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THe Acute and Chronical Diseases of women with Child are the same in Essence or Nature, and have the same signs, with the like Diseases in women not with Child, or in men; wherefore it is needless in this place, to speculate thereupon, let the Reader please to look for them in their pro∣per Chapters.
But the Prognostick of these Diseases is not the same; because in women with Child they are far more dangerous, and very often times mortal. So saith Hippocrates in Aphor. 31. Sect. 5. For a Woman with Child to be feized by an acute disease, is deadly. For it the Disease have a Feaver joyned with it, there is a two-fold danger attending the same (as Galen shews in his Commentary upon this Aphorism) one from the Feaver, which will kil the Child; another from the slender diet which is requisite to the Cure of the Feaver, but is not sufficient to nourish the Infant in the Womb. Or if it be an acute Disease without a Feaver, as the Falling-sickness, Apoplexy, Universal Convul∣sion of the whol Body, the Mother and Infant cannot withstand the violence of the Disease, neither can they bear such strong Medicines as are requisite to the Cure of those Diseases. Yet we must know that this Prognostick is not perpetually true. For we know by the Testimonies and Examples in Authors, and by dayly Experience, that many women with Child having acute Diseases, escape with their lives.
But Chronical or lingering Diseases, as Intermitting Agues, Catarrhs, Tenesmus, &c. do threaten Abortion, and if they cause it not, they can hardly be cured before the woman be brought to bed, but do keep her company till she lie down.
Diseases Acute and Chronical in the first and last months, are more dangerous, than in the inter∣mediate months. For in the first months, the bands wherewith the Infant is fastened to the Womb are weak, so as they may easily be broken, and the tender Infant is more easily over pressed with those preternatural Causes. But in the last months, namely, the sixth, seventh, and eighth, the Child be∣ing grown greater, requires much nourishment, which in these Diseases it is deprived of. Also the foresaid bands do not stick so fast as in the third, fourth, and fifth months, in which there is less dan∣ger of Abortion. Therefore Galen doth excellently compare the Child in the Womb to Fruits han∣ging on a Tree, which upon their first growing out have very tender stalks, so that they may be easi∣ly shaken off with the wind, or any other violent commotion; and when they are neer ripe, they hang not so fast upon the bough, as in the intermediate spaces they did.
Likewise the Cure of the foresaid Diseases in women with child doth remarkably differ, as tou∣ching their Diet, and those two grand Remedies, Blood-letting and purging; whereunto we may ad Medicaments which evacuate by other waies, viz. Such as move the Courie, Piss-drivers, and Sweat∣drivers, because it is feared lest by these evacuations, abortion may be caused: of these therefore we shall only treat at present, referring what else belongs to the Cure of these Diseases to the proper Chapters, where such respective Diseases are handled.
As for Matter of Diet it is not to women with Child in Acute Diseases to be enjoyned so spare, lest the little Infant be famished; neither is it to be allowed so liberal, that the Feaver should be thereby strengthened; but we must steer a middle course, with this Caution, That in the first months of their Belly-burden, a thin Diet be enjoyned, and in the latter somwhat more solid and plentiful, because the Child doth then stand in need of more nourishment. Yet if there must needs be some error in Diet, it is better to err in keeping too full, than too slender diet; for recovery is chief∣ly to be expected from the strength of the Mother, and the Child.
Touching bleeding, that Aphorism of Hippocrates, viz. the 31. of Sect. 5. is presently brought in opposition, where he saies, If a woman with child be let blood, she miscarries, especially if the child be grown. And Galen renders the Reason in his Comment, Because the Blood being let out, the Infant wants its nourishment, whence follows Abortion. On the other side, daily Experience shews, That in very many Diseases of big-bellyed women, especially acute diseases, as the Pleurisie, Inflamation of the Lungs, continual Feavers, and such like, blood-letting is necessary, and may be administred, not only in the first but also in the middle months, and somtimes in the last months of a womans Belly-bearing. Which if it be omitted, both Mother and Child are in great danger of death. And to this latter Opinion the elder Physitians assent, not dissenting from the Mind of Galen and Hippocrates, by so doing. For therefore it is they held a woman would miscarry, if be∣ing with Child, she were let blood, because blood being taken away, the Child would want its Nou∣rishment. So that if blood may so be taken away, as that the Infant shall not want its nourishment, there wil be no danger of Abortion thereby.
