2. Menorrhagia, or an immoderate flow of the menses. · Part 5

Tardiness of labor has sometimes been considered a sign of twins; but this may be occasioned by so great a variety of circumstances, it cannot be at all relied on as an evidence of compound pregnancy. It is true, however, that when two or more children are to be born at a time, the labor of the first is almost universally slow; and this slowness is to be attributed to the greater distention of the womb.

There is one method of which I should speak, that some, in modern times, place much reliance upon in ascertaining the presence of twins in the uterus. Dr. Kennedy, of Dublin, and others, have affirmed that the motion of two fetal hearts may be ascertained by means of auscultation; others again have less confidence in this matter, so that on the whole, it is doubtful whether much reliance is to be placed upon this method. It would be difficult, I apprehend, in most instances, for two practitioners to agree upon this point.

_Management of Twin Cases._—The labor of a woman pregnant with two or more children begins, in all respects, like that in which there is but one; its progress, however, is not in general so regular or rapid. The reason why labor is more tedious in these cases is, that neither child can be subjected so well to the expulsive force of the uterus as when there is but one fetus in its cavity.

It is inculcated as a rule among physicians, to keep a patient as long as possible ignorant of there being more than one child, when this is known. But in almost every conceivable instance, the physician is not aware that he is encountering a case of twins until the first child has been born. After the first child is expelled, we may suspect the presence of another from the following circumstances: first, when the child is small in comparison with the abdomen of the mother; and second, when we find the uterus still large, extending high in the abdomen, and not contracted into a comparatively small and hard tumor, as is usually the case at single birth.

It happens in the greater number of twin cases, that while the physician is waiting for the pulsation in the umbilical cord to cease, or is employed in tying it, or waiting for a pain to expel the placenta, the patient complains with more than ordinary earnestness; on examination it is then found that there is a second child on the point of being born, or the bag of waters may be protruding with more than ordinary firmness, so that almost instantly on their breaking, the child is expelled, and this not unfrequently before there is time to give either the mother or friends notice that a second child is to be born; and fortunately it happens in the great majority of cases that, save the exception of the labor being more protracted and severe in the beginning of those cases, the ultimate births are effected with as little danger and trouble as in the average of single cases.

The rules of practice in twin cases, after the birth of the first child, are plain and not at all ambiguous, as some authors would have them. After the expulsion of the first child, one of two things must happen; first, that pretty severe pains will quickly ensue, and if the position be natural, quickly cause the birth; or second, there will be an entire suspension of pain. In the first case the labor must be conducted in all respects the same as if it were an original one; nor is it at all to be interfered with so long as there is any reasonable prospect that nature will prove adequate to relieve herself; and this she is generally able to do. When pains follow the expulsion of the first child, there is every reason to believe that they will in proper time accomplish the birth of the second, because it will receive the whole influence of the expulsive efforts of the uterus, whereas before it was expended upon both fetuses, and because the subsequent pains will be more powerful, since the uterus is now smaller, and its contractions consequently more perfect; and lastly, because the parts have been already dilated by the passage of the first child.

But if there is a suspension of pain, the rule of practice is equally plain as in the former case; if there should be flooding—which will seldom happen—we are to proceed as we would in any other case of hemorrhage preceding the birth of the child; we are to endeavor to arrest the hemorrhage, and if this cannot be accomplished—which I think it usually may be—we are driven to the necessity of delivering the child by means of art. If there be no hemorrhage present, we are to solicit the contraction of the uterus by frictions and kneading on the abdomen, by cold, wet compresses freely used, by general ablutions; the cold hip-bath, perhaps, in some cases, the frequent drinking of very cold water, taking small pieces of ice into the stomach, and by cold injections in the bowels. But we may safely allow nature to rest herself somewhat before we enter upon these means. A meddlesome midwifery, we should remember, is always bad. As things have been in the healing art, nature has been hindered in her processes, probably scores of times, by manual operations, where she has been really aided once!

_The Placenta._—Usually in twin cases, each child has its own placenta, but this is not always the case.

When there are two placentæ, they are usually connected together; sometimes, also, they are entirely separated.

The number of placentæ is usually in proportion to the number of children. To this rule there are also exceptions. A single placenta and a single cord has been found in a case of twins, the cord branching off into two, some distance from the after-birth. In some rare instances, likewise, the cords are found so closely twined together, that they have the appearance of one.

Before any attempt is made to deliver the placenta, when we have reason to suspect there is another child in the womb, or where we have ascertained such to be the case, we should, at the proper time, separate the cord of the first child, and place a ligature on the part next the mother. The cut extremity of the cord, in such cases, is supposed to yield a more than usual quantity of blood, even to the exhaustion of the second child.

When the placentæ are separate, that of the first child should not be delivered before the birth of the second child. Should it be so delivered, there must necessarily follow a considerable discharge of blood, which might amount to a profuse or fatal hemorrhage. But in some instances the after-birth has been expelled by the natural efforts, without any considerable effusion of blood. In some cases of hemorrhage, when there is only one child, the placenta is thrown off first, and yet without any detriment or danger, such as is usually looked for in such cases.

In cases where it is necessary to extract the child by art, it is also generally looked upon as necessary to deliver the placenta by the same means; but such is not necessarily the case. If there is no hemorrhage, or other cause of alarm, there is no more reason for giving assistance to deliver the placenta than if only one child had been present; we ought either to wait for the spontaneous operation of nature, or, at most, give very little assistance, precisely as we would in a case of single birth.

Whenever it is found necessary to give assistance in the matter of removing the after-births, we are to recollect that the two placentæ should be extracted together, or in quick succession, as the patient would not be freed from the peril of her situation if we did not proceed in this way. If the hand is to be introduced into the uterus, it should not be withdrawn till both the placentæ are detached, and ready to come away. If we are to give assistance by making traction at the cord or cords, we must be careful that each shall bear an equal proportion of the force we think it advisable to use.

We are not to be alarmed if more blood is lost in twin cases than is usual at single births. The discharge is commonly greater in the former cases, and longer continued than in the latter.

_Nursing of Twins._—Should a mother undertake herself to suckle her own children, when both live, in twin cases? If she has strength enough, and a sufficiency of milk, it is better that she do so. No one else can be expected to feel that interest in a child which a mother naturally does. Inasmuch, then, as the period of nursing—if every thing be properly managed—is that in which woman enjoys probably better health and a greater immunity from disease than at any other time of her life, let her, I say, if it be at all within the range of consistency, nurse her own child; and if there is need of aid from any source, it is better, as a general thing, to depend upon pure cow’s milk, with the addition, perhaps, of a very little pure, soft water, but of no other substance whatever, not even sugar, which is so frequently resorted to. By this simple means, in connection with prudent management throughout, the child may be nourished; wholly, if the mother is not able to give it suck, or in part, if it need more nutriment than she is able to afford it.

