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Childbed Fever.Symptoms. -Y or the first two or three days after delivery, there may be no indication of anything wrong ; but on the fourth or fifth day the woman becomes somewhat listless, loses her appetite and has perhaps a slight headache. A few hours subsequent to the development of these symptoms, there occurs a chill which is often of such violence as to shake the patient's bed; this is followed by a high fever, intense pain in the head, flushed face, suffused eyes, pain and extreme tenderness in and around the enlarged womb. Within twenty-four hours the abdomen is often somewhat bloated ; the lochial discharge ceases, or is at least much diminished and often very offensive ; the milk not infrequently is greatly lessened in quantity. In severe cases delirium occurs after a few hours of intense fever. Causes. - The various affections collectively known as puerperal fever, originate in one of two ways : first, and usually, in the neglect to secure complete evacuation of the womb and subsequent cleanliness of the vagina; secondly, and less often, except in hospitals, by infection either from other lying-in women or from the subjects of surgical injuries and infectious disease. It may be said, in general, that the most efficient means for the avoidance of puerperal fever consists in the most scrupulous care as to all the details already indicated as essential in the conduct of labor. The presence of the hand on the abdomen over the womb from the moment that the child is expelled and until at least an hour have elapsed; the removal of the afterbirth by gentle kneading of the womb; the repetition of this process for several days after delivery, in order to expel clots of blood that may have formed in the womb ; the careful cleansing of the external parts every few hours and of the vagina, by the use of the syringe ; the maintenance of the recumbent posture for twelve or fourteen days after delivery-all these are important aids in avoiding the disasters of childbed. The disease is, fortunately, rare in private houses, but numbers many victims in hospitals or other institutions where many sick are gathered under one roof. During certain seasons, too, childbed fever seems epidemic, occurring under the most favorable conditions, even in farm houses far removed from all other human habitations. The treatment of this affection will, of course, be referred to the medical attendant. Before his arrival it is advisable, so soon as the symptoms above detailed have established the nature of the case, to adopt at least three measures : first, the administration of five or ten grains of quinine every three hours; second, the administration of a laxative, or if the stomach be irritable, the injection of warm water into the bowels ; third, the application of heat and moisture to the lower part of the abdomen. This latter measure can be best effected by putting the woman bodily into a bath of a temperature of iooq, and permitting her to remain there fifteen minutes, after which she may be briskly rubbed with a coarse towel and wrapped in warm blankets. If there be no facilities for a full bath, the next best thing is a hip bath ; in the absence of this, two quarts of warm water may be slowly injected into the vagina by a Davidson syringe. In any case, flannels wrung out in hot water should be applied to the abdomen and covered with oiled silk; these cloths should be frequently changed so as to keep the skin warm and moist. After five or six doses, the quinine should be given at longer intervals or in smaller quantities-about three grains every four hours-since the administration of large doses for a long time is followed by ringing in the ears and a semi-stupor, which may last for several days. It is not advisable for the non-professional person to go further than the above treatment, except under medical advice. The physician may find some source of infection - such as a piece of the afterbirth-which it is possible to remove; or he may suggest some additional remedies which the circumstances of the individual case may suggest. The chief indications are as already indicated, to keep the temperature down by the application of hot water and the administration of quinine, and to keep the parts clean and moist. Another distressing incident of childbed is puerperal mania. This is by no means a rare occurrence. It happened in one in every ten cases observed for a considerable time in Paris - and this is probably a low estimate of its frequency. " In the majority of cases, the disease first manifests itself within a fortnight after delivery ; in such cases there is usually, even from the time of delivery, an unusually troubled and agitated manner, a suspicious look upon the face, indicative of anxiety ; a marked peevishness of temper and objection to control or direction ; not infrequently violent fits of passion are exhibited without apparent provocation ; occasionally one of the first indications will be a sullen obstinacy or listlessness and stubborn silence. A patient lies on her back, and can by no means be persuaded to reply to the questions of her attendants, or she will repeat them as an echo, until all at once, without any apparent cause, she will break out into a torrent of language more or less incoherent, and her words will follow each other with surprising rapidity. These symptoms will sometimes show themselves rather suddenly, on the patienc's awakening from a disturbed and unrefreshing sleep, or they may supervene more slowly when she has been harassed with watchfulness for three or four nights in succession, or perhaps ever since her delivery. She will very likely then become impressed with the idea that some evil has befallen her husband, or what is still more usual, her child - that it is dead or stolen ; and if it be brought to her, nothing can persuade her it is her own ; she supposes it to belong to somebody else ; or she will fancy that her husband is unfaithful to her, or that he and those about her have conspired to poison her. Those persons who are naturally the objects of her deepest and most devout affection are regarded by her with jealousy, suspicion and hatred. This is particularly remarkable with regard to her new-born infant, and I have known many instances where attempts have been made to destroy it when it has been incautiously left within her power. Sometimes, though rarely, may be observed a great anxiety regarding the termination of her own case, or a firm conviction that she is speedily about to die. I have observed, upon occasions, a constant movement of the lips while the mouth was shut, or the patient is incessantly rubbing the inside of her lips with her fingers, or thrusting them far back into her mouth ; and if questions are asked, and particularly if she be desired to put out her tongue, she will often compress the lips forcibly together, as if with an obstinate determination of resistance. One peculiarity attending some cases of puerperal mania, is the immorality and obscenity of the expressions uttered ; they are often such, indeed, as to excite our astonishment that women in a respectable station of society could ever have become acquainted with such language. "-Ramsbotham. In many cases lochial discharge ceases and the milk dries up, though this is by no means an essential feature of the case. It is often difficult to persuade the patient to eat, indeed at times it is necessary to employ force to supply her with nourishment. Another unpleasant feature is an occasional disposition to commit suicide. This disease is, fortunately, only temporary, as a rule, and but few deaths occur during its course. In a certain number of cases insanity persists, and may even become permanent. Yet in the majority of instances the delusions gradually disappear, and in the course of three to six weeks the patient becomes again quite rational. But first, if you want to come back to this web site again, just add it to your bookmarks or favorites now! Then you'll find it easy! Also, please consider sharing our helpful website with your online friends.
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