222. The first sign that leads a lady to suspect that she is pregnant is her ceasing to be unwell. This, provided she has just before been in good health, is a strong symptom of pregnancy; but still there must be others to corroborate it.
223. The next symptom is morning sickness. This is one of the earliest symptoms of pregnancy; as it sometimes occurs a few days, and indeed generally not later than a fortnight or three weeks, after conception. Morning sickness is frequently distressing, oftentimes amounting to vomiting, and causing a loathing of breakfast. This sign usually disappears after the first three or four months. Morning sickness is not always present in pregnancy; but, nevertheless, it is a frequent accompaniment; and many who have had families place more reliance on this than on any other symptom.
224. A third symptom is shooting, throbbing, and lancinating pains, and enlargement of the breasts, with soreness of the nipples, occurring about the second month; and in some instances, after the first few months, a small quantity of watery fluid, or a little milk, may be squeezed out of them. This latter symptom, in a first pregnancy, is valuable, and can generally be relied on as conclusive that the female is pregnant. It is not so valuable in an after pregnancy, as a little milk might, even should she not be pregnant, remain in the breasts for some months after she has weaned her child.
225. The veins of the breast look more blue, and are consequently more conspicuous than usual, giving the bosom a mottled appearance. The breasts themselves are firmer and more knotty to the touch. The nipples, in the majority of cases, look more healthy than customary, and are somewhat elevated and enlarged; there is generally a slight moisture upon their surface, sufficient in some instances to mark the linen.
226. A dark-brown areola or disk may usually be noticed around the nipple,[53] the change of color commencing about the second month. The tint at first is light brown, which gradually deepens in intensity, until, toward the end of pregnancy, the color may be very dark. Dr. Montgomery, who has paid great attention to the subject, observes: “During the progress of the next two or three months the changes in the areola are in general perfected, or nearly so, and then it presents the following characters: a circle around the nipple, whose color varies in intensity according to the particular complexion of the individual, being usually much darker in persons with black hair, dark eyes, and sallow skin, than in those of fair hair, light-colored eyes, and delicate complexion. The area of this circle varies in diameter from an inch to an inch and a half, and increases in most persons as pregnancy advances, as does also the depth of color.” The dark areola is somewhat swollen. “There is,” says Dr. Montgomery, “a puffy turgescence, not only of the nipple, but of the whole surrounding disk.”
227. A fourth symptom is quickening. This generally occurs about the completion of the fourth calendar month; frequently a week or two before the end of that period; at other times a week or two later. A lady sometimes quickens as early as the third month, while others, although rarely, quicken as late as the fifth, and, in very rare cases, the sixth month.
228. It will therefore be seen that there is an uncertainty as to the period of quickening, although, as I before remarked, the usual period occurs either on, or more frequently a week or two before, the completion of the fourth calendar month of pregnancy.
229. A lady at this time frequently either feels faint, or actually faints away; she is often either giddy, or sick, or nervous, and in some instances even hysterical. Although, in rare cases, some women do not even know the precise time when they quicken.
230. The sensation of “quickening” is said by many ladies to resemble the fluttering of a bird. “Quickening” arises from the ascent of the womb higher into the belly, as, from its increased size, there is not room for it below. The old-fashioned idea was that the child was not alive until a woman had quickened. This is a mistaken notion, as he is alive, or “quick,” from the very commencement of his formation.
231. Hence the heinous and damnable sin of a single woman, in the early months of pregnancy, using means to promote abortion: it is as much murder as though the child were at his full time, or as though he were butchered when he was actually born!
232. An attempt, then, to procure abortion is a crime of the deepest dye, viz., a heinous murder! It is attended, moreover, with fearful consequences to the mother’s own health; it may either cause her immediate death, or it may so grievously injure her constitution that she might never recover from the shock. If these fearful consequences ensue, she ought not to be pitied: she richly deserves them all. Our profession is a noble one, and every qualified member of it would scorn and detest the very idea either of promoting or of procuring an abortion; but there are unqualified villains who practice the damnable art. Transportation, if not hanging, ought to be their doom. The seducers, who often assist and abet them in their nefarious practices, should share their punishment.
