The suggestion of non-liability to a recurrence of attacks of yellow-fever, so far from possessing any appearance of the nature of a discovery, must have naturally often presented itself to the mind in the early stage of acquaintance with that disease, like one of those illusions, which, because we fondly wish, we almost persuade ourselves to be true, until checked by further experience. From the interest excited by its extensive ravages, a fact of such vital importance in the laws of the disease, instead of escaping the notice of even common observers, or of being treated with neglect by those entrusted with the public health, would have been scized with avidity and confidence by all classes, and long since established by volumes of confirmation, affording to those exposed to the destructive sphere of its operation, indemnity for the past, and security for the future. The reverse is, however, daily exhibited in those islands, in a manner so conspicuously free from ambiguity, that the person who should at this day hazard such an opinion, would be exposed to the negative of every one who had passed a few years within the tropics.

For these reasons, I trust I am justified in concluding, that the doctrines which have called forth these observations are untenable, because they are so far irreconcilable and at variance, that one position cannot be maintained without abandoning the other; for either the Bulam and yellow-fever are not the same disease, and consequently, all the analogical reasoning derived from the latter falls to the ground; or if, as I believe, they are the same, then what has been called the Bulam fever may, and does, attack the human frame more than once; but the name thus assumed must be erroneous, because the yellow-fever is not an imported, or, in other words, a contagious disease, Witney, Oxfordshire, June 2, 1816.

IX.

Case of violent Contraction of the Uterus, threatening Abortion, cured by copious Bleeding, and enormous Doses of Opium. By EDWARD LLOYD KNOWLES, Surgeon, Soham, Cambridgeshire.

THE difference of opinion existing amongst medical practitioners, in regard to the treatment of disorders, is not an unusual occurrence; but any thing that leads to a successful

mode of treatment, even if it should be extended beyond the general practice, probably may not be unworthy of your observations. Under these circumstances, and impressed with the importance of the case, I beg you will give it insertion in your excellent Miscellany.

On the 5th of June last, I was summoned, in a great hurry, to visit Mrs F. of this town. On my arrival, I found her in the most excruciating pain, arising from a violent contraction of the uterus, as she was far advanced in pregnancy, being in her seventh month; the pulse very full and quick, beating 98 in a minute. She was of a robust constitution, bowels regular, and frequently an inclination to vomit. A considerable heat was excited from the violent action the system was thrown into. On examination, not the least dilatation of the os uteri presented. Under these circumstances, I thought the most advisable plan to pursue was, to deplete the system, and alleviate the distressing action of the womb, by opiates to a large extent; as it is observed by most teachers on midwifery, and indeed in almost all treatises on that subject, that where the abortion endeavours to arise from a disposition of the uterus to contract, the plan to be adopted is depleting, and opiates given in considerable quantities. Having so many respectable authorities to support me in this instance determined me to proceed boldly on the following mode of procedure. Immediately, on my arrival, after asking the different questions to decide my mode of treatment, I ordered sixteen ounces of blood to be drawn at 8 o'clock in the morning, with the draught below:

B Tinct. opii, gtt. xl.

Spt, æther nitrosi, 3ss.

Aq. Menth. pip. q. s. M. ft. haust. omni hora sumendus. These were persevered in for four hours without the least perceptible benefit, the pain continuing unabated, and the contraction in the uterus increasing. At mid-day she was bled, and an addition of gr. iss. of opium made to each of the draughts, which were to be repeated every half hour. They were continued for four hours, without any alleviation of pain, notwithstanding the quantity of opium administered, and two pounds of blood abstracted from the arm. The pains came on exactly as they do in labour, at an interval of about five minutes, and that in a manner of the most violent nature. At this time, a bye-stander would most certainly have concluded, the force being so great, that the contents of the uterus must every minute be expelled. When I called again, which was at 4 P. M. it forcibly struck me, from the excessive straining pains, that abortion was rapidly advan*cing; but, on examination, not the least probability of it present

ed, the os tineæ being so completely contracted, that all hopes on that head were annihilated. The pulse continued full, and the symptoms equally violent.

Although I had exceeded the quantity of bleeding and opiates laid down by the professors on midwifery whose lectures I consulted, I still thought myself justified, both in theory and practice, to extend the plan heretofore prescribed; and, indeed, I considered no other method of relieving but that of relaxing. At 7 P. M. sixteen ounces of blood were again taken from the arm, and I directed her to be placed in a warm bath for twenty minutes, and ordered the following medicines to be admini

stered:

B Tinct. opii 3i.

Aq. Mentha pip. 3iss. M. ft. haust. omni hora sumendus, c. ii. pilul. sequent.

B. Gum opii gr. vi. divid. in pilulas vi.

She bore the operation of bleeding and the bath extremely well; had three pains whilst in the water; afterwards she was placed in bed, and bladders filled with warm water were ordered constantly to be applied to the epigastric region. I directed a steady perseverance in the medicines, and left her, with a most sanguine hope of its alleviating the violent agony she laboured under.

