WAKEFULNESS.
Sleeplessness, always distressing, is particularly so to pregnant women.
If prolonged, it leads to serious consequences. It should receive, therefore, the most prompt attention.
The _causes_ of sleeplessness during pregnancy are numerous. Dyspepsia is one of them. Whenever indigestion is present the diet should be plain and simple, and everything avoided which produces heartburn, sourness, or flatulency. It is important also not to take tea or coffee late in the afternoon or evening--a late cup of either being a frequent cause in itself of sleeplessness.
Sometimes the reason for the wakefulness will be found in a want of exercise or too constant confinement to closely-heated rooms. Or, it may be that exciting novels are read late in the evening. Perhaps the evening meal is too heavy and taken too late.
The _treatment_ of sleeplessness consists first, of course in the removal of the apparent cause. The patient should have a regular hour for retiring, which should be an early one. The bed-room should be quiet, well ventilated, and slightly warmed. The bed coverings must not be too heavy nor the pillows too high.
A warm bath of the temperature of 90 to 96 degrees Fahrenheit, taken just before going to bed, often invites sleep. A rapid sponging of the body with warm water may have the same effect. A tumbler of cold water, when the skin is hot and dry, swallowed at bed-time, sometimes affords relief. If the bowels are constipated relief should be sought in the manner we have just mentioned in speaking of constipation.
When there is nervous excitement at night, and the means we have advised fail to propitiate "nature"s soft nurse," there is a sedative medicine which may be used with safety and effect--it is bromide of pota.s.sium.
The same proportion which we have given for the treatment of morning sickness (see page 355) may be now used. Have the three-ounce mixture put up by the druggist, and take a dessert-spoonful or a table-spoonful just before bed-time. It frequently acts almost as if by magic. On no account should recourse be had to opiates or dangerous sedative drugs.
DISEASES OF CHILDBED.
Childbirth being a healthful physiological condition, is usually neither attended nor followed by mischievous results. Occasionally, however, the mother suffers in consequence of the prolonged or difficult character of her labor. The longer the labor the greater the danger to both mother and child. Thus childbirth pangs prolonged beyond twenty-four or thirty-six hours are much more apt to be attended with danger or followed by disease than those terminated within a few hours.
The following aphorisms were laid down by the late distinguished Professor James Y. Simpson, namely:--
The mother is more liable to suffer under diseases of the womb after long than after short labors. The child for some time after birth is more liable to disease and death, in proportion as the labor has been longer in its duration. First labors are longer in duration than subsequent ones, and in a proportionate degree more complicated and dangerous to mother and child. Male births are longer in duration than female births, and in a proportionate degree more complicated and dangerous to mother and child.
Many tedious confinements, however, are happily terminated without the slightest injury to mother or child. Whenever the labor has been unusually prolonged, unusual care and caution should be exercised in the treatment of the mother and infant for many weeks after the event.
One of the most distressing affections to which women are exposed from childbirth is
PUERPERAL MANIA.
This is a variety of insanity which attacks some women shortly after childbirth, or at the period of weaning a child. The period of attack is uncertain, as it may manifest itself first in a very few days, or not for some months after the confinement. Its duration is likewise very variable. In most instances a few weeks restore the patient to herself; but there are many cases where judicious treatment for months is required, and there are a few where the mental alienation is permanent, and the wife and mother is never restored to her sanity.
The question has been much discussed, Whether such a condition is to be imputed to a hereditary tendency to insanity in the family, and also whether a mother who has had such an attack is liable to transmit to her children, male or female, any greater liability to mental disease.
We are well aware what deep importance the answers to these inquiries have to many a parent; and in forming our replies, we are guided not only by our own experience, but by the recorded opinion of those members of our profession who have given the subject close and earnest attention. To the first query, the reply must be made that in one-half, or nearly one-half, of the cases of this variety of insanity there is traceable a hereditary tendency to aberration of mind. Usually one or more of the direct progenitors, or of the near relatives of the patient, will be found to have manifested unmistakable marks of unsoundness of mind. In the remaining one-half cases no such tendency can be traced, and in these it must be presumed that the mania is a purely local and temporary disorder of the brain. The incurable cases are usually found in the first cla.s.s of patients, as we might naturally expect.
