ance. The uterus felt harder than usual, and there was some abdominal tenderness, apparently from flatus. The lochial discharge was natural. At 2, P. M. she had a rigor, accompanied with much pain and tumefaction of the abdomen, and a dull heavy pain in the forehead. Her countenance now appeared pale, and expressive of great anxiety-her breathing was short and frequent, but not laborious-skin hot-pulse 120, weak and easily compressed-abdomen greatly swelled, and tender to pressure-some sickness and faintness; but "the chief seat of uneasiness was in the uterus and right iliac region." When perfectly quiescent, the pain could be tolerated without complaining; but the least movement of the body, or pressure on the part, rendered it excruciating. An ordinary glyster brought away "two full costive and fetid evacuations." Even this produced such a degree of exhaustion that both wine and æthereal cordials were necessary. In the evening, although some relief had followed the enema, all things had got worse again-the abdominal pain had not decreased-the head-ache was greaterthe pulse 130, small, and fluttering. The cordial medicine was continued, and a drachm of the tincture of hyoscyamus to be taken immediately.

On the 21st, the symptoms were aggravated-pulse 140, small and equal-breathing short and hurried-cheeks a little flushed, while a death-like paleness overspread the rest of the face-headache unabated-skin hot-abdomen swollen. Three stools had been procured by an enema-lochial discharge natural. A dose of castor oil; and the cordial mixture to be continued. At four in the afternoon manifest relief had resulted from three evacuations by the castor oil. Much flatus had come away; but the state of the pulse and other symptoms was not altered-the debility was increased. Two glasses of wine, with panada, were ordered in three or four hours. In the evening the alarming symptoms had increased, though the abdominal swelling had diminished-pulse 150, and remarkably feeble-cessation of the mammary secretion-lochial discharge continued, though pale. The cordial mixture was ordered to be repeated; and an anodyne draught with 3j. tinct. hyoscy, and m. xx. tinct. opii, at bed time. 22d. All the symptoms more favourable-had slept and perspired in the night-pain in the head and abdomen greatly relieved-swelling of the belly much diminished— pulse 130 and stronger-tongue clearing at the edges. A dose of castor oil-some wine. From this time her convalescence went on regularly.

Now on this case we shall take the liberty of remarking that, so far from considering the above-described symptoms as unequivocally marking it "the malignant puerperal fever described by Hulme, Doublet, and other authors," we unhesitatingly pronounce it to be a very exquisite specimen of what Dr. Marshall Hall has admirably described, though somewhat vaguely denominated, "a serious mor. bid affection chiefly occurring after delivery, &c. from various sources of irritation and exhaustion." The principal source of this Vol. III. No. 11.

40

irritation Dr. Hall has traced to a disordered and loaded state of the bowels. In short, if any one will turn to Dr. Hall's little work, or to our review of it in the first volume of this series, p. 195, he will see the disease, denominated by Mr. Moir "malignant puerperal fever," fully delineated. We cannot therefore but deprecate the sweeping dogma that would amalgamate this affection with puerperal fever, or puerperal peritonitis, and proscribe the lancet altogether in a complaint where it is our principal resource. As for the peculiar opinion of Mr. Moir's old preceptor, Dr. Hamilton, that in real puerperal fever the lochia continue, and in common hysteritis or peritonitis they are suppressed, we can only say that the profession at large recognize no such distinction, and only consider it a little hobby of the doctor's which he may fairly be allowed to ride about in the class-room for his own health, and the edification of his pupils. Mr. Moir's acquaintance with the variety of forms which diseases assume may be estimated by the following dogmatical assertion. "In all of the cases in which these gentle men (Drs. Gordon, Armstrong, Hey, &c.) succeeded, the pulse beat from 120 to 140, and the lochial discharge was suppressed at the very commencement of the disease-symptoms which, I do not hesitate to affirm, no intelligent practitioner of respectability ever met with in a real case of malignant puerperal fever." Now one of the wo symptoms here denied to malignant puerperal fever, viz. pulse from 120 to 140, was actually present in Mr. Moir's own case; so that by his own dogma Mr. Moir can only pretend to be half of an intelligent and respectable practitioner. Mr. Moir says that the descriptions given by the above-mentioned gentlemen are contradicted by the detail of the individual cases. They may return the compli ment, for Mr. Moir's dogma is unequivocally contradicted by the case which he has brought forward to support it.

