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 Symptomatick Fevers of Women in Child-bed.

THE acute Diseases of Women brought to bed do not only follow the Type of the foresaid Fever, but are sometimes at∣tended with some notable Symptom; to wit, the Quinsey, Plurisie, Peripneumonia, Dysentery, Small Pox, or of some other kind; and then they are call'd by the Names of those Affects. It is not proper to repeat in this Place what belongs to the Natures and Essences of each of them at large, but I shall briefly set down what those Diseases, complicated with the Affects of Women in Child-bed, have peculiar to them, as to their Causes or Cures.

We judge that all those Symptoms proceed from a certain Coagula∣tion of the Blood, and afterward its Extravasation: now while the Blood is extravasated in one part, every natural nad critical Effiux of it is restrain'd in another; wherefore there is danger, lest while the Blood begins to be coagulated either in a particular and usual Focus of Congelation, or universally in its whole Mass, presently the flowing of the Lochia be stopt; which in reality happens for the most part, and therefore those Affects are most commonly mortal to Women in Child-bed: nevertheless, the Cause of their Death, for the most part, happens with some difference, to wit, in the Small Pox, the flowing Lochia call inward the Malignity began to be sent forth outwardly, and wholly poison with their Taint the Mass Blood and the Heart it self; and therefore in the Small Pox those uterine Purgations ought to be stopt: but in the Pleurisie, Quinsey, and the rest, when the Stimulus of the Disease, fix'd here or there in a particular Place calls to it self, and wholly derives from the Womb the Impurities of the Blood which ought to be voided by the Lochia, thereby it increases the Taint of the BLood: the Lochia restrain'd in the Small Pox might be sent forth by a more general way of Excretion, with the venemous Particles of the Disease; with indeed does not succeed in the rest by reason of the small and more spare way of Excretion.

Among these, the Quinsey, Plurisie, and Peripneumonia, by reason both of the great likeness of their Cause, and the Analogy of their Cure, may be considered together. When a Woman in Child-bed is affected with either of these, it is to be judg'd, that besides the Mi∣asms heaped together during the time of Ingravidation, there happens a certain acid disposition of the Blood, by the means of with, whilst it feverishly boyls, certain Particles of it being imbued with a sharp∣ness, fall into a Congelation in this or that place, like Milk turning sour and consequently coagulated: the Blood letted there, and hindred in its Circulation, hinders the Passage of the rest; now the Blood, being obstructed in its Motion, butts against its dam, and so being heaped

together round about, and driven out of its Vessels, grows into a Tu∣mour; thence presently whatsoever haeterogeneous and separable is contained in its Mass, is deposed in the Part affected as in a Sink: wherefore, the Corruptions of the Blood, which ought to be purg'd forth by the Womb, are deriv'd thence toward the Seat of this Dis∣ease; which since they cannot be purged forth sufficiently this way, both the Liquor of the Blood is more notoriously corrupted, and a Crisis of that particular Affect, to wit, of the Quinsey, Plurisie, or some other, is rendred more difficult.

For the Cure of these kinds of complicated Diseases, presently from the very first beginning it must be endeavoured, that the Blood fixt any where and begun to be extravasated, be restor'd to Circulation, and do not make an Impostume, because it is very rarely that Wo∣men in Child-bed, seised with those symptomatick Fevers, are cured by an Abscess or spitting forth of the Matter; wherefore, inward Re∣medies, which fuse the Blood and free it from Coagulation, are to be used; of which kind are chiefly Diaphoreticks filled with a volatile Salt, as Spirit of Harts-horn, of Soot, of Urine, and the Salts them∣selves: also testaceous and bezoartick Powders, Sal Prunella, Deco∣ctions and Juleps of Vegetables promoting the menses or the Urine; in all which those things ought to be mixt, which by Experience are found to be appropriated to uterine Affects: moreover, discussing Re∣medies, which drive away and expell the Matter stinking in the Part affected (of which kind are Liniments, Fomentations, and Cata∣plasms) are carefully to be applyed to it. Mean while, let the violent Motion, and immoderate Effervescence of the Blood be removed far from thence, and let its Excretions of Filth be conveyed still to the lower Parts, by what ways we may: for this end, Frictions, Ligatures, Epispasticks, and (if need be) cupping Glasses, may be applyed to the Feet or Legs: in case the Affect growing very much worse, blooding be indicated; unless there be a great Plethora in the whole Body, and a very acute Inflammation in the Part affected, it will be best to breath a Vein in the Foot, or to open the haemorroid Vessels with Leeches: but if necessity presses for it to be done in the Arm, after Blooding there, let another Bleeding (if it may be admitted) follow in the Leg: nevertheless, we must give a Hint, that opening a Vein ought to be very cautiously ordered in these Cases: for unless it gives Relief (which I have seldom known to happen) presently the Pulse be∣ing rendred more weak, the State of the Diseased becomes worse.

