2. Menorrhagia, or an immoderate flow of the menses. · Part 4

In the first place, then, it is always advisable in labor that you call your medical attendant early. If it is worth your while to have aid at all, it is best to have it in good season. The physician himself always prefers to be called early.

Once you have fixed upon your medical attendant, resolve to be guided by him in every particular, and follow his directions faithfully. If you have, from necessity or otherwise, chosen a _man_-midwife, you need have none of those foolish whims which some among the so-called reformers of the present day would have you to believe.

It is always an unpleasant duty for one to attend a woman in childbed; and be assured that, of all places in the world, a delivery is the last one in which lascivious or lustful excitement is experienced. I wish you, then, one and all, to remember that if it is unpleasant for _you_ to be attended by a man under such circumstances, it is equally so to _him_. If he is a conscientious and benevolent physician, he will cheerfully do that which he considers his duty to do; but as far as his own personal self is concerned, he would much rather be at home, enjoying its quiet and its sleep, if need be.

In regard to your preparation for labor, I will suppose that you have done all in your power to maintain an equable and healthful state of both mind and body, and that you are resigned to encounter whatever God in His mercy may see fit to bring upon you. If you have done all that you could for yourself, and are still willing and determined to do so, surely you should feel contented; you can do no more.

_The Room._—As to the apartment in which you are to be confined, you should take the best one in the house. If possible, you should have one which is well lighted and aired, and which can be readily warmed, if there is need of raising the temperature. If it is in a city, a back room should be preferred in preference to one in front, on account of the noise of the street.

If the labor is to be a tedious one, it is particularly necessary that the air of the apartment be kept as pure as possible. Not only should the strictest attention be paid to ventilation, but all odors and perfumes should be dispensed with. These do no good, for mere _hiding_ the bad air is not _destroying_ it, and they always do more or less harm.

There should not be too many persons in the room when the woman is to be confined. In the country it is by far too much the fashion for a large company of women to get together on such occasions. This always renders the air of the apartment more foul than it otherwise would be, and for other reasons it ought not to be permitted.

I have many a time pitied the condition of women whom I have attended, who had but one room to live in, cook, wash, iron, and at last to be confined in; and yet those women have in general got along better than such as live in a more sumptuous way. Such women are, in fact, _workers_, and employment, as I have before remarked, is a most blessed thing in regard to preparing the system for the important function of labor.

_The Bowels._—If the bowels should be constipated at the time when labor is about to come on—and such is likely to be the case—the woman should use clysters freely. This practice is, in fact, advisable in all cases, inasmuch as it can do no harm. If there is fecal matter in the colon, it is better that it be removed before the birth is about to take place. Hardened excrementitious matters in the lower bowel are always a hindrance to labor.

_The Dress._—Formerly it was considered a matter of importance as to how a woman was dressed in labor. Different countries and provinces had their particular forms of gowns, jackets, chemises, and head-dresses. The great thing, however, to be observed, is simplicity; that is, nothing should be worn which at all interferes with the body in any of its functions or parts. If the dress is such as causes no constriction of the abdomen, the chest, or the neck, such as gives free motion to the limbs, and is of such material that it makes the body neither too hot nor too cold, it is all that is required. Generally too much clothing is worn at the time of labor. It is safer to be on the side of too great coolness than of the opposite extreme.

_The Bed._—This has been called by different names; the _lying-in bed_, _bed of labor_, _bed of pain_, _bed of misery_, _little bed_, etc.

Some women will not make use of any sort of couch whatever. I know a lady in this city who has borne a pretty large family of children, who affirms that she gets along much better upon her hands and knees on the floor than in any other way. Some are delivered standing up, the elbows resting on some object, as the mantle-piece, bureau, the back of a chair, or some other piece of furniture, or perhaps upon the shoulders of a friend. “A strong and well-formed woman,” says Velpeau, “may be delivered in any posture, on a chair, on the floor, a bundle of straw, on foot, and on all the kinds of beds that have been proposed; so that it is only in the cases where nothing interferes with the accoucheur’s doing just what he thinks best, that he ought to attach some value to the composition of the lying-in bed; further, the only essential matter is, that the woman should lie as comfortable as possible, that she should not be incommoded, neither during the pains nor the intervals between them, and that the perineum may have room to dilate.”

Oftener than otherwise in this country, the woman is delivered on the same bed on which she sleeps. Sometimes, also, a cot is used, which also is a very convenient contrivance, since it allows of the free passing of the physician and others about it. It is, likewise, a healthful plan to move from one bed to another after labor; but this is by no means strictly necessary. Cleanliness, comfort, and good air—these are the great requisites in regard to the bed.

_The Position._—If the patient is to lie upon a bed, which is doubtless the preferable plan in the majority of cases, what shall be her position?

This, like many other things, is a matter somewhat of fashion. In Great Britain the woman is always placed upon the left side, with the thighs flexed, that is drawn up toward the body, and the hips brought close to the right side of the bed. The same position is usually adopted in this country; but on the Continent, the woman is placed on her back to be delivered. This, I am inclined to think, is the most favorable, as well as most agreeable position, although perhaps not the most convenient for the medical attendant.

_Exercise._—During a considerable portion of an ordinary labor, it is doubtless better for the patient, especially if she feel inclined to it, to sit up, and walk about a little from time to time. This not only affords some relief, but likewise aids in causing more efficient contraction of the uterus.

_Food and Drink._—It would always be better, so far as food is concerned, for the patient to fast a meal or two before labor comes on. She should, however, be allowed all the drink she desires, pure soft water being the best she can have. If she drink pretty freely, it will be of essential service to her in keeping off feverishness, and in helping the renal organs to act properly. If the pains are tardy, taking now and then a drink of cold water, even against the inclination, will help on the pains. Even ice is used with good effect for this purpose.

LETTER XXVIII. MANAGEMENT AFTER DELIVERY.

Importance of Attention to this Period—Evils of too much Company—Bathing—The Bandages, Compresses, etc.—Sleep—Sitting up soon after the Birth—Walking about—The Food and Drink.

Supposing that the mother has been safely delivered, the child separated, and the after-birth cast off, what advice have we to give in regard to her recovery?

I have before remarked that the birth of the secundines is the most dangerous part of labor, although not the most painful. I have now to remark, that the _real_ danger in midwifery does not commence until after the whole birth is completed. Childbed fever, inflammation and abscess of the breasts, these are the sad mishaps which we have to fear in these circumstances, and for which I feel an anxious solicitude in your behalf.

