Take of Bromide of Potassium, two drachms,Cinnamon water, three fluid ounces.
Take of Bromide of Potassium, two drachms,Cinnamon water, three fluid ounces.
Of this a dessert spoonful may be taken two or three times a day. It may be used with confidence as an entirely safe and harmless remedy in this troublesome affection.
A prescription frequently ordered for the nausea of pregnancy by the late distinguished Dr. Meigs, consisted of equal parts of sweet tincture of rhubarb and compound tincture of gentian—a dessert spoonful to be taken after meals.
Pain in the abdomen, caused by the distension of its walls, may be relieved by the application of equal parts of sweet oil and laudanum.
Another common and annoying, but rarely dangerous, trouble during pregnancy is—
The veins of the legs become distended, knotted, and painful. Women who have borne a number of children suffer most from this affection. It seldom attacks those passing through their first pregnancies. It ordinarily first shows itself during the second pregnancy, and becomes rapidly worse during the third or fourth.
Although it is difficult to cure this disease during the continuance of the pregnancy, much can be done to prevent its occurrence, and to relieve it when present. Tight garters worn below the knee, and closely laced corsets, tend to cause and increase this swollen condition of the veins. Neither should be used during pregnancy.
Relief is best afforded to the suffering parts by means of a well-made and adjustedelastic stocking, which may be readily procured from a druggist or surgical instrument maker. In severe cases it may be necessary for the patient to keep herself as much as possible in the recumbent position on the bed or sofa. In all cases the feet should be supported when seated, so as to keep the blood from further distending the already swollen veins.
That painful condition of the veins of the lower bowel known as hæmorrhoids, or piles, is a not unfrequent annoyance to pregnant women. Sometimes it is caused by prolonged constipation. During the period of pregnancy, therefore, constipation should be guarded against.
Ordinarily the piles are small, and of little consequence beyond the slight uneasiness they occasion. The trifling loss of blood from them is of no account, and often beneficial. The case is different, however, when the piles are large and painful, and give rise to much pain and copious bleeding. They then require prompt treatment.
In thetreatmentof piles the first point to be aimed at is to keep the bowels moderately open. It must not be forgotten, however, that during pregnancy only the mildest of purgatives are ever to be given. Castor oil, although a disagreeable, is a most excellent prescription in these cases. A small dose, repeated when necessary, will be found to actmost kindly. If this remedy be too repugnant to the patient, small quantities of citrate of magnesia, or of cream of tartar, or of some of the natural mineral waters, may be employed. Small injections of lukewarm water are also of great service, and may be tried instead of laxatives.
After every movement the parts should be well sponged with cold water, and an ointment of galls and opium, procured from the druggist, applied.
If the parts become very much inflamed, warm poultices or hot chamomile solutions should be used, and the patient kept in bed until the inflammation subsides.
No attempt is to be made to effect the radical cure of piles during pregnancy. Any such attempt, besides being dangerous, is unnecessary, for the piles usually disappear of their own accord after the confinement. Every effort to make the sufferer more comfortable in the manner we have suggested is, however, right and safe.
Some women always suffer from looseness of the bowels during pregnancy; others are very liable to attacks of it during this period, either coming on without any assignable cause or easily excited by any slight indiscretion in eating. In many instances these attacks alternate with constipation or with morning sickness.
The diarrhœa, if at all severe or prolonged, should not be allowed to go on unchecked, for it quickly weakens the patient and predisposes her to abortion. The fœtus is especially endangered when the passages are attended with much bearing-down pain. In some exceptional cases, however, a slight diarrhœa seems to be beneficial, for every attempt to remove it appears to do harm; but these instances are very rare.
Thetreatmentrequired is a simple, and must be a cautious one. Ordinarily no medicine will be needed. If the patient will merely confine herself to milk and arrowroot and rice for twenty-four hours a cure will be effected in mild cases. When it is apparent that the attack has been caused by improper food, a table-spoonful of castor-oil or a tea-spoonful or two of tincture of rhubarb will remove the offending material in the bowels, upon the presence of which the diarrhœa depends. A small injection of a tea-spoonful of rice water and thirty or forty drops of laudanum will often speedily arrest the excessive discharges, and relieve the pain.
