them from the smaller branches to the larger roots, we arrive at the point where the optic nerve enters. This differs in appearance from the rest of the background of the eye, as it is not covered by pigment, or a network of vessels, but a sort of transverse section of the nerve here lies open to view, with a few fine vessels passing through it. The arteries and veins of the retina enter and leave near the inner part. Sometimes a portion of the vessels may be seen concealed in the substance of the nerve itself, showing that this substance is transparent during life. The two orders of vessels are distinguishable from each other as the blood is of a brighter colour in the arteries, and the walls of the latter and their first subdivisions are thicker than those of the veins. Pulsation cannot be distinctly recognized so far as I have been able to discern, though some observers fancy they can see it. The first divisions of the vessels border the inner side of the optic nerve, and then extend all over the field of the retina. The appearance of the red vessels on the illuminated base is really beautiful. Helmholtz remarks, that, close to the inner side of the nerve, he has always remarked a small semilunar strip of shadow, which appears to be from a fold of the retina. This appearance is universal, and is doubtless produced by the plica semilunaris. In most parts of the eye the base appears of a yellowish red, with a brighter red round the optic nerve, and darker the further we pass from it,-not of an equal colour, but as if with small darker patches. The point of direct vision (macula lutea, or foramen of Soemmering) has a peculiar appearance. The eye is directed exactly upon the ray of light, and the retina is seen at that spot to be darker, greyish-yellow, without admixture of red; and no traces of capillary vessels can be seen on it. It is difficult to make this out without practice, because the reflection from the cornea is apt to destroy it; while this reflection does not interfere when the eye is turned to either side for the examination of the lateral portions of the retina.

As an auxiliary in diagnosis, the ophthalmoscope must prove very valuable, as anything opaque before the retina must mask its vessels. Cloudiness of the vitreous humour, according to its degree, will obscure the view of the vessels of the retina. Opacity of the lens or of its capsule would, of course, act in the same manner.

But it is in assisting the study of the pathology of amaurosis that the chief utility of the instrument will be found. Dr. Donders has already distinguished a limited effusion of blood between the choroid and retina, or in the latter membrane itself with chronic inflammation, -in one case of insensibility of about two-thirds of the retina. After examining a great many sound eyes, I have myself detected, in various forms of partial or total amaurosis, congestion and varicosity of the vessels of the retina, partial removal of the pigment in patches, and exudations into the substance of the retina, or upon its surface. Representations of these appearances, when accurate, are exceedingly beautiful; and the objective symptoms of amaurosis thus become

admirable subjects for the artist. When they have been thoroughly examined and carefully recorded, they must contribute important information towards the history of the disease which Mr. Dalrymple so justly said has "yet to be written."-Med. Times and Gazette, Sept.. 10, 1853, p. 265.

140.-ON A NEW INSTRUMENT FOR THE REMOVAL OF POLYPI FROM THE EAR.

By JOSEPH TOYNBEE, Esq., F.R.S.

Various instruments have been invented having for their object the removal of the small vascular polypi from the external auditory meatus. Of these, by far the best is the snare of Mr. Wilde, which is thus described at p. 420 of that gentleman's work on 'Aural Surgery:" -It consists "of a fine steel stem, five inches long, and bent in the centre, with a moveable bar sliding on the square portion near the handle, which latter fits over the thumb. The upper extremity is perforated with holes running parallel with the stem, and loops at the angle serve the same purpose. A fine wire, fastened to the crossbar, passes through these loops and holes; it should be of such length that, when the cross-bar is drawn up tight to the handle, the ligature is fully on the stretch..........In using it, the cross-bar is pushed forward, and a noose made of the wire at the small extremity, of sufficient size to include the morbid growth, which it is then made to surround, and towards the root of which it is pressed by means of the stem; the cross-bar is then drawn up smartly to the handle, while the point of the stem is pressed downwards; and it never fails of either cutting across or of drawing with it whatever was included in the noose."

The difficulty attendant upon the use of this instrument consists in getting the wire noose around the polypus, which frequently is of a very small size; another disadvantage is, that it cuts off a portion of the growth instead of withdrawing it entire.

The instrument which I have been in the habit of using during several months at St. Mary's Hospital, as well as in private practice, with most satisfactory results, I have called the lever ring forceps, and it is on the principle of M. Luer's scissors. In the interior of the ordinary tube is the delicate steel rod, the end of which is split into two portions, to each of which is fixed a small oval ring, measuring four or five lines long, and from two to three broad. These rings, (the inner surfaces of which are flat,) as seen in Fig. 1, separate from each other when the lever is not pressed; but, as seen in Fig. 2, when the lever is pressed, the rings are brought into contact. The instrument is introduced into the meatus with the rings apart; these may be made to enclose the polypus or a portion of it between them, and then, by pressing upon the lever, the polypus is seized, and can be drawn out.

For the removal of the larger polypi, I am in the habit of using the ring forceps, which are made after the fashion of ordinary dressing

forceps: but, instead of teeth, there is a ring at the end of each blade. The advantage of the rings is, that a portion of the polypus is securely held within them, while, with the ordinary dressing forceps, the polypus is generally broken up, and the removal of the roots is impracticable.

