Midwifery and the diseases of women

by Joel Shew

THE DRINK.

It has been a serious question with some, whether man is at all naturally a drinking animal.

Whatever may be the truth in regard to this question, we all know that man does drink, and that a good deal, and too often of things which he ought never to take.

It is admitted, however, that if a person subsists wholly or principally on farinaceous food and fruits, and avoids stimulants of every kind, and all other excesses, leading throughout a regular, sober, and temperate life, he will seldom experience the sensation of thirst, and would then, consequently, not naturally drink. True, water is one of the most important of all life agents—one which will keep an animal alive more than twice as long as he could exist without it; and notwithstanding the fact that the living body is composed of nearly nine tenths of this element, still, under the circumstances which I have supposed, we do not wish to drink because our natural thirst is answered by the pure water that is contained in the food and the fruits we use.

This, then, I consider the better plan: live in a manner so healthful, so temperate that you will need little drink of any kind.

But if you do at any time need fluid internally, why not act in accordance with all experience, all good judgment, all reason, and adhere to the one best of all drinks?

See how the fever patient takes to water; how the animal, and the vermin that have been poisoned with arsenic. See, too, the faithful cow, the horse, and the ox, how they satisfy themselves with this best and most abundant of all beverages when the hot sun comes down them.

I wish that you could all have pure, soft water, both to drink and to cook with; but you cannot, and then you must do the best you can. However, if you will leave off all useless, and worse than useless expenses in your living, you can soon make a cistern and a filter which will give you an abundance of the best of water—that from the clouds. A very little expense and trouble will also serve to construct an ice-house, so that you can have luxury and health combined, although I wish you to remember that ice should be used sparingly, especially if you should become very much heated and fatigued.

When I sat down to write this evening, I thought I should say something on the properties and effects of those almost universally-used articles, tea and coffee. This much I do say, however, you who are pregnant—you who are nursing, and, indeed, all and every one, do as I for these twelve years have done, ESCHEW THEM ALTOGETHER. They are pernicious in a great many respects. Besides this, I advise you to get my worthy friend Dr. Alcott’s excellent work on TEA and COFFEE. If you will but read that, I think you will conclude that it is a great deal better to do as I have done.

Thanks to Father Mathew, and the noble cause of temperance, there is little need of saying much now concerning the evils of tippling, which women were some years ago in the habit of when Dr. Dewees wrote, and against which he said so much. I need not say to you at this late day, that it is a great deal better for you to leave off alcohol in all its forms, and particularly during the period of which we have been speaking.

LETTER XII.
DISORDERS OF PREGNANCY.

Nausea and Vomiting—Means of Prevention, and Cure.

There are a variety of physiological troubles that are connected with pregnancy. True, women do not all experience these, any or all of them; but inasmuch as you are liable to these affections, it is my duty to speak of them. In doing so, I shall class all of these abnormal symptoms under the general head of “disorders,” because I believe that in a truly natural, or, in other words, healthful state of the system, none of these ailments would be experienced.

Nausea and vomiting, as most of you know, and not a few of you by experience—are, in the present state of society, frequent attendants of pregnancy.

These symptoms occur, for the most part, during the earlier months of gestation. They may, however, continue through the whole period, and in some cases they cease and then return again toward the latter part of it.

Most frequently morning-sickness commences from two to three weeks after the beginning of pregnancy. It may, however, come on the very day of, or next after conception, and some women have been able to discover this circumstance by the occurrence of the vomiting which follows it.

This sickness of the stomach is most apt to occur in the morning. Hence it has been called “morning-sickness,” from the fact that it is most apt to take place at this period of the day. This is in part, doubtless, owing to the circumstance of the woman’s getting up at this time, and not to any thing necessarily connected with that part of the twenty-four hours. If she reclines, the sickness leaves her for the most part, but again appears if she attempts to rise.

The matter thrown up from the stomach varies in character in different cases. Much here depends upon the dietetic habits of the individual and the state of the health. It is more commonly a sort of tough, sour mucus; but sometimes there is vomited an extremely acid, thin water, which in some cases is strong enough to excoriate the mouth and set the teeth on edge. Sometimes, too, bile is thrown up with the other matters.

The appetite is apt to become very variable in these cases; often, indeed, there appears to be none at all; at other times the most singular and even disgusting articles are craved for, and not unfrequently that kind of food which we would suppose the worst for the patient proves to be the best, that is, so far as retaining it on the stomach is concerned.

It may appear a strange doctrine to you, that in general those who suffer from nausea, vomiting, and the other more common accompaniments of pregnancy, get along better than those who experience none of these symptoms. “If vomiting should not be violent, and occur only in the early part of the day, though very troublesome,” observes Dr. Denman, “it is so far from being detrimental, that it is generally found to be serviceable, by exciting a more vigorous action of the uterus, and by bringing the stomach into a better state.”

Some have been afraid that vomiting would cause abortion; and such an occurrence might happen, if this symptom were brought on in a violent manner, as by the administration of powerful drugs. But the vomiting which comes on in consequence of the stomach-sickness, instead of causing premature delivery, appears to be a safeguard against such an occurrence. In other words, those who experience nausea and vomiting, are not so liable to miscarry as those who have none of these symptoms.

