PART II MOTHERHOOD (Part 3)

the free use of drinking water. If water is distasteful, the increase of salt in the food will give a desire for it. It should be added that hard water is extremely constipating. Boiling it will remove in part at least the substances which make it hard, and this should always be done if soft water is not available. It may be brought to boil, cooled, then put in bottles and chilled. Long boiling gives it a disagreeable taste. Exercise helps in all normal functions, and a gentle circular rubbing of the abdomen, with an increase of pressure over the left side, sometimes stimulates in- testinal activity. If the trouble is obstinate and persistent, drugs or injections should be used, for it is of the utmost im- portance that the system be kept in order and the wastes of the body be removed. What to avoid Free drinking of water Exercise AILMENTS OF PREGNANCY 205 INCREASED SALIVATION A patient is sometimes troubled with an excessive secretion of saliva, which may continue for a few weeks, but which sometimes persists throughout preg- nancy. It is not a dangerous ailment, but may be a sugges- troublesome one, especially when the glands become ^°"esf fj°r tender and the gums are swollen and recede from the mouth teeth. Astringent mouth washes, such as hamamelis and laxa- or tannin, generally relieve somewhat, and if the se- cretion of the intestinal tract is increased by saline laxatives (Rochelle or Epsom salts) the excessive sali- vation may be checked. VARICOSE VEINS AND HEMORRHOIDS, OR PILES Both these conditions are caused by undue pres- sure upon the large veins, causing dilation of the branches below them. In the condition known as varicose veins those vessels in the legs become much swollen, as the word . ,. , 1 • 1 Varicose varicose indicates, and their course becomes tortuous, veins and This trouble is in itself very painful, and may lead to a serious difficulty if not remedied. This difficulty is rupture of the vein and consequent hemorrhage. To guard against this possibility a bandage or elastic stocking should be constantly worn if the veins appear prominent. The bandage may be of flannel, thTieg"1* cut on the bias, and should be evenly and closely ap- plied, beginning at the ankle. Very gentle rubbing, always away from the ex- tremities, and toward the heart, sometimes relieves the pain or feeling of pressure, and if the skin feels ofhrubbinef dry, or as if tightly stretched, oil may be used for this rubbing. This is equally useful treatment for the abdomen as the tension becomes great. massage is not effective 206 MOTHERHOOD It is a very good plan to give the breasts also a Prepara- little preparatory treatment, consisting either of alco- ment of hoi bathing, which toughens the skin and makes it the breasts |egs sensjtive when the nursing begins, or of a gentle rubbing with oil, always toward the nipple, which should be pulled out with the fingers if it is not prominent. A baby will often' refuse to nurse if the breasts have very small or sunken nipples, and this treatment carried on for a few weeks before delivery will put the breasts in good condition, make the skin more flexible and less liable to chap, and will save much discomfort. It is often the pressure of tight corsets which has Methods made the nipple flat, and if the massage treatment is e not effective it can be drawn out with a breast pump or similar apparatus. Take a large-mouthed bottle, fill it with boiling water, then empty it and quickly invert over the nipple. As the air in the bottle cools a partial vacuum will be formed, and will cause the nipple to be drawn out Another still more simple method is to place the bowl of an ordinary clay pipe over the nipple and, with the stem between the lips, draw out the air. Very little effort exhausts the air and pulls the nipple well out. If this practice is regularly observed, the nipples Valuable can t>e brought into' much better condition before the results to baby is born, and the amount of worrv and work that baby and •* mother is saved is not appreciated until one has suffered the annoyance of having a hungry baby entirely unable to take the breast. Hemorrhoids or piles are caused also by the con- The cause gested condition of the veins. Those vessels in and rhoids"10 about the rectum become swollen, and small tumors appear, which may protrude on the outside or may be entirely internal. Constipation is often the cause, AILMENTS OF PREGNANCY 207 though sometimes the trouble is present when the bowels are in normal condition. Rest in bed generally corrects the congestion. It may, however, be persistent, when it is intensely pain- Methods ful, and is often accompanied by a nervousness which relief1"1 can not fail to react on the entire system. Com- presses wet in witch-hazel, diluted one-third with water, either cold or warm, give relief, and if the hemorrhoids are internal an injection of about a tea- cup of this witch-hazel solution retained in the bowel is often helpful. An ointment made of witch-hazel tends to contract these small tumors and thus to re- lieve the pressure on the nerves. Diarrhoea and constipation have an equally bad effect upon the condition of pregnancy, and an especial effort should be made to keep the bowels well regu- lated. DECAY OF TEETH That this trouble should accompany childbirth is not surprising when one considers what demands are made upon the vitality of the mother. It seems to be universally true that dental difncul- Demand ties follow the pregnant state, and often the nervous syS°temhe condition of the woman is such that repairing- treat- lfa£s ,t0. r ° difficulties ment is impossible. Such temporary work as can be with the done is, of course, advisable, to save pain, and to pre- serve the teeth. Otherwise Friar's Balsam, Compound Tincture of Benzoin, often gives relief. Iodine may help, and Reliefs in cases of neuralgia hot dry applications are sooth- ing. It may also be comforting to remember that these difficulties, like the unpleasant moth patches or pigmentation of the skin, pass away with the birth of the child. 