Midwifery and the diseases of women

by Joel Shew

According to the celebrated Dr. Blundell, “women after their delivery in general do pretty well, although no attentions are paid to them;” and it is the testimony of the same distinguished author, that “when the constitution is good, and the circumstances are not extraordinary, the less they are interfered with the better;” and yet it must be admitted by every candid and reflecting mind, that, do what we may in all the known possible ways of fortifying and invigorating the general health, woman must, ever in childbirth be subject to some of the most fearful diseases and accidents to which the human frame is liable. Suppose it be only one in fifty, one hundred, or one thousand, that is to be attacked under such circumstances with a threatening and most dangerous malady, who is there that wishes his wife, sister, or friend to be that one—and that one, too, to be subjected to the treatment of an ignorant or unprincipled quack, whether of the male or female stamp? It is for the cases of exception, then, and not the rule, that physicians should toil long and hard in their efforts to remedy the ills to which human nature now is and ever must be subject.

I am led to these remarks, partly from the necessity of the case, but more from the fact, that there are those in modern times who, through ignorance, as we must charitably conclude, would mislead the public on this most important subject. I will go as far as any one in encouraging woman to pursue a rational course in the preparation for, and the consummation of, childbirth. Those who have read my humble efforts at authorship on this subject hitherto, must, I am confident, be aware of this. At the same time, while I would encourage woman—encourage her even more than any of us have yet done—I would have her to understand that there are dangers, fearful and imminent dangers, always attending the parturient state. Be these dangers only one in a hundred or thousand cases, they are yet dangers; and who among us, even of the most experienced, can tell who is to be the subject of them, and who is not? It behooves to be ever watchful in these important matters of the healing art.

I propose, then, here to speak of that most formidable, most fearful of all diseases to which the puerperal condition is liable, the puerperal fever—the puerperal plague, as it has been called—so sudden in its attack, so rapid in its progress, and so fatal in its effects—fatal, that is, according to the old methods of treatment—sanctioned, as they are, by the usage of ages.

Time of Occurrence.—The puerperal or childbed fever comes on usually within the fourth day, reckoning that of delivery the first. It happens oftenest the second or third day. It may come on the first day, or it may, though rarely, attack the patient eight, ten, or more days after delivery. The later the day, the less the danger, as a general fact.

Symptoms.—Childbed fever is more commonly ushered in by a chill, which is not, however, long in duration. This is experienced most along the back, and sometimes about the shoulders and neck. The chill varies in degree of intensity in different cases; with some patients there is a degree of chattering, such as occurs in a severe ague fit; with others there is very little of the symptom; and in some cases no chill whatever is experienced. These last, however, must be the exception to the rule. In almost every conceivable case, a degree of chilliness, greater or less, is experienced. As in other inflammations, this chill is followed by fever. The intensity of the chill is considered no measure of the vehemence of the subsequent fever; the most terrific fever may follow very mild chills, and the contrary. Some regard that there is most danger to be apprehended when the chills are of a mild character.

Here I ought to remark, that patients should not be frightened at every little chill they may experience. The coming on of the milk—the milk fever, as it is called—heat in the breast, and a variety of circumstances other than those of childbed fever, may be preceded by or attended with chills. Indeed, almost every mother with a new-born child experiences more or less of chilly symptoms; and yet fortunately but few are attacked with that terrible malady of which we are treating. So much by way of encouragement in regard to the matter of chills.

In connection with the rigors before mentioned, the patient complains of pains in the abdomen; these may be so slight as to be scarcely perceptible to pressure on the part, or they may be so violent and severe that the gentlest touch of the finger is regarded with apprehension, and the weight of the bed-clothes proves a burden that cannot be borne. “Sometimes the pain,” says Professor Meigs, “which is, at the onset of puerperal fever, felt in the hypogastric region, is too intense to be borne by any human patience; and no exhortation or recommendation can prevent the woman from crying out aloud, or even screaming with her agony. All over the abdomen these pains may be felt, above, below, to the right, to the left, in the region of the diaphragm, and in the lumbar region; this diffusion, however, is neither constant nor frequent, and it is found, especially in the less malignant varieties of the disease, that it is in the region of the navel, and more especially below it, that the patient complains.” Severe after-pains may be experienced in connection with the disease, or the reverse. Little or no fever may occur in connection with severe pain, and so the contrary. If the pain is circumscribed, as we say—confined mostly to one spot—it is far more favorable; but if the pain and tenderness are spread over a large surface, beware, lest there be mischief at hand. If the pain be even slight, and yet diffused extensively over the surface of the abdomen, we must take heed lest we get into trouble that will imminently endanger the patient’s life.

The pulse always rises high in childbed fever. This is one of the most distinctive features of the disease. It is seldom lower than 115 or 120 per minute, except when it is giving way before the power of remedial means. More commonly it rises to from 130 to 140 beats per minute, and it has been known to rise as high as 160 or 170. These last, however, are extreme cases—exceptions to the general rule.

Besides the symptoms enumerated, there sometimes occurs headache, sometimes vomiting, and at others purging, which last symptom is probably in general a good omen.

Duration of the Disease,—Puerperal fever, like most other diseases, is not very uniform in its duration. It is, however, in general short. It may last for a number of days—for many days, if we reckon the convalescence a part of the disease. On the other hand, it may, like the plague itself carry the patient off within the first twenty-four hours of the attack. Three or four days is reckoned to be the average duration of childbed fever, when it occurs in the epidemic form.