LETTER XXXII. TREATMENT OF AFTER-PAINS.

The Nature of After-Pains—The different Kinds—Their Causes—Treatment—The great Value of Water-Cure.

Usually after delivery, the woman experiences more or less pain in or about the abdomen, generally in the womb or the back, constituting what is termed “_after-pains_;” these are called after-pains, because they occur after delivery.

It is an important fact, one well worth considering, that as a rule, no after-pains worth mentioning are experienced during the first confinement. Do women become weakened necessarily by giving birth to children? Are their cares and duties too many as they become mothers, in the present state of society? Are the plans of medical treatment, such as are usually adopted in childbirth, calculated more and more to undermine the constitution? Are people almost universally in the habit of debilitating themselves by connubial excesses in the married state? These are questions of vital importance to all who expect to be mothers.

After-pains proceed from the contraction of the uterus, caused by the presence of bloody clots, the blood having oozed from the orifices of the torn vessels, and becoming coagulated in its cavity. The pains come on usually very soon after the expulsion of the after-birth, and may last a few hours, or for a number of days, according to the nature of the case and the treatment employed. Each severe pain usually expels a clot; they are often increased when the child attempts to suck, a fact showing the great sympathy existing between the uterus and the mammary glands.

After-pains may also be caused by costiveness, or, rather, by the presence of hardened fecal matter in the colon. They may also proceed from flatulency.

Dr. Dewees mentions one kind of after-pains of very distressing character, which he had not seen noticed by other writers. He met with a few cases, and I have myself seen one or two instances of the same kind. It is a most severe and constant pain at the very extremity of the sacrum and coccyx (the extreme lower portion of the spinal column). It begins, Dr. Dewees says, the instant the child is born, and continues, with the most agonizing severity, until overcome by the rapid and liberal use of camphor and opium. The sedative effect of cold water is, I hold, altogether better than these so-called remedies. This pain, it is declared by the patient, is vastly more insupportable than the pains of labor, for it is as intense in character, and holds on almost without intermission, which the pains of labor do not.

After-pains are, no doubt, sometimes rendered much worse than they otherwise would be, by improper management at the time of confinement; if the labor is hurried in an unnatural way, the probability of more severe pains is evidently increased; especially if the after-birth is hurried away before the uterus has sufficient time to contract itself they are rendered more protracted and severe; the better the womb contracts, the less the blood will flow into its cavity.

We should be careful always to distinguish these pains from inflammation of the uterus, peritoneum, or other parts within the abdomen. After-pains are remittent; the abdomen is not particularly painful to the touch; the lochial discharge is not obstructed; the patient has no shivering; milk is secreted in due time; there is no general feverishness worth mentioning; and the pulse is not affected. But in case of inflammation, the opposite of these symptoms obtains. There may be, it is true, and sometimes is, more or less increase of heat when there is simply after-pain, but this heat does not at all amount to inflammation.

There is still another kind of after-pains, different somewhat from any I have yet mentioned. They are called spasmodic. The uterus, like all other parts of the human system, and especially those which are highly endowed with nervous sensibility, is liable to take on spasmodic action. These spasmodic pains are sometimes very violent; the patient writhes in agony, tossing herself from side to side upon the bed, and sometimes it is necessary for a number of persons to hold her. These symptoms sometimes become so violent as to end in convulsions, it is said. Spasmodic after-pains appear to happen, for the most part, with those who are excessively nervous, and particularly with such as have been in the habit of using strong tea and coffee, opium, and other narcotic substances. The fashionable tea and coffee drinking, and the use of morphine and other preparations of opium, which have been so much resorted to in this country these later years, depend upon it, have a great deal to do in these things.

_Treatment._—How are we best to manage these formidable difficulties in midwifery practice? Shall we stupefy the patient with camphor, opium, or prussic acid, as many have done? Shall we do better than this, and tell our patients, as many do, that these pains are natural, and should not therefore be interfered with, and are to be borne with as much patience as the sufferer can put forth? Or shall we adopt a process which is, on the one hand, more potent, more effective, and more powerful than any other known to quell pain and spasm, from whatever cause they may arise; while, on the other, it does not at all injure the constitution, or leave after it any bad effects?

Dr. Dewees tells us it must be admitted that neither camphor nor opium is always successful in calming these distressing contractions of the uterus. They sometimes persevere with great obstinacy, even after the faithful trial of both these remedies; while, in other cases, no form of opium can be made to suit the peculiar idiosyncrasy of the patient, and to some the camphor is absolutely disgusting.

_We_ have a remedy incomparably more effectual than either or both of these, and which will act in the most friendly manner with every patient—pure water, tepid, cool, or cold, judiciously applied, according to the exigencies of the case, is a hundred-fold better than all other remedies combined in subduing the pains in question.

What substance in nature that will at all compare with water in arresting hemorrhage? There is nothing. So also in regard to securing a proper contraction of the uterus, the same principle holds good. We place wet cloths upon the abdomen, the generative parts, the thighs, and a wet sheet about the trunk of the body, if need be, in order to secure the desired effect. Even placing the hands in cold water will, by sympathy, aid in the result.

In the slighter cases of after-pains, the frequent laying on the abdomen cold wet compresses, the same upon the back, together with frequent drinking of cold water, and the use of the accustomed baths—such as are always taken, even when labor pains do not appear—will in general prove sufficient. But in many cases a far more heroic treatment will be found necessary. Many times in the twenty-four hours we may have to persevere in the water appliances, particularly the shallow-bath; the common wash-tub, or the sitting-bath tub, answer very well for this; the patient sitting in the vessel, the feet, of course, being left outside, she is rubbed all over smartly with the wet hand, there being one or more assistants, herself aiding in the operation somewhat; in this way she is rubbed until the desired effect is obtained. No matter if it makes her chilly and shake, as it often does, for it is much better to be shivering with cold, and suffering in this way, than to be writhing and groaning under the effects of these terrible pains.

I have myself, with my own hands, aided in giving these baths by the half hour at the time, and many in the course of a day, and in such cases we have succeeded—usually in a few hours—in getting the mastery of the pains. I cannot conceive of a case in which this treatment, if properly managed, must not succeed. I know that in some cases, where persons have been much injured by narcotic substances, and in which the agony amounts to spasms and convulsions, perhaps, it will be found no boys’ play to cure the case. But I have yet to see the first one in which these remedies will not succeed, and I trust the time is not far distant when both physicians and the people at large, all over this country, and the whole civilized world, will understand and be able to apply, in a very good degree of perfection, these simple and yet immensely valuable means for relieving pain.

