Chapter I: Part 1

THE MARRIED WOMAN’S
PRIVATE MEDICAL COMPANION,
EMBRACING THE TREATMENT OF
MENSTRUATION, OR MONTHLY TURNS,
DURING THEIR
STOPPAGE, IRREGULARITY, OR ENTIRE SUPPRESSION.
PREGNANCY,
AND
HOW IT MAY BE DETERMINED;
WITH THE TREATMENT OF ITS VARIOUS DISEASES.
DISCOVERY TO
PREVENT PREGNANCY;
ITS GREAT AND IMPORTANT NECESSITY WHERE
MALFORMATION OR INABILITY EXISTS TO GIVE BIRTH.
TO PREVENT MISCARRIAGE OR ABORTION.
WHEN PROPER AND NECESSARY
TO EFFECT MISCARRIAGE.
WHEN ATTENDED WITH ENTIRE SAFETY.
CAUSES AND MODE OF CURE OF BARRENNESS, OR STERILITY.

BY DR. A. M. MAURICEAU,
Professor of Diseases of Women.

Office, 129 Liberty street.

NEW YORK.

1847.

Entered according to Act of Congress, in the year 1847, by
JOSEPH TROW,
In the Clerk’s Office of the District Court of the Southern District New
York.

PREFACE.

The “Introduction” in the succeeding pages, being amply explanatory, but few prefatory words will suffice. The object and intention of the work is manifest and self-evident.

It is to extend to every female, whether wife, mother or daughter, such information as will best qualify her to judge of her own maladies, and, having ascertained their existence, apply the proper remedies.

From these pages she will learn the causes, the symptoms and the remedies, for such complaints to which she may be liable, the nature of which she may not desire to impart to another.

Whether married or unmarried, she can, from these pages, compare her own symptoms with those described, and act in accordance with the mode of treatment prescribed. She will thereby be exempt from those doubts, perplexities and anxieties, which arise from ignorance of her situation, or the causes which produce it.

In short, the author sincerely believes that to the female budding into womanhood,—to one about to become a wife, or to the wife about becoming a mother, as well as to every one already a wife and a mother, as also to the female in the decline of years, in whom nature contemplates an important change, the “Married Woman’s Private Medical Companion” contains instructions of such paramount importance, as to embrace the present happiness and future welfare of each.

One word in conclusion. It is not pretended that the concentration of the results of medical research emanates from _one_ author, for be he ever so versed in medical science, he would come far, far short of so herculean a task. It is, therefore, necessarily derived from authors on medical and physiological sciences, of great acquirements and distinguished celebrity.

It hardly need be added that great labour has been encountered in the preparation of a work of this nature, as the most reliable and correct sources have been availed of.

THE AUTHOR.

INDEX

PAGE.
ABORTION—
„ Symptoms of, 169
„ Causes of, 171
„ Treatment of, 171
„ Prevention of, 175
„ When dangerous, 168
„ When necessary to effect, 177
„ When attended with no danger, 169
AFTER-PAINS—
„ Causes of, 203
„ Treatment of, 204
AFTER-BIRTH—
„ Caution respecting, 199
„ Mode of extracting, 199
ARTIFICIAL DELIVERY, 180
BARRENNESS, OR STERILITY—, 223
„ Causes of, 225
„ Treatment of, 230
„ Remedy for, 232
CONCEPTION—(See Pregnancy), 36
„ Signs of, 37
„ Prevention of (See Pregnancy), 104
CHILDREN—Management of, 210
CONCLUDING REMARKS, 237
DELIVERY—Artificial, 180
DISEASES OF PREGNANCY, 61
Desomeaux’s Prevention to Pregnancy, 142
FALSE PAINS IN PREGNANCY, 187
FALSE Conception, 30
FAINTING, during Pregnancy, 87
„ Treatment of, 87
FLOODING, 174
„ Causes of, 23
„ Treatment of, 174
FRENCH SECRET, 144
„ For what purpose used, 144
„ Its use in France, 144
INTRODUCTORY REMARKS, ix
INFANTS, still-born, 202
„ Treatment of, 203
INFLAMMATION OF THE BREASTS, 205
„ To prevent inflamed or broken Breasts, 208
Index, v
LABOUR—Signs of, 182
„ Management of, 185
„ Ordinary or natural, 186
„ Preternatural or Cross-Births, 201
„ Laborious, or difficult, 202
„ Directions during, 198
„ Directions after, 99, 203
MALFORMATION of the Pelvis, 180
MENSTRUATION, or Monthly Turns, 1
„ RETENTION OF, 8
„ Description, 8
„ Causes, 8
„ Symptoms, 9
„ Treatment, 10
„ SUPPRESSION OF, 11
„ Description of, 11
„ Causes, 12
„ Symptoms, 12
„ Treatment of, 13
„ Specific certain to effect a cure, 16
„ PAINFUL AND IMPERFECT, 18
„ Symptoms, 19
„ Causes, 19
„ Treatment, 20
MENSES—
„ IMMODERATE FLOW OF, 22
„ Symptoms, 22
„ Causes, 23
„ Treatment, 23
„ Prevention, 27
„ DECLINE OF THE, 28
„ Symptoms, 30
„ Causes, 30
„ Treatment, 33
MISCARRIAGE—_See Abortion._
MORAND’S “ELIXIR,” 232
„ Its success in effecting Cures, 233
NAVEL CORD—
„ Manner of tying, 198
NURSING, 204
PORTUGUESE FEMALE PILLS, 16
PREFACE, iii
PREGNANCY, Signs of, 36
„ How it may be determined, 37
„ Ceasing to be unwell, 38
„ Morning Sickness, 49, 62
„ Shooting Pains through, Enlargement of and other Changes
of the Breasts, 50
„ Changes of the Nipple, 51
„ Presence of Milk, 54
„ Quickening, 57
PREGNANCY,—DISEASES OF, 61
„ Being unwell during, 96
„ Costiveness, 72
„ Diarrhœa, 76
„ Enlargement of the Veins of the Legs, 82
„ Fainting Fits, 87
„ Heart-Burn, 70
„ Headache, 98
„ Inconvenience from size, 95
„ Painful and distended condition of th Breasts, 90
„ Pains in the Legs, &c., 92
„ Palpitation of the Heart, 85
„ Piles, 78
„ Salivation, or Discharge of Saliva, 89
„ Swelling of the Feet and Legs, 84
„ Soreness and Cracking of the Skin of the Abdomen, 94
„ Toothache, 88
„ Violent movement of the Child, 93
PREGNANCY—PREVENTION OF, 104
„ When unnecessary, 110
„ When indispensable, 107
„ Practicability of, 141
„ Morality of, 146
„ Social importance of, 114
„ Mode of prevention, 142, 143, 144
„ Healthiness of, 145
„ Reasons for prevention, 144
„ Objections answered, 146
„ Proofs of success, 150, 152, 154
„ Use of in France and other parts of Europe, 149
SEXUAL WEAKNESS,
„ Symptoms, 157
„ Causes, 158
„ Treatment, 158
„ Regimen, 163
WOMB, falling down of the, 163

