Sometimes the relaxation becomes complic,ated after labor, with in flammation of the joints. These results are rare in slowly progressive relaxation, but usual in the sudden relaxation of labor, where the so called rupture of the symphyses occurs. Only one affection can be mistaken for relaxation of the joints. This is inflammation of the artic ulations, and we will soon revert to that subject.
should always be considered serious, although not absolutely grave, for the disease predisposes to inflammations of the sym physes, and to their rupture during labor. It may, moreover, persist a long time, thus constituting a real cause of infirmity.
must not be neglected. Although rest suffices most of the time in slight cases, the patients should be carefully watched after confinement. To keep the patients in bed for a very long time, say one month, six weeks or two months, if necessary, anil. to maintain im mobility of the articulations are the first indications. In many cases a towel, a body bandage, a roller bandage, suffice. In others, more ener getic restraint is necessary. Boyer advised a leather girdle, and Martin a complete metallic girdle, quite strong and large enough to encircle the entire pelvis. The spring, the height of which is about one third of an inch, padded and trimmed like those of trusses, is interrupted, anteriorly, and furnished on one side with a strong strap, and on the other with a buckle, by which means the two ends are approximated and firmly hold in contact. We saw a so-called gymnastic girdle used with advantage in one case, and followed by a plaster dressing. But, as Cazeaux properly says, we must, above all, be certain that there is no inflammation of the joints, and must not resort to restraining measures until all inflammation has been dispersed by revulsives. It is well, afterward, to use sulphur douches, which rendered us great service in one case. Patients must be careful not to leave off their apparatus too soon, and must not incur fatigue by taking too much exercise.
Inflammation of the .Articulations.—Injlammation of the Symphyses.
Although generally observed after labor, inflammation of the pelvic symphyses may appear during pregnancy, and to the case,s cited by Hiller, ItIonod, Danyau, Hayn, Joyeux and Kiwisch, we can add two observed by ourselves. Dubois reported three more, in 1879, and we are convinced
that it would be easy to find a larger number still to Fodere, these are, particularly, the puerperal state, scrofula, rlrumatism, and traumatisms incident to labor the disease begins a few days after labor, from the third to the tenth day, sometimes even earlier, in grave cases. In some cases, the characteristic symptoms of relaxation are observed toward the end of pregnancy, and inflammation manifests itself after delivery, and we may say as a result of it. Usually, a chill opens the scene, a fever follows and then the characteristic symptoms appear. The first is pain, which, slight at first, grows rapidly worse, is increased by movements and is localized in the joint attacked. Generally, the sacro-iliac joints are at tacked, and the pain is then usually more violent and lasting. From the joint the pain spreads to the loins and the buttocks, radiating also into the legs. Sometimes it remains fixed in the articulation, or, at least, is augmented by slight pressure in this region or upon the iliac crests. When the symphysis pubis is attacked, the pains are less severe, and are located in the front of the pelvis. When the pain radiates into the legs, it there produces sensations of formication and of numbness, and the sensi bility of the limb may be impaired (cases of Joyeux and Pigoolet). Sometimes the pain radiates into only one limb, and thus simulates sci atica. This happened in one of our cases. The urinary function is often impaired when the symphysis pubis is affected. Sometimes there is dysuria, and sometimes incontinence. The skin over the joint keeps its normal color for some time but often becomes rod, tense and shiny. Soon, a little tumefaction and cedema appear, but these are not constant, and, generally, vaginal palpation is necessary to detect swelling of the articulation. In rare cases the tumefaction fluctuates, an abscess forms, grows large and breaks its way into the pelvis or outward. In the former case death may result, and at the autopsy we find the articular surfaces altered and denuded of their cartilage.