Puerperal fever is a contagious disease. The danger of it being carried from one suffering from it to another patient in the process of confinement is enormous. No conscientious medical man will go from a case of puerperal fever to attend another confinement case with out previously taking the greatest precautions against carrying the disease with him.
The disease, it will thus be understood, does not assume necessarily the same form in each case. In one apparently the poison is absorbed in a very fine form, and multiplying in the blood produces violent fever, diarrhoea, deli rium, &c. In others it is absorbed, as it would seem, by the mouths of the open veins of the womb, in the form of larger particles, which, being carried with the blood current through the body, are arrested in various places, and form small abscesses. In such cases little abscesses may be visible on the skin, on the fingers, &c. In other cases the disease is in the form of an acute inflammation within the belly, as peri tonitis (see p. 265), or as inflammation of the womb itself. Inflammation of the lungs and other organs may speedily arise in the course of the disease, due, doubtless, to the convey ance to these organs of some of the poisonous material.
of the various forms cannot be described, but we may state in some detail the characters of the fever in general. It begins usually within three or four days after delivery, perhaps with a shivering fit (rigor), headache, and depression. The fever soon runs up to a considerable height, 103° or more by the ther mometer (see p. 38). The pulse is rapid and feeble, the skin dry as well as hot; sometimes there is much sweating, and the sweat has a peculiar odour. The discharge from the geni tals may cease ; sometimes it does not, and the discharge is foul - smelling. The formation of milk is usually arrested. The bowels are loose, and the motion very offensive. The tongue be comes brown and dry, and little brown masses (sordea) form on the lips. Vomiting is frequent, tile vomit being offensive. There is usually some amount of pain in the belly, which may become much swollen, adding to the distress. If muttering delirium sets in, and the patient's hands wander about picking at the bed-clothes, the case is as grave as can be. A very hurried feeble pulse, and rapid panting breathing, indi cate sinking from exhaustion.
In other uses, at the very beginning of the fever, the patient complains of acute pain in one spot, usually low down in the belly, and the pain is apt rapidly to extend over the whole belly, which becomes much swollen, and is so painful that the mere weight of the clothes is distressing. To obtain some relief the patient
lies on her back, with her knees drawn up. In such a case, instead of the bowels being loose, they are usually obstinately costive. Later on severe looseness of bowels sets in.
Treatment is too often utterly iu vain. But if everyone were scrupulously careful cases of this disease ought to become exceedingly rare.
Moreover, the variety of the disease is so great that no one method of treatment is suited for each case. While stating this very strongly, we may even in such a very serious disease go on the same principle that pervades this book, and indicate general lines of treatment that may be adopted by any unfortunate enough to have no medical aid within reach. It is best to begin by clearing out the bowels with a large injection of tepid water, 3 or 4 pints. Nourishing food and stimulants must be freely given. Milk, eggs, nourishing soups, such as mutton soup, beef-tea, bough soup, &c., should be given in small quantities often, unless very loose bowels prevent much use of soups. Their loosening effect on the bowels may be to some extent checked by thickening them somewhat with corn-flour. &c. Whisky or brandy should be given in small quantities with milk to the extent of 3 or 4 ounces (one to two wine glassfuls) per day, if it seems to agree. Port wine is also useful, and champagne. The fever is somewhat held iu check by large doses of quinine, 10 to 15 grains every fourth or sixth hour; and to this may be added 10 grains of Dover's powder, if it seems to agree with the patient. If there is pain in the belly, a thick pad of flannel should be lightly wrung out of hot water, sprinkled with turpentine, and laid over the belly. This is kept on and repeated till the whole surface is red. If discharges from the genitals are fcetid, injections must be used with an enema syringe, fitted with a long delivery - tube. Water, rendered pink with Condy's fluid, is employed to the extent of 2 or 3 pints, or carbolic acid solution of a strength of 1 ounce of the acid to 2 pints of water. This injection may be repeated twice daily. Great care must be taken that the in jected fluid escapes freely. The patient's room must be freely but carefully ventilated.