A very interesting account of the puerperal fever, which was epidemic at Aberdeen, has been lately published by Dr. Alexander Gordon. (Robinson, London.) In several dissections of those, who died of this disease, purulent matter was found in the cavity of the abdomen; which he ascribes to an erysipelatous inflammation of the peritonæum, as its principal seat, and of its productions, as the omentum, mesentery, and peritonæal coat of the intestines.
He believes, that it was infectious, and that the contagion was always carried by the accoucheur or the nurse from one lying-in woman to another.
The disease began with violent unremitting pain of the abdomen on the day of delivery, or the next day, with shuddering, and very quick pulse, often 140 in a minute. In this situation, if he saw the patient within 12 or 24 hours of her seizure, he took away from 16 to 24 ounces of blood, which was always sizy. He then immediately gave a cathartic consisting of three grains of calomel, and 40 grains of powder of jalap. After this had operated, he gave an opiate at night; and continued the purging and the opiate for several days.
He asserts, that almost all those, whom he was permitted to treat in this manner early in the disease, recovered to the number of 50; and that almost all the rest died. But that when two or three days were elapsed, the patient became too weak for this method; and the matter was already formed, which destroyed them. Except that he saw two patients, who recovered after discharging a large quantity of matter at the navel. And a few, who were relieved by the appearance of external erysipelas on the extremities.
This disease, consisting of an erysipelatous inflammation, may occasion the great debility sooner to occur than in inflammation of the uterus; which latter is neither erysipelatous, I suppose, nor contagious. And the success of Dr. Gordon's practice seems to correspond with that of Dr. Rush in the contagious fever or plague at Philadelphia; which appeared to be much assisted by early evacuations. One case I saw some time ago, where violent unceasing pain of the whole abdomen occurred a few hours after delivery, with quick pulse; which ceased after the patient had twice lost about eight ounces of blood, and had taken a moderate cathartic with calomel.
This case induces me to think, that it might be safer and equally efficacious, to take less blood at first, than Dr. Gordon mentions, and to repeat the operation in a few hours, if the continuance of the symptoms should require it. And the same in respect to the cathartic, which might perhaps be given in less quantity, and repeated every two or three hours.
Nor should I wish to give an opiate after the first venesection and cathartic; as I suspect that this might be injurious, except those evacuations had emptied the vessels so much, that the stimulus of the opiate should act only by increasing the absorption of the new vessels or fluids produced on the surfaces of the inflamed membranes. In other inflammations of the bowels, and in acute rheumatism, I have seen the disease much prolonged, and I believe sometimes rendered fatal, by the too early administration of opiates, either along with cathartics, or at their intervals; while a small dose of opium given after sufficient evacuations produces absorption only by its stimulus, and much contributes to the cure of the patient. We may have visible testimony of this effect of opium, when a solution of it is put into an inflamed eye; if it be thus used previous to sufficient evacuation, it increases the inflammation; if it be used after sufficient evacuation, it increases absorption only, and clears the eye in a very small time.
I cannot omit observing, from considering these circumstances, how unwise is the common practice of giving an opiate to every woman immediately after her delivery, which must often have been of dangerous consequence.
END OF THE SECOND PART.