§ 249. We shall now return to the treatment of puerperal fever.

Chamomilla is very suitable, provided it had not been abused during or after parturition, if a greater or lesser number of the following symptoms are present: Great restlessness, nervous excitement, dulness of the head, beating headache, particularly in the forehead, oppression of the chest, with shortness of breathing; flaccidity of the breasts, in consequence of the secretion of the milk being arrested; slimy, greenish, watery, or milky diarrhoeic stools, which are frequently accompanied with cutting colic; excessive lochial discharge, with labour-like pains extending from the small of the back towards the front part of the abdomen, and regularly followed by a greater or lesser discharge of coagulated blood; pale yellowish complexion, occasionally and for a short time only yielding to flushes on the cheeks, with general fever-heat, and constant restlessness, anxious, agonizing tossing about, and delirium.

If these symptoms should not entirely yield to the action of Chamomilla, the remaining group of symptoms is sometimes easily controlled by Rhus tox. This remedy is sometimes indicated from the commencement, if the patient's nerves should be very much irritated, and the symptoms should be aggravated by the least chagrin, or if the white lochia should suddenly change to a bloody, coagulated discharge. Chamomilla is always indicated in puerperal fevers, when metrorrhagia is present, with discharge of dark, blackish, coagulated blood, which takes place in paroxysms, or when the hemorrhage is accompanied with violent labour-like pains in the uterus, with much thirst and coldness of the extremities.

Pulsatilla is suitable when the symptoms are opposite to the former; it is indicated when the features of the patient are expressive of her suffering, and a gentle disposition and great nervousness are present; when the lochial discharge had been suddenly suppressed, with a burning sensation of fulness in the internal sexual organs; it is furthermore indicated by paroxysms of nocturnal heat and anguish, palpitation of the heart, sleeplessness; the violent thirst is no counter-indication; it is indicated by diarrhoeic stools rather than costiveness. Pulsatilla is an excellent remedy when the fever has been induced by the abuse of chamomile. It is an excellent remedy when the lochial discharge stopped prematurely or had been arrested by some sudden and violent emotion, such as fright, fear, chagrin, or by a cold; the timely exhibition of Puls, is apt to prevent the occurrence of puerperal fever consequent upon such causes.

Nux vom. is frequently suitable, particularly when the abuse of coffee or chamomile had been one of the exciting causes, provided the symptoms correspond. It is indicated by the following symptoms: Intense pains in the sacral and lumbar region; pricking and bruising pain of the abdomen during motion, contact, cough, or sneezing; bitter taste, and eructations, loathing, nausea, even vomiting, dry lips and tongue, slimy or dingy yellowish coating of the tongue, sensation of heaviness in the sexual parts, with burning heat; suppression of the lochia; constipation, or hard stools, with burning-stinging pains in the rectum; painful micturition, or else retention of urine; dry, parchment-like, burning-hot skin, with great thirst, particularly a desire for cold drinks, full, hard pulse, and sometimes expression of anxiety in the features, and constant restlessness; the secretion of milk is * rather increased than otherwise, inducing turgescence of the breast, with pressure and tension. Nux v. is generally more suitable when the excitement of the circulation has an erethic character.

When Nux is indicated, Coffea should likewise be thought of, particularly when coffee is not the habitual beverage of the patient. But even if this should be the case, Coffea, if indicated, will prove useful. It is required by the following symptoms: Excessive painfulness of the affected parts, excessive bodily and mental excitement, wakefulness, chill, with feverish warmth of the body, delirium, with open eyes, violent colic, with great irritability, which sometimes increases even to despair. Bryonia is indicated by similar symptoms, particularly when the breasts feel empty, (according to others when they feel full and turgid,) when the urine is secreted in larger quantity, the lochia are not suppressed, (or when bloody lochia again make their appearance,) and no pain is felt in the rectum during stool; the exciting causes which have been mentioned for Nux vom. should likewise be absent. Bryonia is more particularly indicated by depression of spirits, painful sticking in the region of one or the other ovary, aggravated by contact, and indicating an inflammatory condition of those parts, with painfulness of the thigh of the affected side, particularly during motion.