No woman while pregnant should allow several days to elapse without a movement from the bowels. The symptoms of constipation, slight at the outset, soon cause great inconvenience. Among the effects, which, sooner or later, show themselves, may be feverishness, sleeplessness, headache, distressing dreams, sickness at the stomach, severe bearing-down pains, and piles.
Medicines are rarely required in the treatment of constipation, and the pregnant woman should never take an active purgative, excepting under medical advice. Outdoor exercise and regularity in soliciting nature's calls, together with a change in the diet, will usually have the desired effect. Brown bread, wheaten grits, oatmeal gruel, ripe fruits, fresh vegetables, stewed prunes, or prunes soaked in olive oil, baked apples, figs, tamarinds, honey, and currant jelly, are all laxative articles which should be tried.
In some instances a tumbler of cold water drunk the last thing at night, and another the first thing in the morning, will act in a most satisfactory manner. If the constipation should resist these safe and homely remedies, which will rarely be found the case, then medical assistance should be called in. On no account should the wife herself, or in accordance with the counsel of any non-medical friend, resort to purgative drugs.
A troublesome cough sometimes affects delicate, nervous women during the early months of pregnancy. If it be not very frequent nor severe, it requires no attention, as it will pass away of itself in a short time. When, however, it disturbs the sleep at night, renders the patient anxious, and causes headache and weariness, it is time to do something for it. It may, indeed, be so violent as to threaten abortion on account of the forcible concussion of the abdomen it produces.
A tea-spoonful of paregoric occasionally repeated during the day will be found a most efficient soothing remedy.
Sleeplessness, always distressing, is particularly so to pregnant women. If prolonged, it leads to serious consequences. It should receive, therefore, the most prompt attention.
Thecausesof 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.
Thetreatmentof 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 anddry, 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 potassium. 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.
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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
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 whethera 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 class 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 pass 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 ata 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.
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 isexhaustion.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 anycause, 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.
This affection, though not confined to married women, is quite common during pregnancy and after confinement. There are few married women who pass through their lives without at some time or other having suffered from it.
We will consider first thatform 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 theform 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 prone to it.
Thetreatmentmust 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 coarse 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.
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 breaststo the limb causing the white swelling. It is scarcely necessary to say this theory is entirely erroneous.
Many, we may say most, married women whose health is broken down by some disease peculiar to their sex, 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 associated 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 rightlyplace the greater tendency of married women to this class 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 illustrative 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 youngmarried 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
Most of them are the penalties inflicted by stern nature on infractions of her laws. Hence the great, the unspeakable, importance of women being made aware of the dangers to which they are exposed, and being fully informed how to avoid them. This task we now assume.
There is, we concede, a tendency in the changes which take place during pregnancy and parturition to expose the system to such accidents. But thistendency can be counteracted by care, and by the avoidance of certain notorious and familiar infractions of the laws of health. It is usually not until she gets up and commences to go about the house, that the woman feels any pain referable to a displaced womb. Very frequently the origin of it is leaving the bed too soon, or attempting to do some work, too much for her strength, shortly after a premature birth or a confinement. Not only should a woman keep her bed, as a rule, for nineteen days after every abortion and every confinement, but for weeks after she commences to move about she should avoid any severe muscular exertion, especially lifting, long walks, straining, or working on the sewing-machine. Straining at stool is one of the commonest causes. Many women have a tendency to constipation for weeks or months after childbirth. They are aware that it is unfavorable to health, and they seek to aid nature by violent muscular effort. They cannot possibly do a more unwise act. Necessarily the efforts they make press the womb forcibly down, and its ligaments being relaxed, it assumes either suddenly on some one well-remembered occasion, or gradually after a succession of efforts, some unnatural position. The same reasoning applies to relieving the bladder, which is connected in some persons with undue effort.
Constipation, if present, must, and almost always can, be relieved by a judicious diet, and the moderate use of injections. These simple methods are much to be preferred to purgative medicines, which are rarely satisfactory if they are continued for much time. When anything more is needed, werecommend a glass of some laxative mineral water, which should be taken before breakfast.
