of the way in which cells are multiplied, changed, and grouped together in the progress of development, is an interpreter of the laws of nutrition and secretion, and the unity of organisation. Now we think these great physiological points immediately concern the practical obstetrician. They ought and must be the beginning of his subject. He alone can use them. And amidst the mass of anatomical facts and observations which they include, he will find the solution and just interpretation of many of the difficulties and diseases he has to encounter. Sterility, extra-uterine gestation, abortion, monstrosities, and so on-can alone be rightly understood by a knowledge of obstetric physiology.

We have our design in making these observations. Midwifery is stigmatised as a low branch of science. It is enough for a man to practise it to be excluded from the honors of the College of Surgeons. And there is a certain superficial countenance given to this odium, in the way in which it is too frequently pursued. We know of no other branch of medicine which may unite, in an equal degree, large experience with profound ignorance. There is many a midwife in London who can number up her 1000 or 2000 cases, with no other practical result, than to have added a rash and reckless confidence to her very defective information. We encounter men too in practice, whose experience has accumulated with a large annual arithmetical progression, who yet remain wonderfully in the dark on the duties and objects of obstetric practice.

It requires little or no study to acquire a certain low taste for midwifery-practice. We have seen many a desultory loiterer at a Lying-in Charity, in full pursuit after this sort of notoriety, and we have met them in after-life, as the full-blown practitioners, all misgiving and selfdistrust annihilated, and stamped and labelled with the self-adjusted title of men of great practical experience.

Now we are far from underrating Clinical Midwifery-every case is instructive-but only as it is properly followed out. We believe firmly that the antidote to nine-tenths of the meddling interfering midwifery, which is the fruitful source of uterine disease, is an experimental knowledge of Obstetric Physiology. It disciplines the mind to careful and exact observation, and in an acquaintance with the harmony, order, and vast resources of Nature in the re-production of the species, is found the best safeguard against marring and disordering her operations. We think that a practical treatise on Midwifery is not complete, unless it fairly enters into the physiology of conception, and the growth and development of the

ovum.

The books which we would now notice are two Treatises on Midwifery, one by Dr. F. Ramsbotham, and the other by M. Moreau. The former is a second edition of a work, which came out in parts in 1841-the latter is an American translation of M. Moreau's work, a part of which, with the engravings, has already appeared in this country, being edited and translated by Mr. Streeter. We have added M. Raciborski's treatise, as introducing a subject of much present interest.

The second edition of Dr. Ramsbotham's work carries with it a significant proof of its value, from the fact that 2500 copies of the first edition have already been disposed of. It is not too a mere reprint of the first, for he has rendered it far more complete and useful by annexing a des

cription of the diseases of the Puerperal and Pregnant States, with some statistical tables afforded by the practice of the Royal Maternity Charity, which he had previously published in the Medical Gazette. The treatises of both authors are embellished with numerous elaborate engravings, there being 110 illustrations in Dr. Ramsbotham's, and many more in M. Moreau's, some of which have been obviously copied into Dr. R.'s Atlas. These engravings are really well executed, and reflect great credit on the artists. They cannot fail to aid the student in understanding the subject, although, here and there, we see a little picture-making, such as the fimbriated extremity of the Fallopian tube in Plate xv. of Dr. Ramsbotham's work, which is frayed out very oddly.

The uterus performs two functions-it gives out the menstrual fluid, and protects, and incubates the ovum during gestation, casting it off during Parturition. The work of M. Raciborski has direct reference to the menstrual function-while the practical treatises necessarily consider it in its other capacity. Our readers must be well aware that the modern theory of menstruation is immediately connected with the full growth and dehiscence of a Graafian vesicle, and the escape of its contents. Dr. Power conjectured this in 1821, describing menstruation as "an effect of disappointed pregnancy;" while M. Negrier, Gendrin, Dr. Lee, and others have endeavoured to establish the same relation between menstruation and the casting off of ova, from an examination of the ovaria of women who have died during the flux. This theory has gained ground, and has been reinforced by the experiments of Bischoff and Raciborski on several species of mammals during the period of heat. The main result of these experiments is, that ova are found to be periodically cast off during the œstrum or heat, and that, too, quite independent of sexual congress. Bischoff has experimented on the bitch, ewe, pig, rabbit, and rat, in order to establish this proposition. It appears to us that he has proved it beyond all reasonable question, and also the observation which is associated with it-that the marks of the extruded ova are left in the ovaria as corpora lutea, the two corresponding in number.

