The lochial discharge is not immediately affected, but gradually diminishes, and is not especially foetid. The milk either does not make its appearance, or the breasts make but a feeble effort to establish their function.
The duration of the fever under the most favorable circumstances is seven days, reaching its greatest intensity on the fifth, but if the temperature reaches 89 1/2 on the morning of the seventh day it will return during the following week; in fact we have seen it return on each seventh day for several weeks after convalescence was fully established.
We base our diagnosis on the peculiar curve marked on the temperature chart, the condition of the lochia, the non- appearance of the milk, and the absence of any localized inflammation.
It is necessary to differentiate from malarial fever with its twenty-four hour curve and previous history, also from the fact that malarial fever diminishes the milk but does not destroy it; from fever and chill from suppression of lochial discharges, by the difference in the head symptoms, which disappear with the return of the discharge; from retro-mastitis by its later onset and the local symptoms; from septicaemia the result of retained fragments of placenta, by the knowledge on the part of the physician that the placenta was complete when expelled, and the foetor of the lochia. Remember that this condition (septicaemia) is first one of local inflammation; true the system may become poisoned, but that is secondary.
Puerperal fever is a constitutional fever, the poison being introduced directly into the system; the other is local and the patient’s life is often saved by the formation of an abscess. We may also have pyaemia, the result of the absorption of the discharge of an old abscess. The history and later development of the symptoms will allow us to differentiate.
As to the prognosis, it is always grave, though in view of the possibilities of our own materia medica we need fear it no more than we would a case of scarlet fever in a non-puerperal patient. I say scarlet fever because I know of no condition, so like it in range of temperature and course to the desquamation which sometimes follows puerperal fever.
History and aetiology are the same in all school; preventive medicine should be. In the case of many diseases our school offers more than any other.
Recalling the part the physician plays as a cause, what course should he follow as to prophylaxis? One word covers all his duty, to our mind: Cleanliness. Cleanliness of the patient’s person, cleanliness on the part of the physician and nurse, cleanliness of instruments. Everything that comes in contact with the patient must be in as perfect an aseptic condition as possible.
No normal discharge from uterus or vagina before, during, or after labor contains any noxious bacteria. Our friends of the antiseptic school insist that we shall use the douche before labor, and in labor long continued use it during its progress, and are certain of the necessity for the use of the antiseptic douche after labor.
The definition of the term “Homoeopathic Obstetrician,” like that of all others, is to assist women during the lying-in period, the essence of the definition being in the word “assist.” If he has followed the above instructions he can, during the lying-in period, assist without fear of causing injury or that he has introduced any poison.
Let me call attention here to the fact that there is as much danger in his placing too much reliance upon the supposed antiseptic properties of drugs commonly in use, as there is danger in the drugs themselves to the patient. The natural logical conclusion of the teaching of the antiseptic enthusiast is that the physician can attend more than one case of puerperal fever if he only uses sufficient antiseptic solution.
That he may attend cases of erysipelas, even take part in post-mortem examination, without danger to his obstetrical patients, provided he uses sufficient antiseptic solution. We see in this the greatest danger, and would caution teachers not to give too great liberty to their students by expatiating too strongly upon the wonderful power of this or that favorite solution.
There is no analogy in nature justifying the course as taught in most of our colleges. We, after much searching, fail to find any record of puerperal fever among animals excepting when operations have been performed; the terrible doctor again the cause.
And should poison have been introduced, what then? Its course through the system has been so rapid that its toxic effort is shown by the chill, the high temperature, etc., while local manifestation of the disease is still insignificant, so that we cannot hope by any locally applied remedies to modify its effects. After the germ has once penetrated the tissues, we soon have constitutional fever, in which the local organs are but slightly implicated. But, doctor, look at the records. True, since the introduction of the antiseptic treatment the disease has been reduced to a minimum, but the prohibition of examination by the students without preparation was stopped at the same time; so was the isolation of patients commenced; so was care on the part of of the attendant physician as to habits first commenced.
We claim that there is certainly no analogy in nature for the use of the douche and no argument further than that puerperal fever diminished after their introduction. The woman of the present day have not improved in their “getting up” by these means, and, further I believe that the use of the douche interferes with nature’s methods of repairing the injuries of child-birth.
It weakness the tissues, and unless something has been left behind by the carelessness of the physician there is nothing that nature has not fully provided for. Again, the douche is advocated to stop the absorption of possibly present poisons. The same power of absorption is present to pick up the drug, and how any Homoeopathic who certainly believes in the sixth potency can use any antiseptic solutions and still expect clear-cut indications for his remedies, we don’t understand.
The oft-repeated example of the savage and of the hard- working woman is a reproach on the obstetrician more than a sign of weakness on the part of his patients. Let us be prepared to meet diseased conditions when they come, but not cause them, and if our conscience is clear that we have not introduced poison by lack of care, we need not follow any of the fashions of the day. The young doctor is taught, should he use the latest antiseptics and lose his patient, that it was the visitation of Providence, and no fault of his. But if his patient should die under other circumstances he is culpable.
Away with such nonsense, and especially by those who have at their command remedies which, when used under our law, in accordance with the teachings of our materia medica, which seems at times to have been written by inspiration, are far more certain as microbe killers than any of the coal-tar products and the danger of introducing disease by the obstetrician is far less than of producing disease by Corrosive sublimate added to the hydrant water of the day. That cases have died from mercurial poison is just as certain as that puerperal fever has claimed victims.
Fortunately, as Homoeopathists, our treatment does not depend open aetiology, and whatever may be our opinion as to that, there is no reason for hesitation as to treatment. As the result of experience, we see no greater reason to fear the result in this disease than in any other severe sickness.
What, I am asked, are the remedies? First of all, Rhus; I never saw a case where it was not called for sooner or later. So constant has been this experience that I anticipate the condition by giving it in the absence of other directly indicated remedies, or when the temperatures remains stationary, not improving under previously prescribed remedies. I need not before this body recount the symptoms, but will add the warning that you need not wait for looseness of the bowels to appear before prescribing Rhus, as has been recommended in many cases of typhoid fever.
Among other remedies, o course, we have Aconite for the characteristic fear of death and restlessness; Bryonia, when the abdominal tenderness is marked, but this is rarely the case; Hyoscyamus for the involuntary discharge of urine and stools; Belladonna when the head symptoms predominate; Arsenicum for its characteristic pulse and stomach condition. The use of Kali carb. has been verified for the yellow, gushing stools which so frequently present themselves about the fifth day. Should the lochial discharge become offensive, it can easily he corrected by carefully-selected remedies, most likely Carbo animalis.
We will state her that if there is reason to believe that there are retained membranes or placenta left in the uterus, the curette is indicated. If spots of tenderness appear on the left side, Lachesis will help; if on the right, Lycopodium. We have known the pain to disappear, not to return, in a very few hours after the administration of these remedies. Frequent sponge baths are advised, their frequently and temperature depending upon the height of the temperature of the patient. The free use of stimulants, in the form of milk punch or brandy and water, and, if nausea is present, champagne.
