The death rate is from five to twenty-five per cent.

Treatment.—Never scrape out (curette) the womb for this disease. The womb should be washed out with a hot salt solution, one teaspoonful of salt to one pint of water, and then packed with ten per cent iodoform gauze. This solution should also be injected hot into the rectum and frequently. The bowels should move freely, and if necessary injections may be given for that purpose.

The strength must be kept up by a liquid diet. Milk, brandy and strychnine, if necessary; 1/100 of a grain of strychnine can be given every four hours. Milk should be given every half hour, about two ounces at one time: or more if it agrees well.

The gauze should be removed gradually, beginning on the third day and ending on the ninth day.

In this disease the interior of the womb is smooth and contains no broken down or foreign tissue. In the next disease, Putrid Endometritis, it is far different, for this is caused by the presence of dead material, such as parts of the after-birth, left in after labor, or sloughing tumors. This material becomes putrid (rotten), and thus causes the disease called "Putrid Endometritis."

[500 MOTHERS' REMEDIES]

PUTRID ENDOMETRITIS.—An inflammation of the inner lining of the womb caused by putrid (rotten), decaying material.

Symptoms.—A chill is sometimes present at the beginning. The fever is high, pulse bounds and feels hard and strong, the face is flushed but there is little or no pain. The discharge from the womb, unless it is blocked by a clot, is foul smelling. The flow after childbirth is scanty, sometimes suppressed. The womb and ovaries are not very tender.

Treatment.—The first thing to do, of course, is to get the dead material, such as parts of an after-birth, clots, shreds, etc., out of the womb, and then scrape the rough surfaces. This must be done carefully and with perfectly clean tools and liquids of every kind. Then wash the womb thoroughly with the hot salt solution. One teaspoonful of salt to one pint of boiled water. After this pack the womb with ten per cent iodoform gauze, which may be bought in this strength. Remove this from the womb about the third to the ninth day. The bowels should be kept open.

Diet.—Should be of milk or at least of liquids only. The patient can be given whisky or brandy and 1/60 grain of strychnine every four hours if needed.



MALIGNANT DISEASES OF THE WOMB.—Cancer or carcinoma is a malignant disease of the neck (cervix) of the womb.

Causes.—The immediate cause is not yet known. Tears and erosions (scraping off and making raw) are supposed to act as direct causes.

Symptoms.—Bleeding is the early and very important symptom. After the change of life (menopause) is over if bleeding occurs and continues it is a very bad sign and the womb should be examined immediately. Later, a watery bloody discharge appears, with pain, loss of weight and general weakness. Pain is not an early symptom. It appears when the disease has spread to the nearby tissue.

Treatment.—The only thing to do is to operate and the earlier the better. The womb and all its belongings should be removed. If this is done early it is very successful. If the case is too far advanced, the only thing to do is to make the patient as comfortable as possible.

For the pain, morphine or opium should be given.

For the discharge, hot water and corrosive sublimate (1 to 2000) is the strength to be used. This should be used daily as an injection into the vagina.

Cancer of the Body of the Womb is found in only about two per cent of womb cancers.

Treatment.—An early operation is then necessary. The chances of obtaining a cure if operation is done is better even than in cancer of the neck of the womb. There is less chance for the adjoining structures to be affected so early and readily.

[ WOMAN'S DEPARTMENT 501]

FIBROID TUMORS OF THE WOMB or Fibromata, Frequency.—Some observers state that twenty to forty per cent of all women over thirty-five years have one or more of these tumors. They are not malignant. They are more common in women who are sterile, unable to become pregnant. They appear early in life and attack all classes. They appear oftener in the body of the womb than in the neck. When in the body of the womb the back wall is the common site. A covering of loose fibrous tissue surrounds the growth. Few blood vessels appear in the tumor, nourishment being received from the surrounding tissues. Their growth is slow, except during pregnancy, when they grow rapidly. There are three varieties named according to their location and the structure covering: or surrounding them. 1. Interstitial; 2. sub-mucus; 3. sub-peritoneal or sub-serous.

1. Interstitial.—They are in the substance of the womb wall. They are usually many and vary in size.

2. Sub-mucus (under the mucous membrane).—They project into the cavity of the womb, are covered by mucous membrane and are attached to the womb by a broad base or pedicle. This is sometimes cut off spontaneously, and then the tumor is expelled from the womb.

3. Sub-peritoneal.—They are under the peritoneum, which forms its outer cover.

Causes.—Are not known. They are more frequent between thirty and forty.

Symptoms.—Difficult monthly sickness, too much blood flowing from the womb, unable to become pregnant, sometimes, and abortion. Bleeding comes more from the sub-mucus variety generally. Pain is caused by the size and weight and by pressure upon the bladder, rectum and the nerves. Death rarely results except from the complications.

MOTHER'S REMEDY. 1. Ulcers of the Womb, Common Wood Cactus for.—"Common wood cactus tea. Take wineglassful three times a. day." Should remove all thorns, chop fine and boil in sufficient water; add gin to make dose more pleasant.

Treatment.—Operation is needed when the symptoms are pressing. The sub-mucus variety may make an early operation necessary on account of their location.

Symptoms Calling for an Operation.—Size of the tumor; from the pressure symptoms; persistent bleeding from the womb. Sometimes it is necessary to remove the entire womb, especially in the interstitial variety, for the walls of the womb may be filled with the tumors.

[502 MOTHERS' REMEDIES]

SUBINVOLUTION OF THE WOMB.—This simply means that the womb, after miscarriage or child-birth, fails to return to its normal size and weight.

Causes.—This is frequently due to getting up too soon after labor.

Symptoms.—Menstruation or too much flow of blood (menorrhagia), dull, heavy feeling in the pelvis, backache or leucorrhea.

Results.—The womb frequently becomes misplaced.

Treatment.—Proper supports should be put in after the womb has been placed in its proper position.

If seen early enough some cases can be cured by tampons of ichthyol used three times a week and prolonged hot water injections at bed time. Cotton soaked in ichthyol and glycerin are frequently of benefit three times a week used as a tampon. The patient should not be on her feet much, or be active. Witch-hazel water can be added to the hot water injection if so desired.



DISEASES OF THE FALLOPIAN TUBES.—These are named after their discoverer, Fallopian, an Italian anatomist. These tubes begin at the part of the body of the womb that extends out like a horn. This is on the sides near the top of the body of the womb. They are two in number and extend outward on each side for about four inches; each end forms a fringe or finger shape to catch the egg, as it emerges from the ovary. Through the center there is a tube or canal, and the inner lining of the womb continues on and lines this canal, the mucous membrane of the Fallopian tubes. When this lining or membrane becomes inflamed it is called Salpingitis or Inflammation of the Fallopian tubes. Salpingitis is derived from two words: Salping, meaning tube; ltis, meaning inflammation; Fallopian was the discoverer. Thus we have Salping(x)itis, or Inflammation of the Fallopian tubes. Unfortunately in medical description it is generally called Salpingitis.



SALPINGITIS. Inflammation of the Fallopian Tubes.—It may be either acute or chronic in character.

Condition.—The tissues of the tubes become swollen when the inflammation runs into the pus stage; the finger-shaped end (outer end) is usually closed by adhesions, the pus accumulates in the tube and we have pus in the tube, or what is technically called [pyo. (pus) Salpinx (tube)] Pyosalpinx. In long standing cases the pus is absorbed or degenerates into a thin watery fluid, forming watery fluid in the tube or [hydro (water) Salpinx (tube)]—hydrosalpinx.

The tube may become attached to neighboring organs. The pus or fluid may drain occasionally into the womb and vagina. It may go into the bladder or bowels.

Causes.—It is usually caused by invading germs from the womb. Gonorrhea is the cause of the most cases.

Symptom.—This disease follows the same kind of an infection in the womb and vagina; the patient complains of pain in the region of the tube, a little to the side or sides of the womb, and the pain is made worse by motion, exercise or long standing. If it is the acute variety, the temperature rises, the pulse grows faster, and sometimes there is nausea and vomiting.

[WOMAN'S DEPARTMENT 503]

The Symptoms of the Chronic Variety are due to congestion and adhesions. There is a constant pain in the region of the tube and the patient protects herself when she walks, rides or sits down. There are difficult, painful monthly periods and too much flow. The history shows gonorrhea or septic infection, that is, disease caused by the absorption of products of putrefaction.

Treatment of the Acute Kind.—First thing is absolute rest and quiet in bed. Then prolonged hot injections in the vagina of hot water, and if you wish, one teaspoonful of listerine, etc., in each injection. Put a hot-water bag to the sore side, or fomentations of different remedies, like hops, catnip, pennyroyal, smart-weed. The applications should not be of great weight. The bowels should be kept open.

For Chronic Variety.—This frequently calls for an operation. When the symptoms are due to inflammation in the tube alone, ten per cent strength of ichthyol and glycerin tampons placed behind the lower part of the womb three times a week do much to improve the condition.

This is an unfortunate disease, and it must be closely watched for symptoms that may arise from a pus condition. There are many cases of this kind in our public hospitals, and when they are due to gonorrhea they may have been caused by the husband who had an acute or latent gonorrhea—an attack he thought cured.



DISEASES OF THE OVARY.

Inflammation of the Ovary or Ovaritis.—This is an inflammation of the ovary and it may be either acute or chronic.

In the acute form the ovary is slightly enlarged and the follicles on the circumference are distended and filled with thick fluid or pus.

