The Married Woman’s Private Medical Companion

RETENTION OF THE MENSES. — Description. — Causes. — Symptoms. — Treatment.

SUPPRESSION OF THE MENSES. — Description. — Treatment.

PAINFUL AND IMPERFECT MENSTRUATION. — Description. — Treatment.

IMMODERATE FLOW OF THE MENSES. — Symptoms. — Causes. — Treatment. — Regimen. — Prevention.

DECLINE OF THE MENSES.

CONCEPTION; OR, PREGNANCY. — CONCEPTION.

In order to procreate the human species, there is a periodical discharge of blood from the vagina of every female, termed the catamenia, or menses. The secretion of this fluid commences at that period of life termed puberty, which occurs at different ages, according to the climate. In some latitudes it commences as early as eight or ten, and in others not until fifteen. As soon as conception or pregnancy commences, this discharge ceases, and goes to support the fœtus, or the child.

The manner in which conception takes place has ever been a fruitful subject of inquiry, but we are unable to account for this change precisely. It is, however, pretty evident that the semen of the male is introduced into the uterus, while the semen of the female is discharged from the ovaria by 37means of the Fallopian tubes, the fimbricated extremity of which closely embraces that organ.

These tubes, by a kind of peristaltic motion similar to the intestines, convey the semen of the female into the uterus, where it unites with the semen of the male; and it is these united fluids which constitute the rudiment of the fœtus, and which often give to the child the appearance and dispositions of their parents. Sometimes one trait is inherited, sometimes another; at other times a new compound or character is formed (like a chemical union), which does not partake of the nature of either of the former.

OF THE MODE BY WHICH PREGNANCY MAY BE DETERMINED. — Ceasing to be unwell. — Morning Sickness. — Shooting pains through—enlargement of—and other changes of the breast. — Quickening.

ON THE DISEASES OF PREGNANCY, AND HINTS FOR THEIR PREVENTION AND RELIEF. — Morning Sickness. — Heartburn. — Costiveness. — Diarrhœa. — Piles. — Enlargement of the Veins of the Legs. — Swelling of the Feet and Legs. — Palpitation of the Heart. — Fainting Fits. — Toothache. — Salivation. — A Painful and Distended Condition of the Breasts. — Cramp, and Pains in the Legs, &c. — Violent movements of the Child. — Soreness and Cracking of the Skin of the Abdomen. — Inconvenience from Size. — Being Unwell during Pregnancy.

In describing the diseases which are incident to the whole period of pregnancy, my design is to take a general popular survey of the subject. I wish simply to communicate that kind of information, which every married and well-educated woman should certainly possess, and can usefully employ. To advance further than this, to those points upon which the assistance of the medical adviser ought to be sought, would be on every account improper, and productive rather of evil than of good.

There is no organ in the body, with the exception of the stomach, that exercises a more extensive control over the female system 62than the womb. Hence, when in the condition of pregnancy, it affects, directly or indirectly, various parts of that system. The effects of pregnancy, however, vary much according to the constitution of the female.

Sometimes a very salutary change is produced, so that the individual enjoys better health during gestation than before. The delicate and frequent-ailing girl, for instance,—the propriety of whose marrying was a matter of doubt among her friends—becoming pregnant, instead of realizing the apprehensions and fears of those most dear to her, will sometimes acquire new life and vigor from the altered circumstances of her condition. On the other hand, speaking generally, it is sometimes the case that harassing and painful symptoms will arise. These are designated the “diseases of pregnancy.”

Nausea or vomiting, is one of the most common and distressing affections of pregnancy. It is chiefly troublesome in the earlier months of gestation, continuing until the period of quickening, when it decreases or ceases spontaneously;—or it does not occur until the latter months of pregnancy, when it subsides only upon delivery. I shall consider these states separately; and—

First, of sickness during the earlier months. 63This arises solely from sympathy with the newly commenced action, and irritable condition of the womb. This is evident from the fact, that, as the novelty of the pregnant state ceases, and the stomach becomes accustomed to it, the sickness subsides gradually, and is rarely troublesome afterwards.

It occasionally commences immediately after conception; and it is a remarkable fact, that a pregnant woman scarcely ever feels sick, until she first gets upon her feet in the morning. Hence it is called the “morning sickness.” She awakes refreshed and well, arises from her bed, and while dressing begins to feel qualmish. At the breakfast table she has no appetite, or if she takes anything, is shortly obliged to leave for her dressing-room, where she returns what she has taken; or, if she has been unable to take anything, ejects a fluid, limpid, thin and watery; and if the vomiting increases in severity, bile is thrown up at the same time. After the lapse of three or four hours, she feels quite well again, and by dinner time sits down with an appetite to her meal.

If there is merely nausea or vomiting without the presence of bile, it is evident that it arises solely from irritability of the stomach, and is not connected with a disordered condition of the digestive organs, which latter circumstance is not unfrequently the case. The best means that can be employed 64to relieve this irritable state will be found in a draught taken twice a day for several days, composed of fifteen grains of magnesia, one drachm of tincture of columba, and an ounce and a half of distilled peppermint water.^[17]

Medicine sometimes is hardly called for; and I have known a tumbler of warm chamomile tea, or even warm water only, taken immediately after nausea was felt, by inducing immediate vomiting, tranquillize the disturbed stomach, and thus abridge the morning attack. It is sometimes attended with advantage to take the chamomile tea before the female rises from her bed. I advised this with the most marked success very lately in the case of a lady who was very much reduced by the morning sickness. It had continued for several weeks, and with so much violence and straining, as to cause blood to be ejected with the fluid. In less than one week, when all other means had previously failed, the above suggestion was successful.

It frequently happens that the acidity is very great, in which case fifteen or twenty grains of magnesia should be taken in a wine-glass of milk^[18]—or, if it is preferred, a 65small tumbler of soda water; but the latter must not be persevered in for any great length of time, as it will then become injurious. The presence of acidity, however, is sometimes so difficult to overcome by alkalies, that these medicines must be given up, and acid remedies employed. Lemonade may first be taken, but lemon juice and water is still better.

The state of the bowels must not be forgotten, and if any of the latter remedies are resorted to, the most marked benefit will be derived from a gentle dose of Epsom or Cheltenham salts every second morning, if so often necessary.^[19]

The diet in such a case must also be carefully attended to; but as this point will be referred to more particularly presently, it is only necessary now to say that the quantity of food taken must bear some proportion to the slightly diminished powers of the digestive functions, and that it will be well, when the sickness is very obstinate and distressing, to take no food at all for several hours after rising. If, after a few hours, the mouth is 66much parched, it may be moistened with a little broth, or weak beef-tea; but let nothing more be taken for five or six hours, and it is most probable that the sickness which has resisted all other means, will thus be relieved.

If this irritable state of the stomach is connected with a disordered condition of the digestive organs, the sickness will be accompanied with the presence of bile in the matter vomited, a furred tongue, confined or irregular action of the bowels, and occasionally with what is termed “a sick headache.” These symptoms are to be relieved by medicines which thoroughly clear out the bowels, allay the irritability of the stomach, and afterwards by those which restore tone to both. But it is to be observed that the following directions are only intended to apply to those simple cases, in which, whether necessary or not, no one ever thinks of consulting their medical adviser, and for which it is certainly desirable that they should have some judicious directions, rather than be left entirely without them. If these symptoms become at all aggravated, it is requisite that they should make immediate application for professional advice.

The bowels will need in the first instance a draught composed of infusion of senna and Epsom salts—the common “black draught,”—with half a drachm of the tincture of henbane in addition. This, with five grains of 67blue pill, most probably effects the object desired; the bowels will be well purged, and the tongue become clean.

The next thing is to allay the irritability of the stomach, which is to be accomplished by the means already pointed out—the effervescing draught of soda, magnesia, chamomile tea, &c.; but in connexion with this, two or three grains of the purified extract of aloes, with an equal quantity of the extract of henbane, must be taken two or three times a week, at bedtime. This will keep the tongue still clean, and the bowels in order.

After a little time, the sickness having subsided, tonic medicines may be used: and a fourth part of the following mixture, taken three times a day, will, under the present circumstances, be the best means of restoring the tone of the stomach and bowels: sulphate of quinine, six grains; diluted sulphuric acid, half a drachm; infusion of columba, five ounces and a half; simple syrup, half an ounce.

Having pointed out the means for mitigating sickness in the early months, there only remains one additional suggestion to make, and it is, that all the remedies for relief detailed may, in some cases, fail. The sickness continues most obstinate; every time the female takes food, or even sometimes when abstaining from it, she vomits; and at last, from this excessive irritability and long-continued 68violent action of the stomach, symptoms threatening miscarriage will manifest themselves.^[20] There is generally in such a case, pain and a sensation of tension about the pit of the stomach, increased after every attack of sickness. If symptoms of miscarriage are not present, the application of nine or twelve leeches to the stomach, and pieces of soft linen rag well soaked with laudanum, constantly applied and renewed, will give the most decided relief. If, however, there is pain in the loins and hips, increasing in frequency and power, becoming at last slightly bearing down, I strongly advise the patient to consult her medical adviser, as the loss of a little blood from the arm, perfect rest in the recumbent position, and other directions which he alone can give, will, in such a case, be absolutely necessary, and I may add, if perseveringly acted up to by the patient herself, be certainly followed by success.

Secondly, of sickness coming on at the conclusion of pregnancy.

This arises from the distended state of the womb affecting mechanically, by its pressure, the coats of the stomach, and certain parts of its neighborhood.

This form of vomiting but rarely occurs; 69for do not let me be supposed to refer to the sickness which sometimes immediately precedes, and generally accompanies, the early part of labour. I am speaking of that irritability of the stomach which may arise about the sixth, seventh, or eighth month, and from which the female has been entirely free during the previous months of gestation, and now producing vomiting of an exceedingly troublesome form.

A lady suffering from sickness thus late in pregnancy, ought to seek medical advice at once. From this cause, if severe, premature labour might be brought on, and judicious medical treatment is always decidedly necessary to mitigate this form of sickness. The patient must lose a little blood, she must keep strictly to her sofa, and the bowels ought to be gently acted upon by small doses of Cheltenham or Epsom salts. A grain of the extract of opium may be given to allay the irritability at night, and cloths dipped in laudanum frequently applied to the pit of the stomach.

In all forms of sickness arising from pregnancy as its cause, the diet must be light, mild, and nutritious, taken in moderate quantities of three or four meals a day. It should consist of mild animal food, boiled or roasted. Chicken, white game boiled, mutton or beef roasted, are the viands most nutritious and easily digested. Stale pure bread untoasted, or pilot bread, mealy potatoes, 70or well-boiled rice, in moderate quantities, may be taken with animal food for dinner. A glass of port wine with warm water at the conclusion of the meal, is the best kind of beverage.

Advantage has often been derived from always taking brown bread, and Jamaica sugar in the morning’s coffee. The healthy operation of the bowels has thus been promoted; although a system of regular exercise by walking, apportioned to the strength, and not continued so long as to fatigue, will generally effect this purpose, while at the same time it gives tone to the general health. Fatigue of body is sedulously to be avoided. Slow and moderate walks, exercise in an open carriage (if the patient has sufficient strength), should be taken daily between breakfast and dinner; always avoiding to sit down to the latter meal tired, and, therefore, probably, with a blunted appetite.^[21]

This is a very distressing symptom, and occurs early after conception; sometimes, 71however, not till after the fourth month; and occasionally is absent altogether. It is produced by an acid forming on the stomach, which rises into the throat, and, from the sensation it occasions, is called heartburn.

It is a very common complaint of pregnancy, and every female knows that she finds relief by taking a little magnesia or chalk, or lime-water and milk, with the occasional use of magnesia; but, although these means generally mitigate this symptom, occasionally it is very severe and almost intractable, and they fail. Under such circumstances, a draught composed of 15 grains of magnesia, 10 drops of the solution of the subcarbonate of ammonia, and 1½ ounce of mint or peppermint water, taken three times a day, and continued for three or four days, will remove the complaint.

If the bowels are confined, as is frequently the case, mild doses of Epsom or Cheltenham salts will be the best aperients. The use of these must be regulated by circumstances,—taken every second, third, or fourth day; that is, resorted to with sufficient frequency and perseverance to guard against costiveness.^[22]

The diet must also, in every case, be strictly attended to, and regulated upon the plan already stated.

A costive state of bowels is one of the most common and, at the same time, troublesome of the diseases of pregnancy. It arises partly from the increased activity which is going on in the womb, and which induces a sluggish condition of the bowels, and partly from the pressure of the now enlarged and expanded womb on the bowels themselves.

A confined state of bowels is the frequent source of many serious evils; it therefore behoves the female to be vigilant and guard against it.

First,—Because, as before stated, pregnancy itself predisposes to constipation.

Secondly,—Because it is much more easily prevented than removed, when, after several days’ confinement, an accumulation of hardened fæces has collected in the lower bowel.

Thirdly,—Because such an accumulation may give rise to inflammation of the bowel itself, and, in the earlier months of pregnancy, to miscarriage; and,

Lastly,—Because, if a female falls into labor with her intestinal canal so loaded, it will of itself be sufficient to render, what would otherwise have been a quick, easy, and safe labor, a long, painful, and difficult one; and may be the cause also of very serious and alarming symptoms some forty or eight-and-forty hours after her labor is over.

The first and leading symptom of this affection is a costive or more consistent state than 73usual of the fæcal excretions, with a less frequent call for evacuation than is customary with the individual when in health. If this is not attended to, and several days, perhaps a week, pass by without the bowels being relieved at all, pain in the head, a foul tongue, and an increased degree of fulness and tension of the abdomen, are experienced. These symptoms are followed, in all probability, by thin watery evacuations, attended with pain, weight, and pressure about the lower bowel; they become frequent; and the female at last, finding that the bowels are not only open again, but even loose, takes chalk mixture. She is not aware that this very looseness is nothing more than increased secretion of the lining membrane of the bowel, caused by the pressure of the accumulated mass of hardened fæces, which it passes and leaves unmoved. The chalk mixture relieves the irritation upon which the looseness depends, but the disease is not removed, and, instead of its being a case simply of costiveness, it has now become one of constipation; an accumulation of hardened stool is distending and irritating, by its pressure, the lower bowel and the womb, and the serious consequences before enumerated may follow.

Very often have I been consulted by a female far advanced in pregnancy for what she supposed mere looseness of bowels, which has already been found to originate under circumstances like these. It is of the highest 74importance that the patient should endeavor to guard against such a result; and without doubt she may avoid it, and regulate her bowels with great comfort to herself, throughout the whole period of pregnancy, if she will only use the means.

In pointing out a plan to accomplish this desirable object, the first prescription I have to offer is by far the most valuable,—“prevention is more easy than cure.”^[23] If the bowels are sluggish to-day,—that is to say, if they are not as freely relieved as usual,—and you do not assist them by medicine, depend upon it, to-morrow they will be confined, and there will be no relief at all. If, then, the bowels, are disposed to be costive, I would recommend one large tablespoonful of castor oil—if it does not nauseate the stomach,—and advise that the dose be repeated in four hours, if the desired effect has not been produced, or a wine-glass of beaume de vie at night; and early the next morning, before leaving the dressing-room, let the lavement be used, the injection consisting merely of a pint of blood-warm water;—or the following pills will be found useful to be kept in the patient’s bedroom:—Two scruples 75of the compound extract of colocynth and one of the extract of henbane divided into twelve pills. Two or three of these may be taken at bedtime, when the bowels have not been, during the day, satisfactorily relieved. These are always ready in the bedroom, and, as they generally answer the object efficiently, and with comfort to the patient, are the most convenient form of aperient.

