is making marvellous advances in the human system. In p. 144 of the fourth edition (published in 1853), we read as follows: "Surely such an amount of drainage as 73 feet in every square inch of skin, assuming this to be the average of the whole body, is something wonderful, and the thought naturally intrudes itself what if this drainage were obstructed? The number of square inches of surface in a man of ordinary height and bulk, is about 2500; the number of pores, therefore, is 700,000, and the number of inches of perspiratory tube 1,750,000—that is, 145,833 feet, or 48,600 yards, or nearly 28 miles." In p. 154 of the present edition (published in 1857), we find that the number of inches of perspiratory tube has been increased to 2,205,000 inches, or nearly 34 miles; so that if the above data are trustworthy, about six miles of tubing have been laid down in "a man of ordinary height and bulk" in the course of four years! In the seventh chapter, On the Chemical Pathology of Cystine, Dr. Bird, after comparing the per-centage compositions of this substance and taurine, observes, that "it appears by no means unlikely that the excretion of cystine may be a means under certain circumstances of compensating for deficient action of the liver quoad the excretion of sulphur." The editor might have appropriately strengthened this view by a reference to the recent observations of Virchow and Cloëtta, from which it appears that cystine may sometimes be found in the liver, and that both taurine and cystine (sometimes one and sometimes the other) may be detected in the kidneys. In minor points, as, for instance, in the correction of the press, we find a similar want of careful editorial superintendence. We have seldom seen proper names so cruelly maltreated. Thus we find Donne for Donné (p. 376); Erischen for Erichsen (p. 431); Grullot and Leblance for Guillot and Leblanc (p. 407); Kolliker for Kölliker (p. 373); Krahmer for Kramer (p. 451), or vice-versá, both spellings being given on the same page; Lallelard for Lallemand (p. 378); Mülder for Mulder (pp. 344, 350, 357, &c.); Pellischer for Pillischer (p. 281); Städder for Städeler (p. 17); and Wohler for Wöhler (pp. 123, 244, &c.). The word hyoscyamus is frequently spelt hyosciamus; several chemical formulæ contain serious errors (see pp. 41, 201, and 332); we read of urates in one place, while in another the same salts are termed bi-urates; while in one part of the book phosphoric acid is symbolically designed as P2 O, in another page we find the same acid written Ph. O'; and finally, in p. 396, we find a reference to the Archiv fur Physiologysche Chimie,' the first word of this title being the only one that does not contain a gross blunder. In conclusion, we would venture to recommend that if another edition should be called for, Dr. Birkett will best discharge his editorial duties by removing with no sparing hand those "passages and plates that have lost a portion of their value from the recent progress of scientific inquiry" to which he alludes in his preface; by condensing many portions of the volume which belong rather to physiology generally than to the special object to which the work is nominally devoted (for instance, the first three chapters might advantageously be condensed into one); by omitting a good many of the cases; and finally, by only introducing such additions as have a practical value in relation to the diagnosis and treatment of Urinary Deposits." 66 REVIEW XIV. Guy's Hospital Reports. Edited by SAMUEL WILKS, M.D., and ALFRED POLAND. Third Series. Vol. IV.-London, 1858. 8vo, pp. 371. WE proceed, as usual, to give a brief analysis of this eminently useful serial. When, year after year, we behold the immense number of valuable facts which by these 'Reports' are added to the stores of medical science, we cannot avoid feeling regret that the example of Guy's is not followed by others of our large metropolitan and provincial hospitals. What a vast amount of clinical knowledge is annually lost for want of some such medium of publicity! While we deprecate the modern tendency to multiply the periodical sources of medical literature, we believe that the place of many of the existing medical journals might be well supplied by hospital reports. No better model could be selected than that of the Reports which the medical officers of Guy's Hospital have been issuing for the last twentytwo years. The hospital case-books of many of our physicians and surgeons, if carefully analysed after a series of years, might be found to contain facts which could have no small influence over the existing medical practice, and in many instances would effect a complete revolution. It is true that many of our hospitals have not the means and resources possessed by Guy's; but this difficulty might be got over by two or more joining together for the object in question. But whatever the plan adopted, we are convinced that a