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administration of an anodyne, and having other professional
engagements, left the house. Mrs. M—— was taken in labor Monday,
December 18th, at 7 o’clock, P. M., and on Sunday, at 7 o’clock, P. M., I
first saw her. Her pains were then almost constant, and such had
been the severity of her suffering, that her cries for relief, as her
medical attendants informed me, had attracted crowds of people
about the door. As soon as I entered her room, she exclaimed, ‘For
God’s sake, doctor, cut me open, or I shall die; I never can be
delivered without you cut me open!’ I was struck with her language,
especially as I had already been informed that she had previously
borne two children.
“On assuring her that she was in a most perilous situation, and at
the same time promising that we would do all in our power to rescue
her, she voluntarily made the following confession:
“About six weeks after becoming pregnant, she called on one of
these infamous female physicians, who, hearing her situation, gave
her some powders, with directions for use. These powders, it
appears, did not produce the desired effect. She returned again to
this woman, and asked her if there were no other way to make her
miscarry. ‘Yes,’ says this physician, ‘I can probe you; but I must have
my price for this operation!’ ‘What do you probe with?’ ‘A piece of
whalebone.’ ‘Well,’ observed the patient, ‘I cannot afford to pay your
price, and I will probe myself.’ She returned home, and used the
whalebone several times; it produced considerable pain, followed by
a discharge of blood. The whole secret was now disclosed. Injuries
inflicted on the mouth of the womb, by other violent attempts, had
resulted in the circumstance as detailed above. It was evident, from
the nature of this poor woman’s sufferings, and the expulsive
character of her pains, that prompt, artificial delivery was indicated.
As the result of the case was doubtful, and it was important to have
the concurrent testimony of other medical gentlemen, and as it
embodied great professional interest, I requested my friends, Drs.
Detmold, Washington, and Doane, to see it. They reached the house
without delay, and, after examining minutely into all the facts, it was
agreed that a bi-lateral section of the mouth of the womb should be
made.
“Accordingly, without loss of time, I performed the operation in
the following manner: The patient was brought to the edge of the bed
and placed upon her back. The index finger of my left hand was
introduced into the vagina as far as the roughness, which I supposed
to be the seat of the os tincae. Then a probe-pointed bistoury, the
blade of which had been previously covered with a band of linen to
within about four lines of its extremity, was carried along my finger,
until the point reached the rough surface. I succeeded in introducing
the point of the instrument into a very slight opening which I found
in the center of this surface, and then made an incision on the right
side. I then withdrew the instrument, and in about five minutes it
was evident that the head of the child made progress. The mouth of
the womb dilated almost immediately, and the contractions were of
the most expulsive character. There seemed, however, to be some
ground for apprehension, that the mouth of the uterus would not
yield with sufficient readiness, and I made an incision of the
posterior lip, through its center, extending the incision to within a
line of the peritoneal cavity. In ten minutes from this time, Mrs. M
—— was delivered of a strong, full-grown child, whose boisterous
cries were heard with astonishment by the mother, and with sincere
gratification by her medical friends. The expression of that woman’s
gratitude, in thus being preserved from what she and her friends
supposed to be inevitable death, was an ample compensation for the
anxiety experienced by those who were the humble instruments of
affording her relief. This patient recovered rapidly, and did not,
during the whole of her convalescence, present one unpleasant
symptom. It is now ten weeks since the operation, and she and her
infant are in the enjoyment of excellent health.
“At my last visit to this patient, with Dr. Forry, she made some
additional revelations, which I think should be given, not only to the
profession but to the public, in order that it may be known, that in
our very midst there is a monster who speculates with human life,
with as much coolness as if she were engaged in a game of chance.
“This patient, with unaffected sincerity, and apparently ignorant of
the moral turpitude of the act, stated most unequivocally to both Dr.
Forry and myself, that this physician, on previous occasions, had
caused her to miscarry five times, and that these miscarriages had, in
every instance, been brought about by drugs administered by this
trafficker in human life. The only case in which the medicines failed
was the last pregnancy, when, at the suggestion of this physician, she
probed herself, and induced the condition of things described, and
which most seriously involved her own safety, as well as that of her
child. In the course of conversation, this woman mentioned that she
knew a great number of persons who were in the habit of applying to
this physician for the purpose of miscarrying, and that she scarcely
ever failed in affording the desired relief; and among others, she
cited the case of a female residing in Houston Street, who was five
months pregnant; this physician probed her, and she was delivered
of a child, to use her own expression, ‘THAT KICKED SEVERAL TIMES AFTER
IT WAS PUT INTO THE BOWL.’”
Thus you have an exemplification of the danger of the wicked and
fearful practice which I have spoken against. If any of you are ever
tempted under such circumstanes, beware!
 UTERINE HEMORRHAGE.
As intimately connected with the subject of abortion, it is fit that I
should here make a few remarks on that form of uterine hemorrhage
which is not connected with childbirth.