233. Flatulence has sometimes misled a young wife to fancy that she has quickened; but, in determining whether she be pregnant, she ought never to be satisfied with one symptom alone; if she be, she will be frequently misled. The following are a few of the symptoms that will distinguish the one from the other: in flatulence, the patient is small one hour and large the next; while in pregnancy the enlargement is persistent, and daily and gradually increases. In flatulence, on pressing the bowels firmly, a rumbling of wind may be heard, which will move about at will; while the enlargement of the womb in pregnancy is solid, resistant, and stationary. In flatulence, on tapping—percussing—the belly there will be a hollow sound elicited as from a drum; while in pregnancy it will be a dull, heavy sound, as from thrumming on a table. In flatulence, if the points of the fingers be firmly pressed into the belly, the wind will wobble about; in pregnancy they will be resisted as by a wall of flesh.
234. The fifth symptom is, immediately after the quickening, increased size and hardness of the belly. An accumulation of fat covering the belly has sometimes led a lady to suspect that she is pregnant; but the soft and doughy feeling of the fat is very different to the hardness, solidity, and resistance of pressure of pregnancy.
235. The sixth symptom is pouting or protrusion of the navel. This symptom does not occur until some time after a lady has quickened; indeed, for the first two months of pregnancy the navel is drawn in and depressed. As the pregnancy advances, the navel gradually comes more forward. “The navel, according to the progress of the pregnancy, is constantly emerging, till it comes to an even surface with the integuments of the abdomen [belly]; and to this circumstance much regard is to be paid in cases of doubtful pregnancy.”[54]
236. Sleepiness, heartburn, increased flow of saliva, toothache, loss of appetite, longings, excitability of mind, a pinched appearance of countenance, liver or sulphur-colored patches on the skin, and likes and dislikes in eating,—either the one or the other of these symptoms frequently accompany pregnancy; but, as they might arise from other causes, they are not to be relied on further than this—that if they attend the more certain signs of pregnancy, such as cessation of being “regular,” morning sickness, pains and enlargement of and milk in the breasts, the gradually darkening brown areola or mark around the nipple, etc., they will then make assurance doubly sure, and a lady may know for certain that she is pregnant.[55]
237. A lady who is pregnant ought on no account to wear tight dresses, as the child should have plenty of room. She ought to be, as enceinte signifies, incincta, or unbound. Let the clothes be adapted to the gradual development both of the belly and the breasts. She must, whatever she may usually do, wear her stays loose. If there be bones in the stays, let them be removed. Tight lacing is injurious both to the mother and to the child, and frequently causes the former to miscarry; at another time it has produced a crossbirth; and sometimes it has so pressed in the nipples as to prevent a proper development of them, so that where a lady has gone her time, she has been unable to suckle her infant, the attempt often causing a gathered bosom. These are great misfortunes, and entail great misery both on the mother and the child (if it has not already killed him), and ought to be a caution and a warning to every lady for the future.
238. The feet and legs during pregnancy are very apt to swell and to be painful, and the veins of the legs to be largely distended. The garters ought at such times to be worn slack, as tight garters are highly injurious, and, if the veins be very much distended, it will be necessary for her to wear a properly-adjusted elastic silk stocking, made purposely to fit her foot and leg, and which a medical man will himself procure for her.
239. A warm bath in pregnancy is too relaxing. A tepid bath once a week is beneficial. Sponging the whole of the body every morning with lukewarm water may with safety and advantage be adopted, gradually reducing the temperature of the water until it be used quite cold. The skin should, with moderately coarse towels, be quickly but thoroughly dried.
240. Either the bidet or sitz-bath[56] ought every morning to be used. The patient should first sponge herself, and then finish up by sitting for a few seconds, or while, in the winter, she can count fifty, or while, in the summer, she can count a hundred, in the water. It is better not to be long in it; it is a slight shock that is required, which, where the sitz-bath agrees, is immediately followed by an agreeable glow of the whole body. If she sits in the water for a long time she becomes chilled and tired, and is very likely to catch cold. She ought, until she become accustomed to the cold, to have a dash of warm water added; but the sooner she can use quite cold water the better. While sitting in the bath she should throw either a woolen shawl or a small blanket over her shoulders. She will find the greatest comfort and benefit from adopting the above recommendation. Instead of giving, it will prevent cold, and it will be one of the means of warding off a miscarriage, and of keeping her in good health.
241. A shower-bath in pregnancy gives too great a shock, and might induce a miscarriage. I should not recommend, for a lady who is pregnant, sea-bathing; nevertheless, if she be delicate, and if she be prone to miscarry, change of air to the coast (provided it be not too far away from home), and inhaling the sea breezes, may brace her, and ward off the tendency. But although sea-bathing be not desirable, sponging the body with sea water may be of great service to her.
