First. A young female shall never have menstruated, and yet conceive.
Secondly. A mother shall conceive while she is nursing, and not
menstruating.
Thirdly. A female shall conceive, and yet be unwell during the first
three, four, or more months of pregnancy.
Fourthly, and lastly. Occasional conception takes place late in life,
after menstruation has apparently ceased for ever.
_First Exception._—Many cases are on record proving this point. I have
met with only two cases; one quite a girl, not having arrived at her
seventeenth year, and yet was in her sixth month of pregnancy when she
applied for a letter for the Finsbury Midwifery Institution; the other
was in her nineteenth year. Menstruation was, subsequent to confinement,
established in the first; with the result of the latter, I am not
acquainted.[9]
Although pregnancy under such circumstances is not of frequent
occurrence, still it does now and then take place. A knowledge of the
fact may therefore prove useful.
_Second Exception._—It is scarcely necessary to advert to the well known
fact that a woman may conceive while she is nursing, without any
previous return of the monthly discharge, except to expose the popular
error, “that a female will not become pregnant during lactation.” This
is very far from being the case. Poor women are much in the habit of
nursing their infants eighteen months, two years, and even two years and
a half, in order to protect themselves, as they imagine, from becoming
pregnant; and many a poor creature have I seen with exhausted frame and
disordered general health, arising from protracted nursing, pursued
alone from this mistaken notion.
I have large opportunities of investigating this, as well as the several
points touched upon in this chapter. On an average, between forty and
fifty poor women call upon me every month, with midwifery letters for
attendance in their confinement: and the result of my inquiries upon the
present question has led me to believe, that more than one third of
these women have conceived at least once while nursing, and very many of
them oftener.[10]
Mrs. M——, ætat. 30, married six years. Became pregnant three months
after her marriage. Having suckled this child for more than two years,
became pregnant a second time. This last died in three weeks, and
immediately after she proved pregnant for a third time. The third child
she brought this morning (being out of health), and assured me that she
had not seen anything since she first conceived, that is, three months
after her marriage, and six years from the present time.
Mrs. W——, ætat. 25, married five years. Has not been unwell since she
first fell in the family way; is now pregnant with a third child, having
hitherto fallen pregnant while nursing.
Many other cases illustrative of this fact I might assert, but these
suffice to prove the exception.[11]
_Third Exception._—That a female should become pregnant, and yet be
unwell during the first three, four, or more months of pregnancy, may
appear an extraordinary statement; but it is a fact, that the menstrual
discharge sometimes continues in its usual regularity for two, three, or
more months after conception, and without any dangerous consequences.
It has been asserted, as an objection, that this discharge is not truly
menstruation; but the discussion of that question does not concern us
here. We have only to consider, whether there does not frequently,
during pregnancy, take place a discharge, so closely resembling
menstruation in its periods, quantity, duration, and appearance, that
neither the female herself nor her medical adviser shall be able to
detect any difference between them; and of this I have no doubt.
It may occur _once_ only after conception, either in diminished quantity
or more profuse than usual. It may thus give rise to miscalculation as
to the expected time of confinement.
It may continue in its usual regularity for _two_ or _three months_. The
following instance of a patient I attended illustrates the fact of its
going on to the period of quickening:—
Mrs. R——, ætat. 27, married eight years. Was first unwell when eighteen
years of age, and continued to be so regularly until she became
pregnant, two years from the time of her marriage. She suckled her first
child for eleven months; soon after she became unwell, and continued so
until she quickened with her second child; a circumstance which she had
not the slightest suspicion of, for there was no perceptible difference
either in the quantity or appearance of the monthly discharge. During
the remaining months of gestation she did not see anything; she
afterwards suckled her little one for ten months; and then was obliged
to wean the child, having an attack of the cholera. She continued from
this time regular for two years; but meeting with a fall, much to her
surprise, two or three days after, miscarried of a four months’ child.
She is now pregnant again, having been regular every month till she
quickened, and expects to be confined, Feb. 1836.
In this case then, the female was unwell in two pregnancies till the
period of quickening; and in the other for four months, when miscarriage
took place from accident.
And lastly, it may occur through the _whole_ period of pregnancy.
Mrs. F—— is now pregnant for the third time. In her first pregnancy the
monthly returns appeared for three periods, regular as to time, and in
quantity and appearance as heretofore. During the second child-bearing,
at every month till confinement. During the third—her present
pregnancy—for three months only. This patient is always unwell while
nursing.
Mrs. J——, now in her eighth pregnancy. Was unwell every month throughout
the first six pregnancies; but the quantity always slightly diminished.
In the seventh, the same circumstances occurred; but premature labour
was this time induced, between the sixth and seventh months, by a fall.
During the present pregnancy she has not seen anything. Is always unwell
while suckling.
Mrs. P—— is in her fourth pregnancy. In the first three was unwell, at
her regular periods, to the time of confinement. The discharge the same
in quantity, but rather lighter appearance. Has been unwell in her
pregnancy every month up to the present time.[12]
The following case proves how important it is that this fact should be
generally known; for up to a very late period, some medical men have
even denied the possibility of this occurrence.
The case I refer to was that of a young lady, privately married, the
gradual enlargement of whose abdomen was decided by her medical
attendant to arise from dropsy; for, although she had most of the
symptoms of pregnancy, and the medical man was aware she had been
married eight months, still, as _she continued to menstruate_, he
declared it impossible that she could be pregnant. Tapping was proposed;
and, except that her general health suffered much at this time, the
operation would have been performed. The delay saved the patient such
unfortunate and mistaken treatment—it might have proved fatal in its
results—and she shortly gave birth to a living and healthy male child.
_Fourth exception._—That women late in life have conceived after
menstruation had apparently ceased for ever, the following cases prove:—
In September, 1834, I was called to the assistance of a female in labour
in her forty-ninth year. She had not been pregnant for twelve years, and
supposed she had ceased to menstruate two years previous to that time.
She did well, and never afterward saw anything.
Mrs. B——, ætat. 39. Has been married eighteen years, commenced to be
unwell very early in life. Has had three children; the last pregnancy
seven years since. Is now again pregnant, her menses having left her
sixteen weeks prior to conception; before which, she had been very
irregular, and supposed she had ceased to be unwell for ever.
Other cases of a similar nature are on record. There can be no doubt
they are authentic; but at the same time it must be acknowledged that a
female is not unlikely to be deceived, by the irregularity which attends
the returns of this discharge, late in life. It so happens, too, that
just before the change of life takes place, there appears in the
constitution of some females a great disposition to pregnancy; so that
many who have ceased to bear children for years, or have been hitherto
barren through the whole of their married existence, at this time, to
the surprise of their friends and themselves, become pregnant.[13]
A knowledge of these facts must be useful, as they will tend to allay
apprehension at what might be supposed disease, both by the mother and
by the hitherto childless woman.
A female must not forget, however, that she may mistake her condition,
and that such mistakes are not at all unlikely to arise from the
circumstance that the symptoms which naturally accompany the _cessation_
of menstruation, much resemble those of pregnancy. She passes over the
menstrual period;—she is struck with this. Other symptoms are soon
manifested; the size increases—the breasts even become swollen and
painful—the stomach disordered, and the appetite capricious;—flatulence
collects in the intestines; and while on this account the size still
increases, the air moving about the bowels gives an inward sensation
which is mistaken by the female for the plunging of the child. Time
alone, or the investigation of the medical attendant, detects the
mistake; and the symptoms are then to be easily removed by the
exhibition of carminative and purgative medicines, the use of active
exercise, and bandaging the distended abdomen.
