the seventh month; when the uterus is too contracted to allow of turning; when the pelvis or passages of the mother are organically contracted; in cases of such extreme exhaustion of the mother as forbid immediate turning or forced delivery; when the child is dead, and when it is premature and not viable." In these views of the above-quoted authorities, M. Negrier does not participate. He has intentionally, he says, omitted to speak of galvanism, because it has not the sanction of French accoucheurs. Even admitting the facts of Dr. Radford as to the powerful influence of galvanism, he doubts its power in contracting the walls of the neck of the uterus, because this part does not, in his opinion, enjoy the sort of contraction which the walls of the body of the womb do. "Dr. Radford's (erroneously written Bradford) first and sixth propositions expressed only admitted facts. The third proposition is irrational. It is at least useless in a case of pelvic deformity requiring craniotomy previously to detach and extract the placenta." According to M. Negrier's anatomical and physiological views, the practice which is advocated in the fourth proposition is dangerous and useless. With reference to the fifth proposition, M. Negrier speaks of the proposed operation as the more rational, because the placenta itself, which under the influence of induced labour would necessarily be detached, would offer but little impediment to the passage of the child. He thinks that galvanism can only be used in maternity charities, as it would take at least one hour to get the apparatus in order for use, supposing a practitioner possessed it, and this delay in severe cases is not often allowed to the accoucheur. What too would country practitioners do unless they carried it always with them? M. Negrier makes no further commentary on Dr. Simpson's papers. M. Jacquemier has not noticed the subject. It appears to us that M. Negrier does not in the least appreciate the important fact, that hæmorrhage is known to cease when the placenta is completely separated from the surface of the womb. Dr. Simpson has undeniably proved this from the 141 cases which he has collected, in which the placenta was expelled or extracted before the child. We apprehend that this standing fact does not admit of controversy. The reputed fatality of the operation of version in placenta-presentations, as gathered from statistics, may be, and we think is, overrated, Dr. Simpson may or may not be right as to the source of hæmorrhage in these cases; the placenta may not be so readily detached in difficult cases as Dr. Simpson supposes, but nothing of this kind affects the fact, that in a case of unavoidable hæmorrhage, where a woman's life is in danger from bleeding, and the womb cannot be emptied by turning, that the bleeding may be stopped by separating and removing the placenta. For our own part we are disposed to accept this fact, and the practice founded on it, as a most important aid in these most trying and anxious cases. It is not designed to supersede the practice of turning, but it is designed to come into operation where this great resource fails us. Since Dr. Radford's and Dr. Simpson's papers several cases have been recorded, bearing out the practical views of these accoucheurs, and we have no doubt but that they will eventually be established as rules of practice in certain cases of unavoidable hæmorrhage. 1847] Jacquemier on Embryotomy. 65 As to the value of galvanism in these and other cases, we still need a large collection of facts, before its just value as a remedial agent can be established. The most recent investigations on it, as applied to midwifery, do not promise so much for it as might have been expected. But we hope Dr. Radford will again publish on this subject. We shall not follow M. Negrier in the treatment of post-partum hæmorrhage. He advocates the use of the plug in all such cases, with external pressure from above. The compression of the aorta, he says, does not entirely suspend a bleeding coming from the cervix. It is a dangerous expedient, as it occasions loss of most precious time, and severely affects the functions of circulation and respiration. M. Jacquemier's Chapters on Version, and Operative Midwifery, are practical and well written. He is what may be called an advocate for the use of the long forceps, but he counsels a careful and prudent attention to the class of cases in which they are serviceable, and to the manner of employing them. He has constructed a comparative table of the results of forceps and craniotomy cases in public establishments at different parts of the world, which exemplifies the evident difference in the proportion of cases in which they are used. Dr. F. Ramsbotham's statistics of the Royal Maternity Charity show a proportion of 1 forceps case to 785 deliveries, whilst the cases of Siebold of Berlin, and Carus of Dresden, are respectively 1 in 7 and 1 in 14! M. Jacquemier regards the vectis as a very inferior tractor to the forceps. He exposes the abuse and fallacy of its employment in Holland, by stating that Bruyn pretends to have dislodged 800 heads in the space of 42 years. We quite agree with our author in thinking that those who pretend to use this instrument so successfully have usually employed it in cases where Nature was equal to the task, if time and patience were only allowed. In France, the vectis is principally used to redress the head. In the operations