result from a residence at a hill-station, and Dr. Moore even commits himself to the dictum that "the longer a European lives on the plains, the less likely is he to receive benefit from the hill climates; for during his residence on the plains he is daily in danger of contracting those diseases, or tendency to diseases, to which sudden removal into a colder atmosphere becomes an obvious and powerful aggravating cause."

The true value of these stations we believe, lies, as Dr. Moore labours to prove, in their utility as periodic retreats for the European before he becomes the subject of disease on the plains, and not after. If the English soldier were sent to them for a short time on his first arrival in India, so that he might be gradually inured to the influence of the tropical sun under which he is called to dwell, and if at stated periods whole regiments, or sections of regiments, were regularly transferred to them, not for curative objects, but solely as a prophylactic measure, we have little doubt that the mortality amongst our Anglo-Indian soldiers would be quickly reduced fifty per cent. There may be some difficulties in the way of carrying out this arrangement, especially in the case of cavalry and artillery, but the results to be achieved by such a step are so great that it would be worth while making large sacrifices in mere official routine to accomplish it.

But when hygienic art has done all that it can to prevent disease, and when all the powers of medicine have been enlisted to cure it, there will still remain a notable residuum of mortality and ruined health which must ever attend the residence of the white man in India. Malaria confronts him wherever he locates himself. It reigns supreme over the low-lying districts in which are situated the great centres of commerce and political importance. It even dogs his steps if he retreats to the cooler air of the mountain ranges; it poisons the water he drinks and the air he breathes; and though he may pass apparently unscathed through the ordeal of his prescribed residence in the country, he will too often reach his native shores only to find that he has brought with him the seeds of its fatal influence in some visceral affection which the change to a colder climate calls into active growth. Under such circumstances as these, his existence in India is little else than a constant combat with disease, from which he cannot hope to escape unconquered but by the aid of a good constitution and the observance of the most regular habits of life. The more perfectly he possesses the former, and the more rigidly he adheres to the latter, the better will be his chance of resisting those attacks to which he will inevitably be exposed, and the longer will he be able to protract his residence in the country.

The possibility of his living there at all is, at best, only a question of time. For the Englishman there is no such thing as permanent acclimatization in India.

"Exposure," writes Dr. Moore, "instead of 'hardening' the system, actually has the contrary effect, and the longer Europeans remain in this country the more they feel the effects of the vertical sun. Men with a larger amount of strength and vital force than others can bear exposure and the effects of heat longer

than those not so gifted; but the deteriorating process, though slow, is nevertheless certain, and if acute dysentery, epidemic cholera, ardent fever, or sunstroke do not some day suddenly destroy, insidious malarious disease, cachexia loci, or splenic leucocythæmia sooner or later results."

These remarks must, however, be understood only as applying to the European who is located in the lower districts of India. There is every reason to believe that on the hillside, and on the elevated plains which are to be found amongst the mountain ranges, life is attended by no more serious risks than it is at home. The indigo planters are acknowledgedly a fine and a healthy set of men, and so far as the experiment has yet been tried there appears to be no cause in the nature of the climate to prevent the permanent establishment of an English colony in these regions, if sufficient inducement could be held out to attract settlers there. The success which has attended the cultivation of tea in the upper districts of India, and the promising prospect which attaches to the still more recent introduction of the cinchona plant,* joined with the advantages which these regions offer for the breeding of sheep and goats, and the cultivation of the vine, will probably er long attract to them a white population in sufficient numbers to allow the question of their suitability for a permanent English colony to be decided without doubt.

ere

Hitherto the unsettled state of the northern provinces, the not unreasonable shyness of capitalists for embarking in Indian undertakings, and the want of efficient means of communication with the sea-coast, have prevented the hill districts from receiving that attention as a field for colonization which they deserve. Now, however, capital is beginning to flow rapidly into India, and the energy with which plans for the formation of railroads and canals throughout every portion of the empire are being pushed forwards, leads to the hope that a few years will see the slopes of the Himalayas, the Neilgherries, the Shevaroys, the Avarallee, and other ranges, as accessible as Snowdon or the Alps. Not that the attainment even of this result would obviate all the obstacles which stand in the way of rapid colonization of these regions, and especially of the expense of a colonization by European soldiers who have served their full time, which has been more than once mooted. Into this, and other matters connected with the soldier's life in India, in respect to which Dr. Moore expresses views that are marked by good sense, practical experience, and general intelligence, we have not, however, space to enter. Those who may feel an interest in them cannot do better than consult his larger work, which will well repay their perusal.