But to proceed; if a patient is too weak to sit up for a half-bath, we must do the best we can with her in the recumbent position, and by dexterous and persevering management, a great deal may be done in these cases. The wet sheet, folded once each way, and then slipped under the patient, so that it can be lapped over the whole trunk and pelvis, and the frequent renewal of the wet compresses under the sheet, upon the abdomen, genitals, and thighs, are invaluable means. The washings of the surface may be repeated as often as is necessary, and the wet sheet should be always changed before it becomes too clammy and warm.

But it is fortunately the order of nature, that where there is great debility not much pain is experienced. If a patient experiences a great deal of after-pain, we may know that she has a pretty good amount of vitality in her organization, and that she can bear a large amount of treatment, sufficient to bring about the desired result.

Water injections for the bowels are also valuable in these cases. I do not think it best to use the water very cold. In one very obstinate case, where the most agonizing after-pains had gone on for hours before I saw the patient, we used, among other means, frequent clysters of water, at about 70° Fah. with excellent effect. Nor would I be afraid to use very cold clysters in such cases.

Some have recommended vaginal injections in strong terms as a remedy of after-pains. It has indeed been affirmed that occasional cold injections to the uterus prove a _sovereign_ remedy for them. But no one of much experience has testified to this. It will be found, I think, by those who have put forth these strong statements, that when they have gained a sufficient amount of experience to enable them to form a good judgment upon these matters, they will find, I am confident, that a much more powerful and general treatment will be necessary in those severer cases. No single application, however powerful, can of itself succeed. But if I am myself in error on this subject, I shall be most happy to become convinced of it, for I love the _truth_ better than every thing else; better even than my own opinions, however strongly and confidently expressed.

I would prefer the tepid vaginal injection—say at a temperature of from 70° to 80° Fah.—rather than the cold. If we have an aching tooth, its nerves all sensitive and bare, we do not take _cold_ water into the mouth, but that which is tepid. We repeat this pretty often, and at the same time rub the face, neck, and other adjacent parts with the coldest water we can get.

If we have a cut and bleeding finger, we do not immerse the wound in cold water, or put cold water upon it, to arrest the bleeding, but we immerse it in tepid water, and make our cold applications some little distance from the wound, as upon the arm and elbow; thus we secure our object in the better way. If we are to treat a felon, we may immerse the hand and arm in cold water, leaving the extreme part, at which the agony is felt, out of it; we may have a wet compress about the painful member, but the greater and more effective applications must be made on other parts, contiguous to the one affected. From these well established principles I infer that the vaginal injections, whatever may be claimed for them, are of minor importance, when compared with the external and more general applications to which I have referred, as a remedy for after-pains. It is to be remembered, likewise, that patients, from the extreme sensitiveness and soreness of these parts after delivery, dread very much applications of this kind. The external applications are soothing, pleasant, and wonderfully effective in relieving soreness, but not so with the internal applications.

Thus, then, it will be perceived, that I place great reliance upon the shallow-bath, tepid, cool, or cold, with prolonged friction by the wet hands, the sitting-bath, the cold wet compresses, often repeated, the wet girdle, cold wet cloths upon the thighs and back, the folded packing sheet, with covering sufficient to keep the patient comfortable, tepid or cold clysters, and water-drinking, together with good nursing throughout, as a remedy for the distressing affection of which I have been treating.

LETTER XXXIII. THE LOCHIAL DISCHARGE.

The Mosaic Law concerning Purification of Women—Nature of the Lochia—Excessive and Offensive Discharge—Treatment of Suppression of the Lochia.

We read in the New Testament, in reference to the birth of the Saviour (Luke ii., 21, 22), that “when eight days were accomplished for the circumcising of the child, His name was called Jesus, which was so named by the angel before He was conceived in the womb;” that “when the days of her purification, according to the law of Moses, were accomplished, they brought Him to Jerusalem, to present Him to the Lord.”

These passages refer to the Mosaic law (Leviticus, chap. xii.), which is as follows:

“And the Lord spake unto Moses, saying, Speak unto the children of Israel, saying, If a woman hath conceived seed, and born a male child, then she shall be unclean seven days; according to the days of the separation for her infirmity, shall she be unclean.

“And in the eighth day the flesh of his foreskin shall be circumcised.

“And she shall then continue in the blood of her purifying three-and-thirty days; she shall touch no hallowed thing, nor come into the sanctuary, until the days of her purifying be fulfilled.

“But if she bear a maid child, then she shall be unclean two weeks, as in her separation: and she shall continue in the blood of her purifying threescore and six days.”

This law refers to what is called in medical science the _lochia_, or _lochial discharge_, the term being derived from a Greek word signifying “a woman in childbed.”

After the birth has taken place and the placenta has been removed, the woman experiences a discharge from the womb, which is at first red in color, consisting, probably, of little else than blood; afterward it acquires a greenish hue, possessing a peculiar and disagreeable odor.

The lochia is considered purifying in its character. It is a natural discharge which oozes from the orifices of blood-vessels, laid open by the separation of the placenta from a portion of the internal surface of the womb. In all cases wherein a wound is made in the living body, or wherever the blood-vessels are by any cause laid open, there must be necessarily more or less discharge before the healing can be fully accomplished; and the same principle holds good in the womb as in other parts of the body.

In quantity, the lochia varies much in different cases; it may be three or four times as abundant, apparently, in one case as in another, both patients recovering, however, with equal facility or difficulty.

The length of time varies also as much as the quantity of this discharge. It may last for a few hours only, for days, but more commonly for weeks; fourteen to twenty-one days may be stated as its usual duration. Something, I think, depends upon the treatment; cleanliness certainly has its effect in these cases. If a woman wash herself three or four times daily, and keep herself at all times as strictly clean as the circumstances will admit of, the process of healing must be materially hastened, the discharge rendered smaller in quantity, and less offensive in character.

_Excessive Discharge._—From various causes the lochia sometimes becomes excessive in quantity. More anciently, when the humeral pathology was much in vogue, this discharge was studied with more attention than in modern times, and our forefathers in medicine may have gone to an extreme in this matter; but certain it is, the importance of the lochia should not be overlooked.

A piece of placenta retained may augment the flow of the discharge. If the patient experience vomiting, very offensive and too great a quantity of lochia, or if very severe after-pains come on, there is some reason to suspect that such is the case; so, also, portions of the membranes may have been retained, causing some degree of irritation. Any thing which debilitates the system, such as too much lying in bed, overheated rooms, too much sitting up, walking, or other exercise, and especially too much excitement in the way of seeing company, gossiping friends, etc., may likewise cause an excessive discharge. In those cases where a portion of the placenta is retained, removing it is often considered the best remedy; but according to one very able author and practitioner, Dr. Blundell, “unless the symptoms are very urgent, it is better to refrain from manual operations; left to its own efforts, the uterus will, perhaps, more safely clear itself.”

