PREGNANCY.
SIGNS OF PREGNANCY.
222. The first sign that leads a lady to suspect that she is pregnant is
her _ceasing to be unwell_. This, provided she has just before been in
good health, is a strong symptom of pregnancy; but still there must be
others to corroborate it.
223. The next symptom is _morning sickness_. This is one of the earliest
symptoms of pregnancy; as it sometimes occurs a few days, and indeed
generally not later than a fortnight or three weeks, after conception.
Morning sickness is frequently distressing, oftentimes amounting to
vomiting, and causing a loathing of breakfast. This sign usually
disappears after the first three or four months. Morning sickness is not
always present in pregnancy; but, nevertheless, it is a frequent
accompaniment; and many who have had families place more reliance on
this than on any other symptom.
224. A third symptom is _shooting, throbbing, and lancinating pains, and
enlargement of the breasts_, _with soreness of the nipples_, occurring
about the second month; and in some instances, after the first few
months, a small quantity of watery fluid, or a little milk, may be
squeezed out of them. This latter symptom, in a _first_ pregnancy, is
valuable, and can generally be relied on as conclusive that the female
is pregnant. It is not so valuable in an _after_ pregnancy, as a
_little_ milk might, even should she not be pregnant, remain in the
breasts for some months after she has weaned her child.
225. The veins of the breast look more blue, and are consequently more
conspicuous than usual, giving the bosom a mottled appearance. The
breasts themselves are firmer and more knotty to the touch. The nipples,
in the majority of cases, look more _healthy_ than customary, and are
somewhat elevated and enlarged; there is generally a slight moisture
upon their surface, sufficient in some instances to mark the linen.
226. A dark-brown areola or disk may usually be noticed around the
nipple,[53] the change of color commencing about the second month. The
tint at first is light brown, which gradually deepens in intensity,
until, toward the end of pregnancy, the color may be very dark. Dr.
Montgomery, who has paid great attention to the subject, observes:
“During the progress of the next two or three months the changes in the
areola are in general perfected, or nearly so, and then it presents the
following characters: a circle around the nipple, whose color varies in
intensity according to the particular complexion of the individual,
being usually much darker in persons with black hair, dark eyes, and
sallow skin, than in those of fair hair, light-colored eyes, and
delicate complexion. The area of this circle varies in diameter from an
inch to an inch and a half, and increases in most persons as pregnancy
advances, as does also the depth of color.” The dark areola is somewhat
swollen. “There is,” says Dr. Montgomery, “a puffy turgescence, not only
of the nipple, but of the whole surrounding disk.”
227. A fourth symptom is _quickening_. This generally occurs about the
completion of the _fourth_ calendar month; frequently a week or two
before the end of that period; at other times a week or two later. A
lady sometimes quickens as early as the _third_ month, while others,
although rarely, quicken as late as the _fifth_, and, _in very rare
cases_, the _sixth_ month.
228. It will therefore be seen that there is an uncertainty as to the
period of quickening, although, as I before remarked, the _usual_ period
occurs either on, or more frequently a week or two before, the
completion of the _fourth_ calendar month of pregnancy.
229. A lady at this time frequently either feels faint, or actually
faints away; she is often either giddy, or sick, or nervous, and in some
instances even hysterical. Although, in rare cases, some women do not
even know the precise time when they quicken.
230. The sensation of “quickening” is said by many ladies to resemble
the fluttering of a bird. “Quickening” arises from the ascent of the
womb higher into the belly, as, from its increased size, there is not
room for it below. The old-fashioned idea was that the child was not
alive until a woman had quickened. This is a mistaken notion, as he is
alive, or “quick,” from the very commencement of his formation.
231. Hence the heinous and damnable sin of a single woman, in the
_early_ months of pregnancy, using means to promote abortion: it is as
much murder as though the child were at his full time, or as though he
were butchered when he was actually born!
232. An attempt, then, to procure abortion is a crime of the deepest
dye, viz., a heinous murder! It is attended, moreover, with fearful
consequences to the mother’s own health; it may either cause her
_immediate_ death, or it may so grievously injure her constitution that
she might never recover from the shock. If these fearful consequences
ensue, she ought not to be pitied: she richly deserves them all. Our
profession is a noble one, and every qualified member of it would scorn
and detest the very idea either of promoting or of procuring an
abortion; but there are unqualified villains who practice the damnable
art. Transportation, if not hanging, ought to be their doom. The
seducers, who often assist and abet them in their nefarious practices,
should share their punishment.
233. Flatulence has sometimes misled a young wife to fancy that she
has quickened; but, in determining whether she be pregnant, she ought
never to be satisfied with one symptom alone; if she be, she will be
frequently misled. The following are a few of the symptoms that will
distinguish the one from the other: in flatulence, the patient is
small one hour and large the next; while in pregnancy the enlargement
is persistent, and daily and gradually increases. In flatulence, on
pressing the bowels firmly, a rumbling of wind may be heard, which
will move about at will; while the enlargement of the womb in
pregnancy is solid, resistant, and stationary. In flatulence, on
tapping—percussing—the belly there will be a hollow sound elicited as
from a drum; while in pregnancy it will be a dull, heavy sound, as
from thrumming on a table. In flatulence, if the points of the fingers
be firmly pressed into the belly, the wind will wobble about; in
pregnancy they will be resisted as by a wall of flesh.
234. The fifth symptom is, immediately after the quickening, _increased
size and hardness of the belly_. An accumulation of fat covering the
belly has sometimes led a lady to suspect that she is pregnant; but the
soft and doughy feeling of the fat is very different to the hardness,
solidity, and resistance of pressure of pregnancy.
235. The sixth symptom is _pouting or protrusion of the navel_. This
symptom does not occur until some time after a lady has quickened;
indeed, for the first two months of pregnancy the navel is drawn in and
depressed. As the pregnancy advances, the navel gradually comes more
forward. “The navel, according to the progress of the pregnancy, is
constantly emerging, till it comes to an even surface with the
integuments of the abdomen [belly]; and to this circumstance much regard
is to be paid in cases of doubtful pregnancy.”[54]
236. _Sleepiness_, _heartburn_, _increased flow of saliva_, _toothache_,
_loss of appetite_, _longings_, _excitability of mind_, _a pinched
appearance of countenance_, _liver or sulphur-colored patches on the
skin_, and _likes_ and _dislikes_ in eating,—either the one or the other
of these symptoms frequently accompany pregnancy; but, as they might
arise from other causes, they are not to be relied on further than
this—that if they attend the more certain signs of pregnancy, such as
cessation of being “regular,” morning sickness, pains and enlargement of
and milk in the breasts, the gradually darkening brown areola or mark
around the nipple, etc., they will then make assurance doubly sure, and
a lady may know for certain that she is pregnant.[55]
CLOTHING.
237. A lady who is pregnant ought on no account to wear tight dresses,
as the child should have plenty of room. She ought to be, as _enceinte_
signifies, _incincta_, or unbound. Let the clothes be adapted to the
gradual development both of the belly and the breasts. She must,
whatever she may usually do, wear her stays loose. If there be bones in
the stays, let them be removed. Tight lacing is injurious both to the
mother and to the child, and frequently causes the former to miscarry;
at another time it has produced a crossbirth; and sometimes it has so
pressed in the nipples as to prevent a proper development of them, so
that where a lady has gone her time, she has been unable to suckle her
infant, the attempt often causing a gathered bosom. These are great
misfortunes, and entail great misery both on the mother and the child
(if it has not already killed him), and ought to be a caution and a
warning to every lady for the future.
238. The feet and legs during pregnancy are very apt to swell and to be
painful, and the veins of the legs to be largely distended. The garters
ought at such times to be worn slack, as tight garters are highly
injurious, and, if the veins be very much distended, it will be
necessary for her to wear a properly-adjusted elastic silk stocking,
made purposely to fit her foot and leg, and which a medical man will
himself procure for her.
ABLUTION.
239. A _warm_ bath in pregnancy is too relaxing. A _tepid_ bath once a
week is beneficial. Sponging the whole of the body every morning with
lukewarm water may with safety and advantage be adopted, gradually
reducing the temperature of the water until it be used quite cold. The
skin should, with moderately coarse towels, be quickly but thoroughly
dried.
240. Either the _bidet_ or sitz-bath[56] ought _every morning_ to be
used. The patient should first sponge herself, and then finish up by
sitting for a few seconds, or while, in the winter, she can count fifty,
or while, in the summer, she can count a hundred, in the water. It is
better not to be long in it; it is a slight shock that is required,
which, where the sitz-bath agrees, is immediately followed by an
agreeable glow of the whole body. If she sits in the water for a long
time she becomes chilled and tired, and is very likely to catch cold.
She ought, until she become accustomed to the cold, to have a dash of
warm water added; but the sooner she can use _quite cold_ water the
better. While sitting in the bath she should throw either a woolen shawl
or a small blanket over her shoulders. _She will find the greatest
comfort and benefit from adopting the above recommendation._ Instead of
giving, it will prevent cold, and it will be one of the means of warding
off a miscarriage, and of keeping her in good health.
241. A shower-bath in pregnancy gives too great a shock, and might
induce a miscarriage. I should _not_ recommend, for a lady who is
pregnant, sea-bathing; nevertheless, if she be delicate, and if she be
prone to miscarry, change of air to the coast (provided it be not too
far away from home), and inhaling the sea breezes, may brace her, and
ward off the tendency. But although sea-bathing be not desirable,
sponging the body with sea water may be of great service to her.
AIR AND EXERCISE.
242. A young wife, in her _first_ pregnancy, usually takes _too long_
walks. This is a common cause of _flooding_, of _miscarriage_, and of
_bearing down_ of the _womb_. As soon, therefore, as a lady has the
_slightest suspicion_ that she is _enceinte_, she must be careful in the
taking of exercise.
243. Although _long_ walks are injurious, she ought not to run into an
opposite extreme; short, gentle, and frequent walks during the whole
period of pregnancy cannot be too strongly recommended; indeed, a lady
who is _enceinte_ ought to live half her time in the open air. Fresh air
and exercise prevent many of the unpleasant symptoms attendant on that
state; they keep her in health; they tend to open her bowels; and they
relieve that sensation of faintness and depression so common and
distressing in _early_ pregnancy.
244. Exercise, fresh air, and occupation are then essentially necessary
in pregnancy. If they be neglected, hard and tedious labors are likely
to ensue. One, and an important, reason of the easy and quick labors and
rapid “gettings about” of poor women, is the abundance of exercise and
of occupation which they are both daily and hourly obliged to get
through. Why, many a poor woman thinks but little of a confinement,
while a rich one is full of anxiety about the result. Let the rich lady
adopt the poor woman’s industrious and abstemious habits, and labor need
not then be looked forward to, as it frequently now is, either with
dread or with apprehension.
245. Stooping, lifting of heavy weights, and overreaching ought to be
carefully avoided. Running, horse exercise, and dancing are likewise
dangerous—they frequently induce a miscarriage.
246. Indolence is most injurious in pregnancy. A lady who, during the
greater part of the day, lolls either on the sofa or on an easy-chair,
and who seldom walks out, has a much more lingering and painful labor
than one who takes moderate and regular open-air exercise, and who
attends to her household duties.
247. An active life is, then, the principal reason why the wives of the
poor have such quick and easy labors, and such good recoveries; why
their babies are so rosy, healthy, and strong; notwithstanding the
privations and hardships and poverty of the parents.
