To make a mixture. Two tablespoonfuls to be taken twice or three times a day, until relief be obtained.

Chalk is sometimes given in heartburn, but as it produces costiveness, it ought not in such a case to be used.

303. Piles are a common attendant upon pregnancy. They are small, soft, spongy, dark-red tumors, about the size either of a bean or of a cherry—they are sometimes as large as a walnut—and are either within or around the fundament; they are then, according to their situation, called either internal or external piles—they may be either blind or bleeding. If the latter, blood may be seen to exude from them, and blood will come away every time the patient has a stool; hence the patient ought to be as quick as possible over relieving her bowels, and should not at such times sit one moment longer than is absolutely necessary.

304. When the pile or piles are very large, they sometimes, more especially when she has a motion, drag down a portion of the bowel, which adds much to her sufferings.

305. If the bowel should protrude, it ought, by means of the patient’s index finger, to be immediately and carefully returned, taking care, in order that it may not scratch the bowel, that the nail be cut close.

306. Piles are very painful and are exceedingly sore, and cause great annoyance, and frequently continue, notwithstanding proper and judicious treatment, during the whole period of pregnancy.

307. A patient is predisposed to piles from the womb pressing upon the blood-vessels of the fundament. They are excited into action by her neglecting to keep her bowels gently opened, or by diarrhœa, or from her taking too strong purgatives, especially pills containing either aloes or colocynth, or both.

308. If the piles be inflamed and painful, they ought, by means of a sponge, to be well fomented three times a day, and for half an hour each time, with hot chamomile and poppy-head tea;^[62] and at bedtime a hot white-bread poultice should be applied.

309. Every time after and before the patient has a motion, she had better well anoint the piles and the fundament with the following ointment:

Mix, to make an ointment.

310. If there be great irritation and intense pain, let some very hot water be put into a close stool, and let the patient sit over it. “In piles attended with great irritation and pain, much relief is often obtained by sitting over the steam of hot water for fifteen or twenty minutes, and immediately applying a warm bread-and-milk poultice. These measures should be repeated five or six times a day (Greeves).”^[63]

311. If the heat be not great, and the pain be not intense, the following ointment will be found efficacious:

Mix.—The ointment to be applied to the piles three times a day.^[64] Or the compound Gall Ointment (B.P.) may, in the same manner, be applied.

312. If the heat and the pain be great, the following liniment will be found useful:

Mix.—The liniment to be frequently applied, by means of a camel’s-hair pencil, to the piles, first shaking the bottle.

313. The bowels ought to be kept gently and regularly opened, either by taking every morning one or two teaspoonfuls of compound confection of senna, or by a dose of the following electuary:

To make an electuary. One or two teaspoonfuls to be taken early every morning.

314. Magnesia and milk of sulphur is an excellent remedy for piles:

Mix.—To make nine powders. One to be taken early every, or every other morning, mixed in half a teaspoonful of new milk.

315. Remember, in these cases, it is necessary to keep the motions in a softened state, as hard lumps of stool would, in passing, give intense pain.

316. If the confection of senna and the other remedies do not act sufficiently, it may be well to give, once or twice a week, a teaspoonful or a dessertspoonful of castor oil.

317. In piles, if they are not much inflamed, and provided there be constipation, a pint of tepid water, administered early every morning as an enema, will be found serviceable. Care and gentleness ought, of course, to be observed in introducing the enema pipe (but which only requires ordinary care), in order not to press unduly on the surrounding piles.

318. The patient ought to lie down frequently in the day. She will derive great comfort from sitting either on an air-cushion or on a water-cushion about half filled with water, placed on the chair; for sometimes she is unable to sit on an ordinary seat.

319. In piles, the patient ought to live on a plain, nourishing, simple diet, but should avoid all stimulants; any food or beverage that will inflame the blood will likewise inflame the piles.

320. Piles in pregnancy are frequently troublesome, and sometimes resist all treatment until the patient is confined, when they generally get well of themselves; but still the remedies recommended above will usually afford great relief, even if they do not effect a cure.

321. Swollen legs from enlarged veins (varicose veins).—The veins are frequently much enlarged and distended, causing the legs to be greatly swollen and very painful, preventing the patient from taking proper walking exercise. Swollen legs are owing to the pressure of the womb upon the blood-vessels above. Women who have had large families are more liable to varicose veins than others. If a lady marry late in life, or if she be very heavy in her pregnancy—carrying the child low down—she is more likely to have the veins to distend.

322. The best plan will be for her to wear an elastic silk stocking,^[65] which ought to be made on purpose for her, in order that it may properly fit the leg and foot. It will draw on like a common stocking. She ought to wear a gauze stocking next the skin, and the elastic stocking over it, as the gauze stocking can then, from time to time, be washed, as can likewise the foot and leg. Moreover, the gauze stocking will be more comfortable next the skin than the elastic stocking.

323. If the varicose veins should be very painful, she had better apply to a medical man, as it may be necessary, in such a case, to have them enveloped in mild plasters, and then rolled.

324. If the feet and legs be cold as well as swollen, a domette^[66] bandage, two inches and a half wide and eight yards long, nicely applied to each leg, from the toes to the knee, will be found a great comfort. One great advantage that domette has over calico is that it will keep in its place for days, while calico will be loose in an hour or two.

325. Stretching of the skin of the belly is frequently, especially in a first pregnancy, distressing, from the soreness it causes. The best remedy is to rub the bowels, every night and morning, with warm camphorated oil, and to apply a broad flannel belt, which should be put on moderately but comfortably tight. The belt ought to be secured in its situation by means of properly adjusted tapes.

326. If the skin of the belly, from the violent stretching, be cracked, the patient had better dress the part affected, every night and morning, with equal parts of simple cerate and of lard—lard without salt—well mixed together, spread on lint; which ought to be kept in its place by means of a broad bandage, similar to the one used in confinements, and which is described in a subsequent paragraph (Bandage after Confinements).

