply.   Goat's or
ass's milk may be  tried with  the  same purpose in
view, or the infant may be kept on the diet just in-
dicated.
  Too much caution  cannot be exercised in keeping
the bottle cleau in the manner pointed out above, as
cleanliness in this respect is very important, and the
child's health is dependent upon it to no little extent.

                NURSING-BOTTLES.

  Nursing-bottles arc of various kinds, shapes, and
forms, so that almost any fancy can be suited in this
respect, or one can be improvised from any kind of
a bottle,  by fastening an india-rubber nipple over its 
colic.                  189
mouth; these may be found in all sizes to suit at the
drug stores generally.  But the neatest, best, and
most popular arrangements  of this kind, at home or
abroad, are the patents of the Messrs. Maw & Son
of London, Botham's of Sheffield, England, and our
own  Eureka Nursing-bottles.  The advantages of
these bottles are, that they have a glass tube perfor-
ating the cork and extending nearly to the floor or
bottom of the vessel, whilst at their upper ends are
attached an india-rubber tube, about six inches long,
with a nipple at the end, just behind which is a shield,
to prevent its being drawn  too far  into the mouth.
With either of these bottles the child can be placed
in a proper position, with the head and shoulders ele-
vated, in its crib, cradle, or bed, and nurse itself cosily;
but care should be taken not to allow it to draw from
the empty bottle, or after its lacteal contents have
been exhausted, or it  will swallow air, which will
cause the stomach to become distended with flatus,
giving rise to that well-known  condition—

                     Colic.

  The occasion of this ailment prevailing so much in
some children, at the breast as well as the bottle, may
be, iu a great measure, attributed to the above fact,
arising  either from the rapacity with which the in-
fant seizes the nipple between its lips at the onset of
nursing, drawing and swallowing before the coveted
liquid flows, or from being retained at the breast after
the latter has become exhausted, and from which it
now obtains nothing, but swallows a portion of the air
drawn through the nostrils.   By attention to these 
190
GYNECOLOGY.
apparently simple things much annoyance to the
mother, pain and physic to the baby, may be spared.
But colic may occur at times from other causes, as
foul stomach, from costivcness, or diarrhea.
  Treatment.—In  the former case much relief may
speedily result from a little jolting upon the knee, in
addition to which may be given, internally, anise,flag-
root, or catnip-tea, or the compound anise powder.  If
it proceed from costiveness, a grain or two of rhu-
barb may be added to the anise; if from diarrhea, four
to ten drops (according to age) of the elixir paregoric,
in  either of the above-mentioned teas or in sweet-
ened water, to which may be added a few drops
of French brandy.  These  will, in  most instances,
prove efficient in removing the flatulence or costive-
ness and checking the looseness of the bowels, if used
respectively as directed.

                 •   Weaning.

  From the period at which the child has reached
the third or fourth month of age its usual diet may
once or twice a day  be substituted by other  food,
such as  the arrowroot, tapioca, and  panada,  or
other easily-digested simple substances; so  that, as
the time  approaches for it to be separated  entirely
from the  breast,  it may be accomplished  without
much trouble—that dread of all mothers.  The pe-
riod at which weaning should take  place varies ac-
cording to circumstances;  but,  as  a  general  rule,
if healthy, when  the  child has reached the age of
one year is about the proper time for  its separation
from the breast, though it is too much the custom 
WEANING.
191
with many mothers  to protract nursing far beyond
this period.
  If the child has been taught to take other food at
intervals,  as  above recommended, the process will
be attended with little or no difficulty.  The periods
for its taking the  breast may be gradually reduced
from four to three, twice, and once daily, and then, by
sufficient feeding at regular intervals, it may be soon
led to forget the breast altogether.  This mode, if
persevered in only a short while, will be found easy,
more  satisfactory,  and far more preferable to those
other means usually adopted by some parents, such
as applying  aloes  and other noxious substances to
the nipples.  These may be successful, but not in less
time than the more  rational method above pointed
out; because in the one the reason and  judgment
of the child are appealed  to, powers which it is
capable of exercising even at this tender age.  At
the same time it is being inducted and instructed
in the principles of substitution, by which it learns
thus early to submit to other changes  in after-life
that may be found  necessary for  its comfort, con-
venience,  and welfare, if reduced to its understand-
ing.   The other mode is evidently more calculated
to fret, excite, and develop some of those perverse
qualities of temper to which the child may be already
too prone by nature, and which may have consider-
able influence for woe upon its future life, temporal
and eternal.  Therefore, it were better not thus to
arouse them.
  Sometimes, from various  causes, it may become
necessary to wean  the child earlier than the period
above mentioned: such, for instance, as great weak- 
192
GYNECOLOGY.
ness and debility on the part of the mother, tending
to vitiate the milk and render it unsuitable  for the
child as  a nutriment; or if pregnancy should take
place; or the  mother may be attacked with some
acute disease,  by which she may be for some time
unable  to  nurse the child.   From any  of these
conditions  supervening, when  a suitable wet-nurse
cannot  be  obtained, the child must be weaned at
once.
   On the other hand, it may be required to prolong
the  period of lactation, owing to  tardiness  on the
part of the child in obtaining its  teeth,  or  from a
too  sensitive condition  of  its  digestive system, de-
pending upon the process of dentition, by which it
is incapable of tolerating any other food than that
derived from the breast.  Either of the above con-
ditions should have some weight in postponing the
time of weaning until the difficulty has passed away,
provided none of those  before-mentioned, to which
she is liable, shall have occurred to the  mother.
   It is  a habit  with some mothers to nurse their
children until  they are two pr three years  of age,
when from no cause is it in the least required; and
we call to mind two instances of the kind at present
(there may be many more)  where the children have
been kept at the breast for even a longer period than
three years, for no other reason than that it was
fancied  to be better for  the child's health; when a
glance at either mother or child was sufficient to dis-
cover its debilitating effects upon  both: The child,
by its pale, attenuated  appearance,  that its stom-
ach was being filled by a fluid, not milk, that sup-
plied, for the time being, the place of a more nutri- 
             DISEASES OF CHILDREN.          193

tious meal that should have been given, and which its
system really demanded. The mother, by her relaxed
and debilitated condition, accompanied with nervous-
ness, frequent palpitations of the heart, and general
lassitude, gave evidence that she was the victim of
a vain hallucination, which, while preying upon her
own life, was abridging that of her offspring.  In
many instances  the object of this prolongation of
lactation is to prevent pregnancy, as it is vainly sup-
posed it will, but which is a fatal error, and there is
no vestige of evidence  to prove such to be the case;
or, if it could be,  the  effects  of the nursing upon
both  mother and  child, by laying the foundation
for a more dreadful disease, would be ten-fold worse
than  that temporary condition which is sought to
be  avoided.  Therefore,  such a practice is  to  be
condemned  and discouraged  by all mothers who
have  at  heart the interest and future well-being of
their offspring and themselves: to ask what mother
has not would be unnecessary  and superfluous.

          DISEASES  OF CHILDREN.

  In the diseases of children, in many instances, very
important circumstances are frequently overlooked
or  made  light  of,  which, if  carefully  considered,
might prove to  be the key wherewith to unlock a
door  that would often throw  a flood of light upon
the case, by which what was apparently complex
will be found susceptible of easy and successful man-
agement. But,  if otherwise treated, merely upon
general principles, according to common indications,
the consequences must often prove dangerous, if not
       13 
194
GYNECOLOGY.
disastrous and fatal, unless perchance the tender pa-
tient luckily escapes, notwithstanding the ordeal of
nauseous medicines it may have to pass through, in
addition to the ailment with which it has to contend.
  One of the most prominent circumstances above
referred to, and which is so often  overlooked, or its
principles  misunderstood, is that  of nutrition and
diet,  some of the rules governing which  we have
endeavored to point out in the  preceding  article
upon the management of children.
  A  child, for instance, may at  first be  well and
hearty, but after awhile begin to  undergo a change
in its general appearance and disposition, accom-
panied by manifestations of uneasiness immediately
after eating, arising from an over-crowded stomach,
or  from something the latter is incapable of digest-
ing.  The food not being properly assimilated, these
symptoms continue more or less  in intensity, until
the child gradually begins to waste away, with its
abdomen greatly enlarged in proportion to the other
parts of its body; its skin becomes pale, the muscles
generally relaxed; its nervous sensibility increased;
it is fretful and peevish, indifferent to play, or soon
 becomes tired and weary from the least exertion;  it
 is incapable of walking, if it walk at all, any ordinary
 distance;  its feet are always cold; it is sleepless, and
 continually thirsty and feverish, especially at night;
 the urine  is scanty and high-colored, or pale and co-
 pious; the discharge from the bowels frequent and
 li«-ht-colored, alternately, or often, at the same time,
 hard and watery, and  always accompanied with a
 considerable  escape of flatus.  The child may ap-
 parently feed well, or be continually hungry, although 
DISEASES OF CHILDREN.          195
its stomach is foul, as  indicated by  sour belchings
and the occasional vomiting  of a pale, acid, frothy
fluid,  which sometimes may be  tinged  with bile.
The parents, wondering why this great change has
taken place, are apt to suppose "the child has worms,"
and all  the neighbors  say the  same; and probably
after  trying, without success, all the  vermifuges ex-
tant, medical advice is sought, and it may be that the
attendant concludes at once, from the general indi-
cations and a superficial examination, and probably
from the supposition of all around, who say, 'Doctor,
I believe the child has worms," that such may be the
case;  or probably it is determined  that its liver,
brain, heart, kidneys, or, if it has a  cough, that  its
lungs, are affected, and  prescribes accordingly; or it
may be made  out  a case of general  debility, and a
course of tonics  and liberal diet are  thought neces-
sary,  and so directed: when, in fact,  the child's diet
is already too  liberal and promiscuous, or inefficient
and hurtful; and if this were inquired into, altered,
and properly regulated, the child would be found to
thrive with little or no medicine at all.
  The above  is  no fancy  sketch, but the  type of
many instances of the  kind, and is drawn from life
in cases  that have come under our own immediate
charge, two of which are here  mentioned in detail
particularly, as they had  been  previously attended
during the past  summer, and in which both, being
almost similarly affected, had been put upon a course
of tonics, without  deriving any benefit therefrom;
but, as the parents stated, they " were  growing worse
every day," from no other cause than that  the at-
tendants had neglected to inquire into the previous 
196
GYNECOLOGY.
manner in which they had been fed, or, if they did,
had failed to prescribe and have carried out a proper
regimen in either case.  Both of these children were
nearly about the same age—one seventeen and the
other twenty months old.  The  younger had not
been weaned, although the  mother was about four
months' gone in a second pregnancy.   In this case
it was evident the child derived no benefit from the
fluid obtained from the breast, which only served to
gratify its appetite for the time being, by filling the
stomach and supplying the place of a more nourish-
ing food that might have been given it, for in a little
while after nursing it would be hungry again.  The
mother "not having  enough milk for it," as she ex-
pressed herself, would allow it to have almost any-
thing to eat that happened first at hand to satisfy and
pacify it, without regard to  the child's age, feeble
digestive powers, or quality of food necessary for it.
   In the other case the same conditions had nearly
obtained, except the child had been weaned, and the
food it had been allowed was altogether unsuitable
to the then present state  of its digestive system.
   The only treatment adopted in these cases was in
accordance with what has been stated above: By al-
lowing nothing but farinaceous substances, with fresh
cow's milk and  lime-water,  beef  tea, veal and  mut-
ton-broths, and a mixture similar  to the following,
of which a half to a full teaspoonful may be given,
in like cases, every four hours during the day:
     Oil of turpentine........................... 1 drachm.
     Pulverized gum arabic..................... 2 scruples.
     Cod-liver oil................................. 1  drachm.
     Peppermint-water........................... 2\ ounces. 
DISEASES OF CHILDREN.          197
   It is not to be understood that the different diet-
 etic substances were given altogether, or in the same
 day, but were alternated, one with the other, from
 day to  day.   Olive or  castor oil may at times be
 substituted for the cod-liver  oil in  the above mix-
 ture, and the latter given alone, in doses of four to
 eight drops,  three times per  day, according to age.
 A powder—composed of mercufy, with chalk  and
 anis powder, half to one grain of the former to two
 of the latter—may occasionally be given along with
 the above.   These  medicines are to act as slight
 stimulants and carminitives to the weakened digest-
 ive apparatus, and assist in the assimilation of the
 food recommended.
   The children, at the time of this writing, are well
 and hearty in looks, and in fact as much so as are
 to be found  anywhere.  As  has  been  already inti-
 mated, we have dwelt thus particularly upon these
 cases only as they are the type of many, and to im-
 press the importance of the facts related upon  the
 minds  of those most interested,  and for no other
 purpose, in hope that it may be the  means of lead-
 ing to  a proper investigation and understanding of
 the subject, when  opportunity is offered, whereby
 many a little one may  be saved much unnecessary
 suffering, the hearts of their parents made to rejoice
 and be  glad  that their child, but now almost lost,
 has again been restored them, renewed in vigor and
 elasticity of mind and body, with the rosy bloom of
 health once more lighting up  its form and features;
 whilst you, who may have been the instrument of so
much good, may be the recipient of  their heartfelt
thanks and lasting gratitude. 
198
GYNECOLOGY.
       Dentition  and its Complications.

  As the above-related symptoms are more or less
present during the period of dentition, and to some
extent may be dependent upon that process, we pro-
ceed to the consideration of that subject as next in
order.

            Eruption op the Teeth.

  The first indications of the formation of teeth in
the infant are by the gums, which hitherto have been
thin and presenting a sharp ridge, now  becoming
thicker  and swollen as the dentine deposition in-
creases, accompanied with  considerable  irritation,
and consequently an increased flow of saliva.  The
teeth arc formed in shut sacs, penetrating the gums
slowly from within outwards and upwards or down-
wards, according to the position they are to  occupy
in the upper or lower jaw.  When fully evolved they
(the deciduous or milk teeth) are twenty in all—eight
front, four in the upper and four in the lower jaw,
which are called incisors, or cutting teeth; next to
these, one on either side, below and above, the four
canine, or dog teeth, commonly  known as the eye
and stomach teeth; and next  to these  the eight
molars, or grinding teeth, four above and four below.
The period at which they first  appear and become
fully evolved varies in different children, but  usually
the process takes place and is completed between
the sixth month and the third year.  There is no
regularity in regard to the order of their appearing,
except in the incisors.  Those in the middle of the 
ERUPTION OF THE TEETH.         199
lower jaw penetrate the gum first, and are soon fol-
lowed by those of the upper in or about the  sixth
or seventh month; then, at the ninth month, the
lateral incisors;  at  the twelfth  month, the first
molars; at  the eighteenth month, the canine; and
in the second and third years, the last of the molars.
These are about the average periods of their evolu-
tion, though, as  above stated, they may differ in
different children.
  Each tooth is divided  by physiologists into  three
parts, consisting  of a body, neck, and root.   They
are composed of three different textures—
  First.  The ivory or dentine makes up the largest
portion of the whole of the tooth, and  constitutes
its form.  It is of a duU'white  color, and somewhat
harder than bone.   Although  it presents a dense,
compact appearance, it is composed of minute tubes,
termed dental tubuli, which are l-10,000th of an inch
in diameter.  They open into  the  pulp cavity, and
radiate from it in almost parallel lines, terminating
in minute cells  or  loops.   They contain  neither
vessels nor nerves, it is supposed.
  Second. The enamel incrusts the body of the tooth,
and, being the hardest, it is thickest upon the grind-
ing surface, which it covers; then, falling down on
cither side, it tapers, terminating  at the neck in a
thin layer.  It is made up of six-sided radiating
prisms of about  l-5,600th of an inch  in diameter.
Like  the dentine,  it apparently  possesses  neither
vessels nor nerves.
  Third. The cementum or crusta petrosa forms a thin
covering for the root.   Its structure is similar to that
of bone.  It is the increase of this substance,  in ad- 
200               GYNECOLOGY.
vanced age, which gives that projecting appearance
to the teeth of old persons.
  Each tooth has a central cavity, containing, besides
its  pulp, an artery, vein, and nerve, which enter it
at the apex of the root.  This cavity becomes dimin-
ished in the adult by the formation of cementum upon
its  inner walls;  thus preventing the exposure of the
pulp from the wearing away of the body of the tooth.
  The principal complications dependent upon  den-
tition, caused by the great change that  the whole
organism of the infant is undergoing in its transition
state from an exclusively milk  to  a more complex
diet, are diarrhea, convulsions, and vomiting.

