The London practice of physick, or, The whole practical part of Physick contained in the works of Dr. Willis faithfully made English, and printed together for the publick good.

The Putrid Fevers of Women in Child-bed.

WOmen in Child-bed, throught the taint of their ill affected Body, as tho they were struck with the Contagion of a pestilential Air, are found to be extreamly obnoxious to a putrid or rather malignant Fever, tho all do not equally receive tha taint of this Disease; for poor Women, Hirelings, Rusticks, and others us'd to hard Labours, also Viragoes, and Whores, who are clandestinely delivered, bring forth without great difficulty, and in a short time after, rising from their Bed, return to their wonted Labours: but Women that are rich, tender and beautiful, and many living a se∣dentary Life, asa tho they partak'd of the Divine Curse after a more severe manner, bring forth in Pain, and presently after their delivery lye in an uneasie and dangerous condition: the reason of which seems to lye in this, that those that use much exercise, continually exagitate, and eventilate the Blood, and therefore after the Menses are stopt, heap

together fewer Miasms for the matter of the Disease; Moreover, labour∣ing and active Women, having the nervous Parts more firm, are less subject to convulsive Mothions, and the affects vulgarly called hysterical: on the contrary, in nice Women, and such as live idly, during the time of their being with Child the mass of Blood becomes impure and fer∣mentative: moreover, because they have the Brain and the System of the Nerves thender and weak, upon any light occasion they undergoe Distractions of the animal Spirits, and disorderly Motions of the nervous Parts: and here it is to be noted by the by, that Women before Men, and some of that Sex before others, are troubled with the Affects called hysterical, not so much by reason of the fault of the Womb it self, but by reason of the weaker Constitutions of the Brain and Genus Ner∣vosum: for in Perons so affected, Passions of Anger, Fear, Sadnes; also all vehement or strong Objects easily pervert the Crases or Functi∣ons of those parts, which when they have been once injur'd, day af∣terward in a manner always accustom them selves to the same Irregula∣rities. But to return whence we made a digression: the Fever even now mentioned is wont to infest Women in Child-bed, at various thimes, and for diver Occasions; sometimes it arises presently after delivery, especially if it has been difficult and laborious, sometimes the second, third, or fourth Week; tho the later it begins, the safer it it is wont to be; the Type of that effect passes after this manner: after a previous indisposition an open feverishness for the most part with a cold and a shivering makes the first invasion, which presently is follow∣ed by a heat, afterward a sweat ensues for a day haply or two, there are various reciprocations of Fits of heat and cold: afterward, the Blood being kindled throughtout, the Lochia, unlefs supprest before, either flow a little, or wholly stop. If the Disease be acute, and of a quick motion, on the third, or fouth day it comes to its height, then there is an intense heat, with a very troublesome drought, a ve∣hement and quick Pulse, there are obstinate Watchings, a great rest∣lessness of the whole Body, so that the Diseased continually toss them∣selves this way and that in their Bed, the Urine is thick and ruddy, and other severe symptoms are rife: whilst the Fever is thus in its height, a Crisis is not to be expected; for I have never seen this Di∣sease resoled by a critical sweat; nay, the case is very dangerous, so that after the Blood has boyl'd for some time, the adust matter pre∣sently being convey'd into the Brain, dangerous and very sore Irregu∣larities of it, and of the Genus Nervosum straitway ensue, for convul∣sive Motions of the Tendons, wonderful distentions about the Viscera, and puffings up, resembling hysterick Passions, oftentimes are raised: Moreover, sometimes a Phrensy, a Delirium, often a Stupor and a Speechlessness also follow; almost in all the strength is suddenly cast down without a manifest Cause, tyhe Pusse becomes weak and uneven, and the Diseased are often precipitated into Death: if any haply es∣cape,

either the flowing of the Lochia being restor'd, or a Diarrhoea superventing, they recover with much adoe after a long lying ill: I have known purple Spots to have appear'd in some; indeed in most the symptoms which regard either the Blood or the nervous Juyce, argue no small malignity.

