§250. Milk-fever of lying-in females. Febris lactea.

Utero-gestation and lactation are natural states, which are not characterized by any morbid symptoms, unless some pre-existing cause in the female organism should develop them. The same may be said of milk-fever, on the third, fourth, or sixth day after parturition. The appearance of the milk in the breast is a purely physiological act, which is not necessarily accompanied by any morbid phenomena. Nevertheless, we discover in some lying-in females a group of morbid symptoms, such as chills, heat, thirst, and sweat; the pulse, which is at first small, gradually becomes fuller, and is sometimes even quite full, and is generally moderately quick, soft, and regular; the exacerbation usually sets in in the evening; towards morning perspiration sets in with relief. Sometimes this kind of fever is attended with drawing pains from the back to the breasts, headache, loss of appetite, flat taste, etc. The paroxysm of fever frequently comes on again on the day following; upon the whole, however, the symptoms are very light, and the general health is but slightly disturbed.

After parturition, the irritability of the nervous system is, of course, increased, so that even a slight cold, emotions, slight dietetic transgressions, and particularly a morbid irritation of the organs which are of particular importance after parturition, the breasts, nipples, sexual parts, may occasion such a fever as has been spoken of above. This kind of morbid irritation may be induced by weaning, after-pains, tumors, injuries, etc.

Inasmuch as the most important diseases sometimes arise from trifling causes in lying-in females, the attending physician should always ascertain whether such fevers are accompanied with disturbance of any of the more important functions of a lying-in female.

§ 251. If the milk-fever should be very slight, it can easily be controlled by diet, and a moderate exercise of the function of nursing.

For the more violent degrees of this fever, the following remedies are indicated: Puls.. Arn, Aconite, Bellad., Bryon., Coff., Ignat., Chamom.. Mercur., Opium. If the fever should have been caused by a cold, and should have the character of a rheumatic fever, Pul-satilla sometimes removes it. If the fever should be a synocha, Aconite is the well known remedy. If there should be less synochal fever, and the rheumatic pains in the chest and mammae more Striking, Bryonia is the most useful remedy, and removes the morbid condition in a few hours. If the fever should be more acute, with inflammatory symptoms in the mammae, (erysipelatous inflammation,) Belladonna is the most important remedy. If the fever should be occasioned by too sudden and too copious a secretion of milk, Rhus tox. will easily remove it.

Such fevers are frequently occasioned by emotions. Sudden joy, for instance, frequently increases the natural irritability of the nervous system in lying-in females to a dangerous extent. Coffea is the best remedy for morbid conditions induced by such causes. If the fever should have been induced by violent chagrin, Chamomilla is the well-known specific, which, if the fever should be violent, may be preceded by a few doses of Aconite. If fright should have been the exciting cause, Opium will generally be found to correspond to the symptoms. Milk-fever caused by fright and chagrin, is most easily removed by Aconite. Fevers arising from internal mortification and grief, yield to Ignatia. If fear should have been the exciting cause, Puls, or Belladonna will be found sufficient. Fevers induced by a sudden ebullition of temper are most easily removed by Nux vom.; if caused by well-founded chagrin, Siaphysagria is the best remedy.

Gastric derangements, with fever, induced by dietetic trangressions during the period of confinement, are treated like gastric affections generally.

If such derangements should have been induced by morbid irritations of any of the organs which are of particular importance during the period of confinement, the treatment has to be conducted with reference to that cause. If mechanical injuries of the sexual organs should be the cause, Arnica is to be given internally; and if the wound should be considerable, the external use of Arnica should not be omitted.

If the derangements should have been occasioned by after-pains, Coffea, Chamomilla, Nux vom., Puls., or Arnica, are indicated. Coffea is indicated by an excessive spasmodic pain, as if all the bowels would be torn. Convulsions frequently supervene; the body bends double, hands and feet start, the patients lament in the most piteous manner, grate their teeth, become cold and stiff. Pulsatilla may be suitable to patients with gentle dispositions, if the fever should have been caused by violent after-pains; if the patient should be very irritable, and start at the least surprise, Puls. would be so much more indicated. Crocus will be found suitable when the fever is accompanied with lancinations in the sexual organs, groin, and from both sides to the small of the back, and when a black, dark, viscid blood is secreted, beyond the normal period. An additional indication for Chamomilla in milk-fever is the passage of coagula, attended with the most violent after-pains. Sometimes these kinds of fever are successfully treated with Nux vom., particularly when violent after-pains are present, which occasion an urging to stool during a recumbent posture, which disappears as soon as the patient sits down to relieve the bowels, and is then followed by spasmodic pains in the uterus and bladder. Arnica is the principal remedy when these fevers arise from pressure and contusion of the uterus, or from injuries received during parturition. Females who wean their infants, should keep their breasts covered with cotton or matting, and should moreover take Bryonia, Belladonna, or Mercurius.