DYSMENORRHEA.
I next speak of dysmenorrhea, or painful, difficult, or laborious menstruation. This is not only a very common affection, but one of the most painful to which females are subject. Many a woman has spent almost her whole menstrual life with as much pain occurring at each menstrual period, as though labor itself had been passed through. What untold sufferings, alas! are women brought to endure in this disease. Can we for a moment suppose that it is in accordance with the designs of a benevolent Creator, that woman should thus suffer? I answer unhesitatingly, it cannot be. Neither can reason, analogy, or the facts of experience be brought to prove the contrary of my position.
The most prominent and distinctive feature of this disease is the pain. This is experienced mostly in the loins. There may also be pains in the uterus; pains, in short that resemble, both in character and severity, those of actual labor. These become so severe and agonizing, in some cases, as to cause the patient to faint. This affection is one in which not only great suffering is experienced, but is also often one of great obstinacy.
Dysmenorrhea may, for the sake of convenience, be divided into three species:
1. The inflammatory; which occurs in persons of a full, plethoric, and sanguine temperament.
2. The neuralgic; which occurs in persons of a highly excitable temperament, and of a delicate habit of body; and,
3. Where there is a mechanical difficulty to the passage of the menstrual fluid, as, for instance, a closed, or nearly-closed vagina, and a too small opening of the womb.
Those suffering from the first species of the disease are such as are generally too indolent in their habits, and partake too freely of rich and gross articles of food.
The second variety of the disease is often caused by the too free use of narcotics and stimulants, such as tea, coffee, opium, and, in some cases, tobacco; though, to woman’s credit, it is to be said this last article is not much used by them.
The third species may arise from some congenital impediment, or such as existed from birth. In the treatment of this last, mechanical or surgical means may, therefore, not unfrequently be resorted to with benefit.
Females, whether married or single, appear to be equally subject to this disease. In some cases, marriage appears to cure it; in other cases, it would seem that it caused it.
A change of air, such as leaving a city to reside in the country; or perhaps on the contrary, in some cases where persons remove from the country to the city, the affection ceases.
Effects of Pregnancy.—Pregnancy appears sometimes to break in upon the disease, and cure it; but it is far oftener true, that females who suffer from dysmenorrhea, are incapable of conceiving. Oftener, in this disease, there is a too scanty flow of the menstrual discharge. Sometimes, however, it commences with little or no discharge, but ends in a very copious gushing forth of the menses, which brings entire relief from the pain. “A membranous substance, or small coagulum, is discharged; if it be a membranous substance it will be found of unequal size, sometimes small, at other times large; and sometimes it resembles the cavity from which it has been expelled; at other times it will be broken into many fragments. After the expulsion of this substance, the woman enjoys ease, unless there be a fresh production, in which case it requires for its expulsion fresh contractile exertions of the uterus.” Dr. Denman regarded the secretion of this membranous substance as a mark of barrenness, and says that he never knew a female conceive, in whom it was formed. This rule, doubtless, often holds true, but not always, as observation proves.
Causes.—The causes of this disease are plainly the same, or very similar, to those which operate greatly to deteriorate the general health. “It would perhaps be very difficult,” says Dr. Dewees, “to assign all of its remote causes. The most common are the application of cold during the flow of the menses; taking cold after abortion; and in some instances it follows the beginning of marriage; but in other instances the causes are so hidden as not to be cognizable; the married and single are alike subject to it.”
Treatment.—Immense mischief has been done in this disease by the administration of powerful medicines. A disease so obstinate in its nature as often to call forth the greatest endeavors on the part of the physician to cure it, has been combated, in instances innumerable, by the most potent drugs. Nor are these poor suffering patients backward themselves to swallow any opiate, anodyne, or antispasmodic, however powerful and however harmful it might prove to the general system, if there is any prospect of obtaining present relief.
As this is one of the most painful affections to which human nature is subject, I will enter particularly into a consideration of the means to be employed to cure it. We may divide the treatment into two heads:
1. That which relates to the general health; and,
2. That which relates to the time in which pain is experienced.
As to the first of these considerations, all that I have said or can say in these letters respecting the means and modes of improving the general health and stamina of the system, should here be brought to mind. The second of these indications, however—that of relieving pain—I will endeavor to explain fully.