At eleven at night I was obliged to visit her again, and, to my great surprise and mortification, considering the quantity of opiates taken, and how far the system had been depleted, the disease was not overcome. The most remarkable circumstance was that of the opiates not affecting the head, producing delirium, or sleep, considering the enormous quantity exhibited. The pulse at this time was 70 in a minute, and rather full; thirst considerable; she had made no urine since the morning. I thought that the pains did not return so frequently as when I saw her last, and I flattered myself that, by pursuing my old plan a little farther, complete success would attend my efforts. Therefore sixteen ounces of blood were abstracted from the arm, and the draughts and pills repeated, each pill now containing three grains of opium. She went through the operation of bleeding very well; and, notwithstanding she had four pounds of the vital fluid abstracted from the arm in twelve hours, she did not appear in the least exhausted. I left her for the night, and directed the medicines to be given regularly, and herself to be kept quiet. About two o'clock the next morning I was called up. They informed me that the pains were relieved, but, to use their own expression, they could not confine her in bed. I naturally

concluded, that, as the excitement in the system was alleviated, the opiates in all probability produced the delirium which I conceived to be the cause of her uneasiness. As the bowels were constipated, the following aperient was administered:

B Infus. sennæ simpl. Zii.
Magnes. sulph. 3ss.

Tincturæ Rhæi palmat. 3i. M. ft. H. statim. sumendus. The draught operated several times, and the head was soon relieved. She had about three hours sleep in the night. I entertained great hopes the paroxysms would not return. About seven the next morning she had a relapse of the pain. On placing my hand on the abdomen, I could plainly perceive the uterus contracting as violently as ever, and the paroxysms returning at intervals with equal impetuosity. Anxious as I was to relieve, I must acknowledge I felt fearful of depleting the system any farther, although the pulse was at 60, and rather strong, as I had exceeded almost the bounds of moderation. Never having before met with a case of this nature that showed such obstinacy; and as the loss of too much blood frequently produces anasarcous swellings from relaxing the absorbent system, I contented myself by extending the opiate plan. The following was taken:

R Tinct. opii 3i.

Mucil. gum, acaciæ 3ij.

Spt. æther nitros. 3ss.

Mistur. camphor. Zij. M. ft. haust. omni hora, sum. With each draught, a bolus, containing four grains of opium, was given.

About one P. M. I visited her again, and was extremely happy to find the pain abated by the first dose of the medicine. The effects of the opiates were desired to be kept up, with an intention of preventing a recurrence. On the 7th, I found her quite tranquil. She had slept most part of the night, and perfectly easy. She complained of a violent soreness of the abdo

She vomited some bile several times this morning. The irritation of the uterus most probably produced the sickness by sympathy. The head was but slightly affected. The pulse at 80. Directed her to continue her anodyne draughts three times a day, each containing gtt. xxv. tincturæ opii, and to remove the abdominal affection, the cathartic draught was repeated. On the morning of the 8th, I visited her again. She passed a quiet night; the soreness of the abdomen nearly removed; the bowels quite regular; head very little affected; the vomiting still continuing at intervals. The prescription below was taken:

B Carbon potass. 3ij.

Tinct opii 3j.

Mistura camph. 3ij. M. ft. mistura cujus sumat cochlear. ii. major. 4tis horis, cum cochlear, i. mag. succi limon. incipiente ebullitione.

Notwithstanding there was a considerable quantity of bile regurgitated into the stomach, from the violent action of the system, still there is no doubt that the effects of the opium rendered the digestive organs somewhat torpid; a circumstance that frequently occurs, when it is necessary to persevere in it for any length of time. With the intention of restoring it to its pristine state, the mixture in the act of effervescence was directed to be taken. On the 9th the head was perfectly easy; passed a quiet night; the nausea nearly subsided. Pulse at 70, and rather full. Ordered her to continue the saline mixture three times a day. Appears to recover rapidly. On the 10th the nausea and vomiting completely removed. Pulse natural, and in fact she appears perfectly well; not the least debility existing, notwithstanding the quantity of blood abstracted.

It may not be improper to observe, about two months previous to this attack, she was affected in a similar manner. A draught composed of gtt. xl. tinct. opii, and blood-letting to 12 ounces, afforded instant relief; and she continued perfectly well, until the affection now detailed. As the quantity of opium in this instance was much greater than what is generally given, the subjoined table, as to the manner and quantity administered from the 5th of June to the 8th, probably may not be uninteresting.

The exact particulars are as follows, taken from my day-book:

The first day she became indisposed, 840 drops of the tincture, and 27 grains of the solid gum, were administered.

Remarks.

My only object in forwarding this case for publication is, to