2. Menorrhagia, or an immoderate flow of the menses. · Part 6

With the view of drawing out the nipple more effectually, it is sometimes asked of the physician, whether it is not advisable to have the breasts drawn by a young puppy, or by a friend, before the birth takes place? An objection to this practice is, that in consequence of the sympathy that exists between the breasts and the womb, exciting the former before the time of the full period of pregnancy might, or, rather, would cause pains in the latter before the proper time; in other words, premature labor would be likely to result. Besides, it is the order of nature that drawing the breast be practiced only after the birth has been accomplished. Nothing whatever can be gained by drawing the breast before delivery.

Sore nipple may arise from a variety of causes. The breast sometimes becomes so inflamed, so hard, so obstinate—all, perhaps, in spite of the best that we can do—that it is found impossible to extract any milk whatever from the lactiferous tubes. Under such circumstances the frequent sucking of the nipple by the child, or, what is worse, by the use of the miserable instruments which have been contrived for drawing the breast, it is often made very sore. At other times, too, the patient’s system appears to be in a state highly calculated to favor cracking or chapping of the surface, such as we observe in many persons, who, when they commence bathing, find their hands and feet becoming very sore. These are always evidences of impurity in the body, and the proof of this fact is found in the circumstance, that if they set resolutely at work to renovate their health by the hydropathic treatment, they become cured of the symptoms, just in proportion as they become firmer and more vigorous in general health.

We need not expect to remedy sore nipples to any great extent so long as the breast remains inflamed. We must first cure the breast, and then with reasonable care and attention the nipple will soon heal of itself. But if the general system is at fault, the blood impure, and the skin at any moment, on the application of a little moisture, liable to crack, then our object should be to employ such a course of constitutional treatment as is calculated to improve the system generally. Sore nipple often consists “in a long, narrow ulcer, wide as a horse-hair, and a sixteenth of an inch long; this ulcer is so small, that it requires a good light to see it; and even then it often cannot be detected, except by bending the nipple over to the opposite side, which discloses it.” This ulcer is often so exceedingly painful, that the mother is unwilling to nurse the child as often as it should be done; thus exposing her to the evils of an over-distended and inflamed breast; and we may judge something of the anguish which the poor patient endures, when we see the tears streaming from her eyes every time the child attempts to nurse. We see, too, how difficult it must be, in many cases, to cure this kind of sore nipple, since every time the child takes it into its mouth it holds and stretches the part, thus causing the crack to become larger and worse.

A great variety of the so-called remedial substances have been tried for the cure of this affection. I would not say that none of the ointments, washes, powders, etc., which have been thus employed have any good effect. But one thing I am confident of, which is, that the water-dressing, that is, fine linen compresses or lint, wet in the purest and softest water, and often changed, to prevent their becoming too warm, in connection with appropriate constitutional treatment, will be found the best that can be resorted to.

Some have recommended very highly the use of nitrate of silver in curing sore nipple. Sometimes, perhaps often, it seems to work well, but by high authority in the profession it is affirmed that in many cases the disease is only made worse; nor has any rule been ascertained by which it can be determined beforehand as to whether harm or good will be the result in any given case.

Professor Meigs regards it as a matter of great consequence, in the application of nitrate of silver, to touch only the granulations, and not the skin itself. His method is, to take a fine camel’s-hair pencil, and dipping it in a solution of the nitrate, to carefully pencil the granulations only. The edge of a large feather, or the feather end of a goose quill, could very well be made to answer the same purpose. It is certain that this application will in many cases give relief, more or less, to sore nipples, as it does to sore lips and other parts; but, as before remarked, it sometimes makes them worse, and we have as yet no rule by which to determine beforehand as to what cases it will be applicable, and what cases not. Those who choose can experiment for themselves. I myself prefer the water-dressings; yet there is no good reason why the two may not be combined, if that is thought best. A solution of twenty grains of the nitrate to an ounce of pure water, is a good proportion in which to use it.

I have already spoken of cleanliness as a prophylactic means in the management of the nipples; and I would here again urge upon the attention of all who are interested in the subject, the exceeding great importance of this observance. Never should a child be nursed without the mother at once, on its leaving off, taking a sponge or soft linen cloth, and making the part perfectly clean, and afterward dry. This may appear a matter of small importance to some, but it is the attention to these small matters that go to make up the great sum of health. Professor Meigs, who admits the great frequency of sore nipples in his own practice, tells us of the method of one of the Philadelphia nurses, Mrs. De Groot, “a most sensible woman, in whose prudence and knowledge of her business he could confide,” and who informed him that the nipple rarely becomes sore under her management, which is as follows: “As soon as the child has left the nipple, Mrs. De Groot cleanses it with a bit of moistened linen. She dries it perfectly, and then, taking the mamilla (nipple) between the thumb and two fingers, she gently compresses it, with a view to assist it in disengorging its capillary vessels, that are rendered turgid by the suction. As soon as she has rendered it soft and flexible again, she covers it thick with fine arrow-root powder, and keeps it in that way perfectly dry. I do not remember,” continues the Professor, “that the ladies she has nursed for me have, any of them, suffered from this annoying disorder.”

Almost any dry substance, of an inert or harmless nature, such as Indian meal, or rye, or wheat flour, would answer as well as the flour of arrow-root to dry the nipple. I mention this fact for the reason that in many parts of the country arrow-root is not easy to be obtained.

The cracks or gaping ulcers of the nipples may be often helped very materially by acting upon a well-known principle of surgery. Wherever in the living body there is a gaping wound, the healing process is found to be facilitated by retaining the parts in close connection. Thus in a common cut or wound, when the edges are separated, we apply stitches or adhesive plaster to bring the parts into closer union, so that in the granulating or reparative process, nature has much less to accomplish. The greater the space to be filled by a new growth, the longer the time required, and the contrary. On this principle, then, of bringing the parts into closer union, thus giving nature a less amount of work to perform, a cracked nipple may often be benefited very much. A delicate strip, or better, if we can manage it, delicate _strips_ of plaster may be applied in such a way as to shorten the reparative process a good deal. Besides, too, the sore part is thus shielded from the action of milk or other deleterious substances that might otherwise come in contact with it. But the plaster has in it no healing property whatever; nothing at all in its nature which can aid the granulations. It only acts as a mechanical agent in keeping the parts in a more favorable condition for healing. The ulcer should be made as clean as possible before any such measure is resorted to.

I should mention particularly, before closing this subject, that bathing the breasts and nipples daily and often, in cool or cold water, before confinement, has a most salutary effect in hardening the parts, and rendering them less liable to inflammation and soreness of whatever kind. So too, indeed, we say of general bathing, and all habits which tend to the improvement of the general health. Always, the better the condition of the general system, the less liable to disease its local parts.

