LETTER XVI.. Disorders of Pregnancy.

DISORDERS OF PREGNANCY.

Its Febrile Condition—Acute Disease—Sleeplessness—Heart-burn—Constipation—Diarrhea—Piles and Hemorrhoids—Their Treatment.

It is said to have been an aphorism of Hippocrates, the father of medicine, who lived more than two thousand years ago, that pregnant women attacked with acute disease always die. This strong assertion cannot be said to hold good, certainly, at the present day; but yet pregnancy, it must be admitted, exercises, as a general fact, a very unfavorable influence on the system in acute disease. The danger here may be said to be three-fold. First, the system is already in a febrile condition, or one very nearly bordering thereto; second, there is the new disease; and third, this often causes the death of the unborn child, and then the dangers of abortion are superadded to the others. “The life of the child, too,” say authors, “is endangered by the treatment necessary for the cure; especially in the use of harsh purgatives, violent emetics, salivation, and profuse bleedings.” But thanks to a better day, we of the water practice are under no necessity of running such fearful risks. We have not only a more effectual way, but one, when managed by judicious hands, harmless and safe. “It is by the prompt use of mild means, and a persevering attention to small matters,” judiciously observes Dr. Maunsel, “that the patient is to be conducted through the dangers that encompass her.” And he justly adds, “Above all, avoid the dreadful blunder of treating a woman for acute disease without discovering that she is pregnant.”

Pregnancy, as I have remarked, is always attended with more or less excitement of the system, an excitement which bears some resemblance to a state of fever. There is also a greater proneness to fevers, even from slight causes, now than at other times. Hence the necessity of avoiding, as far as possible, all such causes; and hence also, the necessity of exercising the greatest care in regard to diet and drinks. Too much food, and that which is too exciting, will cause more harm in pregnancy than at other times, from the greater tendency to fever. The common belief among women is, that more food is needed during pregnancy than at other times, because the food goes to furnish nourishment for two instead of one, that is, for the mother and the child within her. “It is therefore,” says Dr. Dewees, “constantly recommended to eat and drink heartily; and this she too often does, until the system is goaded to fever; and sometimes to more sudden and greater evils, as convulsions or apoplexy.”

If, instead of full diet, women in pregnancy will but try the plan of eating less food, even of becoming very abstemious, they will most assuredly find that they get along better, suffer less from plethora or fullness, and enjoy greater comfort of body in every respect.

SLEEPLESSNESS.

This, in a greater or less degree, not unfrequently occurs during pregnancy. It is most apt to occur during the later months of the period. Within a few days of the birth, however, better rest is experienced, and a greater degree of comfort in every respect. This tendency to sleeplessness during pregnancy is sometimes so troublesome as almost wholly to prevent sleep. “The limbs are agitated by involuntary contractions of the muscles, which, by the frequency and suddenness of their motion, instantly interrupt the sleep to which the woman was at the moment strongly inclined.”

“Sleeplessness,” says Dr. Maunsel, “most frequently affects the weak, nervous, and irritable, occurring sometimes early in pregnancy, oftener toward the end of the term. If the want of sleep continue for many days, it is commonly followed by very grave symptoms, as restlessness, fever, mental disturbance, convulsions, etc.; abortion has resulted from it, and some cases have terminated in insanity; others have destroyed life.” But those who follow a judicious course of water-treatment do not become thus afflicted. If such occurrences should be at all possible in the new modes, the cases would be exceedingly rare. I have known many persons to follow bathing during pregnancy, but none who have had any thing like serious difficulty in obtaining a proper amount of rest.

In many cases this want of sleep in pregnancy does not sensibly impair the general health. Some persons have been under the necessity of walking their room much of the night; and yet, after a short repose at the dawn of day, have been astonished to find themselves as much refreshed, apparently, as after a good night’s rest.

Treatment.—To prevent sleeplessness in pregnancy, a variety of means have been recommended. If there is plethora, or too great fullness of the system, small bleedings and cooling purgatives of mild kind are recommended by almost every author who has written on the subject. It is well known that in many parts of the country, women believe that they cannot get through pregnancy at all without being bled. The doctors have been at the root of this matter in the beginning. This old-fashioned practice, fortunately, is now fast going out of date. It is not for me here to enter into a discussion of the question whether such means ever do any good in pregnancy; but I will say, on the authority of physiological and pathological science, and my own experience, that bathing, water-drinking, and the proper regulation of the general habits, are incomparably the best modes; the best, not only for the time of pregnancy, but also for that of childbirth and the period of nursing.

