« AnteriorContinuar »
and their mode of life is in accordance with their situation. It is for them to follow these precepts, so as not to compromise their health, and that they may, at the end of their pregnancy, bring forth a robust and well-formed infant. What I have just said respecting stays induces me to recommend to women, who purpose nursing, a very great attention to the development of the nipples. Besides leaving off their stays if they compress the nipple, they ought, also, if this part is but slightly prominent, or contracted, to endeavour to make it project. They may succeed in this by causing their husbands to employ suction, or by practising it themselves with a glass tube, made for this purpose.
The accidents of pregnancy, which may affect the health of the foetus and occasion its death, are syphilis, blows on the stomach, and falls on the seat, plethora, very intense mental impressions experienced by the mother, and the various maladies by which she is affected.
The death of the foetus is often the result of blows on the abdomen, or of the falls which women meet with. This is a fact generally admitted, and on which it is useless to speak further. If pregnancy be advanced, and the foetus have manifested its presence by internal movements, these movements cease, and, at the end of a few days, abortion ensues.
Practitioners readily recognize the accidents caused by plethora, which occur during the course of pregnancy. This condition is, moreover, characterised by such evident symptoms, that it is often impossible to mistake them; but what is less known, is the influence of plethora on the product of conception. In this state, the uterus is strongly contracted, and presses more than usual on the foetus, the limbs of which are sometimes, by reason of this contraction, kept in an unnatural position. A great number of congenital deformities result from this, which might, perhaps, be easily prevented by bleeding. In fact, after this little operation, women almost always experience an improvement in their state, and the greater number declare that, under its influence, the movements of the infant become more frequent, more lively, and, in some degree, more easy. If this be so, it must be granted that plethora has not only its disadvantages for the mother, but also for the infant which she carries in her womb.
Very lively mental impressions are especially hurtful to the mother, even more so than to the infant. There is, during pregnancy, such an increase of sensibility, that serious events may throw women into a very extraordinary, and sometimes into a very dangerous state of irritation. Some actually fall into a state of complete mental alienation, and commit the most extravagant actions. As to the longings, as they are vulgarly called, of pregnant women, there is no impropriety in satisfying them when they are not unreasonable; but there should be no hesitation in opposing them when they are ridiculous caprices. There is nothing to be feared from this course; the female comforts herself, and is contented when she finds it impossible to be gratified; and the infant does not feel the influence of the mother's disappointment.
All the fables which have been put forth on the subject of the diseases of the foetus, caused by the longings of the mother, are controverted by observation. The mother marks, and defects in the conformation of children, which were formerly referred to this cause, depend on circumstances entirely different. There is not a woman who, during pregnancy, has not had caprices and longings unsatisfied, and, notwithstanding, when her time arrives, the child comes into the world without bearing on it the deformity which should bear witness to the disappointment of the mother. When, on the contrary, the infants are deformed, and the number of them is small, in comparison to the number of births, searches and interrogations are made, and the conclusion is, that some day or other the mothers had such a fancy or such a desire. It is thus, in general, that those extraordinary histories are fashioned, to which no one in the present day gives any credit.
[There seems reason to believe, however, in the occasional origin of deformities i in the foetus from vivid external impressions acting through the imagination of the \JlUjJl}i,jLJJ-l"it* mother. Boerhaave (Aphor. 1095) speaking of the causes of epilepsy, says that the 7 tendency to this disease may be "born with one, from the imagination of the mother KJ ( I;" when she was pregnant, being shocked at the sight of a person in an epileptic fit." Whitehead (On Hereditary Diseases, p. 1C) relates some cases in confirmation of this rl /
view. In one case which happened to him; a lady was in great dread, in five ^ successive pregnancies, of her children being born blind, on account of her sister's eldest child having had this congenital defect in the left eye. The result of these pregnancies is thus summarily stated: out "of five children, born at the full term . of utcro-gestation, each as remarkable for plumpness and vigour as the mother is for H-4/t / ; n,,' a well-developed frame and robust health, the first, third, and fifth of her children had defective development of the left eye, amounting in one to deformity; and the ( 11 second and fourth had complete loss of vision of the same side."
