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A Clinical History of the Medcial and Surgical Diseases of

Women.-By ROBERT BARNES, M.D., Lond., Censor of the Royal College of Physicians, &c., Obstetric Physician and Lecturer on Obstetrics and the Diseases of Women to the St. George's Hospital. Second American from the second London edition, with 181 illustrations. 8vo. pp. 784. Philadelphia : HENRY C. LEA, 1878.

The first edition of this work appeared in 1874, but since then the book has received at the hands of the author a thorough revision, by which he states that many changes have been made ; space has been gained, by pruning and re-arrangement, so that additional material is given without increasing the size of the the volume. A new chapter on the relations of bladder and bowel disorders to affections of the uterus and appendages is to be found. Many new illustrations have been added, and when these have been borrowed from other works, their source is duly accredited.

We have in this work the experience gained by Dr. Barnes after years of patient labour and study as a practitioner, teacher and examiner, what he has himself observed he has had faithfully illustrated, but he has endeavored to correct his own observations by the illustrations of others.

The work is divided into twenty-nine chapters, the first six being introductory, giving the anatomy of the pelvic organs. The uterus and its appendages, Douglas' Pouch, the axis of movements of the uterus, changes which occur during menstruation. The conditions indicating a necessity for local examination, constitutional reaction, disturbed function, such as amenorrhæa, menorrhagia, dysmenorrhoea, leucorrhoea, irritable uterus, irritable ovary, martodynia, neuralgia, such as spinal irritation, paraplegia, mental derangement, reflex nervous phenomena, vomiting, convulsions and epilepsy, hysteria vaginismus, sterility. The significance of symptoms connected with the bladder, peri-uterine affections, ischuria ; cystitis ; foreign material found in the bladder, causing an irritable condition

of that organ. This calls to mind a case which we published in the last number of this journal of the passage of hair in the urine in a child. On this point the author observes at page 132. “ Hair, fat and teeth may find their way into the bladder and urine. They afford conclusive evidence that a dermoid cyst has contracted adhesions with the bladder, and established a fistulous communication." This bears out the assumption we made in respect to the case above referred to, no dermoid tissue or cyst was found in that remarkable case, and therefore we were forced to look for some other to account for the phenomenon.

A description of the instruments serving for diagnosis and treatment of uterine affections is given in chapter iv.

The various methods of examination are described in chapter V. The pathology of the ovaries. The history of menstruation and disorders of menstruation are next treated of in the succceeding five chapters. Diseases of the ovaries, absence of the ovary, congenital displacements, cysts and their treatment, extra uterine gestation, &c., are described in the next six chapters. There is a chapter on the spinal pathology of the uterus, in which the author takes a rapid view of congenital abnormalities, as he observes this is necessary before entering upon uterine pathology proper, because, these conditions are often attended with disordered function, and give rise to symptoms which are extremely puzzling unless these special conditions were known as likely to exist. This chapter is illustrated with a number of engravings showing various abnormalities, such as a uterus strongly developed to the right, probably a specimen of important development toward the left side, double or biconate uterus, with a single cervix from a specimen in the museum at Guy's Hospital, another of double uterus and vagina also from Guy's Museum. These are of interest from their rarity. The next chapter is on th effects of labour and lactation, involution in defect and excess, conditions marked by altered vascularity, metritis, endometritis, or uterine catarrh, with intra-uterine medication, is the next treated upon. Pelvic cellulitis, pelvic peritonitis, and intro-peritonitis are then discussed : blood effusions in the neighborhood of the uterus, with groups of cases is given in chapter xxi.

Displacements of the uterus forms the subject of the next chapter. These have always been a source of trouble and difficulty to the practitioner, and we need only to refer to the numerous mechanical contrivances each claiming pre-eminence. for the relief of uterine displacements, to indicate the very unsatisfactory practical knowledge we possess on the subject. The author alludes to the fact that some have declared that they have failed to recognize displacements of the uterus, and therefore they refuse to believe in their existence ; of such we can only say they must be obtuse in a degree surpassing belief, as it is impossible to fail to recognize these conditions, if a careful and intelligent examination be made. With regard to pessaries, the author remarks in reference to tho their use, that a prolapsus is a hernia, and a pessary a tenis, and that although surgeons have with ingenuity introduced several operations for the radical cure of displacements, yet“ pessaries are still found necessary.” But before applying them he points to the necessity of careful examination with the aid of the sound, so as to ascertain the presence or absence of adhesive bands.

