WASHING AND DRESSING THE CHILD.
I have a few words to say here on these topics; but I must refer you to my Treatise on Children for a much more full and explicit explanation of them than the limits of this work would admit of. You can all of you who have need obtain that work, I trust; and surely, after you have borne a child, you will feel the greatest interest in learning all that it is possible for you to know respecting the best modes of rearing it.
In general terms, then, I remark, that a child should, soon after its birth, be carefully cleansed by means of pure water and the addition of a little mild soap. The water should not be either too warm or too cold; a moderate temperature, as from 70° to 80° Fah., will be found best. The child should be carefully washed, I said; and in all that is done in handling it, you should remember that it is a frail, delicate thing. Nor need I hint to a mother that inasmuch as some one had to perform all of these small yet multiform offices for us, so should we be willing to perform them for others.
The dress should be loose, and merely sufficient for the purposes of warmth. The child should not be in any way bound with its clothing; nor should a binder or bandage be used.
LETTER XXX.
HYGIENE OF NURSING.
Lactation a Natural and Healthful Process—Rules for Nursing—At what time should Lactation cease?—Food and Drink proper during the Period.
You who reside in the country—as, indeed, most of you do—can hardly credit me when I tell you that it is getting to be quite fashionable in our large cities for a woman not to nurse her own child.
There is in some cases policy on the part of the physician, which lies at the root of this matter. “Why, madam, you are too weak,” the fashionable pill-monger sagely says. “It will injure your constitution, and you cannot raise your child; you must have a wet-nurse.”
Now, all this is very easy for a man to declare. Some say it from ignorance, no doubt, and some from other motives; for physicians, although as a body of men they are as honest as any other, are yet sometimes selfish, and do that which is dishonest and wrong. The selfish doctor knows, of course, very well where his money comes from. He knows—if he is not an ignoramus—that the mother, if she does not nurse her child, is more apt to become sick, so that she will need his services; and, what is more, she is more apt to become pregnant, in which case he will look for another job at midwifery, which pays well.
I would have every one of you to understand that the health of the unnatural mother, who will not nurse her child, suffers from her not fulfilling the order of nature in giving suck. Her system must inevitably get harm from not allowing it to go through the period of lactation naturally. Her life of dissipation, too, is poorly calculated to contribute to health, compared with staying at home and fulfilling the order of nature, as God designed she should do. But she gets her reward even here. There is no period of woman’s life in which she has so great enjoyment, such perfect physical health, as when she is nursing the offspring of her own blood. Her shattered nerves and broken health are poor pay for the so-called enjoyments of a dissipated life.
But it will be said, there are cases in which it is impossible for a mother to fulfill the office of nursing. She may be physically unable; that is, she may not have any milk to give it; her health may be so feeble, and her constitution so much depraved, that it would not be admissible to do so. All this I admit; but such cases are the exception and not the rule.
What are we to think of the mother who voluntarily permits her child to nurse at another breast? How are we to regard the morals of such a mother—one who willingly allows another person to gain the affections of her child—for it always becomes more attached to the one who nurses it than to its own parent? Besides, too, the character of the one who suckles the child is, to a great degree, stamped upon it, and that indelibly, too. Is a mother, then, willing that the child shall take on the character of another, and of one whose disposition and mental peculiarities she probably knows nothing? For one, I cannot envy the man who has a wife that can willingly resign her child to another to nurse.
Rules for Nursing.—After the birth of the child, the mother having rested herself some hours from the pains and anxiety she has passed through, it should be put to the breast with the view of exciting the mammiferous glands to their proper and healthful action. This is better for both mother and child. It may be necessary to make the attempt a number of times, and perhaps for days before the lacteal secretion will be found to take place. But letting the child every now and then make the effort to get milk will be one of the most efficient means of inducing it to flow.
How often to Nurse the Child.—This is a question of great importance; great not less to the parent than the offspring, but one which is by for too much neglected.
It may not be possible to ascertain exactly at what periods it is best to give a child the breast; but one thing may be predicated with the greatest confidence, which is, that there should be a regularity in regard to it. To give the child the breast every half hour one day, and then, perhaps, the next, for the mother to go away for many hours, is certainly not a good practice.
I am led to believe, after having spent a good deal of thought on this subject, that to nurse a child once in about three hours, is perhaps as good a plan as can be fixed upon. Some have regarded four hours as a proper period; but one thing I am satisfied of, that the three hour rule is a good one; there is far more danger of nursing the child too often than there is from the opposite extreme.
It is common, I believe, for mothers to allow the child to take the breast during the night time. I am of the opinion that this practice, likewise, is not a good one. How much do you become fatigued, worn down, as it were, many of you, by allowing the child to take the nipple as often as it chooses in the night? In such cases, how much better you perceive it would be, to rest during the proper hours, so that when the morning comes, instead of being unrefreshed and stupid, you feel buoyant and elastic as a deer.
I am willing, however, to admit that it is probably the better rule for the child to be nursed somewhat late at night; for example, when you retire to rest; after that it should not be allowed nourishment till morning.
At what time to cease Nursing.—This, too, is a question which deserves a careful consideration—one on which the health of both parent and offspring very much depends.
It is probably true that women in the civilized and refined parts of the world do not, as a general fact, nurse their children for as long a period as is the case among the savage nations.
The Indian women of our own country, it would appear, are in the habit of continuing to suckle their children two years or more before weaning them. Nor do they at all allow of cohabitation during this period—a practice which might well be imitated by the more enlightened portions of the human race. “I shall not undertake to determine,” says Dr. Rush, “how far the wholesome quality of the mother’s milk is increased by her (the Indian woman’s) refusing the embraces of her husband during the time of giving suck.” If, then, the mother’s milk is to be deteriorated by the practice referred to, her health, also, must suffer in a corresponding ratio.
It would appear, also, that in Bible times the period of nourishing children at the breast was prolonged to a much greater period than is common in these latter times, for we read of the giving of suck three years.
Reappearance of the Menses.—Some have supposed that the period of nursing should be graduated according to the reappearance of the catamenial discharge, because, as they have supposed, the milk is deteriorated by that circumstance.
Let us inquire, in the first place, at what time after a woman has given birth to a child, does the menstrual function ordinarily commence?
Some authors tell us that this does not happen for nine or ten months, usually. Dr. Meigs tells us that he expects his patients “to become unwell at the seventh month of lactation.” “But more frequently than is generally believed,” says Dr. Tilt, “the periodical flow coincides with the secretion of milk as early as the second or third month of lactation, and this in perfectly healthy women; and I am in a great measure able to confirm the assertion of certain authors, that menstruation often continues regularly from the beginning of lactation.” These, however, are exceptional cases, the rule being that a number of months, ranging probably from seven or eight to fifteen, elapses before the menses reappear.
But it is by no means proved that lactation should be made to cease as soon as the woman has her monthly discharge. I have myself known numbers of cases in which nursing was continued for some months after, and apparently with good results to both mother and child. How is it in those cases where the menses do not cease at all, or, at farthest, come on at a much earlier period than it would be advisable to wean the child? Must we be obliged to wean the child in these cases? I think not.
Dr. Hassall, of London, we are informed, examined with a microscope the milk of a lady taken from her on the second day of menstruation, which had come on for the first time at the ninth month of lactation, and he reported that the milk was perfectly normal in quality.
Dr. Tilt informs us that, having carefully interrogated one hundred women in whom menstruation had returned at different periods of lactation, he learned that the quantity and quality of the milk were varied as follows:
| The same in | 45 |
| Diminished only at the menstrual time | 8 |
| Completely checked in | 1 |
| Impoverished only at the menstrual time | 5 |
| Impoverished then and thenceforth | 2 |
| Increased at the menstrual time | 24 |
| A rush of milk afterward | 15 |
| 100 |
In making the above observations, the thriving of the children was the estimate of the quality of the milk. By “impoverishment,” was meant that the milk looked like whey, and sickened the children.
My belief, then, you will understand to be, that some other criterion than the reappearance of the menses is to be looked for in regard to the time you should continue to suckle a child. Your own health, the infant’s health, the season of the year, the stage of teething, and a variety of circumstances, are to be taken into the account. And I am fully persuaded that the mere fact of the menstrual discharge coming on, is not a sufficient reason why the child should be weaned. Moreover, weaning should be a gradual process, which it cannot be if a woman must cease to nurse it as soon as the menses come upon her.
Food and Drink proper during Lactation.—As a general principle, it may be stated that whatever is best for the constitution of the mother, is also best for that of the child.
Every thing that goes to injure the mother during the period of lactation operates powerfully upon the mammary secretion, deteriorating it in the same proportion that it acts as an unfriendly agent upon her. This secretion, too, be it remembered, is one of the very first of the fluids of the body to become affected under unfavorable circumstances. We know how quickly the milk of a distillery-fed cow becomes impoverished and unhealthy, when the improper food is given to the cow; and precisely the same great physiological principles hold good in the woman as the animal.
Suppose you have a fine cow, to which you have become very much attached, and that has a fine calf; or even suppose you have a sow, to which you have devoted a more than ordinary share of attention, and that she has a fine brood of pigs. It is naturally to be supposed that you would take as much pains as possible with the cow, that she might give good milk for the calf; and if you have a fancy for raising pigs, you would be equally careful in regard to the sow. We will suppose you think there is danger that the animal will not produce milk enough for the required purpose. In such a case, would you give it tea, coffee, or porter to drink? Most assuredly you would not; nor would you consider any woman in her right mind who would. Now, it is just as improper and inconsistent for you to take these articles, any one of them, with the view of improving either the quantity or quality of the milk, as it would be to give them to animals for the same purpose. Farmers can tell you how much better it is for animals, when they are giving milk, to have pure water to drink; and the purer and softer it is, the better does the animal thrive in every respect.
I will not deny that a woman probably needs more fluid when she is nursing than she does at other times, and I presume that she feels a desire for more; if so, she can take it. But surely no one will tell me that there is any thing in the wide world that will at all compare with pure water as a means of quenching the thirst.
In nursing, as well as in all situations, you will find the diet to have a great influence in regulating the desire for drink. If you eat salt, and highly seasoned or sweetened articles, you will experience much more thirst than you would if the diet were more simple. A stimulating diet causes a degree of fever in the body; and water being the best and most natural of all substances for curing fever, nature sets up a demand for it. Remember, then, when you eat any thing that makes you dry, you are doing unwisely, because you are causing a degree of gastric fever, greater or less.
I need not, I think, go any more into details concerning what you should eat and drink while giving suck. The great thing is to do the best possible for your own health, and that also will be best for the child. You should not eat or take nourishing drink any oftener than you would do at other times, nor should you overdo in quantity, because you think you have two to support.
LETTER XXXI.
OF TWINS, TRIPLETS, ETC.
Twins, Triplets, and Quadrigemini of comparatively rare Occurrence—Of the Signs of two or more Children in the Womb—Management of Twin and Triplet Cases—The Nursing of Twins.
It sometimes happens that the woman gives birth to two or more children at the same time. When a mother has twins it is usually the case that both children are smaller than the natural size; they are not, however, both of the same weight; one may be of moderate size, while the other is still more diminutive. But cases have been known to occur, in which both children were above the natural standard. The average weight of twelve twins, examined by Dr. Clarke, as quoted by Dr. Burns, was eleven pounds the pair, or five and a half pounds each, bringing each child considerably under the average weight of a child born singly. Usually the two children, taken together, weigh considerably more than the one at a single birth.
Twins are fortunately of comparatively rare occurrence; so much so as to render it difficult to establish the proportion between them and single births; the cause of their production is evidently mysterious, and altogether beyond the power of human control.
In the Middlesex Hospital, London, according to Dr. Dewees, there was on an average but one case of twins in about ninety-one of births. In Dublin the proportion is greater; in the hospital of that city it was found that one woman in fifty-eight had twins; in the Westminster Hospital, in London, one in eighty; in Dr. Burns’ practice, one in ninety-five; in La Maison d’Accouchement, in Paris, there were, in twenty years, thirty-seven thousand, four hundred and forty-one single births, and four hundred and forty-four twins; in the l’Hospice de la Maternité (Hospital of Maternity) of Paris, the proportion was about one in eighty-eight, according to one return, but according to the testimony of Madame Boivin, of the same institution, the proportion was only one in about one hundred and thirty or forty, while in that of La Maison d’Accouchement the proportion was about one in ninety-one. Dr. Dewees regards, that in this country the proportion of twin cases is, on an average, one in seventy-five. In Wurtemberg, in Germany, there were, according to Dr. Burns, twins once in about eighty-six cases of births.
Triplets.—These are very much more rare than twins. In the returns of the cases in La Maison d’Accouchement, as furnished by Baudelocque, there appears to have been but one in more than eight thousand cases; in the returns of Madame Boivin, of the cases in the l’Hospice de la Maternité, there is one in rather less than seven thousand. In La Maison d’Accouchement there were, according to Dr. Burns, in twenty years, thirty-seven thousand four hundred and forty-one single births, and five triplets. At Wurtemberg, in Germany, there were triplets once in about seven thousand.
Quadrigemini.—Instances of four children at a birth must be exceedingly rare. It is not uncommon to find the announcement of such cases in our public prints; but the truth of these ought evidently to be questioned in most cases; and yet such an occurrence has been known to take place. An instance was said, on good authority, to have occurred in Paris, in October, 1823. Dr. Dewees cites a German author, as giving the case of a woman in Strasburg, who had eleven children at three deliveries, making, of course, four of each at two of the births, and three at the other. The same author quotes from the Albany Argus what he designates an account of “unparalleled fecundity.” Dr. O. F. Paddock, a respectable physician of Fort Covington, Franklin County, gives, in the Franklin Telegraph, an account of an extraordinary birth of five children at one time, from the same mother—three daughters and two sons. Four of them were born alive, but lived a short time. The birth was premature three months, but they were perfectly well-formed and well-shaped. The average weight was about two pounds, and not much difference in their size. Their parents had lately emigrated from Ireland, and arrived in this country in August, 1825. This case is rendered more remarkable by the fact that the mother of these five was delivered, on the 20th of February, 1826, of two; making, in the whole, seven children in less than nine months. The last were born on the 25th November, of the same year.
The same author quotes also another account of remarkable fertility from Dr. Ryan, editor of the London Medical and Surgical Journal. This learned gentleman was called to a patient, aged forty-one, of a sanguine temperament, who had menstruated at the age of twelve, and married between eighteen and nineteen. She had a seven months’ child in the eighth month of her marriage; had twins about the fourth month three times during the year 1829, and again, December 31, when she was attended by Mr. Whitemore, of Cold Bath Fields, and delivered of two infants; and on January 28th, 1830, she was attended by Mr. Thomas, of Bagnigge Wells Road, and delivered of an infant, which he considered of the same age as the preceding. On the seventh of June, 1830, she aborted at the third month; and on the ninth, a second fetus was expelled; and as there was no discharge whatever from that time to the period when Dr. Ryan wrote, she considered herself still pregnant. The abdomen was about the size of a woman’s in the fifth month of utero-gestation. She had twenty-four children in twenty-one years, and menstruated regularly before marriage, and was always in good health when suckling, and ill when breeding; and always became pregnant about the fifth month of lactation. Her mother was seventy years of age, and in good health; she had eighteen children born alive. A relation of her husband had thirty-two children, including miscarriages.
Dr. Dewees gave a case some years since, of a lady with whom he conversed, who was then in her thirty-eighth year, and who declared to him that she had been pregnant two-and-thirty times. Of this number eleven children had been born alive, and at the full time. She repeatedly miscarried of twins, and no abortion was less than near three months. She had been married nearly twenty-three years.
As regards the number of fetuses that may exist in the womb at a time, fable has exerted itself to an almost endless extent; thus, the story of the Countess of Hannenberg may be cited as an instance. She, in consequence of a curse pronounced by a beggar-woman, to whom she had refused money, was delivered of three hundred and sixtyfive fetuses; that is, one for every day in the year, in fulfillment of the wish of the offended mendicant, which was, “that she might have as many children at a birth as there are days in the year.” The curse was said to be accomplished; and, in proof of it, the fetuses are shown to strangers that visit the museum at Leyden. This fable did very well for the year 1276; but, if such cases were said to happen now, they would be more scrupulously investigated, and more rationally accounted for. In the case first noticed, the sexes were pretended to be discoverable, and all the males were called John, and all the females Elizabeth, at their baptism.
Signs of Twins.—A vast deal of thought and investigation have been put forth on the subject of ascertaining twin cases before birth. The physician is often consulted on this subject; but, it need hardly be said that the wisest and most experienced can hardly do more than guess upon so important a matter. Dr. Dewees tells us, we should always answer the question in the negative, and for two reasons, especially; first, because it is impossible to decide it positively; and, secondly, if it could be so decided, it never should be, as much mischief might arise from the uneasiness and fear it might produce.
It may not, however, be wholly uninteresting to our readers to know something of the signs which have been supposed to indicate the presence of more than one child in the uterus. Women who are more than ordinarily large, are apt to suspect themselves pregnant with twins; we very often see such cases, and yet, in few instances, comparatively, the surmises of such patients prove true; they are in general happily disappointed, for no mother, I think, would prefer to run the greater risk of bearing twins.
If a woman be unusually large in the early part of pregnancy, and increase proportionably to the full period, there is some reason, as Dr. Denman regards, that she will have twins; but people will vary very much in regard to what constitutes “large,” and what “small,” in reference to the size of the abdomen in pregnancy: a few will suppose themselves very large when they are, in fact, only of common or moderate size. Particularly in cases of first pregnancy patients are apt to be misled on this subject; there can be no surprise if conjectures on the subject of twins often prove fallacious.
The abdomen of all women with child is in general uniformly distended, without any inequality. It sometimes, however, happens that the tendons, which form what is called the linea alba, which leads from the navel to the middle of the ossa pubis, being less distensible than the sides of the abdomen, which are muscular, divide the abdomen, as it were, into two equal parts by a raphé or indentation through its inferior part. This presumed sign of twins is as ancient as the time when the human uterus, like that of quadrupeds, was supposed to be divided into cornua, a child being thought to be contained in each horn. But as the form of the human uterus is now well understood and known to be equally distensible to its contents, whatever the form of the abdomen may be, unless it is constrained by external means, even less regard is paid to the form of this than to its degree of distention, when we are judging whether it be probable that a woman is pregnant with more than one child.
Women with child—those who have passed through one or more previous pregnancies—are sometimes apprehensive that they have twins, from a greater, a more distant, or other peculiar motion they feel during the period. But sensations of this kind, it hardly need be said, are generally fallacious, as affording any probable evidence of there being more than one child in the uterus. Besides, it is to be remembered, that women never experience the same sensations during any two pregnancies.
Tardiness of labor has sometimes been considered a sign of twins; but this may be occasioned by so great a variety of circumstances, it cannot be at all relied on as an evidence of compound pregnancy. It is true, however, that when two or more children are to be born at a time, the labor of the first is almost universally slow; and this slowness is to be attributed to the greater distention of the womb.
