Headache in the puerperium should be watched carefully, and the cause discovered. Pain in the head may be a habit with the patient, or it may be a symptom of some complication either present or developing, such as toxæmia, eclampsia, or acute yellow atrophy of the liver. In general, it is due to milder conditions like exhaustion, too many visitors, excitement, nerves, or insomnia.
After-pains.—Sometimes patients are greatly annoyed by after-pains. The pain may be due to a clot retained in the uterus or possibly a stimulation of the uterus when the child goes to breast. Gentle massage of uterus, or ergot, quinine, or codeine may be required to bring about the expulsion of the clot or to control the pain. A reasonable degree of after-pain is of favorable significance. (See p. [154].)
CHAPTER XVII
INFECTION
Puerperal fever is a wound infection.
The conditions of the pelvic organs during labor and post partum, are well adapted to receive and develop microorganisms, for the healthy antimicrobic power of the vaginal secretion is absent or diminished.
A long and exhausting labor, possibly accompanied by hæmorrhage, or terminated by an operation, has diminished the immunity and broken the resistance of the tissues to a dangerous degree.
The mucous membrane of vulva and vagina are torn and bruised, the vitality lowered, and the surface covered with bloody lochia, which is an excellent nutritive medium for microbic development. The uterus is a vast, open wound, filled with fibrin, blood clot, and decomposing tissue, while the whole pelvis is maintained at exactly the proper temperature for germ propagation.
Through these wounds, toxins are carried into the circulation, and germs, nourished upon the abundant and favorable culture media, pass through the uterine walls or by way of the lymph channels first into the adjacent tissues and thence to all parts of the body.
Certain definite organisms reach the disintegrating tissues and produce a putrefaction. They do not, however, once their work is done, pass into the body. But in producing putrefaction, they also produce injurious poisons, called toxins, which do enter the body and cause an absorptive fever known as sapræmia.
