epidemic at Leeds appeared, Mr. Hey had not seen the excellent treatise of Dr. Gordon, of Aberdeen, who adopted a different and much more successful practice than had previously been used. The sequel of the volume exhibits the early fatality of the disease under Mr. Hey's management, his gradual and judicious alteration of measures, and his ultimate arrival at the same successful treatment which Dr. Gordon had recommended; under which he cured a long series of cases, some of them of the most alarming kind, without losing a single patient. This detail is extremely interesting, and displays in a high degree the candour, zeal, humanity, industry, and intelligence of the author, to whom, it is obvious, many of the females of Leeds and its vicinity are indebted for their lives and safety under that formidable epidemic.

In the first introductory chapter, Mr. Hey states the pathognomonic symptoms of the disease, to be "fever in child-bed, accompanied with pain which has no complete intermission, and extreme soreness, in the abdomen;" and then adverts to the different views which the most popular writers have entertained of the nature of the puerperal fever. While a few have considered the disease as purely inflammatory, others have supposed it to be a modification of typhus or jail-fever; and others again have adopted a middle course, and believed it to be inflammatory in its commencement, but to have a strong and rapid tendency to putrescence in its progress. Dr. Clarke, and most other writers, have generally deemed the epidemic form of the disease to be of the typhoid kind, and on that account more fatal. Dr. Clarke especially distinguishes the "low fever of child-bed, connected with affection of the abdomen, which is sometimes epidemic," from the inflammatory diseases of the uterus, ovaria, and peritonæum; and Dr. Thomas, who professes to give a summary of the opinions of the most celebrated writers of the present day, in his "Modern Practice of Physic," states, that the puerperal fever "has generally a strong tendency to the typhoid type," and requires an essentially different treatment from inflammation of the uterus, peritonæum, or omentum. This, indeed, is the general VOL. VI. No. 24.

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opinion, we believe, of the profession, resulting from the precepts of those who take the lead in directing public opinion on these subjects. These precepts had no inconsiderable influence on the first attempts of Mr. Hey to cure the epidemic which appeared at Leeds. From a diligent consideration of the circumstances, there was no room for doubt that it was most similar to the "low fever" of Dr. Clarke, and to that of 66 a typhoid type" described by others. At first every case seen by Mr. Hey terminated fatally, with great rapidity. He found by experience, however, that purging gave great relief, though still fearful of carrying it to a great extent, and he did not venture upon the use of the lancet, in a disease "attended by such sudden and early sinking, and in which both these remedies had been so strongly condemned." The complete success, however, which attended the change of practice which he ultimately adopted, led him to the conclusion, that there is no essential difference in the epidemic and sporadic disease, except in the greater violence and severity of the former, and the more active employment of the same remedies by which both are cured.

In Chapter II. the author gives a sketch of the progress of the epidemic at Leeds, and a very perspicuous history of the symptoms, as they fell under his observation. The disease commenced in November 1809, and continued, with some considerable intermissions, till Christmas 1812, after which the author was prevented from seeing any more of it by a long illness in his own person. It attacked all ranks of women indiscriminately, not only in Leeds, but in the country around it, and in towns at some distance, and " many fell victims to the disorder, whose situation, circumstances, and precautions might have been expected to exempt them from it, if any care could have availed them to that end." Yet no connection could be traced between this epidemic and any perceptible variations of the atmosphere; for "it prevailed equally in cold and hot weather, in wet and dry seasons, in winter and summer." There was no other disease particularly prevalent at the same time, except erysipelatous inflammations, which also, according to Dr. Gordon, accompanied the progress of the puerpe

ral fever at Aberdeen. The occurrence of this fever was not at all connected with any particular species of labour; nay it most frequently occurred after the most easy and natural labours.

We need not enter into the detail of symptoms, which are copiously and distinctly described; but we shall quote the following passage, as throwing some light on the nature of the disease, and as comprising observations that are confirmed by all the cases hereafter recorded.

"A degree of fulness in the hypogastric region was often evident from the first attack, and not unfrequently the uterus could easily be perceived, forming a distinct tumour above the pubes. Pressure upon it gave exquisite pain. In about six or eight hours, if the patient was not relieved, the swelling began to extend itself to the whole abdomen, which was soon distended to a great size, and the enlargement of the uterus was lost in the general tumefaction. A diminution in the size of that viscus was a very favourable symptom. The soreness and swelling of the abdomen occasioned great shortness of breathing, and obliged the patient to lie constantly on her back. There was always some mitigation of the disease when the breathing became slower, or the patient was able to change her position, and lie upon her side."

