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Reviews and Notices of Books.Clinical Notes on Uterine Surgery, with Special Reference to the

Management of the Sterile Condition. By J. MARION SIMS,M.D., late Surgeon of the Woman’s Hospital, New York,M.D., late Surgeon of the Woman’s Hospital, New York,&c. London : Robert Hardwicke. 1865.

THE perfection of scientific writing is that in which the valueof words is solely appreciated as they serve to convey clearideas. To arrive at this is one of the rarest accomplishments,and few men have succeeded so perfectly as the author ofthis important book. Before commencing an analysis of itscontents, it is only just to say that its calm clearness of styleand entire absence of affectation, the simplicity, the fearless-ness, and often the homely plainness with which the mostdelicate and the most important subjects are treated, give apeculiar charm to its perusal. Few works have ever issuedfrom the medical press of any country which are more deeplyinteresting than this. No small part of this attraction is pro-bably due to the entire absence of trickiness of any sort ; themanly honesty with which difficulties and occasional failuresare avowed, and the entrain with which the clinical history iswritten of the origin of those many improvements in uterinetherapeutics by which Dr. Marion Sims has inscribed his namein the rolls of fame. The title of the book truly, although verymodestly and incompletely, describes its character. It is acollection of bedside studies of the uterine diseases of which it

treats, notable for their accuracy, and continually challengingour admiration for the sagacity and the originality of theirauthor, the fertility of resource, the unfailing patience, thesuccessful adaptation to new purposes of simple means, theexact perception and clear statement of the vital points of everycase. It is a great privilege to be admitted thus intimately tothe discussion of principles and the relation of practice by asurgeon whose hitherto unwritten experience is rich in the

ample stores of a most varied knowledge and in admirablerules of procedure in a class of cases yet very imperfectlyunderstood; but that privilege is enhanced by the care andcandour with which the whole clinical history of the cases istold, and the constant explanation of the grounds of procedureby a reference to that best of all authorities-Nature.For the first time in the history of medicine, the sterile

condition is here subjected to afull and philosophical analysis,complete as far as the advanced knowledge of our time permits.The causes on which sterility depends are studied in a naturalorder, and the manner of investigating them and their propertreatment indicated. These causes are most various :-

" The trouble in one case may depend upon mere contractionof the os ; in another, upon malformation of the same-inanother, upon engorgement of the cervix-in another uponelongation-in another upon hypertrophy-in another uponsimple induration-in another upon curvature of the canal ofthe cervix-in another upon polypus-in another upon a fibroid- in another upon malposition of the uterus-in another uponsome anatomical anomaly or malformation of the vagina-inanother upon vitiated secretions of the cervix-in another uponthose of the vagina, the one generally acting mechanically, theother chemically-in another upon the absence of spermatozoa;while others may be complicated with several of these anomalies,all subjects of study and investigation."-pp. 2, 3.

It is by the intelligent discrimination of these causes andtheir appropriate treatment that sterility is rescued from theterritory of empiricism, and brought within the reach ofrational and enlightened medicine. The order in which Dr.Marion Sims marshals the inquiry is indicated in the followingadmirable and lucid enumeration of the conditions essential to Iconception. We cannot omit them, for the surgeon who clearlyimpresses them upon his mind in the investigation of thesterile condition in any patient will have advanced half-wayto success :-

1. It occurs only during menstrual life.

"2. Menstruation should be such as to show a healthy stateof the uterine cavity.

"3. The os and cervix uteri should be sufficiently open topermit the free exit of the menstrual flow, and also to admitthe ingress of the spermatozoa.

" 4. The cervix should be of proper form, shape, size, anddensity.

" 5. The uterus should be in a normal position-i. e., neitheranteverted, nor retroverted to any great degree.

"6. The vagina should be capable of receiving and of retain-ing the spermatic fluid.

’’ 7. Semen, with living spermatozoa, should be deposited inthe vagina at the proper time.

" 8. The secretions of the cervix and vagina should notpoison or kill the spermatozoa.

94 I lay these down as postulates, embracing the generalprinciples or laws most favourable-indeed, essential to fecun-dation ; and I propose to take them up seriatim, and to show,from clinical experience, wherein the sterile condition differsfrom the fecund, and to point out, so far as we know, thesurest methods of relief."-pp. 5, 6.

In the first section Dr. Sims is brief; but he touches nosubject in this book on which he does not throw fresh light,and he contributes to our knowledge two remarkable cases ofconception without menstruation, and valuable examples illus-trating errors in diagnosis arising from anomalous conceptions.The second section is one of the greatest value. It deals

with disordered menstruation as related to sterility. Dr.Sims goes always to the heart of his subject, and he treats thismatter with characteristic minuteness and a skill which neverfails him. He illustrates from clinical experience menorrhagiafrom granular erosion, from fibrous engorgement of the cervix,from fungoid granulations, from polypus, from fibrous tumours,from inversion of the uterus, &c. In the narration of thesecases and the exposition of the means of dealing with them,the surgical resources of the author are most conspicuously dis-played, and each case is a study. The part which is played bypolypi of the uterus in producing menorrhagia, the means ofexploring them, of determining their precise site and attachment,are laid down more completely than they have ever been before.