It will now and then happen, however, that the female has let the day slip. When this is the case, in combination with medicine, the use of the lavement is desirable. Medicine alone will not answer the purpose, unless it be taken in doses so strong as will not only move the bowels but irritate them too. With the exhibition of the warm water, mild aperients never fail. Females, generally, are averse to the use of the lavement, and it is a prejudice which is most deeply to be regretted. I have known purgative medicines so often resorted to, and, in time, so increased in power and quantity, because they began to lose their effect, that, by their continual irritation, disease of the lower bowel has been produced, and death has, at last, been the consequence. If, then, the bowels have been one or two days confined, the lavement in the morning will render much less medicine necessary, and frequently have an effect when medicine alone would not. Many ladies use the warm water every second or 76third morning, during the latter weeks of pregnancy; and by this means they regulate their bowels—which would otherwise be confined—with great comfort to themselves, and need no medicine at all.

I will only add one word, in conclusion, upon this subject. Let it be remembered, that if the bowels have been confined several days, and diarrhœa comes on, that this is not a natural relief, but the effect of irritation, caused by the presence of a loaded state of the lower bowel, which must be quickly removed by the medical attendant, or it may give rise to some one of those serious evils already enumerated.

An affection very opposite to that which has just been discussed, may occur during pregnancy. We have seen how diarrhœa may arise as a symptom of costiveness. It will manifest itself, however, independently of such a cause. The intestines may participate in the irregularity of the womb, and, their vermicular action becoming morbidly increased, diarrhœa is the consequence. It is a disease which varies very much in different individuals, and may clearly be divided into two kinds.

One, in which the motions are more loose and frequent than in health, but not otherwise much altered in their appearance. The 77tongue is clean, or only slightly white, and the appetite is pretty good. No medicine is required here; a careful diet will correct the evil.

In the other case, the stools are liquid, dark-coloured, and very offensive, accompanied with a coated tongue, bad taste, offensive breath, loss of appetite, and more or less disorder of the digestive organs. In these latter circumstances, your medical adviser should be consulted; in case you do not see him, I have found at first the following draught, given every three or four hours, very useful—rhubarb, eight grains; ipecacuanha, one grain; dill water, one ounce.

As the tongue cleans, the stool becomes more natural, a wine-glass, three times a day, of some bitter infusion, such as cascarilla, orange peel, or gentian, may be taken with advantage. If the diarrhœa continues for any length of time, it is always wise to have the surface of the body kept warm with flannel; and this is best accomplished by a flannel roller bound gently round the abdomen.

But in either form of this disease, whatever remedies are proposed, there is one mode of treatment applicable to both, and which is the most important of all; a proper system of diet. The food must be sparing in quantity, of the mildest quality, and such as to leave, after the process of digestion, as little excrementitious matter as possible.

78In a recent attack, the first day, the patient should only take mild drinks, containing a small quantity of unirritating nutriment; such as barley water, or arrowroot made with water. Irish moss will be found palatable. During the next day or two the same diet must be continued, but may be given in larger quantity, and of greater strength. Tapioca, sago, and rice-gruel might be added to the list. When the irritation is somewhat allayed, on the third or fourth day, perhaps, broth may be taken; but no solid food of any kind, least of all solid animal food, until the disease is removed or greatly allayed. As soon as this is the case, a small quantity of the lightest animal food may be taken; such as the animal jellies, made from calves’ head or feet, chicken with well-boiled rice, white game boiled, roast mutton and beef may follow; but lamb and veal for the future should be avoided.

It may be observed, that in some cases, where the diarrhœa has been of long standing, a drier diet is best, the liquid food appearing to keep up the disease. Rice well boiled, and merely moistened with a little broth, is the best and one of the most desirable articles of diet in such cases.

Pregnant women are very subject to piles. Both with costiveness and diarrhœa they are 79a frequent attendant, but particularly with the former. They will usually disappear, if they are slight, as soon as the bowels are restored to a healthy action; but they may not, and then will give rise to great suffering.

The pregnant woman recognises piles under two forms: 1, where they exist as little tumours within or without the bowel, becoming, very soon after their exclusion, more solid and firm, unless they early break and bleed; and 2, where they present, without the bowel, a tumour, large in circumference, separable in lobes, altogether like a piece of sponge coloured, and bleeding occasionally from the surface.

Of all the causes which operate in the production of piles, habitual constipation is the most frequent. The excrementitious matter is delayed in the bowel, becomes hard and knotty, and a source of great irritation: this irritation induces a determination of blood to the part, and the gradual dilatation of its vessels takes place as a consequence, which eventually forms the tumours known under the appellation of piles. Now, as in pregnancy there is a greater disposition to costiveness than at any other time, and as piles are a consequence of this disordered function, so this disease is much more prevalent during the pregnant state than at any other period; another argument, and a very 80powerful one, why costiveness should be diligently guarded against.

The symptoms of this complaint are well known. There will be weight, heat, and a sense of fulness about the lower bowel, a frequent desire both to relieve the bowels and bladder; all of which symptoms are removed for a time if a discharge of blood takes place.

If the piles be without the bowel, they are constantly irritated by the friction of the parts in the ordinary motion and erect position of the body, and that to a painful degree during the period of the evacuation of the bowels. If exercise be taken in a carriage, the pain is much aggravated; and if the irritation produce inflammation, the piles will become swollen, red or purple, and excessively painful.

The treatment of this disease, when it occurs during pregnancy, is two-fold—general and local. We must remove the cause by such means as excite a brisker action of the bowels; and our choice of aperients must be directed to those which act efficiently but mildly, and without irritating the lower bowel itself.^[24] Next to small and repeated doses of castor oil—say a tablespoonful,—the 81most desirable form of aperient that can be employed is the confection of senna, that is, lenitive electuary, combined with sulphur and magnesia. Of the following form, a dessert-spoonful or more should be taken, at first, twice daily:—Confection of senna, two ounces; flowers of sulphur, one ounce; carbonate of magnesia, two drachms and a half. In conjunction with this medicine, much benefit may be derived by the injection of half a pint of warm or cold water—whichever soothes most—as a lavement; but it must be administered very cautiously, to avoid irritating the parts with the pipe of the instrument.

It is important that medicine, in frequent use, should be so taken as to act upon the bowels in the evening only; for if the bowels are acted upon in the morning, the patient being obliged to move about all day, will suffer considerable distress and local irritation; whereas, if the bowels are not evacuated till the evening, the horizontal position, and the perfect rest of a long night, will obviate all inconvenience.

Great assistance may be afforded in the cure, and also in alleviating pain, by external applications to the tumours themselves. If, however, the piles are swollen and inflamed, and the pain experienced great, half a dozen leeches, or from half a dozen to a dozen, should be first applied in their immediate neighbourhood, the parts fomented, and 82then warm bread and water poultices renewed every three hours.

These remedies will afford very considerable relief; and, when the inflamed state is subdued, an ointment must be applied to the tumours and around them night and morning, composed of two drachms of powdered galls, half a drachm of camphor, and two ounces of lard; or composed of one drachm of powdered black hellebore root, rubbed down in one ounce of lard. The latter preparation will, for some time after its application, give much pain, but proportionate relief will follow.

The diet must be sparing in quantity, mild in quality, and such as to leave after its digestion, as little to pass through the bowels as possible.

I would beg attention to one more observation on this subject. The removal of piles by operation, during the pregnant state, is perhaps never justifiable. Let the patient, therefore, consult her medical attendant in time, and not by a false delicacy expose herself to an evil which it is her duty to endeavour to prevent.

This is a frequent, but not very troublesome, accompaniment of the latter months of pregnancy. It arises in some degree from the pressure of the womb upon the large venous trunks, impeding to a certain extent 83the free flow of blood through them. It is frequently remarked in pregnant women who have passed a certain age; but it is particularly unusual for it to happen, in the case of young women, even during a series of repeated pregnancies.

When first observed, if the veins have not become knotty,—that is, having little lumps or swellings in their course up the leg,—the only means which it is necessary to employ, is the application of a muslin or cotton bandage,—six yards in length, and as wide as three fingers—from the sole of the foot up to the knee, and sufficiently firm to give support to the venous trunks. This bandage well and equally applied to the limb, with a little aperient medicine twice a week, and the recumbent position for two or three hours in the middle of the day, will cure this form of the affection.

When after a time the veins, more and more distended, have become lengthened, tortuous, coiled up or knotty, the female begins to experience a sense of heaviness, numbness, and sometimes very acute wandering pain, through the whole of the affected limb. In a more advanced stage, in proportion as the knotty tumours increase, the limb becomes generally swollen.

This form of the disease calls for much care and patience on the part of the sufferer. The legs should be strapped, from ankle to knee, with strips of adhesive plaster, and 84over this a muslin or cotton bandage must be applied with a moderate degree of tightness, and kept wet with goulard water. In conjunction with these local appliances, it is sometimes wise to lose a few ounces of blood from the arm, and always necessary to take every other night a gentle aperient, to live upon a spare diet, and for some days to keep the horizontal posture. An elastic laced stocking made for the purpose may be afterward worn, and will be found at once a sufficient support to the limb, and a source of great comfort to the wearer.

In the course of pregnancy, during the latter months particularly, the feet and legs frequently become much enlarged. It is partly owing to the pressure of the womb, but sometimes apparently independent of it. It is first observed towards night, about the ankles; by degrees the swelling rises higher, and the legs may become of a very large size. The female suffering from this complaint, always goes to bed with legs much swollen, but towards morning her face swells, and the enlargement of the legs disappears to a greater or less extent, returning, however, as the day advances.

Sometimes this disease is very trifling in its character, and in ordinary cases, except aperients, no medicine is necessary, and support 85may be given by a well-applied flannel roller; but when the swelling is extensive and permanent, remaining in the same degree after the patient has been for several hours in bed, and connected with uncomfortable sensations in the head, an accelerated pulse, &c., a medical man ought to be consulted, for the consequences might otherwise be dangerous.

If this affection occur for the first time during pregnancy, it is rarely connected with disease of the heart itself; it is therefore without danger, although very distressing. Occasionally there is connected with it throbbing of the vessels in the temples, as also in the abdomen; the latter not unfrequently mistaken by the patient for the beatings of the heart itself.

It will make its attack repeatedly in the course of a day, particularly after a meal; and very frequently at night, on first lying down in bed; and it may be brought on at any time by the slightest agitation of mind.

Treatment for an attack.—When it comes on it is to be relieved by putting the hands and arms up to the elbows in water, as warm as can be borne—friction with the warm hand applied to the feet—absolute rest—and taking the following draught: Compound spirits of ammonia, half a teaspoonful; Camphor 86mixture, a wine-glass. It may be repeated again in an hour or so, if necessary. It will be well to keep a bottle of this mixture in the bedroom; a resource will always be then at hand, and the dread which attends anticipation in a great measure removed. This is the more necessary, as an attack, if it comes on in the night, is always very distressing. The patient awakes, perhaps, out of a frightful dream, with a sense of fluttering in the region of the heart—calls out for breath—begs to have the curtains of the bed withdrawn, the door of the room opened—and will tell you she feels as if she was dying;—wine, brandy, any stimulant that is at hand is resorted to, for the husband or friend of the patient is naturally much excited, and in his alarm scarcely knows how to act. Now there is no occasion for alarm; the sufferer must be assured of this; her mind must be soothed and quieted; the means just pointed out for the relief of a paroxysm must be used; the palpitation will after a little time cease, and the patient will drop off into a quiet and tranquil sleep.

These attacks may be prevented by taking for ten days or a fortnight a teaspoonful of the following electuary three times a day:—Carbonate of iron, one ounce and a half; syrup of ginger, one ounce and a half. The bowels must be carefully regulated; a tablespoonful of Elixir Prop. is the best aperient, provided there are no piles. Fatigue and all 87exertion must be avoided, and the mind kept perfectly tranquil.

Fainting may occur at any period of pregnancy; but is most frequent during the first three months, and especially about the time of quickening. It may come on when the person is at perfect rest; but is ordinarily produced by unusual exertion,—exposure to heat,—or any sudden excitement of the mind. The paroxysm or fit is sometimes of short duration; and the female does not lose her recollection; she has a knowledge of what is going on about her, and soon recovers; but in other instances the fainting fit is complete and of long duration, continuing for an hour, or upwards.

The treatment during a fit.—This consists in immediately placing the patient in a recumbent posture—the use of pungent volatiles—sprinkling the face with cold water—free exposure to air, and the cautious administration of cordials. And if the fit continue long, the extremities must be kept warm, and the friction of a warm hand be applied to the feet.

It is scarcely necessary to add, that those who are subject to these attacks ought to avoid fatigue—crowded or hot rooms—fasting too long, quick motion, and agitation of mind. The bowels must be attended to; and a wine-glass of the infusion of columbo 88or cascarilla, taken every morning, will be useful in giving tone to the system.

After a few weeks the disposition to fainting will altogether subside, and although a very alarming state to those who are inexperienced, yet the subject of it should never allow her mind to be depressed, or to anticipate an unfavorable result. Pure air, simple diet, and regular exercise, as we said above, will do much to prevent it.

This may appear a trifling disease, to notice in connexion with the subject before us: but, in the course of pregnancy, females will sometimes suffer severely from erratic pains in the face and teeth. As these pains are generally induced by the increased irritability of the nervous system, the result of the new action which is going on in the womb, and not from the decay of any particular tooth, extraction of any tooth for its cure is out of the question. Indeed, did the suffering arise from a carious tooth, its removal is unadvisable, inasmuch as this operation has been immediately followed by a miscarriage. The fact is, that the patients who have consulted me while suffering from this affection, have had, apparently, in most cases, very sound teeth; and, feeling confident that its cause has been what has been before pointed out, the treatment has been purely constitutional. 89The following pill may be taken, night and morning:—Socotrine aloes, one grain and a half; blue pill, two grains; together with one drachm of the rust, or carbonate of iron, mixed with treacle or milk. The latter must be repeated twice a day for four days, and then a third dose may be added in the middle of the day; and the remedy continued, even after all uneasiness in the face has subsided for some time, with great advantage to the general health.

The only local application I would advise, is that of washing out the mouth and teeth, night and morning, with salt and cold, or lukewarm water. This plan of treatment not only relieves the painful affection of the face and teeth, but allays also that local irritability of the nerves, upon which it depended.

If a carious tooth seems alone affected, it has been proposed carefully to apply a drop or two of nitric acid, which is said to be infallible; a drop or two of oil of kreosote or cajeput is frequently useful.

A pregnant female must not be surprised, if, some little time after conception, or during any of the months of gestation, the ordinary quantity of saliva, which lubricates and keeps the mouth constantly moist, should increase to such an extent as to be exceedingly troublesome; 90and, indeed, sometimes become so excessive, as seriously to affect her health. It is a symptom of pregnancy, but a very unusual one; although the quantity of saliva discharged has now and then exceeded three, and even four pints daily.

It differs essentially from the salivation produced by the exhibition of mercury, inasmuch as in this case, there is no tenderness of the gums, or disagreeable fœtor in the breath. The fluid itself is either perfectly colorless and transparent, or more tenacious and frothy. It has an unpleasant taste, and, when tenacious, induces vomiting. It is generally accompanied with acidity; and the plan of treatment most advisable, when the disease is moderate in its character, is the frequent use of from twenty to thirty grains of magnesia, say every morning, rinsing the mouth out very often with lime-water, and to resist the desire to discharge the saliva from the mouth as much as possible, for, if it is not very great in quantity, it may be swallowed to advantage. Should this symptom, however, be very excessive, the health will suffer considerably in consequence, and the assistance of the medical man is imperatively called for.