If we could but take into our minds the whole scope of nature, and if we were able to trace, like the Infinite Mind, causes and effects, we should, doubtless, much oftener than we now are, be struck with the evident goodness of the Creator, even in the physical sufferings which He has made it our lot to endure. What is the office of nausea and vomiting in these cases? It is possible, under bad management, for these symptoms to become actually alarming in their extent. But what, it is well for us to inquire, is the design of these occurrences, so common during the period of gestation? Plainly, to restrain the woman from the gratification of a voracious and wayward appetite, the indulgence of which could but be of material detriment to both mother and child.

How is it in sea-sickness? Do we not find that people who go to sea are generally benefited in health thereby, and that none are so much benefited as those who are made sick? And how are they thus benefited? I answer, by the abstinence and fasting which they are compelled to practice. Almost all persons—all, I will say—have more or less of impurity in their bodies, so badly have we treated ourselves, and so badly do we live. Hence it is that in sea-sickness, and in the vomiting that occurs in pregnancy, benefit is received; the body is made to purify itself by its own inherent power.

If every pregnant woman could have nausea enough, no doctor would ever think of bleeding her; it would prevent all that plethora and fullness of the system which, under such circumstances, have led good and honest men, as well as women, to believe it is often best to abstract blood.

But you ask me, are these symptoms really natural, and intrinsically best for the system in pregnancy? I answer, they are not. I believe it possible so to live that a woman pregnant need not have them any more than any one else. In sea-sickness how is it? The sailors—they who are kept up regularly in the open air every four hours at farthest—never have it to any extent worth speaking of. The first time they go to sea they are apt to be sick, like other people; but in a day or two it is all gone—they work it off.

So, too, in the sickness of pregnancy. We never hear of the Indian women having it. They, likewise, are active in their habits, live plainly, and go often into the open air.

One of the most important things to observe in these cases is, not to eat too much, or at wrong times. A great many patients of this kind make sad work with themselves by eating all sorts of things for which they have a relish, and at all hours of the day, just as the fit happens to take them. We know full well how important it is to eat regularly when we are in health. How much more so, then, must it be when we are ill! If you have nausea, or if you have not, but no appetite, drink some pure cold water, and wait; the appetite will come.

It is really surprising to see on how small a portion of food a patient can subsist for many days.

The laboring classes—those who are compelled to work hard, whether they would or not, and who are obliged, in consequence of the iron hand of poverty being upon them, to live on plain, homely fare—they are not troubled with nausea and vomiting, as the idlers and the luxurious are.

You will naturally expect me to speak of the professional treatment for these troubles; and in regard to this, I remark, there are a great many things to be taken into the account. You cannot well know too much in regard to all the means of improving the general health.

The nausea is the most distressing part of morning-sickness, as it also is of sea-sickness. In the former, as in the latter, it is one of the most comforting things that can be done—the most comforting, rather—to take a good draught of pure, soft water, at about the blood temperature. If enough is taken it causes vomiting, which at once brings relief; but if the stomach should not thus be excited to an inverted action, the water will yet do good, as it tends to “settle the stomach,” and this of itself brings a good deal of relief, although not so much as actual vomiting would do.

Some may tell you that vomiting is dangerous in pregnancy—that it is liable to cause abortion. So it is, as I have before said, if it is rendered very violent by the giving of powerful drugs. But any thing like a reasonable emetic, even of the drug kind, is comparatively safe in this respect; so much so, that the most experienced and most honest physicians are not now afraid to vomit a pregnant patient, if they consider it important to resort to that measure. Emetics of the drug kind have even been used, and apparently with good success, as a cure of the nausea of which I have been speaking.

But do not understand me as recommending vomiting, even by water, the best and mildest of all emetics, except in cases of urgency, and when it can be made to take place without great straining or effort. As a general thing it is far better to fast.

I do not know of any thing in which physicians have been more puzzled than in the treatment of these symptoms. They have left nothing in the materia medica untried. The result is, however, that no plan has yet been fixed upon as being a legitimate one, or one that can be depended upon with any tolerable chance of success. Patients have sometimes died of the exhaustion caused by the vomiting, as has been supposed; but I am more inclined to think they have far oftener been drugged to death. It is mostly in the hospitals that these deaths have occurred, and there, as you know, there is great temptation for experimenting. Young physicians are there allowed to make experiments; and there the older ones are also too much tempted to do as they would not wish to be done by.

Physicians have been so much thwarted in these cases, that they have often recommended bringing on premature delivery, fearing that the patient would be destroyed if they did not resort to this dreadful expedient. Most of them, I have no doubt, have acted honestly in these dreadful emergencies. It is to their credit that they seldom, if ever, have resorted to premature delivery without first having counsel on the subject.

I have already hinted that exercise and activity are great helps in keeping off those troubles that so often occur with the pregnant. I would repeat, BE ACTIVE. Do not let a day, a half day, nor even an hour pass over without your doing something. Be active, regularly, habitually active. Let this be your motto, and your practice, too.

