Chapter Ix, and Partake of Foods Which Were Avoided in Pregnancy.

In the first days after confinement, if the milk is slow to secrete, apply bruised castor bean leaves.

FOR EXCESSIVE FLOW OF MILK, once or twice a day use hot fomentations upon the breast, and apply cosmoline, in which there is a trace of camphor. Avoid salt and liquid food. Wear folds of cotton batting over the breast. In either insufficient or excessive flow of milk, guard against pressure of clothing. It is absolutely essential that the blood should circulate freely to and from the breasts.

(No one thing more frequently causes atrophied breasts in any woman than the pressure of corsets and padding ordinarily worn. It is not unusual for a fine development of the breast to result from the removal of all pressure, accompanied by bathing daily with cold water, and following the bath by friction. Should this fail, an apparatus on the principle of dry-cupping is used. This seldom fails of giving the desired results.)

AFTER PAINS often accompany the contraction of the uterus. It is not true that women never have them with the first child and always have them subsequently. Like most of the sufferings of maternity, they are the effect of abnormal conditions. Women, who, in two or three confinements have suffered days with after pains, threatened with spasms and not relieved except by chloroform, have by previous preparation recovered without a twinge of pain.

After pains usually occur periodically every ten or fifteen minutes. They are cramp-like pains accompanied by a feeling as if pricked by many needles. They make one very impatient and nervous, depriving her of needed rest. They are often the result of poisonous doses of ergot taken during labor. The hot water bag or hot fomentations will usually give relief. Must be very hot and kept hot, consequently dry heat is to be preferred. Administering a hot sitz-bath is also excellent treatment. If relief is not obtained, and the physician is not within call, inhale ether moderately. Do not take it internally.

THE LOCHIA is the flow from the vagina which occurs after confinement. At first it has the appearance of fresh blood, then becomes lighter in color, and finally is only a glairy mucus. This varies greatly in amount and duration. As a rule the healthier the woman, and more natural the labor, the less the flow. Cases have come to my knowledge where there was no sanguineous flow, and the patient made a rapid recovery. It is said that healthy squaws have no flow of blood with menstruation, or after delivery. If there is no constitutional disturbance, there need be no anxiety about a scanty flow. If caused by a chill, fever or inflammation, etc., prompt attention will be required, according to accompanying symptoms.

METRORRHAGIA, or profuse flow, often requires treatment before medical aid can be secured. Hot fomentations, hot sitz-bath and hot vaginal injections are the very best applications. Recently the medical profession recognize that heat is better than cold, to arrest hemorrhage. In surgery, hot water is applied to exposed bleeding vessels. Cases are known where hot vaginal injections have instantly arrested bleeding that had resisted applications of ice, styptics and the tampon.

A lady in Michigan, during the menopause, was taken suddenly with violent hemorrhage. For seven days and nights everything was tried in vain to arrest the bleeding. She became cold and clammy, had frequent fainting spells, and death seemed imminent. An old nurse came to take care of her over night. She set aside the physician’s potions and applications. She filled the big wood stove with bricks, and as fast as they were heated wrapped them in wet cloths and put them about the patient, who thus obtained her first sleep for days. The hot bricks were kept to her four days and nights. There was no return of hemorrhage. She made a rapid recovery.

If there are clots, retained placenta or membranes, or any foreign growth present in the uterus, they must be removed by surgical interference, before uterine contractions can be effected and maintained.

PELVIC PERITONITIS, PUERPERAL OR CHILD-BED FEVER. “There is a word of fear that I shall pronounce when I utter the name of Puerperal Fever; for there is almost no acute disease that is more terrible than this. The small pox itself, which reduces the fairest form of humanity to a mass of breathing corruption, can not be looked upon with greater dread. Child-bed fever, like an inexorable Atropos, cuts the thread of life for those to whom Clotho and Lachesis would give the longest span.

“There is something so touching in the death of a woman who has recently given birth to a child; something so mournful in the disappointment of cherished hopes; something so pitiful in the deserted condition of the new-born, helpless creature, forever deprived of those tender cares and caresses necessary to it, that the hardest heart is not found insensible to the catastrophe. It is a sort of desecration for an accouchee to die.”

Thus feelingly writes Prof. Meigs, of Philadelphia, of this disease, the very thoughts of which strike terror to the stoutest heart. This disease is an inflammation of the uterus and its peritoneal covering, and often extends to the entire membrane lining the abdominal cavity, and possibly involves all the pelvic viscera.

