possible, the disease. _Mothers, and all of you who hope or expect to
become mothers, if you wish to save yourselves a great deal of needless
pain and suffering, a great deal of restlessness at night; if you wish
to avoid one of the most troublesome and disheartening affections to
which the female system is ever liable, I warn you in the strongest
feelings of sympathy and regard for your sex, that you avoid, so far as
is possible in the nature of things, the_ CAUSES _of this terrible
disease_.
But some have poor, feeble, scrofulous constitutions, and cannot by any
possibility avoid the inflammation of which I am speaking; and, do what
we will—the best that, in the nature of things, can be—the breast must,
I think, in some cases inflame, suppurate, and break. An accidental
blow, likewise, so slight that it would scarcely be felt upon almost any
other part of the system, may cause a mammary inflammation and abscess.
And, worst of all, to think of many a poor mother who has so poor a
habitation, is so much oppressed by the cares and perplexities of
domestic life, and has such poor care and nursing that she is always in
great danger of suffering with inflamed breasts.
The treatment of this affection, therefore, is a matter for the serious
consideration of both parents and physicians; and, as I before remarked,
a great variety of methods have been adopted for this end.
We should remember that we are to treat an INFLAMMATION, and that the
plain principle of treating all inflammations, of whatever grade or
kind, when of acute character, is the antiphlogistic or
anti-inflammatory plan. By what means and to what extent to use these
means, are circumstances in which the skill, tact, and good judgment of
the physician are to be exercised.
A very common error has been to treat too much _locally_ in this
disease. This is, in fact, a very common fault in medical practice
generally. I have no doubt that many an inflamed breast has been
rendered worse than it otherwise would have been by the too great amount
of local means employed. In many such cases, doubtless, the breast has
been made worse than it would have been had no treatment whatever been
employed.
As soon, therefore, as the patient begins to experience a chill coming
upon her, with pains in the back, limbs, etc., together with a general
uneasiness and restlessness, and, perhaps, with an inflammation already
commenced in one or both of the breasts, no time should be lost in
setting at work resolutely to combat the approaching evil. The sooner we
act, and the more prompt and resolute in the treatment, the greater the
chance of preventing an abscess. We give the rubbing wet-sheet, if there
is not already too much fever, the tepid shallow-bath, with a good deal
of friction; a general cold bath, if the patient is not too weak; the
packing sheet, the wet girdle, wet compresses upon the breasts,
injections of tepid water, and follow up the applications as much and as
often as the symptoms may demand. Above all, the patient should not be
worried by a multitude of ignorant and careless, though, perhaps,
well-meaning friends, who each and all insist that some particular
poultice, or some favorite “cure-all” of theirs will certainly arrest
the difficulty, if the patient will but condescend to use it, and that
if she keeps on with the water, it will certainly cause the breast to
break. How exceedingly foolish, ignorant, and prejudiced are the
multitude in regard to these things! Every practitioner of water well
understands how much we have to encounter in society, because of the
prevailing ignorance of the most common remedial uses of the greatest
and most abundant of all curative agents which God has given to man.
As regards the temperature of the applications, local and general, we do
no violence to the system. Should we persevere sufficiently, we could
cure almost any fever or inflammation with water at 80° Fah., a
temperature so mild that the most delicate child can bear it.
One thing in particular should be remembered: the patient should not be
bundled up closely, and have a great deal of warm bed-clothing, under
the impression that a cold will be taken if such measures are not
adopted. We almost always find patients heating and injuring themselves
in this way. But it should always be remembered, _that when a fever or
inflammation is already present, it is not possible to take an
additional cold_.
As for local applications upon the breasts, fine wet linen cloth should
be used constantly. As to the temperature, I think it best to consult
the patient’s feelings merely. It is, perhaps, best to alternate
somewhat; sometimes to apply warm or tepid cloths, at other times cold.
I think a change is often good; at any rate, we should keep the parts
constantly wet.
