172

Ipse ego Ceenomanum memini quapinguia dives

PascuaSehinâ præterfluit Ollinsnnda,Vidisse insignem juvettem; quo cta-

rior alterNon fuit, Ansoniâ nec fortunatior omni:Vix pubescentis florebat vere juventæ,Divitiis proavisque potens ; et corpore

puleltro ;Cui stndia, aut pernicis equi compes-

cere cnrsum, ’

Aut galeam induere, et pictis splen-descere in armis,

Ant juvenile gravi corpus durare pa-læstrâ.

Venatuque feras agere, et prseverterecervos.

Illtim omnes Ollique Deae, Eridaniqnepuellæ

Optarnnt, nemorumque Deæ, rurisquepuellæ ;

Omnes optatos suspiravere hymenæos.Forsan et ultores Superos neglecta

vocavitNon Jleqnicqnam aliqua, et votis pia

numina moBit.Nam nunium ndentem animis, nec

tanta timentem,Invasit misenmi labes, quâ saevior

usquamNnlla fuit, ntilla unquam aliis specta-

bitlir annis.Panlatim ver id nitidum, flos ille ju-

ventae_ Disperiit, vis illa animi; tum sqnalida

tabes.Artus (horrendnm!) miseros obduxit,

et alte -

Uranclia turgebant fœdis abscesslbus

ossa.

Ulcera (proh Divûm pietatem !) infor-mia pnlchros

Pascebant ocnlos, et diae lncis amo-rpm,

Pascebantque acri cerrosas vulnerenares.

Que tandem infelix fato, post temporeparvo

Æthereas invisas auras, lucemque re-liquit.

Illnm Alpes vicinse, illum vaga fluminaflernnt ;

Illum omncs Ollique Deæ, Eridaniquepuellæ

Fleverunt, nemorumque Deæ,rurisquepuellæ;

Sebinusqne alto gemitnm lacus ediditamne. (Loicd applause.)

REVIEW.

Dr. DAVID D. DAVIS on OperativeMidwifery.

(Concluded from page 109.)

Of Exhaustion of the natural powersconcerned in the function of Parturi-tion, as an indication for the zsse ofInstruments.

OUR author contends that the term

exhaustion, as used in connexion withcases of tedious and laborious partu-rition, is most commonly misapplied,and argues, that as such a state ne-

cessarily implies the previous pos-session of power," so the " efforts of

labour are required to be exerted

with extraordinary vigour and for a

long time, in order to produce a stateof the agents of parturition even ap-proaching to what might deserve thename of exhaustion." But since Dr.

DAVIS is satii-ned that exhaustion snc-

ceeds only to protracted efforts of

labour, he would appear to assume,either that power is possessed equallyby all, or that it is expended more orless liberally by different parturientwomen ; both of which, besides beingcontrary to the nature of things, areamply confuted by experience, and

consequently the Doctor’s aphorism,that exhaustion must be ushered in

by a day and a night of vigorotis la-bour pains, is of no other valne thanas indicative of the result of his prac.tice. Suspension of -labour the au-

thor seems to think of little conse-

quence, upon the principle, we siip-pose, that although Phcebus may sink" beneath the western wave," it is

pretty certain he will again bid us

good-morrow. But undoubtedly ex-

173

haustion may be perfected in a shorterperiod than twenty-four hours, andwhat some may think only a suspen-sion of the efforts of nature, may oc-

casionally prove a complete prostra-tion of power. We entirely agreewith our author, that " the time oc-

cupied-by a labour is never to be con-sidered exclusively as a proper mea-sure of its influence in the productionof an exhausted state of the uartu-

rient powers ;" but we must beg leaveto differ with him when he states,that a considerable " prostration ofthe general constitutional strength"cannot exist " without being accom-panied by a dangerous contusion ofthe organs more immediately coii-

cerned in the labour." This section

of the work is concluded by a case

(in which both the parent and the

child died) intended to illustrate the

opinions of the writer on the subjectswe have touched upon, which, in our

opinion, it is not at all calculated

to do.

