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SPRINGER BRIEFS IN ARCHITEC TURAL DESIGN
AND TECHNOLOGY
Pablo Guillen
Urša Komac
City Form,
Economics and
Culture
For
the Architecture
of Public Space
123
SpringerBriefs in Architectural Design
and Technology
Series Editor
Thomas Schröpfer, Architecture and Sustainable Design, Singapore
University of Technology and Design, Singapore, Singapore
Indexed by SCOPUS
Understanding the complex relationship between design and technology is
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More information about this series at http://www.springer.com/series/13482

Pablo Guillen Urša Komac
•
City Form, Economics

and Culture
For the Architecture of Public Space
123
Pablo Guillen Urša Komac
The University of Sydney Western Sydney University
Sydney, NSW, Australia Westmead, NSW, Australia
ISSN 2199-580X ISSN 2199-5818 (electronic)

SpringerBriefs in Architectural Design and Technology
ISBN 978-981-15-5739-2 ISBN 978-981-15-5741-5 (eBook)
https://doi.org/10.1007/978-981-15-5741-5
© The Author(s), under exclusive license to Springer Nature Singapore Pte Ltd., part of Springer Nature
2020
This work is subject to copyright. All rights are solely and exclusively licensed by the Publisher, whether
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transmission or information storage and retrieval, electronic adaptation, computer software, or by similar
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The use of general descriptive names, registered names, trademarks, service marks, etc. in this
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the relevant protective laws and regulations and therefore free for general use.
The publisher, the authors and the editors are safe to assume that the advice and information in this
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This Springer imprint is published by the registered company Springer Nature Singapore Pte Ltd.
The registered company address is: 152 Beach Road, #21-01/04 Gateway East, Singapore 189721,
Singapore
Contents
1 Introduction . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1
References . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4
2 Why Cities Exist? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5
Reference . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6
3 Cities Are More Important Than Ever . . . . . . . . . . . . . . . . . . . . . . 7
References . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 9
4 Public Goods, Externalities and the City . . . . . . . . . . . . . . . . . . . . . 11
References . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 13
5 Governing for the Public Good: The Problem of City
Governance and Planning . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 15
Reference . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 16
6 Growth and Shape of the Pre-industrial City . . . . . . . . . . . . . . . . . 17
References . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 18
7 The Raise of the Rail-Based Mechanical City . . . . . . . . . . . . . . . . . 19
References . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 24
8 Motorisation and the City: America Leads the World . . . . . . . . . . 27
8.1 The Logic of Congestion . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 42
8.2 How About Smart Cars? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 44
8.3 Modern American City Thinking and Trends . . . . . . . . . . . . . . . 45
8.3.1 The Death and Life of the Great American Cities . . . . . . 45
8.3.2 Paul Mees, Public Transport for Suburbia . . . . . . . . . . . . 46
8.3.3 Edward Glaeser’s Urban Economics Critique . . . . . . . . . 48
8.3.4 Richard Florida . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 49
8.3.5 The New Left, the Gentrification and Other American
Planning Buzzwords . . . . . . . . . . . . . . . . . . . . . . . . ... 49
v
vi Contents
8.3.6 Light Rail Versus the Kochs and the Great American
Public Transport Melancholy . . . . . . . . . . . . . . . . . . . . . 51
References . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 51
9 The Japanese Experience: The Rise of the Minimal Car Use
Megalopolis . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 53
References . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 63
10 Following America, Not Japan: Car Dependent Emerging
Megacities . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 65
References . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 67
11 Motorisation and De-motorisation in Europe . . . . . . . . . . . . . . . . . 69
References . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 74
12 Conclusions . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 75
References . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 77
Appendix A: Public Transport Definitions . . . . . . . . . . . . . . . . . . . . . . . . 79

Appendix B: Architecture for the Public Space in a Car Free City . . . . 81
Chapter 1
Introduction
Abstract This is a book about how the cities utilise space and how the resulting
urban form provides different ways to deal with the tangle of public goods and
externalities caused by agglomeration. We rely on well-known economic thinking
plus a historical analysis to why cities exist and why they have evolved to be the
way they are. We identify several defining factors: the geography and the technology
(both defining what is possible to do), culture (which defines what the society’s goals
are) and the necessary government regulation in the presence of public goods and
externalities (determined both by culture and the desire to achieve positive economic
outcomes). Regulation is the set of rules (not only planning codes) that underpins
how markets are allowed to work in the city. Our method is also comparative as it
explains the evolution of urban form in the US and how it stands in a sharp contrast
with the evolution of urban form in Japan. An emphasis is put on the difference in
regulations between both jurisdictions. We point out that, against the conventional
wisdom, how American cities are constrained by rules that are much further from
the “neoliberal” economic idea of free and competitive markets than the Japanese
ones. We demonstrate how Japanese planning fosters competition and variety in the
availability of goods and services. We also include an explanation of the origin of
the differences in those regulations. We hypothesise how changing regulations could
change the urban form to generate a greater variety of goods and to foster the access
to those goods through a more equitable distribution of wealth. Critically, we point
out that a desirably denser city must rely on public transport, and we also study how a
less-dense city can be made to work with public transport. We conclude by claiming
that changes in regulations are very unlikely to happen in the US, as it would require
deep cultural changes to move from local to a more universal and less excluding
public good provision.
Keywords Urban form · Regulation · Public goods · Externalities · Technology ·

Culture
This book is about explaining the most relevant planning and cultural differences
in the way cities are allowed to function, grow and change. Those are differences
in planning regimes with historical reasons we explore and rooted in culture. They
reflect, but also shape, the mainstream views of the population, but have also very
© The Author(s), under exclusive license to Springer Nature Singapore Pte Ltd., part of 1
Springer Nature 2020
P. Guillen and U. Komac, City Form, Economics and Culture,
SpringerBriefs in Architectural Design and Technology,
https://doi.org/10.1007/978-981-15-5741-5_1
2 1 Introduction
strong economic and spatial implications. That is, most people use, see and feel the
city as a consequence of planning rules they are not aware of. The aim of exploring
these planning differences is not only to help to come closer to best practice given
society’s goals, but even perhaps allowing to direct change or bring more consistency
to those goals.
Following a historical analysis of the evolution of cities influenced both by tech-
nological progress and cultural change, we argue that the unintended consequences
of mass motorisation are at the origin of many, if not most, of the ills affecting con-
temporary cities. We propose a new approach to limit private car usage in urban
environments based on the somehow laisser-faire Japanese experience and compar-
ing it to the more heavy-handed, micro-managed approaches to planning used both
in North America and Europe.
The car-dependent city generates problems that go much further than the obvious
of pollution and excessive energy usage. First of all, universal car usage has huge
implications in terms of land use, as cars need to be parked and will be actually
parked most of the time. The need of parking space (“no parking no business” is,
for instance, the de facto Southern California motto) means that buildings have to be
spaced from each other to leave space for car parking. The result is neighbourhoods
unappealing for pedestrians and leaving no option but driving. Business will be built
and located to the scale and convenience of motorists. This environment makes all
but impossible for small restaurants, cafes and stores to exist as they will not be
even visible from zooming cars. That is, car dependency has an impact in the variety
of goods and services offered. A car dependent city is therefore dominated by huge
stores located far from residential zones and accessible only by car. Such city, coupled
with a locally controlled strict zoning regime in terms of permitted uses, also results
in a closed or socially exclusive city.1 The poor won’t even be visible in the rich
areas and the rich have no reason to adventure driving through the poor areas as there
is nothing interesting for them there. The poor in the car dependent city will suffer
when their car breaks down. Soon they may not be even able to go or to look for work.
As the poor and the rich live far apart, schools will be easily segregated by income
and social mobility will suffer greatly. Last, but not least, there are health benefits
associated to the use of public transport. Indeed, every user of public transport is a
pedestrian who has to walk at least the so-called “last mile” (and probably the first
too). Daily users of public transport don’t need to use ridiculous walking machines
in the gym or standing desks in the office as walking and standing forms part of their
daily commuting to work, errands, shopping and entertainment routine.
Our main point is therefore that different planning regimes result in substantial
differences in urban form, even when these differences often arise from unintended
consequences of the rules chosen. For instance, the Japanese governments of the
1950s wished for a rapid motorisation but at the same time they found it unfeasible,
given the narrowness of most streets, to allow on-street parking. Therefore, national
1 Locally controlled planning has the aim of keeping poorer people away. Also, may be more
accurate to say that a city based on public transport facilitates, but does not guarantee, openness
and inclusivity. These themes will be treated in the body of the book ahead.
1 Introduction 3
laws were passed by the Japanese national parliament mandating one private parking
space per car and making overnight street parking illegal.2 People in Japan did buy
cars at rates not so dissimilar with their American and European counterparts but
soon found them difficult to use for everyday life in the urban environment (Berri
2009).
From our reading of the architecture and urban design literature, we believe that
both architects and urban designers are mostly unaware of the forces that actually
shape cities and of the regulation frameworks put in place to harness and direct those
forces. As a result, architects often overestimate their own contribution to the urban
form. When realising they are not reaching their intended goals, they blame strawmen
such as “capitalism” or “the system” and even wish for a catastrophe that would allow
for a fresh start, see among a myriad of trite articles such as Aureli (2008). Quite on the
contrary, we point out real world examples, mostly in Japanese and European cities,
that could potentially allow architects to achieve positive outcomes in terms of more
liveable cities. Japanese cities look like a straightforward result of what we believe
are wise and clear planning rules. We are not saying that architecture in Japanese
cities is to be emulated, as we will show examples of the commonly low-quality
Japanese architecture, but we point out how the Japanese planning rules would allow
for potentially excellent results. On the other hand, those excellent results would be
much harder to achieve within the Anglo-American planning framework.
To us, European cities do usually look better3 than the ones in Japan and America.
We believe this is partly because the old parts of town were built before cars were
available. Before the Industrial Revolution the relative cost of high-quality crafts-
manship in building must have been much lower than it is now. After all, there were
not that many interesting and skilled jobs for the vast majority of talented individuals
before the Industrial Revolution. After all, the association of clever craftsmen is at
the very origin of the Free-Mason organisation in the Middle Ages. Once education
becomes increasingly available to the masses the majority of the most talented indi-
viduals prefer to become teachers, lawyers, medical doctors, professors of economics
or perhaps software engineers in recent times. Craftmanship is shown in different
ways, that become more rewarded by society in the form of higher salaries. Con-
struction jobs are left to individuals who in the olden times were only deemed worth
of carrying bricks to the masons. Our theory will become painfully compelling every
time our estimated reader, most likely a member of the illustrated class of craftsmen
in one way or another, needs anything repaired or rebuilt at home.
However, it is also true that unlike in Japan European buildings have better sur-
vived the pass of time and the destruction of war.4 In any case, cities in Europe
are nowadays much more car dependent and crowded with cars than their Japanese
2 On street parking is seldom allowed. When allowed, is often metered and indeed, cars still parked
after midnight are towed, see Barter (2014).
3 At least the areas frequented by tourists. Admittedly a value judgement.
4 The widespread use of timber in Japan even for large and symbolic buildings, such as temples
and palaces, has a lot to do with that. European medieval cities were also mostly built with timber,
besides the cathedral and the castle. When the city burned, new buildings were made of more durable
materials. Japanese timber construction was prevalent up until mid twentieth century. Buildings
4 1 Introduction
counterparts. Whenever a city in Europe has managed to limit car usage, that has
happened as a result of a very micro-managed approach and, sometimes, a substantial
cost in terms of public transport subsidy.
In summary, we are advocating for an urban form that is sufficiently dense to
foster encounters at a human scale, encourages the supply of variety goods and
services, provides opportunities for recreation and the enhancement of the soul, it is
not planned around the idea of exclusion and it is serviced by affordable and efficient
public transport that keeps pollution to a bearable minimum. It seems that such a
city would attract and shape the best minds to generate wealth which, appropriately
taxed, could provide and expand the public goods and thus grow in a virtuous cycle.
References
Aureli, P. V. (2008). The project of autonomy: politics and architecture within and against capitalism
(Vol. 4). New York: Princeton Architectural Press.
Barter, P. (2014). Japan’s proof-of-parking rule has an essential twin policy. Reinventing park-
ing. https://www.reinventingparking.org/2014/06/japans-proof-of-parking-rule-has.html. Last
Retrieved on March 01, 2020.
Berri, A. (2009). A cross-country comparison of household, car ownership: A cohort analysis. IATSS
Research, 33(2), 21–38.
Sorensen, A. (2005). The making of urban Japan: Cities and planning from Edo to the twenty first
century. Routledge.
destroyed by fire-bombing during the war were replaced in haste during the post-war economic
recovery resulting in not-so-pleasant looks. See Sorensen (2005).
Chapter 2
Why Cities Exist?
Abstract We argue cities exist are the result of economics forces of agglomeration
mediated by technological progress. That is, urban growth is fuelled by economi-
cally advantageous division of labour. Available technology is the most important
constraint to city growth. However, other factors such as political stability, peace and
the control of plagues are also important.
Keywords Division of labour · Specialisation · Trade · Agglomeration
Humans become settled in a particular place as a result of the Neolithic revolution.

