kind, bodily or mental, ought to be avoided during pregnancy. Running up
stairs too quickly, walking too rapidly, and any undue mental
excitement, increases this difficulty of breathing. Some mothers are in
the habit of taking up heavy children needlessly, and carrying them,
which is one of the most certain means of doing harm to themselves. So
also, inaction is bad for the breathing. If the individual do not have
exercise enough to answer the purposes of health, the system becomes
more plethoric or full, and thus also the difficulty is increased. The
medium of neither too little nor too much should always be observed. The
same also may be said of the diet. And here I remark, that if any
pregnant woman will carefully make the experiment, she will find that in
the latter months of pregnancy, an exceedingly small allowance of food
only, with free water-drinking, bathing, and moderate exercise in the
open air, will be sufficient to keep up her strength, and that in a most
remarkable manner. Let her not be deluded by the old maxim, that because
there are two to support she must take a greater amount of food.
PAIN IN THE RIGHT SIDE.
After gestation has passed the middle of its term, there is experienced
often more or less pain in the right side. This does not usually happen
until after the beginning of the fifth month of pregnancy. It comes on
as a deep-seated pain in the immediate region of the liver; often it is
merely a trifling sensation at first, increasing as pregnancy advances.
It is not increased by ordinary inspirations, as many internal pains
are, although a very full and deep inspiration may augment it in a
slight degree. The pain is seldom, almost never, very great; it is
constant both day and night, but worse in the latter. The patient can
lie on either side, but better on the left. A severe sensation of heat
is sometimes experienced at the part where the pain exists. This is
sometimes almost constant, at others only occasional, and in still a
greater number of instances, nothing of the kind occurs.
Women are more subject to this affection during the first pregnancy than
at subsequent times. It may, however, be experienced after a number of
children have been borne; this is true more especially in those cases
when the child is carried “high up,” as it is called. This comes from
the fact, that the pain is caused by the pressure of the upper part of
the womb upon the liver, which lies mostly upon the right side.
_Treatment._—No material harm can be said to come from this pain, and
for this reason no harsh and severe medical treatment should be adopted
with a view of removing it. Bleeding is well known to be a common remedy
for ordinary pains in the side. But Dr. Dewees, of Philadelphia, whose
experience was so great in all matters pertaining to midwifery, remarks
of this practice, that so far as he had seen it, not the slightest
advantage had arisen from it. “Nor,” observes this candid writer, “has
any other treatment which we have advised been any more successful.
Leeching, cupping, and blistering, have in turn been employed without
benefit. Indeed, we have now ceased to prescribe for this complaint,
unless it be attended with some alteration in the circulating system; if
this be disturbed, and the pulse tense and frequent, advantage is
sometimes experienced from the loss of blood and gentle purging, as this
pain may be aggravated by this condition of the system. But in this
instance, we prescribe for the general condition of the system, and not
for the local affection—as we should have to do most probably as much,
were this pain in the side not present.” These are the candid remarks of
one whose experience in treating diseases of women was as great,
probably, as that of any other man, showing conclusively that ordinary
means are of no avail in this difficulty.
Now I can speak confidently in this matter. The water processes are
effectual in mitigating this pain much, to say the least. I conclude it
is rather a symptom of debility than otherwise. I do not believe it
natural. Bathing to support the general strength, and particularly the
wet girdle, often rewet, especially in hot weather, so as to keep it at
all times cool, and hip-baths, with a good share of friction by the wet
hand over the part affected, will be found excellent means. The
_immediate_ relief caused by the application of the wet girdle will be
often astonishing. Keeping the bowels freely open, as by the habitual
use of brown bread, mush, and the like, and injections of cold water,
are also of service here.
But if, in any case, the pain resists all remedial means, and as we have
before said, those of a severe nature should never be resorted to, the
individual should not allow her mind to become depressed by thinking
that harm must inevitably be caused in consequence of it.
Too much, as well as too little exercise, may cause this difficulty. A
proper medium should therefore at all times be observed.
ITCHING OF THE GENITAL ORGANS.