Of deficient action of the Organs ofParturition on account of Disease,as an indication for the use of Instz u-2)zents -

Indurations and schirrosities of the

uterus, from which a rupture may be

appreher.ded, may indicate’the use ofinstruments, as may also tumours andother diseases affecting its structure,or that of organs immediately con-

tiguous or subservient to it.’The presence in the uterus, dur-

ing gestation, of diseased and unor-ganized structures, such as molæ andhydatids, the gradual formation ofanomalous and morbid functions, andpossibly, in a certain proportion, ofcases of unsound states, even of the

texture of that important organ itself,has sometimes ’had the effect of somuch impairing and, as it were,- ofparalysing its parturient faculty, asto make it indispensably necessaryto have recourse to the use of instru-ments as an auxiliary, or a substitutefor its weak or suspended efforts."-p. 67.

Experience has not furnished theauthor with a case of this kind, nn-

accompanied by a state of over dis-tension of the uterus from an exces-

sive quantity of liquor amnii, which

by over distending may occasion suchan inert state of the uterus as to fur-

nish an indication for the me of in-

struments, which, however, shouldnever be employed until the contract-,ile powers of the uterus have provedtotally unavailing.

Of deficient action of the Uterus fromno obvious cause.

The author here speaks of the ergotof rye (secale cornutum), and borateof soda. The latter substance is eu-

tirely useless, and the former has notbeen proved to possess much efficacyin quickening the pains of parturition.Dr. DAVIS correctly remarks, that in

no " one instance has it supersededthe necessity of using the forceps."

Of the influences of’Diseases, or theresults of diseased states of differentOrgans, as cccuses of deficient action

of the Uterus.These are, 1st, Ascites, which mayhave an un favourable influence on the

function of parturition, both constitu-

tionally, by diminishing the generalpowers of the system, and locally’andmechanically, by impeding and other-wise impairing the actions of the ab-dominal muscles, and those of the

174

other organs where immediately con-cerned in the process of child-birth;2diy, Asthma, "which may- influencethe parturient function in two ways ; ;,viz. first, by being the canse of impe-diment to a free and perfect circula-tion of blood through the pulmonarysystem, and’ thence indirectly that ofa feeble state of all the actions-of life,

and, secondly, by subducting fromthe general assemblage of powers pro-perly interested, and usually. engaged in the process of a portion, at least, ofone of its mostimportant constituents,i. e. the ordinarily concurrent agencyof the diaphragm and intercostal mus-cles." In most of the cases of pro-tracted labour from this cause that

our author has seen " the earliest

stages of the process were those

which appeared to have been princi-pally affected by it ; whilst, in almostevery instance, the use of the forcepsbecame unnecessary as soon as the

orifice of the uterus became sufficient-

ly developed to admit of its safe ap-

plication.—pp. 82, 83.

’ 3dly, Emphysema;" Emphysema, from the rupture of

a part of the bronchial structure ofthe lungs during labour, is an iici-dent to be imputed exclusively to ex-treme severity of the labour pains.I have myself seen four such cases,and they all occurred in the midst ofa tremendous excitement of the heartand arteries. I had no hesitation in

recommending very copious bleeding,which in every instance afforded themost marked relief. Three of the

. patients were delivered without me-chanical assistance. In the fourth,the forceps was introduced to improvethe position of the fretal head; andthen withdrawn. All the childrenwere born alive. The mothers reco-vered perfectly satisfactorily, and theemphysema vanished without punctur-

ing the integuments," which is by nomeans remarkable.-pp. 83, 84.

Of difficult Parturition from rigidity,and otlaer unfavourable states of the

orifice of the Uterus.

Speaking of rigidity, our author’says,"The treatment of protracted la-bour from this cause must have for-its object the removal, or a consider-able subduction of the cause itself,That indication is’to be obtained inpart by mechanical means; but prin-ei p ally and generally more- satisfac-

I torily and beneficially by.. constitu-tional .measures.