That is, the discovery of agriculture and husbandry, which tie people to the land.
Initially a group of humans with family ties would settle in a piece of land and work
together to produce enough food for the clan. In some places, such as particularly
fertile plain of Mesopotamia and the Nile valley, agriculture is especially productive.1
There, a relatively small group of farmers was able to produce enough food for
many people, much more than was needed for themselves and their families. Surplus
appeared, so it was no longer necessary for the entire workforce to toil the land.
So, some people will specialise in farming, but others can now focus on different
occupations and thus become full time builders, craftsmen, soldiers, priests or artists.
This division of labour encourages specialisation. Specialists will produce goods or
services they don’t need for themselves and trade with other specialists. Because of
trade everyone can now be better off than in autarchy, a situation in which people
only produce for themselves. Another interesting feature of production technologies
is that often specialists can produce better and more when they are next to each other
and, critically, also when they are close to people interested in their trades. That is,
close to the market. Those are the forces fuelling the process of agglomeration. Cities
are an economic consequence of specialisation, trade and agglomeration.
Therefore, cities would thrive as much as they can, sustain their population and
attract new dwellers, brought both by the economic opportunity and the fascination
by the plethora of opportunities the city provides. That is, not the variety of goods
provided but also a diverse, large population who may be willing to try new and
1 Most of our historical claims are standard and can be checked in any universal history manual, see
for instance Gombrich (2005) for a fairly comprehensive world history up to the twentieth century.
https://doi.org/10.1007/978-981-15-5741-5_2
6 2 Why Cities Exist?
different things. Architects, artists and professors come to the city because that’s
where their abilities are appreciated and paid for. All the wonders the city has to
offer, its arcades and plazas, its culture, its sophisticated food and theatre cannot
exist if architects, artists and professors, chefs and actors are not paid. If their job is
better in Melbourne, they might just leave Sydney.
Another important fact about cities is that they cannot be taken for granted. For
instance, they came next to disappearing in Western Europe at the time of the bar-
barian invasions. That happened not only because cities where directly attacked and
sacked by invaders but also because, once the authority of the Roman Empire of
the West collapsed, nothing could keep slaves working the fields thus agricultural
surplus disappeared. War and bandits cut trade routes. People had no option but to go
back to the fields to avoid starvation. Without cities, art and culture soon stagnated
in Western Europe, but flourished in the East where law and order still prevailed. For
several centuries to come, Byzantium was the new Rome.
Technology has a big role in increasing the productivity of agriculture and there-
fore causing migrations to cities. The iron Roman plough created an empire. The
steel plough of the early XIX century pushed again masses of workers from the fields
to the factories. The green revolution epitomised by tractors, chemical fertilisers and
insecticide finished the job in the XX century. It is worth noting that many of those
migrants were not only attracted by the opportunity the city had to offer but somehow
expelled from their traditional occupations in the fields. Many were escaping poverty
but ended up in a poor city slum.
Reference
Gombrich, E. H. (2005). A little history of the world. Yale University Press.

Chapter 3
Cities Are More Important Than Ever
Abstract We show how, contrary to predications made in the twentieth century,

the advances of transportation and information technology have not slowed down
the forces of agglomeration. On the contrary, because of the increased human and
physical capital accumulation plus the availability of desirable goods and opportu-
nities, city growth has been accelerating. The world is going through a gradual but
seemingly unstoppable process of urbanisation.
Keywords Economies of scale · Capital accumulation · Contemporary

urbanisation
Not that long ago many scholars have expressed doubts and hopes about the future
of the city. Telecommunication technology and motorisation were seen by most as
ways to stop the forces of agglomeration and allow humans to go back to live close
to nature. Congested, polluted cities were hoped to be a thing of the past by the
twenty-first century. Those hopes have been dashed. A recent study shows1 how
cities of different eras aren’t as different as we might think. Modern settlements
grow similarly to their ancient counterparts. In particular, city growth in all ages is
characterised by productivity increasing faster than population. The city is a source of
economies of scale.2 By and large, the economic success of the city is the main driver
of population growth and urbanisation. Note that the phrase “economic success”
has to be understood in a wide sense. On one hand cities are a good place for
production given the economies of scale fuelled by specialisation, but critically and
often overlooked, cities are also a good place for consumption as they offer a plethora
of varied goods, services and other opportunities3 not available elsewhere. That
explains why not everyone moves to Dubai, which offers excellent salaries (related
1 Ortman et al. (2015).

