The cases in which the forceps are absolutely necessary however, are

VERY RARE, much more so in fact than many people suppose. _Patience_,

and the persevering use of ordinary assistance, would probably succeed

alone in half the cases where they are now employed.

In Murphy's lectures on _difficult Labors_, he gives us some valuable

statistics on this subject. He tells us that in _seventy-five thousand

nine hundred and eleven labors_, the forceps were used only _one

hundred and thirty-eight times_, or once in every _five hundred

and fifty_ labors. In these one hundred and thirty-eight cases

_thirty-five_ of the children died, and _ten_ of the mothers. Dr.

Murphy however, thinks that the general results, to both mother and

child, would be equally favorable if the forceps were _not used at

all_, and he gives the tables of Dr. Collins to support his opinions.

From these tables it really appears that, when all the difficult labors

were left entirely to nature, the number of deaths was _just about

the same as when the forceps are used_, in fact _rather less_, while

the accidents, and subsequent evils, were not nearly so great. Dr.

M. therefore thinks that the forceps should _never_ be used, except

in a few cases where everything is quite favorable to the passage of

the fœtus; and the uterus _cannot_ be made, in a reasonable time, to

contract and expel it; and also when _immediate_ delivery is needed

to save the mother's life, as in flooding. In cases of mere ordinary

difficulty or delay, he decries their use entirely; and he evidently

thinks that when the labor is _fit_ to be terminated by the forceps,

nature can and will terminate it herself if left alone. There is no

doubt but that they are now used a great deal _too much_, either from

a desire to _operate_, or from _want of patience_; and I have no

hesitation in expressing my opinion that more have been _killed_ than

_saved_ by them.

OTHER INSTRUMENTS.

Respecting other instruments, such as the _Crotchet_, the _Vectis_, and

the _Cephalotribe_, or _crushing forceps_, it is not necessary to say

anything here, as their use, when imperatively needed, must necessarily

be confined to the surgeon; and fortunately may now be dispensed with

altogether. The recently introduced practice of bringing on _premature

labor_, in all cases of deformity or smallness of the pelvis, entirely

obviates the necessity for any of these dreadful resorts, if the

difficulty be known in time, which it is sure to be when a sufficient

degree of knowledge is disseminated.

The _Cesarian operation_, or cutting open the womb externally; and

_Cephalotomy_, or the opening of the child's head, may also be

dismissed with the same observations. _They can always be avoided_, if

the real condition of the patient is known in time; and if from neglect

nothing else can be done, they must always be performed by a skillful

surgeon.

CHAPTER XXV.

OPERATIONS WITH THE HAND.

TURNING.

This is one of the most useful operations that the accoucheur can

perform, in many cases, and has the advantage of being altogether

accomplished _by the hand_. Its object is to change the presentation,

when unfavorable, and to facilitate delivery. Most usually the hand is

introduced into the uterus, and the _feet_ are brought down. This is

called _pelvic version_; but sometimes the head is brought to the mouth

of the womb, particularly in shoulder presentations, and this is called

_cephalic version_.

_Cephalic Version._--This can seldom be performed, and not often

attempted with safety. In some cases however, when it is ascertained

that the shoulder presents, and before the membranes are broken, an

effort may be made to remove it and bring the head in its place. To

do this the position of the head must be ascertained externally, and

one hand placed upon it; then with the two forefingers of the other

raise up the shoulder from within, as in ballotment, and endeavor to

push the head into its place. If the child be very moveable this may

sometimes be done, and will be highly advantageous; but most frequently

the substitution cannot be accomplished, and the attempt ruptures the

membranes, after which it is still more difficult, and even becomes

dangerous. Even if the head be brought down there is always danger of

its becoming displaced, and the shoulder again presented, owing to

the tendency which any presentation has to be reproduced. To prevent

this the hand should be firmly pressed on the fœtus, externally, as

soon as the head is brought down, to fix it; and the membranes should

be ruptured so that it may begin to descend, after which there is no

danger of a change.

Cephalic version can be so seldom performed however, and is so

difficult, and sometimes dangerous, that it is seldom or never

attempted; more particularly as pelvic version can always be

substituted, and is more easy and safe. It is true that presentations

of the head are the most favorable, providing they occur before the

rupture of the membranes, but after that event they may not be so

favorable as those of the lower extremities, and certainly are not so

easy or safe to induce.

_Pelvic Version._--Turning to bring down the feet is performed for

various reasons, and under many different circumstances. As a general

principle we may say that it is done either to change the presentation,

when unfavorable, or to terminate the labor when it is lingering,

or when it is desirable to have it over as quickly as possible. The

feet may be drawn through the mouth of the Womb when it is but little

opened, and when they have once passed, the limbs and body soon follow,

and the head seldom remains long behind. The fœtus may in fact be

compared to a _wedge_, of which the feet are the point, and if they

enter the passage the rest part is gradually driven after by the

uterine contractions.

The chief contingencies which call for the operation of turning are, a

protracted labor, a presentation of the placenta, causing hemorrhage,

and a wrong presentation, particularly one of the shoulder.

The operation of turning is very clearly explained by Dr. Lee, and I

know from experience that his directions can be safely relied upon.

It very frequently happens however, that there will be some peculiar

circumstances in a case, which will necessitate more or less change

in the manner of proceeding, so that the practitioner must after all

be guided, to a great extent, by the requirements and conditions then

existing. Dr. Lee's directions therefore, must merely be considered as

_general_ ones, to be modified as occasion may require:--

"When the operation of turning is required before the membranes are

ruptured, and when the orifice of the uterus is widely dilated, and

there are long intervals between the pains, it is accompanied with

little difficulty and danger. Having explained to the patient and

her relatives the nature of the case, let her lie on the left side

near the edge of the bed, with the knees drawn up to the abdomen. Sit

down by the side of the bed, and quietly take off your coat; lay bare

your right arm by turning up the shirt above the elbow, and cover

the back of the hand and the whole forearm with cold cream, lard,

or a solution of soap. Introduce one finger after another into the

vagina, and slowly and effectually dilate its orifice. The hand, in a

conical form, and in a state of half supination, must then be pressed

steadily forward with a semi-rotatory motion against the perineum and

sides of the passage, till it clears the orifice of the vagina. This

should always be done very slowly and gently, as it is accompanied

with great pain. Let the hand remain some time in the orifice of

the vagina, that it may be fully dilated, and offer no resistance

in the subsequent steps of the operation of turning. When the hand

has dilated the vagina sufficiently, in the absence of pain gently

insinuate the points of the fingers and thumb into the os uteri in a

conical form; and if it is not sufficiently open to allow the hand to

pass, you must proceed next to use artificial dilatation here also,

very gently and slowly, always stopping as soon as a pain comes on,

but not withdrawing the fingers altogether at the time from the os

uteri. Having succeeded in dilating the part without rupturing the

membranes, slide the hand up between the membranes and the anterior

part of the uterus into the cavity, and grasp the feet when the

membranes give way. Most frequently the membranes burst as the hand is

entering the uterus, before it reaches the feet, and the liquor amnii

rushes out and is lost, if it is not prevented by pressing the hand

forward firmly into the orifice. Never be contented with one foot when

it is possible to grasp both; and this can always be done when the

liquor amnii has not escaped, and the uterus is not closely contracted

round the body of the child. Seize both feet and legs, and when

there is no pain, draw them down into the vagina; and as the nates

descend through the os uteri, the shoulder and arm will gradually

recede or be retracted, and will offer no obstacle to the remaining

part of the operation, which should be completed as if the nates and

inferior extremities had originally presented, and which has already

been very fully described. In actual practice, except in twin cases,

the membranes have been ruptured and the liquor amnii is gone, in a

great proportion of cases--in about ten to one--long before we are

called upon to deliver by turning, and the operation is then a much

more serious affair. Sometimes, when the os uteri is half dilated,

there is an interval of freedom from pain for several hours after the

rupture of the membranes, and partial escape of the liquor amnii. Here

it is advisable to turn without delay; and the hand can be passed up

into the uterus and the feet brought down with little more difficulty

than if the membranes had not been ruptured."

The operation of turning is however beset with many difficulties, and

unless the conditions for it are very favorable, and the operator

skillful, it may cause greater mischief than it is intended to remedy.

The probability is, as in the case of other operations, that it would

seldom or never be needed if proper means were used in time, and

perseveringly; and it is yet a question whether the prospect, for both

mother and child, would not be more favorable if the delivery was

always left to nature, in those cases where version is now attempted.

Dr. Collins says, "As to turning, the risk to the mother is, in the

majority of cases, so great as to forbid its employment, nor do I think

the practitioner justified by the circumstances in so greatly hazarding

his patient's life."

PART II.

THE DISEASES OF WOMEN DURING PREGNANCY, AND IN CHILD-BED.

Women are liable during pregnancy, and after childbirth, to most of

the diseases which afflict them at other times, and also to many

derangements peculiar to those periods. As a general rule either of

those conditions somewhat modifies the disease, and also necessitates

certain differences in its treatment. My former work on the _Diseases

of Women_ having treated on all those affections common to every other

period, I shall in this confine myself chiefly to those peculiar to

the two conditions referred to; giving their causes, symptoms, and

treatment, with practical hints for their prevention.

SECTION IX.

THE DISEASES OF PREGNANCY.

The diseases which are found during pregnancy are of two kinds; the

first kind called _Sympathetic_, or nervous, consist of various

derangements of different parts of the system, produced chiefly by

nervous sympathy with the Womb. The second kind, called _Idiopathic_,

are real primary derangements of the Generative Organs themselves, or

of those intimately connected with them. Each of these kinds will be

treated of separately.

CHAPTER XXVI.

SYMPATHETIC DISEASES OCCURRING DURING PREGNANCY.

SICKNESS AND VOMITING.

Nausea, or sickness, with or without vomiting, is one of the most

frequent and troublesome accompaniments of pregnancy. It is so general,

in fact, as to be looked upon as one of the earliest and most reliable

signs of that state. It is undoubtedly caused, in the earlier stages,

simply by the intimate sympathy which exists between the stomach and

womb, and which causes one of those organs to be temporarily deranged

whenever the other is in any unusual condition. In the latter months

it is also produced by the enlarged womb pressing on the lower part

of the stomach, as it rises in the abdomen. In many diseases of the

womb, particularly in enlargements, and tumors, the stomach will become

deranged in precisely the same manner as during pregnancy, and the

patient is frequently deceived thereby as to her real condition.

