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But we must not take leave of the Author without intimating to him that a work, containing such a variety of important mattet, would be rendered much more valu.ble by a good Index; and we wish the sale of his book may soon give him an opportunity of supplying this defect in a second edicion. ART. VI. A Treatise on the Puerperal Fever : Wherein the Nature and

Cause of that Disease, fo fatal to Lying-in Women, are represented in a new Point of View, ec. &c. by Nathaniei Hulme, M. D. Phyfician in Ordinary to the City of London Lying in Hotpital, &c. 8vo.

Cadell. 1772.
E think it proper to give a particular account of this

Treatise, as the Author appears to have thrown confiderable or at least new light upon the formidable disease which is the subject of it, both with regard to its feat and cause. With respect to its feat particularly, he differs from all those who have hitherto treated of this disorder, and apparently on the furest grounds ; the inspection of the bodies of those who have died of it. The appearances which presented themselves on dissection suggest likewise a cause of this disorder, totally different from any that have been indicated by preceding inquireis.-But to be more particular.

The puerperal fever, as the Author observes, has hitherto been generally considered rather as a symptom 'or consequence of some other morbid affection, than as a primary disease; and has been very superficially, irregularly, and confusedly described by the generality of medical writers: so that we have foarcely had a determinate name by which to diftingua it.

6 Moit Authors have termed it, An Obstruction or Szapreljoof the Lochia; others, an Inflammation of the Uterus : fome have called it the Lochial Fever; and others, Aftcr-pains :' but he is convinced that none of these delignations are proper; that it proceeds not from any of the causes fuggefted by them; but that it is a dirtemperjui generis, or of a nature peculiar to itleif, and is as much an original or primary disease, as the ague, quincy, or any other complaint incident to the human body. To the mistakes which have been made by the sick and their attendants respecting this disease, which causes then either to neglect it, or to miltake it for After pains, or some colic complaint,' he ascribes, in some mealure, the great fatality attending it: the deaths of the greater part of those who perisli in chid-bed being evidently occasioned by it.

With regard to the cause and feat of this ditemper, it ap. pears, from this treatise, that the first is not to be fought for in an obstruction or suppreflion of the lachia, or of the milk; which are sometimes, though not conitantly, the confequnces, but by no means the causes of this disorderi Neither is it, accordRev, Sept. 1772



ing to the more generally received opinion, to be referred to an inflammation of the uterus. lıs immediate and evident cause, according to the Author, is an inflammation of the intestines and the onenium. This at least is certain, that in the dissections of the bodies of fix women, here minutely related, together with the histories of the preceding disease, the intestines and omentum were conftantly found very much inflamed; the former, in general. considerably diftended with fætid air, and adhering to each other as if paíted together : the latter was always found more or less moitified; a yellow liquor, mixed with pus, fometimes filling the pelvis, and floating among the intestines. In every one of these cases the uterus was found to be perfe&tly form and sound, except indeed in one instance, where a part of its external surface appeared variegated, or marbled with a variety of dark brown spots, produced merely by its having been in contact with the lower part of the mortified omentum. ?

The Author afterwards inquires into the remote or predisponent causes of the inflammatory ftate of these bowels in lying. in-women, and ascribes it to the constantly increasing pressure of the gravid uterus against the intestines and omentum, during the latter months of gestation, and in the time of labour; the ill effects of which are aggravated by occasional causes occurring after delivery: particularly by keeping the patient hot and coltive, and giving her warm {pices and spirituous cordials.

Granting that luch is the real fource and seat of this particular fever, it follows that the danger of it is evident, even a priori, and that considerable mischief may ensue from miltaking this disease for complaints of a very different nature, which it resembles on its fit appearance. The pains in the hypogaftric region with which it begins, are too often considered, by the patient and her attendants, only as after-pains. On that supo position the disease is neglected; or, which is worse, if it be mistaken for some colic complaint, the patient is plied by the good women with hot spices and cawdles, and the inflammation thereby probably rendered inevitably fatal. Though there never was a time in which this diseale did not exist, yet nurses, and women in general, the Author observes, appear to be absolute ftrangers to its name and nature. They should however be taught, he adds, to dread the name of puerperal fever, as they would the name of pestilence or plague; for the one, he apple. hends, destroys not more than the other. They should be taught to know,' he continues, that pain and foreness of the belly, coming on soon after delivery, unless speedily relieved by judicious assistance, will prove mortal in a few days.'

After a particular description of the disease, the Author points out the characteristic marks which distinguish it from those other disorders to which it has the greatest affinity. These are, after

pains, the milk-fever, the miliary fever, the iliac passion, the flatulent colic, the inflammation of the uterus, and the cholera morbus. He next gives the prognosticks, and afterwards the method of cure which he has found most successiul. On this Jaft subject we shall not be particular, but thall observe that he lays the principal stress on the free and repeated use of purgative medicines, such as the fal catharticus, and oleum ricini, or the tarlarus emeticus or vinum antimoniale, given in small doses every two or three hours, till an effectual discharge is procured'; in consequence of which the patient generally finds an im. mediate relief from pain, kind sweats come on, gentle slumbers fucceed, and the pulse becomes more calm and now.' Even in the case of a spontaneous diarrhea fupervening, by which nature frequently endeavours to free herself from the disorder within the abdomen, and to carry it out of the body by means of the nearest emunctory, that evacuation is by no means to be checked; but the discharge of the offending matter is to be promoted by the exhibition of mild aperients. We scarce need to add that this effort of nature is however to be moderated, if it thould be too violent.