_Treatment._—In all these cases the general principles of management are plain and easily understood. We must, of course, as far as possible, remove the causes of the difficulty; we must also treat the system constitutionally in order to improve the general strength. Cooling wet compresses upon the abdomen and genitals, frequent ablutions, the sitting-bath, and in some cases the packing wet-sheet, will prove a highly useful means; vaginal injections of water, tepid injections in the bowels, and drinking of pure, soft water, are also to be recommended.

_Offensive Discharge._—There is one condition of the lochia which is very troublesome from its offensive smell and extremely loathsome character. In such cases the red discharge ceases and is succeeded by a profuse watery one of a greenish color, and which is sometimes called by women “the green water;” it is frequently so acrid as to excoriate the parts upon which it runs. It is often attended with a good deal of general debility, causing, not unfrequently, a considerable degree of hectic fever.

The water processes, practiced in a manner suited to the exigencies of the case, cannot be too highly recommended or too much praised, as a means of purification and cure in this offensive and troublesome malady.

_Suppression of the Discharge._—Women, in general, very much fear a sudden cessation of the lochia, and for the reason that it is generally well understood that this occurrence is attended with circumstances of an unfavorable character. But while patients should, on the one hand, always be careful and considerate in matters pertaining to health, they should, on the other, not become at once frightened at every little cessation of the discharge. As I have before said, it may cease of itself spontaneously, and without harm to the system, within a few hours after birth. Dr. Good, indeed, tells us “that in some women who have healthy labors, there is no lochial discharge whatever, the blood-vessels of the uterus contracting suddenly and closely as soon as the red blood ceases to flow.” This celebrated author points out an example of this kind that occurred to Professor Frank, even after a third natural delivery; the patient, moreover, having been from a girl as destitute of menstruation as afterward of lochia; yet her health was in no respect interfered with.

_Diagnosis and Treatment._—If thus, on examination, we find that there is no increase in the frequency of the pulse, or other unfavorable symptoms, no fear whatever need be entertained. If the patient has taken cold, causing an inflammation of the womb, an accident which may be known by sensations of chilliness along the spine, accompanied, perhaps, with general rigors, by the roundness, hardness, and tenderness of the womb, which may be easily felt through the abdominal coverings; and, if added to all these symptoms, there is great heat of the skin and frequency of the pulse, rising to 110°, 120°, 130°, or even more; then we may know that the suppression is a morbid one—one, too, which if not promptly treated, may soon end in death.

Patients, under such circumstances, have great fears of cold; they bundle themselves up, and heat their systems in all manner of ways, as if their physical salvation depended wholly upon such a course. But the truth is, the mischief has been already done; once there is a severe inflammation or fever upon a patient, it is impossible for her to take another cold until the previous one has been cured.

This fact, then, indicates clearly what the proper treatment of such cases should be; we must treat them on the same general principles of all other inflammations; and as soon as the fever and inflammation are sufficiently removed by means of ablutions, wet compresses, injections, water-drinking, and, if necessary, the packing wet-sheet, the discharge—if any such be at all necessary—must follow as inevitably as a stone falls to the ground. Thus it is, then, that under certain circumstances, a cold may give fever and inflammation; while under other circumstances, cold cures these symptoms. These operations of nature, simple and beautiful as they are, must prove highly interesting to every reflecting mind; and they show, moreover, the goodness, benevolence, and design of the Creator, in furnishing us everywhere, so abundantly, a remedy so powerful and safe as pure, cold water.

In all those diseases following delivery, the excellent Dr. Good observes, “That cleanliness and purity of air are of the utmost importance,” and “that, without these, no plan whatever can succeed; and with them, no other plan is often wanted.” “They are, moreover,” he continues, “of as much moment to the infant as to the mother. It is a striking fact that, in the space of four years, ending in 1784, there died in the lying-in-hospital of Dublin—at that time a badly-ventilated house—2944 children out of 7650; though after the ventilation was improved, the deaths within a like period, and from a like number amounted to not more than 279.”

LETTER XXXIV. OF CHILDBED FEVER.

Milk Fever as distinguished from Puerperal Fever—The great Danger of Childbed Fever—Its Symptoms and Nature—Modes of Treatment—Is it a Contagious Disease?

In the course of two or three days usually after the birth of the child, the woman experiences more or less febrile excitement of the system. This is what is termed _milk_ fever, it being connected with the coming on of the lacteal secretion. The attack sometimes amounts to a “smart febrile fit, preceded by shivering, and going off with a perspiration.” It is not dangerous, seldom lasts over twenty-four hours, and during the time of its appearance the breasts are full, hard, and painful, which distinguishes this from more dangerous fevers.

Puerperal or childbed fever is a very different thing from the foregoing, and is reckoned by physicians as being one of the most fearful of maladies.

According to the celebrated Dr. Blundell, “women after their delivery in general do pretty well, although no attentions are paid to them;” and it is the testimony of the same distinguished author, that “when the constitution is good, and the circumstances are not extraordinary, the less they are interfered with the better;” and yet it must be admitted by every candid and reflecting mind, that, do what we may in all the known possible ways of fortifying and invigorating the general health, woman must, ever in childbirth be subject to some of the most fearful diseases and accidents to which the human frame is liable. Suppose it be only one in fifty, one hundred, or one thousand, that is to be attacked under such circumstances with a threatening and most dangerous malady, who is there that wishes his wife, sister, or friend to be that one—and that one, too, to be subjected to the treatment of an ignorant or unprincipled quack, whether of the male or female stamp? It is for the cases of exception, then, and not the rule, that physicians should toil long and hard in their efforts to remedy the ills to which human nature now is and ever must be subject.

I am led to these remarks, partly from the necessity of the case, but more from the fact, that there are those in modern times who, through ignorance, as we must charitably conclude, would mislead the public on this most important subject. I will go as far as any one in encouraging woman to pursue a rational course in the preparation for, and the consummation of, childbirth. Those who have read my humble efforts at authorship on this subject hitherto, must, I am confident, be aware of this. At the same time, while I would encourage woman—encourage her even more than any of us have yet done—I would have her to understand that there are dangers, fearful and imminent dangers, always attending the parturient state. Be these dangers only _one_ in a hundred or thousand cases, they are yet dangers; and who among us, even of the most experienced, can tell who is to be the subject of them, and who is not? It behooves to be ever watchful in these important matters of the healing art.

I propose, then, here to speak of that most formidable, most fearful of all diseases to which the puerperal condition is liable, the puerperal fever—the puerperal _plague_, as it has been called—so sudden in its attack, so rapid in its progress, and so fatal in its effects—fatal, that is, according to the old methods of treatment—sanctioned, as they are, by the usage of ages.

_Time of Occurrence._—The puerperal or childbed fever comes on usually within the fourth day, reckoning that of delivery the first. It happens oftenest the second or third day. It may come on the first day, or it may, though rarely, attack the patient eight, ten, or more days after delivery. The later the day, the less the danger, as a general fact.

