MIDWIFERY. 



'259 



Of the aggravates the distress, or it exists from the first, attend- 

 Putrperal gj w jth pain in the side as a prominent symptom. 

 *"" Sometime the patient has constant belching, and brings 

 v "" i "" Y "*" up mouthfuls of fluid, which always gives pain. The 

 bowels are either costive, or she purges bilious or dark 

 coloured fteces. These symptoms are more or leas 

 acute, according to the extent to which the peritoneum 

 is affected. They are at first milder and more pro- 

 tracted in those rases where the inflammation begins in 

 the uterus; and in such the pain is often not very 

 great nor very extensive for some time. If the disease 

 is to prove fatal, the swelling and tension of the belly 

 increase, so that the abdomen becomes round and pro- 

 minent, the vomiting continues, the pulse becomes ex- 

 cessively frequent and irregular, the fauces areapthou-, 

 death is marked in the countenance, the extremities 

 cold, and the pain usually ceases rather suddenly. The 

 patient has Unix-freshing slumber, and sometime- deli- 

 rium mill-, I'ut -he may also remain sensible to tin- 

 last. The disease usually proves fatal within five days, 

 but may be protracted for eight or ten days, or even 

 longer. 



The practice in this disease i* very limited, but very 

 important. It consists in an initant recourse to the 

 lancet, which is to be used at first with freedom, but in 

 more advanced stages with circumspection. If it is to 

 prove useful, it will do so soon ; and a freqnent repe- 

 tition toward the latter end can only hasten death. 

 Whilst, therefore, the writer place* his chief reliance on 

 this remedy, he cautions against its abuse. 



Fomentations are soothing and useful, and all the 

 pained part of the abdomen ought to be covered with 

 a cloth wet with oil of turpentine. 



The bowels are to be opened by laxative medicine, 

 and stimulants of any kind are to be avoided. Fruits 

 and grateful drinks are to be prescribed. 



CHAP. XII. 

 Of Puerperal Fever. 



Puerperal fever begins sometimes in an insidious 

 manner, without that shivering which usually gives in- 

 timation of the approach of a serious malady. In other 

 cases, the shivering is perceived, and varies considera- 

 bly in degree ither slight or pretty severe. 



The first symptoms, independent of the shivering, are, 

 frequency of pulse, oppression, nausea, or vomiting, 

 pain in the head, particularly above the eyebrows. 

 The night is pasned itli little sleep, much confusion, 

 and occasionally some delirium ; but this is not common 



It must not, however, be forgotten, that in many in- 

 stances there is no headach in any stage of the disease, 

 nor any sickness nor vomiting in the beginning. In 

 some, the temper from the first In uncommonly irritable, 

 in others there is much timidity, or listles^ness, or 

 apathy. Hysterical symptoms not unfrequeiitly super- 

 vene. 



From the beginning, or very soon afterwards, pain 

 M Ml in the belly ; at first slight, but it soon increases, 

 and in some instances the alxlomen becomes so t. 

 that even the weight of the bed clothes i> |.HK! U . 

 distress. A general fulness, without ten-inn 

 belly, accompanies this from the first, and it usually it . 

 creases pretty rapidly, and may proceed no far as to make 

 the patient nearly as large as she was before deli\ery. In 

 sui-i ibdomen txrcornes trnne.atul the hrc-uthing 



,k much opprrsxd . i, every instance the res- 



pir*Uuu is more or ION affected ; the free action of the 



r*I (tin. 



abdominal muscles, which are concerned in that func- 

 tion, being productive of pain. The degree of pain, its 

 seat, and period of accession, vary in different i --. In 

 some it evidently begins in the uterus and con-.ing in 

 paroxysms, resembles severe after-pains, but never goes 

 entirely off, and is accompanied with bearing-down. 

 The uterine region is painful, particularly toward one 

 side. The os uteri, if examined, is not much more sen- 

 sible than usual. There is generally pain in the back. 

 In other cases the pain is first felt about the lower part 

 of the ribs on one side, and is accompanied with cougli. 

 The belly is tumid, and tender when pressed, but ex- 

 ccptthen, or in turning, the patient complains little of it. 

 Sometimes severe pain, like spasm, attacks the iliac re- 

 gion, and extends down to the thigh, and toward the 

 puhis and bladder. 



The face is sometimes flushed at first, or a patch of 

 deep red appears on the cheeks, but the countenance 

 in general is altogether pale, or at least not suffused, the 

 eves are without animation, and the lips and angles of 

 the eyes are white. The whole features indicate anxie- 

 ty and great debility. When vomiting occurs at the 

 commencement, it is generally bilious. In the 

 course of the disease, it becomes so frequent that no- 

 thing will stay in the stomach ; and, towards the con- 

 clusion of the fever, the fluid thrown up is dark-co- 

 loured like coffee, and frequently firtid. This is a 

 symptom which always, if it do not proceed from a 

 morbid structure, indicates, in whatever disease it oc- 

 curs, an entire loss of tone of that organ, and in this 

 fever is a fatal symptom. But, to proceed with the 

 history. There is, in many instances, great dejection 

 of mind, iind always languor, with general debility of 

 the mu-cul..r fibres, and the patient lies chiefly on her 

 back, or there i* so much listlessncss, that she some- 

 times makes little complaint. The skin is- not very 

 hot, but is rather cl.iininy and relaxed. There are case*, 

 however, where the patient complains of universal and 

 oppressive heat, until toward the end. when the extre- 

 mities become cold. I n ollu-r instance-, the temperature 

 varies, the patient being alternately hotter ami cooler. 

 The tongue is pale or white at first, but presently be- 

 comes brown, and uniformly aphthx an|>ear in the 

 throat, and extend down the oesophagus and ., . 

 the iii>i(le of the mouth. From the irritability of the 

 ttomarh and bowels, it is highly probable that these or- 

 gans participate in the tender .state, and the upix-r part 

 of the larynx seems to be affected from die cough which 

 is excited. 



It lias already been mentioned, th.it the pulse, from 

 the first, is very frequent, mid at that |>crio<l it i> fuller 

 than in simpler peritoneal inflammation, but it HOOD be- 

 comes feeble. The thirst is not always great, at least 

 the jiatient is often careless about drink. The bowel* 

 are often at first bound ; but afterwards, especially 

 alxiut tin- third day, they usually become loose, and 

 the stools are dark, foetid, and often frothy. '1 hi- 

 evacuation seems to give relief. The urine i dark-co- 

 loured, has a brown sediment, and is passed fre- 

 (jnrntly, and with pun. The lochial discharge con- 

 tinues for a time, hut presently is diminished, has a bad 

 smell, or is changed in ap|iearance, or gradually cease* ; 

 and it is observable, tlut the re-appearance of the lo- 

 chia. if they had been suppressed, is not critical The 

 secretion of milk stops, and ihe patient ini|ilflb very 

 seldom about the child. In bad cases, the swelling of 

 the belly increases rapidly. Imt the pain does not al- 

 ways keep pace with the swelling, being sometime' 

 least when the. swelling is greatest and in the end i f 



Of the 



l'u->rpcral 



St;itr 