Now so the case may stand: As first, In the first Months of a Womans Belly-bearing, while the Infant in the womb is little, and wants but little Nourishment, for then its Nourishment by bleeding will not be drawn away, especially if certain signs of superfluity of blood be apparent in the Mother. So that from the first month to the fift blood-letting, may be safely practised. But in the middle and last Months, greater circumspection is to be used, because the Child being greater, and wanting more Nourishment, cannot so safely admit of Phlebotomy. Howbeit, if the Woman abound with blood, and a smal quantity be taken away, she may safely be let blood, because hereby the Disease will be allaied; neither wil so much Nutriment be there by withdrawn from the Child, as to cause Abortion. But if it seem that Hippocrates thought otherwise, let us consider that we let blood after a far other fashion than the Antients did, they let blood by pounds, and we by ounces. The very truth is, there
is no better way to preserve women from Abortion, than by blood-letting, when it springs from over∣much blood strangling the Infant, and overwhelming the same, in such women as have been accusto∣med out of their time of being with child to have a plentiful flux of Courses for divers daies together. Thus Petrus Salius Diversus in the 22. Chapter of his Book of particular Diseases: I for my part protest (quoth he) that I have preserved many women from Abortion, which they had often suf∣fered, only by letting them blood in the first months of their being big. Neither would I have it thought, that no other kind of blood-letting may be practised in childing women, save that which is sparing or moderate. For somtimes plentiful bleeding in the last month hath done very much good. And I have somtimes experienced this plentiful Blood-letting in the last month, when the women with Child were afflicted with a burning Feaver, and were full of Blood hoping thereby an abate∣ment of the Feaver, and an hastening of the Birth, both which I obtain'd by blood-letting, and saved both child and mother in danger of death, by this only Remedy. Which being in some Pati∣ents omitted, and neglected by Physitians, minding more the words of Hippocrates, than the matter it self, hath been the cause that both child and mother hath miserably perished, being strangled by the plenty and fer vency of blood. So far Salius. Amatus Lusitanus, in the 57. Cure of his I. Section, let a woman with child of eighteen yeers of age, blood, in the sixth month, four times with happy suc∣ce, she being in a burning Feaver. And Rodericus a Castro in his third Book of Womens Disea∣eases, Chap. 21. writes, that he let a woman of Lisbon blood, who had a Pleurisie in the eight month, and was given over for desperate by other Physitians, four times and no less one after another, and she recovered, and had a healthy Boy. And to conclude, If I may freely relate somwhat from mine own Experience, I will set down the following History, which is a rare one, and worthy to be regarded. The Wife of John Vicules, Citizen of Montpelier, had three miscarriages one after another at se∣veral times of her being with child: When she was the fourth time with Child, about the end of the second month, she was taken with the same pains of her Belly and Loyns, which had been the usual fore-runners of her former miscarriages. I being called to her, and considering she was a Sanguine Woman, and full of Blood, presently caused four ounces of blood to be taken from her; and within half an hour the foresaid pains quite ceased, and the Woman was so well that she would not use those other Medicines which I prescribed for her to prevent Abortion. Now those Symptomes ap∣peared in the self same time, wherein she was wont to have her Courses, when she was not with Child. Again in the third month of her being with Child, at the same period of time, the same Symptomes return upon her: She sending for me, desires I would order her to be let blood, seeing the month pre∣ceding she had found so sudden help thereby. I consent, and she is again let Blood, with like good success as before. In like manner in her fourth, fifth, sixth, seventh, and eighth months the same Symptomes returning, in their just distances of time, she was again let Blood and presently recovered. The last of h••r ••leedings was but eight daies before the beginning of her ninth month, with like profit 〈◊〉〈◊〉 before; and about the end of the ninth month the said woman brought forth a living 〈◊〉〈◊〉 and Lusty.
Yet I would not have a young Physitian moved with these examples be too bold in letting women Blood in their last months of being with Child. But the Nature of the Diseases and of the women raust be diligently considered, that Medicaments may be conveniencly suited thereunto. Allwaies remembring that sins of omission are lighter than sins of commission, and that it is better in a doubtfull case to fall short, than to outpass the due and fitting bounds. Yet when he finds the evident indications of Blood-letting, let him boldly draw Blood, first enforming the by-standers or friends of the sick, that there is more danger of abortion, and of the death of Infant and Mother from the Cruellty of the disease, than from Blood-letting: and allwaies remembring that but little Blood be taken away, that the Child may not miss of its nourishment. And if plenty of Blood require a larget quantity to be taken away, let it be done at divers times and not all at once.
