The practice of physick in seventeen several books wherein is plainly set forth the nature, cause, differences, and several sorts of signs : together with the cure of all diseases in the body of man / by Nicholas Culpeper ... Abdiah Cole ... and William Rowland ; being chiefly a translation of the works of that learned and renowned doctor, Lazarus Riverius ...

Chap. 24. Of Acute Diseases of Women in Child-bed.

WHat we said before touching the Acute Diseases of women with Child, we may now repeat touching the Acute Diseases of women in Child-bed; viz. That they have the same Essence, and the same Signs, with the like Diseases in women which are not with Child, and in men. So that we shal refer the Reader for the Theory of these Diseases to their proper Chapters.

Now these Acute Diseases are for the most part, continual Feavers, both Essential, as Synchus pu∣trida, a continual Tertian, and the rest; and also Symptomatical, which accompany inward Infla∣mations, as the Pleurisie, Inflamation of the Lungs, Inflamation of the Liver, Phrenzy, and such like.

Yet there is a peculiar sort of Feaver, which besals almost al women in Child-bed, which is called by them the Feaver of their Milk, which is wont to befal them about the third or fourth day after they are brought to bed, when their Milk begins to encrease in their Breasts; and it ariseth from the reflux of the blood from the womb to the Dugs, and the motion and agitation thereof. Which kind of Feaver is reckoned among the Diary Feavers of the longest durance; neither needs it any Medi∣cines, because within three or four daies, viz. about the ninth after her delivery, it is finished by sweat. It is distinguished from putrid Feavers, because commonly it seizes the woman about the fourth day, after her being delivered, and her Dugs begin to be filled with Milk, and to be troubled with hardness, pain, and heat; with heat and heaviness in her Back and Shoulders; also her Child-bed Purgations slow duly, which seldom is seen in putrid Feavers.

Now putrid Feavers do befal women in Child-bed from three causes, viz. Suppression of their Child-bed Purgations or diminishing, by the heaping together of bad Humors during the time of their Belly-bearing, which were agitated by her Labors, or by Errors in their Diet. Some add immode∣rate flux of the Child-bed Purga ions, which is rather a sign of the secret badness of Humors causing the Feaver, but cannot be it self any cause thereof.

In suppression of the Child-bed Purgations, the blood and vitious humors which are collected du∣ring the whol time of her going with child, do flow back again into the greater Veins, and there pu∣trefie, and somtimes are c••rr••ed to the Liver, Spleen, and other parts, in which they raise Inflamati∣ons; or if they abide in the Veins of the womb, they putrefie, and so cause a Feaver, in those wo∣men which were before in perfect health.

But if (the Child-bed Purgations duly flowing) a feaver arise, it comes either from superfluity of Choller, or from errors in Diet. Evil Humors agitated by the Labors and Pains of Travel, do easily inflame and putrefie, and stir up a feaver. Errors of Diet may happen divers waies: And first in point of eating in which women that he In, are wont to be very faulty, stopping themselves with

plenty and variety of Dishes, which cannot be by them digested, but causeth putrefaction in their Bodies. Another error is committed when Childing women do unadvisedly expose themselves unto the cold Air, especially while their Milk-feaver is in its vigor, which is wont to be terminated by sweating and transpiration, which is hindered by heedless admission of the cold Air, whence it comes to pass that the Feaver which of it self was void of danger, and would in a few daies have ceased, is changed into a dangerous putrid Feaver.

There is yet another frequent Cause of the Feavers of Childing Women, viz. When the After∣births are not wholly cast forth, but some portion remains behind. This happens principally in the Womb-Liver, a part whereof is somtimes annexed to the Womb, and left there, doth putrefie; which makes the Child-bed fluxes to come forth greenish, stinking, and Carrion like; and if within few daies it be not separated from the womb, and excluded, it casts the sick woman into great danger of death, seeing it may mortifie the Womb.

If Clotters of Blood, or any other preternatural thing, shal remain in the Cavity of the womb after Child-bearing, it may thereby be known, because the neck of the womb remains soft and open, nei∣ther is the inner Orisice thereof shut, neither is the womb drawn upwards; and whereas, when all goes well after Child-birth, the womb is drawn upwards, and its neck and orifice are quickly shut. An Example here of is propounded by Dr. Havey, in his Treatise de Partu, concerning a woman, who having a malignant Feaver, and being very weak, miscarried; and after exclusion of a perfect Child, and uncorrupted, yet being very weak, with a creeping Pulse and cold Sweats, she was ready to give up the Ghost. He feeling her womb, perceived the Orifice thereof lax, soft, and very wide; and putting in his fingers, he drew forth a Mole as big as a Gooses Egg, having certain holes in it contai∣ning a clammy, black, and stinking putrefied matter, and the woman was soon freed from the foresaid Symptomes, and quickly recovered her health.

