Besides Joseph Capuron (1767-1850), Louis Charles de Deneux (1767– 1846), a pupil of Baudelocque, and CLAUDE MARIE GARDIEN (1767–1838), a famous teacher, familiar to some extent with even the contributions of foreign authorities, ANTOINE DUBOIS (1756-1837), the successor of the elder Baudelocque in the Maternité, particularly distinguished himself as a teacher, and became well-known too in a wide circle by his confinement of Maria Louisa. His son PAUL DUBOIS (1795-1871) met with the same good fortune in his confinement of the second empress, and was a meritorious cultivator of obstetric auscultation, while E. DUBOIS (died 1877) in Paris was a well-known gynæcologist. J. A. H. DEPAUL (1811-1883), Prof. at the Hôpital des cliniques, also devoted attention particularly to obstetrical auscultation, and was an eminent obstetrician as well as editor of the "Archives de tocologie" etc. The old obstetrical reputation of Strassburg was maintained by JOHANN G. C. FRIEDRICH LOBSTEIN (1777-1838) of Giessen, who as early as 1795 revived the memory of cephalic version, and Jos. ALEXIS STOLTZ (born 1803), Flamant's successor, who was one of the first to practise artificial abortion in France. All these physicians acted as a connecting link between France and Germany. The surgeon Armand Louis Marie Alfred Velpeau (1795-1867) also wrote on obstetrics, as well as François Joseph Moreau (1789-1862, [physician to the Maternité and obstetrician to the princesses of the Orleans family (perforation of the perineum);] F. Duparcque (ruptures etc. of uterus, vagina and perineum); Lacour; Paulin Cazeaux (1808-1862) [of Paris and author of the well-known "Traité théorique et pratique de l'art des accouchements", 1840, 8th ed, 1870;] Nicolas Chailly-Honoré (1805– 1866), [Chef de clinique at the obstetrical clinic of the Faculty, and an eminent obstetrician of Paris;] F. K. Bayley; Dubreuilhe; Joseph Dominique Ernest Putégnat (1809-1876), [who was rather a general prac titioner and writer on various medical subjects;] Chassagny and Eugène Armand Després at the Hôpital Cochin. We should also mention: A. H. P. Courty (1819-1886) in Montpellier; Jules Péan of the Hôpital SaintLouis; L. Urdy; Liégeard; Charles James Campbell (1820-1879), [a physician of English parentage settled in Paris, who was active in the introduction of obstetrical anesthesia into France, and one of the most popular and successful obstetricians in Paris; and others. To whom we may add Stéphane Tarnier, Surgeon-in-chief of the Maison et École d'accouchement and inventor of a well-known forceps, and the gynæcological authors mentioned on pp. 906-907.] c. Italians. Among the Italians no physician since the days of Paolo Assalini (1759-1810) and Francesco Asdrubali (1756–1832) has attained any high reputation among foreigners as an obstetrician. On the other hand, however, the literary activity of Italian physicians in the department of midwifery has been very lively. In 1818 men were for the first time permitted to visit the lying-in institutions of Parma, and a chair of midwifery was established in Pisa in 1839 and in Florence in 1840. In Piedmont obstetrical clinics were founded, in Venice and Palermo in 1841, in Genoa 1852 etc. Among the Italian obstetricians we should mention Gennaro Galbiati (1776-1848) of Naples; Bigeschi; M. C. Frari, author of the first Italian treatise on obstetrical operations in. 1844; J. D. Nardo; F. Marzolo; Trinchinetti; Salvatore de Renzi (1800-1872), [Prof. of the history of medicine in the University of Naples and the well-known author of the "Storia della medicina italiana" (1845-48);] Verducci; Ciccone; Fabbri; Pietro Vannoni of Florence; Biancini; Bongiovanni; Bili; Giuseppe Maria Canella (1788-1829) in Trent; Pietro Lazzati (1836-1871) in Milan; Cesare Belluzzi (auscultation for the determination of the fœtal position); Carlo Massarenti (on the same subject); J. Casati in Milan; Ferdinando Verardini of Bologna, chief physician to the Ospedale Maggiore; Eduardo Porro in Milan (Porro's operation or "Utero-ovarian amputation as completive of the Cæsarean operation", 1876); Antonio Rota; Aloysio Valenta in Laibach (an Italian only in nationality); Giustino Mayer (1830-1879; conversely a German with an Italian Christian name) in Naples; G. Calderini in Turin; Teodoro Lovati (1800-1872) in Pavia; Luigi Pastorello (1811-1863) in Padua etc. Still fewer names and works relating to midwifery among the d. Spaniards are of sufficient importance to have attained general knowledge abroad up to the present time. We may notice, however, among their quite recent writers on midwifery: Dr. Torres (died 1888), professor of obstetrics in Madrid; Francesco de Cortejarena y Aldeo and Pedro Brogeras y Lopez. Schroeder's work was also translated into Spanish under the title of "Manual de las enfermedadas de los organos sexuales de la mujer", by A. Vincencio in 1887. e. The English in their midwifery follow, on the one hand, the principle of protecting the mother by utilizing to their utmost the natural forces of parturition and in this department they have appropriated the use of chloroform to a far greater degree than any other people and, on the other hand and connected therewith, the principle of