248. Bear in mind, then, that a lively, active woman has an easier and
quicker labor, and a finer race of children, than one who is lethargic
and indolent. Idleness brings misery, anguish, and suffering in its
train, and particularly affects pregnant ladies. Oh, that these words
would have due weight, then this book will not have been written in
vain. The hardest work in the world is having nothing to do! “Idle
people have the most labor;” this is particularly true in pregnancy; a
lady will, when labor actually sets in, find to her cost that idleness
has given her most labor. “Idleness is the badge of gentry, the bane of
body and mind, the nurse of Naughtiness, the step-mother of Discipline,
the chief author of all Mischief, one of the seven deadly sins, the
cushion upon which the Devil chiefly reposes, and a great cause not only
of Melancholy, but of many other diseases, for the mind is naturally
active; and, if it be not occupied about some honest business, it rushes
into Mischief or sinks into Melancholy.”[57]
249. A lady sometimes looks upon pregnancy more as a disease than as a
natural process; hence she treats herself as though she was a regular
invalid, and, unfortunately, she too often makes herself really one by
improper and by foolish indulgences.
VENTILATION—DRAINAGE.
250. Let a lady look well to the _ventilation_ of her house; let her
take care that every chimney be unstopped, and during the daytime that
every window in every unoccupied room be thrown open.
251. Where there is a skylight at the top of the house, it is well to
have it made to open and to shut, so that in the daytime it may, winter
and summer, be always open; and in the summer time it may, day and
night, be left unclosed. Nothing so thoroughly ventilates and purifies a
house as an open skylight.
252. If a lady did but know the importance—the vital importance—of
ventilation, she would see that the above directions were carried out to
the very letter. My firm belief is that if more attention were paid to
ventilation—to thorough ventilation—child-bed fever would be an almost
unknown disease.
253. The cooping-up system is abominable; it engenders all manner of
infectious and of loathsome diseases, and not only engenders them, but
feeds them, and thus keeps them alive. There is nothing wonderful in all
this, if we consider but for one moment that the exhalations from the
lungs are poisonous! That is to say, that the lungs give off carbonic
acid gas (a deadly poison), which, if it be not allowed to escape out of
the room, must over and over again be breathed. That if the perspiration
of the body (which in twenty-four hours amounts to two or three pounds)
be not permitted to escape out of the apartment, must become
fetid—repugnant to the nose, sickening to the stomach, and injurious to
the health. Oh, how often the nose is a sentinel, and warns its owner of
approaching danger!
254. Truly the nose is a sentinel! The Almighty has sent bad smells for
our benefit to warn us of danger. If it were not for an unpleasant
smell, we should be constantly running into destruction. How often we
hear of an ignorant person using disinfectants and fumigations to
deprive drains and other horrid places of their odors, as though, if the
place could be robbed of its smell, it could be robbed of its danger!
Strange infatuation! No; the frequent flushings of drains, the removal
of nuisances, cleanliness, a good scrubbing of soap and water, sunshine,
and the air and winds of heaven, are the best disinfectants in the
world. A celebrated and eccentric lecturer on surgery,[58] in addressing
his class, made the following quaint and sensible remark: “Fumigations,
gentlemen, are of essential importance; they make so abominable a stink
that they compel you to open the windows and admit fresh air.”
255. It is doubtless, then, admirably appointed that, we are able to
detect “the well-defined and several stinks;” for the danger is not in
them,—to destroy the smell is not to destroy the danger; certainly not!
The right way to do away with the danger is to remove the cause, and the
effect will cease; flushing a sewer is far more efficacious than
disinfecting one; soap and water and the scrubbing-brush, and sunshine
and thorough ventilation, each and all are far more beneficial than
either permanganate of potash, or chloride of zinc, or chloride of lime.
People nowadays think too much of disinfectants and too little of
removal of causes; they think too much of artificial, and too little of
natural means. It is a sad mistake to lean so much on, and to trust so
much to, man’s inventions!
256. What is wanted, nowadays, is a little less theory and a great deal
more common sense. A rat, for instance, is, in theory, grossly maligned;
he is considered to be very destructive, an enemy to man, and one that
ought to be destroyed—every man’s hand being against him. Now, a rat is,
by common sense, well known to be, in its proper place—that is to say,
in sewers and in drains—destructive only to man’s enemies—to the organic
matter that breeds fevers, cholera, diphtheria, etc.; the rat eats the
pabulum or food which would otherwise convert towns into hot-beds of
terrible diseases. That which is a rat’s food is often a man’s poison;
hence a rat is one of the best friends that a man has, and ought, in his
proper place, to be in every way protected; the rat, in drains, is the
very best of scavengers; in a sewer he is invaluable; in a house he is
most injurious; a rat in a sewer is worth gallons of disinfectants, and
will, in purifying a sewer, beat all man’s inventions hollow; the
maligned rat, therefore, turns out, if weighed by common sense, to be
not only one of the most useful of animals, but of public benefactors!
The rat’s element, then, is the sewer; he is the king of the sewer, and
should there reign supreme, and ought not to be poisoned by horrid
disinfectants.
257. If a lady, while on an errand of mercy, should in the morning go
into a poor person’s bedroom after he, she, or they (for oftentimes the
room is crowded to suffocation) have during the night been sleeping, and
where a breath of air is not allowed to enter—the chimney and every
crevice having been stopped up—and where too much attention has not been
paid to personal cleanliness, she will experience a faintness, an
oppression, a sickness, a headache, a terribly fetid smell; indeed, _she
is in a poisoned chamber_! It is an odor _sui generis_, which must be
smelt to be remembered, and will then never be forgotten! Pity the poor
who live in such styes—not fit for pigs! For pigs, styes are ventilated.
But take warning, ye well-to-do in the world, and look well to your
ventilation, or beware of the consequences. “If,” says an able writer on
fever in the last century, “any person will take the trouble to stand in
the sun and look at his own shadow on a white plastered wall, he will
easily perceive that his whole body is a smoking dunghill, with a vapor
exhaling from every part of it. This vapor is subtle, acrid, and
offensive to the smell; if retained in the body it becomes morbid, but
if reabsorbed, highly deleterious. If a number of persons, therefore,
are long confined in any close place not properly ventilated, so as to
inspire and swallow with their spittle the vapors of each other, they
must soon feel its bad effects.”[59]
258. Not only should a lady look well to the ventilation of her house,
but either she or her husband ought to ascertain that the _drains_ are
in good and perfect order, and that the privies are frequently emptied
of their contents. Bad drainage and overflowing privies are fruitful
sources of child-bed fever, of gastric fever, of scarlatina, of
diphtheria, of cholera, and of a host of other infections and contagious
and dangerous diseases. It is an abominable practice to allow dirt to
fester near human habitations; more especially as dirt, when mixed with
earth, is really so valuable in fertilizing the soil. Lord Palmerston
wisely says that “dirt is only matter in the wrong place.”
259. A lady ought to look well to the purity of her _pump-water_, and to
ascertain that no drain either enters or percolates, or contaminates in
any way whatever, the spring; if it should do so, disease, such as
either cholera, or diarrhœa, or dysentery, or diphtheria, or scarlet
fever, or gastric fever, will, one or the other, as a matter of course,
ensue. If there be the slightest danger or risk of drain contamination,
whenever it be practicable, let the drain be taken up and be examined,
and let the defect be carefully rectified. When it be impracticable to
have the drain taken up and examined, then let the pump-water, before
drinking it, be _always_ previously boiled. The boiling of the water, as
experience teaches, has the power either of destroying or of making
innocuous the specific organic fecal life poison, which propagates in
drain contamination the diseases above enumerated.
NECESSITY OF OCCASIONAL REST.
260. A lady who is pregnant ought, for half an hour each time, to lie
one or two hours every day on the sofa. This, if there be either a
bearing down of the womb, or if there be a predisposition to a
miscarriage, will be particularly necessary. I should recommend this
plan to be adopted throughout the whole period of the pregnancy: in the
early months, to prevent a miscarriage, and, in the latter months, on
account of the increased weight and size of the womb.
261. There is, occasionally, during the latter months, a difficulty in
lying down; the patient feeling as though, every time she makes the
attempt, she should be suffocated. When such be the case, she ought to
rest herself upon the sofa, and be propped up with cushions, as I
consider rest at different periods of the day necessary and beneficial.
If there be any difficulty in lying down at night, a bed-rest, well
covered with pillows, will be found a great comfort.
DIETARY.
262. An abstemious diet, during the _early_ period of pregnancy, is
essential, as the habit of body, at that time, is usually feverish and
inflammatory. I should therefore recommend abstinence from beer, porter,
and spirits. Let me, in this place, urge a lady, during her pregnancy,
not to touch spirits, such as either brandy or gin; they will only
inflame her blood, and will poison and make puny her unborn babe; they
will only give her false spirits, and will depress her in an increased
ratio as soon as the effects of the brandy or of the gin have passed
away. She ought to eat meat only but once a day. Rich soups and
highly-seasoned stews and dishes are injurious.
263. A lady who is _enceinte_ may depend upon it that the less
stimulants she takes at these times the better it will be both for
herself and for her infant; the more kind will be her labor and her
“getting about,” and the more vigorous and healthy will be her child.
264. It is a mistaken notion that she requires more nourishment during
early pregnancy than at any other time; she, if anything, requires less.
It has often been asserted that a lady who is pregnant ought to eat very
heartily, as she has two to provide for. When it is taken into account
that during pregnancy she “ceases to be unwell,” and therefore that
there is no drain on that score; and when it is also considered how
small the ovum containing the embryo is, not being larger for the first
two or three months than a hen’s egg, it will be seen how futile is the
assertion. A wife, therefore, in early pregnancy, does not require more
than at another time; if anything, she requires less. Again: during
pregnancy, especially in the early stages, she is more or less sick,
feverish, and irritable, and a superabundance of food would only add
fuel to the fire, and would increase her sickness, fever, and
irritability. Moreover, she frequently suffers from heartburn and from
indigestion. Can anything be more absurd, when such is the case, than to
overload a stomach already loaded with food which it is not able to
digest? No, let nature in this, as in everything else, be her guide, and
she will not then go far wrong! When she is further advanced in her
pregnancy,—that is to say, when she has quickened,—her appetite
generally improves, and she is much better in health than she was
before; indeed, after she has quickened, she is frequently in better
health than she ever has been. The appetite is now increased. Nature
points out that she requires more nourishment than she did at first; for
this reason, the fœtus is now rapidly growing in size, and consequently
requires more support from the mother. Let the food, therefore, of a
pregnant woman be now increased in quantity, but let it be both light
and nourishing. Occasionally, at this time, she has taken a dislike to
meat; if she has, she ought not to be forced to eat it, but should have
instead, poultry, game, fish, chicken-broth, beef-tea, new milk,
farinaceous food, such as rice, sago, batter puddings, and, above all,
if she has a craving for it, good sound, ripe fruit.
265. Roasted apples, ripe pears, raspberries, strawberries, grapes,
tamarinds, figs, Muscatel raisins, stewed rhubarb, stewed pears, stewed
prunes, the inside of ripe gooseberries, and the juice of oranges, are,
during pregnancy, particularly beneficial; they both quench the thirst
and tend to open the bowels.
266. The food of a pregnant woman cannot be too plain; high-seasoned
dishes ought, therefore, to be avoided. Although the food be plain, it
must be frequently varied. She should ring the changes upon butcher’s
meat, poultry, game, and fish. It is a mistaken notion, that people
ought to eat the same food over and over again, one day as another. The
stomach requires variety, or disease, as a matter of course, will ensue.
267. Light puddings, such as either rice, or batter, or suet-pudding, or
fruit puddings, provided the paste be plain, may be taken with
advantage. Rich pastry is highly objectionable.
268. If she be plethoric, abstinence is still more necessary, or she
might have a tedious labor, or might suffer severely. The old-fashioned
treatment was to bleed a pregnant patient if she were of a full habit of
body. A more absurd plan could not be adopted! Bleeding would, by
causing more blood to be made, only increase the mischief; but certainly
it would be blood of an inferior quality, watery and poor. The best way
to diminish the quantity of blood is to moderate the amount of food, to
lessen the supplies.