_Symptoms._—Childbed fever is more commonly ushered in by a chill, which is not, however, long in duration. This is experienced most along the back, and sometimes about the shoulders and neck. The chill varies in degree of intensity in different cases; with some patients there is a degree of chattering, such as occurs in a severe ague fit; with others there is very little of the symptom; and in some cases no chill whatever is experienced. These last, however, must be the exception to the rule. In almost every conceivable case, a degree of chilliness, greater or less, is experienced. As in other inflammations, this chill is followed by fever. The intensity of the chill is considered no measure of the vehemence of the subsequent fever; the most terrific fever may follow very mild chills, and the contrary. Some regard that there is most danger to be apprehended when the chills are of a mild character.

Here I ought to remark, that patients should not be frightened at every little chill they may experience. The coming on of the milk—the milk fever, as it is called—heat in the breast, and a variety of circumstances other than those of childbed fever, may be preceded by or attended with chills. Indeed, almost every mother with a new-born child experiences more or less of chilly symptoms; and yet fortunately but few are attacked with that terrible malady of which we are treating. So much by way of encouragement in regard to the matter of chills.

In connection with the rigors before mentioned, the patient complains of pains in the abdomen; these may be so slight as to be scarcely perceptible to pressure on the part, or they may be so violent and severe that the gentlest touch of the finger is regarded with apprehension, and the weight of the bed-clothes proves a burden that cannot be borne. “Sometimes the pain,” says Professor Meigs, “which is, at the onset of puerperal fever, felt in the hypogastric region, is too intense to be borne by any human patience; and no exhortation or recommendation can prevent the woman from crying out aloud, or even screaming with her agony. All over the abdomen these pains may be felt, above, below, to the right, to the left, in the region of the diaphragm, and in the lumbar region; this diffusion, however, is neither constant nor frequent, and it is found, especially in the less malignant varieties of the disease, that it is in the region of the navel, and more especially below it, that the patient complains.” Severe after-pains may be experienced in connection with the disease, or the reverse. Little or no fever may occur in connection with severe pain, and so the contrary. If the pain is circumscribed, as we say—confined mostly to one spot—it is far more favorable; but if the pain and tenderness are spread over a large surface, beware, lest there be mischief at hand. If the pain be even slight, and yet diffused extensively over the surface of the abdomen, we must take heed lest we get into trouble that will imminently endanger the patient’s life.

The pulse always rises high in childbed fever. This is one of the most distinctive features of the disease. It is seldom lower than 115 or 120 per minute, except when it is giving way before the power of remedial means. More commonly it rises to from 130 to 140 beats per minute, and it has been known to rise as high as 160 or 170. These last, however, are extreme cases—exceptions to the general rule.

Besides the symptoms enumerated, there sometimes occurs headache, sometimes vomiting, and at others purging, which last symptom is probably in general a good omen.

_Duration of the Disease_,—Puerperal fever, like most other diseases, is not very uniform in its duration. It is, however, in general short. It may last for a number of days—for many days, if we reckon the convalescence a part of the disease. On the other hand, it may, like the plague itself carry the patient off within the first twenty-four hours of the attack. Three or four days is reckoned to be the average duration of childbed fever, when it occurs in the epidemic form.

Professor Meigs has well explained why it is that childbed or peritoneal fever is so serious and dangerous a malady as it is. He observes:

“The peritoneum (the lining, membrane of the abdomen), a serous membrane, known for ages as one of the tissues most ready to take on inflammation, undergoes in labor, and during lying-in, changes of the greatest importance. Its great extent may be known by computing the superficial contents of that portion of the serous membrane which invests the alimentary canal. This canal is about forty feet in length, and its outer coat is composed of peritoneum. If cut up by the enterotome, it would be at least four inches wide and forty feet long, affording a superficies of more than thirteen feet, to which should be added the superficial contents of the remainder of the membrane, where it invests the liver, the epiploon, the mesentery and mesocolon, besides the ligamenta lata, and all the other parts which derive from it their serous covering. This vast surface inflames rapidly and totally, and passes through the stage of inflammation with extraordinary speed. It cannot happen that it shall ever be extensively inflamed without a coincident exhibition of the greatest disorder in the functions of the nervous organs directly implicated in its structure, or possessing with it physiological relations that could not be safely disturbed.

The peritoneum is the investiture of the abdominal organs; the peritoneal coat of the stomach is as truly a part of the organ as its muscular or mucous coat; the same is true as to the peritoneum that invests the liver, that of the spleen, and the same truth is of the utmost import when it is stated with regard to the peritoneal coat of the whole alimentary apparatus. It is clear that extensive or universal inflammation of the peritoneal membrane is inflammation of all or many of the organs contained within the cavity of the abdomen. A great puerperal peritonitis, therefore, may be properly regarded as a complex inflammation of a vast number of organs indispensable to existence. Why should we be astonished, then, to see the power of the nervous mass sink under the invasion of causes of destruction so great and so pervading?

“Seeing that the superficies of the peritoneum is equal, probably, to thirteen or fourteen feet, we should have abundant reason to dread so extensive an inflammation from the constitutional irritation which it alone would produce; but when, in addition to that consideration, we take into view the great affusions which may ensue, the suppurations, the interruption of the intestinal functions, the depravation of the actions of the liver, etc., which are occasioned by it, we have still greater reason to deprecate its attack, and to seek for the justest views of its nature, and of the remedies most appropriate for its cure.”

Professor Meigs elsewhere judiciously remarks, that, considering the changes that take place in the reproductive tissues at childbirth, “there is, in fact, greater reason for surprise, when we find it not followed by inflammation, than when we meet with the most violent and destructive cases of that affection.”

_Treatment._—In the year 1846, I treated (in connection with a missionary friend and physician, who is now in Siam) a premature case of childbirth, which, to say the least, threatened to become one of severe puerperal fever. The case was an important one, and as such I here present it to the reader. It was written out with great care and accuracy at the time by the medical friend referred to. I give it in his own words:

“_March 19, 1846._—Desirous of availing myself of an opportunity which Dr. Shew kindly afforded me of witnessing the hydropathic treatment of cases of labor, I accompanied him to No. — Second Street, where he had been summoned a few minutes before, to attend Mrs. S., who was then in need of his services.

“We found the patient an intelligent woman, of the nervous temperament, with her constitution much broken down—though she was but thirty-one years of age—by the results of severe previous labors, the last a miscarriage. After some of her former confinements, she had been weeks and months in recovering. In one case, when, she was treated for puerperal fever, her husband paid in one year not less than one hundred and fifty dollars—no trifling sum out of the earnings of a working man with a large family—to the apothecary alone, for leeches and medicines. The patient had always been in the habit of using strong tea and coffee; drank the _mineral_ water of the city wells; for some months had relished nothing but the little delicacies sent in by her friends, and throughout the winter had been able to do little or nothing at home.