2 That is productivity, or output per worker, increases with the scale of production, see for instance
Nicholson and Snyder (2015) for a simple yet accurate explanation of most of the microeconomic
terms used in this book.
3 Basically, related to cities being full of people you don’t know yet and thus, as a Chicago School
economist would put it, enhancing the “choice set” in many realms, i.e. sexual partners.
https://doi.org/10.1007/978-981-15-5741-5_3
8 3 Cities Are More Important Than Ever
to production), but comes with serious shortcomings in terms of goods, services and
other opportunities on offer.4
The forces of specialisation and agglomeration are nowadays stronger than ever
before. As a result, population is concentrating in cities faster than at any time in
human history, Ritchie and Roser (2018). The world is going through a gradual but
seemingly unstoppable process of urbanisation. If by the beginning of the twentieth
century about 15% of the world population lived in cities, this proportion increased
to 50% in 2007. The accelerated shift of population from rural to urban areas has
also been accompanied by a very strong population and economic growth. World
population went from 1.6 billion in 1900 to 6 billion in 1999.5 All in all, urban
population went from about 250 million at the beginning of the twentieth century
to 3 billion at the end of the century. That’s a 12-fold increase or a 1100% increase
in percentage terms. Urbanisation and population growth are a staggering, unprece-
dented phenomena in human history. Both processes are a result of technological
and cultural changes that, starting in the mid-eighteenth century, gave birth to the
very efficient although still evolving form of production known as capitalism. That
is a mode of production characterised by capital accumulation. In the pursue of ever
higher profits, current profits are invested to expand the production capabilities by
purchasing new and/or better machines (capital) or more sophisticated and efficient
ways of combining capital with labour.6 Indeed, for good and bad, this is main force
behind our thriving, growing cities.
One fact common to all contemporary cities is the huge impact motorisation has
in its organisation. Humans now mostly live in cities, but most of the newer ones
have been built to move around in cars. The older ones had to accommodate to the
new technology. Far from being back to nature humans now live in a tar and steel
jungle where the rich can afford a lawn and a pool as, maybe, a poor substitute of a
meadow and a river of clear waters. Many people rub bumpers rather than shoulders.
The rush hour is still alive and well.
4 That is, if you don’t quite like golden taps and air-conditioned beaches.
5 This fast increase in population was much unexpected by the average person in the mid-twentieth
century. For instance, in the 1940 s Isaac Asimov assumes fairly low overall populations in his
futuristic science fiction novels, see Asimov (2004).
6 Note that capital accumulation is not unique to countries commonly known as capitalists. Both
capital accumulation and technological progress were indeed at the core of the planned economies in
so-called socialist countries. The essential difference lies in that most of the investment is decided
centrally in a planned economy rather than decided by privately owned companies in a not-so-
planned economy. Public infrastructure and public goods are still provided by the state even in the
most capitalist economies. The urban governance problem, particularly related to the city, lies on
what infrastructure to build and which public goods to provide for the city in order to reach which
goals. These problems will be discussed in more detail later on in the book.
References 9
References
Asimov, I. (2004). I, robot. Spectra.

Nicholson, W., & Snyder, C. M. (2015). Intermediate microeconomics and its application, twelfth
edition. Cengage.
Ortman, S. G., Cabaniss, A. H., Sturm, J. O., & Bettencourt, L. M. (2015). Settlement scaling and
increasing returns in an ancient society. Science Advances, 1(1), e1400066.
Ritchie, H., & Roser, M. (2018). Urbanization. Our World in Data.
Chapter 4
Public Goods, Externalities and the City
Abstract We explain the concept of public goods as understood in economics. That

is, non-rivalrous and non-excludable goods as opposed to rivalrous and excludable
private goods. We also explain the concept of externality as the effect on society as
a whole. We show how markets cannot effectively provide neither public goods nor
goods that involve externalities. We argue that cities, as a tangle of public goods and
externalities, need effective governance and thus regulation.
Keywords Public goods · Externalities · Non-market provision
As normally understood public goods are commodities or services provided without

profit, even for free or a nominal fee usually by the government or by a private
organisation on behalf of the government.
We will use in this book a somehow more sophisticated definition of public goods
borrowed from economics. Public goods are thus characterised as being both non-
excludable and non-rivalrous, see Nicholson and Snyder (2015). A good is non-
excludable when it is not possible to prevent people who did not pay from having
it. Streetlights are clearly non-excludable; anyone walking down the street at night
may enjoy them. The safety provided by a well-functioning police force is also non-
excludable. A good is non-rivalrous if it can be used by more than one person at
the same time in a way such that consumption from one individual does not detract
from the enjoyment of other individuals. Streetlights are also non-rivalrous, they can
be enjoyed by many people at the same time. Again, the same can be said about
the safety provided by a well-functioning police force.1 Note, however, that when
a constant number of policemen need to look after an increasingly large group of
people safety can be compromised. The good becomes saturated, rivalry comes into
place and we don’t have a public good anymore.
1 In
fact, the legal system as a whole is a public good. Without a legal system the enforcement of
property rights would be impossible. The mere existence of markets therefore relies on a public
good that must be provided by the government. This fact is as essential as overlooked.
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12 4 Public Goods, Externalities and the City
Private goods, such as pears and laptops, are obviously both excludable and rival-
rous. Goods that are non-excludable and rivalrous, such as a public good that became
saturated, are called “common pool resources”, i.e. fish stocks in the oceans. Finally,
some goods are excludable and non-rivalrous like a movie shown in a cinema. Those
are, by the way, called “club goods” in economics. For instance, a non-toll unsat-
urated road can be understood as a public good. Once it becomes saturated it is a
common-pool resource.
Now it is useful to argue that non-excludable goods are unlikely to be provided by
a for-profit private entity. For instance, if a fireworks show can be seen from people’s
balconies, not many people would be willing to pay for it. Even if most people who
like fireworks were willing to pay $10 for a show, many (or most) could not be
compelled to do so. Therefore, a private fireworks show would not happen because it
is unlikely to be a good business. That is, free markets will not provide public goods.
Free markets are also bad at exploiting common-pool resources.2 Club goods can be
efficiently provided by the market under certain conditions too technical to discuss
here.
A concept close to public goods is that of externalities. A positive externality
arises when something someone affects positively somebody else who does not pay
for it. That is, a $1000 firework show payed for by a rich die-hard fireworks enthusiast
entails a positive externality for everyone else who enjoys it but does not pay for it.
Die-hard rick fireworks enthusiasts, willing to foot the bill all by themselves, are a rare
species so fireworks are most of time payed by the city government and ultimately
funded by taxes.
Negative externalities can be thought to be linked to public bads, that is non-
rivalrous and non-excludable things everyone dislikes.3 For instance, something
someone does for private profit negatively affecting other people who did not pay
for it. That could be the case, for instance, of driving in a congested road. More to
the point, driving to work produces a private benefit and several negative external-
ities. Pollution and congestion are the two most obvious. We will argue afterwards
that planning rules that encourage or impose car dependency in a large urban area
generates other, perhaps more pervasive, negative externalities in terms of land use
and city form. Also, it is very important to understand that free markets are not a
good way of dealing with externalities. As with public goods, a perfectly competitive
industries will produce too much of a negative externality and too little of a positive
externality.
Finally, note that public goods and externalities need to be considered relative to
location. For instance, CO2 emissions entail a global negative externality in terms
of climate change. On the other extreme, local planners may put limits to low socio-
economic families to settle in their municipality as those would bring a negative
2 For instance, an unregulated, perfectly competitive fishing industry would result in depletion of
the fish stocks, see Nicholson and Snyder (2015).
3 Note that something can be a good for some and a bad for others. Fireworks are a good example.
4 Public Goods, Externalities and the City 13
externality in terms of lowering real estate values, decreasing the quality and increas-
ing the cost of public goods provided locally etc. Similarly, Euclidean zoning4 limits
density and imposes single use zones to ameliorate the negative externality caused
by traffic in residential areas. We will argue that these forms of planning, while being
locally effective have a negative regional or nationwide effect. That is, forcing the
poor to live next to the other poor creates huge negative externalities in terms edu-
cation and crime outcomes that affect the city, region or nation as a whole. Limiting
density and separating zones by use has the effect of increasing overall traffic and
congestion. It just pushes it away from particular, often affluent, residential areas.
We have argued that cities are growing fast because of their increased capacity
to produce wealth. That is now mostly happening in the form of highly valuable
services. Cities, however, entail a huge tangle of non-private goods (public, common
pool and club) and a variety of positive and negative externalities that must be dealt
with by government intervention, provision or regulation.5 For instance, public space
generates several public goods at the same time. Architects and city planners need
to be well aware of how the design of the city affects in a positive or negative way
the provision of those goods.
It is also useful to differentiate between a public good and the public good. The
former is a non-excludable, non-rivalrous good and the latter what is good, in the
sense of positive, for the public in general. It could be said that public goods are
provided for the public good, the benefit of the public. And that should indeed be the
goal of government: nothing else other than the public good.
References
Fluck, T. A. (1986). Euclid v. Ambler: A retrospective. Journal of the American Planning

Association, 52(3), 326–337.
Nicholson, W., & Snyder, C. M. (2015). Intermediate microeconomics and its application, twelfth
edition. Cengage.
4 Euclidian zoning, Fluck (1986), will be explained in detail in Chap. 8.

