The nature of this complaint appears to be a severe and sudden

inflammation, commencing either in the womb or some of the neighboring

parts, which, if not arrested, rapidly extends to all the organs of

the pelvis and abdomen, and hastens to a fatal termination with

fearful speed. The precise seat, and place of commencement, of the

inflammation, varies in different cases, but this makes little

difference either in the symptoms, consequences, or treatment of the

disease, and it is of but little use to give a separate name to all

these various forms. Uterine Phlebitis, Metro Peritonitis, Puerperal

Metritis, and Puerperal Peritonitis, are all essentially the same

complaint, and identical with what is called Puerperal, or Childbed

fever.

The disease generally appears from the second to the fifth day after

delivery, but may be delayed as late as the fifteenth or twentieth day,

or commences as early as two or three hours after; and has even been

known to show itself before labor came on.

It usually begins with headache, general debility, uneasy feelings,

creeping of the flesh, and chills: then follow tremblings, numbness of

the limbs, cold feet and hands, with a burning heat in the body. The

abdomen gradually gets tender, so that it cannot bear the slightest

pressure, sharp pains are felt in various parts of it, and the patient

continually complains of twisting and burning within. She prefers to

lie on her back, with the head raised and the knees drawn up, so as to

relax the abdominal muscles. Very soon she complains of great thirst,

and cries out repeatedly from the sharpness of the pain; the headache

increases, and the breathing becomes laborious. Hiccough generally

occurs at an early stage, and is usually accompanied or followed

by vomiting and diarrhœa, but sometimes by obstinate constipation.

The abdomen continues to swell, and becomes still more tender, the

face is pale, bathed with cold perspiration, and indicates in every

line the anxiety and suffering under which the patient labors. The

features seem to be drawn upwards, and all together, or _pinched up_,

and indeed the whole body seems to _shrink_. In general the lochial

discharge either stops altogether or lessens very much, the breasts

remain empty or nearly so, and the pulse is weak and irregular. In some

few cases however, the lochia continues to flow, or even increases,

and the breasts remain full up to the time of death. The urine is

high colored and thick, and causes smarting and burning as it passes

away. The tongue furs and becomes pointed, and pale colored. The eyes

often seem much engorged, and the white part become yellow, as indeed

the skin does over the whole body, owing to derangement of the bile,

and alteration in the character of the blood. In most cases the mind

retains its faculties nearly till dissolution, but there is frequently

a vague sense of uneasiness and fear, with great depression of spirits

and weeping. Some even feel assured, from the beginning, that they will

never recover, and occasionally become delirious.

The duration of this disorder varies considerably, though in most cases

it carries off the sufferer in a short time, frequently even in two or

three days. It may however last five, ten, or twelve days, and has been

known to do so fourteen.

The manner in which it terminates is also different in different cases.

The fluid resulting from the inflammation may either be absorbed, or

suppuration may ensue, and the matter be discharged, either from one

of the natural passages or from an artificial opening; or it may not

be discharged at all. Sometimes gangrene or mortification ensues,

and sometimes the inflammation partly subsides and becomes chronic.

When it terminates by resolution, which is the most favorable mode,

the patient begins to improve about the fourth or fifth day; the

pains become less acute, the swelling and tenderness become less, and

the milk, lochia, and other secretions that were suppressed begin

to reappear. The patient is also able to lie either on the back or

sides, and soon feels conscious herself that she is improving. But

even when a turn for the better has decidedly taken place, too much

confidence should not be prematurely felt, nor should there be any

relaxation of attention, for the slightest causes may bring back all

the symptoms with more than their former severity. When suppuration

ensues, which is most commonly the case, a mass of fluid forms in

the womb or abdomen, and is plainly indicated, either by its moving

about or by a portion escaping from the body. In this case also the

pain and tenderness decreases, and the abdomen seems less hard, but

the pulse becomes weaker, a sense of weight is felt about the womb,

the extremities become cold, chills come on, and gradually the powers

of the system seem to fail till complete exhaustion ensues. When

gangrene or mortification ensues, the termination is nearly the same,

but more rapid, and all the above symptoms are more marked. When it

passes into the chronic form, there is but little permanent abatement

in the severity of the symptoms for some time; they partially lessen

at intervals, but return again, sometimes with renewed vigor, and it

remains long a matter of doubt whether the disease has really passed

the critical period or not. Recovery takes place occasionally in this

form of the disease, but more frequently the patient becomes daily

weaker and more emaciated, diarrhœa and slow fever set in, the vital

powers steadily sink, and at last death ensues. This fatal termination

may however be delayed for an indefinite period, and may ultimately

result from Consumption or Dropsy, both of which frequently follow

chronic puerperal fever.

In regard to the probable termination of this disease, but little

hope can be entertained that it will be favorable. Nor are there many

indications that can be relied upon with certainty, as to what course

it is likely to take. In general it is favorable when the swelling

subsides, and the pains abate in severity, and particularly if the milk

and lochia begin to be secreted again. The indications are also good

in proportion as the symptoms are mild, and when there is no great

sympathetic disturbance of other parts of the system. It is regarded as

unfavorable when the pain and tenderness extends over a large portion

of the abdomen, and when the attack commences very suddenly. The danger

is also considered greater in proportion as the disease begins nearer

to delivery; and when its first symptoms exhibit themselves before

labor it is always considered mortal. It is likewise more dangerous

with twins than with a single birth, and with first children than

afterwards. It is seldom possible however to come to any probable

conclusion till between the fifth and tenth day, and even then it is in

general a matter of great uncertainty.

The best treatment of this fearful disease is one of the greatest

problems in medical science. So many different plans have been adopted,

and with such various success, that the history of past cases affords

but little reliable data to guide us in future ones. In general the

most powerful _antiphlogistic_ measures, or those thought most likely

to reduce the inflammation at once, are immediately resorted to, such

as bleeding, purgatives, and cold bathing. Bleeding is in particular

the great agent depended upon, either from the arm, or by cups and

leeches to the abdomen and vulva. Dr. Gordon, of Aberdeen in Scotland,

who once met with a regular epidemic of puerperal fever in that city,

assures us that nothing else succeeded in arresting the disorder but

copious and frequent bleeding, at the very commencement. He carried it

so far as to take _twenty-four ounces_ at once, and he says that when

he did so the patient was nearly sure to recover, but that at first,

when he only abstracted about twelve ounces, she was as nearly sure

to die. In about fifty cases to which he was called in time, he only

lost _five_, and taking the average of all he attended the recoveries

were about two-thirds of the whole number, which is above the usual

proportion.

It appears however, from the experience of the most eminent

practitioners, that the bleeding must commence early; that the first

abstraction should not be omitted beyond twenty-four hours after

the first symptoms of the disease, and should be as much earlier as

possible. With very few exceptions they also think Gordon's standard

of twenty-four ounces not too much. Indeed it is generally admitted

that if the blood be not drawn _at first_ and in _large portions_, it

had better not be drawn at all. There may be of course many peculiar

circumstances that will make bleeding improper, which nothing but

experience and observation will teach a practitioner, but the number of

such cases is thought to be small. The use of leeches meets with but

few advocates, and certainly they seem to have had but partial success,

compared with the lancet. Dr. Collins of Dublin depended chiefly upon

leeches and Calomel, but he tells us that in _eighty-eight_ cases

_fifty-six_ died when so treated, while in _fifteen_ that were freely

bled from the arm only _eight_ died. In short it appears that the

bleeding must be carried far enough, _at the very beginning of the

disease_, to cut it short at once, or it will be of no avail, it being

of little or no use merely to _check_ it! In conjunction with the

bleeding it is also usual to give enemas of starch and castor oil, or

something similar, and to bathe the extremities in hot water.

I know that this practice of bleeding meets with strong opposition from

many physicians, and that it is objected to by patients generally. I

myself am as much opposed to it as any one reasonably can be, and I am

well aware of the numerous evils which follow it, but still it cannot

be denied that Dr. Gordon's plan has cured a greater number of cases

of _puerperal fever_ than any other yet tried. It is true that many

of those thus cured may have afterwards died of dropsy, convulsions,

typhus and other diseases _produced by the bleeding_, but then the risk

they run of dying from these was less than that from the puerperal

fever, and in a choice of evils we ought to choose the least. It should

also be remembered that some eminent practitioners assert, if this plan

be adopted _promptly_ and _fully_, it will _always cure_, or at least

with very few exceptions.

Several other modes of treatment have also been adopted to dispense

with bleeding, some of which have been much more successful than

others, though none so much so as we could desire. Thus some

practitioners resort immediately to hot fomentations and sweating

medicines, or a hot bath if convenient, together with brisk purgatives,

and injections. Some depend upon Calomel in large doses, with leeches

to the groins and vulva. Others again use cold fomentations, and

cold injections both to the rectum and to the vagina. Others again

use blisters over the abdomen, in conjunction with purgative enemas

and moderate bleeding; but this mode seems to do but little good.

Another plan is to give about six grains of ipecac, and to repeat the

dose several times, at intervals of an hour or less, in conjunction

with purgatives and warm fomentations. Turpentine has also been used

internally and by enema, but seems to have accomplished little good.

Perhaps the most frequent plan after bleeding, is to rub one or two

drachms of _Mercurial Ointment_ well on the skin, over the abdomen,

every two or three hours, sometimes for several days regularly; eight

or ten grains of Calomel being also given daily, at the same time.

This brings on salivation, and in many cases the symptoms begin to

abate in severity as soon as that commences. I am not aware however,

that this treatment is any more successful than bleeding, nor do I

think the consequences afterwards, in a case of recovery, are any

less to be dreaded. It is difficult in fact to say what plan can be

best recommended, even in the majority of cases, and certainly no one

yet tried is applicable to all, on account of the peculiarities and

varying circumstances of each. If the practitioner or patient is not

decidedly opposed to the bleeding plan, that has undoubtedly the best

recommendation, from former success. Next to that perhaps comes the

mercurial treatment, which usually meets with as much opposition as the

bleeding, but which certainly has been frequently found efficacious.

The other plans have met with but little favor, though possibly they

might sometimes succeed when the rest fail.

