CAUSES. It may readily be supposed that this process is subject to very easy arrest, and that this arrest may be induced by a variety of causes. A very common cause is the debility of the patient, whose weakness is so great that the uterine contractions are not sufficiently prompt, powerful, and continuous to check the increased supply of blood to the organ when it is no longer required, and thus to lessen the nutrition which was very necessary before the child was born, but causes hypertrophy when the womb is empty. Another very common causes is the too early resumption of ordinary employments. Even vigorous, healthy, muscular women, who feel quite well and somewhat recent the necessity for retaining the recumbent posture, often “get about” too soon. The change of the muscular structure of the womb plainly indicates that rest in bed should be taken for a least a fortnight and that for several weeks after that there should be frequent recumbency and a very careful return to active exercise. There is some little danger in the present day, when there is such desire and call for activity, lest in abandoning, some of the old-fashioned stifling and weakening customs of “confinement,” the physical necessity for lying down should be ignored. In dispensary practice, where the patients are drawn from the poorer class, who, without attendance and with the claims of a family, are unable or unwilling to submit to restraint after confinement, by far the commonest form of uterine disease is subinvolution of the uterus, with its attendant evils of displacement, and chronic catarrhal conditions of the mucous membrane. Other causes of the evil are inflammation within the pelvis, in any of its varieties; too early return to malarial intercourse, and too appendages are too soon and too much excited. It should also be observed that if the process of involution be confirm the arrest, and by the monthly congestion, causing increase of size and weight, to product permanent enlargement.
There is one error which we are here solicitous to correct, namely, the supposition that it is not so necessary to retain the recumbent posture after abortion as after delivery at full them. Now, involution is as natural and necessary a process in the one case as in the other; and subinvolution may follow abortion, even in the early months of pregnancy, as well as full them; indeed, it is though to be much more likely to occur in the former case than in the latter. This is probably because the womb has not reached the normal condition which provides for the contraction of its muscular fibres.
SYMPTOMS. A feeling of weight, with more or less; bearing-down of the womb, and a tendency to excessive and to frequent menstruation, the severity o the symptoms being in proportion to the extent of the enlargement. But the excessive menstruation is the most troublesome, distressing, and alarming effect and symptom of sub involution. This is explained by the fact that the relaxed state of the muscular tissue favours the exudation of blood, and that there is and undue amount of blood in the congested uterine veins. The profuse flow is not always immediate, even months may elapse before it occurs; but after a while it is experienced, and examination proves that there is enlargement of the uterus due to subinvolution. In the intervals between the periods there is frequently profuse Leucorrhoea, and other attendant symptoms are, debility, great pain in the back, irritability of the bladder, straining, and tenesmus. Granular ulceration of the os and cervix uteri may also accompany subinvolution.
MEDICINAL TREATMENT. Caulophyllum. This remedy is often of great value in subinvolution; it brings on regular uterine contractions, which are followed by great diminution of the womb; it also checks flooding and other consequence of subinvolution. The 1x tinct. is recommended, two drops thrice daily for ten to fourteen days or longer if necessary.
Kali Hydr-iod, Sepia, Lig. Sod., Chlorum, Calcarea C., Sulphur, or other remedy specially suited to particular cases, may be necessary.
ACCESSORY MEANS. The various causes that have been in operation to produce the condition, as already enumerated, must be avoided. Rest, in the recumbent posture, is indispensable. Temporary separation from the husband’s bed generally leads to great improvement, and if combined with other measures, and continued long enough, may lead to complete restoration. In many cases the health of booth husband and wife needs careful supervision. See also the preceding Section, and that on “Profuse Menstruation.”
71. THE NEW-BORN INFANT.
The weight of the new-born infant varies from 62 to 9 pounds. Boys weigh a little more than girls, and the infants of women who have already borne children also generally weigh a little more than first infants. Other circumstances influencing the weight are the height of the parents, their constitution, and the accidents of pregnancy. Feeble and lymphatic women, suffering from Anaemia or Chlorosis, and marrying delicate and spare men, have children which do not weigh more than 42 to 7 pounds. Strong and vigorous subjects may, on the other hand, give birth to very heavy infants, causing difficult labour. Frequent and abundant vomitings in pregnancy may give rise to great diminution in the weight of the infant; thus a woman of habitual good health, who suffered much from this cause, produced a child weighing only 52 pounds. Scrofula and Syphilis also may reduce the weight; the latter especially, if it does not cause the death of the infant at an early period. Haemorrhage occurring during pregnancy, when not very considerable or frequent, does not exert any appreciable influence on the weight; but when it is very abundant, the infant may lose tow or three pounds.
New-born infants, with few exceptions, lose weight during the first days of their existence. But in general after the third day the weight again increases until it rapidly recovers the original amount. Loss of weight may be occasioned by debility at birth in children who are born prematurely or so small that they have not the strength to drink or suck; or by Jaundice, which is so common in infants, and which impedes nutrition. The various forms of accidental infantile disease, by retarding the progress of nutrition and assimilation, may also give rise to loss of weight, which, if prolonged, may endanger life. To these causes may be added imperfect lactation, due either to the bad quality of the milk or ill-formed nipples. The infant does not get enough milk, and sleeps at the breast instead of sucking; and if it is not weighed before and after suckling, it may be thought to have sucked, while it has really taken little or nothing, and may perish of inanition.
After the infant has passed the period of the early degrees of weight, its increase should be progressive, and where this is not so the nurse should be changed. As long as the child sucks vigorously without sleeping at the breasts, and increases daily during the first seven months, the nursing is satisfactory. If it loses weight, or remains stationary, a change is called for. This can only be determined accurately by a weekly weighing. In case of illness of the mother or nurse, when this is only slight and temporary there is no need of interference; but when it is prolonged, and of a nature to affect the milk, change is necessary. Whenever such a change has been determined upon, if a wet-nurse be employed, the latter should not be informed of the intended change until the moment when the new one is ready to take her place; and after receiving the intimation she should not be permitted to nurse the child.
LICENTIATE OF THE ROYAL COLLEGE OF PHYSICIANS; MEMBER OF THE ROYAL COLLEGE OF SURGEONS; LICENTIATE IN MIDWIFERY, LONDON AND EDINBURGH, ETC. PHYSICIAN TO THE READING AND BERKSHIRE HOMOEOPATHIC DISPENSARY.
Author of "The Stepping Stone to Homeopathy and Health,"
"Manual of Homoeopathic Treatment". Editor of "The Homoeopathic World."