Chapter II (2)

Treatment.--This is to replace the womb and keep it in position. Supports of various kinds are used to keep the womb in position after it has been replaced, They must fit thoroughly and give no pain or any discomfort whatever. They are called supports or pessaries. If they are fitted properly they do much good. They should be removed often (every month) and not allowed to grow fast or cause sores in the vagina. There are the ring support and the stem variety and others. The stem variety can be taken out and replaced by wearer at any time. They are made to buckle around the abdomen. They are bungling but effective. The ring kind should be introduced by a competent person who should see that it is of correct size and shape, and worn with comfort. Sometimes these supports fail to cure when adhesions and other diseases exist; it may be impossible to wear them.

Operations.--One operation is to break up the adhesions, the body of the womb brought forward and sewn (sutured) to the abdominal wall. Another operation is to shorten the round ligaments in the inguinal (groin) canal. These are the usual operations, and they are quite successful.

FALLING OR PROLAPSE OF THE WOMB.--The womb may come down and remain in the vagina (incomplete falling). When the womb escapes at the vulva it is called a complete falling (prolapse or procidentia).

For the Incomplete Kind.--Replace the womb and wear a support for months.

For the Complete Falling.--Replace the womb. The patient should remain in bed with daily, hot, prolonged vaginal injections of water for a few weeks. The injection daily of white oak bark tea, of the strength of one ounce of the bark to a pint of hot water, is often of great benefit.

If these measures fail to cure, an operation may be necessary.

MOTHERS' REMEDIES. 1. Falling of the Womb. Unicorn Root for.--"Make a strong tea of unicorn root, and take a half teaspoonful three times a day, This is an excellent remedy for falling of the womb," This is very easily prepared and not bad to take, and in addition to this use an injection of witch-hazel or golden seal.

2. Falling of the Womb, a Fine Herb Combination for.--"Peach leaves, mullein leaves and hops made into a tea, and a pint used twice a day as an injection often cures when other remedies fail." We all know that this combination of herbs is healing and especially in female trouble. The hops, especially, are very soothing to the affected parts.

3. Falling of the Womb, a Physician's. Treatment.--"Knee-chest position. Get down on the knees and put chest and chin to the floor. Retain this position about three minutes several times a day." This is a splendid thing to do, and is recommended by all physicians.

[510 MOTHERS' REMEDIES]

4. Falling of the Womb, a Never Failing Remedy for.--"Ague root (Aletris Farinosa) is a valuable agent to prevent tendency to miscarriage and falling of the womb. It is especially useful for the purpose of restoring the activity of the generative organs giving them vigor and healthy action. Dose of the tincture is from six to ten drops three times a day and of the powdered root five to eight grains." This is an old tried remedy, and is frequently used by physicians alone or in combination with other remedies.

5. Falling of the Womb, White Oak Bark for.--"A mild infusion of white oak bark, or of alum or tannin, used in quantities of a pint, as a douche, will often give immediate relief."

LEUCORRHEA. (The Whites).--This is an over-secretion from the glands that pour out their contents into the vagina or the cervical canal of the womb.

Causes.--It is dependent upon many causes. Tear of the neck of the womb (cervix), displacements, inflammation of the womb and vagina, a run-down condition of the system from any cause. The character of the discharge varies.

From a Torn Cervix, the discharge is thick and mucus-like in character.

In Inflammation of the Canal of the Cervix.--A thick mucus discharge also comes from this trouble.

Inflammation of the Body of the Womb.--The discharge is thin and watery. If the Inflammation is Caused by Gonorrhea the discharge would partake of the pus-like variety.

Symptoms.--Local: is of course mainly the discharge or the irritation often produced by it, especially if it is thin. It then irritates the parts. The patient will be run down. It will be hard to do anything, frequently the patient is very nervous and irritable.

MOTHERS' REMEDIES. 1. Leucorrhea, Slippery Elm for.--"The immediate cause of leucorrhea is either congestion or inflammation of the mucous membrane of the vagina or womb, or both. It is not a disease, but a symptom of some vaginal or uterine disorder; hence, general or specific tonics may be needed but appropriate injection as auxiliary treatment will very much assist in cure. The patient should bathe frequently and freely expose herself to the sunshine, and have good ventilation in the house. If the vaginal passage is very tender and irritable, an infusion, or tea, of slippery elm bark is very soothing and may be used freely with a vaginal syringe. Whatever injection is employed, should be preceded by the free use of castile soap and warm water to thoroughly cleanse the parts." Always lie down after an injection.

[WOMAN'S DEPARTMENT 511]

2. Leucorrhea, Glycerin for.--"One part glycerin to six parts water is a very soothing lotion when there is much tenderness, pain or heat in the vagina. A teaspoonful of tartaric acid in a pint of warm water is a specific, in some cases, acting like magic. Whatever lotion is employed, always use it warm. After cleansing with soap suds, the medicated lotion of not less than two ounces should be injected."

3. Leucorrhea, Common Tea for.--"A very simple remedy that every woman has in the home is a decoction of common tea; used as an injection twice daily is very beneficial." The tea has an astringent action and the tannin contained in the tea leaves is very effective. This remedy is a harmless one, and every woman suffering with this disagreeable disease should give this remedy a trial.

4. Leucorrhea, Witch-hazel for.--"Cleanse the parts well with clear warm water, then inject two quarts of warm water in which has been dropped a tablespoonful of witch-hazel." This is a very good remedy and sure to give relief.