In most cases the sickness does not begin till about the second month,

and it seldom lasts beyond the third or fourth. There are some however,

with whom it commences almost immediately after fecundation, and others

with whom it lasts till the very commencement of labor. I have even

known persons who always experienced the nausea _at the very moment of

conception_, and who were thus aware when that event took place. With

some persons the trouble occurs only during certain parts of the day,

most usually in the morning, while with others it comes on irregularly,

or even endures constantly. In most cases it is not very severe, and

causes but little distress; occasionally however, it is very serious,

and may even lead to fatal results, in spite of all that can be done.

Abortion is frequently brought on by it; and so are faintings, and

spitting of blood. Many women however, will vomit with violence, during

almost the whole period, without either accident or evil effect. The

treatment must vary according to the cause of the derangement, its

violence, and the effect it produces. In regard to diet but little can

be said that will be found generally applicable. Mild and light food

is generally recommended, but is not always the best, for some females

can only keep on their stomachs the most indigestible articles. Perhaps

nothing more can be said, with propriety, than that the patient should

take _whatever she can retain_, particularly if she has become weak

from want of nourishment, which is often the case. Some females can

only keep down a little broth, or tea, or sweetened water, while others

find solid food the best, or fruits. I have known many able to take

_Gum Arabic_, either solid or dissolved in water, and retain it, when

nothing else could be borne. This is nourishing, and may often keep up

the strength till the sickness abates.

There are many remedies that will sometimes relieve, though frequently

they are of no use whatever. A little wine or brandy, or orange flower

water;--a few drops of laudanum, or ether, or essence of peppermint,

may be tried. One or two ipecac, or cayenne, or camphor lozenges,

will sometimes be efficacious, and so will a little Port wine and

Peruvian bark, or a seidlitz powder, or even common soda water. A

tea-spoonful of powdered charcoal succeeds occasionally, or some very

strong bitters, or a cordial, such as a wine-glassful of curacoa. A

plaster of opium may also be placed over the stomach, or one of meal

wet with laudanum. A mustard poultice over the stomach, will frequently

relieve when everything else fails;--sometimes it is more effective

however, when placed on the spine, opposite the stomach. As a general

rule the bowels should be kept free, either with injections or with

mild purgatives, as castor oil, or manna. _Regular bathing_ will

often act as a complete preventive or cure, and the vomiting may be

frequently stopped by simply dashing cold water over the stomach. Some

practitioners recommend _emetics_, and bleeding if the patient be of

a full plethoric habit. Leeches and cups have also been used over the

stomach, and sometimes with good effect. Ether and chloroform have also

been inhaled, and have operated favorably in a few instances. Plentiful

draughts of cold water, or swallowing bits of ice will likewise afford

relief to some.

In several instances the vomiting has been so violent, and the patient

has suffered so much, and become so exhausted from want of nourishment,

that it has been absolutely necessary, after all other means have

failed, to cause miscarriage, as the only means of saving the patient's

life.

Whenever the trouble _can_ be borne, _Patience_ is the grand specific.

The sufferer must recollect that it will surely cease with delivery,

and most probably before.

PTYALISM, OR EXCESSIVE SALIVATION.

Some pregnant females will secrete an immense amount of saliva for

weeks and months in succession, as if they had been salivated. I have

never known a case in which this discharge caused any evil, even when

very great, though it is often troublesome. It would probably not be

judicious to stop it, even if we could do so, as long as it does no

harm, though it may be advisable at times to moderate it. The only

treatment proper to effect this is, to keep the bowels free and the

body well bathed, and to gargle the mouth with mint or balm teas, or

canella water, or a little syrup of poppies.

This discharge, like the vomiting, arises from the sympathetic action

of the uterus, and it generally ceases about the fourth month, though

with some it will last the whole time.

ODONTALGIA, OR TOOTHACHE.

This is also a very general trouble during pregnancy, and sometimes a

very severe one. Like several other sympathetic affections it is very

irregular as to its first appearance and duration, some suffering from

it most of the time, almost without intermission, while others only

have it at intervals, and but slightly.

It sometimes depends upon unsound teeth, but is frequently experienced

without any such cause, and is then a true _neuralgia_. When it arises

from a bad tooth, the pain is usually confined more or less to the

neighborhood of the tooth, but when it is neuralgic it extends over the

greater part or the whole of the jaw and face, and darts about from

one part to another. In true toothache there is also usually more or

less inflammation and swelling, while in the most agonizing neuralgia

nothing of the kind can be seen.

The treatment must be regulated by circumstances. If the pain appears

to be kept up by an unsound tooth, it should by all means be extracted,

unless the patient be so exceedingly nervous and irritable that

abortion is to be feared, in which case the pain must be alleviated as

well as it can be, though there is almost as much danger in leaving the

tooth in such cases as in extracting it. A few leeches to the gums will

sometimes relieve, or a mustard poultice to the cheek, or a blister

behind the ear. The stomach or bowels being out of order may also keep

up the irritation, and regulating them may materially assist in giving

relief. Some persons are relieved by lotions of camphor, or laudanum,

and others by washes of cayenne tea, or alum water. In the neuralgic

form, when no particular tooth can be found in fault, the treatment

must be more general than local. The _Carbonate of Iron Pills_, which

can be purchased at the druggists ready made, have frequently an

excellent effect; from two to four may be taken at a dose, twice a

day, the bowels being kept open, if necessary, by a little tincture of

rhubarb. If the pain comes at regular intervals, or intermits, it may

frequently be stopped by quinine. _Two_ of the ordinary _quinine pills_

may be taken every _five hours_, for two or three days. If the head

feels oppressed by their use, the dose must be lessened to _one_. M.

Guillemeau recommends the following to be tried if other means fail,

and I have known it to be of decided benefit. Take the whites of _two

eggs_, and _two ounces of common black pepper_, in powder, and beat

them well together. Spread this on some tow or cotton, and lay it on

the cheek. It may be kept on till it causes considerable irritation,

and sometimes may be used on both sides.

Some females have been relieved by bathing the face in _cold_ water, or

keeping _ice_ in the mouth, and others by hot fomentations. It has also

been recommended to fill the mouth with cold water, and bathe the cheek

with hot at the same time!

Occasionally an abscess, or gum boil will form, and when there seems a

tendency to that it may be promoted by keeping a roasted fig in between

the cheek and gum, over the part where the abscess points; when full,

it should be lanced, as the discharge usually gives relief.

This pain is however very obstinate sometimes, and defies all

treatment, but is seldom of such long duration when so severe.

DERANGEMENTS OF THE APPETITE.

The powerful sympathetic action of the womb on the stomach produces not

only nausea and vomiting, but various derangements of the appetite and

taste also. All of these require notice, and some need attention.

_Anorexia._--This means a complete distaste, or even disgust, for food,

sometimes of particular articles only, and sometimes for those of every

kind. It seldom lasts beyond the fourth month, but occasionally during

the whole period. It is remarkable how some females will be affected in

this way, and how little they will eat, for several months together.

This however is scarcely ever of any consequence, for the system does

not seem to suffer in the slightest degree; on the contrary, the

mother will remain quite stout, and the child be born fully developed,

though the quantity of food taken has apparently been scarcely

sufficient to sustain life.

In many cases there is even a decided benefit from this state of

things, particularly in those who are of a too full habit.

As long as the loss of appetite is merely of a sympathetic or nervous

character it is not necessary nor advisable to resort to any special

treatment. But when it arises from indigestion, or a foul stomach, it

is necessary to attend to it. A mild emetic of ipecac or warm mustard

and water, may be given, or a dose of Epsom Salts. This state will be

recognized by a furred tongue, unpleasant breath, and uneasiness at the

pit of the stomach; while in the purely nervous anorexia nothing of the

kind is observed. Sometimes it may arise merely from debility of the

stomach, and in that case a few of the _Carbonate of Iron Pills_ will

be of use. In general the patient is benefited rather than injured by

this voluntary fasting.

_Boulimia._--This state is the reverse of the former, meaning a

ravenous appetite. Some females exhibit it in a most extraordinary

degree, and will eat to excess of anything that comes in their way.

Many injure themselves in this manner, by causing indigestion,

flatulence, heartburn, vomiting, and even inflammation of the stomach.

It is of no use reasoning with them, for the appetite is so strong that

they will eat let them suffer ever so much.

All that can be done in such cases is, to drink freely of various

nourishing liquids, such as soup, broth, rice milk, or chocolate; and

by eating jelly, arrow-root, and eggs. These contain much nourishment

in a small space, and satisfy the hunger without overloading the

stomach. The appetite may also be deadened considerably by eating figs,

dates, sugar, or chocolate; and by drinking soda water.

_Capricious Appetite._--Sometimes a female is found to have an

inordinate desire for some one particular article of diet, which she

will eat to excess, but will not touch anything else; this is called

_malacia_. Others will have a craving for some article not proper for

food;--this is called _Pica_. They will devour chalk, cinders, earth,

wood, flies, spiders, charcoal, and various other things, sometimes

of the most disgusting kind, though ordinarily they may be quite

fastidious in their diet. This unnatural desire is also frequently seen

in hysteria and chlorosis, and in several uterine diseases.

It does not appear that a moderate indulgence of these unusual tastes

is at all injurious, unless the article wished for be of a decidedly

hurtful character. On the contrary, it is reasonably conjectured, by

many physiologists, that they arise from a real want in the system of

the very substances longed for. For instance, there may not be in the

mother's blood sufficient _lime_ to form the bones of the child, and

this deficiency is intimated by her desire for chalk or plaster; nature

having no other mode of making her wants known, or of causing them

to be supplied. As a general rule, so long as the indulgence is not

obviously improper, it should be allowed to a reasonable extent, both

to gratify the patient and to answer to what are probably the demands

of nature.

It is seldom that interference is needed in these cases, except when

there is danger of the patient doing herself harm; we may then try to

alter the condition of the stomach, and so change the taste. A gentle

emetic will sometimes do this, or a saline purgative. If these fail use

a few of the _Carbonate of Iron Pills_, or some good strong bitters, or

teas, drunk freely, such as Cammomile, Boneset or Centaury.

PYROSIS.

