vided upon the treatment that ought to be adopted. And I am quite sure that what I shall recommend will meet with reprobation in many quarters. Yet there ought to be, and there must be, a reason and a philosophy that ought to guide all scholars upon a question that seems to be so simple. Instead of this unity of thought and purpose, we are divided; and the Scriptures tell us "that a house divided against itself cannot stand."

I may venture to enumerate the following as the principal remedies in vogue for the cure of such cases as I have described :

1. Bloodletting; 2. Leeching; 3. Cupping; 4. Emetics; 5. Cathartics; 6. Stuping and poultices; 7. Blisters; 8. Turpentine-oil; 9. Opium; 10. Mercury; 11. Tartar emetic; 12. Enemata. These are all that are in common use. In order to seek for some choice of method, I shall inquire seriatim into the utility and reliableness of each of them. Bloodletting. It appears to me that whosoever shall accept those views of the nature of childbed fever that have been herein set forth, must also regard the use of bloodletting as an indispensable element of any method of cure for the disorder. The Student, who truly desires to become acquainted with this great subject, will have examined the history of medicine, and will have made himself familiar with the literature of the subject. He will have learned that, so far back as the age of Hippocrates, the abstraction of blood was relied upon as the most hopeful and safest recourse; and that, throughout the lapse of the centuries of medical history, there have always been some physicians to trust in chief to this remedy. It could not well be otherwise with men who had taken advantage of occasions to examine the nature and extent of the inflammatory lesions exhibited in the dead body. Eucharius Rhodion, Mauriceau and Guillemeau, Lamotte, Puzos, and many others, were persons who had clear views of the phlogosis of childbed fever, and they became in consequence good bleeders; bleeders coup sur coup, as Puzos expresses it.

The notion, the false notion, that the disease is a fever, still continued to mislead, as it still does, many good and wise men; and even of those who clearly perceived the phlegmasia, not a few appeared to have been dominated by the notion of a fever to that degree, that, while they boldly advocated venesection in their writings, they became appalled in presence of the cases, so that their practice, as in Leake's case, and Denman's, fell far short of their promises and expectations.

It chanced that, in 1789, an epidemic childbed fever began to prevail at Aberdeen, and in the neighboring villages and districts, which proved fatal to many women. None of the medical men then in

practice at Aberdeen were acquainted with the disorder, though the same epidemic had been fatally prevalent there in 1760; but the practitioners of that date were now all gone off the stage.

At that time there lived in Aberdeen a physician, Alexander Gordon, who was largely engaged in Midwifery practice; he was a person of sound judgment, of great probity, and truly zealous for the truth. The cases that came under his care proved fatal, one after another, so that out of the first seventeen women whom he attended, he lost nine. Gordon had not cleared his understanding from the pernicious influences of the traitorous word fever; and therefore, through all the tribulation and distress of so many losses, he was never enabled to behold the simple truth of the case, until, upon the death of Isabel Allan, his seventeenth patient, he procured permission to examine the dead remains. The following is his description of what he observed. Let the ingenuous Student read and carefully reflect upon it, with the view to learn what could, what must have been the state of the serous investment of the belly, that could have led to such effects.

"Upon opening the abdomen," says Gordon, “I found the peritoneum and its productions, the omentum, mesentery, and mesocolon, in a state of inflammation. The omentum had lost about half its substance by suppuration. The mesentery and omentum, and all that part of the intestinal canal with which they are connected, were very much inflamed. But the disease appeared more especially to occupy the right side; the right ovarium had come to a suppuration; the colon, from its caput along the course of the ascending arch, was much inflamed and beginning to run into gangrene. A large quantity of pus and extravasated serum appeared in the cavity of the abdomen, which, when taken out and measured, amounted to two English pints. The peritoneal coat of the uterus was inflamed, and the organ itself not so compact and contracted as it ought to have been. Upon opening it, its cavity was found covered with a black-colored substance, which at first had the appearance of mortification, but, when wiped off, was nothing else than the membrana decidua in the state in which it naturally is about this time."

The truth here flashed upon Gordon's mind. A thousand speculations, ten thousand essays like Hulme's, centuries of fixed opinions that childbed fever is a pyrexia, weigh less than nothing in counterpoise of these proofs; that it was a phlegmasia Gordon now knew.

Henceforth, throughout the remainder of the Aberdeen epidemic, which as I have said began in 1789, and prevailed until 1791, Gordon walked in a path of light. He emerged from the gloomy and doubtful track along which he had previously stumbled and groped,

amidst clouds of error, and accompanied with phantoms of the imagination to mislead and baffle him. He saw that the disease is an inflammation, to be combated by antiphlogistics, of which the chief is bloodletting. But he rightfully judged that, to bleed merely, is not to cure; for he judiciously resolved, in using the remedy, so to apply it as to kill the malady at a blow-jugulare febrim. He considered that, like the fabled hydra, its multitudinous heads must be stricken off at a blow, and that, if struck off one at a time, they were only the more speedily reproduced.