  Diarrhea.  (Greek, dia—through, and reo—to flow.)

  This is not exclusively a disease of dentition, but,
often  occurring in this connection, it is usually de-
nominated cholera  infantum, or  summer complaint of
children, and teething.
  The second summer is  the period  generally in
which they are  most  liable  to the disease.  Besides
dentition, the disease may result from a close, im-
pure atmosphere, acting directly upon  the skin, and
through it indirectly upon the digestive system.
  It usually commences with vomiting, attended with
profuse, light-colored,  and thin watery discharges
from the  bowTels.  At the same time the pulse is
quick  and  feeble, the tongue white and slimy, the
skin hot and dry—the head and abdomen especially—
whilst the extremities, which preserve  their natural
temperature  for  a  while, soon  change,  becoming
cold.   Delirium  sometimes occurs about this time, 
CHOLERA INFANTUM.
201
and  is recognized by the wild look  of the  eyes,
whilst there  are  frequent tossings  of the  head
to and fro, with attempts to  bite at imaginary or
real  objects.   The child becomes not  unfrequently
greatly prostrated in a few hours, and  may die sud-
denly from exhaustion; but, as a general rule, the case
continues for some days, or even weeks, with  great
emaciation; the eyes become languid, sunken, and
the whole countenance  changed; the lips thin and
dry; the nose pale and pointed; the skin upon the
forehead tight and shiny.  If the child obtains no
relief, it  soon  falls into a half comatose condition,
with the eyes  half open, whilst the discharges from
the bowels are involuntary and offensive, the  skin
cold and clammy, the abdomen tympanitic or dis-
tended and  tight; all of which symptoms continue
until death comes  to relieve the little sufferer of all
its pain and trouble.
  In the treatment of this disease the first thing to
inquire into is the previous diet of the child.  If still
nursing,  it should be confined  exclusively to the
breast.  If it has been weaned, the diet should con-
sist of cold mucilaginous drinks—such as arrowroot,
ground rice, tapioca, milk, lime-water, and pounded
ice, and the following powder given  every three or
four hours:
     Take hydrargyrum cum creta, (mercury,
           with chalk)............................. 3 grains.
         creta preparata, (prepared chalk)... 8   "
  Make into 6 powders.
  To be followed with a mixture, composed of sub-
carbonate of bismuth twelve grains, and two ounces
of fennel or peppermint-water, of which a teaspoonful 
202
GYNECOLOGY.
may be given every  two or three hours.   At the
Bame  time the "spiced plaster,"  made of powdered
allspice and cloves, wet  in hot  spirits or vinegar,
may be applied to the abdomen, to assist in relieving
the tension.   The above mixture may be alternated
by giving the following:
    Take sulphite of soda.................... 4 grains.
        a»omatic sirup of rhubarb ]     t   , -,
                  r         \.... of each 1 ounce.
        mint-water            J
  Dose, same as the above.

  The gums are to be examined.  If much swollen
and hot they should be lanced, by  cutting well
down upon the teeth.   This, if it is to be done at all,
must be done before the child  becomes too much
prostrated, or it is too late to be of service.   The
operation, parents may be assured, is entirely pain-
less, and there is no danger attending it in one case
out of a thousand.  To secure quiet and repose to
the little sufferer, a mixture of bromide of potash—
twelve grains, in two  ounces of simple sirup and two
of peppermint or  cinnamon-water—may be given.
Dose: a teaspoonful about every four hours.
  The apartment in which the child is kept should
be well ventilated, and, if the case is a protracted ono,
when the weather will  permit, the child  may be
taken out into the fresh air in the morning and early
evening. The turpentine mixture, heretofore given,
will be found beneficial in this complaint.

                  Convulsions.

  The convulsions of infants frequently depend upon
disordered dentition,  but may proceed from other 
VOMITING.                203
causes, such as an over-loaded stomach, or from some
indigestible substance, or perhaps worms, producing
an irritation in the stomach or other portions of the
alimentary canal.  The first indications of their ap-
proach are a twitching of the muscles of the arms or
legs and face,  and  a sudden  rolling of the eyes up-
wards.  Sometimes convulsions may occur without
any of these  premonitory symptoms being mani-
fested.
  The treatment consists in the application of cold
water to the head, or the plunging of the whole body
into a warm bath.  If the paroxysm continues, an
injection, consisting of olive  or castor oil, or lard, in
about four ounces of tepid  water, may be thrown
into the bowels, after which a leech to each  tem-
ple and hot applications to  the extremities. These
remedies will generally prove efficacious in restoring
sensibility, if applied in the order above detailed, after
which a purgative may be  given, followed by the
bromide of potash mixture, as given in the previous
case.   The gums should be examined, and if hot and
swollen, they should be lanced at once.

                   Vomiting.

  Yomiting of itself is not a disease, nor is it to be
regarded as anything serious,  unless accompanied
with  other symptoms.   Most of children will vomit
immediately after nursing, which may be looked upon
as  a  favorable circumstance, as by it the stomach
becomes relieved of over-distension.   If it had con-
tinued, it might be the cause of considerable discom-
fort to the child, if it did not produce convulsions. 
204
GYNECOLOGY.
 But repeated vomitings are very weakening,  and
 soon prostrate the patient, and may be  dependent
 upon some irritation of the brain or its coverings, as
 will be observed more in  detail under the head of
 Hydrocephalus.
   It can usually be relieved, when there is no com-
 plication, by applying mustard, mixed with flour, to
 the region of the stomach, cold to the head,  and
 pounded ice given internally, with lime-water and
 milk.  If there is much prostration, a small quantity
 of French brandy and water or  cold  milk-punch
 will be found advantageous and strengthening.  The
 sub-carbonate of bismuth will sometimes succeed in
 checking vomiting when all  other means fail.  It
 may be given in connection with the  above, in one-
 half to one-grain doses, in water, every hour or two.

           Infantile Remittent Fever.

   This disease may attack children at any age, from
 nine months to twelve or fourteen years.  When
 occurring at the earlier period, it may, to a great ex-
 tent, be dependent  upon  dentition,  though it is
 mostly attributable to errors of diet.   By some it is
 considered to arise from miasmatic influences, and
 by older or earlier writers  to  depend upon worms,
 and is called by them worm fever; probably from the
 fact that  these  vermin are sometimes voided by
 children  affected with this disease.  They may  be
 considered a complication rather than  a cause of the
 disorder.
  The fever usually occurs in one of two forms, acute
or chronic.  The  former attacks the child  suddenly. 
REMITTENT FEVER.
205
The bowels  generally are costive, but sometimes
irregular, and the discharges thin and offensive, the
tongue  coated  white, the  urine pale.  The fever
comes on in the evening, preceded by a chilliness or
rigors.  When  at its  height, the child is drowsy,
its  face flushed, the temperature of the whole body
increased, with the hands and abdomen hotter than
any other portions of the same.  If the child sleeps,
there are moanings, sudden startings, and screaming
accompanying  it;  the pulse varies from one hun-
dred and twenty to one hundred and  fifty, more or
less, per minute; the  fever usually continues from
six to nine hours, when it begins  to abate; it  is then
succeeded by a slight perspiration and  quiet sleep
for awhile.  When the child awakes in the morning
it is apparently better, and perhaps  has some ap-
petite, and becomes  playful.  But toward evening
indications of the approach of fever begin to mani-
fest themselves again.   As they  continue, the fever
threatens to be more violent than on the day before.
It may now be accompanied with vomiting, great
headache, and  sometimes pain in the bowels.  In
the very young, convulsions may take place at this
stage of the  disease.  Each succeeding  day, unless
arrested, the paroxysms assume  a more violent and
threatening aspect, or,  after a  day  or two, they
may moderate, and gradually run into  the  chronic
form, in which the same symptoms  continue,  but
with less violence, or even so insidious  as to proceed
without attracting particular notice, until the child
shows evidence  of declining health by wasting away.
The abdomen becomes enlarged, whilst the  child's
strength gradually fails. The bowels, at first cos- 
206
GYNECOLOGY.
tive, may  be  succeeded by a painful diarrhea,  in
which portions of the food sometimes will bo found
discharged undigested.  The tongue is coated, but
not dry;  the pulse varies from  one hundred  and
twenty to one hundred and forty, usually the former
in the morning and  the latter in the  evening.   If
the disease is not arrested, the symptoms continue
unabated until the child becomes attenuated, wastes
to a mere skeleton, and then dies really from inani-
tion.
  In  the treatment of  this  disease, attention is first
to be  directed to the condition  of the bowels.  If
costiveness prevails, they  should be well opened  by
the administration of a purgative;  the best in this
instance, probably, is the following:
      Take calomel.............................. 1 to 3 grains.
          pulverized rhubarb or jalap..... 1 to 4  "
          pulverized anise-seed............. 1 to 6   "
  The greater or lesser quantity, according to age; made into one
powder and given in sirup.
  If this should fail to act  speedily in six or eight
hours, it may  be followed by a tea or tablespoonful
of castor oil.   After this, in the absence of fever, the
sirup  of quinine, made by  suspending the quinine
in simple sirup, in the proportion of two grains of
the former to an ounce of the latter for a child nine
months old, and from two to twelve grains of quinine
in the same menstruum for those older, according to
\ge, of which a teaspoonful may bo given every two
jO four hours.   If taken in  time, these remedies will
generally  cut  short the attack in forty-eight hours.
If the disease continues, or has made further inroads
upon the system, in  addition to the above the diet 
REMITTENT FEVER.
207
should be inquired into and properly regulated.   A
nursing child should be confined  to  the breast.   If
it has  been weaned  recently or for  some  time, and
is very weak and debilitated, a light  and nourishing
diet should  be allowed, with the  administration  of
the turpentine mixture, as recommended  under the
head of Diseases of Children, in the opening of this
section.  The cod-liver oil may be given alone, and
not  in the mixture, in doses of six  drops to a tea-
spoonful three times per day, according to age.   In
addition to these internal remedies, in the chronic
stage the child may be put into  a tepid  salt-water
bath once a day at first, then after awhile every
other day.  In addition to the salt, or as a substitute
therefor, chamomile flowers x>r red-oak bark may  be
added to the water.   The child  should not be  al-
lowed to remain in the bath more than four minutes,
as a longer period is apt to prove somewhat enervat-
ing.  When taken out of the bath the child  should
bo  briskly rubbed until the skin is perfectly dry,
then dress it and wrap  comfortably  in  a blanket
and put to bed, when it will generally fall  into a
sound sleep, from  which it will awake  refreshed
and more vigorous.  If the child improves, the baths
may be reduced to but one a week.  The effects of
these baths with children are wonderful, and it is
astonishing how rapidly  they improve under their
use from this most-generally tedious and  fatal com-
plaint.
  The only tonics needed in this connection are suit-
able exercise in the open air, with  small doses  of
quinine, as above directed, which act as an anti-
periodic, and at the samo time strengthen and give 
208
GYNECOLOGY.
tone to the whole system.  Both of these are most
excellent adjuvants to the baths.
  The turpentine is not only useful as a slight stim-
ulant to the mucous membrane of the bowels, there-
by removing the flatus,  but it gently stimulates the
kidneys, and will destroy and  expel any  vermin
that may infest the stomach or intestines.  For the
tympanitic and enlarged belly the best application
is the oleum camphorce, to which a few drops of tur-
pentine may be added, rubbed well over the abdomen
two or three times per day.  The latter in the mean-
time should be supported by a flannel bandage, worn
continuously and tolerably tight around the body.
The bandage should be  wide enough to extend from
a little below the hips nearly up  to the  breastbone.
It may be made  with  gussets to fit over the hips,
and tied behind with loops, or carefully and smooth-
ly pinned  on either side of the spinal column.

                Hydrocephalus.

Acute imflammation  of the coverings  of the brain, or
              tuberculosus meningitis.

  The second of these terms—acute inflammation of
the coverings of the brain—expresses the true condi-
tion in this disease, and the first that resulting from
the second, or water on the brain;  whilst the third—
tuberculous deposition in the coverings of the brain
—indicates a predisposition to the tuberculosus dia-
thesis; but the disease  is  generally recognized and
described  under  the  caption  here  given  it—hy-
drocephalus—and manifests itself in one of two
forms, viz,  acute and chronic.   The former may  be 
                HYDROCEPHALUS.             209

subdivided into  three stages.  In the first stage the
symptoms somewhat resemble those of the infantile
remittent.  There is headache, vomiting, costiveness,
the urine scanty, high-colored, and thick, with fever
occurring at alternating periods, in which the tem-
perature of the head  is greatly increased  in  pro-
portion to the  body.   The  tongue is  coated, but
not usually dry; the  eyes are suffused,  with the
pupils contracted.   Unable to sit up or dreading to
be lifted up, the child cries and reaches out to its
crib to be laid down, and then  almost continuously
moans and rolls its head from side to side upon the
pillow. It sleeps but for a very short time, in which
it is restle>s and excited;  in which condition it is
liable  to fall into  convulsions  at anytime;  or the
excitement may somewhat subside, and the disease
pass into the second stage.  In this stage great drow-
siness supervenes, with the  pupils of the eyes dilated
and insensible to light, giving a steady vacant stare,
whilst the balls are  turned to either side.   These,
other things being equal, are unmistakable symptoms
of the child  having passed into the second stage
of the disease.   The pulse  diminishes in frequency
and power.  There is  now considerable tremulous-
ness of the hands and arms, which are usually raised
to the head, accompanied with a constant twitching
of the muscles of  the  face.  The  child, frequently
rousing from its stupor, cries as if in great agony,
and thus passes into the third and last stage, in which
convulsions of a part or the whole of the body take
place.  The pulse becomes  small and frequent; the
pupils more dilated; the skin cold and covered with
a clammy sweat; the  breathing is heavy; the dis-
       14 
210
GYNECOLOGY.
charges from the bowels  are involuntary and very
offensive.   The little patient now becomes entirely
comatose, and may die in  a brief convulsion or pass
quietly away from earth to heaven without a single
struggle.
   The treatment of this variety must be active and
decided from the outset, as there is little hope of re-
covery if  the disease passes into the second stage:
active purges and  leeches to the temples, (some re-
commend bleeding from the arm, even in very young
children,) ice to the head, warmth to the feet, and
blisters back of the neck.  If the disease does not
yield to these measures, and passes into the second
stage, the probabilities of recovery are few indeed.
Should an abatement of symptoms take place, the
treatment must be moderated accordingly, and the
patient put upon a light nourishing diet, slight stimu-
lants, and mild tonics, until  all danger is past and
convalescence evident, which will soon follow.
   The chronic form of hydrocephalus may exist from
birth, or not appear until after a few months, or even
years. It is manifested by a gradual enlargement
of the head, which may continue until it attains an
enormous  size.   This enlargement is owing to an ac-
cumulation of fluid within the  cranium, distending
it  and separating the bones, preventing their ossifi-
cation and union,  thus  leaving the  fontanelles en-
larged, and covered only with membrane.   One case
of this kind has come  under our  notice, in a child
three or four  years old,  in which  the  head  was
larger and apparently weighed more than the whole
remaining portion of  the body.   The additional
symptoms attending this malady are a loss of flesh, 
THRUSH.
211
great dullness and obtuseness of intellect, with evi-
dent manifestations of great pain in the head.  There
are only two ways of treating this form: that is,
compression  of the  head, by  bandaging  it,  or by
puncturing at the fontanelles, allowing the fluid to
escape, after  which the bandages may be continued.
Happily this variety of the disease is very rare, as
there is little hope of recovery.

               Aphthae, or Thrush.

