THE AILMENTS OF PREGNANCY
Nausea and Vomiting--Heartburn--Flatulence--Defective Teeth--Pressure
Symptoms: Swelling of the Feet; Varicose Veins; Hemorrhoids;
Shortness of Breath--Leucorrhea--Toxemias.
Most of the ailments to which prospective mothers are liable are
merely the natural manifestations of pregnancy, exaggerated to such
an extent as to cause inconvenience and discomfort. In the early
months, for example, persistent nausea and vomiting may become the
source of great annoyance, and later the pressure of the womb against
neighboring structures may cause a variety of symptoms. It does not
follow, however, that any of these ailments will necessarily appear.
On the contrary, many women are more healthy during pregnancy than at
any other time.
Occasionally illness is charged to pregnancy with which in reality
pregnancy has nothing to do. While awaiting the birth of a child,
just as at other times, women may suffer from coughs or colds, from
aches or pains, from malaria, pneumonia, typhoid fever, or in fact
from any disease. It is evident that such complications are
accidental; and, though pregnancy confers no immunity against them,
it does not, on the other hand, render women more susceptible to all
kinds of ailment.
And yet there are diseases for which pregnancy is directly
responsible. These are, to a very large extent, preventable; and,
though they occur rarely, precautions for their prevention should be
taken in every case of pregnancy. By far the most important members
of this group are the toxemias of pregnancy. These, as will be
explained later, cause symptoms which the patient herself may
recognize, and her physician may often detect their presence still
earlier by alterations in the composition of the urine. For this
reason routine examination of the urine during pregnancy is a means
of prevention indispensable for safeguarding the health of the
prospective mother.
A number of ailments of which prospective mothers may complain do not
require treatment with medicine. This, however, will not be taken to
imply that there is no need to consult a physician. On the contrary,
and it cannot be emphasized too strongly, the prospective mother
should _seek professional service whenever there is anything about
her condition she does not understand_. Sometimes, when she thus
consults the physician, he will explain to her that what she has
noticed is merely one of the natural manifestations of pregnancy and
that she can have no control over it; at other times he will suggest
changes in her mode of life which will very likely afford her relief.
The frequency with which physicians find that ailments may be
corrected by the adoption of hygienic measures indicates that such
ailments are more often due to ignorance or carelessness than to the
existence of disease.
NAUSEA AND VOMITING.--We have already learned that nausea, especially
in the morning on rising from bed, frequently corroborates the
suspicion of a woman that she has become pregnant. So commonly,
indeed, is this symptom expected that most women take no account of
it other than as an evidence that they have conceived, and
consequently do not complain of it. A few who have heard the old
adage, "a sick pregnancy means a safe one," which incidentally is not
correct, actually accept nausea as a favorable sign. In other cases
the nausea is not to be dismissed so lightly; and a relatively small
group of patients suffer from persistent vomiting. When prospective
mothers are questioned systematically, it appears that at least one-
half and perhaps two-thirds of them experience more or less
discomfort from sick stomach. Generally this begins shortly after a
menstrual period has been missed and ceases six or eight weeks later;
it persists occasionally until the movements of the child have been
perceived.
Nausea and vomiting are limited, in the vast majority of cases, to
the early morning, but some patients are annoyed only after meals,
and a few at irregular intervals during the day. The fact that the
attacks do not always appear at the same time, and that they differ
in severity, indicates that different causes may be concerned in
their production. And it is true that there are several kinds of
vomiting that occur during pregnancy, although the classification
interests only physicians. The laity, however, should understand that
the treatment of any given case will vary according to the class to
which it belongs, and therefore the occurrence of troublesome
vomiting should be promptly reported to the physician.
Most frequently it will be found that there is nothing serious the
matter. The vomiting ceases or, at least, it becomes less troublesome
as soon as the diet has been more carefully arranged, constipation
has been corrected, or other hygienic details, such as outdoor
recreation and mental diversion, have received the attention
requisite for good health. In a much smaller group of cases the
restoration of the womb to a proper position or the treatment of some
other local condition, which can generally be remedied without
difficulty, is all that is necessary. But finally, in extremely rare
instances, the vomiting of pregnancy is due to a definite disease
whose existence may be recognized by special methods of analyzing the
urine. In any case, if the physician is given an opportunity to make
the necessary observations and thus determine the variety of the
vomiting, no time will be lost in beginning effective treatment. In
an overwhelming majority of the cases, as I have said, nothing
serious will be found; and then the control of the vomiting will lie
within the power of the patient herself.