I may take the present opportunity of suggesting, that the Eustachian catheter (Fig. 3.) should be made oval instead of round. The advantages attendant upon the oval shape are, that it passes through the nose with more facility, and with less uneasiness to the patient; and that, when introduced into the faucial orifice of the Eustachian tube, the flattened surfaces are in apposition with the flattened walls of the tube; and the discomfort produced by the pressure of the convex surface in the rounded form of the instrument commonly in use is, at least partially, avoided.Med. Times and Gazette, Nov. 19, 1853, p. 526.

MIDWIFERY,

AND THE DISEASES OF WOMEN.

141.-ON THE MANAGEMENT OF LABOUR CHARACTERIZED BY DEFECTIVE UTERINE ACTION,

AND THE COMPARATIVE VALUE OF ERGOT OF RYE AND GALVANISM IN OBSTETRIC PRACTICE.

By DR. ROBERT BARNES, Lecturer on Midwifery to the Royal Free Hospital Medical College.

Defective uterine action does not always indicate a resort to the ordinary means of stimulating the uterus. There are no occasions in obstetric practice in which nicer discrimination-a more accurate diagnosis is required, before deciding upon the means of relief, than in those cases where the contractile energy is at fault. Our choice must frequently lie between the use of agents calculated to excite contraction, and those which have a directly opposite effect. We are frequently called upon to determine whether it be better to rouse the energies of the uterus, or to resort to manual or instrumental assistance. Upon our interpretation of the symptoms, and our appreciation of all the circumstances of the case, our selection of the mode of interference will depend; and upon this selection may hang the safety or the destruction of the patient.

If it be difficult to solve the preliminary question, whether we should endeavour to excite the uterus to action or not, how cautious ought we not to be in our choice of the particular means for inducing contraction, when that course is determined upon?

The action of Ergot of Rye, and the Objections to its use.— -There is one agent frequently-much too frequently-resorted to on account of its power of exciting uterine contraction, the ergot of rye. A principal object of this paper will be to exhibit the dangerous properties of this drug; to show what little mastery we have over its action when once administered, and the consequently fatal results attending an error in diagnosis-a mistake in the application of the drug. If I further succeed, as I hope to do, in proving that we possess another agent at once more effective, more manageable, and more safe, and capable of useful application in all those cases in which ergot of rye is commonly employed, I shall not have uselessly engaged the time of the reader.

The ergot of rye is capable, under certain circumstances, of producing the most marked and decisive effect in exciting the uterus to

contract. An agent possessing such a power, it need not be said, is liable to abuse. It is notorious that many practitioners carry this drug in their pockets, esteeming it an indispensable adjunct to the practice of midwifery. It is amongst midwives-necessarily the most ignorant of obstetric practitioners-that this custom chiefly prevails. That this should be so is most deeply to be deplored. No agent, no species of interference in natural parturition, supplies more frequent or more distressing illustrations of that maxim, the most trite, the truest, and the most neglected, “a meddlesome midwifery is a bad midwifery," than does the ergot of rye. For one woman who has derived substantial benefit from its use at the time of labour, it may be confidently assumed that one hundred have found reason in longenduring subsequent sufferings to rue the hour when they were made to swallow the nauseous draught under the delusive promise of a speedy release from pangs, bard indeed to bear, but mostly beneficial in their result.

In discussing the uses of ergot in obstetric practice, I think it more convenient to postpone the consideration of its use in inducing premature labour, and to refer in the first place to its employment in labour at the full time. When ergot is administered before the expulsion of the child, the effects are usually as follows:-In virtue of its peculiar property of exciting contraction of the uterus, in about fifteen or twenty minutes the uterus is perceived to be under the influence of the drug. A spasmodic contraction begins in the uterine muscular fibres. Whether this is excited by the direct stimulus of an ergotic element carried in the blood to the uterus, and thus acting inimediately upon the uterine nerves or muscular fibre, or whether the ergotic element acts primarily upon the spinal marrow-that is, whether the first step in ergotic labour is of excentric or of centric origin, it is not easy to determine. But it is quite certain that when once the contractile energy of the uterus is roused, that other actions, violent in proportion to the efforts of the uterus, are brought into operation. Secondary diastaltic or reflex action of the expiratory muscles is induced with a violence in direct relation to the violence of the primary uterine contraction. If there be no invincible obstruction to the expansion of the mouth of the womb and the expulsion of the child, the child will be driven with precipitate fury through the pelvis and os externum, at the imminent risk however of lacerating the perineum, which has had no opportunity of expanding gradually and safely as it does before the normal pressure of a labour completed by the natural powers. It should be respected as a fundamental axiom in obstetrics, that as childbearing is a natural function, so is its safe fulfilment ensured by adequate contrivance. Each step in the long process of parturition-from the first action of the uterine muscular fibres which determines the expansion of the os uteri, to the final contractions which expel the placenta and close the open mouths of the uterine vessels-is only one of a gradation disposed according to a pre-ordained order, with a view