LETTER XXXIII.. The Lochial Discharge.

THE LOCHIAL DISCHARGE.

The Mosaic Law concerning Purification of Women—Nature of the Lochia—Excessive and Offensive Discharge—Treatment of Suppression of the Lochia.

We read in the New Testament, in reference to the birth of the Saviour (Luke ii., 21, 22), that “when eight days were accomplished for the circumcising of the child, His name was called Jesus, which was so named by the angel before He was conceived in the womb;” that “when the days of her purification, according to the law of Moses, were accomplished, they brought Him to Jerusalem, to present Him to the Lord.”

These passages refer to the Mosaic law (Leviticus, chap. xii.), which is as follows:

“And the Lord spake unto Moses, saying, Speak unto the children of Israel, saying, If a woman hath conceived seed, and born a male child, then she shall be unclean seven days; according to the days of the separation for her infirmity, shall she be unclean.

“And in the eighth day the flesh of his foreskin shall be circumcised.

“And she shall then continue in the blood of her purifying three-and-thirty days; she shall touch no hallowed thing, nor come into the sanctuary, until the days of her purifying be fulfilled.

“But if she bear a maid child, then she shall be unclean two weeks, as in her separation: and she shall continue in the blood of her purifying threescore and six days.”

This law refers to what is called in medical science the lochia, or lochial discharge, the term being derived from a Greek word signifying “a woman in childbed.”

After the birth has taken place and the placenta has been removed, the woman experiences a discharge from the womb, which is at first red in color, consisting, probably, of little else than blood; afterward it acquires a greenish hue, possessing a peculiar and disagreeable odor.

The lochia is considered purifying in its character. It is a natural discharge which oozes from the orifices of blood-vessels, laid open by the separation of the placenta from a portion of the internal surface of the womb. In all cases wherein a wound is made in the living body, or wherever the blood-vessels are by any cause laid open, there must be necessarily more or less discharge before the healing can be fully accomplished; and the same principle holds good in the womb as in other parts of the body.

In quantity, the lochia varies much in different cases; it may be three or four times as abundant, apparently, in one case as in another, both patients recovering, however, with equal facility or difficulty.

The length of time varies also as much as the quantity of this discharge. It may last for a few hours only, for days, but more commonly for weeks; fourteen to twenty-one days may be stated as its usual duration. Something, I think, depends upon the treatment; cleanliness certainly has its effect in these cases. If a woman wash herself three or four times daily, and keep herself at all times as strictly clean as the circumstances will admit of, the process of healing must be materially hastened, the discharge rendered smaller in quantity, and less offensive in character.

Excessive Discharge.—From various causes the lochia sometimes becomes excessive in quantity. More anciently, when the humeral pathology was much in vogue, this discharge was studied with more attention than in modern times, and our forefathers in medicine may have gone to an extreme in this matter; but certain it is, the importance of the lochia should not be overlooked.

A piece of placenta retained may augment the flow of the discharge. If the patient experience vomiting, very offensive and too great a quantity of lochia, or if very severe after-pains come on, there is some reason to suspect that such is the case; so, also, portions of the membranes may have been retained, causing some degree of irritation. Any thing which debilitates the system, such as too much lying in bed, overheated rooms, too much sitting up, walking, or other exercise, and especially too much excitement in the way of seeing company, gossiping friends, etc., may likewise cause an excessive discharge. In those cases where a portion of the placenta is retained, removing it is often considered the best remedy; but according to one very able author and practitioner, Dr. Blundell, “unless the symptoms are very urgent, it is better to refrain from manual operations; left to its own efforts, the uterus will, perhaps, more safely clear itself.”

Treatment.—In all these cases the general principles of management are plain and easily understood. We must, of course, as far as possible, remove the causes of the difficulty; we must also treat the system constitutionally in order to improve the general strength. Cooling wet compresses upon the abdomen and genitals, frequent ablutions, the sitting-bath, and in some cases the packing wet-sheet, will prove a highly useful means; vaginal injections of water, tepid injections in the bowels, and drinking of pure, soft water, are also to be recommended.

Offensive Discharge.—There is one condition of the lochia which is very troublesome from its offensive smell and extremely loathsome character. In such cases the red discharge ceases and is succeeded by a profuse watery one of a greenish color, and which is sometimes called by women “the green water;” it is frequently so acrid as to excoriate the parts upon which it runs. It is often attended with a good deal of general debility, causing, not unfrequently, a considerable degree of hectic fever.

The water processes, practiced in a manner suited to the exigencies of the case, cannot be too highly recommended or too much praised, as a means of purification and cure in this offensive and troublesome malady.

Suppression of the Discharge.—Women, in general, very much fear a sudden cessation of the lochia, and for the reason that it is generally well understood that this occurrence is attended with circumstances of an unfavorable character. But while patients should, on the one hand, always be careful and considerate in matters pertaining to health, they should, on the other, not become at once frightened at every little cessation of the discharge. As I have before said, it may cease of itself spontaneously, and without harm to the system, within a few hours after birth. Dr. Good, indeed, tells us “that in some women who have healthy labors, there is no lochial discharge whatever, the blood-vessels of the uterus contracting suddenly and closely as soon as the red blood ceases to flow.” This celebrated author points out an example of this kind that occurred to Professor Frank, even after a third natural delivery; the patient, moreover, having been from a girl as destitute of menstruation as afterward of lochia; yet her health was in no respect interfered with.

Diagnosis and Treatment.—If thus, on examination, we find that there is no increase in the frequency of the pulse, or other unfavorable symptoms, no fear whatever need be entertained. If the patient has taken cold, causing an inflammation of the womb, an accident which may be known by sensations of chilliness along the spine, accompanied, perhaps, with general rigors, by the roundness, hardness, and tenderness of the womb, which may be easily felt through the abdominal coverings; and, if added to all these symptoms, there is great heat of the skin and frequency of the pulse, rising to 110°, 120°, 130°, or even more; then we may know that the suppression is a morbid one—one, too, which if not promptly treated, may soon end in death.

Patients, under such circumstances, have great fears of cold; they bundle themselves up, and heat their systems in all manner of ways, as if their physical salvation depended wholly upon such a course. But the truth is, the mischief has been already done; once there is a severe inflammation or fever upon a patient, it is impossible for her to take another cold until the previous one has been cured.

This fact, then, indicates clearly what the proper treatment of such cases should be; we must treat them on the same general principles of all other inflammations; and as soon as the fever and inflammation are sufficiently removed by means of ablutions, wet compresses, injections, water-drinking, and, if necessary, the packing wet-sheet, the discharge—if any such be at all necessary—must follow as inevitably as a stone falls to the ground. Thus it is, then, that under certain circumstances, a cold may give fever and inflammation; while under other circumstances, cold cures these symptoms. These operations of nature, simple and beautiful as they are, must prove highly interesting to every reflecting mind; and they show, moreover, the goodness, benevolence, and design of the Creator, in furnishing us everywhere, so abundantly, a remedy so powerful and safe as pure, cold water.

In all those diseases following delivery, the excellent Dr. Good observes, “That cleanliness and purity of air are of the utmost importance,” and “that, without these, no plan whatever can succeed; and with them, no other plan is often wanted.” “They are, moreover,” he continues, “of as much moment to the infant as to the mother. It is a striking fact that, in the space of four years, ending in 1784, there died in the lying-in-hospital of Dublin—at that time a badly-ventilated house—2944 children out of 7650; though after the ventilation was improved, the deaths within a like period, and from a like number amounted to not more than 279.”