respecting the stage of disease and thereby give greater certainty to prognosis.

Such is the general scope of Dr. Ringer's little book, which, as a brochure obtainable by all, calls for no analysis. Our duty is to recommend every practitioner to make himself thoroughly conversant with its teachings, as he will thereby find himself much advanced in accuracy of diagnosis and prognosis regarding the most common and fatal malady man is subject to.

Ferraud's Vade-Mecum of Pharmacy.-This work appears well calculated to fulfil the purpose for which it was written. The amount of information it contains is very considerable, and the manner in which it is conveyed terse and clear. It presents an account of almost every drug to which medicinal virtues are attributed, of various substances required by the pharmacien and chemist, and, moreover, of matters more or less outside even the scope of pharmacy and materia medica-as, for instance, albumen, beer, wine, and urinary calculi. In the case of each article are detailed its desivation, its physical appearances, and chemical constitution, with instructions for its preparation; its physiological, therapeutical, and toxicological effects; its doses, and both its recognised and unrecognised or quack formulæ. As examples of the last, we may mention the composition of Holloway's and of Morrison's Pills, besides that of most of the very many secret remedies in repute in France. These may be regarded as curiosities of pharmacy; but over and above such, the formulæ of a large number of ingenious and elegant preparations for which French pharmacy is justly noted are described. These last are particularly worthy of the study of our pharmaceutical chemists (why not called more briefly and euphoniously, pharmaciens or pharmacists?); for English drug-making is assuredly yet open to immense improvements, and there is no need we should be compelled to swallow either the big doses or the nauseous preparations of even the improved British Pharmacopoeia.

Most of the woodcuts in this volume might have been as well left out, for they are often too coarse and imperfect to aid the reader in apprehending the characters of the articles they are intended to illustrate. Altogether the volume has been carefully compiled, and may deservedly be recommended to all students of materia medica and pharmacy.

1 Aide-Mémoire de Pharmacie: Vade-Mecum du Pharmacien. Par EUSEBE FERRAUD. Avec 184 figures. Paris, 1873.

Bell's Manual of Surgical Operations.-A third edition of a book of this sort is a sufficient guarantee for its character and utility, and affords evidence that it is well appreciated. Mr. Bell writes from large experience, both as a surgeon and a lecturer on surgery, and may be assumed to be well acquainted both with the wants of students and junior practitioners, and with the most eligible way of imparting the information they require.

The book is really a manual in the proper sense of the word; the instruction given in it is simple and without extraneous matter, and the style in which it is written is clear and concise. Thirty-eight illustrations are given in elucidation of the description in the text. The chapters on amputations and excisions are preceded by short historical notices respecting the opinions held from time to time, and the varieties of practice introduced by various surgeons. Altogether it is a book that can be safely and strongly recommended to those for whose use it has been specially written.

Curtis on Treatment of Stricture.2-This small book on the treatment of stricture of the urethra by gradual dilatation is an essay to which the Civiale Prize for 1872 was awarded. We may, therefore, fairly expect to find it a work of merit. It goes over the whole subject of stricture, dealing chiefly with cases to which progressive dilatation is applicable; and we need scarcely tell our readers, that that includes by far the greater proportion. It indicates, but does not dwell upon, the rarer examples, in which some other operation, such as forcible rupture or over-distension, is required.

Mr. Curtis is evidently an admirer of the English school, and we note with pleasure that his opinions are formed in a great measure on the teaching of Sir Henry Thompson, and other of our best authorities. It is gratifying also to know, that such sound views of urethral disease and its treatment are so widely diffused.

The author is a strong advocate for the use of those soft bulbous bougies which we have derived from the French, and which have proved such a boon to the sufferers from stricture. It would be well, also, if we were to introduce the French gauge into our practice, for there can be no doubt that the gradations in size of our English instruments are much too

1A Manual of the Operations of Surgery, for the use of Senior Students, House-Surgeons, and Junior Practitioners. Illustrated. By JOSEPH BELL, F.R.C.S. Edin., &c. Third edition, revised and enlarged. Edinburgh, 1874.

2 Du Traitment des Rétrécissements de l'urethra par la dilatation progressive. Par T. B. CURTIS (Boston, U.S.A.), M.D. Paris. Travail couronné par la commission du prix Civiale pour l'année 1872. Paris, 1873.

great; for the system of gradual dilatation, which it is the object of this monograph to recommend, can only be properly carried out by a series of instruments, whose calibre increases by very minute degrees.

Mr. Curtis has appended to his essay a table of seventy cases treated at the Hôpital Necker. Of the patients whose cases are included in this series, he gives the age, the number of the instrument which was passed when they were first seen, as well as of that which could be introduced when they were dismissed, and the duration of the treatment. From this table he concludes that the average duration of treatment by progres sive dilatation is twenty-eight days, and that the stricture is dilated by the extent of a number every three days. Of course, this treatment does not effect a permanent cure. No method does this. It dilates the stricture to its full extent with the least pain and inconvenience to the patient; and if he will take the trouble to pass a full-sized instrument himself once a week he may keep himself practically in a cured condition. And here we may remark that the soft French bougie glides along the urethra so easily, and its introduction is so free from discomfort, that it is no difficult matter to persuade patients to pass them.

