When any or all of this group of symptoms accompany the ceasing to be 'regular,' the morning sickness, the changes in the breasts and the other signs which have been enumerated, the wife may be quite sure that she is pregnant.

8. Changes in the mind.—The most wonderful of all the changes which attend pregnancy are those in the nervous system. The woman is rendered more susceptible, more impressible. Her character is transformed. She is no longer pleasant, confiding, gentle, and gay. She becomes hasty, passionate, jealous, and bitter. But in those who are naturally fretful and bad-tempered a change for the better is sometimes observed, so that the members of the household learn from experience to hail with delight the mother's pregnancy as a period when clouds and storms give place to sunshine and quietness. In some rare cases, also, pregnancy confers increased force and elevation to the ideas, and augmented power to the intellect.

As this book is written for women only, we do not mention any of the signs or symptoms of pregnancy which medical men alone can recognize. We will merely state that there are many other signs besides these referred to, of great value to the doctor. One, the sound of the heart of the child, which the practised ear can detect at about the fifth month, is positive and conclusive.

MISCARRIAGE.

Miscarriage is a fruitful source of disease, and often of danger, to wives. It also causes a frightful waste of human life. Unborn thousands annually die in this manner.

Frequency.—Miscarriage is by no means a rare occurrence. Statistics show that thirty-seven out of one hundred mothers miscarry before they attain the age of thirty years. But this accident is much more apt to occur during the latter than during the first half of the child-bearing period; and therefore it is estimated that ninety out of one hundred of all women who continue in matrimony until the change of life, miscarry.

Influence of age of mother.—A woman who marries at forty is very much disposed to miscarry; whereas, had she married at thirty, she might have borne children when older than forty. As a mother approaches the end of her child-bearing period, it is likely that she will terminate her career of fertility with a premature birth. The last pregnancies are not only most commonly unsuccessful, but there is also reason to believe that the occurrence of idiocy in a child may be associated with the circumstance of its being the last-born of its mother. It has been asserted, in this connection, that men of genius are frequently the first-born. First pregnancies are also fraught with the danger of miscarriage, which occurs more often in them than in others, excepting the latest. A woman is particularly apt to miscarry with her first child, if she be either exceedingly nervous or full-blooded.

Influence of period of pregnancy.—Miscarriage is most frequent in the earlier months of pregnancy—from the first to the third. It is also very prone to happen about the sixth month. Habit makes itself felt here; for women who have many times experienced this sad accident, encounter it nearly always at the same epoch of their pregnancy.

How early can the child live?—The infant is incapable, as a rule, of an independent existence, if brought into the world before the end of the sixth month. The law of France regards a child born one hundred and eighty days after wedlock as not only capable of living, but as legitimate and worthy of all legal and civil rights. There are many cases mentioned, by the older medical writers, of children born previous to this period living. One of the most curious is that recorded by Van Swieten. The boy Fortunio Liceti was brought into the world before the sixth month, in consequence of a fright his mother had at sea. When born, it is said, he was the size of a hand, and his father placed him in an oven, for the purpose, probably, it has been suggested, of making him rise. Although born prematurely, he died late, for we are told that he attained his seventy-ninth year. Professor Gunning S. Bedford of New York records the case of a woman in her fourth confinement, who, before she had completed her sixth month, was delivered of a female infant weighing two pounds nine ounces. The surface of the body was of a scarlet hue. It breathed, and in a short time after birth cried freely. After being wrapped in soft cotton, well lubricated with warm sweet-oil, it was fed with the mother's milk, by having a few drops at a time put into its mouth. At first it had great difficulty in swallowing, but gradually it succeeded in taking sufficient nourishment, and is now a vigorous, healthy young woman.

Dangers to mother.—Wives are too much in the habit of making light of miscarriages. They are much more frequently followed by disease of the womb than are confinements at full terms. There is a greater amount of injury done to the parts than in natural labor. While after confinement ample time is afforded by a long period of repose for the bruised and lacerated parts to heal, after a miscarriage no such rest is obtained. Menstruation soon returns; conception may quickly follow. Unhappily, there is no custom requiring husband and wife to sleep apart for a month after a miscarriage, as there is after a confinement. Hence, especially if there be any pre-existing uterine disease, or a predisposition thereto, miscarriage is a serious thing.

Causes.—The irritation of hemorrhoids or straining at stool will sometimes provoke an early expulsion of a child. Excessive intercourse by the newly married is a very frequent cause. Bathing in the ocean has been known to produce it. Nursing is exceedingly apt to do so. It has been shown by a distinguished medical writer, that, in a given number of instances, miscarriage occurred in seventeen per cent. of cases in which the woman conceived while nursing, and in only ten per cent. where conception occurred at some other time. A wife, therefore, who suspects herself to be pregnant, should wean her child. The extraction of a tooth, over-exertion and over-excitement, a fall, a blow, any violent emotion, such as anger, sudden and excessive joy, or fright, running, dancing, horseback exercise, or riding in a badly-built carriage over a rough road, great fatigue, lifting heavy weights, the abuse of purgative medicines, disease or displacement of the womb, small-pox, or a general condition of ill-health, are all fruitful and well-known exciting causes of this unfortunate mishap, in addition to those which have been before mentioned.

Prevention.—The eminent practitioner, Dr. Tilt, says, 'The way to prevent miscarriage is to lead a quiet life, particularly during those days of each successive month when, under other circumstances, the woman would menstruate; and to abstain during those days not only from long walks and parties, but also from sexual intercourse.'

It is especially desirable to avoid a miscarriage in the first pregnancy, for fear that the habit of miscarrying shall then be set up, which it will be very difficult to eradicate. Therefore newly-married women should carefully avoid all causes which are known to induce the premature expulsion of the child. If it should take place in spite of all precautions, extraordinary care should be exercised in the subsequent pregnancy, to prevent its recurrence. Professor Bedford of New York has said he has found that an excellent expedient in such cases is, as soon as pregnancy is known to exist, 'to interdict sexual intercourse until after the fifth month; for if the pregnancy pass beyond this period, the chances of miscarriage will be much diminished.'

If the symptoms of miscarriage, which may be expressed in the two words pain and flooding, should make their appearance, the doctor ought at once to be sent for, the wife awaiting his arrival in a recumbent position. He may even then be able to avert the impending danger. At any rate, his services are as necessary, and often even more so, as in a labor at full term.

MOTHER'S MARKS.

It is a popular belief that the imagination of the mother affects the child in the womb. It is asserted that infants are often born with various marks and deformities corresponding in character with objects which had made a vivid impression on the maternal mind during pregnancy. This is a subject of great practical interest. We shall therefore give it the careful attention which it deserves.

We have already discussed the operation of the laws of inheritance. It was then stated that the whole story of maternal influence had not been told—that the mother could communicate qualities she never possessed. The potency of imagination at the time of conception over the child has been mentioned. It is now our design to consider its effects, during the period of pregnancy, upon the physical structure and the mental attributes of the offspring. We shall have occasion hereafter, in speaking of nursing, to illustrate the manner in which the child may be affected by maternal impressions acting through the mother's milk. What can be more wonderful than this intimate union between the mother and her child? It is only equaled by that mysterious influence of the husband over the wife, by which he so impresses her system that she often comes in time to resemble him both in mental and physical characteristics, and even transmits his peculiarities to her children by a second marriage. Father, mother, and child are one.

We wish here to premise that our remarks will be based upon the conclusions of skilled and scientific observers only, whose position and experience no medical man will question. All the instances to be related are given upon unimpeachable authority. They are not the narrations of ignorant, credulous people; they are all fully vouched for. We record here, as elsewhere, only the sober utterances of science. The great importance and utility of an acquaintance with them will be patent to every intelligent man and woman.

The effect of the mind upon the body is well known. Strong, long-continued mental emotion may induce or cure disease. Heart disease may be produced by a morbid direction of the thoughts to that organ. Warts disappear under the operation of a strong belief in the efficacy of some nonsensical application. In olden time, scrofula, or the 'king's evil', was cured by the touch of the king. The mind of the patient, of course, accomplished the cure. Under the influence of profound mental emotion, the hair of the beautiful Marie Antoinette became white in a short time. During the solitary voyage of Madame Condamine down the wild and lonely Amazon, a similar change took place. Many other instances might be adduced; but those given are sufficient to show that strong and persistent mental impressions will exert a mysterious transforming power over the body. These facts will pave the way to the consideration of corresponding effects, through the mother's mind, upon the development of the unborn child, forming a part of herself in utero.

Influence of mind of mother on form and color of infant.—There are numerous facts on record which prove that habitual, long-continued mental conditions of the mother at an early period of pregnancy, induce deformity or other abnormal development of the infant.

Professor William A. Hammond of New York relates the following striking case, which occurred in his own experience, and which scarcely admits of a doubt as to the influence of the maternal mind over the physical structure of the foetus.

A lady in the third month of her pregnancy was very much horrified by her husband being brought home one evening with a severe wound of the face, from which the blood was streaming. The shock to her was so great that she fainted, and subsequently had a hysterical attack, during which she was under Dr. Hammond's care. Soon after her recovery she told him that she was afraid her child would be affected in some way, and that even then she could not get rid of the impression the sight of her husband's bloody face had made upon her. In due time the child, a girl, was born. She had a dark red mark upon the face, corresponding in situation and extent with that which had been upon her father's face. She also proved to be idiotic.

