This is a disease which sometimes prevails as an epidemic, and sometimes makes its appearance in a particular locality, prevails for a shorter or longer time, and ceases as suddenly, without our knowing why it came, or the cause of its cessation. "A disease to which all parturient females within the sphere of the epidemic or endemic influence are alike liable, the young as well as the more aged, the strong, the weak; the lady in her well-appointed, comfortable lying-in apartment; the poor daughter of toil in her comfortless miserable garret; she who has passed through a short, natural, favorable labour, as well as the poor, downcast, exhausted parturient, who has just passed through a tedious, difficult, agonizing labour, with a womb strained and bruised, and already in a state of incipient inflammation."

The disease sometimes does not show itself for a week after delivery; most commonly, however, it commences about the third or fourth day. The patient is seized at first with a slight coldness and shivering, succeeded by pains in the head, ringing in the ears, flushing in the face, great anxiety and restlessness. As the disease advances, the whole abdomen becomes affected, is highly painful to the touch, and much swelled. There are also pains in the back, hips, and sometimes in the legs, and the breathing is short and laborious. If the milk has already made its appearance, it suddenly disappears on the approach of the disease, but, if the attack of fever commences sooner, the milk does not appear. The uterine discharges are altered both in quantity and appearance; the urine is turbid, small in quantity, and voided with pain. The skin is hot and dry, the pulse weak and frequent, being often from 110 to 130 in a minute. Thirst prevails, and there is great prostration of strength, with anxiety, depression of spirits, a disinclination to suckle, carelessness about her child, and watchfulness. To these symptoms are daded a pain over the forehead, and a peculiar wildness of the eyes.

Vomiting not unfrequently prevails at the same time, and in so high a degree, as to prevent the smallest quantity of food or medicine from being retained on the stomach. In the progress of the disease, a severe purging often sets in, particularly in those cases where the abdomen has been much distended, and the stools are abundant, serous, and putrid. It seldom happens that any violent delirium arises, but the patient is apt to fall into a low, comatose state, wishing by no means to be disturbed.

After one or two days' continuance of these symptoms, the fever often acquires a malignant and typhoid tendency, particularly in hospitals and confined situations, or when the state of the atmosphere predisposes to diseases of that nature; the lips, teeth and tongue are covered with a dark brown fur; aphthae beset the whole internal surface of the mouth, tongue, uvula, tonsils and throat; the breath is highly offensive; the stools are fetid, of a dark brown colour, and pass off involuntarily; and in a few cases, purple spots appear on different parts of the body.

Puerperal Fever is readily to be distinguished from that affection known as after-pains, by the intervals of ease which attend these last, and by the absence of fever and abdominal tenderness; whereas, in the former, there is fever, with its concomitant symptoms, great soreness and swelling of the abdomen, and an almost uninterrupted continuance of pain, throughout the course of the disease.

The progress of Puerperal Fever is sometimes so very rapid, particularly in warm climates and hot seasons, as to destroy the patient in forty-eight hours. The risk seems to be the greater, according as the disease sets in a longer or shorter time after delivery. When the attack comes on late, the depression of strength is usually not so great, the tumefaction of the abdomen less extensive, and the other symptoms not so violent, and consequently there is a greater chance of the patient's recovery.

The re-appearance of the discharge, and a gradual subsidence of the abdominal swelling and soreness after copious stools, the pulse at the same time becoming slower, with a moist skin, may be regarded in a very favourable light. On the contrary, an agitated countenance, with a hurried unconnected manner of speaking, constant sighing, attended with a tossing about of the arms, pain and oppression at the chest, muttering and stupor, are to be considered as unfavourable symptoms. An extensive swelling of the belly, so as to sound on striking it with the fingers, sudden cessation of pain, irregularity in the pulse, coldness in the extremities, clammy moisture diffused over the whole body, frequent dark-coloured and fetid evacuations by stool, and an indifference to all external objects, denote certain and speedy death.

