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the subject, and of presenting to our readers as much as pos. sible of the valuable matters contained in the volumes now on our table. It is to be regretted, we think, that the two gentlemen in question did not content themselves with giving a full yet explicit account of the epidemic that passed under their review, without deeming it necessary, each to compose a treatise on the disease, by searching the records of the past, and adding the evidence of the dead and the living to their own observations. It is in this way that books are sometimes needlessly multiplied, and documents rendered complicated and in some degree confused.

In each work we have a historical introduction; that of Dr. Mackintosh being the more rambling and diffuse of the two, occupying 157 pages. We shall cull a slight sketch from these chapters.

Hippocrates has described puerperal fever with more distinctness than most other diseases. He has also, as we before said, characterized it as almost always fatal. Historical traces of the complaint may be found in most of the ancients, from the father of physic downwards. We shall not dwell on any

of the ancient records, but come at once to a com, paratively recent period.

Strother, about the year 1716, gave the disease the term puerperal fever, and considered it an inflammation of the uterus. Dr. William Hunter asserted that puerperal fever caused the death of two-thirds of those women who died in child-bed. Hulme, who wrote an excellent treatise on the disease, declared that it was as much to be dreaded as the plague. Denman looked upon it in nearly the same light; and Clarke observed that the most experienced practitioners were staggered at the fatality and embarrassed in the treatment of the disease. In 1770, when it prevailed in London, 19 out of 63 who were delivered in the Westminster new Lying-in-Hospital had the disease, and of these 19, thirteen died. Between the years 1789 and 1792 it prevailed, more or less, in Aberdeen, and gave occasion to the excellent little tract of Dr. Gordon, who states that out of 77 patients he lost 28—the great mortality prevailing at first, when he bled sparingly; for out of the first 27 cases, 23 died—but of the

This great physician, says Dr. Campbell, was in the habit of in. forming his pupils that of 32 patients who were attacked with the disease during two months, only one recovered.

“ We tried,” says he, “ various methods. One woman we took from the beginning and bled her, and she died. To a third we gave confect. aromat. and other cordials and stimuli, and she died. In another we gave cooling medicines, and she also died.” MS. Lectures quoted by Dr. Campbell.

remaining 50 cases, when he came to adopt an energetic practice, by bleeding boldly and early, he only lost five patients. In Home's clinical experiments, we are informed that all who were attacked with puerperal fever in the lying-in wards of the Royal Infirmary, died ! Dr. Mackintosh is sorry to add, “ that in the Lying-in-hospital, as well as out of it, the practice adopted has not met with much better success."

“ Such" says Dr. Campbell, “ was the mortality attending this disease in the practice of three successive professors of midwifery in a celebrated northern university, that the first pronounced it to be incurable, the second declared that we were not only ignorant of the nature of the disease, but equally so of any remedy calculated to afford relief; and the third is so satisfied with the justness of the observations of his predecessors, that to this day, when cases of the disease are related to have been cured, he cannot allow them to have been examples of puerperal fever, but of some other affection confounded with it," P. 11.

To the opinions of the above-mentioned eminent characters, Dr. Campbell's experience enables him to add, that there is no disease of more fatal tendency than the one under consideration—"none in which Nature unassisted can accomplish less, or art more.” If neglected in the beginning, he acknowledges that the physician, however great his talents, can only be a melancholy spectator of mischief which he cannot remedy.

“ I beg the reader," says Dr. Campbell, “ will bear in mind, that I consider myself equally justified in asserting, that the puerperal fever, if detected early, and treated upon principle, from the commencement, admits of being cured with as much certainty as other diseases which were at one time considered irremediable. I pledge myself to prove these assertions in the sequel, in opposition to every thing that may be urged to the contrary." 11.*

The opinions of medical men, even to the present moment, respecting the nature of puerperal fever, are various and dissimilar-some considering the disease as an inflammatory fever-some as a fever arising from extensive inflammation of some or the whole of the abdominal viscera—some consider

Dr.Mackintosh considers himself authorized from experience to state “ that four-fifths of the patients in a well-regulated hospital ought to be cured; and in private practice he feels convinced that at least twothirds should be restored to their families.”—P.55.

Dr. Campbell and his pupils delivered, during the epidemic, 789 women, of whom 79 had puerperal fever, and out of these 22 died. Of the number who died there were only eight in whom bleeding and free purgation had a fair chance. In the other 12 cases the patients were too late in applying, or refused to submit to proper measures.

it as a putrid fever-others as a fever of the typhoid type, complicated with inflammation—while a fourth party look upon it as an affection sui generis, and peculiar to child. bed. *

Symptomatology. There is a very great uniformity not only in the symptoms but in the dissections of puerperal patients, as described by various authors; the discrepancies of opinion, therefore, respecting the nature and treatment, must have originated principally in theory and prejudice. There is good reason to believe, as Dr. Mackintosh observes, that puerperal fever is sometimes formed before the expulsion of the foetus. We have seen more than two or three unequivocal instances of this ourselves one of which is recorded in our quarterly series. Dr. Campbell has found tbat, in by far the majority of cases, “ the disease appeared soon after parturition, generally within the third day.” It very seldom came on so late as the 4th, 5th, or 6th day in Dr. C's practice. In all, except three cases, the disease was ushered in by rigors of various degree and duration-but generally so well marked as to be noticed by Dr. C's patients. On some occasions, however, it only amounted to a sense of chilliness or shivering. The shivering fit was soon succeeded by pain in the forehead and eye-balls, which became very distressing in Dr.Campbell's patients. Dr.Mackintosh, however, does not seem to consider this symptom as very uniform in puerperal fever, having witnessed several fatal cases where it was entirely absent.