Case I.—I recollect a case of this kind that occurred with a lady
who was, I should think, at least sixty years of age. It was in the
month of October, 1846, on a passage from New York to London, in
the packet ship Switzerland, Captain E. Knight. The old lady and
husband had taken a steerage passage from New York. They were
English people, returning after many years’ absence, again to visit
their native country.
One day the old gentleman came on deck and told me his wife was
very sick of uterine hemorrhage, and that he wished my advice. I told
him I would prescribe what I considered to be the best course in such
cases, but that I feared his wife would not be willing to follow it.
Indeed, I had no idea that she would do so.
However, I gave the advice, which was substantially as follows:
First, take old sail-cloth, which was clean, make some pieces into the
shape of towels, and one larger, to be used in the form of a child’s
diaper; place these cloths, wet, about the abdomen and thighs, and
let the patient wear a large one, wet, in the form of a child’s diaper;
let her take but little and very light nourishment for two or three
days, and be careful and not move about too much; help her out
upon deck, when the weather is fine, so that she may enjoy the
invigorating effects of the pure air and light. You need not chill her
much with the wet cloths, but be exceedingly particular that they do
not become too warm; let her wear them the larger portion of the
time, until she becomes quite well.
Contrary to my expectations, the old lady followed the course
resolutely, and in a very short time was again entirely well. She spoke
in great praise of the invigorating effects of the cold cloths; she also
drank cold water. We were at sea about three weeks after this, and
the old lady’s health continued good until we left the ship.
 Case II.—A lady of about the same age, in the winter of 1848–49,
living in Jersey City, experienced uterine hemorrhage. She had been
overdoing in the way of work. A similar course to that in the above
case was followed, and in a few days she also recovered. Rest, alone,
in such cases—that is, abstaining from severe labor, and taking but
very little exercise, such as can be easily borne, and without fatigue—
is alone sufficient for the curing of many of these cases.
Cold hip-baths, of short duration, and often repeated, are always
good in attacks of this kind. Indeed, the more coolness generally to
the body, the better; but we should not chill the extremities too much
—not that it is dangerous to do so, but it is better to avoid it.
In the treatment of hemorrhages, the Indians pursue a very
rational mode of treatment. If a severe hemorrhage follow a wound,
which is not unfrequently the case, they plunge themselves into cold
water, thereby producing a constriction upon the bleeding vessels.
We all know by experience the efficacy of cold to arrest bleeding at
the nose. We put a piece of ice on the neck, pour cold water down the
spine, or even put a cold door-key on the back of the neck, and in
most cases epistaxis ceases. All physicians and surgeons—all who at
all deserve the name of such—know well the power of cold to arrest
hemorrhages—often, too, such as are of the most alarming character.
We should make very poor work indeed, in stopping hemorrhages, if
we were deprived of cold water. Cold water is worth more—
incomparably more for this purpose—than all other remedies under
the firmament of heaven combined.
 LETTER XVI.
DISORDERS OF PREGNANCY.

Its Febrile Condition—Acute Disease—Sleeplessness—Heart-burn—Constipation—

Diarrhea—Piles and Hemorrhoids—Their Treatment.

It is said to have been an aphorism of Hippocrates, the father of

medicine, who lived more than two thousand years ago, that
pregnant women attacked with acute disease always die. This strong
assertion cannot be said to hold good, certainly, at the present day;
but yet pregnancy, it must be admitted, exercises, as a general fact, a
very unfavorable influence on the system in acute disease. The
danger here may be said to be three-fold. First, the system is already
in a febrile condition, or one very nearly bordering thereto; second,
there is the new disease; and third, this often causes the death of the
unborn child, and then the dangers of abortion are superadded to the
others. “The life of the child, too,” say authors, “is endangered by the
treatment necessary for the cure; especially in the use of harsh
purgatives, violent emetics, salivation, and profuse bleedings.” But
thanks to a better day, we of the water practice are under no
necessity of running such fearful risks. We have not only a more
effectual way, but one, when managed by judicious hands, harmless
and safe. “It is by the prompt use of mild means, and a persevering
attention to small matters,” judiciously observes Dr. Maunsel, “that
the patient is to be conducted through the dangers that encompass
her.” And he justly adds, “Above all, avoid the dreadful blunder of
treating a woman for acute disease without discovering that she is
pregnant.”
Pregnancy, as I have remarked, is always attended with more or
less excitement of the system, an excitement which bears some
resemblance to a state of fever. There is also a greater proneness to
fevers, even from slight causes, now than at other times. Hence the
necessity of avoiding, as far as possible, all such causes; and hence
also, the necessity of exercising the greatest care in regard to diet and
drinks. Too much food, and that which is too exciting, will cause
more harm in pregnancy than at other times, from the greater
tendency to fever. The common belief among women is, that more
food is needed during pregnancy than at other times, because the
food goes to furnish nourishment for two instead of one, that is, for
the mother and the child within her. “It is therefore,” says Dr.