You may think me strange when I inform you, that I have had more trouble in the practice of midwifery from the one circumstance of the woman having too much mental excitement within a few days after delivery, than from all other things combined. I am sure I am not mistaken when I assert that I have known more accidents and mishaps to occur from this one cause of seeing company too soon after the birth, than from all other causes put together. So important do I consider it for you to keep, as it were, quiet in this respect, I should think my labor in writing these letters a hundred-fold rewarded, if I could be successful in warning you of the danger of over-excitement at the time when you are getting up from confinement. As the most important advice, then, which I can give in regard to all the subjects connected with midwifery, DO NOT ALLOW YOURSELF TO SEE COMPANY FOR MANY DAYS AFTER THE BIRTH.

“Most of the diseases which affect a woman in childbed,” says the great Velpeau, “may be attributed to the thousands of visits of friends, neighbors, or acquaintances, or the ceremony with which she is too often oppressed; she wishes to keep up the conversation; her mind becomes excited, the fruit of which is headache and agitation; the slightest indiscreet word worries her; the slightest emotions of joy agitate her in the extreme; the least opposition instantly makes her uneasy, and I can affirm, that among the numerous cases of peritonitis met with at the _Hospital de Perfectionnement_, there are very few whose origin is unconnected with some moral commotion.”

Is it not possible to change the fashion in regard to this matter? This remains wholly with yourselves; for we of the masculine gender have nothing to do with it. Are you not all sisters? Why, then, be offended with each other if you do not go to see the sick woman for a whole month after her child is born. Could you not write her now and then a friendly note, or send her some little delicacy to eat, which would be evidence enough that you had not forgotten her? I am aware there are among your sex a certain set of gossiping idlers, who do not know how to kill time in any better way than to be gadding abroad when they are least needed. If one is really sick and needs aid, they are the last persons in the world to leave their homes; they are good for nothing among the sick. To such women I care to say but little, for I consider the task of reforming them a very hopeless one, as all experience proves. Especially where a new method of treatment, as, for example, the water-cure, is practiced, do these twattlers gad about, making mischief wherever they go.

_Bathing._—It is no new thing for a woman to be bathed, and that in cold water, soon after delivery. It was practiced among the Romans, and, as we have seen in another part of these letters, is still the custom among several of the savage nations.

I need not remind you, however, that this practice has, for a long time at least, found no place among the more enlightened portions of our race; that instead of cold water being regarded as a most estimable remedy in childbirth, it has been considered as a very dangerous agent, which, in truth, it is when improperly administered. Many of you can but too easily call to mind the old notions which were instilled into your minds on this subject; notions which you now know to be not only erroneous, but sadly mischievous when carried out in practice.

More than ten years ago, and while I was yet a student in medicine, and had never heard of the water-cure as practiced by the great Priessnitz, I was in the habit of revolving these matters in my mind. It occurred to me often, that if the Roman women, and the Indian women of different nations, could reap so great a benefit as appeared to be derived from ablutions performed soon after childbirth, that our own females too, weakly although they are many of them, could gain similar advantages from pursuing a like course. It was thus that I was led, as far back as 1843, to strike out a course of treatment for myself in these cases, having no medical authority or precedent to go by. The result of this treatment is now, fortunately, getting to be pretty well understood, and the merits of the new method appreciated in almost all parts of our country. In Europe they are altogether behind us in the improvement to which I allude.

I need not here go into any lengthy details concerning the methods of bathing that are proper to be adopted in the parturient state. The numerous cases which I have given will serve as a sufficient guide, I trust, to all of you who are concerned. I may remark, however, in general terms, that there is no need of doing any violence in the way of a bath; and those who have not access to the personal advice and superintendence of a physician who understands the practice, may always act safely by washing the patient in her bed. Thus, if a blanket or some other extra article is placed beneath her, she may easily be washed over the whole surface, piecemeal, a practice which, though it is neither so thorough nor useful in most cases, as it would be to go at once into the tub, is yet a good one, and productive of great comfort.

_The Binder, Compresses, etc._—As to the use of the wet bandage, the compresses, etc., a few words will here be in place. If a dry bandage is ever needed as a support, the wet one is much to be preferred to it. As a general thing, however, we put no bandage upon the woman soon after the birth, as will be seen by reference to the cases given in this work; we wish to change and rewet the application frequently, and for this reason the simple compresses are the most convenient. But when the patient is to sit up or walk about, the wet girdle, if properly arranged with tapes to secure it, and made pretty tight at the lower part of the abdomen, affords a good deal of support. The wet bandage does not slip upward and get out of place near so readily as the dry one.

It will naturally occur to you, whether the going without the old-fashioned belly-bandage will not be likely to prove injurious to the woman’s form. The sum and substance of this whole matter is just this: whatever tends to weaken the constitution in general, and the abdominal muscles in particular, must have a tendency to produce laxity of the fibers, thus rendering the part more pendulous. On the other hand, whatever tends to strengthen the system and to give tone to its fibers, must have a contrary effect. Now, the dry belly-band, even when it is so arranged as to keep its place—which it generally is not—is too apt to become heating, and, of course, a source of debility under such circumstances. For this reason it is plain that a cold wet girdle is altogether better than a dry one. Nor should this even be left on too long a time without changing and rewetting it. This should be done, as a general thing, every three or four hours at farthest, and in warm weather oftener.

_The Repose._—Some have feared to allow the woman to go to sleep for some hours after delivery, fearing that she might be taken in hemorrhage as a consequence. It is possible that a patient under such circumstances may wake suddenly with a flooding upon her, particularly if she be too warmly covered up in bed. But by all of the best authorities it is regarded that the sooner the woman sleeps after she has passed through the agony of labor the better. Sleep is, indeed, no less “nature’s sweet restorer” under such circumstances than at other times; and it would be most cruel to deny a patient this privilege, when it would be so grateful and refreshing to her.

_Sitting up soon after the Birth._—I have proved satisfactorily to myself, that there is great error abroad in this country generally in regard to the parturient woman rising soon after the labor is past. It appears to be the belief of physicians generally in this country, that it is highly dangerous for a woman to sit up before some days after accouchement. The common saying concerning the ninth day you have all of you heard.

Velpeau, of Paris, who is higher authority by far than any old-school man in this country, says: “After this first sleep—that is to say, after the lapse of two or three hours—the patient should sit up in bed, and take a little broth; _this position seems to rest her, and allows the lochia which had accumulated in the vagina to flow readily off_.” That is the point: it serves to REST her; that is, when a woman is tired of lying down, both common sense and instinct declare that she should change her position; in other words, sit up. This very same thing I have taught strenuously for these seven or eight years, as many of you know; and just now, while I am writing, I find that Velpeau long ago recommended the same thing.

