Professor Meigs has well explained why it is that childbed or peritoneal fever is so serious and dangerous a malady as it is. He observes:
“The peritoneum (the lining, membrane of the abdomen), a serous membrane, known for ages as one of the tissues most ready to take on inflammation, undergoes in labor, and during lying-in, changes of the greatest importance. Its great extent may be known by computing the superficial contents of that portion of the serous membrane which invests the alimentary canal. This canal is about forty feet in length, and its outer coat is composed of peritoneum. If cut up by the enterotome, it would be at least four inches wide and forty feet long, affording a superficies of more than thirteen feet, to which should be added the superficial contents of the remainder of the membrane, where it invests the liver, the epiploon, the mesentery and mesocolon, besides the ligamenta lata, and all the other parts which derive from it their serous covering. This vast surface inflames rapidly and totally, and passes through the stage of inflammation with extraordinary speed. It cannot happen that it shall ever be extensively inflamed without a coincident exhibition of the greatest disorder in the functions of the nervous organs directly implicated in its structure, or possessing with it physiological relations that could not be safely disturbed. The peritoneum is the investiture of the abdominal organs; the peritoneal coat of the stomach is as truly a part of the organ as its muscular or mucous coat; the same is true as to the peritoneum that invests the liver, that of the spleen, and the same truth is of the utmost import when it is stated with regard to the peritoneal coat of the whole alimentary apparatus. It is clear that extensive or universal inflammation of the peritoneal membrane is inflammation of all or many of the organs contained within the cavity of the abdomen. A great puerperal peritonitis, therefore, may be properly regarded as a complex inflammation of a vast number of organs indispensable to existence. Why should we be astonished, then, to see the power of the nervous mass sink under the invasion of causes of destruction so great and so pervading?
“Seeing that the superficies of the peritoneum is equal, probably, to thirteen or fourteen feet, we should have abundant reason to dread so extensive an inflammation from the constitutional irritation which it alone would produce; but when, in addition to that consideration, we take into view the great affusions which may ensue, the suppurations, the interruption of the intestinal functions, the depravation of the actions of the liver, etc., which are occasioned by it, we have still greater reason to deprecate its attack, and to seek for the justest views of its nature, and of the remedies most appropriate for its cure.”
Professor Meigs elsewhere judiciously remarks, that, considering the changes that take place in the reproductive tissues at childbirth, “there is, in fact, greater reason for surprise, when we find it not followed by inflammation, than when we meet with the most violent and destructive cases of that affection.”
Treatment.—In the year 1846, I treated (in connection with a missionary friend and physician, who is now in Siam) a premature case of childbirth, which, to say the least, threatened to become one of severe puerperal fever. The case was an important one, and as such I here present it to the reader. It was written out with great care and accuracy at the time by the medical friend referred to. I give it in his own words:
“March 19, 1846.—Desirous of availing myself of an opportunity which Dr. Shew kindly afforded me of witnessing the hydropathic treatment of cases of labor, I accompanied him to No. — Second Street, where he had been summoned a few minutes before, to attend Mrs. S., who was then in need of his services.
“We found the patient an intelligent woman, of the nervous temperament, with her constitution much broken down—though she was but thirty-one years of age—by the results of severe previous labors, the last a miscarriage. After some of her former confinements, she had been weeks and months in recovering. In one case, when, she was treated for puerperal fever, her husband paid in one year not less than one hundred and fifty dollars—no trifling sum out of the earnings of a working man with a large family—to the apothecary alone, for leeches and medicines. The patient had always been in the habit of using strong tea and coffee; drank the mineral water of the city wells; for some months had relished nothing but the little delicacies sent in by her friends, and throughout the winter had been able to do little or nothing at home.
“In consequence of excessive fatigue, a few days before, in ‘house-hunting,’ as she called it, she had been seized on Tuesday, the 17th, at 10 A. M., at the close of the fifth month of her pregnancy, with the pains of labor—her former miscarriage having, of course, induced a predisposition to another. These pains increased in frequency and severity till they caused the greatest suffering, and prevented all sleep on Wednesday night and Thursday, up to the hour (3 P. M.) when she sent for Dr. Shew.”
Here, then, was a patient, whose previous history, impaired constitution, loss of sleep, and exhaustion from intense and almost incessant suffering, protracted now for more than two days, seemed to promise any thing but a speedy recovery, even should delivery be safely effected. It should be added that, up to the time, she was an utter stranger even to the hydropathic treatment.
“Her bowels having been moved the day before, all that was deemed necessary was to render the condition of the patient more comfortable, by resorting to sedative frictions along the spine with a towel wrung out of cold water, and to the tepid hip-bath, with sponging and rubbing the whole surface of the body. After this, less complaint was made, till soon after 6 P. M., when there was a sudden aggravation of the bearing-down pains, resulting in the delivery of a well-formed but still-born male child, of apparently five months.