more extended application of the materials furnished by hospital practice would do far more to advance the science and practice of medicine, than any amount of speculative writing unsupported by a sufficient number of well-observed facts. The present number of the 'Guy's Hospital Reports' contains fourteen original communications, which are illustrated by fourteen lithographic plates and eight woodcuts. The first two communications have reference to the same case. I. Case of Epithelial Cancer of the Esophagus, in which Gastrotomy was performed. By S. O. HABERSHON, M.D. II. Description of the Operation of Gastrotomy. By J. COOPER FORSTER.The subject of this case was a man, aged forty-seven, who was admitted into Guy's Hospital, October 8th, 1857, with considerable dyspnea and feeble voice, but no marked physical signs of mischief in the chest. After he had been in hospital for some time, he began to suffer from severe pain in the throat on coughing, and subsequently on swallowing. Deglutition became more and more difficult and painful, and towards the end of February, 1858, the commencement of the œsophagus was found to be obstructed by a rounded tumour situated below the epiglottis. On March 2nd, the dyspnoea was so extreme that tracheotomy was performed, but without much benefit. In the meantime, the patient had become emaciated to an extreme degree, and suffered from most distressing thirst, and a fearful sense of starvation, while the rectum ejected nutritious enemata almost at once. It was obvious that the patient was dying from pure inanition, and there seemed no reason to doubt that life might be prolonged for a brief period if any means could be devised for introducing nutriment into the system. Three modes of relief suggested themselves: 1st, the forcible introduction of an œsophageal tube; 2nd, opening the oesophagus in the neck; and, 3rd, opening the stomach. The nature of the disease rendered the first of these modes a very hazardous one. A similar case is alluded to, in which an eminent surgeon passed a tube through the diseased mass, and injected half a pint of beef-tea into the pleural cavity. The situation of the disease would have rendered the opening of the oesophagus formidable, dangerous, and useless. Gastrotomy alone appeared to be the operation which could possibly relieve the patient, while the cases recorded and collected by Dr. Murchison showed that wounds of the stomach might become converted into permanent fistulae, and life be prolonged for many years.* After due deliberation, therefore, this operation was performed by Mr. Cooper Forster on March 26th. Chloroform was not administered, as the patient was remarkably cool and collected, and vomiting above all things was to be avoided. The external incision was made in the left linea semilunaris, and the cardiac por * See Memoir on Gastro-Cutaneous Fistula, in the Forty-First Volume of the Medico-Chirurgical Transactions. tion of the stomach was that which was opened. None of the contents of the stomach escaped into the peritoneum, and the margins of the opening in this viscus, which measured about an inch, were carefully attached by sutures to the abdominal parietes. The patient's sufferings were evidently mitigated, and the horrors of a death from thirst and starvation averted; while there was reason to believe that, had the relief been afforded at an earlier period, it might have been more permanent. After the operation, nutriment and stimulants were freely introduced into the stomach; but on the night of the 27th faintness came on, and the patient gradually sank, and died at the end of rather more than forty-four hours. After death, the peritoneum was found healthy; no inflammation, effusion of lymph or serum, or diminution of the normal smoothness of this membrane could be detected; while the opposed serous surfaces round the margins of the opening were found slightly adhering. The growth in the œsophagus appeared to take its origin from the posterior surface of the cricoid cartilage, and the seat of greatest constriction was opposite the upper margin of the sternum. The œsophagus above this was much ulcerated, and there was a fistulous communication with the trachea. There was no cancerous disease in any other organ except the œsophagus. The two papers are accompanied by four plates, illustrating the operation and the post-mortem appearances. III. Pathological Observations. By SAMUEL WILKS, M.D.-1. On Cancer and New Growths.