INTRODUCTORY REMARKS.

In introducing a subject of the nature treated of in this volume we are perhaps treading upon interdicted if not dangerous ground, for the world is not free from those pseudo-moralists, who would check, and, if possible, arrest the onward progress of medical and physiological science, and compel all to trudge on in the old beaten path, neither turning to the left nor the right, much less to look forward, but cast their glance backward. And although they behold every other science marching with rapid strides to comparative perfection:—what through the agency of steam and iron rails, space as it were, annihilated; what but yesterday, comparatively speaking, required weeks to perform, a few hours now suffice; nay the lightning fluid itself is made subservient to man’s powers of discovery and ingenuity, transmitting intelligence from distant points with the speed of thought:—yet, in physiological and medical science, we are required to be as an immovable rock, upon which the overwhelming billows of physiological science and discovery are to wash fruitlessly and in vain, to recede back into the dark sea of ignorance.

Truly, is it that in all that concerns man’s welfare and woman’s happiness, we are to stand still, while improvements and discoveries, in arts and sciences connected with agricultural and mechanical pursuits, are rushing by with the impetus of a torrent? Is it that physiological and medical science has long since reached that state of perfection that improvement and discovery are impossible? Is it that preceding generations had engrossed, in physiology, all the knowledge that could be attained, and left nothing for succeeding generations to attain? Is it that disease, decrepitude, bodily suffering and stinted and imperfect physical development among mankind has no longer an existence? Is it that every woman enjoys the full bloom, virgin freshness and beauty belonging to the enjoyment of a perfect condition of health? Is it that we no longer behold the deathly pale, sallow, sickly female of sixteen or eighteen, in the last stage of some chronic disease, prepared for the cold embrace of death? Is it that for the married woman six of the nine months of pregnancy is often a state of suffering and anguish destructive to her health and cutting off her days? Is it too, that it never happens that she often has children only at the hazard of her own life, and that of her offspring? Is it that children are invariably born healthy and rugged, capable of enduring the ordinary maladies to which infancy may be subject, to be reared into robust and virtuous sons and daughters? Is it that by far the greatest proportion of those born, survive, instead of, at the least, two-thirds being cut off in infancy? No, indeed, it is not because of all this. It is because prejudice or ignorance thinks that if men and women acquired the knowledge whereby to improve their condition as social moral beings, guard against disease, and preserve their health, that _perhaps_, it might lead to immorality and vice. This is ever the pretext to arrest the progress of physiological discovery.

Discoveries, then, so directly and intimately connected with the personal individual happiness of every man, woman, and child, are alone to see no progress; without being met at the threshold with the senseless and idle cry of “vice and immorality.” Thus then, the sufferings, the pains, the anguish, which have existed five hundred years ago, are to be irremediable and endured in despite of any discoveries _by which they can be prevented_. We must do nothing to alleviate, or better still, to prevent, the sufferings of the wife, daughter, or mother, because it was not done five hundred years ago! Monstrously absurd as is this reasoning, yet it is of this kind which the discoveries introduced before the public in this work will be met.

But the subject is one which embraces our social joys and comforts, the endearments of home and the family fire-side, the health and well-being of wives, mothers, and daughters, and cannot be retarded by the cobwebs in its way, to stem its onward course. No female, either married, or about to be married—no wife about becoming a mother—no mother having a daughter—no father who desires to prolong the health, beauty, and vigor of his offspring—no husband who has his own happiness, or the happiness of the companion of his bosom at heart—no young man, even, having a regard to his future welfare, should be without this important little work. Here the wife, mother or daughter, can detect her own complaints, trace them to their causes, and apply the remedy. This is all important. For, how often does the young female (because of a supposed delicacy), suffer in health rather than impart her malady to another, and especially to a medical man; and thus, many diseases, which though trifling in their origin, and at first easily removed, become seated and confirmed in her constitution. How deplorable are the consequences arising either from neglect or ignorance in the treatment of females who are afflicted with a stoppage, irregularity, or entire suppression of the menses or monthly turns, from which spring a train of diseases, which it would, in this place, be useless to enumerate, but which make our wives and daughters sickly, and our offspring short-lived.

