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.
736/824 page 720
![wounded surfaces of the genital organs,is the only essentia] element of puerperal fever. This affection has recently acquired a new interest and importance in this country. Since the early part of the year 1>7<>. the editor has seen many eases of the disease. During the past five years it has prevailed more or less extensively throughout various parts of the country, and in the hospitals of some of our lame cities. Between February 7th, 1870, and July 1st, 1874, about one hundred cases of this disease occurred in the obstetrical wards of the Philadelphia IIos pital, of which twenty-five per cent, were fatal. We have already published a history of the outbreak in the American J<>,,r,i<il of tin Medical Sciences for January, 1875, from which this account of the disease is condensed. Symptoms.—The disease may set in suddenly or be preceded by certain premonitory symptoms. Among the latter are pelvic pain and uneasiness, usually supposed to be after-pains by the patient. This pain is at times associated with swelling and relaxation of the uterus, and a peculiar sunken, pale countenance, which continues throughout the disease. The last is a most important symptom when it occurs. Indeed, we believe it to be the most significant of the phenomena which are likely to be noticed before the outbreak of the disease. Pelvic- pain, tenderness, and enlargement of the uterus may be due to other and temporary cause-, but this change of the countenance, which will be more fully described in the appropriate place, indicates that a potent poison has already entered the blood, and commenced its destructive work. The symptom is withal very characteristic, and more than once it has been the first thing which has excited our alarm on entering the chambers of our patients, or the wards of the hospital. These symp- toms may exist for twelve or eighteen hours before the disease fairly explodes. If these premonitory symptoms are absent, the disease sets in suddenly at the end of the first or during the second, but rarely later than the third day after delivery. It may commence with a well-marked chill or a ri<2;or. The latter is the most common, though even this is some- times absent. The woman rarely has a severe chill. Succeeding this cold stage is a hot one, in which the febrile reaction is high. In the early stages the skin is hot and dry. Later, after two, three, or four days, it becomes moist, the perspiration appearing at irregular intervals. The heat of the skin during the first few days is very great. Calor mordax may be as marked as it is in scarlet, typhus, or relapsing fevers. Later, a marked elevation of temperature is not revealed by the touch. The digestive system is always more or less disturbed. In the early stages the tongue is covered with a white or yellowish-white fur. This sometimes disappears quickly, and in flakes, leaving the organ red, smooth, and dry, in the centre. In some cases the margins are red and clean, with a clean triangular space at the tip. During the last stages of the disease, the tongue may become dry, and covered with sordes. This is nearly always its condition in fatal cases. The appe- tite is almost always destroyed, though many women suffering from this disease will take all the food which is offered to them. Vomiting is a frequent though not a constant symptom. The ejected matters are](https://iiif.wellcomecollection.org/image/b21016112_0736.jp2/full/800%2C/0/default.jpg)