LETTER XXXVI. INFLAMMATION OF THE BREAST.

Structure of the Mammary Gland—Nature and Causes of Inflamed Breast—Means of Prevention and Cure.

It is very common in midwifery-practice to encounter swelling and inflammation of the breast, more commonly within a few days of delivery. In the majority of cases, this inflammation is managed without much difficulty; but in some cases it would appear that the part must suppurate, or break, as we say, forming what we call the mammary or milk abscess. This is one of the most troublesome things women are ever brought to endure; but however much pain and discomfort milk-abscess may cause the patient, it never kills; and yet the patient may be kept for months in the sick room, suffering from the affection more than tongue can tell.

Inflammation of the breast may come on at any time during lactation. It is more common, however, in the earlier than the later parts of the period. The nursing mother cannot, however, at any time be too careful in all matters pertaining to health, since a little imprudence is sufficient, in many cases, to induce this affection. In multitudes of instances it has been brought on by some apparently trifling carelessness, when, with a little forethought and self-denial, perhaps, months of pain, suffering, and discouragement might have been avoided.

In order to understand the management of the female breast during lactation, it is necessary that we should know what it is, its anatomical structure, and its physiological functions.

In structure, the breast is a conglomerate gland, and consists of lobes which are held together by a dense and firm cellular tissue; the lobes are composed of lobules, and the lobules of minute cæcal vesicles, the ultimate terminations of the excretory ducts.

Near the center of each breast there is a small projection of the tegumentary coverings, constituting what is called the nipple; this is surrounded by an areola or border, having a colored tint.

Before conception, this areola is of a pink color; after conception it assumes a brownish hue, which deepens in color as pregnancy advances. This brownish tint continues through life.

About the nipple there are a considerable number of sebaceous follicles, which secrete a peculiar fatty or oily substance for the protection of the delicate skin about the part. During the period of nursing, these follicles become increased in size, having the appearance of pimples projecting from the skin. The sebaceous or fatty secretion from these follicles serve, during lactation, to shield the delicate part from the action of the saliva of the child’s mouth.

The milk-tubes, or excretory ducts, as they are anatomically named, are usually ten to fifteen in number; and as many as twenty-one is said to have been found in a single breast. These tubes commence by small openings at the apex of the nipple, and passed inward parallel with each other toward the central part of the breast, at which place they become enlarged, and branch off in every direction throughout the mammary gland; these communicate in some way with the blood-vessels of the part, and, by a peculiar and wonderful provision of nature, the milk is formed from the blood within them. Among and about the milk-tubes, there are many adipose cells, more or less numerous, and more or less filled in different cases, giving to the part its peculiar rotundity and softness.

The milk-tubes are capable of supplying a quantity of milk greater or less, as the case may be. With some persons, an immense quantity is secreted; at a single time a pint or more of milk may be drawn with a breast-tube from a single breast. But we are not to suppose that all this amount of milk is contained within the ducts at the time we commence drawing it; a small portion may be there, but the greater part is secreted after we commence. After a time the power of the gland to produce it being exhausted, the milk ceases to flow; but after nature has been allowed to rest an hour or two, it again recovers its milk-giving power, and is ready to furnish it liberally, as before. A good cow has an udder, which, if we were to cut it off, could readily be put into a small pail; and yet this same cow is capable of giving milk enough at a single milking to fill two or three pails of the same size. This shows us how admirably fitted these organs are for pouring out that material which is so necessary for the sustenance of the young: a material, simple as it may appear, yet one which art and science, with all their boasted pretensions, cannot at all imitate. The chemist can tell us that milk is composed of a mixture of water, albumen, casein, and oil, which we call cream; but all the chemists in the world cannot make a drop of milk, or any thing that, in physiological properties, will at all compare with it.

The breasts are abundantly supplied with nerves and blood-vessels, and it must be evident that so great a functional power as that which is exerted by the mammary gland during lactation, must be supported by a great quantity of blood and nervous force. Hence it is, that during nursing, the breasts are supplied with a much larger amount of blood, and are much larger in volume than at other times. In this wonderful fact, as in many others of the living body, we see the ever-beautiful order of nature, in adapting her means to her ends. If every thing happened by chance, we might just as soon find the breasts containing less blood when milk is needed, as more. But the doctrine of chance is too palpably absurd to need comment.

_Symptoms of Inflammation of the Breast._—A day or two, or a few days after delivery, we often find the patient apparently so well and in such good spirits that we conclude there is no further need of our attentions. But in a day or two more we are sent for in great haste perhaps. We go, and find the patient downcast, dispirited, and evidently enough sick. We inquire as to what has been the matter. The patient tells us she has been attacked with a chill, in spite of which she could not get warm for one or two hours, or perhaps longer; just such a chill as would be experienced in the coming on of an ague, or any other fever, or some inflammation.

“Inflammation of the breast,” according to a very accurate writer, Dr. Burns, “may be divided into three species, according to its seat—the sub-cutaneous cellular substance, the fascia, and the glandular substance.

“It may take place at any period of nursing, but is most readily excited within a month after delivery. It may be caused by the direct application of cold, engorgement from milk, the irritation of excoriated nipples, mental agitation, etc. Some have the breasts prodigiously distended when the milk first comes, and the hardness extends even to the axillæ. If, in these cases, the nipple be flat, or the milk does not run freely, the fascia partially, in some habits, rapidly inflames. Others are more prone to have the dense substance, in which the acini and ducts are imbedded, or the acini themselves, inflamed.

“The sub-cutaneous inflammation, if circumscribed, differs in nothing from a common phlegmon, and requires the same treatment. It is not easy to resolve it, but a tepid poultice will do this, if it can be done; if not, it brings it forward. When it bursts, the poultice should be exchanged, in a day or two, for mild dressings.

“The inflammation of the fascia, if light, is marked by some little tension of the breast, with erythema of the skin over the affected portion. There is considerable fever, but not much pain, and the disease is likely to yield to tepid fomentations and a purgative, if the milk can be drawn off freely. If the fascia be more extensively or severely inflamed, the breast swells quickly, and this distention adds to the disease, which, indeed, is often caused, at first, by distention of the fascia. The pain is great, and the fever considerable. The inflammation never is confined to the fascia, but is communicated either to the sub-cutaneous cellular substance above it, or to the parts below it, usually to the former, and after, at the same time, to the latter.

“When the deeper parts are affected, the inflammation may be more or less prominent in the lactiferous ducts, or a cluster of acini; or often in that dense, peculiar kind of substance, which is their medium of union, or in those fatty packets which are sometimes met with in the gland. Often it seems to commence in one of the sinuses near the nipple, and, spreading, involves the surrounding cellular substance. In this case, it becomes prominent, and seems as if quite superficial. Milk is not secreted by those acini which have suffered. Matter presently forms, and spreads under the fascia with much distraction; and when, at last, after long suffering, the abscess gives way, much pus is discharged, with pieces of slough, chiefly consisting of portions of fascia. Usually, there is a considerable degree of fever attending the complaint, and the pain is often severe, especially when the breast is extensively affected.”

