Pulse and Temperature.—­The temperature may rise one to one and one-half degrees without the case being abnormal.  The pulse falls after labor, ranging between sixty and seventy.  A rise of temperature, a rapid pulse, a flushed face, a chill, pain or tenderness of the abdomen, and abnormal increase or decrease of the discharge, bleeding, or offensive odor of the discharge should cause suspicion of child-bed (puerperal) fever.  This is a grave condition and results from infection which has taken place during labor or afterward.  The septic matter may be carried in on the fingers or instruments by the physician or attendants, etc.  The most usual sources are unclean hands, instruments and clothing which come in contact with the woman’s genitals.  The attack is usually ushered in during the second to the fourth day by a chill, or chilly sensations, etc., rise of temperature, rapid pulse, accompanied by headache and a feeling of weariness.  The discharge may be increased at first, but later diminished and may cease; or it may be abundant, frothy and of a very fetid odor.  Secretion of milk may fail, the bowels are usually constipated, pain in the abdomen develops.

Treatment.—­If the interior of the womb is smooth, a single antiseptic womb injection should be given; if it contains foreign material or is rough, it should be scraped and then a douche given.  This must be done carefully and with absolute cleanness.  Turpentine stupes should be placed hot on the abdomen for the pain, or where cold feels more grateful the ice bag or cloths wrung out of cold or ice water should be applied over the abdomen, and covered with several thicknesses of flannel and changed as soon as they become heated.  Medicines to relieve the pain may be given.  Hot and cold sponging may be given to reduce the temperature, a little alcohol can be added to the water or the cold or hot pack may be used.

[542 Mothers’ remedies]

Diet.—­This should be nourishing and supporting, and at first, liquid and consist largely of milk; but concentrated broths, jellies, and liquid beef, peptonoids, are useful.  Stimulants should be given in these septic conditions.  From one to two ounces of whisky may be given every three to four hours in the form of milk punch and, if possible, as much red or port wine also.  Women in this condition can stand this treatment.  Salines (salts) should be given to keep open the bowels.

Convulsions. (Eclampsia).—­All forms of convulsions may occur during pregnancy.  They may occur during pregnancy and during labor.  These are usually the result of kidney trouble.  The attacks occur most often during the last three months of pregnancy.  Their frequency is one to three hundred to one to five hundred cases.  It occurs oftener in the first pregnancy, three to one.