Floodingis one of the most dangerous accidents that occur during pregnancy, its consequences being often of the most serious character. The causes that lead to flooding are very numerous, some of them predisposing to it, and others immediately exciting it. Among these may be mentioned a too full habit, violent exertion, falls, coughing, vomiting, straining from costiveness or violent purgatives, forcing medicines, criminal attempts at abortion, overwalking, blows on the abdomen, too much dancing, or running up stairs, strong mental emotions, fright, or anger, andcertain excesses. The immediate cause is the separation of the membrane in which the fœtus is inclosed from the walls of the womb. Flooding may however result from the placenta growing over the mouth of the womb, and being torn as that opens—usually about the sixth or seventh month.—(See the articleFloodingduring Labor.)
In most cases flooding is preceded by dull pain in the loins and groins, and a sensation of weight and dragging. Similar sensations however are often produced by other causes, which makes it difficult to predicate, with any degree of certainty, whether the patient is about to flood or not. The very first appearance of blood from the vagina must thereforebe watched for carefully, as that removes all doubt, and warns us to be prompt with the proper remedies. Sometimes a female will flood internally, the blood being retained by the passage being closed or plugged up by clots, or by its passing behind the membranes, or under the centre of the placenta. These internal or concealed hemorrhages are very dangerous, as the patient may lose much blood before her condition is suspected. It is therefore necessary to bear this in mind, and carefully use every means to ascertain whether such an accident has occurred or not. In general the indications are pretty plain, the patient suffering from deep seated and distressing pains in the back and groins, with great weakness in the limbs, faintness, weak pulse, dimness of sight, ringing in the ears, coldness of the hands and feet, swelling of the abdomen, and finally fainting, particularly if the retained blood suddenly escapes, which it usually does.
In the early months there is more danger to the child from flooding than there is to the mother, because it is nearly certain to lead to abortion. In the latter months, on the contrary, the mother runs the greatest risk, as the child may then live if it be expelled, while the mother may sink and die from excessive loss of blood. There are many females of a very full habit, who suffer but little from hemorrhage, unless it be excessive, indeed some seem to be benefitted by it, and are thus relieved from headache and convulsions. It should, however, be carefully watched, and its effects duly noted.
The treatment of flooding must depend materially upon its severity, and the time when it occurs. In the early months, when the discharge is slight, and when it causes little distress, simple means will answer.The patient must lie on her back, on a hard mattress, with the pelvis raised, by means of a pillow, higher than the rest of the body. The air must be kept fresh and cool around her; she must keep herself quiet in body and mind, live rather low, and drink freely of cooling drinks, such as soda water, lemonade, tamarind tea, or ice water. [The fullest directions for making and using all these drinks will be found in my "Diseases of Woman."]
If the flooding does not stop with these simple means, external applications must be made, of cold, wet cloths, or even ice, over the abdomen, and inside the thighs. Finally, if further treatment is still needed, cold astringent injections may be carefully thrown into the vagina. Cold water is perhaps as good as anything for this purpose, and I have frequently known a most severe flooding checked immediately by injecting cold water into the vagina and rectum, and applying cold wet cloths over the abdomen, and inside the thighs. Some astringent drink may also assist, such as a little syrup of comfrey, or extract of Rhatany, and particularly a tea made of the root of the black currant, as recommended in my "Diseases of Woman."—[A handful of the root may be boiled in two quarts of water, for twenty minutes; it should be sweetened to taste and drunk freely. The common blackberry, or the dew berry, is also excellent, though not so good as the black currant.]—If the patient be nervous and irritable, or suffer much from pain, an opium pill may be taken, or from ten to twenty drops of laudanum.
The general practice in these cases is tobleedfreely andgive opium!And as this practice certainly does succeed in many extreme cases, I should certainly recommend, if the simpler means fail, toresort to it at once. I dislike bleeding very much, in any cases, and here it seems particularly inappropriate; I should therefore saytry almost anything and everything first, but never obstinately refuse to do it if nothing else succeeds.
In some cases a plug or tampon is used, to fill up the vagina. It may be made of a roll of cloth, cotton, or a piece of sponge. This practice, however, is useless in the latter months of pregnancy, and very often fails even at other times. When it succeeds it causes the blood to coagulate, and thus closes up the mouths of the vessels. Quite as often, however, it only keeps it in, and makes it accumulate in the womb till it all rushes away at once; still it may be tried.
