PUERPERAL FEVER. 
613 
stages of the disease ; and such, I believe, will be the general 
result in all cases of puerperal fever. As an “invariable living 
symptom,” Mr. Friend has omitted constipation (it may have 
been an omission), a symptom that 1 dread more than most of 
the others, because it is worse to overcome: it is generally pre- 
ceded by purgation from or without the effects of medicine. 
There is only one thing more which I shall notice connected with 
Mr. Friend’s somewhat ingenious essay, that is, his account of 
the “ suspension of rumination.” He says (page 144), “ that 
the three first stomachs are not, strictly speaking, the organs of 
digestion, but only appointed to receive, to prepare, to separate, 
to send the food thus prepared by an extraordinary route , viz. 
back by the oesophagus to the mouth for remastication” If 
this be not an “ extraordinary route,” it is, at least to me, a 
new one; but Mr. Friend knows better than this, and I can 
easily believe that the error arose from a confusion in the con- 
struction of a sentence or two, and not from ignorance, or I 
might not have noticed it. Although I take no more notice of 
any of Mr. Friend’s “ invariable living symptoms” in puerperal 
fever, it is not that I agree with him respecting either them or 
the “ variable ones it is because no good would result from my 
stating, that I differed with him in the doctrines advanced, un- 
less I gave opinions of my own, based on a sure foundation, and 
calculated to do good to all who are interested in the subject ; 
this lam aware the limits of your Journal will not at present 
permit. But it may be asked, if puerperal fever be not a 
“cerebral disease,” nor one of the “organic motor nerves;” 
where does it begin ? wffiat organs are affected ? and where does 
it terminate ? I refer the inquirer to Case 4, the post-mortem 
appearances of which are faithfully given, and are sufficiently 
characteristic of what the disease is ; where it commences, and 
where it ends. 
To be more explicit, however, I am fully persuaded that the 
uterus is, in the great majority of cases, the only sufferer at the 
commencement of this disease. As the disease advances, the 
peritoneum, the intestines, and most of the viscera of the abdo- 
men, may become affected ; “ but it is soon lost,” (says the clear 
and succinct author, who treats of this disease in the ‘ Library 
of Useful Knowledge’), it is soon lost in a peculiar general in- 
flammatory state, as rapid in its progress as it is violent in its 
nature ; and (sometimes) speedily followed by a prostration of 
vital power that often bids defiance to every stimulus.” 
And is it to be doubted or wondered at, that in the expulsion 
of the foetus, but more particularly where this is accomplished 
