110 OBSTETRICS. 



who has written upon the subject, has adopted a classification in ac- 

 cordance with his own views and experience; it would be impossible, 

 therefore, in a work of this kind, to give a synopsis of all. " The 

 student is liable to be deceived, if he grounds his ideas of this ma- 

 lady solely on the observations of one or two writers, especially 

 those who have witnessed epidemics as they have appeared in hos- 

 pital practice, however graphic the representations may be; because 

 scarcely any two have resembled each other; and because the symp- 

 toms in all cases are much modified by the temperature and other 

 qualities of the atmosphere, the season of the year, the localities in 

 which the disease appears, and several external circumstances, inde- 

 pendently of the constitution of the patient herself."* 



There may be said to be four principal varieties of this disease. 

 The first and most common variety, is characterized by pain and 

 tenderness in the abdomen, preceded by a chill, and accompanied by 

 a hot skin, rapid pulse, and sometimes profuse perspiration. In this 

 form the uterus and its appendages, or the peritoneum, receive the 

 greatest force of the blow. 



The second form assumes the character of a mild typhus, accom- 

 panied by intestinal irritation. It is ushered in by rigors, followed 

 by a hot fit ; and succeeded by nausea and vomiting, or diarrhoea, 

 with most offensive evacuations. The tongue, at first loaded and 

 white, soon becomes preternaturally red, as in those affected by 

 chronic dysentery. The skin is dry and hot, and of a dusky yellow 

 hue; the mind is unsettled, without being absolutely delirious; the 

 debility is extreme, and the limbs tremulous. In some cases these 

 symptoms are followed by acute inflammation of some important 

 organ, or of the joints, softening of the womb, suppuration of its 

 lymphatics, or veins. There is usually suppression of the milk, 

 and sometimes of the lochia. 



In the third variety the main mischief seems to be expended on 

 the nervous system; there is great delirium, agitation, and sense of 

 impending death. This form is liable to be followed by fatal syncope 

 and coma, and may supervene on either of the others. 



The fourth and worst form of puerperal fever affords the most 

 extensive evidence of the diffusion of a poison over the system 

 through the blood, and presents the most perfect analogy with scar- 

 latina maligna. Shivering, and abdominal pain, are followed by 

 rapid exhaustion, quick pulse, glassy eye, and dusky skin. There 

 are often pain in the chest, husky cough, laborious breathing, and 

 other evidence of inflammation of the lungs, which afler death may 

 be found gangrenous. Abscesses of the joints, and cellular tissue ; 

 phlebitis, and gangrene of the intestines, are among the ravages of 

 this most fatal malady, 



* Ramsbotham, p. 415. 



