Dropsy of the Amnion. – The determination of the existence of this disorder of pregnancy is not so easy as that of hydrorrhoea; since there may be an excessive amount of amniotic liquid without any very remarkable distention of the abdominal parietes; and since also the normal amount of the liquid itself is capable of very considerable variation. But generally speaking dropsy of the amnion is an acute disease; and the rapidity of its development together with the distressing constitutional symptoms, afford our best means of diagnosis. This is the more especially the case since, also, ascites almost always complicates this affection.
There does not seem to be any change in the gravity or constitution of the liquor amnii; only an excess of production. The normal quantity may be estimated at three or four pounds, according to the state of pregnancy; but form forty to fifty pints have been found present in dropsy of the amnion. Thus at the fifth or sixth month the uterus may be more distended than usually at full term. The uterus is rounded; fluctuation is more obscure; there is not much thirst; the urine is natural except in cases complicated with general dropsy, and there is sometimes little or no oedematous enlargement of the inferior extremities. Among the most important diagnostic signs are to be found, therefore, the disproportionate size of the tumor to the period of pregnancy; the feebleness of the movements of the child; the great size of the abdomen, -evidently dropsical, – which is less apt to be accompanied by oedema of the thighs and legs, than in ascites.
Dropsy of the amnion may occasion severe suffering to the mother, sensations of suffocation, and hindrance of the circulation; this is probably due in part to the rapidity of the enlargement itself, and in part to the general constitution of the patient. But this difficulty very rarely becomes dangerous to the mother; since its very excess tends to self-relief by producing abortion.
The most important result of this dropsical affection is found in the injury to the foetus, whose nutrition is enfeebled by such excessive secretion; in the total destruction of the foetus, which is sometimes almost entirely dissolved in the amniotic fluid; and in the premature expulsion of the foetus, at a period when its insufficient age, its enfeebled condition, or both together, render it incapable of viability. This subject, an the kindred one of a dropsical condition of the foetus itself, will be considered more fully in a subsequent chapter.
The treatment of dropsy of the amnion must be principally prophylactic; and based upon attendant symptoms and such constitutional indications of predisposition to general or particular forms of dropsy as may be discovered, aided and confirmed by the sensational symptoms which may especially characterize the individual case. For when dropsy of the amniotic cavity has become so extensively developed as to be clearly diagnosed, there will be small hope of eventually saving the product of conception. But even if perfect success may not be thus obtained in the first instance, there will still be reason to hope that in a subsequent pregnancy, a constitutional treatment begun at an earlier period, and more intelligently directed by ampler knowledge of the case, its tendencies and its dangers, may enable the practitioner to obtain a decided improvement in the health of the mother and at the same time secure the safety and the healthfulness of her child. Dropsy of the amnion is always the result of some constitutional dyscrasia, which, under the stimulus of pregnancy, develops itself usually in other directions and in other forms also; for the remedies for this affection consult therefore those mentioned under other varieties of dropsy, and such as may be particularly indicated by the sensational symptoms, – such for example as the sense of suffocation. With regard to the propriety of inducing premature delivery, in extreme cases of this kind, see the subsequent Chapter on Abortion.
AFFECTIONS OF THE APPENDAGES OF THE UTERUS.
Pruritus of the vulva forms one of the most distressing disorders to which women are liable in pregnancy. This affection consists in an incessant and intolerable itching in the external genitals. The immediate cause may be found sometimes in an irritated, inflamed condition of the parts involved; or, as described by another, “it commonly depends on follicular irritation of the vulva, which, if unchecked, passes to aphthous ulceration. Sometimes there may be found no abnormal appearance of the vulva, except such as must arise from the violent rubbing and scratching to which they have been subjected; but, on examination, congestion and even superficial granular ulceration of the cervix uteri may be detected.
This affection is most apt to occur in young women. Churchill relates a case the symptoms of which are very strongly marked: when about four months pregnant, she was attacked by the most intense and incessant itching of the vulva; she had no rest day or night; could scarcely ever sleep, but was obliged to walk up and down all night; she was kept in such an irritated condition by this distress and loss of sleep that she became very cross and irritable. In this case no relief was obtained until after delivery, when the pruritus disappeared of itself. In her next pregnancy this woman suffered in a similar manner; the pruritus returning at about the same period of gestation; but it was removed by local applications directed to the cervix, which was found greatly congested, with superficial granulations around the edge of the os uteri. This affection is sometimes accompanied by sexual excitement; or it may have a periodic character, coming on or being aggravated at certain times of the day.
The Homoeopathic treatment of this disorder should always be constitutional rather than local; for, whether the pathological seat of irritation be found in the parts immediately affected, or in the cervix uteri, the true cause of it must consist in the disturbance of the system which is occasioned by pregnancy. For the remedies consult those previously mentioned in pruritus of unmarried females.
Pains, fixed or wandering, irregular or constant, are often experienced by women in pregnancy; and are frequently so severely felt as to cause them to become the subject of complaint to their physicians. These pains are principally felt on the abdominal, lumbar and inguinal regions; they may be considered as myalgic, – whether characterized by cramps or not, – when they result from fatigue of the muscles; and they may be deemed purely neuralgic, when they are caused by (reflex) irritation of the nervous centres.
The pains which are experienced in the lumbar and inguinal regions, – especially in the early stages of pregnancy, when they cannot be attributed to the size or weight of the gravid uterus, – are usually the manifestations of some disordered condition of the uterus itself. Pains felt in the loins, in the advanced stages of gestation, may be purely myalgic, or the result of strain of the muscles so constantly exerted to maintain the equilibrium by bearing the body backwards. Pains felt in the breasts, and the excessive tenderness and sensibility of these organs, are due to sympathetic nervous irritation; and are therefore properly called neuralgic. Those which are felt in the abdominal parietes, usually appear in the more advanced stage of pregnancy, and may be attributed to over-distention of the muscles and tension upon the nerves. Certain pains in the interior of the thighs, numbness, and cramps of one or both legs, have been supposed to result from pressure upon the sacral nerves. But even these may be caused by the severe dragging upon the various ligaments and consequent irritation of the nervous centres in different parts of the abdomen and back.
Where these pains are aggravated by exercise or movement, perfect quiet should be enjoined. But it is believed that, with the help of the appropriate Homoeopathic remedies, these pains can be so far relieved as to admit of as much exercise as may be necessary for the general health of the mother, and consequently for the greater vigor of the child. There is no doubt that the greater susceptibility to these various pains, – witnessed in some individuals, like the predisposition to many other morbid affections in pregnancy, – is in great measure due to constitutional peculiarity, just as we see in certain constitutions a remarkable facility of straining and laming the muscles and tendons, and of suffering dislocation of the joints, from comparatively slight causes. At any rate, the following remedies or others that may be especially indicated, are capable of affording very marked relief in these cases, – whether the symptoms appear in the earlier part of gestation, and so threaten to result in abortion, or whether they occur principally in the latter part of pregnancy, and tend to increase the immovability and helplessness of the patient. The same may be said of those pains regarded as the results of a certain constitutional weakness of the muscular organs, or of a corresponding irritability of the nervous system.
