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or restlessness, or discomfort, will require a disuse, or a largerdilution, of the stimulant."

I have been favoured by another document from this gen--tleman relative to the peculiar effects of quinine, a copy of,which (having his permission most liberally given to use it asI think proper) is appended to this memorandum, and to whichI beg to direct the most careful attention of medical officers:it contains the results of long experience, and relates to dis-eases of vast importance, in regard to the lives and efficiencyof the troops; and should the results be confirmed-shouldremittent fever in future be as little, or nearly as little, fatalas it has been during the last quarter, treated by the specificunder consideration, a vast advantage will be attained.

In conclusion I have to request that in giving their atten-tion to this memorandum, and to the copy of the paper ofDr. Blair which accompanies it, medical officers will be pleasedto keep in mind, that both are submitted to them for con-sideration, to exercise their reflection and judgment upon, andwith the intent that they may prove helps to the establish-ment of a successful mode of treatment of the formidablediseases to which thev relate.

J. DAVY,Inspector General of Hospitals.Inspector General’s Office,

Barbadoes, Nov. 11th, 1847.(To be continued.)

REPORT OF A CASE OF FACE PRESENTATION.BY ROBERT SELBY, Esq., Surgeon, Bannockburn.

ON the evening of the 20th ult. I was requested to attend theaccouchement of Mrs. D-, the mother of four children.As her previous confinements had been protracted, notice was..not given me until she had been six hours in labour, and on- arrival I learned that the liquor amnii had been evacuatedtwo hours previously. The patient was moving about theroom, and suffering from regular but weak pains, with longintermissions. On examination, the head was found resting-.on the brim of the pelvis, presenting with the " face proper,"so that the finger could be readily introduced into the mouth,the chin towards the pubis, and the os uteri dilated to the sizeof a dollar, soft and relaxed. It has been my common prac-tice in such cases to leave them entirely to nature, and whenthe head has descended, if necessary, to facilitate delivery by.the forceps. But from the nature of her previous labours-,two of them having been terminated by the forceps-I cal--culated that, with the unnatural position of the head, thechild at least must perish by this mode of procedure, and con-sequently determined on turning. Having administered eightydrops of solution of morphia, before proceeding to turn, Iendeavoured to rectify the position of the head, at all times adifficult process, but which in this case, from the liquor amniihaving been so long discharged, was found to be impracticable.I then passed the hand into the uterus, but found it impos-sible, after repeated attempts, to reach the feet. A band of,the circular fibres of the organ were spasmodically contractedaround the body of the child, beyond which the hand couldnot be passed. It now occurred to me-as a hand couldreadily be reached-that if it were converted into a case oiarm presentation, the body of the child would be so faiadvanced, and that turning would then be more easily effectedAnd as matters could not well be worse, I brought down thE.arm, and holding it firmly in one hand, immediately re-introduced the other, when I found no difficulty in reaching thefeet and completing the delivery. The child was born in Estate of asphyxia; but after a’considerable perseverance irthe use of the ordinary means calculated to produce a resuscitation, it eventually recovered.Bannockburn, April, 1848.

HINTS ON THE EFFICIENCY OF VIGOROUSMENTAL AND BODILY EXERCISE COMBINED,AS REMEDIAL IN NEURALGIC AFFECTIONS.

(EXTRACT FROM THE LETTER OF A CORRESPONDENT.). "Just six months have elapsed since I was first

attacked with severe facial neuralgia, and only two weekssince I got rid of it, I hope for ever. A whole host of remedieswere tried in vain. My confidence was first placed in quinine,as an antiperiodic. Every four or six hours I took five grainsof this, without sensible effect.. Some time afterwards I in-creased the dose to seven or eight grains, and took it untilheadach and deafness were produced: a temporary alleviationwas the consequence. Ruminating on this, the idea occurred

to me, that as we look for the sensible effect of mercury onthe gums or salivary glands before we expect its remedialpower, so ought we to look out for the sensible effect ofquinine and many other medicines, which do not appear to beremedial when no such effect is produced. No permanent ad-vantage being derived from quinine, I tried colchicum. Onthis I placed little reliance, and did not therefore long persistin its use. These two remedies were then combined, but withno greater advantage. The routine of external anodyne ap-plications was equally unserviceable.

" I will not occupy more of your valuable space by relatingwhat did no good, but proceed at once to what provedremedial. During a most severe-amost maddening paroxysm,I tried the combination of mental emotion and severe bodilyexertion, and found it wonderfully efficacious. I walkedrapidly about the room, (having previously barred ingress toprevent any idea occurring to spectators of my brain havingbecome affected,) and had a match of fisticuffs with the air.But as the air is not an antagonist likely to excite mentalemotion, (unless in a calm, or contrary wind, at sea,) someother opponent must present himself to the imagination. Theneuralgic cannot do better, at present, than put Louis Philippeinto a corner, and punish him for all the mischief his avariceand ambition have caused in Europe. After a battle of halfan hour I was naturally much fatigued, and in a state of pro-fuse perspiration, but the pain was gone. Next day I recom-menced my exertions, on the premonitory symptoms appear-ing, and prevented the attack; and two or three times since Ihave had occasion to do the same with equal success, using noother medicine all the while, but a frequent glass of generouswine, to keep me in boxing condition, for this remedy isperhaps incompatible with great bodily weakness.

