Chapter XVIII: Part VII: The Change of Life (10)

The _treatment_ required in these cases is mild and simple, but must not be neglected. A warm bath should be taken at bed-time for a number of days; the patient should be kept in an even temperature and out of draughts. The best relief to the distress in the nose, from which the child suffers, is afforded by dipping a hollow sponge in hot water, squeezing it nearly dry, and applying it over the nose and forehead. The common domestic practice of greasing the nose is also beneficial. The wearing of a flannel cap until the disease is cured is a remedy strongly recommended by the late Dr. Meigs. A flannel cap will also often prevent the recurrence of the complaint in those very subject to it.

FITS.

Infants and young children are much more liable to fits and convulsions than adults. The causes which excite them are numerous, and should be generally known, that they may be as far as possible avoided.

Many infants are born with a tendency to fits. The children of feeble parents, or of those who have married very early or very late in life, are apt to be afflicted with a predisposition to them. Great fright or severe shock received by the mother during the latter months of her pregnancy may give rise to convulsions in the child soon after birth.

Pale, badly nourished, soft, flabby children, and those of a sensitive, nervous temperament, are more liable to fits than those who are ruddy and hardy. Hence we find convulsions more common and fatal among the poor and miserable than among the 'well-to-do' and comfortable. City children are more subject to the complaint than the country born and bred.

Fits are very frequent among infants while teething. In such cases lancing the gum secures immediate relief. Another cause of fits, and one which every mother should know, is the giving of meat to the child before its teeth are cut. In such cases the attack is sudden, and often very severe. Children most affected in this way by animal food are those with water on the brain, and those of a very delicate constitution. The juice or broth of meat is in some such instances sufficient to produce fits. The remedy consists in the institution of a milk diet. In all doubtful cases avoid a meat diet in any form, and watch the result.

Strong mental emotions, such as fright, shame, or anger, may cause a fit in a child. A nurse in England threatened to throw a child out of the window if he did not stop crying; the little boy fell at once into convulsions, from which he died.

Among other known causes of fits are confinement to heated, badly ventilated rooms, tight bandaging, and sudden exposure to severe cold or heat.

In treating of the influence of the mother's mind over the nursing child (p. 251), we mentioned a number of instances of children thrown into convulsions by changes in the quality of the milk caused by the mental emotion of the mother. The importance of the subject induces us to quote here the corroborating remarks of Dr. Churchill, in the last edition of his standard work on diseases of children. 'During the first year of life, convulsions may not unfrequently be traced to the milk of the mother or nurse disagreeing with the infant, or having been disordered temporarily by fright, passion, or suffering. Soemmering mentions a curious case of a woman whose milk agreed with her own child, but caused convulsions in all others. M. Guersant relates the instance of a woman deserted by her husband, and in her distress her infant had an attack each time it took the breast. Dr. Underwood mentions a mother who nursed her child immediately after witnessing a sudden death; the child was attacked by convulsions, after which it remained comatose for thirty-six hours, but ultimately recovered. Numerous cases are on record of convulsions supervening upon violent passion in the nurse. I have witnessed more than one case resulting from the mother suckling her child during a time of severe affliction and distress.'

We deem it useless to describe a fit. Almost every one has seen it, and at once recognises it. We shall proceed, therefore, at once to the _treatment._

When a child is attacked with a fit the dress should be loosened, all tight bandages and pins removed, and plenty of fresh air admitted into the room. It should not be held upright in the arms, but placed in a lying position. A warm bath (that most useful remedy in so many of the ailments of children) should be speedily prepared, and the child immersed for a few minutes, then removed, dried, and wrapped in a blanket. A hot mustard foot-bath is also of service. The cause of the fit should be at once sought, for upon it will of course depend to a great extent the treatment required. If the child be teething, and the gums be found to be red and swollen, they should be lanced. If the child has eaten too much, or of improper food, an emetic should be given. A little mustard and salt mixed in a tumbler of warm water affords a ready, safe, and effectual emetic.

The dashing of cold water upon the face will sometimes promptly end the fit. The application of powdered ice in a bladder, or of cold water cloths to the head, is of service where the face is much flushed and the movements very violent.

Children subject to fits should live in a well warmed house. By this we do not mean that the rooms and hall ways should be kept hot, still less that they should be close and improperly ventilated. The temperature of the bed-room should not be lower than 70 degrees, and great care should be taken during cold weather to avoid chilling the child outdoors.

Rubbing of the child's body once a day with good salad oil is an excellent and readily applied remedy in these cases. The little patients do not ordinarily object to it. As it is a procedure calculated to improve the general health, we strongly recommend every mother whose child has frequent fits, to try it.

The dress of the child should be warm, loose, and comfortable. Perfect quietness is important for a time after attacks. Do not excite the child by seeking to amuse it. Let it sleep as much as it will.

In those cases in which a fit has been followed by weakness of the limbs, medical assistance will of course be procured. As a rule, recovery in such instances is slow, but, when properly directed, perfect. Change of scene, country air, and exercise, friction of the body with a flesh-brush or salt towel, salt water baths, and electricity, are all valuable agents towards cure.

NOSE-BLEED.

