quarter of the discharge. They never should be applied to the abdomen of man, woman, or child, in an inflammatory complaint.

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"In the commencement of the disease," says Dr. Campbell, purgation, both in a theoretical and practical point of view, must be considered as highly proper; because at this period, the excitement will be confined to the uterus or peritoneum, or both; and no injury will arise to the intestines from exciting their action by producing increased peristaltic motion, while it is obvious that the secretion from their mucous coat will be increased, and congestion removed. From the consent of the uterus with the intestines, the secretion from its vessels will also be augmented. When the disease has existed for some time, it is natural to conclude, from the pain becoming general all over the abdominal cavity, and the increased irritability of the stomach, that the intestinal tube is involved in the general derangement, an opinion which dissection has invariably confirmed. In this stage, therefore, I do not think we should be justified in having recourse to active purgation, nor even to an occasional brisk cathartic." 273.

Dr. Mackintosh has also a high opinion of purging. He insists on the necessity of keeping up a constant discharge, "and it is sometimes wonderful to see the copious stools that will come away when the medical attendants have thought it was imposssible that any thing could be in the bowels." He does not approve of drastic purgatives. Castor oil, neutral salts, and the like, are recommended by both our authors. Large enemata are very properly directed by Drs. Campbell and Mackintosh.

"When," says Dr. Campbell, "the intestines are obstinate, a cathartic clyster should be administered every hour, to assist the other purgative medicines. When the bowels have been once opened, the domestic enema, to the amount of lbij. as warm as the individual can comfortably bear it, must be thrown into the rectum every second or third hour, while there is any pain in the abdomen. The enemata will increase the secretion from the vessels terminating on the internal surface of the alimentary canal, and greatly soothe the feelings of the patient, by acting as a fomentation to the internal parts. In the latter stages of the disease, they should be preferred

"Dr. Labatt tried the sub. mur. hyd. in doses of j. and 3ss. as recommended by Dr. Armstrong, and he at first thought its exhibition in such large quantity useful; but he afterwards had reason to be satisfied that it was more beneficial when exhibited in doses of ten or twelve grains in combination with some other purgative, such as jalap.-Armstrong, p. 225."

+ "Injections act as fomentations to the uterus, and they should be thrown up frequently, and in large quantity.-MS. of the late Professor Young's Lectures."

to purgatives by the mouth, as being less likely to produce injurious irritation of the intestines." 274.

Dr. Campbell and Dr. Mackintosh are both aware of the great utility to be derived from determining to the surface of the body, and promoting the healthy secretion of the intestinal canal and biliary organ.

"It is of the first consequence," says Dr. Campbell, "to promote general perspiration, with a view that, by determining towards the surface, we may remove local congestion. With this intention, from the moment the cathartic medicines have begun to act, we should exhibit the antimonial oxide in combination with the submuriate of mercury, as directed in the cases. The submuriate, independent of its good effects in promoting the action of the antimony and the cathartics, will also prove beneficial in removing accumulations of the hepatic system."

274.*

Dr. Mackintosh does not point out the means which be employed for the abovementioned purposes. From the hydrargyro-phobia which seems to haunt him on all occasions, we suppose he trusted to antimony or ipecacuan alone. If so, we would not advise others to adopt the same practice; for there is but too much tendency to gastric irritability in all abdominal inflammations, and when sickness is once excited, we can seldom allay it afterwards. We should therefore prefer the plan pointed out by Dr. Campbell.

In a foot note Dr. Campbell informs us that Dr. Davis, (of George Street, Hanover Square, London,) after reducing the system by local and general bleeding and purging, orders the abdomen to be covered with a large blister, and digitalis to be administered in powder, in doses of one or two grains every second hour, and very generally with the best effect. It is well known that Professor Hamilton, of Edinburgh, is much attached to digitalis in puerperal fever. Of oil of turpentine, neither of our authors have any good opinion. In tympanitic affections of the abdomen, occurring in this disease, it was found very useful by that able physician, Dr.

Dr. Vandeuzande, Physician to the Civil Hospital of Antwerp, has lately published a volume on puerperal fever, or puerperal peritonitis, in which he details his almost uniform success in this disease since the year 1808, by pursuing the plan of calomel and opium, first recommended in pulmonic inflammation by our countryman Dr. Hamilton, and since very extensively employed by our tropical practitioners, in fevers and internal inflammations. He asserts, that the cure of puerperal fever was certain, so soon as the salivary glands became affected. He appeals to the testimony of all the pupils and attendants of Antwerp Hospital for the truth of his statements.-See the Quarterly Journal of Foreign Medicine, &c. No. 17, p. 78-9.

Labatt, of Dublin. Of Dr. Payne's observations we not again take notice.

Of opium Dr. Campbell scarcely speaks at all; and except an occasional anodyne diaphoretic draught at bed time, in some particular cases, we believe he has never employed that medicine. This we suspect is a defect in his methodus medendi. We have administered it in very large doses after a powerful impression had been made on the system by bloodletting, with very good effects; and we have reason to know that this is the practice generally pursued by Dr. Armstrong at present. Dr. Mackintosh is decidedly favourable to this plan.

"It has already," says Dr. Mackintosh, "been stated, that I have always placed a great deal of dependence on opium, in the cure of inflammatory affections. I used to prescribe one or two grains of solid opium, or from 60 to 100 drops of laudanum, half the previous dose to be repeated every three hours till the full effect was produced. Experience has long ago convinced 'me, that the apparent want of efficacy of this useful drug, (as well as of many others,) proceeds entirely from its being administered in insufficient doses, and repeated at too long intervals. In inflammatory affections, there is more to be done than the mere abstraction of blood, using purgatives, and calling in to our assistance a strict anti-phlogistic regimen. Nervous irritation alone, if long continued, will undoubtedly produce inflammation; but how much more will it tend to reproduce inflammatory action recently, or perhaps, not yet entirely subdued. It has been proved by experience, that there exists, after child-birth, an increased state of irritability, to allay which, in puerperal fever, I think of more vital consequence, than in any other diseased state of the system." 273.

