of the scapula. A cupping-glass is applied, in the ordinary way; and, as soon as this is removed, several needles (for example, five or six,) are to be plunged perpendicularly, in succession, towards the centre of the part which had been covered by the glass the needles should be inserted by rolling them, in a manner, between the thumb and fore-finger. Common sewing needles, of from two to two inches and a half in length, are proper for the purpose; their points should be very sharp, and they should have sufficient strength to avoid the danger of their being broken: they may penetrate to the depth of about nine lines in a person whose shoulder is tolerably fleshy, and it may be prudent to cover them with wax beyond this extent. If they are let remain in for three or four minutes, as is usual, the patient should be cautioned not to move either the arm or shoulder.

Several tracts have been recently published on the mode of forming an artificial pupil; but an history of the methods proposed cannot here be given: and, each operator considering his own the best, it is hardly possible to form any precise conclusion from a consideration of their various works on the subject: we shall, therefore, merely give references to them. (123)

SIX. The act of parturition being in itself the result of so peculiar a series of functions; and forming also, in a great measure, so distinct a subject for the application of the medical art; we have chosen to consider what immediately relates to those objects in a particular section: it has also appeared to us to be advisable, that such diseases as seem to be expressly consequent on the puerperal state, should be comprised in the same view. These are all equally the subjects of the care of the practitioner in obstetricism.

Several of the most important treatises and observations on these subjects, that have been produced within the last semiannual period, have already been either extensively considered or wholly inserted in the last volume of this Journal; as, those of Prof. FODERE, (124) Mr. KING, (125) our correspondents, Mr. HAMILTON (126) and Dr. H., and that of Mr. POWER. (127)

(123) Further Account of the Result of an Operation for performing artificial Pupil. By J. P. MAUNOIR. Medico-Chirurgical Transactions, Vol. IX. Part II. Longman and Co. London.

Observations on the Operation for Artificial Pupil. By E. RYAN, M.D. Dublin Hospital Reports, Vol. II.

Commentatio de Coresmorphosi, &c. Auctore GUILIELMO Wagner, M.D. Gottingen. 8vo. pp. 80.

De Raphiankistro, &c. &c. Von J. EMDEN, M.D. &c. &c. 8vo. pp. 38. Gottingen.

Ueber den Gegenwärtigen Zustand der Künstlichen Pupillenbildung in Deutschland. Von W. A. J. SCHLAGINTWEIT, Dr. der Med. und Chir. &c. 8vo. VIII. und 117 seit. Munchen.

(124) Medical and Physical Journal, vol. xli. pp. 350, 457, 526.

(125) Ibid. p. 51%.

(126) Ibid. p. 121.

(127) Ibid. p. 332, 424.

The only treatises which come within the view taken for the arrangement of this essay, are those of Dr. DEWEES, (128) of Philadelphia, and Dr. DOUGLASS, (129) of Dublin.

The closing limits of this sketch oblige us to defer entering into the consideration of the work of Dr. Dewees until a subsequent period. This physician, it may however be at present remarked, considers that parturition is not a painful function in the human female in the uncivilized state; and in the present essay he endeavours to ascertain the cause of the change we now witness. Mr. Power has, we consider, commenced the investigation of this interesting question in a very judicious manner: he has traced, with much accuracy and precision, the nature of the results; and it is by proceeding upwards from these phenomena, that we can alone expect to arrive at the knowledge of their causes. The work of Mr. Power must be considered as one of the particularly remarkable literary productions of the existing period.

Considering the "Explanation" of Dr. Douglass in a theoretical manner, it appears calculated to produce important benefit to the practice of obstetricism. The description which he has given of the mode in which the evolution of the fœtus takes place in original presentations of a shoulder, seems to render it evident that such an occurrence may occur, when left to nature, much oftener than has been generally supposed. Dr. Douglass observes, that, in all the recorded cases, it is stated that, shortly before this evolution took place, the shoulder of the child has been forced very low into the pelvis; and that the thorax had occupied so much of its cavity as to preclude the practicability of the hand being passed up into the uterus for the purpose of turning, as is usually done in such presentations. The explanation of the evolution given by Dr. DENMAN, was, that, by the pressure of the fundus of the uterus on the breech of the child, its body was made to turn on its own axis; the thorax rising up into the uterus as the breech was expelled from it, until at length the latter actually became the presenting part. The possibility of such an occurrence is doubted by Dr. Douglass: his own observations have led him to determine, that the shoulder and thorax are, at every successive pain, forced still lower in the pelvis, until the ribs of the side, corresponding with the presenting arm, press on the perineum. At this pe

(128) 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; and Souter, London. 1819.