   Infants and more advanced children are most liable
to this disease, although it may occur at any age. It
is recognized by the presence of small, round, white
specks on the inside of the  lips, cheeks, roof of the
mouth, and  tongue.  They arc formed by elevated
portions of epithelium covering a drop of serous fluid,
and as they fall off, the surface exposed has a reddish
or raw appearance.  They succeed each other at dif-
ferent intervals, in greater or lesser crops. The mouth
is hot and tender, so that sucking cannot be accom-
plished without pain. In attempts to nurse, the child
no sooner grasps the nipple  than it lets go again,
 with crying and fretting.  Sometimes the disease is
 accompanied Avith constitutional symptoms: fever,
 drowsiness,  colicky pains, flatulence, and diarrhea.
 The stools arc green and blimy, and sometimes very
 acrid, which produces a redness and tenderness of
 the anus, giving rise to the common idea that the
 disease has gone through the child.  The cause of this
 disease in infants is frequently owing to a  too free
 use of the spoon, as before  intimated when treating
 of the  management of children, and is most often 
212
GYNECOLOGY.
found in  those children  raised by hand, though it
may depend upon other causes, such as bad diet, im-
pure air, and neglecting to wash out the child's mouth,
which should be done, in  health, once a day at least,
with  tepid water.  It is  not  attended with danger,
unless it assume a low form of gangrenous ulceration,
which it does in some constitutions.
   Treatment.  The mouth  should be well washed with
tepid water, after which with a solution of sulphate
of zinc in rose-water, about the strength of fourteen
grains of the  former to an ounce of the latter, three
or four times  per day.  In addition to this, the well-
known domestic remedy of borax, sage,  and honey
may  be all that is necessary, if  the disease is met at
the beginning.   In  its more advanced stages, and
attended  with fever, the following may be given:
       Take hydrargyrum cum creta............ 2 grains..
           supercarbonate of soda............ 1   "
   Mix and divide into four powders.
One to be given  in any  menstruum, such  as sirup,
honey,  or sweetened water, every  four hours, to be
followed by a teaspoonful of castor oil  in  a  short
time after the last powder is taken.  In the mean-
time a solution of nitrate  of silver in rose-water, ten
grains to the  ounce, to which add one  drop of creo-
sote, to be used as a wash.  It should bo  applied di-
rectly to the patches with a swab of linen.  A mix-
ture composed of
      Chlorate of potash.......................... 12 grains,
      Elixir of  calisaya..........................   1 fluid ounce,
      Orange-flower water......................   1 "    "
  Mix.   May be given internally, in  teaspoonful doses, every
four hours. 
            ERUPTIVE DISEASES—GUM.         213

  And if continued some time will usually effect a cure.
Either the solution of zinc or  nitrate of silver may
be applied to the  mother's nipples, if sore, immedi-
ately  after nursing.  But the  very best remedy in
either case, as we have recently discovered, is the
following:
      Take sulphite of soda......................  8 grains.
          carbolic acid...........................  2   "
          distilled water........................  2 ounces.
  Mix, and use as a wash.

  For older persons the above remedies,  increased
according to age,  will serve equally as well.
EXANTHEMATICA, OR ERUPTIVE DISEASES.

  This classification of diseases will be considered
here only as they commonly affect children.

              Strophulus, or Gum.

  This is a papulous affection of the skin, occurring
in infancy and childhood.  It is commonly known
as the gum.  When the eruption is white, it is called
white gum; when red, red gum;  when yellow, yellow
gum.  It may depend upon some  irritation in the
stomach or incipient teething, and is most common
in infants fed with the spoon.  It is generally harm-
less, and  requires little or no medical treatment in
most  cases, and will disappear after  awhile of its
own accord.  Sometimes a dose of magnesia may be
necessary to expedite its departure, if accompanied
with sour eructations. 
214
GYNECOLOGY.
         Scarlatina, or Scarlet Fever.

  This is a well-known  eruptive contagious disease,
in which  the skin and mucous  membrane of the
throat are involved.  It may present itself in one
of three forms: Scarlatina simplex, mild or simple
scarlet fever; scarlatina anginosa,  in which the in-
flammation of the throat is of a serious nature; and
scarlatina  maligna, or putrid  sore throat, which  is
always dangerous and speedily fatal in most cases.

               Scarlatina Simplex.

  In this form the precursory symptoms are chilli-
ness, followed by flushes of heat, nausea, sometimes
vomiting, and general debility, until the second day,
when the  eruption appears  in  little  elevated red
points, upon the face, neck, chest, and abdomen, also
upon  the tongue, throat, and  palate, which, by the
third day, have become thicker, with serrated edges,
covering the whole  body.  The tongue i3 coated
white, through which the red  elevated papillae pen-
etrate, an indication and characteristic of the dis-
ease;  the pulse is hard,  full, and frequent; the skin
dry and very hot. Upon  the buttock, folds of the
joints, and groin the color generally is of a deeper
hue than elsewhere.  About  the fifth  or sixth day
the spaces  between  the eruptive patches become
wider and  somewhat subdued in color.  Between
this period and the tenth day, in this  variety, des-
quamation, or peeling off of the skin, begins to take
place from the feet, hands, and other portions of the
body, and convalescence usually soon follows. 
SCARLATINA MALIGNA.           215
             Scarlatina Anginosa.

  In this form the symptoms are more violent from
the start, consequently it is more dangerous, from
the throat being more seriously involved, which, by
the second day, may be so much inflamed and swol-
len as not to admit of swallowing without difficulty.
The almonds of the throat and soft palate arc soon
covered with a thick viscid fluid of a light yellowish
or cheesy color.   The eruption, which  appears the
second or third day, is slight, and not so diffused  or
vivid as in the simple variety, and  may suddenly
disappear, when symptoms of inflammation of the
stomach and bowels present themselves, indicated
by the  tongue assuming a  bright  red  color, with
nausea, vomiting, and diarrhea, or, as sometimes is
the case, the bowels are obstinately constipated.
   It is  in this variety of scarlatina  that the little
one hovers so long between life and death, and from
which,  if it recover, those unpleasant  sequels—ab-
scess of the glands of  the throat, deafness, and
dropsy—are apt to ensue.

              Scarlatina Maligna.

   This  form sets in with greater violence than the
last variety; so violent in some instances, that the
little patient may die in twenty-four hours, or in less
time even,  before anything can be done for it.  The
eruption is of a livid hue, and may come and go sev-
eral times, if the  patient survive any length of time.
The pulse  is small and  irregular;  the  tongue and
teeth are rapidly covered with a black or brownish 
216
GYNECOLOGY.
foetid substance; convulsions or coma soon set in,
from which the patient seldom  or never recovers;
consequently there is  little hope to be held out  to
parents and friends from  the beginning, and they
should be early prepared for the  worst.
  The treatment of the first variety is very simple,
easy, and most always successful. If the bowels are"
costive, a mild purge may be given, followed by mild
diaphoretics, such as Dover's powder, one-eighth (f)
to one-quarter (£) of a grain, every four hours; or a
mixture composed of the following:
     Take liquor ammcnise acetatis (spirits of
          mindererus).............................. 3  drachms.
          sweet spirits of nitre................... 1  drachm.
          cinnamon water.........................  H ounce.
  Mix, and give a teaspoonful every four hours.
  To be followed by, or given alternately with, the
above, a mixture composed as follows:
    Chlorate of potash........................... 10 or 15 grains.
    Elixir calisaya...............................  1 ounce.
    Peppermint water...........................  1 ounce.
  To be given, in the same dose as the former mixture, every
four hours.
  The diet should be light,  and as  convalescence
comes on more  nutritious, with beef tea, &c.   The
throat is to be examined in the beginning of the at-
tack, and washed inside with a watery solution (fif-
teen grains to the ounce) of chlorate of potash. Exter-
nally, hartshorn or volatile liniment may be applied,
and the neck bound around with  flannel, and kept on
until the recovery is complete.
   Treatment of Scarlatina Anginosa.  It is this form
in which the treatment is so various, and the disease 
scarlatina maligna.
217
itself so trying to patient, parents, and  attendant.
In addition to the intestinal irritation, the throat is
the principal point of anxiety and part to which the
remedies arc to be  directed.  It is recommended
from the start to rub croton-oil liniment upon the out-
side of the throat and  breast, and wrap around or
cover with flannel; at the same time mop the throat
inside with one of the following formulae:
       Take sulphate of zinc...................... 20 grains.
           rose-water.............................  1 fluid ounce.
  Mix.
   Or,
       Take chlorate of potash.................. 30 grains.
           rose-water............................  1 ounce.
  Mix.
   Or,  that which will be found more efficacious—
       Take nitrate of silver....................... 12  or 24 grains,
             to the same quantity of rose-water as above.
  Mix.
   The patient may be allowed to  swallow from a half
to a teaspoonful of the chlorate of potash mixture ev-
ery time the throat is washed, which should be three
or four times a day,  with either of the above washes.
The following may be given internally:
       Take carbolic acid............................. 1  grain.
           sulphite of soda........................ 2  "
           acetic acid............................... 2  drops.
           simple sirup.............................. 1  ounce.
           purewater..............................  1   "
  Mix.  Of which a teaspoonful may be given every three or four
hours,  together with, at different intervals, shaved  ice, lime-
water, and milk.
   Thecroton oil acts by determining the eruption to
the skin, and thereby relieves the throat and lungs" 
218
GYNECOLOGY.
 to a great extent, whilst the zinc, chlorate of potash,
 and nitrate of silver  assist in subduing the local in-
 flammation.  The carbolic acid, ice, lime-water, and
 milk quiet  the action of the stomach and intestines.
 The  carbolic acid and theNsulphite  have a peculiar
 effect in subduing the fermentation in the stomach,
 whilst the  milk imparts its mild nutritious proper-
 ties.   During the period of desquamation a nutri-
 tious  diet and sirup of quinine, as a tonic, may be
 given.  The following is an excellent formula, espe-
 cially for children:

       Take sulphate of quinine............ 4 to 8 grains.
           fluid extract of glycyrrhiza
            (licorice)........................ 1 fluid ounce.
           elixir calisaya...................    "    "
  Mix, and give a teaspoonful every four hours.

   The temperature of the sick room should be kept
 as equal  as possible, and the patient carefully  pro-
 tected from theslightest changes of the atmosphere,
 by being lightly but sufficiently covered in bed. Flax-
 seed tea and gum-water, as drinks, may be given in
 the active stages of  the disease.
  The malignant variety requires stimulants  and
 tonics from the start, and all efforts should be made
 to determine the  eruption to the skin.   Chlorine is
 highly recommended by some in each variety, espec-
 ially in the anginosa and  malignant. The following
 is the  formula:
       Take chlorine-water....................... 1 drachm.
          pure.water............................ 3 ounces.
          compound sirup of asarum........ 1 ounce.
  Mix.  Dose: A dessert  or tableapoonful, according to age,
every three or four hours. 
MEASLES.                 219
  Scarlatina  is undoubtedly a contagious disease,
though the exact  period of its existence at which it
is most so is  not  understood, but is most probably
before or when the eruption is at its height.   It is
usually epidemic, and, according to circumstances,
prevails in a mild or aggravated form.  As a gen-
eral circumstance it has been of a mild type in this
region since 1864.

        Rubeola, (ruber—red,) or Measles.

  The symptoms  of this disease, at its inception, are
those of fevers generally, accompanied with catarrh,
redness, and suffusion of the eyes, cough, hoarseness,
sneezing, and some constriction of the  chest, and
pain during respiration.
  The eruption appears about the fourth day of the
fever, in the form  of small circular or crescent-shaped
spots on the face, neck, chest, abdomen, and  limbs.
The redness attains its height about the fifth day of
the disease, second of the  eruption, after which  the
general symptoms subside, or become  considerably
moderated.   About the fourth day of  the eruption
the spots  gradually assume a yellowish tint, and in
a day or two more the scarfskin becomes detached
and begins to peel off.  When unaccompanied with
catarrh the disease is  termed French measles, or rube-
ola sine catarrh.
  Sometimes complications, such as bronchitis, pleu-
risy, pneumonia,  ophthalmia,  and diarrhea  are at-
tendant upon measles.  Of these the lung complica-
tions excite  the   most solicitude,  and render  the
disease somewhat dangerous and protracted. 
220
GYNECOLOGY.
  The treatment may be conducted upon the same
principles as in simple scarlatina.  The complications
are to be treated, as if the eruption was not present,
by external applications of mustard first, and, if ne-
ccssary, blister plasters to the breast or back if the
lungs are  affected, and to the belly if diarrhea super-
venes.
  The sudden disappearance of the eruption is some-
times attended with danger, as it is an evidence of
the  intensity of the  internal  irritation,  or may be
attributed to sudden exposure to cold.   Stimulants
and warm bath may be used to overcome this com-
plication.  The hoarse cough which attends conval-
escence will usually yield to a mustard plaster applied
to the breast. If the pulmonary symptoms are slight,
and the outward manifestations of the disease goon
regularly, the prognosis is favorable.
  The disease is contagious, and may be imparted
to others by inoculation.  A  second  attack of this
disease and scarlatina is improbable.

          Varicella, or Chicken Pox.

  This is  an  eruptive contagious disease.  It is ush-
ered in by a slight fever, that disappears upon the
appearance of the eruption, which comes on in a day
or two.  It is vesicular, and matures about the fifth
day, and then begins to dry up,  and falls off about
the  seventh.  A second attack  is  improbable.  It
sometimes occurs as an  epidemic, and is undoubted-
ly caused by a  specific contagion.   In most cases
little or no medical  treatment is  required.  A dose
of Husband's magnesia or a solution  of  the citrate 
vaccination.
221
of magnesia may be given to open the bowels, fol-
lowed by acidulous drinks—lemonade or dried-apple
water, made by pouring boiling water upon dried
apples.  They should be taken cold.

         Vaccination.  ( Vacca—a cow.)

  The vaccine disease is best explained in describing
the process, as follows:
  Having procured some good lymph or a fresh crust
from a healthy child, (an infant of two or three months
old is the best,) remove a small spot of the cuticle or
scarfskin upon the upper third of the  left arm, by
scratching  it with a needle or lancet; or with the
latter make four or five slight incisions, at right an-
gles to each other, not deep enough to draw blood, if
possible, and  insert the lymph, or a portion  of the
crust, previously made  into a thin paste with  a drop
of water.  Allow that inserted in the arm to become
dry, after which it may be let alone, or protected by
a piece of adhesive  plaster placed over it.  If the
patient is susceptible to the disease, about the third,
sometimes not until the fifth or sixth day, a small red
pimple, partly elevated above the surrounding sur-
face, makes its appearance, which in a day  or two
afterwards becomes a vesicle.  This continues to en-
large by its filling with serum, and after awhile be-
comes depressed in the center.  About the sixth day
the areola  or red circle around the base of  the pock
becomes visible.   The whole now continues  to  en-
large until about  the  tenth day, when the disease
usually reaches its  height.   The  pock may now
measure from one-fourth (i) to one-half (I) an inch 
222               GYNECOLOGY.
in diameter, depressed, with a small scab in its cen-
ter.  The areola may extend to a very little distance
from the base of the pock, or it may cover a radius
of four inches or more.  As the scab in the center
enlarges, the serum beneath it is converted into pus.
About between the eighteenth and twenty-first days
the crust  begins to loosen and falls off.  The areola
at this time commences to disappear, leaving a cica-
trix or  scar peculiar to the  disease, so easily recog-
nized by  every one.   In some instances, when the
disease reaches its  height, there is considerable
fever, attended with an eruption on other parts of
the body, and  an enlargement of the gland under
the arm.  If the vaccination pursues  a course  simi-
lar to that marked out above, it  can be relied  upon
as being genuine and protective, not otherwise; for
any one may have a very sore arm, which may jeop-
ardize their lives, from having had inserted into the
former some subtile substance  intended or supposed
to be vaccine virus.  Therefore, it is well to be ac-
quainted with the source  from which the matter to
be used originated.
  The best and safest period for vaccination is at the
ago of two or three months, as at this time generally
there is not so  much disturbance of the system de-
pending upon teething.  The subject for vaccination
should be in good health at the time of the operation,
otherwise its progress may be interrupted, or at least
modified.   There is some difference of opinion  as to
the length of time during which the vaccination con-
tinues  effective.  The safest plan is to have it re-
newed at least once in seven years, or whenever the
small pox prevails in a city, town, or neighborhood. 
VARIOLOID.                223
Although  there is some evidence to prove that in
one or two instances persons who have never been
vaccinated may have suffered from a second and
severe attack of small pox, there is none to show
that those who have  been well vaccinated were
ever attacked with variola or small pox, except in a
very mild form, known almost everywhere as "va-
rioloid."   Consequently, to offer any argument in
support of vaccination at this late day (seeing how
the pestilence that was wont to walk in  darkness
with gigantic strides to and fro about the earth  has
been tamed by its influence) would indeed be a work
of supererogation.  Therefore, it is not our purpose
to attempt it, for its utility is a self-evident truth.
  During the spring of 18G2 the writer vaccinated
not less than five hundred individuals, three fourths
of whom were  children of both  sexes, and it is  be-
lieved that not one of these was attacked with va-
riola during the epidemic then prevailing or since,
though many of them were exposed to the various
forms of the disease.  These facts, it is thought, may
be taken as some little evidence as to the efficacy of
vaccination.

