Chapter V: Part 5

It requires great attention to prevent abortion in subsequent pregnancies, whenever it has happened.

In all such cases, it will be highly necessary to attend to the usual habitudes and constitution of the woman, and to remove that condition which is found to dispose to abortion.

A woman that is subject to miscarriage, and who is of a full plethoric habit, ought to take the tincture of foxglove, twice or thrice a day, for two or three weeks.

She should likewise keep her body perfectly open with gentle aperient medicines, use a spare diet, and avoid all agitations of the mind. The sleep should be abridged in quantity, and taken on a mattress, instead of a feather bed. Regular and moderate exercise should be taken daily, being cautious, at the same time, not to carry it to the length of exciting fatigue.

In women of a weak, lax habit, a nutritive and generous diet, moderate exercise, and tonic medicines, will be required. And, along with nourishing diet, a moderate use of wine should be allowed, if it do not heat the patient, or otherwise disagree. The cold bath is of signal service in every instance where it is not followed by chilliness.

Until gestation be far advanced, it would be advisable for the woman to sleep alone, and strictly avoid every cause which is ascertained to be capable of producing abortion.

Women more frequently miscarry in the second or third month than at any other time; but some have a certain period at which they usually go wrong, and do not vary a week from it. In such cases, the woman should confine herself to the house, avoid the least exercise, and frequently recline on the sofa or bed, till that period be past.

When a female has suffered several abortions, it becomes almost impossible to prevent a repetition at the same period of gestation in a subsequent pregnancy. Nothing, however, will be so successful in preventing a recurrence of a similar misfortune, as in allowing the uterine vessels to recover their tone; for which purpose tonics must be given. Attend to particular symptoms as they occur; with proper diet and exercise. _Sea Bathing_ and the _shower bath_ are both excellent.[46]

_When necessary to effect Miscarriage or Artificial Delivery._

During pregnancy, deformities of the pelvis become objects of solicitude to the accoucheur, when they are of such a character as to render delivery at full term impossible without the interference of cutting operations. At this period only can he guard against the deplorable consequences of these deformities.

_Pelvic Deformities._

The accoucheur may be consulted by a mother anxious to know whether the pelvis of her daughter is such as to justify marriage. His opinion may also be desired by a female pregnant for the first time, in whose mind there may exist fears as to the formation of her pelvis. In this case, he will have to reply to the following questions:

Is delivery at full term compatible with the safety of the child? What influence will the deformity have on pregnancy? What precautions are necessary to guard against accident until the completion of gestation, and to facilitate delivery?

When the accoucheur states that delivery will not be possible without the interference of art, he will then be asked whether this interference will compromise the life of the mother or child; and whether this operation cannot be avoided by some process during pregnancy, either saving the life of mother and child, or sacrificing the child for the benefit of the mother?

In order to answer these questions satisfactorily, and to furnish himself with a rule of conduct in advance, it will be necessary for the accoucheur to know precisely the condition of the pelvis, and the dimensions of the diameters, &c.

However, it must not be supposed that this mensuration can be made with mathematical accuracy; our means will not enable us to obtain this precision; but even if we could, the object we have in view would not be completely accomplished, for, in order to arrive at a rigorous appreciation of the consequences of the deformity and the operations it might require, it would be necessary also to know the exact size of the fœtus, which is not possible.

Happily, in practice, an approximation as to the absolute condition of the pelvis will suffice, and it is easy to arrive at this result. With this view, the accoucheur should, in the first place, learn the previous history of the patient in infancy and youth, and afterward proceed to an external and internal examination.

When the accoucheur is called upon to pass an opinion as to the natural or unnatural conformation of a female, he should, says M. P. Dubois, inquire minutely into the antecedent condition of this woman during her infancy and youth. The history of early life will often, of itself, cause him to suspect the state of the pelvis. He should address the following questions to the parent:

_What diseases was the infant affected with? At what age did they manifest themselves? At what age did the child walk? After walking, did it appear weak in the inferior extremities? Was the erect position possible? Was it easy? Were the articulations large?_

If all these phenomena appeared in infancy, it is highly probable that the pelvis is deformed; and, moreover, it may be affirmed that the symptoms arose from rickets, a disease peculiar to infancy. It commences rarely before eighteen or twenty months, and very seldom after thirteen of fourteen years of age. If there should be curvatures of the spinal column and extremities, it will be almost certain that the pelvis is deformed; and if the curvature commenced in the inferior extremities, we may conclude that it is owing to rachitis, for this disease exerts its influence first on the tibias, then on the bones of the thighs, pelvis, and vertebral column. On the contrary, if the first ten years have been passed without disturbance of the general health, then curvatures must be attributed to malacosteon, especially if the curvature of the spine has preceded that of the lower limbs. Deformity of the spine may exist alone; then we may legitimately hope that the pelvis is not contracted. Experience, indeed, proves that the vertebral column may be considerably curved without the pelvis participating in the deformity, when the inferior extremities are straight; and that, in general, curvatures of the extremities alone accompany pelvic malformations.

