It is hurtful in the inveterate forms of scrofulous ophthalmia, though useful in the early stage. It is bad in the amaurosis of depletion.

It is useful in puerperal peritonitis, and hurtful in the typhoid form of it; as also in the ulcerative stage of dysentery.

In general, it is doubtful in the suppurative stages of inflammation, and in all erysipelatous and erythematous inflammations, or those tending to gangrene. It is hurtful in all cases of pure asthenia from deficiency of red blood." " 222.

The oxymuriate is sometimes preferred to calomel.

Turpentine. Dr. F. has no experience of this remedy. Most patients have an unconquerable loathing of it, and indeed we wonder how any puerperal woman can get it down or keep it down.

Vesicatories and Diuretics are useful auxiliaries-the former after proper depletion. Dr. F. has tried Dr. Stevens's celebrated mixture, without effect of any kind.

"There still remain a few points of interest which I will very briefly dis

cuss.

In the complicated form of puerperal fever, the deposits' which take place in the limbs and eye, require much attention in the treatment. If there be constitutional vigour, or if the part be affected early in the malady, leeches may be applied. They are contra-indicated when these disorganising processes appear in frames enfeebled by disease or constitutional causes. Two or three examples are recorded in my tables, where a few leeches applied, late in the disease, caused immediate sinking. The local inflammation is, even in the very last moments of life, exceedingly painful, and seems to demand depletion; but, unless the whole state of the patient be taken into the account, a dozen of leeches will turn the vibrating scale from life to death.

It is when the eye is attacked that leeching will be oftenest useful. When the seat of deposit is in the cellular and muscular portions of the limb, it should be covered either with a linseed-meal poultice, or with flannels soaked in decoction of poppy and camomile flowers. The ease obtained is very great; the swelling subsides in many instances entirely, leaving the limb unscathed; in others it is removed in every part but two or three spots which are found to be puffed out with pus, which should be evacuated. Where deposition takes place in a joint, the treatment by leeching and poulticing, will sometimes arrest its disorganisation: in all it will give ease. But there is a tardy convalescence to be looked for, and, even with the best surgical attention, it is often impossible to prevent the loss of motion of the affected limb.

There is another effect of this fearful malady, which I have remarked, but never seen described. Persons who have recovered from an attack of puerperal fever, apparently of no great urgency, often do not regain health for several months, nay, even for one or two years. Their pulse continues rapid and irritable, and scarcely an evening passes without slight febrile excitement. In some, boils or abscesses break out from time to time; in others, the mucous membrane of the intestinal canal is affected by the presence of a painful spot, or by great irritability, and the consequent variation in the quantity and quality of its secretions. In all there is much emaciation.

This state of constitution is often produced after exanthematous fevers, and I have known it occur in two instances after puncture from dissection. As yet I have seen no fatal termination to this very distressing, and, to the friends of the patient, and the patient herself, alarming state of things. The plan pursued by me, in its treatment, has been,-1. A sustained course of sarsaparilla and mercurial alteratives. 2. The warm bath twice a-week. 3. A change of cliNo. LX. К к

mate and the use of some of the foreign mineral waters, selected with reference to the peculiarities of the case.

Besides this insidious state of chronic disorder, there is recorded, by most authors, a more obvious derangement of health, the consequences of the effusion into the peritoneal cavity. In these cases the patient either sinks from hectic, or the effused fluid finds a vent through the abdominal parietes. I have, in some five or six cases, remarked the following coincidence, viz.,-The subsidence of a tumid abdomen, and the evacuation, through the vagina, of sero-purulent fluid, in such quantity, as to give the patient and nurse the notion of the bursting of an internal abscess. On examination I could detect no uterine lesion and no perforation.

Could the fluid, effused into the peritoneal cavity, have escaped through the fallopian tubes into the uterus, and thence into the vagina?" 228.

A considerable number of dissections follow, and several valuable statistical tables close the work-a publication which few practitioners will fail to peruse and study, after the full and careful analysis which we have presented them. The ingenious theory which our author has adopted rather than invented, cannot fail to excite one reflection-and that not a very consolatory one, in every thinking mind. Over the primary, the essential cause of puerperal fever, we have no control! We cannot prevent the contaminating matter or miasm from draining into the blood-nor can we neutralize or decompose it when circulating through the body. All we can do is to attempt to counteract the effects which the poison produces on different tissues and organs of the body-but without knowing any specific remedies for such counteraction! We know, to our cost, that the disturbances and diseases roused into action by the febrific miasm of puerperal fever, whatever that miasm may be, are infinitely more unmanageable, and more dangerous in their results, than inflammatory or other lesions arising from other causes. Thus the practitioner is surrounded with doubts and difficulties on every side, and the theory here advocated is unequal to the task of extricating us from the labyrinth-even by the ingenious clue which it furnishes. It is always best, however, to know the TRUTH, whether that truth disclose or not the remedy for the evil. In taking leave of our highly-gifted author, we tender him our best thanks for the pleasure and information which we reaped from a perusal of his volume. Ferge pede quo cepisti.