I must tell you that I have studied and practiced the healing art now a considerable number of years. I have endeavored to learn the truth in this important mission of healing the sick. I now, therefore, solemnly declare to you, that in the whole range of the medical art, so far as I have been able to learn it, I know of nothing that excites in my mind a more lively interest, or a more thankful feeling toward the Author of our being, than the adaptation of cold water as a means of relieving the pain and agony which often attend the menstrual period. There is, if I am a judge in this matter, nothing in the whole range of the materia medica, no, nor in all drug substances combined, that can at all compare with the power of this blessed element to assuage pain. But of this I shall speak more, presently.
As a remedy in painful menstruation, Dr. Good recommends “the advantages of traveling, change of air, and new stimulus given to both the mind and body by novelty of scene, novelty of company, amusing and animating conversation, and exercise of various kinds.” “With these,” continues this author, “may also be combined, in the intervals of the menstrual season, and particularly before the discharge has appeared, the use of cold, and especially of sea-bathing.”
Thus it appears that Dr. Good himself entertained the erroneous notion that cold bathing is a dangerous measure at the menstrual period. He observes, however, that “an unnecessary apprehension of catching cold by the employment of this powerful tonic has been entertained by many practitioners;” that with proper care he had never known it occasion this effect; and that it should only be relinquished when no reactive glow succeeds to the chill produced by immersion, and the system is hereby proved to be too debilitated for its use. But in the water-treatment, as you all know, we are not obliged to resort to cold immersion alone; the rubbing wet-sheet is a most excellent application in those cases where the reactive or calorific force is at a low ebb. We can also use tepid ablutions of various kinds with great advantage, under such circumstances—great, not only as regards the patient’s feelings of comfort and strength, but as to cleanliness, which is also an important consideration.
As to the second indication of treatment in these cases, suppose the pain is already upon you. You ask, “What are we to do?” I answer, there are many things, among which are the following:
The rubbing wet-sheet, with a good deal of rubbing and faithfully applied—many times in the whole day if you find need—is one of the best applications.
The wet girdle, likewise, should be kept constantly about the body, and changed as often as the pain requires. Wet compresses about the thighs and below the knees, or about the calves of the legs, are also useful.
The sitting-bath, cold, and sometimes alternating with warm, is also to be employed. If, at the same time, some one rubs the back well with the wet hand, the relief will be more speedy. In very bad cases, when the pain amounts really to a great agony, sitting in a wash-tub, with a couple of pails of cold water in it, at the same time having two or more persons to aid in rubbing the whole surface, if properly persevered in, must sooner or later quell the pain. Possibly, in some cases, it might require an hour or more to effect the desired object. If the patient becomes too much fatigued to continue the half-bath a long time, she can recline in a folded wet-sheet to rest herself, and then afterward proceed again to the bath. Frictions with the wet hand upon the surface, generally have great effect in assuaging pain in these cases.
The folded wet-sheet, that is, a common double sheet of linen, although cotton answers tolerably well, folded once each way, half of it being wet, and applied about the trunk of the body from the arms downward, is a very soothing application in these cases. Applied in this way, two thicknesses of the sheet next to the surface are wet, and the two outer thicknesses are dry. This is a very convenient application, and one great advantage in using a sheet in this way is, that we can open it in front of the body and rewet it, by sprinkling water upon it, without the patient being obliged to rise. If she is able to get up at the time of rewetting the sheet, it is better to do so; but if she is not, it can be done without. A patient may remain many hours in this folded sheet if there is need, a whole night, for example; but she should not allow herself to become too warm in it, as that would weaken the body. According to the season of the year, it should be rewet more or less often, and the patient should have more or less covering as she may feel a need.
The clyster is also a great help in subduing pain in the womb and back. The tepid, or lukewarm, as a general thing, answers best. We use, sometimes, gallons in succession, until the object is brought about.
The foot-bath is likewise a useful remedy. If the feet are cold, they should be put in warm water, the old-fashioned way; but if otherwise, cold answers the purpose best.
