Part 62

Hygiene of pregnancy.--In pregnancy the dividing line between health and disease is often so shadowy that every care should be given the pregnant woman, not only that she shall escape dangers that may come, but that the future health of the coming baby may be safeguarded.

The care taken in pregnancy therefore should include attention to clothing, food, exercise, rest, sleep, functions of all excreting organs, the breasts, nervous system and the mind.

[520 MOTHERS' REMEDIES]

Clothing.--This should be worn loose. The heavier garments should not be held by the waist but suspended from the shoulders. Flannels, if possible, should be worn next the skin excepting, possibly, during the warmest weather. Every precaution should be taken not to take cold or to chill the surface of the body, as this might bring on an acute trouble of the kidneys. As soon as the womb has risen out of the pelvis during the fourth month, the corset should be absolutely abandoned, since pressure upon the enlarging womb tends to cause acute Bright's disease and uraemia, and these troubles are always to be guarded against. During the later months of pregnancy, when the abdominal enlargement is great, a linen or elastic bandage may be worn with great comfort, but it must be so put on as to support and not press upon the womb.

Food.--The food of the pregnant woman should be simple, wholesome, nutritious, of the kind that is easily digested and enough to satisfy the demands of her system; excessive eating should be avoided. A mixed diet is to be preferred, but the diet should be of such kind as to help to overcome the constipation, usual in pregnancy. Meat should not be eaten in as great quantities. It not only tends to produce more constipation but also has injurious effect upon the kidneys, and anything that in any way puts a greater burden upon the kidneys in pregnancy should be avoided. All foods that are likely to produce indigestion, heart burn, or irritation of the stomach and liver, such as sweets, fried, greasy, highly spiced foods; greasy rich gravies, or pastry should not be eaten.

The heartiest meal should be taken near midday and the stomach, especially at night, should never be overloaded. Water should, be drank freely, as it tends to overcome the constipation and wash out the kidneys. Some women do better with lighter meals and taken more frequently. Some do better by taking their breakfast before rising.

Bathing.--Extremes in hot and cold bathing should be avoided. The skin should be kept active by daily comfortable baths, followed by a brisk rubbing with a rough towel. The Bowels and Bladder.--The bowels, as before stated, are usually constipated and should be kept open by coarse foods, fruit and, when necessary, mild laxatives; mineral waters and enemas especially should not be given. It should not be forgotten that in some women injections into the bowel are liable to bring on contractions of the womb.

No woman, and especially no pregnant woman, should ever neglect the bowels, as much discomfort and ill health are caused by improper eliminations of the bowel contents. The bladder should also have proper care. This is apt to be irritable during the early and later months of pregnancy, owing to being pressed upon by the womb. A mild inflammation arises in some cases. The woman should take plenty of water, either pure or effervescing, to induce sufficient secretion in the kidneys, and also to flush them. This is also very good for an irritable bladder. In order that the physician may keep himself informed regarding the condition of the kidneys, the urine of every pregnant woman should be examined, both chemically and microscopically, every two weeks from the beginning of pregnancy; during the late months of pregnancy the urine analysis should be made weekly. Catherized specimens should be used because leucorrheal discharges, so common in pregnancy, may give the albumin reaction. If the above advice of Dr. Manton, of Detroit, was followed in every case there would be fewer cases of trouble during the confinement. I remember one case; the lady was seven months along when I was called. She was feeling badly and complained much of her eyes; an analysis of the urine showed thick with albumin. The failure of her sight was due to thc condition of her kidneys. If the urine had been examined early and often, her condition might have been prevented. Watch the kidneys, have the urine examined frequently and carefully.

[OBSTETRICS OR MIDWIFERY 521]

Exercise, Rest and Sleep.--Plenty of exercise in the open air should be taken daily, without this health cannot be maintained. It should not be violent or so great as to fatigue and overtire. Slow riding in a carriage and walking will give the best results. Horseback riding and riding in an automobile should be avoided. The woman should sit out of doors as much as possible. Plenty of sleep is also necessary. Eight hours are not too much at night, and lying down an hour or two during the forenoon and afternoon is very restful and desirable.

