LETTER XIX.. Disorders of Pregnancy.

DISORDERS OF PREGNANCY.

Nervousness—Mental Despondency—Longing—The Imagination—Effects of Fright.

During that portion of the woman’s life in which she is capable of bringing forth children, a period usually of about thirty years, the uterus may be justly considered as the great center of her system. The truth of no observation in medicine has been more generally acknowledged than that of the extreme irritability of this organ, and of the propensity or aptitude which the whole body has to become affected or disturbed by its influence. In the progress of the development of the procreative function, great changes take place; and in pregnancy these effects are not the less remarkable.

The changes which are wrought in the system by pregnancy are not less remarkable in the nervous system than in the other parts of the body. The womb itself is highly endowed with nervous connections and sympathies, and in many respects the uterus, during the child-bearing period, may be considered the great nervous center of the female.

When it is remembered how extremely impressible the nervous system becomes during pregnancy, we are taught the importance of preventing women, under these circumstances, from witnessing things that are calculated powerfully to excite the mind. This caution is especially to be observed in regard to exposing her to scenes of suffering, distress, danger, or the agonies of a death-bed. It is a sad thing for a pregnant woman to lose a husband, child, or other near and dear friend.

Pregnant women should be very careful to avoid the sight of convulsive and nervous affections. They should not, on any account, be present when another is in labor; for it has been observed that some become greatly terrified under such circumstances, while of themselves they are able to pass through its agonies with all commendable courage.

MENTAL DESPONDENCY.

When we consider how important an epoch the period of pregnancy is in a woman’s life, we cannot be surprised that her mind should sometimes fall into a state of depression, out of which it is not in her own power, or that of any who are about her, to recall it. In the first pregnancy especially, the mind is apt to become thus affected. Shall I be able to survive the period? Shall I bring forth a well-formed, or a diseased, misshapen, deformed child? Will it not present badly at birth? Shall I not have twins, or triplets, perhaps? What new and untold agonies must I be brought to endure? These, and the like questions, must suggest themselves to the mind of every sensible and reflecting woman, and more particularly so when she is carrying her first child. And so it should be; for, say what we will about the safety of labor, about its being a natural process, etc., there are yet the pains and perils which belong necessarily to it, and which all of your sex who bear children must inevitably, to a greater or less extent, be subject to. I have not, I trust, heretofore, in my medical lifetime, been wholly unmindful of my duty as a physician, in endeavoring to instruct and to encourage your sex in these matters. But I have never wished to conceal my conviction that I regard pregnancy and childbirth as things of very serious moment in a woman’s life; and he who can trifle with them is almost worse than a very fiend. Bear witness, then, I respectfully ask of all of you, that I, for one, have no sympathy with that nonsensical foolishness which would lead some people to tell you that pregnancy and childbirth are matters which need cause you no trouble, no agony, and no pain. I repeat, then, considering the truth in these things, it is not at all surprising that the pregnant woman should feel a good deal of concern in consequence of what she is to pass through.

But I must tell you also, that this mental solicitude is often increased to an unnecessary extent by the inadvertent remarks which are sometimes made respecting some unfavorable case. One tells of one sad accident, and one of another. Now all this is both unkind and unjust. Only place yourselves in the case of the pregnant woman. Would you like to have those strange and horrible stories told you, some of which may be true, and some not? Would you not rather that your sisters would speak to you, generally, at least, of pleasant occurrences, and of pleasant things? If they could not speak to you in a hopeful manner, certainly you would rather they would not speak to you at all.

Did you ever think of one of your sisters who is pregnant with an illegitimate child? If you who have kind husbands and kind friends to take care of you, become low-spirited in pregnancy, what must be the feelings of her who knows that she must constantly be looked upon as an object of shame? What think you of her who has been led astray by the profligate from virtue’s paths of pleasantness and peace? of her who is compelled to consider her pregnancy as a curse instead of a blessing, and who has, in addition to the troubles of this state, to bear up against the agony of her disappointed hopes, her sorrows, and her grief. She must live in anticipation of a shame from which she can find no antidote, no retreat. How often, alas! has such a state of mind ended in a state of disease which has, in a short period, terminated life. Believe we that Jesus of Nazareth would treat such a one as we too often have done, when we know that He said, kindly and affectionately, to a woman who had been caught in the very act of adultery, “GO, AND SIN NO MORE!” Many a one has been thus disowned who might have been a loving mother and an affectionate companion through a long and happy life, and whose death-agonies were only the more embittered by the reflections of her fallen and deserted state.

