PUERPERAL DISEASES. Under this term are included all those diseases which arise out of the state of pregnancy : they are not, however, as the name would seem to imply, peculiar to this condition, but incidental only ; and they are so far modified by it as to require some allusion to their character and mode of treatment. Among the meat alarming of these diseases, and the earliest to make their appear anee, arc puerperal convulsions ; they consist of epileptic seizures, and their character differs in no respect from the ordinary epileptic fits already described in the article EPILEPSY : we therefore shall merely observe in the present place, that convulsions are liable to occur at any time after the sixth month of utero-gestation ; but for the 'reasons about to be stated, the majority of cases are met with during labour. When they occur after delivery, they are generally connected with a loaded state of the large intestine, or with a state of exhaustion from haemorrhage. The cause of these attacks must be looked for in the state of the viscera and large blood-vessels at this period : during gestation, these parts are subjected to a constant and increasing degree of pressure from the gravid uterus, the natural tendency of which is to produce local congestion of the circulating fluid, and an undue accumulation of the excretions within the intestines. At the time of parturition this pressure is materially augmented by the con tractile efforts; which are made to expel the infant ; and the mechanical obstacle thus offered to the flow of blood through the abdominal aorta, determines it in unnatural quantity to the brain. Hence this state of things, if not remedied, may not only produce the disease we have just been considering, but may even give rise to apoplexy. The treatment is obvious, and consists in relieving the vascular system by general and topical bleeding, and unloading the intestines by brisk cathartics.
A recent writer attributes puerperal convulsions to the presence of urea in the blood.
But by far the most important and the most dangerous of puerperal diseases is puerperal peritonitis called also puerperal inflammation, puerperal fever. It usually attacks women a few days
after delivery, and seems to have no connection with the duration or the severity of labour. This fatal disease varies so much in the type of the Inflammation as to be scarcely recognised as the same affection in different individuals and at different periods, the accompanying fever being sometimes strictly inflammatory, and at other times typhoid. In Its most dangerous form it is characterised by a remarkable pros tration of the vital powers, and by a countenance expressive of extreme aoxlety and distress. The pulse is frequent and feeble ; the abdomen tyinlanitic, and unable to bear the slightest pressure ; the bowels are constipated, aud vomiting is not an unfrequent attendant. As the disease proceeds, the lochial discharge and the secretion of milk are suppressed ; and towards its termination, a total cessation of pain isometiinee occurs, and the patient dies, often in full possession of her consciousness to the last. This severe form of puerperal fever Is moat frequently epidemic, and many believe it to be highly contagious. The legions met with in this disease are chiefly manifest in the peritoneum ; hut In the worst cases, the substance of the uterus Itself, and the large veins in its vicinity, present evidences of inflammation. The treatment of puerperal fever is peculiarly difficult ; "every case," observes one of our most celebrated aceoucheurs," must be isolated and studied alone, and looked at by itself, and its management must depend upon Its type and its stage." Bleeding, general and topical; counter-irritation, by means of blisters or spirits of turpentine, applied to the abdomen ; purging, by the exhibition of the last-named medicine, or by largo doses of calomel ; and the latter, given to excite ptyalism, have been the principal remedies used for combating this formidable malady. But the prostration of the vital powers is in some eases so extreme as to afford us little chance of putting into requisition the only means which we possess of combating the inflammatory symptoms.