It must be remembered, also, that _suppression_ of the monthly return
may arise from a variety of causes, altogether independent of
conception. Every female is aware, that exposure to cold, just before
the expected period, is a frequent cause. Different forms of disease,
hardship, or mental emotions, may produce the same result. It does not
follow, therefore, because a woman ceases to menstruate, she _must_ be
pregnant; which naturally presents this inquiry: what dependence, then,
is to be placed upon the omission of menstruation as a symptom or sign
of pregnancy?
When a female ceases to be unwell, and experiences other symptoms of
pregnancy, she must consider her situation as yet uncertain, because
these signs are common to disease as well as pregnancy. But if toward
the third month, while the suppression continues, she recovers her
health, and if her appetite and colour return, she needs no better proof
of pregnancy; for under other circumstances her health would remain
impaired, and even become worse.[14]
_Morning Sickness._
Soon after conception, the stomach often becomes affected with what is
called “morning sickness.” On first awaking, the female feels as well as
usual, but on rising from her bed qualmishness begins, and perhaps while
in the act of dressing, retching takes place.
This symptom may occur almost immediately after conception; but it most
frequently commences for the first time between two or three weeks
after. Now and then it is experienced only the last six weeks or two
months of pregnancy, when it is attended, generally, with much distress
and discomfort. And lastly, it is not unfrequently absent altogether.
It continues, more or less, during the first half of pregnancy, and
subsides about the time when the movements of the child begin to be
felt.
Irritability of the stomach, however, may arise from a variety of causes
totally independent of pregnancy, and connected with disease or
disordered function. Of what avail, then, it will be asked, is this
symptom as a sign of pregnancy? It is so far available:—
The nausea and vomiting of pregnancy are not accompanied by any other
symptom of ill health; but, on the contrary, the patient feels as well
as ever in other respects, and perchance takes her meals with as much
relish as formerly; but while doing so, or immediately after, she feels
suddenly sick, and has hardly time to retire, when she rejects the whole
contents of her stomach, and very shortly after is quite well again. Not
so with sickness arising from disease, or disordered condition of the
stomach.
_Shooting pains through—enlargement of—and other changes of the breast._
When two months of pregnancy have been completed, an uneasy sensation of
throbbing and stretching fulness is experienced, accompanied with
tingling about the middle of the breasts, centring in the nipple. A
sensible alteration in their appearance soon follows: they grow larger
and more firm. The nipple becomes more prominent, and the circle around
its base altered in color and structure, constituting what is called
“the areola.” And, as pregnancy advances, milk is secreted.
The period of gestation at which these changes may occur, as well as the
degree in which they become manifested, varies very much. Sometimes,
with the exception of the secretion of the milk, they are recognised
very soon after conception;—in other instances, particularly in females
of a weakly and delicate constitution, they are hardly perceptible until
pregnancy is far advanced, or even drawing towards its termination.
_Enlargement of the Breast._—The changes in the _form_ and _size_ of the
breast may be the result of causes unconnected with pregnancy. They may
enlarge in consequence of marriage, from the individual becoming stout
and fat, or from accidental suppression of the monthly return. There
are, however, these differences: enlargement from pregnancy may in
general be distinguished from that produced merely from fat, by the
greater firmness of the breast, and its knotty uneven feeling—it is
heavier; and the tension and enlargement from suppressed menstruation,
by its subsiding in two or three days, whereas that caused by pregnancy
continues to increase. Nevertheless, the dependence which may be placed
upon the enlargement of the breast only, as an evidence of pregnancy, is
not very great, and considered alone, but a doubtful sign.
_The Nipple._—Not so the changes which take place in the nipple, and
around its base. These alterations, if present, are of the utmost value,
as an evidence of pregnancy. The changes referred to are these:—
About the sixth or seventh week after conception has taken place, if the
nipple be examined, it will be found becoming turgid and prominent, and
a circle forming around its base, of a colour deeper in its shade than
rose or flesh-colour, slightly tinged with a yellowish or brownish hue,
and here and there upon its surface will be seen little prominent
points, from about ten to twenty in number. In the progress of the next
six or seven weeks, these changes are fully developed; the nipple
becoming more prominent and turgid than ever: the circle around it of
larger dimensions, of an extent of about an inch or an inch and a half;
the skin being soft, bedewed with a slight degree of moisture,
frequently staining the linen in contact with it; the little prominences
of larger size, from the sixteenth to the twelfth of an inch perhaps;
and the colour of the whole very much deepened, but always modified by
the complexion of the individual, being darker in persons with dark
hair, dark eyes, and sallow skins, than in those of fair hair,
light-coloured eyes, and delicate complexions.
Such are the essential characteristics of the true areola, the result of
pregnancy, and, I believe, of that condition only.
This, then, is a most valuable sign; but, unfortunately, it is
frequently absent; and how often it is present, although I have examined
many hundred cases for it, I cannot determine, as unfortunately no note
was made upon this point. It should also be observed, that both in dark
and fair women, the change of colour, without the other appearances, may
be present, and yet pregnancy exist; and I have also seen frequently the
dark circle alone, where pregnancy did not exist; but I never saw an
instance where these prominences were truly developed, without the
presence of pregnancy.
This fact has been more particularly noticed of late years by an eminent
physician-accoucheur, and the attention of the author has, in
consequence, been much directed to it; and, as a striking illustration
of its truth, he may mention, that, called upon very recently to visit
one of the Institution patients, the third day after her delivery, and
having occasion to examine the breast, I pointed out to the gentleman in
attendance the presence of these little prominences around the base of
the nipple; upon which the patient, to my great surprise, immediately
observed, “Ah, sir, I always know when I am pregnant by them, for they
appear about ten days or a fortnight after its occurrence, and
subsequent to delivery diminish gradually, as my milk leaves me.”
It has occurred to me during the past year to be consulted in five cases
of doubtful pregnancy. In _two_ of them, circumstances forbade the
probability of its occurrence; but in both the true areola was
distinctly and fully developed. It decided my opinion; and the result
proved its correctness: both became mothers. _Two others_ had made
themselves patients of the Lying-in-Institution, having obtained letters
for attendance from governors of the charity, and upon which was marked,
by their own calculation, the month of their expected confinement. But I
was led to believe, from observing two or three symptoms, that pregnancy
did not exist.
Their cases were examined, and at last the breast; in both the true
areola was wanting: the review of symptoms decided all doubts. Had,
however, the true areola been present in either, it would at once have
reversed, instead of confirming my first suspicions.
The _fifth_ was pregnant, but the true areola was wanting; and I was
obliged to refer to those signs which can alone be recognised by a
medical man.
The absence, then, of this sign, except in combination with other
circumstances, proves nothing, but, if present, I believe it conclusive.
_The Presence of Milk._—With regard to the presence of milk in the
breasts, as this is a symptom which may arise, and does very generally,
in the latter months of gestation alone, when the existence of pregnancy
has been long determined, it is only mentioned here to refute the
popular error, that “the presence of milk in the breasts is an
infallible proof of pregnancy.” It is no such thing; and many
well-recorded instances could be brought forward to prove the
possibility of its formation under circumstances totally independent of
pregnancy.
