The Mother and Her Child

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Should the urine at any time become highly colored, take a specimen to
your physician at once. Twenty-four hour specimens of urine should be
taken by the patient to her physician every two weeks. Do not send
it--take it.

LEUCORRHEA

While leucorrhea is an unusual complication of pregnancy, it is often
very troublesome and sometimes irritating. Do not take a vaginal
douche unless it has been ordered by your physician, and even then
make sure that the force of the flow of water is very gentle. The bag
of the fountain syringe should be hung only about one foot above the
hips. Soap and water used externally, followed by vaseline or zinc
ointment, will usually relieve the accompanying irritation.

THREATENED ABORTION

In the third chapter attention was called to the formation of the
placenta or "after birth," on the site of the attachment of the cocoon
embryo. At this particular time of the pushing away of the embryo from
the uterine wall, one of the accidents of pregnancy occurs, in which
the embryo becomes completely detached and starts to escape from the
uterus, accompanied by varying degrees of pain and hemorrhage. The
symptoms of this threatened abortion are:

1. Heavy menstrual pains.
2. Backache.
3. Hemorrhage.

The approach of the calendar date of the third month of pregnancy
should be watched for, and all work of a strenuous nature studiously
avoided; while at the first signs of the backache or any unusual
symptom, the expectant mother should immediately go to bed and send
for the physician. One patient who had aborted on four different
occasions was able to pass this danger period by adhering to a rigid
program of prevention during her fifth pregnancy. Two weeks before the
third month arrived she discontinued her teaching and went to bed. She
remained there four weeks, thus running over into the middle of the
following month. Gradually, she resumed her duties of teaching,
carried her precious bundle of life to full term, and is now the proud
and happy mother of a splendid baby girl.

Should abortion seem imminent, from one-eighth to one-fourth of a
grain of morphine sulphate will greatly reduce all uterine
contractions, and this, with the general quieting effect on the whole
system, will usually suffice to prevent an abortion. The patient
should quietly remain in bed from three days to one week.

If the abortion takes place--if a clot accompanied by hemorrhage is
passed--save everything, lie in bed very quietly and send for your
physician at once; and when he does arrive, be content if he does not
make an internal examination at once, for if he should there is more
or less danger of infection. And I repeat--throw nothing away--burn
nothing up, save everything that passes until your physician has
carefully examined it.

SUDDEN ABDOMINAL PAIN

Sudden or severe pains in the abdomen should be reported at once to
your physician, while you should immediately go to bed and quietly
remain there until you receive further instruction from your doctor
when he calls.

In the later stages of pregnancy any appearance of blood should
likewise be noted and reported without delay. These symptoms may not
always be serious, but they are also associated with grave
complications, and should, therefore, be given prompt attention.

MISCARRIAGE

Abortion is a term used to designate the loss of the embryo prior to
or at the third month. Miscarriage applies to the expulsion of the
fetus or emptying of the uterus after the third month. It is possible
for a miscarriage to occur anytime during the interim between the
fourth and ninth months. After the uneventful passing of the third
month, if an accident threatens, we instruct the mother to remain
quietly in bed three to five days at the calendar date comparable with
each menstrual period; and as she approaches the seventh month, we
adjure her to be unusually careful and prudent.

The causes of miscarriages are many: Disease of the embryo, imperfect
fetal development, some constitutional disease of the mother, a faulty
position of the uterus, or it may result from something unusual about
the lining of the uterus such as an endometritis--an inflammation of
the mucus membrane.

Expectant mothers who manifest symptoms of a threatened miscarriage
should studiously avoid such exercises as climbing, riding, skating,
tennis, golf, dancing, rough carriage or automobile riding, and such
taxing labor as sweeping, lifting, washing, running the sewing
machine, window cleaning, the hanging of pictures, draperies, etc.

CRAVINGS

Within reason, a pregnant mother should follow her natural appetite
and satisfy her dietetic longings. Should she desire unusual articles
of food, as far as possible she should have them. The idea has long
prevailed that if the mother does not get what her longing soul
supremely desires, that the on-coming baby is going to cry and cry
until it is given what the mother wanted with all her heart and did
not get. Such an idea is the very quintessence of folly and the
personification of foolishness and superstition.