This disease is more frequently called _water brash_ and sometimes

_heart burn_. It is characterized by the raising of a hot acrid fluid

into the throat, causing a sensation of burning from the stomach

upward, even to the mouth. It is a very frequent attendant upon many

forms of dyspepsia, and is generally experienced more or less by most

pregnant females, arising either from improper diet or from mere

sympathetic derangement. If it arises only from errors of diet, a

reform in that particular is all that is needed, but if it is merely

sympathetic nothing can be done beyond palliating it, to give temporary

relief. For this purpose the patient must take a spoonful of lime

water, in half a tumbler of milk two or three times a day, or some

carbonate of soda, or magnesia, with a few drops of laudanum if there

be any pain. In those cases which resist such remedies a little of the

_compound iron mixture_ may be of service, such as can be obtained at

the druggists. A nourishing diet should also be observed, and plenty of

exercise should be taken in the open air.

DYSPHAGIA.

Difficulty of swallowing, which is meant by this term, is a more

troublesome and alarming affection, frequently attendant on pregnancy.

There is however nothing dangerous in it, except that it frightens

the patient. Some will gasp and be unable to swallow, or even speak,

for a considerable time, and will think they have something in the

throat. It is however entirely a nervous symptom, arising from uterine

irritation, and seldom lasts beyond the third or fourth month. A little

cordial, wine, or brandy, will frequently relieve it, or some spirits

of camphor rubbed on the neck. M. Colombat d'l'Isere recommends the

following ointment, to be rubbed on the neck. Extract of Belladonna

forty-seven grains,--Extract of Strammonium fifteen grains,--white wax

one ounce,--oil of lemons twelve drops.--These must be warmed and well

rubbed together. A dash of cold water on the throat and chest will

often succeed better than anything else.

GASTRALGIA.

This is commonly termed cramp at the stomach, or nervous colic.

It consists of a severe kind of cramp, with dragging and cutting

sensations in the stomach, as if it were being tied in knots and cut to

pieces. Sometimes the attack will only last for a few minutes, and then

totally pass away, at other times it will remain for half an hour or

more, and cause the most intense suffering. The patient will be drawn

together, or doubled up, with her hands placed on her stomach, and will

groan and exhibit in her features the greatest agony; sometimes even,

she will faint away with it.

This affection may, like the others, be merely nervous, and then it

is attended by nothing but the pain. It may also arise from real

inflammation of the stomach, and then it is attended by fever,

excessive soreness and tenderness of the stomach when touched, and by

a hot, dry mouth. In the nervous spasm the pain is frequently relieved

by pressure, but when inflammation exists the pressure increases it.

Some females always have these attacks whenever the stomach is empty,

and they pass away immediately anything is taken to eat or drink. With

others they are often brought on by overloading the stomach, or by

eating some improper articles.

To relieve the spasm, one of the best things is a _tea-spoonful of

Compound Spirits of Lavender_, taken without water. This nearly

always gives relief in ten minutes at most; but if necessary a second

spoonful may be taken in a quarter of an hour. A little brandy, or

peppermint, or curacoa cordial will also succeed in many instances,

or simply drinking freely of any hot tea, or swallowing half a

tea-spoonful of common pepper. A mustard plaster put on hot over the

stomach will scarcely ever fail, even without anything being taken

internally. M. Colombat gives the following recipe as one which he

has found efficacious, and it is certainly a pleasant one. Orange and

Linden Flower waters each two ounces; Syrup of Ether and of Valerian

each one ounce; Syrup of Poppy heads half an ounce. Of this mixture a

tea-spoonful may be given every quarter of an hour till the pain abates.

To prevent the return of the attack, the patient must carefully avoid

everything that disagrees with the stomach, or creates wind; she must

keep the bowels free, and accustom herself to regular bathing or

rubbing the body. If the stomach appear weak, which is often the case,

some Boneset tea, or Port wine and bark, or a few of the Carbonate of

Iron Pills may be advantageous. If there be acid on the stomach, use

the means recommended for heartburn.

CONSTIPATION.

This is a very common trouble with pregnant females, and one that may

lead to many others. Very frequently it arises merely from the pressure

of the expanded uterus upon the large intestine, but it may also arise

from a simple want of power, the uterine action having apparently

weakened the force of all the neighboring organs. It is advisable to

correct it as soon as possible, let it arise how it may, as it is very

apt to cause various derangements of the stomach and intestines, and

even inflammation of the womb itself. As a general rule, not more than

three days should elapse without the bowels being moved, though some

will remain a week or more without any apparent inconvenience; but

there is always danger in such delay.

Many females do themselves much harm by taking what they call opening

medicines, the action of which is often more injurious than the

constipation itself. All drastic purgatives, such as aloes, gamboge,

colocynth, and jalap should be carefully avoided, as they not only

make the costiveness worse after their action is over, but they also

frequently produce inflammation, and even abortion, by the violent

straining they cause. The best medicines, when they are really needed,

are manna, seidlitz powders, or castor oil. Enemas are better however,

as a general rule, such as those of thin starch, or molasses and water,

to which may be added a little castor oil. The grand aim should be, in

all such cases, to stimulate the bowels to an increased action without

medicines, by a properly regulated diet! Salads may be eaten when they

do not cause derangement of the stomach, and ripe or stewed fruits,

particularly figs, dates and prunes. Soups are also good, except they

contain rice, or vermicelli, or maccaroni. Bran bread should be eaten

regularly, and not white. The only meats should be veal or poultry.

As a drink lemonade is excellent, with a little cream of tartar, or

tamarind tea, or barley water sweetened with honey. With some patients

a cup of coffee, or a glass of beer will always relieve the bowels,

especially if a glass of water is also drank after it. I have known

persons neglect the bowels so long that they have become completely

impacted, by the hard fæces, and could be relieved only by instruments.

It is very important to attend to this affection in time, and to

persevere with the means of permanent relief regularly.

DYSENTERY AND DIARRHŒA.

It is frequently the case that pregnant females, instead of being

constipated are afflicted with severe diarrhœa. This may arise from

inflammation, and is then attended by fever, and extreme tenderness and

soreness of the bowels. Most usually however it is entirely nervous,

and arises from the sympathetic irritation of the womb. There is then

no tenderness or soreness, no fever, no derangements of the appetite,

nor in fact any other symptom of any consequence. If it remains long

unchecked blood will be discharged, from the extreme irritation of the

intestines, and it is then called dysentery. This is nearly always

accompanied by fever and general irritation. Sometimes there will be a

constant and painful desire felt to move the bowels, but with little

power to do so, and at the same time a burning heat and unpleasant

sensation at the fundus. This is called _tenesmus_, and the straining

from it has frequently produced abortion.

If the diarrhœa is not excessive, and the female does not lose her

appetite, or strength, it is better let alone, particularly if she

be of a full habit, and disposed to fever. If thought desirable to

check it a little, this may usually be done by a change in the diet.

Rice milk, sago, tapioca, and arrow-root may be taken, white bread

may be used, and not much fluid drunk. If such means are insufficient

an injection may be thrown up the rectum in the morning, of thin

starch, with a tea-spoonful of laudanum. The abdomen may also be well

fomented, and a dose of Tincture of Rhubarb taken occasionally. If

the tenesmus is very troublesome, an injection of tepid water may be

used, and the female should sit occasionally over the steam of hot

water: in extremely painful cases a few leeches may be used round the

fundament, and a hot flaxseed poultice placed over the abdomen. A warm

bath is also an excellent remedy with many. When the diarrhœa still

continues notwithstanding the above remedies, resort should be had to

tonics and opiates. The patient should take Port wine and Peruvian

bark, or some _Gentian wine_, and use injections of Starch and Laudanum

regularly. Cammomile tea may also be freely drunk, and an opium pill

may be taken at night. Above all, the patient must endeavor to avoid

all mental agitation. When dysentery sets in, every effort should be

made to subdue it as early as possible. Half a pint of rice milk, with

ten or fifteen drops of laudanum may be taken two or three times a

day, and an injection may also be used night and morning of flaxseed,

with fifteen or twenty drops of laudanum. M. Colombat recommends the

following recipe as seldom failing to cure. Take the whites of six eggs

and beat them up in a quart of water; then use one-third as a drink,

and the rest as an injection. A neat spoonful should be drunk every

ten minutes, and an injection used every two hours, but not more than

one small syringeful at a time. A tea-spoonful of syrup of poppies,

with some loaf sugar, may also be added to every spoonful that is

drunk. Eggs, jellies, and rich soups, with meat and wine, if there be

no inflammation, may be taken regularly, in addition to the articles

already mentioned.

DYSPNŒA, OR DIFFICULTY OF BREATHING.

There are but few pregnant females who do not complain more or less of

difficulty of breathing, and this difficulty may arise from different

causes. In the earlier months it is caused by sympathetic irritation

only, the same as difficulty of swallowing. In the latter months it is

caused by the enlarged womb filling up the abdomen so much that the

lungs in the chest are pressed upon and have not sufficient room to

play freely. It may also be caused by a plethoric or too full habit,

the lungs then being in reality congested.

The temporary difficulty of breathing which is felt in the early

months, from nervous sympathy, needs scarcely any kind of treatment,

as it passes off naturally in a short time. In severe attacks the same

remedies may be used as for difficulty of swallowing before referred to.

That which arises in the latter months, from pressure of the womb,

can frequently be relieved only by the patient remaining as long as

possible in certain favorable positions. I have known many who could

never sleep except when propped nearly upright, by means of pillows

and cushions, as immediately they assumed the recumbent position the

upward pressure became so great they were nearly suffocated. In such

cases the patient should be careful never to eat or drink to excess,

nor take anything likely to produce wind, because the least increase in

the size of the abdomen adds to the difficulty. The bowels should also

be kept free, and nothing tight or heavy in the way of clothing should

be worn.

This difficulty is most frequently seen in those who have contracted

chests, and in those who have been accustomed to wear corsets and tight

dresses. A deformed pelvis may also give rise to it by forcing the womb

above its usual position. Many females both create and increase this

difficulty by binding themselves tighter than usual during pregnancy,

under the mistaken idea that it enables them to support their burden so

much easier.

When the dyspnœa arises from a full habit the patient must live low,

keep the body regularly bathed and rubbed, and the bowels freely

open by an occasional seidlitz powder, or dose of Epsom Salts. If

the difficulty becomes at any time suddenly great and alarming, the

feet should be placed immediately in hot water, while the patient is

upright; a mustard plaster should also be put upon the chest, and an

opening injection of starch and Castor Oil administered as soon as

possible. The usual practice in such cases is to bleed from the arm,

to the extent of eight or ten ounces, and in case no other means give

relief, this may be tried.

COUGH.

