LETTER XII.. Disorders of Pregnancy.

DISORDERS OF PREGNANCY.

Nausea and Vomiting—Means of Prevention, and Cure.

There are a variety of physiological troubles that are connected with pregnancy. True, women do not all experience these, any or all of them; but inasmuch as you are liable to these affections, it is my duty to speak of them. In doing so, I shall class all of these abnormal symptoms under the general head of “disorders,” because I believe that in a truly natural, or, in other words, healthful state of the system, none of these ailments would be experienced.

Nausea and vomiting, as most of you know, and not a few of you by experience—are, in the present state of society, frequent attendants of pregnancy.

These symptoms occur, for the most part, during the earlier months of gestation. They may, however, continue through the whole period, and in some cases they cease and then return again toward the latter part of it.

Most frequently morning-sickness commences from two to three weeks after the beginning of pregnancy. It may, however, come on the very day of, or next after conception, and some women have been able to discover this circumstance by the occurrence of the vomiting which follows it.

This sickness of the stomach is most apt to occur in the morning. Hence it has been called “morning-sickness,” from the fact that it is most apt to take place at this period of the day. This is in part, doubtless, owing to the circumstance of the woman’s getting up at this time, and not to any thing necessarily connected with that part of the twenty-four hours. If she reclines, the sickness leaves her for the most part, but again appears if she attempts to rise.

The matter thrown up from the stomach varies in character in different cases. Much here depends upon the dietetic habits of the individual and the state of the health. It is more commonly a sort of tough, sour mucus; but sometimes there is vomited an extremely acid, thin water, which in some cases is strong enough to excoriate the mouth and set the teeth on edge. Sometimes, too, bile is thrown up with the other matters.

The appetite is apt to become very variable in these cases; often, indeed, there appears to be none at all; at other times the most singular and even disgusting articles are craved for, and not unfrequently that kind of food which we would suppose the worst for the patient proves to be the best, that is, so far as retaining it on the stomach is concerned.

It may appear a strange doctrine to you, that in general those who suffer from nausea, vomiting, and the other more common accompaniments of pregnancy, get along better than those who experience none of these symptoms. “If vomiting should not be violent, and occur only in the early part of the day, though very troublesome,” observes Dr. Denman, “it is so far from being detrimental, that it is generally found to be serviceable, by exciting a more vigorous action of the uterus, and by bringing the stomach into a better state.”

Some have been afraid that vomiting would cause abortion; and such an occurrence might happen, if this symptom were brought on in a violent manner, as by the administration of powerful drugs. But the vomiting which comes on in consequence of the stomach-sickness, instead of causing premature delivery, appears to be a safeguard against such an occurrence. In other words, those who experience nausea and vomiting, are not so liable to miscarry as those who have none of these symptoms.

If we could but take into our minds the whole scope of nature, and if we were able to trace, like the Infinite Mind, causes and effects, we should, doubtless, much oftener than we now are, be struck with the evident goodness of the Creator, even in the physical sufferings which He has made it our lot to endure. What is the office of nausea and vomiting in these cases? It is possible, under bad management, for these symptoms to become actually alarming in their extent. But what, it is well for us to inquire, is the design of these occurrences, so common during the period of gestation? Plainly, to restrain the woman from the gratification of a voracious and wayward appetite, the indulgence of which could but be of material detriment to both mother and child.

How is it in sea-sickness? Do we not find that people who go to sea are generally benefited in health thereby, and that none are so much benefited as those who are made sick? And how are they thus benefited? I answer, by the abstinence and fasting which they are compelled to practice. Almost all persons—all, I will say—have more or less of impurity in their bodies, so badly have we treated ourselves, and so badly do we live. Hence it is that in sea-sickness, and in the vomiting that occurs in pregnancy, benefit is received; the body is made to purify itself by its own inherent power.

If every pregnant woman could have nausea enough, no doctor would ever think of bleeding her; it would prevent all that plethora and fullness of the system which, under such circumstances, have led good and honest men, as well as women, to believe it is often best to abstract blood.