321. Pendulous belly.—A lady sometimes, from being at these times unusually large, suffers severely; so much so, that she cannot, without experiencing great inconvenience, move about. This, where a patient is stout, and where she has had a large family of children, is more likely to occur, and especially if she has neglected proper bandaging after her previous confinements.

328. She ought in such a case to procure, from a surgical-instrument-maker, an elastic abdominal belt, made purposely for pendulous bellies, which will, without unduly pressing on the belly, be a support. It is a good plan to have the belt made either to lace behind or with straps and buckles, in order to accommodate the belly to its gradually increasing size.

329. If the patient be delicate, and if she has a languid circulation, she ought, instead of the elastic belt, to apply a broad flannel belly-band, which should go twice around the bowels, and must be put on moderately and comfortably tight.

330. The patient, before the approach of labor, ought to take particular care to have the bowels gently opened, as during that time a costive state of them greatly increases her sufferings, and lengthens the period of her labor. I say a gentle action is all that is necessary; a violent one would do more harm than good.

331. Toothache is a frequent complaint of pregnancy; and I wish to caution my gentle reader not to have, during the time she is enceinte, a tooth extracted; miscarriage or premature labor has frequently followed the extraction of a tooth.

332. If the tooth be decayed, the hollow ought to be filled with cotton wool, soaked either in oil of cloves, or in equal parts of oil of cloves and of chloroform, and which should be frequently renewed; or with what I have found an excellent remedy, a little alum dissolved in chloroform.^[67] A bit of cotton wool placed in the ear of the affected side will oftentimes relieve the toothache arising from a decayed tooth. This simple remedy ought always to be tried before resorting to more active treatment. If the above remedies do not relieve, soak a small ball of cotton wool in chloroform, and insert it inside the ear, and let it remain there until the pain be relieved; let it be from time to time renewed. I have frequently found in toothache the above plan most efficacious, and to afford relief when other means have failed.

333. Creasote (spirits of tar) is sometimes applied, but of all remedies it is the worst for the purpose. I have known it, when thus used, severely injure and decay the whole of the remaining teeth: one case in particular I remember, of a gentleman who, by the frequent use of creasote, for the relief of toothache, lost the whole of his teeth!

334. If the teeth be not decayed, especially if the stomach be disordered, let an aperient be taken. The state of the bowels ought always to be attended to, as toothache is frequently relieved, and when the tooth is not decayed, cured by a dose of opening medicine. Let the sides of the face be well fomented with hot chamomile and poppy-head tea, and let a piece of crumb of bread (but not crumbed bread) be soaked for five minutes in boiling milk, and be frequently placed inside the mouth, between the cheek and gum; and let a large hot bread poultice be applied at bedtime to the outside of the face.

335. If the above does not have the desired effect, a piece of brown paper, the size of the palm of the hand, soaked in brandy, and then well peppered with black pepper, should be applied outside the cheek, over the part affected, and kept on for several hours. It ought from time to time to be renewed. This simple and old-fashioned remedy will sometimes afford great relief. It is in these cases preferable to a mustard poultice, as it is less painful, and neither blisters nor injures the skin.

336. If the pepper plaster does not afford relief, a ginger plaster should be tried:

To be well mixed together, adding the water drop by drop (stirring it the while) until it be of the consistence of paste. Let it be applied at bedtime, on linen rag, outside the cheek, and let it remain on all night, or until the pain be relieved.

337. If the tooth be not decayed, and if the pain of the face be more of a neuralgic (tic-douloureux) character, the following pills will frequently afford great relief:

To make twelve pills. One to be taken three times a day.

338. The teeth, in pregnancy, are very apt to decay: I have known several patients, each of whom has lost a tooth with every child!

339. Morning sickness.—It is said to be “morning,” as in these cases, unless the stomach be disordered, it seldom occurs during any other part of the day. Morning sickness may be distinguished from the sickness of a disordered stomach by the former occurring only early in the morning, on the first sitting up in bed, the patient during the remainder of the day feeling quite free from sickness, and generally being able to eat and relish her food as though nothing ailed her.

340. Morning sickness begins with a sensation of nausea early in the morning, and as soon as she rises from bed she feels sick and retches; and sometimes, but not always, vomits a little sour, watery, glairy fluid; and occasionally, if she has eaten heartily at supper the night previously, the contents of the stomach are ejected. She then feels all right again, and is usually ready for her breakfast, which she eats with her usual relish. Many ladies have better appetites during pregnancy than at any other period of their lives.

341. The sickness of a disordered stomach unaccompanied with pregnancy may be distinguished from morning sickness by the former continuing during the whole day, by the appetite remaining bad after the morning has passed, by a disagreeable taste in the mouth, and by the tongue being generally furred. Moreover, in such a case there is usually much flatulence. The patient not only feels but looks bilious.

342. If the stomach be disordered during pregnancy, there will, of course, be a complication of the symptoms, and the morning sickness may become both day and night sickness. Proper means ought then to be employed to rectify the disordered stomach, and the patient will soon have only the morning sickness to contend against; which latter, after she has quickened, will generally leave of its own accord.

343. Morning sickness is frequently a distressing, although not a dangerous complaint. It is only distressing while it lasts, for after the stomach is unloaded, the appetite generally returns, and the patient usually feels, until the next morning, quite well again, when she has to go through the same process as before.

344. It occurs both in the early and in the latter months of pregnancy; more especially during the former, up to the period of quickening, at which time it usually ceases. Morning sickness is frequently the first harbinger of pregnancy, and is looked upon by many ladies who have had children as a sure and certain sign. Morning sickness does not always occur in pregnancy; some women, at such times, are neither sick nor sorry.

345. A good way to relieve it is by taking, before rising in the morning, a cup of strong coffee. If this should not have the desired effect, she ought to try an effervescing draught:

Two Tablespoonfuls of this mixture to be taken with one of lemon-juice every hour, while effervescing, until relief be obtained.

