a blow from a fist on the abdomen. set in, which disappeared in four days. In the fifteenth and sixteenth months menstruation returned, and then an illness, probably a light typhus. When examined, a fœtal head was felt above the navel; the uterus, bent backwards in the pelvis, appeared slightly enlarged and empty. The patient rejected an operation. In August, 1855, an intense erysipelas appeared on the abdomen, and soon after two fistulous openings in the navel, out of which flowed a sanious discharge, and, six months later, hair. The abdomen grew less, and exploration with sounds revealed a decomposing foetus. On the 25th September, 1856, the fistula was enlarged by a crucial incision, and the separate bones were gradually extracted. The patient lay in a precarious state for some time, but gradually she recovered. The cyst contracted; the fistula closed in December; the menses reappeared.

At the end of the term of gestation pains

3. Dr. Harris's case of Fallopian pregnancy. Mrs. Saged twenty-seven, mother of an infant a year old, being apparently in perfect health, was suddenly seized with excruciating pain in the lower abdomen, and faintness, followed by collapse. Death took place in twenty-one hours.

Autopsy-The cavity of the pelvis, as well as the lower and back part of the abdominal cavity, was filled with black blood, partly fluid, partly coagulated. The uterus was scarcely enlarged beyond the size of women who have borne children. Its cavity contained a little mucus, slightly tinged with blood, but no trace of a decidua; the ovaries were healthy, of normal size, very pale in colour (anæmic). In the right Fallopian tube, immediately above the ovary, was a tumour of an oval form, slightly flattened antero-posteriorly, about 1.25 inch long, one inch in vertical diameter, and of a reddish blue colour. A small opening, of a little more than a line in diameter, was detected at its upper surface, perforating the edge of the broad ligament. This tube communicated with the peripheral portion of the body, but not with its interior cavity. An incision made through the cortical portion, so as to divide the body to its centre, revealed a cavity containing a small diaphanous sac, within which was an embryo of a pure white colour, 50 inch long, looking a good deal like a common maggot. ovum was supposed to be of about three or four weeks' gestation. The patient was menstruating at the time of the fatal rupture.

The

[A point of interest in the case, as bearing upon a much disputed question, is, the recorded absence of "membrana decidua" in the uterus. This question appears to the Reporter to turn upon the question, What is the "membrana decidua"? If we conclude with Hunter, that it is a new plastic substance thrown out like the false membrane in croup, then, indeed, we need not be surprised at failing to find it in a uterus one month after conception. And if we look upon it in its true light, as the developed mucous membrane of the uterus itself, then, also, we need not be surprised at not finding, at so early a stage, anything more than mucous membrane, as yet too little altered from its usual appearance to strike the observer as a distinct membrane. The search is for a hypothetical entity, therefore the search fails. Seek for the real entity; it will be found.-REPORTER.]

III. LABOUR AND PUERPERAL STATE.

1. A Case of Epilepsy in a Pregnant and Puerperal Woman. By PROFESSOR HOHL. (Monatsschr. f. Geburtsk. October, 1857.)

2. Starvation of an Infant from Paralysis of the Facial Nerve. By PROFESSOR HOHL. (Loc. cit.)

3. A Case of Incision of the Labia Majora, with Rupture of the Perinæum. By PROFESSOR HOHL (Loc. cit.)

4. A Case of Adherent Placenta: Pyamia: Death. BY PROFESSOR HOHL.

Loc. cit.)

