Part 26
III. IN the next place, the _Closures_ are to be remov’d, and the _clotted_ BLOOD taken away; which being diligently done, the _BELLY_, _LOINS_, and _PRIVITIES_ are to be anointed with the Oil of _sweet Almonds_, or _white Lillies_, mixed with a little warm _Wine_, which may be repeated at pleasure, for allaying the _PAINS_ of these _Parts_: And as the _Woman_ is to be carefully kept always very _warm_, as well as disposed to _Rest_ and _Sleep_; so every now and then, she is to be comforted with some small Matter of any convenient FOOD; abstaining however chiefly from _strong Meats_, as well as from all _hot_ or _strong Liquors_.
IV. A DECOCTION of _Barley_, _Linseed_, and _Chervil_, or _Marsh-Mallows_ and _Violet-Leaves_, with a little Honey of _Roses_, may be afterwards used _Milk-warm_ three or four times a Day, by way of _Fomentation_ for the first five or six Days of _CHILD-BED_: Or, instead of these Things, fresh _warm Milk_, or _Barley-Water_ only may be properly used; always remembring that the _Parts_ be duly cleansed from the _clotted_ BLOOD, _&c._
V. IN the mean time, the _Woman’s_ BREASTS are all along to be kept very close and warm-cover’d with soft _Cloaths_, that the _MILK_ may not _curdle_; which however is no ways yet in the beginning fit for the _CHILD’s Nourishment_, until the _Conflux_ of the _MILK_ and the _Humours_ is over; which, upon the first days after _DELIVERY_, run in abundance to the BREASTS.
VI. SPECIAL Care also must be taken, when the _Woman_ is resolv’d not to _Nurse_ the _CHILD_ herself, that the LOCHIA or _Child-Bed-Evacuations_ flow-off plentifully, in order that thereby the _Shock_ of the _BLOOD_ may be averted from the _BREASTS_; which if not sufficient to prevent that _Inconveniency_, they may be properly anointed with the Oil of _ROSES_ and a little _Vinegar_ beat-up together; or a _CATAPLASM_ of the Meal of _Beans_ and _Vetches_ mixed with _Oxymel_ may be applied to the _BREASTS_; or they may be fomented with a _Decoction_ of the Leaves of _Mint_, _Dill_, or _Parsley_.
VII. IN the time of _Cleansing_, all Noise and Clamour about the _Woman_ ought to be suppressed; and as she herself ought not to talk much, or _aloud_, neither ought any Person about her to be _obstreperous_: Because her _Repose_ is not only thereby disturb’d, but also her _Spirits_ exagitated; which violent Commotion of _Humours_ may readily stop the _natural Course_. And as for the same Reason, all _Passions_ of the Mind are to be suppressed; so the _Woman_ is to keep herself as much as she conveniently can upon her _Back_, carefully avoiding frequent _TURNINGS_ to either Side.
VIII. AFTER ten or twelve Days, proper Measures may be taken to fortify and strengthen the _Members_; and after she has fully done cleansing (which may be about the 20th _Day_, sooner or later after _DELIVERY_, according to the PATIENT’s _Constitution_, or her way of _Living_) some proper _Astringent Medicines_ may be discreetly made use of, for corroborating and reconsolidating the _Parts_.
IX. AS to her _DIET_, during this Time, she ought to be very regular, and live _abstemiously_ (especially the _first Days_) as if she had a FEVER, using only good _Broths_, _Jellies_, fresh-laid _Eggs_, _Ale-soup_ made with fresh _Butter_, or the like; after which, she may begin by degrees to eat a little _Chicken_, _Pullet_, _Capon_, _Veal_, _Mutton_, or any thing else of good _Nutrition_ and easy _Concoction_.
AS to her _DRINK_, if she has no _Fever_, she may use besides her _Cawdles_, small _White-Wine_ and _Water_ for Variety’s sake; but in case of a _Fever_, Water boil’d with a little _Cinnamon_, or _Coriander-Seed_; or a _Ptisan_ of _Liquorish_, _Figs_, and _Aniseeds_ boil’d in Water; or _small Ale_ a little butter’d, as the _Woman_ pleases, are far more convenient; observing always carefully that her _DRINK_, of whatsoever sort, be at all times a little _warmed_.
