ERRORS on this point have arisen from parturition leaving been regarded as a diseases, rather tan a physiological condition. Labour is a process of health, and under ordinary favourable circumstances there is no fever or febrile reaction, or any danger of inflammation; why then should a lady be restricted to gruel or low diet for a week? Indeed, under a low diet inflammatory symptoms are liable to be called into existence and bad matters are more readily absorbed by the uterine vessels. A good diet is the best prophylactic against inflammation. The diet we invariably give is nourishing, digestible, solid food from the very commencement; and we never seen any untoward results. On the contrary, many ladies formerly under the care of doctors who have only a slop diet, have expressed to us their thankfulness for the earlier and more complete restoration to their former condition, and their exemption from debility and other evils inseparable from a low diet. When a patient is delivered in the night or early morning, and there are no favourable symptoms, we allow a mutton chop for dinner on the first day; for other meals, well- made oatmeal-porridge, cocoa or tea, cold-buttered-toast, or bread-and-butter, a breakfast-cupful of arrowroot or gruel, light farinaceous puddings, etc. A too exclusive use of gruel and other slops is apt to distend the stomach, produce Constipation, and retard the necessary changes in the womb.
This is one of the most frequent, and at the same time the most serious of the accidents which complicate the expulsion of the afterbirth. The haemorrhage generally comes on with a rush a few minutes after the child is born, and before the placenta is expelled; occasionally it does not come on for several hours, or in rare cases even for several days.
SYMPTOMS. The blood usually appears externally, which the accoucheur or nurse instantly recognises, and is sometimes so sudden and abundant as to place the patient in great danger; at other times the discharge is confined to the cavity of the womb, when it may escape detection, or be only recognised when it is difficult or impossible to remedy it. Pallor of the face small pulse, dimness of vision, noise in the head, and fainting, are symptoms which accompany dangerous haemorrhage, weather the discharge be internal or external.
MEDICINAL TREATMENT. Caulophyllum, Croc., Hamamelis, Ipecac., Sabin., Secale The indications for these remedies will be found under “Profuse Menstruation,” pp. 43-46.
ACCESSORY MEANS. Immediately the haemorrhage occurs, one hand, previously dipped in cold water, should be placed on the abdomen, to grasp the uterus, to stimulate it to contract; if the same time napkins saturated with cold water (or else hot water See next page) should be suddenly dashed of the external parts. An enema of ice-cold water will often be effectual. Small lumps of ice. when they are obtainable, may be introduced into the vagina, and carried event to the uterus, or pushed up the rectum, to arrest haemorrhage; at the same time, small pieces of ice, in considerable quantities, should be frequently swallowed. The internal and external employment of ice in this manner will rarely fail to effect early and vigorous contraction of the womb. The patient should remain quite still, the hips being a little elevated, and the pillow removed from her head. On the other hand, and application of heat to the spine by means of Chapman’s spinal bags is very efficacious. (See p. 10.) Hot-water injections have also been recommended, as exerting a far more energetic action in the contraction of the arterioles, and thus contracting the uterus. The water employed has been at the temperature of 120 degree. The application of the child to the breast is also useful, as it tends to excite uterine contraction. The patient should be lightly covered, the room kept cool, and a free circulation of air promoted. If the discharge has been alarming, and the patient appears on the point of death, she should have brandy, but slightly diluted with water, in small quantities, at frequent intervals. In this form it is the best stimulus to the heart, and less likely to excite sickness. Beef- tea, or Liebig’s extractum carnis, should be given in small quantities, but frequently.
After flooding the patient is generally inclined to sleep. This tendency should not be interrupted, as sleep wonderfully recruits the exhausted powers. The patient must not, however, be left alone, and frequent examinations should be made by the attendant. In the majority of cases, profuse haemorrhages may be prevented by skilful medical treatment.
PREVENTIVE MEANS. After delivery the patient should remain in silence, and enjoy the most absolute repose of mind and body for least half an hour or an hour. A clean and well-aired napkin should be applied to the vagina as soon after delivery as possible, and the nurse strictly enjoined to examine it, at least every few minutes at first. In this way any excessive discharge will be easily detected. As before remarked, after the lapse of one or two hours the danger of haemorrhage is much reduced.