242. A young wife, in her first pregnancy, usually takes too long walks. This is a common cause of flooding, of miscarriage, and of bearing down of the womb. As soon, therefore, as a lady has the slightest suspicion that she is enceinte, she must be careful in the taking of exercise.
243. Although long walks are injurious, she ought not to run into an opposite extreme; short, gentle, and frequent walks during the whole period of pregnancy cannot be too strongly recommended; indeed, a lady who is enceinte ought to live half her time in the open air. Fresh air and exercise prevent many of the unpleasant symptoms attendant on that state; they keep her in health; they tend to open her bowels; and they relieve that sensation of faintness and depression so common and distressing in early pregnancy.
244. Exercise, fresh air, and occupation are then essentially necessary in pregnancy. If they be neglected, hard and tedious labors are likely to ensue. One, and an important, reason of the easy and quick labors and rapid “gettings about” of poor women, is the abundance of exercise and of occupation which they are both daily and hourly obliged to get through. Why, many a poor woman thinks but little of a confinement, while a rich one is full of anxiety about the result. Let the rich lady adopt the poor woman’s industrious and abstemious habits, and labor need not then be looked forward to, as it frequently now is, either with dread or with apprehension.
245. Stooping, lifting of heavy weights, and overreaching ought to be carefully avoided. Running, horse exercise, and dancing are likewise dangerous—they frequently induce a miscarriage.
246. Indolence is most injurious in pregnancy. A lady who, during the greater part of the day, lolls either on the sofa or on an easy-chair, and who seldom walks out, has a much more lingering and painful labor than one who takes moderate and regular open-air exercise, and who attends to her household duties.
247. An active life is, then, the principal reason why the wives of the poor have such quick and easy labors, and such good recoveries; why their babies are so rosy, healthy, and strong; notwithstanding the privations and hardships and poverty of the parents.
248. Bear in mind, then, that a lively, active woman has an easier and quicker labor, and a finer race of children, than one who is lethargic and indolent. Idleness brings misery, anguish, and suffering in its train, and particularly affects pregnant ladies. Oh, that these words would have due weight, then this book will not have been written in vain. The hardest work in the world is having nothing to do! “Idle people have the most labor;” this is particularly true in pregnancy; a lady will, when labor actually sets in, find to her cost that idleness has given her most labor. “Idleness is the badge of gentry, the bane of body and mind, the nurse of Naughtiness, the step-mother of Discipline, the chief author of all Mischief, one of the seven deadly sins, the cushion upon which the Devil chiefly reposes, and a great cause not only of Melancholy, but of many other diseases, for the mind is naturally active; and, if it be not occupied about some honest business, it rushes into Mischief or sinks into Melancholy.”[57]
249. A lady sometimes looks upon pregnancy more as a disease than as a natural process; hence she treats herself as though she was a regular invalid, and, unfortunately, she too often makes herself really one by improper and by foolish indulgences.
250. Let a lady look well to the ventilation of her house; let her take care that every chimney be unstopped, and during the daytime that every window in every unoccupied room be thrown open.
251. Where there is a skylight at the top of the house, it is well to have it made to open and to shut, so that in the daytime it may, winter and summer, be always open; and in the summer time it may, day and night, be left unclosed. Nothing so thoroughly ventilates and purifies a house as an open skylight.
252. If a lady did but know the importance—the vital importance—of ventilation, she would see that the above directions were carried out to the very letter. My firm belief is that if more attention were paid to ventilation—to thorough ventilation—child-bed fever would be an almost unknown disease.
253. The cooping-up system is abominable; it engenders all manner of infectious and of loathsome diseases, and not only engenders them, but feeds them, and thus keeps them alive. There is nothing wonderful in all this, if we consider but for one moment that the exhalations from the lungs are poisonous! That is to say, that the lungs give off carbonic acid gas (a deadly poison), which, if it be not allowed to escape out of the room, must over and over again be breathed. That if the perspiration of the body (which in twenty-four hours amounts to two or three pounds) be not permitted to escape out of the apartment, must become fetid—repugnant to the nose, sickening to the stomach, and injurious to the health. Oh, how often the nose is a sentinel, and warns its owner of approaching danger!
