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Disturbances Due to Pressure

water, bladder, dropsy, veins, patient, pregnancy and relief


Bladder Troubles.—Such disturbances are frequent in the course of the child-carrying period, and specially, as might be expected, towards the end of the period. The bladder is peculiarly apt to be pressed upon, and fre quent passing of water, pain in the act, or difficulty in emptying the bladder may be ex perienced. Dribbling of urine may arise from pressure on the neck of the bladder interfering with its proper emptying, and may be thus the result, not of inability to retain the water, but from the bladder being constantly overfull. A bandage carefully adjusted while the patient is lying down will often relieve such symptoms by the support it affords to the womb. Occa sionally the use of a belladonna pessary (see Pgssaulas) or the application of hot-water pads relieves irritability. Sometimes the patient will overcome difficulty in making water by changing the position usual in the act of passing water, but sometimes it is necessary to pass the catheter to empty the bladder.

Dropsy, Varicose Veins, and Piles are frequent in pregnancy as the result of pressure, by the enlarging womb, on veins preventing the due return of blood. The feet and legs suffer from the dropsical swelling, and the veins of the inner side of the knee and also of the ankle become swollen and prominent, forming vari cose veins (see p. 326). Sometimes the ankle becomes much discoloured, in consequence, as if it had been severely bruised. For these con ditions there is no cure. They will in nearly every instance disappear after delivery. Some relief may, however, be given by supporting the womb with a bandage put on as the woman lies on her back, and by supporting the veins of the leg with properly-adjusted bandages. All garters should be discarded, and nothing worn tight round the knee. Elastic stockings, if properly fitted, are very useful. The bowels should be regulated with the Hunyadi mineral water already recommended. Piles often also disappear after delivery. Certainly no opera tion for their cure should be undertaken during pregnancy. If they are painful, bathing with very hot water gives great relief, and the gall and opium ointment or the tincture of witch hazel (the American Pond's Extract) may be applied to relieve pain and arrest bleeding. In

this case regularity of the bowels is everything.

Dropsy during pregnancy may, however, be the result of an affection of the kidney, termed albuminuria (see p. 407). In such a case it affects not the lower limbs merely but the whole body, and is a much graver condition than the dropsy due to mechanical pressure. The legs are greatly swollen and the face puffy. ' There are also other symptoms, such as head- ' ache, dimness of sight, and in severe cases con vulsions. The symptoms may, however, not be so serious, and after delivery they may entirely disappear. But a patient who, during preg nancy, suffers from swelling not of the legs only but also of of the body should seek competent advice at once. It is not a condition •for which treatment can be definitely laid down here, except that the bowels should be freely opened and kept freely open, at first by a small tea-spoonful of compound jalap powder, and thereafter by daily doses of mineral water, and the diet should be reduced to milk only, six tumblers per day, and the patient kept at rest in bed.

Another form of dropsy, called dropsy of the amnion, may be mentioned here. It has been pointed out (p. 625) that the growing child is inclosed within a double sac between the walls of which fluid is contained—the waters. In ordinary circumstances the quantity of fluid would not be more than 2 or 3 pints, but in some cases the quantity is enormously in creased. It produces in such cases most exces sive enlargement, and is a source of extreme discomfort to the mother, interfering with movement, affecting breathing, &c. It is usually after the middle of pregnancy that the excess shows itself, not much before the fifth month, and it is commoner in twin pregnancies. When the distension is very great the breathing may be so difficult that some treatment is needed. Nature has often afforded relief by the mem branes spontaneously rupturing, inducing pre mature labour. If it were proved necessary, a physician would imitate this procedure. It is not a condition threatening the life of the mother, but it does seriously that of the child.