Belloc speaks of a servant girl, who being obliged to have sleeping with
her an infant who was being weaned, and which by its crying disturbed
her rest, bethought her of giving it her breast to appease its clamour;
and the result was, that in a short time she had milk enough to satisfy
the child.[15]
The following case is related by Mr. George Semple: Mrs. B——, wife of
John Breward, Simpson Green, near Idle, aged forty-nine, the mother of
nine children, the youngest of whom is twelve years old, lost a
daughter-in-law about a year ago, who died in about a fortnight after
giving birth to her first child. On her death, Mrs. B. took charge of
the infant, a little puny sickly baby. The child was so fretful and
uneasy, that Mrs. B. after many sleepless nights, was induced to permit
the child to take her nipple into its mouth. In the course of from
thirty to thirty-six hours she felt very unwell; her breasts became
extremely painful, considerably increased in size, and soon after, to
her utter astonishment, milk was secreted, and poured forth in the same
abundance as on former occasions, after the birth of her own children.
The child, now a year old, is a fine, thriving, healthy girl, and only a
few days ago I saw her eagerly engaged in obtaining an apparently
abundant supply of healthy nourishment, from the same fountain which,
nearly twenty years ago, poured forth its resources for the support of
her father.”[16]
_Quickening._
There is only one other symptom which I think it useful to notice, that
is quickening; by which is meant, the first sensation experienced by the
mother of the _life_ of the child within her womb.
The first time this motion of the child occurs, the sensation is like
that of the fluttering of a bird within her, and so sudden that she
frequently faints, or falls into an hysterical paroxysm. A day or two
passes by when it recurs. It afterwards increases both in frequency and
degree, until the movements of the child are fully recognised.
It is proper that a female should be informed that the _period_ when
quickening takes place is very uncertain; for an impression is popularly
prevalent that it always occurs _exactly_ at the end of four calendar
months and a half. This is not the case; it varies in different women,
and in the same women during different pregnancies, as the following one
or two instances will prove:—
Mrs. F——. Quickened with her first child at four months: quickened with
the second at fourteen weeks: and is now in her third pregnancy, and
reckons from the fourteenth week again.
Mrs. B——. Has had seven children, and with all felt the motion of the
child for the first time at the third month.
Mrs. Mc M——. Has been several times pregnant; seldom feels movements of
the child at all until the sixth month, and not strongly till the
eighth.
The annexed table of the periods of quickening of seventy cases taken in
the order in which they have been entered in the author’s note-book,
will forcibly stamp the truth of these opinions:
9 Quickened at the 3d month.
11 Quickened at 3½ months.
21 Quickened at the 4th month.
16 Quickened at 4½ months
8 Quickened at the 5th month.
1 Quickened at 5½ months.
4 Quickened at the 6th month.
——
70
——
In a few of these cases, for the sake of convenience I have used round
numbers, when two or three days before or after was the exact time; and
for the sake of correctness, have omitted several cases, in which there
was the slightest doubt in the patient’s mind of the exact time.
It appears from this table, that this symptom takes place more
frequently between the twelfth and sixteenth week, than before or after
these periods; and that subsequent to the 4½ and the expiration of the
sixth month, it may occur in the proportion of more than one case out of
every five.—Before the third month, quickening seldom arises.
This symptom may not be felt by the mother at all, and yet pregnancy
exist. This is rare, but the fact is confirmed by many writers; and I
have met during the last seven years with two instances, and in both the
mothers gave birth to living and healthy children.
Now comes the question, how far this symptom is of value, as a sign of
the pregnant state?
If it has been experienced in former pregnancies, it is invaluable, for
I believe it is not to be mistaken. If it is a first pregnancy and
doubtful, it removes all obscurity, provided the sensation grows
stronger and stronger, until the movements of the child are distinctly
felt.
Four only of the symptoms of pregnancy have been noticed, because the
remainder are not recognisable, except by the accoucheur, although to
him of the greatest value when pregnancy is complicated and doubtful
from the presence of disease.
The nature of these symptoms has been described as plainly, and yet as
briefly, as possible, because of the importance of their being clearly
understood by married women.
I have also endeavored to point out their real value as evidence of
pregnancy—how they are sometimes absent in patients who are pregnant,
and some of them present in those who are not so—because of the doubt
and obscurity which arise from these variations.
And lastly, in bringing these observations to a conclusion, I venture to
say, that if the married female will only take the trouble to make
herself familiar with this little detail, she will not regret the time
as lost or misspent, because it will generally guide her aright, and I
trust save her many moments of anxiety and discomfort.
ON THE
DISEASES OF PREGNANCY,
AND HINTS FOR THEIR
PREVENTION AND RELIEF.
In describing the diseases which are incident to the whole period of
pregnancy, my design is to take a general popular survey of the subject.
I wish simply to communicate that kind of information, which every
married and well-educated woman should certainly possess, and can
usefully employ. To advance further than this, to those points upon
which the assistance of the medical adviser ought to be sought, would be
on every account improper, and productive rather of evil than of good.
There is no organ in the body, with the exception of the stomach, that
exercises a more extensive control over the female system than the womb.
Hence, when in the condition of pregnancy, it affects, directly or
indirectly, various parts of that system. The effects of pregnancy,
however, vary much according to the constitution of the female.
Sometimes a very salutary change is produced, so that the individual
enjoys better health during gestation than before. The delicate and
frequent-ailing girl, for instance,—the propriety of whose marrying was
a matter of doubt among her friends—becoming pregnant, instead of
realizing the apprehensions and fears of those most dear to her, will
sometimes acquire new life and vigor from the altered circumstances of
her condition. On the other hand, speaking generally, it is sometimes
the case that harassing and painful symptoms will arise. These are
designated the “diseases of pregnancy.”
_Morning Sickness._
Nausea or vomiting, is one of the most common and distressing affections
of pregnancy. It is chiefly troublesome in the earlier months of
gestation, continuing until the period of quickening, when it decreases
or ceases spontaneously;—or it does not occur until the latter months of
pregnancy, when it subsides only upon delivery. I shall consider these
states separately; and—
_First_, of sickness during the _earlier_ months. This arises solely
from sympathy with the newly commenced action, and irritable condition
of the womb. This is evident from the fact, that, as the novelty of the
pregnant state ceases, and the stomach becomes accustomed to it, the
sickness subsides gradually, and is rarely troublesome afterwards.
It occasionally commences immediately after conception; and it is a
remarkable fact, that a pregnant woman scarcely ever feels sick, until
she first gets upon her feet in the morning. Hence it is called the
“morning sickness.” She awakes refreshed and well, arises from her bed,
and while dressing begins to feel qualmish. At the breakfast table she
has no appetite, or if she takes anything, is shortly obliged to leave
for her dressing-room, where she returns what she has taken; or, if she
has been unable to take anything, ejects a fluid, limpid, thin and
watery; and if the vomiting increases in severity, bile is thrown up at
the same time. After the lapse of three or four hours, she feels quite
well again, and by dinner time sits down with an appetite to her meal.
