ward islands, in 1642, and within ten years from the time when Barbadoes became tolerably well peopled, a great proportion of the settlers were swept away by a mortal infectious disease. Fortunately we have two unquestionable authorities for the fact. One is the manuscript history of the celebrated Mr. Hubbard, a work now in the possession of the Rev. Mr. Elliot, of Boston, from which I have extracted the account verbatim.

"In 1647 an epidemic sickness passed through the whole country, affecting the colonists and natives, English, French and Dutch. It began with a cold, and in many was accompanied with a light fever. Such as bled, or used cooling drinks, died. Such as made use of cordials, and more strengthening things, recovered for the most part. It extended through the plantations in America and in the West-Indies. There died in Barbadoes and St. Kitts, five or six thousand each. Whether it was a plague or pestilential fever, it prevailed in the islands, accompanied with a great drought, which cut short potatoes and fruits."

Governor Winthrop, of Massachusetts, in a letter to his friend, Mr. Richard Vines, who had just before removed from New-England to Barbadoes, gave him some account of this epidemic in Massachusetts. Fortunately Mr. Vines? answer, dated Barbadoes, April 20, 1648, is preserved and printed in Governor Hutchinson's Collection of Papers. In this the writer gives the following account of the epidemic in that island: "The sickness was an absolute plague, very infectious and destroying, insomuch that in our parish there were buried twenty in a week, and many weeks together fifteen or sixteen. It first seized on the ablest men, both for account and ability of body. Many who had begun and almost finished great sugar-works, who dandled themselves in their hopes, were suddenly laid in the dust, and their estates left unto strangers. Our New-England men here had their share, and so had all nations, especially Dutchmen, of whom died a great company, even the wisest of them. The contagion is well-nigh over; the Lord make us truly thankful for it, and ever mindful of his mercy."

Here we have a clear and sufficiently precise account of an influenza or epidemic disease which invaded the whole continent and adjacent islands of America; and it is remarkable that the events there were precisely the same as have happened in every epidemic influenza of which we have any account. The facts are undeniable. They are simply these:

That within the tropics that condition of the atmosphere which produces a general catarrh, or influenza, invariably produces malignant infectious fevers: and hence the influenza is attended, in winter, with a mortal pestilential pleurisy, and is immediately or speedily followed by the deadly malignant fever, called yellow. Sometimes the scarlet fever intervenes between the influenza and the bilious plague, as it almost always does in our latitudes. The fact is the same in Egypt: an epidemic influenza is always followed speedily by a deadly plague. Those who want complete evidence on this subject, will find it in my History of Pestilential Diseases, a summary of which is contained in the second volume, beginning p. 346.

These facts unfold the whole mystery which so much puzzled the learned Warren, and has puzzled every later medical writer. But it is not for want of facts or evidence that the learned have been perplexed to account for the origin of the plague, and its periodical recurrence; it has been solely for want of observations and registers of facts. If medical gentlemen would extend the range of their observations, and compare cotemporaneous events; and if men generally would note the state of diseases in the country at large, with half the care that they note the smallest political occurrence, there would be no more difference of opinion respecting the origin and contagiousness of distempers, than there is concerning the result of an election. But how is it possible for men to know any thing of the great laws which influence the atmosphere, and controul its vicissitudes, when they limit the range of their remarks to the circumference of a mile-to a single town, city or island? Here is the source of our ignorance and our mistakes. Dr. Warren, a learned and highly respectable physician, had lived a few years in Barbadoes. He found the people generally healthy, and concluded very properly that the island is a healthy one. But in 1732 and 1738 he was astonished at the sudden invasion of a malignant fever, with unusual and mortal symptoms. Like an honest man, he looks around him, and inquires, Whence comes this calamity? Without suspecting what was going on in the atmosphere of the continent and other islands, and influenced, doubtless, by the current popular idea that plague is carried from place to place, he recurs to Martinico for infection. A fleet of merchantmen had arrived there from Marseilles, with Levant goods, and the disease, he was told, appeared about the time these goods were opened! Alas, the weakness of man! It is now known this form of plague which appears in Barbadoes

never occurs in the Levant! and the Asiatic plague, with glandular swellings, never appeared in the West-Indies. Away go all the crude conjectures and idle theories of this worthy man! Had this gentleman extended his views, he would have solved the difficulty like a man of science. He would have discovered a severe and universal influenza immediately preceding the bilious plague of Barbadoes-followed by the same disease on the continent and other islands-and in the latter instance (1737) followed by a like pestilential fever in Mexico, which menaced it with depopulation!