The wet cloths are covered with dry ones, or flannels, if necessary; but
if there is great heat in the part, it is best to leave the compresses
uncovered, so that by evaporation a much greater amount of heat may be
thrown off. Sometimes the breast becomes so heavy and painful, that it
is a great comfort to the patient to have it suspended in a sling.
I have already hinted how important it is to keep the milk well drawn.
The mouth of an adult person is one of the best means, and the infant is
often able to do good service in this way. Some get along pretty well
with a tobacco pipe. But the instruments generally found in the shops
are illy suited to their object. One form, the suction-pump, is an
invaluable piece of mechanism, provided the glass that fits upon the
breast be of the right shape, and have an opening sufficiently large to
admit a man’s thumb. Generally, they are much too small, causing a good
deal of pain when used; but if they are of the right make, they will
draw the breast with more comfort and less pain than the infant itself.
Before the breasts are drawn, they should be well washed, for this will
always help the milk to flow; and in connection with this subject, there
is one highly interesting and instructive fact in regard to bathing.
Thus, a patient may be in a condition in which, in consequence of the
inflammation present, no milk whatever can be obtained. But we give the
patient a good ablution of the whole body, even a simple tepid-bath, and
directly we may succeed in getting milk; and in some instances it is
made actually to drop of itself from the breasts. Even the washing of
the breasts alone will sometimes cause it thus to flow.
Should an inflamed breast ever be opened after the matter has once
formed? The most common practice has been to do it. Dr. Gooch, however,
who is high authority with the profession, speaking of this disease in
that state in which the matter approaches the surface, says: “Will you
open the abscess? If you do, you will relieve your patient from
suffering, and by the evacuation of the matter the constitutional
disturbance ceases; but the wound will not heal so soon, and the
maturation of the abscess will not be so complete as if the whole
process were left to nature.” I have myself opened them at the request
of patients in some instances; but I have become convinced that it would
have been better, in the end, not to do it.
Dr. Burns tells us—although he recommends opening the abscess—that the
puncture is liable to be followed by a troublesome oozing of blood from
the wound, and that in one instance he knew the hemorrhage to prove
fatal.
After the abscess has burst, there is for some time a discharge of
purulent matter, which is not unfrequently mixed with milk. The utmost
cleanliness should be observed, and a considerable amount of general, as
well as local treatment should be kept up until the healing is fully
effected.
Thus, then, in the use of water, locally and generally applied, together
with the proper adaptation of the other hygienic means, I consider that
we have a remedy which far surpasses all others in that troublesome
affection of which I am treating; a remedy which, if it cannot always
cure the inflammation without an abscess, will yet so much mitigate it,
so much promote the healing, and so much support the patient’s strength,
that mammary abscess, if it must occur—and I think, do what we will, in
some few instances such must be the case—it is yet stripped of its
greatest horror, and rendered, generally, a comparatively trifling
affair. Such has been my own experience, and such, I think, will be
found to hold good wherever the water-treatment is faithfully and
skillfully applied.
Dr. Burns has given us a sad picture of what not unfrequently results
from mammary abscess; and that the reader may have, on good authority,
an account of the sad condition which sometimes results from the
affection, I quote his own words:
“It sometimes happens, if the constitution be scrofulous, the mind much
harrassed, or the treatment not at first vigilant, that a very
protracted, and even fatal disease, may result. The patient has repeated
and almost daily shivering fits, followed by heat and perspiration, and
accompanied with induration or sinuses in the breasts. She loses her
appetite, and is constantly sick. Suppuration slowly forms, and perhaps
the abscess bursts, after which the symptoms abate, but are soon
renewed, and resist all internal and general remedies. On inspecting the
breast at some point distant from the original opening, a degree of
œdema may be discovered, a never-failing sign of the existence of
deep-seated matter there, and, by pressure, fluctuation may be
ascertained. This may become distinct very rapidly, and therefore the
breast should be examined carefully, at least once a day. Poultices
bring forward the abscess, but too slowly to save the strength, and,
therefore, the new abscess, and every sinus which may have already
formed or existed, must be, at one and the same time, freely and
completely laid open, and, so soon as a new part suppurates, the same
operation is to be performed. If this be neglected, numerous sinuses
form, slowly discharging fetid matter, and both breasts are often thus
affected. There are daily shiverings, sick fits, and vomiting of bile;
or absolute loathing of food, diarrhea, and either perspiration or a
dry, scaly, or leprous state of the skin; and sometimes the internal
glands seem to participate in the disease, as those of the mesentery, or
the uterus is affected, and matter is discharged from the vagina. The
pulse is frequent, and becomes gradually feebler, till, after a
protracted suffering of some months, the patient sinks. It is
observable, that often, in those cases which seem to depend on a
constitutional cause, and when there is great debility, the sinuses heal
rapidly, after being laid open, but a new part instantly begins to
suppurate. Internal remedies cannot be depended on here, for they cannot
be retained. If they can be taken, they are those of a tonic nature that
we would employ, with opiates to abate diarrhea and procure sleep.”