preserving the mother rather than the child, with of course the eventual sacrifice of the latter for the sake of the mother. Hence has resulted the frequency in English practice of perforation of the head and of artificial abortion, as well as the rarity of the employment of the forceps in difficult labors and the avoidance of Cæsarean section. This trust in the powers of nature and avoidance of the use of the forceps weat so far that in 1819 Sir Richard Croft, obstetrician to the princess Charlotte upon whose life depended the hope of the dynasty, permitted the princess to remain in labor 52 hours, when the child was born dead and the mother died six hours later. Croft, however, shot himself through chagrin over his mismanagement! Still it would seem that a revolution is taking place in English opinions! -Since when and how this change has gradually taken place may be seen very readily from the following statistics. "According to the statistical reports of the Dublin Lying-in Hospital, under the direction of Dr. Joseph Clarke, from 1787 to 1794 in 10,387 cases of labor the forceps were employed only 14 times; six of these cases terminated in the death of the mother. On the other hand, 49 women were delivered by craniotomy, 16 of them with fatal results. From 1815-1821, under the Mastership of Labatt, in 21,867 cases of labor the forceps were not employed a single time. From 18261833, 16,654 (16,414) cases came under the direction of Collins. Of these 24 were terminated, with the forceps, with fatal results in four cases, while craniotomy was performed 118 times. Under Johnson, from 1842-1845, in 6.702 labors the forceps were used in 18 cases, the crotchet in 16 cases and the perforator in 54 cases, with 8 fatal results. Shekleton again resorted to the forceps more frequently, in the period from 1847-1854 using them 220 times in 13,748 cases of labor, with a fatal result in 15 cases. From 1869-1873, Johnston in 4,634 cases applied the forceps in 420 (1:11), with 34 deaths (1:12), while he had only 20 cases of perforation or craniotomy (1: 321), with fatal results in 5 cases. In private obstetrical practice too the forceps were for a long time almost forgotten. Thus Clarke, in a midwifery practice of almost fifty years and including 3,878 cases of labor, had resorted to the forceps in a single case only. What an impulse has been given to the employment of the forceps in the last thirty years may be inferred from the communications of Churchill. While in the first half of this period the forceps were employed once in 351 cases of labor, in the last half the proportion increased to 1: 171, and in private practice to one in sixty." [According to Churchill (Theory and Practice of Midwifery, Phila., 1863 the relative frequency of the use of the forceps among English, French and German obstetricians was: among British practitioners 1: 249; among the French 1:140 and among the Germans 1: 106. An examination of the tables upon which these conclusions are based shows, however, that they must be regarded at best as very rough approximations. Probably all we can safely say is that the forceps are employed more frequently in German and French obstetric practice than in British, but just how much more frequently it is difficult to decide. Churchill's tables likewise convey the idea that face presentations e. g. occur almost twice as often in German practice as in English. While I know no reason for such a fact, and hence doubt the reliability of the statistics, if such is the fact, it is easy to see one reason why the use of the forceps is more frequent in Germany than in Great Britain. There would seem to be also some difference in the frequency of the employment of the forceps by English, Scotch and Irish obstetricians. Thus from the tables of Churchill, analyzed, so far as in my power, with reference to the school of British obstetricians, I find that among the English the forceps were employed once in 511 cases; among the Irish, once in 186 cases, and among the Scotch, once in 101 cases. Still I doubt whether any considerable reliance can be placed upon such comparisons. The dis turbing elements of period, conditions of practice (hospital or private), the predomin ance of a few large practitioners (Ramsbotham e. g. reports 68,435 cases, in which the forceps were employed 112 times) combine to vitiate the conclusions to be drawn from such statistical tables to a degree which makes me very distrustful of them. The tendency to an increased employment of the forceps by British practitioners, as stated by the author, is however undoubtedly true. Whether the increased activity of gynæcological practice is connected genetically therewith is a question which has aroused serious consideration. H.] Among the more eminent English obstetricians of the present century, most of whom also devoted attention to the diseases of women and children, were : SAMUEL MERRIMAN (1771-1852), obstetrician to the Westminster Dispensary and from 1810 to 1825 lecturer on midwifery and the diseases of women and children at the Middlesex Hospital of London, whose "Synopsis of various kinds of difficult parturition, with practical remarks, London, 1814" was sufficiently popular to attain a 5th