Fainting is always an alarming symptom, and when it occurs, the first thing to be ascertained is, whether there be a great discharge or flooding, in which case the danger is extreme, and the treatment of this has been already pointed out. It may also attend inversion of the womb. But same women are, after a tedious and se vere labour, and others even after vet y little suffering, liable to a short and temporary exhaustion, approaching to a fainting fit, or very often to that kind of insensibi lity or lowness, which occurs in a hysteric attack, and like it, this is frequently preceded by an involuntary cry ing or sobbing, immediately after the bunt of the child. This hysterical lowness is not dangerous; indeed, there is never great ground for alarm, whilst the pulse conti nues, and there is no discharge, for in this case the pa tient may rather be said to be in a state of stillness and quietness than fainting. In those cases when e this state occurs after delivery, a few drops of oil of cinnamon on sugar are useful, or we give thirty- drops of laudanum in a little brandy, or hartsborn and water, whilst a free circulation of air is to be preserved. Volatile tincture of valerian is recommended by Dr. Hamilton to be given, as soon as the child is born, to those who are subject to fainting fits, and certainly is a useful remedy.
Actual syncope is much more alarming, even when it does not proceed from hemorrhage, great fatigue, or any other evident cause. There have been instances of sud den death following an easy labour, and in which no suf ficient cause could be ascertained by dissection. The ordinary means of exciting the nervous and vascular system must be resorted to, and persevered in.
Of ?lfter Pains.
After pains are sometimes extremely troublesome during the first three days after delivery, and may even be more distressing than those of labour. They pro ceed from different causes, but the most frequent is the contraction of the womb to acquire its original size, and expel clots. This often occasions irregular grind ing pains in the lower part of the belly, and sometimes in the back, like those of labour. They are usually ac companied with the discharge of clots of blood, and frequently are renewed for a day or two, whenever the child is applied to the breast. They are most effectual ly relieved by a full dose of laudanum, and warm fo mentations. Gentle laxatives, and uniform pressure externally, contribute to relief. Another kind is ac companied with wind in the bowels. The pain is not merely felt in the bottom of the belly, but in different pans, and comes on often like gripes or cholic pains, sometimes accompanied with a little fulness of the bel ly, and pain on pressing hard. This is relieved by a clyster to open the bowels, afterwards a dose of lauda num in peppermint water, and fomentations. An in jection, containing laudanum, is also useful. Some
times worms cause this pain. Severe pains between the ribs and haunch hone may attack in paroxysms, continuing for more than half an hour, and then going off completely. These may be accompanied with quickness of pulse, and the urine is high coloured. They are relieved by opiates, fomentations, sinapisms, and laxatives ; and sometimes a pretty firm bandage gives temporary relief. Constant pain, accompanied with shivering, vomiting, swelling, and tenderness of the belly, fever, and suppression of the cleansings, indicate inflammation, and require the earliest attention.
Of Displacements of the Uterus Pain in the back and lower part of the belly, with a strong beating down, weakness, feeble pulse, and dis charge of blood, require examination, lest the womb be inverted. if much time be lost, the inversion may either prove quickly fatal, or remain during the whole of life.
If the uterus be inverted, examination detects a fleshy tumour filling the vagina, whereas, if the womb be pro perly situated, the vagina is free, and the os uteri is felt open and empty. When the inversion is complete, the uterus is protruded altogether, and forms a fleshy mass, which projects externally. In either case, it must be immediately reduced by moderate pressure, and in general this is easily accomplished. When it has been neglected and becomes chronic, extirpation has in dif ferent instances been practised, on account of the inju rious effect produced by the repeated hemorrhages, mucous discharges, and continued irritation attendant on this state. Some of these have succeeded perfectly ; and in one the author saw the patient in perfect health many years after the operation.
It must next be observed, that in consequence of weakness and relaxation, or of rising and walking too soon, the womb, being yet heavy and large, may sink too much in the vagina, or may even conic to protrude externally. This, in the first degree, is called a bearing down of the womb, and where it proceeds so far as to appear outwardly a procidentia uteri ; but this ex treme degree fortunately seldom happens at first. The patient for a length of time complains of weakness, and pain in the back, a sense of dragging about the loins, weariness and aching about the thighs and lower part of the belly, and unpleasant sensations when she attempts to walk, particularly a bearing down ; and by and bye, when the womb descends lower, she cannot make water easily, and in the whole progress of the complaint the stomach and bowels are apt to be dis ordered, both in their functions and sensations. These affections of the bowels and stomach are very often prominent symptoms, leading of the attention of the patient from the true cause, which sometimes can only be discovered by the examination of a skilful prac titioner.