Chapter XXXIX: Letter XXXVII: Cases in Midwifery (2)

_Case XII._—A lady of delicate health and small stature, twenty-nine years of age, came to our establishment in the autumn of 1850, to be confined with her first child. On the 5th of November, considering herself within a week or ten days of confinement, she went, by my permission, in company with her husband, to hear Jenny Lind, at Tripler Hall. She slept well during the night after the concert, and at six the next morning she was awakened by pains resembling labor. These gradually increased until her child was born, a little after eleven in the forenoon, her labor being, on the whole, an easy one.

Two hours after the delivery she was taken up, and bathed thoroughly in a sitting-bath tub, the water at 70°. Being delicate, it caused her a good deal of shivering at the time; but this amounted to no harm, and usually occurs during a number of the first baths after delivery. At evening she was again bathed as before, and slept well during the night. Cold wet compresses were used freely, as according to our custom in such cases.

The second day, and onward, she was bathed four times—before breakfast, dinner, and supper, and on going to rest. She was able, also, to sit up more or less daily, and the first three days went on, in all respects, apparently well.

The fourth day, in the afternoon, there occurred a circumstance of ominous character, such as I hope it may be my lot seldom to encounter. I refer to the coming on of that most fearful malady, puerperal fever—the puerperal plague, as it has been appropriately called. The patient was already somewhat feverish, which was caused probably by the new excitement of milk in her system.

At the same time some relatives came to see her, it being the first time of their visiting her after the birth. They were in high glee, joking, talking, laughing, and making all manner of fun for a considerable time. All this transpired without my knowledge.

At the edge of evening, I found the patient in a most terrific fever; her flesh was very hot, face flushed, pains in the back, abdomen, and head; the pulse full and throbbing at 140 per minute. Judge my surprise at these phenomena, knowing, as I did, that the patient had been remarkably well in the morning; I had not yet learned of the excitement she had undergone during the afternoon.

It is evident enough, I think, that under such circumstances, some powerful and decided means must be resorted to; otherwise the disease might proceed so rapidly as to destroy the patient’s life, and that too, possibly, within twenty-four hours.

We commenced the treatment by giving her a thorough ablution in water, a little tepid at first. She was then placed in a heavy linen sheet but moderately wrung from cold water, and packed loosely, with but little covering. The object of these applications was gradually to cool the system; to bring down the pulse, as soon as might be, to its natural standard; to arrest the inflammation that was already going on in the abdomen; and to quell the pains. The wet sheet was changed every twenty to thirty minutes. Gradually the pulse became less frequent, and the pains less, till midnight, when we had succeeded in bringing the pulse permanently down to 80, and the pains were quite gone. The wet sheet was then folded each way, making it four double, and placed about the patient’s body, from the arms downward; in this she was to sleep the remainder of the night, having just covering enough to keep her comfortable. But if she should become wakeful from pain or feverishness, the husband was to renew it, that is, rewet it in cold water, and as often as necessary. Once or twice only it was changed before morning.

The reader who is at all acquainted with the danger and the fearfulness of this most awful disease, may form some idea of the anxiety I felt when I first found this patient with the attack upon her. He may judge, too, something of my feelings, when, by midnight, I had succeeded in bringing the pulse down to 80, and quelling all fever and pain.

The next morning the patient appeared in all respects well, but somewhat weak, and not a little blanched. She got along afterward in all respects perfectly well.

In a very short time—I do not now remember in how many days after the birth—she commenced walking out carefully, and riding in the city to improve her strength, with a view of returning home as soon as circumstances might warrant.

When her infant was nineteen days old, feeling in all respects strong and well—as much so, perhaps, as ever in her life—she proceeded, in company with a female attendant, on her journey homeward, about three hundred miles.

I should remark that this patient was always of weak, nervous, and delicate constitution. She had had a miscarriage three years before this confinement, which weakened her a good deal. During this second pregnancy she adopted the water-treatment under my directions, but was obliged to use, both for bathing and drinking as well as other purposes, very hard, limy water—a circumstance considerably against her. She experienced numerous little ailments, but on the whole got along very well.

