Lastly,—Because, if a female falls into labor with her intestinal canal so loaded, it will of itself be sufficient to render, what would otherwise have been a quick, easy, and safe labor, a long, painful, and difficult one; and may be the cause also of very serious and alarming symptoms some forty or eight-and-forty hours after her labor is over.
The first and leading symptom of this affection is a costive or more consistent state than usual of the fæcal excretions, with a less frequent call for evacuation than is customary with the individual when in health. If this is not attended to, and several days, perhaps a week, pass by without the bowels being relieved at all, pain in the head, a foul tongue, and an increased degree of fulness and tension of the abdomen, are experienced. These symptoms are followed, in all probability, by thin watery evacuations, attended with pain, weight, and pressure about the lower bowel; they become frequent; and the female at last, finding that the bowels are not only open again, but even loose, takes chalk mixture. She is not aware that this very looseness is nothing more than increased secretion of the lining membrane of the bowel, caused by the pressure of the accumulated mass of hardened fæces, which it passes and leaves unmoved. The chalk mixture relieves the irritation upon which the looseness depends, but the disease is not removed, and, instead of its being a case simply of costiveness, it has now become one of constipation; an accumulation of hardened stool is distending and irritating, by its pressure, the lower bowel and the womb, and the serious consequences before enumerated may follow.
Very often have I been consulted by a female far advanced in pregnancy for what she supposed mere looseness of bowels, which has already been found to originate under circumstances like these. It is of the highest importance that the patient should endeavor to guard against such a result; and without doubt she may avoid it, and regulate her bowels with great comfort to herself, throughout the whole period of pregnancy, if she will only use the means.
In pointing out a plan to accomplish this desirable object, the first prescription I have to offer is by far the most valuable,—“prevention is more easy than cure.”[[23]] If the bowels are sluggish to-day,—that is to say, if they are not as freely relieved as usual,—and you do not assist them by medicine, depend upon it, to-morrow they will be confined, and there will be no relief at all. If, then, the bowels, are disposed to be costive, I would recommend one large tablespoonful of castor oil—if it does not nauseate the stomach,—and advise that the dose be repeated in four hours, if the desired effect has not been produced, or a wine-glass of beaume de vie at night; and early the next morning, before leaving the dressing-room, let the lavement be used, the injection consisting merely of a pint of blood-warm water;—or the following pills will be found useful to be kept in the patient’s bedroom:—Two scruples of the compound extract of colocynth and one of the extract of henbane divided into twelve pills. Two or three of these may be taken at bedtime, when the bowels have not been, during the day, satisfactorily relieved. These are always ready in the bedroom, and, as they generally answer the object efficiently, and with comfort to the patient, are the most convenient form of aperient.
It will now and then happen, however, that the female has let the day slip. When this is the case, in combination with medicine, the use of the lavement is desirable. Medicine alone will not answer the purpose, unless it be taken in doses so strong as will not only move the bowels but irritate them too. With the exhibition of the warm water, mild aperients never fail. Females, generally, are averse to the use of the lavement, and it is a prejudice which is most deeply to be regretted. I have known purgative medicines so often resorted to, and, in time, so increased in power and quantity, because they began to lose their effect, that, by their continual irritation, disease of the lower bowel has been produced, and death has, at last, been the consequence. If, then, the bowels have been one or two days confined, the lavement in the morning will render much less medicine necessary, and frequently have an effect when medicine alone would not. Many ladies use the warm water every second or third morning, during the latter weeks of pregnancy; and by this means they regulate their bowels—which would otherwise be confined—with great comfort to themselves, and need no medicine at all.
I will only add one word, in conclusion, upon this subject. Let it be remembered, that if the bowels have been confined several days, and diarrhœa comes on, that this is not a natural relief, but the effect of irritation, caused by the presence of a loaded state of the lower bowel, which must be quickly removed by the medical attendant, or it may give rise to some one of those serious evils already enumerated.
Diarrhœa.
An affection very opposite to that which has just been discussed, may occur during pregnancy. We have seen how diarrhœa may arise as a symptom of costiveness. It will manifest itself, however, independently of such a cause. The intestines may participate in the irregularity of the womb, and, their vermicular action becoming morbidly increased, diarrhœa is the consequence. It is a disease which varies very much in different individuals, and may clearly be divided into two kinds.
One, in which the motions are more loose and frequent than in health, but not otherwise much altered in their appearance. The tongue is clean, or only slightly white, and the appetite is pretty good. No medicine is required here; a careful diet will correct the evil.
In the other case, the stools are liquid, dark-coloured, and very offensive, accompanied with a coated tongue, bad taste, offensive breath, loss of appetite, and more or less disorder of the digestive organs. In these latter circumstances, your medical adviser should be consulted; in case you do not see him, I have found at first the following draught, given every three or four hours, very useful—rhubarb, eight grains; ipecacuanha, one grain; dill water, one ounce.