Rule.—All temperatures arising in the puerperium are due to infection, unless satisfactorily explained by finding the source. The possibility of a slightly elevated temperature from insignificant causes may be kept in mind, but such temperatures are transient and yield quickly to appropriate treatment or to none at all.
Puerperal infection is most apt to appear during the first week of the lying-in period, and it generally develops about the third or fourth day post partum. If the symptoms come on later than this, there is always a hope that the infection has taken its origin in something else than the labor.
Symptoms.—In mild cases, a rapid pulse, headache, and a temperature of 101° or 102° F. may be the only symptoms. Severe cases begin with a chill, followed by a marked rise of temperature. The temperature is always irregular and generally remittent.
The pulse rises to 120 or 130 beats a minute, headache and prostration appear, occasionally associated with vomiting.
The flow of lochia may be either increased or diminished and either offensive or free from odor. Foul-smelling lochia is a sign of putrefaction but not necessarily of sepsis.
At the same time there is some tenderness in the lower part of the abdomen, usually most marked at the sides of the uterus. The uterus is larger than it should be, and not hard, but doughy and sensitive to touch.
The involution is arrested, except in cases of pure septicæmia. This is an important reason for the daily observation and recording of the regular descent of the organ.
The disease runs a variable and more or less prolonged course and the prognosis is always doubtful until the event. Signs of grave import are: repeated chills, insomnia, pulse above 120, persistent vomiting and meteorism, with dry, brown tongue.
Treatment.—Mild cases without chill when the uterus is large and the lochia sometimes offensive, are usually sapræmic. Free catharsis, ergot in full doses, and a half-sitting position to aid drainage will cause the symptoms to subside in two or three days.
In the severe type, the treatment is mostly a case for careful nursing. The more energetically the doctor acts, the more liable he is to do harm. The patient needs all her strength to fight the disease, and should not be required to fight the consequences of injudicious interference.