Bryonia The breasts feel heavy, a sort of stony heaviness; rather pale, but hard; dry lips and mouth; constipation of burnt, dry feces; splitting headache; nausea and faintness, on sitting up.
Calcarea carbonica The breasts are distended, the milk scanty; she is cold; feels the cold air very readily; there seems to be a want of vital activity to bring the milk forward; leucophlegmatic constitution.
Chamomilla The breasts are very tender; the nipples inflamed, and swollen; she is restless; thinks she can hardly endure her sufferings; is fretful; sleepless and cross.
Croton t. The breasts may or may not be swollen, but the pain extends from the nipple through to the shoulder-blade every time the child draws at the breast; the suffering is excruciating, a sovereign remedy.
Pulsatilla The breasts are much swollen, and rheumatic pains extend to the muscles of the chest, shoulders, neck, axillae, and down the arms, &c. She is feverish and tearful, but not thirsty.
Rhus-t The breasts are painfully distended and red in streaks, and there is a rheumatic condition of the whole body. Stiffness of the joints; the first movement is painful and stiff; but she can move more easily afterwards. She cannot lie long in one position; she must change in order to find an easier place.
HYGIENIC CARE OF LYING-IN FEMALES.
Where choice is offered, a large, airy chamber should be selected, on the sunny side of the house. Strict attention should be paid to ventilation and cleanliness; remove immediately from the room all matter that emits odor, even soiled linen, and let the air be kept as pure and uncontaminated as possible. There should be a draft of air through the room, but not across the patient’s bed. The genital organs should be bathed under the clothes, with luke-warm water, morning and evening, as long as they are soiled by the lochia. The patient should make no exertion the first three or four days. As soon as she is able, she may be moved from one side of the bed to the other, thus leaving a fresh side to be transferred to as often as she desires for the first ten or twelve days. But during all this time she should never get up from the bed. If she is able, she may leave her bed after ten days and sit up, properly protected, for half an hour or an hour; then she must lie down and rest, so that, little by little, everyday, she may gain more strength. In the same manner she may begin to walk about, little by little, as her strength increases; and, in the summer season, she may ride out during the third week, and in the winter, during the fourth week, in the middle of the day. But she should avoid going to church, or to any other large, cold, damp public place to remain long, for a church service, for instance, under six or eight weeks.
Until the milk has become well established and the breasts have assumed a good healthy condition, the patient should subsist on oatmeal gruel, boiled an hour and a half, or on panada, or some such light-food. Oat-meal gruel is the best, with no spices, only a little salt or sugar, if desired. Immediately after this period is safely reached, which, other things being equal, is usually on the third or fourth day, she may be allowed to return to her usual diet, with the exception of eggs, oysters and fish, which should never be allowed in a lying-in chamber. After the fourth day, beefsteak, mutton-chop, chicken, fruits, vegetables, &c., may usually be taken at pleasure. Cold water must not be forgotten from the first, as a beverage, ad libitum; it is of great use in preserving a healthy condition in lying-in patients.
The bowels usually remain closed for eight or ten days after parturition, and no interference should be permitted; but about this time a spontaneous motion will take place. In the mean time, all symptoms must be prescribed for as occasion requires. If, on account of frequent urging, constipation or diarrhoea, the bowels need attention, see the articles on these conditions in other parts of this work.
A single direction may here be given in respect to the covering for the bed, both of the babe and its mother. Avoid heavy quilts, and use blankets, since they are lighter and warmer, and more healthy, from not exhausting by their oppressive weight. A silk spread stuffed with fine lamb’s wool, makes a covering very light and very warm. So, by the use of light coverings, “easily to be borne, you may save your patient’s strength, thereby securing a more rapid convalescence.
