much exhausted, an enema of gruel may be given; and if there is much soreness of the lining membrane, laudanum or tincture of henbane may be added. Opium may be combined with the alteratives, especially where the diarrhoea still continues profuse. We have often found advantage in this state, from occasional very small doses (eight to ten grains) of sulphate of magnesia in some spiced water, combined with five or six drops of laudanum. Sometimes the nitric or sulphuric acid with laudanum effectually restrains the diarrhoea, and improves the character of the tongue, especially if there are aphthous ulcerations. The usual astringent remedies are inadmissible in the commencement, and only to be employed if the diarrhoea persist after the bowels have been cleared. The diet should be nourishing, but not stimulating, unless there is very great exhaustion. Arrow-root, gruel, broth, jelly, and other bland articles are the safest. Milk with soda or Seltzer water is very grateful to the patient in allaying thirst and keeping up power, especially where there is sickness. As the diarrhoea subsides, and the secretions become healthy, more nourishment may be taken; but any hurry in this respect, and any carelessness in the nature of the diet, often lead to relapses. Infusions of cascarilla or cinchona, with either ammonia or the mineral acids, may be tried in the convalescent stage, and pure air will be then of great advantage. In cases where the head affection follows exhausting labours, with or without other signs of intestinal irritation, still greater caution is necessary in the treatment. In both, from a disposition to be too acutely alive to all ailments after parturition, there is often an eagerness to use active remedies, and especially to bleed." 364. The volume is closed by a long article on diseases of the skin, occupying seventy pages. We should have thought that England might have furnished a labourer for this vine-yard, since many of our physicians and surgeons have distinguished themselves in dermological researches. The editor, however, has laid M. Schedel, of Paris, under contribution for the article in question ; and we are bound to acknowledge that it is constructed with equal care and ability. M. Schedel, indeed, has attained reputation in this branch of medical science long before his appearance on the English stage. If the work be conducted with the talent and research displayed in this first volume, it will command success. OBSERVATIONS ON THE DISEASES INCIDENT TO PREGNANCY AND CHILDBED. By Fleetwood Churchill, M.D. Dublin, 1840. IF DR. CHURCHILL's former work elicited the general approbation of the profession, we feel convinced, that this present continuation (not sequel we are glad to find,) will do so in a yet greater degree. It seems to us, that he has followed out his original design, of combining a condensed practical guide for the young practitioner, together with the means of pursuing the subject in all its details, for those who may wish to do so, in a much more perfect and successful manner, than he did in his former volume. The book, without pretending to contain novel views, or bold and original speculations, but rather a resumé and estimate of all that is known upon the various subjects upon which it treats, yet, is one that will be perused with great interest as well as advantage. We know of no more valuable a present to the stu dent, nay to the practitioner himself, than the results of the careful study of medical literature, by a judicious and practical physician. Opinions and systems, submitted to the test of his critical powers, and accumulated experience, come before us with an authority and importance their original authors could never have invested them with, inspiring the timid practitioner with courage to continue in a course, on which, unaided, he might have felt himself unwarranted in venturing, and proving to the rash that grave errors have been committed even under the sanction of a great man's name. To the unthinking the task of compiling such a work as the present may seem easy enough with a little industry. It is not so. Certainly, bookmakers' compilations are as easy as abundant, (one's very stomach heaves at the idea of another being added to the huge unreadable mass), but how undiscriminating the selections, how artificial the arrangement, how ineffective the conclusions, how destitute of authority, how useless the production, and oh! how fude the perusal of such things. Place the materials in the experienced physician's hands, and how different the result. His opinions upon what others have advised, are nearly as interesting and as important as are the propositions he has himself to advance, and there is a freshness, a vigour, an importance, and an authority about his production, which practical knowledge can alone confer. With pleasure then, do we proceed to present the reader with a detailed account of this valuable, learned, yet practical work. PART I.