346. A glass of champagne, taken the overnight, I have sometimes found to be the best remedy, and, if it has the desired effect, it certainly is the most agreeable.

347. I have known, too, cider, where other things have failed, to succeed in abating morning sickness.

348. Sometimes, until the whole contents of the stomach be brought up, she does not obtain relief from her sickness. She had better, when such is the case, drink plentifully of warm water, in order to encourage free vomiting. Such a plan, of course, is only advisable when the morning sickness is obstinate, and when the treatment recommended above has failed to afford relief.

349. The morning sickness, during the early months, is caused by sympathy between the stomach and the womb; and during the latter months by pressure of the upper part of the womb against the stomach. As we cannot remove the sympathy and the pressure, we cannot always relieve the sickness; the patient, therefore, is sometimes obliged to bear with the annoyance.

350. The bowels ought to be kept gently opened, either by a Seidlitz powder taken early in the morning, or by one or two compound rhubarb pills at bedtime, or by the following mixture:

A wineglassful of this mixture to be taken early in the morning, occasionally, first shaking the bottle.

351. Great attention ought in such a case to be paid to the diet; it should be moderate in quantity, and simple in quality. Rich dishes, highly-seasoned soups and melted butter must be avoided. Hearty meat suppers ought not on any account to be allowed. There is nothing better, if anything be taken at night, than either a teacupful of nicely-made and well-boiled oatmeal gruel, or of arrow-root, or of Arabica Revalenta. Any of the above may be made either with water, or with new milk, or with cream and water.

352. It is an old saying, and, I believe as a rule, a true one, “that sick pregnancies are safe,” more especially if the sickness leaves, which it generally does, after she has quickened. The above remarks, of course, do not include obstinate, inveterate vomiting, occasionally occurring in the latter period of pregnancy, and which not only takes place in the morning, but during the whole of the day and of the night, and for weeks together, sometimes bringing a patient to the brink of the grave. Such a case, fortunately, is extremely rare. Another old and generally true saying is, “that females who have sick pregnancies seldom miscarry.”

353. Means to harden the nipples.—A mother, especially with her first child, sometimes suffers severely from sore nipples. Such suffering may frequently be prevented, if for six weeks or two months before her confinement, she were to bathe her nipples, every night and morning, for five minutes each time, either with eau de Cologne, or with brandy and water, equal parts of each. The better plan will be to have the brandy and water in a small bottle ready for use, and putting a little each time into a teacup, using it fresh and fresh. A soft piece of fine old linen rag should be used for the purpose of bathing. All pressure ought to be taken from the nipples; if the stays, therefore, unduly press them, either let them be enlarged or let them be entirely removed. The nipples themselves ought to be covered with a soft linen rag, as the friction of a flannel vest would be apt to irritate them. Let me recommend every pregnant lady, more especially in her first pregnancy, to adopt either the one or the other of the above plans to harden the nipples; it might avert much misery, as sore nipples are painful and distressing; and prevention at all times is better than cure.

354. The breasts are, at times, during pregnancy, much swollen and very painful; and, now and then, they cause the patient great uneasiness, as she fancies that she is going to have either some dreadful tumor or a gathering of the bosom. There need, in such a case, be no apprehension. The swelling and the pain are the consequences of the pregnancy, and will in due time subside without any unpleasant result. The fact is, great changes are taking place in the breasts; they are developing themselves, and are preparing for the important functions they will have to perform the moment the labor is completed.

355. Treatment.—She cannot do better than, every night and morning, to well rub them with equal parts of eau de Cologne and of olive oil, and to wear a piece of new flannel over them; taking care to cover the nipples with soft linen, as the friction of the flannel may irritate them. The liniment encourages a little milky fluid to ooze out of the nipple, which will afford relief.

356. If stays be worn, the patient should wear them slack, in order to allow the bosoms plenty of room to develop themselves. The bones of the stays ought all to be removed, or serious consequences might ensue.

357. Bowel complaints, during pregnancy, are not unfrequent. A dose either of rhubarb and magnesia, or of castor oil, are the best remedies, and are generally, in the way of medicine, all that is necessary.

358. The diet at such times ought to be simple, small in quantity, and nourishing. Farinaceous food, such as rice, tapioca, sago, Du Barry’s Arabica Revalenta, and arrow-root, are particularly beneficial. Green vegetables and fruits, especially stone fruits and uncooked fruits, ought to be avoided.

359. The surface of the body—the bowels and feet particularly—ought to be kept warm. If a lady suffer habitually from relaxation of the bowels, let her, by all means, wear a flannel vest next the skin.

360. The bladder.—The patient during pregnancy is liable to various affections of the bladder. There is sometimes a sluggishness of that organ, and she has little or no inclination to make water. There is, at another time, a great irritability of the bladder, and she is constantly wanting to pass urine; while, in a third case, more especially toward the latter period of the time, she can scarcely hold her water at all,—the slightest bodily exertion, such as walking, stooping, coughing, sneezing, etc., causing it to come away involuntarily; and even in some cases, where she is perfectly still, it dribbles away without her having any power to prevent its doing so.

361. A sluggish state of the bladder is best remedied by gentle exercise, and by the patient attempting, whether she want or not, to make water at least every four hours.

362. Irritability of the bladder.—The patient ought, during the day, to drink freely of the following beverage:

Boil for a quarter of an hour, then strain, and sweeten either with sugar candy or lump sugar.

363. The bowels ought to be gently opened with small doses of castor oil. The patient must abstain from beer, wine, or spirits, and should live on a mild, bland, nourishing diet.

364. Where the patient cannot hold her water there is not a great deal to be done, as the pregnant womb by pressing on the bladder prevents much present relief. The comfort is, as soon as the labor is over, it will cure itself. She ought frequently in the day to lie down either on a horse-hair mattress or on a couch. She should drink but a moderate quantity of liquid, and if she has a cough (for a cough greatly increases this inability to hold the water), she ought to take the following mixture:

Two tablespoonfuls of this mixture to be taken three times a day.