Professor Dalton of New York states that the wife of the janitor of the College of Physicians and Surgeons of that city, during her pregnancy, dreamed that she saw a man who had lost a part of the ear. The dream made a great impression upon her mind, and she mentioned it to her husband. When her child was born, a portion of one ear was deficient, and the organ was exactly like the defective ear she had seen in her dream. When Professor Dalton was lecturing upon the development of the foetus as affected by the mind of the mother, the janitor called his attention to the foregoing instance. The ear looks exactly as if a portion had been cut off with a sharp knife.

Professor J. Lewis Smith of Bellevue Hospital Medical College, New York, has met with the following cases:—An Irishwoman, of strong emotions and superstitions, was passing along a street, in the first months of her pregnancy, when she was accosted by a beggar, who raised her hand, destitute of thumb and fingers, and in 'God's name' asked for alms. The woman passed on, but, reflecting in whose name money was asked, felt that she had committed a great sin in refusing assistance. She returned to the place where she had met the beggar, and on different days, but never afterwards saw her. Harassed by the thought of her imaginary sin, so that for weeks, according to her statement, she was distressed by it, she approached her confinement. A female infant was born, otherwise perfect, but lacking the fingers and thumb of one hand. The deformed limb was on the same side, and it seemed to the mother to resemble precisely that of the beggar. In another case which Professor Smith met, a very similar malformation was attributed by the mother of the child to an accident occurring, during the time of her pregnancy, to a near relative, which necessitated amputation. He examined both of these children with defective limbs, and has no doubt of the truthfulness of the parents. In May, 1868, he removed a supernumerary thumb from an infant, whose mother, a baker's wife, gave the following history:—No one of the family, and no ancestor, to her knowledge, presented this deformity. In the early months of her pregnancy she sold bread from the counter, and nearly every day a child with a double thumb came in for a penny roll, presenting the penny between the thumb and the finger. After the third month she left the bakery, but the malformation was so impressed upon her mind, that she was not surprised to see it reproduced in her infant.

In all these cases the impression was produced in the early months of pregnancy; but many have been recorded in which malformations in the infant appeared distinctly traceable to strong mental emotions of the mother only a few months previous to confinement, these impressions having been persistent during the remaining period of the pregnancy, and giving rise to a full expectation on the part of the mother that the child would be affected in the particular manner which actually occurred. Professor Carpenter, the distinguished physiologist, is personally cognisant of a very striking case of the kind which occurred in the family of a near connection of his own.

All the above instances have been those of the effects of persistent mental emotion. But it is also true that violent and sudden emotion in the mother leaves sometimes its impress upon the unborn infant, although it may be quickly forgotten.

It is related on good authority that a lady, who during her pregnancy was struck with the unpleasant view of leeches applied to a relative's foot, gave birth to a child with the mark of a leech coiled up in the act of suction on the intended spot.

Dr. Delacoux of Paris says that, in the month of January 1825, he was called to attend a woman in the village of Batignoles, near Paris, who the evening before had been delivered of a six months' foetus, horribly deformed. The upper lip was in a confused mass with the jaw and the gums, and the right leg was amputated at the middle, the stump having the form of a cone. The mother of this being, who was a cook, one morning, about the third month of her pregnancy, on entering the house where she was employed, was seized with horror at the sight of a porter with a hare-lip and an amputated leg.

At a meeting of the Society of Physicians at Berlin, in August 1868, Herr Dupre stated that a woman saw, in the first weeks of her third pregnancy, a boy with a hare-lip; and not only was the child she then carried born with a frightful hare-lip, but also three children subsequently. Another one, a woman in the fifth week of pregnancy, saw a sheep wounded, and with its bowels protruding. She was greatly shocked, and did not recover her composure for several days. She was delivered at term of a child, in other respects well developed, but lacking the walls of the abdomen.

Many remarkable instances have been collected of the power of imagination over the unborn offspring.

Ambrose Pare, the illustrious French surgeon of the sixteenth century, in one of his treatises devotes a chapter to the subject of 'monsters which take their cause and shape from imagination,' and was evidently a strong believer in this influence.

A black child is generally believed to have been born to Marie Therese, the wife of Louis XIV., in consequence of a little negro page in her service having started from a hiding-place and stumbled over her dress early in her pregnancy. This child was educated at the convent of Moret, near Fontainebleau, where she took the veil, and where, till the shock of the Revolution, her portrait was shown.

Examples are given by authors of the force of desires in causing deformities in infants, and the formation upon them of fruits, such as apples, pears, grapes, and others, which the mother may have longed for.

The following is related upon excellent medical authority:—A woman gave birth to a child with a large cluster of globular tumours growing from the tongue, and preventing the closure of the mouth, in color, shape, and size exactly resembling our common grapes; and with a red excrescence from the chest, as exactly resembling in figure and appearance a turkey's wattles. On being questioned before the child was shown to her, she answered, that while pregnant she had seen some grapes, longed intensely for them, and constantly thought of them; and that she was also once attacked and much alarmed by a turkey-cock.

Dr. Demangeon of Paris quotes, in his work on the Imagination, the Journal de Verdun, as mentioning the case of a child, born at Blois, in the eyes of which the face of a watch was distinctly seen. The image was situated around the pupil, and the figures representing the hours were plainly perceived. The mother had experienced a strong desire to see a watch while she was pregnant with this child.

Professor Dalton says, in his Human Physiology, that 'there is now little room for doubt that various deformities and deficiencies of the foetus, conformably to the popular belief, do really originate in certain cases from nervous impressions, such as disgust, fear, or anger, experienced by the mother.' We will now consider the

Influence of the mind of the mother on the mind of the infant; which subject we have not yet touched upon, having confined ourselves to the influence of the maternal mind over the form and color of the unborn child. It will not be necessary to illustrate at length this branch of our topic. Instances are sufficiently common and well known. Dr. Seguin of New York, in his work on Idiocy, gives several cases in which there was reason to believe that fright, anxiety, or other emotions in the mother, had produced idiocy in the offspring. As he remarks, 'Impressions will sometimes reach the foetus in its recess, cut off its legs or arms, or inflict large flesh wounds before birth,—inexplicable as well as indisputable facts, from which we surmise that idiocy holds unknown though certain relations to maternal impressions.'

We have given many strong cases and most excellent authority for the doctrine that the purely mental influence of the mother may produce bodily and mental changes in the unborn infant. But the child is also affected by physical impressions made upon the mother.

Dr. Russegger reports that a woman, who had already borne four healthy children, was, in the seventh month of her pregnancy, bitten in the right calf by a dog. The author saw the wound made by the animal's teeth, which wound consisted of three small triangular depressions, by two of which the skin was only slightly ruffled; a slight appearance of blood was perceptible in the third. The woman was at the moment of the accident somewhat alarmed, but neither then nor afterwards had any fear that her foetus would be affected by the occurrence. Ten weeks after she was bitten, the woman bore a healthy child, which, however, to the surprise of every person, had three marks corresponding in size and appearance to those caused by the dog's teeth in the mother's leg, and consisting, like those, of one large and two smaller impressions. The two latter, which were pale, disappeared in five weeks; the larger one had also become less, and was not so deep colored as it was at birth. At the time of writing, the child was four months old.

Dr. S. P. Crawford of Greenville, Tennessee, reports in a recent number of the Nashville Journal of Medicine, the following sad case:—A lady, in the last stage of pregnancy, was burned by the explosion of a kerosene-oil can. She lived twelve hours after the accident. The face, legs, arms, and abdomen were badly burned. The movements of the child were felt three or four hours after the accident. A short time before the death of the mother she gave birth to the child at full maturity, but still-born. It bore the mark of the fire corresponding to that of the mother. Its legs, arms, and abdomen were completely blistered, having all the appearance of a recent burn.

These instances of a decided influence exerted upon the body and mind of the child in the womb, by physical and mental impressions made upon the mother, might be doubled or trebled. They are as numerous as they are wonderful. Physiologists of the present day do not hesitate to admit the existence of the influence we have been discussing. Reason also comes to the support of facts, to demonstrate and establish its reality. For, if a sudden and powerful emotion of the mind can so disturb the stomach and heart as to cause vomiting and fainting, is it not probable that it can affect the womb and the impressible being within it? Pregnancy is a function of the woman as much as digestion or pulsation of the heart; and if the latter are controlled by moral and mental impressions, why should not the former be also?

In what manner does this influence of the maternal mind act?—Through the blood of the mother. Only a very delicate membrane separates the vital fluid of the mother from that of the infant in her womb. There is a constant interchange of the blood in its body with that in hers through this exceedingly thin membrane; and thus all nervous impressions which have produced an alteration of either a temporary or permanent character in the circulating fluid of the mother, are communicated to the child. Since the mother, as has been shown, can transmit through her blood certain characteristics of mind and body not her own,—for instance, a disease peculiar to a male from her father to her son, or the physical and mental traits of her first husband to the children by her second,—it does not seem at all strange that she should through this same medium, her blood, impart other peculiarities which have made a strong impression upon her mind. Anatomy and physiology therefore fully explain and account for this seemingly mysterious influence.