The Vagina.--When there is a profuse discharge of leucorrhea, a daily vaginal douche is necessary. This should consist of a quart of warm solution (as much as the water will dissolve) of boric acid, or an equal amount of mild carbolic acid (one to eighty). The temperature of the solution should be about 100 degrees F., and it should be injected slowly, and without any force to the stream.

It is also best to remain in the recumbent position for some time after the injection, to rest.

The Breast and Nipples.--These should be bathed once or twice daily in cool or tepid water until the last month or two of pregnancy. Astringent application should not be applied to the nipples to harden them. If the nipples are small, undeveloped or retracted they should be pulled out several times daily by the fingers and gently rubbed, and this will usually stimulate their growth. Cocoa butter or castor oil may be applied during the last month.

Nervous System and the Mind.--The pregnant woman is very susceptible to annoying conditions of the social and domestic surroundings; such should be removed, if possible, and excitement of every kind should be avoided. Everything should be made bright and comfortable around her, cheerfulness should be the rule in the home and she should be treated with every care and consideration. Surroundings will influence the coming baby's future.

[522 MOTHERS' REMEDIES]

Disorders of Pregnancy.--Nausea and vomiting.--The simple nausea and vomiting of pregnancy needs no treatment. This kind generally disappears by the third or fourth month, but it may persist in a mild form during the greater part of pregnancy. Generally the regulation of the diet and attention to the bowels are all that is necessary to be done for this trouble. Foods should be chosen carefully and only such foods taken that agree with the stomach and lessen the constipation. Sometimes taking a light breakfast in bed saves the usual morning sickness. It is best then to remain lying for some time after eating. When the condition is annoying the following powder will give much relief: powder Ingluvin, oxalate of cerium, of each five grains. Mix thoroughly and take one, every one or two hours as needed. A physician should be consulted if this trouble is very severe.

MOTHERS' REMEDIES.--1. Pregnancy, A Great Aid for.--"Soothing syrup or Mother's friend, while pregnant. Two ounces each of cramp bark, blue cohosh, slippery elm, raspberry leaves, squaw vine, orange peel and bitter root. Simmer gently in sufficient water to keep herbs covered for two hours, strain and steep gently down to one quart. Let it stand to cool, then add one cup granulated sugar, and four ounces alcohol. Dose.--One tablespoonful two or three times a day for several weeks before the birth of the child. This has been thoroughly tried and causes an easy birth where difficulty has been expected."

2. Nausea of Pregnancy, Menthol and Sweet Oil for.--"Vomiting and nausea of pregnancy; a twenty per cent solution of menthol in sweet oil; use ten drops on sugar when nausea appears." The menthol acts on the stomach and quiets it. This will be found very beneficial.

3. Pregnancy, Bouillon or Broth for.--"Was weak and generally run down. Family physician warned me I would never survive the birth of another child. I bought each day several beef bones and boiled them for three hours. I also bought chicken feet, scalded them and scraped them until the outside skin peeled off, then boiled the chicken feet with the bones. Skim surface from time to time. I would then heat up a raw egg in a glass and fill glass with this broth and drink it warm." This lady would take a glass whenever thirsty or six or seven times a day. She increased in strength immediately, within a year was the mother of a healthy baby girl now nineteen years old and believes her life was saved by the above. Anyone will find this worth trying.