REVIEW IX.

Medico-Chirurgical Transactions.

Published by the Royal Medical and Chirurgical Society of London. Vol. XLV.-London, 1862. THE present volume of the 'Medico-Chirurgical Transactions,' besides the usual lists of Officers and Fellows of the Royal Medical and Chirurgical Society, contains twenty-four papers, all of which are of very considerable interest, and of each of which we present a brief abstract :

I. Observations on the Discovery of the Original Obstetric Instruments of the Chamberlens. By ROBERT LEE, M.D., F.R.S., Obstetric Physician to St. George's Hospital.-The first notice of the invention of new instrumental operations in the practice of midwifery by the Chamberlens is contained, according to Dr. Lee, in a case related by Mauriceau. This case which occurred in Paris in the year 1670, was given up by Mauriceau, and then undertaken by one of the Chamberlens, who happened to be in Paris at the time, but his efforts were unsuccessful, as the patient died in twenty-four hours after the operative interference. Dr. Lee has not succeeded in meeting with a copy of the first edition of Hugh Chamberlen's translation of Mauriceau's work, but Dr. Munk showed him a copy of the second edition, published in 1696, and there is reason to believe that the second is a reprint of the first, which is said by Mauriceau to have appeared in 1672. The preface to the second edition contains the only account of the midwifery forceps ever published by the Chamberlens. The method of

delivering women by means of instruments, new at the period, is alluded to by Hugh Chamberlen, as a secret known and practised by his father, his brothers, and himself, and he apologizes for not publishing the secret, as such a proceeding might injure their pecuniary gains; but he offers, on behalf of his relatives and himself, to assist any woman who may be in need of their services. The secret was the Chamberlen midwifery forceps, but until the year 1818 it was not certainly known what the invention was. In that year, Mr. Carwardine presented to the Medico-Chirurgical Society a very curious and interesting account of the discovery of the Chamberlen forceps, in a notice published in the ninth volume of the 'Medico-Chirurgical Transactions.' It appears that the estate of Woodham Mortimer Hall, near Maldon, in Essex, was purchased by Dr. Peter Chamberlen, before 1683, and continued in his family till about 1715, when it was sold by Hope Chamberlen to a wine merchant, who bequeathed it to the Wine Coopers' Company. A lady who was intimately acquainted with Mr. Carwardine, accidentally discovered in the floor of a closet in this mansion the hinge of a door, which she soon succeeded in opening. There was a considerable space between the floor and the ceiling below, and this vacancy contained several empty boxes, but among these was a curious chest or cabinet, in which were found a collection of old coins, trinkets, gloves, fans, spectacles, and family letters, and also the

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obstetric instruments. These latter were presented by the family residing at Woodham Mortimer Hall to Mr. Carwardine, and he deposited them with the Medico-Chirurgical Society, thus securing to Chamberlen the posthumous merit of his discovery. The examination of the instruments offered to Mr. Carwardine conclusive proofs of the originality of Chamberlen's invention, and the progress of their construction was distinctly traced in its different stages as it passed through the mind of the inventor. There was first a simple vectis, with an open fenestrum, then there was the idea of uniting two of these instruments by a joint, which makes each blade serve as a fulcrum to the other, instead of making a fulcrum of the soft parts of the mother, and which also supplies a power of drawing the child's head forward. This idea is at first accomplished by a pivot, which being riveted, makes the instrument quite incapable of application. Then he advances so far that he makes a hitch in each vectis for the joint, and fixes a pivot in one only, which is to be received into a corresponding hole in the other blade, after they have been applied separately. But it is practically difficult, or even sometimes impossible, to lock the joint of the forceps with such accuracy as to bring the pivot and the hole into complete contact, and Chamberlen obviated the inconvenience by producing a lighter and more manageable instrument, which, instead of being united by a pivot, is connected by a tape passed through two holes and wound round the joint, a method combining sufficient accuracy of contact, security, and mobility. Mr. Carwardine is led to believe that Chamberlen was his own artificer, as the workmanship is very rough. Dr. Munk, who has supplied Dr. Lee with much valuable information relating to the Chamberlens, believes that there were two Hugh Chamberlens, both physicians, the elder of whom was the translator of Mauriceau, and was the son of Peter Chamberlen, M.D., who died and was buried at Woodham Mortimer. Dr. Munk considers that Peter Chamberlen was the inventor of the forceps, and that he communicated the invention to his three sons, who survived him, and who all practised midwifery.