As it is a matter of very general concern, we shall not close this article, without enforcing from our own judgment and more limited experience, the Author's recommendation of a liberal allowance of that wholesome and grateful element, fresh and cool air, introduced into the chamber of the patient with proper precautions, not only in this disorder, but during the confinement of lying-in women in general. The large and often successive crops of miliary eruptions, accompanied with the fever of that name, and judged to be in a great measure the peculiar attendants of women in child-bed, are doubtless, in many instances, the mere creatures of art, and, if we may be allowed the pun, the forced productions of a hot bed; reared sometimes to an alarming magnitude by a correspondent, fiery, internal regimen. Instead of expatiating on this subject, we fhall only avail ourselves of the Author's large experience on this head, acquired from his particular situation, by transcribing his affertion that, though he has attended more than fourteen hundred women, after their deliveries, in the London Hospital, he does not remember having even once met with an instance of the miliary fever in that house. This he attributes in part to the cool regimen that is strictly enjoined to be observed there; but principally to the admission of fresh and cool air, which is ordered to be let into the wards every day, at an opening in the windows. To the same management he concludes that it is owing that, even in the fever which is one subject of this treatise, he has never observed any petechie, vibices, exantherata, or any other febrile eruptions attending it. Q 2


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A T. VII. Killarney'; a Poem. By John Leslie, A. M. 4to. 63.

Boards. Robinion. 1772.
E have, more than once, had occasion to speak of the

deigitful lake of Killarney, the wonder and the bouit of Ireland ; particularly in our account of Dr. Smith's valuable History of the County of Kerry: fee Review, vol. xvii. p. 56 et fiq.

To the above-mentioned article we refer for a most entertaining description of the amazing scenery which hath given birth to the agreeable poem now before us; and shall hare present to our Readers a short extract or two from Mr. Leslie's perfore mance; a specimen of his versification being all that will be expected from us, on a subject which, fertile as it is, we have aiready, in a great degree, exhausted.

Let Tybur boast her hill, her olive shade,
Her Sybyl's grot, her Annio's fam'd cascade.
Let the vain traveller the praise resound
Of diftane realms, and rave of clallic ground;
Let him o'er continents delighted run,
Or search the isles, the fav’rites of the fun *
Let him of foreign wonders take the round,
Unrival'd ftill Killarney will be found :
Here, brighter charms, fuperior blessings reign,
And Law and Liberty protect the scene.

• The restless paflions, which, like pilgrims, roam,
Here pause a while, and find a pleasing home.
From the wild store, the tuneful and the sage
Catch the warm image to illume their page.
To the fond lover's ravish'd eyes appear,
The lively transcripts of his fair-one here.
Th’ambitious, happy in exalted views,
The glowing fervour of his breait renews.
On deep research, the friend of Nature feeds,
Each in his fav rite wish, and want, succeeds.
As the scene varies, varies cv'ry grace,

And heart-felt pleasure smiles in ev'ry face.' As the ftag-hunting makes a celebrated part of the entertainments of thole who happen to visit the lake at the proper leason for this diversion, we shall select a few lines from that part of the poem in which the hunt is introduced ; and from which our Peaders may infer in what degree the Author poffeffis the dcfcriptiv: p.wers wf poetry:

• The hunter's music breaks upon the car,
Routin" the favage tenant from his lnir.
The mellow horn, the deeper note of hound,
The fruiters proclaim, the fat is round;

* Thole illes called Tbe Fortunate,

On Echo's wing, the joyful accents fly,
The mountains round reverberate the cry.

' Rejoicing in his strength and speed he mocks
Oppoling thickets, and projecting rocks;
The latter'd oak, in vain, refifts his force ;
The distant hills are swallow'd in his course :
Dauntless as yet, he stops a-while to hear;
Liit’ning he doubts, and doubt fore-runs his fear;
His well known range he tries, now devious strays,
Clamour pursues, the gale behind betrays ;
Unsafe the covert, all alarm'd he feels
His foes instinctive, winding at his heels;
He bounds the cavern's yawning jaws, and now,
Darting, he gains the cliffs' tremendous brow. -
He gazes on the deep, he snuffs from far
The gathering tumult, and prepares for war.

• A patient active band, Milelian blood,
Long us’d to scale the steep, and hem the wood,
Such as the Lord's own Hunter, fam'd of old,
For mightielt chale, would glory to behold ;
Or such, by Wolf inspir’d, that fearless itrain'd
Up Abram's heights, and Quebec's ramparts gain'd ;
Steel'd to extremelt toil, and fit to bear
Hunger and thirit, and Zembla's keeneit air,
Nay, time itself; a race of old renown,
And through succeílive ages handed down ;
Their brawny shoulders from encumbrance freed,
Their nervous limbs, wing’d with Achilles' speed,
Hotly pursue, and with unwearied pace,
O’ertake the fugitive, and urge the chace.

· Divided now, 'twixt courage and dismay,
To yield a captive, or to stand at bay;
Maintaining in the pass the glorious strife,
Like Sparta's King, for liberty and life.
With fury wild, he glares around, nor knows
A refuge near, on every side his foes;
Forc'd to a long adieu, his native wood
Determin'd he forsakes, and braves the flood,
Dash'd headlong down: his spirit what avails?
Arrang'd below, an hostile feet assails
With wild uproar; he rides the liquid plain,
And strives the asylum of the illes to gain.
Bays far remote he tries, and lonely creeks,
Steals to the shades, and moss-grown ruins feeks:

Like wand ring Delos, now he thifts the view;
Now, as the imaller galliot, swift and light,
Veering he shuns, or meets th' unequal fight;
At length bewilder'd, all confus'd he roves,
Catching a frewell prospect of his groves :
All efforts vain, o'erwhelm’d, he now mult yield,
To die inglorious, in the wat’sy field:


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