BRONCHOCELE, OR SWELLING IN THE THROAT.
This is often observed in childbed, and sometimes even comes on during labor. It is usually attributed to cold, and no doubt it often does arise from cold, but more frequently it is owing to sympathetic derangement, and from violent attempts to swallow during and after the pains. Many females in fact cry out at those times, that something has broken in the throat, and they fear they are going to suffocate. As a general rule the swelling gradually subsides in a short time, without any special treatment, but sometimes it increases and inflames, and an abscess forms which may become very troublesome, and even dangerous. To prevent this it should be frequently treated with warm fomentations and poultices, till the inflammation subsides, and then with the same washes recommended for indurated or hardened breast, in the preceding section of this chapter. If the swelling becomes hard, and remains indolent, the ointment of hydriodate of potassa may also be prepared and used, as there recommended.
PHLEGMASIA ALBA DOLENS, OR MILK LEG.
This is a painful tumefaction or swelling of one or both of the limbs, which comes on from the fifth to the fifteenth day after delivery. It generally commences with slight pain, or stiffness, or cramp, becoming more painful as it proceeds; but, sometimes, shooting, cutting pains, of great violence, are felt suddenly, at the very commencement. The swelling, also, sometimes comes on gradually, but, at other times, rapidly. In most cases the patient complains of a sudden pain in the groin and thigh, which is preceded by a chill followed by fever, and then the limb begins to enlarge. Most frequently the lower part swells first, and then it extends upward, sometimes, even to the hip. The skin, on the swollen part, looks white, shining and tight, as if ready to break; it is also extremely painful, so that pressure upon it can scarcely be borne. It looks in fact like a thin bag of skin filled with milk, and hence the name milk leg, from an idea that it was really filled with milk, which had, by some means, reached there from the breast. This idea is erroneous, in the sense it is usually taken; the milk does not flow into the leg as many imagine, nor is anything like it to be found there, except a peculiar thin, white matter, when it breaks. Still, however, a sudden stoppage of the milk may cause such a swelling, like a sudden stoppage of any other secretion, but in no other way. It is, probably, most frequently produced by sudden cold, which checks that profuse perspiration into which females gradually fall immediately after delivery, and so drives the perspirable matter within, and causes inflammation and suppuration. A difficult or prolonged labor may also lead to it, by preventing, for a long time, the proper circulation of the blood through the large veins of the pelvis, and so engorging those below. Or the veins may become paralyzed, as it were, by the pressure they have sustained, and so become, for a time, unable to transmit the blood. In fact, both the veins and lymphatics become engorged, as if tied above the limb, and exhibit knots and bundles, like bunches of grapes.
Sometimes the fever will occur some days first, and the female cannot tell what it is owing to, till the swelling comes on; and even this may take place so gradually, and with so little pain, that the limb may be very large before it is observed. I have known females complain of a slight fever only, on going to sleep at night, and wake up in the morning with a confirmed case of milk leg; and I have known others start with a sudden pain in the groin, or hip, and be affected in the same way, in less than two hours.
The disease usually lasts from a month to seven or eight weeks, and terminates, either by a gradual resolution, or scattering, of the fluids, or by suppuration and discharge. When suppuration ensues, there will, sometimes, form one or more very large abscesses, which it may be difficult to heal, and which may lead to serious results, either from their extent, or from the constitutional irritation they produce.
The treatment, at first, consists in warm fomentations, such as those of poppy-heads, or hops, with cooling drinks, purgatives, low unstimulating diet, and occasional doses of James's Fever Powder, to promote perspiration. This is intended to disperse the swelling, and, in general, it does so. If, however, the abscess forms and breaks, in spite of all the means used, it must be treated the same as abscess in the breast, previously described. In ordinary practice, it is the general custom to bleed at the commencement of the disease, or to apply leeches to the groin. This sometimes does good, but frequently is of no service at all, even if it does not make matters worse. I would, however, make the same remarks on bleeding here, as I did in regard to its use in puerperal fever, to which milk leg has a resemblance, in some respects.
Another practice is to use tight bandages, the same as for varicose veins, but I think the plan is not, in general, a successful one, though it may be occasionally. Plunging the limb in cold water, or keeping it wrapped in cold wet cloths, has succeeded much more frequently, and is, with some, a favorite remedy. Stramonium leaves boiled in vinegar, and laid on hot, will also effect a cure sometimes; and so will bathing with hot lye or alcohol. A large poultice of hops, soaked in hot vinegar, has also been found useful.
TROUBLE WITH THE URINE.
The bladder, from its position, is very apt to be inconveniently pressed during the passage of the child, and to be temporarily affected for a short time after, in consequence. Sometimes, the neck of the bladder will be paralyzed, and the urine cannot be discharged. In this case, fomentations of warm milk and laudanum must be used, or a warm hip bath, if there be no danger of flooding, and the bowels must be freely opened. If this does not relieve, the catheter must be used, and always before the bladder is too full. To avoid its becoming so, the attendant should inquire of the female, during the first day, if she has urinated, or feels any inclination that way, so that he may know in time if the difficulty exists. In general, this paralysis passes off in the course of a day, but may endure longer sometimes; in which case the patient herself should speak of it. Cases have been known where the bladder has become so full as to burst through inattention to this matter. The contrary difficulty is occasionally observed, and the urine cannot be retained, but it flows away as fast as it is secreted. It is very seldom, however, that this state remains more than a single day and, more frequently only a few hours. A dash of cold water on the pubes, and against the meatus urinarius, has often corrected it at once, and so has a single purgative dose. If it remain after the first two days without amendment, it is customary to put a small blister on the abdomen, which usually relieves in a short time.