[OBSTETRICS OR MIDWIFERY 523]

Indigestion and Heart-burn.--This should be treated the same as under other conditions. Diet, habits, should be regulated. The bowels and kidneys should be regulated and do their eliminating work. For heart-burn the popular remedy, magnesia may be taken or dilute hydrochloric acid with nux vomica. One teaspoonful or effervescing citrate of magnesia dissolved in water and drank, is a convenient remedy. Also, five drops of diluted hydrochloric acid in water, taken after meals, through a tube, and one or two drops of nux vomica before meals is beneficial. The following is an excellent combination from Dr. Hare, of Philadelphia:

Dilute Hydrochloric Acid 2 drams Essence of Pepsin 1 ounce Compound Tincture of Gentian enough to make 4 ounces

Mix. Take one or two teaspoonfuls in a little water with meals.

In cases where it is impossible to eat anything the patient must be fed by the rectum. In such cases a doctor must be called. Fortunately such severe cases are very rare. The following for rectal feeding is given by Dr. Manton, of Detroit, and is a good combination. Give every four hours:

Liquid Beef Peptonoids 3 drams White of an Egg Whisky 3 drams Beef Tea or Warm Water enough to make 3 ounces

The rectum should be washed out once or twice daily in the interval between the feeding.

Teeth.--The teeth are often affected during pregnancy, softening and decaying rapidly, causing severe neuralgia. The teeth should be cleaned frequently during the day to get rid of the secretions of the mouth, and at night before retiring. Milk of magnesia should be held in the mouth for a few minutes; cavities in the teeth should be stopped with a temporary filling. Teaspoonful of lacto phosphate of lime can be taken three times a day with benefit.

Constipation.--The enlarging womb pressing upon the rectum and also irregularity in diet causes constipation at this time. Daily free bowel movements are necessary to prevent the kidneys from overworking. As stated before, the diet should be strictly regulated. Cascara sagrada cordial is a good mild laxative to take, if necessary.

Difficult Breathing.--This usually comes late in pregnancy and is due to the pressure of the womb upon the diaphragm; the patient should avoid excitement and sleep with the shoulders well elevated. In the ninth month the womb drops lower and the breathing is better.

Varicose Veins and Piles.--Varicose veins: These are due to the pressure on the veins so that the return flow of blood is impeded and occur as a rule late in pregnancy. They are seen oftenest on the inner side of the thighs, the lower extremities, the vulva, and in the region of the anus. As a rule, they do not give much trouble. When they become painful or inflamed the patient should lie down, with the legs elevated and use water of witch-hazel applied with cloths. Elastic stockings, properly fitted, give much relief when the trouble is on the thigh and leg.

[524 MOTHERS' REMEDIES]

Piles.--When these are troublesome the rectum should be emptied by a small dose of salts, and the parts thoroughly washed with warm water, the piles pushed back and local lotions applied (see treatment of piles). Hot fomentations of witch-hazel frequently give great relief to the piles as well as to the varicose veins. Regular movements of the bowels usually will prevent piles. Piles will not usually give rise to much trouble unless constipation exists.

Albumin in the urine. (Albuminuria).--While the urine of about six to ten per cent of all pregnant women contains albumin, the appearance of this symptom should always be regarded with apprehension. Women who are in their first pregnancy are most frequently affected. If the woman has had disease of the kidneys before her pregnancy began this symptom will likely appear in the early months; if it is caused by pressure, etc., it may not appear until after the sixth month, but both acute and chronic. inflammation of the kidneys may develop at any period of pregnancy. Dr. Manton, of Detroit, states, "In the majority of cases, the albuminuria is due to the so-called kidney of pregnancy, in which there is no inflammation, but a fatty infiltration of the epithelial cells associated with anemia of the organ." The urine may also contain casts. Whatever the cause it indicates a condition of insufficiency of the kidney which may lead to serious consequences to the mother and it is also injurious to the (foetus) child. If this symptom develops suddenly the danger to both is greatly increased. For this reason physicians should urge pregnant women to have their urine examined frequently, especially during the later months of pregnancy.