If I were asked what I should advise for those who _would not_ submit

to the use either of the lancet or mercury, I should say, commence with

a strong dose of Epsom Salts, or Jalap, and repeat it in about five

hours after its full operation. Also apply warm fomentations to the

abdomen, or put upon it a flannel bag full of hops soaked in vinegar,

as hot as it can be borne, and put mustard poultices on the feet, and

inside of the thighs. The hands must also be kept as warm as possible,

and the head cool. The diet should be very spare, and contain nothing

heating or stimulating, and cooling drinks, such as ice water, or cold

lemonade, should be drunk freely. The purgative should be repeated at

least every day, for two or three days, or more if the symptoms are not

modified, and the mustard poultices may be regularly used to various

parts of the limbs, for the same length of time. In conjunction with

these means the breasts should also be kept warm, to promote the flow

of the milk, and injections of starch and castor oil should be thrown

up the rectum daily. The object being, as far as possible, to keep the

surface of the body warm, and to cool the internal fever, at the same

time that all the natural secretions are excited as much as possible

to remove any morbid matter that may be formed. It should also be

mentioned that the urine sometimes stops, or at least becomes very

scanty and thick, in which case a little sweet nitre may be given, or

if necessary the catheter must be used. Some bitter tea, as boneset

or chammomile, should also be taken occasionally, and a James's Fever

Powder with it once or twice a day, to promote perspiration; or if

there be severe pains, a dose of Dover's Powders may be used instead.

If the disease passes the acute stage and becomes chronic, the same

means must be pursued, and with strict regularity, or there will be

danger of its again becoming acute. In all cases send for the most

experienced practitioner _as early as possible_, and whatever his plan

may be, if his past success proves it to be tolerably successful,

_submit to it_, whether it be bleeding, salivation, or anything else.

If there be no one at hand on whom dependence can be placed, follow

the plan I have laid down as nearly as circumstances will allow, but

practise it fully without delay, and till a change takes place. Those

persons who make light of this disease, and pretend to say that this

or that simple treatment is all-sufficient, either deceive themselves

or wish to impose upon others. There are few affections more serious,

as will be evident when it is borne in mind that, on an average, _two

females die out of every three attacked by it_. To avoid all liability

to it as far as possible, attend well to the general health during

pregnancy, have everything comfortable, clean, and wholesome, during

labor, and be careful to avoid cold, damp, and all kinds of mental

and bodily excitement afterwards. The assistant also, whoever it may

be, must be as careful and as gentle as possible, so as to avoid all

violence or undue force, and _not to hurry nature_. A want of attention

to such simple details has, undoubtedly, brought on many attacks of

this fearful disease that otherwise would never have been experienced.

AFFECTIONS OF THE BREAST OCCURRING AFTER PREGNANCY.

The functions of the breasts are liable, from many causes, to become

deranged, and such derangements may lead to serious results, both to

the mother and the child. It is a common opinion that females who

nurse are not so liable to suffer in this way as those who do not, but

experience proves this opinion to be untrue; nevertheless, as it is the

duty of mothers to nourish their own offspring, it should be a subject

of careful study to relieve them of this liability as far as possible,

or to assist them when necessary.

_Galacterrhœa._ This means an overflow, or excessive secretion of the

milk, which sometimes takes place, particularly in those who do not

nurse. At the commencement of the milk fever, Galacterrhœa needs but

little attention, but if it continue to the second or third day, proper

remedies should be applied to correct it. These consist in complete

rest, both of body and mind, cooling drinks, and spare diet. If these

do not correct it soon, a flaxseed poultice should be placed on each

breast, and the patient should be made to perspire, either by warm

teas and clothing, or by means of steaming. The bowels should also be

freely opened with castor oil, or a seidlitz powder, and it will often

benefit very much to give warm water freely to drink, with ten grains

of nitrate of potash (_saltpetre_) to the pint.

In those that nurse it is very seldom the case that the secretion of

milk is too profuse, unless the child has been kept too long from

the breast. As a general rule it should be put to nurse in a few

hours after birth, even if there be no milk, because its suction will

materially help to bring on the flow. It frequently happens, when the

child is kept away till the milk comes, that the breasts have swelled

so that the nipple is buried and cannot be laid hold of well by the

mouth, in consequence of which the child does not get nourishment

enough, and the breasts not being well emptied become engorged, and

their functions deranged. All this may be avoided by putting it too

early. Sometimes however notwithstanding every precaution, the flow of

milk is excessively great, and constitutes a real disease, which may

cause great weakness and debility. In such cases it will generally be

found that the diet is too stimulating or too rich, or that the bowels

have been too inactive, and the first step towards an improvement must

consist in correcting these faults. The skin should also be kept active

by frequent bathing and good friction, and the quantity of nourishment

taken should not be greater than the mere healthy support of the body

requires. In particular no stimulating liquors should be used.

_Agalaxy._--This complaint is the reverse of the former, as it consists

in a deficient secretion of milk. The causes of this deficiency are

various; sometimes it arises from a constitutional inertness of the

breasts, sometimes from insufficient nourishment, and sometimes from

profuse discharges in other parts. All excesses also tend to decrease

the quantity of the milk, _particularly those of a certain kind_; and

it is seldom so abundant or lasting either in extreme youth or advanced

age. The appearance of the menses in like manner generally causes the

flow to become less, and it ceases naturally in some much earlier than

in others. Sometimes there is a deformity in the child's mouth, which

prevents its sucking properly, and the milk may stop for want of being

completely drawn. The breasts also may be diseased, or the nipple not

sufficiently prominent, and the same difficulty be thus produced in

another way.

In treating agalaxy, therefore, the first thing is to ascertain if

there be no deformity or disease in either mother or child, which

prevents proper nursing. If there be nothing of the kind, it must

next be ascertained whether the mother has any excessive secretion

elsewhere, such as diarrhœa, great flow of urine, or heavy sweats; if

she have, these must be corrected. It must next be seen if she takes

sufficient nourishment, and of a proper kind for her stomach and

bowels. Sometimes a little spiced wine is excellent, or some porter,

with white meats, and arrow-root milk. If she be of a full habit,

however, and makes much blood, the contrary course must be pursued, and

the diet be made low and unstimulating, while the bowels are kept free

and the skin in good action.

In many cases when the nipple is small, it may be much enlarged by

titillation, just before the child is put to it, after which the

suction will increase it still more.

If the female be advanced in life, or very weak, or if she becomes

pregnant, it may be better to procure a nurse than to attempt to

stimulate the flow at all. The appearance of the menses need not

occasion a suspension of nursing, unless it evidently deranges the

secretion of the milk, or affects the health of the mother; in either

of which cases the child should be weaned at once.

_Engorgement of the Breasts._--The breasts are liable to become

swollen, or engorged, from colds, blows, hard nursing from the child,

over feeding, and from soreness or excoriations preventing them being

fully emptied. This state may occur at any time, but is most frequent

a few days after delivery. In general there is no danger from it,

unless it be very bad or continues too long; it may then inflame and

discharge, or become permanently hardened. To prevent such accidents

the breasts should always be sufficiently emptied, either by the child

or by artificial means, and every precaution should be used against

cold or violence. Constipation must also be guarded against, and the

diet and drink must be carefully observed, so that it be not too

feeding, or too stimulating. Warm fomentations or poultices may also be

used when the breasts are painful, and a Dover's Powder may be given at

night, after bathing the feet in warm water, to promote perspiration.

_Inflammation of the Breasts._--This is only a more advanced stage

of the previous malady, produced by the same causes, and by want of

timely attention. Like simple swelling, it may arise at any time

during nursing, but is more frequent a few days after delivery. As

soon as the inflammation commences the breasts become red, swollen,

and excessively tender, particularly at one point, which soon begins

to project like a nipple, if the disease is not stopped, and at last

bursts and discharges the contained pus. Sometimes the inflammation

is comparatively superficial, and extends only over a small portion

of the surface, but at other times it goes deep and spreads wide. In

proportion to its extent is the severity of the symptoms, which are

those of inflammation in general, such as headache, thirst, fever,

general uneasiness, and cutting pains in the part affected.

As soon as the abscess is formed and can be plainly discovered, it is

usual to open it immediately, because the longer it remains the more

extensive it becomes, and the larger portion of the breast becomes

diseased. It is necessary however to be _certain_, before making an

opening, that it is really an abscess on which we are going to operate,

for sometimes a healthy part of the breast feels very much like one,

and a mistake may easily be made; in fact such a mistake has often

been made, and by men of experience too. In the early stage of the

inflammation every effort should be used to prevent an abscess from

forming, by the use of purgatives, sweating medicines, low diet,

cooling drinks, and warm fomentations over the whole chest. Some

females practice _cold_ fomentations over the breasts, and with good

success, in the commencement of the inflammation, but it may increase

the difficulty with others, and, so far as I have seen, is no more

generally useful than the other method. The warm bath all over the body

is also very serviceable in a number of cases.

It usually happens however, in spite of every precaution, that matter

will form, and its discharge become necessary. As soon as this is

evident, it should be promoted as much as possible, by hot fomentations

and poultices, till the head of the abscess is sufficiently distinct

for it to be safely opened. While the swelling is going on the pain

is often very severe, and it should be eased as much as possible, by

using laudanum in the fomentations, or by putting on an opium plaster.

After an abscess has opened and discharged, it should be kept open for

some time, by little pledgets of lint, to prevent its closing up too

soon, otherwise a portion of the matter may be shut in by the wound

healing over it, and another abscess will form. Warm poultices and

lotions should also be used afterwards, to promote the discharge as

much as possible, but they should not be used after it has evidently

begun to cease naturally. In short every means pointed out should be

used energetically in the first stage, to _prevent_ the gathering, but

if it takes place in spite of them, then it should be _hastened_ and

_discharged_ as early as possible, to prevent its extending. After

this, when it has evidently all escaped, the wound may be suffered to

heal, and the patient must be enjoined to be very careful in future,

for the same accident will be very liable to reappear.

Sometimes these abscesses become very extensive, and remain for a long

time. I have known ten or twelve on one breast, and I have known them

to continue open for many months. When this is the case it is much

to be deplored, as it is very likely indeed to destroy the breast,

and may even lead to more serious results. Attention therefore cannot

be bestowed upon them too early or too unremittingly, particularly

if the female be scrofulous, or of a very full habit. Sometimes the

inflammation attacks both breasts, and at other times only one, in

which case every effort should be exerted to prevent its extending

to the other. In many persons the same side is always affected, and

becomes a scape-goat as it were for the other.