for Embryotomy, M. Jacquemier advocates the use of Baudelocque's cephalotribe, of which there is a drawing. Among the obstetric operations, M. Jacquemier has included the induction of premature labour. The subject is very well discussed, and this section is a very valuable one. He considers it of the greatest importance to distinguish carefully between premature labour and the induction of abortion, and he thinks it is by having confounded the two that there has been so much repugnance shown in adopting the expedient of artificial delivery at the seventh month on the Continent. Our author gives a concise history of the introduction of this operation. In 1756, according to Denman, several medical men in consultation unanimously declared this practice to be useful and moral. In a short time, Macaulay tried it, and Kelly practised it three times on the same woman. In a short time it passed into general practice. In Germany, although Wenzel practised it in 1804 and 1808, and Krann in 1819, it was not generally adopted until the facts published in England were known, and Reisenger's work in 1820 was circulated. From Germany it soon spread into Holland and Italy. In France it was resisted for a long time, and it is only recently, from 1832 to 1835, that the works of Dezeimeris, Velpeau, Dubois, &c. have triumphed over the prejudices with which it was regarded. M. Jacquemier indicates the class of cases in which it ought to be used, but he has not mentioned Dr. Ashwell's name No. 107 5 in connection with the induction of labour in cases where the uterus is affected with hard and fibrous growths. The direct or mechanical means to bring on labour are described as-1. Friction over the fundus and neck of the womb. 2. The detachment of the lower segment of the membranes by the finger. 3. Plugging the vagina. 4. Puncturing the membranes. 5. The introduction of some foreign body into the neck of the uterus. In England the preference is, we believe, generally given to the artificial rupture of the membranes by puncturing either low down, or by conducting the instrument higher up between the uterus and the membranes, to let the liq. amnii escape from this part of the ovum. In France, however, the dilatation of the neck of the uterus by a sponge-tent is the plan most usually adopted. Frictions, the detachment of the membranes, plugging the vagina, &c. are, says M. Jacquemier, but imperfect varieties of this method. MM. Busch and Mende have proposed to dilate the neck by means of three-bladed instruments, which can stretch out after being introduced. M. Dubois uses a speculum to aid the insertion of the tent, which may be retained in the neck by plugging the vagina with sponge. The patient may walk about, and the sponge swells out as it gets moist, and so keeps up a more active dilatation. The subjects of Symphysiotomy and the Cæsarian Section are discussed at length, and the concluding Book, which includes puerperal diseases, and the accidents to the infant from labour, and the management of the infant, are practical, and well deserve a careful perusal. The impression which an examination of M. Jacquemier's Manual has left on our minds is most favourable. It is undoubtedly the best book of the kind now extant. It is a full book-but it is not prolix. It is a scientific book-but it is sensibly written and very practical. We feel persuaded that it will be extensively circulated among French students— and it would give us much pleasure if this notice of it were to attract the English student of midwifery to study it. We confess, on looking at the Preface, we were a little afraid that our author would disappoint us. There are scraps of foolish and peculiarly French vanity, which turn out, however, to be very innocent. In speaking, for instance, of the progress of obstetric medicine during the last and present century, he says that "France having been in this branch of science, as in all others, at the head of the movement, and having filled the world with the noise of her works, cannot consent to be placed behind England or Germany in obstetric science-she must preserve her authority in the midst of these active and fertile nations." We of course are only amused at this little specimen of sectional patriotism, and we are happy to assure our readers that they will not meet with any such vapid nonsense in the work itself. 1847] Ormerod's Clinical Collections in Surgery. 67 CLINICAL COLLECTIONS AND OBSERVATIONS IN SURGERY, MADE 300. Longman, 1846. ALL who are acquainted with the Metropolitan Hospitals must be aware of the exemplary manner, as a general rule, in which the medical officers perform the immediate duties devolving upon them. Let but the sufferings of the most wretched outcast be sufficiently great to secure his admission within the walls of these noble institutions, and he has skill and care lavished upon him equal to that which the wealthiest noble could command: with, too, the additional advantage of the treatment of his case being conducted in the presence of the most competent and most formidable of critical tribunals-that formed by aspiring colleagues and senior students. So, too, the business of hospital teaching, with some exceptions, is far more satisfactorily conducted now than heretofore; and it is the student's own fault if he do not avail himself of the invaluable and never to recur opportunities of improvement which are now so freely opened up to him. But with all this, we