There is one method of which I should speak, that some, in modern times, place much reliance upon in ascertaining the presence of twins in the uterus. Dr. Kennedy, of Dublin, and others, have affirmed that the motion of two fetal hearts may be ascertained by means of auscultation; others again have less confidence in this matter, so that on the whole, it is doubtful whether much reliance is to be placed upon this method. It would be difficult, I apprehend, in most instances, for two practitioners to agree upon this point.
Management of Twin Cases.—The labor of a woman pregnant with two or more children begins, in all respects, like that in which there is but one; its progress, however, is not in general so regular or rapid. The reason why labor is more tedious in these cases is, that neither child can be subjected so well to the expulsive force of the uterus as when there is but one fetus in its cavity.
It is inculcated as a rule among physicians, to keep a patient as long as possible ignorant of there being more than one child, when this is known. But in almost every conceivable instance, the physician is not aware that he is encountering a case of twins until the first child has been born. After the first child is expelled, we may suspect the presence of another from the following circumstances: first, when the child is small in comparison with the abdomen of the mother; and second, when we find the uterus still large, extending high in the abdomen, and not contracted into a comparatively small and hard tumor, as is usually the case at single birth.
It happens in the greater number of twin cases, that while the physician is waiting for the pulsation in the umbilical cord to cease, or is employed in tying it, or waiting for a pain to expel the placenta, the patient complains with more than ordinary earnestness; on examination it is then found that there is a second child on the point of being born, or the bag of waters may be protruding with more than ordinary firmness, so that almost instantly on their breaking, the child is expelled, and this not unfrequently before there is time to give either the mother or friends notice that a second child is to be born; and fortunately it happens in the great majority of cases that, save the exception of the labor being more protracted and severe in the beginning of those cases, the ultimate births are effected with as little danger and trouble as in the average of single cases.
The rules of practice in twin cases, after the birth of the first child, are plain and not at all ambiguous, as some authors would have them. After the expulsion of the first child, one of two things must happen; first, that pretty severe pains will quickly ensue, and if the position be natural, quickly cause the birth; or second, there will be an entire suspension of pain. In the first case the labor must be conducted in all respects the same as if it were an original one; nor is it at all to be interfered with so long as there is any reasonable prospect that nature will prove adequate to relieve herself; and this she is generally able to do. When pains follow the expulsion of the first child, there is every reason to believe that they will in proper time accomplish the birth of the second, because it will receive the whole influence of the expulsive efforts of the uterus, whereas before it was expended upon both fetuses, and because the subsequent pains will be more powerful, since the uterus is now smaller, and its contractions consequently more perfect; and lastly, because the parts have been already dilated by the passage of the first child.
But if there is a suspension of pain, the rule of practice is equally plain as in the former case; if there should be flooding—which will seldom happen—we are to proceed as we would in any other case of hemorrhage preceding the birth of the child; we are to endeavor to arrest the hemorrhage, and if this cannot be accomplished—which I think it usually may be—we are driven to the necessity of delivering the child by means of art. If there be no hemorrhage present, we are to solicit the contraction of the uterus by frictions and kneading on the abdomen, by cold, wet compresses freely used, by general ablutions; the cold hip-bath, perhaps, in some cases, the frequent drinking of very cold water, taking small pieces of ice into the stomach, and by cold injections in the bowels. But we may safely allow nature to rest herself somewhat before we enter upon these means. A meddlesome midwifery, we should remember, is always bad. As things have been in the healing art, nature has been hindered in her processes, probably scores of times, by manual operations, where she has been really aided once!
The Placenta.—Usually in twin cases, each child has its own placenta, but this is not always the case.
When there are two placentæ, they are usually connected together; sometimes, also, they are entirely separated.
The number of placentæ is usually in proportion to the number of children. To this rule there are also exceptions. A single placenta and a single cord has been found in a case of twins, the cord branching off into two, some distance from the after-birth. In some rare instances, likewise, the cords are found so closely twined together, that they have the appearance of one.
Before any attempt is made to deliver the placenta, when we have reason to suspect there is another child in the womb, or where we have ascertained such to be the case, we should, at the proper time, separate the cord of the first child, and place a ligature on the part next the mother. The cut extremity of the cord, in such cases, is supposed to yield a more than usual quantity of blood, even to the exhaustion of the second child.
When the placentæ are separate, that of the first child should not be delivered before the birth of the second child. Should it be so delivered, there must necessarily follow a considerable discharge of blood, which might amount to a profuse or fatal hemorrhage. But in some instances the after-birth has been expelled by the natural efforts, without any considerable effusion of blood. In some cases of hemorrhage, when there is only one child, the placenta is thrown off first, and yet without any detriment or danger, such as is usually looked for in such cases.
In cases where it is necessary to extract the child by art, it is also generally looked upon as necessary to deliver the placenta by the same means; but such is not necessarily the case. If there is no hemorrhage, or other cause of alarm, there is no more reason for giving assistance to deliver the placenta than if only one child had been present; we ought either to wait for the spontaneous operation of nature, or, at most, give very little assistance, precisely as we would in a case of single birth.
Whenever it is found necessary to give assistance in the matter of removing the after-births, we are to recollect that the two placentæ should be extracted together, or in quick succession, as the patient would not be freed from the peril of her situation if we did not proceed in this way. If the hand is to be introduced into the uterus, it should not be withdrawn till both the placentæ are detached, and ready to come away. If we are to give assistance by making traction at the cord or cords, we must be careful that each shall bear an equal proportion of the force we think it advisable to use.
We are not to be alarmed if more blood is lost in twin cases than is usual at single births. The discharge is commonly greater in the former cases, and longer continued than in the latter.
Nursing of Twins.—Should a mother undertake herself to suckle her own children, when both live, in twin cases? If she has strength enough, and a sufficiency of milk, it is better that she do so. No one else can be expected to feel that interest in a child which a mother naturally does. Inasmuch, then, as the period of nursing—if every thing be properly managed—is that in which woman enjoys probably better health and a greater immunity from disease than at any other time of her life, let her, I say, if it be at all within the range of consistency, nurse her own child; and if there is need of aid from any source, it is better, as a general thing, to depend upon pure cow’s milk, with the addition, perhaps, of a very little pure, soft water, but of no other substance whatever, not even sugar, which is so frequently resorted to. By this simple means, in connection with prudent management throughout, the child may be nourished; wholly, if the mother is not able to give it suck, or in part, if it need more nutriment than she is able to afford it.
LETTER XXXII.
TREATMENT OF AFTER-PAINS.
The Nature of After-Pains—The different Kinds—Their Causes—Treatment—The great Value of Water-Cure.
Usually after delivery, the woman experiences more or less pain in or about the abdomen, generally in the womb or the back, constituting what is termed “after-pains;” these are called after-pains, because they occur after delivery.
It is an important fact, one well worth considering, that as a rule, no after-pains worth mentioning are experienced during the first confinement. Do women become weakened necessarily by giving birth to children? Are their cares and duties too many as they become mothers, in the present state of society? Are the plans of medical treatment, such as are usually adopted in childbirth, calculated more and more to undermine the constitution? Are people almost universally in the habit of debilitating themselves by connubial excesses in the married state? These are questions of vital importance to all who expect to be mothers.
After-pains proceed from the contraction of the uterus, caused by the presence of bloody clots, the blood having oozed from the orifices of the torn vessels, and becoming coagulated in its cavity. The pains come on usually very soon after the expulsion of the after-birth, and may last a few hours, or for a number of days, according to the nature of the case and the treatment employed. Each severe pain usually expels a clot; they are often increased when the child attempts to suck, a fact showing the great sympathy existing between the uterus and the mammary glands.
After-pains may also be caused by costiveness, or, rather, by the presence of hardened fecal matter in the colon. They may also proceed from flatulency.
Dr. Dewees mentions one kind of after-pains of very distressing character, which he had not seen noticed by other writers. He met with a few cases, and I have myself seen one or two instances of the same kind. It is a most severe and constant pain at the very extremity of the sacrum and coccyx (the extreme lower portion of the spinal column). It begins, Dr. Dewees says, the instant the child is born, and continues, with the most agonizing severity, until overcome by the rapid and liberal use of camphor and opium. The sedative effect of cold water is, I hold, altogether better than these so-called remedies. This pain, it is declared by the patient, is vastly more insupportable than the pains of labor, for it is as intense in character, and holds on almost without intermission, which the pains of labor do not.
After-pains are, no doubt, sometimes rendered much worse than they otherwise would be, by improper management at the time of confinement; if the labor is hurried in an unnatural way, the probability of more severe pains is evidently increased; especially if the after-birth is hurried away before the uterus has sufficient time to contract itself they are rendered more protracted and severe; the better the womb contracts, the less the blood will flow into its cavity.
We should be careful always to distinguish these pains from inflammation of the uterus, peritoneum, or other parts within the abdomen. After-pains are remittent; the abdomen is not particularly painful to the touch; the lochial discharge is not obstructed; the patient has no shivering; milk is secreted in due time; there is no general feverishness worth mentioning; and the pulse is not affected. But in case of inflammation, the opposite of these symptoms obtains. There may be, it is true, and sometimes is, more or less increase of heat when there is simply after-pain, but this heat does not at all amount to inflammation.
There is still another kind of after-pains, different somewhat from any I have yet mentioned. They are called spasmodic. The uterus, like all other parts of the human system, and especially those which are highly endowed with nervous sensibility, is liable to take on spasmodic action. These spasmodic pains are sometimes very violent; the patient writhes in agony, tossing herself from side to side upon the bed, and sometimes it is necessary for a number of persons to hold her. These symptoms sometimes become so violent as to end in convulsions, it is said. Spasmodic after-pains appear to happen, for the most part, with those who are excessively nervous, and particularly with such as have been in the habit of using strong tea and coffee, opium, and other narcotic substances. The fashionable tea and coffee drinking, and the use of morphine and other preparations of opium, which have been so much resorted to in this country these later years, depend upon it, have a great deal to do in these things.
Treatment.—How are we best to manage these formidable difficulties in midwifery practice? Shall we stupefy the patient with camphor, opium, or prussic acid, as many have done? Shall we do better than this, and tell our patients, as many do, that these pains are natural, and should not therefore be interfered with, and are to be borne with as much patience as the sufferer can put forth? Or shall we adopt a process which is, on the one hand, more potent, more effective, and more powerful than any other known to quell pain and spasm, from whatever cause they may arise; while, on the other, it does not at all injure the constitution, or leave after it any bad effects?
Dr. Dewees tells us it must be admitted that neither camphor nor opium is always successful in calming these distressing contractions of the uterus. They sometimes persevere with great obstinacy, even after the faithful trial of both these remedies; while, in other cases, no form of opium can be made to suit the peculiar idiosyncrasy of the patient, and to some the camphor is absolutely disgusting.
We have a remedy incomparably more effectual than either or both of these, and which will act in the most friendly manner with every patient—pure water, tepid, cool, or cold, judiciously applied, according to the exigencies of the case, is a hundred-fold better than all other remedies combined in subduing the pains in question.
What substance in nature that will at all compare with water in arresting hemorrhage? There is nothing. So also in regard to securing a proper contraction of the uterus, the same principle holds good. We place wet cloths upon the abdomen, the generative parts, the thighs, and a wet sheet about the trunk of the body, if need be, in order to secure the desired effect. Even placing the hands in cold water will, by sympathy, aid in the result.
In the slighter cases of after-pains, the frequent laying on the abdomen cold wet compresses, the same upon the back, together with frequent drinking of cold water, and the use of the accustomed baths—such as are always taken, even when labor pains do not appear—will in general prove sufficient. But in many cases a far more heroic treatment will be found necessary. Many times in the twenty-four hours we may have to persevere in the water appliances, particularly the shallow-bath; the common wash-tub, or the sitting-bath tub, answer very well for this; the patient sitting in the vessel, the feet, of course, being left outside, she is rubbed all over smartly with the wet hand, there being one or more assistants, herself aiding in the operation somewhat; in this way she is rubbed until the desired effect is obtained. No matter if it makes her chilly and shake, as it often does, for it is much better to be shivering with cold, and suffering in this way, than to be writhing and groaning under the effects of these terrible pains. I have myself, with my own hands, aided in giving these baths by the half hour at the time, and many in the course of a day, and in such cases we have succeeded—usually in a few hours—in getting the mastery of the pains. I cannot conceive of a case in which this treatment, if properly managed, must not succeed. I know that in some cases, where persons have been much injured by narcotic substances, and in which the agony amounts to spasms and convulsions, perhaps, it will be found no boys’ play to cure the case. But I have yet to see the first one in which these remedies will not succeed, and I trust the time is not far distant when both physicians and the people at large, all over this country, and the whole civilized world, will understand and be able to apply, in a very good degree of perfection, these simple and yet immensely valuable means for relieving pain.
But to proceed; if a patient is too weak to sit up for a half-bath, we must do the best we can with her in the recumbent position, and by dexterous and persevering management, a great deal may be done in these cases. The wet sheet, folded once each way, and then slipped under the patient, so that it can be lapped over the whole trunk and pelvis, and the frequent renewal of the wet compresses under the sheet, upon the abdomen, genitals, and thighs, are invaluable means. The washings of the surface may be repeated as often as is necessary, and the wet sheet should be always changed before it becomes too clammy and warm.
But it is fortunately the order of nature, that where there is great debility not much pain is experienced. If a patient experiences a great deal of after-pain, we may know that she has a pretty good amount of vitality in her organization, and that she can bear a large amount of treatment, sufficient to bring about the desired result.
Water injections for the bowels are also valuable in these cases. I do not think it best to use the water very cold. In one very obstinate case, where the most agonizing after-pains had gone on for hours before I saw the patient, we used, among other means, frequent clysters of water, at about 70° Fah. with excellent effect. Nor would I be afraid to use very cold clysters in such cases.
Some have recommended vaginal injections in strong terms as a remedy of after-pains. It has indeed been affirmed that occasional cold injections to the uterus prove a sovereign remedy for them. But no one of much experience has testified to this. It will be found, I think, by those who have put forth these strong statements, that when they have gained a sufficient amount of experience to enable them to form a good judgment upon these matters, they will find, I am confident, that a much more powerful and general treatment will be necessary in those severer cases. No single application, however powerful, can of itself succeed. But if I am myself in error on this subject, I shall be most happy to become convinced of it, for I love the truth better than every thing else; better even than my own opinions, however strongly and confidently expressed.
I would prefer the tepid vaginal injection—say at a temperature of from 70° to 80° Fah.—rather than the cold. If we have an aching tooth, its nerves all sensitive and bare, we do not take cold water into the mouth, but that which is tepid. We repeat this pretty often, and at the same time rub the face, neck, and other adjacent parts with the coldest water we can get.
If we have a cut and bleeding finger, we do not immerse the wound in cold water, or put cold water upon it, to arrest the bleeding, but we immerse it in tepid water, and make our cold applications some little distance from the wound, as upon the arm and elbow; thus we secure our object in the better way. If we are to treat a felon, we may immerse the hand and arm in cold water, leaving the extreme part, at which the agony is felt, out of it; we may have a wet compress about the painful member, but the greater and more effective applications must be made on other parts, contiguous to the one affected. From these well established principles I infer that the vaginal injections, whatever may be claimed for them, are of minor importance, when compared with the external and more general applications to which I have referred, as a remedy for after-pains. It is to be remembered, likewise, that patients, from the extreme sensitiveness and soreness of these parts after delivery, dread very much applications of this kind. The external applications are soothing, pleasant, and wonderfully effective in relieving soreness, but not so with the internal applications.
Thus, then, it will be perceived, that I place great reliance upon the shallow-bath, tepid, cool, or cold, with prolonged friction by the wet hands, the sitting-bath, the cold wet compresses, often repeated, the wet girdle, cold wet cloths upon the thighs and back, the folded packing sheet, with covering sufficient to keep the patient comfortable, tepid or cold clysters, and water-drinking, together with good nursing throughout, as a remedy for the distressing affection of which I have been treating.
LETTER XXXIII.
THE LOCHIAL DISCHARGE.
The Mosaic Law concerning Purification of Women—Nature of the Lochia—Excessive and Offensive Discharge—Treatment of Suppression of the Lochia.
We read in the New Testament, in reference to the birth of the Saviour (Luke ii., 21, 22), that “when eight days were accomplished for the circumcising of the child, His name was called Jesus, which was so named by the angel before He was conceived in the womb;” that “when the days of her purification, according to the law of Moses, were accomplished, they brought Him to Jerusalem, to present Him to the Lord.”
These passages refer to the Mosaic law (Leviticus, chap. xii.), which is as follows:
“And the Lord spake unto Moses, saying, Speak unto the children of Israel, saying, If a woman hath conceived seed, and born a male child, then she shall be unclean seven days; according to the days of the separation for her infirmity, shall she be unclean.
“And in the eighth day the flesh of his foreskin shall be circumcised.
“And she shall then continue in the blood of her purifying three-and-thirty days; she shall touch no hallowed thing, nor come into the sanctuary, until the days of her purifying be fulfilled.
“But if she bear a maid child, then she shall be unclean two weeks, as in her separation: and she shall continue in the blood of her purifying threescore and six days.”
This law refers to what is called in medical science the lochia, or lochial discharge, the term being derived from a Greek word signifying “a woman in childbed.”
After the birth has taken place and the placenta has been removed, the woman experiences a discharge from the womb, which is at first red in color, consisting, probably, of little else than blood; afterward it acquires a greenish hue, possessing a peculiar and disagreeable odor.
The lochia is considered purifying in its character. It is a natural discharge which oozes from the orifices of blood-vessels, laid open by the separation of the placenta from a portion of the internal surface of the womb. In all cases wherein a wound is made in the living body, or wherever the blood-vessels are by any cause laid open, there must be necessarily more or less discharge before the healing can be fully accomplished; and the same principle holds good in the womb as in other parts of the body.
In quantity, the lochia varies much in different cases; it may be three or four times as abundant, apparently, in one case as in another, both patients recovering, however, with equal facility or difficulty.
The length of time varies also as much as the quantity of this discharge. It may last for a few hours only, for days, but more commonly for weeks; fourteen to twenty-one days may be stated as its usual duration. Something, I think, depends upon the treatment; cleanliness certainly has its effect in these cases. If a woman wash herself three or four times daily, and keep herself at all times as strictly clean as the circumstances will admit of, the process of healing must be materially hastened, the discharge rendered smaller in quantity, and less offensive in character.
Excessive Discharge.—From various causes the lochia sometimes becomes excessive in quantity. More anciently, when the humeral pathology was much in vogue, this discharge was studied with more attention than in modern times, and our forefathers in medicine may have gone to an extreme in this matter; but certain it is, the importance of the lochia should not be overlooked.
A piece of placenta retained may augment the flow of the discharge. If the patient experience vomiting, very offensive and too great a quantity of lochia, or if very severe after-pains come on, there is some reason to suspect that such is the case; so, also, portions of the membranes may have been retained, causing some degree of irritation. Any thing which debilitates the system, such as too much lying in bed, overheated rooms, too much sitting up, walking, or other exercise, and especially too much excitement in the way of seeing company, gossiping friends, etc., may likewise cause an excessive discharge. In those cases where a portion of the placenta is retained, removing it is often considered the best remedy; but according to one very able author and practitioner, Dr. Blundell, “unless the symptoms are very urgent, it is better to refrain from manual operations; left to its own efforts, the uterus will, perhaps, more safely clear itself.”