Now, it may occur to you, that this kind of treatment, which is so opposed to the old notions, is to be considered as a dangerous one. You know how afraid women are of cold under such circumstances, and how dangerous it is, in fact, to chill the body at certain times. But remember I am speaking of extreme cases of pain. Cold does not injure the body at such times; but, on the contrary, does a great amount of good. You know that if the discharge gets well started in these cases, the pain ceases. Now the cold, instead of checking the discharge, does actually help it to come. The pain, the undue heat in the uterus, the inflammation, as it might almost be styled, is the cause of the discharge not appearing. The application of cold puts a stop to this pain and undue heat, and thus the discharge is helped to come forward.
You will, then, perceive that cold, under circumstances of fatigue and exhaustion, must have a very different effect from what it does when the body is in great pain. In the former case it is highly dangerous; in the latter, highly useful.
But good as cold water is to relieve pain, do not, I beseech you, neglect the means of restoring the general health under these circumstances. It is very foolish, as well as inconsistent, to allow yourselves to go on in habits which your own better judgment must tell you, can only tend to make you worse at the menstrual period. Do not think, that because you have so good a remedy as cold water always at hand, that you can do as you like in regard to self-indulgence.
LETTER VII.
SIGNS OF PREGNANCY.
Importance of the Subject—Difficulties of ascertaining Pregnancy in some Cases—Means by which it is to be Known.
There are some circumstances in which a knowledge of the signs of pregnancy is of very great importance. Dr. Rigby informs us that “there are numerous cases on record where a false diagnosis in women convicted of capital offenses, has led to the most lamentable results, and where dissection of the body after death has shown that she was pregnant.”
Baudelocque, a French writer on the subject, relates the case of a French countess, who was imprisoned during the Revolution, in consequence of being accused of carrying on a treasonable correspondence with her husband, an emigrant. She was ordered to be examined by two of the best midwives in Paris, and they declared her not pregnant. She was accordingly beheaded upon the guillotine, and her body taken to the School of Anatomy, where it was opened by Baudelocque, who found twins in the fifth month of pregnancy.
A great many mistakes of this kind have been made, first and last, in the medical world. Not many months ago, in this city, two eminent practitioners—one of them in particular being one of the most celebrated in the world—had a patient whom it was declared had an internal tumor, from which it would not be possible for her to recover. The physician who attended principally in the case, went often to visit the lady, to crowd up the tumor, as it was called. After a time the physician was sent for early in the morning, to visit the case, as the lady was suffering a good deal of pain. He said he would make it his first visit to see her. On arriving, what must have been his surprise to find his patient already delivered of a fine boy!
The signs of pregnancy, that are very difficult to understand; or, in other words, to ascertain whether a woman is really pregnant in a given case, may be a very difficult matter, if not absolutely an impossible one.
You will agree with me, I am confident, that the old custom of impanneling a jury of twelve matrons, where a court of justice wished to ascertain whether a woman was quick with child or not, was not a good one. If the most experienced physicians and midwives are liable to great mistakes in these matters, how much more so those who have paid little attention to the subject.
But it is my purpose in the present letter to speak of the ordinary signs, changes, and appearances which will usually be found to be accompaniments of this state; and that you will feel a deep interest in the subject, I am already fully aware.
Suppression of the menses, as you well know, is not necessarily a sign of pregnancy. As a rule to which there can be but few exceptions, menstruation and pregnancy do not go on together. Indeed, many writers contend that there can never be menstruation in connection with fecundity. Others assert the contrary. But the rule is, pregnancy and menstruation cannot be present at the same time. But, as we have seen elsewhere, there is often suppression of the menses from various other causes than the one we are now considering.
Nausea, and vomiting in the morning, constitute one of the most common signs of pregnancy; but it is to be remembered also, that, in a considerable proportion of cases, no stomach-sickness, whatever, is experienced. On the other hand, likewise, many persons have nausea and vomiting arising from other causes than pregnancy.
If the child dies in the mother’s womb, it is believed that nausea and vomiting, for the most part, cease immediately.
