Part 10

When first observed, if the veins have not become knotty,—that is, having little lumps or swellings in their course up the leg,—the only means which it is necessary to employ, is the application of a muslin or cotton bandage,—six yards in length, and as wide as three fingers—from the sole of the foot up to the knee, and sufficiently firm to give support to the venous trunks. This bandage well and equally applied to the limb, with a little aperient medicine twice a week, and the recumbent position for two or three hours in the middle of the day, will cure this form of the affection.

When after a time the veins, more and more distended, have become lengthened, tortuous, coiled up or knotty, the female begins to experience a sense of heaviness, numbness, and sometimes very acute wandering pain, through the whole of the affected limb. In a more advanced stage, in proportion as the knotty tumours increase, the limb becomes generally swollen.

This form of the disease calls for much care and patience on the part of the sufferer. The legs should be strapped, from ankle to knee, with strips of adhesive plaster, and over this a muslin or cotton bandage must be applied with a moderate degree of tightness, and kept wet with goulard water. In conjunction with these local appliances, it is sometimes wise to lose a few ounces of blood from the arm, and always necessary to take every other night a gentle aperient, to live upon a spare diet, and for some days to keep the horizontal posture. An elastic laced stocking made for the purpose may be afterward worn, and will be found at once a sufficient support to the limb, and a source of great comfort to the wearer.

Swelling of the Feet and Legs.

In the course of pregnancy, during the latter months particularly, the feet and legs frequently become much enlarged. It is partly owing to the pressure of the womb, but sometimes apparently independent of it. It is first observed towards night, about the ankles; by degrees the swelling rises higher, and the legs may become of a very large size. The female suffering from this complaint, always goes to bed with legs much swollen, but towards morning her face swells, and the enlargement of the legs disappears to a greater or less extent, returning, however, as the day advances.

Sometimes this disease is very trifling in its character, and in ordinary cases, except aperients, no medicine is necessary, and support may be given by a well-applied flannel roller; but when the swelling is extensive and permanent, remaining in the same degree after the patient has been for several hours in bed, and connected with uncomfortable sensations in the head, an accelerated pulse, &c., a medical man ought to be consulted, for the consequences might otherwise be dangerous.

Palpitation of the Heart.

If this affection occur for the first time during pregnancy, it is rarely connected with disease of the heart itself; it is therefore without danger, although very distressing. Occasionally there is connected with it throbbing of the vessels in the temples, as also in the abdomen; the latter not unfrequently mistaken by the patient for the beatings of the heart itself.

It will make its attack repeatedly in the course of a day, particularly after a meal; and very frequently at night, on first lying down in bed; and it may be brought on at any time by the slightest agitation of mind.

Treatment for an attack.—When it comes on it is to be relieved by putting the hands and arms up to the elbows in water, as warm as can be borne—friction with the warm hand applied to the feet—absolute rest—and taking the following draught: Compound spirits of ammonia, half a teaspoonful; Camphor mixture, a wine-glass. It may be repeated again in an hour or so, if necessary. It will be well to keep a bottle of this mixture in the bedroom; a resource will always be then at hand, and the dread which attends anticipation in a great measure removed. This is the more necessary, as an attack, if it comes on in the night, is always very distressing. The patient awakes, perhaps, out of a frightful dream, with a sense of fluttering in the region of the heart—calls out for breath—begs to have the curtains of the bed withdrawn, the door of the room opened—and will tell you she feels as if she was dying;—wine, brandy, any stimulant that is at hand is resorted to, for the husband or friend of the patient is naturally much excited, and in his alarm scarcely knows how to act. Now there is no occasion for alarm; the sufferer must be assured of this; her mind must be soothed and quieted; the means just pointed out for the relief of a paroxysm must be used; the palpitation will after a little time cease, and the patient will drop off into a quiet and tranquil sleep.

These attacks may be prevented by taking for ten days or a fortnight a teaspoonful of the following electuary three times a day:—Carbonate of iron, one ounce and a half; syrup of ginger, one ounce and a half. The bowels must be carefully regulated; a tablespoonful of Elixir Prop. is the best aperient, provided there are no piles. Fatigue and all exertion must be avoided, and the mind kept perfectly tranquil.

Fainting Fits.

Fainting may occur at any period of pregnancy; but is most frequent during the first three months, and especially about the time of quickening. It may come on when the person is at perfect rest; but is ordinarily produced by unusual exertion,—exposure to heat,—or any sudden excitement of the mind. The paroxysm or fit is sometimes of short duration; and the female does not lose her recollection; she has a knowledge of what is going on about her, and soon recovers; but in other instances the fainting fit is complete and of long duration, continuing for an hour, or upwards.

