difficulties. Headache is often brought on solely by constipation; that
is, in many cases we remove the constipation, and the headache is sure
to leave with it. Sickness of the stomach and vomiting are always
aggravated, and often caused by it. The same also may be said of
heart-burn, palpitation, and fainting. Sleeplessness, and, in fact,
almost every one of the disorders of pregnancy, may be said to be either
caused directly, or greatly aggravated, by constipation of the bowels.
Even miscarriage has been known to be induced by it.
Some persons have gone an almost incredible length of time without any
movement of the bowels. A whole week is not uncommon. Dr. Dewees
mentions a case of fourteen days, and no doubt there have been those who
have gone one to three whole weeks.
_Treatment._—What have we to do in order to cure constipation of the
bowels? Does not every person of common sense understand at this day,
that the more we dose the system for constipation, the more we may? Let
those answer who have tried these things. Always, other things being
equal, the more we take drugs for constipation, the worse it grows. We
must therefore look to some other means of cure.
Constipation of the bowels may always be cured, and this by the most
simple means. Dr. Dewees mentions a case where a lady had suffered three
successive miscarriages from this cause, and by the constant use of
brown bread, drinking only water, and taking no animal food or
broths—taking now and then a little castor-oil, or the like, which,
however, he did not reckon upon as having done any material good—enabled
her to pass safely through the whole time. We need here only mention, in
general terms, that constipation in pregnancy is to be cured just the
same as constipation in any other case. Brown bread, fruits, and
vegetables, with a very moderate use of milk, if the patient desires it;
regular exercise, the hip-bath, wet girdle, injections of cold water, or
tepid, if that is preferred—these are the means to be used. The brown
wheat or rye mush will be found most excellent. No woman, if she can
have brown bread, and occasionally an injection, need ever suffer from
constipation of the bowels.
DIARRHEA.
Sometimes the reverse of constipation occurs during pregnancy; namely,
diarrhea. This also not unfrequently alternates with constipation.
Constipation, however, is the most frequent symptom.
_Treatment._—Singular as it may appear, diarrhea should be treated on
the same general principles as constipation. Fortify and invigorate the
general health, observing at the same time a correct general regimen,
and either symptom disappears. In diarrhea, the hip-bath, often
repeated, the wet girdle, and cold injections, taken as often as there
is any disposition for the bowels to act, are effectual means. The diet
should be regulated on the strictest principles. If a diarrhea is very
severe, entire abstinence from all nourishment, except water, for a day
or two, is a very salutary remedy. Food should then be taken with the
same precautions as in nausea and vomiting.
PILES AND HEMORRHOIDS.
Piles and hemorrhoids are more apt to occur in pregnancy than at other
times; and when these already exist, they are apt to become worse at
this period. Constipation being more apt to occur in pregnancy, and that
condition of the system being the one in which these symptoms are most
liable to occur when the woman is not pregnant, so also they occur more
frequently now than at other times. The constant pressure of the fetus
upon the blood-vessels within the pelvis has also an agency in the
matter, because every thing that causes sluggishness of circulation
tends to bring on piles. So also the more sedentary habits of many
females, during the period of pregnancy, are often a cause of this
difficulty; but in other cases the opposite extreme is practiced—too
much exercise or standing on the feet. Both these extremes may cause
piles in pregnancy, or aggravation when they previously existed.
Cathartic medicines not unfrequently bring on a “fit of the piles.”
This affection always denotes a wrong state of things in the general
health. A really healthy person can never have the piles. Some, however,
who are what would be termed tolerably well and strong in general
health, experience such symptoms, but such is not the rule. Old cases,
particularly, denote derangement of the general system.
When piles come on suddenly, they are often attended with very great
pain and suffering to the patient. Not only is the pain great at the
part affected, but there is also feverishness, pain, and a very
unpleasant feeling in the head, with deep and severe pain in the back.
_Treatment._—As to the treatment and general management in this
affection, we should of course do the best that may be for the general
health. As a general fact, no surgical operation should be allowed upon
piles during pregnancy. These operations are often attended with so
great pain, that abortion might be the result.
