told by many writers not to be solicitous about the second, but to extract by one alone.-(Portal,a Puzos, Giffard, Delavrye,c Wigand, Carus, Siebold, Kilian.) The reason given is simply to avoid pain to the mother, and to save the difficulty and trouble of seeking for a second. A similar recommendation has been given by my intelligent friend Mr. Radford, of Manchester, but for very different, and as far as my experience goes, for very valid reasons:

"The results of practice," he says, "prove, what might be inferred by reasoning, that the child's life is much more frequently preserved in those cases in which it presents the breech, than where the feet come down first." "Is there then no practice which would enable us to bring down a part, approximating in its measurements to those of the breech presentation, which we have already stated to be so safe to the child, but which cannot be effected in turning operations? There is,-and this practice consists in NEVER bringing down more than ONE FOOT in the manual operation of turning a child." The following measurements were obtained from children born at the full period of utero-gestation:

The circumference of that portion of the head

which presents in labour, is from . Do. of the breech, with the thighs flexed upon the abdomen, as in breech presentations, from .

Do. of the breech, with one thigh turned upwards towards the abdomen, the other extended, from

Do. of the hips, the legs extended as in feet presentation, from

a Pratique des Accouchemens, p. 31.

b Traité des Accouchemens, pp. 169, 170.

12 to 13 inches.

12 to 131 do.

11 to 12 do.

10 to 11 do.

d Die Operative Geburtshülfe, vol. i. pp. 401-2.

• Edinburgh Med. and Surg. Journal, April,1832, p. 260, or Essays, pp.14, 15, 16.

It is evident from these measurements, that it will be safer for the child to bring down only one foot, for inasmuch as the breech with the thigh turned up is more bulky than the hip with the legs extended, by so much will the passage be better prepared to admit the quick transit of the child's head, upon which the safety of the infant depends.

From what has been stated, it will appear that the difficulties of the operation are almost entirely owing to the uterus being in action. When it is quiescent, or nearly so, the operation is easy; but when the contractions are violent, it is often tedious, difficult, and very painful, both for the patient and operator. These contractions equally impede the introduction of the hand, the finding of the feet, and the turning of the child. Once so much is accomplished, they become of valuable assistance in completing the delivery.

The danger to the mother may arise-1. From the operator not changing the direction of his hand, in accordance with the pelvic axes, and consequently pushing his fingers through the vagina.

2. The hand may be forced through the walls of the uterus, if too much force be used in searching for the feet.

3. The uterus may bruise itself against the hand or the limbs of the foetus when making the turn.-(Velpeau.)a

4. Without any evident injury, the irritation of the operation may give rise to subsequent inflammation."

5. The shock may be serious or even fatal.

a De l'Art Accouchemens, p. 394.

b Lest I should be supposed to have overdrawn this melancholy picture, I will quote the testimony of Dr. Blundell :

"The grand error to which you are obnoxious, is the one of too much force, arte non vi. Contusions, inflammations, lacerations, fractures, decapitations; these are the tremendous consequences resulting from this error; consequences at once fatal to the mother and child. Laceration of the womb, laceration of the vagina, extensive laceration of the perineum, one or other of these will certainly occur, if you operate rudely, and now and then perhaps when turning is performed with the nicest care. Those make a mock of turning, who have never seen its dangers; it is, at best, a fearful operation."-Blundell, Principles and Practice of Obstetricy, p. 398.

The simple enumeration of these dangers ought, one would think, to go far towards obviating most of them.

The dangers to the child consist-1. In compression of the funis, which commences about the time the buttocks appear at the os externum.-(Ould,a Dewees, Michaelis, Ritgen.")After this time, if there be much delay, the child will perish from the interrupted circulation, unless by chance the cord should have lodged in the angle at the junction of the sacrum and ileum. To obviate this danger, it was proposed by Pugh to introduce a pipe into the child's mouth, and excite respiration, whilst the head was as yet in the vagina. Bigelow and Baudelocques are said to have tried this in practice.