SLEEP.
269. The bedroom of a pregnant lady ought, if practicable, to be large
and airy. Particular attention must be paid to the _ventilation_. The
chimney should on no account be stopped. The door and the windows ought
in the daytime to be thrown wide open, and the bedclothes should be
thrown back, that the air might, before the approach of night, well
ventilate them.
270. It is a mistaken practice for a pregnant woman, or for any one
else, to sleep with closely-drawn curtains. Pure air and a frequent
change of air are quite as necessary—if not more so—during the night as
during the day: and how can it be pure, and how can it be changed, if
curtains are closely drawn around the bed? Impossible. The roof of the
bedstead ought not to be covered with bed furniture; it should be open
to the ceiling, in order to prevent any obstruction to a free
circulation of air.
271. The bed must not be loaded with clothes, more especially with a
thick coverlet. If the weather be cold, let an _extra_ blanket be put on
the bed, as the perspiration can permeate through a blanket when it
cannot through a thick coverlet.
272. A lady who is pregnant is sometimes restless at night—she feels
oppressed and hot. The best remedies are:—(1) Scant clothing on the bed.
(2) The lower sash of the window, during the summer months, to be left
open to the extent of six or eight inches, and during the winter months,
to the extent of two or three inches; provided the room be large, the
bed be neither near nor under the window, and the weather be not
intensely cold. If any or all of these latter circumstances occur, then
(3) the window to be closed and the door to be left ajar (the landing or
the skylight window at the top of the house being left open all night,
and the door being secured from intrusion by means of a door-chain.) (4)
Attention to be paid, if the bowels be costive—but not otherwise—to a
_gentle_ action of the bowels by castor oil. (5) An abstemious diet,
avoiding stimulants of all kinds. (6) Gentle walking exercise. (7)
Sponging the body every morning—in the winter with _tepid_ water, and in
the summer with _cold_ water. (8) Cooling fruits in the summer are in
such a case very grateful and refreshing. (See paragraph 264.)
273. A pregnant woman sometimes experiences an inability to lie down,
the attempt occasionally producing a feeling of suffocation and of
faintness. She ought, under such circumstances, to lie on a bed-rest,
which must, by means of pillows, be made comfortable; and she should
take, every night at bedtime, a teaspoonful of sal-volatile in a
wineglassful of water.
274. Pains at night, during the latter end of the time, are usually
frequent, so as to make an inexperienced lady fancy that her labor was
commencing. Little need be done; for unless the pains be violent, nature
ought not to be interfered with. If they be violent, application should
be made to a medical man.
275. A pregnant lady must retire early to rest. She ought to be in bed
every night by ten o’clock, and should make a point of being up in good
time in the morning, that she may have a thorough ablution, a stroll in
the garden, and an early breakfast; and that she may afterwards take a
short walk either in the country or in the grounds while the air is pure
and invigorating. But how often, more especially when a lady is first
married, is an opposite plan adopted! The importance of bringing a
healthy child into the world, if not for her own and her husband’s sake,
should induce a wife to attend to the above remarks.
276. Although some ladies, during pregnancy, are very restless, others
are very sleepy, so that they can scarcely, even in the day, keep their
eyes open! Fresh air, exercise, and occupation are the best remedies for
keeping them awake.
MEDICINE.
277. A young wife is usually averse to consult a medical man concerning
several _trifling_ ailments, which are nevertheless, in many cases, both
annoying and distressing. I have therefore deemed it well to give a
brief account of such _slight_ ailments, and to prescribe a few _safe_
and _simple_ remedies for them. I say _safe_ and _simple_, for _active_
medicines require skillful handling, and therefore ought not—unless in
certain emergencies—to be used except by a doctor himself.
278. I wish it, then, to be distinctly understood that in all _serious_
attacks, and in _slight_ ailments if not quickly relieved, a medical man
ought to be called in.
279. A costive state of the bowels is common in pregnancy; a _mild_
aperient is therefore occasionally necessary. The mildest must be
selected, as a strong purgative is highly improper, and even dangerous.
Calomel and all other preparations of mercury are to be especially
avoided, as a mercurial medicine is apt to weaken the system and
sometimes even to produce a miscarriage.
280. An abstemious diet, where the bowels are costive, is more than
usually desirable, for if the bowels be torpid, a quantity of food will
only clog and make them more sluggish. Besides, when labor comes on, a
loaded state of the bowels will add much to a lady’s sufferings as well
as to her annoyance.
281. The best aperients are castor oil, salad oil, compound rhubarb
pills, honey, stewed prunes, stewed rhubarb, Muscatel raisins, figs,
grapes, roasted apples, Normandy pippins, oatmeal and milk gruel,
coffee, brown bread and treacle, raw sugar (as a sweetener of the food),
Du Barry’s Arabica Revalenta.
282. Castor oil, in pregnancy, is a valuable aperient. Frequent and
small are preferable to occasional and large doses. If the bowels be
constipated (but _certainly_ not otherwise), castor oil ought to be
taken regularly twice a week. The best time for administering it is
early in the morning. The dose is from a teaspoonful to a
dessertspoonful.
283. The best ways of administering it are the following: Let a
wineglass be well rinsed out with water, so that the sides may be well
wetted; then, let the wineglass be half filled with cold water, fresh
from the pump. Let the necessary quantity of oil be now carefully poured
into the center of the wineglass, taking care that it does not touch the
sides; and if the patient will, thus prepared, drink it off at one
draught, she will scarcely taste it. Another way of taking it is,
swimming on warm new milk. A third _and a good method_ is, floating on
_warm_ coffee; the coffee ought, in the usual way, to be previously
sweetened and mixed with cream. There are two advantages in giving
castor oil on coffee: (1) it is a pleasant way of giving it—the oil is
scarcely tasted; and (2) the coffee itself, more especially if it be
sweetened with _raw_ sugar, acts as an aperient; less castor oil, in
consequence, being required; indeed, with many patients the coffee,
sweetened with _raw_ sugar, alone is a sufficient aperient. A fourth and
an agreeable way of administering it is on orange-juice—swimming on the
juice of one orange.
284. Some ladies are in the habit of taking it on brandy and water; but
the spirit is apt to dissolve a portion of the oil, which afterwards
rises in the throat.
285. If _salad oil_ be preferred, the dose ought to be as much again as
of castor oil; and the patient should, during the day she takes it, eat
either a fig or two, or a dozen or fifteen of stewed prunes, or of
stewed French plums, as salad oil is much milder in its effects than
castor oil.
286. Where a lady cannot take oil, one or two compound rhubarb pills may
be taken at bedtime; or a Seidlitz powder early in the morning,
occasionally; or a quarter of an ounce of _tasteless salts_—phosphate of
soda—may be dissolved in lieu of table salt, in a cupful either of soup,
or of broth, or of beef-tea, and be occasionally taken at luncheon.
287. When the motions are hard, and when the bowels are easily acted
upon, two, or three, or four pills made of Castile soap will frequently
answer the purpose; and if they will, are far better than any ordinary
aperient. The following is a good form:
Take of—Castile Soap, five scruples;
Oil of Caraway, six drops:
To make twenty-four pills. Two, or three, or four to be taken at
bedtime, occasionally.[60]
288. A teaspoonful of honey, either eaten at breakfast, or dissolved in
a cup of tea, will frequently comfortably and effectually open the
bowels, and will supersede the necessity of taking aperient medicine.
289. A basin of thick Derbyshire oatmeal gruel, made either with new
milk or with cream and water, with a little salt, makes an excellent
luncheon or supper for a pregnant lady; it is both nourishing and
_aperient_, and will often entirely supersede the necessity of giving
opening medicine. If she prefers sugar to salt, let _raw_ sugar be
substituted for the salt. The occasional substitution of coffee for tea
at breakfast usually acts beneficially on the bowels.
290. Let me again urge the importance of a lady, during the whole period
of pregnancy, being particular as to the state of her bowels, as
costiveness is a fruitful cause of painful, of tedious, and of hard
labors. It is my firm conviction that if a patient who suffers from
constipation were to attend more to the regularity of her bowels,
difficult cases of labor would rarely occur, more especially if the
simple rules of health were adopted, such as: attention to diet—the
patient partaking of a variety of food, and allowing the farinaceous,
such as oatmeal and the vegetable and fruit element, to preponderate;
the taking of exercise in the open air; attending to her household
duties; avoiding excitement, late hours, and all fashionable amusements.
291. Many a pregnant lady does not leave the house—she is a fixture. Can
it, then, be wondered at that costiveness so frequently prevails?
Exercise in the fresh air, and occupation, and household duties are the
best opening medicines in the world. An aperient, let it be ever so
judiciously chosen, is apt, after the effect is over, to bind up the
bowels, and thus to increase the evil. Now, nature’s medicines,—exercise
in the open air, occupation, and household duties,—on the contrary, not
only at the time open the bowels, but keep up a proper action for the
future: hence their inestimable superiority.
292. Where a lady cannot take medicine, or where it does not agree with
her, a good remedy for constipation in pregnancy is the _external_
application of castor oil—castor oil as a liniment—to the bowels The
bowels should be well rubbed every night and morning with the castor
oil. This, if it succeed, will be an agreeable and safe method of
opening the bowels.
293. Another excellent remedy for the costiveness of pregnancy is an
enema, either of warm water or of Castile soap and water, which the
patient, by means of a self-injecting enema apparatus, may administer to
herself. The quantity of warm water to be used is from half a pint to a
pint; the proper heat is the temperature of new milk; the time for
administering it is early in the morning, twice or three times a week.
The advantages of clysters are, they never disorder the stomach—they do
not interfere with the digestion—they do not irritate the bowels—they
are given with the greatest facility by the patient herself—and they do
not cause the slightest pain. If an enema be used to open the bowels, it
may be well to occasionally give one of the aperients recommended above,
in order, if there be costiveness, to insure a thorough clearance of the
_whole_ of the bowels.
294. If the bowels should be opened once every day, it would be the
height of folly for a pregnant lady to take either castor oil or any
other aperient. She ought then to leave her bowels undisturbed, as the
less medicine she takes the better. If the bowels be daily and properly
opened, aperients of any sort whatever would be highly injurious to her.
The plan in this, as in all other cases, is to leave well alone, and
never to give physic for the sake of giving it.
295. _Diarrhœa._—Although the bowels in pregnancy are generally costive,
they are sometimes in an opposite state, and are relaxed. Now, this
relaxation is frequently owing to their having been too much
constipated, and nature is trying to relieve itself by purging. Such
being the case, a patient ought to be careful how, by the taking of
chalk and of astringents, she interferes with the relaxation.
296. The fact is, that in all probability there is something in the
bowels that wants coming away, and nature is trying all she can to
afford relief. Sometimes, provided she is not unnecessarily interfered
with, she succeeds; at others, it is advisable to give a mild aperient
to help nature in bringing it away.
297. When such be the case, a gentle aperient, such as either castor oil
or rhubarb and magnesia, ought to be chosen. If castor oil, a
teaspoonful or a dessertspoonful, swimming on a little new milk, will
generally answer the purpose. If rhubarb and magnesia be the medicine
selected, then a few doses of the following mixture will usually set all
to rights:
Take of—Powdered Turkey Rhubarb, half a drachm;
Carbonate of Magnesia, one drachm;
Essence of Ginger, one drachm;
Compound Tincture of Cardamoms, half an ounce;
Peppermint Water, five ounces and a half:
Two tablespoonfuls of the mixture to be taken three times a day, first
shaking the bottle.