There is nothing in the world that will produce so great relief in piles
as fasting. If the fit is severe, live a whole day (or even two, if
necessary) upon pure, soft, cold water alone. Give then very lightly of
vegetable food. Those who have suffered the agony of this affection, if
they will but have patience to try this means, will find the truth of my
remarks.
Water applications are also very useful in this disease. Dr. Dewees
observes: “The pregnant woman may derive both comfort and advantage from
sitting in a demi-bath of cold water, for five or ten minutes at a time,
two or three times a day, when the complaint is advancing, or when about
to retire; that is, after the severer symptoms have abated, or before
they are high.” This advice is partly right and partly not. There is a
notion with many that cold water-applications in high inflammation are
not good; that they increase the difficulty instead of making it less.
Thus in a burn, it is said that after the application of cold water the
pain becomes worse. This is not true, although it appears to be so; for
so great is the relief afforded by the application, that the pain
_appears_ worse, when in fact it is not; but only keep on continuously
with the cold water-treatment, and the pain does not return at all. Such
at least is the fact in all burns, however severe, when the surface is
not destroyed; and the same principle holds good in all high
inflammations from whatever cause. Very frequent sitz-baths, or merely
washing the part often in cold water, will be found excellent in these
severe cases of piles. Cold compresses worn upon the part also afford
great relief. Cold injections are also useful. But, as before mentioned,
_fasting and the regulation of the diet_ are the great means.
LETTER XVII.
DISORDERS OF PREGNANCY.
Headache: the Nervous and the Plethoric kinds—Stye in the
Eye—Salivation—Hemorrhage from the Stomach—Cramp of the
Stomach—Toothache—Jaundice.
Headache is one of the most common of all the disorders of pregnancy. It
may occur at any part of the period; in the early months, it is supposed
that nervous headache is most apt to occur; in the latter, headache
arises more frequently from plethora. In such cases there may be
throbbing of the temples, suffusion of the eyes, ringing in the ears,
indistinct vision, and flashes of light passing before the eyes. If the
headache gets to be very severe—_splitting_, as we may say—there is
danger of either apoplexy or puerperal convulsions. But these things, be
it remembered, do not come upon those who live moderately and
temperately, lead an active, industrious, and regular life, go often
into the open air, and practice daily ablutions.
That form of headache in pregnancy which occurs often, and is not a sick
or nervous headache, so-called, is regarded by authors generally as
being a very serious affair.
_Treatment._—Dr. Maunsel says of the nervous form of this disease:
“This, especially if it take the form of hemicrania (that in which the
pain is confined to one half of the head), is one of the most
unmanageable of all the diseases of pregnancy.”
According to the old practice, prompt and decided measures must be taken
in these cases, especially if the affection is of that form arising from
a general fullness of the system.
“If the state of the system indicates bleeding,” says Dr. Maunsel, “it
will commonly do good; local should be preferred to general bleeding. If
bleeding is not indicated, we should at first attend to the secretions;
when these are corrected, antispasmodics and anodynes come in well.
Hyosciamus and camphor, a grain of each, is a good remedy; also the
volatile tincture of valerian. The external application of some anodyne
extract, as stramonium, belladonna, or cicuta, may be tried, but with
caution, lest they produce the poisonous effects of the drug.”
Dr. Churchill remarks: “These nervous headaches may usually be relieved
by antispasmodic medicines, or diffusible stimuli, such as valerian,
hartshorn, etc.
“Eau de Cologne applied to the forehead, or a blister behind the ears,
is often useful.
“A brisk purgative should also be given occasionally.
“A much more active treatment will be necessary when there are any
symptoms of plethora, or vascular excitement about the head, both for
the relief of the pain and for the purpose of anticipating evil
consequences. Blood should be taken from the arm, in quantity according
to the strength of the patient and the relief afforded; and this should
be repeated, or leeches applied to the temples, if necessary. We are not
to rest satisfied that enough has been done until the pain is relieved,
and the arterial system reduced to the ordinary standard.
