In such a condition of the uterus and the patient, none of the ordinary means of exciting contraction could have been employed with equal safety and advantage. The necessity of inducing contraction to expel the contents of the womb and arrest the hemorrhage was obvious, and the utility of galvanism in accomplishing this was manifest. I am disposed to regret that the galvanism was not more freely used. The expulsion of the hydatid placenta might have been hastened.

It is beyond the strict scope of this paper, but I may be permitted to refer to the advantages attending the use of galvanism in amenor rhoea, hysteria, and other diseases of females, advantages which have been clearly established by Dr. Golding Bird, Dr. Gull, and others. The stimulating influence of galvanism is well worthy of trial for the purpose of exciting the lacteal secretion.

Mode of Applying Galvanism.-I have now gone through a series of illustrations affording evidence of the use and value of galvanism in most of the forms of labour characterized by defective uterine action, and in other cases where the indication is to excite the contractile property of the uterus. I will conclude this paper with a brief description of the mode in which this powerful agent should be applied, and a summary of the advantages it especially possesses in obstetric practice over the ergot of rye. The ordinary electro-magnetic apparatus in use for medical purposes is, I believe, the best form that can be employed. The principle of this apparatus consists in the induction of magnetic currents by a current of electricity, and the production of a rapid succession of feeble shocks by continual interruptions to the current. I have observed that the uterine contractions are always provoked at the break and renewal of the circuit. Repeated shocks act as a far more effectual and certain stimulus to uterine contractility than a continued current. It is probably through inattention to this fact that some practitioners have failed in effecting contraction of the uterus by means of galvanism. As to the mode of applying the poles, I do not think it necessary to apply one over the spine, and the other to the neck of the uterus, as is usually done. I have found the application of the discs, covered with thin flannel moistened in water, one on either side of the abdomen over the uterus, much more convenient, and quite as effectual. The practice of applying one pole over the spine and the other to the neck of the uterus, further seems to me to be based upon an erroneous view of the mode in which galvanism acts upon muscular fibre. When the poles are thus applied, one to the spine and the other to the cervix uteri, it is doubtful whether the ensuing contraction of the uterus is due to primary excitation of the spinal marrow. It is proved by the experiments of Matteucci, and it is confirmed by general observation, that galvanism acts directly upon the muscular fibre, stimulating it to contraction. It is clear that this direct action can be as effectually obtained by passing the shocks through the uterus, by placing the poles on either

side of the abdomen. I would not be understood to affirm that this immediate action of galvanism upon the muscular fibre is its sole mode of action, but that it is the primary and essential one: this primary peristaltic action commenced, the secondary and tertiary diastaltic, emotional, and voluntary reactions upon the uterus follow* The duration of the application must depend upon the requirements of the case. It is often found that nothing but a primary excitation is wanted, and that this being supplied, the uterus will go on contracting spontaneously. In those cases where it is required to originate uterine contraction, as in the induction of premature labour, several applications of an hour's duration will be necessary. The uterus cannot be roused to perfect action before the appointed time without repeated stimulation.

The Special Advantages of Galvanism as an Agent for Producing Uterine Contraction.-Among the advantages of galvanism more especially worthy of attention are-

1st. The simplicity of the operation.

2nd. The extensive range of cases in which it may be successfully employed, rendering the electro-magnetic apparatus a desirable addition to the armamentarium of the obstetric practitioner.

3rd. The perfectly manageable character of the agent. Its action may be broken off and renewed at pleasure. The moment we think the uterus is acting too powerfully under its use, we may instantly withdraw the existing agency, and leave the uterus to the ordinary

*It will be seen, from what has been said above that I cannot concur implicitly in the views or conclusions of Dr. Golding Bird expressed in the following quotation:-" In the magneto-electric coil in which currents are excited by repeatedly breaking contact by a vibrating bar, we have two currents moving in opposite directions, to each of which the patient is submitted. Now these currents are of unequal strength; and if the most energetic that on breaking contact-be passed in the direction of the vis nervosa, it will produce painful contractions, which the moment it passes in the opposite direction, will become relaxed: for a direct current tends to produce contraction; an inverse current, paralysis. Hence, I should urge the accoucheur not to employ the apparatus in which both these currents are produced, but simply the single current machine. In using this, I would suggest the positive conductor to be placed over the lumbo-sacral region, and the other to be carried by gentle friction over the abdominal surface. In this way, powerful uterine contractions may be easily produced."