254. Truly the nose is a sentinel! The Almighty has sent bad smells for our benefit to warn us of danger. If it were not for an unpleasant smell, we should be constantly running into destruction. How often we hear of an ignorant person using disinfectants and fumigations to deprive drains and other horrid places of their odors, as though, if the place could be robbed of its smell, it could be robbed of its danger! Strange infatuation! No; the frequent flushings of drains, the removal of nuisances, cleanliness, a good scrubbing of soap and water, sunshine, and the air and winds of heaven, are the best disinfectants in the world. A celebrated and eccentric lecturer on surgery,[58] in addressing his class, made the following quaint and sensible remark: “Fumigations, gentlemen, are of essential importance; they make so abominable a stink that they compel you to open the windows and admit fresh air.”
255. It is doubtless, then, admirably appointed that, we are able to detect “the well-defined and several stinks;” for the danger is not in them,—to destroy the smell is not to destroy the danger; certainly not! The right way to do away with the danger is to remove the cause, and the effect will cease; flushing a sewer is far more efficacious than disinfecting one; soap and water and the scrubbing-brush, and sunshine and thorough ventilation, each and all are far more beneficial than either permanganate of potash, or chloride of zinc, or chloride of lime. People nowadays think too much of disinfectants and too little of removal of causes; they think too much of artificial, and too little of natural means. It is a sad mistake to lean so much on, and to trust so much to, man’s inventions!
256. What is wanted, nowadays, is a little less theory and a great deal more common sense. A rat, for instance, is, in theory, grossly maligned; he is considered to be very destructive, an enemy to man, and one that ought to be destroyed—every man’s hand being against him. Now, a rat is, by common sense, well known to be, in its proper place—that is to say, in sewers and in drains—destructive only to man’s enemies—to the organic matter that breeds fevers, cholera, diphtheria, etc.; the rat eats the pabulum or food which would otherwise convert towns into hot-beds of terrible diseases. That which is a rat’s food is often a man’s poison; hence a rat is one of the best friends that a man has, and ought, in his proper place, to be in every way protected; the rat, in drains, is the very best of scavengers; in a sewer he is invaluable; in a house he is most injurious; a rat in a sewer is worth gallons of disinfectants, and will, in purifying a sewer, beat all man’s inventions hollow; the maligned rat, therefore, turns out, if weighed by common sense, to be not only one of the most useful of animals, but of public benefactors! The rat’s element, then, is the sewer; he is the king of the sewer, and should there reign supreme, and ought not to be poisoned by horrid disinfectants.
257. If a lady, while on an errand of mercy, should in the morning go into a poor person’s bedroom after he, she, or they (for oftentimes the room is crowded to suffocation) have during the night been sleeping, and where a breath of air is not allowed to enter—the chimney and every crevice having been stopped up—and where too much attention has not been paid to personal cleanliness, she will experience a faintness, an oppression, a sickness, a headache, a terribly fetid smell; indeed, she is in a poisoned chamber! It is an odor sui generis, which must be smelt to be remembered, and will then never be forgotten! Pity the poor who live in such styes—not fit for pigs! For pigs, styes are ventilated. But take warning, ye well-to-do in the world, and look well to your ventilation, or beware of the consequences. “If,” says an able writer on fever in the last century, “any person will take the trouble to stand in the sun and look at his own shadow on a white plastered wall, he will easily perceive that his whole body is a smoking dunghill, with a vapor exhaling from every part of it. This vapor is subtle, acrid, and offensive to the smell; if retained in the body it becomes morbid, but if reabsorbed, highly deleterious. If a number of persons, therefore, are long confined in any close place not properly ventilated, so as to inspire and swallow with their spittle the vapors of each other, they must soon feel its bad effects.”[59]
258. Not only should a lady look well to the ventilation of her house, but either she or her husband ought to ascertain that the drains are in good and perfect order, and that the privies are frequently emptied of their contents. Bad drainage and overflowing privies are fruitful sources of child-bed fever, of gastric fever, of scarlatina, of diphtheria, of cholera, and of a host of other infections and contagious and dangerous diseases. It is an abominable practice to allow dirt to fester near human habitations; more especially as dirt, when mixed with earth, is really so valuable in fertilizing the soil. Lord Palmerston wisely says that “dirt is only matter in the wrong place.”