The Procatarctick Causes of this Fever, on which the malignity and mighty danger of this Disease depend, are chiefly two; viz. first, an evil dispostion of the Blood, after a long suppression of the Menses: secondly (after delivery) the evil affects of the Womb from the dangerous labours of Women (which make out the Divine maledi∣ction:) after the Menses being long supprest, the Blood does not on∣ly grow turgid, and its sulphureous parts being rais'd too much, are rendred more apt for Inflammation, but moreover, the mass of Blood is imbued with very fermentaive Particles, so that (as is hinted be∣fore) being struck as it were with a venemous Miasm, as it ferments, it forthwith is dispos'd toward a putrefaction and corruptive irre∣gularities, and besides, it may presently poyson the nervous Liquour, and render it offensive to the Brain and the whole Genus Nervosum: this kind of taint communicated to the blood, ought to be purg'd forth by a copious flowing of the Lochia; but if after delivery the Womb be out of order, their is not only a stoppage of the Lochia, and so the Reparation of the whole blood is hindred, but besides, stinking Ichors are thence transmitted to the blood, and greatly infect it. Also by rea∣son of convulfive motions begun about the Womb, and thence conti∣nued to the other Parts, Irregularities are rais'd in the Blood and Juyces, whcih often conspire to the production or exasperation of a Fever.

The evident Causes which either cause an actual effervescence in the Blood, having gotten a Dyscrasy, or trouble the whole Body with the Distempers of the Womb are divers; for these make a painful deli∣very, a solution of unity about the Womb, a contusion, a retention of preternatural things, an ulcerous disposition, and a great many other Accidents, which are caus'd throught some necessity; but the occasions in the power of Patients, and easie to be avoided, which are wont to raise this Fever, are chiefly two; viz. an ill form of Dyet, and a taking Cold. It's a usual thing to give to weak Women after Child-birth, on the first and second day, the Flesh of Animals, or their Gelly-broths, and other Food very disproportionate to their Constitutions; whence presently an indigestion and great disquietings arise in the Viscera, and feverish turgescencies in the Blood, by reason of a nutritive Juyced richer than it ought. Befides Errours commit∣ted in Dyet, often an Injury is Caus'd, for that their Bodies, which are very tender, and by reason of the Labours of Child-birth, and the Ex∣clusion of the Foetus, are all full of open Pores, are too unwarily ex∣pos'd to the open Air: for most, being impatient of their Bed, put on

their Cloaths, and rise from it within a day or two, or sooner than they ought: thereby presently the Pores of the Skin being presently stopt, and the Air getting into the Uterine Parts, tanspiration is check'd, and often the Lochia are suddenly stop'd, either of which suffices to raise a feverish effervescence.

The conjunct Cause, or formal Reason of this Distemper, compre∣hends chiefly these three things; to wit, there are present, first a mighty Dyscrasie of the Blood, that growing very hot from a Fever occasionally rais'd, it does not burn evenly, nor does is subdue by degreeds the adust Recrements, and purge them forth critically; more∣over, the boyling Blood is presently loos'ned in its Mixture, and its Texture being loos'ned, it declines toward Corruption; hence when it has a little abated of its Heat, the Spirits, being cast from their Go∣vernance, are driv'n into Confusion: mean while, the sulphureous Particles become masterless and exorbitant; wherefore the Strength fails without a manifest Cause, the Pulse becomes weak and disorderly. Tho from the Deflagration of the Blood a great many adust Recrements are heap'd together, yet nothing is duely concocted or separated; but Nature being greatlyopprest, altho the Diseased continually sweat, they often receive no ease thereby: but the Febrile Matter, which ought to be purged forth, being conveyed into the Head and Genus Nervosum, causes there very sore Perturbations of the animal oeconomy. Second∣ly, The Tragedy of this Disease, for a good part of it, is ascribed to the nervous Juyce forthwith turning sharp, and therefore rendred dis∣proportionate to the Brain and its Appendix; for this being defiled with a Taint contracted from the Blood, does not gently irrigate and mildly inspire its Subjects, but (as when an Infusion of Vitriol is pour'd on a Worm) mightily vellicates, and irrtates into Contrqactions, and as it were into Motions of Trepidatons and Leapings those tender Parts, and sometimes wholly overthrows their Functions: hence Con∣tractions, severe Convulsions, a Delirium, Watchings, sometimes a Stupor, and sleepy Affects, happen to Women after Delivery. Ihird∣ly, whilst these things are done, often a third Troop of Symptoms in∣fest the Diseased; to wit, for that the Womb, being some way hurt, moves it self disorderly, and is struck with a Contraction in these or those Parts; thence presently by the Membranes nad nervous Ductus's convulsive Motions pervade the whole Region of the Abdomen, where∣fore the Viscera and Hypochondres are blowen up, Belchings and vio∣lent Vomitings are raised; afterward the Affect creeping upward, and possessing the nervous Parts of the Thorax, a difficult and uneven Breathing, a Palpitation of the Heart, a sense of Choaking in the Throat, by reaon of the Muscles there drawn together, and other Symptoms are raised throughout the whole, upon the same Injuries being communicated to the Brain.