The treatment during a fit.—This consists in immediately placing the patient in a recumbent posture—the use of pungent volatiles—sprinkling the face with cold water—free exposure to air, and the cautious administration of cordials. And if the fit continue long, the extremities must be kept warm, and the friction of a warm hand be applied to the feet.

It is scarcely necessary to add, that those who are subject to these attacks ought to avoid fatigue—crowded or hot rooms—fasting too long, quick motion, and agitation of mind. The bowels must be attended to; and a wine-glass of the infusion of columbo or cascarilla, taken every morning, will be useful in giving tone to the system.

After a few weeks the disposition to fainting will altogether subside, and although a very alarming state to those who are inexperienced, yet the subject of it should never allow her mind to be depressed, or to anticipate an unfavorable result. Pure air, simple diet, and regular exercise, as we said above, will do much to prevent it.

Toothache.

This may appear a trifling disease, to notice in connexion with the subject before us: but, in the course of pregnancy, females will sometimes suffer severely from erratic pains in the face and teeth. As these pains are generally induced by the increased irritability of the nervous system, the result of the new action which is going on in the womb, and not from the decay of any particular tooth, extraction of any tooth for its cure is out of the question. Indeed, did the suffering arise from a carious tooth, its removal is unadvisable, inasmuch as this operation has been immediately followed by a miscarriage. The fact is, that the patients who have consulted me while suffering from this affection, have had, apparently, in most cases, very sound teeth; and, feeling confident that its cause has been what has been before pointed out, the treatment has been purely constitutional. The following pill may be taken, night and morning:—Socotrine aloes, one grain and a half; blue pill, two grains; together with one drachm of the rust, or carbonate of iron, mixed with treacle or milk. The latter must be repeated twice a day for four days, and then a third dose may be added in the middle of the day; and the remedy continued, even after all uneasiness in the face has subsided for some time, with great advantage to the general health.

The only local application I would advise, is that of washing out the mouth and teeth, night and morning, with salt and cold, or lukewarm water. This plan of treatment not only relieves the painful affection of the face and teeth, but allays also that local irritability of the nerves, upon which it depended.

If a carious tooth seems alone affected, it has been proposed carefully to apply a drop or two of nitric acid, which is said to be infallible; a drop or two of oil of kreosote or cajeput is frequently useful.

Salivation.

A pregnant female must not be surprised, if, some little time after conception, or during any of the months of gestation, the ordinary quantity of saliva, which lubricates and keeps the mouth constantly moist, should increase to such an extent as to be exceedingly troublesome; and, indeed, sometimes become so excessive, as seriously to affect her health. It is a symptom of pregnancy, but a very unusual one; although the quantity of saliva discharged has now and then exceeded three, and even four pints daily.

It differs essentially from the salivation produced by the exhibition of mercury, inasmuch as in this case, there is no tenderness of the gums, or disagreeable fœtor in the breath. The fluid itself is either perfectly colorless and transparent, or more tenacious and frothy. It has an unpleasant taste, and, when tenacious, induces vomiting. It is generally accompanied with acidity; and the plan of treatment most advisable, when the disease is moderate in its character, is the frequent use of from twenty to thirty grains of magnesia, say every morning, rinsing the mouth out very often with lime-water, and to resist the desire to discharge the saliva from the mouth as much as possible, for, if it is not very great in quantity, it may be swallowed to advantage. Should this symptom, however, be very excessive, the health will suffer considerably in consequence, and the assistance of the medical man is imperatively called for.

A Painful and Distended Condition of the Breasts.

Pain and tension of the breasts frequently attend, as also they are natural consequences of, conception.

In a first pregnancy, a large and rapid development of this organ may take place, the breast becoming two or three times as large as before marriage; but if tight lacing be only avoided, and the breasts be permitted to expand, no material inconvenience will arise from this circumstance.

As, however, these symptoms are sometimes attended with considerable distress, I would advise, under such circumstances, the application of half a dozen leeches, or more, tepid fomentations, and a gentle aperient—two drachms of Epsom salts in a little peppermint water—night and morning. These means, by relieving the over distension and fulness of the vessels of the part, remove the cause and complaint at once.

If these symptoms occur to a female who may have been several times pregnant, and formerly has had an abscess in one or other breast, that bosom is generally most painful which was before affected, and there will be an increased hardness about it, which may give rise, perhaps, to the apprehension of an abscess again forming, or, what is much worse, to the disease terminating in cancer. Both these fears are groundless: and, if she will only use fomentations, gentle friction frequently during the day, with almond oil and laudanum—about a drachm of the latter, to an ounce of the oil, warm,—and exercise patience, everything will do very well.