-DISEASES INCIDENT TO PREGNANCY. I. ON THE LOCAL AND CONSTITUTIONAL CONSEQUENCES OF PREGNANCY. "Pregnancy, then, may be strictly considered as a physiological state, but as one bordering so closely upon the pathological, that it is sometimes difficult to point out the boundary between them; and not unfrequently this boundary is palpably transgressed in several organs or in their functions. In the present chapter, the changes which are induced by gestation, considered as an altered,' but not morbid' process, will be enumerated, in order that we may more distinctly appreciate the diseased actions which occasionally require our interference.' 4. The author first slightly describes the various anatomical changes the uterine system undergoes: thus, the loosening and enlarging the texture of the uterus -the great increase of vessels capable of carrying red blood to it-the altered state of the nerves going to it, which are not distended, but actually hypertrophied by addition to their substance,* -so too are the lymphatics proportionally enlarged. The organ goes on progressively encreasing, distending the abdomen and displacing the bowels, until, according to the calculations of Levret, its capacity is increased 5.19, and its solid substance in the ratio of 12 to 1, compared with the virgin state. The ovary and fallopian tube are considerably more vascular than usual. * For an account of the recent discovery by Dr. Lee, of a large supply of nervous matter for the gravid uterus, see Medical Gazette, Vol. 26, p. 41. That new actions, and new or enlarged sympathies should result from this altered anatomical structure, would be naturally expected; and thus, the general state of the body may become materially changed, especially by the induction of a state of plethora, as shewn by the usually buffy state of the blood, and increased quickness of pulse. Again, many individual organs suffer: some mechanically, and, thus, according to the degree of the enlargement of the uterus, and its position in the cavity of the pelvis or abdomen, we may have constipation, retention or incontinence of urine, severe abdominal or lumbar pain, dyspnoea, jaundice, indigestion, varicose veins, cedema, a painfully stretched or pendulous state of the skin of the belly, &c. ; others from sympathetic irritation, as the morning sickness, diarrhoea, the production of the milky appearance in the urine (which may sometimes much assist us in our diagnosis of pregnancy), by the secretion of kiesteine by the kidneys. That the general nervous system should be in a very excitable state can cause no surprise, and the evil influence of depressing mental emotions and presentiments, and of disagreeable external impressions, is well known. II. THE GENERAL MANAGEMENT OF PREGNANT FEMALES. In endeavouring to relieve the various evils attendant on the state of pregnancy, we must not be too meddling but content ourselves with applying a palliative treatment. Thus, although in some cases bloodletting will be very proper, yet, to employ this means indiscriminately, would indeed be most hurtful. In the same manner, aperients, emetics, opiates, though not to be used without good cause, may each occasionally prove of great utility, and will, indeed, together with due attention to pure air, appropriate diet, and an easy dress, enable us to combat successfully with all ordinary cases of sympathetic irritation. Even the local effects resulting from the pressure of the gravid uterus, may also be much alleviated by the use of aperients and lavements, the periodical evacuation of the bladder, and the maintenance of the recumbent or other appropriate posture. III. DISEASES OF THE GENITAL ORGANS IN PREGNANT WOMEN. 1. Edema of the Labia.-This chiefly appears towards the latter months of pregnancy. It is usually produced by pressure preventing the return of the blood by the veins; and, according to Davis, is especially likely to occur where the pelvis is sufficiently capacious to permit the enlarged uterus to sink into it. In other cases, it may form part of a general tendency to œdema; and, indeed, in most cases the lower extremities are also thus affected. It is usually unattended by inflammation, but at other times it has coexisted with erysipelas. It may reach a large size, and must be distinguished from the sanguineous effusion occurring during labour. A mild purge and the horizontal posture are sufficient to dissipate most cases, and "much comfort is derived from bathing the parts twice a-day with tepid milk and water, and afterwards dusting them with some absorbent powder." Should the distention be great, the parts should be punctured. No. LXV. H 2. Pruritus of the Vulva.-Dr. Churchill, referring to his former volume for fuller information, quotes a case from Dewees of severe pruritus, arising from aphthæ, which was completely relieved by the application of a strong solution of borax. He also recommends the use of solutions of acetate of lead or nitrate of silver, while some cases may require active antiphlogistic treatment. Dr. Dewees' case reminds us of one, which occurred to us some time since, in the person of a lady far advanced in pregnancy, who suffered the most dreadful torments from pruritus. With a delicacy we at once deplored and respected, she resisted an inspection until our stock of remedies, and her own powers of endurance were alike exhausted, when, upon examination, we found several large patches of slightly raised ulcers of a pale appearance, upon the inner surfaces of the labia. We drew a stick of nitrate of silver across each. The patient slept soundly, the first time for many a night, and scarcely ever suffered again during the rest of her pregnancy. 