“After a certain amount of good effect has been produced, great benefit
will often result from the application of a blister to the nape of the
neck.”
Now compare with the above practice of bleeding and dosing, _secundum
artem_, the true and rational one.
In nineteen cases out of twenty, the nervous headache comes from either
tea or coffee drinking, or the use of improper food. Only remove the
causes, then, and the difficulty vanishes. Strange to say, however,
there are many women who have either so little confidence in what any
one can say to them, or so little control over themselves, they will not
even make the experiment. Should one who has been cured tell them the
fact, they will not yet believe; nor would they if one should rise from
the dead. Such persons—those who have the truth set before them, and yet
will not act—are welcome to all their tea and coffee, their fine food,
their bleeding and dosing, and their sick headache.
STYE IN THE EYE.
This form of boil, occurring on the eyelid, sometimes appears as one of
the disorders connected with pregnancy, more particularly in its earlier
part.
Stye is much more apt to happen with those who have a disordered stomach
than with the healthy. As a general rule, however, it may be regarded
that boils are healthy; that is, it denotes a very good state of the
vitality, when it has the power thus to throw morbid matter out of the
system. Still, it is yet more healthy to have the body so pure that it
has no need whatever of symptoms of the kind of which I am speaking.
A stye is much more painful than might be expected, considering its
small size. This is owing both to the vehemence of the inflammation and
to the excessive sensibility of the part upon which it is situated. The
disturbance caused by it may become so great as to amount to a good deal
of feverishness and restlessness, attended not unfrequently with a
severe pain in the head.
_Treatment._—We cannot do a great deal in such cases, except to let
matters take their own course. It is productive of a good deal of relief
to hold the eye in tepid water, and if the patient will consent to live
two or three days almost wholly without food, the suffering will be
rendered much less, and the stye will come the sooner to a head.
SALIVATION.
There is often a greater or less degree of this symptom during the
period of pregnancy. Probably all women experience, at this time, a more
than ordinary flow of the salivary fluid. This sometimes becomes very
excessive and troublesome to the patient, especially at night, when the
sleep is disturbed by the frequent necessity of emptying the mouth. Dr.
Dewees observes: “It is almost always accompanied with acidity of the
stomach and constipation of the bowels; the fluid discharged from the
mouth, for the most part, is perfectly colorless and transparent; at
other times it is more tenacious and frothy, and the quantity poured out
is sometimes incredibly profuse. It almost always has an unpleasant
taste, though not attended with an offensive smell; it keeps the stomach
in a constant state of irritation, and not unfrequently provokes
vomiting, especially if the saliva be tenacious, and requires an effort
to discharge it.” This author relates a case where salivation commenced
at the second month of pregnancy, in which the patient discharged daily
from one to three quarts of salivary fluid, and became so weakened
thereby, that she was unable to sit up without immediately fainting.
The above description of salivation in pregnancy may be said to apply to
patients who live according to the ordinary modes of society. I have,
during nine years past, known many women who have passed through
pregnancy, practicing at the same time daily bathing, water-drinking,
exercising regularly in the open air, with plain diet, and in no
instance have I known salivation to prove at all inconvenient or
troublesome. I judge that this affection, if such we may call it, can
only come on when the general health is at fault, or the dietetic and
other hygienic habits bad. True, there is probably always more or less
increase of the salivary secretions in pregnancy, but if good habits are
daily persevered in, I think no one will be troubled at all in this
matter.
I find in a late work on Females—Professor Meigs’s—the following remarks
on this subject, which go to show, on good authority, the uselessness of
drug-treatment in this affection:
“I am sorry to tell you (the Professor addressing himself to his class),
that I know of no remedy at all to be depended upon for the management
of these great salivations. They are the troublesome concomitants of the
gestation, and they cease with the cessation of the gestation. They
cannot be cured by alkalies or acids, by venesection or purgation, or by
any therapeutical treatment with which I am acquainted. If it were just,
always to attribute the salivation to a state of the stomach, then it
would be reasonable to apply remedies with a view to correct a faulty
state of that organ, in hopes of curing the salivation.”
