“But if she bear a maid child, then she shall be unclean two weeks, as in her separation: and she shall continue in the blood of her purifying threescore and six days.”
This law refers to what is called in medical science the lochia, or lochial discharge, the term being derived from a Greek word signifying “a woman in childbed.”
After the birth has taken place and the placenta has been removed, the woman experiences a discharge from the womb, which is at first red in color, consisting, probably, of little else than blood; afterward it acquires a greenish hue, possessing a peculiar and disagreeable odor.
The lochia is considered purifying in its character. It is a natural discharge which oozes from the orifices of blood-vessels, laid open by the separation of the placenta from a portion of the internal surface of the womb. In all cases wherein a wound is made in the living body, or wherever the blood-vessels are by any cause laid open, there must be necessarily more or less discharge before the healing can be fully accomplished; and the same principle holds good in the womb as in other parts of the body.
In quantity, the lochia varies much in different cases; it may be three or four times as abundant, apparently, in one case as in another, both patients recovering, however, with equal facility or difficulty.
The length of time varies also as much as the quantity of this discharge. It may last for a few hours only, for days, but more commonly for weeks; fourteen to twenty-one days may be stated as its usual duration. Something, I think, depends upon the treatment; cleanliness certainly has its effect in these cases. If a woman wash herself three or four times daily, and keep herself at all times as strictly clean as the circumstances will admit of, the process of healing must be materially hastened, the discharge rendered smaller in quantity, and less offensive in character.
Excessive Discharge.—From various causes the lochia sometimes becomes excessive in quantity. More anciently, when the humeral pathology was much in vogue, this discharge was studied with more attention than in modern times, and our forefathers in medicine may have gone to an extreme in this matter; but certain it is, the importance of the lochia should not be overlooked.
A piece of placenta retained may augment the flow of the discharge. If the patient experience vomiting, very offensive and too great a quantity of lochia, or if very severe after-pains come on, there is some reason to suspect that such is the case; so, also, portions of the membranes may have been retained, causing some degree of irritation. Any thing which debilitates the system, such as too much lying in bed, overheated rooms, too much sitting up, walking, or other exercise, and especially too much excitement in the way of seeing company, gossiping friends, etc., may likewise cause an excessive discharge. In those cases where a portion of the placenta is retained, removing it is often considered the best remedy; but according to one very able author and practitioner, Dr. Blundell, “unless the symptoms are very urgent, it is better to refrain from manual operations; left to its own efforts, the uterus will, perhaps, more safely clear itself.”
Treatment.—In all these cases the general principles of management are plain and easily understood. We must, of course, as far as possible, remove the causes of the difficulty; we must also treat the system constitutionally in order to improve the general strength. Cooling wet compresses upon the abdomen and genitals, frequent ablutions, the sitting-bath, and in some cases the packing wet-sheet, will prove a highly useful means; vaginal injections of water, tepid injections in the bowels, and drinking of pure, soft water, are also to be recommended.
Offensive Discharge.—There is one condition of the lochia which is very troublesome from its offensive smell and extremely loathsome character. In such cases the red discharge ceases and is succeeded by a profuse watery one of a greenish color, and which is sometimes called by women “the green water;” it is frequently so acrid as to excoriate the parts upon which it runs. It is often attended with a good deal of general debility, causing, not unfrequently, a considerable degree of hectic fever.