MILK-FEVER. 589 



being stronger, for example, in nervous and delicate women, when 

 the womb is already sore, and in a state approaching to inflamma- 

 tion, than in those who are in an opposite condition, though in fact 

 the contractions are similar in both cases. It is by attending to 

 these particulars that we are enabled without difficulty to explain 

 their great severity in some women where there is nothing to be ex- 

 pelled from the genital organs, and their mildness in others, where 

 they coincide with the escape of large coagula; and how it happens, 

 that, instead of diminishing after the second day, they, on the con- 

 trary, continue to augment in some cases until the third and fourth 

 day, &c. 



It is important not to confound them with an incipient metritis or 

 peritonitis, which however is a pretty difficult matter where they 

 reach a certain extent of great severity; having too often avoided 

 making this distinction is the reason why authors differ so much 

 on the subject of puerperal peritonitis, and the treatment adapted to 

 it; as long as the after-pains are clearly intermittent, and during 

 their intervals the belly is not sore, while there is no fever and they 

 have not been ushered in with a chill, there is nothing to fear and 

 nothing to do; they are frequently followed by a pretty severely 

 painful sensation at the hypogastrium, acceleration of the pulse, 

 thirst, and heat of the skin, and notwithstanding, are not followed by 

 any serious complaints. But we must in such cases pay attention to 

 them, and not forget that they may be the first symptom of a, mortal 

 disease. 



When moderate they may be trusted to the resources of the 

 economy, or we may give one or two cups of a weak infusion of 

 chamomile, which rarely fails to make them disappear in the course 

 of a day or two; otherwise, it is sometimes useful to prescribe a hip 

 bath, and emollient or slighdy narcotic injections; to exhibit seda- 

 tives or antispasmodics internally, or to bleed the patient once or 

 twice, either from a vein or by topical means, while at the same 

 time the hypogastrium is covered with cataplasms, and this accord- 

 ingly as the woman is weak, nervous, or plethoric; it may be ne- 

 cessary even to introduce one or two of the fingers towards tite os 

 uteri for the purpose of assisting in the expulsion of a clot that may 

 adhere too strongly; but in the great majority, these cases require 

 no assistance. 



1249. The Mllk-fever generally appears on the third day, some- 

 times on the first or second, or not until the fourth, fifth or sixth day; 

 I have seen it not come on until the eighth, in a young woman at the 

 Hospital cle la Faculte: headache, without chills, heat and dryness 

 of the skin are its common precursors; the pulse which is at first 