If the hemorrhages should occur so frequently, or be so excessive, in spite of all treatment, as to endanger the safety of the patient, there is no other resource left to save her life but to produce abortion, because the presence of the fœtus and its appendages is evidently then the irritating cause which keeps up the discharge, and it cannot be expected to stop till the womb is emptied.
When the fœtus is prematurely expelled before it can survive, it is called anAbortion, but if its expulsion take place so late that it can live, it is calledMiscarriage. Both these are serious accidents. In abortion the child is lost, as a matter of course, but in miscarriage it may live, after the seventh month. The danger to the mother is considerable from both, though greatest probably from abortion. It is probable that many very early miscarriages take placeunperceived, the female suffering but little from the accident, and the embryo being too small to be seen, unless carefully looked for.
The most frequent periods for such accidents are found to be six months, five months, and three months; and what is very singular, a much greater number of male children are aborted than females, the proportion being about sixteen to eleven.
These accidents are so intimately connected with flooding, that many writers always treat of them together, considering the flooding merely as the most frequent cause and symptom of miscarriage or abortion. In speaking therefore of the immediate causes of premature expulsion of the fœtus, we place hemorrhage first, and the causes before enumerated which produce that as being its most frequent remote ones.
A full habit, with tendency to local congestion, seems to predispose a female very much to miscarriage; every one so constituted should carefully avoid luxurious living and an inactive life. Violent bodily exertion, falls, or blows, or strong mental excitement are most usually the immediate causes, though with some it will come on spontaneously without any such exciting agencies. Some females will miscarry many times in succession, and always so near the same period, that they can tell to a day or two when it will happen. It seems to become a habit of the womb with them to contract at that particular time, and the only way to break through thehabitis for them to avoid becoming pregnant for some considerable time, say two or three years after, they may then go the full time, but will seldom do so if they conceive immediately after having miscarried. In some persons miscarriage is caused byatoo eagergratification of certain desires; but in others it may arisefrom the opposite cause.
There is a disease of the womb also by no means unfrequent, though but little understood, which undoubtedly causes much miscarriage, and that isRheumatism of the Womb!This mostly exists before the pregnancy however, and should be then treated according to the plan laid down in my "Diseases of Woman."
Miscarriage also arises in many females from a rigid state of the muscular fibres of the womb, which not relaxing sufficiently to allow that organ to expand become irritated by the pressure they experience, and begin to contract. This contraction of the womb of course soon leads to the expulsion of its contents, the same as in real labor. Women with their first children are more liable to miscarriage than others on this account, the womb not having become habituated as it were to the necessary relaxation.
And this is the reason also why some females, after suffering from this accident many times in succession at last escape it. In general they miscarry early the first time, from the womb not relaxing sufficiently, but go a little longer the next time, and longer still the next, and so on till they reach the full period. The fibres of the womb have gradually become accustomed to relax, and have borne the irritation longer and longer each pregnancy, till at last they have forborne to contract till the proper time. I knew one female who miscarriedtwenty-one timesin succession, getting gradually nearer to the full period each time, till at last she reachednine months, and was rewarded with a living child.
Sometimes the accident may be produced by a uterine tumor, by a great quantity of water in thewomb, or even by there being more than one child, because in either of these cases there is required more room than ordinary; and of course from the greater expansion required, the liability is increased. Various womb diseases may also be mentioned as causes, or adhesions of its walls or ligaments to the walls of the abdomen, and also a diseased state of the placenta. The pressure of corsets and tight dresses also not unfrequently lead to the same result. Some general diseases undoubtedly often cause miscarriage, such as measles, jaundice, scarlet fever, consumption, and probably many others, particularly those in which the quality of the blood is much altered, or the nervous power much exalted or depressed. Convulsions have already been mentioned as being frequent causes of miscarriage, and all strong mental or moral impressions. Indeed these last causes operate more than is suspected, and make it necessary for a pregnant female to be kept as calm in her mind as it is possible for her to be. I have even known one to miscarry from a frightin a dream.
It is also a fact, though not generally known, that there are certain diseasesof the fatherthat may produce miscarriage, and unfortunately they are of that kind that often remain for a long time in the system without much external manifestation, so that many persons think they are perfectly free from them even while they are working such mischief.