Dewees, “constantly recommended to eat and drink heartily; and this
she too often does, until the system is goaded to fever; and
sometimes to more sudden and greater evils, as convulsions or
apoplexy.”
If, instead of full diet, women in pregnancy will but try the plan of
eating less food, even of becoming very abstemious, they will most
assuredly find that they get along better, suffer less from plethora or
fullness, and enjoy greater comfort of body in every respect.
 SLEEPLESSNESS.
This, in a greater or less degree, not unfrequently occurs during
pregnancy. It is most apt to occur during the later months of the
period. Within a few days of the birth, however, better rest is
experienced, and a greater degree of comfort in every respect. This
tendency to sleeplessness during pregnancy is sometimes so
troublesome as almost wholly to prevent sleep. “The limbs are
agitated by involuntary contractions of the muscles, which, by the
frequency and suddenness of their motion, instantly interrupt the
sleep to which the woman was at the moment strongly inclined.”
“Sleeplessness,” says Dr. Maunsel, “most frequently affects the
weak, nervous, and irritable, occurring sometimes early in
pregnancy, oftener toward the end of the term. If the want of sleep
continue for many days, it is commonly followed by very grave
symptoms, as restlessness, fever, mental disturbance, convulsions,
etc.; abortion has resulted from it, and some cases have terminated
in insanity; others have destroyed life.” But those who follow a
judicious course of water-treatment do not become thus afflicted. If
such occurrences should be at all possible in the new modes, the
cases would be exceedingly rare. I have known many persons to
follow bathing during pregnancy, but none who have had any thing
like serious difficulty in obtaining a proper amount of rest.
In many cases this want of sleep in pregnancy does not sensibly
impair the general health. Some persons have been under the
necessity of walking their room much of the night; and yet, after a
short repose at the dawn of day, have been astonished to find
themselves as much refreshed, apparently, as after a good night’s
rest.
Treatment.—To prevent sleeplessness in pregnancy, a variety of
means have been recommended. If there is plethora, or too great
fullness of the system, small bleedings and cooling purgatives of mild
kind are recommended by almost every author who has written on
the subject. It is well known that in many parts of the country,
women believe that they cannot get through pregnancy at all without
being bled. The doctors have been at the root of this matter in the
beginning. This old-fashioned practice, fortunately, is now fast going
out of date. It is not for me here to enter into a discussion of the
question whether such means ever do any good in pregnancy; but I
will say, on the authority of physiological and pathological science,
and my own experience, that bathing, water-drinking, and the proper
regulation of the general habits, are incomparably the best modes;
the best, not only for the time of pregnancy, but also for that of
childbirth and the period of nursing.
Dr. Dewees recommended for this affection, low diet, cool air, and
cold water, as being among the best remedies. And Dr. Denman says,
that “a glass of cold water drank at bedtime is not a contemptible
remedy;” and he might have said one of the best, especially if the
dose be soon repeated. And Dr. Dewees, in quoting this advice of Dr.
Denman, adds, “We know that bathing the hands and face in cold
water is an excellent practice, and should always be resorted to.”
Dr. Maunsel says, “Pediluvia (foot-baths), or, what is better, hip-
baths, very often do good.” But the important matter of temperature,
the doctor does not speak of. A warm hip-bath and a cold one are
very different things. He remarks, also, well, “that the diet should be
cooling, and exercise in the open air as freely as circumstances will
permit.”
I may, however, dismiss this whole matter of sleeplessness in
pregnancy, by saying, that those who bathe daily, exercise
judiciously, and, when possible, in the open air, drink only pure soft
water (and all can have this from the clouds), partake only of plain
and unstimulating food, and sleep upon hard beds and pillows, in
cool, fresh air, will rarely, if ever, be troubled with want of sleep.
One other thing, however; it sometimes seems necessary for
persons in pregnancy to get a “nap” during the day. Those who have
great cares, and many in our country have, often find it extremely
difficult to get through the long, hot days of summer without sleep.
Now, in such cases, if the woman can go by herself, and be wholly
undisturbed, and feel entirely free from every care, and thus get a
good half hour or an hour’s sleep, she will be much refreshed
thereby. It is necessary to observe that the clothing should be
removed as at night. Persons often wonder how it is that they feel
worse after sleeping than before. When one lies down, if the clothing
be left on, too much heat is retained about the surface, and thus
debility, instead of refreshment, is experienced. This day-sleeping
should be done with the stomach empty, as at three or more hours
after a meal, and not in the afternoon, as that would be liable to
cause wakefulness at night. It is truly surprising how much, under
favorable circumstances, a short sleep even will refresh the powers of
life.
 HEART-BURN.