Like the previous affection cough is most usually produced during

pregnancy by sympathetic irritation. It may arise, however from a

partial congestion, or inflammation of the lungs or bronchial tubes,

produced by a too great determination of blood to them. In the merely

nervous cough, there is no expectoration, nor any soreness or pain in

the chest, and it will frequently disappear for several days together.

No particular attention need be bestowed upon this cough, unless

it become so violent as to threaten abortion. In that case a pill,

containing one grain of opium, may be taken, or from ten to fifteen

drops of laudanum, whenever the attack is severe. Barley water, or

gum arabic water, may also be freely drunk, with a large spoonful of

Syrup of Poppies added to each pint. A small dose of Hive Syrup, or

Paregoric, will also be found sometimes better than anything else. An

enema of Starch and Laudanum, as formerly described, will also relieve,

in some cases, better than anything taken by the mouth. The body should

be kept warm, particularly the feet, and a mustard poultice may be

placed over the chest, if the straining at any time becomes too great.

Some patients experience relief from an assafœtida pill, or a little

musk, and others from a small dram of cordial, or wine.

If there be expectoration, with fever, and tenderness in the chest,

or sharp pains when a long breath is drawn, there is reason to fear

inflammation of the lungs, or bronchitis. In this case all the above

means, except the wine and stimulants, may also be used only more

freely, and the mustard poultice must be kept on till it makes a

blister. The patient must live low, her feet must be frequently bathed

in hot water, and her bowels regularly opened either with saline

purgatives or enemas. All that is requisite is to keep the inflammation

from extending till after delivery, when it usually subsides without

any further trouble. As soon as the womb is emptied, its pressure

upon the abdominal aorta ceases, and the blood can then flow freely

to the lower extremities, and thus the lungs become relieved and the

inflammation goes down.

PALPITATION OF THE HEART.

This is also a frequent accompaniment of pregnancy, and one that is

likely to cause alarm sometimes, from its violence. Unless dependant

upon organic disease of the heart however, it is in general only

a nervous affection, and passes away with delivery. We may always

reasonably suppose it to be nervous when it occurs only during

pregnancy, and particularly if it is irregular in its frequency and

violence. I have known females who were always attacked with it about

the same period, and who could therefore always tell when it was coming

on, and sometimes even how long it would last. It will sometimes come

on during sleep, and so forcibly as to waken the patient instantly. At

other times while awake, it will commence so suddenly that she will

sink down as if struck by a powerful blow.

The only directions that can be given for alleviating it are, to keep

as quiet as possible, use the bath regularly, avoid constipation,

and live rather low, particularly if the patient be of a full habit.

Exercise should also be taken regularly in the open air, but not of a

violent kind. She should also sleep with the head on a high pillow,

and never eat late suppers, nor take any food that disagrees with the

stomach.

All kinds of stimulants, such as wine, coffee and spices, should be

abstained from, and all powerful emotions carefully guarded against.

During an attack a few drops of Laudanum, or an Opium pill may be

taken, and the feet placed in hot water. An Assafœtida pill is

sometimes good, or a little Ether. Bleeding is generally practised in

extreme cases, but there is often considerable danger in it.

A too full habit is often the exciting cause of the palpitation, as may

be seen by the patient being always liable on the slightest exertion

to flushed face, dimness of sight, ringing in the ears, swelling of

the limbs, and puffiness of the gums, sometimes to such an extent that

the mouth will taste of blood. Such persons should carefully observe

a moderate unstimulating and simple diet, and never allow the bowels

to remain constipated more than a single day. They should also rub and

wash the skin well, and study calmness and quiet.

SYNCOPE, OR FAINTING.

In this condition, which is just the reverse of the former, the heart

suspends its action altogether; the breathing ceases, all power of

motion and feeling is lost, the face turns ghastly pale, the eyes

close, and the individual seems as if actually dead. It seldom lasts

however more than five minutes, when the pulse gradually begins to

beat, the color returns, and the individual slowly recovers. Some

females are liable to such attacks once a month, others once a week,

others every few days, and some at irregular periods. They are

generally preceded by a dull pain at the pit of the stomach, fullness

in the head, yawning, and loss of sight, or ringing in the ears.

The causes that predispose to this fainting are not very well

understood, though there is no doubt but it is mainly dependant upon

uterine disturbances. In some females it is brought on by the sudden

motions of the fœtus, or by their remaining too long in one posture.

In others it is produced by straining from constipation, or by sudden

fright or anger. In very nervous persons it not unfrequently arises

from unpleasant sights, smells, and sounds. In fact it is caused in

them much the same as a common hysterical fit, such as is described in

my _Diseases of Woman_. A full habit, and over feeding, or drinking

stimulating liquors may also bring it on, and so on the contrary may a

state of weakness and exhaustion.

This accident is more alarming than dangerous, except to the child,

which may lose its life if the fainting lasts too long.

To recover a person from one of these fainting fits, she should be laid

upon her back on a level place, and every part of her dress should

be carefully loosed. Some strong odor should then be applied to the

nostrils, such as hartshorn, vinegar, burnt feathers, or smelling

salts. The body should be well rubbed over the heart and lungs, either

with the hand or with a soft, dry napkin. Cold water may also be

dashed on the face, and the hands may be well chafed. If the fit still

endures, a mustard plaster may be placed on each arm, or the whole body

may be placed in a warm bath, if convenient. Care should also be taken

to admit the fresh air freely. As soon as she begins to show signs of

consciousness, a little wine or brandy may be placed in the mouth, and

the body may be elevated a little.

To guard against such attacks, the same precautions as to diet and mode

of life must be observed as were directed in the article on palpitation

of the heart; and, as this accident is most frequent in those of a

hysterical habit, they should carefully follow the advice given in the

article _Hysteria_, in my _Diseases of Woman_.

HEADACHE AND DIZZINESS IN THE HEAD.

Each of these distressing affections, both of which are very common

during pregnancy, may arise either from nervous excitement or from a

full habit and determination of blood to the head. Nervous headache

is generally met with in the earlier months of pregnancy, and is

characterized by being frequently periodical, and often confined to

particular spots. It also commences suddenly, from some excitement

or depression of mind, and leaves little or no distress when it is

gone. The headache, which arises from a too full habit, commences with

flushing of the face, heaviness in the eyes, dull pain in the forehead,

and a sense of uneasiness, with disposition to sleep or dose. It seldom

comes on much till the latter months of gestation. Headache may arise

also accidentally, from derangement of the stomach, but this cause is

easily ascertained by the furred tongue, loss of appetite, and bitter

taste in the mouth; it is also felt most acutely in the back of the

head, down by the neck, and passes away immediately the stomach is

corrected by an emetic, or by fasting.

Nervous headache during pregnancy often defies all our attempts to

alleviate it, though we sometimes succeed in doing so. The best general

remedies are warm baths, and, if the bowels are constipated, enemas of

starch and castor oil daily. To these may be added occasional small

doses of Laudanum, or an Opium pill, or two grains of Camphor. Smelling

odors, such as Camphor, Cologne, or Hartshorn, will relieve some, but

will make others worse; so that its utility can only be determined by

experience. When a severe attack comes on, the patient should put her

feet in warm water, or use a warm bath, take a few drops of Laudanum,

or a little Musk, or Valerian, and then try to go to sleep. To guard

against the attack, she must never overload the stomach, nor take

anything indigestible; and never think too much nor allow herself to

become excited or depressed.

When the trouble is caused by a too full habit, she must observe the

directions given in the articles on palpitation of the heart, and

Syncope. The diet must be mild and not too nutritious, the bowels must

be regularly moved every day, chiefly by Epsom Salts and Seidlitz

Powders, and regular gentle exercise must be taken in the open air.

In the latter months it is especially important to attend to a severe

headache _immediately_, particularly when the pain is seated _at the

top of the head_, because it is very likely, if unchecked, to terminate

in convulsions. The means above recommended must be carefully and

perseveringly applied; the feet must be kept warm, the bowels freely

opened, and the head kept cool by wet clothes, or cold lotions, or ice.

It is the general practice in all such cases, if the pain does not

abate soon, and the pulse be full and quick, to bleed freely at the

arm, and the most eminent physicians of the Allopathic school assure

us, that the life of the patient frequently depends upon its being done

promptly. I have no doubt, however, but that relief can be generally

obtained by the simple means described, if they are used early and

perseveringly.

INSOMNIA, OR SLEEPLESSNESS.

There are few affections that cause more real distress during pregnancy

than this. Many females will be utterly unable to sleep for many days

and nights together, and others can only obtain a few minutes broken

and unrefreshing sleep at distant intervals. There is danger, when this

state becomes highly aggravated, that it may lead to delirium, or that

the want of rest may wear away the strength to such a degree, that

the patient will sink from mere exhaustion. There are some females,

however, who will remain without sleep, or at most take but very

little, for a long time, without suffering any inconvenience.

This affection is essentially a nervous one, and the only means likely

to relieve it are those that have a tendency to soothe and calm the

nerves. If the patient be surrounded by any irritating circumstances

they should be at once removed, or she herself removed from them.

Particular attention must be paid to the diet, so that no derangement

of the stomach or bowels be kept up, and a regular system of out-door

exercise must be practised. A warm bath just before going to bed, with

a good rubbing of the skin, will frequently act like magic in procuring

rest. As a general rule narcotic drugs should not be used, but in

extreme cases they may be resorted to sparingly. A single Opium pill,

or a few drops of Laudanum may be taken after the bath. If the patient

be thin and delicate, she should eat meat, eggs, and milk, and take a

little wine, if it causes no unpleasant symptoms. Indeed a glass of

wine will frequently act better than Laudanum, and so will ale with

some, and coffee with others. If the patient be of a full habit these

things will be improper, and may injure. She should then be kept quiet,

and fed sparingly. _Music_ has a powerful effect in many of these

cases:--a slow, solemn air, played while the patient is reclining after

her bath, seldom fails in inducing sleep.

TEMPORARY AFFECTION OF THE SIGHT, HEARING, AND SMELL.

