Among the severer diseases which the physician has to combat, puerperal fever holds a first place, and in ordinary practice gives a large mortality. It is true the disease is a severe one, and the tendency is to death, still a good treatment will give success here as elsewhere. To show the necessity of careful study, I will give a letter from one of our physicians
"Prof. Scudder—I have encountered puerperal fever to my sorrow, I had two cases which were delivered two days apart; both took chill about twenty-four hours after—one died on the eighth day, the other is now in articulo-mortis. I found that Veratrum and Aconite were of no use whatever. I commenced on the first just as the chill was going off; gave, Rx Veratrum, gtts. 1.; Aconite, gtts. xv.; Water, ℥iv. Teaspoonful every hour, until the pulse should come down; it came down as in any fever, and I gave directions to put the doses farther apart to hold what we had gained. I soon noticed a sudden flagging of the vital powers. The pulse was never brought below sixty-eight; but it began to break up and feel like dropping of water, or the blood current would seem to be separated in separate drops with the pulse. I can describe it no other way; it had a doughy feel. As I saw the vital powers flagging, I changed it to Aconite, gtts. xxx.; Veratrum, gtts. xv.; on this the pulse rose to one hundred. The disease seemed to be running a rapid course notwithstanding the pulse was kept down. The green and black vomit, which Meigs speaks of, set in at this time; I weakened the medicine, added Belladonna, but I saw my patient was going to die; the friends thought I thought so and changed doctors. Thus I got a bad case off my hands, but I was satisfied. The patient lived two and a half days after I was discharged. What the alter treatment was I know not.
"The other case went the same way, with the exception, she had more pain; and in addition to the sedatives, I gave sudorific tincture, and kept up perspiration, but she will last no longer than the first. I can not think either would have died sooner had they not had the sedatives; I thought I could control the fever just as I wanted to; both had full bounding pulse in the start. I do not think the sedatives influence an inflammation of the peritoneum. I was once talking with an Old School practitioner, and he said Veratrum was a specific for pneumonia and inflammations on the surface, but he said it exercised no curative effect on peritonitis. Is this true? I thought it then an old fogy notion of his, but I do not know but he was correct. He said his remedy was Opium; it is sedative and curative; but I failed to see it. Please let me hear from you and let me know if you have modified your views since you wrote your diseases of women.
"Later. My second case is dead. I am discouraged in this disease; will we have to go back on Gordon's plan? I shall attend no more obstetrical cases until I have more light. Why don't our men write on the subject? I do not recollect of seeing a single article on it in the Journal since I have been taking it. Are they afraid to report the results of their treatment? I thought to control it as I would a case of' pneumonia or diphtheria."
Just here is the place to impress what I have been teaching these many years. We want to know what the first wrong is, upon what the fever is based. The sedatives are not the remedies for puerperal fever, either in large or small doses, and no one need expect a cure from the administration of large quantities, thinking to crush the fever out—it crushes the patient out instead.
Puerperal fever is a septicaemia from beginning to end. Caused by absorption of animal matter from the uterus, it is to be met by such remedies as antidote this in the blood. Secondarily come small doses of the sedatives, means to establish secretion, to sustain vital power, and to meet special indications. This is the best way to look at the therapeutics of the disease, though in some cases special symptoms will direct to the specific remedy.
Cleanliness is better than godliness in puerperal disease, and is the first thing to be looked after—the ordinary lying-in room us fearfully foul. Have everything about the patient clean, and especially have good ventilation and clean air. When there is danger of puerperal disease, the soft parts should be cleansed twice daily with a weak Chlorate of Potash Water, warm; sponging the thighs, hips, and abdomen, at the same time. Its use as a vaginal injection is sometimes good.
Chlorate of Potash is the puerperal antiseptic.
Where there is danger of puerperal fever give it early, and continue until all danger is past. "An ounce of prevention is worth many pounds of cure."
But Chlorate of Potash is not always the antiseptic, though it will be used oftener than any other. Given the peculiar lochial fetor to breath, and I would always use it, or if there was a general sickly cadaveric odor.
Baptisia stands next to Chlorate of Potash. The indications are fullness of tissues and dusky coloration of mucous membranes. Fullness of abdomen, without the marked tension of abdominal wall is a good indication.
Sulphite of Soda is indicated by the pallid, dirty tongue. Sulphurous Acid by the dirty tongue, thick, moist coat, without pallor. Muriatic Acid by the pinched dry tongue, deep red of mucous membranes.
Need I say that I would very much prefer to trust my puerperal patient to cleanliness, with the proper antiseptic alone, than to the entire Materia Medica without?
But Podophyllin is a remedy in some puerperal fevers, and may be indicated this year. The special indication is fullness of the sub-cutaneous veins, tissues generally show fullness, and with this symptom I should not hesitate to give it to thorough action. It may be classed with special remedies, and fullness of cutaneous veins is the specific indication; but it must be used early if at all.
The treatment thus far would be—thorough cleanliness; the proper antiseptic; small doses of the right sedative; food and rest.
Macrotys has a special use in some of these cases, and its influence is markedly beneficial. Given muscular pains, tensive pains in region of uterus, but without proper involution, and Macrotys is wanted.
Pulsatilla comes in play where the disease is ushered in by marked uneasiness and fear, though it holds but a secondary place.
Rhus is sometimes indicated. Orbital pain; flushing of left cheek; burning pain in vagina or vulva; burning heat of skin; skin tense, dry, burning; and we would give Rhus with a certainty of good success.
Bryonia is also deemed a valuable remedy. The indications are—pain in the base of the brain; flushing of right cheek; pain in knees; and especially where there is marked evidence that the disease is confined to the serous membranes.
Small doses of Quinine and Morphia are useful in the advanced stage of the disease to give rest to the nervous system, and stimulation. I usually order, Rx Quinine, grs. x.; Morphia, grs. j. Make ten pills, and give one every four hours.
The Eclectic Medical Journal, Vol. XXXIV, 1874, was edited by John M. Scudder, M.D.