5 Some economic thinking suggests that the cost of market failure due to public goods, externalities
etc. is actually lower than the cost of government failure. That is the cost imposed on society in
terms of taxes, lobbying, corruption and so on. Notwithstanding government ought to be less than
perfect, we deeply disagree with this line of thought.
Chapter 5
Governing for the Public Good: The
Problem of City Governance
and Planning
Abstract We discuss the problem of city governance in general and with regards
to urban planning in particular. Although cities exist because of their capacity to
generate wealth, we do not believe that elected public officials should focus solely
on the maximisation of economic growth. Indeed, cities are not only centres of pro-
duction but also residence and consumption of private and public goods. Elected
official should then strive to maximise a social welfare outcome rather than a merely
monetary one. Any planning policy is a form of government intervention or regula-
tion. Given the complexity of interconnected public goods and externalities posed
by agglomeration, the need for regulation is unavoidable.
Keywords City governance · Public good · Urban planning · Regulation
We have argued that specialisation and trade foster agglomeration. Cities grow
because they are a hotbed of economic opportunity. Should city governance be
thus focused on the generation of wealth? Of course not, good governance is to
be focused on the public good, which is what economists call maximising social
welfare. Of course, that does not simply imply maximising the generation of wealth.
Politicians would ideally have some abstract and overarching goals, for instance
equality of opportunity, the provision of certain public goods, a certain degree of
redistribution of income and economic growth. Those goals would together generate
a particular social welfare outcome. Different political platforms would emphasise
different aspects in terms of social welfare. Some would insist on income distribu-
tion while others would support economic growth combined or not with universal
education as a mean to achieve equal opportunity as the ultimate goals of society. In
a democratic system people choose a political platform through voting to organise
society according to a particular set of principles, for a limited time.
A politician likely to become a planning minister should seek advice on how to
reflect their ideals in the planning portfolio. In the best-case scenario, the job of
such politician is to convince a majority of the electorate of the merits of a political
platform on planning. We are not saying that a politician should ignore any ideas
or suggestions coming from the public, but they should see how they fit with expert
advice and the political principles. For instance, if one asks the public about placing
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Shall they go on thus keeping up this so-called beauty and
delicateness, even if it be at the expense of ennui, debility,
nervousness, and general ill health?
Or, on the other hand, shall they go often and freely into the open
air, walking miles every day; or what is perhaps better, engage in
active, and, if possible, out-door pursuits, a part of each day?
In the one case, health is, as a general thing, easy to obtain; in the
other, impossible.
As children know by instinct, and physiologists by scientific facts,
human beings must go often into the open light of day, in order to
insure firm and enduring bodily health.
Nor are the good effects of light less important on the feelings,
habits, and mental manifestations of the individual.
AIR AND EXERCISE.
Would that I could now impress upon your minds, in some good
degree, the importance of AIR and EXERCISE in pregnancy.
See how well the Indian women get along with child-bearing; and
you know they are active in their habits, and go a great deal in the
open air.
How well, too, the poor, laboring people, the Irish and the
Germans, get along in having children; and are not they obliged to
work? Labor! verily thou art a blessing which we poor mortals do but
poorly prize!
I must say to you, then, in my humble way, to all of you who are
pregnant, DO NOT FAIL TO WORK. Work regularly—not too much at a
time, but little and often, avoiding all extremes. Go out, too, EVERY
DAY, and get the fresh air and light of heaven. So will you be rewarded
for every thing you do.
LETTER XI.
MANAGEMENT IN PREGNANCY.
Of the Diet Proper in this Period—Animal and Vegetable Food—Superiority of the

latter—The Drink.
I have in different places, in these letters, made some remarks on

the subject of food and drink. I thought it necessary, however, to be a
little more explicit on so important a matter.
I have in another letter said some things on the subject of those
strange and peculiar longings which women sometimes experience
in pregnancy, and have given you some advice on that point, which I
wish you also to bear in mind in this place.
Have you not often heard women remark, that when they are
pregnant they ought to eat more food than at other times, because
they have two to support!
It is my duty to tell you in all frankness, as also earnestness, that if
any one makes such a plea an excuse for dietetic indulgence; or if any
one, from ignorance on the subject, sets to eating more freely in
pregnancy than she would do at ordinary times, she will be very
liable to harm herself seriously; and more than that, she may thus
actually destroy her child, and have an abortion. If she should be so
fortunate as to run clear of this sad evil, she would yet be liable to
indigestion, costiveness, diarrhea, and all the long list of troubles
that grow out of a disordered state of the stomach and alimentary
canal at this period of her life.
Let us make a little calculation in regard to this matter of “having
two to support” in pregnancy.
The growth of the fetus, as depending upon the mother, is in
proportion to the length of time it is destined to remain in the womb.
In the first place, let us endeavor to ascertain the average weight of
infants at birth. I do not know that we have any tables in this country
that throw light upon the subject. We can, however, go to France,
where the industry of physicians has reduced almost every thing
connected with the medical art to figures and rules.
At the L’Hospice de la Maternité, in the city of Paris, the following
results were ascertained in regard to 7077 cases of births:
34 weighed from 1 to 1½ pounds.

69 „ 2 „ 2½ „
164 „ 3 „ 3½ „
396 „ 4 „ 4½ „
1317 „ 5 „ 5½ „
2799 „ 6 „ 6½ „
1750 „ 7 „ 7½ „
463 „ 8 „ 8½ „
82 „ 9 „ 9½ „
3 „ 10 „ 10½ „
The average weight of children, then, at birth, would appear to be

only between six and seven pounds. To make our calculation a safe
one, we will suppose the average to be seven pounds.
There is also to be taken into the account the placenta, the
membranes, and the liquor amnii, with which the child is
surrounded. We may, then, make the following calculation:
Weight of the fetus, 7 pounds, or 112 ounces.

„ placenta and membranes 16 „
„ liquor amnii 16 „
In all 144 „
The number of days in a normal pregnancy is about two hundred

and eighty. Reckoning three meals to a day—and some average more
than this number—we have eight hundred and forty meals in the
period. Now, according to the rule of three, if eight hundred and
forty meals are to produce one hundred and forty-four ounces, how
much must one meal produce? The answer, in decimals, is one
hundred and seventy-one thousandths of an ounce, and a fraction
over, or only a little more than one and one half tenths of an ounce at
each meal.
You will then at once perceive how absurd it is for a woman to
think that she must cram herself with food when she is pregnant,
because of the notion that she has two to eat for instead of but one as
at other times.
An intelligent and well-meaning lady of this city, Mrs. Pendleton,
once put forth a work entitled, “Childbirth Made Easy.” The theory of
the book was given on the authority of some English writers; and the
purport of it was, that in order to bear and bring forth a child as
easily as possible, the mother should live principally on fruit, more
particularly toward the close of the period of gestation. The more
substantial forms of food, it was contended, went to make too much
bone in the fetus, and hence, that if these were avoided, the bones
would be smaller and softer, in which case the birth would be the
more easy. The work also recommended the water-treatment, and all
other good rules of health.
I have no doubt that such a course of dieting in pregnancy would
do a good deal toward mitigating not only the pains, but the dangers
of the puerperal state.
The greatest of all dietetic enemies the world over is excess in
quantity. You see, then, how admirably this theory would work in
practice, although it might be false in real fact.
At any rate, you cannot be too careful of your diet when you are
pregnant. There is no period of your lives in which it is more
necessary to guard against all error than in this; and excessive
alimentation, as I before remarked, is the greatest of all dietetic
mistakes. It was one of Jefferson’s great canons of life, that we never
repent of having eaten too little. So I will say after him, that I never
knew a pregnant woman to suffer from taking too small an amount
of nutriment, but I have known many to suffer from eating too much.
I have elsewhere remarked, that the period of pregnancy is
necessarily attended by a greater liability to febrile and inflammatory
disease than is ordinarily the case. Every one knows—that is, every
one who knows any thing at all about the subject—that flesh-meat is
more heating and feverish in its tendency than the farinacea and
fruits. Mark, then, the evidence of the wisdom and benevolence of
the Creator, in taking away, for the most part, your appetite for
animal food when you are pregnant. You are more liable to disease at
this time than you are at others; and when disease does lay hold, it is
more apt to go hard with you. God in His mercy then says, “I will
take away the woman’s appetite for flesh when she is pregnant; yea, I
will give her nausea, and loathing, and vomiting, for her heart is
prone to lead her to excess.”
Do not then, I warn you, eat animal food at this time, even if you
should have some appetite for it, as is sometimes the case.
Observe, also, how very sumptuously you may live in the
vegetarian way. Indian mush; rye mush; rye and Indian bread; rye
bread; corn bread, or Johnny-cake, as it is called in many parts;
hominy; cracked wheat; wheaten mush; peas; beans; pumpkins;
squashes; melons; apples, green, dried, or otherwise, with a little of
milk and eggs, if need be, a little sweet; and a great many other
things, which I need not now mention, which you can have according
to the season. How well we could live, all of us, if we but would,
without causing the farmers to wring the chickens’ necks off, to beat
out the brains of the faithful ox and the affectionate cow with an axe,
or to cut off the head of the innocent lamb. Do you ever think of
these things when you eat meat?
What would you think of a woman who would eat pork meat and
pork grease in pregnancy? You have heard a great deal of scrofula—
that dreadful disease. In the long catalogue of maladies to which the
human body is subject, there is not one more fearful, more dreadful
than this. Scrofula is the swine’s disease; and the word is from the
Latin scrofa, which means a sow. The swine is, probably, of all living
creatures, the most subject to it. Think, then, of a woman’s eating
such food when she is performing so important an office in God’s
government as that of nourishing within her own body a living child.
How much pain, disease, and suffering may she cause by her
improper conduct at this time; or, on the other hand, how much
happiness and physiological well-being, if she pursues a proper
course. “Wisdom’s ways are ways of pleasantness” to her also as to
her child.
If it were not wandering to much from the tenor of my subject, I
might speak of the cheapness of living on vegetable food.
In this country of abundance we do not often see much misery
arising from want of sustenance. Still such things do happen, and
now and then in almost every part. True, our charities are
munificent, our country fertile, our people industrious, and on the
whole, benevolent; yet, there is always room for charity to work in. If
we cannot find an object at home, assuredly we can somewhere; and
we ought never to be satisfied with our course of self-denial, so long
as there is one hungry mouth more in the wide world to fill. I have
often thought of these things, I admit, when I have been eating
things which I ought not to have eaten. I presume you have done the
same thing all of you, for the human heart is as prone to evil as the
sparks are to fly upward, or a stone to fall to the ground.
If I could speak a word to a husband through you, on this
important matter of diet in pregnancy, I would say to him, “Do not,
as you love your wife, tempt her to any excess while she is pregnant.
Remember how you loved her when she consented to give you that
which was of incomparably more importance to you than the whole
world besides, her own faithful, loving heart. Remember, too, how
much she is made to suffer on your account. You can aid her by your
example, and by your sympathy you can uphold her; but the pains,
the agonies, and the perils of childbirth, these all are inevitably hers.
I say, therefore, set your wife a good example yourself. If you do not
thus aid her, surely as God liveth will you be made to suffer for your
evil deeds.”
If you should think that I have, in the course of these letters,
harped too much upon the subject of diet, I must ask your
indulgence. The importance of the topic, I am sure you will admit;
but as to my method of treating it, that is another thing. If you
consider that I have made a mistake, that I have taken up too much
of your time with that which you, perhaps, already understand, I
hope you will set it down against me only as a mistake of the head,
and not one of the heart, as the theologians say.
THE DRINK.
It has been a serious question with some, whether man is at all
naturally a drinking animal.
Whatever may be the truth in regard to this question, we all know
that man does drink, and that a good deal, and too often of things
which he ought never to take.
It is admitted, however, that if a person subsists wholly or
principally on farinaceous food and fruits, and avoids stimulants of
every kind, and all other excesses, leading throughout a regular,
sober, and temperate life, he will seldom experience the sensation of
thirst, and would then, consequently, not naturally drink. True,
water is one of the most important of all life agents—one which will
keep an animal alive more than twice as long as he could exist
without it; and notwithstanding the fact that the living body is
composed of nearly nine tenths of this element, still, under the
circumstances which I have supposed, we do not wish to drink
because our natural thirst is answered by the pure water that is
contained in the food and the fruits we use.
This, then, I consider the better plan: live in a manner so healthful,
so temperate that you will need little drink of any kind.
But if you do at any time need fluid internally, why not act in
accordance with all experience, all good judgment, all reason, and
adhere to the one best of all drinks?
See how the fever patient takes to water; how the animal, and the
vermin that have been poisoned with arsenic. See, too, the faithful
cow, the horse, and the ox, how they satisfy themselves with this best
and most abundant of all beverages when the hot sun comes down
them.
I wish that you could all have pure, soft water, both to drink and to
cook with; but you cannot, and then you must do the best you can.
However, if you will leave off all useless, and worse than useless
expenses in your living, you can soon make a cistern and a filter
which will give you an abundance of the best of water—that from the
clouds. A very little expense and trouble will also serve to construct
an ice-house, so that you can have luxury and health combined,
although I wish you to remember that ice should be used sparingly,
especially if you should become very much heated and fatigued.
When I sat down to write this evening, I thought I should say
something on the properties and effects of those almost universally-
used articles, tea and coffee. This much I do say, however, you who
are pregnant—you who are nursing, and, indeed, all and every one,
do as I for these twelve years have done, ESCHEW THEM ALTOGETHER.
They are pernicious in a great many respects. Besides this, I advise
you to get my worthy friend Dr. Alcott’s excellent work on TEA and
COFFEE. If you will but read that, I think you will conclude that it is a
great deal better to do as I have done.
Thanks to Father Mathew, and the noble cause of temperance,
there is little need of saying much now concerning the evils of
tippling, which women were some years ago in the habit of when Dr.
Dewees wrote, and against which he said so much. I need not say to
you at this late day, that it is a great deal better for you to leave off
alcohol in all its forms, and particularly during the period of which
we have been speaking.
LETTER XII.
DISORDERS OF PREGNANCY.
Nausea and Vomiting—Means of Prevention, and Cure.
There are a variety of physiological troubles that are connected