An irritable state of the stomach is one of the most common symptoms in the early part of this period. The breasts often, at first, grow smaller; after two or three months, they enlarge, and sometimes become painful. A fluid, somewhat resembling milk, only more watery, is not unfrequently observed to ooze from these parts during the early months of gestation. The nipple is seen to be surrounded by a brownish circle; this is at least true in many cases. In the beginning of pregnancy, the abdomen does not necessarily grow larger, as might at first be supposed. Indeed, good authorities assert, that in the commencement of the period, it becomes rather flatter than formerly; and that when it does first increase in size, it is rather from inflation of the bowels, particularly the colon, than from expansion of the uterus. An enlargement of the abdomen may arise from such a variety of causes as the obstruction of the menses, dropsy, diseases of the ovaries, or of the womb. This sign must necessarily always be looked upon with caution, especially in those cases where there is a strong desire for progeny.
I remarked that a fluid resembling milk, is sometimes one of the signs of pregnancy. When this secretion takes place, it is looked upon by many of those who are not well-informed on the subject, as being a certain sign of this state. But it should be remembered, that not unfrequently when the menses cease from some other cause than that of pregnancy, a milky fluid is secreted in the breast. This has been known, likewise, to take place in women who had passed the child-bearing period, in young girls and infants, and even in men. Dr. Dewees gives us a case which is well calculated to impress upon us how careful we should be in forming our judgment in cases of this kind. It is as follows:
“I once knew a considerable quantity of milk form in the breasts of a lady, who, though she had been married a number of years, had never been pregnant, but who, at this time, had been two years separated from her husband. She mentioned the fact of having milk to a female friend, who, from an impression that it augured pregnancy, told it to another friend, as a great secret, who, in her turn, mentioned it to another friend; and thus, after having enlisted fifteen or twenty to help them keep the secret, it got to the ears of the lady’s brother. His surprise was only equalled by his rage; and in a paroxysm he accused his sister, in the most violent and indelicate terms, of incontinency, and menaced her with the most direful vengeance.
“The lady, conscious of her innocence, desired that I should be sent for forthwith, and insisted her brother should not leave the room until I arrived. Some time elapsed before this could be accomplished, as we were several miles from each other, during the yellow fever of 1798. During the whole of this time she bore his threats and revilings with almost exemplary patience and silence. I at length arrived; and, in the presence of the brother and a female friend, she informed me of what I have just stated, and said, her object in sending for me was, to submit to such an examination as I might judge proper to determine whether she were pregnant or not. She would not permit her brother to leave the chamber, and I conducted the examination without his withdrawing. This thing turned out as I had anticipated, from the history given at the moment, of her previous health. I pronounced her not pregnant; and she died in about eight months after of pulmonary consumption, in which disease obstruction of the catamenia is not an unfrequent occurrence.”
Quickening is one of the most unequivocal of the signs of pregnancy. This usually happens about the middle of the period. It may occur, however, as early as three months; not unfrequently, probably, at the end of four months; and sometimes considerably later than the middle of the period, or four and a half months. In quickening, “the motion is first felt in the hypogastrium, and is languid and indistinct, but by degrees it becomes stronger. It is possible for women to mistake the effects of wind for the motions of a child, especially if they have never borne children, and are anxious for a family.” But the sensation produced by wind in the bowels is not confined to one spot, and is very often referred to a part of the abdomen where the motion of a child could not possibly be felt. It must, however, be acknowledged that sometimes a sensation seems to be produced, distant from the uterus, and higher than the child can actually lie. This may be from motion communicated through the folds of the intestines, and the result shows that the woman was not mistaken in her sensation. It is not to be supposed that the child is not alive previous to the period of quickening, though the code of criminal law is absurdly founded on that idea. The child is alive from the first moment that it becomes visible, but the phenomena of life must vary much at different periods. It is seldom felt to move until after the ascent of the uterus out of the pelvis. Does the motion of the child arise from any change of the phenomena of life at that time in the child itself, or from the muscular power becoming stronger, or from the uterus now being in a situation where, there being more sensibility, the motion is better felt? All of these circumstances probably contribute to the sensation, which becomes stronger as the child acquires more vigor, and as the relative proportion of liquor amnii decreases. This fetal motion, however, is not to be confounded with the sensation sometimes felt by the mother, from the uterus rising out of the pelvis, and which precedes the feeling of fluttering.
