LETTER XVII.. Disorders of Pregnancy.

DISORDERS OF PREGNANCY.

Headache: the Nervous and the Plethoric kinds—Stye in the Eye—Salivation—Hemorrhage from the Stomach—Cramp of the Stomach—Toothache—Jaundice.

Headache is one of the most common of all the disorders of pregnancy. It may occur at any part of the period; in the early months, it is supposed that nervous headache is most apt to occur; in the latter, headache arises more frequently from plethora. In such cases there may be throbbing of the temples, suffusion of the eyes, ringing in the ears, indistinct vision, and flashes of light passing before the eyes. If the headache gets to be very severe—splitting, as we may say—there is danger of either apoplexy or puerperal convulsions. But these things, be it remembered, do not come upon those who live moderately and temperately, lead an active, industrious, and regular life, go often into the open air, and practice daily ablutions.

That form of headache in pregnancy which occurs often, and is not a sick or nervous headache, so-called, is regarded by authors generally as being a very serious affair.

Treatment.—Dr. Maunsel says of the nervous form of this disease: “This, especially if it take the form of hemicrania (that in which the pain is confined to one half of the head), is one of the most unmanageable of all the diseases of pregnancy.”

According to the old practice, prompt and decided measures must be taken in these cases, especially if the affection is of that form arising from a general fullness of the system.

“If the state of the system indicates bleeding,” says Dr. Maunsel, “it will commonly do good; local should be preferred to general bleeding. If bleeding is not indicated, we should at first attend to the secretions; when these are corrected, antispasmodics and anodynes come in well. Hyosciamus and camphor, a grain of each, is a good remedy; also the volatile tincture of valerian. The external application of some anodyne extract, as stramonium, belladonna, or cicuta, may be tried, but with caution, lest they produce the poisonous effects of the drug.”

Dr. Churchill remarks: “These nervous headaches may usually be relieved by antispasmodic medicines, or diffusible stimuli, such as valerian, hartshorn, etc.

“Eau de Cologne applied to the forehead, or a blister behind the ears, is often useful.

“A brisk purgative should also be given occasionally.

“A much more active treatment will be necessary when there are any symptoms of plethora, or vascular excitement about the head, both for the relief of the pain and for the purpose of anticipating evil consequences. Blood should be taken from the arm, in quantity according to the strength of the patient and the relief afforded; and this should be repeated, or leeches applied to the temples, if necessary. We are not to rest satisfied that enough has been done until the pain is relieved, and the arterial system reduced to the ordinary standard.

“After a certain amount of good effect has been produced, great benefit will often result from the application of a blister to the nape of the neck.”

Now compare with the above practice of bleeding and dosing, secundum artem, the true and rational one.

In nineteen cases out of twenty, the nervous headache comes from either tea or coffee drinking, or the use of improper food. Only remove the causes, then, and the difficulty vanishes. Strange to say, however, there are many women who have either so little confidence in what any one can say to them, or so little control over themselves, they will not even make the experiment. Should one who has been cured tell them the fact, they will not yet believe; nor would they if one should rise from the dead. Such persons—those who have the truth set before them, and yet will not act—are welcome to all their tea and coffee, their fine food, their bleeding and dosing, and their sick headache.

STYE IN THE EYE.

This form of boil, occurring on the eyelid, sometimes appears as one of the disorders connected with pregnancy, more particularly in its earlier part.

Stye is much more apt to happen with those who have a disordered stomach than with the healthy. As a general rule, however, it may be regarded that boils are healthy; that is, it denotes a very good state of the vitality, when it has the power thus to throw morbid matter out of the system. Still, it is yet more healthy to have the body so pure that it has no need whatever of symptoms of the kind of which I am speaking.

A stye is much more painful than might be expected, considering its small size. This is owing both to the vehemence of the inflammation and to the excessive sensibility of the part upon which it is situated. The disturbance caused by it may become so great as to amount to a good deal of feverishness and restlessness, attended not unfrequently with a severe pain in the head.

Treatment.—We cannot do a great deal in such cases, except to let matters take their own course. It is productive of a good deal of relief to hold the eye in tepid water, and if the patient will consent to live two or three days almost wholly without food, the suffering will be rendered much less, and the stye will come the sooner to a head.

SALIVATION.