In the chronic variety the ovary may be small and contain cysts; there is a destruction of the follicles and a hardened condition develops. The function of the ovary is then impaired.

Causes.—Gonorrhea, septic infection from adjacent tissues, acute fever diseases, mumps, and peritonitis. Falling (prolapse) often gives rise to chronic inflammation.

Symptoms.—Pain in the lower abdomen (pelvis), difficult and painful menstruation, too much monthly flow (menorrhagia), and painful intercourse.

Treatment.—Ichthyol (ten percent) and glycerin tampons placed behind the lower back part of the womb three times a week. The bowels should be kept open with salts. The diet should be milk or liquid. Sometimes an operation is necessary. In the department on operations this subject will be touched upon in regard to operations.

PHYSICIANS' TREATMENT.—Change of the mode of life, and proper hygienic measures will generally be all that is needed.

[504 MOTHERS' REMEDIES]

TUMORS OF THE OVARY.—Cystoma is the most common tumor of the ovary. The word "cystoma" means a cyst tumor, or cystic tumor. A cyst means a cavity containing fluid and surrounded by a covering (capsule). Ovarian cyst or tumors is often seen in print these days. Ovarian tumor takes in the cystic variety, cancer and sarcoma, two malignant tumors.

Symptoms.—These depend upon the size of the tumors. The large tumors are generally cystic. Examination of the vagina shows the pelvis filled by a tense, watery, fluctuating mass. Examining the abdomen, the abdomen is seen more or less distended by a regular swelling, and sometimes this is enormous. The abdomen is rounded and there is no bulging at the sides like there is in ascites (dropsy). The navel is not prominent. The tumor can be outlined. It cannot be in ascites.

Treatment.—In bygone years tapping was done for these tumors. If it gets large or the health fails, an operation should be performed. This is very successful in uncomplicated cases. Inside of two months the patient is about well. I know I have saved many lives of women by recommending an operation for such tumors.

For the congested ovary, treatment by tampons and medicine often helps. I have frequently given a medicine called Apis-Mel for this condition and with success. I give it in tablets of 1/100 of a grain regularly four times a day.



MENSTRUATION AND ITS DISORDERS.—Normal menstruation occurs monthly in the female. There is a flow of blood from the cavity of the womb. The time for its beginning is different in different countries, it being earlier in warm climates, ten to twelve years, and later in cold ones (fifteen to seventeen years); the average is fourteen years.

Pregnancy suspends menstruation and often nursing the child does, also. Menstruation continues longer in robust, healthy women. Change of life (Menopause) occurs usually between forty and fifty years. The healthy girl and woman comes around every twenty-eight to thirty days. This is the usual time. The flow lasts from two to eight days and the quantity is about one ounce each day. A slight feeling of weight and fullness in the lower abdomen (pelvis) should be the only symptom present in a healthy female. The blood lost should not cause any special degree of weakness.



PREMATURE MENSTRUATION. Too early menstruation.—Premature or precocious menstruation is when it occurs before puberty. This is in part hereditary, but bad associations may be a cause of this early menstruation.

Treatment.—The cause, if possible, should be removed. The nerves should be kept quiet by rest and, if needed, general tonics like iron, arsenic, and nux vomica prescribed and given.

[WOMAN'S DEPARTMENT 505]

DELAYED MENSTRUATION.—This is often caused by slow development of the generative organs. The girl may not come around until seventeenth to nineteenth year.

Causes.—It may be due to heredity. Lack of proper nourishment and proper exercise are the most important causative factors.

MOTHERS' REMEDIES.—l. Obstruction of Monthly Flow.—An herb combination for.

Poplar Bark 2 ounces Ginger 1/2 ounces Bayberry 1 ounce Cinnamon 1/2 ounce Anise Seed 1/2 ounce Golden Seal 1/4 ounce

Mix well and give a teaspoonful in a cup of boiling water sweetened with sugar two or three times a day. Excellent in obstructions of the monthly periods, debility, loss of appetite, etc. This combination is fine when used as a tonic. It is stimulating and has been known to cure many severe cases.

2. To Promote the Menses, Smartweed for.—"Smartweed is good to promote the menses. Always steep in cold water; never boil. Dose.—Two teaspoonsful every hour. Be sure to take warm."



VICARIOUS MENSTRUATION (In place of).—When menstruation is absent or suppressed, bleeding sometimes occurs periodically, from the ear, nose, any existing raw surface, leg, ulcer, and from the respiratory (breathing) tract, and also from the bowels.



AMENORRHEA.—This is absence of menstruation.

Causes.—Delayed puberty, anemia (want of proper blood) chlorosis (green sickness). diabetes, malaria, tuberculosis and acute illness may cause it. Sometimes change of climate causes it and nursing baby too long.

Symptoms.—If it is associated with atresia, that is, want of the normal outlet, of course no signs of flowing can show, but colicky, cramp-like, monthly pains appear in the lower abdomen. These increase in severity as the retained blood distends the womb.

Treatment.—If there is no opening for the vagina or cervix one must be made, by operation. If it is due to anemia or chlorosis, Blaud's pills will benefit. The following is the formula:

Dried Sulphate of Iron 2 drams Carbonate of Potash 2 drams Syrup—Sufficient quantity to make forty-eight pills.

Take one to three pills three times a day, after meals.



MENORRHAGIA.—Too much bleeding at the monthly periods. If it occurs between the monthly periods it is called Metrorrhagia, womb-bleeding at any time, especially between the periods.

Causes.—These may be constitutional or local, the latter being the most important.

Local Causes.—These are inflammation of the womb, displacements of the womb, malignant disease of the womb, fibroid tumors and disease of the ovaries.

[506 MOTHERS' REMEDIES]

Symptoms.—Sudden or gradual increase in the amount of blood lost at the monthly periods. Then secondary anemia, weakness and run-down feeling.

PHYSICIANS' TREATMENT. 1. Profuse Menstruation, an Easily Prepared Herb Remedy for.—

"Cranesbill Root 1 ounce White Poplar Bark 2 ounces Bistort Root 1 ounce Golden Seal 1 ounce Geranium 1/2 ounce Cloves 1/2 ounce Ginger 1/2 ounce Ground Sugar 1/2 pound

Mix. This compound is excellent for complaints of weak females, such as leucorrhea, bearing-down, or profuse menstruation, etc. Dose: One teaspoonful of the powder, in a half cup of boiling water three times a day. Drink the clear liquid only." Any woman suffering with, female trouble will find the above combination very beneficial.

2. In young girls and women who are not married, thirty drops of the fluid extract of Ergot three times a day. This medicine will cause the womb to contract. Hot douches can be given to married women. If the bleeding is severe it may be necessary to pack the vagina with sterile gauze. Ergotin ten to twenty drops, may be needed, given hypodermically. If it is due to constitutional causes, like anemia, a played-out feeling, paleness. weakness, etc., a tonic treatment is needed.

3. Blaud's pills will do well. This is the formula:

Dried sulphate of iron 2 drams Carbonate of potash 2 drams Syrup enough to make a mass

Mix and make forty-eight pills. Take one to three, three times a day after meals.

4. If the appetite is poor, bitter tonics such as gentian, quassia, cinchona, or nux vomica are needed.

Compound Tincture Cinchona 2 ounces Compound Tincture Gentian 2 ounces

Mix. Take one teaspoonful before meals, in a little water.

5. Tincture of nux vomica in doses of two to three drops after meals is a good stomach and bowel tonic.

6. Golden seal root made into a tea is good in some cases, especially if the tongue is much coated.

7. Oil of Erigeron or flea-bane is good for oozing bleeding. Dose: Three to five drops in a capsule every four hours.

8. Oil of cinnamon in one dose of one-half dram is good where flea-bane oil cannot be used or obtained; usual dose, one to five drops. An infusion can be made of the cinnamon bark and drank freely.

[WOMAN'S DEPARTMENT 507]

9. Cranesbill (Geranium maculata). The fluid extract is splendid when diluted three or four times with boiled water, used locally for bleeding from the womb, or as an injection for the same; or an infusion can be made of the plant and injected into the vagina. The local cause mentioned should be treated. The displacement should be corrected.



DYSMENORRHEA or Difficult Menstruation.—This term means difficult and painful monthly periods. The pain may occur before, during or after the periods.

Causes.—It may be caused by a narrow cervical canal, the canal from the inner womb to the vagina. This is often very narrow and almost closed. Again it is produced by the womb being turned back and bent on the canal, thus partially closing it. This causes the blood to be retained in the womb and then the womb contracts to expel the blood, pains being the natural result. Diseases of the womb and ovaries also cause it. Sometimes the membrane of the womb is cast off in the form of shreds or even a cast of the inner womb.

Symptoms.—The flow may be scanty, moderate or profuse, often clotted. The pain varies. It may be slight before the flow, or the first day or two, or it may be severe, agonizing and continuous for one or two days, or during the whole period and sometimes for some days after there may be pains.

MOTHERS' REMEDIES. 1. Painful Menstruation, a Good Tonic for.—"This may be relieved by sitting over the steam of a strong decoction of tansy, wormwood, and yarrow, and fomenting the abdomen with the same. Then take the following in wineglassful doses:—One ounce each of ground pine, southern wood, tansy, catnip and germander, simmering in two quarts of water down to three pints and pour boiling hot on one ounce of pennyroyal herb, strain when cold and take as per dose above."

