This is a complaint which generally proceeds from relaxation, or from some exertion before the womb has returned to its usual size, or from its remaining for a length of time larger than usual. This naturally sug gests a caution against rising too soon, or making any early exertion ; and it is peculiarly incumbent on those who are delicate in constitution, or enfeebled by pre vious disease, to be on their guard in this respect. Although, doubtless, rash management on the part of the midwife may occasion this complaint, yet it is much oftener the fault of the patient herself. It must also be impressed on the mind, that it may succeed a miscarriage, or may even occur in unmarried women, from excessive discharge, fluor albus, or violent exer tion, when out of order. Rest in a recumbent posture is of the greatest service in the early stage. The bowels arc to be kept in a very regular state, by daily doses of Cheltenham salt, or sal polychrest, or any other mild laxative, in order to lessen the quantity of circulating fluid ; and for the same purpose liquids ought to be avoided, that the uterus may speedily diminish in size and weight. The diet should be such as tends to in crease the strength, and for the same purpose, in a month after delivery, the cold bath may be employed, if no particular symptom forbid it. The application of a proper bandage round the whole belly, with a mode rate degree of firmness, often gives great relief to the uneasy feelings ; and the early use of a compress over the uterine region, so as to excite to absorption, may be useful. Astringent injections tend to contract the va gina, and are sometimes of benefit. if these means fail, then we most employ a pessary. This is a com plaint which is apt to be increased during the first three months of subsequent pregnancy, but after the third month it disappears.
There is another affection which may be confounded with this, nam,ly, a relaxation and protrusion of the vagina itself. This forms a soft swelling or promi nence at the orifice of the vagina, which sometiffics completely encircles the opening, but oftener is more on the one side than on the other, or is greatest be hind. It gives no particular inconvenience, unless it exist in a great degree, and it usually disappears on going to bed. It requires the use of astringent decoc tions, or alum water, externally, or employed as injec tions, and the frequent application of cold water, by means of a sponge. Internal astringents, such as tinc ture of kino, have been thought useful. If the patient be weak, strengthening remedies are proper, such as bark, steel, the cold bath, Cc. In this, as well as in the former complaint, it is of great service to support the perineum permanently ; the best mode of cluing which, is by an elastic steel truss similar to that used for prolapsus ani.
Of Irregularities of the Lochial Discharge.
An increased, and sometimes a continued discharge, after delivery, is often the consequence of getting up too soon, or making sonic early exertion It is usually attended with pain in the back, and always produces weakness. It is to be removed by avoiding exertion,
taking some strengthening medicine, such as bark and wine, and using, if it continue, the shower-bath. The aching pain in the back is often removed by the appli tion of an adhesive or warm plaster.
The Iochial discharge is in some women very trif ling, and may even stop very soon NVith011t any had effect. But when it is suddenly checked by exposure to cold, or other cauties, most painful consequences may follow, such as swelling of the belly, great pain, sickness, and fever. These symptoms are dangerous at all times, but arc still more to be dreaded, as they often attend inflammation, and indeed the two cases can only be distinguished by minute attention. A purgative clyster should be instantly administered, a cloth, soaked in oil of turpentine, or hut lomentations applied to the belly, and a perspiration encouraged by a saline julep, containing anutnomal witle, together with tepid drinks. An anodyne clyster is also useful, and if the pain continue, the lancet must be used. In this disease, the suppression of the discharge is an effect rather than a cause, and indeed does not uniturmly take place, for the symptoms arise from spasm of the ute rine fibres. This differs front inflammation in coming on most suddenly ; the pain from the first is severe, but it remits, or sometimes for a few seconds goes entirely off. But it must not be supposed that this state can continue long without exciting inflammation.
Ill-smelled discharge proceeds from clots of blood lodging about the womb, and requires strict attention to cleanliness ; it may even be necessary to wash the discharge from the passage, by means of a syringe. If, however, this discharge be attended with sickness or nausea, quick pulse, hot skin, parched hands and feet, thirst and want of appi tire, or repeated discharges of blood, and pain in the lower part of the belly and back, then there is reason to conclude that part of the after-birth remains in the womb, and great attention is necessary to preserve the patient. This affection often passes at first for a weed.
The patient is worn out by nocturnal perspiration, fever, and want of nourishment, until at length a putrid mass is discharged from the womb, perhaps about the ninth or tenth day, or even after some weeks of suffer ing, and then the patient generally recovers.
The bowels are to be regulated, either by laxatives or opiate injections, according to their state. The diet must be light, such as chicken broth, beef tea, feet jelly, at row root, Ste. The elixir of vitriol is use ful for promoting appetite and checking perspiration. Camphorated mixture is of service for allaying nervous affections. Great attention must be paid to cleanliness and ventilation. Astringent injections have been em ployed, and sometimes with advantage.