Of Uterine Inflammation, Inflammation of the womb usually begins between the second and fifth day after delivery, but it may take place at a later period. It is pointed out by a pain in the lower part of the belly, which gradually increases in violence, and continues without intermission, though it is subject to occasional aggravations. The uterine re gion is very painful when it is pressed, and it is a little swelled. There is, however, no general swelling of the abdomen with tension, unless the peritoneum have be come affected. But the parietcs are rather slack, and we can feel the uterus distinctly through them to be harder than usual, and it is very sensible. There is also pain felt in the back, which shoots to the groins ; and there is usually a difficulty of voiding the urine, or a complete suppression, or distressing degree of stran gury. The situation of the pain will vary according to the part of the uterus first and principally affected. The internal parts become also frequently of a deep red co lour, and the vagina and uterus have their temperature increased. The lochial discharge is very early suppres sed, and the seretion of milk diminished or destroyed. Nearly about the same time that the local symptoms ap pear, or perhaps a little earlier, the system becomes af fected. The pulse very early becomes frequent, and somewhat hard. The patient is chilly, or has a shiver ing fit succeeded by increased temperature of the skin, and it is not unusual for her to be sick, or to vomit bilious fluid. The tongue is white and dry, and the urine high coloured and turbid. The vomiting in some cases con tinues, and the bowels are at first bound, but afterwards the stools are passed more frequently. If the perito neum come to partake extensively of the disease, then we have early swelling and tenderness of the abdomen, and the danger is greatly increased.
This disease calls for the early and free use of the lancet, which is the principal remedy ; and the number of times that we repeat the evacuation, must depend upon the constitution of the patient, the effects produ ced, and the period of the disease. If three or four days have passed over, the pulse may be full and frequent ; but this is an indication that suppuration is going on, which will be ascertained by throbbing pain, Sic. In this case the lancet is hurtful. Mild laxatives are also highly proper. Fomentations are very useful, and ex ternal irritations are likewise of benefit after the acute stage has been subdued by the lancet. The application of oil of turpentine is perhaps as useful as any other that can be made. Diaphoretics ought to be administered, such as the saline julep, with the addition of anti monial wine and laudanum. This is the best internal remedy we can employ. Emollient clysters, or some times anodyne clysters, give relief. In the suppurative stage we must keep the bowels regular, give light nourishment, apply fomentations, and allay pain with anodynes. When the matter is discharged, a removal to the country will be useful, and tonic medicines should be given.
Of Peritoneal Inflammation.
The peritoneal lining of the abdomen, or the cover ing of the intestines, may be inflamed alone ; or this disease may be combined with inflammation of the uterus.
Peritoneal inflammation may be caused by violence during delivery, or the application of cold, or the inju dicious use of stimulants. It may not come on for three weeks after delivery, but it usually commences on the second day, and earlier than inflammation of the womb ; and it may often be observed, that the pulse continues frequent from the time of delivery. It is preceded or attended by a shivering and sickness, or vomiting, and it is marked by pain in the belly, which sometimes is very universal, though, in other cases, it is at first confined to one spot. The abdomen very soon becomes swelled and tense, and this state rapidly increases. The pulse is fre quent, small, and sharp, the skin hot, the tongue either clean, or white and dry ; the patient thirsty, she vomits frequently, the milk is not secreted, and lochia are fre quently obstructed. These symptoms often come on very acutely, but it ought to be deeply impressed on the mind of the reader, that they may also approach insi diously. Wandering pain is felt in the belly, neither acute nor altogether constant. It passes for after-pains, but it is attended with frequency of pulse, and some ful ness of the belly, and a little sickness. But whether the early symptoms come on rapidly or slowly, they soon in crease, the belly becomes as large as before delivery, and is often so tender, that the weight of the bed-clothes can scarcely be endured ; the patient also feels much pain when she turns. The respiration becomes very difficult, and sometimes a cough comes on, which ag gravates the distress, or it exists from the first, attended with pain in the side as a prominent symptom. Some times the patient has constant belching, and brings up mouthfuls of fluid, which always gives pain. The bowels are either costive, or she purges bilious or dark-colour ed faces. These symptoms are more or less acute, ac cording to the extent to which the peritoneum is affect ed. They are at first milder and more protracted in those cases where the inflammation begins in the uterus ; and in such the pain is often not very great nor very ex tensive for some time. If the disease is to prove fatal, the swelling and tension of the belly increase, so that the abdomen becomes round and prominent, the vomiting continues, the pulse becomes excessively frequent and irregular, the fauces are apthous, death is marked in the countenance, the extremities cold, and the pain usually ceases rather suddenly. The patient has unrefreshing slumber, and sometimes delirium mite, but she may also remain sensible to the last. The disease usually proves fatal within five days, but may be protracted for eight or ten days, or even longer.