Essays on the puerperal fever and other diseases peculiar to women. Selected from the writings of British authors previous to the close of the eighteenth century / Edited by Fleetwood Churchill.

  • Churchill, Fleetwood, 1808-1878
Date:
1849
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Licence: Public Domain Mark

Credit: Essays on the puerperal fever and other diseases peculiar to women. Selected from the writings of British authors previous to the close of the eighteenth century / Edited by Fleetwood Churchill. Source: Wellcome Collection.

    63/580 (page 51)
    natural, safe, or effectual remedy in this case. I mean that spontaneous hemorrhages are seldom critical in this disease, that women in childbed bear bleeding worse than in other circum- stances, and that we shall be very often disappointed in our ex- pectations if we rely upon it. It is likewise worthy of observation, that those women who have lost much blood at the time of de- livery are more liable to this disease than others, and that it is much more fatal to them. The consequences also of erring by the too free use of the lancet are commonly worse and more irremediable than those which arise from the opposite caution.! In general, however, it will be found necessary to take away some blood in the beginning, and we must be guided as to the quantity by the strength of the patient and by the violence of the symptoms. If much benefit has been derived from the first operation, and the circumstances of the case should require it, we shall be justified in repeating it, but with circumspection; for we shall commonly find that subsequent bleedings are either useless or prejudicial, if the first has failed to give per- ceptible relief. It was also observed that this evacuation should take place in the beginning, because after the fever has continued a very few days, the putrid symptoms advance very * [Upon this point, however, Dr. Denman changed his opinion; for in the third edit., dated 1785, I find the following paragraphs substituted for the above :—“ But I am now convinced by manifold experience that my reasoning was fallacious, and my fears groundless ; and that what I had considered as proofs of the insufficiency or impropriety of bleeding, ought in reality to be attributed to the neglect of performing it in an effectual manner at the very beginning of the disease. In short, if the first stage be suffered to pass unheeded, the opportunity will be lost; and the physician afterwards called in, however great his talents may be, will too often have the morti- fication of being a spectator of mischief which he cannot then remedy, and of an event which he can only deplore. “Tt is in general absolutely necessary to bleed freely in the beginning of the puerperal fever, and we may then avail ourselves of the advantage which this opera- tion affords, with equal safety and propriety as in any other inflammatory disease under other circumstances. With respect to the quantity of blood drawn, we are to be guided by the constitution of the patient, and the violence of the symptoms. If benefit should be derived from the first operation, and the violence of the disease should require it, we shall be justified in repeating it at short intervals, not with a view of moderating or retarding the progress of the inflammation, but, if possible, of wholly suppressing it ; for when the fever has remained for a very few days, the putrid symptoms advance very rapidly, and its continuance depends upon causes which can- not be removed by bleeding. When the attack is violent, and the constitution feeble, it may be more safe, and sometimes more expeditiously serviceable, to draw blood by - scarification or cupping, or by the application of eight or ten leeches to that part of the abdomen which appears to be principally affected.” (p. 20.)—Ep.]