A System of midwifery : including the diseases of pregnancy and the puerperal state / by William Leishman.
- William Leishman
- Date:
- 1875
Licence: Public Domain Mark
Credit: A System of midwifery : including the diseases of pregnancy and the puerperal state / by William Leishman. 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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![within the first twenty-four hours after its commencement. The patient should be hied when Bitting up in bed, and the flow should not be checked till syncope is about to occur. To lie useful, venesection must be employed boldly. We have seen it terminate the disease at once. There are few American practitioners, however, who follow either general or local depletion by the use of purgatives. These are very universally condemned in this country as dangerous remedies in this disease. They excite peristaltic action of the bowels, and incr rather than relieve the irritation and inflammation. The depletion should be followed by the use of vc rat rum viride and opium. Of the former enough should be given to keep the pulse thoroughly under control. It should be kept at 7) or 80 per minute. Opium relieves pain, quiets emotional disturbance, allays nervous irri- tability, and arrests the peristaltic movements of the bowels. It has t<» ho given boldly and in large quantities,because in this disease there i< a remarkable tolerance of its effects. Professor Alonzo Clark, with whom this plan of treatment originated, says that a woman who was unaccustomed to the use of opium in health, and who was not intem- perate, took the first twenty-six hours, of opium and sulphate of mor- phia, a quantity equivalent to 106 grains of opium: in the second twenty-four hours she took 472 grains: on the third day, 236 grains: on the fourth day. 1l!<> grains: on the fifth day. 54 grains: on the sixth day. ±1 grains : and on the seventh, 8 grains. It is therefore apparent that we are to be guided by the effect produced rather than by the quantity of medicine administered. My own rule i< to give enough of some fluid preparation of opium to bring the respirations down to 1 '1 per minute. The probabilities are that they will fall to 10 or even to x. which need occasion no alarm if the medicine has been carefully given. To produce this impression it is safe to commence with doses of one-third or one-half of a grain of morphia in solution, given every bour, and continued until the desired effect is produced. If it fails in this, the dose must be increased until the woman is semi-narcotized. The effect must he produced, no matter what quantity of opium is Deeded to do it. If vomiting interferes with the administration of the remedy by the stomach, it may be given by hypodermic injection. The opiate often has to he continued for many days. The tolerance of the patient is the best guide to follow in deciding when to diminish the quantity or to stop its use. A- the disease improves, the tolerance diminishes. Patients are often injured by stopping the opium too soon. This fact cannot be too strongly impressed upon tin' mind of the young practitioner. The local treatment of peritonitis is important. Turpentine stupes applied t«> the abdomen, and kept on as long as the patient will bear them, are useful as counterirritants, while, as Prof, Barker -;i\-. enough of the remedy i- probably absorbed to produce -mie constitu- tional effect. This is shown in the restoration of the suspended lochia] discharge, the diminution of the tympany, and the stimulation of the patient. When the turpentine i- removed, the abdomen Bhould be covered with soft cloths, wet with warm water, to which laudanum may <>r may uol he added, according to circumstances. The whole Bhould be](https://iiif.wellcomecollection.org/image/b21016112_0731.jp2/full/800%2C/0/default.jpg)