This is not unfrequently one of the first unpleasant symptoms that
women experience after becoming pregnant. It sometimes becomes
very distressing, and difficult to manage according to the ordinary
modes. “It is generally,” says Dr. Dewees, “very distressing and very
difficult to subdue.” He had known large and repeated doses of the
alkalies given with scarcely any temporary alleviation, and much less,
permanent benefit.
The great cause of heart-burn in pregnancy, as well as in other
cases, is acidity of the stomach; and acidity of the stomach comes
from improper food. Very seldom, indeed, can a pregnant woman be
troubled with heart-burn, acidity of the stomach, or vomiting, if the
dietetic and other habits be regulated according to principle.
Pregnant women, in this country of abundance, generally eat a great
deal too much food. They have also too little exercise in the open air.
Some, indeed, have too much exercise, as in doing household work;
but more are injured by doing too little than too much. But in this
country ninety-nine of the one hundred eat too much food while in
the pregnant state.
Treatment.—To cure the heart-burn, let the woman, when she first
experiences it, at once desist in the quantity of food. If she rises in
the morning and finds the symptom upon her, she may be certain
that digestion has gone on badly the day previous, and that the
stomach contains portions of the undigested aliment which has
passed into the acetous fermentation, and thus causing the difficulty
she experiences. What is to be done in such a case? Will the
introduction of another portion of food into the already disordered
stomach make matters any the better? Certainly not, except for a
short time. When the stomach is goaded on by a new meal, the
individual may feel the better for half an hour; but, other things
being equal, it in the end only makes the matter worse. Fasting a
meal or two, with water-drinking for its tonic effect, is the best
possible means. The stomach, thus, has time to regain its vigor, and
food taken in moderation, subsequently, will then be found to agree
perfectly well. It will here also surprise any one to learn how small an
amount of food is really necessary, with water-drinking, to sustain
the strength.
If the heart-burn is very troublesome, it will be found of great
relief for the patient to vomit by means of water. This, in most cases,
will take place very easily by drinking, in quick succession, a number
of tumblers of soft water, about blood-warm temperature. This, with
a little help, as by putting the finger in the throat, will be found
sufficient; and if, in any case, the vomiting does not take place, the
water yet does much good by means of diluting the offending matters
in the stomach. Thus, suppose there is one ounce of acid matters in
the gastric cavity, and that ten ounces of pure water are introduced
therein, the offending mass is weakened tenfold; so that even if
vomiting does not take place, great relief is experienced. I would not
have any one make too great an effort to produce vomiting, especially
in pregnancy, for hard vomiting might cause abortion. There is,
however, no danger except the vomiting caused by drug substances.
Water-vomiting is easier than can be imagined by those who have
tried only the old modes.
Soda and other alkalies, taken so often to ease heart-burn, do more
harm than good in the end. The wet girdle, worn occasionally about
the abdomen, and managed so as to produce a cooling effect, will be
found of great service in invigorating the stomach, thus tending to
prevent heart-burn, acidity, and the like. So, also, the general
ablutions, which ought never, for a single day, to be omitted during
pregnancy, as we may say, too, of other times.
In heart-burn, arising from whatever cause, it is a very common
custom, both with the profession and the people, to give alkalies, as
magnesia and chalk. Dr. Dewees, I remarked, had known large and
repeated doses given, with scarcely any temporary alleviation, much
less permanent benefit. It is of little effect, certainly, to continue
giving these articles, when at the same time the dietetic habits are
such as are certain of keeping up the difficulty. This would hold true
even if the articles administered were perfectly neutral in their
effects as to harm, which can never be the case. All drug substances,
however much good they do, at the same time cause a certain
amount of harm. The articles, magnesia and chalk, the ones generally
resorted to in this difficulty, are moreover often impure. This is
particularly true of the latter article.
Dr. Dewees mentions a case in which the lady’s health was utterly
destroyed by her enormous use of chalk. “I formerly attended a lady,
with several children,” says he, “who was in the habit of eating chalk
during the whole term of pregnancy; she used it in such excessive
quantities as to render the bowels almost useless. I have often known
her without an evacuation for ten or twelve days together, and then it
was only procured by enemata (injections); and the dejections were
literally chalk. Her calculation, I well remember, was three half-
pecks for each pregnancy; she became as white nearly as the
substance itself; and it eventually destroyed her, by so deranging her
stomach that it would retain nothing upon it.” I repeat, that these
alkaline substances always and inevitably do more harm than good;
and the part of wisdom is to do without them.
 CONSTIPATION.
During the early months of pregnancy, there appears to be a
greater tendency to constipation than in the latter months, a fact
which is the direct reverse of what we should expect from a priori
reasoning. But during the whole period, constipation is more apt to
occur than at other times.
Constipation is exceedingly common among all classes of females
in this country at the present day. The American people have such a
predilection for fine food, it is a hard matter to make any great
change in this respect. It is in the dietetic habits, more than in any
other, that we are to look for the causes of this evil.