I must tell you also that water-treatment is a most useful help. Take the rubbing wet-sheet when you feel so badly, and see how great a change it will work. Wear the wet girdle, and take the cold hip-bath, not too long at a time, if necessary. I do not know that I can recommend eating ice, as some have done; yet it has sometimes appeared to act very favorably, and great quantities have been used by some in this way, without any apparent harm.

The cold water injections are much to be recommended in cases of costiveness, which often occurs in connection with the vomiting.

LETTER XIII.
DISORDERS OF PREGNANCY.

Fainting—Its Causes—Symptoms—Results—Treatment.

Fainting sometimes happens in pregnancy, even with those who are not subject to it at other times. It is more apt to occur at or about the time of quickening. Some persons are very subject to it, from very slight causes, during the whole period of pregnancy; others experience it only occasionally; and some have it repeatedly, and some periodically. It is more commonly the weakly and delicate who are thus attacked; but some healthy females are subject to it. It happens with some every month periodically, with others every week, and in some cases every two or three days, or even oftener.

Causes.—Fainting in pregnancy is often excited by the first movements of the child, even while they are weak, and by subsequent ones when strong. It is sometimes a consequence of palpitation, or derangement of the heart’s action and of the circulation. Too great exercise of either mind or body, want of exercise and employment, violent mental emotions, running too quickly up stairs, want of sleep, offensive sights and odors, overeating, and too great heat in the apartment—each of these may bring on fainting in pregnancy. Dr. Campbell observes, “As in the gravid (pregnant) state, fainting seizes individuals so suddenly, and that, too, while they are in perfect health, it is difficult, more especially in the early months, to account for it, since the uterus at this period cannot, from its bulk, produce any interruption or irregularity in the circulation of the heart or larger vessels. The womb, however, may influence the heart in another, viz., through the medium of the nerves, whereby irregularity of its action, as often happens from a similar cause on other occasions, is produced; this inordinate action may lead to some irregular distribution of the blood in the cerebral vessels, and hence fainting.”

Symptoms.—The patient experiences a feeling of langour, weariness, and weakness, and there is a frequent inclination to yawn or sigh; the sight becomes dim; surrounding objects appear to turn round; specks float before the eyes; there is a ringing or buzzing in the ears; the face becomes pale, and thus the patient becomes faint and insensible. The premonitory symptoms, if any appear, are sometimes so rapid in their course, that the patient is unable to call attention to them.

During the fit there is no pulsation at the wrists; the heart beats but faintly; breathing is nearly suspended; the muscles lose their power, and a cold sweat breaks out over the surface. But there is no convulsive motions of the limbs, nor any frothing at the mouth, in a case of simple fainting.

This condition of things may last only a few minutes, or for several hours. When the fit begins to pass off, respiration becomes more distinct, the patient utters a few long-drawn sighs, the heart begins to act with more energy, the pulse at the wrist becomes more perceptible, some color appears in the face, and the consciousness is again restored. In some cases consciousness is not entirely lost, and in some it is long before it is fully regained.

“There is a species of syncope,” says Dr. Burns, “that I have oftener than once found to prove fatal in the early stage of pregnancy, dependent, I apprehend, on organic affections of the uterus; that viscus being enlarged, or otherwise diseased, though, perhaps, so slightly, as not previously to give rise to any troublesome, far less, pathognomonic symptoms. Although I have met with this fatal termination most frequently in the early stage, yet I have also seen it take place so late as the sixth month of pregnancy.”

Cases of organic disease of the heart, however, are rare, so that you ought not to think, at every little fainting spell you may experience, that you have a disease of this organ. If in the syncope there is convulsive motion of the limbs, distortion of the features, and frothing at the mouth, it is only a hysterical spasm.

If fainting happens most toward the close of pregnancy, it is to be regarded with more suspicion, according to the opinions of some authors; not so much, however, for the immediate consequences, as for its effect upon the convalescence after parturition.

This symptom sometimes occurs in consequence of an internal hemorrhage, in which case it is generally never prolonged, accompanied with fullness and tension of the abdomen, dull pain and weight in the pelvic region, permanent blanching of the surface, and after a short time a discharge of blood from the vagina.

Results.—In fainting, the circulation becomes for the time almost suspended. When, therefore, we consider the dependence of the fetus upon the maternal circulation, we cannot suppose that its frequent recurrence is wholly innocuous to the child. Occasional fits of syncope, however, appear to do no harm to the fetus; and yet it is always best to avoid the occurrence as much as possible. It has been known to cause abortion when it has been often repeated.

Treatment.—The patient should, during the fit, be placed in the most comfortable posture, the recumbent being the best, the head at the same time being laid rather low, and, if possible, where a current of cool or cold air can be made to blow over it, particularly upon the face; sprinkling cold water in the face, and washing and rubbing the face and hands in cold water are useful measures. In some cases it would be also advisable, or rather necessary, to wash and rub the whole surface.

A full injection of tepid water will aid materially in bringing about consciousness and circulation in these cases.

