LETTER XVIII.. Disorders of Pregnancy.

DISORDERS OF PREGNANCY.

Difficulty of Breathing—Pain in the Right Side—Itching of the Genitals—Swellings of the Limbs—Cramps of the lower Extremities—Pain of the Breasts—Hysteria—Physical Hindrances—Exposure to Disease.

Toward the latter months of pregnancy, there is always, necessarily, more or less difficulty. The uterus becomes so large, and fills so much of the abdomen, that the upward and downward motion of the diaphragm, or partition between this and the chest, is greatly impeded. Hence the dyspnœa, or difficulty of breathing. A cough, likewise, not unfrequently attends this symptom, and becomes so severe in some cases as to cause abortion.

Prevention.—Great and protracted exertion, severe fatigue of whatever kind, bodily or mental, ought to be avoided during pregnancy. Running up stairs too quickly, walking too rapidly, and any undue mental excitement, increases this difficulty of breathing. Some mothers are in the habit of taking up heavy children needlessly, and carrying them, which is one of the most certain means of doing harm to themselves. So also, inaction is bad for the breathing. If the individual do not have exercise enough to answer the purposes of health, the system becomes more plethoric or full, and thus also the difficulty is increased. The medium of neither too little nor too much should always be observed. The same also may be said of the diet. And here I remark, that if any pregnant woman will carefully make the experiment, she will find that in the latter months of pregnancy, an exceedingly small allowance of food only, with free water-drinking, bathing, and moderate exercise in the open air, will be sufficient to keep up her strength, and that in a most remarkable manner. Let her not be deluded by the old maxim, that because there are two to support she must take a greater amount of food.

PAIN IN THE RIGHT SIDE.

After gestation has passed the middle of its term, there is experienced often more or less pain in the right side. This does not usually happen until after the beginning of the fifth month of pregnancy. It comes on as a deep-seated pain in the immediate region of the liver; often it is merely a trifling sensation at first, increasing as pregnancy advances. It is not increased by ordinary inspirations, as many internal pains are, although a very full and deep inspiration may augment it in a slight degree. The pain is seldom, almost never, very great; it is constant both day and night, but worse in the latter. The patient can lie on either side, but better on the left. A severe sensation of heat is sometimes experienced at the part where the pain exists. This is sometimes almost constant, at others only occasional, and in still a greater number of instances, nothing of the kind occurs.

Women are more subject to this affection during the first pregnancy than at subsequent times. It may, however, be experienced after a number of children have been borne; this is true more especially in those cases when the child is carried “high up,” as it is called. This comes from the fact, that the pain is caused by the pressure of the upper part of the womb upon the liver, which lies mostly upon the right side.

Treatment.—No material harm can be said to come from this pain, and for this reason no harsh and severe medical treatment should be adopted with a view of removing it. Bleeding is well known to be a common remedy for ordinary pains in the side. But Dr. Dewees, of Philadelphia, whose experience was so great in all matters pertaining to midwifery, remarks of this practice, that so far as he had seen it, not the slightest advantage had arisen from it. “Nor,” observes this candid writer, “has any other treatment which we have advised been any more successful. Leeching, cupping, and blistering, have in turn been employed without benefit. Indeed, we have now ceased to prescribe for this complaint, unless it be attended with some alteration in the circulating system; if this be disturbed, and the pulse tense and frequent, advantage is sometimes experienced from the loss of blood and gentle purging, as this pain may be aggravated by this condition of the system. But in this instance, we prescribe for the general condition of the system, and not for the local affection—as we should have to do most probably as much, were this pain in the side not present.” These are the candid remarks of one whose experience in treating diseases of women was as great, probably, as that of any other man, showing conclusively that ordinary means are of no avail in this difficulty.