with pregnancy. True, women do not all experience these, any or all
of them; but inasmuch as you are liable to these affections, it is my
duty to speak of them. In doing so, I shall class all of these abnormal
symptoms under the general head of “disorders,” because I believe
that in a truly natural, or, in other words, healthful state of the
system, none of these ailments would be experienced.
Nausea and vomiting, as most of you know, and not a few of you by
experience—are, in the present state of society, frequent attendants
of pregnancy.
These symptoms occur, for the most part, during the earlier
months of gestation. They may, however, continue through the whole
period, and in some cases they cease and then return again toward
the latter part of it.
Most frequently morning-sickness commences from two to three
weeks after the beginning of pregnancy. It may, however, come on
the very day of, or next after conception, and some women have been
able to discover this circumstance by the occurrence of the vomiting
which follows it.
This sickness of the stomach is most apt to occur in the morning.
Hence it has been called “morning-sickness,” from the fact that it is
most apt to take place at this period of the day. This is in part,
doubtless, owing to the circumstance of the woman’s getting up at
this time, and not to any thing necessarily connected with that part
of the twenty-four hours. If she reclines, the sickness leaves her for
the most part, but again appears if she attempts to rise.
The matter thrown up from the stomach varies in character in
different cases. Much here depends upon the dietetic habits of the
individual and the state of the health. It is more commonly a sort of
tough, sour mucus; but sometimes there is vomited an extremely
acid, thin water, which in some cases is strong enough to excoriate
the mouth and set the teeth on edge. Sometimes, too, bile is thrown
up with the other matters.
The appetite is apt to become very variable in these cases; often,
indeed, there appears to be none at all; at other times the most
singular and even disgusting articles are craved for, and not
unfrequently that kind of food which we would suppose the worst for
the patient proves to be the best, that is, so far as retaining it on the
stomach is concerned.
It may appear a strange doctrine to you, that in general those who
suffer from nausea, vomiting, and the other more common
accompaniments of pregnancy, get along better than those who
experience none of these symptoms. “If vomiting should not be
violent, and occur only in the early part of the day, though very
troublesome,” observes Dr. Denman, “it is so far from being
detrimental, that it is generally found to be serviceable, by exciting a
more vigorous action of the uterus, and by bringing the stomach into
a better state.”
Some have been afraid that vomiting would cause abortion; and
such an occurrence might happen, if this symptom were brought on
in a violent manner, as by the administration of powerful drugs. But
the vomiting which comes on in consequence of the stomach-
sickness, instead of causing premature delivery, appears to be a
safeguard against such an occurrence. In other words, those who
experience nausea and vomiting, are not so liable to miscarry as
those who have none of these symptoms.
If we could but take into our minds the whole scope of nature, and
if we were able to trace, like the Infinite Mind, causes and effects, we
should, doubtless, much oftener than we now are, be struck with the
evident goodness of the Creator, even in the physical sufferings
which He has made it our lot to endure. What is the office of nausea
and vomiting in these cases? It is possible, under bad management,
for these symptoms to become actually alarming in their extent. But
what, it is well for us to inquire, is the design of these occurrences, so
common during the period of gestation? Plainly, to restrain the
woman from the gratification of a voracious and wayward appetite,
the indulgence of which could but be of material detriment to both
mother and child.
How is it in sea-sickness? Do we not find that people who go to sea
are generally benefited in health thereby, and that none are so much
benefited as those who are made sick? And how are they thus
benefited? I answer, by the abstinence and fasting which they are
compelled to practice. Almost all persons—all, I will say—have more
or less of impurity in their bodies, so badly have we treated
ourselves, and so badly do we live. Hence it is that in sea-sickness,
and in the vomiting that occurs in pregnancy, benefit is received; the
body is made to purify itself by its own inherent power.
If every pregnant woman could have nausea enough, no doctor
would ever think of bleeding her; it would prevent all that plethora
and fullness of the system which, under such circumstances, have led
good and honest men, as well as women, to believe it is often best to
abstract blood.
But you ask me, are these symptoms really natural, and
intrinsically best for the system in pregnancy? I answer, they are not.
I believe it possible so to live that a woman pregnant need not have
them any more than any one else. In sea-sickness how is it? The
sailors—they who are kept up regularly in the open air every four
hours at farthest—never have it to any extent worth speaking of. The
first time they go to sea they are apt to be sick, like other people; but
in a day or two it is all gone—they work it off.
So, too, in the sickness of pregnancy. We never hear of the Indian
women having it. They, likewise, are active in their habits, live
plainly, and go often into the open air.
One of the most important things to observe in these cases is, not
to eat too much, or at wrong times. A great many patients of this kind
make sad work with themselves by eating all sorts of things for which
they have a relish, and at all hours of the day, just as the fit happens
to take them. We know full well how important it is to eat regularly
when we are in health. How much more so, then, must it be when we
are ill! If you have nausea, or if you have not, but no appetite, drink
some pure cold water, and wait; the appetite will come.
It is really surprising to see on how small a portion of food a
patient can subsist for many days.
The laboring classes—those who are compelled to work hard,
whether they would or not, and who are obliged, in consequence of
the iron hand of poverty being upon them, to live on plain, homely
fare—they are not troubled with nausea and vomiting, as the idlers
and the luxurious are.
You will naturally expect me to speak of the professional treatment
for these troubles; and in regard to this, I remark, there are a great
many things to be taken into the account. You cannot well know too
much in regard to all the means of improving the general health.
The nausea is the most distressing part of morning-sickness, as it
also is of sea-sickness. In the former, as in the latter, it is one of the
most comforting things that can be done—the most comforting,
rather—to take a good draught of pure, soft water, at about the blood
temperature. If enough is taken it causes vomiting, which at once
brings relief; but if the stomach should not thus be excited to an
inverted action, the water will yet do good, as it tends to “settle the
stomach,” and this of itself brings a good deal of relief, although not
so much as actual vomiting would do.
Some may tell you that vomiting is dangerous in pregnancy—that
it is liable to cause abortion. So it is, as I have before said, if it is
rendered very violent by the giving of powerful drugs. But any thing
like a reasonable emetic, even of the drug kind, is comparatively safe
in this respect; so much so, that the most experienced and most
honest physicians are not now afraid to vomit a pregnant patient, if
they consider it important to resort to that measure. Emetics of the
drug kind have even been used, and apparently with good success, as
a cure of the nausea of which I have been speaking.
But do not understand me as recommending vomiting, even by
water, the best and mildest of all emetics, except in cases of urgency,
and when it can be made to take place without great straining or
effort. As a general thing it is far better to fast.
I do not know of any thing in which physicians have been more
puzzled than in the treatment of these symptoms. They have left
nothing in the materia medica untried. The result is, however, that
no plan has yet been fixed upon as being a legitimate one, or one that
can be depended upon with any tolerable chance of success. Patients
have sometimes died of the exhaustion caused by the vomiting, as
has been supposed; but I am more inclined to think they have far
oftener been drugged to death. It is mostly in the hospitals that these
deaths have occurred, and there, as you know, there is great
temptation for experimenting. Young physicians are there allowed to
make experiments; and there the older ones are also too much
tempted to do as they would not wish to be done by.
Physicians have been so much thwarted in these cases, that they
have often recommended bringing on premature delivery, fearing
that the patient would be destroyed if they did not resort to this
dreadful expedient. Most of them, I have no doubt, have acted
honestly in these dreadful emergencies. It is to their credit that they
seldom, if ever, have resorted to premature delivery without first
having counsel on the subject.
I have already hinted that exercise and activity are great helps in
keeping off those troubles that so often occur with the pregnant. I
would repeat, BE ACTIVE. Do not let a day, a half day, nor even an hour
pass over without your doing something. Be active, regularly,
habitually active. Let this be your motto, and your practice, too.
I must tell you also that water-treatment is a most useful help.
Take the rubbing wet-sheet when you feel so badly, and see how
great a change it will work. Wear the wet girdle, and take the cold
hip-bath, not too long at a time, if necessary. I do not know that I can
recommend eating ice, as some have done; yet it has sometimes
appeared to act very favorably, and great quantities have been used
by some in this way, without any apparent harm.
The cold water injections are much to be recommended in cases of
costiveness, which often occurs in connection with the vomiting.
LETTER XIII.
Fainting—Its Causes—Symptoms—Results—Treatment.
Fainting sometimes happens in pregnancy, even with those who