This water-treatment is incomparably better than that which is usually adopted, such as giving the patient wine, brandy, spirits, carbonate of ammonia, etc.

It generally happens that people themselves, without the aid of the physician, have to manage cases of syncope. This they can readily enough do as a general thing; but if it should prove at all persistent or troublesome, they should lose no time in getting the best medical advice they can obtain.

Prevention.—Every thing should be done that may be to restore the general health. Oftener by far than otherwise, fainting is purely a symptom of debility. This fact of itself suggests the measures that should be adopted in order to ward off the attacks.

LETTER XIV.
DISORDERS OF PREGNANCY.

Abortion—Its Nature and Ill Effects—Its Causes—Means of Prevention.

Abortions are evidently not in the order of nature. We see in the animal kingdom that, as a general fact, gestation everywhere goes on to its full and normal period; that abortions are very rarely indeed seen; but when we come to consider the animal man, we find a different state of things. With man, and man only, abortions are frequent.

Certain classes of females are more subject to abortion than others. Fleshy or excessively fat women, and those who experience excessive menstruation; those who are hysterical, nervous, irritable, or excessively sensitive; those who have a very fair complexion, and are rickety, scrofulous, or have any other taint of the general system; those who have dropsy, or are affected with cancers; those who drink tea and coffee freely, and eat habitually highly concentrated and stimulating food; those who live a life of excitement, frequenting balls, parties, and theaters late at night; those who are in the habit of much novel reading, and perhaps, above all, those who, in connection with their sensual and worse than brutish husbands, abuse the marital privileges, are most apt to abortion. If husbands have any regard for the physical welfare of either their wives or offspring, or even their own health, let them refrain from all sexual indulgences during the period of the wife’s pregnancy. Dr. Edward Baynard, a quaint but able English writer, one hundred and fifty years ago, in speaking of the evil effects of swathing and dressing infants too tightly, indulged in the following reflections: “’Tis a great shame that greater care is not taken in so weighty an affair, as is the birth and breeding of that noble creature, man; and, considering this stupid and supine negligence, I have often wondered that there are so many men as there are in the world; for what by abortions, too often caused by the unseasonable, too frequent, and boisterous drunken addresses of the husband to the wife, when young with child, and her high feeding, spiced meats, soups, and sauces, which, with strait lacings, dancings, and the like, one full half of the men begotten are destroyed in the shell, squabbed in the nest, murdered in embryo, and never see light; and half of the other half are overlaid, poisoned by ill food, and killed at nurse,” etc.

Terror, fright, and excessive fatigue, also, not unfrequently cause abortion. All unpleasant sights, and all undue mental excitements, should be, as far as possible, avoided by those who are pregnant.

There are vile books in circulation, sold too, sometimes, by highly respectable booksellers, in which the writers affirm that abortion can be produced without any harm to the constitution. There is one physician in this city, whose book we saw a few days since in a bookstore in the city of Boston, in which he proposes to effect abortion with perfect safety; but, for the package of medicine, a fee of ten dollars must be sent, of course, in advance. It may be of service to some who may peruse these pages, for me to inform them, that there is always great danger in causing the expulsion of the fetus. The most powerful medicines for this purpose are often known to fail. Gastritis, enteritis, peritonitis, and death itself, has been caused by medication, without causing the intended abortion. And in those cases where the desired object is by chance brought about, sad is it to think, what for years must be the health. Even life-long misery and suffering have often been caused by drugging the system to produce abortion.

You have read those lines of Ovid, which Dryden gives us:

“But righteous vengeance of their crimes pursues,

And they are lost themselves who would their children lose,

The poisonous drugs, with mortal juices fill

Their veins, and undesigned themselves they kill.

Themselves upon the bier are breathless borne

With hair tied up, which was in ringlets worn.”

Women cannot be too careful of their bodily health during the period of pregnancy. If they would avoid, among a multitude of evils, the great misfortune of abortion, they cannot be too vigilant, and watchful, and careful in all matters pertaining to health at this time. Any imprudence here, such as would scarcely be noticed at other times, may lay the foundation for much future suffering.

I am here led to remark, that too much labor and exercise, as well as idleness and habits of effeminacy generally, in this hard-working country of ours, not unfrequently cause this evil. Lazy people do habitually too little; industrious people often too much.

It appears that abortions are becoming more and more frequent in this country at the present day. It is notorious that the habits of Americans are not now as simple as they formerly were. More tea and coffee are drank, more rich and stimulating food is used, and there is a vast deal more idleness withal. Formerly labor was more dignified, more respected; but labor now is degrading. It is not fashionable to spin, weave, knit, sew, wash, and to make bread, as in the good days of our grandmothers. People are everywhere growing more indolent. “The sluggard will not plow by reason of the cold; he shall, therefore, beg in harvest, and have nothing.” So, also, those who will not employ the limbs and muscles which God has given them for use, cannot have permanent and enduring health at any price.

