in the investigation of disease, and should never be omitted or objected to. For the purpose of facilitating description, the cavity is mapped by vertical and horizontal lines, in a similar manner to the abdomen. Refer to Abdomen - Heart · - Lungs Respiration.

CHEST-Water in.-See Dropsy. CHICKEN POX is a mild eruptive disease which spreads by infection, and chiefly attacks children, occurring once during life. It is preceded in most, but not in all cases, by slight feverishness, for one or two days. The eruption first appears in the form of conical pimples with a white head, on the breast, shoulders and neck, more sparingly on the face, and on the body generally. On the second day, the vesicles appear like little globular blisters, but with very slight surrounding inflammation; on the third and fourth days, the fluid they contain becomes opaque or whey-like; they now either break or shrivel up, forming thin puckered crusts, which fall off piecemeal in one or two days more, seven or eight days being the whole time occupied by the course of the disorder. Little or no treatment is required beyond a gentle aperient repeated once or twice, and care taken that the child does not irritate by scratching.

Chicken pox might be mistaken for modified small pox by the inexperienced; it is distinguished by the absence or extreme mildness of premonitory fever, and by the rapid development, course, and different form of the vesicles, particularly in the absence of the central depression, which characterises the true small pox vesicle.

CHICORY.-The Cicorium intybus, the root of which, when roasted and ground, forms the well-known adulteration of coffee. Some persons consider the admixture of chicory with coffee an improvement, and at all events harmless, but the recent investigations of the "Lancet Sanitary Commission," tend to show that infusion of chicory, alone especially, and also when mixed with coffee in the proportion of twenty-five per cent., produced sense of weight at the stomach, languor, and head-ache; it has, by an eminent continental authority, been assigned as one of the exciting causes of amaurosis. Infusion of chicory occasionally acts as an aperient, at other times as a diuretic. In consequence of chicory not containing essential oil, it has not, when roasted, the fragrance of coffee, its infusion has a "sweetish and mawkish taste, and is dark coloured, thick and glutinous." But although chicory is used as an adulteration, the recent Lancet investigations go to prove

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that it is itself extensively adulterated with various substances. These are, 66 carrot, parsnip, mangel-wurzel, beans, lupin seeds, wheat, rye, dog biscuit, burnt sugar, red earth, horse chesnut, acorns, oak bark, tan, mahogany saw-dust, baked horse's and bullock's liver, Hamburg powder," which consists of peas roasted and ground, and coloured with the next article, Venetian red," also an adulteration. Perhaps after such disclosures, few persons will prefer chicory in their coffee; and, at all events, the moral fraud of vending for the pure article, that which is mixed, ought not to be suffered. When hot water has been allowed to stand for some time on coffee containing chicory powder, the grains of the latter lose their colour, and resemble small brown sago, whilst those of the coffee become rather darker than before.

CHILD-BED.-The term may be applied either to the actual labour itself, or to the confinement generally, from the first commencement of the symptoms to the completion of convalescence. It is in the latter sense it will be considered in this article.

The process of child-birth consists of a series of the most beautiful adaptations to the mechanism and structural and vital endowments of the human frame, with every providential provision for the safety both of the mother and infant, during the trying but important event. When the full period of pregnancy is completed, the process which is to free the womb of its contents, commences with the preparatory relaxation of the various parts connected with the passage of the child into the world; shortly, the long-closed orifice, or "mouth" of the organ begins to open or dilate, allowing, in the first place, the protrusion of the membraneous bag which contains the fluid, or waters, in which the infant floats, and which protrusion forms a soft wedge, dilating the maternal structures preparatory to the passage of the hard head of the infant, which follows as propelled by the expulsive efforts of the womb. Sooner or later, however, this membraneous bag gives way under the pressure, the waters are discharged with a gush, and the head itself becomes, in great measure, the dilating agent. Although not in the position at the commencement of labour, at its conclusion, the head of the infant should pass from the mother with the face looking directly backwards, and in the great majority of cases it does so, attaining the position by a series of turns which cannot be profitably explained to the unprofessional. In some cases, however, the position of the head is reversed, so that it

passes with the face directed forwards, causing a more protracted and painful labour. Moreover, the head may not come forward, or "present first, at all, but some other portion of the child, causing an irregular or cross birth.