It happens likewise in some women that the Orifice of the womb presently after their delivery, is so shut up, that the blood contained within the womb, suddenly clottering and putrefying, causeth most sad Symptomes, and when no Art can bring it forth, present death follows. Yet Dr. Harvey relates in the place aforesaid, the History of a woman cured by him of this Disease. The Lips of the Water-gate were swelled, and very hot; the mouth of the womb was hard and close shut: He opened it a little with an Iron Instrument which he forcibly put in, so as it would admit an Injection made by a Syringe; and thereupon, clotted, black, and stinking blood, some pounds in quantity came away, by which means the sick woman had present ease.

The Prognostick of these Feavers herein only differs from the Prognostick of such like Feavers which happen to those that are not in a childing condition; because through the Labors of Child∣birth, the strength of the patient is more dejected; and by reason of the Child-bed Purgations sup∣pressed there is a greater redundancy of Humors in the Veins; and in both respects the Party is in greater danger.

The Decision of that famous Question, Whether the computation of the daies of the womans sick∣ness, ought to be made from the beginning of her Disease, or from the day in which she is delivered of her Child, makes much to cleer the Prognostick of this Disease, especially to foretel the Crisis. Which Question we shal therefore thus briefly determine: If the Birth of the Child were natural, attended with no grievous symptomes, and the Child-bed Purgations were as they should be, and the Feaver come some daies after, the account ought not to be made from the day of the Childs birth, but from the day the Feaver began, which was provoked by some other preternatural Cause, viz. Evil Humors lurking within the Body, or from some external Cause. But if the Child-birth were hard and beside the Course of Nature, and the Feaver arose after three or four daies; we must reckon from the day of the Childs birth; because then the whol order of the Body began to be overthrown, and the Humors to be disturbed, which was followed by the Feaver. So in grievous wounds of the wont of the Head especially, though the Feaver come not til after the fourth of fifth day, yet the account is wont to be made from the day of the wound received, because the Humors began then to be in a com∣motion, and to be disposed to cause a Feaver.

The Cure of these Feavers, differs not from the Cure of other Feavers, unless in point of those great Remedies, Blood-letting, and Purging,; in the administration whereof, there is no smal scru∣ple, which we shal briefly endeavor to remove.

As for letting of Blood in acute Diseases of women in Child-bed, the disagreement of Authors is so great, by reason of the contrary Indications on the one side, and on the other, that we can scarcely find two of the same mind. We shal briefly in these following Theorems or Maxims, propound that Opinion which cometh neerest the Mind of the wisest Authors, and is in the course of Practice most successful.

An Acute Disease befals a Child-bed woman, either in the beginning, or in the middle, or in the end of her Lying in.

If it happen in the beginning, and the woman be plentifully purged, there must be no other eva∣cuation

of blood, than that which is directed by Nature when she rightly and conveniently performs her Operations. But if the Child-bed Purgations are suppressed, or flow sparingly, let the interiot Veins be opened, and take a good quantity of blood away: because at that time the Child-bed Pur∣gations of blood, ought by the appointment of Nature to be plentiful.

If an Acute Disease happen in the middle time of her Lying In, two things are to be considered. The one is, Whether the Morbifick matter be contained in one particular place, or if it be dispersed through the Veins? The second, Whether the Woman hath been conveniently purged or not, in regard of quantity? If the Disease proceed from matter scattered abroad, as in Feavers, and the wo∣man hath not been fully purged, the lower Veins ought to be opened: because both the Morbisick Matter wil be diminished, and her Natural flux wil be provoked. But if the woman have been suffi∣ciently purged, and the Disease get ground, and the Natural Evacuation have not been sufficient for the Disease, the inferior Veins must be opened notwithstanding; and so much blood must be taken away, that by two Evacuations that may be accomplished, which the Disease requires, according to the Doctrine of Galen, in the ninth Book of his Method, Chap. ••.

If the Feaver be very high, and great heat vex the Patient, let that be done which we shal presently declare; which ought to be performed when the Disease ariseth of Matter driven into some corner, and there putrefying.