Many a precious babe has suffered as a victim of this notion of
"craving" and "marking." One mother gave her baby a huge mouthful of
under-ripe banana because "she knew that was just what he wanted,
because, when pregnant, she had craved and craved bananas and for some
reason or another she did not get them." The soft, smooth piece of
banana slipped down the baby's throat--on into the stomach and
intestines--caused intestinal obstruction and finally the end came;
and we registered one more victim to the fallacies of fear and the
superstitious belief in "cravings" and "markings." Occasionally some
cravings are unusual and freakish, for instance, egg shells, leather,
candles, chalk, and other abnormal tastes are developed. Of these we
have only to say, "Rise above them, become mistress of the situation
and change your longings." If such abnormal cravings come to you in
the kitchen, don your bonnet and go at once out of doors and take a
walk. Don't be foolish just because somebody told you foolish stories
about these things.

CONSTIPATION

Bowel hygiene is an important part of the management of pregnancy.
Constipation often proves to be very troublesome. In another chapter
this subject is treated at some length. Here, we pause only long
enough to say that habit has much to do with this difficulty. A
regular time should be set apart each day for attending to this
important matter.

HEMORRHOIDS

Of all the maladies that the human family falls heir to, hemorrhoids
are among the commonest and, we may add, the most neglected. Any woman
who enters pregnancy, suffering from hemorrhoids, is going to have her
full share of suffering and pain before she has finished with her
labors. Taken early, they may be greatly helped, if not entirely
relieved, by the daily use of the medicated suppository (See
Appendix). The bowel movements should never be allowed to become hard,
the dietetic advice of another chapter should be carefully followed
and the oil enema, as described in the appendix, should be used if
necessary. For immediate relief, hot witch-hazel compresses may be
applied; or, in the case of badly protruding piles, the patient should
immerse the body in a warm bath and by the liberal use of vaseline
they can usually be replaced. The physician should be called and he
will advise any further treatment the case may require.

VARICOSE VEINS

Varicose veins or the distension of the surface veins of the legs are
very common among women in general and pregnant women in particular.
The legs should be elevated whenever the patient sits, while in bad
cases they should be bandaged while standing. There are many elastic
surgical stockings on the market today that, if put on before rising
in the morning, will give much relief and comfort all during the day.
Any large medical house or physician's supply house can furnish them
according to your measurements--which should be taken before getting
out of bed in the morning. These measurements are taken according to
instructions and usually are of the instep, ankle, calf of leg, length
of ankle to knee, etc.

CRAMPS

Cramps are sharp, exceedingly painful muscular spasms occurring in the
muscles of the calf of the leg, the toes, etc. The expectant mother
in the later months of pregnancy awkwardly turns in bed, is suddenly
awakened and without a moment's warning, is seized with a most
excruciating pain in her leg or toe. The most effectual treatment for
these cramps is quickly to apply a very cold object to the cramping
muscle. Extremes of either heat or cold usually relieve as well as the
vigorous grasping or kneading of the muscle. A hot foot bath on going
to bed will often prevent an attack. A long walk in the latter months
of pregnancy should invariably be followed by a short hot bath or a
foot bath. Many attacks may be avoided by this procedure.

SWELLINGS

All swellings should be taken seriously by the pregnant mother to this
extent, that she save a twenty-four hour specimen of urine and that
she personally take it to her physician, with a report of her
"swellings." This symptom may or may not indicate kidney
complications. The blood-pressure together with chemical and
microscopical analysis of the urine will determine the cause.

Slight swelling of the feet is often physiological and is due to
pressure of the heavily weighted uterus upon the returning veins of
the legs. The progress of the veinous blood is somewhat impeded, hence
the accumulation of lymph in the tissues of the legs, ankles, and
feet.

Never allow yourself to guess as to the cause of swellings, always
take urine to the physician and allow him definitely to ascertain the
true cause. All tight bands of the waist and knee garters must be
discarded at this time. The same general treatment suggested for
varicose veins holds here.

GOITRE

The enlargement of the thyroid gland--goitre--is physiological during
pregnancy, and is believed to be caused by the throwing into the
maternal blood stream of special protein substances derived from the
fetus. As just stated, this is more or less physiological, will
usually pass away after the babe is born, and, therefore, need give
the mother no particular concern. Tight neck bands should be replaced
by low, comfortable ones. The bowels should move freely every day, and
water drinking be increased as well as sweating of the skin encouraged
by a short, hot bath, followed by the dry blanket pack, while the head
is kept cool by compresses wrung from cold water. In this manner the
elimination of these poisons is increased through both the skin and
the kidneys.