“In consequence of excessive fatigue, a few days before, in ‘house-hunting,’ as she called it, she had been seized on Tuesday, the 17th, at 10 A. M., at the close of the fifth month of her pregnancy, with the pains of labor—her former miscarriage having, of course, induced a predisposition to another. These pains increased in frequency and severity till they caused the greatest suffering, and prevented all sleep on Wednesday night and Thursday, up to the hour (3 P. M.) when she sent for Dr. Shew.”

Here, then, was a patient, whose previous history, impaired constitution, loss of sleep, and exhaustion from intense and almost incessant suffering, protracted now for more than two days, seemed to promise any thing but a _speedy_ recovery, even should delivery be safely effected. It should be added that, _up to the time_, she was an _utter stranger_ even to the hydropathic treatment.

“Her bowels having been moved the day before, all that was deemed necessary was to render the condition of the patient more comfortable, by resorting to sedative frictions along the spine with a towel wrung out of cold water, and to the tepid hip-bath, with sponging and rubbing the whole surface of the body. After this, less complaint was made, till soon after 6 P. M., when there was a sudden aggravation of the bearing-down pains, resulting in the delivery of a well-formed but still-born male child, of apparently five months.

“In about fifteen minutes the after-birth was detached, and taken away. Not even the usual amount of hemorrhage occurred. A bandage was applied to the abdomen, as the patient expressed a wish for it; and after resting awhile, a little panada was given her as nourishment.

“Mrs. S. continued very comfortable through the evening; no excess of the natural discharge; complained only of exhaustion, and slight difficulty of passing urine. As there was some heat of the surface—the pulse being from 90 to 100—tepid sponging was resorted to, which proved very grateful to the patient.

“_Second Day (Friday), Seven, A. M._—Found the patient had obtained considerable sleep at intervals during the night; felt very comfortable, though occasionally had slight pains in the abdomen; tongue moist; pulse 81; had passed a little water during the night, but with difficulty; had a strong desire for a cup of coffee, but persuaded her to take a little panada in its place; had not much appetite; was permitted to sit up for a few minutes while her bed was made.

“_Half-past Eleven, A. M._—Mrs. S. still very comfortable; found her sitting up in the rocking-chair, the very picture of convalescence. Sponging enjoined, if any feverishness should arise.

“_Three, P. M._—Dr. S. sent for, as the patient had been seized a few minutes before, rather suddenly, with a sharp pain in the left side. Had been drinking a tumbler of cold lemonade. Had a natural movement of the bowels that morning, and passed a little water. The tepid sponging of the surface had been neglected. Pain fixed, severe, pretty constant, remitting only for a moment or so. No corresponding contractions of the uterine tumor observed. Some pain also complained of in the hip, with which she had, on a former occasion, been troubled. Up to that time had had no chill. Warm fomentations were applied, but with little relief.

“_Half-past Four, P. M._—A chilliness felt, then shivering, prolonged, with increase of the fixed pain of the side; pulse 112, weak; patient restless, anxious, desponding; knitting of the brows, involuntary weeping. A bottle of warm water was applied to the feet, and soon after, the chills ceased.

“A large warm enema was now administered; this brought away considerable fecal matter; and fomentations were applied to the abdomen. Next, the patient was seated in the hip-bath, at a temperature of 95°, for fifteen minutes, when water was passed more freely than before, and a slight nausea experienced. The result of this was complete abatement, for the time, of the pain in the uterine region, the diminution of the frequency of the pulse to 90, and great comfort. The bandage to the abdomen having been removed, to allow of the bath, was not replaced. If need be, fomentations to be kept up.

“At 7 P. M. found the patient in a profuse perspiration; pain in the abdomen had lost its acuteness; _soreness_ there was all now complained of—soreness in the head, ‘in the bones, and all over.’ Abdomen swollen, and tender on pressure; breathing shallow; pulse 110–12; discharge from the womb (the lochial discharge) arrested. Patient is to be kept quiet; to take no nourishment; no fire to be in the room.

“At 9¼ P. M., the perspiration still continues; complains of pain in the hip, but chiefly in the left side, as before, and shooting across the abdomen; pain now very severe, increased by coughing; breathing thoracic (shallow), and 28 in the minute; pulse 98; is thirsty; tongue moistish, with a slight milky coat. Fomentations as usual.

“_Half-past Ten, P. M._—Pain increasing in the abdomen and hip; tenderness increasing; can scarce bear slight pressure on the abdomen; knees drawn up; restless, discouraged; pulse 100, though not very full or strong; skin still slightly moist.

“In this critical state of things, when nearly every symptom of that fearful disease, puerperal fever, was invading the system, and when, according to the prescribed rules of practice, the most vigorous antiphlogistic measures would be called for, a plan of treatment was adopted that was, as it seemed to me, far more likely to _kill_ than to _cure_, and which I could not but protest against at the time, but which, as the result proved, was eminently calculated to turn back the tide of disease so rapidly setting in. It certainly afforded striking evidence of the resources of hydropathy, and its promptness and efficiency in relieving pain, and extinguishing inflammation.

“Mrs. S. was carefully lifted from her bed, and after being placed in her chair, was transferred to a hip-bath, containing about one pail of water fresh from the Croton hydrant near by, of the temperature of 42° Fah. A towel, wrung out of cold water, was applied to the forehead at the same time. Of course she was well covered with blankets. She had been seated there but a few minutes, when she expressed herself as feeling _very comfortable indeed_. The severe pain in her abdomen and thigh _had left her as if by magic_, and so complete was the relief, that she fell into a gentle doze, from which, awakened by nodding, she observed, ‘There, I feel so easy now, I lost myself, I believe.’

“While in the bath, her pulse was lowered several beats in the minute; the unimmersed parts of the body remained warm; the hips were to her of a refreshing coolness. After remaining thus seated in the water about twenty-five minutes—a slight addition of more cold water, by gradual pouring, having been made during this time—she was lifted back to the bed. Her pain had now entirely vanished; the natural lochial discharge was soon restored; the pulse reduced to 94; and, warm and comfortable, she had a prospect of a good night’s rest.

“_Third Day (Saturday), Seven A. M._—Found patient looking comfortable and happy. No pain now in the abdomen, slight soreness only; tympanitis (swelling) gone; tongue moist, and hardly coated; pulse 79; had had no sensation of chilliness after her bath, but slept from 12½ to 4 A. M., without waking, and another doze after that; window had been a little raised all night, and no fire in the room, though it was cool. Now was able to pass water without difficulty. Was directed to take for breakfast some coarse wheaten bread, toasted, and softened with milk, and a little scraped apple, if she wished.

“_Eleven, A. M._—Mrs. S. appears very comfortable. With the aid of a friend has been up and changed her clothing. Pulse 84; complains of no pain of any consequence in the abdomen.

