The Works of Aristotle the Famous Philosopher Part 10

SIGNS.

Signs of coming abortion are a falling away of the breast, with a flow of watery milk, pains in the womb, heaviness in the head, unusual weariness in the hips and thighs, and a flowing of the courses. Signs denoting that the fruit is dead in the womb are sunken eyes, pains in the head, frights, paleness of the face and lips, gnawing at the stomach, no movements of the infant; coldness and looseness of the mouth of the womb. The stomach falls down, whilst watery and b.l.o.o.d.y discharges come from the womb.

CHAPTER XIV

_Directions for Pregnant Women._

The prevention of untimely births consists in removing the aforementioned causes, which must be effected both before and after conception.

Before conception, if the body be too hot, dry or moist, employ such treatment as to counteract the symptoms; if the blood be vitiated purify it, if plethoric, open the liver vein; if gross, reduce it; if too thin strengthen and nourish it. All the diseases of the womb must be removed as I have shown.

After conception, let the atmosphere be kept temperate, do not sleep too much, avoid late hours, too much bodily exercise, mental excitement, loud noises and bad smells, and sweet smells must also be avoided by those who are hysterical. Refrain from all things that may provoke either urine or menstruation, also salt, sour, and windy food, and keep to a moderate diet.

If the bowels are confined, relieve the stomach with injections made of a decoction of mallows and violets, with sugar and salad oil; or make a broth with borage, buglos, beetroot, and mallows, and add a little manna to it. If, on the other hand, she be troubled with looseness of the bowels, do not check it with medical advice, for all the uterine fluxes have some bad qualities in them, which must be evacuated before the discharge is stopped.

A cough is another thing to which pregnant women are frequently liable, and which causes them to run great danger of miscarrying, by the shock and continual drain upon the vein. To prevent this shave off the hair from the coronal commissures, and apply the following plaster to the place.

Take half an ounce of resin, a drachm of laudanum, a drachm each of citron peel, lignaloes and galbanum, with a sufficient quant.i.ty of liquid and dry styrax. Dissolve the gum in vinegar and make a plaster, and at night let her inhale the fumes of these lozenges, thrown upon bright coals. Take also a drachm and a half each of frankincense, styrax powder and red roses: eight drachms of sandrich, a drachm each of mastic, benjamin and amber; make into lozenges with turpentine, and apply a cautery to the nape of the neck. And every night let her take the following pills:--Half an ounce each of hypocistides, terrae sigilatae and fine bole; two drachms each of bistort, alcatia, styrax and calamint, and one drachm of cloves, and make into pills with syrup of myrtles.

In pregnant women, a corrupt matter is generated which, flowing to the ventricle, spoils the appet.i.te and causes sickness. As the stomach is weak, and cannot digest this matter, it sometimes sends it to the bowels which causes a flux of the stomach, which greatly adds to the weakness of the womb. To prevent all these dangers the stomach must be strengthened by the following means:--Take one drachm each of lignaloes and nutmeg; a scruple each of mace, cloves, mastic, laudanum; an ounce of oil of spikenard; two grains of musk, half an ounce each of oil of mastic, quinces and wormwood, and make into an ointment for the stomach, to be applied before meals. Instead of this, however, you may use ceroc.u.m stomachile Galeni. Take half an ounce each of conserve of borage, buglos and atthos; two drachms each of confection of hyacinths, candied lemon peel, specierum, diamarg, pulo. de genunis: two scruples each of nutmeg and diambra; two drachma each of peony roots and diacoratum, and make into an electuary with syrup of roses, which she must take twice a day before meals. Another affection which troubles a pregnant woman is swelling of the legs, which happens during the first three months, by the superfluous humours descending from the stomach and liver. To cure this, take two drachms of oil of roses, and one drachm each of salt and vinegar; shake them together until the salt is dissolved, and anoint the legs with it hot, rubbing it well in with the hand. It may be done without danger during the fourth, fifth and sixth months of pregnancy; for a child in the womb is compared to an apple on the tree. For the first three months it is a weak and tender subject, like the apple, to fall away; but afterwards, when the membranes become strengthened, the fruit remains firmly fastened to the womb, and not subject to mischances, and so it remains, until the seventh month, until when it is near the time, the ligaments are again relaxed (like the apple that is almost ripe).

They grow looser every day, until the appointed time for delivery; if, therefore, the body is in real need of purging, the woman may do it without danger in the fourth, fifth or sixth month, but neither before nor after that unless in the case of some violent illness, in which it is possible that both mother and child may perish. Apply plasters and ointments to the loins in order to strengthen the fruit in the womb.

