The practice in this disease is very limited, but very important. It consists in an instant recourse to the lancet, which is to be used at first with freedom, but in more advanced stages with circumspection. If it is to prove useful, it will do so soon ; and a frequent repe tition toward the latter end can only hasten death. Whilst, therefore, the writer places his chief reliance on this remedy, he cautions against its abuse.
Fomentations are soothing and useful, and all the pained part of the abdomen ought to be covered with a cloth wet with oil of turpentine.
The bowels are to be opened by laxative medicine, and stimulants of any kind are to be avoided. Fruits and grateful drinks are to be prescribed.
Of Puerperal Fever.
Puerperal fever begins sometimes in an insidious manner, without that shivering which usually gives in timation of the approach of a serious malady. In other cases, the shivering is perceived, and varies considera bly in degree, being either slight or pretty severe. The first symptoms, independent of the shivering, are frequency of pulse, oppression, nausea, or vomiting, pain in the head, particularly above the eyebrows. The night is passed with little sleep, much confusion, and occasionally some delirium ; but this is not common in the commencement.
It must not, however, be forgotten, that in many in stances there is no headach in any stage of the disease, nor any sickness nor vomiting in the beginning. In some, the temper from the first is uncommonly iritable, in others there is much timidity, or listlessness, o: apathy. Hysterical symptoms not unfrequently super vene.
From the beginning, or very soon afterwards, pain is felt in the belly ; at first slight, but it soon increases, and in some instances the abdomen becomes so tender, that even the weight of the bed clothes is productive of distress. A general fulness, without tension of the belly, accompanies this from the first, and it usually in creases pretty rapidly, and may proceed so far as to make the patient nearly as large as she was before delivery. In such cases the abdomen becomes tense, and the breathing is much oppressed ; indeed, in every instance, the res piration is more or less affected ; the free action of the abdominal muscles, which are concerned in that func tion, being productive of pain. The degree of pain, its seat, and period of accession, vary in different cases. In some it evidently begins in the uterus, and, coming in paroxysms, resembles severe after-pains, but never goes entirely off, and is accompanied with bearing-down.
The uterine region is painful, particularly toward one side. The os uteri, if examined, is not much more sen sible than usual. There is generally pain in the back. In other cases the pain is first felt about the lower part of the ribs on one side, and is accompanied with cough. The belly is tumid, and tender when pressed, but ex cept then, or in turning, the patient complains little of it. Sometimes severe pain, like spasm, attacks the iliac re gion, and extends down to the thigh, and toward the pubis and bladder.
The face is sometimes flushed at first, or a patch of deep red appears on the cheeks, but the countenance in general is altogether pale, or at least not suffused, the eyes are without animation, and the lips and angles of the eyes are white. The whole features indicate anxie ty and great debility. When vomiting occurs at the very commencement, it is generally bilious. In the course of the disease, it becomes so frequent that no thing will stay in the stomach ; and, towards the con clusion of the fever, the fluid thrown up is dark-co loured like coffee, and frequently foetid. This is a symptom which always, if it do not proceed from a morbid structure, indicates, in whatever disease it oc curs, an entire loss of tone of that organ, and in this fever is a fatal symptom. But, to proceed with the history. There is, in many instances, great dejection of mind, and always langour, with general debility of the muscular fibres, and the patient lies chiefly on her back, or there is so much listlessness, that she some times makes little complaint. The skin is not very hot, but is rather clammy and relaxed. There are cases, however, where the patient complains of universal and oppressive heat, until toward the end, when the extre mities become cold. In other instances the temperature varies, the patient being alternately hotter and cooler. The tongue is pale or white at first, but presently be comes brown, and uniformly aptha appear in the throat, and extend down the oesophagus, and over all the inside of the mouth. From the irritability of the stomach and bowels, it is highly probable that these or gans participate in the tender state, and the upper part of the larynx seems to be affected from the cough which is excited.