_Treatment._—A great variety of methods have been adopted for the prevention and cure of inflamed breasts. This affection is often brought on, doubtless, by carelessness, neglect of drawing the milk from the parts sufficiently often in the beginning, excessive fatigue, seeing too much company, too much care and anxiety of the mind, overfeeding, hot and stimulating drinks, feather beds and pillows, overheated rooms, want of attention to bathing and cleanliness, and last though not least, excessive drugging; these are among the more prominent of the causes of inflamed breasts.

The first and most important consideration, then, is to avoid, if possible, the disease. _Mothers, and all of you who hope or expect to become mothers, if you wish to save yourselves a great deal of needless pain and suffering, a great deal of restlessness at night; if you wish to avoid one of the most troublesome and disheartening affections to which the female system is ever liable, I warn you in the strongest feelings of sympathy and regard for your sex, that you avoid, so far as is possible in the nature of things, the_ CAUSES _of this terrible disease_.

But some have poor, feeble, scrofulous constitutions, and cannot by any possibility avoid the inflammation of which I am speaking; and, do what we will—the best that, in the nature of things, can be—the breast must, I think, in some cases inflame, suppurate, and break. An accidental blow, likewise, so slight that it would scarcely be felt upon almost any other part of the system, may cause a mammary inflammation and abscess. And, worst of all, to think of many a poor mother who has so poor a habitation, is so much oppressed by the cares and perplexities of domestic life, and has such poor care and nursing that she is always in great danger of suffering with inflamed breasts.

The treatment of this affection, therefore, is a matter for the serious consideration of both parents and physicians; and, as I before remarked, a great variety of methods have been adopted for this end.

We should remember that we are to treat an INFLAMMATION, and that the plain principle of treating all inflammations, of whatever grade or kind, when of acute character, is the antiphlogistic or anti-inflammatory plan. By what means and to what extent to use these means, are circumstances in which the skill, tact, and good judgment of the physician are to be exercised.

A very common error has been to treat too much _locally_ in this disease. This is, in fact, a very common fault in medical practice generally. I have no doubt that many an inflamed breast has been rendered worse than it otherwise would have been by the too great amount of local means employed. In many such cases, doubtless, the breast has been made worse than it would have been had no treatment whatever been employed.

As soon, therefore, as the patient begins to experience a chill coming upon her, with pains in the back, limbs, etc., together with a general uneasiness and restlessness, and, perhaps, with an inflammation already commenced in one or both of the breasts, no time should be lost in setting at work resolutely to combat the approaching evil. The sooner we act, and the more prompt and resolute in the treatment, the greater the chance of preventing an abscess. We give the rubbing wet-sheet, if there is not already too much fever, the tepid shallow-bath, with a good deal of friction; a general cold bath, if the patient is not too weak; the packing sheet, the wet girdle, wet compresses upon the breasts, injections of tepid water, and follow up the applications as much and as often as the symptoms may demand. Above all, the patient should not be worried by a multitude of ignorant and careless, though, perhaps, well-meaning friends, who each and all insist that some particular poultice, or some favorite “cure-all” of theirs will certainly arrest the difficulty, if the patient will but condescend to use it, and that if she keeps on with the water, it will certainly cause the breast to break. How exceedingly foolish, ignorant, and prejudiced are the multitude in regard to these things! Every practitioner of water well understands how much we have to encounter in society, because of the prevailing ignorance of the most common remedial uses of the greatest and most abundant of all curative agents which God has given to man.

As regards the temperature of the applications, local and general, we do no violence to the system. Should we persevere sufficiently, we could cure almost any fever or inflammation with water at 80° Fah., a temperature so mild that the most delicate child can bear it.

One thing in particular should be remembered: the patient should not be bundled up closely, and have a great deal of warm bed-clothing, under the impression that a cold will be taken if such measures are not adopted. We almost always find patients heating and injuring themselves in this way. But it should always be remembered, _that when a fever or inflammation is already present, it is not possible to take an additional cold_.

As for local applications upon the breasts, fine wet linen cloth should be used constantly. As to the temperature, I think it best to consult the patient’s feelings merely. It is, perhaps, best to alternate somewhat; sometimes to apply warm or tepid cloths, at other times cold. I think a change is often good; at any rate, we should keep the parts constantly wet.

The wet cloths are covered with dry ones, or flannels, if necessary; but if there is great heat in the part, it is best to leave the compresses uncovered, so that by evaporation a much greater amount of heat may be thrown off. Sometimes the breast becomes so heavy and painful, that it is a great comfort to the patient to have it suspended in a sling.

I have already hinted how important it is to keep the milk well drawn. The mouth of an adult person is one of the best means, and the infant is often able to do good service in this way. Some get along pretty well with a tobacco pipe. But the instruments generally found in the shops are illy suited to their object. One form, the suction-pump, is an invaluable piece of mechanism, provided the glass that fits upon the breast be of the right shape, and have an opening sufficiently large to admit a man’s thumb. Generally, they are much too small, causing a good deal of pain when used; but if they are of the right make, they will draw the breast with more comfort and less pain than the infant itself.

Before the breasts are drawn, they should be well washed, for this will always help the milk to flow; and in connection with this subject, there is one highly interesting and instructive fact in regard to bathing. Thus, a patient may be in a condition in which, in consequence of the inflammation present, no milk whatever can be obtained. But we give the patient a good ablution of the whole body, even a simple tepid-bath, and directly we may succeed in getting milk; and in some instances it is made actually to drop of itself from the breasts. Even the washing of the breasts alone will sometimes cause it thus to flow.

Should an inflamed breast ever be opened after the matter has once formed? The most common practice has been to do it. Dr. Gooch, however, who is high authority with the profession, speaking of this disease in that state in which the matter approaches the surface, says: “Will you open the abscess? If you do, you will relieve your patient from suffering, and by the evacuation of the matter the constitutional disturbance ceases; but the wound will not heal so soon, and the maturation of the abscess will not be so complete as if the whole process were left to nature.” I have myself opened them at the request of patients in some instances; but I have become convinced that it would have been better, in the end, not to do it.

Dr. Burns tells us—although he recommends opening the abscess—that the puncture is liable to be followed by a troublesome oozing of blood from the wound, and that in one instance he knew the hemorrhage to prove fatal.

After the abscess has burst, there is for some time a discharge of purulent matter, which is not unfrequently mixed with milk. The utmost cleanliness should be observed, and a considerable amount of general, as well as local treatment should be kept up until the healing is fully effected.