The mechanical means are common’

ly understood, and the principal con-stitutional measure is the abstraction

of blood, which, in some instances,has been carried to a great extent.In one case, for example, Dr. DEwEEs,of Philadelphia, took from a lusty pa-tient upwards of two quarts of bloodwith perfect success, and three yearsafterwards delivered the same woman

by precisely similar treatment.* Inanother case he employed tobaccoeiiem-.tta, but without success.The principles to be attended to

in the application of the forceps andother instruments, on account of ex-

traordinary rigidity, small capacity,or other unfavourable states of theorifice of the uterus, are comprised inthe following rules :—

" 1. Simple rigidity, without dis-

ease, will generally yield to judiciousconstitutional treatment, and the can-tious use of the finder; -and therefore,.in such cases, the application of theforceps will very rarely be required.

Midwifery, p. 379. Dr. DAVISjustly condemns prospective bleedingin anticipation of a mere possibitity,which might or might not be realizedby the event.

175

.2d. The operation of vaginal hyste-rotomy should never be had recourseto, until after the failure of every fairattempt to remove impediments to thedilatation of the orifice of the uterus

by the finger, or rounded end of acatheter or sound.

’

3d. It should always have for its

locality, as the centre of the incisionsto be made from it, the proper situa-tion of the os uteri, indicated usuallyby a cicatrix, nipple-like projection, asort of sulcns between the- agglutinat-ed labia of the uart. or some other

specific peculiarity in the feel of itsstructure. To guard against all pos-sible rashness’, I would suggest, thatso important an operation shouldnever be undertaken without the sanc-tion of a well-appointed consultation.

4th. As an operation of so muchconsequence should never be under-taken too soon, nor until the evidenceof its necessity shall have been ren-dered perfectly satisfactory ; so, onthe other hnnd, it should not be de-layed too long, so as to expose thestructures concerned to the dangers offatal contusion and laceration. -

5th. After forming and freely-eom-municating to the friends of the pa-tient a suitable prognosis, the -opera-tion of vaginal hysterotomy should beperformed, even in the most desperatecircumstances, rather than suffer bothmother and child to perish, withoutany effort to save them.*

6th. Should the section of the orificeand neck of the uterus be unfortu-nately succeeded by a profuse haemor-rhage, or, in the event of its being solong delayed, that it might be highlyimprobable that the uterus would becompetent to resume its office, . orfinally to effect its own delivery, thenit should become a matter of delibe-ration with the practitioner, whetherhe should further assist, by having re-conrse to the use of the forceps, or tothe manual operation of delivering bythe feet. As a general principle, itcannot be denied, that the hand, being

* Dr. DAVIS here cites a case inillustration of this principle, fromHEATH’s translation of Baudelocque’sMidwifery, vol. ii. p. 107, and re-

fers to another in Leroux’s Journal,vol. xxxvi. p. 151.

of softer texture, and itself endowedwith fee’ing; would be the more gen-tle instrument. On the contrary, ifwe suppose the fmtal head consider-ably advanced, or deeply engaged illthe cavity of the pelvis, and a suffi-cient extent of communication to havebeen made between the uterus andthe vagina, it is evident that the ap-plication of the forceps might provea much preferable measure. To se-

cure, however, all the mechanical ad-vantages attainable in such deplorablecases with the least possible adili-tional injury to parts already wound-ed and perhaps diseased, our artshould be furnished with a much-

greater variety of instruments of the

forceps class than it has hithertopossessed."—pp. 96, 97, 98It is impossible, by any analysis

that our limits will allow, to give -an -

adequate idea of the compartments ofthe work which succeed to the prinei-ples above cited, more particularlyof those which are devoted to the con-

sideration of " syncope during la-

bour," the" importance of a justprognosis," convulsions, and hæmor-rhage ; nor is it possible, without

the assistance of plates, to explainwith sufficient accuracy to be useful

the various modifications of instrtt-

ments, and their application, that arehere proposed and described, be-

cause the author, relying upon theexcellence of his plates, has not beenso particular or copious as he mighthave been with his descriptive letter-press ; but this is hardly a fault, fotcertainly the former metliod of illus-tration possesses many ad vantages, andwithout it, probably the subject conldscarcely have been rendered at all in-

telligible, or at least to the extent it isat present. There is one instrument

notwithstanding (the forceps) which.our author tells us, upon the authority

176

of the late Mr. LOWRY, cannot evenbe described by a drawing, and ofthis he strongly recommends instru-ment-makers to procure a model from

the original maker;* again, speakingof other instruments, he says " It isextremely difficult to give. a drawingor description which would enable aworkman to make them without a

model." The plates, however, havethe merit of showing their correct

application, under the various posi-tions and circumstances which indi-

cate their nse, but this also, as our readers must be aware, is equally in-explicable, without such graphic illus-trations as a reference to the volume

