infamous female physicians, who, hearing her situation, gave her some
powders, with directions for use. These powders, it appears, did not
produce the desired effect. She returned again to this woman, and asked
her if there were no other way to make her miscarry. ‘Yes,’ says this
physician, ‘I can probe you; but I must have my price for this
operation!’ ‘What do you probe with?’ ‘A piece of whalebone.’ ‘Well,’
observed the patient, ‘I cannot afford to pay your price, and I will
probe myself.’ She returned home, and used the whalebone several times;
it produced considerable pain, followed by a discharge of blood. The
whole secret was now disclosed. Injuries inflicted on the mouth of the
womb, by other violent attempts, had resulted in the circumstance as
detailed above. It was evident, from the nature of this poor woman’s
sufferings, and the expulsive character of her pains, that prompt,
artificial delivery was indicated. As the result of the case was
doubtful, and it was important to have the concurrent testimony of other
medical gentlemen, and as it embodied great professional interest, I
requested my friends, Drs. Detmold, Washington, and Doane, to see it.
They reached the house without delay, and, after examining minutely into
all the facts, it was agreed that a bi-lateral section of the mouth of
the womb should be made.
“Accordingly, without loss of time, I performed the operation in the
following manner: The patient was brought to the edge of the bed and
placed upon her back. The index finger of my left hand was introduced
into the vagina as far as the roughness, which I supposed to be the seat
of the _os tincae_. Then a probe-pointed bistoury, the blade of which
had been previously covered with a band of linen to within about four
lines of its extremity, was carried along my finger, until the point
reached the rough surface. I succeeded in introducing the point of the
instrument into a very slight opening which I found in the center of
this surface, and then made an incision on the right side. I then
withdrew the instrument, and in about five minutes it was evident that
the head of the child made progress. The mouth of the womb dilated
almost immediately, and the contractions were of the most expulsive
character. There seemed, however, to be some ground for apprehension,
that the mouth of the uterus would not yield with sufficient readiness,
and I made an incision of the posterior lip, through its center,
extending the incision to within a line of the peritoneal cavity. In ten
minutes from this time, Mrs. M—— was delivered of a strong, full-grown
child, whose boisterous cries were heard with astonishment by the
mother, and with sincere gratification by her medical friends. The
expression of that woman’s gratitude, in thus being preserved from what
she and her friends supposed to be inevitable death, was an ample
compensation for the anxiety experienced by those who were the humble
instruments of affording her relief. This patient recovered rapidly, and
did not, during the whole of her convalescence, present one unpleasant
symptom. It is now ten weeks since the operation, and she and her infant
are in the enjoyment of excellent health.
“At my last visit to this patient, with Dr. Forry, she made some
additional revelations, which I think should be given, not only to the
profession but to the public, in order that it may be known, that in our
very midst there is a monster who speculates with human life, with as
much coolness as if she were engaged in a game of chance.
“This patient, with unaffected sincerity, and apparently ignorant of the
moral turpitude of the act, stated most unequivocally to both Dr. Forry
and myself, that this physician, on previous occasions, had caused her
to miscarry five times, and that these miscarriages had, in every
instance, been brought about by drugs administered by this trafficker in
human life. The only case in which the medicines failed was the last
pregnancy, when, at the suggestion of this physician, she probed
herself, and induced the condition of things described, and which most
seriously involved her own safety, as well as that of her child. In the
course of conversation, this woman mentioned that she knew a great
number of persons who were in the habit of applying to this physician
for the purpose of miscarrying, and that she scarcely ever failed in
affording the desired relief; and among others, she cited the case of a
female residing in Houston Street, who was five months pregnant; this
physician probed her, and she was delivered of a child, to use her own
expression, ‘THAT KICKED SEVERAL TIMES AFTER IT WAS PUT INTO THE BOWL.’”
Thus you have an exemplification of the danger of the wicked and fearful
practice which I have spoken against. If any of you are ever tempted
under such circumstanes, beware!