That this is a description of abdominal inflammation, beginning probably in the uterus, and extending to all the duplicatures of the peritoneum, who can doubt? The symptoms recorded in the next paragraph have, indeed, misled the best observers into a notion of typhus; but by the test of, we may almost say, unvarying success, Mr. Hey proved that these typhoid symptoms are anticipated by the lancet and copious purgation.

"If the disorder was not checked, great depression of strength and other appearances of sinking quickly supervened. The pulse was too rapid to be counted; the tongue sometimes, though not usually, became dry and brown, and the teeth were covered with sordes; the cheeks were flushed; the countenance was wild and expressive of great distress; and the whole body was covered with a clammy sweat. At this period

the violent pain of the abdomen often ceased; but its distention occasioned pains in the back, sides, and chest, sometimes accompanied with spasmodic paroxysms of dyspnea. The patient became restless, and affected with vomiting, hiccough, delirium, and other symptoms which are the usual harbingers of dissolution, though not peculiar to this fever; and the melancholy scene was usually closed in a few days from the commencement of the attack." p. 24-5.

After a series of valuable practical observations on the va riations in the periods of attack and termination, and of different symptoms, particularly of the rigor, pain, state of tongue, affection of the head, and condition of the blood when drawn, the author proceeds, in the third and longest chapter, to the detail of cases, which are interspersed with many practical remarks, and followed by a general view of the method of cure. The progress of his opinion in the treatment of the malady is traced in a very interesting manner. After the relation of two fatal cases, in which, as well as in all that had been mentioned to the author and his father in the practice of others, the want of success had led them to meditate beforehand upon the treatment to be adopted in the next case that should occur, the author states the views which they took of the subject. Great temporary relief had been produced by purgatives in the two preceding cases; the stools were slimy and dysenteric; and there was obviously abdominal inflammation, "which seemed, however, of a kind not likely to bear blood-letting." They determined, therefore, to adhere more closely to Dr. Denman's plan, of purging freely in the day, and procuring repose at night by an opiate; and also to evacuate the bowels early in every case by a gentle laxative, as the means of prevention. The "undesired opportunity" of putting this suggestion to the test soon occurred.

A lady was attacked with shivering, pain, and heat, about forty-eight hours after an easy delivery. The progress of the disease is fully detailed, reports being given daily, and great relief was obviously obtained from free purgation with manna and sulphate of magnesia, with intermediate anodynes, and fomentations of the abdomen. The operation of the purgatives

was followed again and again by diminution of the fever, and even of the abdominal tenderness on pressure, and two quiet nights were produced; but on the third day, the symptoms again recurred, and continued to increase, with vomiting; and on the fourth, the pain and soreness were nearly gone, and other symptoms of commencing gangrene indicated the approach of the fatal termination, which took place on the following day. The fourth case we shall quote on account of its brevity.

"The circumstance most worthy of remark in the fourth case, was the early and sudden transition from symptoms of active inflammation to those of debility and sinking. The patient was a robust woman, who was lying in of her first child. She was delivered on Sunday afternoon at four o'clock, and on the following day, she was directed to take, at intervals, a solution of sulphate of magnesia, as a means of prevention.

"At two o'clock on Tuesday morning she was attacked with the disease, and I was called to visit her about five. The pain was more severe than in any of the former cases; and was accompanied with a full strong pulse. The sulphate of magnesia had not operated. I prescribed a purging draught with sulphate of soda and manna āā Zss. in two ounces of infusion of senna. I also directed a cathartic injection to assist its operation. A consultation with a physician took place in the forenoon, when eight or ten leeches, and afterwards a blister, were ordered to be applied to the abdomen.

"At three p. m. the pulse had evidently begun to lose its strength, and other symptoms of debility had become manifest. A distention of the abdomen, which had previously taken place, advanced with rapidity; an obstinate vomiting supervened; and the disease finished its career in thirty-five hours from its first seizure.

"It will not be thought surprising, by those at least who consider the puerperal fever as a modification of typhus, or as having a strong and rapid tendency to it, that the result of this case tended to confirm our fears of having recourse to the lancet." p. 51.

The 5th case was still more rapidly fatal; for the disease