Varioloid, (variola small—pox: Gr., eidos—"like" or
                    "form")

  A modified form of small pox, in which there is
but slight or no febrile symptoms in most cases.   It
appears with an unimportant papulous or vesicular
eruption, which runs on until about the fifth or sixth
day and then dries up.
  Little or no medical treatment is required, except 
224
GYNECOLOGY.
a saline purgative of epsom salts or magnesia, and
careful protection at the same time from the vicissi-
tudes of the atmosphere.  Persons  who have not
been vaccinated are liable  to take small pox from
this disease; a fact which of itself ought to be a suffi-
cient proof of the efficacy of vaccination to modify
an attack of small pox, and induce all to avail them-
selves of the protecting influence of the same.

Variola, (varius—"spotted," or vari—"pimples")
                   Small  Pox.

  This is not a disease peculiar to childhood, but as
children that have not been vaccinated seemingly
are more prone to an attack, and from the very na-
ture of things are more exposed to the  disease, than
grown persons, its character may be  here noticed
and its course described.
  It is contagious, and inaugurated by fever setting
in and continuing for two or three days before the
eruption appears.  There  are  three varieties, viz:
the distinct, the confluent, and the malignant.  In the
first, the pustules are distinctly separated from one
another, and, with good nursing, will usually ter-
minate favorably.  In the second, the symptoms of
fever are more aggravated, the pustules thick, and
run  into each  other.  In  the  third, malignant or
black small pox,  the eruption  sometimes does not
appear until  after death, which may result in from
twelve to twenty-four hours from commencement
of the attack.  It  is then to  be seen making its
appearance under the  skin in  dark or livid spots,
which  soon  coalesce and  spread over the  whole 
small pox.
225
body, giving it the peculiar feature from which its
name is derived.
  Three distinct stages occur  in the first and second
variety: The eruptive, maturitive, and declining stage.
The first of these stages sets in about the third day
of the fever, appearing in minute red  pimples, on
the face first, then the body, and extending out upon
the extremities.  By the fourth or fifth day they form
into pustules, with a depression in the  center, (um-
bilicated.)   About the sixth day they become full and
distended, losing their umbilicated feature.  About
the eighth day, the maturitive stage, they assume a
brownish  color;  and by the tenth or eleventh day
they begin to burst or dry up; and from this to the
twentieth  day, the  declining stage,  they fall off,
leaving their characteristic scar or depression  upon
the skin.
  It is a  favorable indication, and  can in most of
cases, if not every one, be relied upon as such, when
the pustules become  well-developed, and  run the
regular course as marked out above.   On the con-
trary, if the pustules fill  slowly, and present  q, re-
laxed or flabby appearance, it may be looked  upon
as a serious case,  and death may occur at any pe-
riod, probably from some  violent  internal complica-
tion hitherto not manifest.
  During the epidemic that prevailed  in this city
(Washington) in  1861 and 1862, being at that time
a city physician to the  poor, (fourth ward,) the
writer had some days  under  charge as  many as fif-
teen and  twenty cases of all varieties,  from which
continued experience  he  soon learned  to make up
a prognosis, favorable or unfavorable, very  shortly
       15 
226               gynecology.
 after the eruption made its appearance, in which he
 seldom or never failed to see his predictions in refer-
 ence to the termination of the malady realized even
 in confluent cases, in which there is always so much
 to excite anxiety and  doubt as to  how the disease
 will possibly terminate.
   The treatment consists principally in having good
 and constant nursing, by some one not afraid of the
 disease.   We bmve seen many die from sheer neglect,
 apparently arising from fear on the part of those
 immediately around the patient.  If the bowels are
 costive in the beginning of the attack, they may be
 opened by calomel and jalap, or magnesia alone, after
 which Dover's powder may be given as a diaphoretic
 and to secure rest  at  night, mucilaginous drinks,
 flavored with lemon; to which may be added sweet
 spirits of nitre, one ounce to the pint  of flaxseed-tea
 or gum water.  The diet should be light—beef tea,
 rice and milk.  If necessary, as indicated by great
 difficulty in swallowing, the throat may be swabbed
 out with a solution of nitrate of silver, about twenty
 grains to the half ounce of water.  As convalescence
 becomes evident, the diet should be more nourishing
 and  slightly stimulative; wine whey  or milk  punch
 and  sirup of quinine may be given.
  The odor exhaled from the body during an  attack
 of this disease is peculiar, and if once inhaled will
 not easily be forgotten; in fact the disease can be
 detected in a  house by one who has an acute olfac-
 tory, and is acquainted  with the odor.  The  sick
apartment should be well ventilated,  and disinfect-
ants  freely used.  All persons are liable to an attack,
unless previously vaocinated. 
CROUP.
227
                     Croup.

  This disease is so called from the peculiar noise
made in breathing during an attack.  It is likened
to that made by a chicken affected with the pip.
There are two varieties recognized by medical wri-
ters  in this country, viz, the catarrhal and pseudo
membraneous.
  The first is usually preceded by symptoms of ca-
tarrh and a thick husky cough.  The paroxysm takes
place generally at night, when the patient suddenly
awakes with a difficulty of breathing, accompanied
with  a shrill noise, great anxiety, restlessness, and
distress in the effort to obtain a full inspiration ;
the face is flushed, the  cheeks turgescent, with an
expression of great anxiety for  relief.   Death by
asphyxia may result from the violence of the attack,
or it may subside spontaneously, and be renewed the
next night.
  It is best treated by giving an emetic in the par-
oxysm.  For this purpose a half  to a  teaspoonful
of sirup of ipecacuanha may be given in warm wa-
ter, and repeated at short intervals until vomiting
has been induced.  This is the best emetic for young
children, though tartar  emetic, one to three  grains,
may be given in the same menstruum—warm water;
also sulphate of zinc, two or three grains at  a time.
Afterwards the throat and breast may be rubbed with
some stimulating liniment, as turpentine and the vol-
atile or croton oil, to be  followed by the internal ad-
ministration of sirup of ipecacuanha, six drops to a tea-
spoonful, according to age, every four hours, to keep 
228
GYNECOLOGY.
up slight nausea.  It will be necessary to give calo-
mel to break up the plastic tendency of the  blood.
Thus—

   Take calomel.................................... 2 to 4 grains.
        ipecacuanha.............................. J to 1 grain.
        anis powder,  a sufficient quantity.     __
  Mix, and divide into four powders; one to be given every four
hours.

  If the paroxysm be severe and protracted, the
patient may be put into a warm bath, and leeches
applied to the temples or throat.
   The pseudo membraneous (false membrane) croup.—
The membrane is formed from the exudation which
takes place in the trachea or windpipe.  It is of an
exceedingly plastic  or pasty nature.   The cough, at
first muffled and dry, is soon attended with  an ex-
pectoration of  a  thick, viscid,  and  ropy mucus.
There is great turgescence  about the  neck and  face,
the cheeks are swollen and livid.   If not arrested,
the disease continues to advance, and  the symptoms
become more aggravated.   The cough, though less
frequent, is now more suffocative, and  the patient, in
efforts to breathe, throws about the arms and grasps
the throat or any immediate surrounding objects, and
shortly dies in convulsions or great distress, not only
to the sufferer, but  to those near, who are compelled
to behold the horrible spectacle without being able
to afford relief.
   The treatment is the same as in the  former variety
in the beginning, though it must be  more decided.
Calom.cl must be given, with a view of bringing the
system under immediate control, and tartar emetio 
             SPASM OF THE GLOTTIS;          229

or ipecacuanha, to keep up a continual nausea, to
break up  and, if possible, expel the adventitious
membrane.  In all  cases, without  waiting  to see
which of the two forms the disease is going to as-
sume, it is best to commence with croton liniment,
applied externally, and a strong solution of nitrate of
silver, twenty to forty grains to the ounce of water,
internally to the throat.  The mopping of the throat
will  serve the place of an emetic sometimes, from
exciting the fauces; if not, the  latter  may be given
afterwards.   The operation  of tracheotomy, opening
the trachea or windpipe,  may  be performed when
other means give no hope of relief; but to  be ser-
viceable it should not be too long delayed.


             Spasm of the Glottis,

  Or spasmodic croup.—A condition  apt to occur  in
children about the  time  of weaning,  caused by  in-
gesta or irritation in teething.  It is manifested  by
a sudden difficulty of breathing, from a spasm of the
muscles of the tongue.  The child loses its  breath,
throws  up  its  hands, and turns  blue about the
mouth and under the eyes.  Upon recovering, the
child makes  a long crowing inspiration.  If severe
and  protracted, the paroxysm is apt  to prove fatal.
   Treatment.—During the spasm throw cold water
upon the  face or put the child into  a warm bath,
which means will usually  be successful in breaking
up the spasm; afterwards give a close of castor oil,
and keep the child upon a light diet for several days
to prevent a return. 
230               GYNECOLOGY.
  Diphtheria, or Diphtheritis, (a pellicle, a skin.)

   This disease resembles and is sometimes confound-
ed with croup, but it differs from the latter in the part
attacked.  Croup is usually confined to the trachea,
(see Croup,) whilst diphtheria attacks the pharynx or
back and side of the throat, and  may extend down
into the oesophagus or gullet.  It is manifested by
an inflammation of the parts, soon followed  by a
white or yellowish mucus, evolved from the lining
membrane, filling up the pharynx and covering the
almonds of the ears, attended with a dangerous and
very low form of fever,  with great prostration.  If
not relieved, suffocation  and death soon take place.
   The treatment must be decided and active from the
start,and addressed to the part affected—the throat;
nitrate of silver, thirty grains to the ounce of water,
or even stronger, applied by means of a mop inside,
and cioton oil outside, freely rubbed until an erup-
tion is produced, and then cover with flannel.  The
inside should be mopped three or four  times a day
at first,  and then but once or twice a day, with the
internal administration of calomel and ipecacuanha,
until the inflammation has been reduced; to be fol-
lowed by quinine and slight stimulants  in the debil-
ity that .ensues.  Diphtheria is apt to be followed by
paralysis  of one or more parts of the  body, which
sooner or later passes off, and  the patient entirely
recovers therefrom.  Chlorate of  potash in solution
has been  recommended, and  is a favorite remedy
with some, as a wash for the throat and to be taken
internally. We have always considered the disease 
WHOOPING cough.
231
too formidable and dangerous to trust to such a mild
application to the throat in the acute stage, in which
the treatment, as above given, has been attended with
no little success in our hands, but consider it useful in
connection with elixir calisaya, given internally, in
the debilitated stage of the disease.   Tincture of the
muriate of iron, in doses of fifteen or twenty drops, fre-
quently repeated, is recommended by some; but we
would not advise its being given in such large doses
or at all to very young children.  Two to five drops,
according to age, would probably be inside of safety.
The disease  usually prevails in an epidemic form.
It is believed to be contagious by some, and doubted
by others.   But one thing is certain, and that is, if
one of a family, consisting of a number of children, is
attacked with the disease, the others usually take it.
Therefore it  is well to examine the throats of all in
a family, if one have the disease, with a view of early
counteracting any symptoms  of inflammation that
may be present. Frequently the disease is so insidi-
ous,  as to subtilely attack and destroy the patient
before anything can  be done for it;  consequently
any manifestations of the disease should be attended
to without a  moment's delay, and be met with deter-
mined and decided treatment.
  The sulphite of soda and carbolic acid,  as pre-
scribed in the treatment of scarlatina, may be used
as a  wash to the throat and given internally in diph-
theria with some benefit.

        Pertussis, or Whooping Cough.
  This is a well known and easily-recognized con-
tagious disease, particularly attacking children, sel- 
232
GYNECOLOGY.
dom or never but once the same individual.  Adults
are liable to have an attack if they have  escaped it
in childhood.
  It usually begins with a cold or catarrh, which
may last for some days, when  the cough becomes
convulsive and recurs at irregular intervals, brief at
first, but after awhile lasting almost twenty minutes
in some cases.  Each spasm consists of a quick succes-
sion of coughs, until the patient  is nearly exhausted.
The fit of coughing is accompanied with  the expec-
toration of a thick shreddy phlegm, and  sometimes
terminates in vomiting, or it is interrupted by a so-
norous inspiration or whoop peculiar to the disease.
In the paroxysm the face becomes puffed or swollen,
and livid; the eyes suffused and  balls protruded.  In
the beginning of the attack the coughing does not
come so frequently, but after awhile it recurs several
times a day, and becomes more severe toward evening
until the period of decline, when it comes on in the
morning and evening only, and  still later, at the
latter period or evening alone.
  Whooping cough generally continues from five to
nine weeks or longer. The younger the child, the
greater  is the danger.   Pneumonia and  bronchitis
are sometimes complications.  If these do not exist,
the intervals of cough are unattended with fever or
loss of appetite, and the child can go about almost
the same as usual.
  Treatment.—At the  inception of the disease it is
well to  administer a mild purgative of rhubarb or
jalap, to be followed by—
     Take sirup of ipecac......................... 2 drachms.
         sirup of asarum....................... \\ ounces. 
WORMS.
233
          sweet spirits of nitre................. 2 drachms.
          oil of amber........................... 4 or 6 drops.
  Combined into a mixture, of which a tea or dessertspoonful
may be given every three or four hours.
  If complicated with pneumonia or bronchitis, a fly
blister may be applied to the chest.
  The gum ammoniac plaster, worn  constantly upon
the breast, will considerably modify the spasms of
coughing, and cut short  the  disease.  It should be
large  enough to cover the whole of the breast, ex-
tending from the collar bones to the inside of either
shoulder,  down over and below  the  breast-bone.
The milk  of asafoetida,  one ounce, may be added
to the above  mixture, or given alone in teaspoonful
doses every  four hours.   Alum, powdered,  in two-
grain doses, is recommended by  Dr. Meigs in this
disease.  Frictions of garlic, oil of amber, and tinc-
ture of  belladonna,  to  the  spine, are  considered
useful  in  modifying the paroxysms, and may be
tried.
  The disease is supposed to depend upon a peculiar
irritation  of  the pneumogastric, a nerve distributed
to the lungs and stomach.  When the disease proves
fatal, it is from the complications above  mentioned,
or from oedema of the lungs, and  sometimes from
pressure upon  the brain, produced by a protracted
paroxysm  of coughing.  Vaccination is said to bo
influential in modifying an attack of  whooping
cough.
                     Worms.