LETTER XXXVII.
CASES IN MIDWIFERY.
A Collection of Facts Illustrative of the Effects of Water-Treatment
before, during, and after Childbirth.
In the year 1843, at which time the water-cure had been heard of this
side of the Atlantic only by a very few, I for the first time applied
water-treatment in a case of midwifery. I had, it is true, been for
months, and I may say years, studying upon the matter, as a student of
medicine who is determined, above all things, to learn and practice the
truth, ought; yet I had no opportunity of bringing the principles which
I believed in to bear directly upon any given case previously to the
period referred to. The following then, are some of the leading
particulars of my first case:
_Case I._—The lady was a resident of this city, of a feeble constitution
by inheritance, and, I think, twenty-one or two years of age. For three
or four years previous to her confinement her health had been, on the
whole, much improved. Her constitution seemed, indeed, to undergo a
remarkable change for the better, in consequence of leaving off tea,
coffee, spices, butter, and flesh-meat, and at the same time practicing
the daily bath. She, in short, became, as her flesh-eating friends said,
“a thorough Grahamite.” Notwithstanding her improvement, however, she
suffered miscarriage two or three times in as many years.
During the period of pregnancy of which I am speaking, I advised her to
be very particular in keeping up her baths, exercise, diet, etc. She
followed the advice faithfully. She suffered somewhat from neuralgic
pains in the abdomen, but these were in general readily checked by the
use of wet compresses, and the sitting and other baths. Few patients
have ever been as faithful as she was in carrying out all good rules.
She kept up her bathing and exercise to the very day of labor.
There was one circumstance which operated against her a good deal toward
the close of the period. A worthy and skillful medical friend advised
that she should have premature delivery brought on, because her pelvis
was, as he said, too small to allow of the birth of a full-grown child.
This advice, however, she would not, on any account, entertain,
notwithstanding she had the utmost confidence in the skill and honesty
of her friend. She resolved to trust God for the result, although she
was well aware that she was to pass through a most fearful ordeal of
danger and suffering. As it proved afterward—for she has borne a number
of children since—her own instinct was better than all the knowledge of
her medical friend.
Her labor was a very severe one, and she met it with most praiseworthy
courage. She was at length delivered safely. The child was of more than
average size, but owing to a malformation it could not live. Her
maternal feelings were of the strongest kind, and the loss of her child
was a great blow upon her spirits. She was, however, up daily, more or
less, from the very first. Indeed, it was not two hours after the
birth—she having been awake all night—before she stood up, and was
thoroughly washed in cold water from head to foot. She knew what cold
water had done for her before, and she was not afraid that it would fail
her now in her time of need.
She pursued the treatment from day to day, observing the greatest care
not to overdo. She understood well, young as she was, the great
importance of mental quiet under such circumstances, and saw no company
for many days. On the sixth day she had so far recovered as to be able
to walk to the Battery, a distance of a mile and a half. The weather
being hot, she rested awhile upon the shady seats of that beautiful
inclosure, and was much refreshed with the sea breezes which are so
genial at that season of the year. Afterward she walked back home,
making, in all, a morning excursion of three miles.