The likelihood of the children, in turn, inheriting any such predisposition, depends on the answer to the inquiry we first put. If the mania itself is the appearance of a family malady, then the chances are that it will pa.s.s downward with other transmissible qualities. But if the mania arise from causes which are transitory, then there is no ground for alarm.
An inquiry still more frequently put to the physician by the husband and by the patient herself after recovery, is, Whether an attack at one confinement predisposes her to a similar attack at a subsequent similar period. There is considerable divergence of opinion on this point. Dr.
Gooch, an English physician of wide experience, is very strenuous in denying any such increased likelihood, while an American obstetrician of note is quite as positive in taking the opposite view. The truth of the matter undoubtedly is, that where the mania is the exhibition of hereditary tendency, it is apt to recur; but where it arises from transient causes, then it will only occur again if such causes exist.
THE IMPORTANCE OF PREVENTION.
Here, therefore, we perceive the importance of every woman, who has had, or who fears to have, one of these distressing experiences, being put on her guard against disregarding those rules of health the neglect of which may result so disastrously. One of the most powerful of these causes is _exhaustion_. We mean this in its widest sense, mental or physical. In those instances where mania appears at weaning, it is invariably where the child has been nursed too long, or where the mother has not had sufficient strength to nourish it without prostrating herself. It should be observed as a hygienic law, that no mother should nurse her children after she has had one attack of mania. The mere nervous excitement is altogether too much for her. She must once and for ever renounce this tender pleasure. We even go so far as to recommend that no woman in whose family a mental taint is hereditary shall nurse her children.
Anxiety, low spirits, unusual weakness from any cause, are powerful predisposing causes; and therefore in all cases, especially in those where the family or personal history leads one to fear such an attack, they should be avoided. The diet should be nourishing and abundant, but not stimulating. Cheerful society and surroundings should be courted, and indulgences in any single train of ideas avoided. As for directions during the attack, they are unnecessary, as to combat it successfully often tasks the utmost skill of the physician; and it will be for him to give these directions.
WHITE-FLOWING.
This affection, though not confined to married women, is quite common during pregnancy and after confinement. There are few married women who pa.s.s through their lives without at some time or other having suffered from it.
We will consider first that _form of white discharge which affects pregnant women_. It ordinarily comes on during the latter half of pregnancy. Not only does it occasion much inconvenience, but it may, when copious, seriously weaken the system and impair the health.
The best treatment consists in a regulated, but supporting, diet without stimulants, the avoidance of all marital relations, plenty of rest in bed or on a sofa, a warm hip bath every morning, and the use of injections. One of the best injections for this purpose is made by adding a table-spoonful of lead-water to a pint of water, and injecting the whole twice a day, by means of a rubber, hard-ball syringe. As this solution will stain the body-linen, due precautions should be taken.
Instead of this injection, a small tea-spoonful of alum dissolved in a pint of water and injected once a day may be used.
We will now say a few words upon the _form of white-flowing which affects women after childbirth_. It is a common result of too frequent confinements or of successive abortions. In women of a tendency to consumption it has been observed that white-flowing is more apt to arise in connection with child-bearing. Prolonged nursing, resulting in great debility of the mother, often produces very profuse white discharges.
In warm countries this affection is much more frequent than elsewhere.
Moist and damp climates are said also to render women particularly p.r.o.ne to it.
The _treatment_ must have regard to the general health of the patient.
The mode of life must be regulated. A change of scene, if it can be procured, is often of the greatest benefit. Baths are also very useful.
They may be taken in the form of a "sponge bath," or "hip bath." If the former be preferred, the patient should every morning, in a warm room, sponge the whole body, at first with tepid water and, after a time, with cold, the skin being well dried and rubbed with a coa.r.s.e towel. The hip-bath may be employed either of simple, or of salt, or of medicated water. It should be at first warm, and afterwards cold. The skin is to be well rubbed after the hip as after the sponge-bath. The hip-bath may be medicated with three or four table-spoonfuls of alum, or with a quarter of a pound of common household soda.
In connection with this treatment, injections should be employed in the manner just directed for the white-flowing of pregnancy.
MILK-LEG.