  Three varieties or species of worms usually inhabit
the intestinal canal of children and others. They 
234
GYNECOLOGY.
are the ascaris lumbricoides, a round, long worm, from
four to twelve inches in length, which occupies the
stomach and intestines.   The head is sharp and set
within three tubercles, whilst the tail terminates in
a fine point.  The ascaris vermicularis, or thread-worm,
is about  an inch or less in length.  These usually
infest the rectum, and a few may be discovered  by
dilating the same, when they will gradually wriggle
themselves out, or they may be removed with  blunt-
pointed forceps.  The tamia, or tape-worm, of which
there are two species commonly found in the human
subject: tcenia lata, the broad tape-worm, from three
to fifteen feet in length, and occupies the upper part
of the  intestines;  tamia solium, the long tape-worm,
from thirty to forty feet long, found  occupying the
same situation as the former.
  The  symptoms indicating the presence of worms
generally arc griping pains in the abdomen, nausea,
vomiting, irregular or  loss of appetite, disturbed
sleep,in which there is a gritting of  the teeth, irri-
tation  or itching of the nose or  anus, foul breath,
dilitation of the pupils, headache, strabismus or squint-
ing,  emaciation, and  sometimes convulsions.  The
bowels are irregular, mostly loose, aud stools slimy.
  The causes operating to favor the development of
worms are indigestible and unwholesome food.  The
principal object in  the treatment is to expel the ver-
min, and then by  suitable diet and tonic  medicines
prevent their further growth.   The first  indication
is  accomplished by medicines  called anthelmintics.
The  most effective of these are  cowhage, pink-root,
wormseed, camphor, and turpentine.
  A  grain or two of calomel mixed with sugar, and 
PORRIGO LARVALIS.
235
given to a child, followed soon after with a dose of
castor-oil and turpentine, a tea to a  tablespoonful
of the former, according to age, and four to fifteen
drops of the latter, will frequently expel all  the
lumbricoides that may be in the stomach or intes-
tines.  An injection into the rectum of Castile soap-
suds will wash out the  thread-worms.   Turpentine
in large doses has been recommended for the tape-
worm.  The oil of fern likewise.  But probably the
very best vermifuge is  made by rubbing  up about
four to  twelve grains of santonin with an ounce of
the  "fluid  extract  of spigelia and  senna."  Four
grains to  the ounce of extract will be of sufficient
strength for very young children.  Dose:  half to a
full teaspoonful, given three times a day.  This mix-
ture has less of the odor peculiar to most medicines
of this kind, which  makes them so nauseous to chil-
dren and even adults; a circumstance of itself that
commends it to parents generally.
  A good preparation for children suspected of hav-
ing worms is the compound sirup of koosso, combined
in the same proportion with the spigelia or alone.
Dose, same as the above.  After the expulsion, good
wholesome diet and exercise are the best means of
preventing their development again.

               PORRIGO LARVALIS.

   Crusta lactea, or milk crust.  This easily-recognized
malady is  almost exclusively confined to infants,
and commonly makes its appearance on the forehead
and cheeks, at first in little white and pointed pim-
ples, crowded together upon a red surface.  They 
236
GYNECOLOGY.
soon break  and discharge a viscid fluid, which be-
comes  hard  and forms thin yellowish scabs.  This
process may continue, becoming thicker and spread-
ing, until the whole  face, except the eyelids  and
nose, are covered;  hence the term larvalis, a mask.
The eruption is attended with considerable itching,
which  may disturb the sleep and affect the appetite
and  digestion, thereby causing  some  debility  and
distress.   Sometimes the eyes become inflamed, and
the ears  give out a  discharge, whilst the glands
under  the latter are swollen and  tender.  Diarrhea
may set in, attended  with a wasting away.  But
most often the disease terminates favorably, though
it may be somewhat protracted and troublesome.
  The treatment  consists in attention to the bowels
and regulating the diet, as has been already pointed
out at an earlier period in this work.  The affected
parts may be bathed in tepid water and Castile soap,
followed by a watery solution of sugar of lead. Cod-
liver oil internally, in doses of a few drops to a tea-
spoonful, according to age, will  be found useful in
this disease.

            Incontinence of Urine.

  Children are usually affected with this condition.
It may depend  upon  debility or paralysis of the
sphincter muscle of the bladder, a muscle surround-
ing the neck or outlet of that organ, or upon a sensi-
tive state of the  whole bladder, whereby it is unable
to retain the urine, especially during sleep.
  The treatment is to give tone to the whole system
by good diet and tonics.   The following formula for 
MUMPS.
237
the administration of iron will  be found pleasant
and effectual for children:
   Muriated tincture of iron.......................... 1 drachm.
   Tincture of cantharides............................. £ drachm.
   Chlorate of potash................................... 1 scruple.
   Simple sirup........................................... 2 ounces.
   Orange-flower water................................. 2 ounces.
  Mix, and give from a tea to a dessertspoonful every four hours.
  The iron pay be increased to two drachms for
adults.
  The flannel bandage, previously recommended in
this work, will be found useful  in  this  disease, by
the protection to, and the  gentle  irritation and ex-
citement of, the circulation upon the surface it sur-
rounds, thus preserving from chilliness or the sudden
changes  of the atmosphere, which usually excite the
kidneys  or produce a contraction  of the bladder. It
is well for parents, upon themselves retiring for the
night, when  the  child has  been  put to bed  earlier,
to rouse it up and let it  use the vessel.  This not
only relieves the distended bladder, as  it is apt to
be at this time,  but gives  it an  opportunity to re-
cover its wonted tone  and sensibility.   Besides, it
accustoms the child to getting up, which it will soon
learn to do  of its own accord when  it desires to
micturate.

              Parotitis, or Mumps.

  This well-known affection is an inflammation of
the parotid glands,  the glands situated under the
ears.
  The indications are a slight fever, which moderates
upon the appearance of an enlargement under the 
238
GYNECOLOGY.
ear;  sometimes it is on but one side, at  others on
both.  It usually increases in  size until the fourth
day, and then gradually subsides.
  Treatment.—In most cases, a dose of one teaspoon-
ful or more of magnesia, to move the bowels, at the
same time apply to the tumor some stimulating lini-
ment, (volatile liniment is about the best,)  and cover
with flannel.
  Mumps are apt to become troublesorrfe from their
tendency to recede,  and attack the glands of the
breast in female and the testicles in male children.
This is sometimes the result of applying cold to the
tumor in the beginning.  Warm applications to the
glands under the ear, mustard, or a blister-plaster
back of the neck, will be  necessary to invite them
back.
   AFFECTIONS OF EYELIDS  AND EYES.

  Under this head those most commonly affecting
children only will bo but briefly considered.

              Hordeolum, or Sty.

  A painful boil at the edge of the  eyelid.
  Treatment.—In  the beginning it  may be arrested
by the application of cold, or alum-curd, made by
rubbing alum with the white of an egg.  Afterwards
it may be necessary to encourage it to suppurate by
poultices.   When  it has fully formed it may be punc-
tured with  a needle. 
CLUB-FOOT.
239
               Ophthalmia  Tarsi.

  This is an inflammation of  the margin of the eye-
lids, so that they stick together from the congealed
lachrymal  fluid accumulating during sleep.   It is
commonly found in those of a scrofulous tendency.
  Treatment.—Attention to diet, and the application,
three or four times a day with a camel's-hair pencil,
of citrine ointment.

       Purulent Ophthalmia in Children

  Usually appears a few days after  birth, most fre-
quently about the  third.
  Symptoms.—The lids, which are kept closed, upon
being drawn open, present a red appearance, and at
the same  time  discharge a  thick purulent mucus.
It is attended  with  considerable restlessness and
sometimes fever.
  Treatment.—Keep the eye well washed with breast-
milk or tepid water.  If it does not yield to this, wash
with a weak solution  of sugar-of-lead water.   Or
      Take sulphate of cadmium................ 3 grains.
          rose-water.............................. 1 ounce.
  Mix.  Drop one or two drops in the eye two or three times a
day.
   TALIPES, (talus—ankle, pes—foot,) Club-foot.

  This  deformity, which unfortunately occurs to
some  children,  may  exist at birth or be acquired
afterwards.  In the first instance it is attributed to 
240
GYNECOLOGY.
some peculiar disturbance, originating in the brain
or spinal system, which produces an irregular con-
traction of the muscles on either side of the limb;
thus  destroying  the  antagonism  that  otherwise
would and should have existed between the muscles
affected.   The acquired condition may be the result
of injury  to  the  foot  or ankle, or a disease of the
same—such as rickets or the sequelae of scarlet fever,
small pox, or from convulsions.  There are three
varieties mostly  met with: 1st.  That in which the
foot is turned inwards and rests upon its outer edge>
talipes varus; 2d. Where the foot is turned outwards
and rests  upon  its inner  edge, talipes  valgus; 3d.
That in which the foot rests  upon the ball of the
great and smaller toes, talipes equinius.   There are
other varieties, which  receive names according to
the position the foot assumes, but those given above,
as before  intimated, are most frequently met with.
   The treatment of these  conditions requires some
knowledge of surgery, and more properly belongs to
the domain of that art.  Therefore it is enough to
merely mention  them here,  and refer  the reader
who  may desire to pursue the subject further to
any standard surgical work.


                   HYGIENIC.

      "Eeason's whole pleasure, all the joys of sense,
       Lie in three words: health, peace, and competence.
       But health consists of temperance alone,
       And peace,  oh virtue, peace is all thy own."
  Few persons, especially those who scoff either di-
rectly or by innuendo at "the healing art," consider 
HYGIENIC
241
that to the active workers therein we are indebted
for  the comparative immunity enjoyed by all from
"the pestilence that walketh in darkness, or the de-
struction that wasteth at  noonday."  Nor do they
think of the sacrifices endured by them : the wear and
tear of both  body  and mind, whether engaged in
efforts to promote the welfare of a whole community,
or at the bedside of the solitary sick, endeavoring to
restore the patient to health, relatives, or friends.
Little do they think that with the laborers in that
art  originated  all those sanitary measures now in
use or being adopted by all large cities throughout
the  civilized  world, the efficacy of which arc  so
apparent  in  lessening their  rates of  mortality.
Neither do  they remember that  to  the unweary
disciples of iEsculapius they should be ever grateful
for  the knowledge we possess in relation  to ventila-
tion, heating,  and  otherwise  rendering  healthy,
comfortable, and  convenient large public buildings,
hotels, and private houses, and also "the great ships
that go down  to the sea," that were wont to  be
great magazines  of disease  and death.   Let  them
for  a moment  ponder over these and a  thousand
other little and big things, all of which  originated
in and emanated from one or the other branches of
medicine, to render the world pleasant for the abode
of man and beast during their sojourn in  it, and we
are sure, "if judgment hath not 'flown to brutish
beasts.' and they lost their reason," their derisive
smile must give place to honor and praise.
  In conclusion, wo will not be able to more than
glance at some of these great sanitary measures that
      16 
242
GYNECOLOGY.
may seem  befitting the purposes of this work;  the
first of which relates to air.


                       Air.

      "Thou cheerful guardian of the ruling year,
       Whether thou wanton'st on the western gale,
       Or shak'st the rigid pinions of the north,
       Diffusest life and vigor through the tracts
       Of air, thro' earth and ocean's deep domain.
       Without thy cheerful, active energy
       No rapture swells the breast; no poet sings;
       No more the maids of Helicon delight:
       Come then with me, 0 Goddess, heavenly gay!
       Begin the song, and let it sweetly flow;
       And let it sweetly teach thy wholesome laws,
       1 How best the fickle  fabric to support
       Of mortal man—in healthy body how
       A healthful mind the longest to maintain.'"

   One of the most important bodies  with which
 sanitary science has to  deal  is the atmosphere we
 breathe, and in and by which we live, move,  and
 have our being.   This vast ocean, at whose bottom
 we are placed, surrounds the whole earth fifty miles
 deep, or more properly high, and of course is carried
 around with it in its diurnal motion of one thousand
 and forty miles  an hour, and along with it  in its
 orbit at the rate of sixty-eight thousand miles per
 hour,  by means  too wonderful for us to compre-
 hend; but  wo know that, like Andromeda to  the
 rock, it  is  chained to earth by the law of gravita-
 tion, with  a weight and  pressure  equaling fifteen
 pounds to  the square inch.  It is composed of, in
 100 parts— 
air.                   243
      Nitrogen............................................... 76.84
      Oxygen................................................ 23.10
      Carbonic acid.........................................  0.04
      And a trace of ammonia.

  Whilst this immense  body is at rest, as regards
 the motion of the earth, if it remained so in respect
 to ourselves, of course it must soon become saturated
 with all kinds of deleterious substances evolved from
 decayed animal  and vegetable matters.  But in this,
 as in all other of His works, God has provided against
 such  a  contingency in endowing it with elasticity,
 by which its particles can move upon one another,
 compressed here and expanded  there, and its tem-
 perature hot or  cold, according to its  situation near
 or remote from the earth's surface.   At one time a
 portion of it is suspended over the wide expanse of
 waters, taking the latter up in the form of vapor,
 like a sponge, until, saturated, it is pushed aside by
 another  from  the dry land, which in  its turn be-
 comes likewise charged.  Thus the air is kept con-
 tinually in motion, and, in accordance  with its ve-
 locity, it is the gentle zephyr, the driving gale,  or
 the raging, rushing, roaring, crushing tornado. Part-
 ing slowly with  some water in one place, it falls the
 cooling shower;  by having its vapor wrung suddenly
 from it in another, it descends a driving rain or pelt-
 ing hail-storm, filling with fear and awe some of the
 habitants of earth, and striking deeper terror into
the souls of others by the vivid  electrical flash and
the thunder's loud crash that accompany it.  These
are the forces and means nature uses to purify the
air, so essential to  animal and vegetable life.
  Some idea in relation to the quantity of what are 
244
GYNECOLOGY.
termed special impurities of air may be formed, when
we consider only one or two of the sources from
which they may emanate.  A healthy adult ordina-
rily  exhales from  the lungs in twenty-four hours
twelve to sixteen cubic feet of carbonic acid, besides
an additional quantity from the skin, the amount of
which has not yet been definitely determined.  From
the last-mentioned source, within  the same period
of time, is  also  evolved from twenty-five to thirty-
five  ounces of watery vapor, which upon examina-
tion has been found  to be principally nitrogenous
and very foetid.  These impurities accumulate and
render  noxious  the atmosphere of all ill-ventilated
churches, school-houses, private dwellings, and sick-
rooms.   Almost every animal gives out a proportion-
ate quantity of this gas, besides that emanating from
large manufactories, the  result of  the partial com-
bustion of coal  only.  Carbonic acid and carbonic
oxide are impurities most fatal to animal life.   An
increase of these to fifteen or twenty volumes in one
thousand, above normal,  will in  some persons pro-
duce dizziness and  fainting, and if it should amount
to fifty  in one thousand volumes, death.  This is the
reason why some individuals are required to retire
from crowded  and badly ventilated churches and
halls; and others, if they remain, are attacked with
syncope or fainting from the cause just mentioned.
Consequently the treatment in these cases is to re-
move the patient into a pure atmosphere, which will
soon cause a reaction in the system.
  Wo have already pointed out the means by which
nature purifies the air upon a large scale—by winds,
storms,  rains, and  electricity.  In  cities, dwellings, 
DISINFECTANTS.
245
and sick-rooms, agents commonly  known as disin-
fectants are employed by man for the same purpose
on a  small scale.   They  are generally classed  as
solids, fluids, and gases.  Most important among the
first of these are lime, charcoal,  and dried earth;  of
the fluids, permanganate of potash, (Condy's fluid,)
and carbolic  acid  are mostly used; of the gases,
chlorine, nitrous, and sulphurous acids are the most
powerful agents.
  The following processes for obtaining some of the
above and other well-known antiseptics are given
for general information :
  Chlorine Gas.—The most  simple and easy mode
of preparing this powerful disinfectant, on  a small
scale, is  by placing in an open glass or  porcelain
vessel one tablespoonful of common salt, and then
pouring upon it a small proportion of sulphuric acid,
(vitriol.)  Another simple mode of obtaining a supply
of this gas is by taking a small quantity of  chlo-
ride of lime, in an  ordinary  saucer, and pouring a
little sulphuric acid upon it; or it may be left alone,
(the chloride of lime,) exposed to the air, the car-  ,
bonic acid of which is absorbed by the lime and sets
the chlorine free.  Still another way to obtain it is
by the action of sulphuric acid, diluted with water,
upon  a powder composed of equal  parts of black
oxide of manganese and common  salt.   Again, it
may be prepared by two parts of muriatic  acid, with
one of water and one of black oxide of manganese.
The  least  quantity of this  gas will serve  for  an
ordinary-sized room, and even then great care must
be exercised in having the room well ventilated.
  Burnett's Disinfecting Fluid is a solution of the 
246
GYNECOLOGY.
chloride  of zinc, about two hundred grains of the
salt  to an ounce of water.  For  common use this
should be still further diluted to the  extent of one
ounce of the fluid to a quart of water.  It may be
sprinkled about the  floor, in the water-closets, and
bed-pans, or a room may be purified by saturating
flannel with  the fluid and waving  it  to and fro
through  and around  it.
  Ledoyen's Disinfecting Fluid is a solution of the
nitrate of lead, one drachm to  one ounce of water.
This, combined with solutions of the salts of copper,
will destroy the odor of sulphuretted hydrogen. The
latter may be easily recognized as that present in
bad  eggs.
  Ozone can be obtained by mixing  permanganate
of potassa, two parts, with three of sulphuric acid;
this forms an opaque olive-green mixture, which, if
exposed to air, will give out ozone for some time.
Another mode of obtaining it is from old ether that
has  been allowed  to  stand some time.  If a wide-
mouthed  glass or earthen vessel be moistened with
this, and a glass or iron rod well heated placed into
it, ozone will be given out therefrom for several days.
  Ozone is stated by Professor B. Silliman, Jr., to
be an allotropic, or double condition of oxygen.  Its
peculiar  odor  is detected in the atmosphere after a
considerable  discharge  of electricity.  Hence its
name, from ozumi, to smell.  Ozone may also  be
generated by  allowing phosphorus to slowly con-
sume in a globe vessel of moist  air.
  Sulphurous Yapor.—The most simple  mode  of
obtaining this is by burning sublimed flowers of sul-
phur. 
WATER.
247
  Sulphate of Iron, (Green Vitriol.)—This is an ex-
cellent and easily-procured disinfectant.   If it  is
mixed with lime, oxide of iron is set free, which, by
its affinity for more oxygen, destroys all effete mat-
ter within its range.  Hence its utility in diarrhea,
typhus and typhoid fevers, to disinfect the  stools.
As possessing specific properties, against the spread
of cholera  especially, carbolic acid  and sulphate of
iron, mixed to saturation, is generally conceded the
very best.   Carbolic acid alone is an excellent anti-
septic.  Fresh  earth, charcoal, heat from steam or
dry to two hundred or more degrees of Fahrenheit's
thermometer,  are also simple  and  easily-obtained
disinfectants.   Ashes of bituminous  and anthracite
coal are also good for the same purpose.
   Iodine, when exposed to the air, gives off a vapor,
affording a simple means of obtaining an efficient
antiseptic.
   There are other disinfectants than those given
above, -but  none  are  more efficient and easier ob-
tained, and that is why we have given them a place
here.
   Of  course,  as  before intimated,  these  are mere
auxiliaries  to ventilation, without proper attention
to which the disinfectants themselves must prove
deleterious and dangerous to health  and life.

