LETTER XX.. Drug-Treatment in Pregnancy.

DRUG-TREATMENT IN PREGNANCY.

Effects of Blisters—Emetics—Purgative Medicines—Bleeding.

I could hope that not one of the large number of persons whom I address, would ever be subjected to any of the processes of drug-treatment in so critical a period as pregnancy. The water-treatment I regard as being so much safer, as well as more effectual, for the eradication of any and all the diseases to which you may be subject at this time, as well as others, that I should be very glad if I could say something to inspire you with a greater degree of confidence in the new method. But perhaps I am wrong; some of you, at least, have the fullest confidence in the sanative powers of water, and have no need of any thing more being said on that point. It is proper, however, that I say something here respecting the effects of certain drugs and drug-appliances, in this period.

BLISTERS.

It is the testimony of honest and capable practitioners, that these are far more liable to do harm in pregnancy than at other times.

Dr. Dewees asserts that he had known two cases of abortion caused by the use of blisters, although he acknowledged they had, in some cases, been advantageously resorted to as a means of preventing that evil. But how, it may be asked, are physicians to know when to use them, and when not? This no man can tell. Nor have we any need of blistering at this or any time, because there are better means, which are entirely safe.

The same able author whom I just quoted, tells us that blisters are much more likely to produce strangury during pregnancy than in other cases; and that when this occurs, it is almost sure to be followed by the most distressing and untoward symptoms. Entire retention of urine sometimes follows the use of cantharides in these circumstances, which can only be relieved by the use of the catheter. There is also, at such times, not unfrequently so distressing an inclination and violence of effort to void urine, as to be surpassed only by the agony of labor itself. Bloody urine has sometimes followed the use of a blister; and a discharge of mucous from the internal surface of the bladder has continued, as a consequence, for a long time after. “It is true,” observes a distinguished author, “these are extreme cases; but they nevertheless occur, and should, therefore, suggest a great deal of caution in their employment, especially in the more advanced periods of gestation.”

EMETICS.

These are no more necessary in pregnancy than blisters. Severe vomiting is sometimes productive of abortion; and who is wise enough to foretell what may be the effect of a dose of tartar emetic given to a woman when in this highly impressible state? A single emetic has caused severe and permanent pain, which has been removed only after parturition has taken place.

PURGATIVE MEDICINES.

That pregnant women do not bear purging so well as at other times, is a matter of common observation among medical men. There is in such practice a great liability of causing abortion, especially if it be carried too far. It is not difficult to account for the fact, when we remember how great is the sympathy which exists between the womb and the bowels.

If you should be obliged, any of you, under such circumstances, to be purged, I advise you to see to it that you know what medicines you take. Those particularly which have a powerful effect upon the bowels should be avoided; aloes, colocynth, scammony, and gamboge, should on no account be tolerated. These have a particular effect in exciting the lower part of the alimentary canal, causing tenesmus or a bearing-down pain in the rectum, which, by sympathy, is very liable to be communicated to the womb. This is shown by the fact that dysentery often causes miscarriage.

BLOOD-LETTING.

Not many years since, it was generally supposed that a woman could not pass through the period of pregnancy safely without being bled; and although a change has been wrought in the public mind in regard to this practice, there are yet many who labor under erroneous impressions in regard to this subject. There are those who regard it as indispensable to resort to this measure, notwithstanding there may be no particular symptom that, under other circumstances, would be considered necessary to warrant a resort to the measure.

It must be admitted, however, that pregnancy is attended with a degree of fullness, and a tendency to plethora, which does not obtain in other states of the system. There is, indeed, always, during pregnancy, a greater liability to febrile and inflammatory diseases than is ordinarily experienced. But all this does not prove that blood-letting should be practiced in all, or in any considerable number of cases. Besides, also, it is doubted by many honest and able practitioners of the medical art, as to whether bleeding is ever, under any circumstances, necessary. There are others, too, who believe in the comparative necessity of blood-letting under certain conditions of the system, but who, at the same time, hold that there are better, safer, and more efficacious means of bringing about the required object. At all events, physicians very seldom, at the present day, resort to blood-letting during pregnancy, either in this country or the old; and in those rare cases in which this measure is resorted to, it is in answer only to indications of an imperative and decided nature.

Nor is the practice of blood-letting a comparatively harmless one, as many suppose it to be. “Why,” it is said, “if it is not absolutely necessary, it can yet do me no harm.” This is a poor recommendation of a remedy. If a remedy is not capable of doing harm under some circumstances, it would hardly be possible for it to do good at any time. The testimony of the strongest advocates for the practice is, that blood-letting has frequently been known to do serious, and sometimes irreparable mischief, when practiced during the period of which we are speaking.

Dr. Eberle gives the following good advice on this subject: “A very severe and troublesome pain is often experienced in the right hypochondrium during the latter period of pregnancy; and this suffering is, almost always, sought to be mitigated or removed by blood-letting. When decided evidences of plethora accompany this painful affection, bleeding will occasionally procure considerable relief; but in the majority of instances, no mitigation whatever is obtained from this measure. The relief which is sometimes procured by bleeding is always of short duration, the pain usually returning in the course of two or three days; and if the bleeding is thus frequently repeated, as is sometimes done, much mischief is apt to be produced by the general debility and languor which it tends to occasion. When the symptoms of vascular turgescence throughout the system are conspicuous in connection with this pain in the side, it will certainly be proper to diminish the mass of the circulating fluid by venesection; but when no indications of this kind are present, blood ought not to be abstracted, merely on account of this affection, for it will most assuredly fail of procuring the desired relief, and may, when not particularly called for, operate unfavorably on the general health of the patient. Moderation in diet, together with a proper attention to the state of the bowels, and the use of gentle exercise by walking, will, in general, do much more toward the removal of this source of uneasiness and suffering, than will result from blood-letting, when this evacuation is not specially indicated by the fullness and firmness of the pulse, or by other manifestations of general vascular plethora.”

But in these cases, when so careful a practitioner as Dr. Eberle even, would think it best to resort to the lancet, it is a well-attested fact, that fasting and prudent abstemiousness are far better, more effectual, and more permanent in their action upon the system than blood-letting. The hunger-cure, which I have so often for years past recommended, is a most valuable remedy in all plethora or over-fullness of the system, and in all kinds and degrees of pain arising from such fullness. See, too, how reasonable it looks; for the body, as you know, is always wasting itself, so that if we stop off the supply, the over-fullness must by a natural process very soon become cured; hence I say, do not be bled in pregnancy; and when you have need FAST.