When the means used succeed in scattering the swelling, its dispersion

is usually followed by some critical discharge, such as diarrhœa, or a

great flow of urine, or even by profuse perspiration, which shows how

nature operates in removing the diseased matter, and cautions us not

rashly to check such discharges.

It is a very serious matter for the swelling to _indurate_ or harden,

as it sometimes will, without either scattering or dispersing, as it

is then constantly liable to become worse again, besides destroying

the structure of the gland. Every means should therefore be used to

prevent this, by promoting its dispersion or discharge, in the way

already pointed out. It is also very good in these cases to bathe

frequently with alum water, or decoction of white oak bark, or even to

rub on some of the _Ointment of Hydriodate of Potassa_, diluted with

an equal weight of fresh lard. A piece as large as a hickory nut may

be well rubbed on twice a day, for three or four days, but it should

be stopped immediately the swelling begins to subside, and not used

again unless it still remains or again increases. In many cases pretty

frequent friction, with the hand anointed with a little oil, will be

all sufficient, especially if a hot fomentation be used afterwards.

_Excoriations, or Cracks in the Breasts._--The annoyance from this

cause is sometimes very great, the pain which is experienced when the

child begins to nurse being so acute that it is impossible for the

mother to allow it to remain. Frequently I have known it compel weaning

much earlier than was desirable, and sometimes it has even been so

bad, that the dress could scarcely be borne against the breasts. The

precise cause of this liability to crack is not known, nor do we know

of any certain means to prevent it. In many cases however I have known

it prevented, to a great extent, by having the nipple gently sucked,

very frequently, for six weeks or two months before childbirth. This

hardens it, and if a wash of borax water be also used, after each time,

it will be gradually prepared for its proper use. Our means of curing

this troublesome affection are very limited, and frequently everything

fails that is tried. The mucilage of Quince seed, prepared by bruising

and boiling them in a small quantity of water, rubbed over the sores

with a soft feather, immediately after nursing, often does much good.

The mucilage from the tender tops of young sassafras sometimes succeeds

better than that from the Quince, and a bruised leaf from the large

_horse-shoe Geranium_, laid on like a poultice, is sometimes better

than either. A good lotion may also be made with a quarter of an

ounce of borax, and a tea-spoonful of laudanum, to half a pint of

warm water, to be used frequently during the day. Some females use a

wash made of saleratus, with considerable benefit, and others find

relief from one made of nut galls, or white oak bark. Most of these

means however are well known, and many others also, which, like them,

sometimes succeed and often fail. The artificial nipple, or _shield_,

should be tried if none of these means succeed, and frequently it

will enable the mother to allow the child to nurse, though it may not

altogether prevent the pain.

It not unfrequently happens that the child's mouth may be diseased,

particularly with _apthæ_, or thrush, and this may possibly keep up

the excoriations; in like manner the state of the breasts may also

influence the mouth, and therefore the condition of each should be well

ascertained when anything is the matter with either.

BRONCHOCELE, OR SWELLING IN THE THROAT.

This is often observed in childbed, and sometimes even comes on

during labor. It is usually attributed to cold, and no doubt it often

does arise from cold, but more frequently it is owing to sympathetic

derangement, and from violent attempts to swallow during and after the

pains. Many females in fact cry out at those times, that something has

_broken_ in the throat, and they fear they are going to suffocate. As a

general rule the swelling gradually subsides in a short time, without

any special treatment, but sometimes it increases and inflames, and an

abscess forms which may become very troublesome, and even dangerous.

To prevent this it should be frequently treated with warm fomentations

and poultices, till the inflammation subsides, and then with the same

washes recommended for indurated or hardened breast, in the preceding

section of this chapter. If the swelling becomes hard, and remains

indolent, the ointment of hydriodate of potassa may also be prepared

and used, as there recommended.

PHLEGMASIA ALBA DOLENS, OR MILK LEG.

This is a painful tumefaction or swelling of one or both of the limbs,

which comes on from the fifth to the fifteenth day after delivery. It

generally commences with slight pain, or stiffness, or cramp, becoming

more painful as it proceeds; but, sometimes, shooting, cutting pains,

of great violence, are felt suddenly, at the very commencement. The

swelling, also, sometimes comes on gradually, but, at other times,

rapidly. In most cases the patient complains of a sudden pain in the

groin and thigh, which is preceded by a chill followed by fever, and

then the limb begins to enlarge. Most frequently the lower part swells

first, and then it extends upward, sometimes, even to the hip. The

skin, on the swollen part, looks white, shining and tight, as if ready

to break; it is also extremely painful, so that pressure upon it can

scarcely be borne. It looks in fact like a thin bag of skin filled with

milk, and hence the name _milk leg_, from an idea that it was really

filled with milk, which had, by some means, reached there from the

breast. This idea is erroneous, in the sense it is usually taken; the

milk does not flow into the leg as many imagine, nor is anything like

it to be found there, except a peculiar thin, white matter, when it

breaks. Still, however, a sudden stoppage of the milk may cause such

a swelling, like a sudden stoppage of any other secretion, but in no

other way. It is, probably, most frequently produced by sudden cold,

which checks that profuse perspiration into which females gradually

fall immediately after delivery, and so drives the perspirable

matter within, and causes inflammation and suppuration. A difficult

or prolonged labor may also lead to it, by preventing, for a long

time, the proper circulation of the blood through the large veins of

the pelvis, and so engorging those below. Or the veins may become

paralyzed, as it were, by the pressure they have sustained, and so

become, for a time, unable to transmit the blood. In fact, both the

veins and lymphatics become engorged, as if tied above the limb, and

exhibit knots and bundles, like bunches of grapes.

Sometimes the fever will occur some days first, and the female cannot

tell what it is owing to, till the swelling comes on; and even this

may take place so gradually, and with so little pain, that the limb

may be very large before it is observed. I have known females complain

of a slight fever only, on going to sleep at night, and wake up in the

morning with a confirmed case of milk leg; and I have known others

start with a sudden pain in the groin, or hip, and be affected in the

same way, in less than two hours.

The disease usually lasts from a month to seven or eight weeks, and

terminates, either by a gradual resolution, or scattering, of the

fluids, or by suppuration and discharge. When suppuration ensues, there

will, sometimes, form one or more very large abscesses, which it may be

difficult to heal, and which may lead to serious results, either from

their extent, or from the constitutional irritation they produce.

The treatment, at first, consists in warm fomentations, such as

those of poppy-heads, or hops, with cooling drinks, purgatives, low

unstimulating diet, and occasional doses of James's Fever Powder, to

promote perspiration. This is intended to disperse the swelling, and,

in general, it does so. If, however, the abscess forms and breaks, in

spite of all the means used, it must be treated the same as abscess

in the breast, previously described. In ordinary practice, it is the

general custom to _bleed_ at the commencement of the disease, or to

apply leeches to the groin. This sometimes does good, but frequently is

of no service at all, even if it does not make matters worse. I would,

however, make the same remarks on bleeding here, as I did in regard to

its use in _puerperal fever_, to which milk leg has a resemblance, in

some respects.

Another practice is to use tight bandages, the same as for varicose

veins, but I think the plan is not, in general, a successful one,

though it may be occasionally. Plunging the limb in cold water,

or keeping it wrapped in cold wet cloths, has succeeded much more

frequently, and is, with some, a favorite remedy. Stramonium leaves

boiled in vinegar, and laid on hot, will also effect a cure sometimes;

and so will bathing with hot lye or alcohol. A large poultice of hops,

soaked in hot vinegar, has also been found useful.

TROUBLE WITH THE URINE.

The bladder, from its position, is very apt to be inconveniently

pressed during the passage of the child, and to be temporarily affected

for a short time after, in consequence. Sometimes, the neck of the

bladder will be _paralyzed_, and the urine cannot be discharged. In

this case, fomentations of warm milk and laudanum must be used, or a

warm hip bath, if there be no danger of flooding, and the bowels must

be freely opened. If this does not relieve, the catheter must be used,

and always before the bladder is too full. To avoid its becoming so,

the attendant should inquire of the female, during the first day, if

she has urinated, or feels any inclination that way, so that he may

know in time if the difficulty exists. In general, this paralysis

passes off in the course of a day, but may endure longer sometimes;

in which case the patient herself should speak of it. Cases have been

known where the bladder has become so full as to _burst_ through

inattention to this matter. The contrary difficulty is occasionally

observed, and the urine cannot be retained, but it flows away as fast

as it is secreted. It is very seldom, however, that this state remains

more than a single day and, more frequently only a few hours. A dash of

cold water on the pubes, and against the meatus urinarius, has often

corrected it at once, and so has a single purgative dose. If it remain

after the first two days without amendment, it is customary to put a

small blister on the abdomen, which usually relieves in a short time.

APPENDIX.

ON PREVENTING PAIN IN CHILDBIRTH.

USE OF CHLOROFORM IN MIDWIFERY.

AN ENQUIRY INTO THE UTILITY AND PROPRIETY OF PREVENTING THE PAIN AND

SUFFERING WHICH USUALLY ATTENDS CHILDBIRTH, WITH AN ACCOUNT OF THE

MEANS TO BE EMPLOYED FOR THAT PURPOSE.

In the preface to this work I remarked that a great part, and, perhaps,

nearly the whole, of the suffering and danger to which parturient

females are exposed, arises, undoubtedly, from their bad physical

education and mode of life; and that, in a more rational state of

existence, it was probable that both would be so slight as to excite no

apprehension. This improved state of things is much to be desired, and

should, of course, be striven for by all friends of humanity. But, in

the mean time, it is proper to consider whether there are any means by

which those now living can be relieved in their hours of distress. The

agony which many females endure at this time is so great that there are

few circumstances under which relief is more needed, or would be more

acceptable; and I, for one, cannot subscribe to the doctrine that such

relief would be improper, unless it prove to be injurious. There are

some persons, I know, who say that this suffering has been _ordained_

for woman, and that it _ought to be_ endured. This notion, I think,

needs no refutation, it being just as unreasonable as to say that the

sick should be allowed to suffer and die without assistance, because

_their_ condition has been ordained. There are others, and men of

science, too, who think that the pains of childbirth are necessary to

its safe accomplishment, and that they are also valuable in a _moral_

point of view. This opinion will be examined by and by, and the facts

on which it is founded, carefully analyzed; but it is first necessary

to state the means of prevention usually employed, and to note their

mode of action, and effects.