If this elevation of the fetus takes place suddenly, the sensation accompanying it is pretty strong, and the woman, at the time, often feels sick or faint; and in irritable habits, even an hysterical fit may attend it. From the time when this is felt, women are said to have quickened, and they afterward expect to be conscious of the motion of the child.
The motion of the child, in many, soon increases, and becomes very vigorous; in others, it is languid during the whole of pregnancy; and in a few cases scarcely any motion has been felt, although the child at birth be large and lively. The morning-sickness, and many of the sympathetic effects of pregnancy generally abate after this, and the health improves during the last two quarters.
There is also liability to mistake in regard to quickening, as well as in the other signs of pregnancy. Thus, hysterical persons in particular may feel motions in the bowels, or imagine that they feel them, which they suppose to be the motions of a living child. This is much more apt to occur with those who are very desirous to be pregnant. Other persons also, doubtless, who are not hysterical, may, from flatulency in the bowels, be led into errors in this matter.
In some cases it is probably impossible for the female actually to determine whether pregnancy exists. These cases, however, are exceptions to the rule. As a general thing, there is no difficulty in determining by, or after, the middle of the period, whether a woman is with child.
A manual examination, by a competent physician or midwife, is the most certain test. In ascertaining pregnancy after the middle of the period, there is some liability to error. Practitioners of great experience, as I have before remarked, have made errors in regard to this matter.
Seeing, then, how difficult it is to determine positively beforehand in any case whether pregnancy really exists, you will, I am confident, look charitably upon those who are suspected of this state, without a full and sufficient cause. “It is better that ninety-nine wicked persons should escape, than that one righteous one should be punished.”
LETTER VIII.
DURATION OF PREGNANCY.
Difficulties of Ascertaining it—Rules by which it is to be Known—At what Age can a Fetus Live?
The question relating to the duration of pregnancy is a difficult one. The general belief is, that the term lasts about nine calendar months. We hear spoken of “nine calendar months,” “ten lunar months,” “forty weeks,” or “two hundred and eighty days,” as indicating the length of this period.
It should be recollected, that there may be a material difference between nine calendar months and ten lunar months, as also between nine calendar months and forty weeks. Nine calendar months may fall short of forty weeks by from four to seven days. Thus, it may be two hundred and seventy-three days, two hundred and seventy-four, two hundred and seventy-five, or two hundred and seventy-six days, instead of two hundred and eighty days, or forty weeks.
What are the means by which the true duration of pregnancy, or an approximation thereto, may be established?
1. Cessation of the menses. This is by no means an infallible sign, as every one knows. The menstrual function, as we have already seen, often becomes obstructed from other causes than pregnancy. Conception may take place without the woman being regular. Thus, it may occur some months, even, after the menses have ceased from other causes. If, then, the reckoning should be made to commence at the time when cessation occurred, it would be found very fallacious in many cases. On the other hand, menstruation may occur one or more times after conception has taken place. So, also, it appears to be well established, that pregnancy may occur before menstruation ever appeared with the individual.
2. The period of quickening. This, too, is not a reliable source of reckoning the period of gestation. Quickening sometimes takes place, doubtless, before it is perceived. It takes place, also, at very variable periods, as I have elsewhere remarked; sometimes as early as the third month, sometimes not until the fifth, or, perhaps, the sixth. The range of quickening may be said to extend over a period of at least sixteen weeks. Thus it will appear that this mode of reckoning is by no means to be depended upon, although it often has been.
3. Peculiar sensations soon after conception. Some persons experience peculiar sensations within a day or two after conception. This is not true of every case, nor does the same individual experience these symptoms at each time of pregnancy. At one time she may have them, and at another time not.
4. Nausea and vomiting. These symptoms are too indefinite to enable us to form any just idea of the time when conception takes place. Some individuals do not experience them at all; some experience them very soon, almost immediately after conception; others not until the lapse of weeks, in some cases, probably months.
5. Coition. In the generality of cases it is impossible to know at what precise period pregnancy has commenced, because it is not known when the effectual coition took place. Now and then, however, such cases do occur; and in such instances, which are, on the whole, very rare, we find that the period of pregnancy varies somewhat as to its length.