If there is merely nausea or vomiting _without the presence of bile_, it
is evident that it arises solely from irritability of the stomach, and
is not connected with a disordered condition of the digestive organs,
which latter circumstance is not unfrequently the case. The best means
that can be employed to relieve this irritable state will be found in a
draught taken twice a day for several days, composed of fifteen grains
of magnesia, one drachm of tincture of columba, and an ounce and a half
of distilled peppermint water.[17]
Medicine sometimes is hardly called for; and I have known a tumbler of
warm chamomile tea, or even warm water only, taken immediately after
nausea was felt, by inducing immediate vomiting, tranquillize the
disturbed stomach, and thus abridge the morning attack. It is sometimes
attended with advantage to take the chamomile tea before the female
rises from her bed. I advised this with the most marked success very
lately in the case of a lady who was very much reduced by the morning
sickness. It had continued for several weeks, and with so much violence
and straining, as to cause blood to be ejected with the fluid. In less
than one week, when all other means had previously failed, the above
suggestion was successful.
It frequently happens that the acidity is very great, in which case
fifteen or twenty grains of magnesia should be taken in a wine-glass of
milk[18]—or, if it is preferred, a small tumbler of soda water; but the
latter must not be persevered in for any great length of time, as it
will then become injurious. The presence of acidity, however, is
sometimes so difficult to overcome by alkalies, that these medicines
must be given up, and acid remedies employed. Lemonade may first be
taken, but lemon juice and water is still better.
The state of the bowels must not be forgotten, and if any of the latter
remedies are resorted to, the most marked benefit will be derived from a
gentle dose of Epsom or Cheltenham salts every second morning, if so
often necessary.[19]
The diet in such a case must also be carefully attended to; but as this
point will be referred to more particularly presently, it is only
necessary now to say that the quantity of food taken must bear some
proportion to the slightly diminished powers of the digestive functions,
and that it will be well, when the sickness is very obstinate and
distressing, to take no food at all for several hours after rising. If,
after a few hours, the mouth is much parched, it may be moistened with a
little broth, or weak beef-tea; but let nothing more be taken for five
or six hours, and it is most probable that the sickness which has
resisted all other means, will thus be relieved.
If this irritable state of the stomach is connected with a _disordered
condition_ of the _digestive organs_, the sickness will be accompanied
with the presence of bile in the matter vomited, a furred tongue,
confined or irregular action of the bowels, and occasionally with what
is termed “a sick headache.” These symptoms are to be relieved by
medicines which thoroughly clear out the bowels, allay the irritability
of the stomach, and afterwards by those which restore tone to both. But
it is to be observed that the following directions are only intended to
apply to those simple cases, in which, whether necessary or not, no one
ever thinks of consulting their medical adviser, and for which it is
certainly desirable that they should have some judicious directions,
rather than be left entirely without them. If these symptoms become at
all aggravated, it is requisite that they should make immediate
application for professional advice.
The bowels will need in the first instance a draught composed of
infusion of senna and Epsom salts—the common “black draught,”—with half
a drachm of the tincture of henbane in addition. This, with five grains
of blue pill, most probably effects the object desired; the bowels will
be well purged, and the tongue become clean.
The next thing is to allay the irritability of the stomach, which is to
be accomplished by the means already pointed out—the effervescing
draught of soda, magnesia, chamomile tea, &c.; but in connexion with
this, two or three grains of the purified extract of aloes, with an
equal quantity of the extract of henbane, must be taken two or three
times a week, at bedtime. This will keep the tongue still clean, and the
bowels in order.
After a little time, the sickness having subsided, tonic medicines may
be used: and a fourth part of the following mixture, taken three times a
day, will, under the present circumstances, be the best means of
restoring the tone of the stomach and bowels: sulphate of quinine, six
grains; diluted sulphuric acid, half a drachm; infusion of columba, five
ounces and a half; simple syrup, half an ounce.
Having pointed out the means for mitigating sickness in the early
months, there only remains one additional suggestion to make, and it is,
that all the remedies for relief detailed may, in some cases, fail. The
sickness continues most obstinate; every time the female takes food, or
even sometimes when abstaining from it, she vomits; and at last, from
this excessive irritability and long-continued violent action of the
stomach, symptoms threatening miscarriage will manifest themselves.[20]
There is generally in such a case, pain and a sensation of tension about
the pit of the stomach, increased after every attack of sickness. If
symptoms of miscarriage are not present, the application of nine or
twelve leeches to the stomach, and pieces of soft linen rag well soaked
with laudanum, constantly applied and renewed, will give the most
decided relief. If, however, there is pain in the loins and hips,
increasing in frequency and power, becoming at last slightly bearing
down, I strongly advise the patient to consult her medical adviser, as
the loss of a little blood from the arm, perfect rest in the recumbent
position, and other directions which he alone can give, will, in such a
case, be absolutely necessary, and I may add, if perseveringly acted up
to by the patient herself, be certainly followed by success.
_Secondly_, of sickness coming on at the _conclusion_ of pregnancy.
This arises from the distended state of the womb affecting mechanically,
by its pressure, the coats of the stomach, and certain parts of its
neighborhood.
This form of vomiting but rarely occurs; for do not let me be supposed
to refer to the sickness which sometimes immediately precedes, and
generally accompanies, the early part of labour. I am speaking of that
irritability of the stomach which may arise about the sixth, seventh, or
eighth month, and from which the female has been entirely free during
the previous months of gestation, and now producing vomiting of an
exceedingly troublesome form.
A lady suffering from sickness thus late in pregnancy, ought to seek
medical advice at once. From this cause, if severe, premature labour
might be brought on, and judicious medical treatment is always decidedly
necessary to mitigate this form of sickness. The patient must lose a
little blood, she must keep strictly to her sofa, and the bowels ought
to be gently acted upon by small doses of Cheltenham or Epsom salts. A
grain of the extract of opium may be given to allay the irritability at
night, and cloths dipped in laudanum frequently applied to the pit of
the stomach.
In all forms of sickness arising from pregnancy as its cause, the diet
must be light, mild, and nutritious, taken in moderate quantities of
three or four meals a day. It should consist of mild animal food, boiled
or roasted. Chicken, white game boiled, mutton or beef roasted, are the
viands most nutritious and easily digested. Stale pure bread untoasted,
or pilot bread, mealy potatoes, or well-boiled rice, in moderate
quantities, may be taken with animal food for dinner. A glass of port
wine with warm water at the conclusion of the meal, is the best kind of
beverage.
Advantage has often been derived from always taking brown bread, and
Jamaica sugar in the morning’s coffee. The healthy operation of the
bowels has thus been promoted; although a system of regular exercise by
walking, apportioned to the strength, and not continued so long as to
fatigue, will generally effect this purpose, while at the same time it
gives tone to the general health. Fatigue of body is sedulously to be
avoided. Slow and moderate walks, exercise in an open carriage (if the
patient has sufficient strength), should be taken daily between
breakfast and dinner; always avoiding to sit down to the latter meal
tired, and, therefore, probably, with a blunted appetite.[21]
_Heartburn._
This is a very distressing symptom, and occurs early after conception;
sometimes, however, not till after the fourth month; and occasionally is
absent altogether. It is produced by an acid forming on the stomach,
which rises into the throat, and, from the sensation it occasions, is
called _heartburn_.
