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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.
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![counted pulses of 165 or 170.] Tlie head rarely suffers much at first; but, in the progress of the disease, is apt to become stupid and comatose. The flow of the milk and of the lochia are usually suspended, though the latter is not always so ; but, in this last case, the discharge is thinner and more acrid. The stomach is sometimes, but not generally, troubled with sickness, and frequently discharges an offensive |>orraceous saburra; and a troublesome diarrhoea attacks the bowels.* In the opinion of Mr. .John Hunter, the disease takes place in consequence of an injury done to the peritonauni, as forming a cavity, by which its present state is either suddenly changed or rendered imperfect. The injury, done to the peritomeum in the case of women aflcr delivery, he ascrilies, as his sentiments are delivered by Mr. Cruiksliank, ta two causes. Sometimes it pro- ceeds from a want of disposition in the womb to recover itself after labour; by which the j>eriton.Tun, os a cavity, must necessarily be affected. At other times from a too sudden emptying of the alxlomen; whence the peritomeum cannot always recover itself so as to be properly adapted to its new condition. This last cause, he observes, may also hold wuh men after the operation of the para- centesis. Hut, in them, besides the sudden emptying of the abtlomen, there is the additional crrcumstance of a wound, which renders the peritoneum, as a cavity, imperfect. When an inflam- piation of the peritoneum occurs, it most frequently happens, as he stHl further remarks, that it spreads over all the cavity of the abdomen. An extravasation of fluids takes place into that cavity, mixed with pus. The different viscera adhere by their peritoneal coats. The intestines are distended with air. And the irritation, thus induced, kills the j)atient long Imfore granulations, or an obli- teration of the cavity in the second method, can occur.f Neither of these two causes, however, by themselves will often, if ever, produce the fever before us, or even peritona-al inflammation alone. I'or the uterus is perpetually exhibiting a morbid enlarge- ment. without a disposition to recover itself: and the abdomen, sudden evacuation, while no such fever ensues. There must co- operate a peculiar temperament, or a peculiar condition of body at * “ If wc consult tlic works of the most celctirated writers in this country on pucr[K-ra! fever, it will clenriy apjrcar,” says Dr. UolH'rt Lee, “ that they all de- scribe the disease as commencing with a sense of soreness, or cxrjuisilc tenderness in the region of the uterus ; and that where it proves fatal, the appearances on dissection are such, as afford unetpiivucal proofs of inflammation of one or more of the pelvic and abdominal viscera. Strother, Burton, Millar, and Vallace Johnson, state, that the distinguishing marks of the disease are pain of the hypo- gastric region, alxlomen and loins, and that relief often follows venesection.” (Cjclop. of Bract. Me<l., loc. cit.; These unintended conflrmations of the inmlerri doctrine which Dr. fiood represents as having been also that of Hip. pocrates and Boerlmave) are highly deserving of attention. Ed. t Edin. Med. Comment., vol. iii. p. Now that the pathology of pucr- peral fever is better midorstood, these reasonings about the cause of peritonitis, the imaginary essence of the disease, are not of great im|K)rtnnce. Tliat the pr'riumarum is fretpienlly inflamed, is nndonhieilly true; hut that it is always so, is not the fact. In c;isi*s, eiaminetl after death by M. Tonelle, the uterus was afl'ectrd in 197, and the periton.xum in 19:1. There wa.s pus in the uterine veins and lymphalict in 134 cases. Des Fievres I’ucrjrerales olrservfes a la Matemite de J’aris, ]>cndaiit r.\iin£-e 1829; Arch. Gcii. de MW., Mars it Avril, 1830. — Ed. Cek. IV. Srec. HI. 8 E. Synochus puerjrerarum. Explanation given by J. Hunter. Tltese causes rarely adequate of themselves. A peculiar temperament of body neces- sary as an ac- cessory.](https://iiif.wellcomecollection.org/image/b28268878_0001_0775.jp2/full/800%2C/0/default.jpg)
