242 



MIDWIFERY. 



Of the 



IVeirnant 



State. 



CHAP. III. 

 Of the Disorders incident to the Pregnant Stale. 



state. 



Of the dis- IT is riot to be expected that the uterus can undergo 

 orders incl- the great and active changes which it experiences after 

 dent to the conception, without affecting to a greater or less de- 

 prcgnant gree the whole frame, and particular organs. The 

 general sympathy which exists amongst the different 

 parts of the body, as well as the particular influence 

 which individual systems and viscera exert on one an- 

 other, render it impossible for one part to have its 

 action materially altered, increased, or diminished, 

 without producing more extensive effects. 



The effects produced by the gravid uterus may be 

 classed under the following heads : 1st, Those which 

 arise from the sympathy of particular parts with the 

 uterus, some of which have their activity increased, 

 others diminished. Examples of these we have in the 

 changes produced on the breasts and stomach. 2d, 

 Those which proceed from more general sympathy, as 

 we see exemplified in the nervous and vascular sys- 

 tems. 3d, Those which are occasioned chiefly by a 

 mechanical cause, as oedema of the feet, and swelling 

 of the veins. Few, if any, of these effects, however, 

 can be said to arise purely and entirely from one class 

 of causes. They may be individually referable to one 

 or other class chiefly, but the causes themselves are so 

 interwoven and mixed up with one another, and there 

 are so many reactions, that the classification must be 

 taken with circumspection, and a latitude allowed. 



From the brisk and increased action which goes on 

 in the uterus, so long as gestation continues, and the 

 ovum thrives, we find that a change takes place in the 

 state of the blood. It does not assume an inflamma- 

 tory appearance, but it becomes sizy, an effect not pe- 

 culiar to pregnancy, but produced by many other local 

 irritations. The arterial system is likewise exerted, 

 so that the pulse becomes sharper, sometimes stronger, 

 and generally, in the commencement of pregnancy, 

 variable. The functions dependent on the blood-vessels 

 are also influenced ; animal heat is often increased, the 

 deposition of fat, and perhaps of other constituent parts 

 of the frame, is either actually lessened, or the process 

 of absorption is increased, or both of these take place ; 

 for in general the female becomes thinner. Yet there 

 is rather a redundancy than a deficiency of blood, for 

 plethora is apt to exist during pregnancy. In many 

 cases these effects -appear only in a moderate degree ; 

 in other cases, however, the patient is actually feverish, 

 sleeps almost none, and becomes extremely emaciated. 

 As this condition, like the other disorders of pregnan- 

 cy, arises from the state of the uterus, it is evident that, 

 to long as the latter exists, the former must continue ; 

 and all we can do is, to mitigate what we cannot cure. 

 This is best done by strict attention to the state of the 

 bowels, taking occasionally the saline jalap, avoiding 

 much animal food, every thing of an irritating or heat- 

 ing nature, and even abstaining from all unnecessary 

 quantity of the blandest liquids, sleeping on a firm ma- 

 tress, with no more bed-clothes than are requisite, pro- 

 curing a free ventilation of air, and detracting blood 

 from the veins, if the symptoms do not yield to this re 

 pimen. With regard to exercise, there has been some 

 diversity of opinion ; but all must agree, that where 

 there is a tendency to abortion, this must be abstained 

 from altogether, or taken in great moderation till the 

 period of danger be past. Where there is no cause, 

 however, to forbid it, advantage is very evidently tie- 



rived from regular, but moderate exercise, taken daily 

 to such extent as does not occasion fatigue. It is part- 

 ly from the opportunity of taking such exercise with 

 facility, and partly from the salutary influence of pure 

 air on the whole frame, that many patients experience 

 great benefit from spending the period of pregnancy in 

 the country, although inconveniences of a different na- 

 ture may result from this practice. The stomach and 

 bowels very early are affected by pregnancy, producing 

 sickness, vomiting, heartburn, fastidious appetite, cos. 

 tiveness, or an opposite condition of the bowels, and a 

 train of secondary symptoms ensuing therefrom. When 

 these disorders are in a moderate degree, little requires 

 to be done ; and indeed some men of judgment have 

 reasoned themselves into a belief, that, as they arise na- 

 turally from pregnancy, we ought not to be very soli- 

 citous in removing them. This principle, if followed 

 up, would lead to most absurd as well as dangerous 

 practices in medecine, and, in the present case, would, 

 particularly with regard to costiveness, make us over- 

 look, and indeed encourage a very decided cause of 

 both distressing and formidable disease. Partly from, 

 the effects produced by the uterus itself on the nervous 

 system, but still more decidedly by the state of the 

 bowels during pregnancy, many hysterical and anoma- 

 lous affections are produced, and irregular and painful 

 actions excited in distant parts ; and, from the same 

 cause, the brain itself is acted on, and a determination 

 of blood made to the head, which produces severe head- 

 aches, convulsions, or apoplexy itself. We are yet ig- 

 norant of much which relates to the mutual re-action of 

 the nervous and sanguiferous systems, and perhaps over- 

 look too much the agency of the spinal marrow in 

 many of those severe disorders of the two systems, 

 which have their origin in the state of the abdominal 

 viscera. Nothing tends more to prevent those harass- 

 ing, and often dangerous symptoms, styled nervous, 

 than rigid attention to the bowels. But experience and 

 observation have taught the writer, that when these 

 have actually taken place, particularly if attended with 

 a sense of fulness in the head, much giddiness, or head- 

 acli of an oppressive kind, or any degree of stupor, that 

 the lancet is the mean chiefty to be trusted. Fashions 

 are not confined to Bond Street, but prevail as much 

 amongst physicians as milliners; and perhaps the present 

 system is to trust too much to the efficacy of purgatives, 

 and too little to the effect of blood-letting. 



It is not meant to say that the common hysterical 

 fits which may attack women about the early period 

 of pregnancy, or at quickening, require the lancet, or 

 that these fits, at any period, demand it, unless accom- 

 panied with much plethora. They may be overcome 

 by purgatives, light diet, and antispasmodics, aided 

 sometimes by tonics. But there is no fallacy more 

 dangerous than the doctrine, that venesection is impro- 

 per, merely because the complaint assumes the ap- 

 pearance of hysteria. There are few disorders in the 

 pregnant state, which, when severe, are not relieved by 

 bleeding, unless they evidently are dependent on a 

 state of debility. The very sickness and vomiting of 

 pregnant women are best relieved by this remedy, 

 which subdues the excessive irritation of the stomach ; 

 or, if it fail, the application of leeches to the epi fe astric 

 region is almost certainly beneficial ; whilst a general 

 plan is followed for the relief of a systematic condi- 

 tion, particular remedies must be employed for ob- 

 viating special symptoms: tl<u heartburn must be re- 

 moved by antacids, such as chalk or magnesia, com- 

 bined with ammonia or soda; flatulent pains, by laxsu 



Of the 



Pregnant 



State. 