5. Leucorrhea, White Oak Bark for.--"White oak bark one ounce, water one pint. This makes a very good injection and will be found very effective,"

6. Leucorrhea, a Good Herb Remedy for.--"Inject into the vagina with a female syringe, a tea of bistort or beth root, and cranesbill, night and morning and take the following night and morning in wineglassful doses.

White Pond Lily Root. 2 ounces
Unicorn Root 2 ounces
Wahoo Root 1 ounce
Golden Seal 1 ounce
Cinnamon 1 ounce

Add three pints of water, simmer to one quart, pour boiling hot upon one ounce of grated nutmeg, one-half ounce ginger, powdered, one half pound of granulated sugar. Exercise in the open air and nourishing food are indispensable."

7. Leucorrhea, Common Vinegar for.--"Two tablespoonfuls vinegar in two quarts of water (warm or hot), used as a douche at bedtime, until cured," This will cure some mild cases and has an astringent action.

8. Leucorrhea, an Easily Prepared Remedy for.--"Red oak bark tea used with syringe; follow with hot water." Steep the red oak bark and make a tea of it, using about two or three teaspoonfuls of the bark to a pint of hot water. This acts as an astringent and the red oak bark contains a good deal of tannin which is very beneficial in cases of this kind.

9. Leucorrhea, Home-Made Suppositories for.--"Take a small piece of medicated cotton, and saturate in pure glycerin and insert in the vagina at night, after a warm salt injection has been taken to thoroughly cleanse the parts." So many women of today are careless about taking injections, at least once or twice a week. Many of these diseases could be avoided in the beginning by women being more cleanly. This saturated cotton acts as a suppository absorbing the mattery secretion and in that way relieves the congestion.

[512 MOTHERS' REMEDIES]

10. Leucorrhea, a Good Home Remedy for.--"Cleanse the parts affected with warm water with a little castile or ivory soap in it, by means of an injection. Then inject a full syringe of the mixture, made by dropping a tablespoonful of extract of witch-hazel (Pond's is best) into warm water; repeat each night until cured." The injection of soap and water is one of the essential things to do for leucorrhea, as it cleanses the parts thoroughly and the witch-hazel is very soothing and healing.

11. Leucorrhea, a New York Doctor's Remedy for.--"Fluid extract of Oregon grape root (sometimes called mild grape) mixed with a simple syrup and given in teaspoonful doses, three times a day, is recommended by Dr. W. W. Myers, as a curative for leucorrhea."

PHYSICIANS' TREATMENT.--First is to do away, if possible, with local disease, like inflammations, tear of the cervix, etc. The general system should be built up with tonics. The same treatment as for anemia and chlorosis will be usual for this trouble. Refer to those diseases.

Local.--The vagina should be kept as clean as possible with the hot water injections. To the hot water many simple remedies can be added with much benefit.

1. One ounce of white oak bark in a pint of boiling water makes a good injection for this trouble. Before any medicine is used the vagina should always be washed out by an injection of warm water. Then follow with the indicated injection and retain it as long as possible.

2. Tannic acid and glycerin, equal parts, one ounce to two quarts of warm water, is a good injection.

3. Lloyd's Golden Seal is splendid, used in the proportion of four teaspoonsful to a pint of warm water.

4. This combination gives good service:--

Sulphate of Zinc 1 dram
Sulphate of Alum 1 dram
Glycerin 6 ounces

Put a tablespoonful to each quart of warm water and use as injection.

It is well to remember the injections must be given in large quantities, and used in a fountain syringe. A gallon can be used at one time.

5. Witch-hazel in warm water makes an excellent injection in many cases. It can be used in the proportion of one-fifth water of witch-hazel to four-fifths of warm water.

6. Many other simple remedies may be named, Cranesbill is one. Vaginal cones are now made for leucorrhea. These are used about every third night and a thorough injection taken the next day. There are many varieties, most of them are good and can be bought at any drug store.

[WOMAN'S DEPARTMENT 513]

MENOPAUSE. (Change of Life). The active menstrual life lasts on an average for thirty years and ends between forty and fifty years of age. The courts have recognized the age of fifty-three years as the limit that a woman can become pregnant.

The onset of the change of life, may be sudden or gradual. The organs shrink and waste. The womb shrinks and part of its muscular tissue disappears and its walls become thin, soft and relaxed. The ovaries become small and harder. The vagina shortens and also becomes narrower. Sudden mental shock, wasting disease or change of climate, may cause a sudden appearance of the change of life.

Symptoms.--Many women hardly notice any change, as it comes on gradually. Other women have all kinds of bodily and mental symptoms, and some are afraid of becoming insane. The heart palpitates readily, feelings of heat and cold, flushes of heat of the face, followed by sudden sweating. Rush of blood to the head so quickly sometimes as to make the patient lose temporary consciousness. The spirits are very much depressed, sleeplessness is common in some women.

MOTHERS' REMEDIES. 1. Change of Life, a Useful Herb Remedy for.-- "Motherwort is one of the most useful herbs to relieve obstructed menstrual flow. There is no better herb for cleansing the womb and removing obstructions in the female at change of life. Dose: A wineglassful of the decoction three times a day."

2. Change of Life, excessive Flowing. An Old Tried Remedy for.--"One ounce of nutmeg, grated, one pint Jamaica rum. Mix well and shake before taking. Dose :--One teaspoonful three times a day as long as necessary." I tried this remedy upon the advice of a physician at the time of "change of life" and was very soon relieved, so I heartily recommend it.