By the use of Dr. Sims’s peculiar method of uterine examination,which is clearly described in the first part of the book, and bythe use of the sponge-tent for dilating the cervix prior to ex-ploration, he shows that the cavity of the uterus may be inves-tigated with ease, and the morbid conditions which are presentdetermined with a precision which a few years since wouldhave been deemed not only marvellous but incredible.

Of the manner of using the sponge-tents, the manipula-tions, the precautions, and the little instrumental adjunctswhich are desirable, Dr. Sims treats with a detail which isnever wearisome, because it never degenerates into mere ver-biage. Every word has here, as throughout the book, its spe-cific object and significance; and although in one sense a re-markable example of how much an accomplished physicianmay find it necessary to say upon an apparently (not really)trifling subject, in another it is a perfect specimen of true con-ciseness. It would hardly be possible to omit a sentence withoutmore or less serious loss. Dr. Sims illustrates the subject ofpolypus with great care, gently, and most usefully. " Time

was," as he truly says, " when women died of polypi withoutany effort being made for their relief. This is not so now.No delicate operation is easier; none more successful." " Wefear, however, that it still not seldom happens that the causeof menorrhagia remains long undetected, and that patients areunrelieved from the failure to detect them; and the completeillustration which is here given of the means of explorationand treatment will be of the greatest service to every prac-titioner, and is full of instruction even for the most experi-enced. The subject of inversion of the uterus is treated withfulness and originality. The author gives an interesting ac-count of his experience, and a theory of the method of re-duction which is well conceived and carefully thought out.The paper recently read by Dr. Sims at the Obstetrical Society

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sufficiently explains his views on this subject; and the follow-ing paragraph illustrates its bearing on the subject of steri-lity :-

" The patient in whom I was so fortunate as to restore theorgan after twelve months of inversion, subsequently con-ceived ; and thus we see the important bearing of this operationupon the subject of sterility. Even Dr. Tyler Smith’s success-ful case of reduction after nearly twelve years of inversion, wasfollowed by conception ; and these two cases are, I think, suf-ficient to warn us against a too hasty resort to the operation ofamputation.

"

With this quotation we must for the present close, having,however, only half noticed a small, and that, perhaps, not themost important, part of this suggestive and remarkable work.We cannot omit, however, to notice the graceful allusion

which the author makes to the political circumstances whichhave induced him to take up his residence in England. He

has earned the personal not less than the scientific respect ofthe profession in this country, and that good opinion will beincreased by this volume.We must say, too, a word in favour of the technical getting-

up of the book, which is universally good; and of the excellenceof the illustrations, taken from nature, with which it is liber

ally illustrated. Dr. Sims evidently knows well the value ojthe Horatian maxim, and seeks to instruct his readers by thEaid of figures as well as by text; so that almost every otherpage is enriched with an engraving. They are all originalthey do great credit to the artists, and still more to the author,adding considerably to the value of the work.

ON THE APPLICATION OF OZONE TO SANITARYPURPOSES.

To the Editor of THE LANCET.

SIR,-I hope on a future occasion to be allowed an oppor-tunity of laying before your readers a paper embodying theresults of two years’ ozonometric observations, made chieflywith a view to ascertain the influence exercised by atmo-spheric ozone over epidemic diseases. My present object inaddressing you is to request that you will allow me space inyour columns to describe a very simple and inexpensive methodof generating ozone and of applying it to sanitary purposes.

Schonbein found that a little pure ether put into a bottle filled with oxygen or atmospheric air, and exposed to diffusedlight, the bottle being occasionally shaken, had partiallychanged its nature after a lapse of four months. Althoughproducing no action on litmus paper, it discharged the colourof a solution of indigo, converted phosphorus when immersedin it into phosphorous acid, eliminated iodine from iodide- ofpotassium, &c.; thus showing that it had acquired many ofthe properties of ozone. This discovery led to a mode offorming ozone by moistening the interior of a bell-glass re-ceiver, or a large-mouthed bottle, with ether, and plunginginto it a glass rod previously heated in the flame of a spiritlamp. On experimenting, some few weeks since, with ozoneformed in this manner, I was surprised to find that, at theexpiration of ten days, the bottle I had used, although openand freely exposed to the air, was still highly ozonised. Ithen ozonised a large glass vessel by the same process, and inthe course of a few minutes thoroughly rubbed the interiorwith a towel, and found that, although the towel had becomeozonised, the glass vessel still retained its power of liberatingiodine from iodide of potassium, of decolorising sulphate ofindigo, of destroying sulphuretted hydrogen, &c. These pro-perties were retained by the glass vessel and the towel forseveral days.Viewing ozone as oxygen in a dynamical condition, its in-