259. A lady ought to look well to the purity of her pump-water, and to ascertain that no drain either enters or percolates, or contaminates in any way whatever, the spring; if it should do so, disease, such as either cholera, or diarrhœa, or dysentery, or diphtheria, or scarlet fever, or gastric fever, will, one or the other, as a matter of course, ensue. If there be the slightest danger or risk of drain contamination, whenever it be practicable, let the drain be taken up and be examined, and let the defect be carefully rectified. When it be impracticable to have the drain taken up and examined, then let the pump-water, before drinking it, be always previously boiled. The boiling of the water, as experience teaches, has the power either of destroying or of making innocuous the specific organic fecal life poison, which propagates in drain contamination the diseases above enumerated.
260. A lady who is pregnant ought, for half an hour each time, to lie one or two hours every day on the sofa. This, if there be either a bearing down of the womb, or if there be a predisposition to a miscarriage, will be particularly necessary. I should recommend this plan to be adopted throughout the whole period of the pregnancy: in the early months, to prevent a miscarriage, and, in the latter months, on account of the increased weight and size of the womb.
261. There is, occasionally, during the latter months, a difficulty in lying down; the patient feeling as though, every time she makes the attempt, she should be suffocated. When such be the case, she ought to rest herself upon the sofa, and be propped up with cushions, as I consider rest at different periods of the day necessary and beneficial. If there be any difficulty in lying down at night, a bed-rest, well covered with pillows, will be found a great comfort.
262. An abstemious diet, during the early period of pregnancy, is essential, as the habit of body, at that time, is usually feverish and inflammatory. I should therefore recommend abstinence from beer, porter, and spirits. Let me, in this place, urge a lady, during her pregnancy, not to touch spirits, such as either brandy or gin; they will only inflame her blood, and will poison and make puny her unborn babe; they will only give her false spirits, and will depress her in an increased ratio as soon as the effects of the brandy or of the gin have passed away. She ought to eat meat only but once a day. Rich soups and highly-seasoned stews and dishes are injurious.
263. A lady who is enceinte may depend upon it that the less stimulants she takes at these times the better it will be both for herself and for her infant; the more kind will be her labor and her “getting about,” and the more vigorous and healthy will be her child.
264. It is a mistaken notion that she requires more nourishment during early pregnancy than at any other time; she, if anything, requires less. It has often been asserted that a lady who is pregnant ought to eat very heartily, as she has two to provide for. When it is taken into account that during pregnancy she “ceases to be unwell,” and therefore that there is no drain on that score; and when it is also considered how small the ovum containing the embryo is, not being larger for the first two or three months than a hen’s egg, it will be seen how futile is the assertion. A wife, therefore, in early pregnancy, does not require more than at another time; if anything, she requires less. Again: during pregnancy, especially in the early stages, she is more or less sick, feverish, and irritable, and a superabundance of food would only add fuel to the fire, and would increase her sickness, fever, and irritability. Moreover, she frequently suffers from heartburn and from indigestion. Can anything be more absurd, when such is the case, than to overload a stomach already loaded with food which it is not able to digest? No, let nature in this, as in everything else, be her guide, and she will not then go far wrong! When she is further advanced in her pregnancy,—that is to say, when she has quickened,—her appetite generally improves, and she is much better in health than she was before; indeed, after she has quickened, she is frequently in better health than she ever has been. The appetite is now increased. Nature points out that she requires more nourishment than she did at first; for this reason, the fœtus is now rapidly growing in size, and consequently requires more support from the mother. Let the food, therefore, of a pregnant woman be now increased in quantity, but let it be both light and nourishing. Occasionally, at this time, she has taken a dislike to meat; if she has, she ought not to be forced to eat it, but should have instead, poultry, game, fish, chicken-broth, beef-tea, new milk, farinaceous food, such as rice, sago, batter puddings, and, above all, if she has a craving for it, good sound, ripe fruit.
265. Roasted apples, ripe pears, raspberries, strawberries, grapes, tamarinds, figs, Muscatel raisins, stewed rhubarb, stewed pears, stewed prunes, the inside of ripe gooseberries, and the juice of oranges, are, during pregnancy, particularly beneficial; they both quench the thirst and tend to open the bowels.
266. The food of a pregnant woman cannot be too plain; high-seasoned dishes ought, therefore, to be avoided. Although the food be plain, it must be frequently varied. She should ring the changes upon butcher’s meat, poultry, game, and fish. It is a mistaken notion, that people ought to eat the same food over and over again, one day as another. The stomach requires variety, or disease, as a matter of course, will ensue.