Take one drachm each of gum Arabic, galangale, bistort, hypocistid and storax, a drachm and a half each of fine bole, nutmeg, mastic, balaust, dragon's blood and myrtle berries, and a sufficient quant.i.ty of wax and turpentine and make into a plaster. Apply it to the loins in the winter, and remove it every twenty-four hours, lest the loins should become overheated by it. In the interim, anoint the private parts and loins with _countess' balsam_ but if it be summer time and the loins hot, the following plaster will be more suitable. Take a pound of red roses, two drachms each of mastic and red Sanders, one drachm each of bole ammoniac and red coral, two drachms and a half each of pomegranate seed and prepared coriander seed, two scruples of barberries, one ounce each of oil of mastic and of quinces, and plantain-juice.

Anoint the loins also with sandalwood ointment, and once a week wash them with two parts of rose-water and one of white wine mixed together and warmed at the fire. This will a.s.suage the heat of the loins, get rid of the oil of the plaster from the pores of the skin, and cause the fresh ointment or plaster to penetrate more easily, and to strengthen the womb. Some think that a load-stone laid upon the navel, keeps a woman from abortion. The same thing is also stated of the stone called _aet.i.tes_ or eagle-stone, if it is hung round the neck. Samian stone has the same virtue.

CHAPTER XV

_Directions for Women when they are taken in Labour, to ensure their safe Delivery, and Directions for Midwives._

Having thus given the necessary directions to pregnant women, how to manage their health during their pregnancy, I will now add what is necessary for them to do, in order that they may be safely delivered.

When the time of birth draws near, the woman must be sure to send for a skilful midwife, and that rather too soon than too late. She must have a pallet bed ready to place it near the fire, so that the midwife and those who are to help her, may be able to pa.s.s round it, and give a.s.sistance on either side, as may be required. A change of linen must be in readiness, and a small stool to rest her feet against, as she will have more power when her legs are bent, than when they are straight.

When everything is thus ready, and when the woman feels the pains coming on, if the weather be not cold, she should walk about the room, rest on the bed occasionally, waiting for the breaking of the waters, which is a fluid contained in one of the outward membranes, and which flows out thence, when the membrane is broken by the struggles of the child. There is no special time for this discharge, though it generally takes place about two hours before the birth. Movements will also cause the womb to open and dilate, and when lying long in bed will be uncomfortable. If she be very weak she may take some mild cordial to give her strength, if her pain will permit her; and if the labour be tedious, she may be revived with chicken or mutton broth, or she may take a poached egg; but she must be very careful not to eat to excess.

There are many postures in which women are delivered; some sitting in a chair, supported by others, or resting on the bed; some again upon their knees and resting on their arms; but the safest and most commodious way, is in the bed, and then the midwife ought to observe the following rules:--Let her lay the woman upon her back, with her head a little raised by means of a pillow, with similar supports for her loins and b.u.t.tocks, which latter should also be raised, for if she lies low, she cannot be delivered so easily. Then let her keep her knees and thighs as far apart as she can, her legs bent inward towards each other, and her b.u.t.tocks, the soles of her feet and her heels being placed upon a small rest, placed for the purpose, so that she may be able to strain the stronger. In case her back should be very weak, a swathing band should be placed under it, the band being doubled four times and about four inches broad. This must be held by two persons who must raise her up a little every time her pains come on, with steady hands and in even time, but if they be not exact in their movements, they had better leave her alone. At the same time two women must hold her shoulders so that she may strain out the foetus more easily; and to facilitate this let one stroke or press the upper part of her stomach gently and by degrees. The woman herself must not be nervous or downhearted, but courageous, and forcing herself by straining and holding her breath.

When delivery is near, the midwife must wait patiently until the child's head, or some limb, bursts the membranes, for if the midwife through ignorance, or through haste to go to some other woman, as some have done, tears the membrane with her nails, she endangers both the woman and the child; for by lying dry and lacking that slipperiness which should make it easy, it comes forth with severe pains.

When the head appears, the midwife must hold it gently between her hands, and draw the child, whenever the woman's pains are upon her, but at no other times; slipping her forefingers under its armpits by degrees, and not using a rough hand in drawing it out, lest the tender infant might become deformed by such means. As soon as the child is taken out, which is usually with its face downwards,--it should be laid upon its back, that it may receive external respiration more freely; then cut the navel string about three inches from the body, tying the end which adheres to it with a silk string, as closely as you can; then cover the child's head and stomach well, allowing nothing to touch its face.