298. The diet ought to be simple, plain, and nourishing, and should
consist of beef-tea, of chicken-broth, of arrow-root, and of well-made
and well-boiled oatmeal gruel. Meat, for a few days, ought not to be
eaten; and stimulants of all kinds must be avoided.
299. If the diarrhœa be attended with pain in the bowels, a flannel bag
filled with hot table salt, and then applied to the part affected, will
afford great relief. A hot-water bag, too, in a case of this kind, is a
great comfort.[61] The patient ought, as soon as the diarrhœa has
disappeared, gradually to return to her usual diet, provided it be
plain, wholesome, and nourishing. She should pay particular attention to
keeping her feet warm and dry; and, if she be much subject to diarrhœa,
she ought to wear around her bowels, and next to her skin, a broad
flannel belly-band.
300. _Heartburn_ is a common and often a distressing symptom of
pregnancy. The acid producing the heartburn is frequently much increased
by an overloaded stomach. The patient labors under the mistaken notion
that, as she has two to sustain, she requires more food during this than
at any other time; she consequently is induced to take more than her
appetite demands, and more than her stomach can digest;—hence heartburn,
indigestion, etc. are caused, and her unborn babe, as well as herself,
is thereby weakened.
301. An abstemious diet ought to be strictly observed. Great attention
should be paid to the _quality_ of the food; greens, pastry, hot
buttered toast, melted butter, and everything that is rich and gross,
ought to be carefully avoided.
302. Either a teaspoonful of Henry’s magnesia, or half a teaspoonful of
carbonate of soda—the former to be preferred if there be
constipation—should occasionally be taken in a wineglassful of warm
water. If these do not relieve—the above directions as to diet having
been strictly attended to—the following mixture ought to be tried:
Take of—Sesquicarbonate of Ammonia, half a drachm;
Bicarbonate of Soda, a drachm and a half;
Water, eight ounces:
To make a mixture. Two tablespoonfuls to be taken twice or three times
a day, until relief be obtained.
Chalk is sometimes given in heartburn, but as it produces costiveness,
it ought not in such a case to be used.
303. _Piles_ are a common attendant upon pregnancy. They are small,
soft, spongy, dark-red tumors, about the size either of a bean or of a
cherry—they are sometimes as large as a walnut—and are either within or
around the fundament; they are then, according to their situation,
called either _internal_ or _external_ piles—they may be either _blind_
or _bleeding_. If the latter, blood may be seen to exude from them, and
blood will come away every time the patient has a stool; hence the
patient ought to be as quick as possible over relieving her bowels, and
should not at such times sit one moment longer than is absolutely
necessary.
304. When the pile or piles are very large, they sometimes, more
especially when she has a motion, drag down a portion of the bowel,
which adds much to her sufferings.
305. If the bowel should protrude, it ought, by means of the patient’s
index finger, to be immediately and carefully returned, taking care, in
order that it may not scratch the bowel, that the nail be cut close.
306. Piles are very painful and are exceedingly sore, and cause great
annoyance, and frequently continue, notwithstanding proper and judicious
treatment, during the whole period of pregnancy.
307. A patient is predisposed to piles from the womb pressing upon the
blood-vessels of the fundament. They are excited into action by her
neglecting to keep her bowels gently opened, or by diarrhœa, or from her
taking too strong purgatives, especially pills containing either aloes
or colocynth, or both.
308. If the piles be inflamed and painful, they ought, by means of a
sponge, to be well fomented three times a day, and for half an hour each
time, with hot chamomile and poppy-head tea;[62] and at bedtime a hot
white-bread poultice should be applied.
309. Every time after and before the patient has a motion, she had
better well anoint the piles and the fundament with the following
ointment:
Take of—Camphor (powdered by means of a few drops of
Spirits of Wine), half a drachm;
Prepared Lard, two ounces:
Mix, to make an ointment.
310. If there be great irritation and intense pain, let some very hot
water be put into a close stool, and let the patient sit over it. “In
piles attended with great irritation and pain, much relief is often
obtained by sitting over the steam of hot water for fifteen or twenty
minutes, and immediately applying a warm bread-and-milk poultice. These
measures should be repeated five or six times a day (Greeves).”[63]
311. If the heat be not great, and the pain be not intense, the
following ointment will be found efficacious:
Take of—Powdered Opium, one scruple;
Camphor (powdered by means of a few drops of
Spirits of Wine), half a drachm;
Powdered Galls, one drachm;
Spermaceti Ointment, three drachms:
Mix.—The ointment to be applied to the piles three times a day.[64] Or
the compound Gall Ointment (B.P.) may, in the same manner, be
applied.
312. If the heat and the pain be great, the following liniment will be
found useful:
Take of—French Brandy,
Glycerin, of each, half an ounce:
Mix.—The liniment to be frequently applied, by means of a camel’s-hair
pencil, to the piles, first shaking the bottle.
313. The bowels ought to be kept gently and regularly opened, either by
taking every morning one or two teaspoonfuls of compound confection of
senna, or by a dose of the following electuary:
Take of—Sublimed Sulphur, half an ounce;
Powdered Ginger, half a drachm;
Cream of Tartar, half an ounce;
Confection of Senna, one ounce;
Simple Syrup, a sufficient quantity:
To make an electuary. One or two teaspoonfuls to be taken early every
morning.
314. Magnesia and milk of sulphur is an excellent remedy for piles:
Take of—Carbonate of Magnesia,
Milk of sulphur, of each, three drachms;
Mix.—To make nine powders. One to be taken early every, or every other
morning, mixed in half a teaspoonful of new milk.
315. Remember, in these cases, it is necessary to keep the motions in a
_softened_ state, as _hard_ lumps of stool would, in passing, give
intense pain.
316. If the confection of senna and the other remedies do not act
sufficiently, it may be well to give, once or twice a week, a
teaspoonful or a dessertspoonful of castor oil.
317. In piles, if they are not much inflamed, and provided there be
constipation, a pint of tepid water, administered early every morning as
an enema, will be found serviceable. Care and gentleness ought, of
course, to be observed in introducing the enema pipe (but which only
requires ordinary care), in order not to press unduly on the surrounding
piles.
318. The patient ought to lie down frequently in the day. She will
derive great comfort from sitting either on an air-cushion or on a
water-cushion about half filled with water, placed on the chair; for
sometimes she is unable to sit on an ordinary seat.
319. In piles, the patient ought to live on a plain, nourishing, simple
diet, but should avoid all stimulants; any food or beverage that will
inflame the blood will likewise inflame the piles.
320. Piles in pregnancy are frequently troublesome, and sometimes resist
all treatment until the patient is confined, when they generally get
well of themselves; but still the remedies recommended above will
usually afford great relief, even if they do not effect a cure.
321. _Swollen legs from enlarged veins (varicose veins)._—The veins are
frequently much enlarged and distended, causing the legs to be greatly
swollen and very painful, preventing the patient from taking proper
walking exercise. Swollen legs are owing to the pressure of the womb
upon the blood-vessels above. Women who have had large families are more
liable to varicose veins than others. If a lady marry late in life, or
if she be very heavy in her pregnancy—carrying the child low down—she is
more likely to have the veins to distend.
322. The best plan will be for her to wear an elastic silk stocking,[65]
which ought to be made on purpose for her, in order that it may properly
fit the leg and foot. It will draw on like a common stocking. She ought
to wear a _gauze_ stocking next the skin, and the _elastic_ stocking
over it, as the gauze stocking can then, from time to time, be washed,
as can likewise the foot and leg. Moreover, the gauze stocking will be
more comfortable next the skin than the elastic stocking.
323. If the varicose veins should be very painful, she had better apply
to a medical man, as it may be necessary, in such a case, to have them
enveloped in mild plasters, and then rolled.
324. If the feet and legs be cold as well as swollen, a _domette_[66]
bandage, two inches and a half wide and eight yards long, nicely applied
to each leg, from the toes to the knee, will be found a great comfort.
One great advantage that domette has over calico is that it will keep in
its place for days, while calico will be loose in an hour or two.
325. _Stretching of the skin of the belly_ is frequently, especially in
a first pregnancy, distressing, from the soreness it causes. The best
remedy is to rub the bowels, every night and morning, with warm
camphorated oil, and to apply a broad _flannel_ belt, which should be
put on moderately but comfortably tight. The belt ought to be secured in
its situation by means of properly adjusted tapes.
326. _If the skin of the belly_, from the violent stretching, _be
cracked_, the patient had better dress the part affected, every night
and morning, with equal parts of simple cerate and of lard—lard without
salt—well mixed together, spread on lint; which ought to be kept in its
place by means of a broad bandage, similar to the one used in
confinements, and which is described in a subsequent paragraph (_Bandage
after Confinements_).
321. _Pendulous belly._—A lady sometimes, from being at these times
unusually large, suffers severely; so much so, that she cannot, without
experiencing great inconvenience, move about. This, where a patient is
stout, and where she has had a large family of children, is more likely
to occur, and especially if she has neglected proper bandaging after her
previous confinements.
328. She ought in such a case to procure, from a
surgical-instrument-maker, an elastic abdominal belt, made purposely for
pendulous bellies, which will, without unduly pressing on the belly, be
a support. It is a good plan to have the belt made either to lace behind
or with straps and buckles, in order to accommodate the belly to its
gradually increasing size.
329. If the patient be delicate, and if she has a languid circulation,
she ought, instead of the elastic belt, to apply a broad flannel
belly-band, which should go twice around the bowels, and must be put on
moderately and comfortably tight.
330. The patient, _before the approach of labor_, ought to take
particular care to have the bowels _gently_ opened, as during that time
a costive state of them greatly increases her sufferings, and lengthens
the period of her labor. I say a _gentle_ action is all that is
necessary; a _violent_ one would do more harm than good.
331. _Toothache_ is a frequent complaint of pregnancy; and I wish to
caution my gentle reader not to have, during the time she is _enceinte_,
a tooth extracted; miscarriage or premature labor has frequently
followed the extraction of a tooth.
332. If the tooth be decayed, the hollow ought to be filled with cotton
wool, soaked either in oil of cloves, or in equal parts of oil of cloves
and of chloroform, and which should be frequently renewed; or with what
I have found an excellent remedy, a little alum dissolved in
chloroform.[67] A bit of cotton wool placed in the ear of the affected
side will oftentimes relieve the toothache arising from a decayed tooth.
This simple remedy ought always to be tried before resorting to more
active treatment. If the above remedies do not relieve, soak a small
ball of cotton wool in chloroform, and insert it inside the ear, and let
it remain there until the pain be relieved; let it be from time to time
renewed. I have frequently found in toothache the above plan most
efficacious, and to afford relief when other means have failed.
333. Creasote (spirits of tar) is sometimes applied, but of all remedies
it is the worst for the purpose. I have known it, when thus used,
severely injure and decay the whole of the remaining teeth: one case in
particular I remember, of a gentleman who, by the frequent use of
creasote, for the relief of toothache, lost the whole of his teeth!
334. If the teeth be not decayed, especially if the stomach be
disordered, let an aperient be taken. The state of the bowels ought
always to be attended to, as toothache is frequently relieved, and when
the tooth is not decayed, cured by a dose of opening medicine. Let the
sides of the face be well fomented with hot chamomile and poppy-head
tea, and let a piece of crumb of bread (but not crumbed bread) be soaked
for five minutes in boiling milk, and be frequently placed inside the
mouth, between the cheek and gum; and let a large hot bread poultice be
applied at bedtime to the outside of the face.
335. If the above does not have the desired effect, a piece of brown
paper, the size of the palm of the hand, soaked in brandy, and then well
peppered with black pepper, should be applied outside the cheek, over
the part affected, and kept on for several hours. It ought from time to
time to be renewed. This simple and old-fashioned remedy will sometimes
afford great relief. It is in these cases preferable to a mustard
poultice, as it is less painful, and neither blisters nor injures the
skin.