Superfine flour is, I hold, the greatest of all causes of constipation.
I know tea and coffee, which are astringent articles, have a tendency
to cause this condition of the bowels; and the same may be said of
idleness and physical inactivity; but too great richness of food—and
superfine flour is the article most concerned in this—is the great
cause of constipation. Our country abounds with it everywhere. By
our numerous railroads and canals, superfine flour is transported
from one end of the country to the other, so that in large districts,
where formerly the people were in the habit of eating coarse bread,
as of rye and Indian, and were consequently more healthy, they now
use the superfine. Even a beggar would sneer at one for offering him
brown bread.
Constipation, common as it is everywhere among females, is still
more common in pregnancy. This arises, first, from the pressure of
the enlarged womb upon the lower bowel; and second, there being a
new action set up in the uterus, there is, as a natural consequence, a
greater tendency to torpor in the bowels; but the principal cause is
that of the pressure.
This condition of the bowels induces of itself numerous other
difficulties. Headache is often brought on solely by constipation; that
is, in many cases we remove the constipation, and the headache is
sure to leave with it. Sickness of the stomach and vomiting are
always aggravated, and often caused by it. The same also may be said
of heart-burn, palpitation, and fainting. Sleeplessness, and, in fact,
almost every one of the disorders of pregnancy, may be said to be
either caused directly, or greatly aggravated, by constipation of the
bowels. Even miscarriage has been known to be induced by it.
Some persons have gone an almost incredible length of time
without any movement of the bowels. A whole week is not
uncommon. Dr. Dewees mentions a case of fourteen days, and no
doubt there have been those who have gone one to three whole
weeks.
Treatment.—What have we to do in order to cure constipation of
the bowels? Does not every person of common sense understand at
this day, that the more we dose the system for constipation, the more
we may? Let those answer who have tried these things. Always, other
things being equal, the more we take drugs for constipation, the
worse it grows. We must therefore look to some other means of cure.
Constipation of the bowels may always be cured, and this by the
most simple means. Dr. Dewees mentions a case where a lady had
suffered three successive miscarriages from this cause, and by the
constant use of brown bread, drinking only water, and taking no
animal food or broths—taking now and then a little castor-oil, or the
like, which, however, he did not reckon upon as having done any
material good—enabled her to pass safely through the whole time.
We need here only mention, in general terms, that constipation in
pregnancy is to be cured just the same as constipation in any other
case. Brown bread, fruits, and vegetables, with a very moderate use
of milk, if the patient desires it; regular exercise, the hip-bath, wet
girdle, injections of cold water, or tepid, if that is preferred—these
are the means to be used. The brown wheat or rye mush will be
found most excellent. No woman, if she can have brown bread, and
occasionally an injection, need ever suffer from constipation of the
bowels.
 DIARRHEA.
Sometimes the reverse of constipation occurs during pregnancy;
namely, diarrhea. This also not unfrequently alternates with
constipation. Constipation, however, is the most frequent symptom.
Treatment.—Singular as it may appear, diarrhea should be treated
on the same general principles as constipation. Fortify and invigorate
the general health, observing at the same time a correct general
regimen, and either symptom disappears. In diarrhea, the hip-bath,
often repeated, the wet girdle, and cold injections, taken as often as
there is any disposition for the bowels to act, are effectual means.
The diet should be regulated on the strictest principles. If a diarrhea
is very severe, entire abstinence from all nourishment, except water,
for a day or two, is a very salutary remedy. Food should then be
taken with the same precautions as in nausea and vomiting.
 PILES AND HEMORRHOIDS.
Piles and hemorrhoids are more apt to occur in pregnancy than at
other times; and when these already exist, they are apt to become
worse at this period. Constipation being more apt to occur in
pregnancy, and that condition of the system being the one in which
these symptoms are most liable to occur when the woman is not
pregnant, so also they occur more frequently now than at other
times. The constant pressure of the fetus upon the blood-vessels
within the pelvis has also an agency in the matter, because every
thing that causes sluggishness of circulation tends to bring on piles.
So also the more sedentary habits of many females, during the period
of pregnancy, are often a cause of this difficulty; but in other cases
the opposite extreme is practiced—too much exercise or standing on
the feet. Both these extremes may cause piles in pregnancy, or
aggravation when they previously existed. Cathartic medicines not
unfrequently bring on a “fit of the piles.”
This affection always denotes a wrong state of things in the general
health. A really healthy person can never have the piles. Some,
however, who are what would be termed tolerably well and strong in
general health, experience such symptoms, but such is not the rule.
Old cases, particularly, denote derangement of the general system.
When piles come on suddenly, they are often attended with very
great pain and suffering to the patient. Not only is the pain great at
the part affected, but there is also feverishness, pain, and a very
unpleasant feeling in the head, with deep and severe pain in the
back.