This affection usually appears about ten days or two weeks after confinement. The first symptoms which show themselves are general uneasiness, chills, headache, and a quickened pulse. Then pains in the groin, extending down the thigh and leg of that side are complained of.
Soon the whole limb becomes enlarged, hot, white, and shining.
Feverishness and sleeplessness now naturally show themselves.
The disease rarely lasts more than two or three weeks, although the limb remains stiff, perhaps, for a number of weeks longer. It is painful, but not dangerous--rarely proving fatal.
When one leg is recovering, the disease sometimes attacks the other, and runs through the same course.
The treatment consists in enveloping the limb in turpentine stupes, followed by the application of poultices to the groin and a light diet at first. So soon as the severity of the attack is over, tonics and a generous diet should be given. The limb is then to be painted with tincture of iodine, or rather a mixture of one part of the tincture of iodine with two parts of alcohol, and afterwards wrapped in a flannel bandage.
The term "milk-leg" has been applied to this inflammation, for such it is, from the notion that in some way the milk was diverted from the b.r.e.a.s.t.s to the limb causing the white swelling. It is scarcely necessary to say this theory is entirely erroneous.
INWARD WEAKNESS.
Many, we may say most, married women whose health is broken down by some disease peculiar to their s.e.x, refer the commencement of their suffering to some confinement or premature birth. Perhaps, in four cases out of five, this breaking down is one of the symptoms of a displacement of the internal organs,--a malposition, in other words, of the uterus. This is familiarly known as an "inward weakness;" and many a woman drags through years of misery caused by a trouble of this sort.
It is true that these malpositions occur in unmarried women, and occasionally in young girls. But it is also true that their most frequent causes are a.s.sociated with the condition of maternity. The relaxation of the ligaments or bands which hold the uterus in its place, which takes place during pregnancy and parturition, predisposes to such troubles. It requires time and care for these ligaments to resume their natural strength and elasticity after childbirth. Then, too, the walls of the abdomen are one of the supports provided by nature to keep all the organs they contain in proper place by a constant elastic pressure.
When, as in pregnancy, these walls are distended and put on the strain, suddenly to be relaxed after confinement, the organs miss their support, and are liable to take positions which interfere with the performance of their natural functions. Therefore we may rightly place the greater tendency of married women to this cla.s.s of diseases among the perils of maternity.
Within the last fifteen years, probably no one branch of medical science has received greater attention at the hands of physicians than this of diseases of women. Many hitherto inexplicable cases of disease, much suffering referred to other parts of the system, have been traced to local misfortunes of the character we have just described. Medical works are replete with cases of the highest interest ill.u.s.trative of this. We are afraid to state some of the estimates which have been given of the number of women in this country who suffer from these maladies; nor do we intend to give in detail the long train of symptoms which characterize them. Such a sad rehearsal would avail little or nothing to the non-medical reader. It is enough to say, that the woman who finds herself afflicted by manifold aches and pains, without obvious cause; who suffers with her head and her stomach and her nerves; who discovers that, in spite of the precepts of religion and the efforts of will, she is becoming irritable, impatient, dissatisfied with her friends, her family, and herself; who is, in short, unable any longer to perceive anything of beauty and of pleasure in this world, and hardly anything to hope for in the next,--this woman, in all probability, is suffering from a displacement or an ulceration of the uterus. Let this be relieved, and her sufferings are ended. Often a very simple procedure can do this. We recall to mind a case described in touching language by a distinguished teacher of medicine. It is of an interesting young married lady, who came from the Southern States to consult him on her condition. She could not walk across the room without support, and was forced to wear, at great inconvenience to herself, an abdominal supporter. Her mind was confused, and she was the victim of apparently causeless unpleasant sensations. She was convinced that she had been, and still was, deranged.
The physician could discover nothing wrong about her system other than a slight falling of the womb. This was easily relieved. She at once improved in body and mind, soon was able to walk with ease and freedom, and once more enjoyed the pleasure of life. In a letter written soon after her return home, she said, "This beautiful world, which at one time I could not look upon without disgust, has become once more a source of delight." How strongly do these deeply felt words reveal the difference between her two conditions!
There is one source of great comfort in considering these afflictions.
It is, that they are in the great majority of cases traceable to