commenced twenty-six hours after delivery, and notwithstanding the patient was attended four times that day, and consultations held, she died forty-three hours after that event, and about seventeen from the commencement of the disease. The sixth case ended fatally in about forty-eight hours; and in this, some camphor mixture and bark were prescribed in consultation. In the seventh there appeared to be great predisposition to the disease during the latter part of pregnancy. Purging materially alleviated the symptoms at first, but an erysipelatous inflammation attacked the nates and pudendum on the third day, and on the sixth the patient died. In the eighth case the disease came on so late as six days after delivery, and copious purging was the remedy resorted to, together with anodyne clysters to soothe the irritation which it might occasion; and this patient with some difficulty recovered. It was remarkable, that "though the bowels were freely evacuated on the day after delivery, and never afterwards became constipated; and though, after the attack of the disease, purgatives and clysters were given every day, yet a remarkable quantity of hardened feces was repeatedly discharged.”— "On a view of the last case," the author adds, "I am persuaded that, had we not been too fearful of exhausting the strength of the patient, but had purged her more briskly at first, the disease would much sooner have been brought to a close." p. 77. Soon afterwards two other cases were successfully treated chiefly by purging; but after this time four were attacked by the disease fatally. Of the fourteen cases then here mentioned, which occurred in the author's practice between December 1809 and June 1810, eleven terminated in death, and three in recovery. The last case which he saw had exhibited considerable appearances of inflammation; purging had been the only remedy from which he observed any relief; and having seen an abstract of Dr. Gordon's practice in Thomas's Modern Practice of Physic, in which bleeding and purging were the remedies depended upon, Mr. Hey now felt strongly inclined to try the use of the lancet, notwithstanding the general impression respecting the low and typhoid type of the disease. A stout wo man was attacked with symptoms of puerperal fever (Case ix.) on the third day after labour, which had been accompanied by considerable hæmorrhage. After using a purging medicine and clyster, he took away seven ounces of blood, at 5 p. m. and applied a blister; at 8 p. m. the blood was found highly firm and buffy, and seven ounces more were taken, which proved more firm and buffy than the former; at 10, great relief to all the symptoms had been produced. This relief continued all next day, copious alvine evacuations being also produced, and till the evening of the following day, when a violent affection of the head came on, with strong quick pulse, which was relieved by leeches to the temples, and by the abstraction of three ounces of blood from the temporal artery. On the following day she continued better on the side of the head which had been bled, and three ounces were taken from the other, and an ounce and half more in the evening, in consequence of a relapse. On the next day some symptoms of paralysis showed themselves, and in consultation some wine and an etherial medicine were ordered. There was no farther abdominal affection; but the patient became delirious, and died on the 13th day in a state of great distress and restlessness. This case was in fact a remarkable instance of metastasis; but the entire removal of the abdominal affection, and the appearance of the blood, confirmed the author in his notion of the propriety of blood-letting. In the 10th case, which occurred soon after, he took away 20 ounces of blood, seven or eight hours after the disease commenced, and found the pain diminished while the blood was flowing, and the next morning nearly gone; purging was continued two days, and the patient recovered without further complaint. From this time the author adopted Dr. Gordon's method, (whose treatise he had now obtained,) and which coincided with, and confirmed his own recent views; and after this period he attended a great number of patients, attacked with equal or more violence than those whom he had already treated, of whom, however, but three died, namely, in the following order, the 11th, 13th, and 15th cases; but after this period, by a still more vigorous pursuit of the same plan, he had the satisfaction of seeing all his patients recover. In the three fatal cases, indeed, the circumstances were such as to afford no disparagement to the principle of the treatment employed: in the 13th case, venesection was not permitted; and in the 15th, the disease was so much subdued, that the patient went on to the end of six weeks, and perished rather from the sequelæ, than from the actual disease. We quote the following case (the 21st) as a specimen of the author's active and successful management of this previously fatal disease. "August 3d, 1812, at one o'clock in the morning, the wife of T. W. of Hunslet, a woman of rather delicate appearance, was delivered by a midwife of her 12th child, after an easy labour of about an hour. Her discharge both at the time of labour and afterwards was said to be severe, but not excessive. On the following morning she had a shivering fit, which was not, however, succeeded by pain; and she remained well throughout the day. The after-pains were slight. "5th.