But you ask me, are these symptoms really natural, and intrinsically best for the system in pregnancy? I answer, they are not. I believe it possible so to live that a woman pregnant need not have them any more than any one else. In sea-sickness how is it? The sailors—they who are kept up regularly in the open air every four hours at farthest—never have it to any extent worth speaking of. The first time they go to sea they are apt to be sick, like other people; but in a day or two it is all gone—they work it off.

So, too, in the sickness of pregnancy. We never hear of the Indian women having it. They, likewise, are active in their habits, live plainly, and go often into the open air.

One of the most important things to observe in these cases is, not to eat too much, or at wrong times. A great many patients of this kind make sad work with themselves by eating all sorts of things for which they have a relish, and at all hours of the day, just as the fit happens to take them. We know full well how important it is to eat regularly when we are in health. How much more so, then, must it be when we are ill! If you have nausea, or if you have not, but no appetite, drink some pure cold water, and wait; the appetite will come.

It is really surprising to see on how small a portion of food a patient can subsist for many days.

The laboring classes—those who are compelled to work hard, whether they would or not, and who are obliged, in consequence of the iron hand of poverty being upon them, to live on plain, homely fare—they are not troubled with nausea and vomiting, as the idlers and the luxurious are.

You will naturally expect me to speak of the professional treatment for these troubles; and in regard to this, I remark, there are a great many things to be taken into the account. You cannot well know too much in regard to all the means of improving the general health.

The nausea is the most distressing part of morning-sickness, as it also is of sea-sickness. In the former, as in the latter, it is one of the most comforting things that can be done—the most comforting, rather—to take a good draught of pure, soft water, at about the blood temperature. If enough is taken it causes vomiting, which at once brings relief; but if the stomach should not thus be excited to an inverted action, the water will yet do good, as it tends to “settle the stomach,” and this of itself brings a good deal of relief, although not so much as actual vomiting would do.

Some may tell you that vomiting is dangerous in pregnancy—that it is liable to cause abortion. So it is, as I have before said, if it is rendered very violent by the giving of powerful drugs. But any thing like a reasonable emetic, even of the drug kind, is comparatively safe in this respect; so much so, that the most experienced and most honest physicians are not now afraid to vomit a pregnant patient, if they consider it important to resort to that measure. Emetics of the drug kind have even been used, and apparently with good success, as a cure of the nausea of which I have been speaking.

But do not understand me as recommending vomiting, even by water, the best and mildest of all emetics, except in cases of urgency, and when it can be made to take place without great straining or effort. As a general thing it is far better to fast.

I do not know of any thing in which physicians have been more puzzled than in the treatment of these symptoms. They have left nothing in the materia medica untried. The result is, however, that no plan has yet been fixed upon as being a legitimate one, or one that can be depended upon with any tolerable chance of success. Patients have sometimes died of the exhaustion caused by the vomiting, as has been supposed; but I am more inclined to think they have far oftener been drugged to death. It is mostly in the hospitals that these deaths have occurred, and there, as you know, there is great temptation for experimenting. Young physicians are there allowed to make experiments; and there the older ones are also too much tempted to do as they would not wish to be done by.

Physicians have been so much thwarted in these cases, that they have often recommended bringing on premature delivery, fearing that the patient would be destroyed if they did not resort to this dreadful expedient. Most of them, I have no doubt, have acted honestly in these dreadful emergencies. It is to their credit that they seldom, if ever, have resorted to premature delivery without first having counsel on the subject.

I have already hinted that exercise and activity are great helps in keeping off those troubles that so often occur with the pregnant. I would repeat, BE ACTIVE. Do not let a day, a half day, nor even an hour pass over without your doing something. BE ACTIVE, REGULARLY, HABITUALLY ACTIVE. Let this be your motto, and your practice, too.

I must tell you also that water-treatment is a most useful help. Take the rubbing wet-sheet when you feel so badly, and see how great a change it will work. Wear the wet girdle, and take the cold hip-bath, not too long at a time, if necessary. I do not know that I can recommend eating ice, as some have done; yet it has sometimes appeared to act very favorably, and great quantities have been used by some in this way, without any apparent harm.

The cold water injections are much to be recommended in cases of costiveness, which often occurs in connection with the vomiting.