Treatment.—As to the treatment and general management in this
affection, we should of course do the best that may be for the general
health. As a general fact, no surgical operation should be allowed
upon piles during pregnancy. These operations are often attended
with so great pain, that abortion might be the result.
There is nothing in the world that will produce so great relief in
piles as fasting. If the fit is severe, live a whole day (or even two, if
necessary) upon pure, soft, cold water alone. Give then very lightly of
vegetable food. Those who have suffered the agony of this affection,
if they will but have patience to try this means, will find the truth of
my remarks.
Water applications are also very useful in this disease. Dr. Dewees
observes: “The pregnant woman may derive both comfort and
advantage from sitting in a demi-bath of cold water, for five or ten
minutes at a time, two or three times a day, when the complaint is
advancing, or when about to retire; that is, after the severer
symptoms have abated, or before they are high.” This advice is partly
right and partly not. There is a notion with many that cold water-
applications in high inflammation are not good; that they increase
the difficulty instead of making it less. Thus in a burn, it is said that
after the application of cold water the pain becomes worse. This is
not true, although it appears to be so; for so great is the relief
afforded by the application, that the pain appears worse, when in
fact it is not; but only keep on continuously with the cold water-
treatment, and the pain does not return at all. Such at least is the fact
in all burns, however severe, when the surface is not destroyed; and
the same principle holds good in all high inflammations from
whatever cause. Very frequent sitz-baths, or merely washing the part
often in cold water, will be found excellent in these severe cases of
piles. Cold compresses worn upon the part also afford great relief.
Cold injections are also useful. But, as before mentioned, fasting and
the regulation of the diet are the great means.
 LETTER XVII.
DISORDERS OF PREGNANCY.

Headache: the Nervous and the Plethoric kinds—Stye in the Eye—Salivation—

Hemorrhage from the Stomach—Cramp of the Stomach—Toothache—Jaundice.

Headache is one of the most common of all the disorders of

pregnancy. It may occur at any part of the period; in the early
months, it is supposed that nervous headache is most apt to occur; in
the latter, headache arises more frequently from plethora. In such
cases there may be throbbing of the temples, suffusion of the eyes,
ringing in the ears, indistinct vision, and flashes of light passing
before the eyes. If the headache gets to be very severe—splitting, as
we may say—there is danger of either apoplexy or puerperal
convulsions. But these things, be it remembered, do not come upon
those who live moderately and temperately, lead an active,
industrious, and regular life, go often into the open air, and practice
daily ablutions.
That form of headache in pregnancy which occurs often, and is not
a sick or nervous headache, so-called, is regarded by authors
generally as being a very serious affair.
Treatment.—Dr. Maunsel says of the nervous form of this disease:
“This, especially if it take the form of hemicrania (that in which the
pain is confined to one half of the head), is one of the most
unmanageable of all the diseases of pregnancy.”
According to the old practice, prompt and decided measures must
be taken in these cases, especially if the affection is of that form
arising from a general fullness of the system.
“If the state of the system indicates bleeding,” says Dr. Maunsel, “it
will commonly do good; local should be preferred to general
bleeding. If bleeding is not indicated, we should at first attend to the
secretions; when these are corrected, antispasmodics and anodynes
come in well. Hyosciamus and camphor, a grain of each, is a good
remedy; also the volatile tincture of valerian. The external
application of some anodyne extract, as stramonium, belladonna, or
cicuta, may be tried, but with caution, lest they produce the
poisonous effects of the drug.”
Dr. Churchill remarks: “These nervous headaches may usually be
relieved by antispasmodic medicines, or diffusible stimuli, such as
valerian, hartshorn, etc.
“Eau de Cologne applied to the forehead, or a blister behind the
ears, is often useful.
“A brisk purgative should also be given occasionally.
“A much more active treatment will be necessary when there are
any symptoms of plethora, or vascular excitement about the head,
both for the relief of the pain and for the purpose of anticipating evil
consequences. Blood should be taken from the arm, in quantity
according to the strength of the patient and the relief afforded; and
this should be repeated, or leeches applied to the temples, if
necessary. We are not to rest satisfied that enough has been done
until the pain is relieved, and the arterial system reduced to the
ordinary standard.
“After a certain amount of good effect has been produced, great
benefit will often result from the application of a blister to the nape
of the neck.”
Now compare with the above practice of bleeding and dosing,
secundum artem, the true and rational one.
In nineteen cases out of twenty, the nervous headache comes from
either tea or coffee drinking, or the use of improper food. Only
remove the causes, then, and the difficulty vanishes. Strange to say,
however, there are many women who have either so little confidence
in what any one can say to them, or so little control over themselves,
they will not even make the experiment. Should one who has been
cured tell them the fact, they will not yet believe; nor would they if
one should rise from the dead. Such persons—those who have the
truth set before them, and yet will not act—are welcome to all their
tea and coffee, their fine food, their bleeding and dosing, and their
sick headache.
 STYE IN THE EYE.