_Case XIII.—Nov. 8, 1850._—A lady residing in the city of Brooklyn, of small stature, tolerably good constitution, nervous temperament, and I should judge about twenty-five or six years of age, gave birth to her third child near midnight of the above date. Having suffered a good deal at her last preceding confinement, particularly with after-pains, she had resolved at this time to adopt the water-treatment.

Very soon after the birth, the placenta having been expelled soon after the child, the most fearful after-pains commenced, precisely in the same way the patient had suffered before; and she had doubtless, as many have, experienced incomparably more pain after the birth of the child than before it. This is all unnatural and wrong, and would not be, if human beings had from the first always obeyed the physical laws. But is there no method by which these pains—terrible and persistent as they often are—may be prevented? Certainly, if the experience of thousands may be taken as a guide. No drugs can do it. Suppose we give strong opiates, as some few of the more stupid practitioners may yet sometimes do, we may allay the pains somewhat for the time. But who does not know that the pains are in the end made worse? And what havoc does such treatment make with the nervous system? But, fortunately, physicians have, as a general thing, abandoned this practice.

In this case we helped the patient into the wash-tub, having the back elevated two or three inches by a block of wood, she sitting in it with the feet outside, and there being a couple of pails of tepid water in it. She was rubbed for a long time—say fifteen or twenty minutes—until all pain was removed. A large, heavy sheet was then folded both ways, making it four double, and laid upon the bed; on this she was placed, after which it was folded about her, reaching from the arms to the knees. The application caused a good deal of shivering, but as I told her, _the more shivering the less pain_, she bore it patiently. She was covered, so as to make her in a reasonable time comfortable, and there was, I believe, moderately warm applications made to the feet.

This being at about one o’clock in the night, I directed that if the pains should again come on, as they probably would, she should be rubbed as before a long time in the shallow-bath, have the wet-sheet renewed, use the wet towels about the abdomen and genitals, as we always do, without exception, in such cases, and to repeat these processes without any reference to hours or time of day, as might be needed to keep off the pains. Once only before morning was it necessary to repeat them, and she enjoyed, on the whole, a good half night’s rest _in the folded wet-sheet_. In the morning another bath was taken, when she found herself very comfortable, and, withal, strong.

This patient being at a considerable distance from my home, I saw her, I think, but twice after the birth. She bathed three or four times daily, used the wet compresses freely, and took injections according to need, and suffered almost nothing with after-pains. She kept her strength well, and sat up to rest herself more or less every day.

The third or fourth night—the latter, I think it was—she was a good deal wakeful from fever. Seeing her in the morning, I directed the bath and folded wet-sheet as before, which at once subdued all unfavorable symptoms. Had she resorted to them in the night time as often as the symptoms might have demanded, she would have obtained a good night’s rest.

All things considered, our intelligent patient found a vast difference between water-treatment and that to which she had been before subjected; and she was well rewarded for the heroism, self-denial, and perseverance which she manifested at and before the time of her confinement.

_Case XIV.—November 10, 1850._—This is a case of an intelligent young lady of this city, of apparently delicate health, and, I should judge, twenty-two or twenty-three years of age.

Having been recently married, she spent the winter of 1849–50 probably in too much excitement for the health of one in her state. Her home besides—a fashionable boarding house—was not one at which the proper food could be obtained; in short, she lived too freely, and that upon food of improper character.

In the month of May she experienced a severe attack of bilious fever, and also, comparatively unacquainted with the water-treatment, she had the good sense to determine at once to submit herself confidently to the new method; she had, indeed, no confidence in any other, and her intelligent husband coincided with her in opinion, while the other friends objected strongly to what they considered a piece of fool-hardiness.

By the freest use of packing sheets, of short duration, shallow-baths in the wash-tub, the wet girdle and tepid clysters frequently repeated, together with entire abstinence from all food, she was completely cured in a few days.

Here let it be remembered, that such attacks of fever, as indeed of all severe acute diseases, are far more dangerous when they occur during pregnancy.