It is also important that the female should understand the cause which might occasion a stoppage of the menses to possess the information contained in this work, by which it can be ascertained whether it may not arise from pregnancy and thereby avoid that anxiety of mind arising from an uncertainty as to her real situation, alternately imagining the one or the other, as her inclinations or fears may tend.

During pregnancy, many a wife lives in almost perpetual bodily ailment and suffering, which ought and should be prevented, and would not in most cases exist if this work is perused. Here important truths and discoveries are revealed, which may be the means of saving many an affectionate wife and fond mother from a premature grave. How many females marry, who, in becoming pregnant, jeopardize their life, would learn, if they perused these pages, of the discovery by which _pregnancy can be prevented_, by means at once safe, simple, certain, and healthy, and thus many a victim would not fall a sacrifice to the Cæsarean operation.

In respect, too, when a woman is threatened with miscarriage or abortion it is important that the treatment, either to prevent it, or, when that is impracticable, to assist and expedite it, should be thoroughly understood, and its treatment made clear and simple, that no unnecessary alarm need be occasioned when it occurs.

So, too, in regard to the various diseases accompanying and belonging to pregnancy, every woman should know how to prevent the one and ameliorate the other.

And finally, the subject of unfruitfulness, sterility, or barrenness, is here presented in a manner, which, to some extent, demonstrates that in most cases it can be cured, yet how many are pining in childless loneliness, in utter despair of cure.

Such are some of the important topics treated of in these pages, so intimately connected with every woman’s peace and happiness, with which every woman should be conversant, and yet how little informed are most females with what concerns themselves, their children, and their husbands so much.

MANAGEMENT

OF

FEMALE COMPLAINTS.

MENSTRUATION.

One of the principal constitutional characteristics of the female, is menstruation, or the monthly evacuations peculiar to the sex.

This important operation generally takes place about the age of twelve or thirteen; but varies through the world, either in degree or frequency, both from constitution and climate.

Women in the higher ranks of life, and those of a delicate, nervous constitution, are subject to sickness, headache, and pains in the back and loins, during periodical evacuation. Those of the lower rank, inured to exercise and labor, and strangers to those refinements which debilitate the system, and interrupt the functions essential to the preservation of health, are seldom observed to suffer at these times, unless from general indisposition, or a diseased state of the womb.

After the discharge has become established it recurs periodically while in health; and its recurrence is so regular, that it can be calculated with great exactness. The usual period of its visitations is from twenty-seven to thirty days. As to the time of its continuance, this is various in different women; but it seldom continues longer than six days, or less than three, and does not cease suddenly, but in a gradual manner.

Its approach is generally preceded by certain feelings of oppression or deviation from the ordinary state of health, which warn the individual of what is to happen. There is, in particular, a sensation of fulness about the lower part of the belly, and a relaxation about the uterine system which can scarcely be overlooked by the most heedless. The appetite becomes delicate, the limbs tremble and feel weak, the face becomes pale, and there is a peculiar dark streak or shade under the eyes; sometimes great restlessness, slight fever, headache, heavy and dull pain in the small of the back and bottom of the belly, swelled and hardened breasts, &c. All of which are sometimes instantly relieved by a trifling discharge from the vagina, and this not necessarily colored. It must at the same time be admitted, that in some few constitutions these feelings are so inconsiderable as to be little attended to; so that the woman mixes in society as usual without any apparent inconvenience.

The period at which the menses make their appearance, is various; it is much influenced by constitution, climate and mode of life. As a general rule, it takes place at puberty, or at that period at which the female is capable of propagating her species; and this period varies as climate may differ. They constantly, however, keep pace with the development of the body; where this is rapid, they will appear proportionably earlier; where this process is slower, they will appear later: but whenever the menses appear as regular evacuations, they mark the period of puberty: thus, in hot countries, women commence to menstruate at eight or nine years of age, and are not unfrequently mothers at ten.[1]

In the more northern regions, as in Lapland, &c., this evacuation is generally delayed until the female has attained her eighteenth or nineteenth year: in the temperate latitudes the average period will be found from the fourteenth to the sixteenth year. A difference, will, nevertheless, be found in the women who may reside in cities, and in those who dwell in the country of each respective portion of the globe. It may also be observed, that in cold countries, women continue to menstruate for a longer period than in warm; and as a general rule, it will be found they are obnoxious to this discharge double the period that elapses before it commences. Thus, women who have not this discharge until eighteen, will be found to have it until beyond fifty; those who commence at fourteen or fifteen, will leave off at forty-five; those who begin so early as eight or nine, will have it cease at twenty-five or six.[2]

On the appearance of the menses, or monthly turns, nature seems to perfect her work, both as regards development and proportion: it is the period of the most perfect beauty of which the female is susceptible; it is the one at which the moral changes are not less remarkable than the physical; it is a moment, of all others, the most replete with consequences to the inexperienced and confiding female.

At this period a great variety of interesting and curious phenomena present themselves: the voice is found to change; the neck and throat to increase in size, and to become more symmetrical; the mammæ to swell; the nipple to protrude; the chest to expand; the eyes to acquire intelligence, and increase of brilliancy; in a word, a new being, almost, is created.