Another method of reckoning has been to count from the time of the last menstrual discharge. Dr. Merriman, of London, has published a table of the births of 144 mature children, calculated from the day after the last menstruation was perceivable. According to this table
| 3 | were born in the | 37th | week. |
| 13 | „ | 38th | „ |
| 14 | „ | 39th | „ |
| 83 | „ | 40th | „ |
| 22 | „ | 41st | „ |
| 15 | „ | 42d | „ |
| 10 | „ | 43d | „ |
| 4 | „ | 44th | „ |
Dr. Guy, of London, gives the following cases:
| A case by | Dr. Nixon | 273 or 276 | days |
| „ | Dr. Montgomery | 280 | „ |
| „ | Dr. Forster, of New York | 283 or 285 | „ |
| A case before | Lancaster Assizes | 284 | „ |
| A case by | Dr. Dewees | 286 or 288 | „ |
| „ | Dr. Desormeaux | 290 | „ |
| „ | Dr. Reid | 292 or 293 | „ |
The results of these cases are as follows:
| Average | of the seven cases | 284 or 285 | days. |
| Minimum | „ | 273 or 276 | „ |
| Maximum | „ | 292 or 293 | „ |
| Range | „ | 16, 17, 19, or 20 | „ |
| Excess | above 280 days, | 12 or 13 | days. |
| Excess | above nine calendar months, | 16 or 17 to 19 or 20 | days. |
Thus it is plain that the period of gestation is more variable than some have supposed.
The same thing is also observed in animals, where, in general, a much more true record can be kept, than is possible in regard to the human species. M. Tessier, in France, caused a set of observations to be made on the duration of pregnancy in 160 cows, which commonly go nine months with young. His table is as follows:
| 3 | brought forth on the | 270th day. | |
| 50 | „ | 270th to the 280th | day. |
| 68 | „ | 280th to the 290th | „ |
| 20 | „ | 300th | day. |
| 5 | „ | 308th | „ |
| 14 | „ | 241st to the 260th | „ |
There is, as will be seen in this table, a variation of sixty-seven days in the time a cow may carry her young.
A similar variation has been found in mares as cows, respecting the time of gestation. The same author—M. Tessier—made observations which were extended to 102 mares. The shortest period at which they brought forth was two hundred and forty-one days, the longest at three hundred and eight days.
Where there is no knowledge as to the precise time when an impregnation took place—and such is the fact in almost all cases with the human subject—a very good mode of reckoning is this: first ascertain the precise time when the menses last appeared, then reckon two weeks; at which time consider pregnancy as beginning. Nine calendar months, or forty weeks, which may vary somewhat from that period, will be about the time at which labor will ordinarily come on.
Another method is as follows: Quickening takes place at about the twentieth week; add twenty weeks more to the previous time, and we have an approximation to the truth. But, as I have elsewhere shown, the time of quickening is subject to a good deal of variation, namely, from the twelfth to perhaps the thirtieth week.
I think it will seldom be found to happen that labor occurs short of forty weeks, or 280 days, after the last appearance of the menses. But it is not out of place for me to inform you that medical men have varied considerably in regard to the duration of pregnancy. Thus, Dr. Guy has quoted five authorities, of greater or less eminence, to wit:
Sir Charles Clarke; 40 weeks—280 days.
Dr. Blegborough; 39, usually 40 weeks—273–280 days.
Mr. Pennington; 37 weeks; some, 40 weeks—259–280 days.
Dr. Gooch; a day or two before or after nine calendar months—271, 274, 275, or 278 days.
Dr. D. Davis; a day or two under nine calendar months.
The question as to the length of time it is necessary for a child to remain in the mother’s womb, in order to enable it to live, or to render it viable, as the term is, has been a very puzzling one to writers on medical jurisprudence. On this subject, I do not know that I can interest you in any better way than to give you some of the remarkable examples on record which go to establish the point.
“I have seen,” says Belloc, “a girl who, at birth, was only twelve and three quarters inches in length, whose skin was of a marbled redness, whose head was covered with down, whose nails were imperfectly formed, and who altogether bore a close resemblance to a young flayed rabbit. She was fed with the spoon for eight days, because she was unable to suck. Nevertheless, she is not only at the present moment alive, in her seventeenth year, but is likewise an extremely clever, amiable girl, above the middle stature, graceful in figure, and gay in her disposition. The mother could not fix with precision the date of her conception, but was convinced she was not at the term even of seven months. I considered her at six months, at the utmost.”