365. Fainting.—A delicate woman, when she is enceinte, is apt either to feel faint or to actually faint away. When it is considered the enormous changes that, during pregnancy, take place, and the great pressure there is upon the nerves and the blood-vessels, it is not at all surprising that she should do so. There is one consolation, that although fainting at such times is disagreeable, it is not at all dangerous, unless the patient be really laboring under a disease of the heart.

366. Treatment.—If the patient feel faint, she ought immediately to lie down flat upon her back, without a pillow under her head; that is to say, her head should be on a level with her body. The stays and any tight articles of dress—if she has been foolish enough to wear either tight stays or tight clothes—ought to be loosened; the windows should be thrown wide open; water ought to be sprinkled on her face; and sal-volatile—a teaspoonful in a wineglassful of water, or a glass of wine ought to be administered. Smelling-salts must be applied to the nostrils. The attendants—there should only be one or two present—should not crowd around her, as she ought to have plenty of room to breathe.

367. She must, in the intervals, live on a good, light, generous diet. She should keep early hours, and ought to sleep in a well-ventilated apartment. The following strengthening medicine will be found serviceable:

Two tablespoonfuls of the mixture to be taken three times a day.

If she be delicate, a change either to the country, or, if the railway journey be not very long, to the coast, will be desirable.

368. A nervous patient during this period is subject to palpitation of the heart. This palpitation, provided it occur only during pregnancy, is not dangerous; it need therefore cause no alarm. It is occasioned by the pressure of the pregnant womb upon the large blood-vessels, which induces a temporary derangement of the heart’s action. This palpitation is generally worse at night, when the patient is lying down. There is, at these times, from the position, greater pressure on the blood-vessels. Moreover, when she is lying down, the midriff, in consequence of the increased size of the belly, is pressed upward, and hence the heart has not its accustomed room to work in, and palpitation is in consequence the result.

369. The best remedies will be either half a teaspoonful of compound spirits of lavender or a teaspoonful of sal-volatile in a wineglassful of camphor julep,^[68] or a combination of lavender and of sal-volatile:

Mix.—A teaspoonful of the drops to be taken occasionally in a wineglassful of water.

370. These medicines ought to lie on a table by the bedside of the patient, in order that they may, if necessary, be administered at once. Brandy is in these cases sometimes given, but it is a dangerous remedy to administer every time there is palpitation; while the lavender and the sal-volatile are perfectly safe medicines, and can never do the slightest harm.

371. Mental emotion, fatigue, late hours, and close rooms ought to be guarded against. Gentle out-door exercise, and cheerful but not boisterous company are desirable.

372. Cramps of the legs and of the thighs during the latter period, and especially at night, are apt to attend pregnancy, and are caused by the womb pressing upon the nerves which extend to the lower extremities. Treatment.—Tightly tie a handkerchief folded like a neckerchief round the limb a little above the part affected, and let it remain on for a few minutes. Friction by means of the hand either with opodeldoc or with laudanum (taking care not to drink it by mistake) will also give relief. Cramp sometimes attacks either the bowels or the back of a pregnant woman; when such is the case, let a bag of hot salt, or a hot-water bag,^[69] or a tin stomach warmer filled with hot water and covered with flannel, or a stone bottle containing hot water, wrapped in flannel, be applied over the part affected; and let either a stone bottle of hot water or a hot brick, which should be incased in flannel, be placed to the soles of the feet. If the cramp of the bowels, of the back, or of the thighs be very severe, the following mixture will be serviceable:

A wineglassful of this mixture to be taken at bedtime occasionally, and to be repeated, if necessary, in four hours.

373. “The whites,” during pregnancy, especially during the latter months, and particularly if the lady has had many children, are frequently troublesome, and are, in a measure, owing to the pressure of the womb on the parts below causing irritation. The best way, therefore, to obviate such pressure, is for the patient to lie down a great part of each day either on a bed or on a sofa.

374. She ought to retire early to rest; she should sleep on a horse-hair mattress and in a well-ventilated apartment, and she must not overload her bed with clothes. A thick, heavy quilt at these times, and indeed at all times, is particularly objectionable; the perspiration cannot pass readily through it as through blankets, and thus she is weakened. She ought to live on plain, wholesome, nourishing food; but she must abstain from beer and wine and spirits. The bowels ought to be gently opened by means of a Seidlitz powder, which should occasionally be taken early in the morning.

375. The best application will be, to bathe the parts with warm fuller’s earth and water, in the proportion of a handful of powdered fuller’s earth to half a wash-hand-basinful of warm water; and the internal parts ought, night and morning, to be bathed with it. If the fuller’s earth should not have the desired effect, an alum injection^[70] ought, every night and morning, by means of an india-rubber vaginal syringe,^[71] to be syringed up the parts; or fifteen drops of solution of diacetate of lead should be added to a quarter of a pint of lukewarm water, and be used in a similar manner as the alum injection.

376. Cleanliness, in these cases, cannot be too strongly urged. Indeed, every woman, either married or single, ought, unless special circumstances forbid, to use either the bidet or a sitz-bath. If she has not the “whites,” or if she has them only slightly, cold, quite cold water is preferable to tepid. I should advise, then, every lady, both married and single, whether she has the “whites” or not, a regular sitz-bath^[72] every morning (except during her “poorly times”)—that is to say, I should recommend her to sit every morning in the water (in cold water) for a few seconds, or while she can count a hundred; throwing the while either a small blanket or shawl over her shoulders, but having no other clothing on except slippers on her feet. She should, for the first few mornings, make the water lukewarm; but the sooner she can use it cold—quite cold—the more good it will do her.

377. If the above plan were more generally followed, women of all classes and ages would derive immense benefit from its adoption, and many serious diseases would be warded off. Besides, the use of the sitz-bath, after a time, would be a great comfort and enjoyment.