A Dysentery takes its Rise in a manner from the like Cause, as the foresaid Affects; but because in this, the extravasated Blood is pre∣sently poured forth, nor being restrain'd in the Body creates a mis∣chief there, and is still more corrupted: and since this way of Excre∣tion is performed near the uterine Efflux, and does not derive it after∣ward another way, hence less danger is feared from this Disease than

from the others before mentioned; tho oftentimes this Affect is mor∣tal to Women in Child-bed, and that the rather, because by a Dysen∣tery things that qualifie and gently astringe the Blood are indicated: and these are found too apt to stop the flowing of the Lochia: where∣fore in this case, till Women delivered are in a manner purg'd enough by a long flowing, let the Cure of the other Disease be omitted, and let the fierceness of Symptoms be restrain'd only by lenifying things.

The Indications of the Small Pox do not only differ from those ev'n now above described, but are attended by some Contrary to them∣selves; for they require the Flowings of the Lochia to be alittle stopr, (as is said before;) tho withal, that the Efflorescence of the Blood, and a gentle Sweat, be continued: for since in this Disease there is a double venemous Ferment, and the corrupted Particles of the Blood are carried forth two ways, Care is tob e taken that the less and nar∣rower Passage do not draw to it self all the Matter, or more than it can let forth: therefore, lest the Lochia too copiously flowing draw inward∣ly the Venom, which is apt to make an outward Efflorescence, the form of Dyet must be somewhat chang'd; and in the first place let things be boyled in the Broths of the Diseased, which have an Alexi∣pharmick together with an astringent Vertue (as the Roots of Tormen∣til and of Bistort,) also it is good to give at due Intervals of time, Pow∣ders, Juleps, and Opiates, endowed with such a kind of Vertue: moreover, in this Case let it by no means be allowed Women to feed on Flesh and Broths made of it, or to rise from bed; but a quiet both Mind and Body being procured by what means we may, and a Diet being ordered of those things which do not exagitate the Blood, let the business in a manner wholly be committed to God and Nature.

It were an easie thing to illustrate wlth Stories and Observations what is said above concerning the acure Diseases of Women in Child-bed; ut the Examples which may be brought in this kind, are for the most part deplorable and of an ill Event; for those Fevers generally are ter∣minated in Death. Now to describe these kinds of Sicknesses will nei∣ther confirm the Endeavour of a Physician, nor at all recommend the method of Physick used in them; however, since the Knowledge of these makes for the better Diagnostick of that Disease, I shall here propose certain singular Cases and Varieties of Symptoms of Women after Delivery; in which, tho Forms and ways of curing seldom occur, at leastwise you will have certain Rules of Precaution of no con∣temptible use.

A renowned Woman about twenty fix years of Age, was delivered of a sixth Child with great difficulty, and not without danger of Life. On the second day, she are a whole Chicken. On the third, being taken up from her Bed, she sate for four hours in a Chair. The night following she was ill, at which time the Milk sprang into her Breasts; which ne∣vertheless