-We here meet with a further development of Dr. Wilks's views of the pathology of morbid growths, to which we have already* had occasion to allude, and with which we in the main agree. Dr. Wilks observes: "We will state at the outset our firm conviction that cancer, in the commonly received acceptance of the term, has no peculiarities which can always distinguish it from other morbid growths, or even from many healthy structures. Some experience in testing this debateable question has satisfactorily proved the truth of the assertion, having seen, for example, wellmarked encephaloid disease, which displayed merely small nuclei by the microscope, offering nothing peculiar to the eye of those well versed in the use of the instrument; and, on the other hand, we have known healthy cells from parts of the alimentary canal, from the kidney, from the Pacchionian bodies, &c., considered as cancerous, when this idea of their nature was suggested to the observer." (p. 19.) But even those growths which are "homologous" in their structure, not unfrequently put on many of the characters which for long were attributed to cancer only-such as rapidity of growth, tendency to spread, &c.; so that, if we were to arrange tumours according to the degree of their so-called "malignancy," those at the top of the scale may be called cancerous; but we can draw no boundary line between the last on the scale, which we would style cancer, and the first, which we would designate by some other name. The question, then, to be asked with reference to a new growth is not so much-is it malignant or not? as-what degree of malignancy has it? Dr. Wilks observes, that when from any cause a blastema is thrown out, the natural tendency is for it to be developed into tissues similar to those in its vicinity; but if there is any "vice in the constitution," the disposition in the new formation to ally itself to the healthy tissue will be lessened. Thus he explains the origin of cancer, and we are therefore somewhat at a loss to explain why, at another place, he speaks of the "cachectic condition spoken of in cancer," as only a result of the local disease, unless he considers a vice in the constitution, and a cachexia, as two very different conditions, the distinction between which we can scarcely appreciate. The author's observations are accompanied by the records of a number of cases which have come under his observation at Guy's Hospital. In reference to melanosis, he holds the view that the colouring matter is merely adventitious, and may occur in any form of growth. Hence he accounts for the difference of opinions as to the malignancy of the disease. "A simple fibrous Brit. and For. Med. Chir. Rev., April, 1858. tumour, for example, near the eye, may contain pigment, and not return. A cancer, however, in the same spot, may also be black, and that shall return." (p. 33.) Several cases corroborative of this opinion are alluded to. 2. Acute and Chronic Disease.-Dr. Wilks objects to the commonly received opinion, that chronic diseases are very frequently the sequelae of acute; and endeavours to show that an opposite doctrine is much nearer the truth, or that disease is mostly chronic, and if not arrested will become acute. One remark under this head is at the present moment of peculiar interest : "Although there are constantly cases of pneumonia treated in the hospital, post-mortem inspection has not revealed a single idiopathic case for more than a year past; and the same may be said of pleurisy, though to a less extent." (p. 52.) 3. On the Relative Importance of Disease of the Aortic and Mitral Valves of the Heart. If we are to judge from the duration of illness or loss of health in the two cases, the author believes that the general opinion is correct as to the greater severity of the disease which has its origin in the mitral valve; but if we date from the probable time at which the respective maladies commenced, he thinks we may readily arrive at an opposite conclusion. The records of Guy's Hospital fully corroborate the view, that, as a general rule, the disease of the mitral orifice has its origin in rheumatic endocarditis; whereas disease of the aortic orifice is due to a strain on the vessel or valves, occurring for the most part in men who are accustomed to use strenuous exertions with their arms. 4. Contre-Coup.-The records of Guy's Hospital lend no support to the prevalent error, that when a blow is inflicted at one point of the cranium, a fracture and extravasation of the blood may take place in an opposite direction. The base may certainly be fractured from a fall on the vertex ; but this is by direct continuance of the force, and not by contre-coup. The cerebral substance also on the other side opposite to the fracture may become torn, and extravasation ensue. Yet in such a case the injury to the brain is of greater importance than the effused blood, and could not be benefited by any surgical interference. During many years, the author has never seen a case on the post-mortem table, where trephining on the side opposite to that injured could possibly have given any relief. 5. Chronic Rheumatic Arthritis.-The characters of this affection are detailed with much accuracy, and Dr. Wilks agrees with Dr. Adams in considering it as distinct from both rheumatism and gout. IV. On the Operation of Opening the Urethra in the Perinæum. By THOMAS BRYANT.