In ordinary cases depression of the spirits is most apt to come on during the earlier months of gestation. Dr. Montgomery speaks of a curious fact connected with the state of mind in pregnant women, when their bodily health is at the same time good, namely, that however depressed or dispirited with gloomy forebodings they may have felt in the early part of their pregnancy, they in general gradually resume their natural cheerfulness as gestation advances; and a short time before labor actually commences, often feel their spirits rise, and their bodily activity increase to a degree they had not enjoyed for months before. This, however, does not always take place, for in some cases the despondency continues to the very end of the period, at which time it generally disappears, but not until the pains of labor have actually commenced. With some, likewise, the despondency continues even after the labor has been passed through, and amounts almost to a fit of mental derangement.

Treatment.—It should always be remembered, that in most cases of the kind I have been considering, the state of health is not good. In some cases the deranged state of the body operates, doubtless, to depress the spirits and to derange the mental manifestations. In other cases the mind appears to become first affected, and afterward the body suffers in consequence thereof. In some cases, also, it is to be supposed that the action is reciprocal, and probably pretty fairly balanced between the two.

This explanation will enable us to form an opinion as to what the course of treatment should consist in, which is, as far as possible, to remove the causes of the difficulty.

In the slighter cases of mental depression a little improvement of the general health is often sufficient to work a radical change in the patient’s feelings. In the more persistent cases we should do all in our power to tranquilize the mind and restore the bodily health.

LONGINGS.

Some women, when pregnant, experience the most strange and wayward desires in regard to particular articles of food. This sensation is what is commonly called longing; and it is believed that if the preternatural craving is not gratified, a likeness or representation of the article longed for is very apt to be impressed upon the child.

It is true that some writers of eminence—as Professor Meigs, of Philadelphia, for example—have doubted the existence of any such sensation as the one in question; but the majority of writers are of the opposite opinion. Women also themselves—and they ought to be the best judges in a matter of this kind—do tell us that they know positively the truth of such a sensation as longing.

There are some remarkable facts on record concerning the symptoms which I am considering, and which would go to prove that it is not always the good things of this world that are longed for. If women were always in the habit of craving good and savory dishes under these circumstances, we should have some reason to suspect them of dishonesty in regard to the reality of longing; but when the fickle and morbid appetite is found often to crave the most unrelishable articles, we must admit the truth of the doctrine of which we are speaking.

A lady has been known, who, when not pregnant, having a great horror of eating eels, and yet when in this situation she has demanded them with an importunity not to be resisted. She would not only eat them with avidity, but in large and repeated quantities, for the first few months; she would then become indifferent to them, but not averse, until after her delivery.

A woman pregnant, riding over a common, has scented spoiled shad that had been thrown out, and became instantly so fascinated by their odor, that she obliged her husband to take some of them into his gig; and as soon as she arrived at home, began to eat of them, raw as they were, and continued to do so daily until they were consumed, though they were extremely offensive to every body else in the house.

A woman pregnant, while passing through her kitchen, has taken a disgusting piece of bacon boiling in a soap-kettle, out of the vessel, eating it afterward, with the greatest relish.

These are, it is true, extreme cases; but there are many which are far from being of a character so trifling as to warrant the conclusion that no such thing as longing for strange and disgusting articles during pregnancy exists. Indeed, the truth of the doctrine is so well understood among all classes as not to need any further proof.

Should these longings in pregnancy be gratified, and if so, to what extent? This is a question of great practical importance, and one which should be deeply pondered upon.

It is notorious, in the first place, that longing seldom, if ever, occurs in a woman of good health and a well-constituted mind. If we observe correctly, we shall find that it occurs seldom, if ever, in any other than delicate and nervously irritable women.

It occurs, in the second place, particularly among those who are indolent in their habits, having little or nothing to do, and without any wholesome object of thought or occupation with which to “kill time.”

It occurs, in the third place, to those who have been in the habit of being pampered and indulged on every occasion. A woman who is continually in the habit of saying to her indulgent husband that she wants this, that, and the other thing, and if the good husband sees fit to gratify his interesting spouse in every thing which a morbid fancy can imagine, he will have business enough to kill his time, and a feeble, sickly wife in the bargain.

If this longing occurs only to the feeble and delicate, to the nervous, the indolent, and those who have been habitually pampered, what, I ask, are we to do in the premises? Shall we gratify every whim of a nervous, unhealthy person, or shall we rather advise her to live on plain and wholesome food, at the same time directing her to occupy herself, body and mind, as a reasonable being should? It does not certainly require much common sense to enable one to settle this question as it should be.