Indeed, it is not on simple probabilities that the accoucheur is to interdict the marriage[47] of a young girl, or determine, during pregnancy, to perform an operation, with the view of protecting the mother against the dangers of delivery at full term.

_Premature Artificial Delivery._

Thanks to the efforts of MM. Stoltz, Dezeimeris, P. Dubois, and Velpeau, delivery brought on before the full term is an operation hereafter recognised in French midwifery. For a long time it proved useful to our neighbors in England and Germany, while a foolish prejudice caused it to be rejected by French practitioners, who did not hesitate even to have recourse to the Cæsarean section and symphyscotomy.

We have not within the walls of Paris one solitary example of a woman who had survived the Cæsarean section. She who lived the longest was one of those on whom I assisted M. P. Dubois to operate. She died on the seventeenth day of a tetanic affection, when everything promised a most successful result.—(_Bull. of the Acad. of Med._, t. iii., p. 694; t. v., p. 25.)

When the contraction is such that a living fœtus cannot be brought forth, the accoucheur has then to choose between the Cæsarean section or miscarriage.

During pregnancy, abortion will present an extreme and last resource. And it would seem more humane to sacrifice, before the period of viability, an embryo whose existence is so uncertain, in order to protect the mother from the perilous chances of symphyscotomy and the Cæsarean section.

I must confess that, if such an alternative were presented to me, the diameter of the pelvis being only two inches, I should not hesitate to propose this means.

The abuse and criminal extension of such a resource is reprehensible, but not its proper and authorized employment. This operation should always be undertaken with great care, and all necessary precaution used to satisfy the public mind of its necessity.

LABOR, DELIVERY, ETC.

After seven months of pregnancy the fœtus has all the conditions for breathing and exercising its digestion. It may then be separated from its mother, and change its mode of existence. Child-birth rarely, however, happens at this period: most frequently the fœtus remains two months longer in the uterus, and it does not pass out of this organ till after the revolution of nine months.

Examples are related of children being born after ten full months of gestation; but these cases are very doubtful, for it is extremely difficult to know the exact period of conception. The legislation in France, however, has fixed the principle, that child-birth may take place up to the two hundred and ninety-ninth day of pregnancy.

Nothing is more curious than the mechanism by which the fœtus is expelled; everything happens with wonderful precision; all seems to have been foreseen, and calculated to favor its passage through the pelvis and the genital parts.

The physical causes that determine the exit of the fœtus are the contraction of the uterus and that of the abdominal muscles; by their force the liquor amnii flows out, the head of the fœtus is engaged in the pelvis, it goes through it, and soon passes out by the valve, the folds of which disappear; these different phenomena take place in succession, and continue a certain time; they are accompanied with pains more or less severe; with swelling and softening of the soft parts of the pelvis and external genital parts, and with an abundant mucous secretion in the cavity of the vagina. All these circumstances, each in its own way, favor the passage of the fœtus. To facilitate the study of this action, it may be divided into several periods.

_The first period of child-birth._—It is constituted by the precursory signs. Two or three days before child-birth a flow of mucus takes place from the vagina, the external genital parts swell and become softer; it is the same with the ligaments that unite the bones of the pelvis; the mouth of the womb flattens, its opening is enlarged, its edges become thinner; slight pains, known under the name of _flying pains_, are felt in the loins and abdomen.

_Second period._—Pains of a peculiar kind come on; they begin in the lumbar region, and seem to be propagated towards the womb or the _rectum_; and are renewed only after intervals of a quarter or half an hour each. Each of them is accompanied with an evident contraction of the body of the uterus, with tension of its neck and dilatation of the opening; the finger directed into the vagina discovers that the envelopes of the fœtus are pushed outward, and that there is a considerable tumor, which is called _the waters_; the pains very soon become stronger, and the contraction of the uterus more powerful; the membranes break, and a part of the liquid escapes; the uterus contracts on itself, and is applied to the surface of the fœtus.

_Third period._—The pains and contractions of the uterus increase considerably; they are instinctively accompanied by the contraction of the abdominal muscles. The woman who is aware of their effect is inclined to favour them, by making all the muscular efforts of which she is capable: her pulse then becomes stronger and more frequent; her face is animated, her eyes shine, her whole body is in extreme agitation, and perspiration flows in abundance. The head descends into the lower strait of the pelvis.

_Fourth period._—After some moments of repose the pains and expulsive contractions resume all their activity; the head presents itself at the vulva, makes an effort to pass, and succeeds when there happens to be a contraction sufficiently strong to produce this effect. The head being once disengaged, the remaining parts of the body easily follow, on account of their smaller volume. The section of the umbilical cord is then made, and a ligature is put around it at a short distance from the umbilicus or navel.

_Fifth period._—If the midwife has not proceeded immediately to the extraction of the placenta after the birth of the child, slight pains are felt in a short time, the uterus contracts freely, but with force enough to throw off the placenta and the membranes of the ovum; this expulsion bears the name of _delivery_. During the twelve or fifteen days that follow child-birth the uterus contracts by degrees upon itself, the woman suffers abundant perspirations, her breasts are extended by the milk that they secrete; a flow of matter, which takes place from the vagina, called _lochia_, first sanguiferous, then whitish, indicates that the organs of the woman resume, by degrees, the disposition they had before conception.