There is often a greater or less degree of this symptom during the period of pregnancy. Probably all women experience, at this time, a more than ordinary flow of the salivary fluid. This sometimes becomes very excessive and troublesome to the patient, especially at night, when the sleep is disturbed by the frequent necessity of emptying the mouth. Dr. Dewees observes: “It is almost always accompanied with acidity of the stomach and constipation of the bowels; the fluid discharged from the mouth, for the most part, is perfectly colorless and transparent; at other times it is more tenacious and frothy, and the quantity poured out is sometimes incredibly profuse. It almost always has an unpleasant taste, though not attended with an offensive smell; it keeps the stomach in a constant state of irritation, and not unfrequently provokes vomiting, especially if the saliva be tenacious, and requires an effort to discharge it.” This author relates a case where salivation commenced at the second month of pregnancy, in which the patient discharged daily from one to three quarts of salivary fluid, and became so weakened thereby, that she was unable to sit up without immediately fainting.

The above description of salivation in pregnancy may be said to apply to patients who live according to the ordinary modes of society. I have, during nine years past, known many women who have passed through pregnancy, practicing at the same time daily bathing, water-drinking, exercising regularly in the open air, with plain diet, and in no instance have I known salivation to prove at all inconvenient or troublesome. I judge that this affection, if such we may call it, can only come on when the general health is at fault, or the dietetic and other hygienic habits bad. True, there is probably always more or less increase of the salivary secretions in pregnancy, but if good habits are daily persevered in, I think no one will be troubled at all in this matter.

I find in a late work on Females—Professor Meigs’s—the following remarks on this subject, which go to show, on good authority, the uselessness of drug-treatment in this affection:

“I am sorry to tell you (the Professor addressing himself to his class), that I know of no remedy at all to be depended upon for the management of these great salivations. They are the troublesome concomitants of the gestation, and they cease with the cessation of the gestation. They cannot be cured by alkalies or acids, by venesection or purgation, or by any therapeutical treatment with which I am acquainted. If it were just, always to attribute the salivation to a state of the stomach, then it would be reasonable to apply remedies with a view to correct a faulty state of that organ, in hopes of curing the salivation.”

All this goes to prove, that you who are troubled with this affection are to depend upon the rational means, air, exercise, diet, and water-treatment, and not upon drugs, to remedy it. Mark too, how, year by year, the superiority of these hygienic and curative influences is being recognized by medical men, and how the old methods of dosing the system are going into disrepute.

HEMORRHAGE FROM THE STOMACH.

In consequence, probably, of a general fullness of the system, or perhaps from the cessation of the menstrual function, a discharge of blood sometimes takes place from the stomach, in the earlier periods of pregnancy. It is generally small in quantity, and continues but a short time. The occurrence, generally, causes a good deal of alarm to the patient, but it is seldom to be looked upon as a dangerous affection.

Treatment.—If the hemorrhage arises from too great fullness of the system, a reducing process should at once be commenced—not by drugging the system, or by blood-letting, but by abstinence and fasting.

If the discharge should be at all alarming, we should place cold wet compresses upon the abdomen; we should, in short, proceed upon the same general principles as we would in any other case of hemorrhage.

If the bleeding occurs in consequence of hard vomiting, as it sometimes may, we should take measures to arrest that symptom.

I remark, in conclusion, that this affection is a very unfrequent one, and such, in most cases, as should cause no alarm.

URINARY DIFFICULTIES.

Incontinence of urine is quite apt to occur toward the end of pregnancy.

It arises often from the pressure of the womb upon the neck of the bladder.

There is a notion with some of the “old women,” that incontinence of urine is an indication of good labor.

Treatment.—This difficulty cannot, of course, be altogether remedied; the cause cannot be removed. It may be lessened, however, by short and frequent hip-baths, wet bandages, and cold bathing. Drinking soft water instead of hard, will also be found to have a good effect in all difficulties of the bladder whatever.

Blisters are always liable to bring trouble upon the urinary organs, but more particularly so in pregnancy. The system is then in a more excitable or impressible state. Strangury in pregnancy is a very distressing and untoward symptom when it follows the use of blisters. Dr. Dewees had known cases where entire retention of urine followed the use of blisters, so obstinate that it could only be relieved by the catheter, causing a distressing inclination and violence of effort, only to be surpassed by labor itself. Retention may also come on from other causes.

Treatment.—It can be very seldom indeed necessary to resort to the use of the catheter for draining off the urine, if cold hip-baths, cold foot-baths, and even the cold general bath, if necessary, be sufficiently persevered in. Cold has a truly wonderful effect in causing the flow of urine.

CRAMP OF THE STOMACH.

This affection, as it occurs in pregnancy, is most common with those whose stomachs have become much enfeebled by dietetic improprieties, excess in the use of warm drinks, and by the abuse of medicines.