Dr. Guy, of London, mentions a case given by Dr. Rodman, in which he describes the mother as “more cautious in her decisions, accurate in her observations, and steady in her deportment than what is usually met with in society.” She had borne five children previously, and in this instance “was confident that the period of her gestation was less than nineteen weeks.” Premature labor came on in consequence of fatiguing exertions, and she was delivered of a living male infant.
“Not daring to allow the washing of the infant’s body, he was speedily wiped, and wrapped in flannel, with only an opening in the dress around his mouth for the admission of air; and by the time the dressing was over, the mother was ready to take him into the warm bed with herself. It is common, if there be much apparent weakness, to feed a child the first twelve hours after birth very frequently, yet, in this instance, although the child was weak, no feeding was attempted until beyond that time; the nourishing heat with the mother in bed was relied on. On the following day, the head, body, and extremities of the child were surrounded with fine cotton wool, pressed to appear like cloth, to the thickness of two or three folds, and over that the flannel, as before; and again the child was given to the mother in bed. His vital energy was so deficient, that even with this dress, of himself, he was unable to support the degree of warmth which was necessary to his existence. The heat of a fire was evidently injurious, as he soon became weaker when exposed to it; while the warmth of the mother in bed enlivened and strengthened him. Too much heat induced a sickly paleness of his face, with an obvious expression of uneasiness in his countenance; and the abstraction of heat, even by tardily undressing his head, brought on a nervous affection, or starting of the muscles all over his body. From seeing how these morbid affections were induced, the child was kept regularly and comfortably warm, by the mother and two other females alternately lying in bed with him, for more than two months. After this, he could be left alone from time to time, but was still undressed very cautiously, and only partially at any one time. It was not till the child was three weeks old that the length or weight of the body could be ascertained. The length was found to be thirteen inches, and the weight 1 lb. 13 oz. avoirdupois. It was extremely difficult to get the child to swallow nourishment the first week; the yellow gum soon came on, and the thrush seized him severely on the eighth day, and was not cured till the end of the third week. During the first week, he was fed with toasted loaf bread, boiled with water, sweetened, and strained through fine linen; in the second week, twenty drops of beef tea were added to the two or three tea-spoonsful of his mother’s milk, and in two days afterward he made exertions to suck. His mother’s milk was gradually substituted, at least in part, for the panada, though this was still continued occasionally, with a few drops of port wine. Under this careful management he attained the age of four months, at which time his health and excretory functions were peculiarly regular.”
Dr. Guy has arranged a table showing the lengths and weights of children reported to be born during the fifth and sixth months of gestation, with the assumed age and the probable age, according to estimates and observations which he had made and collected from various authors on the subject. It is as follows:
| Author. | Length. | Weight. | Survived its Birth. | Asserted Age. | Age according to Estimates and Observations. | |
|---|---|---|---|---|---|---|
| Inches. | lb. | oz. | Days | |||
| Rodman | 11–13 at 3 w’ks. | 1 | 13 | 1 yr. 9 m. | 133 | 5 months possibly. |
| Outrepont | 13½ | 1½ | 0 | 8 years | 175 or 189 | 6 months. |
| Belloc | 12¾ | 17 years | 6 months | possibly 5 months. | ||
| Bucholtz | 14 | 1½ | 0 | 2 days | 189 days | 6 months. |
| Kopp | 12¼ | 2 | 0 | 4½ days | 182 | 6 months. |
| Fleischmann | 11½ | 1 | 5 | 8 days | 168 | possibly 5 months. |
| Christison | 13 | 1 | 7 | 8½ hours | 167 | possibly 5 months. |
| Mr. Thomson | 12½ | 1 | 8¾ | 3½ hours | 5 months | 5 months. |
Thus, it would appear, that it is possible for a child to live when born at about the end of the sixth month of fetal life, and, perhaps, somewhat earlier. But these cases must, I think, be rare, and not according to the general rule.
