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therefore a good opportunity of applying the means for its recover^ ■which have been already mentioned. Without losing a moment, the head of the child was placed in a slightly depending position Ce the front of the bed, inflation succeeding lateral compression of the chest under the axilla? was had recourse to, a quantity of fluid expelled by pressure and cleared out with the finger from the *irpassages and pharynx, intermittent pressure was applied to the sternum in the manner which has been described, the chest was repeatedly and briskly rubbed with spirits, and in a short time the incuV colour of the lips began to change to vermilion, and respiration commenced. It had, however, to be occasionally assisted by pressure of the chest, and inflation, for about a quarter of an hour. The child, when born, and to a considerable extent for the first quarter of an hour, was too feeble to cry, and its sensibility was too obtuse to mate me hope that any benefit would arise from "smacking" the nates or soles of the feet, or from using other indirect means to excite respiration which in less severe cases are usually so effectual. All tits measures adopted, it will be noticed, had direct reference to the establishment of the respiratory functions. In such a case, it should constantly be kept in mind that every moment lost before a pure circulation has been restored, rapidly diminishes our chances of ultimate success.

It will be observed also that, in the management of the first part of the labour in this case, I interfered only so far as to rupture the membranes; and perhaps it would have been better practice not to have done even this until the os uteri had been dilated to about double the size of a crown piece, which I reckon generally finishes the first half of the labour process. This is my usual practice, as I am, as a general rule, very averse to any active interference in the first half of labour; but not at first surmising the exact cause of detention, I thought the labour would be greatly advanced by bringing the head and os uteri more nearly into contact. Not succeeding in this, I immediately conjectured, from the woman's previous labours having been so very easy, that the advance of the head was prevented by the shortness of the cord, and I left matters to nature for the next forty hours, being pretty confident that no material injury would result to either mother or child until more vigorous pains had forced the head deeper into the pelvis. It will be recollected that there had been more or less of labour for two days previous to this time, but never of a very active character, so that the woman had been in labour, when I was called the second time, for nearly four days. As she was not at all exhausted, however, I felt I was safe, even at this stage, though the pains occasionally flagged, in waiting for nature, and in not using any forcing measures. I did not, therefore, as perhaps would have been considered proper by some practitioners, think it necessary to use the secale cornutum; indeed I now very rarely resort to the use of this medicine at all in obstetric cases, having employed it during the last two and a half years not more than twice,

and not for many years in the first half of labour.1 It was at halfpast four p.m. on the 9th that the real danger commenced, when the ear could be felt a little above and to the right of the symphysis pubis, and when the head was about to suffer compression from entering the bony pelvic circle, lessened in its dimensions by the swollen uterus. Every hour lost after this point of progress had been attained became perilous in the extreme. I waited nearly an hour without finding that almost any advance or revolution of the head took place. To have trusted longer to nature would, I consider, have been certainly to have sacrificed the child at least; while, at this stage, to have employed the comparatively inefficient ergot (or at least to have trusted to it to any extent), when the head had come within reach of the forceps, I hold to be unsafe practice. Even had this been an otherwise comparatively easy case, where the head had emerged from the uterus, I should not have felt myself justified in allowing the head to remain in the unfavourable position mentioned more than a couple of hours without interfering. Here, with the disadvantage of an intervening thickened uterus, interference became a matter of necessity, there being no probability of the revolution of the face from the left acetabulum into the hollow of the sacrum being accomplished in safety. At first, in using the forceps, I simply exerted traction; but, as the head advanced, I also turned it round, as I -usually do, so as also to secure its revolution—in precisely the same mode, indeed, as the head would naturally advance from this position by the vis a tergo of labour pains. I notice, from an article of news in the 22d No. of the British and Foreign Medico-Chirurgical Review, p. 565, that on this point a controversy has taken place between Professor Scanzoni and Dr Moser, the latter of whom speaks of it