’can alone supply.There is one instrument (the ost eo-

tomist, or bone-pliers) which the au-thor recommends in cases of extreme

distortion of the pelvis, as capable,not only of enabling " skilful ope-rators to effect deliveries in cases of

moderate distortions with mnch more

facility to themselves," but also" of

reducing, almost to zero, the necessityof having recourse to that last extre-mity of our art, and the forlorn hopeof the unhappy patient, the Cæsarean

operation." The instrument appearsto be of considerable power, and is

thus described :-" The whole is made of solid and

well-tempered steel ; its cutting endsare worked into two long and fenes-trated oval rims, of tineqlial size, hutof nearly equal strength ; the smallei-is of a size to enter into and to fitclosely within the parietes of the

larger; the mutually adapted parts ofeach being formed into a continuousoval edge, they become competent,

* Mr.Botschan, of Worship-street,Finsbury-square.

when brought together and firmly ap-plied to their object, to exert a pro.digious power upon a portion of boneplaced within their grlsp;’the ban-dles are of great length in proportionto the parts anterior to the joint, andbeing of sufficient strength to be per-fectly inelastic and inflexible, theirpower must be deemed equal to thefull length of- their leverage, multi.plied by the muscular force employedin using them."—pp. 305, 30G." One or two sections taken out

by the osteotomist from the basis ofthe skull, which is by far the mostbulky part of the foetat cranium, willgenerally have the effect of putting auend to all difficulty. In cases ’ofgreater conttuement, a tew adutttonatsections will, perhaps, require to bemade, in order to give a sufficientdegree of facility to the after part ofthe operation. The extreme breadthof the broadest oval rim of’ the osteo-tomist is precisely three-quarters ofan inch ; I may, therefore, take it forgranted, that wherever there may besufficient space to admit of the intro-duction of this instrument, togetherwith the point of an index finger tofeed it with successive purchases ofbone, it will be practicable to effect,and therefore prudent to attempt, thedelivery by the natural passages.-There are few pelves, even in largecollectioits of distorted ones, with su-perior apertures so smail as not tofurnish from between an inch and allinch and a half of space in the diree-tion of their congregate diameters ; or,at lea<t, of antero-posterior diametersacross some part of their brim. Inany such cases I should think it myduty to avail myself of the use of theosteotomist, and to undertake the de-livery by the natural passages."-p. 307.

This instrument, and tlie mode of

using it, are accurately described bya plate. Dr. DAVIS, it seems, hascertain models of several deformed

pelves,, made of very hard oak, which

by the aid of straps and buckles,and an os coccygis of very strong

leatlter appended to the parts of theapparatus, representing the sacrum,

177

" as also sacro-ischiatic ligaments ofthe same materials, and certainly notless yielding than their natural proto-types, which are fixed, at their properpoints of attachment respectively, tothe sacral and ischial bones, by strongbrass plates," &c. All these thingsbeing arranged, " little subjects," ge-nerally the produce of still-births, orof deaths supervening shortly after-wards, are firmly strapped down inthe position determined upon at thebrim of distorted pelves, and a prin-cipal operator, and two assistant pn-

pils, are appointed to undertake the

delivery. Among these " represen-tative" pelves, is that of Elizabeth

Thompson, described by Dr. HULL,in which " the largest circle that canbe formed in any part of the superioraperture does not exceed, in diame-

ter, one inch," through which, it would

seem, Dr. DAVIS has osteotomised and

extracted the remains of several dead

children. No doubt such apparatusas these are extremely ingenious, andbetter calculated than precepts to

initiate the pupil into the mysteriesof the art; but it must be borne in

mind, that here are no soft parts to

interfere with or to be injured by thefree motions of the operator ; besides

which, there are other hindrances

and circumstances to be considered,which may render a very confident

and successful practitioner on " re-’

presentatives" a very silly and ineffi-cient one in the puerperal chamber,where, at last, he who wishes to learnthis art will be compelled to resort.Such contrivances, however, are notwithout their value, nor are they, webelieve, altogether without precedent.

