a little is pushed into the rectum, and a piece of cotton is put over 

the anus. This protects the clothes from soiling and keeps the 

medicine in place for a longer time. Instead of ointment a cocoa 

butter suppository may be used. A suppository of the following 

composition is good: powdered nutgalls, 3 grains; oil of cade, 3 

drops; resorcin, 1 grain; bismuth subnitrate, 5 grains; cocoa butter, 

20 grains. One such suppository to be inserted three times a day. The 

ointment and the suppository given above, if used in conjunction with 

the proper regulation of the bowels, will not only relieve but will 

cure most cases of hemorrhoids caused by pregnancy. 

=Itching of the Vulva. Pruritus Vulvae.= Itching of the external 

genitals during pregnancy is not uncommon. This may be due to the 

fact that the vulva is generally congested and swollen during 

pregnancy or it may be caused by an increased leucorrheal discharge. 

The itching is sometimes very severe, and if the patient scratches 

with her nails and produces bleeding, she may cause an infection of 

the parts. The patient should be cautioned against scratching; she 

should try simple measures to relieve the itching. A small towel or 

gauze compress wrung out of boiling water and applied to the vulva 

several times a day, followed by a free application of stearate of 

zinc powder is often efficient. If it is not, the following salve may 

be tried: carbolic acid, 10 grains; menthol, 5 grains; resorcin, 15 

grains; zinc oxide, 1 dram; and white vaseline, one ounce. In very 

severe cases the vulva should be painted with a solution of silver 

nitrate, 25 grains to 1 ounce of distilled water. 

=Varicose Veins.= In most women during pregnancy the veins in the legs 

become somewhat enlarged. This is due to the pressure of the womb, 

which interferes with the circulation. If the veins become very 

prominent, swollen and tortuous, they are called varicose. This 

condition should be prevented, because it often and to some degree 

always persists permanently even after the pregnancy is over. The best 

precautionary measure is for the woman to wear a well-fitting 

abdominal belt or maternity corset, which supports the womb and does 

not permit it to sink too low into the pelvis. If varicose veins have 

been permitted to develop, the woman should wear well-fitting rubber 

stockings, or at least have the legs bandaged with woven elastic 

bandages. The bandage must be applied by a competent person, uniformly 

and not too tightly. Constipation has also a bad effect in making 

varicose veins worse; the bowels should therefore also be looked 

after. In some severe cases all measures are of little value unless 

the patient at the same time stays in bed or on a couch for a few 

days, with the legs elevated.