MANAGEMENT OF LABOR.

Women in general are ignorant of parturition or delivery. Almost all of them are under the impression that labor is completed more by art than nature; hence the most noted accoucheurs are employed to attend during this interesting period; and professional men, in general, have no wish to undeceive them on this subject, as their interest is too much concerned. It is often astonishing to see the credulity and ignorance manifested on these occasions. Thanks and blessings have been poured forth, under the idea that he had saved their lives in labor, when the accoucheur had merely looked on and admired the perfectly adequate powers of nature, and superintended the efforts of her work; and it is nature that accomplishes all, while the accoucheur gets the credit of it. There is not one case in a thousand in which he can do more than remain a silent spectator, except to calm the fears of the ignorant and timid attendants. The mischief and injury that are done by the untimely interference of art are incalculable.

In pregnancy women are bled till they have not strength enough to accomplish delivery; and, when it takes place, the forceps or other instruments are used, which often prove fatal to the mother or child, or both.

There are various particulars to be avoided, and several things to be done, in the management of women during labor. We have room here to state only a few, and shall begin by pointing out the course to be pursued in

_Natural Labor._

When called to a woman supposed to be in labor, ascertain if her pains are _true_ or _false_, which may be easily known by a little inquiry. If the female complains of flying or unsettled pains about the system, occurring mostly toward evening or during the night, and being slight or irregular, it may be taken for granted that they are spurious or false. If these symptoms prove troublesome, an infusion or tea of _hops_ may be taken; or, if this is not sufficient to relieve them, or procure sleep, an anodyne may be taken; and it may be necessary also to give laxative medicines or an injection, with a little laudanum.

_True pains_ may be known by the pain being more concentrated in the lower part of the belly, through the loins and hips.

The pains now increase in regularity and force, returning every ten or fifteen minutes, and leaving the woman comparatively easy in the intervals.

When the pains become regular and severe, there is a discharge of slimy matter, tinged with blood, known by the name of _shows_. At this period of labor it will be proper for the person who attends the labor to examine, in order to ascertain what part of the child presents, which may be done by requesting the female to sit in the chair or on the side of the bed, and to extend the legs, when the longest finger, dipped in sweet oil, may be passed up the vagina to the part which presents, and the sense communicated will determine the nature of the presentation. In nineteen cases out of twenty, or in almost every case, the head will be felt. Frequent examinations should be avoided.

Dr. Bard, speaking of examinations, remarks: “What terms shall I use to condemn, as it deserves, the abominable practice of boring, scooping, and stretching the soft parts of the mother, under the preposterous idea of making room for the child to pass. It is impossible to censure this dangerous practice too severely; it is always wrong; nor can there be any one period in labor, the most easy and natural, the most tedious and difficult, the most regular or preternatural in which it can be of the least use; in which it will not unavoidably do great mischief: it will render an easy labor painful; one which would be short, tedious; and one which, if left to nature, would terminate happily, highly dangerous.”

“All that is proper to be done in a case of natural labor, from its commencement to its termination,” says Dr. McNair, “will suggest itself to any person of common understanding; and I have long labored under the conviction, that the office of attending women in their confinement should be intrusted to prudent females. There is not, according to my experience, and the reports of the most eminent surgeons, more than one case in three thousand that requires the least assistance. I am aware, however, that there are crafty physicians who attempt, and often succeed, in causing the distressed and alarmed female to believe that it would be altogether impossible for her to get over her troubles without their assistance; and, for the purpose of making it appear that their services are absolutely necessary, they will be continually interfering, sometimes with their instruments, when there is not the least occasion for it. There is no doubt in my mind but that one-half of the women attended by these men are delivered before their proper period; and this is the reason why we see so many deformed children, and meet with so many females who have incurable complaints.”

It is a very common circumstance for an inexperienced (or he may be an experienced, but ignorant) practitioner to attempt a rupture of the membranes, and in doing so, rupture the bladder, which would render the woman miserable during life. We are acquainted with twenty-five or thirty females who have met with this sad misfortune, and many of them have been attended by those who are termed our most successful, or old experienced physicians.

Dr. Rush, speaking of child-bearing among the Indians, says, “that nature is their only _midwife_; their labors are short and accompanied with little pain; each woman is delivered in a private cabin, without so much as one of her own sex to attend her: after washing herself in cold water, she returns in a few days to her usual employment; so that she knows nothing of those accidents which proceed from the carelessness or ill management of _midwives_ or doctors, or the weakness which arises from a month’s confinement in a warm room.”