3. Change of Life. Good Advice From an Experienced Mother.--"The first and most important point to consider is the general health of the patient. If the general health can be sustained there will be no danger attending this critical period of life. Therefore whatever form of disease may manifest itself the one object should be to seek a remedy in time. Take special pains to preserve general good health and take care not to overwork, take plenty of outdoor exercise and keep up a regular action of the bowels. Purify the blood with tonics if necessary."

PHYSICIANS' TREATMENT.--Exercise, fresh air, with freedom from worry, anxiety and care. Many women at this time of life need much encouragement, and cheerful company is a good tonic. Prominent annoying symptoms should be met with the proper medicine. Irregular bleeding of the womb at this time or after should lead to an examination as to its origin.

[514 MOTHERS' REMEDIES]

CYSTOCELE--Cystocele is simply a tumor formed by the bladder pressing into the walls of the vagina. The bladder descends into the pelvis on account of relaxation or destruction of its normal support. The anterior wall of the vagina yields.

Causes.--Tear of the perineum allows the bottom of the pelvis to relax. Undue relaxation of the ligaments of the bladder and of the floor of the pelvis, with over distention of the bladder, are responsible for the majority of the cases.

Symptoms.--Weight and dragging feeling. A tumor can be felt in the vagina. It decreases when the bladder is emptied.

Treatment.--Supports are suitable in some cases (Skene's pessary). An operation is necessary in many cases.

RECTOCELE.--The muscle that holds up the lower end of the rectum is relaxed or torn and this deprives the lower end of the rectum of its support so that during expulsion of the feces forward distention of the anterior wall of the rectum into the vagina results. The posterior wall of the vagina is carried before the advancing anterior rectal wall, and appears at the entrance of the vagina as a bulging tumor which is increased in size with every effort of the rectum to cast out the feces.

Causes.--Hard child-birth (labor) and the long time the head of the child was resting on the perineum. This resulted in an overstretching or tear of the muscle that holds up the lower end of the bowel and the parts were necessarily weakened.

Symptoms.--It is hard to entirely empty the rectum because of the presence of the tumor. This is soft, rounded, increasing and decreasing in size and disappears upon pressure.

Treatment.--Keep, if possible, the tumor from getting larger, regulate the bowels.

An operation may be necessary to restore the parts to their normal condition. A physician must be consulted.

[OBSTETRICS OR MIDWIFERY 515]

OBSTETRICS OR MIDWIFERY

Small bodies are contained in the ovaries. These are called eggs or ova. The human egg is about 1/125 of an inch in diameter. This egg enlarges and one or more escape from the ovaries, usually about the time of the monthly sickness, and are caught by the ends of the Fallopian tube, enter its canal and are carried into the womb. After they have arrived in the womb they are, as a rule, cast off with the secretion and leave the body. If in the course of its travel from the ovaries, through the tube to the womb, the female ovum or egg meets with the male elements, fertilization or impregnation may take place. If then it is not cast off it generally lodges in the womb and pregnancy has begun. The male and female elements are usually supposed to meet in the outer portion of the Fallopian tubes, fertilization then taking place; but this can occur any place from the ovary to the womb. When the fertilized egg enters the womb it is usually arrested in the folds of the womb membrane nearest the opening of the tube and at once attaches itself to the womb wall. The folds by which it is surrounded then grow forward and their edges unite over the egg or ovum forming a sac--the decidua reflexa. Then follows the development of this ovum and with it the development of the womb, and this growth or development constitutes the process which is called pregnancy.

The Embryo or impregnated egg is nourished in the womb by measures preparing for it. The placenta or after-birth forms during the third month of pregnancy. Its function is to furnish nourishment breathing (respiration) and excreting power to the embryo or impregnated egg. The fully developed after-birth is a roundish spongy mass with a diameter of about eight inches and weighs about one pound. It is usually thickest at the center, the edges thinning out to the membranes. The inner surface is smooth and glistening and is covered by a membrane (amnion) and beneath this two arteries and a vein branch in all directions.

The cord is attached to the inner surface of the after-birth and is of a glistening white color, varying in thickness, and is about twenty-two inches long, but it may be longer or shorter. It contains two arteries and a vein, which run in a somewhat spinal course.

DEVELOPMENT AT DIFFERENT MONTHS.--

First month.--There are indications of the eyes, mouth and anus. The extremities are rudimentary. The heart is 4/10 of an inch long.

Second month.--It is now about one inch long. The eyes, nose and ears can be distinguished. External genitals. There are suggestions of the hands and feet.

[516 MOTHERS' REMEDIES]

Third month.--The ovum is now the size of a goose-egg. Fingers and toes separate, nails look like fine membranes. The neck separates the head from the body. The sex can now be told. Length is five inches. Weight about 460 grains.

Fourth month.--Six inches long and now weighs 850 grains. Short hairs are present. Head equal to about one-fourth entire body. May perceive quickening.

Fifth month.--Ten inches long; weighs eight ounces. Eyelids begin to separate. Heart sounds can be heard. Quickening takes place.

Sixth month.--Twelve inches long; weighs 23-1/2 ounces. There is hair on the head, eyebrows and eyelashes are present. Testicles show near the abdominal rings (openings).

Seventh month.--Fifteen inches long; weight 41-1/2 ounces. Pupillary membrane disappears.

Eighth month.--Sixteen inches long; weight 3-1/2 pounds. Left testicle has descended into the scrotum. Nails protrude to end of finger tips.

Ninth month.--Eighteen inches long; weighs 4-1/2 to 7 pounds. Features are complete.