For the difficulty with the bladder we mentioned, diet is also efficacious. It is familiarly known that several popular articles of food have a decided action in stimulating the kidneys: for instance, asparagus and water-melon. Such articles should be freely partaken, and their effect can be increased by some vegetable infusion, taken warm,—as juniper-tea or broom-tea. The application to the parts of a cloth wrung out in water as hot as it can conveniently be borne, is also a most excellent assistant to nature.
Similar strains on the muscles of the abdomen are consequent on violent coughing and vomiting. Therefore these should be alleviated, as they always can be, by some anodyne taken internally. Any medical man is familiar with many such preparations, so that it seems unnecessary to give any formula, particularly as it would have to be altered, more or less, to suit any given case.
Women of languid disposition and relaxed muscles are frequently urged to 'take exercise,' and to 'go to work.' Their condition sometimes excites censure rather than commiseration, because it is thought that they do not exert, and thus strengthen, themselves as much as they should. We are quite as much in favour of work and vigorous muscles as any one. But often it were the most foolish advice possible to give a woman, to tell her to seek active exercise. It is just what she should avoid, as it may ultimately give rise to that very trouble which,now only threatening, is the cause of her listlessness. Many instances are familiar to every physician of extensive experience, where a long walk, a hard day's work, a vigorous dance in the evening, or a horseback ride, has left behind it a uterine weakness which has caused years of misery. Especially after confinement or premature delivery it is prudent for a woman to avoid any such exertion for months and months. Moderate employment of her muscles in any light avocation, short walks and drives, fresh air, with judicious exercise,—these are well enough in every instance, but beyond them there is danger. We know too well that advice like this will sound like mockery to some who read these lines. They have to work, and work hard; they have no opportunity to spare themselves; the iron hand of necessity is upon them, and they must obey. We can but sympathize with them, and cheer them with the consolation that many a woman has borne all this and lived to a healthy and happy old age. Nature has surrounded the infinitely delicate machinery of woman's organization with a thousand safeguards, but for all that, the delicacy remains; and it is because so many women are forced to neglect their duties to their ownselves, that so many thousands walk the streets of our great cities, living martyrs.
But no. We must modify what we have just written. In justice to our own sex, and in all truthfulness, we cannot allow the blame to be removed altogether from women themselves. They alone are responsible for one of the most fruitful causes of their wretchedness. The theme is a threadbare one.We approach it without hardly any hope that we shall do good by repeated warnings utterly monotonous and tiresome. But still less can we feel comfortable in mind to pass it over in silence. We refer to the foolish and injurious pressure which is exerted on the lower part of the chest and the abdomen by tight corsets, belts, and bands to support the under-clothing; in other words,
Why it is, by what strange freak of fashion and blindness to artistic rules, women of the present day think that a deformed and ill-proportioned waist is a requisite of beauty, we do not know. Certainly they never derived such an idea from a contemplation of those monuments of perfect beauty bequeathed to posterity by the chisels of Attic artists, nor from those exquisite figures which lend to the canvas of Titian and Raphael such immortal fame. Look, for instance, at that work of the former artist, now rendered so familiar by the chromo-lithographic process, called 'Titian's Daughter.' It is the portrait of a blonde-haired maiden holding aloft a trencher heaped with fruits. She turns her face to the beholder, leaning slightly backward to keep her equilibrium. Her waist is encircled by a zone of pearls; and it is this waist we would have our readers observe with something more than an æsthetic eye. It is the waist of health as well as beauty. Narrower than either the shoulders or the hips, it is yet anything than that 'wasplike waist,' which is so fashionable a deformity. With such a waist, a woman is fitted to pass through her married state with health and pleasure. There is little fear that she will be the tenant of doctors' chairs, and the victim of drugs and instruments. Let women aim at beauty, let them regard it as a matter of very high importance, worth money and time and trouble, and we will applaud them to the echo. But let them not mistake deformity, vicious shape, unnatural and injurious attitudes, and hurtful distortions for beauty. That not only degrades their physical nature, but it lowers their tastes, and places them in æsthetics on a level with the Indian squaw who flattens her head and bores her nose, and with the Chinese woman who gilds her teeth, and compresses her foot into a shapeless mass. True beauty is ever synonymous with health; and the woman who, out of subservience to the demands of fashion, for years squeezes her waist and flattens her breast, will live to rue it when she becomes a mother. Away, then, with tight corsets and all similar contrivances.
