Observations on the Operation for Artificial Pupil, illustrated by Cases and Engravings. By E. RYAN, M.D. Senior Surgeon to the Kilkenny County Hospital, &c.

The remarks contained in this paper are deduced from extensive experience and apparent accuracy of observation, and appear to be judicious and well-founded; but, as the subject is not generally interesting, we shall not enter into a particular consideration of them.

On closing this volume, we observe, that, being principally composed of histories of facts, but little interspersed with argu ments, the remarks of the critic must be nearly confined to such as relate to the estimation of the value of those facts: the transcriptions we have given from it will show that we recognise in it much very valuable matter; but the proportion of con mon-place observations which it also contains, shows that a more severe selection on the part of the editors will be necessary to preserve to the work the high character it has justly acquired.

Cases of Hydrophobia. By GEORGE PINCKARD, M.D. Deputy Inspector-General of Hospitals to his Majesty's Forces; Physician to the Bloomsbury Dispensary, the London Female Penitentiary, &c. &c. 8vo. pp. 38. Callow, 1819.

We shall introduce this work to our readers by the words of the author in the preface: he says,

"Amidst the conflicting opinions of the medical world, respecting the nature and treatment of a disease so ill-understood, so uniformly fatal, and (comparatively) so seldom witnessed, as hydrophobia, it were to be wished that physicians felt it a duty to record every case which presented itself to their observation.

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Under this impression I noted minutely the occurrences in a case which was lately brought under my care at Battle-bridge, intending to give them to the public through the medium of some periodical work. But it has been suggested to me, that, as three other cases* of this untractable disease have fallen under my observation at different periods, it might be more satisfactory to collect them together, and publish them all under the same cover.

"Adopting this suggestion, I shall content myself with plainly narrating the history of the several cases, leaving the reader to draw such conclusions as the circumstances may seem to warrant.

"At present I am inclined to believe, that all the curative means which have been tried are equally inefficacious; still, by publishing the cases which occur, facts may be developed which may lead to a better knowledge of the disorder; and it is reasonable to hope, that,

* These were published at different times in the London Medical Journal..

whatever contributes towards establishing the true character of the disease, brings us nearer to the discovery of a remedy.

"One fact of high importance may be remarked in the case of Mr. Hubbard that the disease supervened, notwithstanding the free application of caustic to the wound, within less than twenty-four hours after it was inflicted; whence it appears that each moment of delay is fraught with extreme hazard; and that in every instance the sovereign preventive, a complete excision of the part, or the most perfect de struction by caustict or the actual cautery, should be effected as speedily as possible."

These sentiments will be echoed by every true physician; and the zeal of the author to promote the elucidation of the malady to which they relate, must be generally applauded. We have not, it is true, hitherto acquired any precise etiological knowledge of it, but we must not therefore suffer our hopes to be depressed: that of tetanus was, until a few years since, as little known; but, by pursuing the course of which Dr. Pinckard has here given so good an example, that of tracing, accurately, a description of the morbid phenomena during life, and the physical appearances after death, in all cases, whether or not any thing novel or peculiar might be obvious in them, the nature of the latter disease has at length been ascertained.

We regret to find that some cases of hydrophobia have recently occurred, of which histories have not been published by the medical attendants; and still more so, that examination of the dead bodies has yet oftener not been made. Permission to effect this should be urged in every instance, and we would on this point offer one suggestion, that the centres of the ganglionic system of nerves, especially the coeliac plexus, be accurately examined. Reasoning by induction from the symptoms, we are led to suspect that a morbid state of this part of the nervous system is a chief, if not an essential, cause in the production of the phenomena witnessed in this disease; and no notice is taken of the state of it in any of the cases on record.

The histories of Dr. Pinckard must be considered of much value, being related with perspicuity, and deduced from comprehensive views. If we ever discover the primary morbid lesion, the advantage of possessing such histories as these will then be more clearly apparent: we shall probably find every remark in them illustrative of the nature and progressive development of the train of phenomena evinced in this malady.

To insure an effectual application of the caustic to every part of the wound, might it not be advisable to use it in a liquid form, such as the muriatic, nitric, or sulphuric, acid?

CRITICAL ANALYSIS

OF

RECENT PUBLICATIONS, IN THE DIFFERENT BRANCHES OF MEDICINE AND SURGERY;

SELECT MEMOIRS, AND HISTORIES OF CASES;

In the Literature of Foreign Nations.

Παρίδες ἄρα

Ανδράσιν, ὦ παραῖς ἄνδρες, ἀγαλλόμεθα.

An Essay on the Means of lessening Pain, and facilitating certain Cases of difficult Parturition. By W. P. DEWEES, M.D. Lecturer on Midwifery in Philadelphia, &c. 8vo. pp. 156. Dobson and Son, Philadelphia, 1819; with the epigraph,

ut si

Cœcus iter monstrare velit.-HOR,

THE HE title of this work is the most interesting one that can be given to a medical essay. What can more certainly and forcibly engage the attention of every physician, than a dissertation on the means of lessening the pain and danger of child-birth? The fatality of this state, although not so extensive at present as it was a century or two since, when it was chiefly superintended by female practitioners, is still dreadful. Every attempt, therefore, to lessen its danger, either by a relation of the results of fortunate experience, or by speculative reasoning, must be respectively received with the warmest gratification, and examined with the most assiduous care; though it must be acknowledged that the practice of medicine has not often been directly benefitted by prolusions of the latter kind. The essay of Dr. Dewees comprises matter possessing both of the above characters."

Before we enter into the consideration of the author's view of the proximate causes of the pain and danger of child-birth peculiar to women of civilized life, let us, since speculations on it are now to be indulged, adduce a sketch of that which we have ourselves taken of this subject; not from slight and casual consideration, but from repeated and serious attention.