Thus, then, in the use of water, locally and generally applied, together with the proper adaptation of the other hygienic means, I consider that we have a remedy which far surpasses all others in that troublesome affection of which I am treating; a remedy which, if it cannot always cure the inflammation without an abscess, will yet so much mitigate it, so much promote the healing, and so much support the patient’s strength, that mammary abscess, if it must occur—and I think, do what we will, in some few instances such must be the case—it is yet stripped of its greatest horror, and rendered, generally, a comparatively trifling affair. Such has been my own experience, and such, I think, will be found to hold good wherever the water-treatment is faithfully and skillfully applied.

Dr. Burns has given us a sad picture of what not unfrequently results from mammary abscess; and that the reader may have, on good authority, an account of the sad condition which sometimes results from the affection, I quote his own words:

“It sometimes happens, if the constitution be scrofulous, the mind much harrassed, or the treatment not at first vigilant, that a very protracted, and even fatal disease, may result. The patient has repeated and almost daily shivering fits, followed by heat and perspiration, and accompanied with induration or sinuses in the breasts. She loses her appetite, and is constantly sick. Suppuration slowly forms, and perhaps the abscess bursts, after which the symptoms abate, but are soon renewed, and resist all internal and general remedies. On inspecting the breast at some point distant from the original opening, a degree of œdema may be discovered, a never-failing sign of the existence of deep-seated matter there, and, by pressure, fluctuation may be ascertained. This may become distinct very rapidly, and therefore the breast should be examined carefully, at least once a day. Poultices bring forward the abscess, but too slowly to save the strength, and, therefore, the new abscess, and every sinus which may have already formed or existed, must be, at one and the same time, freely and completely laid open, and, so soon as a new part suppurates, the same operation is to be performed.

If this be neglected, numerous sinuses form, slowly discharging fetid matter, and both breasts are often thus affected. There are daily shiverings, sick fits, and vomiting of bile; or absolute loathing of food, diarrhea, and either perspiration or a dry, scaly, or leprous state of the skin; and sometimes the internal glands seem to participate in the disease, as those of the mesentery, or the uterus is affected, and matter is discharged from the vagina. The pulse is frequent, and becomes gradually feebler, till, after a protracted suffering of some months, the patient sinks. It is observable, that often, in those cases which seem to depend on a constitutional cause, and when there is great debility, the sinuses heal rapidly, after being laid open, but a new part instantly begins to suppurate. Internal remedies cannot be depended on here, for they cannot be retained. If they can be taken, they are those of a tonic nature that we would employ, with opiates to abate diarrhea and procure sleep.”

LETTER XXXVII. CASES IN MIDWIFERY.

A Collection of Facts Illustrative of the Effects of Water-Treatment before, during, and after Childbirth.

In the year 1843, at which time the water-cure had been heard of this side of the Atlantic only by a very few, I for the first time applied water-treatment in a case of midwifery. I had, it is true, been for months, and I may say years, studying upon the matter, as a student of medicine who is determined, above all things, to learn and practice the truth, ought; yet I had no opportunity of bringing the principles which I believed in to bear directly upon any given case previously to the period referred to. The following then, are some of the leading particulars of my first case:

_Case I._—The lady was a resident of this city, of a feeble constitution by inheritance, and, I think, twenty-one or two years of age. For three or four years previous to her confinement her health had been, on the whole, much improved. Her constitution seemed, indeed, to undergo a remarkable change for the better, in consequence of leaving off tea, coffee, spices, butter, and flesh-meat, and at the same time practicing the daily bath. She, in short, became, as her flesh-eating friends said, “a thorough Grahamite.” Notwithstanding her improvement, however, she suffered miscarriage two or three times in as many years.

During the period of pregnancy of which I am speaking, I advised her to be very particular in keeping up her baths, exercise, diet, etc. She followed the advice faithfully. She suffered somewhat from neuralgic pains in the abdomen, but these were in general readily checked by the use of wet compresses, and the sitting and other baths. Few patients have ever been as faithful as she was in carrying out all good rules. She kept up her bathing and exercise to the very day of labor.

There was one circumstance which operated against her a good deal toward the close of the period. A worthy and skillful medical friend advised that she should have premature delivery brought on, because her pelvis was, as he said, too small to allow of the birth of a full-grown child. This advice, however, she would not, on any account, entertain, notwithstanding she had the utmost confidence in the skill and honesty of her friend. She resolved to trust God for the result, although she was well aware that she was to pass through a most fearful ordeal of danger and suffering. As it proved afterward—for she has borne a number of children since—her own instinct was better than all the knowledge of her medical friend.

Her labor was a very severe one, and she met it with most praiseworthy courage. She was at length delivered safely. The child was of more than average size, but owing to a malformation it could not live. Her maternal feelings were of the strongest kind, and the loss of her child was a great blow upon her spirits. She was, however, up daily, more or less, from the very first. Indeed, it was not two hours after the birth—she having been awake all night—before she stood up, and was thoroughly washed in cold water from head to foot. She knew what cold water had done for her before, and she was not afraid that it would fail her now in her time of need.

She pursued the treatment from day to day, observing the greatest care not to overdo. She understood well, young as she was, the great importance of mental quiet under such circumstances, and saw no company for many days. On the sixth day she had so far recovered as to be able to walk to the Battery, a distance of a mile and a half. The weather being hot, she rested awhile upon the shady seats of that beautiful inclosure, and was much refreshed with the sea breezes which are so genial at that season of the year. Afterward she walked back home, making, in all, a morning excursion of three miles.

This, then, I put down as one of the first of the American cases of hydropathy, and _the_ first in childbirth. Thanks to Priessnitz, there have been thousands since.

_Case II.—June 26, 1846._—Two weeks ago, Mrs. E., of 56 Prince Street, informed me that she had arrived very near the end of the period of her first pregnancy, and that she desired me to attend her in childbirth. By conversation I soon found she was well-informed in the new system, and the modes of preserving health, and this without her having had any particular advantages for acquiring such knowledge. She had read faithfully and understanding upon the subject of health, a duty which too few mothers observe. Mrs. E. is about twenty-two years of age, with constitution naturally very good, although not remarkably strong. Her attention became directed to bathing about two months since. She performed two ablutions daily, and took sitz-baths; discontinued the use of tea and coffee, took very little animal food, living principally upon coarse bread, hominy, cracked wheat, and fruits. She took frequent exercise in the open air, and by these means became sensibly invigorated in general health, and was kept perfectly free from unpleasant symptoms of every kind. I advised my patient to go on as she had done perseveringly and to the last. Her very kind and affectionate husband and her mother, as well as other good-meaning relations, insisted that she should take a different course, particularly in food and drink. But she chose understandingly to pursue her own way, feeling full confidence that she would be able to prove to her friends that she was in the right, and that young persons were not necessarily less knowing than older ones.