The bearing which these experiments has upon menstruation in the human female, as produced by a like cause, is on the supposition that the œstrum of the subordinate mammals and the catamenial period are strictly analogous. We do not think that this is satisfactorily made out. Our authors, M. Bischoff, Pouchet, &c., have, in our estimation, adopted this analogy without securing it; and the inference with us is, that they have thereby failed to throw any light upon the cause of menstruation. There is this amount of analogy between the two-that in both there is a local flux of blood to the ovaries and uterus, and that the excitement of the ovaries in particular is visible in both. We quite subscribe to the doctrine, that the uterus merely gives out the hæmorrhage, which as a flux would be abrogated, were the ovaries deficient. This has long since been proved by the congenital absence of the ovaries in Mr. Pears' case, and the extirpation of them in Mr. Pott's case, both of them concurring with a permanent amenorrhoea; although we have sometimes been surprised at the regularity of the menstrual flux, both in its return and quantity, where both ovaries have been the subject of encysted disease, and almost every trace of their structure effaced. But the characteristic of the oestrum is

the high venereal excitement which denotes the aptitude for conception. And we are told by Bischoff, Raciborski, &c., that sexual desires are especially manifested in women at the menstrual period, coincident with the supposed escape of the ovum. Nay, not only so, but that the chance of conception is greatly diminished if coitus does not take place a few days before, or within eight days after, the period-the latter being fixed as the time which the ovum requires for its transit through the tube. And M. Pouchet even regards the mid-period as affording a physical impossibility to conception.

We really do not see on what ground this notion is formed. Our own experience by no means confirms the statement, that sexual desires are rife in the human female at the monthly periods-nor that conception takes place at or near this period more than at any other time. We have known several instances where conception has occurred at a fortnight and three weeks after a flow; and M. Bischoff's limit of eight or ten days, as marking the residence and protection of the ovum within the oviduct is assuredly negatived in a wholesale way by the laws of the Jews, which forbid sexual congress until the woman has been clean for eight days. We can assure M. Bischoff, that this race is prolific enough with us, and that their progeny do not bear out the statement, that the risk of pregnancy is greatly diminished by his measure of the postponement of marital intercourse. It is to be noticed, too, that the period of heat in some animals, as the cow, mare, &c. comes on during lactation, very soon after the accomplishment of gestation. Here again is an obvious difference between the two functions. Indeed, we demur altogether to the analogy which has been instituted between the œstrum and the menstrual period. We think the experiments of M. Bischoff very valuable, as elucidating the place where the generative elements may meet and ova be fertilised; but we think any conclusion is strained and unsupported which attempts to fix similar phenomena, as he has shewn to occur at the time of heat, as the necessary concomitant of menstruation in the human female.

To us, it appears, that the most important facts on which this hypothesis of menstruation rest are derived from the post-mortem examination of the internal organs of generation during the menstrual period. Cases have been cited by Lee, Gendrin, Raciborski, Bischoff, and many others, which seem at first sight to establish a definite condition of the ovary as the uniform attendant on the menstrual flux. This condition consists in the presence of matured Graafian vesicles at the surface of the ovary ready to burst, or of the rent calices, with the aperture on the surface still visible, and leading to the emptied but vascular sac, or the various phases of reparative action around the opening. To these have been added an altered state of the lining membrane of the uterus, which is said to be raised into fungiform villi, an expansion of the Fallopian tube, and a general hyperemia of the entire sexual system. We have availed ourselves of several opportunities which have occurred to us to test the accuracy of these appearances, and the result is, that we remain sceptical about their justifying the dogma, that there is a stringent and necessary relation between the maturation of the follicles and escape of their contents, and the phenomena of menstruation. The term maturation wants defining. If it implies simply a full sized vesicle—so far near the surface as to shine through the serous and

capsular envelopes of the ovary, which, on being burst, lets out an ovum with its pellucid doubled vitelline ring, surrounded by the tunic of granules and held in the fluid contained within the epithelial lining of the sac, the vascular layer of which is well covered with vessels-we do not hesitate to say that we have seen this well displayed, not only at every period of the inter-menstrual times; but even before the menses have been established. And then again, with reference to the action on the surface of the ovary, with the opening for the passage outwards of the ovum. In the first place, we do not believe this to be constant. We have undoubtedly seen the rent and beneath it an empty sac; but we have also examined the uteri of women dying during menstruation, when this has not been apparent. But, what is equally sure, we have seen the same appearances altogether independent of the catamenial time. Our own experience in the investigation of this matter has not been small, and we have found that the ovary in the general run of inspections, is rarely in a healthy state. The Graafian vesicles are altered in a variety of ways, and amongst them openings on the surface of the ovary, with subjacent vacant sacs, has been not unfrequently witnessed. Sometimes the openings are choked up with a vascular growth from below, and the appearance of a repairing rent is often given by an enlarged follicle near the surface, whose contents have been broken up and then absorbed, the falling in of the parietes, marking the factitious rent. We might greatly extend the false appearances which are seen in the ovaries, which tend materially to lessen the weight we should otherwise attach to the changes in them which have thought to be destinctive of the occurrence of menstruation.