This form of boil, occurring on the eyelid, sometimes appears as
one of the disorders connected with pregnancy, more particularly in
its earlier part.
Stye is much more apt to happen with those who have a disordered
stomach than with the healthy. As a general rule, however, it may be
regarded that boils are healthy; that is, it denotes a very good state of
the vitality, when it has the power thus to throw morbid matter out
of the system. Still, it is yet more healthy to have the body so pure
that it has no need whatever of symptoms of the kind of which I am
speaking.
A stye is much more painful than might be expected, considering
its small size. This is owing both to the vehemence of the
inflammation and to the excessive sensibility of the part upon which
it is situated. The disturbance caused by it may become so great as to
amount to a good deal of feverishness and restlessness, attended not
unfrequently with a severe pain in the head.
Treatment.—We cannot do a great deal in such cases, except to let
matters take their own course. It is productive of a good deal of relief
to hold the eye in tepid water, and if the patient will consent to live
two or three days almost wholly without food, the suffering will be
rendered much less, and the stye will come the sooner to a head.
 SALIVATION.
There is often a greater or less degree of this symptom during the
period of pregnancy. Probably all women experience, at this time, a
more than ordinary flow of the salivary fluid. This sometimes
becomes very excessive and troublesome to the patient, especially at
night, when the sleep is disturbed by the frequent necessity of
emptying the mouth. Dr. Dewees observes: “It is almost always
accompanied with acidity of the stomach and constipation of the
bowels; the fluid discharged from the mouth, for the most part, is
perfectly colorless and transparent; at other times it is more
tenacious and frothy, and the quantity poured out is sometimes
incredibly profuse. It almost always has an unpleasant taste, though
not attended with an offensive smell; it keeps the stomach in a
constant state of irritation, and not unfrequently provokes vomiting,
especially if the saliva be tenacious, and requires an effort to
discharge it.” This author relates a case where salivation commenced
at the second month of pregnancy, in which the patient discharged
daily from one to three quarts of salivary fluid, and became so
weakened thereby, that she was unable to sit up without immediately
fainting.
The above description of salivation in pregnancy may be said to
apply to patients who live according to the ordinary modes of society.
I have, during nine years past, known many women who have passed
through pregnancy, practicing at the same time daily bathing, water-
drinking, exercising regularly in the open air, with plain diet, and in
no instance have I known salivation to prove at all inconvenient or
troublesome. I judge that this affection, if such we may call it, can
only come on when the general health is at fault, or the dietetic and
other hygienic habits bad. True, there is probably always more or less
increase of the salivary secretions in pregnancy, but if good habits
are daily persevered in, I think no one will be troubled at all in this
matter.
I find in a late work on Females—Professor Meigs’s—the following
remarks on this subject, which go to show, on good authority, the
uselessness of drug-treatment in this affection:
“I am sorry to tell you (the Professor addressing himself to his
class), that I know of no remedy at all to be depended upon for the
management of these great salivations. They are the troublesome
concomitants of the gestation, and they cease with the cessation of
the gestation. They cannot be cured by alkalies or acids, by
venesection or purgation, or by any therapeutical treatment with
which I am acquainted. If it were just, always to attribute the
salivation to a state of the stomach, then it would be reasonable to
apply remedies with a view to correct a faulty state of that organ, in
hopes of curing the salivation.”
All this goes to prove, that you who are troubled with this affection
are to depend upon the rational means, air, exercise, diet, and water-
treatment, and not upon drugs, to remedy it. Mark too, how, year by
year, the superiority of these hygienic and curative influences is
being recognized by medical men, and how the old methods of
dosing the system are going into disrepute.
 HEMORRHAGE FROM THE STOMACH.
In consequence, probably, of a general fullness of the system, or
perhaps from the cessation of the menstrual function, a discharge of
blood sometimes takes place from the stomach, in the earlier periods
of pregnancy. It is generally small in quantity, and continues but a
short time. The occurrence, generally, causes a good deal of alarm to
the patient, but it is seldom to be looked upon as a dangerous
affection.
Treatment.—If the hemorrhage arises from too great fullness of
the system, a reducing process should at once be commenced—not
by drugging the system, or by blood-letting, but by abstinence and
fasting.
If the discharge should be at all alarming, we should place cold wet
compresses upon the abdomen; we should, in short, proceed upon
the same general principles as we would in any other case of
hemorrhage.
If the bleeding occurs in consequence of hard vomiting, as it
sometimes may, we should take measures to arrest that symptom.
I remark, in conclusion, that this affection is a very unfrequent
one, and such, in most cases, as should cause no alarm.
 URINARY DIFFICULTIES.
Incontinence of urine is quite apt to occur toward the end of
pregnancy.
It arises often from the pressure of the womb upon the neck of the
bladder.
There is a notion with some of the “old women,” that incontinence
of urine is an indication of good labor.
