112 OBSTETRICS. 



In the fourth variety, the two indications are : First. To attend to 

 the local lesions. Second. Never to forget that these are not the 

 disease, but merely the effect of a more diffusive, though concealed 

 cause, to act on which our remedies should be directed. The 

 rationale of the treatment, therefore, consists in the exhibition of 

 such remedies as will act on the cause, and such as will alleviate or 

 remove the local affections ; taking care that in our attempt to effect 

 the latter end, we do not so act on the constitution as to give addi- 

 tional energy to the more deadly power of the concealed cause. 

 (Ferguson.) In the early stage, leeches, blisters, calomel and 

 opium, &c., should be used as required : and in the latter stage, 

 stimulants and tonics. 



MILK FEVER. 



The milk fever generally begins on the third day afler delivery, 

 sometimes on the first or second, or not until the fourth, fiflh, or 

 sixth. It is ushered in with chills, headache, pains in the back and 

 limbs ; the pulse, at first small and hard, soon becomes developed, 

 and the skin hot ; the breasts grow hard, swelled, and painful in a 

 few hours, so as to prevent the motion of the arms. This condition 

 of things is followed by a sweat, and the fever abates in the course of 

 twelve or twenty-four hours, and the secretion of milk is established ; 

 the breasts, however, remain tumid and painful much beyond this 

 period, especially in women who do not give suck. The lochia, 

 too, are often suspended or diminished during this time. 



Treatment. — The bowels should be freely moved by the adminis- 

 tration of a saline cathartic, or oil. If the fever runs high, a small 

 bleeding should be practised. If the breasts are painful to the touch, , 

 they should be covered with warm emollient poultices, and if not 

 relieved by this, a few leeches should be applied to them. 



These means are important to prevent the formation of a mam- 

 mary abscess. The breast should not be allowed to fill with milk, 

 but should be drawn either by the child, or artificially, as often as 

 it becomes distended. Should suppuration unfortunately take place, 

 the pus should be evacuated as soon as possible, and a warm 

 poultice applied. If sinuses remain from the burrowing of pus, 

 compression should be made upon the gland by means of adhesive 

 straps. If a milk fistula should be the result, the orifice should be 

 filled with a tent, and the wound allowed to granulate from the 

 bottom. 



INVERSION OF THE WOMB. 



The inversion may be either partial or complete. Partial inver- 

 sion may be known by the absence of the fundus behind the pubes, 

 and the presence of a large solid tumour in the vagina, accompanied 

 by profuse hemorrhage, intense pain in the pelvis, violent tenesmus, 