While this growth goes on in the embryo the womb itself shows changes. The virgin womb averages 2-3/4 inches in length, 1-3/4 inches in width and 1 inch in thickness and weighs about 12 drams. At term (confinement) the womb is about 14 inches long, 10 inches wide, and 9-1/2 inches thick. This increase in size is necessary for its growing contents and is due to both an enlargement of its tissues (hypertrophy) and to an increase in the number of its cells (hyperplasia). The muscular fibres are elongated to about 11 inches, and they are five times thicker than they are in a womb that is not pregnant. The cervix or neck of the womb participates but little in these changes, and remains practically the same until a few weeks before confinement. It becomes softened as the result of congestion, and the glands are more active, secreting a thick glairy mucus. The canal also is more or less dilated.

While this process is going on in the womb, various other conditions show themselves, sometimes in the parts of the body so distant that it may not be easy to discover the connection with the womb. Almost any part of the body is liable to show changes from its normal condition; and yet some of these changes are so constant and regular as to be regarded as signs of pregnancy. It must not be forgotten, however, that sure signs of pregnancy, such as cannot be induced by other causes, are very limited, especially in the early months.

[OBSTETRICS OR MIDWIFERY 517]

Changes occur in the genital organs that may lead a physician to suspect that pregnancy may exist; but the first symptom that attracts the attention of the woman, is the passing of the monthly period. This is not an absolute sign of pregnancy, since other things or conditions may cause it. The effect of the mind upon the body may cause it, and it also occurs sometimes in early married life without any appreciable cause, unless it may be then due to the effect upon the nervous system of the marital relation. Again, the monthly sickness sometimes continues in a greater or less degree, during a part or even the whole of pregnancy. Usually this discharge is due to some diseased condition of the cervix. The fear of impregnation in unmarried women after illicit intercourse will occasionally suspend menstruation for one or two months.

Nausea and Vomiting.--Another symptom upon which considerable dependence is placed is the morning sickness (nausea and vomiting). While this symptom is common, yet its absence does not prove that the woman is not pregnant. Some women go through the whole pregnancy without any sign of this symptom.

Nausea accompanied or not by vomiting may appear at the very time of conception, but it usually appears about the fourth or fifth week of pregnancy and continues until the sixteenth week or longer. In some cases it may last but a short time, in others it may continue until confinement. It may be light or severe; It generally manifests itself upon arising in the morning and subsides in a short time, but it may occur at any time of the day and continue during the entire waking hours. It may be absent entirely and, in rare instances, manifest itself in the husband alone. I have known of one such case. This nausea may be excited only by various odors or sights or may be caused by constipation. An increased secretion from the salivary glands usually accompanies the stomach disturbances and in some cases it may amount to salivation. An irresistible desire for certain articles of food or drink, generally of a sour or acid nature, is often developed. Indigestion, gas in the bowels and belching of gas are frequently present. The appetite is often capricious or it may be entirely lost (anorexia).

Breasts.--Changes in the breasts also constitute a sign of pregnancy. As an early symptom, there may be a feeling of fullness, sometimes pain. They become larger and firmer from the development of the individual lobules, which have an irregular knotty feel. A fat deposit takes place between the lobules and in the other parts of the breast. The nipples increase in size, are harder to the touch, become more prominent. A few drops of a turbid fluid, colostrum, may be pressed from the nipple as early as the third month. The veins under the skin become larger and more conspicuous. The rose-colored circles (rings) around the nipples are broadened and are slightly elevated above the surrounding skin and there is a marked increase in their pigmentation, the color varying with the complexion of the individual from reddish pink to brown and black. These changes usually occur at the beginning of the third month, and if the woman has already had a child the question of pregnancy has been decided by inspection of these breast changes.

Bladder.--This is sometimes irritable in the later months, causing a frequent desire to pass urine. It sometimes occurs in the second or third week and is sometimes followed, later, by an inability to retain the urine which escapes at any time. This, however, is not frequent.

[518 MOTHERS' REMEDIES]

Abdominal changes.--There is a slight flattening of the lower abdomen at the second month, due to the sinking of the womb. There is also a slight retraction (drawing back) of the navel. After the third month, when the womb begins to ascend out of the pelvis, a progressive enlargement of the abdomen begins and continues until near the end of pregnancy, when the womb again sinks and the so-called lightening occurs. The protrusion of the abdomen is more marked usually on the right side. There is often an increased deposit of fat in the lower portion of the abdomen, as well as on the hips and thighs. The navel may protrude after the sixth month,

Pigmentation.--Pigmentation or darkening of the middle line of the abdomen begins by the eighth or twelfth week, and a dark band about 1/8 of an inch wide extends from the pubis (bone) to and around the navel or even higher. This shows plainer in brunettes, where it is quite conspicuous. Discolorations also appear on other parts of the body, especially on the face, "moth patches."

Quickening.--This is caused by the movement of the child (foetus) in the womb. The impact of the enlarging womb, through the child (foetal) movements, against the abdominal wall about the sixteenth week of pregnancy gives rise to this sensation called quickening. Some women claim to have experienced this sensation at a much earlier date, and by some it is not felt at all. Gas in the bowels and contraction of the muscles of the abdomen may give a chance for mistakes. In the later months of pregnancy, the movements sometimes become so violent as to produce perceptible movements of the womb and the abdominal muscles, and sometimes they are the cause of the pain.

The Blood.--The blood is increased in quantity and slightly altered in its composition. The water, fibrin and white corpuscles are increased; the red cells are at first relatively diminished, but later return to normal.