But, secondly-it is to be noticed in Bischoff's experiments, that corpora lutea marked the site of the ova which had been cast off from the ovary. This fact is corroborated too, by Haighton's experiments on the rabbit. Where are the corpora lutea at the menstrual periods in the female? We know the office of the corpus luteum-and assuredly it is admirably designed to help forward the safe escape of the ovum from the ovary. Speaking of its function, Malpighi says "cujus ope ovulum separatur fovetur et stato tempore ejicitur." Its power of marking out and nourishing is unquestionably subordinate to the mechanism it offers for passing the ovum on to the tube. Every thing conspires to direct the impregnated ovum outwards, the vascular couch around it, the increased quantity of fluid within the follicle, possibly too the retinacula-if they really exist. Indeed, the regular uniform action of the corpus luteum in this respect, looks so much like a definite means for a necessary end, that we are loath to admit any other less regular and less apparent means for the same end. We readily admit that rents exist sometimes on the surface of the ovary, even through the capsule, without corpora lutea; but they are the results of a morbid action in the ovary, whereby its stroma is altered, and its envelopes diseased, and are widely different from openings produced by a normal process. We have never seen corpora lutea during the menstrual period-that is of a like structure and appearance as those which are seen when we know an ovum has been cast off after impregnation. We hope we have said enough on this subject to shew that it still needs proof, and further investigation, and that the proper subjects for the investigation and the proof are not the lower animals at the time of heat, but the human female during the menstrual periods.

Gendrin speaks of a change in the lining membrane of the uterus during menstruation, which is elevated into fungiform villi. We know this change well, and have traced its formation; but at present we forbear to say more of it, than that we have not found it a common concomitant of menstruation. The lining membrane of the womb during the flux is sometimes seen clear and smooth, when wiped with a cloth or sponge, as in the interval between the catamenia. If its tissue is pressed, a number of dark points appear, from which the menstrual fluid oozes out. And this we conceive to be the most important change in this part of the uterus. It directly concerns the alteration in its vascular structure. The fluid which comes forth is, by some, called the menstrual secretion, by others, the monthly hæmorrhage or flux, and the former sneer at the latter for adopting the views of the Ancients with reference to the discharge of blood. For our own part, we view the menstrual period as a true hæmorrhage, and that the flux itself is furnished by the open orifices of veins-not arteries. It comes from the very same veins which, when the womb is enlarged by pregnancy, are seen large and open on the inner surface of the uterus, and surrounded by its muscular fibre. We might well turn round upon the opposite party and ask them to demonstrate the glandular or other structure from whence this so-called secretion flows. We know the existence of uterine glands, but it was never contended that they furnished it.— Whence, then, does it come? On the other hand, the microscopic analysis of the menstrual fluid shews clearly that it is made up of blood-corpuscles, and the chemical analysis of it, with its peculiarity of not coagulating, exhibits nothing more than blood mixed with the mucous secretions which it meets with in its passage from the uterus to the vulva. We think, too, that the great tendency which the uterus, in its morbid states, has in causing hæmorrhage, bears a distinct relation to this natural bleeding; and we have seen that Dr. Oldham, of Guy's Hospital, has recently investigated this subject with reference to the bleedings of polypi, which he has shewn to come from the open mouths of veins in the growths themselves. Our limits will not permit us to pursue this subject further.

In the works of M. Moreau and Dr. F. Ramsbotham most of the subjects connected with Obstetric Medicine are treated of. The former is the more elaborate work, and embraces some subjects on the Art des Accouchemens which are omitted in the latter; while the supplementary Essays on the Diseases of the Pregnant and Puerperal States, in the recent edition of Dr. R.'s work, renders it the more useful and complete text-book.

We cannot forbear to notice a subject of complaint by Dr. Ramsbotham. It appears that, very soon after his book was published in England, an edition of it, with the drawings, came out in Philadelphia; and not only so, but the Editor was anonymous, and emasculated the work, by leaving out a part of Dr. R.'s annotations and the whole of his Appendix, and then, curiously enough, translated this abominable liberty into the term revision. It is not necessary for us to inquire whether the book would be better if shorn of a portion of the Notes and the entire Appendix, but we fully sympathise with Dr. Ramsbotham in his complaint. The Philadelphians are fond of this sort of outrage on courtesy and integrity. It is a very smart thing to appropriate another man's labour and copy his drawings, and revise his work for the American public. They seem to have an establishment