PUERPERAL FEVER. 109 



Should the process of labour or parturition be interfered with ? 

 If the convulsions occur during gestation, the uterus should not be 

 interfered with. Should they occur at the commencement of labour, 

 the propriety of interference may be questioned ; the safest plan is 

 merely to rupture the membranes, (provided the os uteri is dilated or 

 dilatable,) which sometimes hastens the progress of the labour. 

 Version has been condemned. When the head has descended into 

 the pelvis, and there is sufficient space, the forceps should be used. 

 The attempt should be made during an interval of the paroxysm ; 

 should the fit recur at this time, the blade should be withdrawn, for 

 fear of injuring the mother. 



Should the head of the child be fixed in the pelvis, so as to be 

 immovable with the forceps, it may be necessary to open the head. 

 Before this is done, however, all the attendant circumstances should 

 be carefully weighed; the child may be alive; the labour, if left to 

 itself, may terminate naturally ; and lastly, even if terminated by 

 art, the fits may not necessarily cease. 



Apoplectic convulsions. — Generally speaking, in this form there is 

 little or no convulsions, no distortion of the face, and no frothing at 

 the mouth ; the muscles are flaccid and powerless ; the respiration is 

 stertorous, the patient is insensible, and there is generally no repeti- 

 tion of the paroxysm. 



The attack is generally preceded by headache, ringing in the ears, 

 total or partial blindness, and flushing of the face. The pulse is 

 full, slow, and laboured during the attack, and the pupils insensible 

 to light. This form almost always occurs during labour, and is 

 caused by the violent strain upon the cerebral vessels during the ex- 

 pulsive eflbrts. 



Treatment. — Bloodletting in a full and copious stream, either from 

 the arm, jugular vein, or temporal artery. This should be repeated, 

 if needful, or followed by local depletion, in the form of cups or 

 leeches. If the patient is benefited by it, the head should then be 

 shaved and ice applied, and the bowels freely evacuated. 



If this variety occur during labour, and the uterine action be sus- 

 pended, the patient should be delivered as speedily as possible, in 

 order to save the child; for this purpose, if the head be within reach, 

 the forceps should be applied. The after treatment of all these cases 

 requires the greatest watchfulness and quiet. Should the patient be- 

 come maniacal, all sources of irritation, within and without, should 

 be removed, the patient kept quiet in a dark room, and under the in- 

 fluence of tartar emetic. 



PUERPERAL FEYER. 



This malady has received various names, such as childbed fever ^ 

 puerperal fever ^ peritoneal fever ^ puerperal peritonitis^ low fever of 

 childbed, &c. ; by some it has been considered as a fever dependent 

 on local inflammation, by others as a blood disease. Each author 



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