It has already been mentioned, that the pulse, from the first, is very frequent, and at that period it is fuller than in simp.er peritoneal inflammation, but it soon be comes feeble. The thirst is not always great, at least the patient is often careless about drink. The bowels are often at first bound ; but afterwards, especially about the third day, they usually become loose, and the stools are dark, foetid, and often frothy. This evacuation seems to give relief. The urine is dark-co loured, has a brown sediment, and is passed fre quently, and with pain. The lochial discharge con tinues for a time, but presently is diminished, has a bad smell. or is changed in appearance, or gradually ceases; and it is observable that the re-appearance of the lo 'cilia, if they had been suppressed, is not critical. The secretion of milk stops, and the patient inquires very seldom about the child. In bad cases, the swelling of the belly increases rapidly, but the pain does not al ways keep pace with the swelling, being sometimes least when the swelling is greatest, and in the end it generally goes entirely off. The breathing becomes laborious in proportion as the belly enlarges. The strength sinks, the pulse, always frequent, becomes weak and tremulous, the throat and mouth appear sloughy ; perhaps the stools are passed involuntarily, and the patient usually dies about the fifth day of the disease, but in some cases not until the fourteenth, in others, so early as the second day. In some instances death is preceded by low delirium, or stupor ; in others the mind continues unimpaired till within a few minutes of dissolution, and the patient is carried off after a fit of a convulsive kind.
Tnis fever attacks generally on the second, and some times the third day after delivery ; but it has also oc curred so late as alter a week. The earlier it attacks, the greater is the danger ; and few women recover who have the belly much swelled.
On dissection there is found in the abdomen a con siderable quantity of fluid, similar to that met with in peritonitis. The ornentum and peritoneum are inflam ed, but perhaps very slightly, and gangrene is unusual. The swelling is neither proportioned to the inflamma tion effusion, nor in every instance dependent on these, but on that inflation of the bowels which results from the relaxation of the muscular fibres of the bowels, which is so common in the puerperal state, particularly in puerperal disease. The uterus is not more affected than the intestines. In some cases the thoracic viscera are it fl ,tired. There is the most satisfactory evidence that this disease is infectious, and also that it is epidemic over a greater or less extent of country in particular years.
As it has been confounded by many with peritonitis, it is not to he wondered at if very opposite modes of tritatment should be proposed. This attempt to identify puerperal, or, as it has been called, low child-bed fever, with simp:e it,flammation, is practically of the most mis chievous and ought to be resisted by all attentive obsc rvers of disease.
Eat ly and copious venesection has been strongly ad vis,d, us the most effectual remedy ; and in a disease which proves so Ilttal under any treatment, the author has felt it to be his duty, even under many doubts, to in eke a full and Ltithful trial of the plan. The result
has compl,tely convinced him, that copious and repeat ed is a most useless and a most dangerous practice; and if he can prevent his younger brethren from being led away by the pl.nusible arguments olti, h have been adduced in favour of tire lancet, he shall hAve performed an important service to those who are att.-A.k ed with the disease. lie is not inclined to forbid Il together the detraction of blood, but he wishes to hitilt that practice to those cases where the symptoms of intl., in mation are the most decided, and particularly to those where the pain is fixed, us, for instance, in the side, or in the uterus ; the lancet, in such instances, should be early employed, but ought not to be repeated, and where the symptoms are not decided, it should be altogether omitted. None have recovered who have been largely and repeated)) bled, although the blow 1 was such as is met with in inflammation, and all the recoveries he has met with, have been amongst those who either were not bled at all, or only once, and sparingly,* Laxatives, bark, and light nourishment, to support the strength, arc the most useful internal remedies. In the more advanced stages, wine, to act as a cordial, and opiates, to allay irritation, will be useful. Blisters have been advised, but they are more injurious than bene ficial. The application of turpentine is certainly of advantage, and in general gives more relief than lomen tations.
If the patient recover, the bowels remain long in an irritable state, and require much attention.
Of Chronic Swelling of the Abdomen.
It is not unusual, if the patient be exposed to Cold after delivery, or have any puerperal disease 9f an in flammatory nature, for the belly to become swollen and prominent, with some degree of tension. This tume faction arises from inflation of the bowels, and is de pendent on some disease of the uterine appendages, generally of one or both of the ovaria. The connection between the intestines and the uterus and ovaria is well seen, both in the early weeks of gestation, and at the menstrual period, many females about that time having the bowels much distended with air ; and this very dis ease under consideration, may be produced by exposure to cold during menstruation.
It is a complaint of some importance, not only on account of appearance, but also as it indicates the exis tence of a local disease, or change of structure, which, at some future period, may prove formidable. It is sometimes succeeded by ascites, but much more fre quently by that disease improperly called dropsy of the ovariutn. In some however, it seems to be entirely dependent on the state of the bowels, at least no other disease manifests itself in future life. When it is not symptomatic of organic affection of the uterine system, it may be sometimes removed by strict attention to the action of the bowels, which is kept up by aperient medicines, administered so as to invigorate, and not weaken the muscular fibres of the intestines. These medicines must be varied according to their ef fect, and may be combined with tonics, and uniform but moderate compression of the abdomen, or long continued frLtinn every morning old evening.