The view here stated, and indorsed by modern science, is one which ought to have great weight with the mother, her relatives and friends. The practical conclusion which it suggests is, that as during pregnancy there is unusual susceptibility to mental impressions, and as these impressions may operate on the fragile structure of the unborn being, this tendency should be well considered and constantly remembered, not only by the woman herself, but by all those who associate or are thrown in contact with her. Upon the care displayed in the management of the corporeal and mental health of the mother during the whole period of pregnancy, the ultimate constitution of the offspring greatly depends. All the surroundings and employments of the pregnant woman should be such as conduce to cheerfulness and equanimity. Above all, she should avoid the presence of disagreeable and unsightly objects. Vivid and unpleasant impressions should be removed as soon as possible by quiet diversion of the mind. All causes of excitement should be carefully guarded against.

In leaving the subject of maternal impressions, we will call attention to the manifest difference in extent and degree between the influence of the father and that of the mother over the offspring. That of the father ceases with impregnation. That of the mother continues during the whole term of pregnancy, and, as we shall shortly see, even during that of nursing.

EDUCATION OF THE CHILD IN THE WOMB.

The outlines drawn by the artist Flaxman are esteemed the most perfect and graceful in existence. From earliest childhood he manifested a delight in drawing. His mother, a woman of refined and artistic tastes, used to relate that for months previous to his birth she spent hours daily studying engravings, and fixing in her memory the most beautiful proportions of the human figure as portrayed by masters. She was convinced that the genius of her son was the fruit of her own self-culture. What a charming idea is this! What an incentive to those about to become mothers, to cultivate refinement, high thoughts, pure emotions, elevated sentiments! Thus they endow their children with what no after education can give them.

The plastic brain of the foetus is prompt to receive all impressions. It retains them, and they become the characteristics of the child and the man. Low spirits, violent passions, irritability, frivolity, in the pregnant woman, leave indelible marks on the unborn child. So do their contraries; and thus it becomes of the utmost moment that during this period all that is cheerful, inspiring, and elevating should surround the woman. Such emotions educate the child: they form its disposition, they shape its faculties, they create its mental and intellectual traits. Of all education, this is the most momentous.

CAN A WOMAN BECOME AGAIN PREGNANT DURING PREGNANCY?

Can a woman during pregnancy conceive, and add a second and younger child to that already in the womb?

It is not uncommon in the canine race for a mother to give birth at the same time to dogs of different species, showing conclusively the possibility, in these animals, of one conception closely following another. So a mare has been known to produce within a quarter of an hour, first a horse, and then a mule. And in the human race cases are on record in which women have had twins, of which the one was white and the other colored, in consequence of intercourse on the same day with men of those two races. Dr. Henry relates that in Brazil a Creole woman, a native, brought into the world at one birth three children of three different colors,—white, brown, and black,—each child exhibiting the features peculiar to the respective races.

In all such instances the two conceptions followed each other very rapidly, the offspring arriving at maturity together, and being born at the same accouchement. But more curious and wonderful examples of second and concurrent pregnancies have been published than these—as, for instance, those in which a child bearing all the attributes of a foetus at full term is born two, three, four, and even five, months after the first, which appeared also to have been born at full term. Marie Anne Bigaud, aged thirty-seven, gave birth, April 30, 1748, to a living boy at full term, and on the ensuing September 16, to a living girl, which was recognised, by the size and well-developed condition of its body and limbs, to have been also carried until full term. This fact was observed by Professor Eisenman, and by Leriche, surgeon-major of the military hospital of Strasbourg. It will be noticed that there was an interval of four and a half months between the two accouchements. The first child lived two and a half months, and the second a year. In this instance there was not a double womb, as might perhaps be supposed, for after the mother's death an examination proved that the uterus was single.

Another case of this kind is the following:—Benoite Franquet of Lyons brought into the world a girl on January 20, 1780, and five months and six days afterwards a second girl, also apparently at term, and well nourished. Two years later these two children were presented, with their certificates of baptism, to two notaries of Lyons, MM. Caillot and Desurgey, in order that the fact might be placed on record and vouched for, because of its value in legal medicine.

The number of the entirely authenticated cases now known of the birth of fully developed children within from two to five months of each other, can leave no doubt as to the possibility of such an occurrence. The only question which remains is in regard to the periods of conception. Are the two children in such cases twins, conceived at the same time, but the growth of the last-born so retarded that it did not arrive at maturity until a number of months after its fellow? or, Has a second conception taken place at an interval of several months after the first? If this latter view be true, then, in the instance of Marie Anne Bigaud, above related, the second child must have been conceived after the first had quickened. Then, also, two children of different ages, the offspring of different fathers, may exist in the womb at the same time. The weight of scientific observation and authority has now established the fact that, in very rare instances, a second conception may take place during pregnancy. It must not be understood as necessarily following from this statement, that when two children are born at the same time,—one fully developed, and the other small and apparently prematurely born,—the two were conceived at different times. The smaller may have been blighted and its growth hindered by the same causes which bring about such effects in cases of single births of incompletely developed children. A similar supposition may account for the birth of a second child within a month or two after the first, for the first may have been prematurely born, and the second carried to full term. But no such supposition can explain the cases referred to, and others which might be mentioned, in which the interval has been five or six months, each child presenting every indication of perfect maturity. The only explanation possible in such instances, which, as has been said, are well authenticated, although few in number, is, that a second pregnancy has occurred during the first.

The above facts would seem sufficiently wonderful. There are others, however, of the same nature still more so. In some instances, the product of the second conception, instead of developing independently of the first, has become attached to it, and the phenomenon has been presented of the growth of a child within a child—a foetus within a foetus. Such a singular occurrence has been lately recorded in a German journal. A correspondent of the Dantzic Gazette states that on Sunday, February 1, 1869, at Schliewen, near Dirschau, 'a young and blooming shepherd's wife was delivered of a girl, otherwise sound, but having on the lower part of her back, between the hips, a swelling as big as two good-sized fists, through the walls of which a well-developed foetus may be felt. Its limbs indicate a growth of from five to six months, and its movements are very lively. The father called in the health commissioner, Dr. Preuss, from Dirschau, and begged him to remove the swelling together with the foetus. The doctor, however, after a careful examination, declared that there was a possibility in this extraordinary case of the child within the swelling coming to fruition. Its existence and active motions were palpable to all present. No physician could be justified in destroying this marvelous being. It ought rather to be protected and cherished. The new-born girl, notwithstanding her strange burden, is of unusual strength and beauty, and takes the breast very cheerfully.'

We find something further in regard to this singular birth in the Weser Zeitung of February 20, 1869. It quotes from the Dantzic Gazette some remarks by the health commissioner, Dr. Preuss of Dirschau, in which the doctor declares the facts contained in the report given above to be correct. He was summoned on the 1st of February to the child, and saw the vigorous movements, and felt the members of a foetus within the swelling, as described. It was evidently a double creation. The case thus far, though rare, is not unique. 'But what is novel, and hitherto perfectly unnoticed in medical literature, is the fact that not only the girl, which has been carried its full term, is alive to-day, but the foetus within the swelling has also, in the eleven days after birth, further developed, and palpably increased in size. The swelling is now four and a half inches long, three and a half inches wide, and high and pear-shaped; the head lies underneath on the left, the body towards the right.'

Further particulars and the latest intelligence we have concerning the progress of this case are to the effect that the child was brought by special request before the Natural History Society of Dantzic, and thence the mother went to Berlin for medical advice.

MORAL ASPECTS OF THIS QUESTION.

Upon proper judgment and discrimination in the application of the facts we have just been dwelling upon, may depend a wife's honor, and the happiness of the dearest social relations. We will suppose an example. A husband, immediately after the impregnation of his wife, is obliged to quit her, and remains absent a year. In the meanwhile she gives birth to two children, at an interval of a number of weeks. The question will then come up, Whether, under such circumstances, it is possible for her to do so consistently with conjugal purity.

It will be recollected that, in speaking of twins, we remarked that it was not very uncommon for an interval of days or weeks to elapse between the births, and it has just been stated that impregnation during pregnancy is extremely rare. The presumption, therefore, in the case supposed, is as very many to one that the two births were the result of a twin pregnancy. In the absence of any other evidence against the wife's chastity, it should not even be called in question. This decision receives the support of the maxim in law that a reasonable doubt is the property of the accused, and of the Christian principle that it is better that ninety-nine guilty should escape than that one innocent should be condemned. Hence the teachings of science and of human and divine law all coincide to protect the sacred rights and the precious interests at stake against an unjust suspicion, which even the doctrine of chances would render untenable.

CAN A CHILD CRY IN THE WOMB?

There are some cases, recorded on undoubted authority, in which the child has been heard to cry while in the womb. These are very exceptional. Under ordinary circumstances, it is impossible for the child either to breathe or cry, because of the absence of air. It is only when the bag of membranes has been torn, and the mouth of the child is applied at or near the neck of the uterus, that this can take place. The infant is not unfrequently heard to cry just before birth, after labor has commenced, but before the extrusion of the head from the womb, in consequence of the penetration of air into the uterine cavity.