PRACTICAL OBSERVATIONS ON THE CAUSES AND TREATMENT OF CURVATURES OF THE SPINE. By Samuel Hare. 1838. An analysis of this book, addressed as it is more to the public than to the profession, would be misplaced; but we will glance at one or two of the opinions of the author.

After speaking of curvature of the spine in general, he treats of the various forms in which it may shew itself, viz. lateral curvature, angular curvature or projection, excurvation, and incurvation. We notice as a defect, that he has not sufficiently distinguished the essential differences between these, but has treated them as mere varieties of the same disease, distinguished from each other rather by the difference of the curve, than by

any essential difference in the nature of the affections producing them. Thus, lateral curvature, from the tenor of his observations, would seem equally to be a result of disease of the spine, properly so called, as is angular projection certainly, he does mention that the latter generally arises from caries, but he does not sufficiently dwell upon the difference of the nature of the former; but rather, by making general observations, which may be applied to either, would lead a reader (and especially an unprofessional reader) to infer, that he considers them, not as distinct diseases, but as varieties of the same; nay, after a careful perusal, we are unable to say, that the author does not consider setons, blisters, &c. as applicable to one of these as to the other. Indeed, the term diseased spine, applied to the simply distorted spine from lateral curvature, we consider as objectionable, confounding it, as it does, with the very different affection usually known by that name, and thus giving rise to erroneous views of its nature and treatment.

Mr. Hare considers, that lateral curvature arises from a softened state of the bones, produced by a prior state of deranged health, and acted upon by undue pressure, whereas it is well known, that at first, at least, the bones are in their natural condition: he lays, also, too great stress upon the pushing or compressing effects of the stays upon the spinal column and upper extremities, as a direct means of producing the distortion: not that this detestable instrument of torture can be well too-much blamed or criticised, but our condemnations and criticisms are forcible and effectual only in proportion as they are justly and judiciously directed: and thus the chief burtfulness of this article of dress arises, not from the immediate effects of the pressure it itself exerts upon the spinal column, &c., but, from the enfeebled state of the muscular supports of the spine, (the natural stays of the body,) it engenders, by the inaction it obliges. Without pretending to be much versed in the history of the toilet, we think we may assert, that the laces of our modern belles are not drawn tighter than those of their predecessors were wont to be; but their being less engaged in domestic and active occupations, and more and more sacrificed to the modern mania for booklearning and accomplishments, entailing upon them nearly continual confinement, and most irksome and unvaried positions, will serve to account for that alarming increase of twisted spines observed of late years.

The author's chapter on treatment is but a meagre affair, for besides some obvious directions, as to the attention required for the general health, he seems to confine himself to the recommendation of the use of his "apparatus," which he declares to be applicable to the treatment of all kinds of curvatures, and even to the relief of cases of spinal irritation; but how long this apparatus requires generally to be continued-how its use should be modified for some cases, or forbidden for others (if any), he informs us not: and indeed we must infer that, for its successful application in cases usually considered as requiring very varying treatment, the personal inspection of its inventor would be necessary. We had intended transcribing his description of this apparatus, but for the mere purposes of criticism it is too long, and we will only advert to its nature, and the objects he has in view in employing it. It consists of an inclined plane, having pullies arranged in different directions, to which are attached weights, and straps for making extension between the head, axilla, and ankles, and sometimes from one or

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both shoulders, while compresses may be so adjusted, as to make the desirable degree of pressure on the projecting spine, sternum, hip, or side, as the case may be. The author thus sums up the objects he has in view: the italics are our own.

"1st. By means of the inclined plane and extension, to bring the bony structure of the body into as near a form of symmetry as may be, and, of course, to keep it in that state.

"2nd. By medicinal treatment, to improve the general health, forward the deposition of osseous matter in the bones, and assist Nature in establishing the healthy functions of each organ.

"3d. By friction and shampooing, as a substitute for exercise, (he says elsewhere confinement absolutely necessary,') or in some cases by hand-swings, and other gymnastic exercises, compatible with the first object of treatment, to develop the muscular structure.” 127.