1. Professor Hohl's case of epilepsy in a pregnant woman is interesting. Auguste K., aged thirty, of a healthy family. In her fifteenth year first menstruated. The catamenia appeared only three times this year. In her sixteenth year, after a violent heat in the summer, she was seized with her first epileptic fit From this time the fits returned regularly every two or three weeks, but did not appear to stand in relation to the menstrual periods. Several months prior to her delivery it was apparent that, through the oft-repeated epileptic attacks, her mental functions had been impaired-her memory especially had suffered. During pregnancy, the fits had neither increased nor diminished. Received into hospital, the fits soon showed themselves; they were clearly epileptic. The face became much congested; the lips and eyelids were œdematous, the pupils without sensibility. No albumen was ever found in the urine. The foetal pulsation was heard; up to this time the fits had no effect upon the life of the child. It was remarkable that as the period of delivery neared, the fits increased decidedly in frequency. Five days before, two violent attacks; the next day, three. After the third day the condition in the intervals was quite changed. The patient no more recovered her mental or bodily strength. The cervix uteri was now nearly effaced. The head was freely moveable on the pelvic brim. As the fits now reacted injuriously upon the mother, delivery was determined upon. The uterine douche was used every two hours for fifteen minutes. After the sixth application, contractions began; but these ceased and convulsions returned. Bleedings, by cupping to the neck, and leeches to the head, had no influence in assuaging the symptoms. Cold affusions to head were used, and had the good effect of producing a quiet sleep through the night. Next morning labour-pains returned every quarter of an hour, and the os uteri expanded. On the following morning the liquor amnii escaped; a rather severe flooding ensued, which ceased during the expulsion of the child. The child was still-born. The placenta came in fifteen minutes. Immediately after the birth, another fit seized her, less intense than the preceding. Shortly afterwards, the body was convulsed every four or five minutes by strong electric-like shocks, which, after some hours, ended in death through coma.

Autopsy. The brain was very soft. The pia mater was easily detached, a little thicker than natural; between the membranes some clear serum; in the ventricles a tablespoonful of clear fluid. The skull was in places, especially on the frontal bone and on either side of the coronal suture, thinned and transparent; on the frontal bone were small puerperal osteophytes. In the rest of the body, particularly in the kidneys, the most careful microscopical examina tion discovered nothing abnormal. [This case is an example of puerperal convulsions, with oedema, and without albuminuria. In this country the attempt to deliver would have been commenced earlier, and persevered with resolutely, either by turning, forceps, or craniotomy. By one of these means the labour would probably have been effected thirty-six hours sooner. Would the mother have been saved? She would at least have had a better chance.-REPORTER.]

2. Professor Hohl has related, in his Report of the Lying-in Hospital at Halle, a case in which the death of a new-born child was brought about in a very unusual manner. A woman in whom labour was arrested, through complete absence of uterine contraction, was delivered by the forceps, the head lying in the pelvic cavity. In consequence of the pressure of the left blade of the forceps, there resulted a paralysis of the facial nerve of the left side, which resisted all treatment. By this the infant was hindered from suckling, since all the milk ran out of the corner of the mouth on the paralysed side. Everything, prior to being swallowed, had to be placed within the grasp of the muscles of the pharynx. The child was thus gradually reduced by atrophy, and died on the twelfth day

3. In a previous report, we gave an account of Professor Scanzoni's proposed 42-XXI.

.18

method for preventing the laceration of the perinæum in difficult labour, by making incisions in the labia majora. In a case in which this operation was resorted to by Professor Hohl in the Lying-in Hospital at Halle, although five incisions were made, the perinæum was torn notwithstanding. The incisions, says Hohl, had no other advantage than making so many wounds the more.

4. A case recorded by Professor Hohl shows that in certain cases of adherent placenta, complete extraction is impossible or dangerous; it also illustrates the consequences of this accident. A patient in the Halle Lying-in Hospital, delivered of an immature fœtus, was seized immediately afterwards with violent flooding. Attempt being made to extract the placenta, it was found that about three-fourths of it adhered to the uterus. It was about half detached, when the patient suddenly moved so strongly that the hand grasping a portion of the placenta was thrown out of the uterus and vagina. As the patient would not permit another attempt and the flooding went on increasing, chloroform was administered. On examination, it was now found that the os uteri was closed by spasm, effectually preventing the passage of the hand. Nothing but small fragments, thickly studded with chalk-concretions, could be extracted. On the following day, a purulent, horribly offensive discharge began, and a strong shivering fit, followed by heat and sweat, appeared. This was repeated on the second night, and again on the third. Collapse followed, with unquenchable thirst, severe headaches, dry tongue, delirium-in short, all the symptoms of pus-poisoning. On the fourth day there appeared, for the first time, pain on pressure in the left side; this increased with the exacerbation of the other symptoms. She died on the eleventh day, having first exhibited raging, subsiding into muttering delirium. Death set in with peculiar electric-like shocks. Autopsy-Considerable purulent exudation in the abdomen, and adhesions. In the uterus was a completely calcified piece of placenta the size of a walnut, intimately united with the uterine wall. The blood in the body was cherry red, and nowhere coagulated.

