the bleeding vessels tends materially at this moment to check the discharge. Having gained these advantages, the operator now procures a little respite from action; and of this interval it is desirable to take advantage carefully to inspect the situation of the woman. If the loss already sustained shall have brought on syncope, or excessive faintness, recourse must be had to stimulants, which have been previously got ready at hand; but if it should not seem to have made much impression, stimulants may be dispensed with.

*

"When I have been obliged to have recourse to a forced delivery by turning, under a state of great exhaustion, I have frequently fancied, that the shock inflicted upon the nervous system by the violence of the operation has greatly increased the danger of the woman, and has sometimes hastened a fatal result. In reflecting upon this presumption, in cases of sudden depression under a placental presentation, it has seemed to me desirable, if possible, to obtain a truce from the flooding before delivery is attempted, that the system may somewhat rally from its preceding effects. I have therefore thought, that if, in these desperate cases, by any gentle means, the liquor amnii could be discharged, without inducing a greater degree of placental separation, some advantage would be derived from uterine contraction, and the violence of the discharge would be thereby checked. I must however in candour declare, that I have not had an opportunity of realizing the practical effect of this suggestion since it occurred to my mind; I offer it therefore merely as an object of future consideration. The method I would propose is, to penetrate the centre of the placenta by a perforator, or other sharply-pointed instrument, and allow the liquor amnii to run off. If the discharge should be thereby checked, delivery may be put off for a short time; but if the discharge should continue afterwards, delivery must not be delayed. Let it be clearly understood, however, that this act will not supersede the necessity of delivery sooner or later, and that it will cause some loss of the child's blood from the laceration of the placental vessels.

"I have repeatedly remarked, that among those cases which have terminated fatally, in several of them that event has seemed to me to be hastened by too quick an extraction of the child; by too sudden evacuation of the uterine contents. If the hand in turning be allowed to enter the uterus without resistance, and if, after it is in complete possession of the cavity, no contractile effort be perceptible in the parietes, the extraction of the child should be very gradually performed. When the breech is brought down, its pressure generally suspends the discharge. When this is the case, there can be no immediate necessity for the quick extraction of the body and head; and I feel perfectly satisfied, that by such a mode of proceeding, much injury is occasionally done to the woman. But on this point, as on many others, the practice must be regulated by the state of the woman, and that of the child, under due discretion and judgment.” 295-302.

Fortunately, cases of this nature demanding so large an exercise of judgment and firmness on the part of the obstetric practitioner are comparatively rare.

The convulsions that occasionally take place in the puerperal state are described in a really graphic manner (pp. 316-19); and Dr. Ramsbotham seems strongly inclined to join M. Andral in attributing a greater tendency to their occurrence to a peculiar electrical condition of the atmosphere. They are certainly more often observed to happen in thundery weather. Dr. Ramsbotham advises for their treatment,

"The abstraction of blood, and the free evacuation of the bowels, the constant application of cold evaporating fluids to the whole surface of the head, or the local affusion of a stream of cold water upon the vertex." 326.

The writer of the present article suggests, as a more manageable mode than any other hitherto proposed of obtaining the salutary effects of refrigeration—the use of the cold pillow, recommended by his preceptor the late Professor Davis. This apparatus, which is composed simply of a large bullock's bladder, about three-parts filled with cold water, and is in general readily attainable, has the advantage of being continually applicable to the vertex of the patient, without the discomfort that attends repeated cold affusions, and with the advantage of being changed with ease, as often as the water contained loses its necessary coldness. In more than one case, the writer has had the happiness of bringing labor with puerperal convulsions to a successful termination, a result which he has in no small degree laid to the instrumentality of the "cold pillow."

Many useful practical remarks are comprised in the chapters on Rupture and Retroversion of the Uterus.

The necessity for attending to the condition of the bladder and rectum, and regularly evacuating their contents (particularly those of the former organ) during pregnancy, is strongly insisted on; and many distressing circumstances are shown to have arisen from a non-attendance to these peremptory duties alone. While speaking of rupture of the uterus, our author remarks.

"In all cases of this accident, there is a narrowness if not an absolute deformity of the pelvis, so that perforation of the head becomes, too commonly, indispensably necessary to the delivery. But if the presenting part of the child shall have retreated from the situation which it had previously occupied, so that a considerable portion of the child has escaped into the abdominal cavity, delivery must be effected by the introduction of the hand, and extraction by the feet." 428.

Speedy Delivery is proved by Dr. Ramsbotham to be decidedly the indication of treatment in the event of this perilous accident; and by resorting to it he has himself been enabled to save the life of the patient, and even procure her restoration to health, in two out of three successful cases of this nature, which are recorded at the end of the work.