Since nausea is usually experienced in the morning on rising from the
recumbent to the upright posture, measures to prevent an attack
should be begun even before the patient raises her head from the
pillow. In the first place something to eat should be taken as soon
as she awakens. The most satisfactory results follow eating two or
three pieces of crisp toast or a Bent's cracker (sold by grocers),
either of which should be thoroughly chewed and swallowed without
taking anything to drink. Good results are also obtained, though less
uniformly, from eating other food, such as fruit, oatmeal, or eggs.
The benefit secured from this procedure is explained, perhaps, by the
activity of the digestive organs and the effect of that activity upon
the circulation of the blood. The food eaten before rising is not
intended to take the place of breakfast, which ordinarily will be
eaten later. Furthermore, it is essential to remain in bed until half
an hour after the food was taken; and not to rise then unless
perfectly comfortable. Anyone who is inclined to be nauseated should
get up slowly and dress leisurely, sitting down as much as possible
while putting on the clothes. If breakfast is not desired at once, it
should not be forced, but some food should be eaten between early
morning and noon.
It is an exceedingly good rule to bend every effort toward escaping
the initial attack of nausea, for in this way one soon gains
confidence, and overcomes the depressing habit of being continually
on the watch for the symptom, lest she be taken unawares.
Exceptionally, however, patients feel more comfortable if they vomit
in the morning; this may be helpful, for example, if a large meal has
been eaten just before retiring the previous night.
Next to morning sickness in point of frequency comes the disposition
to be nauseated about meal time. Those who vomit after the meal is
finished are frequently inclined to eat soon again; and there is no
reason why they should not. Sick stomach after meals may be due to
several causes, such as eating hurriedly, eating too much, or
selecting food that is difficult to digest. If a meal is bolted the
stomach may be overloaded before the appetite is appeased; and
consequently those who eat too much are fortunate when the stomach
rejects the excess. Eating slowly and masticating the food
thoroughly, we know, is the proper way to insure taking no more than
is needed.
One of the most valuable precautions against persistent nausea
consists in taking small amounts of food five or six times during the
day. Directions regarding the frequency of meals and the choice of
food have been given in Chapter IV, to which the reader may refer. It
may be repeated, however, that a prospective mother should naturally
avoid anything which she knows is likely not to agree with her. On
the other hand, she is almost certain not to be nauseated by any
article of food for which she has an appetite.
Lying down for a short while after meals frequently serves to prevent
an attack of vomiting. It is a good rule, furthermore, at whatever
time of day the sensation of nausea may occur, to lie down
immediately. An ice bag or cloths wrung out of cold water, if applied
to the abdomen, often give relief; warm applications occasionally
serve the same purpose better. Some patients prevent nausea by
constantly wearing a flannel bandage about the abdomen.
Many instances of the vomiting of pregnancy cannot be explained by
errors in diet, for the attacks come on repeatedly whether the
stomach contains food or not. Under these circumstances mental
influences frequently have to be reckoned with. Indeed, in most cases
of vomiting of pregnancy dietetic and other hygienic measures are of
no avail unless the patient learns to divert her attention from
troublesome thoughts.
That the brain can exert an influence over the stomach is a fact well
substantiated both by physiological experiment and by medical
observation. In all probability there is a definite spot in the
brain, called the "vomiting center," the irritation of which causes
retching and the upheaval of the contents of the stomach. As this
nervous mechanism is possessed by everyone, it is not called into
existence by the advent of pregnancy. Nevertheless, it seems likely
that pregnancy renders it more sensitive, and it is certain that
pregnancy establishes new means by which the center may be
stimulated. This admission does not imply, however, that the
prospective mother must submit to inevitable discomfort, for she can
and should muster the strength to resist it.
