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

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Puerperal tion of air, which he evinces to be of the greateft im-
i portance. In refpedl of bleeding, he informs us, that,
upon the flrictefl. inquiry, he cannot find that thofe who
have bled the molt copioully have had the greateft fue-
cefs, either in private or holpitai practice, fie even
lee ms to queftion the propriety of this evacuation in any
cafe ; but approves of emetics, cathartics, and clyfters,
for cleanfing the prinue vice, and likevvife of fuch me¬
dicines and diet as will corredt the putrid humours : add¬
ing, tnat an upright polture and free ventilation are at
all limes ufeful, and abfolutely neceiTary, botli for the
prevention and cure of the difeafe.
Another writer who treats of the childbed fever is
Dr Leake, who has publilhed the refult of his obferva-
tions on this difeafe from April 1768 to the autumn of
the year 17705 but chiefly from December 176910
May 177°, during which period the childbed fever
prevailed much about London.
Dr Leake tells us that this fever generally commen¬
ced the evening of the fecond or morning of the third
day alter delivery, with a rigor or Ihivering fit. Some¬
times it invaded foon after delivery 5 and at other times
though rarely, it has feized fo late as the fifth or fixth
day. Now and then it feemed to be occalioned by
catching cold, or by errors in diet 5 but oftener by an¬
xiety of mind. Sometimes the thirl! was great 5 though
the tongue had, in general, a better appearance at the
beginning than is common in other fevers. It was fel-
dom ever black or very foul : but, as the difeafe advan¬
ced, became white and dry, with an increafe of thirl! 5
and at laft ivas of a brownilh colour towards the root,
where it was {lightly covered with an infpiflated mu¬
cus. The lofs of Ifrength was fo great and hidden,
that few of the patients could turn in bed without af-
liltance, even fo early as the firlt or fecond day after
the attack. The lochia, from firlt to lalt, were not
obltructed, nor deficient in quantity 5 neither did the
quality of this difeharge feem to be in the leal! alter¬
ed from its natural date 5 a prefumption, fays the au¬
thor, that the uterus was not at all affebted. Of this
he was convinced by making a confiderable preffure
above the pubes with the hand, which did not occa-
fion pain 5 but when the fame degree of preflure was
applied higher, between the Itomach and umbilical re¬
gion, it became almoll intolerable. A perfeft crifis
feldom if ever happened in this fever, which he imputes
to the great oppreflion of the vital powers, whereby
they were rendered unable to produce fuch an event.
When the difeafe proved mortal, the patient general¬
ly died on the 10th or nth day from the firlt attack.
In thofe who died of the fever, the omentum was found
luppurated 5 an inflammation of which part, or of the
inteftines, Dr Leake concludes to be the proximate
cauie of the difeafe.
. In confequence of this idea of the caufe of the dif¬
eafe, Dr Leake affirms that venefeftion is the only re¬
medy which can give the patient a chance for life. But,
though it be the principal refource to be depended
upon at the beginning of the fever, he obferves that
it will feldom prove of fervice after the fecond or third
day 5 and if direfted yet later, will only weaken and
exhauft the patient 5 when, matter having begun to
form in the omentum, the progrefs of the difeafe can
no longer be prevented by that evacuation. At this
period the blood begins to be tainted by the abforption
5
C 1 N E- Appendix.
of the purulent fluid 5 and the fever, from being inflam- Puerperal
matory, is changed into a putrid nature. Fever.
After bleeding in fuch a quantity as the fymptoms ' r—'
require, he adviies that the corrupted bile be evacua¬
ted and corre&ed as foon as pofiible 5 that the diar¬
rhoea, when exceflive, be reltrained by emollient ano¬
dyne cly Iters and gentle fudonfics, or even by opiates
and mild aftringents, when the patient’s flrength be¬
gins to fink under the difeharge 5 and, lallly, that
where the figns of the putrefaction or intermiffion take
place, antiieptics and the cinchona may be admini-
Itered.
The great uniformity of the fymptoms in all Dr
Leake’s patients might authorife an opinion, that the
fever which he deferibes was in a great meafure a dif¬
eafe fui generis, and depended much upon the conlti-
tution of the air preceding and during the period in
which the fever prevailed.
Dr Kirkland has alio made judicious obfervations on
this fubjefl, He rejeefs the opinion that the puerpe¬
ral fever is a difeafe fui generis, and arifes always from
the fame caufe. The particular lituation of childbed
women, he acknowledges, occafions a fimilarity in the
appearance of all the febrile fymptoms : but he afr
firms that the fame kind of fever may be produced by
various caufes 5 for inftance, by an inflammation of the
uterus or abdomen, by putrid blood or other matter,
and putrid miafms. The fymptoms, he obferves, will
vary according to the time of feizure. If the fever
happen in three or four days after delivery, all the
fymptoms ufual to the fituation of the patient will
make their appearance 5 but if it do not invade till
the milk has been fecreted, and the lochial difeharge be
nearly finilhed, the fymptoms, if the breads are proper¬
ly drawn, will, for the mod part, be thofe only which
are common to that kind of diforder by which the fe¬
ver has been produced.
With refped to the cure of puerperal fevers, Dr Kirk¬
land advifes the antiphlogidic method when they arife
from inflammation 5 but when this method fails of fuc-
cefs, and a diarrhoea fupervenes, the difeafe has changed
its nature, having become more or lefs putrid, and re¬
quires a very different treatment.
His obfervations relative to the management of the
diarrhoea merit attention. No one, lays he, would
purge and bleed to cure the colliquative fever arifing
from the abforption of matter in large wounds 5 and yet
the only difference is, that in the puerperal fever the
matter abforbed from the uterus, &c. adds with more
violence, becaufe the blood is commonly thinner and
the habit in a more irritable Hate. We fee, continues
he, that abforbed matter purges as effectually as if any-
purging medicine had been given by the mouth 5 and
may we not therefore do harm by additional purging,
when there has been a large evacuation, efpecially as
purges in this cafe are incapable of entirely removing
the fatties morbi?
He confiders cinchona as the principal remedy, as
foon as the pulfe finks, the heat is leffened, and the
ftomach will bear it. If this increafe the diarrhoea be¬
yond moderation, he joins with it fmall dofes of lauda¬
num j but if the diarrhoea Ihould entirely flop without
the fever going off, in place of laudanum he advifes a
proper quantity of rhubarb. Should the diarrhoea, not-
withltanding the ufe of the medicines propofed, be¬
come