LETTER XV.. Disorders of Pregnancy.

DISORDERS OF PREGNANCY.

The Evils of Abortion—The great Danger of bringing it on purposely—Cases—Illustrations of the Methods of Cure—Uterine Hemorrhage—Cases of Cure.

In the summer of 1849, walking down the Bowery, in the city of New York, I fell in company with a lady whom I had attended in childbirth, some three years previously. She was of middling stature, and I should judge twenty-five or six years of age. She said she had been for some time desiring to speak to me concerning her health. Since the birth of her last child she had a number of times experienced abortion, at three or four months from the commencement of pregnancy. She could not understand why it should be so; she was tolerably careful in diet, and bathed, to some extent, daily. She was, perhaps, in her husband’s store too much of the time, standing upon her feet, waiting upon customers, etc. Formerly she was a great walker, and could endure a good deal of fatigue, but latterly she was becoming less and less able to take long walks. She soon became fatigued, whereas, formerly, she could go to almost any extent in pedestrian exercise. The question was, how to avoid these abortions and their ill consequences. I gave her advice concerning diet, bathing, exercise, etc., and the next day wrote her husband substantially as follows:

“DEAR SIR—Your very worthy wife inquired of me yesterday what she should do in reference to preventing abortions, to which she is of late growing subject. I advised her the following treatment:

“1. Perform thorough ablution on rising in the morning. Drink some water, and walk in the open air, but not so much as to induce great fatigue. Housework is very good, but going into the open air, an hour or thereabout before dinner, will be better.

“2. Take the rubbing wet-sheet, and after it the sitting-bath ten minutes. Take also some kind of exercise before and after this bath.

“3. In the afternoon practice the same thing as in the forenoon.

“4. The rubbing wet-sheet on going to rest.

“5. It is very important that due attention be paid to diet. She should eat no meat, butter, and as little sweet as possible. Rice, brown bread, Indian mush, hominy or samp, potatoes, good fruits, and milk—these are the best articles for her.

“6. In addition to the above advice which I gave to your wife, there is a very important matter to be observed. Do you not practice too frequent cohabitation with her? This is, perhaps, of all, the most prominent among the causes of abortion. Taking a survey of the animal kingdom, we observe it to be a law, that animals do not cohabit during the period of pregnancy.

“Knowing that you are a kind and good-hearted husband and desire the best good of your wife, I take the liberty of submitting to you the following rules, which, I am confident, you will agree with me will be safe:

“1. Always sleep separately for six months at least, and twelve would be better. By that time we have every reason to believe your wife will enjoy her natural health.

“2. Suppose that after these six or twelve months, pregnancy again occurs, sleep then again separately during the entire period, and at the same time let your wife follow a similar course in water, diet, exercise, etc., to that I have above recommended.

“Then will she be able to prevent those disastrous consequences of frequent abortion.”

Case II.—In the spring of 1845, I was called upon by a gentleman and his lady for advice in regard to herself, she being then at about the middle of the term of pregnancy. She was threatened, as she believed, frequently with abortion. The year previously she had had a bad miscarriage, which was occasioned by a fall. She was of scrofulous habit of body, and had borne already seven or eight children, a number of whom had died.

I directed the patient to practice general ablution two or three times daily, with hip-baths of short duration, to exercise in the open air, and ride frequently, according as she could bear; but to be careful never to do too much at a time. A little overdoing would be liable to cause the difficulty with which she was threatened. The strictest care in diet I strongly advised her to observe.

She went on faithfully in the fulfillment of these directions, and about the end of the month of August, in exceedingly hot weather, she gave birth to her child. She followed the water-treatment resolutely, according to my directions, and in ten days was able to enjoy very long walks in the city. Twice she has been pregnant since that time; and at the time of writing this, has gone to the eighth month without experiencing any symptoms of abortion.

I should remark, this lady had frequently had miscarriages before the one above referred to.