Dr. Whitney remarks; “I have had many cases where I found the attendants alarmed, and some in tears, from supposing that they should have had help sooner, fearing the worst consequence from delay; but, admitting that the ‘doctor knew best,’ they would wait calmly for hours, when in nature’s time all ended well. I pledge myself as a physician, that all honest doctors will tell you that _labor_ is the work of _nature_, and she generally does it _best_ when left to herself.”[48]

“Among the Araucanian Indians,” says Stevenson in his Twenty Years’ Residence in South America, “a mother, immediately on her delivery, takes her child, and going down to the nearest stream, washes herself and it, and returns to the usual labor of her station.”

“The wonderful facility with which the Indian women bring forth their children,” say Lewis and Clark in their well known journal, “seems rather some benevolent gift of nature, in exempting them from pains which their savage state would render doubly grievous, than any result of habit. One of the women who had been leading two of our pack horses, halted at a rivulet about a mile behind, and sent on the two horses by a female friend. On enquiring of one of the Indian men the cause of her detention, he answered, with great appearance of unconcern, that she had just stopped to lie in, and would soon overtake us. In fact, we were astonished to see her in about an hour’s time come on with her new-born infant, and pass us on her way to the camp, apparently in perfect health.”

Washington Irving, in his work entitled Astoria, relates a similar incident in the following language: “The squaw of Pierre Dorion (who, with her husband, was attached to a party travelling over the Rocky Mountains in winter-time, the ground being covered with several feet of snow) was suddenly taken in labor, and enriched her husband with another child. As the fortitude and good conduct of the woman had gained for her the good will of the party, her situation caused concern and perplexity. Pierre, however, treated the matter as an occurrence that could soon be arranged, and need cause no delay. He remained by his wife in the camp, with his other children and his horse, and promised soon to rejoin the main body on their march. In the course of the following morning the Dorion family made its appearance. Pierre came trudging in advance, followed by his valued, though skeleton steed, on which was mounted his squaw with the new-born infant in her arms, and her boy of two years old wrapped in a blanket, and slung on her side. The mother looked as unconcerned as if nothing had happened to her; so easy is nature in her operations in the wilderness, when free from the enfeebling refinements of luxury and the tampering appliances of art.”

When it has been ascertained that the labor is natural, or that there are no impediments or obstacles, there will be very little more to do than superintend the process. It will be necessary to give instructions to the attendants to make suitable preparation, or have everything required in readiness.

The woman may be delivered upon a bed or a cot, as is most convenient; if a bed be used, all but the mattress should be turned back toward the head, and it should be so prepared that the moisture from the uterus and other discharges may not add to the discomfort of the woman. A dressed skin, oilcloth, or folded blanket may be placed on that part of the mattress on which the body of the woman is to rest; a coarse blanket folded within a sheet, ought to be laid immediately beneath the patient, to absorb the moisture, which must be removed after delivery; the rest of the bed-clothes are to be put on in the ordinary way. The woman, when she is no longer able to remain up may lie down, with her head elevated in any position which is most desirable; and in nearly every case that I have ever attended the back has been preferred, although most all writers recommend that the woman be placed upon her side: the latter practice is unnatural and wrong, for obvious reasons; it retards the labor pains, and prevents the midwife from superintending the progress of the labor; the pillow that is directed to be placed between the knees, to keep them widely separated, soon gets displaced by the motion or change of the female; and the legs, instead of being kept apart, again come in contact, and thus the passage of the child is obstructed: but when the female is placed upon her back this difficulty is obviated, a free passage is permitted, the pains are more effectual, the spine is better supported, and better access can be had to the parts during labor and after the delivery of the child; in short, there is a decided advantage in this position in every respect.

The dress of women in labor should be light and simple, both to keep themselves from being overheated, and to prevent anything from being in the way of what assistance is necessary. In addition to the means recommended, I direct a sheet to be placed around the waist of the woman, to prevent the blood, excrements or waters from coming in contact with the linen or clothes, and, as much as possible, the bed; her linen may be tucked or pushed up so far that there will be no necessity of a removal after delivery.

Every thing being thus adjusted, very little more will be necessary but to wait patiently the efforts and operations of nature. There should be but few attendants in the room, and these are not to whisper to each other, or to express any fears or doubts.

A humane midwife will use every ingenious effort in her power to quiet the useless fears, and support and comfort the patient. A crowd of frightened, hysterical women, assailing the ears of the woman with tales of woe and sad disasters that have happened should be admonished. Half a dozen midwives, each making pretensions to great skill, ambition, and competition for obstetric fame, assembled around a feeble woman when labor is of a lingering character, is always an unfortunate circumstance, and it would be much better if nearly every one were afar off.

When the pains become very severe, quickly succeeding each other, the midwife, or the person who officiates, may sit by the side of the woman, and, upon every severe pain, may keep her hand upon the parts, even though no manner of assistance can be afforded, and occasionally, when the head of the child presses hard, it may be gently touched or pressed with the longest finger, in order to ascertain the parts that prevent the progress of labor, as well as to be able to give from time to time suitable encouragement: not only so; in the last stage of labor the hand may be kept near the parts, to know the moment when the head of the child presents, as some little assistance at this time is called for; but not by supporting the perinæum, as some advise, but,

_First._ To remove any obstruction which often arises from the clothes.

