visited. But the best illustrations are to be found in the Centre Division. When this force broke up after the termination of the campaign, His Majesty's 24th Regiment of Dragoons, and 87th Regiment of Foot, and the 1st Battalion Sth Regiment Native Infantry marched to Cawnpore; where they were stationed in April and May, when the city and cantonment were suffering from the disease. At this time the 24th Dragoons remained quite free; His Majesty's 37th had two slight cases, among the recruits who had not been with the Centre Division, and no death; and the 1st Battalion 8th Regiment N. I. had, according to one statement, no case, according to another, one only, and according to a third, three or four, all slight attacks. The situation of the latter Corps was such, as to give additional proof of the immunity of bodies previously exposed not being accidental. For it so happened, that this Battalion was placed right between the 2d Battalion 15th N. I. and Craigie's Levies; both of which suffered severely, as not having earned the same means of protection. Camp followers of all descriptions were equally exempt; and one person only, an European Officer, who had been with the Centre Division, fell a victim to the disorder. In like manner, the 2d Battalion 25th Regiment Native Infantry, which again fell in with the disease in April, whilst marching from the Tiraee for Lucknow by Gorruckpore, then suffered comparatively little. It had indeed 25 cases and 5 deaths; but of these only one was a case of relapse or recurrence, and even in it the symptoms of both attacks were very mild. But a still more extraordinary instance occurred in Lord Hastings' camp, during the march to Gorruckpore, towards the latter part of the same month. The disease here first broke out among the followers of a gentleman, who had just joined the party; and in a few days attacked between 50 and 60, out of 400, chiefly of the class of bearers. It next got among the servants of several Gentlemen in the Civil Service then in attendance upon the Governor-General; and to the period of its decline, was confined to such persons, as had not been with the Centre Division. This could not be explained on any difference of situation; for the party daily changed ground, and the new comers were mixed promiscuously with those, who had been previously exposed to infection. Nay, it further appears, that after attacking the first party, the disease made a long stretch, and next shewed itself amongst other persons, not yet seasoned, in the opposite end of the line: leaving all between untouched. If any other proofs were necessary, we might cite the case of the 2d Battalion 3d Regiment, the greater part of which, having had the disease at Shergurh, were not at all affected, although stationed at Banda, when the town suffered severely. But enough, we think, has been already said, to shew, that the human frame, on being exposed for some time to the pestilential virus, got habituated to it, and in a great measure became insusceptible of its malignant influence,

There is reason to believe, that the lower animals were in some measure affected by the corrupt state of the air at this period. For it was observed in many instances, that an unusual mortality occurred amongst black cattle, sheep, dogs, and other domestic animals. Thus in the Backergunge District, cattle had the disorder, and were cured by opium and the other remedies found most serviceable in the human species. Cows when seized, shed their young. So, in Tipperah, great numbers of horned cattle and sheep were seized with vomiting and convulsions, and suddenly expired. In 1815 again, half the cattle of the lower part of Tipperah were carried off by a disease similar to Cholera. In Delhi, dogs died rapidly; and more horses than usual were carried off by the dry gripes. In the Rajpootana Force, and throughout the whole of the Jeypore

"In this city, a curious thing was, that large swarms of flies, which had infested the place before the breaking out of the Epidemic, wholly disappeared during its prevalence; and returned as it withdrew. This might be owing to the cold, sharp, westerly wind then blowing."

and Nagpore territories, the season was remarkably fatal to camels; and in the Centre Division, domestic animals of all descriptions died in great numbers; but in the latter instance the mortality might be ascribed to want of proper care and food. At Sumbhulpore, an Elephant had every symptom of Cholera; and was cured by brandy and laudanum. But the affection of brutes was by no means general. Thus in Dacca, Mymensing, Kajshaby, Nuddeea, Bhaugulpore, Tirhoot, Sarun, &c. the lower orders of animals are expressly stated to have enjoyed their usual health: So that the circumstance of their sickness in other quarters, during the prevalence of the Epidemic, may have been perfectly fortuitous." 195.

The last section is on the treatment of cholera. With this we need not occupy our readers. The following short summary conveys the result of the practice of our brethren in Bengal.

"1. The disease sometimes attacked with such extreme violence, as from the commencement, apparently to place the sufferer beyond the reach of medical aid, and to render every curative means employed equally unavailing.

2. The difference in the degree of mortality amongst those, who did, and those who did not take medicine, was such, as to leave no doubt, that, when administered in time, and with discrimination, it frequently saved the patient from death.

3. The chances of a patient's receiving benefit from medicine, diminished in proportion with the increased duration of the attack.

4. In Europeans generally, and in robust Natives, bleeding could commonly be practised, where the patient was seen within one, two, or perhaps three hours, from the beginning of the attack; and in all cases, in which it was resorted to, under such favourable circumstances, it was more successful than any other remedy, in cutting short the disease: usually resolving spasm; allaying the irritability of the stomach and bowels; and removing the universal depression under which the system laboured.

5. Amongst the generality of Natives, the depressing influence of the disease was so powerful, and rapid in its operation, as almost immediately to produce complete collapse, and nearly destroy arterial action: and, therefore, to render venesection, for the most part, from the beginning, impracticable.

