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.