Treatment.—In all these cases the general principles of management are plain and easily understood. We must, of course, as far as possible, remove the causes of the difficulty; we must also treat the system constitutionally in order to improve the general strength. Cooling wet compresses upon the abdomen and genitals, frequent ablutions, the sitting-bath, and in some cases the packing wet-sheet, will prove a highly useful means; vaginal injections of water, tepid injections in the bowels, and drinking of pure, soft water, are also to be recommended.
Offensive Discharge.—There is one condition of the lochia which is very troublesome from its offensive smell and extremely loathsome character. In such cases the red discharge ceases and is succeeded by a profuse watery one of a greenish color, and which is sometimes called by women “the green water;” it is frequently so acrid as to excoriate the parts upon which it runs. It is often attended with a good deal of general debility, causing, not unfrequently, a considerable degree of hectic fever.
The water processes, practiced in a manner suited to the exigencies of the case, cannot be too highly recommended or too much praised, as a means of purification and cure in this offensive and troublesome malady.
Suppression of the Discharge.—Women, in general, very much fear a sudden cessation of the lochia, and for the reason that it is generally well understood that this occurrence is attended with circumstances of an unfavorable character. But while patients should, on the one hand, always be careful and considerate in matters pertaining to health, they should, on the other, not become at once frightened at every little cessation of the discharge. As I have before said, it may cease of itself spontaneously, and without harm to the system, within a few hours after birth. Dr. Good, indeed, tells us “that in some women who have healthy labors, there is no lochial discharge whatever, the blood-vessels of the uterus contracting suddenly and closely as soon as the red blood ceases to flow.” This celebrated author points out an example of this kind that occurred to Professor Frank, even after a third natural delivery; the patient, moreover, having been from a girl as destitute of menstruation as afterward of lochia; yet her health was in no respect interfered with.
Diagnosis and Treatment.—If thus, on examination, we find that there is no increase in the frequency of the pulse, or other unfavorable symptoms, no fear whatever need be entertained. If the patient has taken cold, causing an inflammation of the womb, an accident which may be known by sensations of chilliness along the spine, accompanied, perhaps, with general rigors, by the roundness, hardness, and tenderness of the womb, which may be easily felt through the abdominal coverings; and, if added to all these symptoms, there is great heat of the skin and frequency of the pulse, rising to 110°, 120°, 130°, or even more; then we may know that the suppression is a morbid one—one, too, which if not promptly treated, may soon end in death.
Patients, under such circumstances, have great fears of cold; they bundle themselves up, and heat their systems in all manner of ways, as if their physical salvation depended wholly upon such a course. But the truth is, the mischief has been already done; once there is a severe inflammation or fever upon a patient, it is impossible for her to take another cold until the previous one has been cured.
This fact, then, indicates clearly what the proper treatment of such cases should be; we must treat them on the same general principles of all other inflammations; and as soon as the fever and inflammation are sufficiently removed by means of ablutions, wet compresses, injections, water-drinking, and, if necessary, the packing wet-sheet, the discharge—if any such be at all necessary—must follow as inevitably as a stone falls to the ground. Thus it is, then, that under certain circumstances, a cold may give fever and inflammation; while under other circumstances, cold cures these symptoms. These operations of nature, simple and beautiful as they are, must prove highly interesting to every reflecting mind; and they show, moreover, the goodness, benevolence, and design of the Creator, in furnishing us everywhere, so abundantly, a remedy so powerful and safe as pure, cold water.
In all those diseases following delivery, the excellent Dr. Good observes, “That cleanliness and purity of air are of the utmost importance,” and “that, without these, no plan whatever can succeed; and with them, no other plan is often wanted.” “They are, moreover,” he continues, “of as much moment to the infant as to the mother. It is a striking fact that, in the space of four years, ending in 1784, there died in the lying-in-hospital of Dublin—at that time a badly-ventilated house—2944 children out of 7650; though after the ventilation was improved, the deaths within a like period, and from a like number amounted to not more than 279.”
LETTER XXXIV.
OF CHILDBED FEVER.
Milk Fever as distinguished from Puerperal Fever—The great Danger of Childbed Fever—Its Symptoms and Nature—Modes of Treatment—Is it a Contagious Disease?
In the course of two or three days usually after the birth of the child, the woman experiences more or less febrile excitement of the system. This is what is termed milk fever, it being connected with the coming on of the lacteal secretion. The attack sometimes amounts to a “smart febrile fit, preceded by shivering, and going off with a perspiration.” It is not dangerous, seldom lasts over twenty-four hours, and during the time of its appearance the breasts are full, hard, and painful, which distinguishes this from more dangerous fevers.
Puerperal or childbed fever is a very different thing from the foregoing, and is reckoned by physicians as being one of the most fearful of maladies.
According to the celebrated Dr. Blundell, “women after their delivery in general do pretty well, although no attentions are paid to them;” and it is the testimony of the same distinguished author, that “when the constitution is good, and the circumstances are not extraordinary, the less they are interfered with the better;” and yet it must be admitted by every candid and reflecting mind, that, do what we may in all the known possible ways of fortifying and invigorating the general health, woman must, ever in childbirth be subject to some of the most fearful diseases and accidents to which the human frame is liable. Suppose it be only one in fifty, one hundred, or one thousand, that is to be attacked under such circumstances with a threatening and most dangerous malady, who is there that wishes his wife, sister, or friend to be that one—and that one, too, to be subjected to the treatment of an ignorant or unprincipled quack, whether of the male or female stamp? It is for the cases of exception, then, and not the rule, that physicians should toil long and hard in their efforts to remedy the ills to which human nature now is and ever must be subject.
I am led to these remarks, partly from the necessity of the case, but more from the fact, that there are those in modern times who, through ignorance, as we must charitably conclude, would mislead the public on this most important subject. I will go as far as any one in encouraging woman to pursue a rational course in the preparation for, and the consummation of, childbirth. Those who have read my humble efforts at authorship on this subject hitherto, must, I am confident, be aware of this. At the same time, while I would encourage woman—encourage her even more than any of us have yet done—I would have her to understand that there are dangers, fearful and imminent dangers, always attending the parturient state. Be these dangers only one in a hundred or thousand cases, they are yet dangers; and who among us, even of the most experienced, can tell who is to be the subject of them, and who is not? It behooves to be ever watchful in these important matters of the healing art.
I propose, then, here to speak of that most formidable, most fearful of all diseases to which the puerperal condition is liable, the puerperal fever—the puerperal plague, as it has been called—so sudden in its attack, so rapid in its progress, and so fatal in its effects—fatal, that is, according to the old methods of treatment—sanctioned, as they are, by the usage of ages.
Time of Occurrence.—The puerperal or childbed fever comes on usually within the fourth day, reckoning that of delivery the first. It happens oftenest the second or third day. It may come on the first day, or it may, though rarely, attack the patient eight, ten, or more days after delivery. The later the day, the less the danger, as a general fact.
Symptoms.—Childbed fever is more commonly ushered in by a chill, which is not, however, long in duration. This is experienced most along the back, and sometimes about the shoulders and neck. The chill varies in degree of intensity in different cases; with some patients there is a degree of chattering, such as occurs in a severe ague fit; with others there is very little of the symptom; and in some cases no chill whatever is experienced. These last, however, must be the exception to the rule. In almost every conceivable case, a degree of chilliness, greater or less, is experienced. As in other inflammations, this chill is followed by fever. The intensity of the chill is considered no measure of the vehemence of the subsequent fever; the most terrific fever may follow very mild chills, and the contrary. Some regard that there is most danger to be apprehended when the chills are of a mild character.
Here I ought to remark, that patients should not be frightened at every little chill they may experience. The coming on of the milk—the milk fever, as it is called—heat in the breast, and a variety of circumstances other than those of childbed fever, may be preceded by or attended with chills. Indeed, almost every mother with a new-born child experiences more or less of chilly symptoms; and yet fortunately but few are attacked with that terrible malady of which we are treating. So much by way of encouragement in regard to the matter of chills.
In connection with the rigors before mentioned, the patient complains of pains in the abdomen; these may be so slight as to be scarcely perceptible to pressure on the part, or they may be so violent and severe that the gentlest touch of the finger is regarded with apprehension, and the weight of the bed-clothes proves a burden that cannot be borne. “Sometimes the pain,” says Professor Meigs, “which is, at the onset of puerperal fever, felt in the hypogastric region, is too intense to be borne by any human patience; and no exhortation or recommendation can prevent the woman from crying out aloud, or even screaming with her agony. All over the abdomen these pains may be felt, above, below, to the right, to the left, in the region of the diaphragm, and in the lumbar region; this diffusion, however, is neither constant nor frequent, and it is found, especially in the less malignant varieties of the disease, that it is in the region of the navel, and more especially below it, that the patient complains.” Severe after-pains may be experienced in connection with the disease, or the reverse. Little or no fever may occur in connection with severe pain, and so the contrary. If the pain is circumscribed, as we say—confined mostly to one spot—it is far more favorable; but if the pain and tenderness are spread over a large surface, beware, lest there be mischief at hand. If the pain be even slight, and yet diffused extensively over the surface of the abdomen, we must take heed lest we get into trouble that will imminently endanger the patient’s life.
The pulse always rises high in childbed fever. This is one of the most distinctive features of the disease. It is seldom lower than 115 or 120 per minute, except when it is giving way before the power of remedial means. More commonly it rises to from 130 to 140 beats per minute, and it has been known to rise as high as 160 or 170. These last, however, are extreme cases—exceptions to the general rule.
Besides the symptoms enumerated, there sometimes occurs headache, sometimes vomiting, and at others purging, which last symptom is probably in general a good omen.
Duration of the Disease,—Puerperal fever, like most other diseases, is not very uniform in its duration. It is, however, in general short. It may last for a number of days—for many days, if we reckon the convalescence a part of the disease. On the other hand, it may, like the plague itself carry the patient off within the first twenty-four hours of the attack. Three or four days is reckoned to be the average duration of childbed fever, when it occurs in the epidemic form.
Professor Meigs has well explained why it is that childbed or peritoneal fever is so serious and dangerous a malady as it is. He observes:
“The peritoneum (the lining, membrane of the abdomen), a serous membrane, known for ages as one of the tissues most ready to take on inflammation, undergoes in labor, and during lying-in, changes of the greatest importance. Its great extent may be known by computing the superficial contents of that portion of the serous membrane which invests the alimentary canal. This canal is about forty feet in length, and its outer coat is composed of peritoneum. If cut up by the enterotome, it would be at least four inches wide and forty feet long, affording a superficies of more than thirteen feet, to which should be added the superficial contents of the remainder of the membrane, where it invests the liver, the epiploon, the mesentery and mesocolon, besides the ligamenta lata, and all the other parts which derive from it their serous covering. This vast surface inflames rapidly and totally, and passes through the stage of inflammation with extraordinary speed. It cannot happen that it shall ever be extensively inflamed without a coincident exhibition of the greatest disorder in the functions of the nervous organs directly implicated in its structure, or possessing with it physiological relations that could not be safely disturbed. The peritoneum is the investiture of the abdominal organs; the peritoneal coat of the stomach is as truly a part of the organ as its muscular or mucous coat; the same is true as to the peritoneum that invests the liver, that of the spleen, and the same truth is of the utmost import when it is stated with regard to the peritoneal coat of the whole alimentary apparatus. It is clear that extensive or universal inflammation of the peritoneal membrane is inflammation of all or many of the organs contained within the cavity of the abdomen. A great puerperal peritonitis, therefore, may be properly regarded as a complex inflammation of a vast number of organs indispensable to existence. Why should we be astonished, then, to see the power of the nervous mass sink under the invasion of causes of destruction so great and so pervading?
“Seeing that the superficies of the peritoneum is equal, probably, to thirteen or fourteen feet, we should have abundant reason to dread so extensive an inflammation from the constitutional irritation which it alone would produce; but when, in addition to that consideration, we take into view the great affusions which may ensue, the suppurations, the interruption of the intestinal functions, the depravation of the actions of the liver, etc., which are occasioned by it, we have still greater reason to deprecate its attack, and to seek for the justest views of its nature, and of the remedies most appropriate for its cure.”
Professor Meigs elsewhere judiciously remarks, that, considering the changes that take place in the reproductive tissues at childbirth, “there is, in fact, greater reason for surprise, when we find it not followed by inflammation, than when we meet with the most violent and destructive cases of that affection.”
Treatment.—In the year 1846, I treated (in connection with a missionary friend and physician, who is now in Siam) a premature case of childbirth, which, to say the least, threatened to become one of severe puerperal fever. The case was an important one, and as such I here present it to the reader. It was written out with great care and accuracy at the time by the medical friend referred to. I give it in his own words:
“March 19, 1846.—Desirous of availing myself of an opportunity which Dr. Shew kindly afforded me of witnessing the hydropathic treatment of cases of labor, I accompanied him to No. — Second Street, where he had been summoned a few minutes before, to attend Mrs. S., who was then in need of his services.
“We found the patient an intelligent woman, of the nervous temperament, with her constitution much broken down—though she was but thirty-one years of age—by the results of severe previous labors, the last a miscarriage. After some of her former confinements, she had been weeks and months in recovering. In one case, when, she was treated for puerperal fever, her husband paid in one year not less than one hundred and fifty dollars—no trifling sum out of the earnings of a working man with a large family—to the apothecary alone, for leeches and medicines. The patient had always been in the habit of using strong tea and coffee; drank the mineral water of the city wells; for some months had relished nothing but the little delicacies sent in by her friends, and throughout the winter had been able to do little or nothing at home.
“In consequence of excessive fatigue, a few days before, in ‘house-hunting,’ as she called it, she had been seized on Tuesday, the 17th, at 10 A. M., at the close of the fifth month of her pregnancy, with the pains of labor—her former miscarriage having, of course, induced a predisposition to another. These pains increased in frequency and severity till they caused the greatest suffering, and prevented all sleep on Wednesday night and Thursday, up to the hour (3 P. M.) when she sent for Dr. Shew.”
Here, then, was a patient, whose previous history, impaired constitution, loss of sleep, and exhaustion from intense and almost incessant suffering, protracted now for more than two days, seemed to promise any thing but a speedy recovery, even should delivery be safely effected. It should be added that, up to the time, she was an utter stranger even to the hydropathic treatment.
“Her bowels having been moved the day before, all that was deemed necessary was to render the condition of the patient more comfortable, by resorting to sedative frictions along the spine with a towel wrung out of cold water, and to the tepid hip-bath, with sponging and rubbing the whole surface of the body. After this, less complaint was made, till soon after 6 P. M., when there was a sudden aggravation of the bearing-down pains, resulting in the delivery of a well-formed but still-born male child, of apparently five months.
“In about fifteen minutes the after-birth was detached, and taken away. Not even the usual amount of hemorrhage occurred. A bandage was applied to the abdomen, as the patient expressed a wish for it; and after resting awhile, a little panada was given her as nourishment.
“Mrs. S. continued very comfortable through the evening; no excess of the natural discharge; complained only of exhaustion, and slight difficulty of passing urine. As there was some heat of the surface—the pulse being from 90 to 100—tepid sponging was resorted to, which proved very grateful to the patient.
“Second Day (Friday), Seven, A. M.—Found the patient had obtained considerable sleep at intervals during the night; felt very comfortable, though occasionally had slight pains in the abdomen; tongue moist; pulse 81; had passed a little water during the night, but with difficulty; had a strong desire for a cup of coffee, but persuaded her to take a little panada in its place; had not much appetite; was permitted to sit up for a few minutes while her bed was made.
“Half-past Eleven, A. M.—Mrs. S. still very comfortable; found her sitting up in the rocking-chair, the very picture of convalescence. Sponging enjoined, if any feverishness should arise.
“Three, P. M.—Dr. S. sent for, as the patient had been seized a few minutes before, rather suddenly, with a sharp pain in the left side. Had been drinking a tumbler of cold lemonade. Had a natural movement of the bowels that morning, and passed a little water. The tepid sponging of the surface had been neglected. Pain fixed, severe, pretty constant, remitting only for a moment or so. No corresponding contractions of the uterine tumor observed. Some pain also complained of in the hip, with which she had, on a former occasion, been troubled. Up to that time had had no chill. Warm fomentations were applied, but with little relief.
“Half-past Four, P. M.—A chilliness felt, then shivering, prolonged, with increase of the fixed pain of the side; pulse 112, weak; patient restless, anxious, desponding; knitting of the brows, involuntary weeping. A bottle of warm water was applied to the feet, and soon after, the chills ceased.
“A large warm enema was now administered; this brought away considerable fecal matter; and fomentations were applied to the abdomen. Next, the patient was seated in the hip-bath, at a temperature of 95°, for fifteen minutes, when water was passed more freely than before, and a slight nausea experienced. The result of this was complete abatement, for the time, of the pain in the uterine region, the diminution of the frequency of the pulse to 90, and great comfort. The bandage to the abdomen having been removed, to allow of the bath, was not replaced. If need be, fomentations to be kept up.
“At 7 P. M. found the patient in a profuse perspiration; pain in the abdomen had lost its acuteness; soreness there was all now complained of—soreness in the head, ‘in the bones, and all over.’ Abdomen swollen, and tender on pressure; breathing shallow; pulse 110–12; discharge from the womb (the lochial discharge) arrested. Patient is to be kept quiet; to take no nourishment; no fire to be in the room.
“At 9¼ P. M., the perspiration still continues; complains of pain in the hip, but chiefly in the left side, as before, and shooting across the abdomen; pain now very severe, increased by coughing; breathing thoracic (shallow), and 28 in the minute; pulse 98; is thirsty; tongue moistish, with a slight milky coat. Fomentations as usual.
“Half-past Ten, P. M.—Pain increasing in the abdomen and hip; tenderness increasing; can scarce bear slight pressure on the abdomen; knees drawn up; restless, discouraged; pulse 100, though not very full or strong; skin still slightly moist.
“In this critical state of things, when nearly every symptom of that fearful disease, puerperal fever, was invading the system, and when, according to the prescribed rules of practice, the most vigorous antiphlogistic measures would be called for, a plan of treatment was adopted that was, as it seemed to me, far more likely to kill than to cure, and which I could not but protest against at the time, but which, as the result proved, was eminently calculated to turn back the tide of disease so rapidly setting in. It certainly afforded striking evidence of the resources of hydropathy, and its promptness and efficiency in relieving pain, and extinguishing inflammation.
“Mrs. S. was carefully lifted from her bed, and after being placed in her chair, was transferred to a hip-bath, containing about one pail of water fresh from the Croton hydrant near by, of the temperature of 42° Fah. A towel, wrung out of cold water, was applied to the forehead at the same time. Of course she was well covered with blankets. She had been seated there but a few minutes, when she expressed herself as feeling very comfortable indeed. The severe pain in her abdomen and thigh had left her as if by magic, and so complete was the relief, that she fell into a gentle doze, from which, awakened by nodding, she observed, ‘There, I feel so easy now, I lost myself, I believe.’