X. FINALLY, as the _Child-Bed-Woman_’s Body is always to be kept open, if not otherways naturally so, by a proper gentle _CLYSTER_, repeated as often as Necessity requires, until the _Course_ of the LOCHIA is quite over; so afterwards she ought to take one or more proper gentle PURGES, for cleansing the _Stomach_ and the _Bowels_ of such vitious _Humours_, as _Nature_ could not otherways evacuate: Upon which, a repeated Strengthening _BATH_ may be most pertinently used, as also, in order that she may again the more successfully _begin upon a new Score_, other proper Measures may be prudently taken.
THUS we suppose that all things have succeeded well with our _Puerperial Woman_; in which Condition the above-mention’d is her only requisite _REGIMEN_: But in Case of any _Preternatural Accident_, we must come to her _Assistance_, according as the Nature of _Circumstances_ does require: Of all which in their Order, as they most commonly happen to the _Woman_ in her present _Condition_; and FIRST——
CHAP. II. _Of the AFTER-PAINS._
THESE PAINS, which usually accompany or follow after the _BIRTH_, are common to all _Child-Bed-Women_; and in that _Natural Sense_, as they proceed only from the quantity of _BLOOD_ abounding in the relaxed Womb, distending its _MEMBRANES_, or arise from its _Acrimony_; so they gradually cease, and in two or three days quite vanish: Wherefore I am not to insist upon _Those_, which only affect the debilitated WOMB.
BUT it often and too commonly also happens, that another Sort, justly call’d _Preternatural AFTER-PAINS_, afflict the _Woman_; which she sometimes feels about her _Loins_ and her _Groins_, sometimes about the _Navel_, sometimes all over the _Belly_, and sometimes in the WOMB only, and that sometimes with a little, and sometimes without any _Intermission_.
THE most common _Cause_ of which _PAINS_ is generally one of the _Five_ following; _Viz._ 1. The _External AIR_, especially the more _frigid_, which easily penetrates into the WOMB, if not carefully prevented: 2. _Clotted BLOOD_, or some other _foreign Body_ left behind in the WOMB: 3. Some _Acrid_, and _Mordacious_ BLOOD adhering to the WOMB, which excites and stimulates _Excretion_: 4. The _SERUM_ vellicating or twitching the _excoriated_ part of the WOMB: Or, 5. _WINDS_ elevated from the _Humours_ fermenting in its _Substance_; which, together with those turgent _Humours_, tear its tender _TUNICKS_.
NOW because these PAINS often excruciate the _Woman_ as much as the _real_ LABOUR-PAINS do, and since they are not always without _Danger_, Necessity demands that they should be either _cured_, or at least _mitigated_: Which may be most properly done, by convenient relaxing and attenuating _Medicines_ outwardly applied, as well as inwardly taken, when the _Case_ does not require the _Hand-Cure_, or manual Operation.
HOWEVER, yet more particularly, in respect of the PAINS, from what _Cause_ soever they may proceed, _CLYSTERS_ of _Milk_ with the _Yolks of Eggs_ are proper; as are also emollient _Fomentations_ mix’d with attenuating and _Uterine Medicines_; a _Fumigation_ of _BRANDY_; a _Decoction_ of the _Recrements_ of the _Regulus_ of _Antimony_; such things being of a _sulphurous Nature_: And moreover, in fine, all _AFTER-PAINS_ are eased by _Aromatick_ and _Carminative Remedies_; such as Seeds of _Anise_, _Carway_, _Cummin_, _Fennel_, _Penny-Royal_, _Roman-Camomil_, &c. infus’d or boil’d in _Wine_ or _Water_, adding thereto a very little _Mace_ and _Saffron_.
