Chart 3.—Chart showing rise in temperature about 3rd day after delivery in a streptococcus infection.
Chart 4.—Chart showing rise in temperature about 7th day after delivery in gonorrheal infection.
In gonorrheal infections the temperature does not go up until later, from the sixth or to the tenth day, as a rule. (Chart [4].) The patient is not usually very ill and generally recovers. But the gonococcus is very likely to produce an inflammation of the tubes and to close up the fimbriated opening. Thus it is impossible for ova thereafter to enter the tube and gain access to the uterus and accordingly the patient cannot again become pregnant. Unlike other infections, gonorrhea is not conveyed to the patient during or soon after labor on instruments or examining fingers, but is already present in the vulvo-vaginal glands and from them may travel to the uterine cavity and to the tubes.
Treatment and Nursing Care. Preventive. There is so little that can be done toward curing a patient suffering from puerperal infection that the greatest effort should be made to prevent the disease. The nurse’s part in preventing this complication is an important one and consists of making such preparation for labor that it may be conducted with absolute cleanliness; maintaining the same asepsis during delivery as she would throughout a major surgical operation and protecting the perineum from infection after delivery.
Curative. The curative treatment for puerperal infection resolves itself largely into good nursing care. The patient should be kept warm and quiet and as comfortable as possible; elimination is promoted, her strength is saved and her general resistance increased in every way possible. The head of the bed is frequently elevated, to promote drainage; the windows are kept open to provide plenty of fresh air; the diet is light and nourishing and the patient is encouraged to drink an abundance of water. Ice caps to the head and abdomen are frequently used to make the patient more comfortable; also cold sponge baths when the temperature is high.
A patient suffering from puerperal infection should be conscientiously isolated. If the nurse who cares for her is forced to come in contact with other patients, she should wear gloves and a gown while attending the infected woman and thoroughly scrub and soak her hands after each attention.
It was formerly the practice to curette the patient suffering from puerperal infection, and give intra-uterine douches, but it is now pretty generally believed that neither of these procedures does any appreciable good, but on the other hand may do harm. The objection to curettage is on the ground that by this means the protective wall which Nature has developed to prevent the further invasion of bacteria into the uterine tissues, is removed and a new bleeding area is provided for further and easy development of the inflammation.
Antiseptic douches seem to be useless, for if they are strong enough to be germicidal they are likely to injure the tissues and also do harm by being absorbed into the system; while weaker solutions will not destroy the organisms but are likely to carry more infective material up into the uterus. In cases of putrid endometritis, however, if the doctor cleans out the uterus with his finger, a douche of sterile salt solution is often given for the purpose of removing any putrefactive material which may have been left behind.
Phlegmasia alba dolens or “milk leg.” In some cases of puerperal infection, thrombi are formed in the veins of the pelvis, from which particles may be broken off and carried to various parts of the body and cause phlebitis or even abscesses. If thrombi lodge in the large vessels of the thigh, the interference of the venous circulation results in swelling and tenderness of the leg which is often referred to as “milk leg.” This condition is rather rare and does not usually appear until the second or third week after delivery.