On contemplating the natural history of man, through his various degrees of intellectual cultivation, from the Papous to the most civilized nations of the temperate climates of Europe, we see a progressive increase in the pain and suffering of the female in the act of parturition. Amongst the former, the mother, after the expulsion of her infant without a sigh or a groan, rises to go and bathe it in a neighbouring stream, and immediately assumes her ordinary and active habits of life in the latter, parturition is an act of long and dangerous suffering, and is fatal to the life of at least one in fifty of those who undergo its pains.

This difference is not chiefly dependant on diversity of anatomical structure; for we find that civilized tribes of a certain race of people

suffer the dangers to which we have just alluded; whilst other tribes of the same race, remaining in the state of barbarism, encounter the act of parturition without either grief or fear, although no remarkable difference of formation is evident. This is witnessed in the Tartars and in the Chinese.. In the ruder tribes of the former, the female joins the progress of her horde immediately after delivery; whilst the suf ferings of the latter on the same occasion are hardly inferior to those of the most delicate European. The Chinese husband may now take to his bed on the birth of his child, but he does not find his wife able to attend on him with the pampering luxuries he then, from custom, may require. It is common at present, in some of the more retired parts of Ireland, for the women who dwell in huts formed only of stone-walls, a thatched-roof, and a door; in which the only furniture is an iron pot, a few knives, and some wooden bowls; containing neither chair, table, bed, nor altar of the Penates ;—and who, passing their lives with so little about them to excite variety of ideas, are in such a state of non-intellectuality, that they seem to be guided by what in brutes is termed pure instinct;-it is common for those females to appear without their cabins within a few hours after their delivery, which they have quietly undergone, without fear and without trouble. But, is it thus with those of their country women who inspired their own Anacreon with those ideas of sentimental refinement that are the acmé of human feeling?

It is not, then, to anatomical formation, but to physiology, that we must look for the explanation of this phenomenon.

An ancient philosopher, whose profound wisdom is often rendered obscure by the metaphorical manner in which he expressed his scntiments, seems to have attributed the sorrow of child-birth to the changes effected in women by unrestrained indulgence of the passions, and intellectual cultivation. To this explanation we can only add a few illustrative observations.

It is ascertained that the ganglionic system of nerves supplies the parts subservient to organic life, in which may be included those appropriate to the re-production of the species, with the sensibility necessary for the execution of their functions: excitement of this sensibility is not directly perceived by the sensorium, or, as the French physiologists expressively term it, the moi, so as to give rise directly to either pain or pleasure. Thus, notwithstanding the delicate sensi bility of the stomach, the digestion of the food is not attended with conscious, perception. When this does take place, from the functions of organic or nutritive life, it is because, from inordinate impressions, the sensorium is also excited. Sometimes impressions on the brain are also made by the ganglionic, system of nerves, that induce volition without either pain or pleasure, (or it is so slight, perhaps from habit, as not to be very forcible,) as in the expulsion of the urine and fæces,

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Excitement of the cerebral system and an effort of volition, appear to be necessary, in persons subservient to our habits of civilized life, for the expulsion of the contents of several of the reservoirs of the excretory matters of the body; it is evident with respect to the bladder

and rectum; for, in some cases of apoplexy and palsy, when all the functions of organic life, especially digestion, chylification, and the secretion of the urine, are carried on with the ordinary vigour, retention of the urine and fæces will take place, not from any inordinate material obstruction, but because the sensorium is not excited to direct the act of volition to aid in their expulsion. That the same excitement of the sensorium is necessary to procure the expulsion of the fetus from the uterus, seems to be evident; but this is effected in the savage, as well as in wild brute animals, with but little or no pain, any more than the evacuation of the fæces.

It may be doubted whether or not this excitement of the cerebral system in the cases above mentioned, occurs in the savage; that is, whether or not it be a natural law in the animal economy; since the urine and fæces are sometimes evacuated during sleep, without dream. ing, by children; and uterine action is known to go on in parturient women during sleep, (it should be here observed, that this is not ac companied with any action of the abdominal muscles,) and fœtuses have been expelled from the uterus after the cessation of the functions of animal or relative life. This question does not affect our explanation, since such a connexion of cerebral with ganglionic nervous energy does take place in ordinary circumstances in civilized life; and if it be not a primitive natural law, the influence of the cause of the pains of child-birth we are about to designate, is only the more forcibly shown. This is the inordinate sympathy and synenergy that civilization has produced between the nervous systems of organic and of relative animal life. Impressions on the former of these, that produce but little excitement of the latter in the savage, or one whose intellectual faculties have not been much developed, cause intense suffering and action in persons whose cerebral system has acquired that superiority in the human economy, which is produced by our habits of society and our mental cultivation. This is evident in a multitude of facts. It may here be sufficient to point out the extreme bodily injury savages will undergo, without showing signs of much pain, and their almost absolute freedom from insanity; whilst a little disorder of the stomach or liver, in persons in a state of civilization, especially those in whom this is carried to the greatest degree of refinement, will fre quently be productive of mania.

Applying this principle to parturition, we would say, that the call made by the uterus in that act on the cerebral system, which in the savage is either not experienced, or so slightly perceived as only to cause an effort with no more sensation of pain than what ordinarily takes place in the expulsion of the fæces, produces in the woman of civilized life, in whom indulgence of the passions and intellectual cul. tivation have caused an inordinate development of cerebral energy, the pain and other serious accidents they so generally endure.

This, then, is the view we are disposed to take of this phenomenon: could we indulge in a more detailed explanation, it might be rendered more apparently correct; but we are contented with pointing out to others what we believe to be an interesting course of enquiry, and one that, if pursued, might perhaps lead to some useful results. Before