(129) An Explanation of the real Process of the "Spontaneous Evolution of the Fatus," &c. By JOHN C. DOUGLASS, M,D. &c. 8vo. pp. 45. Hodges and M'Arthur, Dublin. 1819.

riod, not only the entire arm, but the shoulder also, can be perceived externally, with the clavicle lying under the arch of the pubis. By further uterine contractions, the ribs are forced more forward, appearing at the os externum as the vertex would in a natural labour; the clavicle having been, by degrees, forced round on the anterior part of the pubis, with the acromion facing the mons veneris. The foetus now forms the larger segment of a circle, with the head resting on the pubis internally, and the breech in the hollow of the sacrum, or at the brim of the pelvis ready to descend into it; and, by a few more contractions of the uterus, this, and the remainder of the trunk and the lower extremities, are expelled. Thus, the breech is not the first part of the body which appears at the os externum: it is the side of the thorax, corresponding with the presenting arm, which thus appears; but the breech is momentarily expelled before the posite side of the thorax. The head and one arm still remain. The presenting arm now gets forward on the symphisis pubis externally, and the head and other arm are distending the perinæum and the os externum.

op.

The above description is derived from observations made in

seven cases,

From the above rationale of the process of the evolution, it is evident that it is an occurrence which may rationally be expected, and which may also be calculated on, under certain circumstances; whilst, according to the explanations previously given of it, the occurrence of it must appear a matter of such uncertainty, as to lead the practitioner to the use of almost any other measures, on which more confidence of a favourable issue could be placed. The application of this consideration to practice, is sufficiently obvious. It is not meant that it should exclude the necessity of turning in those cases in which that operation has generally been considered to be indicated; but only under the following circumstances: "If the arm of the foetus should be almost entirely protruded, with the shoulder pressing on the perinæum; if a considerable portion of the thorax be in the hollow of the sacrum, with the axilla low in the pelvis; if, with this disposition, the uterine efforts be still powerful, and if the thorax be forced sensibly lower during the presence of each successive pain:" for then, the evolution may with great confidence be expected; and an operation, always terrifying, and commonly dangerous, to the suffering female, may be avoided.

On concluding an essay, intended to give such a view of the recent events in the universal republic of medicine as may disclose to the reflective mind some knowledge of those occurrences of the most importance, both with respect to their immediate

influence, and the future revolutions they are qualified to produce; we are led to offer some remarks, dictated by a sense of duty to our own exertions, and by a proper regard for the interests of the science to which they have been devoted.

When the great extent of the subjects to be comprised in the series of dissertations commencing with the present, is duly reflected on; and when it is also considered, that, according to the method traced in the preceding essay, they must be the results of individual researches; it will be evident that repeated efforts will be requisite to give them the degree of perfection to which they may be raised by the same talents and similar exertions, with those which were employed in the construction of that here produced. Progressive experience will probably suggest means by which the arrangement of the various subjects may be rendered more lucid, and by which a more numerous assemblage of facts may be embraced in an equal extent of literary narration. Several retrospective observations and adventitious remarks, which have here been adduced in order to show precisely the course we intend to pursue, and to obviate the obscurities which might attend a novel arrangement of the subjects of medical history, will be avoided as unnecessary on future occasions, Experience will also be requisite to enable us to seize, in the course of our literary researches, all the objects dispersed in divers tracts, often concealed under fictitious. appearances, and to display them in their proper characters, and arrange them in their appropriate order. Time will also be necessary to render fully effective the measures which have been taken to acquire information of all that may transpire in the more remote parts of the globe.

