§ 242. Puerperal fever.

This is an acute fever, to which lying-in women are exclusively liable, and which is generally accompanied with disturbance of one or more of the functions peculiar to those persons.

No disease has caused more lively discussion among physicians than puerperal fever; for no disease is more obscure than that malady.

The fever generally develops itself a few days after parturition. Its symptoms seem to constitute an acute peritonitis, where the fever frequently makes its appearance before the pain is felt, although there are cases where fever and pain appear simultaneously. The burning or cutting colicky pains are most frequently experienced in the umbilical region, whence they spread rapidly over the whole abdomen, and frequently become so violent that the least pressure or even touch is intolerable. Sometimes the fever exists without any pain. Meteorism sets in. Vomiting is frequently one of the first and most troublesome symptoms; the substances which the patient vomits up being at times like verdigris, dirty, bitter, and even faecal matter; at others, a discoloured, blackish fluid, resembling coffee-dregs. This is a bad symptom, for it points to a gangrenous softening of the mucous membrane of the stomach. At times, obstinate constipation, at others profuse diarrhoea, with bilious, purulent, fetid, grayish, blackish, bloody discharges, is present. The face is extremely pale, with circumscribed redness and sunken appearance of the cheeks; it exhibits an expression of consternation and despair.

If the fever should occur at a time when epidemic or endemic diseases prevail, it is disposed to assume the character of these diseases. Generally the fever has an erethic character, but it may likewise be a synocha, or a fever with typhoid or putrid symptoms. The erethic fever sets in with chills, followed by heat which alternates with the chills .for the first twenty-four hours, after which the heat becomes permanent, with irritated, hurried pulse, hot and dry skin, reddish urine, and abatement of the symptoms in the morning. These phenomena are more distinct when the fever is a synocha. If the fever have an adynamic character, the symptoms are: Sunken, disfigured countenance, prostration of strength, decreased painfulness of the abdomen, increased meteorism, vomiting, which cannot be allayed, diarrhoea, dry tongue and lips, which look as if coated over with soot, apathy, suppressed or discoloured, fetid lochia, small, very frequent pulse, dry or clammy, cool skin, miliaria, etc.

§ 243. According to the symptoms, the fever ought to be classed as follows: Peritonitis erethica; peritonitis inflammatoria; peritonitis erysipelatosa or gas-trico-biliosa; peritonitis typhosa, septica. The disease generally lasts from 5 to 15 days, but it may become fatal in from 2 to 3 days, or it may become a protracted disease. Terminations: Recovery, or else death by exudation, paralysis, etc.

The disease may be occasioned by colds, emotions, such as fright, fear, chagrin; injuries of the womb. Predisposing causes are: inflammation of adjoining parts, heavy labour, abuse of Chamomile-tea during and after parturition, and particularly the abominable practice of applying cold water to the pubic region to arrest metrorrhagia which set in soon after birth.

The prognosis is frequently unfavourable. If the patient be constitutionally feeble and cachectic, the prognosis is more unfavourable than if the patient should be robust and should generally enjoy good health. The prognosis depends likewise upon the character of the epidemic; upon the diseases with which the fever happens to be complicated; upon the period when the fever set in; for the sooner after parturition, the more acute the disease. The prognosis is unfavourable when the fever is attended with inflammation of the uterine veins and putrefaction of the uterus.

§ 244. The remedies corresponding to puerperal fever, are: Aconite, Chamom., Bellad., Puls., Rhus t., Ipec, Bryon., Colocynthis, Coff., Hyoscyom., Stramon., Arn., Ars., Nux v., Mercur., Platin., Verat., and several others.

The treatment has always to be commenced with Aconite, if the symptoms correspond to an inflammation of the bowels, or if pleuritic symptoms should be present. Even in fevers which are attended with frequent paroxysms of anguish, repeated doses of Aconite are of great service, although Ipec., Ars., Bryon., and other remedies are likewise indicated.

Before continuing our remarks on the treatment of puerperal fever, it seems expedient to speak of a disease which frequently co-exists with puerperal fever; we mean