_Pruritus pudendi_, or itching of the genital parts, becomes sometimes a
most troublesome and distressing complaint in pregnancy—so troublesome,
indeed, as utterly to set decency at defiance. Cases under the ordinary
modes of treatment, have been known to be so severe as to compel the
lady to remain in her chamber for months.
The causes of this affection cannot always be ascertained. A want of
proper cleanliness is no doubt often one of the principal sources of it.
A great variety of remedial means have been used in this disease.
Astringents, such as alum, borax, acids, etc. are the agents indicated.
But cold is the greatest astringent of all; no matter how troublesome
the affection, it is completely within our control by the use of cold
hip-baths, cold cloths, ice, and the like. In a late number of
Braithwait’s “Retrospect,” one of the leading English periodicals of
medicine and surgery, it is stated by Dr. James Arnott, “that a most
distressing attack of this affection was completely subdued by two
congelations, each of about thirty seconds’ duration, after a prussic
acid lotion and other routine applications had been tried in vain.” By
“congelation,” Dr. Arnott means the application of intense cold, by the
use of ice between cloths, or some freezing mixture, but not an actual
freezing of the parts, as some might suppose. But shallow hip-baths of
cold water from a well, persevered in, will be found sufficient in every
case.
It should be remembered that _uncleanliness_ is a most fruitful source
of this troublesome affection.
SWELLINGS OF THE LIMBS AND VARICOSE VEINS.
Swellings of the lower limbs, and varicose or knotty and swelled veins,
may occur in pregnancy from the same causes as piles and hemorrhoids,
namely, an obstructed circulation.
Washing the parts affected with cold water, and attention to the general
health, are the means to be used here. Do no violence to the system. The
exercise should be moderate. Nor should the woman be too inactive; the
medium course in all cases is the better rule.
If the patient can find time to lie down a number of times during the
day, removing her clothing at each time, she will find the practice a
good one.
CRAMPS IN THE LOWER LIMBS.
Toward the close of pregnancy, cramps may occur in the lower
extremities, because of the pressure of the child upon the large nerves
that pass down them. This is seldom very troublesome, and cannot, of
course, be altogether prevented. Too great fatigue, and any thing that
tends to depress the general health, will at least make the matter worse
than it otherwise would be.
PAIN IN THE BREASTS.
Mastodynia, or pain in the breasts, is more common in the first
pregnancy. Compression by clothing may cause the difficulty. Washing the
parts with cold water, and wet bandages or cloths worn upon the parts,
are the means to be used. If the pain is of a spasmodic kind, it may be
best in some cases to use warm fomentations.
HYSTERIA.
There appears to be with many a greater tendency to hysterical symptoms
during pregnancy, than at other times.
Hysterical females are, for the most part, those who live a life of
excitement, attending frequently balls, theaters, and public exhibitions
late at night, and especially such as are much addicted to tea and
coffee drinking, the use of concentrated and stimulating food, and have
little exercise in the open air.
_Treatment._—Medicines, especially the preparations of opium, also have
a tendency to cause hysterical symptoms. Pregnant women should, then, as
far as possible, avoid these causes of so pitiable a disease. Whether in
pregnancy, or at other times, hysteria cannot come upon those who live
correctly, and maintain at all times good and permanent health. I will
here further remark, that all novel reading should be avoided during
pregnancy; and the less the better, I may say, at all times, of such
novels as ninety-nine hundredths of all that are put forth at the
present day.
PHYSICAL HINDRANCES.
There are various _mechanical_ inconveniences connected with this state.
In the earlier months more particularly, there is pressure upon the
rectum, causing a tendency to constipation. This should be guarded
against, not by “the due administration of mild laxative medicines,” for
that only tends to make matters worse in the end, but by the use of
proper food, such as cracked wheat or rye, brown or unbolted bread,
Indian mush, well boiled, and good fruits and vegetables, in their
season. Exercise, employment, daily bathing, and clysters, tepid or
cold, according to the season, and the patient’s strength, should all be
brought to bear in the case.
