perhaps favour his readers with an explanation of this new mode of concluding an elaborate criticism. If he meant to say that his own folly has no limits, I am perfectly satisfied with his use of the term, and would enquire, as Job did, "Shall vain words have an end?"-Job xvi. 3. As to the expression, “German enthusiasm and folly," I remark, that I am not surprised to find in the production of this able Reviewer such a contradiction in terms as "enthusiasm and folly: this logical Critic perhaps does not know, that no fool can be an enthusiast; but, being sufficiently acquainted with his illogical nonsense throughout his review, I would only observe, that I am unable to reply to the term German, which he has prefixed to the above phrase, and by which he attacks the nation to which I belong. How can I reply to such scurrility? Shall I be so mean as to assert, that, because he is illiberal, the whole nation to which he belongs is illiberal too? By no means. I wish rather to refer my readers, and especially my forgetful Reviewer, to what I have said in the eighth page of my Preface; at the same time, however, I cannot restrain myself from uttering my suspicion, that, on account of his excessive illiberality, my Reviewer is not an Englishman, and, even if he were born in England, he surely cannot be of English extraction, for, when I consider his malicious illiberality, I am totally at a loss to conceive to what nation we can trace his origin, unless it be to that of the Caffres or Cannibals. My wise Reviewer next observes," indeed we might not have noticed it at all," &c. He would have given us one mark of wisdom had he been altogether silent on the subject, for the wisest man that ever lived said, "Even a fool, when he holdeth his peace, is counted wise.”—Prov. xvii. 28. But by way of excuse for not having been totally silent, this wise man assigns as his motive for writing, "the exhortation of the author to professional men to clear the subject from all impurities;" but I addressed myself to learned professional men, (page 108.) and I apprehend my Reviewer belongs not to that class. He seems, therefore, to be an intruder, and, of his own accord, to have taken upon himself to represent the whole of the medical faculty. If he had this right, I should then be obliged to exclaim, "O tempora! O mores!" But I am far, very far, from conceiving, that the very respectable body of medical gentlemen in this country, a country which can boast of a Freind, a Mead, a Hunter, a Cullen, a Monro, a Cheselden, and others whom I could name, were I not fearful of affecting the modesty of those great men who are now living; I repeat, that I am far from thinking they would be willing to be represented by such an illogical, illiberal man. To I now dismiss this criticus criticorum, assuring him, and all others who review in such a manner as he does, that I shall act according to the advice of Solomon," Answer not a fool"-Prov. xxvi. 4.; and shall address myself to those respectable Reviewers, who are guided solely by a love of truth. such Reviewers I address myself in the words of my Preface, "incomplete and defective as this Treatise may be, yet the hope consoles me, that it may possibly prove a guide to others, endowed with more learning and greater talent than myself, to walk in the same path with better success: if, however, it should prove to be altogether deficient, I hope, that amidst the demolition of the system here laid down, materials may yet be found, which may be of service in the erection of a new and firmer edifice." "I am open to conviction in any case where I may receive instruction: it is but a human mind that conceives a system, and a human mind that receives it." London, November, 1822. M. LOEWE, M. D. Ingraved for the London Med! & Phy! Journal & Preblished Fibt 1.1223.by. Couar. 73.8: Paule Church Yard. Medical and Physical Journal. 2 OF VOL. XLIX.] FEBRUARY, 1823. [NO. 288. For many fortunate discoveries in medicine, and for the detection of numerous errors, the world is indebted to the rapid circulation of Monthly Journals; and there never existed any work, to which the Faculty, in Europe and America, were under deeper obligations, than to the Medical and Physical Journal of London, now forming a long, but an invaluable, series.-RUSH. ORIGINAL COMMUNICATIONS, ART. I.-Two Cases of Caesarean Operation, one of which proved successful. By JOHN J. U. VAN BUREN. Communicated by Dr. CARSON, of Liverpool.-[With an Engraving.]' On the 27th of April, 1820, Dr. Doty was called to visit a slave, named Beneba, belonging to William's Hope estate. She was five feet seven inches in height, aged thirty-five years. He was informed by the attendants that she had been nearly sixty hours in labour; that the waters had been discharged, almost at its commencement; and that the pains had, at times, been very severe. He found the pulse regular, the breathing natural, and no symptoms of exhaustion. On examination per vaginum, he found the impeded labour occasioned by a peculiar malformation of the pelvis, occasioned evidently by disease of the bones. The small diameter of the pelvis,-viz. between the pubis and os sacrum,-was so narrow as not to admit, with the utmost pressure, the introduction of three fingers: the space was certainly not two inches. From the symphisis pubis a tuberosity projected, about an inch and a half towards the os sacrum. Its base transversely, in a line with the rami, áppeared to be an inch and a half, and perpendicularly, or in a line with the symphisis, appeared to be about two inches. The os sacrum was much contracted towards the pubis; the transverse diameter of the pelvis was sufficient to have allowed the passage of the child. The child was alive; the os tince well dilated; the head presenting naturally. Dr. Doty was informed that this was the patient's sixth child; that she had been delivered of four dead children, all of whom were born without surgical assistance, except the last, on which occasion, I found, she had been in labour three days; the child was dead, but there was no difficulty in removing it without instruments. It was evident to Dr. Doty that the tuberosity must be an exostosis of NO. 288. the bone, which had been formed since her last delivery; and, the Cæsarean operation being indispensably necessary, he immediately requested my attendance. After having attentively examined the state of the pelvis, and found the malformation such as to render it impracticable to introduce any instrument for the removal of the child, I did not hesitate in coinciding with Dr. Doty in the necessity of the immediate performance of the Cæsarean section; being of opinion that, where the state of the pelvis is such as to prevent the possibility of the child's passing, no time should be lost, from the firmest persuasion that lives would be saved by the early resort to the operation, instead of waiting (as is too frequently the case) until the patient becomes exhausted by useless efforts to expel the child. The patient, instruments, and dressings, being ready, I operated in the following manner:-Having placed the patient on her back on the table, with a common scalpel I made an incision through the integuments, from the umbilicus to the pubis, so as to expose the linea alba. An opening was then made at the superior part of the incision, through the aponeurosis of the linea alba, into the cavity of the abdomen. Introducing two fingers as a defence against wounding any of the viscera, with a curved bistoury the linea alba and peritoneum were divided, the full extent of the first incision. The uterus immediately presented itself; an inspection, to ascertain the situation of the placenta, being previously made with all possible dispatch. An incision was made into the superior part of the fundus uteri, and extended about seven inches, when the foetus and placenta were extracted as speedily as possible. In the instant of removing the foetus, a prolapsus of the intestines took place, but they were immediately returned, and kept in situ by Dr. Doty. The lips of the external wound were brought in contact by sutures and adhesive plaster, care being taken not to include the peritoneum in the sutures. The eighteen-tail bandage was used, the patient put to bed, and an anodyne given. Previous to operating, I weighed well in my mind the importance of the operation, the responsible situation I stood in regarding the life of the patient, and my own reputation as a surgeon. In considering these circumstances, I did not hesitate in adopting the plan pursued; discarding the usual method, as retarding the operation, by the taking-up of arteries, and endangering the life of the patient by the freer admission of air, in consequence of muscular contraction. Particular care should be taken to prevent a prolapsus of the intestines; and, when it does occur, they should be returned with the greatest dispatch by the assistant: otherwise, it will |