254 



Of the Pu- 

 erperal 

 State. 



MIDWIFERY. 



PART III. OF THE PUERPERAL STATE. 



Of the Pu- 

 crperal 

 State. 



CHAP. I. 

 Of the Management immediately aj 'ter Delivery. 



or the ma- When the after-birth is expelled, it is too much the 

 rugem nt practice with many to sit up in bed immediately, and 

 immediate- have the clothes shifted. Most alarming floodings, and 

 i.v after de- o ther bad consequences, may result from this. The first 

 thing to be done is, very slowly to remove the wet sheet 

 from below the patient, she next turns slowly on her 

 back, and has a bandage applied so firmly round the 

 belly as to give the feeling of a pleasant support. The 

 bandage often consists of a broad towel folded double, 

 but it is better to have one made of stout cotton cloth, 

 with tapes to tie, or buttons, with two rows of holes. 

 It is prevented from slipping upwards and wrinkling 

 by a thigh piece, and in some cases it may be necessary 

 also to have a shoulder strap. Many,- with advantage, 

 npply under this a compress, made of a napkin or quilt- 

 ed pad. The bandage being applied, a flannel petti- 

 coat, open in the middle, is next put on, and wrapt 

 round the limbs, and a soft napkin is to be applied to 

 absorb the discharge. If the patient be fatigued, no 

 more is to be done, but if she be not, an aired shift and 

 bedgown can be put on,, and she is laid to rest ; but 

 if a half shift be used during labour, there is sel- 

 dom great occasion to change it, for several hours at 

 least. Although we are thus cautious respecting speedy 

 shifting en account of the effect often produced by slight 

 exertion, especially after a lingering labour, or in deli- 

 cate women, yet the necessity of changing the clothes, 

 us soon as prudence will permit, ought to be inculca- 

 ted, and afterwards shifting every day, and having the 

 discharge washed away, morning and evening, with a 

 sponge and lukewarm water. The number of bed-clothes 

 must be regulated by the season, but they never should 

 be so many as to promote sweating, which weakeus the 

 patient, and gives a tendency to catch cold. It is usual 

 to give some cordial after delivery, such as brandy or 

 cinnamon-water. Unless the strength be exhausted, 

 there is seldom occasion for this, and it often does harm. 

 A little wine and water may be given if fatigued, or a 

 little panado with wine ; or if the labour have been ling- 

 ering, and there is much languor, a little Madeira wine, 

 without water, is very proper. 



A stool should be procured within thirty-six hours 

 after delivery, by means of a suitable doze of magnesia, 

 or a little castor oil. If the patient is not to nurse, the 

 laxatives should be rather brisker. 



The urine should always "be passed within twelve 

 hours, at farthest, after delivery, and if there be any diffi- 

 culty in voiding it, fomentations will'be useful. After a 

 severe labour, it is necessary to be very attentive to the 

 yoiding of the urine and the state of the soft parts. 



The diet ought to be light, and should consist, for the 

 first two days, of tea and cold toast for breakfast, beef 

 or chicken soup for dinner, and panado for supper. 

 Afterwards a bit of chicken may be taken for dinner, 

 and, as recovery goes on, the usual diet may be return- 

 ed to. In these directions, however, regard must be 

 had to the previous habits and present state of the pa- 

 tient. The drink at first should be toast water, and malt 

 liquor is, for some days, to be avoided ; wine, or wine 

 and water, may then be allowed, if no fever be present, 



and the weakness or former habits of the patient require 

 it. In a good recovery, the patient may have the bed 

 made on the third day, but, during the time, she should 

 recline on a sofa. In a day or two longer she may be 

 allowed to be dressed and sit a little, but ought not to 

 walk about or leave the room for some time ; and, even 

 in summer, should not go out for an airing in less than 

 three weeks. Many, before this time, do rise, and even 

 attend to domestic cares earlier, but they often suffer 

 very much, either from a weakening discharge or a fall- 

 ing down of the womb. 



CHAP. II. 



Of Tremor and Fainting Fits. 



It is not unusual for women, very soon after deli- Of Tremor 

 very, to be seized with a violent shaking or shivering, and faint- 

 sometimes in consequence of rash and sudden exposure ing fitt> 

 to cold, after being heated with the exertion of labour, 

 but often from no evident cause. Nothing, in general, 

 gives so speedy relief as a pretty large dose of lauda- 

 num, forty drops, for instance, in peppermint water, 

 or in a little brandy and water. At the same time, the 

 patient is kept in perfect rest, and when she is inclined 

 to shake, she must be held gently by an assistant, so as 

 to prevent her from doing so in a great degree, If she 

 feel cold, and the teeth chatter, the application of a 

 v.-a; m cloth to the stomach and feet is useful. This is 

 not a dangerous, and seldom an obstinate affection. If 

 it, however, should be prolonged, camphor is of ser- 

 vice. 



Fainting is always an alarming symptom, and when 

 it occurs, the first thing to be ascertained is, whether 

 there be a great discharge or flooding, in which case the 

 danger is extreme, and the treatment of tliis has been 

 already pointed out. It may also attend inversion of 

 the womb. But some women are, after a tedious and 

 severe labour, and others even after very little suffer- 

 ing, liable to a short and temporary exhaustion, ap- 

 proach ing .to a fainting fit, or very often to that kind of 

 insensibility or lowness, which occurs in a hysteric at- 

 tack, and like it, this is frequently preceded by an in- 

 voluntary crying or sobbing immediately after the birth 

 of the child. This hysterical lowness is not danger- 

 ous ; indeed, there is never great ground for alarm, 

 whilst the pulse continues, and there is no discharge, 

 for in this case the patient may rather be said to be in 

 a state of stillness and quietness than fainting. In those 

 cases where this state occurs after delivery, a few drops 

 of oil of cinnamon on sugar are useful, or we give thirty 

 drops of laudanum in a little brandy, or hartshorn and 

 water, whilst a free circulation of air is to be preserved. 

 Volatile tincture of valerian is recommended by Dr. 

 Hamilton to be given, as soon as the child is born, to 

 those who are subject to fainting fits, and certainly is a 

 useful remedy. 



Actual syncope is much more alarming, even when 

 it does not proceed from hemorrhage, great fatigue, or 

 any other evident cause. There have been instances of 

 sudden death following an easy labour, and in which 

 no sufficient cause could be ascertained by dissection. 

 The ordinary means of exciting the nervous and vascu. 

 lar system must be resorted to, and persevered in. 