P. S. The following case has just passed under our notice. Mrs. Moore, 24 years of age, was delivered of her first child on Saturday, the 19th of October, after only two hours of labour. The placenta came away spontaneously. On Sunday she was seized with a severe and long-continued rigor, succeeded by great reaction, acute pain and tenderness of the abdomen, especially above the groins, with a pulse of 120. Mr. Bagster saw her and bled her to nearly 30 ounces, when tendency to syncope took place. The blood was deeply buffed. A cathartic was exhibited, which operated. On Monday, Mr. Bagster found the pulse 130, and all the inflammatory symptoms again increased. She was again bled nearly to syncope. On Tuesday we saw her with Mr. Bagster. The pulse was 146 -the abdomen exquisitely sensible, and a little tumefied-the skin rather hot-the face flushed-constant anxiety and tossing about in the bed-the lochia nearly suppressed this day, and not before-no afflux of milk to the breasts-delirium during the preceding night, but now calm and collected. The pulse was very small, with the above-mentioned rapidity. We expressed to Mr. B.

our opinion that inflammatory action was still going on, and that although there was little chance of recovery, yet depletion was still the only means that afforded that chance. Thirty leeches to the abdomen, and after they came off and bled a few hours, the whole belly nearly was covered with a blister. Three grains of calomel and a quarter of a grain of opium were ordered every four hours. She slept two or three hours on Tuesday night, and had two stools, but of a dark watery kind, in the morning. On Wednesday we found her much relieved in respect to pain and tenderness of the abdomen, but the pulse was 160, and still smaller than ever. We then considered that effusion had taken place. She had no sickness at stomach till Thursday, and she died that night. Mr. B. opened her, and Dr. Cowie was present with us. Full two pints of seropurulent effusion mixed with flakes of coagulable lymph were found in the abdomen. The peritoneum, in many places on the small intestines, was inflamed and nearly gangrened-both ovaries were in a state of incipient gangrene-and the right one was surrounded with a quantity of thick puruloid matter. The uterus, when slit open, presented marks of inflammation on its internal surface.

Now what will Mr. Moir, or his oracle Dr. Hamilton, call the above disease? Had no dissection taken place, it would have been puerperal fever, and the patient, of course, was killed by depletion: -but dissection having amply justified the means that were used then, we suppose, it will be denied that it was real puerperal fever!

5. Tar Vapour Dr. James Forbes, Deputy Inspector of Military Hospitals, has given the inhalation of tar vapour, as recommended by Sir A. Crichton, a trial in pulmonary affections, the result of which corresponds with our own experience in this remedy. It is, as Dr. Forbes observes, a difficult thing sometimes, to distinguish between chronic affections of the mucous membrane, and tubercular ulceration in the parenchymatous structure of the lungs. In the latter state tar vapour, like all other remedies, fails. But it does more-it aggravates the complaint, as we ourselves have witnessed. In chronic catarrhal complaints, however, it often is of service. We can scarcely agree with our author in his pathology of chronic catarrh. He considers it to be a disease succeeding inflammatory action of the bronchia, but which is itself unattended with any lesion or inflammation; but, on the contrary, has for its cause a morbid relaxation of the lining membrane of these tubes." This "morbid relaxation" must surely be some kind of "lesion," even if it be not of an inflammatory nature. But we are far from

Dr Forbes. Med. and Phys. Journal, 284.

believing that this morbid relaxation, and this "preternaturally increased secretion" of the mucous membrane of the lungs is unconnected with chronic inflammation. On the contrary, we think they are, if not one and the same, at least twin brothers, or probably as cause and effect with each other. Dr. Forbes illustrates his pathology by the state of the urethra in gleet; but really we think gleet exhibits an unequivocal example of chronic inflammation in the mucous membrane of the urethra, as a mucous diarrhoea does that of the lining membrane of the intestines. Be this as it may, we shall give the result of our author's experience with tar vapour.