378. Where a lady suffers severely from the “whites,” she ought to visit the coast. There is nothing in such cases that generally affords so much relief as the bracing effects of sea-air. Of course, if she be pregnant, she ought not to bathe in the sea, but should, every night and morning, bathe the external parts with sea water.

379. When the patient has been much weakened by the “whites,” she will derive benefit from a quinine mixture^[73]—a dose of which ought to be taken twice or three times a day.

380. Irritation and itching of the external parts.—This is a most troublesome affection, and may occur at any time, but more especially during the latter period of the pregnancy; and as it is a subject that a lady is too delicate and too sensitive to consult a medical man about, I think it well to lay down a few rules for her relief. The misery it entails, if not relieved, is almost past endurance.

381. Well, then, in the first place, let her diet be simple and nourishing; let her avoid stimulants of all kinds. In the next place, and this is a most important item of treatment, let her use a tepid salt and water sitz-bath.^[74]

382. The way to prepare the bath is to put a large handful of table salt into the sitz-bath, then to add cold water to the depth of three or four inches, and sufficient hot water to make the water tepid or lukewarm. The patient must sit in the bath; her slippered feet being, of course, out of the water, and on the ground, and either a woolen shawl or a small blanket being thrown over her shoulders: which shawl or blanket ought to be the only covering she has on the while. She should remain only for a few seconds, or while she can count, in the winter, fifty, or the summer, a hundred, in the bath. Patients generally derive great comfort and benefit from these salt and water sitz-baths.

383. If the itching, during the daytime, continue, the following lotion ought to be used:

To make a lotion. The parts affected to be bathed three or four times a day with the lotion. Or the parts may be bathed two or three times a day with equal parts of vinegar and water.

384. The external parts, and the passage to the womb (the vagina), in these cases, are not only irritable and itching, but are sometimes hot and inflamed, and are covered either with small pimples, or with a whitish exudation of the nature of aphtha (thrush), somewhat similar to the thrush on the mouth of an infant; then the addition of glycerin to the lotion is a great improvement, and usually gives immense relief. Either of the following is a good lotion for the purpose:

To make a lotion. The part affected to be bathed every four hours with the lotion, first shaking the bottle.

Or,

To make a lotion. To be used in the same manner as the preceding one.

385. If a premature expulsion of the child occur before the end of the seventh month, it is called either a miscarriage or an abortion; if between the seventh month and before the full period of nine months, a premature labor.

386. There is a proneness for a young wife to miscarry, and woe betide her, if she once establish the habit! for it, unfortunately, often becomes a habit. A miscarriage is a serious calamity, and should be considered in that light; not only to the mother herself, whose constitution frequent miscarriages might seriously injure, and eventually ruin; but it might rob the wife of one of her greatest earthly privileges, the inestimable pleasure and delight of being a mother!

387. Now, as a miscarriage may generally be prevented, it behooves a wife to look well into the matter, and to study the subject thoroughly for herself, in order to guard against her first miscarriage; for the first miscarriage is the one that frequently leads to a series. How necessary it is that the above important fact should be borne in mind! How much misery might be averted; as, then, means would, by avoiding the usual causes, be taken to ward off such an awful calamity. I am quite convinced that in the majority of cases, miscarriages may be prevented.

388. Hence the importance of a popular work of this kind, to point out dangers, to give judicious advice, that a wife may read, ponder over, and “inwardly digest,” and that she may see the folly of the present practices that wives—young wives especially—usually indulge in, and thus, that she may avoid the rocks they split on, which make a shipwreck of their most cherished hopes and treasures.

389. Let it then be thoroughly understood,—first, that a miscarriage is very weakening—more weakening than a labor; and, secondly, that if a lady has once miscarried, she is more likely to miscarry again and again; until, at length, her constitution is broken, and the chances of her having a child become small indeed!

390. Causes.—A slight cause will frequently occasion the separation of the child from the mother, and the consequent death and expulsion of the fœtus; hence the readiness with which a lady sometimes miscarries. The following are the most common causes of a young wife miscarrying: Taking long walks; riding on horseback; or over rough roads in a carriage; a long railway journey; overexerting herself, and sitting up late at night. Her mind, just after marriage, is frequently too much excited by large parties, by balls, and concerts.

391. The following are, moreover, frequent causes of a miscarriage: Falls; all violent emotions of the mind, passion, fright, etc.; fatigue; overreaching; sudden shocks; taking a wrong step either in ascending or in descending stairs; falling down stairs; lifting heavy weights; violent drastic purgatives; calomel; obstinate constipation; debility of constitution; consumptive habit of body; fashionable amusements; dancing; late hours; tight lacing; indeed, anything and everything that injuriously affects either the mind or the body.

392. The old maxim that “prevention is better than cure” is well exemplified in the case of a miscarriage. Let me, then, appeal strongly to my fair reader to do all that she can, by avoiding the usual causes of a miscarriage which I have above enumerated, to prevent such a catastrophe. A miscarriage is no trifling matter; it is one of the most grievous accidents that can occur to a wife, and is truly a catastrophe.

393. Threatening or warning symptoms of a miscarriage.—A lady about to miscarry usually, for one or two days, experiences a feeling of lassitude, of debility, of malaise, and depression of spirits; she feels as though she were going to be taken “poorly;” she complains of weakness and of uneasiness about the loins, the hips, the thighs, and the lower part of the belly. This is an important stage of the case, and one in which a judicious medical man may, almost to a certainty, be able to stave off a miscarriage.

394. More serious, but still only threatening symptoms of a miscarriage.—If the above symptoms are allowed to proceed, unchecked and untended, she will, after a day or two, have a slight show of blood; this show may soon increase to a flooding, which will shortly become clotted. Then, perhaps, she begins for the first time to dread a miscarriage! There may at this time be but little pain, and the miscarriage might, with judicious treatment, be even now warded off. At all events, if the miscarriage cannot be prevented, the ill effects to her constitution may, with care, be palliated, and means may be used to prevent a future miscarriage.