Most women form, or endeavour to form, a calculation as to the period at which they may expect to be confined, and while some do it with considerable apparent exactness, others get far wrong, much to the inconvenience of themselves and of those appointed to attend upon them. The most usual calculation as regards the duration of pregnancy, is forty weeks from the last menstrual crisis, and this is generally made the basis of the calculation; but as more cases fall within the period than extend beyond it, it is safer for expectant mothers to arrange their preparations for the thirtyeighth week than later. By some it is thought, that the duration of pregnancy in the case of a male child is longer than in that of a female. As, however, cases of premature confinement of living children are not uncommon, it is always desirable that essentials be provided for as early as possible.

The most generally received premonitory sign of approaching labour at the full period, is " sinking," that is, from twenty-four to forty-eight hours before the actual process commences, the female seems as if she were smaller and lighter altogether, the waist especially showing a diminution in size. At this time, also, there is generally a degree of fidgetiness, or undefined mental anxiety, similar to that which is observable in the lower animals, and there frequently exists irritability of the bowels and bladder, calling for repeated efforts at relief. When the bowels are very troublesome, and there is much involuntary straining, or, as it is called, "tenesmus:" nothing relieves more than a clyster consisting of half-a-pint of gruel with twenty drops of laudanum. At length, slight twinges of pain are experienced, either in the womb itself, or in the back, hips and thighs, or in all together, and there is more or less discharge of slimy mucus, generally streaked with blood: shivering, with nausea or vomiting, are also frequent concomitants of the first accession of labour.

As time advances, the pains become more defined and regular, and when these, the "grinding" pains, have fairly commenced, the first stage of labour may be considered as established. This stage lasts, on an average, from six to twelve hours, but may, of course, much exceed, or fall short of this stated period: during its continuance, the

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mouth of the womb undergoes "dilatation," or full opening. Towards the close of the first or dilating stage of labour, the pains are altered in character, and become expulsive, or as they are popularly termed, bearing down," at first slightly so, but as the process advances, their forcing character is more strongly marked, and in most instances, the nearer the birth of the child, the more powerful and nearly connected are they, until at last the infant is expelled. Generally towards the middle of the expulsive stage, the "waters' are discharged; the sudden gush sometimes causes alarm to the inexperienced, who ought on this account to be forewarned of the circumstance. The whole process of labour, in the case of first children, averages from twelve to thirty hours; it is, however, not only as regards time, but in every other respect, liable to great variation. Attacks of spurious pain, resembling true labour, are not uncommon during the last month of pregnancy, but these may be known by the absence of the previous sinking, and of most of the other symptoms above enumerated, as characteristic of the real process. The attack is often the result of confined bowels, or of indigestion, and is removable by a table-spoonful of castor-oil with ten drops of laudanum, or by a dose of rhubarb and magnesia. Occasionally, active labour commences with a species of spurious spasmodic pains, which want the regularity of the true ones, and only teaze and exhaust the patient, who is herself conscious that they are "doing no good." In such a case, the best treatment is to administer five-and-twenty drops of laudanum, and to keep the patient perfectly quiet, so that she may sleep if possible; if she does so, in all probability she wakes in a few hours with real labour in full activity; but sometimes even sleep does not intervene, the anodyne seems at once to convert the spasmodic into the real useful labour pain, and contrary to its usual effect, actually to stimulate the progress of the case. Occasionally, when labour has reached a certain stage, pain becomes suspended without obvious cause, and continues so, for a longer or shorter period: in such cases patience is the best resource, unless the cessation of pain appears to be connected with some of the complications of child-birth to be hereafter noticed. The discharge of the waters is sometimes the first sign of the commencement of labour, or perhaps, more correctly, their discharge from imprudent exertions, such as shakes, jumps, &c., hurry on the process, which, in such cases, is often lingering. This premature discharge not unfrequently occurs,

