The local congestions which arise in such cases from the obstruction of the general circulation, or even from constitutional predisposition to pulmonary apoplexy, are connected with palpitation of the heart and rush of blood to the face and head. These local difficulties, whether dependent upon constitutional dyscrasia or not, are inseparably connected with the other forms of disorder which occur in the pregnant condition; since every part of the system sympathizes with the whole, and the whole with every part, hence the remedy which will cure any one, must also be the one which more or less accurately corresponds to them all. Hence, too, the radical cure of such cases is seen to be a work of time; the disturbance of the harmony of the system by pregnancy, becomes gradually relieved, as the circulation and play of the vital forces are equalized by eliminating from the interior of the organization those subtle, hereditary miasms, which poison the springs of life in their original fountains.
For the treatment of the cough, dyspnoea, palpitation, and other disturbances of the respiratory and circulatory systems in gestation, we recommend therefore no particular medicines; but advise the thorough study of those already detailed under the various forms of gastric disturbances, with reference to the most copious and reliable works on Materia Medica that can be procured. The leading symptoms of the case may be found in connection with the pulmonary difficulties, with the gastric derangements, or with some abnormal condition of the secretions or excretions; and the remedy at first indicated by the principal symptoms, if it do not in time remove the entire train of morbid conditions, will remove some of them. Then a new prescription may require to be made for the case as it then presents itself. But it will sometimes be found that the remedy which is indicated at the first, being Homoeopathic to the particular form of constitutional dyscrasia in the patient, and given at intervals and in higher potencies, will eventually remove all the various forms of trouble, and restore the patient to complete health.
Affections of the circulation, during pregnancy, may be made to include two distinct classes of morbid conditions: First, those which relate to changes in the constitution and character of the blood itself; and, secondly, those which regard the alterations in the blood-vessels. In the first class may be enumerated plethora, hydraemia, anaemia and uraemia. The second class includes varices and hemorrhoids.
We give brief notices of the various changes which the blood undergoes in pregnancy, without intending to imply that these pathological conditions are of much value in prescribing, in the present state of our knowledge. Nor, indeed, are we ever likely to be very greatly dependent upon them, since the sensational and other subjective symptoms afford most reliable guides to the remedies which will, at the same time, remove these pathological results and the constitutional causes from which they were derived.
Plethora, in pregnancy, means principally that increased activity of the circulation which corresponds to the increased activity of the nervous system. The volume of the blood may be increased, and this increase may sometimes be obtained at the expense of the quality of the blood itself. Thus, as the bulk of the circulating fluid is augmented, it becomes more thin and watery. And this condition is expressed by the term hydraemia, or watery blood.
Plethora alone is insufficient to account for the vertigo, giddiness, flushes of the face, dimness of vision, ringing in the ears, flashes of heat all over the body, and attacks of fainting, which often annoy pregnant females. Some of these conditions it should, however, be remembered, may arise from the opposite or anaemic condition of the blood. Even in plethora, while some few of the symptoms may be due to the pressure of the apparently augmented quantity of the blood, the greater part must doubtless arise from the influence of the vitiated character of the blood itself, rendered more serous. Since it is evident how similar symptoms, as of debility, may appear to spring from too much, and also from too little blood. The same thing is seen in cases of severe hemorrhage, where the other fluids in the body are rapidly called upon to replace the quantity which is requisite for the flow of the current. The intimate connection of this hydraemic condition of the blood, which often appears in the latter part of the period of gestation, with the varices forms of dropsical accumulation, will be obvious. It is sufficient to remark here, that the common source of all these morbid conditions of the blood, and of the subsequent effusions and oedematous infiltrations, is to be found in the psoric dyscrasia developed and aggravated by the constitutional excitement of pregnancy.
Anaemia constitutes a still greater degree of depravation of the blood, under the prolonged influence of many of the other morbid conditions of pregnancy. The failure of nutrition from the severe nausea and vomiting which sometimes persist even through the whole course of pregnancy, and from other gastric disturbances and intestinal difficulties, in addition to some original morbid tendency in the system itself, sometimes reduces the pregnant female to a very feeble, almost cachectic condition. This condition is still further aggravated by the constantly increasing demand made upon it for the support of the growing foetus. And the exhaustion in such cases may prove fatal, either before or after delivery, unless the very root of the difficulty is reached and removed by the appropriate remedy.
Among the more active consequences of such impoverished condition of the blood, in pregnancy, as in chlorosis, should be noticed certain local congestions. These are developed in different parts of the body, according to the direction of the constitutional weakness; thus in some persons we see epistaxis; in others, haemoptysis; in others still, haematemesis; and in others finally, certain forms of uterine hemorrhage to be afterwards described more particularly in connection with the other principal causes of abortion. For each of these forms of local congestion the appropriate remedy must be selected in accordance with all the conditions present.
Uraemia, or the retention of the urea in the blood, will be mentioned in connection with albuminuria, with which it is usually a complementary symptom. All these forms of dilution, depravation or poisoning of the blood, may be cured by the exhibition of the remedies indicated by all the attendant circumstances, symptoms and conditions; not by any means failing to consider the mental and moral states and symptoms, which latter may constitute the most important indications to guide us in the selection of the curative remedy, even for such pathological changes. The same deep-seated constitutional influence that disturbs the harmony of the circulation and the proportions of the constituents of the blood, most powerfully and much more palpably affects the intellectual faculties, the sensibilities and even the affections.
Haemorrhoids and varices are similar affections of the blood- vessels; their principal differences consisting in the different circumstances under which the venous enlargements which constitutes them are placed. Haemorrhoids may make their appearance in the earlier or in the later months of pregnancy. In the first instance, they may result in part from pressure exerted directly upon the internal iliacs, by the expanding uterus before it has emerged from the pelvis. In the latter case, the gravid uterus exerts pressure upon the common iliacs. Still, this affection of the haemorrhoidal veins is by no means entirely caused by such mechanical pressure, otherwise it would be much more common than it now is, if not indeed universal.
In females predisposed to constipation, or in whom the internal psoric miasm develops itself in such obstruction of the bowels, haemorrhoids are an almost necessary consequences of this condition in pregnancy. And the inactive habits that aggravate the constipation, at the same time augment the haemorrhoidal enlargements. But whether due to the inactive state of the circulation, which is a necessary attendant of inactive habits, to mechanical pressure, to constipation, to psoric dyscrasia, or, as is generally the case in greater or less degree, to all these influences combined, the piles constitute a very painful condition in pregnancy. They may be blind, that is, never bleed; and inward, never protruding, and still occasion much suffering. They may protrude with each evacuation, sometimes become strangulated and difficult of replacement; and by their exhausting hemorrhages may greatly weaken the strength.
Varices are a similar enlargement of the more external veins of the vulva, sometimes even of those within the vagina also, and of the lower limbs. These enlargements are scarcely less common in pregnancy than are the hemorrhoids; but, except they appear in the vulva, they are usually far less painful. A brief notice of varicose veins, with the principal remedies indicated in this condition of the system and circulation, may be found on page seventy-second of this work.
