Sect. 9. Swelling of the Feet and Legs.

In the course of pregnancy, during the latter months particularly, the feet and legs frequently become much enlarged. This is partly owing to the pressure of the womb, but sometimes apparently independent of it. It is first observed towards night about the ankles; by degrees the swelling rises higher, and the legs may become of a very large size. The sufferer from this complaint always goes to bed with her legs much swollen; but towards morning the face swells, and the enlargement of the legs disappears to a greater or less extent, returning, however, as the day advances.

Sometimes this complaint is very trifling in its character, requiring only that the bowels be kept freely open, and the feet and legs supported by a wellapplied flannel roller; but when the swelling is extensive and permanent, remaining in the same degree after the patient has been for several hours in bed, and connected with uncomfortable sensations in the head and an accelerated pulse, a medical man ought to be consulted-for the consequences might otherwise be dangerous.

Sect. 10.-Toothache.

This may appear a trifling disease to notice in connection with the subject before us; but, in the course of pregnancy, women will sometimes suffer severely from erratic pains in the face and teeth. As these pains are generally induced by the increased irritability of the nervous system, the result of the new action which is going on in the womb, and not from the decay of any

particular tooth, extraction of any tooth for its cure is out of the question. Indeed, should the suffering arise from a carious tooth, its removal will be advisable, provided the patient is strong enough to bear the shock of the operation. The fact is, that the patients who have consulted me while suffering from this affection have had apparently, in most cases, very sound teeth; and feeling confident that its cause has been what has been before pointed out, the treatment has been purely constitutional. We should trust, therefore, to efficient laxatives, tonics, good diet, with a little wine, and sedative fomentations (poppyheads). Small doses of quinine, combined with a little tincture of steel, sometimes work wonders. These remedies may be continued for some time with great advantage to the general health, even after all uneasiness in the face has for some time subsided.

The only local application I would advise is that of washing out the mouth and teeth, night and morning, with a tumbler of lukewarm water containing a teaspoonful of common salt. This plan of treatment not only relieves the painful affection of the face and teeth, but allays also that local irritability of the nerves upon which it depends.

Sect. 11.-Salivation.

A pregnant woman must not be surprised if, some little time after conception, or during any of the months of gestation, the ordinary quantity of saliva, which lubricates and keeps the mouth constantly moist, should increase to such an extent as to be exceedingly troublesome, and, indeed, sometimes becomes so excessive as seriously to affect her health. It is a symptom

of pregnancy, but a very unusal one, although the quantity of saliva discharged has now and then exceeded three, and even four, pints daily.

It differs essentially from the salivation produced by the employment of mercury, inasmuch as in this case there is no tenderness of the gums, or disagreeable fœtor in the breath. The fluid itself is either perfectly colourless and transparent, or tenacious and frothy. It has an unpleasant taste, and, when tenacious, induces vomiting. It is generally accompanied with acidity; and the plan of treatment most advisable, when the disease is moderate in its character, is the frequent use of from 20 to 30 grains of magnesia, say every morning, rinsing the mouth out very often with lime-water; or the following gargle may be tried: two fluid ounces of glycerine of borax, mixed with half a pint of rose-water. To be used several times a day. Should this symptom, however, be very excessive, the health will suffer considerably in consequence, and the assistance of the medical man is imperatively called for.

As this affection is of very rare occurrence as a symptom of pregnancy, the following case is inserted; it will serve as a good illustration, and at the same time afford encouragement and confidence to any that may be similarly affected. It occurred in the practice of my friend the late Mr. Hooper, of Newington, in whose words I quote it :

'A respectable married lady, about thirty-two years of age, of a pale and sallow complexion and nervous temperament, has been the subject of salivation in three pregnancies out of four. In two instances this symptom appeared as the first indication of her situation; and in all three it continued throughout the whole

of the remaining period of gestation. The average quantity of saliva discharged was about a pint daily; it was not attended by any fœtor, but with some irritability about the glands of the throat and fauces.

'Twice out of three pregnancies this symptom disappeared directly after delivery (say forty-eight hours), but the time before last it remained about two weeks. It was mostly suspended during the latter part of each labour, when the pains were frequent and severe. 'The general health did not suffer.'

Sect. 12.-A Painful and Distended Condition of the Breasts.

Pain and tension of the breasts frequently attend conception.

In a first pregnancy a large and rapid development of this organ may take place, the breasts becoming two or three times as large as before marriage; but if tight lacing be carefully avoided, and the breasts be permitted to expand, no material inconvenience will arise from this circumstance.

As, however, these symptoms are sometimes attended with considerable distress, I would advise, under such circumstances, the application of half-adozen leeches, tepid fomentations, and a gentle aperient, viz. two drachms of Epsom salts in a little peppermint-water, night and morning. These means, by relieving the over-distension and fullness of the vessels of the part, remove the cause and complaint at once.

If these symptoms occur to an individual who has been several times pregnant, and has formerly had an abscess in one or other breast, that bosom is generally most painful which was before affected; and there will

be an increased hardness about it, which may give rise, perhaps, to the apprehension of an abscess again forming; these fears are groundless; and if fomentations are employed, with gentle friction, frequently during the day, with almond-oil and laudanum-about a drachm of the latter to an ounce of the oil, warm-and patience is exercised, everything will do very well.

Nature often seeks her own cure; and a colourless thin fluid runs from the nipple, which relieves the symptoms.

Sect. 13.-Cramp and Pains in the Legs, &c.

Some women, during the latter months of pregnancy, suffer dreadfully from cramp and pain in the legs and about the sides and lower part of the stomach. This symptom arises from the pressure of the womb upon certain nerves in its neighbourhood which proceed to the extremities.

If the cramp be seated in the muscles of the leg, a hard knotty induration is perceivable to the touch, accompanied with great soreness, the latter continuing for a long time after the lump has disappeared. An uneasy position of the muscles is a sufficient cause of irritation to produce it; and it is frequently removed by simply rising from the bed or sofa, and walking about the room, so as to put the muscles of the leg into action. If this does not succeed, warm friction with the naked hand, or with camphorated oil, generally will. If spasm affect the sides, or lower part of the stomach, the speediest relief will be obtained from ten or twenty drops of laudanum, with the same amount of ether, in distilled peppermint-water, or even, at the moment, a little brandy-and-water. I also direct