This, then, I put down as one of the first of the American cases of
hydropathy, and _the_ first in childbirth. Thanks to Priessnitz, there
have been thousands since.
_Case II.—June 26, 1846._—Two weeks ago, Mrs. E., of 56 Prince Street,
informed me that she had arrived very near the end of the period of her
first pregnancy, and that she desired me to attend her in childbirth. By
conversation I soon found she was well-informed in the new system, and
the modes of preserving health, and this without her having had any
particular advantages for acquiring such knowledge. She had read
faithfully and understanding upon the subject of health, a duty which
too few mothers observe. Mrs. E. is about twenty-two years of age, with
constitution naturally very good, although not remarkably strong. Her
attention became directed to bathing about two months since. She
performed two ablutions daily, and took sitz-baths; discontinued the use
of tea and coffee, took very little animal food, living principally upon
coarse bread, hominy, cracked wheat, and fruits. She took frequent
exercise in the open air, and by these means became sensibly invigorated
in general health, and was kept perfectly free from unpleasant symptoms
of every kind. I advised my patient to go on as she had done
perseveringly and to the last. Her very kind and affectionate husband
and her mother, as well as other good-meaning relations, insisted that
she should take a different course, particularly in food and drink. But
she chose understandingly to pursue her own way, feeling full confidence
that she would be able to prove to her friends that she was in the
right, and that young persons were not necessarily less knowing than
older ones.
_June 26._—To-day Mrs. E. sent for me early in the morning. She had
experienced by turns slight labor pains from 9 A. M. the day before; was
not able to sleep much in the night. Took baths as usual, and walked in
the open air. This morning she practiced general ablution and
sitting-baths as usual. Cold water renders the pains more efficient,
which is a good symptom. Walking about the room has the same effect. The
pains increased very gradually, and this afternoon, notwithstanding they
grew more severe, she was able to sleep at times between them. These
continued to increase until six o’clock this evening, at which time she
gave birth to a remarkably fine, healthy daughter. In a few minutes the
after-birth was expelled, and no undue flooding occurred. Wet towels
were placed upon the abdomen and the genital parts, and the face, hands,
and feet were sponged, each of these applications having a most soothing
and refreshing effect.
In the case of the infant, care was taken to avoid the great error so
generally practiced, of separating the cord by which the child is
attached to the mother, too soon.
The separation after due time being made, the infant was washed in soft
water made very slightly tepid, with the addition of a little mild soap.
No bandage was put about its abdomen, for the reason that it always
causes more or less harm—that is, if there is no malformation of parts,
and always tends to induce the very difficulty it is designed to
prevent, viz., that of rupture. The kind-hearted mother of Mrs. E.
insisted, as a matter of course, that the bandage should be applied as
in the good days of old, but Mrs. E. said “_Do as the doctor says._”
Very light muslin clothing was then placed upon the infant, after which
it was left, without drug or dose, quietly to sleep.
_9½ o’clock, Evening._—Returned. Mrs. E., happy and contented, has been
enjoying sound, refreshing sleep. Has had no nourishment since morning.
Took then a little fruit. Prefers to wait until morning before taking
any more. I recommended her to take fruit every day from the first, that
the infant may be accustomed to her doing so. If mothers omit fruit for
a while and then commence its use, the milk generally distresses the
child. I believe that, as a rule, the judicious use of well-matured
fruits will not cause any difficulty in the child, provided the above
direction is from the first and onward complied with.
Mrs. E. is now to take a bath—that is, with assistance, the whole
surface is to be cleansed, portion by portion, by means of cloths wet in
moderately cold water. This will cause a sense of great comfort—will
increase the strength and promote sleep. As is very common on such
occasions, the friends object strongly to the use of cold water. “Oh, it
will give you a death cold! how can you do it?” and the like expressions
are used. But the patient well understands that she needs the
invigorating and soothing effect of the ablution, and that when the
system is sufficiently warm, it will not only be perfectly safe, but
highly beneficial. She prefers, as she has done, to practice upon
rational and well-ascertained principles, rather than to be guided by
the whims and caprices that custom with its iron rule entails upon
society.