                     Water.

   The next most important sanitary substance with
which we have to deal is water.  It is known to most
every one that its elementary constituents are hy-
drogen and oxygen.  We have seen how it is taken 
248
GYNECOLOGY.
up from oceans, seas, and rivers in the form of vapor
by the atmosphere, and  how  it falls again to the
earth in rain, hail, and snow.   A portion of it, filter-
ing through the  earth's  crust, necessarily partakes
of the nature of  all soluble substances with which
it comes in contact, from which result the various
mineral springs;  whilst the remainder finds its way
through  rills, rivulets, and streams back to its orig-
inal source.
  How to obtain a sufficient supply of good water
for drinking and other purposes has been almost the
chief aim of all large  communities from time imme-
morial.  The pools of  Solomon, near Bethlehem, said
to be at this time in almost as perfect a state as when
first made, were,  it is  thought, but part of a plan to
supply Jerusalem with water.  It seems that the
ancient Romans were  so much devoted  to procuring
a plentiful supply of water, that none of our modern
systems of aqueducts excel, if they equal, their efforts
in that respect.  Some conception of the quantity
required for  necessary uses by a  thickly-inhabited
city may be arrived  at, when we consider that a
healthy individual ordinarily  consumes, in twenty-
four hours, from seventy to eighty fluid ounces, one
half of which perhaps  is taken imperceptibly in solid
food, and the remainder in a liquid state, whilst for
bathing purposes, when perfect cleanliness is desired,
about  fifty gallons for a general, six gallons for a
shower, and from twelve  to eighteen gallons for a
hip-bath.  Attention  to the skin is of the greatest
importance for the preservation of health.  Besides
removing the detached particles of epidermis  and
dust caught and retained  by perspiration, the fre- 
FOOD.
249
qnent ablutions of the body tend to harden the sys-
tem against rheumatism, colds, and some affections
of the kidneys.   There is no doubt that a more free
use of this liquid, for the purposes just mentioned,
by persons generally, especially upon children, would
tend to lessen considerably many of the diseases that
flesh is now heir to.  The general indications of good
drinking-water are well known, and may be described
as follows: It should be transparent, colorless, odor-
less, tasteless, cool, and pleasant to the taste.

                      Food.

  We have already considered this subject as it re-
gards infants and children.
  Food is required by mankind and animals in gen-
eral for two purposes: (1,) to supply the waste in-
duced  by the wear and tear of the  tissues  of the
body,  (2,) to keep up the animal heat.  Liebig,
who is good authority in the premises, makes two
classifications, which  we  propose merely to glance
at.   One includes all nitrogenous substances,  which
he terms the plastic elements of nutrition; the other,
non-nitrogenized  matters, which  serve  as fuel to
maintain the animal heat.  The former comprehends
flesh of all kinds, the latter all fats, starch, and su-
gars.  Of starch, besides  other well-known depots,
we  have a plentiful supply in  the ordinary potato.
The source of fats and sugars are too well known to
require mentioning.
  The amount required daily by a healthy individual
is from twenty-five to thirty-five  ounces, of  which
about one-fifth  should be animal food.   The office 
250
GYNECOLOGY.
of cook is no mean one; yet the functions apper-
taining thereto are greatly under-estimated by some,
and very few who profess to be  cooks really know
anything  about it.   To  do it  justice the subject
would  demand a volume, but we can only give it a
passing remark.  There are but two proper modes
of dressing or cooking  meats,  which arc boiling
and broiling, (the latter including roasting.)  In the
former instance, the meat should not be put in until
the water has reached the boiling point.   The ob-
ject being to retain the  nutritious substances, it is
accomplished by the  hot water constringing  the
albumen and muscular fibres upon the surface, and
thereby preventing their escape.  If soup is to be
made,  then it is best to put the meat in cold water,
and  allow  the  temperature to gradually increase,
as the object in  that case is to extract  the  nutri-
tive principle.  In broiling  and roasting, the coals
must be bright and glowing in the first, and  the
oven hot in the second instance, in order to coagu-
late  the albumen and retain within  the  juices of
the meat.

                   Clothing.

  Upon this subject our object will be rather more
to consider the advantages  of different fabrics  for
the purposes of clothing  than a discussion of either
the mode or manner of dressing, though the latter
as much as the  former probably belongs to the  do-
main of hygiene.  As a  general circumstance, the
stylo of dress varies  according to climate and the
state of civilization attained by a nation.   In some 
CLOTHING.
251
parts of Africa and Australia the costume of either
sex is almost similar to or hardly any improvement
upon that worn by our first  parents in the Garden
of Eden.  The costume  now in vogue among the
Chiuese, and probably with  the Japanese, has been
the same at least a thousand years, without change
of fashion.  Unlike our own, eastern women never
dress for public display.  When they go abroad, it is
in long robes and with  their faces closely veiled;
consequently among them there can be no rivalry in
the  matter of dress; no  envyings, hates, or strifes,
originating in  or growing out of the same.  Nor is it
to be expected they indulge in innuendoes reflecting
upon the morals as well as  the taste of others, be-
cause they are capable of or prefer to wear this or
that extravagant  or simple style of bonnet, cloak,
or dress.  Would that we could prevail upon a few
of our own countrywomen  to imitate those of  the
land of Mohammed in the matter of dressing, only
to please their own lords; or to devote but a small
portion of the time usually  spent at their toilets to
intellectual or industrial pursuits.  Then there would
be no need of contending for "woman's rights;"  no
need of "sorOsis;" neither would there be wanting
means to mitigate or entirely put an end to the " social
evil," now so fearfully on the increase in our cities.
Because our women, possessing  as a general thing
an innate individuality, wherein they  differ from
those of eastern and other nations, if they could be
educated, and continued in possession  of  this ad-
vantage after passing from girlhood to womanhood,
they would be no less a power in the land for good,
as they ought to be, than  man.  But, instead  of 
252
GYNECOLOGY.
this being the case, we behold many becoming the
mere plaything, of man, catering only to his sensual
desires, having no more ambition than to receive in
turn from  him, for the gratification of his lust, the
wherewithal to clothe and adorn their frail frames;
then  languishing into sloth, indifference, and de-
pendence, with all former innocence and personality
obliterated and destroyed forever.   Thus, instead of
making themselves intellectually the equal of man,
as it is undoubtedly in their power to do in many if
not in  all instances,  as it is now and as has been
illustrated by a few of the sex in  all ages, without
being allowed to vote, we soon behold them gradu-
ally dropping into the foibles and follies of the times:
some immolating their health, others health and even
virtue,  upon the  altar of deified  fashion.   Other
causes, tending to such fearful consequences in a
great measure, may be traced to the example unin-
tentionally set by the affluent, which, the less fortu-
nate endeavoring to  imitate, will, in not a few in-
stances, lead them to part—we record it in sorrow—
with their chastity.  To the former we would say,
consider what a wonderful responsibility rests upon
you, and—
          "In thy more  exalted state,
           A just and equal temper show;
           That all who see thee rich and great,
           May deem thee worthy to be so."
  Wo have been unwittingly led into the above di-
gression on account of the great interest manifested
everywhere in relation to the moral bearing of the
present mode of female dress, which it is hoped will
prove to the reader a sufficient apology therefor 
CLOTHING.
253
  As stated at the beginning of this subject, the ob-
ject will  be to consider the advantages of different
materials for the purposes of clothing, rather than
any peculiar mode, we now return to the considera-
tion of the same. In our climate and that of Europe,
clothing  is required  principally  for protecting  the
body against the sudden  changes  of temperature.
Woolens  of  all kinds answer this  purpose  better
than any other fabrics for spring, fall, and winter
wear, on  account of their being  bad conductors of
heat and powerful absorbers of the water evaporated
from the surface of  the body during perspiration.
This evaporation is necessary in order to reduce the
heat of the body generated by exercise or exertion of
any kind; but if allowed to go on too rapidly, great
chilliness, or  even catarrh, pleurisy, pneumonia, or
rheumatism, may be  the result.  Dry woolen cloth-
ing will prevent either of these  conditions, by con-
densing the vapor from the surface.  At the same
time the woolens give  out their  latent heat, which
makes them warm and  genial after or during sweat-
ing.  This vapor would pass through cotton or linen
without condensation and evaporate upon the out-
side, thereby giving up at once the caloric contained
therein, producing that well-known  unpleasant sen-
sation of chilliness upon the surface of the body. If
ladies attending receptions during the social season,
with their light and airy clothing, would bear these
facts in mind, and provide themselves with suitable
woolen coverings, to throw around them after whirl-
ing in the mazy dance, they would  suffer less from
colds and other disorders,  so prevalent among them
during these periods.  For— 
254
GYNECOLOGY.
   " When dressed for the evening, ladies, now a-days,
      Scarce an atom of dress on them leave;
    We would not blame them for what is an evening dress,
      But a dress that is suited for Eve."
  For summer wear, white or light linen is prefer-
able and more pleasant, because then the surround-
ing atmosphere is generally  above the temperature
of the body, and is reflected therefrom  by the white
fabric outside, whilst its texture allows of free egress
of the heat  generated by the body on  the inside.
The same will apply to cotton, silk, and other light
fabrics.

                     Exercise.

                     "By toil the flaccid nerves
       Grow firm, and gain a more compacted tone;
       The greener  juices are by toil subdued,
       Mellowed, and subtilized;  the vapid old
       Expelled; and all the rancor of the blood.
       Begin with gentle toils, and as your nerves
       Grow'firm, to hardier by just steps aspire.
       The prudent, even in every moderate walk,
       At first but saunter;  and by slow degrees
       Increase their pace.  This doctrine of the wise
       Well knows  the master of the flying steed."
  This is an important hygienic measure, no less on
account of its effects upon the system generally, than
those it has upon respiration, and the tone  and de-
velopment given  to the muscles brought into  play
by it.  The quantity of inspired air, as well as the
expired  carbonic  acid, is increased to about double
that given off by  the body in  a state of rest.  To be
beneficial and healthy, it is  to be indulged in  by
some cautiously and with prudence, or  it may prove 
EXERCISE.
255
hurtful, as it immediately excites the heart's action
^considerably above normal, according to the kind or
the violence with which it is carried on.   If intem-
perately,  the  tender tissues of the lungs  may  bo
injured by their engorged state, resulting from the
increased quantity  of blood forced into them, or the
valves of the  heart itself may become thickened or
otherwise affected.   A deficiency of exorcise, on the
other hand, tends to weaken the heart's action, in-
ducing general debility of the system at large, with
an atrophied condition of the organs of circulation,
and consequently a gradual waste of body, and con-
sumption.   An individual entering upon  any new
or unusual exercise should pay due attention to the
pulse; if this  rises to one hundred and twenty pul-
sations in a minute, the  exertion must bo consider-
ably moderated and gradually terminated.  After
the  exercise has ceased, the skin, if it has been ex-
posed, or, if not, the body, ought to be properly pro-
tected, as has been already intimated, else the rapid
evaporation therefrom will produce chilliness, or
provoke a cold in the individual who has engaged in
it and neglected  this precaution.  The  nature of
the exercise should be  such as  to call into play all
or as many as possible of the muscles of the body.
With this view, as  coming within  the means of
every one, none  are better than walking, say from
three to six miles per day, or the various gymnas-
tic institutions should be patronized by those who
can afford it.   The fashionable and, to some, fascinat-
ing game of  croquet may be indulged in.  Boiling
over the floor, or gliding more smoothly over the ice
upon  skates,  are all healthy and graceful exercises, 
256
GYNECOLOGY.
 that may be frequently resorted to by nearly all ages
 of either sex.  Children, as a general circumstance,
 require long intervals of repose between any regular
 exercise, as their muscles  demand more rest  for
 reparation,  during which period they  absorb and
 retain for some time so much water as to prevent
 any urine being  secreted or voided for some hours
 after exertion.  Very young children and infants
 are not to be  overlooked in  the matter of out-door
 exercise.  For by it—

         " They acquire a vigor and elastic spring
          To which they were not born."

   During the  fall and winter, whenever the weather
 is suitable, they should be taken out into the open
 air, for it is only at these periods of the year the
 doors  and windows of houses are  kept closed, to
 retain the heat  generated  by the  fires.  Children
 moving  about continuously in  this close atmos-
 phere, rendered deleterious by the exhalations from
 their own and the bodies of other  inmates, besides
 the unconsumed carbonic acid gas that escapes from
 the coal-stove or grate now  so commonly used, can
 hardly pass through these  seasons without being
 stricken with disease of some kind.  When the little
 ones are to be taken out of the house, due regard
 should be shown for them in  the matter of dress, by
 their being well protected from the  cold in winter,
 and not too  warmly bundled  up at other seasons of
 the year, when there is no  occasion for it.  They
 ought not to be kept out long or until they become
 chilled, as the  reaction on taking them into a warm
room is apt to produce faintness, vomiting, or ca- 
NURSERY.                 257
tarrh,  ana at night perhaps an  attack of croup.
These unhappy sequences may often be prevented by
removing the soiled napkins, shoes,  and stockings
at once  upon being taken into the  house.  Then
place the feet of the child within your own hands,
and  allow the former to be gradually warmed by
extracting heat  from the  hands, or they  may be
briskly rubbed  until warm  enough;  if they  are
very cold, and present a purple appearance,  the feet
should be bathed in spirits of camphor, arnica, whis-
key, or  brandy, after  which the  child should be
again properly dressed  or put to bed.   The child's
nurse ought to be instructed to pay proper attention
to her  charge whilst out, and bring it into the house
upon the least manifestation of  discomfort on its
part.
                   Nursery.

