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neighborhood advised her to apply to the affected parts, clay steeped in vinegar. This advice was readily followed; and four days after the use of the remedy, the tension, pain, and size of the breasts diminished considerably; the respiration was much more easy; but the fever continued, with occasional chills; and in proportion as the milk left the mammae, the abdomen became inflated, and was the seat of violent pain and tension. At this period, eight or nine days after the first application of the above remedy, I was sent for. Learning from the attendants that the suppression of milk had not been followed by an evacuation, I did not hesitate to impute the disorders of the abdomen to a metastasis of this fluid; consequently, I deemed it necessary to bleed the patient, and, notwithstanding the flow of the lochiae, I was induced, from the swelling and tension of the abdomen, to prefer abstracting blood from the arm. I ordered injections of warm water, and flannels wet with some emollient fomentation to be applied to the abdomen; tea and an infusion of veronica were prescribed; she was put on a rigid diet, and the child ordered to be removed. In the evening I repeated the bleeding; and the next day, not
perceiving any sensiblé change in the condition of my patient, I again had recourse to venescetion. The following day the fever was considerably diminished—and the urine, somewhat foul, flowed rather abundantly. In order to promote its secretion, I directed the use of aperient broths, which were rendered purgative, every three or four days, with the salts of Duobus. There was not a drop of milk in the breasts, and tranquillity soon succeeded the fever, thirst, and pain which had so much disturbed her; but the abdomen becoming more and more enlarged, I made an attentive examination, and was not a little surprised to find a distinct fluctuation. “Despairing now of the absorption of this matter, which appeared to me to be in great quantity, I was of opinion that there was no other hope than that of puncture. An opposition on the part of the relatives caused it to be deferred for some days. They finally consented to it, and I drew off by this operation about fifteen pounds of milky fluid, charged with small clots, occasionally stopping up the canula of the trochar, which, however, was soon remedied by the introduction of a stylet. The fluid having ceased to pass through the canula, I injected a portion of warm water, which was soon returned mingled with what remained of this milky material. I continued these injections until the water came out nearly clear. The ordinary bandage for paracentesis was then applied, and the patient soon fell asleep. “The day after the puncture, I found her quite comfortable, complaining merely of slight pain in the abdomen, which was of but short duration, and most probably occasioned by the natural adaptation of the parts after the evacuation of the fluid. “There was no subsequent effusion, and the milk appeared in the breasts in sufficient quantity for the child, which now continued to nurse. “The lochial discharge, which had not undergone any very sensible derangement, notwithstanding the repeated bleedings from the arm, continued for nearly a month, and in a short time the patient was restored to perfect health. She has since had several children, all of which she has nursed, without the renewal of any of the accidents which had followed her first confinement.” This fact on many accounts is very curious; it confirms several opinions which I have already expressed. We see, in the first place, the suspension of the milky secretion occasioned by astringent applications, and the immediate conse
quence to be inflammation of the peritoneum. This phlegmasia produced no sensible derangement in the course of the lochiae. As soon as the patient was convalescent, the milk, which had disappeared from the breasts, returned: but this return was evidently the effect, the consequence, and not the cause of the cure : we cannot with any reason contest the truth of this assertion. I will recur hereafter to the treatment employed during the course of the disease, and I shall find additional proof in support of my opinion. I will merely observe here, that the development of peritonitis at the same time that the secretion of milk was arrested, does not prove that the milk had been carried to the abdomen, or that there had occurred any metastasis. It is easy to explain it otherwise, and in a manner that accords much better with the facts. An inflammatory movement takes place towards the breasts; if this movement should meet with an insurmountable obstacle in the mammae, there will be no secretion, no exudation of milk. It may happen that the fluxion, instead of ceasing, will direct itself towards the peritoneum, where we must suppose it is attracted in preference to any other part by some particular agent; then, instead of a milky secretion, inflammation ensues, which will produce an exhalation of serosity more or less abundant, more or less charged with fibrinous concretions. I have supposed that the inflammatory action would be directed towards the peritoneum: it might likewise be directed towards the pleura, lungs, brain, &c. There then passes what we observe in circumstances entirely opposed to the particular condition of the puerperal state, after the suppression, for example, of the menstrual or hemorrhoidal evacuation. Have we not frequently known a peritonitis, pleurisy, pneumonia, &c. to be the result of a similar suppression ?
Rare in epidemic, constipation is frequent in sporadic peritonitis. It is difficult to say whether it should be regarded as the cause or effect of peritoneal inflammation. We can readily imagine both of these suppositions. In fine, it may happen that peritonitis, by diminishing the biliary, pancreatic, and mucous secretions, will become the cause of constipation. It may also happen that the collection of fecal matter, by distending the intestines, either by its volume alone, or by the gas it evolves, will produce inflammatien of the peritoneum. It is by no means uncommon to find acute pains of the bas-ventre