Time and again an unhappy frame of mind exaggerates or prolongs the
vomiting of pregnancy. Thus, disappointment, anxiety, grief, fright,
and other types of mental uneasiness not only magnify the discomfort
but sometimes are its sole cause. The curious cases in which the
husband suffers from nausea while his wife is pregnant are explained
by mental influences. As a result of the same kind of influence,
women who imagine themselves to be pregnant often suffer from violent
vomiting, which ceases as soon as they discover their error. On the
other hand, women who for several months remain ignorant of the fact
that they are pregnant rarely suffer from sick stomach.
Any kind of worry may be and often is the direct cause of the
vomiting of pregnancy, though patients are often unwilling to confess
it; and occasionally do not seem to know what it is that troubles
them. In any event, having received the assurance of her physician
that there is nothing serious the matter, the prospective mother who
is annoyed by nausea should make every effort not to become self-
centered. She should have congenial companionship and should interest
herself in pursuits outside of, as well as within, her home. Of all
the measures that may be employed to overcome this manifestation of
pregnancy the most fundamental and essential is mental diversion.
HEARTBURN.--Obviously, it would not be fair to consider indigestion
as one of the ailments peculiar to pregnancy, for anyone is liable to
suffer from indigestion. Yet dyspeptic symptoms, more especially
heartburn and flatulence, occur so frequently at this time that
something should be said regarding their causation and treatment.
A burning sensation rising from the stomach into the throat,
familiarly called heartburn, is generally due to an overabundant
secretion of hydrochloric acid, which is, as we have learned, a
normal constituent of the gastric juice. Of late, the conditions
which influence its secretion have been the subject of laboratory
investigation, which has disclosed, among other interesting facts,
the way to _prevent_ heartburn. These experiments have taught
that the introduction of fat into the stomach shortly before a meal
decreases the amount of acid secreted during digestion. Consequently,
anyone who is troubled by heartburn and wishes to avoid it _should
take a tablespoonful of olive oil, a cup of cream, or a glass of rich
milk fifteen or twenty minutes before meal-time_.
On the other hand, fatty food eaten with the meals prolongs the stay
of food in the stomach and causes an increase in the secretion of
hydrochloric acid. An excess of the acid, as we have just learned, is
favorable to the development of heartburn. Therefore, as a further
precaution against this source of discomfort, it is advisable not to
use a large amount of butter or of salad oil, and to refrain from
fried food, rich desserts, or any other article of diet known to
contain a relatively large amount of fat.
Once it has developed, heartburn will be aggravated by taking cream
or olive oil. The most rational _curative measures_ then consist
in diluting the acid by drinking a couple of glasses of water and in
counteracting (neutralizing) the acid by taking a teaspoonful of
baking soda (bicarbonate of soda) or a tablespoonful of limewater;
and, if necessary, either of these doses may be repeated. Patients
often adopt the very sensible habit of carrying with them a block of
magnesium carbonate, which they nibble whenever the symptom appears.
FLATULENCE.--The distention of stomach and intestines with gas,
technically called flatulence, may be associated with heartburn or
appear independently. The gas arises from the action of bacteria upon
the food. There can be little doubt that flatulence occurs so
regularly during pregnancy because the pressure of the enlarged womb
prevents the contents of the intestine from moving along as rapidly
as they have done previously.
To be relieved from this source of discomfort, it is necessary, in
the first place, that the bowels should be regularly evacuated; very
often nothing further is required than to overcome the habit of
constipation. Occasionally, however, the diet must be arranged so as
to exclude food which is likely to form gas. For example, parsnips,
beans, corn, fried food, candy, cake, and sweet desserts, all of
which are known to cause flatulence, should be avoided; in aggravated
cases the allowance of starchy food of every kind should be cut down
to small portions.
Since the production of gas in the intestine is due to the action of
bacteria sometimes relief from flatulence is secured only after the
administration of intestinal antiseptics. Drugs, however, will be
prescribed by the physician, and will not be employed until the
simpler hygienic measures have failed. Similarly, the physician
should decide whether it is advisable for the patient to drink milk
inoculated with harmless bacteria (The Bulgarian Bacillus) which has
lately been placed on the market. The bacteria thus administered in
the milk are antagonistic to the intestinal bacteria that produce
gas, and consequently have been recommended for the treatment of
flatulence. If this commercial product cannot be conveniently
obtained, one may use instead tablets containing the bacteria, which
can be supplied by druggists.