UTERINE HEMORRHAGE.
As intimately connected with the subject of abortion, it is fit that I
should here make a few remarks on that form of _uterine hemorrhage_
which is not connected with childbirth.
_Case I._—I recollect a case of this kind that occurred with a lady who
was, I should think, at least sixty years of age. It was in the month of
October, 1846, on a passage from New York to London, in the packet ship
Switzerland, Captain E. Knight. The old lady and husband had taken a
steerage passage from New York. They were English people, returning
after many years’ absence, again to visit their native country.
One day the old gentleman came on deck and told me his wife was very
sick of uterine hemorrhage, and that he wished my advice. I told him I
would prescribe what I considered to be the best course in such cases,
but that I feared his wife would not be willing to follow it. Indeed, I
had no idea that she would do so.
However, I gave the advice, which was substantially as follows: First,
take old sail-cloth, which was clean, make some pieces into the shape of
towels, and one larger, to be used in the form of a child’s diaper;
place these cloths, wet, about the abdomen and thighs, and let the
patient wear a large one, wet, in the form of a child’s diaper; let her
take but little and very light nourishment for two or three days, and be
careful and not move about too much; help her out upon deck, when the
weather is fine, so that she may enjoy the invigorating effects of the
pure air and light. You need not chill her much with the wet cloths, but
be exceedingly particular that they do not become too warm; let her wear
them the larger portion of the time, until she becomes quite well.
Contrary to my expectations, the old lady followed the course
resolutely, and in a very short time was again entirely well. She spoke
in great praise of the invigorating effects of the cold cloths; she also
drank cold water. We were at sea about three weeks after this, and the
old lady’s health continued good until we left the ship.
_Case II._—A lady of about the same age, in the winter of 1848–49,
living in Jersey City, experienced uterine hemorrhage. She had been
overdoing in the way of work. A similar course to that in the above case
was followed, and in a few days she also recovered. Rest, alone, in such
cases—that is, abstaining from severe labor, and taking but very little
exercise, such as can be easily borne, and without fatigue—is alone
sufficient for the curing of many of these cases.
Cold hip-baths, of short duration, and often repeated, are always good
in attacks of this kind. Indeed, the more coolness generally to the
body, the better; but we should not chill the extremities too much—not
that it is dangerous to do so, but it is better to avoid it.
In the treatment of hemorrhages, the Indians pursue a very rational mode
of treatment. If a severe hemorrhage follow a wound, which is not
unfrequently the case, they plunge themselves into cold water, thereby
producing a constriction upon the bleeding vessels. We all know by
experience the efficacy of cold to arrest bleeding at the nose. We put a
piece of ice on the neck, pour cold water down the spine, or even put a
cold door-key on the back of the neck, and in most cases epistaxis
ceases. All physicians and surgeons—all who at all deserve the name of
such—know well the power of cold to arrest hemorrhages—often, too, such
as are of the most alarming character. We should make very poor work
indeed, in stopping hemorrhages, if we were deprived of cold water. Cold
water is worth more—incomparably more for this purpose—than all other
remedies under the firmament of heaven combined.
LETTER XVI.
DISORDERS OF PREGNANCY.
Its Febrile Condition—Acute
Disease—Sleeplessness—Heart-burn—Constipation—Diarrhea—Piles and
Hemorrhoids—Their Treatment.
