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the pensively interesting nature of the subject itself, have obtained the good fortune of a more general ana lasting popularity than the more original and splendid efforts of genius have often been successful in attaining. Refinement and taste-the cultivated taste of a connoisseur, rather than the boldness and freedom of original thought-are the prominent characteristics of Mr. Rogers's poetry. They will be recognised in the present production, which forms as complete a contrast to Lara as could be desired, for the purpose of illustrating the peculiar merits of each. There is a slightness, but, at the same time, a finished
ap- pearance, in the latter poem, which reminds us of the minute beauties of a water-colour drawing. The effect seems to be produced, less by outline and determinate strokes, than by the softly blending tints and shadowing of the landscape. The principal fault is that of indistinctness in the conduct of the story, which is not sufficiently made out to be, at first, intelligible. It has probably arisen from a too great studiousness to give the appearance of compression, and a light effect, to the poetry. The reader is, after all, left to guess how long Jacqueline was absent from her father's house. The first canto, which was probably meant to convey only the effects of her sudden departure from the village, seems to assert, contrary to the sequel of the story, that she was gone and gone for ever. The poem will, however, be found to please much more on a second perusal, especially after the deep and tragicinterest excited by the preceding Tale has sufficiently subsided, to leave the mind at leisure to receive emotions of so very different a kind. The following extract must suffice as a specimen of Jacqueline.
• Oh! she was good as she was fair.
• In her who mourned not, when they missed her, The old a child, the young a sister?
No more the orphan runs to take
Art. VIII. Facts and Observations relative to the Fever commonly called
Puerperal. By John Armstrong, M. D. Member Extraordinary of the Royal Medical Society of Edinburgh, and one of the Physicians to the Sunderland Dispensary. Longman and Co. London; Consta
ble and Co. Edinburgh. 8vo. pp. 162, price 8s. 6d. London, 1814. THE occasional occurrence of Puerperal Fever as an Epide
demic disease in particular districts, has given to its pathology a high degree of importance, and renders the general diffusion of correct views concerning its nature and treatment, of the utmost consequence to society. The information already obtained by the examination of the body after death, (the most valuable of all the sources of improvement in medicine, and which alone, in doubtful cases, can unfold the nature of disease, and the changes which are produced by it on the human frame, and convert conjecture into knowledge,) las clearly demonstrated that this fever is most intimately connected with inflammation of the peritondal membrane, and that to be successfully treated, it must be regarded as an active, inflammatory disease. Still, however, something may always be added to our knowledge of disease by an intelligent and faithful observer of nature; and we are far from thinking so favourably of the state of medical practice in this country, (though it is, perhaps, as highly favoured in this respect, as it is in many others, as not to believe that there are numerous individuals in the profession, wlio may
receive considerable advantage from an attentive perusal of the volume under our consideration. To young practitioners more especially, we may confidently recommend it as a safe and faithful guide, which, in the absence of positive experience, may relieve them from infinite anxiety and embarrassment, and enable them to add to the grateful recollections attending a faithful discharge of duty, the supreme satisfaction of having been instrumental in rescuing the life of a fellow creature, at an interesting and important period, from the most imminent peril. During the year 1813,
the Puerperal fever made its appearance in Sunderland, and its vicinity; and the opportunity which was thus afforded to Dr. A. of observing the disease in its several stages, and of directing its treatment, has supplied him with • his principal materials. As the fever was not, however, confined to that neighbourhood alone, but appeared, about the same period, in some other parts of the adjacent country, he has inserted, in an appendix, several communications from intelligent practitioners, who had rather extensive opportunities of observing it. We shall not dwell on the history of the disease, for its general character is much the same in all situations, and is but little influenced by local circumstances. Our attention will be better occupied in noticing the principal circumstances in the mode of treatment recommended by Dr. Armstrong, and which, under his direction, was attended with signal success. We may observe, however, that our Author's history of the disease is faithful and judicious; and that he has pointed out, with minute attention, those circumstances which must direct the practitioner in his diagnosis, as well as in the prognosis of the dis
Dr. Armstrong thinks it of importance, in reference to the treatment, to distinguish two stages of the disease, since it is in the first stage only that medical treatment can be attended with much prospect of success : when it has advanced to its second stage, the powers of medicine are of little avail. To this distinction in the period of the disease, Dr. A. seems to have paid particular attention; and as he has inculcated the importance of keeping it constantly in view, with a degree of earnestness which proves his own sense of that importance, and which corresponds with our views, we shall transcribe his own observations on the subject.
• In the first stage, after the signs have ceased, the pulse is hardly ever less than 120, and sometimes, though as far as I have observed, very seldom, as high as 140, in the minute ; the blood does not seem to flow in a soft, easy, natural current, but comes against the finger with a kind of vibratory motion, and more than ordinary pressure is commonly required to stop its course along the artery, which feels rather hard and tense. The skin is dry and hotter than natural, the patient complains of great pain and soreness of the abdomen, breathes nearly forty times in the minute, vomits mucus and bile, is
generally bound in the belly, has a white dry tongue, considerable chirst, and labours under all the restlessness and irritation of fever.'