_Second._ To support the child in its passage, and in the interval of pains; and to keep the head from pitching downward, and thus obstructing the labor.

_Third._ To detach the umbilical cord or navel-string from the neck when it encircles it, as is often the case, and which endangers the life of the child.

_Fourth._ To deliver the woman in case of hemorrhage or great flooding; but at the same time there must be no further interference of art; little or nothing can be done toward facilitating the delivery of the child, except when a large bag or collection of water presents and opposes, when it may be ruptured with the longest finger, which often affords much aid, although such is the ignorance and credulity of some women, that they suppose almost everything to be accomplished by art. Physicians or midwives who watch only the process of labor, and do little or nothing, are pronounced inhuman and cruel, and perhaps ignorant, because they are honest in not interfering with the simple and beautiful process of labor, or in other words, for relying upon the great resources of nature: but such is the fashion and credulity of mankind, or rather womankind, that physicians are obliged to take the advantage of such ignorance and credulity, and regulate their proceedings accordingly. We have often been obliged to stand for hours over a woman, under pretence of aiding delivery, when, in _reality_, we did nothing at all. The labor would have progressed just as well had we been out of the room; but this deception we have been obliged to practise, in order to satisfy ignorant, gossiping, or crying attendants. When the woman is disposed to make much noise, she should be directed to hold her breath during the pains, and aid or assist them by pressing downward as much as possible. The feet may press against the bed-post, and the woman take hold of a handkerchief and pull when a pain occurs; or she may grasp the hand of an assistant for that purpose. Sometimes, from various causes, labor is very much retarded, from rigidity of the parts, the situation of the child, debility, &c.; when this occurs, and labor is tedious and protracted, our reliance must still be upon the powers of nature. We may, however, aid her efforts, by warm fomentations of _bitter herbs_, often applied to the lower part of the belly, which will prove relaxing, and will facilitate the labor; warm diluent drinks may also be given, such as _tansy_, _pennyroyal_, _&c._

If the labor still continues stationary, we have nothing to fear, provided there is a right presentation; but should the pains become feeble or lessened from flooding, debility, or any cause, or should they prove unavailable, after a reasonable length of time, a drachm of _spurred rye_ or _ergot_ may be put into a tea-cup, and a gill of boiling water poured upon it, and, when cool, a tablespoonful given every fifteen minutes. This will increase the pains, and speedily accomplish a delivery; but it should be very seldom, or never, used, except when there is a right presentation, and under the most urgent circumstances.

It is prudent, by judicious precaution and care, to remove obstructions, prevent accidents by holding or supporting the child in a proper position, and giving such aid as reason and judgment will dictate. Receiving the child, preventing its fall, securing the navel cord, assisting in the removal and disposal of the after-birth, are objects which are to be accomplished, and all in the most calm and simple manner; no hurry or excitement is necessary, but, on the contrary, they embarrass. Yet how common is it that females in general, married and unmarried, are so uninformed and ignorant, that, instead of attending to those duties, if necessary, or in cases of emergency, they are thrown into the greatest consternation, and perhaps run out of the room and let the child suffocate by the bed-clothes, or by the navel cord twisted about the neck, and die merely for the want of a little common sense and knowledge, which might be acquired in an hour. Is it not highly disgraceful, if not criminal, that farmers can, and do, attend to those duties toward their stock, and yet remain entirely ignorant of them toward their nearest relations? Young women and men are taught music, dancing, drawing, needle-work, and many ornamental branches considered so essential to a polite education; yet they are suffered to remain entirely ignorant on a subject of so much vital importance. Is there any hope or prospect of enlightening this generation, or must it be delayed till the next, and have them look back with amazement at our ignorance? We hope there is something yet redeeming in a large proportion of the community; that the people will yet awake to their own interests.

When the head is delivered, all that is necessary to do is, to support it, and wait for the pains to expel the child; except it seems livid and in danger of injury, or when the cord is twisted around the neck, when assistance must be rendered, to accomplish the delivery. The face of the child must now be turned upward, and the cord freed from the neck or body; the person who assists will pass a narrow piece of tape around the cord or navel-string, about an inch from the body, and tie as tight as it can be drawn, otherwise hemorrhage or bleeding will take place; and another must be tied at a little distance from it, above, and be separated between them with a pair of scissors. The child is then to be given to the nurse, to be washed, dried, and dressed. The woman must now be covered, and directed to lie quiet.

_The After-birth._—The after-birth or placenta must be detached or removed, if nature does not accomplish it in a short time. Generally, after about twenty or thirty minutes, a pain is felt, which may be sufficient to expel it; if it should not, and should there be no pain, gentle manual attempts may be made to remove it.

The head and breast may be elevated, and the cord taken hold of by the left hand: the two first fingers may be carefully introduced into the vagina, and the anterior or forepart of the placenta or after-birth held in this situation for some minutes, in order to excite a contraction of the uterus. The woman may now be directed to hold her breath and press down, which forces it forward; and at the same time a little extension may be made upon the cord with the left hand, while extension is made upon the after-birth with the right; this will almost invariably extract it in a few minutes. If from any cause it should not, no farther attempts must be made for the present, but left for a few hours, when, if the natural contractions of the uterus do not remove it, it must be done in the manner recommended, with this difference, that a little more force be used. In the interval, however, everything wet must be taken away.