The quantity of fluid expended at a menstruous period differs in different individuals; with girls who precociously menstruate, the quantity is in general smaller, and the returns less regular. Climate exerts an influence upon the quantity discharged, as well as upon the periods at which this evacuation shall commence. Thus, in the equatorial and more northern regions, it is less than in the more temperate climates.

It is of importance for women to know that occasional irregularities are not always the consequences of disease. Constitutions vary as much in respect to the regular returns of this discharge, as they do with regard to their first appearance or final cessation. Those in whom the change occurs very early from vigor of constitution, require little to be done for them; but in weak and delicate habits, the non-appearance of this evacuation is too often considered as the cause, whereas it ought to be viewed as the effect, of the state of the habit unpropitious to its taking place. And, according to family practice, under this false impression, warm teas and forcing medicines are employed at the approach of this disease, which have often done much harm.

Nature is not so defective in her own judgment as to require auxiliaries. Care should be taken to improve the general state of the health, by attention to diet, moderate exercise, change of air, &c.

In some instances the menstrual discharge does not make its appearance before the age of seventeen or eighteen, and, nevertheless, health is not in the least affected. The mere want of evacuation at the ordinary time, therefore, is not to be considered as morbid, unless the system be evidently deranged thereby. In many cases, however, symptoms of disease appear which are evidently connected with the defect of the menses, and go off upon its discharge. The treatment, in such cases, must be regulated by the particular circumstances and constitution of the individual. There is no remedy adapted to every case of this kind; but an open state of the bowels, and a due regulation of the diet, together with moderate exercise, are useful in every instance of this complaint. Warm clothing, too, particularly about the lower extremities, is of most essential benefit. The occasional use of the warm bath is pleasant and beneficial, especially if the skin be dry and warm. As the health improves, the cold bath will prove an auxiliary, if, after using it, the patient feels a glow of heat and a greater degree of liveliness. When the means ordinarily employed have failed, marriage, or a change of climate, has produced the wished-for effect.

In some instances the evacuation is impeded by a mechanical cause, that is an obstruction of the passage to the womb. This occasionally is met with, and the chief obstacle to its speedy removal is the difficulty of ascertaining its existence. The operation by which it is completely remedied, is not more painful nor formidable than blood-letting.

Fortunately, in most cases, the evacuation takes place in due time, and the constitution sustains no material or permanent injury. It is, however, in every instance, proper to pay particular attention to the system during the continuance of the evacuation.

The stomach and bowels, at this period, are very easily disordered, and therefore, everything which is heavy or indigestible, ought to be avoided. Some are hurt by eating fruits or vegetables; others by taking fermented liquor. In this respect experience must enable each individual to judge for herself. Exposure to cold, particularly getting the feet wet, is hurtful, as it tends suddenly to obstruct the discharge. The same effect is likewise produced by violent passions of the mind, which are also, at this time, peculiarly apt to excite spasmodic affections, or hysterical fits.

It is, in general, a very proper rule not to administer any very active medicines, at this time, unless some violent symptom absolutely requires them. Opiates, for instance, are, in many cases, necessary to allay spasmodic affections, or abate pain; and they are, in such circumstances, uniformly safe. They give speedy relief to hysterical feeling or suffocation, or to spasm of the stomach or bowels.

Dancing, exposure to much heat, or making any great or fatiguing exertion, are improper. These causes may increase, to an improper degree, the quantity of the evacuation, and in certain circumstances may give a disposition to a falling down of the womb.

RETENTION OF THE MENSES.

_Description._

The menstrual discharge is liable, from many causes, to become obstructed at the period when it ought to appear; when this takes place it is attended with very painful or serious effects; and, if nature is not assisted, the health is impaired or the constitution undermined, inducing consumption or some other complaint.

_Causes._

The remote cause of this complaint is most frequently suppressed perspiration; and it may arise, in part, from an inactive sedentary life, and such habits as are peculiar to the higher classes of society, particularly in cities and towns. The proximate cause of it seems to be a want of power in the system, arising from inability to propel the blood into the uterine vessels with sufficient force to open their extremities and to allow a discharge of blood from them.

_Symptoms._

Heaviness, listlessness to motion, fatigue on the least exercise, palpitation of the heart, pains in the back, loins, and hips, flatulence, acidities in the stomach and bowels, costiveness, a preternatural appetite for chalk, lime, and various other absorbents, together with many other dyspeptic symptoms. As it advances in its progress the face becomes pale, and afterward assumes a yellowish hue, even verging upon green, whence it has been called green sickness; the lips lose their rosy color; the eyes are encircled with a livid areola; the whole body has an unhealthy appearance, with every indication of a want of power and energy in the constitution; the feet are affected with swellings; the breathing is much hurried by any great exertion of the body; the pulse is quick, but small; and the person is liable to a cough, and to many of the symptoms of hysteria. Sometimes a great quantity of pale urine is discharged in the morning, and not unfrequently hectic fever attends. In cases of a more chronic character there is a continued, though variable, state of sallowness, yellowness, darkness, or a wan, squalid, or sordid paleness of complexion, or ring of darkness surrounding the eyes, and extending perhaps a little toward the temples and cheeks.

