This affection also appears, like the preceding, to arise from obstructed circulation, but instead of the blood accumulating it is merely the serum, or watery portion of it. The swellings are generally whitish, and spread about, and a small pit remains in them when pressed with the finger. They are found on various parts of the lower limbs, and on the groin or abdomen, and also upon the external lips, in which place they are often exceedingly troublesome. As a general rule these swellings are of small account, and as they disappear with delivery, but little attention need be bestowed upon them. Sometimes, however, they become very extensive, and so engorged that they inflame and are extremely painful. They have even been known to mortify, and cause considerable sloughing, particularly when chafed and afterwards wet with the urine. In these extreme cases there may be serious disturbance of the general health, from the constant irritation, and from the patient being unable to walk about. I have often known the limbs and vulva covered with patches of Erysipelas from this cause. Sometimes the swellings even become so large that they interfere with the process of delivery.
The treatment of this affection consists in rest, particularly lying down, saline purgatives, regular, and frequent washing the parts with cold milk and Laudanum, or with a solution of Borax, half an ounce to a pint of water, to be used cold and with a tea-spoonful of Laudanum added to it. Simple cold water is frequently quite sufficient. In general all kinds of ointments are injurious, but if other means fail to give relief, the Cucumber Ointment may be tried. The wash should always be used after urinating, and the parts must not be rubbed, but lightly dried with a piece of soft linen. Fullers earth is often an excellent application when there is chafing.
If the patient be of a full habit, she must carefully diet herself, and bathe regularly. If she be thin and weak, a generous diet will be advisable, with meat and even a little wine.
HYDRORRHEA, OR PROFUSE DISCHARGE OF WATER.
This consists in a discharge of water, more or less profuse, from the vagina, at various periods during pregnancy. Some females will only discharge a small quantity, at intervals, others will have a constant dropping, and others again will pour out an immense quantity, sometimes several pints, or even quarts, in the course of a few days. In general this water is quite limpid and colorless, but sometimes it contains much mucus, and at other times it is tinged with blood. It does not appear that this discharge leads to any evil result, even when excessive, and I only refer to it to relieve anxiety. The origin of this water is not yet ascertained, but it is generally thought to be secreted between the membranes and the womb, and to be quite distinct from the liquor amnii.
PUSTULES, AND MUCOUS DISCHARGES.
Occasionally the external lips will be covered with pustules during pregnancy, and frequent discharges of mucus will occur from the vagina. They are both however caused by the unusual action of the uterine system, and merely require frequent bathing of the parts with milk and Laudanum, and regular action of the bowels. The most important thing to remark in connection with them is that they have often been mistaken, even by medical men, for the effects of syphilitic disease, and much distress has resulted from such mistakes.
DERANGEMENTS OF THE URINARY ORGANS.
Several derangements of the urinary organs are liable to occur during pregnancy, partly from sympathetic irritation, and partly from mere pressure. Some of these may be partially relieved, others have to be borne as patiently as they can be till delivery removes them.
The swollen womb often presses on the neck of the bladder, and hinders the passage of the urine, or even obstructs it sometimes altogether, and thus causes straining, burning heat, and great distension of the bladder. In some instances this passes off as the pregnancy advances, owing to the womb rising higher in the abdomen, but in other cases it remains more or less, during the whole term. It is particularly important, in such cases, that the female should not let the difficulty remain too long unremedied, for if the bladder be very full it may become utterly impossible to empty it by natural effort. Sometimes the difficulty is much lessened by lying on the back a short time before attempting to urinate, or by raising up the abdomen with the hand at the time. Many females can urinate with tolerable comfort while lying on the back or abdomen, and others are much relieved by constantly wearing a bandage. Constipation always makes this difficulty worse, and sometimes even causes it, by keeping the rectum full and thus increasing the pressure. In all such cases it will be readily seen, that forcing medicines are not only useless, but liable to cause injury. The change of position, rest, and supporting the abdomen are the means to be relied upon. If these fail, and the urine accumulates, the catheter must be used. A warm bath, or fomentation with warm water and Laudanum, will assist, and sometimes relieve alone. To ease the burning and distress the patient must drink freely of gum water, or barley tea, with a little Syrup of Poppies.