Pain and tension of the breasts frequently 91attend, as also they are natural consequences of, conception.

In a first pregnancy, a large and rapid development of this organ may take place, the breast becoming two or three times as large as before marriage; but if tight lacing be only avoided, and the breasts be permitted to expand, no material inconvenience will arise from this circumstance.

As, however, these symptoms are sometimes attended with considerable distress, I would advise, under such circumstances, the application of half a dozen leeches, or more, tepid fomentations, and a gentle aperient—two drachms of Epsom salts in a little peppermint water—night and morning. These means, by relieving the over distension and fulness of the vessels of the part, remove the cause and complaint at once.

If these symptoms occur to a female who may have been several times pregnant, and formerly has had an abscess in one or other breast, that bosom is generally most painful which was before affected, and there will be an increased hardness about it, which may give rise, perhaps, to the apprehension of an abscess again forming, or, what is much worse, to the disease terminating in cancer. Both these fears are groundless: and, if she will only use fomentations, gentle friction frequently during the day, with almond oil and laudanum—about a drachm of the latter, 92to an ounce of the oil, warm,—and exercise patience, everything will do very well.

Nature often seeks her own cure, and a colourless, thin fluid runs from the nipple, which relieves the symptoms.

Some females, during the latter months of pregnancy, suffer dreadfully from cramp and pain in the legs, and about the sides and lower part of the stomach. This symptom arises from the pressure of the womb upon certain nerves in its neighbourhood, which proceed to the extremities.

If the cramp be seated in the muscles of the legs, a hard, knotty induration is perceivable to the touch, accompanied with great soreness, the latter continuing for a long time after the lump has disappeared. An uneasy position of the muscles is a sufficient cause of irritation, to produce it, and it is frequently removed, by simply rising from the bed or sofa, and walking the room, so as to put the muscles of the leg into action. If this does not succeed, warm friction with the naked hand, or with camphorated oil, generally will.

If spasm affect the sides, or lower part of the stomach, the speediest relief will be obtained from twenty, to five-and-twenty, or thirty drops of laudanum, with a little ether, in distilled peppermint water, or, even at the moment, a little brandy and water; but I 93generally order, for patients who are at all subject to this affection, the following mixture:—Batley’s sedative solution of opium, one drachm; compound tincture of lavender, half an ounce; distilled peppermint water, six ounces. Two tablespoonfuls to be taken before retiring to rest, if there is the slightest intimation of an approaching attack, and also direct that the feet be put into a mustard foot-bath. During the attack, great benefit will be derived from the external application of hot flannels, moistened with the compound camphor liniment.

Before the third month of pregnancy, the child is not sufficiently developed to enable it to move. When a little further advanced in growth, it moves, but so feebly and imperfectly, that the mother is not yet sensible of it. A period, however, soon arrives, when its movements, although at first like the mere fluttering of a bird, acquire a power and force, that enable it to give decided proof of life. It is instantly recognised, the female knows she has quickened, and perhaps the sensation experienced is so sudden, that she faints. After this time the motions of the child increase both in frequency and degree, and are readily perceived by the mother, but after a time the womb accustomed to this action within itself, is less sensible of its effects, and except as a satisfactory 94evidence of the life of the child, is little regarded.

Sometimes, however, the child is disagreeably active, so violent as not merely to alarm the mother, but occasion much sickness and uneasiness;—sleepless nights; feverish symptoms, &c., and all this to such an extent, as to require medical interference. If this is not thought necessary, relief will be obtained from losing blood, when not otherwise objectionable, to the amount of a few ounces; gentle aperients, and a night draught containing from twenty-five to thirty drops of Batley’s sedative solution of opium. These remedies will afford the greatest relief, and if the symptoms are not altogether removed by them, the female must then endure patiently, recollecting they are a proof that the child is alive and vigorous.^[25]

It will sometimes happen during the latter months of pregnancy, that the skin covering the abdomen will not yield readily. This produces much uneasiness; the skin becomes tender and fretted, and if there is very great distension, cracks. It forms a source of great discomfort, and renders the female miserable whenever she moves.

95It is to be relieved by fomenting the parts with a decoction of poppy-heads;^[26] and the frequent use of warm almond oil, applying in the intervals spermaceti ointment, spread very thinly on a piece of soft linen.

Many women in the latter months of gestation experience considerable annoyance, and sometimes severe suffering from the great size of the abdomen, and from want of support, when even not so very large. This is a rare occurrence in a first pregnancy, owing to the firmness of the abdominal muscles, but very frequent in subsequent ones. Little women especially suffer from this unpleasant cause, and, in fact, it is so universally the case with all, who have borne children rapidly, that it is highly important for a female to be provided with the means of relieving it.

There is but one remedy with which I am acquainted, but have usually found it answer every purpose. It is wearing during the day-time a well-applied belt, next the skin. It must be sufficiently broad for its upper edge to surround the abdomen above the point of its greatest diameter, and its lower 96edge to come down to, and be supported by, the hips. It must be drawn tight by a lace-string behind, as circumstances may require, and it must likewise be supported by broad straps passing over the shoulders. This will give the required support to the womb, and when the patient is in an upright position, as much as possible of the weight, of what she externally carries, will be thrown upon, or hang from, her shoulders.

Those who suffer much from this cause, ought also to lie down upon a couch or bed, for two or three hours every day; this will give great relief to the muscles.

A female may be pregnant, and yet be unwell for one period or more while in that condition. Indeed, it may take place every month to the time of quickening, and has even continued in some rare cases up to the time of delivery.

Now, although this can scarcely be called one of the diseases of pregnancy—for it, ordinarily, in no way, interferes with the health—still, as while the discharge is actually present it predisposes to miscarriage, it is necessary to give one or two hints of caution.

Any female, then, thus circumstanced should manage herself with great care immediately before the appearance, during the 97existence—and directly after the cessation of the discharge. She should observe the most perfect quiet of body and mind—keeping upon the sofa while it lasts, and carefully abstaining from any stimulating or indigestible article of food, and if any symptoms of pain, uneasiness, or threatening miscarriage come on, immediately seek medical advice.

A case, showing the necessity of carefulness under such circumstances, occurred to me some time since, and its relation is all that I need add upon this point.

A lady, resident in Gloucestershire, missing one period, suspected herself of being pregnant, but being unwell on the following month, supposed herself mistaken. She had occasion, however, to come to London on the second day of her being unwell—Monday. On the Wednesday following she suffered considerable uneasiness from the exertion attendant upon the journey, and on Friday while from her hotel was obliged to return home in haste, and before night, miscarried.

Here then is a case in point—first proving, what some persons deny, that a female may be unwell and yet be pregnant, for she could not perceive the slightest difference in the appearance of the discharge from what ordinarily took place, and it was exact as to the time of its return—and next, showing how necessary is great caution, and the most perfect quiet, since undoubtedly this lady would 98not have miscarried, if her journey had only been delayed another week.

Jaundice sometimes occurs in the early or latter parts of the pregnancy—certain affections also of disordered functions of the heart, producing palpitation—a troublesome cough, accompanied with considerable pain in the head, sudden attacks of difficulty of breathing, and distressing inconvenience from irritable bladder.

These, and many other slight affections, may manifest themselves during gestation, but of those I say nothing. It would be advancing beyond the bounds by which I thought it right to limit myself, and departing from the object proposed.^[27]

99I have finished what was purposed, and presented the married female with that information 100for direction and relief, in those little ailments and discomforts which frequently 101arise during pregnancy, for which she does not think it necessary to consult her 102medical adviser, and yet from which she will 103not unfrequently go on suffering for weeks, rather than speak of them.

PREVENTION TO CONCEPTION.

We have seen from the preceding pages, that in addition to what may be termed diseases ordinarily attendant upon a state of pregnancy, there are others in which to become pregnant is to hazard the health, and often the life of the woman, involving a peremptory necessity either for instrumental or Cæsarean operation, premature delivery or miscarriage. Apart from its agonizing torture, the danger of the Cæsarean operation is imminent to a frightful extent. Premature delivery is often attended with success, but the offspring being prematurely born, if they survive, rarely attain maturity, and even then mostly during their short existence very sickly. Miscarriage, although attended with but little danger when skilfully effected and properly conducted, can only be considered as an alternative; only a choice of evils. But thanks to the indefatigable researches of the learned and humane M.M. Desomeaux for his great discovery by which pregnancy can be prevented. By this discovery every woman can have in her own power the means of prevention.

The imperative, and self-evident necessity 105that, in some cases, pregnancy should not take place, cannot, for a moment, be doubted, in view that it is within the knowledge of every medical man, who makes his profession subserve the amelioration of the suffering to which the female is subject—knowledge, too, acquired within the sphere of his daily practice—that there are women who should not become pregnant, for with them pregnancy is peril to life. And even when life is spared, the birth of every child snatches many years from the life of the mother, hurrying her, with a constitution shattered, and health destroyed, to a premature grave.

Some women are so constituted that they cannot give birth, not to say to healthy, but not to living children. Others again cannot give birth at all, except through the instrumental mangling and cutting of the Cæsarean operation—of a piece-meal extraction of the infant from the mother’s womb—happy, indeed, if the woman’s life fall not a sacrifice to the butchery. Truly, such spectacles are too horrid to contemplate. And yet such women are permitted to become pregnant, in total ignorance that pregnancy ought and can be prevented, by safe, simple, invariably healthy, and infallibly certain means.

Some women, again, although not in immediate danger from becoming too frequently pregnant, yet during seven or eight of the nine months of pregnancy, experience the utmost agony of mind and body, making 106existence a continuous state of misery and suffering, destructive alike of their health, beauty, vigor, and spirits; who, after confinement and recovery, live in constant and perpetual fear and dread of again becoming pregnant, again to undergo the series of intense sufferings from which they have but just emerged. Life, under such circumstances, to the fond and affectionate wife, is but a constant suffering. Can it be otherwise to the kind husband? Can he behold the partner of his joys and sorrows—his bosom companion—the mother of his children—his solace in sickness or difficulty, thus dragging out her days of wretchedness and anguish, emaciated, disheartened, broken in body and spirits; and that, too, in the meridian of her life, in the hey-day of her existence, perceptibly sinking into an early grave, to leave her offspring motherless, or entrust them to the cold and sordid care of the world! Can a husband, possessing the feelings of a man, behold this with indifference; nay, will he not shudder at the possibility of such consequences arising from too frequent pregnancy! Will he not pause and reflect ere he becomes the cause from which such dreadful effects would flow? Surely, if he is a thinking, reflecting, rational, humane man, he must reflect—he must pause, and permit the adoption of the mode pointed out in these pages, by which pregnancy can be prevented, and that, too, without the least sacrifice of 107those pleasurable sensations experienced in the connubial embrace.

The happiness as well of husband, of wife, and children, will be enhanced by the preservation of her health, by lengthening the intervals between the periods of pregnancy, making the interval between the births three, four, or more years (as in France), depending upon the health of the wife. Thereby it will, under ordinary circumstances, be preserved to rear, guard, and educate her children,—to soothe and comfort the declining years of the father when age and decrepitude are upon him. When, perchance, his own sufferings can be assuaged by only her hand, who alone knows and anticipates his every wish—whose affectionate attention, having accompanied him through the rugged path of life, alone knows how to impart content and happiness.

Surely, then, circumstances do arise where it is folly, madness, wickedness, to permit pregnancy to take place.

Where, for example, the health of the wife evidently sinks under a too frequent state of pregnancy or a too rapid increase of family; or the births taking place in too close succession.

Where the female cannot be in a state of pregnancy without the most intense and excruciating suffering during such period, endangering her own future health, and perhaps that of her offspring.

Where an incapacity exists to give birth 108to living children, either in consequence of malformation of the pelvis, or other deformity; and where, from the same, or other causes, recourse is necessarily had to the Cæsarean operation. All which causes have either the health or the life of the female in view.

But there are still other reasons scarcely less urgent why pregnancy should be sometimes prevented, which have the welfare of the offspring in view.

It is but too lamentable a fact that the sins or misfortunes of the parent are visited upon their offspring. It is indisputable that diseases which carry off their thousands, are, many of them, hereditary,—transmissible from parent to child. Such as confirmed consumption, King’s Evil, or Scrofula, Gout, Venereal Disease, Hypochondria, Insanity, and other diseases, and even drunkenness.

In view, then, of the transmission of disease and suffering to our offspring, should they even survive a brief existence, every reflecting being should hesitate whether it were not better to prevent pregnancy than to thrust human beings into the world, and blighting their brief existence with entailed disease and wretchedness—for such offspring are seldom reared to maturity. This fact accounts for the great mortality of children, especially in cities. Those, however, that do pass through a sickly childhood, becoming necessarily endeared to their parents, are cut 109off in their early years—sometimes in the bloom of youth—blasting the fond hopes just springing into existence in the breasts of their parents. Thus, in some families, five or six, one after another, are apparently prematurely cut off.

The causes, doubtless, to a superficial observer, looking only upon effects, appear inexplicable: not so to those who look beyond mere effects. To such the present is but the child of the past, and the parent of the future.

In discussing, therefore, the propriety, the morality, nay, the inevitable necessity, in some cases, of preventing pregnancy, it has an important bearing.

In presenting these considerations, however, we must bear in mind that they are not applicable where the female is capable of enduring the ordinary inconveniences arising from a state of pregnancy, or where her health is not thereby injuriously affected, because the reasons for prevention do not, in such case, exist. Indeed, it is not unusual, that the health of the female, so far from being injured, is often improved, in consequence of the existence of pregnancy, and others, again, who enjoy perfect health without reference to their condition in this respect.

And, again, it is unquestionable that children are often a source of domestic happiness—the binding link—the pledge of affection 110and love—the delight and joy of parents, upon whose growth and development they look with pride mingled with fond anticipations of the future. The paths of life are made less rugged, the charms of home more pleasant, toil itself becomes less irksome by their influence.

When, therefore, neither the life nor health of the mother is jeopardized, and the offspring free from hereditary or constitutional taint, it is, of course, unnecessary that preventive measures should be used. Neither is it, under such circumstances, recommended.

In regard, however, to the prevention of pregnancy, there are still other views, taking still other grounds, treating the subject in a moral and social point of view, which, although not strictly belonging to its consideration in a medical and physiological character, are yet of sufficient interest to be embraced in this work.

The following remarks are from a celebrated physiological writer, and are certainly worthy of consideration, whether we coincide with the author or not. He thus eloquently introduces the subject:

“Libertines and debauchees! these pages are not for you. You have nothing to do with the subject of which they treat. Bringing to its discussion, as you do, a distrust or contempt of the human race—accustomed as you are to confound liberty with license, 111and pleasure with debauchery, it is not for your palled feelings and brutalized senses to distinguish moral truth in its purity and simplicity. I never discuss this subject with such as you.