“_Half-past One, P. M._—Had been under the necessity of getting up without assistance, and fatigued herself, and thus induced a return of very severe pain in the uterine region. Dr. S. was sent for, when resort was had again to the hip-bath, filled with cold water from the hydrant, which had with such wonderful promptitude averted the danger of puerperal fever, with which she was threatened on the evening of the second day; as on that occasion, in less than five minutes, the pain and feverishness was completely quelled. She was allowed to remain in the bath half an hour, and requested to abstain from food till evening.

“_Five, P. M._—Patient doing remarkably well; cheerful; free from pains in the abdomen, save now and then a very slight one; some soreness on pressure; pulse 84, compressible.

“_Ten, P. M._—Had slept during evening; had taken a little nourishment. Has some difficulty in passing water, and as occasional slight pains and soreness still continues in the abdomen, the cold hip-bath, at 42° Fah., was again resorted to for about thirty minutes. During this time the pulse was lowered from 80 beats in a minute to 70; water was passed freely, and pains put to flight.

“After the bath, the patient continuing warm and comfortable, was directed, should there be any return of pains during the night, to seat herself in the hip-bath, which was left in the room.

“_Fourth Day (Sunday), Half-past Seven, A. M._—Patient had slept most of the night; looks bright; feels ‘very comfortable;’ pulse 72, soft and natural; had raised herself in bed without difficulty, and washed. On account of some difficulty in passing water, the hip-bath was used for about fifteen minutes, when the urine flowed more copiously and freely than at any previous time. Left seated in the rocking-chair; sitting up occasionally; she says it has rested and refreshed her from the first.

“Appetite good; thinks even the plainest food would be relished. Breakfast to be as before; the toasted coarse bread, soaked in milk, with a little scraped apple. Directed to take no nourishment at any time, unless a decided appetite, nor then oftener than three times in a day. Is to take an enema and another hip-bath in the course of the morning.

“_Six, P. M._—Had continued to gain during the day till toward evening. It most unfortunately happened that an intoxicated man, mistaking the house, strayed into the room where she was lying, with no attendant but a young girl; seating himself, without any ceremony, in the rocking-chair, with a lighted cigar in his mouth, he smoked away to his satisfaction, and then very deliberately composed himself for a nap. This strange visitor, and the fumes of the tobacco, had given poor Mrs. S. a severe headache, the first with which she had been troubled; considerable nausea, with paleness of the face, cold feet, etc. A towel wet with cold water was applied to the head, and a hip-bath ordered.

“_Half-past Nine, P. M._—Was rapidly recovering from the effects of the afternoon’s unexpected visit; sat up awhile.

“_Fifth Day (Monday)._—At 7½ A. M., found Mrs. S. sitting up in bed sewing; pulse 75; had rested well; has a good appetite. Breakfast to be as before; may safely take a hip-bath at any time when suffering from pains and is not made very chilly by sitting in it.

“Was able this morning to rise and walk about the room unsupported. Required no assistance in getting to the bath; bowels moved naturally; sat up several hours to-day; appears bright, pleasant, and cheerful.

“_Sixth Day (Tuesday)._—Mrs. S. feels to-day as much better than she did yesterday, as she did yesterday better than the day before. Sat up, and was about the room nearly all day; continues the practice of daily sponging the whole surface, and the use of the hip-bath. At night, retention having ensued from over-distention of the bladder, in consequence of an untimely and protracted visit from some of patient’s friends, Dr. S. was sent for, and deemed it advisable to resort to the catheter, which she had frequently been compelled to use on former occasions, sometimes for months together.

“_Seventh Day (Wednesday)._—Mrs. S. appeared to be better in the morning; able to rise without assistance, to walk about, and even to sweep the room; catheter again required.

“_Eighth Day (Thursday)._—During the night, of her own accord, took two or three or four cool hip-baths, and found them refreshing, and of service in promoting easy evacuation of the bladder. At one time dropped asleep, and remained so an hour or more—sitting in the water. Pulse in the morning. Dressed the children and arranged the room herself to-day; and though a week had hardly elapsed since her confinement, felt _strong enough in the morning to go down stairs_, and to do a half day’s work in sewing, etc., from which she appeared to experience no injury. A few days after she ventured to ride down to the lower part of the city, and having since continued to improve, save an occasional return of an old difficulty—retention—is most gratefully sensible, under Heaven, to her physician and hydropathy, for a far more speedy and pleasant convalescence than she ever experienced after any of her former confinements.”

Professor Gilman, of this city (New York), in his edition of the Dublin Practice of Midwifery, gives us the following account of a method of treatment which was adopted with remarkable success in the old country:

“In an epidemic (puerperal fever), which raged at Keil in 1834, ’35, and ’36,” says Professor G., “Michælis used ice, both externally and internally, with excellent effect. The cases in which he gave it with success were marked by burning pain and heat in the bowels, thirst, painful eructations, and tenderness of the epigastrium. The brain was clear; no delirium. The ice was given by the mouth, in bits the size of the finger, every half hour or oftener; it was also applied over the abdomen in a large bullock’s bladder, extending from the epigastrium to the pelvis, in a layer half an inch thick. This application was in some cases continued for three days, the bladder being changed as soon as the ice melted. It was very grateful to the patient, and Michælis thought it had cured some cases where affusion had actually taken place into the peritoneal cavity. The use of ice was not persisted in unless it was grateful to the patient. The symptoms of amendment were a sudden and very great fall in the frequency of the pulse, a peaceful sleep, relief from the painful eructations, and diminished distention of the bowels. A profuse watery diarrhea occurring with these favorable changes, seemed to him to be critical.”

This treatment of Michælis is certainly a very bold one. Those who are well acquainted with the water-treatment will be able at once to comprehend the fact, that the applications mentioned were sufficient to cause “a sudden and very great fall in the frequency of the pulse, a peaceful sleep, relief from the painful eructations, and diminished distention of the bowels.” Nor is it incredible that a cure might thus take place, even in some cases where affusion into the peritoneal cavity had actually taken place, since the effort of nature tends always, so long as life lasts, necessarily to that end. It is well worthy of remark, that the treatment of Michælis was persisted in only so long as it was grateful to the patient. This is an important rule to remember.

Nor do I regard it necessary, absolutely, to use ice in the treatment of this or any other inflammatory affection. Water—even at the temperature of rivers at this latitude in the summer—which is usually, I believe, at about 70° Fah., may be made very effectual in the cure of inflammatory diseases. Thus, if we wrap one or more wet sheets about a patient, having him, at the same time, on a cool straw bed, and neither the bed or wet sheets having any covering whatever, we, through the natural processes of evaporation and refrigeration, abstract in a short time a great amount of animal heat. We may likewise change these applications as often as we desire, or pour water upon the sheets frequently, and thus cool the patient to any desirable extent, without the use of ice or water that is extremely cold. It should be understood, also, that general applications—applications over the whole or a large part of the body’s surface—are far more effectual in reducing the inflammation of a local part, than applications locally made can be. This fact is not generally understood.