CHAP. III. _Of the Suppression of the LOCHIA, or Child-Bed-Purgations._
THE _LOCHIA_ are nothing else, but the ignobler part of the _Blood_ and congested _Humours_, which after the _BIRTH Nature_ evacuates and discharges out of the _Uterine Vessels_, in consequence of the _Divulsion_ and _Separation_ of the PLACENTA from the WOMB. Which _LOCHIA_ however differ always according to the Constitution and Disposition of the _Woman_, and that not only in _Quantity_, but also in _Quality_: For if the _PATIENT_ be otherways Healthy, and Well-disposed, _these_ are at first of a _florid rosy Colour_, degenerating day by day into a _Pale-dye_; Whereas if otherways, they are sometimes _Aqueous_, and sometimes _Bilous_, _Melancholick_, &c. And, according also to the usual _Habit_ of Body, and _Way of Living_, _some_ Women _flood_ more plentifully, _others_ more sparingly; _some_ a longer, and _others_ a shorter Time: as for Instance——
A _Woman_ given to _Ease_, and _high Living_, being delivered of a MALE, may _cleanse_ from twenty to thirty Days; and if of a FEMALE, from thirty to forty-two Days at most, however still declining in _Quantity_ from Day to Day: Whereas _another_ given to _Exercise_, may _flood_ only from eight to fifteen Days; and _that_ also perhaps more _sparingly_, or by _Intervals_ of one or two Days. But it oftentimes happens, that this _Evacuation_ is either suppressed in Whole, or in Part; of which _Suppression_ or _Preternatural Retention_, I am now about to speak.——
FIRST then, the _Cause_ of this EVIL, proceeds either from an _Obstruction_ of the _Uterine Vessels_, occasion’d by _thick BLOOD_ stopping the _Passages_: Or, SECONDLY, from a _Constriction_ or _Compression_ of the same _Vessels_, occasioned by an _oblique Situation_ of the WOMB, or by cold _Air_, cold _Drink_, or the like, which readily constrict their _Orifices_, as well as contract the WOMB itself: Or, THIRDLY and lastly, the _Cause_ may proceed from the _BLOOD_’s being retracted and converted to some _other Part_ of the Body; which is most commonly occasion’d by some _Passion_ or _Perturbation_ of Mind, that may not only turn the _Shock_ of the _BLOOD_ to the BREASTS, but also retard the _Motion_, and thicken the MASS of the same _BLOOD_.
THE _DIAGNOSTICKS_ however of this _Distemper_ are manifest; for either no _BLOOD_ is voided at all, or too small a _Quantity_, in respect to the _Size_, _Temperament_, and _Constitution_ of the _PATIENT_: But besides, it may be also known by the following _Symptoms_; viz. a _SWELLING_ of the _BELLY_, upon the Retention of the _Humours_ that ought to be evacuated; a _Difficulty of Breathing_ arises; PAINS seize the _Abdomen_, as also the _Loins_ and the _Groins_; a _Fever_ and _Tremblings_ follow; as _Faintings_ do upon a weak, quick and unequal _Pulse_; something _fuliginous_ appears in the _Urine_; and a livid, black, grumous, or nauseous _Matter_ is excreted.
HENCE proceed various _PROGNOSTICKS_; viz. _Fevers_, _Spitting_ or _Vomiting_ of BLOOD, _Melancholy_, _Inflammations_ of the _Liver_, _Quincy_, _Pleurisy_, _Frenzy_, _Dropsy_, _Apoplexy_, and _Madness_ itself: The _least_ of which may prove of fatal _Consequence_, wherefore Delays in this _Condition_ are most dangerous; because when any of _these_ heavy SYMPTOMS has befallen the _Woman_, there is scarce any Hope left for her _Recovery_; whereas _before_, they may be artfully prevented, and the _Cure_ duly perfected by convenient _DIET_, _Venæsections_, _Revulsive Medicines_, &c.
BUT more particularly the _Cure_ ought to vary, according to the _difference_ of the co-incident SYMPTOMS: For since continual _Fevers_ and _Inflammatory Diseases_ most commonly follow upon this _Suppression_ or _Diminution_ of the LOCHIA, we must take great Care that, endeavouring to promote the _FLUX_, and to open the _Uterine Vessels_, we do not augment the _FEVER_ and _Inflammation_; which will certainly happen, (if without distinction) we use the _hot Medicines_ prescribed by many AUTHORS.
