chief objection to his sketch of his tour is its want of animation. Like a dull picture, it contains no prominent object to fix the attention; and various scenes, rich with the materials of description, are introduced too cursorily and faintly to arrest the mind of the reader, or to satisfy him that Mr. B. was fully alive to the grandeur of the objects which he contemplated. The composition, too, is frequently inelegant. In point of political feeling, he is a resolute Antigallican, and as much disposed (p. 85, &c.) to panegyrize Lord Castlereagh for his diplomatic exploits, as a traveller of a very different stamp (Mr. Hobhouse) is to condemn him.

ART. VII. A Treatise on the Puerperal Fever, illustrated by Cases, which occurred in Leeds and its Vicinity, in the Years 1809-1812. By William Hey, jun. Surgeon of the General Infirmary, and of the House of Recovery at Leeds. pp. 250. 8s. Boards. Longman and Co. 1815.

8vo.

THIS is an interesting and instructive publication, and still

more deserves that character when taken in connection with the work of Dr. Armstrong on the same subject, reviewed in our lxxvith volume, p. 369. Dr. A. gave an account of an epidemic puerperal fever, which had prevailed in 1813 in Sunderland and its vicinity; clearly described the symptoms; referred them, without hesitation, to the immediate or the remote effects of an inflammatory state of the body; and decisively recommended the system of copious depletion. We learn from Mr. Hey's narrative that, for the space of about three years before the commencement of the Sunderland epidemic, a disease of the same description had existed in and about Leeds; that he had adopted similar views respecting both the nature and the treatment of the complaint; and that he had even prepared his work for the press, but had been prevented by ill health from actually publishing it until after the appearance of Dr. Armstrong's volume. We have no doubt of the correctness of Mr. Hey's statement; and it is material because it enables us to regard him as furnishing an independent testimony, and equally original with Dr. Armstrong.

Mr. Hey justly observes that no disease exists, of the same importance with the puerperal fever, about which so great a diversity of opinion has prevailed: some writers considering it as a highly inflammatory disease, and others as of a typhoid nature; and each of them, in course, prescribing modes of treatment in conformity with his theory, and exactly opposite to the other: while a third set of writers, apparently among the most judicious, and of the highest authority

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thority on medical topics, have chosen a kind of middle course, and have consequently adopted a wavering and inert line of practice. Dr. Gordon, of Aberdeen, had indeed taken the same view of the subject with Dr. Armstrong and Mr. Hey, and published an excellent treatise on this disease in 1795: but his doctrine was so much at variance with the general opinion, that it appears to have made little impression on the public mind. - Mr. Hey begins by defining the disease to be fever in child-bed, accompanied with pain which has no intermission, and extreme soreness in the abdomen.' He then remarks on the several appearances which it assumes under different circumstances, so as to have induced some authors to regard it as inflammatory, and others as of an opposite nature; and he mentions the distinctions which have been laid down between its various forms, and the attempts of Dr. Clarke, &c. to point out distinct species depending on the parts primarily affected, or on something peculiar in the situation and constitution of the patient. All these distinctions, however, he regards as of no use in practice, or even as productive of embarrassment; and he conceives that the only essential difference, in the cases of what ought to be called puerperal fever, consists in their degree of violence, and their being epidemic or simply sporadic: for it seems to be admitted that, whenever the disease exists epidemically, it is more urgent in all its symptoms. No circumstance could be ascertained which seemed to have any effect in producing the complaint; nor in fact was there any cause, either external or internal, which could be assigned for it.

After these preliminary observations, the symptoms of an acute attack are minutely and (as it would appear) faithfully detailed. They commence with rigor, accompanied by severe pain in the abdomen; while the pulse, the head, the skin, the temperature, the secretions and excretions, and the digestive organs, are all considerably affected. The state of the abdomen, which is the origin and centre of the evil, and the termination of the disease, are thus described :

› 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 of the 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 REV. OCT. 1816.

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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.

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 dyspnœa. The patient became restless, and affected with VOmiting, hiccough, delirium, and other symptoms which are 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.'

The third chapter is intitled Cases and Method of Cure.' It contains accurate reports of most of the cases which occurred to the author, and of many of those which were attended by his father, with a minute detail of their practice. We are made acquainted, in the most candid and explicit manner, with their want of success in the commencement of the epidemic, with the opinions which they entertained on the subject, with the change which was gradually produced by experience in their views of the disease, and with the ultimate cures which were obtained.

