These distinctions, which will appear in the course of this trea tise to be well founded, have never been defined or used by European physicians, so far as my information extends; and to the want of them are to be ascribed many errors and absurdities in opinion, as well as warm controversies in regard to the contagion of the plague.'

European physicians, far from overlooking this distinction, were long occupied in discussing it; as the writings of every author on fever and pestilential diseases will testify. They employed, it is true, different terms; and they disputed whether contagion took place ad distans, or per tactum : but, for several years past, the doctrine of the contagium ad distans has been regarded as exploded by facts.

Mr. Webster seems to imagine that physicians attribute the rise of Epidemics, in all instances, to individual contagion: but in this also he mistakes. The cause of plague, or of typhus, it is admitted, may be generated by the confined ef fluvia proceeding from the bodies of persons originally healthy; it is also allowed that a certain state of the atmosphere may create a more general predisposition to be affected by the appli cation of contagious effluvia: but the propagatior of certain fevers by contact, or by residence with a patient, is a fact so completely established by the united experience of physicians, that we must blame Mr. Webster most seriously for deriding the assertion as a prejudice. It will be truly unfortunate for America, if Mr. W.'s opinion should obtain even a temporary ascendency, because it will lead the inhabitants to neglect the most effectual means of averting the dreadful scourge under which they have repeatedly suffered.

If an earthquake in Europe be supposed to produce an epidemic fever in America, we ought to possess a clear account of the progressive action of the noxious cause, from the very foot of Etna or Vesuvius, on every island and every ship found in the direction of the effluvia, to Philadelphia or New York. It is likewise impossible, either on this theory, or on the belief of similar influence from a comet, to explain why an Epidemic should be confined, during several months, to so small a portion of the atmosphere as that which envelopes one town, whatever be its size. While the yellow fever raged at Philadelphia, persons who fled from the town found themselves in safety at the distance of a few miles in the country. The atmosphere, therefore, was not rendered noxious by any general cause. The experimentum crucis, however, on this question, is the success which has attended the removal of patients from their own habitations into fever-hospitals; and the check which has thus been repeatedly given to the progress of Epidemics, even of the plague itself, demonstrates the existence and the evil of individual contagion.

Let

Let us hear no more, then, of these obsolete doctrines, which can produce no result but despair, (since medicine would be in vain opposed to diseases depending on comets or earthquakes); and let the American government, guided by the experience of European physicians, adopt the easy and salutary precaution of establishing large fever-hospitals in their cities, and especially in their sea-ports. When this measure is carried into execution, on a scale sufficiently extensive, it will always be in their power to stifle epidemic fevers in their origin. Posterity will wonder that one visitation of a pestilential Epidemic was suffered to pass over, without recurrence to a method of relief which will appear self-evident to succeeding times.

We have thought it necessary to express our unqualified disapprobation of Mr. Webster's doctrine of Epidemics, on account of the immense importance of the subject; yet it is necessary to add that his collection of facts is very large, and displays a mind of much vigour and general acuteness, though on this subject his information is not accurate.

ART. XII. Two Memoirs on the Cesarean Operation. By M. Baudelocque, Sen. Professor of Midwifery in the School of Medicine of Paris, &c. Translated from the French: With a Preface, Notes, an Appendix, and Six Engravings. By John Hull, M.D. 8vo. pp. 240. 68. 6d. Boards. Bickerstaff. 1801.

THE

HE history of controversies, which unhappily forms a great share of the history of philosophy, is a continued satire on the misapplication of human talents. In antient times, the Faculty were divided in their opinions concerning the best method of boiling water-gruel: more recently, it was keenly disputed in Paris whether a patient, who had a pain in his right side, ought to be blooded in the right arm or the left; and Fontenelle has immortalized the grand controversy respecting the Dutch boy with the golden tooth. In all these instances, the animosity of the disputants seems to have been in the inverse ratio of the importance of the question; but, in the case to which our attention is now called, it must be owned that, however harsh and improper the conduct of some defenders of the Cæsarean operation may have been, the object for which they have contended cannot be deemed trifling.

Dr. Hull, the translator of this volume, having in several instances performed or advised the Cæsarean operation, when the event proved uniformly fatal to the mother, and having been led into a controversy to defend his want of success, has naturally turned his thoughts to a foreign alliance, in order to

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support the cause which he was unable to maintain by the result of his own experience. When we are told that the practice has frequently succeeded in France, but never in this country, we are reminded of sop's Traveller, who boasted that he could leap to a prodigious distance in Rhodes, though he was incapable of performing the same feat at home: but, when we analyze more closely the evidence collected by M. Baudelocque, the mystery is unravelled. It seems that the Cæsarean operation has not succeeded in France, when performed publicly, under the inspection of well informed professional men, and with every advantage from the manner of executing it, and of care in subsequent dressing and attendance: but that it has answered to admiration, when it has been done with a bad razor in the middle of a forest, or by the horns of a bull in a field! We shall quote M. Baudelocque's own words, on this subject, and shall leave the reader to judge how far the comparative evidence has been properly weighed:

The case just related, and that of M.Tarbès, appear as proper to engage your attention as the two following, with which they form the most remarkable contrast. In one, fifteen professors of a celebrated school pronounce upon the necessity of the Cæsarean operation it is performed by one of them under the direction of the others, and is unattended with success. In the other a number of practitioners, almost equal to that of the professors of Montpelier, see no other resource than the Caesarean operation: it is performed in the midst of this crowd of luminaries, and the event is not more fortunate. In one of the two following cases, one man constitutes himself the arbiter of the destiny of the woman and her infant; he decides upon the necessity of one of the most important operations of our art; he undertakes it without any assistants except her husband, a woman eighty years of age, and a little girl. Two leagues distant from home and in the middle of the night, he deems it as useless to procure the instruments, suitable for the performance of it, as to call in any of his brethren. He operates with a bad razor and he preserves the mother, as he would also have preserved the child, if it had been alive at the time. In the second, which is undoubtedly still more extraordinary, the accoucheur opens the abdomen.and the womb of a woman, whom he believes to be dead; he extracts the child, and takes flight the moment the woman, who was only in a syncope, sends forth a sigh and complains of the injury done to her; and this operation is nevertheless followed by the success, which nature seems pleased to deny in most instances to the most wisely combined efforts of art, as if she were afraid to share the glory of it with men, who would seem better entitled than the others to attribute the success to themselves.'

We are sorry to find that so strenuous an advocate for the operation rests the chance of its success on the ignorance and brutality of those who undertake to perform it. Surely an im

partial

partial inquirer would be led, by this strange opposition of events, to doubt the accuracy of these romantic accounts. We certainly must deduct, on this consideration, every alleged fact, which the reporters of these Memoirs do not affirm from their own knowlege. They are evidently partial to the adoption of the practice, and they catch with avidity at every testimonial, however slight, which can be produced in its favour. Making this allowance, we apprehend that no judicious practitioner in this country will venture on an experiment, which even M. Baudelocque acknowleges (p. 129.) to be but seldom attended with a fortunate result.

In the Appendix, written by the translator, are two additional cases of the performance of the Cesarean operation in Great Britain, both followed by the death of the mother. When shall we have done with these melancholy proofs of its fatality? We cannot help remarking that the number of instances, in which this operation has taken place, has increased amazingly since the commencement of this controversy. For the sake of humanity, let the subject be dropped; and let those whose passions may have been inflamed by dispute, to an undue degree of pertinacity in the opinion which they have espoused, have time to reflect coolly, and be induced to desist from the repetition of experiments so discre ditable to the art of surgery. The present writer is disposed, we observe, to concede one point on this subject. He says:

The number of fatal cases of this kind, that have been recorded and collected, is now so great as almost to preclude every hope of preserving the life of a mother, affected with Malacosteon, by the Cæsarean operation. The lips of the external wound, though kept in the most perfect contact by means of sutures and adhesive plasters, shew little, or no, dispostion to heal by the first intention; and the effects of the inflammation, arising from the incomplete state of the abdominal cavity, and the injured and exposed state of the viscera, cannot be long supported by these feeble and nearly exhausted systems.'

We suppose, however, that few medical men will agree with him in considering this as a reason for performing the operation on healthy women; and, as he expresses himself, as an operation of election, not of necessity. The advocates for the Cæsarean section have, till now, represented it as the last resource, in very rare instances of deformity; so rare, indeed, that the operation was, till lately, regarded as prohibited by general consent. If Dr. Hull means to recommend this horrible practice in preference to the crotchet, we scarcely know terms sufficiently strong to reprobate the publication of such an opinion. What are we to conclude from the following among other expressions?

We

We have recourse to it only as an operation of necessity, where we can neither accomplish the delivery by diminishing the bulk of the child, nor by any other means. The practitioners of France and other states on the Continent of Europe perform it, not only as an ope ration of necessity, but as an operation of election, where the mother may confessedly be delivered with considerable safety, by sacrificing the life of the child: it would appear also, that in general they have recourse to the operation, before the patient has suffered very much from the continuance of labour. Upon these grounds only, Í apprehend, is the greater success of the Continental compared with that of the British surgeons to be accounted for. And it may be expectcd, not without reason, when the propriety and necessity of this operation are universally admitted, and when surgeons proceed to the performance of it in the carly stage of labour, that a greater propor tion, both of parents and children, will be preserved than has been hitherto done.'

At this happy season of a general peace, we beg leave to propose an amnesty to the violent partisans on both sides in this debate:

"Already have their quarrels fill'd the world

With widowers and with orphans:

'Tis time to sheath the sword, and spare mankind." CATO. This volume is concluded by some remarks on the Mollities Ossium, or Malacosteon, as the author terms it, which he imputes to a deficiency of phosphate of lime in the structure of the bones. Dr. Hull has also added some observations on the nosological place of Malacosteon, which he proposes to refer to the same genus with Rachitis. On this subject, we think,

his reasoning is very doubtful. Though some points of resem blance may subsist between these diseases, we know at present too little of the history of Mollities Ossium to be prepared for this arrangement. Rickets are so decidedly confined to an early period of life, that we should hesitate to rank with them a rare complaint, attending advanced age, unless it could be proved that the persons affected by Mollities Ossium had been attacked by rickets in their youth; which, we believe, has never yet been pretended. Nosological arrangements, which are always arbitrary, are, it is true, of little importance in themselves: but they may sometimes lead to bad practice, and it then becomes necessary to check the zeal of their admirers.

This auther, who almost rivals Mr. Chalmers in the number of his appendices, has likewise subjoined an account of three Cases of the Cæsarean operation performed in France, in which the event was favourable to the mother; one of these women was again subjected to it in a subsequent labour, and died. Another fatal case (and we hope to hear of no more) is added.

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