395. Decided symptoms of a miscarriage.—If the miscarriage be still proceeding, a new train of symptoms develop themselves; pains begin to come on, at first slight, irregular, and of a “grinding” nature, but which soon become more severe, regular, and “bearing down.” Indeed, the case is now a labor in miniature; it becomes le commencement de la fin; the patient is sure to miscarry, as the child is now dead, and separated from its connection with the mother.

396. The most usual time for a lady to miscarry is from the eighth to the twelfth week. It is not, of course, confined to this period, as during the whole time of pregnancy there is a chance of a premature expulsion of the contents of the womb. A miscarriage before the fourth month is at the time attended with little danger; although, if neglected, it may forever injure the constitution.

397. There is, in every miscarriage, more or less of flooding, which is the most important symptom. After the fourth month it is accompanied with more risk; as the further a lady is advanced in her pregnancy, the greater is the danger of increased flooding; notwithstanding, under judicious treatment, there is every chance of her doing well.

398. A medical man ought in such a case always to be sent for. There is as much care required in a miscarriage as, or more than, in a labor.

399. If bearing down, expulsive pains—similar to labor pains—should accompany the flooding; if the flooding increase, and if large clots come away; if the breasts become smaller and softer; if there be coldness, and heaviness, and diminution in the size of the belly; if the motion of the child (the patient having quickened) cannot be felt; if there be “the impression of a heavy mass rolling about the uterus [womb], or the falling of the uterine tumor from side to side in the abdomen [belly] as the patient changes her position;”^[75] and if there be an unpleasant discharge, she may rest assured that the child is dead, and that it is separated from all connection with her, and that the miscarriage must proceed, it being only a question of time. Of course, in such a case—if she has not already done so—she ought immediately to send for a medical man. A miscarriage sometimes begins and ends in a few days—five or six; it at other times continues a fortnight, and even in some cases three weeks.

400. Treatment.—If a patient has the slightest “show,” she ought immediately to confine herself either to a sofa or she should keep in bed. A soft feather bed must be avoided; it both enervates the body and predisposes to a miscarriage. There is nothing better for her to sleep on than a horse-hair mattress. She either ought to lie flat upon her back or should lie upon her side, as it is quite absurd for her merely to rest her legs and feet, as it is the back and the belly, not the feet and the legs, that require rest.

401. Let her put herself on a low diet, such as on arrow-root, tapioca, sago, gruel, chicken-broth, tea, toast and water, and lemonade; and whatever she does drink ought, during the time of the miscarriage, to be cold. Grapes, at these times, are cooling and refreshing.

402. The temperature of the bedroom should be kept cool; and, if it be summer, the window ought to be thrown open; aperient medicines must be avoided; and if the flooding be violent, cold water should be applied externally to the parts.

403. Let me strongly urge upon the patient the vast importance of preserving any and every substance that might come away, in order that it may be carefully examined by the medical man.

404. It is utterly impossible for a doctor to declare positively that a lady has miscarried, and that all has properly come away, if he have not had an opportunity of examining the substances for himself. How often has a lady declared to her medical man that she has miscarried, when she has only parted with clots of blood! Clots sometimes put on strange appearances, and require a practiced and professional eye to decide at all times upon what they really are.

405. The same care is required after a miscarriage as after a labor; indeed, a patient requires to be treated much in the same manner—that is to say, she ought for a few days to keep her bed, and should live upon the diet I have recommended after a confinement, avoiding for the first few days stimulants of all kinds. Many women date their ill state of health to a neglected miscarriage; it therefore behooves a lady to guard against such a catastrophe.

406. A patient prone to miscarry, ought, before she become pregnant again, to use every means to brace and strengthen her system. The best plan that she can adopt will be TO LEAVE HER HUSBAND FOR SEVERAL MONTHS, and go to some healthy spot; neither to a fashionable watering-place nor to a friend’s house, where much company is kept, but to some quiet country place; if to a healthy farm-house so much the better.

407. Early hours are quite indispensable. She ought to lie on a horse-hair mattress, and should have but scant clothing on the bed. She must sleep in a well-ventilated apartment. Her diet should be light and nourishing. Gentle exercise ought to be taken, which should alternate with frequent rest.

408. Cold ablutions ought every morning to be used, and the body should be afterward dried with a coarse cloth. If it be winter, let the water be made tepid and let its temperature be gradually lowered until it be used quite cold. A shower-bath is, in these cases, serviceable; it braces and invigorates the system, and is one of the best tonics that she can use.

409. If she be already pregnant it would not be admissible, as the shock of the shower-bath would be too great, and may bring on a miscarriage; but still she ought to continue the cold ablutions.

410. A lady who is prone to miscarry, ought, as soon as she is pregnant, to lie down a great part of every day; she must keep her mind calm and unruffled; she should live on a plain diet; she ought to avoid wine and spirits and beer; she should retire early to rest, and she must have a separate sleeping apartment. She ought as much as possible to abstain from taking opening medicine; and if she be actually obliged to take an aperient—for the bowels must not be allowed to be constipated—she should select the mildest (such as either castor oil or lenitive electuary or syrup of senna), and even of these she ought not to take a larger dose than is absolutely necessary, as a free action of the bowels is a frequent cause of a miscarriage.

411. The external application of castor oil as a liniment, and as recommended at page 144, is a good and safe remedy for a patient prone to miscarry; and if sufficiently active, is far preferable to the mildest aperient. Another great advantage of the external application of castor oil is, it does not afterward produce constipation as the internal administration of castor oil is apt to do. If the external application of castor oil in the manner advised at page 144 should not have the desired effect, then an enema—a clyster of warm water, a pint—ought, in the morning, two or three times a week to be administered.

412. Gentle walking exercise daily is desirable: long walks and horseback exercise ought to be sedulously avoided. A trip to the coast, provided the railway journey be not very long, would be likely to prevent a miscarriage; although I would not, on any account, recommend such a patient either to bathe or to sail on the water, as the shock of the former would be too great, and the motion of the vessel and the sea-sickness would be likely to bring on what we are anxious to avoid.