3. Vaginal Leucorrhea. Few pregnant women are entirely without this. It would seem to be excited by the pressure of the uterus creating irritation, and impeding the return of the blood, with which these parts are now so abundantly supplied. It is sometimes, though very rarely, accompanied by febrile action. When it is excessive it causes much debility and dorsal pain. Its removal is by no means easy, and, perhaps, of questionable propriety, seeing that it may possibly act as an useful derivative. Great cleanliness, mild astringent washes, and when the habit is feeble tonics, constitute the treatment. 4. Mentruation during Pregnancy.-The author refers to a large host of authorities upon this interesting subject, and afterwards thus expresses himself. "However strange it may appear, the cases on record are too numerous, and too well authenticated, to leave us in doubt that a discharge resembling the catamenia, in colour, quality, and periodicity, does not unfrequently occur during gestation. I have myself seen three or four cases of this deviation. In one it continued up to the 8th month inclusive; in the others it was arrested between the 4th and 6th month; but in all it was well marked, returning regularly, and varying but little in quantity and quality from the ordinary discharge. Still more remarkable and rare are those cases where the catamenia appear for the first time during pregnancy, or only during gestation." 33, 36. The discharge is usually paler than natural, and the quantity less, but it is never coagulable. He considers its source to be the vaginal mucous membrane, aided perhaps by that of the cervix. 5. Discharge of Watery Fluid from the Vagina.-This is quite distinct from leucorrhoea, being a colourless bland fluid, discharged in quantities varying from a few ounces to some pints daily, by which, however, the size of the abdomen is not lessened. Great weakness and lumbar pain accompany it. Dr. Churchill is in doubt whether the vaginal mucous membrane, or the chorion be its source. Dr. Davis calls it a dropsy of the chorion. Every accoucheur must be familiar with examples, in which there has been dribbling of considerable quantities of fluid from the vagina, for days, or even weeks, prior to labor, and yet at that time, the membranes are found apparently perfect. Dr. Davis considers the affection a dangerous one, but our author does not take so serious a view of it. It is not under our control. 6. Dropsy of the Amnion.-Dr. C. justly observes that as this results from an excessive action of the secretory vessels of the amnion, so, properly speaking, it should be considered a disease of the ovum, and not of the uterus. It is sometimes connected with a diseased state of the placenta. Its chief symptom and inconvenience arises from the excessive distention of the abdomen. The child is usually feeble or diseased at birth, or it dies before. Labor may be temporarily delayed by it, and flooding is more likely to follow. All we can do is to attend to the well-ordering of the general system. "Should the distention be enormous, and the distress be very great, we shall be justified in having recourse to the induction of premature labor, especially because in these cases the child is generally lost when left to nature. Whilst this operation is in our power, it appears to me quite unjustifiable to have recourse to abdominal paracentesis, as recommended by some authors (Scarpa, Desmarais, Davis.)" 51. 7. Rheumatism and Spasm of the Uterus.-Although rheumatism of the uterus is recognised as a well-established disease by several German and French writers, yet we agree with the opinion formerly expressed in this journal,* that, although the possibility of such an affection occurring in a muscular tissue like the uterus may be admitted, yet, that the cases hitherto published are by no means conclusive. So, also, Dr. Churchill, by placing this disease under the same head with spasm of the uterus, would seem to doubt its identity with rheumatism, as no one can assert more than a very partial similarity between the two diseases. Indeed, whether we consider the symptoms he enumerates, or the means of cure he recommends, (consisting of occasional depletion, sudorifics, and opiates) we see rather the signs of spasmodic affections, accompanied sometimes with a little fever, than of rheumatism. The simultaneous existence in some cases of pains of a rheumatic character in other parts of the body, is almost the only fact in favour of the existence of the latter. 8. Hysteritis.-This affection is usually limited to the portion of the uterus where the placenta is attached; the cervix, however, often eventually participates in the diseased action, while the rectum and bladder become sympathetically excited. There is often much constitutional disturbance. If the disease be extensive the child will probably perish in utero, or be prematurely expelled. Dr. Murphy† states, that rupture of the uterus may often be traced to hysteritis, occurring during gestation. Leeches in sufficient number, and the affecting the mouth slightly with calomel and opium, are the usual means of cure. * Med. Chir. Rev. No. 62, p. 563, and No. 63, p. 238. |