INTERCEPTED LETTERS.

569 as they considered me to be the head of the Accoucheur department. and suffered judgment to go by I think it but respectful towards you, who On Tuesday last a jury assembled in the hold so prominent a situation in the I Court of Common Pleas, Guildhall, to classical and scientific atmosphere of this settle the amount of damages, when FIVE country, and whose moral example is so HUNDRED POUNDS were awarded to the duly estimated, though not always folplaintiff. We shall probably publish a lowed, by your professional brethren, to I think I ought to say on this state brief report of the proceedings as they important occasion, and I am also conoccurred in court, in the next number of fident that your extended experience and this Journal. MoRisoN, we are informed, great tact may suggest to me some appropriate, and at the same time delicate, pays upwards of SEVEN THOUSAND answers tothe interrogatories which the

tried, with drew that plea from the-record, Committee, default. at

il’

what

year to Government for the may make. "I anticipate being asked how it was his with which three-halfpenny stamps that I became a licentiate of your College, boxes of trash are plastered!! What must - in fact, by what means I got a degree. " Now it does not appear to me necesbe the character of that Legislature which to expose the precise nature of all thus submits to be bribed into a tole- sary yourkind offices with the ARCHBISHOP ration of a system so disastrous to the OFCANTERBURY, and the difficulties we to overcome in getting his HOLINESS public health, and which, if it were a over to our ways of thinking. I brought little more widely extended, would comtherefore propose to state to the complete the ruin of the medical profession,, mittee, that you, my kind friend, some were good enough to say that as it has already proved the disgrace off years ago, acceptable to the College of medical science in this country ? If thePhysicians if I uere to become one of their sale of " secret remedies" is not abolished members, and that you did me the honour to invite me to become a licentiate of the by law, no new enactment for effecting me- College, abandoning my own former coldical reform will possess the value of thee lege-the College of Surgeons. And I must say that I consider the event to be paper on which the clauses are written. one of the chief of my life; it is one which has given me the highest personal

rourrns a

committee

had

it would be

gratification. It is also probable that I shall be PARLIAMENTARY COMMITTEE. - The asked, besides, what is the honour atis a list of witnesses who have following to being a licentiate of the College been examined by the Medical Committee of Physicians,—what advantage I receive since Friday last :in practice from being a licentiate of that Drs. FLErCHER, 1. A. ROBERTRON, and College. 11 I will then state, that at the comSHARPEY, of Edinburgh. mencement of my education (which Professors T. THOMSON and R. LEE ; I should have Drs. CORKINDALE and SMALE, and Mr. exceedingly imperfect) it no greater honour to be a thought of BucHANAN, Glasgow. licentiate of the College of Physicians than Professor CLARKE, and Drs. HENDER- a Fellow of the College of Surgeons; sox and DAVIDSoN, of Aberdeen; and but circumstanced as I was in later life, Professor BRIGGS, of St. Andrew’s. and invited, without application on my part, to become a licentiate of the College of Physicians, I did consider it to be an exceeding great honour to be a memINTERCEPTED LETTERS. ber of one of the most learned bodies in this country. " With regard to pecuniary considera[THE LECTURE ON MIDWIFERY DELItions, it was a positive loss; for until I VERED BEFORE THE MEDICAL COM- had the honour of being invited to the MITTEE.] College of Physicians, I performed a va" DEAR SIR HENRY, - Having been l of operations, none of which I should riety accidentally at the board-room of St.t- think it right to perform now. The pube lie must suppose, that since I have had a George’s Hospital, it was hinted to me that I should be examined by the Medical Lambeth degree, my knowledge of such

tached

was

.