Case III.—A very small, delicate, young woman, of this city, being about seven months advanced in pregnancy, went to an evening party, at which she danced. Being very fond of that exercise, she, no doubt, overdid the matter. Indeed, dancing at all in that condition is rather a hazardous experiment. Abortion came on, attended with a great deal of prostration. Water-treatment was practiced in this case, and she recovered as well as could be expected. She felt very sad at thus having lost her child, and resolved for the future to do better. Since that she has succeeded in bringing forth a tolerably healthy offspring.

Case IV.—I knew, some years since, a young married lady, in the city of Boston, who was much addicted to novel reading, and going to balls, theaters, parties, etc., at night. She walked a long way one very hot, sultry night in midsummer, and became overheated and fatigued. On arriving home she commenced bleeding, which became so severe that before a physician could be obtained she fainted many times, and apparently came very near losing her life.

Case V.—I recollect a case which occurred some years ago—one, indeed, which I shall not soon forget, because of the fatigue and anxiety it caused me. A gentleman came after me in the night time, telling me that his wife was bleeding, and had already bled to such an extent that he believed she would be dead before I could get to her. On arriving at the house, I found she had fainted many times, and that she had bled enormously, and even then there was no amendment of the symptoms. I do not know that I ever saw a person apparently so near death from hemorrhage as this lady, and yet recover. I had to remain with her almost constantly for two days and nights, before she appeared to be at all safe.

Years afterward, this lady gave me the following information respecting the cause of that frightful abortion:

Suspecting that she had become pregnant, and much against her inclination at the time, she resolved upon procuring an abortion. Pregnancy, she said, at that time would interfere very much with her comfort, arrangements, etc. She consulted a lady-clairvoyant in reference to the matter. The clairvoyant could not even tell her whether pregnancy existed or not; but to make safe in the matter, she ordered some vegetable teas to be drank in large quantities, which she said would expel the fetus, if one existed. She thus went on for some time. Her general health became deranged by the dosing, and yet no abortion was procured. Afterward, more powerful medicines were directed by the clairvoyant. These she found were at length making great mischief with her health; her stomach became very much deranged, and a regular tertian intermittent set in, yet no abortion came on.

At length, one day her children fell down stairs. Hearing them, she ran down two flights with the greatest precipitation, and as if she were in no sense delicate in health. This, together with the fright she experienced, prostrated her system very much, caused a great trembling to come over her, which soon resulted in the miscarriage I have referred to.

It was a long time—many months—before this patient recovered any thing like her former health. She was low-spirited, dull, inactive, and could take no comfort of life.

Case VI.—Two years after this the same lady was again pregnant. One day she did a very large washing, together with other kinds of work, and became much exhausted. This, again, brought on miscarriage, attended with fearful bleeding as before. A resolute course of treatment was practiced, and thus she was again rescued from danger; but such attacks are always worse than labor at full time.

Case VII.—While I have been writing and arranging these letters, I have been called to visit a lady who has been pregnant a few weeks the second time. Her first child has been somewhat ill from teething—in fact, a good deal sick for some days and nights, and taking care of him, bathing, dressing, applying the bandages, etc., to him, has made her quite weak. Two or three days ago, her husband was gone from home of an evening, and being a very punctual man in such matters, as all good husbands are, his wife expected him home early. He was, however, hindered beyond his time. This caused her a good deal of anxiety, although he had a friend with him. Soon after his return, bearing-down pains came on, and some discharge. Afterward she got better, and then in a day or two much worse. The mother-in-law gave her gin, the old-fashioned way to help on the courses, not believing, I suppose, that she was pregnant. But nature did better than the dosing; it would not let her abort. About this time I was sent for, whereupon I told her to keep pretty quiet, put on a heavy wet girdle, and change it as often as she felt bearing-down pain—every hour or two, at farthest. The cloth worn upon the genitals, under such circumstances, was also to be kept wet in cold water. But first of all, she was to take a good washing by sitting before a fire in a wash-tub, with tepid water, but not quite warm. This gave her a good deal of relief. In the morning I found her quite well, and free from pain and discharge.

It is far from being my wish, by any of these letters, to fill your minds with unpleasant thoughts or ideas of horror. But it occurred to me that you were, perhaps, many of you not aware that there are vile persons in our great cities who make it a regular business to procure abortions. Now I need not repeat to you, that a practice so wicked and unnatural as this must necessarily be fraught with great danger.