In alluding to the doctrine of superfœtation, our author asserts, p. 391, an enlightened physiology has nearly exploded the idea of that occurrence," but this is an error, if we are to entertain the theories of Raciborski, Drs. Power, Laycock, &c. which contribute to show that superfœtation is not only a very possible event, but probable as well-and offer for it a satisfactory rationale.

We could well have pardoned Dr. Ramsbotham, for pronouncing er cathedra on this and other critical points, upon which no clear light has been thrown till lately. But his objections are always gentle : he has no offensive dogmatism; and with the advantage of obstetric medicine always at heart, he frankly acknowledges when he has been misled.

Dr. Ramsbotham's treatise does not extend to the management of either the mother or child after the completion of delivery. Neither is it furnished with plates of any description; but the principles and practice inculcated are illustrated by upwards of 170 well-selected cases. Altogether, if this work be less copious and comprehensive than some others of its

class, it is still of high value; and, not only as a companion to other works, but for its intrinsic merits, it ought to have a place in every public and private medical library.

A PRACTICAL AND THEORETICAL TREATISE ON THE DIAGNOSIS, PATHOLOGY, AND TREATMENT OF DISEASES OF THE SKIN, ARRANGED ACCORDING TO A NATURAL SYSTEM OF CLASSIFICATION, AND PRECEDED BY AN OUTLINE OF THE ANATOMY AND PHYSIOLOGY OF THE SKIN. By Erasmus Wilson, Consulting Surgeon to the St. Pancras Infirmary, Lecturer on Anatomy and Physiology, &c. London: Churchill, 1842. 8vo. pp. 407.

THE pathology of the Skin is a subject of so much interest and importance that we are not sorry to meet with a work dedicated especially to its consideration. Since the time of Willan and Bateman, the subject has been much neglected in England, the field has been occupied by translations, and it is therefore refreshing to find British energy again bending to the task and seeking to maintain those rights that a long line of distinguished authors, from Daniel Turner downwards, have established. The author of the present volume is known to fame by his works on anatomy, and as the first chapter evinces, this subject and its twin sister Physiology have been laid deeply under contribution in order to plan out a fair foundation, on which as fair a superstructure, should, it might be hoped, arise. And truly, after a careful perusal of the work, we think that Mr. Wilson has succeeded in effecting the object he appears to have had in view, and we shall endeavour to give proof of our opinion by placing before our readers such quotations and comments as may be interesting either from their novelty or practical utility.

To the subject of Classification the author has devoted considerable attention, and he proposes and follows in the present volume a new system of arrangement, for which he claims the designation of the " Natural System." But we quote his words :

"The basis of the natural system of classification rests upon anatomy and physiology, and herein lies its strength, its simplicity, its easy application, and its truth. The dermis and its dependencies, its glands and its follicles, are the undoubted seat of all the changes which characterise cutaneous pathology. These, then, constitute my four primary divisions, namely

Diseases of the Dermis,

Diseases of the Sudoriparous Glands,
Diseases of the Sebaceous Glands,

Diseases of the Hair and Hair-follicles."

He next enquires into the nature of the general diseases of these separate tissues, and lastly into their particular forms and the varieties of those forms. The author's arrangement is shown in the following table :—

..

From Parasitic Animalcules ..

IV. DISEASES OF THE HAIRS AND HAIR-FOLLICLES.

We consider this classification to be a decided improvement on that of Willan, which has been generally followed to the present day. The Willanean system is founded on the more obvious external characters of the disease, and is neither scientific or philosophical. For instance, if the disorder consist of vesicles, the disease belongs to the order Vesiculæ; if pustules, Pustula; if pimples, Papula; if scales, Squamæ, &c. Here then it would seem at first sight that a fixed and unsliding scale is laid down, by which the school-boy might jump to a correct diagnosis of the disease. But is this supposition founded in fact? We think not, nay, we know that the diagnosis of diseases of the skin is in the highest degree perplexing to many practitioners. But this is not all, the system involves other and greater objections; the same disease may and actually does, as in the case of small-pox, pass through several different orders of the Willanean Classification in its course. At first it is an exanthem; seen a little later it would be classed under papula; still later it is a vesicular affection, and after that it becomes a member of the order pustula, where we find it located by Willan. But we pass over this and other objections to the artificial system of Willan to enquire how far similar objections may be made to the classification of our author. It must be confessed that these do not exist: Mr. Wilson has based his system on the immutable principles of sound pathology, and he has, to use his own words, "created a system which should embrace all the advantages of the natural system (as applied to botany), while it retained all the benefits derivable from the artificial system." The ordinary principles of diagnosis employed in the Willanean system are equally applicable in the natural system; if the disease is vesicular, the practitioner will find it under the head of "In