DEFECTIVE TEETH.--Unless suitable precautions are observed, the
digestive disturbances of pregnancy have a tendency to injure the
teeth. The regurgitation of the acid contents of the stomach, for
example, may cause cavities to develop or may enlarge those that
already exist. In all probability the damage done in this way--and
not the removal of lime from the teeth for the formation of the
child's skeleton, as some have thought--is responsible for the origin
of the saying that "every child costs a tooth." This notion is of
course absurd, yet it is quite true that toothache and the decay or
loosening of the teeth are not infrequently associated with
pregnancy. On this account, throughout the period of pregnancy
particular care should be given the teeth.
One of the very first duties of a prospective mother, after she knows
that conception has taken place, is to visit her dentist. This step
is very important as a means of insuring the teeth against such
harmful influence as pregnancy may have upon them. If the dentist
finds the teeth in poor condition, the patient should consent to have
them treated immediately. That this is the reasonable course seems
sufficiently obvious, yet the majority of women have been slow to
adopt such a view.
For a long time dental work of every description was incorrectly
believed to have an untoward effect upon the development of the
child; and the extraction of a tooth, it was thought, would surely be
followed by miscarriage. Although the extraction of teeth is not
frequently undertaken nowadays, I have known several prospective
mothers who required the operation, and who had it performed without
experiencing a single untoward symptom. Very naturally dental work
should be restricted during pregnancy to that which is absolutely
necessary, and temporary fillings generally suffice; but whatever is
needed should be done without delay.
Brushing the teeth after meals and removing particles of food that
may have been caught between them--important enough at all times--are
of even greater importance during pregnancy. If the gums are sore and
the teeth show a tendency to loosen, the best tooth-paste is one
containing potassium chlorate.
An alkaline mouth-wash should be used several times a day; after an
attack of vomiting it is always advisable to rinse the mouth with
such a solution. As a wash either lime water or milk of magnesia, or
a solution of bicarbonate of soda may be used; they are equally good.
Lime water may be prepared at home inexpensively in the following
way: Place a teacupful of builders' lime in a large bowl and add two
quarts of water; thoroughly mix and allow to settle. Pour off and
throw the water away, since it often contains impurities. Add two
quarts of water again and allow the mixture to stand three or four
hours, stirring occasionally. Strain through a piece of muslin into
bottles and keep well corked. One tablespoonful of this solution
should be added to a glass of water to obtain the proper strength for
a mouth-wash.
PRESSURE SYMPTOMS.--Because human beings walk erect, and not on all
fours, they are liable to suffer from various ailments of pregnancy
that quadrupeds escape. Thus the upright posture is the chief factor,
at least, in causing such complaints as swollen feet, varicose veins,
hemorrhoids, and cramps in the legs. The attention of patients should
be called to the source of these troubles, for in most instances they
can be prevented by forethought and prudence.
During the last two or three months of pregnancy every prospective
mother should carefully avoid being too much on her feet; she should
lie down, as has already been emphasized, at regular times of day and
frequently sit down to rest. Proper support for the abdomen, such as
is afforded by a correct corset or a maternity supporter, lifts the
pregnant uterus, and to a notable extent relieves of pressure the
structures beneath it. On the other hand, incorrectly made corsets,
the use of circular garters, and running a sewing machine by foot-
power all aggravate the pressure symptoms of pregnancy.
_Swelling of the Feet_.--So long as the swelling is confined to
the feet and legs it does not mean that there is trouble with the
kidneys; the swelling is satisfactorily explained by the pressure of
the enlarged uterus upon the veins which pass through the lower part
of the abdomen and conduct the blood from the legs on its way back to
the heart. The womb is rarely heavy enough during the first half of
pregnancy to interfere with the flow of blood through these vessels,
but in the last few months such interference is very common.