  The  nursery for children should be well ventilated,
and kept as near as can  be  at an  equable tempera-
ture.   If possible it should be  located on that side
of the house most exposed to the sun, that its light
may penetrate into the room, imparting its  invigor-
ating rays and genial warmth to the inmates.  The
habit with some mothers, nurses, and others, of
teazing children, or of learning them to revenge any
real or imaginary wrong upon one another,  or any-
thing that may have apparently injured them, is
altogether reprehensible, and should  be avoided.
Likewise ought to be discountenanced, in the pres-
ence of children, all marvelous tales,  hobgoblin and
ghost stories, which ,are calculated to  excite their
fears and work  upon the imagination.  No doubt
      17 
258               GYNECOLOGY.
from the above cause has originated many cases of
inflammation of the brain or its coverings, and early
death, or, what may  be  considered almost as bad,
if not worse than death, an extreme sensitiveness
of the  nervous system, by which the child may be
thrown into spasms  at  the slightest  noise,  or be
afraid to remain  a moment in the dark without be-
ing close to or in the  arms of some  one with whom
it may feel itself safe from harm.  Indeed it is no
exaggeration to  say that it not only affects them
thus whilst young, but in many instances  clings to
them until they may have grown up to womanhood
or manhood, when, from  a want of sufficient moral
courage or self-confidence, they will prove themselves
imbecile and unfitted to  enter upon the realities of
life, without becoming disheartened and discouraged
at the  first reverse that overtakes them.   Thus the
idea may be fixed in the mind that the actual duties
of life are too onerous and arduous  for them.  And,
brooding over this fancy, they become extremely
sensitive, selfish,  or melancholy and demented, and
at length  terminate  what is to them a miserable
existence in an insane asylum,  or  seek the desired
isolation and repose in suicides' graves.
  Therefore, all ye to whom is given the charge of
raising  children, ponder  over the  truths above set
forth, and by all means  in  your power discourage,
do away with, and denounce  all idle, fearful, non-
sensical tales.  Let your children  be early taught
the duty of self reliance; to  be generous, compas-
sionate, faithful, and religious.  Fearful only to wrong
one another, and their Father which is in Heaven
and their Saviour.   With such principles early im- 
NURSERY.
259
pressed upon and instilled into their minds, they
must necessarily grow up to be strong;  mentally
morally, and  physically well-fitted to  serve in any
sphere of life into which God and their capacity may
lead them.  For  "they that wait upon  the  Lord
shall renew their strength; they shall mount up
with wings as  eagles; they shall run, and not be
weary; and they shall walk, and not faint."
FINIS. 
 
GLOSSAKY.
                           A
Abdomen—The belly.
Abdominal—Relating to the belly.
Abdominal Rings—Openings in the lower portion of the belly
    under the skin, just above the goin, through which pass the
    spermatic cord  in males and round ligaments of the womb
    in females.
Ablactation—Cessation of sucking.
Abnormal—Unnatural.
Absorb—To suck up.
Abortion—Untimely birth.
Abortives—Medicines to induce abortion.
Acceleration—To hasten.
Acetabulum—Literally vinegar-cup, the cup-like cavity of the
    hip-bone.
Acetate—Acetic acid combined with a salt.
Acetic Acid—Vinegar.
Acute—Active, severe.
Adolescence—To grow, period prior to full growth.
Adult—Full  growth; attained  about the twenty-fifth year in
    males, twenty-first year in females.
Adventitious—Accidental or false.
After-birth—Placenta secundines.
Ala—A wing.
Albumen—As white of eggs and sap of plants.
Alkaline—Opposed to acid.
Aloe, Socotrine,  ) Purgative medicines, which act upon the
                 >  rectum.  The dose is about eight to ten
Aloe, Barbadoes, J  grains, in pill or powder.
Alteratives—Medicines that gradually restore health.
                                                261 
262
GLOSSARY.
Ammonia—Volatile salt, commonly known as hartshorn.
Ammoniac—A gum, resin.
Amygdala—Almonds of the throat, the tonsils.
Anemia—Poor blood.
Anatomical—Belonging to anatomy.
Anatomy—The science of the structure of animals.
Anginose—Sore throat, suffocation.
Anodyne—A medicine to relieve pain.
Anorexia—Want of appetite.
Antiseptics—Disinfectants.
Anus—Outlet of the bowels.
Anus, Imperforate—Closure of the anus.
Apex—Point, extremity.
Aphtha—To inflame, the thrush or sore mouth.
Apoplexia—Congestion of lungs or brain.
Appetite—To desire or relish food.
Aq.ua—Water.
Arcanum—Secret.
Arteries—Tubes through which the blood flows from the heart.
Articulation—Joined together, a joint.
Ascites—Dropsy of the abdomen.
Assimilation—Converting food into nutriment.
Astringent—Medicines  which  contract tissue
Atonic—Loss of tone or power.
Attenuated—Emaciated.
Auscultation—To explore with the ear.
Axilla—Arm-pit.
Axis—Center of a revolving body.

                           B
Bismuth, Sub-carbonate—Astringent and anti-acid medicine.
Bladder—Reservoir for the urine.
Bladder, Neck of—Orifice of the urethra.
Bladder, Fundus of—The  body-.'
Bougie—Instrument for dilating.
Bregma—To moisten.
Bromide of Potassium—Bromic acid  and potash.
Bronchia—Air tubes of the lungs.
Bronchitis—Inflammation of the bronchia. 
GLOSSARY.
263
                            o
Caducous—To fall, temporary.
Calomel—The mild chloride of mercury.
Canine Teeth—Commonly called eye and stomach-teeth.
Caruncula—A little piece of flesh.
Casein—Cheese, albumen of milk.
Catheter—An instrument to draw the urine.
Caul—The amnion, &c.
Cauterize—To burn with caustic.
Cervix—The neck.
Chalybeates—Preparations of iron.
Change of Life—Cessation of menses.
Chest—The thorax.
Chronic—Long continued.
Citrine Ointment—Nitrate of mercury ointment.
Coat—A covering.
Colon—The large intestine.
Colostrum—First milk.
Comatose—Drowsiness, stupor.
Congenital—From birth.
Consumption—A wasting disease.
Corpulency—Excessive increase of the body.
C#stiveness—Constipation, or bound in the bowels.
Creosote—A liquid distilled from tar.
Creta—Chalk.
Critical—Crisis, period of change.
Croton Liniment—Croton and olive oil.
Cupping—Taking blood with cupping-glasses.
Cuticle—Scarf-skin.
Cyanosis—Blue skin.
Cyst—A bladder.

                            D
Debility—Loss of strength.
Deciduous—To fall off.
Dementia—Feeble, or loss of intelligence.
Diagnose—To determine the nature of a disease.
Diaphoretics—Medicines acting upon the skin. 
264
GLOSSARY.
Diaphragm—Muscles  separating the thoracic and  abdominal
    cavities.
Diet—Troper kind of food.
Digestion—Change of food into chyme.
Dilatation—Opening, widening.
Disinfectant—That which purifies the air.
Diuretic—Medicines acting upon kidneys.
Dover's Powder—Ipecac, opium, and  potash.  Full  dose for
    adult, ten grains, which is equivalent to one grain of opium
    and one of ipecac.


Elixir, Calisaya—Preparation of cinchona bark.
Elixir Paregoric—A mild carminative and anodyne for  chil-
    dren.   Dose: three drops to a teaspoonful, according to age.
Emaciation—Becoming thin, lean.
Embryo—To  bud,  applied to child  in  the womb until  third
    month, when it is  called the foetus.
Emetic—That which causes vomiting.
Emetic, Tartar—An emetic and sedative medicine.
Emphysema—Wind-dropsy, inflated with air.
Epigastrum—Over the region of the stomach.
Epithelium—The layer of epidermis covering the mucous mem-
    branes.
Eructation—Belching.
Extravasation—Out  of the proper vessel.

                           P
F.ECES—Excrement.
Farinaceous—Containing farina
Fecundation—Impregnation, conception.
Filament—A thread.
Fimbria—A fringe.
Formula—A form of prescription.
Fourchette—A fork.
Frontal—Relating to  the forehead.
Function—Office of an organ.
Funis—Navel cord. 
GLOSSARY.
265
                           G
Generation—Reproduction.
Germ—Rudiment of life, a seed.
Germinal Membrane—Covering of the ovum.
Gestation—Period of pregnancy.
Gland—A secretory body, as the fiver, &c.
Glycyrrhiza—Licorice.

                           H
Hallucination—Erroneous imagination.
Hare-lip—A division of the lip, malformation of the lip.
Hernia—A protrusion of the intestine.
Horizontal—Lying down, level.
Hygiene—That  branch of medicine devoted to the means of
    preserving health.
Hygienic—Relating to hygiene.
Hysteria—Hysterics.
                            I
Ice-cap—Bladder filled with ice for the head.
Idiosyncrasy—Individual peculiarities.
Ilia—The flanks.
Iliac—Relating  to the ilia.
Imbecility—Weakness of mind.
Impacted—Wedged in or locked.
Imperforate—Closed.
Inanition—Not  nourished.
Incisors—The cutting-teeth.
Index Finger—Forefinger.
Indigenous—Native.
Indurated—Hardened.
Ingesta—Indigestion.
Injection—To throw with' a syringe liquids iuto the bowels or
    vagina.
Intestines—The bowels.
Inversion—To turn inwards.
Invert—Turn upside down.
Irritation—Excitement.
Jalap—A purgative medicine. 
266
GLOSSARY.
                           K
Koosso—A vermifuge medicine to expel worms.
                           L

Lactation—The period of sucking.
Lacteal—Belonging to the  milk.
Lamina—A plate.
Larynx—Upper part of the wind-pipe.
Lesion—A hurt.
Lethargy—Forgetfulness.
Ligate—To bind.
Linea—A line.
Liquor Sanguinis—Fluid portion of the blood.
Longitudinal—Long, extending lengthwise.
Lunar Caustic—Nitrate of  silver.
Lymph—Liquid floating in  the lymphatics.
Lymphatics—Minute tubes  ramifying the whole body.

                           M

Malaria—Marshy emanations.
Malformation—Unnatural.
Mamm^;—The breasts.
Mammary Abscess—Gathering of the breast.
Mammary Gland—Milk  gland.
Mania—Insanity.
Maturation—Ripening.
Meconium—First discharge  from the bowels of infants.
Membrane—A tissue.
Membrane, False—Formed by coagulation of blood.
Membrane, Mucous—Lining cavities exposed to air.
Membrane, Serous—Lining cavities not exposed to air.
Membranes, The—Applied to those enveloping the foetus.
Meninges—Membranes of the brain and spinal cord.
Menstruum—A solvent.
Mesentery—Tissue uniting the bowels.
Miasma—Malaria.
Micturition—The act of passing water.
Monad—A simple particle,  atom, or unit. 
GLOSSARY.
267
Morphia, Bimeconite of—Preparation same strength of lauda-
    num.
Mucus—Mucilaginous substances.
Muriates—Muriatic acid combined with bases, as iron, &c.
                           N
Nates—The buttock.
Nausea—Disposition to vomit.
Nostrum—Literally " our own," applied to quack remedies.

                            O
Obesity—Corpulency.
Obliquus—Oblique, slanting.
Occiput—Back part of the head.
G^dema—A swelling.
Opium—Juice of the poppy.
Os Innominata—Bones without a name.

                            P
Palliatives—Medicines to relieve temporarily.
Panada—Bread-pap.
Papilla—A teat or pimple.
Perineum—Space between anus and vagina.
Plethoric—Full habit.
Pleura—Lining of the chest and covering of the lungs.
Pleurisy, Pleuritis—Inflammation of the pleura.
Pneumonia—Inflammation of substance of the lungs.
Prognosis—To foretell.
Pudendum—External organs of generation.
Pulse—From pulso, "I beat;"  the beating of the arteries; that
    at the wrist (the radial) is chosen for cpnvenience;  it is con-
    sidered in relation to its quickness, hardness, strength, the
    interval between  the beats, and the number of beats in a
    given time.
Purgative—A purging medicine.
Quod Deus bene vertat—May God direct it to a good end.
                            R
Ramus—A branch.
Rectum—Straight; the  fundament or terminus of the bowels. 
268
GLOSSARY.
Remittent—To subside, without intermission,
Respiration—Breathing.
Rotation—Motion, revolving.
Ruga—A wrinkle.
                            S
Sacral—Belonging to the sacrum.
Saline—The nature of a salt.
Scrofula, King's Evil—Swelling of the glands, a bad condition
    of the system generally.
Scrotum—A bag, that containing the testicles in the male.
Solution—To dissolve a substance in any menstruum.
Secrete—To separate.
Soporific—Medicines to produce sleep.
Spermatozoa—Animalculae  of the fecundating fluid.
Sphincter—Muscles surrounding outlets or openings in the body.
Stage—Periods or degrees of disease.
Sternum—Breast-bone.
Stertor—Snoring.
Stupor—Insensibility.
Sugar  of Milk—A substance obtained from whey by evapora-
    tion.  It possesses some of the properties of sugars generally.
Suppuration—Gathering, forming pus, commonly known as fes-
    tering.
Symphysis—Union of bones, without apparent motion.
Syphilis—Venereal disease.
                            T
T.enia-Tape—Tape-worm.
Thorax—The  chest.
Tissue—A web, the flesh.
Tonics—Medicines that give tone and strength.
Trachea—The wind-pipe.
Transverse—Crosswise.
Tubercular—Relating to tubercles, consumption.
Tumor—Enlargement.
Tuberosity—A protuberance.
Tympanitic—Drum-like, tense.
Typhoid—Like typhus.
Typhus—Stupor, slow fever. 
GLOSSARY.
269
                           u
Umbilicus—The navel.
Urea—A principle peculiar to urine.
Urethra—Outlet of the bladder.
Urinemia—Urea in the blood.
                            V
Vagina—A sheath.
Veins—Tubes that convey the blood back to the heart
Ven.e Cav^;—Applied to the two largest veins in the body.
Ventral—Relating to the belly.
Vermifuge—Medicines to expel worms.
 Vernix caseosa—The white cheesy substance present upon in-
     fants  at  birth.  It is apparently soluble  in, and easily re-
     moved by, the application of lard.
 Vertebra—One of the spinal bones.
 Vesicular—Little bladder.
 Vulva—External organs of generation.
                            W
 Weaning—Separation from the breast.
                            z
 Zino, Sulphate of—White vitriol. 
 