when some other portion of the child than the head is first in the birth. It being presupposed, that every female in expectation of her confinement, if inexperienced herself, will, under the advice and guidance of female friends, provide for, and make those arrangements most suited to her individual case and circumstances, as soon as the first symptoms of approaching labour exhibit themselves, the female attendants ought certainly to be summoned; but should a medical man be engaged, it is proper before sending for him, to feel assured that the process has commenced in earnest. When, sinking pains recurring regularly every ten minutes or quarter-of-an-hour, are accompanied with slight "shew, as the discharge of slimy mucus is termed, the medical attendant may be safely summoned, and he will, or ought to see to all subsequent details.

When female attendance is trusted to, these details require to be carefully and judiciously insisted upon :

A lying-in chamber ought to be as roomy, and, whilst free from draughts, as well ventilated as circumstances will permit-see Bed-room-it ought too to have a fireplace, which it is ascertained beforehand can be used without half suffocating the patient with smoke-not an uncommon annoyance. The bed should be of such moderate height, that an attendant can conveniently give assistance to the patient. A mattress is always preferable to feathers, and curtains, as in beds generally, are better dispensed with. In addition to the ordinary furniture, a night-chair and bed-pan should be provided; and a vessel of some kind which can be used as a bath for the infant. Some waterproof material is requisite for guarding the bed against injury from moisture. Formerly, a prepared skin used to be the general material, but there are now many waterproof articles, quite as well or better adapted for this purpose. Sheet gutta percha answers well, and is cheap. An easy chair, a bottle for pure water, a little brandy, a fan, and bottle of smelling salts, cups and vessels, including a sickfeeder-see Bed-room-for administering either food or medicine, are all advantageous additions to the numerous little .etceteras; these are, sponge, washing flannel, and starch powder; a little lard without salt, or cold cream, soft towels, and abundance of napkins or doubles; four ties or ligatures, each six inches long, and composed severally of four plies of stout linen thread; a pair of blunt-pointed scissors that will cut, and a flannel receiver for the infant. A little laudanum and sal

volatile ought always to be at hand; but when a medical man is in attendance, he more generally carries these with him.

One female friend, and no more, in addition to the nurse, should be present at the accouchement; but it is advisable to have another female in the house, though not actually present in the room, particularly if a midwife only has charge of the case. Mothers ought never to be present at the confinement of their daughters.

As

As soon as labour commences, the chamber should be prepared, all extraneous articles removed, and whatever may be wanted put in order; the guard placed upon the bed, and the latter so arranged, that when the patient lies upon her left side near the edge of it, there may be plenty of room for those about her to pass and act. The patient herself ought to be encouraged to walk about, and her mind kept occupied and cheerful by conversation; light nourishment, such as a cup of tea or gruel, being given as desired, in small quantity at once; at this time too, if the bowels are at all confined, they should be unloaded by a dose of castor-oil, or better still, by an enema, consisting of a pint of thin gruel, to which a table-spoonful of olive-oil is added. time advances, and as soon as the pains exhibit signs of "bearing down," the patient if not previously undressed, should now be so, and the folded binder-see Binder-placed on the abdomen, so as to give gentle and equ able support. The patient may stille ontinue to walk about a little, but as soon as the pains become decidedly expulsive, she must be placed in bed upon her left side, and remain so, unless raised up for necessary purposes, until the infant is born. During all this time the room should be kept moderately cool-if regulated by a thermometer, about 55° Fahr. The patient, most likely, particularly towards the end of her labour, will become extremely hot, and then the occasional and moderate use of the fan is very agreeable. She should be induced, from time to time, to take a few spoonfuls of gruel; but the stomach is not to be overloaded, and above all things, the pernicious and too prevalent custom of giving stimulants, brandy, rum, &c., is to be avoided. A case which really requires such aids, requires also the presence of a medical man to sanction and regulate their use; if given when not required, feverish heat, headache, thirst, general uncomfortableness, and it may be, after bad consequences, are the only results. Amid the poorer, and indeed among some of the better classes in the country, it is customary for patients to be "put to-bed," in their day-clothes; independent of the

