II. CURATIVE TREATMENT.
Where, notwithstanding all our precautions, puerperal affections arise, we must resort at once to the curative treatment. Is this treatment the same for all cases, does there exist, in a word, a general treatment appli cable to every case? Certainly not, and the treatment must vary with the variety of the disease. We believe, however, that there are two agents which should ever be employed, and which in many instances have a most marked beneficial effect. These agents are quinine and alcohol. The quinine should be used in doses of fifteen to thirty grains daily, and the alcohol is to be given in any suitable form. These two agents, combined with the carbolic douche, are for us the remedies par excellence. We much prefer them, and they appear to us much superior to either aconite and quinine, as recommended by Depaul, the eucalyptus globulus, the salycilate of soda used in Germany, the Warburg tincture, used in England. [Warburg's tincture will be found of special utility in those instances where the symptoms are not specially decided in favor of sepsis, but point rather to a malarial element complicating the puerperal state. It is best administered in capsules containing a drachm of the inspissated tincture, and the guide to the dose is the effect on the bowels. The combination acts to best advantage when the bowels are lightly touched, and in our experience two capsules administered each night will have the desired end. In case the woman is constipated, we have found it useful to prepare the way for the Warburg by giving a full saline laxative some hours previously to the first capsule. Obscure cases of fever in the puer peral state, without special definite symptoms, but occurring in a neigh borhood where the causes of malaria are rife, will often find their explanation in the way in which they yield to Warburg's tincture.—Ed.] To pass now to the treatment of the different forms of puerperal fever, we range these forms under the following heads.
1. The inflammatory form, metritis, peri- and parametritis, circum scribed and generalized peritonitis.
2. Putrid infection.
3. Purulent infection.
4. True septictemia.
5. Phlegmasia alba dolens.
In the first four terms we must act energetically and quickly, since success will depend in great part on the little time which has elapsed between the appearance of the symptoms and the institution of treatment.
1. Inflammatory Affections.—a. Jfetritis, perimetritis, parametritis. The first phenomena are chill, pain, and fever, and it is against them that we must bring to bear our therapeutics.
The first thing to do is to warm the patient by means of hot-water bottle, bed-clothes, warm alcoholized drinks, and next to control the pain and the first inflammatory symptoms. Local venesection by means of wet-cups or by leeches admirably subserve this purpose. We much prefer leeches applied over the site of the pain at the point of maximum intensity. Ten leeches on each inguinal region will ordinarily diminish the pain notably, and if this persists the leeching must be renewed. They are to be allowed to drop off themselves, and bleeding for a number of hours afterwards is to be encouraged by hot fomentation or by poultices.. At the same time, about ten grains of the sulphate of quinine should be administered, to be repeated morning and evening on the following days. The leech-sites are to be thickly spread with belladonna ointment (onguent napolitaine belladonna), morning and evening, and over this hot poultices are to be kept. The bowels are not to be moved till the third day and then by means of oil and glycerin enemata. If this does not suffice, a mild purga tive should be given. From what we have already stated, the patient re ceives a carbolized douche morning and evening, repeated more frequently if the lochia become foetid. In case the disease is complicated by peH- or parametritis, if the pain recurs, we renew the leeching, although in this event we prefer a large fly-blister. We abstain from local examination. Later, if the affection changes into phlegmon, or pelvic peritonitis, we resort to the blister, and when the affection abates, we administer baths. In certain cases, where the tongue is markedly coated, we have begun the treatment with advantage by giving an emeto-cathartic.