260 



M I D W I F E R Y. 



State. 



Of tlie generally goes entirely off. The breathing becomes la- 

 Pnerperal borious in proportion as the belly enlarges. The 

 strength sinks, the pulse, always frequent, becomes 

 weak and tremulous, the throat and mouth appear 

 sloughy ; perhaps the stools are passed involuntarily, 

 and the patient usually dies about the fifth day of the 

 disease, but in some cases not until the fourteenth, in 

 others, so early as the second day. In some instances 

 death is preceded by low delirium, or stupor ; in others 

 the mind continues unimpaired till within a few mi- 

 nutes of dissolution, and the patient is carried off after 

 a fit of a convulsive kind. 



This fever attacks generally on the second and some- 

 times the third day after delivery ; but it has also oc- 

 curred so late as after a week. The earlier it attacks, 

 the greater is the danger ; and few women recover who 

 have the belly much swelled. 



On dissection there is found in the abdomen a con- 

 siderable quantity of fluid, similar to that met with in 

 peritonitis. The omentum and peritoneum are inflam- 

 ed, but perhaps very slightly, and gangrene is unusual. 

 The swelling is neither proportioned to the inflamma- 

 tion nor effusion, nor in every instance dependent on 

 these, but on that inflation of the bowels which results 

 from the relaxation of the muscular fibres of the bowels, 

 which is so common in the puerperal state, particularly 

 in puerperal disease. The uterus is not more affected 

 than the intestines. In some cases the thoracic viscera 

 are inflamed. There is the most satifactory evidence that 

 this disease is infectious, and also that it is epidemic 

 over a greater or less extent of country in particular 

 years. 



As it has been confounded by many with peritonitis, 

 it is not to be wondered at if very opposite modes of 

 treatment should be proposed. This attempt to iden- 

 tify puerperal, or, as it has been called, low child-bed 

 fever,with simple inflammation, is practically of the most 

 mischievous nature, and ought to be resisted by all at- 

 tentive observers of disease. 



Early and copious venesection has been strongly ad- 

 vised, as the most effectual remedy ; and in a disease 

 which proves so fatal under any treatment, the author 

 has felt it to be his duty, even under many doubts, to 

 make a full and faithful trial of the plan. The result 

 has completely convinced him, that copious and repeat- 

 ed bleeding is a most useless and a most dangerous 

 practice ; and if he can prevent his younger brethren 

 from being led away by the plausible arguments which 

 have been adduced in favour of the lancet, he shall have 

 performed an important service to those who are attack- 

 ed with the disease. He is not inclined to forbid al- 

 together the detraction of blood, but he wishes to limit 

 that practice to those cases where the symptoms of inflam- 

 mation are the most decided, and particularly to those 

 where the pain is fixed, as, for instance in the side, or 

 in the uterus ; the lancet in such instances should be 

 early employed, but ought not to be repeated, and where 

 the symptoms are not decided, it should be altogether 

 omitted. None have recovered who have been largely 

 and repeatedly bled, although the blood was such as is 

 met with in inflammation, and all the recoveries he has 

 met with, have been amongst those who either were not 

 bled at all, or only once, and sparingly. 



LaJUtives, bark, and light nourishment, to support 

 the sfl^gth, are the most useful internal remedies. In 

 the more advanced stages, wine, to act as a cordial, and 

 opiates, to allay irritation, will be useful. Blisters have 

 been advised, but they are more injurious than bene- 

 ficial. The application of turpentine is certainly of 



advantage, and in general gives more relief than fo- Of the 



mentations. Puerperal 



If the patient recover, the bowels remain long in an !Stale - . 

 irritable state, and require much attention. "V"' 



CHAP. XIII. 



Of Chronic Swelling of the Abdomen. 



It is not unusual, if the patient be exposed to cold Of Chronic 

 after delivery, or have any puerperal disease of an in- Swelling of 

 flammatory nature, for the belly to become swollen and the Abdo " 

 prominent, with some degree of tension. This tume- m 

 faction arises from inflation of the bowels, and is de- 

 pendent on some disease of the uterine appendages, 

 generally of one or both of the ovaria. The connection 

 between the intestines and the uterus and ovaria, is well 

 seen, both in the early weeks of gestation, and at the 

 menstrual period, many females about that time hav- 

 ing the bowels much distended with air ; and this very 

 disease under consideration, may be produced by ex- 

 posure to cold during menstruation. 



It is a complaint of some importance, not only on 

 account of appearance, but also as it indicates the exis- 

 tence of a local disease, or change of structure, which, 

 at some future period, may prove formidable. It is 

 sometimes succeeded by ascites, but much more fre- 

 quently by that disease improperly called dropsy of 

 the ovarium. In some instances, however, it seems 

 to be entirely dependent on the state of the bowels, at 

 least no other disease manifests itself in future life. 

 When it is not symptomatic of organic affection of the 

 uterine system, it may be sometimes removed by strict 

 attention to the action of the bowels, which is kept up 

 by aperient medicines, administered so as to invigorate, 

 and not weaken the muscular fibres of the intestines. 

 These medicines must be varied according to their ef- 

 fect, and may be combined with tonics, and uniform 

 but moderate compression of the abdomen, or long con- 

 tinued friction every morning and evening. 



When it is dependent on ovarian disease, the at. 

 tention must be directed to the removal of that, which 

 is a matter of great difficulty. The present excellent 

 and zealous Professor of Midwifery in the University 

 of Edinburgh, Dr. Hamilton, has informed the author, 

 that he has, in some cases, been successful by employ- 

 ing patting or friction externally, and prescribing the 

 solution of muriate of lime. 



This chronic swelling is not to be confounded with 

 a tumefaction of a more acute nature, which sometimes 

 occurs in the puerperal state, without pain, or indica- 

 tion of inflammation. The same experienced practi- 

 tioner compares this swelling to a pillow of down, for, 

 by pressing with the hand, a similar soft sensation is 

 perceived : the hand sinks, but the swelling imme- 

 diately rises on removing the pressure. It is consider- 

 ed as a fatal symptom. 



CHAP. XIV. 



Of the Signs that a Woman has been recently delivered. 



It is sometimes an object of great importance in Of the 

 medical jurisprudence, to determine whether a woman signs that a 

 have lately been delivered of a child. Thig can be woman has 

 done by examination of the breasts, the external ap- been r *~ 

 pearance of the abdomen, and the condition of the ute- 'y^^j *' 

 rus and vagina. We find the labia and vagina relax- 

 ed, somewhat tumid, and of a deeper red than usual. 

 The perineum is generally injured, or the fourchette 

 at least is torn. There is a sanguineous discharge. 