It is said to have been an aphorism of Hippocrates, the father of
medicine, who lived more than two thousand years ago, that pregnant
women attacked with acute disease always die. This strong assertion
cannot be said to hold good, certainly, at the present day; but yet
pregnancy, it must be admitted, exercises, as a general fact, a very
unfavorable influence on the system in acute disease. The danger here
may be said to be three-fold. First, the system is already in a febrile
condition, or one very nearly bordering thereto; second, there is the
new disease; and third, this often causes the death of the unborn child,
and then the dangers of abortion are superadded to the others. “The life
of the child, too,” say authors, “is endangered by the treatment
necessary for the cure; especially in the use of harsh purgatives,
violent emetics, salivation, and profuse bleedings.” But thanks to a
better day, we of the water practice are under no necessity of running
such fearful risks. We have not only a more effectual way, but one, when
managed by judicious hands, harmless and safe. “It is by the prompt use
of mild means, and a persevering attention to small matters,”
judiciously observes Dr. Maunsel, “that the patient is to be conducted
through the dangers that encompass her.” And he justly adds, “Above all,
avoid the dreadful blunder of treating a woman for acute disease without
discovering that she is pregnant.”
Pregnancy, as I have remarked, is always attended with more or less
excitement of the system, an excitement which bears some resemblance to
a state of fever. There is also a greater proneness to fevers, even from
slight causes, now than at other times. Hence the necessity of avoiding,
as far as possible, all such causes; and hence also, the necessity of
exercising the greatest care in regard to diet and drinks. Too much
food, and that which is too exciting, will cause more harm in pregnancy
than at other times, from the greater tendency to fever. The common
belief among women is, that more food is needed during pregnancy than at
other times, because the food goes to furnish nourishment for two
instead of one, that is, for the mother and the child within her. “It is
therefore,” says Dr. Dewees, “constantly recommended to eat and drink
heartily; and this she too often does, until the system is goaded to
fever; and sometimes to more sudden and greater evils, as convulsions or
apoplexy.”
If, instead of full diet, women in pregnancy will but try the plan of
eating less food, even of becoming very abstemious, they will most
assuredly find that they get along better, suffer less from plethora or
fullness, and enjoy greater comfort of body in every respect.
SLEEPLESSNESS.
This, in a greater or less degree, not unfrequently occurs during
pregnancy. It is most apt to occur during the later months of the
period. Within a few days of the birth, however, better rest is
experienced, and a greater degree of comfort in every respect. This
tendency to sleeplessness during pregnancy is sometimes so troublesome
as almost wholly to prevent sleep. “The limbs are agitated by
involuntary contractions of the muscles, which, by the frequency and
suddenness of their motion, instantly interrupt the sleep to which the
woman was at the moment strongly inclined.”
“Sleeplessness,” says Dr. Maunsel, “most frequently affects the weak,
nervous, and irritable, occurring sometimes early in pregnancy, oftener
toward the end of the term. If the want of sleep continue for many days,
it is commonly followed by very grave symptoms, as restlessness, fever,
mental disturbance, convulsions, etc.; abortion has resulted from it,
and some cases have terminated in insanity; others have destroyed life.”
But those who follow a judicious course of water-treatment do not become
thus afflicted. If such occurrences should be at all possible in the new
modes, the cases would be exceedingly rare. I have known many persons to
follow bathing during pregnancy, but none who have had any thing like
serious difficulty in obtaining a proper amount of rest.
In many cases this want of sleep in pregnancy does not sensibly impair
the general health. Some persons have been under the necessity of
walking their room much of the night; and yet, after a short repose at
the dawn of day, have been astonished to find themselves as much
refreshed, apparently, as after a good night’s rest.
_Treatment._—To prevent sleeplessness in pregnancy, a variety of means
have been recommended. If there is plethora, or too great fullness of
the system, small bleedings and cooling purgatives of mild kind are
recommended by almost every author who has written on the subject. It is
well known that in many parts of the country, women believe that they
cannot get through pregnancy at all without being bled. The doctors have
been at the root of this matter in the beginning. This old-fashioned
practice, fortunately, is now fast going out of date. It is not for me
here to enter into a discussion of the question whether such means ever
do any good in pregnancy; but I will say, on the authority of
physiological and pathological science, and my own experience, that
bathing, water-drinking, and the proper regulation of the general
habits, are incomparably the best modes; the best, not only for the time
of pregnancy, but also for that of childbirth and the period of nursing.