It is a very common complaint of pregnancy, and every female knows that
she finds relief by taking a little magnesia or chalk, or lime-water and
milk, with the occasional use of magnesia; but, although these means
generally mitigate this symptom, occasionally it is very severe and
almost intractable, and they fail. Under such circumstances, a draught
composed of 15 grains of magnesia, 10 drops of the solution of the
subcarbonate of ammonia, and 1½ ounce of mint or peppermint water, taken
three times a day, and continued for three or four days, will remove the
complaint.
If the bowels are confined, as is frequently the case, mild doses of
Epsom or Cheltenham salts will be the best aperients. The use of these
must be regulated by circumstances,—taken every second, third, or fourth
day; that is, resorted to with sufficient frequency and perseverance to
guard against costiveness.[22]
The _diet_ must also, in every case, be strictly attended to, and
regulated upon the plan already stated.
_Costiveness._
A costive state of bowels is one of the most common and, at the same
time, troublesome of the diseases of pregnancy. It arises partly from
the increased activity which is going on in the womb, and which induces
a sluggish condition of the bowels, and partly from the pressure of the
now enlarged and expanded womb on the bowels themselves.
A confined state of bowels is the frequent source of many serious evils;
it therefore behoves the female to be vigilant and guard against it.
_First_,—Because, as before stated, pregnancy itself predisposes to
constipation.
_Secondly_,—Because it is much more easily prevented than removed, when,
after several days’ confinement, an accumulation of hardened fæces has
collected in the lower bowel.
_Thirdly_,—Because such an accumulation may give rise to inflammation of
the bowel itself, and, in the earlier months of pregnancy, to
miscarriage; and,
_Lastly_,—Because, if a female falls into labor with her intestinal
canal so loaded, it will of itself be sufficient to render, what would
otherwise have been a quick, easy, and safe labor, a long, painful, and
difficult one; and may be the cause also of very serious and alarming
symptoms some forty or eight-and-forty hours after her labor is over.
The first and leading symptom of this affection is a costive or more
consistent state than usual of the fæcal excretions, with a less
frequent call for evacuation than is customary with the individual when
in health. If this is not attended to, and several days, perhaps a week,
pass by without the bowels being relieved at all, pain in the head, a
foul tongue, and an increased degree of fulness and tension of the
abdomen, are experienced. These symptoms are followed, in all
probability, by thin watery evacuations, attended with pain, weight, and
pressure about the lower bowel; they become frequent; and the female at
last, finding that the bowels are not only open again, but even loose,
takes chalk mixture. She is not aware that this very looseness is
nothing more than increased secretion of the lining membrane of the
bowel, caused by the pressure of the accumulated mass of hardened fæces,
which it passes and leaves unmoved. The chalk mixture relieves the
irritation upon which the looseness depends, but the disease is not
removed, and, instead of its being a case simply of costiveness, it has
now become one of constipation; an accumulation of hardened stool is
distending and irritating, by its pressure, the lower bowel and the
womb, and the serious consequences before enumerated may follow.
Very often have I been consulted by a female far advanced in pregnancy
for what she supposed mere looseness of bowels, which has already been
found to originate under circumstances like these. It is of the highest
importance that the patient should endeavor to guard against such a
result; and without doubt she may avoid it, and regulate her bowels with
great comfort to herself, throughout the whole period of pregnancy, if
she will only use the means.
In pointing out a plan to accomplish this desirable object, the first
prescription I have to offer is by far the most valuable,—“prevention is
more easy than cure.”[23] If the bowels are sluggish to-day,—that is to
say, if they are not as freely relieved as usual,—and you do not assist
them by medicine, depend upon it, to-morrow they will be confined, and
there will be no relief at all. If, then, the bowels, are _disposed_ to
be costive, I would recommend one large tablespoonful of castor oil—if
it does not nauseate the stomach,—and advise that the dose be repeated
in four hours, if the desired effect has not been produced, or a
wine-glass of beaume de vie at night; and early the next morning, before
leaving the dressing-room, let the lavement be used, the injection
consisting merely of a pint of blood-warm water;—or the following pills
will be found useful to be kept in the patient’s bedroom:—Two scruples
of the compound extract of colocynth and one of the extract of henbane
divided into twelve pills. Two or three of these may be taken at
bedtime, when the bowels have not been, during the day, satisfactorily
relieved. These are always ready in the bedroom, and, as they generally
answer the object efficiently, and with comfort to the patient, are the
most convenient form of aperient.
It will now and then happen, however, that the female has let the day
slip. When this is the case, in combination with medicine, the use of
the lavement is desirable. Medicine alone will not answer the purpose,
unless it be taken in doses so strong as will not only move the bowels
but irritate them too. With the exhibition of the warm water, mild
aperients never fail. Females, generally, are averse to the use of the
lavement, and it is a prejudice which is most deeply to be regretted. I
have known purgative medicines so often resorted to, and, in time, so
increased in power and quantity, because they began to lose their
effect, that, by their continual irritation, disease of the lower bowel
has been produced, and death has, at last, been the consequence. If,
then, the bowels have been one or two days confined, the lavement in the
morning will render much less medicine necessary, and frequently have an
effect when medicine alone would not. Many ladies use the warm water
every second or third morning, during the latter weeks of pregnancy; and
by this means they regulate their bowels—which would otherwise be
confined—with great comfort to themselves, and need no medicine at all.
I will only add one word, in conclusion, upon this subject. Let it be
remembered, that if the bowels have been confined several days, and
diarrhœa comes on, that this is not a natural relief, but the effect of
irritation, caused by the presence of a loaded state of the lower bowel,
which must be quickly removed by the medical attendant, or it may give
rise to some one of those serious evils already enumerated.
_Diarrhœa._
An affection very opposite to that which has just been discussed, may
occur during pregnancy. We have seen how diarrhœa may arise as a symptom
of costiveness. It will manifest itself, however, independently of such
a cause. The intestines may participate in the irregularity of the womb,
and, their vermicular action becoming morbidly increased, diarrhœa is
the consequence. It is a disease which varies very much in different
individuals, and may clearly be divided into two kinds.
One, in which the motions are more loose and frequent than in health,
but not otherwise much altered in their appearance. The tongue is clean,
or only slightly white, and the appetite is pretty good. No medicine is
required here; a careful diet will correct the evil.
_In the other case_, the stools are liquid, dark-coloured, and very
offensive, accompanied with a coated tongue, bad taste, offensive
breath, loss of appetite, and more or less disorder of the digestive
organs. In these latter circumstances, your medical adviser should be
consulted; in case you do not see him, I have found at first the
following draught, given every three or four hours, very useful—rhubarb,
eight grains; ipecacuanha, one grain; dill water, one ounce.
As the tongue cleans, the stool becomes more natural, a wine-glass,
three times a day, of some bitter infusion, such as cascarilla, orange
peel, or gentian, may be taken with advantage. If the diarrhœa continues
for any length of time, it is always wise to have the surface of the
body kept warm with flannel; and this is best accomplished by a flannel
roller bound gently round the abdomen.
But in either form of this disease, whatever remedies are proposed,
there is one mode of treatment applicable to both, and which is the most
important of all; a proper system of _diet_. The food must be sparing in
quantity, of the mildest quality, and such as to leave, after the
process of digestion, as little excrementitious matter as possible.
In a recent attack, the _first_ day, the patient should only take mild
drinks, containing a small quantity of unirritating nutriment; such as
barley water, or arrowroot made with water. Irish moss will be found
palatable. During the _next_ day or _two_ the same diet must be
continued, but may be given in larger quantity, and of greater strength.
