Suppression of Urine. In the country it often happens, that the practitioner does not see his patient any more after leaving her safely delivered. In such cases, It will be necessary for him to leave general directions with the attendants; the most material of which is, that the nurse shall send for him, if, upon trying, the patient finds herself unable to make water, at the distance of eighteen or twenty hours after delivery. If the pa tient be neglected, the bladder swells to an enormous size, and at last bursts, in which case death is inevitable.
When the practitioner has been sent for, he must not be satisfied with the pa tient's telling him that she has since made water, and that a little escapes frequent ly; all this amounts to nothing, and must not eicuse a moment's delay in the in troduction of the catheter. It will gene rally be necessary to draw off the water once or twice a day ; but from distance of residence this will sometimes be im possible. In such a case it is not very difficult to teach the nurse how to per form this operation, by spewing her the parts, and pointing out the little orifice, at the same time telling her, the instru ment must be passed up carefully and slowly till the water flows from the other end of the tube.
Effusion of Blood into the Cellular Sfem brane of the Labia Pudendi. This is an accident which now and then happens after delivery. It is merely a mechanical effect of pressure, and very rarely occurs. In one case where the parts had been • previously much strained, the swelling was first observed by the patient's finding h erself unable to close her thighstogether. This blood, if left to itself, will first coa gulate round the orifice of the bleeding vessel, and afterwards the whole quan tity of effused blood becomes fixed.— There are two ways by which the parts may get rid of this blood, if its quantity be considerable ; either by the skin sloughing off, by which part of the blood may escape, or by the part inflaming and suppurating. When the latter circum stance happens, and it is determined to open it, the orifice made cannot be too small, so that the matter be allowed to sescape : for the constitutional weakness at such a time as this will give a ten dency to gangrene in any part which is divided. Cold is the only application that is to be at all regarded. It has been re commended to cut and scarify the part ; but this is objectionable, because, should the artery continue to bleed after the openings are made, the situation of the patient at once becomes serious, for we must necessarily be perfectly ignorant where the ruptured vessel is, and con sequently as perfectly unable to stop it.
Should it ulcerate, the treatment should he the same as that of an ulcer in any other part of the body.
Lochial Discharge. this is meant that discharge which follows the expul sion of the placenta, continues for several days, and diminishes in proportion as the uterus contracts. A short time after de livery the vessels which before poured out red blood, will, from the womb hav ing contracted to a certain degree, only ooze forth serum. When small pieces of the maternal part of the placenta remain, with fragments of the membranes, &c. and mix with the lochial discharge, they constitute what the nurses call the green water ; and these discharges generally subside in six or eight days, more or less. They will, however, often be reproduced by very slight causes; such as sitting up right, endeavouring to walk, eating sti mulating food, or indeed any thing which may increase the action of the heart and arteries. In a strong woman of tense fibres the discharge will be of shorter duration than in a weak woman of lax fibres; if a woman be quiet it will not continue so long as if she be restless. Where the quantity is profuse, and it flows for too long a period, the constitu tion becomes weakened, and it is neces sary to give bark, with the vitriolic acid, or the conserve of roses.
Lacerated Perineum. The intermediate part of the body, situated between the vagina and rectum, is called perinzum ; and from its peculiar situation is very liable to accident from the violence of pressure in labour ; this will sometimes happen with the most careful practi tioner ; it will now and then give way in a trifling degree, and is in such cases or no further consequence, than from its leaving the parts a little sore and weak for a kw days. The only laceration of consequence is that from before back wards to the rectum, by which the os ex ternum and rectum are laid into one, and the sphincter ani consequently torn asun der. This accident is, however, extreme ly rare, and may always he prevented by supporting that part of the perinzum with the hand.