WHEREFORE in this _Case_ repeated _Venæsections_ sometimes in the _Ancle_, and sometimes in the _Arm_; and _cupping Glasses_ applied to the _Thighs_ and _Shins_; as also _Rubbing_ of the _Legs_ and _Thighs_ well, are generally sufficient _Remedies_; especially if followed with one or more Cleansing, or partly opening, partly cooling, and Emollient _CLYSTERS_, of a _Decoction_ of _Mallows_, _Pellitory_, or the like; in which strain’d _Liquor_, the _Pulp_ of _CASSIA_ with a Dram of _Nitre_, and _Sugar_, and _Honey_ may be dissolved: As also _Fomentations_ and _Fumigations_ of Emollient and Aperient _Medicines_ that are not sharp, may be very pertinently used. Finally, the _Infusion_ of JESUITS-BARK in Water, may be properly given three or four Times a day; and purging _PTISANS_, after the _first days_, are of good _Service_ in the present _Case_.
CHAP. IV. _Of the immoderate Flux of the LOCHIA._
THE too copious and long lasting, or immoderate FLUX of the _Child-Bed Purgations_, is no less _Preternatural_, than the former _Case_ of their being altogether _suppressed_, or in part _diminished_. Tho’ it is however to be observ’d, that there can be no certain _Quantity_ of flowing BLOOD, nor any certain _Time of Duration_ of this FLUX prefix’d or determined to the _Puerperial Woman_, as aforesaid: Wherefore the _Excess_ of this _Evacuation_ is best known by the _Loss of Strength_, _sinking of the_ SPIRITS, and the great _Uneasiness_ of the PATIENT.
THE _Cause_ of this _Distemper_ is, either _1st_, a too great _Plenty_ of the abounding BLOOD; or _2dly_, its _Tenuity_ and _Acrimony_ stimulating Nature to _Excretion_; or _3dly_, too great an _Apertion_ of the _Uterine Vessels_; or _4thly_ and lastly, a violent _Extraction_ of the _AFTER-BIRTH_: For the _Flux of the LOCHIA_ proceeding meerly from the _Separation_ of the PLACENTA from the WOMB, the more strong and violent this _Separation_ or _Divulsion_ is, the more the _Vessels_ in the _Concave Part_ of the WOMB are torn or dilacerated; and so being either too much _opened_, or too difficult to _reconsolidate_, they discharge BLOOD immoderately.
HENCE, I say, this immoderate _FLOODING_, is not only known by the great _Quantities_ of _BLOOD_ voided, by its _Continuance_, or by coming away in _Clods_, and much at a time; but also by the _Loss of Strength_, and a _Defect_ of _SPIRITS_; upon which follows a low, debilitated and frequent _PULSE_; Loathing of _VICTUALS_; _PAINS_ in the _Hypochondriacks_, with a _Twisting_ of the _GUTS_, and _Griping_ of the _BELLY_; a _Dimness_ of _SIGHT_; a _Hissing_ of the _EARS_; and at last _Swoonings_ or _Convulsions_, proceeding from the _Depauperation_ of the _BLOOD_: Which after an immoderate _FLUX_ always disorders the _SPIRITS_, because when the MASS of it is much lessened, it cannot keep its due _Mixture_ and _Disposition_.
IN this _Case_ the true PROGNOSTICK is, that, if all immoderate _Hæmorrhagies_ are dangerous; because by them, the _Treasure_ of _LIFE_ (the _natural Heat_) is exhausted: _Then_, without Controversy, the immoderate _Flux_ of the LOCHIA, whether after LABOUR, or after a _MISCARRIAGE_, is full of _Danger_; as coming upon the _PATIENT_ at a most unseasonable time, when her _Strength_ is already spent.
THE _Cure_ of this _Distemper_ ought to be well-weigh’d, and very cautiously perform’d, because the definite _Quantity_ of _BLOOD_ to be evacuated cannot be well or certainly known: And because if any Part of _That_ be stopped, which ought to be ejected, it of course flows to some _other Part_, and excites _Inflammations_ or other heavy _SYMPTOMS_. Wherefore this is only, in the Beginning, to be corrected by proper _DIET_, and some other convenient light Means: But afterwards by repeated _Venæ-Sections_ in the ARMS, if _Strength_ will permit; and proper _Astringents_ inwardly taken, as well as outwardly applied; continuing always a _Thickening_, _Cooling_, and _Astringent DIET_: But farther yet, as the Patient grows _weaker_, she ought also to have some _corroborative Remedies_, to enable her to stand out the _Cure_. _Fomentations_ for the _lower Belly_ of OXYCRAT, or an astringent _Decoction_; _Fumigations_ of the same _Decoction_, or of hot OXYCRAT, are very convenient and helpful on this Occasion, as are also _astringent Injections_.