Reaction now succeeds this cold stage, as in other fevers, with the usual phenomena of lot skin, quick pulse, thirst, and diminished secretions. A third stage generally shews itself more or less, with a perspiration on the skin, chiefly confined to the trunk of the body. But the great pathogno

* We shall give the following classification from the very able work of Dr. Campbell :

“ By the following authors it is considered as an inflammation of the uterus : Hippocrates, Galen, Celsus, Ætius, Paulus, Avicenna, Raynalde, Felix Platerus, Sennertus, Riverius, Sylvius, Strother, Mauricean, La Motte, Sydenham, Boerhaave, Van Swieten, Hoffman, Jussieu, Villars, Astruc, Pouteau, and Denman. By Hulme, Leake, and La Roche, as an inflammation of the omentum and intestines. Willis, Levrèt, Puzos, and Doublèt, consider the disease as of a peculiar nature. Peu, Tissot, Le Roi, and White, imagined the disease to be of a putrid nature. Petit, Selle, Kirkland, and Walsh, were of opinion that the disease was of a complicated nature. Finch, Stoll, and Doulcet, considered this affection of a biliary nature. Walter, Johnston, Forster, Cruickshanks, Bichat, Pinel, Gardien, Capuron, Gordon, Armstrong, and Hey, look upon it as inflammation of the peritoneum.” 21. Vol. III. No. 12.

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monic symptom in this disease is pain, especially on pressure, in some part of the abdomen. This, however, is not, in general, complained of until after the appearance of the other symptoms; at other times, there is no distinct interval of ease between the after-pains and those which are fixedthe former degenerating, as it were, into the latter. Pressure with the band should never be neglected by the practitioner ; as the pain will otherwise sometimes escape the attention of the patient in describing her feelings. At the commencement of the disease the pain is pretty constant, but in cases advancing towards a fatal termination, intervals of ease have been remarked by almost all writers, and afford fallacious hopes to the patient, the friends, and sometimes to the inexperienced practitioner. The situation of the pain has been described as very various. In our own practice we have found it more frequently in one or other iliac region stretching across to the middle of the hypogastrium. This pretty nearly coincides with the experience of Dr. Campbell, who observes

" In all my cases, there was pain in the hypogastrium at the commencement of the disease, dartiog into one or both iliac regions. In a few examples of this affection, patients described the pain as having commenced in one or other of the iliac regions, and extended towards the uterus, which organ felt enlarged, and was exceedingly sensible upon pressure. In my practice, therefore, I can with confidence assest, that the pain in the beginning of this affection was chiefly confined to the hypogastric and iliac regions. Patients never complained of it in the umbilicus or epigastrium except in one case, * until the disorder had continued for some time, and I am firmly of opinion, that those writers who describe the pain as having been chiefly seated in the epigastric region, in some instances, at the commencement of the disease, must have deceived themselves by confounding its stages. I trust, I may be excused for making this assertion, because from the number of cases I have treated, I must have witnessed the various modifications of this complaint." 32.

Dr. Mackintosh found the pain fixed in some part of the abdomen, usually the hypogastric region, or at one or other side, where the uterine tumour was generally recognized. The pain, from being sometimes slight at first, quickly became excruciating, so that the patient was unable to turn in bed, dreading the slightest touch, even of the bed-clothes. u When,"

says Dr. Campbell, we have not succeeded in arresting the progress of this formidable disorder, the pain gradually ad

« * Vide Case II. of this work, the only one where the patient complained of pain in the epigastric region from the commencement."

vances from the lower part of the abdomen to the umbilicus, and from that into the epigastric region, accompanied by short intervals of ease, but afterwards returning with increased violence, attacking the patient as it were by paroxysms such as I have already described, At the commencement of this disease, I generally found the abdomen more or less tumid, and this tumidity increased in proportion as the situation of the patient became more precarious, until the abdomen, in some instances, was as prominent as before delivery.* This happened in some of our first fatal cases, where the lancet had neither been so early nor so boldly employed as on subsequent occasions; but after we began to have recourse to bleeding earlier, and with greater freedom, the abdomen, although somewhat distended in every unsuccessful case, was not, however, enlarged to the same extent as the first. The uterus, in almost every instance, could be distinctly felt above the pubes, it was extremely sensible to the touch, and my impression is, that this organ increases in size during the disease; for on comparing in my own mind, the uteri of females in a healthy state, immediately after the placenta is thrown off, with those which I procured from the unfortunate victims of the puerperal fever, I am quite satisfied as to the correctness of the opinion I have now advanced.”+ 33.

From the beginning there is generally great derangement of the vascular system. In many ot Dr. Campbell's patients the pulse continued frequent from the moment of delivery, and then the fever set in on the second or third day. The last-mentioned author considers the deviation from a natural state in the pulse to be the very first symptom in order of time, and that by carefully watcbing this, he has detected the disease, as it were, in embryo, and arrested its further progress without being obliged to have recourse to any very bold measures. Dr. C. has never found the pulse under 110 after the disease had been fairly formed-more frequently it was 120 to 130__and when the fever had continued some time it was seldom under 140. In the advanced stages of cases that terminated fatally the pulse was oftener above than under 140.

“ In the commencement,” says Dr. C. “ the pulsation is sometimes full, but more generally hard; and as the disease advances, it becomes contracted or thready; frequently intermits; and towards the close, it is so weak for a considerable period as to be scarcely perceptible." 35.

* «The swelling of the abdomen having once begun increases very rapidly, insomuch that the belly will become as large as it had been be. fore delivery.”

† “ The uterus was lying about the brim of the pelvis, and considerably more enlarged and distended than it ought to have been.—Gordon, Case III. See Cases XVII. XXVII. XXXIX. and XL. of this work.”

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