CHAPTER XV.. Post Partum Diseases.

POST PARTUM DISEASES.

“Mysterious to all thought, A mother’s prime of bliss, When to her eager lips is brought Her infant’s thrilling kiss.”

Proper bathing and diet are as essential after as before confinement. At least once a day the patient requires a bath. Ordinarily use tepid water. Sponge and dry a portion of the body at a time, keeping the balance protected. If there is heat in the back, bathe it several times a day. Should the patient be nervous and uneasy, try dry hand friction. A compress, too, is often serviceable, worn across the back for two or three hours, followed by bathing and rubbing. The breasts should be bathed frequently, and the colder the water the better. This prevents sensitiveness to cold, and may consequently prevent gathered breasts. Three to five days after confinement the patient can be put into a sitz-bath with benefit. Let the temperature of the water be from 85° to 95°. This bath is restful, cleansing and restorative, and is really as beneficial after as before parturition. A woman can often sit in a bath for a few moments when the same time spent in a chair would prove injurious.

Change the linen of bed and person daily, and the napkins every three or four hours. Keep the room light and well ventilated. The temperature of the room should never exceed 70°. A few years since not a ray of light or a breath of fresh air was allowed in the parturient room, and if the woman was to touch cold water, it was deemed sure death. In some parts of this country, within twenty years, the bed even was not changed for nine days after confinement. With frequent bathing and a constant supply of fresh air the patient will not be sensitive to cold, and inflammation and other post partum diseases will in consequence be rare.

The vagina must be syringed at least twice a day with water in which there are a few drops of carbolic acid. Use a fountain syringe, and have the patient recline over a bed pan. Thus the parts will be kept cleansed, and carbolic acid prevents septic poisoning. If the bowels do not move naturally by the third or fourth day, give an enema, one quart of tepid water. The regimen advised in this book having been followed, one will rarely be troubled with constipation. Beware of cathartics. Most of them have a specific action upon the uterus as well as upon the bowels, and will do harm. This is notably the case with aloes and podophyllum.

The food must be simple in character and easy of digestion, especially until after the milk is established. Bran or graham gruel is the very best food the first day or two. Having been withheld from the diet during pregnancy, on account of containing the phosphates which have a tendency to harden the bones, it should now be taken for that very purpose.

Many are prejudiced against graham gruel, yet it has been proven that most women relish it better than anything else after labor. In the Home of the Friendless, Leavenworth, Kan., are many cases of confinement every year. Almost universally the inmates are prejudiced against graham in any form, and rarely taste it before confinement. A former matron had been a nurse in a Water Cure. Invariably she brought a bowl of graham gruel to the mother a few hours after delivery. She never had one express any repugnance to it. On the contrary, they would say, “That tastes good;” “That goes right to the spot;” “Can any one eat too much of anything that is so good?” and similar expressions, showing that there was an actual relish for the dish. The gruel should be made thin at first, and without cream or milk. After a few days it can be made thick like mush, and eaten with fruit or cream and sugar. New milk, wheatlet, cracked wheat, barley, oatmeal, graham gems, fruit, etc., can be added to the diet as desired.

There is no need of milk fever. Women have been led to expect more or less constitutional disturbance accompanying the advent of the milk. With the bathing and diet recommended above, even if she has not had the best conditions during pregnancy, one hardly realizes any change in the system at that time. When patients were fed on brandy panada, wine whey, strong tea, and beef broth, were kept in unventilated rooms, deprived of water externally and internally, and besides were poisoned with drugs, it is no wonder they had milk fever, and were liable to other post partum diseases.

The child should be placed to the breast several times a day, even if there seems to be no milk. The act of nursing stimulates secretion, prevents engorgement, and from sympathetic relation causes uterine contractions. When the breasts become filled and are knotty and tender, bathe them in hot water and have them drawn. If the child does not empty them sufficiently, the nurse or some member of the family should do it. This is better than a breast pump, and can be easily done by remembering to lap the tongue around the nipple until it meets the upper lip.

The old tradition used to be that a woman, on no account, must leave her bed before the ninth day. No matter how well she felt, the nine days must be spent in bed. There is no positive rule. One must be guided by her strength. Probably few women can expect to be about before four or five days. The cases where they can leave their beds earlier than that are exceptional.