Some years ago, a celebrated physiologist, who supposed that the chief

cause of pain and difficulty in labor was the size and hardness of the

child's _bones_, advanced the theory that if these bones were less

developed, and softer, the pain and difficulty would be materially

lessened, if not entirely removed. He proposed, therefore, since the

hardness of the bones is caused by the deposition of _lime_ in them,

which is derived, of course, from the blood of the mother, that she

should avoid taking anything to eat or drink, during pregnancy, that

contained lime. This, he supposed, would keep the bones of the child

soft till after birth, and so allow them to give way and crush together

during delivery, and thus prevent the suffering and difficulty usually

experienced. It was also thought that the bones of the mother would be

partially softened at the same time, and give way a little, so as to

facilitate the process still more.

I am not aware, however, that this theory has ever succeeded in

practice, either in the human species or in the lower animals, though

frequently tried. Nature will work on her own plan, and will develop

the bones of the fœtus, while in the womb, to a certain extent,

providing she has the means to do so; and if these are withheld, she

is very likely to suspend its development altogether, rather than send

it forth imperfect. I have known cases where everything was withheld,

for the whole period, that contained a particle of lime, and yet the

child's bones were as hard at birth as in any other case; the material

being, probably, taken from the bones of the mother, which might be

thus weakened, and made liable to displacement, without any good result

whatever. It is also a question whether such a course, supposing it

to succeed, might not be dangerous in another way, by causing an

imperfection in the child which its future growth could not overcome.

I have known some cases where this practice appeared to have caused

abortion from imperfect development, and several others in which there

was too much reason to fear that the child was injured, though safely

born. As this is, therefore, at best, a very uncertain and ineffective

process, and is also, probably, dangerous to the mother or child, or

both, it does not appear to me worthy of further attention, and I

merely allude to it in order to make the present sketch of such means

complete.

The other means are such as do not interfere, in any way, with the

natural processes, but merely prevent sensation or feeling at the

time of delivery. _Mesmerism_ has been recommended, and, in some few

instances, tried, for this purpose, but its success has either been so

small, or its action so uncertain, that no dependance can be placed

upon it, notwithstanding many persons assert its power. Opium and other

powerful drugs have also been given, but so much of them is required,

at that time, to produce a sufficient effect, that their use becomes

dangerous. Other substances, in the form of _vapour_, or _gas_, have

also been used, the effects of which only last for a short time, and

are not, generally speaking, at all dangerous. Among them may be

mentioned nitrous oxide, or _laughing gas_, carbonic acid, sulphuric

ether, and chloric ether, all of which were first employed in severe

surgical operations.

The success of these agents, especially _ether_ and _chloroform_, in

_preventing pain_, is undoubted; nor do they appear to have any other

effect, nor to prevent any necessary effort or process of nature,

except in a few cases which will be mentioned further on. Many hundred

operations of the most severe kind, such as cutting off limbs, removing

tumors, stones, and so forth, have been performed while the patients

were under the influence of these agents, and without causing them

_the slightest pain_; in fact, many remain, during the whole process,

in a pleasant dream, and cannot be persuaded, when they wake, that

the dreaded operation is over. The same thing has also been observed

in hundreds of cases of midwifery, both in natural labor and when

instruments have been used. In numerous instances the female has been

_put to sleep_, and safely delivered, without knowing or feeling

anything whatever, during the whole time; the first intimation that

she had become a mother, being the cheering cry of her newborn babe.

In some instances, the state of insensibility has been continued for a

long time, and during its continuance, the most hazardous operations

have been safely performed.

So far as can be safely judged, from the limited time during which such

means have been used, it appears that there is no danger whatever,

from their employment, except when improperly administered, and in

certain peculiar conditions of the system; which causes of danger

will, of course, be removed by competent experience and knowledge. It

is highly encouraging however, to note, though ether and chloroform

have both been used so extensively and indiscriminately, both by those

who understood their nature and those who did not, that the cases in

which they are proved to have done injury, are _not more than two or

three_; and in all those that I have heard of, some obvious impropriety

had been committed in their use. It should be borne in mind, however,

that even if the danger from them was considerable, we might still be

justified in their use. It is well known that, in numerous cases, the

_fear_ of suffering, beforehand, and its severity while being endured,

produce the most serious, and even fatal results. Many a patient has

passed safely through the ordinary effects of a painful operation,

and yet sunk from the mere effects of _fear_ and physical suffering.

Instances have even been known in which a fear of this kind has caused

_death_, and frequently it has given a shock from which the patient

never fully recovered. There is also, frequently, great danger from the

violent efforts and struggles of a person in pain, and many necessary

operations are even prevented altogether by them; this is often

observed in difficult labors. When insensibility is produced, however,

all these causes of difficulty and danger are removed; the patient's

_fears_ are quieted, suffering is entirely prevented, and there is no

struggling to prevent the necessary assistance. Supposing, therefore,

that the ill effects of these agents were more certain and greater in

amount than has yet appeared, it would still be a question whether the

evil they really prevent is not greater than that which they possibly

_may_ cause.

In regard to the two agents now chiefly used, _ether and chloroform_,

there is no difference in their mode of action, but the chloroform

appears to be more speedy, certain, and efficacious, and is,

therefore, the most valuable, but proportionably more dangerous when

improperly administered. There are numerous instruments or _inhalers_,

for administering these vapors, most of which are both costly and

complicated, and all of which may be easily dispensed with. A very good

plan is to take a large sponge and dip it in hot water, then squeeze

out the water and pour on the ether or chloroform, and hold it over the

mouth and nose. In two or three minutes consciousness and feeling will

both be gone, and the patient will sink into a calm sleep which will

last sometimes ten or fifteen minutes, and may be kept up as long as

desired, by putting the sponge to the mouth for a few minutes whenever

there are signs of waking. When it is left off the patient gradually

comes round as if waking from ordinary sleep, and frequently speaks of

having been in a dream, sometimes of a very pleasant character, but

never knows what has taken place. No ill effects follow, but sometimes

there is a little drowsiness or stiffness of the limbs, which soon

passes off. A pocket handkerchief soaked in the fluid, and held over

the mouth and nose will answer equally well; but whatever is used, _it

must not be pressed close_, because a portion of air ought to enter

with the vapor to prevent suffocation; and it should also be removed

immediately the effect is produced. When it is borne in mind how much

these requisites have been neglected, and how _impure_ the ether or

chloroform has often been, it is wonderful that more accidents have

not occurred; and the fact that so few have happened under such a

state of things, and with our little experience, goes far to prove

that there is little or no danger at all in competent hands, with

pure materials. The accounts circulated in the papers of "_death from

ether_," and "_fatal effects of chloroform_," have mostly been gross

exaggerations, and frequently false altogether. In most of the cases

where death has _followed_ from the use of these agents, it has been

proved to arise from other causes, and would have happened if they had

not been used. In one or two cases, however, of surgical operations,

the ether itself appears to have caused death by producing suffocation,

or congestion of the lungs; but, even in these, it has been shown that

it was used in an improper manner. Thus a young woman in Newcastle in

England, inhaled ether to have a diseased toe-nail cut off, and died.

It appears, however, that there was an evident disposition in her to

congestion or rushes of blood, and therefore she was not a fit subject,

and besides, the ether was poured on a _thick table cloth_, which, of

course, prevented the entrance of _air_ along with the vapor, and thus

suffocated. I believe there is _not a single case_ on record of injury

resulting when due precautions have been used, and I have not heard of

one at all in midwifery practice.

_Ether_ having been the first article used, I shall first give an

account of its effects, and then proceed to chloroform, explaining the

mode of administration, and other incidental matters, as I proceed. The

best article on ether which I have met with, is a review in the British

and Foreign Medical Review for April, 1847, of some pamphlets on the

subject, from which I shall make an extract.

In the state of perfect etherization we believe all sensation

is abolished; in a less perfect state an obscure perception of

external objects remains, while the sense of pain is extinct. The

psychical state is various. Generally speaking, the sense of external

impressions becomes at first confused, then dull, then false, with

optical spectra or auditory illusions, general mental confusion,

and then a state of dreaming or utter oblivion. In the majority of

cases the mind is busy in dreaming, the dreams being generally of an

active kind, often agreeable, sometimes the reverse, occasionally

most singular; and, frequently, a great deal is transacted in the few

short moments of this singular trance. Many of the patients who have

undergone the most dreadful operations, such as amputation of one or

both thighs or arms, extraction of the stone, excision of bones,

extirpation of the mamma, have readily detailed to us, and most with

wondering thankfulness, the dreams with which, and with which alone,

they were occupied during the operations. The character of the dreams

seemed to be influenced, as in ordinary cases, by various causes,

immediate or remote, present or past, relating to events or flowing

from temperament.

A good many seemed to fancy themselves on the railway amid its whirl

and noise and smoke; some young men were hunting, others riding on

coaches; the boys were happy at their sports in the open fields, or

the filthy lane; the worn Londoner was in his old haunts carousing

with his fellows; and our merry friend, Paddy, of the London Hospital,

was again at his fair, wielding his shelala in defence of his friends.

Others, of milder mood, and especially some of the women patients from

the country, felt themselves suddenly transported from the great city

and the crowded hospital-ward to their old quiet home in the distant

village, happy once more with their mothers and brothers and sisters.

As with the dying gladiator of the poet, the thoughts of these poor

people--

"Were with the heart, and that was far away."

Some seemed transported to a less definite but still happy region,

which they vaguely indicated by saying they were in heaven; while

others had still odder and warmer visions, which need not be

particularized.

For the purpose of obtaining information on all the points of this

most interesting subject, we personally questioned all the patients in

the London hospitals, who, at the period of our visits, still remained

in the wards after the ether-operations. They were in all fifty-four,

and the great majority had been the subjects of capital operations.

