RESPIRATION AND PULMONARY CAPACITY.
Winckel, who believes the normal respiratory rate to be 16 or 18 the minute, has found during the first fourteen days, in 16 cases, 16 respira tions, in 1 case 17, and in 6 cases 18 respirations per minute. Wild Sims finds a higher mean, 23 respirations. According to him, the capacity of the lungs, in general, augments after labor, although often it does not change, and at times even diminishes.
Dohrn, who has directly measured the pulmonary capacity, has found: in 60 per cent. of cases, augmentation to 131.8 cubic inches; in 26 per cent. 8.6 cubic inches; in 14 per cent. no change.
In primipara3 this increase is less than in multiparte. These results are opposed to those of Wintrich, of Kuchenmeister, of Fabius, who have found that the lung capacity after labor was equal to or below that before labor. The experiments of Reinhard confirm those of Dohrn.
Circulation.—Blot, Naegel6 and Grenser, Bouchacourt, Marey, Fritsch, Winckel, and others, have specially studied the modifications of the circu lation, and all are agreed on this point that the blood, and the modifica tions in the organs of circulation, are in intimate connection with the in crease in pulmonary activity. The blood, rich in fibrin, takes up in the lungs a•greater quantity of oxygen than it could retain during the last few months of gestation. This blood, rich in fibrin, and surcharged with oxygen, excites the heart and the arteries to contract with energy: whence results the fact that during the first few days, the woman's pulse is fuller and harder. Again, the thoracic and abdominal organs, which had been displaced during pregnancy, return to their normal position. Therefore the circulation becomes freer and more energetic: for the same reason the oedematous conditions of pregnancy rapidly disappear during the puerpe rium, and the varices, developed during pregnancy, diminish notably, if not altogether." (Naegele and Grenser.) Another phenomenon has been noted by Stoltz, and carefully studied by Blot in 1863, and this is the slowing of the pulse. More or less accen tuated in healthy puerperEe, this slowing is all the more marked the better the state of the body-health. The pulse-rate may fall to 35 per minute, and it oscillates between 44 and 60. More rapid in multiparEe than in primiparEe, the slowing may last for a few hours to fifteen or twenty days. It begins, ordinarily, within the twenty-four hours follow ing labor, augments, remains stationary, and little by little disappears. It may even persist during lactation: it is independent of the duration of labor, but is under the influence of the least pathological change; it is ob served after miscarriage, and premature labor, as well as after normal labor, and the most intense uterine contractions do not cause it to disap pear. Abundant hemorrhage influences it: the position of the woman
causes notable variation: it is a most valuable prognostic sign, for it is met with only in healthy puerperEe.
The above conclusions of Blot have been confirmed by Falischi of Sienna, by Winckel, Baumfelder and Gruber. The latter compares the pulse of the puerpera to that met with on the sound side of hemiplegics: the pulse of the healthy woman is anacrotic, in febrile states it becomes dicrotic.
the early puerperal lays the function of digestion is poorly performed. The appetite is slight; the thirst, however, is in creased, constipation is the rule, partly because during labor the finesl matter has been evacuated either spontaneously, or by enema; partly, be cause the woman eats but little; partly because the peristaltic contractions of the intestine are lacking in power, and therefore the Neal matter travels slowly; partly, finally, because the relaxed abdominal muscles cannot assist in the expulsion of the accumulation in the rectum.
Urinary has been studied, in particular, by Gassner, Winckel, Kleinwachter, Fritsch, Klemmer, Schroeder.
Gassner showed, at the outset, that the amount of urine is notably in creased, (he mentions the case of a woman, who, suffering from consid erable oedema, passed, in the forty two hours after labor, twenty-two pounds of urine), and that this increase is manifest even in women who are not oedematous. According to Winckel, there is an increase during the first days of the puerperium, in particular the first forty-eight hours. The urine is clear, without deposit, of a low specific gravity. The absolute amount of urea, phosphates, and sulphates, is a trifle less; that of the chlorides remains about the same. As the condition of the genital organs returns to the normal, the quantity of urine diminishes, the specific grav ity approaches the normal, the color becomes yellow, and the urea, etc., reach the mean standard figure. An important point is that the excre tion of the contents of the urine follows the temperature curve. The mean amount of urine excreted by a healthy puerpera during the first six days is 350 ounces, the specific weight is 1.010. It is not unusual to find a little albumin in this urine, and, further, Blot, Kirsten, Brucke, Ivanoff, and Hempel, have detected sugar. Spiegelberg and Hempel explain the presence of sugar by resorption from the milk. The increase in the secretion from the kidney is intended chiefly to remove from the organism a large amount of water, but we must believe as well that the products of oxidation are thus, in part, eliminated.