IS IT A SON OR DAUGHTER?

It is a common saying among nurses, that there is a difference in the size and form of the pregnant woman, according to the sex she carries. This may well be doubted. Neither is it true that one sex is more active in its 'movements' than the other. It is quite possible, however, for a wife to know the sex of the foetus, if she can tell about what time in her month conception took place. If it occurred directly after a monthly sickness, the child is a girl; if directly before, it is a boy. When a woman is 'out' in her reckoning, and goes beyond the period of her expected confinement, it will ordinarily turn out to be a boy. The skilful doctor can, in the later months of pregnancy, settle the question of sex in some cases. The beats of the foetal heart are more frequent in females than in males. The average frequency of pulsations of twenty-eight female foetuses has been found to be one hundred and forty-four in the minute, the lowest figure being one hundred and thirty-eight; of twenty-two male foetuses, one hundred and twenty, the lowest figure being one hundred and twelve. Therefore, when the pulsations of the heart of the child in the womb are counted,—as can easily be done by a practised medical ear during the last months of pregnancy,—and are found to be over one hundred and thirty in a minute, it is a daughter; if under one hundred and thirty, a son. In this manner, the sex of an unborn child can be predicted with tolerable accuracy, excepting only when illness of the foetus has deranged the action of its heart.

ARE THERE TWINS PRESENT?

Certain signs lead to the suspicion of twins, such as being unusually large, and the fact that the increase in size has been more than ordinarily rapid. Sometimes also the abdomen is divided into two distinct portions by a perpendicular fissure. In other cases the movements of a child can be felt on each side at the same time. And in twin pregnancies the morning sickness is apt to be more distressing, and all the other discomforts incident to this condition increased. But these signs and symptoms, when present in any given case, are not conclusive, for they may be noticed when there is only one child. The doctor has one characteristic and infallible sign by which he can ascertain whether the woman be pregnant with twins. It is furnished to him again by the art of listening,—or auscultation, as it is technically called,—the same that, as we have already seen, may enable him to determine the sex of the child. When the beatings of two foetal hearts are heard on opposite portions of the abdomen, the nature of the pregnancy is apparent.

LENGTH OF PREGNANCY.

What is the ordinary duration of pregnancy? Almost every woman considers herself competent to make the answer—nine months. She may be surprised to learn, however, that such an answer is wanting in scientific precision. It is too indefinite, and is erroneous. There is a great difference between the calendar and the lunar month. Each lunar month having twenty-eight days, the period of nine lunar months is two hundred and fifty-two days. Nine calendar months, including February, represent, on the contrary, two hundred and seventy-three days. Now the average duration of pregnancy is two hundred and eighty days, that is forty weeks, or ten lunar months.

While most extended observations have shown that as a general rule, forty weeks, or two hundred and eighty days, is the true period of pregnancy, are we justified in the conclusion that this is its invariable duration? This important question, upon the answer to which so often depend the honor of families, the rights of individuals, and sometimes the interests of nationalities, has been in all times the subject of careful research by physicians, philosophers, and legislators. On the one side, have been those who contend that the laws of nature are invariable, and that the term of pregnancy is fixed and immutable. On the other side, have been those who assert that the epoch of accouchement can be greatly advanced or retarded by various causes, some of which are known, and others not yet appreciated. Abundant and satisfactory testimony has proved that the prolongation of pregnancy beyond the ordinary period of two hundred and eighty days, or forty weeks, is possible. Nor is this contrary to what is observed in regard to other functions of the human body. There is no process depending upon the laws of life which is absolutely invariable either as to the period of its appearance or duration. It is known, as we have already pointed out, that puberty may be advanced or retarded; the time at which the change of life occurs in women, as we shall have occasion hereafter to show, is also subject to variation; and it is a matter of common observation with mothers, that the period of teething is sometimes strangely hurried or delayed. A certain degree of variability, therefore, being frequently observed, and entirely compatible with health, in the various other natural processes, why should that of pregnancy form an exception, and be invariably fixed in its duration? And observation upon the lower animals affords most convincing evidence that nature is not controlled by any uniform law in reference to the length of pregnancy. In the cow, the usual period of whose pregnancy is the same as in the human female, instances of calving six weeks beyond the ordinary term are not at all uncommon.

As an illustration of the great interest sometimes attaching to the inquiry under discussion, we may cite the celebrated Gardner Peerage Case, tried by the House of Lords in 1825. Allen Legge Gardner petitioned to have his name inscribed as a peer on the Parliament Roll. He was the son of Lord Gardner by his second wife. There was another claimant for the peerage, however,—Henry Fenton Iadis,—on the ground, as alleged, that he was the son of Lord Gardner by his first and subsequently divorced wife. Medical and moral evidence was adduced to establish that the latter was illegitimate. Lady Gardner, the mother of the alleged illegitimate child, parted from her husband on the 30th of January, 1802, he going to the West Indies, and not again seeing his wife until the 11th of July following. The child whose legitimacy was called in question was born on the 8th of December of that year. The plain medical query therefore arose, Whether this child born either three hundred and eleven days after intercourse (from January 30th to December 8th), or one hundred and fifty days (from July 11th to December 8th), could be the son of Lord Gardner. As there was no pretence that there was a premature birth, the child having been well developed when born, the conception must have dated from January 30th. The medical question was therefore narrowed down to this: Was the alleged protracted pregnancy (three hundred and eleven days) consistent with experience? Sixteen of the principal obstetric practitioners of Great Britain were examined on this point. Eleven concurred in the opinion that natural pregnancy might be protracted to a period which would cover the birth of the alleged illegitimate child. Because, however, of the moral evidence alone, which proved the adulterous intercourse of Lady Gardner with a Mr. Iadis, the House decided that the title should descend to the son of the second Lady Gardner.

There is on record one fact, well observed, which establishes beyond cavil the possibility of the protraction of pregnancy beyond two hundred and eighty days, or forty weeks. The case is reported by the learned Dr. Desormeaux of Paris, and occurred under his own notice in the Hopital de Maternite of that city. A woman, the mother of three children, became insane. Her physician thought that a new pregnancy might re-establish her intellectual faculties. Her husband consented to enter on the register of the hospital each visit he was allowed to make her, which took place only every three months. So soon as evidence of pregnancy showed itself, the visits were discontinued. The woman was confined two hundred and ninety days after conception.

The late distinguished Professor Charles D. Meigs of Philadelphia published a case, which he deems entirely trustworthy, of the prolongation of pregnancy to four hundred and twenty days, or sixty weeks. Dr. Atlee reports two cases, which nearly equaled three hundred and fifty-six days each. Professor Simpson of Edinburgh records, as having occurred in his own practice, cases in which the period reached three hundred and thirty-six, three hundred and thirty-two, three hundred and twenty-four, and three hundred and nineteen days. In the Dublin Quarterly Journal of Medical Science a case of protracted pregnancy is related by Dr. Joynt. The evidence is positive that the minimum duration must have been three hundred and seventeen days, or about six weeks more than the average. Dr. Elsaesser found, in one hundred and sixty cases of pregnancy, eleven protracted to periods varying from three hundred to three hundred and eighteen days.

In treating of the subject of miscarriage, we mentioned instances, recorded by physicians of skill and probity, proving beyond a shade of doubt that a woman may give birth to a living child long before the expiration of the forty weeks. The Presbytery of Edinburgh, Scotland, some time since decided in favor of the legitimacy of an infant born alive, within twenty-five weeks after marriage, to the Rev. Fergus Jardine.

One of the most enlightened countries in Europe has, in view of the facts in reference to the extreme limits of pregnancy, enacted, in the Code Napoleon, that a child born within three hundred days after the departure or death of the husband, or one hundred and eighty days after marriage, shall be considered legitimate. The law further states that a child born after more than three hundred days shall not be necessarily declared a bastard, but its legitimacy may be contested. The Scotch legislation on this subject is very similar to the French.

CAUSES OF PROTRACTED PREGNANCY.

It has been asserted by some that an infant is born at ten or eleven months because at nine months it has not acquired the growth which is necessary in order to induce the womb to dislodge it. The popular notion is, that a child carried beyond the usual term must necessarily be a large one. Rabelais has reflected this common opinion in his celebrated romance entitled 'Gargantua,' in which he represents the royal giant of that name as having been carried by his mother, Gargamelle, eleven months. When born, the child was so vigorous that he sucked the milk from ten nurses. He lived for several centuries, and at last begot a son, Pantagruel, as wonderful as himself. Such reasoning cannot, however, be seriously maintained, as many children carried longer than nine months have not been more fully developed than some born a few weeks prematurely; and the size of the child has nothing to do with the bringing on of labor, as we shall show hereafter. Protracted pregnancies are caused by a defect in the energy of the womb, induced by moral as well as physical influences. As a rule, a woman who leads a regular life, and observes the physiological laws of her being, which laws it has been our aim to point out, will be confined at the term that nature usually marks out, that is, at the expiration of two hundred and eighty days, or forty weeks, from conception.

This brings us to the consideration of the question,

HOW TO CALCULATE THE TIME OF EXPECTED LABOR.