Belladonna 30, is indicated by the following symptoms: Disappearance of the milk from the mammae, or else partial accumulation of milk with cord-shaped hardnesses, redness, radiating toward one point, (erysipelatous inflammation,) with stinging and tearing pains in the breast; short, oppressed breathing, anxiety; drawing, stinging, labour-like pains deep in the abdomen, with painful dragging towards the sexual parts and anus, and constant urging to stool, without ability to satisfy the desire, on account of a spasmodic constriction of the rectum, (for which Belladonna is a specific;) discharge of coagulated, fetid, black blood, or suppression of the lochial discharge; meteorism of the whole abdomen, without eructations or emission of flatulence, stinging-digging pains in the abdomen, which are aggravated by contact, and attended by constant irritation in the chest, and short cough; burning heat of the whole body, particularly of the forehead and palms of the hands, sweat on the rest of the body, and violent or moderate thirst, sometimes attended with impeded deglutition; excessive headache, a sort of pressing and pushing, particularly in the forehead, distention of the vesels of the head, and tur-gescence of the vessels of the scleratica, with con-traction or dilatation of the pupils, imparting to the eyes a glassy appearance; these symptoms are sometimes accompanied with illusions of sight, scintillations, luminous vibrations and colours before the eyes or even with amaurotic blindness; headache, which is increased by motion or noise, or even by the mere motion of the eyeballs, and is frequently so excessive that the patient loses her senses and is attacked with furious delirium.; the sleep is disturbed, and not it-freshing, the patient being constantly tossing about. Belladonna always deserves consideration when a puerperal fever has a typhoid character, or inclines to typhus, when symptoms of an inflammatory irritation of the meningeal membranes or brain is present, and when it was caused by violent emotions.

Arsenic is a distinguished remedy in puerperal fever. It is indicated by the following symptoms: Burning, or burning-gnawing pains in the interior of the offended parts, with inability to lie on the -affected side, and diminution of the pains during motion. Excessive anguish, with sudden prostration of strength, sunken, extinct eyes, yellow, livid complexion, nightly sleeplessness, restlessness, tossing about, and sensation as if burning-hot water were running through the blood-vessels: sleep disturbed by frightful and anxious dreams. The Arsenic-fever is always very violent; the heat is burning and dry with great thirst, frequent drinking, though little at a time, dry and parched lips, phlyctaenae about the mouth, nausea, and aversion to food, bilious vomiting, violent aching-burning pains in the abdominal organs, meteorism, oppressive pains in the chest, dizziness and headache, restlessness, delirium, small, feeble, intermittent pulse, etc.

Colocynthis is indispensable in puerperal fevers occasioned by indignation, chagrin, on account of unworthy treatment; they commence with tainting fits and sleeplessness, and are characterized by feverish heat, hot, dry skin, hard, full, and quick pulse, alternate sopor and delirium, with the eyes open, disposition to escape, heat about the head, stinging in the eyes and forehead, dark-red face, yellowish-coated tongue, bitter taste in the mouth, and of everything the patient eats, colic and diarrhoea after taking the least nourishment, with pain in the pit of the stomach on touching it; perceptible beating of the heart and all the arteries.

Arnica deserves a preference over all other remedies, if a condition resembling puerperal fever should have been developed by injuries occurring during parturition.

Hyoscyamus is a principal remedy in such fevers, particularly when typhoid symptoms predominate, with frequent discharge of coagula and spasmodic symptoms of the whole body or of single parts, trismus, starting of the whole body or extremities; and when these symptoms owe their origin to emotions of various kinds, Stramonium is related to Hyoscyamus.

Platina is indicated by irritation of the sexual organs, which frequently increases to nymphomania, and is accompanied with copious discharge of thick blood; the patient complains of a painful pressing down in the sexual organs, and distressing pain in the small of the back, with almost constant internal chills; violent pressing pain in the forehead, which is aggravated by every motion, and is attended with anguish, an anxious burning heat in the face, great thirst, and apprehensions of death. Sepia, Bell donna, Crocus, are likewise more or less indicated by those symptoms.

The diet should consist of light soups or broth, with a little bread, gruel, sago, vermicelli; after the fever has abated, a more substantial but easily digestible kind of nourishment may be substituted. Toast-water, sweetened with sugar, cherry or raspberry-juice, are the best kinds of beverage for the patient.