action of the limbs are considerably altered by the division of the artery: the same follows the division of a nerve in any part of the body. That the nerves are dependent upon the vascular system for transmitting, what is termed, nervous power, may be proved by bleeding animals to death, as related by Drs. Moulson and Seeds. Respecting the voluntary and involuntary muscles, the following opinion is entertained by some individuals :-that they are supplied by the same nerves, and that it is only by the stimulus applied to the involuntary muscles that keeps them in continual action. For instance, the heart is stimulated by the blood; withdraw that, and the heart ceases to act. The bowels act from the stimulus of their contents; the liver, &c. in the same way. The arteries in the arm and fore-arm running between muscles, are supplied by the same nerves as the muscles themselves. When the voluntary muscles are put into action, a greater quantity of blood is immediately directed to the nerves; and with the friction of the muscles, they give an increased influence to the muscles, so as to effect any object desired, in which force is required. The ganglia are not considered as so many small brains, but only binding the nerves in such a manner, that when an increased action is required, they act in the same manner as other nerves do when compressed by muscles :-for instance, when the intestines become filled with food, the nerves stretched upon them are drawn forwards, and these nerves, proceeding from ganglia, have their power increased in proportion as they are extended by the intestines, and bound down by ganglia. By disease, voluntary muscles become involuntary. In paralysis, apply galvanism to a leg or an arm, and immediately it acts. Subtract the stimulus of the blood from the arteries, and they become ligaments. So far it is considered as a proof, that involuntary actions in the different parts of the body are continued by the application of a stimulus, and that ganglia do not serve the office of minor brains, nor are there two sets of nerves in the human body, the one supplying the voluntary, and the other the involuntary muscles. How far the above conclusions may be correct, we do not take upon ourselves to determine; but shall leave so intricate a subject for those who may have more time than we have to theorize upon it. In consequence of the intimate relation and connexion which subsist between all parts of the economy, Dr. N. considers it impossible to portray the various forms under which disease may appear, or to form any correct nosological system. "There are two ways in which the bodily structure of man may be described. We may speak of it as being composed of distinct sets of structures, as of those which are comprised under the terms vascular system, and its appendages, nervous system, muscular system, and basal structure, which latter term comprehends the bones, the ligaments, and the varieties of membrane; or we may treat of it after the manner of geographers, as consisting of the head, of the neck, of the thorax, of the abdomen, and of the upper and lower extremities; subdividing each of these parts, and enumerating the several contents of each. An equal degree of mischief may result from each of these modes of considering our structure. For whichever mode we adopt, we acquire a habit of considering each portion which we enumerate as a distinct and insulated part. The consequence is, that when any deviation from the healthy state occurs in any one of the subdivisions which we have made, our attention is fixed upon the diseased condition of this particular portion of the body, while every other portion is supposed to preserve its former healthy state. Thus, those who have adopted the first mode of considering our bodily structure speak of diseases of the nervous system, diseases of the vascular system, and diseases of the muscular system. In so doing, they are incorrect, inasmuch as a disordered state of either of these systems implies also a diseased condition of each of the other systems. "Those, on the other hand, who adopt the latter mode of regarding our bodily fabric, speak of diseases of the head, of the chest, of the abdomen, of the skin, &c. They subdivide these into diseases of the cranium, of the cranial brain, of the lungs, of the heart, of the liver, of the stomach. of the bowels, of the spleen, of the pancreas, and so on. These persons act incorrectly also ; because, inasmuch as, in each part which they enumerate, there are portions of the general nervous system, and of the general vascular system, it is evident that each part cannot be considered as a distinct insulated republic, but as a constituent portion of the general commonwealth, whose health is dependent upon a certain condition of every portion of the body." P. 143-4. Were it possible to construct a correct nomenclature of diseased states of the human body, it would be truly desirable; but in our present state of knowledge, that is impossible. If the symptoms of disease were universally attended to, and not the name, more correct and fortunate practice would result therefrom. Dr. N. perfectly coincides in opinion with those who will not allow dropsy to be a disease, but merely a consequence of various deviations from the healthy state. Indeed, ascites or anasarca, succeeding scarlatina, require very little medicinal treatment, provided the lancet has been used in the onset. He strenuously admonishes the practitioner to guard against being governed in his practice by any nosological system, but seriously to attend to the symptoms as they present themselves, and to the junior members of the profession, in particular, we would recommend the following for their perusal. "We must attend to every symptom, carefully investigating the causes of each, and from a general review of all the symptoms, and of all their several causes, we must endeavour to detect the primary source of the general disturbance, of which the symptoms are merely the sensible effects. The symptoms will be our guides in this research; and, as soon as we have discovered the object of our investigation, those guides should be dismissed from our notice. For in vain shall we combat effects, if the cause remain unsubdued." 