“It has been remarked, that nothing is so suspicious in a woman, as vehement pretensions to especial chastity; it is no less true, that the most obtrusive and sensitive stickler for the etiquette of orthodox morality is the heartless rake. The little intercourse I have had with men of your stamp, warns me to avoid the serious discussion of any species of moral heresy with you. You approach the subject in a tone and spirit revolting alike to good taste and good feeling. You seem to pre-suppose—from your own experience, perhaps—that the hearts of all men and more especially of all women, are deceitful above all things and desperately wicked; that violence and vice are inherent in human nature, and that nothing but laws and ceremonies prevent the world from becoming a vast slaughter-house, or an universal brothel. You judge your own sex and the other by the specimens you have met with in wretched haunts of mercenary profligacy; and, with such a standard in your minds, I marvel not that you remain incorrigible unbelievers in any virtue, but that which is forced on the prudish hot-bed of ceremonious orthodoxy. I wonder not that you will not trust the natural soil, 112watered from the free skies and warmed by the life-bringing sun. How should you? you have never seen it produce but weeds and poisons. Libertines and debauchees! cast these pages aside! You will find in them nothing to gratify a licentious curiosity; and, if you read them, you will probably only give me credit for motives and impulses like your own.

“And you, prudes and hypocrites! you who strain at a gnat and swallow a camel; you whom Jesus likened to whited sepulchres, which without indeed are beautiful, but within are full of all uncleanness; you who affect to blush if the ankle is incidentally mentioned in conversation, or displayed in crossing a stile, but will read indecencies enough, without scruple, in your closets; you who, at dinner, ask to be helped to the bosom of a duck, lest by mention of the word breast, you call up improper associations; you who have nothing but a head and feet and fingers; you who look demure by daylight, and make appointments only in the dark—you, prudes and hypocrites! I do not address. Even if honest in your prudery, your ideas of right and wrong are too artificial and confused to profit by the present discussion; if dishonest, I desire to have no communication with you.

“Reader! if you belong to the class of prudes or of libertines, I pray you, follow my argument no further. Stop here, and 113believe that my heresies will not suit you. As a prude, you would find them too honest; as a libertine, too temperate. In the former case, you might call me a very shocking person; in the latter, a quiz or a bore.

“But if you be honest, upright, pure-minded—if you be unconscious of unworthy motive or selfish passion—if truth be your ambition, and the welfare of our race your object—then approach with me a subject the most important to man’s well-being; and approach it as I do, in a spirit of dispassionate, disinterested free inquiry. Approach it, resolving to prove all things, and hold fast that which is good. The discussion is one to which it is every man’s and every woman’s duty (and ought to be every one’s business) to attend. The welfare of the present generation, and—yet far more—of the next, requires it. Common sense sanctions it. And the national motto of my former country, ‘Honi soit qui mal y pense,’^[28] may explain the spirit in which it is undertaken, and in which it ought to be received.”

PREVENTION TO CONCEPTION; CONSIDERED IN ITS SOCIAL BEARINGS.

“What would be the probable effect, in social life, if mankind obtained and exercised a control over the instinct of reproduction?

“My settled conviction is—and I am prepared to defend it—that the effect would be salutary, moral, civilizing; that it would prevent many crimes and more unhappiness; that it would lessen intemperance and profligacy; that it would polish the manners and improve the moral feelings; that it would relieve the burden of the poor, and the cares of the rich; that it would most essentially benefit the rising generation, by enabling parents generally more carefully to educate, and more comfortably to provide for, their offspring. I proceed to substantiate as I may these positions.

“And first, let us look solely to the situation of married persons. Is it not notorious, that the families of the married often increase beyond what a regard for the young beings coming into the world, or the happiness of those who give them birth, would dictate? In how many instances does the hard-working father, and more especially the mother, 115of a poor family, remain slaves throughout their lives, tugging at the oar of incessant labor, toiling to live, and living but to toil; when if their offspring had been limited to two or three only, they might have enjoyed comfort and comparative affluence! How often is the health of the mother, giving birth every year to an infant—happy if it be not twins!—and compelled to toil on, even at those times when nature imperiously calls for some relief from daily drudgery—how often is the mother’s comfort, health, nay, her life, thus sacrificed! Or, if care and toil have weighed down the spirit, and at last broken the health of the father, how often is the widow left, unable, with the most virtuous intentions, to save her fatherless offspring from becoming degraded objects of charity, or profligate votaries of vice!

“Fathers and mothers! not you who have your nursery and your nursery-maids, and who leave your children at home, to frequent the crowded rout, or to glitter in the hot ball-room; but you by the labor of whose hands your children are to live, and who, as you count their rising numbers, sigh to think how soon sickness or misfortune may lessen those wages which are now but just sufficient to afford them bread—fathers and mothers in humble life! to you my argument comes home, with the force of reality. Others may impugn—may ridicule it. By bitter experience you know and feel its truth.

116“Yet this is not all. Every physician knows, that there are many women so constituted that they cannot give birth to healthy—sometimes not to living children. Is it desirable—is it moral, that such women should become pregnant? Yet this is continually the case, the warnings of physicians to the contrary notwithstanding. Others there are, who ought never to become parents; because, if they do, it is only to transmit to their offspring grievous hereditary diseases; perhaps that worst of diseases, insanity. Yet they will not lead a life of celibacy. They marry. They become parents, and the world suffers by it. That a human being should give birth to a child, knowing that he transmits to it hereditary disease, is in my opinion an immorality. But it is a folly to expect that we can ever induce all such persons to live the lives of Shakers. Nor is it necessary; all that duty requires of them is, to refrain from becoming parents. Who can estimate the beneficial effect which rational moral restraint may thus have, on the health, beauty, and physical improvement of our race, throughout future generations?

“But, apart from these latter considerations, is it not most plainly, clearly, incontrovertibly desirable, that parents should have the power^[29] to limit their offspring, whether 117they choose to exercise it or not? Who can lose by their having this power? and how many may gain! may gain competency for themselves, and the opportunity carefully to educate and provide for their children! How many may escape the jarrings, the quarrels, the disorder, the anxiety, which an overgrown family too often causes in the domestic circle?

“It sometimes happens, that individual instances come home to the feelings with greater force than any general reasoning. I shall, in this place, adduce one which came immediately under my cognizance.

“In June, 1829, I received from an elderly gentleman of the first respectability, occupying a public situation in one of the western states, a letter requesting to know whether I could afford any information or advice in a case which greatly interested him and which regarded a young woman for whom he had ever experienced the sentiments of a father. In explanation of the circumstances to which he alluded, he enclosed me a copy of a letter which she had just written to him, and which I here transcribe verbatim. A letter more touching from its simplicity, or more strikingly illustrative of the unfortunate situation in 118which not one, but thousands, in married life, find themselves placed, I have never read.

“‘The friendship which has existed between you and my father, ever since I can remember; the unaffected kindness you used to express towards me, when you resided in our neighborhood, during my childhood; the lively solicitude you have always seemed to feel for my welfare, and your benevolence and liberal character, induce me to lay before you in a few words, my critical situation, and ask you for your kind advice.

“‘It is my lot to be united in wedlock to a young mechanic of industrious habits, good dispositions, pleasing manners, and agreeable features, excessively fond of our children and of me; in short, eminently well qualified to render himself and family and all around him happy, were it not for the besetting sin of drunkenness. About once in every three or four weeks, if he meet, either accidentally or purposely, with some of his friends, of whom, either real or pretended, his good nature and liberality procure him many, he is sure to get intoxicated, so as to lose his reason; and, when thus beside himself, he trades and makes foolish bargains, so much to his disadvantage, that he has almost reduced himself and family to beggary, being 119no longer able to keep a shop of his own, but obliged to work journey work.

“‘We have not been married quite four years, and have already given being to three dear little ones. Under present circumstances, what can I expect will be their fate and mine? I shudder at the prospect before me. With my excellent constitution and industry, and the labor of my husband, I feel able to bring up these three little cherubs in decency, were I to have no more: but when I seriously consider my situation, I can see no other alternative left for me, than to tear myself away from the man who, though addicted to occasional intoxication, would sacrifice his life for my sake; and for whom, contrary to my father’s will, I successively refused the hand and wealth of a lawyer and of a preacher; or continue to witness his degradation, and bring into existence, in all probability, a numerous family of helpless and destitute children, who, on account of poverty, must inevitably be doomed to a life of ignorance, and consequent vice and misery.

“Need I add one word of comment on such a case as this? Every feeling mind must be touched by the amiable feeling and good sense that pervade the letter. Every rational being, surely, must admit, that the power of preventing, without injury or sacrifice, the increase of a family, under such circumstances, 120is a public benefit and a private blessing.

“Will it be asserted—and I know no other even plausible reply to these facts and arguments—will it be asserted, that the thing is, in itself, immoral or unseemly? I deny it; and I point to the population of France, in justification of my denial. Where will you find, on the face of the globe, a more polished or more civilized nation than the French, or one more punctiliously alive to any rudeness, coarseness or indecorum? You will find none. The French are scrupulous on these points, to a proverb. Yet, as every intelligent traveller in France must have remarked, there is scarcely to be found, among the middle or upper classes (and seldom even among the working classes), such a thing as a large family; very seldom more than three or four children. A French lady of the utmost delicacy and respectability will, in common conversation, say as simply—(ay, and as innocently, whatever the self-righteous prude may aver to the contrary)—as she would proffer any common remark about the weather: ‘I have three children; my husband and I think that is as many as we can do justice to, and I do not intend to have any more.’^[30]

121“I have stated notorious facts, facts which no traveller who has visited Paris, and seen anything of the domestic life of its inhabitants, will attempt to deny. However heterodox, then, my view of the subject may be in this country, I am supported in it by the opinion and the practice of the most refined and most socially cultivated nation in the world.

“Will it still be argued, that the practice, if not coarse, is immoral? Again, I appeal to France. I appeal to the details of the late glorious revolution—to the innumerable instances of moderation, of courage, of honesty, of disinterestedness, of generosity, of magnanimity, displayed on the memorable ‘three days,’ and ever since; and I challenge comparison between the national character of France for virtue, as well as politeness, and that of any other nation under heaven.

“It is evident, then, that to married persons, the power of limiting their offspring to their circumstances is most desirable. It may often promote the harmony, peace, and comfort of families; sometimes it may save from bankruptcy and ruin, and sometimes it may rescue the mother from premature death. In no case can it, by possibility, be worse than superfluous. In no case can it be mischievous.

“If the moral feelings were carefully cultivated, if we were taught to consult, in everything, rather the welfare of those we 122love than our own, how strongly would these arguments be felt? No man ought even to desire that a woman should become the mother of his children, unless it was her express wish, and unless he knew it to be for her welfare, that she should. Her feelings, her interests, should be for him in this matter an imperative law. She it is who bears the burden, and therefore with her also should the decision rest. Surely it may well be a question whether it be desirable, or whether any man ought to ask, that the whole life of an intellectual, cultivated woman, should be spent in bearing a family of twelve or fifteen children; to the ruin, perhaps, of her constitution, if not to the overstocking of the world. No man ought to require or expect it.

“Shall I be told, that this is the very romance of morality? Alas! that what ought to be a matter of every day practice—a commonplace exercise of the duties and charities of life—a bounden duty—an instance of domestic courtesy too universal either to excite remark or to merit commendation—alas! that a virtue so humble that its absence ought to be reproached as a crime, should, to our selfish perceptions, seem but a fastidious refinement, or a fanciful supererogation!

“But I pass from the case of married persons to that of young men and women who have yet formed no matrimonial connexion.

123“In the present state of the world, when public opinion stamps with opprobrium every sexual connection which has not received the orthodox sanction of an oath, almost all young persons, on reaching the age of maturity, desire to marry. The heart must be very cold, or very isolated, that does not find some object on which to bestow its affections. Thus, early marriages would be almost universal, did not prudential considerations interfere. The young man thinks, ‘I must not marry yet. I cannot support a family. I must make money first, and think of a matrimonial settlement afterwards.’

“And so he goes to making money, fully and sincerely resolved, in a few years to share it with her whom he now loves. But passions are strong, and temptations great. Curiosity, perhaps, introduces him into the company of those poor creatures whom society first reduces to a dependence on the most miserable of mercenary trades, and then curses for being what she has made them. There his health and his moral feelings alike are made shipwreck. The affections he had thought to treasure up for their first object, are chilled by dissipation and blunted by excess. He scarcely retains a passion but avarice. Years pass on—years of profligacy and speculation—and his first wish is accomplished; his fortune is made. Where now are the feelings and resolves of his youth?

“He is a man of pleasure—a man of the world. He laughs at the romance of his youth, and marries a fortune. If gaudy equipages and gay parties confer happiness, he is happy. But if these be only the sunshine on the stormy ocean below, he is a victim to that system of morality which forbids a reputable connexion until the period when provision has been made for a large, expected family. Had he married the first object of his choice, and simply delayed becoming a father until his prospects seemed to warrant it, how different might have been his lot! Until men and women are absolved from the fear of becoming parents, except when they themselves desire it, they ever will form mercenary and demoralizing connexions, and seek in dissipation the happiness they might have found in domestic life.

“I know that this, however common, is not an universal case. Sometimes the heavy responsibilities of a family are incurred at all risks; and who shall say how often a life of unremitting toil and poverty is the consequence? Sometimes—if even rarely—the young mind does hold to its first resolves. The youth plods through years of cold celibacy and solitary anxiety; happy, if before the best hours of life are gone, and its warmest 125feelings withered, he may return to claim the reward of his forbearance and of his industry. But even in this comparatively happy case, shall we count for nothing the years of ascetical sacrifice at which after-happiness is purchased? The days of youth are not too many, nor its affections too lasting. We may, indeed, if a great object require it, sacrifice the one and mortify the other. But is this, in itself, desirable? Does not wisdom tell that such sacrifice is a dead loss—to the warm-hearted often a grievous one? Does not wisdom bid us temperately enjoy the spring-time of life, ‘while the evil days come not, nor the years draw nigh’ when we shall say, ‘we have no pleasure in them?’

“Let us say, then, if we will, that the youth who thus sacrifices the present for the future, chooses wisely between two evils, profligacy and asceticism. This is true. But let us not imagine the lesser evil to be a good. It is not good for man to be alone. It is for no man’s or woman’s happiness or benefit that they should be condemned to Shakerism. It is a violence done to the feelings, and an injury to the character. A life of rigid celibacy, though infinitely preferable to a life of dissipation, is yet fraught with many evils. Peevishness, restlessness, vague longings, and instability of character, are among the least of these. The mind is unsettled, and the judgment warped. Even the very instinct 126which is thus mortified assumes an undue importance, and occupies a portion of the thoughts which does not of right or nature belong to it; and which, during a life of satisfied affection, it would not obtain.

“I speak not now of extreme cases, where solitary vice^[31] or disease, or even insanity, has been the result of ascetical mortification. I speak of every day cases; and I am well convinced that (however wise it often is, in the present state of the world, to select and adhere to this alternative), yet no man or woman can live the life of a conscientious Shaker, without suffering, more or less, both physically, mentally, and morally. This is the more to be regretted, because the very noblest portion of our species—the good, the pure, the high-minded, and the kind-hearted—are the chief victims.

“Thus, inasmuch as the scruple of incurring 127heavy responsibilities deters from forming moral connexions, and encourages intemperance and prostitution, the knowledge which enables man to limit his offspring, would, in the present state of things, save much unhappiness and prevent many crimes. Young persons sincerely attached to each other, and who might wish to marry, would marry early; merely resolving not to become parents until prudence permitted it. The young man, instead of solitary toil or vulgar dissipation, would enjoy the society and the assistance of her he had chosen as his companion; and the best years of life, whose pleasures never return, would not be squandered in riot, or lost through mortification.