think the Hospital Medical Officer is seldom sufficiently impressed with the duty which devolves upon him, as respects. the profession at large, of freely communicating the results which his position has enabled him to achieve. We hold that no man is morally justified in taking any such important office who is forgetful or careless of this obligation, inasmuch as he prevents another conferring an important benefit upon mankind, which he himself is either incompetent or unwilling to accomplish. The Guy's Hospital Reports furnish an excellent example of what may be done by the united efforts of men who are alive to the duties of the offices they hold; and the names of Brodie, Latham, Ashwell, &c., point to recent admirable individual exceptions to the general apathy we are deploring. May the surgeons of St. Bartholomew's arouse themselves, and follow so excellent a lead! In the mean time we have Mr. Ormerod, a most industrious student, and late house-surgeon of that hospital, coming forward with his "Clinical Illustrations," the fruit of nine years' assiduous observation in the surgical wards. It is just such a work a hard student ought to produce, and is not liable to an objection that attaches to the published lucubrations of several junior practitioners. If many of the senior members of our profession have manifested an undue remissness in wielding the pen and delivering opinions which would be listened to with attention and instruction, no such coyness has been exhibited on the part of some of the younger portions of the fraternity. With many of these, a few years' hospital practice (especially if a portion have been passed in a foreign country) seems to confer the right of discussing all matters ex cathedra: and, in elaborate original articles in the periodicals, or even substantive treatises, subjects are disposed of with readiness and precision, upon which the sages of our profession see cause yet to hesitate and doubt. Mr. Ormerod confines himself to a concise record of the most interesting facts which have come under his notice, adding here and there general observations legitimately derived from the extensive field of observation that has been laid open to him. His work is divided into twenty chapters, treating successively of the more important surgical diseases, the last six being devoted to a consideration of the relative merits of mercury and iodine in the treatment of syphilis. This essay obtained for its author the award of the Jacksonian Prize in 1842. The miscellaneous character and conciseness of the descriptions of the first portions of the work render any continuous analysis of these out of the question. We shall therefore content ourselves with reference to some few topics, noticing the chapters on the treatment of syphilis somewhat more at length. Fracture of the Thigh.-Some of the signs of fracture of the neck of the femur are frequently absent, although it is rare to find them all so. However doubtful they may be, all injuries of the hip occurring in old people must be narrowly watched, as several days may elapse before it can be positively declared that a fracture has not taken place. "The result alone can test the point, and nearly always the result is, that the limb is broken.” A woman, æt. 66, who had been knocked down on her right hip, was admitted. Shortening of about an inch, but without the slightest aversion; was observed. The absence of this was explained after death by the partial laceration of the capsule and the irregularity of the fracture, the lower fragment being wedged into and overlapped by the upper.* In treating fracture of the thigh, "The bed of Mr. Earle, and the bent position on the side, have been discontinued latterly in great part at St. Bartholomew's, for the long straight splint. The limbs unite better, the trouble is less, and the expense is much less; the high beds being very dear, and spoiling a blanket each time that they are covered. There is also another evil in hospitals; if fleas and bugs once get into a high bed, it is very hard to get rid of them. There are, however, some cases in which a high bed is good. If a patient has two broken thighs or legs, a high bed allows the chest to be raised, and thus he can move and is less liable to risk in vomiting. It is said, that a fracture in the upper third is not so liable to rise on the high bed, as the lower portion can be brought to meet it. This is very doubtful, indeed, in practice. Thighs broken in the middle, and not fully extended, generally unite with the lower end of the upper part on the outside, or in front of the upper end of the lower portion. This is very hard to prevent on the high bed, and a mere matter of chance on the side; but with a long splint, and a long inguinal band right up to the axilla, as high as can well be done, it is partially prevented."-P. 45. Fracture of the Leg.-A case is cited in which a man walked from Highgate to Smithfield (4 miles) in four hours, the tibia being broken across its middle, and the fibula somewhat lower down! When fracture of the fibula is difficult of detection, Mr. Ormerod recommends the following procedure :-- "Place the right hand with the ends of the fingers on the fibula midway between its two extremities, and press it towards the tibia. Even in the stout *For a few interesting observations on the diagnosis of this affection, by M. Velpeau, the reader is referred to the Foreign Periscope of our present number. |