is concerned, the untrue aphorism that "meddlesome midwifery is bad," and subjecting women to hours of fruitless waiting, and all the risks of continuous pressure, rather than resort to the simple expedient of an early use of the forceps. He must be a bungler indeed who can produce a vesico-vaginal fistula by means of the forceps; and we presume that there is scarcely a case on record where the formation of the fistula can be unquestionably traced to mechanical injury from this source.

We are happy to find that of late years this fact has been more or less recognised, but it is to be feared that even yet the "laissez aller" system of midwifery and the unreasonable dread of interference are too often answerable for the causation of what may most truthfully be described as a preventible accident.

IV.-Airs and Waters.'

IT may be accepted as a fact in modern physic that the treatment of disease by drugs, as pursued by our forefathers, has, in

1 Die Heilquellen und Kurorte der Schweiz, und einiger der Schweiz zunächst angrenzenden Gegenden der Nachbarstaaten. Zweite umgearbeitete und sehr vermehrte Ausgabe. Von Dr. MEYER-AHRENS, Zurich, 1867.

Le Climat de Pau sous le Rapport Hygiénique et Médical. Par le Dr. ED. CARRIÈRE. Paris, 1870.

The Principal Baths of Rhenish Germany. By Edwin Lee, M.D. Fifth Edition. London, 1870.

The Climate of the South of France as suited to Invalids; with notices of Mediterranean and other Winter Stations. By CHARLES THEODORE WILLIAMS, M.D., &c. Second Edition, with an Appendix. London, 1870.

The Baths and Wells of Europe: their Action and Uses, with Hints on Change of Air and Diet Cures. By JOHN MACPHERSON, M.D., &c. With a Map. London, 1869.

The Climate and Resources of Madeira, as regarding chiefly the necessities of Consumption and the welfare of Invalids. By MICHAEL C. GRABHAM, M.D., &c. London, 1870.

Winter and Spring on the Shores of the Mediterranean; or, the Riviera, Mentone, Italy, Corsica, Sicily, Algeria, Spain, and Biarritz, as Winter Climates. By J. HENRY BENNET, M.D., &c. Fourth Edition. London, 1870.

Notes of a Season at St. Moritz in the Upper Engadine, and of a Visit to the Baths of Tarasp. By J. BURNEY YEO, M.B., &c. London, 1870.

The Roman Climate: its Influence on Health and Disease, serving as an Hygienical Guide. By G. TAUSSIG, M.D. Rome, 1870. Pp. 130.

Eaux Minérales. Articles in the Nouveau Dictionnaire de Médecine et de Chirurgie Pratiques,' 1870, tome xii. By HENRI BUIGNET, E. VERJON, and A. TARDIEU.

Des Eaux Minérales de Contrexéville, et de leur emploi dans le traitement de la Gravelle, de la Gout'e, du Catarrhe vésical, &c. Par le Dr. A. E. DEBOUT. Paris, 1870. Pp. 96.

a very considerable degree, given place to that by hygienic measures and dietetic regulations. Among the former change of air occupies the first rank, and is a measure that gains daily in popularity, and in almost equal degree in the growing opportunities afforded to people of all classes to avail themselves of it.

Nothing could exhibit more plainly the popular estimate of the benefits of change of air than the number of books yearly produced for the purpose of instructing the sick and their advisers in the choice of fitting places of resort, or of vaunting the virtues of some locality that has made good its claims, or at least hopes to do so, as a place of recovery remarkable for the climate, or for the healing springs it is blessed with, or, as often happens, for the combination of the two endowments.

Nor are the migratory propensity of the sick in search of health, and the production of numerous works on change of air and health-giving spas, phenomena at all peculiar to our own well-abused island and its climate; on the contrary, the fashion of betaking themselves, for health sake, to some distant place of repute for its climate, or for its waters, is even more rife among the people of the continent than among ourselves; and if our own press be deemed prolific in books on watering-places and health resorts, it makes but a feeble approach in that respect to that of Germany and France; and not only must it yield to the foreign press in respect to the number of works published, but still more in that of their magnitude. Of this fact the treatise that stands first in the list appended to this review may be cited as an example. English doctors generally would not, we venture to say, have imagined Switzerland to be so rich in health-giving spas as to have afforded Dr. Meyer-Ahrens occasion to produce the large octavo, closely printed volume of 812 pages referred to, on the mineral waters and health-resorts of that small country Could an English author be found to write a like exhaustive treatise on the watering-places of his native land, a publisher adventurous enough to incur the cost of its publication could not be hoped for.

It is, indeed, an astonishing thing to note in foreign book circulars the numbers and the size of the class of works in question annually issued from the press; but sufficient evidence may be gathered from the preceding remarks of the popular conviction prevailing in continental Europe of the value of change of air, and of the resorting to mineral springs and baths, as means of cure.

The question of the invalid, where to go with the best chance of recovery or of prolonged life, can be sufficiently answered, in reference to the principal places of resort, by one or more of the

books whose titles are attached to this article. These treatises differ much in scope. Dr. Macpherson's, although not the largest, is the most comprehensive in range of subjects, giving a sketch of the best known baths and wells of Europe, including those of Great Britain, besides instructive chapters on bath-life, on change of air, on the internal and external use of water, and on the so-called diet-cures, represented by the grape- and the milk-cure. Under two heads, " bathing" and "wells," he collects what he has to say of the situation, the chemical composition, and the reputed uses of the mineral waters of Europe best known to fame. As a consequence of the very large number of places to be noticed within the compass allotted for the purpose, the remarks on a considerable proportion are very superficial, and supply little besides an index to the chemical characters of their mineral waters. Did the value of these health resorts reside solely, or well nigh so, in their waters, this amount of information might, in many instances, almost suffice; but the fact of the case is, that the mineral waters are in numerous instances of minor importance to the invalid than the site and climate; and, moreover, the tendency of modern inquiry has been to abstract largely from the supposed virtues of mineral water baths.