are not subject to it at other times. It is more apt to occur at or about
the time of quickening. Some persons are very subject to it, from very
slight causes, during the whole period of pregnancy; others
experience it only occasionally; and some have it repeatedly, and
some periodically. It is more commonly the weakly and delicate who
are thus attacked; but some healthy females are subject to it. It
happens with some every month periodically, with others every
week, and in some cases every two or three days, or even oftener.
Causes.—Fainting in pregnancy is often excited by the first
movements of the child, even while they are weak, and by
subsequent ones when strong. It is sometimes a consequence of
palpitation, or derangement of the heart’s action and of the
circulation. Too great exercise of either mind or body, want of
exercise and employment, violent mental emotions, running too
quickly up stairs, want of sleep, offensive sights and odors,
overeating, and too great heat in the apartment—each of these may
bring on fainting in pregnancy. Dr. Campbell observes, “As in the
gravid (pregnant) state, fainting seizes individuals so suddenly, and
that, too, while they are in perfect health, it is difficult, more
especially in the early months, to account for it, since the uterus at
this period cannot, from its bulk, produce any interruption or
irregularity in the circulation of the heart or larger vessels. The
womb, however, may influence the heart in another, viz., through the
medium of the nerves, whereby irregularity of its action, as often
happens from a similar cause on other occasions, is produced; this
inordinate action may lead to some irregular distribution of the
blood in the cerebral vessels, and hence fainting.”
Symptoms.—The patient experiences a feeling of langour,
weariness, and weakness, and there is a frequent inclination to yawn
or sigh; the sight becomes dim; surrounding objects appear to turn
round; specks float before the eyes; there is a ringing or buzzing in
the ears; the face becomes pale, and thus the patient becomes faint
and insensible. The premonitory symptoms, if any appear, are
sometimes so rapid in their course, that the patient is unable to call
attention to them.
During the fit there is no pulsation at the wrists; the heart beats
but faintly; breathing is nearly suspended; the muscles lose their
power, and a cold sweat breaks out over the surface. But there is no
convulsive motions of the limbs, nor any frothing at the mouth, in a
case of simple fainting.
This condition of things may last only a few minutes, or for several
hours. When the fit begins to pass off, respiration becomes more
distinct, the patient utters a few long-drawn sighs, the heart begins
to act with more energy, the pulse at the wrist becomes more
perceptible, some color appears in the face, and the consciousness is
again restored. In some cases consciousness is not entirely lost, and
in some it is long before it is fully regained.
“There is a species of syncope,” says Dr. Burns, “that I have oftener
than once found to prove fatal in the early stage of pregnancy,
dependent, I apprehend, on organic affections of the uterus; that
viscus being enlarged, or otherwise diseased, though, perhaps, so
slightly, as not previously to give rise to any troublesome, far less,
pathognomonic symptoms. Although I have met with this fatal
termination most frequently in the early stage, yet I have also seen it
take place so late as the sixth month of pregnancy.”
Cases of organic disease of the heart, however, are rare, so that you
ought not to think, at every little fainting spell you may experience,
that you have a disease of this organ. If in the syncope there is
convulsive motion of the limbs, distortion of the features, and
frothing at the mouth, it is only a hysterical spasm.
If fainting happens most toward the close of pregnancy, it is to be
regarded with more suspicion, according to the opinions of some
authors; not so much, however, for the immediate consequences, as
for its effect upon the convalescence after parturition.
This symptom sometimes occurs in consequence of an internal
hemorrhage, in which case it is generally never prolonged,
accompanied with fullness and tension of the abdomen, dull pain
and weight in the pelvic region, permanent blanching of the surface,
and after a short time a discharge of blood from the vagina.
Results.—In fainting, the circulation becomes for the time almost
suspended. When, therefore, we consider the dependence of the fetus
upon the maternal circulation, we cannot suppose that its frequent
recurrence is wholly innocuous to the child. Occasional fits of
syncope, however, appear to do no harm to the fetus; and yet it is
always best to avoid the occurrence as much as possible. It has been
known to cause abortion when it has been often repeated.
Treatment.—The patient should, during the fit, be placed in the
most comfortable posture, the recumbent being the best, the head at
the same time being laid rather low, and, if possible, where a current
of cool or cold air can be made to blow over it, particularly upon the
face; sprinkling cold water in the face, and washing and rubbing the
face and hands in cold water are useful measures. In some cases it
would be also advisable, or rather necessary, to wash and rub the
whole surface.
A full injection of tepid water will aid materially in bringing about
consciousness and circulation in these cases.
This water-treatment is incomparably better than that which is
usually adopted, such as giving the patient wine, brandy, spirits,
carbonate of ammonia, etc.
It generally happens that people themselves, without the aid of the
physician, have to manage cases of syncope. This they can readily
enough do as a general thing; but if it should prove at all persistent
or troublesome, they should lose no time in getting the best medical
advice they can obtain.
Prevention.—Every thing should be done that may be to restore
the general health. Oftener by far than otherwise, fainting is purely a
symptom of debility. This fact of itself suggests the measures that
should be adopted in order to ward off the attacks.
LETTER XIV.
Abortion—Its Nature and Ill Effects—Its Causes—Means of Prevention.
Abortions are evidently not in the order of nature. We see in the