2. Painful Menstruation, a Home Remedy for.—"Let the patient take an active cathartic; then when put to bed let a half cup of hop tea be given; and a douche of one quart of hot water into which ten drops of laudanum have been dropped, be injected." A cathartic is not necessary in all cases. If the bowels have been moving freely do not take one. The douche will give great relief providing the woman can take one while menstruating. Some women can and some cannot.

[508 MOTHERS' REMEDIES]

PHYSICIANS' TREATMENT.—If the womb is displaced it should be corrected. Any disease of the womb or ovaries should be treated. If the canal is too much closed, gradual and careful dilation between the periods, will often remove this cause in time. The bowels should be kept regular at all times.

1. For the attack.—Never take opium or alcohol for it in any form; it is so easy to form the habit and a doctor who gives it is simply dodging effective general and local treatment between the periods. If it is due to taking cold, or from any local cause, the following treatment is good: The patient should take a hot sitz bath, being well covered by a blanket, while in the tub and afterwards, and should immediately get into bed as soon as the buttocks are dried and remain there well covered. A turpentine stupe is now to be used, prepared as follows: Place a tin cup containing the turpentine in a vessel containing hot water. This will keep the turpentine warm. Dip a piece of flannel into very hot water and wring it out in a twisted towel, and after it is perfectly dry and no dripping, dip it into the hot turpentine and wring it out again to free it from too much of the drug. Apply the cloth while hot and allow it to remain until it causes discomfort. Then withdraw it or it will blister the skin if left on too long. Fomentations wrung out of teas like hop, pennyroyal, smart-weed, etc., applied and kept warm often do much good. At the same time pennyroyal tea can be drank freely. A five-cent package can be bought at any drug store. Hot lemonade will help also. The object is to produce relaxation of the tissues through the local applications and tea drinking. If there is constipation, the bowels should be moved freely with epsom salts, half ounce dose, in the morning before breakfast. If there is much pain a belladonna suppository, one-half grain of the extract, can be inserted into the rectum.

2. If the patient's nervous system is run down the "Rest Cure" will be of benefit, and medicines to strengthen the nerves. Exercise, outdoor life, horseback riding are of great benefit in toning the system.

3. Fluid extract of blue cohosh is a good medicine in this disease, especially if there is some rheumatism during the interval. One or two drops every hour will be enough.

4. Tincture of Pulsatilla in doses of three drops every hour is good for the pain, especially in blonde girls and women.

5. Tincture of Cocculus I have found to be of great benefit. Put five drops of a good pure tincture into a glass half full of water and give two teaspoonfuls every ten to fifteen minutes until relieved. This I give in cases I am called to and have not the time then to find out what the real cause may be.



DISPLACEMENTS.—Turning back or retro-displacements. This includes retro- version and retro-flexion. Retro-version means turning back, in plain terms. Retro-flexion means bending back, bending of the body of the womb, or the neck, backward. Retro-flexion is more common than retro-version.

Causes.—Some are congenital, that is, from birth, and a few are the result of some injury, falls or blows. It is more often found in child-bearing women, and this may be due to the fact that the womb has not returned to its normal size and weight, and therefore there is more weight for the ligaments to hold up. The ligaments often relax and do not support the womb as thoroughly as before.

Symptoms.—Backache, a sense of weight in the lower abdomen, difficult menstruation, leucorrhea, sterility, or repeated abortion and constipation. The constipation is often due to the womb lying on the rectum.

[WOMAN'S DEPARTMENT 509]

Treatment.—This is to replace the womb and keep it in position. Supports of various kinds are used to keep the womb in position after it has been replaced, They must fit thoroughly and give no pain or any discomfort whatever. They are called supports or pessaries. If they are fitted properly they do much good. They should be removed often (every month) and not allowed to grow fast or cause sores in the vagina. There are the ring support and the stem variety and others. The stem variety can be taken out and replaced by wearer at any time. They are made to buckle around the abdomen. They are bungling but effective. The ring kind should be introduced by a competent person who should see that it is of correct size and shape, and worn with comfort. Sometimes these supports fail to cure when adhesions and other diseases exist; it may be impossible to wear them.

Operations.—One operation is to break up the adhesions, the body of the womb brought forward and sewn (sutured) to the abdominal wall. Another operation is to shorten the round ligaments in the inguinal (groin) canal. These are the usual operations, and they are quite successful.



FALLING OR PROLAPSE OF THE WOMB.—The womb may come down and remain in the vagina (incomplete falling). When the womb escapes at the vulva it is called a complete falling (prolapse or procidentia).

For the Incomplete Kind.—Replace the womb and wear a support for months.

For the Complete Falling.—Replace the womb. The patient should remain in bed with daily, hot, prolonged vaginal injections of water for a few weeks. The injection daily of white oak bark tea, of the strength of one ounce of the bark to a pint of hot water, is often of great benefit.

If these measures fail to cure, an operation may be necessary.

MOTHERS' REMEDIES. 1. Falling of the Womb. Unicorn Root for.—"Make a strong tea of unicorn root, and take a half teaspoonful three times a day, This is an excellent remedy for falling of the womb," This is very easily prepared and not bad to take, and in addition to this use an injection of witch-hazel or golden seal.

2. Falling of the Womb, a Fine Herb Combination for.—"Peach leaves, mullein leaves and hops made into a tea, and a pint used twice a day as an injection often cures when other remedies fail." We all know that this combination of herbs is healing and especially in female trouble. The hops, especially, are very soothing to the affected parts.

3. Falling of the Womb, a Physician's. Treatment.—"Knee-chest position. Get down on the knees and put chest and chin to the floor. Retain this position about three minutes several times a day." This is a splendid thing to do, and is recommended by all physicians.

[510 MOTHERS' REMEDIES]

4. Falling of the Womb, a Never Failing Remedy for.—"Ague root (Aletris Farinosa) is a valuable agent to prevent tendency to miscarriage and falling of the womb. It is especially useful for the purpose of restoring the activity of the generative organs giving them vigor and healthy action. Dose of the tincture is from six to ten drops three times a day and of the powdered root five to eight grains." This is an old tried remedy, and is frequently used by physicians alone or in combination with other remedies.

5. Falling of the Womb, White Oak Bark for.—"A mild infusion of white oak bark, or of alum or tannin, used in quantities of a pint, as a douche, will often give immediate relief."



LEUCORRHEA. (The Whites).—This is an over-secretion from the glands that pour out their contents into the vagina or the cervical canal of the womb.

Causes.—It is dependent upon many causes. Tear of the neck of the womb (cervix), displacements, inflammation of the womb and vagina, a run-down condition of the system from any cause. The character of the discharge varies.

From a Torn Cervix, the discharge is thick and mucus-like in character.

In Inflammation of the Canal of the Cervix.—A thick mucus discharge also comes from this trouble.

Inflammation of the Body of the Womb.—The discharge is thin and watery. If the Inflammation is Caused by Gonorrhea the discharge would partake of the pus-like variety.

Symptoms.—Local: is of course mainly the discharge or the irritation often produced by it, especially if it is thin. It then irritates the parts. The patient will be run down. It will be hard to do anything, frequently the patient is very nervous and irritable.

MOTHERS' REMEDIES. 1. Leucorrhea, Slippery Elm for.—"The immediate cause of leucorrhea is either congestion or inflammation of the mucous membrane of the vagina or womb, or both. It is not a disease, but a symptom of some vaginal or uterine disorder; hence, general or specific tonics may be needed but appropriate injection as auxiliary treatment will very much assist in cure. The patient should bathe frequently and freely expose herself to the sunshine, and have good ventilation in the house. If the vaginal passage is very tender and irritable, an infusion, or tea, of slippery elm bark is very soothing and may be used freely with a vaginal syringe. Whatever injection is employed, should be preceded by the free use of castile soap and warm water to thoroughly cleanse the parts." Always lie down after an injection.

[WOMAN'S DEPARTMENT 511]

2. Leucorrhea, Glycerin for.—"One part glycerin to six parts water is a very soothing lotion when there is much tenderness, pain or heat in the vagina. A teaspoonful of tartaric acid in a pint of warm water is a specific, in some cases, acting like magic. Whatever lotion is employed, always use it warm. After cleansing with soap suds, the medicated lotion of not less than two ounces should be injected."

3. Leucorrhea, Common Tea for.—"A very simple remedy that every woman has in the home is a decoction of common tea; used as an injection twice daily is very beneficial." The tea has an astringent action and the tannin contained in the tea leaves is very effective. This remedy is a harmless one, and every woman suffering with this disagreeable disease should give this remedy a trial.

4. Leucorrhea, Witch-hazel for.—"Cleanse the parts well with clear warm water, then inject two quarts of warm water in which has been dropped a tablespoonful of witch-hazel." This is a very good remedy and sure to give relief.

5. Leucorrhea, White Oak Bark for.—"White oak bark one ounce, water one pint. This makes a very good injection and will be found very effective,"

6. Leucorrhea, a Good Herb Remedy for.—"Inject into the vagina with a female syringe, a tea of bistort or beth root, and cranesbill, night and morning and take the following night and morning in wineglassful doses.

White Pond Lily Root. 2 ounces Unicorn Root 2 ounces Wahoo Root 1 ounce Golden Seal 1 ounce Cinnamon 1 ounce

Add three pints of water, simmer to one quart, pour boiling hot upon one ounce of grated nutmeg, one-half ounce ginger, powdered, one half pound of granulated sugar. Exercise in the open air and nourishing food are indispensable."

