695

benefit resulting from these measures, in order to ascertainaccurately the condition of the parts, he placed her under theinfluence of chloroform, and had then no difficulty in intro-ducing an ordinary-sized speculum. The mucous membraneof the vagina was much reddened, dry, and rough, with smallpapillae prominent on its surface. The os uteri presented on itsposterior lip an ulcer, the size of a fourpenny-piece, and both lipswere thickened as if by chronic inflammation. There was a thickphlegm-like discharge from the os, which was apparently re-tained in the highest part of the vagina by the spasmodic con-dition of the canal. So offensive had this discharge becomeby retention that it resembled that found in carcinomatousdisease of the uterus. Dr. Murray, having thoroughly cleansedthe parts, applied the solid nitrate of silver freely over thewhole surface of the os and cervix uteri. He then introduceda fold of lint, saturated with a strong solution of nitrate ofsilver, into the speculum ; and, when this was withdrawn, thelint was left in contact with the walls of the vagina. Thiswas allowed to remain for about ten minutes before removal.This treatment was repeated on two subsequent occasions atintervals of a fortnight, when the patient was again under theinfluence of chloroform. After this, at her next visit, she wasso much improved that no chloroform was required, and anapplication of diluted tincture of iodine was made to the osand cervix without occasioning her much distress. The dis-

charge completely ceased, the ulcer healed, and the patient isnow (about three months since the treatment was commenced)freed from the irritation which caused her so much misery.

In this case it is fair to connect the vaginismus with thediseased condition of the os uteri.

Medical Societies.OBSTETRICAL SOCIETY OF LONDON.

AT the meeting of this Society held on the 7th ult., Dr.Barnes in the chair, Professor Mattie, of Paris ; Dr. Belcher,Bristol; Dr. H. J. Bransom, Scarborough; Dr. W. H. Strange,Belsize-park ; and Mr. A. 1:. Steele, Liverpool, were electedfellows of the Society.

Dr. MURRAY showed a new Trocar and Canula for tappingand withdrawing the Cyst in Ovariotomy. The instrumentwas made for him by Messrs. Mayer and Meltzer, of GreatPortland-street. It consisted of an ordinary-shaped trocarand canula, the canula having fastened to it at its upper thirdtwo self-acting brackets, or pieces of steel, bent up at a rightangle, by means of which the cyst wall is secured at themoment of tapping. The trocar passes through a slit in thetubing which is attached to the canula, and on withdrawingthe trocar this slit immediately closes. Dr. Murray has severaltimes used this instrument, and he considers it light, simplein construction, and certain in its action.

Dr. GRAILY HEwTT exhibited a specimen of AcephalousMonstrosity, with absence of Abdominal Covering.

Dr. WYNN WILLIAMS read a "Case of Haemorrhage due toretained Placenta, supposed to be the Placenta of a PreviousAbortion. "

Dr. EASTLAKE gave the particulars of a " Case in which theRight Arm of the Child was extruded through the Anal Orificeduring Labour." The patient had, previous to her presentpregnancy, undergone an operation for laceration of the

perineum, and the conclusion drawn by the author was,-thatprimarily the presentation was that of a "hand and head,"and that as labour progressed the arm descended with thehead, and was at length forced through a weak portion of theposterior vaginal wall, and in this manner escaped through theanus. The labour terminated naturally, and a living malewas born.

CONTRIBUTION TO THE PATHOLOGY OF PUERPERAL

ECLAMPSIA.

BY DR. J. BRAXTON HICKS, F.R.S.,CO-LECTUBER ON MIDWIFERY ETC. AND ASSISTANT PHYSICIAN-

ACCOUCHEUR AT GUY’S HOSPITAL,EXAMINER IY MIDWIFERY A.T THE UNIVERSITY OF LONDON.

The author first of all traced our knowledge up to the pre-sent day, from the period when Dr. Lever showed the factthat albumen in the urine was a very constant accompanimentof puerperal convulsions. He then showed that it was at first,

and still is by many, considered that the convulsions de-pended on uraemia ; and that after the advance of Frerichs’i theory it was supposed that the decomposition of urea intocarbonate of ammonia was the cause of these convulsions. Butthe author went on to show that, from experiment of late, itmight be considered doubtful whether this explanation wouldhold. Another important fact had been shown by various

experiments—nanmely, that even after the injection of urea! into the veins ura’rme symptoms did not arise immediately, a1least for twenty-fuur hours. If, then. it could be shown thatbefore the first convulsion there was no abnormal condition olthe urine, it was argued that the convulsions could not be the result of urfemia, as generally supposed-at least as the result o:the kidney disease. But if it were shown that, although n(albumen existed in the urine before the convulsion, nor indeecany evidence whatever of ill-health up to the very moment o’attack, yet that shortly after the first fit not only alburneiwas to be found, but also all the evidences of acute desqua mative nephritis were present within twelve hours, then theauthor considered that we must admit either (1st) that these

