A manual of midwifery : including the pregnancy and the puerperal state / by Karl Schroeder ; translated into English from the third German edition by Charles H. Carter.

  • Karl Schroeder
Date:
1873
Catalogue details

Licence: Public Domain Mark

Credit: A manual of midwifery : including the pregnancy and the puerperal state / by Karl Schroeder ; translated into English from the third German edition by Charles H. Carter. Source: Wellcome Collection.

Provider: This material has been provided by the Harvey Cushing/John Hay Whitney Medical Library at Yale University, through the Medical Heritage Library. The original may be consulted at the Harvey Cushing/John Hay Whitney Medical Library at Yale University.

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    tinal irritation. In the milder cases there is fulness and swelling of the intestine, with Blight inflammatory irritation of the mucous membrane ; but certainly, in rare instances, the irritation is con- tinual to the serous coat, and it may assume the proportions of peri- toneal irritation, and even that of acut«' peritonitis. The abdomen, already somewhat swollen and hard, swells still more. A circumscribed, or more frequently a more diffused, tender- ness, which may reach a very high degree, is observed (chiefly in tlie caecal region), and prolonged and even persistent vomiting may follow. The due evacuation of the intestine causes a rapid subsidence of all the symptoms. The diagnosis must rest chiefly upon feeling the faecal masses. A greatly distended rectum has less value, but more so the distension of Douglas's pouch with a very distended intestina] coil, which can be felt through the posterior wall of the vagina ; but the uniform distension of the whole intestinal canal is most distinctly observable by means of palpation of the abdomen, for although in normal puerperal women the abdomen is quite commonly somewhat distended, yet it is soft and easily compressed; but by the retention of large masses of faeces it becomes hard, as a rule uniformly unyield- ing, so that the uterus can be felt only with difficulty, even in the first days of the puerperal state. In other cases diffused swellings are felt. If also, by a combined examination, the sides of the uterus are found to be free from pain, and if there is tenderness, especially in the caecal region, we have uot to do with peritonitis in consequence of infection, but intestinal irritation through koprostasis. And in spite of the woman's assertion that the bowels have been opened regularly, that diagnosis must be persisted in, for it sometimes (and not rarely) occurs that, in spite of daily evacuations, the intestine is enormously distended. The line of treatment to be adopted is evident. It is advisable to pay attention to the intestinal functions in all puerperal women immediately after delivery, and especially in cases in which the bowels appear to be greatly overfilled. Aperient medicines ought to be given on the first or at the least on the second day after delivery. They are, as a rule, always indicated when the woman has had no stool until about the. fourth day. Castor oil is the mildest aperient, it irritates the bowels the least, and yet causes with great certainty a free evacuation. In rare instances only, re- peated doses of it do not act, and preparations of senna or rhubarb or calomel should then be administered. It'castor oil is refused on account of its nauseous taste salines may be given, which, of course, usually produce watery stools. But diarrhoea need not particularly he feared in the puerperal state. Often very Large quantities of feecea are evacuated by means of purgatives, but Poppel relates a of koprostasis which was relieved in the course of four days by forty-four very copious stools. Profuse haemorrhage is another frequenl cause of the elevation of tin- temperature of puerperal women. There ia pretty constantly increased frequency of pulse, lasting tor a Long time. The tempera- ture, as a rule, rises up to 89 C. (1022 P.), and remains, with less regular morning remissions, between 38 <(. and 39° C;