Tapioca, sago, and rice-gruel might be added to the list. When the
irritation is somewhat allayed, on the _third_ or _fourth_ day, perhaps,
broth may be taken; but no solid food of any kind, least of all solid
animal food, until the disease is removed or greatly allayed. As soon as
this is the case, a small quantity of the lightest animal food may be
taken; such as the animal jellies, made from calves’ head or feet,
chicken with well-boiled rice, white game boiled, roast mutton and beef
may follow; but lamb and veal for the future should be avoided.
It may be observed, that in some cases, where the diarrhœa has been of
long standing, a _drier_ diet is best, the liquid food appearing to keep
up the disease. Rice well boiled, and merely moistened with a little
broth, is the best and one of the most desirable articles of diet in
such cases.
_Piles._
Pregnant women are very subject to piles. Both with costiveness and
diarrhœa they are a frequent attendant, but particularly with the
former. They will usually disappear, if they are slight, as soon as the
bowels are restored to a healthy action; but they may not, and then will
give rise to great suffering.
The pregnant woman recognises piles under two forms: 1, where they exist
as little tumours within or without the bowel, becoming, very soon after
their exclusion, more solid and firm, unless they early break and bleed;
and 2, where they present, without the bowel, a tumour, large in
circumference, separable in lobes, altogether like a piece of sponge
coloured, and bleeding occasionally from the surface.
Of all the _causes_ which operate in the production of piles, habitual
constipation is the most frequent. The excrementitious matter is delayed
in the bowel, becomes hard and knotty, and a source of great irritation:
this irritation induces a determination of blood to the part, and the
gradual dilatation of its vessels takes place as a consequence, which
eventually forms the tumours known under the appellation of _piles_.
Now, as in pregnancy there is a greater disposition to costiveness than
at any other time, and as piles are a consequence of this disordered
function, so this disease is much more prevalent during the pregnant
state than at any other period; another argument, and a very powerful
one, why costiveness should be diligently guarded against.
The _symptoms_ of this complaint are well known. There will be weight,
heat, and a sense of fulness about the lower bowel, a frequent desire
both to relieve the bowels and bladder; all of which symptoms are
removed for a time if a discharge of blood takes place.
If the piles be without the bowel, they are constantly irritated by the
friction of the parts in the ordinary motion and erect position of the
body, and that to a painful degree during the period of the evacuation
of the bowels. If exercise be taken in a carriage, the pain is much
aggravated; and if the irritation produce inflammation, the piles will
become swollen, red or purple, and excessively painful.
The _treatment_ of this disease, when it occurs during pregnancy, is
two-fold—general and local. We must remove the _cause_ by such means as
excite a brisker action of the bowels; and our choice of aperients must
be directed to those which act efficiently but mildly, and without
irritating the lower bowel itself.[24] Next to small and repeated doses
of castor oil—say a tablespoonful,—the most desirable form of aperient
that can be employed is the confection of senna, that is, lenitive
electuary, combined with sulphur and magnesia. Of the following form, a
dessert-spoonful or more should be taken, at first, twice
daily:—Confection of senna, two ounces; flowers of sulphur, one ounce;
carbonate of magnesia, two drachms and a half. In conjunction with this
medicine, much benefit may be derived by the injection of half a pint of
warm or cold water—whichever soothes most—as a lavement; but it must be
administered very cautiously, to avoid irritating the parts with the
pipe of the instrument.
It is important that medicine, in frequent use, should be so taken as to
act upon the bowels in the evening only; for if the bowels are acted
upon in the morning, the patient being obliged to move about all day,
will suffer considerable distress and local irritation; whereas, if the
bowels are not evacuated till the evening, the horizontal position, and
the perfect rest of a long night, will obviate all inconvenience.
Great assistance may be afforded in the cure, and also in alleviating
pain, by external applications to the tumours themselves. If, however,
the piles are swollen and inflamed, and the pain experienced great, half
a dozen leeches, or from half a dozen to a dozen, should be first
applied in their immediate neighbourhood, the parts fomented, and then
warm bread and water poultices renewed every three hours.
These remedies will afford very considerable relief; and, when the
inflamed state is subdued, an ointment must be applied to the tumours
and around them night and morning, composed of two drachms of powdered
galls, half a drachm of camphor, and two ounces of lard; or composed of
one drachm of powdered black hellebore root, rubbed down in one ounce of
lard. The latter preparation will, for some time after its application,
give much pain, but proportionate relief will follow.
The _diet_ must be sparing in quantity, mild in quality, and such as to
leave after its digestion, as little to pass through the bowels as
possible.
I would beg attention to one more observation on this subject. The
removal of piles by operation, during the pregnant state, is perhaps
never justifiable. Let the patient, therefore, consult her medical
attendant in time, and not by a false delicacy expose herself to an evil
which it is her duty to endeavour to prevent.
_Enlargement of the Veins of the Legs._
This is a frequent, but not very troublesome, accompaniment of the
latter months of pregnancy. It arises in some degree from the pressure
of the womb upon the large venous trunks, impeding to a certain extent
the free flow of blood through them. It is frequently remarked in
pregnant women who have passed a certain age; but it is particularly
unusual for it to happen, in the case of young women, even during a
series of repeated pregnancies.
When first observed, _if the veins have not become knotty_,—that is,
having little lumps or swellings in their course up the leg,—the only
means which it is necessary to employ, is the application of a muslin or
cotton bandage,—six yards in length, and as wide as three fingers—from
the sole of the foot up to the knee, and sufficiently firm to give
support to the venous trunks. This bandage well and equally applied to
the limb, with a little aperient medicine twice a week, and the
recumbent position for two or three hours in the middle of the day, will
cure this form of the affection.
When after a time the _veins, more and more distended, have become
lengthened, tortuous, coiled up or knotty_, the female begins to
experience a sense of heaviness, numbness, and sometimes very acute
wandering pain, through the whole of the affected limb. In a more
advanced stage, in proportion as the knotty tumours increase, the limb
becomes generally swollen.
This form of the disease calls for much care and patience on the part of
the sufferer. The legs should be strapped, from ankle to knee, with
strips of adhesive plaster, and over this a muslin or cotton bandage
must be applied with a moderate degree of tightness, and kept wet with
goulard water. In conjunction with these local appliances, it is
sometimes wise to lose a few ounces of blood from the arm, and always
necessary to take every other night a gentle aperient, to live upon a
spare diet, and for some days to keep the horizontal posture. An elastic
laced stocking made for the purpose may be afterward worn, and will be
found at once a sufficient support to the limb, and a source of great
comfort to the wearer.
_Swelling of the Feet and Legs._
In the course of pregnancy, during the latter months particularly, the
feet and legs frequently become much enlarged. It is partly owing to the
pressure of the womb, but sometimes apparently independent of it. It is
first observed towards night, about the ankles; by degrees the swelling
rises higher, and the legs may become of a very large size. The female
suffering from this complaint, always goes to bed with legs much
swollen, but towards morning her face swells, and the enlargement of the
legs disappears to a greater or less extent, returning, however, as the
day advances.
