If I were asked what I should advise for those who would not submit to the use either of the lancet or mercury, I should say, commence with a strong dose of Epsom Salts, or Jalap, and repeat it in about five hours after its full operation. Also apply warm fomentations to the abdomen, or put upon it a flannel bag full of hops soaked in vinegar, as hot as it can be borne, and put mustard poultices on the feet, and inside of the thighs. The hands must also be kept as warm as possible, and the head cool. The diet should be very spare, and contain nothing heating or stimulating, and cooling drinks, such as ice water, or cold lemonade, should be drunk freely. The purgative should be repeated at least every day, for two or three days, or more if the symptoms are not modified, and the mustard poultices may be regularly used to various parts of the limbs, for the same length of time. In conjunction with these means the breasts should also be kept warm, to promote the flow of the milk, and injections of starch and castor oil should be thrown up the rectum daily. The object being, as far as possible, to keep the surface of the body warm, and to cool the internal fever, at the same time that all the natural secretions are excited as much as possible to remove any morbid matter that may be formed. It should also be mentioned that the urine sometimes stops, or at least becomes very scanty and thick, in which case a little sweet nitre may be given, or if necessary the catheter must be used. Some bitter tea, as boneset or chammomile, should also be taken occasionally, and a James's Fever Powder with it once or twice a day, to promote perspiration; or if there be severe pains, a dose of Dover's Powders may be used instead.
If the disease passes the acute stage and becomes chronic, the same means must be pursued, and with strict regularity, or there will be danger of its again becoming acute. In all cases send for the most experienced practitioner as early as possible, and whatever his plan may be, if his past success proves it to be tolerably successful, submit to it, whether it be bleeding, salivation, or anything else. If there be no one at hand on whom dependence can be placed, follow the plan I have laid down as nearly as circumstances will allow, but practise it fully without delay, and till a change takes place. Those persons who make light of this disease, and pretend to say that this or that simple treatment is all-sufficient, either deceive themselves or wish to impose upon others. There are few affections more serious, as will be evident when it is borne in mind that, on an average, two females die out of every three attacked by it. To avoid all liability to it as far as possible, attend well to the general health during pregnancy, have everything comfortable, clean, and wholesome, during labor, and be careful to avoid cold, damp, and all kinds of mental and bodily excitement afterwards. The assistant also, whoever it may be, must be as careful and as gentle as possible, so as to avoid all violence or undue force, and not to hurry nature. A want of attention to such simple details has, undoubtedly, brought on many attacks of this fearful disease that otherwise would never have been experienced.
AFFECTIONS OF THE BREAST OCCURRING AFTER PREGNANCY.
The functions of the breasts are liable, from many causes, to become deranged, and such derangements may lead to serious results, both to the mother and the child. It is a common opinion that females who nurse are not so liable to suffer in this way as those who do not, but experience proves this opinion to be untrue; nevertheless, as it is the duty of mothers to nourish their own offspring, it should be a subject of careful study to relieve them of this liability as far as possible, or to assist them when necessary.
Galacterrhœa. This means an overflow, or excessive secretion of the milk, which sometimes takes place, particularly in those who do not nurse. At the commencement of the milk fever, Galacterrhœa needs but little attention, but if it continue to the second or third day, proper remedies should be applied to correct it. These consist in complete rest, both of body and mind, cooling drinks, and spare diet. If these do not correct it soon, a flaxseed poultice should be placed on each breast, and the patient should be made to perspire, either by warm teas and clothing, or by means of steaming. The bowels should also be freely opened with castor oil, or a seidlitz powder, and it will often benefit very much to give warm water freely to drink, with ten grains of nitrate of potash (saltpetre) to the pint.
In those that nurse it is very seldom the case that the secretion of milk is too profuse, unless the child has been kept too long from the breast. As a general rule it should be put to nurse in a few hours after birth, even if there be no milk, because its suction will materially help to bring on the flow. It frequently happens, when the child is kept away till the milk comes, that the breasts have swelled so that the nipple is buried and cannot be laid hold of well by the mouth, in consequence of which the child does not get nourishment enough, and the breasts not being well emptied become engorged, and their functions deranged. All this may be avoided by putting it too early. Sometimes however notwithstanding every precaution, the flow of milk is excessively great, and constitutes a real disease, which may cause great weakness and debility. In such cases it will generally be found that the diet is too stimulating or too rich, or that the bowels have been too inactive, and the first step towards an improvement must consist in correcting these faults. The skin should also be kept active by frequent bathing and good friction, and the quantity of nourishment taken should not be greater than the mere healthy support of the body requires. In particular no stimulating liquors should be used.
Agalaxy.—This complaint is the reverse of the former, as it consists in a deficient secretion of milk. The causes of this deficiency are various; sometimes it arises from a constitutional inertness of the breasts, sometimes from insufficient nourishment, and sometimes from profuse discharges in other parts. All excesses also tend to decrease the quantity of the milk, particularly those of a certain kind; and it is seldom so abundant or lasting either in extreme youth or advanced age. The appearance of the menses in like manner generally causes the flow to become less, and it ceases naturally in some much earlier than in others. Sometimes there is a deformity in the child's mouth, which prevents its sucking properly, and the milk may stop for want of being completely drawn. The breasts also may be diseased, or the nipple not sufficiently prominent, and the same difficulty be thus produced in another way.
In treating agalaxy, therefore, the first thing is to ascertain if there be no deformity or disease in either mother or child, which prevents proper nursing. If there be nothing of the kind, it must next be ascertained whether the mother has any excessive secretion elsewhere, such as diarrhœa, great flow of urine, or heavy sweats; if she have, these must be corrected. It must next be seen if she takes sufficient nourishment, and of a proper kind for her stomach and bowels. Sometimes a little spiced wine is excellent, or some porter, with white meats, and arrow-root milk. If she be of a full habit, however, and makes much blood, the contrary course must be pursued, and the diet be made low and unstimulating, while the bowels are kept free and the skin in good action.
In many cases when the nipple is small, it may be much enlarged by titillation, just before the child is put to it, after which the suction will increase it still more.