Gordon says: "The method I proved most successful was, by copi ous bleeding soon after the attack of the disease." *** "When I took away only ten or twelve ounces of blood from my patient she always died; but when I had courage to take away twenty or twenty. four ounces at one bleeding, in the beginning of the disease, the patient never failed to recover."***"If, therefore, a practitioner is called to a patient in the beginning of puerperal fever, he must never take away less than twenty or twenty-four ounces of blood at one bleeding; otherwise he will fail in curing the disease." "I know that this will be thought too large a quantity, by those who never take away more than eight or ten ounces of blood from their patients; but such prac titioners would never cure puerperal fever; for, unless a practitioner venture to take away the quantity mentioned, it would be much more prudent in him not to bleed at all, because his patient will certainly die, and the bleeding will be blamed." * "And I felt this prejudice in its full force, when I had not courage to take away more than ten or twelve, or fourteen or even sixteen ounces, of blood from my patients. But when I had resolution to take twenty or twenty-four ounces at one bleeding, I disregarded it, because I was sure that that quantity, taken away within six or eight hours after the attack, would certainly cure the disease, and that of course there would be no clamor against the bleeding. But, when I was not called at the beginning or soon after the attack, I did not bleed at all." * * * * "Now, when I was called early to patients in the puerperal fever, and had courage to take away twenty-four ounces at one bleeding, I never failed at once to cure the disease." **** "After much experience in the disease, and mature deliberation concerning the conduct most proper to be pursued in my peculiar situation, I came to the following resolution: If called to a case within twelve hours after the attack, I insisted on bleeding the patient, and promised for its success; but if at a later period, or from twelve to twenty-four hours after the attack, in that case, like Sydenham with the same remedy in the smallpox, I

thought it incumbent on me to propose it as the only effectual remedy, but I neither insisted on it nor promised for its success."

Many valuable publications upon childbed fever have appeared since the date of Gordon's work. It is not very long since I procured to be published, through the approbation of Dr. John Bell, now Professor of the Practice of Physic at Cincinnati, a volume containing, first, a short article on puerperal fever, by myself, designed as an introduction to the rest of the volume, which consists of the works of Gordon, Hey, of Leeds, Armstrong, of Sunderland, and Robert Lee, of London, on puerperal fever. I have considered that the doctrine of those four authors, as to childbed fever, is so clear, and so clearly descriptive of the facts, and the treatment by bloodletting, set forth in a light so true, that it might serve as a sufficient text and guidebook for the brethren in this country, many of whom cannot have access to rich libraries of medicine. I am still of the opinion, that all those who shall truly possess themselves with the contents of that collection will be well informed and safe men. Safe, I mean, for the public.

While I so confidently recommend the above-named authors, I still more sincerely wish that all the American accoucheurs could read the essays of Tonnellé, of Legouais, of the younger Baudelocque, of Meissner, Kiwisch, and other good writers, who have seen the truth and told the truth as to the phlogistic nature of the malady, and the necessity there is for an antiphlogistic method. I feel sure that few reasonable, well-thinking men could read them without coming over to our opinion. As to the statements contained in the above extracts taken from Gordon, I subscribe to them as the truth, pure and simple, for I know them to be true as to my own experience. His experience amounted to seventy-seven cases; mine goes far beyond that number, and all that I have saved have been saved by the lancet. I am indebted in chief to Gordon for the privilege of standing on a platform, from which I can look over and beyond the mere signs, and discover the things, which they but outwardly represent. In the failing pulses, and amidst all the disheartening evidences of the typhal state, I can look upon the expanding area of the inflammation as the cause, and the sole cause of the declension of the forces, and the overthrow of the functions. If I cannot cure her by venesection, my patient may recover by the providence of God. All other human means seem to me to be useless and beneath contempt, as prime remedies, venesection being omitted.

Hence, my advice to the Student is to learn to confide in venesection as the sole therapeutical hope; but, in the meanwhile, continuing the

other remedies, which are but the juvantia and adjutoria of the masterful and hopeful chief and leader in the conflict against this dreadful, most fatal disorder.

Gordon points out twenty or twenty-four ounces as the proper quantity of blood to be drawn in the early stages of the malady. Probably, he has in this hit upon the happy medium, and I most warmly advise the Student to follow him. Still, the question as to a second venesection will often arise, and I am by no means willing to say that another bleeding shall be regarded as imprudent at a later stage. It is clearly incompetent for any man to determine, beforehand, that twenty-four ounces shall be sufficient in all constitutions alike to effect the cure; and certainly some women may bear, and even require to have taken away thirty ounces, or even a larger quantity. What I most desire in the Student, and what I thank Gordon most for, is the earnestness with which he fixes the lowest limit at twenty ounces.

Let the Student read Hey, Armstrong, and Lee, Legouais, Baudelocque, Dance, Meissner, and Kiwisch, to discover more clearly, if possible, the grounds for defending the antiphlogistic treatment.

It is true that this treatment is combated in very high quarters, and among others by that most excellent and worthy writer, Dr. Robert Collins, of Dublin. This gentleman's experience in the treatment of hospital cases, which was considerable, led him to the opinion that bleeding is not the proper remedy for those cases, however much it may be applicable in out-of-door patients. He says, "at least, in four epidemics which I have witnessed, the symptoms were usually of the lowest typhoid description, the pulse being so feeble and indistinct, as to make you dread, in many, even the application of leeches," &c.

Dr. Collins had charge of eighty-eight cases, of which thirty-two recovered, and fifty-six died. Only fifteen of the eighty-eight were bled, of whom seven recovered, and eight died. He adds: "The result of my observations upon the treatment of puerperal fever is, that general bleeding, except when there is a strong full pulse, and the symptoms are of a highly inflammatory character, is injurious." Such are the words of Dr. Collins, from which it is plain that he entertains views of the malady different from those I have in this chapter set forth. I look upon the cases of peritonitic form as being invariably dependent upon a primordial area or disk of inflammation, which ought to be limited and then resolved by early venesection.

Upon examining Dr. Collins's cases of fatal disease, the No. 60, page 424, gives us the example of a woman delivered at 4 P. M. on the 12th. On the 13th, had slight pain in uterine region; pulse quick; an oil draught. In the afternoon, pain greater; soreness; hurried pulse;