All this goes to prove, that you who are troubled with this affection
are to depend upon the rational means, air, exercise, diet, and
water-treatment, and not upon drugs, to remedy it. Mark too, how, year
by year, the superiority of these hygienic and curative influences is
being recognized by medical men, and how the old methods of dosing the
system are going into disrepute.
HEMORRHAGE FROM THE STOMACH.
In consequence, probably, of a general fullness of the system, or
perhaps from the cessation of the menstrual function, a discharge of
blood sometimes takes place from the stomach, in the earlier periods of
pregnancy. It is generally small in quantity, and continues but a short
time. The occurrence, generally, causes a good deal of alarm to the
patient, but it is seldom to be looked upon as a dangerous affection.
_Treatment._—If the hemorrhage arises from too great fullness of the
system, a reducing process should at once be commenced—not by drugging
the system, or by blood-letting, but by abstinence and fasting.
If the discharge should be at all alarming, we should place cold wet
compresses upon the abdomen; we should, in short, proceed upon the same
general principles as we would in any other case of hemorrhage.
If the bleeding occurs in consequence of hard vomiting, as it sometimes
may, we should take measures to arrest that symptom.
I remark, in conclusion, that this affection is a very unfrequent one,
and such, in most cases, as should cause no alarm.
URINARY DIFFICULTIES.
Incontinence of urine is quite apt to occur toward the end of pregnancy.
It arises often from the pressure of the womb upon the neck of the
bladder.
There is a notion with some of the “old women,” that incontinence of
urine is an indication of good labor.
_Treatment._—This difficulty cannot, of course, be altogether remedied;
the cause cannot be removed. It may be lessened, however, by short and
frequent hip-baths, wet bandages, and cold bathing. Drinking soft water
instead of hard, will also be found to have a good effect in all
difficulties of the bladder whatever.
Blisters are always liable to bring trouble upon the urinary organs, but
more particularly so in pregnancy. The system is then in a more
excitable or impressible state. Strangury in pregnancy is a very
distressing and untoward symptom when it follows the use of blisters.
Dr. Dewees had known cases where entire retention of urine followed the
use of blisters, so obstinate that it could only be relieved by the
catheter, causing a distressing inclination and violence of effort, only
to be surpassed by labor itself. Retention may also come on from other
causes.
_Treatment._—It can be very seldom indeed necessary to resort to the use
of the catheter for draining off the urine, if cold hip-baths, cold
foot-baths, and even the cold general bath, if necessary, be
sufficiently persevered in. Cold has a truly wonderful effect in causing
the flow of urine.
CRAMP OF THE STOMACH.
This affection, as it occurs in pregnancy, is most common with those
whose stomachs have become much enfeebled by dietetic improprieties,
excess in the use of warm drinks, and by the abuse of medicines.
_Treatment._—By way of comparison, let me present you with the remarks
of a celebrated European author, Doctor Churchill, concerning the
medical treatment of this affection, that you may see what you think of
the reasonableness of it. He says:
“Our first object is to quiet the pain by a full dose of laudanum.
“When this is attained, we may proceed to remove the cause, and to
arrest any intestinal irregularity. Dr. Burns recommends aloetic
purgatives, but these may not in many cases be suitable. If there be
piles, as is very often the case with pregnant females, they will rather
prove injurious than beneficial. I have found Gregory’s powder,
electuary of sulphur and senna, or castor-oil, to answer the purpose
better.
“During the intervals of the attack, tonics (of which oxide of bismuth
or preparations of iron are recommended) or stomachics may be exhibited.
A belladonna or opium plaster, or a blister over the stomach, is often
very useful.
“Should the attack be very severe, bleeding, or leeches to the
epigastrium, may be advisable; this will be especially the case should
there be any symptoms of congestion about the head, and more for the
purpose of preventing an attack of convulsions, than even for the relief
of the gastric affection.”
Assuredly you will say that drug-treatment affords a _variety_ of
resources, notwithstanding it is so little to be depended upon.
I need hardly hint to you how much better, safer, and more effectual the
water processes are than all the drugs of the _materia medica_ to cure a
case of cramp in the stomach.