336. If the pepper plaster does not afford relief, a ginger plaster
should be tried:
Take of—Powdered Ginger,
Flour, of each one tablespoonful;
Water, a sufficient quantity:
To be well mixed together, adding the water drop by drop (stirring it
the while) until it be of the consistence of paste. Let it be
applied at bedtime, on linen rag, _outside_ the cheek, and let it
remain on all night, or until the pain be relieved.
337. If the tooth be not decayed, and if the pain of the face be more of
a neuralgic (tic-douloureux) character, the following pills will
frequently afford great relief:
Take of—Sulphate of Quinine, twenty-four grains;
Powdered Extract of Liquorice, six grains;
Treacle, a sufficient quantity:
To make twelve pills. One to be taken three times a day.
338. The teeth, in pregnancy, are very apt to decay: I have known
several patients, each of whom has lost a tooth with every child!
339. _Morning sickness._—It is said to be “morning,” as in these cases,
unless the stomach be disordered, it seldom occurs during any other part
of the day. Morning sickness may be distinguished from the sickness of a
disordered stomach by the former occurring only early in the morning, on
the first sitting up in bed, the patient during the remainder of the day
feeling quite free from sickness, and generally being able to eat and
relish her food as though nothing ailed her.
340. Morning sickness begins with a sensation of nausea _early_ in the
morning, and as soon as she rises from bed she feels sick and retches;
and sometimes, but not always, vomits a little sour, watery, glairy
fluid; and occasionally, if she has eaten heartily at supper the night
previously, the contents of the stomach are ejected. She then feels all
right again, and is usually ready for her breakfast, which she eats with
her usual relish. Many ladies have better appetites during pregnancy
than at any other period of their lives.
341. The sickness of a disordered stomach unaccompanied with pregnancy
may be distinguished from morning sickness by the former continuing
during the whole day, by the appetite remaining bad after the morning
has passed, by a disagreeable taste in the mouth, and by the tongue
being generally furred. Moreover, in such a case there is usually much
flatulence. The patient not only feels but looks bilious.
342. If the stomach be disordered during pregnancy, there will, of
course, be a complication of the symptoms, and the morning sickness may
become both day and night sickness. Proper means ought then to be
employed to rectify the disordered stomach, and the patient will soon
have only the morning sickness to contend against; which latter, after
she has quickened, will generally leave of its own accord.
343. Morning sickness is frequently a distressing, although not a
dangerous complaint. It is only distressing while it lasts, for after
the stomach is unloaded, the appetite generally returns, and the patient
usually feels, until the next morning, quite well again, when she has to
go through the same process as before.
344. It occurs both in the early and in the latter months of pregnancy;
more especially during the former, up to the period of quickening, _at
which time it usually ceases_. Morning sickness is frequently the
_first_ harbinger of pregnancy, and is looked upon by many ladies who
have had children as a sure and certain sign. Morning sickness does not
always occur in pregnancy; some women, at such times, are neither sick
nor sorry.
345. A good way to relieve it is by taking, _before rising in the
morning_, a cup of strong coffee. If this should not have the desired
effect, she ought to try an effervescing draught:
Take of—Bicarbonate of Potash, one drachm and a half;
Water, eight ounces:
Two Tablespoonfuls of this mixture to be taken with one of lemon-juice
every hour, while effervescing, until relief be obtained.
346. A glass of champagne, taken the overnight, I have sometimes found
to be the best remedy, and, if it has the desired effect, it certainly
is the most agreeable.
347. I have known, too, cider, where other things have failed, to
succeed in abating morning sickness.
348. Sometimes, until the whole contents of the stomach be brought up,
she does not obtain relief from her sickness. She had better, when such
is the case, drink _plentifully of warm water_, in order to encourage
free vomiting. Such a plan, of course, is only advisable when the
morning sickness is _obstinate_, and when the treatment recommended
above has failed to afford relief.
349. The morning sickness, during the early months, is caused by
sympathy between the stomach and the womb; and during the latter months
by pressure of the upper part of the womb against the stomach. As we
cannot remove the sympathy and the pressure, we cannot always relieve
the sickness; the patient, therefore, is sometimes obliged to bear with
the annoyance.
350. The bowels ought to be kept gently opened, either by a Seidlitz
powder taken early in the morning, or by one or two compound rhubarb
pills at bedtime, or by the following mixture:
Take of—Carbonate of Magnesia, two drachms;
Sulphate of Magnesia, one ounce;
Peppermint water, seven ounces:
A wineglassful of this mixture to be taken early in the morning,
occasionally, first shaking the bottle.
351. Great attention ought in such a case to be paid to the diet; it
should be moderate in quantity, and simple in quality. Rich dishes,
highly-seasoned soups and melted butter must be avoided. Hearty meat
suppers ought not on any account to be allowed. There is nothing better,
if anything be taken at night, than either a teacupful of nicely-made
and well-boiled oatmeal gruel, or of arrow-root, or of Arabica
Revalenta. Any of the above may be made either with water, or with new
milk, or with cream and water.
352. It is an old saying, and, I believe as a rule, a true one, “that
sick pregnancies are safe,” more especially if the sickness leaves,
which it generally does, after she has quickened. The above remarks, of
course, do not include obstinate, inveterate vomiting, occasionally
occurring in the _latter_ period of pregnancy, and which not only takes
place in the morning, but during the whole of the day and of the night,
and for weeks together, sometimes bringing a patient to the brink of the
grave. Such a case, fortunately, is extremely rare. Another old and
generally true saying is, “that females who have sick pregnancies seldom
miscarry.”
353. _Means to harden the nipples._—A mother, especially with her first
child, sometimes suffers severely from sore nipples. Such suffering may
frequently be prevented, if for six weeks or two months before her
confinement, she were to bathe her nipples, every night and morning, for
five minutes each time, either with _eau de Cologne_, or with brandy and
water, equal parts of each. The better plan will be to have the brandy
and water in a small bottle ready for use, and putting a little each
time into a teacup, using it fresh and fresh. A soft piece of fine old
linen rag should be used for the purpose of bathing. All pressure ought
to be taken from the nipples; if the stays, therefore, unduly press
them, either let them be enlarged or let them be entirely removed. The
nipples themselves ought to be covered with a soft linen rag, as the
friction of a flannel vest would be apt to irritate them. Let me
recommend every pregnant lady, _more especially in her first pregnancy_,
to adopt either the one or the other of the above plans to harden the
nipples; it might avert much misery, as sore nipples are painful and
distressing; and prevention at all times is better than cure.
354. The _breasts are_, at times, during pregnancy, _much swollen and
very painful_; and, now and then, they cause the patient great
uneasiness, as she fancies that she is going to have either some
dreadful tumor or a gathering of the bosom. There need, in such a case,
be no apprehension. The swelling and the pain are the consequences of
the pregnancy, and will in due time subside without any unpleasant
result. The fact is, great changes are taking place in the breasts; they
are developing themselves, and are preparing for the important functions
they will have to perform the moment the labor is completed.
355. _Treatment._—She cannot do better than, every night and morning, to
well rub them with equal parts of _eau de Cologne_ and of olive oil, and
to wear a piece of new flannel over them; taking care to cover the
nipples with soft linen, as the friction of the flannel may irritate
them. The liniment encourages a little milky fluid to ooze out of the
nipple, which will afford relief.
356. If stays be worn, the patient should wear them slack, in order to
allow the bosoms plenty of room to develop themselves. The bones of the
stays ought all to be removed, or serious consequences might ensue.
357. _Bowel complaints_, during pregnancy, are not unfrequent. A dose
either of rhubarb and magnesia, or of castor oil, are the best remedies,
and are generally, in the way of medicine, all that is necessary.
358. The diet at such times ought to be simple, small in quantity, and
nourishing. Farinaceous food, such as rice, tapioca, sago, Du Barry’s
Arabica Revalenta, and arrow-root, are particularly beneficial. Green
vegetables and fruits, especially stone fruits and uncooked fruits,
ought to be avoided.
359. The surface of the body—the bowels and feet particularly—ought to
be kept warm. If a lady suffer habitually from relaxation of the bowels,
let her, by all means, wear a flannel vest next the skin.
360. _The bladder._—The patient during pregnancy is liable to various
affections of the bladder. There is sometimes a _sluggishness_ of that
organ, and she has little or no inclination to make water. There is, at
another time, a great _irritability_ of the bladder, and she is
constantly wanting to pass urine; while, in a third case, more
especially toward the latter period of the time, she can scarcely _hold
her water_ at all,—the slightest bodily exertion, such as walking,
stooping, coughing, sneezing, etc., causing it to come away
involuntarily; and even in some cases, where she is perfectly still, it
dribbles away without her having any power to prevent its doing so.
361. _A sluggish state of the bladder_ is best remedied by gentle
exercise, and by the patient attempting, whether she want or not, to
make water at least every four hours.
362. _Irritability of the bladder._—The patient ought, during the day,
to drink freely of the following beverage:
Take of—Best Gum Arabic, one ounce;
Pearl Barley, one ounce;
Water, one pint and a half:
Boil for a quarter of an hour, then strain, and sweeten either with
sugar candy or lump sugar.
363. The bowels ought to be gently opened with _small_ doses of castor
oil. The patient must abstain from beer, wine, or spirits, and should
live on a mild, bland, nourishing diet.
364. _Where the patient cannot hold her water_ there is not a great deal
to be done, as the pregnant womb by pressing on the bladder prevents
much present relief. The comfort is, as soon as the labor is over, it
will cure itself. She ought frequently in the day to lie down either on
a horse-hair mattress or on a couch. She should drink but a moderate
quantity of liquid, and if she has a cough (for a cough greatly
increases this inability to hold the water), she ought to take the
following mixture:
Take of—Compound Tincture of Camphor, half an ounce;
Compound Spirits of Lavender, half a drachm;
Oxymel of Squills, six drachms;
Water, six ounces and a half:
Two tablespoonfuls of this mixture to be taken three times a day.
365. _Fainting._—A delicate woman, when she is _enceinte_, is apt either
to feel faint or to actually faint away. When it is considered the
enormous changes that, during pregnancy, take place, and the great
pressure there is upon the nerves and the blood-vessels, it is not at
all surprising that she should do so. There is one consolation, that
although fainting at such times is disagreeable, it is not at all
dangerous, unless the patient be really laboring under a disease of the
heart.
366. _Treatment._—If the patient feel faint, she ought _immediately_ to
lie down flat upon her back, without a pillow under her head; that is to
say, her head should be on a level with her body. The stays and any
tight articles of dress—if she has been foolish enough to wear either
tight stays or tight clothes—ought to be loosened; the windows should be
thrown wide open; water ought to be sprinkled on her face; and
sal-volatile—a teaspoonful in a wineglassful of water, or a glass of
wine ought to be administered. Smelling-salts must be applied to the
nostrils. The attendants—there should only be one or two present—should
not crowd around her, as she ought to have plenty of room to breathe.
367. She must, in the intervals, live on a good, light, generous diet.
She should keep early hours, and ought to sleep in a well-ventilated
apartment. The following strengthening medicine will be found
serviceable:
Take of—Sulphate of Quinine, twelve grains;
Diluted Sulphuric Acid, half a drachm;
Syrup of Orange-peel, half an ounce;
Water, seven ounces and a half:
Two tablespoonfuls of the mixture to be taken three times a day.
If she be delicate, a change either to the country, or, if the railway
journey be not very long, to the coast, will be desirable.