6. In such cases the cure was best attempted by diluents, powerful anodynes, and stimulants; combined with calomel; and followed up by mild laxatives, and tonics.

7. Although it cannot be affirmed, that calomel possessed any specific power in checking the disorder, it was undoubtedly frequently useful in soothing irritability; and was, perhaps, of more certain sedative operation than any other medicine." 247.

Here we conclude. We shall make few remarks. We have placed the substance of all the Indian Reports before our readers, and they may form, as we have formed, conclusions from them. The bulk of the profession being now put in possession of these data, may proceed to the investigation of the disease as it exists in our own country, or in others, less cramped by ignorance, less fettered by prejudice than they would have been without them. For our own parts, we declare that we had rather know nothing of the disease, as it first shewed itself in India, than know it through the medium of the imperfect, patched, and garbled statements, which have abused of late the public ear. We have dedicated some trouble, some time, and some space, to procuring and reviewing these documents, and we deem no apology necessary to our readers for their re-publication. On the contrary, we conceive that we have

done a service to those who are anxious for sound information, correct facts, and narratives highly interesting to all, but particularly so to medical

men.

VI.

A MANUAL OF MIDWIFERY, OR COMPENDIUM OF GYNECOLOGY AND PAIDONOSOLOGY, &c. By Michael Ryan, M. D., &c. Small Octavo, pp. 737. Third edition, with plates, 1831. Price 12s.

THE talented and industrious author of this manual has rendered it totally impossible for us to analyze the work. It is itself a condensed analysis of most other works on the subject. Let himself speak.

"It has been long remarked that all our knowledge of any science might be easily compressed into a small compass, by confining it to a simple enunciation of fact and inference. It appeared to me that this principle might be applied with peculiar advantage to the Science and Practice of Obstetrity; and it was by a rigorous adherence to it, that I have accomplished this work. My object was to concentrate facts and opinions, to describe them in language as simple as possible, under such arrangement and classification as would afford the easiest reference to the immediate object of research." Preface.

Dr. R. alludes to the inconvenience which he experienced in the earlier years of his practice for want of such a compendium; and states that, from the flattering encouragement the first two editions have received in this country, on the Continent, and in America, he has been stimulated to spare no pains in preparing this impression with all the improvements of which it was susceptible. Every line of this third edition has been re-written, and carefully revised, referring, on all occasions, to the last editions of the standard works on midwifery.

"In publishing this compendium, my object has been to present students and young practitioners with a concise, yet comprehensive, view of the exact state of Obstetric knowl edge, by compressing into a small space all that is essential to be known upon the subject." ix.

Dr. Ryan has proposed a new nomenclature, which we hardly expect to see soon adopted, in consequence of the general disinclination to learn new names, of old things. We must give Dr. Ryan's nomenclature, however, the praise of being more classical and erudite than that which is in general use among obstetric writers. Whether it is entirely original, we have not time or inclination to enquire; but we take it for granted that it is, from Dr. Ryan's own assertion. Embryotomy, dystocia, and one or two other terms are, of course, adopted from preceding systems of terminology. Dr. R. claims the merit of being the first to change man-midwife into the more erudite name of obstetrician-and midwifery into obstetricy. Velpeau and others have adopted this improvement.

"The work is divided into four Parts, and each is subdivided into Articles and Sections.

The First Chapter is entitled Gynæcotomy, and comprises the Anatomy of the Sexual Organs of Women.

The Second Chapter is headed Gynæcophysiology, and is divided into four Articles; 1. Nubility; 2. Utero-gestation, or Pregnancy; 3. Delivery; and 4. Lactation, or the Period of Suckling.

The Third Chapter is entitled Gynæcopathology, and is divided into four Articles; 1. Parthenosology, or diseases of nubility, or of women in the unimpregnated state; 2. Encyonosology, or diseases of utero-gestation or pregnancy; 3. Distocia, difficult labour, or morbid parturition; 4. Lochinosology, or diseases of puerperal women.

The Fourth Chapter is designated Paidonosology, or diseases of infants and children." xiv.

As we have before observed, it is quite impossible to even attempt an analysis of such a work as this, displaying, as it does, the laborious research of years, and a solidity of condensation and concentration which we could not hope to equal, much less to surpass. All we can do is to strongly recommend a work which indeed has proved its own merits by arriving at a third edition, and to offer an ample specimen of the performance, taken at random, and by no means the most favourable sample which we could adduce.

"PUERPERAL FEVER-FATAL CHILD-BEd Fever.

It is become fashionable of late years to question the opinions of our predecessors, and in no instance more remarkably so than on the nature of the disease under consideration. There is no disease about which there is so much dissonance of sentiment as puerperal fever; many of the most eminent obstetricians in Europe and America entertain discordant opinions as to the pathology of the disease. Some contend that it is excessively absurd to speak of puerperal fever, except as a symptom of a local disease. (Conquest, Blundell, Duges,) while others, as Hamilton, Burns, Joseph and John Clarke, Roux, Velpeau, Mastoscheck, Raimann, Hartman, Boer, Schiffner, Festi, Belletzky, and Editors of the Edinburgh Medical and Surgical Journal, 1824, entertain a different opinion.

The first accurate account of purperal fever appeared in the Mem. de l'Acad. Roy. de Soc. 1746, for a full detail of which I refer the reader to my Essay in the London Med, and Sur. Journ. 1829, vol. iii. p. 18.

Dr. Gooch has given an imperfect history of this disease, and absolutely contradicts himself. At one time he strenuously maintains that it is peritonitis, or as he unfortunately designated it, peritoneal fever; and in future pages he tells us, that depletion is not the remedy in some cases; so that he is and is not a monopathologist. Subsequent experience has proved, beyond all doubt, that the disease under notice is not peritonitis. This will appear by a reference to the essays of Dr. Conquest and M. Tonnellé, which I have inserted in full in the London Med. and Surg. Journ. 1830, vol. v. No. 25.

Dr. Conquest objects to the vague term puerperal fever, under which are confounded the most opposite diseases of the brain, chest, abdomen, and pelvis. He informs us, that in many cases the morbid appearances are not sufficient to account for death. He has only found a fallopian tube, or ovary inflamed. In other cases there are hysteritis, uterine phlebitis, gangrene of the uterus, and agglutination of all the pelvic viscera. The type of the inflammation will be so modified by circumstances as scarcely to be recognised as the same disease in different women, in different districts, and during peculiar constitutions of the atmosphere. He thinks the disease communicable by medical men and nurses, that gestation and parturition produce a change in the physical condition of the female, which

so modifies diseases as to give it a specific character. This is decidedly the general opinion of medical practitioners. He is certain that the disease may commence during gesta tion, from mental depression, impure air, bodily fatigue, low living, improper food, &c. It may commence as hysteritis, or peritonitis. The approach of the disease is often so obscure as to elude detection.

When the disease is inflammatory, copious depletion is the remedy: when epidemic, it defies all treatment. The greatest caution must be observed in using the lancet. Leeches and cupping are often valuable adjuvants; hot turpentine applied to the abdomen is of great use, it should be used with flannel every six hours for ten minutes at each time, until high erythematous efflorescence takes place. In my own practice I use it freely at once, until the erythema appears. Oil of turpentine alone, or combined with castor-oil and laudanum, is a valuable purgative in all cases, not admitting of much reduction of power. Opium and mercurials, in large doses, are invaluable after bleeding and purging. The reader will find further observations on the efficacy of these remedies on referring to the article Peritonitis in a former page. Camphor in scruple doses, combined with opium, is a valuable anodyne in cases of great restlessness. Digitalis, nitrate of potass, ipecacuanha, and antimony are valuable adjuvants, but must not be relied on exclusively. Such are the leading facts detailed by Dr. Conquest in his Observations on Puerperal Inflammation, commonly called Puerperal Fever, read before the Hunterian Society of London, February 1830. M. Tonnellé prefers the term puerperal fever to peritonitis or metro-peritonitis, because it is more comprehensive than the others; it expresses nothing by itself, and does not prejudice the nature of the disease. He informs us, that the disease raged at the Maternité during the year 1829, with more violence than at any period since the establishment of that Hospital. He gives the following account of the Pathology. 'It is in the most violent cases that the integrity of the peritoneum is most constantly preserved; it is mostly inflamed in the hypogastric region. The internal surface of the uterus is almost always covered with a putrilaginous matter of a red brown colour, and of an insupportable fetidity. The proper tissue of the uterus is rarely changed, except by ramolissement or putrescence. Suppuration of the veins and lymphatics of the uterus, is seen in three out of five cases of puerperal fever, and is nearly as constant as peritonitis. It may extend to the ovarian, hypogastric, and abdominal veins. This phlebitis exists generally on the sides of the uterus. M. Dance held that it existed more frequently near the insertion of the placenta. The lymphatics may take up fetid fluids after delivery, and become inflamed. The presence of pus in the vessels, and its necessary transmission through the circulation, causes rapidly a palpable infection of the blood, and a certain number of phenomena which impress on puerperal fever an especial character, a characteristic physiognomy. In two hundred and twenty-two cases, the uterus was affected in one hundred and ninety-seven, and the peritoneum in one hundred and ninety-three; there was pus in the uterine veins, and lymphatics in one hundred and thirty-four cases. The terms peritonitis or metro-peritonitis cannot be applied to many of the alterations described, but the term puerperal fever may bo applied to all-it prejudices none of them.' (Des Fièvres Puerperales observées à la Maternité de Paris, pendant l'Année 1829, &c. Par M. Tonnellé. Arch. Gen. de Med. Mars et Avril, 1830; Lond. Med. and Surg. Journ., July 1830.)

SYMPTOMS OF PUERPERAL FEVER.

The disease commences from one to eight days after delivery, the patient complains loudly of the severity of the after-pains, and refers all her suffering to the region of the pubis and uterus. The disease is ushered in with much shivering or rigors, the pulse varying from 120 to 160. There is a great prostration of mind and body, and a sense of