Dr. Mackintosh found Mr. Batley's liquor opii sedativus a valuable medicine. He begins with a dose of fifteen or twenty drops, and it is repeated in doses of ten drops every hour till relief be obtained.

It is hardly necessary, after the pathology and treatment sketched out here; to say any thing respecting diet and regimen during the fever and convalescence. It is evident that great abstemiousness must be the rule of conduct.

Both our authors take some short notice of what has been termed by Dr. Armstrong the congestive form of puerperal fever, which appears to us to depend entirely on want of power in the system to establish reaction. In some of the unwholesome countries of the earth it is not uncommon for men to die in the cold stage of ague, thus exhibiting exquisite specimens of congestive disease. When congestion takes place in any fever, it is just a predominance of the cold over the hot stages-where they are disproportionately blended,

instead of succeeding each other-where one part is in a state of excitement, and another, or many others, in a state of torpor or venous turgescence. These cases are, of course, far more dangerous, and more difficult to manage than those of pure excitement. Dr. Campbell only met with one instance of this kind, and speaks hesitatingly of the treatment, as not founded on personal experience. The following extract presents all that is known on the subject.

"In the treatment of this affection, the great and continual de pression of the living powers from the moment it is ushered in, marked by the diminution of the temperature of the body, and the retrocession of the blood from the surface, as well as the rapid and destructive progress of the disease, would seem to suggest more than ordinary efforts on the part of the practitioner to support the powers of the system. At the same time, since the examination of the body after death demonstrates such extensive and decided evidences of congestion in the vessels of the large cavities, every attempt should be made to remove this accumulation of blood, by equalizing the circulating mass, and determining towards the surface.

"Whenever a practitioner is called to a puerperal patient after a paroxysm of rigors, and discovers that its effects have been too permanent, producing an unusually weak, slow, and perhaps an irregular pulse, with great prostration of strength, pallid and collapsed countenance, with coldness of the whole body, but more especially of the extremities, such steps should immediately be adopted as are likely to cause a re-action of the vascular system. With this view, the patient should, with the least possible delay, be placed in the waru bath; or, if she cannot be removed from bed, we should attempt to restore the heat of the body, by covering her with a succession of blankets wrung out of hot water, while she is at the same time to be surrounded with bottles, or bladders, containing hot water; hot irons, or hot bricks, may also be successfully employed for the same purpose. Frictions, with ardent spirits, or with the aq. amon. might prove beneficial; and a cautious attempt must be made to recruit the living powers, by the internal exhibition of some diffusible stimuli-either sulphuric ether or brandy-punch, given in suitable proportions at proper intervals until the temperature of the body be somewhat restored; or camphor, in large doses, may be administered with the same intention.

"In consequence of the blood having receded from the surface, there must be a great accumulation of it in the large veins immediately connected with the heart, in common with other venous trunks; which must not only interrupt the transit of the venous blood from more remote parts towards the right auricle, but even obstruct the immediate action of the heart, an organ, already somewhat paralyzed by the powerful shock which the system has received.

"From this oppressed state of the heart, we might from theory be disposed to subtract blood from the general system, with the intention of relieving this organ; but were we tempted to have recourse

to this practice before re-action has commenced, I doubt not but it would speedily determine the fate of the patient. If bleeding, therefore, is ever to be tried, it must be with great caution. When we have succeeded in restoring the action of the heart and arteries, and temperature of the body to some extent, the patient must then be treated according to the symptoms which afterwards present themselves. In these cases, it is scarcely necessary to state, that very little can be effected except at the commencement; and even then, I must agree with Dr. Armstrong in thinking, that the results of our practice, in many instances, are only calculated to throw a stigma on the resources of our art.'

283.

In the few cases of this kind whch Dr. Mackintosh saw, the time for treatment was gone by, and he was only left “a silent witness to the speedy termination of life." From annlogy with other congestive diseases, he would place the patient in a bath of 112°, and "if possible, open a vein while immersed." We would be more inclined to wait till re-action came on by the bath and diffusible stimuli-and then to bleed according to the degree of the superinduced excitement.

Dr. Campbell closes the original part of his work with many judicious observations on the prevention of puerperal fever, and, indeed, of puerperal diseases in general, which are well worthy the attention of the junior branches of the profession. He then introduces tables indicative of the state of the weather during the prevalence of the late epidemic, concluding with an appendix, containing a republication of Dr. Gordon's Treatise on the Epidemic Puerperal Fever of Aberdeen, originally published in 1795, and now out of print and very scarce.

Dr. Mackintosh concludes his work with an analytic sketch. of the practice of Hulme, and a short review of the cases of Leake, Gordon, and Hey, principally with the view of shewing the failure of bleeding, from not being boldly and confidently followed up; and the superior success of that practice, in the same hands, when early and copiously employed. Dr. Mackintosh has, also, added an appendix, containing eight pages of strictures on Mr. Moir's case of puerperal fever, on which we made a short commentary in our last number. M. has come to almost exactly the same conclusions as ourselves and after all, we think, the case was hardly worth so much criticism.

Dr.

In the endeavour to present our readers with a copious view of the etiological, pathological, and therapeutical matters contained in these two important volumes, we have left