MIDWIFERY. 



Of the Pu- be small and superficial, the spot soon becomes red, and 

 et last breaks, occasioning, comparatively speaking, Httle 



'._^-* t -'__* distress, and scarcely giving any interruption to nur- 

 sing. But if it be deeper, or more extensive, and the 

 glandular part of the breast be affected, all the symp- 

 toms are more severe, the progress is tedious, and the 

 strength is apt to be reduced by fever, perspiration, and 

 want of appetite. In these cases, if the abscess do not 

 point and break soon, no good can be gained by delay, 

 an opening should be made so as to evacuate the matter 

 freely. This not only gives immediate relief, but pre- 

 vents a farther extension of the mischief, and the foun- 

 dation of future disease. In every instance, a free 

 opening should be procured for the pus, and if sinuses 

 form, these must be opened completely and at once. 

 In unhealthy inflammation of the breast, different glands 

 may successively be affected in both breasts, and slow 

 abscesses form, which produce troublesome sinuses when 

 they burst. In all such cases, it is necessary daily to 

 examine the breast, for the constitution is apt to be un- 

 dermined by repeated attacks of shivering and fits of 

 fever. The stomach is impaired, anorexia and reach- 

 ing take place, and a fatal cahectic state is produced. 

 These shiverings are removed by opening the abscess, 

 or evacuating the confined matter, and the general 

 health is restored, by laying open any sinuses which 

 may form. Light nourishment, with a liberal propor- 

 tion of wine, varied tonics, and the use of opiates and 

 laxatives, according to circumstances, are proper. In- 

 durations or local affections from torpidity are benefited 

 by a gentle course of mercury. When the patient can 

 take nourishment, there is seldom any great danger ; 

 but if she have a perpetual and intractable loathing at 

 food, with diarrhoea, and especially if she be of a stru- 

 mous habit, there is much ground to fear ultimately a 

 fatal issue. In some instances the mesenteric glands, 

 in others the uterus itself, are affected in the course 

 of the disease, which may be protracted for some 

 months. 



CHAP. X. 

 Of Uterine Inflammation. 



Of uterine Inflammation of the womb usually begins between 

 inflamma- the second and fifth day after delivery, but it may take 

 lion. place at a later period. It is pointed out by a pain in 



the lower part of the belly, which gradually increases 

 in violence, and continues without intermission, though 

 it is subject to occasional aggravations. The uterine 

 region is very painful when it is pressed, and it is a lit- 

 tle swelled. There is, however, no general swelling 

 of the abdomen with tension, unless the peritoneum 

 have become affected. But the parietes are rather slack, 

 and we can feel the uterus distinctly through them to 

 be harder than usual, and it is very sensible. There is 

 also pain felt in the back, which shoots to the groins ; 

 and there is usually a difficulty in voiding the urine, or 

 a complete suppression, or distressing degree of stran- 

 gury. The situation of the pain will vary according to 

 the part of the uterus first and principally affected. 

 The internal parts become also frequently of a deep 

 red colour, and the vagina and uterus have their temper- 

 ature increased. The lochial discharge is very early sup- 

 pressed, and the secretion of milk diminished or de- 

 stroyed. Nearly about the same time that the local 

 symptoms appear, or perhaps a little earlier, the system 

 becon.es affected. The pulse very early becomes fre- 

 quent, and somewhat hard. The patient is chilly, or 

 has a shivering fit succeeded by increased, temperature 



of the skin, and it is not unusual for her to be sick, or Of the Pu- 

 to vomit bilious fluid. The tongue is white and dry, rprl 

 and the urine high-coloured and turbid. The vomiting __ ^ 

 in some cases continues, and the bowels are at first 

 bound, but afterwards the stools are passed more fre- 

 quently. If the peritoneum come to partake exten- 

 sively of the disease, then v/e have early swelling and 

 tenderness of the abdomen, and the danger is greatly 

 increased. 



This disease calls for the early and free use of the 

 lancet, which is the principal remedy ; and the number 

 of times that we repeat the evacuation, must depend 

 upon the constitution of the patient, the effects produ- 

 ced, and the period of the disease. If three or four 

 days have pas?ed over, the pulse may be full and fre- 

 quent ; but this is an indication that suppuration is 

 going on, which will be ascertained by throbbing pain, 

 c. In this case the lancet is hurtful. Mild laxatives 

 are also highly proper. Fomentations are very use- 

 ful, and external irritations are likewise of benefit after 

 the acute stage has been subdued by the lancet. The 

 application of oil of turpentine is perhaps as useful as 

 any other that can be made. Diaphoretics ought to 

 be administered, such as the saline jalap, with the ad- 

 dition of antimonial wine and laudanum. This is the 

 best internal remedy we can employ. Emollient clys- 

 ters, or sometimes anodyne clysters, give relief. In 

 the svippurative stage we must keep the bowels regu- 

 lar, give light nourishment, apply fomentations, and 

 allay pain with anodynes. When the matter is dis- 

 charged, a removal to the country will be useful, and 

 tonic medicines should be given. 



CHAP. XI. 



Of Peritoneal Inflammation. 



The peritoneal lining of the abdomen, or the cover- of perito. 

 ing of the intestines, may be inflamed alone ; or this neal inflam- 

 disease may be combined with inflammation of the roation. 

 uterus. 



Peritoneal inflammation may be caused by violence 

 during delivery, or the application of cold, or the in- 

 judicious use of stimulants. It may not come on for 

 three weeks after delivery, but it usually commences on 

 the second day, and earlier than inflammation of the 

 womb ; and it may often be observed, that the pulse 

 continues frequent from the time of delivery. It is 

 preceded or attended by a shivering and sickness, or 

 vomiting, and it is marked by pain in the belly, which 

 sometimes is very universal, though, in other cases, it is 

 at first confined to one spot. The abdomen very soon 

 becomes swelled and tense, and this state rapidly in- 

 creases. The pulse is frequent, small, and sharp, the 

 skin hot, the tongue either clean, or white and dry ; 

 the patient thirsty, she vomits frequently, the milk is 

 not secreted, and lochia are frequently obstructed. 

 These symptoms often come on very acutely, but it 

 ought to be deeply impressed on the mind of the read- 

 er, that they may also approach insidiously. Wander- 

 ing pain is felt in the belly, neither acute nor altoge- 

 ther constant. It passes for after-pains, but it is at- 

 tended with frequency of pulse, and some fulness of 

 the belly, and a little sickness. But whether the 

 early symptoms come on rapidly or slowly, they soon 

 increase, the belly becomes as large as before delivery, 

 and is often so tender, that the weight of the bed- 

 clothes can scarcely be endured ; the patient also feels 

 much pain when she turns. The respiration becomes 

 very difficult, and sometimes a cough comes on which 