7. Leucorrhea, Common Vinegar for.—"Two tablespoonfuls vinegar in two quarts of water (warm or hot), used as a douche at bedtime, until cured," This will cure some mild cases and has an astringent action.

8. Leucorrhea, an Easily Prepared Remedy for.—"Red oak bark tea used with syringe; follow with hot water." Steep the red oak bark and make a tea of it, using about two or three teaspoonfuls of the bark to a pint of hot water. This acts as an astringent and the red oak bark contains a good deal of tannin which is very beneficial in cases of this kind.

9. Leucorrhea, Home-Made Suppositories for.—"Take a small piece of medicated cotton, and saturate in pure glycerin and insert in the vagina at night, after a warm salt injection has been taken to thoroughly cleanse the parts." So many women of today are careless about taking injections, at least once or twice a week. Many of these diseases could be avoided in the beginning by women being more cleanly. This saturated cotton acts as a suppository absorbing the mattery secretion and in that way relieves the congestion.

[512 MOTHERS' REMEDIES]

10. Leucorrhea, a Good Home Remedy for.—"Cleanse the parts affected with warm water with a little castile or ivory soap in it, by means of an injection. Then inject a full syringe of the mixture, made by dropping a tablespoonful of extract of witch-hazel (Pond's is best) into warm water; repeat each night until cured." The injection of soap and water is one of the essential things to do for leucorrhea, as it cleanses the parts thoroughly and the witch-hazel is very soothing and healing.

11. Leucorrhea, a New York Doctor's Remedy for.—"Fluid extract of Oregon grape root (sometimes called mild grape) mixed with a simple syrup and given in teaspoonful doses, three times a day, is recommended by Dr. W. W. Myers, as a curative for leucorrhea."

PHYSICIANS' TREATMENT.—First is to do away, if possible, with local disease, like inflammations, tear of the cervix, etc. The general system should be built up with tonics. The same treatment as for anemia and chlorosis will be usual for this trouble. Refer to those diseases.

Local.—The vagina should be kept as clean as possible with the hot water injections. To the hot water many simple remedies can be added with much benefit.

1. One ounce of white oak bark in a pint of boiling water makes a good injection for this trouble. Before any medicine is used the vagina should always be washed out by an injection of warm water. Then follow with the indicated injection and retain it as long as possible.

2. Tannic acid and glycerin, equal parts, one ounce to two quarts of warm water, is a good injection.

3. Lloyd's Golden Seal is splendid, used in the proportion of four teaspoonsful to a pint of warm water.

4. This combination gives good service:—

Sulphate of Zinc 1 dram Sulphate of Alum 1 dram Glycerin 6 ounces

Put a tablespoonful to each quart of warm water and use as injection.

It is well to remember the injections must be given in large quantities, and used in a fountain syringe. A gallon can be used at one time.

5. Witch-hazel in warm water makes an excellent injection in many cases. It can be used in the proportion of one-fifth water of witch-hazel to four-fifths of warm water.

6. Many other simple remedies may be named, Cranesbill is one. Vaginal cones are now made for leucorrhea. These are used about every third night and a thorough injection taken the next day. There are many varieties, most of them are good and can be bought at any drug store.

[WOMAN'S DEPARTMENT 513]

MENOPAUSE. (Change of Life). The active menstrual life lasts on an average for thirty years and ends between forty and fifty years of age. The courts have recognized the age of fifty-three years as the limit that a woman can become pregnant.

The onset of the change of life, may be sudden or gradual. The organs shrink and waste. The womb shrinks and part of its muscular tissue disappears and its walls become thin, soft and relaxed. The ovaries become small and harder. The vagina shortens and also becomes narrower. Sudden mental shock, wasting disease or change of climate, may cause a sudden appearance of the change of life.

Symptoms.—Many women hardly notice any change, as it comes on gradually. Other women have all kinds of bodily and mental symptoms, and some are afraid of becoming insane. The heart palpitates readily, feelings of heat and cold, flushes of heat of the face, followed by sudden sweating. Rush of blood to the head so quickly sometimes as to make the patient lose temporary consciousness. The spirits are very much depressed, sleeplessness is common in some women.

MOTHERS' REMEDIES. 1. Change of Life, a Useful Herb Remedy for.— "Motherwort is one of the most useful herbs to relieve obstructed menstrual flow. There is no better herb for cleansing the womb and removing obstructions in the female at change of life. Dose: A wineglassful of the decoction three times a day."

2. Change of Life, excessive Flowing. An Old Tried Remedy for.—"One ounce of nutmeg, grated, one pint Jamaica rum. Mix well and shake before taking. Dose :—One teaspoonful three times a day as long as necessary." I tried this remedy upon the advice of a physician at the time of "change of life" and was very soon relieved, so I heartily recommend it.

3. Change of Life. Good Advice From an Experienced Mother.—"The first and most important point to consider is the general health of the patient. If the general health can be sustained there will be no danger attending this critical period of life. Therefore whatever form of disease may manifest itself the one object should be to seek a remedy in time. Take special pains to preserve general good health and take care not to overwork, take plenty of outdoor exercise and keep up a regular action of the bowels. Purify the blood with tonics if necessary."

PHYSICIANS' TREATMENT.—Exercise, fresh air, with freedom from worry, anxiety and care. Many women at this time of life need much encouragement, and cheerful company is a good tonic. Prominent annoying symptoms should be met with the proper medicine. Irregular bleeding of the womb at this time or after should lead to an examination as to its origin.

[514 MOTHERS' REMEDIES]

CYSTOCELE—Cystocele is simply a tumor formed by the bladder pressing into the walls of the vagina. The bladder descends into the pelvis on account of relaxation or destruction of its normal support. The anterior wall of the vagina yields.

Causes.—Tear of the perineum allows the bottom of the pelvis to relax. Undue relaxation of the ligaments of the bladder and of the floor of the pelvis, with over distention of the bladder, are responsible for the majority of the cases.

Symptoms.—Weight and dragging feeling. A tumor can be felt in the vagina. It decreases when the bladder is emptied.

Treatment.—Supports are suitable in some cases (Skene's pessary). An operation is necessary in many cases.



RECTOCELE.—The muscle that holds up the lower end of the rectum is relaxed or torn and this deprives the lower end of the rectum of its support so that during expulsion of the feces forward distention of the anterior wall of the rectum into the vagina results. The posterior wall of the vagina is carried before the advancing anterior rectal wall, and appears at the entrance of the vagina as a bulging tumor which is increased in size with every effort of the rectum to cast out the feces.

Causes.—Hard child-birth (labor) and the long time the head of the child was resting on the perineum. This resulted in an overstretching or tear of the muscle that holds up the lower end of the bowel and the parts were necessarily weakened.

Symptoms.—It is hard to entirely empty the rectum because of the presence of the tumor. This is soft, rounded, increasing and decreasing in size and disappears upon pressure.

Treatment.—Keep, if possible, the tumor from getting larger, regulate the bowels.

An operation may be necessary to restore the parts to their normal condition. A physician must be consulted.

[OBSTETRICS OR MIDWIFERY 515]

OBSTETRICS OR MIDWIFERY

Small bodies are contained in the ovaries. These are called eggs or ova. The human egg is about 1/125 of an inch in diameter. This egg enlarges and one or more escape from the ovaries, usually about the time of the monthly sickness, and are caught by the ends of the Fallopian tube, enter its canal and are carried into the womb. After they have arrived in the womb they are, as a rule, cast off with the secretion and leave the body. If in the course of its travel from the ovaries, through the tube to the womb, the female ovum or egg meets with the male elements, fertilization or impregnation may take place. If then it is not cast off it generally lodges in the womb and pregnancy has begun. The male and female elements are usually supposed to meet in the outer portion of the Fallopian tubes, fertilization then taking place; but this can occur any place from the ovary to the womb. When the fertilized egg enters the womb it is usually arrested in the folds of the womb membrane nearest the opening of the tube and at once attaches itself to the womb wall. The folds by which it is surrounded then grow forward and their edges unite over the egg or ovum forming a sac—the decidua reflexa. Then follows the development of this ovum and with it the development of the womb, and this growth or development constitutes the process which is called pregnancy.

The Embryo or impregnated egg is nourished in the womb by measures preparing for it. The placenta or after-birth forms during the third month of pregnancy. Its function is to furnish nourishment breathing (respiration) and excreting power to the embryo or impregnated egg. The fully developed after-birth is a roundish spongy mass with a diameter of about eight inches and weighs about one pound. It is usually thickest at the center, the edges thinning out to the membranes. The inner surface is smooth and glistening and is covered by a membrane (amnion) and beneath this two arteries and a vein branch in all directions.

The cord is attached to the inner surface of the after-birth and is of a glistening white color, varying in thickness, and is about twenty-two inches long, but it may be longer or shorter. It contains two arteries and a vein, which run in a somewhat spinal course.

DEVELOPMENT AT DIFFERENT MONTHS.—

First month.—There are indications of the eyes, mouth and anus. The extremities are rudimentary. The heart is 4/10 of an inch long.

Second month.—It is now about one inch long. The eyes, nose and ears can be distinguished. External genitals. There are suggestions of the hands and feet.

[516 MOTHERS' REMEDIES]

Third month.—The ovum is now the size of a goose-egg. Fingers and toes separate, nails look like fine membranes. The neck separates the head from the body. The sex can now be told. Length is five inches. Weight about 460 grains.