208 MOTHERHOOD PALPITATION This is more often present during the later months, theUSeai°f w^en tne uterus has risen so high in the abdominal pitation cavity that by its pressure it interferes with the action of the heart. Very little can be done to relieve this condition, but it is usually of short duration. Coughing and labored breathing during pregnancy Cough- aiso need occasion . no alarm. In the early months ing and * labored they are doubtless nervous or sympathetic troubles, ing and later they are due to the pressure of the enlarged uterus. SCIATICA Pain in the sciatic vein which runs down the Causes of under side of the leg from the thigh is sometimes caused by pressure due to constipation or to a dis- placement of the uterus. If brought about by the former, laxatives and thorough rectal irrigations con- taining oil or glycerine, to empty the bowel com- pletely, is the treatment suggested. Constipation should be especially guarded against. PRURITUS A general itching of the skin, with no sign of erup- The cause tion, is a nervous disorder which is very trying, and of the ' . , T . J ° , itching may be a great strain on the system. It is aggravated relief3 a^ the periods when the menses would ordinarily occur. Baths in water containing baking soda relieve the itching, particularly if followed by a thorough rubbing with vaseline. Bismuth, zinc oxide, or starch may be used to powder the skin, and linseed oil or lime-water may be applied on a cloth. It is a condi- tion which is difficult to cure, but which usually ends with the birth of the child. AILMENTS OF PREGNANCY 209 IRRITATION OF THE BLADDER Irritation of the bladder is usually caused by pres- sure of the enlarging womb during the first months Remedial of pregnancy. Mucilaginous drinks, such as flax- seed tea or slippery elm, will sometimes relieve the pain, and keeping the bowels open assists by freeing the bladder from additional pressure. ABDOMINAL BANDAGE Sometimes the abdomen is so large that moving about is difficult, and there may be considerable pain felt on walking. A fitted bandage can be used in such The use Abdominal Bandage cases, and may give great relief. Regular abdominal bandages can be purchased at shops where surgical of,cabU or hospital supplies are kept, but they are very ex- j^1"3 pensive, and it is possible to cut and fit them at home, using one of the paper patterns. Unbleached muslin, lasting, or twilled cotton are suitable materials, and the bandage should be closely fitted so that it will actually support the dependent abdomen. These, then, are some of the minor ills that may complicate the state of child-bearing. They may be extremely uncomfortable and they may restrict one's 210 MOTHERHOOD method of living, and clamor till they draw attention to themselves, and divert one from the desired state Minor ills of healthy-mindedness. But after all these ailments nancyCg are temporary, none of them lasting beyond the nine andPnotry montns> and most of them merely incidental during alarming that time. None of them need occasion alarm, if if ordi- . . nary care ordinary care is taken, as in the case of the varicose veins to bandage the legs, or in constipation to cor- rect the difficulty and keep the system in order. THE PHYSICIAN There are symptoms, however, which need to be when the regarded, which if noticed in time and reported to a mother" good physician may be relieved, but which may result choose her n alarming disease if allowed to run their course. It physician [s on this account that I should advise the young mother to choose her physician and put herself under his care during the first months of her pregnancy. Certain symptoms, such as persistent headache, Symptoms spots before the eyes, scanty, high-colored urine, a for special x J J ° treatment dropsical, appearance, or flowing before term, should always be reported as soon as they are noticed, be- cause they may be indications for special treatment. The urine is a valuable guide to the physician in The urine diagnosis, and frequent examinations of it are ad- as a guide yjg^j^ Three pints in the twenty-four hours is the normal amount, and often if the quantity diminishes it is only because the patient is not taking enough fluid, and it can be brought up by increasing the daily supply of water. It is perfectly feasible for a woman to have a its prepa- little oversight in regard to the quantity passed, and ration for jts appearance, and if she finds either out of the nor- examina- x x ' tion mal she should at once send a specimen to her phy- sician for examination. A pint graduate-glass can be AILMENTS OF PREGNANCY 211 used for a measure, and the amounts recorded, or a large bottle or jar can be substituted. The pint or half-pint measure can be indicated on the bottle by strips of cloth, paper, or adhesive plaster pasted on. The receptacle for the urine should be washed and scalded each day. In sending a specimen to the Sanitary doctor special care should be taken to wash the bottle necessary and the cork very thoroughly, as impurities added in this way may interfere with the result of his examina- tion. A physician is then capable of judging whether the condition is a serious one, and he can relieve the minds of his patient and of her friends, besides giving the essential remedies. • MiDWIVES I