In a particular Acute Disease, as the Pleurisie, Inflamation of the Lungs, Squinzy, and the like; we must mark whether the Fluxion be only beginning, so that the Disease is only ready to seize upon the Patient, or is in its beginning, and very little blood be collected in the part. For then the inserior Veins are to be opened, that revulsion may be made to such opposite part. For then the inserior Veins are to be opened, that revulsion may be made to such opposite parts as are at greatest distance from the part affected, and by that means that preposterous motion of Humors may be stopped. But if the fluxion be already in good measure begun, and an Inflamation bred which proves very troublesom, whether the woman be sufficiently purged, or not, the superior Veins are presently to be opened right against the Part affected, because such an Evacuation draws Blood out of the Part Affected. But if the inferior Veins should be opened, which are neither next the part affected, neither can evacuate therefrom, both the strength of the Patient will be weakened by the evacuation, and that matter which is by Nature driven into a corner, and subdu∣ed, wil not be thereby diminished. And so you must either draw all her blood in a manner out of her Veins, to revel the matter of the Disease from the part affected; or the woman will be killed by the Disease before sufficient Revulsion be made. Neither need we fear, lest by taking blood from the upper Veins, we should draw the Course thereof from the womb, because in such Cases the supe∣rior parts of the Body do abound with blood. And although much blood be taken away, yet are not the Veins so emptied, that they should be forced to draw new blood from other parts. Yet for the greater Caution, it will not be unprofitable before blood be taken from the superior Veins, to cause the Thighs to be lustily rubbed, and presently after to tie them with bands so hard as to pain the wo∣man, which must abide so bound til the bleeding be over, and a little after they may be loosened; and now and then Cupping-Glasses must be fastened to the same parts, or at least they must be again wel rubbed. So we may procure an evacuation of the Matter offending, and yet preserve the Natu∣ral course of the blood towards the Womb.

The same course is to be taken in vehement and burning Feavers: For although the matter of∣fending be dispersed through the Body, yet is the burning heat so great about the Heart and Bowels, that it cannot be so wel extinguished by the opening of a smal, and far distant Vein, as by the opening of a neerer and greater, such as is the Vein called Basilica.

This Method of Curing may be observed not only in Child-bed women, but in other women who are taken with Acute Diseases, and have their monthly Courses upon them.

If in the end of a Womans Lying-In, an acute Disease befal her, the same Course must be followed as in the middle, the same conditions being observed; observing this for a Rule, That by how much a woman is further from the beginning of her Lying-In, by so much more safely may the uper Veins be opened; but the neerer she is to the beginning, yea, even in the middle, we are to open those Veins with the greater premeditation. And if the Disease be not importunate, nor the sharpness thereof require such a thing, and the Natural Purgation be copious, we must wholly abstain. But if the Purgation be scanty, we must open the inferior Veins to supply that which is wanting in the Evacuation. But if the contrary shal happen, let us follow that Rule which we presceibed to be fol∣lowed, in fol∣lowed, in the urgency of an acute Disease.

The use of Purging in Childing Women that are held with acute Diseases, shal be comprehended in these following Maxims.

While the Child-bed Purgations do Naturally flow, a Purge is never to be administred; for it is to be feared lest Nature be diverted from her business.

But if the Child-bed Purgations are not kindly, we must consider whether their consist its Quantity, or in Quality.

If they offend in Quantity, so as to be too little, so that the woman be purged either not at al, or not sufficiently: After al Remedies fit to procure these Purgations have been given in vain, and the Morbisick matter appears digested, eight, ten, or twelve daies being past since she was brought to Bed, according to the more or less urgency of the Disease, she may be purged gently, wholly abstaining from al stronger Purgatives.

If other Purgations offend only in Quality, so that a white flux, or some other unnatural color do proceed from her, the Matter being ripe, she may in the last part of her Lying-In, be safely purged.

But this must evermore be generally observed, That by how much the longer a Childing Woman is distant from the day of her bringing to bed, by so much the more safely she may be purged, and contrarywise: For Experience hath taught us, That women wanting their Child-bed Purgations, if after the seventh or ninth day they are taken with a loosness, they commonly scape. But if the Loosness seize upon them upon the first daies, viz. on the secoed, third, or fourth, for the most part they die.

And so have we finished the Cures of Womens Sicknesses; all Praise and Honor be given to God therefore.