Bleeding from the nose may be produced by a blow or by over-exercise of the child at play. In either case the trouble is usually a trifling one. Some children, however, are liable to attacks of nose-bleed coming on without any assignable causes. One of the consequences of scarlet fever and whooping cough is sometimes a tendency to repeated and serious spells of bleeding from the nose.

The _treatment_ in these cases consists in quieting the alarm of the child if it be frightened, and in applying cold water or pounded ice to the nose and forehead and to the back of the neck. It is because of its coldness that the key placed down the back, as so commonly advised in domestic practice, does good.

An exaggerated idea of the amount of blood lost is often a cause of distress to parents. They forget that the child has been bleeding in a vessel of water, and that a very little blood darkly colors a large quantity of water.

Bleeding from the nose is sometimes a favorable symptom, as when it occurs during a fever, or when in girls approaching womanhood it precedes the expected signs of puberty. It is an unfavorable symptom, however, in scrofulous children and in girls affected with green-sickness, as in these instances it aggravates the existing disorders.

In those rare cases of protracted bleeding which resist the remedies we have mentioned, it may be necessary for the surgeon to plug the nostrils, both in front and at their opening into the throat.

This extreme measure is fortunately scarcely ever called for, and can only be carried out by the physician.

WORMS.

Children are often thought to have worms when entirely free from them. There is hardly a symptom of any disease which has not been supposed by some to be a sign of the presence of worms. A child suffering from some other complaint is, therefore, not unfrequently dosed with vermifuges to its injury. We can give the mother one symptom of worms which is infallible. It is the only one upon which she can rely, namely, the detection of worms in the stools of the child. Until these expelled intruders are actually found she should be slow to believe that the child is thus affected, and still slower to give worm medicine. Before beginning treatment, let the mother wait until the need of it is made out by the result of the examination we have mentioned.

The _treatment_ of the ordinary worms to which children are subject is simple and usually speedily efficacious. Commence with a dose of Epsom salts, of magnesia, or of cream of tartar, as may be preferred. The next day administer a vermifuge, of which the best and pleasantest is _santonine_. Obtain from the druggist three or four three-grain powders of this medicine. Give the half or the whole of one of these powders, according to the age of the child, at bed-time. The next morning administer a purgative dose of oil or salts. Repeat this treatment every other day until three doses of santonine have been taken. Or, from two to six grains, according to the age of the patient, may be dissolved in two table-spoonsful of castor-oil, and a tea-spoonful given every hour until it operates.

An excellent domestic remedy for worms, one which was a great favorite with the celebrated Dr. Rush of Philadelphia, is common salt. For a child two or three years old, the proper dose is a tea-spoonful mixed in a wine-glassful of water. When the child can be got to take it in sufficient quantity, this remedy is a very efficient one.

Most cases of supposed worms in children are best treated by regulating the diet, by attention to the air and exercise of the child, by warm baths, and by endeavoring to improve the appetite, the digestion, and the strength. The food should be plain and unirritating (bread, milk, rice, arrowroot, chicken, lamb or mutton broth, beef-tea, mutton chop, young chicken); the meals should be taken in smaller quantities than usual, and at regular intervals. Sweets and confectionery should be forbidden, and but few vegetables permitted for awhile. A perseverance in this regimen for a short time will usually cure the little patient without the necessity of resorting to any vermifuge.

Worms are most frequent between the ages of three and ten years. Girls are oftener affected than boys. A tendency to worms is hereditary. Cases occur more frequently during the spring and autumn than during the other seasons. A residence in cold, damp, unhealthy situations leads to their production in many instances.

BED-WETTING.

This troublesome disorder is not unfrequently met with in children--more especially boys--under twelve years of age. It is a mistake to suppose, as is done by some parents, that slothfulness or negligence is the invariable and only cause of this infirmity; on this point Dr. Vogel says:--'In most cases which I have observed, the children through their own sense of honor or on account of repeated punishments, had a lively interest in avoiding the accident, and yet were unable to do this without appropriate treatment pursued for months, and even years.' Dr. Tanner states:--'Very frequently this affection is the consequence of bad habits; being favored by the free use of fluids during the after part of the day, by exposure to cold in the night, and by lying on the back.'

The presence of worms in the bowels is one of the causes of this annoying ailment, and they should be sought for in all cases. Stone in the bladder sometimes occasions the affection, but in such instances other symptoms will soon point to the true nature of the trouble.

This subject is one of an importance which demands some attention from us in a work for parents. In the language of Dr. Vogel, 'the effects of this malady are unpleasant, for the psychical development in particular suffers. The repeated punishments which these children undergo blunt their sense of honor considerably; they become cowardly and deceitful, and have no personal spirit. If great and expensive cleanliness is not practised, the bed, and even the whole room, acquires a urinous odor, which contaminates the atmosphere and begets conditions by no means favorable to healthy growth. Such children may be ultimately attacked by indolent ulcers on the nates and lower extremities, the results of urinous excoriations.'

The only _symptom_ ordinarily present is that the child towards morning or in the middle of the night wets the bed without waking. This may happen several times during the sleep, and recur every night. In some cases the act takes place only every other night, but it is rare that there is an interval of more than one night.