The author gives a description of many forms of pessary, and refers to the objectionable features of some, especially Zwanck's instrument. The expanded wings of this instrument are apt to produce ulceration of the vaginal walls, and in some instances, the author states, he has found difficulty in removing the instrument as it had become incarcerated by union of granulation tissue, and contraction of the ulcerated surfaces. Hodge's lever pessary is, perhaps, the least objectionable of all forms of uterine support, but even this instrument will in some cases utterly fail of giving relief. Thomas' pessary, which is a modification of Hodge's instrument, is often of great use in extreme cases of prolapsus, but the author states that in practice he has found a pessary invented by Dr. Scott, of Woodstock, Canada West, to answer the purpose far better. The various operations for the relief of prolapsus uteri, are referred to. Versions and flexures of the womb are next discussed, and the various

methods of treatment given. Chapter xxiv is dovoted to tumours of the uterus, malignant and benign, their structure, seat, shape, density, vascularity, the law of growth, &c., and their treatment. He does not condemn, nor yet speak hopefully of the removal of tumours of the uterus by abdominal • section, either alone or with the uterus, and he remarks that the time has not yet come for giving a confident opinion ; " at “present there is little ground for enthusiastic advocacy of the " practice.” That for the present the question must remain subjudice,

Uterine polypi, tubercle, and cancer of the uterus are next discussed, and the last two chapters are devoted to diseases of the vagina and of the vulva. The arrangements of the subjects discussed are peculiarly his own, and open to objection, but the subject matter is particularly readable. We commend this work to our subscribers, it is a valuable addition to the literature of the subject, and to the practical man will be found an invaluable guide.

Extracts from British and Foreign journals.

Unless otherwise stated the translations are made specially for this Journal.

Circulation of the Blood in the Extremities.- Professor Lister, of London, on the influence of position on the circulation of the blood in the extremities, lately communicated to the Paris Academy of Medicine the results of his personal researches on this important subject. In the ordinary operations for resection of the wrist joint the hæmorrhage was quite abundant; and with a view to remedy the evil, he raised the arm to be operated upon, and kept it elevated for several minutes, after which the tourniquet of Petit was rapidly adjusted so as to arrest the circulation in it. By this procedure the arm was almost completely deprived of blood, and the surgeon allowed the double advantage of being able to avoid the hæmorrhage, and to inspect the parts with care and precision. The advantage thus obtained seemed sufficiently important to Professor Lister to recommend the method in other operations.

Towards the close of the year 1873 he explained to his students the value of this method. He raised one of his arms perpendicularly, while the other was allowed to hang at his side, to shew the difference in color of the two hands placed in such different positions. The reduction in temperature which occurred in the elevated hand convinced him that something was going on which purely mechanical effects could not explain, and that the diminution of the blood pressure within the vessels was due to a stimulus of the vaso-motor nerves of the arm, and to a reflex contraction of the muscular fibres of the arteries.

Some physiological experiments on animals have confirmed the author's opinion; and he concludes from them that the facts observed cannot be explained as purely mechanical results of the diminution and increase in the blood pressure in consequence of the change in position of the limb. The arteries are but little disposed to yield to an increase of pressure coming from within. Thus, notwithstanding the powerful force with which the blood is propelled by the cardiac contractions, their diameter may be considered constant during the systolic and diastole. M. Lister made the following experiment before the Academy : applying an elastic band on a limb near its juncture with the body, after having been elevated for several minutes, it was observed to remain free from blood, although the limb was allowed to hang down, On raising the limb the second time and in that position removing the band, it rapidly filled with blood, notwithstanding the fact that the position was the same which caused the blood to leave before the application of the tourniquet.

These results are explained thus by Prof. Lister : After the tissues of a limb have been deprived of blood, for a certain time, then arises, so to speak, a circulatory want, and this acts as a stimulus to relax the arteries by acting through the vaso-motor in the same manner as heat. This stimulus of the circulatory want causing relaxation of the arteries, becomes stronger than the stimulus of relaxation of the veins excited by gravity, which, in another case, would cause their contraction.

Another experiment consists in exciting the circulation by a few minutes running, and then to raise the arm and lower it

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