Sometimes this disease is very trifling in its character, and in
ordinary cases, except aperients, no medicine is necessary, and support
may be given by a well-applied flannel roller; but when the swelling is
extensive and permanent, remaining in the same degree after the patient
has been for several hours in bed, and connected with uncomfortable
sensations in the head, an accelerated pulse, &c., a medical man ought
to be consulted, for the consequences might otherwise be dangerous.
_Palpitation of the Heart._
If this affection occur for the first time during pregnancy, it is
rarely connected with disease of the heart itself; it is therefore
without danger, although very distressing. Occasionally there is
connected with it throbbing of the vessels in the temples, as also in
the abdomen; the latter not unfrequently mistaken by the patient for the
beatings of the heart itself.
It will make its attack repeatedly in the course of a day, particularly
after a meal; and very frequently at night, on first lying down in bed;
and it may be brought on at any time by the slightest agitation of mind.
_Treatment for an attack._—When it comes on it is to be relieved by
putting the hands and arms up to the elbows in water, as warm as can be
borne—friction with the warm hand applied to the feet—absolute rest—and
taking the following draught: Compound spirits of ammonia, half a
teaspoonful; Camphor mixture, a wine-glass. It may be repeated again in
an hour or so, if necessary. It will be well to keep a bottle of this
mixture in the bedroom; a resource will always be then at hand, and the
dread which attends anticipation in a great measure removed. This is the
more necessary, as an attack, if it comes on in the night, is always
very distressing. The patient awakes, perhaps, out of a frightful dream,
with a sense of fluttering in the region of the heart—calls out for
breath—begs to have the curtains of the bed withdrawn, the door of the
room opened—and will tell you she feels as if she was dying;—wine,
brandy, any stimulant that is at hand is resorted to, for the husband or
friend of the patient is naturally much excited, and in his alarm
scarcely knows how to act. Now there is no occasion for alarm; the
sufferer must be assured of this; her mind must be soothed and quieted;
the means just pointed out for the relief of a paroxysm must be used;
the palpitation will after a little time cease, and the patient will
drop off into a quiet and tranquil sleep.
_These attacks may be prevented_ by taking for ten days or a fortnight a
teaspoonful of the following electuary three times a day:—Carbonate of
iron, one ounce and a half; syrup of ginger, one ounce and a half. The
bowels must be carefully regulated; a tablespoonful of Elixir Prop. is
the best aperient, provided there are no piles. Fatigue and all exertion
must be avoided, and the mind kept perfectly tranquil.
_Fainting Fits._
Fainting may occur at any period of pregnancy; but is most frequent
during the first three months, and especially about the time of
quickening. It may come on when the person is at perfect rest; but is
ordinarily produced by unusual exertion,—exposure to heat,—or any sudden
excitement of the mind. The paroxysm or fit is sometimes of short
duration; and the female does not lose her recollection; she has a
knowledge of what is going on about her, and soon recovers; but in other
instances the fainting fit is complete and of long duration, continuing
for an hour, or upwards.
_The treatment during a fit._—This consists in immediately placing the
patient in a recumbent posture—the use of pungent volatiles—sprinkling
the face with cold water—free exposure to air, and the cautious
administration of cordials. And if the fit continue long, the
extremities must be kept warm, and the friction of a warm hand be
applied to the feet.
It is scarcely necessary to add, that those who are subject to these
attacks ought to avoid fatigue—crowded or hot rooms—fasting too long,
quick motion, and agitation of mind. The bowels must be attended to; and
a wine-glass of the infusion of columbo or cascarilla, taken every
morning, will be useful in giving tone to the system.
After a few weeks the disposition to fainting will altogether subside,
and although a very alarming state to those who are inexperienced, yet
the subject of it should never allow her mind to be depressed, or to
anticipate an unfavorable result. Pure air, simple diet, and regular
exercise, as we said above, will do much to prevent it.
_Toothache._
This may appear a trifling disease, to notice in connexion with the
subject before us: but, in the course of pregnancy, females will
sometimes suffer severely from erratic pains in the face and teeth. As
these pains are generally induced by the increased irritability of the
nervous system, the result of the new action which is going on in the
womb, and not from the decay of any particular tooth, extraction of any
tooth for its cure is out of the question. Indeed, did the suffering
arise from a carious tooth, its removal is unadvisable, inasmuch as this
operation has been immediately followed by a miscarriage. The fact is,
that the patients who have consulted me while suffering from this
affection, have had, apparently, in most cases, very sound teeth; and,
feeling confident that its cause has been what has been before pointed
out, the treatment has been purely constitutional. The following pill
may be taken, night and morning:—Socotrine aloes, one grain and a half;
blue pill, two grains; together with one drachm of the rust, or
carbonate of iron, mixed with treacle or milk. The latter must be
repeated twice a day for four days, and then a third dose may be added
in the middle of the day; and the remedy continued, even after all
uneasiness in the face has subsided for some time, with great advantage
to the general health.
The only local application I would advise, is that of washing out the
mouth and teeth, night and morning, with salt and cold, or lukewarm
water. This plan of treatment not only relieves the painful affection of
the face and teeth, but allays also that local irritability of the
nerves, upon which it depended.
If a carious tooth seems alone affected, it has been proposed carefully
to apply a drop or two of nitric acid, which is said to be infallible; a
drop or two of oil of kreosote or cajeput is frequently useful.
_Salivation._
A pregnant female must not be surprised, if, some little time after
conception, or during any of the months of gestation, the ordinary
quantity of saliva, which lubricates and keeps the mouth constantly
moist, should increase to such an extent as to be exceedingly
troublesome; and, indeed, sometimes become so excessive, as seriously to
affect her health. It is a symptom of pregnancy, but a very unusual one;
although the quantity of saliva discharged has now and then exceeded
three, and even four pints daily.
It differs essentially from the salivation produced by the exhibition of
mercury, inasmuch as in this case, there is no tenderness of the gums,
or disagreeable fœtor in the breath. The fluid itself is either
perfectly colorless and transparent, or more tenacious and frothy. It
has an unpleasant taste, and, when tenacious, induces vomiting. It is
generally accompanied with acidity; and the plan of _treatment_ most
advisable, when the disease is moderate in its character, is the
frequent use of from twenty to thirty grains of magnesia, say every
morning, rinsing the mouth out very often with lime-water, and to resist
the desire to discharge the saliva from the mouth as much as possible,
for, if it is not very great in quantity, it may be swallowed to
advantage. Should this symptom, however, be very excessive, the health
will suffer considerably in consequence, and the assistance of the
medical man is imperatively called for.
_A Painful and Distended Condition of the Breasts._
Pain and tension of the breasts frequently attend, as also they are
natural consequences of, conception.
In a first pregnancy, a large and rapid development of this organ may
take place, the breast becoming two or three times as large as before
marriage; but if tight lacing be only avoided, and the breasts be
permitted to expand, no material inconvenience will arise from this
circumstance.
As, however, these symptoms are sometimes attended with considerable
distress, I would advise, under such circumstances, the application of
half a dozen leeches, or more, tepid fomentations, and a gentle
aperient—two drachms of Epsom salts in a little peppermint water—night
and morning. These means, by relieving the over distension and fulness
of the vessels of the part, remove the cause and complaint at once.