The _cause_ of this failing is sometimes very simple and one easily remedied; for it is often the result of neglecting to take young children up once during the many hours they require for sleep. By attention to this matter and to the diet, the habit may be speedily broken. Unfortunately most cases are not so quickly amenable to treatment.

In the _treatment_ of this infirmity, corporal punishment should not be thought of. It is useless, cruel, and unnatural. The child might as well be punished because it squints or has club-foot.

Care must be taken to see that the little patient eats or drinks nothing for several hours before bed-time. The child should also be awakened a little before midnight, and at a very early hour in the morning, and made to empty its bladder. It is of great importance to get the child to sleep upon its side or face, as lying upon the back is sure to increase the trouble. Indeed, it is frequently observed that the child always remains clean when it is prevented from turning upon its back during sleep. The difficulty lies in the prevention. The plan of tying a cloth or towel around the child with a knot over the spinal column, to awaken it by the pain when it rolls over upon the back, so often proposed, seems good advice easily followed. But practically it fails, as it is impossible, without making the bandage too tight, to keep it in place. The benefit which, in some instances, has followed the employment of a succession of small blisters directly over the lower part of the spinal column, is doubtless due to their forcing the child to sleep upon the face or side. The remedy is somewhat a painful one, but should be tried in obstinate cases.

The child's general health, if enfeebled, should be improved by cold baths, bitter tonics, and if possible a change of air. In no case should any mechanical means be employed to arrest the infirmity. Serious and even fatal results have followed such attempts.

If the precautions and simple remedies we have mentioned fail, recourse must be had to the family physician. The drugs which are of benefit are too powerful to be entrusted to any other hands. The hygienic method of cure we have pointed out will, if instituted early, be effectual in all excepting very obstinate cases, which latter indeed sometimes resist for a long time the best efforts of medical skill.

LOOSENESS OF THE BOWELS.

Children under one year of age should have two movements of the bowels in the twenty-four hours, and those from one to three years at least one stool a day.

A slight attack of looseness is often beneficial if it passes away within a day or two. It is easy, however, for such an attack to become hurtful, especially if the food be improper, or the weather warm. A looseness which is of no consequence in the winter may well excite uneasiness during the summer months.

Diarrhoea in a healthy child is ordinarily preceded by vomiting. If the diarrhoea persist long, the little patient is much prostrated by it, and rapidly reduced in flesh. Such an attack should never, therefore, be neglected.

In the case of an infant not weaned, it should be removed from the breast for half a day or more, that the stomach may have little or nothing to do. Barley or rice water, or ordinary water, may be given in small quantities at a time to relieve the thirst. This in many cases will be all the treatment required.

In the case of an elder child, all meat and vegetables should be at once forbidden, and the only food allowed for a day or two must be rice and milk, arrowroot, or milk and water.

The dose of castor oil which is so frequently given by nurses in these cases under the impression that the oil is 'healing,' is only of service when the diarrhoea has been caused by food of improper quality or quantity. It then aids nature in her efforts to get rid of the offending matter, which by its irritation is doing the mischief. In such instances one dose of the oil is quite sufficient. It has no 'healing' virtues, and should not be repeated from day to day.

Children who are teething are frequently affected with looseness. A warm bath every evening, and attention to the gums, will be ordinarily all that is required in these cases, at least during the cold months. It is of the utmost importance, however, during the summer that such patients, if living in the city, should be at once removed into the country; otherwise their lives are in danger.

Looseness of the bowels in children is usually best treated by careful management of the clothing and diet, by attention to all that affects the health, and by avoiding as much as possible the administration of medicines. No case should be allowed, however, to run on without seeking competent medical advice.

An excellent remedy for the diarrhoea of children is the subnitrate of bismuth.

This medicine may be disguised in the food, as in a case narrated by Dr. Inmann. A lad about ten years old was brought to him by an aunt, who stated that the boy suffered much from diarrhoea, and was emaciating visibly; that he would not try any domestic remedy, was an obstinate fellow, and determined to take no medicine. After sending the lad to another room the doctor recommended the lady to get some white bismuth and give it to the cook, telling her to mix a large pinch of it with some butter, and to send in the bread and butter so arranged that the lady would know which was for the boy. This was done. The lad was duly drugged without his knowledge, and the diarrhoea stopped in two days.

INDIGESTION.

Infants and young children suffer often from indigestion, or _dyspepsia_, as well as adults. One of the most frequent signs of this disorder is vomiting. But every infant which throws up its milk is not suffering from indigestion. Vomiting is sometimes a sign of health, and shows that the stomach is vigorous enough to free itself promptly from excess of food. The child is thus saved from the effects of over-feeding. The obvious remedy is to diminish the quantity of milk taken at each nursing or meal.

But vomiting from over-feeding is very different from that caused by irritation of the stomach, which causes it to reject proper food. The common sense of the mother will enable her easily to distinguish between the two sorts. In the former, the child remains cheerful, happy, and well nourished, scarcely changing countenance even while the superabundant milk is being returned from its stomach. In the latter, the child soon becomes pale, feeble, and distressed looking. Over-feeding, if persisted in, may occasion indigestion.

