CHILD BED FEVER PUERPERAL FEVER



Puerperal fever runs a very rapid course sometimes terminating fatally in a few hours; in other instances, in which the uterus itself is less immediately involved, and the disorder assumes more closely the form of a peritonitis, its duration is much longer, according to the treatment adopted. But in the Homoeopathic, as in the Allopathic practice, it is important to be able to detect the first symptoms of the disease, and to apply the appropriate remedies in its earliest stages and on the very first appearance of the evil.

II. ESSENTIAL NATURE. A correct physiological knowledge forms the indispensable foundation for sound pathology; and sound pathological views of particularly forms of disease are of course absolutely essential to diagnosis and prognosis; nor can they under any circumstances fail to exert some important influence in practice. For by such knowledge alone are we able to understand the relative value and especial significance of many more or less prominent symptoms, and thus to realize which are the most indispensable to be covered in selecting the remedy. No student or physician can be too well informed. And as regards therapeutics, pathology, while like fire a very bad master, may still be made a very useful servant. And indeed to physician in. his age of would, of whatever school, can possibly do justice either to himself, to thus patients and friends, or to society, in relation to puerperal fever, who does not understand the actual pathological changes which transpire in the various forms of disease usually included undo this general name.

The term milk fever, now usually to express the constitution l excitement which precedes or accompanies the secretion of milk in women recently delivered, formerly implied much more, and involved certain physiological absurdities and some consequent pathological errors. In the old humoral pathology, the menstrual flow was supposed to consist of a fermentable mass, which, if retained in the system, except during pregnancy, occasioned various severe disorders. This flow was supposed to be replaced, during pregnancy, by milk which, originally secreted in the mammary glands, was thence in some way transferred and deposited about he uterine placenta, for the nourishment of he foetus. After the birth of the child, the former menstrual necessity was supposed about the uterine placenta, for the nourishment of the foetus. After the birth of the child, the former menstrual necessity was supposed to be supplied at first by the lochia, wand afterwards by the flow of milk directly from the mammae. And this latter process being interrupted, it was believed that the pale or whitish lochia represented the milk again determined towards the uterus and discharged therefrom. And the blood was supposed to be poisoned by such inward revolution of the milk in. the later case, as by that of the menstrual discharge in the instance first mentioned.

Now in order to correct this long train of error we need but to revert to the truly physiological nature of menstruation. In our explanation for the function of ovulation in a preceding chapter., nineteen was made foe the monthly periodic nisus which was at once preliminary to and typical of the grand finale of reproduction. And thus periodic nisus was shown to be accompanied by a certain amount of uterine engorgement, which as relieved by the crisis of the menstrual flow. The whole of this is also still more closely a type of what occurs in pregnancy, and after partition. During pregnancy, and especially in its more advanced stags, the uterine sinuses have become very largely developed, and the entire uterus may be said to have assumed a state of permanent engorgement, which is truly physiological as long as the foetus remains to be nourished in the uterus. But with the expulsion of he foetus remains to be nourished in the uterus. But with the expulsion of the foetus at term all this is chanted;l the after pains proceed to reduce the womb to it original condition, and by such contractions of the uterine walls the extra volumes of blood remaining or still flowing into he uterine sinuses and gradually expelled in the form of the lochia; the open mouths of he sinuses themselves are gradually closed up, and at the same time the former abundant flow of blood into the uterus, now no longe needed in such quantity, is gradually diminished. Thus the lochia are seen to result from the gradual disgorgement of the womb and its restoration to its normal condition before pregnancy. But the open mouths of the vessels upon the utero-placental portion of the parents of the womb may become closed cup before the womb itself is entirely reduced to its natural size, and so before the undue amount of blood is entirely prevented from being thrown into the uterus; under such circumstances the excess of blood flowing into the womb is relieved, not as at first by and actual hemorrhage (purely sanguineous lochia), but by an execution which gradually become more serious and watery till it finally ceases.

