Encyclopaedia Britannica, or, a Dictionary of arts, sciences, and miscellaneous literature : enlarged and improved. Illustrated with nearly six hundred engravings > Volume 13, MAT-MIC

appendix. M E D I
Puerperal 0f cure, it will be proper to mention Here the eircum-
Fever. fiances by which it may be known with greater cer-
"■"_v tainty.
The pains of the abdomen, attending the childbed
fever, may be dillinguifhed from thofe called after-
pains, by their uninterrupted continuance through the
courfe of the difeafe, though fometimes they" fuffer
exacerbations •, whereas, in the latter, they often to-
tally intermit. They are alfo diftinguifhable by the ab-
fence of fever with concomitant fymptoms in’the one,
and their evident exiftence in the other.
Many circumftances evince a diffimilarity between
the puerperal and miliary fevers, notwithllanding the
fymptoms of anxiety and oppreflion are common to
both mfomuch that the nature of the approachin0*
difeafe may be afeertained at the very commencement
of its attack. In the puerperal fever the rigor is more
violent, of longer duration, and not interrupted, as it is
in the other. The pulfe is fuller and ftronger the tkin
is more hot ; and the tongue, whether moiit or dry,
though generally the latter, is not of a white, but
brownifh appearance 5 and the urine is alfo higher co¬
loured. Eruptions, which are critical in miliary fevers,
procure no mitigation of the puerperal fever, and
cordials generally increafe it.
When the original attack of the puerperal fever hap¬
pens to coincide with the febrile commotion which is
excited in childbed women by the milk, the nature of
it may at firft be mifapprehended ; but the concomitant
fymptoms, and greater violence of the difeafe, muft in
a fhort time diflipate fuch an error.
From all the moft accurate accounts of this difeafe,
and from the period at which it generally commences,
there feems reafon to conclude, that it owes its rife
more immediately to accidents after delivery. For it
is allowed that it may follow a labour under the belt
and moft favourable circumftances, though endeavours
to dilate the os internum are fuppofed frequently to
produce it. The more immediate caufes generally af-
figned by authors are a ftoppage of perfpiration, the
too free ufe of fpic'es, and the neglect of procuring
ftools after delivery 5 hidden frights, too hafty a fe-
paration of the placenta, and binding the abdomen too
tight. The putrid appearance, hoivever, which this
difeafe fo loon aflumes, affords ground to fufpeft that
the prcdifpoftng caufe of it is a vitiated ftate of the
humours 5 for it is generally obferved to be moft pre¬
valent in an unhealthy feafon, and among women of a
weakly and fcorbutic conftitution. But from its pre¬
valence in fome particular hofpitals, while others in the
fame city are entirely free from it, there can be little
doubt that it is often communicated by contagion from
one female to another. This opinion is corroborated
alfo by many other circumftances j particularly by the
means by which it has been removed from hofpitals.
It would feem, however, that this contagion does not
a£l on the female fyftem without a certain predifpofition,
and that this predifpofition is induced by thofe changes
to which the female habit is fubjefted in confequence of
delivery.
Within thefe few years this fever has been treated
of by feveral writers, moft of whom have differed from
each other in their fentiments of the nature of the dif¬
eafe. The firft; in the order of publication is Dr
Denman, who feems to be of opinion, that it may de-
CINE. -463
rive its origin either from a redundancy or too great Puerperal
acrimony of the bile, the fecretion of which appears, Fever-
to be much interrupted in the time of geftation. In
.Dr Manning’s treatife on this fever, he" mentions its
being highly probable that fuch a caufe contributes
greatly to produce the difeafe, efpecially where the
putrid tendency of the humours is increafed by un-
wholefome air and diet.
It has likewife been the fate of the puerperal fever,
that no difeafe has more divided the fentiments of phy-'
ficians in regard to the method of cure. The appa¬
rent indications and contra-indications of bleeding,
and other remedies, arifing from the complication of
inflammatory and putrid fymptoms ; the equivocal ap¬
pearance of the vomiting and purging, as whether
they be critical or fymptomatical 5 and the different
caufes whence fymptoms fimilar to each other may
arife in pregnant women ; all thefe circumftances con¬
cur to involve the fubjefl in great obicurity and inde-
cifion. If we carefully attend to the feveral charac-
teriftics of the difeafe, however, fo as to be able to di-
ftinguifh it from every other puerperal complaint, and
obferve at the fame time the ufual manner of its de-
clenfion, our judgment may be guided in the method
of cure by the falutary efforts of nature. But, in
order to obtain a clearer view of the genuine indica¬
tions, it will be proper to confider them under the fe¬
veral lights in which they have been generally apitated
by authors.
One of the moft effential points to be afeertained in
the cure of the childbed fever, refpedts the pro¬
priety of bleeding. A free ufe of the lancet has been
generally regarded as the moft fuceefsful expedient
in practice ; and there are fome inftances of critical
haemorrhages which wmuld feem to confirm its uti¬
lity. But Dr Denman thinks we may fafely affirm
from experience, that for one who rvill be benefited by
large bleeding, a much greater number will be inju¬
red, and that even almoft irretrievably. Nor can this
feem furprifing, when we confider the fituation of
childbed women. In moft, the evacuations confe-
quent upon delivery are fufficient to diminifh any un¬
due fuperabundance of the fluids 5 and if, as frequent¬
ly happens, the difeafe be produced by too hafty a fe-
paration of the placenta, the confequence of which is
generally a very copious difeharge of blood, we can
never fuppofe that nature will be affifted in overcoming
the febrile commotion, by the farther evacuation of
the vital fluid, through the defeat of which ffie is now
rendered unequal even to the ordinary fupport of the
animal oeconomy. We may appeal to every praflical
phyfician, how much he has known the pulfe to fink,
and what a train of nervous fymptoms he has obferved
to fucceed an excels of the difeharge above mentioned..
Befides, it is an axiom in phyfic, that a remedy which
cures any diforder, will always prove fufficient to pre¬
vent it; and therefore, if bleeding were the proper cure
in the childbed fever, the difeafe ought to have been
prevented by a large evacuation of blood, when that
happened previous to its attack. Experience, how¬
ever, in this, as in all other difeafes, is the only uner¬
ring guide we can follow 5 and whoever regulates his
practice by fadl and obfervation, will be convinced that
bleeding, efpecially in a larger quantity, is, in general,
very far from being attended with fuccefs. Bleeding
is