The first fourteen patients were treated according to the plan which was sanctioned by the best authorities; laxatives, diaphoretics, and opiates forming the principal remedies: but eleven of the cases terminated unfavourably. After mature deliberation, the author then resolved to employ copious bleeding and purgatives; from which he had hitherto been restrained, partly by the prevailing doctrines on the subject, as contained in what were considered the most valuable publications, and partly by the rapid alteration from the first or inflammatory stage of the complaint to a state of the greatest apparent debility. The result of the new practice was most satisfactory; and, in thirty-six cases which fell under his care after this time, the disease proved fatal in only two instances. Several of them are fully detailed, and of others a general statement is given: but we cordially acquiesce in the following sentiment: 'Enough has been said to fulfil the design proposed in this chapter, viz. to illustrate the character of the disease under consideration; to shew the insufficiency of the

* Indeed, the disease seldom allowed time for these changes.'

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means which had been usually recommended for its cure; and to elucidate that method of cure, which proved invariabły successful, whenever it was fairly tried.'

To the relation of individual cases, succeeds ، a connected view of the Method of Cure;' a section which we strongly recommend to the perusal of our medical readers. The author acknowleges his obligation to Dr. Gordon's treatise, with which he coincides, in all the essential points; and, where any minute differences of opinion exist, they are attributed more to some variation in the nature of the epidemic than to any disagreement in principle. The whole of the treatment may indeed be summed up in this one sentence: 'The method of cure consists in large evacuations by bleeding and purging; and, although other remedies may sometimes be useful auxiliaries, these are indispensable; and they alone will generally be found sufficient, if they are employed in a proper and seasonable manner.' When called in at the very commencement of the case, Mr. Hey informs us that he seldom took away more than 24 ounces of blood: but, if eight or ten hours had elapsed, a considerably larger quantity was often found necessary. It was not, however, so much any precise quantity as the effect produced by it which determined the practice; for it is expressly stated that the only limit to the detraction of blood is the removal or the considerable diminution of pain.

A concluding chapter consists of General Remarks on Puerperal Fever,' in which different questions are discussed respecting the nature of the disease; and, in the first place, whether what has been called puerperal fever be always the same disease, or whether it may not be sometimes an inflammation of the uterus and peritoneum, and at others of a typhoid tendency. He thinks that this distinction does not exist, and says; On this point, I might rest satisfied with referring to the history and symptoms of the disease, as already detailed, leaving it with the reader to compare them with other descriptions of the puerperal fever; and confidently relying on their general coincidence.' He conceives that the epidemial prevalence of the disease in question was a sufficient characteristic of its nature, because this circumstance never takes place with respect to simple inflammation of the uterus and peritonæum. - He afterward inquires whether the puerperal fever is essentially the same disease under all the different appearances which it assumes.' The answers to this question have been very various, and great authorities may be quoted as supporting precisely contrary opinions: but Mr. Hey coincides with Dr. Gordon in supposing

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posing that the puerperal fever is always inflammatory at the beginning, and becomes putrid only in its progress, and that this putrescency is only the effect, or consequence, of previous inflammation neglected, or improperly treated.' On this principle, he accounts for the very opposite statements that have been given concerning the effects of bleeding; some writers of respectability having altogether prohibited its use, or having employed it in a very limited degree only.

The last question of importance relates to the infectious nature of the disease; a point on which, as on many others, the greatest contrariety of sentiment has existed. Dr. Gordon has no doubt that the Aberdeen-epidemic was highly infectious; while Mr. Hey speaks on the subject with uncertainty, and confesses that he has not been able to form a decided opinion on it.' This cautious spirit confers on the work no small degree of additional value, and gives the more confidence in the author's judgment on those topics on which he speaks without hesitation. It is, however, unnecessary for us to say more in commendation of this treatise, because our account of it will prove that it merits the attentive perusal of every medical practitioner.

ART. VIII. Historical Sketches of Politics and Public Men, for the Year 1813. 8vo. pp. 265. 8s. Boards. Longman and Co.

We owe an apology to the writer of this clear and temperate summary, for having so long delayed a notice of his publication. He has on this, as on a former occasion, (see M. R. for August 1813,) gone over all the leading topics of the year, and brought within a very convenient compass a mass of information which most readers have previously received only through the medium of news-papers and magazines; receptacles of so unconnected and frequently of so contradictory a nature, as often to leave those who peruse them at a loss to form a clear or conclusive opinion. The topics discussed in the present volume are

Ministerial and Party-changes during the Year. -The Case of the Princess of Wales. - The Catholic Question. - Renewal of the East-India-Charter. - Finances. - Campaign in the Peninsula. Campaign in the North and in Germany.-America.

To whatever part of the book we turn, we discover the labours of a mind anxious to arrive at a fair and deliberate conclusion; a merit of such rare occurrence, that it induces us to look with a very indulgent eye on a few mistakes or rather