After recovering from this attack, our patient went for a time to the country, and followed all along a good course of bathing, with more attention to diet. Her health improved constantly up to the close of her period.

She came to labor the night of November 10, 1850. It lasted only about six hours—rather a quick one for the first—natural, and on the whole easy. Her child was a fine healthy boy.

Cold wet compresses were used freely, as ordinarily in such cases. She suffered little or nothing from after-pains.

The lady was inclined to take only a moderate course of bathing during recovery, and I did not regard it best to urge her. Two or three times a day, however, she had an entire ablution of some sort. I think she sat up more or less every day. She had all along a good appetite, slept well at night, felt cheerful and contented, and in a few days found herself in all respects quite well.

This case, although not of very marked character, is yet an instructive one, when we take into consideration all of the circumstances connected with her pregnancy.

_Case XV._—A laboring woman, who had been deserted by an intemperate husband, applied to me in the summer of 1850 for advice. She was poor and melancholic, and knew not what to do. Our house was too full to receive her at the time, but a benevolent lady of the city gave her a good home, and some small wages, for what light work she was able to perform, but on the condition that she should find some other place in which she should be confined.

This was her second pregnancy, her first child having died at birth. She was now debilitated, and had worn her clothing a good deal too tight. I endeavored to persuade her to do all she could under the circumstances toward the restoration of her health, and especially, to avoid the great evil which I have mentioned.

On the 18th of November, 1850, the patient having been some days an inmate of our establishment, gave birth to an apparently healthy male child, weighing nine pounds. During two days she experienced pains, more or less. Being very much busied at the time myself, my worthy friend, Dr. Wm. E. Rogers, of Waymart, Wayne county, Pa., superintended the delivery in a faithful and skillful manner. With his own hands he changed the wet cloths every few minutes, during the period of four hours. These, of course, aided very materially in warding off after-pains, and all other evils incident to the puerperal state.

The patient having no nipples, could not nurse her child. They had been _countersunk_, as carpenters would say; that is, they had been driven into the breast, doubtless by the patient having been in the habit of wearing too tight clothing upon them. This not unfrequently happens with those who unwisely attempt to improve upon the form which nature has given them.

No milk whatever could be obtained from the breasts; they were inflamed considerably, three or four days at first, but, by appropriate treatment, the difficulty soon ceased.

Previous to entering our establishment, the patient had never in her life taken an entire ablution, that she could remember of. After the birth, she had, in connection with the compresses, one towel-bath a day. Three days after the birth, that is, on the fourth morning, she found herself sufficiently strong to enable her to go down five flights of stairs without assistance, and twice went out of doors. The next day she worked in the kitchen, and by following up the daily bathing, with care and diet, she was very soon fully recovered.

It will be seen that this patient had comparatively but little general treatment. The persevering use of the cold fomentations, adopted at the first after delivery, must have operated powerfully in warding off heat and other inflammatory symptoms, which tend so much to reduce the strength.

Considering the fact of the inflammation of the breasts, and that no milk whatever could be obtained, it was rather remarkable that she was carried through it without having them suppurate and break.

_Case XVI.—December 20, 1850._—The patient was, I judge, about twenty-five or twenty-six years of age; apparently of scrofulous habit; eighteen months before, gave birth to her first child. At that time she was kept in her room three months constantly, with a broken breast. This time she resolved to avail herself of the water-treatment, with a hope of avoiding the awful sufferings which she had before endured.

She bathed pretty freely and daily during this her second period, following the advice laid down in the work entitled “Water-Treatment in Pregnancy and Childbirth.” She kept also busy about household duties, which aided her a good deal in maintaining good general health.

On the evening of the above-mentioned day, December 21st, 1850, the patient was confined, pregnancy having lasted only 265 days, 15 days short of the usual time; the labor was, on the whole, an easy one, and ended between 6 and 7 o’clock in the evening.

Usual treatment, with cooling compresses, was followed faithfully, and after the patient resting a little, a thorough ablution in the wash-tub was given. She slept well during the night.

