THE PUERPERAL STATE.
Of the Management immediately after Delivery WHEN the after-birth is expelled, it is too much the When the after-birth is expelled, it is too much the practice with many to sit up in bed immediately, and have the clothes shifted. Most alarming floodings, and other bad consequences, may result from this. The first thing to be done is, very slowly to remove the wet sheet from below the patient, she next turns slowly on her back, and has a bandage applied so firmly round the belly as to give the feeling of a pleasant support. The bandage often consists of a broad towel folded double, but it is better to have one made of stout cotton cloth, with tapes to tie, or buttons, with two rows of holes. It is prevented from slipping upwards and wrinkling by a thigh-piece, and in some cases it may be necessary also to have a shoulder strap. Many, with advantage, apply under this a compress, made of a napkin of quilt ed pad. The bandage being applied, a flannel petticoat, open in the middle. is next put on, and wrapt round the limbs, and a soft napkin is to be applied to absorb the dis charge. If the patient be no more is to be done, hut if she be not, an aired shift and bedgown can be put on, and she is laid to rest ; but if a half shift be used during labour, there is seldom great occasion to change it, for several hour s at least. Although we are thus cautious respecting speedy shifting on account of the effect often produced by slight exertion, especially alter a lingering labour, or in delicate women, yet the necessity of chang ing the clothes, as soon as prudence will permit, ought to be inculcated, and afterwards shifting every day, and having the discharge washed away, morning and even ing, kith a sponge and lukewarm water. The number of bed-clothes must be regulated by the season, but they never should be so many as to promote sweating, which weakens the patient, and gives a tendency to catch cold. It is usual to give some cordial after delivery, such as brandy or cinnamon-water. Unless the strength be ex hausted, there is seldom occasion for this, and it often does harm. A little wine and water may be given if fatigued, or a little panado with wine ; or if the labour have been lingering, and there is much langour, a little Madeira wine, without water, is very proper.
A stool should be procured within thirty-six hours after delivery, by means of a suitable dose of magnesia, or a little castor oil. If the patient is not to nurse, the laxa
tives should be rather brisker.
The urine should always be passed within twelve hours, at farthest, after delivery, and if there be any diffi culty in voiding it, fomentations will be useful. After a severe labour, it is necessary to be very attentive to the voiding of the urine, and the state of the soft parts.
The diet ought to be light, and should consist, for the first ft% o days, of tea and cold toast for breakfast, beef or chicken soup for dinner, and panado for supper. Af terwards a bit of chicken may be taken for dinner, and, as recovery goes on, the usual diet may be returned to. In these directions, however, regard must be bad to the previous habits and present state of the patient.* The drink at first should be toast water, and malt liquor is, for some days, to be avoided ; wine, or wine and water, may then be allowed, if no fever be present, and the weakness or former habits of the patient require it. In a good recovery, the patient may have the bed made on the third day, but, during the time, she should recline on a sofa. In a clay or two longer she may be allowed to he dressed and sit a little, but ought not to walk about or leave the room for some time ; and, even in summer, should not go out for an airing in less than three weeks. Many, before this time, do rise, and even attend to do mestic cares earlier, but they often suffer very much, either from a weakening discharge, or a falling down of the womb.
Of Trenzor and Fainting Fits It is not unusual for women, very soon after delivery, to be seized with a violent shaking or shivering, some times in consequence of rash and sudden exposure to cold, after being heated with the exertion of labour, but often from no evident cause. Nothing, in general, gives so speedy relief as a pretty large close of laudanum, forty drops, for instance, in peppermint water, or in a little brandy and water. At the same time, the patient is kept in perfect rest, and when she is inclined to shake, she must be held gently by an assistant, so as to prevent her from doing so in a great degree. If she feel cold, and the teeth chatter, the application of a warn, cloth to the stomach and feet is useful. This is not a dangerous, and seldom an obstinate, affection. If it, however, should be prolonged, camphor is of service.