MEDICAL INTELLIGENCE.

The University of Oxford and Medical Students.

A LETTER by Mr. Pearson* to the Provost of Oriel has recently gone through two editions, in which it is proposed to offer certain facilities to medical students who wish to take their degree at Oxford. It has always appeared to us a strange anomaly that the most liberal of the professions should be almost ignored by the two largest universities of England, and that medicine should be left to shift for herself, in the pursuit of truth, while she so especially requires that otium cum dignitate for the prosecution of scientific research which the fostering influences of a rich university can bestow. We will not say that the science of medicine has thriven the worse for the neglect, but she has had to fight harder battles to secure her recognition by the State than would have been otherwise necessary, and quackery has been more rampant because the comparative exclusion of medicine from the universities has allowed gentlemen to become erudite classical and mathematical scholars without imparting to them an inkling of the logic of nature. While we rejoice that there is a prospect of English medical men becoming associated with their own universities, instead of being driven to other countries to obtain university distinction, we do so quite as much because we believe that the universities will

A Letter to the Provost of Oriel on a Scheme for making Oxford more accessible to Medical Students generally. By C. H. Pearson, M.A., Fellow of Oriel College, and late of St. George's Hospital. London, 1858.

gain as that medical students will profit. In fact, in order to secure a large accession of medical students to Oxford, it will be necessary not merely to diminish the period of residence, but to insure the means by which the student may go through his medical curriculum as completely and as satisfactorily at Oxford as at a London school. It appears to us an error to suppose that a small town is unfitted for a medical school. We would wish to see all medical schools transferred to small towns, because in them alone can there be that control over the young men, and that intercourse between pupil and professor which is one of the main elements in beneficial instruction. The opposing argument, that large hospitals are necessary, and cannot be supported in small towns, falls to the ground at once if we look to the comparative merits of some British and foreign schools. Many might be named that have been the cradle of great professional men, which do not boast of what are commonly called large hospitals. The principle itself is mistaken: the student is bewildered in large hospitals. It is much better for him that he should study diseases in a few well-marked cases, which will abide in his memory as types for comparison throughout his career, than that he should walk the hospitals in the desultory manner that yet prevails. It is not the hospital that makes the eminent student, but the professor; and, without drawing invidious comparisons with other professions, we may with pride point to the many distinguished names that adorn the roll of medical science who, without being supported by patronage or powerful aid, have succeeded in diffusing the greatest benefits of sanatory and sanitary science among their cotemporaries. But the system cannot be a just one which compels every votary of science to regard her only as a means to an end. It is most desirable that there should be some well-endowed professorships to which men of great ability may aspire, and which may enable the holder to devote himself exclusively to scientific pursuits, without the benumbing cares of earning the daily bread. The practical character of the English practitioner will doubtless always belong to the body of English medical men; but the crudities of empiricism may be softened down, and the general character of the mass of practitioners be elevated, by contact with other minds and by the consciousness that their science takes an acknowledged and equal place with the liberal professions.

We have not space to enter into the detail of the proposals embodied in Mr. Pearson's interesting pamphlet. We only wish most cordially to assent to the general doctrine involved in his plan-that medicine should be duly represented at the ancient English universities. But we go further than Mr. Pearson and his friends, for we think that, by a slight extension of their plan, the benefits of a university education may be more fully secured to the medical student, and that, by encouraging and enabling him to go through his entire curriculum at the university, he will be in every way fitted to avail himself subsequently, if he have the spare time, of the greater opportunities of observation in the metropolitan hospitals. To the majority of London students this wealth now lies hidden; it remains not only unexplored, but unintelligible, though it is open to their eyes, because they do not possess that careful training which a London medical school can scarcely afford them. Let Oxford continue in the path of enlightened reform which she has recently entered upon, and we look forward with great confidence to an advancement of medical science hitherto unknown. That there will be crowds of young men able and willing to avail themselves of the opportunities offered them we do not hesitate confidently to affirm.