60. AFTER PAINS
Except after a first labour, women generally suffer from after- pains, the nature and intensity of which are much influenced by the character of the labour and the constitutional peculiarities of the patient. After-pains are liable to increase with each succeeding labour, and unless proper treatment is adopted, the pains may be very excessive, and prevent sleep. Much, however, may be done both in the way of preventing them, and of moderating their violence.
CAUSE. Uterine Contraction. After the birth of the child, and the detachment and expulsion of the afterbirth, muscular contractions are still necessary to close the now empty womb, and to reduce that organ to its natural size in the unimpregnated state. This is termed Involution. After-pains are said to be often troublesome in women who have taken chloroform during labour. This may be due to the severity of the pains, or the pains may seem greater from their mitigation during labour. In the latter case, Dr. Ludlam recommends five drops of Chloroform to be added to half a tumbler of water, and a teaspoonful to be administered as often as the pains recur.
MEDICINAL TREATMENT. Arnica, Belladonna, Camph., Chamomilla, Coffea, Gelsemium, Nux V., Sabin., Secale, Xanth.
INDICATIONS FOR THE PRINCIPAL REMEDIES.
Arnica. Pains following a protracted, hard labour. This remedy may also be used externally. Twenty drops of the strong tincture of Arnica to a teacupful of warm water. A napkin, saturated with the lower part of the abdomen, and covered with oiled silk or dry flannel to prevent too rapid evaporation.
Belladonna. After-pains, with headache, flushed face, nervousness, and restlessness.
Chamomilla. After-pains or irritable patients.
Coffea. Extreme sensibility, the pains being almost insupportable, with sleeplessness and restlessness.
Gelsemium. From its remarkable power of diminishing excessive muscular activity, this remedy is recommended.
Viburnum covers the same symptoms.
Nux Vomica. Severe after-pains and the discharge of large from clots; flatulence.
Sabina. Intermittent forcing-pains.
Secale. Continuous forcing after-pains. A high potency is better than a low one.
Xanthoxylum. This remedy is said to be of inestimable value in after-pains.
61. THE LOCHIA (Cleansings)
This is a healthy discharge which takes place after delivery, and in colour and appearance at first resembles the menstrual discharge. Gradually, however, it becomes lighter, yellowish, and before its final cessation, of a greenish or whitish hue. In a majority of cases the red colour changes in about a week on the yellowish shade. It varies considerably in different women, being in some thin and scanty, and continuing with a few days, and in others is so profuse as almost to amount to flooding, and lasting for weeks. The latter is most common in patients who have been troubled with too copious menstruation, who have borne many children, and who have indulged in the pleasures of the table. In some cases, too, this discharge has a disagreeable odour.
IRREGULARITIES. The following deviations from the normal discharge require medical and hygienic treatment: A sudden arrest of the lochia; a too prolonged or sanguineous discharge; lochia having foetid odour. The latter condition may be blood-poisoning. (See Section on “Puerperal Fever.”)
MEDICINAL TREATMENT. Aconite, Belladonna, Bryonia, Calcarea C., Hydras., Hyoscyamus, Platina, Pulsatilla, Sabin., Secale, Sepia, Sulphur
INDICATIONS FOR THE PRINCIPAL REMEDIES.
Aconitum. Too profuse bright red discharge with quick pulse, scanty, hot urine, and for plethoric patients. If there is pain from slight pressure over the womb, a strong Aconite lotion, hot, should be applied over the seat of pain.
Belladonna. Scanty discharge with headache, flushed face, and confusion of ideas; also when the lochia is foetid, and there are the above symptoms.
Bryonia. Suppression of the lochia; intense headache, with fullness and heaviness; pain in the breasts; aching in the back; hot, red, and scanty urine.
Hydrastis. Offensive lochia, with suppressed or scanty urine.
Pulsatilla. Simple scanty discharge.
Sabina. Similar symptoms to those described under Aconitum, minus the febrile ones; also when the red flow continues after it ought to have changed colour.