Generally the limbs are equally affected, yet occasionally the
swelling is more marked on one side or the other. The characteristic
changes begin in the feet. The skin covering the back of the foot
becomes tense and has a waxen appearance; it is easily indented,
bearing for a moment the imprint of anything that is pressed against
it. Often the swelling extends no higher than the ankles, but it may
involve the calves, the thighs, or even the vulva, which is the
region between the thighs.
If the swelling remains slight, no attention need be paid to it. But
if it becomes extensive or painful, nothing will give relief except
going to bed. Patients observe for themselves that the swelling
lessens during the night, and from this usually learn that the proper
treatment is rest. When it is absolutely impossible to remain in bed
long enough for the swelling to disappear, the next best plan is to
accept every opportunity, during the day, to sit down and prop up the
feet.
_Varicose Veins_.--The distention of the surface veins of the
legs, the condition known as varicose veins, is not a peculiarity of
pregnancy. Anyone who must be on his feet a great deal is liable to
suffer from this ailment. It is true, nevertheless, that pregnancy
increases the likelihood of the development of varicose veins. The
walls of the vessel are generally able to withstand whatever strain
is placed upon them during the first pregnancy, and usually the
varicosed condition does not develop until after there have been
several pregnancies.
As a rule, both legs are similarly affected, but if only one, it is
more likely to be the right. This is explained by the fact that the
position of the child within the womb is ordinarily such as to cause
greater pressure on the vessels of the right side. For the same
reason when the legs are unequally affected, generally the veins of
the right side are the larger. In any case, however, the birth of the
child removes the source of the interference, and during the lying-in
period, provided that the patient remains quiet for a sufficient
length of time, the vessels regain their normal caliber. Once they
have been distended, however, the veins remain more susceptible to
engorgement. Consequently, in order not to increase the strain these
vessels naturally bear during the latter months of pregnancy, the
precautions just mentioned for the avoidance of all the pressure
symptoms should be strictly observed. Upon the first intimation that
the veins are becoming dilated, a patient should be unusually careful
to keep off her feet all that she can. Only in extreme cases will it
be compulsory to go to bed. But, if the veins are large and painful,
she should stay in bed until material improvement has taken place.
Subsequently she should wear a flannel bandage, snugly applied, about
the leg from the toes to a point somewhat above the knee; the bandage
should extend higher whenever the veins of the thigh also are
dilated. In putting on the bandage the heel may be left uncovered;
after leaving the foot a turn of the bandage will be taken around the
ankle and thence applied upward. A flannel bandage may be easily made
at home. Bias strips are cut about three inches in width and sewed
together end to end so that the joining will lie flat. Unless the
bandage must extend far above the knee, eight yards will be a
sufficient length.
Elastic stockings, which may be purchased from a druggist, serve the
same purpose as the bandage, but are very much less durable. Even if
worn during the day they should be taken off at night; and when
protection of the veins is required after going to bed, the bandage
is the most sanitary way of securing it.
The danger that one of the vessels will break may be disregarded, if
they are constantly protected by the measures that have been
mentioned. In the event of accident, however, make firm pressure over
the bleeding point with a freshly laundered handkerchief, and apply
an ice bag outside the dressing until the doctor arrives.
_Hemorrhoids_.--Hemorrhoids are caused in the same way as
varicose veins of the legs. The two conditions differ merely in point
of location; but hemorrhoids, on account of their location, are much
more exposed to irritation.
Although the development of hemorrhoids cannot always be prevented,
it is a well-known fact that constipation renders the chance of their
appearance much greater. In a measure, therefore, regular, daily
evacuation of the bowels serves to prevent the ailment, and also to
cure it, once it has developed. But walking and even standing
aggravate hemorrhoids. The recumbent posture, as might be expected,
is of itself frequently enough to give relief. It is much more likely
to do so, however, if the hips are elevated by placing a pillow under
them.
In severe cases it is helpful to restrict the diet for a few days
until the congestion and acute suffering have subsided. If the
hemorrhoids protrude, they should be replaced (which the patient may
generally do for herself), and an ice bag should be applied to the
seat of pain. Various ointments and suppositories of different
composition are valuable in the treatment of this ailment, but, as
not all cases are relieved by the same medicine, a physician should
be consulted to learn what is most suitable in any given instance.
