The cause of the swelling is a phlebitis of the external iliac or femoral vein which becomes thrombosed or so filled with clots that the return circulation is impeded.
Symptoms.—The attack is signalized by a rise of temperature to 102° to 104° F. There is headache, pain in the affected limb, and general prostration. It is a true sepsis.
The disease appears usually in the latter part of the second week of puerperium, when the patient has begun to congratulate herself that all danger is over. In many cases the doctor has yielded to importunity and let the patient get up before involution was sufficiently advanced and the patient will report that she got up too early.
The limb must be immobilized and kept warm. The immobility should be maintained for at least ten days after the fever has subsided and the pain gone.
The convalescence may be protracted over weeks and months.
Bed sores may complicate a long convalescence. Bathing with alcohol or alcohol and alum, and the frequent change of the patient’s position will usually prevent them. Rubber rings and sheeting should not be used if it can be avoided. Ointments containing zinc are of great value in the cure of this affection.
Phlebitis, in minor degree or in localized sections, may occur in the veins of the leg and the site of the invasion will be outlined as red lines or as irregular nodules. Some fever may attend the condition. Rest of the affected member, with ice bags for the pain, constitute the treatment. Bed sores must be guarded against.
Sudden death in the puerperium is a shocking disaster. Rapid death may follow the complications of labor accompanied by hæmorrhage, such as placenta prævia, rupture of the uterus, etc.; but death may be sudden, without warning, from pulmonary embolism, acute myocarditis, fatty degeneration of the heart, or the entrance of air into the uterine veins. This may happen several days after labor in a woman who is passing through a convalescence apparently normal in every respect. Such an event is probably due to a thrombus which may form in any of the veins of the body, but more frequently in those of the pelvis and legs. In the latter it may be recognized by hard lumps that form somewhere along the course of the veins in consequence of a phlebitis. There is always the menace that some fragment of this mass, which is merely a hard clot of blood, may become detached and float off in the circulation to other parts of the body, such as heart, lungs, or brain (embolism), and by interference with those structures, produce paralysis or instant death. When a thrombus is diagnosed, the affected part must be kept as quiet as possible. No massage is permissible. Tincture of iodine or 20 per cent ichthyol may be applied. The woman should remain quiet for at least ten days after the apparent disappearance of the symptoms.
CHAPTER XVIII
THE CARE OF THE CHILD
Hitherto the mother and the complications and changes peculiar to her condition have been selectively considered, to the neglect of the child; but the labor being over, and the nurse having assured herself that the uterus is hard, that there is no hæmorrhage, and that the mother is resting, now turns to the child lying in its blanket. A hot water bag, carefully tested, should lie at its feet wrapped in toweling or napkins.