_Walking About._—Precisely the same principle holds good in regard to walking and all other modes of exercise as in sitting up. A little and often should be the rule. The cases which I shall give you will form a sufficient guide on this point.

I have known a great many more persons to be injured by inactivity, remaining too much in bed and in overheated rooms, than by walking about too much and too soon.

_The Food and Drink._—I have but a word here to say on this subject. The patient should begin directly after birth with the same kinds of food and drink which she intends to use during the period of nursing. If she is to eat fruit, which I consider good for her, she should take it from the first. Prudence should, of course, be exercised in regard to _quantity_ as well as quality of food under these circumstances.

One of the greatest and most common errors in regard to the diet soon after labor, is that of partaking of articles which are of too fine and concentrated a nature. The bowels tend naturally to sluggishness for some days after confinement; hence the diet should be of an opening nature, such as brown bread, cracked-wheat mush, good fruit in its season, and good vegetables. It is a poor practice to keep the patient for nine days on tea, superfine bread, toast and butter, and the like articles. It is no wonder that women dieted in this way become constipated, nervous, low-spirited, and feverish.

LETTER XXIX. MANAGEMENT OF THE CHILD.

Of Separating the Umbilical Cord—Practices of different Nations—Of Still-Birth, and Resuscitation of the Child—Washing and Dressing it.

It was necessary, in describing the three stages of labor, to pass over for the time an important matter, namely, that which relates to our attention to the umbilical cord. In treating of this subject, it will be necessary for me to repeat some things which I have said in another volume, a “Treatise on the Management and Diseases of Children.”

Soon after the birth of the child, separating the umbilical cord requires our attention. How shall this be done? Shall we use a sharp or a dull instrument in making the division? Shall we apply a ligature? where, and in what manner to the cord?

It is reported of the aborigines of Brazil, that they merely bite or chew off the cord, as many of the animal tribes are found to do. This is imitating nature closely enough, certainly, and more so, perhaps, than the usages of civilized society would warrant us in doing at the present day.

Dr. William Hunter, in 1752, remarked in his manuscript lectures concerning the method which the instinct of animals leads them to adopt, as follows:

“I will give you an idea of their method of procedure, by describing what I saw in a little she dog of Mr. Douglass’. The pains came on, the membranes were protruded; in a pain or two more they burst, and the puppy followed. You cannot imagine with what eagerness the mother lapped up the waters, and then taking hold of the membranes with her teeth, drew out the secundines; these she devoured also, licking the little puppy as dry as she could. As soon as she had done, I took it up, and saw the navel-string much bruised and lacerated. However, a second labor coming on, I watched more narrowly, and as soon as the little creature was come into the world, I cut the navel-string, and the arteries immediately spouted out profusely. Fearing the poor thing would die, I held the cord to its mother, who, drawing it several times through her mouth, bruised and lacerated it, after which it bled no more.”

This chewing, bruising, or tearing a part in which blood-vessels exist, causes them to contract in such a way as to prevent the occurrence of hemorrhage. This fact we see exemplified in cases where an arm or other limb is torn off with machinery, in which it is found that no bleeding of consequence takes place. But if a limb is severed with a sharp-cutting instrument, the arteries must be secured.

The New Zealanders, I am informed by a medical friend who spent some time among that people, cut, or rather tear off the umbilical cord with the edge of a shell, something like that of the clam or oyster of our own country.

It matters little, however, what instrument or material is used to effect the object in question. The cord being immediately after birth a dead substance, possessing no sensibility whatever, we may bite it off, or we may use a shell, a sharp knife, or a pair of good scissors or shears, whichever method we choose, remembering always that it is of little consequence how we do it, and that it is as natural, precisely, for a man to exercise his ingenuity in making and using a convenient instrument as it is for a brute to use his teeth.

In the time of Hippocrates, it was not customary to divide the umbilical cord previously to the expulsion of the placenta. If this was slow in coming away, the child was placed upon a pile of wool, or on a leather bottle with a small hole in it, so that by the gradual subsidence of the skin or pile of wool, the weight of the child might draw almost by insensible degrees upon the placenta. In this way it was extracted without violence.

In modern times, it has been almost universally the custom to separate the child very soon after delivery, and before the after-birth has come away. “As soon as the child cries lustily, proceed at once to separate the cord,” is the common doctrine among medical practitioners. But it is better, evidently, to wait, before this is done, until all pulsation has ceased in the cord. If we take the cord between the thumb and finger, we readily ascertain when its pulsation has ceased. It has a large vein in it for the transmission of blood from the mother to the child, and two small arteries, which return the impure or worn-out blood after it has gone the rounds of the fetal circulation. Blood is the only nourishment the child has while it is in the mother’s womb. Hence it would be manifestly improper to rob the child of any portion of the fluid coming from the mother to it.

The ancients not only waited for the expulsion of the after-birth before tying the cord, but if the child was at all feeble or dead at birth, the placenta, when expelled, was laid upon its belly as a comforting and restoring application. This practice, singular as it may appear to us in modern times, is not altogether without its philosophy; the mild, genial warmth of the after-birth was supposed to act favorably on the feeble powers of life, if such existed, or if it was dead, it was supposed the infant might thus be recovered.

Speaking of later methods, Dr. Denman observes: “It has been the practice to divide the funis (cord) immediately after the birth of the child; and the weaker this was, the more expedition it was thought necessary to use; for the child being supposed to be in a state similar to that of an apoplectic patient, a certain portion of blood might, by this means, be discharged from the divided funis, and the imminent danger instantly removed. There is another method which I have seen practiced, the very reverse of the preceding; for in this the loss of any quantity of blood being considered as injurious, the navel-string was not divided, but the blood contained in its vessels was repeatedly stroked from the placenta toward the body of the child. In all these different methods, and many others founded on caprice, or on directly contrary principles, children have been treated in different times and countries, and yet they have generally done well; the operations of nature being very stubborn, and, happily, admitting of considerable deviation and interruption, without the prevention of her ends.”

“There is yet, in all things,” continues this author, “a perfectly right as well as a wrong method; and, though the advantage or disadvantage of either may be overlooked, the propriety and advantage of the right method must be evidently proved by individual cases, and of course by the general result of practice. In this, as well as in many other points, we have been too fond of interfering with art, and have consigned too little to nature, as if the human race had been destined to wretchedness and disaster, from the moment of birth, beyond the allotment of other creatures.”

It is the testimony of this author, however, that some children, after they had began to breathe, had respiration checked, and died after the cord was divided in consequence, this having been done too soon. Beyond a doubt, many children have been destroyed in this way, and in this, as in many other things in the healing art, medical men have been too much in the habit of interfering with nature, and thwarting her in her operations.

