sequence is, that good papers often appear in journals which must necessarily have but a limited sphere of circulation, and they too often become in a measure buried in oblivion from the fact that the journals themselves are apt after a few years, or after they have served the purposes of their original promoters, to die a natural death. Those who are acquainted with the periodical literature of our profession in this country during the last half century are well aware that many journals have been started and conducted for a few years with vigour, which have then dwindled down, and ultimately ceased to exist. We have before us the titles of at least a dozen such, which are scarcely known, even by name, to the majority of the profession. With every wish for a more prosperous career to the journal, the appearance of which has elicited these remarks, we proceed to say a few words on its objects and contents.

The journal is arranged somewhat on the plan of the "Edinburgh Medical Journal," consisting of three parts: Original Communications, Reviews, and Periscope. Its principal object, however, appears to be for the publication of original communications, which extend over 166 pages; the Reviews occupying twenty-one pages; and the Periscope, which in this number has reference solely to Midwifery, only five. The original communications are eleven in number. Some of them contain the details of interesting surgical cases; others are little more than essays on the subjects treated of, while one or two appear unnecessarily prolix. They are as follows:

I. On the Nature, Causes, Statistics, and Treatment of Erysipelas. By P. H. BIRD, F.R.C.S., London.—Mr. Bird was the author of the Jacksonian prize essay on erysipelas. The results of his investiga tions, in which there is nothing very original, may be summed up in the following general conclusions:

"To conclude, then, erysipelas is merely an example in the skin of that diffuse inflammation, which in other tissues constitutes diffuse inflammation of the mucous membrane, diffuse phlebitis, puerperal fever-all of which have a common origin, a poison in the blood, are infectious and contagious, and may mutually produce each other.

"Erysipelas is best treated by stimulants and support, and when complicated with inflammation of the subcutaneous cellular tissue, by early incisions, which should extend to the depth of the disease." (p. 15.)

The author confirms the observations of Williams and Gulliver, as to the occasional presence in erysipelas of pus-corpuscles in the blood of parts remote from the affected textures. When, however, we remember the difficulty, if not the impossibility, of distinguishing puscorpuscles from the white corpuscles of the blood, the observation loses much of its force. At all events, however, we question the correctness of his explanation, that these corpuscles result from "blood globules becoming converted into pus."

II. On the Radical Cure of Inguinal Hernia. By HOLMES COOte, F.R.C.S. &c., London.-Mr. Coote advocates a more frequent recourse

to a radical cure, in preference to the more common palliative treatment by pressure. He details the various operations which have been proposed by different surgeons, but recommends the plan adopted by Wutzer (not Wützer), of simple invagination of a portion of the scrotum into the inguinal canal. Numerous cases in which this has been successfully practised, are alluded to. The author does not appear to be aware of the very elaborate memoir on this subject, published during the present year at Stockholm by Dr. Carl Benedict Mesterton, Lecturer on Surgery in the University of Upsala, and of which we give an abstract elsewhere. Dr. Mesterton, after a most careful investigation, advocates Rothmund's modification of Wutzer's operation as most certain and permanent in its results.

III. Case of Cæsarian Section. By Dr. CHARLES CLAY, Manchester. The operation was performed on account of a fibro-cartilaginous tumour, weighing from three to four pounds, originating from the upper and central portion of the curve of the sacrum, and filling the cavity of the pelvis, so as with difficulty to admit the finger between its surface and that of the pubes. The patient sank on the nineteenth day after the operation: but this was not undertaken till three days after the cessation of labour. The word Cæsarean occurs eleven times in the communication, and is invariably spelt Cæsarian.

IV. Observations on Syphilitic Retinitis. By Dr. W. F. WADE, Birmingham. This paper contains the record of a single case of retinitis, which the author believed to be of a syphilitic origin.

