REVIEW XI.

On the Signs and Diseases of Pregnancy. By T. H. TANNER, M.D., Assistant-Physician for Diseases of Women and Children to King's College Hospital.-London. pp. 504.

DURING the several years in which a physician has but little occupation except what he imposes upon himself, Dr. Tanner has evidently read what others had done before him, studied the literature of his profession, and become a careful observer and chronicler of facts which he had himself an opportunity of witnessing. No one can fail, by perseverance in such a course, to contribute to the advancement of medical science. The work now before us, 'On the Signs and Diseases of Pregnancy,' proves industry, freedom of expression, clearness of arrangement, and at least a good theoretical knowledge, on the part of the author; it forms a good text-book, in short, on the subject of which it treats. As a scientific work, however, we cannot speak of it with unqualified praise, there being but little in it that can be said to be original, and a good deal in reference to the "great ones of the past" that might better have been omitted. The first chapter will supply many instances of what we mean, showing that although "they can now only speak to us through their writings," it would be quite as well did they not speak to us at all. No one doubts the "great inventive powers of authors," but to mix up fiction and the marvellous with what is intended to be really practical, seems to us of very doubtful utility. Leaving these fancies of a bygone age, we will make a few remarks on the rest of the work, and with a desire to do justice to its author. The book consists of twelve chapters, divided as follows: 1. General Observations on the State of Pregnancy. 2. The Signs and Symptoms of Pregnancy. 3. The Diseases which Simulate Pregnancy. 4. The Duration of Pregnancy. 5. The Premature Expulsion of the Fœtus. 6. The Examination of Substances expelled from the Uterus, &c. 7. Extra-Uterine Gestation. 8. Superfotation-Missed Labour. 9. The Diseases which may Co-exist with Pregnancy, and their Reciprocal Influence. 10. The Sympathetic Disorders of Pregnancy. 11. The Diseases of the Urinary and Generative Organs. 12. The Displacements of the Gravid Uterus. We may observe once for all, that the subjects discussed in these several divisions are treated with perspicuity, and in a comprehensive, intelligible manner, so as to afford a very favourable opportunity to students to make themselves acquainted with them historically as well as practically; and although it cannot be said they contain much of novelty to those who have had experience, we doubt not that the book will be referred to with interest by many who may wish to refresh their memory or test their own views of practice in the important branch of the profession of which it treats.

It is well known to us all that difficulties often arise in determining the existence or non-existence of pregnancy; we every now and then

meet with cases of such a doubtful nature that nothing but the greatest tact and vigilance can protect us from error; and the consequences of making mistakes may be disastrous to our own reputation, and entail upon others a vast amount of misery and wretchedness. Dr. Tanner has therefore very carefully arranged and described the signs and symptoms of pregnancy, and the various diseases which simulate it, or which may be mistaken for it. He particularly insists upon the value of auscultation, alleging the fourth month as the period at which the uterine souffle can be heard, and the fifth as that in which we may discover the sounds of the fœtal heart. We believe these signs to be invaluable, and well worthy of careful study; but it has several times happened in our experience that when we have distinctly heard the fœtal heart, the capacity for hearing it by others present has been wanting; and we doubt whether, as a general rule, it can be distinguished by many with certainty as early as the beginning of the fifth month. As a sign to be relied upon at an earlier period of pregnancy, our author insists very much upon the presence of mammary secretion; and lays it down as a law, that when a woman is gravid for the first time, and has missed two monthly periods, a drop or more of fluid may be expressed from the breasts, which, on minute examination, will be found to present all the characters of true milk; while, from the presence of even this small quantity, in the great majority of cases, we may alone successfully predicate the existence of pregnancy.

With regard to the necessity on the part of the practitioner for always exercising great caution and circumspection in the diagnosis of the diseases which simulate pregnancy, we cannot do better than quote our author's own words.

"In some cases the most experienced physician will have misgivings; hence, none need be so foolhardy as to descend to guesswork. He, however, who really desires to prove accurate will generally be so; since he will take care not to come to a positive conclusion without a careful review and calm consideration of all the circumstances of the case. He will weigh well all the data on which reliance can be placed; for, otherwise, though his judgment may be founded on what is apparently strong evidence, yet, from not considering, or from being ignorant of, one or two small facts, the deduction is not unlikely to be wrong.