But it is asked, Would you pay all attention to physical culture, and neglect the mental? I answer, no. I would have my daughters taught music, painting, drawing, as well as science generally, but on no account would I do this at the expense of bodily health. Nor is there any need of this; the highest possible cultivation of the mental manifestations can only be accomplished when the physical powers are suitably and proportionably developed to their fullest extent. “A sound mind in a sound body, is nature’s inevitable law.” There is yet one evil pertaining to the subject of abortion, an increasing one too, in some parts of our country at least, of which I should speak.

Abortion, it will thus be seen, is a serious evil. Its consequences may, in general terms, be condensed as follows:

1. A stronger tendency to a recurrence of the evil. Those who miscarry once are much more apt to do so again.

2. Menorrhagia, or an immoderate flow of the menses.

3. Irregularity of the monthly periods; these occurring either too often or too seldom, and attended with much prostration of the general health.

4. Dysmenorrhea, or painful, laborious menstruation, accompanied often with more pain and suffering than attend labor itself.

5. Hysteria, or hysterics, depression of spirits, disquietude, dissatisfaction with life, its pursuits, pleasures, and enjoyments, and an habitual melancholic state of mind.

6. Dyspepsia, with all its train of pains and penalties. This picture, terrible as it may appear, is no imaginary one. Every well-informed physician will at once recognize the truth of all that has been affirmed. It is a bad state of the system which allows of abortion. One abortion ordinarily is far more trying and worse upon the constitution, than two labors at full term.

Means of Prevention.—In speaking of the evils of abortion, the means of preventing such an occurrence have necessarily been hinted at. There are yet other things, however, which should be referred to on this subject.

It will naturally suggest itself to every reflecting mind, that the great object to be attained in regard to the prevention of abortion, is a thorough, habitual, and permanent cultivation of the physical powers. Invigorate the general system to its fullest extent; accomplish this, not only for a single time, but, as it were, perpetually, by daily and never-ceasing effort. Is not health the greatest of all earthly blessings? How, then, in order to secure it, can we do or sacrifice too much?

In reference to the prevention of abortion, let the following particulars be observed:

1. The use of cold water. In all cases of abortion there is too great laxity of the system; there is a want of tonicity, so to say; the fibers are, as it were, unstrung. Cold bathing, for its tonic, constringing, and invigorating effect, has for centuries been recommended as a most valuable means of preventing this evil. In pregnancy, the same general principles should be observed in fortifying and invigorating the general health as at other times. No violence should be done to the system. A general bath in the morning, cool or cold, according to the individual’s strength; a hip or sitz-bath of five or ten minutes’ duration, two or three times during the day, and an ablution with water, not too cold, on going to rest, will ordinarily be sufficient for the daily routine of treatment in those cases where there is tendency to abortion; such a course is, in fact, good at all times. The wet girdle, elsewhere explained, will often be of advantage; but to make it a tonic or strengthening application, as it should always be under these circumstances, great care must be taken that it does not become too warm. This is very apt to be the case in hot weather. It must then be changed often and rewet. If it becomes too hot, it weakens the system instead of strengthening it, thus tending to cause the very difficulty it is intended to prevent. “Injecting cold water into the vagina twice or thrice a day,” says Dr. Burns, in his work on midwifery, “has often a good effect, at the same time that we continue the shower-bath.” And this writer also observes, “that when there is much aching pain in the back, it is of service to apply cloths to it, dipped in cold water, or gently to dash cold water on it, or employ a partial shower-bath, by means of a small watering can.” Water, let it be remembered, is the greatest of all tonics to the living system.

2. Feather beds and overheated rooms. These have much to do in causing abortions. People ought never to sleep on a feather bed, unless, possibly, very old and feeble persons, who have long been accustomed to them. In such cases it might not always be safe to make a change in cold weather suddenly. But for a pregnant woman to sleep on a feather bed is one of the worst of practices. And here also I must mention that feather pillows, as well as feather beds, do a great amount of harm. Even those who have emancipated themselves from the evils of feather beds usually retain the feather pillow. It is a wise old maxim, “to keep the head cool.” The head has blood enough, more than any other part of the system, to keep it warm. No person, not even the youngest infant, should ever sleep on a bed or pillow made of feathers. The animal effluvia coming from them is bad, and the too great amount of heat retained about the surface debilitates the system in every respect.

3. Undue mental excitements. Let those who are pregnant avoid theaters, balls, and parties late at night, all highly excitable public meetings, whether literary, political, or religious, and all undue mental and moral excitements of whatever kind. In no situation is it more necessary for a human being to maintain a pleasant, consistent, and equable frame of mind, and good and permanent health of body, than in pregnancy.

4. Sexual indulgences. The more strictly chaste and free from sexual indulgences, the better for the woman during pregnancy.

5. Recurrence of abortion. Every succeeding miscarriage is more apt to be followed by a recurrence of the evil; the body, as it were, like the mind, is capable of getting into bad habits. Those who have abortion oftenest are most liable to their recurrence; and every attack is more apt to be worse than the preceding one.

6. General health. Abortion always indicates a bad state of the system generally. A person of really good health could scarcely have abortion. Possibly fright, unpleasant occurrences, or accidents, might cause such a result. Abortion always injures the general health. Labor at full term is natural, and is therefore attended with less danger. Abortions are unnatural.

