Phelps, Henry, 1766-1852. Extracts from a Treatise on lying in women & their Management by Charles White. B MS Misc., Countway Library of Medicine.

Extracts from a Treatise on Lying in Women & their Management & c & By Charles White 3d Edition in 1785.

Puerperal Fever

Causes: during Pregnancy, tightness of stays and petticoat bindings, weight of ye Pockets &. press ye enlargd Uterus & c against ye lower intestines, prevents their Evacuation hence ye thinner parts are absorbed by the Lacteals causing Constipatio Aloi -- further increasd by a sedentary Life & bad Diet -- hence an inclination to putridity & Loss of appetite follows. Alimentary Canal no longer distended {from} food ye Bile collects & stagnates, acquiring a putrid acrimony Labour hot Chamber -- foul phlogisheated Air, heating Liquors given her -- long confind to a horozontal posture ye warmth keeping ye Parietes of ye Abdomen lax -- faeces not protruded. lochia stagnating -- too early delivery of the shoulders {inflammation} Uteri & --

Symptoms She is seizd with a rigor a few days after Delivery returning at incertain periods -- at other times yr is no rigor it creeps on gradually, {beginning} {from} putrid sweats, vomiting of porraceous matter or diarrhaea of putrid matter -- constant tenesmus tumour pain, & soreness of Abdomen {general} pains from dyspnoea Tongue 1st white & moist or else dry hard & brown -- Nausea Pulse in ye increase always grows quick, small & creeping -- {from} anxiety [?] {from} praecordia & {great} debility -- Lochia sometimes not diminishd, or but little, {what} flows is foetid, or it is wholly suppressd Breast grows flaccid & ye milk is lost -- Petechiae appear involuntary excretions convulsions & death -- Dissection shews a gangrene of ye viscera -- effused serum & other marks of {Inflammation}

Miliary Fever

From ye observations of various Authors these inferences may be drawn [?] This Eruption is often an attendant on contagious fevers & never appears without a preceding sweat -- 2d Time of eruption not certain -- it is not Critical 3d Cooling method not prejudicial if it removes ye cause of ye disease -- 4 Puerpenal not liable to it from any other cause {than} inclination to putridity -- or relaxd skin -- 5 The Cuticular secretions renderd -- acrid by lodging & exposure to air soon become putrid.

Milk Fever

Proximate cause, an accumulation of milk in the breast occasioning pain, {inflammation}, &c never terminating in gangrene seldom in schirrus

Remote causes Cold constringing ye vessel, -- spirituous repellents too sudden stoppage of ye Lochia

Predisponent a firmness & imperviousness of ye lactiferous tubes in an irritable habit -- impeding ye flow of milk -- as in ye 1st lying in -- ye Lactiferous tubes are naturally convoluted -- but yy are made more so by tight dress -- hence ye milk is drawn with difficulty

Suction makes ye breast more conical -- hence ye tubes straighter

Directions for the pregnant state

Catamenia not causd by a {general} Plethora -- not plethoric while pregnant -- a Woman menstruates 4 {times} in a year -- ye Child is found to weigh 15 lbs -- {Mineral} Waters -- Equitation & cold bathing preferable to VS -- Nausea &c &c rather from a sympathetic affection of Uterus & weak [?] than Plethora -- Cont Elx Vitrol &c But Excercise to be avoided if {there} are symptoms of abortion -- or near ye latter end of pregnancy. To keep open ye bowels -- ripe fruit -- small doses of Aloetics daily (if yy are not subject to ye piles) mixd {from} alius antiseptic resinous gums -- gentle emetics -- bitter teas, {vegetable} acids, Columbo, as it preserves bile from putrefaction -- Neutrals -- raw eggs -- [by?] destroy ye tenacity of ye Gluten obstructing ye D. Common Choledochus cures ye Jaundice -- Children never lie too high -- Women should wear jumps with large shoulder straps -- if ye belly is pendulous -- Bandage above ye Pubis {When} near delivery it is good to lye down often --

Natural Births

Confine ye patient to no position -- {When} a pain obliges her to lie down -- {when} examine {when} it is going off if yr is a proper presentation tell her off it -- but dont conclude {when} she {will} be delivered -- If costive an Enema {which} also relieves ye spasms of ye abdomen -- Let ye position be what it will during Labour -- yet ye Woman should be in a horizontal posture {when} ye child is born -- grease not always to be used -- a hand against ye Perinaeum to prevent Laceration -- After ye delivery of ye head ye shoulders should be allowd to make ye turns -- resting between the pains -- upon this depends ye easy or difficult exclusions of the Secundines & After Pains -- {when} ye uterus is suddenly unloaded ye uterus contracts irregularly & retains ye plactenta [illegible] by a spasm -- & after pains causd by ye Relaxation {following} -- the Funis should not be cut, till ye circulation has ceasd in it no matter if ye end toward ye woman does bleed it open it -- Extract placenta by gently pulling ye Funis & {pressing} ye abdomen

Prevention of Puerperal Fevers &c.