In the chapter on Premature Expulsion of the Foetus, some remarks are made on what is termed, in medico-legal phraseology, "livebirth." In contested lawsuits relating to the inheritance of, or succession to, property, and on some other occasions, it is sometimes a matter of considerable importance to determine whether a child was born alive, even though it may have perished shortly afterwards; and this raises the question as to what constitutes a live birth. Formerly, we believe, the act of respiration or crying was necessary as evidence of a child being born alive; but, owing to some recent cases in civil jurisprudence, it seems that the mere muscular movements of the limbs or the features, independent of any signs of respiration, are sufficient evidence, and held now to be ample enough proof, of "livebirth." The latest decision which has been given in such a case is in that of Brock v. Killock, before Vice-Chancellor Sir J. Stuart, on

April 29th, of the present year. The question raised was whether a child was born alive or not; and turned on the evidence of Dr. Freeman, the medical man who delivered the child's mother, and that of the other medical men who had given opinions pro and con upon Dr. Freeman's statements. The case is reported in 'The Times' of May 1st, 1861. Four of the medical men swore to the absence of respiration. Dr. Freeman said the child was born alive, in consequence of the pulsation of the umbilical cord. The ViceChancellor considered the proof of the performance of one clear vital function was enough to show the existence of life, and he thought that pulsation was enough. Dr. Tyler Smith, in his affidavit, said "it would be much better to take as a proof of live-birth a single vital act, such as the beating of the heart after separation from the mother, which can hardly be mistaken, than an undefinable amount of respiratory action, which must always be doubtful and difficult of proof in cases where the child dies shortly after delivery." The Vice-Chancellor said that, upon the whole, he was of opinion that it had been satisfactorily proved that the child had been born alive.

One of the most fatal diseases of foetal life, without any doubt, is syphilis; and it is scarcely possible to imagine any more important subject for strict investigation and study than the transmission of the syphilitic poison by parents to their offspring. It is the greatest scourge, we hesitate not to say, that is inflicted upon mankind; the greatest evil that exists in the world; the chief source of nine-tenths of the illness and misery that flesh is heir to; a true exemplification of the certainty of ample punishment for sin, even in this present world. We have neither time nor space to dilate upon this melancholy statement, although we would fain believe that much of the evil we have spoken of would be prevented, were the circumstances which lead to it fully known and appreciated by the public; that many, indeed, were they aware of the possibility of their transmitting syphilis to their offspring, would rather lose their own lives than contract marriages likely to be followed by such frightful consequences. We have been induced to make these few observations, not only for the purpose of leading the mind to the contemplation of the possibility and frequency of the evils spoken of, but also of inserting our author's description of the chief morbid appearances found after birth in syphilitic fœtal diseases-viz.,

"A copper-coloured cutaneous eruption, abscesses in the lungs, or indurations of portions of the pulmonary tissue; diffused or circumscribed suppuration of the thymus gland; the infiltration of an albuminous fluid into the parenchyma of the liver, disconnecting and deranging its proper secreting structure; and lastly, the presence of numerous pemphigoid vesicles, having a blue or violet tinge, and being seated on the palmar or plantar regions, is stated to be a veritable indication of syphilis, though one of its most rare phenomena."

We must now conclude our brief notice of Dr. Tanner's book, by recommending it as a useful practical work. We have read it, upon the whole, with satisfaction, and consider it a good epitome of the signs and diseases of pregnancy.

REVIEW XII.

Norsk Magazin for Lægevidenskaben. Udgivet af det Medicinske Selskab i Christiania. Anden Række. Redigeret af A. W. MÜNSTER, VOSS, FAYE, W. BOECK, LUND. Bind XIII., XIV., & XV. Hefte 12.-Christiania, 1859–60–61.

Norwegian Magazine for Medical Literature. Published by the Medical Society in Christiania. Second Series. Edited by A. W. MUNSTER, Voss, FAYE, W. BOECK, LUND. Vols. XIII., XIV., and XV., comprising twelve numbers. Christiania, 1859-60-61. NORWEGIAN medical literature, and the proceedings of the profession in that remote corner of Europe, being but imperfectly known to practitioners throughout Great Britain, we are induced to notice briefly the publication whose title heads this article, especially as the work possesses considerable reputation in the country where it appears, and further, really deserves notice from foreigners.