Of a similar objectionable character are many of the devices which ignorant men connected with the medical profession urge upon the public for the sake of remedying curvature of the spine, restoring the figure, or supporting the abdomen. Not a few of such braces and supporters are seriously dangerous. A good brace, well-fitting, carefully adjusted, suited to the particular case, is often of excellent service; but the majority of them do not answer this description. Our advice is, that no girl, and still more no mother, should wear one of these without it is fitted upon her by an experienced hand. We have known more than one instance where the binder puton after childbirth has been wrongly placed, and pinned so firmly that it has resulted in producing falling of the womb. This, too, should be sedulously looked after.
All these are causes which are strictly under the control of the woman herself. They are therefore such as she should have in mind and be on her guard against. There are others, but they are less frequent, which are beyond her power; and it would be labor lost, therefore, for us to mention them.
Equally vain would it be for us to speak of the various means by which difficulties of this nature are removed. Probably no one branch of medical surgery has been more assiduously cultivated than this; and the number of supporters, pessaries, braces, and levers which have been recently brought before the medical profession for this purpose is simply appalling. There are women and men who make it their business to carry them through the country and sell them on commission. We distinctly warn our readers against this class. They are almost invariably ignorant and unscrupulous, rich in promises, and regardless of performances. She who patronizes them will be sure to lose her money, and will be lucky if she does not forfeit her health also.
The most we shall do is to give some advice how to treat such complaints on principles of hygiene. And indeed this means nearly one-half the battle. For without these simple cares, treatment of any kind is useless, and sure to fail; and with them, many complaints are remedied as well as avoided.
The first point we would urge is, that the woman who finds herself thus afflicted should seek to have such a position that she canrest.If she is burdened with family cares, let her, if possible, diminish or escape them for a time. A rest of a month or two, not at a fashionable watering-place, nor at a first-class hotel in some noisy city, but in quiet lodgings, or with some sympathizing friend, will be of great advantage. This she should obtain without travelling too far. Prolonged motion in railway carriages is in every instance injurious. If it must be undertaken, for instance, in order to consult a qualified physician or to reach some friends, the modern appliances of comfort, such as air-cushions, foot-rests, and head-supports, should be provided. They cost but little, and to the invalid their value is great. No such journey should be undertaken at or near the time when the monthly illness might come on, as the suffering is always greater at these periods.
The pleasant associations which group themselves around ahappy homeare an important element in the treatment of diseases which, like these, are so intimately connected with the mind and nervous system. It will not do heedlessly to throw such advantages away. When the homeispleasant, and rest can there be had, the patient, in the majority of instances, will do well to abide there. But when this is not the case, for any reason, be it domesticinfelicities, in which the husband has a share,—be it disagreeable relatives, or importunate and tedious visitors,—then the sooner such a mental weight is removed or avoided the better.
Thedietis a very common subject of error. It is popularly supposed that everybody who is weak should eat a 'strengthening' diet,—meat three times a day,—eggs, ale, and beef-tea to any extent. This is a great error. Frequently such a diet has just the contrary effect from what is expected. The patient becomes dyspeptic, nervous, and more debilitated than ever. The rule is, that only that diet is strengthening which is thoroughly digested, and taken up in the system. Frequently, we may say in the majority of cases, a small amount of animal food, especially game, fowls, fish, and soups, with fresh vegetables, and ripe fruits, will be far more invigorating than heavier foods. Pastry, cakes, and confectionery should be discarded, and great regularity in the hours of meals observed. Stimulants of all kinds are, as a rule, unnecessary, and highly spiced food is to be avoided. There is an old German proverb which says, 'Pepper helps a man on his horse, and a woman to her grave.' This is much too strong; but we may avail ourselves, in this connection, of the grain of truth that it contains.