“While in the bath, her pulse was lowered several beats in the minute; the unimmersed parts of the body remained warm; the hips were to her of a refreshing coolness. After remaining thus seated in the water about twenty-five minutes—a slight addition of more cold water, by gradual pouring, having been made during this time—she was lifted back to the bed. Her pain had now entirely vanished; the natural lochial discharge was soon restored; the pulse reduced to 94; and, warm and comfortable, she had a prospect of a good night’s rest.
“Third Day (Saturday), Seven A. M.—Found patient looking comfortable and happy. No pain now in the abdomen, slight soreness only; tympanitis (swelling) gone; tongue moist, and hardly coated; pulse 79; had had no sensation of chilliness after her bath, but slept from 12½ to 4 A. M., without waking, and another doze after that; window had been a little raised all night, and no fire in the room, though it was cool. Now was able to pass water without difficulty. Was directed to take for breakfast some coarse wheaten bread, toasted, and softened with milk, and a little scraped apple, if she wished.
“Eleven, A. M.—Mrs. S. appears very comfortable. With the aid of a friend has been up and changed her clothing. Pulse 84; complains of no pain of any consequence in the abdomen.
“Half-past One, P. M.—Had been under the necessity of getting up without assistance, and fatigued herself, and thus induced a return of very severe pain in the uterine region. Dr. S. was sent for, when resort was had again to the hip-bath, filled with cold water from the hydrant, which had with such wonderful promptitude averted the danger of puerperal fever, with which she was threatened on the evening of the second day; as on that occasion, in less than five minutes, the pain and feverishness was completely quelled. She was allowed to remain in the bath half an hour, and requested to abstain from food till evening.
“Five, P. M.—Patient doing remarkably well; cheerful; free from pains in the abdomen, save now and then a very slight one; some soreness on pressure; pulse 84, compressible.
“Ten, P. M.—Had slept during evening; had taken a little nourishment. Has some difficulty in passing water, and as occasional slight pains and soreness still continues in the abdomen, the cold hip-bath, at 42° Fah., was again resorted to for about thirty minutes. During this time the pulse was lowered from 80 beats in a minute to 70; water was passed freely, and pains put to flight.
“After the bath, the patient continuing warm and comfortable, was directed, should there be any return of pains during the night, to seat herself in the hip-bath, which was left in the room.
“Fourth Day (Sunday), Half-past Seven, A. M.—Patient had slept most of the night; looks bright; feels ‘very comfortable;’ pulse 72, soft and natural; had raised herself in bed without difficulty, and washed. On account of some difficulty in passing water, the hip-bath was used for about fifteen minutes, when the urine flowed more copiously and freely than at any previous time. Left seated in the rocking-chair; sitting up occasionally; she says it has rested and refreshed her from the first.
“Appetite good; thinks even the plainest food would be relished. Breakfast to be as before; the toasted coarse bread, soaked in milk, with a little scraped apple. Directed to take no nourishment at any time, unless a decided appetite, nor then oftener than three times in a day. Is to take an enema and another hip-bath in the course of the morning.
“Six, P. M.—Had continued to gain during the day till toward evening. It most unfortunately happened that an intoxicated man, mistaking the house, strayed into the room where she was lying, with no attendant but a young girl; seating himself, without any ceremony, in the rocking-chair, with a lighted cigar in his mouth, he smoked away to his satisfaction, and then very deliberately composed himself for a nap. This strange visitor, and the fumes of the tobacco, had given poor Mrs. S. a severe headache, the first with which she had been troubled; considerable nausea, with paleness of the face, cold feet, etc. A towel wet with cold water was applied to the head, and a hip-bath ordered.
“Half-past Nine, P. M.—Was rapidly recovering from the effects of the afternoon’s unexpected visit; sat up awhile.
“Fifth Day (Monday).—At 7½ A. M., found Mrs. S. sitting up in bed sewing; pulse 75; had rested well; has a good appetite. Breakfast to be as before; may safely take a hip-bath at any time when suffering from pains and is not made very chilly by sitting in it.
“Was able this morning to rise and walk about the room unsupported. Required no assistance in getting to the bath; bowels moved naturally; sat up several hours to-day; appears bright, pleasant, and cheerful.
“Sixth Day (Tuesday).—Mrs. S. feels to-day as much better than she did yesterday, as she did yesterday better than the day before. Sat up, and was about the room nearly all day; continues the practice of daily sponging the whole surface, and the use of the hip-bath. At night, retention having ensued from over-distention of the bladder, in consequence of an untimely and protracted visit from some of patient’s friends, Dr. S. was sent for, and deemed it advisable to resort to the catheter, which she had frequently been compelled to use on former occasions, sometimes for months together.
“Seventh Day (Wednesday).—Mrs. S. appeared to be better in the morning; able to rise without assistance, to walk about, and even to sweep the room; catheter again required.
“Eighth Day (Thursday).—During the night, of her own accord, took two or three or four cool hip-baths, and found them refreshing, and of service in promoting easy evacuation of the bladder. At one time dropped asleep, and remained so an hour or more—sitting in the water. Pulse in the morning. Dressed the children and arranged the room herself to-day; and though a week had hardly elapsed since her confinement, felt strong enough in the morning to go down stairs, and to do a half day’s work in sewing, etc., from which she appeared to experience no injury. A few days after she ventured to ride down to the lower part of the city, and having since continued to improve, save an occasional return of an old difficulty—retention—is most gratefully sensible, under Heaven, to her physician and hydropathy, for a far more speedy and pleasant convalescence than she ever experienced after any of her former confinements.”
Professor Gilman, of this city (New York), in his edition of the Dublin Practice of Midwifery, gives us the following account of a method of treatment which was adopted with remarkable success in the old country:
“In an epidemic (puerperal fever), which raged at Keil in 1834, ’35, and ’36,” says Professor G., “Michælis used ice, both externally and internally, with excellent effect. The cases in which he gave it with success were marked by burning pain and heat in the bowels, thirst, painful eructations, and tenderness of the epigastrium. The brain was clear; no delirium. The ice was given by the mouth, in bits the size of the finger, every half hour or oftener; it was also applied over the abdomen in a large bullock’s bladder, extending from the epigastrium to the pelvis, in a layer half an inch thick. This application was in some cases continued for three days, the bladder being changed as soon as the ice melted. It was very grateful to the patient, and Michælis thought it had cured some cases where affusion had actually taken place into the peritoneal cavity. The use of ice was not persisted in unless it was grateful to the patient. The symptoms of amendment were a sudden and very great fall in the frequency of the pulse, a peaceful sleep, relief from the painful eructations, and diminished distention of the bowels. A profuse watery diarrhea occurring with these favorable changes, seemed to him to be critical.”
This treatment of Michælis is certainly a very bold one. Those who are well acquainted with the water-treatment will be able at once to comprehend the fact, that the applications mentioned were sufficient to cause “a sudden and very great fall in the frequency of the pulse, a peaceful sleep, relief from the painful eructations, and diminished distention of the bowels.” Nor is it incredible that a cure might thus take place, even in some cases where affusion into the peritoneal cavity had actually taken place, since the effort of nature tends always, so long as life lasts, necessarily to that end. It is well worthy of remark, that the treatment of Michælis was persisted in only so long as it was grateful to the patient. This is an important rule to remember.
Nor do I regard it necessary, absolutely, to use ice in the treatment of this or any other inflammatory affection. Water—even at the temperature of rivers at this latitude in the summer—which is usually, I believe, at about 70° Fah., may be made very effectual in the cure of inflammatory diseases. Thus, if we wrap one or more wet sheets about a patient, having him, at the same time, on a cool straw bed, and neither the bed or wet sheets having any covering whatever, we, through the natural processes of evaporation and refrigeration, abstract in a short time a great amount of animal heat. We may likewise change these applications as often as we desire, or pour water upon the sheets frequently, and thus cool the patient to any desirable extent, without the use of ice or water that is extremely cold. It should be understood, also, that general applications—applications over the whole or a large part of the body’s surface—are far more effectual in reducing the inflammation of a local part, than applications locally made can be. This fact is not generally understood.
Is Childbed Fever a Contagion?—This disease is believed by many to be at times contagious. It would, doubtless, be a difficult undertaking to prove positively that such is the fact. It is the opinion of some able writers on medicine, “that there is unquestionably an epidemic influence, or atmospheric constitution, which sometimes, in extensive districts of country, in villages, in towns, and cities, and especially in crowded lying-in hospitals, determines, by an unknown force, the attack of childbed fever, and so modifies the pathognomonic conditions as to hurry numerous victims to the grave, and this, notwithstanding the most reasonable methods of cure.”
But that the disease is really communicable from one patient to another, is not so palpable. One author—Professor Meigs—a man whose good character and long experience entitle his opinions to much weight, tells us that a great experience—and few have enjoyed greater—has not enabled him to perceive that he has been the means of disseminating this malady among lying-in women, to whom he had given professional aid while attending upon dangerous and fatal attacks of it, or after making or witnessing autopsic examinations of the bodies of the dead. On the other hand, Dr. Gooch, an author whose opinions are probably equally deserving of respect, tells us in reference to puerperal fever, that it is not uncommon for the greater number of cases to occur in the practice of one man, while the practitioners of the neighborhood, who are not more skillful or busy, meet with few or none. A practitioner opened the body of a woman who had died of puerperal fever, and continued to wear the same clothes. A lady whom he delivered a few days afterward was attacked with, and died of a similar disease; two more of his lying-in patients, in rapid succession, met with the same fate. Struck by the thought that he might have carried the contagion in his clothes, he instantly changed them, and met with no more cases of the kind.
A woman in the country, who was employed as washerwoman and nurse, washed the linen of one who had died of puerperal fever; the next lying-in patient she nursed died of the same disease; a third nursed by her met with the same fate, till the neighborhood, getting afraid of her, ceased to employ her. The disease has been known, according to Dr. Gooch, to occur in some wards of a hospital, while the others were at the same time free from it. Dr. Blundell, who is certainly very high authority, while he admits that this fever may occur spontaneously, and that its infectious nature may be plausibly disputed, affirms, that in his own family he had rather that those he esteemed the most should be delivered, unaided, in a stable—by the manger side—than that they should receive the best help in the fairest apartment, but exposed to the vapors of this pitiless disease. Gossiping friends, wet-nurses, monthly nurses, the practitioner himself—these are the channels by which, in Dr. Blundell’s estimation, the infection is principally conveyed.
Some authors contend, also, that it is only through the influence of the imagination, or by sympathy, that puerperal fever becomes more prevalent by times than ordinarily; and there can be but little doubt that these causes operate to a greater or less extent in communicating the malady. If a weak and nervous patient fears it, and especially if it is prevailing epidemically in the neighborhood in which she resides, she is much more liable to an attack than if she had no thoughts whatever of the disease. It is, moreover, under such circumstances more likely to prove fatal than when it occurs sporadically.
Fortunately, however, the question of contagion does not at all affect the treatment of this terrible malady. All agree that it is an inflammatory disease which demands, under all circumstances, at our hands, an antiphlogistic or anti-inflammatory treatment. There can be no two opinions on this point; and it is a circumstance worthy of the most particular remark, that we have in water-treatment the most abundant of therapeutic resources by which to combat inflammation of whatever name or grade—resources more potent and effective, a hundred-fold, than any other ever known to man.
LETTER XXXV.
OF SORE NIPPLES.
This Complaint is a very common one—Its Causes—Methods of Prevention and Cure.
Excoriated or sore nipples are very common, as every one acquainted with matters of childbirth knows. “You can have at present,” says Professor Meigs to his class of young men, “no idea of the vexations that women endure in nursing their children in the month, from sore nipples: a complaint so common, that I am always surprised when I hear one of my patients say she does not suffer from it.” “The nurses and doctors,” says Dr. Gooch, “have a long list of remedies for this complaint; but it is in general obstinate, and the remedies are ineffectual; in attempting to cure it, you are rowing against the stream; as long as the cause, namely, the action of the child’s mouth in sucking, is renewed at short intervals, local applications are of little use.”
What, when, are we to do with sore nipples? an affection apparently so trifling, and yet one which causes an amount of suffering that can be adequately appreciated only by those who are brought to endure it? Are we to suppose that it is the order of nature that women should thus suffer in that most important matter, the rearing of their young? Do we find any analogy in nature by which we are led to such a conclusion? It is very plain, I think, that we do not. All mammiferous animals, when left to themselves, nourish their young without disease or pain. Thus, too, would it be with the human species, did we, as the animals, live in accordance with the natural laws.
Let us look, then, for the causes here concerned.
1. The general Condition of the System.—In consequence of the ill-governed habits of the generality of females, both in pregnancy as well as at other times, a great amount of morbid matter is formed in the system. Too much food is eaten generally, and of improper kinds. The blood, fluids, and secretions of the system generally are in an impure state. Thus it is, that when a small wound or abrasion is made, the part does not readily heal. A drunkard’s system often becomes so impure that he festers and dies of a mere pin-scratch. Thus we see that the condition of the living body may be modified at pleasure to an almost indefinite extent. Women, particularly, who are, or who ever expect to be pregnant, cannot be too particular—cannot take too much pains, in order to preserve a pure and healthy state of the general system. Depend upon it, this will tell when they come to that ever-important period of nursing the new-born babe.
2. Cleanliness.—Many, no doubt, get sore nipples, in great part, because of their want of attention to cleanliness. Wash the nipples often, and keep them at all times most scrupulously clean, if you wish to prevent them becoming diseased. Nowhere is it more necessary that this ever-important duty should be strictly observed.
3. The Dress.—It is said that the Greek women were in the habit of supporting their bosoms by a certain contrivance called strophium, and the Roman women by one called fascicola, which were not at all liable to compress or countersink the nipple, as carpenters would say. The breast should always be left free to grow in all its parts; and if there had never been any corsets, busks, or tight dresses among us, we should not meet that troublesome affection, the countersink of the nipple. If young ladies could know how great an amount of suffering they are rendering themselves liable to, when they compress their bodies in this way, they would, I am sure, one and all, avoid that which can do them no good at the time, and must end in inevitable harm. Sad is it to think that they have never been taught on the subject; their mothers are not acquainted with it, nor are there any popular works treating of these matters from which they can gain the information which would prove of such signal benefit to them. It is, then, with feelings of earnest regard for the condition of the sex, that I prepare this work for those who stand in so much need of that information which it attempts to put forth.
With the view of drawing out the nipple more effectually, it is sometimes asked of the physician, whether it is not advisable to have the breasts drawn by a young puppy, or by a friend, before the birth takes place? An objection to this practice is, that in consequence of the sympathy that exists between the breasts and the womb, exciting the former before the time of the full period of pregnancy might, or, rather, would cause pains in the latter before the proper time; in other words, premature labor would be likely to result. Besides, it is the order of nature that drawing the breast be practiced only after the birth has been accomplished. Nothing whatever can be gained by drawing the breast before delivery.
Sore nipple may arise from a variety of causes. The breast sometimes becomes so inflamed, so hard, so obstinate—all, perhaps, in spite of the best that we can do—that it is found impossible to extract any milk whatever from the lactiferous tubes. Under such circumstances the frequent sucking of the nipple by the child, or, what is worse, by the use of the miserable instruments which have been contrived for drawing the breast, it is often made very sore. At other times, too, the patient’s system appears to be in a state highly calculated to favor cracking or chapping of the surface, such as we observe in many persons, who, when they commence bathing, find their hands and feet becoming very sore. These are always evidences of impurity in the body, and the proof of this fact is found in the circumstance, that if they set resolutely at work to renovate their health by the hydropathic treatment, they become cured of the symptoms, just in proportion as they become firmer and more vigorous in general health.
We need not expect to remedy sore nipples to any great extent so long as the breast remains inflamed. We must first cure the breast, and then with reasonable care and attention the nipple will soon heal of itself. But if the general system is at fault, the blood impure, and the skin at any moment, on the application of a little moisture, liable to crack, then our object should be to employ such a course of constitutional treatment as is calculated to improve the system generally. Sore nipple often consists “in a long, narrow ulcer, wide as a horse-hair, and a sixteenth of an inch long; this ulcer is so small, that it requires a good light to see it; and even then it often cannot be detected, except by bending the nipple over to the opposite side, which discloses it.” This ulcer is often so exceedingly painful, that the mother is unwilling to nurse the child as often as it should be done; thus exposing her to the evils of an over-distended and inflamed breast; and we may judge something of the anguish which the poor patient endures, when we see the tears streaming from her eyes every time the child attempts to nurse. We see, too, how difficult it must be, in many cases, to cure this kind of sore nipple, since every time the child takes it into its mouth it holds and stretches the part, thus causing the crack to become larger and worse.
A great variety of the so-called remedial substances have been tried for the cure of this affection. I would not say that none of the ointments, washes, powders, etc., which have been thus employed have any good effect. But one thing I am confident of, which is, that the water-dressing, that is, fine linen compresses or lint, wet in the purest and softest water, and often changed, to prevent their becoming too warm, in connection with appropriate constitutional treatment, will be found the best that can be resorted to.
Some have recommended very highly the use of nitrate of silver in curing sore nipple. Sometimes, perhaps often, it seems to work well, but by high authority in the profession it is affirmed that in many cases the disease is only made worse; nor has any rule been ascertained by which it can be determined beforehand as to whether harm or good will be the result in any given case.
Professor Meigs regards it as a matter of great consequence, in the application of nitrate of silver, to touch only the granulations, and not the skin itself. His method is, to take a fine camel’s-hair pencil, and dipping it in a solution of the nitrate, to carefully pencil the granulations only. The edge of a large feather, or the feather end of a goose quill, could very well be made to answer the same purpose. It is certain that this application will in many cases give relief, more or less, to sore nipples, as it does to sore lips and other parts; but, as before remarked, it sometimes makes them worse, and we have as yet no rule by which to determine beforehand as to what cases it will be applicable, and what cases not. Those who choose can experiment for themselves. I myself prefer the water-dressings; yet there is no good reason why the two may not be combined, if that is thought best. A solution of twenty grains of the nitrate to an ounce of pure water, is a good proportion in which to use it.
I have already spoken of cleanliness as a prophylactic means in the management of the nipples; and I would here again urge upon the attention of all who are interested in the subject, the exceeding great importance of this observance. Never should a child be nursed without the mother at once, on its leaving off, taking a sponge or soft linen cloth, and making the part perfectly clean, and afterward dry. This may appear a matter of small importance to some, but it is the attention to these small matters that go to make up the great sum of health. Professor Meigs, who admits the great frequency of sore nipples in his own practice, tells us of the method of one of the Philadelphia nurses, Mrs. De Groot, “a most sensible woman, in whose prudence and knowledge of her business he could confide,” and who informed him that the nipple rarely becomes sore under her management, which is as follows: “As soon as the child has left the nipple, Mrs. De Groot cleanses it with a bit of moistened linen. She dries it perfectly, and then, taking the mamilla (nipple) between the thumb and two fingers, she gently compresses it, with a view to assist it in disengorging its capillary vessels, that are rendered turgid by the suction. As soon as she has rendered it soft and flexible again, she covers it thick with fine arrow-root powder, and keeps it in that way perfectly dry. I do not remember,” continues the Professor, “that the ladies she has nursed for me have, any of them, suffered from this annoying disorder.”