Treatment.—By way of comparison, let me present you with the remarks of a celebrated European author, Doctor Churchill, concerning the medical treatment of this affection, that you may see what you think of the reasonableness of it. He says:

“Our first object is to quiet the pain by a full dose of laudanum.

“When this is attained, we may proceed to remove the cause, and to arrest any intestinal irregularity. Dr. Burns recommends aloetic purgatives, but these may not in many cases be suitable. If there be piles, as is very often the case with pregnant females, they will rather prove injurious than beneficial. I have found Gregory’s powder, electuary of sulphur and senna, or castor-oil, to answer the purpose better.

“During the intervals of the attack, tonics (of which oxide of bismuth or preparations of iron are recommended) or stomachics may be exhibited. A belladonna or opium plaster, or a blister over the stomach, is often very useful.

“Should the attack be very severe, bleeding, or leeches to the epigastrium, may be advisable; this will be especially the case should there be any symptoms of congestion about the head, and more for the purpose of preventing an attack of convulsions, than even for the relief of the gastric affection.”

Assuredly you will say that drug-treatment affords a variety of resources, notwithstanding it is so little to be depended upon.

I need hardly hint to you how much better, safer, and more effectual the water processes are than all the drugs of the materia medica to cure a case of cramp in the stomach.

If it is a bad case—acute, as we say—at once drink warm water enough to cause speedy vomiting.

The tepid clysters, used to the extent of gallons, that is, by repetition, if need be, is also a serviceable remedy.

We also use wet compresses, frictions, and the hip-bath, if necessary; but as a general fact, as soon as we cleanse the stomach and bowels thoroughly, the cramping ceases.

Afterward, as in all cases of stomach ailment, and all other ailments, great care should be observed in regard to the food.

TOOTHACHE.

Breeding with a toothache is an old proverb. Toothache is certainly more apt to occur during pregnancy than at other times, and not unfrequently it is a very early symptom of this state. And what may appear singular, the teeth ache without being diseased. Especially those who drink strong tea and coffee are more subject to this nervous toothache, as we may term it; toothache where there is no decay. Ceasing with the cause, then, is the surest means of relief.

Treatment.—It is dangerous to extract teeth in the early months of pregnancy. The operation has been often known to cause immediate abortion. There is the greater danger of this in the early months.

Bleeding has often been practiced for this affection in pregnancy; but that is a worse than useless resort, and moreover, generally fails of the object. After a few days of full diet, the affection is quite certain to return, and appears to be even the more obstinate for the bleeding. Fasting, with water-drinking, is a much better mode. Very seldom will toothache withstand twenty-four hours’ entire abstinence from all food. If the face has become much swelled, of course so great relief could not be experienced in so short a time. But even then the fasting is of incalculable good. General bathing, and going into the open air, are also excellent means. The rubbing wet-sheet is particularly applicable. And Dr. Burns, in his work on midwifery, years ago said, “Sometimes a little cold water held in the mouth abates the pain.” This will be the case whenever the toothache is one of inflammation; but if it be of the more nervous kind, warm water will give more relief. If the nerve is much exposed, it is perhaps always best to hold warm, or at least lukewarm water in the mouth, and at the same time to practice very brisk and continued rubbing of the face, temples, neck, etc., with the hand wet often in cold water. Wet bandages upon the face are also good. If the aching be of the nervous kind, that is, without inflammation, warm bandages, often repeated, afford the most relief.

I must repeat, that I hope none of you will ever consent to have your teeth extracted, or in any way operated on, while pregnancy exists.

JAUNDICE.

This, as a disease of pregnancy, is one that most frequently makes its appearance in the latter months of the period.

This state of the system should not be confounded with that in which the woman acquires a dark, almost yellow color, which, however, is not jaundice, and readily passes off after the delivery has taken place.

Causes.—In pregnancy, as at other times, this affection is often preceded by a disordered state of the stomach and alimentary canal generally. There is also, generally, a sense of weight and tightness in the abdomen, especially at the pit of the stomach, and in the right side. But in some cases none of these symptoms are observed.

Sometimes abortion has happened in connection with this state of the system; such, however, is not often the case.

Treatment.—If it is attended with violent symptoms, as is sometimes the case, it will be necessary to use active measures to cure it. In a majority of cases, however, a few days of abstemious living, alternating now and then with a day of entire fasting, together with plentiful drinking of pure, soft water, and a moderate share of bathing, will suffice to effect a cure. The wet-sheet pack is especially useful in these cases.