These disorders are quite common during pregnancy, particularly in the

latter months. Some females will be utterly unable to distinguish any

odors, even the most powerful; others completely lose their taste, and

others again become deaf or blind. When they are caused only by the

sympathetic action of the womb, such deprivations are seldom of long

duration, though they may recur at frequent intervals. In some cases

they remain a considerable time, and great fear is felt that they may

become permanent, but there is little danger of such a result. I knew

a lady who suddenly lost her sight when about two months gone, and who

remained totally blind till about three hours after her delivery, when

her sight returned in a moment as perfect as before. The same thing

has frequently been observed of the other senses. In some cases the

vision will not be lost but perverted, and the patient will then see

everything double, or larger or smaller than natural, or always of a

wrong color. In like manner some will hear imaginary conversations, or

will fancy everybody is shouting, or perhaps only whispering, though

they are all the time speaking in their natural voice.

These perversions, when thus produced, need occasion no alarm, and

seldom require attention, unless accompanied by other urgent symptoms.

They may arise however, from a fullness of blood in the head, in which

case they are accompanied by a flushed face and drowsiness, and are

preceded by bright sparks flashing before the eyes, or by ringing in

the ears.

The treatment of all these affections should be the same as that

recommended for most of the previous derangements, particularly for

_Headache_, _Syncope_, and _Palpitation of the Heart_. If there be

nervous excitement merely, it must be calmed in the same way as

recommended in the articles referred to, and also in the last one on

sleeplessness. If the female be of a full habit, and there is evidently

a pressure of blood on the brain and nerves of the special senses, the

same means should be adopted to reduce the system, and draw the blood

to the extremities, that have already been described.

In such cases these sudden deprivations of sight and hearing sometimes

indicate the commencement of Convulsions, or Apoplexy, particularly

if they occur during labor, when every means should be resorted to

_instantly_ to relieve the pressure on the brain. If no simpler means

succeed in a reasonable time, it is the general custom to bleed freely

from the arm, and there is no question but this frequently removes the

difficulty at once, whatever objections may be made to the practice.

It is also proper to say that many eminent practitioners, who are not

advocates of the lancet in general, strenuously urge that it should be

used immediately if the sight or hearing suddenly disappear in this

way at any time. And I certainly have myself known these accidents

sometimes followed by a fit of Apoplexy, or Convulsions, and even

death. Such was the case with a friend of one of my patients. She

found one day, quite suddenly, that she could only see _half_ of any

thing she looked at, and at times it even disappeared altogether.

Nothing was done for her, and in about five hours after the first

attack she fell speechless and died before they could lift her upon

the bed. It will therefore be a necessary precaution, in all pregnant

females of a full habit, to attend rigidly to the advice that has been

given, because _simple_ means, used in time, and regularly, may prevent

the necessity of stronger ones altogether. In purely nervous cases of

this kind no apprehension whatever need be felt, and no such practice

as bleeding is required.

DISORDERED JUDGMENT, INCLINATIONS, AND PROPENSITIES.

The sympathetic irritation of the uterus, in some females produces

extraordinary phenomena of this kind, from simple desire to the most

furious craving, and from mere caprice to actual insanity. There is no

doubt but that many of these unusual desires, or _longings_ as they

are called, are either produced or much aggravated by the imagination

of the patient, and frequently would never be experienced at all,

if the idea was not suggested by other people having had the same.

Custom and imitation are very powerful in such cases, particularly

when the nervous sensibility is much exalted. Still the most singular

aberrations of this kind will often arise without any such adventitious

aid, and the fact should be borne in mind, so that these temporary

vagaries may be regarded with proper charity and forbearance.

Some females will entirely change in their dispositions at these

times, the most amiable and mild becoming positively ill-natured and

malicious;--the gentle will turn headstrong, the haughty and proud will

become humble, and the gay will become melancholy, or the sad will

madly seek every kind of gaiety. Such things however should never be

remembered, nor be brought up against them afterwards, for truly at

such times _they know not what they do_!

Women have been known while in this state, to become thievish, or to

have an irresistible propensity to burn or kill. Some have even been

known to exhibit great talents for music or poetry, though ordinarily

without any capacity for such things. Some will suddenly exhibit a

most extraordinary intellect, while others will become quite silly. A

medical writer tells us an instance of one female who always had an

excellent sound judgment while pregnant, but _no memory_, while in

her ordinary state she had a poor judgment but _a most extraordinary

good memory_. The celebrated Baudelocque gives an account of another

who could scarcely eat anything but what she _stole_, while going to

market; and another writer mentions a lady who longed till she was

almost delirious to bite a piece out of a baker's shoulder, who worked

opposite her window. There is even an account of one who longed to eat

some of her husband, whom she dearly loved, and who actually killed

him to satisfy her appetite, and then salted pieces of the body to

keep for future use. A writer named Vives also tells us of a female

whose husband paid a large sum of money for her to be allowed to bite

a young man's neck, it being evident that she would be nearly certain

to miscarry unless so gratified. In the year 1816, at Mons, in France,

an unfortunate woman in this condition was seized with an irresistible

impulse to destroy her children, and actually drowned three of them,

and herself afterwards. She had previously sent a poisoned cake also to

one at school, but fortunately it was not eaten.

Generally speaking all these things pass away with delivery, if not

before, unless it be actual insanity, which sometimes remains. All

that can be done is to attend strictly to the general health, keep the

skin, bowels, and stomach, in good action, and remove all depressing

or irritating circumstances. If there be a propensity to anything

decidedly injurious or dangerous, the patient must be strictly watched,

but without its being perceived or known by her, for fear of exciting

suspicion in those who would be disposed to be cunningly secret or

revengeful. Proper diet, regular bathing, and out-door exercise often

correct many of these things.

HÆMOPTYSIS, HÆMATEMESIS AND EPISTAXIS.

These three terms mean _spitting of blood_, _vomiting of blood_,

and _bleeding from the nose_, all of which frequently occur during

pregnancy.

Spitting of blood is most usually observed in nervous women, and in

those of a full habit. It is caused partly by sympathetic irritation,

and partly by the womb pressing upwards against the diaphragm and

lessening the size of the chest, which deranges the circulation in

the lungs, and causes rupture of their blood vessels. The premonitory

symptoms are pains round the waist, cold extremities, creeping of

the skin, and a sensation of anxiety or depression round the heart.

The attack begins by difficulty of breathing, heat in the chest, and

dry cough, followed by spitting up more or less bloody frothy mucus;

all which symptoms are much increased by violent exercise, or a hot

atmosphere. In ordinary cases a mere spitting of blood need occasion no

great alarm, unless attended by symptoms of inflammation, or unless the

patient has had cough, and other indications of pulmonary derangement

before conception.

In hæmatemesis the blood is vomited from the stomach, and is in black

clots, frequently mixed with the food, or bile, while that which comes

from the lungs in spitting on the contrary is bright red, and quite

fresh. In vomiting of blood also, there is seldom any cough or exertion

of any kind.

The treatment of spitting of blood must be nearly the same as for many

other derangements already described. When there is a full habit, the

patient must live low, keep the bowels free, and the skin in good

order, and avoid all agitation of mind or over exertion of body. An

Opium pill occasionally will be useful, or a few drops of laudanum. The

cough must be combatted in the way recommended in my previous article

on _Cough_. Lemonade or tamarind tea, with some Syrup of Poppies

added, may be freely drunk, or some of the black currant root tea. The

treatment of Hæmatemesis is precisely the same. Occasionally however

the blood will pass into the intestines and occasion colic, and then it

must be removed by administering an enema of starch and castor oil, or

a little manna may be taken.

Epistaxis, or bleeding from the nose, is much more frequent than either

of the preceding, but is seldom of much consequence. In many cases in

fact it is highly beneficial, as it relieves the head from pressure,

and thus obviates many inconveniences. If it continue too long, or

becomes excessive, it may generally be arrested by putting cold wet

cloths between the eyes, and on the cheeks, while the head is kept

elevated. The feet and hands should be kept warm, and the air breathed

should be as cold as possible. In extreme cases, the nostrils may be

plugged with bits of sponge, or cotton, or some powdered alum may be

snuffed up them. The best plan is to raise the hands above the head and

put something very cold, as a lump of ice for instance, or a piece of

cold iron, between the shoulders; this seldom fails.

VARICOSE VEINS.

Very often in pregnant women the veins in different parts, but

particularly of the thighs and legs will swell out in knots, either

singly or in bunches, sometimes like strings of beads, or like the

links of a chain. These are called _Varices_, and occasionally they

attain a large size, and extend to various other portions of the body,

as the external lips, vagina, and mouth of the womb. Some women in fact

have them over nearly the whole body. They are caused by the pressure

of the womb on the large abdominal veins, preventing the return of the

blood and disturbing the balance of circulation between the veins and

arteries. In the majority of cases, unless very large, they cause but

little inconvenience, and may be let alone, but sometimes they cause

pain, or become so full that there is danger of their bursting, and

then it is necessary to interfere.

The first thing to be done is to relieve the abdominal veins from the

pressure of the womb, and this may be done by the patient keeping more

or less the horizontal position, and carefully avoiding all violent

exertion. The swelling is always worse during the latter part of the

day, particularly if the woman has been much on her feet, she should

therefore apply a cloth roller round the limbs before she rises in

the morning. If this be carefully put on, just tight enough not to

interfere with the motion of the limbs, nor totally obstruct the

circulation, it will prevent the varices to a great extent, if not

altogether. Brisk friction with the hand will disperse the swelling

in many persons, or warm fomentations, but sometimes _cold_ bathing

answers better. It is advisable always to disperse them as soon as

possible, for if they remain too long that part of the vein becomes

permanently weakened by being overstretched, and will be always liable

to swell again from any slight cause. It is particularly advisable in

these cases to avoid constipation, and also to keep the skin in good

action by bathing and frictions.

If at any time one of these varices should burst, it need occasion no

alarm, unless it be seated on a large vein, and the bleeding becomes

profuse. To stop it, bind on firmly over the rent any firm _cold_ body,

as a flat stone, or a large silver coin, passing the bandage several

times round. In slight cases a simple cold compress will be sufficient,

or a little powdered alum, or some vinegar and water. In short any of

the usual remedies for stopping bleeding from wounds. The female must

be quite still till it is stopped, and must be careful when she begins

to move about again, because it is liable to break out afresh. Those of

a very full habit must live low, and avoid all stimulants, so as not to

increase the quantity of blood in the body more than is necessary. It

is advisable to remove the varices, as much as possible, before labor

comes on, particularly if they are situated on the lips, or in the

vagina, because they may burst during delivery and cause considerable

inconvenience, or even danger. It is rare that these swellings continue

after delivery, but if they should do so, the same treatment must be

persisted in as before.

HÆMORRHOIDS, OR PILES.