Secale. Very offensive dark discharge.
ACCESSORY MEANS. In suppression of the lochia, flannels wrung of hot water should be applied to the external pars, and frequently renewed, a second flannel being ready when the first is removed. also, if necessary, injections into the vagina of warm infusion of Camomile flowers. When the discharge is bright, or continues too long, the patient should retain the horizontal posture be kept quiet, and fed with suitable diet.
PREVENTIVES. After a confinement, ablution of the Parts by means of a soft sponge and warm water (containing a little tincture of Calendula a teaspoonful to the half pint, for the first two or three washings), at least twice in every twenty-four hours, the parts being immediately but thoroughly dried, is essential for the health and comfort of the patient, and to prevent the discharge from becoming offensive. The napkins should be frequently changed, and always applied warm, as the application of cold might be followed by an arrest of the lochial discharge. There is no objection in ordinary cases to the patient’s sitting up in the chair the day after delivery, while the bed is made. The daily use of the chair favours the discharge of putrid coagula; and carbolised injections may be employed to aid the evacuation. After the first day the patient may also wash herself, the exertion being helpful rather than otherwise. If the lochia be offensive, the chair should be used more frequently.
62. PUERPERAL CONVULSIONS.
Women are liable to convulsions of variable intensity and character before , during, and after labour; but, happily, the affection is one of very rare occurrence.
CAUSES. The predisposing causes are hereditary tendency, an excitable temperament, or some previous injury or diseases of the head, etc.; and among the exciting causes may be mentioned the irritation produced by a distended rectum or bladder, by the dilation of the orifice of the womb, or by the presence of the child in the maternal passages, etc.
SYMPTOMS. An attack of convulsions may come on suddenly, without any premonitory warning, or it may be preceded by one or more of the following symptoms; Drowsiness, weight, beating, or pain in the head; heat in the scalp, flushing of the face, or redness of the eyes; numbness of the hands; twitching of the muscles of the face and limbs; irregular and slow pulse; ringing in the ears; vertigo; pain and oppression on the region of the heart; restlessness, anxiety, etc. The fully developed convulsions are characterised by unconsciousness; violent spasmodic movements of the muscles of the face, limbs, and drunk; swelling of the face; foaming at the mouth; grinding of the teeth; apparently suspended, or short, hurried respiration; involuntary action of the bladder and bowels; profuse cold, clammy sweat, etc. The convulsions may subside in from two to five minutes, leaving the patient in a state of comatose insensibility, or deep stertorous sleep, from which she may suddenly awake, quite unconscious of what has been the matter, in a quarter of an hour or twenty minutes. No further paroxysms may come on, and the patient may steadily progress towards complete convalescence. Frequently, however, the convulsions recur again and intervals varying from fifteen to thirty minutes, the patient never recovering consciousness from one fit of another.
The alarming character of the symptoms, and the serious nature of the disease, demand al the skill and coolness of the most accomplished physician to meet the requirements of each case, but pending his arrival much previous time may be saved by the intelligent attendant administering one of the following remedies, and carrying out the recommendations of the accessory treatment.
MEDICAL TREATMENT. Aconite, Belladonna, Chamomilla, Coffea, Hyoscyamus, Ignatia, Opium
INDICATIONS FOR THE PRINCIPAL REMEDIES.
Aconitum. The presence of fever, with some premonitory symptoms, would be an indication for this medicine.
Belladonna. This is the most useful and the most frequently indicated remedy, and the only one which need be administered in the majority of cases both during the convulsions and the intervals.
Hyoscyamus. If there be much restlessness or anxiety, and a suspicion of approaching convulsions, Hyoscyamus may be given.
Opium. May be required or remove the dullness and stupor which sometimes remain after the subsidence of the convulsions.
ADMINISTRATION. For the premonitory symptoms, a dose every half- hour, or oftener. During the convulsions, every three or five minutes, the medicine being dropped between the lips or upon the tongue. After the convulsions, every half-hour, hour, or less frequently.,
ACCESSORY MEANS. The character should be moderately darkened, but freely supplied with cool and fresh air. Warm clothing should be applied to the feet the body, and cold lotion or ice to the head. If necessary, delivery should be accomplished by instrumental means, and the bladder and bowels emptied, but these are matters which must be left to the judgment of the medical attendant.