Some writers have labored to prove that child-bed fever was truly a phlegmasia or local inflammation, and not a veritable fever. This distinction, in reality without a difference, forms the pathological basis for the most approved Allopathic treatment, which consists in immediate copious and exhausting venesection, ad deliquium. (Meigs on Child bed Fever, Passing) But although possessing a various and remarkable local de elopement, child-bed fever no less truly involves the entire body in its course; since indeed it must have originated from causes no less universal in their influence upon the economy of he system. Child-bed fever, since it appears in persons of dissimilar constitution, a nd is developed under various influences k must necessarily assume very different forms the principal of which are briefly mentioned here in order to present a clear view of the essential nature of the disease, reserving their more complete description to the subsequent section on symptoms.

In child-bed fever then there may be:

I. Inflammation of he peritoneal covering of the uterus, and of the general peritoneal safe; constituting what is usually termed puerperal peritonitis.

II. Inflammation of the uterus, or metritis; this may be either inflammation of this may be either inflammation toe inner wall of the whole mass, or muscular coat of the uterus (endangitis) with ramollescnece and even putrescence of its entire texture; or, finally, inflammation of the eternal, peritoneal stratum, ex- metritis.

III. Inflammation of and suppuration in the uterine sinuses, whose canals are converted into abscesses filled with pus. It some of these cases of metro-phlebitis, the womb itself seems wholly to escape; while the supportive process become every rapidly and insidiously developed.

. Inflammation of the ovaries and Fallopian tubes. In some instances these uterine appendages have been found very much diseased, while the uterus itself remained comparatively unaffected. In one remarkable case pus discharged into the abdominal cavity from the free extremity of the Fallopian tube was found to have occasioned fatal peritonitis.

That these varieties of inflammation may occur independently of each other has been proved by repeated post-mortem examinations but they are most frequently met with in different forms of combination. Puerperal peritonitis seldom occurs without some degree of inflammation of the uterine appendages; bug both these structure may be severely affected while the muscular coat of the uterus and the veins and absorbents, remain wholly exempt from womb are liable to severe attacks of inflammation, without any corresponding affection of the peritoneum by which they are covered; although it more frequently happens that inflammation excited originally either in the veins, absorbents or muscular coat, involves also the peritoneum. This form of inflammation in the vascular and muscular tissues of the uterus, may be so malignant as to become fatal even before thus extending to the peritoneal membranes. This is important to be borne in mind, since absence of pain and of tenderness in the abdomen does not preclude the possibility of a dangerous attack of child bed fever. In cases of uterine phlebitis, purulent matter may be deposited not only in the veins of the womb, but in different parts of the body, and even in the lungs; ad in puerperal peritonitis the pleura and other serous membranes may sympathize with the peritoneal inflammation.

III. – ETIOLOGY. – The causes of child-bed fever may seem sufficiently obvious in many cases; but in numerous other instances they are decidedly obscure. A natural and easy labor does not necessarily preclude an attack; nor indeed are the majority of difficult labors followed by this disorder. The particular influences which singly or in combination may lead to puerperal fever in any given case are not always assignable. Sometimes this disease appears to arise spontaneously and without our being able to attribute it to any causes whatever. In such cases, therefore, we are driven back to first principles, and compelled to seek in some profound dyscrasia of the individual constitution, or in what may be nearly the same thing, some hitherto unmanifested exhaustion of the patient’s system, for the efficient cause of an attack which may prove as rapidly fatal in its termination as it was sudden and unforeseen in its onset.

H.N. Guernsey
Henry Newell Guernsey (1817-1885) was born in Rochester, Vermont in 1817. He earned his medical degree from New York University in 1842, and in 1856 moved to Philadelphia and subsequently became professor of Obstetrics at the Homeopathic Medical College of Pennsylvania (which merged with the Hahnemann Medical College in 1869). His writings include The Application of the Principles and Practice of Homoeopathy to Obstetrics, and Keynotes to the Materia Medica.