-Mr. Bryant enters upon the discussion of this much-vexed question apart from all personal feeling. His remarks may be regarded as coming from one entirely unprejudiced, and merit the attentive perusal of the surgeon. He justly draws a distinction between the opening of the urethra without a staff, which he denominates "perineal section," and "the external division," or Syme's Operation. In the discussions which have taken place upon this subject, these two operations have too frequently been confounded. The paper is accompanied by the histories of eighteen cases in which one or other of these operations was performed. We are glad to find Mr. Bryant speak so favourably of his experience of Mr. Syme's operation, and that he has failed to observe those frightful consequences which its opponents have attributed to it. His opinion regarding the operation may be summed up in his own words: "Cases of stricture do occur occasionally which are so exquisitely sensitive, and in which the passage of a catheter, however skilfully performed, is followed by such severe constitutional and local disturbance as to produce more harm than good; and others, which are relieved by means of a catheter, and are even fully dilated, but which have a tendency to contract again immediately upon the omission of the treatment. In such cases, the operation of 'external division' is most valuable." (p. 80.) Such are the only cases, and only such, for which Mr. Syme has recommended the operation. V. On Ophthalmostasis, with an Account of an Improved Method of Extrac tion of the Cataract. By JOHN F. FRANCE.—Mr. France gives an account of the various means which have been recommended for steadying the globe in the operation for extraction of cataract, and he recommends the ordinary artery forceps applied immediately beneath the inferior-margin of the cornea, as infinitely preferable to them all. The histories are given of twenty cases in which the operation was performed in the manner recommended.. VI. On the Existence of Copper in Organic Tissues. By WILLIAM ODLING, M.B., F.C.S., and AUGUST DUPRE, Ph. D.-The analyses and observations of the authors show that copper is a natural and constant constituent of living organisms, or, at any rate, that it has a very extensive distribution in the organic kingdom. Of twenty-five samples of bread, seven yielded distinct traces of copper; and of fifteen other specimens, of which larger quantities of materials were employed, in one only could no trace of the metal be detected. Of twenty samples of wheatflour, traces of copper were discovered in every specimen, and it was likewise found in every one of twenty-nine specimens of grain. Copper also was found in several other vegetable products, and in many animal tissues. Dr. Odling's analyses render it highly probable that the poisonous effects which have frequently followed upon eating mussels and other shell-fish, have been due to their containing copper. The tissues of the higher animals, particularly those of the liver and kidneys, usually contained copper in notable quantity, whereas the blood in general contained but very minute traces of it. The authors are scarcely prepared to maintain that copper is a necessary and invariable constituent of living organisms, yet they agree with Dr. Christison in thinking that its possible presence must not be overlooked in medico-legal researches. VII. A Collection of several Cases of Contusions of the Abdomen, accompanied with Injury to the Stomach and Intestines. By ALFRED POLAND.-This is a very elaborate paper, containing the histories of upwards of seventy cases in which accidents of divers sorts have ensued upon blows over the abdomen. These have been arranged under the following heads: A. Contusion attended with injury to the stomach: I. Traumatic gastritis. II. Chronic inflammation, ending in abscess and external fistulous openings. B. Contusion, attended with injury to the small and large intestines: Traumatic enteritis. I. III. Contusion of the bowel, with subsequent sloughing and ulceration. IV. Ruptured coats of intestine. 1. Ruptured duodenum. 2. Ruptured jejunum. 3. Ruptured ileum. 4. Cases of ruptured bowel occurring in persons the subject of hernia, but independent of any hernial mischief. 5. Contusions of small intestine while in a hernial sac. 6. Rupture of the large intestines. The illustrative cases have partly been under observation at Guy's Hospital, but for the most part have been collected from the published archives of Medicine and Surgery. Our space will not permit us to do more than call attention to these cases, all of which are of much rarity and interest. We would only mention the two cases which have been cited as examples of chronic inflammation followed by abscess and external fistulous openings. Both of these were probably examples of simple ulcer of the stomach, and it may be doubted how far the local injuries to |