63. MILK FEVER-PUERPERAL EPHEMERA
When the breasts are first called upon to perform this function, there is sometimes a little circulatory disturbance which is called the “Milk Fever.” This is a normal process, and ordinary requires nothing but the early application of the child. In severe cases there is speedy accession of more serious symptoms, which frequently run on into the formidable diseases called Puerperal, or Childbed Fever. (See next Section.)
Usually Milk fever is of short duration, consisting of one or two paroxysms, which occur a few days after childbirth, and attended with diminution of the milk and lochia, but with no local functional or structural disturbance.
It appears about a week after delivery, rarely sooner, sometimes later; prevails in low, humid, marshy districts where the population is sparse, or near stagnant ditches and pools i hence it is malarious in its character.
SYMPTOMS. Chill, rigors, increased temperature and perspiration; pain in the head, back, and limbs. Pricking sensations of milk, urine, and lochia are suspended. The secretions of milk, urine, and lochia are suspended. The eyes are sunken; the fingers blue; the pulse is feeble and somewhat hurried.
When perspiration breaks out freely, the other secretions are re-established, the patient improves, and the fever passes away.
MEDICINAL TREATMENT. Aconite, Belladonna, Bryonia, China, Coffea, Acid phosphoricum., Rhus, Ver-V.
INDICATIONS FOR THE PRINCIPAL REMEDIES.
Aconitum may be safely had recourse to when much fever is present, especially at the commencement.
Belladonna should prove useful when, with swelling and pain of the breasts, there is some cerebral disturbance.
Bryonia. On the subsidence of the febrile symptoms, should there be oppressed and laborious breathing, headache, and constipation.
Acid phosphoricum. Should there remain profuse perspiration after the fever has abated.
Pulsatilla. This medicine is an excellent one for promoting the establishment of the secretion of milk, especially when the febrile symptoms are attended with considerable muscular rheumatic pains.
ACCESSORY MEANS. The patient’s chamber should be kept cool and well aired. All mental excitement or worry should be avoided. The diet should be light, such as gruel, arrowroot, barley-water, sago, etc., and taken in small quantities at a time. So long as the fever lasts the child should not be put to the breasts, but they should be drawn gently by the nurse, either with a breast- pump or otherwise, if full and uneasy.
64. PUERPERAL FEVER
This is a continued fever occurring in childbirth, sometimes following neglected Milk Fever, sometimes appearing as an independent affection. It is distinguished from Milk Fever i n that it is usually attended with peritoneal inflammation, uterine phlebitis, or other local functional and structural disturbances. According to the best authorities, this fever is very fatal, Dr. Ferguson being of of opinion that, “with all the resources which medicine at present offers, we shall find that one case in every three die die”; and that “to save two out of three may be termed good practice.” When the disease proves fatal, death usually occurs in from one to eight days. The disease is infectious, and has often appeared as an epidemic, attacking any women who happened to be confined at the time. It is, therefore, no small matter that we have in our Materia Medica-which, of course, Dr. Ferguson and his colleagues ignore remedies which prescribed according to the law of similars, and given in the early stage, are often sufficient to cure this disease.
CAUSES. Instrumental or difficult labour; foetid lochia; 1M. D’Espine, in a thorough investigation of post-partum inflammations, came to the conclusion that blood-poisoning from foetid lochia is the origin of Peritonitis, the so-called Milk Fever, and other inflammations and congestions liable to occur after accouchement. Febrile action in the first week after delivery almost always depends on absorption of lochia through slight abrasions or lacerations of the utero-vaginal canal. It may continue for some weeks, should the uterus not be firmly contracted, or should the lochia be foetid. In the latter case ulcerations through which absorption takes place, may almost always be found either on the cervix or in the vagina. neglect of cleanliness; decomposing fragments of retained placenta; violent emotional disturbances; contracted, or personal transmission of the poison from one patient to another by doctors and nurses. Other animal poisons, as that from Erysipelas, Scarlatina, Typhus, and from the post-mortem or dissecting-room, are capable of exciting Puerperal Fever, as conveyed by the persons and dresses of the attendants of the patient, even after the exercise of great caution. The disease derives great importance, both from its extreme danger and its frightfully contagious character.