V. On Conservative Surgery. By F. C. SKEY, F.R.S., F.R.C.S., London. Mr. Skey takes a retrospect of the history and progress of surgery during the last three-quarters of a century, and shows that the object of modern surgeons is "to repair and to restore, rather than to mutilate and to remove." In the propriety of always having this object in view, we entirely concur with him; but we do think that his anxiety to annihilate surgical operations has carried him too far when, in speaking of the treatment of popliteal aneurism, he makes the following assertions :-"The compress has taken the place of the knife. The operation' for popliteal aneurism is about to be numbered among the relics of the past." We are sure that the success of compression has not been established in the conclusive manner that Mr. Skey would have us believe, and are convinced that the treatment by ligature is not attended by a mortality of twenty-five per cent. It is well known that the distinguished Professor of Clinical Surgery in the University of Edinburgh has performed the operation twenty-five times with invariable success.

VI. Case of Excision of the Knee-Joint. By Dr. WILLIAM MASFEN, Stafford. The operation was undertaken for extensive disease of the knee-joint, of some years' standing. It was followed by irritative

fever, and the patient died exhausted on the twenty-first day after the operation.

VII. On Rational Therapeutics. By Dr. R. C. R. JORDAN, Birmingham. This paper consists of some sensible observations on the mode of action of drugs. These are divided into three classes: Eliminants, Tonics, and Specifics. The last class, according to Dr. Jordan, would 66 include not only counter-poisons, if such exist, but those agents which, uniting with the tissues of the body, or helping in its chemical processes, thus supply the deficiencies produced by disease." Dr. Jordan appears to doubt if we have any specifics in the sense of counter-poisons to disease. Quinine in ague he considers to act through the nervous system as a tonic; mercury and iodine in syphilis, as eliminants. Under the head of specifics, which supply deficiencies in the body, we have iron in anæmic diseases, and others. There is no proof, however, that the antiscorbutic virtues of the Cruciferæ are to be attributed to their containing sulphur. It has not yet been shown that in scurvy there is a deficiency of sulphur in the system : and how would this theory explain the action of lemon-juice and other known remedies?

VIII. Contributions to Surgery, by EVAN THOMAS, M.R.C.S., Manchester. This paper contains three cases of considerable interest.

The first is one in which the knee-joint of a lad, aged twelve, was excised, on account of disease of four years' standing. The patient was dismissed cured from the hospital two months and a half after the operation; and four years after, the following note was taken of his condition :

"He is in the enjoyment of perfect health, and is in good condition. The stiff leg is perfectly straight, and its muscles almost as well developed as in the other leg; on admeasurement, it is shorter by an inch and a half, but there is nothing discoverable in his gait but a stiff knee." (p. 63.)

The second is a case in which the knee-joint was excised, but in which amputation of the thigh had subsequently to be performed.

The third case is one in which the right femoral artery was successfully ligatured, on account of a popliteal aneurism. About six months after, a second aneurism appeared in the left ham, for which the left femoral artery was also tied, with success.

IX. Case of Femoral Aneurism. By W. SANDS Cox, F.R.S., Birmingham.-In this case compression was first resorted to, but on the fifth day was discontinued, in consequence of its producing tenderness and very severe pains in the groin. This pain continued, and the aneurism increased in size. Twelve days after the removal of the compression, a ligature was applied to the external iliac; but gangrene set in, and the patient died on the twelfth day after the operation. It is but fair to add, that Professor Cox had not a sufficiently good instrument to compress the artery alone, without exerting pressure on the veins and nerves.

X. The Principles of Treatment of Chronic Phthisis Pulmonalis. By EDWARD SMITH, M.D., London.-This paper, which extends over upwards of fifty pages, is rather a general treatise on the whole subject of phthisis. As such, it would be apart from our object in this place to enter into any detail concerning it. There are one or two observations, however, contained in it, which we cannot pass without comment.