l

570 is things in

lost, and, therefore, if the gaps cases, without watchfulness, without

by

care,

had not been filled up or with obtrusiveness, may be converted are no gaps at all in sur- into cases of the greatest hazard. Thus I should have been minus so much I will proceed, my dear Sir Henry, and income as would have been gained by my thenwill proceed to state, that the act of practice as a surgeon. All this I can state labour is made up of a resistance to be conscientiously, my dear Sir Henry, for overcome, and a power capable of overthough the whole world knows that I re- coming it; and that the last should beat commend my nephew to do everything first ; but this does not always occur; surgical that may come to the shop, no one the resistance is then greater than the can suppose that 1 do not derive a fair power, and, consequently, it becomes nefor it. cesary either to increase the power by per-centage Next I will proceed to give the Com- artificial means, or, in cases of dispromit.tee a description of the termmid- portion between the cavity and the body wifery,’ and on that I will read them a which has to pass through it, either to long lecture, and so bamboozle them in lessen the volume of the body which has the course of it, that they shall make nei- to pass through, or to sacrifice the life of ther head nor tail of what I state. Any the woman to preserve the life of that man may write intelligibly, if he only un- body, the child. It is a settled axiom, that derstands what he is to write about ; but the head of a child, which in its short I aspire to something beyond that. The diameter, taking case with case, measures accomplishments that are within reach of four inches, cannot pass through a cavity any man are not worth having. For my which measures less than three, without part I have, by great industry and hard a diminution of its size. A diminution of labour, acquired such flippancy in the use its size can only be effected by lessening of words, that I can speak for an hour and the quantity of its contents, namely, the a quarter, and afterwards defy any man brain; and I need not say, that if you reeither to repeat what I have said, or express move the contents of the skull, namely, what I meant. For example, suppose I the brain, you destroy the life of the peram asked by one of the wise-acres of the son to whom that brain belonged. It Committee, whether I am a midwife; I appears, then (I shall continue), that those will say’No; I am a man-midwife.’ Then cases of difficulty and of danger which dethey will say, perhaps, ’What do you con- I pend upon the disproportion between the siderto be included in the term midwifery ?’ which has to pass through, and the In the answer to that, I will be a little cavity through which that body has to prolix, explaining that prolixity is neces- pass, are cases which require great attensary, and declaring, that if the Committee tion, much anatomical knowledge, accuwill give me leave to state, I consider the i, rate powers of comparison between the act of midwifery not merely to compre- major and the minor, great judgment as hend the superintendence of a function in to the determination whether life should which nothing is required, and, conse- be sacrificed, and which life of the two quently, concerning which, nothing is to should be sacrificed. The difference of be done, but to involve the management half an hour, the difference of a quarter of a great number of cases of great dif- of an hour, determines the fact whether ficulty—of great danger—of cases in the practitioner should destroy the child’s which, if treated rightly, life is preserved, life to preserve the life of its mother, by and, if treated improperly, is destroyed. opening its head, or whether he shall It may be right to state, that the process adopt such other means, I mean the emof human parturition is very different ployment of time, especially, as may posfrom the process of parturition in other sibly justify him in waiting without animals. I will then go on literally to operating. I shall then go on to tell say, that in order to obviate the effects ofthem that there are other cases, and, to gravitation, the cavity through which the lengthen the yarn, shall say, that in the contents of the womb have to pass, is not greater number of instances, the presenplaced in the same line with the trunk oftation of the child is by its head; but the body in the human subject, as it is in that in once out of seventy times, it hapother animals; and the price which is pens that other parts than the head, such paid for the advantage of the erect pos- as the shoulder, the back, or the breast, ture of the body, is in proportion to the will present themselves; and that it is increase of the difficult3-, and of the danger impossible that a body so pre. can pass through that cavity, unattendant upon parturition. Cases of the the nature of that presentation be most simple kind, which are included under the head of natural labour, are by changed. " Don’t think, my dear Baronet, that I watchfulness, care, and doing but little, attended with little hazard; but these stop here. By no means. My zeal is