animal kingdom that, as a general fact, gestation everywhere goes on
to its full and normal period; that abortions are very rarely indeed
seen; but when we come to consider the animal man, we find a
different state of things. With man, and man only, abortions are
frequent.
Certain classes of females are more subject to abortion than
others. Fleshy or excessively fat women, and those who experience
excessive menstruation; those who are hysterical, nervous, irritable,
or excessively sensitive; those who have a very fair complexion, and
are rickety, scrofulous, or have any other taint of the general system;
those who have dropsy, or are affected with cancers; those who drink
tea and coffee freely, and eat habitually highly concentrated and
stimulating food; those who live a life of excitement, frequenting
balls, parties, and theaters late at night; those who are in the habit of
much novel reading, and perhaps, above all, those who, in
connection with their sensual and worse than brutish husbands,
abuse the marital privileges, are most apt to abortion. If husbands
have any regard for the physical welfare of either their wives or
offspring, or even their own health, let them refrain from all sexual
indulgences during the period of the wife’s pregnancy. Dr. Edward
Baynard, a quaint but able English writer, one hundred and fifty
years ago, in speaking of the evil effects of swathing and dressing
infants too tightly, indulged in the following reflections: “’Tis a great
shame that greater care is not taken in so weighty an affair, as is the
birth and breeding of that noble creature, man; and, considering this
stupid and supine negligence, I have often wondered that there are
so many men as there are in the world; for what by abortions, too
often caused by the unseasonable, too frequent, and boisterous
drunken addresses of the husband to the wife, when young with
child, and her high feeding, spiced meats, soups, and sauces, which,
with strait lacings, dancings, and the like, one full half of the men
begotten are destroyed in the shell, squabbed in the nest, murdered
in embryo, and never see light; and half of the other half are overlaid,
poisoned by ill food, and killed at nurse,” etc.
Terror, fright, and excessive fatigue, also, not unfrequently cause
abortion. All unpleasant sights, and all undue mental excitements,
should be, as far as possible, avoided by those who are pregnant.
There are vile books in circulation, sold too, sometimes, by highly
respectable booksellers, in which the writers affirm that abortion can
be produced without any harm to the constitution. There is one
physician in this city, whose book we saw a few days since in a
bookstore in the city of Boston, in which he proposes to effect
abortion with perfect safety; but, for the package of medicine, a fee of
ten dollars must be sent, of course, in advance. It may be of service to
some who may peruse these pages, for me to inform them, that there
is always great danger in causing the expulsion of the fetus. The most
powerful medicines for this purpose are often known to fail.
Gastritis, enteritis, peritonitis, and death itself, has been caused by
medication, without causing the intended abortion. And in those
cases where the desired object is by chance brought about, sad is it to
think, what for years must be the health. Even life-long misery and
suffering have often been caused by drugging the system to produce
abortion.
You have read those lines of Ovid, which Dryden gives us:
“But righteous vengeance of their crimes pursues,
And they are lost themselves who would their children lose,
The poisonous drugs, with mortal juices fill
Their veins, and undesigned themselves they kill.
Themselves upon the bier are breathless borne
With hair tied up, which was in ringlets worn.”
Women cannot be too careful of their bodily health during the
period of pregnancy. If they would avoid, among a multitude of evils,
the great misfortune of abortion, they cannot be too vigilant, and
watchful, and careful in all matters pertaining to health at this time.
Any imprudence here, such as would scarcely be noticed at other
times, may lay the foundation for much future suffering.
I am here led to remark, that too much labor and exercise, as well
as idleness and habits of effeminacy generally, in this hard-working
country of ours, not unfrequently cause this evil. Lazy people do
habitually too little; industrious people often too much.
It appears that abortions are becoming more and more frequent in
this country at the present day. It is notorious that the habits of
Americans are not now as simple as they formerly were. More tea
and coffee are drank, more rich and stimulating food is used, and
there is a vast deal more idleness withal. Formerly labor was more
dignified, more respected; but labor now is degrading. It is not
fashionable to spin, weave, knit, sew, wash, and to make bread, as in
the good days of our grandmothers. People are everywhere growing
more indolent. “The sluggard will not plow by reason of the cold; he
shall, therefore, beg in harvest, and have nothing.” So, also, those
who will not employ the limbs and muscles which God has given
them for use, cannot have permanent and enduring health at any
price.
But it is asked, Would you pay all attention to physical culture, and
neglect the mental? I answer, no. I would have my daughters taught
music, painting, drawing, as well as science generally, but on no
account would I do this at the expense of bodily health. Nor is there
any need of this; the highest possible cultivation of the mental
manifestations can only be accomplished when the physical powers
are suitably and proportionably developed to their fullest extent. “A
sound mind in a sound body, is nature’s inevitable law.” There is yet
one evil pertaining to the subject of abortion, an increasing one too,
in some parts of our country at least, of which I should speak.
Abortion, it will thus be seen, is a serious evil. Its consequences
may, in general terms, be condensed as follows:
1. A stronger tendency to a recurrence of the evil. Those who
miscarry once are much more apt to do so again.
2. Menorrhagia, or an immoderate flow of the menses.
3. Irregularity of the monthly periods; these occurring either too
often or too seldom, and attended with much prostration of the
general health.
4. Dysmenorrhea, or painful, laborious menstruation,
accompanied often with more pain and suffering than attend labor
itself.
5. Hysteria, or hysterics, depression of spirits, disquietude,
dissatisfaction with life, its pursuits, pleasures, and enjoyments, and
an habitual melancholic state of mind.
6. Dyspepsia, with all its train of pains and penalties. This picture,
terrible as it may appear, is no imaginary one. Every well-informed
physician will at once recognize the truth of all that has been
affirmed. It is a bad state of the system which allows of abortion. One
abortion ordinarily is far more trying and worse upon the
constitution, than two labors at full term.
Means of Prevention.—In speaking of the evils of abortion, the
means of preventing such an occurrence have necessarily been
hinted at. There are yet other things, however, which should be
referred to on this subject.
It will naturally suggest itself to every reflecting mind, that the
great object to be attained in regard to the prevention of abortion, is
a thorough, habitual, and permanent cultivation of the physical
powers. Invigorate the general system to its fullest extent;
accomplish this, not only for a single time, but, as it were,
perpetually, by daily and never-ceasing effort. Is not health the
greatest of all earthly blessings? How, then, in order to secure it, can
we do or sacrifice too much?
In reference to the prevention of abortion, let the following
particulars be observed:
1. The use of cold water. In all cases of abortion there is too great
laxity of the system; there is a want of tonicity, so to say; the fibers
are, as it were, unstrung. Cold bathing, for its tonic, constringing,
and invigorating effect, has for centuries been recommended as a
most valuable means of preventing this evil. In pregnancy, the same
general principles should be observed in fortifying and invigorating
the general health as at other times. No violence should be done to
the system. A general bath in the morning, cool or cold, according to
the individual’s strength; a hip or sitz-bath of five or ten minutes’
duration, two or three times during the day, and an ablution with
water, not too cold, on going to rest, will ordinarily be sufficient for
the daily routine of treatment in those cases where there is tendency
to abortion; such a course is, in fact, good at all times. The wet girdle,
elsewhere explained, will often be of advantage; but to make it a
tonic or strengthening application, as it should always be under these
circumstances, great care must be taken that it does not become too
warm. This is very apt to be the case in hot weather. It must then be
changed often and rewet. If it becomes too hot, it weakens the system
instead of strengthening it, thus tending to cause the very difficulty it
is intended to prevent. “Injecting cold water into the vagina twice or
thrice a day,” says Dr. Burns, in his work on midwifery, “has often a
good effect, at the same time that we continue the shower-bath.” And
this writer also observes, “that when there is much aching pain in the
back, it is of service to apply cloths to it, dipped in cold water, or
gently to dash cold water on it, or employ a partial shower-bath, by
means of a small watering can.” Water, let it be remembered, is the
greatest of all tonics to the living system.
2. Feather beds and overheated rooms. These have much to do in
causing abortions. People ought never to sleep on a feather bed,
unless, possibly, very old and feeble persons, who have long been
accustomed to them. In such cases it might not always be safe to
make a change in cold weather suddenly. But for a pregnant woman
to sleep on a feather bed is one of the worst of practices. And here
also I must mention that feather pillows, as well as feather beds, do a
great amount of harm. Even those who have emancipated themselves
from the evils of feather beds usually retain the feather pillow. It is a
wise old maxim, “to keep the head cool.” The head has blood enough,
more than any other part of the system, to keep it warm. No person,
not even the youngest infant, should ever sleep on a bed or pillow
made of feathers. The animal effluvia coming from them is bad, and
the too great amount of heat retained about the surface debilitates
the system in every respect.
3. Undue mental excitements. Let those who are pregnant avoid
theaters, balls, and parties late at night, all highly excitable public
meetings, whether literary, political, or religious, and all undue
mental and moral excitements of whatever kind. In no situation is it
more necessary for a human being to maintain a pleasant, consistent,
and equable frame of mind, and good and permanent health of body,
than in pregnancy.
4. Sexual indulgences. The more strictly chaste and free from
sexual indulgences, the better for the woman during pregnancy.
5. Recurrence of abortion. Every succeeding miscarriage is more
apt to be followed by a recurrence of the evil; the body, as it were,
like the mind, is capable of getting into bad habits. Those who have
abortion oftenest are most liable to their recurrence; and every attack
is more apt to be worse than the preceding one.
6. General health. Abortion always indicates a bad state of the
system generally. A person of really good health could scarcely have
abortion. Possibly fright, unpleasant occurrences, or accidents, might
cause such a result. Abortion always injures the general health. Labor
at full term is natural, and is therefore attended with less danger.
Abortions are unnatural.
7. Vegetable diet. This was observed by the celebrated Dr. Cheyne,
of England, to have a great influence in preventing abortion; milk,
however, which is in some sense a form of animal food, was generally
used. A total milk and seed diet, as Dr. Cheyne terms it, was a most
excellent means of preventing unfertility and abortion.
8. Tea, coffee, and spices. All stimulants, that is, articles which do
not go to nourish the system, such as tea, coffee, tobacco, wine,
porter, spirits, and the like, should be strictly avoided. All
stimulation of the system is followed, necessarily, by commensurate
depression. A person takes a stimulant, and feels better for the time.
In the same proportion as the stimulation will be the consequent
depression. The more a stimulant is used, the more necessity will
there be to keep up the habit; and the more the habit is followed, the
weaker does the system become. Thus in pregnancy, by the use of
stimulation, the system becomes more liable to abortion.
9. Exercise. More than one hundred years ago, the celebrated Dr.
Cheyne remarked, concerning abortion and its causes, as follows: “It
is a vulgar error to confine tender-breeding women to their
chambers, couches, or beds, during all the time of their pregnancy.
This is one of the readiest ways to make them miscarry. It is like the
common advice of some unskillful persons to such as have
anasarcous or dropsical legs; namely, to keep them up in chairs, on a
level with their seats, which is the ready way to throw up the humors
into their bowels, and fix them there. The only solid and certain way
to prevent miscarriage, is to pursue all those means and methods
that are the likeliest to procure or promote good health, of which air
and gentle exercise are one of the principal. All violence or excesses
of every kind are to be carefully avoided by the parturient; but fresh
air, gentle exercise, walking, being carried in a sedan or chaise on
even ground, is as necessary as food or rest, and therefore is never to
be omitted, when the season will permit, by tender breeders.”
In my next letter I shall speak in detail concerning the special
treatment that should be adopted in these cases.
LETTER XV.
The Evils of Abortion—The great Danger of bringing it on purposely—Cases—