Hygiene and Treatment of the Child immediately after its Birth. The moment the child has been entirely delivered, it should be placed upon the bed with its back towards the mother; the sheet with the other covering lying next to her (the nicer bed- covering, blankets, &c., being first turned back) should be allowed to fall between the child and its mother. Thus the latter will be perfectly covered and protected from exposure; while the new-born child lies in full view. Its little face should be wiped with a soft napkin; and as soon as its respiration becomes well established, the cord should be tied about an inch and a half from its abdomen, so firmly as to preclude any possibility of hemorrhage after the shrinking of the tissues. Should the cord seem large and tapering from the abdomen, great care must be taken not to include any portion of the intestine, which latter, if present in the cord, should be stripped back into the abdomen, before lying. The cord having been cut, the child is to be placed in a flannel blanket upon the bed, by seizing the feet with one hand and placing the other under the shoulders and neck. In this manner the operation can be performed neatly, without a risk of soiling the bed-clothes or carpets, a precaution which should always be observed.
The child should now be washed and dressed. Some unctuous matter, such as lard or oil, should be rubbed into all those places covered with the caseous, which latter will then be entirely removed upon being washed with a little soap and water. The navel should next be dressed; this may be done by taking a piece of old linen about three inches square and of double thickness, tear down one edge to the middle, slip this on to the cord in contact with the skin of the abdomen, double up the sides so as to overlap the middle, apply a flannel bandage around the body, then may be added the diaper, the shirt, the flannel petticoat, and the little muslin slip. This constitutes the babe’s dress for the bed; when it is taken up it should also have a little shawl or blanket provided for that purpose, which should always be laid aside upon its return to bed. The diapers should always be changed immediately after being soiled or wet, both day and night; other wise almost incurable sores will inevitably result. At his daily visits, the physician should observe that the infant is not smothered while lying in bed, but has an opportunity of breathing like other human beings. Its pillow should not be more than two inches and a half thick; and it should be made of hair untufted, so that it may be pulled apart and made light and airy every few hours.
Should the child be troubled with retention of urine, Aconite will be the remedy most likely to afford relief. See Dystocia. If the meconium does not pass off naturally, Mercurius, Nux v., Bryonia, or Pulsatilla may be resorted to. See Constipation.
The child is not always born in so healthy a condition as to be capable of undergoing promptly the treatment above described. Sometimes it comes into the world in a state of apparent death. This condition may result from three distinct classes of causes; and may present corresponding differences in the appearances of the child.
I. Apparent death of the child may result from shock to its nervous system in general, or to some special lesion of a particular portion of it. In the former class may be instanced the severe compression which the brain undergoes in certain cases of contracted pelvis, and from the application of the forceps under difficult circumstances, especially in the superior strait; in the latter class may be instanced the still more serious lesions of the medulla oblongata which may result from extreme rotation of the head, from undue traction upon the head after it is delivered, or from too much force applied to the body in order to deliver the head still detained within the pelvis. This latter is one of the most frequent causes of the fatality so commonly attendant upon breech presentations. The injury to the brain. not necessarily preventing respiration, may pass away and the life of the child still be preserved. Such however is not the case with serious lesion of the medulla oblongata, which renders respiration impossible. However, as it may not be known that such injury exists, unless the child’s neck should have been distorted by some remarkable violence, every case of apparent death in the new-born babe should be treated as if there were a possibility of recovery.
II. Injuries of the placental circulation may have been the cause of the apparent death of the child. These may variously arise, from compression of the umbilical cord between the sides of the pelvis and the head or body of the child; from winding of the cord so tightly around the neck as to obstruct the circulation in the umbilical vessels; from the premature separation of the placenta, which may occur in cases of delivery by the breech, when all but the head has been delivered; or from great retraction of the uterus itself when only the head remains within it, such retraction preventing the admission of fresh blood into the uterine sinuses in sufficient quantity to supply the child. By either of these causes a real asphyxia may be produced. A similar condition may result from such an accumulation of mucus in the nose and mouth as will prevent the introduction of air into the bronchia. In addition to the breathlessness, this condition will be indicated by discoloration of the skin, which may exhibit a violet or blackish-blue color; the muscles are motionless; the limbs flexible, and the body warm; but the pulsations of the cord, of the radial artery and even those of the heart, are faint and imperceptible.