_June 26._—To-day Mrs. E. sent for me early in the morning. She had experienced by turns slight labor pains from 9 A. M. the day before; was not able to sleep much in the night. Took baths as usual, and walked in the open air. This morning she practiced general ablution and sitting-baths as usual. Cold water renders the pains more efficient, which is a good symptom. Walking about the room has the same effect. The pains increased very gradually, and this afternoon, notwithstanding they grew more severe, she was able to sleep at times between them. These continued to increase until six o’clock this evening, at which time she gave birth to a remarkably fine, healthy daughter. In a few minutes the after-birth was expelled, and no undue flooding occurred. Wet towels were placed upon the abdomen and the genital parts, and the face, hands, and feet were sponged, each of these applications having a most soothing and refreshing effect.

In the case of the infant, care was taken to avoid the great error so generally practiced, of separating the cord by which the child is attached to the mother, too soon.

The separation after due time being made, the infant was washed in soft water made very slightly tepid, with the addition of a little mild soap. No bandage was put about its abdomen, for the reason that it always causes more or less harm—that is, if there is no malformation of parts, and always tends to induce the very difficulty it is designed to prevent, viz., that of rupture. The kind-hearted mother of Mrs. E. insisted, as a matter of course, that the bandage should be applied as in the good days of old, but Mrs. E. said “_Do as the doctor says._” Very light muslin clothing was then placed upon the infant, after which it was left, without drug or dose, quietly to sleep.

_9½ o’clock, Evening._—Returned. Mrs. E., happy and contented, has been enjoying sound, refreshing sleep. Has had no nourishment since morning. Took then a little fruit. Prefers to wait until morning before taking any more. I recommended her to take fruit every day from the first, that the infant may be accustomed to her doing so. If mothers omit fruit for a while and then commence its use, the milk generally distresses the child. I believe that, as a rule, the judicious use of well-matured fruits will not cause any difficulty in the child, provided the above direction is from the first and onward complied with.

Mrs. E. is now to take a bath—that is, with assistance, the whole surface is to be cleansed, portion by portion, by means of cloths wet in moderately cold water. This will cause a sense of great comfort—will increase the strength and promote sleep. As is very common on such occasions, the friends object strongly to the use of cold water. “Oh, it will give you a death cold! how can you do it?” and the like expressions are used. But the patient well understands that she needs the invigorating and soothing effect of the ablution, and that when the system is sufficiently warm, it will not only be perfectly safe, but highly beneficial. She prefers, as she has done, to practice upon rational and well-ascertained principles, rather than to be guided by the whims and caprices that custom with its iron rule entails upon society.

_First Morning after Confinement.—June 27, Six o’clock._—Mrs. E. slept sweetly and soundly during the whole night, waking only a few minutes at one time. She feels greatly refreshed, and able to rise and take a bath; judges by her feelings that she will be benefited by sitting up; has a good appetite. I advise her to sit up as much of the time, little by little, as she feels inclined. She proposes eating very sparingly of well-boiled cracked wheat, with a little uncooked milk and berries.

_Half-past Nine, P. M._—Mrs. E. has sat up at different times during the day. No after-pains or particular discomfort of any kind. Every time of sitting up has done her good. She has taken food at three different times. Will take a sponging now, and retire to rest.

_Second Morning after the Birth._—Mrs. E. slept remarkably well during the whole night. Has been up, performed a bath, walked about the room, and is much invigorated. Felt decidedly the need of the bath; it strengthened her much. Has no after-pains or difficulty of the breasts. The milk secretes abundantly. The bowels are moved by injections of tepid water. Mrs. E. will sit up the greater part of the day.

_Third Morning after Birth.—Eleven, A. M._—Mrs. E. rested well during the night. Arose at six, and took her usual bath. Reclines now awhile. Would be able to walk up and down stairs were it necessary. Her infant is remarkably well, and sleeps the greater part of the time. Mrs. E. is one of that very small number of mothers that has energy of character, resolution, and system enough to nurse her infant regularly, and not during the night time. Once in three hours, between 6 A. M. and 9 P. M., at the very most, is as often as she will allow it to take the breast.

_Seventh Day._—Mrs. E. has been improving day by day, from the first. She has had no inconvenience whatever; no pains of any kind, no swelling of the breasts or feverishness. Has well-nigh her natural amount of strength. Her infant, too, is doing remarkably well.

_Case III.—Nov., 1845._—Mrs. C., a poor woman of this city, not long since made known to me, that in her destitute condition she would receive, as a great favor, if I would attend her in childbirth. She informed me that on previous like occasions, she had suffered beyond description, both at the time of confinement and subsequently. She had borne two children—the first it was necessary for her physician to destroy before the birth could take place. The birth of the second was also attended with the greatest difficulty. It was now some weeks before her expected time. Her husband had deserted her, so that she was compelled to follow her occupation (that of a seamstress) during the whole day and much of the night. From this constant sitting and confinement within doors, she had become much enfeebled, and had a severe and constant pain in the side.

I directed her to wash the whole body daily twice, when not chilly, in Croton water, and to take each half day as much exercise in the open air as she could possibly find time for, and could practice without causing too great fatigue. The woman followed the directions, and was at once sensibly benefited. The severe pain in the side left her almost immediately. When her period arrived, delivery took place in a very short time, and with comparatively little suffering. Bathing in mild forms was practiced the day of, and subsequent to, delivery, and the patient walked about each day, and was scarcely _confined_ a single hour.

There is one fact to be mentioned in her management of the infant. She was directed at first to have it washed in tepid water. Supposing she would follow the same course for the future daily washings, I made no further inquiry till some days after, when I ascertained that she had used the water of the natural temperature. I asked her why she did not moderate the temperature of the water as at first, and as people generally do. She answered, that when she bathed herself before the child’s birth, every bath seemed to strengthen it very much; and, therefore, she chose to use the cold water now for the same reason. She had the good sense always to keep the child sufficiently warm, particularly after the bath. It is proper to mention that the Croton water at this time was not far from 65° Fah. The child has been, and is now, one of the healthiest and most vigorous I have ever seen of the age.

The above notes were written some months since. The case is again brought to mind, by the mother’s coming to-day to work for us at her usual occupation. She says, “What a strange thing it is, my little baby has never been sick a single hour. What wouldn’t I give if my other boy could have been so.” The child is one of the brightest imaginable; knowing, observing, good-natured, and now, at the age of six months, sits near his mother, playing, laughing, crowing—the most perfect picture of health. He is every day once, and generally twice, washed in cold water.