Dr. Dewees recommended for this affection, low diet, cool air, and cold water, as being among the best remedies. And Dr. Denman says, that “a glass of cold water drank at bedtime is not a contemptible remedy;” and he might have said one of the best, especially if the dose be soon repeated. And Dr. Dewees, in quoting this advice of Dr. Denman, adds, “We know that bathing the hands and face in cold water is an excellent practice, and should always be resorted to.”

Dr. Maunsel says, “Pediluvia (foot-baths), or, what is better, hip-baths, very often do good.” But the important matter of temperature, the doctor does not speak of. A warm hip-bath and a cold one are very different things. He remarks, also, well, “that the diet should be cooling, and exercise in the open air as freely as circumstances will permit.”

I may, however, dismiss this whole matter of sleeplessness in pregnancy, by saying, that those who bathe daily, exercise judiciously, and, when possible, in the open air, drink only pure soft water (and all can have this from the clouds), partake only of plain and unstimulating food, and sleep upon hard beds and pillows, in cool, fresh air, will rarely, if ever, be troubled with want of sleep.

One other thing, however; it sometimes seems necessary for persons in pregnancy to get a “nap” during the day. Those who have great cares, and many in our country have, often find it extremely difficult to get through the long, hot days of summer without sleep. Now, in such cases, if the woman can go by herself, and be wholly undisturbed, and feel entirely free from every care, and thus get a good half hour or an hour’s sleep, she will be much refreshed thereby. It is necessary to observe that the clothing should be removed as at night. Persons often wonder how it is that they feel worse after sleeping than before. When one lies down, if the clothing be left on, too much heat is retained about the surface, and thus debility, instead of refreshment, is experienced. This day-sleeping should be done with the stomach empty, as at three or more hours after a meal, and not in the afternoon, as that would be liable to cause wakefulness at night. It is truly surprising how much, under favorable circumstances, a short sleep even will refresh the powers of life.

HEART-BURN.

This is not unfrequently one of the first unpleasant symptoms that women experience after becoming pregnant. It sometimes becomes very distressing, and difficult to manage according to the ordinary modes. “It is generally,” says Dr. Dewees, “very distressing and very difficult to subdue.” He had known large and repeated doses of the alkalies given with scarcely any temporary alleviation, and much less, permanent benefit.

The great cause of heart-burn in pregnancy, as well as in other cases, is acidity of the stomach; and acidity of the stomach comes from improper food. Very seldom, indeed, can a pregnant woman be troubled with heart-burn, acidity of the stomach, or vomiting, if the dietetic and other habits be regulated according to principle. Pregnant women, in this country of abundance, generally eat a great deal too much food. They have also too little exercise in the open air. Some, indeed, have too much exercise, as in doing household work; but more are injured by doing too little than too much. But in this country ninety-nine of the one hundred eat too much food while in the pregnant state.

Treatment.—To cure the heart-burn, let the woman, when she first experiences it, at once desist in the quantity of food. If she rises in the morning and finds the symptom upon her, she may be certain that digestion has gone on badly the day previous, and that the stomach contains portions of the undigested aliment which has passed into the acetous fermentation, and thus causing the difficulty she experiences. What is to be done in such a case? Will the introduction of another portion of food into the already disordered stomach make matters any the better? Certainly not, except for a short time. When the stomach is goaded on by a new meal, the individual may feel the better for half an hour; but, other things being equal, it in the end only makes the matter worse. Fasting a meal or two, with water-drinking for its tonic effect, is the best possible means. The stomach, thus, has time to regain its vigor, and food taken in moderation, subsequently, will then be found to agree perfectly well. It will here also surprise any one to learn how small an amount of food is really necessary, with water-drinking, to sustain the strength.

If the heart-burn is very troublesome, it will be found of great relief for the patient to vomit by means of water. This, in most cases, will take place very easily by drinking, in quick succession, a number of tumblers of soft water, about blood-warm temperature. This, with a little help, as by putting the finger in the throat, will be found sufficient; and if, in any case, the vomiting does not take place, the water yet does much good by means of diluting the offending matters in the stomach. Thus, suppose there is one ounce of acid matters in the gastric cavity, and that ten ounces of pure water are introduced therein, the offending mass is weakened tenfold; so that even if vomiting does not take place, great relief is experienced. I would not have any one make too great an effort to produce vomiting, especially in pregnancy, for hard vomiting might cause abortion. There is, however, no danger except the vomiting caused by drug substances. Water-vomiting is easier than can be imagined by those who have tried only the old modes.