The death of the child also is sure to produce miscarriage, and this may result from various causes, such as external injuries and violence, or from remaining too long in the warm bath and thereby causing congestion of blood in the womb. Small pox and syphilis in the mother may also cause the death of the child,though not always. Many having been born at full term with these diseases upon them.
In general the fœtus is expelled very soon after it dies, but occasionally it is retained for a considerable time, and may not pass away till it is completely decayed. It has even been known to become almost fluid, and several months elapse before it was entirely expelled. Most women know when it dies, by its seeming to fall down to the bottom of the abdomen, like a dull weight, and also by its feeling verycold. Very often, however, there is no indication of its death whatever. M. Chailly mentions a case where the embryo died, probably when about fifteen days old, but the placenta continued to grow, and the lady was delivered when about six months and a half gone of the dead embryo, only about a quarter of an inch in length, though the after-birth was nearly large enough for one of the usual size. In this case it had died but not decayed, and remained in the womb six months and a half. In cases of twins also, one will sometimes die at an early period, but remain till the other is born at full term.
Thegrowth of the placenta over the mouth of the womb, andshortness of the chord, have already been referred to as causes both of flooding and miscarriage; and to these may be added monstrous or deformed fœtuses, which rarely reach the full term.
It is probable that there are many constitutional and individual peculiarities predisposing to miscarriage, with which we are not much acquainted, and which may account for the constant occurrence of that accident in many females, notwithstanding all we can do. Ascrofuloustaint is with good reason supposed to be one of these, and it is probable that thedisease of the placenta, and its consequent separation from the womb, before referred to, is mostlycaused by a taint of this kind. In many instances, where a female has miscarried from no apparent cause, if the placenta be carefully examined it will be found dotted here and there with diseased spots, sometimeslike scrofulous sores!It is advisable always to ascertain this, and to carefully examine the fœtus and its appendages. In all cases the advice I gave tokeep from being pregnant for some time, will be found most likely to succeed in averting the accident, both because it gives the womb time to regain its strength and break through itshabit, and also because it gives us time to operate upon the constitutional taint, if there be reason to suppose it exists.
It is a curious fact, but one often observed, thatliving in certain localitieseven predisposes to miscarriage. There is a certain district in France where the females are so liable to it, that all who can do so leave the place when they become pregnant, and thus escape the greater risk. Miscarriage also becomes epidemic at certain times, and prevails like contagious diseases; several instances of this are recorded in history.
Bleeding is also supposed to be a cause of abortion, and probably it may lead to it in certain states of the system, but by no means so certainly as many suppose. Instances have been known of pregnant females being bled from ten to twenty times without any evil result, even though carried so far as to make them faint. Mauriceau tells us of one who was bledninetytimes, and yet was delivered of a healthy living child at full term. In like manner many other ordinary causes of abortion will often fail entirely of their usual effects. Thus Mauriceau informs us that a female seven months gone fell upon the hard pavement froma three story windowand broke her arm,but yet did not miscarry. Madame Lachapelle also tells us of a young pregnant woman who threw herself down stairs purposely, from fear that she should have to submit to the Cesarean operation, she having a deformed pelvis. The fall caused her death soon after, but did not make her miscarry. Certain powerful medicines are also taken by some, a very small quantity of which, in most cases, produces abortion immediately, but without effecting what they desire, though it sometimes poisons themselves.
Indeed the power which the womb sometimes exhibits to retain its contents in spite of the most violent disturbing agencies, is truly astonishing. Cases have been known even where the womb itself has been severely wounded, and yet miscarriage did not take place; as in the case of a poor country-woman whom I heard of, who accidentally fell upon a sharp wooden stake, and run it far into the body, injuring the womb in a terrible manner, but strange to say, though far advanced in pregnancy, she recovered and went safely through her full time. I have often known women begin to flood and suffer from dreadful pain, with other common symptoms of abortion, as early as the second month, and yet they went safely the full time, though these signs continued the whole time. In some cases the waters have even been partially discharged, and yet abortion did not result. M. Velpeau tells us of an instance where the bag of waters broke, in a female six months gone, and one arm of the child even came down into the vagina, and yet the arm returned, the discharge ceased, and she went her full term.