If it is a bad case—acute, as we say—at once drink warm water enough to
cause speedy vomiting.
The tepid clysters, used to the extent of gallons, that is, by
repetition, if need be, is also a serviceable remedy.
We also use wet compresses, frictions, and the hip-bath, if necessary;
but as a general fact, as soon as we cleanse the stomach and bowels
thoroughly, the cramping ceases.
Afterward, as in all cases of stomach ailment, and all other ailments,
great care should be observed in regard to the food.
TOOTHACHE.
Breeding with a toothache is an old proverb. Toothache is certainly more
apt to occur during pregnancy than at other times, and not unfrequently
it is a very early symptom of this state. And what may appear singular,
the teeth ache without being diseased. Especially those who drink strong
tea and coffee are more subject to this nervous toothache, as we may
term it; toothache where there is no decay. Ceasing with the cause,
then, is the surest means of relief.
_Treatment._—It is dangerous to extract teeth in the early months of
pregnancy. The operation has been often known to cause immediate
abortion. There is the greater danger of this in the early months.
Bleeding has often been practiced for this affection in pregnancy; but
that is a worse than useless resort, and moreover, generally fails of
the object. After a few days of full diet, the affection is quite
certain to return, and appears to be even the more obstinate for the
bleeding. Fasting, with water-drinking, is a much better mode. Very
seldom will toothache withstand twenty-four hours’ entire abstinence
from all food. If the face has become much swelled, of course so great
relief could not be experienced in so short a time. But even then the
fasting is of incalculable good. General bathing, and going into the
open air, are also excellent means. The rubbing wet-sheet is
particularly applicable. And Dr. Burns, in his work on midwifery, years
ago said, “Sometimes a little cold water held in the mouth abates the
pain.” This will be the case whenever the toothache is one of
inflammation; but if it be of the more nervous kind, warm water will
give more relief. If the nerve is much exposed, it is perhaps always
best to hold warm, or at least lukewarm water in the mouth, and at the
same time to practice very brisk and continued rubbing of the face,
temples, neck, etc., with the hand wet often in cold water. Wet bandages
upon the face are also good. If the aching be of the nervous kind, that
is, without inflammation, warm bandages, often repeated, afford the most
relief.
I must repeat, that I hope none of you will ever consent to have your
teeth extracted, or in any way operated on, while pregnancy exists.
JAUNDICE.
This, as a disease of pregnancy, is one that most frequently makes its
appearance in the latter months of the period.
This state of the system should not be confounded with that in which the
woman acquires a dark, almost yellow color, which, however, is not
jaundice, and readily passes off after the delivery has taken place.
_Causes._—In pregnancy, as at other times, this affection is often
preceded by a disordered state of the stomach and alimentary canal
generally. There is also, generally, a sense of weight and tightness in
the abdomen, especially at the pit of the stomach, and in the right
side. But in some cases none of these symptoms are observed.
Sometimes abortion has happened in connection with this state of the
system; such, however, is not often the case.
_Treatment._—If it is attended with violent symptoms, as is sometimes
the case, it will be necessary to use active measures to cure it. In a
majority of cases, however, a few days of abstemious living, alternating
now and then with a day of entire fasting, together with plentiful
drinking of pure, soft water, and a moderate share of bathing, will
suffice to effect a cure. The wet-sheet pack is especially useful in
these cases.
LETTER XVIII.
DISORDERS OF PREGNANCY.
Difficulty of Breathing—Pain in the Right Side—Itching of the
Genitals—Swellings of the Limbs—Cramps of the lower Extremities—Pain of
the Breasts—Hysteria—Physical Hindrances—Exposure to Disease.
Toward the latter months of pregnancy, there is always, necessarily,
more or less difficulty. The uterus becomes so large, and fills so much
of the abdomen, that the upward and downward motion of the diaphragm, or
partition between this and the chest, is greatly impeded. Hence the
dyspnœa, or difficulty of breathing. A cough, likewise, not unfrequently
attends this symptom, and becomes so severe in some cases as to cause
abortion.