In what respect the pupils fromthis " wonder-working academy’* sur-

pass those educated at other schools

we have not been able ts) discover,but it certainly does appear to us,

that the almost indignant tone of su-

periority which the teacher and au-thor has assumed (however much hiszeal for the advancement of opera-tive midwifery may be pleaded in

mitigation) would have been " morehonoured in the breach than in the

observance." Such a line of conduct

but ill accords with our notions of

excellence, of with our views of pro-priety. We do not take Dr. DAVIS

to be an invidious sinner, nor do

we think that he has trespassed to

the extent that others have, or at

least to the extent that a modern

surgeon and vain and self-opinionedcritic has, whose conduct has been somuch and so justly reprobated in thismetropolis, and whose fate, we trust,will be a beacon to future lecturers

and authors not to allow the insigni-ficant approbation of a few foolishfriends to indnce them to risk their

frail barks of reputation on the oceansof controversy, or to propel themupon those fatal quicksands wliicli self-

esteem, self-complacency, and nar-row-minded views and prospects of

self.interest, are sure to meet with.

It may be pleasant to do so and so,to endeavour to obscure a rival’s fame,or to monopolize, if it were possible,all the knowledge of the d;iy ; but ofthis we are sure, that the man who

has the most science will ever be the

most humble, and that he who pos-

sesses the least will of consequencemanifest the greatest arrogance and

178

the most profound conceit. All such

employments should be avoided, as

Horace hinted long ago:&mdash;. Interfiisa nitentes

Vites &aelig;quora Cycladas.

Withal, in spite of what we havebeen obliged to say, the present work

is, in our opinion, the most completethat has yet appeared on the subjectof operative midwifery, and will beplaced on the shelf with JOHN BELL’S" Principles" and COOPER " On Dis-

locations," with a certainty of beingremembered and consulted as long aseither.

LIVING SKELETON.

THERE is a sort of rabid curiositywhich affiicts the inhabitants of this

metropolis, and which, like canine

madness, seems to increase with the

influence of the dog-star. It is, ac-

cordingly, at this season of the yearthat speculators generally attempt toturn this disease .to account by the

introduction of some extraordinary novelty. Not a summer passes with-out its mermaid, its fire-eater, or itsBonassus; and the public are now

invited, at the moderate charge of

half a crown a dupe, to the spectacleof an emaciated Frenchman, under

the attractive title of a " Living Ske-leton." This exhibition is one of the

most impudent and disgusting at-

tempts to make a profit of the publicappetite for novelty, by an indecent

exposure of human suffering and de-’gradation, which we have ever wit-nessed. We are not, however, about

to gratify the person who has draggedthe victim of his cupidity from his na-tive country, for the purposes of a pub-lic exhibition, by expressing any ex-traordinary indignation at his conduct.He is, no doubt, perfectly aware ofthe advant ages of the " puff collu-sive," and would be well content

it should go forth to -the public, thatthe " Living Skeleton," as he stylesthis unfortunate foreigner, is a sightwhich nobody ought to see) and which,nevertheless, every body was profli-gate enough to be -running to see.We shall better defeat his mercenary

object by stating, that a month’s at-tendance in our Hospitals is sufficientto render such spectacles as this "Liv-

ing Skeleton" but too familiar to the

eyes of the student, and that we havefrequently seen cases of emaciation,from phthisis and disease of the mesen-teric glands, quite as affiicting as thatfor the exhibition of which an attemptis now made to extract money from the

pockets of the public. As to the state-ment, that this wret&eacute;hed individual

enjoys a state of perfect health, it is,upon the face of it, ridiculous; and-the

slightest examination of the patientestablishes its falsehood. It is a case

of disease and suffering to which thepublic are invited&mdash;disease, for whichthere is np remedy, and suffering,which admits of no termination, ex-

cept that which is likely to be accele-

rated by the ’daily exposure of the, patient’s-person in a state of nudity,to be gazed at and handled by idleand senseless spectators. We were

sorry to find that the -person who has

brought over this unfortunate fo-

reigner, under the hyp-ccritical pre-