PATHOLOGY. 2G3 
psarance of the fever, and all the fymptoms. Suppura¬ 
tion is marked by a remiffion of the pain, with rigors, 
throbbings, and lieftic fever: in fome cafes, pus is dif- 
charged with the urine. 
On the firft coming-on of this complaint, a quantity 
of blood, proportionable to the feverity of the pain, 
ought immediately to be taken away; and, if the firft 
bleeding does not afford conliderable relief, the ope¬ 
ration fhould be repeated on the fame day, or on the next 
at fartheft. Topical bleeding with feveral leeches will 
alfo be proper. 
After bleeding, fomentations and clyfters may be ufed. 
The patient is at the fame time to be directed to drink 
plentifully of barley-water, thin gruel, whey, or linleed 
or marfh-mallow tea. The inteftines are to be emptied 
by gentle purgatives, as frequently as the occafion may 
require, in addition to emollient clyfters. The warm 
bath, and diaphoretics, fuch as the faline medicine com¬ 
bined with naufeating dofes of tartarifed antimony, will 
at the fame time be proper. When the febrile fymptoms 
do not run high, and the inflammation has been fub- 
dued by a vigorous adoption of antiphlogiftic remedies, 
opiates may be ufed occaftonally to foothe pain, and may 
be added to the clyfters. In nephralgia, they are very 
important remedies, but not in pure nephritis. 
In nephritis, the application of blifters is fometimes 
pfoper. The cantharides ufed in them fhould be infil¬ 
led in boiling water, a mode of proceeding which de- 
ftroys their irritating operation on the kidneys. If this 
be not done, abforption of the bliftering-fluid will do 
more harm than the local ftimulus will do good. To¬ 
wards the termination of the complaint, foda is a ufeful 
remedy. The reader will find fome further ufeful re¬ 
marks on this complaint under the articles Nephritis 
and Nephralgia, vol. xvi. p. 721. 
15. Emprefma cyftitis, inflammation of the bladder: 
pain and fweHing in the hypogaftric region ; difcharge of 
urine painful or obftrudted ; tenefmus. It is often the 
refult of wounds, fometimes of cantharides; more gene¬ 
rally idiopathic. 
The treatment of thisdifeafe is the fame as that of ne¬ 
phritis, except that drinking large quantities of fluid 
muft be forbidden. Purging clyfters, containing opium, 
fliould be injefted very freely in this complaint. 
16. Emprefma hyfteritis, inflammation of the womb: 
pain, fwelling, and tendernefs, in the hypogaftric region; 
heat, pain, and tendernefs, of the os uteri; vomiting; 
pulfe quick and low. It has two varieties. 
a. H. fimplex, the organ being unimpregnated : pain 
permanent, circumfcribed, throbbing; feveracauma. 
B. H. puerperarum : pain lefs acute, lefs circumfcribed ; 
flow of urine difficult; fever a fynochus or typhus. 
The uterus is obvioufly liable to fuffer inflammation, 
like the other vifcera of the body, from the common 
caufes of inflammatory difeafe. In the unimpregnated 
date, however, it is lefs frequently attacked by this dif- 
order than mod of the neighbouring organs ; and feldom, 
if ever, is thus affedfted, except about the periods when 
its veffels are in a Hate of increafed adfion, in confequence 
of the occurrence of the menftrual difcharge. At thefe 
periods, when not only the uterine fyftem, but the con- 
ftitution in general, undergoes a flight erethifm, or ten¬ 
dency to febrile excitement, fudden expofure to cold, 
violent exercife, great heats, or very high feeding, occa- 
fionally bring on inflammation in the womb ; more efpe- 
cially in females of plethoric habit. 
The moll frequent caufe of inflammation of the womb, 
however, is the irritation or injury which it is liable to 
fuffer during the procefs of parturition or abortion ; oc¬ 
currences which arife from the preflure different parts of 
this organ neceffarily undergo, during thefe procefl'es. 