7. Vegetable diet. This was observed by the celebrated Dr. Cheyne, of England, to have a great influence in preventing abortion; milk, however, which is in some sense a form of animal food, was generally used. A total milk and seed diet, as Dr. Cheyne terms it, was a most excellent means of preventing unfertility and abortion.

8. Tea, coffee, and spices. All stimulants, that is, articles which do not go to nourish the system, such as tea, coffee, tobacco, wine, porter, spirits, and the like, should be strictly avoided. All stimulation of the system is followed, necessarily, by commensurate depression. A person takes a stimulant, and feels better for the time. In the same proportion as the stimulation will be the consequent depression. The more a stimulant is used, the more necessity will there be to keep up the habit; and the more the habit is followed, the weaker does the system become. Thus in pregnancy, by the use of stimulation, the system becomes more liable to abortion.

9. Exercise. More than one hundred years ago, the celebrated Dr. Cheyne remarked, concerning abortion and its causes, as follows: “It is a vulgar error to confine tender-breeding women to their chambers, couches, or beds, during all the time of their pregnancy. This is one of the readiest ways to make them miscarry. It is like the common advice of some unskillful persons to such as have anasarcous or dropsical legs; namely, to keep them up in chairs, on a level with their seats, which is the ready way to throw up the humors into their bowels, and fix them there. The only solid and certain way to prevent miscarriage, is to pursue all those means and methods that are the likeliest to procure or promote good health, of which air and gentle exercise are one of the principal. All violence or excesses of every kind are to be carefully avoided by the parturient; but fresh air, gentle exercise, walking, being carried in a sedan or chaise on even ground, is as necessary as food or rest, and therefore is never to be omitted, when the season will permit, by tender breeders.”

In my next letter I shall speak in detail concerning the special treatment that should be adopted in these cases.

LETTER XV.
DISORDERS OF PREGNANCY.

The Evils of Abortion—The great Danger of bringing it on purposely—Cases—Illustrations of the Methods of Cure—Uterine Hemorrhage—Cases of Cure.

In the summer of 1849, walking down the Bowery, in the city of New York, I fell in company with a lady whom I had attended in childbirth, some three years previously. She was of middling stature, and I should judge twenty-five or six years of age. She said she had been for some time desiring to speak to me concerning her health. Since the birth of her last child she had a number of times experienced abortion, at three or four months from the commencement of pregnancy. She could not understand why it should be so; she was tolerably careful in diet, and bathed, to some extent, daily. She was, perhaps, in her husband’s store too much of the time, standing upon her feet, waiting upon customers, etc. Formerly she was a great walker, and could endure a good deal of fatigue, but latterly she was becoming less and less able to take long walks. She soon became fatigued, whereas, formerly, she could go to almost any extent in pedestrian exercise. The question was, how to avoid these abortions and their ill consequences. I gave her advice concerning diet, bathing, exercise, etc., and the next day wrote her husband substantially as follows:

“Dear Sir—Your very worthy wife inquired of me yesterday what she should do in reference to preventing abortions, to which she is of late growing subject. I advised her the following treatment:

“1. Perform thorough ablution on rising in the morning. Drink some water, and walk in the open air, but not so much as to induce great fatigue. Housework is very good, but going into the open air, an hour or thereabout before dinner, will be better.

“2. Take the rubbing wet-sheet, and after it the sitting-bath ten minutes. Take also some kind of exercise before and after this bath.

“3. In the afternoon practice the same thing as in the forenoon.

“4. The rubbing wet-sheet on going to rest.

“5. It is very important that due attention be paid to diet. She should eat no meat, butter, and as little sweet as possible. Rice, brown bread, Indian mush, hominy or samp, potatoes, good fruits, and milk—these are the best articles for her.

“6. In addition to the above advice which I gave to your wife, there is a very important matter to be observed. Do you not practice too frequent cohabitation with her? This is, perhaps, of all, the most prominent among the causes of abortion. Taking a survey of the animal kingdom, we observe it to be a law, that animals do not cohabit during the period of pregnancy.

“Knowing that you are a kind and good-hearted husband and desire the best good of your wife, I take the liberty of submitting to you the following rules, which, I am confident, you will agree with me will be safe:

“1. Always sleep separately for six months at least, and twelve would be better. By that time we have every reason to believe your wife will enjoy her natural health.

“2. Suppose that after these six or twelve months, pregnancy again occurs, sleep then again separately during the entire period, and at the same time let your wife follow a similar course in water, diet, exercise, etc., to that I have above recommended.

“Then will she be able to prevent those disastrous consequences of frequent abortion.”

Case II.—In the spring of 1845, I was called upon by a gentleman and his lady for advice in regard to herself, she being then at about the middle of the term of pregnancy. She was threatened, as she believed, frequently with abortion. The year previously she had had a bad miscarriage, which was occasioned by a fall. She was of scrofulous habit of body, and had borne already seven or eight children, a number of whom had died.