They were unanimous in their expressions of delight and gratitude

at having been relieved from their diseases without suffering. In

listening to their reports, it was not always easy to remain unmoved

under the influence of the conceptions thereby communicated, of the

astonishing contrast between the actual physical condition of the

mangled body in its apparent tortures on the operating table of a

crowded theatre, and the really happy mental state of the patient at

the time.

This perfect freedom from pain is proved by every case wherein the

vapor has been efficiently administered, although there are frequently

the same cries uttered, and the same motions practised as when pain

is experienced which proves that nothing is prevented but the mere

_feeling_, which it can be of no use whatever for any one to suffer

from.

_Chloroform_ has been more recently introduced than ether, but has

nevertheless been used quite as much, or probably more, and, in

general, with still more success. It was first described, I believe, by

Professor Simpson of Edinburgh, at a sitting of the medical society of

that city, in November, 1847, and several cases were narrated, two of

which I quote.

I have employed it in obstetric practice with entire success. The

lady to whom it was first exhibited during parturition, had been

previously delivered in the country by perforation of the head of the

infant, after a labor of three days' duration. In this, her second

confinement, pains supervened a fortnight before the full time.

Three hours and a half after they commenced, ere the dilatation of

the os uteri was completed, I placed her under the influence of the

chloroform, by moistening with half a teaspoonful of the liquid, a

pocket-handkerchief, rolled up in a funnel shape, and with the broad

or open end of the funnel placed over her mouth and nostrils. In

consequence of the operation of the fluid it was once more renewed in

about ten or twelve minutes. The child was expelled in twenty-five

minutes after the inhalation was begun. The mother subsequently

remained longer soporose than commonly happens after ether. The crying

of the child did not, as usual, rouse her; and some minutes elapsed

after the placenta was expelled, and after the child was removed by

the nurse into another room, before the patient awoke. She then turned

round and observed to me that she had "enjoyed a very comfortable

sleep, and, indeed, required it as she was so tired, but would

now be more able for the work before her." I evaded entering into

conversation with her, believing, as I have already stated, that the

most complete possible quietude forms one of the principal secrets for

the successful employment of either ether or chloroform. In a little

time, she again remarked, that she was afraid her "sleep had stopped

the pains." Shortly afterwards her infant was brought in by the nurse

from the adjoining room, and it was a matter of no small difficulty

to convince the astonished mother that the labor was entirely over,

and that the child presented to her was really her "own living baby."

Perhaps I may be excused for adding, that since publishing on the

subject of ether inhalation in midwifery, seven or eight months ago,

and then for the first time directing the attention of the profession

to its great use and importance in natural and morbid parturition,

I have employed it, with few and rare exceptions, in every case of

labor that I have attended, and with the most delightful results.

And I have no doubt whatever, that some years hence the practice

will be general. Obstetricians may oppose it, but I believe our

patients themselves will force the use of it upon the profession. I

have never had the pleasure of watching over a series of better and

more rapid recoveries, nor once witnessed any disagreeable result

follow to either mother or child, whilst I have often seen an immense

amount of maternal pain and agony saved by its employment. And I most

conscientiously believe that the proud mission of the physician is

distinctly twofold--namely, to alleviate human suffering, as well as

preserve human life.

In another part of the same publication Professor Simpson has another

list of cases, all equally favorable. In some of these the labors were

protracted _many hours_, and in others, operations with instruments

were performed, of the most terrible character, such as would, under

ordinary circumstances, have been attended with the most horrible

suffering. As this article gives an instance of nearly every kind of

delivery under the influence of chloroform, and contains also some

admirable reflections upon its employment, I quote it in order to make

the present account complete.

CASE 2.--Seen with Mr. Carmichael; a second labor; she began

the chloroform inhalation before the dilatation of the os uteri

was entirely completed; the child was expelled in fifty minutes

afterwards. I kept her under the chloroform for a quarter of an hour,

till the placenta was removed, the binder applied, and the body and

bed-clothes were arranged and adjusted. On awaking she declared that

she had been sleeping refreshingly; she was quite unaware that the

child was born, till she suddenly heard it crying at its first toilet

in the next room. An hour afterwards she declared she felt perfectly

unfatigued, and not as if she had borne a child at all. In her first

or preceding confinement she had been in severe labor for twenty

hours, followed by flooding. No hæmorrhage on the present occasion.

CASE 3.--Patient unmarried; a first labor; twins; the first child

presented by the pelvis, the second with the hand and head. The

chloroform was exhibited when the os uteri was nearly fully dilated;

the passages speedily became greatly relaxed, (as has happened in

other cases placed under its full influence,) and in a few pains the

first child was born, assisted by traction. I broke the membranes

of the second, pushed up the hand, and secured the more complete

presentation of the head; three pains expelled the child. The mother

was then bound up, her clothes were changed, and she was lifted into

another bed; during all this time she slept soundly on, and for a

full hour afterwards, the chloroform acting in this as in other cases

of its prolonged employment, as a soporific. The patient recollected

nothing from the time of the first inhalations, and was greatly

distressed when not one but two living children were brought in by the

nurse to her. Dr. Christison, who was anxious to observe the effect of

the chloroform upon the uterus, went along with me to this patient.

CASE 4.--Primipara; of full habit; when the first examination was

made, the passages were rigid, and the os uteri difficult to reach.

Between six and seven hours after labor began, the patient, who was

complaining much, was apathized with the chloroform. In about two

hours afterwards, the os uteri was fully dilated, and in four hours

and a half after the inhalation was begun, a large child was expelled.

The placenta was removed, and the patient bound up and dressed before

she was allowed to awake. This patient required an unusual quantity

of chloroform, and Dr. Williamson, who remained beside her, states to

me, in his notes of the case, "the handkerchief was moistened often,

in order to keep up the soporific effect. On one occasion I allowed

her to emerge from this state for a short time, but on the accession

of the first pain, she called out so loudly for the chloroform that it

was necessary to pacify her by giving her some immediately. In all,

four ounces of chloroform were used." Like the others, she was quite

unconscious of what had gone on during her soporised state, and awoke

altogether unaware that her child was born.

CASE 6.--Second labor. The patient--a person of a small form and

delicate constitution--bore her first child prematurely at the

seventh month. After being six hours in labor, the os uteri was

fully expanded, and the head well down in the pelvic cavity. For two

hours subsequently it remained fixed in nearly the same position,

and scarcely, if at all, advanced, although the pains were very

distressing, and the patient becoming faint and exhausted. She

entertained some mistaken religious feelings against ether or

chloroform, which had made her object to the earlier use of the

latter; but I now placed her under its influence. She lay, as usual,

like a person soundly asleep under it, and I was now able, without any

suffering on her part, to increase the intensity and force of each

recurring pain, by exciting the uterus and abdominal muscles through

pressure on the lower part of the vagina and perinæum. The child was

expelled in about fifteen minutes after the inhalation was commenced.

In a few minutes she awoke to ask if it was really possible that her

child had been born, and was overjoyed to be told that it was so.

I have the conviction, that in this case the forceps would in all

probability have been ultimately required, provided I had not been

able to have interfered in the way mentioned. I might, it is true,

have followed the same proceeding, though the patient was not in an

anæsthetic state; but I could not have done so without inflicting

great agony upon her.

CASE 7.--A third labor; the patient had been twice before confined of

dead premature children; once of twins, under the care of Mr. Stone,

of London; the second time of a single child under my charge. The

liquor amnii began to escape about one o'clock, A.M., but without

pains for some time. I saw her between three and four o'clock, with

the pains commencing and the os uteri beginning to dilate. In two

hours afterwards, the third stage was well advanced, and the pains

becoming very severe, she had the chloroform exhibited to her, and

slept soundly under its influence. In twenty minutes the child was

born and cried very loudly without rousing the mother. In about twelve

or fifteen minutes more she awoke as the application of the binder was

going on, and immediately demanded if her child was really born alive,

as she thought she had some recollection of hearing the nurse say

so. She was rejoiced beyond measure on her son being brought in and

presented to her.

CASE 9.--In the Maternity Hospital; first child. Labor began at 10

P.M., (Nov. 21st.) I was desired to see her at six A.M., (22nd.)

The os uteri was well dilated, but it was evident that the pelvic

canal was contracted throughout, and the head was passing with unusual

difficulty through the brim. The patient was complaining much of

her sufferings. It was evident that it would be a very tedious, and

probably, at last, an instrumental case, and one therefore calculated

to test the length of time during which chloroform might be used.

She began to inhale it at a quarter past six, A.M., and was kept

under its influence till a quarter past seven, P.M.,--the date of her

delivery--_thirteen hours_ in all. From the time it was begun till

the time delivery was completed, her cries and complaints ceased,

and she slept on soundly throughout the day. The bladder required to

be emptied several times with the catheter. The head passed the os

uteri at ten A.M., and during the day, gradually descended through the

pelvis. At seven P.M., I at last deemed it proper to deliver her by

the forceps; the head, which was now elongated and œdematous, having

by that time rested for some hours against the contracted pelvic

outlet, with little or no evidence of advancement; the bones of the

fœtal cranium overlapping each other, and the fœtal heart becoming

less strong and distinct in its pulsations. A warm bath, irritation of

the chest, &c., were necessary to excite full and perfect respiration

in the infant. Whilst we were all busied with the infant, the mother

lost some blood, but the placenta was immediately removed, and the

uterus contracted perfectly. On afterwards measuring the quantity of

blood lost, it was calculated to amount to fifteen or eighteen ounces.

The mother's clothes were changed, she was bound up, and removed to a

dry bed before she awoke. She had at first no idea that the child was

born, and was in no respect conscious of being delivered. In fact, she

had been "sleeping," according to her own account, from the time she

had begun the inhalation, and thought she remembered or dreamed that

she heard Dr. Williamson, the house-surgeon, speak near her once or

twice. Dr. Beilby, Dr. Ziegler, &c., saw the case with me. Three days

afterwards I found the mother and child perfectly well. She continued

to recover so rapidly, that she insisted on leaving the hospital on

the tenth day after delivery.

A sufficient number of such accounts as these could be collected to

fill a large volume; but these are quite sufficient for our purpose.

In regard to the objections to using chloroform or ether, in midwifery,

it will be thought by most persons, and with good reason, too, that the

safety and success which has attended their use, is itself a sufficient

answer to all objections.

