a few passages, and present a few specimens of the matter and manner.

Our first extract shall be from the section on protracted labours; and we fear our author, even in these enlightened days, has not much overcharged his sketches.

"Within the whole range of obstetric science, there is nothing which so much distinguishes the judicious practitioner from the man who disgraces medicine, as the management of protracted labours. One man, by incessant meddling, produces rigidity of parts, and even inflames the os uteri so that his patient through his folly shall suffer from a most painful and protracted labour.

"Another, officiously interferes with the beautifully simple and admirably adapted process of nature; and presumes that, by rupturing the membranes as soon as he can detect them, or by using his lever on lever principles, by which many women are rendered wretched for life, he shall accelerate parturition.

"A third, urges his patient to be constantly taking stimulants, such as wine and spirits; or to employ voluntary exertion, under the cant terms of holding in her breath and forcing down ; whilst the os uteri is not dilated half enough to permit the head to be forced through, and the consequence is, that the woman becomes so exhausted by useless exertions, that she at last has not power enough to expel the child, and instruments must be had recourse to.

"Another practitioner allows the head to remain through hours and days of laborious parturition in a position which will never permit it to pass through the pelvis, until the mother is worn out by fruitless efforts; though the malposition might have been rectified at the commencement of labour without difficulty.

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"A fifth, is altogether unconcerned about the condition of parts, until the head has been so long, and so firmly wedged in the superior aperture of the pelvis, that mortification follows.

"To complete this mournful series of portraits, every one of which is drawn from a living character, another, instead of waiting for uterine action to throw off the placenta, will pull at the funis as at a cart rope, until the uterus is inverted, or formidable hemorrhage follows; and when, as a consequence of his meddling, the uterus is filled with coagulated blood, and it strives to empty itself by strong contractions, which are called after-pains, he will strive to counteract the salutary operation, by exhibiting large doses of opium to quiet these pains, which are intended to repair the mischief he had himself produced. These sketches have not one shade too deep, and they are but a sample of those practical evils, which are of almost every day occurrence." 77.

We observe at page 167, that Dr. Conquest speaks in high terms of the long forceps, as an "invaluable instrument," but little known and much less estimated, or it would be employed by accoucheurs as a most important substitute for the perforator and crotchet, in many of those cases in which children are now destroyed."

"This instrument is principally applicable,

"First, to those cases of deformity at the brim of the pelvis, in which the diminished capacity of the pelvis is from sacrum to pubes, and yet so slight, that a little power beyond what the uterus can employ, would expel living children, which are now almost universally sacrificed at the shrine of prejudice. It is applicable, Secondly, to those cases of hæmorrhage, convulsions, &c, in which the head of the child is resting on the superior aperture of the pelvis, and in which delivery being essential to the well-doing of the mother, is now usually effected by opening the head of the child.

"The long forceps in contradistinction to the short ones, aré to be applied over the occiput and face of the child, so that the convex edges of the blades may correspond to the concavity of the sacrum.

"When used, the power may be exerted laterally, or from side to side, with moderate traction, remembering that the axis of the brim of the pelvis requires the handles to be kept backwards towards the os coccygis, but as the head descends, its most favourable position in relation to the pelvis must be secured.

"It has been extremely gratifying to myself and to several highly esteemed friends, to have been by this means instrumental already in rescuing not a few children whose heads had been condemned to be opened." 108.

The preferable mode of procuring premature labour, where that event is desirable, consists, our author states, in gently carrying the forefinger of the left hand through the os uteri, and then passing it round and round within the os and cervix uteri, so as to detach the decidua. By this mode the membranes are left entire, so that the foetus cannot be destroyed by pressure, (as is the case where the membranes are ruptured,) and the mouth of the womb and vagina are gradually dilated by the protrusion of the liquor amnii performing its wedge-like office, as in natural labour. Parturition usually commences in from twenty-four to ninety-six hours, and the management of the case depends on the nature of the presentation.

On the subject of spontaneous evolution of the foetus, our author thinks that it is rather "a doubling of the foetus, so that the arm changes its situation but very little, perhaps not at all, whilst the nates are forcibly expelled before the upper extremity." Our readers will see that this corresponds with Dr. Gooch's ideas, in our last number.

The section on uterine hæmorrhage contains a great mass of important, judicious, and valuable matter. We must close this article with the following extract:-

"The exhibition of very large doses of opium, to restrain uterine hæmorrhage, has been recommended by several deservedly eminent accoucheurs.

"Both reason and experience appear to concur in condemning Vol. II. No. 5.

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this practice; for whilst it is admitted that under some circumstances opium is highly beneficial, its indiscriminate employment is undoubtedly fraught with mischief.

"The result of calm and dispassionate investigation on this subject is, that opium in large doses, in cases of uterine hæmorrhage, generally does harm, by paralyzing the contractile energies of the uterine and arterial fibres; and that this valuable medicine is useful, and only useful under the existence of some such circumstances as the following:

"It is decidedly beneficial, when hæmorrhage has gone on until the vital powers have become reduced extremely low; and when, with other symptoms of exhaustion, the stomach manifests great irritability.

"It is no less valuable an agent, when hæmorrhage is the consequence of irregular contraction of the uterine fibres, whether of the circular or longitudinal.

"In either of these cases, it is a very efficacious article of the materia medica; but it appears most dangerous to attempt to maintain its utility, or to rely on its efficacy in cases of active and alarming uterine hæmorrhage.

