The NERVOUS SHOCK, caused by the last pains of labor, in some cases is very severe. This is indicated not only by the exhaustion, but by the countenance which is expressive of suffering, anxiety and oppression. The pulse may be very slow or unusually rapid, the breathing may be panting. Opium is the best remedy, and this may be given in small doses repeated, or a teaspoonful of paragoric may be given, also aromatic ammonia, and 3 or 4 drops of spirits of camphor.
The STATE OF THE PULSE after a natural labor soon comes down to near the ordinary standard; if it remains above a hundred it is because there is some special cause. It will be quick if there are very hard afterpains, a tendency to flooding, diarrhœa or disturbance of the stomach, and it is quickened also when lactation commences.
The LOCHIAL DISCHARGE ordinarily continues about three weeks, at first of pure blood mixed with coagula, and if good uterine contraction has not been secured, coagula may be expelled for several days after the delivery. Sometimes there is a SUDDEN DECREASE OF THE LOCHIA, perhaps on the fifth and sixth day, and at the same time an increased bulk of the womb, and increased frequency of the pulse. Apply hot fomentations to the abdomen, and probably some clots will be expelled, but at the same time give purgative enemata; and if there is abdominal tenderness give an aromatic purgative and laudanum. (F. 108, 122). There are remarkable differences in the QUANTITY, QUALITY AND ODOR OF THE LOCHIA without any morbid affection of the uterus or vagina. But when the lochia are acrid, the vagina, labia and external parts become excoriated, and smarting or itching is caused. Try extreme cleanliness, frequent bathing, lead lotions, black wash, vaginal injections of warm water, and F. 153, 154.
If the discharge ceases a few hours after birth, or if it continues the usual time, but in very small quantity, or if it is prolonged beyond the usual period, or if it is excessive at first, and if at the same time all the other symptoms are favorable, there is not occasion for much medicine, though it may be necessary to give the patient a better diet, possibly some tonics. (F. 174, 175). It sometimes occurs that the lochia is suddenly discharged in double quantity after the patient is permitted to sit up or walk about. In such cases enjoin extra rest.
If the red discharge continues longer than usual, or if it return after yellow or greenish discharges, you should be on your guard against HEMORRHAGE. Enjoin rest in a horizontal position under light clothing.
Occasionally the LOCHIA HAVE A VERY FETID ODOR. It is not very rare to observe a very disagreeable odor in the lochia without any bad results, but this often indicates the retention and putrefaction of coagula or a small portion of the placenta or membranes. Syringe out the vagina freely night and morning with Labaraques solution or some other antiseptic wash, (F. 153) and once or twice a day with warm milk and water. A weak solution of carbolic acid 1 in 50 may be used, and it may be proper to throw it into the uterus.
The SECRETION OF MILK generally becomes established in about forty-eight hours, and very often on the third day the breasts become turgid, hot and painful. There may, or may not, be some general disturbance, fever, chills, &c., but if there is it will usually be relieved after the milk is drawn out. It is customary on the morning of the third day to secure an action of the bowels, and this generally allays the vascular action if it is excessive. But very trivial causes may set up INFLAMMATION OF THE BREAST, and this is always liable to end in suppuration, which may be long continued and distressing.
The MAMMARY INFLAMMATION may follow exposure to cold, a blow or other injury on the breast, some temporary engorgement of the lacteal tubes, or sudden and depressing mental emotions, and it often follows from fissures and erosions of the nipples. To prevent the formation of an abscess, endeavor to remove the engorgement of the lacteal ducts by gentle hand friction with oil or F. 209, 202. Moderate the inflammation by giving five drops of the extract Phytolacca decandra (Poke root) every two hours—give saline cathartics, minute doses of aconite, and perhaps a large dose of quinine. Keep the patient in bed and have the affected breast supported by a suspensory bandage. Apply hot fomentations containing a solution of carbolic acid, or poultices containing it, and the breasts may be smeared with belladonna extract rubbed down with glycerine; or belladonna liniment or ointment may be applied (F. 201). Belladonna plasters or diachylon plasters may be useful. Give 15 grains bromide potassa.
When pus has formed notwithstanding efforts made to cure the inflammation, as soon as it is near the surface so that it can be detected by the fluctuation, the abscess should be opened. During the last few years careful surgeons have been unwilling to make any incision or lance even an ordinary abscess without employing some antiseptic method, such perhaps as the following:
The patient’s skin where the incision is to be made, is first to be washed in 1 to 1000 bichloride of mercury solution—hands and instruments employed in the work must touch nothing that is not sterilized; hands must be washed in the same solution before operating—sponges that are used must be cleaned and stored in a 1 to 20 carbolic acid solution, and instruments must be soaked in the same for 15 minutes before being used, and some apply a large wad of bichloride of cotton or gauze to catch the exuded pus.