Now I can speak confidently in this matter. The water processes are effectual in mitigating this pain much, to say the least. I conclude it is rather a symptom of debility than otherwise. I do not believe it natural. Bathing to support the general strength, and particularly the wet girdle, often rewet, especially in hot weather, so as to keep it at all times cool, and hip-baths, with a good share of friction by the wet hand over the part affected, will be found excellent means. The immediate relief caused by the application of the wet girdle will be often astonishing. Keeping the bowels freely open, as by the habitual use of brown bread, mush, and the like, and injections of cold water, are also of service here.

But if, in any case, the pain resists all remedial means, and as we have before said, those of a severe nature should never be resorted to, the individual should not allow her mind to become depressed by thinking that harm must inevitably be caused in consequence of it.

Too much, as well as too little exercise, may cause this difficulty. A proper medium should therefore at all times be observed.

ITCHING OF THE GENITAL ORGANS.

Pruritus pudendi, or itching of the genital parts, becomes sometimes a most troublesome and distressing complaint in pregnancy—so troublesome, indeed, as utterly to set decency at defiance. Cases under the ordinary modes of treatment, have been known to be so severe as to compel the lady to remain in her chamber for months.

The causes of this affection cannot always be ascertained. A want of proper cleanliness is no doubt often one of the principal sources of it.

A great variety of remedial means have been used in this disease. Astringents, such as alum, borax, acids, etc. are the agents indicated. But cold is the greatest astringent of all; no matter how troublesome the affection, it is completely within our control by the use of cold hip-baths, cold cloths, ice, and the like. In a late number of Braithwait’s “Retrospect,” one of the leading English periodicals of medicine and surgery, it is stated by Dr. James Arnott, “that a most distressing attack of this affection was completely subdued by two congelations, each of about thirty seconds’ duration, after a prussic acid lotion and other routine applications had been tried in vain.” By “congelation,” Dr. Arnott means the application of intense cold, by the use of ice between cloths, or some freezing mixture, but not an actual freezing of the parts, as some might suppose. But shallow hip-baths of cold water from a well, persevered in, will be found sufficient in every case.

It should be remembered that uncleanliness is a most fruitful source of this troublesome affection.

SWELLINGS OF THE LIMBS AND VARICOSE VEINS.

Swellings of the lower limbs, and varicose or knotty and swelled veins, may occur in pregnancy from the same causes as piles and hemorrhoids, namely, an obstructed circulation.

Washing the parts affected with cold water, and attention to the general health, are the means to be used here. Do no violence to the system. The exercise should be moderate. Nor should the woman be too inactive; the medium course in all cases is the better rule.

If the patient can find time to lie down a number of times during the day, removing her clothing at each time, she will find the practice a good one.

CRAMPS IN THE LOWER LIMBS.

Toward the close of pregnancy, cramps may occur in the lower extremities, because of the pressure of the child upon the large nerves that pass down them. This is seldom very troublesome, and cannot, of course, be altogether prevented. Too great fatigue, and any thing that tends to depress the general health, will at least make the matter worse than it otherwise would be.

PAIN IN THE BREASTS.

Mastodynia, or pain in the breasts, is more common in the first pregnancy. Compression by clothing may cause the difficulty. Washing the parts with cold water, and wet bandages or cloths worn upon the parts, are the means to be used. If the pain is of a spasmodic kind, it may be best in some cases to use warm fomentations.

HYSTERIA.

There appears to be with many a greater tendency to hysterical symptoms during pregnancy, than at other times.

Hysterical females are, for the most part, those who live a life of excitement, attending frequently balls, theaters, and public exhibitions late at night, and especially such as are much addicted to tea and coffee drinking, the use of concentrated and stimulating food, and have little exercise in the open air.

Treatment.—Medicines, especially the preparations of opium, also have a tendency to cause hysterical symptoms. Pregnant women should, then, as far as possible, avoid these causes of so pitiable a disease. Whether in pregnancy, or at other times, hysteria cannot come upon those who live correctly, and maintain at all times good and permanent health. I will here further remark, that all novel reading should be avoided during pregnancy; and the less the better, I may say, at all times, of such novels as ninety-nine hundredths of all that are put forth at the present day.