edition (1839); SIR CHARLES MANSFIELD CLARKE (1782-1857), the son of John Clarke, an eminent London obstetrician of the last century. Sir Charles Clarke held the position of surgeon to Queen Charlotte's Lying-in Hospital, and lectured on midwifery and the diseases of women and children from 1804 to 1821. He was also ordinary physician to Queen Charlotte; AUGUSTUS BOZZI GRANVILLE (1783-1871; his real name was Bozzi), a native of Milan and an alumnus of Pavia, who settled in London and acquired an extensive practice in midwifery. He was also accoucheur to the Westminster General Dispensary, and published in 1819 a report on the obstetrical practice of that institution in 1818, from which we see that the forceps were employed five times in 640 cases of labor. His literary activity, however, was directed more especially to the subjects of materia medica, the plague, quarantine etc. ROBERT GOOCH (1784-1830), physician to the Westminster Lying-in Hospital and lecturer on midwifery in the medical school of St. Bartholomew's Hospital, as well as a popular and successful practitioner in London. His "Account of some of the most important diseases of women", 1829, is perhaps his best known and most highly prized work. JOHN RAMSBOTHAM, and his more eminent son, FRANCIS HENRY RAMSBOTHAM (1800-1868), both lecturers on midwifery at the London Hospital Medical School and highly esteemed obstetricians. The former published some 'Practical observations in midwifery" etc., London, 1821-32, while the elaborate work of the latter, "The principles and practice of obstetric medicine and surgery", London, 1841, became one of the most popular text-books of English and American students for a long period. The younger Ramsbotham employed ergot for the purpose of inducing premature labor, a practice which resulted in the death of nearly half the children. DAVID DAVIS (1777-1841), accoucheur to the Queen Charlotte Lying-in Hospital and from 1827 lecturer on midwifery at University College, who published in 1825 the "Elements of operative midwifery", and his son JOHN HALL DAVIS (1811-1884), from 1863 lecturer on midwifery at the medical school of Middlesex Hospital, and a successful and popular London obstetrician. He published in 1858 his "Illustrations of difficult parturition", and in 1865 a second edition containing statistics of 13,783 deliveries, from which we see that he was exceedingly cautious in the use of the forceps (6 times in 7302 cases); JAMES BLUNDELL, professor of obstetrics at Guy's Hospital Medical School and physician to the Lyingin Charity of London, and a careful investigator of the subject of transfusion. "The principles and practice of obstetricy ", London, 1834; SIR CHARLES Locock (1799-1875), a pupil of Brodie and James Hamilton of Edinburgh, physician accoucheur to queen Victoria in all her confinements, and lecturer on midwifery at St. Thomas's and St. Bartholomew's Hospitals, to whom we owe also the discovery of the efficacy of bromide of potassium in the treatment of epilepsy; ROBERT LEE (1793-1877) of Melrose, a pupil of the Scotch school, who settled in London and became famous as an obstetrician, as well as an anatomist and physiologist. He occupied the obstetrical chair of the medical school of St. George's Hospital for many years, delivered the Lumleian and Croonian lectures before the College of Physicians, and was particularly distinguished as a student of the anatomy and physiology of the uterus. Of his numerous works the "Elements of midwifery" etc. (1837), "The morbid anatomy of the uterus and its appendages" (1838) and "The anatomy of the nerves of the uterus" (1841) are perhaps best known; WILLIAM TYLER SMITH (1815-1873), physician accoucheur to St. Mary's Hospital and author of a well-known and highly esteemed "Manual of obstetrics, theoretical and practical", (1858). In 1860, chiefly through his exertions and influence, the Obstetrical Society" of London was founded, an organization which has contributed largely to the elevation of obstetrical practice in Great Britain. John T. Conquest (1789-1866), lecturer on midwifery at St. Bartholomew's Hospital, Michael Ryan (died 1840 or 41) at the North London Medical School, Samuel Ashwell, author of "A practical treatise on parturition" etc., London, 1828, etc. also deserve mention. Among the more recent teachers of midwifery at the London medical schools are J. Braxton Hicks and Alfred L. Galabin at Guy's Hospital; J. Matthews Duncan at St. Bartholomew's; Dr. Gervis at St. Thomas's; Dr. Palfrey at the London Hospital Medical School; Dr. Black at the Charing Cross Hospital; William M. Graily Hewitt at University College Hospital; William S. Playfair and Dr. Hayes at King's College Hospital; Dr. Edis at Middlesex Hospital; Robert Barnes at St. George's; Alfred Meadows and Alfred Wiltshire at St. Mary's Hospital; Drs. Potter and Grigg at the Westminster Hospital; Drs. Heywood Smith and Fancourt Barnes at the British Lying-in Hospital, etc. Among the more eminent obstetricians of the Scotch school we may mention: JOHN BURNS (1775-1850), Regius professor of surgery and lecturer on midwifery in the University of Glasgow, who wrote on the anatomy of the gravid uterus, "The principles of midwifery" etc., |