“My readers will remark, that all the arguments I have hitherto employed, apply strictly to the present order of things, and the present laws and system of marriage. No one, therefore, need be a moral heretic on this subject to admit and approve them. The marriage laws might all remain for ever as they are; and yet a moral check to population would be beneficent and important.

“But there are other cases, it will be said, where the knowledge of a preventive would be mischievous. If young women, it will be argued, were absolved from the fear of consequences, they would rarely preserve their chastity. Unlegalized connexions would be common and seldom detected. Seduction 128would be facilitated. Let us dispassionately examine this argument.

“I fully agree with that most amiable of moral heretics, Shelley, that ‘Seduction, which term could have no meaning in a rational society, has now a most tremendous one.’^[32] It matters not how artificial the penalty which society has chosen to affix to a breach of her capricious decrees. Society has the power in her own hands; and that moral Shylock, Public Opinion, enforces the penalty, even though it cost the life of the victim. The consequences, then, to the poor sufferer, whose offence is, at most, but an error of judgment or a weakness of the heart, are the same as if her imprudence were indeed a crime of the blackest dye. And his conduct who, for a momentary, selfish gratification, will deliberately entail a life of wretchedness on one whose chief fault, perhaps, was her misplaced confidence in a villain, is not one whit excused by the folly and injustice of the sentence.^[33] Some poet says,

What epithet then belongs to him who makes it a trade to win a woman’s gentle affections, betray her generous confidence, and then, when the consequences become apparent, abandon her to dependence, and the scorn of a cold, a self-righteous, and a wicked world; a world which will forgive anything but rebellion against its tyranny, and in whose eyes it seems the greatest of crimes to be unsuspecting and warm-hearted! I will give my hand freely to a galley-slave, and speak to the highway-robber as to an honest man; but there is one character with whom I desire to exchange neither word nor greeting—the cold-hearted, deliberate, practised, and calculating seducer!

“And, let me ask, what is it gives to the arts of seduction their sting, and stamps to the world its victim? Why is it, that the man goes free and enters society again, almost courted and applauded for his treachery, while the woman is a mark for the finger of reproach, and a butt for the tongue of scandal? Because she bears about her the mark of what is called her disgrace. She becomes a mother; and society has something tangible against which to direct its anathemas. Nine-tenths, at least, of the misery and ruin which are caused by seduction, even in the present state of public opinion 130on the subject, result from cases of pregnancy.

“If the little being lives, the dove in the falcon’s claws is not more certain of death, than we may be, that society will visit, with its bitterest scoffs and reproaches, the bruised spirit of the mother and the unconscious innocence of the child.

“If, then, we cannot do all, shall we neglect a part? If we cannot prevent every misery which man’s selfishness and the world’s cruelty entail on a sex which it ought to be our pride and honor to cherish and defend; let us prevent as many as we can. If we cannot persuade society to revoke its unmanly and unchristian^[34] persecution of those who are often the best and gentlest of its members—let us, at the least, give to woman what defence we may, against its violence.

“I appeal to any father, trembling for the reputation of his child, whether, if she were induced to form an unlegalized connexion, her pregnancy would not be a frightful aggravation? I appeal to him, whether a preventive which shall save her from a situation which must soon disclose all to the world, would not be an act of mercy, of charity, of philanthropy—whether it might not save him from despair, and her from ruin? The fastidious conformist may frown upon the question, but to the father it comes 131home; and, whatever his lips may say, his heart will acknowledge the soundness and the force of the argument it conveys.

“It may be, that sticklers for morality will still demur to the positions I defend. They will perhaps tell me, as the committee of a certain society in this city lately did—that the power of preventing conception ‘holds out inducements and facilities for the prostitution of their daughters, their sisters, and their wives.’

“Truly, but they pay their wives, their sisters, and their daughters, a poor compliment! Is, then, this vaunted chastity a mere thing of circumstance and occasion? Is there but the difference of opportunity between it and prostitution? Would their wives, and their sisters, and their daughters, if once absolved from the fear of offspring, all become prostitutes—and sell their embrace for gold, and descend to a level with the most degraded? In truth, but they slander their own kindred: they libel their own wives, sisters, and daughters. If they spoke truth—if fear were indeed the only safeguard of their relatives’ chastity, little value should I place on virtue like that! and small would I esteem his offence, who should attempt to seduce it.^[35]

132“That chastity which is worth preserving is not the chastity that owes its birth to fear and to ignorance. If to enlighten a woman regarding a simple physiological fact will make her a prostitute, she must be especially 133predisposed to profligacy. But it is a libel on the sex. Few, indeed, there are, who would continue so miserable and degrading a calling, could they but escape from it. For one prostitute that is made by inclination, ten are made by necessity. Reform the laws—equalize the comforts of society, and you need withhold no knowledge from your wives and daughters. It is want, not knowledge, that leads to prostitution.

“For myself, I would withhold from no sister, or daughter, or wife of mine, any ascertained fact whatever. It should be to me a duty and a pleasure to communicate to them all I knew myself; and I should hold it an insult to their understandings and their hearts to imagine, that their virtue would diminish as their knowledge increased. Vice is never the offspring of just knowledge, and they who say it is, slander their own nature. Would we but trust human nature, instead of continually suspecting it, and guarding it by bolts and bars, and thinking to make it very chaste by keeping it very ignorant, what a different world we should have of it! The virtue of ignorance is a sickly plant, ever exposed to the caterpillar of corruption, liable to be scorched and blasted even by the free light of heaven; of precarious growth; and even if at last artificially matured, of little or no real value.

“I know that parents often think it right and proper to withhold from their children—especially 134from their daughters—facts the most influential on their future lives, and the knowledge of which is essential to every man and woman’s well-being.^[36] Such a course has ever appeared to me ill-judged and productive of very injurious effects. A girl is surely no whit the better for believing, 135until her marriage night, that children are found among the cabbage leaves in the garden. The imagination is excited, the curiosity kept continually on the stretch; and that which, if simply explained, would have been recollected only as any other physiological phenomenon, assumes all the rank and importance and engrossing interest of a mystery. Nay, I am well convinced, that mere curiosity has often led ignorant young people into situations, from which a little more confidence and openness on the part of their parents and guardians, would have effectually secured them.

“But if we could prevent the circulation of truth, why should we? We are not afraid of it ourselves. No man thinks his morality will suffer by it. Each feels certain that his virtue can stand any degree of knowledge. And is it not the height of egregious presumption in each to imagine that his neighbor is so much weaker than himself, and requires a bandage which he can do without? Most of all is it presumptuous to suppose, that that knowledge which the man of the world can bear with impunity, will corrupt the young and the pure-hearted. It is the sullied conscience only that suggests such fears. Trust youth and innocence. Speak to them openly. Show them that you respect them, by treating them with confidence; and they will quickly learn to respect and to govern themselves. You enlist even their pride in 136your behalf; and you will soon see them make it their boast and their highest pleasure to merit your confidence. But watch them, and show your suspicions of them but once,—and you are the jailor, who will keep his prisoners just as long as bars and bolts shall prevent their escape. The world was never made for a prison-house; it is too large and ill-guarded: nor were parents ever intended for jail-keepers; their very affections unfit them for the task.

“There is no more beautiful sight on earth, than a family among whom there are no secrets and no reserves; where the young people confide everything to their elder friends—for such to them are their parents—and where the parents trust everything to their children; where each thought is communicated as freely as it arises; and all knowledge given, as simply as it is received. If the world contain a prototype of that Paradise, where nature is said to have known no sin or impropriety, it is such a family; and if there be a serpent that can poison the innocence of its inmates, that serpent is SUSPICION.

“I ask no greater pleasure than thus to be the guardian and companion of young beings whose innocence shall speak to me as unreservedly as it thinks to itself; of young beings who shall never imagine that there is guilt in their thoughts, or sin in their confidence; and to whom, in return, I may impart every 137important and useful fact that is known to myself. Their virtue shall be of that hardy growth, which all facts tend to nourish and strengthen.

“I put it to my readers, whether such a view of human nature, and such a mode of treating it, be not in accordance with the noblest feelings of their hearts. I put it to them, whether they have not felt themselves encouraged, improved, strengthened in every virtuous resolution, when they were generously trusted; and whether they have not felt abased and degraded, when they were suspiciously watched, and spied after, and kept in ignorance. If they find such feelings in their own hearts, let them not self-righteously imagine, that they can only be won by generosity, or that the nature of their fellow-creatures is different from their own.

“There are other considerations connected with this subject, which farther attest the social advantages of the control I advocate. Human affections are mutable, and the sincerest of moral resolutions may change.^[37] Every day furnishes instances of alienations, and of separations; sometimes almost before the honey-moon is well expired. In such 138cases of unsuitability, it cannot be considered desirable that there should be offspring; and the power of refraining from becoming parents until intimacy had, in a measure, established the likelihood of permanent harmony of views and feelings, must be confessed to be advantageous.

“It would be impossible to meet every argument in detail, which ingenuity or prejudice might put forward. If the world were not actually afraid to think freely or to listen to the suggestions of common sense, three-fourths of what has already been said would be superfluous; for most of the arguments employed would occur spontaneously to any rational, reasoning being. But the mass of mankind have still, in a measure, everything to learn on this subject. The world seems to me much to resemble a company of gourmands, who sit down to a plentiful repast, first very punctiliously saying grace over it; and then, under the sanction of the priest’s blessing, think to gorge themselves with impunity; as conceiving, that gluttony after grace is no sin. So it is with popular customs and popular morality. Everything is permitted, if external forms be but respected. Legal roguery is no crime, and ceremony-sanctioned excess no profligacy. The substance is sacrificed to the form, the virtue to the outward observance. The world troubles its head little about whether a man be honest or dishonest, so he knows how to avoid the 139penitentiary and escape the hangman. In like manner, the world seldom thinks it worth while to inquire whether a man be temperate or intemperate, prudent or thoughtless. It takes especial care to inform itself whether in all things he conforms to orthodox requirements; and if he does, all is right. Thus men too often learn to consider an oath an absolution from all subsequent decencies and duties, and a full release from all responsibilities. If a husband maltreat his wife, the offence is venal; for he premised it by making her at the altar, an ‘honest woman.’ If a married father neglects his children, it is a trifle; for grace was regularly said before they were born.

“With such a world as this, it is a difficult matter to reason. After listening to all I have said, it may perhaps cut me short by reminding me, that nature herself declares it to be right and proper, that we should reproduce our species without calculation or restraint. I will ask, in reply, whether nature also declares it to be right and proper, that when the thermometer is at 96°, we should drink greedily of cold water, and drop down dead in the streets? Let the world be told, that if nature gave us our passions and propensities, she gave us also the power wisely to control them; and that, when we hesitate to exercise that power we descend to a level with the brute creation, and become the sport 140of fortune—the mere slaves of circumstance.^[38]

“To one other argument it were not, perhaps, worth while to advert, but that it has been already speciously used to excite popular prejudice. It has been said, that to recommend to mankind prudential restraint in cases where children cannot be provided for, is an insult to the poor man; since all ought to be so circumstanced that they might provide amply for the largest family. Most assuredly all ought to be so circumstanced; but all are not. And there would be just as much propriety in bidding a poor man to go and take by force a piece of Saxony broadcloth from his neighbor’s store, because he ought to be able to purchase it, as to encourage him to go on producing children, because he ought to have the wherewithal to support them. Let us exert every nerve to correct the injustice and arrest the misery that results from a vicious order of things; but, until we have done so, let us not, for humanity’s sake, madly recommend that which grievously 141aggravates the evil; which increases the burden on the present generation, and threatens with neglect and ignorance the next.

“It now remains, after having spoken of the desirability of obtaining control over the instinct of reproduction, to speak of its practicability.

“I have taken great pains to ascertain the opinions of the most enlightened physicians of Great Britain and France on this subject; (opinions which popular prejudice will not permit them to offer publicly in their works;) and they all concur in admitting, what the experience of the French nation positively proves, that man may have a perfect control over this instinct: and that men and women may, without any injury to health, or the slightest violence done to the moral feelings, and with but small diminution to the pleasure which accompanies the gratification of the instinct, refrain at will from becoming parents. It has chanced to me, also, to win the confidence of several individuals, who have communicated to me, without reserve, their own experience: and all this has been corroborative of the same opinion.

“However various and contradictory the different theories of generation, almost all physiologists are agreed, that the entrance of the sperm itself (or of some volatile particles proceeding from it) into the uterus, must precede conception. This it was that probably 142first suggested the possibility of preventing conception at all.”

The eloquent writer, who was at that time unaware of the existence of Desomeaux’s mode of prevention to conception,^[39] states 143the same result was attained by a complete withdrawal on the part of the male previous to emission. But this mode, it will be readily perceived, is attended with, to some, insurmountable difficulties.

In the first place, few men can invariably control themselves in this respect, and to be an effectual preventive, he must ever, and invariably control his passions. Now it cannot be denied, that even those who habitually can, and do control themselves, will inevitably, now and then, in so exciting a passion, lose their self-control. It is impossible to do otherwise. And one moment’s forgetfulness defeats the end. In the second place, even if always and invariably practicable, it makes the act of coition incomplete and unsatisfactory. In the third place it would be almost, nay quite impossible, to prevent an imperceptible 144and unconscious escape of semen, sufficient however to produce conception, often giving rise to unjust and unfounded suspicions, when, in fact, the cause for the existence of pregnancy is the same as though no withdrawal was practised. And lastly, its effects upon the constitution are frequently not unlike those produced by onanism. In addition to which, it is unsafe, because uncertain; consequently, when indispensable to prevent pregnancy, is of no avail, if not actually dangerous.^[40]

To sum up, in brief, why pregnancy should be prevented, the reasons adduced seem to be conclusive to the able and talented writer, in its moral, social, and physiological aspect.

Morally. Firstly. It induces early marriages by removing the principal obstacle 145thereto, viz.: the fear of having offspring before the parents are in a pecuniary condition to support, rear, and educate them. And,

Secondly, By inducing early marriages, seductions would become less frequent, and consequently prostitution, comparatively, become extinct.

Socially. Firstly. Young men, instead of seeking excitement and amusement in the intoxicating cup, gaming, night carousals, brothels, &c., acquiring habits of dissipation deadening alike to the keen, fresh susceptibilities belonging to youth—habits too, which often cling to them in after life, habits which, perhaps for ever destroy their health,—as tainting their constitution with some foul and incurable disease,—would, with a view to early marriage, cultivate the social and domestic ties, while yet pure and uncontaminated by contact with the dissolute and vicious. And

Secondly, Young persons, even though with very limited means, would nevertheless marry, and by not becoming parents, be enabled, unitedly, to husband their resources, with the view to the bettering their condition pecuniarily; in the meantime, and in the days of their youth, enjoying all those social endearments which each sex finds in the society of the other, where reciprocity of views, interests, and feelings exists. So too, those in middling circumstances would marry 146early, merely deferring an increase of family until they will have established themselves in some business, ere the constant accumulating expenses of an increasing family encroach upon, or eat up their small capital, the immediate incurrence of which thus early would, perhaps, for ever destroy the means for the comfortable provision of themselves, as also the future welfare of their children.

Physiologically. By inducing early marriages, the dire evils arising from promiscuous sexual intercourse with the tainted or diseased, will gradually disappear, and in a generation or two we would find springing up, in the place of the present sickly, puny race, a healthy, robust, and pure generation.