uncleanliness of the proceeding, it is not at all times free from danger, when, after the confinement is over, it becomes requisite to remove these clothes, and substitute the bed-dress; the usual excuse, that it is for the support given by the stays, is quite inadmissible when the binder is used, which amply supplies the place of the above undesirable articles; besides, the presence of the stays and clothes may seriously interfere with measures which must be taken in some particular cases, such as those of flooding. Another practice which is often followed by midwives cannot be too strongly condemned, it is that of delivery being effected with the patient kneeling on the floor; it is highly dangerous. Such attention must always be given to the bladder that it may be duly emptied, although, in most instances, the sensations of the patient herself ensure this point.

When the last strong pains of labour are expelling the head of the child, the midwife who has, or who ought to have, sufficient experience to be aware of the progress of the case, should elevate the upper knee during the occurrence of each pain, for the purpose of affording free space; this mode of proceeding is preferable to the pillow placed between the knees, which heats, and is always getting displaced. A towel or some such material is frequently attached to the bed-post or some fixed point, and many women appear to derive comfort from holding it during the paroxysm of pain; it may be permitted, if it does not encourage too great efforts at straining. The feet must be kept warm; cold feet may retard the frequency and force of the pains.

It cannot be too strongly impressed upon the minds of all, that child-birth is a natural process, and one fully competent in all ordinary cases-and in more extraordinary ones than might be imagined-to accomplish its end, safely and unassisted. And without assistance, or any attempt at assistance, it must and ought to be completed as far as female attendance is concerned.

As soon as the head of the infant is born, the attendant midwife ought to pass her fingers around its neck, to ascertain, as sometime occurs, that the navel cord is not twisted around it; should it be so, she must endeavour gently to slip it over the head, otherwise the neck may be so strongly compressed as to occasion fatal strangulation. The cord may be coiled once, or two or three times around the neck. At this period also, the mouth and nostrils of the child-if there is any delay in the passage of the body-should be kept as free as possible from the surrounding discharges, which

may be drawn in by the efforts to breathe. Neither ought the body, or even the legs of the infant to be drawn from the mother, their expulsion should be left to the natural efforts of the womb, for if too suddenly emptied, its natural action becomes embarrassed, and irregular contraction, accompanied with unnecessary pain and discharge, may be the consequence. The infant being fully born, the navel cord must be tied by the ligatures, which have been ready provided; the first being placed about three fingers' breadth from the body of the child, and the other about an inch and a-half further; the intervening portion of cord being divided by the scissors. The infant now separated from the mother is to be placed in the flannel, in the arms of the nurse, and put in a moderately warm situation.-See Children.

In tying the navel cord one or two cautions are requisite. The first ligature must not be placed nearer the body than the distance above-named; and before the second is put on, it is well-to prevent spurting-to squeeze the blood up towards the body of the mother, out of the intervening portion. For cutting the cord, a pair of blunt-pointed scissors should be used, and care taken at the moment, that no other portion of the child is intruded between the blades; it has occurred that a finger or toe has been lopped off by a careless attendant. After the cord is cut through, the cut extremity attached to the child must be carefully examined, to make certain that it does not bleed, particularly if the cord be thicker than usual, in which case the tying must be most carefully performed. From careless tying and neglect, infants have bled to death from the navel vessels immediately after birth. Should the infant not appear to breathe as soon as born, it is well to delay the severance of the cord for a minute or two, whilst at the same time the mouth and nostrils are freed from all adhering mucus, and efforts are made to rouse, by blowing upon the face, or by two or three smart taps on the back. As soon as the infant is separated from the mother, it is proper to ascertain by the hand placed upon the abdomen that there is not a twin child; if there be, the remaining bulk will indicate it in a way that can scarcely be mistaken, and should it prove so, the recurrence of the pain which is to effect the expulsion of the second child, must be quietly waited for, unless hemorrhage, or some other occurrence, dictates a different course. In most cases of twin children, the second is quickly and easily born, after pain sets in.