1 It may be interesting to the profession to know that, in all the 467 cases referred to, I have used the ergot, I think, only five times', and solely in labours where the pains had first failed to bring the head within reach of the forceps ; and that in none of them was blood-letting, tartar emetic, etc., resorted to with the idea of removing rigidity of the uterus or other parts. I believe such practice, from the experience 1 have had, to be very rarely called for, it being about twenty years since I have bled any patient in labour. The rule I have acted upon has been simply to wait in the first half of labour (using in rare instances moderate doses of T. Opii. to allay excessive irritation, or to abate fruitless pains), and to prevent by the active measures which I have described, the second half from becoming protracted. This practice, therefore, contrasts on the one hand with the late Professor Hamilton's rule, that the first stage of labour should not be allowed to continue more than twelve or fourteen hours; and on the other with the inert, and, I must be allowed to think, dangerous practice which has latterly been followed bv many eminent accoucheurs, of leaving, with few exceptions, the whole of the labour process almost entirely to nature. It may be satisfactory also to state, that notwithstanding the forceps have been used so often, not the slightest local injury has happened to any of the mothers, and very rarely even the least excoriation to any of the children. I think it right to repeat that Dr Zeigler's form of forceps was used, as it appears to me that these possess several advantages over any others I have seen.

NEW SERIES. NO. V. MAT 1855. . 3 P

as "erroneous and dangerous in the highest degree." As far as my own experience goes, I have no hesitation in saying, very decidedly, that attention to it is of very great importance in the application of the forceps, and that, to the ease with which this manipulation enables many otherwise difficult labours to be accomplished, I owe much of my success in these instances.

On the present occasion, I found it necessary to withdraw the forceps before pushing the uterus over the head. In other similar cases, however, I have repeatedly succeeded in pushing up the uterus with the left hand while the forceps were held with the right.

The child, I may mention, continued feeble and uneasy for the first twelve hours, but afterwards did well; and the mother made an excellent recovery.

$art Stcoutr.


Obstetric Memoirs and Contributions of James Y. Simpson, M.D.etc., Vol. I. Edited by Drs Priestley and Storer. Edinburgh, 1855.

We have frequently, of late years, had the collected writings of various physicians brought under our critical pen; and whilst most of these volumes have justified the projects of their authors in the

gratifying reception they have met with from the profession, they ave, at the same time, tended greatly to enhance and diffuse their reputation.

In more widely popular walks of literature this practice of publishing collected essays has been approved and sanctioned by the illustrious names of Mackintosh, Macaulay, Jeffrey, Rogers, Foster, and many others. In these instances the public mind had already long and fully appreciated the character and value of the writings, and, in some sense, called for their publication in a separate form. The authors were already well-known and well-read ; their collected essays could do very little to increase their present reputation, however much they might contribute to consolidate and perpetuate

{losthumous fame. Scientific are not justly comparable to purely iterary works in these respects. While the latter may have an everlasting value arising from sources quite independent of truth or of facts, scientific labours, unless philosophically exact, are always at the mercy of the latest inquirer. They may be at once shivered and destroyed by the artillery of the critic, and their highest glory is to have stretched so far in advance of their times as to remain long in use before they are consigned to the shelf to fill their small space in the historical ranks.

The obstetric memoirs and contributions of the eminent author under review are gathered together by two of his pupils, under a feeling that justice to his high reputation as an obstetrician demanded a more tangible and permanent form for his works than the loose and mutually distant pages of the British journals of medicine. The editors also believe that they will be the means of supplying many of his former pupils with papers which the latter have vainly striven to obtain, inasmuch as they were published originally in journals which are now out of print. Before entering on a brief notice of Dr Simpson's labours, we shall take leave of his editors. That they have acquitted themselves in a manner deserving of all praise we are urgent to acknowledge. Their publishers have issued the work in the form of a handsome octavo volume, beautifully printed. The numerous and miscellaneous subjects are well-arranged and classified, and the only desideratum is an alphabetical index, which we hope to find in the next volume.

