The Lochial Discharge.—From the time of delivery until the uterus has returned to its ordinary condition, there is poured from it a discharge, at first like blood, and afterwards thin and light colored, called the Lochia. The duration of this discharge varies from one week to a month, and its quantity from one ounce to six or eight ounces, daily. It gradually diminishes however, and frequently stops for a few days altogether. In women who do not nurse it is both more abundant, and lasts longer, than in those who do. The bloody color usually disappears after the first or second day, though sometimes it will show itself again, even when the discharge has nearly ceased, particularly if the female exert herself too soon.
It appears that this discharge is essential to health, and great attention should therefore be bestowed on the patient, if it be too small, or cease too soon, or too suddenly. In most cases it ceases naturally during the milk fever, and of course its disappearance then need not excite alarm. Sometimes also, it does not attain its full quantity till some days after its commencement. If however, it remains small past the third day, or does not appear when the milk fever is over, means should be taken for increasing it. The best means for this purpose are warm poultices and fomentations over the abdomen, and injections in the rectum of simple warm water. Some practitioners advise two drachms of powdered Camphor to be sprinkled on each poultice, and probably it is an excellent addition. Occasionally the lochia is very offensive, and in that case a simple cleansing injection may be frequently used of thin starch, or Chammomile tea.
During the whole period of the Lochia in fact, even in ordinary cases, the female will be all the more comfortable, and better, for an occasional injection, and frequent washing. This is very much neglected, though it never ought to be so. The only care required is not to expose her to cold, which is quite unnecessary.
The Milk Fever.—About the second or third day there usually commences a peculiar temporary excitement in the system, called the milk fever, which requires to be described because it may be confounded with something more serious. It is generally ushered in by headache, flushed face, and a hot dry skin; the pulse beats slowly, and the breasts become hard, while the veins upon them appear very full. In a short time however, the pulse becomes quicker, a perspiration breaks out, and the breasts become still larger and fuller, so that the female can scarcely bring her arms to her body. These symptoms last about a day, or two days at most, and seldom become much aggravated.
Occasionally the milk fever is preceded by a slight chill, or by a furred tongue, or sick stomach, but not very frequently.
The precise causes of this temporary fever are unknown, though probably it is connected with the full establishment of the secretion of milk, and hence its name. It is seldom very severe in those who nurse, and frequently does not appear at all. During its continuance, and for some time after, the female must carefully avoid exposure to cold, and keep herself quiet; her diet should also be rather restricted, and light and unstimulating. An occasional seidlitz powder may also be of service, or a simple injection.
Making the Bed.—It is not customary to disturb the female, for the purpose of making her bed, till the milk fever is passed; or, if that does not appear, till the tenth or twelfth day; and then it should be done with care, and so as not to expose her unnecessarily.
First sitting up, and Going out.—This must of course be determined more by the condition of the patient, and the state of the weather, than by any rules. It may be as well to remark however, no matter how the patient may feel, that the first attempt should always be made with care. Very frequently she thinks herself stronger, and more capable, than she really is, and premature or undue exertion may do great injury. In most cases the female is allowed to rise within the first week, and sit for a short time in an arm chair; after which she begins to walk slowly about the room. The first going out is fixed, by fashion, at one month. Many females however, are unfit to leave the house till long after that time, and others should by no means be confined to it so long. Of course these proceedings should depend, as already remarked, upon the patient's strength and inclinations, and upon the state of the weather, and not upon any fashionable observances. Some females are quite able to rise, and even walk out, in a few days, with benefit to themselves; and it exhibits as great a want of correct feeling, or common sense, for any one to make disparaging remarks on them for their early appearance, as it would if they were to blame the poor invalid for keeping her bed.
The apartment should be kept constantly well ventilated, particularly if the female is confined to it, and all soiled linen, or other sources of foul air, should be removed as quickly as possible. There is reason to believe that inattention to this, and to properly cleansing the person of the female, frequently produces child-bed fever.