INSOMNIA, OR SLEEPLESSNESS.
There are few affections that cause more real distress during pregnancy than this. Many females will be utterly unable to sleep for many days and nights together, and others can only obtain a few minutes broken and unrefreshing sleep at distant intervals. There is danger, when this state becomes highly aggravated, that it may lead to delirium, or that the want of rest may wear away the strength to such a degree, that the patient will sink from mere exhaustion. There are some females, however, who will remain without sleep, or at most take but very little, for a long time, without suffering any inconvenience.
This affection is essentially a nervous one, and the only means likely to relieve it are those that have a tendency to soothe and calm the nerves. If the patient be surrounded by any irritating circumstances they should be at once removed, or she herself removed from them. Particular attention must be paid to the diet, so that no derangement of the stomach or bowels be kept up, and a regular system of out-door exercise must be practised. A warm bath just before going to bed, with a good rubbing of the skin, will frequently act like magic in procuring rest. As a general rule narcotic drugs should not be used, but in extreme cases they may be resorted to sparingly. A single Opium pill, or a few drops of Laudanum may be taken after the bath. If the patient be thin and delicate, she should eat meat, eggs, and milk, and take a little wine, if it causes no unpleasant symptoms. Indeed a glass of wine will frequently act better than Laudanum, and so will ale with some, and coffee with others. If the patient be of a full habit these things will be improper, and may injure. She should then be kept quiet, and fed sparingly. Music has a powerful effect in many of these cases:—a slow, solemn air, played while the patient is reclining after her bath, seldom fails in inducing sleep.
TEMPORARY AFFECTION OF THE SIGHT, HEARING, AND SMELL.
These disorders are quite common during pregnancy, particularly in the latter months. Some females will be utterly unable to distinguish any odors, even the most powerful; others completely lose their taste, and others again become deaf or blind. When they are caused only by the sympathetic action of the womb, such deprivations are seldom of long duration, though they may recur at frequent intervals. In some cases they remain a considerable time, and great fear is felt that they may become permanent, but there is little danger of such a result. I knew a lady who suddenly lost her sight when about two months gone, and who remained totally blind till about three hours after her delivery, when her sight returned in a moment as perfect as before. The same thing has frequently been observed of the other senses. In some cases the vision will not be lost but perverted, and the patient will then see everything double, or larger or smaller than natural, or always of a wrong color. In like manner some will hear imaginary conversations, or will fancy everybody is shouting, or perhaps only whispering, though they are all the time speaking in their natural voice.
These perversions, when thus produced, need occasion no alarm, and seldom require attention, unless accompanied by other urgent symptoms. They may arise however, from a fullness of blood in the head, in which case they are accompanied by a flushed face and drowsiness, and are preceded by bright sparks flashing before the eyes, or by ringing in the ears.
The treatment of all these affections should be the same as that recommended for most of the previous derangements, particularly for Headache, Syncope, and Palpitation of the Heart. If there be nervous excitement merely, it must be calmed in the same way as recommended in the articles referred to, and also in the last one on sleeplessness. If the female be of a full habit, and there is evidently a pressure of blood on the brain and nerves of the special senses, the same means should be adopted to reduce the system, and draw the blood to the extremities, that have already been described.
In such cases these sudden deprivations of sight and hearing sometimes indicate the commencement of Convulsions, or Apoplexy, particularly if they occur during labor, when every means should be resorted to instantly to relieve the pressure on the brain. If no simpler means succeed in a reasonable time, it is the general custom to bleed freely from the arm, and there is no question but this frequently removes the difficulty at once, whatever objections may be made to the practice. It is also proper to say that many eminent practitioners, who are not advocates of the lancet in general, strenuously urge that it should be used immediately if the sight or hearing suddenly disappear in this way at any time. And I certainly have myself known these accidents sometimes followed by a fit of Apoplexy, or Convulsions, and even death. Such was the case with a friend of one of my patients. She found one day, quite suddenly, that she could only see half of any thing she looked at, and at times it even disappeared altogether. Nothing was done for her, and in about five hours after the first attack she fell speechless and died before they could lift her upon the bed. It will therefore be a necessary precaution, in all pregnant females of a full habit, to attend rigidly to the advice that has been given, because simple means, used in time, and regularly, may prevent the necessity of stronger ones altogether. In purely nervous cases of this kind no apprehension whatever need be felt, and no such practice as bleeding is required.