true and more simple. Artificial rotation is an example of the nimia diligentia medici.

All our authors seem to be hesitating before committing themselves frankly to the more advanced practice in the use of the forceps. But they will certainly free themselves from the trammels of tradition. We feel confident that their practice is already better than their teaching. Playfair subscribes to the old law, "The position of the head should be accurately ascertained" before applying the forceps; yet, at p. 182, he admits, quoting Barnes, "that it is unimportant." His diagrams, figs. 151, 152, are not accurate or very intelligible. Fig. 151 is perplexing through the introduction of four hands; and in fig. 152 the blades showing "traction" would assuredly slip; the head is not grasped beyond its equator. Nor is Leishman exempt from criticism on this point. Fig. 151" shows introduction of upper blade," the point at the vulva pointing forwards, an almost impossible way of passing it; and he introduces three hands, one holding the lower blade, a needless complexity. The surgeon can very well do this with the back of one hand, whilst using both to insert the second blade. Indeed in most cases he must do his work without help, and if he cannot the sooner he learns the better. Leishman, too, like all who use straight forceps, advises that the blades should be applied to the sides of the head; and of course says that "the buttocks must be brought to the edge of the bed." This last injunction is not always easy to obey; with the double-curved forceps it is not necessary; and in the endeavour to obey the first the operator will commonly be frustrated unless the head be near the outlet. By and by it will be recognised that it is the pelvis that governs the application of the forceps more than the head.

Leishman figures, p. 593, a craniotomy-forceps, which we caution the young practitioner to reject. It is the old villanous instrument with fixed joint and spikes insides the blades. Such an instrument is difficult to apply in cases of marked contraction, and when applied it will not hold well; it is apt to tear away. The spikes are a bungling substitute for good workmanship. The blades should hold by accurate parallelism, as in the models of Simpson, Barnes, Hall Davis and Matthews; and the blades being separate are more easily adjusted.

Playfair rightly extols the cephalotribe; but his description and diagram suggest that he can hardly have mastered the principle of its action. At p. 205 he says, "in order that the base of the skull may be reached and effectually crushed," &c. Now, as a matter of fact, it is very rare indeed for the base to be crushed; as soon as its edges are caught between the blades, the base almost infallibly cants, turns over, so that the remains

of the cranial vault are flattened down upon the base, the whole forming a kind of disc, and thus it passes through the pelvis edge on, like a plate. The diagram (fig. 165) gives no correct idea of the action of the cephalotribe. Leishman entertains the same erroneous view, that the object of the cephalotribe "is to crush the unyielding base into a pulp."

66

Success in appreciation of the operative procedures in labour with contracted pelvis must be based upon a right understanding of the mechanism of labour under this condition. A fair account of this is given in Schroeder. This account Playfair quotes, ascribing the merit of it to the German school. But it is really much better done in Barnes. The key of the whole process is what this author has described and figured as the curve of the false promontory;" the projecting promontory representing a point around which the head must revolve before it can enter the pelvic cavity, and enter the orbit of exit or "Carus' curve." All extracting force must follow, first Barnes's promontorial curve, then the pubic curve. Due observance of this law wonderfully facilitates extraction, and saves the mother from injury. In head-last labours it is of paramount importance. It is from neglect of it that the trunk is pulled away from the head.

Playfair speaks, it seems to us, with imperfect appreciation of the operation of" bisection," as it was called by D. D. Davis, a form of which is decapitation. Speaking of cases where turning is difficult or impossible, he says (p. 388, vol. i): "Should all these means fail, we have no resource but the mutilation of the child by embryulcia or decapitation, probably the most difficult and dangerous of all obstetric operations.' We can answer for it that in some cases, at any rate, decapitation is one of the most easy and safe. It is entirely scientific and satisfactory. Rightly done, all the violence falls upon the dead child. The mother is absolutely respected. In some cases undoubtedly it is difficult to get a hook or wire or whipcord round the neck. In such cases division of the spinal column by strong scissors is

our resource.

Playfair, in like manner, entertains an undue estimate of the difficulty of extracting the decapitated head left in utero. "Perforation," he says (vol. ii, p. 210), “is by no means easy, on account of mobility." He does not describe the operation. If the head is properly fixed by the two hands of an assistant upon the pelvic brim there is no difficulty in perforation; and then the head is readily extracted, either by the craniotomy forceps or by cephalotribe. It is an affair of ten minutes. In discussing "decapitation," Leishman omits all notice of the very important alternative sometimes called for, of bisection of the

trunk, or spondylotomy. Nor is Leishman very happy on this point. He thinks the operation difficult, and prefers the midwifery-forceps after perforation. We hope he will try the craniotomy-forceps, not the one he has figured, but a good one, and he will find the operation easy enough.

Discussing the conditions for Cæsarian section, Leishman contends, quoting Dubois, for a minimum conjugate of two inches. But he ignores the obvious fallacy that lies in comparing the dicta of men who worked thirty years ago with bad instruments with the experience of those who now work with improved instruments. Dubois himself would have admitted the expediency of delivery after craniotomy below two inches if he could have accomplished it. This is one of the things practitioners have to learn how to do, and not to rest content with a dogma laid down under conditions that have passed

away.