Fourth month.—Six inches long and now weighs 850 grains. Short hairs are present. Head equal to about one-fourth entire body. May perceive quickening.

Fifth month.—Ten inches long; weighs eight ounces. Eyelids begin to separate. Heart sounds can be heard. Quickening takes place.

Sixth month.—Twelve inches long; weighs 23-1/2 ounces. There is hair on the head, eyebrows and eyelashes are present. Testicles show near the abdominal rings (openings).

Seventh month.—Fifteen inches long; weight 41-1/2 ounces. Pupillary membrane disappears.

Eighth month.—Sixteen inches long; weight 3-1/2 pounds. Left testicle has descended into the scrotum. Nails protrude to end of finger tips.

Ninth month.—Eighteen inches long; weighs 4-1/2 to 7 pounds. Features are complete.

While this growth goes on in the embryo the womb itself shows changes. The virgin womb averages 2-3/4 inches in length, 1-3/4 inches in width and 1 inch in thickness and weighs about 12 drams. At term (confinement) the womb is about 14 inches long, 10 inches wide, and 9-1/2 inches thick. This increase in size is necessary for its growing contents and is due to both an enlargement of its tissues (hypertrophy) and to an increase in the number of its cells (hyperplasia). The muscular fibres are elongated to about 11 inches, and they are five times thicker than they are in a womb that is not pregnant. The cervix or neck of the womb participates but little in these changes, and remains practically the same until a few weeks before confinement. It becomes softened as the result of congestion, and the glands are more active, secreting a thick glairy mucus. The canal also is more or less dilated.

While this process is going on in the womb, various other conditions show themselves, sometimes in the parts of the body so distant that it may not be easy to discover the connection with the womb. Almost any part of the body is liable to show changes from its normal condition; and yet some of these changes are so constant and regular as to be regarded as signs of pregnancy. It must not be forgotten, however, that sure signs of pregnancy, such as cannot be induced by other causes, are very limited, especially in the early months.

[OBSTETRICS OR MIDWIFERY 517]

Changes occur in the genital organs that may lead a physician to suspect that pregnancy may exist; but the first symptom that attracts the attention of the woman, is the passing of the monthly period. This is not an absolute sign of pregnancy, since other things or conditions may cause it. The effect of the mind upon the body may cause it, and it also occurs sometimes in early married life without any appreciable cause, unless it may be then due to the effect upon the nervous system of the marital relation. Again, the monthly sickness sometimes continues in a greater or less degree, during a part or even the whole of pregnancy. Usually this discharge is due to some diseased condition of the cervix. The fear of impregnation in unmarried women after illicit intercourse will occasionally suspend menstruation for one or two months.

Nausea and Vomiting.—Another symptom upon which considerable dependence is placed is the morning sickness (nausea and vomiting). While this symptom is common, yet its absence does not prove that the woman is not pregnant. Some women go through the whole pregnancy without any sign of this symptom.

Nausea accompanied or not by vomiting may appear at the very time of conception, but it usually appears about the fourth or fifth week of pregnancy and continues until the sixteenth week or longer. In some cases it may last but a short time, in others it may continue until confinement. It may be light or severe; It generally manifests itself upon arising in the morning and subsides in a short time, but it may occur at any time of the day and continue during the entire waking hours. It may be absent entirely and, in rare instances, manifest itself in the husband alone. I have known of one such case. This nausea may be excited only by various odors or sights or may be caused by constipation. An increased secretion from the salivary glands usually accompanies the stomach disturbances and in some cases it may amount to salivation. An irresistible desire for certain articles of food or drink, generally of a sour or acid nature, is often developed. Indigestion, gas in the bowels and belching of gas are frequently present. The appetite is often capricious or it may be entirely lost (anorexia).

Breasts.—Changes in the breasts also constitute a sign of pregnancy. As an early symptom, there may be a feeling of fullness, sometimes pain. They become larger and firmer from the development of the individual lobules, which have an irregular knotty feel. A fat deposit takes place between the lobules and in the other parts of the breast. The nipples increase in size, are harder to the touch, become more prominent. A few drops of a turbid fluid, colostrum, may be pressed from the nipple as early as the third month. The veins under the skin become larger and more conspicuous. The rose-colored circles (rings) around the nipples are broadened and are slightly elevated above the surrounding skin and there is a marked increase in their pigmentation, the color varying with the complexion of the individual from reddish pink to brown and black. These changes usually occur at the beginning of the third month, and if the woman has already had a child the question of pregnancy has been decided by inspection of these breast changes.

Bladder.—This is sometimes irritable in the later months, causing a frequent desire to pass urine. It sometimes occurs in the second or third week and is sometimes followed, later, by an inability to retain the urine which escapes at any time. This, however, is not frequent.

[518 MOTHERS' REMEDIES]

Abdominal changes.—There is a slight flattening of the lower abdomen at the second month, due to the sinking of the womb. There is also a slight retraction (drawing back) of the navel. After the third month, when the womb begins to ascend out of the pelvis, a progressive enlargement of the abdomen begins and continues until near the end of pregnancy, when the womb again sinks and the so-called lightening occurs. The protrusion of the abdomen is more marked usually on the right side. There is often an increased deposit of fat in the lower portion of the abdomen, as well as on the hips and thighs. The navel may protrude after the sixth month,

Pigmentation.—Pigmentation or darkening of the middle line of the abdomen begins by the eighth or twelfth week, and a dark band about 1/8 of an inch wide extends from the pubis (bone) to and around the navel or even higher. This shows plainer in brunettes, where it is quite conspicuous. Discolorations also appear on other parts of the body, especially on the face, "moth patches."

Quickening.—This is caused by the movement of the child (foetus) in the womb. The impact of the enlarging womb, through the child (foetal) movements, against the abdominal wall about the sixteenth week of pregnancy gives rise to this sensation called quickening. Some women claim to have experienced this sensation at a much earlier date, and by some it is not felt at all. Gas in the bowels and contraction of the muscles of the abdomen may give a chance for mistakes. In the later months of pregnancy, the movements sometimes become so violent as to produce perceptible movements of the womb and the abdominal muscles, and sometimes they are the cause of the pain.

The Blood.—The blood is increased in quantity and slightly altered in its composition. The water, fibrin and white corpuscles are increased; the red cells are at first relatively diminished, but later return to normal.

Nervous System.—The nervous system is over sensitive and the disposition of the woman may undergo a radical change, mental exaltation and depression are often exhibited.

Constipation is the Rule.—Neuralgias in different parts of the body, especially in the face and teeth, are common. Palpitation of the heart and difficulty in breathing may be experienced. A discharge from the vagina is almost always present, due to the increased circulation in the cervix and vagina.

The Foetal Heart-beat.—This is the one positive sign of pregnancy and it may be heard as early as the sixteenth to the twentieth week. It has been compared to the ticking of a watch under a pillow. It ranges in frequency from one hundred and ten to one hundred and fifty to a minute.

[OBSTETRICS OR MIDWIFERY 519]

Pelvic Signs.—As early as the first month of pregnancy a faint violet color of the anterior wall of the vagina just below the opening of the urethra may be distinguished. In the third month this color has become purplish and pronounced. This sign is present in eighty per cent of cases. There is also a more or less marked lividity of the vaginal portion of the cervix from the first month of pregnancy. Also there is softening of the cervix as early as the sixth week, and as pregnancy advances the whole of the cervix is softened.

Duration of Pregnancy.—This is for all practical purposes two hundred and eighty days.

How to Determine Date of Confinement.—The best rule is to count backward three months from the first day of the last menstrual period and add seven days to it. To be more accurate, in April and September only six days should be added; in December and January, five days; and in February, four days.

Position of the Womb.—At four months the top of the womb has risen above the pelvic brim bone in front; at five months, it is midway between the bone (pubic) and the navel; at six months, it is at the navel; at seven months, it is four fingers breadths above the navel; at eight months, it is midway between the navel and the bottom of the breast bone; at nine months, it is to the breast bone; from the middle to the end of the ninth month, the top of the womb sinks to about the position occupied at the eighth month.

Twins occur about once in ninety to one hundred and twenty, triplets once in one thousand eight hundred and seventy-five, and quadruplets once in three hundred and seventy-one thousand one hundred and twenty-six pregnancies. The causes are unknown. Twin conception is more common in women who have borne children, and more so in the elderly than in the young, first bearing women (primiparae).

Sex.—Children from the same ovum (egg) are always of the same sex. Of twins in general, more than one-third are males, less than one-third are females, and in the remaining one-third both sexes occur. The after-birth is always, at least at first, double.

Diagnosis.—In twin pregnancy the symptoms and disorders of pregnancy are apt to be exaggerated, and watery swelling above the pubic bone is almost always present in the latter months. The abdomen is larger and broader and there may be a depression dividing the abdominal wall in two spaces. The womb is much distended and the walls are thin.

Hygiene of pregnancy.—In pregnancy the dividing line between health and disease is often so shadowy that every care should be given the pregnant woman, not only that she shall escape dangers that may come, but that the future health of the coming baby may be safeguarded.

The care taken in pregnancy therefore should include attention to clothing, food, exercise, rest, sleep, functions of all excreting organs, the breasts, nervous system and the mind.