413. As the usual period for miscarrying approaches (for it frequently comes on at one particular time), let the patient be more than usually careful; let her lie down the greatest part of the day; let her mind be kept calm and unruffled; let all fashionable society and every exciting amusement be eschewed; let both the sitting and the sleeping apartments be kept cool and well ventilated; let the bowels (if they be costive) be opened by an enema (if the external application of castor oil, as before recommended, be not sufficient); let the diet be simple and yet be nourishing; let all stimulants, such as beer, wine, and spirits, be at this time avoided; and if there be the slightest symptoms of an approaching miscarriage, such as pains in the loins, in the hips, or in the lower belly, or if there be the slightest show of blood, let a medical man be instantly sent for, as he may, at an early period, be able to ward off the threatened mishap.

FALSE LABOR PAINS.

414. A lady, especially in her first pregnancy, is sometimes troubled with spurious labor pains; these pains usually come on at night, and are frequently owing to a disordered stomach. They affect the belly, the back, and the loins; and occasionally they extend down the hips and the thighs. They attack first one place and then another; they come on at irregular intervals; at one time they are violent, at another they are feeble. The pains, instead of being grinding or bearing down, are more of a colicky nature.

415. Now, as these false pains more frequently occur in a first pregnancy, and as they are often more violent two or three weeks toward the completion of the full time, and as they usually come on either at night or in the night, it behooves both the patient and the monthly nurse to be cognizant of the fact, in order that they may not make a false alarm and summon the doctor before he is wanted, and when he cannot be of the slightest benefit to the patient.

416. It is sometimes stated that a woman has been in labor two or three weeks before the child was born! Such is not the fact. The case in question is one probably of false pains ending in true pains.

417. How, then, is the patient to know that the pains are false and not true labor pains? False labor pains come on three or four weeks before the full time; true labor pains at the completion of the full time; false pains are unattended with “show;” true pains generally commence the labor with “show;” false pains are generally migratory—changing from place to place—first attacking the loins, then the hips, then the lower portions, and even other portions of the belly—first one part, then another; true pains generally begin in the back; false pains commence as spasmodic pains; true pains as “grinding” pains; false pains come on at uncertain periods, at one time a quarter of an hour elapsing, at others, an hour or two hours between each pain; at one time the pain is sharp, at another trifling; true pains come on with tolerable regularity, and gradually increase in severity.

418. But remember—the most valuable distinguishing symptom is the absence of “show” in false labor pains, and the presence of “show” in true labor pains. It might be said that “show” does not always usher in the commencement of labor. Granted; but such cases are exceedingly rare, and may be considered as the exception and not the rule.

419. Treatment.—A dose of castor oil is generally all that is necessary; but if the pains still continue, the patient ought to be abstemious, abstaining for a day or two from beer and from wine, and rubbing the bowels every night at bedtime either with camphorated oil, previously warmed, or with laudanum (taking care not to drink it by mistake). Either hot salt, in a flannel bag, or a hot-water bag applied every night at bedtime to the bowels, frequently affords great relief.

420. If the pains be not readily relieved she ought to send for a medical man. A little appropriate medicine will soon have the desired effect.

421. These false labor pains might go on either for days, or even for weeks, and at length may terminate in real labor pains.

PERIOD OF GESTATION—“THE COUNT.”

422. The period of gestation is usually^[76] two hundred and eighty days—forty weeks—ten lunar or nine calendar months.

423. It will be well for a lady, in making her “count,” to commence her “reckoning” about three days after the last day of her being “unwell.” The reason we fix on a woman conceiving a few days after she has “ceased to be unwell” is that she is more apt to do so soon after menstruation than at any other time.^[77]

424. A good plan to make the “reckoning” is as follows: Let forty weeks and a few days, from the time specified above, be marked on an almanac, and a lady will seldom be far from her calculation. Suppose, for instance, the last day of her “ceasing to be unwell” was on January the 15th, she may expect to be confined very near October 23d.

425. Another plan, and one recommended by Dr. Tanner, to make the “count,” is the following: “To effect this readily, we cannot do better than follow the plan of most German obstetricians, who learn the probable day of delivery thus: the date of the last menstruation being given, they calculate three months backward and add seven days. For example, suppose the 20th January to be the last day of the last menstrual period, labor will be due about the 27th October—i.e. on the 280th day.”^[78]

BEING OUT IN THE RECKONING.

426. A lady, sometimes, by becoming pregnant while she is suckling, is put out of her reckoning; not being unwell at such time, she consequently does not know how to “count.” She ought, in a case of this kind, to reckon from the time that she quickens—that is to say, she must then consider herself nearly half-gone in her pregnancy, and to be within a fortnight of half her time; or, to speak more accurately, as soon as she has quickened, we have reason to believe that she has gone about one hundred and twenty-four days: she has therefore about one hundred and fifty-six more days to complete the period of her pregnancy. Suppose, for instance, that she first quickened on May the 17th, she may expect to be confined somewhere near October the 23d. She must bear in mind, however, that she can never make so correct a “count” from quickening (quickening takes place at such various periods) as from the last day of her being “unwell.”

427. A lady is occasionally thrown out of her reckoning by the appearance, the first month after she is enceinte, of a little “show.” This discharge does not come from the womb, as that organ is hermetically sealed; but from the upper part of the vagina, the passage to the womb, and from the mouth of the womb, and may be known from the regular menstrual fluid by its being much smaller in quantity, by its clotting, and by its lasting generally but a few hours. This discharge, therefore, ought not to be reckoned in the “count,” but the one before must be the guide, and the plan should be adopted as recommended in page 186, paragraph 423.

“IS IT A BOY OR A GIRL?”

