MIDWIFERY. 



25.5 



CHAP. III. 

 Of After Paint. 



After pains are sometimes extremely troublesome 

 during the first three days after delivery, and may even 

 be more distressing than those of labour. They pro- 

 ceed from different causes, but the most frequent is the 

 contraction of the womb to acquire its original size, 

 and expel clots. This often occasions irregular grind- 

 ing pains in the lower, part of the belly, and sometime* 

 in the back, like tho-e of labour. They are usually ac- 

 companied with the discharge of clots of blood, and 

 frequently are renewed for a day or two, whenever the 

 child is applied to the breast. They are most effectual- 

 ly relieved by a full dose of laudanum, and wa. 

 mentations. Gentle laxatives, and uniform pressure 

 externally, contribute to relief. Another kind is ac- 

 companied with wind in the boweU. The pain is not 

 merely felt in the bottom of the belly, but in different 

 pert*, and comes on often like gripes or cholic pains, 

 sometimes accompanied with a little fulness of the bel- 

 ly, and pain on pressing hard. This is relieved by a 

 clyster to open the bowels, afterwards a dote of lauda- 

 num in peppermint water, and fomentations. An in- 

 jection, containing laudanum, is also useful. Some- 

 times worms cause this pain. Severe pain* between 

 the ribs and haunch bone may attack in pare- 

 continuing for more than half an hour, and then going 

 off completely. These may be accompanied with 

 .nest of pulse, and the urine is high coloured. 

 They are relieved by opiates, fomentations, sinapisms, 

 and laxatives; and sometimes a pretty firm bandage 

 temporary relief. Constant pain, accompanied 

 with shivering, vomiting, s welling, and tenderness of 

 the belly, fever, and suppression of the cleansings, indi- 

 cate inflammation, and require the earliest attention. 



CHAP. IV. 

 Of Diiplac-menlt of Ike Ulfrmt. 



Of plac*. p^n in the back and lower part of the belly, with a 

 strong bearing down, weakm , and dis- 



ic utniu. c | ur g e o f blood, require examination, lest the womb 

 be inverted. If much time be lost, the inversion may 

 either prove quickly fatal, or remain during the whole 

 of life. 



1 1' the uterus be inverted, examination detects a fleshy 

 turn the vagina, whereas, if the womb be pro- 



perly situated, the vagina is free, and the os i. 

 telt open and empty. When the inversion is complete, 

 the uterui is protruded altogether, and furms fleshy 

 mass, wh u externally. I n either case, i t 



be immediately reduced by moderate pressure, and in 

 general this is easily accomplished. When it has been 

 neglected and becomes chronic, extirpation I, >> in (lit*, 

 ferent instances been practised, on account 

 rious effect produced by the repeated hemorrhages, 

 mucous discharges, and continued irritation attendant 

 on this state. Some of these have succeeded pen 

 and in one the author saw the patient in perfect health 

 many years after the operation. 



It must nrxt be observed, that in consequence of 

 we.iki.eu and relaxation, or of rising and walking too 

 soon, the womb, Uir s ' yi t heavy and large, may sink 

 too much in the vagina, or may even come to protrude 

 externally. This, i; degree, is called a I 



down of the womb, and where it proceeds so far as to 

 ppear outwardly, a procidentia uteri ; but this ex- 

 6 



treme degree fortunately seldom happens at first. The 

 patient for a length of time complains of weakness, 

 and pain in the back, a sense of dragging about the 

 loins, -weariness and aching about the thighs and 

 lower part of the belly, and unpleasant sensations 

 when she attempts to walk, particularly a bearing down ; 

 and by and bye, when the womb descends lower, she 

 cannot make water easily, and in the whole progress of 

 the complaint the stomach and bowels are'apt to be dis- 

 ordtred both in their functions and sensations. These 

 affections of the bowels and stomach are very often pro- 

 minent symptoms, leading off the attention of the pa- 

 tient from the true cause, which sometimes can only be 

 i red by the examination of a skilful practition- 

 er. 



This is a complaint which generally proceeds from 

 relaxation, or from some exertion before the womb hat 

 returned to its usual size, or from its remaining for a 

 length of time larger than usual. This naturally 

 gcsU a caution against rising too soon, or making anj 

 early exertion; and it is peculiarly incumbent on those 

 who are delicate in constitution, or enfeebled by pre- 

 vious disease, to be on their guard in this respect. 

 Although, doubtless, ra-li management on the part of 

 the midwife may occa-ion tlii-, complaint, yet it is 

 much oftcncr the fault of the patient herself. It must 

 also be impressed on the mind, that it may succeed a 

 miscarriage, or may even occur in unmarried women, 

 from excessive discharge, fluor albus, or violent exer- 

 tion, when out of order. I' : in a recumbent pos- 

 ture is of the greatest service in the early stage. The 

 bowels are to be kept in I tate, by dnily 



clo.cs of Cheltenham salt, or sal r< i order to 



lessen the quantity of circttlnti!-^ tluid ; nnd for the 

 tame purpose liquids ought to be avoided, that the 

 uterus may speedily dimini>h in sire and weight. The 

 diet should be such as tends to increase the strength, 

 and fi purpose, in a month after deli 



:y be employed, if no particular symp- 

 it. The application of a proper bandage 

 round tlic whole In-lly, with n moderate degree of firm- 

 ness, s great : feelings ; 



and the early u.e of a compress over the uterine re- 

 gion, to as to excite to absorption, may be useful. 

 Astringent injections tend to contract the vagina, and 

 are sometimes of benefit. If these means fail, then 

 we must employ a pessory. This is a complaint which 

 u apt tu be increased <l iriii.; the first three months of 

 subsequent pregnancy, but after the third month it 

 disappears. 



There U another affection which may be confounded 

 with this, namely, a relaxation ami protrusion of the 

 vagina iuelf. This forms a soft swelling or proini- 

 at the orifice of the vagina, which sometimes 

 coropletely-encircles the opening, but oftcner is more 

 on the one side than on t . or is greatest be- 



hind. It gives no particular inconvenience, unless it 

 exist in a great degree, and it usually disappears on 

 going to bed. It requires the use of astringent decoc- 

 or alum water, externally, or employed as injec- 

 tions, and the frequent application of cold water, by 

 means of a sponge. '^enU, such as tinc- 



ture of kin-), have been thought useful. If the patient 

 be weak, strengthening remedies are proper, tuch as 

 bark, steel, tin >, &c. In this, as well as in 



the former complaint, it is of great service to support 

 tlie v'rineum permanently ; the best mode of doing 

 whit , is by an elastic steel truss similar to that used 

 for prolapsuf ani. 



Of the r\<- 