Almost any dry substance, of an inert or harmless nature, such as Indian meal, or rye, or wheat flour, would answer as well as the flour of arrow-root to dry the nipple. I mention this fact for the reason that in many parts of the country arrow-root is not easy to be obtained.
The cracks or gaping ulcers of the nipples may be often helped very materially by acting upon a well-known principle of surgery. Wherever in the living body there is a gaping wound, the healing process is found to be facilitated by retaining the parts in close connection. Thus in a common cut or wound, when the edges are separated, we apply stitches or adhesive plaster to bring the parts into closer union, so that in the granulating or reparative process, nature has much less to accomplish. The greater the space to be filled by a new growth, the longer the time required, and the contrary. On this principle, then, of bringing the parts into closer union, thus giving nature a less amount of work to perform, a cracked nipple may often be benefited very much. A delicate strip, or better, if we can manage it, delicate strips of plaster may be applied in such a way as to shorten the reparative process a good deal. Besides, too, the sore part is thus shielded from the action of milk or other deleterious substances that might otherwise come in contact with it. But the plaster has in it no healing property whatever; nothing at all in its nature which can aid the granulations. It only acts as a mechanical agent in keeping the parts in a more favorable condition for healing. The ulcer should be made as clean as possible before any such measure is resorted to.
I should mention particularly, before closing this subject, that bathing the breasts and nipples daily and often, in cool or cold water, before confinement, has a most salutary effect in hardening the parts, and rendering them less liable to inflammation and soreness of whatever kind. So too, indeed, we say of general bathing, and all habits which tend to the improvement of the general health. Always, the better the condition of the general system, the less liable to disease its local parts.
LETTER XXXVI.
INFLAMMATION OF THE BREAST.
Structure of the Mammary Gland—Nature and Causes of Inflamed Breast—Means of Prevention and Cure.
It is very common in midwifery-practice to encounter swelling and inflammation of the breast, more commonly within a few days of delivery. In the majority of cases, this inflammation is managed without much difficulty; but in some cases it would appear that the part must suppurate, or break, as we say, forming what we call the mammary or milk abscess. This is one of the most troublesome things women are ever brought to endure; but however much pain and discomfort milk-abscess may cause the patient, it never kills; and yet the patient may be kept for months in the sick room, suffering from the affection more than tongue can tell.
Inflammation of the breast may come on at any time during lactation. It is more common, however, in the earlier than the later parts of the period. The nursing mother cannot, however, at any time be too careful in all matters pertaining to health, since a little imprudence is sufficient, in many cases, to induce this affection. In multitudes of instances it has been brought on by some apparently trifling carelessness, when, with a little forethought and self-denial, perhaps, months of pain, suffering, and discouragement might have been avoided.
In order to understand the management of the female breast during lactation, it is necessary that we should know what it is, its anatomical structure, and its physiological functions.
In structure, the breast is a conglomerate gland, and consists of lobes which are held together by a dense and firm cellular tissue; the lobes are composed of lobules, and the lobules of minute cæcal vesicles, the ultimate terminations of the excretory ducts.
Near the center of each breast there is a small projection of the tegumentary coverings, constituting what is called the nipple; this is surrounded by an areola or border, having a colored tint.
Before conception, this areola is of a pink color; after conception it assumes a brownish hue, which deepens in color as pregnancy advances. This brownish tint continues through life.
About the nipple there are a considerable number of sebaceous follicles, which secrete a peculiar fatty or oily substance for the protection of the delicate skin about the part. During the period of nursing, these follicles become increased in size, having the appearance of pimples projecting from the skin. The sebaceous or fatty secretion from these follicles serve, during lactation, to shield the delicate part from the action of the saliva of the child’s mouth.
The milk-tubes, or excretory ducts, as they are anatomically named, are usually ten to fifteen in number; and as many as twenty-one is said to have been found in a single breast. These tubes commence by small openings at the apex of the nipple, and passed inward parallel with each other toward the central part of the breast, at which place they become enlarged, and branch off in every direction throughout the mammary gland; these communicate in some way with the blood-vessels of the part, and, by a peculiar and wonderful provision of nature, the milk is formed from the blood within them. Among and about the milk-tubes, there are many adipose cells, more or less numerous, and more or less filled in different cases, giving to the part its peculiar rotundity and softness.
The milk-tubes are capable of supplying a quantity of milk greater or less, as the case may be. With some persons, an immense quantity is secreted; at a single time a pint or more of milk may be drawn with a breast-tube from a single breast. But we are not to suppose that all this amount of milk is contained within the ducts at the time we commence drawing it; a small portion may be there, but the greater part is secreted after we commence. After a time the power of the gland to produce it being exhausted, the milk ceases to flow; but after nature has been allowed to rest an hour or two, it again recovers its milk-giving power, and is ready to furnish it liberally, as before. A good cow has an udder, which, if we were to cut it off, could readily be put into a small pail; and yet this same cow is capable of giving milk enough at a single milking to fill two or three pails of the same size. This shows us how admirably fitted these organs are for pouring out that material which is so necessary for the sustenance of the young: a material, simple as it may appear, yet one which art and science, with all their boasted pretensions, cannot at all imitate. The chemist can tell us that milk is composed of a mixture of water, albumen, casein, and oil, which we call cream; but all the chemists in the world cannot make a drop of milk, or any thing that, in physiological properties, will at all compare with it.
The breasts are abundantly supplied with nerves and blood-vessels, and it must be evident that so great a functional power as that which is exerted by the mammary gland during lactation, must be supported by a great quantity of blood and nervous force. Hence it is, that during nursing, the breasts are supplied with a much larger amount of blood, and are much larger in volume than at other times. In this wonderful fact, as in many others of the living body, we see the ever-beautiful order of nature, in adapting her means to her ends. If every thing happened by chance, we might just as soon find the breasts containing less blood when milk is needed, as more. But the doctrine of chance is too palpably absurd to need comment.
Symptoms of Inflammation of the Breast.—A day or two, or a few days after delivery, we often find the patient apparently so well and in such good spirits that we conclude there is no further need of our attentions. But in a day or two more we are sent for in great haste perhaps. We go, and find the patient downcast, dispirited, and evidently enough sick. We inquire as to what has been the matter. The patient tells us she has been attacked with a chill, in spite of which she could not get warm for one or two hours, or perhaps longer; just such a chill as would be experienced in the coming on of an ague, or any other fever, or some inflammation.
“Inflammation of the breast,” according to a very accurate writer, Dr. Burns, “may be divided into three species, according to its seat—the sub-cutaneous cellular substance, the fascia, and the glandular substance.
“It may take place at any period of nursing, but is most readily excited within a month after delivery. It may be caused by the direct application of cold, engorgement from milk, the irritation of excoriated nipples, mental agitation, etc. Some have the breasts prodigiously distended when the milk first comes, and the hardness extends even to the axillæ. If, in these cases, the nipple be flat, or the milk does not run freely, the fascia partially, in some habits, rapidly inflames. Others are more prone to have the dense substance, in which the acini and ducts are imbedded, or the acini themselves, inflamed.
“The sub-cutaneous inflammation, if circumscribed, differs in nothing from a common phlegmon, and requires the same treatment. It is not easy to resolve it, but a tepid poultice will do this, if it can be done; if not, it brings it forward. When it bursts, the poultice should be exchanged, in a day or two, for mild dressings.
“The inflammation of the fascia, if light, is marked by some little tension of the breast, with erythema of the skin over the affected portion. There is considerable fever, but not much pain, and the disease is likely to yield to tepid fomentations and a purgative, if the milk can be drawn off freely. If the fascia be more extensively or severely inflamed, the breast swells quickly, and this distention adds to the disease, which, indeed, is often caused, at first, by distention of the fascia. The pain is great, and the fever considerable. The inflammation never is confined to the fascia, but is communicated either to the sub-cutaneous cellular substance above it, or to the parts below it, usually to the former, and after, at the same time, to the latter.
“When the deeper parts are affected, the inflammation may be more or less prominent in the lactiferous ducts, or a cluster of acini; or often in that dense, peculiar kind of substance, which is their medium of union, or in those fatty packets which are sometimes met with in the gland. Often it seems to commence in one of the sinuses near the nipple, and, spreading, involves the surrounding cellular substance. In this case, it becomes prominent, and seems as if quite superficial. Milk is not secreted by those acini which have suffered. Matter presently forms, and spreads under the fascia with much distraction; and when, at last, after long suffering, the abscess gives way, much pus is discharged, with pieces of slough, chiefly consisting of portions of fascia. Usually, there is a considerable degree of fever attending the complaint, and the pain is often severe, especially when the breast is extensively affected.”
Treatment.—A great variety of methods have been adopted for the prevention and cure of inflamed breasts. This affection is often brought on, doubtless, by carelessness, neglect of drawing the milk from the parts sufficiently often in the beginning, excessive fatigue, seeing too much company, too much care and anxiety of the mind, overfeeding, hot and stimulating drinks, feather beds and pillows, overheated rooms, want of attention to bathing and cleanliness, and last though not least, excessive drugging; these are among the more prominent of the causes of inflamed breasts.
The first and most important consideration, then, is to avoid, if possible, the disease. Mothers, and all of you who hope or expect to become mothers, if you wish to save yourselves a great deal of needless pain and suffering, a great deal of restlessness at night; if you wish to avoid one of the most troublesome and disheartening affections to which the female system is ever liable, I warn you in the strongest feelings of sympathy and regard for your sex, that you avoid, so far as is possible in the nature of things, the CAUSES of this terrible disease.
But some have poor, feeble, scrofulous constitutions, and cannot by any possibility avoid the inflammation of which I am speaking; and, do what we will—the best that, in the nature of things, can be—the breast must, I think, in some cases inflame, suppurate, and break. An accidental blow, likewise, so slight that it would scarcely be felt upon almost any other part of the system, may cause a mammary inflammation and abscess. And, worst of all, to think of many a poor mother who has so poor a habitation, is so much oppressed by the cares and perplexities of domestic life, and has such poor care and nursing that she is always in great danger of suffering with inflamed breasts.
The treatment of this affection, therefore, is a matter for the serious consideration of both parents and physicians; and, as I before remarked, a great variety of methods have been adopted for this end.
We should remember that we are to treat an INFLAMMATION, and that the plain principle of treating all inflammations, of whatever grade or kind, when of acute character, is the antiphlogistic or anti-inflammatory plan. By what means and to what extent to use these means, are circumstances in which the skill, tact, and good judgment of the physician are to be exercised.
A very common error has been to treat too much locally in this disease. This is, in fact, a very common fault in medical practice generally. I have no doubt that many an inflamed breast has been rendered worse than it otherwise would have been by the too great amount of local means employed. In many such cases, doubtless, the breast has been made worse than it would have been had no treatment whatever been employed.
As soon, therefore, as the patient begins to experience a chill coming upon her, with pains in the back, limbs, etc., together with a general uneasiness and restlessness, and, perhaps, with an inflammation already commenced in one or both of the breasts, no time should be lost in setting at work resolutely to combat the approaching evil. The sooner we act, and the more prompt and resolute in the treatment, the greater the chance of preventing an abscess. We give the rubbing wet-sheet, if there is not already too much fever, the tepid shallow-bath, with a good deal of friction; a general cold bath, if the patient is not too weak; the packing sheet, the wet girdle, wet compresses upon the breasts, injections of tepid water, and follow up the applications as much and as often as the symptoms may demand. Above all, the patient should not be worried by a multitude of ignorant and careless, though, perhaps, well-meaning friends, who each and all insist that some particular poultice, or some favorite “cure-all” of theirs will certainly arrest the difficulty, if the patient will but condescend to use it, and that if she keeps on with the water, it will certainly cause the breast to break. How exceedingly foolish, ignorant, and prejudiced are the multitude in regard to these things! Every practitioner of water well understands how much we have to encounter in society, because of the prevailing ignorance of the most common remedial uses of the greatest and most abundant of all curative agents which God has given to man.
As regards the temperature of the applications, local and general, we do no violence to the system. Should we persevere sufficiently, we could cure almost any fever or inflammation with water at 80° Fah., a temperature so mild that the most delicate child can bear it.
One thing in particular should be remembered: the patient should not be bundled up closely, and have a great deal of warm bed-clothing, under the impression that a cold will be taken if such measures are not adopted. We almost always find patients heating and injuring themselves in this way. But it should always be remembered, that when a fever or inflammation is already present, it is not possible to take an additional cold.
As for local applications upon the breasts, fine wet linen cloth should be used constantly. As to the temperature, I think it best to consult the patient’s feelings merely. It is, perhaps, best to alternate somewhat; sometimes to apply warm or tepid cloths, at other times cold. I think a change is often good; at any rate, we should keep the parts constantly wet.
The wet cloths are covered with dry ones, or flannels, if necessary; but if there is great heat in the part, it is best to leave the compresses uncovered, so that by evaporation a much greater amount of heat may be thrown off. Sometimes the breast becomes so heavy and painful, that it is a great comfort to the patient to have it suspended in a sling.
I have already hinted how important it is to keep the milk well drawn. The mouth of an adult person is one of the best means, and the infant is often able to do good service in this way. Some get along pretty well with a tobacco pipe. But the instruments generally found in the shops are illy suited to their object. One form, the suction-pump, is an invaluable piece of mechanism, provided the glass that fits upon the breast be of the right shape, and have an opening sufficiently large to admit a man’s thumb. Generally, they are much too small, causing a good deal of pain when used; but if they are of the right make, they will draw the breast with more comfort and less pain than the infant itself.
Before the breasts are drawn, they should be well washed, for this will always help the milk to flow; and in connection with this subject, there is one highly interesting and instructive fact in regard to bathing. Thus, a patient may be in a condition in which, in consequence of the inflammation present, no milk whatever can be obtained. But we give the patient a good ablution of the whole body, even a simple tepid-bath, and directly we may succeed in getting milk; and in some instances it is made actually to drop of itself from the breasts. Even the washing of the breasts alone will sometimes cause it thus to flow.
Should an inflamed breast ever be opened after the matter has once formed? The most common practice has been to do it. Dr. Gooch, however, who is high authority with the profession, speaking of this disease in that state in which the matter approaches the surface, says: “Will you open the abscess? If you do, you will relieve your patient from suffering, and by the evacuation of the matter the constitutional disturbance ceases; but the wound will not heal so soon, and the maturation of the abscess will not be so complete as if the whole process were left to nature.” I have myself opened them at the request of patients in some instances; but I have become convinced that it would have been better, in the end, not to do it.
Dr. Burns tells us—although he recommends opening the abscess—that the puncture is liable to be followed by a troublesome oozing of blood from the wound, and that in one instance he knew the hemorrhage to prove fatal.
After the abscess has burst, there is for some time a discharge of purulent matter, which is not unfrequently mixed with milk. The utmost cleanliness should be observed, and a considerable amount of general, as well as local treatment should be kept up until the healing is fully effected.
Thus, then, in the use of water, locally and generally applied, together with the proper adaptation of the other hygienic means, I consider that we have a remedy which far surpasses all others in that troublesome affection of which I am treating; a remedy which, if it cannot always cure the inflammation without an abscess, will yet so much mitigate it, so much promote the healing, and so much support the patient’s strength, that mammary abscess, if it must occur—and I think, do what we will, in some few instances such must be the case—it is yet stripped of its greatest horror, and rendered, generally, a comparatively trifling affair. Such has been my own experience, and such, I think, will be found to hold good wherever the water-treatment is faithfully and skillfully applied.
Dr. Burns has given us a sad picture of what not unfrequently results from mammary abscess; and that the reader may have, on good authority, an account of the sad condition which sometimes results from the affection, I quote his own words:
“It sometimes happens, if the constitution be scrofulous, the mind much harrassed, or the treatment not at first vigilant, that a very protracted, and even fatal disease, may result. The patient has repeated and almost daily shivering fits, followed by heat and perspiration, and accompanied with induration or sinuses in the breasts. She loses her appetite, and is constantly sick. Suppuration slowly forms, and perhaps the abscess bursts, after which the symptoms abate, but are soon renewed, and resist all internal and general remedies. On inspecting the breast at some point distant from the original opening, a degree of œdema may be discovered, a never-failing sign of the existence of deep-seated matter there, and, by pressure, fluctuation may be ascertained. This may become distinct very rapidly, and therefore the breast should be examined carefully, at least once a day. Poultices bring forward the abscess, but too slowly to save the strength, and, therefore, the new abscess, and every sinus which may have already formed or existed, must be, at one and the same time, freely and completely laid open, and, so soon as a new part suppurates, the same operation is to be performed. If this be neglected, numerous sinuses form, slowly discharging fetid matter, and both breasts are often thus affected. There are daily shiverings, sick fits, and vomiting of bile; or absolute loathing of food, diarrhea, and either perspiration or a dry, scaly, or leprous state of the skin; and sometimes the internal glands seem to participate in the disease, as those of the mesentery, or the uterus is affected, and matter is discharged from the vagina. The pulse is frequent, and becomes gradually feebler, till, after a protracted suffering of some months, the patient sinks. It is observable, that often, in those cases which seem to depend on a constitutional cause, and when there is great debility, the sinuses heal rapidly, after being laid open, but a new part instantly begins to suppurate. Internal remedies cannot be depended on here, for they cannot be retained. If they can be taken, they are those of a tonic nature that we would employ, with opiates to abate diarrhea and procure sleep.”
LETTER XXXVII.
CASES IN MIDWIFERY.
A Collection of Facts Illustrative of the Effects of Water-Treatment before, during, and after Childbirth.
In the year 1843, at which time the water-cure had been heard of this side of the Atlantic only by a very few, I for the first time applied water-treatment in a case of midwifery. I had, it is true, been for months, and I may say years, studying upon the matter, as a student of medicine who is determined, above all things, to learn and practice the truth, ought; yet I had no opportunity of bringing the principles which I believed in to bear directly upon any given case previously to the period referred to. The following then, are some of the leading particulars of my first case:
Case I.—The lady was a resident of this city, of a feeble constitution by inheritance, and, I think, twenty-one or two years of age. For three or four years previous to her confinement her health had been, on the whole, much improved. Her constitution seemed, indeed, to undergo a remarkable change for the better, in consequence of leaving off tea, coffee, spices, butter, and flesh-meat, and at the same time practicing the daily bath. She, in short, became, as her flesh-eating friends said, “a thorough Grahamite.” Notwithstanding her improvement, however, she suffered miscarriage two or three times in as many years.