Many rules for this purpose have been laid down. We shall merely give one, the most satisfactory and the most easily applied. It was suggested by the celebrated Professor Naegele of Heidelberg, and is now generally recommended and employed by physicians. The point of departure in making the calculation is the day of the disappearance of the last monthly sickness; three months are subtracted, and seven days added. The result corresponds to the day on which labor will commence, and will be found to be two hundred and eighty days from the time of conception, if that event has occurred, as ordinarily, immediately after the last menstrual period. Suppose, for instance, the cessation of the last monthly sickness happened on the 14th day of January; subtract three months, and we have October 14; then add seven days, and we obtain the 21st day of the ensuing October (two hundred and eighty days from January 14) as the time of the expected confinement. This method of making the 'count' may be relied upon with confidence, and only fails, by a few days, in those exceptional cases in which conception takes place just before the monthly period, or during the menstrual flow.

CARE OF HEALTH DURING PREGNANCY.

This subject, the proper management of the health from conception to childbirth, is worthy of careful consideration. The condition of pregnancy, though not one of disease, calls for peculiar solicitude, lest it should lead to some affection in the mother or in the child. For it ought to be remembered that the welfare of a new being is now in the balance. The woman has no longer an independent existence. She has entered upon the circle of her maternal duties. She became a mother when she conceived. The child, though unborn, lives within her; its life is a part of her own, and so frail, that any indiscretion on her part may destroy it. The danger to the child is not imaginary, as the large number of miscarriages and still-births proves.

All mothers desire to have healthy, well-formed, intelligent children. How few conduct themselves in such a manner as to secure a happy development of their offspring! Puny, deformed, and feeble-minded infants are daily ushered into the world because of a want of knowledge, or a sinful neglect of those special measures imperatively demanded in the ordering of the daily life, by the changed state of the system consequent upon pregnancy. We shall therefore point out those laws which cannot be infringed with impunity, and indicate the diet, exercise, dress, and, in general, the conduct most favorable to the mother and child during this critical period, in which the wife occupies, as it were, an intermediate state between health and sickness.

FOOD.

The nourishment taken during pregnancy should be abundant, but not, in the early months, larger in quantity than usual. Excess in eating or drinking ought to be most carefully avoided. The food is to be taken at shorter intervals than is common, and it should be plain, simple, and nutritious. Fatty articles, the coarser vegetables, highly salted and sweet food, if found to disagree, as is often the case, should be abstained from. The flesh of young animals—as lamb, veal, chicken, and fresh fish—is wholesome, and generally agrees with the stomach. Ripe fruits are beneficial. The diet should be varied as much as possible from day to day. The craving which some women have in the night or early morning may be relieved by a biscuit, a little milk, or a cup of coffee. When taken a few hours before rising, this will generally be retained, and prove very grateful, even though the morning sickness be troublesome. Any food or medicine that will confine or derange the bowels is to be forbidden. The taste is, as a rule, a safe guide, and it may be reasonably indulged. But inordinate, capricious desires for improper, noxious articles, should of course, be opposed. Such longings, however, are not often experienced by those properly brought up. It is a curious fact, that the modification in the digestive system during pregnancy is sometimes so great that substances ordinarily the most indigestible are eaten, without any inconvenience, and even with benefit, while the most healthful articles become hurtful, and act like poison.

As pregnancy advances, particularly after the sixth month, a larger amount of food, and that of a more substantial character, will be required. The number of meals in the day should then be increased, rather than the quantity taken at each meal.

CLOTHING.

The dress during pregnancy should be loose and comfortable, nowhere pressing tightly or unequally. The word enceinte, by which a pregnant woman is designated, meant, originally, without a cincture,—that is, unbound. The Roman matrons, so soon as they conceived, were obliged to remove their girdles. Lycurgus caused the enactment of the Spartan law, that pregnant women should wear large dresses, so as not to prejudice the free development of the precious charges of which nature had rendered them the momentary depositaries. Stays or corsets may be used, in a proper manner, during the first five or six months of pregnancy, but after that they should either be laid aside, or worn very loosely. Any attempt at concealing pregnancy, by tight lacing and the application of a stronger busk, cannot be too severely condemned. By this false delicacy the mother is subjected to great suffering, and the child placed in jeopardy. The shape of the stays should be moulded to that of the changing figure, and great care should be taken that they do not depress the nipple or irritate the enlarging breasts.

The amount of clothing should be suited to the season, but rather increased than diminished, owing to the great susceptibility of the system to the vicissitudes of the weather. It is especially important that flannel drawers should be worn during advanced pregnancy, as the loose dress favors the admission of cold air to the unprotected parts of the body. A neglect of this precaution sometimes leads to the establishment of the painful disease known as rheumatism of the womb.

Pressure upon the lower limbs, in the neighborhood of the knee or the ankle joint, should be avoided, more particularly towards the last months. It is apt to produce enlargement and knotting of the vein, swelling and ulcers of the legs, by which many women are crippled during their pregnancies, and sometimes through life. Therefore the garters should not be tightly drawn, and gaiters should not be too closely fitted, while yet they should firmly support the ankle.

EXERCISE.

Moderate exercise in the open air is proper and conducive to health during the whole period of pregnancy. It should never be so active nor so prolonged as to induce fatigue. Walking is the best form of exercise. Riding in a badly-constructed carriage, or over a rough road, or upon horseback, as well as running, dancing, and the lifting or carrying of heavy weights, should be scrupulously avoided, as liable to cause rupture, severe flooding, and miscarriage. During the early months, in particular, extraordinarily long walks and dancing ought not to be indulged in. Journeys are not to be taken while in the pregnant state. Railway travelling is decidedly objectionable. The vibratory motion of the cars is apt to produce headache, sickness at the stomach, faintness, and premature labor. All these precautions are especially to be observed in the first pregnancy.

We must not be understood as condemning exercise and fresh air. They are of the greatest importance to mother and child. But the amount of exercise should be regulated by the dictates of common sense and the woman's own sensations. If she can only walk a short distance each day with comfort, let that suffice. She should not force herself to go to a certain place nor to promenade during a certain time in the twenty-four hours. So soon as fatigue is felt, the walk should cease. Let the walks be frequent and short, rather than few and long. They should also be made as pleasant as possible, by companionship and surroundings that will occupy the feelings and imagination in an agreeable manner with new and cheerful impressions. A tendency to indolence is to be combated. A gently active life is best calculated to preserve the health of the mother and her unborn child. But with even the most robust a moderation of the ordinary pursuits and avocations is called for. The nervous and delicate cannot make with safety their customary daily exertions in the performance of their household or social duties and pleasures.

Towards the end of pregnancy the wife should economize her forces. She should not remain long standing or kneeling, nor sing in either of these postures.

BATHING.

Those who have not been accustomed to bathing should not begin the practice during pregnancy, and in any case great care should be exercised during the latter months. It is better to preserve cleanliness by sponging with tepid water than by entire baths. Foot-baths are always dangerous. Sea-bathing sometimes causes miscarriage, but sea air and the sponging of the body with salt water are beneficial. The shower-bath is of course too great a shock to the system, and a very warm bath is too relaxing. In some women of a nervous temperament, a lukewarm bath taken occasionally at night during pregnancy has a calming influence. This is especially the case in the first and last month. But women of a lymphatic temperament and of a relaxed habit of body are always injured by the bath.

VENTILATION.

We have spoken of the benefits of outdoor air during pregnancy. Attention should also be directed to keeping the atmosphere in the sitting and sleeping rooms of the house fresh. This can only be accomplished by constantly changing it. The doors and windows of every room, while unoccupied, should be kept thrown open in the summer-time, and opened sufficiently often in the winter to wash out the apartments several times a day with fresh air. The extremes of heat and cold are to be, with equal care, avoided. The house should be kept light. Young plants will not grow well in the dark. Neither will the young child nor its mother flourish without sunlight. The ancients were so well aware of this, that they constructed on the top of each house a solarium, or solar air-bath, where they basked daily, in thin attire, in the direct rays of the sun.

SLEEP.

During pregnancy a large amount of sleep is required. It has a sedative influence upon the disturbed nervous system of the mother. It favors, by the calmness of all the functions which attends it, the growth of the foetus. Neither the pursuit of pleasure in the evening, nor the observance of any trite maxims in regard to early rising in the morning, should be allowed to curtail the hours devoted to slumber. Pregnant women have an instinctive desire to lie abed late, which, like the other promptings of nature during this period, should not be disregarded. At least eight hours out of the twenty-four can be profitably spent in bed. No night-watching ought ever to be undertaken during pregnancy.

Feather beds should be avoided. The heat which they maintain about the body is inconvenient and dangerous, predisposing to flooding and exhausting perspirations. The hair or sponge mattress is to be preferred. The bed-clothing should not be too heavy. Blankets are to be employed rather than coverlids, as they are lighter and more permeable to perspiration. The mattress and cover should be well aired during the day. The sleeping-room should be capacious and well ventilated, and no curtains permitted about the bed.