368. A nervous patient during this period is subject to _palpitation of
the heart_. This palpitation, provided it occur only during pregnancy,
is not dangerous; it need therefore cause no alarm. It is occasioned by
the pressure of the pregnant womb upon the large blood-vessels, which
induces a temporary derangement of the heart’s action. This palpitation
is generally worse at night, when the patient is lying down. There is,
at these times, from the position, greater pressure on the
blood-vessels. Moreover, when she is lying down, the midriff, in
consequence of the increased size of the belly, is pressed upward, and
hence the heart has not its accustomed room to work in, and palpitation
is in consequence the result.
369. The best remedies will be either half a teaspoonful of compound
spirits of lavender or a teaspoonful of sal-volatile in a wineglassful
of camphor julep,[68] or a combination of lavender and of sal-volatile:
Take of—Compound Spirits of Lavender, one drachm;
Sal-Volatile, eleven drachms:
Mix.—A teaspoonful of the drops to be taken occasionally in a
wineglassful of water.
370. These medicines ought to lie on a table by the bedside of the
patient, in order that they may, if necessary, be administered at once.
Brandy is in these cases sometimes given, but it is a dangerous remedy
to administer _every_ time there is palpitation; while the lavender and
the sal-volatile are perfectly safe medicines, and can never do the
slightest harm.
371. Mental emotion, fatigue, late hours, and close rooms ought to be
guarded against. Gentle out-door exercise, and cheerful but not
boisterous company are desirable.
372. _Cramps_ of the legs and of the thighs during the latter period,
and especially at night, are apt to attend pregnancy, and are caused by
the womb pressing upon the nerves which extend to the lower extremities.
_Treatment._—Tightly tie a handkerchief folded like a neckerchief round
the limb a little above the part affected, and let it remain on for a
few minutes. Friction by means of the hand either with opodeldoc or with
laudanum (_taking care not to drink it by mistake_) will also give
relief. Cramp sometimes attacks either the bowels or the back of a
pregnant woman; when such is the case, let a bag of hot salt, or a
hot-water bag,[69] or a tin stomach warmer filled with hot water and
covered with flannel, or a stone bottle containing hot water, wrapped in
flannel, be applied over the part affected; and let either a stone
bottle of hot water or a hot brick, which should be incased in flannel,
be placed to the soles of the feet. If the cramp of the bowels, of the
back, or of the thighs be very severe, the following mixture will be
serviceable:
Take of—Compound Tincture of Camphor, one ounce;
Dill Water, five ounces:
A wineglassful of this mixture to be taken at bedtime occasionally,
and to be repeated, if necessary, in four hours.
373. “_The whites_,” during pregnancy, especially during the latter
months, and particularly if the lady has had many children, are
frequently troublesome, and are, in a measure, owing to the pressure of
the womb on the parts below causing irritation. The best way, therefore,
to obviate such pressure, is for the patient to lie down a great part of
each day either on a bed or on a sofa.
374. She ought to retire early to rest; she should sleep on a horse-hair
mattress and in a well-ventilated apartment, and she must not overload
her bed with clothes. A thick, heavy quilt at these times, and indeed at
all times, is particularly objectionable; the perspiration cannot pass
readily through it as through blankets, and thus she is weakened. She
ought to live on plain, wholesome, nourishing food; but she must abstain
from beer and wine and spirits. The bowels ought to be gently opened by
means of a Seidlitz powder, which should occasionally be taken early in
the morning.
375. The best application will be, to bathe the parts with warm fuller’s
earth and water, in the proportion of a handful of _powdered_ fuller’s
earth to half a wash-hand-basinful of warm water; and the _internal_
parts ought, night and morning, to be bathed with it. If the fuller’s
earth should not have the desired effect, an alum injection[70] ought,
every night and morning, by means of an india-rubber vaginal
syringe,[71] to be syringed up the parts; or fifteen drops of solution
of diacetate of lead should be added to a quarter of a pint of lukewarm
water, and be used in a similar manner as the alum injection.
376. Cleanliness, in these cases, cannot be too strongly urged. Indeed,
every woman, either married or single, ought, unless special
circumstances forbid, to use either the bidet or a sitz-bath. If she has
_not_ the “whites,” or if she has them only slightly, _cold_, quite cold
water is preferable to tepid. I should advise, then, _every_ lady, both
married and single, whether she has the “whites” or not, a regular
sitz-bath[72] _every morning_ (except during her “poorly times”)—that is
to say, I should recommend her to sit every morning in the water (in
cold water) for a few seconds, or while she can count a hundred;
throwing the while either a small blanket or shawl over her shoulders,
but having no other clothing on except slippers on her feet. She should,
for the first few mornings, make the water lukewarm; but the sooner she
can use it cold—quite cold—the more good it will do her.
377. If the above plan were more generally followed, women of all
classes and ages would derive immense benefit from its adoption, and
many serious diseases would be warded off. Besides, the use of the
sitz-bath, after a time, would be a great comfort and enjoyment.
378. Where a lady suffers severely from the “whites,” she ought to visit
the coast. There is nothing in such cases that generally affords so much
relief as the bracing effects of sea-air. Of course, if she be pregnant,
she ought not to bathe in the sea, but should, every night and morning,
bathe the external parts with sea water.
379. When the patient has been much weakened by the “whites,” she will
derive benefit from a quinine mixture[73]—a dose of which ought to be
taken twice or three times a day.
380. _Irritation and itching of the external parts._—This is a most
troublesome affection, and may occur at any time, but more especially
during the latter period of the pregnancy; and as it is a subject that a
lady is too delicate and too sensitive to consult a medical man about, I
think it well to lay down a few rules for her relief. The misery it
entails, if not relieved, is almost past endurance.
381. Well, then, in the first place, let her diet be simple and
nourishing; let her avoid stimulants of all kinds. In the next place,
and this is a most important item of treatment, let her use a tepid salt
and water sitz-bath.[74]
382. The way to prepare the bath is to put a large handful of table salt
into the sitz-bath, then to add _cold_ water to the depth of three or
four inches, and sufficient _hot_ water to make the water _tepid_ or
_lukewarm_. The patient must sit in the bath; her slippered feet being,
of course, out of the water, and on the ground, and either a woolen
shawl or a small blanket being thrown over her shoulders: which shawl or
blanket ought to be the only covering she has on the while. She should
remain only for a few seconds, or while she can count, in the winter,
fifty, or the summer, a hundred, in the bath. Patients generally derive
great comfort and benefit from these salt and water sitz-baths.
383. If the itching, during the daytime, continue, the following lotion
ought to be used:
Take of—Solution of Diacetate of Lead, one drachm;
Rectified Spirits of Wine, one drachm;
Distilled Water, one pint:
To make a lotion. The parts affected to be bathed three or four times
a day with the lotion. Or the parts may be bathed two or three times
a day with equal parts of vinegar and water.
384. The external parts, and the passage to the womb (the vagina), in
these cases, are not only _irritable_ and _itching_, but are sometimes
_hot_ and _inflamed_, and _are covered either with small pimples_, or
_with a whitish exudation_ of the nature of _aphtha_ (thrush), somewhat
similar to the thrush on the mouth of an infant; then the addition of
glycerin to the lotion is a great improvement, and usually gives immense
relief. Either of the following is a good lotion for the purpose:
Take of—Biborate of Soda, eight drachms;
Glycerin five ounces;
Distilled Water, ten ounces:
To make a lotion. The part affected to be bathed every four hours with
the lotion, first shaking the bottle.
Or,
Take of—Solution of Diacetate of Lead,
Rectified Spirits of Wine, of each, one drachm;
Glycerin, five ounces;
Rose Water, ten ounces and a half:
To make a lotion. To be used in the same manner as the preceding one.
MISCARRIAGE.
385. _If a premature expulsion of the child_ occur before the end of the
seventh month, it is called either a _miscarriage_ or an _abortion_; if
between the seventh month and before the _full_ period of nine months, a
_premature labor_.
386. There is a proneness for a young wife to miscarry, and woe betide
her, if she once establish the _habit_! for it, unfortunately, often
becomes a habit. A miscarriage is a serious calamity, and should be
considered in that light; not only to the mother herself, whose
constitution frequent miscarriages might seriously injure, and
eventually ruin; but it might rob the _wife_ of one of her greatest
earthly privileges, the inestimable pleasure and delight of being a
_mother_!
387. Now, as a miscarriage may _generally_ be prevented, it behooves a
wife to look well into the matter, and to study the subject thoroughly
for herself, in order to guard against her _first_ miscarriage; for the
_first_ miscarriage is the one that frequently leads to a _series_. How
necessary it is that the above important fact should be borne in mind!
How much misery might be averted; as, then, means would, by avoiding the
usual causes, be taken to ward off such an awful calamity. I am quite
convinced that in the majority of cases, miscarriages may be prevented.
388. Hence the importance of a _popular_ work of this kind, to point out
dangers, to give judicious advice, that a wife may read, ponder over,
and “inwardly digest,” and that she may see the folly of the present
practices that wives—young wives especially—usually indulge in, and
thus, that she may avoid the rocks they split on, which make a shipwreck
of their most cherished hopes and treasures.
389. Let it then be thoroughly understood,—first, that a miscarriage is
very weakening—more weakening than a labor; and, secondly, that if a
lady has once miscarried, she is more likely to miscarry again and
again; until, at length, her constitution is broken, and the chances of
her having a child become small indeed!
390. _Causes._—A slight cause will frequently occasion the separation of
the child from the mother, and the consequent death and expulsion of the
fœtus; hence the readiness with which a lady sometimes miscarries. The
following are the most common causes of a young wife miscarrying: Taking
_long_ walks; riding on horseback; or over rough roads in a carriage; a
_long_ railway journey; overexerting herself, and sitting up late at
night. Her mind, just after marriage, is frequently too much excited by
large parties, by balls, and concerts.
391. The following are, moreover, frequent causes of a miscarriage:
Falls; all violent emotions of the mind, passion, fright, etc.; fatigue;
overreaching; sudden shocks; taking a wrong step either in ascending or
in descending stairs; falling down stairs; lifting heavy weights;
violent drastic purgatives; calomel; obstinate constipation; debility of
constitution; consumptive habit of body; fashionable amusements;
dancing; late hours; tight lacing; indeed, anything and everything that
injuriously affects either the mind or the body.
392. The old maxim that “prevention is better than cure” is well
exemplified in the case of a miscarriage. Let me, then, appeal strongly
to my fair reader to do all that she can, by avoiding the usual causes
of a miscarriage which I have above enumerated, to prevent such a
catastrophe. A miscarriage is no trifling matter; it is one of the most
grievous accidents that can occur to a wife, and is truly a catastrophe.
393. _Threatening or warning symptoms of a miscarriage._—A lady about to
miscarry usually, for one or two days, experiences a feeling of
lassitude, of debility, of _malaise_, and depression of spirits; she
feels as though she were going to be taken “poorly;” she complains of
weakness and of uneasiness about the loins, the hips, the thighs, and
the lower part of the belly. This is an important stage of the case, and
one in which a judicious medical man may, almost to a certainty, be able
to stave off a miscarriage.
394. _More serious, but still only threatening symptoms of a
miscarriage._—If the above symptoms are allowed to proceed, unchecked
and untended, she will, after a day or two, have a slight show of blood;
this show may soon increase to a flooding, which will shortly become
clotted. Then, perhaps, she begins for the first time to dread a
miscarriage! There may at this time be but little pain, and the
miscarriage _might_, with judicious treatment, be even now warded off.
At all events, if the miscarriage cannot be prevented, the ill effects
to her constitution may, with care, be palliated, and means may be used
to prevent a future miscarriage.