SYMPTOMS. In Puerperal Fever there are rigors (shivering fits), followed by an increase of temperature (rising to 105 6 degree); more rapid pulse (ranging from 120 to 160); hurried, short respiration; distressing thirst; sometimes nausea and vomiting; and distention, pain, and great tenderness over the region of the womb, causing the patient to lie on her back, and drawn up her knees to relive the abdomen from muscular pressure, and from the weight of the bed-clothes; suppression of the milk (if it has been secreted at all); also suppressed, or scanty and foetid lochial discharge; there are severe pains in the head, flushed face, glistening eyes, anxious countenance, and sometimes delirium, and, unless the disease is checked, typhoid, or malignant symptoms rapidly supervene. This fever commonly occurs within a few days after childbirth; and it is remarkable that in most cases the patient loses all interest in the faint, and even expresses dislike to it and the husband. Convalescence is often exceedingly slow.
MEDICINAL TREATMENT. Aconite, Arsenicum, Baptisia, Belladonna, Bye., Hyoscyamus, Mercurius, Opium, Phosphorus Ac., Rhus., Verbascum V.
INDICATIONS FOR THE PRINCIPAL REMEDIES.
Aconitum. This remedy should be given as soon as the first indications of fever are noticed. it is usually sufficient in simple Milk Fever, and when there are no symptoms of brain disturbance.
Baptisia. As the indications of fever become more marked this is preferable to Aconite; and when enteric symptoms supervene Rhus should supersede Belladonna
Belladonna. Congestive headache, flushed face, altered pupils, great restlessness, tossing about, mental distress, and other symptoms of approaching delirium or severe disease. If the lochial discharge is not entirely suppressed, but is foetid, this remedy is still very suitable. at the same time Aconite should be continued in alternation with Belladonna, and at brief intervals till professional aid can be obtained.
Bryonia. Distended breasts, oppression, and shooting pain in the chest, etc.
It is not to be expected than a non-professional person will venture to undertake the treatment of such a grave disease as Puerperal Fever, but his intelligent employment of one of the above remedies until the arrival of a physician may be of material importance.
ADMINISTRATION. A dose every half-hour, hour, or two hours, according to the violence of the symptoms.
ACCESSORY MEANS. Frequent small draughts of cold water should be given; this relieves the thirst, and promotes perspirations. Barley, milk, or strong beef-tea between the doses of medicine will help to keep to the patient’s strength; even stimulants may be required; brandy rather than chloroform. Hot water will relieve vomiting; but better still is a grain of Sulph- carbonate of soda 1Dr. G.D. Beebe, of Chicago, says of Sulpho Carbonate of Soda: “During nearly two years I have administered this slat in many hundreds of cases of scarlet fever and diphtheria, as well as reasonable number of cases of erysipelas and puerperal fever, both with a view to the prevention of epidemic contagion and in the treatment of these forms of diseases. The Sulpho-Carbonate of Soda is readily soluble, and very diffusive when brought within reach of the absorbents. It is odourless, and a taste differing but little from soda. By its administration the blood and tissues of the human body may be thoroughly disinfected without any exciting any toxic effects of the drug. Administered to children breathing an atmosphere loaded with scarlet fever of diphtheritic contagion, it acts as an absolute preventive, with exceptions so rare, and with symptoms so light when any appear, that one is forced to believe that the fault was rather in an efficient dose tan in the agent. Given when either of these diseases has developed an attack, within a few hours the activity of the diseases has ceased, and the remaining symptoms soon fade out into health. Administered to a case of puerperal fever, when one septicaemic chill follow another, with the hot, drenching sweat between, and if not too late in the history of the case, the patient may be assured that not more than one chill will follow its first administration, and the high temperature and icteric hue of the skin will disappear with the most gratifying promptness. No less gratifying is the action of this substance when administered in erysipelas. The rapidly spreading inflammation of the skin stops short, and convalescence begins. The constancy with which these results