Cleanliness, in its widest sense, is an important element in the treatment. Not only should the whole surface of the body be thoroughly washed several times a week, but the whole person should besoakedby remaining in the water for an hour or more. This has an excellent effect, and is far from unpleasant. It was regarded in the days ofancient Rome as such a delightful luxury, and such a necessity, indeed, that every municipality erected public bathing establishments, with furnaces to heat the water to such a temperature that persons could remain in it for several hours without inconvenience.
The use of public baths is almost unknown in this country; but, in place of them, every modern house of even moderate pretensions has its own bath-room, so that the custom of cleanliness might appear to be hardly less general among all classes than in old Rome.
The difficulty is, that so few people appreciate that to thoroughly cleanse the skin, still more for the bath to have a medicinal effect, it must be prolonged far beyond the usual time we allow it. The European physicians, who, as a rule, attach much greater importance to this than ourselves, require their patients to remain immersed two, three, four, and occasionally even ten or twelve hours daily! This is said to have most beneficial results; but who would attempt to introduce it in this country?
Local cleanliness is of equal importance. This is obtained by means of——
of simple water, or of some infusion or solution. The use of the syringe as an article of essential service in preserving the health of married women should never be overlooked. Even when they are aware of no tendency to weakness or unusual discharge, it should be employed once or twice aweek; and when there is debility or disease of the parts actually present, it is often of the greatest service.
There are many varieties of female syringes now manufactured and sold, some of which are quite worthless. Much the most convenient, cleanly, and efficient is the self-injecting india-rubber syringe, which is worked by means of a ball held in the hand, and which throws a constant and powerful stream. They come neatly packed in boxes, occupying small space, and readily transported from place to place. Much depends on knowing how to apply them. The patient should be seated on the edge of a low chair or stool with a hard seat, immediately over a basin. The tube should then be introduced as far as possible without causing pain, and the liquid should be thrown up for five or ten minutes. About one or two quarts may be used of a temperature, in ordinary cases, a little lower than that of the apartment. Water actually cold is by no means to be recommended, in spite of what some physicians say to the contrary. It unquestionably occasionally leads to those very evils which the judicious use of the syringe is intended to avoid.
No fluid but water should be used in ordinary cases. When, however, there is much discharge, a pinch of powdered alum can be dissolved in the water; and when there is an unpleasant odor present, a sufficient amount of solution of permanganate of potash may be added to the water, to change it to a light pink color. This latter substance is most admirable in removing all unpleasantodors; but it will stain the clothing, and must on that account be employed with caution.
We will add a few warnings to what we have just said about injections. There are times when they should be omitted,—as for instance during the periodical illness, when the body is either chilled or heated, and generally when their administration gives pain. There are also some women in whom the mouth of the womb remains open, especially those who have borne many children. In such cases, the liquid used is liable to be thrown into the womb itself, and may give rise to serious troubles. These should either omit the use of the syringe altogether, or obtain one of those which throw the water backward and not forward. This variety is manufactured and sold by various dealers.
Irrigationsare more convenient in some respects than injections. They are administered in the following manner:—A jar holding about a gallon of water, simple or medicated, as may be advisable, is placed upon a table or high stand. A long india-rubber tube is attached to the bottom of the jar, ending in a metallic tube, and furnished with a stopcock. The patient seats herself on the edge of a chair over a basin, introduces the tube, and turns the stopcock. The liquid is thus thrown up in a gentle, equable stream, without any exertion on her part. No assistant is required, and the force and amount of the liquid can be exactly graduated by elevating or lowering the jar, or by turning the stopcock. When there is much debility, or when it is desirable to apply the liquid for a long time, this method is much preferable to syringing. Thenecessary apparatus can readily be obtained in any large city. It has, however, the drawback that the jar is large, and not convenient to carry on journeys.
We shall close this chapter on Health in Marriage by a few words on some of theailments to which mothers are subject while nursing.
Gathering of the breasts may occur at any time during the period of nursing, but it is most frequently met with within the first three months after childbirth, and is more common after the first than after subsequent confinements. All women are more or less liable to it, but those who are weakly, and particularly those who are scrofulous, are most prone to its attacks.