I convulsions produced the nephritis, or (2nd) that some abnormal ingredient in the blood produced simultaneously irritation of the cerebro-spinal system and of the kidney, or (3rd:that the highly congested venous system produced by thEspasm of the glottis was able to cause the nephritis.The four cases brought forward by the author showed the

development of the acute kidney-disease after the first convulsion, being about half of those where he had an opportunity of examining the state of the urine early; and as thidifficulty of obtaining the urine sufficiently early was great, hithought it was better to bring forward these cases in order tobtain the co-operation of the Society to ascertain the frequency of these cases, and to elucidate other facts mentionecin the paper which required further clearing up. He mori

particularly alluded to the opinion that the urine of pregnanwomen was very frequently albuminous. The author adde(50 to the 50 of Dr. Lever, and in only one of these 100 waialbumen found. He also doubted the evidence of the pressuretheory. One subject in particular required further research-namely, whether the urine of ordinary male epileptics becomealbuminous after a fit. From those cases he bad examined hhad not found it so ; but those who had charge of these case:might readily clear up this point. The author thought it verprobable that those cases where the urine had been foun(highly charged with albumen when examined after the fit:had set in for some time, would have belonged to the class hhad brought forward had the urine been examined before ; aany rate, if there had been prior disease of the kidney it iclear that they become acutely affected, and it had yet to beshown why at this particular juncture the acute attack ha<arisen. Dr. Hicks thought before we could attempt any theoryon this subject we must collect more facts; and for this reasonhe ventured upon no theory himself, but solicited the aid othe Society to increase our knowledge on these subjects. Th,cases were then read.Remarks were made by the following gentlemen :-Dr

Graily Hewitt, Mr. Benson Baker, and Dr. Barnes. DrHicks replied, and the meeting adjourned.

Reviews and Notices of Books.Orthop&oelig;dic: A Systematic Treatise upon the Prevention a?2(l

Correctinn of Deformities. By DAVID PRi-,icE, M. D.Philadelphia : Lindsay and Blakiston. London : Trubner.

i pp. 240. 1866.

; THIS treatise, whilst aiming at great completeness, offersbut little novelty to those acquainted with the numerousworks on orthop&aelig;dics in this and other countries. Beginningwith arrest of development, the author takes the opportunityto introduce the artificial palate of his countryman, Dr. Nor-

man Kingsley, and then glances verv brietly at the variouscongenital malformations met with in surgical practice. withouthowever suggesting any new methods for their treatment.’ An outline of the effects of muscular contraction is then given,and large extracts are made from the works of Todd, Brown-

S&eacute;quard, and Barwell. Strabismus naturally comes in here,! but is dismissed in four pages, which include lnnd extracts on! the curative employment of the stereoscope and of plane

696

prisms. Itinammation and the effects of injuries are thenbriefly considered, and conclude the first part.The second part is the longer, and treats of Spinal Deformi-

ties. Long extracts are given from various authorities, andparticularly from Mr. Adams’recent lectures on Spinal Curva-ture, though the author apparently confuses that gentlemanwith Sir William Fergusson, and speaks several times of SirW. A(lams! Numerous woodcuts of the hideous and cruel

apparatus which have been produced from the earliest timesto the present are given, and the author believes that "theclaim of Sir Jl’ Adams, that a twist of the spine is essentialto lateral curvature, is completely disproved by a specimen ofthe deformity in his possession.’’The chapter on Talipes is the most important in the book,

and the author seems to follow Mr. Barwell’s lead in the

pathology and treatment of the affection, though he deniesthat gentleman’s originality in the treatment by elastic bands.This has been a common practice among American surgeonsfor many years, though Barwell, strangely enough, claims it

as his peculiar invention."-p. 184. According to the authorthe following out of each paralysed muscle by a distinct india-rubber cord is unnecessary, and has great disadvantages whichare sufficiently familiar to those who have attempted to adhereto the practice inculcated in Mr. Barwell’s book. He says(p. 195) :-"The pull directly in the line of these tendons, besides being ’,

a refinement of treatment, difficult and sometimes impossibleto execute, is one which acts at a great mechanical disadvan-tage, implying a greater Tzressure upon the skin, to accomplish Ia given amount of change of position, than would be requiredby a direct pull." ,

And, again, a little further on he remarks :-" There is this great disadvantage in this attempt to imitate

the oblique action of the muscles : that the pressure upon theskin is three or four times what it is necessary to make itwhen the most direct pull is obtained."The italics are our own, for these sentences exactly give the I,

difficulty found in following Barwell’s plan-viz., to preventexcoriation and ulceration of the skin. Dr. Prince describesand figures a modification of his own, by which the foot isunfolded transversely, whilst the india-rubber bands, carriednp the leg and thigh, get a firm hold without causing ulcera-tion of the skin. The unfolding is produced by a piece ofgutta percha moulded around the foot, upon which a pair ofcallipers is made to exercise the necessary pressure.The concluding section of the work treats of deformities

after fractures, and the author relates two interesting cases ofnnunited fracture successfully treated by drilling, and theapplication of Malgaigne’s spike to compress the extremitiesof the bones and hold them in position.