Occasional rest is also necessary in the daytime. A nap of an hour or two upon a sofa or lounge will then prove very refreshing. In the earlier months of pregnancy it will tend to prevent miscarriage, and in the latter months to relieve the distress consequent upon the increased size of the womb. It is not unusual, as the close of pregnancy approaches, for a feeling of suffocation to ensue when the woman attempts to lie down. This may be overcome by supporting the back and shoulders with cushions and pillows. Or a bed-chair may be employed. This, if well constructed and covered, will often be found very grateful at night, in the last few weeks of pregnancy.

THE MIND.

A tranquil mind is of the first importance to the pregnant woman. Gloomy forebodings should not be encouraged. Pregnancy and labor are not, we repeat, diseased conditions. They are healthful processes, and should be looked upon as such by every woman. Bad labors are very infrequent. It is as foolish to dread them, as it is for the railway traveller to give way to misgivings in regard to his safety. Instead of desponding, science bids the woman to look forward with cheerfulness and hope to the joys of maternity.

The bad effects of fear upon the mother's mind are illustrated by Plutarch, who, in his Life of Publicola, mentions that, 'at a time when a superstitious fear overran the city of Rome, all the women then pregnant brought forth imperfect children, and were prematurely delivered.' But we have already spoken, in treating of mothers' marks, of the influence of mental emotions over the unborn child, and the necessity of avoiding their exciting causes.

Because of their deleterious tendency, severe study as well as arduous and protracted manual labor ought to be avoided. The nervous systems of many women are also injuriously affected during pregnancy by perfumes, which at other times are agreeable and innocuous. It is therefore prudent not only to exclude all offensive scents, but also to abstain from the strong odors of various strong perfumes, eau-de-cologne, and of flowers. Large bouquets often cause feelings of faintness, and sometimes temporary loss of consciousness. The extreme liability of the nervous system of the pregnant woman to be affected injuriously to herself and child by scenes of suffering or distress, and by disgusting or frightful objects, cannot be too strongly impressed upon every one. She should be protected from all that will disturb her, and should be constantly treated with soothing and encouraging kindness. Her manifestations of irritability, her caprices, her melancholy anticipations, are not to be scoffed at, but combated with a mixture of reasoning and patient forbearance. On her part, she should endeavour to co-operate with those around her, in sedulously shunning all injurious influences, and in banishing as quickly as possible all improper longings. She should remember that, although she herself may escape mischief from them, her child may suffer. She is the custodian of interests dearer to her than her own.

RELATION OF HUSBAND AND WIFE DURING PREGNANCY.

During those days when the wife, if she were not pregnant, would have been 'unwell,' marital intercourse should be abstained from. It is then injurious to the mother, and dangerous to the life of the child, as it is liable to excite miscarriage. But if this habitual epoch of the monthly sickness be avoided, there is no reason why passion should not be gratified in moderation and with caution during the whole period of pregnancy. There is one exception to be made to this general course of conduct. In those cases in which a miscarriage has occurred in the first pregnancy, every precaution should be employed—for reasons which have been dwelt upon in a previous article—to prevent its happening again after the second conception. Under such exceptional circumstances, therefore, the husband and wife should sleep apart during the first five months of pregnancy. After that period their ordinary relations may be resumed. When a miscarriage has taken place, intercourse should not be permitted within a month of the accident. The observance of this direction is of the utmost importance. Its neglect is the frequent cause of severe and intractable diseases of the womb.

EFFECT OF PREGNANCY ON HEALTH.

We have had occasion to remark that pregnancy is not a condition of disease. It is not only an evidence of health, but during its continuance it confers increased physical vigor. As a rule, a woman enjoys better health during her pregnancy than at any other time; she is less liable to contagious and other maladies; she is less apt to die than at any other period of her life; and her general constitution seems also then to receive a favorable impress, for wives and mothers live longer than celibates. It is wisely decreed that when woman is engaged in this, to her, anxious stage of reproduction, she shall not be exposed to the pains and dangers of disease, and that those great covenants of nature—marriage and child-bearing—shall be rewarded by added strength and length of days.

There are certain disorders incident, in exceptional cases, to pregnancy, of which we shall shortly speak. In general, however, we repeat that this condition is one of extraordinary health. More than this, in numerous instances it exerts an ameliorating influence upon pre-existing diseases, suspending their march, or bringing about a decidedly curative effect. Thus, various obstinate chronic affections of the skin, of the womb and ovaries, and of the brain and nervous system, frequently get well during pregnancy; and it is well known to every physician, that by the judicious management of this state, and of the lying-in period, troublesome displacements of the womb may be arrested.

It should nevertheless ever be recollected that the condition of pregnancy is one of excitement and enhanced susceptibility to impressions of all kinds. For this reason a change in the habits of life is necessary; and the importance of the directions laid down for the care of the health during this period, cannot be too strongly insisted upon.

The diseases to which the wife is exposed during pregnancy will be treated of in the chapter on 'Health in Marriage.'



CONFINEMENT.

PREPARATIONS FOR CHILDBIRTH.

Certain foolish preparations are sometimes made by wives, with the best intentions. Perhaps one of the most common and absurd of these is the local use of sweet oil, in order to facilitate the dilatation of the parts, for which purpose it is perfectly inert. There are, however, some wise and even necessary precautions which every wife should know and employ, to guard against unpleasant and dangerous complications in childbirth.

In particular, the condition of the breasts towards the close of pregnancy demands attention. Scarcely any pain in the lying-in chamber is greater or more difficult to bear than that which the young mother suffers from excoriated nipples. This troublesome and often very intractable affection is nearly always the consequence of the want of care previous to confinement. During the latter part of pregnancy the nipples sometimes become sunken or flat, being retracted as the breasts increase in size, because of the want of elasticity on the part of the milk tubes. In order to remedy this fault, we have known a breast-pump or puppy to be applied. Such treatment is dangerous, as it may excite premature contraction of the womb, and miscarriage. Nipple-shields, with broad bases and openings, should always be obtained. They are safe, and effectually secure the prominence of the nipples, when worn constantly, day and night, during the last month or so of pregnancy. Wives who have never had children ought to take special care to ascertain before labor whether this depressed condition of the nipples exists, and to correct it in the manner indicated.

In the first pregnancy it is also important to harden the nipples. This may be done by occasionally gently rubbing them between the thumb and finger, and by bathing them twice a day during the last six weeks with tincture of myrrh, or with a mixture of equal parts of brandy and water, to which a little alum has been added. This procedure will render the surfaces less sensitive to the friction of the child's mouth, and thus avert the distress so often occasioned in the first confinement by tenderness of the nipples.

If the nipples be rough or nodulated in appearance, like a strawberry or a raspberry, they are more apt to become excoriated or fissured than if they present a smooth surface. Under such circumstances, make a solution of the sulphate of zinc, of the strength of one grain to the ounce of rose water, in a wide-mouthed bottle, then tilt the bottle upon the nipple, and allow it to remain there for a few minutes several times a day. Simple tenderness of the nipples and slight fissures may be averted by the application either of a lotion of borax (two scruples of borax in three ounces of water, and an ounce of glycerine), of the honey of borax, or of the tincture of catechu, and by protecting the parts from the pressure of the stays and the friction of the flannel vest.

It is of the greatest moment to the comfort of the mother, that all affections of the nipples should be prevented or remedied before labor; for the treatment of sore nipples when the child is at the breast is often unsatisfactory, while the suffering they occasion is very great, even sometimes giving rise to mammary abscess.

There are certain articles of clothing and dressings for the bed which should be cared for in advance, in order that they may be ready when required.

The mother should be provided with short-gowns, to be worn over the chemise instead of the ordinary night-gowns. It is of consequence to procure a proper bandage. It should be made of heavy muslin, neither too coarse nor too fine; an ordinarily good quality of unbleached muslin is the best. The material is to be cut bias, about one and a quarter yard in length, and from twelve to eighteen inches in breadth, varying, of course, with the size of the person. It should be just large enough to encircle the body after confinement, with a margin of a couple of inches, and to extend down below the fulness of the hips. The measurement should be taken, and the bandage made to fit, when four and a half months advanced. It should be narrow above, wider below, and gored in such a manner that it will be a little narrower at the lower extremity than a few inches above, so as to prevent it, when adjusted, from sliding upwards. A bandage constructed in this manner will be very comfortable; and is not apt to become displaced, after application, as is invariably the case when a towel or a straight piece of muslin is used. The way in which it is to be applied will be detailed hereafter.

The child's clothing should consist first of a piece of flannel or some woollen material for a binder. This should be from four to six inches in width, and from twelve to sixteen inches in length; that is to say, wide enough to extend from the armpits to the lower part of the abdomen, and long enough to go once and a half times around the child, having the double fold to come over the abdomen. There should be no embroidery about this. A shirt, which it is desirable should be woollen, is to be provided to place over the binder. It should be made to come up tolerably high in the neck, and to extend down the arm. Neither it nor any other portion of the child's clothing should be starched. The petticoat, which may be open its whole length behind, is to be put over the shirt; two may be used—a short and a long one. Next comes the child's ordinary frock or slip, and above this an apron to protect the dress from the frequent discharges from the stomach. Then a shawl, of flannel or any other warm material, is to be provided, to throw over the shoulders if the weather be cold. Socks, and pieces of old soft linen, free from stiffening, for napkins or diapers, complete the child's outfit.