It was at first thought, by some physicians, that the expulsive force

of the womb was lessened when the pain was prevented; but this is not

the case; on the contrary, it has been, in many cases, much increased.

It was also thought by others that there was more danger from flooding,

and convulsions, than in ordinary cases; but this is also equally at

variance with truth, for it appears, beyond doubt, after a careful

examination of all the cases recorded, that there is much _less_

danger, particularly from convulsions, than when the patient is allowed

to be tortured and terrified by feeling pain. Dr. Simpson remarks in

another part of the article above quoted:--

The question which I have been repeatedly asked is this--Will we

ever be "justified" in using the vapor of ether to assuage the pains

of natural labor? Now, if experience betimes goes fully to prove to

us the safety with which ether may, under proper precautions and

management, be employed in the course of parturition, then, looking

to the facts of the case, and considering the actual amount of pain

usually endured, I believe that the question will require to be quite

changed in its character. For, instead of determining, in relation

to it, whether we shall be "justified" in using this agent under the

circumstances named, it will become, on the other hand, necessary to

determine whether, on any grounds, moral or medical, a professional

man could deem himself "justified" in withholding and _not_ using any

such safe means, (as we at present presuppose this to be,) provided he

had the power, by it, of assuaging the pains and anguish of the last

stage of natural labor, and thus counteracting what Velpeau describes

as "those piercing cries, that agitation so lively, those excessive

efforts, those inexpressible agonies, and those pains apparently

intolerable," which accompany the termination of natural parturition

in the human mother.

Since the latter end of January I have employed etherization with

few and rare exceptions, in every case of labor which has been under

my care. And the results, as I already stated in THE LANCET, have

been, indeed, most happy and gratifying. I never had the pleasure of

watching over a series of more perfect or more rapid recoveries; nor

have I once witnessed any disagreeable result to either mother or

child. I do not remember a single patient to have taken it who has

not afterwards declared her sincere gratitude for its employment, and

her indubitable determination to have recourse again to similar means

under similar circumstances. Most have subsequently set out, like

zealous missionaries, to persuade other friends to avail themselves

of the same measure in the hour of suffering. And a number of my

most esteemed professional brethren in Edinburgh have adopted it

with success and results equal to my own. At the same time, I most

sincerely believe that we are, all of us, called upon to employ it,

by every principle of true humanity, as well as by every principle of

true religion. Medical men may oppose, for a time, the superinduction

of anæsthesia in parturition, but they will oppose it in vain; for

certainly our patients themselves and their friends will force the use

of it upon the profession. The whole question is, I believe, even now,

one merely of time. It is not--Shall the practice come to be generally

adopted? but--When shall it be generally adopted? And, for my part,

I more than doubt if any man (rejecting willingly its benefits) is

really justified, on any grounds, moral or medical, in deliberately

desiring and asking his patients to shriek and writhe in their agonies

for a few months, or a few years longer, in order that, by doing so,

they may defer, forsooth, to his professional apathy, or pander to his

professional caprices and prejudices.

Another objection has also been advanced against the employment of

ether or chloroform, the force of which must be estimated by every one

for themselves. It is well known that many, if not most of the lower

animals during labor, or immediately afterward, _experience certain

feelings and desires stronger than at any other time_; and it is

supposed that such would be the case, as a general rule, with human

beings, if it were not for the _pain_ which overpowers everything

else. This supposition has, in fact, been partly verified in a few

cases; several females having confessed, after recovering from a

painless labor under the influence of ether, that their dreams during

the sleep were of _a peculiar warm character_! How far this may be

_generally_ the case, of course, we have no means of ascertaining, nor

do I consider it to be practically of any consequence to know, because

it can in no way interfere with the safe progress and termination of

the labor, which alone is what we are properly concerned in. I have

merely thought it proper to state the fact as being a singular one,

and to make my readers acquainted with it. Physicians are well aware

that the peculiar feelings referred to are frequently produced by

various causes which act on the nervous system, such as _mesmerism_,

and even by _strong devotional excitement_. I have known females with

strong moral impressions who always carefully avoided _both_ the above

causes, from having discovered their liability to produce such effects;

in fact, this has been one objection raised to allowing mesmerists to

operate upon young persons, and several cases of moral failing having

been attributed to this cause. It is not at all improbable, therefore,

that such results may occasionally occur during labor, though we are

not at all justified in assuming that they will in any particular case.

How far this may be considered an objection to the employment of such

means, must be however, as I before remarked, decided by all persons

_for themselves_, and _for themselves only_! It is not a _medical_

question at all.

Notices of Dr. Hollick's Lectures.

DR. HOLLICK AND PHYSIOLOGY.--The second of a series of Lectures, by

this gentleman, on human physiology, and the all important truths

connected with our physical constitution, was attended by a full

house, in National Hall, last evening. The time was well spent, and

so appeared to think the audience. On the delivery of the first of

these Lectures on Tuesday evening, the speaker in a comprehensive and

well-digested exordium, placed himself and the subject right with

the public. His manner, language and style, did the first; his sound

logic, his argument, his candor and research, accomplished the second.

Apart from the interesting and apposite details of the wonders of

reproduction, the illustrations of the immutable wisdom of nature,

which teem in the animal and vegetable worlds--which

"Glows in each stem, and blossoms in each tree;

Lives through all life, extends through all extent,

Spreads undivided, operates unspent."

Apart from all this, Dr. Hollick's Lecture was excellent as a defence

of truth, a vindication of the right of free and unshackled inquiry,

and as a convincing refutation of that silly, but far too prevalent

opinion that there are truths of which it is better to remain in a

state of ignorance. Had nothing else been imparted in the forcible and

well defined exordium of Dr. Hollick than this judicious demolition

of that fallacious, silly, but injurious twaddle which would forbid

research to pass in advance of the old landmarks prescribed by custom,

ignorance, or a spurious morality--even that would well deserve the

public patronage. Truths, well set forth, will make an impression,

whether their investigation be fashionable or not. There is an affinity

between the capacity to learn, and the truths to be learned, which

always results, when a fitting opportunity is presented, in a free

inquiry, and the gentleman who is bringing, in a judicious and elevated

manner, a knowledge of those fundamental principles of our corporeal

existence which are abused because unknown, will accomplish more good

than half a dozen teachers of higher pretensions, and lower ability.

It was gratifying to observe the decorum--the sense of respect for

both speaker and subject, that was observed throughout the evening,

which evidently shows that those who go there are actuated by higher

motives than mere curiosity; by desires more ennobling than a passing

gratification; in a word, it was clear that those who composed Dr. H.'s

hearers, were men who know and dare to think, and who will profit by

these most useful discourses.--_New York Herald, Aug. 7, 1844._

THE ORIGIN OF LIFE.--We attended Dr. Hollick's Lecture at the Masonic

Hall, on Monday evening, and if we were to say we were delighted, we

should but feebly express the gratification we experienced. It was,

in fact, a whole series of anatomical lectures crowded into one, and

that one so divested of technicalities, and rendered so concise, so

intelligible to the most illiterate mind, and withal couched in such

delicate as well as perspicuous language, that the most fastidious

could find no fault, nor the idlest curiosity go away uninformed.

The human figure--a French model, made, we believe, of _papier

mache_--is beautifully constructed, and every trifling organ is not

only an accurate counterpart of nature, but can be taken apart,

opened, examined, &c., with an ease that renders the study as perfect

as an actual dissection, without the _desagremens_ that attend a

scrutiny of the real subject. We advise all who love knowledge, and

particularly a knowledge of their physical organization, to attend

these lectures.--_Phila. Spirit of the Times_, Dec. 4, 1844.

At a Meeting of the Class attendant upon Dr. Hollick's Select Lectures

on the Physiology and Philosophy of the "Origin of Life" in Plants and

Animals, held at the Lecture Room of the Museum, Wednesday evening,

December 1, 1844, George G. West, Esq., was called to the Chair, and

Samuel W. Black appointed Secretary.

_Resolved_, That we have listened with unfeigned pleasure and interest

to the Course of Lectures delivered by Dr. Hollick, and now brought

to a close, and that we deem it an act of justice to him and the

community, to express our entire confidence in his character, ability,

and the manner of illustrating his subject, which, to use the words of

a daily journal, "is couched in such delicate as well as perspicuous

language, that the most fastidious could find no fault, nor the idlest

curiosity go away unimproved."

_Resolved_, That a committee of three be appointed to tender to Dr. H.

the thanks of the Class for his courtesy to the members in affording

them every facility for obtaining information upon the subject of his

Lectures, and that he be requested to repeat the Course at the earliest

period consistent with his other engagements.

Published in all the Philadelphia daily papers of December 14, 1844,

and signed by _one hundred and forty_ of the most respectable and

influential inhabitants.

(See similar Resolutions, with _over two hundred names_ attached, in

the Philadelphia daily papers of March, 9, 1844; also of March 16; and

on several other occasions.)

_From the Philadelphia Daily Papers, Feb. 21, 1845._

At a meeting of the Ladies composing Dr. Hollick's Class, held on

Wednesday afternoon, February 19th, in the Lecture Room of the Museum,

the following Resolutions were unanimously adopted, and ordered to be

published in one or more of the city papers:

_Resolved_, That we have listened with great pleasure and interest to

Dr. Hollick's Lectures, and are happy to add our testimony to the many

already recorded in behalf of such Lectures: and regarding Dr. Hollick

as a benefactor of his race, and especially of our sex, we cordially

wish for him abundant success, and ample reward in the consciousness of

doing good.

_Resolved_, That we will exert ourselves to induce our female friends

and acquaintances to avail themselves of the great and rare privilege

of obtaining the valuable instruction imparted in these Lectures in so

chaste and dignified a manner.

Signed on behalf of the meeting by

SARAH WEBB, Sec'y. SUSAN WOOD, President.

--> With over 50 names attached thereto.

(See also similar Resolutions, with numerous names, on Feb. 27, 1846,

March 20, 1846, and on April 10, 1846, with over _three hundred names

attached_.)