During the period of pregnancy of which I am speaking, I advised her to be very particular in keeping up her baths, exercise, diet, etc. She followed the advice faithfully. She suffered somewhat from neuralgic pains in the abdomen, but these were in general readily checked by the use of wet compresses, and the sitting and other baths. Few patients have ever been as faithful as she was in carrying out all good rules. She kept up her bathing and exercise to the very day of labor.
There was one circumstance which operated against her a good deal toward the close of the period. A worthy and skillful medical friend advised that she should have premature delivery brought on, because her pelvis was, as he said, too small to allow of the birth of a full-grown child. This advice, however, she would not, on any account, entertain, notwithstanding she had the utmost confidence in the skill and honesty of her friend. She resolved to trust God for the result, although she was well aware that she was to pass through a most fearful ordeal of danger and suffering. As it proved afterward—for she has borne a number of children since—her own instinct was better than all the knowledge of her medical friend.
Her labor was a very severe one, and she met it with most praiseworthy courage. She was at length delivered safely. The child was of more than average size, but owing to a malformation it could not live. Her maternal feelings were of the strongest kind, and the loss of her child was a great blow upon her spirits. She was, however, up daily, more or less, from the very first. Indeed, it was not two hours after the birth—she having been awake all night—before she stood up, and was thoroughly washed in cold water from head to foot. She knew what cold water had done for her before, and she was not afraid that it would fail her now in her time of need.
She pursued the treatment from day to day, observing the greatest care not to overdo. She understood well, young as she was, the great importance of mental quiet under such circumstances, and saw no company for many days. On the sixth day she had so far recovered as to be able to walk to the Battery, a distance of a mile and a half. The weather being hot, she rested awhile upon the shady seats of that beautiful inclosure, and was much refreshed with the sea breezes which are so genial at that season of the year. Afterward she walked back home, making, in all, a morning excursion of three miles.
This, then, I put down as one of the first of the American cases of hydropathy, and the first in childbirth. Thanks to Priessnitz, there have been thousands since.
Case II.—June 26, 1846.—Two weeks ago, Mrs. E., of 56 Prince Street, informed me that she had arrived very near the end of the period of her first pregnancy, and that she desired me to attend her in childbirth. By conversation I soon found she was well-informed in the new system, and the modes of preserving health, and this without her having had any particular advantages for acquiring such knowledge. She had read faithfully and understanding upon the subject of health, a duty which too few mothers observe. Mrs. E. is about twenty-two years of age, with constitution naturally very good, although not remarkably strong. Her attention became directed to bathing about two months since. She performed two ablutions daily, and took sitz-baths; discontinued the use of tea and coffee, took very little animal food, living principally upon coarse bread, hominy, cracked wheat, and fruits. She took frequent exercise in the open air, and by these means became sensibly invigorated in general health, and was kept perfectly free from unpleasant symptoms of every kind. I advised my patient to go on as she had done perseveringly and to the last. Her very kind and affectionate husband and her mother, as well as other good-meaning relations, insisted that she should take a different course, particularly in food and drink. But she chose understandingly to pursue her own way, feeling full confidence that she would be able to prove to her friends that she was in the right, and that young persons were not necessarily less knowing than older ones.
June 26.—To-day Mrs. E. sent for me early in the morning. She had experienced by turns slight labor pains from 9 A. M. the day before; was not able to sleep much in the night. Took baths as usual, and walked in the open air. This morning she practiced general ablution and sitting-baths as usual. Cold water renders the pains more efficient, which is a good symptom. Walking about the room has the same effect. The pains increased very gradually, and this afternoon, notwithstanding they grew more severe, she was able to sleep at times between them. These continued to increase until six o’clock this evening, at which time she gave birth to a remarkably fine, healthy daughter. In a few minutes the after-birth was expelled, and no undue flooding occurred. Wet towels were placed upon the abdomen and the genital parts, and the face, hands, and feet were sponged, each of these applications having a most soothing and refreshing effect.
In the case of the infant, care was taken to avoid the great error so generally practiced, of separating the cord by which the child is attached to the mother, too soon.
The separation after due time being made, the infant was washed in soft water made very slightly tepid, with the addition of a little mild soap. No bandage was put about its abdomen, for the reason that it always causes more or less harm—that is, if there is no malformation of parts, and always tends to induce the very difficulty it is designed to prevent, viz., that of rupture. The kind-hearted mother of Mrs. E. insisted, as a matter of course, that the bandage should be applied as in the good days of old, but Mrs. E. said “Do as the doctor says.” Very light muslin clothing was then placed upon the infant, after which it was left, without drug or dose, quietly to sleep.
9½ o’clock, Evening.—Returned. Mrs. E., happy and contented, has been enjoying sound, refreshing sleep. Has had no nourishment since morning. Took then a little fruit. Prefers to wait until morning before taking any more. I recommended her to take fruit every day from the first, that the infant may be accustomed to her doing so. If mothers omit fruit for a while and then commence its use, the milk generally distresses the child. I believe that, as a rule, the judicious use of well-matured fruits will not cause any difficulty in the child, provided the above direction is from the first and onward complied with.
Mrs. E. is now to take a bath—that is, with assistance, the whole surface is to be cleansed, portion by portion, by means of cloths wet in moderately cold water. This will cause a sense of great comfort—will increase the strength and promote sleep. As is very common on such occasions, the friends object strongly to the use of cold water. “Oh, it will give you a death cold! how can you do it?” and the like expressions are used. But the patient well understands that she needs the invigorating and soothing effect of the ablution, and that when the system is sufficiently warm, it will not only be perfectly safe, but highly beneficial. She prefers, as she has done, to practice upon rational and well-ascertained principles, rather than to be guided by the whims and caprices that custom with its iron rule entails upon society.
First Morning after Confinement.—June 27, Six o’clock.—Mrs. E. slept sweetly and soundly during the whole night, waking only a few minutes at one time. She feels greatly refreshed, and able to rise and take a bath; judges by her feelings that she will be benefited by sitting up; has a good appetite. I advise her to sit up as much of the time, little by little, as she feels inclined. She proposes eating very sparingly of well-boiled cracked wheat, with a little uncooked milk and berries.
Half-past Nine, P. M.—Mrs. E. has sat up at different times during the day. No after-pains or particular discomfort of any kind. Every time of sitting up has done her good. She has taken food at three different times. Will take a sponging now, and retire to rest.
Second Morning after the Birth.—Mrs. E. slept remarkably well during the whole night. Has been up, performed a bath, walked about the room, and is much invigorated. Felt decidedly the need of the bath; it strengthened her much. Has no after-pains or difficulty of the breasts. The milk secretes abundantly. The bowels are moved by injections of tepid water. Mrs. E. will sit up the greater part of the day.
Third Morning after Birth.—Eleven, A. M.—Mrs. E. rested well during the night. Arose at six, and took her usual bath. Reclines now awhile. Would be able to walk up and down stairs were it necessary. Her infant is remarkably well, and sleeps the greater part of the time. Mrs. E. is one of that very small number of mothers that has energy of character, resolution, and system enough to nurse her infant regularly, and not during the night time. Once in three hours, between 6 A. M. and 9 P. M., at the very most, is as often as she will allow it to take the breast.
Seventh Day.—Mrs. E. has been improving day by day, from the first. She has had no inconvenience whatever; no pains of any kind, no swelling of the breasts or feverishness. Has well-nigh her natural amount of strength. Her infant, too, is doing remarkably well.
Case III.—Nov., 1845.—Mrs. C., a poor woman of this city, not long since made known to me, that in her destitute condition she would receive, as a great favor, if I would attend her in childbirth. She informed me that on previous like occasions, she had suffered beyond description, both at the time of confinement and subsequently. She had borne two children—the first it was necessary for her physician to destroy before the birth could take place. The birth of the second was also attended with the greatest difficulty. It was now some weeks before her expected time. Her husband had deserted her, so that she was compelled to follow her occupation (that of a seamstress) during the whole day and much of the night. From this constant sitting and confinement within doors, she had become much enfeebled, and had a severe and constant pain in the side.
I directed her to wash the whole body daily twice, when not chilly, in Croton water, and to take each half day as much exercise in the open air as she could possibly find time for, and could practice without causing too great fatigue. The woman followed the directions, and was at once sensibly benefited. The severe pain in the side left her almost immediately. When her period arrived, delivery took place in a very short time, and with comparatively little suffering. Bathing in mild forms was practiced the day of, and subsequent to, delivery, and the patient walked about each day, and was scarcely confined a single hour.
There is one fact to be mentioned in her management of the infant. She was directed at first to have it washed in tepid water. Supposing she would follow the same course for the future daily washings, I made no further inquiry till some days after, when I ascertained that she had used the water of the natural temperature. I asked her why she did not moderate the temperature of the water as at first, and as people generally do. She answered, that when she bathed herself before the child’s birth, every bath seemed to strengthen it very much; and, therefore, she chose to use the cold water now for the same reason. She had the good sense always to keep the child sufficiently warm, particularly after the bath. It is proper to mention that the Croton water at this time was not far from 65° Fah. The child has been, and is now, one of the healthiest and most vigorous I have ever seen of the age.
The above notes were written some months since. The case is again brought to mind, by the mother’s coming to-day to work for us at her usual occupation. She says, “What a strange thing it is, my little baby has never been sick a single hour. What wouldn’t I give if my other boy could have been so.” The child is one of the brightest imaginable; knowing, observing, good-natured, and now, at the age of six months, sits near his mother, playing, laughing, crowing—the most perfect picture of health. He is every day once, and generally twice, washed in cold water.
Case IV.—Oct. 25, 1847.—The same woman was again confined early last spring. She had been living, I found, in a small cellar-room, where there were but three small panes of glass, and to which the sun could never come. The place was damp and dark, and the air necessarily very foul, it being in an alley in which many poor, dirty families were living. Here the poor woman lived, paying an exorbitant rent, supporting herself and two children by the hardest work rather than beg.
The night of her confinement was a very stormy one. The wind howled among the old buildings, tearing off shingles and shutters, and the rain poured down in perfect torrents. Ships were lost that night, and sailors, with the captain and officers, swept overboard.
The labor this time, as before, was an easy one. It took place at midnight. Every thing went on well, and she was, after a reasonable time, left to get sleep, as we supposed she would. I found, however, in the morning, that, notwithstanding she had been wholly free from pain, she had not slept at all. She acknowledged that, powerful as had been the effects of water for good at the previous time, the old ideas had yet haunted her, that she must either die, or submit to the application of those terrible instruments that had been used in her first confinement. She now felt so rejoiced at her getting through again safely, that she could not sleep at all. So we found her in the morning early, she, her two children, and the new-born babe, all on one narrow settee bed together, apparently contented and happy.
Two ladies who understood these matters of water-treatment, went now, it being Saturday morning, and administered our patient a bath. The water was moderated a little, but left still quite cool. This day she could obtain no sleep, for she had but one room, and the children must remain there. She sat up considerably, but not so much as to cause over-fatigue. In the evening the ladies went again, and administered the bath. She slept well during the night. The next morning, Sunday (the second day), the ablution was administered at 7 o’clock, at which time the patient arose. She remained up all day, until 10 o’clock in the evening, at which time the ladies again administered the bath. She slept well this night, was up all the next day, and so onward, and has been constantly well up to the present time.
Case V.—Dec. 12, 1845.—Was called in the night between one and two, by Mr. Brown, living at 40 Oliver-st., to visit his wife, then in labor. At the beginning of the evening previous, Mrs. B. began to experience premonitory symptoms—took, as usual, a sitting-bath, reclined upon the bed, and slept about three hours, when she was awakened at 10 o’clock by labor pains. These occurred regularly until the time of our arrival and onward, growing more and more effectual, until four in the morning, at which time she gave birth to a fine healthy daughter. The after-birth was cast off in a few minutes, after which Mrs. B. felt easy and inclined to rest. After being made comfortable, she was desired to sleep awhile, and was told that she would be refreshed and invigorated by an ablution after sleep, and that she would be able to sit up a short time by way of a change.
Nine, P. M.—Returned to see Mrs. B. Found her quite comfortable, after-pains slight; had slept a part of the time. From the commencement of labor she had drank as freely of Croton water as was desired—had drank nothing but cold water for about a year. Had she been accustomed to warm or hot drinks there would have been a liability to increase of after-pains by taking cold water. In such cases the drink must be warm, unless there is much feverishness and thirst, in which the cold drink would be tolerated and most agreeable. Appetite was good. Mrs. B. said she could relish any thing; was very fond of Indian mush, with a little syrup; thought she had better not take any thing till dinner time—she would drink water, and be on the safe side. To this I of course agreed. She felt none of the giddiness, nervousness, great weakness, and depression of spirits she had always hitherto felt after childbirth. There was now and then a slight after-pain. She sits up little by little, and drinks water when she feels an inclination. She will take food once to-day, that is dinner, and I will come again by evening.
Seven, P. M.—Returned again. Mrs. Brown has been sitting up and bearing her weight at different times during the day. She ate of the plain favorite dish, Indian mush and molasses, with a piece of dry bread, and water to drink. The bread tasted very sweet, the appetite was so good. The husband had now returned, and the bathing could be carried out. A wash-tub was brought into the room, and placed before the fire to be warmed. At the same time, water, warm and cold, was procured. A stick of wood was placed under one side of the tub, and thus the two-fold object of a hip and general rubbing-bath could be accomplished at the same time. Mrs. B. walked to the tub, and, her husband aiding, took a good bath. The water was made mild, of about 80° or 85° Fah.; while sitting in the bath, the body being well guarded all about with blankets, a good deal of rubbing was practiced upon different parts of the system, and particularly the back. This had the effect of promoting after-pains, and of strengthening the part, and in fact the whole system, very much. The lower extremities were, of course, outside the tub, and those were bathed afterward. A night-bath of this kind at such times seems, indeed, to increase the strength tenfold. Pains are relieved, the nerves strengthened, and a wonderful change wrought.
Second Day (Sunday), between Eight and Nine, A. M.—Mrs. B. slept well during the night, and until late this morning. All were in bed so long, and as Mrs. B. appeared so well, it was thought best, for want of time, to omit the general bath until toward dinner. Told her that, for a change, it would be best to go occasionally to other parts of the house; but to be careful not to overdo, or to be up too long. At any time pain or weakness was felt in the back, a good rubbing of the part with the wet hand or towel would prove very serviceable. Requested Mr. Brown that an enema of tepid water be administered. This could be repeated twice if necessary to cause the desired effect.
Six o’clock, P. M.—Mrs. B. has eaten to-day sparingly twice, a breakfast and dinner, the last with her family. Has walked up and down stairs without inconvenience or assistance.
Third Day (Wednesday), A. M.—Mrs. B. rested well last night. Feeling a little fatigue the preceding evening, she concluded to omit the bath. It would have been refreshing, however, but this morning she feels remarkably well, and has been doing light work. Has been up nearly all the morning. Took the sitting and general rubbing-bath early before breakfast. Was cautioned not to be up or to do too much. Food to be plain, as usual, and the drink, cold water.
Seven, P. M.—Mrs. B. has been up most of the day. Appetite remarkably good; thinks she took a little cold by sitting unconsciously in a draught of air. A carious tooth commenced aching, which proved a warning. There has been some feverishness, probably nothing more than milk fever. This will be prevented by the tepid-bath, the latter to be repeated as often as the feverishness returns, if such should be the case. There has been some caking and pain in the breasts. The pain is effectually removed by perseverance in placing very warm or hot wet napkins upon the breasts, covering these with dry warm flannels, and repeating them very often until the pain is relieved. Breasts to be well drawn, and the bowels moved by a full injection of tepid water. If Mrs. B. perseveres as she always has, she will have a good night’s rest.
Fourth Day.—Mrs. B. rested well; continues the baths, plain diet, sitting up, and moderate exercise, as usual, and is progressing rapidly toward firm health and strength.
Fifth, Sixth, and Seventh Days.—Mrs. B. proceeded cautiously, and with the most favorable results.
Eighth Day, Eleven, A. M.—Mrs. B. has been about all the morning, has been giving way to her great propensity to industry, practicing at the wash-tub. She does not believe at all in idleness. The only danger is that she may do too much.
Ninth Day.—Mrs. B. is about as usual; feels that she has an abundance of strength to walk some distance in the city. She could walk out with impunity, notwithstanding the weather is very cold, but it is thought best, on the whole, since she is so much about house, and pays so much attention to bathing and ventilation, that she should remain within doors yet, a little.
She says that at the end of three weeks from the birth of the child next older, when beginning to attempt to sit up, she was weaker than she has been at any moment since the birth of the last one. With all her children she has been very weak.
Case VI.—Late in the month of January, of the present year (1850), I was called early in the morning to visit a young married lady, in Fourth Avenue, who was said to be in great suffering from spasms and vomiting. She had not slept during the night, and it was necessary for her husband to remain up with her the whole time. I found her with very high general fever, and oft-recurring spasms, attended with bilious vomiting. The fact of her being in an advanced stage of pregnancy, with this complication of untoward symptoms upon her, designated the case too clearly to a practiced observer, as being one of both delicacy and danger. The parties in the case had no knowledge whatever of the water-cure, or of my particular methods of treatment, and had called me, being the nearest physician, and, as they supposed, of the old school. No medicines had as yet been administered, but the patient, as is common on such occasions, had been deluged with a great variety of articles, in the way of liquid food and drinks, with the hope of “settling the stomach,” a process which can seldom succeed, and, as often practiced, is quite sufficient of itself to make even a well person sick.
The patient and her husband both thought, as a matter of course, that “some physic must be given.” I told them we would first give a tepid-bath, at 70° Fah. This I assured them would give great relief, and knowing well, too, the great prejudice among English people (for they were English) against bathing in pregnancy, I aided the husband, with my own hands, in administering it, thus to be certain of its being well and faithfully done. This they both thought at the time a rather harsh method of treatment; but they had employed the doctor, and he being resolute and determined, they could not refuse. The bath gave great relief, and then, all shivering and cold, a very large wet girdle was put upon the patient, after which she was wrapped warmly in bed, with moderately warm bricks to the feet.
After having allowed the patient to rest awhile, a large injection was administered, and with the best effect. Occasionally, too, retching still occurred (for symptoms of this kind never cease suddenly, and, indeed, should not), at which times tepid water was given freely to drink, for the purpose of aiding vomiting.
Thus the treatment was pursued: as the symptoms appeared to demand, the tepid half-bath, with a good deal of friction, the wet girdle, constantly or nearly so, the injections, and the water-drinking were kept up. From the first moment onward, the patient recovered as rapidly as could be desired. She slept a good deal during the day, and also well at night. The next morning she was quite well, although weak. She then commenced taking nourishment gradually. No further serious troubles were experienced during the period of pregnancy.
The 4th of April, 1850, the above-mentioned lady, at about the end of eight months of pregnancy, as was supposed was delivered. There was more or less of pain during thirty-six hours previous to the birth. The pains were rather severe during the most of twenty-four hours, proving that good health, with abundant exercise and bathing, are not necessarily of themselves capable of causing short and easy labor.