Hemorrhoids often grow progressively worse as pregnancy advances, and
are frequently aggravated immediately after the birth of the child;
but they generally disappear within a few weeks. Whenever a natural
cure is not thus effected, it may become necessary to resort to
surgical treatment. Operative procedures, however, should not be
undertaken during pregnancy, since the condition is likely to
reappear before the child is born.
_Cramps in the Legs_.--There are nerves as well as blood vessels
that the pregnant uterus may press upon, and pressure of this kind
may cause pain. At times the pain is definitely localized at the
point where the nerve is pressed upon; under these circumstances the
discomfort is felt in the lower part of the back. On the other hand,
the pain may be referred to the point where the nerve ends. In this
way is explained not only pain in the leg but also those sensations
of numbness and tingling which prospective mothers not infrequently
complain of. The presence of these pressure symptoms is usually
limited to the last few weeks of pregnancy. They often begin about
the time the child's head enters the bony canal through which it is
ultimately born; engagement of the head, as this is called, occurs
simultaneously with the dropping of the waist-line, that is, about
two or three weeks before delivery. From the time the head is engaged
all the pressure symptoms become somewhat more intense.
From the very nature of their causation, it is clear that cramps in
the legs are difficult to treat. The recumbent posture lessens the
discomfort, and, if in addition the hips are elevated, absolute
comfort will occasionally be secured. Whether or not the
administration of medicine is advisable must be determined by the
physician who has the opportunity to see the patient. The birth of
the child, of course, removes the cause of the pressure and
permanently relieves this discomfort.
_Shortness of Breath_.--Besides the ailments caused by the
downward pressure of the pregnant uterus, there are also symptoms due
to its upward growth. Thus shortness of breath is regularly noted
toward the end of pregnancy, and, as has already been mentioned, it
is one of the reasons for exercising leisurely.
Unlike the other pressure symptoms, shortness of breath is ordinarily
aggravated by the recumbent posture, for lying flat on the back
increases the compression of the chest. At night, which is frequently
the time when difficulty in breathing is most pronounced, the patient
may, if necessary, sleep propped up in bed. For this purpose an
appliance called a back-rest may be used, but an extra pillow under
the head and shoulders is usually sufficient.
LEUCORRHEA.--The meaning of the white discharge from the vagina known
as leucorrhea is variable: at times it indicates the existence of an
ailment requiring treatment, and at other times it does not. To be on
the safe side, therefore, anyone who is troubled by leucorrhea should
obtain her physician's opinion as to its significance.
Normally, as we learned in Chapter V, there is an increase in the
vaginal secretion during pregnancy; but this fact is rarely
noticeable until the latter months. Usually it is pronounced only
during the last few weeks. At that time, owing to its antiseptic
qualities, this pale white fluid should not be disturbed by the use
of douches. In the early months of pregnancy, however, leucorrhea may
cause such inconvenience as to demand medical treatment.
While itching is the most disagreeable effect of such a vaginal
discharge, it should be known that itching is not always due to
leucorrhea. Thus it may be caused by a highly concentrated urine, and
in that event will be relieved by drinking a larger amount of water;
or it may be due to the presence of unusual constituents in the
urine. Skin diseases also cause itching; and light haired people,
since they have more delicate skins that brunettes, are especially
susceptible to these ailments. To such skin affections soap and water
may be very irritating; so that when they exist it is often advisable
to cleanse the parts with olive oil. In other cases, ointments are
required and will be prescribed by the physician.
Itching of the skin over the extremities or over the whole body, it
is clear, cannot be attributed to leucorrhea, but in these very rare
cases the irritation would seem to be caused by some waste product
which is being eliminated through the sweat glands. We do not know
what the substance is, but, as the symptom appears so seldom, it must
be due to an unusual kind of waste product or else to one whose
elimination normally occurs through other channels. The affection of
the skin thus brought about is really a very mild kind of poisoning,
and since the offending substance arises in the body of the patient
herself the condition is called an autointoxication. Effective
treatment consists in drinking water freely and taking a cathartic,
for the one stimulates the kidneys and the other the bowels to assist
in getting rid of the cause of the trouble.