395. _Decided symptoms of a miscarriage._—If the miscarriage be still
proceeding, a new train of symptoms develop themselves; pains begin to
come on, at first slight, irregular, and of a “grinding” nature, but
which soon become more severe, regular, and “bearing down.” Indeed, the
case is now a labor in miniature; it becomes _le commencement de la
fin_; the patient is sure to miscarry, as the child is now dead, and
separated from its connection with the mother.
396. The most usual time for a lady to miscarry is from the eighth to
the twelfth week. It is not, of course, confined to this period, as
during the whole time of pregnancy there is a chance of a premature
expulsion of the contents of the womb. A miscarriage _before_ the fourth
month is _at the time_ attended with little danger; although, if
neglected, it may _forever_ injure the constitution.
397. There is, in every miscarriage, more or less of flooding, which is
_the_ most important symptom. _After_ the fourth month it is accompanied
with more risk; as the further a lady is advanced in her pregnancy, the
greater is the danger of _increased_ flooding; notwithstanding, under
judicious treatment, there is every chance of her doing well.
398. A medical man ought in such a case always to be sent for. There is
as much care required in a miscarriage as, or more than, in a labor.
399. _If bearing down, expulsive pains_—similar to labor pains—should
accompany the flooding; if the flooding increase, and if large clots
come away; if the breasts become smaller and softer; if there be
coldness, and heaviness, and diminution in the size of the belly; if the
motion of the child (the patient having quickened) cannot be felt; if
there be “the impression of a heavy mass rolling about the uterus
[womb], or the falling of the uterine tumor from side to side in the
abdomen [belly] as the patient changes her position;”[75] and if there
be an unpleasant discharge, she may rest assured that the child is dead,
and that it is separated from all connection with her, and that the
miscarriage _must_ proceed, it being only a question of time. Of course,
in such a case—if she has not already done so—she ought _immediately_ to
send for a medical man. A miscarriage sometimes begins and ends in a few
days—five or six; it at other times continues a fortnight, and even in
some cases three weeks.
400. _Treatment._—If a patient has the slightest “show,” she ought
immediately to confine herself either to a sofa or she should keep in
bed. A soft feather bed must be avoided; it both enervates the body and
predisposes to a miscarriage. There is nothing better for her to sleep
on than a horse-hair mattress. She either ought to lie flat upon her
back or should lie upon her side, as it is quite absurd for her merely
to rest her legs and feet, as it is the back and the belly, not the feet
and the legs, that require rest.
401. Let her put herself on a low diet, such as on arrow-root, tapioca,
sago, gruel, chicken-broth, tea, toast and water, and lemonade; and
whatever she does drink ought, during the time of the miscarriage, to be
cold. Grapes, at these times, are cooling and refreshing.
402. The temperature of the bedroom should be kept cool; and, if it be
summer, the window ought to be thrown open; aperient medicines _must_ be
avoided; and if the flooding be violent, cold water should be applied
externally to the parts.
403. Let me strongly urge upon the patient the vast importance of
preserving _any_ and every substance that might come away, in order that
it may be carefully examined by the medical man.
404. It is utterly impossible for a doctor to declare positively that a
lady has miscarried, and that all has properly come away, if he have not
had an opportunity of examining the substances for himself. How often
has a lady declared to her medical man that she has miscarried, when she
has only parted with clots of blood! Clots sometimes put on strange
appearances, and require a practiced and professional eye to decide at
all times upon what they really are.
405. The same care is required _after a miscarriage_ as after a labor;
indeed, a patient requires to be treated much in the same manner—that is
to say, she ought for a few days to keep her bed, and should live upon
the diet I have recommended after a confinement, avoiding for the first
few days stimulants of all kinds. Many women date their ill state of
health to a _neglected_ miscarriage; it therefore behooves a lady to
guard against such a catastrophe.
406. A patient prone to miscarry, ought, _before_ she become pregnant
again, to use every means to brace and strengthen her system. The best
plan that she can adopt will be TO LEAVE HER HUSBAND FOR SEVERAL MONTHS,
and go to some healthy spot; neither to a fashionable watering-place nor
to a friend’s house, where much company is kept, but to some quiet
country place; if to a healthy farm-house so much the better.
407. Early hours are quite indispensable. She ought to lie on a
horse-hair mattress, and should have but scant clothing on the bed. She
must sleep in a well-ventilated apartment. Her diet should be light and
nourishing. _Gentle_ exercise ought to be taken, which should alternate
with frequent rest.
408. Cold ablutions ought every morning to be used, and the body should
be afterward dried with a coarse cloth. If it be winter, let the water
be made tepid and let its temperature be gradually lowered until it be
used quite cold. A shower-bath is, in these cases, serviceable; it
braces and invigorates the system, and is one of the best tonics that
she can use.
409. _If she be already pregnant_ it would not be admissible, as the
shock of the shower-bath would be too great, and may bring on a
miscarriage; but still _she ought to continue the cold ablutions_.
410. A lady who is prone to miscarry, ought, _as soon as she is
pregnant_, to lie down a great part of every day; she must keep her mind
calm and unruffled; she should live on a plain diet; she ought to avoid
wine and spirits and beer; she should retire early to rest, _and she
must have a separate sleeping apartment_. She ought as much as possible
to abstain from taking opening medicine; and if she be actually obliged
to take an aperient—for the bowels must not be allowed to be
constipated—she should select the mildest (such as either castor oil or
lenitive electuary or syrup of senna), and even of these she ought not
to take a larger dose than is absolutely necessary, as a _free_ action
of the bowels is a frequent cause of a miscarriage.
411. The _external_ application of castor oil as a liniment, and as
recommended at page 144, is a good and safe remedy for a patient prone
to miscarry; and if sufficiently active, is far preferable to the
mildest aperient. Another great advantage of the _external_ application
of castor oil is, it does not afterward produce constipation as the
_internal_ administration of castor oil is apt to do. If the _external_
application of castor oil in the manner advised at page 144 should not
have the desired effect, then an enema—a clyster of warm water, a
pint—ought, in the morning, two or three times a week to be
administered.
412. Gentle walking exercise daily is desirable: _long_ walks and
horseback exercise ought to be sedulously avoided. A trip to the coast,
provided the railway journey be not very long, would be likely to
prevent a miscarriage; although I would not, on any account, recommend
such a patient either to bathe or to sail on the water, as the shock of
the former would be too great, and the motion of the vessel and the
sea-sickness would be likely to bring on what we are anxious to avoid.
413. As the _usual_ period for miscarrying approaches (for it frequently
comes on at one particular time), let the patient be more than usually
careful; let her lie down the greatest part of the day; let her mind be
kept calm and unruffled; let all fashionable society and every exciting
amusement be eschewed; let both the sitting and the sleeping apartments
be kept cool and well ventilated; let the bowels (if they be costive) be
opened by an enema (if the _external_ application of castor oil, as
before recommended, be not sufficient); let the diet be simple and yet
be nourishing; let all stimulants, such as beer, wine, and spirits, be
at this time avoided; and if there be the _slightest_ symptoms of an
approaching miscarriage, such as pains in the loins, in the hips, or in
the lower belly, or if there be the slightest show of blood, let a
medical man be _instantly_ sent for, as he may, at an early period, be
able to ward off the threatened mishap.
FALSE LABOR PAINS.
414. A lady, especially in her first pregnancy, is sometimes troubled
with _spurious labor pains_; these pains usually come on at night, and
are frequently owing to a disordered stomach. They affect the belly, the
back, and the loins; and occasionally they extend down the hips and the
thighs. They attack first one place and then another; they come on at
irregular intervals; at one time they are violent, at another they are
feeble. The pains, instead of being _grinding_ or _bearing down_, are
more of a colicky nature.
415. Now, as these false pains more frequently occur in a _first_
pregnancy, and as they are often more violent two or three weeks toward
the completion of the full time, and as they usually come on either at
night or in the night, it behooves both the patient and the monthly
nurse to be cognizant of the fact, in order that they may not make a
false alarm and summon the doctor before he is wanted, and when he
cannot be of the slightest benefit to the patient.
416. It is sometimes stated that a woman has been in labor two or three
weeks before the child was born! Such is not the fact. The case in
question is one probably of _false_ pains ending in _true_ pains.
417. _How, then, is the patient to know that the pains are false and not
true labor pains?_ False labor pains come on three or four weeks
_before_ the full time; true labor pains _at_ the completion of the full
time; false pains are unattended with “show;” true pains generally
commence the labor with “show;” false pains are generally
migratory—changing from place to place—first attacking the loins, then
the hips, then the lower portions, and even other portions of the
belly—first one part, then another; true pains generally begin in the
back; false pains commence as spasmodic pains; true pains as “grinding”
pains; false pains come on at uncertain periods, at one time a quarter
of an hour elapsing, at others, an hour or two hours between each pain;
at one time the pain is sharp, at another trifling; true pains come on
with tolerable regularity, and gradually increase in severity.
418. But remember—the most valuable distinguishing symptom is the
_absence_ of “show” in false labor pains, and the _presence_ of “show”
in true labor pains. It might be said that “show” does not always usher
in the commencement of labor. Granted; but such cases are exceedingly
rare, and may be considered as the exception and not the rule.
419. _Treatment._—A dose of castor oil is generally all that is
necessary; but if the pains still continue, the patient ought to be
abstemious, abstaining for a day or two from beer and from wine, and
rubbing the bowels every night at bedtime either with camphorated oil,
previously warmed, or with laudanum (taking care not to drink it by
mistake). Either hot salt, in a flannel bag, or a hot-water bag applied
every night at bedtime to the bowels, frequently affords great relief.
420. If the pains be not readily relieved she ought to send for a
medical man. A little appropriate medicine will soon have the desired
effect.
421. These _false_ labor pains might go on either for days, or even for
weeks, and at length may terminate in _real_ labor pains.
PERIOD OF GESTATION—“THE COUNT.”
422. The period of gestation is usually[76] two hundred and eighty
days—forty weeks—ten lunar or nine calendar months.
423. It will be well for a lady, in making her “count,” to commence her
“reckoning” about three days after the last day of her being “unwell.”
The reason we fix on a woman conceiving a few days after she has “ceased
to be unwell” is that she is more apt to do so soon after menstruation
than at any other time.[77]
424. A good plan to make the “reckoning” is as follows: Let forty weeks
and a few days, from the time specified above, be marked on an almanac,
and a lady will seldom be far from her calculation. Suppose, for
instance, the last day of her “ceasing to be unwell” was on January the
15th, she may expect to be confined very near October 23d.
425. Another plan, and one recommended by Dr. Tanner, to make the
“count,” is the following: “To effect this readily, we cannot do better
than follow the plan of most German obstetricians, who learn the
probable day of delivery thus: the date of the last menstruation being
given, they calculate three months backward and add seven days. For
example, suppose the 20th January to be the last day of the last
menstrual period, labor will be due about the 27th October—_i.e._ on the
280th day.”[78]
BEING OUT IN THE RECKONING.
426. A lady, sometimes, by becoming pregnant while she is suckling, is
put out of her reckoning; not being unwell at such time, she
consequently does not know how to “count.” She ought, in a case of this
kind, to reckon from the time that she quickens—that is to say, she must
then consider herself nearly half-gone in her pregnancy, and to be
within a fortnight of half her time; or, to speak more accurately, as
soon as she has quickened, we have reason to believe that she has gone
about one hundred and twenty-four days: she has therefore about one
hundred and fifty-six more days to complete the period of her pregnancy.
Suppose, for instance, that she first quickened on May the 17th, she may
expect to be confined somewhere near October the 23d. She must bear in
mind, however, that she can never make so correct a “count” from
quickening (quickening takes place at such various periods) as from the
last day of her being “unwell.”
427. A lady is occasionally thrown out of her reckoning by the
appearance, the first month after she is _enceinte_, of a little “show.”