DR. HOLLICK'S LECTURES.--These Lectures continue to attract much

attention, and are commended by all who hear them. During the past week

Dr. H. has given a private Lecture and exhibition of his models to

many of our prominent Senators and public men, all of whom expressed

themselves highly gratified, and desirous that another class should be

formed to accommodate their friends who had not attended.--_National

Intelligencer, Jan. 30, 1846._

DR. HOLLICK is a gentleman of no less knowledge in his profession than

eloquence in his means of imparting it, and he is certainly deserving

of great credit and support for his exertions in a new field of such

universal importance. We commend these Lectures with the fullest

confidence to the attention of our citizens.--_N. Y. Sun, Aug. 6, 1845._

"LETTERS FROM NEW YORK, NO. 11."

"* * * * There have been several courses of Lectures on Anatomy, this

winter, adapted to popular comprehension. I rejoice at this; for it

has long been a cherished wish with me that a general knowledge of the

structure of our bodies, and the laws which govern it, should extend

from the scientific few into the common education of the people. I

know of nothing so well calculated to diminish vice and vulgarity as

universal and rational information on these subjects. But the impure

state of society has so perverted nature, and blinded common sense,

that intelligent women, though eagerly studying the structure of

the Earth, the attraction of the Planets, and the reproduction of

Plants, seem ashamed to know anything of the structure of the human

Body, and of those Physiological facts most intimately connected with

their deepest and purest emotions, and the holiest experience of

their lives. I am often tempted to say, as Sir C. Grandison did to

the Prude--'Wottest thou not how much _in_-delicacy there is in thy

delicacy?'

"The only Lectures I happened to attend were those of Dr. Hollick,

which interested and edified me much. They were plain, familiar

conversations, uttered and listened to with great modesty of language,

and propriety of demeanor. The Manikin, or Artificial Anatomy, by

which he illustrated his subject, is a most wonderful machine invented

by a French Physician. It is made of _papier mache_, and represents

the human body with admirable perfection, in the shape, coloring, and

arrangement, even to the minutest fibres. By the removal of wires it

can be dissected completely, so as to show the locality and functions

of the various Organs, the interior of the Heart, Lungs, &c.

"Until I examined this curious piece of mechanism, I had very faint and

imperfect ideas of the miraculous machinery of the house we live in. I

found it highly suggestive of many things to my mind." * * *

L. M. C.

[Extract from a Letter in the "Boston Courier" of Monday, June 3d,

1844, by Mrs. L. M. Child.]

DR. HOLLICK'S LECTURES.--We cordially say to those who love a

scientific treat not to fail to attend. More instruction is contained

in those three Lectures, than can be mastered by a twelve month's

reading.--_Baltimore Clipper, March 30, 1847._

WRITING DESK AND GOLD PEN PRESENTED TO DR. H. By ONE OF HIS LADY

CLASSES.

[Illustration]

DR. HOLLICK--Dear Sir: The members of your class, desiring the

gratification of offering you some testimonial of their personal

regard, and grateful appreciation of the benefits which you are

conferring upon them and their sex generally, respectfully request your

acceptance of the accompanying writing desk.

Were it necessary, we might repeat our assurances that your services to

humanity will be, by us, long and gratefully remembered. The women of

this generation have reason to rejoice that, by your efforts, a new and

extensive field of information has been opened to them, whence they may

derive treasures of knowledge, of immense importance to themselves and

their posterity, hitherto concealed within professional enclosures.

Wishing you health and happiness, we beg leave to subscribe ourselves,

Truly your Friends,

Signed on behalf of the class by,

M. G.

(500 present.) O. W. B.

_Philadelphia March 20, 1845._

[Illustration]

NOTICES OF BOOKS.

_From the New York Herald._

OUTLINES OF ANATOMY AND PHYSIOLOGY, WITH A DISSECTING PLATE OR THE

HUMAN ORGANIZATION, by Frederick Hollick, M. D. We regard this as one

of the most valuable works issued in a long time. It is a complete

general treatise on anatomy and physiology, and the dissected plate

answers the purpose of a model of the human frame. Dr. Hollick is

entitled to great credit for his laudable desire to disseminate a

knowledge of subjects that are of such vital consequence to all, but

which hitherto has been monopolized by the medical profession. We

commend it to all as a work of great merit and usefulness.

_From the Patriot, Baltimore, March 24th, 1847._

OUTLINES OF ANATOMY, &c.--Dr. F. Hollick, whose history as the

great _simplifier_ of the human anatomy, so well known throughout

the country, and whose public Lectures have won for him so high a

reputation, has just published a work which he designates "Outlines

of Anatomy and Physiology for Popular Use." This book contains a very

curiously and ingeniously arranged plate, which opens by pieces, so

that the different parts of the organs of the human system may be seen

in all their variety, all of which are fully explained in English.

The second part of this invaluable work gives a general description

of these organs and parts of the system, under the division of bones,

muscles, arteries, veins, &c., &c. This work should fall into the hands

of every family.

_From the New York Argus, January 9, 1847._

NEUROPATHY.--This is a new name, but a good one, being the title of a

work by Dr. F. Hollick, whose excellent Lectures on various subjects

will be remembered by many of our citizens. In this work is explained

the action of Galvanism, Electricity and Magnetism; Homœopathy

and Allopathy are contrasted in theory and practice; Mesmerism is

discussed, and other subjects "too numerous to mention," treated in a

manner at once novel and instructive. Dr. Hollick has also published

a work on "Anatomy and Physiology for Popular Use," illustrated with

a new dissected plate of the human organization, of most ingenious

construction. Of this work we shall have more to say anon. It is no

ordinary production.

_From the New York Sunday Times and Messenger, Jan. 10, 1847._

"OUTLINES OF ANATOMY AND PHYSIOLOGY, FOR POPULAR USE," illustrated

by a new dissected plate of the human organization, and by separate

views. The work is designed either to convey a general knowledge of

these subjects in itself, or as a key for explaining larger and more

complete works. These Outlines should be in the hands of every body;

and Dr. Hollick, or any one else, is a public benefactor who furthers

the publication of such able, interesting, and truly important works.

_From the Pennsylvanian, (Philadelphia,) Jan. 26, 1847._

The following in regard to two works from the pen of Dr. Hollick, of

this city, we copy from the Washington Union, of the 20th instant:--

OUTLINES OF ANATOMY AND PHYSIOLOGY FOR POPULAR USE. _By Frederick

Hollick, M. D., Lecturer on Anatomy, Physiology, &c._--We regard

this as an eminently useful publication. It gives in a form far

more condensed and intelligible than we have before seen, a very

comprehensive view of the human organization. The dissected plate of

the human anatomy, which forms an interesting feature of the work, is

to us at least a novelty. The explanations are drawn up with great

simplicity, and cannot be misunderstood by the general reader, while

they, with the illustrations, will often serve to render more clear and

precise the views of scientific and professional students.

_From the Sunday Mercury, New York._

DR. HOLLICK'S LAST WORK--_The Diseases of Woman, their Causes and

Cure familiarly explained, with Practical Hints for their prevention,

&c._--We regard this as an invaluable production, the most useful,

in many respects, which has yet emanated from this distinguished

author and practitioner. It is just the kind of work which has ever

been wanted, and is just suitable to the excellent purpose for which

it was intended; this it accomplishes most fully, and its extensive

circulation must be productive of vast practical benefit. It is works

of this nature and CHARACTER which really do good; which exhibit

plain facts in a plain manner, and record in language simple and

intelligible, knowledge of the most vital importance to the health

and consequent happiness of every daughter, sister, wife, and mother

in the land. The work is dedicated to the LADIES OF AMERICA, and we

congratulate them upon the possession of a friend at once so able, so

sincere and valuable as Dr. Hollick. Burgess, Stringer & Co., of this

city, are the publishers.

_The New York Sun says of this Book_:

"BURGESS & STRINGER have just issued a most invaluable work, being a

treatise upon the diseases of women, by the celebrated Dr. Hollick.

We have thoroughly examined the work, and can say without hesitation,

that it should be in the hands of every mother who cares for the health

of her daughters, and every woman who values physical and mental

well-being. Dr. Hollick and his publishers have done a public benefit

by issuing such a book."

_From the New York Sunday Times._

DR. HOLLICK'S great work, THE DISEASES OF WOMAN, which will be found

advertised in another column, is truly a valuable production, and

well sustains the author's well-earned reputation. It is a complete

practical treatise on female diseases, scientific enough for a

medical man, and yet so plain that every body can understand it, and

so delicately written that even the most fastidious cannot object

to a single passage. Much of the matter it contains is quite new in

this country, even to medical men, and of the greatest interest and

importance. The anatomical plates are superb, and the whole book is

excellently got up. Every adult female in the land should read this

book; the information it gives would prevent an incalculable amount of

disease and suffering, if possessed in time; or it will teach the best

way to cure it when unfortunately established.

WORKS PUBLISHED BY DR. HOLLICK.

OUTLINES OF

ANATOMY AND PHYSIOLOGY,

BY FREDERICK HOLLICK, M. D.

This is the most complete, and at the same time most simple work ever

issued on the subject. It is illustrated in a novel manner, by a

_large colored Plate_ of the Human Organization, which _dissects_ by

means of separate layers, _from the surface of the Abdomen down to the

Spine_, showing all the Organs in their proper places, all connected

together, and many of them in sections! the whole being colored to

life. This plate is on an entire new plan, nothing of the kind having

ever before been invented; it is almost as complete as a model, and is

invaluable for private study, for teachers, and for Medical students.

The explanations are familiar, and divested of technicalities: and it

is still further illustrated by separate wood-cuts throughout the work,

and a beautifully engraved portrait on Steel of the author. One volume,

quarto, bound, price One Dollar. Third Edition.

NEUROPATHY;

OR,

THE TRUE PRINCIPLES OF THE ART

OF

=HEALING THE SICK=.

BY FREDERICK HOLLICK, M. D.

Being a complete practical treatise on the use of GALVANISM,

ELECTRICITY, and MAGNETISM, in the cure of disease, and a comparison

between their powers, and those of Drugs or Medicines.

These two works are published by T. B. PETERSON, No. 98 Chestnut-st.,

Philadelphia, and for sale by Booksellers and News Agents generally

throughout the United States.

THE ORIGIN OF LIFE.

A complete popular Treatise on the _Philosophy_ and _Physiology_ of

REPRODUCTION, in Plants and Animals, with a detailed description of

human generation. Illustrated by colored plates of the male and female

systems. New being at every stage, &c. Published by Nafis & Cornish,

268 Pearl street, New York. Price $1. _Thirtieth Edition_, with

additional Plates and various improvements.

