AFFECTIONS FOLLOWING CHILDDBIRTH.
There are several affections following childbirth which deserve to be briefly stated. The most immediate of these is loss of blood, called technically postpartum hemorrhage, and which is often consequent on one or other of the causes which have been noticed in connection with childbed hemorrhage itself. There is a fever of a temporary kind, which sometimes follows the reaction of la bor and is called puerperal ephemera. This has already been de scribed as the affection termed milk fever or weed, at page 56, amongst diseases that run a definite course. Under the same head is also included the serious affection following childbirth called puerperal or childbed fever, a distinctly contagious malady. To these have to be added, as occasional affections, inflammation of the peritoneum, metro-peritonitis and puerperal peritonitis; the formation of abscess in the iliac or pelvic regions, iliac or pelvic abscess; sloughing of the neck of the womb or neighboring struct ures; the various kinds of fistula, which have been described already; inflammation of the breast, and breast abscess.
Two other affections following on childbirth are of a kind in which the nervous system is. involved, namely, puerperal convul sions and puerperal mania.
Puerperal convulsions have a distinction and importance as in dicating a special form of nervous disturbance. The convulsive seizures may commence during the period of labor, but more com monly they follow delivery. They may continue in repeated par oxysms for several hours, and be attended by insensibility, the end, unfortunately, being in many instances fatal. I believe, from my own observation of the phenomena and of the causes that lead to them, that there are at least two varieties of eclampsia : one, in which the convulsive moments are reflex, and result from irrita tion in the parts locally concerned in childbirth; the other, in which the seizures are due to the accumulation in the body of some poisonous excrete, probably urea, which ought to have been thrown off by natural excretion, but which has been retained, owing to the pressure of the gravid womb on the excreting renal glands. The nature, however, of eclampsia remains yet to be learned with precision, as does also the grave question of its suc cessful management for the purpose of prevention or cure.
Puerperal Puerperal mania may be connected with parturition or with the yielding of milk, lactation. The attack is of a mental kind, and is often at first very severe, amounting to violent frenzy, with aberration, under which deeds of violence of the worst kind may be perpetrated. The severity of the acute symptoms is sometimes resolved by sudden and complete return to mental health; but, more commonly, the acute stage is succeeded by one of melancholy and depression which lasts for many weeks or even months. In most instances of puerperal mania the hereditary proclivity to mental disease is distinctly marked. One of my medical con freres, who during a professional life of fifty years had been en gaged actively in attendances at childbirth, once reported to me that he had never known an instance of the disease in which the proclivity was not traceable.