Like similar periodicals, in England as elsewhere, for communicating knowledge, the one under review contains, first, original communications, some being both interesting and valuable; next, reviews, reports, and extracts from other journals; afterwards, notices concerning scientific medicine, the treatment of diseases as they occur in Norway, with the effects of remedies; and ultimately, medical news, or items of general information.

Among the original communications in this Norwegian periodical, an interesting account of a journey recently made in the United States of North America, by Professor Voss, may be mentioned, although perhaps esteemed of greater value in the opinion of the writer's countrymen, than it would prove to Englishmen, on account of the information thus imparted respecting a Republic and its medical institutions, with which the latter are much better acquainted. As statements of an entirely local character, however, possess more value among British readers, we now subjoin a brief statistical report of the diseases which came under treatment in the hospital during March, 1859, seeing that such account indicates the type of maladies generally prevalent at that season. For example, 53 cases of pneumonia were there admitted, of whom 5 died; influenza comprised 227 patients, 4 ending fatally; diarrhoea and cholorine 101, but no deaths; typhus 19, among whom 1 died; croup 5, death following in 3; puerperal fever 3, whereof 1 died; and lastly, 18 cases of scarlatina, 8 of diphtheria, 7 of varicella, and 14 of pertussis, all of which 47 inmates, however, ultimately recovered.

In subsequent numbers, Professor Boeck contributes elaborate observations on the question of Syphilization, which inquiry thus seems to occupy as much attention among Norwegian surgeons, as it does at present both in France and England. Professor Faye likewise publishes an extended and valuable paper on obstetric pathology, showing that department of medical practice is also there zealously culti

vated. Subsequently, Dr. Holst communicates a minute report of the different skin diseases treated during two years ending in June, 1858, at the national hospital for these complaints, whereby it appears that syphilis and gonorrhoea were common affections. Thus, among 484 male patients, 149 laboured under the former malady, while 219 out of 410 female patients were similarly affected. On the other hand, 117 males had gonorrhoea, but not one woman is stated to have been admitted under that category, although it ought to be added 41 females had leucorrhoea, and 69 urethritis; no males are classed in the latter column. These facts may perhaps explain the above anomaly, as also that 77 men were enumerated as suffering from "epididymitis." Finally, scabies comprised 88 cases, of whom 60 were male and 28 female patients. Various other original articles of interest might be likewise alluded to on the present occasion, which have appeared in the periodical now designated; we can only now add that, for those who may be able to read the Danish language, the Norwegian Magazin' will amply repay perusal, as well on account of the matter it contains, as from being a good exponent of medical literature, and of the professional or scientific questions which now occupy our brother practitioners in that part of Europe.

One of the features characterizing the publication which has been thus briefly brought under notice must not be overlooked—namely, the reports therein given of the proceedings of the Christiania Medical Society, as also the remarks made during its discussions by various members showing that here, as elsewhere, there exists a friendly interchange of opinions and experience among the profession of this northern metropolis, alike beneficial to each associate as to the community at large.

This Society meets fortnightly, and in most respects resembles similar Associations for the promotion of knowledge elsewhere established; while those foreigners who desire to become more intimately acquainted with what their medical associates are doing in the far North, may peruse advantageously that portion of the journal now indicated. Had present limits permitted, we should have certainly made some more special allusions to this department, but to do so now being beyond the narrow scope originally proposed, when the task was undertaken to bring briefly before English readers the subject of Norwegian medicine, it only remains to refer any student who feels anxious to obtain further information respecting such matters to the work itself, which deserves examination-supposing, of course, that inquirers understand the Norsk language.

Believing a few cursory remarks respecting the present condition of medicine in Scandinavia may be interesting to most readers, especially to those who perhaps have not paid much attention to occurrences among their professional friends in so northern a portion of the Continent, we may mention that in Christiania there is an university of some repute, having usually about eight hundred students, and comprising a medical faculty, with professors whose fame is not confined to their own country. It possesses an admirable library of nearly