While, however, we are desirous of applying this illustration to all the operations which the Professor has performed on the genital organs of the female, and are willing to include the operation for fistula in ano, which can scarcely be considered a disease peculiar to women,-we cannot see the advantage of speculum examinations in presence of such a class.

Though it is certain that there are women willing to submit to any exposure, yet the introduction of a speculum is so simple a matter as not to need such demonstration; for the teacher cannot instruct the class in the exact manipulation necessary to embrace the os uteri favorably in particular cases (which appears to us to be the sole difficulty to a wellinformed student); and it is impossible for any one to see the structures revealed, unless he be placed in advantageous proximity to the instru

ment.

Classes for the study of uterine disease must be small, in order that any benefit may accrue from actual demonstration.

The only instruction conveyed by the use of this instrument in his clinique seems to us to have been the fact that exposure was shown to be unnecessary.

Many cases were presented to the class, which practitioners are accustomed to treat with pessaries, and the various forms and methods are appropriately described. Dr. Bedford is very sparing in the use of this instrument, and while signalizing the evils which they may occasion, does not omit to allude to the remarkable immunity from annoyance observed

in some cases.

We remember hearing from Dr. Shekleton, of the Dublin Lying-in Hospital, of a curious case in point.

A woman entered in labor, and the pupil on duty failed to determine the presentation, and sent for the doctor, who, with much trouble, removed a flat, perforated, box-wood pessary, the presence of which had been forgotten by the patient. It had been introduced before her pregnancy.

The doctor's favorite pessary is the india-rubber ball, with a hole to admit the escape and introduction of air. He does not allude to the annoyances which we have witnessed in our practice from the use of this instrument, viz. the admission within the ball of vaginal mucus, and its foul condition after a short period of time.

The intra-uterine pessaries are not recommended; and, indeed, we are satisfied from observation that they are rarely of benefit, and we have seen the uterus ulcerated and utterly intolerant of their presence; and while we would hesitate to resort to their use, yet we can never forget the testimony of several of Dr. Simpson's patients, that they were bed and sofa-ridden for years, and that practitioner after practitioner failed to procure relief until the introduction of what Robert Lee, of London, irreverently styled the "impaling machine." One lady, we remember, whom we saw in Dr. Simpson's office, told us that she had just returned from a walk to the top of "Arthur's Seat," and that previously to the use of the intra-uterine pessary, she had been bed-ridden.

The remarks of our author on uterine displacements are sound, prac

tical, and temperate-verging to no extreme of opinion, but displaying a careful appreciation of all the prominent views of the subject.

In enforcing the certainty of the test of ballottement, he might have alluded to those rare cases of deception from displacement of the uterus, as in the case of ante-flexion given by Depaul.

The much-vexed question of ulceration of the cervix receives the attention which it merits. In reference to this subject our author remarks:

It is to be regretted that medical men, like others in the various walks of life, are apt in their discussions to be arrayed by pride of opinion, and influenced too much by love of victory. Truth is often obscured by such motives, and consequently a serious check given to the healthy progress of scientific inquiry.

A fact which must be admitted by all who calmly watch the discussions which agitate the medical world.

The fallacies of Dr. West's arguments in his recent work, are well summed up in the following sentence:

It is not, in my judgment, logical to measure pathological changes by the peculiar physiological or anatomical condition of a part in health.

The vascular tumor of the meatus was presented to the class on two occasions. On p. 65, Dr. Bedford advises its removal with curved scissors, "This is all which will be necessary."

and says,

We regret that Dr. B. did not enter more fully into this subject, for certainly the general experience of the profession with this disease renders most persons unwilling to assume the responsibility of thus guaranteeing a cure. On the contrary, several cases present themselves to our recollection, where this practice was ineffectual beyond the production of temporary relief. Indeed, one poor girl lately committed suicide from despair at ever being freed from her sufferings.

