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47
ing 95 women attended after full-time deliveries, and nearly all were
in need of medical attention. I have prepared a list of the various
abnormalities met with; and it makes instructive, though sad, reading.
It is as followsProlapse of the uterus, 5; Abscess of Bartholin's
gland, 2; Bartholin's cyst, 1; Endocervicitis, 2; Pendulous abdomen
needing a surgical belt, 1; "White leg," 1; Subacute phlebitis, 1;
Deficient lactation, 6; Cracked nipples, 5; Eczema of breasts, 1;
Breast abscess, 6; Pyelitis, 2; Whitlow, 1; Prorians, 1; Suspected
sinusitis, 2; Anaemia and debility, 10; Suspected phthisis, 1; Manic
depressive insanity, 1; Extreme neurasthenia, 1.
In addition, 1 encountered 31 cases of subinvolution of the uterus
with persistence of lochia.
Eor many years now, I have been struck by the frequency with
which subinvolution of the uterus is met amongst working-class women
after childbirth, and this little series of cases demonstrates it; for
persistence of the lochia was present in a more or less severe degree
in 31 out of the 95 women seen by me after their confinements; that
is to say, in 33 per cent. In normal circumstances, the lochia should
have ceased by the fourteenth day at the very outside, yet in this
series of cases the lochia was still present on an average of 24 days
after childbirth.
The usual sequence of events is, that the patient is discharged
from Hospital 10 or 14 days after her confinement with the uterus
involuting satisfactorily, the lochia having ceased. As soon, however,
as she begins to get about and perform her household duties, the
lochia appears again and she comes up to the Clinic complaining of
feeling poorly and, indeed, looking so. Frequently too her supply of
breast milk begins to fail simultaneously. Some of our most satisfactory
results have been obtained in such cases for, after a course
of ergot and iron have been taken and our instructions as to " rest
periods" have been followed, the uterus involutes well and the
patient begins to feel fit again. At the same time too, her supply of
breast milk improves, especially if extra milk has been taken. I should
add that " rest periods " are attained by feeding the baby in the semirecumbent
position, thus ensuring 20 minutes rest every 3 hours and
by taking a mid-day rest of at least an hour.