MILK FEVER. Ill 



There are a few general sy^nptoms which may be added to those 

 mentioned above as characterizing the different forms. The pulse 

 is always accelerated, ranging from 110 to 140, or 160; in the in- 

 flammatory form it is full and hard ; in the adynamic, weak and 

 small ; pain is not uniformly present, though most generally ; there 

 is great tympanitis, and generally constipation. The lochia and 

 milk are usually suspended; the urine is suppressed, or voided with 

 great pain; tormina and tenesmus are present; and there is often a 

 vomiting of yellow or green bitter matter, and in the last stage, a 

 discharge resembling black vomit. The intellect is often undis- 

 turbed to the last, though the patient often takes a great aversion to 

 her infant. 



Numerous causes have been laid down as productive of this dis- 

 ease : among the predisposing, are atmospheric vicissitudes, de- 

 pressing passions, unhealthy residences, dissipation, bad diet, &c. 

 Among the exciting are, epidemic influences, intestinal irritation, 

 retained placenta, difficult labour, suppression of lochias and lacteal 

 secretion, and contagion. 



There are many who look upon this as a blood disease, who 

 believe that puerperal fever originates in a vitiation of the fluids ; 

 and that the causes which are capable of vitiating the fluids are par- 

 ticularly rife after childbirth ; and that the various forms of puer- 

 peral fever depend on this one cause, and are deducible from it. 

 Others, on the contrary, believe that the primary impression is made 

 upon the nervous system. 



The treatment must vary according to the form of disease we 

 have to contend with. In the first, or inflammatory form, instant 

 recourse must be had to bloodletting, which must be pushed to the 

 extent of syncope if necessary. The abdomen should then be 

 covered with leeches, which are to be followed by hot fomentations. 

 The bowels should also be freely opened with a purgative, after 

 which calomel and opium should be administered, with the view of 

 producing its constitutional effects. 



In the second form, bleeding, except in the early stage, will be 

 generally improper, and even then should be restricted to plethoric 

 patients. The principal reliance must be placed on purgative medi- 

 cines, as salines and mercurials. A full dose of calomel should be 

 exhibited, and followed by a purgative ; after free evacuation, 

 calomel and opium should be administered. After the bowels are 

 unloaded, purgation should cease, as it rather causes depression ; 

 mercurials and salines, or tonic stimulants and carminatives, should 

 be used, according as the disease sho\vs marks of excitement or 

 depression. In the low form, bark, camphor, or ammonia appear to 

 be particularly indicated. 



In the third or nervous form, warm purgatives should be ad- 

 ministered, or laxative enemata, after which a few doses of opium 

 should be exhibited. Bloodletting is generally uncalled for. 