_Treatment._

As this disease proceeds from debility, it is evident that the great object to be fulfilled will be to give tone and energy to the system; and if this debility has arisen from a sedentary life, the patient must begin immediately to exercise in the open air, and, if practicable, to change her residence. The tepid or warm bath should be used in preference to the cold. The first medicine given may be the pulverized _mandrake root_, combined with a little _cream of tartar_. This, as well as other medicines, should be taken upon an empty stomach: after it has been given, _motherwort_, _pennyroyal_, and other herb teas may be freely drunk. After the exhibition of the purgative, which may be occasionally repeated, _gum aloes_ may be taken, combined in such a manner as to prevent the piles. This medicine, from its action upon the uterus through the medium of the rectum, is very useful in retention of the menses. _Emmenagogues_, or “forcing medicines,” should not be used to bring on the menses, except there be a struggle or effort of nature to effect it, which may be known by the periodical pains and pressing down about the hips and loins. When this occurs let the feet be bathed, and perspiration promoted, by drinking freely of diluent teas, such as _pennyroyal_, _motherwort_, and _garden thyme_. Should considerable pains attend the complaint, eight or ten grains of the _diaphoretic powders_ may be given, and _fomentations of bitter herbs_ applied over the region of the womb. _Desomeaux’s Portuguese Pills_ are now recommended as the best specific, especially if the disease proves obstinate.

The female should be very careful not to expose herself to the vicissitudes of the weather, and not suffer the feet or clothes to become wet: warm clothing must be worn, and particularly flannel. For pain apply a heated brick, covered, to the bowels.

The diet should be light, nutritious, and easy of digestion.

SUPPRESSION OF THE MENSES.

_Description._

In this disease there is a partial or total obstruction of the menses in women from other causes than pregnancy and old age. The menses should be regular as to the quantity and quality; that this discharge should observe the monthly period, is essential to health. When it is obstructed, nature makes her efforts to obtain for it some other outlet; if these efforts of nature fail, the consequence may be, fever, pulmonic diseases, spasmodic affections, hysteria, epilepsy, mania, apoplexy, green sickness, according to the general habit and disposition of the patient. Any interruption occurring after the menses have once been established in their regular course, except when occasioned by conception, is always to be considered as a case of suppression. A constriction of the extreme vessels, arising from accidental events, such as cold, anxiety of mind, fear, inactivity of body, irregularities of diet, putting on damp clothes, the frequent use of acids and other sedatives, &c., is the cause which evidently produces a suppression of the menses. This shows the necessity for certain cautions and attentions during the discharge. In some few cases it appears as a symptom of other diseases, and particularly of general debility in the system, showing a want of due action of the vessels. When the menses have been suppressed for any considerable length of time, it not unfrequently happens that the blood which should have passed off by the uterus, being determined more copiously and forcibly to other parts, gives rise to hemorrhages; hence it is frequently poured out from the nose, stomach, lungs, and other parts, in such cases. At first, however, febrile or inflammatory symptoms appear, the pulse is hard and frequent, the skin hot, and there is a severe pain in the head, back, and loins. Besides, the patient is likewise much troubled with costiveness, colic pains, and dyspeptic and hysteric symptoms.

_Treatment._

It will be necessary, in the treatment of this disease, to remove urgent symptoms if they are present. If the patient is in severe pain, give the _diaphoretic powders_,[3] and at the same time let a strong infusion of _garden thyme_ and _pennyroyal_ be freely given. Immerse the feet in warm lye water, and rub well with coarse flannel. If relief is not obtained in the course of an hour, or in a very short time, a strong decoction of bitter herbs should be thrown into a proper vessel, and the patient steamed fifteen or twenty times, as long as she is able to bear, or until perspiration is produced; immediately after which let her be put in bed, covered warm, and the herbs be enclosed in flannel or muslin, and applied to the lower part of the abdomen or belly. This process will almost immediately relieve the urgent symptoms. After this our next object will be, to regulate the menstrual discharge, by a proper course of strengthening medicine; that recommended under the head of _chlorosis_, or _a retention of the menses_, may be taken with advantage. Inasmuch as both proceed from debility, it is evident that it must be removed in order to effect a cure; and, therefore, that medicine and treatment which strengthen and invigorate the system, will invariably benefit the patient. The skin, stomach, and intestines, all seem concerned in the production of this disease, and hence our attention should be directed to a restoration of their proper offices: the stomach and bowels should be cleansed and stimulated to a healthy action; perspiration must be promoted, and, in short, every secretion and excretion of the system. If the stomach is in a morbid condition, let an emetic be occasionally given, and afterwards a dose of _mandrake_; both of which may be repeated as occasion requires. The patient may then take the following tonic bitters: Take prickly ash bark, two ounces; wild cherry tree bark, two ounces; Seneca snake-root, one ounce; tansy, one ounce; gum socotrine aloes, half an ounce; devil’s bit, two ounces: pulverize; to every two ounces of the powder add half a pint of boiling water and one quart of Holland gin, and half a wineglassful taken three or four times a day. This may be continued while it agrees with the patient, or as long as benefit is derived. About once a month there will generally be felt more or less symptoms preceding a catamenial discharge; considerable pain will be felt through the lower part of the abdomen, hips, and loins, showing that there is a strong effort or struggle of nature to return the menses. Our principal object, when this occurs, should be, to aid her salutary efforts, as directed in the Retention of the Menses. The patient should sit over the steam of _bitter herbs_ for ten or fifteen minutes, retaining the steam by means of a blanket, to concentrate it upon the lower part of the body; at the same time the feet may be bathed, and tansy tea freely drunk. The abdomen should also be fomented, as before directed. It will not be necessary, however, to use these means, except there is an obvious indication to return the menses.[4]

It must be recollected that when the patient labors under some other disease, there is such debility that there is not superfluous blood sufficient to keep up the menstrual discharge; and in this case our attention must be directed to the primary affection, without any regard to such symptoms; it is also very necessary to bear in mind the fact, that the menses are often suppressed from pregnancy. By a proper attention, we can always discriminate between a suppression of the menses and pregnancy; and the principal diagnostic symptom is, that in the former complaint there is a pain or affection of the head, attended with dizziness.