Indigestion during the first year of life shows itself by languor, pallor, and evident discomfort. The child wishes to be constantly at the breast, and suckles eagerly, but vomits the milk shortly after, usually curdled. The bowels are either constipated or too loose. The most prominent and often the only symptoms are this alternation of vomiting and an eager desire to take the breast, associated with loss of flesh and strength. The child is evidently not nourished by the food it takes, and if relief be not afforded it sinks, and dies from starvation in the course of a month or two.

Children who are _weaned abruptly, and at a very early period_, are liable to a serious form of indigestion, which may come on in a few days after weaning, or not for several weeks.

Older children are liable to slight attacks of indigestion, which are attended with vomiting or purging, or both, for a few days, when the stomach recovers its health. In some cases, however, the derangement continues longer, the child then losing its appetite, and suffering from colic, and becoming fretful, pale, and weak. The breath becomes sour, and the passages green. Such cases require careful watching and treatment, especially during the hot weather of the summer.

In infants at the breast indigestion is usually caused by giving the breast too often or by an excess or change in the quality of the milk. Errors in diet on the part of the mother, and other faults which we have pointed out in our chapter on nursing, are the most frequent causes of this ailment. In children who are weaned the causes are almost invariably improper food or food taken too frequently, or in too large quantities. The hint should be taken when a child rejects its food, to change it, or give it less. Instead of this, too frequently the child is urged to take more, and thus derange the stomach.

The _treatment_ of indigestion in childhood is usually easy and satisfactory. The first thing is to look to and regulate the quantity and quality of the food. If it be due to excess of food, this is easily remedied. If due to improper quality, change it promptly. When the mother's health is such that her milk is found to frequently or constantly disagree with her child, a suitable wet-nurse must be procured.

In most cases the attack is mild, and readily yields to a few hours' abstinence from food. As it often happens, especially in artificially-fed infants, that the gastric juice is more acid than it should be, great benefit is derived from the use of _precipitated chalk or carbonate of soda_. A few grains of either of these, given several times a day for a few days, will be found to effect a surprising change and alone restore the appetite and digestion.

In older children an attack of indigestion should be the signal for putting them upon a simpler and more restricted diet for a time. Milk, eggs, arrowroot, tapioca, sago, panada, &c., are better than animal food. If the child becomes much weakened, jellies, chicken, lamb, mutton, or oyster broth, beef tea, or wine whey, should be given to check the tendency to exhaustion.

We repeat, that most cases of indigestion in infants and children yield promptly to an immediate change in the diet, without medicine.

HINTS ON HOME GOVERNMENT.

On this subject, as it may be regarded as outside of our domain of hygiene, we have but few words to say. We wish, however, in the interests of medicine and hygiene, to insist upon the necessity of training children to prompt, implicit obedience to the parental voice. As physicians, we have seen the spoilt, undisciplined child, when sick, rebellious alike to persuasion and command, refusing food and medicine, revolting against the slightest examination, and by its violence and capriciousness, converting a slight illness into a dangerous one. For a child unaccustomed to obedience there is no proper treatment possible when sick; nor when well is there any proper care possible for the preservation of the health. What it wants, and not what it ought to have, is given it, and every one knows that a child's instincts are no guide to health. With health, happiness is sacrificed also. There is no surer way of making a child miserable than by accustoming it to obtain all it wishes, and to encounter no will but its own. Its desires grow by what they feed upon. As a French writer on education has well expressed it: 'At first it will want the cane you hold in your hand, then your watch, then the bird it sees flying in the air, and then the star twinkling overhead. How, short of omnipotence, is it possible to gratify its ever-growing wants?' Accustom the child to hear 'no' and 'must,' but let these hard words be softened by voice and manner--an art in which every true mother excels.

But, on the other hand, do not harass the child by needless restrictions, nor worry it by excess of management. We desire to call attention here to the words of an eminent English divine and learned writer, Archbishop Whately:--

'Most carefully should we avoid the error which some parents, not (otherwise) deficient in good sense commit, of imposing gratuitous restrictions and privations, and purposely inflicting needless disappointments, for the purpose of inuring children to the pains and troubles they will meet with in after life. Yes; be assured they _will_ meet with quite _enough_ in every portion of life, including childhood, without your strewing their paths with thorns of your own providing. And often enough you will have to limit their amusements for the sake of needful study, to restrain their appetites for the sake of health, to chastise them for faults, and in various ways to inflict pain or privations for the sake of avoiding some greater evils. Let this always be explained to them whenever it is possible to do so; and endeavor in all cases to make them look on the parent as never the _voluntary_ giver of anything but good. To any hardships which they are convinced you inflict reluctantly, and to those which occur through the dispensation of the All-wise, they will more easily be trained to submit with a good grace, than to any gratuitous sufferings devised for them by fallible man. To raise hopes on purpose to produce disappointment, to give provocation merely to exercise the temper, and, in short, to inflict pain of any kind, merely as a training for patience and fortitude--this is a kind of discipline which man should not presume to attempt. If such trials prove a discipline not so much of cheerful fortitude as of resentful aversion and suspicious distrust of the parent as a capricious tyrant, you will have only yourself to thank for the result.' It is a matter of common observation that those who complain of their fortune and lot in life have often to complain only of their own conduct. The same is true of those who complain of their children. They have themselves only to blame in each case.