It is the order of nature, and moreover a truly wonderful phenomenon, that in proportion as respiration becomes established in the new-born child, the pulsation in the umbilical cord begins to cease, first at the placenta, and so gradually onward to the child; physiologists are puzzled to explain the circumstance, but the fact is plain.

Hence it follows, that if the cord were left to itself, without any ligature, it would not expose the child to hemorrhage, or other accidents, even though it should be cut clean, and not contused or torn; some little blood might flow from the cut end, but every thing being left to nature, this could amount to but little, and such as would do no harm. But for the sake of cleanliness, it is proper that a ligature should be applied.

But it will be objected, that in some cases—though very rare—children have been known to bleed to death at the umbilicus. This has, indeed, happened in some few cases, in spite of ligatures, and every thing else in the way of styptics that could be applied. But these extreme cases are not to serve as guides in forming rules of practice. Nature has exceptions to all her rules. Besides, we may account for many of these occurrences, by the fact that the natural operations are often perverted by improper treatment. Thus, if children are swathed tightly, as has been too often the case in civilized society, compressing the chest and the abdomen, and causing them to cry from distress, the embarrassed state of the viscera suffices to disorder the general circulation, and enable the blood again to pass out of the navel.

Hence, as a matter of practical safety, although it is not necessary, as a rule, to apply a ligature to the umbilical cord, even when we cut it very near the abdomen of the child, we had better do it, as no harm can come from the procedure; it is possible for it to do good, even to save the life of the child; properly applied, it is not possible for it to do harm.

As to the point at which we divide the cord—whether at a half an inch or an inch and a half from the abdomen—every one must be his own judge. It is an old woman’s notion, both in this country and in the old, which was derived from the physiology of the ancients, and which requires that the cord should be cut very near the umbilicus if the child was a girl, and very far from it if it is a boy; such a mode of cutting being supposed to exert a great influence upon the development of the generative organs.

Notwithstanding the objections of some of the old women, I have separated the cord very near—say within half an inch of the abdomen. This is a much neater and more cleanly mode than it is to leave two or three inches of a dead substance to putrefy upon the child; besides, the more cleanly the part is kept, the more quick does the healing process take place.

“As to the ligature itself,” says Velpeau, “De la Motte advises us to apply it at the distance of one inch, Deventer, Levret, and the moderns, at the distance of two fingers’ breadths, others at three, four, five, six, and even twelve inches from the abdomen. Some persons have recommended the application of two, and in such a way that the one nearest the abdomen should not be so tight as the other. Sometimes it has been recommended to draw it very tightly, at others very loosely. One person is content with a single turn, and a single knot; and another thinks there should be two turns, and a double knot; a third, like Planck and M. Desormeaux, makes first one turn and one knot, and then bends the cord into a noose to tie another knot upon it.”

“A majority of the Philadelphia accoucheurs,” says Professor Meigs, of that city, “in tying the navel-cord, pass two strong ligatures each twice around it, securing them with two knots; the one an inch and a half, and the other two inches and a half from the abdomen, and divide it between the two with a pair of sharp scissors. This is a cleanly practice in all cases, and prudent, if not essential, in twins;” cleanly, that is, because, as the professor means the second ligature—that is, the one that is nearest the mother—prevents the blood coming from the placenta, and soiling the bed; the same principle I usually adopt, only the first ligature is placed half an inch, instead of an inch and a half from the abdomen. Sometimes, however, as in the night, it is perhaps better to leave the cord an inch or two long, and the next day tie it nearer the body. The ligature, since we use it at all, should be drawn very tightly; the cord being a dead animal substance after birth, very soon shrinks; hence if the ligature is not very tightly drawn, it may slip off in a day or two. In tying the ligature, we should be careful not to pull at the child, for in so doing we might cause a rupture, or a tendency to such an occurrence.

In making the division—which is usually done with a pair of good shears or scissors—we must be careful to avoid cutting off a finger, toe, or the private member. The infant, in its struggles, is very apt to get some of these parts in the way just as one is making the cut.

As to the kind of ligature: some think they must always have a narrow tape; and hence we often find, in attending a case, that the mother has already prepared herself with this material. But a common round thread is to be preferred; we can draw this more tightly than we can a flat ligature. A strong linen thread, doubled and twisted if we think it necessary, I consider the best. “Some would not dare to use any thing except tape,” says Velpeau; “whereas wiser persons make use of whatever they can find at hand.”

One circumstance should be particularly noticed in regard to tying the cord. It is said that it is possible for umbilical hernia to take place before the child’s birth. In such case a portion of its intestine must have protruded into cord. Hence, in such case, if we were to tie a ligature about the cord near the body, and where the intestine is—a fact that we can know by the cord being bulged out, or enlarged at the part—and should cut it off so as to sever the intestine, we should inevitably kill the child. Few practitioners have ever seen such a case; but inasmuch as it is said that such hernia may possibly exist, we should always watch for it. It would be easy to detect, but if one should have any doubt as to whether there is hernia or not, he may apply the ligature an inch or two from the child’s body, and thus make sure of doing no harm.

It is important to remember, that at the time of, and before making the separation, the child should be so placed as to allow the most free respiration; it has just begun to breathe for the first time in life; it is just as important that it has good air as it is for any of us. Many a tender infant has been injured at the very beginning by being smothered among the bed-clothes as soon as born. People everywhere, think it will take cold as soon as it is exposed to the air; but think, you who understand the anatomy and physiology of the human system, how exceedingly delicate the fine internal net-work of its little lungs is! And think you that the external skin is less able to bear the new impression of the atmosphere than the lungs are?

As to difficulties at the child’s navel, I have never had them. It is certainly a very simple thing to leave it altogether to itself, with the exception, the second day and onward, of laying upon it a soft, clean, wet compress, of four or five thicknesses, so that it remains constantly moist. This water-dressing, often renewed, and kept thoroughly clean, heals the navel more quickly than can be done in any other known way.

From what I have been able to learn, I infer that with water-dressing this healing is effected from one fourth to one third less time than by the usual methods.

The period of the natural separation of the cord varies considerably in different cases. According to M. Gardien, it usually falls off on the fourth or fifth day. M. Orfila says the fourth, fifth, or sixth day. M. Dennis the fifth, sixth, seventh, or eighth day. M. Billard remarks, that the desiccation is complete toward the third day, and it is on the fourth or fifth day that the cord is separated from the abdomen.