When labour is completed, the binder must be tightened up, so as to give gentle and comfortable support to the now lax abdomen, and the patient left quiet until the accession of pain gives signal of the throwing off of the after-birth.-See Afterbirth. When this is effected, the binder will again require slight tightening, and a warm napkin, sprinkled with brandy, should be applied to the mother. At this time, chilliness, succeeding the profuse perspiration, is often complained of, and should be counteracted by some additional covering. The female must now be allowed to remain quiet, but not left alone, and so far attended to, that any symptoms of faintness, or undue discharge of blood-flooding-may be detected. If all goes well, in the course of half-an-hour, if desired, a cupful of gruel or arrow-root may be given; in the course of another half-hour, a dry, warm, open, flannel skirt, and dry napkins should be substituted for those which have become wet; by this time, everything ought to be arranged and quiet for the patient's repose.

Such are the incidents of natural and regular labour; and could we calculate upon the process following undeviatingly the same course in all cases, it might safely and at all times be left to the care of judicious and instructed females; but, as too well known, accidents and difficulties of the most formidable nature will arise, which tax to the utmost the skill and nerve of the well-educated practitioner; and with some, this is an argument why every case of confinement should be attended by a medical man--in many situations at least, a physical impossibility. As, therefore, many cases must be left to female care, the foregoing directions will, it is trusted, lead to their safer and better management, whilst those which are to follow, are intended to point out what cases ought never to be trusted to a female attendant, and what symptoms occurring in a case under female care, indicate the approach of such difficulty or danger as requires the attendance of the male accoucheur. As a general rule, in a first confinement, it is always desirable to have the attendance of a medical practitioner, and especially so, should the female be the subject of any deformity, such as curvature of the spine, should she in early life have suffered from any tendency to rickets, or been the subject of epileptic fits at any period of life. Also, if there exists any suspicion of heart or other organic disease. If a previous confinement has in any way been irregular, or has required instrumental or artificial delivery of any kind; if convulsive fits have occurred; or if there has been

flooding, either from difficulty with the after-birth, or any other cause, the woman ought never to trust herself in the hands of a female.

When a midwife, either professed or otherwise, is in attendance upon a case, fainting coming on at any period, any symptoms of wandering or delirium, or of convulsion, any unusual discharge of blood whilst the process is going on, should at once be the signal for summoning medical assistance; also, should the labour be more than usually protracted, without obvious cause, provided the pains are regular, sufficiently numerous, or forcible; should the navel cord, or anything unusual, such as the infant's hand, be felt protruding externally; and lastly, if after the child is born there is any difficulty with the afterbirth-see Afterbirth-either with or without flooding.

In the interval which must or may elapse in many cases before medical assistance can be obtained, should fainting come on, the female must be laid on the bed with the head on a level with the body, air should be freely admitted around her, and smelling-salts used to the nostrils, whilst brandy, or sal volatile are administered by the mouth. It ought to be ascertained whether there is any discharge of blood externally, and if so cloths, dipped in cold or iced water, are to be freely used to the lower part of the bowels. Wandering or delirium, or convulsion, must be soothed by the most perfect quiet, and by the free use of cold applications to the head, and mustard plasters to the calves of the legs; whilst if the person be of full habit, and if the face is full and flushed, from six to a dozen leeches are to be applied to the temples. In all cases of unusual discharge of blood, the measures recommended under the article "Abortion" are to be employed, and it must be borne in mind, that if the accident occurs after the birth of the child, firm pads composed of folded napkins must be kept firmly bound over the situation of the womb-in other words, one or two inches below the navel-and kept there whilst cold is used to the external parts. In a case of sudden and profuse outward flooding after the birth of the child, occurring in a thin individual, much may be done to arrest it, by some one instantly pressing the hand firmly and steadily upon the belly - at the naveluntil the pulsation of the great main artery, or aorta, is felt, and felt as arrested by the pressure, to beat up to the hand, but not beyond it.

It must, however, be kept in mind that alarming, and even fatal loss of blood