The Fevers of Women afte Delivery, are scarce ever free from danger, tho sometimes it happens for them to be cur'd about the first beginnings, by a thin Diet, and upon restoring the flowing of the Lo∣chia: but if the feverish Distemper has laid deep Roots, that the Blood be wholly kindled, and boyls immoderately, we can give but an ill Prognostick; and there will be a greater Cause of Danger, if be∣sides a Heat diffus'd through the whole, the Diseased are seised with a frequent Shivering, if they are affected with a great Restlessness, and Watchings, with sudden Concussions of their Bodies, or Contra∣ctions of the Tendons: if on the third or fourth Day they complain of a ringing of the Ears, with a great Repletion of the Head, you may presently gather, that a great Evil is at hand, to wit, a Mertastasis of the febrile and offensive Matter into the Brain; nor is less to be feared if there lyes an Oppression and Load on the Praecordia that the Disea∣sed cannot freely breath, nor draw their Breath deep, nor form the bottom of the Thorax; but only from the upper part of it, and that short and with a Blowing, so that in the mean while the Diseased are forc'd to fit upright, and to move themselves this way and that, after a restless manner; for this argues the Blood to stagnate about the Heart and Lungs, also that it is apt to grow clotty, and to be coagula∣ted: and if worse yet Affects of the Brain and Genus Nervosum ensue, and the Pulse becomes weak and uneven, you may declare the Case to be desperate: but if (as if sometimes falls out, tho rarely) after a Fever is kindled, and threatens severely, either a flowing of the Lochia, or a Diarrhoea happens with Relief, some Hope may be admitted.

Concerning the Cures of these kinds of Fevers, a Physician has a ve∣ry hard Task; because, among the Vulgar, all Medicines to Women in Child-bed are accounted not only useless, but likewise very hurtful; wherefore, Physicians are selfom called, but when there is no place left for Medicines, and the occasion for a useful Assitstance is wholly past: and if they are present about the first beginnings of the Disease, it will not be an easie thing to procure Health to the Diseased by vul∣gar Remedies; and whatsoever they try, unless it gives Help, is af∣firmed by old Women, and those that are about them, as pernicious, and the only Cause of their Death: that in reality, there is wont to accrue to us about the Cure of no Disease, less benefit and more Dis∣grace than of this.

Now the method of Cure (even as in contagious Diseases) is twofold; to wit, Prophylactick and Therapeutick: the former of these delivers Precepts and Cautions, with which Women in Child-bed are preserved from the Incursion of Fevers; the other suggests curative Intentions, with which the Diseased (if it may be) recover again their Health.