[520 MOTHERS' REMEDIES]

Clothing.—This should be worn loose. The heavier garments should not be held by the waist but suspended from the shoulders. Flannels, if possible, should be worn next the skin excepting, possibly, during the warmest weather. Every precaution should be taken not to take cold or to chill the surface of the body, as this might bring on an acute trouble of the kidneys. As soon as the womb has risen out of the pelvis during the fourth month, the corset should be absolutely abandoned, since pressure upon the enlarging womb tends to cause acute Bright's disease and uraemia, and these troubles are always to be guarded against. During the later months of pregnancy, when the abdominal enlargement is great, a linen or elastic bandage may be worn with great comfort, but it must be so put on as to support and not press upon the womb.

Food.—The food of the pregnant woman should be simple, wholesome, nutritious, of the kind that is easily digested and enough to satisfy the demands of her system; excessive eating should be avoided. A mixed diet is to be preferred, but the diet should be of such kind as to help to overcome the constipation, usual in pregnancy. Meat should not be eaten in as great quantities. It not only tends to produce more constipation but also has injurious effect upon the kidneys, and anything that in any way puts a greater burden upon the kidneys in pregnancy should be avoided. All foods that are likely to produce indigestion, heart burn, or irritation of the stomach and liver, such as sweets, fried, greasy, highly spiced foods; greasy rich gravies, or pastry should not be eaten.

The heartiest meal should be taken near midday and the stomach, especially at night, should never be overloaded. Water should, be drank freely, as it tends to overcome the constipation and wash out the kidneys. Some women do better with lighter meals and taken more frequently. Some do better by taking their breakfast before rising.

Bathing.—Extremes in hot and cold bathing should be avoided. The skin should be kept active by daily comfortable baths, followed by a brisk rubbing with a rough towel. The Bowels and Bladder.—The bowels, as before stated, are usually constipated and should be kept open by coarse foods, fruit and, when necessary, mild laxatives; mineral waters and enemas especially should not be given. It should not be forgotten that in some women injections into the bowel are liable to bring on contractions of the womb.

No woman, and especially no pregnant woman, should ever neglect the bowels, as much discomfort and ill health are caused by improper eliminations of the bowel contents. The bladder should also have proper care. This is apt to be irritable during the early and later months of pregnancy, owing to being pressed upon by the womb. A mild inflammation arises in some cases. The woman should take plenty of water, either pure or effervescing, to induce sufficient secretion in the kidneys, and also to flush them. This is also very good for an irritable bladder. In order that the physician may keep himself informed regarding the condition of the kidneys, the urine of every pregnant woman should be examined, both chemically and microscopically, every two weeks from the beginning of pregnancy; during the late months of pregnancy the urine analysis should be made weekly. Catherized specimens should be used because leucorrheal discharges, so common in pregnancy, may give the albumin reaction. If the above advice of Dr. Manton, of Detroit, was followed in every case there would be fewer cases of trouble during the confinement. I remember one case; the lady was seven months along when I was called. She was feeling badly and complained much of her eyes; an analysis of the urine showed thick with albumin. The failure of her sight was due to thc condition of her kidneys. If the urine had been examined early and often, her condition might have been prevented. Watch the kidneys, have the urine examined frequently and carefully.

[OBSTETRICS OR MIDWIFERY 521]

Exercise, Rest and Sleep.—Plenty of exercise in the open air should be taken daily, without this health cannot be maintained. It should not be violent or so great as to fatigue and overtire. Slow riding in a carriage and walking will give the best results. Horseback riding and riding in an automobile should be avoided. The woman should sit out of doors as much as possible. Plenty of sleep is also necessary. Eight hours are not too much at night, and lying down an hour or two during the forenoon and afternoon is very restful and desirable.

The Vagina.—When there is a profuse discharge of leucorrhea, a daily vaginal douche is necessary. This should consist of a quart of warm solution (as much as the water will dissolve) of boric acid, or an equal amount of mild carbolic acid (one to eighty). The temperature of the solution should be about 100 degrees F., and it should be injected slowly, and without any force to the stream.

It is also best to remain in the recumbent position for some time after the injection, to rest.

The Breast and Nipples.—These should be bathed once or twice daily in cool or tepid water until the last month or two of pregnancy. Astringent application should not be applied to the nipples to harden them. If the nipples are small, undeveloped or retracted they should be pulled out several times daily by the fingers and gently rubbed, and this will usually stimulate their growth. Cocoa butter or castor oil may be applied during the last month.

Nervous System and the Mind.—The pregnant woman is very susceptible to annoying conditions of the social and domestic surroundings; such should be removed, if possible, and excitement of every kind should be avoided. Everything should be made bright and comfortable around her, cheerfulness should be the rule in the home and she should be treated with every care and consideration. Surroundings will influence the coming baby's future.

[522 MOTHERS' REMEDIES]

Disorders of Pregnancy.—Nausea and vomiting.—The simple nausea and vomiting of pregnancy needs no treatment. This kind generally disappears by the third or fourth month, but it may persist in a mild form during the greater part of pregnancy. Generally the regulation of the diet and attention to the bowels are all that is necessary to be done for this trouble. Foods should be chosen carefully and only such foods taken that agree with the stomach and lessen the constipation. Sometimes taking a light breakfast in bed saves the usual morning sickness. It is best then to remain lying for some time after eating. When the condition is annoying the following powder will give much relief: powder Ingluvin, oxalate of cerium, of each five grains. Mix thoroughly and take one, every one or two hours as needed. A physician should be consulted if this trouble is very severe.

MOTHERS' REMEDIES.—1. Pregnancy, A Great Aid for.—"Soothing syrup or Mother's friend, while pregnant. Two ounces each of cramp bark, blue cohosh, slippery elm, raspberry leaves, squaw vine, orange peel and bitter root. Simmer gently in sufficient water to keep herbs covered for two hours, strain and steep gently down to one quart. Let it stand to cool, then add one cup granulated sugar, and four ounces alcohol. Dose.—One tablespoonful two or three times a day for several weeks before the birth of the child. This has been thoroughly tried and causes an easy birth where difficulty has been expected."

2. Nausea of Pregnancy, Menthol and Sweet Oil for.—"Vomiting and nausea of pregnancy; a twenty per cent solution of menthol in sweet oil; use ten drops on sugar when nausea appears." The menthol acts on the stomach and quiets it. This will be found very beneficial.

3. Pregnancy, Bouillon or Broth for.—"Was weak and generally run down. Family physician warned me I would never survive the birth of another child. I bought each day several beef bones and boiled them for three hours. I also bought chicken feet, scalded them and scraped them until the outside skin peeled off, then boiled the chicken feet with the bones. Skim surface from time to time. I would then heat up a raw egg in a glass and fill glass with this broth and drink it warm." This lady would take a glass whenever thirsty or six or seven times a day. She increased in strength immediately, within a year was the mother of a healthy baby girl now nineteen years old and believes her life was saved by the above. Anyone will find this worth trying.

[OBSTETRICS OR MIDWIFERY 523]

Indigestion and Heart-burn.—This should be treated the same as under other conditions. Diet, habits, should be regulated. The bowels and kidneys should be regulated and do their eliminating work. For heart-burn the popular remedy, magnesia may be taken or dilute hydrochloric acid with nux vomica. One teaspoonful or effervescing citrate of magnesia dissolved in water and drank, is a convenient remedy. Also, five drops of diluted hydrochloric acid in water, taken after meals, through a tube, and one or two drops of nux vomica before meals is beneficial. The following is an excellent combination from Dr. Hare, of Philadelphia:

Dilute Hydrochloric Acid 2 drams Essence of Pepsin 1 ounce Compound Tincture of Gentian enough to make 4 ounces

Mix. Take one or two teaspoonfuls in a little water with meals.

In cases where it is impossible to eat anything the patient must be fed by the rectum. In such cases a doctor must be called. Fortunately such severe cases are very rare. The following for rectal feeding is given by Dr. Manton, of Detroit, and is a good combination. Give every four hours:

Liquid Beef Peptonoids 3 drams White of an Egg Whisky 3 drams Beef Tea or Warm Water enough to make 3 ounces

The rectum should be washed out once or twice daily in the interval between the feeding.

Teeth.—The teeth are often affected during pregnancy, softening and decaying rapidly, causing severe neuralgia. The teeth should be cleaned frequently during the day to get rid of the secretions of the mouth, and at night before retiring. Milk of magnesia should be held in the mouth for a few minutes; cavities in the teeth should be stopped with a temporary filling. Teaspoonful of lacto phosphate of lime can be taken three times a day with benefit.

Constipation.—The enlarging womb pressing upon the rectum and also irregularity in diet causes constipation at this time. Daily free bowel movements are necessary to prevent the kidneys from overworking. As stated before, the diet should be strictly regulated. Cascara sagrada cordial is a good mild laxative to take, if necessary.

Difficult Breathing.—This usually comes late in pregnancy and is due to the pressure of the womb upon the diaphragm; the patient should avoid excitement and sleep with the shoulders well elevated. In the ninth month the womb drops lower and the breathing is better.

Varicose Veins and Piles.—Varicose veins: These are due to the pressure on the veins so that the return flow of blood is impeded and occur as a rule late in pregnancy. They are seen oftenest on the inner side of the thighs, the lower extremities, the vulva, and in the region of the anus. As a rule, they do not give much trouble. When they become painful or inflamed the patient should lie down, with the legs elevated and use water of witch-hazel applied with cloths. Elastic stockings, properly fitted, give much relief when the trouble is on the thigh and leg.