In regard to the morality of preventing conception it is contended that everything which tends to the amelioration of mankind, to improve their condition physically, morally, and socially, or equalize their condition pecuniarily, cannot be immoral. That the instinct of reproduction should be, like our other appetites and passions, subject to the control of reason,—that when the gratification of this instinct results in evil effects either to ourselves or to our offspring, or even to society—if such evil can be prevented, it is the obligation of morality that it should be.

It is contended, then, that the use of a preventive to conception will make men and women rational, reflecting, thinking beings, 147regardful alike of their own welfare and the welfare of their offspring. That it will banish poverty, vice and profligacy, by enabling the poor to improve their pecuniary condition and thus engendering habits of frugality, reflection and economy, which the prospect of future competency is so calculated to inspire. Vice so often springing from despair and hopeless poverty will disappear, because the children, by reason of the competence and moral structure of the parents, will not in infancy be thrust upon the world to mingle with the depraved and the licentious. Sexual profligacy and licentiousness will be checked, as early marriages become more prevalent and universal, as there then will exist no reasons as now, why two persons, attached to each other, should not marry, refraining merely from becoming parents. Dishonorable advances therefore would be spurned, seductions thus have no existence, and prostitution, the offspring of seduction, would be unknown, and even the ravages of that disease, engendered by promiscuous sexual intercourse, now carrying off its tens of thousands, transmitting its pestiferous poison to thousands yet unborn, would entirely disappear.

The able author thus concludes his views:

“And now let my readers pause. Let them review the various arguments I have placed before them. Let them reflect how 148intimately the instinct of which I treat is connected with the social welfare of society. Let them bear in mind, that just in proportion to its social influence, is it important that we should know how to control and govern it; that when we obtain such control, we may save ourselves—and, what we ought to prize much more highly, may save our companions and our offspring, from suffering or misery; that, by such knowledge, the young may form virtuous connexions, instead of becoming profligates or ascetics; that, by it, early marriage is deprived of its heaviest consequences, and seduction of its sharpest sting; that, by it, man may be saved from moral ruin, and woman from desolating dishonor; that by it the first pure affections may be soothed and satisfied, instead of being thwarted or destroyed—let them call to mind all this, and let them say, whether the possession of such control be not a blessing to man.

“As to the cry which prejudice may raise against it as being unnatural, it is just as unnatural (and no more so) as to refrain, in a sultry summer’s day, from drinking, perhaps, more than a pint of water at a draught, which prudence tells us is enough, while inclination would bid us drink a quart. All thwarting of any human wish or impulse may, in one sense, be called unnatural; it is not, however, ofttimes the less prudent and proper on that account.”

149As to the practical efficacy of this preventive, the experience of France, where it is universally practised, might suffice in proof. We know, at this moment, several married persons who have told us, that, after having had as many children as they thought prudent, they had for years employed it with perfect success. For the satisfaction of our readers, we will select some instances.

A few weeks since, a respectable and very intelligent father of a family, about thirty-five years of age, who resides west of the mountains, called at our office. Conversation turned on the present subject, and we expressed to him our conviction that this preventive was effectual. He told us he could speak from personal experience. He had married young, and soon had three children. These he could support in comfort, without running into debt or difficulty; but, the price of produce sinking in his neighborhood, there did not appear a fair prospect of supporting a large family. In consequence, he and his wife determined to limit their offspring to three. They have accordingly used it for seven or eight years; have had no more children; and have been rewarded for their prudence by finding their situation and prospects improving every year.

The next communication from which we shall copy is from a young man of excellent character, living in a neighboring state, and 150now one of the conductors of a popular periodical. After suggesting to us the propriety of re-publishing some English works now out of print, he proceeds as follows:

“Had I not been addressing you upon another subject, I should not have ventured to obtrude on you my small need of approbation; but I cannot let slip this opportunity of endeavoring to express how much I feel indebted to you for its publication.

“To know how I am so indebted, it is necessary you should also know something of my situation in life; and when it is described, it is perhaps a description of the situation of two-thirds of the journeymen mechanics of this country.

“I have been married nearly three years, and am the father of two children. Having nothing to depend upon but my own industry, you will readily acknowledge that I had reason to look forward with at least some degree of disquietude to the prospect of an increasing family and reduced wages: apparently the inevitable lot of the generality of working men.

“I had apparently nothing left but to let matters take their own course, when your valuable work made its appearance.

“I read it; and a new scene of existence seemed to open before me. I found myself, in this all-important matter, a free agent, and, in a degree, the arbiter of my own destiny. 151I could have said to you as Selim said to Hassan,—‘

My visions of poverty and future distress vanished; the present seemed gilded with new charms, and the future appeared no longer to be dreaded. But you can better imagine, than I describe, the revolution of my feelings.

“I have since endeavored to circulate this book as widely as my limited opportunities permit, and shall continue to do so, believing it to be the most useful work that has made its appearance.”

The next extract, from an inhabitant of Pennsylvania, we have selected chiefly as it furnishes a beautiful, and, alas! a rare, example, of that parental conscientiousness which scruples to impart existence where it cannot also impart the conditions necessary to render that existence happy. In this view, the control in question is indeed all-important. Were such virtue as this cultivated in mankind generally, how soon might the very seeds of disease die out among us, instead of bearing, as now, their poison-fruit from generation to generation! and how far might human beings, in succeeding ages, surpass their forefathers in strength, in health, and in beauty!

This view of the subject is to the physiologist, 152to the philosopher, to every friend of human improvement, a most interesting one. ‘So long,’ to use the words of an eloquent lecturer, ‘as the tainted stream is unhesitatingly transmitted through the channel of nature, from parent to offspring, so long will the text be verified which “visits the sins of the fathers on the children, even to the third and fourth generation.”’ And so long, we would add, will mankind—wise and successful whenever there is question of improving the animal races—be blind in perceiving, and listless in securing, that far nobler object, the physical, and thereby—in a measure—the mental and moral improvement of our own.

Here is the extract which led to these remarks:—

“I was born of poor parents, and early left an orphan. When of age, though my circumstances promised poorly for the support of a family, I desired to marry, knowing that a good wife would greatly add to my happiness. The preventive spoken of in your book presented itself to my mind, and for seven years that I have now been married, it has been used. I was successful in business, and acquired the means of maintaining a family; but still I have been unwilling, because my constitution is such a one as I think a parent ought not to transmit to his offspring. I prefer not 153to give birth to sentient beings, unless I can give them those advantages, physical as well as moral and intellectual, which are essential to human happiness.”

From the letter of an aged French gentleman, who holds a public office in the western country, I translate the following; and I would to heaven that every young man and woman in these United States could read it:

“I have read your work with much interest; and desire that it may have a wide circulation and that its recommendations may be adopted in practice. If you publish another edition, I could wish that you would add a piece of advice of the greatest importance, especially to young married persons. Many women are ignorant, that, in the gratification of the re-productive instinct, the exhaustion to the man is much greater than to the woman; a fact most important to be known, the ignorance of which has caused more than one husband to forfeit his health, nay, his life. Tissot tells us, that the loss by an ounce of semen is equal to that by forty ounces of blood;^[41] and that, in the case of the healthiest man, nature does not demand connexion oftener than once a month.^[42]

154“How many young spouses, loving their husbands tenderly and disinterestedly, if they were but informed of these facts, would watch over and preserve their partners’ healths, instead of exciting them to over-indulgence.”—Another extract.

“A member of the Society of Friends, from the country, called at our office; he informed me that he had been married twenty years, had six children, and would probably have had twice as many, but for the preventive, which he found in every instance efficacious. By this means he made an interval of two or three years between the births of each of his children. Having at last a family of six, his wife earnestly desired to have no more; and on one occasion, when the preventive was neglected to be used, she shed tears at the prospect of again becoming pregnant. He said he knew, in his own neighborhood, several married women who were rendered miserable on account of their continued pregnancy, and would have given anything in the world to escape, but knew not how.”

Our readers may implicitly depend on the 155accuracy of the facts we have stated. Though in the present state of public opinion we may not, for obvious reasons, give names in proof.

That most practical of philosophers, Franklin, interprets chastity to mean, the regulated and strictly temperate satisfaction, without injury to others, of those desires which are natural to all healthy adult beings. In this sense, chastity is the first of virtues, and one most rarely practised, either by young men or by married persons, even when the latter most scrupulously conform to the letter of the law.

It is all important for the welfare of our race, that the re-productive instinct should never be selfishly indulged; never gratified at the expense of the well-being of our companions. A man who, in this matter, will not consult, with scrupulous deference, the slightest wishes of the other sex; a man who will ever put his desires in competition with theirs, and who will prize more highly the pleasure he receives than that he may be capable of bestowing—such a man appears to me, in the essentials of character, a brute. The brutes commonly seek the satisfaction of their propensities with straight-forward selfishness, and never calculate whether their companions are gratified or teased by their importunities. Man cannot assimilate his nature more closely to theirs, than by imitating them in this.

Again. There is no instinct in regard to 156which strict temperance is more essential. All our animal desires have hitherto occupied an undue share of human thoughts; but none more generally than this. The imaginations of the young and the passions of the adult are inflamed by mystery or excited by restraint, and a full half of all the thoughts and intrigues of the world has a direct reference to this single instinct. Even those, who like the Shakers, ‘crucify the flesh,’ are not the less occupied by it in their secret thoughts; as the Shaker writings themselves may afford proof. Neither human institutions nor human prejudices can destroy the instinct. Strange it is, that men should not be content rationally to control, and wisely to regulate it.

SEXUAL WEAKNESS — Symptoms. — Causes. — Treatment. — Regimen.

This complaint, commonly called fluor albus, or whites, to which women are peculiarly subject, must form an important object of attention, since it is always attended with disagreeable symptoms; and, when aggravated, soon spoils the beauty of a fine face, weakens the digestive powers, produces a general bad habit, and occasions sterility.

An irregular discharge from the passage leading to the womb, of a fluid, which, in different women, varies much in colour, being of a white, green, yellow, or brown hue. In the beginning it is, however, most usually white and pellucid, and, in progress of the complaint, acquires the various discolourations and different degrees of acrimony, whence proceed a slight smarting on making water. Besides the discharge, the patient is frequently afflicted with severe and constant pains in the back and loins, indigestion, paleness of the face, chilliness, and languor. In process of time, every symptom becomes highly aggravated, the feet and ankles swell, palpitations, and a difficulty of respiration are experienced, the menstrual discharge is rendered irregular, the urine is turbid, the mind is dejected, and either consumption or 158dropsy supervenes, and terminates a miserable existence.

In some languid habits, the fluor albus returns periodically, instead of the proper menstrual evacuation, until the patient’s constitution is duly invigorated.

It may be produced by any cause which either weakens or irritates the womb and its appendages. It may arise from general debility of the constitution, but it is especially caused by circumstances impairing the power of the womb itself, as, for instance, a severe labour, a miscarriage, or profuse menstruation.

In some instances it appears to depend on a full and irritable habit of body, and, in other cases, of local irritation, such as disorders of the womb, or of the urinary organs, or a collection in the gut, of the small thready worms called ascarides.

Upon the high authority of Dr. Hamilton, this disease is most frequently first brought on by some imprudence in respect to diet and clothing, or exposure to cold or fatigue, or neglect of the bowels about the time when menstruation begins.

In the treatment of this complaint regard must be had to the apparent cause, and to 159the state of the patient. The discharge is too often considered by the sex as the effects of general weakness in their habit, and, therefore, they are led to the indiscriminate use of heating medicines, as port wine, balsam copaibæ, &c., without paying attention to the habit of the body, or cause of the disease.

A milk diet, change of air, and the partial cold bath, as sponging the loins and thighs with cold water every morning, with attention to cleanliness and proper exercise, are often sufficient to arrest the disease, if early adopted.

In addition to this plan of treatment, if the patient be of a full habit, a disposition to fever from slight causes, attended with a sense of heat about the passage to the womb, it will be necessary to have recourse to the lancet, cooling cathartics, and febrifuge medicines, and to inject, several times a day, flax-seed tea or milk and water, into the passage of the womb. In the great majority of cases, the complaint arises from general debility or laxity of the vessels of the parts, and in such cases the indications of cure are to increase the vital heat, promote the digestion, and restrain the preternatural discharge. In order to which, recourse must be had to such of the tonic medicines as will be found to agree best with the patient. Of these, the bark and elixir vitriol, the tonic powders or pills, the rust or tincture of steel, and lime-water have usually been employed, and often with 160good effects. In some instances, however, I have known these medicines to fail, when the nitric acid, diluted, in doses of a wineglassful, three or four times a day, wonderfully succeeded.

Previously to the exhibition of tonic medicines, it is advisable to give a dose of ipecacuanha or antimonial wine. Gentle emetics are supposed to be of singular utility in this complaint, not only by cleansing the stomach and bowels, and making a revulsion of the humors from the inferior part of the body, but likewise by their exciting all the powers of the constitution to a more vigorous action.

The bowels must be kept in a regular state by conjoining a few grains of rhubarb with some of the tonic medicines, or by taking occasionally, at bedtime, one of the aloetic, or aperient or diaphoretic pills; or, in the morning, a teaspoonful of Epsom salts dissolved in a tumbler of water.

If there be a fulness of the stomach after eating, the tincture of rhubarb in small doses will excite digestion. In obstinate cases, it is often expedient to produce a change in the system, by giving a grain or two of calomel, or one of the mercurial pills at bedtime, until the gums become slightly affected, and then the cure may be completed by strengthening medicines, together with the shower bath.

Besides tonics, stimulating medicines, such 161as commonly determine to the urinary passages, have very frequently been employed with great benefit. Of these, rosin in doses of ten grains in the yolk of an egg, or a spoonful of molasses, or balsam copaibæ in doses of a teaspoonful, or tincture of cantharides in doses of twenty or thirty drops in some mucilaginous drink, and taken three or four times a day, will be found most salutary.

These means strike at the cause of the complaint; but if it do not remove the effect very soon, we are not to trust to them alone. For once a morbid secretion being excited, it is very apt to continue, although the exciting cause cease to operate.

On this account, we ought, without delay, to have recourse to astringent injections, such as a strong decoction of red oak bark, with the addition of a little alum or a solution of alum in water. Half an ounce of the former to be dissolved in a bottle of water; which should be thrown into the vagina by means of a female syringe, two or three times a day. The celebrated Dr. Burns says, after many trials, he satisfied himself, that although assistance may be derived from internal medicines and the cold bath, yet the chief dependence is to be placed on astringent applications to the seat of the discharge; and these, where there is no fulness of the general system, nor any affection of the womb 162itself, are perfectly safe, and seldom fail in producing a cure.

It will be prudent, when this disease occurs as an early symptom of pregnancy, not to check the discharge suddenly, lest miscarriage be the consequence; but it may be moderated by injections of water, with the addition of a little vinegar, or an infusion of green tea. Neither should the discharge be suddenly suppressed when it has been of long standing, and acquired a considerable degree of acrimony, with an offensive smell. For if it be unseasonably checked, the belly swells, and a train of the most disagreeable symptoms occurs. In such cases, soap suds, or an infusion of chamomile flowers or hops, should be frequently thrown up the vagina; and, as soon as the blood is freed of its impurities, by suitable medicines, and has recovered, in some measure, its soft and balmy quality of which it has been deprived, the astringent injections may be employed with perfect safety.

The application of a blister to the sacrum, has, in some obstinate cases, been attended with advantage.

When the fluor albus proceeds from worms, purgatives and bitter clysters are the proper remedies.