The child was born at about five o’clock in the afternoon. Soon a thorough ablution was performed in the sitting-bath. No patient ever had a better understanding of what was necessary in the case, and none, certainly, could be more free from all sensations of false modesty or delicacy; nor could any one pursue the treatment with greater confidence than she did. There was no time when she could not easily sit up or stand, if necessary, and, with the good nursing of her husband, she improved most rapidly. She wore the wet girdle most of the time, alternating, however, now and then, with simple fomentations. She bathed four times during the first twenty-four hours after the birth, washing the whole body thoroughly at each time, the water being moderated to from 60° to 70° Fah. She sat up during this time about six hours in all, and walked by spells a little in her room. She suffered somewhat with after-pains, but the means before mentioned, together with injections to the bowels, generally brought relief. All along her appetite and sleep were good.
The second day the patient sat up most of the time, and walked to other parts of the house, and for an hour and a half visited a friend. She could have gone abroad in the open air, had it been necessary for her so to do.
The third morning, that is, when her infant was two and a half days old, the patient walked with her husband a distance of about three fourths of a mile, visiting a friend. She was fatigued somewhat, but, on the whole, benefited by the undertaking.
After this, she walked abroad in the open air daily, always having to go down from the third story of the house in which she lived. In one week she went about the city, teaching her scholars in French, German, music, etc., as she had done up to the very day of labor.
And now, to exhibit things in their true light, let this lady’s case, as it occurred under water-treatment, be contrasted with the drug-treatment employed on a previous like occasion.
Between two and three years before, she was pregnant with her first child. Then, as during the last time, she was attacked with cramps, vomiting, and fever. She was laid by a fire in an almost insensible state, and had mustard draughts placed over a large part of the surface. She was also dosed a good deal internally, and salivated with calomel.
At labor, as well as during pregnancy, she was attended by one of the best physicians of London. It was three weeks before she could leave her bed; in four weeks she left her room for the first, and did not go out of the house until six weeks had elapsed. She was then no stronger than in two days after confinement, under water-treatment.
Here, then, was a great difference in the result of the two methods—a difference so great that it cannot possibly be appreciated, except by those who have actually experienced them in their own persons.
One fact more should be mentioned in this case; the lady had been exceedingly depressed in mind through the whole, or most of the period; she, with her husband, having left the Old World for the New. A combination of circumstances most perplexing and depressing had worked upon her mind, and she was haunted perpetually with the idea that she must die a stranger in a strange country. Thus things went on till about nine weeks before she was confined, or the time before-mentioned, of her acute illness. But no sooner were the laws of life, health, and disease unfolded to her ever-active and intelligent mind, than she at once set resolutely and cheerfully to the performing of every task. No item in the way of bathing, exercise, diet, etc., was ever omitted. The story of her case tells whether or not she was rewarded for her faithfulness.
Case VII.—Early in the morning of the 22d of May, 1850, I was called to visit a lady of this city, about thirty years of age, far advanced in her sixth pregnancy. She had, during this period, as before, been much in the habit of taking alcoholic stimulants, principally in the form of brandy, judging, from her feelings, she needed the stimulus. But its only effect was to render her at all times much more liable to take on inflammatory disease.
Four days before I was called, this lady was taken with very severe bilious vomiting, and cramp of the stomach. Two physicians were consulted, and a variety of medicines used. Still the patient continued, day by day, to grow worse, and could get neither relief nor sleep. Being told that she was in danger of convulsions, she and her husband concluded they would change their physician and try the water-treatment.
I found the patient then retching and vomiting almost incessantly, the stomach cramping, the bowels constipated, with high general fever and flush of countenance, the pulse being 130 per minute, or about double its normal beat, and the patient had not slept for three days.
Treatment.—This was very simple. The whole body was well washed in water at about 80° Fah., a full clyster was administered, and wet, cooling fomentations were put freely over the chest and abdomen. Almost immediately the patient experienced a short but refreshing sleep. The cloths were changed often, the surface was sponged as it became too hot or uncomfortable. The general washing in the wash-tub was practiced once in four hours from the first, which always brought sleep. When retching and nausea came on, tepid water was taken freely to help the vomiting. This gave great relief. No other drink than water was taken, and no food until the vomiting had ceased. After this, well-boiled Indian-meal gruel was given, beginning with a single tea-spoonful at first, and then increasing the quantity as could be borne, at the next regular meal-time. After the first day the patient was bathed three or four times in the twenty-four hours. The clysters and fomentations were continued as circumstances required. No very cold water was used in any form.
In three days’ time the patient was up and about, and in all respects quite well, though somewhat weak.
Eleven days after commencing the treatment in the above case, namely, on Sunday morning, the 2d of June, 1850, the patient was taken very suddenly in labor. Within half an hour after the very first sensation of any pain, and before her husband could call me, her child was born, a sixth son. She suffered but little, and was delivered while in the standing posture, but the after-birth remained unborn. I found her weeping for fear that she would be subjected to some horrible water-applications, of which she had read. I told her that my mode of practice was altogether different from that which she so much feared, and that, at any rate, no honest physician would ever subject a patient to any process which she could not heartily concur in. I told her, moreover, that I would much prefer that she should have her old physician if she chose, and that she could not possibly offend me if she would but frankly take her own choice. Her husband then desired that she would pursue that course which she herself preferred. With the explanation I had given, she concluded at once to go on with the matter as I might see fit to advise. “Well,” said I to myself, “we will see how a mixed treatment will answer—a little of the old, and a little of the new.”
The patient was perfectly willing to be bathed in tepid water, which I also advised. But she wanted the old-fashioned obstetrical bandage or binder, as she had used it before. I explained to her all about its nature and effects, and consented that she might use it if she would take it off at each time of bathing, and at all times when she found it causing too great heat. Her husband bathed her four times the first day in bed; the women would not help at all. She was able to sit up in bed, and the second day and onward, she bathed herself, the old nurse always making herself absent at the time. She had suffered with after-pains before, but nothing worth mentioning this time. Injections were used from time to time, and the wet towels over the abdomen. The second day the patient was up in her room. The third morning, as I went to her door, I heard some one singing, and, on entering, found it was the patient herself, alone, sitting up with her infant in her arms.
The fourth morning the lady was so well that there was no excuse for a doctor any more. She said she had to keep her room, and mostly her bed, for four weeks always before. Now in three days she was perfectly well, bathing herself repeatedly every day; whereas always before she had never dared wash herself short of a whole month, and then only with whisky! She was now convinced that the only safe way to prevent taking cold, was to bathe.
This, then, may be put down as a remarkable case. Eleven days before labor the patient was very dangerously sick. The birth was exceedingly easy and short; and, although such labors are not, on the whole, as safe as those which are more difficult and protracted, she yet recovered her usual health in a remarkably short period of time, and without any mishap or pain. She bathed but very little, comparatively, although that little told well. No application whatever of cold water was made.
Case VIII.—While the cholera was committing its fearful ravages in the city of Brooklyn, during the summer of 1849, a worthy and intelligent lady, the wife of a sea captain, was preparing to leave for the country, whither I was to go with her to attend her looked-for case of childbirth. Monday, the 9th day of July, she was busy packing trunks and preparing to move, and probably overworked. At all events, she did not feel well, and experienced pains similar to those of labor, all day Tuesday. I remained in the house over night, but in the morning the patient was better. Still there occurred at times periodical pains, and I told the patient that if they were true and natural pains of labor, a bath would accelerate and make them worse; or if they were false pains, and such as did not indicate the near approach of labor, the bath would cure or render them less. They were, however, increased.
At eight o’clock in the evening labor came to a close, the result being a fine, healthy, female child. One hour after, namely, at 9 o’clock, the patient feeling rested, was helped into a sitting-bath tub, and well washed, for some minutes, over the whole surface. The water was fresh and cool from the cistern. As may be imagined, the patient felt incomparably more comfortable after a good cleansing in this manner, and a degree of refreshment that can be conceived of only by those who have had the practical illustration of it in their own persons, was experienced. A plenty of wet linen towels were placed over the abdomen and genitals, and by these means the patient was enabled to pass, on the whole, a very good night.
She had, she informed me, always suffered intolerable anguish for days after the birth of her other children, five or six in number, I believe. Even with the first—a thing very uncommon—she had experienced most severe torture. It was therefore a great object at this time to do every thing possible to prevent the after-pains. Toward morning, as she began to grow more warm, the pains came on in a slight degree.
At 6½ o’clock (the 12th, the first morning after the birth), the patient was again thoroughly washed from head to foot in the hip-tub. After this a large linen sheet, the whole being wet, and folded in the form of a very large girdle (large enough to cover the whole trunk of the body), was employed. It was wrapped round from end to end, its object being to act as a great and moderately cooling, and necessarily soothing fomentation, to the body, to keep off inflammation and subdue pain. The weather being most excessively sultry and hot, only one dry sheet was placed over her as a covering. She was to remain in this condition so long as the wet sheet did not become uncomfortable or too warm. At 10 the same forenoon, after having slept a good nap, a second ablution was practiced.
She now took a trifle of nourishment in the form of oatmeal gruel, the first since the birth of the child. The two whole days previous, likewise, she had not eaten in all the amount of half a common meal. This three days’ abstinence proved a most valuable means in warding off fever and pain. Nor did it materially impair the strength.
In the afternoon of the same day (the 12th) the patient again took a good bath, fresh from the cistern. She slept considerably both forenoon and afternoon, and suffered positively no more pain. She sat up in her rocking-chair to rest herself in the afternoon and evening, at which time still another bath was to be repeated; but feeling so comfortable, and sleeping withal, she concluded to omit it.
The next morning (the 13th) the patient sat up and took her breakfast, namely, a small piece of simple brown-bread toast.
Thus she went on, bathing and using the fomentations freely each and every day, and very soon regained her full strength. Indeed, she was not at any time so weak as to prevent her walking. She always, after the first night, appeared happy, cheerful, and smiling. She now had no pains whatever, while always before, in childbed, she had suffered greatly for many days after the birth.
The peculiarities of this case are the following:
1. The patient bathed during the whole period of pregnancy daily, by means of that invaluable application, the dripping or rubbing wet-sheet.
2. She wore, of her own accord, the wet compress over the stomach the whole time of pregnancy, night and day; a means which seemed most effectually to prevent heart-burn, nausea, and a host of stomach difficulties, to which she had on previous like occasions been subject.
3. The very abstemious diet subsisted on. She ate much of the time but little else than brown bread and water, and this in small quantity.
4. The extreme heat of the weather.
5. The fact that epidemic cholera was raging most fearfully at the time, in the same neighborhood.
6. The great amount of treatment that was practiced.
7. The freedom from all after-pains, to which the patient had on all previous like occasions been subject.
8. The great rapidity with which she recovered her full strength.
Let those who would imitate a treatment of this kind, be sure of the principles on which they act. Experience is the great teacher in these things. The timid and inexperienced must be content to practice in a less heroic mode.
Case IX.—July 15, 1850.—This is the case of a lady who resided in our establishment, about thirty years of age, of delicate health, and scrofulous tendency. She bathed through her whole period, and paid tolerable regard to diet, but was too much encumbered with domestic duties to allow of suitable exercise in the open air. This was her second pregnancy.
She came to labor very suddenly on the evening of the above date—labor lasting only about half an hour. The pains were exceedingly severe. The presentation of the child was an obscure one, but I succeeded in bringing down the feet foremost, and then, by arranging successively the body and the head in a proper position, I met with no serious obstacle in effecting the delivery. The after-birth came away in a short time, with very little manual aid. Cold wet cloths were at once placed over the abdomen, genitals, and thighs, and often renewed. There were some after-pains. After resting half an hour, the patient was raised as she desired, placed in a hip-bath, and thoroughly washed all over with water, temperature of the Croton, and which produced an effect which she designated as “heavenly.” A folded wet sheet was placed about her body, and being left in a condition which would not allow of her becoming either too hot or too cold, she soon slept sweetly. She had also slept somewhat before the bath. Changing the wet application from time to time, she obtained a very good night’s rest.
The next day she used the wet applications according to her feelings of comfort, and was washed four times thoroughly from head to foot in a hip-bath. Immediately after the first bath, early in the morning, she sat in a rocking-chair, had water brought to her, and then washed her infant, unaided, with her own hands, because no one could perform this important duty so well as herself; she continued so to do daily from the first.
She was herself bathed three or four times daily until she was perfectly recovered, which was in a very short time. She sat up four hours the first day, and so onward. Her infant did remarkably well.
About midsummer, 1847, this same lady was confined, under my care. Not long before the beginning of pregnancy at that time, she had suffered from a very severe attack of fever; but by dint of perseverance in good habits, she got along very well through the period, though the labor was a severe one, and the perineum became torn. There was likewise some trouble from swelling of the breasts. But notwithstanding these drawbacks, she was able to sit up, walked out very soon, and on the whole recovered remarkably well. The sitting-bath and wet compresses had evidently a very salutary effect in healing the perineum; the child also thrived well. This lady had been some years, for the most part, a vegetarian, and drinks neither tea nor coffee.
Case X.—July 31, 1850.—A lady residing in a healthy part of the country was confined the tenth time at this date. She ate no flesh-meat during pregnancy; the diet was entirely vegetable, including the different kinds of berries and fruits in their season; her drink pure water only.
Living thus, she was able to attend to the dairy, making her own butter, and performing all the cooking herself for a family of eleven persons, up to the very day of her confinement.
Labor commenced in the evening, and soon after, at the recommendation of her husband, she was sponged over the whole surface with cold spring water, and soon after took a cold sitting-bath. In about an hour after this she was delivered of a fine plump boy weighing ten pounds. After resting a little, and being somewhat fatigued and suffering some pain, her husband proposed another ablution, to which she readily consented. After this she slept well till sunrise the next morning. The wet girdle had been worn nights some time previous to labor, and was continued about a week after it.
The first morning she was washed all over, and felt very comfortable after it. She partook of rye-bread toast and blue-berries, with water for drink; this was her whole breakfast, and her appetite was good. At night she took a sitz-bath for five minutes, the chill taken off the water, then sponged the body and retired to rest; she slept well all night. She had no nurse but her husband.
The second morning she experienced no pain; followed the course of the preceding day, namely, the bathing of the body and the sitz-bath washing; partook of unleavened wheat-meal cakes for breakfast, with good ripe berries; for dinner, corn-bread with berries; supper, dry toast made of brown bread, with blue-berries; no drink at any time but the best of pure cold water. The third morning she walked about the room; helped to bathe herself; appetite good; food pretty much the same as the day previous; spent a large share of the day sewing; sitz-bath washing as usual at night. The fourth day she was able to bathe and dress herself, partook of meals with the family, and kept about house all day.
From this time forward she took the entire care of her child; neither mother nor child have taken one particle of medicine, nor any herb drinks of any kind or name, and both have been perfectly well and regular in all their habits up to this time, it being two months since the birth. All that the child has ever had was two or three tea-spoonsful of cold water at the time of its birth; after which it was put to the breast. I ought to mention that the child has also, from the very first, been washed every morning in water made slightly tepid.
Case XI.—This is the case of a newly-married lady of this city, twenty-four years of age, of nervous temperament, studious habits, and highly sensitive but well-balanced mind. She had been for years engaged in teaching in the South, and suffered very much with dyspepsia. She had followed water-treatment, pretty thoroughly, one year before she became pregnant. The first four months of this period, it being the winter season, she took the sitting-bath an half hour every morning in cold water, and after it bathed the whole body. During the day she wore a large wet girdle, covering the whole trunk of the body, always during the day rewetting before it became dry; at night it was left off.
She experienced at first much trouble from nausea and prostration.
By the use of the wet girdle, the sitting-bath, and general washing, in connection with abstinence—for she passed whole days eating not more than a fourth part of a Boston cracker in the twenty-four hours—she soon got the mastery of her stomach-sickness, and other troubles.
After the first four months she took the half-hour sitting-bath and general washing three times daily, and wore the large wet girdle as before. She was active in her habits, and for the greater part of the time appeared in as good health as ever in her life before. She remained in the city until the summer, and then left for the country.
About the middle of August, 1850, as she was on the point of returning to the city to make ready for her approaching confinement, under my care, she met with a fall. This brought on labor some weeks earlier, as she supposed, than it should have been. It was rather severe, lasting twenty-four hours. She took ether, as is the custom with many in New England, where she was—an unnatural and injurious practice as I regard it to be. Her child was born on the morning of the 15th of August, soon after midnight. During labor she ate nothing, bathed a number of times, and took clysters of water, all of which served to refresh the system.
In less than an hour after the birth, she was helped into the tub; sat some ten minutes in the water, and was washed over the whole surface. She could easily have borne her weight. The wet girdle was applied, and other cooling fomentations, after which she slept soundly till morning.
She was then bathed again, as before, and after this washed her infant herself, and dressed it the first time, and thereafter continued daily to take the care of it.
She took daily three baths in the wash-tub, the water always at about 70° Fah., and continued to wear the wet girdle and compresses night and day the whole of the first two weeks.
The first day she sat up half an hour, besides taking the baths. She could easily have remained up a large share of the time, but being among those who knew nothing of water-treatment, she preferred being on the safe side. The second day she sat up an hour, and felt well and strong. The first and second days she ate almost nothing. The third day she was up all the time, and took her meals with the family. The fourth day she walked out, and visited two families near. The fifth day she carried her child in her arms, walking with perfect ease a quarter of a mile, and feeling no fatigue. During the first days she had some trouble with swelling of the breasts. Cold water was poured upon them a good deal, and wet compresses worn. She also persevered much in drawing them herself with the tobacco pipe, and by these means conquered the difficulty readily. In three weeks she was able to travel alone with the infant, some 250 miles, to this city. She came first about four miles in a stage coach, thence by railroad to the steamboat, thence over night to the city, and then rode nearly or quite three miles over the rough pavements in the morning to her city home, it being just three weeks to a day from the birth of her infant.
This worthy and intelligent lady remarked, that she considered it her duty to make known to the world her experience in the water-treatment. She said “that many suppose they cannot avail themselves of the advantages of the new method, for the reason that they are not within the reach of a physician who is competent to practice it. But,” she continued, “there is not a lady in the whole United States who may not readily learn as much about it as I myself did. I gained all my knowledge from books, and had never for once conversed with any one who had gone through with the treatment in childbirth.” Great good must necessarily be accomplished if women will but read, understand, and practice, carefully and intelligently, for themselves.
Case XII.—A lady of delicate health and small stature, twenty-nine years of age, came to our establishment in the autumn of 1850, to be confined with her first child. On the 5th of November, considering herself within a week or ten days of confinement, she went, by my permission, in company with her husband, to hear Jenny Lind, at Tripler Hall. She slept well during the night after the concert, and at six the next morning she was awakened by pains resembling labor. These gradually increased until her child was born, a little after eleven in the forenoon, her labor being, on the whole, an easy one.
Two hours after the delivery she was taken up, and bathed thoroughly in a sitting-bath tub, the water at 70°. Being delicate, it caused her a good deal of shivering at the time; but this amounted to no harm, and usually occurs during a number of the first baths after delivery. At evening she was again bathed as before, and slept well during the night. Cold wet compresses were used freely, as according to our custom in such cases.