After {Delivery} apply clean linen - let the patient sleep & move ye child & Visitors into another room - a large chamber is necessary - {which} should have a northern aspect in summer {with} blinds outside - small fire in Winter - patient should not be disturbd at night - in a few hours - {when} ye patient has had some rest - she should sit up & apply ye child to her breast milk or not - & {repeat} 4 or 5 times {per} die - but it is not necessary to feed ye child at night - patient should lie {with} her head &c high sit up {when} she eats or suckles - & when she minges do it on her hands & hand knees - Upright posture prevents stagnation of Lochia, Faeces & promotes {contraction} of Uterus & Abdomen Much caudle & thick gruel [?] clog ye stomach and pall ye Appetite All liquors should be taken cold - never eat meat but once {per} die - If she dont suckle - she must be very abstemious Acescent food dont alway affect ye child - ye green stools may rather be from ye weak digestion - Air of ye chamber should be temperate Perspiration rather depends on dryness {than} heat of ye air - for it is greater in frosty {than} in open moist weather - ventilate ye chamber daily - never wash it - let ye carpets be daily aird - let her get up ye 1st day if she can - never lie beyond ye 3d - then apply clean aird linen to ye bed - procure a Stool each day by Enema or Laxative -- don't purge on ye 1st days as it promotes absorption, except it has already taken place - {when} it prevent ye depostion of acrid matter on ye omentum &c - Lochia sometimes stop on the 1st day {when} obstructed not to be forced down - {When} ye discharge is great if from irrtations & spasms causd by acrimony - Opiates &c. Cort[?] is given without lessening the Lochia or Catamenia - Astringents - horizontal posture - cold to ye abdomen & cold water injected in Utero Water in an Ox bladder applied to ye abdomen - & give Nitre - let ye breast be drawn 4 or 5 times {per} die - rendering ye breasts conical assists If ye Mammae are hard & knotty rub {with} soft oil 3d {per} die or apply Goutards Vegeto-{Mineral} Water - to prevent fissure Bees Wax Rings should be applied circ[?] Papillas - Fissures are heald by a Mucilage of G Arabic et Decoct cooling seeds - Vinegar sprinkled over ye room refreshing but not so antiseptic as imagind - it renders ye air moist - Explosions of G powder more effectual & in putrid Cases Fermenting liquors should be set in ye room

Cure of the Puerperal Fever

At the beginning of the rigor if she be really colder {than} in health warm things should be applied to ye feet & ye extremities gently rubd {with} tepido manu to prevent stagnation in Ye capillaries In ye hot fit reduce ye heat to ye natural standard & ye sweat {will} come on the sooner & perhaps terminate Ye disorder - "There is a certain degree of heat necessary to produce sweating in all persons {which} varies {with} ye constitution & circumstances - a heat above ye [?] or less hinders ye Evacuation" Alexander - cold should not be applied during ye sweat - If she has ye usual symptoms as described viz. Nausea pain &c. give an Emit either of Ipecac or Antimonie {preparation} {which} should be {repeated} 2 {times} {per} die or P. A. N. for ye Saliva & Alimentary juice contain little fixed air hence {they} absorb putrid miasmata - But if there pain in bowels - Cathartios or Emetics increase it - Enemas often After these Evacuations. Saline draught & [?] [mindorisi?] - If ye Nausea continues give [?] Columbo jeu Extract [?] or a few spoonfuls of the infusion 4 times {per} die - if ye bowels are not open add to each dose Vitriolated [Tartar?] [?] - If {great} irritation ([?] deliris) opiates {with} Ipecac & If cough & dyspnea puke {with} few {grains} of Ipecac - Pains in thorax Seneka [?] 3 {times} per die - If ye diarrhaea [smites?] ye patient support {with} Wine & Nutritives - astringent draughts - starch & opiate Enema's, or Ipecac in small doses - In ye decline C[?] and Pyrmont Water {with} {elixir} Vitriolic - Vegeta acids preferable to ye {Mineral} - If ye D is at 1st inflammatory it [sometimes?] turns putrid - Now give her clean Linen every day - wash her hands face & teeth in cold water {when} not in a sweat - Set up in & get out of bed evry day - Nitre is improper in all disease where putrid bile abounds - bleeding never necessary except in {inflammation} of the Uterus In ye last stage - C[?] Wine. Volat Alcali et [?] ad abdomen & throw antiseptic injections into ye Uterus - to wash out ye putrid fomes &c.

Miliary Fever

Cure Give an Emet [statem?] (not in ye paroxysm) no acid with it they prevent its operation - {repeat} omni die. Enema's - cold air & upright posture - horizontal posture bad - Epithastic, diuretics Volatile Alcali & Emmonagogues bad - Camphor says de Haen causes strangury spasms &c. - It [?] Cantharid et oe terebinth produces strangury {per} Heberden - But it may be given with acids or Nitre - (it sometimes cures Ulcers of ye legs) - If opiates are necessary give {them} {with} Ipecac - If very weak - give Wine or Brandy &c - Ipecac {Emetic} - If Diarrhea [?] Astringents & avoid teflacea - contrayerva or Cordial - C[?] by ye mouth or in clysters [?] acid and Lineti Boracis - Must[?] . oe [cinnamon?] for hiccups - Cold aquar stimulants

The situation of the child in Utero is now supposd to be this - head down to ye [?] one Ear to ye pubis & ye other to ye sacrum with ye feet to ye Fundus Uteri - it back & belly to ye Ilia - Cold does not seem to check critical eruptions Putrid Fevers floodings & death have been occasioned by retention of ye secundines - Floodings cease by a timely removal of it - The Manual Extraction should not be attempted whilst there are any spasmodick contractions across ye Uterus Opiates remove the spasms - It is not safe to leave ye Woman before it is extracted - Cold bathing not only prevents Miscarriages but much increases ye flow of a Nurses Milk The Foetal Life should not be destroyd befor ye Animal takes Place - Membrana decidua is vascular belongs to ye Uterus often looks black on dissection Brazilian Women have easy Labours, are very fruitful - they retire & bring forth alone & return after washing themselves & Child; The Husband's lying in bed the first 24 hours, being treated as if yy endured the pains - Newhoffs Voyages p154 - Nature has been 17 minutes extruding ye shoulders of ye child after ye head had pass'd - & by yt means prevented After pains Prolapsus Vaginae from too hasty extrusion of shoulders & seldom from sitting up after delivery