_First Morning after Confinement.—June 27, Six o’clock._—Mrs. E. slept
sweetly and soundly during the whole night, waking only a few minutes at
one time. She feels greatly refreshed, and able to rise and take a bath;
judges by her feelings that she will be benefited by sitting up; has a
good appetite. I advise her to sit up as much of the time, little by
little, as she feels inclined. She proposes eating very sparingly of
well-boiled cracked wheat, with a little uncooked milk and berries.
_Half-past Nine, P. M._—Mrs. E. has sat up at different times during the
day. No after-pains or particular discomfort of any kind. Every time of
sitting up has done her good. She has taken food at three different
times. Will take a sponging now, and retire to rest.
_Second Morning after the Birth._—Mrs. E. slept remarkably well during
the whole night. Has been up, performed a bath, walked about the room,
and is much invigorated. Felt decidedly the need of the bath; it
strengthened her much. Has no after-pains or difficulty of the breasts.
The milk secretes abundantly. The bowels are moved by injections of
tepid water. Mrs. E. will sit up the greater part of the day.
_Third Morning after Birth.—Eleven, A. M._—Mrs. E. rested well during
the night. Arose at six, and took her usual bath. Reclines now awhile.
Would be able to walk up and down stairs were it necessary. Her infant
is remarkably well, and sleeps the greater part of the time. Mrs. E. is
one of that very small number of mothers that has energy of character,
resolution, and system enough to nurse her infant regularly, and not
during the night time. Once in three hours, between 6 A. M. and 9 P. M.,
at the very most, is as often as she will allow it to take the breast.
_Seventh Day._—Mrs. E. has been improving day by day, from the first.
She has had no inconvenience whatever; no pains of any kind, no swelling
of the breasts or feverishness. Has well-nigh her natural amount of
strength. Her infant, too, is doing remarkably well.
_Case III.—Nov., 1845._—Mrs. C., a poor woman of this city, not long
since made known to me, that in her destitute condition she would
receive, as a great favor, if I would attend her in childbirth. She
informed me that on previous like occasions, she had suffered beyond
description, both at the time of confinement and subsequently. She had
borne two children—the first it was necessary for her physician to
destroy before the birth could take place. The birth of the second was
also attended with the greatest difficulty. It was now some weeks before
her expected time. Her husband had deserted her, so that she was
compelled to follow her occupation (that of a seamstress) during the
whole day and much of the night. From this constant sitting and
confinement within doors, she had become much enfeebled, and had a
severe and constant pain in the side.
I directed her to wash the whole body daily twice, when not chilly, in
Croton water, and to take each half day as much exercise in the open air
as she could possibly find time for, and could practice without causing
too great fatigue. The woman followed the directions, and was at once
sensibly benefited. The severe pain in the side left her almost
immediately. When her period arrived, delivery took place in a very
short time, and with comparatively little suffering. Bathing in mild
forms was practiced the day of, and subsequent to, delivery, and the
patient walked about each day, and was scarcely _confined_ a single
hour.
There is one fact to be mentioned in her management of the infant. She
was directed at first to have it washed in tepid water. Supposing she
would follow the same course for the future daily washings, I made no
further inquiry till some days after, when I ascertained that she had
used the water of the natural temperature. I asked her why she did not
moderate the temperature of the water as at first, and as people
generally do. She answered, that when she bathed herself before the
child’s birth, every bath seemed to strengthen it very much; and,
therefore, she chose to use the cold water now for the same reason. She
had the good sense always to keep the child sufficiently warm,
particularly after the bath. It is proper to mention that the Croton
water at this time was not far from 65° Fah. The child has been, and is
now, one of the healthiest and most vigorous I have ever seen of the
age.