Parents who do not appreciate the responsibilities of their position usually err on the side of over-indulgence to their children; on the contrary, those fully alive to the importance of home discipline often err on the side of over-regulation. To the latter, we commend the reply of an old lady to the anxious inquiry made by the mother of a too rigorously disciplined child as to what course should be pursued, 'I recommend, my dear, a little wholesome neglect.'

Lessons of truthfulness; of fortitude in bearing pain and disappointment; of the duty of right doing, because it is right and not because it is the best policy; of frugality and industry; of self-denial, contentment, and charity, should be early impressed upon the plastic mind of infancy. We wish also, in this connection, to quote the words of a wise physician and observer of men, that 'the little child who is brought up to repeat short and simple prayers at his mother's knees, has a rule of conduct thereby instilled into him which will probably never be forgotten; and, in after life he may not only look back to these beginnings with feelings of reverence and love, but the recollection of them may serve to strengthen him in some good resolution, and help him to resist many a powerful temptation.'

We have had occasion frequently in various parts of this work to point out the intimate relations which exist between the physical and mental nature of parents and their offspring. Like parent, like child. The same close connection and sympathy extends to the moral and religious character; hence that direction and training which relies largely upon the _force of parental example_ is the most effective method of home government. Virtuous precepts, or rigidly enforced rules of conduct, avail little unless the parent keeps the path to which he points the child.

'Well, upon my word, Mrs. Primrose, you have the handsomest children in the whole country.' 'Ah! neighbor,' replied the wife of the Vicar of Wakefield, 'they are as heaven made them--handsome enough if they be good enough--handsome is that handsome does.'

IS THE RACE DEGENERATING?

This is a question which perplexes some minds in our times. A German author of note has recently written a volume to prove that each generation is feebler than the preceding. Old physicians say that in their youth diseases of exhaustion were rarer than now-a-days. For this our habits of life, the pressure on our nervous systems, the prevalence of hereditary diseases, and the excessive use of narcotics and stimulants, are held responsible. 'The fathers,' say these croakers, 'have eaten sour grapes, and the children's teeth are set on edge.'

We attach little weight to these gloomy views. There are plenty of facts on the other side. The suits of old armour still preserved in our museums prove that, as a rule, we have slightly gained in weight and size. Tables of life insurance companies and reports of statistics show that the average length of human life is greater than it ever was. Dr. Charles D. Meigs used to state in his lectures that the size of the head of American infants at birth is somewhat greater than in the Old World.

That there are more numerous diseases than formerly, is not true; but it is true that we know more, for we have learned to detect them more readily and to examine them more minutely. This is especially true of such as are peculiar to women. Within the last ten or twenty years so much that is of sovereign importance has been contributed to this department of medical science, that it is hardly possible for one to become an expert in it unless he gives it his whole attention.

To avoid the tendency to debilitated frames and chronic diseases, woman should therefore learn not only the laws of her own physical life, but the relations in which she stands to the other sex. Thus she can guard her own health, and preserve her offspring from degeneracy. It is only by enlightenment, and the extension of knowledge on the topics relating to soundness of body and mind, that we can found rational hopes of a permanent and wide-spread improvement of the race.

Some have maintained, not understanding the bearing of the facts, that such degeneracy is more conspicuous in the frame of woman than anywhere else. They quote the narratives of travellers, who describe with what fortitude--we might almost say with what indifference--the Indian women, and those of other savage races, bear the pangs of childbirth, and how little the ordeal weakens them. A squaw will turn aside for an hour or two when on the march, bear a child, wash it in some stream, bind it on the top of her load, and shouldering both, quietly rejoin the vagrant troop. Our artificial life seems indeed, in this respect, to be to blame; but if we look closer, we can learn that these wild women often perish alone, that they are rarely fertile, that unnatural labors are not unknown, and that the average duration of their life is decidedly less than among the females in civilised States.

HEALTH IN MARRIAGE.

_THE PERILS OF MATERNITY._

In the early part of this work we quoted some authorities to show that those women who choose single life as their portion do not escape the ills of existence, nor do they protract their days, but, on the contrary, as shown by extensive statistics, are more prone to affections of the mind, and die earlier. While, therefore, nature thus rewards those who fulfil the functions of their being, by taking part in the mysterious processes of reproduction, and perpetuating the drama of existence, it is true also that she associates these privileges with certain deprivations and suffering. We do not wish to throw around the married state any charms which are not its own. Rather is it our aim to portray with absolute, and therefore instructive, fidelity all that this condition offers of unfavorable as well as favorable aspects.

Let us say at once, maternity has its perils,--perils as peculiar and as inevitable as those which pertain to single life. Our present purpose is to mention these, and by stating their nature and what are their causes, so far as known, to put married women on their guard against them. Some are almost trifling, at least not involving danger to life; others most harassing to the sufferer and to her friends.

We shall now consider the principal diseases to which married women are exposed from pregnancy, from childbirth, and from nursing.