2. If much extracting force be used, the spine may be dislocated; the hips also; and the leg has been pulled off.

3. Compression of the head is enumerated by Deweesh as one of the dangers to which the foetus is exposed.

It only remains now for me to say a word as to the after treatment. The patient will probably need an anodyne after the operation, and it is good practice to join a few grains of calomel with the opium or Dover's powder. It will be necessary to exert great watchfulness to detect the first inroads of inflammatory action, which must be met by antiphlogistics, according to the strength of the patient and the violence of the attack.

Careful inquiry should be made as to the character of the lochial discharge each day, and if necessary the vagina may be syringed with warm water.

The most absolute quiet and rest is desirable. If the infant be alive, the mother should not be teased with it for some hours.

a System of Midwifery, p. 104.

e See his Treatise on Version.

Compendious System, &c. p. 290.

d Anzeigen der Mechanischen Hülfen, 1820.

e Treatise of Midwifery, 1754.

f Journal de Progres, &c. 2nd Series, vol. i. 1829.

Revue Medicale, 1831, vol. iv. p. 505.

h Compendious System, &c. P. 290.

ART. XI.-Observations on the Treatment of Delirium Tremens, without Opium. By T. CAHILL, M.D.

MANY years since, when a student, having witnessed some very sudden deaths in delirium tremens, treated with opium, I often questioned the propriety of that practice, indiscriminately applied. More recent instances of fatality in the same disease, treated in a similar manner, served to confirm my doubts on the subject. Yet, when I came to treat the disease myself, I was obliged to pursue the routine until forced by circumstances to try other means, the utility of which experience, in my opinion, has confirmed. Having satisfied my own mind of the safety and certainty of a less heroic practice, I am anxious to lay before the profession the mode of treatment I have been led to adopt, and the facts on which that treatment has been founded, in order that those who have more ample opportunities of observing, and much greater knowledge in treating, disease than I can presume to, may put its efficacy to the test.

CASE I. When in Newry, as locum tenens of Doctor Fitzpatrick, I was called to see Mr. J. T., an innkeeper of that town, about 65 years old, of a broken constitution, with an intermitting pulse. I saw him for the first time on the 19th of January, 1835; he had taken a draught containing one grain of acetate of morphia, on the previous evening, which threw him into a lethargic sleep, with stertorous breathing, from which he awoke more excited than before. Ordered 3 vi. castor oil; the douche to be applied as often as possible to his head.

20th. Morning. Bowels freed by the oil; delirium as yesterday. His bed-room being next to a large dining-room, seldom used and consequently cold, I allowed him to walk through it in his night dress (under surveillance) whenever he became warm and excited.

Evening. Much cooler and easier; the walk through the large room always produced calmness and quiet.

21st. Bowels again constipated. Castor oil to be repeated.

Whenever excitement increases, the douche to be used to his head, and to be permitted to walk about the large room.

22nd. The oil has had effect; no sleep. Having heard that his son had shot a hare, wished to get some soup made of it without the knowledge of his son, (an idea that his family had conspired to poison him having been a prominent characteristic of his delirium,) I ordered him to be allowed to take the soup as if it were given without my knowledge or that of his family. Evening. Has taken the soup, and is now asleep.

23rd. Quite rational, but complains much of weakness; has slept a great deal during the night. No relapse.

CASE II. March 24th, 1835. Called to see Mr. M., his usual medical attendant having been obliged to attend the assizes of Downpatrick; found him in a state of high delirium, and exhibiting symptoms of gastritis; incessant vomiting, thirst, and pain on the slightest pressure over the region of the stomach. Ordered twenty leeches to the epigastrium, a blister to be applied when the bleeding ceases; purgative enemata, and cold drink, a small quantity at a time.

25th. The gastric symptoms abated; delirium nearly as before; his friends expressing very great anxiety to have him able to resume his duties as soon as possible, I ordered an eight ounce mixture, containing 3i. of acet. opii, one tablespoonful to be taken every second hour, the quantity to be increased, and the interval diminished, as might appear necessary. 3x. of acet. opii were taken before it produced sleep, and I was frequently about to give it up from the very violent excitement, and slight contraction of the pupils produced by it, but I had not sufficient experience of, and of course little confidence in, the palliative plan pursued in the first case, I therefore persevered, and ultimately sleep followed.

26th. He is quite collected, but weak; the gastritis has returned with more than its former intensity, even cold drinks give pain, and solids cannot be endured. Ordered the dressing