Soda and other alkalies, taken so often to ease heart-burn, do more harm than good in the end. The wet girdle, worn occasionally about the abdomen, and managed so as to produce a cooling effect, will be found of great service in invigorating the stomach, thus tending to prevent heart-burn, acidity, and the like. So, also, the general ablutions, which ought never, for a single day, to be omitted during pregnancy, as we may say, too, of other times.

In heart-burn, arising from whatever cause, it is a very common custom, both with the profession and the people, to give alkalies, as magnesia and chalk. Dr. Dewees, I remarked, had known large and repeated doses given, with scarcely any temporary alleviation, much less permanent benefit. It is of little effect, certainly, to continue giving these articles, when at the same time the dietetic habits are such as are certain of keeping up the difficulty. This would hold true even if the articles administered were perfectly neutral in their effects as to harm, which can never be the case. All drug substances, however much good they do, at the same time cause a certain amount of harm. The articles, magnesia and chalk, the ones generally resorted to in this difficulty, are moreover often impure. This is particularly true of the latter article.

Dr. Dewees mentions a case in which the lady’s health was utterly destroyed by her enormous use of chalk. “I formerly attended a lady, with several children,” says he, “who was in the habit of eating chalk during the whole term of pregnancy; she used it in such excessive quantities as to render the bowels almost useless. I have often known her without an evacuation for ten or twelve days together, and then it was only procured by enemata (injections); and the dejections were literally chalk. Her calculation, I well remember, was three half-pecks for each pregnancy; she became as white nearly as the substance itself; and it eventually destroyed her, by so deranging her stomach that it would retain nothing upon it.” I repeat, that these alkaline substances always and inevitably do more harm than good; and the part of wisdom is to do without them.

CONSTIPATION.

During the early months of pregnancy, there appears to be a greater tendency to constipation than in the latter months, a fact which is the direct reverse of what we should expect from a priori reasoning. But during the whole period, constipation is more apt to occur than at other times.

Constipation is exceedingly common among all classes of females in this country at the present day. The American people have such a predilection for fine food, it is a hard matter to make any great change in this respect. It is in the dietetic habits, more than in any other, that we are to look for the causes of this evil.

Superfine flour is, I hold, the greatest of all causes of constipation. I know tea and coffee, which are astringent articles, have a tendency to cause this condition of the bowels; and the same may be said of idleness and physical inactivity; but too great richness of food—and superfine flour is the article most concerned in this—is the great cause of constipation. Our country abounds with it everywhere. By our numerous railroads and canals, superfine flour is transported from one end of the country to the other, so that in large districts, where formerly the people were in the habit of eating coarse bread, as of rye and Indian, and were consequently more healthy, they now use the superfine. Even a beggar would sneer at one for offering him brown bread.

Constipation, common as it is everywhere among females, is still more common in pregnancy. This arises, first, from the pressure of the enlarged womb upon the lower bowel; and second, there being a new action set up in the uterus, there is, as a natural consequence, a greater tendency to torpor in the bowels; but the principal cause is that of the pressure.

This condition of the bowels induces of itself numerous other difficulties. Headache is often brought on solely by constipation; that is, in many cases we remove the constipation, and the headache is sure to leave with it. Sickness of the stomach and vomiting are always aggravated, and often caused by it. The same also may be said of heart-burn, palpitation, and fainting. Sleeplessness, and, in fact, almost every one of the disorders of pregnancy, may be said to be either caused directly, or greatly aggravated, by constipation of the bowels. Even miscarriage has been known to be induced by it.

Some persons have gone an almost incredible length of time without any movement of the bowels. A whole week is not uncommon. Dr. Dewees mentions a case of fourteen days, and no doubt there have been those who have gone one to three whole weeks.

Treatment.—What have we to do in order to cure constipation of the bowels? Does not every person of common sense understand at this day, that the more we dose the system for constipation, the more we may? Let those answer who have tried these things. Always, other things being equal, the more we take drugs for constipation, the worse it grows. We must therefore look to some other means of cure.

