In case of an actual laceration of the perinzum, the first step is to empty the bowels by a brisk purge ; after the medi cine has operated, the parts should be perfectly cleansed from all fzculent ter, and then the thighs should be ban daged together, by which there is a pro bability of the parts uniting by the first intention, and in some cases this has suc ceeded. Should this fail, the only chance is, not to allow the parts to heal except by uniting with each other. If considera ble inflammation takes place, it must be reduced by the use of fomentations and cataplasms, and of cooling laxative medi cines, and if. the pain be violent, opiates may be given. When suppuration occurs, bark must be administered. The dress ings may be superficial.
.9fter Paine. Every woman who has been in labour is subject to what are call ed after-pains, though they do not always occur equally. They come on at regular intervals, and are more or less violent. These pains are very rarely felt after a first lying-in ; and they are less when the labour has been retarded, allowing the uterus to contract gradually behind the body of the child, than where the expid. sion of the child has been hastened, the uterus then contracting suddenly, but not perfectly. In consequence of these pains, and the fatigue which the woman has sustained throughout the labour, it is a very general and excellent practice to give an opiate of from twenty to thirty drops of laudanum, and afterwards to repeat it in such a diminished quantity as shall allay the irritation, but not the con traction of the uterus.
An after-pain will perhaps come on an hour after delivery, by which a large coagulum may be expelled ; and after that others, by which smaller coagula will be separated ; and then an after-pain as violent as any of the rest, to throw off one of the smallest possible size. To some women these are very distressing, and are borne with less patience than the labour-pains, as the latter they know are for a good purpose, while the pains after delivery afford no such consolation, and yet are sometimes as violent as the wont pains of labour can be. These pains may be moderated by warm applications to the abdomen, and by small doses of lau danum.
General Treatment of a Woman after Delivery. Practitioners formerly had va rious ways of treating a woman after de livery. Of these the principal were the high or stimulating mode of treatment ; and the low or starving system. • The best practice is to avoid both of these extremes, and to treat the woman entirely according to her situation; if strong and healthy, she may be kept for a few days upon gruel, barley-water, and toast and water; and then, if she be per fectly free from fever,she may eat a little animal food. But if of a weakly constitu tion, she may have animal food the first day ; in the former case no wine should be allowed, in the latter both wine and whatever else will nourish her should be administered. In general no meat should
be allowed for the first three days; bread pudding may be permitted, but if there be the least tendency to inflammation or fever, nothing further. With regard to medicine, much will depend upon the cir cumstances of the patient ; the great ob ject is to keep her quiet; and if this can not be done without medicine, medicine must be given. A saline draught, either with or without spermaceti, will gene rally be sufficient ; and at night a small dose of the sp. rather. vitr co. which may be increased if the patient's nights be restless. it is of high importance, how ever, to give a purge on the third day. It is of little consequence what purgative is used, as long as an evacuation is pro duced. For many weeks before delivery the bowels of a woman are never emptied of their solid contents ; and the quantity that thus accumulates is sometimes very astonishing. Should the purge not ope rate, an enema should be exhibited the same evening ; after which not a day should be allowed to pass without a stool being procured, and this strict attention should continue for the first fortnight.
Fever rarely or never happens where proper care has been taken to preserve a regularity of action in the in testines. Where the bowels are neglect ed, and there is a disposition to inflam matory fever, the milk being formed in considerable quantity, will greatly in. crease that tendency to fever.
Sore Nipples. This is a complaint of ten met with, and very troublesome, and most probably arises from an artificial mode of living. Many women use con siderable pressure upon their breasts, and under such circumstances it is natural to expect that the nipples being pressed in, may be absorbed altogether ; or if this do not take place, they will give way upon the child sucking, and become sore and painful. if this have occurred in a pre vious lying-in, the parts may be strength ened by applying to them astringent re medies two or three months before la bour. When, however, soreness of the nipple has taken place, the best way to protect it is to use an artificial teat, by which the child can suck equally well, and the nipple itself being undisturbed, will soon heal. The way in which one of these instruments is prepared, is to procure a fresh teat from a heifer, and scooping out the inside, to steep the skin in spirits for an adequate length of time, and then fasten it on the glass instrument : glass is preferable, because by seeing the milk we may be assured that the child is properly nourished. A woman is capable of giving milk with a flat or even a con cave surface, by drawing it out with a glass tube that has a small ball to it, by which a vacuum is produced: when im mediately as the glass is removed, the child being put to the breast will keep it • out by sucking till satisfied.