Treatment.—This difficulty cannot, of course, be altogether
remedied; the cause cannot be removed. It may be lessened,
however, by short and frequent hip-baths, wet bandages, and cold
bathing. Drinking soft water instead of hard, will also be found to
have a good effect in all difficulties of the bladder whatever.
Blisters are always liable to bring trouble upon the urinary organs,
but more particularly so in pregnancy. The system is then in a more
excitable or impressible state. Strangury in pregnancy is a very
distressing and untoward symptom when it follows the use of
blisters. Dr. Dewees had known cases where entire retention of urine
followed the use of blisters, so obstinate that it could only be relieved
by the catheter, causing a distressing inclination and violence of
effort, only to be surpassed by labor itself. Retention may also come
on from other causes.
Treatment.—It can be very seldom indeed necessary to resort to
the use of the catheter for draining off the urine, if cold hip-baths,
cold foot-baths, and even the cold general bath, if necessary, be
sufficiently persevered in. Cold has a truly wonderful effect in
causing the flow of urine.
 CRAMP OF THE STOMACH.
This affection, as it occurs in pregnancy, is most common with
those whose stomachs have become much enfeebled by dietetic
improprieties, excess in the use of warm drinks, and by the abuse of
medicines.
Treatment.—By way of comparison, let me present you with the
remarks of a celebrated European author, Doctor Churchill,
concerning the medical treatment of this affection, that you may see
what you think of the reasonableness of it. He says:
“Our first object is to quiet the pain by a full dose of laudanum.
“When this is attained, we may proceed to remove the cause, and
to arrest any intestinal irregularity. Dr. Burns recommends aloetic
purgatives, but these may not in many cases be suitable. If there be
piles, as is very often the case with pregnant females, they will rather
prove injurious than beneficial. I have found Gregory’s powder,
electuary of sulphur and senna, or castor-oil, to answer the purpose
better.
“During the intervals of the attack, tonics (of which oxide of
bismuth or preparations of iron are recommended) or stomachics
may be exhibited. A belladonna or opium plaster, or a blister over the
stomach, is often very useful.
“Should the attack be very severe, bleeding, or leeches to the
epigastrium, may be advisable; this will be especially the case should
there be any symptoms of congestion about the head, and more for
the purpose of preventing an attack of convulsions, than even for the
relief of the gastric affection.”
Assuredly you will say that drug-treatment affords a variety of
resources, notwithstanding it is so little to be depended upon.
I need hardly hint to you how much better, safer, and more
effectual the water processes are than all the drugs of the materia
medica to cure a case of cramp in the stomach.
If it is a bad case—acute, as we say—at once drink warm water
enough to cause speedy vomiting.
 The tepid clysters, used to the extent of gallons, that is, by
repetition, if need be, is also a serviceable remedy.
We also use wet compresses, frictions, and the hip-bath, if
necessary; but as a general fact, as soon as we cleanse the stomach
and bowels thoroughly, the cramping ceases.
Afterward, as in all cases of stomach ailment, and all other
ailments, great care should be observed in regard to the food.
 TOOTHACHE.
Breeding with a toothache is an old proverb. Toothache is certainly
more apt to occur during pregnancy than at other times, and not
unfrequently it is a very early symptom of this state. And what may
appear singular, the teeth ache without being diseased. Especially
those who drink strong tea and coffee are more subject to this
nervous toothache, as we may term it; toothache where there is no
decay. Ceasing with the cause, then, is the surest means of relief.
Treatment.—It is dangerous to extract teeth in the early months of
pregnancy. The operation has been often known to cause immediate
abortion. There is the greater danger of this in the early months.
Bleeding has often been practiced for this affection in pregnancy;
but that is a worse than useless resort, and moreover, generally fails
of the object. After a few days of full diet, the affection is quite certain
to return, and appears to be even the more obstinate for the
bleeding. Fasting, with water-drinking, is a much better mode. Very
seldom will toothache withstand twenty-four hours’ entire
abstinence from all food. If the face has become much swelled, of
course so great relief could not be experienced in so short a time. But
even then the fasting is of incalculable good. General bathing, and
going into the open air, are also excellent means. The rubbing wet-
sheet is particularly applicable. And Dr. Burns, in his work on
midwifery, years ago said, “Sometimes a little cold water held in the
mouth abates the pain.” This will be the case whenever the toothache
is one of inflammation; but if it be of the more nervous kind, warm
water will give more relief. If the nerve is much exposed, it is perhaps
always best to hold warm, or at least lukewarm water in the mouth,
and at the same time to practice very brisk and continued rubbing of
the face, temples, neck, etc., with the hand wet often in cold water.
Wet bandages upon the face are also good. If the aching be of the
nervous kind, that is, without inflammation, warm bandages, often
repeated, afford the most relief.
I must repeat, that I hope none of you will ever consent to have
your teeth extracted, or in any way operated on, while pregnancy
exists.