DISEASES OF PREGNANCY.

In treating of pregnancy we have pointed out that it was a healthy and happy condition to most women. The exceptional cases are mainly those in which the health is injured by mental trouble or anxiety. Thus the young and delicate girl newly married is full of vague alarms in regard to the pains and dangers of her untried path to maternity. She frets herself and embitters her life during those months in which tranquility is of the utmost importance. Is it surprising, then, that her health should be disordered, and that she should suffer from some of the diseases incident to the pregnant state?

Again, the mother of a large family, but the mistress of a small income, is distressed by the thought of additional expense, which it seems to her, particularly in her nervous state, impossible to meet. This condition of protracted anxiety is ill fitted to enable her to resist any tendency to disease to which she may be exposed. Indeed, prolonged vexation from these and other causes not unfrequently tend to _puerperal mania_ (a disease of which we shall shortly have something to say), or to some other nervous affection.

The wife during pregnancy should therefore be treated with unusual kindness by those about her, and every attempt made to soften her lot. The erroneous impression prevails among some that the pregnant wife should enure herself to toil and hardship. This notion is doubtless due to the observation that domestic animals that are subjected to a life of labor bring forth their young with little suffering. 'The cow in the country farm living unfettered in the meadow until the day of calving, has in general a safe and easy labor. The poor beast, on the contrary, which is kept in a town dairy, has a time so incredibly dangerous that the proprietor generally sells off his stock every year, and replaces it with cows in calf; such cows not being put into the stalls till within six or eight days of the expected period of labor. The deduction from this is that an artificial mode of life--a life maintained by improper food, and without a sufficient supply of pure air, or a due amount of exercise--has a most deleterious influence upon the process of labor; and not that a toilsome existence, embittered with all the pains and anxieties of poverty, gives comparative immunity from danger in the hour of childbirth.' One of the discomforts of pregnancy is--

MORNING SICKNESS.

This affection, when confined, as is usually the case, to the morning and early part of the day, rarely requires much medical care. Its absence, which, as we have said, is a frequent cause of miscarriage, is more to be regretted than its presence especially as it is apt to be replaced by more serious troubles.

Relief will be afforded by washing the face and hands in cold water, and taking a cup of milk or a little coffee and a biscuit or sandwich, _before raising the head from the pillow_ in the morning, remaining in bed about a quarter of an hour after this early meal; then dressing quickly, and immediately going out for a half-hour's walk. Rest in a half-recumbent posture during the day, particularly after meals, is beneficial. The affection is mostly a nervous one, and is best combated by eating. The food should be plain and unirritating, but nutritious, and should be taken frequently, in small quantities at a time.

When the nausea and vomiting are excessive, and continue during the day, there is generally some disordered condition of the digestive apparatus.

This may be corrected by taking at night a tea-spoonful of the confection of senna, a pleasant preparation of this ordinarily disagreeable medicine, and by drinking three times a day, before each meal, a wine-glassful of a tea made with columbo. Half an ounce of powdered columbo should be added, for this purpose, to a pint of boiling water.

Dr. John H. Griscom of New York recommends the bromide of potassium, which is a harmless medicine for domestic practice, as affording the most useful means of arresting the nausea attendant on pregnancy.

The following prescription may be compounded by any druggist, and will often be found very effective:

Take of Bromide of Potassium, two drachms,
Cinnamon water, three fluid ounces.

Of this a dessert spoonful may be taken two or three times a day. It may be used with confidence as an entirely safe and harmless remedy in this troublesome affection.

A prescription frequently ordered for the nausea of pregnancy by the late distinguished Dr. Meigs, consisted of equal parts of sweet tincture of rhubarb and compound tincture of gentian--a dessert spoonful to be taken after meals.

_Pain in the abdomen_, caused by the distension of its walls, may be relieved by the application of equal parts of sweet oil and laudanum.

Another common and annoying, but rarely dangerous, trouble during pregnancy is--

VARICOSE VEINS.

The veins of the legs become distended, knotted, and painful. Women who have borne a number of children suffer most from this affection. It seldom attacks those passing through their first pregnancies. It ordinarily first shows itself during the second pregnancy, and becomes rapidly worse during the third or fourth.

Although it is difficult to cure this disease during the continuance of the pregnancy, much can be done to prevent its occurrence, and to relieve it when present. Tight garters worn below the knee, and closely laced corsets, tend to cause and increase this swollen condition of the veins. Neither should be used during pregnancy.

Relief is best afforded to the suffering parts by means of a well-made and adjusted _elastic stocking_, which may be readily procured from a druggist or surgical instrument maker. In severe cases it may be necessary for the patient to keep herself as much as possible in the recumbent position on the bed or sofa. In all cases the feet should be supported when seated, so as to keep the blood from further distending the already swollen veins.

PILES.

That painful condition of the veins of the lower bowel known as hæmorrhoids, or piles, is a not unfrequent annoyance to pregnant women. Sometimes it is caused by prolonged constipation. During the period of pregnancy, therefore, constipation should be guarded against.