Induction of labour is fairly discussed by both our authors; but we cannot understand the necessity Playfair points to, of passing the hand into the vagina for the purpose of introducing the bougie into the uterus. We have never found occasion for this. We always like to see ideas supposed to be settled attacked now and then. It compels revision of the grounds upon which they rest, and even if the attack fail to disturb the old conviction, it cannot fail to make the conviction a more rational one. It has been settled for a hundred years that the induction of labour is a proper thing to do when there is such contraction of the pelvis that a living child at term cannot be born per vias naturales. But latterly, Spiegelberg and Litzmann contend that it is better and safer to the mother to leave the labour to come on at term, and that the risk to the child is so great in artificially induced labour as to lead to the conclusion that the operation should be altogether abandoned, except perhaps in the extreme distortion in which the Cæsarian section might otherwise be necessary. Of course this heterodox view is supported by statistics. Upon this we would observe that English experience would hardly show any increase of risk to the mother; whilst if even a few children are saved, the balance of life is entirely in favour of the operation. If in Germany the operation is so fatal to the mother, we are compelled to conclude that there is great room for improvement in practice in that country. We have had but one death, and that was in a case of extreme osteomalacic deformity, brought into a hospital, where diphtheria attacked the patient. That the German objection should be endorsed to a modified degree by Duncan is, perhaps, not surprising. He has at least that part of Simpson's merit of scepticism carried into practice which

We

led his predecessor to rip up every settled conviction. concur with Playfair in admitting that the operation has been performed more often than was absolutely necessary; but this does not invalidate the general argument. And when Duncan enforces his objection by insisting on the rarity of great distortions, emphasising it by declaring that a case of extreme distortion has hardly been known in Scotland within the memory of man, he does not really meet the question. That distortions do occur out of Scotland, at any rate, is too certain; and it it is not less certain that hundreds of men quite competent in the matter testify to the fact that, after being compelled to sacrifice one or more children, they have happily brought living children into the world, the mothers too having encountered less risk than when delivered at term.

The case is well stated by Playfair, and decided with excellent judgment.

In describing the diseases of childbed, Leishman shows the same want of grasp that we notice in dealing with the diseases of pregnancy, in bringing together disorders that spring more or less directly from common conditions, and which, though differing in some of their manifestations and issues, are yet naturally associated. Playfair has seen this relation a little more clearly. Both authors contributed excellent material to the discussion on puerperal fever at the Obstetrical Society; both have studied the subject with great care, and both have set forth the case with clearness and ability. Dr. Leishman's statement is remarkable for the candour with which he revises the doctrines he laid down in his first edition. High as was our respect for his character before, we feel that he has earned a just claim to increased confidence as a teacher and practitioner by his readiness to re-examine and correct his published opinions.

Dr. Playfair's description of puerperal fever is a remarkably able statement of the most recent doctrines. He adopts the division into autogenetic and heterogenetic cases, but omits to assign this classification and the terms which express it to Dr. Barnes, the originator. A. very excellent chapter in Playfair is that in which he describes the state of women after labour, and the management of puerperal women. The same praise is due to the description of the new-born infant and the care it requires. Nothing could be more useful to the student and young practitioner.

In conclusion we may congratulate those who teach, those who practise, and those who are learning the science and practice of obstetric medicine, that we possess two manuals that fairly represent the actual state of our knowledge, that may

be generally trusted for the information they contain, and for the judgment with which it is set forth.

Notwithstanding the literary blemishes we have found it incumbent upon us to point out, it is no more than just to say that both works are written with considerable ability. The style of Leishman is graceful, clear, orderly, and flowing. It is most pleasant reading. Dr. Playfair's capacity for seizing a subject and placing it in a clear light before the reader is conspicuous. This and the other merits which characterise his book will remain; the blemishes will disappear.

VIII. Food: its Adulterations and Analysis.1

THAT the health and physical well-being of a community are matters bound up with the food of the people is an incontrovertible proposition, and its truth is nowhere more apparent than in the English-speaking race. The differences between the squalid, typical wild Irishman, and the Irishman well fed and prosperous in England and America, are matters of notoriety, and in no small degree due to differences of food. The Dorsetshire labourer with his scanty fare is incapable of executing the same amount of work as the better fed, and consequently more stalwart, Norfolk or Yorkshire labourer. That this difference is mainly one caused by food is shown in this, that the worse-fed south country farm-labourer when he migrates, and becomes the beef-eating navigator in a more northerly region, is by no means manifestly inferior in physical capacity and endurance

11. Food: its Adulterations, and the Methods for their Detection. By ARTHUR HILL HASSALL, M.D. Lond. London, 1876, pp. 896.

2. Nouveau Dictionnaire des Falsifications et des Altérations des Aliments, des Médicaments, &c. Par J. LEON SOUBEIRAN. Paris, 1874, pp. 634.

3. Dictionnaire des Altérations et Falsifications des Substances Alimentaires Médicamenteuses et Commerciales. Par M. A. CHEVALLIER, en collaboration avec M. ER. BAUDRIMANT. Paris, 1875, pp. 1260.

4. Adulterations of Food, with Short Processes for their Detection. ROWLAND J. ATCHERLEY, Ph. D., F.C.S. London, 1874, pp. 112.

By

5. Die Chemische Werthbestimmung eineger Starkwirkender Droguen. Von

Dr. G. DRAGENDORFF. St. Petersburg, 1874, pp. 126.

(The Chemical Valuation of some of the more Potent Drugs. By Dr. G. DRAGENDORFF).

6. Milk Analysis. By J. ALFRED WANKLYN, M.R.C.S.

pp. 70.

London, 1874,

7. Tea, Coffee, and Cocoa Analysis. By J. A. WANKLYN. London, 1874,

pp. 59.

8. The Commercial Handbook of Chemical Analysis. By A. NORMANBY, enlarged by HENRY M. NOAD, Ph. D., F.R.S. London, 1875, pp. 480.