When the child has been thus brought forth, if it be healthy lay it aside, and let the midwife attend to the patient by drawing out the afterbirth; and this she may do by wagging and stirring it up and down, and afterwards drawing it out gently. And if the work be difficult, let the woman hold salt in her hands, close them tightly and breathe hard into them, and by that she will know whether the membranes are broken or not. It may also be known by making her strain or vomit; by putting her fingers down her throat, or by straining or moving her lower parts, but let all be done immediately. If this should fail, let her take a draught of elder water, or the yolk of a new laid egg, and smell a piece of asafoetida, especially if she is troubled with a windy colic. If she happen to take cold, it is a great obstruction to the afterbirth; in such cases the midwife ought to chafe the woman's stomach gently, so as to break, not only the wind, but also to force the secundine to come down. But if these should prove ineffectual, the midwife must insert her hand into the orifice of the womb and draw it out gently.

Having thus discussed common births, or such as are generally easy, I shall now give directions in cases of extremity.

CHAPTER XVI

_What ought to be done in cases of extremity, especially in women who, in labour, are attacked by a flux of blood, convulsions and fits of wind._

If the woman's labour be hard and difficult, greater care must be taken than at other times. And, first of all, the situation of the womb and her position in lying must be across the bed, and she must be held by strong persons to prevent her from slipping down or moving during the surgeon's operations. Her thighs must be put as far apart as possible, and held so, whilst her head must rest upon a bolster, and her loins be supported in the same manner. After her rump and b.u.t.tocks have been raised, be careful to cover her stomach, belly and thighs with warm clothes, to keep them from the cold.

When the woman is in this position, let the operator put up his or her hand, if the neck of the womb be dilated, and remove the coagulated blood that obstructs the pa.s.sage of the birth; and by degrees make way gently, let him remove the infant tenderly, having first anointed his hand with b.u.t.ter or some harmless salve. And if the waters have not come down, they may then be let out without difficulty. Then, if the infant should attempt to come out head foremost, or crosswise, he should turn it gently, to find the feet. Having done this, let him draw out one and fasten it with ribbon and then put it up again, and by degrees find the other, bringing them as close together and as even as possible, and between whiles let the woman breathe, and she should be urged to strain so as to help nature in the birth, that it may be brought forth. And to do this more easily, and that the hold may be surer, wrap a linen cloth round the child's thighs, taking care to bring it into the hand face downwards.

In case of flux of blood, if the neck of the womb be open, it must be considered whether the infant or the _secundine_, generally called the afterbirth, comes first, and as the latter happens to do so occasionally, it stops the mouth of the womb and hinders the birth, and endangers both the woman's and the child's life. In this case the afterbirth must be removed by a quick turn. They have deceived many people, who, feeling their softness, have supposed that the womb was not dilated, and by that means the woman and child, or at least the latter, have been lost. When the afterbirth has been removed, the child must be sought for and drawn out, as directed above; and if the woman or the child die in such a case, the midwife or the surgeon are blameless because they have used their best endeavours.

If it appears upon examination that the afterbirth comes first, let the woman be delivered as quickly as possible, because a great flow of blood will follow, for the veins are opened, and on this account two things have to be considered.

_First_:--The manner in which the afterbirth advances, whether it be much or little. If the former, and the head of the child appears first, it may be guided and directed towards the neck of the womb, as in the case of natural birth, but if there appears any difficulty in the delivery, the best way is to look for the feet, and draw it out by them; but if the latter, the afterbirth may be put back with a gentle hand, and the child taken out first. But if the afterbirth has come so far forward that it cannot be put back, and the child follows it closely, then the afterbirth must be removed very carefully, and as quickly as may be, and laid aside without cutting the entrail that is fastened to it; for you may be guided to the infant by it, which must be drawn out by the feet, whether it be alive or dead, as quickly as possible; though this is not to be done except in cases of great necessity, for in other cases the afterbirth ought to come last.

In drawing out a dead child, these directions should be carefully followed by the surgeon, viz.--If the child be found to be dead, its head appearing first, the delivery will be more difficult; for it is an evident sign that the woman's strength is beginning to fail her, that, as the child is dead and has no natural power, it cannot be a.s.sisting in its own delivery in any way. Therefore the most certain and the safest way for the surgeon is, to put up his left hand, sliding it into the neck of the womb, and into the lower part of it towards the feet, as hollow in the palm as he can, and then between the head of the infant and the neck of the womb. Then, having a forceps in the right hand, slip it up above the left hand, between the head of the child and the flat of the hand, fixing it in the bars of the temple near the eye. As these cannot be got at easily in the occipital bone, be careful still to keep the hand in its place, and gently move the head with it, and so with the right hand and the forceps draw the child forward, and urge the woman to exert all her strength, and continue drawing whenever her pains come on.