Few, indeed, would be the cases of lateral curvature in which we could consent to condemn a patient to this stretching and pushing practice, considering it as we do, not only as unscientific and injurious in its nature, but also as negatively hurtful, by consuming much time, (many hours daily being passed upon the plane,) which might be employed in well-directed exercises. Even supposing, that by these means the spinal column could be drawn or pushed into its natural position, yet, afterwards, in order to retain it there, powerful muscular supports are as necessary as ever, and in the enfeebled state of the system, found in these cases, these are only to be generated by judicious, varied, regular, but not exhausting exercises, followed by simple horizontal repose. We doubt whether much good can ever be accomplished by machinery after the deformity has become fully formed, while, for the prevention of its progress in the early stage, there can be no question, that to such means we must not resort, but seek by free exercise, and an absence of fatiguing or injurious positions, to avert the threatened mischief. The reader will find some excellent observations upon this subject, in one of Mr. Lawrence's lectures.*

ment.

It can never be urged too often upon our medical brethren to use their utmost influence in their respective walks in life, to prevent, as far as in them lies, the farther increase of this terrible infliction upon modern refineMuch may be done by their advice, judiciously given, and strenuously urged: often by it they may procure a degree of immunity from corporeal restraint in early life, which will materially aid the frame in resisting afterwards the tyrannic grasp of fashion. The following note of the author is injudicious:

"It is a mistaken opinion, and attended with some degree of injustice, to attribute the prevailing cause of this extensive and distressing evil to the customs and discipline adopted at public (?) schools: the cause is in operation, and the disease generally commences long before the period at which children are accustomed to leave the parental roof. A remark of this nature seems the more necessary, as the conductors of ladies' seminaries have often a degree of censure cast upon them, which they by no means deserve.” 66.

Viewing the affection, as we do, as generally resulting from deficient

* Medical Gazette, Vol. VI. p. 612.

muscular exertion, too close confinement, and the maintenance of irksome postures, we are convinced that it very often originates, and is always aggravated, by the discipline observed at ladies' schools, than which, one more destructive to health we cannot imagine: true it is, that parents are ultimately the cause of this, by cruelly and absurdly requiring so much to be taught to their children. That some governesses wish to emancipate themselves from these prejudices we know, but that the great bulk encourage them everybody knows: in fact, the present race of governesses, from their total ignorance of the first principles which should direct their physical education, are totally incapacitated for taking charge of our female youth. The crying want in this country is, instruction for the instructors. An observation is requisite upon the proposal for treating the angular curvature or projection.

"The necessity of early attention to the treatment of angular deformity will be sufficiently evident from the consideration of the state of the vertebræ : after the softened portion has suffered compression for some time, the bodies become absorbed, ossific matter is thrown out, which unites and consolidates the approximated surfaces of the bones in the position in which they happen to be placed hence the absolute necessity of attending to the state and position of the spine in the earliest stages of the disease. If the ossific matter be allowed to accumulate upon the vertebræ, while the column is in a distorted form, the process of restoration will evidently be difficult, and altogether inefficient: but if it receive early and requisite attention while in a soft state-if it can be made straight, and kept so sufficiently long for the ossific matter to deposit itself in the vacant space, an anchylosis free from deformity, or nearly so, will be the result." 90.

We think our author will find few medical men who will be willing to follow his suggestion, of keeping a spine, in which a removal of bone has occurred, stretched upon an inclined plane. In the early stages, where antiphlogistic and counter-irritant means are required, to avert or arrest the mischief, although the patient must be kept perfectly quiet in bed, yet who is there would stretch him on an inclined plane? Suppose that the disease has advanced, even to the destruction and removal of more or less of the bodies of the vertebræ, who is there, aware that this bone will not be reproduced by insisting upon a forcibly extended position, would frustrate the mode of cure that Nature herself adopts? namely, the falling together and anchylosing of the vertebræ, which bound the chasm above and below, thereby compensating for the loss of substance; but, by these very means, necessitating the angular projection. Suppose the patient is not seen until angular projection has been thus formed, who, by extension and compression, would seek to restore the uniformity of the spinal column, at the expense of risking the integrity of its canal?

In a concluding chapter, Mr. Hare gives us his ideas upon pulmonary consumption: want of space prevents our pursuing this subject; but, that his opinions are amply open to criticism, the reader will believe, when we inform him that the author considers the disease rarely if ever hereditary, but as originating in prior inflammatory attacks; that it is a more or less curable affection, while a most excellent preventive consists in three months' confinement to his apparatus, thereby expanding the chest, straightening the spine, and improving the general health!