PAINFUL AND IMPERFECT MENSTRUATION.

_Description._

Besides the two deviations from the usual course of nature already mentioned, there sometimes occurs a third, viz. where menstruation, although not wholly suppressed, is nevertheless somewhat difficult, and accompanied with severe pains in the back, loins, and bottom of the belly. This disease is owing to a weak action of the vessels of the uterus, or spasm of its extreme vessels, and is to be obviated by tonics, warm bathing, both local and general, together with the use of anodynes, which should be employed as soon as the symptoms which denote its approach are apparent. This complaint is a common, and generally an extremely harassing, affection. It may occur at every period during the menstruation stage of life; but it appears to be most common between the twentieth and thirtieth years of age, and in subjects of an irritable and sanguineous temperament. In many instances severe pains are experienced in the back, loins, and lower part of the abdomen for five or six hours previous to the appearance of the menses. This, however, soon ceases, and an immediate aggravation of the torturing pain follows. Sometimes the catamenia begin to flow moderately, with little or no previous pains; but in an hour or two, they become suddenly arrested, at the same time that violent pains come on in the hips, side, loins, back, and thighs, with a distressing sensation of forcing or bearing down. Occasionally a very slight menstrual discharge continues uninterruptedly for three or four days, accompanied throughout with extremely severe pains in the abdomen; and in some rare instances the catamenial evacuation, although attended with great suffering, is sufficiently copious and prolonged in its course, and may even exceed the regular duration and quantity of an ordinary healthy menstruation.

_Treatment._

Since it is well known that a derangement in the uterine functions must generally proceed from a check of perspiration, astringing the minute ends of the uterine vessels, or in some manner deranging their functions, causing debility, &c., it will appear clear that our first attention must be directed to the skin. Cold appears to be the cause of the disease, and heat seems to remove it; therefore, when these periods of distress occur, let the patient sit over a strong decoction of bitter herbs, such as tansy, hoarhound, wormwood, catnip and hops, while a blanket is thrown round the waist of the patient to confine the steam to the lower parts. After the diseased person has been thus steamed and the feet bathed, let her be put into a bed, warmly covered, and diluent drinks given, such as tansy, thyme, pennyroyal, &c. At the same time let fomentations of the same herbs, enclosed in a flannel bag, be applied to the abdomen, as before directed. This will produce perspiration and afford immediate relief; and when these distressing symptoms are removed, and the patient becomes comfortable, a course of treatment must be adopted to prevent a recurrence of these symptoms, or to produce a natural flow of the catamenial discharge; and similar to that recommended under the preceding complaints. Herbs may be freely drunk.

A writer on this subject thus remarks, “This case of painful menstruation deserves particular attention, because it impairs the health of patients by its present effects, and seems to render them less prolific in future. Dr. Fothergill has afforded relief to several by the following process: Let the patient have near her a few pills, consisting of opium, gr. i. each, made soft with a little of any kind of conserve. She is to take one of these pills the moment the pain attending this discharge comes on. A pill may be taken every hour till the pain ceases: more than two will seldom be required; yet they must be taken in quantities sufficient to mitigate the pain. Let the patient keep either in or upon the bed, or at least in a recumbent posture, drink moderately of any diluting liquor, as herb teas, weak whey, or thin broth. When the time is past, a course of chalybeate bitters, in small doses, may be continued, till within a few days of the return; and the bowels should be kept open with some proper laxative. This excruciating pain seems to be spasmodic, and to proceed from the extreme irritability of the uterine system.” The _diaphoretic powders_ will be found very useful. Diet and exercise are important. A hot brick or salt, enclosed in flannel wet with vinegar, and applied to the bowels, soon relieves the pain.

IMMODERATE FLOW OF THE MENSES.

This alarming complaint may occur under two different states of the constitution. In the one, the woman is of full habit, and often of a ruddy countenance. In the other, she is pale, delicate, and easily fatigued.

_Symptoms._

In plethoric habits it is often preceded by headache, giddiness, or difficult breathing, and is afterwards attended with pain in the back and loins, universal heat, and a frequent, strong, and hard pulse. But when it arises from general debility, or in consequence of a laxity of the organ, paleness of the face, chilliness, lassitude of the body, oppressed breathing on the slightest effort, pains in the back on remaining any length of time in an erect posture, and coldness of the extremities, together with a long train of nervous complaints.

_Causes._

A variety of causes may produce this troublesome disease. Some of these are general, such as a state of great weakness, or of too much blood; others are local, such as debility of the uterus, occasioned by tedious labor or frequent miscarriages. It may also be produced by accidental circumstances determining the blood more copiously and forcibly into the uterine vessels, as violent exercise in dancing, much straining at stool from great costiveness, contusion on the belly, excess in venery, or strong passions of the mind, particularly at the menstrual period.

_Treatment._

In the management of this disease we have two objects: first, to moderate the discharge and procure present security; and, secondly, to prevent a return.

The first thing to be done when the hemorrhage is sudden or profuse, is instantly to remove the clothing which may occasion the least interruption to the free circulation of the blood, and to put the patient to bed, lightly covered with clothes. So long as this discharge continues, it is of importance to keep her in a recumbent posture, as cool as possible, and perfectly at rest, both in body and mind. Cloths, dipped in cold vinegar and water, and renewed as often as they become warm. These cold applications have a powerful effect in restraining uterine hemorrhage, and ought never to be omitted where the discharge of blood is profuse.

