When the cold fit comes on, our object is to hasten the hot one, which is done, not by putting many bed clothes on the patient, for these are hurtful, but by giving frequently a small quantity of some warm drink, such as gruel or lemonade, and applying a bottle, filled with warm water, to the feet and pit of the stomach, or to the back, if it feel cold. When the hot fit is established, these applications are to be removed, and the tepid drinks continued till the sweat comes out. Means are not to be employed for pushing this far, but by taking a very little drink, and lying quiet for some hours, it is to be en couraged to continue in a moderate degree, till all the uneasy feelings and feverish symptoms are removed. Then warm dry linen is to be put on, and cold avoided with care. It requires much prudence to say when the perspiration ought to be checked, but it is a good gene ral.rule, to continue it till the fever is removed. After the sweating is over, a little panado with wine is proper. A repetition of the fever is to be prevented, by avoiding those causes which first brought it on, keeping the bowels open, taking some strengthening medicines, such as bark, and procuring rest by opiates. When there is a tendency to return, and no local disease can be detected, the fit is sometimes checked by taking twenty-five drops of laudanum an hour before the ex pected time of attack, and applying warm flannel to the hack. During the intervals, infusion of bark, or the cautious use of arsenic, will be useful.
If palpitation occur frequently, either along with this fever or without it, the best remedy is a large dose of laudanum, in a glass of peppermint water, and during the interval, the volatile tincture of valerian, with laxa tives, or the camphorated mixture, will be proper.
If the attacks of fever be repeated, or if it become con tinued, it will be necessary to give up nursing ; and indeed in many cases the secretion of milk becomes so much di minished as to render it impossible for the child to be nourished by the parent. When local pain, or symp toms indicating the existence of inflammatory action in any organ appear, no cure can be expected till that or gan be relieved.
Of Milk Fever.
The secretion of the milk is often accompanied with a considerable degree of fever, called the milk fever. This is partly owing to that disturbance which is always to a certain degree excited in the system, whenever a new process is established, and partly owing to the swel ling or irritation of the breasts themselves. In this view, it may, though of short duration, be compared to the teething fever of infants. This fever commences about the second or third day after delivery, and consists of a cold, a hot, and a sweating stage, during each of which, the symptoms are so much the same with those describ ed under the name of weed, or ephemeral fever, that it is needless to repeat them. It must not, however, be supposed, that the fever takes place in every instance, more than that every child has a teething fever : and even in those cases where the fever is considerable, there is very little danger. There can be no difficulty in dis tinguishing this disease, for the breasts are full, hard, and painful, circumstances which at once point out the nature of the complaint. By way of preventing this fever, it has been recommended, that the child be applied to the breast as soon after delivery as the strength of the pa tient will permit, and this is extremely proper if the trial be made in such a way as not to fatigue her. It is also useful to procure a stool early, and it is even proper, where the patient is stout, of a full habit, and does not purpose to nurse, to give laxatives more freely, in order to diminish the quantity of milk, and prevent swelling and irritation of the breasts.
When milk fever does take place, the treatment is very simple, consisting in giving warm drink, such as gruel, or lemonade, in small quantity during the cold stage, and applying warm flannel to the feet and sto mach. In the hot stage, the curtains are to be thrown open, the coverlet taken off, and tepid drink, with gentle diaphoretics, given to excite perspiration. In the sweat
ing stage, the perspiration, which is generally sour smelled, is to be gently encouraged, till it be universal, and the patient feel relieved, then it is to be lessened, and the management is the same as in weed. These means are to be employed to an extent, and with a de gree of attention, proportioned entirely to the severity of the symptoms.
Of Inflammation of the Breasts.
When, in consequence of exposure to cold, or of tha pain and tension, occasioned by the retention of the milk, in those who do not, or cannot suckle, inflammation of the breast is excited, there is great reason to apprehend that suppuration will take place. This disease is easily known by the pain, hardness, and swelling which ac company it. In some cases, the whole breast seems to be affected, in others, only one half, and in many the af fection is more circumscribed, or small and superficial. This complaint is generally accompanied by fever, and that is sometimes smart, when the mammary affection is so obscure as to escape observation for several hours, or even for a day or two. When the breast inflames, it is evident that the retention of the milk must, for a time at least, increase the pain. The first and earliest object, therefore, must be to have the breast gently drawn, either by the child or by other means, provided these at tempts do not give pain, for if they do so, and the milk do not come readily, more hurt than good will be done. The breast should be gently fomented with a sponge dipped in tepid water, and then covered with a poultice of bread and milk, so as to continue the soothing effects of the fomentation. The patient should keep in bed, and have the breast properly supported. Spare dry diet and laxatives are proper. If the pain and hardness do not very soon go off, but, on the contrary, the former becomes more severe and throbbing, suppuration must take place, and it is to be encouraged by bread and milk poultices, applied hotter than formerly. If the abscess be small and superficial, the spot soon becomes red, and at last breaks, occasioning, comparatively speaking, little dis tress, and scarcely giving any interruption to nursing. But if it be deeper, or more extensive, and the glandu lar part of the breast by affected, all the symptoms arc more severe, the progress is tedious, and the strength is apt to be reduced by fever, perspiration, and want of appetite. In these cases, if the abscess do not point and break soon, no good can be gained by delay, an opening should be made so as to evacuate the matter freely. This not only gives immediate relief, but prevents a farther extension of the mischief, and the foundation of future disease. In every instance, a free opening should he procured for the pus, and if sinuses form, these must be opened completely and at once. In unhealthy inflam mation of the breast, different glands may successively be affected in both breasts, and slow abscesses form, which produce troublesome sinuses when they burst. In all such cases, it is necessary daily to examine the breast, for the constitution is apt to be undermined by repeated attacks of shivering and fits of fever. The stomach is impaired, anorexia and reaching take place, and a fatal cachectic state is produced. These shiver ings are removed by opening the abscess, or evacuating the confined matter, and the general health is restored, by laying open any sinuses which may form. Light nourishment, with a liberal proportion of wine, varied tonics, and the use of opiates and laxatives, according to circumstances, are proper. Indurations or local affec tions from torpidity are benefited by a gentle course of mercury. When the patient can take nourishment, there is seldom any great danger ; but if she have a per petual and intractable loathing at food, with diarrhoea, and especially if she be of a strumous habit, there is much ground to fear ultimately a fatal issue. In some instances the mesentetic glands, in others the uterus it self, are affected in the course of the disease, which may be protracted for some months.