The Main Sewage Question.

Before entering upon the enormous expenditure which the great sewagenterception works would entail upon the metropolis, it is clearly desirable that the sanitary necessity of such a step be ascertained. We belong to those who

think that the maintenance of the public health merits any expenditure necessary to secure it. Still, in paying our money, we should wish to be assured of a certain return; and it is at least doubtful whether sufficient proof exists that the present system of discharging the contents of the sewers at different points into the Thames is productive of the injury to the public health which is the main argument for the necessity of the main drainage system. In the quarterly and annual reports of their medical officer of health, Dr. Barnes, recently issued by the vestry of Shoreditch, it is argued by the author, that the state of the health of those who live on the Thames and on its shores does not prove the river to be pernicious. Dr. Barnes observes that if the theory be true that the river exercises a deadly influence, it should be traced-1, in the severest degree, amongst those who live on its waters; 2, in those who dwell near its shores; and 3, that we ought to find comparative immunity from fever and diarrhoea amongst those who live at a distance from the river. Dr. Barnes maintains that the evidence on these points is wanting, while he calls attention to an illustrative fact, that "since the replacement of the old Dreadnought' by the present ship, now nine months ago, not a case of fever has originated on board this floating hospital." If fever be a test of prevalence and concentration of miasm, this fact has a strong bearing upon the question at issue.

While Dr. Barnes evidently tends to the belief that the main sewage plans are based on an error in principle, he admits that the "bed and banks of the Thames urgently need improvement, but on other grounds than that of increasing the self-purifying capacity of its water." He asks that the works necessary to insure these improvements be first carried out, and expresses his conviction that it will be time to consider further remedies when it is proved that these are insufficient in a sanitary point of view. We fear that, by adopting such a proposal, we should, if after all the main sewage system be found necessary, only be postponing, and thus enhancing, the difficulty. Our own opinion is, that there is great danger in limiting the discharge of the sewage of a town like London to one or two emunctories. The risk of a derangement in their working would be indeed great, as there would be no safety-valves by which an arrest in the discharge could be rendered innocuous; this, however, is a different view of the question from that proposed by Dr. Barnes. That a further inquiry into the sanitary evidence bearing upon the case is necessary cannot be doubted, and for this reason we bring Dr. Barnes' reports specially to the notice of our readers, though without pledging ourselves to support them.

BOOKS RECEIVED FOR REVIEW.

Quarterly Report of Medical Officer of Health for Shoreditch. Sept. 26, 1857. By Robert Barnes, M.D. London, 1857.

Part

The Medical Profession in Great Britain and Ireland. By Edwin Lee, M.D. II. London, 1857.

The Effect of Climate on Tuberculous Disease. By Edwin Lee, M.D. London, 1858. pp. 323.

Norsk Magazin for Lægevidenskaben. Christiania. Band xi. Hefte 9, 10.

The Boston Medical and Surgical Journal. Vol. LVII. No. X.

On the Pathology of Articular Cartilages. By Thomas Bryant, Esq., F.R.C.S. London, 1857. (Reprint.)

Catalogue of Human Crania in the Coldection of the Academy of Natural Sciences

of Philadelphia. By J. A. Meigs, M.D. Philadelphia, 1857.

Fourteenth Annual Report of the Managers of the State Lunatic Asylum. Albany,

1857.

The American Journal of Insanity. Oct. 1857.

Das Wesen und die Entstehung der Spondylolisthesis. Von Dr. Wilhelm Lambl. Würzburg, 1857. pp. 79.

Annual Medical Report of the Kent Lunatic Asylum, for the year 1856-7. Maidstone, 1857.

The Enlarged Prostate: its Pathology and Treatment. By Henry Thompson, F.R.C.S. London, 1858. pp. 320.

Transactions of the Pathological Society of London. Vol. VIII. London, 1857.