soon disappeared upon the Application of the Diachylum Plaister. The next Morning she complained of a Lassitude, and a Pain like a Soreness of her whole Body, also of a Vomiting, a Nauseousness, and a Plenitude about the Ventricle and Hypochondres: a very trou∣blesome Night followed. On the fifth day she was more openly se∣verish, and felt sometimes a Shivering, sometimes a Burning all about her. She nauseated all things, had an Oppression of the Stomach, moreover, being restless, and without Sleep, the Lochia flowed but lit∣tle, but a whitish Humour (vulgarly call'd a flowing of Milk) flow'd from her. In the Evening she had a heaviness about the Fore-head and Temples, as tho she were sleepy, and began to sleep a little: af∣ter an hour and a half, awaking with a troubled Fancy, she complain'd of her Head being increas'd as it were to a mighty Bulk, also of her Jaws being closed that she could not open her Teeth, and of her Fifts being closely contracted; moreover, in her whole Body she seemed to perceive a pungitive sort of a Stupor: the Ventricle and Hypochon∣dres continued still distended and puffed up. To this Person Frictions, Ligatures, cupping Glasses, and other Remedies, both inwardly and outwardly, were applied for recalling the Lochia, and deriving the Recrements of the Blood from the Head: the weak and disorderly Pulse did not admit Blooding: Powders and Juleps for gently moving a Sweat, and fusing the Blood and nervous Juice, and hindring them from Restagnations, were diligently given. Moreover, Fomentations sometimes of linnen Cloths dipt in an emollient Decoction, sometimes of the tepid Viscera of Anirnals were applied to the lower Part of the Belly; mean while, stinking things (as is wont to be done to Persons troubled with hysterick Fits) were held to the Nostrils, for hindring the impetuous flowing of the Blood and Spirits to the Head. Now these things and others being carefully plyed for many Hours, she seem∣ed to perceive some ease, tho she still dreaded of closing her Eyes, or preparing her self for Sleep; for, her Eye lids being closed, a thou∣sand Phantasms came into her Head, with a noise, and a ringing in her whole Head. She passed the Night almost without Sleep; assoon as she began to slumber, presently being frighted, and being opprest in the Praecordia, she awaked. On the sixth day, about Noon, she had a cold Shivering, with a strong Concussion of the whole Body; to which, as in the Fit of an Intermittent Fever, presently a Heat, afterward a copious Sweat succeeded, tho no Relief hapned to the sick Person thereby: for presently after the Sweat, the feverish Heat renewed, and convulsive Affects more infested her. The Night following, when al∣so the other Symptoms grew worse, a Palsie was raised first in the Tongue, and then presently in the Throat, that she could not speak, and scarce at all swallow. On the seventh day, about the same Hour, a cold Shivering again, with a Heat and a Sweating, scised her, and thence∣forward the Pulse was far weaker and uneven; also a difficult Respira∣ion,

with short Breath, seised her; she knew not the Standers by. On the eighth day she dyed.

Many Occasions concured to the Death of this Woman, predispos'd to a Fever by reason of her Ingravidation, they greatly increasing the Malignity of the Disease; for, the hurting of the Womb through the difficult Delivery, the sudden striking of the Milk from the Breasts, the eating of Flesh, and the too quick rising from Bed, all concurred, as tho conspiring together, for a greater Mischief. The Blood taken with a feverish Burning began Disorders: it drew the Lochia, and haply other Corruptions of the Womb, into it self, and thence acquir'd a greater Taint and a wholly venemons Disposition; the Membranes of the Vis∣cera, whether upon their being fill'd with a degenerate nervous Juyce, or upon Contractions being communciated to them from the Womb, were struck with convulsive Motions: for those kinds of Inflammations and Distensions about the Abdomen, are really the Effects of Convul∣sions: for tho the direct Fibres contracting that Member, often com∣press it, yet when the Fibres both streight and transverse, and others placed in a various Site, are convulsed together in the Membrane com∣passing about the Cavity, part of it swells like a blown Bladder, into the Vacuity of which the Air secundarily passes it self. So far it is from what is ulgarly said, viz. That the Air, or Flatus's first heap'd together there, are the Cause of the Distension. In our Sick Person the Blood growing hot, and soon being full of an adust and malignant matter, presently, it being incapable of being subdued, and separated by Sweat, endeavoured to fix it in the Brain; the first discharge of that Matter on the Head, by reason of the Animal Spirits being half overwhelmed, brought the Sense of the Heads being very much increast in bulk; which happens after the like manner, as when the Foot, being seised with a Stupor, seems to be felt much greater than it self: now that af∣ter some ease, by slumbering, and closing the Eyes, the Affect return'd anew, the Reason is, because Watching, and the stirring of the Senses, in some sort shake off and remove from them the Matter besetting the Brain and Nerves; which nevertheless, being seated near, and in a Readiness, Sleep stealing on, is as it were imbib'd by them, and throughly enters their Bodies together with the nutritive Juice. Now the Blood, tho it had copiously discharged the Recrements on the Brain, yet it became not free it self; but being still full of an impure Load, fell as it were upon a critical Efflorescence, and with a Shiver∣ing, followed by a Heat and a Sweat (as is usual in a great Excretion) it tryed again and again to shake off its Burthen; tho all it could do by that Effort was, that the Matter sticking to the Brain got deeper Root in it, and fixing it self in certain Sprouts of the Nerves, it took away Speech, and Swallowing, and then afterward Sensation; and the Mass of the Blood being deprav'd more and more by degrees, at length it became unable for supporting Life.