BUT however sometimes, and not seldom, it happens, that this _Case_ proceeds from the negligent or ignorant _MIDWIFE_, by her not duly _cleansing_ the WOMB; by which Means, some part (how small soever) of the _SECUNDINE_ or _Membrane_, or some _clotted BLOOD_, or perhaps a _MOLE_, miscall’d a _false Conception_, may be left behind in the WOMB; which distending that _Body_, occasions not only an immoderate FLUX, but also stirs up violent PAINS, not unlike to _those_ of LABOUR: In this pitiful _Condition_, all possible Diligence must be prudently used to fetch away and remove this _Cause_, which is only most effectually to be done by the _Hand-Cure_, in the manner already abundantly set forth.
AFTER which, the _PATIENT_ is to be treated as _before_, laying her _equally flat upon her Back_, and keeping her very _still_ and _quiet_ in BED; which BED may however in this _Case_ be kept a little _Cool_, as well as her _Chamber_, lest HEAT should provoke and continue the _Course_ of the FLUX.
MOREOVER, in fine, it also sometimes happens, that immoderate _Purgations_ proceed from some gross _Excrements_ contain’d in the RECTUM antecedent to the Time of LABOUR; which, as they puff up the _Belly_, so they also commonly occasion severe CHOLICKS; but these being discreetly evacuated by a pretty strong emollient CLYSTER, the FLOODING immediately ceases.
CHAP. V. _Of the Acute Distempers incident to CHILD-BED-WOMEN._
WE are in this place only to consider the _Acute Distempers_ of the _Puerperial Woman_, because the Time of _lying-in_ is not of such a long _Continuance_ as to admit of _Chronick Diseases_: And these _Acute Ones_, in short, which they are most commonly subject to, are continual FEVERS, (Either, 1. _Essential_, that is, FEVERS proceeding first from the BLOOD; or, 2. _Symptomatick_ FEVERS, that is, such as follow upon the internal _Inflammations_, which often attend the _Child-Bed-Woman_;) as also _Frenzies_, _Watchings_, _Lethargies_, _Convulsions_, _Epilepsies_, &c.—
BUT more especially there is _one_ particular kind of FEVER, which invades almost all labouring _Women_ the third or fourth Day after the _BIRTH_, and is commonly call’d the _MILK-FEVER_; because about that time, the _MILK_ begins to generate more plentifully in the BREASTS, taking its _Rise_ from the Motion and Agitation of the BLOOD, which converts it from the WOMB to the BREASTS. This _Distemper_, resolving itself about the ninth Day by SWEAT, is of no dangerous _Consequence_; provided the _PATIENT_ observes a good and proper DIET, and duly prevents all _Cold_, that might readily stop the SWEAT, and carefully preserves the MILK from _coagulating_ or _putrefying_ in her BREASTS, whence the _Symptomatick FEVERS_ commonly arise: Wherefore, I say, this _MILK-FEVER_, being of the extended _Ephemerick_ Sort, and ceasing of itself, requires no great _Cure_.
ONLY in this _Case_, it is a vulgar _Error_ among the _good Women_, that because this _FEVER_ lasts only four or five Days at most, coming on about the fourth, and ending about the ninth Day after the _BIRTH_, they take all _Fevers_ in this time, for the _MILK-FEVER_; and consequently thro’ this _Mistake_, neglecting, or not regarding duly the true _Condition_, the PATIENT is very often endanger’d: Which _Mistake_, that they may for the future diligently avoid, I shall subjoin here some certain SIGNS of _Distinction_ in due Course. But previously——
THE _Causes_ of all _FEVERS_ incident to the _Child-Bed-Woman_, are either the _Suppression_ of the LOCHIA in whole or in part; or the vitious _Quality_ of the _Humours_ accumulated in _Gestation_, and exasperated in the BIRTH; or a vitious irregular _DIET_ in the time of _lying-in_; or the cold AIR, or any such _Accident_ by bad Management, may readily convert the _MILK-FEVER_ into a putrid and dangerous _one_; as a latent _CACOCHYMY_ may also easily dispose it to _Corruption_.