153. Annexed to these elements of pathology are three appendices; the first is an analysis of the phenomena of fever; the second are remarks on inflammation; and the third are aphorisms respecting absorption. So much of late has been written both upon fever and inflammation, that we must refer our readers to Dr. Nicholl's work that they may duly appreciate it. After reviewing the several causes from which the symptoms of fever may arise, Dr. N. thus sums up : "It appears, then, that the several states which give rise to the several symptoms which accompany the progress of fever, may be arranged thus: In the Early Stage. At the Height. In the Decline. "Diminished sensibility Increased sensibility of Diminished sensibility of the nervous system. the nervous system. of the nervous system. Diminished action of the Increased action of the Enfeebled action of the heart. heart. heart. Contracted state of the Increased flow of blood Relaxed state of the small small arteries. through the smaller arteries." arteries; the opposi- P. 177. "The commencement and progress of fever are not always characterized by the train of states which have been laid down in the foregoing analysis. In some instances the symptoms which usher in fever, are such as denote the existence of increased sensibility of the nervous system, which may arise from an erethismal, or an inflamed, condition of the cerebral structures. The second stage of fever will, in these cases, be constituted by states similar to those which ushered in the attack; the difference being, that in the second stage they exist in a greater degree, and to a greater extent. The first and second stages of fever in these cases, then, differ in degree, not in essential character. The increased sensibility, in these cases, may proceed from erethism, to which inflammation may succeed, or the inflammatory state may exist from the commencement. The third stage, in these cases, may be characterized by states, similar to those which have been already pointed out as occurring in the decline of fever." 184. The brief sketch which we have thus presented to our readers, we trust, will be a sufficient inducement for our brethren in the profession to have recourse to the work itself, in order that its merits, of which it possesses no small share, may be duly appreciated. X. Practical Observations in Midwifery; with a Selection of Cases. Part I. By JOHN RAMS BOTHAM, M. D. Lecturer on Midwifery, at the London Hospital, and one of the Physician-Accoucheurs to the Lying-in Charity for delivering poor married Women at their own Habitations. London, 1821; 422 pages, octavo. NONE of the charitable institutions, with which this metropolis abounds, are more deserving of praise than those established for the relief of parturient women. More than five thousand poor females pass through the "pains and perils of child-birth" annually, under the care of the midwives belonging to the Charity to which Dr. Ramsbotham is attached. This immense number of patients must render difficult and important cases of frequent occurrence, and afford the medical officers the most ample opportunities of observing every variety in the process of parturition. The obstetric art has thus been brought to such a state of maturity, that little improvement can be expected, excepting from those who are engaged in the most extensive practice of it; and we are happy to find that they, whose office it is to assist the birth of mankind, and to relieve some of the miseries, and avert some of the dangers, to which the fairer sex is exposed, are not less zealous in the cause of science than their brethren who have adorned the other branches of the profession by their exertions in our hospitals, fleets, and ar mies. The author of the work before us sets out with a brief description of the gravid uterus, the parietes of which he says are neither muscular, tendinous, cartilaginous, nor membranous; but consist of a structure sui generis and peculiar to that organ. He next proceeds to describe the process of parturition. He very justly observes that the more gradually and slowly the body and limbs of the child are expelled after the passage of the head, the more perfectly does the uterus contract. This was particularly noticed by Mr. White of Manchester, who advised the expulsion of the child to be retarded in quick labours, to promote and expedite the separation of the placenta. After the birth of the child it is an excellent rule for the accoucheur to lay his hand upon the abdomen of the patient. He thus avoids the disgrace of leaving her undelivered of a second child in a twin-case; and is enabled to ascertain the degree of contraction the uterus has undergone. The expulsion of the placenta should be left as much as possible to the efforts of nature; but if these should not be sufficient within one hour, it will generally be found that the afterbirth has been detained by some unusual cause, and to require a manual extraction. The occurrence of hæmorrhage might render an earlier and more hasty separation of the placenta requisite; and we know, from experience, that when it has formed a morbid adhesion to the uterine parietes, an occurrence which sometimes happens even in the hourglass contraction, it is not essential to our ultimate success for us to harass our patient with attempts to detach all the straggling portions of it which have unavoidably been lacerated, especially when they adhere with firmness, and are of a volume too small to be grasped with the fingers. The contractile effort of the uterus, which continues after the expulsion of its contents, is generally attended with pain, particularly after the second and subsequent labours. When the pain is distressing an opiate may be given with advantage, in such a dose as merely to moderate its violence; but, when the after-pains continue beyond the second day without fever, we have invariably relieved our patients by giving them an active purge. From this practice Dr. Ramsbotham has also seen the best effects. A few days after delivery the lactary secretion is established. Dr. Ramsbotham's sentiments on the subject of suckling exactly correspond with those which we have always held. "A voluntary refusal to suckle on the part of any woman evinces a want of the tenderest feelings, and of maternal affection for her new-born babe. But it does not merely implicate a dereliction of duty; it likewise involves an evasion of the strongest impulses of the human heart: it occasions a transfer of filial affection, gratitude. |