The second day, and onward, she was bathed four times—before breakfast, dinner, and supper, and on going to rest. She was able, also, to sit up more or less daily, and the first three days went on, in all respects, apparently well.
The fourth day, in the afternoon, there occurred a circumstance of ominous character, such as I hope it may be my lot seldom to encounter. I refer to the coming on of that most fearful malady, puerperal fever—the puerperal plague, as it has been appropriately called. The patient was already somewhat feverish, which was caused probably by the new excitement of milk in her system.
At the same time some relatives came to see her, it being the first time of their visiting her after the birth. They were in high glee, joking, talking, laughing, and making all manner of fun for a considerable time. All this transpired without my knowledge.
At the edge of evening, I found the patient in a most terrific fever; her flesh was very hot, face flushed, pains in the back, abdomen, and head; the pulse full and throbbing at 140 per minute. Judge my surprise at these phenomena, knowing, as I did, that the patient had been remarkably well in the morning; I had not yet learned of the excitement she had undergone during the afternoon.
It is evident enough, I think, that under such circumstances, some powerful and decided means must be resorted to; otherwise the disease might proceed so rapidly as to destroy the patient’s life, and that too, possibly, within twenty-four hours.
We commenced the treatment by giving her a thorough ablution in water, a little tepid at first. She was then placed in a heavy linen sheet but moderately wrung from cold water, and packed loosely, with but little covering. The object of these applications was gradually to cool the system; to bring down the pulse, as soon as might be, to its natural standard; to arrest the inflammation that was already going on in the abdomen; and to quell the pains. The wet sheet was changed every twenty to thirty minutes. Gradually the pulse became less frequent, and the pains less, till midnight, when we had succeeded in bringing the pulse permanently down to 80, and the pains were quite gone. The wet sheet was then folded each way, making it four double, and placed about the patient’s body, from the arms downward; in this she was to sleep the remainder of the night, having just covering enough to keep her comfortable. But if she should become wakeful from pain or feverishness, the husband was to renew it, that is, rewet it in cold water, and as often as necessary. Once or twice only it was changed before morning.
The reader who is at all acquainted with the danger and the fearfulness of this most awful disease, may form some idea of the anxiety I felt when I first found this patient with the attack upon her. He may judge, too, something of my feelings, when, by midnight, I had succeeded in bringing the pulse down to 80, and quelling all fever and pain.
The next morning the patient appeared in all respects well, but somewhat weak, and not a little blanched. She got along afterward in all respects perfectly well.
In a very short time—I do not now remember in how many days after the birth—she commenced walking out carefully, and riding in the city to improve her strength, with a view of returning home as soon as circumstances might warrant.
When her infant was nineteen days old, feeling in all respects strong and well—as much so, perhaps, as ever in her life—she proceeded, in company with a female attendant, on her journey homeward, about three hundred miles.
I should remark that this patient was always of weak, nervous, and delicate constitution. She had had a miscarriage three years before this confinement, which weakened her a good deal. During this second pregnancy she adopted the water-treatment under my directions, but was obliged to use, both for bathing and drinking as well as other purposes, very hard, limy water—a circumstance considerably against her. She experienced numerous little ailments, but on the whole got along very well.
Case XIII.—Nov. 8, 1850.—A lady residing in the city of Brooklyn, of small stature, tolerably good constitution, nervous temperament, and I should judge about twenty-five or six years of age, gave birth to her third child near midnight of the above date. Having suffered a good deal at her last preceding confinement, particularly with after-pains, she had resolved at this time to adopt the water-treatment.
Very soon after the birth, the placenta having been expelled soon after the child, the most fearful after-pains commenced, precisely in the same way the patient had suffered before; and she had doubtless, as many have, experienced incomparably more pain after the birth of the child than before it. This is all unnatural and wrong, and would not be, if human beings had from the first always obeyed the physical laws. But is there no method by which these pains—terrible and persistent as they often are—may be prevented? Certainly, if the experience of thousands may be taken as a guide. No drugs can do it. Suppose we give strong opiates, as some few of the more stupid practitioners may yet sometimes do, we may allay the pains somewhat for the time. But who does not know that the pains are in the end made worse? And what havoc does such treatment make with the nervous system? But, fortunately, physicians have, as a general thing, abandoned this practice.
In this case we helped the patient into the wash-tub, having the back elevated two or three inches by a block of wood, she sitting in it with the feet outside, and there being a couple of pails of tepid water in it. She was rubbed for a long time—say fifteen or twenty minutes—until all pain was removed. A large, heavy sheet was then folded both ways, making it four double, and laid upon the bed; on this she was placed, after which it was folded about her, reaching from the arms to the knees. The application caused a good deal of shivering, but as I told her, the more shivering the less pain, she bore it patiently. She was covered, so as to make her in a reasonable time comfortable, and there was, I believe, moderately warm applications made to the feet.
This being at about one o’clock in the night, I directed that if the pains should again come on, as they probably would, she should be rubbed as before a long time in the shallow-bath, have the wet-sheet renewed, use the wet towels about the abdomen and genitals, as we always do, without exception, in such cases, and to repeat these processes without any reference to hours or time of day, as might be needed to keep off the pains. Once only before morning was it necessary to repeat them, and she enjoyed, on the whole, a good half night’s rest in the folded wet-sheet. In the morning another bath was taken, when she found herself very comfortable, and, withal, strong.
This patient being at a considerable distance from my home, I saw her, I think, but twice after the birth. She bathed three or four times daily, used the wet compresses freely, and took injections according to need, and suffered almost nothing with after-pains. She kept her strength well, and sat up to rest herself more or less every day.
The third or fourth night—the latter, I think it was—she was a good deal wakeful from fever. Seeing her in the morning, I directed the bath and folded wet-sheet as before, which at once subdued all unfavorable symptoms. Had she resorted to them in the night time as often as the symptoms might have demanded, she would have obtained a good night’s rest.
All things considered, our intelligent patient found a vast difference between water-treatment and that to which she had been before subjected; and she was well rewarded for the heroism, self-denial, and perseverance which she manifested at and before the time of her confinement.
Case XIV.—November 10, 1850.—This is a case of an intelligent young lady of this city, of apparently delicate health, and, I should judge, twenty-two or twenty-three years of age.
Having been recently married, she spent the winter of 1849–50 probably in too much excitement for the health of one in her state. Her home besides—a fashionable boarding house—was not one at which the proper food could be obtained; in short, she lived too freely, and that upon food of improper character.
In the month of May she experienced a severe attack of bilious fever, and also, comparatively unacquainted with the water-treatment, she had the good sense to determine at once to submit herself confidently to the new method; she had, indeed, no confidence in any other, and her intelligent husband coincided with her in opinion, while the other friends objected strongly to what they considered a piece of fool-hardiness.
By the freest use of packing sheets, of short duration, shallow-baths in the wash-tub, the wet girdle and tepid clysters frequently repeated, together with entire abstinence from all food, she was completely cured in a few days.
Here let it be remembered, that such attacks of fever, as indeed of all severe acute diseases, are far more dangerous when they occur during pregnancy.
After recovering from this attack, our patient went for a time to the country, and followed all along a good course of bathing, with more attention to diet. Her health improved constantly up to the close of her period.
She came to labor the night of November 10, 1850. It lasted only about six hours—rather a quick one for the first—natural, and on the whole easy. Her child was a fine healthy boy.
Cold wet compresses were used freely, as ordinarily in such cases. She suffered little or nothing from after-pains.
The lady was inclined to take only a moderate course of bathing during recovery, and I did not regard it best to urge her. Two or three times a day, however, she had an entire ablution of some sort. I think she sat up more or less every day. She had all along a good appetite, slept well at night, felt cheerful and contented, and in a few days found herself in all respects quite well.
This case, although not of very marked character, is yet an instructive one, when we take into consideration all of the circumstances connected with her pregnancy.
Case XV.—A laboring woman, who had been deserted by an intemperate husband, applied to me in the summer of 1850 for advice. She was poor and melancholic, and knew not what to do. Our house was too full to receive her at the time, but a benevolent lady of the city gave her a good home, and some small wages, for what light work she was able to perform, but on the condition that she should find some other place in which she should be confined.
This was her second pregnancy, her first child having died at birth. She was now debilitated, and had worn her clothing a good deal too tight. I endeavored to persuade her to do all she could under the circumstances toward the restoration of her health, and especially, to avoid the great evil which I have mentioned.
On the 18th of November, 1850, the patient having been some days an inmate of our establishment, gave birth to an apparently healthy male child, weighing nine pounds. During two days she experienced pains, more or less. Being very much busied at the time myself, my worthy friend, Dr. Wm. E. Rogers, of Waymart, Wayne county, Pa., superintended the delivery in a faithful and skillful manner. With his own hands he changed the wet cloths every few minutes, during the period of four hours. These, of course, aided very materially in warding off after-pains, and all other evils incident to the puerperal state.
The patient having no nipples, could not nurse her child. They had been countersunk, as carpenters would say; that is, they had been driven into the breast, doubtless by the patient having been in the habit of wearing too tight clothing upon them. This not unfrequently happens with those who unwisely attempt to improve upon the form which nature has given them.
No milk whatever could be obtained from the breasts; they were inflamed considerably, three or four days at first, but, by appropriate treatment, the difficulty soon ceased.
Previous to entering our establishment, the patient had never in her life taken an entire ablution, that she could remember of. After the birth, she had, in connection with the compresses, one towel-bath a day. Three days after the birth, that is, on the fourth morning, she found herself sufficiently strong to enable her to go down five flights of stairs without assistance, and twice went out of doors. The next day she worked in the kitchen, and by following up the daily bathing, with care and diet, she was very soon fully recovered.
It will be seen that this patient had comparatively but little general treatment. The persevering use of the cold fomentations, adopted at the first after delivery, must have operated powerfully in warding off heat and other inflammatory symptoms, which tend so much to reduce the strength.
Considering the fact of the inflammation of the breasts, and that no milk whatever could be obtained, it was rather remarkable that she was carried through it without having them suppurate and break.
Case XVI.—December 20, 1850.—The patient was, I judge, about twenty-five or twenty-six years of age; apparently of scrofulous habit; eighteen months before, gave birth to her first child. At that time she was kept in her room three months constantly, with a broken breast. This time she resolved to avail herself of the water-treatment, with a hope of avoiding the awful sufferings which she had before endured.
She bathed pretty freely and daily during this her second period, following the advice laid down in the work entitled “Water-Treatment in Pregnancy and Childbirth.” She kept also busy about household duties, which aided her a good deal in maintaining good general health.
On the evening of the above-mentioned day, December 21st, 1850, the patient was confined, pregnancy having lasted only 265 days, 15 days short of the usual time; the labor was, on the whole, an easy one, and ended between 6 and 7 o’clock in the evening.
Usual treatment, with cooling compresses, was followed faithfully, and after the patient resting a little, a thorough ablution in the wash-tub was given. She slept well during the night.
The patient had long been troubled with piles, and, as usually happens under such circumstances, she experienced a good deal of trouble from the affliction at the time of the former birth. So also, at this time, it came on so bad as almost wholly to prevent her sitting up.
With the view of checking it as soon as might be, we commenced the next morning with the cold packing-sheet, twenty minutes. She had four baths in all during the day and evening, the water pretty nearly cold. She felt all along perfectly well, and would have been able to sit up a good deal the first day, were it not for the troublesome ailment mentioned.
The second day, and onward through the first week, the treatment followed was the cold pack in the morning twenty minutes, and the bath after it; bath in the wash-tub before dinner; the cold pack and bath again toward evening; the bath again before going to rest; and cold compresses most or all of the time, night and day.
At the end of the week the patient was so well that she could go about the house, take charge of her infant herself, and had already dismissed her nurse. She had suffered no feverishness, no pain, nor any restlessness at night. Nor was her strength scarcely at all impaired.
It is now more than two months since the birth of her child, and I have often heard from her, as being in all respects well.
Two important circumstances helped very much in this case; the patient herself is a very intelligent and assiduous person, and had studied faithfully and understandingly the method of treatment which, in her good judgment, she chose to adopt. Her husband, too, had a good understanding of the matter, and was himself a most faithful nurse.
Case XVII.—A young lady, just married, emigrated from the city of Edinburgh, Scotland, early in the summer of 1850. She had been pregnant one month before starting. She was of delicate health, small stature, of fair hair and complexion, and, as we would say, of scrofulous tendency. She had always been sedentary in her habits, and was occupied, for the most part, sitting and within doors. She had, in short, had but poor opportunity for the development of her physical powers, and had contracted a bad lateral curvature of the spine.
The ship’s passage across the Atlantic was a long and boisterous one of eight weeks; she was a good deal seasick, and after the first week was compelled, for want of strength, to remain in her berth night and day; thus she continued for six entire weeks; the eighth, and last week of the passage, she was able to be out a little.
The patient, together with her husband, took up her residence in the very heart of this, in the summer, hot and unhealthy city. She had always been accustomed to a much cooler climate, and now became necessarily a good deal debilitated. She had lived for a time mostly, or altogether, upon the vegetarian principle, in the old country; but in this city she adopted a different course, using coffee, and perhaps tea, and some other articles not altogether friendly to health.
She consulted me, however, some ten or twelve weeks before confinement. I advised her at once to avoid flesh-meat, to drink only cold water, and to bathe and exercise much more than she had been in the habit of doing; the advice was followed faithfully, and with the happiest effects.
December 29, 1850.—Sunday morning, at 4 o’clock, her labor ended. For fifty hours, without intermission, it had continued, depriving her of rest almost wholly, three nights. Of all the examples of fortitude and patience which I have ever witnessed under such circumstances, this was the most remarkable. Notwithstanding the great length of time the labor lasted, the patient did not at any moment despond, nor did she, to my knowledge, utter a single word of complaint. At times she would recline; then again she would sit up, walk about the room, or engage in some light work. She bathed also repeatedly, as the pains were progressing, and the ablutions appeared to refresh the system, and support her strength materially. I repeat, this very worthy lady’s fortitude and resignation were remarkable, and such as I shall not soon forget.
This, as I have remarked, was her first child. Under such circumstances there is usually but slight loss of blood. But in this case, owing perhaps, partly to the patient’s constitution or state of health, and partly to the severity of her labor, considerable flooding succeeded the expulsion of the after-birth. To check this, she was at once raised and put in the cold sitting-bath. The effect was as sudden and as favorable as could be desired.
The patient had something of after-pains, but not a great deal. Three and four baths were taken daily, and the cooling compresses were freely used.
There were circumstances in this case which caused me some trouble in anticipation; no urine was passed for full thirty-one hours after delivery. Considering how much had been done in the way of bathing, water-drinking, and wet compresses, it was singular that such should have been the case. But no harm whatever occurred in consequence of the renal secretion being so long prevented.
Day by day, the patient gained strength; it was against her recovery somewhat that she was obliged to remain in the same room—and a rather small one—where the family cooking and other work was done. Still, through great faithfulness and perseverance in the treatment, she recovered in all respects remarkably well.
The notes I made of the case at the time are as follows:
“First Day.—Patient was sponged over in bed a number of times, whenever the cooling compresses were not found sufficient to check the after-pains. Slept considerably during the first night, but, as is common after the rest has been broken a number of nights in succession, the sleep was somewhat disturbed. The compresses were changed very often. She was not raised up for a bath, as it was thought that, in consequence of the severity and great length of the labor, she was too weak.
“Second Day.—Bath in the wash-tub three times, and body sponged in bed two or three times besides. Urine was passed thirty-one hours after the birth. Patient sat up to-day in bed.
“Third Day.—Bath in the tub four times; the water cold as usual. She preferred this; it gave her nerve. It made her shake a good deal at the time, but this circumstance is attended with no danger. Sat up an hour and a half at a time to-day. Appetite good.”
It was remarkable in this case, that the pulse remained at 100 and upward for a number of days after delivery; yet the recovery was certainly highly favorable.
Within the second week the patient was able to go out and walk in the open air.
In eighteen days she brought her infant in her own arms to my house, a distance of about one mile, and returned again home, experiencing very little fatigue.
About six weeks after the delivery she met with an accident, which caused her considerable suffering. She received a blow upon one of the breasts, not very severe, but sufficiently so to cause an inflammation, which ended in abscess, or broken breast, as it is usually termed. By following up the water processes faithfully, that is, by taking frequent ablutions, packing-sheets, with compresses constantly upon the breasts, sometimes tepid and at others cold, according to the feelings of comfort, she passed through the period of healing much better than is usually the case with broken breast.
Considering the patient’s constitution, her voyage across the Atlantic, her residence in the heart of a hot, unhealthy city, the length and tediousness of her labor, her recovery was remarkable.
Case XVIII.—This is the case of a young married lady with her first child. She is of rather nervous temperament; too active naturally for the good of her system.
January 11, 1851.—She was confined after a seven hours’ labor. Two or three days before, she had evidently overdone at ironing and other household duties, which she was too fond of performing. Her full period would, I think, have been six to seven weeks later, the birth being premature, in consequence of the over-exertion alluded to. The child, however, was above the average weight—a daughter—but did not seem to possess its full share of vitality.
The usual treatment of ablutions three and four times a day, with cooling compresses, the wet girdle, clysters, etc., was practiced, and with the happiest results. The patient sat up, day by day, and recovered, not quite so rapidly as some, but in all respects well.
Case XIX.—A lady, thirty-eight years of age, recently married, came to her confinement the 4th of March, 1851. For two months only she had been bathing, with reference to her expected time; her health has generally been very good, and all along, during the period of pregnancy, she attended personally to her household matters, rendering her little habitation as perfect a specimen of order and cleanliness as could be conceived of.
All this tended powerfully to preserve health of body, and cheerfulness and contentment of mind, circumstances never more important than during the period of pregnancy.
We would expect, naturally, that a patient at this age would suffer the first time a severe and protracted labor. But in her case it was far otherwise. True, for two days previous to delivery she experienced some symptoms of labor, but was able to be about, and slept considerably nights. At 10 o’clock, A. M., on the 4th instant, labor had fully commenced; at 4 P. M., delivery took place; making labor only six hours, on the whole a short one.
Not long after the birth, the patient was helped into the tub for a thorough wash. She would have been able, I think, to perform the ablution herself alone; still, it was thought best that she should make no effort at the first bath.
It is now the third day since delivery, and the patient has had three or four ablutions daily in water at 70° Fah. She has used the compresses freely; the wet girdle much of the time, which she finds to strengthen her back. She sat up more or less every day, usually after the bath.
The third from the birth, she was going about her room, putting things in order, feeling in all respects well. The milk was secreted freely, and she has had no trouble from the breasts, from feverishness, or any other cause; the infant doing also as well as the mother.
On the sixth day, the patient went from home, taking her infant with her, on a visit to a friend residing in another street.
LETTER XXXVIII.
CONCLUDING REMARKS.
Hysteria—Its Prevention and Cure—Leucorrhea, or Whites—Falling of the Womb.
There are two or three topics connected with the diseases of the sex, respecting which volumes might be written, concerning which I will here make some practical remarks.