The history, pathology, and treatment of puerperal fever and crural phlebitis.

Date:
1842
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Licence: Public Domain Mark

Credit: The history, pathology, and treatment of puerperal fever and crural phlebitis. Source: Wellcome Collection.

Provider: This material has been provided by the University of Massachusetts Medical School, Lamar Soutter Library, through the Medical Heritage Library. The original may be consulted at the Lamar Soutter Library at the University of Massachusetts Medical School.

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    pain. In most of the fatal cases the countenance has, from the commencement, been anxious and pallid, and the extremities cold. There is no uniformity observable in the appearance of the tongue in puerperal peritonitis. It is sometimes entirely covered with a thin, moist, white, or cream-like film; at other times, it is of a deep-red, or brown colour in the centre, with a thick, yellow, or white fur on the edges. The lochia are often entirely suppressed; in other cases, only diminished in quantity. In some instances, they have an offen- sive odour. The mammae usually become flaccid ; yet, in some fatal cases, the milk has been secreted until a short period before death. The urine is often passed with pain and difficulty. Diagnosis. — This variety of uterine inflammation is frequently confounded with disordered states of the intestinal canal, the irre- gular spasmodic contractions of the uterus, which constitute after- pains, hysteralgia, and simple suppression of the lochial discharge. In cases of intestinal irritation, or disordered states of the stomach or bowels after delivery, which are not of such frequent occurrence as some writers have represented, the pain is from the commence- ment of the attack diffused over the whole abdomen ; it is rather a griping than acute pain, does not commence in the region of the uterus, and is but little, if at all, aggravated by pressure. The abdomen is generally soft, puffy, and distended. The tongue is loaded ; there is thirst and headache ; neither the lochia, nor the secretion of milk are suppressed. The febrile attack is usually preceded by evident signs of derangement of the bowels, such as flatulence, nausea, vomiting, constipation, or diarrhoea. Puerperal peritonitis is developed in a large proportion of cases before the end of the fourth day after delivery, sometimes even within twenty- four hours; whereas this affection rarely appears until the termi- nation of the first week. It is sometimes difficult to distinguish inflammation of the peri- toneum from after-pains and hysteralgia. Where the pulse is ac- celerated, the remissions of pain incomplete, the lochia scanty or suppressed, and the hypogastrium tender on pressure, we shall arrive at a correct diagnosis, by considering the peritoneal coat of the uterus in a state of congestion and inflammation, and employ- ing antiphlogistic treatment. There are few puerperal women, except those of a feeble and irritable constitution, or who have been previously exhausted by profuse hemorrhage, or some chronic disease, who are seriously injured by cautious depletion, local or general; and where death has followed the abstraction of sixteen or twenty ounces of blood from the arm, the fatal result may fairly be attributed to disease, and to the neglect of the remedy rather than to its abuse. In cases of intestinal irritation, I have often found the local abstraction of blood followed by decided relief: and the same holds true with respect to the severe irregular pains without inflammation, which often occur subsequently to delivery, and do not yield to the ordinary means of treatment.