creased activity giving it the power of rapidly converting theproducts of animal and vegetable decomposition into innocuouscompounds, I began to test the power of this chemical ozonein a privy, the atmosphere of which was highly charged withsulphuretted hydrogen and probably other deleterious gases.Before commencing operations, I placed a vessel containing aweak solution of permanganate of potash on the seat, the lidbeing raised. In an hour the colour was perfectly destroyed.

I then placed large glass jars, which had been ozonised bymeans of ether and a hot glass rod, in several parts of theprivy; and by this, and other methods about to be described,I have kept the atmosphere so pure that a solution of per-manganate of potash of the same strength as that first usedwill retain its colour for several days. On finding that clethscould be ozonised by merely rubbing them over an ozonisedsurface, I began to suspect that heat was not absolutely neces-sary, and on pouring a small quantity of ether into a wide-mouthed bottle, it immediately afforded ozonic reaction, whichcontinued active for a considerable time. I have since foundthat sheets, blankets, beds, clothing, bandages, lint, cardedcotton, paper, and many other materials may be ozonised bysimply pouring a small quantity of a certain kind of ether over

them. Unfortunately I am not able to describe what thatparticular kind of ether is, but believe it to be very old etherwhich has absorbed a good deal of oxygen, that process havingbeen favoured by exposure to light. Out of upwards of thirtysamples of ether which I have examined, I have only foundone to answer the purpose thoroughly, and this I know wasimported into the colony about eight years since. Of theother samples three or four answered tolerably well, and manygave no ozonic reaction at all.

It is well known that oil of turpentine has the property ofgenerating ozone. How it does so has not been satisfactorilyexplained. Some chemists consider that the oxygen of theatmosphere is converted into ozone by contact with the vapourof the turpentine; but this, like everything connected withozone, seems to be veiled in mystery. I have found thatmany substances, particularly those which are known as dis-infectants, will, under certain conditions, generate ozone. Ihave succeeded with the vapour of cajeput oil, carbolic acid,creasote, pyroligneous acid, kerosine, naphtha, coal-tar, andchloroform, the reaction from chloroform being very feeble.

The question naturally occurs, Is it really ozone-activeoxygen-that is generated by my simple process ? I believe itfor the following reasons : It rapidly destroys sulpurettedhydrogen ; it converts sulphite of lead into sulphate ; it libe-rates iodine from iodide of potassium; it possesses powerfulbleaching properties, and quickly decolorises a solution ofsulphate of indigo ; it oxidises iron and silver when they areslightly moistened ; it coagulates albumen and casein, alteringtheir colour, and giving to them a greenish tinge ; and it in-duces intense headache and sore.throat when it is breathed forany length of time.The normal amount of ozone in the atmosphere has not yet

been determined. It must, however, be very small. It hasbeen given, I think by Dr. Berigny, of Versailles, as one partin ten thousand. It is known to be more plentiful in the opencountry than within the confines of towns and villages, and itis also known to be almost entirely absent from inhabitedhouses.Now, it appears to me quite possible that the sanitary con-

dition of hospitals, factories, schools, and indeed of all esta-blishments in which the atmosphere is liable to become vitiated,may be greatly improved by the occasional presence of arti-ficially generated ozone.

I am. Sir. vour obedient servant.

Geelong, Victoria, Sept. 1865. JOHN DAY, M.D.

EXCISION OF THE TONGUE.

WILLIAM MACCORMAC, M.D., F.R.C.S.I.

yo the Editor of THE LANCET.

SIR,-I read with much interest the sequel to Prof. Syme’scase of complete excision of the tongue. He comments uponthe almost perfect power of speech after the organ of speechpar excellence had been totally removed, and observes that heis not aware of any case on record in which the power of arti-culation remained so perfect.During the winter of 1857, I remember seeing in the recep-

tion hall of the Imperial Academy of Medicine a man fromwhom M. Ricord had excised the entire tongue some consider-able time previous. 1 looked into his mouth and saw thatthere was not a remnant of the tongue left. He was of middleage, well nourished, and contented-looking. I was inexpres-sibly surprised upon hearing this man talk fluently and withperfect ease, and, as far as I could detect, without any defi-ciency whatever in the power of articulation.

I am, Sir, yours faithfully,WILLIAM MACCORMAC, M.D., F. R. C. S.I.

Howard-street, Belfast, Jan. 20th, 1866.