_Case IV.—Oct. 25, 1847._—The same woman was again confined early last spring. She had been living, I found, in a small cellar-room, where there were but three small panes of glass, and to which the sun could never come. The place was damp and dark, and the air necessarily very foul, it being in an alley in which many poor, dirty families were living. Here the poor woman lived, paying an exorbitant rent, supporting herself and two children by the hardest work rather than beg.

The night of her confinement was a very stormy one. The wind howled among the old buildings, tearing off shingles and shutters, and the rain poured down in perfect torrents. Ships were lost that night, and sailors, with the captain and officers, swept overboard.

The labor this time, as before, was an easy one. It took place at midnight. Every thing went on well, and she was, after a reasonable time, left to get sleep, as we supposed she would. I found, however, in the morning, that, notwithstanding she had been wholly free from pain, she had not slept at all. She acknowledged that, powerful as had been the effects of water for good at the previous time, the old ideas had yet haunted her, that she must either die, or submit to the application of those terrible instruments that had been used in her first confinement. She now felt so rejoiced at her getting through again safely, that she could not sleep at all. So we found her in the morning early, she, her two children, and the new-born babe, all on one narrow settee bed together, apparently contented and happy.

Two ladies who understood these matters of water-treatment, went now, it being Saturday morning, and administered our patient a bath. The water was moderated a little, but left still quite cool. This day she could obtain no sleep, for she had but one room, and the children must remain there. She sat up considerably, but not so much as to cause over-fatigue. In the evening the ladies went again, and administered the bath. She slept well during the night. The next morning, Sunday (the second day), the ablution was administered at 7 o’clock, at which time the patient arose. She remained up all day, until 10 o’clock in the evening, at which time the ladies again administered the bath. She slept well this night, was up all the next day, and so onward, and has been constantly well up to the present time.

_Case V.—Dec. 12, 1845._—Was called in the night between one and two, by Mr. Brown, living at 40 Oliver-st., to visit his wife, then in labor. At the beginning of the evening previous, Mrs. B. began to experience premonitory symptoms—took, as usual, a sitting-bath, reclined upon the bed, and slept about three hours, when she was awakened at 10 o’clock by labor pains. These occurred regularly until the time of our arrival and onward, growing more and more effectual, until four in the morning, at which time she gave birth to a fine healthy daughter. The after-birth was cast off in a few minutes, after which Mrs. B. felt easy and inclined to rest. After being made comfortable, she was desired to sleep awhile, and was told that she would be refreshed and invigorated by an ablution after sleep, and that she would be able to sit up a short time by way of a change.

_Nine, P. M._—Returned to see Mrs. B. Found her quite comfortable, after-pains slight; had slept a part of the time. From the commencement of labor she had drank as freely of Croton water as was desired—had drank nothing but cold water for about a year. Had she been accustomed to warm or hot drinks there would have been a liability to increase of after-pains by taking cold water. In such cases the drink must be warm, unless there is much feverishness and thirst, in which the cold drink would be tolerated and most agreeable. Appetite was good. Mrs. B. said she could relish any thing; was very fond of Indian mush, with a little syrup; thought she had better not take any thing till dinner time—she would drink water, and be on the safe side. To this I of course agreed. She felt none of the giddiness, nervousness, great weakness, and depression of spirits she had always hitherto felt after childbirth. There was now and then a slight after-pain. She sits up little by little, and drinks water when she feels an inclination. She will take food once to-day, that is dinner, and I will come again by evening.

_Seven, P. M._—Returned again. Mrs. Brown has been sitting up and bearing her weight at different times during the day. She ate of the plain favorite dish, Indian mush and molasses, with a piece of dry bread, and water to drink. The bread tasted very sweet, the appetite was so good. The husband had now returned, and the bathing could be carried out. A wash-tub was brought into the room, and placed before the fire to be warmed. At the same time, water, warm and cold, was procured. A stick of wood was placed under one side of the tub, and thus the two-fold object of a hip and general rubbing-bath could be accomplished at the same time. Mrs. B. walked to the tub, and, her husband aiding, took a good bath. The water was made mild, of about 80° or 85° Fah.; while sitting in the bath, the body being well guarded all about with blankets, a good deal of rubbing was practiced upon different parts of the system, and particularly the back. This had the effect of promoting after-pains, and of strengthening the part, and in fact the whole system, very much. The lower extremities were, of course, outside the tub, and those were bathed afterward. A night-bath of this kind at such times seems, indeed, to increase the strength tenfold. Pains are relieved, the nerves strengthened, and a wonderful change wrought.

_Second Day (Sunday), between Eight and Nine, A. M._—Mrs. B. slept well during the night, and until late this morning. All were in bed so long, and as Mrs. B. appeared so well, it was thought best, for want of time, to omit the general bath until toward dinner. Told her that, for a change, it would be best to go occasionally to other parts of the house; but to be careful not to overdo, or to be up too long. At any time pain or weakness was felt in the back, a good rubbing of the part with the wet hand or towel would prove very serviceable. Requested Mr. Brown that an enema of tepid water be administered. This could be repeated twice if necessary to cause the desired effect.

_Six o’clock, P. M._—Mrs. B. has eaten to-day sparingly twice, a breakfast and dinner, the last with her family. Has walked up and down stairs without inconvenience or assistance.

_Third Day (Wednesday), A. M._—Mrs. B. rested well last night. Feeling a little fatigue the preceding evening, she concluded to omit the bath. It would have been refreshing, however, but this morning she feels remarkably well, and has been doing light work. Has been up nearly all the morning. Took the sitting and general rubbing-bath early before breakfast. Was cautioned not to be up or to do too much. Food to be plain, as usual, and the drink, cold water.

_Seven, P. M._—Mrs. B. has been up most of the day. Appetite remarkably good; thinks she took a little cold by sitting unconsciously in a draught of air. A carious tooth commenced aching, which proved a warning. There has been some feverishness, probably nothing more than milk fever. This will be prevented by the tepid-bath, the latter to be repeated as often as the feverishness returns, if such should be the case. There has been some caking and pain in the breasts. The pain is effectually removed by perseverance in placing very warm or hot wet napkins upon the breasts, covering these with dry warm flannels, and repeating them very often until the pain is relieved. Breasts to be well drawn, and the bowels moved by a full injection of tepid water. If Mrs. B. perseveres as she always has, she will have a good night’s rest.

_Fourth Day._—Mrs. B. rested well; continues the baths, plain diet, sitting up, and moderate exercise, as usual, and is progressing rapidly toward firm health and strength.

_Fifth, Sixth, and Seventh Days._—Mrs. B. proceeded cautiously, and with the most favorable results.

_Eighth Day, Eleven, A. M._—Mrs. B. has been about all the morning, has been giving way to her great propensity to industry, practicing at the wash-tub. She does not believe at all in idleness. The only danger is that she may do too much.