The patient had long been troubled with piles, and, as usually happens under such circumstances, she experienced a good deal of trouble from the affliction at the time of the former birth. So also, at this time, it came on so bad as almost wholly to prevent her sitting up.

With the view of checking it as soon as might be, we commenced the next morning with the cold packing-sheet, twenty minutes. She had four baths in all during the day and evening, the water pretty nearly cold. She felt all along perfectly well, and would have been able to sit up a good deal the first day, were it not for the troublesome ailment mentioned.

The second day, and onward through the first week, the treatment followed was the cold pack in the morning twenty minutes, and the bath after it; bath in the wash-tub before dinner; the cold pack and bath again toward evening; the bath again before going to rest; and cold compresses most or all of the time, night and day.

At the end of the week the patient was so well that she could go about the house, take charge of her infant herself, and had already dismissed her nurse. She had suffered no feverishness, no pain, nor any restlessness at night. Nor was her strength scarcely at all impaired.

It is now more than two months since the birth of her child, and I have often heard from her, as being in all respects well.

Two important circumstances helped very much in this case; the patient herself is a very intelligent and assiduous person, and had studied faithfully and understandingly the method of treatment which, in her good judgment, she chose to adopt. Her husband, too, had a good understanding of the matter, and was himself a most faithful nurse.

_Case XVII._—A young lady, just married, emigrated from the city of Edinburgh, Scotland, early in the summer of 1850. She had been pregnant one month before starting. She was of delicate health, small stature, of fair hair and complexion, and, as we would say, of scrofulous tendency. She had always been sedentary in her habits, and was occupied, for the most part, sitting and within doors. She had, in short, had but poor opportunity for the development of her physical powers, and had contracted a bad lateral curvature of the spine.

The ship’s passage across the Atlantic was a long and boisterous one of eight weeks; she was a good deal seasick, and after the first week was compelled, for want of strength, to remain in her berth night and day; thus she continued for six entire weeks; the eighth, and last week of the passage, she was able to be out a little.

The patient, together with her husband, took up her residence in the very heart of this, in the summer, hot and unhealthy city. She had always been accustomed to a much cooler climate, and now became necessarily a good deal debilitated. She had lived for a time mostly, or altogether, upon the vegetarian principle, in the old country; but in this city she adopted a different course, using coffee, and perhaps tea, and some other articles not altogether friendly to health.

She consulted me, however, some ten or twelve weeks before confinement. I advised her at once to avoid flesh-meat, to drink only cold water, and to bathe and exercise much more than she had been in the habit of doing; the advice was followed faithfully, and with the happiest effects.

_December 29, 1850._—Sunday morning, at 4 o’clock, her labor ended. For fifty hours, without intermission, it had continued, depriving her of rest almost wholly, three nights. Of all the examples of fortitude and patience which I have ever witnessed under such circumstances, this was the most remarkable. Notwithstanding the great length of time the labor lasted, the patient did not at any moment despond, nor did she, to my knowledge, utter a single word of complaint. At times she would recline; then again she would sit up, walk about the room, or engage in some light work. She bathed also repeatedly, as the pains were progressing, and the ablutions appeared to refresh the system, and support her strength materially. I repeat, this very worthy lady’s fortitude and resignation were remarkable, and such as I shall not soon forget.

This, as I have remarked, was her first child. Under such circumstances there is usually but slight loss of blood. But in this case, owing perhaps, partly to the patient’s constitution or state of health, and partly to the severity of her labor, considerable flooding succeeded the expulsion of the after-birth. To check this, she was at once raised and put in the cold sitting-bath. The effect was as sudden and as favorable as could be desired.

The patient had something of after-pains, but not a great deal. Three and four baths were taken daily, and the cooling compresses were freely used.

There were circumstances in this case which caused me some trouble in anticipation; no urine was passed for full thirty-one hours after delivery. Considering how much had been done in the way of bathing, water-drinking, and wet compresses, it was singular that such should have been the case. But no harm whatever occurred in consequence of the renal secretion being so long prevented.