1. Tho this Fever, however malignant it be, is not accus'd of Con∣tagion, and there be no fear in those that lye in, of a venemous Miasm being received from without; nevertheless, all Women in Child-bed

have an innate Minera of Virulency, and ought to have a care of the mischief of this, as a Fomes of a mighty Malignity; wherefore they have need of an exact Governance, that after Child-birth the Impuri∣ties of the Blood and Humours may be duely purg'd without the danger of a Fever; and that the evil Affects of the Womb be healed; and that the Strength, broken and debilitated by Child-birth, may be duely restored. For these ends, these three things are to be chiefly inculcated in the Praescripts of Physicians: First, I think it necessary that a most exact form of Diet be ordered Women in Child-bed; to wit, that at least for a Week they wholly feed on Oat Broths, sometimes prepar'd with Ale, sometimes of Water mixed with White-wine; because they are much emptied, therefore they may sup often of them; but let no∣thing of a solid or strong Food be given; for I have diligently observ'd that an over-hasty eating of Flesh, or of a rich Food, has oftentimes brought these Fevers. For, Women in Child-bed ought to be ma∣naged not only as Persons sorely woulded, but as having gotten a fe∣verish Indisposition from a troubled Crasis and Distemperature of the Blood; for in them, the Blood being for a long time too much exalt∣ed and inspired with an impure Miasm, presently upon the Access of any sulphureous Fuel, takes a light Flame. The second Care, after Diet, must be, that the Pores be not clos'd, or the Lochia stopt, upon the unwary Admission of an outward Cold; for upon the lightest oc∣casion, the way of the Transpiration being chang'd, the Blood, before fermenting, falls into Disorders, also the Womb being touch'd with the breath of the Air, contracts it self, and closes the Mouths of the Ves∣sels, that the Lochia do not flow: wherefore in any wise Women ought to be kept in Bed five days after Child-bearing. I know its the vulgar way to take Women out of Bed the third day, but I have known many to have fall'n into Fevers thereby; and in truth, if we will have Child-bearing Women secure from danger, the safest way will be, to keep them in Bed longer. There remains a third Scope concerning Preservation, that in Women in Child-bed, by giving somewhat gently to stir the Blood, we continue a flowing of the Lo∣chia: for this end Midwives are wont (if at any time after a difficult Child-birth that Evil be fear'd) to give Sperma coeti, Powder of Irish Slate, or Saffron steep'd with White-wine: moreover, to pre∣pare Broths, that they may fuse the Blood more, of Water mixed with White or Rhenish Wine, in which, or also in Whey, they boyl Mary gold-flowers, Penny Royal, or Mugwort. There are a great many other kinds of Administrations in use for Women in Child-bed, which I willingly pass by, as being valgarly known.

The Cure of the Fever following Child-birth far differs from the Method used in Putrids: for in that it is not to be expected that the Blood being struck with a Febrile Burning, should burn on by degrees and then should subdue the adust Recrements heap'd together by de∣grees

in its Bosom, and should separate the same by a Crisis; but ra∣ther (as is best done in a malignant) assoon as the Blood boyls immo∣derately, it is good to exagitate it, and to send forth its haeterogene∣ous and impure Mixtures by Remedies gently promoting Sweat; wherefore it is usual among the Vulgar (and that not amiss) to give presently Sudorificks to Women in Child-bed that are feverish: by this means the Blood being eventilated, its Effervescence is appeased; also by reason of its Agitation, the Lochia, apt to be restrained, are stimulated to a flowing. It is much disputed among Authors whence the Beginnings of these kinds of Fevers ought to be computed; to wit, Whether from the Birth it self, or from the first Sense of the Fever∣ishness: but it little matters whether it be concluded this way or that; for, since this Fever does not justly observe the wonted Stages of Pu∣trids, nor is to have a Crisis, nor at all admits the use of a Cathartick Remedy, there is no cause for us to be any ways sollicitous concerning its Period or Mensuration as to days: but it will be only useful for us to distinguish concerning its curative Indications, of what things are to be done in the Beginning, Encrease, and End of this Disease; what also we ought to attempt while the Strength holds somewhat good; and what in the same being depressed and greatly dejected.