N. B.--This is the only popular and yet strictly scientific work on the

Generative Functions ever yet published.

THE

=DISEASES OF WOMAN=,

THEIR CAUSES AND CURE

FAMILIARLY EXPLAINED;

With PRACTICAL HINTS for their prevention and for the preservation of

Female Health. By F. HOLLICK, M. D. _Especially designed for every

Female's Private Use_. BURGESS, STRINGER & CO., corner of Broadway and

Ann streets, New York, and for Sale by all Booksellers. Second Edition.

Price $1--300 pages, beautifully bound, and illustrated with numerous

splendid ANATOMICAL PLATES. By remitting $1 in a letter to T. W.

STRONG, 98 Nassau-st., N. York, it will be forwarded to any part of the

Country.

--> _No Female should be without it._

The above works, along with the present one, constitute a complete

practical and popular Library of Anatomy, Medicine and Physiology.

They have all been purposely designed for the instruction of

non-professional readers, but at the same time are so scientifically

correct, and so complete, that they would serve as text books for

Medical students. The favor they have already met with, and the

extensive circulation they have attained, is proof that they both meet

the wants of the public and enjoy its approbation.

_From the Boston Mail, March 7, 1848._

DR. HOLLICK'S SEPARATE LECTURES TO LADIES AND GENTLEMEN ON

PHYSIOLOGY.--The importance of adult persons, of both sexes,

understanding themselves, and their natural relations, must be obvious

to every thinking mind. The present ignorance on these matters is,

undoubtedly, the chief cause of the vices and sufferings which so

extensively prevail, and our only hope of a beneficial change must be

founded on a proper system of public instruction. This instruction

is difficult to impart we admit, and there are but few men qualified

for imparting it. We have no hesitation, however, in saying that Dr.

H. is one of these men. He knows how to preserve in his subject all

that intense interest which it intrinsically possesses, and yet to

divest it of everything in the slightest degree obnoxious to censure,

or even distrust. He has a happy faculty of making every thing easy

to be understood, and yet avoiding the slightest approach to undue

familiarity. All who attend, express themselves both surprised and

delighted, and unhesitatingly recommend his Lectures wherever they go.

Many of the most eminent Ladies in our city were among his auditors

last week, and were unreserved in their expressions of approbation,

both for the Lecture itself, and for the becoming modesty and true

refinement that characterised its delivery. The present series, which

commence to-day, has been anxiously expected, and will no doubt be

numerously attended by both sexes, but particularly by the Ladies, many

of whom were unable to gain admission last week.

[Illustration: THE GOLD MEDAL PRESENTED TO DR. HOLLICK,

BY

THE

LADIES OF PHILADELPHIA.]

IMPORTANT NOTICE TO LADIES!

THE PATENT ELASTIC AND MEDICATED PESSARY;

FOR THE RELIEF AND PERMANENT CURE OF

PROLAPSUS UTERI, OR FALLING OF THE WOMB;

Prolapsus Vagina, Rupture of the Bladder or Intestine into the Vagina;

Retroversion, or Anteversion of the Womb; and also, in many cases,

of LEUCORRHŒA, or Fluor Albus; invented by DR. HOLLICK, and first

described in his "Diseases of Woman."

This Instrument is CERTAIN TO CURE all the above named diseases, WHERE

A CURE IS POSSIBLE. It can be worn with perfect ease by young or old,

summer or winter, night or day, without the slightest inconvenience.

It is made of a soft elastic material, which never corrodes, and which

gives way to the slightest motions of the body. It can never become

displaced, nor fail to effectually support the parts, and is so light

that it only weighs _one ounce_.

--> This is the only Instrument of the kind ever invented,

and certainly the only one that can CURE FALLING OF THE WOMB; or be

worn with ease, to relieve it, when incurable. DR. HOLLICK is the only

person who keeps it, as he has NO AGENT ANY WHERE, at present.

N. B.--The article is PATENTED: but, besides this, NO IMITATIONS,

however similar, can be depended upon, because the Original is

impregnated, in a peculiar manner, KNOWN ONLY TO THE INVENTOR, with a

substance which imparts its MEDICINAL Power, and without which it would

be comparatively inefficacious.

All the old fashioned TRUSSES, SUPPORTERS, PESSARIES, &c., are entirely

superseded by this Instrument, which can only be obtained from _Dr.

Hollick_, _New York_, who will also give the necessary directions as

to its use and application. _It may be sent any distance. Price--Five

Dollars._

ADVERTISEMENT.

DR. HOLLICK is daily receiving numerous Letters from all parts of the

country, the answering of which has hitherto been a great tax on his

time, already sufficiently occupied; he is therefore compelled to

announce, that in future he cannot attend to any which merely request

advice, unless they contain the customary fee of FIVE DOLLARS. Address,

_Dr. Hollick_, _New York_.

* * * * *

Transcriber's Notes

Page 39 states, "In Plate VII. the line marked † crosses the upper

strait, or brim of the Pelvis," but there is no † in the original image.

On page 341, Chapter XXIII was incorrectly labeled Chapter XXII. That

has been corrected here.

Minor punctuation errors were corrected on pages vi, 4, 13, 19, 90,

141, 151, 200, 202, 206, 215, 258, 271, 301, 313, 323, 346, 457, 460,

464.

Inconsistencies in hyphenation and capitalization have been retained.

Original spellings have been retained except in the cases of these

apparent typographical errors:

Page 29, "situate" changed to "situated." (This is the part situated

between...)

Page 53, "tha" changed to "that." (Thus some authors asserted that...)

Page 56, "barenness" changed to "barrenness." (...or, in other words,

which produce barrenness...)

Page 64, "Tincœ" changed to "Tincæ." (The Os Tincæ, or mouth of the

Womb.)

Page 116, "is" changed to "in" in two instances. (...Womb in a first

pregnancy, and in a female...)

Page 138, "expeeted" changed to "expected." (...or before the expected

period...)

Page 156, "foetal" changed to "fœtal." (...and covered with the fœtal

membranes...)

Page 183, "rotale" changed to "rotate." (...the head is compelled to

turn, or rotate...)

Page 203, "cephalio" changed to "cephalo." (...it is called the right

cephalo iliac position...)

Page 238, "langour" changed to "languor." (...falls into a quiet and

pleasing langour...)

Page 240, "signs" changed to "sign." (...and if there is no sign of its

coming...)

Page 243, "subseqnent" changed to "subsequent." (...being done in their

subsequent labors.)

Page 247, "asphyxated" changed to "asphyxiated." (...are most likely to

become asphyxiated...)

Page 253, "capble" changed to "capable." (...she thinks herself

stronger, and more capable...)

Page 255, "presentatious" changed to "presentations." (...very

unfavorable presentations of the fœtus...)

Page 257, "unforseen" changed to "unforeseen." (...alarmed when

unforeseen difficulties occur...)

Page 281, "developement" changed to "development." (The development of

the head cannot be ascertained...)

Page 307, "cause" changed to "causes." (Still such presentation

occasionally causes...)

Page 311, "presentatations" changed to "presentations." (...most

dangerous of all the presentations...)

Page 313, "and" changed to "any." (...child and pelvis from any other

cause.)

Page 323, "recommeuds" changed to "recommends." (Mauriceau recommends

that women...)

Page 333, "continuanee" changed to "continuance." (...the continuance

of pregnancy to the full period...)

Page 333, "inadmissable" changed to "inadmissible." (The plug is here

totally inadmissible...)

Page 341, "honr" changed to "hour." (...may be preserved for an hour or

two...)

Page 341, "amni" changed to "amnii." (...and then if the liquor

amnii...)

Page 349, "introdueed" changed to "introduced." (When the first blade

is properly introduced...)

Page 371, "distate" changed to "distaste." (This means a complete

distaste...)

Page 380, "meat" changed to "neat." (A neat spoonful should be drunk...)

Page 385, "weaknes" changed to "weakness." (...a state of weakness and

exhaustion.)

Page 385, "chlid" changed to "child." (...than dangerous, except to the

child...)

Page 395, "unles" changed to "unless." (...unless very large, they

cause...)

Page 397, "truely" changed to "truly." (...as truly so as those on the

limbs...)

Page 408, "mattrass" changed to "mattress." (...lie on her back, on a

hard mattress...)

Page 409, "accummulate" changed to "accumulate." (...and makes it

accumulate in the womb...)

Page 413, "ocurrence" changed to "occurrence." (...which may account

for the constant occurrence...)

Page 418, "ccnclusion" changed to "conclusion." (In conclusion it

should be remarked...)

Page 422, "temblings" changed to "tremblings." (...then follow

tremblings, numbness of the limbs...)

Page 426, "spmptoms" changed to "symptoms." (...after the first

symptoms of the disease...)

Page 436, "two" changed to "too." (...or too unremittingly,

particularly...)

Page 441, "oocasional" changed to "occasional." (...occasional doses of

James's Fever Powder...)

Page 441, "James' fever powders" changed to "James's Fever Powder."

(...occasional doses of James's Fever Powder...)

Page 445, "recommened" changed to "recommended." (Mesmerism has been

recommended...)

Page 445, "develope" changed to "develop." (...will develop the bones

of the fœtus...)

Page 450, "crowed" changed to "crowded." (...on the operating table of

a crowded theatre...)

Page 452, "minmtes" changed to "minutes." (...the child was expelled in

fifty minutes afterwards.)

Page 455, "throngh" changed to "through." (...with unusual difficulty

through the brim.)

Page 457, "humau" changed to "human." (...natural parturition in the

human mother.)

Page 459, "coporeal" changed to "corporeal." (...principles of our

corporeal existence...)

Page 460, "1840" changed to "1846." (March 20, 1846)

Page 464, "Peansylvanian" changed to "Pennsylvanian." (From the

Pennsylvanian, (Philadelphia,) Jan. 26, 1847.)

On page 240, an extra "an" was removed from the phrase "...to wait more

than an hour..."

On page 456, the word "of" was missing from the phrase "...after a

careful examination of all the cases recorded..."

On page 457, an extra "of" was removed from the phrase "the superinduction

of anæsthesia."