A young woman, in the sixth month of pregnancy, caught a full view of a double ^A < •'. . t / hare lip while under operation; she fainted; and at the full time of utero-gestation, was delivered of a well-grown female child, who had double hare lip and cleft palate, like the one she saw three months before. No such deformity had been previously known, either in her family or in that of her husband.
A lady, in reduced circumstances, had borne four healthy children at full term. She possessed a robust constitution, and was descended of a healthy stock, both as regards body and mind. Her husband and his family had been similarly favoured; but he, from being a faithful and affectionate companion, became dissipated and cruel. When five months advanced in her fifth pregnancy, the unkindness she received from her husband threw her into a state of great mental distress and despondency, during the prevalence of which she attempted to destroy herself by drowning, but was opportunely rescued. She was delived at the full term of utero-gestation, of a boy, who survives, but who is completely imbecile. She then bore a female child, who also survives, and is perfectly healthy. She had then an abortion, in the fourth month, and died nine months afterwards of malignant disease
It in a
of the uterus. Neither idiotcy nor malignant disease had been previously known in the family of either parent.
It would, moreover, appear that powerful impressions operating upon the mother are capable of producing corresponding effects upon the foetus in utero, independently of the imaginative faculty, in evidence of which Mr. Whitehead relates the following case: A woman in strong mind, in competent circumstances, thirty-two years of age, and in the seventh month of her sixth pregnancy, had occasion to visit the shop of a grocer, and while she was in the act of delivering her orders, a heavy weight fell upon the instep of her left foot. She was in great pain, and, being unable to walk, >-i 14 i*' '/was immediately carried home in a conveyance. Whilst sitting with the injured limb iu a foot-bath, she felt a sudden and violent struggle within her, followed, on the instant, by a plentiful escape of water, per vaginam, which was the liquor amnii. She was placed in bed, and a medical man sent for; who, finding the pains of labour . i < ■ ', > ■■ strong and frequent, and a foot of the fetus already low down, proceeded to deliver. The child (female) was puny, but alive, and apparently healthy. Its left foot, which i l^ , had been the first to present, was found to be firmly contracted towards the inner aspect of the limb, the heel being raised, and solei muscles rigid and unyielding. , This state of parts continuing, the foot was forcibly brought into its natural position,
and there maintained by means of a bandage, and thus its use and symmetry were eventually restored. After some ineffectual efforts to bring away the placenta, the abdomen was examined, and it was found that another child remained in the uterus, the birth of which was hourly and daily waited for. In the course of ten dayB, no indications of labour coming on, the patient was sufficiently recovered to attend to her household duties, and continued to do so until the completion of the natural term of pregnancy, when she was safely delivered of a full-grown male child, in vigorous health. This event happened precisely Bixty days after the preceding birth. No milk appeared in the breasts until after the second birth, when she was enabled to nurse both children. The twins are still living, and in perfect health.
Broadhurst (Afedical Times and Gazelle, 1853) gives the following instance of the effect of mental emotion on the fcetus. A woman, during the sixth month of pregnancy, suffered from sudden and intense fear; by a powerful muscular effort she saved her life. For four days after this occurrence she believed her child to be dead, as it remained motionless. After this time, however, it again began to be felt, and, in a few days, its movements were as distinct as before the accident. The child was born at the eighth month, with the most severe talipes varus and cheirismus.
One effect of the siege of Landau, and of the explosion of the arsenal was, as we are assured by those who were present, that of ninety-two children who were born soon after, fifty-nine died in consequence of their mothers' alarm, others lived a few months only, some few were idiotic, and, again, others were born with numerous fractures of the bones.—P.H.B.]
The diseases of the mother during pregnancy have each their influence on the product of conception. As we have said, this subject will be treated in a separate chapter, at the same time with all that relates to the influence of the nurse on the health of infants. It is sufficient to say, that amongst these diseases, some determine abortion; these are cholera, confluent small pox, severe typhoid fever, syphilis, certain non-syphilitic fungous excrescences at the neck of the uterus, excessive leucorrhcea, &c.: others affect the health of the foetus; these are slight small pox, syphilis, scrofula, and some chronic diseases; and finally, there are a few, amongst which pneumonia must be placed, ^^<JcU*a • which seem to have but a slight influence on the health of infants.