Diabetes: its various Forms and different Treatments. ByGEORGE HARLEY, M.D., F.R.S., Professor in UniversityCollege, &u. London : Walton and Maberly. 1866.

THE subject of diabetes has been studied originally by Dr.Harley, both in its physiological and pathological aspects.He holds, with Bernard, that sugar is formed during life inthe liver. He differs from Bernard in thinking that the sugarformed in the liver is not destroyed in the lungs, but in thecapillaries of the general circulation and in the way of a properphysiological assimilation.

Dr. Harley’s pathological views of diabetes arise easily outof his physiological views of the production and use of sugar.He cousiders it essential to distinguish two forms of diabetes :the one dependent merely on an excessive formation of sugar,the other on a defective assimilation of it. In the latter formof the disease Dr. H.irley disapproves of the ordinary dietetictreatment, and allows bread and other generally forbiddenarticles. In diabetes from excessive formation he withholdsstarchy forms of food. Dr. Harley goes into detail as to the

diagnosis of these different forms of the disease. We are not

quite convinced that the distinction he draws is a sound one,and that the different states he describes are not different

stages only of the same pathological condition. A largerclinical experience is requisite to settle this point. Howeverthis may be, Dr. Harley’s book is a concise, practical, and,withal, authoritative statement of the subject of diabetes.

Religio Anim&oelig;, and other Poems. By ALFRED RICHARDS,Author of "Crcesus, King of Lydia." London : Moxonand Co. 1866.

COLONEL RICHARDS’ volume has a claim upon our notice,not more for its literary merits than for the ability and vigourwith which he treats of some of those evils afflicting humanityin reprehension of which THE LANCET has taken a prominentpart. If, therefore, we deviate from our ordinary course innoticing the volume before us, it is in acknowledgment of thevaluable labours of a con,f"rere in the salutary task of improvingthe condition of the poor and helpless in the metropolitanworkhouses. The name of Colonel Richards is honourablyidentified with several able productions, but in none of these,able as they are, has he treated the subjects which he haschosen for elaboration by his muse with a nobler motive thanthat which influenced him in " R,-.1 igio Anim&aelig;." If the suf-

fering poor have had many advocates in favour of a. betterstate of things, in simple prose, the credit of bringing poetryto their support at the present time is due certainly to Mr.Richards. Byron said of Crabbe, that if he was Nature’s" sternest painter," he was "still the best." Mr. Richards isno unworthy disciple of such a man. The difficulty of the taskwhich he proposed to himself could scarcely be over-estimated.No one can rise from the perusal of this admirable volumewithout being impressed with the conviction that the sternesttruths may be embodied in the most highly finished poeticlines. We commend Mr. Richards’ volume not only to themembers of our profession, but to all who can sympathisewith the claims of a helpless, and often, in many respects, ameritorious class of poor. Dryden composed some of hisnoblest essays in defence of the religion which he reverenced.Cowper exercised his talents and his great abilities in supportof the rights of Englishmen, rich and poor. Crabbe was atonce the minister of religion and the poet of the poor. Bloom-

field, with the same sympathies, made himself immortal inthe same cause. Colonel Richards has a just claim to be placedin the illustrious category of those who have made poetry sub-servient to the highest dictates of humanity.

ON OVARIAN DROPSY AND ITS PROBABLEHEREDITARY TENDENCY.

To the Editor of THE LANCET.

SIR,&mdash;During the last two months we have had two sistersas patients, both suffering from ovarian dropsy. They statethat their mother’s sister had the same disease. This is, per-haps, something more than a coincidence, and seems to pointto a hereditary tendency.

My friend, Dr. Matthews Duncan, of Edinburgh, in replyto a letter from me, states : " While I have no doubt thatovarian dropsy is to some extent hereditary, in common withother diseases, I have no evidence of auy value to send you inproof of the point. Absolute proof can easily be imagined,but it would be so difficult of attainment that I do not meanto attempt it. Cases ltke those under your care will be, formost students, sufficient, though not absolute proof. You shouldplace them on record. My friend Dr. Thomas Keith, theeminently successful ovariotomist, tells me he has had a casein which he had reason to believe that the mother was similarlyaffected. "

I think the question is of some interest, and worthy of theattention of the profession.

I am, Sir, your obedient servant,Kidde:minster Infirmary, Dec. 15th, 1866. JOHN ROSE, M.D.JOHN ROSE, M.D.