I thought I would present you with the account of a case of this kind, given us by a celebrated professor of this city, Dr. G. S. Bedford. It is as follows:

“Mrs. M—— was the mother of two children, and had been suffering extremely, for the last fourteen hours, from strong expulsive pains, which, however, had not caused the slightest progress in the delivery. I was likewise informed, that about four hours before I saw the case, Dr. Miner, an experienced physician, had been sent for, and, after instituting a vaginal examination, remarked to the attending physicians, that, in all his practice, he had never met with a similar case. Dr. Miner suggested the administration of an anodyne, and having other professional engagements, left the house. Mrs. M—— was taken in labor Monday, December 18th, at 7 o’clock, P. M., and on Sunday, at 7 o’clock, P. M., I first saw her. Her pains were then almost constant, and such had been the severity of her suffering, that her cries for relief, as her medical attendants informed me, had attracted crowds of people about the door. As soon as I entered her room, she exclaimed, ‘For God’s sake, doctor, cut me open, or I shall die; I never can be delivered without you cut me open!’ I was struck with her language, especially as I had already been informed that she had previously borne two children.

“On assuring her that she was in a most perilous situation, and at the same time promising that we would do all in our power to rescue her, she voluntarily made the following confession:

“About six weeks after becoming pregnant, she called on one of these infamous female physicians, who, hearing her situation, gave her some powders, with directions for use. These powders, it appears, did not produce the desired effect. She returned again to this woman, and asked her if there were no other way to make her miscarry. ‘Yes,’ says this physician, ‘I can probe you; but I must have my price for this operation!’ ‘What do you probe with?’ ‘A piece of whalebone.’ ‘Well,’ observed the patient, ‘I cannot afford to pay your price, and I will probe myself.’ She returned home, and used the whalebone several times; it produced considerable pain, followed by a discharge of blood. The whole secret was now disclosed. Injuries inflicted on the mouth of the womb, by other violent attempts, had resulted in the circumstance as detailed above. It was evident, from the nature of this poor woman’s sufferings, and the expulsive character of her pains, that prompt, artificial delivery was indicated. As the result of the case was doubtful, and it was important to have the concurrent testimony of other medical gentlemen, and as it embodied great professional interest, I requested my friends, Drs. Detmold, Washington, and Doane, to see it. They reached the house without delay, and, after examining minutely into all the facts, it was agreed that a bi-lateral section of the mouth of the womb should be made.

“Accordingly, without loss of time, I performed the operation in the following manner: The patient was brought to the edge of the bed and placed upon her back. The index finger of my left hand was introduced into the vagina as far as the roughness, which I supposed to be the seat of the os tincae. Then a probe-pointed bistoury, the blade of which had been previously covered with a band of linen to within about four lines of its extremity, was carried along my finger, until the point reached the rough surface. I succeeded in introducing the point of the instrument into a very slight opening which I found in the center of this surface, and then made an incision on the right side. I then withdrew the instrument, and in about five minutes it was evident that the head of the child made progress. The mouth of the womb dilated almost immediately, and the contractions were of the most expulsive character. There seemed, however, to be some ground for apprehension, that the mouth of the uterus would not yield with sufficient readiness, and I made an incision of the posterior lip, through its center, extending the incision to within a line of the peritoneal cavity. In ten minutes from this time, Mrs. M—— was delivered of a strong, full-grown child, whose boisterous cries were heard with astonishment by the mother, and with sincere gratification by her medical friends. The expression of that woman’s gratitude, in thus being preserved from what she and her friends supposed to be inevitable death, was an ample compensation for the anxiety experienced by those who were the humble instruments of affording her relief. This patient recovered rapidly, and did not, during the whole of her convalescence, present one unpleasant symptom. It is now ten weeks since the operation, and she and her infant are in the enjoyment of excellent health.

“At my last visit to this patient, with Dr. Forry, she made some additional revelations, which I think should be given, not only to the profession but to the public, in order that it may be known, that in our very midst there is a monster who speculates with human life, with as much coolness as if she were engaged in a game of chance.