Dr. Churchill, of Dublin, kept an account of the period of its decadence in 200 cases, and it occurred as follows:

In 1 case it fell on the 2d day. „ 4 cases „ 3d „ „ 20 „ „ 4th „ „ 52 „ „ 5th „ „ 81 „ „ 6th „ „ 24 „ „ 7th „ „ 10 „ „ 8th „ „ 7 „ „ 9th „ „ 1 case „ 10th „

According to Dr. Churchill, then, it would appear, that the fifth and sixth days are the ordinary periods of the detachment. The cord has been known to remain undetached as long as fifteen days; but such cases must be very rare.

Complete cicatrization is commonly effected by the end of the second week. The healing powers vary somewhat in different cases. In one case, where both the father and the mother were of scrofulous tendency, it was a number of weeks before the healing process was fully completed. The child, however, in the end did well.

OF STILL-BIRTH.

The child may be born _still_, from its not having passed to its full period, or from various causes it may not have vital stamina enough to enable it to live. In some cases the child is born without any manifestations of life whatever appearing. The face is swollen and livid, the body flaccid, and the navel-string does not pulsate.

In such cases we should not at once wholly despair of life, although there is not usually much to hope for; yet, inasmuch as cases of this kind are now and then recovered, they ought not to be immediately abandoned without making suitable efforts for the resuscitation of the vital powers.

A frequent cause of the absence of respiration in the new-born infant is, separating the umbilical cord too soon after birth. Such is the opinion of Denman, Burns, Baudeloque, Dewees, Elberle, etc., etc., and there can be no doubt that many a child has been destroyed by this inconsiderate practice. By all well-qualified and skillful practitioners it is laid down as a rule, “_that the cord is not to be tied until the pulsations in its arteries have ceased_;” and this any person of ordinary understanding, and without medical knowledge, can easily ascertain, by simply taking the cord between the thumb and forefinger.

In consequence of the neglect of this rule, Doctor Dewees tells us that he had reason to believe he had seen several instances of death, and this of a painful and protracted kind. “And that this is probably one of the causes of the many deaths, in the hands of ignorant midwives and practitioners,” this author observes, “we have too much reason to suppose.” The practice with many is, to apply a ligature to the cord the instant the child is born, without any regard whatever to its pulsation, or the state of the child’s respiration.

_Treatment._—In the cases of asphyxia, to which I have referred, various methods of treatment have been adopted, some of which are, no doubt, valuable, while others are meddlesome, and worse than useless.

If the child is livid and dark-colored, it has been recommended to abstract blood. This is best done at the umbilical cord; that is, by separating it. If the blood will not flow, it is recommended to strip some blood from it. It is, however, admitted that, in general, very little, if any, can be obtained in this way.

It has also been recommended to apply a cupping-glass to the umbilicus, so that by exhausting the air from the part the blood may be brought into motion, and thus made to flow, and this even after the heart has ceased to act. I know of no author, however, who has succeeded in this method.

The object of abstracting blood in any of these various ways is to set the vital fluid in motion, and to relieve the congested parts. But it appears to me that there is a far better method than this, and that is simply by friction with the wet hand. The child has in no case _too much_ blood; it is only in the wrong place. The wet hand does not at all injure the skin; the cold water—for cold only should be used here—acts as a stimulus to the vital power, and the motion of the hand and the pressure will set a hundred-fold more blood in circulation than the mere separating of the umbilical cord could do. Hence it is that I would depend much upon friction, and very little, if any, upon the abstraction of blood. This latter practice is destined to become as obsolete in time, as that of bleeding in a severe injury or shock of the system—a method which has deservedly gone out of date among all scientific practitioners of the medical art.

In conjunction with the measure which I have just recommended, there is another of importance, which should be faithfully made; and that is, an effort to excite the respiratory function by artificial inflation of the lungs, and compression of the chest with the hands, so as to imitate in a measure the natural acts of inspiration and expiration. In doing this the operator must apply his mouth to that of the infant—the latter having been first freed of the mucus that attaches to it—at the same time closing its nostrils, and endeavor by a moderate but uniform force of expelling the air from the mouth, to fill the lungs of the child. As the air is thrown into the lungs, the chest of the child must be allowed to expand as much as it will; and then, as this act is discontinued, the chest should be compressed a little, carefully, so as to imitate the natural motion of these parts.

Authors disagree as to the amount of force allowable in forcing air into the lungs of a new-born child. Some have recommended a “forcible insufflation,” while others contend that such a practice is fraught with danger to the child. It appears from a series of experiments that have been made in France on animals, and from observations relative to the human subject, that no very great force of insufflation is necessary to rupture the delicate air-cells, and cause a fatal emphysema of the pulmonary structure. In sheep, and in the dead human subject, the air-cells were ruptured by a force of insufflation not greater than that which may be made by a person of ordinary respiratory vigor, without any very violent effort.

To obviate the unfortunate accident of rupturing the air-cells of the lungs, the air should be thrown into the respiratory passage through a silk handkerchief folded double, or a fine napkin laid over the mouth of the infant.

In all cases of retarded, impeded, or suspended respiration immediately after birth, care should be promptly paid to the removal of the viscid mucus, which is usually to be found lodged in the mouth and throat of new-born infants. In some instances the quantity of mucus is so great, and its quality so tough, that it is believed the child could not possibly breathe if the obstruction was not removed from the parts. In all cases, therefore, if there appears to be any difficulty whatever in regard to respiration, it is best to remove this mucus by means of the finger, surrounded by a handkerchief or piece of soft linen. If there is reason to believe that the mucus is also lodged in the throat and beyond the reach of the finger, it has been recommended that the child should be turned with its face downward, and the body raised higher than the head. In this position, the child’s back, between the shoulders, is to be patted with the hand, and its body gently shaken, so as to disengage any matters that may be lodged in the trachea, and permitting it to flow out of the mouth by making this the depending part. At the same time, if the back is rubbed with the hand wet in cold water, the stimulating effect will aid in the expulsion of the offending cause from the throat.

Infants are sometimes born in a state of asphyxia, when, instead of lividity and swelling of the countenance, there is the opposite extreme, the face and surface of the body, generally, being pale, exhibiting a want of vitality. In such cases, it is of the utmost importance that the cord be not divided too hastily; on no account, indeed, should this be done until the pulsation has ceased. The viscid mucus should at once be removed from the mouth and fauces by the methods before mentioned; and it has been recommended to apply brandy, spirits of camphor, hartshorn, etc., to the mouth and nostrils, with the view of exciting the respiratory function. It is doubtful, however, if such articles do any permanent good whatever, and they are certainly liable to harm. At any rate, it is better, I am confident, to sprinkle cold water upon the surface, and to make friction with the cold wet hand. This will set the blood in motion, and aid the vital powers incomparably more than the stimulants mentioned.