Day by day, the patient gained strength; it was against her recovery somewhat that she was obliged to remain in the same room—and a rather small one—where the family cooking and other work was done. Still, through great faithfulness and perseverance in the treatment, she recovered in all respects remarkably well.

The notes I made of the case at the time are as follows:

“_First Day._—Patient was sponged over in bed a number of times, whenever the cooling compresses were not found sufficient to check the after-pains. Slept considerably during the first night, but, as is common after the rest has been broken a number of nights in succession, the sleep was somewhat disturbed. The compresses were changed very often. She was not raised up for a bath, as it was thought that, in consequence of the severity and great length of the labor, she was too weak.

“_Second Day._—Bath in the wash-tub three times, and body sponged in bed two or three times besides. Urine was passed thirty-one hours after the birth. Patient sat up to-day in bed.

“_Third Day._—Bath in the tub four times; the water cold as usual. She preferred this; it gave her nerve. It made her shake a good deal at the time, but this circumstance is attended with no danger. Sat up an hour and a half at a time to-day. Appetite good.”

It was remarkable in this case, that the pulse remained at 100 and upward for a number of days after delivery; yet the recovery was certainly highly favorable.

Within the second week the patient was able to go out and walk in the open air.

In eighteen days she brought her infant in her own arms to my house, a distance of about one mile, and returned again home, experiencing very little fatigue.

About six weeks after the delivery she met with an accident, which caused her considerable suffering. She received a blow upon one of the breasts, not very severe, but sufficiently so to cause an inflammation, which ended in abscess, or broken breast, as it is usually termed. By following up the water processes faithfully, that is, by taking frequent ablutions, packing-sheets, with compresses constantly upon the breasts, sometimes tepid and at others cold, according to the feelings of comfort, she passed through the period of healing much better than is usually the case with broken breast.

Considering the patient’s constitution, her voyage across the Atlantic, her residence in the heart of a hot, unhealthy city, the length and tediousness of her labor, her recovery was remarkable.

_Case XVIII._—This is the case of a young married lady with her first child. She is of rather nervous temperament; too active naturally for the good of her system.

_January 11, 1851._—She was confined after a seven hours’ labor. Two or three days before, she had evidently overdone at ironing and other household duties, which she was too fond of performing. Her full period would, I think, have been six to seven weeks later, the birth being premature, in consequence of the over-exertion alluded to. The child, however, was above the average weight—a daughter—but did not seem to possess its full share of vitality.

The usual treatment of ablutions three and four times a day, with cooling compresses, the wet girdle, clysters, etc., was practiced, and with the happiest results. The patient sat up, day by day, and recovered, not quite so rapidly as some, but in all respects well.

_Case XIX._—A lady, thirty-eight years of age, recently married, came to her confinement the 4th of March, 1851. For two months only she had been bathing, with reference to her expected time; her health has generally been very good, and all along, during the period of pregnancy, she attended personally to her household matters, rendering her little habitation as perfect a specimen of order and cleanliness as could be conceived of.

All this tended powerfully to preserve health of body, and cheerfulness and contentment of mind, circumstances never more important than during the period of pregnancy.

We would expect, naturally, that a patient at this age would suffer the first time a severe and protracted labor. But in her case it was far otherwise. True, for two days previous to delivery she experienced some symptoms of labor, but was able to be about, and slept considerably nights. At 10 o’clock, A. M., on the 4th instant, labor had fully commenced; at 4 P. M., delivery took place; making labor only six hours, on the whole a short one.

Not long after the birth, the patient was helped into the tub for a thorough wash. She would have been able, I think, to perform the ablution herself alone; still, it was thought best that she should make no effort at the first bath.

It is now the third day since delivery, and the patient has had three or four ablutions daily in water at 70° Fah. She has used the compresses freely; the wet girdle much of the time, which she finds to strengthen her back. She sat up more or less every day, usually after the bath.

The third from the birth, she was going about her room, putting things in order, feeling in all respects well. The milk was secreted freely, and she has had no trouble from the breasts, from feverishness, or any other cause; the infant doing also as well as the mother.

On the sixth day, the patient went from home, taking her infant with her, on a visit to a friend residing in another street.