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Late in the puerperium vaginal douches are unobjectionable, and patients may take them unassisted, for then the fluid will not penetrate the womb so long as it has a free escape from the outlet of the vagina.
Tollunt piscem vivum et mittunt eum in puerperium suum, et tamdiu ibi tenent, donec mortuus fuerit, et decocto pisce vel assato, maritis suis ad comedendum tradunt. Ideo faciunt ut plus in amorem suum exardescant. Si fecisti, duos annos per legitimas ferias pœniteas." Remedies taken internally are not the only ones which stimulate man to sexual intercourse.
Walters looked into the statistics of such cases and found 36 accidental removals of the uterus in the puerperium with 14 recoveries. All but three of these were without a doubt attended by previous inversion of the uterus. A medical man was tried for manslaughter in 1878 because he made a similar mistake.
Immediately before and after delivery, particularly in primiparæ, there is usually a moderate degree of leucocytosis. If the labour is normal and the puerperium uncomplicated, the number of leucocytes regains the normal in about a week. Lactation has no appreciable effect on the number of leucocytes. In new-born infants the leucocyte count is abnormally high, ranging from 15,000 to 20,000.
Neumann investigated the knee-jerk in 500 women during pregnancy, labor, and the puerperium, and in a large number found that there was a progressive exaggeration with the advance of pregnancy, little or no change being observed in the early months; sometimes when no change was observed during pregnancy the knee-jerk still increased during labor, reaching its maximum at the moment of the expulsion of the foetus; the return to the normal condition took place gradually during the puerperium.
Nor will the inscription upon the altar serve to establish Pliny's opinion; because Agrippina was delivered of two daughters in that country, and any child-birth, without regard to sex, is called puerperium, as the ancients were used to call girls puerae, and boys puelli. Farewell, my dear Agrippina, and take what care you can to come safe and well to your Germanicus."
The mother was attacked with pneumonia on the fifth day of her puerperium, but recovered; the child died in four weeks of intestinal catarrh. Gautier found measles transmitted from the mother to the fetus in 6 out of 11 cases, there being 2 maternal deaths in the 11 cases.
The average loss for the first week alone is said to equal one-twelfth of the patient's weight at the conclusion of labor; the total loss for the whole of the puerperium corresponds to one-tenth of her weight at the beginning of it. Variations from the rule are attributed to individual peculiarities of nutrition.
In the latter part of the puerperium there may be doubt as to whether a discharge is menstrual or lochial; though, if necessary, an examination of the interior of the womb would always settle the question, for structural changes in the uterine mucous membrane form the most characteristic feature of menstruation.
The traditional custom of doing so has given to the first few weeks following delivery the popular name, "the Lying-in Period." To these weeks physicians usually apply the technical term puerperium, the child's period, a designation which brings to mind the secretion of milk which, though not a retrogressive change, is, nevertheless, one of the most distinctive results of childbirth.
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