428. It has frequently been asked, “Can a medical man tell, before the child is born, whether it will be a boy or girl?” Dr. F. J. W. Packman, of Wimborne, answers in the affirmative. “Queen bees lay female eggs first, and male eggs afterward. In the human female, conception in the first half of the time between menstrual periods produces female offspring, and male in the latter. When a female has gone beyond the time she calculated upon, it will generally turn out to be a boy.”^[79] It is well to say generally, as the foregoing remarks are not invariably to be depended upon, as I have had cases to prove. Notwithstanding, I believe that there is a good deal of truth in Mr. Packman’s statement.

MONTHLY NURSE.

429. It is an important, a most important, consideration to choose a nurse rightly and well.

430. A monthly nurse ought to be middle-aged. If she be young, she is apt to be thoughtless and giggling; if she be old, she may be deaf and stupid, and may think too much of her trouble. She should have calmness and self-possession. She must be gentle, kind, good-tempered, and obliging, but firm withal, and she should have a cheerful countenance. “Some seem by nature to have a vocation for nursing; others not. Again, nursing has its separate branches; some have the light step, the pleasant voice, the cheering smile, the dextrous hand, the gentle touch; others are gifted in cookery for the sick.”^[80] The former good qualities are essential to a monthly nurse, and if she can combine the latter—that is to say, “if she is gifted in cookery for the sick”—she will, as a monthly nurse, be invaluable. Unless a woman have the gift of nursing, she will never make a nurse. “Dr. Thynne held that sick-nurses, like poets, were born, not made.”^[81]

431. She ought neither to be a tattler, nor a tale-bearer, nor a “croaker,” nor a “potterer.” A tattler is an abomination; a clacking tongue is most wearisome and injurious to the patient. A tale-bearer is to be especially avoided; if she tell tales of her former ladies, my fair reader may depend upon it that her turn will come.^[82] But of all nurses to be shunned as the plague is the “croaker,” one that discourses of the dismal and of the dreadful cases that have occurred in her experience, many of which, in all probability, she herself was the cause of. She is a very upas-tree in a house. A “potterer” should be banished from the lying-in room; she is a perpetual worry—a perpetual blister! She is a nurse without method, without system, and without smartness. She potters at this and potters at that, and worries the patient beyond measure. She dreams, and drawls, and “potters.” It is better to have a brusque and noisy nurse than a pottering one—the latter individual is far more irritating to the patient’s nerves, and is aggravating beyond endurance. “There is one kind of nurse that is not uncommon in hospitals [and in lying-in rooms], and that gives more trouble and worry than all the others together, viz., the ‘pottering’ nurse. Of all nuisances, defend us from a potterer.... The woman always has the very best intentions in the world, but is totally devoid of method and smartness. You never know when she has begun anything, and you certainly will never know when she has finished it. She never does finish it, but she sometimes leaves off.... She seems incapable of taking in a complete and accurate idea of anything, and even while you are speaking to her it is easy to see that her attention cannot be concentrated, and that her mind is flying about among half a dozen subjects. If she is in the least hurried, she loses what little intellect she ordinarily possesses, moans feebly in a sotto voce monotone, fetches the wrong articles, does the wrong thing at the wrong time, and is always in the way.”^[83]

432. Some monthly nurses have a knack of setting the servants at loggerheads, and of poisoning the minds of their mistresses toward them. They are regular mischief-makers, and frequently cause old and faithful domestics to leave their situations. It will be seen, therefore, that it is a momentous undertaking to choose a monthly nurse rightly and well.

433. Fortunately for ladies the class of nurses is wonderfully improved, and the race of Sairey Gamp and Betsey Prig is nearly at an end.

434. She ought to be either a married woman or a widow. A single woman cannot so well enter into the feelings of a lying-in patient, and has not had the necessary experience. Moreover, a single woman, as a rule, is not so handy with an infant (more especially in putting him for the first time to the breast) as a married woman.

435. She must be sober, temperate, and healthy, and free from deafness and from any defect of vision. She should have a gentle voice and manner, but yet be neither melancholy nor hippish. She ought to be fond of children, and must neither mind her trouble nor being disturbed at night. She should be a light sleeper. “Scrupulous attention to cleanliness, freshness, and neatness” in her own person, and toward the lady and the infant, are most important requisites.

436. A fine lady-nurse that requires to be constantly waited upon by a servant is not the one that I would recommend. A nurse should be willing to wait upon herself, upon her mistress, and upon the baby with alacrity, with cheerfulness, and without assistance, or she is not suitable for her situation.

437. As the nurse, if she does her duty, devotes her time, her talent, and her best energies to the lady and infant, a mistress ought to be most liberal in the payment of a monthly nurse. A good one is cheap at almost any price, while a bad one, though she come for nothing, is dear indeed. A cheap nurse is frequently the ruin of the patient’s and of the baby’s health, and of the peace of a household.

438. The monthly nurse ought to be engaged early in the pregnancy, as a good nurse is caught up soon, and is full of engagements. This is most important advice. A lady frequently has to put up with an indifferent nurse from neglecting to engage her betimes. The medical man at the eleventh hour is frequently besought to perform an impossibility—to select a good nurse; and which he could readily have done if time had been given him to make the selection. Some of my best nurses are engaged by my patients as early as two or three months after the latter have conceived, in order to make sure of having their favorite nurses. My patients are quite right; a good nurse is quite of as much importance to her well-doing as a good doctor; indeed, a bad nurse oftentimes makes a good doctor’s efforts perfectly nugatory.

439. It is always desirable, whenever it be possible, that the doctor in attendance should himself select the monthly nurse, as she will then be used to his ways, and he will know her antecedents—whether she be sober, temperate, and kind, and that she understands her business, and whether she be in the habit of attending and of following out his directions, for frequently a nurse is self-opinionated, and fancies that she knows far better than the medical man. Such a nurse is to be scrupulously avoided. There cannot be two masters in a lying-in room; if there be, the unfortunate patient will inevitably be the sufferer. A doctor’s directions must be carried out to the very letter. It rests with the patient to select a judicious medical man, who, although he will be obeyed, will be kind and considerate to the nurse.