Ordinarily the piles are small, and of little consequence beyond the slight uneasiness they occasion. The trifling loss of blood from them is of no account, and often beneficial. The case is different, however, when the piles are large and painful, and give rise to much pain and copious bleeding. They then require prompt treatment.

In the _treatment_ of piles the first point to be aimed at is to keep the bowels moderately open. It must not be forgotten, however, that during pregnancy only the mildest of purgatives are ever to be given. Castor oil, although a disagreeable, is a most excellent prescription in these cases. A small dose, repeated when necessary, will be found to act most kindly. If this remedy be too repugnant to the patient, small quantities of citrate of magnesia, or of cream of tartar, or of some of the natural mineral waters, may be employed. Small injections of lukewarm water are also of great service, and may be tried instead of laxatives.

After every movement the parts should be well sponged with cold water, and an ointment of galls and opium, procured from the druggist, applied.

If the parts become very much inflamed, warm poultices or hot chamomile solutions should be used, and the patient kept in bed until the inflammation subsides.

No attempt is to be made to effect the radical cure of piles during pregnancy. Any such attempt, besides being dangerous, is unnecessary, for the piles usually disappear of their own accord after the confinement. Every effort to make the sufferer more comfortable in the manner we have suggested is, however, right and safe.

DIARRHOEA.

Some women always suffer from looseness of the bowels during pregnancy; others are very liable to attacks of it during this period, either coming on without any assignable cause or easily excited by any slight indiscretion in eating. In many instances these attacks alternate with constipation or with morning sickness.

The diarrhoea, if at all severe or prolonged, should not be allowed to go on unchecked, for it quickly weakens the patient and predisposes her to abortion. The foetus is especially endangered when the passages are attended with much bearing-down pain. In some exceptional cases, however, a slight diarrhoea seems to be beneficial, for every attempt to remove it appears to do harm; but these instances are very rare.

The _treatment_ required is a simple, and must be a cautious one. Ordinarily no medicine will be needed. If the patient will merely confine herself to milk and arrowroot and rice for twenty-four hours a cure will be effected in mild cases. When it is apparent that the attack has been caused by improper food, a table-spoonful of castor-oil or a tea-spoonful or two of tincture of rhubarb will remove the offending material in the bowels, upon the presence of which the diarrhoea depends. A small injection of a tea-spoonful of rice water and thirty or forty drops of laudanum will often speedily arrest the excessive discharges, and relieve the pain.

CONSTIPATION.

No woman while pregnant should allow several days to elapse without a movement from the bowels. The symptoms of constipation, slight at the outset, soon cause great inconvenience. Among the effects, which, sooner or later, show themselves, may be feverishness, sleeplessness, headache, distressing dreams, sickness at the stomach, severe bearing-down pains, and piles.

Medicines are rarely required in the treatment of constipation, and the pregnant woman should never take an active purgative, excepting under medical advice. Outdoor exercise and regularity in soliciting nature's calls, together with a change in the diet, will usually have the desired effect. Brown bread, wheaten grits, oatmeal gruel, ripe fruits, fresh vegetables, stewed prunes, or prunes soaked in olive oil, baked apples, figs, tamarinds, honey, and currant jelly, are all laxative articles which should be tried.

In some instances a tumbler of cold water drunk the last thing at night, and another the first thing in the morning, will act in a most satisfactory manner. If the constipation should resist these safe and homely remedies, which will rarely be found the case, then medical assistance should be called in. On no account should the wife herself, or in accordance with the counsel of any non-medical friend, resort to purgative drugs.

COUGH.

A troublesome cough sometimes affects delicate, nervous women during the early months of pregnancy. If it be not very frequent nor severe, it requires no attention, as it will pass away of itself in a short time. When, however, it disturbs the sleep at night, renders the patient anxious, and causes headache and weariness, it is time to do something for it. It may, indeed, be so violent as to threaten abortion on account of the forcible concussion of the abdomen it produces.

A tea-spoonful of paregoric occasionally repeated during the day will be found a most efficient soothing remedy.

WAKEFULNESS.

Sleeplessness, always distressing, is particularly so to pregnant women. If prolonged, it leads to serious consequences. It should receive, therefore, the most prompt attention.

The _causes_ of sleeplessness during pregnancy are numerous. Dyspepsia is one of them. Whenever indigestion is present the diet should be plain and simple, and everything avoided which produces heartburn, sourness, or flatulency. It is important also not to take tea or coffee late in the afternoon or evening--a late cup of either being a frequent cause in itself of sleeplessness.

Sometimes the reason for the wakefulness will be found in a want of exercise or too constant confinement to closely-heated rooms. Or, it may be that exciting novels are read late in the evening. Perhaps the evening meal is too heavy and taken too late.

The _treatment_ of sleeplessness consists first, of course in the removal of the apparent cause. The patient should have a regular hour for retiring, which should be an early one. The bed-room should be quiet, well ventilated, and slightly warmed. The bed coverings must not be too heavy nor the pillows too high.

A warm bath of the temperature of 90 to 96 degrees Fahrenheit, taken just before going to bed, often invites sleep. A rapid sponging of the body with warm water may have the same effect. A tumbler of cold water, when the skin is hot and dry, swallowed at bed-time, sometimes affords relief. If the bowels are constipated relief should be sought in the manner we have just mentioned in speaking of constipation.