I directed the patient to practice general ablution two or three times daily, with hip-baths of short duration, to exercise in the open air, and ride frequently, according as she could bear; but to be careful never to do too much at a time. A little overdoing would be liable to cause the difficulty with which she was threatened. The strictest care in diet I strongly advised her to observe.

She went on faithfully in the fulfillment of these directions, and about the end of the month of August, in exceedingly hot weather, she gave birth to her child. She followed the water-treatment resolutely, according to my directions, and in ten days was able to enjoy very long walks in the city. Twice she has been pregnant since that time; and at the time of writing this, has gone to the eighth month without experiencing any symptoms of abortion.

I should remark, this lady had frequently had miscarriages before the one above referred to.

Case III.—A very small, delicate, young woman, of this city, being about seven months advanced in pregnancy, went to an evening party, at which she danced. Being very fond of that exercise, she, no doubt, overdid the matter. Indeed, dancing at all in that condition is rather a hazardous experiment. Abortion came on, attended with a great deal of prostration. Water-treatment was practiced in this case, and she recovered as well as could be expected. She felt very sad at thus having lost her child, and resolved for the future to do better. Since that she has succeeded in bringing forth a tolerably healthy offspring.

Case IV.—I knew, some years since, a young married lady, in the city of Boston, who was much addicted to novel reading, and going to balls, theaters, parties, etc., at night. She walked a long way one very hot, sultry night in midsummer, and became overheated and fatigued. On arriving home she commenced bleeding, which became so severe that before a physician could be obtained she fainted many times, and apparently came very near losing her life.

Case V.—I recollect a case which occurred some years ago—one, indeed, which I shall not soon forget, because of the fatigue and anxiety it caused me. A gentleman came after me in the night time, telling me that his wife was bleeding, and had already bled to such an extent that he believed she would be dead before I could get to her. On arriving at the house, I found she had fainted many times, and that she had bled enormously, and even then there was no amendment of the symptoms. I do not know that I ever saw a person apparently so near death from hemorrhage as this lady, and yet recover. I had to remain with her almost constantly for two days and nights, before she appeared to be at all safe.

Years afterward, this lady gave me the following information respecting the cause of that frightful abortion:

Suspecting that she had become pregnant, and much against her inclination at the time, she resolved upon procuring an abortion. Pregnancy, she said, at that time would interfere very much with her comfort, arrangements, etc. She consulted a lady-clairvoyant in reference to the matter. The clairvoyant could not even tell her whether pregnancy existed or not; but to make safe in the matter, she ordered some vegetable teas to be drank in large quantities, which she said would expel the fetus, if one existed. She thus went on for some time. Her general health became deranged by the dosing, and yet no abortion was procured. Afterward, more powerful medicines were directed by the clairvoyant. These she found were at length making great mischief with her health; her stomach became very much deranged, and a regular tertian intermittent set in, yet no abortion came on.

At length, one day her children fell down stairs. Hearing them, she ran down two flights with the greatest precipitation, and as if she were in no sense delicate in health. This, together with the fright she experienced, prostrated her system very much, caused a great trembling to come over her, which soon resulted in the miscarriage I have referred to.

It was a long time—many months—before this patient recovered any thing like her former health. She was low-spirited, dull, inactive, and could take no comfort of life.

Case VI.—Two years after this the same lady was again pregnant. One day she did a very large washing, together with other kinds of work, and became much exhausted. This, again, brought on miscarriage, attended with fearful bleeding as before. A resolute course of treatment was practiced, and thus she was again rescued from danger; but such attacks are always worse than labor at full time.

Case VII.—While I have been writing and arranging these letters, I have been called to visit a lady who has been pregnant a few weeks the second time. Her first child has been somewhat ill from teething—in fact, a good deal sick for some days and nights, and taking care of him, bathing, dressing, applying the bandages, etc., to him, has made her quite weak. Two or three days ago, her husband was gone from home of an evening, and being a very punctual man in such matters, as all good husbands are, his wife expected him home early. He was, however, hindered beyond his time. This caused her a good deal of anxiety, although he had a friend with him. Soon after his return, bearing-down pains came on, and some discharge. Afterward she got better, and then in a day or two much worse. The mother-in-law gave her gin, the old-fashioned way to help on the courses, not believing, I suppose, that she was pregnant. But nature did better than the dosing; it would not let her abort. About this time I was sent for, whereupon I told her to keep pretty quiet, put on a heavy wet girdle, and change it as often as she felt bearing-down pain—every hour or two, at farthest. The cloth worn upon the genitals, under such circumstances, was also to be kept wet in cold water. But first of all, she was to take a good washing by sitting before a fire in a wash-tub, with tepid water, but not quite warm. This gave her a good deal of relief. In the morning I found her quite well, and free from pain and discharge.

It is far from being my wish, by any of these letters, to fill your minds with unpleasant thoughts or ideas of horror. But it occurred to me that you were, perhaps, many of you not aware that there are vile persons in our great cities who make it a regular business to procure abortions. Now I need not repeat to you, that a practice so wicked and unnatural as this must necessarily be fraught with great danger.