Perhaps the free difcharge of the lochia, which is a ne- 
ceflary confequence of the feparation of the placenta, 
anfwers the fecondary purpofe of local depletion, and 
thus, like a copious blood-letting inftituted by art, pre- 
Vol. XIX. No. 1302. 
vents the evils which would otherwife be very likely to 
enfue. This fuppofition is rendered farther probable, 
from the circumftance that inflammation of the uterus, 
when it comes on a few days after child-birth, is con¬ 
nected with a fuppreffion of the lochial difcharge. 
Inflammation of the fubftance of the uterus ufually be¬ 
gins about the fecond or third day after deli very ; and is 
firft known to exill by a fenfation of pain felt at the lower 
part of the abdomen, which gradually increafes in vio¬ 
lence, and is diftinguilhable from after-pains by its con- 
ftancy. After-pains are intermittent, like the pains of 
labour, depending, like them, upon contractions of the 
uterus ; but the pain of inflammation, arifing from the 
uninterrupted adiion of the veffels, is neceffarily unre¬ 
mitting. The patient complains much of any preflure 
applied externally to the region of the uterus ; and this 
organ feels larger than common under the hand, as well 
as much harder, refembling almoft a ftone in firmnefs. 
Marks of conftitutional affeCtion foon appear in the ini 
creale of heat over the whole body, a white and dry 
tongue, third, head-ache, a hard, full, and ftrong, pulfe, 
(when the difeafe occurs in full habits,) and in all cafes 
a frequency of pulfe, from 100 to 120 ftrokes in a minute. 
Very foon after the attack, theftomach is ufually affedted 
with ficknefs and vomiting ; but this fymptom is not in¬ 
variable. There is commonly a confiderabie degree of 
pain in the back, fhooting round the pelvis to the groins, 
and down the thighs. Not only the lochial difcharge, 
but alfo the fecretion of milk, is for the moft part in¬ 
terrupted. The bowels are varioufly affedted; often 
coftive in the commencement of the difeafe, but frequent¬ 
ly very loofe as it advances. The urine is commonly 
high-coloured, depofiting fometimes a pink-coloured fe- 
diment, when it can be feen unmixed with the uterine 
difcharges. It will fometimes be found, when the dif¬ 
eafe has communicated with the neck of the bladder, or 
when the uterus and bladder have fullered, that fuppref¬ 
fion of urine will take place, fo that the catheter muft be 
employed two or three times a-day to draw it eft’. On 
the other hand, we have feen the inflammation apparent¬ 
ly extend to the kidneys, in which cafe no urine was fe- 
creted for two or three days ; yet the patient experienced 
the fenfation of an urgent defire to make water, probably 
from the inflammation being likewife communicated to 
the neck of the bladder. If the inflammation is very 
great, it may fpread to the peritoneum, covering the 
lundus of the uterus, and lining the cavity of the belly ; 
in which cafe there is great fwelling, tendon, and forenefs 
of the belly; and other new fymptoms arife, fuch as cha¬ 
racterize the child-bed fever, defcribed under Parturi¬ 
tion, vol. xviii, p. 674. 
In the progrefsof the difeafe, flight fliiverings frequent¬ 
ly take place at different times in the day, while the 
acutenefs of the pain is diminilhed, and the face of the 
patient becomes occafionally fluflied. Thefe fymptoms, 
together with the increafed frequency and weaknefs of 
the pulfe, mark the tendency of the difeafe either to 
fuppuration, or to a dangerous failure of the vital 
powers. The tongue puts on a fiery red orfcarlet ap¬ 
pearance, which is often followed by aphthae : fymptoms 
of great general irritation l'ucceed ; and the patient is 
often cut oft' in a ffiort time. Now and then, however, a 
flow of fetid lochia relieves thefe fymptoms: the pulfe 
becomes lefs frequent; the flufliings more rarely appear; 
the tongue grows paler, and the fkin, which before had 
been hot and dry, now relaxes and is cooler; a fponta- 
neous diarrhoea comes on, and the patient recovers. 
The cafe is more favourable, and the profpeCt of recovery 
greater, where thefe Ihiverings and flufliings have never 
occurred; but where the uterus gradually becomes 
fofter, and lefs tender on preffure, the lochial difcharge 
returns in its ufual quality and quantity, and the fecre¬ 
tion of milk begins again. 
As the difeafe is often extended to different organs at 
the fame time, and the fymptoms muft neceffarily be 
3 Y rather 