This discharge does not come from the womb, as that organ is
hermetically sealed; but from the upper part of the vagina, the passage
to the womb, and from the mouth of the womb, and may be known from the
regular menstrual fluid by its being much smaller in quantity, by its
clotting, and by its lasting generally but a few hours. This discharge,
therefore, ought not to be reckoned in the “count,” but the one before
must be the guide, and the plan should be adopted as recommended in page
186, paragraph 423.
“IS IT A BOY OR A GIRL?”
428. It has frequently been asked, “Can a medical man tell, before the
child is born, whether it will be a boy or girl?” Dr. F. J. W. Packman,
of Wimborne, answers in the affirmative. “Queen bees lay female eggs
first, and male eggs afterward. In the human female, conception in the
first half of the time between menstrual periods produces female
offspring, and male in the latter. When a female has gone beyond the
time she calculated upon, it will generally turn out to be a boy.”[79]
It is well to say _generally_, as the foregoing remarks are not
_invariably_ to be depended upon, as I have had cases to prove.
Notwithstanding, I believe that there is a good deal of truth in Mr.
Packman’s statement.
MONTHLY NURSE.
429. It is an important, a most important, consideration to choose a
nurse rightly and well.
430. A monthly nurse ought to be middle-aged. If she be young, she is
apt to be thoughtless and giggling; if she be old, she may be deaf and
stupid, and may think too much of her trouble. She should have calmness
and self-possession. She must be gentle, kind, good-tempered, and
obliging, but firm withal, and she should have a cheerful countenance.
“Some seem by nature to have a vocation for nursing; others not. Again,
nursing has its separate branches; some have the light step, the
pleasant voice, the cheering smile, the dextrous hand, the gentle touch;
others are gifted in cookery for the sick.”[80] The former good
qualities are essential to a monthly nurse, and if she can combine the
latter—that is to say, “if she is gifted in cookery for the sick”—she
will, as a monthly nurse, be invaluable. Unless a woman have the gift of
nursing, she will never make a nurse. “Dr. Thynne held that sick-nurses,
like poets, were born, not made.”[81]
431. She ought neither to be a tattler, nor a tale-bearer, nor a
“croaker,” nor a “potterer.” A tattler is an abomination; a clacking
tongue is most wearisome and injurious to the patient. A tale-bearer is
to be especially avoided; if she tell tales of her former ladies, my
fair reader may depend upon it that her turn will come.[82] But of all
nurses to be shunned as the plague is the “croaker,” one that discourses
of the dismal and of the dreadful cases that have occurred in her
experience, many of which, in all probability, she herself was the cause
of. She is a very upas-tree in a house. A “potterer” should be banished
from the lying-in room; she is a perpetual worry—a perpetual blister!
She is a nurse without method, without system, and without smartness.
She potters at this and potters at that, and worries the patient beyond
measure. She dreams, and drawls, and “potters.” It is better to have a
brusque and noisy nurse than a pottering one—the latter individual is
far more irritating to the patient’s nerves, and is aggravating beyond
endurance. “There is one kind of nurse that is not uncommon in hospitals
[and in lying-in rooms], and that gives more trouble and worry than all
the others together, viz., the ‘pottering’ nurse. Of all nuisances,
defend us from a potterer.... The woman always has the very best
intentions in the world, but is totally devoid of method and smartness.
You never know when she has begun anything, and you certainly will never
know when she has finished it. She never does finish it, but she
sometimes leaves off.... She seems incapable of taking in a complete and
accurate idea of anything, and even while you are speaking to her it is
easy to see that her attention cannot be concentrated, and that her mind
is flying about among half a dozen subjects. If she is in the least
hurried, she loses what little intellect she ordinarily possesses, moans
feebly in a _sotto voce_ monotone, fetches the wrong articles, does the
wrong thing at the wrong time, and is always in the way.”[83]
432. Some monthly nurses have a knack of setting the servants at
loggerheads, and of poisoning the minds of their mistresses toward them.
They are regular mischief-makers, and frequently cause old and faithful
domestics to leave their situations. It will be seen, therefore, that it
is a momentous undertaking to choose a monthly nurse rightly and well.
433. Fortunately for ladies the class of nurses is wonderfully improved,
and the race of Sairey Gamp and Betsey Prig is nearly at an end.
434. She ought to be either a married woman or a widow. A single woman
cannot so well enter into the feelings of a lying-in patient, and has
not had the necessary experience. Moreover, a _single_ woman, as a rule,
is not so handy with an infant (more especially in putting him for the
first time to the breast) as a _married_ woman.
435. She must be sober, temperate, and healthy, and free from deafness
and from any defect of vision. She should have a gentle voice and
manner, but yet be neither melancholy nor hippish. She ought to be fond
of children, and must neither mind her trouble nor being disturbed at
night. She should be a light sleeper. “Scrupulous attention to
cleanliness, freshness, and neatness” in her own person, and toward the
lady and the infant, are most important requisites.
436. A fine lady-nurse that requires to be constantly waited upon by a
servant is not the one that I would recommend. A nurse should be willing
to wait upon herself, upon her mistress, and upon the baby with
alacrity, with cheerfulness, and without assistance, or she is not
suitable for her situation.
437. As the nurse, if she does her duty, devotes her time, her talent,
and her best energies to the lady and infant, a mistress ought to be
most liberal in the payment of a monthly nurse. A good one is cheap at
almost any price, while a bad one, though she come for nothing, is dear
indeed. A cheap nurse is frequently the ruin of the patient’s and of the
baby’s health, and of the peace of a household.
438. The monthly nurse ought to be engaged _early_ in the pregnancy, as
a _good_ nurse is caught up soon, and is full of engagements. This is
most important advice. A lady frequently has to put up with an
indifferent nurse from neglecting to engage her betimes. The medical man
at the eleventh hour is frequently besought to perform an
impossibility—to select a _good_ nurse; and which he could readily have
done if time had been given him to make the selection. Some of my best
nurses are engaged by my patients as early as two or three months after
the latter have conceived, in order to make sure of having their
favorite nurses. My patients are quite right; a good nurse is quite of
as much importance to her well-doing as a good doctor; indeed, a _bad_
nurse oftentimes makes a _good_ doctor’s efforts perfectly nugatory.
439. It is always desirable, whenever it be possible, that the doctor in
attendance should himself select the monthly nurse, as she will then be
used to his ways, and he will know her antecedents—whether she be sober,
temperate, and kind, and that she understands her business, and whether
she be in the habit of attending and of following out his directions,
for frequently a nurse is self-opinionated, and fancies that she knows
far better than the medical man. Such a nurse is to be scrupulously
avoided. There cannot be two masters in a lying-in room; if there be,
the unfortunate patient will inevitably be the sufferer. A doctor’s
directions _must_ be carried out to the very letter. It rests with the
patient to select a judicious medical man, who, although he will be
obeyed, will be kind and considerate to the nurse.
440. A monthly nurse ought to be in the house a week or ten days before
the commencement of the labor, in order that there may be neither bustle
nor excitement, and no hurrying to and fro at the last moment to find
her; and that she may have everything prepared, and the linen well aired
for the coming event.
441. She must never be allowed, unless ordered by the medical man, to
give either the patient or the baby a particle of medicine. A quacking
monthly nurse is an abomination. An infant who is everlastingly being
drugged by a nurse is sure to be puny and delicate.
442. A monthly nurse ought to understand the manner of putting on and of
tightening the bandage after a confinement. This, every night and
morning, she must do. The doctor generally does it the first time
himself, viz., immediately after the labor. It requires a little knack,
and if the nurse be at all awkward in the matter, the medical man will
only be too happy to show her the way, for he is quite aware the
support, the comfort, and the advantage it will be to his patient, and
he will be glad to know that the nurse herself will be able to continue
putting it on properly for some weeks—for at least three weeks—after the
lying-in.
443. If nurses better understood the proper method of bandaging patients
after their labors, there would not be so many ladies with pendulous
bellies and with ungainly figures. It is a common remark that a lady’s
figure is spoiled in consequence of her having had so many children.
This, provided efficient bandaging after _every_ confinement had been
properly resorted to, ought not to be. But then, if a monthly nurse is
to do those things properly, she ought to be properly trained, and many
of them have little or no training; hence the importance of choosing one
who thoroughly knows and will conscientiously do her duty.
444. A monthly nurse who thoroughly understands her business will always
have the lying-in room tidy, cheerful, and well ventilated. She will not
allow dirty linen to accumulate in the drawers, in corners, and under
the bed; nor will she allow any chamber utensil to remain for one moment
in the room after it has been used. If it be winter, she will take care
that the fire in the grate never goes out, and that it is never very
large, and that the room is kept as nearly as possible at one
temperature—namely, at 60° Fahrenheit. She will use her authority as a
nurse, and keep the other children from frequently running into the
room, and from exciting and disturbing her mistress; and she will make a
point of taking charge of the baby, and of keeping him quiet while the
mother, during the day, is having her necessary sleep.
445. A good monthly nurse fully comprehends and thoroughly appreciates
the importance of bathing the external parts concerned in parturition
every night and morning, and sometimes even oftener, for at least two or
three weeks after a confinement. And if the medical man deem it
necessary, she ought to understand the proper manner of using a vaginal
syringe. If the nurse be self-opinionated, and tries to persuade her
mistress not to have proper ablution—that such ablution will give
cold—she is both ignorant and prejudiced, and quite unfit for a monthly
nurse; and my advice is, that a lady ought on no account to engage such
a person a _second_ time.
446. In another part of this work I have entered fully on the vital
importance of ablution after a confinement, and I need not say more than
again to urge my fair reader to see that the monthly nurse properly
carries it out, and that, if there be any objections made to it by the
nurse, the medical man be appealed to in the matter, and that his
judgment be final. Assured I am that every doctor who understands his
profession will agree with me, that the regular ablution of the parts
after a labor is absolutely indispensable. The nurse, of course, will
take care to guard the bed from being wet, and will not expose the
patient unnecessarily during the process; she will be quick over it, and
she will have in readiness soft, warm, dry towels to speedily dry the
parts that have been bathed. The above is most important advice, and I
hope that my fair inquirer will engage a monthly nurse that will do her
duty in the matter.
447. Before concluding a list of some of the duties of a monthly nurse,
there are four more pieces of advice I wish to give both to a wife and
to a monthly nurse herself, which are these: (1) Never to allow a nurse,
until she be ordered by the doctor, to give either brandy, or wine, or
porter, or ale to the patient. (2) I should recommend every respectable
monthly nurse to carry about with her an india-rubber vaginal syringe.
One of the best for the purpose is Higginson’s syringe,[84] which is one
constructed to act either as an enema apparatus, or, by placing the
vaginal pipe over the enema pipe, as a vaginal syringe. She will thus be
armed at all points, and will be ready for any emergency. It is an
admirable invention, and cannot be too well known. (3) I should advise a
monthly nurse while on duty, whatever she may do at other times, to doff
her crinoline. A woman nursing a baby with a stuck-out crinoline is an
absurdity, and if it were not injurious both to the mother and to the
infant (as the nurse in crinoline cannot do her duty either to the one
or to the other) she would be a laughable object. A new-born baby
pillowed in steel! (4) I should recommend every monthly nurse, while in
the lying-in room, to wear either list slippers or the rubber slippers,
as creaking shoes are very irritating to a patient. “Nurses at these
times should wear slippers and not shoes. The _best_ slippers in
sick-rooms are those manufactured by the North British Rubber Company,
Edinburgh: they enable nurses to walk in them about the room without
causing the slightest noise; indeed, they may be called ‘the noiseless
slipper’—a great desideratum in such cases, more especially in all head
affections of children. If the above slippers cannot readily be
obtained, then list slippers—soles and all being made of list—will
answer the purpose equally as well.”[85]