The attack ordinarily commences from the third to the ninth day after delivery. Previous to this, the patient has seemed all right, when suddenly, often apparently without cause, she is taken with a chill. Rigors more or less severe extend up and down the spinal column. Clothing does not seem to impart any warmth. Almost simultaneously with the chill, periodical pains will be felt in the womb, and if there is not much constitutional disturbance, may be taken for after pains. Usually, however, they are accompanied by great soreness and tenderness in the pelvis; the abdomen soon bloats and becomes tympanitic; the legs are flexed to relieve the tension; the weight of the clothes, even, cannot be borne. The milk dries up, the lochia cease, there is headache, great thirst, increase of temperature, a quick, wiry or bounding pulse.

All of these appalling symptoms are accompanied by great anxiety of mind and distressed expression of countenance. A dark circle forms about the eyes, which are sunken, the nose pinched, and the lips drawn, and the face is flushed or very pale. The course of this dread disease is extremely rapid. “It will not unfrequently happen that she shall die within thirty-six or forty-eight hours from the onset of the malady, and some cases terminate fatally even in eight hours. They are to be cured promptly or not at all. Such a malady as this hurries with hot and furious haste to a turn, beyond which there is not and cannot be any useful therapia.”

Perhaps I shall be condemned for picturing to the sensitive imagination of the pregnant woman the possible dangers of this dread disease. Her attendants will look out for it, and she should not be led to anticipate it. For two reasons, however, she should be forewarned:

First, that she may at once summon her medical attendant.

Second, that the causes of this disease being known, she may avoid them.

Do not delay one moment in calling your physician. Having the symptoms indicated, procrastination is suicidal. The doctor would better come ten times for a nervous chill or after-pains, if by chance the mistake should be made, than that you should fail once to notify him of an attack of puerperal fever.

Under improved methods of treatment this disease does not terminate fatally as frequently as formerly.

The causes of this disease are:

First. The inflammatory condition of the system before delivery. If the fruit diet has obviated this, there is nothing to fear.

Second. The use of ergot in confinement. Puerperal fever following poisoning by ergot is very rapid in its course, and soon terminates in gangrene. If this drug were banished from practice, child-bed fever would be rare.

Third. Contusions and bruises from instruments not handled dextrously cause inflammation.

Fourth. The use of cathartics, tonics, stimulants and other drugs after delivery.

It is within the power of every woman that she shall not be subject to these causes of puerperal fever.

Some late teachers claim that all child-bed fever is pyæemia, blood-poisoning, and can not be avoided. Why is it, then, that it is notably absent in those who have led a hygienic life? Why is it that those physicians who insist on preparatory treatment seldom meet with it in their practice? Others claim that the disease is contagious, and that the poison can be conveyed by physician and nurse.

Dr. W. S. Playfair, of London, who gives to this disease the name of Puerperal Septicæmia, says: “The whole tendency of recent investigations is daily rendering it more and more certain that obstetricians have been led into error by the special violence and intensity of the disease, and that they have erroneously considered it to be something special to the puerperal state, instead of recognizing in it a form of septic disease, practically identical with that which is familiar to surgeons under the name of pyæmia or septicæmia.

“If this view be correct, the term ‘puerperal fever,’ conveying the idea of a fever such as typhus or typhoid, must be acknowledged to be misleading, and one that should be discarded as only tending to confusion.

“According to this theory, the so-called puerperal fever is produced by the absorption of septic matter into the system. It is not essential that the poison should be peculiar or specific; for, just as in surgical pyæmia, any decomposing organic matter either originating within the generative organs of the patient herself, or coming from without, may set up this morbid action.”

THE TREATMENT OF PERITONITIS should be prompt and thorough. Sweat the patient as soon as possible. Place several steaming bricks or ears of boiled corn about her. Frequent hot enemas by rectum and vagina are beneficial. If gangrene threatens, it is often arrested by the application of a yeast and charcoal poultice. Take any good lively yeast, make a sponge of corn meal and graham flour, equal parts. When light, add two tablespoons of charcoal to one pint, put on to a large cloth covered with thin gauze and lay over the entire abdomen. Must be changed frequently, not allowing it to get dry. An injection should be given per rectum every three hours, of weak carbolic soapsuds.

The nutriment should be diluted hot milk, or oatmeal gruel. Small pieces of ice will be grateful.

When these directions are followed faithfully, accompanied by appropriate remedies, most cases can be saved.

Even if it should be proven that this disease is septic poisoning, a healthy tone of the organs resists the absorption of the foreign agent, which proves a poison. In twenty years of general practice I never had a fatal case outside of the hospital. My experience emphasizes what I have stated, that the hygienic life and habits, and the avoidance of drugs and instruments go far toward preventing child-bed fever.