Many topics relating to the management of the parturient woman, the nouveau-né, and difficult cases of midwifery, have received full attention; and we have read with great gratification the remarks on pp. 350 and 351 in reference to the use of the forceps.

In many parts of the volume students are taught with great emphasis the value of Blundell's maxim that, "meddlesome midwifery is bad midwifery;" and cautious resort to instrumental midwifery is dwelt on with the force to be anticipated from one who has necessarily seen so much of the evils to be expected from the combination of rashness with ignorance. For while a special surgical education is demanded by the public for the removal of a fatty tumor, the impression is too prevalent that all are alike qualified to perform the operations often demanded in the interest of the laboring woman or child. And indeed we do not understand why some authors deem it necessary to teach the young practitioner how the patient's mind should be prepared for the performance of these operations; when our observation in different countries has con

vinced us that the great difficulty is to withstand the urgent entreaties of women to save them the lingering delay of natural labor.

We are only too happy to rank Dr. Bedford in the category with Drs. Dewees & Meigs in reference to the proper time for using the forceps; and the remarks on pp. 350 and 351 class our author with what we may term the American School of operative midwifery-holding a happy medium between the rashness of many continental practitioners and the dangerous, even criminal, neglect and delay advocated by so many authors of Great Britain, whose works serve as text books for their countrymen and for so many of our own.

We receive the views of Dr. Bedford in reference to the relative advantages of the Cæsarean section and embryotomy, with the same gratification, though regretting that they should not have been expressed more at length. Though how he could have omitted to mention the names of Radford & Simpson in connection with the importance of fœtal life, we are at a loss to understand; since there is no more earnest advocate of the principle in question than Dr. Radford; and Dr. Simpson would deserve the thanks of the profession, if he had done nothing else than show the fallacious deductions of Dr. Collins from the very facts which he had accumulated so laboriously.

In the venereal diseases presented to the class, we do not consider that the value of a careful diagnosis has been sufficiently insisted upon, nor do we think that the important question of treatment has received the attention which it merits.

On p. 198 we have the case of a married woman suffering from purulent discharges from the urethra, with scalding. The patient suspected her husband, and the Dr. tells the class "that her suspicions I have confirmed." This would seem sadly at variance with the cardinal rules of the Lecturer, that the happiness and confidence of individuals is never to be invaded by a professional man.

On p. 16, and elsewhere, the class is led to trust their diagnosis of gonorrhoeal ophthalmia, in a great measure, to the fact of one eye alone being affected. We are afraid that such confidence will often lead them into error; and have clearly in our minds two cases under our care lately in a charitable institution devoted to the reception of children. In them but one eye was affected, and while purulent discharges and great lividity of the conjunctiva existed, the other eye was sound and able to bear the light. Yet we know that no suspicion of a gonorrhoeal cause could be entertained; nor would we be willing to admit "a livid color of the lids," as a characteristic symptom. We regret to see that in this case also the mother of the child was confirmed in her suspicions by the Professor.

We are told on p. 340, that "in secondary syphilis, where mercury has been previously employed in the primary state with judgment, the iodide of potassium rarely fails to effect a cure." We submit that in the absence of more clearly defined views between secondary and tertiary forms of syphilis, this principle will inevitably tend to the disappointment of the class.

Do we understand Dr. B. to say, for instance, that the iodide will cure a well-marked secondary papular eruption?

We read, p. 339, that "whatever may be the practice of physicians, I tell you with all the emphasis of truth, that in the primary forms of syphilis, mercury is the heroic remedy, the sine qua non," &c., excepting "sloughing chancre, and a scrofulous condition of the system" from the exhibition of this agent.

We believe that syphilis in the male is much better understood than in the female; for we believe that the distinction between the indurated and the non-indurated chancre, is by no means so ready of detection in the latter; and we turned to the cases of syphilitic disease, in the hope of finding that this subject had received its well-merited attention, but we have been disappointed.

Indeed, we feel compelled to say, that the work before us, which contains so careful and interesting, as well as sound å summary of the great points in the treatment of the diseases therein referred to, yet does not present us with any one original or novel method of treatment, or explanation of disease.