In the first place, the chief point on which the author insists throughout the paper, is the necessity of recognising a "pre-tubercular stage" of phthisis. Every one admits that in cases of phthisis there has been a state of body predisposing to the deposition of tubercle; but few, if any, we think, will agree with Dr. Smith in making this predisposition the first stage of the disease; still less, in believing that we have any evidence by which the existence of such a stage is clearly indicated: in other words, that in a given case, we can say that tubercle is about to be deposited in the lungs, before any deposition has actually taken place. Indeed, it is a fact established on the highest authority (Skoda and Louis), that tubercle may occasionally exist in the lungs without any possibility of its detection. How, then, does Dr. Smith venture to assert that he can, from any signs or symptoms, predict its deposition, when sometimes it may be impossible to diagnose its actual presence by all the tests known to the best observers? The symptoms of the "pre-tubercular stage," mentioned by Dr. Smith, are very vague and unsatisfactory. They are principally "shorter breathing, less breathmotion;" "expiration quick, forcible;" and a diminution of "the quantity of tidal air in ordinary breathing." Seeing that Dr. Smith lays claim to such accuracy of diagnosis in the early stage of phthisis, we are at a loss to understand how he objects to Dr. Pollock's conclusions as to the period of the year in which phthisis originates, on the ground that "we cannot determine the moment of origin of the disease." (p. 81.) But not only is lessened respiration an unmistakeable symptom of "pre-tubercular stage" of phthisis; according to Dr. Smith, it is also an essential cause of the disease. (p. 117). How, then, does he explain what, at another place (p. 80), he is unable to deny the comparative infrequency of consumption in tropical countries, where the respiratory function is known to be much less active than in colder regions?

Dr. Smith makes some novel observations on the various conditions of the throat met with in phthisis. Three different varieties are mentioned. 1. A state of pallor, without injection of the vessels; 2. A state of pallor, with injection of defined vessels in some parts, and enlarged mucous follicles in the pharynx and uvula; 3. A state of desquamation, of fibrinous deposition, or of ulceration, generally met with only in advanced cases. Allusion is also made to the appro

priate treatment in each of these varieties.

The author does not think that much assistance can be derived from the microscopic examination of the sputa in the diagnosis of phthisis. The discovery of tubercular matter in the sputum he views with mistrust; and as to the presence of elastic fibres, he observes, this is

certainly an evidence of destruction, but not of the nature of the destruction, although in a case of bronchitis masking tubercular disease it may render essential service. These, however, are precisely the cases in which the test has been recommended.

As to the treatment of phthisis, believing that the disease mainly depends on diminished respiration, Dr. Smith recommends voluntary deep inspirations and exercise. We have not space here to consider the propriety of such a treatment, but would merely observe, that it is purely a theoretical one, and that no cases are adduced to prove its efficacy.

Dr. Smith's opinion as to the proper diet in phthisis is expressed in the following very vague sentence:

"As a rule it may be affirmed that much of the hydro-carbonaceous food lessens respiration, and hence such are not the most fitting articles of food; but, at the same time, it is equally certain that they are necessary to the system, and must be supplied to it; whilst their effect in this direction is counteracted by the administration of other kinds of food." (p. 123.)

As to cod-liver oil, he at one place (p. 77) couples it with "the little idol of mesmerism, magnetism, table-rapping, homoeopathy," &c.; and at another (p. 127) he regards it as being only of use when the patient is poor, and cannot obtain suitable food, including fats, or when he cannot be induced to take a proper quantity of food.

We have already had occasion to allude to Dr. Smith's voluminous writings on the subject of phthisis, and have come to the conclusion that, while they indicate much labour and industry on his part, they yet contain much that is perfectly theoretical and unwarranted by the facts which he adduces; and that while he accuses others of worshipping "little idols," he is not altogether guiltless of this species of idolatry himself.

XI. Observations on the History, Pathology, and Treatment of Melanosis. By OLIVER PEMBERTON, M.R.C.S., Birmingham.-This is a lengthened memoir on the subject of melanosis, and contains a notice of all the recorded cases of the disease to which the author has had access. It is illustrated by some good coloured lithographs. Mr. Pemberton regards melanosis, and we think rightly, as merely a variety of encephaloid cancer, distinguished by the deposit of pigment granules in the interior of the cancer cells, or interspersed amongst the other elements of the growth. These pigment granules, on microscopic examination, we have generally found to be of a dark brown colour, not "black."

Melanotic cancer is considered by the author under the two heads of primary and secondary. The primary form originates in the skin or eyeball, more rarely in the subcutaneous cellular tissue. As regards secondary melanosis, a very interesting table is given (p. 145), showing the comparative frequency of the disease in the internal organs; out of thirty-five cases in which the post-mortem appearances have been recorded, the liver and lungs were the organs most frequently

40-xx.

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