It was long a disputed point amongst the Medical Profession, whether Puerperal Fever was or was not contagious; but it is now generally acknowledged that it is highly contagious, and may not only be conveyed from one patient having Puerperal Fever to another lying-in woman, but the fever poison may be conveyed to her by a medical attendant, midwife or nurse, from any patient affected with Erysipelas, or from a dead body.

In the terrible epidemic of Erysipelas which prevailed near Norristown, Pennsylvania, in the autumn of 1847, "old and young, male and female, fell before it," says Dr. Corson, "and yet there seemed to be one class which it preferred. The mother, as she lay helpless and exhausted from the labour and agony endured in giving birth to her child, was marked as a victim. The deadly poison was infused into her veins, and, in many instances, a few hours sealed her doom." "I lost more puerperal women during the epidemic than for twenty years before."

Dr. Gordon, writing on the epidemic peritonitis after childbirth which prevailed at Aberdeen in 1789-1790 says: "The disease seized such women only as were visited or delivered by a prac-tioner, or taken care of by a nurse, who had previously attended patients afflicted with the same disorder." And Dr. Armstrong observed that forty out of the forty-three cases that happened in Sunderland, (in 1813), occurred in the practice of one surgeon and his assistant.

Mr. Robertson, of Manchester, states the following facts, in a paper in the "Medical Gazette:" From December 3, 1830, to January 4, 1831, a midwife attended thirty patients for a public charity. Sixteen of these were attacked with Puerperal Fever, and they all ultimately died. In the same month, 380 women were delivered by other midwives for that institution; but none of the 380 suffered in the smallest degree.

In the great General Hospital at Vienna there are three compartments appropriated to lying-in women. Here upwards of 6000 births take place annually. One of these compartments is assigned to the instruction of medical men and midwives; another to the instruction of midwives only. In the former of these two, fatal Puerperal Fever was so very much more prevalent than in the latter, as to attract the notice and the intervention of the government. It appeared upon inquiry that the male students busied themselves with the investigations of the dead-house, and the dissecting-room. A regulation was therefore made and enforced, that every student should wash his hands in a solution of Chlorine both before and after every examination of the genital organs in the living subject. From that time the excessive mortality from Puerperal Fever declined, until it became the same in each of the two compartments. The death-rate, which in 1846 had been 13 per cent., in 1848 was only 1 1/2.

Treatment

As early as possible after the inflammation has set in, which may be known by the tenderness of the belly on gentle pressure, from twenty to forty leeches should be applied. Sometimes no further abstraction of blood will be required; but in severe cases, a repetition of this local bleeding may be requisite. If the small and feeble'pulse, which is characteristic of acute inflammation within the abdomen, should become fuller and softer after the bleeding, you may consider it good evidence that the bleeding has been beneficial.

After the leeches have fallen off, a large, warm, but light poultice should be laid over the abdomen; or it may be constantly fomented with flannels wrung out of hot water. Whichever is used must be renewed frequently, and never allowed to get cool. These means will encourage bleeding from the leech-bites, and are generally found to afford great comfort to the feelings of the patient.

Purgatives are calculated to do harm, as it is absolutely necessary that the patient should be disturbed as little as possible.

A pill of one grain of solid Opium, or 30 drops of Laudanum, may be given, and this may be repeated as soon as the effect of the first dose goes off, or after the first dose of Opium, Bromide of Potash may be given in ten or fifteen grain doses every three or four hours. Bottles of hot water, or mustard poultices may be applied to the feet. If the patient is troubled with sickness at the stomach, small Effervescing Draughts may be taken frequently till the stomach is quieted.

If the bowels should have been confined for some time, and the patient should feel uncomfortable in consequence, an injection of warm water may be given.

As long as the fever lasts, the diet must be unstimulating, but the patient's strength must be supported by gruel, sago, chicken broth, and light things of that description.