Wherefore the foresaid Aphorism of Hippocrates does not absolutely forbid the opening of a vein, but only warnes that Physitians be wary what they do in that kind. Which is elegantly delivered by Cornelius Celsus in the 10. Chapter of his 2 Book, in these words. The Antients did judg that young and old people could not bear Blood-letting. And they perswaded themselves that a woman with Child, let Blood would miscarry. But experience hath since taught us, that these are no generall Rules, and there are other considerations of more weight, which the Practi∣tioner is to regard. For it matters not of what Age the Patient is, nor what she hath in her Body, but what her strength is. So that if a young man be weak, or a woman not with Child be weak, Blood is ill taken from them, for the remaining strength dies, and they perish. But a strong Child, and a strong old man, and a woman with Child that is lustly, are safely cured by bleading. So for Celsus. Some latter Physitians have dared to open the lower veins in women with Child, to Cure the Falling-sickness by consent of the Womb, the venerial and pestilential Bubo, yea, and to prevent abortion, as we may see in Zacutus Lusitanus in his Book of Wonderful Cures Obs. 23. Book, 1. and Obs. 130 and 151 of Book 2. Who by his own and other mens
experiments endeavours to prove, that such Blood-letting may be safely practised. Which I leave to prudent Physitians to consider of.
We said about the beginning of this Chapter, that there is no difference in Curing the diseases of women with Child, saving with respect to the greater remedies; which difference must be in them thus determined, viz. That the diseases which hold women not with Child, as vomiting, want of appetite and the like; in them being not with Child, they are to be Cured rather by vomiting than by Blood-letting, because they come from evil humors abounding in the stomach and the whol Body; but in women with Child, they need rather Blood-letting, because they Spring from Blood retained in in the very beginning of their being with Child. And experience hath taught that the vomiting, which is wont often to trouble women with Child, is in the first months of Childing exasperated by purges; but by bleeding much abated, yea and wholly taken away, if the Blood-letting be ite∣rated every month till the symptom cease.
The use of Purging in women with Child Hippocrates hath defined in Aphor. 1. Sect. 4. Wo∣men with Child (saith he) are to be purged if the humor offending do work in the fourth month and to the seventh, But these about the seventh less. And we must take heed what we do when the Child is very young, or old. Galen in his Comment saies that there is the same proportion between a Child in the Womb and fruit upon the true. For fruit when it first grows upon the bough, it is held by a very tender stalk, and therefore quickly falls, being shaken by a vehement wind. after∣wards when they are grown greater, they are not easily separated from the boughs. And yet when they are fully ripe they fall off of their own accord. In the same manner women suffer abortion in the first and last months, because in them the Child is not so fast tied to the Womb. But in this Age of ours, purges are wont to be given to women with Child in all the months (very neer) of their being with Child in diseases springing from the tyranny of humors & excrements vitiated, when the matter is in motion and works, or when it is concocted: so often as there is more danger seared from the evil humor causing the disease, than from the commotion raised by the purging Medicaments. Gen∣tle and harmless Medicaments have made Physitians bolder in this kind, such I mean as we use at this day, as Rhubarb, Myrobalans, Cassia, Manna, Senna, Agarick and the like. But we must allwaies remember that saying of Hippocrates; and we must more freely give purges in the middle months and more warily in the first and last. Also the use of Pills is ever more suspected in women with Child; both because they make a greater commotion in the Body, and also by reason of the Aloes, which by reason of the extream bitterness is an enemy to the Child, and is thought to open the mouths of the veines. But if sometimes the use thereof seems necessary, in some grevious infirmities of the stomach, which are wont frequently to infest women with Child the first months of their being with Child bearing, let it be carefully washed with Rose-water, that the acrimony thereof may be taken away; or let it be mixt with strengthening and astringent things, as Rhubarb, Mastich and such like.
Clysters are not very safe, because by compressing the Womb they may cause abortion. So that when there is need of them, and in women accustomed to that kind of evacuation, they must be made in less quantity, and of such things as are rather mollfying and lenefying than much purging.
In a word, touching Sweat-drivers, Piss-drivers, and such things as move the Courses, our Opi∣nion is, That Movers of the Courses properly so called are never to be used in women with Child. And Piss-drivers because they likewise are apt to bring down the Courses, ought to be suspected; and if the necessity of some disease require the use of them, the gentler must be made choice of. And finally, Sweat-drivers may be safely given, because they drive the humors out, by the habit of the Body, whereby no danger of abortion is incurred, in so much that some women in the middle of their being with Child, have bin Cured of the whores Pox, without harm to their Child.