These are troublesome annoyances at any time, but particularly during

pregnancy, and unfortunately they are very common at that time. They

are, no doubt, chiefly caused in the same way as varicose veins, that

is by the enlarged womb preventing the proper flow of the blood in

the small veins, and so causing them to swell, and form tumors. They

may in fact be called varices, as truly so as those on the limbs.

In many persons however they are undoubtedly brought on merely by

_Constipation_, which will undoubtedly either cause them or make them

much worse when otherwise produced. In general they become worse as the

pregnancy advances, because the womb becomes larger and the bowels are

more apt to be confined.

As long as they only cause inconvenience, without any particular

distress or urgent symptom, they may be let alone, or be slightly

treated in the way of palliation, till after delivery, when they

will disappear. Occasionally however, they grow to a large size, so

as to hinder the passage of the bowels, and prevent the patient from

sitting down or walking. They may then cause inflammation, and bring

on falling of the intestine, or abortion, by the straining which they

necessitate when the bowels are moved. And even if these extreme

results do not follow, there may be serious derangements of the general

health, indicated by difficulty of breathing, sleeplessness, headache,

and fever. In short there are few of the derangements incident to

pregnancy so annoying as this, and unfortunately, from its nature, the

sufferer dislikes to speak of it and seek the necessary assistance.

Many prefer undergoing the most excruciating agony for months, rather

than complain, which shows the necessity for females knowing how to

treat themselves, when possible.

The bleeding which sometimes takes place from Piles is more often

beneficial than otherwise, unless it becomes excessive, from rupture

of a large vessel, in which case, if the wound is external, it may be

treated the same as the ruptured varicose vein; if it be internal, the

remedies must be injected with a syringe, or a large roll of lint or

cotton may be soaked in alum water and passed up the rectum. Frequently

bathing the thighs and perineum with cold water will be sufficient.

To relieve the pain and swelling, the female should sit over the

steam of hot water, and use the warm bath. If the piles are external,

they should be bathed with hot milk and Laudanum, or rubbed with any

soothing ointment, particularly the _Cucumber Ointment_, mentioned

in my Diseases of Woman, or with _Stramonium Ointment_. If they are

internal the milk and Laudanum should be injected if possible, or some

thin starch and Laudanum, and a stiff roll of cloth may be smeared with

the ointment and introduced. In general, ointments or other greasy

matters are not so good as the milk or starch. In conjunction with

this, the bowels must be kept free, either with enemas or castor oil,

or by using a seidlitz powder in the morning. This is indispensable,

for if constipation exists, no applications can render much service.

The patient must also avoid fatigue, and not remain too long upon her

feet, nor sit long, particularly on a hard seat, and if she be of a

full habit she must live low, to avoid making too much blood. It is

also important, at all times, to avoid using drastic purgatives, such

as Aloes, Colocynth, or Gamboge, as they always make piles much worse,

or even cause them.

ŒDEMA, OR WATERY SWELLINGS.

This affection also appears, like the preceding, to arise from

obstructed circulation, but instead of the blood accumulating it is

merely the serum, or watery portion of it. The swellings are generally

whitish, and spread about, and a small pit remains in them when pressed

with the finger. They are found on various parts of the lower limbs,

and on the groin or abdomen, and also upon the external lips, in which

place they are often exceedingly troublesome. As a general rule these

swellings are of small account, and as they disappear with delivery,

but little attention need be bestowed upon them. Sometimes, however,

they become very extensive, and so engorged that they inflame and are

extremely painful. They have even been known to mortify, and cause

considerable sloughing, particularly when chafed and afterwards wet

with the urine. In these extreme cases there may be serious disturbance

of the general health, from the constant irritation, and from the

patient being unable to walk about. I have often known the limbs and

vulva covered with patches of Erysipelas from this cause. Sometimes the

swellings even become so large that they interfere with the process of

delivery.

The treatment of this affection consists in rest, particularly lying

down, saline purgatives, regular, and frequent washing the parts with

cold milk and Laudanum, or with a solution of Borax, half an ounce to

a pint of water, to be used cold and with a tea-spoonful of Laudanum

added to it. Simple cold water is frequently quite sufficient. In

general all kinds of ointments are injurious, but if other means fail

to give relief, the _Cucumber Ointment_ may be tried. The wash should

always be used after urinating, and the parts must not be rubbed, but

lightly dried with a piece of soft linen. Fullers earth is often an

excellent application when there is chafing.

If the patient be of a full habit, she must carefully diet herself,

and bathe regularly. If she be thin and weak, a generous diet will be

advisable, with meat and even a little wine.

HYDRORRHEA, OR PROFUSE DISCHARGE OF WATER.

This consists in a discharge of water, more or less profuse, from

the vagina, at various periods during pregnancy. Some females will

only discharge a small quantity, at intervals, others will have a

constant dropping, and others again will pour out an immense quantity,

sometimes several pints, or even quarts, in the course of a few days.

In general this water is quite limpid and colorless, but sometimes it

contains much mucus, and at other times it is tinged with blood. It

does not appear that this discharge leads to any evil result, even when

excessive, and I only refer to it to relieve anxiety. The origin of

this water is not yet ascertained, but it is generally thought to be

secreted between the membranes and the womb, and to be quite distinct

from the liquor amnii.

PUSTULES, AND MUCOUS DISCHARGES.

Occasionally the external lips will be covered with pustules during

pregnancy, and frequent discharges of mucus will occur from the vagina.

They are both however caused by the unusual action of the uterine

system, and merely require frequent bathing of the parts with milk and

Laudanum, and regular action of the bowels. The most important thing to

remark in connection with them is that they have often been mistaken,

even by medical men, for the effects of syphilitic disease, and much

distress has resulted from such mistakes.

DERANGEMENTS OF THE URINARY ORGANS.

Several derangements of the urinary organs are liable to occur during

pregnancy, partly from sympathetic irritation, and partly from mere

pressure. Some of these may be partially relieved, others have to be

borne as patiently as they can be till delivery removes them.

The swollen womb often presses on the neck of the bladder, and hinders

the passage of the urine, or even obstructs it sometimes altogether,

and thus causes straining, burning heat, and great distension of the

bladder. In some instances this passes off as the pregnancy advances,

owing to the womb rising higher in the abdomen, but in other cases

it remains more or less, during the whole term. It is particularly

important, in such cases, that the female should not let the difficulty

remain too long unremedied, for if the bladder be very full it may

become utterly impossible to empty it by natural effort. Sometimes the

difficulty is much lessened by lying on the back a short time before

attempting to urinate, or by raising up the abdomen with the hand at

the time. Many females can urinate with tolerable comfort while lying

on the back or abdomen, and others are much relieved by constantly

wearing a bandage. Constipation always makes this difficulty worse,

and sometimes even causes it, by keeping the rectum full and thus

increasing the pressure. In all such cases it will be readily seen,

that forcing medicines are not only useless, but liable to cause

injury. The change of position, rest, and supporting the abdomen are

the means to be relied upon. If these fail, and the urine accumulates,

the catheter must be used. A warm bath, or fomentation with warm water

and Laudanum, will assist, and sometimes relieve alone. To ease the

burning and distress the patient must drink freely of gum water, or

barley tea, with a little Syrup of Poppies.

There is one manœuvre which, if practised aright, will nearly always

allow the female to urinate with ease, and fortunately she can practise

it herself. It consists in introducing two of the fingers into the

vagina, and raising up the womb, as if practising the _ballotment_.

This removes the pressure from the bladder, and the urine then escapes

by natural effort. A few trials will soon enable any one to do this,

particularly if they notice well the form and position of the parts, as

shown in the plates of this work. A lady who heard me mention this in

one of my Lectures, afterwards stated that the knowledge of it enabled

her to dispense altogether with the catheter, which she was previously

necessitated to use during most of her pregnancy.

When there is merely a nervous irritation causing the difficulty,

the warm bath, or fomentation with warm water and Laudanum will be

sufficient, or a little Belladonna Ointment may be rubbed over the

meatus urinarius, while some starch and Laudanum is injected carefully

into the vagina.

CRAMPS.

These arise from the womb pressing on the nerves of the sacrum, and

are therefore not under the control of medicine. All that can be done

is to change the position of the body as much as possible, from lying

down to standing up, and by turning from one side to another. Brisk

rubbing with the hand will also assist in giving relief. The cramps

however usually disappear after delivery, and must therefore be borne

as patiently as possible till that takes place.

PRURITUS, OR ITCHING OF THE EXTERNAL PARTS.

Having treated this affection fully in my _Diseases of Woman_, I cannot

do better than extract the article from that work on the subject.

"This disease, though not so immediately dangerous as some others, is

perhaps the most distressing that can be met with.

"It consists in an intolerable and incessant itching of the parts,

which nothing seems to allay. Sometimes it is so bad that the female

is almost tormented to death; she cannot see company, or walk out, and

often shuts herself up alone in her agony. Many have fainted from it,

and some have even become delirious. I have seen patients whose hands

it was necessary to tie, to prevent them tearing themselves to pieces.

"The causes of pruritus appear to be most of those that produce simple

inflammation, which it very frequently accompanies or precedes.

Pregnant females are very liable to it, and in some it will continue,

in spite of all that can be done, till after delivery, when it

usually disappears. I have known it produce abortion. Some females

always have it at the menstrual period, and others during nursing.

Occasionally there is a little eruption attending it, but not

always, though the parts are generally swollen and red. Parasites

are sometimes the exciting cause, and should always be destroyed

immediately.

"The treatment consists in first attending strictly to the diet, which

must be light and unirritating, and to the regular action of the

bowels and womb; and in using the cooling washes and lotions before

mentioned. If the itching still continues, use either of the following

washes to the parts:--Sub. carbonate of potash three drachms, water

four ounces; put a tea-spoonful of this into a quart of warm water,

and use it three times a day.--A tea-spoonful of Eau de Cologne to a

pint of warm water.--Sulphate of Zinc, half a tea-spoonful to a quart

of warm water. Both these may be used many times in the day.--Borax

half an ounce, Sulphate of Morphia six grains; pure water half a pint.

This last seldom fails of giving relief. It should be applied three or

four times a day, with a piece of soft linen, the parts being first

washed with warm soap and water. A tea-spoonful of laudanum will

sometimes answer as well as the six grains of Sulphate of Morphia.

"Caustic has been employed, and blisters to the inside of the thighs,

but such violent remedies are seldom either necessary or serviceable.

