The puerperal Fever will be affected and diversified by different constitutions and temperaments, whether robust, plethoric, or delicate; by the quantity of the lochial discharge, the putrid atmosphere in the sick room, the medical treatment, the state of the atmosphere and seasons, and morbid quality of the prevailing febrile epidemick. Between five and fifteen days terminates the event in recovery or death. It is always most fatal when most epidemick, and the sooner it attacks after delivery. In some of our London hospitals, one half of the women ill of this fever have died; in others, one of seven. The crisis by discussion is followed by diarrhœa, by a serous or purulent transudation from the omentum or mesentery, into the abdomen; and from this cause sometimes consumption and dropsy. Some, even after a favourable crisis, have recovered slowly. When gangrene is the direful event, it is commonly within four or six days from the attack, and is known by the usual symptoms.
The predisposing and occasional _causes_ are, a peculiar noxious constitution of the atmosphere; errors in the non-naturals; anxiety of mind; hot cordial regimen; heated unventilated rooms after delivery, and impure air; hence miliary eruptions and profuse sweats. The immediate cause is generally ascribed to inflammation of the omentum, mesentery, or peritoneum, and the sudden contraction of the womb after delivery, dragging and tearing down with it these membranes. But it merits the most serious and mature investigation, whether to employ the remedies accommodated to inflammatory, or to nervous and putrid fever. We know that purulency in the abdomen and thorax is likewise found in the putrid fever of the West Indies.
_After-Pains; Weed, Milk-Fever; Inflammation of the Breasts_, are far less formidable foes than the preceding. After parturition, women are sometimes afflicted for some days with pains resembling colick; both in torture and severity extremely harassing. The _causes_ are, the continued and sudden contraction of the womb towards its natural dimensions; fragments of the placenta or membranes, or of clotted blood in the womb; injuries done to the fibres of the womb during parturition; violent extension of the suspensory ligaments; inflammation and irritation of the womb, or its neck: tender state of the intestines; flatulence; flatulent food; suppression of the lochia; errors in the non-naturals; a second child. Weed, or ephemera, sometimes occurs, and is the most simple and innocent species of fever; it is preceded by lassitude, slight wandering pains; a succession of shivering, heat and sweat, resembling an intermittent paroxism; and in the space of a few hours, or at the utmost days, the fever disappears. The causes are some errors in the non-naturals. Milk fever: during pregnancy and parturition the breasts sympathize greatly with the womb. This natural fever begins three or four days after delivery, with shivering and heat, pain, distention and throbbing of the breasts, shooting to the armpits, restlessness; after twenty-four hours, commonly terminating by sweat, diarrhœa, eruption of milk: the usual quantity of this nutritive fluid is from two to three pints daily. In the preceding puerperal stage, inflammation of one, but rarely of both breasts, is a frequent affliction, varying in degree and severity: its symptoms are local redness and swelling, burning heat, extreme tenderness, throbbing; and is terminated by discussion, frequently by suppuration; sometimes by scirrhus. The _causes_ are impetuous rush of milk to the breasts; excess of milk; not suckling; milk obstructed in the breasts or lactiferous tubes; suckling too soon; obstructed lochia; cold and obstructed perspiration.