A Renowned Woman, Married a little under Twenty, being with Child, and during the time of her Ingravidation having used but little Diet, and almost no Exercise, underwent in her Travail Pains and Throws, but with Intermission and a frequent Respite, for twelve Hours, and brought forth a Son; the Foetus came away with the Se∣cundine, and all things were well about the Womb. On the first and second days she was indifferently well, but on the third, after a light Shivering, she began to complain of a Thirst and a Heat; which a Loosness followed, so that she had four Stools that day; the Night passed in a manner without Sleep, the feverish Distemper continued afterward for two days after the same manner; she daily had three or four Stools, the Lochia as yet flowing moderately. On the sixth day, when by the Perswasion of Women she had taken somewhat for mode∣rating her Loosness, the Purgings of the Womb were in a manner wholly stopt: at which time, the Fever became more intense, and Symptoms resembling Hysterical arose; for, in the Praecordia she had great and frequent Oppressions, and had a sense of Choaking in the Throat. On the seventh day, there was a more intense Heat, and a difficult and more painful Breathing; and then by a Physician's Order, at that time first call'd, three ounces of Blood were drawn from the Foor, after which, for four Hours, she was better; for a quiet Sleep, with a copi∣ous Sweat, ensued, the Lochia, tho in a small quantity, appear'd again: in the Evening all things grew worse, the Strength being very much resolv'd, the Pulse became weaker, and uneven; she complain'd also of a Noise and a ringing of the Ears, with a Plenitude of the Head, moreover she had Leapings of the Tendons in her Wrists, also sudden Convulsions of the whole Body, and still the Loosness troubled her. To this Person Cordials and other Remedies and kinds of Administrati∣ons diligently used by the Prescripts of many Physicians, did not the least good; the pulse growing weaker, and the Strength decreasing by degrees, on the ninth day after Delivery she died.

This Fever depended very much on the vicious Disposition of the Body, as on the procatarctick Cause; for I have often observed, that it falls out ill with Women in Child-bed, who when they are with Child, unwholsomly seed on fruits and any sorts of food, and living without Motion and Exercise, indulge themselves only to Idleness and Rest: the Blood, by reason of the previous Cachexia, without any evident Occasion, fell a burning as it were of its own accord; now whilst it boyled, deposing its Recrements and Impurities still inward, it brought the Loosness: nor did its Mass become more pure from that almost continued Excretion, but its Mixture or Crasis being still more depra∣ved, at length the Blood fell wholly from its genuine Nature, and be∣came uncapable of fermenting in the Heart: the Loosness naturally hap'ning was ill stopt, especially by the use of AsTringents; for I have often observed, that these things are not attempted without danger:

for a Loosness has cured some that were ill, and in that Lady, and in many others (as we have sufficiently found by Experience) tho it did not take away the Fever, yet it freed them from the more severe Af∣ects of the Brain and Genus Nervosum; whence this Diseased was whol∣ly without a Delirium, nor was she seised with convulsive Motions, till she was brought almost to the last.