As an apology for any rudeness which may appear in these essays, relating especially to their literary character, we ob serve, that the rapidity with which they must be written, neces sarily prevents the application of what the finest of critics stated to be requisite, in order to give to a literary production the faintest reflection of those traits, which he has wholly appro priated to his own works: this, however, is not worthy of consideration in the estimation of their real merits; for medicine is in itself too interesting to every reflective mind, to render the borrowed ornaments of rhetoric, or refined elegance of diction, at all desirable in the language in which its dictates are conveyed. Leaving to the votaries of the gay train of the Muses, their Lydian sportiveness, their flowery garlands, and their crowns of bays; the followers of HIPPOCRATES will endeavour to assume the simple gracefulness of manner which he inculcated by precepts, and exemplified in himself. W. HUTCHINSON.

London; June the 30th, 1819.

ALTHOUGH obliged to omit, in the present Number, the favours of our Correspondents, we cannot defer the insertion of the following note from Dr.

PEW:

To the Editor of the London Medical and Physical Journal. SIR,-The time seems at length arrived, and all the necessary facts seem now to be furnished, for the free, full, and effective, discussion of the vaccine question; and I do most sincerely hope, that this discussion may be final and incontrovertibly conclusive; and, since Dr. Forester seems kindly to have promised Dr. Bent his assistance, and it is possible that some other gentlemen may still add a few remarks on what I have said, it is my intention to put off paying my respects to Dr. Bent for some time, under the hope that may trespass only once more on your pages; and I write this merely to assure him, that he is not forgotten, and shall not be neglected by, sir, &c. &c.

Sherborne, Dorset; 12th June, 1819.

R. PEW.

In the review of a Memoir on Intestinal Worms, by Dr. BARRY, in the last volume of this Journal, a passage was transcribed, (page 499,) in which the sense was observed to be obscure: this, we have been informed by Dr. Barry, depends on a typographical error. By reading, in the second line of that passage, popularly instead of properly, the sense of the whole paragraph is clearly developed.

REPORT OF DISEASES.

OUR various sources for information have furnished us with but little that has been remarkable in the diseases of the preceding month. No malady appears to be so especially prevalent as to be particularly designated, according to the views with which this Report is made. The fever which has often formed the subject of our observations, still exists; but, from the want of any extensive establishment appropriated for it, it is difficult to ascertain, with much accuracy, to what extent: we believe that this is not considerable, and that it is on the decline. The lungs and brain are now the organs chiefly implicated in the local disease with which it is accompanied.

Scarlatina of a mild character, and without much affection of the throat, is of rather frequent occurrence, and usually terminates in the most favourable manner, under a cooling regimen and restricted diet.

We have seen a few cases of dropsy succeeding to intermittent fever, in the lower class of the applicants to the public dispensaries. These have been successfully treated, speaking generally, by laxatives and digitalis. In one recent case, the fever (tertian) returned after the use of some violent purgatives taken by the patient, a middle-aged mother, without medical advice. The dropsy is now disappearing, and the state of the system in the intervals of the febrile paroxysms is more nearly approaching in appearance to that of health. Leeches to the abdomen, the warm bath, and a spare diet, have been the remedies. It is proposed to employ ciuchona in a few days,

Several very troublesome cases of dyspepsia have appeared in elderly persons, who were ordinarily disposed to that affection, apparently solely in consequence of a free use of purgatives, (in general, salts, alone or combined with senna, but sometimes some of the resinous extracts,) which they took from a notion that they would be salutary at the present season. After all the ordinary remedies had failed to give relief, pills composed of rhubarb and ginger, (containing from five to ten grains of the former,) taken daily, so as to cause a little constipation of the bowels, have produced the most prompt and decisive good effects. One patient, a man of a spare habit, aged about 65 years, is invariably affected with flatulence, spasms of the stomach, vomiting after taking food, and acidity in the stomach, whenever his bowels are lax; and is immediately restored to health by the rhubarb-pills, which induce constipation.

TO CORRESPONDENTS, &c.

The Communications of Doctors KINGLAKE, PAINCHAUD, and VON EMBDEN; and Surgeons Overrend, SutlifFE, and Down; and SENEX; will appear in the next Number.

The Meteorological Table, and the List of Books, are necessarily deferred until the ensuing Number.