• In the second stage the pulse is never under 140, and frequently rises above 160 in the minute, while it is always exceedingly variable, weak, and compressible ; the tenderness of the belly is usually much diminished, and the fulness increased ; cold partial perspirations first break out about the face, neck, and extremities, the centre of the body particularly the surface of the abdomen, remaining dry and of a pungent heat for some time afterwards ; the patient rarely shivers much, but has repeated chills; vomits dark grumous matter, seldom breathes less than sixty times in the minute, has generally a loose belly, a brown, black, or reddish parched tongue, unquenchable thirst, tremulous hands, lightness and swimming of the head, con- i fusion of thought, a delirium, and, several hours before death, a remarkably relaxed, cold, damp skin,'
As this formidable disease will sometimes proceed with a rapidity so great as to prove fatal within forty-eight hours from its commencement, or even less, it is of the utmost importance that the active treatment, by which alone its progress can be arrested, should be employed as early as possible after its symptoms are once unequivocally manifested; and the earlier after this period, in the same proportion will be the probability that the disease will be crushed at once, and that the patient will speedily be restored to health. In his recommendation of bleeding, the great remedy in all cases of active inflammation, Dr. Armstrong agrees with all our best practical writers; but to be really beneficial, it must be free, from a large orifice, and the quantity must be proportioned to the violence of the symptoms and the strength of the patient, and repeated at a short interval if it shall have failed, in the first instance, to give a decided check to the progress of the disease. Immediately after the first venesection, a purgative is to be given, and Dr. A. appears to have, most judiciously, appreciated the value of freely evacuating the bowels, and to have employed it with a degree of boldness which las not been usual in the practice of this country. His favourite remedy is a scruple, or half a drachm, of calomel, suspended in mucilage, given at once, and followed by a dose of sulphate of magnesia dissolved in infusion of senna, to be repeated every hour, until the bowels were very freely acted upon. This formed the basis of the treatment employed, but combined of course with the general adoption of the antiphlogistic regimen. The success of this practice was most satisfactory, and a reference to the proportion of recoveries which it effected, will more strongly recommend it to universal adoption, than any encomium of vurs. From the 1st of January to the Ist of October, 1813, it appears, that forty-three cases of Puerperal fever, occurred to five practitioners residing in and near Sunderland,
and of this number only five cases terminated fatally : a more honourable testimony to the skill of the individuals under whose care they fell, could not be exhibited, for we believe there is not on record another instance of success so complete.
• The thirty-eight successful cases,' Dr. Armstrong remarks, were all treated by copious depletion of one kind or other, and in twenty-nine of them, calomel was exhibited in doses of a scruple or half a drachm at the beginning, and occasionally repeated in the course of the distemper. For the most part it passed so expeditiously along the intestinal canal that there were very few instances in which ptyalism was excited, and whenever this was the case, it seemed a favourable circumstance, all the patients with one exception, recovering with more than ordinary celerity from the time that the mouth became affected. And further to illustrate the superior efficacy of large doses of calomel, it may be here remarked, that in none of the five cases which proved fatal, more than fourteen grains of calomel were given on the accession of the fever, jalap, sulphate of magnesia, and castor oil, being the cathartics chiefly employed during its progress. p. 71.
This is the judicious practice employed by Dr. A.; but some of his correspondents appear to have relied almost exclusively on the employment of purgatives, which, in so dangerous a disease, is, we think, to be reprobated, since not only is a purgative inferior to venesection in its general impression on the body, but the effect produced by the latter is immediate, while some hours must, in general, elapse before the action of the former can be produced in any effectual degree. As auxiliaries, purgatives are invaluable, but they ought not to supersede venesection, except in the mildest cases, and even in them, local bleeding by means of Jeeches, ought also to be employed. In some of the cases which came under the notice of Dr. A. and in which the constitution was delicate, bleeding was deemed inadmissible, and the treatment was by purgatives; but though these cases did well, their recovery was slow and doubtful for some time, and they had a strong tendency to hectic, long after the abdominal symptoms disappeared. In such cases as these, we are persuaded that the greatest benefit would have resulted from the local abstraction of blood by leeches. Under the more vigorous practice of copious bleeding followed by purging, or by purging and vomiting in succession, the patients were generally convalescent on the fourth or fifth day, and from that period rapidly recovered their former health and strength. We cannot speak of emetics in this disease from our own experience, though they seem to have been employed with advantage in some of the cases noticed in this volume. There appear to us, however, to be strong reasons to question their utility. The violent contraction of the abdominal muscles, produced by the act of vomiting,