A worthy Matron about thirty six Years of Age, going with Child the seventeenth time, was very sad, and perplex'd with Thoughts that she should dye in Child-bed upon her Delivery: but (as it pleased God) she was very well delivered of a Son, and was chearful for three days after. On the fourth day, having eaten more of a Chicken than she ought, a little before Night she fell into a feverish Distemper, with a Vomiting, and the Lochia were stop'd: all the night she lay without Sleep and restless; the next Morning, within an Hours space she had four Stools, and seem'd to be reliev'd; about Noon (at which time I came) she complained again of a Heat and a Drought, also of a Palpi∣tation of the Heart, and of the Ascent of a certain heavy thing in her Throat; the Pulse was quick and small, the Urine was ruddy, the Lo∣chia scarce appeared. I ordered that Cordial Juleps, and things mo∣ving a Uterine Purgation, should be given to this Person; moreover, That Fomentations should be applyed to the lower part of the Belly, also that the Legs and Feet should be often rubbed with warm Cloaths: at the time for Sleep, I gave her a Grain of Laudanum, with half a Scruple of Saffron powdred in a Spoonful of Treacle Water. She slept qui∣etly, and the Lochia flowed plentifully, afterward, using a thin Diet, and things gently promoting a uterine Flux for a few days, she per∣fectly recovered.

A Noble Woman, Young, and Handsome, had a good easie Deli∣verance of a second Daughter, and for six days being well as to the Lo∣chia and other Accidents, she was wholly free from the Suspicion of any Distemper; she daily are Flesh, and being taken forth of Bed she lived chearfully in her chamber. On the seventh day, without a ma∣nifest Cause, she had a Shivering, with a Fever, and the Lochia were lessened, tho not supprest. To the tenth day after her Delivery, be∣ing only gently feverish, and the Purgings of the Womb still flowing, she liv'd free from any severe Symptom; but then, tho very feverish, she seemed more chearful than usual, and more confident of her doing well; in the night she slept little or scarce at all; the morning follow∣ing (at which time I first visited her) she was manifestly delirous, the Lochia were stopt, and the whole Body was in a Shivering, the Ten∣dons in the Wrists were convulsed, so that her Pulse was scarce to be distinguished; which in the mean while was weak, uneven, and very quick. I declar'd, That this Person, unless the Hand of God unex∣pectedly delivered her, must dye in a short time; however, six Grains of Oriental Bezoar being given in a Spoonful of a Cordial Julep, and

causing a copious Sweat with a better Pulse, and afterward other Cor∣dials given at due Intervals, gave some hope of doing well, tho doubt∣ful, and not to be relyed on. After four Hours after I came, being in a languishing Condition, she had a very large Stool, then presently her Strength wholly fell, and within an hour and a half she died.

A Woman of Quality, scarce exceeding twenty Years of Age, of a florid Countenance, and a thin Body, the Lochia flowing immoderate∣ly after Child-birth, used certain astringent Remedies by the Advice of the Attendants, whereby they were wholly stopt: but a Loosness fol∣lowed; which increasing for three days, the Women gave her other Remedies to stop the Loosness, nor were they frustrated of Success; mean while they brought a dangerous Fever, and Affects as it were hysterical in the place of the former; for the unfortunate Woman in Child-bed was affected with a Thirst, and a Heat, with Watchings, afterward with a frequent Swooning, and cold Sweats. Being called at this time, I ordered Cordial Remedies, and things to promote ute∣rine Purgations to be drank, and likewise a Clyster to be injected; the Loosness of the Belly being again procur'd, the Lochia also came down, and the Diseas'd being freed from the foresaid Symptoms, and the more severe Disease, viz. the Nurses Remedies, soon recovered from her Fever.

Here let it be observed by the By, that it's very dangerous either to stop, or to alter, or to thwart any Motion raised by Nature, tho anomalous.

