PUELCHE. 530 PUERTA DEL SOE. trade in cattle, salt, and tobacco with the tribes Avest of the mountains. They have large herds of cattle and horses, are expert with the bolas, and fond of gambling and music. They wear their hair flowing or gathered behind into a queue decked with silver beads, with a bright (urban about the head, and a blanket wrapped about the waist and held in place by a belt. Physicallj' they are of medium stature, broad- chested, and inclined to corpulency. They pluck out the beard and eyebrows, and the women paint their faces in red and black. PUENTE DE CALDERON, pwan'ta da kiil'- da-ron' (Sp., bridge of Calderon). A bridge over the Eio Grande de Santiago, about 30 miles from the city of Guadalajara, Mexico, noted as the scene of the defeat of tlie revolutionary forces under Hidalgo, about 80,000 poorly armed, by Calleja with 6000 well-equipped troops, January 17, 1811. PTJENTE GENIL, nanel'. A town of South- ern Spain in the Province of Cordova, situated 32 miles south of Cordova on the river Genii, which is here crossed by a stone bridge, and on the railroad to Malaga. It has a secondary coP lege and a public library; it is surrounded by olive orchards, and its principal industry is the manufacture of olive oil. Population, in 1900, 12.959. PUENTES fpwan'tas) DAM, Failure of. See Daiis, paragraph Failure of Dams. PTJER'PERAL FEVER (from Lat. puerpera, parturient woman, from jiuer, child -|- parere, to bear), PrERPEBAL Sep.si.s, Childbed Fever. A fever appearing in puerperal women within a week after labor — usually from the third to the fifth day — attended with septic infection of the blood and acute inflammation of one or more of the reproductive organs or the loose cellular tissues connected with them, and often charac- terized by severe and widespread complications. This fever was long considered specific, and under the names childbed fever, lying-in fever, etc., was a fatal and frequent complication of the puerperium. particularly in lying-in hospitals. It is now known that the disease is due to infection from some microorganism introduced into the genital tract by contact with unclean hands, instruments, dressings, clothing, or bed- ding. The credit of pointing out the true origin of this disease is due to Dr. Oliver Wendell Holmes, who in 1843 promulgated the doctrine of extragenital infection. In 1847 Semmelreis pro- claimed the same teachings in Europe. Since modern antiseptic midwifery has caused the hands, instruments, and the materials used in the lying-in room to be sterilized, puerperal fevcT has become a comparatively rare occurrence, while a better knowledge of its pathology and prompt treatment of its earliest symptoms make it a much less fatal and severe sequel of labor. The complications that may arise in puerperal fever are both grave and numerous. Pericarditis, pleurisy, endocarditis, pneumonia, and inflam- mation of the joints may occur, and the liver, kidneys, bladder, or spleen may be secondarily infected. The disease is iisually ushered in with violent and prolonged chills, followed by an irregular fever, uneasiness, nausea, extreme gen- eral depression, with a rapid, feeble pulse, and shallow respiration. The expression is anxious, the tongue heavily coated, and the urine scanty and albuminous. Severe cases run a rapid course and often terminate fatally within a week. The prevention of puerperal infection by the exercise of rigid cleanliness in every labor case, and particularly when instrumental interference is demanded, is now one of the most important duties of the obstetrician. (See A>'TISEPtics.) Wlicn, however, infection has taken place, on the appearance of the initial syinjitoms the genital tract should be irrigated at frequent intervals with from three to four quarts of some warm antiseptic solution. Mercuric chloride, creolin, carbolic acid, or plain normal salt solutions are those usually employed for this purpose. If this measure does not j)rove efficient in abating the fever in a short time, it is necessary to explore the uterine cavity and remove by means of the wire curette the decomposing material which is almost certain to be found there. Frequent douching with one of the solutions named above is continued until convalescence sets in. The general treatment is stinuilatiug and supportive. An abimdance of easily digestible liquid food, such as milk, beef tea, broths, and animal juices, must be given. Alcoholic stimulants may have to be given in large amounts with strychnine and other cardiac tonics. Fever is reduced preferably by cold sponging, and abdominal pain and swelling relieved liy the application of the hot-water coil or hot-turpentine stupe. Com- plications nnist be met as they arise. PUERPERAL INSANITY. A term applied to mental derangement occurring during the first si.x weeks of the puerperal stat-e. During the great changes comprised in the onset of labor and the beginning of uterine involution, with the nerve drain, the rapid metabolism of tissue and the necessity for sudden adjustment to a new order of life, the risks of every woman are great; and the mother who is predisposed to mental de- rangement is in especial danger. The onset of an attack of puerperal insanity is frequently sudden, but more frequently preceded by nerve fag, insomnia, restlessness and garrulity, fickle fancy, unreasonable likes or dislikes, and per- verted afl"ection. Suspicion and obstinacy, vio- lent hatred of husband or infant follow. Delu- sions' and hallucinations of a terrifying kind occur, and there is constant excitement, per- petual talking in an incoherent way, impulsive action, often obscenity in speech and conduct, and often homicidal or suicidal impulse. Puerperal insanity takes the form of mania in about one-half of the cases, of melancholia in about one-half. Moral shock has often a strong influence in the production of this insanity, for over 25 per cent, of the cases occur in mothers of illegitimate children. It is frequent in primipara;. About one-half are violent or homicidal, about one-quarter of the cases are suicidal. Eighty per cent, of the eases re- cover. The treatment nnist be directed toward the genital apparatus, the digestive tract, the capacity for sleep, and the necessity for hydro- therapy. Custodial care is, in the vast majority of the cases, necessary; for removal from fa- miliar home surrotmdings is valuable. Consult Bevan Lewis, Text-hook of Mental Diseases (Lon- don, 1889). PXTERTA DEL SOL, pwar'ta del sol (Sp., Gate of the Sun). The chief square of Madrid, on the site of the former eastern gate of the .