THE true _DIAGNOSTICKS_, in my Opinion, are as follow, _viz._ FIRST, the _MILK-FEVER_ is known from hence, that it always begins about the _Fourth Day_, when the _BREASTS_ begin to fill with _MILK_; and then the _LOCHIA_ flowing regularly, the _Woman_ finds a certain _Gravity_ or Weight in her _Back_ and _Shoulders_.
BUT, SECONDLY, when the _LOCHIA_ are _suppressed_, whether in whole, or in part, ’tis then certain that the present _FEVER_ proceeds from thence; the _BELLY_ thereby swells and is puffed up, as also it is _pained_ when _touched_; and the _Humours_, at last, putrefying in the _WOMB_, it ejects a certain _fœtid or corrupt Matter_.
WHEREAS, THIRDLY, if the _FEVER_ neither proceeds from the _MILK_, nor from any Irregularity of the _LOCHIA_, why then it must necessarily either proceed from the _vitious Quality_ and Preparation of the _Humours_; or from a _Cacochymical Habit_ of Body; or from an _irregular Way of Living_ in time of _GESTATION_.
THE most certain _PROGNOSTICKS_ are as follow, _viz._ FIRST, All _Acute Diseases_ in _Child-bed Women_, whose _Strength_ is impaired by their _LABOUR_, are much more dangerous than in any _Others_. SECONDLY, These which proceed from the _Suppression_ of the _LOCHIA_ are most dangerous; because the _Humours_ putrefying in the _WOMB_, occasion most severe _SYMPTOMS_, yea and too commonly _DEATH_ itself, unless a lucky _Diarrhæa_, or a timely _Ejection_ of the corrupted Matter, prevents the _Misfortune_. THIRDLY, The self-same is the unfortunate _Consequence_, when the _Distemper_ proceeds from the vitious _HUMOURS_; for _Nature_ then not being able to expurgate their abounding Superfluity by the _LOCHIA_, the _PATIENT_ must needs be greatly endanger’d, if not overwhelm’d.
THE most adviseable _Cure_, FIRST, as to the _MILK-FEVER_, is only to be committed to _Nature_, the _Woman_ using always a proper _DIET_, and carefully animadverting, that the _SWEAT_, in which it commonly terminates, be no ways checked, impeded, or obstructed.
SECONDLY, As to the _Watchings_, _Deliria’s_, _Epilepsies_, &c. which the _PATIENT_ is subject to in this Condition; as they proceed only from _Vapours_ of the _BLOOD_ and _Humours_, ascending to the _Head_, when the _LOCHIA_ do not flow regularly, or when the _Woman_ is _Feverish_: So the _Cure_ of these distemper’d _Cases_ depends (at first) chiefly upon retracting the _HUMOURS_ from the _Head_ to the inferiour Parts, and correcting the _Course_ of the _LOCHIA_: Because, if these flow orderly, and the vitious _Humours_, from which such depraved _Vapours_ as affect the _Head_, be removed and evacuated, all such _SYMPTOMS_ quickly cease and vanish of their own Accord.
THIRDLY, in the other above-mentioned _Cases_, the _PATIENT_ ought always to be treated according to the various Circumstances of her _Condition_; I mean, according to the attending _SYMPTOMS_, conformable also to which the ingenious _Physician_ will always judiciously take his prudent Measures: Since the _Cure_ does not always depend upon the _same Method_; especially when a _symptomatick_, or concomitant _FEVER_, joins the _first_, as it very often happens, by an _Inflammation_ of some _particular Part_, proceeding from something of the vitious _HUMOURS_ enforcing itself upon the same very _Part_.
NOW, in short, tho’ such _Inflammations_ may affect any _Part_ of the Body, yet (I think) the most common _Case_ is, that which affects the _PLEURA_; and from hence (the _Pleurisy_ joining the _FEVER_) the _Woman_ labours under both these complicated _Acute Diseases_ at once. The _Cure_ of which difficult and dangerous _Condition_ belongs only to the ablest _Physician_, to whom I should be justly censured, in impertinently offering any _Instruction_ upon this Subject. Finally, in a word, from what has been said in the _Chapter_ of the _Acute Diseases_ of Women with _CHILD_[181], we may more fully gather what is to be prudently done to Women in _CHILD-BED_, afflicted with the like _Distempers_.
CHAP. VI. _Of the various other Accidents incident to the CHILD-BED-WOMAN._