If the patient be of a full habit, attended with severe pain in the head or back, and febrile symptoms, it will be proper to give the antimonial, or febrifuge powders, or mixture.[5]

The state of the belly must be attended to. It can be kept gently open by the cathartic mixture, sulphur, or any mild laxative medicine. Stimulating purgatives or clysters, under such circumstances, are improper, from their tendency to increase the discharge.

When no symptoms indicating an increased action in the vessels of the womb are present, astringent medicines should be employed. And, in cases where the discharges have not continued long, and the strength not much impaired, it is often sufficient to arrest the disease by giving fifteen or twenty drops of elixir vitriol, or six or eight grains of alum dissolved in a glass of cold water every hour; or, what is preferable, alum whey, sweetened to the taste, in doses of a small cupful, as often as the stomach will receive it. But, if the discharge be obstinate, we should have recourse to pills of sugar of lead and opium.[6]

In no instance which has come under my knowledge, where the hemorrhage was in consequence of a laxity of the uterine vessels, have these pills failed in producing the desired effect.

In those cases where the hemorrhage is profuse, or of long continuance, and resists the means already pointed out, it will be proper to inject into the uterus from a gill to half a pint of a strong decoction of oak bark, in which one or two drachms of alum have been dissolved, or as much of the saturated solution of alum in water, in order to constringe and strengthen the vessels of the womb. This may be repeated twice or thrice a day, according to circumstances.

When symptoms of an increased action in the vessels of the womb are observable, the tincture of foxglove, in doses of twenty drops every four hours, constitutes the best remedy.

When there is reason to suppose the hemorrhage proceeds from a scirrhous or ulcerated state of the womb, all that can be done, is to afford temporary relief by giving opium in large doses. Indeed, opiates may be given with advantage in every case where there is considerable pain or anxiety, and the patient much exhausted. Under these circumstances, from one to two teaspoonfuls of laudanum, or from two to four grains of opium, according to the urgency of the case, will be useful not only in giving a check to the discharge, but also in preserving the strength, and abating nervous irritation. In most cases it is preferable to give opium in the form of injections to allay the spasmodic pains of the womb; and, when administered in this way, clysters of thin starch or gruel, in each of which two teaspoonfuls of laudanum are added, should be given every two hours until relief be obtained. (_See Abortion and Flooding._)

_Regimen._

The diet, at the time of excessive discharge, must be light and cool. The drink must always be cold, as ice-water, lemonade, or tamarind beverage. Port wine, in such cases, is too frequently resorted to, which uniformly does harm by increasing the circulation.

_Prevention._

To prevent a recurrence of the attack in those who are subject to it, the patient must necessarily avoid the causes by which it has been produced.

When it is evident that the discharge is in consequence of a full habit, it will be proper to reduce the system by living sparingly, by keeping the bowels rather in a laxative state, and by rising early, and taking through the day regular but frequent exercise; and, after the plethora is removed, by strengthening the vessels which have been over-distended, by the use of the cold bath.

In a greater number of cases, however, we meet with a delicate constitution and spare habit, with pale countenance: this state requires the use of sea bathing or the shower bath, and the vessels of the womb are particularly strengthened by pouring cold water daily on the back and loins.

It will be advisable to use a generous nutritive diet, with wine, and to have recourse to some of the tonic medicines, as advised under the head of obstructed menses, to strengthen the system generally. At the same time the bowels must be attended to, and invigorating exercise taken daily; whilst on the other hand, fatigue, and especially exposure to relaxing heat, must be carefully avoided.

DECLINE OF THE MENSES.

The nearer a woman approaches her forty-fifth year (_cæteris paribus_), will be the risk of some irregularity in the menses; and as this period is more frequently the one at which any latent disease of the uterus shows itself, it is always looked forward to with much anxiety by women. Indeed, so replete is this time with horrors to many, that we may very justly suspect apprehension to be the cause of some of the distressing symptoms, which sometimes accompany this interesting process of the human uterus.

Delicate women, and especially those who have lived idly, have this period of life arrive earlier than those of a contrary constitution, and opposite habits. We have already noticed, in our section on Suppression, that this change sometimes takes place at a very early period of life, and this without leaving any injurious consequences behind it; and, on the other hand, we find many cases on record, where this discharge had continued with regularity to a much longer period than the ordinary one. Gardien mentions a case which fell under his own notice, where this evacuation continued with great exactness, until beyond the seventy-fifth year; others, still more uncommon, are mentioned by various writers.[7]

This change is sometimes effected so silently, that the woman scarcely notices her altered condition; at others, its approach is so gradual, as not to attract observation, until the diminished quantity gives warning that it is about to take its leave for ever; while, again, the irregularity, both in period and quantity, may be such, as justly to give alarm, as well as to produce the most serious danger.

But, as a general rule, it may be observed, that when the woman arrives at about her forty-fifth year, she finds her menses to become irregular, both in the quantity of fluid evacuated, and in the periods they observe; being sometimes in advance, and at others, not appearing until long after the accustomed time. The woman also finds some alteration has taken place in her general health; she becomes pale, debilitated, and nervous; arising, however, for the most part, from the too frequent returns of this discharge, or its too great abundance.