When the head is drawn out, he must immediately slip his hand under the child's armpits, and take it quite out, and give the woman a piece of toasted white bread, in a quarter of a pint of Hippocras wine.

If the former application fails let the woman take the following potion hot when she is in bed, and remain quiet until she begins to feel it operating.

Take seven blue figs, cut them into pieces and add five grains each of fenugreek, motherwort and rue seed, with six ounces each of water of pennyroyal and motherwort; reduce it to half the quant.i.ty by boiling and after straining add one drachm of troches of myrrh and three grains of saffron; sweeten the liquor with loaf sugar, and spice it with cinnamon.--After having rested on this, let her strain again as much as possible, and if she be not successful, make a fumigation of half a drachm each of castor, opopanax, sulphur and asafoetida, pounding them into a powder and wetting the juice of rue, so that the smoke or fumes may go only into the matrix and no further.

If this have not the desired effect, then the following plaster should be applied:--Take an ounce and a half of balganum, two drachms of colocynth, half an ounce each of the juice of motherwort and of rue, and seven ounces of virgin bees' wax: pound and melt them together, spreading them on a cere-cloth so that they may spread from the navel to the os pubis and extending to the flanks, at the same time making a pessary of wood, enclosing it in a silk bag, and dipping it in a decoction of one drachm each of sound birthwort, savin colocinthis, stavescare and black h.e.l.lebore, with a small sprig or two of rue.

But if these things have not the desired effect, and the woman's danger increases, let the surgeon use his instruments to dilate and widen the womb, for which purpose the woman must be placed on a chair, so that she may turn her b.u.t.tocks as far from its back as possible, at the same time drawing up her legs as close as she can and spreading her thighs open as wide as possible; or if she is very weak it may be better to lay her on the bed with her head downwards, her b.u.t.tocks raised and both legs drawn up. Then the surgeon may dilate the womb with his speculum matrices and draw out the child and the afterbirth together, if it be possible, and when this is done, the womb must be well washed and anointed, and the woman put back to bed and comforted with spices and cordials. This course must be adopted in the case of dead children and moles, afterbirths and false births, which will not come out of themselves, at the proper time. If the aforementioned instrument will not widen the womb sufficiently, then other instruments, such as the drake's bill, or long pincers, ought to be used.

If any inflammation, swelling or congealed blood happens to be contracted in the womb under the film of these tumours, either before or after the birth, let the midwife lance it with a penknife or any suitable instrument, and squeeze out the matter, healing it with a pessary dipped in oil of red roses.

If the child happens at any time to be swollen through cold or violence, or has contracted a watery humour, if it is alive, such means must be used as are least injurious to the child or mother; but if it be dead, the humours must be let out by incisions, to facilitate the birth.

If, as often happens, the child is presented feet foremost, with the hands spreading out from the hips, the midwife must in such a case be provided with the necessary ointments to rub and anoint the child with, to help it coming forth, lest it should turn into the womb again, holding both the infant's arms close to the hips at the same time, that it may come out in this manner; but if it proves too big, the womb must be well anointed. The woman should also take a sneezing powder, to make her strain; the attendant may also stroke her stomach gently to make the birth descend, and to keep it from returning.

It happens occasionally, that the child presenting itself with the feet first, has its arms extended above its head; but the midwife must not receive it so, but put it back into the womb, unless the pa.s.sage be extraordinarily wide, and then she must anoint both the child and the womb, and it is not safe to draw it out, which must, therefore, be done in this manner.--The woman must lie on her back with her head low and her b.u.t.tocks raised; and then the midwife must compress the stomach and the womb with a gentle hand, and by that means put the child back, taking care to turn the child's face towards the mother's back, raising up its thighs and b.u.t.tocks towards the navel, so that the birth may be more natural.

If the child happens to come out with one foot, with the arm extended along the side and the other foot turned backwards; then the woman must be immediately put to bed and laid in the above-described position; when the midwife must immediately put back the foot which appears so, and the woman must rock herself from side to side, until she finds that the child has turned, but she must not alter her position nor turn upon her face. After this she may expect her pains and must have great a.s.sistance and cordials so as to revive and support her spirits.