Are we, when we place the positive conductor over the spine, and the negative one over the abdominal surface, warranted in assuming that we are passing a current in the direction of the vis nervosa? Are we so much as warranted in assuming that we are acting upon the contractility of the uterus through the medium of nerves at all? Conclusions such as these should be based upon demonstration. Has the uterus been isolated from all surrounding textures, preserving only its connexions with the spinal and sympathetic nervous systems; and have the effects of passing a "single current" along the nerves in a centripetal and centrifugal direction been observed? No. But this has been observed: that muscular fibre, both voluntary and involuntary, will contract under the galvanic stimulus when its relations with the nervous centres are severed altogether! The only legitimate conclusion from the known facts appears to be, that, whether the shocks of the single or double current machines be passed through the uterus in one direction or in the other, whether through the lumbo-sacral region and the abdomen or cervix uteri, or from side to side of the abdominal walls, the uterine muscular fibre is stimulated and will contract. The observations of Matteucci, upon which the reasonings of Dr. Golding Bird appear to be built, apply more especially to the effect of very feeble currents upon the motor and sensitive nerves of the spinal system and the voluntary muscles.

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physiological stimuli, which seldom impel the organ to undue activity. It moreover admits of easy regulation; both the strength and duration of this agent are completely under our command. We have it in our power to imitate in a remarkable manner the natural pains both as to intensity and intermission. Ergot has neither measure nor certainty.

4th. Its peculiar appropriateness and efficacy in cases of extreme exhaustion of the system, where deglutition is difficult or impossible, or where the stomach rejects everything; where any other mechanical application to the uterus is dangerous or inconvenient, and especially where the introduction of the hand into the uterus would be likely to be attended by injury or even a fatal result. Indeed, it may be truly said that in cases of extreme exhaustion, galvanism is the last resource left to us. The galvanic stimulus can be applied when everything besides is out of the question. The uterine muscular fibre will respond to this stimulus when the nervous system is utterly prostrate, when the heart has ceased to beat, when the patient is moribund or even dead.

5th. Galvanism is less exhausting to the system than ergot or most other means of exciting contraction. It acts directly upon the uterine muscular fibre, and scarcely taxes at all the general powers of the system.

6th. It does not necessarily preclude or supersede the use of other remedies tending to fulfil the same indication.*-Lancet, Nov. 12, 1853, p. 456.

Dr. MACKENZIE bore ample testimony to the correctness of Dr. Barnes' conclusions. He himself had been for some time engaged in testing the use of galvanism in cases of uterine disease as well as in obstetric practice. He believed that there were four classes of cases in which galvanism might be usefully employed-1st, for the induction of premature labour, as Dr. Barnes' cases proved; 2ndly, in the various forms of inertia uteri during labour; 3rdly, in placenta prævia: in this condition the blood which he believed escaped from the uterine arteries could in no way be so effectually restrained as by galvanism, which he believed would speedily develope the action of the uterus; 4thly, there was another series of cases, of various forms of passive hemorrhage and leucorrhoea. He related the case of a patient who had been delivered five weeks: for

* An apparatus which combines to the greatest extent, compactness, portability, and efficiency is an especial desideratum to the obstetric practitioner. I know of no instrument that possesses these advantages to the same extent as that of Mr. Hearder, of Plymouth. This instrument is well-made, it does not occupy one-half the space of those usually sold, and whilst the maximum power is considerably greater, it admits, by the most simple means, of accurate and minute graduation. This last quality, independently of its obvious utility in regulating the power according to the effect desired, is one which the scientific practitioner will appreciate as affording the means of comparing his own observations with those of others. Further improvements in this machine are being effected which will carry compactness to the furthest extent, and render it in every way admir ably suited to the obstetric practitioner.

the first eighteen days she had been free from hemorrhage; hemorrhage had then set in; she became blanched, and exhibited evident marks of excessive loss of blood; this degenerated into passive hemorrhage. There was no disease of the cervix uteri. He applied galvanism; the hemorrhage stopped, and on the next day it had not returned; the application was repeated. He was confident that in galvanism we possessed an agent worthy of further investigation.