practice physic (there my

gery),

I the

body I

perfectly ! sented less

shall

571 not of the half-and-half kind. I "shall,"1Icoagulate unless it he at rest; it is equally assure you, proceed as follows : Gentle-obvious, that it cannot be at rest in a men (I shall say), if a case be large vessel, where the pressure behind would prevent it. Here, therefore, is given treated, or mistaken, there is no but that of life or death. If the case be to the uterus of the woman, and to the known and treated, but not treated skil- uterus of the woman only, a muscular the contraction of the uterus itself, fully, an accident of the most fatal nature, namely, a rupture of the uterus, a com- by the exertion of which muscular power munication made between the cavity of.the sides of the vessels are compressed each other, so that that which the abdomen and the external air, is not happen by a mere contractior. effected by the improper performance such operation, and thelife of the womanof the bloodvessel itself, is effected by the is devoted. There are cases, and they are contraction of the muscular fibres which

ignorantly question: ’

I .power,

against

ofcould

of hemorrhage occurring surround the bloodvessels, producing and Some of those cases of he- making a specific ligature on each bleedmorrhage dependupon the opposition ofing vessel, of ,the thickness of the uterus the placenta to the opening at the This is the provision of nature of the womb, or as it is called, the by Providence to the human uterus; uteri. In those cases the first part of theit is not given to the uterus of any other process, which involves the dilatation of animal, since the structure of the placenta that opening that opens the door through in other animals is so formed, that while which the child is to pass into the world,-one part comes away, another part remains this natural act, that in 99 cases out ofbehind. It is that the of the mode of restraining he100, or a much larger proportion, is give an opening through which the con- morrhage, by producing the contraction tents of the uterus are to be discharged,- of the bloodvessels, by forwarding the as it proceeds, involves the patient in a coagulation of the blood, and especially by state of positive and imminent danger. producing contraction of the uterus itself, For the body which is so placed, consists is of infinite importance to everybody who of a collection of bloodvessels, which being has the care of the act of parturition ; torn through, the life of the child is sa- i and a vast number of women are lost crificed by the loss of blood, and theevery year by the ignorance of persons There is but another woman would either die undelivered, orupon this subject. she would die of hemorrhage- after that: case, that which has been calledconvul. delivery. So that in such a case, it be-sion,’ ’puerperal convulsion,’ because it is comes necessary actually to make a per-unlike any other convulsion in some of foration by the hand through such pla-- its circumstances. Such cases, in ignocenta or mass, and to deliver the child1 rant practice, almost always end fatally; through the opening so made, in order tobut, in good practice, almost all end prevent the further certain consequencewell; and the like may be said with reof the non-perforrnance of such an opera-gard to the cases of hemorrhage. A bad tion ; and that certain consequence iss practitioner will lose nineteen out of death. twentv of his cases of hemorrhage: a " I think this will bother the committee good practitioner will hardly ever lose a not a little; and they will say, Such a case, though he may live to a considerable learned man as this can only belong to a age. Another danger presents itself, and eollege that deserves our protection.’ Per- in cases the most natural. It happens haps some member will still doubt this. very often that the placenta, or connectFor such an emergency I will be prepared, ing medium between the mother and the and will carry my lecture a little further. child (it is as well, my dear Sir HENRY, I will then proceed thus : - Gentlemen to make the subject rather clear to the (I will say), in labours the most natural, Committee, wherefore I occasionally in women of weak powers, it very often give these little dictionary explanations), happens that hemorrhage takes place from thismedium (I shall say) is situate at the bloodvessels, and that such hemorrhage part of the bag called the uterus. becomes the cause of death. It is very If an ignorant practitioner forcibly draws the funis when the uterus is rewell known to physicians and surgeons. and, I may say, to physiologists and phi- laxed, and before the placenta is sepalosophers in general, that the restriction rated, he draws down with it the uterus of hemorrhage in the body is attributed tc that an external tumour two causes, namely, to the coagulation o which was an internal cavity, and either the blood, which forms a plug in thl destroying immediately the life of the pableeding vessel, and to the contraction o tient by such violence done to parts inthe bloodvessels, which obliterates thei: capable of bearing it, or producing a disease which is inconvenient, cavity.It is obvious that the blood canno

not

unfrequent,

in labour.