For the permanent and temporary dressing of the bed there should be provided a piece of impervious cloth (oiled silk is the neatest) about a yard square; a piece of ordinary table oil-cloth or rubber-cloth; a number of old sheets and comfortables, and a piece of thick carpet. The manner in which these are to be used will be explained shortly.

A pair of small rounded scissors; a package of large pins, one and a half inches in length, for the bandage of the mother, and smaller ones for that of the child; some good linen bobbin for the doctor to tie the navel-string; good toilet soap and fine surgical sponge for washing the child; a piece of soft linen or muslin for dressing the navel; a box of unirritating powder; and a pile of towels,—should all be had and laid aside many weeks before they are wanted. These, together with the material for dressing the bed, the child's clothing, and the mother's bandage, ought to be placed together in a basket got for the purpose, in order that they may all be easily and certainly found at a time when perhaps the hurry and excitement of the moment would render it difficult otherwise to collect them all immediately.

SIGNS OF APPROACHING LABOR.

One of the earliest of the preliminary signs of the coming on of confinement occurs about two weeks before that event. It is a dropping or subsidence of the womb. The summit of that organ then descends, in most cases, from above to below the umbilicus, and the abdomen becomes smaller. The stomach and lungs are relieved from pressure, the woman breathes more freely, the sense of oppression which troubled her previously is lost, and she says she feels 'very comfortable.' This sensation of lightness and buoyancy increases, and a few days before the setting in of labor she feels so much better that she thinks she will take an extra amount of exercise. The mother of a number of children is acquainted with this sign, but the wife with her first child may exert herself unduly in the house or outdoors, and induce labor when in the street or away from home. Hence the importance of a knowledge of this premonitory symptom.

A second precursory sign of labor is found in the increased fulness of the external parts, and an augmented mucous secretion, which may amount even to a discharge resembling whites, and requiring the wearing of a napkin. This symptom is a good one, indicating a disposition to relaxation, and promising an easy time.

The third preliminary sign which we shall mention, is the change in the mental state of the pregnant woman. She has a feeling of anxiety and of fidgetiness, sometimes accompanied with depression of spirits. This condition of emotional distress, modified in particular cases by reason, self-control, and religion, may continue for several days, perhaps, when

THE SYMPTOMS OF ACTUAL LABOR

make their appearance. The first of these is generally the 'show.' It is the discharge of the plug of mucus which has occupied the neck of the womb up to this time, and is ordinarily accompanied by a little blood. Perhaps before this, or perhaps not for some hours after, the 'pains' will develope themselves. These recur periodically, at intervals of an hour or half an hour at the outset, and are 'grinding' in character. True labor pains are distinguished from false by the fact that they are felt in the back, passing on to the thighs, while false pains are referred to the abdomen; by their intermittent character, the spurious pains being more or less continuous; and by the steady increase in their frequency and severity. In case of doubt as to their exact nature, the doctor should be summoned, who will be able to determine positively whether labor has begun.

The other symptoms which point to the actual commencement of labor are a frequent desire to empty the bowels and bladder, nausea and vomiting, which, in the early part of confinement, is a good sign; shiverings, unattended with any sensation of cold; and, finally, the rupture and discharge of the contents of the 'bag of waters.'

Before passing on to the consideration of the management of the confinement into which the wife has now entered, a few words may be appropriately said upon the

CAUSE OF LABOR.

Neither the size nor the vigor of the child has any influence in bringing about delivery at full term. The ancient theory—which received the support of the distinguished naturalist Buffon—that the infant was the active agent in causing its own expulsion, is an exploded one. It was asserted by some that hunger excited the foetus to struggle to free itself from the womb; others were disposed to attribute its efforts to accomplish its entrance into the world, to the need of respiration which it experienced. But all these ingenious theories, which presupposed the embryo to be actuated by the same feelings which would influence a grown person if shut up in such a confined abode, are unsatisfactory, and not tenable. It is well known that the child may die in the womb, without retarding or interfering in any way with the coming on of the process of labor. This fact alone shows that the foetus is, or at any rate may be, absolutely passive either in regard to the induction or advancement of delivery. The determining cause of labor is seated in the womb itself. The contractions of this organ occasion the 'pains' and expel the child, assisted by the muscles of the abdomen and the diaphragm. That the assistance of the latter forces is not necessary, is conclusively proved by the occurrence of childbirth after the decease of the mother. For instance, a case is on record in which labor commenced and twins were born after the mother had been dead for three days.

CARE DURING LABOR.

We will suppose labor to have commenced. The preparation of the bed for the occupancy of the mother is now to be attended to. As she is to lie on the left side of the bed, this is the side, and the only one, which is to be dressed for the occasion. In order to do so, remove the outer bed-clothes one at a time, folding them neatly on the right side of the bed so that they can easily be drawn over when desired. The permanent dressing is to be placed beneath the lower sheet and upon the mattress. A soft impervious cloth—which, in speaking of the preparation for confinement, we directed to be procured—is placed next to the surface of the bed. The upper edge should be nearly as high as the margin of the bolster, and it should extend down to a distance at least a foot below the level of the hips, so as to certainly protect the bed from the discharges. Upon the top of this a blanket or sheet is laid, and the whole fastened by pins. The lower sheet of the bed, which had been turned over to the right side, to permit the application of the dressing, is now to be replaced. Over the position of this permanent dressing, on the top of the bed-sheet, a neatly-folded sheet, with the folded edge down, is adjusted and pinned in its place. It is upon this sheet that the patient is to be drawn up after her confinement, which will take place upon the temporary dressing of the bed now to be arranged. It consists of an oil-cloth, which should extend up beyond the lower edge of the permanent dressing, overlapping the folded sheet which has been placed above it, and should fall over the side and bottom of the bed. A comfortable or any soft absorbent material is placed over this impervious cloth and covered with a folded sheet, completing the temporary dressing. The bed-clothes may now be adjusted, concealing the dressings from view until they are wanted. The valances at the foot of the bed should be raised, and a piece of carpet placed on the floor. The bed should have no foot-board, or a very low one.

The dress of the mother.—Either a folded sheet should be adjusted around the waist as the only skirt, so as not to interfere with the walking, or a second chemise should be put on, with the arms outside the sleeves, to extend from the waist to the feet. Then the chemise next the body should be drawn up and folded high up around the breast. It should be plaited neatly along the back, and brought forward and fastened by pins. This should be thoroughly done, so that the linen may not be found wet nor soiled when it is drawn down after confinement. A wrapper or dressing-gown may be worn during the first stage of labor, before it is necessary to go to bed. When, however, that time comes, the wife will take her place on her left side on the temporary dressing, with a sheet thrown over her, her head on a pillow so situated that her body will be bent well forward, and her feet against the bed-post. A sheet should be twisted into a cord and fastened to the foot of the bed, for her to seize with her hands during the accession of the 'bearing-down pains.' Care should be taken to have a number of napkins, a pot of fresh lard, and the basket containing the scissors, ligature, bandage, etc.—which have been previously enumerated in the remarks on preparations for childbirth—at hand, for the use of the doctor.

We have now noted all that it is useful for the wife to know in regard to the preparation for and management of confinement, when a physician is in attendance, as, for obvious reasons, he should always be. In some instances, however, the absence of the doctor is unavoidable, or the labor is completed before his arrival. As a guide to the performance of the necessary duties of the lying-in room under such circumstances, we give some

HINTS TO ATTENDANTS.

The room during confinement should be kept quiet. Too many persons must not be allowed in it, as they contaminate the air, and are apt by their conversation to disturb the patient, either exciting or depressing her. So soon as the head is born, it should be immediately ascertained whether the neck is encircled by the cord; if so, it should be removed or loosened. The neglect of this precaution may result fatally to the infant, as happened a short time since in our own practice; the infant, born a few minutes before our arrival, being found strangled with the cord about its neck. It is also of importance at once to allow of the entrance of air to the face, to put the finger in the mouth to remove any obstruction which may interfere with respiration, and to lay the babe on its right side, with the head removed from the discharges. The cord should not be tied until the infant is heard to cry. The ligature is to be applied in the following manner:—A piece of bobbin is thrown around the navel-string, and tied with a double knot at the distance of three fingers' breadth from the umbilicus; a second piece is tied an inch beyond the first, and the cord divided with the scissors between the two, care being taken not to clip off a finger or otherwise injure the unsuspecting little infant, as has occurred in careless hands more than once. When the child is separated from the mother, a warm blanket or a piece of flannel should be ready to receive it. In taking hold of the little stranger, it may slip out of the hands and be injured. To guard against this accident, which is very apt to occur with awkward or inexperienced persons, always seize the back portion of the neck in the space bounded by the thumb and first finger of one hand, and grasp the thighs with the other. In this way it may be safely carried. It should be transferred, wrapped up in its blanket, to some secure place, and never put in an arm-chair, where it may be crushed by some one who does not observe that the chair is already occupied. The head of the child should not be so covered as to incur any danger of suffocation.

ATTENTION TO THE MOTHER.