Nervous System.--The nervous system is over sensitive and the disposition of the woman may undergo a radical change, mental exaltation and depression are often exhibited.

Constipation is the Rule.--Neuralgias in different parts of the body, especially in the face and teeth, are common. Palpitation of the heart and difficulty in breathing may be experienced. A discharge from the vagina is almost always present, due to the increased circulation in the cervix and vagina.

The Foetal Heart-beat.--This is the one positive sign of pregnancy and it may be heard as early as the sixteenth to the twentieth week. It has been compared to the ticking of a watch under a pillow. It ranges in frequency from one hundred and ten to one hundred and fifty to a minute.

[OBSTETRICS OR MIDWIFERY 519]

Pelvic Signs.--As early as the first month of pregnancy a faint violet color of the anterior wall of the vagina just below the opening of the urethra may be distinguished. In the third month this color has become purplish and pronounced. This sign is present in eighty per cent of cases. There is also a more or less marked lividity of the vaginal portion of the cervix from the first month of pregnancy. Also there is softening of the cervix as early as the sixth week, and as pregnancy advances the whole of the cervix is softened.

Duration of Pregnancy.--This is for all practical purposes two hundred and eighty days.

How to Determine Date of Confinement.--The best rule is to count backward three months from the first day of the last menstrual period and add seven days to it. To be more accurate, in April and September only six days should be added; in December and January, five days; and in February, four days.

Position of the Womb.--At four months the top of the womb has risen above the pelvic brim bone in front; at five months, it is midway between the bone (pubic) and the navel; at six months, it is at the navel; at seven months, it is four fingers breadths above the navel; at eight months, it is midway between the navel and the bottom of the breast bone; at nine months, it is to the breast bone; from the middle to the end of the ninth month, the top of the womb sinks to about the position occupied at the eighth month.

Twins occur about once in ninety to one hundred and twenty, triplets once in one thousand eight hundred and seventy-five, and quadruplets once in three hundred and seventy-one thousand one hundred and twenty-six pregnancies. The causes are unknown. Twin conception is more common in women who have borne children, and more so in the elderly than in the young, first bearing women (primiparae).

Sex.--Children from the same ovum (egg) are always of the same sex. Of twins in general, more than one-third are males, less than one-third are females, and in the remaining one-third both sexes occur. The after-birth is always, at least at first, double.

Diagnosis.--In twin pregnancy the symptoms and disorders of pregnancy are apt to be exaggerated, and watery swelling above the pubic bone is almost always present in the latter months. The abdomen is larger and broader and there may be a depression dividing the abdominal wall in two spaces. The womb is much distended and the walls are thin.

Hygiene of pregnancy.--In pregnancy the dividing line between health and disease is often so shadowy that every care should be given the pregnant woman, not only that she shall escape dangers that may come, but that the future health of the coming baby may be safeguarded.

The care taken in pregnancy therefore should include attention to clothing, food, exercise, rest, sleep, functions of all excreting organs, the breasts, nervous system and the mind.

[520 MOTHERS' REMEDIES]

Clothing.--This should be worn loose. The heavier garments should not be held by the waist but suspended from the shoulders. Flannels, if possible, should be worn next the skin excepting, possibly, during the warmest weather. Every precaution should be taken not to take cold or to chill the surface of the body, as this might bring on an acute trouble of the kidneys. As soon as the womb has risen out of the pelvis during the fourth month, the corset should be absolutely abandoned, since pressure upon the enlarging womb tends to cause acute Bright's disease and uraemia, and these troubles are always to be guarded against. During the later months of pregnancy, when the abdominal enlargement is great, a linen or elastic bandage may be worn with great comfort, but it must be so put on as to support and not press upon the womb.

Food.--The food of the pregnant woman should be simple, wholesome, nutritious, of the kind that is easily digested and enough to satisfy the demands of her system; excessive eating should be avoided. A mixed diet is to be preferred, but the diet should be of such kind as to help to overcome the constipation, usual in pregnancy. Meat should not be eaten in as great quantities. It not only tends to produce more constipation but also has injurious effect upon the kidneys, and anything that in any way puts a greater burden upon the kidneys in pregnancy should be avoided. All foods that are likely to produce indigestion, heart burn, or irritation of the stomach and liver, such as sweets, fried, greasy, highly spiced foods; greasy rich gravies, or pastry should not be eaten.

The heartiest meal should be taken near midday and the stomach, especially at night, should never be overloaded. Water should, be drank freely, as it tends to overcome the constipation and wash out the kidneys. Some women do better with lighter meals and taken more frequently. Some do better by taking their breakfast before rising.

Bathing.--Extremes in hot and cold bathing should be avoided. The skin should be kept active by daily comfortable baths, followed by a brisk rubbing with a rough towel. The Bowels and Bladder.--The bowels, as before stated, are usually constipated and should be kept open by coarse foods, fruit and, when necessary, mild laxatives; mineral waters and enemas especially should not be given. It should not be forgotten that in some women injections into the bowel are liable to bring on contractions of the womb.