I thought I would present you with the account of a case of this kind, given us by a celebrated professor of this city, Dr. G. S. Bedford. It is as follows:

“Mrs. M—— was the mother of two children, and had been suffering extremely, for the last fourteen hours, from strong expulsive pains, which, however, had not caused the slightest progress in the delivery. I was likewise informed, that about four hours before I saw the case, Dr. Miner, an experienced physician, had been sent for, and, after instituting a vaginal examination, remarked to the attending physicians, that, in all his practice, he had never met with a similar case. Dr. Miner suggested the administration of an anodyne, and having other professional engagements, left the house. Mrs. M—— was taken in labor Monday, December 18th, at 7 o’clock, P. M., and on Sunday, at 7 o’clock, P. M., I first saw her. Her pains were then almost constant, and such had been the severity of her suffering, that her cries for relief, as her medical attendants informed me, had attracted crowds of people about the door. As soon as I entered her room, she exclaimed, ‘For God’s sake, doctor, cut me open, or I shall die; I never can be delivered without you cut me open!’ I was struck with her language, especially as I had already been informed that she had previously borne two children.

“On assuring her that she was in a most perilous situation, and at the same time promising that we would do all in our power to rescue her, she voluntarily made the following confession:

“About six weeks after becoming pregnant, she called on one of these infamous female physicians, who, hearing her situation, gave her some powders, with directions for use. These powders, it appears, did not produce the desired effect. She returned again to this woman, and asked her if there were no other way to make her miscarry. ‘Yes,’ says this physician, ‘I can probe you; but I must have my price for this operation!’ ‘What do you probe with?’ ‘A piece of whalebone.’ ‘Well,’ observed the patient, ‘I cannot afford to pay your price, and I will probe myself.’ She returned home, and used the whalebone several times; it produced considerable pain, followed by a discharge of blood. The whole secret was now disclosed. Injuries inflicted on the mouth of the womb, by other violent attempts, had resulted in the circumstance as detailed above. It was evident, from the nature of this poor woman’s sufferings, and the expulsive character of her pains, that prompt, artificial delivery was indicated. As the result of the case was doubtful, and it was important to have the concurrent testimony of other medical gentlemen, and as it embodied great professional interest, I requested my friends, Drs. Detmold, Washington, and Doane, to see it. They reached the house without delay, and, after examining minutely into all the facts, it was agreed that a bi-lateral section of the mouth of the womb should be made.

“Accordingly, without loss of time, I performed the operation in the following manner: The patient was brought to the edge of the bed and placed upon her back. The index finger of my left hand was introduced into the vagina as far as the roughness, which I supposed to be the seat of the os tincae. Then a probe-pointed bistoury, the blade of which had been previously covered with a band of linen to within about four lines of its extremity, was carried along my finger, until the point reached the rough surface. I succeeded in introducing the point of the instrument into a very slight opening which I found in the center of this surface, and then made an incision on the right side. I then withdrew the instrument, and in about five minutes it was evident that the head of the child made progress. The mouth of the womb dilated almost immediately, and the contractions were of the most expulsive character. There seemed, however, to be some ground for apprehension, that the mouth of the uterus would not yield with sufficient readiness, and I made an incision of the posterior lip, through its center, extending the incision to within a line of the peritoneal cavity. In ten minutes from this time, Mrs. M—— was delivered of a strong, full-grown child, whose boisterous cries were heard with astonishment by the mother, and with sincere gratification by her medical friends. The expression of that woman’s gratitude, in thus being preserved from what she and her friends supposed to be inevitable death, was an ample compensation for the anxiety experienced by those who were the humble instruments of affording her relief. This patient recovered rapidly, and did not, during the whole of her convalescence, present one unpleasant symptom. It is now ten weeks since the operation, and she and her infant are in the enjoyment of excellent health.

“At my last visit to this patient, with Dr. Forry, she made some additional revelations, which I think should be given, not only to the profession but to the public, in order that it may be known, that in our very midst there is a monster who speculates with human life, with as much coolness as if she were engaged in a game of chance.

“This patient, with unaffected sincerity, and apparently ignorant of the moral turpitude of the act, stated most unequivocally to both Dr. Forry and myself, that this physician, on previous occasions, had caused her to miscarry five times, and that these miscarriages had, in every instance, been brought about by drugs administered by this trafficker in human life. The only case in which the medicines failed was the last pregnancy, when, at the suggestion of this physician, she probed herself, and induced the condition of things described, and which most seriously involved her own safety, as well as that of her child. In the course of conversation, this woman mentioned that she knew a great number of persons who were in the habit of applying to this physician for the purpose of miscarrying, and that she scarcely ever failed in affording the desired relief; and among others, she cited the case of a female residing in Houston Street, who was five months pregnant; this physician probed her, and she was delivered of a child, to use her own expression, ‘THAT KICKED SEVERAL TIMES AFTER IT WAS PUT INTO THE BOWL.’”

Thus you have an exemplification of the danger of the wicked and fearful practice which I have spoken against. If any of you are ever tempted under such circumstanes, beware!