G74 PARTURITION. 
forbidden ; they are very rarely required, even when the 
third ftage of labour is nearly terminated, but in the ear¬ 
lier periods are almoft always manifeftly injurious. The 
attendants in the lying-in chamber frequently object to 
toaft and water, lemonade, oranges, and other fubacid 
fruits, &c. but, under many circumftances, fuch articles 
are highly grateful to the patient, and may be indulged 
in without hazard. 
If the prefence of the praXitioner in the lying-in cham¬ 
ber is not abfolutely required, it is better for him to be 
in another room ; thus the patient, being lefs under re- 
ftraint, will attend to the calls of nature, which ought 
not to be interrupted. It has already been obferved, 
that during the early ftages of labour a frequent urgency 
to make water is prefent. The bowels (hould be opened 
by caftor-oil, or other mild aperients, early in the labour. 
After the labour has made much progrefs, the reftum, if 
loaded, {hould be emptied by clyfters. Indeed, the uti¬ 
lity of clyfters, in almoft every ftage of labour, is fo ap¬ 
parent, that it is to be lamented they are not more fre¬ 
quently employed. 
The fpirits of the patient (hould be kept up, by kind 
and cheerful converfation. Noify difcourfe is always of- 
fenfive to the parturient woman, and all converfation on 
melancholy or unpleafant topics (hould be checked. Par¬ 
ticularly no mention (hould be made of unfortunate cafes 
in midwifery. The difereet praXitioner will difeourage 
all fuch fubjeXs of difcourfe; and will likewife endea¬ 
vour to prevent calumnious reflexions and infinuations 
againft his medical brethren, whofe character and repu¬ 
tation are too often abufed in the lying-in chamber. 
After the child has breathed freely and cried vigoroufly, 
a ligature may be made upon the navel-ftring, at the dif- 
tance of two inches from the belly, and another an inch 
nearer to the placenta, and the funis (hould be divided 
with a pair of feifl'ors between the two ligatures, the fe- 
cond ligature being intended only to prevent blood ef- 
caping from the divided cord, and foiling the bed. The 
London PraXice of Midwifery, and Dr. Conqueft, direX 
this operation to be performed under the bed-clothes, 
“ it being indelicate and unneceflary to expofe either 
mother or child.” But Dr. Merriman very juftly obferves, 
that “ it {hould never be done under the bed-clothes. A 
very carelefs accoucheur, not long ftnee, included one of 
the little fingers of the child, in the ligature which he 
bad made upon the funis, and cut off the firft joint with 
his feifl'ors and Dr. Denman ufed to mention in his 
leXures the calamitous inftance of a praXitioner who in¬ 
cluded the penis of a child between the blades of his feif- 
fors. Thefe accidents, as Dr. Merriman very juftly ob¬ 
ferves, could not have happened, had the part to be di¬ 
vided been brought into view. 
We may juft add, that, after dry warm linen has been 
put on, all impurities removed, and a little well-boiled 
gruel given, the woman (hould be left perfeXly quiet, the 
child put by her fide, and the room, with a moderate 
light, kept perfeXly tranquil. 
The procefs by which, under the mod favourable cir- 
cumftances, a child is produced or brought into the world, 
is with great propriety called labour, as it is rarely effeXed 
without confiderable exertion, which has the ufual effeX, 
that of exhaufting the ftrength and fpirits of the woman. 
Thefe are to be recruited in the fame manner as if the 
walte had been occafioned by any other kind of exercife; 
viz. by reft, and by taking a moderate portion of plain 
and Ample food at (mail intervals. In the choice of their 
food, the women may generally be allowed to confult 
their own taftes, which will rarely, at fuch times, incline 
them to fpiced meats, or to drinks that are heating. It 
will be proper that they be kept in a recumbent pofture 
for the firft four or five days, only leaving their beds fo 
long as may be fufticient to open and refrefli them. By 
that time the veflels of the uterus will be fo much con. 
traXed, as to remove all danger of haemorrhage, or of an 
inconvenient defeent of that vifeus, which is fometimes 
the confequence of leaving the bed too early. It is pro¬ 
per alfo, on the fecond, or at the lateft on the third, day 
after being delivered, to procure (tools, either by purging- 
medicines or by giving a clyfter. By thefe means the fe¬ 
ver which is ufually excited by the fecretion of the milk 
will be moderated. This, which is called the milk-fever, 
is of fliort duration, lading only three or four days, and 
is not attended with danger. In the cure, nothing is re¬ 
quired but to keep the body open, and to fupply the pa¬ 
tient with diluting drinks, taken warm, with the view of 
inducing a gentle perfpiration. 