TOXEMIAS.--In order to understand what are known as the
toxemias of pregnancy, we must remember that the nutrition of our
bodies involves three separate and distinct sets of processes. What
we eat is, in the first place, digested and absorbed into the body;
secondly, the products of digestion are utilized by the tissues; and,
finally, the waste material is thrown off from the body. Any one of
these processes may be carried out in a way that is not consistent
with health. Most of us realize that disturbances may occur in the
course of digestion, and we are also aware that the excretory organs
occasionally fail to do their work in a satisfactory way. But what
laymen, perhaps, do not appreciate is that the intermediary steps--
between the time when the food is absorbed and the time when the
waste material is finally eliminated--may not be taken precisely as
health requires. Of course, any person may be the subject of one or
another of these nutritional disorders, but unquestionably such
disorders are somewhat more frequent during pregnancy than at other
times. Nor is this difficult to understand, for the nutritional
processes of two beings are here linked together. They generally
proceed harmoniously, but if they do not there results an
autointoxication of the mother which is called a toxemia.
Such toxemias, with extremely rare exceptions, do not occur in the
early months, but are associated with the period of the active growth
of the fetus, namely, the second half of pregnancy. For this reason,
and for some others which do not concern us here, it seems probable
that the nutritional processes of the child are primarily responsible
for these ailments. This view, however, must be somewhat modified,
for experience has clearly taught that the efficiency with which the
maternal excretory organs do their work has a great deal to do with
the effect that the fetal waste products have upon the mother. On
this account she has been urged to pay attention to personal hygiene.
It is also necessary, however, that she should become acquainted with
the symptoms which give warning that the excretory organs are acting
imperfectly.
Autointoxication can almost always be prevented. The means of
prevention are neither mysterious nor difficult to carry out; they
lie within the power of every prospective mother, for they consist
merely of what has already been discussed, namely, the intelligent
regulation of the diet, the care of the body, and a correct ordering
of the daily life. To the chapters dealing with these subjects
reference should be made and particular attention should be paid to
what has been said concerning:
(1) Wearing suitably warm clothes,
(2) Bathing regularly,
(3) Taking a proper amount of exercise,
(4) Drinking water liberally,
(5) Avoiding an excessive quantity of meat,
(6) Guarding against constipation.
At present the value of prevention in the treatment of the toxemias
of pregnancy is so clearly recognized that charitable organizations
employ nurses to visit women of the poorer classes during pregnancy
in order to instruct them about the measures that I have just
indicated. Remarkable results have already been obtained. In one
clinic where this method has been adopted the frequency of all kinds
of toxemia, I am told, has notably diminished, and serious types are
not permitted to develop. Similar results should be obtained in
private practice when patients place themselves under medical
supervision at the beginning of pregnancy. Under these favorable
circumstances symptoms of autointoxication probably occur not oftener
than once in every hundred pregnancies, but nine out of ten of them,
being promptly recognized, yield readily to relatively simple
treatment.
The early detection of such complications depends largely upon the
patient herself. As has been emphasized--and it cannot be said too
frequently--she should not fail to submit, at appropriate intervals,
a specimen of urine for examination. It is by such an examination
generally that the development of a toxemia is first detected.
Occasionally, however, significant signs will attract the patient's
attention before there is any change in the urine. For that reason,
it is important to notify the physician if any of the following
symptoms appear:
(1) Serious vomiting.
(2) Persistent headache.
(3) Dizziness.
(4) Puffiness about the face.
(5) Blurring of vision, or the appearance of black
spots before the eyes.
(6) Neuralgic pains, especially in the pit of the stomach.
It must be clearly understood, however, that any of these symptoms
may be present without indicating that a toxemia is developing.
Nevertheless, they should be brought to the physician's attention
without delay, and, at the same time, a specimen of urine should be
given him for examination.
Although the kidneys are not responsible for all the toxemias of
pregnancy, an analysis of the urine affords the most definite means
of determining whether or not such a condition is present. When thus
detected, prompt treatment will guarantee to the patient almost
certain relief. On the other hand if, as usually happens, the
analysis shows conclusively that there is nothing serious the matter,
this reassurance fully justifies the trouble taken to secure it.