Illustrations of the Methods of Cure—Uterine Hemorrhage—Cases of Cure.
In the summer of 1849, walking down the Bowery, in the city of

New York, I fell in company with a lady whom I had attended in
childbirth, some three years previously. She was of middling stature,
and I should judge twenty-five or six years of age. She said she had
been for some time desiring to speak to me concerning her health.
Since the birth of her last child she had a number of times
experienced abortion, at three or four months from the
commencement of pregnancy. She could not understand why it
should be so; she was tolerably careful in diet, and bathed, to some
extent, daily. She was, perhaps, in her husband’s store too much of
the time, standing upon her feet, waiting upon customers, etc.
Formerly she was a great walker, and could endure a good deal of
fatigue, but latterly she was becoming less and less able to take long
walks. She soon became fatigued, whereas, formerly, she could go to
almost any extent in pedestrian exercise. The question was, how to
avoid these abortions and their ill consequences. I gave her advice
concerning diet, bathing, exercise, etc., and the next day wrote her
husband substantially as follows:
“Dear Sir—Your very worthy wife inquired of me yesterday what she should do
in reference to preventing abortions, to which she is of late growing subject. I
advised her the following treatment:
“1. Perform thorough ablution on rising in the morning. Drink some water, and
walk in the open air, but not so much as to induce great fatigue. Housework is very
good, but going into the open air, an hour or thereabout before dinner, will be
better.
“2. Take the rubbing wet-sheet, and after it the sitting-bath ten minutes. Take
also some kind of exercise before and after this bath.
“3. In the afternoon practice the same thing as in the forenoon.
“4. The rubbing wet-sheet on going to rest.
“5. It is very important that due attention be paid to diet. She should eat no
meat, butter, and as little sweet as possible. Rice, brown bread, Indian mush,
hominy or samp, potatoes, good fruits, and milk—these are the best articles for
her.
“6. In addition to the above advice which I gave to your wife, there is a very
important matter to be observed. Do you not practice too frequent cohabitation
with her? This is, perhaps, of all, the most prominent among the causes of
abortion. Taking a survey of the animal kingdom, we observe it to be a law, that
animals do not cohabit during the period of pregnancy.
“Knowing that you are a kind and good-hearted husband and desire the best
good of your wife, I take the liberty of submitting to you the following rules, which,
I am confident, you will agree with me will be safe:
“1. Always sleep separately for six months at least, and twelve would be better.
By that time we have every reason to believe your wife will enjoy her natural
health.
“2. Suppose that after these six or twelve months, pregnancy again occurs, sleep
then again separately during the entire period, and at the same time let your wife
follow a similar course in water, diet, exercise, etc., to that I have above
recommended.
“Then will she be able to prevent those disastrous consequences of frequent
abortion.”
Case II.—In the spring of 1845, I was called upon by a gentleman

and his lady for advice in regard to herself, she being then at about
the middle of the term of pregnancy. She was threatened, as she
believed, frequently with abortion. The year previously she had had a
bad miscarriage, which was occasioned by a fall. She was of
scrofulous habit of body, and had borne already seven or eight
children, a number of whom had died.
I directed the patient to practice general ablution two or three
times daily, with hip-baths of short duration, to exercise in the open
air, and ride frequently, according as she could bear; but to be careful
never to do too much at a time. A little overdoing would be liable to
cause the difficulty with which she was threatened. The strictest care
in diet I strongly advised her to observe.
She went on faithfully in the fulfillment of these directions, and
about the end of the month of August, in exceedingly hot weather,
she gave birth to her child. She followed the water-treatment
resolutely, according to my directions, and in ten days was able to
enjoy very long walks in the city. Twice she has been pregnant since
that time; and at the time of writing this, has gone to the eighth
month without experiencing any symptoms of abortion.
I should remark, this lady had frequently had miscarriages before
the one above referred to.
Case III.—A very small, delicate, young woman, of this city, being
about seven months advanced in pregnancy, went to an evening
party, at which she danced. Being very fond of that exercise, she, no
doubt, overdid the matter. Indeed, dancing at all in that condition is
rather a hazardous experiment. Abortion came on, attended with a
great deal of prostration. Water-treatment was practiced in this case,
and she recovered as well as could be expected. She felt very sad at
thus having lost her child, and resolved for the future to do better.
Since that she has succeeded in bringing forth a tolerably healthy
offspring.
Case IV.—I knew, some years since, a young married lady, in the
city of Boston, who was much addicted to novel reading, and going to
balls, theaters, parties, etc., at night. She walked a long way one very
hot, sultry night in midsummer, and became overheated and
fatigued. On arriving home she commenced bleeding, which became
so severe that before a physician could be obtained she fainted many
times, and apparently came very near losing her life.
Case V.—I recollect a case which occurred some years ago—one,
indeed, which I shall not soon forget, because of the fatigue and
anxiety it caused me. A gentleman came after me in the night time,
telling me that his wife was bleeding, and had already bled to such an
extent that he believed she would be dead before I could get to her.
On arriving at the house, I found she had fainted many times, and
that she had bled enormously, and even then there was no
amendment of the symptoms. I do not know that I ever saw a person
apparently so near death from hemorrhage as this lady, and yet
recover. I had to remain with her almost constantly for two days and
nights, before she appeared to be at all safe.
Years afterward, this lady gave me the following information
respecting the cause of that frightful abortion:
Suspecting that she had become pregnant, and much against her
inclination at the time, she resolved upon procuring an abortion.
Pregnancy, she said, at that time would interfere very much with her
comfort, arrangements, etc. She consulted a lady-clairvoyant in
reference to the matter. The clairvoyant could not even tell her
whether pregnancy existed or not; but to make safe in the matter, she
ordered some vegetable teas to be drank in large quantities, which
she said would expel the fetus, if one existed. She thus went on for
some time. Her general health became deranged by the dosing, and
yet no abortion was procured. Afterward, more powerful medicines
were directed by the clairvoyant. These she found were at length
making great mischief with her health; her stomach became very
much deranged, and a regular tertian intermittent set in, yet no
abortion came on.
At length, one day her children fell down stairs. Hearing them, she
ran down two flights with the greatest precipitation, and as if she
were in no sense delicate in health. This, together with the fright she
experienced, prostrated her system very much, caused a great
trembling to come over her, which soon resulted in the miscarriage I
have referred to.
It was a long time—many months—before this patient recovered
any thing like her former health. She was low-spirited, dull, inactive,
and could take no comfort of life.
Case VI.—Two years after this the same lady was again pregnant.
One day she did a very large washing, together with other kinds of
work, and became much exhausted. This, again, brought on
miscarriage, attended with fearful bleeding as before. A resolute
course of treatment was practiced, and thus she was again rescued
from danger; but such attacks are always worse than labor at full
time.
Case VII.—While I have been writing and arranging these letters, I
have been called to visit a lady who has been pregnant a few weeks
the second time. Her first child has been somewhat ill from teething
—in fact, a good deal sick for some days and nights, and taking care
of him, bathing, dressing, applying the bandages, etc., to him, has
made her quite weak. Two or three days ago, her husband was gone
from home of an evening, and being a very punctual man in such
matters, as all good husbands are, his wife expected him home early.
He was, however, hindered beyond his time. This caused her a good
deal of anxiety, although he had a friend with him. Soon after his
return, bearing-down pains came on, and some discharge. Afterward
she got better, and then in a day or two much worse. The mother-in-
law gave her gin, the old-fashioned way to help on the courses, not
believing, I suppose, that she was pregnant. But nature did better
than the dosing; it would not let her abort. About this time I was sent
for, whereupon I told her to keep pretty quiet, put on a heavy wet
girdle, and change it as often as she felt bearing-down pain—every
hour or two, at farthest. The cloth worn upon the genitals, under
such circumstances, was also to be kept wet in cold water. But first of
all, she was to take a good washing by sitting before a fire in a wash-
tub, with tepid water, but not quite warm. This gave her a good deal
of relief. In the morning I found her quite well, and free from pain
and discharge.
It is far from being my wish, by any of these letters, to fill your

minds with unpleasant thoughts or ideas of horror. But it occurred to
me that you were, perhaps, many of you not aware that there are vile
persons in our great cities who make it a regular business to procure
abortions. Now I need not repeat to you, that a practice so wicked
and unnatural as this must necessarily be fraught with great danger.
I thought I would present you with the account of a case of this
kind, given us by a celebrated professor of this city, Dr. G. S. Bedford.
It is as follows:
“Mrs. M—— was the mother of two children, and had been
suffering extremely, for the last fourteen hours, from strong
expulsive pains, which, however, had not caused the slightest
progress in the delivery. I was likewise informed, that about four
hours before I saw the case, Dr. Miner, an experienced physician,
had been sent for, and, after instituting a vaginal examination,
remarked to the attending physicians, that, in all his practice, he had
never met with a similar case. Dr. Miner suggested the

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