This, the first volume of the work, has 857 pages. Within these limits we have no less than 81 different chapters on the same number of topics. These are classified as follows:—43 topics under the head of the Special Pathology of the Unimpregnated Female; 5 on the Physiology and Pathology of Pregnancy; 33 on Natural and Morbid Parturition. This mere numerical analysis of the multifarious researches and observations of Dr Simpson will not afford a fair and full idea of the range of subjects which have occupied his pen. In the preface are mentioned many valuable papers in medical ethics, science, and practice, as well as in antiquities, which are properly omitted from an obstetrical work. Many of the papers or chapters in the present volume consist of a few lines of summary statement, and do not deserve these names; but this is amply made up for in numerous others, which are deeply engraven with marks of their author's energy, in the widest literary research, in acute and searching criticism of the opinions of others, in original and forcible suggestions, and intrepid practice.

The great majority of the subjects discussed in the book are now, or have recently been, the obstetrical topics of the day. They are presented here, just as thev were left by the author, without the very much to be desired addition of being advanced nearer to final decision. We regret that, from their very number, we cannot enter upon any of these subjects so inviting to the controversial appetites of our critical pen. They are open subjects for future obstetricians, who will find them here admirably exposed, and defended with the greatest zeal and ability.

The first part comprises topics on the Special Pathology of the Unimpregnated Female. In it we would mark for special perusal the elaborate Memoir on the Uterine Sound. The uses of this instrument are, of course, enumerated and enforced by the author of its name and general introduction into practice, with all the zeal ot an enthusiast. The chief value of the paper, in our eyes, consists of the great quantity and variety of pathological facts which Dr Simpson introduces in the course of his descriptions of the applications of this valuable instrument. The chapter on Morbid Involution of the Uterus is highly important, and is an able description of the deviations from the natural progress of the involution or diminution of the womb after delivery. Much more evidence, however, is required to prove the occurrence of morbidly excessive involution. The uterus atrophies in old age, and under some other circumstances. But the discovery of a small womb in a woman who had previously borne a child, subsequently laboured under amenorrhcea, and who died with grave and complicated chronic disease of the viscera, does not prove the existence of such a condition as super-involution of the womb after delivery. In the case described it was as likely to be the result of the amenorrhoea induced by the constitutional disease; and if the woman had recovered, might have been temporary, the organ enlarging again as restored health restored the catamenia. Besides, in this interesting case, it is also possible that the womb may have just returned to the same size and condition as before pregnancy. The girl menstruated at the early age of thirteen, and possibly, if not probably, with the small uterus of that age. This uterus menstruating at that early period thus gave indication of its ability to hold and mature a fetus in its probably small cavity at that time. What its size was before pregnancy no one knows, and consequently no one can decide exactly whether it became morbidly atrophied after delivery or not.

In this part we have also excellent chapters on polypus, on excision of cauliflower excrescence, on retroversion of the unimpregnated uterus, on pelvic fistula?, on the different ruptures of ovarian cysts, on the dysmenorrha:al membrane, and on the fecundity of females co-twin with males. In many of the chapters we desiderate the full and latest experience of the author, with results. We also find some terms grating on our ears as paradoxes, the results of misused words; for example, acne of the cervix, a part where such a disease cannot exist, there being there none of the peculiar structures which acne attacks; also, hemorrhoids of the cervix, where nothing like hemorrhoids in structure ever was seen.

Part second of the work consists of five brief chapters on the physiology and pathology of pregnancy.

The third part on natural and morbid parturition, occupies more than a half of the entire volume. A great deal of this space is filled with the author's well known and very able essays on the separation of the placenta before the birth of the child in placenta praevia, on turning as a substitute for craniotomy and the long forceps, on the sex of the child as a cause of difficulty during parturition, and a Report of the Edinburgh Royal Maternity Hospital during a singularly fortunate term of two years, when it was under the immediate

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