“This patient, with unaffected sincerity, and apparently ignorant of the moral turpitude of the act, stated most unequivocally to both Dr. Forry and myself, that this physician, on previous occasions, had caused her to miscarry five times, and that these miscarriages had, in every instance, been brought about by drugs administered by this trafficker in human life. The only case in which the medicines failed was the last pregnancy, when, at the suggestion of this physician, she probed herself, and induced the condition of things described, and which most seriously involved her own safety, as well as that of her child. In the course of conversation, this woman mentioned that she knew a great number of persons who were in the habit of applying to this physician for the purpose of miscarrying, and that she scarcely ever failed in affording the desired relief; and among others, she cited the case of a female residing in Houston Street, who was five months pregnant; this physician probed her, and she was delivered of a child, to use her own expression, ‘THAT KICKED SEVERAL TIMES AFTER IT WAS PUT INTO THE BOWL.’”

Thus you have an exemplification of the danger of the wicked and fearful practice which I have spoken against. If any of you are ever tempted under such circumstanes, beware!

UTERINE HEMORRHAGE.

As intimately connected with the subject of abortion, it is fit that I should here make a few remarks on that form of uterine hemorrhage which is not connected with childbirth.

Case I.—I recollect a case of this kind that occurred with a lady who was, I should think, at least sixty years of age. It was in the month of October, 1846, on a passage from New York to London, in the packet ship Switzerland, Captain E. Knight. The old lady and husband had taken a steerage passage from New York. They were English people, returning after many years’ absence, again to visit their native country.

One day the old gentleman came on deck and told me his wife was very sick of uterine hemorrhage, and that he wished my advice. I told him I would prescribe what I considered to be the best course in such cases, but that I feared his wife would not be willing to follow it. Indeed, I had no idea that she would do so.

However, I gave the advice, which was substantially as follows: First, take old sail-cloth, which was clean, make some pieces into the shape of towels, and one larger, to be used in the form of a child’s diaper; place these cloths, wet, about the abdomen and thighs, and let the patient wear a large one, wet, in the form of a child’s diaper; let her take but little and very light nourishment for two or three days, and be careful and not move about too much; help her out upon deck, when the weather is fine, so that she may enjoy the invigorating effects of the pure air and light. You need not chill her much with the wet cloths, but be exceedingly particular that they do not become too warm; let her wear them the larger portion of the time, until she becomes quite well.

Contrary to my expectations, the old lady followed the course resolutely, and in a very short time was again entirely well. She spoke in great praise of the invigorating effects of the cold cloths; she also drank cold water. We were at sea about three weeks after this, and the old lady’s health continued good until we left the ship.

Case II.—A lady of about the same age, in the winter of 1848–49, living in Jersey City, experienced uterine hemorrhage. She had been overdoing in the way of work. A similar course to that in the above case was followed, and in a few days she also recovered. Rest, alone, in such cases—that is, abstaining from severe labor, and taking but very little exercise, such as can be easily borne, and without fatigue—is alone sufficient for the curing of many of these cases.

Cold hip-baths, of short duration, and often repeated, are always good in attacks of this kind. Indeed, the more coolness generally to the body, the better; but we should not chill the extremities too much—not that it is dangerous to do so, but it is better to avoid it.

In the treatment of hemorrhages, the Indians pursue a very rational mode of treatment. If a severe hemorrhage follow a wound, which is not unfrequently the case, they plunge themselves into cold water, thereby producing a constriction upon the bleeding vessels. We all know by experience the efficacy of cold to arrest bleeding at the nose. We put a piece of ice on the neck, pour cold water down the spine, or even put a cold door-key on the back of the neck, and in most cases epistaxis ceases. All physicians and surgeons—all who at all deserve the name of such—know well the power of cold to arrest hemorrhages—often, too, such as are of the most alarming character. We should make very poor work indeed, in stopping hemorrhages, if we were deprived of cold water. Cold water is worth more—incomparably more for this purpose—than all other remedies under the firmament of heaven combined.