No woman, and especially no pregnant woman, should ever neglect the bowels, as much discomfort and ill health are caused by improper eliminations of the bowel contents. The bladder should also have proper care. This is apt to be irritable during the early and later months of pregnancy, owing to being pressed upon by the womb. A mild inflammation arises in some cases. The woman should take plenty of water, either pure or effervescing, to induce sufficient secretion in the kidneys, and also to flush them. This is also very good for an irritable bladder. In order that the physician may keep himself informed regarding the condition of the kidneys, the urine of every pregnant woman should be examined, both chemically and microscopically, every two weeks from the beginning of pregnancy; during the late months of pregnancy the urine analysis should be made weekly. Catherized specimens should be used because leucorrheal discharges, so common in pregnancy, may give the albumin reaction. If the above advice of Dr. Manton, of Detroit, was followed in every case there would be fewer cases of trouble during the confinement. I remember one case; the lady was seven months along when I was called. She was feeling badly and complained much of her eyes; an analysis of the urine showed thick with albumin. The failure of her sight was due to thc condition of her kidneys. If the urine had been examined early and often, her condition might have been prevented. Watch the kidneys, have the urine examined frequently and carefully.

[OBSTETRICS OR MIDWIFERY 521]

Exercise, Rest and Sleep.--Plenty of exercise in the open air should be taken daily, without this health cannot be maintained. It should not be violent or so great as to fatigue and overtire. Slow riding in a carriage and walking will give the best results. Horseback riding and riding in an automobile should be avoided. The woman should sit out of doors as much as possible. Plenty of sleep is also necessary. Eight hours are not too much at night, and lying down an hour or two during the forenoon and afternoon is very restful and desirable.

The Vagina.--When there is a profuse discharge of leucorrhea, a daily vaginal douche is necessary. This should consist of a quart of warm solution (as much as the water will dissolve) of boric acid, or an equal amount of mild carbolic acid (one to eighty). The temperature of the solution should be about 100 degrees F., and it should be injected slowly, and without any force to the stream.

It is also best to remain in the recumbent position for some time after the injection, to rest.

The Breast and Nipples.--These should be bathed once or twice daily in cool or tepid water until the last month or two of pregnancy. Astringent application should not be applied to the nipples to harden them. If the nipples are small, undeveloped or retracted they should be pulled out several times daily by the fingers and gently rubbed, and this will usually stimulate their growth. Cocoa butter or castor oil may be applied during the last month.

Nervous System and the Mind.--The pregnant woman is very susceptible to annoying conditions of the social and domestic surroundings; such should be removed, if possible, and excitement of every kind should be avoided. Everything should be made bright and comfortable around her, cheerfulness should be the rule in the home and she should be treated with every care and consideration. Surroundings will influence the coming baby's future.

[522 MOTHERS' REMEDIES]

Disorders of Pregnancy.--Nausea and vomiting.--The simple nausea and vomiting of pregnancy needs no treatment. This kind generally disappears by the third or fourth month, but it may persist in a mild form during the greater part of pregnancy. Generally the regulation of the diet and attention to the bowels are all that is necessary to be done for this trouble. Foods should be chosen carefully and only such foods taken that agree with the stomach and lessen the constipation. Sometimes taking a light breakfast in bed saves the usual morning sickness. It is best then to remain lying for some time after eating. When the condition is annoying the following powder will give much relief: powder Ingluvin, oxalate of cerium, of each five grains. Mix thoroughly and take one, every one or two hours as needed. A physician should be consulted if this trouble is very severe.

MOTHERS' REMEDIES.--1. Pregnancy, A Great Aid for.--"Soothing syrup or Mother's friend, while pregnant. Two ounces each of cramp bark, blue cohosh, slippery elm, raspberry leaves, squaw vine, orange peel and bitter root. Simmer gently in sufficient water to keep herbs covered for two hours, strain and steep gently down to one quart. Let it stand to cool, then add one cup granulated sugar, and four ounces alcohol. Dose.--One tablespoonful two or three times a day for several weeks before the birth of the child. This has been thoroughly tried and causes an easy birth where difficulty has been expected."

2. Nausea of Pregnancy, Menthol and Sweet Oil for.--"Vomiting and nausea of pregnancy; a twenty per cent solution of menthol in sweet oil; use ten drops on sugar when nausea appears." The menthol acts on the stomach and quiets it. This will be found very beneficial.

3. Pregnancy, Bouillon or Broth for.--"Was weak and generally run down. Family physician warned me I would never survive the birth of another child. I bought each day several beef bones and boiled them for three hours. I also bought chicken feet, scalded them and scraped them until the outside skin peeled off, then boiled the chicken feet with the bones. Skim surface from time to time. I would then heat up a raw egg in a glass and fill glass with this broth and drink it warm." This lady would take a glass whenever thirsty or six or seven times a day. She increased in strength immediately, within a year was the mother of a healthy baby girl now nineteen years old and believes her life was saved by the above. Anyone will find this worth trying.

[OBSTETRICS OR MIDWIFERY 523]

Indigestion and Heart-burn.--This should be treated the same as under other conditions. Diet, habits, should be regulated. The bowels and kidneys should be regulated and do their eliminating work. For heart-burn the popular remedy, magnesia may be taken or dilute hydrochloric acid with nux vomica. One teaspoonful or effervescing citrate of magnesia dissolved in water and drank, is a convenient remedy. Also, five drops of diluted hydrochloric acid in water, taken after meals, through a tube, and one or two drops of nux vomica before meals is beneficial. The following is an excellent combination from Dr. Hare, of Philadelphia:

Dilute Hydrochloric Acid 2 drams
Essence of Pepsin 1 ounce
Compound Tincture of Gentian enough to make 4 ounces

Mix. Take one or two teaspoonfuls in a little water with meals.

In cases where it is impossible to eat anything the patient must be fed by the rectum. In such cases a doctor must be called. Fortunately such severe cases are very rare. The following for rectal feeding is given by Dr. Manton, of Detroit, and is a good combination. Give every four hours:

Liquid Beef Peptonoids 3 drams
White of an Egg
Whisky 3 drams
Beef Tea or Warm Water enough to make 3 ounces

The rectum should be washed out once or twice daily in the interval between the feeding.

Teeth.--The teeth are often affected during pregnancy, softening and decaying rapidly, causing severe neuralgia. The teeth should be cleaned frequently during the day to get rid of the secretions of the mouth, and at night before retiring. Milk of magnesia should be held in the mouth for a few minutes; cavities in the teeth should be stopped with a temporary filling. Teaspoonful of lacto phosphate of lime can be taken three times a day with benefit.

Constipation.--The enlarging womb pressing upon the rectum and also irregularity in diet causes constipation at this time. Daily free bowel movements are necessary to prevent the kidneys from overworking. As stated before, the diet should be strictly regulated. Cascara sagrada cordial is a good mild laxative to take, if necessary.

Difficult Breathing.--This usually comes late in pregnancy and is due to the pressure of the womb upon the diaphragm; the patient should avoid excitement and sleep with the shoulders well elevated. In the ninth month the womb drops lower and the breathing is better.

Varicose Veins and Piles.--Varicose veins: These are due to the pressure on the veins so that the return flow of blood is impeded and occur as a rule late in pregnancy. They are seen oftenest on the inner side of the thighs, the lower extremities, the vulva, and in the region of the anus. As a rule, they do not give much trouble. When they become painful or inflamed the patient should lie down, with the legs elevated and use water of witch-hazel applied with cloths. Elastic stockings, properly fitted, give much relief when the trouble is on the thigh and leg.

[524 MOTHERS' REMEDIES]

Piles.--When these are troublesome the rectum should be emptied by a small dose of salts, and the parts thoroughly washed with warm water, the piles pushed back and local lotions applied (see treatment of piles). Hot fomentations of witch-hazel frequently give great relief to the piles as well as to the varicose veins. Regular movements of the bowels usually will prevent piles. Piles will not usually give rise to much trouble unless constipation exists.

Albumin in the urine. (Albuminuria).--While the urine of about six to ten per cent of all pregnant women contains albumin, the appearance of this symptom should always be regarded with apprehension. Women who are in their first pregnancy are most frequently affected. If the woman has had disease of the kidneys before her pregnancy began this symptom will likely appear in the early months; if it is caused by pressure, etc., it may not appear until after the sixth month, but both acute and chronic. inflammation of the kidneys may develop at any period of pregnancy. Dr. Manton, of Detroit, states, "In the majority of cases, the albuminuria is due to the so-called kidney of pregnancy, in which there is no inflammation, but a fatty infiltration of the epithelial cells associated with anemia of the organ." The urine may also contain casts. Whatever the cause it indicates a condition of insufficiency of the kidney which may lead to serious consequences to the mother and it is also injurious to the (foetus) child. If this symptom develops suddenly the danger to both is greatly increased. For this reason physicians should urge pregnant women to have their urine examined frequently, especially during the later months of pregnancy.

Treatment.--Regulation of the diet; in pronounced cases the diet should consist entirely of milk and the patient should take three or four quarts in twenty-four hours. Meats, pastry and sweets must be prohibited, but vegetables such as squash, spinach, salads may be added to the dietary in ordinary cases. Vichy water may be taken alone or with the milk, and may be taken freely. The bowels should be kept open with citrate of magnesia (one to two teaspoonfuls in water) or epsom salts in peppermint water. Exercise in the open air can be taken in moderation. Warm clothing should be worn and flannel next the skin; exposure to cold and draughts should be carefully avoided. If the more special symptoms appear, such as persistent headache, vertigo, ringing in the ears, black or bright spots floating before the eyes, dimness of vision, an abortion of miscarriage should be induced without delay. Fortunately such cases are rare and with care from the beginning seldom occur. Pregnant women should inform their family physician at the beginning of pregnancy of their condition, and in the great majority of cases serious troubles can be prevented. Physicians expect this information and receive it as a matter of course, and no woman should hesitate to inform her physician either personally or through her husband.

[OBSTETRICS OR MIDWIFERY 525]

Abortion, Miscarriage, Premature Labor. (Accidents of pregnancy).--These three terms indicate a premature expulsion of the products of conception. Let us medically define these terms as follows; Abortion implies expulsion of the foetus before the sixteenth week. Miscarriage, the expulsion between the sixteenth and twenty-eighth weeks. Premature labor designates the time of expulsion as between the twenty-eighth week to within a few weeks before the normal termination of pregnancy. Miscarriage is the term popularly used for the accidental loss of the products of conception. Abortion, in the popular mind, expresses the intentional loss of the products of conception. Abortion in the medical sense, takes place about once in every four or five pregnancies. It occurs more frequently in those who have borne children, occurring generally in the third or fourth pregnancy, or toward the end of the child-bearing period, and it takes place more frequently between the ninth and sixteenth week, when the after- birth is in process of formation; and it is more liable to occur at the time of the month when the normal menstruation would be due. It should be borne in mind also that abortion occurring at this period is quite dangerous to the mother's future health, and also dangerous to life; so that at the first indication of abortion a physician should be called for this trouble, because it needs care, both to prevent it and to assist the woman to a successful ending when it is impossible to prevent it. This is more dangerous to life than confinement at full term, and is apt to leave behind a tendency to recurrence at the same time in the future pregnancies, and also makes the woman liable to inflammatory conditions of the womb.

Causes.--Abortion may be induced by many causes due to the mother, father, and child. Among maternal causes may be mentioned any serious disease, especially fevers, when accompanied by a rash on the skin, such as smallpox, measles, scarlet fever. It is hard for a pregnant woman to go through one of these diseases, without having an abortion. Syphilis, tuberculosis, malaria, organic heart and kidney disease, diabetes, anemia, and systemic poisoning also are causes; nervous disturbances as shock, fright, sorrow, convulsions, chorea; mechanical causes, violent exercise, lifting, blows, falls, coughing, vomiting; local causes, as wrong position of the womb, inflammation of the womb, etc.; all are causes.

Causes. Due to the Father. Paternal.--Syphilis, alcoholism, lead poisoning, excessive venery, extremes of youth or old age.

Foetal Causes.--Disease of the after-birth, other parts, of cord, death of the foetus, placenta pravia, and yet many women are subjected to falls, blows, etc., who carry their child to full term.

[526 MOTHERS' REMEDIES]

Symptoms.--These vary with the period of pregnancy where they occur. In the earlier months the symptoms are those of profuse menstruation, sometimes accompanied by more pain perhaps than usual. The ovum is then so small that it escapes notice. In the profuse flow there may be unaccustomed clots of blood; when this trouble occurs later in pregnancy there are two constant symptoms which, together with the history of the case, render the diagnosis easy. These prominent and constant symptoms are pain and bleeding. The symptoms may be preceded by a bearing down feeling in the lower abdomen, with backache, frequent calls to pass urine, and a discharge from the vagina, that is a mixture of mucus and water. After these symptoms last for a shorter or longer time, labor pains set in, the bleeding increases and the contents of the womb are discharged. The ovum may be expelled whole when it looks like a huge blood clot, or it may be expelled partly and the membranes left behind; or the embryo (child) alone, surrounded by the transparent membrane, escapes.

If the after-birth has formed it may be cast off entire or piecemeal. The embryo (child) alone may escape, the neck of the womb contracts and shuts; bleeding persists for an indefinite period, for weeks and weeks, until the health of the poor woman is seriously affected. Persistent bleeding of this kind is almost always due to the retention of portions of the after-birth or membranes, and should prove to the woman that there is a serious condition existing which should be speedily corrected. A physician should be called who should make a thorough examination; and if such a condition as above described is found, should free the womb from its retained products, which are not only sapping the woman's life, but also rendering the future health of the womb very uncertain.

Threatened Abortion.--If a bleeding takes place in the woman who is pregnant, abortion may be assumed to threaten; a careful examination will usually settle this matter.

Inevitable Abortion.--The abortion is probably inevitable if the bleeding becomes persistent and free, the cervix softens, the womb dilates and the labor pains set in. Still in spite of all these conditions, the bleeding and pain may cease, and the pregnancy go on to full term, The result of these cases, if carefully and properly treated, is favorable as far as the mother is concerned.

Treatment. Preventive. In women where repeated abortions have occurred, the cause should be diligently sought for. If syphilis exists the treatment should be begun at the beginning of pregnancy. But when no special cause can be found, and an irritable condition of the womb is suspected to be present, the patient must be kept quiet in bed, especially at the time when menstruation would normally occur. She should also be guarded against lifting, fright, worry, over-exertion; and medicines like bromide of potash, five to fifteen grains at a dose, given to quiet and allay the nervous irritability.

Treatment of Threatened Abortion.--The patient should go to bed, lie down and remain there, and if possible be not only quiet physically, but also quiet mentally. The main remedy is opium, and if necessary to obtain a quick action it can be given hypodermically in the form of morphine. Otherwise, laudanum may be given by the mouth, twenty drops, repeated cautiously, every three or four hours as required, or it can be given in thirty-drop doses combined with a couple of ounces of starch water by the rectum. Extract of opium in pill form, one grain three times a day by the month; or a suppository of opium, one grain, may be inserted into the rectum every four to six hours. After the bleeding and pain have ceased, the emergency is probably passed; but rest in bed and quiet should be the routine for one or more weeks, and the patient should always rest in bed at the usual time of the menstrual period, during the remainder of the pregnancy.

[OBSTETRICS OR MIDWIFERY 527]

Treatment of the Inevitable Abortion.--If the cervix is hard and the canal is not dilated, especially if the bleeding is free, the vagina should be packed full at once, if possible, with iodoform gauze. Rolls five yards long and two inches wide can be bought perfectly adapted to this purpose. A speculum should be used (Sims' or Graves') and the gauze should first be packed tightly into corners (fornices) around the cervix, then over the cervix and well down to the outlet. This should be held in place by a proper (T) bandage. The gauze can be removed in from twelve to twenty-four hours, and the ovum will generally be found lying upon the upper part of the packing, or in the canal that is now dilated, from which it can easily be removed. Sometimes it is necessary to repack and allow it to remain for another twelve hours as the canal has not been sufficiently dilated by the first packing. This packing not only causes the canal to dilate but usually stops the bleeding. After the ovum has been expelled an antiseptic vaginal douche should be given twice a day for a week or longer.

If at the first examination the cervix is found softened and the mouth of the womb is open, but the womb has not yet expelled its contents, the sterile (clean) finger may be introduced into the womb and the ovum and membranes loosened and taken away, while this is being done counter pressure should be made over the abdomen. After the womb has been cleared of all its contents an antiseptic solution should be used, carefully, in the womb to wash it out, and this followed by washing out of the vagina. The after treatment is the same as that for labor at full term. The woman should remain in bed at least ten days.