§ 245. Putrefaction of the uterus, or endometritis septica.

This disease never occurs except in lying-in females, both after miscarriage and natural delivery. Precursory symptoms exist even during pregnancy, but they are so slight that no very dangerous disease is apprehended. Anomalies occur likewise during parturition, such as spasmodic pains, slow labor, exhaustion, symptoms which do not indicate the approach of any very dangerous disease. Local symptoms are: Burning pain over the symphysis pubis; on examination, the uterus is found contracted and hard; in other cases there is no pain, the uterus is distended, raised, the substance is soft, flaccid, insensible, the lochia are ichorous, and have a fetid smell. The labia are swollen, and gangrenous streaks are discovered in the vagina. The neck of the uterus is soft, burning-hot. not very painful, discharging a bloody ichor on pressure. The mammae become flaccid, the flow of milk either stops suddenly or gradually.

The patient experiences chills, followed by heat; dry, hot skin, particularly in the palms of the hands. She does not complain of pain, but a feeling of indescribable weakness and languor of the extremities. The respiration is oppressed, the pulse frequent, small, feeble, wiry. There is a peculiar distortion of the features, great restlessness, anguish, unquenchable thirst, though the tongue is at first moist. The mind dwells upon thoughts of death. Little by little the skin becomes dead, like paper; there is a sensation as if a cool air were blowing on the parts, although the body is otherwise hot to the touch; delirium, grasping at flocks, irregular, laboured breathing, and even lock-jaw, supervene. These symptoms indicate putrefaction of the uterus, which is generally a fatal disease, inasmuch as death is near at hand when the symptoms are sufficiently developed to diagnose the disease.

§ 246. The disease lasts from 10 days to a fortnight. Women who lead a sedentary life, have much care and anxiety, live in damp dwellings, are most liable to it. The disease occurs either spontaneously or epidemically (in lying-in hospitals.)

Terminations: Recovery, by separation of the gangrenous parts, and abatement of the fever; suppuration, leading to phthisis of the uterus; death.

The prognosis is highly unfavourable. The more fetid the lochia, the more dangerous the disease; putrefaction occurring during pregnancy, or spontaneously, is likewise very dangerous. Livid complexion, and supervention of convulsions, are very dangerous symptoms.

§ 247. During a practice of 28 years, I have met with only three cases of putrefaction of the womb, attended with an eruption of rash on the trunk, and, during the last two days, with miliaria alba; all those cases proved fatal. Aconite, Ipec, Bryon., China, Ars., Arn., Puls., seem to correspond to the disease, but are given without avail. The disease might perhaps be arrested if attacked during pregnancy, but the symptoms are so little developed that neither the patient nor the physician is aware of the approaching change. Carbo animalis or veget. might perhaps prove useful if the disease be fully developed. Kreasot., Sec. corn., Phosphorus, and Nitr. ac, in large doses, correspond perhaps more than any other remedies to uterine affections and gangrenous symptoms of other organs.

Before resuming our remarks on the treatment of puerperal fever, we will first indicate the treatment of