Dr. Theodore Williams's book, although primarily devoted to an examination of the climate of the South of France, has become, especially in its "second edition with an appendix," an exponent of the climatology of the far wider region of the whole seaboard of the Mediterranean, including Italy, Algeria, Spain, and Corsica, whilst it also describes the Alpine sanatoria of Switzerland.

The fourth edition of Dr. Henry Bennet's work on The Shores of the Mediterranean' has likewise so expanded as to embrace the climatology, not only of the Riviera, but also of Italy at large, of Sicily and Corsica, of Biarritz, and Arcachon in France; of Algiers, and Algeria, and, lastly, of Spain. But it will be satisfactory to the admirers of Mentone to know that, as the result of all his search for a better climate, no preferable place has been found. It does not seem that he travelled so far as the distant island of Madeira to examine its merits as a home for the invalid. Had he done so he would have encountered Dr. Grabham, who possibly might have secured a verdict from him in favour of that sea-girt locality. However this might have been, Madeira will not suffer in popularity from the want of an advocate, or of a book to make known its merits.

Among the other works under notice, that by Dr. Burney Yeo will probably attract many readers, inasmuch as its subject, the hygienic value of mountain climates, has more novelty and

interest just now. And if it might be wished the author's opportunities of observation had been more extended than those derivable from an autumn vacation, yet we have the conviction, from the information conveyed, that he made the best use of his time and carefully considered the matter he took in hand to examine.

The climate of Pau finds an admiring writer in Dr. Carrière, who has made a very satisfactory collection of facts relative to that town as a health resort.

Dr. Lee's little treatise on the baths of Rhenish Germany has been so welcomed by readers that it has reached a fifth edition, and may, therefore, claim exemption from the hands of the critic as a well-established favourite with the public.

Lastly, the climate of Rome, in relation to health, has found a very modest exponent in Dr. Taussig, a German physician, who has taken up his abode in that city. Many years ago Rome had the benefit of the recommendation of Sir James Clark as a resort for chest invalids and others; but of late years the prevailing feeling has been against its fitness as such, and Dr. Taussig, we consider, fails to establish a character for the city such as is likely to induce many patients to adopt it as a residence in lieu of the admittedly superior climates to be found on the Riviera and in other Mediterranean stations.

Something of the general scope of the principal works under notice may be gathered from the preceding remarks. In the following digest of the more important facts relative to airs and waters as curative agents we shall have to borrow from them all, and in so doing further pourtray their features.

If to prescribe change of air be, in some instances, a proceeding dictated by genuine recognition of its value as a remedial agent, it is certainly, in others, one determined by only some general impression that good results may follow it; or, more simply still, by a desire to be quit of a troublesome patient, or of one whose perverse chronicity is a standing argument against the efficacy of the medical treatment he has been submitted to. But although a change of air, and of surrounding circumstances can never be prejudicial to health if a proper locality be selected, it ought, nevertheless, not to be indiscriminately recommended, with no sufficient regard had to the mental, social, and business relations of the patient. Nor, again, should it be prescribed without definite and intelligent views regarding the character of the place and climate required by the circumstances of the malady under which the patient labours.

These certainly are but truisms, yet withal they are often enough overlooked.

In forming an estimate of the value of change of air, and of

that of the several health-resorts to invalids, there are many circumstances to be borne in mind.

In the first place, the mental as well as the physical constitution of individuals has to be consulted. It is of great moment to pleasurably excite the mind, to call forth emotions of satisfaction and delight. This holds good in all cases, although necessarily with much greater force when there is an overwrought mind or mental despondency. If we accepted the descriptions of the advocates of the many health-resorts in the world, the conclusion would follow that well-nigh all of them are detached fragments of the original Paradise, replete with all that can make life enjoyable, and walled round from the incursions of death, except with regard to those improperly located individuals to which the enemy had rightful claim before their entrance into the Eden.

Dr. Bennet, whose picture of Mentone emulates in warmth of colouring that given of any other refuge for the invalid, is fain to admit that

"The descriptions of the winter climate of Nice, Cannes, Hyères, and Italy in general, contained in most books of travel, works on climate, and guide-books, are mere poetical delusions. The perpetual spring, the eternal summer, the warm southern balmy atmosphere, described to the reader in such glowing terms, only exist in the imagination of the writers."

Indeed, the imagination is called in requisition to depict in bright colours the virtues and charms of every locality that lays claim to the character of a health-resort, and that can find a scribe to record them. Yet, although this is the case, it is still easy to discover, in most instances, from one guide-book or another, those special features of any one locality which are deemed its excellencies, and also to arrive at an opinion of its suitableness to any given case, both mentally and bodily. To these ends, the contrasts, or the comparative estimates, most of the writers on health-resorts set before their readers are a great aid. Dr. Bennet has wisely instituted such estimates in the case of most of the places mentioned in his work, referring to Mentone as his standard. Dr. Carrière has kept the same object in view, but, to show the merits of the climate of Pau, curiously contrasts it chiefly with that of Venice, that is, with one which possesses small claim to the consideration of invalids.

That the mind may be pleasurably affected it is necessary not only to supply beauty of scenery, with sunshine to enjoy it, but also those circumstances of life and surroundings to be found in agreeable society, in comfortable lodgings and enjoyable diet, and in means for securing mental diversion and exercise, and

94-XLVII.

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