Treatment.--Regulation of the diet; in pronounced cases the diet should consist entirely of milk and the patient should take three or four quarts in twenty-four hours. Meats, pastry and sweets must be prohibited, but vegetables such as squash, spinach, salads may be added to the dietary in ordinary cases. Vichy water may be taken alone or with the milk, and may be taken freely. The bowels should be kept open with citrate of magnesia (one to two teaspoonfuls in water) or epsom salts in peppermint water. Exercise in the open air can be taken in moderation. Warm clothing should be worn and flannel next the skin; exposure to cold and draughts should be carefully avoided. If the more special symptoms appear, such as persistent headache, vertigo, ringing in the ears, black or bright spots floating before the eyes, dimness of vision, an abortion of miscarriage should be induced without delay. Fortunately such cases are rare and with care from the beginning seldom occur. Pregnant women should inform their family physician at the beginning of pregnancy of their condition, and in the great majority of cases serious troubles can be prevented. Physicians expect this information and receive it as a matter of course, and no woman should hesitate to inform her physician either personally or through her husband.

[OBSTETRICS OR MIDWIFERY 525]

Abortion, Miscarriage, Premature Labor. (Accidents of pregnancy).--These three terms indicate a premature expulsion of the products of conception. Let us medically define these terms as follows; Abortion implies expulsion of the foetus before the sixteenth week. Miscarriage, the expulsion between the sixteenth and twenty-eighth weeks. Premature labor designates the time of expulsion as between the twenty-eighth week to within a few weeks before the normal termination of pregnancy. Miscarriage is the term popularly used for the accidental loss of the products of conception. Abortion, in the popular mind, expresses the intentional loss of the products of conception. Abortion in the medical sense, takes place about once in every four or five pregnancies. It occurs more frequently in those who have borne children, occurring generally in the third or fourth pregnancy, or toward the end of the child-bearing period, and it takes place more frequently between the ninth and sixteenth week, when the after- birth is in process of formation; and it is more liable to occur at the time of the month when the normal menstruation would be due. It should be borne in mind also that abortion occurring at this period is quite dangerous to the mother's future health, and also dangerous to life; so that at the first indication of abortion a physician should be called for this trouble, because it needs care, both to prevent it and to assist the woman to a successful ending when it is impossible to prevent it. This is more dangerous to life than confinement at full term, and is apt to leave behind a tendency to recurrence at the same time in the future pregnancies, and also makes the woman liable to inflammatory conditions of the womb.

Causes.--Abortion may be induced by many causes due to the mother, father, and child. Among maternal causes may be mentioned any serious disease, especially fevers, when accompanied by a rash on the skin, such as smallpox, measles, scarlet fever. It is hard for a pregnant woman to go through one of these diseases, without having an abortion. Syphilis, tuberculosis, malaria, organic heart and kidney disease, diabetes, anemia, and systemic poisoning also are causes; nervous disturbances as shock, fright, sorrow, convulsions, chorea; mechanical causes, violent exercise, lifting, blows, falls, coughing, vomiting; local causes, as wrong position of the womb, inflammation of the womb, etc.; all are causes.

Causes. Due to the Father. Paternal.--Syphilis, alcoholism, lead poisoning, excessive venery, extremes of youth or old age.

Foetal Causes.--Disease of the after-birth, other parts, of cord, death of the foetus, placenta pravia, and yet many women are subjected to falls, blows, etc., who carry their child to full term.

[526 MOTHERS' REMEDIES]

Symptoms.--These vary with the period of pregnancy where they occur. In the earlier months the symptoms are those of profuse menstruation, sometimes accompanied by more pain perhaps than usual. The ovum is then so small that it escapes notice. In the profuse flow there may be unaccustomed clots of blood; when this trouble occurs later in pregnancy there are two constant symptoms which, together with the history of the case, render the diagnosis easy. These prominent and constant symptoms are pain and bleeding. The symptoms may be preceded by a bearing down feeling in the lower abdomen, with backache, frequent calls to pass urine, and a discharge from the vagina, that is a mixture of mucus and water. After these symptoms last for a shorter or longer time, labor pains set in, the bleeding increases and the contents of the womb are discharged. The ovum may be expelled whole when it looks like a huge blood clot, or it may be expelled partly and the membranes left behind; or the embryo (child) alone, surrounded by the transparent membrane, escapes.