I have known the parts to be deeply scarified with the lancet, and

even burnt with a _red hot iron_, without at all alleviating the

pruritus.

"In young persons it seems to be often produced by constipation,

worms, and gravel; but it most probably depends, essentially, on some

impurity, or irritating quality, in the blood, or in the natural

secretions of the parts, which should therefore never be allowed to

remain long unwashed.

"Sitting in cold water, and the application of ice to the parts, has

given relief. I have also effected many cures, almost instantaneously,

by means of a small _Galvanic plate_, so constructed as to be worn

just within the vulva.

"All remedies must of course be applied with caution during pregnancy;

and it must be recollected that sometimes the disease _will_ continue,

more or less, till after delivery, though the distress from it may be

much alleviated."

CHAPTER XXVII.

IDIOPATHIC, OR PRIMARY DISEASES INCIDENT TO PREGNANCY.

FLOODING, OR HEMORRHAGE.

Flooding is one of the most dangerous accidents that occur during

pregnancy, its consequences being often of the most serious character.

The causes that lead to flooding are very numerous, some of them

predisposing to it, and others immediately exciting it. Among these

may be mentioned a too full habit, violent exertion, falls, coughing,

vomiting, straining from costiveness or violent purgatives, forcing

medicines, criminal attempts at abortion, overwalking, blows on

the abdomen, too much dancing, or running up stairs, strong mental

emotions, fright, or anger, and _certain excesses_. The immediate

cause is the separation of the membrane in which the fœtus is inclosed

from the walls of the womb. Flooding may however result from the

placenta growing over the mouth of the womb, and being torn as that

opens--usually about the sixth or seventh month.--(See the article

_Flooding_ during Labor.)

In most cases flooding is preceded by dull pain in the loins and

groins, and a sensation of weight and dragging. Similar sensations

however are often produced by other causes, which makes it difficult to

predicate, with any degree of certainty, whether the patient is about

to flood or not. The very first appearance of blood from the vagina

must therefore be watched for carefully, as that removes all doubt,

and warns us to be prompt with the proper remedies. Sometimes a female

will flood internally, the blood being retained by the passage being

closed or plugged up by clots, or by its passing behind the membranes,

or under the centre of the placenta. These internal or concealed

hemorrhages are very dangerous, as the patient may lose much blood

before her condition is suspected. It is therefore necessary to bear

this in mind, and carefully use every means to ascertain whether such

an accident has occurred or not. In general the indications are pretty

plain, the patient suffering from deep seated and distressing pains in

the back and groins, with great weakness in the limbs, faintness, weak

pulse, dimness of sight, ringing in the ears, coldness of the hands and

feet, swelling of the abdomen, and finally fainting, particularly if

the retained blood suddenly escapes, which it usually does.

In the early months there is more danger to the child from flooding

than there is to the mother, because it is nearly certain to lead to

abortion. In the latter months, on the contrary, the mother runs the

greatest risk, as the child may then live if it be expelled, while the

mother may sink and die from excessive loss of blood. There are many

females of a very full habit, who suffer but little from hemorrhage,

unless it be excessive, indeed some seem to be benefitted by it, and

are thus relieved from headache and convulsions. It should, however, be

carefully watched, and its effects duly noted.

The treatment of flooding must depend materially upon its severity, and

the time when it occurs. In the early months, when the discharge is

slight, and when it causes little distress, simple means will answer.

The patient must lie on her back, on a hard mattress, with the pelvis

raised, by means of a pillow, higher than the rest of the body. The air

must be kept fresh and cool around her; she must keep herself quiet in

body and mind, live rather low, and drink freely of cooling drinks,

such as soda water, lemonade, tamarind tea, or ice water. [The fullest

directions for making and using all these drinks will be found in my

"Diseases of Woman."]

If the flooding does not stop with these simple means, external

applications must be made, of cold, wet cloths, or even ice, over the

abdomen, and inside the thighs. Finally, if further treatment is still

needed, cold astringent injections may be carefully thrown into the

vagina. Cold water is perhaps as good as anything for this purpose,

and I have frequently known a most severe flooding checked immediately

by injecting cold water into the vagina and rectum, and applying cold

wet cloths over the abdomen, and inside the thighs. Some astringent

drink may also assist, such as a little syrup of comfrey, or extract of

Rhatany, and particularly a tea made of the root of the black currant,

as recommended in my "Diseases of Woman."--[A handful of the root may

be boiled in two quarts of water, for twenty minutes; it should be

sweetened to taste and drunk freely. The common blackberry, or the dew

berry, is also excellent, though not so good as the black currant.]--If

the patient be nervous and irritable, or suffer much from pain, an

opium pill may be taken, or from ten to twenty drops of laudanum.

The general practice in these cases is to _bleed_ freely and _give

opium_! And as this practice certainly does succeed in many extreme

cases, I should certainly recommend, if the simpler means fail, to

resort to it at once. I dislike bleeding very much, in any cases, and

here it seems particularly inappropriate; I should therefore say _try

almost anything and everything first_, but never obstinately refuse to

do it if nothing else succeeds.

In some cases a plug or tampon is used, to fill up the vagina. It

may be made of a roll of cloth, cotton, or a piece of sponge. This

practice, however, is useless in the latter months of pregnancy, and

very often fails even at other times. When it succeeds it causes the

blood to coagulate, and thus closes up the mouths of the vessels. Quite

as often, however, it only keeps it in, and makes it accumulate in the

womb till it all rushes away at once; still it may be tried.

If the hemorrhages should occur so frequently, or be so excessive, in

spite of all treatment, as to endanger the safety of the patient, there

is no other resource left to save her life but to produce abortion,

because the presence of the fœtus and its appendages is evidently then

the irritating cause which keeps up the discharge, and it cannot be

expected to stop till the womb is emptied.

ABORTION, OR MISCARRIAGE.

When the fœtus is prematurely expelled before it can survive, it is

called an _Abortion_, but if its expulsion take place so late that

it can live, it is called _Miscarriage_. Both these are serious

accidents. In abortion the child is lost, as a matter of course, but

in miscarriage it may live, after the seventh month. The danger to

the mother is considerable from both, though greatest probably from

abortion. It is probable that many very early miscarriages take place

unperceived, the female suffering but little from the accident, and the

embryo being too small to be seen, unless carefully looked for.

The most frequent periods for such accidents are found to be six

months, five months, and three months; and what is very singular, a

much greater number of male children are aborted than females, the

proportion being about sixteen to eleven.

These accidents are so intimately connected with flooding, that many

writers always treat of them together, considering the flooding merely

as the most frequent cause and symptom of miscarriage or abortion. In

speaking therefore of the immediate causes of premature expulsion of

the fœtus, we place hemorrhage first, and the causes before enumerated

which produce that as being its most frequent remote ones.

A full habit, with tendency to local congestion, seems to predispose

a female very much to miscarriage; every one so constituted should

carefully avoid luxurious living and an inactive life. Violent bodily

exertion, falls, or blows, or strong mental excitement are most usually

the immediate causes, though with some it will come on spontaneously

without any such exciting agencies. Some females will miscarry many

times in succession, and always so near the same period, that they can

tell to a day or two when it will happen. It seems to become a habit of

the womb with them to contract at that particular time, and the only

way to break through the _habit_ is for them to avoid becoming pregnant

for some considerable time, say two or three years after, they may then

go the full time, but will seldom do so if they conceive immediately

after having miscarried. In some persons miscarriage is caused by a

_too eager_ gratification of certain desires; but in others it may

arise _from the opposite cause_.

There is a disease of the womb also by no means unfrequent, though but

little understood, which undoubtedly causes much miscarriage, and that

is _Rheumatism of the Womb_! This mostly exists before the pregnancy

however, and should be then treated according to the plan laid down in

my "Diseases of Woman."

Miscarriage also arises in many females from a rigid state of the

muscular fibres of the womb, which not relaxing sufficiently to allow

that organ to expand become irritated by the pressure they experience,

and begin to contract. This contraction of the womb of course soon

leads to the expulsion of its contents, the same as in real labor.

Women with their first children are more liable to miscarriage than

others on this account, the womb not having become habituated as it

were to the necessary relaxation.

And this is the reason also why some females, after suffering from this

accident many times in succession at last escape it. In general they

miscarry early the first time, from the womb not relaxing sufficiently,

but go a little longer the next time, and longer still the next, and

so on till they reach the full period. The fibres of the womb have

gradually become accustomed to relax, and have borne the irritation

longer and longer each pregnancy, till at last they have forborne

to contract till the proper time. I knew one female who miscarried

_twenty-one times_ in succession, getting gradually nearer to the full

period each time, till at last she reached _nine months_, and was

rewarded with a living child.

Sometimes the accident may be produced by a uterine tumor, by a great

quantity of water in the womb, or even by there being more than one

child, because in either of these cases there is required more room

than ordinary; and of course from the greater expansion required, the

liability is increased. Various womb diseases may also be mentioned

as causes, or adhesions of its walls or ligaments to the walls of

the abdomen, and also a diseased state of the placenta. The pressure

of corsets and tight dresses also not unfrequently lead to the same

result. Some general diseases undoubtedly often cause miscarriage, such

as measles, jaundice, scarlet fever, consumption, and probably many

others, particularly those in which the quality of the blood is much

altered, or the nervous power much exalted or depressed. Convulsions

have already been mentioned as being frequent causes of miscarriage,

and all strong mental or moral impressions. Indeed these last causes

operate more than is suspected, and make it necessary for a pregnant

female to be kept as calm in her mind as it is possible for her to be.

I have even known one to miscarry from a fright _in a dream_.

It is also a fact, though not generally known, that there are

certain diseases _of the father_ that may produce miscarriage, and

unfortunately they are of that kind that often remain for a long time

in the system without much external manifestation, so that many persons

think they are perfectly free from them even while they are working

such mischief.

The death of the child also is sure to produce miscarriage, and this

may result from various causes, such as external injuries and violence,

or from remaining too long in the warm bath and thereby causing

congestion of blood in the womb. Small pox and syphilis in the mother

may also cause the death of the child, though not always. Many having

been born at full term with these diseases upon them.