II. On Certain Grave Evils attending Tenotomy, and on a New Mode of Curing Deformities of the Foot. By RICHARD BARWELL, F.R.C.S., Assistant-Surgeon to the Charing-cross Hospital.—Mr. Barwell thinks that the modern operation of tenotomy in the treatment of deformities of the foot has been much over-rated, and that it often produces lameness which is worse than the original disease. He reviews the experiments on dogs performed by M. Bouvier, and shows that in all the recorded cases some of the subcutaneous structures were permanently injured. Although post-mortem examinations of the human subject are rather rare, Mr. William Adams has collected the results of thirteen autopsies, in six of which the tendo-achillis only was divided ; but Mr. Barwell observes that in the seven other cases other tendons were also divided, and in every one of these latter, one or more of the severed tendons was either not united at all or was adherent to the bone or surrounding parts, so as to abolish the action of the muscle. When the tibialis posticus and flexor longus digitorum were divided, they never

united so as to be of the slightest use, while the tibialis anticus is more exposed to extinction by non-union than by false union. Mr. Barwell concludes, that such muscles as the tibialis posticus, flexor longus digitorum, and probably also the peronæi, might as well be struck with sudden and irremediable paralysis as be subject to the knife of the tenotomist, and that of some other tendons a nearly similar remark might be made, particularly of those in front of the foot. In one of Mr. Adams's cases, an attempt had been made to divide the posterior tibial tendon; but, although the case was successfully treated, it was subsequently discovered, on a post-mortem examination by Mr. Adams, that the tendon was not divided. Hence Mr. Barwell asks whether many of the cases in which the tendon was really divided would not have done as well without such division, and he argues that the tendons in question should never be divided, except in the very rare cases in which no other means will succeed in reducing the deformity. It is therefore necessary to return to mechanical treatment for the elongation of certain muscles. The best forms of instrument hitherto invented act on the principle of confining the foot in a shoe, which, by means of springs, bends or twists the limb in a direction contrary to that of the deformity; but Mr. Barwell considers this instrument objectionable for various reasons, and more especially because it twists the foot only as a whole, without reference to the action of the special tendons and muscles, and to the nature and uses of the bones of the foot. Mr. Barwell then describes a simple mode of treatment devised by himself, and which he illustrates by plates. The apparatus consists of strapping-plaister, a piece of tinned iron, about an inch broad and as long as the patient's leg, a few india-rubber springs, and some other accessory contrivances. The application consists in exercising pressure upon the particular muscle or tendon affected, and thus gradually removing the distortion.

III. Congenital Malformation of the Eyes in Three Children of One Family. By THOMAS NUNNELEY, F.R.C.S., Senior Surgeon to the Leeds General Eye and Ear Infirmary. In this communication Mr. Nunneley describes a peculiar condition which he observed in the eyes of three children-two girls and a boy. In the girls, who were not affected in the same degree, the globes of both eyes were not perfectly round, being flattened in some manner by the recti muscles, and were smaller than natural. The sclerotic coats were very vascular; the irides dull, thin, and tremulous; and the pupils not in the axis of vision, but placed considerably to the nasal side. Both eyes were myopic. In the case of the boy, there was a total absence of the iris in each eye; the ciliary processes were either deficient altogether, or were too small to be seen; the choroïd appeared to be normal, of a dense black colour in ordinary light, and with the ophthalmoscope the vessels were seen to be beautifully developed. The retina and the lens appeared to be natural. Although no visible difference could be detected in the two eyes, the boy saw much better with the left than with the right, and he learned his lessons at school like other boys. The vision was not improved at all by either