pulse is fast, the woman looks
pale, anxious and feels cold, restless, gaping, usually it comes from a
relaxed, softened and enlarged womb.

[OBSTETRICS OR MIDWIFERY 541]

Treatment.--In severe forms no time must be lost in securing contraction
of the womb and the method employed for expelling the after-birth should
be employed to expel clots. Grasp the womb over the abdomen, employ firm
but gentle kneading, pressing downward. The pillows should be removed, the
foot of the bed elevated twelve to eighteen inches, a preparation of ergot
given by the mouth or hypodermically in the thigh. If these measures fail
the hand and arm should be sterilized and inserted in the womb, all clots,
etc., removed and pressure made over the abdomen on the womb while the
hand is still there. This pressure and presence of the hand close the
bleeding vessels in the womb. The hand should remain, while the kneading
goes on externally, on the womb.

This kneading should be kept up until the womb contracts. The hand can
then be removed from the vagina, while gentle kneading is slowly kept up
over the womb. The womb should be closely watched for hours after.
Bleeding very seldom occurs again, but it might. If the bleeding is more
of an oozing, an injection of very hot water, 120 degrees F., through a
long douche nozzle, directly into the womb cavity may be given. This is
very effective for any kind of bleeding. Lemon juice or boiled vinegar can
be added to the injection. Everything used must be perfectly clean or
child-bed fever may be caused by these measures. After the womb has
thoroughly contracted, it is sometimes of benefit to place a rubber bag
filled with cold water over the pubic bone to prevent subsequent
relaxations of the womb. Weakness can be met by hypodermics of whisky or
brandy and strychnine, one-thirtieth of grain, injected hypodermically to
stimulate the heart.

Pulse and Temperature.--The temperature may rise one to one and one-half
degrees without the case being abnormal. The pulse falls after labor,
ranging between sixty and seventy. A rise of temperature, a rapid pulse, a
flushed face, a chill, pain or tenderness of the abdomen, and abnormal
increase or decrease of the discharge, bleeding, or offensive odor of the
discharge should cause suspicion of child-bed (puerperal) fever. This is a
grave condition and results from infection which has taken place during
labor or afterward. The septic matter may be carried in on the f