When a child is born, some idea may be formed respecting its age by the appearance it presents. A description of the signs of maturity and immaturity, founded upon that of two French authors, Foderé and Capuron, will serve to contrast the one with the other.
The signs of maturity are the following:
The ability to cry as soon as the child reaches the atmospheric air, or shortly thereafter, and also to move its limbs with facility, and more or less strength; the body being of a clear red color; the mouth, nostrils, eyelids, and ears perfectly open; the bones of the cranium possessing some solidity, and the fontanelles not far apart; the hair, eyebrows, and nails perfectly developed; the free discharge of the urine and meconium in a few hours after birth; and finally, the power of swallowing and digesting, indicated by its seizing the nipple, or a finger placed in its mouth.
The signs of immaturity, on the other hand, are the following:
The length and volume of the infant—much less than those of an infant in full term; it does not move its members, and makes only feeble motions; it seems unable to suck, and has to be fed artificially; its skin is of an intense red color, and traversed by numerous bluish vessels; the head is covered with a down, and the nails are not formed; the bones of the head are soft, and the fontanelles are widely separated; the eyelids, mouth, and nostrils closed; it sleeps continually, and must be preserved by artificial heat; and, lastly, it discharges its urine and meconium imperfectly, and often after a long interval.
You will, of course, readily comprehend that the appearances of children at birth, even of the same age of fetal life, must be subject to a good deal of variation. Some are much stronger than others, and the size and weight also varies a good deal. At one time a mother may have a very large, strong, and well-formed child, and at another a small and weak one. The size, however, does not determine the healthfulness of a child.
LETTER IX.
MANAGEMENT IN PREGNANCY.
Importance of Attention to the Health at this Period—Clothing, and its Effects—How to Regulate it.
There is, perhaps, no period of life in which the management of the health becomes a matter of more importance than in pregnancy. A little mismanagement here is not unfrequently sufficient to cause the individual life-long suffering and disease. I have known a woman, in the fifth or sixth month of pregnancy, to go to an evening party, become excited and mirthful, remain late at night, eating and drinking, as is customary on such occasions, and perhaps, worst of all for a person in such a condition, engage freely in the dance. Immediately, thereupon, that woman has been taken with uterine hemorrhage, that ended necessarily in abortion, a circumstance always more unfavorable to the constitution than labor itself. I have known such a woman to be not only in a very precarious and dangerous situation at the time, but to experience for many months afterward an extreme prostration of the general health, and an amount of suffering from depression of spirits and nervousness, with all its multitudinous train of ills, which cannot be conceived of only by those who have suffered them. I have known a woman commit imprudences, such as doing a great deal of work at one time, when she was generally indolent in her habits; and thus, by the indolence and overworking alternately, abortion, hemorrhage, attended with fainting—and which has brought her to the very verge of death—has been caused. I have known, too, imprudent women, who, dissatisfied with themselves and their condition, have taken powerful medicines, with the idea of removing their unwelcome obstructions, and thus to bring upon themselves a train of evils and sufferings which have ended only in the sleep of death. I have known, too, women to be exceedingly injured by the gross habits of their prurient husbands during this period. The abominable and disgusting practice to which I here allude is, I fear, exceedingly common. It cannot be too much reprobated or spoken against. He that uses his wife like a brute during this time, is, to say the least, little better than those who go away from home in quest of illicit intercourse.
Women, too, are liable to accidents during this period. I lately had a case in this city (New York), of a strong, healthy woman, who had borne a number of children, and, at about the end of the seventh month, an unfortunate circumstance occurred, in which no person was to blame, and by which she became so much and so suddenly frightened as to be prostrated on her bed for nearly a week. She did not recover the general tone of the system during the remainder of the period; and the day after the birth of the child, it was seized with fits resembling those arising from fright. The child, as well as the mother, was very feeble. By very prudent management, however, both finally recovered.
All great and powerful excitements, whether of mind or body—every thing, in short, that is not consistent with a uniform, even tenor of both mental, moral, or physical life, should, as far as possible, be avoided. If ever woman’s life is to run like the smooth and placid stream, let it be at this time, on which so much, not only of her own health, but that of her offspring, depends.