Total. Cured. Improved. No Effect. | Bad Effect.

DISEASES.
Phth. Pulm. 19.
Catar. Chron. 32.

6. Apparent Pregnancy. On the 6th June, 1820, Dr. Dewees was requested to see a young lady who had been suddenly taken ill with severe pain in the uterine region, and almost instantly afterwards with delirium and mental disturbance. She complained much of her head, palpitation of the heart, and of occasional sense of suffocation. She had frequent lucid intervals from the delirium. She had not menstruated for more than a year-her belly was much swelled-her breasts enlarged-she had morning sickness-and "all the usual signs of pregnancy." Dr. D. on examining the abdomen, felt a circumscribed tumour within it, which, he was very certain, was an enlarged uterus, and he thought he distinctly perceived the motion of a fœtus. As there were febrile symptoms, bleeding and other antiphlogistic measures were ordered, which removed the symptoms before described, and she remained well for a fortnight. At the expiration of this period they again returned, precisely as before, and were again dissipated by the same remedies. The symptoms returned twice more, and twice more they were removed. -Mean time, the abdomen continued to enlarge, and the feet and ankles to swell. On careful examination, it was found that there was a fluid in the abdomen, evinced by evident fluctuation. As the "young lady's character was beyond reproach, and as there was no perceptible increase of the uterine tumour during the last two months, Dr. D. began to conclude that he had ascites instead of pregnancy to deal with. He therefore prescribed the volatile tincture of guaiacum, in doses of a tea-spoonful thrice a day in a wine-glass full of milk. After taking this medicine for a few days, it purged her very briskly, and made her discharge very large quantities of urine. Some few drops of laudanum being added, she was enabled to persevere in its use for three weeks, without further inconvenience, at

Dr. Dewees. Philadelphia Journal of the Medical and Physical Sciences, No. VII.

the end of which time no vestige of water was discoverable in the abdomen," but a serous discharge was observed from the vagina, which was soon followed by a sudden gush of fluid blood, to the amount of about three pints, which soon abated in quantity, and at the end of a week, entirely ceased." She menstruated at regular periods after this, and continued to enjoy good health. We leave our obstetric readers to form their opinions respecting the above case. In a moral point of view it is interesting, as it shows how easily a derangement in the uterine economy may lead to the most cruel and unjust suspicions.

7. Dropsy of the Kidney. A medical practitioner, ætat. 25 years, had enjoyed good health till the age of 15, when he suffered an attack of nephritis in the left kidney, from which he gradually though slowly recovered-always experiencing pain and inflammatory symptoms after much fatigue or exposure to severe cold; but giving way to gentle purgatives and low diet. In the beginning of February, 1821, he had a very severe attack, reaching in a few days to an alarming and dubious height. In addition to hardness, there was a sense of crepitation in the seat of the pain. He was bled freely, and gradually but partially recovered in six weeks. He had repeated attacks the succeeding summer, but they gave way to evacuations and low diet. After getting stouter than usual, he attempted to ride on horseback. The trotting motion gave him great agony. On the 8th September his final attack commenced, and the symptoms were similar in kind, though intenser in degree, than those which he had been accustomed to experience previously. principal symptom was a fixed, knawing pain extending from the spine to the umbilical region, increased by pressure, and by motion of the trunk. The contact of air gave him great distress. His urine was small in quantity, and once or twice slightly tinged with blood -it never was milky or purulent. The evening previous to death he complained of inability to make water. His bowels were generally costive, and his pains were aggravated by constipation. Relief, though temporary, always followed alvine evacuations. The pulse at the commencement of the attack was 84, and gradually rose to 120. Bleeding always gave relief for a time. A day or two previous to his decease, what he passed was not fœculent, but gelatinous matter, and was accompanied with most excruciating pain. A strong idea prevailed in his own mind that the complaint was spasmodic enteritis," a disease of which we confess we cannot form any clear idea. He never had thirst or rigors his skin was generally moist and bedewed with perspiration. He never experienced much emaciation, even to the last.

Dr. Howison.-Ed. Journal, No. 73.

Chir. Journal, (for July, 1816.)

Dr. James Johnson.-Med.