It is also advisable in these cases, if respiration is particularly tardy, to inflate the lungs carefully, according to the method before recommended. But the applying hot brandy, flannels wrung out of hot spirits, etc., which have often been used on such occasions, are worse than useless, and ought never to be resorted to.

Infants, in this condition, should not be given up too hastily. Numbers of cases have happened in which a half hour or more has elapsed before respiration has been established. Even a much longer period than thirty minutes has transpired in some cases before the breathing has been established.

The time will come, probably, when electricity will become so well understood as to enable us to make it a valuable agent in cases of still-birth and suspended animation. In the present state of knowledge, however, it is better, I think, to depend on the stimulus of cold water, frictions, and the other means to which I have already referred. But great care is necessary in the management of all such cases; and I have no doubt that many more infants have been killed by too meddlesome and injudicious management, than have been saved by the use of artificial means. The tendency in cases of this kind always has been to do too much. It is one of the greatest acquirements in art to learn when _not_ to do.

WASHING AND DRESSING THE CHILD.

I have a few words to say here on these topics; but I must refer you to my Treatise on Children for a much more full and explicit explanation of them than the limits of this work would admit of. You can all of you who have need obtain that work, I trust; and surely, after you have borne a child, you will feel the greatest interest in learning all that it is possible for you to know respecting the best modes of rearing it.

In general terms, then, I remark, that a child should, soon after its birth, be carefully cleansed by means of pure water and the addition of a little mild soap. The water should not be either too warm or too cold; a moderate temperature, as from 70° to 80° Fah., will be found best. The child should be _carefully_ washed, I said; and in all that is done in handling it, you should remember that it is a frail, delicate thing. Nor need I hint to a _mother_ that inasmuch as some one had to perform all of these small yet multiform offices for us, so should we be willing to perform them for others.

The _dress_ should be loose, and merely sufficient for the purposes of warmth. The child should not be in any way _bound_ with its clothing; nor should a binder or bandage be used.

LETTER XXX. HYGIENE OF NURSING.

Lactation a Natural and Healthful Process—Rules for Nursing—At what time should Lactation cease?—Food and Drink proper during the Period.

You who reside in the country—as, indeed, most of you do—can hardly credit me when I tell you that it is getting to be quite fashionable in our large cities for a woman _not to nurse her own child_.

There is in some cases policy on the part of the physician, which lies at the root of this matter. “Why, madam, you are too weak,” the fashionable pill-monger sagely says. “It will injure your constitution, and you cannot raise your child; you must have a wet-nurse.”

Now, all this is very easy for a man to declare. Some say it from ignorance, no doubt, and some from other motives; for physicians, although as a body of men they are as honest as any other, are yet sometimes selfish, and do that which is dishonest and wrong. The selfish doctor knows, of course, very well where his money comes from. He knows—if he is not an ignoramus—that the mother, if she does not nurse her child, is more apt to become sick, so that she will need his services; and, what is more, she is more apt to become pregnant, in which case he will look for another job at midwifery, which pays well.

I would have every one of you to understand that the health of the unnatural mother, who will not nurse her child, suffers from her not fulfilling the order of nature in giving suck. Her system must inevitably get harm from not allowing it to go through the period of lactation naturally. Her life of dissipation, too, is poorly calculated to contribute to health, compared with staying at home and fulfilling the order of nature, as God designed she should do. But she gets her reward even here. There is no period of woman’s life in which she has so great enjoyment, such perfect physical health, as when she is nursing the offspring of her own blood. Her shattered nerves and broken health are poor pay for the so-called enjoyments of a dissipated life.

But it will be said, there are cases in which it is impossible for a mother to fulfill the office of nursing. She may be physically unable; that is, she may not have any milk to give it; her health may be so feeble, and her constitution so much depraved, that it would not be admissible to do so. All this I admit; but such cases are the exception and not the rule.

What are we to think of the mother who voluntarily permits her child to nurse at another breast? How are we to regard the morals of such a mother—one who willingly allows another person to gain the affections of her child—for it always becomes more attached to the one who nurses it than to its own parent? Besides, too, the character of the one who suckles the child is, to a great degree, stamped upon it, and that indelibly, too. Is a mother, then, willing that the child shall take on the character of another, and of one whose disposition and mental peculiarities she probably knows nothing? For one, I cannot envy the man who has a wife that can willingly resign her child to another to nurse.

_Rules for Nursing._—After the birth of the child, the mother having rested herself some hours from the pains and anxiety she has passed through, it should be put to the breast with the view of exciting the mammiferous glands to their proper and healthful action. This is better for both mother and child. It may be necessary to make the attempt a number of times, and perhaps for days before the lacteal secretion will be found to take place. But letting the child every now and then make the effort to get milk will be one of the most efficient means of inducing it to flow.

_How often to Nurse the Child._—This is a question of great importance; great not less to the parent than the offspring, but one which is by for too much neglected.

It may not be possible to ascertain exactly at what periods it is best to give a child the breast; but one thing may be predicated with the greatest confidence, which is, that there should be a _regularity_ in regard to it. To give the child the breast every half hour one day, and then, perhaps, the next, for the mother to go away for many hours, is certainly not a good practice.

I am led to believe, after having spent a good deal of thought on this subject, that to nurse a child once in about three hours, is perhaps as good a plan as can be fixed upon. Some have regarded four hours as a proper period; but one thing I am satisfied of, that the three hour rule is a good one; there is far more danger of nursing the child too often than there is from the opposite extreme.

It is common, I believe, for mothers to allow the child to take the breast during the night time. I am of the opinion that this practice, likewise, is not a good one. How much do you become fatigued, worn down, as it were, many of you, by allowing the child to take the nipple as often as it chooses in the night? In such cases, how much better you perceive it would be, to rest during the proper hours, so that when the morning comes, instead of being unrefreshed and stupid, you feel buoyant and elastic as a deer.

I am willing, however, to admit that it is probably the better rule for the child to be nursed somewhat late at night; for example, when you retire to rest; after that it should not be allowed nourishment till morning.

_At what time to cease Nursing._—This, too, is a question which deserves a careful consideration—one on which the health of both parent and offspring very much depends.

It is probably true that women in the civilized and refined parts of the world do not, as a general fact, nurse their children for as long a period as is the case among the savage nations.

The Indian women of our own country, it would appear, are in the habit of continuing to suckle their children two years or more before weaning them. Nor do they at all allow of cohabitation during this period—a practice which might well be imitated by the more enlightened portions of the human race. “I shall not undertake to determine,” says Dr. Rush, “how far the wholesome quality of the mother’s milk is increased by her (the Indian woman’s) refusing the embraces of her husband during the time of giving suck.” If, then, the mother’s _milk_ is to be deteriorated by the practice referred to, her health, also, must suffer in a corresponding ratio.