But there are those among women who honestly believe that if their cravings are not satisfied in pregnancy, the child is very liable to become marked with an appearance like that of the article longed for.

The fallacy of this belief will at once be apparent, when it is considered how many cases of longing there are—cases, too, which are never gratified, while, at the same time, but very few children are ever found marked. The imagination can have no more effect here than in the cases of malformation, the absence or addition of a part, or in determining the color of a child. Hence a woman need not fear, as I have known them to do, that if their morbid appetite is not gratified in every particular, they are in danger of bringing forth a marked child. But more of this in another place.

Some physicians are of the opinion, it is true, that it is best to gratify longings to a certain extent. But suppose they are not gratified: the worst that can come is sickness at the stomach, nausea, and possibly vomiting—symptoms which, all of them, vanish soon enough, ordinarily, if the diet is made what it should be, in connection with good habits generally.

The truth is, that the mind itself is more disordered than the stomach in these cases. Hence an important consideration in the cure of it is, to provide the individual with some useful and wholesome employment, which at the same time engages both the mind and body healthfully. At the same time the food should be of such a character as is best suited to a delicate state of the system, remembering always, that there is no period of life in which more care is necessary, in this respect, than in pregnancy.

But if, on the other hand, the preternatural craving is indulged, and the mind is left to prey upon itself, as it will without any suitable employment, the sensation will grow more and more persistent, and the fancy will be continually excited to produce new whims for its gratification, which, if answered, must necessarily be attended with detriment to both mother and child.

THE IMAGINATION.

Women are sometimes troubled about certain matters in pregnancy, which, if they had a proper knowledge on the subject, would cause them no mental disquietude whatever. Thus it is believed that the marks which sometimes appear on children, and continue through life, are to be attributed entirely to the workings of the mother’s imagination during this period, and that even the color of the offspring may be determined by this circumstance alone.

The origin of this belief is, indeed, coeval with the history of the race. But antiquity alone is not a sufficient argument for any doctrine, no matter how old or how venerable a theory, if we know it to be disproved by the actual facts. If we were to take the antiquity of a doctrine or belief as the rule, and not have regard to reason and experience there would be no end to error, and no improvement.

In the earliest period of medicine this delusion prevailed; and Hippocrates, honest and learned as he was, yet believed it, and aided in its propagation. Through his influence kings and nobles acted upon the principle, which, in some cases, at least, was made the cloak of wickedness and deception. Thus Hippocrates saved a noblewoman—and honestly, without doubt, though ignorantly—from the severity of the law, when she had given birth to a colored child, herself and husband both being white. He alleged that the darkness of its color was the effect of a picture of an Ethiopian that hung upon the wall in her chamber, and which was often the object of her contemplation. Galen was also of the opinion that a picture was sufficient, if contemplated with interest, to give a corresponding appearance to the fetus in utero; and Soranus declares that the tyrant Dionysius, who was deformed and ill-favored himself, employed the aid of beautiful pictures, with the hope that his wife might have comely issue. Cælius Rhodius also mentions that Fabius Quintillian saved a woman from suspicion, after she had brought forth a negro child, by asserting that the circumstance arose from the fact of her taking great pleasure in viewing the picture of a black man in her apartment. From the prevalence of this belief it was, likewise, that Heliodorus formed the first, and, as is said, one of the most beautiful novels in the world, called the “Loves of Theagenes and Carachlea,” the latter having been born white from black parents, but the queen, her mother, had often viewed, during her pregnancy, the picture of Andromeda, who was painted with a white face; and the sages attributed the white color of the child to the force of the mother’s imagination.

This superstition—for it does not deserve a better name—has probably always been believed in the world, and for a long time will continue to be by many, but not to that extent which it anciently was. We cannot believe, if cases like these, occurring in the time of Hippocrates and Quintillian, were to occur in our own day, and were now to be presented for judicial decision, that any judge or jury could be found so ignorant as to decide that the color of a child can be changed by force of the mother’s imagination alone; but things scarcely less ridiculous and absurd are believed by almost every member of society who has any belief whatever on the subject. Thus it is now a matter of common belief, that the imagination of the mother may impose upon the skin certain resemblances to things upon which the fancy has been much employed, such as fruit, articles of food and drink, animals, insects, etc., or by the destruction of certain parts of the body, such as the head, arms or legs, lips, etc., or by the production of an additional part, as the fingers, toes, head, etc.