The child (hould be put to the breads a few hours after, 
the completion of the labour, that it may get fome mouth¬ 
fuls of the thin whey-like fluid which is at firft fecreted. 
This will ltimulate its bowels, and enable them to dif- 
charge the meconium, or black vifeid excrements, with 
which they are always filled. It will alfo keep the breads 
of the mother from being too much diftended, the pain 
occafioned by which, if it is not the caufe of, yet it cer¬ 
tainly tends to increafe, the milk-fever. 
But there is another fever to which women are at this 
time fubjeXed, which is attended with confiderable dan¬ 
ger, and which not unfrequently proves fatal. It is 
called, from an opinion that it is peculiar to this (late, the 
puerperal fever. Its commencement is almoft always 
marked by a ftrong fhivering fit, which is followed by a 
quick pulfe, head-ache, laflltude, and dejeXion of the 
fpirits. It fometimes makes its attack during the labour, 
more frequently on the next or fubfequent day.' It is 
fometimes miftaken for the milk-fever; but, befides that 
its attack is earlier than that of the milk-fever, which 
never comes on until the third day after delivery, the 
fecretion of the milk is in this fever interrupted, and the 
breads, inftead of being full and turgid, remain flaccid. 
From after-pains, with, which it is fometimes confounded, 
it is to be diftinguifhed by the quicknefs of the pulfe, 
arifing very foon to 120 ftrokes in a minute, by the head¬ 
ache, naufea, and other concomitants of fever. Tender- 
nefs of the abdomen, increafing to extreme l'orenefs and 
pain, foon come on, which are increafed by drawing in 
the breath, and are rendered almoft intolerable by cough¬ 
ing. As there is always a high degree of inflammation 
of the peritoneum prefent in this fever, and perhaps of 
fome of the contained vifeera, we cannot be too early in 
taking away eight, ten, or twelve, ounces of blood from 
the arm, according to the ftrength of the patient. If 
the abdomen appears diftended, attended with forenefs 
and pain, fix or eight leeches may be advantageoufly ap¬ 
plied to that part, which may be afterwards fomented 
with flannels wrung out of a decoXion of camomile and 
marfli-mallows moderately heated, and then covered with 
a poultice made with linfeed meal. A draught with in- 
fufion of fenna and fome neutral Fait may be given to 
procure two or three (tools. The bowels may afterwards 
be kept open, and the pain relieved by giving a drachm 
of purging fait with two or three drops of the tinXure 
of opium, in a fufliciency of water to diftolve the fair, 
every two or three hours. There are few cafes that will 
require or bear a repetition of the bleeding. If, how¬ 
ever, the pulfe (hould appear to be ftrong, and the pain, 
with the difficulty in breathing, require it, that may be 
done on the fecond or third day; and a blifter may be 
applied over the part of the abdomen which is moll dif- 
trefled. A blifter applied to the nape of the neck, fuc- 
ceeds remarkably in relieving the pain of the head. 
There is rarely delirium, at the lead not to any confider¬ 
able degree, attending this fever. The patient (hould be 
nourifhed with light broths, panada, and fuch like mild 
food, and drink barley-water, gruel, baum-tea, toaft and 
water, or, where preferred, table-beer. By perfifting in 
the ufeof thefe remedies, the fever is frequently fubdued 
by the end of fix or eight days, when recourfe may be 
had to a light decoXion or infufion of bark, or fome other 
tonic taken twice in the day to recruit the ftrength. Too 
often, however, thefe and all other means that have been 
devifed 
