Man-Midwife, Male Feminist: The Life and Times of George Macaulay, M.D., Ph.D. (1716-1766)

Appendix C: A Case of Shivering in Half an Hour after Delivery from the Case-Books of Dr. Christopher Kelly

A Case of Shivering in half an hour after Delivery [:]

Mrs. Scott Aged 28 was on Saturday night the 13 of May 1769 at 9 o'clock deliverd of her 4th Child after an easy labour. The Child was dead and very putrid and there were undoubted reasons for concluding She had the Lues Veneria [syphilis]—Half an hour after delivery She had a violent Shivering which continued more than a quarter of an hour;—Sunday about 1 o'clock We saw her, when She had a quick pulse some heat in her Skin, a restlessness, and a little Sickness, but considering the shivering; the quickness and fulness in the pulse was hardly w[ha]t might be expected, and which Acct. Bleeding was now omitted. The Abdomen was a little Tender & had a general tension, but very little pain. Some Coagula came away soon after delivery, and now there was a proper Discharge of Lochia. Two grams of Tartarus Emeticus was ordered to be put into a pint of Barlay Water wth an Ounce of Mummea; of which she was to take a tea cup full every half hour, till Vomiting or Purging or bothe were produced, which were effected by taking it only twice; She having five or six stools, and vomited incessantly for some time. She had a restless night Slept and Sweat but little.

—Monday, noon, being the 3d day, She complaind of great pain in the Belly which was exquisitely Tender, but no great fulness; her pulse was quick and very full, her Tongue white, & there was little Lochea but of a tolerable Colour. Ten Ounces of blood were now taken away...and... She cryed out with the violence of the pains, her Arm was Unbound, and nine ounces more were drawn;—An Emolient Clyster with Oil was orderd to be thrown up every 8 hours and an eight Ounced Saline Mixture with an Ounce of Mummea & 2 drachms of Magnesia directed for her to take of every four or five hours; and warm applications to be made to the Abdomen.

Tuesday the 4th day at 1 o'Clocke We found she had purged much till six this morning, sweat moderately and got some refreshing Sleep, The Page  254pulse good; the Belly softer but still very tender, the piles and great soreness about the Anus prevented the clysters being administered as directed; Warm applications to the Abdomen were orderd and to Continue her Medicine as before.

Wednesday the 5th at 1 o'clock She had had nine stools since yesterday, One of which we saw...was Thin, Bilious, and Foetid; her pulse was smooth and vibrating, her Belly very Tender, and she had a restless night, at 4 yesterday in the afternoon She had a very violent shivering which last and another at 9 at night but not so violent as the former; Emollient Clysters with Oil were again ordered to [be] given often, if possible, The Belly to be Fomented [?] well twice or thrice a day, and the Same Medicines continued; a little Lochia of a good Colour but the frequency of the Stools (some of wch on the Cloths) made it difficult to ascertain the Quantity. Thursday 6 day at 4 o'clock. We were informed at 4 in the afternoon of the preceeding day She had a Shivering, but not so violent as on Tuesday. She had had 8 or 9 Stools, but very small ones. She sd she had had some sleep in the night and that her Belly was easier; it appeared to us a little softer, but still very tender.

One Emolliant Clyster had with difficulty been thrown up and retained an hour or more; her pulse was full and very quick, her breathing rather short, She had a pale or cadaverous look and dry Tongue beginning to be brown; She sd she had perspired, but her Skin was now dry & hot.

Under these circumstances we agreed to give her 7 grains of Dr. James's powder every two hours till it should have some manifest Effect, and to visit her again at 1/2 past 8 in the Evening.

When we learnt she had had 2 Stools but not large ones since we saw her before, that she had sweat a little, but that She had not Vomited, or had any Sickness till about an hour before we arrived when we found her reaching [sic] a little, She told us her Belly was much easier, but upon pressing it ever so lightly She complained very much; —her pulse was now 143 or 144 in a minute, but not the firmness it had in the morning, her countenance was worse, and respiration quicker, but the Tongue rather Moister than at noon.—She having taken the 3rd powder of grains, at 7 in the Evening it was agreed she shd not take any more of it till 12 or 1 in the morning and Page  255then 10 grains, and repeat the same quantity again in 6 or 7 hours more, unless any Violent Effect of it should forbid the repetition of it.

Friday Noon: A Scruple of the powder given bet. 12 & 1 She had a v[ery] violent shivering at 2 and was very restless, and had frequent Reachings [i.e. "retchings"] almost all night [whence] to 2 [x] 10 grains of the powder were omitted, She had 9 or 10 smallstools, and got no rest till abt 6 in the morning, her pulse is rather weak but very frequent, near 140 in a minute; She breaths quick; her Belly is Soft but very Tender, her Tongue has not that dryness it had yesterday. Eight ounces of Decoctions cort. with 2 Ozs. Of Saturated Lemon Juice was ordered for her to take two or three spoonfuls of every two hours.

Saturday at 1: O'Clock She had another violent shivering in the night and was very restless all night, the least motion in Bed brought on some degree Shivering, She has had 7 or 8 stools, but small ones & not loose or liquid; flat pieces of Faeces were seen floating in Urine in the Chamber pots, some of which were of a green colour; her Belly is now rather full, and continues Tender, her Tongue, which was rather moister yesterday than Thursday, is now more, and very little discolourd; her pulse is rather fuller today than yesterday, but very frequent almost 140 in a minute; her countenance not worse, but appears comatous; she complains much of pain in her Belly, that She cannot turn in bed without exquisite pain; it is rather full than otherwise and exquisitely tender to the Touch.

The Decoct Cort: with the addition of Spermatceti; and ten grains of Puh: Cort: Piren: to each dose, and an Emollient Clyster is what was now ordered for her.

About six this Evening She died.

Upon opening her Body the next Evening the usual appearances of Inflammation were Found. The Possentim was adhering to the peritoneum everywhere by a kind of gluten as were the Intestines to each other. There was a great deal of purulent fluid in the Cavity of the Abdomen, as there generally is in Such Cases; the right Ovarium was adhering to the Psoas Muscle, and there seemed to be rather more Inflamation on that Side than the other; in two or three different parts of the Intestines there were Spots which had gangrenous appearences.

The Uterus itself was very little discoloured, and there was not in any part of its substance the least appearance of Abcess. Upon dividing one of the Fallopian Tubes there issued upon squeezing it, a little Matter.

N. B. From the Womans Acct of herself before she died, it appears that She had been taking a great deal of Medicine for her Lues Veneria—in all probability Mercurials. [Diagnosis: Shiverings fatal post part.]