In order to settle this question satisfactorily, and beyond the possibility of mistake or doubt, it is well for us to look at the facts of nature as they exist everywhere about us, or, in other words, to the anatomy and physiology of the human body as it really is.

In regard to the anatomical connection between the mother and fetus, it is to be observed that it is altogether indirect, and is carried on only through the medium of the circulation. There is no nervous connection between mother and child; that is, no nervous filament, however small, has ever been detected passing from one to the other. “From this wise and all-important arrangement,” observes Dr. Dewees, “it follows that the fetus is not subject to the various and fluctuating condition of the sanguiferous, or to the never-ending changes of the nervous system of the mother; since no direct communication exists between her blood-vessels or nerves and those of the fetus, to impose upon it any alteration that may take place in her system, or to render the child liable, through the medium of nervous connection, to her affections.” If the indirect connection that exists between the mother and child were better understood, and more justly appreciated, we should, doubtless, hear much less of the influence of the imagination of the mother upon the body of her infant, and thus one of the greatest of the attendant evils of pregnancy would be removed.

It is not to be denied that cases do occur in which there seems to be a hereditary predisposition to the perpetuation of supernumerary parts, marks, etc., in certain families; such as an additional thumb, finger, toe, or double teeth, in place of single; but such cases are not the result of any mental emotion, but are merely the effect of hereditary predisposition, the truth of which is admitted on all hands, and is a very different thing from that which we are now considering.

It has not been attempted, on the part of any, to determine at what precise period during pregnancy the imagination begins or ceases to have an influence upon the body of the child, but, according to the accounts given, every period is liable to the accidents or anomalies in question. The imagination, it is supposed, has the power, not only of causing the creation of a new part, but also of destroying one or more of the members of the body. Now, suppose a leg, an arm, or a toe, to be cast off, must it not be expelled from the womb? And who has ever detected such an occurrence? Besides, too, is it to be supposed that nature would arrest the flow of blood after the part has been separated from the body of the fetus? There can be no doubt as to what is the truth in this matter.

Dr. Dewees mentions the case of a child that was born with but the stump of an arm, which, at the time of birth, was perfectly healed, or, rather, presented no evidence of ever having had a wound upon it at all. The mother declared that she had been frightened at the sixth month of pregnancy by a beggar. But what became of the lopped-off arm? and what arrested the bleeding? The child was born healthy and vigorous, and neither scar, wound, or blood could be discovered. In this case, as in all others of this kind, the “freak of nature” commenced at the first of gestation, the imagination of the mother having nothing to do with it.

The most learned and experienced medical men are all agreed on this subject. Dr. William Hunter, it is said, used to declare in his lectures, that he experimented in a lying-in-hospital upon two thousand cases of labor, to ascertain this point. His method was as follows: As soon as a woman was delivered, he inquired of her whether she had been disappointed in any object of her longing, and what that object was? If her answer were Yes, whether she had been surprised by any circumstance that had given her an unusual shock, and of what that consisted? Whether she had been alarmed by any object of an unsightly kind, and what was that object? Then, after making a note of each of the declarations of the woman, either in the affirmative or negative, he carefully examined the child; and he assured his class that he never, in a single instance of the two thousand, met with a coincidence. He met with blemishes when no cause was acknowledged, and found none when it had been insisted on.

Dr. Hunter, however, confessed that he met with one case in his private practice that puzzled him; and he told his pupils he would merely relate the facts, and leave them to draw their own conclusions. A lady had been married several years without proving pregnant, but at last she had the satisfaction to announce to her husband that she was in that situation. The joy of the husband was excessive, nay, unbounded, and he immediately set about to qualify himself for the all-important duty of educating his long wished-for offspring. He read much, and had studied Martimus Scribelerus with great patience and supposed advantage, and had become a complete convert to the supposed influence of the imagination upon the fetus in utero. He accordingly acted upon this principle. He guarded his wife, as far as in him lay, against any contingency that might affect the child she carried. He therefore gratified all her longings most scrupulously; he never permitted her to exercise but in a close carriage, and carefully removed from her view all unsightly objects.

The term of gestation was at length completed, and the lady was safely delivered, by the skill of Dr. Hunter, of a living and healthy child; it had, however, one imperfection—it was a confirmed mulatto. On this discovery being made, the father was at first inexorable, and was only appeased by his dutiful and sympathizing wife calling to his recollection the huge, ugly negro that stood near the carriage door the last time she took an airing, and at whom she was severely frightened!