_Ninth Day._—Mrs. B. is about as usual; feels that she has an abundance of strength to walk some distance in the city. She could walk out with impunity, notwithstanding the weather is very cold, but it is thought best, on the whole, since she is so much about house, and pays so much attention to bathing and ventilation, that she should remain within doors yet, a little.

She says that at the end of three weeks from the birth of the child next older, when beginning to attempt to sit up, she was weaker than she has been at any moment since the birth of the last one. With all her children she has been very weak.

_Case VI._—Late in the month of January, of the present year (1850), I was called early in the morning to visit a young married lady, in Fourth Avenue, who was said to be in great suffering from spasms and vomiting. She had not slept during the night, and it was necessary for her husband to remain up with her the whole time. I found her with very high general fever, and oft-recurring spasms, attended with bilious vomiting. The fact of her being in an advanced stage of pregnancy, with this complication of untoward symptoms upon her, designated the case too clearly to a practiced observer, as being one of both delicacy and danger. The parties in the case had no knowledge whatever of the water-cure, or of my particular methods of treatment, and had called me, being the nearest physician, and, as they supposed, of the old school. No medicines had as yet been administered, but the patient, as is common on such occasions, had been deluged with a great variety of articles, in the way of liquid food and drinks, with the hope of “settling the stomach,” a process which can seldom succeed, and, as often practiced, is quite sufficient of itself to make even a well person sick.

The patient and her husband both thought, as a matter of course, that “some physic must be given.” I told them we would first give a tepid-bath, at 70° Fah. This I assured them would give great relief, and knowing well, too, the great prejudice among English people (for they were English) against bathing in pregnancy, I aided the husband, with my own hands, in administering it, thus to be certain of its being well and faithfully done. This they both thought at the time a rather harsh method of treatment; but they had employed the doctor, and he being resolute and determined, they could not refuse. The bath gave great relief, and then, all shivering and cold, a very large wet girdle was put upon the patient, after which she was wrapped warmly in bed, with moderately warm bricks to the feet.

After having allowed the patient to rest awhile, a large injection was administered, and with the best effect. Occasionally, too, retching still occurred (for symptoms of this kind never cease suddenly, and, indeed, should not), at which times tepid water was given freely to drink, for the purpose of aiding vomiting.

Thus the treatment was pursued: as the symptoms appeared to demand, the tepid half-bath, with a good deal of friction, the wet girdle, constantly or nearly so, the injections, and the water-drinking were kept up. From the first moment onward, the patient recovered as rapidly as could be desired. She slept a good deal during the day, and also well at night. The next morning she was quite well, although weak. She then commenced taking nourishment gradually. No further serious troubles were experienced during the period of pregnancy.

The 4th of April, 1850, the above-mentioned lady, at about the end of eight months of pregnancy, as was supposed was delivered. There was more or less of pain during thirty-six hours previous to the birth. The pains were rather severe during the most of twenty-four hours, proving that good health, with abundant exercise and bathing, are not necessarily of themselves capable of causing short and easy labor.

The child was born at about five o’clock in the afternoon. Soon a thorough ablution was performed in the sitting-bath. No patient ever had a better understanding of what was necessary in the case, and none, certainly, could be more free from all sensations of false modesty or delicacy; nor could any one pursue the treatment with greater confidence than she did. There was no time when she could not easily sit up or stand, if necessary, and, with the good nursing of her husband, she improved most rapidly. She wore the wet girdle most of the time, alternating, however, now and then, with simple fomentations. She bathed four times during the first twenty-four hours after the birth, washing the whole body thoroughly at each time, the water being moderated to from 60° to 70° Fah. She sat up during this time about six hours in all, and walked by spells a little in her room. She suffered somewhat with after-pains, but the means before mentioned, together with injections to the bowels, generally brought relief. All along her appetite and sleep were good.

The second day the patient sat up most of the time, and walked to other parts of the house, and for an hour and a half visited a friend. She could have gone abroad in the open air, had it been necessary for her so to do.

The third morning, that is, when her infant was two and a half days old, the patient walked with her husband a distance of about three fourths of a mile, visiting a friend. She was fatigued somewhat, but, on the whole, benefited by the undertaking.

After this, she walked abroad in the open air daily, always having to go down from the third story of the house in which she lived. In one week she went about the city, teaching her scholars in French, German, music, etc., as she had done up to the very day of labor.

And now, to exhibit things in their true light, let this lady’s case, as it occurred under water-treatment, be contrasted with the drug-treatment employed on a previous like occasion.

Between two and three years before, she was pregnant with her first child. Then, as during the last time, she was attacked with cramps, vomiting, and fever. She was laid by a fire in an almost insensible state, and had mustard draughts placed over a large part of the surface. She was also dosed a good deal internally, and salivated with calomel.

At labor, as well as during pregnancy, she was attended by one of the best physicians of London. It was three weeks before she could leave her bed; in four weeks she left her room for the first, and did not go out of the house until six weeks had elapsed. _She was then no stronger than in two days after confinement, under water-treatment._

Here, then, was a great difference in the result of the two methods—a difference so great that it cannot possibly be appreciated, except by those who have actually experienced them in their own persons.

One fact more should be mentioned in this case; the lady had been exceedingly depressed in mind through the whole, or most of the period; she, with her husband, having left the Old World for the New. A combination of circumstances most perplexing and depressing had worked upon her mind, and she was haunted perpetually with the idea that she must die a stranger in a strange country. Thus things went on till about nine weeks before she was confined, or the time before-mentioned, of her acute illness. But no sooner were the laws of life, health, and disease unfolded to her ever-active and intelligent mind, than she at once set resolutely and cheerfully to the performing of every task. No item in the way of bathing, exercise, diet, etc., was ever omitted. The story of her case tells whether or not she was rewarded for her faithfulness.

_Case VII._—Early in the morning of the 22d of May, 1850, I was called to visit a lady of this city, about thirty years of age, far advanced in her sixth pregnancy. She had, during this period, as before, been much in the habit of taking alcoholic stimulants, principally in the form of brandy, judging, from her feelings, she needed the stimulus. But its only effect was to render her at all times much more liable to take on inflammatory disease.

Four days before I was called, this lady was taken with very severe bilious vomiting, and cramp of the stomach. Two physicians were consulted, and a variety of medicines used. Still the patient continued, day by day, to grow worse, and could get neither relief nor sleep. Being told that she was in danger of convulsions, she and her husband concluded they would change their physician and try the water-treatment.

I found the patient then retching and vomiting almost incessantly, the stomach cramping, the bowels constipated, with high general fever and flush of countenance, the pulse being 130 per minute, or about double its normal beat, and the patient had not slept for three days.