267. Light puddings, such as either rice, or batter, or suet-pudding, or fruit puddings, provided the paste be plain, may be taken with advantage. Rich pastry is highly objectionable.
268. If she be plethoric, abstinence is still more necessary, or she might have a tedious labor, or might suffer severely. The old-fashioned treatment was to bleed a pregnant patient if she were of a full habit of body. A more absurd plan could not be adopted! Bleeding would, by causing more blood to be made, only increase the mischief; but certainly it would be blood of an inferior quality, watery and poor. The best way to diminish the quantity of blood is to moderate the amount of food, to lessen the supplies.
269. The bedroom of a pregnant lady ought, if practicable, to be large and airy. Particular attention must be paid to the ventilation. The chimney should on no account be stopped. The door and the windows ought in the daytime to be thrown wide open, and the bedclothes should be thrown back, that the air might, before the approach of night, well ventilate them.
270. It is a mistaken practice for a pregnant woman, or for any one else, to sleep with closely-drawn curtains. Pure air and a frequent change of air are quite as necessary—if not more so—during the night as during the day: and how can it be pure, and how can it be changed, if curtains are closely drawn around the bed? Impossible. The roof of the bedstead ought not to be covered with bed furniture; it should be open to the ceiling, in order to prevent any obstruction to a free circulation of air.
271. The bed must not be loaded with clothes, more especially with a thick coverlet. If the weather be cold, let an extra blanket be put on the bed, as the perspiration can permeate through a blanket when it cannot through a thick coverlet.
272. A lady who is pregnant is sometimes restless at night—she feels oppressed and hot. The best remedies are:—(1) Scant clothing on the bed. (2) The lower sash of the window, during the summer months, to be left open to the extent of six or eight inches, and during the winter months, to the extent of two or three inches; provided the room be large, the bed be neither near nor under the window, and the weather be not intensely cold. If any or all of these latter circumstances occur, then (3) the window to be closed and the door to be left ajar (the landing or the skylight window at the top of the house being left open all night, and the door being secured from intrusion by means of a door-chain.) (4) Attention to be paid, if the bowels be costive—but not otherwise—to a gentle action of the bowels by castor oil. (5) An abstemious diet, avoiding stimulants of all kinds. (6) Gentle walking exercise. (7) Sponging the body every morning—in the winter with tepid water, and in the summer with cold water. (8) Cooling fruits in the summer are in such a case very grateful and refreshing. (See paragraph 264.)
273. A pregnant woman sometimes experiences an inability to lie down, the attempt occasionally producing a feeling of suffocation and of faintness. She ought, under such circumstances, to lie on a bed-rest, which must, by means of pillows, be made comfortable; and she should take, every night at bedtime, a teaspoonful of sal-volatile in a wineglassful of water.
274. Pains at night, during the latter end of the time, are usually frequent, so as to make an inexperienced lady fancy that her labor was commencing. Little need be done; for unless the pains be violent, nature ought not to be interfered with. If they be violent, application should be made to a medical man.
275. A pregnant lady must retire early to rest. She ought to be in bed every night by ten o’clock, and should make a point of being up in good time in the morning, that she may have a thorough ablution, a stroll in the garden, and an early breakfast; and that she may afterwards take a short walk either in the country or in the grounds while the air is pure and invigorating. But how often, more especially when a lady is first married, is an opposite plan adopted! The importance of bringing a healthy child into the world, if not for her own and her husband’s sake, should induce a wife to attend to the above remarks.
276. Although some ladies, during pregnancy, are very restless, others are very sleepy, so that they can scarcely, even in the day, keep their eyes open! Fresh air, exercise, and occupation are the best remedies for keeping them awake.
277. A young wife is usually averse to consult a medical man concerning several trifling ailments, which are nevertheless, in many cases, both annoying and distressing. I have therefore deemed it well to give a brief account of such slight ailments, and to prescribe a few safe and simple remedies for them. I say safe and simple, for active medicines require skillful handling, and therefore ought not—unless in certain emergencies—to be used except by a doctor himself.
278. I wish it, then, to be distinctly understood that in all serious attacks, and in slight ailments if not quickly relieved, a medical man ought to be called in.
