The history, pathology, and treatment of puerperal fever and crural phlebitis.

Date:
1842
Catalogue details

Licence: Public Domain Mark

Credit: The history, pathology, and treatment of puerperal fever and crural phlebitis. Source: Wellcome Collection.

Provider: This material has been provided by the University of Massachusetts Medical School, Lamar Soutter Library, through the Medical Heritage Library. The original may be consulted at the Lamar Soutter Library at the University of Massachusetts Medical School.

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    after labour, and the effect of the purgmg bolus given on the fol- lowing day, she was attacked, on the 2d of December, about noon m the manner described in the last case. In the evening, I found that the pain had not returned in any considerable degree : but the abdomen was becoming tender, and slight pains came on now and then. I directed a purging injection ; and desired that the cathartic solution, which had been ordered at the first visit, but of which little had been taken, might be continued every two hours during the night, or until proper evacuations had been procured. In the morning, I was sorry to find that the injection only had been given; and that all the symptoms were increasing. I desired that three table-spoonfuls of the solution might be given imme- diately, and repeated in three hours, with a scruple of jalap in each dose. I directed also a repetition of the injection. At noon, my father visited the patient with me. The pain was still increasing : the abdomen had become very sore, and the pulse frequent: in short, the disease was rapidly advancing; and we were satisfied that nothing could save her life, unless bleeding and purging might do it. We therefore agreed, that eight ounces only of blood should be taken from the arm, on the supposition*that, in this case, more could not safely be lost. Finding, after I had drawn this quantity, that the patient was not faint; and believing that her life depended upon taking, at this time, such a quantity as would cure the disease (for I apprehended that a repetition of the bleeding would not be practicable); I suf- fered the blood to flow till some degree of faintness was perceived, which did not happen before I had taken fourteen ounces. The faintness was considerable, and continued for two hours in a degree but just removed from syncope, which was scarcely pre- vented by the frequent exhibition of some nutritious liquid in small quantities. During this period, the pain was quite removed ; but returned in some measure when the faintness had ceased. A scruple of jalap, with the addition of three grains of calomel, was continued at intervals of three hours; and it was not until the purgatives began to operate, about 8 o'clock in the evening, that complete relief was obtained. From that time the pulse immediately declined in frequency. The patient had a comfortable night; and her reco- very proceeded without interruption. The remarks made on the 12th Case are peculiarly applicable to the preceding one ; and they both afford convincing evidence that the means which are necessary for the cure of the disease will not always prevent it. The progress of the disease in this case, was, indeed, slower than usual; so that a lapse of twenty-four hours between the first attack and the bleeding did not prove fatal ; but this may, with much probability, be attributed to the evacuations previous to its commencement. For those evacuations were not only very copious, but, if estimated by the ability of the patient to sustain them, as well as by their actual quantity, they may be con- sidered as larger than in any other case.