"When exhibited under the before-mentioned circumstances, to secure its full effect, it is necessary to give it in doses of four or five grains, repeating it every second or third hour whilst necessary, with a diminution of one grain from each successive dose." 169.

The foregoing extracts do not do justice to the little volume before us; and any attempt at a regular analytical delineation would be doing it a still greater injustice. We remember well the time when, in the early years of our obstetric practice, we should have considered this pocket reference, on puzzling occasions, in the lying-in room, a most welcome treat. As such we recommend it to the young practitioner ; while to the more experienced accoucheur it will prove a useful remembrancer.

ARTERIAL INFLAMMATION.

IV.

1. Quelques Observations pour servir à l'Histoire de l'Arterite, ou Inflammation des Artères. Par M. DALBANT, a Paris. Juillet, 1819.

2. M. VAIDY in Journal Complimentaire. Août, 1819. 3. M. VAIDY in Revue Medicale. Mai, 1820.

INFLAMMATION is an abstract term employed in medical philosophy to express WHAT is generated in a living part by the influence of certain causes whose particular effects determine inordinate action in the nervous and vascular organs of that part. This WHAT is not an entity, a thing, because

it does not exist as an essential substance: it is a condition, a state, because it consists in the external qualities of the living part which is its seat; and it is a morbid state, because it depends on the presence of new and unnatural or unhealthy accidental differences introduced into the external qualities of the part, by whatever agent may be their determinative cause. Inflammation, then, is a morbid state, a disease, dependent on the circumstances of organic matter; and, consequently, is not peculiar to the human race. Animals, throughout all their tribes, are exposed to suffer from any of the modifications which its varieties may assume. Being thus uninfluenced by the conditions of man's intellectual nature, its manifestations appear only in the derangements of his vital actions, and his organic structure alone can become the subject of those phenomena which attend the developement of inflammatory disease.

Vascular inflammation is produced by those causes which determine irregular action in the nerves and vasa vasorum, or vessels whose function is to supply and maintain the structural elements of the lymphatic and sanguiferous organs. Our present researches, however, shall be restricted to an investigation of the distinctive forms, and their pathology, as existing in a morbid state of the arterial tubes.

Arteries, being composed of the elementary principles peculiar to all the diversities of animal structure, are consequently exposed to the same morbid changes in their vital actions. Inflammation of these vessels, previously to the time of those authors, from whose writings, and the records of our own experience, we propose to select the materials of this article, had been as unfrequently noted as it was imperfectly described. We shall, therefore, be somewhat particular in our endeavours to illustrate its causes, nature, and influences; hoping that these our labours may, in some. degree, contribute to the better understanding of an untractable disease.

I. ETIOLOGY. Arteritis may be modified, in its nature and degree, by a variety of causes which predispose the arterial textures to become the seat of inflammatory action. Among the predisponent causes may be enumerated-the plethoric idiosyncracy-indulgence in the use of rich foods and drinks. -influences of climate-effects of inflammatory and febrile affections-suppression of established periodical or permanent discharges, especially the sanguineous-reiterated paroxysms of convulsive, spasmodic, and other nervous diseases--unrestrained sway of the irascible passions--intemperate and luxurious habits of all kinds, particularly such as

possess a tendency to induce or confirm an excess of action in the chylopoietic and sanguiferous vessels.

Arterial inflammation is often complicated with other organic diseases; and, not unfrequently, it arises from causes whose progressive operation cannot be retraced. It may be determined by compression, insolation, congelation-by punctured, incised, contused, and lacerated wounds, originating from chirurgical or traumatic agency-by vital exhaustion, mental agitation, violent and forcible exertion, atmospherical vicissitudes-by the mechanical or chymical effects of extraneous substances, solid, fluid, or gazeous— by contact of other morbid organs-and by many of the exciting causes from which particular inflammations proceed.

11. SYMPTOMATOLOGY. Arterial inflammation often completes an insidious and fatal course without its existence being ever indicated by the presence of one distinctive sign. The traces of its ravages, in such it:stances, remain for ever unknown, or, by the researches of pathological anatomy, are incidentally detailed and explained. Our own limited observation inclines us to conclude, that its origin and formation are many times obscured by the indefinite nature of its symptomatic effects. Sometimes, especially when its determining causes escape notice, its symptoms are indistinguishable from those by which the fever, called synochal, is accompanied in other cases, they differ little from those-connected with sub-acute or chronic inflammation of the larger abdominal and thoracic organs. When the disease, however, resigns the latent, and assumes a manifest, character,

progress is not different, and its symptoms vary not, from those which mark it when consecutive to an ascertainable or violent cause.

Early in the disease, if its developement is not sudden, the patient is restless, impatient, watchful, irritable: he experiences partial flushings, which gradually increase both in frequency and extent: his bowels are inactive, but his pulse is imperceptibly affected. By and by, he complains of a deep-seated pain in some part of the abdominal or thoracic regions, and seldom fails to describe it as being hot, lancinating, spasmodic, and increased by slight exertion. Disturbance of the vascular system now supervenes : respiration is accelerated, and the breath feels offensive from its heat. The mouth, however, remains humid, the tongue red, the lips moist and natural. Rigours at last are felt; and, as the disease advances, the internal pain becomes more diffused. The original flushings give place to a true febrile