When there is nervous excitement at night, and the means we have advised fail to propitiate 'nature's soft nurse,' there is a sedative medicine which may be used with safety and effect--it is bromide of potassium. The same proportion which we have given for the treatment of morning sickness (see page 355) may be now used. Have the three-ounce mixture put up by the druggist, and take a dessert-spoonful or a table-spoonful just before bed-time. It frequently acts almost as if by magic. On no account should recourse be had to opiates or dangerous sedative drugs.

DISEASES OF CHILDBED.

Childbirth being a healthful physiological condition, is usually neither attended nor followed by mischievous results. Occasionally, however, the mother suffers in consequence of the prolonged or difficult character of her labor. The longer the labor the greater the danger to both mother and child. Thus childbirth pangs prolonged beyond twenty-four or thirty-six hours are much more apt to be attended with danger or followed by disease than those terminated within a few hours.

The following aphorisms were laid down by the late distinguished Professor James Y. Simpson, namely:--

The mother is more liable to suffer under diseases of the womb after long than after short labors. The child for some time after birth is more liable to disease and death, in proportion as the labor has been longer in its duration. First labors are longer in duration than subsequent ones, and in a proportionate degree more complicated and dangerous to mother and child. Male births are longer in duration than female births, and in a proportionate degree more complicated and dangerous to mother and child.

Many tedious confinements, however, are happily terminated without the slightest injury to mother or child. Whenever the labor has been unusually prolonged, unusual care and caution should be exercised in the treatment of the mother and infant for many weeks after the event.

One of the most distressing affections to which women are exposed from childbirth is

PUERPERAL MANIA.

This is a variety of insanity which attacks some women shortly after childbirth, or at the period of weaning a child. The period of attack is uncertain, as it may manifest itself first in a very few days, or not for some months after the confinement. Its duration is likewise very variable. In most instances a few weeks restore the patient to herself; but there are many cases where judicious treatment for months is required, and there are a few where the mental alienation is permanent, and the wife and mother is never restored to her sanity.

The question has been much discussed, Whether such a condition is to be imputed to a hereditary tendency to insanity in the family, and also whether a mother who has had such an attack is liable to transmit to her children, male or female, any greater liability to mental disease. We are well aware what deep importance the answers to these inquiries have to many a parent; and in forming our replies, we are guided not only by our own experience, but by the recorded opinion of those members of our profession who have given the subject close and earnest attention. To the first query, the reply must be made that in one-half, or nearly one-half, of the cases of this variety of insanity there is traceable a hereditary tendency to aberration of mind. Usually one or more of the direct progenitors, or of the near relatives of the patient, will be found to have manifested unmistakable marks of unsoundness of mind. In the remaining one-half cases no such tendency can be traced, and in these it must be presumed that the mania is a purely local and temporary disorder of the brain. The incurable cases are usually found in the first class of patients, as we might naturally expect.

The likelihood of the children, in turn, inheriting any such predisposition, depends on the answer to the inquiry we first put. If the mania itself is the appearance of a family malady, then the chances are that it will pass downward with other transmissible qualities. But if the mania arise from causes which are transitory, then there is no ground for alarm.

An inquiry still more frequently put to the physician by the husband and by the patient herself after recovery, is, Whether an attack at one confinement predisposes her to a similar attack at a subsequent similar period. There is considerable divergence of opinion on this point. Dr. Gooch, an English physician of wide experience, is very strenuous in denying any such increased likelihood, while an American obstetrician of note is quite as positive in taking the opposite view. The truth of the matter undoubtedly is, that where the mania is the exhibition of hereditary tendency, it is apt to recur; but where it arises from transient causes, then it will only occur again if such causes exist.

THE IMPORTANCE OF PREVENTION.

Here, therefore, we perceive the importance of every woman, who has had, or who fears to have, one of these distressing experiences, being put on her guard against disregarding those rules of health the neglect of which may result so disastrously. One of the most powerful of these causes is _exhaustion_. We mean this in its widest sense, mental or physical. In those instances where mania appears at weaning, it is invariably where the child has been nursed too long, or where the mother has not had sufficient strength to nourish it without prostrating herself. It should be observed as a hygienic law, that no mother should nurse her children after she has had one attack of mania. The mere nervous excitement is altogether too much for her. She must once and for ever renounce this tender pleasure. We even go so far as to recommend that no woman in whose family a mental taint is hereditary shall nurse her children.

Anxiety, low spirits, unusual weakness from any cause, are powerful predisposing causes; and therefore in all cases, especially in those where the family or personal history leads one to fear such an attack, they should be avoided. The diet should be nourishing and abundant, but not stimulating. Cheerful society and surroundings should be courted, and indulgences in any single train of ideas avoided. As for directions during the attack, they are unnecessary, as to combat it successfully often tasks the utmost skill of the physician; and it will be for him to give these directions.

WHITE-FLOWING.

This affection, though not confined to married women, is quite common during pregnancy and after confinement. There are few married women who pass through their lives without at some time or other having suffered from it.