Dr. Dewees recommended for this affection, low diet, cool air, and cold
water, as being among the best remedies. And Dr. Denman says, that “a
glass of cold water drank at bedtime is not a contemptible remedy;” and
he might have said one of the best, especially if the dose be soon
repeated. And Dr. Dewees, in quoting this advice of Dr. Denman, adds,
“We know that bathing the hands and face in cold water is an excellent
practice, and should always be resorted to.”
Dr. Maunsel says, “Pediluvia (foot-baths), or, what is better,
hip-baths, very often do good.” But the important matter of temperature,
the doctor does not speak of. A warm hip-bath and a cold one are very
different things. He remarks, also, well, “that the diet should be
cooling, and exercise in the open air as freely as circumstances will
permit.”
I may, however, dismiss this whole matter of sleeplessness in pregnancy,
by saying, that those who bathe daily, exercise judiciously, and, when
possible, in the open air, drink only pure soft water (and all can have
this from the clouds), partake only of plain and unstimulating food, and
sleep upon hard beds and pillows, in cool, fresh air, will rarely, if
ever, be troubled with want of sleep.
One other thing, however; it sometimes seems necessary for persons in
pregnancy to get a “nap” during the day. Those who have great cares, and
many in our country have, often find it extremely difficult to get
through the long, hot days of summer without sleep. Now, in such cases,
if the woman can go by herself, and be wholly undisturbed, and feel
entirely free from every care, and thus get a good half hour or an
hour’s sleep, she will be much refreshed thereby. It is necessary to
observe that the clothing should be removed as at night. Persons often
wonder how it is that they feel worse after sleeping than before. When
one lies down, if the clothing be left on, too much heat is retained
about the surface, and thus debility, instead of refreshment, is
experienced. This day-sleeping should be done with the stomach empty, as
at three or more hours after a meal, and not in the afternoon, as that
would be liable to cause wakefulness at night. It is truly surprising
how much, under favorable circumstances, a short sleep even will refresh
the powers of life.
HEART-BURN.
This is not unfrequently one of the first unpleasant symptoms that women
experience after becoming pregnant. It sometimes becomes very
distressing, and difficult to manage according to the ordinary modes.
“It is generally,” says Dr. Dewees, “very distressing and very difficult
to subdue.” He had known large and repeated doses of the alkalies given
with scarcely any temporary alleviation, and much less, permanent
benefit.
The great cause of heart-burn in pregnancy, as well as in other cases,
is acidity of the stomach; and acidity of the stomach comes from
improper food. Very seldom, indeed, can a pregnant woman be troubled
with heart-burn, acidity of the stomach, or vomiting, if the dietetic
and other habits be regulated according to principle. Pregnant women, in
this country of abundance, generally eat a great deal too much food.
They have also too little exercise in the open air. Some, indeed, have
too much exercise, as in doing household work; but more are injured by
doing too little than too much. But in this country ninety-nine of the
one hundred _eat too much food while in the pregnant state_.
_Treatment._—To cure the heart-burn, let the woman, when she first
experiences it, at once desist in the quantity of food. If she rises in
the morning and finds the symptom upon her, she may be certain that
digestion has gone on badly the day previous, and that the stomach
contains portions of the undigested aliment which has passed into the
acetous fermentation, and thus causing the difficulty she experiences.
What is to be done in such a case? Will the introduction of another
portion of food into the already disordered stomach make matters any the
better? Certainly not, except for a short time. When the stomach is
goaded on by a new meal, the individual may feel the better for half an
hour; but, other things being equal, it in the end only makes the matter
worse. Fasting a meal or two, with water-drinking for its tonic effect,
is the best possible means. The stomach, thus, has time to regain its
vigor, and food taken in moderation, subsequently, will then be found to
agree perfectly well. It will here also surprise any one to learn how
small an amount of food is really necessary, with water-drinking, to
sustain the strength.