When the after-birth has come away, the mother should be drawn up a short distance—six or eight inches—in bed, and the sheet which has been pinned around her, together with the temporary dressing of the bed removed, a clean folded sheet being introduced under the hips. The parts should be gently washed with warm water and a soft sponge or a cloth, after which an application of equal parts of claret wine and water will prove pleasant and beneficial. We have also found the anointing of the external and internal parts with goose grease, which has been thoroughly washed in several hot waters, to be very soothing and efficient in speedily allaying all irritation. This ought all to be done under cover, to guard against the taking of cold. The chemise pinned up around the breast should now be loosened, and the woman is ready for the application of the bandage, which is to be put on next the skin. If properly and nicely adjusted, it will prove very grateful. The directions for making it have already been given. In order to apply it, one half of its length should be folded up into plaits, and the mother should lie on her left side; lay the plaited end of the bandage underneath the left side of the patient, carrying it as far under as possible, and draw the loose end over the abdomen; then let the mother roll over on her back upon the bandage, and draw out the plaited end. If the abdominal muscles are much relaxed and the hip-bones prominent, a compress of two or three towels will be wanted. The bandage should be first tightened in the middle by a pin applied laterally, for strings should never be employed. The pins should be placed at intervals of about an inch. The lower portion of the bandage should be made quite tight, to prevent it slipping up. The mother is now ready to be drawn up in bed upon the permanent dressing: this should be done without any exertion on her part. A napkin should be laid smoothly under the hips (never folded up), to receive the discharges. If she prefer to lie on her left side, place a pillow behind her back.

ATTENTION TO THE CHILD.

The baby may now be washed and dressed. Before beginning, everything that is wanted should be close at hand, namely a basin of warm water, a large quantity of lard or some other unctuous material, soap, fine sponge, and a basket containing the binder, shirt, and other articles of clothing. First rub the child's body thoroughly with lard. The covering can only be removed in this way; the use of soap alone will have no effect unless the friction be so great as to take off also the skin. The nurse should take a handful of lard and rub it in with the palm of the hand, particularly in the flexures of the joints. In anointing one part, the others should be covered, to prevent the child from taking cold. If the child is thus made perfectly clean, do not use any soap and water, because the skin is left in a more healthful condition by the lard, and there is risk of the child's taking cold from the evaporation of the water. But the face may be washed with soap and water, great care being taken not to let the soap get into the child's eyes, which is one of the most frequent causes of sore eyes in infants. The navel-string is now to be dressed. This is done by wrapping it up in a circular piece of soft muslin, well oiled, with a hole in its centre. The bandage is next to be applied. The object of its use is to protect the child's abdomen against cold, and to keep the dressing of the cord in its position. The nature, shape, and size of the binder have been described. It should be pinned in front, three pins being generally sufficient. The rest of the clothing before enumerated is then put on.

The child is now to be applied to the breast at once. This is to be done, for three reasons. First, it very often prevents flooding, which is apt otherwise to occur. Secondly, it tends to prevent milk fever, by averting the violent rush of the milk on the third day, and the consequent engorgement of the breast and constitutional disturbance. The third reason is, that there is always a secretion in the breast from the first, which it is desirable for the child to have; for it acts as a cathartic, stimulating the liver, and cleansing the bowels from the secretions which fill them at the time of birth. There is generally sufficient nourishment in the breasts for the child for the first few days. The mother may lie on the one side or the other, and receive the child upon the arm of that upon which she is lying. If the nipple be not perfectly drawn out so that the child can grasp it in its mouth, the difficulty may be overcome by filling a porter-bottle with hot water, emptying it, and then placing the mouth of the bottle immediately over the nipple. This will cause, as the bottle cools, a sufficient amount of suction to elevate the sunken nipple. The bottle should then be removed and the child substituted,—a little sugar and water or sweetened milk being applied, if necessary, to tempt the child to take the breast.

FURTHER ATTENTION TO THE MOTHER.

The patient should be cleansed every four or five hours. A soft napkin, wet with warm soap and water, should for this purpose be passed underneath the bed-clothing, without exposing the surface to a draft of air. After using the soap and water, apply again the dilute claret wine and the goose grease. Much of the safety of the mother depends upon the observation of cleanliness. The napkin should not be allowed to remain so long as to become saturated with the discharges.

The mother should maintain rigidly the recumbent position for the first few days, not raising her shoulders from the pillow for any purpose, and should abstain from receiving visitors, and from any social conversation for the first twenty-four hours.

For the first three or four days, until the milk has come and the milk fever passed, the mother should live upon light food,—oatmeal gruel, tea and toast, panada, or anything else of little bulk and unstimulating character. Afterwards the diet may be increased by the addition of chicken, lamb, mutton or oyster broth, buttered toast, and eggs. The object of light nourishment at first is to prevent the too rapid secretion of milk, which might be attended with evil local and constitutional effects. If, however, the mother be in feeble health, it will be necessary from the outset that she shall be supported with nourishing concentrated food. Beef-tea will then be found very serviceable, particularly if made according to the following recipe:—Take a pound of fresh beef from the loins or neck. Free it carefully from all fat. Cut it up into fine pieces, and add a very little salt and five grains of unbroken black pepper. Pour on it a pint of cold water, and simmer for forty minutes. Then pour off the liquor, place the meat in a cloth, and, after squeezing the juice from it into the tea, throw it aside. Return to the fire, and boil for ten minutes.

After the first week, the diet of the lying-in woman should always be nutritious, though plain and simple. The development of the mammary glands, the production of the mammary secretion, and the reduction which takes place in the size of the womb, all require increased nourishment, that they may be properly performed.

After the third or fourth day the dress should be changed. The dress worn during labor, if our directions have been carried out, will not have been soiled. The clothing should be changed without uncovering the person, and without raising the head from the pillow. Pull the bed-gown from over each arm, and draw it out from under the body. Then unfasten the chemise in front and draw it down underneath her so that it can be removed from below, as it should not be carried over the head. Place her arms in the sleeves of the clean chemise, throw its body over her head, and, without lifting her shoulders from the bed, draw it down. Then change the bed-gown in the same manner.

In changing the upper sheet, it should be pulled off from below, and the clean one carried down in its place from above, underneath the other clothing, which can be readily accomplished by plaiting the lower half. In introducing a clean under-sheet, one side of it should be plaited and placed under the patient, lying on her left side; when she turns on her back, the plaits can then be readily drawn out. These directions, though apparently trivial, are important. The object is to guard against the great danger to which the mother is exposed by sitting up in bed for even a few minutes during the first week.

Cathartic medicine should not be administered the first, the third, or any other day after confinement, unless it is needed. If the patient is perfectly comfortable, has no pain in the abdomen, no headache, and is well in every respect, she should be let alone, even if her bowels have not been moved. If a laxative be called for, citrate of magnesia is much pleasanter and equally as efficacious as the castor-oil so frequently administered on this occasion.

TO HAVE LABOR WITHOUT PAIN.

Is it possible to avoid the throes of labor, and have children without suffering? This is a question which science answers in the affirmative. Medical art brings the waters of Lethe to the bedside of woman in her hour of trial. Of late years chloroform and ether have been employed to lessen or annul the pains of childbirth, with the same success that has attended their use in surgery. Their administration is never pushed so as to produce complete unconsciousness, unless some operation is necessary, but merely so as to diminish sensibility and render the pains endurable. These agents are thus given without injury to the child, and without retarding the labor or exposing the mother to any danger. When properly employed, they induce refreshing sleep, revive the drooping nervous system, and expedite the delivery.

They should never be used in the absence of the doctor. He alone is competent to give them with safety. In natural, easy, and short labor, where the pains are readily borne, they are not required. But in those lingering cases in which the suffering is extreme, and, above all, in those instances where instruments have to be employed, ether and chloroform have a value beyond all price.

MORTALITY OF CHILDBED.

The number of the pregnancy affects the danger to be expected from lying-in. It has been declared by excellent authority, that the mortality of first labors, and of childbed fever following first labors is about twice the mortality attending all subsequent labors collectively. After the ninth labor the mortality increases with the number. A woman having a large family, therefore, comes into greater and increasing risk as she bears her ninth and successive children.

The age of the woman also affects the mortality accompanying confinement. The age of least mortality is near twenty-five years. On either side of this, mortality increases with the diminution or increase of age. The age of the greatest safety in confinement therefore corresponds to the age of greatest fecundity. And during the whole of child-bearing life, safety in labor is directly as fecundity, and vice versa. Hence modern statistics prove the correctness of the saying of Aristotle, that 'to the female sex premature wedlock is peculiarly dangerous, since, in consequence of anticipating the demands of nature, many of them suffer greatly in childbirth, and many of them die.' As the period from twenty to twenty-five is the least dangerous for childbirth, and as first labors are more hazardous than all others before the ninth, it is important that this term of least mortality be chosen for entering upon the duties of matrimony. This we have already pointed out in speaking of the age of nubility.

The sex of the child is another circumstance affecting the mortality of labor. Professor Simpson of Edinburgh has shown that a greater proportion of deaths occurs in women who have brought forth male children.

The duration of labor also influences the mortality of lying-in. The fatality increases with the length of the labor. It must be recollected, however, that the duration of labor is only an inconsiderable part of the many causes of mortality in childbirth.