have spoken of engaging a physician, and have not considered any alternative. There ought to be none, and yet midwives do a flourishing business, in The dan- spite of the increase of knowledge upon the subject f;tt7eUS of proper care in confinement. If we could trace Jj °^dge back the histories of the cases of blood-poisoning fol wives lowing childbirth that are brought to our hospitals — which, in fact, has been done — we should find a sur- prising proportion of them laid at the door of the midwife. A little knowledge is a dangerous thing in the practice of medicine no less than in philosophy, and this is where the danger lies. Childbirth is so nearly a normal process that many women pass through the ordeal safely with assistance only in regard to separating the child from the after-birth. The trained and licensed midwives do understand fairlv well the after-care of mother and And their ' 1 -1 i i e' • consequent child, but most of them are entirely unequal to any inability emergencies, and so suspicious of any lack of confi- emergcn- dence in their ability that they often will not confess cies 212 MOTHERHOOD lack of knowledge till the trouble has become com- plicated. Any medical student who has served his term in Principles a hospital understands the principles of absolute sur- cai^iean- gical cleanliness and the importance of carrying them regarded" ou* *n confinement cases. But with many midwives these principles are unappreciated or disregarded, and while they may be clear-headed, capable, and vigor- ous in normal cases, their lack of technical knowledge makes their presence in the lying-in chamber a men- ace rather than a safeguard. This is probably truer of the older women of this class than of the younger ones, who have much more thorough training, but it is impossible that they should have the technical skill of the reliable physician. ADVICE OF FRIENDS If it is wise to consult a physician it is equally ad- Do not visable not to consult one's friends and neighbors. consult ■ . 7^ friends or So many well-meaning and kindly women have a neig ors mor^^ jove for ^ abnormal that they treasure all the grewsome tales they have heard and retell them — in even more grewsome detail — for the benefit of the young expectant mother, who may be puzzled by per- fectly natural symptoms. I was called the other day to see a small boy who A touch- had pneumonia. The mother met me at the door, in mg story tears^ ancj as j went into the room she said sadly, "I am afraid Donald is leaving me." One or two neigh- bors were standing about in the little room, looking their sympathy. . I went to the bed where the child was lying. His pulse was full, regular, and not as fast as the day before, and the little hand I held in mine was moist and cool. His eyes were closed, not half-opened as AILMENTS OF PREGNANCY 213 sick children's often are, and his breathing was deep it was and easy. It was returning health, not death, that heaith,ing had quieted his delirium and had put him to sleep. not death His mother told me afterward that she had not been so alarmed when he became quieter till a friend had come in and, on looking at him, had shaken her head and said, "This is the end," and had gone out without more words. It was absolutely unnecessary alarm, and, even if his condition had been serious, nothing would have been gained. The mother, who needed all her strength and alertness, was undone and helpless. This is somewhat far afield from our subject, ex- cept to show that the judgment of the untrained person may better be withheld, especially when it finds no helpful expression. Cheer and hopefulness take us out of many a slough of despond, and the prospective mother, par- ticularly at the birth of the first child, should have a hopefulness double portion. It is a strange road that she treads, prospective and there are dark places where she needs the mother friendly hand and reassuring word to give her courage. SPECIAL RECEIPTS— IN NAUSEA This is one of the most digestible forms of milk, Koumiss and can often be retained by a very delicate stomach when other foods cause nausea. Dissolve one-third of a yeastcake in lukewarm water. Stir the water into one quart of milk of the same temperature. Add one tablespoon of sugar and fill bottles within one and one-half inches from the top. Cork and invert the bottles, and let them stand at a temperature of 8o° F. for six hours. The corks should be tied securely unless bottles with 214 MOTHERHOOD patent stoppers are used. Chill and serve on the following day. If the digestion is impaired it may be well to give Peptonized partially predigested milk, which will relieve the stomach of a part of its work. It must be understood that the digestive ferment used in such a preparation continues its action as long as it is kept at a favorable temperature. Con- sequently the milk must be taken very shortly after it is made, or must be kept very cold, when the proc- ess is retarded ; or it must be quickly raised to the boiling point, which entirely destroys the activity of the ferment. Put two tablespoons of cold water in a goblet or glass; dissolve in this the powder contained in one of the Fairchild peptonizing tubes, then add fresh cold milk to fill the glass; stir the mixture thoroughly, and drink at once. Warm milk may be used instead of cold, when the process of digestion will be carried a little further. If the milk with the powder is brought rapidly to the boiling point, further digestion will be checked and the sweetness will be retained. The difficulty is that the flavor of the milk may change unless this is very carefully prepared. The bitter taste which develops does not indicate any harmful change in