" The truth is, that nervous affections are prevented and re-moved by a great diversity of counter-irritations, or new andsuperseding actions in the system. It is absurd to talk ofquinine as a specific in ague. Twenty years ago I stopped anague with which I had been long annoyed, by violent horseexercise, taken about the usual time of attack. I had takenbark and arsenic on former occasions for the same disease,with no greater efficacy."In conclusion I have to observe, that between facial rheuma-

tism, neuralgia, and certain species of toothach, there is greatsameness of character; and I would strongly recommend myremedy of mental and bodily excitement in all three. Shouldany of the readers of THE LANCET be successful in the applica-tion of this principle, I should be glad if he would record hissuccess in its pages. There is, perhaps, nothing very new in theprinciple. In some medical periodical, the late Dr. Marcethas related a cure he made of severe chronic rheumatism inhis own person, by violent and prolonged exercise; and thequick pace about the room of persons affected with toothach,or other sharp pains, would show that this remedy is in somesort instinctive....

" Nor was the principle of this treatment unknown toDarwin, as appears by the following extract from his’Zoonomia,’ cl. ii. 1, 3, 18:-’ Two dysenteric patients in thesame ward of the Infirmary at Edinburgh, quarrelled andwhipped each other with horsewhips for a long time, and wereboth much better after it, owing, perhaps, to the exertion ofso much sensorial power of volition, which, like real insanity,added excitement to the whole system.’ Dr. Darwin’s expla-nation is much more rational than that of Dr. Mason Good,who quotes the first half of the above in his chapter on dysen-tery, probably more for the sake of the reader’s amusementthan his edification, and rather absurdly talks of the horsewhipexercise as a sudorific i)lan."’

ON POOR-LAW MEDICAL RELIEF.

BY AN EX-GUARDIAN.NO. II.

THE proposition made in my last communication on thissubject, was to place the union houses on the same footing asthe county pauper lunatic asylums. The benefits that wouldresult from such a course seem to me to be so many, and soobvious, that I am astonished to find an individual has nothitherto been found to propagate the scheme. The benefitsthat would result would be shared by the ratepayers, by thepoor, by the medical profession, and by society. The rate-payers would be benefited to a considerable extent bothdirectly and indirectly-they would be benefited by knowingthat the services of a qualified and competent man were ex-clusively devoted to maintaining the health, and consequentability to work, of those who, with their families, would other-

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wise be recipients of the rates; they would be benefited byhaving regular and efficient medical assistance bestowed onthe sick poor, and thus a more speedy relief from maintainingthem more certainly ensured. In an indirect pecuniary wayit is believed they would be benefited, inasmuch as therewould be fewer individuals to be paid for important servicesrendered; and, by having a combination of duties centered inone individual, he would be satisfied with a just and reasonablesalary, less in amount than the guardians will ultimately becompelled to give under the present system. Again wouldthe ratepayers be benefited by the saving of the large sumsnow paid for

" extras," including vacciiiation-a sum amount-ing in some instances, and in certain unions, to very nearlythe whole amount of the district officer’s annual salary.These extras would merge into a trifling addition to theannual stipend, and be a considerable saving to the guardiansand ratepayers. Let us contrast the systems, and call figuresto our aid to show the benefits of the new suggestion.

In the present plan there is one most objectionable item-one that has always had my sternest opposition, for I havefelt that it was injurious to all the parties concerned,- meanthe subscription usually made to the funds of county hospitalsand infirmaries. The chief advocate for this expenditure hasbeen that very versatile gentleman, Sir Thomas FranklandLewis. The reasons given for it have been that it is a savingto the rates. But from whom did the "saving" come? Fromthe surgeons, certainly. A smaller salary was allotted tothem by the late central board than was felt to be requiredby the nature of their duties, and their eyes were allured bythe tempting bait of" extras" in prospectu. But, without theknowledge of nine-tenths of the surgeons, subscriptions were egiven to hospital committees to receive all casualties, andthus the surgeons have been deprived of their promised re-ward. The present head of the poor-law commission is notat all responsible for this piece of iniquity-it was one of themany evil deeds of the late defunct body. Justice compelsme to add that in some unions this system has not been actedon, and the surgeons have consequently had a moderatereturn for extras. But to make the contrast. I may as wellgo on with the Upton Union, as that is now fairly before themedical public. The guardians nf lhaf. nninn lately paid fnr

If the guardians, with the sanction of the commissioner,were to adopt my suggestion, the expense would be somethinglike the following.-

I am glad to see the Editor of THE LANCET so far adoptingthe plan as to urge the treatment of all the union surgicalcases in the house-a plan I have repeatedly recommended,but with little good effect.The subject is far from being exhausted at present, and,

with the Editor’s permission, further comments shall be re-sumed in succeeding papers, as convenience offers.

