WE are in this place only to consider the Acute Distempers of the Puerperial Woman, because the Time of lying-in is not of such a long Continuance as to admit of Chronick Diseases: And these Acute Ones, in short, which they are most commonly subject to, are continual Fevers, (Either, 1. Essential, that is, Fevers proceeding first from the Blood; or, 2. Symptomatick Fevers, that is, such as follow upon the internal Inflammations, which often attend the Child-Bed-Woman;) as also Frenzies, Watchings, Lethargies, Convulsions, Epilepsies, &c.—
BUT more especially there is one particular kind of Fever, which invades almost all labouring Women the third or fourth Day after the BIRTH, and is commonly call’d the MILK-FEVER; because about that time, the MILK begins to generate more plentifully in the Breasts, taking its Rise from the Motion and Agitation of the Blood, which converts it from the Womb to the Breasts. This Distemper, resolving itself about the ninth Day by Sweat, is of no dangerous Consequence; provided the PATIENT observes a good and proper Diet, and duly prevents all Cold, that might readily stop the Sweat, and carefully preserves the Milk from coagulating or putrefying in her Breasts, whence the Symptomatick FEVERS commonly arise: Wherefore, I say, this MILK-FEVER, being of the extended Ephemerick Sort, and ceasing of itself, requires no great Cure.
ONLY in this Case, it is a vulgar Error among the good Women, that because this FEVER lasts only four or five Days at most, coming on about the fourth, and ending about the ninth Day after the BIRTH, they take all Fevers in this time, for the MILK-FEVER; and consequently thro’ this Mistake, neglecting, or not regarding duly the true Condition, the Patient is very often endanger’d: Which Mistake, that they may for the future diligently avoid, I shall subjoin here some certain Signs of Distinction in due Course. But previously——
THE Causes of all FEVERS incident to the Child-Bed-Woman, are either the Suppression of the Lochia in whole or in part; or the vitious Quality of the Humours accumulated in Gestation, and exasperated in the Birth; or a vitious irregular DIET in the time of lying-in; or the cold Air, or any such Accident by bad Management, may readily convert the MILK-FEVER into a putrid and dangerous one; as a latent CACOCHYMY may also easily dispose it to Corruption.
THE true DIAGNOSTICKS, in my Opinion, are as follow, viz. First, the MILK-FEVER is known from hence, that it always begins about the Fourth Day, when the BREASTS begin to fill with MILK; and then the LOCHIA flowing regularly, the Woman finds a certain Gravity or Weight in her Back and Shoulders.
BUT, Secondly, when the LOCHIA are suppressed, whether in whole, or in part, ’tis then certain that the present FEVER proceeds from thence; the BELLY thereby swells and is puffed up, as also it is pained when touched; and the Humours, at last, putrefying in the WOMB, it ejects a certain fœtid or corrupt Matter.
WHEREAS, Thirdly, if the FEVER neither proceeds from the MILK, nor from any Irregularity of the LOCHIA, why then it must necessarily either proceed from the vitious Quality and Preparation of the Humours; or from a Cacochymical Habit of Body; or from an irregular Way of Living in time of GESTATION.
THE most certain PROGNOSTICKS are as follow, viz. First, All Acute Diseases in Child-bed Women, whose Strength is impaired by their LABOUR, are much more dangerous than in any Others. Secondly, These which proceed from the Suppression of the LOCHIA are most dangerous; because the Humours putrefying in the WOMB, occasion most severe SYMPTOMS, yea and too commonly DEATH itself, unless a lucky Diarrhæa, or a timely Ejection of the corrupted Matter, prevents the Misfortune. Thirdly, The self-same is the unfortunate Consequence, when the Distemper proceeds from the vitious HUMOURS; for Nature then not being able to expurgate their abounding Superfluity by the LOCHIA, the PATIENT must needs be greatly endanger’d, if not overwhelm’d.
THE most adviseable Cure, First, as to the MILK-FEVER, is only to be committed to Nature, the Woman using always a proper DIET, and carefully animadverting, that the SWEAT, in which it commonly terminates, be no ways checked, impeded, or obstructed.
SECONDLY, As to the Watchings, Deliria’s, Epilepsies, &c. which the PATIENT is subject to in this Condition; as they proceed only from Vapours of the BLOOD and Humours, ascending to the Head, when the LOCHIA do not flow regularly, or when the Woman is Feverish: So the Cure of these distemper’d Cases depends (at first) chiefly upon retracting the HUMOURS from the Head to the inferiour Parts, and correcting the Course of the LOCHIA: Because, if these flow orderly, and the vitious Humours, from which such depraved Vapours as affect the Head, be removed and evacuated, all such SYMPTOMS quickly cease and vanish of their own Accord.
THIRDLY, in the other above-mentioned Cases, the PATIENT ought always to be treated according to the various Circumstances of her Condition; I mean, according to the attending SYMPTOMS, conformable also to which the ingenious Physician will always judiciously take his prudent Measures: Since the Cure does not always depend upon the same Method; especially when a symptomatick, or concomitant FEVER, joins the first, as it very often happens, by an Inflammation of some particular Part, proceeding from something of the vitious HUMOURS enforcing itself upon the same very Part.
NOW, in short, tho’ such Inflammations may affect any Part of the Body, yet (I think) the most common Case is, that which affects the PLEURA; and from hence (the Pleurisy joining the FEVER) the Woman labours under both these complicated Acute Diseases at once. The Cure of which difficult and dangerous Condition belongs only to the ablest Physician, to whom I should be justly censured, in impertinently offering any Instruction upon this Subject. Finally, in a word, from what has been said in the Chapter of the Acute Diseases of Women with CHILD[181], we may more fully gather what is to be prudently done to Women in CHILD-BED, afflicted with the like Distempers.