Pain in the back and loins is often mitigated by the application of a large adhesive or strengthening plaster, and by avoiding a standing posture of long continuance, much 163walking, dancing, or any other violent exertion.

Women should carefully avoid all the remote causes of the disease: they should pay diligent attention to cleanliness, by washing the parts frequently with cold water; and when there are excoriations, milk and water, or lead water, may be employed as a wash.

The diet should be light, cordial, and nourishing, consisting of isinglass dissolved in milk by boiling it, jellies, custards, rice, milk, soft-boiled eggs, gelatinous broths, and light meats, together with a prudent use of genuine wine, particularly claret or port.

Women, affected with this disease, should by no means indulge in the use of tea and other warm slops of a relaxing nature; but should lie on a mattress in preference to a feather bed; and they should rise early, and take such daily exercise as their strength will admit, particularly on horseback. When there is much languor, with chilliness, friction with the flesh-brush, and wearing flannel next the skin, must not be omitted.

FALLING DOWN OF THE WOMB.

MISCARRIAGE OR ABORTION. — Symptoms. — Causes. — Treatment. — Regimen. — Prevention. — When necessary to effect Miscarriage or Artificial Delivery. — Pelvic Deformities. — Premature Artificial Delivery.

We now come to the consideration of a subject, in respect to which there exists much misapprehension and ignorance, causing useless and unnecessary alarm and anxiety to those who may be so unfortunate as to be subject, at particular periods of gestation, to abortion or miscarriage.

The dangers of abortion or miscarriage are often magnified and exaggerated. It is dangerous if produced by a fall, a blow, a kick from a horse, or any other external bodily violence or injury, causing internal contusion, or rupture of some blood-vessels; and, also, but not to the same extent, if produced by sudden fright, violent fits of passion, &c., or from general debility or disease of the uterus; but the danger arises more from the cause which produces the miscarriage, than from the miscarriage itself; as it is well known by those versed in obstetrics that, where it is deemed indispensable to effect a miscarriage, either because of the existence of a deformed pelvis, diseased uterus, or other causes, if skilfully effected, it is attended 169with no danger, especially in the earlier stages of pregnancy.^[43]

When miscarriage is about to take place, its first symptoms are generally occasional stinging pains at the bottom of the belly, extending across and around the loins and hips; a feeling of fatigue of the legs, pain in the forehead, burning sensation of the eyes. The breasts, which before were distended, become soft and flabby, hot and cold flashes, attended with thirst, fever, and shiverings. In a day or two after the appearance of these symptoms, a discharge from the womb takes place of yellow matter, tinctured with red. If not arrested at this stage, the pains across the loins become more severe and frequent, attended with a sense of dead weight, and bearing down about the womb, the water is discharged, and the expulsion of the contents of the womb takes place. The symptoms of miscarriage, however, vary with the causes which produce them, or the state of habit, 170age, or health of the patient; some recovering immediately, and rapidly, and with but little inconvenience. Where miscarriage arises from a serious accident, such as violent falls, bruises, &.c., the symptoms are somewhat aggravated, and more severe, and are often preceded and accompanied with violent and profuse floodings and discharges of coagula, in addition to the other symptoms; although moderate flowing is not an unfrequent symptom in miscarriages.

It is always accompanied with two circumstances, separation of the membranous bag, and expulsive efforts or contraction of the womb itself. The first is productive of discharge, the second of pains like those of labor. Sometimes the separation or detachment of part of the conception takes place before any pain is felt; on other occasions, the pain, or contraction of the womb, takes place first, and produces a separation. In the first of these cases, the symptoms of abortion take place suddenly, and are usually occasioned by fatigue, sudden exertion, or fright. In the second, the pains come on, and there are particular feelings, and changes, which indicate that a miscarriage is likely to take place; as, for instance, the cessation of the morning sickness, the subsidence of the breasts, &c.

Miscarriage is preceded by floodings, pains in the back, loins, and lower part of the abdomen, evacuation of the water, shiverings, 171palpitation of the heart, nausea, anxiety, fainting, subsiding of the breasts and belly, pain in the inside of the thighs, opening and moisture of the womb.

The principal causes of miscarriage are blows or falls; great exertion or fatigue; sudden frights and other violent emotions of the mind; a diet too sparing or too nutritious; the abuse of spirituous liquors; other diseases, particularly fevers and hæmorrhages; likewise excessive bleeding, profuse diarrhœa or colic, particularly from accumulated fæces; immoderate venery, &c.

When a woman is threatened with a miscarriage, there are two objects to attend to; the first is, to prevent it if we can; the second is to manage it so that as little blood as possible be lost; and both these are obtained by the same means. With this view, the patient should immediately, on the first alarm, undress and go to bed, lightly covered, with a firm determination not to rise till the process be either checked or completely over. There should be little fire in the room, though it be winter; and in summer, the windows must be opened. Cloths wet with cold water, should instantly be applied to the lower 172part of the belly, and back: the drink must be cold, and everything stimulating should carefully be avoided.

In robust habits, or when the symptoms have been brought on suddenly by some such cause as a fall or exertion, it is proper to bleed; and, in cases of sickness or great feebleness, to give a dose of laudanum; or, what is better, to administer the anodyne clysters.^[44]

Opiates are useful in every case where we hope to prevent abortion, and must be repeated more often or seldom, according to the effect they produce. They are, however, improper in those cases where miscarriages must decidedly take place. Their tendency to occasion costiveness, when employed, must be obviated by clysters, or some gentle laxative medicine, such as calcined magnesia, 173Epsom salts, or a little castor oil. If there be a continued but trifling discharge, great advantage may be derived from injecting, three or four times a day, up the vagina, a solution of alum. Indeed, in all protracted cases, this is of much benefit. The solution ought to be thrown up pretty high, that it may reach the womb.

When these means produce not the desired effect, and along with the discharge of blood large clots come off attended with bearing down or pains in the back and loins, especially if the symptoms which precede abortion have appeared, there must be every probability that the threatening event cannot be avoided; then we must conduct the patient through the process.

In all cases during the last stage of pregnancy, where our endeavors to stop or repress the hemorrhage prove abortive, it will be advisable to deliver her as soon as possible.

When the whole conception come away at once, the pain and discharge usually go off; but, if only the fœtus come away, all the symptoms either continue and increase till the placenta come away, or, if they be for a time suspended, they are sure to return, except in early miscarriages of ten or twelve weeks pregnancy, when sometimes the fœtus is expelled separately, and the placenta comes immediately after, but the latter frequently remains several days. The most prudent mode in such cases 174is to leave it to nature, which sooner or later expels this foreign body.

After the process is over, if the discharge be profuse, and do not stop on the application of cold water to the lower part of the belly, it will be proper to plug up the vagina, and this is best done by taking a piece of soft sponge, dipping it in sweet oil, and then wringing it gently. This is to be introduced with the finger, portion after portion, until the lower part of the vagina be well filled. The remainder is then to be firmly pressed on the orifice; and held there some time for the effused blood to coagulate. In obstinate cases, previously to the introduction of the plug, we may insert a little pounded ice, or snow tied up in a rag, if to be procured,^[45] but neither of these should be continued so long as to produce pain or much shivering. In addition to this mode of treatment, it will be advisable to have recourse to the astringent medicines, as advised under the head of Immoderate Flow of Menses.

Arrow-root, tapioca, sago, panada, or rice milk, constitute a proper regimen. If the process be protracted, and the strength much impaired, the diet may be more liberal. In 175every case, ripe fruit is safe and useful. The bowels are to be kept regular, and sleep, if necessary, is to be procured by an anodyne.

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 176bath 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]

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.

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 178accident 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 179patient 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 180of 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.

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 181by 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; 183by 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, 184with 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. 185The 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.

TREATMENT AFTER DELIVERY.

NURSING.

INFLAMMATION OF THE BREASTS. — To prevent Inflamed or Broken Breasts.

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, 211milk 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 212to 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 213of 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 214assured 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.

“It is no new or uncertain doctrine, that the quality of the mother’s milk is affected by her own health and conduct, and that in 215its turn it directly affects the health of the nursling. Even medicines given to the parent act upon the child through the medium of the milk; and a sudden fit of anger, or other violent mental emotion, has not unfrequently been observed to change the quality of the fluid so much as to produce purging and gripes in the child. Care and anxiety, in like manner, exert a most pernicious influence, and not only diminish the quantity, but vitiate the quality of the milk.

“It is a common mistake to suppose that, because a woman is nursing, she ought, therefore, to live very fully, and to add an allowance of wine, porter, or other fermented liquor, to her usual diet. The only result of this plan is to cause an unnatural degree of fullness in the system, which places the nurse on the brink of disease, and which of itself frequently puts a stop to, instead of increasing, the secretion of the milk. The health and usefulness of country nurses are often utterly ruined by their transplantation into the families of rich and luxurious employers. Accustomed at home to constant bodily exertion, exposure to the air, and a moderate supply of the plainest food, they live in the enjoyment of the best health, and constitute excellent nurses. But the moment they are transplanted from their proper sphere, their habits and mode of life undergo an unfavourable change. Having no longer any laborious duties to perform or any daily 216exposure to encounter, they become plethoric and indolent; and as they are at the same time too well fed, the digestive functions become impaired, the system speedily participates in the disorder, and the milk, which was at first bland, nourishing, and plentiful, now becomes heating and insufficient, and sometimes even stops altogether.”

Cocoa shells, made precisely like coffee, make a very pleasant and nutritious drink for nursing females.

Weaning.—“Diet for infants after weaning may be pure milk, two parts, water, one part; slightly sweetened. This,” says Combe, “makes the nearest approach to the nature of the mother’s milk, and, therefore, is more suitable than any preparation of milk and flour, or any other that can be given.” A child, as a general rule, one year old, ought to be gradually weaned, and the appearance of the teeth shows the propriety of giving food a little more substantial than milk. Bread a day old, mixed with milk and sweetened, may be given in connexion with nursing. Gruel, arrowroot, plain bread, Indian and rice puddings as they grow older, and subsequently bread and butter, thickened milk, hasty pudding or Indian, potatoes, and vegetables. Not a particle of flesh should ever be given. By the use of meat the system becomes excited, and diseases of irritation are apt to be produced, which impede nutrition, and lead ultimately to the production 217of scrofula and other organic changes in the glands and bowels, and not unfrequently also in the brain and lungs. In these instances the child generally eats heartily, but, nevertheless, continues thin, and is subject to frequent flushing and irregularity of the bowels, headache, and restlessness. His mind partakes of the general irritability of the system, and peevish impatience takes the place of the placid good humour natural to healthy childhood. In this state the ordinary diseases of infancy—measles, scarlet fever, and hooping-cough—are often attended with an unusual and dangerous degree of constitutional disturbance; and when inflammation takes place it is borne with difficulty, and the system does not easily rally; or the digestive organs become irritated, and the various secretions immediately connected with digestion are diminished, especially the biliary secretion. Constipation of the bowels soon follows; congestion of the hepatic and abdominal veins succeeds, and is followed by the train of consequences which have already been detailed. In reality the wonder comes to be, not that so many children die, but that so many survive their early mismanagement. A morbid condition of the system arises, extremely favourable to the production of scrofulous, consumptive, dyspeptic, and other diseases, under which, perhaps, the infant sinks; and yet, strange to state, parents 218will stuff their children with flesh and grease two or three times a day.

Says Combe, “One of the most pernicious habits in which children can be indulged is that of almost incessant eating. Many mothers encourage it from the facility with which, for a time, the offer of ‘something nice’ procures peace. Even from infancy the child ought to be gradually accustomed to eat only when hungry, and when food is really required. After two years of age an interval of four hours between meals, will rarely be more than enough; and to give biscuit, fruit, or bread, in the meantime, is just subtracting from the digestive power of the stomach. Like almost every organ of the body, the stomach requires a period of repose after the labour of digestion; and accordingly, in the healthy state, the sensation of appetite never returns till it has been for some time empty. To give food sooner, therefore, is analogous to making a weary traveller walk on without the refreshment of a halt.”

“When we reflect that the object of digestion is, to furnish materials for the growth of the body, and to supply the waste which the system is constantly undergoing, it must appear self-evident that, if the digestive powers be impaired by disease, by improper quantity or quality of food, or by any other cause, the result must necessarily be the formation of an imperfect chyle, and, consequently, 219of imperfect blood. The elements of the blood are derived from the chyle, and, if it be vitiated, the blood also must suffer: if the blood be diseased, so must necessarily be all the organs which it supplies; and if the body be thus debilitated, can any wonder be felt that it should no longer be able to resist the action of offending causes which full health alone can withstand?”

Clothing.—Infants and children are often injured by improper clothing. It is customary for some nurses to wrap them in such a quantity as to injure their health; moderation in this respect should be observed, due regard being paid to that which is sufficient to render them comfortable. Infants, when first born, have clothing enough almost to smother them.

Medicine.—Another very reprehensible custom is, to pour down some nauseous drug, such as paregoric, Godfrey’s cordial, or some other articles, every time the child begins to cry or is fretful, by which it becomes habituated to the use of opium, and makes it necessary to increase the dose in order to produce the same effect.

Another injurious practice is to give frequently worm lozenges (the basis of which is calomel or mercury) upon any attack of illness, under the impression that the disorder is occasioned by worms. By this imprudent course both the health and life of the child are endangered. Therefore those who wish 220to bring up their children in a healthy condition must avoid these evils, and be content to follow the simple path of nature and common sense.

Few things tend more to the destruction of children than drenching them with drugs. Medicine may be sometimes necessary for children; but that it injures them ten times for once it does them good, I will venture to assert. A nurse or mother, the moment her child seems to ail anything, runs immediately to the doctor or the apothecary, who throws in his powders, pills and potions, till the poor infant is poisoned; when the child might have been restored to perfect health by a change of diet, air, exercise, clothing, or some very easy and simple means.

Care must be taken to keep the bowels regular, which may be effected in most cases by the milk of the mother alone. Most of the complaints in children arise from flatulence or wind; to remove which give common catnip or fennel seed tea, let them drink it freely, and let the mother regulate her diet.

When children complain of pain in the stomach and bowels, it may be necessary sometimes to give a moderate dose of vegetable physic; senna and manna is very good; after the operation of physic let the diet be attended to. Green fruit must be avoided, and whatever is hard of digestion. The feet should be often bathed in warm water, the bowels must be fomented with bitter 221herbs, and it is also necessary to give the child sufficient exercise in the open air.

Bathing should never be neglected, as it contributes much to health. Many complaints of the skin and the system are caused by the neglect of this practice. Filth collects on the surface, obstructs perspiration, which retains morbid humors, and which are thrown upon some of the internal organs and create irritation. Is it not owing to this that infants fret and cry so much? Daily bathe with tepid water; this is also good for galling, chafing, excoriations, &c.

Pure Air and Exercise.—This is very necessary; impure and confined air with the want of exercise, causes disease; and hence children in cities are more pale, feeble, and sickly than those who live in the country and breathe pure air and play in the dirt. Confining children at home, in low, confined, dirty houses, cellars, and in school-rooms, is pernicious; also crowding too many in sleeping-rooms. When children are confined in small apartments, the air not only becomes unwholesome, but the heat relaxes their solids, renders them delicate, and disposes them to colds and many other disorders. Nor is the custom of wrapping them too close in cradles less pernicious. One would think that nurses were afraid lest children should suffer by breathing free air, as many of them actually cover the child’s face while asleep, and others wrap a covering over the whole cradle, 222by which means the child is forced to breathe the same air over and over all the time it sleeps. Children, therefore, must have as much exercise and air as possible, and should be employed in something useful and interesting.