bottom itself. I

os! given

toji knowledge

quite obvious,

upper down

itself, making

,permanent

572 and not to be removed but by the removal that this is ,a misapprehension or misconof the uterus itself. Those cases 1 have ception on your part; but these obliquities It occurs of mind, however easily they may pass in seen happen again and again. sometimes (and there is an instance upon another corporation, will be suspected in record of a man who was tried at the Old a body so distinguished as ours for its Bailey for such practice) that the practi- moral feeling and dignified character. tioner, not aware of that which he has But I do not detract from the merit of done, has continued to drag until he has your dramatic description of midwifery. torn the uterus out of the body, bringing The whole, at the same time, is playful with it the intestines and parts contained and physiological, and the parts are so in the cavity of the belly- you know what twisted and involved, that I defy WARthe belly is, Gentlemen-and the patient BURTON, or any of his clique, to unravel has died. There is yet another case, which, the web which you have constructed. I if not constituting what may be called the confess it is perfectly incomprehensible to act of labour--Gentlemen, you know what " Your faithful but mystified friend, labovr is-may be considered fairly as being " H. H. the prelude of labour; I mean the ordinary 1834." " London, If the oak is valuable case of abortion. as an oak, the acorn is valuable which produces it; and therefore, as far as huPROVINCIAL MEDICAL ASSOman life is concerned, cases of abortion CIATION. are of as much importance as cases of labour. But it is notorious to persons who " Hos ego versiculos feci, tulit alter honores." practise this part of the profession, that all those cases are met by ignorant pracTo the Editor of THE LANCET. titioners with a remedy of one colour, and that colour red. They are met by a comSiR,—As the next meeting of the Assobination of medicines of three different ciation takes place on the 18th iust., I kinds, so that you know, before you see trust to your known impartiality for the the prescription, what a patient has taken. insertion of the following in the next NumThose cases demand great knowledge; ber of your valuable periodical, and am, Sir, they may arise in weak habits and in your obedient servant, GEORGE SHEWARD. strong habits; they may depend upon the loss of the vitality of that which is within Upton-upon-Severn, July 6, 1834. the uterus, and they may be irretrieveable ; or they may depend upon the sepaTo the Members of the PROVINCIAL ration of the ovum from the uterus, which AND SURGICAL ASSOCIATION. MEDICAL separation may be partial only, and, by the last volume of the remain Gentlemen,—In treatment, judicious par- " may only tial, or they may depend upon the con.. Transactions" of your Association, is traction of the uterus, the walls of which the report of a case of a foreign body organ contracting upon its contents, may found in the heart of a child who died, work its expulsion; all these cases (dif- some time since, at Baughton, in this neighferent in themselves) require manage- bourhood ; and as the author of that case ment also very different. I think I have has, in my opinion, been deficient in good stated enough to show the importance of faith towards me, I shall take the liberty that part of the profession which professes of making a few observations upon the to superintend the function of child-bear- subject. ’ In the first place I distinctly state, that ing, and the necessity which there is for examining into the qualifications of per- although the case is published by " Thos. sons who are to superintend the function, Davis, Esq., surgeon, Upton-upon-Sein whatever department of the profession vern," not a tithe of what is there printed was written by him, and that the notes, they may happen to be. on which such report was founded, were " Believe me yours, sincerely, " furnished by me, and received by Dr. C. M. C." Hastings in my handwriting. I was de" DEAR SIR CHARLES, - Upon the sired by the Hon. W. Coventry, in whose whole I am rather pleased with what service the father of the boy was, to be you propose to state to the Committee, present at the opening of the body, in but I send you back your letter for you consequence of what he considered the to revise it. You surely will not have the extraordinary nature of the case, Mr. effrontery to state that I invited you to Davis having asserted that the boy had become a licentiate of our Royal College, recovered from the accident, and sunk and that it was acceptable to us for you to under an attack of ague!". No mention of join our learned body. It may appear this is made in the report, or of the treat--