BACKACHE

The backache of the later months of expectancy is very annoying and
often spoils an otherwise restful night's sleep. This is probably also
a pressure symptom, if the physician's analysis of the urine proves
that the kidneys are not at fault. If you have electric lights in the
home, a very useful contrivance can be made which will give you great
relief. The light end of an extension cord, five to seven feet in
length, is soldered into the center of the bottom of a bright, pressed
tin pail about twelve inches in diameter at the top and nine or ten
inches deep. With the bail removed, screw in a sixteen or thirty-two
candle power bulb and attach the extension cord to a nearby wall or
ceiling socket. This arrangement supplies radiant heat and is called a
photophore (See Fig. 3). Apply this twofold remedial agent--light and
heat combined--to the painful back (underneath the bed clothing) and
our restless mother will go to sleep very quickly. This may safely be
used as often and as long as desired.

[Illustration: Fig. 3. The Photophore.]

PERNICIOUS VOMITING

Persistent, prolonged, and very much aggravated cases of morning
sickness are termed pernicious vomiting. The patient emaciates because
of the lack of ability to keep food long enough to receive any
benefits therefrom.

In treating these cases the sufferer should be put to bed in a room
with many open windows, or, if the weather permit, should be out of
doors on a comfortable cot. She should remain in bed one hour before
the meal is served and from one to three hours afterward. The mind
should be diverted from her condition by good reading, friends, or
other amusements. The utmost care and tact should be used in the
preparation of her food, and art should be manifested in the
daintiness of the tray, etc. We found one mother was nauseated even at
the sight of her tray and so we planned a call that should bring us to
her home at the meal hour. The tray came in with the attendant in
unkempt attire, who said, as she placed it carelessly down on a
much-loved book our patient had been reading: "I heard you say you
liked vegetable soup so I brought you a big bowl full." As I gazed at
the tray, I saw a large, thick, gravy bowl running over with the soup.
I usually like vegetable soup, but at the sight of that sloppy looking
bowl--well, I thought I should never care for it again.

After installing a new maid who had a sense of service and daintiness,
and who took real pleasure in the selection of the dishes for the
tray, as well as the quality and quantity of food served in them, our
patient made speedy recovery, went on to full term and became a happy
mother.

There is no doubt that the mind has very much to do with this vexing
complication of pregnancy. One mother immediately stopped vomiting
everything she ate when told by her husband that "the doctor said he
was coming in the morning to take you away from me to the hospital if
you didn't stop vomiting." Everything known should be tried for the
relief of these patients and in extreme cases, when the mother's life
is endangered, pregnancy should be terminated.

INSOMNIA

The neutral full bath, temperature 97 F., maintained for twenty
minutes to one-half hour, should be taken just on going to bed. The
patient must not talk--must rest in the bath--absolutely quiet. The
causes of insomnia should be determined if possible, and proper
measures employed to remove them. They may consist of backache,
cramps, frequent urination, pressure of the uterus on the diaphragm or
pressure against the sides of the abdomen. The bed should be large,
thus giving the patient ample room to roll about.

The following procedures may be tried in an effort to relieve the
sleeplessness:

Rubbing of the spine, alcohol or witch-hazel rubbing of the entire
body, the neutral bath, or the application of the electric
photophore--described a few pages back--may be made to the painful
part. _Do not resort to drugs_, unless you are directed to do so by
your physician.

HEADACHE

Headaches should not be allowed to continue unobserved by the
attending physician. Measure the daily output of urine, which should
be at least three pints or two quarts. In case of daily or frequent
headaches, notify your physician at once and take a twenty-four hour
specimen of urine to him. Headache is an early symptom of retained
poisons and if early reported to the physician quick relief can be
given the patient and often severe kidney complications be avoided by
the proper administration of early sweating procedures. Water drinking
should be increased to two quarts (about ten glasses) a day. Less food
and more water are the usual indications in the headaches of
pregnancy.

HIGH BLOOD-PRESSURE

Blood-pressure is called _high_ when the systolic pressure registers
above 150 to 160 millimeters of mercury. Pressure above 165 should be
taken seriously and the patient should keep in close touch with her
physician. Tri-weekly examinations of the urine should be made, while
eliminating baths should be promptly instituted. The subject of
blood-pressure in relation to pregnancy will be fully dealt with in
the next chapter--in connection with toxemia, eclampsia, etc.