It would appear, also, that in Bible times the period of nourishing children at the breast was prolonged to a much greater period than is common in these latter times, for we read of the giving of suck _three_ years.

_Reappearance of the Menses._—Some have supposed that the period of nursing should be graduated according to the reappearance of the catamenial discharge, because, as they have supposed, the milk is deteriorated by that circumstance.

Let us inquire, in the first place, at what time after a woman has given birth to a child, does the menstrual function ordinarily commence?

Some authors tell us that this does not happen for nine or ten months, usually. Dr. Meigs tells us that he expects his patients “to become unwell at the seventh month of lactation.” “But more frequently than is generally believed,” says Dr. Tilt, “the periodical flow coincides with the secretion of milk as early as the second or third month of lactation, and this in perfectly healthy women; and I am in a great measure able to confirm the assertion of certain authors, that menstruation often continues regularly from the beginning of lactation.” These, however, are exceptional cases, the rule being that a number of months, ranging probably from seven or eight to fifteen, elapses before the menses reappear.

But it is by no means proved that lactation should be made to cease as soon as the woman has her monthly discharge. I have myself known numbers of cases in which nursing was continued for some months after, and apparently with good results to both mother and child. How is it in those cases where the menses do not cease at all, or, at farthest, come on at a much earlier period than it would be advisable to wean the child? Must we be obliged to wean the child in these cases? I think not.

Dr. Hassall, of London, we are informed, examined with a microscope the milk of a lady taken from her on the second day of menstruation, which had come on for the first time at the ninth month of lactation, and he reported that the milk was perfectly normal in quality.

Dr. Tilt informs us that, having carefully interrogated one hundred women in whom menstruation had returned at different periods of lactation, he learned that the quantity and quality of the milk were varied as follows:

The same in 45 Diminished only at the menstrual time 8 Completely checked in 1 Impoverished only at the menstrual time 5 Impoverished then and thenceforth 2 Increased at the menstrual time 24 A rush of milk afterward 15 ——— 100

In making the above observations, the thriving of the children was the estimate of the quality of the milk. By “impoverishment,” was meant that the milk looked like whey, and sickened the children.

My belief, then, you will understand to be, that some other criterion than the reappearance of the menses is to be looked for in regard to the time you should continue to suckle a child. Your own health, the infant’s health, the season of the year, the stage of teething, and a variety of circumstances, are to be taken into the account. And I am fully persuaded that the mere fact of the menstrual discharge coming on, is not a sufficient reason why the child should be weaned. Moreover, weaning should be a _gradual_ process, which it cannot be if a woman must cease to nurse it as soon as the menses come upon her.

_Food and Drink proper during Lactation._—As a general principle, it may be stated that whatever is best for the constitution of the mother, is also best for that of the child.

Every thing that goes to injure the mother during the period of lactation operates powerfully upon the mammary secretion, deteriorating it in the same proportion that it acts as an unfriendly agent upon her. This secretion, too, be it remembered, is one of the very first of the fluids of the body to become affected under unfavorable circumstances. We know how quickly the milk of a distillery-fed cow becomes impoverished and unhealthy, when the improper food is given to the cow; and precisely the same great physiological principles hold good in the woman as the animal.

Suppose you have a fine cow, to which you have become very much attached, and that has a fine calf; or even suppose you have a sow, to which you have devoted a more than ordinary share of attention, and that she has a fine brood of pigs. It is naturally to be supposed that you would take as much pains as possible with the cow, that she might give good milk for the calf; and if you have a fancy for raising pigs, you would be equally careful in regard to the sow. We will suppose you think there is danger that the animal will not produce milk enough for the required purpose. In such a case, would you give it tea, coffee, or porter to drink? Most assuredly you would not; nor would you consider any woman in her right mind who would. Now, it is just as improper and inconsistent for you to take these articles, any one of them, with the view of improving either the quantity or quality of the milk, as it would be to give them to animals for the same purpose. Farmers can tell you how much better it is for animals, when they are giving milk, to have pure water to drink; and the purer and softer it is, the better does the animal thrive in every respect.

I will not deny that a woman probably needs more fluid when she is nursing than she does at other times, and I presume that she feels a desire for more; if so, she can take it. But surely no one will tell me that there is any thing in the wide world that will at all compare with pure water as a means of quenching the thirst.

In nursing, as well as in all situations, you will find the diet to have a great influence in regulating the desire for drink. If you eat salt, and highly seasoned or sweetened articles, you will experience much more thirst than you would if the diet were more simple. A stimulating diet causes a degree of fever in the body; and water being the best and most natural of all substances for curing fever, nature sets up a demand for it. Remember, then, when you eat any thing that makes you _dry_, you are doing unwisely, because you are causing a degree of gastric fever, greater or less.

I need not, I think, go any more into details concerning what you should eat and drink while giving suck. The great thing is to do the best possible for your own health, and that also will be best for the child. You should not eat or take nourishing drink any oftener than you would do at other times, nor should you overdo in quantity, because you think you have two to support.

LETTER XXXI. OF TWINS, TRIPLETS, ETC.

Twins, Triplets, and Quadrigemini of comparatively rare Occurrence—Of the Signs of two or more Children in the Womb—Management of Twin and Triplet Cases—The Nursing of Twins.

It sometimes happens that the woman gives birth to two or more children at the same time. When a mother has twins it is usually the case that both children are smaller than the natural size; they are not, however, both of the same weight; one may be of moderate size, while the other is still more diminutive. But cases have been known to occur, in which both children were above the natural standard. The average weight of twelve twins, examined by Dr. Clarke, as quoted by Dr. Burns, was eleven pounds the pair, or five and a half pounds each, bringing each child considerably under the average weight of a child born singly. Usually the two children, taken together, weigh considerably more than the one at a single birth.

Twins are fortunately of comparatively rare occurrence; so much so as to render it difficult to establish the proportion between them and single births; the cause of their production is evidently mysterious, and altogether beyond the power of human control.

In the Middlesex Hospital, London, according to Dr. Dewees, there was on an average but one case of twins in about ninety-one of births. In Dublin the proportion is greater; in the hospital of that city it was found that one woman in fifty-eight had twins; in the Westminster Hospital, in London, one in eighty; in Dr. Burns’ practice, one in ninety-five; in La Maison d’Accouchement, in Paris, there were, in twenty years, thirty-seven thousand, four hundred and forty-one single births, and four hundred and forty-four twins; in the l’Hospice de la Maternité (Hospital of Maternity) of Paris, the proportion was about one in eighty-eight, according to one return, but according to the testimony of Madame Boivin, of the same institution, the proportion was only one in about one hundred and thirty or forty, while in that of La Maison d’Accouchement the proportion was about one in ninety-one. Dr. Dewees regards, that in this country the proportion of twin cases is, on an average, one in seventy-five. In Wurtemberg, in Germany, there were, according to Dr. Burns, twins once in about eighty-six cases of births.