In general the fœtus is expelled very soon after it dies, but

occasionally it is retained for a considerable time, and may not

pass away till it is completely decayed. It has even been known to

become almost fluid, and several months elapse before it was entirely

expelled. Most women know when it dies, by its seeming to fall down to

the bottom of the abdomen, like a dull weight, and also by its feeling

very _cold_. Very often, however, there is no indication of its death

whatever. M. Chailly mentions a case where the embryo died, probably

when about fifteen days old, but the placenta continued to grow, and

the lady was delivered when about six months and a half gone of the

dead embryo, only about a quarter of an inch in length, though the

after-birth was nearly large enough for one of the usual size. In this

case it had died but not decayed, and remained in the womb six months

and a half. In cases of twins also, one will sometimes die at an early

period, but remain till the other is born at full term.

The _growth of the placenta over the mouth of the womb_, and _shortness

of the chord_, have already been referred to as causes both of flooding

and miscarriage; and to these may be added monstrous or deformed

fœtuses, which rarely reach the full term.

It is probable that there are many constitutional and individual

peculiarities predisposing to miscarriage, with which we are not

much acquainted, and which may account for the constant occurrence

of that accident in many females, notwithstanding all we can do. A

_scrofulous_ taint is with good reason supposed to be one of these, and

it is probable that the _disease of the placenta_, and its consequent

separation from the womb, before referred to, is mostly caused by a

taint of this kind. In many instances, where a female has miscarried

from no apparent cause, if the placenta be carefully examined it will

be found dotted here and there with diseased spots, sometimes _like

scrofulous sores_! It is advisable always to ascertain this, and to

carefully examine the fœtus and its appendages. In all cases the advice

I gave to _keep from being pregnant for some time_, will be found most

likely to succeed in averting the accident, both because it gives the

womb time to regain its strength and break through its _habit_, and

also because it gives us time to operate upon the constitutional taint,

if there be reason to suppose it exists.

It is a curious fact, but one often observed, that _living in certain

localities_ even predisposes to miscarriage. There is a certain

district in France where the females are so liable to it, that all who

can do so leave the place when they become pregnant, and thus escape

the greater risk. Miscarriage also becomes epidemic at certain times,

and prevails like contagious diseases; several instances of this are

recorded in history.

Bleeding is also supposed to be a cause of abortion, and probably

it may lead to it in certain states of the system, but by no means

so certainly as many suppose. Instances have been known of pregnant

females being bled from ten to twenty times without any evil result,

even though carried so far as to make them faint. Mauriceau tells us

of one who was bled _ninety_ times, and yet was delivered of a healthy

living child at full term. In like manner many other ordinary causes

of abortion will often fail entirely of their usual effects. Thus

Mauriceau informs us that a female seven months gone fell upon the

hard pavement from _a three story window_ and broke her arm, but yet

did not miscarry. Madame Lachapelle also tells us of a young pregnant

woman who threw herself down stairs purposely, from fear that she

should have to submit to the Cesarean operation, she having a deformed

pelvis. The fall caused her death soon after, but did not make her

miscarry. Certain powerful medicines are also taken by some, a very

small quantity of which, in most cases, produces abortion immediately,

but without effecting what they desire, though it sometimes poisons

themselves.

Indeed the power which the womb sometimes exhibits to retain its

contents in spite of the most violent disturbing agencies, is truly

astonishing. Cases have been known even where the womb itself has been

severely wounded, and yet miscarriage did not take place; as in the

case of a poor country-woman whom I heard of, who accidentally fell

upon a sharp wooden stake, and run it far into the body, injuring the

womb in a terrible manner, but strange to say, though far advanced

in pregnancy, she recovered and went safely through her full time. I

have often known women begin to flood and suffer from dreadful pain,

with other common symptoms of abortion, as early as the second month,

and yet they went safely the full time, though these signs continued

the whole time. In some cases the waters have even been partially

discharged, and yet abortion did not result. M. Velpeau tells us of an

instance where the bag of waters broke, in a female six months gone,

and one arm of the child even came down into the vagina, and yet the

arm returned, the discharge ceased, and she went her full term.

The _progress of a miscarriage_ varies according to the time at which

it occurs, and the causes from which it arises. When it results from

any violence or accident, it usually takes place in a short time,

and is preceded by abundant flooding, which comes on immediately.

The discharge of blood however, is lesser the nearer we approach the

full term, so that a female six months gone is not in nearly so much

danger from flooding as one only two or three months gone. The reason

is this, in the early months nearly the whole of the fœtal membranes

are attached to the womb, so that in case of their being separated, it

bleeds from nearly all its internal surface, but in the latter months

the only point of attachment is the placenta. In the latter months

also the womb contracts vigorously, and so closes its vessels, but in

the early months its contractions are comparatively feeble. In those

cases also, where the child has been dead a considerable time before

its expulsion, there is seldom much flooding, the connection between

it and the mother having been more or less destroyed by decay of the

parts. The same result mostly follows a miscarriage from internal

disease, particularly of the placenta. Indeed in some of these cases,

the blood-vessels connecting the fœtus with the mother have been so

completely destroyed, that no blood whatever could escape from them.

In regard to the probable consequences of premature delivery, it

has already been remarked that it is more dangerous in the early

months than the latter. It may also be added that it is much more

dangerous, at any time, when caused by violence of any kind, or by

forcing medicines, than when it occurs naturally. The danger is much

increased if it occurs during fever, or any eruptive disease, or if

the patient be suffering from diarrhœa or convulsions. As a general

rule we may say, in all cases, that miscarriage or abortion is always

more dangerous to mother and child than natural labor, both in its

present and in its future consequences. During an attack of jaundice an

abortion may terminate fatally in a few hours; and very frequently the

trouble with the after treatment is very great and long-continued.

The treatment in an accident of this kind must vary according as we are

required to prevent it, or to remedy the evils that follow when it has

occurred.

If an abortion be threatened from any cause, the same general practice

must be adopted as recommended for _flooding_, the indications being

the same. I believe myself that in most cases, except from accidental

violence or internal disease, miscarriage may be averted. I knew a

lady who had miscarried many times, always at the same period, who

avoided it at last by simply _preventing constipation_ from the first

commencement of pregnancy, and by using an enema every evening of warm

starch and water, pretty thick, with about thirty drops of laudanum.

This was administered by means of a common injection pipe, just before

going to bed, and continued till after she had quickened, and repeated

occasionally after that, if she felt any premonitory symptoms of

uterine disturbance. If the patient be of a full habit, she should

also, _from the very beginning_, live low, keep the bowels free, and

the skin in good action, and take gentle regular exercise in the open

air.

When all the means used are found of no avail, and it becomes evident

that the fœtus must be expelled, every endeavor should be used to

assist nature in its removal as early and as safely as possible. For

this purpose the same treatment, as far as practicable, must be pursued

as in a real labor. If the hand can be conveniently introduced, without

undue force, it may be so, to remove clots, or to take hold of any

part of the fœtus which may present, and assist in its extraction.

In the early months considerable help may be given, sometimes by

introducing the finger into the mouth of the womb, with a little

extract of Belladonna, to promote its relaxation, but no _force_ must

be exerted in doing so. If any part of the after-birth can be laid hold

of it should be withdrawn, but no extraordinary effort must be used

to reach it. Frequently it happens that a portion of the after-birth

remains in spite of all attempts to take it away, and there is a

_possibility_ that it may produce inflammation of the womb, but no very

serious apprehensions need be felt of such a result, providing the

patient is properly attended to in other respects. The retained portion

gradually decays, and passes away, merely occasioning inconvenience

and being very offensive. The danger from leaving it except at a very

late period, is generally thought to be less than that from using any

forcible means to remove it.

The best means for correcting the offensive discharge are cleansing and

antiseptic injections. Warm soap suds are very good, or a decoction of

Peruvian bark in water. Strong _coffee_ is also excellent, or a weak

solution of chloride of lime. The bowels must be kept free, and the

skin carefully cleansed and well rubbed. On all occasions when the hand

can be introduced with moderate and safe efforts it should be so, and

the after-birth removed.

In conclusion it should be remarked, that the tendency to miscarry,

like many female diseases, is undoubtedly owing, in great part, to the

general debility and weakness which characterizes so many women at

the present day, and which is brought on chiefly by neglect of their

physical education when girls, and by their artificial mode of life

afterwards.

SECTION X.

THE DISEASES OF WOMEN IN CHILDBED, AFTER LYING IN.

CHAPTER XXVIII.

DISEASES OF CHILDBED.

PUERPERAL FEVER, OR CHILDBED FEVER.

This is undoubtedly the most serious of all those maladies that so

often follow labor. It appears from medical records that puerperal

fever has been known from very remote times, and that it has

frequently become _epidemic_, or has spread from one to another,

like the Cholera. In hospitals this has often been observed, and

also in cities, sometimes almost every female delivered in the place

having been attacked while it prevailed. There is also no doubt but

that it is _contagious_, or capable of being transmitted from one

person to another, like small pox. Numerous instances have been

known where nurses and physicians have conveyed it to all whom they

attended, during a long period after having been with a single case.

One physician, after attending a case of puerperal fever, lost nine

patients successively from the same disease, before he suspected the

cause, and an old nurse assured me, that when she was a young woman,

she was the unfortunate means of conveying it to two females whom

she visited, by merely having been in the room a short time with one

who was suffering from it. It is therefore highly important that all

persons who may happen to be with a female so affected should not

attend another case of childbirth for some time, and particularly that

they should not wear any portion of the same clothing they had then

on, and that they should bathe the whole body several times. If a

case occurs in a hospital or other public institution, the female must

be carefully isolated from all the others, and none of her attendants

must be permitted on any account, to visit other puerperal patients,

till after a sufficient time has elapsed, and every precaution has been

taken.

The causes that produce this terrible disorder are not very well

understood; some of them probably predispose to it before delivery,

or even before pregnancy, while others are connected with labor and

its consequences. Among the former may be mentioned, improper diet,

an inactive life, anxiety of mind, bad air, a damp situation, a full

habit, or great weakness, the frequent use of stimulants, and _certain

excesses_! The principal causes operating immediately are difficult

labors, violent treatment, the use of instruments, tearing away the

placenta too soon, retention of the lochia, cold, rising from the

bed too soon, depression or excitement of the mind, over exertion in

talking to and seeing company, and neglect of cleanliness. The most

frequent cause probably is cold or damp, which checks the lochia and

the perspiration, and leads directly to inflammation. It is on this

account that the complaint is nearly always worse in winter than

in summer, and prevails most in low damp situations, and in badly

ventilated apartments, or in those insufficiently warmed. In most warm

countries, and in those of an equable temperature, where the females

remain much in the open air, and use regular exercise, puerperal fever

appears to be but little known.