Thecausesof inflammation of the breast are numerous. It may be created by a blow or fall, by a cold, by mental excitement, by indiscretions in eating or drinking, and by moving the arms too much when the breasts are enlarged, but its most common cause is undue accumulation of milk in the breasts. Dr. Bedford is of the opinion that in nineteen cases out of twenty it is the result of carelessness—of neglect in not having the breasts properly drawn. 'For example, the child may be delicate, and not able to extract the milk; or the nurse, in the gratification of some ancient prejudice derived from a remote ancestry, does not think it proper to allow the infant to be put to the breast for two or three days after its birth. In this way, the milk ducts become greatly distended, inflammation ensues, which, if not promptly arrested, terminates in suppuration.'
Often the love of pleasure brings with it this punishment to the nursing mother who neglects her maternal duties. During an evening spent in society or at the theatre the breasts cannot be relieved in the manner required for the preservation of their health.
Soreness of the nipples, which renders suckling painful, often leads the mother to avoid putting the child to the breast as often as she should. It is only when forced by the pain in the over-distended parts that she can summon courage to permit of their being emptied. This partial and irregular nursing is very dangerous, and cannot fail, in most cases, to lead to the very painful affection of which we are now speaking.
No nursing mother is safe whose breasts are not properly and daily emptied. If this cannot be done by the child, another infant should be applied, or a small puppy, either of which expedients is preferable to a breast-pump, which, however, is much better than neither. If the tender or chapped condition of the nipples interferes with free nursing, this condition must be promptly remedied. When undue accumulation of milk is threatened gentle friction of the breasts with sweet oil and camphor is also of service; and they should be supported by means of a handkerchief placed under them and tied over the shoulders.
It must not be forgotten, however, that thoughgentlerubbing afford relief to the breasts when they are hard, knotty, and over-distended, any friction isinjurious if gathering has actually commenced. In all cases, therefore, it is of importance to distinguish between over-distension (which mayleadto inflammation) and a condition of already established gathering of the breasts. This it is not difficult to do. In the former case the skin is pale, there is little or no tenderness, and the hardness is evenly diffused over the whole of the breast; whereas, when gathering has taken place there is a blush of redness on some portion of the breast, which is always painful to the touch, and which will be found to be particularly hard and sore in some one spot.
Thesymptomsof gathered breasts we have just described in part. The severity of the symptoms will depend upon the extent and depth of the inflammation. The affection is always ushered in by shivering, followed by fever and a shooting pain in the breasts. A small, hard, painful swelling will be noticed in the breast even before the skin shows any sign of redness. This swelling increases in size and the suffering becomes very great and difficult to bear, preventing sleep and prostrating the whole system. The secretion of milk is suspended at least during the first active stage of the disease.
The object oftreatmentis to prevent the formation of an abscess by subduing the inflammation as speedily as possible. This is to be sought first by keeping the breast as nearly empty as possible. For this reason the child should be assiduously applied to the affected rather than to the well side, although suckling will be painful. Indeed, it is better, if it can be done, to procure an older child and let it keep the milk under. When, however,the inflammation is fully established, the pain will compel the restriction of the child to the well side. The application of warmth is both grateful to the part and beneficial. This may be done by means of poultices or fomentations, or by immersing a wooden bowl in hot water and putting the breast, wrapped in flannel, within it. This latter means will be found an easy and agreeable one of keeping up the application of dry heat. The bowels should be briskly purged by a dose of citrate of magnesia or cream of tartar. The diet must be mild, and the breasts supported in a sling. If, in spite of all these efforts, an abscess actually forms, the attending physician will doubtless advise its immediate opening, to which advice the patient should accede, as that is the course which will afford her quicker and more effectual relief than she can hope for from nature's unaided efforts at effecting a discharge of the pent-up matter.
It is interesting for the mother to know that if her child be still-born, or if unfortunately she be unable from any of the reasons mentioned in our chapter on Hindrances to Nursing to give the breast at all to her child, she is not liable to gathering on this account. This is contrary to what might be expected. It is not the mother who is unable to nurse at all who suffers, but she who does so in an unsatisfactory manner and who fails to have her breasts properly emptied.
The first milk which makes its appearance in the breast towards recovery from inflammation is likely to be stringy and thick, and should, therefore, be rejected before nursing is resumed.