Dr. Dewees, whose experience in matters connected with the birth of children was probably as great as that of any other individual, tells us that he commenced practice with the popular belief concerning the effect of the mother’s imagination upon the physical condition of the child. But he had watched these things attentively for many years, and for the want of facts to substantiate the truth of the common belief, he was obliged to abandon it. He came to the conclusion that the imagination of the mother has no influence whatever upon the form or complexion of the fetus.

Fortunately, these absurd notions have long since been rejected by all sensible, observant, and intelligent physicians; and the fact that multitudes of those who are, or are to become mothers, do yet believe them, is the only reason for attempting a refutation of them. If we can but convince mothers of the fallacy of the belief we have been combating, we shall save them a great amount of anxiety and alarm. With many, who are not by any means to be classed among the “weak, ignorant, and superstitious” of females, every sudden or unexpected occurrence that happens to strike them with fear, or produces any strong mental emotion or excitement, is apt to impress them with alarming apprehensions as to the effects it may have on the development and conformation of the child in the womb. These ridiculous illusions, moreover, are often much increased by the strange stories respecting marks and malformations, occasioned, as is asserted, by the imagination of the mother; and these narratives always find their way among the credulous in society; for ignorant nurses, and gossiping idlers among the old women, are everywhere to be found, and all of them are well stocked with extraordinary examples of the pretended influence of which we are speaking. If a child is born with any spot or blemish upon its body, or with any malformation whatever, forthwith the mother is questioned as to the whole circumstances of the matter. If, at any time during pregnancy, any thing has attracted her attention, or strongly impressed the mind, which bears any resemblance or similitude to the mark, spot, blemish, or malformation of the child, it is at once put down as the certain cause of the defect. In this way these absurd apprehensions are often made to take so deep a hold upon the mind of pregnant females, that no expostulation or ridicule of the physician, or other friend, can entirely subdue them; and in some instances these apprehensions become so fixed as to cause a great degree of anxiety and distress of mind, and not unfrequently cause a great amount of physical suffering and ill health.

EFFECTS OF FRIGHT.

I have already remarked that the mind of the pregnant woman should be kept as calm, composed, and contented as possible during the pregnant state. In no respect is this advice more appropriate than in regard to the strong impressions of fear and every sudden emotion of an unpleasant kind.

Some of the most remarkable cases illustrative of the effects of fright in pregnancy, are given by Baron Percy, an eminent French surgeon, as having occurred at the siege of Landau, in 1793. It is stated that, in addition to a violent cannonading, which kept the women for some time in a constant state of alarm, the arsenal blew up with a terrific explosion, which few could listen to with unshaken nerves. Out of ninety-two children born in that district within a few months afterward, sixteen died at the instant of birth; thirty-three languished for from eight to ten months, and then died; eight became idiotic and died before the age of five years; and two came into the world with numerous fractures of the bones of the limbs, caused by the cannonading and explosion! “Here, then,” as Dr. Combe observes, “is a total of fifty-nine children out of ninety-two, or within a trifle of two out of every three, actually killed through the medium of the mother’s alarm, and its natural consequences upon her own organization.” Cases are recorded, in which the mother, being abruptly informed of the death of her husband, has suffered an immediate miscarriage in consequence. In some cases the child has survived, but has afterward, throughout life, been subject to great nervousness and liability to fear. James I., King of England, is said always to have had a constitutional aversion to a drawn sword and to any kind of danger, which was attributed to the constant anxiety and apprehension which his mother suffered during the period of gestation.

It will appear very plain to any one who is at all acquainted with this subject, that an impression which is powerful enough to cause such effects upon the child as the cases given by Baron Percy would indicate, must also act with detriment upon the mother. Indeed, it is only through the mother’s organization that it is possible for the impression to be communicated to the child; and although the mother’s life is not often actually destroyed under such circumstances, her nervous system may yet receive a shock which is sufficient to cause her life-long misery and ill health.

The practical lessons to be drawn from such facts are many, and, for the most part, easy to comprehend. They teach us how important it is that a woman who is pregnant should, by all that is in her power, shun scenes of fear and danger. Husbands, and all who are in any way connected with her, should spare no pains in rendering this important and trying period of her life as happy and tranquil as the circumstances will allow. True, she should not make a baby of herself, or be babied by others; but, considering the liability to danger while in this condition, she should be careful of herself, in all respects, while passing through the period, and those about her should use all due caution in regard to it.