279. A costive state of the bowels is common in pregnancy; a mild aperient is therefore occasionally necessary. The mildest must be selected, as a strong purgative is highly improper, and even dangerous. Calomel and all other preparations of mercury are to be especially avoided, as a mercurial medicine is apt to weaken the system and sometimes even to produce a miscarriage.
280. An abstemious diet, where the bowels are costive, is more than usually desirable, for if the bowels be torpid, a quantity of food will only clog and make them more sluggish. Besides, when labor comes on, a loaded state of the bowels will add much to a lady’s sufferings as well as to her annoyance.
281. The best aperients are castor oil, salad oil, compound rhubarb pills, honey, stewed prunes, stewed rhubarb, Muscatel raisins, figs, grapes, roasted apples, Normandy pippins, oatmeal and milk gruel, coffee, brown bread and treacle, raw sugar (as a sweetener of the food), Du Barry’s Arabica Revalenta.
282. Castor oil, in pregnancy, is a valuable aperient. Frequent and small are preferable to occasional and large doses. If the bowels be constipated (but certainly not otherwise), castor oil ought to be taken regularly twice a week. The best time for administering it is early in the morning. The dose is from a teaspoonful to a dessertspoonful.
283. The best ways of administering it are the following: Let a wineglass be well rinsed out with water, so that the sides may be well wetted; then, let the wineglass be half filled with cold water, fresh from the pump. Let the necessary quantity of oil be now carefully poured into the center of the wineglass, taking care that it does not touch the sides; and if the patient will, thus prepared, drink it off at one draught, she will scarcely taste it. Another way of taking it is, swimming on warm new milk. A third and a good method is, floating on warm coffee; the coffee ought, in the usual way, to be previously sweetened and mixed with cream. There are two advantages in giving castor oil on coffee: (1) it is a pleasant way of giving it—the oil is scarcely tasted; and (2) the coffee itself, more especially if it be sweetened with raw sugar, acts as an aperient; less castor oil, in consequence, being required; indeed, with many patients the coffee, sweetened with raw sugar, alone is a sufficient aperient. A fourth and an agreeable way of administering it is on orange-juice—swimming on the juice of one orange.
284. Some ladies are in the habit of taking it on brandy and water; but the spirit is apt to dissolve a portion of the oil, which afterwards rises in the throat.
285. If salad oil be preferred, the dose ought to be as much again as of castor oil; and the patient should, during the day she takes it, eat either a fig or two, or a dozen or fifteen of stewed prunes, or of stewed French plums, as salad oil is much milder in its effects than castor oil.
286. Where a lady cannot take oil, one or two compound rhubarb pills may be taken at bedtime; or a Seidlitz powder early in the morning, occasionally; or a quarter of an ounce of tasteless salts—phosphate of soda—may be dissolved in lieu of table salt, in a cupful either of soup, or of broth, or of beef-tea, and be occasionally taken at luncheon.
287. When the motions are hard, and when the bowels are easily acted upon, two, or three, or four pills made of Castile soap will frequently answer the purpose; and if they will, are far better than any ordinary aperient. The following is a good form:
To make twenty-four pills. Two, or three, or four to be taken at bedtime, occasionally.[60]
288. A teaspoonful of honey, either eaten at breakfast, or dissolved in a cup of tea, will frequently comfortably and effectually open the bowels, and will supersede the necessity of taking aperient medicine.
289. A basin of thick Derbyshire oatmeal gruel, made either with new milk or with cream and water, with a little salt, makes an excellent luncheon or supper for a pregnant lady; it is both nourishing and aperient, and will often entirely supersede the necessity of giving opening medicine. If she prefers sugar to salt, let raw sugar be substituted for the salt. The occasional substitution of coffee for tea at breakfast usually acts beneficially on the bowels.
290. Let me again urge the importance of a lady, during the whole period of pregnancy, being particular as to the state of her bowels, as costiveness is a fruitful cause of painful, of tedious, and of hard labors. It is my firm conviction that if a patient who suffers from constipation were to attend more to the regularity of her bowels, difficult cases of labor would rarely occur, more especially if the simple rules of health were adopted, such as: attention to diet—the patient partaking of a variety of food, and allowing the farinaceous, such as oatmeal and the vegetable and fruit element, to preponderate; the taking of exercise in the open air; attending to her household duties; avoiding excitement, late hours, and all fashionable amusements.