Pressure upon the urethra, or neck of the bladder, is also one of the
mechanical evils of pregnancy, rendering the evacuation of urine
difficult, and sometimes painful. To prevent this, the patient should be
exceedingly careful to evacuate the bladder frequently, and never to
allow the calls of nature to go unanswered; nor should she stand or walk
too much at a time, as this is calculated, in a powerful manner, to
increase the difficulty. The same may be said in regard to the feeling
of weight which is experienced in the loins during the early part of the
period; and in reference to all these mechanical evils of pregnancy, I
remark that it is of great service for the patient to recline, for a
short period, a number of times a day. If she is of active disposition
and habits she may not feel inclined to do so; yet she will find the
practice a good one, and productive of much comparative comfort.
If the abdomen becomes too pendulous, as it sometimes does, owing to the
flaccidity of the abdominal parietes, a considerable degree of relief
may be obtained from stays of a proper construction. These, however,
should be so fashioned and arranged as not to overheat the parts,
otherwise they will be made weaker, and thus more harm than good will be
the result. The wet girdle, suitably applied, is an excellent appliance.
Nor should any of these helps be used too much of the time.
EXPOSURE TO DISEASE.
Pregnant females should not expose themselves to infectious diseases;
although it appears to be established that they are not, under such
circumstances, as liable to contract such disease as at other times.
Still, if they do contract them, the result is likely to be a more
serious one; and in case the mother escapes, the child may suffer, and
abortion, even, may be the result.
VACCINATION.
I am opposed to vaccination at all times. It is better, I believe, to
live carefully and consistently in all respects, and trust nature for
the result. There are many objections to vaccination, which I need not
here mention. Pregnant women especially, who are necessarily, in the
present state of things, more than others, subject to inflammatory
diseases, and less liable, when attacked by acute disease, to recover
therefrom, should not be vaccinated. Here are Professor Meigs’s earnest
injunctions on the subject. Writing to his class, he observes:
“Pregnant women ought not to be vaccinated. This is a rule which I would
advise you to depart from only on the most urgent occasions. If a woman
have been ever vaccinated, and appeal to you to re-vaccinate her,
because there is a prevalent variolous epidemic, I hope you will refuse
to accede to her request. Small-pox is exceedingly and peculiarly
pernicious to pregnant women. She who has it, and miscarries, or who is
brought to bed at term, generally dies. It is, in my opinion,
inexcusable to expose her to so great a risk—a risk far greater than
that from accidental contagion, or that of the epidemy. But the vaccine
is identical with the variolous animal poison, saving some lessened
intensity of its malignant form, derived from its having been modified
by the nature of another mammal. To inoculate a cow with small-pox
virus, is to give her the vaccine disease, with the lymph of which you
can vaccinate, but not reproduce unmodified small-pox. Keep your
pregnant patients clear of small-pox, in all its forms, whether modified
or unmodified. Do not vaccinate them. I have been the witness of
dreadful distress from the operation. Eschew it, I entreat you.”
By way of digression, we may inquire, if pregnancy is an objection to
vaccination, why should _any_ person be vaccinated? If those who are in
a condition which renders them most susceptible of disease should not be
exposed to the variolous poison, why should others who are less
susceptible? If any are to take the risk of small-pox without
vaccination, I think the strong can afford to do it, rather than the
weak. If vaccination is good for any thing, it should be, I think, the
most worth for those who are the most liable to harm from the variolous
disease.
LETTER XIX.
DISORDERS OF PREGNANCY.
Nervousness—Mental Despondency—Longing—The Imagination—Effects of
Fright.
During that portion of the woman’s life in which she is capable of
bringing forth children, a period usually of about thirty years, the
uterus may be justly considered as the great center of her system. The
truth of no observation in medicine has been more generally acknowledged
than that of the extreme irritability of this organ, and of the
propensity or aptitude which the whole body has to become affected or
disturbed by its influence. In the progress of the development of the
procreative function, great changes take place; and in pregnancy these
effects are not the less remarkable.
The changes which are wrought in the system by pregnancy are not less
remarkable in the nervous system than in the other parts of the body.
The womb itself is highly endowed with nervous connections and
sympathies, and in many respects the uterus, during the child-bearing
period, may be considered the great nervous center of the female.
When it is remembered how extremely impressible the nervous system
becomes during pregnancy, we are taught the importance of preventing
women, under these circumstances, from witnessing things that are
calculated powerfully to excite the mind. This caution is especially to
be observed in regard to exposing her to scenes of suffering, distress,
danger, or the agonies of a death-bed. It is a sad thing for a pregnant
woman to lose a husband, child, or other near and dear friend.
Pregnant women should be very careful to avoid the sight of convulsive
and nervous affections. They should not, on any account, be present when
another is in labor; for it has been observed that some become greatly
terrified under such circumstances, while of themselves they are able to
pass through its agonies with all commendable courage.
MENTAL DESPONDENCY.
When we consider how important an epoch the period of pregnancy is in a
woman’s life, we cannot be surprised that her mind should sometimes fall
into a state of depression, out of which it is not in her own power, or
that of any who are about her, to recall it. In the first pregnancy
especially, the mind is apt to become thus affected. Shall I be able to
survive the period? Shall I bring forth a well-formed, or a diseased,
misshapen, deformed child? Will it not present badly at birth? Shall I
not have twins, or triplets, perhaps? What new and untold agonies must I
be brought to endure? These, and the like questions, must suggest
themselves to the mind of every sensible and reflecting woman, and more
particularly so when she is carrying her first child. And so it should
be; for, say what we will about the safety of labor, about its being a
natural process, etc., there are yet the pains and perils which belong
necessarily to it, and which all of your sex who bear children must
inevitably, to a greater or less extent, be subject to. I have not, I
trust, heretofore, in my medical lifetime, been wholly unmindful of my
duty as a physician, in endeavoring to instruct and to encourage your
sex in these matters. But I have never wished to conceal my conviction
that I regard pregnancy and childbirth as things of very serious moment
in a woman’s life; and he who can trifle with them is almost worse than
a very fiend. Bear witness, then, I respectfully ask of all of you, that
I, for one, have no sympathy with that nonsensical foolishness which
would lead some people to tell you that pregnancy and childbirth are
matters which need cause you no trouble, no agony, and no pain. I
repeat, then, considering the truth in these things, it is not at all
surprising that the pregnant woman should feel a good deal of concern in
consequence of what she is to pass through.
But I must tell you also, that this mental solicitude is often increased
to an unnecessary extent by the inadvertent remarks which are sometimes
made respecting some unfavorable case. One tells of one sad accident,
and one of another. Now all this is both unkind and unjust. Only place
yourselves in the case of the pregnant woman. Would you like to have
those strange and horrible stories told you, some of which may be true,
and some not? Would you not rather that your sisters would speak to you,
generally, at least, of pleasant occurrences, and of pleasant things? If
they could not speak to you in a hopeful manner, certainly you would
rather they would not speak to you at all.
Did you ever think of one of your sisters who is pregnant with an
illegitimate child? If you who have kind husbands and kind friends to
take care of you, become low-spirited in pregnancy, what must be the
feelings of her who knows that she must constantly be looked upon as an
object of shame? What think you of her who has been led astray by the
profligate from virtue’s paths of pleasantness and peace? of her who is
compelled to consider her pregnancy as a curse instead of a blessing,
and who has, in addition to the troubles of this state, to bear up
against the agony of her disappointed hopes, her sorrows, and her grief.
She must live in anticipation of a shame from which she can find no
antidote, no retreat. How often, alas! has such a state of mind ended in
a state of disease which has, in a short period, terminated life.
Believe we that Jesus of Nazareth would treat such a one as we too often
have done, when we know that He said, kindly and affectionately, to a
woman who had been caught in the very act of adultery, “GO, AND SIN NO
MORE!” Many a one has been thus disowned who might have been a loving
mother and an affectionate companion through a long and happy life, and
whose death-agonies were only the more embittered by the reflections of
her fallen and deserted state.