[524 MOTHERS' REMEDIES]

Piles.—When these are troublesome the rectum should be emptied by a small dose of salts, and the parts thoroughly washed with warm water, the piles pushed back and local lotions applied (see treatment of piles). Hot fomentations of witch-hazel frequently give great relief to the piles as well as to the varicose veins. Regular movements of the bowels usually will prevent piles. Piles will not usually give rise to much trouble unless constipation exists.

Albumin in the urine. (Albuminuria).—While the urine of about six to ten per cent of all pregnant women contains albumin, the appearance of this symptom should always be regarded with apprehension. Women who are in their first pregnancy are most frequently affected. If the woman has had disease of the kidneys before her pregnancy began this symptom will likely appear in the early months; if it is caused by pressure, etc., it may not appear until after the sixth month, but both acute and chronic. inflammation of the kidneys may develop at any period of pregnancy. Dr. Manton, of Detroit, states, "In the majority of cases, the albuminuria is due to the so-called kidney of pregnancy, in which there is no inflammation, but a fatty infiltration of the epithelial cells associated with anemia of the organ." The urine may also contain casts. Whatever the cause it indicates a condition of insufficiency of the kidney which may lead to serious consequences to the mother and it is also injurious to the (foetus) child. If this symptom develops suddenly the danger to both is greatly increased. For this reason physicians should urge pregnant women to have their urine examined frequently, especially during the later months of pregnancy.

Treatment.—Regulation of the diet; in pronounced cases the diet should consist entirely of milk and the patient should take three or four quarts in twenty-four hours. Meats, pastry and sweets must be prohibited, but vegetables such as squash, spinach, salads may be added to the dietary in ordinary cases. Vichy water may be taken alone or with the milk, and may be taken freely. The bowels should be kept open with citrate of magnesia (one to two teaspoonfuls in water) or epsom salts in peppermint water. Exercise in the open air can be taken in moderation. Warm clothing should be worn and flannel next the skin; exposure to cold and draughts should be carefully avoided. If the more special symptoms appear, such as persistent headache, vertigo, ringing in the ears, black or bright spots floating before the eyes, dimness of vision, an abortion of miscarriage should be induced without delay. Fortunately such cases are rare and with care from the beginning seldom occur. Pregnant women should inform their family physician at the beginning of pregnancy of their condition, and in the great majority of cases serious troubles can be prevented. Physicians expect this information and receive it as a matter of course, and no woman should hesitate to inform her physician either personally or through her husband.

[OBSTETRICS OR MIDWIFERY 525]

Abortion, Miscarriage, Premature Labor. (Accidents of pregnancy).—These three terms indicate a premature expulsion of the products of conception. Let us medically define these terms as follows; Abortion implies expulsion of the foetus before the sixteenth week. Miscarriage, the expulsion between the sixteenth and twenty-eighth weeks. Premature labor designates the time of expulsion as between the twenty-eighth week to within a few weeks before the normal termination of pregnancy. Miscarriage is the term popularly used for the accidental loss of the products of conception. Abortion, in the popular mind, expresses the intentional loss of the products of conception. Abortion in the medical sense, takes place about once in every four or five pregnancies. It occurs more frequently in those who have borne children, occurring generally in the third or fourth pregnancy, or toward the end of the child-bearing period, and it takes place more frequently between the ninth and sixteenth week, when the after- birth is in process of formation; and it is more liable to occur at the time of the month when the normal menstruation would be due. It should be borne in mind also that abortion occurring at this period is quite dangerous to the mother's future health, and also dangerous to life; so that at the first indication of abortion a physician should be called for this trouble, because it needs care, both to prevent it and to assist the woman to a successful ending when it is impossible to prevent it. This is more dangerous to life than confinement at full term, and is apt to leave behind a tendency to recurrence at the same time in the future pregnancies, and also makes the woman liable to inflammatory conditions of the womb.

Causes.—Abortion may be induced by many causes due to the mother, father, and child. Among maternal causes may be mentioned any serious disease, especially fevers, when accompanied by a rash on the skin, such as smallpox, measles, scarlet fever. It is hard for a pregnant woman to go through one of these diseases, without having an abortion. Syphilis, tuberculosis, malaria, organic heart and kidney disease, diabetes, anemia, and systemic poisoning also are causes; nervous disturbances as shock, fright, sorrow, convulsions, chorea; mechanical causes, violent exercise, lifting, blows, falls, coughing, vomiting; local causes, as wrong position of the womb, inflammation of the womb, etc.; all are causes.

Causes. Due to the Father. Paternal.—Syphilis, alcoholism, lead poisoning, excessive venery, extremes of youth or old age.

Foetal Causes.—Disease of the after-birth, other parts, of cord, death of the foetus, placenta pravia, and yet many women are subjected to falls, blows, etc., who carry their child to full term.

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Symptoms.—These vary with the period of pregnancy where they occur. In the earlier months the symptoms are those of profuse menstruation, sometimes accompanied by more pain perhaps than usual. The ovum is then so small that it escapes notice. In the profuse flow there may be unaccustomed clots of blood; when this trouble occurs later in pregnancy there are two constant symptoms which, together with the history of the case, render the diagnosis easy. These prominent and constant symptoms are pain and bleeding. The symptoms may be preceded by a bearing down feeling in the lower abdomen, with backache, frequent calls to pass urine, and a discharge from the vagina, that is a mixture of mucus and water. After these symptoms last for a shorter or longer time, labor pains set in, the bleeding increases and the contents of the womb are discharged. The ovum may be expelled whole when it looks like a huge blood clot, or it may be expelled partly and the membranes left behind; or the embryo (child) alone, surrounded by the transparent membrane, escapes.

If the after-birth has formed it may be cast off entire or piecemeal. The embryo (child) alone may escape, the neck of the womb contracts and shuts; bleeding persists for an indefinite period, for weeks and weeks, until the health of the poor woman is seriously affected. Persistent bleeding of this kind is almost always due to the retention of portions of the after-birth or membranes, and should prove to the woman that there is a serious condition existing which should be speedily corrected. A physician should be called who should make a thorough examination; and if such a condition as above described is found, should free the womb from its retained products, which are not only sapping the woman's life, but also rendering the future health of the womb very uncertain.

Threatened Abortion.—If a bleeding takes place in the woman who is pregnant, abortion may be assumed to threaten; a careful examination will usually settle this matter.

Inevitable Abortion.—The abortion is probably inevitable if the bleeding becomes persistent and free, the cervix softens, the womb dilates and the labor pains set in. Still in spite of all these conditions, the bleeding and pain may cease, and the pregnancy go on to full term, The result of these cases, if carefully and properly treated, is favorable as far as the mother is concerned.

Treatment. Preventive. In women where repeated abortions have occurred, the cause should be diligently sought for. If syphilis exists the treatment should be begun at the beginning of pregnancy. But when no special cause can be found, and an irritable condition of the womb is suspected to be present, the patient must be kept quiet in bed, especially at the time when menstruation would normally occur. She should also be guarded against lifting, fright, worry, over-exertion; and medicines like bromide of potash, five to fifteen grains at a dose, given to quiet and allay the nervous irritability.

Treatment of Threatened Abortion.—The patient should go to bed, lie down and remain there, and if possible be not only quiet physically, but also quiet mentally. The main remedy is opium, and if necessary to obtain a quick action it can be given hypodermically in the form of morphine. Otherwise, laudanum may be given by the mouth, twenty drops, repeated cautiously, every three or four hours as required, or it can be given in thirty-drop doses combined with a couple of ounces of starch water by the rectum. Extract of opium in pill form, one grain three times a day by the month; or a suppository of opium, one grain, may be inserted into the rectum every four to six hours. After the bleeding and pain have ceased, the emergency is probably passed; but rest in bed and quiet should be the routine for one or more weeks, and the patient should always rest in bed at the usual time of the menstrual period, during the remainder of the pregnancy.

[OBSTETRICS OR MIDWIFERY 527]

Treatment of the Inevitable Abortion.—If the cervix is hard and the canal is not dilated, especially if the bleeding is free, the vagina should be packed full at once, if possible, with iodoform gauze. Rolls five yards long and two inches wide can be bought perfectly adapted to this purpose. A speculum should be used (Sims' or Graves') and the gauze should first be packed tightly into corners (fornices) around the cervix, then over the cervix and well down to the outlet. This should be held in place by a proper (T) bandage. The gauze can be removed in from twelve to twenty-four hours, and the ovum will generally be found lying upon the upper part of the packing, or in the canal that is now dilated, from which it can easily be removed. Sometimes it is necessary to repack and allow it to remain for another twelve hours as the canal has not been sufficiently dilated by the first packing. This packing not only causes the canal to dilate but usually stops the bleeding. After the ovum has been expelled an antiseptic vaginal douche should be given twice a day for a week or longer.

If at the first examination the cervix is found softened and the mouth of the womb is open, but the womb has not yet expelled its contents, the sterile (clean) finger may be introduced into the womb and the ovum and membranes loosened and taken away, while this is being done counter pressure should be made over the abdomen. After the womb has been cleared of all its contents an antiseptic solution should be used, carefully, in the womb to wash it out, and this followed by washing out of the vagina. The after treatment is the same as that for labor at full term. The woman should remain in bed at least ten days.