When therefore any Woman brought to Bed is first affected with this Fever (whose Invasion is distinguished from the Lacteal, because it begins for the most part with a cold Shivering) presently we must en∣deavour that the Fewel be plentifully withdrawn from the burning Blood; and, as I have advised above, let the Flesh of Animals, or Broths made of the same, be wholly forbidden: for these fix the Blood, and constipate it too much, and hinder its purging, which is very necessary both by the Lochia, and by cutaneous Transpiration: and rather, tho the Fever be pressing, let Decoctions, Powders, and Confections, be given of moderately hot things: of this kind (as I said before) are the Decoctions, or distilled Waters of the Flowers of Marygolds, of the Leaves of Penny-royal, of Mugwort, of the Roots of Scorzonera, also bezoartick Powders, Spirit of Harts-horn, the fixed Salts of Herbs, &c. If the Lochia are stopt, we must try all ways to move them to flow again; for promoting these, Frictions conduce, and Ligatures about the Thighs and Legs, also in the Soles of the Feet, sometimes cupping Glasses, or Vesicatories about the Thighs, or Hips, also in the Soles of the Feet; sometimes also Blooding in the Ancle is good: mean while, let a Fomentation of an hysterick Decoction be applyed about the Share, or let a Weathers Caul, taken forth warm, be laid on the lower Part of the Belly: it has been found by Experi∣ence, that Pessaries, and uterine Injections, have sometime done good; if the Belly be costive, let it be gently loos'ned by the Violet Suppository, or an emollient Clyster. We must beware of a too strong Irritation, because it is known, that in Child-bed the Strength is sud∣denly

cast down, with a Swooning, by a copious Purging, even as in a Malignant Fever. If at any time, with a Suppression of the Lochia, there be a mighty Perturbation of the Blood with a Vomiting, a Thirst, and Watchings, I have often known Laudanum mix'd with Saffron given with good Success. Instead of a cooling Julep, this kind of Mixture may be proper: viz. Take Water of Penny-royal, and of Bawm, of each three ounces, Histerick-water two ounces, Syrup of Mug∣wort an ounce and a half, Tincture of Saffron two drams, Castoreum tyed in a Rag and hung in the Glass a Scruple. Mix them. Let three or four Spoonfuls of this be taken divers times in a day.

2. If, notwithstanding the use of these kinds of Remedies, the Fe∣ver still grows worse, and is increased by degrees with a worse Appa∣ratus of Symptoms, so that besides the Disorders of the Blood, the Brain and nervous Parts begin to be affected, Medicines, tho a great many of them of every kind are tryed, oftentimes can do nothing: nay, in this ease, the Indications are in a manner coincident with those that are to be made use of in the Plague it self; for, the Lochia being a good while supprest, they cannot easily, or searce at all, be brought again in a great Confusion of the Blood and Humours: therefore it is good quickly to raise a Sweat; to wit, That the Corruptions made in the Blood and nervous Juice, and restagnating from the Womb, may in some sort be sent forth by Sweat and insensible Transpiration: wherefore here Bezoartck Powders and Confections, Spirit of Harts-horn or of Soot, Tinctures of Coral or of Pearl, conduce. I have sometimes seen, that by the help of these kinds of Medicines, in a desperate Case, somewhat of Hope has shewn it self, the Pulse and other Symp∣toms promising a little better; tho the Cure has seldom succeeded: but when that use of Cordials was remitted, the Diseased fell head∣long into Death, with a weak Pulse, and a Loosness forthwith ari∣sing.

3. When still the case of the Diseased grows worse and worse, that the Fever being increased, the Pulse is weak and uneven, and frequent Shiverings, and convulsive Motions infest the whose Body, with a Delirium, or a Stupor; then let the Physician, first giving a Progno∣stick of Death, insist on fewer Remedies, and those, in a manner, on∣ly Cardiack: and let him wholly abstain from Blooding, Scarifying, Vesicatories, or the use of Cupping Glasses; for such Administrations bring only an ill-will and Disgrace, that thereby we are accounted by Women hard-hearted and cruel.