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But we must not take leave of the Author without intimating to him that a work, containing fuch a variety of important matter, would be rendered much more valuable by a good Index; and we wish the fale of his book may foon give him an opportunity of fupplying this defect in a fecond edition.
ART. VI. A Treatise on the Puerperal Fever: Wherein the Nature and Caufe of that Difeafe, fo fatal to Lying-in Women, are reprefented in a new Point of View, &c. &c. By Nathaniel Hulme, M. D. Phyfician in Ordinary to the City of London Lying in Hotpital, &c. 8vo. 3 s. Cadell. 1772.
E think it proper to give a particular account of this
to thrown confi
derable or at leaft new light upon the formidable difeafe which is the fubject of it, both with regard to its feat and cause. With refpect to its feat particularly, he differs from all those who have hitherto treated of this diforder, and apparently on the fureft grounds; the infpection of the bodies of thofe who have died of it. The appearances which prefented themselves on diffection fuggeft likewife a caufe of this diforder, totally different from any that have been indicated by preceding inquires.-But to be more particular.
The puerperal fever, as the Author obferves, has hitherto been generally confidered rather as a fymptom or confequence of fome other morbid affection, than as a primary difeafe; and has been very fuperficially, irregularly, and confuledly described by the generality of medical wiiters: fo that we be fearcely had a determinate name by which to diftinguid. it. • Moit Authors have termed it, An Obstruction or Supprep. n if the Lochia; others, an Inflammation of the Uterus: fome have called it the Lochial Fever; and others, After-pains :' but he is convinced that none of thefe defignations are proper; that it proceeds not from any of the caufes fuggefted by them; but that it is a diftemper jui generis, or of a nature peculiar to itleif, and is as much an original or pary difeafe, as the ague, quincy, or any other complaint incident to the numan body. To the miftakes which have been made by the fick and their attendants refpecting this difeafe, which caufes them either to neglect it, or to miltake it for After-pains, or fome colic complaint,' he afcribes, in fome meafure, the great fatality attending it: the deaths of the greater part of thofe who perifh in chid-bed being evidently occafioned by it.
With regard to the caufe and feat of this diftemper, it appears, from this treatife, that the fift is not to be fought for in an obftruction or fuppreflion of the lodia, or of the milk; which are fometimes, though not conftantly, the confequences, but by no means the caules of this diforder. Neither is it, accordREV, Sept. 1772.
ing to the more generally received opinion, to be referred to an inflammation of the uterus. Its immediate and evident caufe, according to the Author, is an inflammation of the intestines and the enientum. This at least is certain, that in the diffections of the bodies of fix women, here minutely related, together with the hiftories of the preceding difeafe, the inteftines and omentum were conftantly found very much inflamed; the former, in general. confiderably diftended with feetid air, and adhering to each other as if pafted together: the latter was always found more or less mortified; a yellow liquor, mixed with pus, fometimes filling the pelvis, and floating among the intestines. In every one of thefe cafes the uterus was found to be perfectly firm and found, except indeed in one inftance, where a part of its external furface appeared variegated, or marbled with a variety of dark brown fpots, produced merely by its having been in contact with the lower part of the mortified omentum./
The Author afterwards inquires into the remote or predif ponent causes of the inflammatory ftate of thefe bowels in lyingin-women, and afcribes it to the conftantly increafing preffure of the gravid uterus against the inteftines and omentum, during the latter months of geftation, and in the time of labour; the ill effects of which are aggravated by occafional caufes occurring after delivery: particularly by keeping the patient hot and coftive, and giving her warm fpices and fpirituous cordials.