Constipation of the bowels may always be cured, and this by the most simple means. Dr. Dewees mentions a case where a lady had suffered three successive miscarriages from this cause, and by the constant use of brown bread, drinking only water, and taking no animal food or broths—taking now and then a little castor-oil, or the like, which, however, he did not reckon upon as having done any material good—enabled her to pass safely through the whole time. We need here only mention, in general terms, that constipation in pregnancy is to be cured just the same as constipation in any other case. Brown bread, fruits, and vegetables, with a very moderate use of milk, if the patient desires it; regular exercise, the hip-bath, wet girdle, injections of cold water, or tepid, if that is preferred—these are the means to be used. The brown wheat or rye mush will be found most excellent. No woman, if she can have brown bread, and occasionally an injection, need ever suffer from constipation of the bowels.

DIARRHEA.

Sometimes the reverse of constipation occurs during pregnancy; namely, diarrhea. This also not unfrequently alternates with constipation. Constipation, however, is the most frequent symptom.

Treatment.—Singular as it may appear, diarrhea should be treated on the same general principles as constipation. Fortify and invigorate the general health, observing at the same time a correct general regimen, and either symptom disappears. In diarrhea, the hip-bath, often repeated, the wet girdle, and cold injections, taken as often as there is any disposition for the bowels to act, are effectual means. The diet should be regulated on the strictest principles. If a diarrhea is very severe, entire abstinence from all nourishment, except water, for a day or two, is a very salutary remedy. Food should then be taken with the same precautions as in nausea and vomiting.

PILES AND HEMORRHOIDS.

Piles and hemorrhoids are more apt to occur in pregnancy than at other times; and when these already exist, they are apt to become worse at this period. Constipation being more apt to occur in pregnancy, and that condition of the system being the one in which these symptoms are most liable to occur when the woman is not pregnant, so also they occur more frequently now than at other times. The constant pressure of the fetus upon the blood-vessels within the pelvis has also an agency in the matter, because every thing that causes sluggishness of circulation tends to bring on piles. So also the more sedentary habits of many females, during the period of pregnancy, are often a cause of this difficulty; but in other cases the opposite extreme is practiced—too much exercise or standing on the feet. Both these extremes may cause piles in pregnancy, or aggravation when they previously existed. Cathartic medicines not unfrequently bring on a “fit of the piles.”

This affection always denotes a wrong state of things in the general health. A really healthy person can never have the piles. Some, however, who are what would be termed tolerably well and strong in general health, experience such symptoms, but such is not the rule. Old cases, particularly, denote derangement of the general system.

When piles come on suddenly, they are often attended with very great pain and suffering to the patient. Not only is the pain great at the part affected, but there is also feverishness, pain, and a very unpleasant feeling in the head, with deep and severe pain in the back.

Treatment.—As to the treatment and general management in this affection, we should of course do the best that may be for the general health. As a general fact, no surgical operation should be allowed upon piles during pregnancy. These operations are often attended with so great pain, that abortion might be the result.

There is nothing in the world that will produce so great relief in piles as fasting. If the fit is severe, live a whole day (or even two, if necessary) upon pure, soft, cold water alone. Give then very lightly of vegetable food. Those who have suffered the agony of this affection, if they will but have patience to try this means, will find the truth of my remarks.

Water applications are also very useful in this disease. Dr. Dewees observes: “The pregnant woman may derive both comfort and advantage from sitting in a demi-bath of cold water, for five or ten minutes at a time, two or three times a day, when the complaint is advancing, or when about to retire; that is, after the severer symptoms have abated, or before they are high.” This advice is partly right and partly not. There is a notion with many that cold water-applications in high inflammation are not good; that they increase the difficulty instead of making it less. Thus in a burn, it is said that after the application of cold water the pain becomes worse. This is not true, although it appears to be so; for so great is the relief afforded by the application, that the pain appears worse, when in fact it is not; but only keep on continuously with the cold water-treatment, and the pain does not return at all. Such at least is the fact in all burns, however severe, when the surface is not destroyed; and the same principle holds good in all high inflammations from whatever cause. Very frequent sitz-baths, or merely washing the part often in cold water, will be found excellent in these severe cases of piles. Cold compresses worn upon the part also afford great relief. Cold injections are also useful. But, as before mentioned, fasting and the regulation of the diet are the great means.