A form of disease sometimes occurs after delivery which, from its resemblance in some particulars to the one we have just alluded to requires notice. is due to etomachal and intestinal irritation ; and is ushered in by rigors, followed by great heat of skin, a full and frequent pulse, and loaded tongue. The abdomen may be tumid and painful on pressure, and the head may be affected by symptoms of phrenitis, as intolerance of light, noise, wakefulness, and delirium. The affection of the head and that of the abdomen frequently co-exist or alternate in the same case ; and this conjunction of the two affec tions serves to assist in the diagnosis between peritonitis and the present complaint. As it is of the greatest importance in a therapeutic point of view to distinguish puerperal inflammation from intestinal irritation, much may be learnt by the exhibition of large injections of warm water, an examination of the evacuations, and an observation of the effects thus produced upon the disease. In intestinal disorders, the faeces will be found to be scybalous, or at least offensive and dark-coloured, and in large quantities ; and the relief obtained will be found to depend upon the proper evacuation of the bowels. Another characteristic of intestinal irritation is the susceptibility to fainting upon blood-letting. The treatment of this disorder may be summed up in the words of Dr. Marshall Hall. "In peritonitis," he observes, "the freest blood letting must be aided by purgative medicines ; whilst in intestinal irritation, the freest and fullest evacuation of the intestines must be aided by blood-letting ; for although both blood-letting and purging are to be used in every case, yet the former the remedy in in flammation, and the latter in intestinal irritation." In describing the last-mentioned disease, we have alluded to the combination of cerebral symptoms, which so frequently are present. This disturbance of the intellectual functions is sometimes so great and so continued, as to lead to the supposition that the brain is the seat of some active inflamma tory disease; and were we, acting upon this supposition, to have recourse to antiphlogistie remedies only, we should probably lose our patient. This alarming disorder has been termed puerperal insanity, or puerperal mania. It comes on rather insidiously : there is a little excitement during the day and sleeplessness at night ; then delirium, and then actual mania; the pulse is somewhat accelerated, the tongue furred, the skin hot, the bowels costive, and the secretion of milk diminished. It seems to arise from a combination of causes acting upon an originally irritable temperament, but rendered still more so by intestinal disorder and haemorrhage, or by the debility consequent upon suckling. Blood-letting in these cases is generally fatal; the treat ment consists in regulating the bowels and preserving extreme quiet of mind and body, with a nutritious but not stimulating diet.
When speaking of puerperal fever,it was observed that the large veins in the vicinity of the uterus frequently presented traces of inflammation. Uterine and crural phlebitis, however, occurs as a distinct disease, and has been described under the terms of phlegmasia dolma, cede= puerperarum, the white swelling of lying-in women, &e.; but it is only within a few years that the true nature of this disease has been fully understood, having been first pointed out to the pro fession by Dr. Robert Lee. It may appear as early as the fourth day after delivery; but, in the majority of cases, it is not till the second or third week that it makes its appearance; and, in many instances, attacks women who are recovering from puerperal fever. It is ushered in with rigors, and these are succeeded by heat, thirst, and other symptoms of pyrexia. There is a acme of pain, first experienced in the uterine region, and gradually descending in the course of the iliac and crural veins down one leg, accompanied by swelling, and great tenderness upon pressure along the course of the vessels, which are hard as a cord, and roll under the fingers. In some eases an
crythematous redness of the integuments of the limb is met with; but in the majority they are smooth, shining, tense, and colourless. The power of moving the limb is completely lost, and it is greatly and uniformly swollen throughout its whole extent. Sometimes, after the inflammation has subsided in one limb, the other is attacked in a similar way. The pain and febrile symptoms usually diminish within a few days after the occurrence of the swelling ; but sometimes the pain is excruciating throughout the whole period of the acute stage of the disease. The duration of the acute stage is various in different individuals; in the greater number of cases it terminates in two or three weeks ; but the limb still remains powerless and oedematous. In some women the limb does not return to its natural state for many months, or years, or even during life. The appearances ou dissection which are met with in this disease are similar to those which charac terise inflammation of the veins generally. The causes of this affection are supposed to be owing to the orifices of the veins in the lining membrane of the uterus being left open after the separation of the placenta, by which a direct communication is established between the cavities of these veins and the atmospheric air. The treatment of phlegmasia dolma consists in the local abstraction of blood by leeches applied to the groin, and in the course of the large venous trunks of the limb ; hot fomentation to the part, and the administration of diaphoreties and saline purgatives. After the inflammatory symptoms have subsided, the limb may be supported by a bandage; aud slight friction made use of.
There is a disorder occasionally met with In the puerperal state, which, from not being mentioned in the article lituoaunnot, mist be alluded to hi this place. The symptoms about to be detailed are owing to less of blood, uterine Inemorrhrgo during and shortly after parturition being not an unfreuent occurrence. The more immediate effects of Hemorrhage are fainting; and where the loss of blood has been great, this symptom is sometimes so prolonged as to be not only dangerous, but fatal. It is the more remote consequences of loss of blood that we are to speak of in this place : we have seen already how a combination of this with intestinal disorder and other irritating causes gives rise to puerperal mania ; we shall now view the effects of kTmorrhage as they are met with uncombined with the conditions previously alluded to. This condition of system has been called by the French pathologists a etato of anima, and Is characterised by a pallid condition of the skin ; great nervous excitability; a throbbing of the temples ; vertigo ; tinnitus aurium; a frequent, jerking, com pressible pulse; a great tendency to faint on the slightest exertion, or in the upright position ; palpitation of the heart ; halitant respiration ; and, generally, great thirst. The treatment to be adopted in anemia from Ions of blood, consists in maintaining a perfect quiet of mind and body, in a free exposure of the patient to fresh air, a mild but nutri tive diet, and a regular but not an over-active state of the bowels. Tho symptoms we have just enumerated as arising from loss of blood aro sometimes met with, in a mitigated form, at a much later period of the puerperal state, and arise from the drain occasioned by super. lactation. The treatment of these cases is more simple, and consists generally in the weaning of the child, the adoption of a more nutritive diet, and change of air. With respect to what are called milk abscesses, they arise from the inflammation consequent on over-dis tention of the Lactiferous tubes, and require the same mode of treatment an is adopted in abscess when it occurs in other parts than the breast. [Anscess.] They are beet prevented by permitting the infant to suck within a few hours after delivery, and by repeating this act frequently. When the secretion of milk is excessive, the bowels should be kept freely open by saline purgatives.