_Triplets._—These are very much more rare than twins. In the returns of the cases in La Maison d’Accouchement, as furnished by Baudelocque, there appears to have been but one in more than eight thousand cases; in the returns of Madame Boivin, of the cases in the l’Hospice de la Maternité, there is one in rather less than seven thousand. In La Maison d’Accouchement there were, according to Dr. Burns, in twenty years, thirty-seven thousand four hundred and forty-one single births, and five triplets. At Wurtemberg, in Germany, there were triplets once in about seven thousand.

_Quadrigemini._—Instances of four children at a birth must be exceedingly rare. It is not uncommon to find the announcement of such cases in our public prints; but the truth of these ought evidently to be questioned in most cases; and yet such an occurrence has been known to take place. An instance was said, on good authority, to have occurred in Paris, in October, 1823. Dr. Dewees cites a German author, as giving the case of a woman in Strasburg, who had eleven children at three deliveries, making, of course, four of each at two of the births, and three at the other. The same author quotes from the Albany Argus what he designates an account of “unparalleled fecundity.” Dr. O. F. Paddock, a respectable physician of Fort Covington, Franklin County, gives, in the Franklin Telegraph, an account of an extraordinary birth of five children at one time, from the same mother—three daughters and two sons. Four of them were born alive, but lived a short time. The birth was premature three months, but they were perfectly well-formed and well-shaped. The average weight was about two pounds, and not much difference in their size. Their parents had lately emigrated from Ireland, and arrived in this country in August, 1825. This case is rendered more remarkable by the fact that the mother of these five was delivered, on the 20th of February, 1826, of two; making, in the whole, seven children in less than nine months. The last were born on the 25th November, of the same year.

The same author quotes also another account of remarkable fertility from Dr. Ryan, editor of the London Medical and Surgical Journal. This learned gentleman was called to a patient, aged forty-one, of a sanguine temperament, who had menstruated at the age of twelve, and married between eighteen and nineteen. She had a seven months’ child in the eighth month of her marriage; had twins about the fourth month three times during the year 1829, and again, December 31, when she was attended by Mr. Whitemore, of Cold Bath Fields, and delivered of two infants; and on January 28th, 1830, she was attended by Mr. Thomas, of Bagnigge Wells Road, and delivered of an infant, which he considered of the same age as the preceding. On the seventh of June, 1830, she aborted at the third month; and on the ninth, a second fetus was expelled; and as there was no discharge whatever from that time to the period when Dr. Ryan wrote, she considered herself still pregnant. The abdomen was about the size of a woman’s in the fifth month of utero-gestation. She had twenty-four children in twenty-one years, and menstruated regularly before marriage, and was always in good health when suckling, and ill when breeding; and always became pregnant about the fifth month of lactation. Her mother was seventy years of age, and in good health; she had eighteen children born alive. A relation of her husband had thirty-two children, including miscarriages.

Dr. Dewees gave a case some years since, of a lady with whom he conversed, who was then in her thirty-eighth year, and who declared to him that she had been pregnant two-and-thirty times. Of this number eleven children had been born alive, and at the full time. She repeatedly miscarried of twins, and no abortion was less than near three months. She had been married nearly twenty-three years.

As regards the number of fetuses that may exist in the womb at a time, fable has exerted itself to an almost endless extent; thus, the story of the Countess of Hannenberg may be cited as an instance. She, in consequence of a curse pronounced by a beggar-woman, to whom she had refused money, was delivered of three hundred and sixtyfive fetuses; that is, one for every day in the year, in fulfillment of the wish of the offended mendicant, which was, “that she might have as many children at a birth as there are days in the year.” The curse was said to be accomplished; and, in proof of it, the fetuses are shown to strangers that visit the museum at Leyden. This fable did very well for the year 1276; but, if such cases were said to happen now, they would be more scrupulously investigated, and more rationally accounted for. In the case first noticed, the sexes were pretended to be discoverable, and all the males were called John, and all the females Elizabeth, at their baptism.

_Signs of Twins._—A vast deal of thought and investigation have been put forth on the subject of ascertaining twin cases before birth. The physician is often consulted on this subject; but, it need hardly be said that the wisest and most experienced can hardly do more than _guess_ upon so important a matter. Dr. Dewees tells us, we should always answer the question in the negative, and for two reasons, especially; first, because it is impossible to decide it positively; and, secondly, if it could be so decided, it never should be, as much mischief might arise from the uneasiness and fear it might produce.

It may not, however, be wholly uninteresting to our readers to know something of the signs which have been supposed to indicate the presence of more than one child in the uterus. Women who are more than ordinarily large, are apt to suspect themselves pregnant with twins; we very often see such cases, and yet, in few instances, comparatively, the surmises of such patients prove true; they are in general happily disappointed, for no mother, I think, would prefer to run the greater risk of bearing twins.

If a woman be unusually large in the early part of pregnancy, and increase proportionably to the full period, there is some reason, as Dr. Denman regards, that she will have twins; but people will vary very much in regard to what constitutes “large,” and what “small,” in reference to the size of the abdomen in pregnancy: a few will suppose themselves very large when they are, in fact, only of common or moderate size. Particularly in cases of first pregnancy patients are apt to be misled on this subject; there can be no surprise if conjectures on the subject of twins often prove fallacious.

The abdomen of all women with child is in general uniformly distended, without any inequality. It sometimes, however, happens that the tendons, which form what is called the linea alba, which leads from the navel to the middle of the ossa pubis, being less distensible than the sides of the abdomen, which are muscular, divide the abdomen, as it were, into two equal parts by a raphé or indentation through its inferior part. This presumed sign of twins is as ancient as the time when the human uterus, like that of quadrupeds, was supposed to be divided into cornua, a child being thought to be contained in each horn. But as the form of the human uterus is now well understood and known to be equally distensible to its contents, whatever the form of the abdomen may be, unless it is constrained by external means, even less regard is paid to the form of this than to its degree of distention, when we are judging whether it be probable that a woman is pregnant with more than one child.

Women with child—those who have passed through one or more previous pregnancies—are sometimes apprehensive that they have twins, from a greater, a more distant, or other peculiar motion they feel during the period. But sensations of this kind, it hardly need be said, are generally fallacious, as affording any probable evidence of there being more than one child in the uterus. Besides, it is to be remembered, that women never experience the same sensations during any two pregnancies.