In ordinary cases depression of the spirits is most apt to come on
during the earlier months of gestation. Dr. Montgomery speaks of a
curious fact connected with the state of mind in pregnant women, when
their bodily health is at the same time good, namely, that however
depressed or dispirited with gloomy forebodings they may have felt in
the early part of their pregnancy, they in general gradually resume
their natural cheerfulness as gestation advances; and a short time
before labor actually commences, often feel their spirits rise, and
their bodily activity increase to a degree they had not enjoyed for
months before. This, however, does not always take place, for in some
cases the despondency continues to the very end of the period, at which
time it generally disappears, but not until the pains of labor have
actually commenced. With some, likewise, the despondency continues even
after the labor has been passed through, and amounts almost to a fit of
mental derangement.
_Treatment._—It should always be remembered, that in most cases of the
kind I have been considering, the state of health is not good. In some
cases the deranged state of the body operates, doubtless, to depress the
spirits and to derange the mental manifestations. In other cases the
mind appears to become first affected, and afterward the body suffers in
consequence thereof. In some cases, also, it is to be supposed that the
action is reciprocal, and probably pretty fairly balanced between the
two.
This explanation will enable us to form an opinion as to what the course
of treatment should consist in, which is, as far as possible, to remove
the causes of the difficulty.
In the slighter cases of mental depression a little improvement of the
general health is often sufficient to work a radical change in the
patient’s feelings. In the more persistent cases we should do all in our
power to tranquilize the mind and restore the bodily health.
LONGINGS.
Some women, when pregnant, experience the most strange and wayward
desires in regard to particular articles of food. This sensation is what
is commonly called _longing_; and it is believed that if the
preternatural craving is not gratified, a _likeness_ or _representation_
of the article longed for is very apt to be impressed upon the child.
It is true that some writers of eminence—as Professor Meigs, of
Philadelphia, for example—have doubted the existence of any such
sensation as the one in question; but the majority of writers are of the
opposite opinion. Women also themselves—and they ought to be the best
judges in a matter of this kind—do tell us that they know positively the
truth of such a sensation as longing.
There are some remarkable facts on record concerning the symptoms which
I am considering, and which would go to prove that it is not always the
good things of this world that are longed for. If women were always in
the habit of craving good and savory dishes under these circumstances,
we should have some reason to suspect them of dishonesty in regard to
the reality of longing; but when the fickle and morbid appetite is found
often to crave the most unrelishable articles, we must admit the truth
of the doctrine of which we are speaking.
A lady has been known, who, when not pregnant, having a great horror of
eating eels, and yet when in this situation she has demanded them with
an importunity not to be resisted. She would not only eat them with
avidity, but in large and repeated quantities, for the first few months;
she would then become indifferent to them, but not averse, until after
her delivery.
A woman pregnant, riding over a common, has scented spoiled shad that
had been thrown out, and became instantly so fascinated by their odor,
that she obliged her husband to take some of them into his gig; and as
soon as she arrived at home, began to eat of them, raw as they were, and
continued to do so daily until they were consumed, though they were
extremely offensive to every body else in the house.
A woman pregnant, while passing through her kitchen, has taken a
disgusting piece of bacon boiling in a soap-kettle, out of the vessel,
eating it afterward, with the greatest relish.
These are, it is true, extreme cases; but there are many which are far
from being of a character so trifling as to warrant the conclusion that
no such thing as longing for strange and disgusting articles during
pregnancy exists. Indeed, the truth of the doctrine is so well
understood among all classes as not to need any further proof.
Should these longings in pregnancy be gratified, and if so, to what
extent? This is a question of great practical importance, and one which
should be deeply pondered upon.
It is notorious, in the first place, that longing seldom, if ever,
occurs in a woman of good health and a well-constituted mind. If we
observe correctly, we shall find that it occurs seldom, if ever, in any
other than delicate and nervously irritable women.
It occurs, in the second place, particularly among those who are
indolent in their habits, having little or nothing to do, and without
any wholesome object of thought or occupation with which to “kill time.”