CHAPTER VI

TOXEMIA AND ITS SYMPTOMS

At the close of the preceding chapter on the complications of
pregnancy, brief mention was made of blood-pressure as a possible
source of anxiety. This chapter will be devoted to a further
discussion of the subjects of toxemia, eclampsia, convulsions, and
especially blood-pressure--in connection with other leading symptoms
of these serious complications of pregnancy.

TOXIC SYMPTOMS

In a former chapter we learned that the developing child nearly
doubled its weight in the last two months of pregnancy. As the child
grows, its metabolic waste matter is greatly increased, while all
these poisonous substances must finally be eliminated by the mother.
Now, the mother's waste matter is of itself considerably increased;
and so, if the kidneys, the liver, and the skin are already over-taxed
in their work of normal elimination--if they are already doing their
full quota of work--we can readily see that the additional waste
matter of the unborn child will throw much extra work on the already
overworked eliminative organs, and this results in a condition of
toxemia. Certain symptoms accompany this state of constitutional
poisoning or auto-intoxication--the chief of which are:

1. Headache.
2. Dizziness.
3. Blurring of the vision.
4. Swelling of the feet and hands, or puffiness of the face.
5. Diminished urine.
6. Vomiting.
7. High blood-pressure.
8. Albumin and casts in the urine.

Any one of these symptoms may or may not indicate toxemia; but it
should be reported at once to the attending physician. In the presence
of one or more of these symptoms an expectant mother is always safe,
while awaiting the physician's advice, in carrying out the following
program:

1. Drink more water or lemonade.
2. Take a mild cathartic.
3. Avoid eating much meat and other highly protein foods.

CONVULSIONS OF PREGNANCY

This serious complication of the last weeks of pregnancy demands
immediate attention. They may almost invariably be avoided if the
blood-pressure and the urine are studiously watched during the latter
part of the expectant period.

If you are unable to get your physician at once, the following
treatment should be administered immediately.

1. A hot colonic flushing (See Appendix).

2. A hot bath followed by the hot blanket pack (See Appendix).

3. One drop of croton oil on a bit of sugar may be placed
on the back of the tongue.

4. Chloroform may be administered, provided a competent
nurse or other medical person is present.

The appearance of convulsions which have been preceded by one or more
of the symptoms noted under the head of "toxemia," indicates that the
patient has become so profoundly intoxicated and poisoned by the
accumulating toxins, that the lives of both mother and child are
jeopardized by threatened eclampsia. At such a time, the attending
physician will immediately set about to bring on labor, and thus seek
to empty the uterus at the earliest possible moment.

CARDINAL SYMPTOMS OF TOXICITY

Since toxemia (eclampsia) is one of the complications of pregnancy
most to be dreaded, it is fortunate that it almost invariably exhibits
early danger signals which, if recognized and heeded, would enable the
patient and physician to initiate proper measures to avert danger
and escape the threatened disaster. The presence of this toxic danger
is indicated by the persistent presence of the following three
symptoms:

1. Persistent, dull headache.
2. Presence of casts in the urine.
3. Persistent high blood-pressure, with tendency to increase.

Of course, albumin will probably appear in the urine along with the
casts, but it is the continued appearance of the casts that is of more
importance as a danger signal. Albumin is quite common in the urine of
the expectant mother, but casts--long continued--suggest trouble.
Headache as an indicator of toxemia is of special significance when
coupled with the other two cardinal symptoms of eclampsia--urinary
casts and increasing high blood-pressure. Therefore, the necessity for
frequent urinary tests and blood-pressure examinations during the last
weeks of pregnancy--especially, if the patient has suffered from
headaches and has been running albumin in the urine.

[Illustration: Fig. 4. Taking the Blood Pressure]

HIGH BLOOD-PRESSURE

Blood-pressure is a term used to indicate the actual pressure of the
blood stream against the walls of the blood vessels. The
blood-pressure machine tells us the same story about our circulatory
mechanism, that a steam gauge does about a high-pressure boiler (See
Fig. 4). The normal blood-pressure varies according to the age of the
patient. For instance, the normal pressure of a young person, say up
to twenty years of age, runs from 100 to 120 millimeters of mercury;
and then, as the age advances, the blood-pressure increases in direct
ratio; for every two years additional age the blood-pressure increases
about one point--one millimeter.