follow the administration of this admirable antiseptic constitutes a demonstration on the septic character of the disease wellnigh as convincing as the recognition of the parasite under the microscope; and coming, as we do through those clinical observations by a different route, to the same conclusions reached by Pasteur and his co-labourers, the conclusions are both gratifying and suggestive.” dissolved in half a glass of water; a teaspoonful every few hours. Perfect rest and quiet, with absence of all appearance of excitement or alarm in the attendant, are imperatively necessary. Occasional sponging of the body with tepid water is soothing, and if there is much abdominal distention and tenderness, a dry heated brain-poultice, in a bag, is the best local application. Repeated fomentations and lavements of the vagina are valuable; indeed, if the parts were sponged with hot water three or four times a day there would be fewer case of this fever. The napkins should be frequently examine, and all foul discharge effectually cleansed away, and the room disinfected with Carbolic acid. Indeed, when the discharges are offensive, it is well to inject up the vagina some warm water, to which a few drops of Carbolic acid have been added; or as a more agreeable preparation, Chlorate of potash grs. xij. water x3j; a dessert-spoonful of this to a teacupful of warm water for injection, or to be applied by wetting compresses with the mixture. Dr. Macleod, of Ben Rhydding, states that he saved his own wife from a fatal termination of Puerperal Fever, after the physicians had expressed the opinion that she could not recover, by the injection of three drachms of Condy’s fluid in a wash-hand-basinful of water of 64 degree; followed by a similar operation on the following day with two drachms of the fluid. The temperature of the room should be maintained at about 68 degree, the ventilation through. The nursing of the child should be discontinued with the first active symptoms of fever.
65. PUERPERAL MANIA (Mania Puerperarum)
Gestation, the lying-in period, and nursing, are occasionally complicated by mental derangement, either of a quiet melancholy character, or of a more acute and violent description. The latter is more liable to occur during or immediately after labour, while melancholia, less dangerous to life, but more frequently followed by derangement of the mental faculties, more commonly occurs when the system is drained and exhausted by childbearing, or prolonged suckling.
SYMPTOMS. The symptoms of melancholy-mania are generally preceded by signs of exhaustion. There is also in incipient stage, the mind being wrong, but still able to notice its wandering tendency. The memory becomes weak, the spirits depressed, and various fancies haunt the brain. The patient is abstracted, listless, and silent. A conviction of her husband’s infidelity, or of her own, couple with agonising remorse and contrition, is one of the most common and painful delusions to which this class of patients is a prey; and in numerous instances attempts at suicide result.
Acute mania appears while the patient is sustaining the effects of labour, an occur suddenly and violently. The face may be pale, and the pulse soft and slow. The manner is agitated and excited, the tongue utters violent and often obscene language, and there is generally a tendency to suicide or child-murder. The bowels are constipated; the tongue thickly furred; the secretion of urine and milk nearly arrested, and the skin harsh and dry. There may be either disturbed sleep, or sleeplessness; also a persistent refusal to take food.
CAUSES. This affection scarcely ever occurs except where there is hereditary tendency. The exciting causes are labour, flooding suppression of the lochia, fright, weakness as a result of prolonged nursing, jaundice, or other disease.
MEDICINAL TREATMENT. Arsenicum, Aurum, Belladonna, Cann. I., China, Cim., Hyoscyamus, Ignatia, Platina, Pulsatilla, Stramonium, Verbascum A., Verbascum V.
INDICATIONS FOR THE PRINCIPAL REMEDIES.
Belladonna. Violent delirium from sudden lochial suppression. Staring eyes, hot skin, suppressed urine. etc.
Cannabis Indica. Catalepsy; imagines she is the Queen or the Virgin Mary, etc.
China. Mania following prolonged lactation, or flooding; recurrent headache.
Hyoscyamus. Jealousy; fits of violence; alternating with moroseness, restlessness in sleep, etc.
Ignatia. Persistent silent melancholy; tearfulness; obstinacy.
Stramonium. Violent rage, with constant use of abusive language.