If these symptoms occur to a female who may have been several times
pregnant, and formerly has had an abscess in one or other breast, that
bosom is generally most painful which was before affected, and there
will be an increased hardness about it, which may give rise, perhaps, to
the apprehension of an abscess again forming, or, what is much worse, to
the disease terminating in cancer. Both these fears are groundless: and,
if she will only use fomentations, gentle friction frequently during the
day, with almond oil and laudanum—about a drachm of the latter, to an
ounce of the oil, warm,—and exercise patience, everything will do very
well.
Nature often seeks her own cure, and a colourless, thin fluid runs from
the nipple, which relieves the symptoms.
_Cramp, and Pains in the Legs, &c._
Some females, during the latter months of pregnancy, suffer dreadfully
from cramp and pain in the legs, and about the sides and lower part of
the stomach. This symptom arises from the pressure of the womb upon
certain nerves in its neighbourhood, which proceed to the extremities.
If the cramp be seated in the muscles of the legs, a hard, knotty
induration is perceivable to the touch, accompanied with great soreness,
the latter continuing for a long time after the lump has disappeared. An
uneasy position of the muscles is a sufficient cause of irritation, to
produce it, and it is frequently removed, by simply rising from the bed
or sofa, and walking the room, so as to put the muscles of the leg into
action. If this does not succeed, warm friction with the naked hand, or
with camphorated oil, generally will.
If spasm affect the sides, or lower part of the stomach, the speediest
relief will be obtained from twenty, to five-and-twenty, or thirty drops
of laudanum, with a little ether, in distilled peppermint water, or,
even at the moment, a little brandy and water; but I generally order,
for patients who are at all subject to this affection, the following
mixture:—Batley’s sedative solution of opium, one drachm; compound
tincture of lavender, half an ounce; distilled peppermint water, six
ounces. Two tablespoonfuls to be taken before retiring to rest, if there
is the slightest intimation of an approaching attack, and also direct
that the feet be put into a mustard foot-bath. During the attack, great
benefit will be derived from the external application of hot flannels,
moistened with the compound camphor liniment.
_Violent movements of the Child._
Before the third month of pregnancy, the child is not sufficiently
developed to enable it to move. When a little further advanced in
growth, it moves, but so feebly and imperfectly, that the mother is not
yet sensible of it. A period, however, soon arrives, when its movements,
although at first like the mere fluttering of a bird, acquire a power
and force, that enable it to give decided proof of life. It is instantly
recognised, the female knows she has quickened, and perhaps the
sensation experienced is so sudden, that she faints. After this time the
motions of the child increase both in frequency and degree, and are
readily perceived by the mother, but after a time the womb accustomed to
this action within itself, is less sensible of its effects, and except
as a satisfactory evidence of the life of the child, is little regarded.
Sometimes, however, the child is _disagreeably_ active, so violent as
not merely to alarm the mother, but occasion much sickness and
uneasiness;—sleepless nights; feverish symptoms, &c., and all this to
such an extent, as to require medical interference. If this is not
thought necessary, relief will be obtained from losing blood, when not
otherwise objectionable, to the amount of a few ounces; gentle
aperients, and a night draught containing from twenty-five to thirty
drops of Batley’s sedative solution of opium. These remedies will afford
the greatest relief, and if the symptoms are not altogether removed by
them, the female must then endure patiently, recollecting they are a
proof that the child is alive and vigorous.[25]
_Soreness and Cracking of the Skin of the Abdomen._
It will sometimes happen during the latter months of pregnancy, that the
skin covering the abdomen will not yield readily. This produces much
uneasiness; the skin becomes tender and fretted, and if there is very
great distension, cracks. It forms a source of great discomfort, and
renders the female miserable whenever she moves.
It is to be relieved by fomenting the parts with a decoction of
poppy-heads;[26] and the frequent use of warm almond oil, applying in
the intervals spermaceti ointment, spread very thinly on a piece of soft
linen.
_Inconvenience from Size._
Many women in the latter months of gestation experience considerable
annoyance, and sometimes severe suffering from the great size of the
abdomen, and from want of support, when even not so very large. This is
a rare occurrence in a first pregnancy, owing to the firmness of the
abdominal muscles, but very frequent in subsequent ones. Little women
especially suffer from this unpleasant cause, and, in fact, it is so
universally the case with all, who have borne children _rapidly_, that
it is highly important for a female to be provided with the means of
relieving it.
There is but one remedy with which I am acquainted, but have usually
found it answer every purpose. It is wearing during the day-time _a
well-applied belt_, next the skin. It must be sufficiently broad for its
upper edge to surround the abdomen above the point of its greatest
diameter, and its lower edge to come down to, and be supported by, the
hips. It must be drawn tight by a lace-string behind, as circumstances
may require, and it must likewise be supported by broad straps passing
over the shoulders. This will give the required support to the womb, and
when the patient is in an upright position, as much as possible of the
weight, of what she externally carries, will be thrown upon, or hang
from, her shoulders.
Those who suffer much from this cause, ought also to lie down upon a
couch or bed, for two or three hours every day; this will give great
relief to the muscles.
_Being Unwell during Pregnancy._
A female may be pregnant, and yet be unwell for one period or more while
in that condition. Indeed, it may take place every month to the time of
quickening, and has even continued in some rare cases up to the time of
delivery.
Now, although this can scarcely be called one of the diseases of
pregnancy—for it, ordinarily, in no way, interferes with the
health—still, as while the discharge is actually present it predisposes
to miscarriage, it is necessary to give one or two hints of caution.
Any female, then, thus circumstanced should manage herself with great
care immediately before the appearance, during the existence—and
directly after the cessation of the discharge. She should observe the
most perfect quiet of body and mind—keeping upon the sofa while it
lasts, and carefully abstaining from any stimulating or indigestible
article of food, and if any symptoms of pain, uneasiness, or threatening
miscarriage come on, immediately seek medical advice.
A case, showing the necessity of carefulness under such circumstances,
occurred to me some time since, and its relation is all that I need add
upon this point.
A lady, resident in Gloucestershire, missing one period, suspected
herself of being pregnant, but being unwell on the following month,
supposed herself mistaken. She had occasion, however, to come to London
on the second day of her being unwell—Monday. On the Wednesday following
she suffered considerable uneasiness from the exertion attendant upon
the journey, and on Friday while from her hotel was obliged to return
home in haste, and before night, miscarried.
Here then is a case in point—first proving, what some persons deny, that
a female may be unwell and yet be pregnant, for she could not perceive
the slightest difference in the appearance of the discharge from what
ordinarily took place, and it was exact as to the time of its return—and
next, showing how necessary is great caution, and the most perfect
quiet, since undoubtedly this lady would not have miscarried, if her
journey had only been delayed another week.
Jaundice sometimes occurs in the early or latter parts of the
pregnancy—certain affections also of disordered functions of the heart,
producing palpitation—a troublesome cough, accompanied with considerable
pain in the head, sudden attacks of difficulty of breathing, and
distressing inconvenience from irritable bladder.
These, and many other slight affections, may manifest themselves during
gestation, but of those I say nothing. It would be advancing beyond the
bounds by which I thought it right to limit myself, and departing from
the object proposed.[27]
I have finished what was purposed, and presented the married female with
that information for direction and relief, in those little ailments and
discomforts which frequently arise during pregnancy, for which she does
not think it necessary to consult her medical adviser, and yet from
which she will not unfrequently go on suffering for weeks, rather than
speak of them.