PHYSICAL HINDRANCES.

There are various mechanical inconveniences connected with this state. In the earlier months more particularly, there is pressure upon the rectum, causing a tendency to constipation. This should be guarded against, not by “the due administration of mild laxative medicines,” for that only tends to make matters worse in the end, but by the use of proper food, such as cracked wheat or rye, brown or unbolted bread, Indian mush, well boiled, and good fruits and vegetables, in their season. Exercise, employment, daily bathing, and clysters, tepid or cold, according to the season, and the patient’s strength, should all be brought to bear in the case.

Pressure upon the urethra, or neck of the bladder, is also one of the mechanical evils of pregnancy, rendering the evacuation of urine difficult, and sometimes painful. To prevent this, the patient should be exceedingly careful to evacuate the bladder frequently, and never to allow the calls of nature to go unanswered; nor should she stand or walk too much at a time, as this is calculated, in a powerful manner, to increase the difficulty. The same may be said in regard to the feeling of weight which is experienced in the loins during the early part of the period; and in reference to all these mechanical evils of pregnancy, I remark that it is of great service for the patient to recline, for a short period, a number of times a day. If she is of active disposition and habits she may not feel inclined to do so; yet she will find the practice a good one, and productive of much comparative comfort.

If the abdomen becomes too pendulous, as it sometimes does, owing to the flaccidity of the abdominal parietes, a considerable degree of relief may be obtained from stays of a proper construction. These, however, should be so fashioned and arranged as not to overheat the parts, otherwise they will be made weaker, and thus more harm than good will be the result. The wet girdle, suitably applied, is an excellent appliance. Nor should any of these helps be used too much of the time.

EXPOSURE TO DISEASE.

Pregnant females should not expose themselves to infectious diseases; although it appears to be established that they are not, under such circumstances, as liable to contract such disease as at other times. Still, if they do contract them, the result is likely to be a more serious one; and in case the mother escapes, the child may suffer, and abortion, even, may be the result.

VACCINATION.

I am opposed to vaccination at all times. It is better, I believe, to live carefully and consistently in all respects, and trust nature for the result. There are many objections to vaccination, which I need not here mention. Pregnant women especially, who are necessarily, in the present state of things, more than others, subject to inflammatory diseases, and less liable, when attacked by acute disease, to recover therefrom, should not be vaccinated. Here are Professor Meigs’s earnest injunctions on the subject. Writing to his class, he observes:

“Pregnant women ought not to be vaccinated. This is a rule which I would advise you to depart from only on the most urgent occasions. If a woman have been ever vaccinated, and appeal to you to re-vaccinate her, because there is a prevalent variolous epidemic, I hope you will refuse to accede to her request. Small-pox is exceedingly and peculiarly pernicious to pregnant women. She who has it, and miscarries, or who is brought to bed at term, generally dies. It is, in my opinion, inexcusable to expose her to so great a risk—a risk far greater than that from accidental contagion, or that of the epidemy. But the vaccine is identical with the variolous animal poison, saving some lessened intensity of its malignant form, derived from its having been modified by the nature of another mammal. To inoculate a cow with small-pox virus, is to give her the vaccine disease, with the lymph of which you can vaccinate, but not reproduce unmodified small-pox. Keep your pregnant patients clear of small-pox, in all its forms, whether modified or unmodified. Do not vaccinate them. I have been the witness of dreadful distress from the operation. Eschew it, I entreat you.”

By way of digression, we may inquire, if pregnancy is an objection to vaccination, why should any person be vaccinated? If those who are in a condition which renders them most susceptible of disease should not be exposed to the variolous poison, why should others who are less susceptible? If any are to take the risk of small-pox without vaccination, I think the strong can afford to do it, rather than the weak. If vaccination is good for any thing, it should be, I think, the most worth for those who are the most liable to harm from the variolous disease.