July, 1848.

POLITICAL PRISONERS.—The commissioners appointed overthe late political prisoners have fixed the diet of these personsas follows :-Brown bread, one pound and a half daily ; whitebread, for soup, three ounces and a half daily ; meat, half a-pound, five times a week ; vegetables, three-quarters of a pinttwice a week; wine, ten fluid ounces daily. These regulationsare to be printed and fixed in a conspicuous manner in allprisons. The sanitary state of the men continues satisfactory.

Reviews.

The Medical Practitioxaer’s Register qf Midwifery Cases. Con-sisting of a Series of Tabular Pages for the Entry of 500Cases; an Alphabetical Index; Exemplifications of themanner in which the Columns may be filled up; and anObstetric Calendar. 4to. London: John Smith, Govern-ment Stationer, Long-acre. 1848.

IN the last volume of THE LANCET we noticed a " Register ofCases Professionally Attended," which was published underthe recommendation of the Registrar-General, to serve as anote-book of cases for medical practitioners. The patronagewhich it has received from the profession seems to haveencouraged the publisher to produce a register especiallyadapted for midwifery cases. The latter is a goodly book,about ten inches by eight and a half, half-bound, and gilt-lettered. We extract the following passages descriptive of it,from its preface-"The greater number of circumstances admitting of being

classified in a tabular form in a Register of Midwifery Cases,’leads to the introduction of a larger number of separatecolumns than was necessary in the General Register of Cases.Accordingly, the practitioner will here separately note thenumber of times the patient has been pregnant (includingabortions and the current pregnancy)-her age-the date ofher last menstruation-supposed date of conception-occur-rences during the pregnancy (such as the period of quicken-ing, prevalence of morning-sickness, haemorrhage, abscess,injuries or moral impressions received, &c. &c.) in so far asthey may exercise any influence on the progress and termina-tion of the case-the duration of the pregnancy (as whetherterminating with the sixth, seventh, ninth or other lunarmonth)-the date and hour of the commencement of labour-and the presentation. The space allotted for the occurrencesduring labour will admit of a brief but complete summary ofevents down to the removal of the placenta-and othercolumns are inserted for the date of the termination of labour- duration of labour-number of children born-sex-livingor still-born-weight and length of the child or foetus, whichin the case of an abortion would assist in determining its age- occurrences to the mother after labour (such as the firstappearance of milk,or of fever, &c.) and occurrences to the childor children within a period ofa month from the birth.-Thecolumn appropriated to the entry of the expected date oflabour will also render the table useful to the medical man asa memento of anticipated as well as past occasions for his ser-vices. In a register sufficiently complete to admit of notesunder each of the foregoing heads, all the details of import-ance for ordinary purposes are comprised.

" The utility of this register is further promoted by its hav-ing an alphabetical index for the cases recorded in its pages;andhas appended toil the PERioDoscopE, or OBSTETRIC CALENDAR,invented by Dr. Tyler Smith. This instrument, constructedon the simple principle of reducing calendar months to lunarmonths, and arranged for use according to the periodicities ofthe female sex, informs the accoucheur in ordinary cases,without the trouble of calculation, of the time when labourmay be expected, the date of quickening, and the viability ofthe feetus; the times of special danger of abortion, and theother accidents of utero-gestation. When labour has takenplace, the practitioner will be able, at a glance, to see thenumber of days pregnancy has lasted, and to record them inthe appropriate column. The Periodoscope is engraved onsteel, and mounted in two parts, so as to revolve; it is alsoaccompanied by explanatory letter-press.

" In filling up the columns, precision in the dates, thenumber of hours, and other statistical details, is highly de-sirable. Accuracy in these particulars will very muchenhance the value of the record, and greatly facilitate a sub-sequent analysis of its contents. Such an analysis ought tobe made at least once a year. For ordinary use it might beundertaken by the practitioner himself; but we earnestlysuggest to the medical profession that considerable puhlicadvantage would attend the establishment of a central asso-ciation, to which the books might be annually sent, and whichwould undertake to have the returns digested into an abstractform, for the benefit of medical science and of the community.

" Specimen cases, showing the manner in which the entriesmight be made, have been furnished by Dr. John Hall Davis,Physician to the Royal Maternity Charity, &c., to whosesupervision the arrangement of the several columns has beensubmitted previously to publication."