Granting that fuch is the real fource and feat of this particular fever, it follows that the danger of it is evident, even a priori, and that confiderable mifchief may enfue from miftaking this disease for complaints of a very different nature, which it refembles on its fuift appearance. The pains in the hypogastric region with which it begins, are too often confidered, by the patient and her attendants, only as after-pains. On that fuppofition the disease is neglected; or, which is worse, if it be mistaken for fome colic complaint, the patient is plied by the good women with hot fpices and cawdles, and the inflammation thereby probably rendered inevitably fatal. Though there never was a time in which this difeafe did not exift, yet nurses, and women in general, the Author obferves, appear to be abfolute ftrangers to its name and nature. They fhould however be taught, he adds, to dread the name of puerperal fever, as they would the name of peftilence or plague; for the one, he apprehends, deftroys not more than the other. They should be taught to know,' he continues, that pain and forenefs of the belly, coming on foon after delivery, unlefs fpeedily relieved by judicious affiftance, will prove mortal in a few days.'
After a particular defcription of the difeafe, the Author points out the characteristic marks which distinguish it from those other diforders to which it has the greatest affinity. These are, after
pains, the milk-fever, the miliary fever, the iliac paffion, the flatulent colic, the inflammation of the uterus, and the cholera morbus. He next gives the prognofticks, and afterwards the. method of cure which he has found most successful. On this laft fubject we shall not be particular, but fhall obferve that he lays the principal ftrefs on the free and repeated ufe of purgative medicines; fuch as the fal catharticus, and oleum ricini, or the tartarus emeticus or vinum antimoniale, given in small doses every two or three hours, till an effectual discharge is procured'; in confequence of which the patient generally finds an immediate relief from pain, kind fweats come on, gentle flumbers fucceed, and the pulfe becomes more calm and flow.' Even in the cafe of a fpontaneous diarrhoea fupervening, by which nature frequently endeavours to free herfelf from the diforder 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 difcharge of the offending matter is to be promoted by the exhibition of mild aperients. We fcarce need to add that this effort of nature is however to be moderated, if it fhould be too violent.
As it is a matter of very general concern, we shall not clofe this article, without enforcing from our own judgment and more limited experience, the Author's recommendation of a liberal allowance of that wholefome and grateful element, fresh and cool air, introduced into the chamber of the patient with proper precautions, not only in this diforder, but during the confinement of lying-in women in general. The large and often fucceffive 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 inftances, the mere creatures of art, and, if we may be allowed the pun, the forced productions of a hot bed; reared fometimes to an alarming magnitude by a correfpondent, fiery, internal regimen. Instead of expatiating on this fubject, we fhall only avail ourfelves of the Author's large experience on this head, acquired from his particular fituation, by transcribing his affertion that, though he has attended more than fourteen hundred women, after their deliveries, in the London lying-in Hofpital, he does not remember having even once met with an inftance of the miliary fever in that houfe. This he attributes in part to the cool regimen that is ftrictly enjoined to be obferved there; but principally to the admiffion of fresh and cool air, which is ordered to be let into the wards every day, at an opening in the windows. To the fame management he concludes that it is owing that, even in the fever which is the fubject of this treatife, he has never obferved any petechie, vibices, exanthemata, or any other febrile eruptions attending it.
A&T. VII. Killarney; a Poem. By John Leflie, A. M. 4to. 6s. Boards. Robinion. 1772.
E have, more than once, had occasion to speak of the delightful lake of Killarney, the wonder and the boast of Ireland; particularly in our account of Dr. Smith's valuable Hiftory of the County of Kerry: fee Review, vol. xvii. p. 56 et feq.
To the above-mentioned article we refer for a most entertaining defcription of the amazing feenery which hath given birth to the agreeable poem now before us; and fhall here prefent to our Readers a fhort extract or two from Mr. Leflie's perfor mance; a fpecimen of his verfification being all that will be expected from us, on a fubject which, fertile as it is, we have already, in a great degree, exhaufted.
Let Tybur boast her hill, her olive fhade,
Or fearch the ifles, the fav'rites of the fun *;
The reflefs paffions, which, like pilgrims, roam,
As the ftag-hunting makes a celebrated part of the entertainments of thofe who happen to vifit the lake at the proper feafon for this diverfion, we fhall felect 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 poffeffes the deferiptive p wers of poetry:
• The hunter's mufic breaks upon
* Thofe ifles called The Fortunate.
On Echo's wing, the joyful accents fly,
• Divided now, 'twixt courage and dismay,