Licence: Public Domain Mark
Credit: The study of medicine / by S. Cooper. Source: Wellcome Collection.
Provider: This material has been provided by Royal College of Physicians, London. The original may be consulted at Royal College of Physicians, London.
774/788 (page 716)
![Gen. IV. Spec. III. 8 E. Synochus puerperarutn. Description. Great fre- quency of the pulse. itself, and that the uterus is often very little affected; and this too, though the inflammation should spread, as it often does, toother organs in the vicinit)'. * llie disease usually commences on the second or third day after delivery; though, sometimes, it occurs rather later, and, according to Professor Frank, sometimes a little before delivery.f [Dr. Blundell has known death occur, with all the symptoms of puer- peral fever, within the first four-and-twenty hours after parturition ; and Dr. Haighton used to relate the case of a woman who died of a puerperal fever, which commenced ten or twelve days after delivery. According to Dr. Blundell, the later the attack, the less is generally the pertinacity of the symptoms.] It is marked by all the common symptoms of a severe febrile incursion, in combination with the tenseness and tenderness of the belly. The muscles of the back and hips are in great pain; the abdomen is tender, often acutely painful, and the pain is greatly increased by pressure, which peculiarly distinguishes this disease from enteritis; and, as the diaphragm is affected by contiguous sympathy, the breathing is also short and laborious, accompanied with most distressing anxiety. [In puerperal fever, the pulse is noted for its extra- ordinary frequency. Dr. Blundell says that it, is scarcely ever below ] 15 in a minute, unless the disease be yielding to remedies ; and more commonly it rises to 120, 130, or HO; and he has • Puerperal fever is much better understood at the present time, than when Dr. Good wrote this part of liis work ; and instead of its being essentially a disorder proceeding from peritonitis, as was once the common belief, it is only sometimes accidentally conjoined with it. Hence the idea of the case being the same as peritonitis from Lipping is completely erroneous. “ I’rom the 1st of Janu.iry, 1827, to the 1st of June, 1832,” says Dr. Lee, “ 162 cases of well- marked puerperal fever came under our immediate observation in private practice, and in the British Lying-in Hospital, and other institutions in the western dis- tricts of London. We watched the symptoms and progress of these cases with the closest attention, observed the elfects of the different remedies employed, and, where death took place, we carefully examined the alterations of structure in the uterine and other organs. Of fifty-six cases, which proved fatal, the bodies of forty-four were examined, and in all there was found some morbid change, the effect of inflammation, either in the peritonwal coat of the uterus, or uterine appendages, in tlie muscular tissue, in the veins, or in the absorbents of the uterus, which accounted, in the most satisfactory manner, for all the constitutional dis- turbance which had been observed during life. The peritonajum and uterine appendages were found inflamed in thirty-two eases; in twenty-four cases tliere was uterine phlebitis; in ten there was inflammation and softening of the mus- cular tissue of the uterus; and in four the absorbents were filled with pus. 'I'hese observations are subversive of the general opinion, now prevalent in Europe and America, that there is a specific, essential, idiopathic fever, which attacks )uicrperal women, and which may arise independent of any local affection in the uterine organs, and even prove fatal, without leaving any perceptible change in the organization of any of their different textures. As the constitutional symptoms thus appear invariably to derive their origin from a local cause, it would be more philosophical, and more consistent with the correct principles of physiological arrangement, to banish entirely from medical nomenclature the tenns puerperal and childbed fever, and to substitute in their jilace that nj uterine iiifiammcUiun, or inflammation of the uterus and its appendages in puerperal women. The terms puerperal peritonitis and perilonatal fever, employed by some English and foreign physicians, are not less objectionable than puerperal fever ; for, in many of the fatal cases, there is no proof whatever of the existence of any affection of the peritomeum.” Dr. 11. Lee, in Cyclop, of Pract. Med., art. PuERrKBAi. Fever. — En. f Dc Cur. Ilcm. Morb, tom. ii. p- 189. 8vo. Mannh. 1792,](https://iiif.wellcomecollection.org/image/b28268878_0001_0774.jp2/full/800%2C/0/default.jpg)