If the heart-burn is very troublesome, it will be found of great relief
for the patient to vomit by means of water. This, in most cases, will
take place very easily by drinking, in quick succession, a number of
tumblers of soft water, about blood-warm temperature. This, with a
little help, as by putting the finger in the throat, will be found
sufficient; and if, in any case, the vomiting does not take place, the
water yet does much good by means of diluting the offending matters in
the stomach. Thus, suppose there is one ounce of acid matters in the
gastric cavity, and that ten ounces of pure water are introduced
therein, the offending mass is weakened tenfold; so that even if
vomiting does not take place, great relief is experienced. I would not
have any one make too great an effort to produce vomiting, especially in
pregnancy, for hard vomiting might cause abortion. There is, however, no
danger except the vomiting caused by drug substances. Water-vomiting is
easier than can be imagined by those who have tried only the old modes.
Soda and other alkalies, taken so often to ease heart-burn, do more harm
than good in the end. The wet girdle, worn occasionally about the
abdomen, and managed so as to produce a cooling effect, will be found of
great service in invigorating the stomach, thus tending to prevent
heart-burn, acidity, and the like. So, also, the general ablutions,
which ought never, for a single day, to be omitted during pregnancy, as
we may say, too, of other times.
In heart-burn, arising from whatever cause, it is a very common custom,
both with the profession and the people, to give alkalies, as magnesia
and chalk. Dr. Dewees, I remarked, had known large and repeated doses
given, with scarcely any temporary alleviation, much less permanent
benefit. It is of little effect, certainly, to continue giving these
articles, when at the same time the dietetic habits are such as are
certain of keeping up the difficulty. This would hold true even if the
articles administered were perfectly neutral in their effects as to
harm, which can never be the case. All drug substances, however much
good they do, at the same time cause a certain amount of harm. The
articles, magnesia and chalk, the ones generally resorted to in this
difficulty, are moreover often impure. This is particularly true of the
latter article.
Dr. Dewees mentions a case in which the lady’s health was utterly
destroyed by her enormous use of chalk. “I formerly attended a lady,
with several children,” says he, “who was in the habit of eating chalk
during the whole term of pregnancy; she used it in such excessive
quantities as to render the bowels almost useless. I have often known
her without an evacuation for ten or twelve days together, and then it
was only procured by enemata (injections); and the dejections were
literally chalk. Her calculation, I well remember, was three half-pecks
for each pregnancy; she became as white nearly as the substance itself;
and it eventually destroyed her, by so deranging her stomach that it
would retain nothing upon it.” I repeat, that these alkaline substances
always and inevitably do more harm than good; and the part of wisdom is
to do without them.
CONSTIPATION.
During the early months of pregnancy, there appears to be a greater
tendency to constipation than in the latter months, a fact which is the
direct reverse of what we should expect from _a priori_ reasoning. But
during the whole period, constipation is more apt to occur than at other
times.
Constipation is exceedingly common among all classes of females in this
country at the present day. The American people have such a predilection
for fine food, it is a hard matter to make any great change in this
respect. It is in the dietetic habits, more than in any other, that we
are to look for the causes of this evil.
Superfine flour is, I hold, the greatest of all causes of constipation.
I know tea and coffee, which are astringent articles, have a tendency to
cause this condition of the bowels; and the same may be said of idleness
and physical inactivity; but too great richness of food—and superfine
flour is the article most concerned in this—is the great cause of
constipation. Our country abounds with it everywhere. By our numerous
railroads and canals, superfine flour is transported from one end of the
country to the other, so that in large districts, where formerly the
people were in the habit of eating coarse bread, as of rye and Indian,
and were consequently more healthy, they now use the superfine. Even a
beggar would sneer at one for offering him brown bread.
Constipation, common as it is everywhere among females, is still more
common in pregnancy. This arises, first, from the pressure of the
enlarged womb upon the lower bowel; and second, there being a new action
set up in the uterus, there is, as a natural consequence, a greater
tendency to torpor in the bowels; but the principal cause is that of the
pressure.