(To be continued.)

1

MEDICAL REPOSITORY,

FOR

FEBRUARY, MARCH, AND APRIL, 1804.

ARTICLE I.

CASE of RUPTURE of the UTERUS: Communicated by THOMAS C. JAMES, M. D. of Philadelphia, to Dr. MIL

LER.

N the 18th of February, in the afternoon, I was desired, by a respectable gentleman of this city, to visit his wife, who was the mother of several children, and then in labour, attended by a midwife. The history of her case, as far as he was acquainted with it, he briefly related to me.

It appears from the account of the midwife, that labourpains had come on the preceding morning, and she was called about two o'clock, A. M. The head presenting, the membranes ruptured, and the waters were discharged about seven o'clock, and the labour appeared to advance regularly, and with sufficient rapidity, until about nine o'clock, A. M. at which period the os uteri was considerably dilated, and the head so far engaged in the pelvis as to afford a prospect of the labour being terminated in ten or twelve succeeding pains; when, upon her sitting up in the bed, and making some exertion, she complained of a sudden pain, and sensation of fainting, appeared to be considerably agitated and tremulous, and said that "the child had gone back again." Upon the midwife's examining again, she could distinguish no presenting part of the infant; and, being much alarmed, Dr. Shippen was sent for, who, upon a common examination per vaginam, could reach no part of the child. Being obliged to leave her to attend another lady, he recommended to the husband to call upon me.

It was between four and five o'clock P. M. before I could attend, when I found her in a state of considerable anxiety, with quick and laborious respiration, restlessness, thirst, and vomiting of every thing she drank, with great flatulency.

VOL. I.

2T

She had experienced no labour-pains, as I was assured, after nine o'clock in the morning; since which time she had taken about fifty drops of tincture of opium. Upon examination, I found the history which had been given of the state of the parts perfectly correct; and could distinguish nothing beyond the os uteri, which was completely relaxed and dilated, except what felt to me like coagula of blood, or loose membranes receding from my finger: there was a small discharge of blood from the vagina, but not more than she had been accustomed to in her former labours.

At ten o'clock at night I again visited her, and found her much in the same state in which I had left her. She had been sensible of some relief from some medicine which had been prescribed, but had felt no return of labour-pains.

Being under the necessity of leaving her, I could not see her again until six o'clock the next morning; and found that she had been distressed with incessant vomiting and extreme difficulty of respiration through the night. Her countenance expressed great anxiety, and her pulse had sunk considerably. She had, indeed, felt three attacks of pain in the abdomen, which, she said, seemed more like cramp or spasin than regular labour-pain; and she complained exceedingly of pain at "the pit of the stomach," feeling, as she expressed it,

as

if there were a knot there." I thought, upon laying my hand upon the abdomen, which was extremely large and pendulous, that I could distinguish the limbs of the child more plainly than in any case that had ever occurred to me, notwithstanding her being extremely corpulent.

Reflecting upon her situation, I had very little reason to doubt that a rupture of the uterus had taken place, and felt the necessity of proceeding to deliver her as soon as I possibly could. At the same time wishing for a consultation with some of my medical brethren, I endeavoured to procure a meeting with Dr. Shippen, but his servant did not deliver my message to the Doctor, as he had been up the greatest part of the night with the patient before alluded to. I then proceeded, as the case became more urgent from her increasing debility, (although the discharge of blood from the vagina was still trifling) to introduce my hand, with the intention of turning the child, and delivering by the feet.

The first thing distinguishable by my fingers, upon the introduction of my hand through the os uteri, were some coagula of blood; but my elbow had passed considerably into the vagina before I could reach any part of the child. My