Again; “The premature exertion of intellect to which the mind is stimulated at our schools, by the constant emulation and vanity, far from strengthening, tends to impair the health and tone of the brain, and of all the organs depending on it; and hence we rarely perceive the genius of the school manifesting in future years any of the superiority which attracted attention in early life.”

BARRENNESS. — Causes. — Treatment.

Sterility proceeds from either a temporary or permanent incapability of conceiving or retaining the embryo, till it acquires a form. The causes producing this incapability, may consist in some malformation or deficiency of the womb, or its appendages, which cannot always be discovered during life, or in merely a weakness in the action of the womb. This last is by far the most frequent cause, and it is occasioned by local weakness of the womb, or general affections of the whole system; and is marked usually by an obstruction, deficiency, or redundancy of the menstrual evacuation, or by the complaint termed female weakness.

It may be considered as highly probable, that the absence of the capacity to be impregnated, will sometimes depend upon the imperfect condition of either the uterus itself or of the ovaries. If the former, it may consist in some derangement of the secreting surface of this organ; for, though there may be a regular discharge of a colored fluid, and this so nearly resembling the perfect secretion as to deceive the senses, it may yet want an essential condition or quality, and 224thus entail barrenness—hence, all women are not fruitful who may have a regular catamenial discharge; though, as far as can be determined by appearances, this discharge is every way healthy, and at the same time, the ovaries free from fault.

If it depend upon an imperfection of the ovaria, it may not, perhaps, admit of relief. The diseases of the ovaria may consist, 1st, in their imperfect development; 2dly, in derangement of structure; 3dly, in a want of a healthy organization of the ova themselves. Now, either of these conditions of the ovaria may be so complete as to altogether destroy their influence upon the secreting surface of the uterus; the catamenial discharge may, therefore, continue, with all due regularity, and yet the woman may be barren; and, hence, this discharge cannot be considered, rigidly, as a constant sign of fertility.

Yet it may be safely admitted, as a general rule, that women who menstruate regularly without pain, or the expulsion of coagula, or false membrane, are fecund; and that the reverse of these conditions is almost sure to be attended with sterility. It may also be observed, that we cannot attach much consequence to the quantity evacuated; for the woman who may evacuate double the quantity of another, is not for this reason more certainly prolific. I have known a number of instances of repeated impregnations, where, 225as far as could be ascertained, not more than two ounces were habitually evacuated; and this not occupying more than a day and a half, or two days, for its elimination: while, on the contrary, I have known women who were barren, discharge three or four times this quantity; and the fluid bear all the sensible marks of a healthy secretion. From this it would appear, that mere regularity in returns, the elimination of a proper quantity of fluid, and this fluid apparently of a healthy character, do not always declare the woman to be fecund. Yet, when the woman has never menstruated, or when this discharge has altogether ceased, agreeably to the ordinary arrangement of nature, or from disease, she either never becomes impregnated, or ceases to become so, if she ever have been.

We proceed on the principle of rectifying the constitution, where it is injured or weak, and of restoring the menstrual evacuation, to its due and healthy state. The means for effecting these purposes, must depend on the situation of the individual.

There are chiefly two states of the constitution productive of those deviations in the action of the womb, which cause barrenness. The first is a state of fulness, and a disposition to obesity.

The person gradually becomes fat and inactive, the menstrual evacuation continues 226regular for some time; but at last diminishes, and becomes obstructed, or goes to the opposite extreme, and becomes frequent or profuse. The patient is either barren or subject to false conceptions. This state is to be rectified by spare or vegetable diet, total abstinence from malt liquor, regular and constant exercise, especially early in the mornings and on horseback, the prudent use of laxatives, and after some time the cold bath. These means will, if persisted in prudently, effect the desired changes; but if pushed to an undue degree, and especially if repeated purgatives, and much vinegar, or great abstinence be resorted to, the health may be completely ruined.

The second state is that of relaxation; the habit is spare, instead of corpulent; the mind lively, and, perhaps, even irritable; the menstrual evacuation either profuse, or it recurs too frequently, and at times clots and shreds are discharged.

This requires a different treatment: the diet, if not unusually nutritive, is at least not to be sparing, the exercise must not be carried the length of fatigue, the cold bath is useful, and strengthening medicines are required.

Such remedies as have been pointed out for the removal of irregularities of the menstrual evacuations, or of the fluor albus, must be employed when necessary.

There are also certain diseases of the female 227genital organs, which, when they exist, are found to cause sterility. Polypus in utero is very generally considered to belong to this class; but although the opinion is generally correct, it is not universally true, for it has happened that conception took place notwithstanding the presence of a very large tumor in the uterus. Of this the late Dr. Beatty (Trans. of the Association of Coll. of Phys. in Ireland, vol. 4) has described a very remarkable instance, which occurred in Dublin in the year 1820. The patient was a lady twenty-five years old, who, in consequence of the indisposition of her husband, had left his bed in May, 1819, to which she did not return until August, 1820. In the previous May she first perceived what she termed a “lump in her womb,” attended with external swelling and soreness on pressure at the lower part of the abdomen. This swelling was not permanent, but was observed to disappear during the menstrual period. Finding an increase in her unpleasant symptoms, she applied to Dr. Beatty in September, and on the 28th of that month he made an examination per vaginam. The os uteri was found dilated to the size of a dollar, and in its opening was a large dense substance with a regular smooth surface. On the 10th of November, while out in her carriage, she had a moderate discharge of blood from the vagina, and upon examination the parts were found as they were a month before. At two o’clock 228the following morning she miscarried, the embryo was entire, the membranes not being ruptured: the contained fœtus was about three months old—a period corresponding with the time at which the connubial intercourse had been resumed, and at which she had last menstruated; and just three months after she first experienced uterine uneasiness. The tumor was expelled in six days afterwards by pains resembling labor, the uterus was inverted by its descent, but on separation of the slight attachment between it and the tumor it was easily reduced. The weight of the tumor was found to be nearly four pounds. This lady was delivered of a healthy boy on the 10th of February, 1822. This was an instance of pregnancy during the existence of a tumor of considerable magnitude in the uterus; but we believe it to be an exception to what usually takes place.

Inflammation, suppuration, calculous depositions, cancer, cauliflower excrescence, corroding ulcer, the irritable uterus of Dr. Gooch, and any disease in which the texture of the uterus is much engaged, or with which the constitution sympathizes strongly, are so many obstacles to impregnation, as are diseases of the ovaria, in which the natural structure of these organs is obliterated, and both of them engaged. Leucorrhœa, when profuse, is very often also attended by barrenness; but this is by no means a constant effect, as we have known instances in which 229this disease existed to a great extent without preventing impregnation.

A question has arisen whether menstruation is necessary in order that a woman shall be prolific; and it is generally stated that women who do not menstruate cannot conceive. (Paris and Fonblanque, Med. Jur. vol. i., p. 214.) This is true when applied to those who have never menstruated, but is not in cases that have had even a single monthly discharge. Foderé (Méd. Légale, vol. i., p. 397, ed. 2me) states that, in the first edition of his work, he had maintained that females who do not menstruate are sterile: but he afterwards was obliged to change his opinion, from having observed some patients under his own care enjoying good health without this evacuation, and bearing many children. One of them was a woman thirty-five years old, the mother of five children, the last of which she was suckling. She was in good robust health, and had never menstruated but once at the age of seventeen years. It would appear that a single occurrence of this periodical evacuation is a sufficient indication of generative power; and although irregularity in subsequent years is frequently attended by sterility, it is not to be taken as an absolute cause of it. There is a form of dysmenorrhœa described by Dr. Denman (Denman’s Midwifery, 6th edit., p. 90), and Dr. Dewees (Dewees’ Midwifery, p. 154) of Philadelphia, which both these authors state to be productive 230of barrenness. The striking peculiarity in this disease is the formation of an adventitious membrane in the uterus, which is expelled after severe and protracted suffering at each menstrual period. This membrane is sometimes thrown off in pieces, and at others entire, at which time it bears the strongest resemblance to the decidua, so much so that, when it occurs in unmarried females, it may and sometimes does give rise to most painful suspicions. There is a preparation in the museum of the College of Surgeons, Dublin, of an entire membrane of this kind, which might deceive the most experienced eye. Morgagni relates a very remarkable instance in which pregnancy occurred during the existence of the habit just described, but it is probable that there was a suspension of the disease for a time in that case, when the capability of conceiving might exist.

It is well known that instances have happened in which persons have lived for years in unfruitful matrimony, and being after divorce remarried, have both had children. This is a fact which in the present state of our knowledge we are not able satisfactorily to explain, and we will not delay the reader by offering any speculative opinion upon it.

The treatment of impotence and sterility must be influenced by the causes from which they spring, some of which are incurable, 231whilst others may be removed by appropriate remedies. Those cases which depend upon congenital deficiency of the penis, testicles, vagina, uterus, Fallopian tubes, or ovaria, belong to the former; but we have seen that some of those arising from malformation and disease of these parts are susceptible of cure. Such are phimosis, adhesion of the prepuce to the glands with diminution of the orifice of the urethra, priapism, partial paralysis, strictures in the urethra, diseases of the neighbouring parts, contracted vagina, occlusion of the mouth of this canal by adhesion of the labia, or by a dense hymen, prolapsus and procidentia uteri, polypus in utero, leucorrhœa, dysmenorrhœa: all these are more or less capable of removal either by operation or general treatment.

By persisting carefully in a proper plan, sterility may at length be frequently removed. There are many instances of women bearing children, after having been several years barren.

Various remedies have been recommended for the cure of barrenness, among which tincture of cantharides is the most prominent, but its effects being evanescent, are invariably succeeded by lassitude and debility, and therefore can be attended with no good results. The various preparations of sassafras and sarsaparilla are useless and not in the least calculated to reach the nature of the case. The specific known as the most successful 232in curing sterility or barrenness—and it has certainly performed wonderful cures—is the celebrated Morand’s preparation, called “Morand’s Elixir,” which appears to be specially adapted to give tone and healthiness to the generative functions, for the discovery of which, he received a handsome donation from the French government, as also frequently rewarded by the liberality of private individuals, who have realized their fond wishes by his discovery.

Its effects, it is said, are so wonderful upon the general health, and particularly upon the generative functions, that a medical writer of some note says that he has recommended its use in several instances, and, with one single exception (a case of malformation), with invariable success. He says:

“I was acquainted with a very worthy married couple whose life was, if not embittered, at least unhappy, because of their having no offspring. They were of respectable and influential standing, possessed of property, surrounded by friends and relatives, were then married nearly ten years, and desirous only of having children to make them happy. Physicians were consulted without success, because physicians mostly look upon sterility as incurable.

“About this time I visited a patient who had been married about seven years without having children, who was affected with fluor albus (whites), and was using ‘Morand’s 233Elixir,’ by my recommendation, to eradicate this weakening complaint from the system. This lady having been married seven years, as I before observed, without offspring, had nearly resigned herself to a conviction that she was destined to have none. In recommending ‘Morand’s Elixir,’ I had the fullest confidence that it would accomplish a thorough cure of her complaint, because I had often used it in my practice, and with invariable success, but I had neither hope nor expectation of its ability to remove what I then considered confirmed sterility, or barrenness, as I then gave no credence to the various marvellous properties it was alleged to possess, classing it merely among the impositions of the day. The lady continued its use, and I found her health evidently and perceptibly improve. The fluor albus entirely disappeared and her health was restored. Under pretence that she derived great benefit from it she still continued its use, however, and to my utter surprise, as well as the great joy of her husband, four months after she commenced its use, she became pregnant, and in due time was delivered of a fine, fat, healthy daughter, and had two more children in close succession after.^[49]

234“The lady being of the most pure and irreproachable character, it may well be supposed that it gave me the greatest confidence in recommending this truly wonderful ‘Elixir,’ in like cases. When, therefore, I was consulted by the husband of the lady first mentioned, I did not hesitate to recommend ‘Morand’s Elixir,’ and informing him of its effect in the case described. My advice was followed. In due course of time this worthy couple had their fondest wishes realized. Since which time they also have had several children. Their gratitude to me for recommending its use, was unbounded. My confidence in the virtues of ‘Morand’s Elixir,’ was confirmed, and I have heard of its success in other instances. Indeed, I am convinced, that if the case is curable, ‘Morand’s Elixir’ is infallible.”

It has attained a pre-eminent celebrity in France, Germany, on the continent of Europe generally, as well as in England, for its unexampled success in removing general debility, weakness, physical imbecility and supposed barrenness (for judging from the astonishing results of ‘Morand’s Elixir,’ it is denied that it really exists). The truly wonderful effect of the “Morand’s Elixir,” has now established the fact that most, if not all, supposed natural incurable defects, are only artificial ones, within the powers of the skill and scientific combination of the virtues and essences of the most nourishing, strengthening and invigorating 235fruits and plants of Italy to remove. Its action is not sudden and ephemeral, leaving the system but the more debilitated by reason of the previous unnatural excitement, but is gentle and gradual, by degrees displacing the latent causes affecting the body, strengthening and invigorating the generative functions, cheering the mind, enlivening the spirits, engendering a free, full and healthy circulation, and thus arousing the sexual feelings.

Great and surprising as are the results of the skilful and scientific combination in the composition of “Morand’s Elixir,” it is not idly pretended that without any reference to the circumstances of each individual case of supposed barrenness, it will, unaided and unassisted, in a few weeks, remove deep seated and obstinate cases of unfruitfulness—causes which had been growing, strengthening and fastening for years. Far from it. The absurdity of such pretence is manifest on the face of it. Assistants, in many instances, must be resorted to for successful treatment, in respect to diet, clothing, occupation, &c. Instant and immediate relief is neither to be expected nor practicable; and even if practicable would lead to the most injurious results, aggravating instead of relieving. A remedy, therefore, to be permanent, must be gradual to an almost imperceptible degree, slowly but surely removing the stagnant humors and impure secretions, by the searching 236and penetrating virtues of the “Elixir,” systematically purging the system of those dormant and inactive particles, which frustrate the action of the generative functions, and thus dislodging the cause of unfruitfulness. It may take some time ere this is accomplished; but, by a proper perseverance in the course marked out, success, sooner or later, is inevitable. Thousands who had imagined themselves irretrievably doomed to descend to the grave unpitied and unmourned by interesting and affectionate children have, by the use of “Morand’s Elixir,” been blessed with offspring to love and adore in infancy and youth, and to look to for comfort and solace in old age.

In all cases of incontinence of urine, fluor albus, gleet, painful and difficult menstruation, incipient stages of consumption, languor, debility, night sweats and wakefulness, it is surprisingly efficient and certain. Its chief and great celebrity, however, in eradicating every symptom of that state of the functions superinducing barrenness or sterility, is too well established to require comment. Indeed, such has been its success, as to make it doubtful that what is usually termed barrenness in fact exists, since by the use of this wonderful remedy, properly persevered in, a cure has in all cases been effected, and what had been supposed incurable natural defects proved to be only some deranged state of the functions.

As there are many who pine and grieve 237for children—who feel desolate and lonely without the enlivening and cheering influence of children around the domestic hearth, the author does not deem it inappropriate or out of place to present this celebrated specific for the consideration of those to whom it might prove a great blessing. He has taken its Agency for the United States, at his Office, 129 Liberty street. Letters must be postpaid and addressed to Box “1224,” New York City.

CONCLUDING REMARKS.