_Subsequent Treatment._—After the labour has been thus completed, if the woman is not too weak, assistants may raise her up, and seat her upon the side of the bed or cot, while another removes all the wet clothing from the patient and her bed, and with a little warm spirits washes off the blood, water, &c., that remain on her person. This is particularly necessary, as the omission of it may give rise to puerperal fever. We know not that others have practised this method; but we have found it conducive to the comfort as well as the health of the patient. Some practitioners will not suffer the woman to be removed from the situation in which she has been delivered under twelve or twenty-four hours, for fear of hemorrhage or flooding; but this is a great and dangerous error. It is impossible to tell what mischief may arise in consequence of suffering her to remain drenched in water and blood for this length of time.

After these precautions have been observed, and the bed properly prepared, on which has been placed folded blankets, skin, or oilcloth, covered with a warm sheet, she may be laid down, and a diaper or suitable piece of muslin laid to the parts to absorb the lochial discharges. A bandage may be also placed around the abdomen or belly, and made moderately tight, but not so as to render her uncomfortable. A large tub, previously well dried, may be placed by the side of the bed, and the woman directed to place her feet in it, and, when she is lifted up, everything that is around her wet to be passed into it. It prevents the necessity of afterward washing the floor and carpet, which might prove injurious by causing a check to perspiration.

_Preternatural labor, or cross-births_, are those in which some other part than the head presents. We cannot in general assign any reason for such occurrences, nor can the woman, by any sensation of her own, be assured that the presentation is unusual. Apprehensions of this kind should not be indulged in. If the feet or breech present, the delivery is to be accomplished by properly accommodating the position of the child to the capacity of the pelvis, but no force should be employed; and though there is always some risk to the life of the infant, yet there is none to the mother. If the arm, shoulder, or sides of the child present, the delivery is not impossible, but difficult, until the infant be turned and the feet, brought down into the passage. This is an operation which may be done with comparative ease and safety, if the wrong position of the infant be discovered before the waters are discharged; but other wise both mother and child are in considerable danger, though there is often a spontaneous evolution, and delivery is effected. The womb closely contracting round the body of the infant when the water is drained away, and being soft and spongy in its texture, it is liable to be torn if much force be employed, and then either the child may escape into the cavity of the belly, or, if it be extracted by the feet, blood may be effused from the womb into that cavity, and such injury be done as to prove fatal. Women too frequently add to the danger of the operation of turning, by their restlessness and impatience; they should remember how much is at stake, and exert all their fortitude, so as not to embarrass the practitioner.

The labor having been thus accomplished, it will be necessary to guard against any subsequent symptoms which may occur or take place.

In _tedious_ and very _difficult_ labors, and where common physicians use the lancet, the hot bath will be found of extraordinary benefit in facilitating labor, by its relaxing the system without debility; altogether better than bleeding. First apply spirits, water, and salt to the head; then let the woman continue in the bath about fifteen minutes.

* * * * *

_Still-born Infants._—This occurs from difficult labors, or the cord encircling the neck; or a membrane may cover the head or body. When anything of the kind occurs, the membrane should be immediately removed. If no signs of life appear, the infant may be put into the warm bath, and the mouth and body wiped dry. A little cold water may be dashed into the face, the lungs inflated by some person, and a slight motion made upon the chest in imitation of breathing. The navel-string may be permitted to bleed a little.

TREATMENT AFTER DELIVERY.

_After-pains._—Soon after delivery these usually come on, and with some women prove remarkably severe. The quicker the labor has been, the slighter will they prove in general. Women with their first child are seldom much troubled with after-pains; but as the uterus is thought to contract less readily after each future labor, so they are more liable to suffer from them in any succeeding delivery than in the first.

When after-pains prove so troublesome as to deprive the patient of her rest, it will be necessary to have recourse to _fomentations_ or _anodynes_; red pepper and spirits, simmered together a few minutes, and flannels dipped in it and applied to the belly, will generally relieve them; if it fails, apply a fomentation of _bitter herbs_, and give two teaspoonfuls of the tincture of _hops_ in milk or tea. If these fail, which I never knew, give half a teaspoonful of _capsicum_ in milk. These remedies are to be assisted by keeping up a sufficient pressure on the belly at the same time by means of a broad bandage.

NURSING.

A child must not be put to the breast, if the mother’s health is very poor, or if she has any venereal, scrofulous, consumptive taint, or herpetic disease, St. Anthony’s fire, &c. We have conversed with females who are subject to the last complaint, and who have communicated it to their children, which destroyed them all. The poison is transmitted from the mother to the child. In any of these cases, the infant must be reared on the nursing bottle. It is best to use cream instead of milk; the child thrives well upon it, less quantity answers, and it does not curdle, like milk, upon the stomach.