_Is Childbed Fever a Contagion?_—This disease is believed by many to be at times contagious. It would, doubtless, be a difficult undertaking to prove positively that such is the fact. It is the opinion of some able writers on medicine, “that there is unquestionably an epidemic influence, or atmospheric constitution, which sometimes, in extensive districts of country, in villages, in towns, and cities, and especially in crowded lying-in hospitals, determines, by an unknown force, the attack of childbed fever, and so modifies the pathognomonic conditions as to hurry numerous victims to the grave, and this, notwithstanding the most reasonable methods of cure.”

But that the disease is really communicable from one patient to another, is not so palpable. One author—Professor Meigs—a man whose good character and long experience entitle his opinions to much weight, tells us that a great experience—and few have enjoyed greater—has not enabled him to perceive that he has been the means of disseminating this malady among lying-in women, to whom he had given professional aid while attending upon dangerous and fatal attacks of it, or after making or witnessing autopsic examinations of the bodies of the dead. On the other hand, Dr. Gooch, an author whose opinions are probably equally deserving of respect, tells us in reference to puerperal fever, that it is not uncommon for the greater number of cases to occur in the practice of one man, while the practitioners of the neighborhood, who are not more skillful or busy, meet with few or none. A practitioner opened the body of a woman who had died of puerperal fever, and continued to wear the same clothes. A lady whom he delivered a few days afterward was attacked with, and died of a similar disease; two more of his lying-in patients, in rapid succession, met with the same fate. Struck by the thought that he might have carried the contagion in his clothes, he instantly changed them, and met with no more cases of the kind.

A woman in the country, who was employed as washerwoman and nurse, washed the linen of one who had died of puerperal fever; the next lying-in patient she nursed died of the same disease; a third nursed by her met with the same fate, till the neighborhood, getting afraid of her, ceased to employ her. The disease has been known, according to Dr. Gooch, to occur in some wards of a hospital, while the others were at the same time free from it. Dr. Blundell, who is certainly very high authority, while he admits that this fever may occur spontaneously, and that its infectious nature may be plausibly disputed, affirms, that in his own family he had rather that those he esteemed the most should be delivered, unaided, in a stable—by the manger side—than that they should receive the best help in the fairest apartment, but exposed to the vapors of this pitiless disease. Gossiping friends, wet-nurses, monthly nurses, the practitioner himself—these are the channels by which, in Dr. Blundell’s estimation, the infection is principally conveyed.

Some authors contend, also, that it is only through the influence of the imagination, or by sympathy, that puerperal fever becomes more prevalent by times than ordinarily; and there can be but little doubt that these causes operate to a greater or less extent in communicating the malady. If a weak and nervous patient fears it, and especially if it is prevailing epidemically in the neighborhood in which she resides, she is much more liable to an attack than if she had no thoughts whatever of the disease. It is, moreover, under such circumstances more likely to prove fatal than when it occurs sporadically.

Fortunately, however, the question of contagion does not at all affect the treatment of this terrible malady. All agree that it is an inflammatory disease which demands, under all circumstances, at our hands, an antiphlogistic or anti-inflammatory treatment. There can be no two opinions on this point; and it is a circumstance worthy of the most particular remark, that we have in water-treatment the most abundant of therapeutic resources by which to combat inflammation of whatever name or grade—resources more potent and effective, a hundred-fold, than any other ever known to man.

LETTER XXXV. OF SORE NIPPLES.

This Complaint is a very common one—Its Causes—Methods of Prevention and Cure.

Excoriated or sore nipples are very common, as every one acquainted with matters of childbirth knows. “You can have at present,” says Professor Meigs to his class of young men, “no idea of the vexations that women endure in nursing their children in the month, from sore nipples: a complaint so common, that I am always surprised when I hear one of my patients say she does not suffer from it.” “The nurses and doctors,” says Dr. Gooch, “have a long list of remedies for this complaint; but it is in general obstinate, and the remedies are ineffectual; in attempting to cure it, you are rowing against the stream; as long as the cause, namely, the action of the child’s mouth in sucking, is renewed at short intervals, local applications are of little use.”

What, when, are we to do with sore nipples? an affection apparently so trifling, and yet one which causes an amount of suffering that can be adequately appreciated only by those who are brought to endure it? Are we to suppose that it is the order of nature that women should thus suffer in that most important matter, the rearing of their young? Do we find any analogy in nature by which we are led to such a conclusion? It is very plain, I think, that we do not. All mammiferous animals, when left to themselves, nourish their young without disease or pain. Thus, too, would it be with the human species, did we, as the animals, live in accordance with the natural laws.

Let us look, then, for the causes here concerned.

1. _The general Condition of the System._—In consequence of the ill-governed habits of the generality of females, both in pregnancy as well as at other times, a great amount of morbid matter is formed in the system. Too much food is eaten generally, and of improper kinds. The blood, fluids, and secretions of the system generally are in an impure state. Thus it is, that when a small wound or abrasion is made, the part does not readily heal. A drunkard’s system often becomes so impure that he festers and dies of a mere pin-scratch. Thus we see that the condition of the living body may be modified at pleasure to an almost indefinite extent. Women, particularly, who are, or who ever expect to be pregnant, cannot be too particular—cannot take too much pains, in order to preserve a pure and healthy state of the general system. Depend upon it, this will tell when they come to that ever-important period of nursing the new-born babe.

2. _Cleanliness._—Many, no doubt, get sore nipples, in great part, because of their want of attention to cleanliness. Wash the nipples often, and keep them at all times most scrupulously clean, if you wish to prevent them becoming diseased. Nowhere is it more necessary that this ever-important duty should be strictly observed.

3. _The Dress._—It is said that the Greek women were in the habit of supporting their bosoms by a certain contrivance called _strophium_, and the Roman women by one called _fascicola_, which were not at all liable to compress or countersink the nipple, as carpenters would say. The breast should always be left free to grow in all its parts; and if there had never been any corsets, busks, or tight dresses among us, we should not meet that troublesome affection, the countersink of the nipple. If young ladies could know how great an amount of suffering they are rendering themselves liable to, when they compress their bodies in this way, they would, I am sure, one and all, avoid that which can do them no good at the time, and must end in inevitable harm. Sad is it to think that they have never been taught on the subject; their mothers are not acquainted with it, nor are there any popular works treating of these matters from which they can gain the information which would prove of such signal benefit to them. It is, then, with feelings of earnest regard for the condition of the sex, that I prepare this work for those who stand in so much need of that information which it attempts to put forth.