Placenta Praevia.—The after-birth is placed in the lower part of the womb; (after-birth before the child). This is a dangerous condition and terrible bleeding may occur. It occurs about one time out of every one thousand. The main symptom is bleeding and this may occur at any period of pregnancy. It usually appears from the seventh to the ninth month. The outset is without any appreciable reason and without pain. The amount of blood lost at the first attack may be so slight as to escape notice or copious enough to endanger the life of the mother. This flow may occur at any time during these months, and it may be small or great. If during the course of pregnancy the bleeding occurs at intervals in the increasing amount, the greater will be the loss of blood during the labor.

Treatment.—There is little danger of dangerous bleeding before the seventh month, and a waiting treatment may be adopted, but the woman should be closely watched and told what the trouble is, so she will be willing to remain quiet. Rest in bed, the avoidance of all muscular exercise and quieting medicines may enable the mother to carry the child until it can live, when pregnancy must be quickly terminated. If the child is dead the womb must be emptied at once. After the seventh month an expectant treatment is no longer allowable, and authorities declare the pregnancy should be terminated without delay. The mother is in great danger from sudden free flow. This treatment must be given by an experienced hand and only a physician can do it. If the pregnancy is allowed to continue to full term the danger to the woman is very great, as the mortality runs from thirty to sixty-five per cent; but under modern treatment it has been brought down to five to ten per cent. The death rate of the child is between fifty and seventy-five per cent.

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Labor.—Labor may be defined as the physiological termination of pregnancy whereby the mature foetus (child) and its appendages (after-birth, etc.), are separated from the maternal organism.

Premonitory Signs of Labor.—Premonitory signs of labor, usually observed from one to two weeks before the onset of the labor pains, is a sinking down of the womb in the abdomen, whereby some of the unpleasant features of pregnancy are relieved, and the so-called "lightening" takes place. The waist line becomes small, the breathing is easier and the general well-being of the woman is better, so that her friends are attracted by her feeling of relief. But as a result of the womb descent and the consequent pressure, irritation of the bladder and rectum may occur, and she may have frequent calls to empty these organs. The vagina secretes more actively, the veins enlarge, some dropsy may appear in the extremities, and the womb contractions of pregnancy, which have been painless, begin to cause more and more discomfort.

These false pains recur at regular intervals of hours or even days, and generally at night, last for a varying period and usually disappear in the morning. They often deceive the woman and lead her to the belief that the labor has already begun; but examination of the cervix will reveal that this is not so. It is well to bear in mind that the true labor pains usually begin in the back, extend down to the thighs and often around to the front and they recur at regular intervals, and with increasing intensity.

The beginning of labor is characterized by recurring pains at regular intervals and of increasing severity. There is also a discharge from the vagina of mucus, and this is sometimes tinged with blood, "the show." If an examination is now made, it will be found that the cervix (neck of the womb) is shortened, and that the mouth of the womb is beginning to dilate. At the beginning, the pains are usually in the back and spread to the abdomen and down the thighs; but they may be felt first in the abdomen. They return every half hour or twenty minutes, but as labor goes on the interval is shortened, so that toward the end of the second stage when the child is being born, they appear to be continuous, and the patient feels as if she is encircled by a belt of pain; however, with all this, she will bear the suffering easier and better for she knows that progress is being made, and that she will soon be over the pains and the child born. A pain rarely lasts more than one minute.

[OBSTETRICS OR MIDWIFERY 529]

STAGES OF LABOR.—First stage extends from the beginning of labor until the mouth of the womb is dilated. Second stage, from the complete dilation until the complete birth of the child. Third stage, from the birth of the child until the expulsions of the after-birth—Placenta.

The First Stage.—The first stage varies greatly in different women. The average duration of this stage is from ten to fourteen hours in the woman with the first child, and six to eight hours in the woman who has borne children. During this stage the woman prefers to remain on her feet, sit, stand or walk about. The amount of pain experienced varies greatly, according to the temperament of the patient; in nervous women it may be excessive. The pains now have nothing of that bearing down character which they afterward acquire; they are described as "grinding," are usually felt in the front. The genitals become bathed with secretions, which are sometimes tinged with blood. This is an especially trying period to a young wife, for she cannot see that the pains are doing any good, only making her restless, tired and nervous. Little can be done by the physician in this stage except to encourage and explain what is really being accomplished by these seemingly futile pains and by tact and proper encouragement, a physician tides this stage over and gives great comfort to the needy patient. This stage ends with the opening and dilation of the mouth of the womb and the second or expulsive stage sets in, with pains altered in character.

Second Stage.—The pains now become more frequent and severe and last longer, and the patient now manifests a strong desire to expel the contents of the womb. The woman now feels better in bed and when the pains come she involuntarily bears down, with each contraction she sets her teeth, takes a deep breath, fixes the diaphragm, contracts the muscles of the abdomen and bears down hard if you allow her to do so. The knowledge that she is working to overcome an obstacle gives her some satisfaction and she feels that she is accomplishing something by the efforts she is making. The physician can aid greatly by suggesting to the patient how to use the pains and how much bearing down to do. He can tell her when not to bear down, and so save her strength for the next real pain when bearing down will do good. Although the pains are really harder in this stage, nervous women suffer no more, for their mind is now concentrated upon the work at hand. Sometimes at the beginning of this stage the patient feels chilly or has a severe chill; a hot drink and more covering counteract this. Another phenomena is the escape of the waters and a lull in the pains for a little time, when they come on more effectively than before as the womb contracts down upon the child and is not hindered by the "bag of water." The pains keep on at intervals until the child is born and the physician can now be of help by guiding, directing and assisting the birth of the head. This stage averages about two hours.

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Third Stage.—The birth of the head is very soon followed by the shoulders and the rest of the body, and the woman is now at comparative rest. The cord is now tied and cut and the child laid away, if all right, in a warm place until it can be washed and dressed. Following the birth of the child there is a short resting period, the contractions of the womb cease and it becomes smaller through retraction. After a few minutes the pains begin again, the after-birth separates from its attachment in the womb, and together with the membranes is extruded into the vaginal canal and vulvar opening; whence it can be easily delivered by pressing upon the abdomen over the lump (womb) and by guiding the after-birth with the cord. This should be done slowly so that the membranes will all come away with the after-birth.

This should always be examined to be certain that everything has come away. A greater or less amount of clots of blood come with the after-birth. The contraction of the womb stops the bleeding, one hand should be kept on the abdomen over the womb, to see that it remains hard and retracted. The womb moves under the hand. If it softens, gentle rubbing should be kept up and the womb will soon remain contracted. This stage averages about fifteen minutes.



MANAGEMENT OF LABOR.—Preparation of the Bed.—The bed should be high, springs not soft, with a firm and smooth mattress. It should be placed so that both sides are accessible. The bed should be made up on the right side as a rule, as the woman usually lies on her left side when delivered. Place a rubber, or an oil cloth sheet, over the mattress, and over this an ordinary muslin sheet and secure this with safety pins to the corners of the mattress. This is the permanent bed; on top of this is the second rubber sheet and this is covered with another muslin sheet and both held by safety pins. This is the temporary bed. Plenty of hot and cold boiled water should also be at hand. Frequently only a temporary bed is made with rubber or oil cloth underneath, blanket and sheet above this. They should be fastened so that the movements of the woman will not disorder them. These can be removed after the confinement and new, clean warm clothes put in their place. The objection to this is the woman may be too tired to be moved, while, with the permanent and temporary bed arrangement she need not be moved at all, only lifted, while the temporary bed is being removed and she is then let down easily upon clean bedding.

Preparation of the Patient.—The patient, if she desires, can take a full bath. The bowels should be moved thoroughly with a soap and water injection so that the rectum will be fully emptied. This makes labor not only easier, but pleasanter, as no feces will be discharged during labor. The bladder should also be emptied. The external organs should be scrupulously cleansed and bathed with some antiseptic solution, like glycothymoline, listerine, borolyptol, etc. A fresh suit of underwear may then be put on and over this a loose wrapper.

[OBSTETRICS OR MIDWIFERY 531]

Examination of the Patient.—The physician needs to satisfy himself as to the position of the child, etc. This can be done by an examination of the abdomen and also of the vagina. He must determine whether the child is alive, its position, the condition of the cervix and mouth of the womb. In making such examination a routine plan should be adopted. The coat must be removed, the shirt sleeves turned up and the hands and arms washed with soap and water. The abdomen should be thoroughly palpated (felt) and listened to with the ear or stethoscope to determine the character of the child's heart beat, whether it be very slow, one hundred and twenty or less, or a very rapid one, one hundred and fifty or more. It may indicate danger to the child and necessitate a hurried delivery. After these things have been done, the hands and arms must again be thoroughly washed and sterilized, the fingers anointed with carbolated vaselin and the examination of the vagina made.

This cleanliness is necessary, and if this plan were carried out by everyone connected with the patient during the whole confinement, there would be fewer cases of "child-bed" fever, with its resultant diseases. The patient should lie on her back with the knees drawn up. There is no need for any exposure now, for the covering can be held up by an attendant so that it will not touch the physician's hands. The soft parts are now separated by the fingers of one hand while the examining fingers are introduced into the vagina. These fingers should never touch any external part and especially the parts near the anus. If the cervix is found to be long and the canal still undilated, or only slightly so, and especially if it is the first child (primipara), the physician's presence is not needed and he may safely leave for an hour or two. But if the mouth (os) of the womb is dilated to the size of a silver dollar he should on no account leave the house.