2. Irritability of the Bladder.-More frequently the bladder is rendered unusually irritable, and uneasiness in the region of this organ is felt.

This state requires a very different treatment from the former; for here soda and all saline medicines, which would render the urine stimulating, must be strictly avoided. Small doses of castor-oil, so as to keep the bowels gently relaxed; three or four grains of the extract of henbane, twice a day for four or five days; and drinking freely of mucilaginous fluids (barley-water or linseed tea), will give decided relief.

3. Inability to retain the Urine. This is not at all an uncommon circumstance in the last two or three months of pregnancy. It is produced by the pressure of the womb on the bladder, by which the urine is forced off involuntarily whenever the person coughs or moves quickly; or, if she be not troubled to this degree, she will be unable to retain much of it, being obliged to void it frequently.

It is to be relieved by the recumbent posture, and by wearing, during the daytime, a well-applied belt to the abdomen,' which will give support to the womb, and prevent, in some measure, the pressure upon the bladder; but it is only to be permanently cured by delivery.

Sect. 19.-Irritation of the External Parts.

A woman is naturally loth to consult her medical attendant when labouring under this affection. Delicacy causes her to shrink from making any communication to another about it; and she will endure the physical distress to which it gives rise for days and 1 See p. 98.

weeks, rather than do violence to her feelings. But this troublesome and distressing complaint, unless some remedy is early had recourse to, always grows worse and worse; and as, at its commencement, it admits of speedy and permanent relief, I think it right to point it out.

This tender and irritable state may affect the external parts only, or it may extend within. In either case it will produce the most intolerable itching, especially during the night, when it is sometimes hardly bearable.

It now and then commences in the early part of pregnancy; and when this happens, and it is neglected, it may continue until delivery takes place. At other times—and this I believe to be the most common-it does not attack the female until the sixth or seventh month.

If it is only slight, it may quickly be removed with the following lotion :-Goulard's extract, one drachm and a half; distilled water, one pint. Mix. With this the parts should be washed four or five times a day; and, at the same time, from half a pint to a pint of the same lotion must be thrown up into the vagina by means of a proper syringe.1 These means, together with a little laxative medicine, will produce speedy and perfect cure.

If, however, the irritation is very great, and extends within the vagina, if the disease has existed some time, and if nothing has been hitherto done for its relief, some additional means must be had recourse to. The parts just within should be thoroughly cleansed with warm water, and then smeared over with the Goulard's extract; and this must be repeated morning and night, the external parts being washed freely four or five See fig. 4, p. 104.

times a day with the Goulard lotion already prescribed for a milder form of this complaint. Or, if this fail to give relief, a strong solution of borax must be had recourse to:-Borate of soda, four drachms; distilled water, sixteen ounces. Mix. These measures, with the employment of a gentle laxative night and morning—as the liquid magnesia, or two drachms of Epsom salts in a wine-glass of the infusion of roses-and the recumbent posture (which is indispensable), will remove this troublesome affection.

If the itching is intolerable at any time, iced water, or a bladder containing broken pieces of ice, will afford a temporary suspension of the fit; and it may be necessary to apply leeches, if the disease be very obstinate.

Occasionally this irritation is due to the presence of thread-worms in the lower bowel. In such cases, it can only be cured by getting rid of the worms; this is best effected by enema of salt and water, which may be administered every morning until relief is obtained.

If in any case, after the irritation has nearly subsided, there be present considerable heat, redness, and swelling of the external parts, great benefit will be derived from bathing them liberally three or four times a day with a strong decoction of poppy-heads1 (to be used warm), and the applying a bread-and-water poultice.

The diet throughout must be moderate, with a total abstinence from stimulants of every kind.

Sect. 20.-Leucorrhoea, or the Whites.

A discharge sometimes accompanies pregnancy, occurring, however, most frequently to those who are bearing children in quick succession.

1 See note, p. 97.

In the Early Months.-If the discharge is but small in quantity, it will be only necessary to use the bidet with cold or tepid water, liberally night and morning, and to sponge the whole body every morning.

If, however, it is present to such an extent as to render the woman really uncomfortable, then a more vigorous treatment will be necessary: this will consist in the employment of a tepid hip-bath every night and morning, plenty of rest in bed, on a mattress, with only moderate covering, a regulated but nutritious diet, without any stimulants, and the proper employment of simple injections. The injection I most frequently order is made by the addition of a quarter of an ounce of powdered alum to each pint of water. It can be used night and morning or even three times daily, according to the severity of the disease. The most simple and at the same time most efficient apparatus for administering such an injection is figured below.

MAW

FIG. 4.

It consists of an elastic syphon with a suitable tube. Any amount of injection can be used, according to circumstances, and not the least of its advantages is that it is made and intended for self-administration. It is useful to have such an apparatus, as it can be used for a variety of purposes. Messrs. Maw supply these syphons provided with different sized and shaped tubes, and they can be had of any respectable chemist,

This condition will now and then be accompanied with a feeling of bearing down as if everything would drop through, symptoms which will receive appropriate treatment by the adoption of the above plan (more particularly the recumbent posture), and, if not entirely relieved, will be found to disappear altogether between the fourth and fifth month.

If the discharge is in excess, no scruples of delicacy should prevent medical advice being sought; for if it is not attended to, most probably miscarriage will result.

In the Latter Months.-Coming on in the latter months for the first time, provided it is not profuse, it is useful; for there will generally be symptoms of weight, heat, and discomfort present, which are alleviated by the discharge.

If, however, it is excessive, the frequent use of the bidet, and injections of tepid water into the vagina, will be productive of great comfort. The bowels should be kept constantly open by mild aperient medicines. And the recumbent position, by diminishing the pressure of the womb upon the parts from which the discharge proceeds, will tend greatly to reduce the quantity. Should these means fail to diminish the amount of discharge, the Goulard injection may be thrown up into the vagina with great relief night and morning: Goulard's extract, one drachm and a half; distilled water, one pint.

I think it right to observe that, when this discharge continues in considerable quantity during the whole period of pregnancy, it predisposes to premature delivery. Again and again have I known the same individual prematurely confined from this cause alone -her hopes thus repeatedly blighted, and, what is worse, her health unstrung for a long period.