[ 12 ]
and more fatal, in large cities and in hospitals, than in the country, and in private practice, some have supposed, that it is a disorder very similar to the cinanche maligna, or ulcerated sore throat? Allowing for the different seat of the disorder, they ask, are not the symptoms very similar? and may it not be supposed that it is an inflammation of the mucous membrane of the uterus and parts adjacent? and do not the equivocal symptoms before mentioned, in some measure, confirm this idea?
It may not be improper to observe, that although Dr. Hulme supposes this disorder to arise from inflammation, yet he says that bleeding is to be used with great caution.
From the beginning of the year 1768 to 1770, the puerperal fever prevailed much in and about London. Dr. Leak published the observations he made in that interval. It seemed to be occasioned, he said, by catching cold, or by errors in diet, but oftener by anxiety of mind. He says the depression of strength was so sudden and so great, that few of the patients could turn in bed without assistance, even so early as the first or second day of the attack. The lochia, he observes, were not, from first to last, obstructed, nor deficient in quantity, neither did the quality of the discharge seem to be altered from its natural state; and what is remarkable, a considerable pressure above the pubes did not occasion pain, while the same degree of pressure between the stomach and umbilical region produced a pain almost intolerable; and in them that died, he says the omentum was found suppurated; he therefore concludes, with Dr. Hulme, that an inflammation of that part and of the intestines, is the proximate cause of the disor-
