256 



MIDWIFERY, 



Of the Pu- 

 erperal 



State. 



Of irregu- 

 larities of 

 the lochial 

 discharge. 



Of swelled 

 leg. 



CHAP. V. 



Of Irregularities of the Lochial Discharge. 



AN increased, and sometimes a continued discharge, 

 after delivery, is often the consequence of getting up 

 too soon, or making some early exertion. It is usually 

 attended with pain in the back, and always produces 

 weakness. It is to be removed by avoiding exertion, 

 taking some strengthening medicine, such as bark and 

 wine, and using, if it continue, the shower-bath. The 

 aching pain in the back is often removed by the appli. 

 cation of an adhesive or warm plaster. 



The lochial discharge is in some women very trif- 

 ling, and may even stop very soon without any bad 

 effect. But when it is suddenly checked by exposure 

 to cold, or other causes, most painful consequences 

 may follow, such as swelling of the belly, great pain, 

 sickness, and fever. These symptoms are dangerous 

 at all times, but are still more to be dreaded, as they 

 often attend inflammation, and indeed the two cases 

 can only be distinguished by minute attention. A 

 purgative clyster should be instantly administered, a 

 cloth, soaked in oil of turpentine, or hot fomentations 

 applied to the belly, and a perspiration encouraged by 

 a saline jalap, containing antimonial wine, together 

 with tepid drinks. An anodyne clyster is also useful, 

 and if the pain continue, the lancet must be used. In 

 this disease, the suppression of the discharge is an effect 

 rather than a cause, and indeed does not uniformly take 

 place, for the symptoms arise from spasm of the ute- 

 rine fibres. This differs from inflammation in coming 

 on most suddenly ; the pain from the first is severe, but 

 it remits, or sometimes for a few seconds goes entirely 

 off. But it must not be supposed that this state can 

 continue long without exciting inflammation. 



Ill-smelled discharge proceeds from clots of blood 

 lodging about the womb, and requires strict attention 

 to cleanliness ; it may even be necessary to wash the 

 discharge from the passage, by means of a syringe. 

 If, however, this discharge be attended with sickness 

 or nausea, quick pulse, hot skin, parched hands and 

 feet, thirst and want of appetite, or repeated discharges 

 of blood, and pain in the lower part of the belly and 

 back, then there is reason to conclude, that part of the 

 after-birth remains in the womb, and great attention 

 is necessary to preserve the patient. This affection 

 often passes at first for a weed. 



The patient is worn out by nocturnal perspiration, 

 fever, and want of nourishment, until at length a pu- 

 trid mass is discharged from the womb, perhaps about 

 the ninth or tenth day, or even after some weeks of 

 suffering, and then the patient generally recovers. 



The bowels are to be regulated, either by laxatives 

 or opiate injections, according to their state. The diet 

 must be light, such as chicken broth, beef tea, calf's- 

 feet jelly, arrow-root, &c. The elixir of vitriol is use- 

 ful for promoting appetite and checking perspiration. 

 Camphorated mixture is of service for allaying nervous 

 affections. Great attention must be paid to cleanli- 

 ness and ventilation. Astringent injections, by way 

 of tanning the retained mass, have been employed, and 

 sometimes with advantage. 



CHAP. VI. 

 Of Swelled Leg. 



AFTER delivery, one of the legs is sometimes affected 

 with a painful swelling, which is often, though not always 



correctly, attributed to some violence in the labour, or Of the Pu- 

 some imprudence afterwards. It makes its appearance erperal 

 about ten days after delivery, sometimes sooner or State. 

 even later. It begins with fever, and pain in the back, """Y""" 

 or lower part of the belly, particularly about the groin, 

 where there is considerable stiffness felt. The pain 

 may gradually extend down the limb, but more fre- 

 quently it is, after these symptoms, suddenly felt in 

 the calf of the leg or knee, and presently the whole 

 limb, which formerly perhaps was cold, becomes hot 

 and swelled. The acute pain slowly abates, but the 

 limb continues tender, and can scarcely be moved. 

 The pulse becomes much quicker, the face pale, the 

 strength is greatly impaired, and frequently very co 

 pious perspiration adds to the weakness. 



The duration of this disease is variable, but in gene, 

 ral it is considerable, and occasionally after one thigh 

 becomes better, the other becomes affected with simi- 

 lar symptoms. In one case, which lately was attended 

 by the author, the inferior and both superior extremi- 

 ties were successively attacked. The complaint in the 

 upper parts was preceded by pain and stiffness in the 

 side of the chest. There is always great debility at- 

 tendant on this disease, and even a tendency to syn. 

 cope. 



The treatment consists in the immediate application 

 of leeches, or of hot solution of acetite of lead to the 

 groin, at the same time that a purgative is administer- 

 ed. If the symptoms go on, and the limb becomes af- 

 fected and swelled, relief is sometimes obtained by 

 rubbing with camphorated oil, or tincture of soap and 

 opium ; but fomentations with hot water are more 

 generally useful. At the same time the bowels are to 

 be kept regular with cream of tartar, and sleep pro 

 cured by anodynes. When the acute symptoms are 

 over, and the limb only remains weak, friction with 

 the flesh-brush is proper, and a roller should be ap- 

 plied with moderate firmness from the toes to the 

 groin. The cold bath is useful to re-establish the health. 

 The diet ought, after the inflammatory symptoms have 

 abated, to be nourishing, and the re- establishment of 

 the health is promoted by removing to the country. 

 Tonic medicines at this period are also useful. 



CHAP. VII. 



Of Ephemeral and Remittent Fevers. 



Women, who are disturbed much in their repose, Ofepheme- 

 who have suffered greatly during labour, who have ral and re - 

 very sore nipples, who are inattentive to their diet, mittent ** 

 distressed in their mind, or exposed to cold, are liable ver *" 

 to an attack of fever, called in this country a weed. 

 The fit begins with dullness, cold feet, and violent 

 trembling; pain in the back, headach, anil in some 

 instances, inclination to vomit. Presently flushes of 

 heat are felt, which at last become steady, and the pa- 

 tient feels extremely hot and restless. In some time 

 afterwards, perspiration breaks out, continues for a 

 considerable time, and at last abates, leaving the pa- 

 tient free from fever, but very languid. During both 

 the cold and hot stage the pulse is frequent, and there 

 is thirst ; but in the sweating stage both these symp- 

 toms decline. The whole fit is usually finished with- 

 in twenty-four hours, frequently in a much shorter 

 period. There may be only one attack, but it is not 

 uncommon for the fits to come on every day for more 

 than a week, nearly about the same time, or an hour 

 sooner or later each day; and in that case they are pre- 

 ceded by coldness in the back, accompanied with ach- 