MAMMARY ABSCESS, or inflammation of the breast, often called “gathered” or “bealed” breast, is usually ushered in with a chill, succeeded by feverish symptoms. Darting pains are felt in the breast, which, as the disease progresses, extend to the arm-pits. The breasts swell, become hard and tender to the touch--even nursing is painful. If pus forms, the skin becomes dark red, the enlarged breast softens, accompanied by a throbbing pain. The patient is feverish, nervous, irritable, has irregular chills, night sweats, debility, etc.

Hot fomentations should be used promptly and thoroughly at the first threatening symptoms. Wring a cloth out of an infusion of phytolacca, and keep hot by applying the water bottle containing a small quantity of very hot water. If too much water is put into the bottle it is made uncomfortably heavy. If the fresh root cannot be obtained, use the fluid extract, ten drops to a pint of water. Keep the breast well drawn and persevere in the hot applications; suppuration can usually be prevented. Farmers know the value of phytolacca, and use it with their new milch cows in case of caked bag.

Aconite should be taken internally if there is alternate chill and fever, with thirst and throbbing pulse, one drop of tincture in ten tablespoons of water, a spoonful every half hour.

Bryonia, 2d.--Constant aching in the bones and soreness of the flesh. Dose, six pellets every hour.

Use only liquid food until the disease is surely arrested. Keep quiet and have plenty of fresh air. Unless the suppuration is very deep the breast should never be lanced.

FOR EXCORIATED NIPPLES, bathe in a warm borax lotion, two grains to one cup of soft water; after which apply carbolated cosmoline or calenduline. If the base of the nipple is deeply cracked, before using the cosmoline, wash with a solution of nitrate of silver, one grain to two ounces of water. Protect with a shield while the child is nursing. None of the above preparations are harmful to the child, except the nitrate of silver, and the cases where this is needed are rare.

FOR INSUFFICIENT MILK, drink freely of new warm milk. Have it brought to the bed, and drink at least a pint. Take it one or two hours before breakfast. If milk cannot be obtained possessing animal warmth, take new milk, add one-tenth water, and heat over a water bath to a temperature of 120 degrees. Cheese makers testify that the addition of water prevents rennet from coagulating the casein. In the stomach also, warm water prevents the pepsin from curdling the milk. If it is as warm as the stomach, and does not coagulate, it will be taken up by the absorbents and conveyed directly to the blood, without going through the process of digestion. Mothers who have a great aversion to milk, learn to cultivate a decided relish for it for the sake of the child.

Dr. R. P. Harris, in speaking of milk as a diet for delicate mothers, says: “Those who with ordinary food invariably fail to nurse longer than a few weeks, are capable by this diet of becoming not only good nurses, but also of gaining flesh while secreting the milk in abundance. When a delicate mother of eighty-six pounds’ weight, who had failed after a month with each of three infants, is enabled by it to nurse a child eighteen months, and gain at the same time nineteen pounds, the diet must be an effective one.” The article next best for promoting the secretion of milk is cocoa or chocolate, prepared with plenty of milk.

Every form of malt and spirituous liquors should by all means be avoided. They derange the nervous and digestive systems of both mother and babe. Custom, happily, has to a large extent done away with the idea that “nursing women must have ale or beer.” To those who still maintain this view, I would recommend the study of the question, whether the help expected is at all commensurate with the danger incurred of a pernicious appetite being cultivated in both mother and child.

Good digestion is usually all that is essential for an abundant flow of milk. The food should be simple but nutritious. Depend upon grains and fruits mainly, and by no means exclude the bran from the wheat flour. The saline elements in the bran not only stimulate digestion, but excite the secretion of milk as well. Try the experiment of feeding an Alderney cow upon fine flour, excluding the bran. By the lack of milk you will prove that the bran contains elements pre-eminently stimulating to lacteal secretions.

Oysters eaten raw or slightly cooked are said to increase the flow of milk. Honey, too, often proves invaluable. With bread and gems, instead of the carbonaceous butter, eat honey. It stimulates all the secretions. It is evident that foods rich in phosphates are the best to increase lactiferous flow. Therefore, study well the food table in