Theprogress of a miscarriagevaries according to the time at which it occurs, and the causes from which it arises. When it results from any violenceor accident, it usually takes place in a short time, and is preceded by abundant flooding, which comes on immediately. The discharge of blood however, is lesser the nearer we approach the full term, so that a female six months gone is not in nearly so much danger from flooding as one only two or three months gone. The reason is this, in the early months nearly the whole of the fœtal membranes are attached to the womb, so that in case of their being separated, it bleeds from nearly all its internal surface, but in the latter months the only point of attachment is the placenta. In the latter months also the womb contracts vigorously, and so closes its vessels, but in the early months its contractions are comparatively feeble. In those cases also, where the child has been dead a considerable time before its expulsion, there is seldom much flooding, the connection between it and the mother having been more or less destroyed by decay of the parts. The same result mostly follows a miscarriage from internal disease, particularly of the placenta. Indeed in some of these cases, the blood-vessels connecting the fœtus with the mother have been so completely destroyed, that no blood whatever could escape from them.
In regard to the probable consequences of premature delivery, it has already been remarked that it is more dangerous in the early months than the latter. It may also be added that it is much more dangerous, at any time, when caused by violence of any kind, or by forcing medicines, than when it occurs naturally. The danger is much increased if it occurs during fever, or any eruptive disease, or if the patient be suffering from diarrhœa or convulsions. As a general rule we may say, in all cases, that miscarriage or abortion is always more dangerous tomother and child than natural labor, both in its present and in its future consequences. During an attack of jaundice an abortion may terminate fatally in a few hours; and very frequently the trouble with the after treatment is very great and long-continued.
The treatment in an accident of this kind must vary according as we are required to prevent it, or to remedy the evils that follow when it has occurred.
If an abortion be threatened from any cause, the same general practice must be adopted as recommended forflooding, the indications being the same. I believe myself that in most cases, except from accidental violence or internal disease, miscarriage may be averted. I knew a lady who had miscarried many times, always at the same period, who avoided it at last by simplypreventing constipationfrom the first commencement of pregnancy, and by using an enema every evening of warm starch and water, pretty thick, with about thirty drops of laudanum. This was administered by means of a common injection pipe, just before going to bed, and continued till after she had quickened, and repeated occasionally after that, if she felt any premonitory symptoms of uterine disturbance. If the patient be of a full habit, she should also,from the very beginning, live low, keep the bowels free, and the skin in good action, and take gentle regular exercise in the open air.
When all the means used are found of no avail, and it becomes evident that the fœtus must be expelled, every endeavor should be used to assist nature in its removal as early and as safely as possible. For this purpose the same treatment, as far as practicable, must be pursued as in a real labor. If the hand can be conveniently introduced, without undue force, it may be so, to remove clots, or to take holdof any part of the fœtus which may present, and assist in its extraction. In the early months considerable help may be given, sometimes by introducing the finger into the mouth of the womb, with a little extract of Belladonna, to promote its relaxation, but noforcemust be exerted in doing so. If any part of the after-birth can be laid hold of it should be withdrawn, but no extraordinary effort must be used to reach it. Frequently it happens that a portion of the after-birth remains in spite of all attempts to take it away, and there is apossibilitythat it may produce inflammation of the womb, but no very serious apprehensions need be felt of such a result, providing the patient is properly attended to in other respects. The retained portion gradually decays, and passes away, merely occasioning inconvenience and being very offensive. The danger from leaving it except at a very late period, is generally thought to be less than that from using any forcible means to remove it.
The best means for correcting the offensive discharge are cleansing and antiseptic injections. Warm soap suds are very good, or a decoction of Peruvian bark in water. Strongcoffeeis also excellent, or a weak solution of chloride of lime. The bowels must be kept free, and the skin carefully cleansed and well rubbed. On all occasions when the hand can be introduced with moderate and safe efforts it should be so, and the after-birth removed.
In conclusion it should be remarked, that the tendency to miscarry, like many female diseases, is undoubtedly owing, in great part, to the general debility and weakness which characterizes so many women at the present day, and which is brought on chiefly by neglect of their physical education when girls, and by their artificial mode of life afterwards.
SECTION X.THE DISEASES OF WOMEN IN CHILDBED, AFTER LYING IN.
THE DISEASES OF WOMEN IN CHILDBED, AFTER LYING IN.