_Atrophy from Suckling._—Some women of a delicate constitution cannot suckle long without an evident appearance of declining health; and, if persisted in, it might terminate in a general wasting of the body and loss of strength, or some morbid affection of the lungs. When, therefore, a woman finds her health declining, and that she gets weaker every day with loss of appetite and languor, she ought immediately to leave off suckling; she should use a generous diet, with a moderate quantity of wine bitters daily, and, if convenient, change the air, particularly if an inhabitant of a large and populous city or town. If the change is not found sufficiently efficacious of itself, when conjoined with a restorative diet, a course of _tonics_ should be given. Gentle exercise on horseback or in a carriage will greatly assist the effect of these remedies.

INFLAMMATION OF THE BREASTS.

This disease is easily known by the pain, hardness, and swelling which accompany it. In some cases the whole breast appears to be affected; in others, only on one side; and, in some, the effect is small and superficial.

When the breast inflames, it is evident that the retention of the milk must, for a time at least, increase the pain.

The first object then should be to have the breasts drawn, either by the child or some other means; but, should the milk not come away readily, and the pain be increased thereby, farther attempts must not be made; otherwise both the disease and sufferings of the woman may be aggravated. A cooling diet and an open state of the bowels are necessary while the swelling continues. And it is better for the patient to remain in bed, as the weight of the breast, while in the erect posture, often increases the inflammation. The breast should be gently rubbed with a small quantity of sweet oil or unsalted butter, and poultices of crumb of bread and lead water applied. If the pain and hardness do not very soon go off by this application, warm emollient poultices, as milk and bread, with a little oil, or united with the leaves of the thorn apple, must be had recourse to. These poultices will not promote suppuration unless the inflammation has proceeded so far, that the process has already begun, and in this case the sooner it is produced the better.

If the abscess do not point and break soon, no good can be gained by delay: an opening should therefore be made, so as to evacuate the matter freely. This not only gives immediate relief, but prevents a farther extension of the mischief. The milk and bread or flax-seed poultices must be continued for a few days, in order to remove the hardness, and then the part must be dressed, as in ordinary cases.

Indurations remaining after an abscess, may be frequently remedied by the application of a mercurial plaster, or cloths wet with the camphorated spirit, or rubbing the part, night and morning, with mercurial ointment, united with a little camphor.

Sometimes after the abscess heals, and the breast seems to be cured, it swells a little, especially towards night. This is from weakness, and is cured by strengthening the constitution.

Many women suffer more from this complaint than from all the various stages of pregnancy, labor, and delivery combined, and with whom broken breasts are an invariable attendant of confinement; they overlook all the other sufferings they have to undergo, and fix their dread and apprehension upon this. It is, therefore, all-important _that inflammation of the breasts should not be permitted to take place_, by proper precautionary measures, _and this can, in all cases, be accomplished_, by the mode of treatment pointed out in this work, which, as yet, has not been mentioned in any other, but of its invariable success there is not a shadow of doubt, as it has been tested under circumstances the most unfavorable, in cases where every confinement was attended with broken breasts, till this mode of treatment was had recourse to, and the patients, to their great surprise and joy, for the first time entirely escaped their uniform affliction. It is hoped the medical faculty will avail themselves of this invaluable mode of treatment, that hereafter inflammation of the breasts may be unknown, since prevention is so easy and practicable.

_To prevent Inflamed or Broken Breasts._

This most desirable and important object is accomplished by covering the entire breasts with diachylon plaster (which can be obtained of every druggist, the machine-spread is preferable) rather tightly or closely put on, merely making a round hole (about the circumference of a dollar) for the nipple, sufficiently large not to interfere with the suckling of the infant, should it be put to the breast; and if not, it is not only unnecessary to draw the milk, but it would be advisable to refrain from it, even if a little pain or distension should supervene, as the milk is sure to find an outlet in the nipple. The plaster must be cut round and embrace and cover the entire of each breast, and should be put on within eight or ten hours after delivery, and before the milk threatens. The effect is to superinduce the flow of milk to the nipple, from which it freely and profusely flows, in no case requiring the application of stimulants to induce its discharge, and, by keeping the breasts in constant moisture, effectually prevents hardness by coagulation of milk. In ten days or thereabout the plasters can be taken off without inconvenience.

It is not too much to say that broken or inflamed breasts are impossible when this precautionary mode of treatment is adopted, as it has, in every instance, where it has been tested upon those who before were invariably afflicted with broken breasts, been attended with most triumphant success; and it has thus been put to the test in more than fifty instances to the writer’s personal knowledge. In communicating this important fact, therefore, he does so with the most thorough confidence that he is conducing to the amelioration of much suffering, and without assuming that this may not be known to others, he can only say that he has not met with any mention of it in any works to which he has had access. Should those, therefore, into whose hands this work may fall have a wife, or a relation, or a neighbor, who, heretofore, have been afflicted with inflamed or broken breasts, they would have it in their power to ameliorate, nay, prevent much suffering, which to the author of these lines will be a source of heartfelt satisfaction.

MANAGEMENT OF CHILDREN.

It is during infancy that the foundation of a good constitution is generally laid, and it is, therefore, important that parents be taught the best method of managing their offspring, in order to preserve their health. Great ignorance is manifested on this subject; it is owing to this that so many children sicken and die; and, furthermore, it is in consequence of this ignorance in our forefathers that the present generation have become so weak, sickly, and effeminate; and most of these evils may be imputed to errors in diet, regimen, _mineral_ and _depletive_ agents, &c. We have departed from the simplicity of nature, and we must, of course, suffer the penalty.

_1st. On Diet._—If the mother or nurse has enough of milk, the child will need little or no food for the third or fourth month. It will then be proper to give it a little of some food that is easy of digestion once or twice a day; this will ease the mother, will accustom the child by degrees to take food, and will render the weaning both less difficult and less dangerous. All great and sudden transitions are to be avoided in nursing; for this purpose the food of children ought not only to be simple, but to resemble as nearly as possible the properties of milk: indeed, milk itself should make a principal part of their food, not only before they are weaned, but for some time after.

Next to milk we would recommend good bread, which may be given to a child as soon as it shows an inclination to chew; and it may at all times be allowed as much as it will eat. The very chewing of bread will promote the cutting of the teeth and the discharge of saliva, while, by mixing with the nurse’s milk in the stomach, it will afford an excellent nourishment.

Many are in the habit of pouring down various liquids and mixtures made of rich substances, and so much sweetened that the tender organs of digestion are impaired, and acidity and bowel diseases follow; articles of this nature should be avoided: no food, except the milk of the mother, should be given, unless absolutely necessary; nature has designated this liquid exclusively for the nourishment of the infant, and, indeed, we may say, for children.

There is another precaution to be observed, which is, “never to put an infant to a wet-nurse if it can possibly be avoided;” such persons are generally strangers, and they often communicate the most loathsome and fatal diseases; besides, their milk is often rendered unwholesome by age or other causes: this is a very unnatural practice.

The milk of the mother, then, should constitute the only food of the infant, except in cases of disease, when it becomes necessary to obtain a wet-nurse, or bring up the children on the bottle, which can be done very easily.

We attended a lady who was almost covered with a _herpetic complaint_, or the _salt rheum_, and that, too, when her child was born. She was treated and cured her of the complaint. The infant was fed on milk, by introducing a silver tube into a bottle containing it.

We never knew a child so quiet and free from pain; as much so as any offspring of the brute creation, which are free from it merely by following nature or instinct, which never errs. The milk should be of the best quality, and, if possible, of the same cow.

Now, it appears to us, that if females imitated these animals, were to live on vegetable instead of animal food, and drink nothing but water, they would not only bring forth as easy as the Indians or these animals, but their offspring would be free from pain, and perhaps be as exempt from sickness. Would not this course produce a revolution in our habits, health, and in the practice of medicine? In the present diseased state of society it might require a long time to bring about a change in the system; but an immediate benefit would follow by adopting these physiological principles. Do not these facts open a new field of investigation and improvement?

Is it not notorious that some infants are crying a great portion of their time in consequence of pain? and is it natural, or can there be any other cause, except the poison communicated to it, through the medium of the blood, before and after it is born; or the disease may proceed from the impurity of the mother’s milk, occasioned by errors in diet? It is self-evident that it is so, from the fact that animals are free from these symptoms.

Can there be any other cause why so many children are in distress from birth, and generally die young, or continue weak and sickly all their lives? There must be a reformation in the habits, taste, and education of modern females. Many mothers are as ignorant, when they have brought a child into the world, of what is to be done for it as the infant itself.

Says Combe: “The leading error in the rearing of the young, I must again repeat, is _over-feeding_, an error serious in itself, but which may easily be avoided by the parent yielding only to the indications of appetite, and administering food slowly and in small quantities at a time. By no other means can the colics, and bowel-complaints, and irritability of the nervous system, so common in infancy, be effectually prevented, and strength and healthy nutrition be secured. Nature never meant the infant stomach to be converted into a receptacle for laxatives, carminatives, antacids, spicy stimulants and astringents; and when these become necessary, we may rest assured that there is something faulty in our management, however perfect it may seem to ourselves. The only exception is where the child is defectively constituted, and then, of course, it may fail to thrive under the best measures which can be advised for its relief.

“Another cause of infantile indigestion, and which is too much overlooked through ignorance of its importance, is _vitiation of the quality of the milk_, caused by imprudence, neglect, or anxiety on the part of the mother. The extent to which this cause operates in inducing irritation and suffering in the child, is not generally understood; and, accordingly, it is not unusual for mothers to display as much indifference to health, regimen, and tranquillity of mind during nursing, as if the milky secretion, and all other bodily functions, were independent of every external and corporeal influence. Healthy, nourishing, and digestible milk can proceed only from a healthy and well-constituted parent; and it is against nature to expect that, if the mother impairs her health and digestion by improper diet, neglect of exercise, impure air, or unruly passions, she can, nevertheless, provide a wholesome and uncontaminated fluid, as if she were exemplary in her observance of all the laws of health.