Goulay on Stricture of the Urethra.-This work professes to deal with the whole subject of urinary diseases; but this it does in very varying proportions. Some points are fully discussed, while others are passed over very lightly. Its chief fault is that it is too exclusively devoted to operative proceedings. A very distinguished London surgeon has lately drawn attention, in the pages of the British Medical Journal,' to the medical treatment of stricture of the urethra, and he has laid great stress upon the measures which may be adopted in order to relieve the patient, even before a catheter or a sound is passed. Perhaps Mr. Savory goes too far in this direction. But there can be no doubt that what may be called the medical treatment of stricture is too much overlooked, and that surgeons are apt to proceed to operations of greater or less severity before they have exhausted the milder measures by which the case may often be ameliorated, if not cured.

There may be something in American life which makes the class of cases that come before a surgeon differ somewhat from those which we usually see in this country. Severe accidents may be more frequent, and it may be more difficult in outlying

1 Diseases of the Urinary Organs; including Stricture of the Urethra, Affections of the Prostate, and Stone in the Bladder. By JOHN W. S. GOULAY, M.D., late Professor of Surgery in the University of New York. New York, 1873. Pp. 368.

107-LIV.

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parts of the country to get good surgical advice promptly. But whatever may be the reason, we have been struck, while carefully perusing this volume, at the large number of cases that have been submitted to severe operations-a much larger proportion, we imagine, than would be found in the practice of the leading operating surgeons on this side of the Atlantic.

The author opens with a good account of the various modes of examining the urethra for stricture and of the instruments which are used for that purpose, the best of which, like the bulbous bougies, we owe to our French brethren. He then explains the method of using the tunnelled sounds which he has introduced, and which are among the most useful of the novel suggestions contained in the book. A very fine whalebone bougie is first insinuated gently through the stricture, and then the tunnelled sound is threaded upon it and passed over it into the bladder. Subsequently other larger sounds of the same description may be introduced, and thus the first step is taken towards the treatment of the stricture by gradual dilatation. In some instances of very narrow and tortuous strictures the whalebone bougie and the tunnelled sound may obviate the necessity for a severe operation. The space, however, which the author bestows upon these simple methods is but small, and he passes on at once to discuss divulsion, internal urethrotomy, and external urethrotomy. Upon this last subject he dilates at great length-at very disproportionate length, as it appears to us; for, after all, the milder measures which are applicable to the vast majority of cases are of more importance. than the severe operations which are applicable to only a few. The subject of retention of urine next engages his attention, and here he reverts again to the use of his tunnelled sound, which would appear in cases of this kind to be sometimes of real value. Rupture of the bladder or urethra, with their terrible accompaniment, extravasation of urine, naturally follow next, and the subject is treated at considerable length and gives scope for the introduction of some interesting cases. Then follow chapters upon the diseases of the prostate, and the work concludes with the consideration of lithotomy and lithotrity.

Thus it is clear that a great many most important subjects are traversed in the comparatively brief space of 368 pages. The great fault of the work, as before remarked, is that, while it proposes to treat of the whole subject of the diseases of the urinary organs, it really is principally occupied with their operative treatment. For example, cystitis, both in its acute and chronic forms, is a most troublesome and distressing affection, often taxing all the resources of the practitioner, and

yet it is here passed over in a couple of pages. It admits of no great operation; it requires much careful watching and much attention to details on the part of the surgeon, and hence it does not fall in with the genius of our author.

Canty on the Skin.-This work consists of twenty-four letters addressed to an imaginary "Sir," who may be supposed to be thirsting for instruction in cutaneous medicine. We learn from the author that the publication is much needed, inasmuch as dermatological literature is in an inchoate state; we are, indeed, invited to make merry over the shortcomings of some well-known English treatises, which, in their superficiality, verbiage and inaccuracy, seem as foils to the more philosophical work before

But poor as our countrymen's performances may be, our patriotism is gratified by learning that we are, nevertheless, in the van of progress. In combating the assertion that France and Germany are in advance of us, our author remarks

"The three great additions to the means of cure of skin diseases have been glycerine introduced by Startin, calomel baths by Henry Lee, and the articles on arsenic and mercury by Hunt-all English. That other nations have written on dermatology, that they have examined, noted, and collected numerous cases and interminable minutiæ, is very true, but the result of all such work is simply nil."

It is for this reason, we presume, that not a single reference is made to any foreign dermatologist of eminence, except Hebra, whose work, as far as principles of treatment or causation are concerned, "might as well have been written by a machine." As Englishmen, we may feel proud to have two authorities who can be appealed to, and are quoted as thoroughly trustworthy, viz. Mr. Hunt and Mr. Jabez Hogg.

Turning to the work itself, we learn that the author's purpose is to unite skin affections to general medicine, and therefore much of the volume is occupied with the discussion of fundamental questions in pathology. Here we are met with much that is new and somewhat startling. "The blood is a fluid containing red granules, smaller indefinite granular matter, and white corpuscles." "In disease the white corpuscles increase in number and the red granules decrease in number." The performances of the white corpuscles are so remarkable that after reading this book we have come to the conclusion that nothing but a foreign incapacity for observation could have allowed Cohnheim to have passed over their mutations.

1 Diseases of the Skin: in Twenty-four Letters on the Principles and Practice of Cutaneous Medicine. By HENRY EVANS CANTY, Surgeon to the Liverpool Dis pensary for Diseases of the Skin. Pp. 365. London, 1874.