When the neck of the uterus contracts in a moderate degree after birth, and certain pains, called by the midwives “after pains,” ensue, in consequence of the difficulty with which the clots are expelled, the case is considered a favorable one, and is so in fact; for it indicates vigour on the part of the uterus, and that it is inclined readily to contract to its usual bulk; the result of which is that the lochia are duly expelled, and health restored to the woman.
But I have observed in some women the uterine orifice so closed immediately after parturition, that the blood has been retained in the uterus, and then, becoming putrid, has induced the most dangerous symptoms; and when art did not avail to promote its exit, the woman has presently died.
A noble lady in childbed being attacked with fever for want of the ordinary lochial discharge, had the pudenda swollen and hot; finding the uterine orifice hard and firmly closed, I forcibly dilated the part by means of an iron instrument sufficiently to admit of my introducing a syringe and throwing up an injection; the effect of which was that grumous and fetid blood, to the amount of several pounds, flowed away, with present relief of the symptoms.
The wife of a doctor of divinity was brought to me; a lady of a very tolerable constitution, but who was barren, and having an extreme desire for progeny, had tried all kinds of prescriptions in vain. In her the catamenia appeared at their proper period; but at times, especially after horse exercise, a bloody and purulent discharge came from the uterus, and then, in a short time, ceased suddenly. Some considered the case as one of leucorrhœa; others, led chiefly by the fact that the discharge was not continually present, and in small quantities, but appeared by intervals and in abundance, suspected a fistulous ulcer; whereupon they examined the whole vagina by means of a speculum uteri, and applied various remedies, but in vain; when I was at length called to her. I opened the uterine orifice, and immediately two spoonfuls of pus came away of a sanious character and tinged with streaks of blood. On seeing this I said that there was a hidden ulcer in the uterine cavity, and by applying suitable remedies I restored her to her former state of health. But during the time when I was engaged in her cure, when the ordinary remedies did not appear to be doing much good, I applied stronger ones, suspecting as I did that the ulcer was of long standing, and perhaps covered by exuberant granulations. I therefore added a little Roman vitriol to the injection employed previously, the effect of which was to make the uterus contract suddenly and become as hard as a stone; at the same time various hysterical symptoms showed themselves, such, I mean, as are generally supposed by physicians to arise from constriction of the uterus, and the rising of “foul vapours” therefrom. The symptoms continued some time, until by the application of soothing and anodyne remedies the uterus relaxed its orifice; upon which the acrid injection, together with a putrid sanies, was expelled, and in a short time the patient recovered.
I have introduced this account from my “medical observations” for the purpose of showing how acutely sensible the uterus is, and how readily it closes on the approach of danger, especially when urgent symptoms accompany the puerperal state. Women are peculiarly subject to these accidents, especially those among them who lead a luxurious life, or whose health is naturally weak, and who easily fall into disorders. Country women, and those accustomed to a life of labour, do not become dangerously ill on such small grounds. Some of them may be found pregnant a month after delivery; whilst two months frequently elapse before others are able to set about the ordinary occupations of life.
It is laid down by Hippocrates,[375] that as many days are required for the “after-purgings” as there are for the formation of the fœtus; therefore there are more for a female than a male child. “But this,” says Scaliger,[376] “is false; for in none of our women do “the cleansings” last more than a month; in very many they cease on the fifteenth day; in some even on the seventh day; and I have seen a case where they lasted only until the third day, although the woman had borne twins.” Galen has many observations on this subject in his work περὶ κυουμένων, (On the Formation of the Fœtus.) In the New World, it is said that the woman keeps apart the day only on which she is delivered, and then returns to her ordinary occupations.
I will add, in conclusion, an extraordinary instance told me by the noble Lord George Carew, Earl of Totness, and long Lord-Lieutenant of Munster in Ireland—he who wrote the history of these times. A woman, great with child, was following her husband, who served as a soldier, and it happened that the army, when on the march, was compelled to halt for the space of an hour near a small river which impeded their passage; whereupon the woman, who felt her labour at hand, retired to a neighbouring thicket, and there, without the aid of a midwife or any other preparation, gave birth to twins; after she had washed both herself and them in the running stream, she wrapped the infants in a coarse covering, tied them on her back, and the same day marched barefoot twelve miles with the army, without the slightest harm ensuing. The following day the Viceroy, Earl Mountjoy, who at that time was leading an army against Kinsale, then occupied by the Spaniards, and the Earl of Totness, were so affected by the strange incident, that they appeared at the font, and had the infants called by their own names.