[Dr. WINN considers ergot of rye to be the more powerful ecbolic agent, and much prefers its use to that of galvanism.]Lancet, Nov. 5, 1853, p. 437.

142.-Galvanism as an Obstetric Agent. By DR. THOMAS RADFORD, Manchester.-[Dr. Radford was first led to the use of galvanism in midwifery from observing its value in a case of atony of the bladder. He has used it]

1st. In cases of tedious labour arising from uterine inertia.

2nd. In cases of accidental hemorrhage, either before or after the rupture of the membranes, and especially when exhaustion from loss of blood exists.

3rd. In cases of "placenta prævia," in which the practice of detaching the placenta is adopted, and the vital powers are greatly depressed.

4th. In cases of internal flooding before or during labour. 5th. In cases of post-partum floodings.

6th. In cases of hour-glass or irregular contraction of the uterus. 7th. To originate, de novo, uterine action, or in cases in which it is desired to induce premature labour.

8th. In cases of abortion, when the indications show the necessity, or justify the expulsion of the ovum.

9th. In cases of asphyxia in infants.

Galvanism is especially advantageous as a general stimulant in all those cases in which the vital powers are extremely depressed fron loss of blood. Its beneficial effects are to be observed in the change of the countenance, restoring an animated expression; in its influence on the heart and arteries; in changing the character of respiration; and its warming influence on the general surface. I have several times observed, in cases in which other powerful stimulants have failed to produce any beneficial effects, the most decided advantage accrue after its application.

I have never observed that the child, in utero, has been injured by its use, which gives it a great advantage over the administration of secale cornutum, which, in many cases, is destructive of it. "This drug is liable to great deterioration; its operation is not always certain, its failure depending sometimes, perhaps, on its inert qualities, but frequently on a constitutional idiosyncrasy which resists its powers.

There are organic states which forbid its use: when the os uteri is undilated or undilatable, the child being still alive, it ought not to be administered. If in such a case it induces powerful tonic contraction of the uterus, it destroys the child. We cannot control or confine its action, and therefore it is totally unsuitable to cases in which we only want a limited effect. Again, if exhaustion is an element in the case, it is wholly inapplicable, as we ought not to adopt any means which tend further to depress the vital powers. The powerful and sanitary influence of galvanism was most decidedly obtained in the preceding case," (referring to a case to which these remarks were appended), "and the great advantage of this agent is, that its effects may be carried to any degree, from first only exciting the uterus so to contract that its diameters are lessened, and that its tissue comes to be applied to the body of the child. These, however, may be at pleasure increased, so as to accomplish the expulsion of the child and placenta. The gradual changes produced upon the uterine tissue were admirably seen in the foregoing case, and also its great power developed by its continued application-to arrest the discharge, expel the child and the placenta, and leave the organ safe from the occurrence of post-partum flooding."-Extracted from a case detailed in the proceedings of the local branch of the Provincial Medical and Surgical Association,

1847.

In the above-named case I used the poles externally, and have before this, and ever since adopted this mode of application.-Lancet, Nov. 26, 1853, p. 500.

143.-ON THE USE OF CHLOROFORM IN LABOUR. [At a meeting of the Royal Medical and Chirurgical Society, Dr. ROBERT LEE gave an account of seventeen cases of parturition, in which chloroform was inhaled with pernicious effects.]

He thought that a contemplation of the subtle action of this poison on the nervous system would have induced caution in its application to practice, but, on the contrary, the greatest levity had characterized its employment. Very soon after the discovery of its physiological effects the author was astonished and confounded by the announcement of its application to midwifery; and it was not difficult for him to forsee that rashness in its application and use would lead to most deplorable results, and he regretted to find that in this he had not been mistaken. It was not wonderful that women doomed to bring forth their offspring in pain and sorrow should seek to escape from the troubles of our race by means of this treacherous gift of science; neither could we feel surprise that the instances of women who were saved from the grievous pains of child-bearing, without bad consequences, should have for a time reduced to silence those unwelcome monitors who pointed to the possible evils of this new agent; but it did seem strange to the author that, amidst so wide-spread an ex