It has been observed, but incorrectly, that mercurial treatment is a "<- / , . cause of abortion; this is a serious mistake; it is on the contrary >' "_y *-. the best preservative against it from the moment it cures syphilis, UM.LLL (^ which is its most frequent exciting cause.
ON THE ATTENTION REQUIRED AFTER BIRTH.
The accoucheur gives his first attention to the infant by tying the cord; he removes, by means of a bath, all the greasy matter from the skin, examines the conformation of the natural openings, and directs the first clothing of the new-born infant. He should attentively investigate the health of the father and mother in order to become acquainted with the infant's constitution, and thus be enabled to give adequate directions as to its hygiene and aliment.
The medical man is, in fact, often consulted by the mother to ascertain if she is able to nurse her infant; if the state of her health is opposed to it; if the condition of the breasts will allow of it; and, finally, as to the selection of a nurse in those cases where they are not considered fit to undertake suckling.
Everything relating to the nurse, and to feeding, will be treated of in a special chapter; in this, we shall only occupy ourselves with the health of the mother, who is disposed to nurse her infant herself, in reference as much to the future qualities of the milk, as to the conformation of the breasts.
How May It Be Known Ip A Woman 18 Able To Nurse
When the constitution of women is deteriorated by any general malady, easy of discovery, or the possible development of which is indicated by hereditary antecedents, they must not be permitted to undertake the suckling of their infants. To this end, too much prudence cannot be exercised for timely remedying the original vitiation of the constitution, and for correcting, by the aliment given by a healthy wet nurse, the hereditary vices which, sooner or later, will develop themselves in the children.
Women, who by too close a consanguinity, belong to a tuberculous, cancerous, rickety, gouty, or syphilitic race, ought to reflect deeply before giving the breast to their infant. If they present any tymptom of these affections, they should be positively interdicted from suckling.
The health of the father ought also to be taken into consideration, for it is possible that an alliance or croiting with a more healthy race has imprinted on the foetus a vitality altogether different from that which would result from an alliance between two races vitiated either in their origin or constitution.
The practitioner must know how to estimate the qualities of the product of conception from the health of the father and of the mother; and to determine if the unfavourable constitution of the mother may have been corrected by the impregnation of the father, and vice versa. In cases where any doubts may remain on his mind, there is but one method of settling the question, and that is, by committing the infant
itt?-j t° a we* nurse.
Apart from this general condition of the mother, her actual constitution or hereditary disposition, there are women whom we may consider competent to suckle their children, and who are, nevertheless, unable to undertake this duty. We judge of this condition from the characteristics of the mammary secretion at the last period of pregnancy: although it must be admitted that these characteristics, to which we are about to allude, only possess a very limited value. They cannot by their absence determine the conduct of the practitioner, so as to decide if the woman should, or should not, suckle the child herself. When, on the other hand, they do exist, they should be taken into deep consideration.
There are some women whose constitution is evidently vitiated, who, before delivery, have a satisfactory mammary secretion, and who yet should not suckle. In this number must be reckoned tuberculous women.
There are others, on the contrary, tuberculous or non-tuberculous, who present before delivery an altered mammary secretion, on account of which they may be considered incapable of undertaking lactation.
What Are The Characteristics Of The Secretion Of The
We shall here make an extract from the excellent treatise of M. Donne.* This physician has treated the question now under consideration in so satisfactory a manner as to leave nothing to be desired.
"It is known that from a more or less advanced stage of pregnancy, often even from the commencement of conception, a preparatory process takes place in the mammary gland, whence a certain quantity of yellowish viscous matter results, which can be expressed by a moderate degree of pressure, carefully exercised on the organ; it is to this imperfect milk that the name of colostrum has been applied in medicine.
* Conmli auf mirei tur Vallaitemmt H tur la manitre d'dcrer la cnfanU nmtwaunCM. 2nd edit. Paris, 1846. p. 38.