291. Many a pregnant lady does not leave the house—she is a fixture. Can it, then, be wondered at that costiveness so frequently prevails? Exercise in the fresh air, and occupation, and household duties are the best opening medicines in the world. An aperient, let it be ever so judiciously chosen, is apt, after the effect is over, to bind up the bowels, and thus to increase the evil. Now, nature’s medicines,—exercise in the open air, occupation, and household duties,—on the contrary, not only at the time open the bowels, but keep up a proper action for the future: hence their inestimable superiority.
292. Where a lady cannot take medicine, or where it does not agree with her, a good remedy for constipation in pregnancy is the external application of castor oil—castor oil as a liniment—to the bowels The bowels should be well rubbed every night and morning with the castor oil. This, if it succeed, will be an agreeable and safe method of opening the bowels.
293. Another excellent remedy for the costiveness of pregnancy is an enema, either of warm water or of Castile soap and water, which the patient, by means of a self-injecting enema apparatus, may administer to herself. The quantity of warm water to be used is from half a pint to a pint; the proper heat is the temperature of new milk; the time for administering it is early in the morning, twice or three times a week. The advantages of clysters are, they never disorder the stomach—they do not interfere with the digestion—they do not irritate the bowels—they are given with the greatest facility by the patient herself—and they do not cause the slightest pain. If an enema be used to open the bowels, it may be well to occasionally give one of the aperients recommended above, in order, if there be costiveness, to insure a thorough clearance of the whole of the bowels.
294. If the bowels should be opened once every day, it would be the height of folly for a pregnant lady to take either castor oil or any other aperient. She ought then to leave her bowels undisturbed, as the less medicine she takes the better. If the bowels be daily and properly opened, aperients of any sort whatever would be highly injurious to her. The plan in this, as in all other cases, is to leave well alone, and never to give physic for the sake of giving it.
295. Diarrhœa.—Although the bowels in pregnancy are generally costive, they are sometimes in an opposite state, and are relaxed. Now, this relaxation is frequently owing to their having been too much constipated, and nature is trying to relieve itself by purging. Such being the case, a patient ought to be careful how, by the taking of chalk and of astringents, she interferes with the relaxation.
296. The fact is, that in all probability there is something in the bowels that wants coming away, and nature is trying all she can to afford relief. Sometimes, provided she is not unnecessarily interfered with, she succeeds; at others, it is advisable to give a mild aperient to help nature in bringing it away.
297. When such be the case, a gentle aperient, such as either castor oil or rhubarb and magnesia, ought to be chosen. If castor oil, a teaspoonful or a dessertspoonful, swimming on a little new milk, will generally answer the purpose. If rhubarb and magnesia be the medicine selected, then a few doses of the following mixture will usually set all to rights:
Two tablespoonfuls of the mixture to be taken three times a day, first shaking the bottle.
298. The diet ought to be simple, plain, and nourishing, and should consist of beef-tea, of chicken-broth, of arrow-root, and of well-made and well-boiled oatmeal gruel. Meat, for a few days, ought not to be eaten; and stimulants of all kinds must be avoided.
299. If the diarrhœa be attended with pain in the bowels, a flannel bag filled with hot table salt, and then applied to the part affected, will afford great relief. A hot-water bag, too, in a case of this kind, is a great comfort.[61] The patient ought, as soon as the diarrhœa has disappeared, gradually to return to her usual diet, provided it be plain, wholesome, and nourishing. She should pay particular attention to keeping her feet warm and dry; and, if she be much subject to diarrhœa, she ought to wear around her bowels, and next to her skin, a broad flannel belly-band.
300. Heartburn is a common and often a distressing symptom of pregnancy. The acid producing the heartburn is frequently much increased by an overloaded stomach. The patient labors under the mistaken notion that, as she has two to sustain, she requires more food during this than at any other time; she consequently is induced to take more than her appetite demands, and more than her stomach can digest;—hence heartburn, indigestion, etc. are caused, and her unborn babe, as well as herself, is thereby weakened.
301. An abstemious diet ought to be strictly observed. Great attention should be paid to the quality of the food; greens, pastry, hot buttered toast, melted butter, and everything that is rich and gross, ought to be carefully avoided.
302. Either a teaspoonful of Henry’s magnesia, or half a teaspoonful of carbonate of soda—the former to be preferred if there be constipation—should occasionally be taken in a wineglassful of warm water. If these do not relieve—the above directions as to diet having been strictly attended to—the following mixture ought to be tried: