menced this medication, the alarming symptoms disappeared, the parts returned to their natural condition, the fistula closed, and the tears flowed easily through the nasal duct. Every thing promises at present that the cure will be permanent.

The case which I have just related was of the most serious character; the disease had made so much progress that the success of an operation appeared to me to be doubtful. A few injections were sufficient to dispel all my doubts; it is the first time that I have employed them in similar circumstances, and I beg my medical brethren to employ it before operating. It would be fortunate if this simple means should succeed, I do not say in all, but in a great number of cases; for an operation, however simple and easy it may be, has its inconveniences, which are often very serious; we have had a fatal example in a young person, resident in a town in this neighbourhood. He had a fistula lachrymalis, and was desirous of getting rid of this disgusting inconvenience. He set out, by the advice of his physician, for Paris, where he was operated on, I do not know by what surgeon; the canula was introduced into the duct, and he returned home perfectly well. Some days after his arrival, he fell into a complete state of mania. Would this misfortune have happened to him without the operation? I will not presume to say; I simply relate the fact. It is always the case that the idea of undergoing an operation makes a deep impression upon certain individuals; that the canula, by its presence, must irritate more or less the parts; the cribriform plate of the ethmoid is there, and the brain is not far distant.

Paralysis of the Bladder cured by injecting Laudanum into it.'-A patient, convalescent from cholera, was attacked with retention of urine, which continued and was only relieved by the catheter. Baths, fomentations, and rubefacients, were used by M. Tambone in vain. After washing out the bladder, laudanum was injected, and suffered to remain in it. After eight hours, the patient was surprised to experience an inclination to pass the urine, and in four hours the desire recurred. By continuing the remedy a cure was effected.

Medical Bibliography-In the Zeitschrift für die gesammte Medicin, the editors, as is their wont, have given a bibliography of foreign medical literature for the year 1837; classified under the headsHistory of Medicine and Bibliography; Anatomy; Psychology and Physiology Phrenology; Semiotics, Pathogeny, Pathology, and Therapeutics; (Homœopathy; Fevers and Inflammations; Diseases of the Head, Neck, and Chest; Diseases of the Abdomen, Urinary and Genital Organs; Diseases of the Skin; Scrofula and Syphilis; Cholera; Nervous and Mental Diseases ;) Surgery; Diseases of the Eyes, Ears, and Teeth; Obstetrics; Diseases of Women and Children; Dietetics; Popular Medicine and Hygiène; Medical Topography; Pharmacy; Materia Medica; Art of Prescribing (Formular); Toxicology and Magnetism; Legal Medicine; Medical Encyclopædias and Lexicographic Works; Collections and Transactions of Societies; Editions and Translations of the Ancients; Biography and Veterinary Medicine.

The American works enumerated are, Goddard on the Nerves; Griffith's Introductory Lecture in the University of Maryland; Morton's Illustrations

1 Osservatore Medico di Napoli, and Zeitschrift für die gesammte Medecin, April, 1838, s. 516.

2 Jan., 1838, s. 191.

of Consumption; Sewell's Examination of Phrenology; E. H, Barton's Introductory Lecture on Auscultation; Haxall on Exploration of the Chest; King on Purpura; Bushe on Diseases of the Rectum; Hayward, on Diseases of the Knee-Joint; Warren on Tumours; Littell on Diseases of the Eye;1 Warrington's Translation of Duparcque; Tuckerman on the Climate of Santa Cruz; Dunglison's Medical Student; Dunglison's Address to the Medical Graduates of Jefferson Medical College; J. P. Harrison's Oration on the Investigation of Medical Science; and J. McNaughton's Address' before the Medical Society of the State of New York.

Table of the Sick and Mortality in the Hôtel-Dieu, of Paris, during

Twenty Years.2.

The table exhibits a regular and signal improvement in the ratio of mortality; the difference in twenty years being as 1014 to 457.

Legitimate and Illegitimate Births in Paris. It would appear from tables recently published, that there were born in Paris, from 1816 to 1825, 351,082 legitimate children, and 194,758 illegitimate. Of these, 31,066 were stillborn, and 88,101 died in the first year of existence;—a frightful picture of the physical and moral evils of the looseness of public manners.3

Contusion of the. Eye-Separation of the Iris from the Ciliary Ligament—Amaurosis-Cure. By DR. FRICKE, of Hamburg.-A case of this kind is given by Dr. Fricke, in his report of the Surgical Department of the General Infirmary at Hamburg, for the last quarter of 1836. The patient, a female, thirty-one years of age, received a violent blow with the fist on the right eye, in consequence of which the functions of the eye were sus

1 We are pleased to observe, that an English edition of this excellent "Manual," "revised and enlarged," is advertised in the Lond. Med. Gazette, for July 14th.-Ed. 2 Annales d'Hygiène publique, &c., Oct., 1837.

3

Zeitschrift für die gesammte Medicin, Jan., 1838, s. 178. 4 Ibid. April, 1838, s. 437.

pended, and violent inflammation supervened. Before her admission into the hospital she had been subjected to very energetic treatment, and calomel. had been administered for several days so as to induce copious ptyalism. On her reception into the hospital, the violence of the inflammation had been got under. The iris, torn from the ciliary ligament was of a green colour, and exhibited no trace of fibrous structure. With the exception of the power of distinguishing light from darkness, the functions of the eye continued entirely lost.

Dr. Fricke continued the antiphlogistic plan of treatment to a mild degree, and afterwards put her upon the use of slightly stimulating collyria, with tinctura opii. Revellents to the intestinal canal and the skin were not neglected. Under this management the iris not only resumed its healthy colour and condition, but vision was completely restored, so that in six weeks the patient was able to leave the hospital. The iris, where it was separated from the ciliary ligament, had united in such sort that two pupils were formed, separated by a small stripe..

Medical College of Richmond, Va.-We have been favoured with a list of the professors of this new medical school. They are,-1. Th. Johnson. M. D., (formerly Professor of Anatomy in the University of Virginia,) Professor of Anatomy and Physiology. 2. John Cullen, M. D., Professor of Theory and Practice of Medicine. 3. L. W. Chamberlayne, M. D., Professor of Materia Medica and Therapeutics. 4. R. L. Bohannan, M. D., Professor of Obstetrics and Diseases of Women and Children. 5. Aug. L. Warner, M. D., (late Professor of Anatomy and Surgery in the University of Virginia,) Professor of Surgery. 6. Socrates Maupin, M. D., Professor of Chemistry and Pharmacy. Aug. L. Warner, M. D., Dean of the Faculty.

NECROLOGY.

Fabré-Palaprat, Salmade, Meunier.-Died recently, at Paris, Dr. FabréPalaprat, General Director of the Société Médico-Philanthropique.

Also, Dr. A. Salmade, Member of the Academy, and formerly Physician to Louis XVIII. and Charles X. He published numerous essays in the Recueil périodique de la Société de Médecine; and was the author of several works on popular Medicine.

At Strasburg, Dr. Meunier, professor of medicine in the university there.

BOOKS RECEIVED.

From Dr. Oppenheim, one of the Editors.—Zeitschrift für die gesammte Medicin, April, Mai, Juni, 1838.

From the Author. Homœopathic Practice of Medicine. By Jacob Jeanes, M. D. 8vo, pp. 392. Philadelphia, 1838.

From Messrs. Haswell, Barrington & Haswell, the Publishers.-The Surgeon's Practical Guide in Dressing, and on the Methodic Application of Bandages. Illustrated by numerous engravings. By Thomas Cutler, late Staff-Surgeon in the Belgian Army. 24mo, pp. 208. Philada., 1838. From Jacob Snyder, Jr., Esq.-Nos. 5, 6, 7, and 8, of the Student's Magazine. Published at the Pennsylvania Institution for the Instruction of the Blind.

THE

AMERICAN MEDICAL
MEDICAL INTELLIGENCER.

Vol. II.

September 1, 1838.

No. 11.

ART. I.-CASES ILLUSTRATING THE USE OF THE FORCEPS. BY S. A. COOK, M. d., buskirk's bridge, new york.

The invention of embryospastic instruments has placed in the hands of the scientific obstetrician the means of frequently terminating at discretion difficult or tedious labour,' without injury either to the mother or child. Yet I am persuaded that the advantages to be derived from their judicious use are diminished, often entirely withheld, through the influence of a fearful array of imaginary difficulties and dangers, with which writers on midwifery have prefaced their application. The mind, and especially that of the young practitioner, revolts at the idea of adding to the sufferings or dangers it may be called to witness; and, though perhaps justly impressed with a sense of responsibility, overawed by the dogmas of teachers, procrastinates until interference is unnecessary, the efforts of nature having, after a fearful struggle, triumphed, or, what is perhaps as frequent, the patient sunk and beyond the reach of art.

The easy application of the forceps is entirely dependent on the stage of labour. Indeed, "when the os uteri is fully dilated, the soft parts relaxed, the head resting on the perinæum, or nearly so, and the pelvis of sufficient, size to permit the attendant to reach the ear with the finger," it "is so simple, that any individual, with moderate experience, may readily effect it;"2 and though their possible use allows of considerable range from this point, yet the nearer the head approaches it, the less will be the difficulty or danger attending the operation. Whenever, therefore, a case is thus far advanced, either the danger or suffering of the patient, or even the danger of the child, may call for the forceps. A few cases will, perhaps, better illustrate the principles by which I have been governed in practice.

CASE 1. Exhaustion. April 7, 1837.-J. W., aged 17. 1 o'clock, a. m. Had been in moderate labour thirteen hours, with first child, when her pains ceased entirely. At her urgent request she was now permitted to walk about the room, and they soon returned with great activity, and in less than two hours advanced the head so far into the pelvis that it touched the perinæum, when they ceased to press, though they continued almost constantly, and extremely agonising. Her pulse soon became very feeble, countenance sunken, forehead covered with a sticky perspiration: when, at 3 o'clock, A. M., I applied the forceps, and in twenty-five minutes delivered her of a large healthy boy. She recovered very rapidly, getting about the house in a few days.

CASE 2. Exhaustion. March 13th, 1838.-A. J. 2 o'clock, P. M. Had been in severe labour with fifth child sixteen hours. Countenance haggard; pulse scarcely perceptible; occasional vomiting; uterus fully dilated, though the head remained high in the pelvis; vertex presenting, and so far advanced as to preclude the possibility of turning. Fearing that there might arise a necessity for using the perforator, I gave her some brandy and

1 Alexander Hamilton's Midwifery.

VOL. II.-11

2 Collins's Pract. Treat. on Midwifery.

camphor (and sent six miles over bad roads for Dr. Morris, for advice). She revived, her pains increased, and in three hours the head had so far advanced that the vertex touched the perinæum; when she again became exhausted, the pains ceasing notwithstanding the continued use of stimulants. Dr. M. having arrived and concurring, I applied the forceps, which increased the pains, so that with very little assistance the child (a boy) was expelled. She recovered slower than usual with her, though without any symptom requiring treatment; and in the end both parent and child did

well.

CASE 3. Exhaustion-complicated-child dead. March 13, 1837.M. M. In labour with first child. Commenced actively; waters discharged before my arrival. On examination per vaginam, anterior fontanelle presented, with the funis in advance, protruding from the os tincæ, though dilated only to the size of a dollar. Every effort to keep it back proving unavailing, the labour was allowed to proceed without interference until the uterus was fully dilated, and the head engaged in the pelvis, when the pains not advancing the labour, I changed the position of the head to a vertex presentation. Though the pains declined in activity the labour advanced considerably during the three succeeding hours, when, after having been in labour twenty-two hours, she became restless, throwing herself from side to side of her bed; countenance sunken; pulse very feeble; with a cold and clammy surface. Judging that I could reach the head with the forceps (although the vertex did not rest on the perinæum by an inch or more), I gave her some brandy, which reviving her, I applied the forceps, and assisting the pains completed the labour. Child (a boy) dead and much discoloured. The patient recovered very rapidly.

and

CASE 4. Threatened Cerebral Irritation. April 24, 1834.-P. E. In labour with her second child. During her former parturition her case assumed an anomalous character. I gathered the following history from herself and family. At the close of each uterine contraction the pain passed up the back to the head, producing there a sensation of extreme agony, blindness, supposed at the time to be temporary, followed by a general nervous tremor. The labour terminated without assistance, and the patient was left with amaurosis, from which time, though a little improved, she had never recovered her sight. This unfortunate termination was attributed, with how much truth I know not, to a fall from her chair, hitting the back of her head against one of its posts, about two weeks before her labour.

At this time, after having been about six hours in labour, the head of the child being advanced, so as nearly to touch the perinæum, a similar train of anomalous symptoms occurred. In a short time the suffering in the head became very severe. In fact the pain of the uterine contraction appeared to be almost perfectly transferred to the brain, and ceased to advance the labour. This state continued about an hour, when, fearing that the consequence of farther delay would be an augmentation of the existing amaurosis, I applied the forceps, and in twenty minutes delivered her of a living child (girl). Both the patient and the child did well; the mother's blindness remaining as before.

It will be perceived that the above cases were of a character that called for immediate action. If the forceps were necessary, their urgency admitted of no delay. Hence the rules that writers have attempted to establish, of waiting from six to twenty-four hours after the head shall have reached a position favourable to their application, were not considered applicable with them. Indeed I am confident that such rules can never be adopted in practice, with safety to the patient or credit to the practitioner. To me but one rule appears consistent. To use the forceps cautiously but promptly,-1. Wherever the danger of the patient can be diminished. 2. Wherever, without increasing her danger, her suffering can be in a considerable degree lessened. 3. Or wherever, without increasing either the danger or suffering of the mother, the safety of the child may be insured.

Buskirk's Bridge, Aug. 1, 1838.