_Treatment._—This was very simple. The whole body was well washed in water at about 80° Fah., a full clyster was administered, and wet, cooling fomentations were put freely over the chest and abdomen. Almost immediately the patient experienced a short but refreshing sleep. The cloths were changed often, the surface was sponged as it became too hot or uncomfortable. The general washing in the wash-tub was practiced once in four hours from the first, which always brought sleep. When retching and nausea came on, tepid water was taken freely to help the vomiting. This gave great relief. No other drink than water was taken, and no food until the vomiting had ceased. After this, well-boiled Indian-meal gruel was given, beginning with a single tea-spoonful at first, and then increasing the quantity as could be borne, at the next regular meal-time. After the first day the patient was bathed three or four times in the twenty-four hours. The clysters and fomentations were continued as circumstances required. No very cold water was used in any form.

In three days’ time the patient was up and about, and in all respects quite well, though somewhat weak.

Eleven days after commencing the treatment in the above case, namely, on Sunday morning, the 2d of June, 1850, the patient was taken very suddenly in labor. Within half an hour after the very first sensation of any pain, and before her husband could call me, her child was born, a sixth son. She suffered but little, and was delivered while in the standing posture, but the after-birth remained unborn. I found her weeping for fear that she would be subjected to some horrible water-applications, of which she had read. I told her that my mode of practice was altogether different from that which she so much feared, and that, at any rate, no honest physician would ever subject a patient to any process which she could not heartily concur in. I told her, moreover, that I would much prefer that she should have her old physician if she chose, and that she could not possibly offend me if she would but frankly take her own choice. Her husband then desired that she would pursue that course which she herself preferred. With the explanation I had given, she concluded at once to go on with the matter as I might see fit to advise. “Well,” said I to myself, “we will see how a mixed treatment will answer—a little of the old, and a little of the new.”

The patient was perfectly willing to be bathed in tepid water, which I also advised. But she wanted the old-fashioned obstetrical bandage or binder, as she had used it before. I explained to her all about its nature and effects, and consented that she might use it if she would take it off at each time of bathing, and at all times when she found it causing too great heat. Her husband bathed her four times the first day in bed; the women would not help at all. She was able to sit up in bed, and the second day and onward, she bathed herself, the old nurse always making herself absent at the time. She had suffered with after-pains before, but nothing worth mentioning this time. Injections were used from time to time, and the wet towels over the abdomen. The second day the patient was up in her room. The third morning, as I went to her door, I heard some one singing, and, on entering, found it was the patient herself, alone, sitting up with her infant in her arms.

The fourth morning the lady was so well that there was no excuse for a doctor any more. She said she had to keep her room, and mostly her bed, for four weeks always before. Now in three days she was perfectly well, bathing herself repeatedly every day; whereas always before she had never dared wash herself short of a whole month, _and then only with whisky_! She was now convinced that the only safe way to prevent taking cold, was _to bathe_.

This, then, may be put down as a remarkable case. Eleven days before labor the patient was very dangerously sick. The birth was exceedingly easy and short; and, although such labors are not, on the whole, as safe as those which are more difficult and protracted, she yet recovered her usual health in a remarkably short period of time, and without any mishap or pain. She bathed but very little, comparatively, although that little told well. No application whatever of cold water was made.

_Case VIII._—While the cholera was committing its fearful ravages in the city of Brooklyn, during the summer of 1849, a worthy and intelligent lady, the wife of a sea captain, was preparing to leave for the country, whither I was to go with her to attend her looked-for case of childbirth. Monday, the 9th day of July, she was busy packing trunks and preparing to move, and probably overworked. At all events, she did not feel well, and experienced pains similar to those of labor, all day Tuesday. I remained in the house over night, but in the morning the patient was better. Still there occurred at times periodical pains, and I told the patient that if they were true and natural pains of labor, a bath would accelerate and make them worse; or if they were false pains, and such as did not indicate the near approach of labor, the bath would cure or render them less. They were, however, increased.

At eight o’clock in the evening labor came to a close, the result being a fine, healthy, female child. One hour after, namely, at 9 o’clock, the patient feeling rested, was helped into a sitting-bath tub, and well washed, for some minutes, over the whole surface. The water was fresh and cool from the cistern. As may be imagined, the patient felt incomparably more comfortable after a good cleansing in this manner, and a degree of refreshment that can be conceived of only by those who have had the practical illustration of it in their own persons, was experienced. A plenty of wet linen towels were placed over the abdomen and genitals, and by these means the patient was enabled to pass, on the whole, a very good night.

She had, she informed me, always suffered intolerable anguish for days after the birth of her other children, five or six in number, I believe. Even with the first—a thing very uncommon—she had experienced most severe torture. It was therefore a great object at this time to do every thing possible to prevent the after-pains. Toward morning, as she began to grow more warm, the pains came on in a slight degree.

At 6½ o’clock (the 12th, the first morning after the birth), the patient was again thoroughly washed from head to foot in the hip-tub. After this a large linen sheet, the whole being wet, and folded in the form of a very large girdle (large enough to cover the whole trunk of the body), was employed. It was wrapped round from end to end, its object being to act as a great and moderately cooling, and necessarily soothing fomentation, to the body, to keep off inflammation and subdue pain. The weather being most excessively sultry and hot, only one dry sheet was placed over her as a covering. She was to remain in this condition so long as the wet sheet did not become uncomfortable or too warm. At 10 the same forenoon, after having slept a good nap, a second ablution was practiced.

She now took a trifle of nourishment in the form of oatmeal gruel, the first since the birth of the child. The two whole days previous, likewise, she had not eaten in all the amount of half a common meal. This three days’ abstinence proved a most valuable means in warding off fever and pain. Nor did it materially impair the strength.

In the afternoon of the same day (the 12th) the patient again took a good bath, fresh from the cistern. She slept considerably both forenoon and afternoon, _and suffered positively no more pain_. She sat up in her rocking-chair to rest herself in the afternoon and evening, at which time still another bath was to be repeated; but feeling so comfortable, and sleeping withal, she concluded to omit it.

The next morning (the 13th) the patient sat up and took her breakfast, namely, a small piece of simple brown-bread toast.

Thus she went on, bathing and using the fomentations freely each and every day, and very soon regained her full strength. Indeed, she was not at any time so weak as to prevent her walking. She always, after the first night, appeared happy, cheerful, and smiling. She now had no pains whatever, while always before, in childbed, she had suffered greatly for many days after the birth.

The peculiarities of this case are the following:

1. The patient bathed during the whole period of pregnancy daily, by means of that invaluable application, the dripping or rubbing wet-sheet.

2. She wore, of her own accord, the wet compress over the stomach the whole time of pregnancy, night and day; a means which seemed most effectually to prevent heart-burn, nausea, and a host of stomach difficulties, to which she had on previous like occasions been subject.

3. The very abstemious diet subsisted on. She ate much of the time but little else than brown bread and water, and this in small quantity.