INDEX.
A monad...................................  85
Abdominal supporters.............  55
Abortion....................................  79
        accidental...................  79
        causes of.....................  79
        criminal....................  82
        intentional.................  82
        natural.........................  79
Accidental hemorrhage............ 145
Accoucheur..............................  10
Acetabulum..............................  22
Acute inflammation  of  cover-
  ings of the brain.................... 208
After-pains............................... 123
Affections of the eyes............... 238
After-birth................................ lie
Air............................................ 242
Allantois...................................  65
Amenorhoea..............................  36
Ammoniac plaster.....................233
Amnii, liquor............................  64
Amnion....................................  64
Amphola mesenterica...............  67
Anaesthesia................................ 1C7
Anatomy..................................  21
Antaphrodisiacs.......................  95
Anteversion of the womb.........  56
Anteflexion  of the  womb..........  57
Antiquity of midwifery............   9
Anus, imperforate.....................180
Aphthae................................... 211
Apoplectic convulsions........... 154
Area germinativa......................  63
Aristotle.................................... 106
Asparagus.................................  95
Attention to navel..................... 181
Avicenna...................................  12
Axes of pelvis...........................  26
Axiom in midwifery................. 178

               B

Ballottement............................  99
Bandage.............................. 118,122
        effects of not applying  54
        for children................. 208
        for  infants................... 122
Baptista Forta.......~.................. 168
Barrenness...............................  84
Battledore placenta.................  66
Baudelocque........................ 16, 108
Bed.......................................... 117
    preparation  of................... 117
Beginning of man.....................  85
Blastodermic or budding vesi-
  cle.........................................  63
Blood, circulation of.................  73
      loss of............................ 145
Blotch, milk............................. 235
Blunt hook............................... 141
Bottles, nursing........................ 188
Breech presentation................. 132
Bregma...................................  28
Brief intervals in child-bearing  88
Broad ligaments of the womb...  32
Burnett's disinfecting fluid...... 245
By-laws of the London College
  of Physicians and Surgeons...  16

                C

Csssarean operation.........12,14, 144
Calendar for calculating gesta-
  tion........................................  73
Camerarius..............................  15
Cannabis Indica..........t............. 167
Caput succedaneum.................. 179
Carbolic acid............................. 247
Care of navel............................. 181
Caruneulee myrtiformis............  30
Cases in which forceps are used 139
Catemenia.................................  34
Causes  operating  to produce
  falling of the womb...............  54
Caul.......................................... 129
Cavity of the womb...................  31
Celsus.......................................  77
Cephalotomy............................. 142
Cessation of menses..................  45
Chamberlin...............................  15
Change in life...........................  45
Chicken pox............................. 220
Child, management after deliv-
  ery......................................... 178
      raising by hand.............. 186
Child-bed fever......................... 156
          mania........................ 155
Child, turning the..................... 134

                      271 
272
INDEX.
Children, diseases of..........»....  193
Chloral, hydrate of....................  176
Chlorine gas.............................  245
Chloroform...............................  173
Chlorosis...................................  166
Cholera infantum......................  200
Chorda dorsalis........................   67
Chorion..................................   65
Chronic Amenorrhea...............   40
Circulation,  foetal......................   74
            in general..............   73
Classification of labor..............  HI
Clement................................. 10,14
Clitoris.....................................   30
Clitorism..................................   90
Clothing..................................  250
Club-foot..................................  239
Complications   affecting  the
  child atbirth.........................  125
Condy's fluid.............................  245
Coccygis..................................  24
Coition......................................   85
Colic......................................... 189
Colostrum................................. 182
Communicative visitors............ 117
Conception, false......................  41
Conduct of labor....................... 116
Convulsions, apoplectic............ 154
             epileptic.;............ 152
             hysterical..........  151
             of children........... 202
             puerperal............. 151
Cord, umbilical.........................  66
      prolapsus of..................... 144
      falling of..........................  144
Cough, whooping...................... 231
Courses....................................  34
Cows'  milk.............................. I86
           how prepared.........  187
Craniotomy.............................. 142
Criminal abortion.....................  82
Critical period..........................   45
Croup..................................... 227
       pseudo membraneous, or
        false............................. 228
       spasmodic...................... 229
Crural phlebitis........................163
Crusta lactis.............................. 235
Cyanosis....................................  77

                D

Dansean shower........................  88
Dante.......................................  93
Davy, Sir Humphrey................ 169
Death begins with life..............   75
Delivery, management of child
  after.......................................178
Deciduous membrane..............   61
Dentition.................................. 198
Development of foetus..............   62
Deviations  from  vertex  pre-
  sentations............................. 130
Devil's bite...............................  33
Diameters of pelvis.................. 25
Diarrhea of children................. -«>0
Difference  between menstrual
  fluid and blood...................••• 35
Difference in male and female
  pelvis........................-:■•■,•••■;;
Difference in the size of skull
  of male and female child...... 29
Difficult  or tedious labors........ 127
Dimensions of foetal head......... 29
              foetus................. 69
Diphtheria................................. 230
Diseases of children................ 1SJ3
           menstruation......... 36
Disinfectants........................... 245
Divisions of pelvis.................... 25
            womb................... 31
Doctor Channing..................... 171
       Godwin........................ 170
       Hickman..................... 169
       Jackson....................... 170
       Liston.......................... 170
       Mackintosh.................. 41
       Mitchell....................... 170
       Morton......................... 178
       Moore........................ 169
       Perkins........................ 171
       J. Y. Simpson............... 171
        Snow...........................169
       Wood and Bache.......... 170
Dysmenorrhcea......................... 40
Dystocia....................................133

                E

Emansio mensium....................  36
Embryo....................................  69
Embryotomy............................143
Embryulcia............................. 142
Enlarged nymphse....................  91
Epileptic convulsions............... 152
Epispadias ...............................  91
Ergot, first use of.....................  15
       in labor......................... 120
Eruptive diseases..................... 213
Eruption of the teeth............... 198
Ether, sulphuric....................... 169
          "     ....................... 173
Eutocia.................................... HI
Exanthematica......................... 213
Exercise..................................254
External labia...........................  29
         organs of generation..  29
         os uteri.......................  31
Eyes, affections of the............ 238



Face, presentations...™...™...... 131
Falling of cord......................... 144
           womb......................  63
Fallopian tubes........................  32
False conception......................  41
False membraneous croup....... 228 
LNDEX.
273
Fecundation, when most proba-
  ble, &c.................................... 87
Female organs of generation... 29
Ferguson, Dr............................ 15G
Fertility................................... 84
Fever, child-bed........................ 156
      infantile remittent......... 204
      scarlet......................... 214
      peritoneal...................... 156
      puerperal....................... 156
Fillet or noose.......................... 142
First milk................................. 182
     manual of midwifery........ 12
Fistula, vaginal........................ 91
Flowers.................................... 34
Foetal head............................... 27
Foetus....................................... 69
      indications of  maturity
        and immaturity........... 71
      circulation in the............ 73
      dimensions of................. 69
      development of............... 62
      pathology and signs of its
        death........................... 78
      premature expulsion of... 79
Foramen ovale.......................... 76
Fontanelles.............................. 28
Food......................................... 249
Forceps.................................... 137
        how to  use................... 14U
Forehead, presentations of the.. 130
French measles....................... 219
Fioude..................................... 106
Funis, or umbilical cord........... 66

                G

Gathered breast........................124
Generation................................ 58
          organs of................. 29
          viviparous............... 62
Genitals, loss of vitality in the.. 94
Germinal vesicle....................... 33
         membrane................ 63
Gestation, period of.................. 72
          calendar.................. 73
Glottis,  spasm of the................. 229
Graafian vesicles....................... 33
Green sickness....................... 166
Grinders.................................... 113
Gum, red................................... 213
     yellow............................. 213
      white............................... 213
Gynecology, definition of......... 10

                II    <

Head, foetal............................... 27
           dimensions of....'..... 29
Heat in animals........................ 89
Heart, cavities of the................ 75
Henry II of France.................. 90
Hemorrhage, accidental........... 145
             after delivery...... 148
Hemorrhage from navel..........  180
             unavoidable........  147
Hemp, Indian...........................  167
Hook, blunt..............................  141
Hordeolum..............................  238
Hydrate of chloral....................  176
Hydrocephalus.........................  208
Hygienic...................................  240
Hymen....................................  30
       imperforate...................  91
Hypospadias............................  91
Hippocrates.............................  11
Hysteralgia..............................  51
Hysteria..................................  165
Hysterical convulsions............  151

               I

Ilium........................................  22
Immoral books, effect upon the
  mind......................................  93
Immaturity of foetus.................  71
Imperforate anus.....'.................  180
            hymen..................  91
            urethra..................  180
Iucontinence of urine...............  236
Indian hemp...........  .................  167
Indications of immature foatus..  71
             mature foetus......  71
Infants, feeding.......................  182
Infant, purging the..................  183
       stimulating the............  183
Infantile remittent fever..........  £04
Inflammation of the covering
  of the brain..........................  208
Inflammation of the womb.......  156
Internal labia..........................  29
        os uteri.....................  32
Inversion of the womb............  150
Iodine.......................................  247
Irritable uterus.........................  51
Ischium....................................  22

               K

Kiesteine..............................«•  98



Labia externa...........................  29
      interna............................  29
Labor, classification of.............  Ill
       conduct of.....................  116
       difficult or tedious........  127
       in general...  .................  107
       mechanism of...............  103
       loss of blood in.............  145
       positions in..................  108
       presentations................  107
       preternatural.................  133
       proper..........................  Ill
       stages of........................  112
       tedious...........................  127
Lacing, effects of...................... 63 
274
INDEX.
Ledoyen's disinfecting fluid.... 246
Lever........................................ 141
Leueowhoea..............................  48
Ligaments of ovaries...............  33
Ligatures.................................. 118
Ligaments of the womb............  32
Linea ilia pectinea.................  23
Liquor amni..............................  64
Lochia...................................... 123
Longings.................................. 102
Loss of blood in labor.............145
              during gestation 145
Lower extremity presentations, 133

               M

Macula germinativa..................  33
Madam la Villiere.................. 10,14
Male  pelvis...............................  27
Management of child............... 178
Mania, child-bed....................... 155
Mandragora..............................168
Mandrake................................. 168
Marriage, sanctity of.................  84
May apple................................ 108
Measles................................... 219
       French......................... 219
Mechanism of labor.................. 108
Mec nium................................. 182
Midwives in England................  17
Middlesome midwifery........... 178
Membrane, germinative...........  63
Membranes, development of.....  65
           of foetus.................  64
           rupture of.............. 120
Membraneous croup................. 228
Menorrhagia.............................  42
Menses.....................................  34
Menstruation...........................  34
             cessation of.........  45
             disease of............  36
            vicarious..............  44
Metastasis lactis.......................163
Milk blotch............................... 235
Milk, cow's................................ 186
    first.................................. 182
    not  enough.......................196
    leg..................................... 163
    time of its flow.................. 182
    woman's............................ 186
Monsel's salt.............................  43
Mons  veneris...........................  29
Monthly periods........................  34
Morsus diabola.........................  33
Mulberry mass..........................  63
Mumps...................................... 237

               N

Navel, care of..........-.................181
      detachment of............... 181
      hemorrhage at............... 180
Nervous  pregnancy.................. 105
Noose....................................... 142
Nostrums.................................. 39
         mongers................... 47
Nurse, wet................................. 185
Nursing.................................... 181
        bottles.......................... 188
        effects of, upon mothers 184
                     child..... 192
        regular......................... 185
Nursery.................................... 257
Nurses in England................... 17
Nymphae................................... 29

               O

(Edema dolens.......................... 163
        laetum......................... 163
One idea-isms.......................... 18
Operation Csesarean.................. 144
          craniotomy............... 143
          of turning................. 135
          with forceps............. 140
Opposition,  to nostrums........... 47
Opthalmia, purulent................. 239
           tarsi....................... 239
Os externa............................... 32
   innominata.......................... 21
   interna................................. 32
   sacrum................................ 21
   uteri.................................... 32
Ovum....................................... 32
Ovaries..................................... 33
       ligaments of the........... 33
Oysters..................................... 95
Ozone....................................... 246

               P

Pare, Ambrose.......................... 14
Parotitis.................................... 237
Pathology of foetus.................... 78
Pelvis....................................... 21
     axes of............................ 26
      diameters of.................... 25
      false................................ 25
      divisions of..................... 25
      male and female............. 27
     true................................. 25
Period of gestation.................. 72
Peritoneal fever....................... 156
Permanganate of potash.......... 245
Persulphate of iron................... 43
Pertussis................................... 231
Pessaries___............................. 55
Phoenerete............................... 11
Phlegmosia  dolens.................... 163
Placenta, the............................. 66
         battledore................. 66
         delivery of................. 122
         preevia....................... 147
         retained.................... 150
Pleasure, warning relating to... 96
Plural  births............................. 159
Porrigo larvalis........................ 235
Porta baptista........................... 168 
INDEX.
275
Positions................................... 108
Pregnancy................................  96
          nervous................... 105
          phenomena of.........  96
          simulated................ 105
          treatment of........... 103
Premature expulsion of foetus...  79
Preparation of cow's milk......... 187
Presentations........................... 107
             deviations  from
               vertex.............. 130
             breech................ 132
             face..................... 131
             forehead............. 130
             lowerextremities 133
             upper  extremi-
               ties.............108, 134
Preternatural labor................... 133
Prolapsus of the cord.............. 144
                womb.............  53
Prolongation of lactation.......... 192
Protogala................................. 182
Pseudo membraneous croup....  228
Psoriasis.................................. 104
Ptvalism..................................  98
Puberty...................................  34
Pubis.......................................  23
Pudenda..................................  29
Puerperal convulsions............. 151
          fever........................ 156
          mania...................... 155
Pulse........................................  75
     effects of chloroform on.. 173
Purgatives, caution against...... 102
Purging the  infant................... 183
Purulent opthalmia.................. 239

               d
Quadruplets...............7.............. 159
Quantity of blood in the body...  75
Queen Catharine of France......  90
Queen Mary........................... 106
Quetelet..................................  88
Quickening..................:...........  99

               R

Raising child by hand.............. 186
Rational signs of pregnancy..... 101
Real cause of divorces..............  97
Regular....................................  88
Remittent, infantile  remittent
  fever.................................... 204
Restitution.............................. 110
Retroflexion of womb...............  57
Retroversion    "   ...............  57
Rhodion...................................  14
Rigby.......................................  78
Rigidity of  the mouth of the
  womb..................................... 127
Rigidity, soft parts.................... 129
Round "ligaments of the womb..  32
Rousset...................................  13
Rubeola.................................... 219
S
Sacrum.....................................  24
Saint Paul on matrimony..........  84
Scarlatina................................. 214
          anginosa................... 215
          maligna.................... 215
          simplex.................... 214
          treatment of............. 216
Scarlet fever............................. 214
Sensible signs of pregnancy..... 101
Sex of child.............................  87
Sexual indifference..................  89
Sickness....................................  34
Signs of death of foetus.............  78
      of pregnancy................... 101
Show......................................... 114
Simulation............................. 105
Small pox................................ 224
Spasm of glottis....................... 229
          vagina......................  91
Spermatozoa............................  60
Sphincter vagina....................  31
Spirit of the  work.....................  19
Spooa, feeding with................. 182
Sorrows of conception...............  9
Stages of labor.......................... 112
Sterility....................................  84
Stroma......................................  3a
Strophulus................................ 213
Stye.......................................... 238
Sulphate of iron........................ 247
Sulphurous vapor..................... 246
Summer complaint of children. 200
Suppressiomensium.................  39
Suppressed menstruation.........  39
Swelling of the limbs................ 152

               T

Table for calculating the period
  of gestation...........................  73
Table  showing  difference  in
  woman's and cow's milk........ 186
Talipes...................................... 239
       equinius........................ 240
       valgus........................... 240
       varus............................. 240
Tedious labor........................... 127
Teeth, eruption of..................... 198
Teething................................... 200
The female pelvis.....................  22
Theodoric................................. 108
The period of gestation............  72
The term midwifery..................  10
The true physician...................  18
Thrush..................................... 211
Treatment of pregnancy........... 103
Triple births............................. 159
Tuber ischia.............................  23
Tubes, Fallopian.......................  32
Tuberculosus meningitis......... 208
Tumor of scalp......................... 179
Tunica albuginea.....................  36 
276
INDEX.
Turgescence.............................179
Turning the child..................... 135
        hew to perform the op-
          eration of................. 135
        when required............ 134
Twins, triplets, quadruplets...... 159

               V

Umbilical cord, the..................  66
Unavoidable hemorrhage......... 147
Unnecessary interference......... 178
Urethra...................................  30
       imperforate.................. 180
Urine, incontinence................. 236
Uterus.......................................  31
       anteflexion.....................  57
       anteversion....................  50
       divisions of....................  31
       hysteralgia, or irritable..  51
       inflammation of............ 156
       ligaments of...................  32
       mouths of the................  32
       prolapsus of the.............  53
       retroflexion of the.........  57
       retroversion of the.........  57
       size of the virgin...........  31

               V

Vaccination.............................. 221
Vagina....................................  30
       sphincter of...................  31
       spasm of........................  91
Vaginal fistula..........................  91
Value and object of the work... 137
Varicella.........................._....... 220
Variola...................................... 224
Varioloid.................................. 223
Vascular area..........----. —.....
Vectis.......................................
Veities......................................
Vernix caseosa.........................
Vesalius...................................
Version....................................
Vertex presentations...............
Vicarious menstruation.............
Vice................,.........................
Vomiting of children................
         during labor.............
                 pregnancy....,
Vulva........................................

               W

Water.......................................
      on the brain....................
Waters, rupture  of the bag of...
Weaning,...................................
Wet nurse.................................
Whites.....................................
Whooping cough.......................
Woman's milk.........................
Woman,  everyone a law to her-
  self.......................................
Womb......................................
      anteflexion.....................
      anteversion.....................
      divisions of the..............
      falling of  the.................,
      inflammation of the.......
      inversion  of..................
      ligaments of..................
      prolapsus of the.............
      retroversion of the........,
      mouth of  the.................,
Worms..................................
       fever from....................
 tS7
141
 13
122
 13
134
130
 44
 94
203
113
 99
 29
247
208
120
190
185
 48
231
186

102
 31
 57
 56
 31
 63
156
150
 32
 63
 57
 32
233
£04 
/ 
 
 
 
 
NLM005809529