-At four o'clock in the morning, she was suddenly seized, without any previous chilliness, with a violent pain in the body, resembling labour-pain, but of much longer duration. It increased progressively during the day; and in the intervals, which were not longer than a quarter of an hour; the abdomen was sore. "I first saw her between four and five in the afternoon, and found her crying out in pain like a woman in labour, &c.""The patient had taken some opening medicine, which had produced one loose evacuation in the morning. The symptoms, in this case, were not the most alarming, considering that thirteen hours had elapsed since the commencement of the disease; but the pain was violent, and the loss of time was more than a counterbalance to the apparent mildness of the other symptoms. I was therefore satisfied that large bleeding in the first instance was necessary; especially as night was approaching, and the patient lived at some distance from me. I first took away twenty-five ounces of blood, without producing any degree of faintness; when I closed the orifice for a few moments, till another basin was procured; and then drew nine ounces more. She was now disposed to faint, and the pain was much diminished. I put my finger on the orifice, and waited a while. The faintness soon went off, and the pain returned; I therefore took away six ounces more, making in the whole forty ounces. The patient becoming again very faint, I tied up the arm: she soon recovered, and remained easy. Pulse 88." (It was "112 and hard" before the bleeding.) "A clyster was injected as soon as it could be prepared, which in ten minutes produced a very copious evacuation of solid fæces. At six p.m. I gave a bolus with half a dram of jalap and four grains of calomel; and left directions that three table spoonfuls of the cathartic solution" (water eight ounces, sulphate of magnes. one ounce) "should be taken every two hours, till the bowels should be well opened, beginning two hours after the bolus. Half-past ten, p. m. The pain had returned soon after I left her, and with as much severity as before the bleeding. She had had three small watery stools, which did not appear to be the effect of the purgatives. The heat of the skin was now considerable, and was attended with much restlessness. The pulse was at 120, and still hard. The tongue was rather white, and the abdomen was much more tender; particularly in the region of the uterus, which had become enlarged, and easily distinguishable. The increase of all the symptoms since my former visit seemed not only to justify the quantity of blood then taken, but to require a further evacuation. I tied up the arm, and took eight ounces from the same orifice, when, the patient proving faint, I desisted. The pain was much alleviated by this second bleeding, and the pulse came down to 84. I ordered the solution to be taken every hour. "6th. Eight a. m.—She had remained nearly free from pain all the night; the soreness had greatly abated, the uterus was diminished in size, and she had slept several hours. The skin was moist, and of a natural heat; the pulse at 100. She had taken above two ounces of magnes. sulphas, besides the purging bolus; and had had many small evacuations, which, however, contained but little fæces. Two boluses were therefore prescribed, with fifteen grains of jalap and two of calomel in each, to be taken with an interval of two hours; and the solution was ordered to be afterwards continued. VOL. VI. 3 X No. 24. "Six p.m.-Both the boluses had been taken, and the remainder of the third ounce of magnes. sulphas, which had procured a great number of natural stools. The patient continued free from pain; the soreness of the abdomen was quite gone, and the uterus was scarcely to be felt. "7th. She had slept the greatest part of the night, and the pulse was at 84. The bowels were kept open, and she continued convalescent."-p. 131. We cannot help remarking, on the perusal of this and most of the cases here related, how very easy it would be for any treatment of this sort to lose its credit; and how very unlikely that it should ever gain credit, against the prejudices of education, in ordinary hands; because its failure to cure, when timidly used, or when resorted to late, or by men who did not thus assiduously repeat their visits at intervals of a few hours, in proportion to the danger of their patients, would probably be construed into actual injury. And it has been thus perhaps from the inefficient influence of a small bleeding, begun too late, or repeated after too long an interval, that the natural tendency of the disease to rapid lowness may have been supposed to be the result of, or at least to have been aggravated by the ill-managed remedy. The necessity of proportioning blood-letting, in all cases, to the actual effect which it is observed to produce upon the patient and the disease, and not by any arbitrary measure of ounces, if we would do justice to the patient, and obtain the full agency of the remedy, must be very obvious; and it is perhaps to this assiduous and judicious use of the means, that the great success of Mr. Hey is to be chiefly imputed. In the conclusion of this chapter there are many excellent practical observations, which the length to which we have already extended our remarks will not permit us to recapitu late. Bleeding and purging, when employed in a proper and seasonable manner, were obviously adequate to the cure of the disease, and other remedies were merely auxiliary. Dr. Gordon affirmed, that one bleeding of 24 ounces, if performed within six or eight hours of the attack, together with a single purgation, never failed to cure the disease; that if called within 12 hours he promised success from bleeding; but if the |
