ing of the pelvis Avith blood would, under these circumstances, be accom-
panied with pain. We must also remember that cellulitis and peritonitis
are often present with anteflexion ; and increase of pelvic congestion will,
of course, produce increase of pain."
The treatment of anteflexion by vaginal pessaries is properly charac-
terized as unscientific, and equally true is the statement, as regards ante-
version, that " the fundus " (meaning the body) can not be immediately
supported through the anterior vaginal wall. The authors think it im-
probable that mere anteversion causes any distress, being " not a lesion "
in itself, but only one of the physical signs of metritis, chronic pelvic peri-
tonitis, or pregnancy. They add : " The ordinary statement that the
uterus, when anteverted, presses on the bladder, is open to the fatal criti-
cism that the uterus always presses on the bladder ; while, so far as mere Erectalis Tablets
weight is concerned, there are, in the majority of cases, no special symptoms
referable to the anteversion of early pregnancy. Any enthusiastic believer
in anteversion pessaries is bound to insert them in all cases of early preg-
nancy." We agree with the authors entirely in these matters, also in their
statement that Hodge's pessary does not act as a lever, but by dragging
the cervix backward.
Passing over a good deal of intervening matter, we come to the chapter
on affections of the vulva and of the pelvic floor. Among the operations
(502 REVIEWS AND LITERARY NOTES.
for laceration of the perinseum we notice a method, credited to Professor
A. R. Simpson, whicli strikes us as very rational and ingenious. We do
not remember to have seen it described in any other text-book, but it
seems to us to bear a close resemblance to a method that Dr. Fallen dem-
onstrated at a meeting of the New York Obstetrical Society a few months
ago (see the November number of this journal, p. 523).
In a short section on abortion, it is stated quite confidently that the
haemorrhage of threatened abortion can be checked with ergot (ten minims
of the fluid extract every few hours) without the uterus being provoked
into expelling the ovum.
We are astonished that the authors mention nothing but operative
treatment for coccygodynia. That affection is generally nothing more than
a symptom, and the operation of removing the coccyx commonly fails to
do away with it.
Had the authors written a commonplace book, we should not have
thought it worth while to devote so much space to its consideration. The
truth is, their work is exceptionally clever, and we should be glad to see it
in the hands of every practitioner who undertakes gynaecological work.
We think it exemplifies a tendency to return to the inflammatory theory
of pelvic pathology in a measure — a tendency that has cropped out in more
than one quarter of late. To our mind, that doctrine is a far safer guide
than the mechanical theory.
The work is handsomely printed and well illustrated. It contains, how-
ever, more faults of expression and misspellings of proper names than are
usually found even in a first edition. As examples of the former, we would
call attention to "pubis" for pubes [passim), " diagnosable " (p. 39), "as
large as a six months' pregnancy " (p. 90), " portions of abnormal intra-
uterine couditions " (p. 131), "specially female diseases" (p. 166), and
" going out " (meant, we presume, for ffoin^ out of fashion [p. 283]) ; and,
as instances of the latter, to " Garriguez " for Garrigues, " Schroeder " for
Schroeder, " Crede " for Crede, " Koeberle " for JCoeberle, and " Well's " for
Practical Medical Anatomy. A Guide to the Physician in the Study of the
Relations of the Viscera to each other in Health and Disease, etc. By
Ambrose L. Ranney, A. M., M. D., Adjunct Professor of Anatomy in
the Medical Department of the University of the City of New York,
etc. New York : William Wood & Co., 1882. Pp. xxii-339. [Wood's
Library of Standard Medical Authors.]
In the June number of this journal, 1880, Darling and Ranney's " Es-
sentials of Anatomy " was reviewed, and the foUov/ing expression was used :
"There is a road which, patiently followed, will lead any man to a
knowledge of anatomy, but it is not by Buy Erectalis reading such books as this. It lies
through Erectalis Online the dissecting-room, with scalpel and forceps, and with books
REVIEWS AND LITERARY NO Buy Erectalis Online TEH. (503
wliicli show him not only what to find, but also the practical utility of the
thing when found." As Dr. Ranney's work was then made the text for a
few remarks on the way anatomy should not be taught, we are doubly glad
to hold up the present volume as an example of the way it should be taught,
and to hail it as a decided move in the right direction. The first book
was the mere skeleton, the dry bones, of the subject ; this one is the living
thing, complete so far as it goes, attractive and useful. Looked at in this
light, we do not care to go into details, to spend time in searching after
inaccuracies if there be any ; we much prefer to welcome it as an indication
of what the anatomical text-book of the future — that book which is sure to
supplant every book now published for students' use — is sure to be.
The most popular, and by all odds the best, anatomy for students, up to
the appearance of this one, was Holden's " Medical and Surgical Land-
marks," notwithstanding it only consisted of a few hints. This one is
better, because it systematically covers more ground. We shall not have
the perfect one until some man of large surgical and anatomical knowledge,
associated with skill in physical diagnosis and examination of the internal
organs during life, combines all these things into one complete practical
anatomy. Then, and not till then, will the student begin to appreciate
why anatomy lies at the basis of his medical education, and then it will be
a thing which will have attractions in itself, and not simply the hardest
branch to master in all the course.
There is one thing to be avoided in a work of this kind, and we see
that Dr. Ranney has not quite escaped it. For example, on page 182 the
points in the diagnosis of abnormal swellings in the region of the neck