From this statement we except the remarks on puerperal convulsions on p. 475, where we find the hypothesis, as to "whether they may not be due, not to albuminuria, but to an excessive accumulation of'kiestine' in the blood."

The existence of kiestine, and its value as a test of pregnancy are alluded to more than once in the course of the volume before us.

We find on p. 474 the following words:-"You will observe that almost as a universal rule, the urine of pregnant women will differ from urine under other circumstances in one remarkable particular, viz. it contains an element called kiestine, which in its essential qualities resembles casein." "The kidneys perform their office in furnishing an outlet for deleterious substances, such as urea, and I believe, kiestine, &c." Farther on, diseases of the nervous system in mothers who do not nurse, are referred by our author to the accumulation of kiestine in the blood.

Therefore, Dr. Bedford is to be considered as standing alone in his profession in his belief of the existence and importance of this peculiar ingredient of the urine.

This is a subject which has occasioned considerable interest to the reviewer, who possesses in manuscript a resumé of all that has been written on the subject, and has, moreover, preserved a tabular record of the appearances observed in the urine of about 160 women, and some men. The value of the microscopic observations rests on the authority of Dr. Henry Van Arsdale; and this careful examination, based on no pre-conceived opinions, led to the belief that there existed no ingredient in the urine of pregnancy peculiar to that state, or to the female sex; therein agreeing with Veit and others, who have examined this subject with great minuteness and care.

The time which we can command does not allow us to pursue this

topic farther; but we purpose shortly to publish the results of our observa

tions.

The great question of the influence of uræmia has received much attention from our author, who has evidently devoted much thought to the subject. We regret to notice the use of that very vague term, "Bright's disease," which might now be discarded from the nosology with great advantage, signifying, as it now does, all the pathological changes, from simple congestion of these organs, to utter disorganization of structure.

One important fact in Christison's paper has not been referred to, though it bears with great force on the argument in favor of the fact that the presence of albuminuria may indicate nothing more than temporary derangement, without risk of permanent trouble.

We refer to the friend of Christison, who could produce albuminuria at will, by eating cheese, just as in the cases referred to by Dr. Bedford, where the same result was occasioned by eating eggs. Dr Christison kept the experimenter in view, and mentions the fact of his death from Bright's disease "not very long after.

In terminating our remarks upon this work, we cannot refrain from saying, that we opened the volume with prejudice, and that careful examination of its contents has convinced us, that the result proposed to himself by the author has been most satisfactorily attained. We are convinced that the opportunities afforded to the class by this Clinique have been very great indeed, and that they have been developed by the Professor with assiduity, enthusiasm, and no ordinary powers of clinical in

struction.

That the book is not free from defects, is, we think, evident from the preceding remarks; that it actually invites deprecatory criticism is too evident; that Dr. Bedford is aware of this cannot be doubted, for he must remember the remark of Job, " Oh that mine enemy had written a book!"

The imaginary conversations contained in Dr. Meigs' work, drew down a storm of censure which we never believed to be just, for we are not of those who would bring authors or men to our procrustean bed, but would allow for the differences dependent on the varieties of individual tastes and character.

The conversations repeated verbatim in the work, show that the imaginary conversations with Miss Helen Blanque and others, are not chimerical, but faithful types of what may be met with in practice.

The very fact that a professor in a medical college should take the trouble of publishing to the world a fair example of his style of teaching, cannot be without a beneficial influence on the cause of medical instruction, for rivalry develops talent and industry.

We regret that we have not been able to allude to other topics considered by our author; for there is so much of interest, as to cause us to desist from our task with unfeigned reluctance; but circumstances of a peculiar nature have necessarily deprived us of the time which we had confidently anticipated.

E.

[The length of the notice of Dr. Bedford's work, furnished us by a friend, has excluded other notices intended for this No., which we must defer until our next.-EDS.]