If the after-birth has formed it may be cast off entire or piecemeal. The embryo (child) alone may escape, the neck of the womb contracts and shuts; bleeding persists for an indefinite period, for weeks and weeks, until the health of the poor woman is seriously affected. Persistent bleeding of this kind is almost always due to the retention of portions of the after-birth or membranes, and should prove to the woman that there is a serious condition existing which should be speedily corrected. A physician should be called who should make a thorough examination; and if such a condition as above described is found, should free the womb from its retained products, which are not only sapping the woman's life, but also rendering the future health of the womb very uncertain.

Threatened Abortion.--If a bleeding takes place in the woman who is pregnant, abortion may be assumed to threaten; a careful examination will usually settle this matter.

Inevitable Abortion.--The abortion is probably inevitable if the bleeding becomes persistent and free, the cervix softens, the womb dilates and the labor pains set in. Still in spite of all these conditions, the bleeding and pain may cease, and the pregnancy go on to full term, The result of these cases, if carefully and properly treated, is favorable as far as the mother is concerned.

Treatment. Preventive. In women where repeated abortions have occurred, the cause should be diligently sought for. If syphilis exists the treatment should be begun at the beginning of pregnancy. But when no special cause can be found, and an irritable condition of the womb is suspected to be present, the patient must be kept quiet in bed, especially at the time when menstruation would normally occur. She should also be guarded against lifting, fright, worry, over-exertion; and medicines like bromide of potash, five to fifteen grains at a dose, given to quiet and allay the nervous irritability.

Treatment of Threatened Abortion.--The patient should go to bed, lie down and remain there, and if possible be not only quiet physically, but also quiet mentally. The main remedy is opium, and if necessary to obtain a quick action it can be given hypodermically in the form of morphine. Otherwise, laudanum may be given by the mouth, twenty drops, repeated cautiously, every three or four hours as required, or it can be given in thirty-drop doses combined with a couple of ounces of starch water by the rectum. Extract of opium in pill form, one grain three times a day by the month; or a suppository of opium, one grain, may be inserted into the rectum every four to six hours. After the bleeding and pain have ceased, the emergency is probably passed; but rest in bed and quiet should be the routine for one or more weeks, and the patient should always rest in bed at the usual time of the menstrual period, during the remainder of the pregnancy.

[OBSTETRICS OR MIDWIFERY 527]

Treatment of the Inevitable Abortion.--If the cervix is hard and the canal is not dilated, especially if the bleeding is free, the vagina should be packed full at once, if possible, with iodoform gauze. Rolls five yards long and two inches wide can be bought perfectly adapted to this purpose. A speculum should be used (Sims' or Graves') and the gauze should first be packed tightly into corners (fornices) around the cervix, then over the cervix and well down to the outlet. This should be held in place by a proper (T) bandage. The gauze can be removed in from twelve to twenty-four hours, and the ovum will generally be found lying upon the upper part of the packing, or in the canal that is now dilated, from which it can easily be removed. Sometimes it is necessary to repack and allow it to remain for another twelve hours as the canal has not been sufficiently dilated by the first packing. This packing not only causes the canal to dilate but usually stops the bleeding. After the ovum has been expelled an antiseptic vaginal douche should be given twice a day for a week or longer.

If at the first examination the cervix is found softened and the mouth of the womb is open, but the womb has not yet expelled its contents, the sterile (clean) finger may be introduced into the womb and the ovum and membranes loosened and taken away, while this is being done counter pressure should be made over the abdomen. After the womb has been cleared of all its contents an antiseptic solution should be used, carefully, in the womb to wash it out, and this followed by washing out of the vagina. The after treatment is the same as that for labor at full term. The woman should remain in bed at least ten days.