The average pregnant woman starts in her pregnancy with a
blood-pressure of say, 125 millimeters, but as pressure symptoms
increase, and as constipation manifests itself, and as the circulating
fluids are further burdened with the toxins which are eliminated from
the child, the blood-pressure normally increases to about 140 mm., and
later, possibly to 150 mm. If the pressure goes no higher, we are not
alarmed, for we have come to recognize a blood-pressure of 140 as
about the normal pressure of the pregnant woman.

There are a number of factors which enter into the raising of the
blood-pressure. For instance, at any time during the pregnancy, if the
eliminative organs of the mother are doing inefficient work, if she
falls a victim to a torpid liver, diseased kidneys, decreased skin
elimination, or sluggish bowels, then, with the added and extra
excretions from the child, there is superimposed upon the mother far
more than the normal amount of eliminative work--and then, because of
improper and incomplete elimination, the blood-pressure is
increasingly raised.

ECLAMPSIA PREVENTED

This whole subject can best be illustrated by relating a story, the
actual experience of Mrs. A. This patient came to the office with a
history of Bright's disease (albumin and casts in the urine), and
chronic appendicitis. While treating her for the kidney condition,
preparatory to an operation for the removal of the troublesome
appendix--in the very midst of this treatment--she became pregnant,
and great indeed was our dismay. We entertained little hope of getting
both the mother and child safely through. Frequent examination of
urine was instituted, the albumin did not increase and the
blood-pressure remained at normal--about 124 mm. She paid weekly or
bi-weekly visits to the office and carefully followed the regime
outlined. She drank abundantly of water and strictly followed the
dietary prescribed. Weeks and months passed uneventful, until we
approached the last six weeks of pregnancy, and then we found to our
surprise one day that the blood-pressure had made a sudden jump up to
175 mm., while the urine revealed the presence of numerous casts and
albumin--in the meantime the albumin had entirely disappeared. There
were also other urinary findings which showed that the liver was not
doing its share in the work of burning up certain poisons.

In her home we began the following program: Every day we had her
placed in a bathtub of hot water, keeping cold cloths upon her brow,
face and neck, and then, by increasing the temperature of the bath, we
produced a very profuse perspiration. She was taken out of this bath
and wrapped in blankets, thus continuing the sweat. All meat, baked
beans, and such foods as macaroni and other articles containing a high
per cent of protein were largely eliminated from her diet. At times
she did not even eat bread. Her chief diet was fruit, vegetables, and
simple salads, and yet the albumin and casts continued to increase in
the urine and the blood-pressure climbed up to 190 mm.

As we approached the last two weeks of pregnancy, this little woman
was taken to the hospital and systematic daily treatment with sweating
procedures was begun. Among other things, she had a daily electric
light bath. After each of these baths she was wrapped in blankets and
the sweating continued for some time. Careful estimations of albumin
were made daily and the blood-pressure findings noted three times a
day. During the last week of pregnancy she lived on oranges and
grapes. Day by day she was watched until the eventful hour arrived.
She went into the delivery room and gave birth to a perfectly normal
child. The albumin and casts quickly cleared up, the blood-pressure
lowered, and today the little woman is a fond mother of a beautiful
baby boy.

It is hard to estimate what might have taken place had not her
elimination been stimulated. The blood-pressure was our guide. Had the
albumin (without casts) appeared in the latter weeks of pregnancy
with a blood-pressure of 140 or 150 mm., we would not have become
excited, for the reason that in every normal pregnancy there is
often present a trace of albumin in the latter weeks; but when
the blood-pressure jumped to 170 or 190, then we knew that
toxemia--eclampsia--convulsions--were imminent. So we have in recent
years, come to look upon the blood-pressure as an exceedingly
important factor--as an infallible indicator of approaching
trouble--as a red signal light at the precipice or the point of
danger; and it not only warns us of the danger, but it tells us about
how near the boilers are to the bursting point. The glassy eye, the
headache, the full bounding pulse and the blurring of vision, are all
symptoms accompanying this high blood-pressure, so that in these
enlightened days no practitioner can count himself worthy the name, or
in any way fit to carry a pregnant woman through the months of
waiting, unless he sees, appreciates, and understands the value of
blood-pressure findings in pregnancy.

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