At this time, also, the woman sometimes becomes the victim of a strange illusion, should the menses not have returned for several periods; for she now supposes herself to be pregnant, as her abdomen enlarges, as do the mammæ; her appetite becomes capricious, or she has strange longings, &c., the whole of the rational signs of this condition being present, in her imagination, even to the motion of the child. This delusion is most common to women who marry late in life, and who are very desirous of offspring. Now the breasts lose their intumescency; the morning sickness vanishes; the swelling of the abdomen subsides; the imagined stirrings of the fœtus cease, or the sensation becomes so unequivocal as to satisfy that it arises from the movement of wind; and, to put everything beyond hope, the menses return in overwhelming quantity. It is highly proper, that practitioners, and especially the younger part of them, should be put upon their guard in respect to this condition of the patient, and not too easily yield credence to all her wishes may dictate, or absolutely to treat as an impossibility, a circumstance of which there is occasionally an example.

It seems that the apprehensions of this period of life have arisen mainly from the notions entertained of the final cause of the menses; namely, that it gives vent to peccant humours. But females should be made to know, that all this is purely the theory of the vulgar; as the menstrual blood is formed from the general mass; and, consequently, if that be pure, the other will be; therefore, the idea is altogether ill-founded. But unfortunately, whenever this discharge is less abundant than usual, the most serious fears are entertained, that there will be a retention of a portion, which will cause disease, either in the uterus itself, or in some other part of the body; hence, a diminished menstruous secretion is always more alarming to the female, than an unusual flow. But it may be well to remark, that there is a great difference between the cessation of this discharge, and the suppression of it. In the one instance, it is an event which nature has designed should take place, and is effected altogether by arrangements of the system itself; and, of course, one of its natural processes: in a word, as much so as its commencement; but the suppression, from some morbid agency, is in direct opposition to the intentions of nature, and will, of course, be followed by some baleful consequence, if it continue beyond a certain period.

The vulgar error, that “women at this period of life are always in danger,” is replete with mischief to the suffering sex; and I feel it a duty to declare, that they are not necessarily more obnoxious to disease at this, than at any other period of their existence.[8] That they are sometimes liable to a disease at this time; and that disease one of the most terrible in the long list of human infirmities, I admit; but must, nevertheless, insist that _Cancer_ (the disease to which I allude, and the one so much dreaded) is more rare in the uterus than in certain other portions of the body; for instance, the mammæ; and, perhaps, I am within the truth, when I say, that there are three instances of the latter for one of the former. If latent dispositions to disease, either in the uterus or other parts, become active about this period of life, it is not because the declining menses excite them; but because the disease is slow in developing itself, and is, perhaps, kept in check for a long time, by the menstrual discharge serving as an important evacuation; especially when the uterus may be the seat of the complaint. In such instances, the foundation of the disease was laid, perhaps, at the time when the menses were the most perfect, as regards period and quantity; consequently, they could have had no agency in its production; but, on the contrary, from its frequently relieving the engorgement of the vessels, served to keep it in subjection for a long time; not as a specific discharge, but as a mere depletion; or, in other words, that if an equal quantity of blood could have been by any other means as certainly abstracted from the uterus, the same favorable result would have followed. Coincidences in the human system are so common, that they are frequently mistaken for cause and effect; hence the cessation of the menstrual discharge, and the appearance of scirrhi and cancers, are considered as cause and effect.

At this period of life, nothing will so effectually secure the woman against injuries which may arise from the irregularities of the menstrual discharge, as a well-regulated regimen. By regimen, in this place, we would wish to be understood, not only eating and drinking, but exercise of both body and mind, including the proper government of the passions; in a word, everything which relates to both moral and physical existence.

A well-ordered course of exercise in the open air in well-selected weather, and great simplicity of diet, is of the utmost importance to the female at this period of life, and should never be neglected, if it be possible to indulge in them. By these means, the nervous, muscular, vascular, and lymphatic systems are all preserved more certainly in equilibrium with each other, since they are the best calculated to ensure a reciprocation of their respective offices; and, consequently, to maintain that condition of the system, termed health. Hence, the justness of the remark, that the women who live in the country, and who exercise freely in the open air; who have fulfilled their duties scrupulously as mothers, by suckling their children, agreeably to the views of nature; who do not goad their systems by over-stimulating food and drinks; who do not relax their bodies by too long indulgence in bed, have but little suffering at this period.

From this it will follow, that a milk and vegetable diet, together with pure water as a drink; regular exercise, not carried to fatigue; keeping the bowels well open, by well-selected food, as the fruits of the season in proper quantities: the bran bread if necessary; but not by medicine, unless absolutely required; governing the temper; restraining the passions, as well mental as animal, will largely contribute to the safety and comfort of this period. All that we have just recommended, is calculated to place the system in a condition by which it shall preserve its various forces; have its irritability diminished; its sensibility moderated; and pretty certainly prevent that condition of the blood-vessels, most decidedly unfriendly to the general health at this time, called plethora. And, though last, not least in fair estimation, is an attention to cleanliness. The external organs should be washed with lukewarm water at least twice a day, and the whole body once a week, by going into a lukewarm bath. In using the bath, care should be taken to come out of it as soon as the purposes of cleanliness are answered.

Our next concern is with the derangement of the discharge at or about the period of cessation: this will consist, 1st, in a diminution of the proper quantity; and, 2dly, in an excess of it. As regards the first, we have already said enough when treating of the suppression of the menses; and, with respect to the second, it must be treated according to the rules prescribed for the management of hemorrhage from the uterus from any other cause, that is, first, to diminish the quantity discharging; secondly, to prevent an excessive return.

CONCEPTION;
OR,
PREGNANCY.

CONCEPTION.

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