A Woman of Note, about twenty years of Age, of a full and well-flesh'd Habit of Body, aborted twice within a Years space; when af∣terward she had conceived with Child, by her Physician's Order, once a Month drinking plentifully of Whey, she raised a Vomiting, whereby she was wont to cast up a great deal of thick and clammy Flegm; al∣so during the time of her being with Child she was let Bood five times. The time of Child-bearing being over, she brought forth a Boy with great Difficulty: the Secundine came away entirely, and she purged egregiously. On the second day, as she raised her self on her Feet in her Bed, that the Cloaths might be put in order, she took Cold; and thenceforward the bloody Lochia were wholly stopt, and only a little serous Water flowed forth. On the third day she began to complain of an acute Pain in the right-side; the Women present applyed to it Bags of Camomile made warm with Bricks: nevertheless, the Affect was very much increast with a bloody Spittle. On the fourth day after Delivery a most acute Pain, with a most difficult and very painful Breathing, seised her. By the Order of a Physician then coming from the Neighbourhood, six ounces of Blood were drawn from the Basili∣ca, and she suddenly found Relief, and was better for ten Hours. At Midnight a pricking Pain returned with the wonted fierceness: at other Physicians being called to consult, they all concluded that it was necessary to bleed again in the Arm of the Side affected. Blood being

drawn to four ounces, the Pain remitted, and the Diseased breathed better: afterward Diaphoreticks being giv'n, she fell into a copious Sweat, with a quiet Sleep; but the Pulse became more quick and weaker: also Contractions of the Tendons appear'd in the Wrists. Presently afterward she talked light-headed, and within twenty four Hours after Blood was drawn the last time, she died.

That this Lady, upon the Lochia being supprest, together with a Fe∣ver, fell into a pleurisie, the Cause in some measure seems to be the Bleeding so often used during the time of her going with Child; for by this means the Blood, accustomed to be breathed by the Arm, after∣ward fermenting, leaving the Womb, ran towards the wonted way of being let forth; where not finding a Passage, it fixed it self in the neighbouring side as in the next seat of Extravasation. Moreover, be∣sides the usual state of a Pleurisie, no small Malignity was added to this Disease; for the Blood being freed from Extravasation, presently began to be corrupted in its Crasis, and on the third Day of the Fever was so far deprav'd, that it was not able to ferment longer in the Heart, and so to continue Life.

Not long since, the Wife of a certain Smith was brought to Bed at the time that her Children were sick of the Small Pox in the same House, and her self, as it seems, took the Contagion of the Disease; for, on the second day after Delivery Pushes began to break forth with a feverish Incalescence, and a Pain in the Loins; which for three days, the Lochia flowing moderately, rise up as they ought to good Wheals; and tho a uterine Purgation happened copiously at this time, she had the Small Pox very thick in her whole Body; nor were they only on the Surface of the Skin, but they likewise so filled the Cavity of the Mouth and Throat, that she was scarce able to speak or to swallow. On the sixth day, after being delivered, the Lochia flow'd immoderately, whereby presently the Small Pox falling, a Swooning, frequent Convulsi∣ons, and other Symptoms of an ill nature, assail'd the Diseased, which threatned Death in a short time. Being called, I prescribed half a dram of this Powder to be taken constantly every three Hours in a Spoonful of the following Julep; viz.

Take Roots of Tormentil powdred two drams, the best Bole-armoniack one dram, Species of Hyacynth half a dram, make a Powder.

Take Water of Scordium compound, of Dragonwort, of Meadow sweet, of each three ounces, Acetum Theriacale an ounce, Syrup of Corals two ounces, burnt Harts-horn half a dram, make a Julep.

Moreover, I ordered that in her Broth, and in all things she drank, the Roots of Tormentil should be boyled; by these Remedies the ute∣rine Purgation was wholly stopt, and the Small Pox without any severe Symptom, being ripened by degrees, fell away.

This Case was really difficult, and was managed with a great deal of Danger; viz It was dangerous either for the Lochia or Small Pox

to be kept in, and nevertheless, the full Eruption of either hindred the Motion of the other: as long as both proceeded moderately, the Bu∣smess being left to the Guidance of Nature, went on indifferently well; but when the one prevailing, the Assistance of Art was required, it was necessary to check the Lochia, and to put forward the Small Pox.